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.

Monday Morning Update 7/4/11

From Michigan Wolverine: “Re: Munson Healthcare downtime. At least the administrator was truthful about the ‘chaos,’ if not about the patient care.” The three-hospital Michigan system loses all connectivity to the world when a planned switch to a backup fiber optic circuit fails. Applications, paging systems, wireless devices, and their IP telephones all went down hard, requiring 4.5 hours for recovery.

From The PACS Designer: “Re: 3D Web browsing. WebGL permits 3D viewing if you use Google Chrome (coming soon to Firefox 6 ). TPD thinks healthcare may find the web 3D feature helpful in following the diagnosis of conditions, such as viewing a colonoscopy result along with healthcare treatment videos. An excellent example to view in 3D on Chrome is the WebGL Iceberg Demo. ”

From Peter: “Re: thoughts on Google Health. Brilliant, lucid, and real. Thanks, Mr. H :)” This comment came all the way from New Zealand, so I figured I could at least mention it (especially since I appreciate it).

From Ilya: “Re: Johns Hopkins. Going with Epic for ambulatory to start in a project called Ambulatory First, with a statement from the JHM CEO that ‘we will continue to look for systemwide opportunities for the Epic system to support our health care reform initiatives and goals.” Ilya sent over the CEO’s e-mail announcement, which also points out that Hopkins has more than a dozen patient records systems that are going away. I’m sure additional planning and approvals will be required, but the tea leaves seem to say that Epic will replace a bunch of Hopkins systems very soon, most notably Allscripts Sunrise.

From A CIO: “Re: job change. You recently mentioned my new job. Your reach across the industry is amazing. I’ve heard from people I haven’t been in contact with for years.” I really love hearing that since it’s a blast to get people reconnected just by mentioning them in some way. Maybe I should profile one reader each week with a mini-bio and a photo just to see who reaches out to them.

From McOffice: “Re: executive offices. I was in the office of McKesson CEO John Hammergren a few years ago. It was understated and functional like a working manager’s office, but the view of the Golden Gate Bridge was pretty sweet.”

From Lusitania: “Re: executive offices. McKesson executives in Westminster, CO have very modest offices. Only a few have line-of-sight to the Rocky Mountains – most just see cubicles or walls. The cubes on the west side actually have a better view. The largest offices only have room for an additional four-top conference table. Otherwise, even our lowest directors have offices that match in size and furniture quality (basic Office Depot mahogany).”

From Cam: “Re: executive offices. We’re in an old mill right on a river between two waterfalls with 20-foot ceilings, wood, and brick. We fish out the window. The CEO’s office is filled with Legos.” I love old mills on rivers, with rough brick and massive wood beams. Somehow it feels right to be working on something high tech in historical, industrial surroundings. Cam was less philosophical when I made that flowery statement in responding to his e-mail, replying with tongue in cheek that, “except our history has to do with exploiting children in a mill setting and we work for pediatricians .”

From Delbert: “Re: executive offices. Judy Faulkner’s is big, but unassuming. Prairie style with a desk area in one part and an almost living room seating area. It’s right by the entrance to one of the buildings, so visits arrive via a sidewalk that goes right by her windows. Definitely no evidence of pretense of wealth and power in her digs.”

From Antoine: “Re: executive offices. NextGen’s two executives share a single office. No parking space, no special bathroom, they swipe the same security card to get into the building. The SVP has the exact same office as her managers – no windows. Very much the NextGen vibe, modest and unassuming.”

From IntelliDoze: “Re: IntrinsiQ. After looking for several years, it finally has a buyer in ABSG (AmeriSource Bergen Specialty Group). The press release will come out Tuesday. All of the employee options are under water, but on the bright side, they will be asked to sign two-year non-competes! The only folks making money are private equity firm Accel-KKR, not a huge return, but happy to get any return after buying at the top of the market.” Unverified. IntrinsiQ makes the IntelliDose chemotherapy protocol management tool and oncology-specific data mining applications.

From Fess Up: “Re: nextEMR. Those guys are still showing the CCHIT 2011 logo on their site even after you reported that CCHIT ordered them to take it down. They simply didn’t receive that certification.” They now have both the ONC-ATCB and CCHIT logos on their site, so I guess that’s some improvement – they added the correct one, but failed to take down the incorrect one.

Happy Independence Day to my fellow Americans. Some contrarian US history: the Declaration of Independence was signed on July 4, 1776 when the 13 insurgent colonies that were at war with their own British government announced that they were illegally breaking off and starting their own country. It’s very much like when the Southern states announced their secession from the Union in the 1860s, except the British weren’t quite as brutal in using scorched earth force against civilians to keep their empire intact. It was their Vietnam, a humiliating defeat at the hand of cunning rebels that we celebrate annually with hot dog eating contests and China-sourced pyrotechnics. My flag is waving today to celebrate our country, even though its history (both old and new) is uncomfortably less virtuous than they teach in school. But in any case, happy Fourth of July, if you must call it that (and Merry Twenty-Fifth of December).

My Time Capsule editorial from five years ago this time around, squinting in the bright sun after being buried since 2006: Vendors Should Make Software That Crusty Night-Shift Nurses Can Love. I veered into an overly broad generalization about nurses and computers that will probably raise hackles all over again: “Looking over their computer shoulder is like watching your kid play tee-ball – you try to help them by sending powerful telekinetic messages (‘Press Shift-Tab … Shift-Tab’) or with surreptitious body English.”

Listening: Skins, almost new from Buffalo Tom, a Boston alt rock guitar band that has drifted in and out of obscurity since 1986, but has always been good. Great road trip music that also wins my highest and rarely awarded honor: it has gone on my gym MP3 player. 

A good Google Health epitaph from Zak Kohane at Children’s Boston: “Google is unwilling, for perfectly good business reasons, to engage in block-by-block market solutions to health-care institutions one by one and expecting patients to actually do data entry is not a scalable and workable solution.” Let me be clear in saying that Zak is brilliant (and not just because I know he reads HIStalk and would make a fine writer for it, hint hint). Check out this provocative  article in which he suggests that computers could replace doctors for a lot of the protocol-driven work doctors do, which probably elicited predictable “doctors aren’t fry-slinging teens working at McDonalds” knee-jerk reactions instead of thinking about his point – do we really need doctors to do a lot of what doctors do instead of more important stuff? (and he’s a doctor, so his opinion counts double, not to mention that the military already delivers a large amount of care, including that on the battlefield, using non-physicians who have undergone focused training):

We want our healthcare providers, and particularly our physicians, to be completely up-to-date across the exponentially growing knowledge base of medicine, from drug side effects to genomics. Yet, in this era of  “evidence-based medicine,” we also expect these same physicians to follow well-defined protocols (algorithms on paper or on in electronic medical record systems) so that each patient receives the care that panels of experts have determined to be best. Just as McDonald’s follows sophisticated but regimented systems to make and sell its French fries and shakes.

So, which is it? Is each patient encounter a potential virtuoso tour of the medical arts and biomedical applied sciences? Must each doctor be the equivalent of Todd English? Or is it enough that each patient receive an honorable, workman-like execution of the best guidelines that are available? It is becoming increasingly apparent that we cannot afford a model that claims both kinds of performance delivered by the same person with the same job description.

Welcome to new HIStalk Platinum Sponsor Covisint, part of Detroit’s Compuware. The company enables “information ecosystems” that allow all healthcare players to securely communicate and collaborate. Its ExchangeLink platform connects hospitals to other providers (physicians, post-acute, referrers) by supporting workflow-driven fax solutions, a secure inbox for online delivery, and document exchange with practice EMRs. It has all the pieces and parts built in: identify management, MPI, and record locator service, and is used by states and HIEs to share information on a large scale to improve quality and coordinate care. Covisint’s App Cloud offers third party apps for e-prescribing, lab orders and results, referrals, disease management, EMR/PHR, and others from names such as Epocrates, DocSite Registry, Ingenix CareTracker, Allscripts, Dossia, and DrFirst. The company just won a MSHUG innovation award for its work with Vermont Blueprint for Health in providing a central registry, clinical decision support, and a care team portal. Many thanks to Covisint for supporting HIStalk.

Here’s a Covisint overview video that I found on YouTube.

A Bloomberg Businessweek post by business intelligence expert Leonard Fuld reminds everybody that his war game simulation predicted that Allscripts needed to merge with another company to avoid becoming an also-ran (it’s not mentioned whether the simulation gave Allscripts the idea). Like many prognosticators, he doesn’t mention other predictions that may not have panned out, like those involving McKesson and GE Healthcare in the same scenario (or his March 2007 statement that “the all-powerful MySpace, with its 130 million-plus members, seems invincible.”) Still, he seems to know his stuff when it comes to competitive intelligence.

Texas Health Presbyterian Hospital Dallas begins RFID equipment tracking, citing studies indicating that nurses spend up to 15% of their time tracking down needed equipment. The 898-bed hospital says it’s saving $30K per month by avoiding equipment rental. The vendor is Intelligent InSites tied into a Skytron ZigBee wireless network. The hospitals plans to use more RTLS apps tied into its systems (Epic, TeleTracking, and Siemens Invision).

Tampa-based software vendor MedHOK releases 360ACO, an analytics solution for complying with proposed CMS ACO rules.

A reader sent over the JAMIA article that looked at “errors” with e-prescribing. I’d take it with a large grain of salt. The study did indeed use prescriptions from 2008, even though it’s just now being published. Since the retail pharmacies faxed over the de-identified prescriptions, they had no way to know which were truly e-prescribed vs. just printed off from a computer system. Potential ADEs included the potential of harmless issues, like rash or nausea. Most of the “errors” involved omitted or unclear information, such as how long to take the med (which was probably already discussed with the patient and assumed from the quantity prescribed). They also could not make any conclusions about particular e-prescribing or pharmacy systems and had no way to assess how practices implemented their systems or how physicians were trained to use them. To me, the only valid conclusion is that doctors could turn on more edit-checking capabilities of their e-prescribing systems to reduce inefficient clarification callbacks from pharmacies. I don’t see much patient safety impact. Unfortunately, the rags often pick up a story like this and run with it, adding misleading but sexy headlines and trying to make the conclusions seem more dramatic.

The numbers are unchanged from my 2007 survey: a scant 13% of the most healthcare IT-savvy people on the planet keep their medical information in a PHR. New poll to your right: who is most responsible for the lack of sharing of patient information?

This is strange: Walmart is donating the time of its 142 in-house lawyers to Medicaid patients of Arkansas Children’s Hospital, taking on the government agencies and schools that don’t provide those patients with the benefits to which they believe they are entitled. The company says it will be “facilitative” rather than “adversarial” to Medicaid. If you’re a taxpayer unhappy with the huge entitlement programs you’re funding through your labor, this is probably not the best news you’ve heard today.

Thanks to the companies that supported HIStalk in June by starting or renewing their sponsorship. I do nothing to solicit sponsors except to e-mail a little handout PDF that Inga and I threw together when someone asks for one, so I appreciate those that persist in overcoming our appearance of indifference to support what we do.

Unrelated, but kind of amusing: the hammy, preachy host of the endlessly re-run, 2008-cancelled To Catch a Predator (“Have a seat over there. What do you think would have happened if I wasn’t here and a 14-year-old girl was home alone?”) is himself caught on hidden camera as he engages in nocturnal hanky panky with a hot TV anchor 58% of his age and 100% not his wife. Unlike the sickos his show entrapped for almost-honorable reasons (not to mention ratings), he wasn’t unnecessarily pounced on by a dozen camera-hogging, Taser-wielding police officers as he tried to leave the hotel.

E-mail Mr. H.

News 7/1/11

Top News

  Third-party firms that implement vendors’ applications outperform the vendors themselves – except in the case of Epic. Deloitte earns the highest overall marks among third-party firms in KLAS’s survey. Coastal and Peer Consulting outscored GE in overall customer satisfaction by 30 or more points; ACS and Vitalize beat Allscripts by 20-plus points, and Encore and Vitalize outscored Cerner by 20-plus points. Epic outperformed them all.

Reader Comments

 

From Johnny “Hot Rocks” Garcia: “Re: making appointments online. Check out ZocDoc and take note of its investors!” ZocDoc allows searching for doctors within a ZIP code by specialty and accepted insurance. It’s pretty cool, although available only in eight metro areas so far. They have an iPhone app. Investors include The Founders Fund (run by the founders of PayPal, Napster, and Facebook), Jeff Bezos (Amazon) and the chairman and CEO of Salesforce.com. 

From Glenergy: “Re: Allscripts. A new general counsel – Jackie Studer from GE.” Unverified.

From Jordan: “Re: copied medical records. Kind of expensive for an electronic copy.” Texas Health Resources charges state-mandated fees for medical record duplication: $42.05 for the first 10 pages of a paper record, $64.07 if they’re on microfilm, and a flat fee of $76.20 for electronic records requested in electronic form. The state may set the price, but I would have to guess hospitals had input into the rather large numbers. That makes the paper statements of banks look like a great deal, although their free online option isn’t even offered by hospitals. Charging more for an electronic dump is odd, although if you’ve looked at a hospital chart, your $42.05 isn’t going to go far considering the stacks of paper that go far beyond 10 pages. Maybe they should just charge law firms 10 times that amount and let patients have copies of their own information at no cost. Most hospitals think they’re doing patients a big favor by letting them see what they’ve written about them.

From Viking: “Re: GE Healthcare. A marketing director friend had their job eliminated this morning, saying there’s a sweeping org change underway.” Unverified. GEHC doesn’t respond to personnel rumors, so I didn’t even bother asking.

From Terminator: “Re: PHRs. I wonder if their functions are gaining ground as standalone apps that people actually do use? For example, Walgreens keeps all my prescription records and I can access them from anywhere, so I have no reason to import them to a PHR. I use an online tool for diabetes logging, although it would cool if it were updated automatically from any meter I use. If I see a glucometer that allows batch uploads of data to a site like this one, I’m grabbing it! That’s all I want in a PHR except for lab data and the ability to communicate with providers, but patient portals are adding PHR-like features as well, some of which have access to data and have appointment-setting tools.” That’s the big debate – would consumers prefer an independent but minimally functional tool like Google Health or one that’s rich in function and data, but tied to a specific provider? So far, they seem to be saying B (and who can blame them, given that both are free?) Notice above that Walgreens even offers online pharmacy chat right from the public Web page, although it would be interesting to know who’s on the other end.

From LaidOffInDallas: “Re: UT Southwestern Medical Center. Just laid off several IT employees.” UT Southwestern just announced that, due to the loss of $31 million in state funding, it has cut 350 staff positions, laying off 105 employees.

From Former CIO: “Re: Epic art. I would suggest that Mr. Ciotti’s opinions about wasting client money are focusing on the wrong target. The vendors who are wasting money are those that spend more on marketing and less on development, thus producing products that are not integrated and do not support patient care needs. Perhaps the artwork enhances employee attitudes and they get more work done for the money. The cost of the product is a fraction of the true cost of ownership when one considers clinician time and effort. Even so, the cost of the product is still competitive.” At least Epic is sharing the investment with employees instead of hogging the goodies for its executives in a “we’re better than you” kind of way, such as companies that give the suits reserved parking spaces, private bathrooms, and offices that would hold 20 of the veal pen cubicles that the real workers toil in. I can’t vouch for Judy’s office since I haven’t seen it, but I picture it as quirky but modest. That’s a fun challenge: e-mail me with a description of the top dog’s office wherever you work – I will run them anonymously. If they have really splendid digs, make sure to snark it up some.

HIStalk Announcements and Requests

Stuff you’ll want to check out this week on HIStalk Practice: Micky Tripathi details the difficulties associated with tracking and reporting clinical quality measures for Meaningful Use. HHS halts its mystery shopper program for measuring access to primary care. Experts suggest reasons practices are behind schedule for the HIPAA 5010 transition. Dr. Gregg struggles with HITECH guilt and living on the dole. Costco jumps into the EHR world with deals on Allscripts MyWay. AAFP launches its $90/year clinical messaging system. While you are over on HIStalk Practice, sign up for the e-mail updates like the rest of HIT’s coolest kids.

Listening: reader-recommended Belle and Sebastian, 70s-style indie pop from Scotland. A nice sample is here, if you can overlook the fact that the preachy announcer sounds like Mike Myers playing the Scottish dad in So I Married an Axe Murderer.

I’m thinking about refreshing the look of the site and maybe even changing the smoking doc logo in some way. I’ve been using this layout for years, and while I don’t really care all that much one way or another, I guess it’s time for an update (I think Inga is interested). If you have ideas, let me know. Most of the responses I’ve received in the past have been of the “don’t change anything” variety, so that’s the default course of action to challenge. 

I’ll probably publish a Monday Morning Update even though it’s Independence Day (please call it that rather than the Fourth of July). You can amuse me over the weekend by connecting on LinkedIn and Facebook, signing up for e-mail updates, or just checking in to let me know that I’m not the only one with HIStalk on my mind. Have a great holiday. I’ll be taking a few days off starting next weekend, leaving the fabulous Inga and Dr. Jayne in charge.

Jobs on the sponsors-only Job Board: Director of Marketing – Hospital Segment, Director Sales Operations, Senior Enterprise Sales Executive Hospital Southeast. On Healthcare IT Jobs: CEO & President, Clinical Nurse Analyst, Epic Resolute Consultant.

Sales

Aspirus (WI) signs a clinical documentation contract for MedQuist’s DocQment EP.

University of Utah selects Authentidata Holding Corp. for its three-year telehealth project that includes health information exchange, workflow management services, and remote patient monitoring solutions.

University of Oklahoma chooses OmniMD as a preferred provider for medical transcription services.

VHA signs an agreement with Deloitte to offer RCM consulting services to its 1,350 not-for-profit community hospitals.

Ochsner Health System (LA) signs up for Philips VISICU, which will make it the first eICU program in the state when implementation is finished next year.

Announcements and Implementations

InterSystems names Gila River Health Care (AZ) the winner of its Breakthrough Applications Award for using InterSystems DeepSee BI technology with its Diabetic Analysis Management System.

Scripting automation vendor Boston Software Systems celebrates its 25th anniversary.

Medtronic announces a free smart phone app for its CareLink telemetry system for implantable cardiac devices.

Innovation and Research

Cisco announces its Android-powered Cius tablet, due out at the end of July, with the video above featuring Palomar Pomerado Health Chief Innovation Officer Orlando Portale (starting at around the 41 minute mark). The Cius will cost $700, has no 4G connectivity, has only a few dozen apps available from Cisco’s own store, and is sure to bring up the puzzled question, “Why would I want this instead of an iPad that costs less?”

Technology

Oracle will buy storage startup Pillar Data Systems for an undisclosed price. That company’s CEO and majority shareholder: Larry Ellison, who also happens to be the CEO of Oracle. He claims he recused himself from the acquisition discussions, although he didn’t mention why a guy with an Oracle-generated net worth of $40 billion was off running another company on the side.

Other

The developer of Nashville’s Medical Trade Center says it will not break ground until at least 60% of its space is leased. The developer anticipated this goal would have already been met, but a mere 20% of the space is under contract. Committed lessees so far include HIMSS, Steelcase, and mdi Consultants.

  A Florida doctor who moved to a cloud-based EMR a year ago loses access to the records when his Internet connection goes down. He’s been treating patients blindly for three days so far while Comcast tries to fix his broadband. I’ll predict that ONC won’t make his experience the focus of one of its feel-good EMR stories: “If can’t access a patient’s medical records, I’m afraid in the rush of things I might miss something or not do as good a job as I normally would.” His phones are down, too.

Note to companies seeking to become “leading” suppliers in healthcare: your message tends to be more powerful when you reference the correct vertical market in your press release (unless there’s a connection I missed between vehicle dealers and healthcare). 

I saw a press release about a survey claiming that more than 50% of consumers would choose a hospital based on their Facebook and Twitter presence. I found that hard to believe, so I e-mailed the company to ask for the methodology. They offered to provide it if I bought the report for $1,250. I guess I’ll just remain skeptical.

The coroner says mistakes made at Marin General Hospital (CA) helped kill an ICU patient. A doctor, a respiratory therapist, and three nurses were identified as putting the patient on a ventilator, then leaving the room without making sure it was working. It wasn’t.

A study of electronic prescriptions finds that about 10% contain at least one error, the same percentage as paper prescriptions. I only have access to the abstract, but I notice that (a) the electronic prescriptions reviewed were form 2008 for some reason; (b) the study treated all errors equally, with the most common being omitted information (which causes no patient harm); (c) it looked at “potential adverse drug events,” which could indicate lack of decision support on the e-prescribing end, but not necessarily (for example, I don’t know if they counted potential drug interactions as “errors” if the electronic prescriber of Drug A was the same one who prescribed Drug B, which is not necessarily either prescriber’s fault).

Weird News Andy says this man couldn’t have picked a better place to have a heart attack. He complains of chest pain during a cardiologist’s lecture on heart disease at Central Maine Medical Center, then collapses with no pulse or respiration. One of three cardiac nurses in the room jump starts him with a defibrillator, whereupon he is treated in the ED and is doing fine.

Strange: a former managing director of bankrupt investment banking firm Lehman Brothers is busted for trying to pass photocopied prescriptions for Oxycontin and Ritalin at the local drug store. Police follow his Range Rover to his $35 million home and arrest him.

Not healthcare related, but an indication of pervasive technology. The Pope tweets on an iPad to help launch a media portal. Yes, that Pope. You might want to friend him.

Sponsor Updates

• T-System celebrates its 15th anniversary with a five-video series about the history of emergency medicine and of the company.
• ADP AdvancedMD will expand its workforce by 45% this and add up to 100 new jobs in the Salt Lake City area.
• West Penn Allegheny Health System (PA) will continue its rollout of Allscripts EHR to its employed physicians and begin offering Allscripts MyWay to its 2,000 affiliated physicians.
• East End Health Alliance (NY) and its member hospitals choose MedVentive’s Population Manager for sharing clinical information and monitoring performance against evidence-based medicine. MedVentive also announces that former Massachusetts HHS Secretary Charlie Baker is joining its governing board.
• MEDSEEK enters a strategic alliance with Diebold to offer an automated patient check-in, co-payment, and appointment scheduling solution utilizing Diebold’s self-service kiosk.
• ZirMed earns its highest-ever rating in the most release KLAS rankings. In addition, 100% of its surveyed clients indicated they would buy ZirMed again.
• Indiana University Health Centers select eClinicalWorks for two campuses.
• Iatric Systems announces that its PtAccess, Patient Discharge Instructions, PHR Connect, Clinical Document Exchange, Visual Flowsheet, and PHI Interface solutions have received ONC-ATCB 2011/2012 Certification.
• Capsule’s DataCaptor medical device integration software earns a KLAS score of 90.5 with three Konfidence Level check marks in the 2011 mid-term performance review.
• Washington and Idaho Regional Extension Center (WIREC) includes e-MDs as one of the seven vendors chosen for its initial Group Purchase Program.
• LawLogix joins Perceptive Software’s partner developer network to offer a central document repository with forensic-level audit controls using Perceptive’s ImageNow software, allowing HR departments to manage I-9 and E-Verify compliance requirements.
• A new KLAS report on HIEs names MobileMD as the highest-rated vendor serving the private HIE market segment.

EPtalk by Dr. Jayne

Multiple news outlets (including HIStalk Practice) picked up the announcement that the Department of Health and Human Services is scrapping its “Mystery Shopper” initiative, originally aimed at determining whether physicians’ acceptance of new patients depended on type of insurance. Observant folks will notice they left the door open to bring this one back later though, stating, “we have determined that now is not the time to move forward with this research project.”

I don’t need a bunch of grant money to tell you the answer to the question of “can you get seen quicker with good insurance” is “yes.” And if we’re talking about specialist physicians, the answer is “double yes.”

I practice in a major metropolitan area with multiple health systems, numerous tertiary referral centers, and some topnotch medical schools. From experience, if you are a Medicaid patient who needs to see an orthopedic surgeon or a neurologist, there less than a handful of places that will see you at all, and even then you’re going to wait. Most likely, you’re going to wind up being seen in a residency clinic.

I’m fortunate to work for a health system that doesn’t force employed physicians to cap Medicaid patient panels — we have a mission to care for those in need. As a result, I do more than my share of Medicaid care compared to my private practice colleagues, who may cap at 150-200 Medicaid patients if they even take Medicaid at all (and many don’t). Reimbursement doesn’t cover the cost of the visit, and frankly, I don’t remember the last time my practice made a profit. If not for the mission of the health system and their generous subsidy, I’d have had to go out of business before I ever had a chance to make a go of it.

There are some patients who are working the system, but the majority of my Medicaid patients are folks that have fallen on hard times or have had other life-altering events such as an unplanned pregnancy or a severe medical issue impact their lives. Some of the most rewarding patient relationships I have are with these patients, who are genuinely appreciative of the care they get.

I practice evidence-based medicine and don’t refer unless I have to. It breaks my heart to have patients waiting six months or more to see a specialist when I know that if they had a commercial payer, I could get them an appointment within a few weeks. I’ve been forced to expand my scope of practice because specialists won’t see Medicaid patients. It’s almost like being the Little Doctor on the Prairie when in fact, I’m just a few doors down from Starbucks.

(And thank you to my “generous” specialty colleagues willing to proctor me in expanding my procedural techniques because you didn’t want to actually see the needy patients yourselves. Guess what? I don’t just do them on Medicaid patients now — I keep all the procedures in-house.)

I’d be happy to charge CMS, HHS, or anyone else willing to listen a hefty fee to tell them how to increase access for Medicaid patients. States such as Colorado are already at critical shortages of primary care physicians. Articles such as this should be required reading for the politicians deciding how to carve up the healthcare pie. Some ideas:

• Increase the attractiveness of the primary care specialties by increasing Medicaid and Medicare payments for primary care and other cognitive (non-procedural) specialties. The relatively low primary care salaries — coupled with hefty administrative burden, constant on-call and hospital work, and rising patient expectations — are no match for the financial lure of other specialties.
• Increase loan-repayment plans for primary care and/or offer more zero-interest loans for these disciplines. Most of my classmates came out of training with at least a quarter of a million dollars in student loans. Unless you have a vocation for primary care, a salary of $300-$400K each year looks a lot more welcoming than the $130-$140K primary care starting salary when you’re sporting a student loan payment that’s more than most mortgages.
• Increase the availability of case managers, care coordinators, dieticians, health coaches, and social workers for Medicaid patients at no cost to the physician. Don’t tie it to some ACO-type scheme. I promise with this infrastructure, if you build it they will come. (My apologies to William Kinsella for shamelessly poaching your line.)
• Remove administrative barriers for care of medically and/or socioeconomically needy patients, regardless of payer. In addition to the above, remove the requirement that physicians pay for translator services for patients and reimburse this through payers, public or private. I’ve paid over $450 for interpreter services for a visit that I was paid $24. And this is a patient that needed to come in every month because they were complicated – it was a minimum of $150 to get the interpreter to come. Thank goodness my health system is willing to subsidize this, because most private docs don’t have the luxury.
• Reduce the administrative burden related to health IT initiatives. If you’re going to require something (like submission of data to an immunization registry or submission of syndromic surveillance data) ensure that the states actually have an infrastructure to receive the data. Do not send me on a pointless mission to contact department after department across multiple states trying to find someone who has any idea what I’m talking about, only to find out my state can’t accept either kind of data.
• Make quality initiatives make sense. Micky Tripathi’s Pretzel Logic: The Quality measure Conundrum says it all. Most clinicians want to give good quality care. But when it becomes so complicated that the average physician is torn between the spirit of the incentive program and the somewhat malleable calculations to demonstrate it, there are a good chunk of docs that decide it’s just not worth it.
• Understand that the push for healthcare IT has actually made it easier for providers to “cherry pick” the healthy patients or “lemon drop” those that are non-compliant or have poor payers. Back when we had paper charts, it was a lot of work for providers to weed those patients out. Now docs can report on them on a monthly basis with the click of a mouse and decide which patients are too difficult to manage. Probably not what was intended, is it?

So even though it’s dead for now, I’m taking bets on how long it takes the Mystery Shopper program to show itself again. Any takers? E-mail me.

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

News 6/29/11

Top News

French IT services vendor Capgemini is looking for IT services acquisitions in the US, particularly in the healthcare sector. Says the CEO, “We are a marginal player in several of the key markets. For instance, we are non-existent in healthcare in the US, which I think is a mistake. So we need acquisitions.” You may recall that Cap bought Ernst & Young Consulting in 2000, stuck their name on it (above), then sold it to Accenture five years later after losing a ton of money. I worked with E&Y quite a bit at a previous hospital employer back in their heyday and they were excellent for strategic planning, IT governance stuff, and security work. I had a couple of occasions to work with Cap and they were clueless.

Reader Comments

From Susan: “Re: Kettering Medical Center (OH). Went live on Epic May 1 on inpatient, ambulatory, and revenue cycle.” The video is here.

From CloseToEpic: “Re: Epic. Heard from a Madison, WI apartment owner that Epic has hired approximately 2,000 new employees who will be starting end of summer. Apartments filling up around Madison.” Unverified, but reasonable.

From WildcatWell: “Re: Google PHR dead. Told ya so. Give a brother some love! Your EMR/EHR insight is THE industry leader. Let’s get all your readers together – I’ll buy the first round.” WCW is a good information source, but I notice that his drink offer was made anonymously.

From Academic CIO: “Re: HIStalk’s eighth birthday. You have really created a resource that, on top of the insight, information, and perspective you deliver, has replaced the trade mags we used to read to try to get a handle on what was happening in the industry (and which were really only giving the vendor-approved view anyway).” I really appreciate those kind words – thanks. The best part about it is getting to connect with some really interesting people and to help bring a variety of opinions to the table.

HIStalk Announcements and Requests

Inga’s taking a semi-break, so I’m soloing this time around. She’ll be back shortly.

Vince Ciotti poses this (easy) question: “What vendor spends (wastes?) the most of its clients’ money on extravagant architecture and frivolous artwork?” Examples above from Vince’s collection.

Ed Marx added an update to his June 15 post with responses to reader comments.

Sales

Sentara Healthcare (VA) contracts with TeleHealth Services for its interactive patient education solution.

SSM Health Care (MO) contracts with revenue cycle solutions vendor Passport Health Communications for SaaS-based eligibility and financial screening solutions and services for its 15 hospitals.

People

Practice Fusion names Cora M. Tellez to its board. She’s the former president of Health Net and CEO of Blue Shield of California-Bay Region.

Mark Lederman, formerly VP/CIO at Interfaith Medical Center (NY), has been named VP/CIO at Chilton Hospital (NJ). We swap e-mails occasionally and he sent over the update, so congratulations to Mark.

Announcements and Implementations

UMass Memorial Health Care (MA) integrates MyCareTeam’s MCT Clinical diabetes management system with its Allscripts ambulatory EHR, enabling patients to upload their glucose readings.

Chicago mayor Rahm Emanuel announces that Allscripts will add 300 new jobs in the city by the end of 2012. The company will also host its annual user convention at McCormick Place starting next year.

UPMC implements Oracle GoldenGate with Cerner’s 724Access software to help reduce potential EMR downtime.

A Bama Buddy find: a hospital reports that a batter’s box-type outline made of duct tape outside the rooms of infected patients helps reduce infections, reminding employees about contact precautions and giving them a safe zone in which they can still interact with patients without gowning up.

Allscripts announces Allscripts RCM Services at HFMA, which it describes as a cloud-based, outsourced business office for physician practices that is charged as a percentage of monthly collections.

Government and Politics

CMS selects The Lewin Group for a project to reduce the number of hospital readmissions for Medicare beneficiaries and improve quality outcomes for patients transitioning from hospitals to other care settings. The company, which is part of OptumInsight, will receive $2.3 million for the first year of the five-year program.

California lawmakers put together a bill that would require clinicians to flag any information they change in electronic medical records. The bill originally required all changes to be identified by user and to let patients see changes to their own records, but those requirements were removed after big healthcare organizations expressed their opposition that California’s standards would then differ from federal standards.

Innovation and Research

Deborah Peel MD of Patient Privacy Rights sent a link to this story about Personal, a soon-to-be-launched site that lets consumers store information about themselves and then sell it to commercial organizations willing to pay for it. It’s 100 “gems” include such information as when your next oil change is due and what kind of food you like, which they’ll broker on your behalf for 10% of the proceeds. It has some big-time financial backers. Her interest: something like that could give consumers control of their healthcare information, which is being freely sold without their consent for purposes not necessarily in their best interests. It could be used like a PHR, where people enter information that could be made available to sell (to companies) or to providers (for free).

Technology

The Robert Wood Johnson Foundation introduces an online directory that includes performance measurements for hospitals and doctors. It links 197 reports with information on outcomes, cost of care, and whether patients received recommended tests and treatments.

Other

The LA Times picks up the story reported here awhile back, in which a premature baby was killed by sodium chloride overdose due to a data entry error into a hospital pharmacy’s IV compounder software. The article tries to link that human error to IT safety in general, but the problem really was a lack of IT: Advocate Lutheran General Hospital apparently had no interface between its pharmacy system and the compounder software, so they let unlicensed personnel (pharmacy techs) do the manual data entry, where it’s pretty easy to accidentally swap the values of the electrolytes (although properly installed software should have given a warning). I’ve seen that problem first hand (unfortunately) and developed a simple but elegant solution (fortunately). If you’re a CIO, e-mail your pharmacy director and ask how IV formulas get to Abacus or whatever IV compounding software your hospital uses and whether they have warnings set up in it.

1-800 Labwear brings out a lab coat with outside pockets specifically designed to hold an iPad (which they spell incorrectly).

Sponsor Updates

• Kony is named the Most Innovative Company of the Year by the American Business Awards in the technology company category.
• Hayes Management Consulting adds a Regulatory and Compliance services division that will focus on federal healthcare mandates, HIPAA billing and security policy, EDI V5010, and ICD-10. Anita Archer will lead the division.
• Northeast Valley Health Corporation (CA) and Community Health Center Network (CA) are among 32 community health centers to select NextGen EHR solutions.
• Vitalize Consulting Solutions earns an average score of 88.62 in its five service areas as measured by KLAS in its mid-term performance review.
• T-System celebrates its 15-year anniversary.
• Northern Virginia Regional Health Information Organization (NoVaRHIO) launches a pilot program with Picis that will allow ED clinicians from Inova Alexandria Hospital ED clinicians to quickly access prescription information.
• Medicity’s Health Information Exchange Solution for hospitals receives Federal Certification for meaningful use.
• Inland Northwest Health Services announces that the Spokane Virtual Lifetime Electronic Record (VLER) pilot is now enabling the secure exchange of electronic health information using the Nationwide Health Information Network (NwHIN) Exchange. The use of VLER improves the portability of health information to Veterans and active duty Service members in the Spokane, WA area.
• CMS awards the Medicare Part D Transaction Facilitator contract to RelayHealth.
• Orthopedic Institute (SD) chooses the SRS EHR  for its 38 specialty providers.
• East Liverpool City Hospital (OH) goes live on ChartMaxx by MedPlus.
• Thomson Reuters launches Infection Xpert, a clinical intelligence dashboard that combines real-time clinical surveillance information, patient information, and patient-specific reference content from Micromedex for reducing and managing hospital-acquired infections.
• Nashville’s 211 Call Center health navigator program, operated by Family & Children’s Service, chooses MyHealthDIRECT to allow operators to connect callers with available area providers specific to their needs, including the ability to search available provider appointments.
• Ness County Hospital (KS) goes live on the ChartAccess Comprehensive EHR from Prognosis Health Information Systems just four months after its selection. The hospital plans to meet Stage 1 MU requirements by the end of the year.
• Main Line Health (PA) signs a five-year extension with MobileMD for its 4D health information exchange service, which it has used since 2007 to connect four hospitals and more than 30 practices to create a virtual complete medical record.
• Workforce management software vendor Concerro licenses two labor analyses tools from Workforce Prescriptions to allow it to offer labor efficiency review services that cover scheduling practices, agency use, care delay causes, and policies that impact labor ability. Hospitals average $7 million in annual realized savings from labor misalignment. The company’s take on labor management is covered in its blog, with the latest topic being the complexity of managing hospital labor costs.
• NCR is exhibiting at HFMA this week (Booth 1420), talking about self-service solutions that improve efficiency, cost, and revenue cycle.

More Thoughts on Google Health

Nobody’s really disappointed or even surprised that Google Health is dead (actually, few have even noticed, which tells you all you need to know about its problems). The only surprise is that such an unenthusiastic effort came from one-time paradigm-buster Google in the first place.

Actually, maybe the biggest surprise is that Google is shutting Google Health down in an embarrassingly public raising of the white flag. It would be one thing if they were spending a lot of R&D money on it, but there’s no evidence of that. The app is somewhere between simple and ugly, announcements of new functionality or connectivity have come along once in a blue moon, and no lofty promises were made that it would ever be anything more than it was. Given that GOOG’s market cap is $156 billion, and that pretty much nobody was using Google Health anyway, maybe they should have just abandoned it to die quietly instead of convening a very public funeral, raising ugly questions about the cause of death.

The only real traction Google Health got was among folks who wanted to see a brash, smart, and well-funded upstart barge its way into the healthcare IT vendor mix, elbowing out the companies that have been around for decades to shake them out of their maddening complacency. In that respect, Google ironically did what the non-healthcare IT vendors are sometimes blamed for doing: it laid down a smokescreen of rosy PR, under-delivered on even modest promises, ignored the advice that users and experts were giving, and then just cut and run when the going got tough, another healthcare dabbler that should have known better.

I thought Google Health would do OK, if for no reason other than the company seemed committed to hanging in there, at least initially (they threw the stereotypical launch party at HIMSS, then went silent). But the signs were there. The inexperienced folks they put in charge were replaced by even less experienced folks. Their HIMSS booth was a joke, an empty table with a few black-and-white photocopied half sheets of paper handouts. They didn’t make any acquisitions; they didn’t create any innovative technologies; they didn’t differentiate themselves publicly from HealthVault; and they made no apparent attempt to flex their muscle with the providers, EMR vendors, and insurance companies that were sitting on the key asset needed to make their product fly: data.

Sometimes visionary companies can create a market by thinking big and solving a problem consumers didn’t even know they had (MP3 players and Facebook, for example). This wasn’t one of those times. Google Health was a solution looking for a problem, much like its high-flying and equally dead stable mate Google Buzz. If nothing else, Google Health proved that Google is just as fallible as arch-rival Microsoft in thinking it understands what customers want without bothering to actually ask them.

Here’s my epitaph for Google Health, not as a PHR expert (which I’m not, since I have little interest in them) but as an average consumer/patient.

1. Google knows just one business: pushing ads in the faces of users willing to tolerate them in return for getting free access to some reasonably useful Web tools. Without large numbers of eyeballs, Google wasn’t interested, and without those useful tools, neither were the eyeballs.
2. The Google Health model required massive uptake to be successful by its standards, but it was designed to address the health needs of the vocal 2% rather than the indifferent 98%. Hospitals learned that lesson long ago – if you want doctors to use CPOE, you aim your technology at the average doc (busy, struggling, and administration-suspicious), not the geeked out, administration-friendly CMIO who has little in common with them other than wearing a white coat but who sometimes can dangerously convince everyone else they speak for the majority (not like Dr. Jayne, in other words, who actually practices medicine and uses the systems she supports).
3. When it comes to healthcare, consumers are not empowered, and no amount of technology will change that. They have a tiny bit of discretion when it comes to choosing a doctor, but almost none when choosing a hospital or insurance company. Cool Web tools or not, Joe Sixpack has no leverage over the massive bureaucracies of the average academic medical center or insurer.
4. Those massive bureaucracies suck big time at managing their own data. The last thing they want to do is (a) share their crappy and unreliable information with patients, or (b) import unvetted patient information from some other source and then have to figure out what to do with it since they are paid for piecework, not thoughtful reflection of piles of information.
5. “Health” is a good thing that everybody wants for everyone else, but “healthcare delivery” is a cutthroat fight for the financial pie. Collaborative tools are tough sell when the folks at the table are trying to stab each other in the back without being noticed, but especially so when Google didn’t even seem interested in working with them.
6. The average person (be careful who you picture – the masses are not healthcare- or IT-savvy) sees his or her own healthcare as someone else’s problem. They get sick, they use someone else’s money (insurance) to see a provider, they want immediate gratification from pills or surgery, they aren’t interested in information or recommendations of lifestyle changes. Few of them study the government’s dietary recommendations, interface their bathroom scale to a computer program, or participate in online support groups. They just want to be left alone, secure in the knowledge that their poor health choices can be overcome by an insurance-assigned doctor or hospital. Any suggestion that electively unhealthy folks pay more for their healthcare than electively healthy ones is met with cries of discrimination. The only way to get their attention would be to pay them to take better care of themselves, just like giving your kid $10 for each A on their report card.
7. Only a tiny number of zealots will accurately and consistently enter their health information into an online shoe box. Not only is it work, there’s no apparent payoff since most providers don’t have the time or interest to read what those folks entered (partially because the technologies they use don’t play well with others any more than those providers themselves).
8. Consumers use technology for three reasons: it provides them with emotional satisfaction (Facebook), it offers them convenience (Amazon, paying bills online), or it saves them money (eBay, Groupon). Google Health and most PHRs offer none of these benefits.
9. Addressing the convenience aspect requires removing the friction of healthcare delivery system transactions. They are horribly inefficient, often because the doctors, hospitals, and insurance companies themselves are horribly inefficient (which lends credence to the argument that arming either Joe Sixpack or providers with a lot of technology doesn’t necessarily make things better, particularly when it comes to patient outcomes).
10. Nobody really trusts big companies all that much, and people are especially suspicious of who sees their health information. Geeks might trust Google with their entire identity, but the average person probably won’t.

Now is probably a great time to retire the term Personal Health Record. It had a questionable premise to start with, but now Google has tainted it as being a plain, static Web page that’s about as fun to use as TurboTax and a whole lot less useful.

I’m an average patient and I want nothing to do with a Google-like PHR. What I want is to be able to:

1. Make electronic appointments, including being able to search for openings at multiple locations or among competing providers. I don’t want to have get on the telephone or compose an e-mail.
2. Request prescription refills.
3. See my lab results as soon as they are available, with a personalized explanation of what they mean.
4. E-mail my doctor and get a timely response.
5. Get specifically requested information to my doctor efficiently, and know that he’ll ask for the information he needs, it will remain on file in case it’s needed again, and I’ll have a say in the decisions made from it.
6. Get automatic reminders for EMR-triggered events (vaccinations, next physical exam due, etc.) but with the option to suppress those that aren’t helpful.
7. Manage someone else’s health with their permission, such as a child or parent.
8. Earn an insurance or treatment discount for following recommendations that result in measurably improved health.
9. Solicit bids or search prices for services not covered by insurance.
10. View any health information recorded about me with an efficient mechanism to correct any errors.

The average PHR doesn’t do most of these things. They can’t unless providers, insurance companies, and EMR vendors can be convinced to work together. Patients don’t have the sway to make that happen. Employers might, or perhaps some kind of government mandate.

Short of that, PHRs are going to struggle since, by definition, they are trying to bring competing parties together electronically without giving them an incentive to do so. That leaves PHRs as little more than a spreadsheet on which a few consumers can record their own information that nobody will look at.

Many folks who cheerlead for PHRs do so with a vested interest instead of as a consumer. So here’s the challenge to those inclined to comment on this post: instead of the usual pedantic posturing about PHRs as a technology or a business, tell me how YOU PERSONALLY use a PHR, what benefits you’ve received, and what you wish it would do. The “experts” can’t stop talking about Google Health, but none of them so far has admitted actually using it or any other PHR.

Contacts

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

Experian To Acquire Medical Present Value for $185 Million

Ireland-based financial information and technology vendor Experian announced this morning that it will acquire Medical Present Value for $185 million in cash. The Austin, TX-based MPV offers revenue cycle services to providers that include eligibility verification, patient-friendly statements, credit scoring services, and claims software.

MPV, which has annual revenue of $45 million, will become part of Experian’s North America Credit Services division, which offers services for running small businesses. The company’s other healthcare product is SearchAmerica, a 2008 acquisition that evaluates patients for their likelihood of payment and eligibility for financial assistance programs.

Dan Johnson, president of Experian’s Healthcare Services, was quoted in the announcement as saying, “Healthcare providers in the US face growing challenges when it comes to billing and collecting payments for services. With the addition of MPV, Experian is able to provide a more comprehensive set of products and services across the healthcare payments life cycle and help clients manage multiple vendors through a single point of contact”

MPV was founded in 1998 and serves more than 75,000 providers. Its principal investors are Rho Ventures, CenterPoint Ventures, Star Ventures, and Care Capital.

Monday Morning Update 6/27/11

Google makes it official: the company is shutting down three-year-old Google Health on January 1, 2012. Google predictably did what its know-it-all technology company predecessors have done over the years: dipped an arrogant and half-assed toe into the health IT waters; roused a loud rabble of shrieking fanboy bloggers and reporters (many of them as light on healthcare IT experience as Google) who instantly declared it to be the Second Coming that would make all decades-old boring vendors instantly obsolete or subservient to the Googleplex; and then turned tailed and slunk off at the first sign of lackluster ROI, leaving the few patients and providers who actually cared high and dry except for those same old boring vendors who have stuck it out for decades instead of chasing whatever sector looked juicy at the moment.

Why did Google Health fail? Simple and obvious: consumer demand for personal health records is close to zero, which has always been the case and probably always will be. Convincing patients to take the time and effort to maintain PHRs is as tough a sell as convincing doctors to voluntarily use CPOE, and for the same reasons: those doing the work don’t get much benefit. Patients don’t want to maintain their own records and clinicians aren’t about to trust patient-maintained information for making treatment decisions (not to mention that taxpayer-incented HIEs and Epic’s MyChart are stealing their thunder by not relying on patient-powered sneakernet in the first place). PHRs aren’t fun. They don’t accrue Farmville points, you can’t put pictures of your cat or a funny YouTube video on them, and you don’t get HITECH money for typing in your weight every now and then. The only model Google knows involves near-universal adoption that gets advertisers salivating, not having a tiny contingent of wellness buffs and savvy chronic disease suffers using their free online service. Ultimately, Google’s problem is that an awful lot of Americans care about reality TV and celebrity gossip more than their health. They’re more interested in patch-me-up-doc “healthcare” than I-need-to-make-better-choices “health” that requires proactive electronic tools. The most shocking aspect of Google Health’s announcement in 2008 was either that Google hadn’t figured that out or that they thought they could succeed anyway.

Want to bet that Google will come crawling back to healthcare one of these days when earnings start to slip? That’s what generally happens with those short attention span technology vendors. Like Microsoft before it, Google has gone from a dominant force that can do no wrong to a clearly fallible company that makes a ton of money, but that often is more of a follower than a leader with surprisingly routine and easily predicted product failures. And speaking of Microsoft, I’m not sure whether Google Health’s timely death is good news or bad for HealthVault, a better product, but still facing the same uninterested market even with the loss of its only high-profile competitor (advantage: Dossia?)

It’s OK to include scanned documents in an EMR, say 86% of respondents, while a less-forgiving 14% of purists say no way, electronic doesn’t just mean electronic, it means discrete data only. New poll to your right, in honor of the dearly departed Google Health: do you keep a current and medical reliable electronic Personal Health Record? I asked that same question in 2007, when 88% of the most technologically and medically savvy people in healthcare said they did not (maybe Google should have taken those results as one of those warning cow skulls in the desert).

Suggestion to anyone claiming to be an insightful Epic expert: your credibility will be enhanced if you spell the company’s name right (it is not EPIC).

A company approached me about sponsoring the HIStalk reception at HIMSS next year (I love that I don’t have to troll to get companies interested since I don’t have the time or inclination to do that). I found out from those folks something I hadn’t noticed: HIMSS has completely screwed around with the Las Vegas conference days, with the pre-conference stuff starting on Monday (Saturday is now Monday, in other words) and the sessions run Tuesday through Friday (so everybody will need to bail out for home on Thursday instead of Wednesday). Great – now you can’t do a Saturday night stay when trying to find a cheap flight and we’ll either have to travel with all the other business schmos on Monday or fly out a day early. They’ve moved my cheese and I’m unhappy, but I’ll get over it. So, despite my concluding HISsies slide from Orlando, the reception is probably not going to be Monday night if I decide to do another one. If you’re slotted to present a Friday session, you might want to plan for a roundtable instead of an auditorium.

I am absolutely loving Vince Ciotti’s HIStory series. He’s getting lots of e-mails and kudos, even from 20-something HIT sprouts who understand the “doomed to repeat history” thing and figure they can learn from the pioneer diaries. Vince recently had calls from Jim Pesce (McAuto) and Mike Kaufman, who are following his series and contributed to the installment above (I’m really impressed with Mike’s history since I didn’t realize his deep roots when he and I have exchanged e-mails over the years).  E-mail Vince if you have some history inside your head or on paper that would round out his recollections. The industry goes back to the late 1960s (Meditech was formed in 1969), so with 40-plus years having gone by, it’s time to document some of this stuff.

Speaking of Mike Kaufman, in Googling to see what he’s up to, I see that he, along with fellow former Eclipsys SVP Hans Boerma MD and money guy Frank Panaccio formed KBT Partners, which offers advisory services to healthcare IT and related companies.

I’m also quite enjoying the work of Micky Tripathi in his monthly Pretzel Logic column on HIStalk Practice. His writing is fluid and personal (not to mention entertaining) and he’s obviously an expert in all things EMR (fortunately, since he’s the president and CEO of the Massachusetts eHealth Collaborative). I just posted his Quality Measures Conundrum piece and it should be required reading for anybody who cares about EMRs or Meaningful Use.

My Time Capsule editorial this week from 2006: Medical Equipment Sales Boom While Health IT Struggles. A snip: “The takeaway message is that, science aside, doctors and hospitals will utilize the hell out of something when they’re paid to do so (equipment, drugs, supplies, and for-profit referral centers). While it’s nice if patient care is improved, it’s only mandatory that it not be worsened.”

A Harvard Business Review working paper covers why creative tension among company executives can be a good thing. One of its examples is Misys CEO Mike Lawrie, who in 2008 insisted that the company’s open source division not be rolled into Allscripts but rather allowed to compete with it for resources, which supposedly benefited both groups.

Speaking of Misys, the company offering to buy it is revealed as Fidelity National Information Services, a Jacksonville, FL-based bank technology firm that has a healthcare division (benefit administration, PHR, consumer health portal, ID cards, lockbox, revenue cycle).

Weird News Andy revives this story: mourners filing past the coffin at a Russian woman’s funeral are startled when she raises up and begins screaming, not nearly as dead as the local hospital had said. The funeral-goers’ time wasn’t wasted, however: the woman had a heart attack from all the commotion and died minutes later in the same hospital.

A survey finds that no surveyed physicians in the UK, New Zealand, Canada, and Sweden said they practice defensive medicine, compared to the 92% in the US who admit to letting fear of lawsuits drive their medical decisions.

CapSite releases the Lite version of its database, strictly for providers and hospitals. The Web-based tool provides access to thousands of contracts and proposals from peer institutions, complete with pricing and T&C covering 800 vendors in HIT, imaging, medical devices, and services. It’s free for 30 days and the company is signing me up to check it out, so I’ll be interested to snoop around since I love looking at contracts.

Athenahealth buys Point Lookout Resort and Conference Center, 396-acre, $7.7 million property near its Belfast, Maine operations center, which it will use for client and employee training. The facility overlooks Penobscot Bay and has 106 cottages, a bowling alley, and a beach. I’m thinking we need an HIT geek summer camp, complete with marshmallow roasts, snipe hunts, and furtive ukelele-inspired groping around the campfire.

OptumInsight (formerly Ingenix) is awarded a patent for its LifeCode natural language processing technology, which can extract content and context from electronic medical records. That technology runs the company’s computer-assisted coding applications,  which the company says can ease the transition to ICD-10.

I’m pleased with this find since I’m thrifty (cheap, some might say, including someone with whom I share a bed). I take low-dose lisinopril for blood pressure (my BP is only 115/55, but my doc likes me to take it for some reason). I thought Walgreens offered $4 generics, but they don’t any more, so they charged me $10 for 30 tablets. I looked for alternatives and found that not only does Walmart offer a long list of maintenance meds for $10 for a 90-day supply, but mail delivery to your door is free. That is Walgreens Strike 2, the first being that they charge almost $50 for a vial of Canine HIStalk’s insulin while Walmart sells their custom-relabeled Novo Nordisk insulin for only $24.88. We may have a healthcare crisis in this country, but it would be a heck of a lot worse without Walmart (at least now that they offer health insurance to more of their employees).

Atlanta-based startup Digital Assent, which developed the PatientPad ad-powered patient check-in tool for practices, raises $7.5 million in a Series B funding round. The founders came from Sythis, which developed an interactive selling solution that licensed its technology for PatientPad.

Sad: a hospital-based physician finds that someone is checking out porn and Googling phrases such as “rat poison symptoms in humans” on his office computer. It turns out to be the hospital’s night shift security guard, who has since confessed to trying to kill his family by poisoning them and who is now charged with beating his pregnant wife, his father-in-law, and his five-year-old daughter to death with a baseball bat and then burning down his house.

Cleveland’s MetroHealth System, getting heat from the county council about no-bid consulting contracts and excessive spending, takes positive action: it hires a $300 per hour PR company (without bidding, I assume) to help its executives practice for their appearance in front of the investigating committee.

Another Weird News Andy story that has me in stitches is this story, which he entitles Four Inches? Just a Flesh Wound. An 11-year-old girl trimming her horse’s mane opens up a 10 cm gash in her chest when the horse bolts. Her mother calls emergency response for an ambulance, only to be told to clean the wound, apply pressure, give aspirin, and then drive to the nearest hospital within eight hours or so. The hospital’s first question when she arrived: “Why didn’t you call an ambulance?”

E-mail Mr. H.

News 6/24/11

Top News

McKesson signs a definitive agreement to acquire Portico Systems, a supplier of provider management tools for health plans, for a reported $90 million in cash.

Reader Comments

From Polymorph: “Re: ambulatory rumors. TactusMD just pulled out of their Meaningful Use / EncounterPro offer. EncounterPro has pulled their open source project and also brought in a new management team.” Unverified. These aren’t companies I follow, so I have nothing to add.

From Bull City: “Re: Duke going Epic. According to job listings on their HR site, Duke is replacing McKesson Horizon with Epic. MCK loses a showcase site and development partner, Epic steals yet another high-profile client.” Even non-psychics could have seen that coming since Duke has Epic ambulatory underway and hospitals rarely stop there.

From David: “Re: home brewery. I saw this article and thought maybe you had some extra time aside from HIStalk and the hospital.” It’s a fun article, but it’s not about me. The high-end home brewery of Tim Artz, a director of Agfa HealthCare’s government health IT and imaging business, is featured (he gets extra points for having a homemade meat smoker, whose product surely goes nicely with his beer).

From Joey Cheesesteak: “Re: Investors Business Daily article. One of my daily reads (along with HIStalk). Their daily 10 Secrets to Success section is highly recommended.” IBD characterizes Cerner shares as slow but steady. I used to subscribe, but finally figured there was no way my casual reading was going to pit me favorably against professional money managers in the zero-sum game of buying stocks. I put my little stash in a wrap account, where it has outperformed my returns and given me someone to blame other than me when it doesn’t. However, I just now remember meeting with some investment guy at Cerner’s user group in Orlando years ago and he kept pressuring me to name one healthcare stock to buy. I told him Cerner. I’m sure he’s taking all the credit.  

From MT Hammer: “Re: Webmedx. Acquired by Nuance, as told to employees in a conference call Tuesday. Webmedx was the #3 player in the MT field behind Nuance and CBay/MedQuist.” Unverified. Webmedx was the #1 KLAS transcription services vendor for 2009 and 2010 and offers natural language processing solutions for clinical documentation.

HIStalk Announcements and Requests

If you still aren’t tuned in to HIStalk Practice, here are some of the goodies you missed over the last week: Henry Schein MicroMD GM Keith Slater shares insights on why physicians should or should not implement EHRs. A whole lot of physician practices are not ready for the 5010 transaction set. Healthcare insurers mess up one out of every five claims processed, costing $17 billion in administrative costs — wow. Don Michaels, PhD of Hayes Management Consulting and the Harvard School of Public Health takes about full plates and the ICD-10 500-pound gorilla. Forbes uncovers Practice Fusion’s vision for making money. The cloud looks pretty good in terms of security breaches. While catching up on the latest HIStalk Practice news, help us keep our supporters happy and our servers humming by touring the offerings of our sponsors.

On the Jobs Board: Solutions Executive, Systems Engineer, Technical Marketing Engineer. On Healthcare IT Jobs: CEO & President, Clinical Application Analyst, Manager of Data Governance, Horizon Implementation Consultant.

Listening: new from Montreal power poppers Simple Plan, cheery, loud summer music mostly about girls, such as You Suck at Love. It’s like sangria on a hot day: fizzy, sweet, unchallenging, and likely to lock in memories of what you were doing during those ephemeral days when you were enjoying it constantly. They’re big supporters of charitable causes.

Your HIStalk punch list: (a) sign up for the e-mail updates if you haven’t already, joining a highly selective group of 7,414 subscribers who have Pavlovian reactions of various types when I ring their inbox bell; (b) engage Inga, Dr. Jayne, and me in social intercourse by making our electronic acquaintance on Facebook or LinkedIn (Dann’s LinkedIn HIStalk Fan Club is up to 1,666 members, universally cute and smart from what I can see); (c) vanquish your predilection for passivity and send me news, rumors, photos, guest articles, or sentimental yearnings; (d) love my sponsors at least a little for their brave support of what may be the most amateurish and off-the-wall site in the button-down world of HIT (You Suck at Love? Really?), appreciate their ads by clicking forcefully, check out the Resource Center, and trust that despite the inevitable role conflicts between you as a prospect and they as a vendor, you at least have HIStalk in common and therefore share an appreciation of the offbeat.

Acquisitions, Funding, Business, and Stock

Healthport merges with Universata, a provider of release of information services.

Shares in Philips take a hit after the Dutch consumer electronics giant warns of lower sales right before the quarter’s end. The company says it will cut costs and restructure.

CSC gets European Commission approval to acquire iSoft, although shareholder approval is still required.

People

Guillermo Moreno, formerly of Diebold and past president of the South Florida chapter of HIMSS, joins staffing firm Experis as VP of its healthcare practice.

Navicure names Craig Potts as EVP of sales. He was previously with Fiserv.

Christine Connelly, the high-powered CIO of England’s Department of Health, will leave her position at the end of the month. She says organization management is being restructured and she has decided not to pursue one of the remaining executive positions.

Announcements and Implementations

Omnicell’s new G4 medication dispensing system earns ONC-ATCB certification as a Modular EHR.

Baptist Health System (AL) and Henry Ford Health System (MI) will pilot a new cloud-based imaging management system from AT&T that provides quick access to images from any system and provides secure image access to referring physicians and facilities.

Mercy Medical Center-Sioux City (IA) makes the local paper for its new Web-based system that allows patients to pre-register, pay bills, and print a medication card.

Government and Politics

ONC announces that it has made its healthcare IT teaching curriculum available to the public at no charge, including higher education institutions in the US and elsewhere. The material was developed with a $10 million ONC grant. Content covers work redesign, technical support, networking, usability, and project management. It also includes modules with hands-on lab assignments that use the free VistA for Education EHR. The links sent to me didn’t work, but check ONC’s site.

The US Supreme Court strikes down a Vermont statute that prohibits the selling of prescription data to drug companies (usually via third-party vendors such as IMS Health) so they can develop customized sales pitches for doctors. The court found that Vermont had a vested interested in prohibiting prescription drug marketing as a form of censorship since it is a purchaser of generic drugs, not to mention that the advertising lobby argued that drug marketing is free speech. IMS wet its corporate pants at the news, vowing to gear up its hugely profitable business in the interest of public health and healthcare reform.

Innovation and Research

The Children’s Boston/Harvard Medical School SMART Platform Apps Challenge chooses the Meducation app by Polyglot System as the winner of its $5,000 innovation prize, which focused on add-on EMR applications. Meducation will be added to the SMART App Store that launches next year, modeled after its Apple counterpart. Meducation pulls medication lists from the patient record, then allows printing simplified instructions in several languages. It was developed under an NIH grant for underserved populations.

Two UCSF medical students create MediBabble, a free  app that lets caregivers play pre-recorded patient history questions in various languages to patients who don’t speak English. It asks questions that require only yes-no answers or pointing to a body part.

Technology

Microsoft’s Craig Mundie pitches the company’s Kinect motion-based game controller at the Pacific Healthcare Summit, citing its potential use in avatar-based group therapy sessions for mental health patients and as a way for doctors to interact with medical records systems using voice and gestures. I didn’t see a video, but above is one from Wake Forest Baptist (NC) showing the use of Kinect to manipulate medical images.

Other

A 21-year-old con man poses as a doctor at OHSU Hospital (OR), providing medical advice to a patient from the hospital’s coffee shop while wearing a fake hospital badge and uniform. He also claimed to be a software developer at Microsoft.

PatientSecure is getting publicity like I’ve never seen from its little press release about NYU Langone Medical Center going live on its palm scanning system for verifying patient identity. Above is a lengthy evening news piece from ABC’s New York affiliate.

Aspirus Wausau Hospital (WI) loses phone service and network connectivity for several hours on Wednesday when a maintenance worker accidentally triggers a fire suppression system, requiring ambulances to be diverted and some appointments to be rescheduled.

Weird News Andy can’t decide if this is real or The Onion. A UK hospital, claiming it’s too broke to install a nurse call system in the wing for elderly patients, hands out tambourines instead. It even provides a backup system: maracas. A relative said, “These people are pensioners – not members of the Monkees or Mick Jagger,” apparently missing the fact that the once-youthful rockers she mentioned are pensioners themselves – Davy Jones is 65, Peter Tork is 69, Mick Jagger is 67, and Keith Richards has to be at least 185.

WNA also weighs in on this gut-wrenching invention: a self-propelled endoscopy device called The Mermaid, a tadpole-like, joystick-controlled camera that can swim the entire length of the GI tract in a few hours, starting from either end.

Sponsor Updates

• MedAptus will demonstrate its Intelligent Charge Capture technology at next week’s HMFA ANI conference in Orlando.
• Also participating in HFMA ANI: EDIMS.
• MED3OOO’s InteGreat EHR passes all required elements in the CCHIT 2011 Ambulatory, Child Health, and Security test scripts and is now a Pre-Market Conditionally CCHIT Certified 2011 Ambulatory EHR additionally certified for Child Health.
• Encore Health Resources is named one of Best Places to Work in Healthcare.
• Besler Consulting will feature its BVerified-Revenue Integrity Auditor at HFMA ANI next week. It allows hospitals to quickly act on revenue enhancement and compliance opportunities.
• Capario achieves full accreditation with the Healthcare Network Accreditation Program (HNAP) from the Electronic Healthcare Network Accreditation Commission (EHNAC).
• Catholic Health Initiatives (CHI) is featured as a case study in “getting staffing right” in the new issue of HFMA’s Leadership. Its eight-hospital pilot of Clairvia’s CVM tracks patient progress through the hospital and tracks progress and expected length of stay against CMS benchmarks, suggesting optimal staffing levels and skill mix along the way.
• Concerro offers a complimentary Webcast that covers Joint Commission Emergency Management Standards.
• KLAS ranks Encore Health Resources in second place (missing first by 0.2 points) in advanced health information technology services.
• EnovateIT’s Fred Calero wins Michigan’s Entrepreneur of the Year.
• Health Language, Inc. unveiled the latest release of its LEAP I-10 at last week’s AHIP’s Institute 2011 Conference in San Francisco.
• Sage Healthcare adds nine new clients for its cloud-based Sage Intergy On-Demand PM/EHR.
• Healthwise offers a white paper on Getting Patients to Meaningful Use.
• GetWellNetwork releases a list of winners of its third annual Interactive Patient Care awards. Top honors went to The Indiana Heart Hospital for using GetWellNetwork’s Heart Failure Care Plan to reduce readmission rates and help cardiac patients manage their condition.
• T-System promotes Bill Hall to VP of solution development, Scott Martin to manager of solution management, and Hank Hikspoors to director of new product development.

EPtalk by Dr. Jayne

A networking site for physicians has been launched by Doximity. Unlike my recent trip to the CMS Web site, a visit to Doximity found that my correct and updated practice address was already on file. Advertising the ability to not only connect colleagues but to allow “HIPAA secure messages,” Doximity is supported on iPhone, iPad, Android, and PC platforms. CEO Jeff Tangney co-founded Epocrates. I’m not sure what advantages it has over other networking platforms just yet, but I’m going to keep my eye on it.

Those of us that work in the primary care trenches have seen a variety of body piercings, some of which have gone awry. Researchers  at the Northwestern University School of Medicine have been using a technology developed at the Georgia Institute of Technology that allows patients with spinal cord injuries to steer wheelchairs using a magnetic tongue stud. The magnet sends signals to a headset, which then transmits to an iPod that controls the wheelchair. Although glue was originally used to hold the magnet in place, trials found that a tongue piercing was more reliable.

Life in the fast lane, literally: personalized medical monitoring devices are one of the coolest and least-discussed types of health information technology. This year I’ve been following IndyCar driver Charlie Kimball, who has Type I diabetes. Kimball wears a continuous blood glucose monitor that feeds to a gauge on the dash right next to other traditional race car data points. He finished 13th in this year’s Indianapolis 500.

News of the Obvious

Surprise, surprise: a Harvard study demonstrates that watching TV, snacking on chips, and staying up too late can cause weight gain. Researchers looked at over 120,000 Americans over a 20-year period and found an average weight gain of three to four pounds per four years. I wonder what the results would look like if it was repeated on IT department staffers, EHR and CPOE implementation teams, and Meaningful Use consultants during the last two years?

More non-surprises, as shared by Bama Bubba: Sleep Deprivation in Medical Caregivers Has Deadly Results.  Extended hospital shifts increase the risk of patient safety compromise as well as vehicular accidents. Having had a close encounter with a rural route mailbox after being up all night, I know this to be true. Starting next month, incoming first-year resident physicians will be limited to 16-hour shifts rather than the current 30-hour cap. Having trained “back in the day” when there were no work hour limits, I see this is a positive step towards a more humane training program, but the jury is still out on what impact the work hour limits may have on resident learning.

Contacts

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

News 6/22/11

Top News

The VA awards The Informatics Application Group a $5 million contract to serve as the custodial agent that will manage a proposed open-source development program for VistA.

Reader Comments

From Anon: “Re: ONC. Recently cancelled a number of print and Web ad contracts. They have instructed their ad agency to work with 10% of their original million-dollar budget.” Unverified.

HIStalk Announcements and Requests

Vince Ciotti is loving all the comments, stories, and even corrections he’s getting to his HIStory series. He gave the OK to run his e-mail address for anyone who wants to get in touch. 

Thanks to the following sponsors (new and renewing) and long-term advertisers that supported HIStalk, HIStalk Practice, and HIStalk Mobile in May. We appreciate their support.

Acquisitions, Funding, Business, and Stock

PwC acquires Implementation Specialists (ISH).

athenahealth’s Jonathan Bush and Ed Park are among a group of angel investors and VC firms investing in HIT start-up Kyruus. The company’s software platform compiles data from public and private sources to create predictive analytics and professional profiles on physicians. Sound big brother-ish.

Misys doesn’t have much healthcare presence these days, but for those who still follow the company, it confirms that a potential buyer is interested in acquiring the company at a valuation of $1.4 billion.

Sales

North Idaho Health Network picks MobileMD to provide HIE services for five hospitals and 305 physicians.

People

PatientKeeper president and CEO Paul Brient wins the Ernst & Young Entrepreneur of the Year award for New England and is now eligible for consideration for the national award.

Former Ingenix VP Tom MacDougall joins Curaspan Health Group as the company’s first CTO.

Prognosis Health Information Systems appoints William M. Conroy to its board. He was CEO and president of Initiate Systems until IBM acquired the company in March 2010.

University Health Care System (GA) names Leslie Clonch as VP/CIO. He was previously with Doctors Hospital at Renaissance (TX).

Announcements and Implementations

The University of Kansas Hospital goes live with 240 evidence-based order sets using Zynx Health’s clinical decision support solutions. The ZynxCare tools are deployed via KUMD’s Epic EHR.

Accenture and MOH Holdings announce that the first phase of Singapore’s National EHR system is now live.

The data warehouse appliance product of Health Care DataWorks earns EHR Modular certification for calculating and submitting inpatient and ambulatory clinical quality measures.

Yuma Regional Medical Center (AZ) gets a mention in the local paper for its $70 million Epic implementation.

Cooper University Hospital (NJ) says it’s the first in the country to transmit real-time clinical information for dialysis patients in the ICU. iSirona’s  medical device connectivity software sends the information to the hospital’s Epic system, allowing doctors to monitor the effectiveness of dialysis treatments from any location. They’re planning something similar for vent patients.

Government and Politics

CMS will use predictive modeling to fight Medicare fraud. It’s the same sort of risk-scoring technology that credit card companies use, but modified to analyze Medicare claims. That reminds me of the time VISA called me to see if I really did purchase several hundred dollars worth of goods and services at a strip club (the answer was no.) I wonder if Medicare will start calling up 70-year-old men to verify whether they indeed had procedures performed to sever their vasa deferentia?

The National Library of Medicine launches MedlinePlus Connect, a free service that allows health organizations and providers to link patient portals and EHRs to MedlinePlus.gov for consumer health information. Providers can meet one of the 10 menu set criteria for Meaningful Use by linking to it.

An India-born weight loss doctor who took in $25 million from billing insurance companies for questionable weight loss treatments makes the FBI’s Most Wanted list. The complaint says the doctor’s five clinic locations billed for tests not needed or not performed, allowed employees to hand out controlled substances without asking a doctor, and dressed up unlicensed personnel and passed them off as nurses. He got in trouble a couple of years ago for insider trading.

Technology

SAP is apparently offering an EMR.

Other

Several health systems and a few HIT vendors earn spots on ComputerWorld’s 100 Best Places to Work in IT 2011. Top health systems include Kaiser Permanente (16), Texas Health Resources (19), and Lehigh Valley Health Network (20). Recognized vendors include Cerner (27), Quest Diagnostics (70), and Compuware (86).

NextGen will host a webinar this Thursday called Tips from a Physician on Transforming Your Practice Through Meaningful Use. The physician presenter has already led 29 doctors achieve Medicare Meaningful Use.

Weird News Andy proclaims himself Sad News Andy because  of this tragic story from the UK: a top orthopedic surgeon hangs himself in the garage of his estate, reportedly after making a relatively minor surgical error.

Fallon Clinic (MA) joins Atrius Health. Both are Epic users.

Odd: a man gives a bank teller a robbery note demanding $1, then sits quietly waiting for police to arrest him. The reason: he’s unemployed, ill, and has been turned down for disability and Social Security. He’s hoping the court puts him away for several years (and says he’ll do it again if not) so he can receive medical care, after which he plans to collect Social Security and move to the beach.

Ohio Public Radio covers electronic medical records, with Dr. Gregg as one of the guests along with folks from ONC and Ohio Health Information Partnership.

Sponsor Updates

• CynergiskTek and its partner Diebold will exhibit their enterprise security solutions at next week’s HFMA ANI 2011 conference in Orlando.
• ADP AdvancedMD is sponsoring at this week’s Utah Promontory HIE and Technology Connectivity Conference in West Valley City, UT.
• Emdeon expands its services portfolio with the acquisition of Chapin Revenue Cycle Management, a provider of hospital-based revenue cycle services.
• GetWellNetwork’s chief outcomes officer David W. Wright is appointed to the board of directors for the American Nurse Credentialing Center.
• TeleTracking Technologies will host a free conference on automating transfer center operations August 17-18 in Nashville.
• HMS Direct, a subsidiary of Healthcare Management Systems, will expand its data center capacity by utilizing hosting services from Peak 10 Inc.
• Thomson Reuters’ Pharmacy Xpert  and Clinical Xpert CareFocus earn ONC-ATCB modular certification.
• Medicity announces that its ProAccess technology has received ONC-ATCB modular certification.
• Benefis Health System (MT) selects NextGen Ambulatory EHR, PM, and HIE technology for more than 80 physicians at its hospital-owned practice.
• Access releases a new version of its on-demand forms applcation.
• QuadraMed and Elsevier align to combine Elsevier/MC Strategies ICD-10 e-learning suite with QuadraMed’s ICD-10 Countdown Program.
• Elsevier also signs an exclusive partnership with The Quality Group (TQG) to market TQG’s Health Care Series, a customized process improvement training solution for healthcare professionals.
• McGraw-Hill Higher Education and Greenway Medical Technologies announce an online HIT course for colleges and universities. Integrated Electronic Health Records: An Online Course and Worktext for Greenway Medical Technologies’ PrimeSUITE will be offered through McGraw-Hill’s Connect Plus teaching solution.
• OptumInsight (Ingenix) collaborates with InstaMed to offer CareTracker Payment Connect, an electronic bill payment service for patients.
• Billian’s HealthDATA will exhibit at HFMA ANI 2011 in Orlando next week. Check in on Foursquare and show it to the booth reps and they’ll give you a Starbucks gift card.

Contacts

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

Monday Morning Update 6/20/11

From Cheesy Politics: “Re: Epic. At least one Wisconsin political blogger sees it as evil. She does have a point: isn’t HITECH about government getting more control over health information to be able to push out mandates?” I read that post when it was published, but like most partisan blogs, it was a bit too hysterical for me to mention here. Not to mention factually incorrect, saying HITECH has set aside “almost $100 million in total” for EHR incentives (oh, if only) and that the Health IT Policy Committee that Judy Faulkner sits on is “the federal Health IT board.” I agree that the government runs healthcare and will continue to expand its influence over it, but that’s to be expected – they’re paying for most of it in the form of redistributed taxpayer money.

From The PACS Designer: “Re: Prezi. In a recent blog post on HIStalk, Will Weider mentioned that he used Prezi as his online presentation software which he preferred over other possible choices. Prezi seems to be more user friendly with its zooming whiteboard concept, and is gaining more popularity because this feature.” It can “Prezify” your PowerPoint slides, I note. Price ranges from free to $159 per year. PC Magazine gave it 3.5 stars in October, mostly because of limited design choices, but said presentations are “an animated visual feast.” I’m not sure that’s enough reason to switch, especially if you aren’t already using PowerPoint’s animation tools (and let’s face it, for most in-person presentations, those “animated visual feasts” would be super annoying, so I’d save them for making videos).

From Former CIO: “Re: corporate proxy reports. Not healthcare related, but amazing.” A corporate governance group highlights corporate proxy disclosures that are bizarre:  one company’s CEO agrees to spend 80% of his “business time” on the company’s affairs, up from the previously agreed on 60%. I have to say I was disappointed – the proxy disclosures are nothing compared to the perks executives get that aren’t disclosed. Even non-profit hospitals and groups are quite generous with the executive bennies: cars, private club dues, travel, and big bonuses. Clueless VPs get fashionable technologies to screw up, meaning they’ll make impatient calls to the CIO to demand that the on-call field support tech be sent over to their summer home to fix the hospital-provided, state-of-the-art laptop that the VP’s teenage son messed up while torrenting porn.

Several readers have e-mailed over the years saying that they would like to support HIStalk’s sponsors, but can’t easily figure out who offers what products and services from the ads. They suggested an online guide similar to the one that HIMSS puts together for conference exhibitors, where you can look up companies by category. Great idea, so we’re doing an HIStalk Resource Center that does exactly that. You can navigate by company name or category and jump between companies by breadcrumb links. You can also request information by clicking a “send RFI” link that will let you contact a company directly without having to fool around with composing an e-mail or finding the contact form on their site. It’s a work in progress. I’ve added a tiny clickable banner right below the Founding Sponsor ads that will take you there.

When Ricky Roma left his A Few Good Men parody rebuttal to Dr. Jayne’s complaints about IT, I knew it was too good to not promote to the main page of HIStalk instead of leaving it as a comment. Your reactions proved me correct – it’s darned funny and, for those of us who have worked the IT side of the house, a good description of why IT shops don’t always have the budget or labor to support Apple’s latest gizmo. In case you weren’t around or paying attention back in 2009, check out Ricky’s excellent Tales of the Dark Side (a  snip: “Remember, the demo is an illusion. A lunch demo, doubly so. ”) I’ve been pestering him to write more for HIStalk ever since. If I thought an outpouring of support would convince him, I’d start a petition.

Not good news if you compete with Epic: while survey respondents give differing reasons for its success, combining answers 3, 5, and 6 together suggest that more than 60% believe it’s because Epic’s product is better. New poll to your right: is it OK that an electronic medical record contains scanned documents along with discrete data fields?

Watching: In Plain Sight, my new favorite Netflix series. You could neatly categorize most people by the character they find most attractive: federal marshal Mary Shannon of the Witness Protection Program, her sister Brandi, or her partner Marshall (who I guess would be Marshal Marshall). Brilliant acting and writing, like this quote: “The second revelation came as I sat at the bar in morose solitude, pondering the cantilevered relationship between bartender’s gut and lower extremities. And this is important, so pay attention. Before the big bang, before time itself, before matter, energy, velocity, there existed a single, immeasurable state called yearning. This is the special force that, on a day before there were days, obliterated nothing into everything. It is the unseen strings tying planets to stars. It’s the maddening want we feel from first breath to last light.” And Listening: Yes, The BBC Recordings 1969-70. Truly amazing and polished, complex music played live by guys in their early 20s, one of my favorite bands (through Relayer, anyway). Stupendously good.

Cerner forms a joint venture in Saudi Arabia to offer Millennium to hospitals there, working with a government-owned investment firm and a business development group.

Dr. Jayne is interested in learning more about IBM’s Medical Record Text Analytics solution (a spinoff of Watson), so if you’re an in-the-know IBMer, feel free to contact her. She missed last week’s Webinar on the topic, I assume.

I see from his Facebook updates that Ed Marx has reached the top of Mount Kilimanjaro, Africa’s tallest peak at over 19,000 feet (that’s an earlier training pic above, just in case you were thinking that it doesn’t really look all that tall). Ed’s an ardent HIStalk supporter: he voluntarily writes for us (very well, I should add); he Likes all of our Facebook posts; and he graciously took time out of his HIMSS schedule to speak at our sponsor lunch in Orlando. Therefore, I quite reasonably conclude that Ed is the man.

My Time Capsule editorial this week from 2006: Before You Buy, Look at the Impact on User Productivity.

ONC is using some of its tsunami of taxpayer money for publicity: ghost-written blogs, contests, and now advertising. The one above has a new “campaign” that I’m guessing came from an expensive PR firm: "Putting the I in Health IT.”

Weird News Andy summarizes this story as “The government paying more than necessary and offering less than effective options? I’m shocked, shocked to find that is going on here! </casablanca>” UCSF researchers say Medicaid could save a lot of money by paying for drugs that are on WHO’s Essential Medicines List, which is used by 131 of 151 countries surveyed, instead of letting each state make up their own inconsistent lists. If you’re a fan of creeping socialism, you’ll be happy to note that 20% of the country is on Medicaid. Sometimes I get the feeling that those of us who pay taxes to support everyone else are getting to be a tiny minority.

Speaking of Medicaid’s wasting of money (was that redundant?), North Carolina’s project to replace its Medicaid claims processing system is now two years behind schedule and more than $200 million over budget, not to mention that the state will also pay EDS another $110 million to process claims over two years since the new system isn’t ready. The contractor is CSC, the company that’s even more behind and over budget in Britain’s NPfIT boondoggle, also responsible for Medicaid system problems in other states. The state isn’t blaming CSC, though – they say it’s the federal government’s constant Medicaid tinkering that keeps changing the specs. The state is offering to change the five-year, $287 million contract to a seven-year, $495 million one with Uncle Sam picking up 90% of the tab. I have several reactions: (a) never hire CSC to do anything; (b) North Carolina is obviously ignoring my advice since CSC’s punishment for missing budget and deadline is to get more money; (c) as everybody who knows billing is well aware, the government may talk efficiency and modernization, but its arcane Medicare and Medicaid payment requirements ensure that providers can adopt neither; and (d) it’s pathetic that a mid-sized state has to spend $500 million just to manage Medicaid payments (small compared to Medicare) and none of that money does anything to improve population health or patient care – it’s just an administrivia management system created by an unholy alliance of contactors, lobbyists, and government employees (many of those in the latter category planning an eventually profitable exodus to one of the first two.)

Minnesota Public Radio runs a surprisingly comprehensive and balanced article on electronic medical records in rural hospitals, covering (a) the benefits; (b) the penalties; (c) the shortage of HIT labor for both providers and vendors; and (d) the likelihood that EMR pressures along with healthcare reform will force rural hospitals to sell out to bigger and better-funded organizations or shut down completely. A quote from the CEO of a 14-bed hospital (above): “I’m not sure that even God’s bank has enough money for electronic medical records. Are we working on it? We’re working ourselves crazy. Eighty percent of our capital budget every year goes toward implementing another aspect of EMR.” The article talks a lot about Duluth-based SISU, a non-profit hospital consortium that offers Meditech systems, hosting services, group purchasing, and IT expertise.

Clueless Internetters who probably couldn’t name the Secretary of State or point out Canada on a map focus their limited intellectual capacity on tracking down Haynes Management, a 21-employee real estate company that supposedly fired an employee whose wife was diagnosed with cancer. In their haste to become part of a viral mob reacting emotionally to the one side of the story they read, the nitwits Google over to Hayes Management Consulting (apparently deciding that the N in Haynes is insignificant) and start sending hate e-mail. Hayes issues a press release denying that it’s them. When Inga e-mailed me the press release, I gave an instant reply: “Hayes is brilliant for using this to promote themselves. It’s fun to write about, so I bet it will get picked up.” Which it has. 

Lehigh Valley Hospital-Cedar Crest (PA) kills a kidney transplant patient, a 51-year-old nun, with insulin when defective blood glucose testing strips erroneously show her as hyperglycemic. Communication problems were also involved: a nurse from the hospital’s remote ICU monitoring station noticed the difference between results from the test strips and from blood draws, but didn’t tell anyone.

Chuck Friedman, ONC’s chief science officer and one-time #2 guy there, is leaving to run an informatics program at University of Michigan. We told you on June 8, courtesy of rumor reporter Roman DeBeers, that he was quitting, although Chuck ignored my e-mail asking for confirmation. ONC’ers sure like those academic appointments.

Here’s Vince’s latest HIStory, for which he credits the help of Bob Haist of SMS/ISD and Bob Pagnotta of MDS/Tymshare.

Dell will spend $80 million on an ad campaign pitching its capabilities beyond selling commodity PC hardware, with one of the four TV ads showing a doctor. 

Strange: the medical school dean of the University of Alberta is demoted to professor after parts of the graduation speech he delivered were found to have been taken verbatim from a similar speech Atul Gawande gave at Stanford last year. Graduates claim they Googled a particular phrase, “velluvial matrix,” on their smart phones as the dean spoke, allowing them to follow along from Gawande’s original speech. It was a giveaway since Gawande made the phrase up, as he explains later in his own speech: “OK, I made that last one up. But the velluvial matrix sounds like something you should know about, doesn’t it? And that’s the problem. I will let you in on a little secret. You never stop wondering if there is a velluvial matrix you should know about.”

University of Florida gets a $500K NIH grant to create EHR alerts using genetic information, which will influence treatment decisions involving an unnamed drug to prevent heart attack and stroke (which I assume is clopidogrel). 

A Maryland infrastructure company gets a $45 million contract to work with a China-based counterpart in developing a cloud computing center to host electronic medical records in that country.

Utah announces Clinical Health Information Exchange (cHIE), a statewide HIE (part of the Utah Health Information Network) with participation from Intermountain, MountainStar, IASIS, and University of Utah. It’s actually been around for a year or so as I recall, so maybe the announcement was related to broader participation.

Just in case you need something to run on your iPad: Big Fish Games releases the free Hospital Haste, where you “help Nurse Sally work quickly to diagnose, treat, and cure all of her patients.” (obviously they aren’t intimately familiar with what nurses are legally allowed to do).

E-mail Mr H.

News 6/17/11

Top News

The California Hospital Association files suit against the state public health department to block a requirement that hospitals report detailed information about surgical site infections starting June 1. CHA says most hospitals don’t have the information available electronically, so they would have to take time away from patient care to dig through records manually.

Reader Comments

From Ricky Roma: “Re: Dr. Jayne’s IT comments. Doctor, we live in a world that has networks, and that network has to be guarded by men with decreased budget and staff. Who’s gonna do it? You? The executive staff? We IT guys have a greater responsibility than you could possibly fathom. You weep for your iPad, and you curse IT. You have that luxury. You have the luxury of not knowing what I know. Denying iPhones, while tragic, probably saves PHI. And my existence, while grotesque and incomprehensible to you, saves PHI. You don’t want the truth, because deep down, in places you don’t talk about in the doctors’ lounge, you want me on that network. You need me on that network. We use words like governance, security, encryption. We use these words as the backbone of a career spent defending something. You use them as a punch line. I have neither the time nor the inclination to explain myself to a physician who sees patients under the blanket of the very security that I provide, and then questions the manner in which I provide it. I would rather you just said thank you and went on your way, Otherwise, I suggest you log on to a PC like everyone else. Either way, I don’t give a damn what device you think you are entitled to.” Brilliant as always from one of my favorite (but seldom heard) contributors.

From Mile High Club: “Re: WSJ article on use of corporate jets. It includes a searchable database, finding that destinations often coincided with the vacation homes of executives. McKesson had 41 flights to Martha’s Vineyard and Laconia, NH (probably someone’s house on Lake Winnipesaukee).”

HIStalk Announcements and Requests

This week on HIStalk Practice: additional background on the RWJF report that found diabetics treated by practices with EHRs received significantly better care than those treated at paper-based offices. Turns out the paper-based offices also had almost five times more non-insured or Medicaid patients than the EHR-based practices and twice as many non-white patients. Also: Julie McGovern of Practice Wise shares tips for creating a disaster recovery plan. A new organization is launched to certify medical scribes. Less than one-third of physicians are expected to remain independent by 2013.  Dr. Gregg shares HITECH support woes and wins. If you like the ambulatory world (and who doesn’t?) then you’ll want to make sure to sign up for the HIStalk Practice e-mail updates.

In almost totally unrelated to HIT news: a couple of girlfriends and I stayed at a upscale hotel recently for a little getaway. All three of us came home with what I have diagnosed to be bed bug bites (you know, I did the Internet research thing and compared my bites to the online photos.) Which leads me to wonder: are bed bugs the latest work hazard for HIT road warriors? It’s a totally disgusting topic, I realize, but it’s an issue I never really worried about in my traveling days. FYI, I complained to the hotel; they checked the room and told me they found no evidence of bed bugs. BFFs and I are thus considering whether we’d be better off visiting a dermatologist or simply seeking a psych consult.

Listening: Black Joe Lewis & The Honeybears from Austin, TX, recommended by a reader. Here’s what I e-mailed to her: “I’m doing hideously uncoordinated chair-based dance moves to Booty City, thinking I’ve gone back in time to the 60s to listen to Edwin Starr doing 25 Miles from Home. Now I’m going to want to accentuate everything I say with an emotional ‘HUuaaH’ just like this guy (and James Brown) I’m making that ‘white man trying to be funky’ look by scrunching up my nose, sneering, and and squinting as I bob my head out of time with the music and do some walking bass on the air guitar.”

On the Jobs Page: Solutions Executive – Virtual Office, Technical Marketing Engineer – Work from Home, Healthcare IT Technical Recruiter. On Healthcare IT Jobs: Allscripts Test Manager and Test Resource, Implementation Consultant, Meditech PCM Implementation Analyst.

First, do no harm. Once that’s done, (a) sign up for e-mail updates in the box to your upper right (unless your display is set to low resolution, in which case it could be just about anywhere); (b) send me news, rumors, and anything that would tickle my sophomoric humor; (c) find Inga, Dr. Jayne, my sites, and me on your favorite social not-working tool and make the appropriate electronic connections so we can feign mass appeal; (d) accept my personal challenge to randomly inspect five of the admittedly large number of ads to your left and click them, waiting excitedly as in the presence of Monty Hall to see what’s behind Door Number 3 and knowing that you are thereby supporting us keyboard-clackers who work absurd hours after our day jobs; and (e) don’t worry, be happy.

Thanks to Bulletin Healthcare, new to both HIStalk and HIStalk Practice as a Platinum Sponsor. The publishing company sends out electronic newsletters to 400,000 doctors every morning by 8:00 a.m., working with two dozen leading medical associations to meet the unique news requirements of their members  as a valued member benefit (American Medical Association’s AMA Morning Rounds, American College of Physician Executives’ ACPE Daily Digest, and American College of Cardiology’s CV News Digest, to name a few.) The Reston-based company is the medical division of Bulletin News, which provides executive news briefings for the President and most of the Cabinet. They’re happy to tell companies about their advertising programs, should yours have an interest. Thanks to Bulletin Healthcare for supporting HIStalk and HIStalk Practice.

Sales

The Regional Medical Center at Memphis (TN) purchases Carestream Health’s Vue RIS for radiology scheduling and reporting.

The University of Virginia Health System extends its licensing agreement for Streamline Health’s document workflow solutions and adds Streamline’s Correspondence Workflow application.

People

Press Ganey promotes Robert Draughon from president and CFO to CEO, replacing Richard B. Siegrist, Jr. Siegrist will transition to chief innovation officer and remain on the board. We reported this Monday, courtesy of a rumor report from South Bend Snoop.

PatientSafe Solutions names Joseph Condurso president and COO. He was a CareFusion VP and also spent time with Cardinal Health.

EnovateIT president Fred Calero wins Ernest & Young’s Entrepreneur of the Year award for Michigan and Northwest Ohio in the healthcare services category.

Vivek Kundra, the nation’s first CIO, will quit in August to take a Harvard fellowship. Like his boss, opinions vary on whether he has accomplished anything of positive significance. Nobody has said much about a possible successor, so I don’t know if Aneesh Chopra has the cred or interest.

Industry long-timer Rick O’Pry, founder of JR O’Pry Consulting and IntraNexus, launches a consulting company called HIT Strategists.

Announcements and Implementations

St. Michael’s Hospital (MN) will go live on Meditech on July 1.

Mayo-Austin (MN) apologizes to patients for long registration delays caused by the EMR it installed in April, saying it “has temporarily slowed down our registration process and phone response time as we check the accuracy of patient information and become more proficient with the system.” They’ve hired more staff. I bet decreased patient satisfaction and increased headcount to do the same work wasn’t in their business plan.

Omnicell’s OmniRX medication dispensing system wins Best in KLAS for hospitals 200 beds and over.

PDR Secure launches the RxEvent adverse event reporting service, which will allow doctors to report drug problems directly from their EHR. It was developed in conjunction with Greenway, the American Pharmacists Association, and athenahealth.

UPMC announces its HealthTrak mobile app for iPhones and iPads that allows patients to review their test results, history, meds, and appointments. It’s based on Epic’s MyChart.

Innovation and Research

Fujitsu works with a hospital in Japan to roll out a patient guidance system based on e-paper. Patients carry an electronic card holder that guides them to diagnostic departments, checks them in, and accepts their payment. They can wander around while waiting since the system calls them when it’s their turn (not that hospitals have anywhere interesting to wander around in anyway, but at least they could distance themselves from Unemployment TV).

Technology

Ottawa Hospital is deploying mobile technology in a big way, purchasing 2,800 iPads for its 456-bed facility. The CIO notes that its iPad and iTouch users include doctors, nurses, pharmacists, respiratory therapists, and even janitors.

Online physician networking site QuantiaMD finds that over 30% of physicians use tablet devices, 20% of them in clinical settings.

Panasonic announces that it will bring out an enterprise-grade, Android-powered Toughbook tablet in the fourth quarter.

Other

Sparrow Health System (MI) hosts a job fair in an attempt to fill 70 to 80 IT job openings. Analysts will support the health system’s $100 million Epic EHR implementation. Starting salaries are $50-80K.

The Missouri Hospital Association estimates that 90% of the state’s hospitals use an EHR for at least one of 24 functions. On average, hospitals use about nine EHR functions, though 44% use at least 13.

CapSite believes the ambulatory EHR and PM market will exceed $3 billion through 2013, with 63% of physicians replacing their current PM systems for an integrated PM/EHR and 38% upgrading or replacing their current PM. Capsite’s 2011 U.S. Ambulatory EHR and PM Study also predicts that 50% of physician will be investing in ambulatory EHR systems. In terms of current market penetration, Allscripts and Epic each have 16%, followed by eClinicalWorks, NextGen, and GE.

A tornado in Verona, WI left Epic powerless for most of last Thursday, forcing it to run on backup generators.

A California man is arrested for pretending to be a medical doctor. A patient got suspicious after he told her to treat her kidney disorder by eating watermelon in a hot tub.

Weird News Andy is speechless about this story: a woman in Sweden with fever, chills, and aches calls four times over four days for an ambulance, but is turned down because she is still able to speak. She dies. But WNA is tittering at this piece about English hospitals warning employees that their uniforms must not expose their midriffs or “excess cleavage” (whatever that means) after patients complained.

Sponsor Updates

• SCI Solutions posts a video describing its new Arrival Manager product and a cool flipbook of its annual Innovations in Access Management magazine.
• MEDSEEK wins the 2011 Frost & Sullivan North American Health Records Technology Leadership award.
• FormFast and T-System collaborate to integrate the print management portion of FormFast’s workflow software with the T-Sheets documentation system.
• CareTech Solutions announces that two of its clients won 2011 Aster Awards for their Web sites.
• AsquaredM is offering a June 23 Webinar on improving revenue cycle performance with Lean Six Sigma.
• Hanger Orthopedic Group will deploy NextGen Ambulatory EHR and PM at its 675 orthotic and prosthetic patient care centers in 45 states.
• The Tennessee-headquartered RegionalCare Hospital Partners selects Healthcare Management Services (HMS) to provide clinical and financial applications .
• McKesson VP and medical director David Nace, MD is speaking about bundled payments at this week’s AHIP conference in San Francisco.
• A health center customer of TELUS Health Solutions wins an Ingenious Award for using the company’s remote patient monitoring solution to increase nurse productivity, reduce home visits, and save $450 per patient.
• Humana will offer financial assistance to physicians adopting Allscripts EHR as part of is as part Humana Medical Home EHR Rewards Program.
• Pinehurst Dermatology (NC) contracts for the SRS EHR.
• API Healthcare hires Kathy Douglas, RN, MHA as the company’s chief nursing officer. She founded the non-profit On Nursing Excellence.
• TeleTracking Technologies will preview its new RTLS solution at the 2011 Association for Advancement of Medical Instrumentation conference being held June 25-27 in San Antonio.
• HHS’s Office of Minority Health and Quest Diagnostics announce a program to  donate 75 MedPlus EHR user licenses and one year’s subscription fees to physicians in small practices serving minority populations in Houston.
• Perceptive Software names Glenn Cross VP of Marketing.
• MED3OOO is offering an on-demand Webinar on Why ACOs Should Be Physician Led that features Amit Rastogi MD, president and CEO of PriMed LLC, a 70-provider medical group in Connecticut.

EPtalk by Dr. Jayne

Mile·stone (noun)

1. A stone functioning as a milepost.
2. A significant event or stage in the life, progress, development or the like of a person, nation, etc.

I believe in celebrating milestones. With the rapid pace that many of us run each day, it’s easy to overlook key events. We get used to doing the same tasks each day / week / month / year, falling into the cycle of “lather-rinse-repeat” and losing sight of the work that we are accomplishing.

I encourage my team to remember that, although this may be the 43rd time they’ve trained “E-prescribing 101,” this is the first time the users in their classes are seeing it. I remind them to remember the impact they are having on our end users and that completion of each class is an accomplishment.

We just took our 250th physician live on one of our clinical systems. The go-live wasn’t any different than any other go-live — the physician was aggravated that he had to be there and I was aggravated at having to deal with his surliness towards the IT team. However, calculating the number of times we’ve executed the same process multiplied by the number of people needed to work closely together to successfully get that physician live, it becomes significant. If you would have offered me a bet at the start of the rollout that we’d have this many physicians live on that application at this point, I wouldn’t have taken it.

We tend to take for granted the things that seem to be always present. Maybe we celebrate the beginnings and the ends — the new teammates and the retirements — but we forget to mark the events that happen along the way.

The five-year anniversary of an incredibly challenging project is passing without anyone in our organization other than those of us who were on the team at the beginning noticing. On one hand, maybe it’s good that the tool has become such a part of the organization that it’s not a big deal. But for those of us who still have flashbacks from the go-live (and probably a little post-traumatic stress disorder), it’s amazing.

Celebrating milestones helps us learn what others value and why it matters. Last Wednesday was HIStalk’s eighth birthday. Although Mr. H mentioned it, he tends to be the somewhat shy and retiring type, so it was pretty low key. I’d like to do my part to celebrate HIStalk and reflect on the impact Mr. H and company have had on me.

As a reader, HIStalk provides a reliable, humorous, and entertaining source of information that I could not possibly have uncovered without hours of sifting through the announcements, updates, and studies that come through my inbox and across my desk each week. It gives me tidbits of industry gossip that sometimes hit too close to home.

I’ve learned things about competing health systems that I could not have sleuthed out on my own. I’ve surprised vendor execs by asking them to confirm rumors about their companies that they haven’t even heard themselves. I’ve experienced HIStalkapalooza and the IngaTini.

As a member of the HIStalk team, I’ve had the opportunity to see different sides of vendors as Inga and I cruised the aisles at HIMSS, at one point switching badges to see if it made a difference in how we were received. One of the high points was meeting Mr. H for the first time in the HIStalk limo, changing into our doctor disguises and walking down International Drive with Inga in her amazing boots. We saw our sponsors, many of whom compete directly with each other, breaking bread together at the HIStalk luncheon.

I’ve learned that whether people like a particular piece I’ve written or whether they hate it, I don’t take it too personally either way.

This has been an opportunity to meet amazing people, make new friends, and learn that being anonymous can be a challenge. Using Dr. Jayne’s e-mail address, I’ve emailed people I’ve known for years — and have been ignored. I’ve socialized with key players in government and healthcare and have had to bite my lip to keep from saying, “OMG, if you knew you were talking to Dr. Jayne you would not have just said that.”

I’ve also built necessary career skills – namely the ability to keep coffee from coming out my nose when my co-workers quote HIStalk pieces that I’ve had a hand in.

Best of all, I’ve learned that what may seem like an insignificant event at the time can be a life-changing one. I’d like to thank a certain vendor exec for casually asking, “Do you read HIStalk?” over drinks on a certain day in 2009. At the time, I didn’t. But thanks to that simple question, along with the faith and support of Mr. H and Inga, as well as the camaraderie of Dr. Gregg and Dr. Travis (MD recently conferred!) I’m about to click SEND on Dr. Jayne’s 50th post. Here’s to milestones.

Contacts

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

News 6/15/11

Top News

Three Kentucky healthcare systems will form a single organization with a combined 91 hospitals, clinics, and home health agencies. The new system will include the University of Louisville Hospital, the James Brown Cancer Center, the six-hospital Jewish Hospital & St. Mary’s Healthcare, and the seven-hospital St. Joseph Health System. As part of the deal, Catholic Health Initiatives will make an incremental capital infusion of $320 million to support the system.

A new Robert Wood Johnson Foundation report finds that 51% of office-treated diabetics in Cleveland received all the care they needed from practices using electronic medical records vs. 7% from paper-based practices. A similar correlation was found for diabetic outcomes. I didn’t see study methodology so I can’t really evaluate it to determine if it adequately proved cause vs. effect, but it’s interesting.

Reader Comments

From Paula: “Re: Vince’s HSD piece. What about McDonnell-Douglas IHS? It was an innovative system for its time. When McAuto decided to get out of the hospital systems business, it was sold.” Here’s a reply from Vince:

Thanks for reading these dusty old bits of trivia! Yes, IHS (Integrated Health Systems) was one of many turnkey minicomputer systems that the shared giants offered in the 80s – which is going to be the next epoch in HIS-tory covered. McAuto bought IHS in the mid-90s as a DEC-based "total" HIS, to complement their wide array of other turnkey mini offerings, including HDC, MHS, LabCom, RXCom and RadCom. SMS offered a bunch of minis too: ACTIon 400, 700 & 1200, Spirit Choice, and MS4. Ironic the shared giants got into minis so big! Stay tuned for all the details in two weeks."

From Former TMISer: “Re: Commission on Professional and Hospital Activities (CPHA). Vince might want to do a piece on them since they were maybe the first to computerize healthcare data on a large scale. It was a grant-supported non-profit that collected, processed, and stored abstracted data on more than 50% of hospitals back in 1969, offering three products: Professional Activity Study, Medical Audit Program, and Length of Stay Study. All were paper-based printouts. CPHA was influential in the development of the International Classification of Diseases and its length of stay data contributed materially to the development of DRGs.”

 

From The PACS Designer: “Re: StartUp Health. In addition to HIStalk giving smaller companies a chance to succeed, the federal government has announced a program called StartUp Health. This new effort will help entrepreneurs create a long-term roadmap for success by providing education, support, and capital to build a health and wellness business.”

From augurPharmacist: “Re: American Society of Health-System Pharmacists. The Summer Meeting in Denver has lots of HIT content. Discussions include bar code scanning at each step of the intra-hospital supply chain such that ‘when a drug product changes hands, it gets scanned.’ There’s a growing awareness about the technologies required to enable intended pharmacist practice model change from inside the pharmacies to the patient side. Lots more information available on pharmacy’s professional initiative referred to as PPMI by searching ‘PPMI.’”

From J.U. Stice: “Re: nextEMR. Looks like they are the most recent ONC-ATCB certified EHRs to die on the vine. No employees, unpaid bills, empty promises. Classic story of underfunding and no marketing traction. If you build it, they will come? I don’t think so.” I contacted CEO and Founder Alan Faustino MD, who provided this response:

Reports of our demise have been greatly exaggerated. While we have experienced our share of growing pains, like most companies in this economy, we are still offering the same outstanding service and support that has help us survive in this turbulent and confusing HIT period. As a matter of fact, we have been vetted out by several organizations recently from a financial and technology point of view and have been successful in developing strong relations that will sustain this company today and into the future. As an example, we have been chosen as the EMR of choice for the McFarland group to implement and use EMR for research initiatives. We have weekly webinars and look forward to using our technology to better the overall success and increase influenza immunization to the under represented in this country. I can assure you that the NMA and the Cobb institute would no likely involve themselves with a company not in operation. As a matter of fact, we have in conjunction with the McFarland group a webinar tonight and welcome anyone to join and "feel our pulse" Like many businesses, we have had to let go of some employees for financial or performance reasons. However, we wish these people well and hopefully they will find more constructive things to do with their time. However, I do appreciate the "press." Hopefully, HIStalk will allow us to show a different perspective on our company and welcome the opportunity to let the physician community know how nextEMR, along with our partners, are giving physicians the technology to be frankly better physicians today.

From Chip: “Re: poll on giving patients a list of employees who accessed their electronic medical record. You have to do this to pass ARRA and EHR certification requires it, so vendors must have overcome any technical hurdles.”

HIStalk Announcements and Requests

I have to give a shout out to Best Buy for some superior customer service I just received. I bought a new Asus PC from them, but noticed it had integrated graphics rather than the advertised 1 GB ATI graphics card, which was almost certainly an error in the specs Asus gave them (or perhaps an Asus manufacturing mistake). It wasn’t a huge deal and it wasn’t Best Buy’s fault, but I called the local Best Buy store where I had picked it up (I had done ship-to-store) and they told me to bring it over. They gave me a brand new 2 GB card ($100) and for “my inconvenience” (basically, next to none), they had the Geek Squad folks install it while I waited – all at no charge. I felt bad for even calling since the graphics aren’t all that important to me, but Best Buy really came through. The new PC is working great and I’m finally off Vista and WinXP (except at work, of course, where the ten-year-old XP still reigns unchallenged).

Sales

Norton Healthcare (KY) purchases the Morrisey Concurrent Care Manager application to automate its care management processes

People

James Hauschildt EdD, MA, BSN, RN is named academic dean of Saint Luke’s College of Health Sciences (MO). He was formerly with Dearborn Advisors, Dell, Cerner, and the Air Force nurse corps.

Announcements and Implementations

Massena Memorial Hospital (NY) goes live on MEDHOST’s EDIS.

Shands Healthcare (FL) goes live on its $95 million Epic EMR at three facilities. A fourth facility will be added in September and several faculty practices will go up next year. The same article includes some interesting facts about Epic: the company has 240 customers; one-fourth of the country’s physicians use Epic software; and, 110 million patients (38% of all patients) will be in an Epic system once pending implementations are complete.

The School of Medicine at the University of Alabama-Birmingham starts its EHR implementation, which will be completed in five phases over the next 18 months. Stephen Stair MD, the physician executive sponsor of the project, provides an update above.

West Tennessee Healthcare System deploys BIO-key International biometric ID software within its Sentillion Vergence solution.

A nine-physician internal medicine group in Michigan sells itself to Oakwood Healthcare, saying it passed on aligning with Henry Ford Health System because HFHS couldn’t get its EMR installed quickly enough. HFHS says the EMR wasn’t a priority because they are replacing their McKesson system with a $100 million custom system from RelWare and didn’t see the point in installing a system that will be gone in two years. Oakwood uses NextGen, but signed a contract in April to implement Epic in its hospitals and practices at a cost of $60 million.

Philips will roll out its eICU system in India within a year.

Government and Politics

Maine legislators vote to allow residents to opt out of the state’s HIE database.

Mark your calendar: July 3 is the last day eligible hospitals and critical access hospitals can begin their 90-day reporting period in fiscal year 2011 for the Medicare EHR incentive program. Eligible Providers have until October 3.

The Boston Globe points out that the state still does business with IBM’s Cognos division even as one of the company’s former salespeople goes on trial for giving kickbacks to the speaker of the house of Massachusetts in return for getting software contracts without going through the required bidding process. Neither IBM or Cognos, which had not been acquired by IBM at the time of the alleged incident, have been charged, but it’s possible the SEC could get involved if evidence suggests that the sale boosted the acquisition value of Cognos.

The UK’s NHS says that even though the country’s “digital by default” policy requires citizens to communicate with government agencies by digital means, that requirement will not be imposed on those seeking health services. Instead, the government will meet whatever demand citizens have, with one of its technical leaders saying, “The idea that we should wait for everyone to agree before offering digital services is ludicrous.”

Innovation and Research

A study finds that implementation of healthcare IT had no effect on outcomes for nursing home patients, other than it seemed to make them more disruptive.

Other

HIMSS names Hudson River Healthcare (NY) as its single finalist for the Community Health Organization Davies award.

Mayo Clinic’s chairman of health policy and research says that the clinic won’t be participating in an ACO, at least based on the proposed rule. According to Douglas Wood MD, Mayo’s objections include the use of oversight boards to judge performance, the proposed anti-trust rules, the methods of measuring effectiveness of care, and the way patients would be assigned to ACOs.

maxIT Healthcare celebrates its 10-year anniversary by sending out its executives in an RV with a cool paint job, driving across the country to visit its consultants and clients in the field.

Weird News Andy noodles out a great story about a doctor and a diva (he clarifies they are not one and the same in this particular case). An opera singer (on the left above) shopping at a Manhattan Trader Joe’s gets annoyed at a teenaged boy who blocks her husband from grabbing a frozen Pad Thai dinner. Hubby complains loudly, so the boy’s mom (a doctor, on the right above), bellows out, “Get that pole out of your ass.” The opera singer admits that she then slapped the doctor, but adds that she needed slapping because the doctor was “getting into her personal space.” The opera singer is on trial for attempted assault.  

Here’s a great interview and character study of Bill Gates, who talks about global health and how his kids will need to find regular jobs because he’s not giving them much money (“much” meaning quite different things to Bill than to you and me). Trivia: he bristles when the reporter asks if his kids have iPhones, iPads, or iPods, saying, “They have the Windows equivalent … they are not deprived children.” You forget how young he was (21) when he and Paul Allen started Microsoft in 1975 – the photo above is from 1984, well into the company’s growth and the year that Windows was launched. He looks about 12.

I like this well-written and just-sarcastic-enough editorial by a physician and former president of AAPS, whose bio contains this wry observation: “As a life-long dog lover and trainer, she realizes that her dogs have better access to medical care and more medical privacy than she has, and her veterinarians are paid more than physicians in the United States for exactly the same types of surgery.” Among her unhappy but amusing observations (not all of which are correct) about medical practice is this:

Now there’s also “healthcare reform.” That includes the push for the EHR (electronic health record). Physicians are being bribed with $44,000 for installing one that meets the government’s desire to have your formerly private medical record on a government database. With this system, a keystroke can fill your medical record with mistakes, yet a physician can’t write a progress note without learning to navigate a computer program so obsessive that the detail required to order a simple test would do for a moon landing. The former head of CMS (Centers for Medicare and Medicaid Services), Nancy-Ann Min DeParle, made around $2 million dollars working for the company whose program it is, before she became an unaccountable “Czar” in the present regime.

A female visitor trips while walking out of the elevator at Louisiana Medical Center and Heart Hospital. She claims permanent injuries to her arm, shoulder, and neck that cause her pain and suffering, disability and mental anguish, loss of income, loss of earning capacity, and expenses. She’s suing the hospital for $600,000.

Sponsor Updates

• Highmark selects MEDecision’s collaborative health management solutions to support the management of its 4.8 million members.
• Practice Fusion hires Edwin Miller as its first VP of product management. He previously worked for Curaspan, Artromick, and athenahealth.
• Health Language is demonstrating its upgraded version of LEAP I-20 at booth #335 at this week’s AHIP conference in San Francisco.
• CareTech Solutions and its client, Central Maine Medical Center (ME) are chosen by the Ohio Hospital Association to present an IT security case study, Security Assessments: A Tool to Manage Risks and Achieve HIPAA Compliance, at OHA’s annual meeting this week in Columbus.
• The 49-bed Monroe County Medical Center (KY) contracts with Healthcare Management Systems for its EHR suite.
• The City Paper of Nashville and Nashville’s Entrepreneurs’ Organization name ICA president and CEO Gary Zegiestowsky as one of the top ten entrepreneurs in the Nashville area.
• ZirMed earns a #79 ranking on HCI’s 100 list of top HIT companies.
• Business Alabama magazine and Best Companies Group name MEDSEEK one of the 2011 Best Companies to Work For in Alabama.
• PatientKeeper releases its Charge Capture solution for Android.
• Nebraska Medical Center chooses Voalte’s integrated communication solution.
• Sage Healthcare Division announces that more than a dozen healthcare facilities have chosen Sage Intergy Meaningful Use Edition.
• Moses Cone Health System (NC) selects ProVation Order Sets for its five hospitals.
• Duncan Regional Hospital (OK) will implement T-SystemEV STAT to manage average length of stay in its ED.
• North Shore-LIJ Health System extends its enterprise agreement with Surgical Information Systems by choosing the SIS Anesthesia documentation solution.
• The entire recruiting team of Intellect Resources achieves Certified Personnel Consultant certification.
• NYU Langone Medical Center implements the PatientSecure palm scanning solution for biometric patient identification. A patient commented, “This technology makes you feel like a VIP. You just put your palm on the scanner and you’re done registering at your doctor’s office, no clipboard, no hassle of paperwork to check in, plus, it’s absolutely secure. It’s immediate and instantaneous. Never in my life have I experienced health care like this before. ”

Contacts

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

Monday Morning Update 6/13/11

From South Bend Snoop: “Re: Press Ganey. CEO Rick Siegrist is resigning. There are rumors of a possible sale of the company to GE, J&J, or 3M, which seem farfetched.” Unverified. I didn’t realize that he co-founded TSI, PatientFlow Technology, and HealthShare Technology.

From Mr. Roboto: “Re: Meditech. They’ve always steered clients to JJWild, now Dell. A former Meditech person told me that Meditech was getting financial considerations for every system sold by JJWild. I find it highly unlikely that Dell (like JJ) is doing anything technically proprietary for Meditech except throwing them a fee for each system sold.” Unverified.

From Komodo: “Re: Meditech. Dell and Meditech have a gentleman’s agreement that Dell will supply all 6.x hardware and therefore design consulting, leading to application and conversion consulting. Now that Dell is becoming cozy with Epic, Howard Messing may be re-thinking this position since his customers don’t like the no-choice solution. I hope you can get Howard to respond.”

Welcome to new HIStalk Platinum Sponsor The Advisory Board Company. I’ve been a fan of the DC-headquartered company for quite awhile since I’ve always liked their super-summarized best practice guides covering big hospital issues such as capacity management and medication errors (I made myself look like a star once by skimming their throughput document and applying its recommendations to my hospital’s particular bed management challenges). Other than best practices research and tools, the company also offers clinical research, leadership development, BI and analytics, and consulting services. The ABCO connection to HIStalk, however, is its Crimson Initiative, a physician performance management analytics solution that gives hospitals (and their physicians) a 360-degree view of physician performance measures such as patient satisfaction, compliance with order sets, and adherence to key quality and utilization metrics. Crimson is used by over 400 hospitals and contains physician analytics and benchmarking information covering 15% of the entire country’s admissions. Paul Roscoe, CEO of the Crimson business unit (and former president of Sentillion and GM of Microsoft Health Solutions Group) e-mailed me awhile back to say that his Sentillion experience with HIStalk was so positive that he asked ABCO’s marketing team to sponsor, saying that HIStalk is “insightful, thought-provoking, funny, and a great source of inspiration for my iTunes collection,” of which the latter is of course the most satisfying to me. You may recall that Advisory Board acquired University of Michigan spinoff Cielo MedSolutions in February 2011, which gives it capabilities in population management analytics and patient registries for physician practices that support risk-based arrangements by making sure patients are current on preventive care and screenings. Thanks to The Advisory Board Company and its Crimson Initiative for supporting HIStalk.

Speaking of Crimson, above is a video from Robert Wood Johnson University Hospital that describes a pilot study that reduced length of stay by 8% and cost per case by $276. Another study by Memorial Hermann found that it saved $358 per patient admission.

Larry Garber MD, medical director of informatics for Fallon Clinic (MA), sent over a press release indicating that as of May 23, Fallon doctors make up more than 10% of those who have successfully attested to Meaningful Use. An amazing 99% of Fallon’s doctors have achieved MU with their use of its Epic system.

Chris Rauber, a reporter for the San Francisco Business Times who I exchange information with fairly often, is writing a story about UCSF’s IT struggles and needs insider sources (anonymous is OK). If you can help him out with details and confirmation, he would appreciate an e-mail.

This week’s e-mail from Kaiser CEO George Halvorson talks about their control of hypertensive patients through use of a care team, proactive interventions, evidence-based medicine, and EMR tracking. The result: Kaiser went from 44% of hypertensive patients controlled to 80% (vs. the national average of less than 50%).

I’m not sure what to make of these survey results: 40% say it’s a good, technically reasonable idea to give patients a list of all views of their EHR information if they ask, while 32% like the idea but think it’s too challenging technically (which would have been my vote). A solid 28% think it’s just a bad idea in general, which puzzles me a bit since I’m not seeing the downside. New poll to your right, following up on all the discussion generated by Thoughtful CIO’s guest post about “why Epic?”: what factor is most responsible for Epic’s sales success?

My Time Capsule editorial that’s seeing daylight for the first time since April 2006: If You Want Testing For Usability, Reliability and Maintainability, Tell CCHIT. A sample: “CCHIT standards that address data management within the four walls will prepare organizations to feed the data demands that RHIOs will create. As I’ve said before, a RHIO without data-ready members is like TV cable with no programs.”

Vince Ciotti says he has received quite a few e-mails from his fellow memory lane strollers about his HIStory series, so his latest chapter should unleash golden memories from the sunny slopes of long ago: the story of McAuto, once a household word (in HIT-related households, anyway), but largely forgotten today.

Retiring Compuware co-founder and CEO Peter Karmanos Jr. says he has two goals to accomplish before leaving the company in two years: boost annual sales of the application performance management division from $250 million to $2 billion and to get an IPO done for Covisint, whose healthcare offerings include the Covisint ExchangeLink Platform for connectivity among hospitals, practices, and HIEs.

E-mail Mr. H.

News 6/10/11

Top News

ONC chooses ANSI for a three-year term as the Approved Accreditor (ONC-AA) of its Permanent Certification Program (ONC-ACB) that will replace the ONC-ATCB designation in 2012.

Reader Comments

From Cabrito: “Re: Meditech. I hear that customers upgrading to 6.0 are required to buy all hardware from Dell, pay Dell an enormous implementation fee, and pay ongoing fees to Dell for maintenance. If they choose not to do so, they have to pay Meditech to certify the hardware. This smells of the East Coast good ol’ boys club. Does 6.0 really require hardware that’s all that different from Dell or any other vendor?” I passed your inquiry along to Meditech and invited them to respond. The company’s response was, “No comment.” That made me think of the old Magic days, when you had to buy specifically programmed (and much more expensive) display terminals because it wouldn’t run on anything else. I would hope that’s not the case here.

From William Hanson MD: “Re: my book, Smart Medicine. Thanks for calling it out. I am indeed the CMIO at Penn now. I’m an avid reader of your blogs. Keep up the good work. Thanks, Bill.” I see Amazon has added “Look Inside” for the book and it’s an engaging read – Bill is a really good writer.

From the medical consumer’s standpoint, a generation of patients who grew up with Google, eBay, and Wikipedia will soon have access to comparably comprehensive, current information about medicine and its practitioners. They’ll be able to find best-performing doctors and hospitals in the same way they can now shop for best-buy electronics and credit card rates. The successful practitioner and medical systems of the future will be the ones that adapt best to the new patient, who was raised on universal information and immediate gratification.

From IT Director: “Re: HIStalk. Your site was instrumental these last few years to help me sort out the different HIS vendors and to see where the industry is now and where it is going. Our C-level has been mystified that I knew so much about the industry, largely thanks to you and Inga. HIStalk has a HUGE impact — don’t change a thing. Happy shoe wishes to Inga.” Thank you.

From Saul Revere: “Re: Paul Egerman, founder of eScription. Pretty strong language in claiming Republications are ‘incapable of simple arithmetic’ and ‘I have more money than I could possibly imagine.’ The problem is that his own math is perilously stupid — to plug the current projected deficit over the next five years by taxing those with more than $200K income, tax collections would have to triple.” The conservative site’s article makes a point that I somewhat believe: if a person or group wants everybody’s taxes raised to support some pet cause, why aren’t they voluntarily supporting that cause themselves by sending in their own extra checks to the Treasury? Still, these are liberals with huge incomes, so at least their proposal would hit their own personal bottom line. And Paul’s right: his windfalls from selling IDX to GE and eScription to Nuance have certainly given him all the money he’ll ever need and then some. He says the Bush-era tax cuts saved him over $10 million and he didn’t trickle any of it down, as was the case with most of the mega-millionaires joining him in the proposal. I don’t dislike their idea, but the problem is that politicians from both parties have pushed the country so far into the red that even the few billion dollars it would generate won’t help much, as you noted. I also see that Googling “Paul Egerman” still brings up my 2005 interview with him (one of my favorites) as #1 of 83,600 hits. I asked him about his Democratic politics back then and he gave a good answer (although in the interest of full disclosure, Paul sought me out at HIMSS years ago as Mr. H and he won me over with his friendly manner and by picking up the breakfast tab):

I grew up in a single parent home. We didn’t have a lot of money. In fact, it was before there was welfare, and I got my healthcare at a county hospital. Our family got by as a result of a lot of help from a lot of people, and I’m very fortunate that I’m to be a member of what I call the Winner’s Circle right now. It was a wonderful ride and I’m very fortunate that I’m able to do well. The reason that I have "blue state" political beliefs is that I personally know that I couldn’t have made it without the help of the government and lot of people. I think the Winner’s Circle should be expanded and other people should have that same opportunity that I had. I respect other people’s opinions and I keep politics separate from my business, but my involvement in politics is only because I’m interested in good government.

A representative from Dell e-mailed that the reader’s comment from Monday stating that Kootenai Medical Center’s Meditech system is hosted by Inland Northwest Health Services was incorrect. She says Dell is hosting that hospital on its MSite Meditech hosting solution, which has brought several hospitals live and has 40 more contracted.

From HIS Junkie: “Re: webinar. ONC is now competing with HIMSS, charging $100 for a webinar on HIT trends that other firms charge $1,000 for. I guess ONC is doing all they can to reduce the federal deficit. Maybe they should stick to fixing the mess that has been created with all the convoluted new MU regs.” The webinar is through National eHealth Collaborative. Most of their NeHC University offerings are free, but a few cost $100. If I ever leave my day job and free up some time, the first thing I’ll do is run some webinars and industry news and trends analysis. I have endless ideas, but zero time.

From Lula: “Re: AHIMA. I didn’t see that you ran the news about Alan Dowling.” I totally forgot since we had already run a solid rumor a week ago that the top AHIMA brass had quit and former CEO Rose Dunn had been brought back in some capacity. That turned out to be correct, as I expected: AHIMA CEO Alan Dowling exits after a little more than a year, along with COO Sandra Fuller. The “some capacity” for Rose Dunn is interim CEO. We heard some rumblings that the new folks had tried to implement some good ideas but stepped on toes in the process. Alan has impeccable credentials: master’s degrees in computer science and healthcare management engineering, an MIT PhD in health management and information systems, consulting experience with E&Y, and 35 years in the Air Force with a rank of colonel. Association work is probably quite a bit different than running a company, so maybe it just wasn’t a good personality fit.

HIStalk Announcements and Requests

This week on HIStalk Practice: new FAQs from CMS. The Louisiana Care Quality Forum REC designates Greenway’s PrimeSUITE EHR as a supported EHR product. Industry experts tell a Congressional committee that financial and regulatory barriers make EMR adoption difficult for small practices. IPAs could be coming back in vogue, thanks to the emerging ACO model. Take a tour of the HIStalk Practice site and make my day by  signing up for the e-mail updates.

Listening: new from Black Lips, fiercely independent, ragged Atlanta-based garage punk (think 1965 Rolling Stones with some Pixies and Dandy Warhols elements added). I wouldn’t want to be in the presence of either the band or their die-hard fans since I have a feeling both are seriously psycho, but the new CD is outstanding.

I mentioned that Mike Cemeno had been promoted from interim CIO to CIO at Waterbury Hospital (CT). That wasn’t the case: while the hospital’s newsletter introduced him with the CIO title, there was a line further down in the article noting that Mike and the executives featured with him were hired as interim management, which I missed. He and I have swapped some chatty e-mails — he hasn’t decided to apply and hasn’t been offered the job.

 Modern Healthcare is running its 100 Most Influential People in Healthcare poll. I keep hoping I’ll at least be nominated one of these days (especially given that Nancy-Ann DeParle is on the list and nobody’s heard of her since she took the supposedly high-profile White House health reform job), but until then, I found some familiar, HIStalk-friendly names that might be worth one of your five votes: Jonathan Bush (athenahealth CEO), John Halamka (CareGroup CIO), James “Kipp” Lassetter (Medicity founder), Ed Marx (Texas Health Resources SVP/CIO and HIStalk contributor), Deborah Peel MD (Patient Privacy Rights founder), Peter Pronovost (Johns Hopkins professor), Sunny Sanyal (T-System CEO), and Glen Tullman (Allscripts CEO). I’m sure I missed other friends of HIStalk in my quick skim down the list, but I’ll add them as I notice. I figure a tiny bit of Ed Marx’s influence can be attributed to his regular and well-received HIStalk posts, so Inga and I will bask in his reflected glory if he wins.

Thanks to Elsevier Clinical Decision Support for sponsoring HIStalk at the Gold level. The company is behind some well-known clinical content brands (Clinical Pharmacology, Mosby’s, OnFormulary, CPM Guidelines, and First Consult) and also offers Pinpoint Quality (clinical performance data analysis), Pinpoint Review (clinical surveillance), Clinical Measures (intervention and error documentation), Risk Navigator Clinical (predictive analytics), Risk Navigator Performance (provider care patterns for improved clinical and financial outcomes), Risk Navigator Provider (helps physicians analyze real-time patient information for care and communications), and quite a few more systems. The common thread is point-of-care technology and content that improves quality, safety, and cost-effectiveness. Thanks to Elsevier Clinical Decision Support for helping keep the HIStalk keyboards clacking.

Speaking of Elsevier, they’re accepting nominations for Mosby’s Nursing Superheroes, launched last month during Nurses Week. Four winners will be announced in October. 

On the Jobs Page: Meditech CPOE Consultant, Sales Executive – Medical Device Experience, Regional Sales Executive – NYC, Associate Regional Sales Executive. On Healthcare IT Jobs: Epic Lead Analyst, Ambulatory Clinical Analyst I, Director, Product Management, Clinical Healthcare IT Project Manager.

Acquisitions, Funding, Business, and Stock

Streamline Health reports a net loss of $281,000 ($.03/share) for the first quarter. That compares to a net loss of $1.18 million a year ago. Revenue was up 17% to $4.14 million.

A judge in Australia rules that iSoft will have to pay CSC $2 million US if the struggling company decides to sell to a different suitor. Former iSoft chairman Gary Cohen, who has said he wants to buy iSoft himself, says he is pleased with the judge’s decision.

Sales

LHP Hospital Group (TX) contracts with Conifer Health Solutions to provide patient access and business office services.

Wishard Health Services (IN) selects MedTouch to design, build, and integrate the health system’s patient portal and RelayHealth into a site. Patients can request appointments, view lab results, communicate with physicians, and access patient education content.

People

Former AHIMA CEO Linda Kloss joins the Precyse Advisory Council.

Announcements and Implementations

CliniComp completes a two-year installation of Essentris-EMR at 59 Military Health System inpatient treatment facilities worldwide.

Government and Politics

HHS and ONC introduce the Investing in Innovations (i2) Initiative to spur innovations in HIT. As part of the rollout, CMS awards Health 2.0 and the Capital Consulting Corporation $5 million to fund projects supporting innovations and to encourage HIT development using mechanisms like prizes and challenges.

The VA chooses Systems Made Simple and Technatomy Corporation to provide software development, support, and documentation for several projects of its EVEAH program (Enhance the Veteran Experience and Access to Healthcare).

Innovation and Research

Above is an interview with Orlando Portale, chief innovation and technology officer of Palomar Pomerado Health (CA), whose self-developed mobile patient information app was named one of 12 finalists in the I Awards for innovation in wireless and mobile healthcare. It’s an impressive app, judging from the screen shots above.

Technology 

WebPAX is awarded a patent for technology that allows a Web browser to display medical images stored in multiple geographic locations. The image management company holds several other patents that allow viewing diagnostic-quality images in a Web browser with full PACS capabilities. The Durham, NC company says its solution requires no client software, runs on any browser on either PCs or Macs, and is storing 180 million images online with 1,400 physician users. The technology is also used for clinical trials and physician training. I assume it was either developed for or used by Duke given the duhs.duke.edu address in the screen shot above.

Other

A report says that 76% of Fortune 50 companies are in healthcare or have health divisions. The same study predicts the health market will account for nearly nearly one-fifth of the GDP by 2019 and (optimistically) forecasts that 58% of small physician practices will roll out EHRs over the next two years. Perhaps more realistic: the mobile health market will grow from $1.4 billion in 2008 to $12.7 billion by 2014.

Weird News Andy can find no words to describe this story from England: a patient high on drugs and alcohol goes to the hospital ED for treatment. Employees decide he’s just drunk, so they leave him a corridor to sleep it off, with nurses stepping over him frequently. Ten hours later, a nurse finally checks on him and finds him dead. Security cameras captured video of employees dragging his uncovered body away like a sack of fertilizer.  

Nineteen people in western Pennsylvania are charged with high-tech oxycodone trafficking: they obtained doctor names, DEA numbers and license numbers from a Web site; created a computer prescription template; and put their own cell phone numbers on the prescription form so they could verify the prescriptions when pharmacies called.

Pfizer starts the first clinical drug study to be conducted over the Internet, with patient contact performed via Internet questionnaires, video, and Web pages instead of home visits.

Sponsor Updates

• Lehigh Valley Health Network (PA) will use T-System’s DigitalShare documentation system to support its on-scene emergency healthcare during this weekend’s 5-Hour Energy 500 event at Pocono Raceway.
• Siemens partners with Surgical Information Systems to offer the SIS Anesthesia solution to the enterprise healthcare clients of Siemens.
• Healthcare Informatics ranks MED3OOO 47th on its HCI 100 list of top HIT companies by revenue. Orion comes in at 64 and Capario earns the number 87 spot.
• Medicity is awarded a second patent on its Novo Grid technology for clinical information exchange.
• Tucson Medical Center and OptumInsight (Ingenix) announce plans to create a sustainable health community based on the ACO model.
• Central DuPage Hospital (IL) contracts with iSirona for its medical device connectivity solution.
• Sage hosts a June 28th webinar on Meaningful Use success, featuring two physicians who have already received incentive checks. Register here.
• KLAS ranks Encore Health Resources as one of the top two overall performers in the HIT advisory services segment.
• Nuesoft posts a video on FDA regulation of EHRs.

EPtalk by Dr. Jayne

Government Health IT reports that the Association of Academic Health Centers finds the HIPAA Privacy Rule’s disclosure requirements to be “excessive and burdensome” and requests an exemption for researchers.

Statistic of the week: fewer physicians filed address changes last year, possibly reflecting the impact of the economy on physician decisions to relocate or retire. American Medical News notes economic pressures and the state of the housing market as possible factors. Interestingly, plastic surgeons had the lowest move rate, approximately half that of family physicians. Although I do love medical data and working with it, sometimes working with statistics makes me crazy. It would be more interesting if they did it like baseball: left-hander Dr. Jones is 14 for 15 on successful colon biopsies with the Olympus scope, 15 for 15 with the Pentax. You could even have baseball-like trading cards for your favorite attending physicians.

Legislative Corner

Sometimes I get a little burned out on reading about healthcare legislation, specifically Medicare/Medicaid regulations, reimbursement, Meaningful Use, etc. Although it’s a key part of my job, it just gets a bit depressing. I decided to find out what other health-related activities our lawmakers are pursuing when they’re not trying to tell the IT department how to do our jobs. Here goes:

For my Southern friends, North Carolina lawmakers are debating the Youth Skin Cancer Prevention Act that would require minors to get a physician’s prescription for indoor tanning. It’s coming down to cancer prevention vs. parental rights. Since the pools are now open, what I’ve seen of the outdoor tanning habits of teenagers is extremely concerning. Makes me thankful that my “too much time at the computer” paleness will hopefully keep the wrinkles at bay.

Speaking of wrinkles, New Jersey may require a statement of medical necessity for Botox injections received by patients under age 18. Teens are seeking the injections in an attempt to prevent wrinkles. The issue “took on a new urgency” after reports of the so-called Botox Mom who injected her eight-year-old. Botox is a godsend for certain medical conditions; however, the cosmetic version is a big-time money maker. I’d like to see a requirement that anyone who wants to use Botox for wrinkle prevention has to demonstrate their commitment by slathering on SPF 50 every day (see above).

Not to be outdone by their neighbor, New York is considering a dress code aimed at reducing hospital-acquired infections. Neckties, jewelry, and watches would be banned under a “bare below the elbow” dress code. Although the evidence doesn’t seem to support their approach, I definitely worry about people who are less than great at handwashing because they are worried about getting their cuffs or watch wet. Personally, I’d like to see someone take aim at white coats — I’ve seen some nasty ones out there lately. Makes me want to keep coupons for the 99-cent dry cleaners in my pocket to hand out.

Finally, legislation with an IT twist. Florida’s new law to prevent physicians from asking about gun ownership in certain situations (HB 155) gets a new enemy: The Brady Center to Prevent Gun Violence. A lawsuit was filed this week that states the inability to ask about guns in the home prevents physicians from educating patients. IT staffers beware: even if the physician’s question is relevant to the patient’s care or safety, the law prevents the response from being entered into a database.

Contacts

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

News 6/8/11

Top News

Merge Healthcare acquires Ophthalmic Imaging Systems (OIS) for approximately $30.3 million in stock. OIS and its subsidiary Abraxas Medical Solutions offer EMR and PM products, as well as digital imaging systems.

Reader Comments

From The PACS Designer: “Re: Apple at WWDC. This week, Steve Jobs announced Apple’s next generation of products. The Apple iOS 5 will ship this coming fall and will support iPhone 3GS, and 4, iPad 1 and 2, and iPod touch third and fourth generation. Also of keen interest was Apple’s new LionOS operating system for iMacs, which will sell for $29.99.”

 From Roman DeBeers: “Re: Chuck Friedman. ONC’s chief scientific officer is leaving in July after four years.” Unverified. I e-mailed him to confirm, but he didn’t respond.

From Jim: “Re: speeding up HIStalk. I think you gave tips before. I’m a bean counter, so technically deficient. Any ideas? Love this resource!” Here we go: (a) I assume you are an IE user since it’s the most trouble-prone browser by far, so use the infinitely faster and better Firefox or Chrome browser instead, even if just for reading HIStalk; (b) if you can’t dump IE, upgrade it if you can since old versions (anything before IE8) are notoriously buggy and slow; (c) add the extension print to any HIStalk web address to view a bare-bones print layout that doesn’t include graphics, sidebar content, sponsor ads, etc. There are all kinds of browser options that can slow you down, which is another reason to like the non-IE ones – those browsers seem to work better without tweaking. 

From JC: “Re: Ingenix / Optum. Looks like they will be the winning bidder over GE to acquire HMS/MedHost. I hear it will become their EDIS of choice.” Unverified.

Acquisitions, Funding, Business, and Stock

Germany-based surgery software vendor Brainlab acquires Voyant Health, the Israel-headquartered vendor of the TraumaCad, OrthoWeb, and VoyantFlow specialized surgery planning tools for orthopedic surgeons. Voyant has also announced future availability of its VoyantLink cloud-based image exchange network.

CSC announces the launch of its Global Institute for Emerging Healthcare Practices with the stated mission of “monitoring worldwide trends, conducting regional and multi-country studies, and evaluating emerging operational practices and technologies that have the potential to improve performance of healthcare industries around the world.” I think all that marketing-speak is really just saying that CSC wants to be a bigger player in healthcare and having a name that includes Global Institute sounds very noble. Mr. H’s cynicism is clearly rubbing off.

Israel-based dbMotion builds up its presence in Australia as the government prepares to bid out big contracts for a new Personally Controlled E-Health Records system, which will allow all Australians to review their meds, immunizations, and lab results electronically. The program, announced a year ago, is a building block for the National Health and Hospitals Network and will cost $500 million US over two years.

Intel launches its AppUp hybrid cloud service that offers pre-packaged, subscription-priced applications to small businesses, but allowing those small businesses to store their data on their own local server. Allscripts was listed as a vendor whose applications will soon be added to the catalog.

McKesson gets sued yet again over claims that it conspired with Hearst Corp. to inflate average wholesale prices of drugs (AWP, also known as Ain’t What’s Paid since it’s a phony number of dubious value). This time, it’s Michigan doing the suing, claiming its Medicaid program overpaid pharmacy claims for eight years because of a secret McKesson-Hearst collusion to inflate AWPs via Hearst’s First DataBank drug database. McKesson has settled several related racketeering lawsuits for several hundred millions of dollars over this same issue, but an early estimate of the company’s exposure was $15 billion. Here’s my analogy: First DataBank published the equivalent of one of those baseball card price books that claim to survey card shops to find out what cards are selling for. Customers used the book for the unintended purpose of pricing their own cards (in theory, there would then be one universal price since all sellers would set the same price from the same book). States and other insurers, lacking a way to determine what drugs really cost but insistent on paying based on any kind of cost, even a totally phony one, latched onto AWP as a lazy substitute even though everybody knows that nobody pays AWP. The plaintiffs are like customers who bought baseball cards at the book price, only to find out that the book didn’t do their surveys very well, causing them to overpay for a Ken Griffey Jr. rookie card. McKesson’s role, if I’m remembering right off the top of my head, was minimal – FDB started surveying only McKesson to get the AWPs it published and McKesson says it was unaware of that fact, not to mention that there was no benefit to McKesson for inflating the prices anyway. My take: stupid buyers who overpay always blame someone else and expect to be reimbursed for their incompetence.

Sales

Health Management Associates contracts to deploy the MEDHOST ED solutions in 58 hospitals.

In Canada, CGI Group signs a seven-year, $50 million contract with University Health Network of Toronto to develop a shared diagnostic imaging repository.

People

Former national coordinator David Blumenthal is named chairman of the Commonwealth Fund Commission on a  High Performance Health System.

Former Yale-New Haven ACIO Michael Cemeno is named CIO of Waterbury Hospital (CT), removing the “interim” portion of his title.

Union Hospital (IN) promotes Kym Pfrank from VP of information systems to the newly created role of SVP and CIO.

Former WellSpan Health VP/CIO/CTO Buddy Gillespie joins infrastructure and hosting vendor Distributed Systems Services as director of healthcare solutions.

Dave Roberts, HIMSS VP of government relations and Solana Beach, CA city council member, is appointed to an HHS panel that will advise CMS and HHS on issues such as insurance outreach programs and helping consumers understand health plans.

Announcements and Implementations

Epic names Dell as its first Community Connect Certified Consulting Firm for EMR/PM services. The new designation is designed for service firms implementing Epic for affiliated physician offices and community hospitals on a shared EMR.

CAP, AHA, and Surescripts are recruiting hospital laboratories and critical access hospitals to participate in the Lab Interoperability Cooperative (LIC). It’s funded by a two-year CDC grant and aims to electronically connect hospital labs with public health agencies. It will be represented at the Healthcare IT Connect summit in Washington June 21-23.

Lee Memorial Health System (FL) goes live on its $70 million Epic system.

The use of AirStrip OB at Novant Health (NC) is profiled in an article in the Charlotte newspaper. The article also mentions AirStrip OB’s use in three Presbyterian hospitals in Charlotte, with an interesting angle: doctors are nicer to nurses when called in the middle of the night because they can immediately pull out their iPhones to look at the OB tracing in real time instead of getting impatient as the nurse describes what they’re seeing.

Government and Politics

Kentucky’s governor announces that two HIT-related companies have set up North American headquarters in Newton and will bring 20 jobs there: Arcron Systems (a Korea-based hospital information system vendor) and Meaningful Use Technologies. Despite the governor’s bragging, I think it’s actually one company with two lines of business. I couldn’t make much sense out of the Web site of the former (“With the help of our experienced professionals and years of reflecting clients’ opinions to our products, Arcron Systems strives to promote public healthcare and to facilitate understanding medical industries”) and the latter seems to be the implementation arm of the former. Arcron itself appears to be connected to the Hyundai Medis medical tourism company and the Hyundai Group conglomerate (shipping containers, securities, elevators, logistics, and other stuff, but not the carmaker, apparently).

HHS CTO Todd Park left his big athenahealth cash-out retirement in his 30s for government service because he was promised a role as “entrepreneur-in-residence.” He describes his job: “I have no budget. I have no formal team. I don’t control any government contracts. I don’t control any grants. It’s perfect, because it actually gives you the kind of freedom to maneuver, to really be a change agent.”

Innovation and Research

The Wall Street Journal covers Project RED (“Re-Engineered Discharge) that prepares inpatients for discharge and uses an animated “virtual discharge advocate” to provide instructions to patients and verify that they understand them. The program was developed at Boston University Medical Center, supported by grants from AHRQ, NIH, and NHBLI. Everything can be downloaded from its site.

Other

From last week’s e-Health conference in Toronto: the CEO of the Ontario Hospital Association makes waves by suggesting that physicians should be required by law to use EMRs and that paying physicians who don’t is an “unfair and inappropriate use of public money.” Meanwhile, the president and executive director of the Montreal Regional Health and Social Services Agency in Quebec blames poor technology for low EMR adoption rates, noting the systems are of little use to physicians or patients and that “we tried to create monsters and nobody wanted to use them.” Love those Canucks.

County-owned Singing River Health System (MS) gets approval to borrow $40 million to buy an EMR and to make unrelated improvements, although one county supervisor questioned why the two-hospital system would take out a 25-year loan for software that might last only ten years. I’m assuming its Epic since the hospital’s LinkedIn profile mentions an Epic project director.

A new book by William Hanson, MD of University of Pennsylvania School of Medicine went on sale Tuesday. Smart Medicine: How the Changing Role of Doctors Will Revolutionize Health Care discusses data mining, genomics, electronic medical records, telemedicine, and other technologies. I’m not clear on whether he’s CMIO there since it’s mentioned in some online bios, but not his own or that of Penn Medicine — those show him as professor of anesthesiology, critical care, surgery, and internal medicine.

The sheriff of Winkler County, TX (above left) goes on trial for helping a doctor (right) retaliate against two nurses who expressed anonymous concerns about the doctor’s performance to the Texas Medical Board. The nurses, who had worked at Winkler County Memorial Hospital for a total of 47 years, were fired and charged with felonies after the doctor asked his friend the sheriff to find out who sent the complaint letter about him. The medical board has placed the doctor on probation for four years; the nurses won a $750,000 settlement from the county, the hospital, and sheriff; and lawmakers passed a bill that protects nurses from retaliation when they are advocating for patients. The sheriff faces 10 years in prison if convicted of either of the two felonies with which he has been charged – misuses of official information and retaliation – plus a misdemeanor charge of official oppression. The county attorney and the hospital administrator were also charged and the doctor faces four criminal counts.

Sponsor Updates

• MEDecision will showcase is new Alineo and InFrame platforms at the 2011 Western EOC conference this week in Chicago and at AHIP June 15-17 in San Francisco.
• St. Joseph’s Health Center in Toronto selects Intelligent Forms Suite from Access for its electronic forms management system.
• Twenty-one Texas providers have received Medicaid EHR incentive checks for their meaningful use of the e-MDs EHR.
• Shareable Ink partners with Waiting Room Solutions to combine its digital pen technology with the EHR from Waiting Room Solutions.
• T-Systems will donate its T-Sheets documentation solution to the Texas Disaster Medical System, a collaboration of state and local public health agencies and providers that facilitates disaster planning and provides emergency response care.
• Jason Poteet joins Cumberland Consulting Group as director of business development.
• Cancer Treatment Centers of America selects Micromedex from Thomson Reuters for evidence-based drug, disease, toxicology, and patient education information.
• Radiology & Imaging Specialists (FL) contracts with GE for its Centricity OneView solution.
• Practice Fusion earns full ONC-ATCB certification from the Drummond Group.
• Ingenix announces that its transition to the OptumInsight name is complete.
• Wolters Kluwer Health releases a query tool to streamline the collection of quality data for the GI Quality Improvement Consortium benchmarking initiative.
• Spring Hill Primary Care (WV) contracts with Sage Healthcare Division for the Intergy Meaningful Use Edition.
• CHRISTUS Health picks MEDSEEK’s eHealth ecoSystem and ecoSmart solutions.
• UltraLinq Healthcare will donate an ultrasound machine and its UltraLinq solution to benefit Gift of Life International, an organization that coordinates surgeries for children with congenital heart defects. The donation is being made in connection with next week’s American Society of Echocardiography Scientific Sessions in Montreal.
• AnMed Health (SC) chooses Wellsoft’s EDIS to integrate with its existing McKesson suite of products.
• Nashville General Hospital will implement MyHealthDirect to connect its patients with appropriate providers.
• Danbury Orthopedic Associates (CT) chooses the SRS EHR. 
• Adena Health System (OH) chooses the eClinicalWorks EHR/PM and patient portal for its 150 employed physicians.

Contacts

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

Thomson Reuters to Sell Healthcare Business

News and information provider Thomson Reuters has announced that it will sell its healthcare business, which includes software and data products for clinicians, hospitals, and drug manufacturers. CEO Thomas Glocer said in the announcement that its healthcare business “lacks the integration with and global scale of our other units” and that proceeds from its sale will be reinvested in its core markets of financial, legal, media, and science.

Thomson Reuters is a publicly traded company with annual revenue of $13 billion and market capitalization of $31 billion. The company says the healthcare business generates $450 million in annual revenue, with a profit margin comparable to its consolidated 19.3%. Its products are used by more than 3,000 US hospitals.

Popular Thomson Reuters healthcare products include Micromedex (drug reference), CareNotes (patient education), ClinicalXpert Navigator (mobile patient information), CareDiscovery (benchmarking), CareFocus (clinical surveillance), Ascent (financial management), The 100 Top Hospitals program, and Clinical Performance Solutions (formerly Solucient and Medstat).

The company’s benchmarking database stores information from more than 750 healthcare organizations and is claimed to be the largest in the industry. Its MarketScan data warehouse contains information on more than 40 million unique patients. Thomson Reuters announced on May 25 that it had jointly developed a data and analytics solution with GE Healthcare to support population-based effectiveness and outcomes research.

The company says it expects the sale of the unit to close by the end of the year. Morgan Stanley and Allen & Co are its financial advisors.

We interviewed John Loyack, the company’s director of healthcare product management, in December.

Monday Morning Update 6/6/11

From Cop Rock: “Re: Meditech 6.0 multi-facility. Steward Health Care was set up by Cerebrus Capital Management to run the six Caritas Christi hospitals it bought from the Archdiocese of Boston. Their Meditech 6.0 implementation will encompass all six hospitals, surely the largest implementation to date of 6.0.”

Another reader mentioned that the first multi-site 6.0 install may have been Kootenai Medical Center (ID), whose systems, he points out, are hosted by HIStalk sponsor Inland Northwest Health Services. That organization, via its Information Resource Management subsidiary, performs HIT work that includes an HIE, all kinds of Meditech services, and consulting related to ARRA, infrastructure, revenue cycle, and clinical processes. Not to mention the services they provide to physicians throughout the Northwest that include hosted GE Centricity apps, help desk, networking, desktop management, and e-mail services. Their latest newsletter is here. I figured I might as well mention them since I haven’t said too much about them lately and I keep forgetting that they’re doing cool stuff.

From Portnoy’s Complaint: “Re: Georgetown. Georgetown Memorial / Waccamaw Community Hospital is running Meditech 6.0, now live for one week at two hospital campuses about 30 miles apart. A few minor bugs remain to be ironed out, mostly with running reports from secondary report writers; also old scanned images from MT 5.0 are not viewable, but should be fixed soon. Some one-time patches run to fix problems at go-live with patients not crossing over have unfortunately resulted in those patients still appearing on rounding lists though they’ve already been discharged. No major meltdowns from physician staff during the transition. Meditech support staff were reportedly helpful and senior Meditech administration came on site to learn about the problems with implementation and they seemed genuinely interested in creating a better product. Kudos to CIO Frank Scafidi and his team for managing the transition.” Unverified.

From Mike: “Re: free PDFs from the National Academies Press. Here’s the press release. Everybody can now download their 4,000 reports for free.” Mike, who runs Meaningful Use Rule Consulting, listed some now-free HIT-related titles (the first thing I thought of was using them as texts for online courses):

• Digital Infrastructure for the Learning Health System: The Foundation for Continuous Improvement in Health and Health Care: Workshop Series Summary (2011) Institute of Medicine (IOM)
• The Future of Nursing: Leading Change, Advancing Health (2011) , Institute of Medicine (IOM)
• Innovations in Health Literacy: Workshop Summary (2011)
• Preliminary Observations on Information Technology Needs and Priorities for the Centers for Medicare and Medicaid Services: An Interim Report (2010)

From The PACS Designer: “Re: Windows 8. Microsoft has released details of their upcoming introduction of Windows 8, which is rumored to be available in the fall. The Windows Start screen will now be the method to access your most important features by using tile graphics and the touch feature everywhere instead of the icon clicking available currently for your existing applications. Additionally, it looks like Microsoft ported many of the Windows Phone 7 User Interface graphics to this new release to compete with the Apple iPhone.” My take is this: every other Windows release sucks. Think about the dog upgrades people paid good money for, like Windows 98 Second Edition, Windows ME, and Vista. Windows 7 was good, therefore history suggests being wary of Windows 8. I hope MSFT surprises me. I’m finally taking the plunge to Windows 7, replacing my two-year-old desktop PC with a model on sale at Best Buy for a price I couldn’t resist (my current one is a $349 barebones kit that I did myself, adding in the extra parts and Win XP from its predecessor). I hate to replace a relatively new PC, but I’m having odd lockups and the hassle and cost of reformatting to install Win 7 makes the replacement option attractive. I’ll keep the old one as a spare or maybe raid the good parts I added in, like the Thermaltake power supply. 

From Todd: “Re: CIO salaries. I remember seeing it on the site, but couldn’t locate it. Can you provide the link or tell me how you found the salaries? Thank you (as always) for your great site. I’m not sure why you keep your day job or how you pull off doing everything you do, but your work is sincerely appreciated wide & far by the HIT industry.” I really like my day job – not only is it interesting and challenging, I get to see what I do have a direct impact on patient care, patient safety, and clinician satisfaction and I would miss that. Plus, I work for a non-profit hospital employer I really admire, not like when I worked for the uber-sleazy for-profit hospital (that didn’t last long) or the clueless vendor (that lasted way too long). In both cases, I wanted to wear a paper bag over my head to work each day so nobody would recognize me. The CIO salary information (old) is here. You can look salaries up by finding the 990 form for a non-profit hospital – I use GuideStar or Foundation Center (sign up for a free account for the former). Search by organization name, choose the most recent 990, and then look under two sections: Part VII (highly compensated employees) or in the appendices. Sometimes the CIO isn’t listed because they aren’t on the highest paid list, or sometimes they’re listed by name and not title, or sometimes they pull a UPMC and form a separate management company to keep the public from knowing what they’re paying. Above is one from WellStar, which I randomly chose (I blurred the names because the CIO in question is an HIStalk reader, so I figure I owe him that). Sometimes you can find how much a hospital paid an IT vendor if that vendor is among their highest paid. In WellStar’s case, McKesson is #1, with $10 million in payments over one year. If a vendor’s 990 isn’t listed, they are required by law to provide you one if you ask (the same goes for HIMSS and any other non-profit).

Speaking of sticking with healthcare as a profession, two-thirds of survey respondents would. New poll to your right: is a proposed HHS rule that requires EHRs to log all access to patient records and providers to make those logs available to the patient on request a great idea that’s technically reasonable, a great idea that’s technically unreasonable, or just a bad idea?

Say hello to new HIStalk Gold Sponsor Ignis Systems of the ultra-cool city of Portland, OR. The company’s EMR-Link gives its 4,000 physician users an efficient way to enter lab orders, which is important since docs do that almost constantly. They don’t need to enter orders once in the EMR and again in the lab ordering system. In fact, they don’t need an EMR at all. EMR-Link does medical necessity and insurance checking, prints order sheets, prints ABNs if needed, and routes orders automatically to the correct lab based on insurance and location. Repeat what I just said about radiology orders, since EMR-Link also integrates radiology ordering into the EMR. Meaningful Use is all about interoperability and connectivity, while physician acceptance is about workflow — EMR-Link connects EMRs to lab and rad providers, but also connects orders and results to any HIE. Setup is in hours, not weeks, docs just work like they’ve always worked, and everybody gains efficiency and saves money. I found an excellent and surprisingly unbiased presentation from January on their site that talks about EMR expectations, ARRA, and integration. I was also amused at the fun executive bios (the CEO’s history: “Working for a 600-person company was too big; a one person company was too small. This seems just right.”) Thanks to the folks at Ignis Systems for supporting HIStalk.

My Time Capsule editorial from 2006 for this time around: Small Vendors With Good Ideas Can Carve a Niche In Healthcare. Other than a now-outdated reference to Myspace, here’s an amuse-bouche: “Build something that supports what healthcare users themselves want to do, not what someone else wants them to do. Sounds obvious, but think about CPOE, nursing documentation, and other software that forces change on users who don’t want it, often leading to fierce resistance and vendor acrimony.”

Reading the long-forgotten word Myspace makes me think of another former technology darling that’s now a head-scratching trivia question: Second Life. Remember when Cerner and all those “visionary” hospitals wasted time, money, and press releases sticking virtual worlds out there with no apparent awareness of how utterly ridiculous that was? Nobody was using the dog-slow Second Life except nerds living in their parents’ basement and pervs hoping for creepy simulated hookups. I criticized Second Life in 2007 and proclaimed it a goner a year ago: “I said in 2007 that I thought Second Life was clunky and pointless despite all the hospitals and webheads raving about how transformative it was going to be for business and consumer commerce. Maybe in a virtual world, but in the real one, Second Life parent Linden Labs is tanking. Predictably, Second Life proved to be as pointless for corporations as it was for everybody else.” I predicted the same outcome for Twitter in that post, so we’ll see if I’m as wrong about that as when I proclaimed Epic as irrelevant back in 2003.

I ran the first of several Innovator Showcase pieces this weekend. My volunteer panel of investment bankers and a provider chose a handful of companies from dozens that applied to be featured, looking at those that were small and innovative. Logical Progression was the first and I’ll follow that format for the others: company info, a quick read about what they do, a pitch video made specifically for the HIStalk Showcase, a customer interview, and an executive interview. It’s like being at a venture fair, but with the ability to research the company and product in a more leisurely fashion. I’ll follow up with Chris from Logical Progression in a few weeks to find out if anything has changed.

HIStalk turns eight years old on Wednesday. It’s hard to believe it’s been that long. I figure I work on HIStalk at least 40 hours per week, so that’s about 16,000 hours (and counting) that I won’t be getting back.

We ran a reader comment about e-prescribing vendors being pushed by practices to get them running by June 30 so they can bang out their 10 Medicare e-prescriptions to avoid a 1% Medicare penalty, while doing 25 electronic prescriptions will earn them a 1% bonus. e Interactive Universe is capitalizing on that rush, offering a system they say can be running in just a few hours, including online training. The company guarantees that the required volume can be met in less than one business day.

Shareable Ink sent over an advance copy of a press release going out next week that announces its partnership with Waiting Room Solutions. Shareable Ink’s digital pen and paper has been paired up with WRS’s ONC-ATCB certified small-practice EHR. Three customers of the package have already received Medicare incentive payments, one of them being Lawrence Gordon MD of ENT Specialty Care, who credits both companies with getting him to MU attestation so quickly (April 20) and with improving the health of his patients.

Here’s the latest HIStory from Vince Ciotti, with a personal history of the biggest name in HIT for decades, Shared Medical Systems (they were cloud before cloud was cool).

The use of AirStrip Cardiology at several Broward County, Florida hospitals is profiled by the local CBS TV station.

St. Luke’s Episcopal Hospital (TX) implements GE Healthcare’s Patient Care Capacity Management, developed at Mount Sinai in New York. From the announcement, it appears to be a combination of consulting services and the AgileTrac RFID tracking system for employees, patients, and equipment. St. Luke’s expects to save $10 million by using it.

The Institute of Medicine will hold its second health data forum this Thursday, June 9 in Bethesda, MD (it will be simulcast as well). The event will feature 50 companies that are building tools around government databases. Speakers include HHS Secretary Kathleen Sebelius, HHS CTO Todd Park, the CEO of Walgreens, the CTO of the VA, Aneesh Chopra, Tim O’Reilly, and others.

Rock Health, the cool new accelerator for Web-based and mobile health applications, chooses its inaugural class of 11 startups. Three are in stealth mode, but announced were (a) Brainbot – mental performance; (b) CellScope – home diagnosis; (c) Genomera – personal health collaboration; (d) Health in Reach – procedure marketplace; (e) Omada Health – clinical treatment social networking; (f) Pipette – patient monitoring and education; (g) Skimble – mobile fitness; and (h) WeSprout – connecting health data and community.

Florida Governor Rick Scott changes his mind about the proposed doctor shopper database he promised to kill just a few weeks ago, signing a pain clinic bill that will start it up on October 1. The bill also prohibits doctors from selling meds directly from their offices, calls for an automatic six-month suspension for doctors who overprescribe, and requires pharmacies and drug wholesalers to report suspicious drug usage. Interesting stated fact: 85% of national sales of oxycodone occur in Florida, often bought by middlemen who resell it to drug-stupored Appalachian hillbillies. Right after the bill was signed, federal authorities raided the office of an Orlando doctor who prescribed 303,000 oxycodone doses in one year, more than the entire state of California. Given the rampant Medicare fraud that Florida is also known for, perhaps the feds should just move all of their agents there in an Iraq-like surge.

Beth Israel Deaconness physician informaticist Shane Reti is conducting a New Zealand trial of the iPad 2 as a kiosk at which patients complete an allergy form and check the accuracy of the clinic’s allergy records. The information is sent to the doctor’s smart phone for review during the visit.

Citrus Valley Health Partners (CA) hires Paveljit Bindra as CMO/CMIO. He brings impressive credentials: cardiologist, Harvard undergrad and MD, Fulbright scholar at Oxford, Mass General and Penn residencies, and a Wharton MBA in both finance and healthcare management.

Bizarre: a teenager in China sells a kidney to buy an iPad 2 and an iPhone. The hospital in which the illegal surgery was performed said it wasn’t responsible since it had rented out its urology department to the businessman who arranged the transaction.

E-mail me.

HIStalk Innovator Showcase – Logical Progression 6/3/11

Company name: Logical Progression
Address: 125 Edinburgh Drive, Suite 210, Cary, NC 27511
Web address: www.logicalink.com
Telephone: 919.655.1970
Year founded: 2005
FTEs: 8

Elevator pitch
Logical Ink is a tablet-based documentation software solution that helps healthcare organizations improve their documentation and replace paper-based workflows with interactive, mobile, pen/touch-friendly electronic forms.

Business and product summary
Our core competency is providing healthcare organizations a patient and provider-friendly way to capture documentation in a mobile setting. We’ve been focused on the pains providers are having with the adoption of electronic medical records and the pains hospitals are having with eliminating paper in patient-centric settings such as registration and consents. Traditional approaches such as desktop and Web-based software have a miserable track record of success because of a number of factors. We address this with years of research, guidance from a number of physicians/providers in the industry, and a balance of technologies: our interactive forms platform, digital ink, handwriting/voice recognition, mobile tablet devices and sophisticated integration with existing clinical systems.

We provide a simple, monthly subscription pricing model that is based on the number of forms you submit through our document portal.

Who is your target customer?
Hospitals and medium to large clinics.

What customer problem do you solve?
We help hospitals fill the gaps in their EMR and more easily transition to electronic medical records with a provider- and patient-friendly solution. We eliminate paper forms while introducing eforms intelligence to validate at the point of care, capture clean documentation, feed the completed documents to the enterprise content management (no more manual scanning/indexing) and feed the captured discrete data to the clinical repository.

Who are your competitors?
Topaz SigPad solutions, Digital Pen solutions like Shareable Ink, Salar, Phreesia are all in our space (patient/clinical documentation and patient check-in) and doing good things. But paper and the status quo (traditional approaches to the EMR interface) are our biggest competitors.

Why are you better than your competitors?
In short, our technology, our approach (pen + tablet), and our people. We offer things you can’t do on paper, sig pads or digital pen: interactive forms with video playback, image capture and annotation, colored ink for emphasis, zoom in/out, in-place editing/erasing, drop-down lists, dynamically hidden form sections based on answers (e.g., mark pregnancy question as read-only/hidden if patient is male), dynamic form content (populate informed consent risks based on selected procedure), and popup instructions/tooltips.

Real-time validation at the point of care for missing dates, signatures, and values. We can lock down parts of a document based on security roles. We provide real-time integration with the EMR or clinical repository via HL7/ODBC to keep demographics, vitals, medications, allergies and orders current in the documentation. We’re active in CFR Part 11 compliance because of our work in clinical trials.

We are the only vendor focused on using tablets (Windows, iPad, Android) and pen-based input (along with traditional keyboard and voice). That means no paper and no wires so providers can remain bedside. We have over 30 years combined experience with enterprise eforms and mobile technologies. We’re experts in everything tablet.

Pitch video created specifically for this Showcase

Customer interview (the HIM manager for a large, prestigious academic medical center)

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

As we were making the move to a fully electronic health record, we did an assessment of all of our documents within the record. We realized that we had several types of documents that our major systems could not support. The documents were in different care settings and completed by different role groups, but they all had a common denominator – they were documents that required a patient signature. Some of those documents were being scanned, but we knew that this was an interim step and were looking for something that could truly move us from a paper to an electronic record. 

We were additionally challenged with a highly decentralized environment where our clinicians have offices in several locations throughout the campus (or the state). When we we made changes to forms based on policy or regulatory requirements, it was very difficult to ensure that we had appropriate version control. Inevitably someone would still be using an old version of a form.

Finally, we wanted to make sure that documents were available when they were needed. Our environment meant that forms were sent via interoffice mail or faxed to the correct office after being completed. This inevitably led to delays in availability which led to bottlenecks in our workflow. 

The initial feedback has been quite positive from both the front end clinicians and the back office staff. The technology is easy to use and mimics paper. The output is crisp, clear, and the patients seem to love it. The decision support has been very helpful in ensuring that documents are completed before they are filed in our repository

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

The Logical Ink team has been great. From the start, they were constantly thinking about solutions to our concerns. We chose the procedure consent as our document to pilot. One of the key issues that we needed to resolve was how to provide our physicians with the flexibility and freedom to complete the document as they felt was appropriate while maintaining structure around document classification and content. Logical Ink worked with us to provide an innovative solution to the issue that made our physicians, our IT department, and HIS happy. They are still developing ways to innovate within our project parameters, the most recent example is embedding a video into a form to assist with patient education.

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

I would recommend that you take a look at Logical Ink if you need a flexible solution to complete your EHR migration which is capable of capturing patient signatures, handwriting, and integrating multimedia.

An interview with Chris Joyce, founder and president of Logical Progression

Tell me how your solution is better than digital pens.

We have really embraced a paperless forms platform that’s more interactive than the forms platform that you’d get with digital pen. We do share a lot of the natural user experience with writing your notes in the margins, capturing discrete data, just the familiarity that the physicians and the patients would have immediately when they see the interface. But obviously, when we put our forms on the tablet, we’re paperless, there are no wires attached, so that’s the immediate thing you notice.

Once you’re completing a form, we provide validation at the point of care. The forms platform will highlight required fields that have to be signed or filled out. If you try to save a form and you’ve got incomplete data, it will tell you there at the point of care, “The patient forgot to sign this,” or, “They forgot to date this” and you can correct it on the spot. You’re not having to wait until you’ve docked the pen and you’re receiving an alert after the fact. We think that’s pretty important for just cleaner documentation in general. It really doesn’t disrupt the physicians because they can quickly correct that and move on.

There are some little things like drop-down lists that can be dynamically populated from the clinical repository, pop-up tool tips for help instructions, color ink annotation on diagrams that can be pulled from a static library or even the camera on the tablet. Those are some of the major differences.

I believe overall, as you just get off of paper, the better off you are when it comes to archiving as well. Our electronic form in the source document. I’s the original source and we know when we archive that that we don’t have any extra pieces of information that have to go along with that.

I’ll ask you an investor-type question. Are any parts of your offering patented?

They are not.

You said you compete mostly with paper and traditional EMR interfaces. How hard do you think it will be to get customers to spend money on your product to replace those?

We have had some pushback historically because people expect our user experience to be baked into their EMR solution. Ultimately, that’s one of the reasons why we want greater exposure. I believe that they’re correct in a lot of ways that if you’re going to provide a mobile, physician-friendly module to your EMR, you should have an experience like Logical Ink in your product. We are, however, complimentary to that investment.

In practice, even though hospitals are investing a lot of money in electronic clinical systems, there are a lot of gaps that are left over. Not all physicians are created equally, so some will have weaker areas than others, but particularly in the areas where we’re extending the EMR to the patient in their documentation in intake and registration, in questionnaires — there are big holes there — but in the physician areas of the ED and the clinical documentation and the anesthesia record, those are just areas where the conventional approach is so frustrating and weak for the physicians that it’s a non-starter.

We get calls from ED physicians a lot that are looking at our solution because they’re very concerned about their productivity loss if they were to switch to a traditional-based system. We certainly recognize that we are providing something that a lot of the larger vendors should be providing just as general sensibilities for mobility and user-friendliness.

Do you think it will be hard to convince hospitals to trust a small company to provide and support technology that in many ways could be mission-critical?

We haven’t had that big of a problem there. Historically, IT and healthcare is risk-averse. The same could be said for clinical trials and the life sciences folks. It seems like the consumer tablet market and the Meaningful Use legislation has really reached a critical mass with that sort of forcing them to take greater chances, to get meaningful progress toward electronic records.

I think that the EMR vendors have been around long enough and their traditional approaches have been tried out. It’s not due to lack of money. I’s not due to the lack of not trying. It’s just there are some fundamental problems with their approaches and I think that there are going to be some vendors and some hospitals that will take those risks to go ahead and make progress.

What is the next level for the company and what will it take to get there?

We’ve been fortunate to have an explosion of tablets in the last year and that has obviously forced us to innovate. We were initially supporting Windows tablets only. With the introduction of the iPad and the Android devices, you’re finding that the platforms are very fragmented.

The software development platform is what I’m speaking to. We will continuously support the new, emerging devices and it will force us to also re-think some of our approaches. Traditionally we’ve been looking at a pen-based interface, whereas the new tablets don’t always come with a stylus. In some cases we’ll introduce Digital Ink to those platforms and use third-party styluses or we’ll make the forms platform more flexible for additional types of input, like touch, soft keyboard, that type of thing.

As far as business, what does it take to advance?

Our goal in participating in HIStalk and in this discussion is really to raise awareness. We want to, in the short term, get more hospitals to adopt solutions like ours just to be aware that they exist and just see the benefits of them.

I think ultimately from a business standpoint, we would like to partner with a large EMR vendor that’s ambitious and wants to address the mobility and the user-friendliness of their documentation solutions and integrate Logical Ink into that experience.