News 1/13/12

Top News

Adventist Health expands its affiliation with Cerner, announcing plans to implement Cerner Ambulatory EHR across its 130 clinics.

Reader Comments

From Booth Babe: “Re: HIMSS and HIStalkapalooza. Have mercy on the aching feet of worn out tradeshow floor ‘workers’ who have only minutes to spare getting from work to FUN. Do you know how often during aching feet moments we think of the upcoming party and how it drives us through each additional hour until we can cut loose and have some fun?! I would never have time to deck out as some of those fashionistas did last year, though they looked fabulous and were fun to see. Maybe you should add a category for best ‘survivor’ shoes for tradeshow performance. ” Gee, the term “survivor” shoes is right up there with the “straight from the exhibit hall” style company logo shirts. That being said, I have a couple pair of great shoes similar to the ones above that are comfy enough for the trade shoe floor, yet stylish enough for a quick transition to Vegas nightlife. E-mail me if you want details on the brand.

From ThickAndThin: “Re: McKesson. To acquire European firm MACH4 Pharma Systems?” Unverified. The England-based company sells drug packaging and preparation automation for hospital pharmacies.

From DeepThrowIT: “Re: White House CTO Aneesh Chopra. Word on the street is that he will announce in the next few weeks that he will be leaving his job. No word on where he’s going next.” He’s a young guy (39) with a lot of enthusiasm and charisma, so if the rumor is true, we’ll see whether he pursues money (running a private company) or power followed by money (running for office.)

From LeftCoaster: “Re: EDI 5010. Oregon and Washington hospitals are experiencing significant issues with transmission and receipt after mandated January 1 use, but deferred enforcement until April 1. Clearinghouse vendor [vendor name omitted] is a huge problem – they are not responding to support calls and hospitals are considering switching. Both Cigna and Providence Health Plan claim they are unable to transmit payments and organizations are having major cash flow problems, particularly community hospitals. Anyone else having problems?” Unverified, so I removed the vendor’s name. Further reports are welcome.

From Nasty Parts: “Re: [vendor name omitted]. Is moving away from their legacy EHR product and all efforts will be put behind a SaaS product they bought last year. 400+ people will be RIF’d as a result in the near future.” I removed the vendor name while we try to get confirmation (which I don’t expect to be successful), but Nasty Parts has been accurate about this company in the past.

HIStalk Announcements and Requests

Highlights from HIStalk Practice this week include: Dr. Gregg explains why he is skipping the HIMSS soup line this year. Hospitals now employ 20% of physicians. CareCloud grows rapidly. A breakdown of EP attestations by EMR product. Age affects physicians’ perceptions of HIT. A little bit of ambulatory HIT news is like a ray of sunshine of a cloudy day. In other words, by signing up for e-mail updates on HIStalk Practice, you can keep the winter doldrums at bay. Thanks for reading.

Welcome to Humedica, sponsoring both HIStalk and HIStalk Practice at the Platinum level. The Boston informatics company offers SaaS-based clinical business intelligence solutions that create a real-time longitudinal patient care view, giving providers insight into their patient populations, the outcomes of the treatments and procedures, and how those factors impact quality, outcomes, and cost. For physician practices, the company’s MinedShare Ambulatory product supports clinical, operational, and financial benchmarking. Humedica partners with Anceta, the informatics subsidiary of AMGA, to allow its members to collaborate on quality improvement and to share best practices. I interviewed President and CEO Michael Weintraub last month, where he talked about the company’s top-rated performance in KLAS, its partnership with Allscripts, the $50 million in capital investment the company has received, and what’s next for the industry after EMRs. Thanks to Humedica for their support of HIStalk and HIStalk Practice.

Speaking of Humedica, the company announces a predictive analytics tool that analyzes EMR data (not claims information) to identify high-risk CHF patients and intervene before they require hospitalization. Preventable heart failure admissions cost up to $35 billion per year, with 40% of Medicare CHF patients readmitted within 90 days. MinedShare client Community Physician Network (IN) says the tool will help it perform in an Accountable Care Organization model by avoiding unnecessary admissions and providing better patient outcomes.

Reminder: you app and Web developers still have plenty of time to enter Nuance’s 2012 Mobile Clinician Voice Challenge, considering that it takes only a couple of lines of application code to speech-enable your mobile or Web app for clinicians and the deadline isn’t until February 3. Prizes and fame could be yours. Even non-programmers can get a shot at the prize kitty by tweeting about the contest.

Acquisitions, Funding, Business, and Stock

T-System acquires Practice Management Associates, a provider of coding and billing services for EDs.

TriZetto Group, which last week acquired Medical Data Express, acquires Kocsis Consulting Group.

Practice Fusion raises an additional $2 million in funding, raising its total to $38 million from Band of Angels, Felicis Ventures, and other investors.

Columbia University signs an exclusive agreement with Health Fidelity to commercialize its MedLEE text-based natural language processing technology. Fidelity offers its own NLP solution called Fidelity Platform, which uses MedLEE to extract medical data from unstructured text and generate SNOMED codes from it.

In Europe, CompuGroup Medical acquires Netherlands-based ambulatory and pharmacy systems vendor Microbais Werkmaatschappij BV. The transaction also gives CompuGroup a 51% stake in healthcare connectivity startup MediPharma Online.

Sales

Barnabas Health (NJ) adds MedeAnalytics’ Revenue Cycle Intelligence solution to compliment its existing Patient Access Intelligence solution.

El Paso Children’s Hospital (TX), which opens next month, selects RCM provider Cymetrix for business office technology and services.

The DoD awards GE Healthcare a three-year, $43 million extension of its contract for patient monitoring systems.

Illinois Neurological Institute selects JEMS Technology to provide tele-stroke evaluation.

Massachusetts Eye and Ear selects PatientKeeper Charge Capture and PatientKeeper P4P for its 250 clinicians.

Catholic Health East signs a five-year, $40 million contract to implement AUXILIO’s managed print services in its 19 hospitals.

People

Former Google Health exec Missy Krasner joins Morgenthaler Ventures as executive in residence. She was also previously senior communications director at ONC under David Brailer.

Medical appointment booking site ZocDoc adds former Senators Tom Daschle and Bill Frist to its advisory board.

Encore Health Resources promotes Thomas J. Niehaus from EVP of client services to president and COO. Dana Sellers remains as CEO. In case you missed it, Mr. H recently interviewed Joe Boyd, Encore’s chairman of the board.

Lisa Conley, formerly with McKesson, joins Sunquest Information Systems as VP of North American sales and global marketing.

Industry long-timer Kerry de Vallette joins OPTIMA Credentialing as EVP of sales and marketing.

Interactive patient care systems vendor Skylight Healthcare Systems names Scott Johnson as VP of sales. He was previously with A-Life Medical and Philips.

Announcements and Implementations

North Hawaii Community Hospital begins implementation of its HIE, which uses Wellogic’s technical platform

Intelligent Medical Objects announces the successful integration of 2012 ICD-10-CM within its newly released IMO Problem IT 2012 Regulatory 1.3 software.

Nuance Communications expands the availability of Dragon Medical to French-speaking Canadian providers with the delivery of Dragon Medical 11 French.

Yale New Haven Hospital SVP/CIO Daniel Barchi provides an update on its Epic project. Six practices of 27 physicians are live, with e-prescribing at 91% and 80% of encounters closed the same day. Physician productivity for those docs is nearly back to pre-Epic levels. Greenwich Hospital will be the first hospital to go live in April. Daniel is one of few CIOs who has implemented Epic in two large health systems (he came from Carilion) so I asked him how it was the second time. He says Epic’s greatest strength is that they fully believe and trust their own process — developing their own software, rarely partnering with other companies, and creating finely detailed training plans. The benefit for customers, he says, is that if you just follow their plan, you will have a successful go-live.

Innovation and Research

Researchers at the University of Washington develop medical robots that support the open source Robot Operating System, saying it’s time to get away from proprietary, one-off medical robots and allow universities to collaborate in sharing their applications.

Technology

Ford partners with Microsoft, Healthrageous, and BlueMetal Architects to develop “the car that cares,” which would monitor the health and wellness of drivers. Data would be collected biometrically and through voice capture, then uploaded into HealthVault.  And I thought texting while driving was distracting.

A doctor in Canada gets her smart phone PHR app certified by Canada Health Infoway, only the second app to earn that distinction. She named it Mihealth, with the “Mi” referring to her feeling that adopting digital data in Canada was Mission: Impossible.

The Qualcomm Tricorder X Prize offers $10 million to anyone who can create a Star Trek-like tricorder that can diagnose medical conditions non-invasively. The X Prize Foundation chairman helpfully adds, “We don’t have a requirement that it makes the same noise.”

Other

An AHRQ study finds that 5% of Americans account for 50% of the country’s $1.26 trillion in healthcare costs. The top 1% of spenders account for 22% of the costs.

Could there be a connection? Life expectancy is up two years since 2000 and Hostess, maker of Twinkies, DingDongs (my personal fav), and HoHos, files for bankruptcy protection. Experts blame a shift toward healthy foods.

Here’s a point/counterpoint issue to mull over. Inga and I disagree on the value of CMS’s attestation statistics. Inga thinks the percentage of each vendor’s customers that have attested is a good benchmark, so she did lots of spreadsheet work to compare vendors and to assume that varying percentages among them must be reflective of product capabilities and ease of use in meeting Meaningful Use requirements. I said the information is useless for that purpose since it’s more reflective of unmeasured customer demographics and buying criteria than anything else and that it would be wrong (not to mention statistically indefensible) to use the CMS figures to infer that vendors with a higher percentage of successfully attested users have a better product for earning Meaningful Use money. Feel free to take sides. One thing’s for sure: vendors who massage the data into slick marketing collateral won’t be footnoting their handouts with statistical disclaimers.

Weird News Andy says “the eyes have it” in referring to this story, in which researchers are working on a smart contact lens that can continuously and non-invasively monitor glucose levels, electrolytes, and cholesterol, sending the results electronically.

Former Steve Jobs mentor turned nemesis John Sculley, who served as Apple CEO for 10 years, is interviewed at the Consumer Electronics Show, where he was promoting a company he advises and invests in, Audax Health. He describes his interest:

The area I am particularly excited about now is healthcare. Healthcare has been the last major industry that hasn’t been touched by technology in terms of productivity and consumer adoption in the way so many other industries have. While I’m not bringing any technology experience to the healthcare industry, I do see some similarities between what I was asked to do when I came to Apple, which was to bring big brand consumer marketing to Apple and carry it over to the whole Silicon Valley industry – because everybody does that today – well that same opportunity exists today in healthcare. Health innnovation enabled by digital technologies to build big consumer service brands, is an incredibly interesting complex problem to work on. Audax is really the first social health company and it’s focused on consumer engagement in the healthcare space bringing in a lot of the social media technologies and experiences that have been learned from companies like Facebook and Zynga and others.

The federal government adds insurance fraud to the list of charges faced by a Louisiana doctor that also includes possession of child pornography. The doctor was medical director for a company that monitored neurophysiologic surgeries over the Internet, billing insurance companies for their time. He and the company are accused of billing for surgeries in which no Internet connection was established, padding their billed hours, and instructing non-physician employees to log on to the monitoring system and pose as physicians for billing purposes.

An Indiana health insurance plan alerts 2,700 members that their records may have been exposed on the Internet in February 2011, when a server was inadvertently opened up to the Web during an upgrade.

Sponsor Updates

• SRS helps its customer Midwest Ortho (IL) celebrate its successful MU attestation with a tasty-looking cake.
• Pete Rivera of Hayes Management Consulting  discusses building leaders and improving team effectiveness.
• Picis will participate in this month’s 2012 Military Health System Conference in Maryland.
• OnX and MEDSEEK enter into a strategic partnership that allows OnX to distribute all of MEDSEEK’s enterprise patient engagement solutions.
• MED3OOO shares details of InteGreat EHR’s improved KLAS scores.
• Minnesota’s REC recognizes e-MDs customer Christopher Wenner, MD for being one of the state’s first providers to achieve Meaningful Use.
• Gateway EDI and AAPC align to offer ICD-10 training for practices, starting with a January 24 Webinar.
• Orion Health opens its 14th international office in Paris.

EPtalk by Dr. Jayne

It may only be Thursday as I write this, but I’m really wishing it was Friday. This has been a hectic week full of clinical snafus and customer services annoyances.

The first guilty party is HIMSS, whose registration system apparently malfunctioned last month. HIMSS12 registrants were charged a zero dollar amount for their HIMSS renewals. I received an e-mail notice about the registration problem and was told that someone would call me to discuss whether or not I really wanted to renew. They did, while I was seeing patients. I didn’t want to ignore it and risk a snafu in Las Vegas.

I called the customer service number left on my voice mail and the answering staffer had no idea what I was talking about. After more than 15 minutes on the phone and two call transfers, they finally got their act together. I hope the conference itself runs much more smoothly. And to HIMSS, let me introduce you to the concept of service recovery. If you accidentally undercharge people, let it go and use it as a lesson learned. Did that many people really register on those two days that you are going to suffer without the extra $160 per person? Goodwill is invaluable.

The second guilty party was the staff at Well-Known University Medical Center whose performance at the check-in desk gave new meaning to the phrase “epic fail.” Not only did they insist that my insurance information wasn’t in the system (doubtful since it just paid a claim last week on another appointment) but they were also rude about it. As I sat in the waiting room, I was also annoyed by their ham-handed questioning of patients on race and ethnicity. I wanted to jump up and intervene with some better scripting.

If organizations can’t even handle those customer service basics, I have no idea how they’re going to achieve Meaningful Use, let alone be a meaningful participant in an ACO. Not to mention that they didn’t ask everyone about race and ethnicity. I’m not sure if they just “assumed” for the rest of us or if they decided to judge by appearance.

The final straw was a resident physician who actually was using his BlackBerry to e-mail or text during my visit. Really. Talk about smartphone distractions. He set it on the table between us and typed as he was doing the exam. I know for sure he wasn’t documenting in the EHR because the scribe was tapping away at the PC in the corner.

The resident didn’t think it was funny when I asked him if I was keeping him from something important. He did sheepishly put it in his pocket. Maybe he should have noticed the “faculty” label on my encounter bill. Oops!

Lest you think I’ve just become Angry Jayne, some good things did happen this week. Inga and I strategized on the coveted HIStalkapalooza beauty queen sashes and I have narrowed down the list of candidates who are vying for the chance to escort me to the event.

HIMSS released their list of its 2011 Best Hospital IT Departments. Texas Health Resources, whose IT shop is led by contributor Ed Marx, is listed for large hospitals.

I’m curious about Nemours/Alfred I. DuPont Hospital for Children, which is described on the “medium hospitals” list as having 237 IT staff for its 180 licensed beds. I could certainly do a lot more with 1.3 staffers per patient. I wonder what their nursing ratio is?

Life Technologies Corp. announces that its new Ion Torrent genome sequencer will be able to map an individual human genome in a single day for less than $1,000. Although technically this is HOT, sequencing of a person’s genome brings up lots of controversial ethical and legal issues, not to mention the cost of the human expertise needed to transform the genetic data into something meaningful and to then counsel patients.

The absolute highlight of my week, though, is this delightful video about computers in medicine circa 1964. Thanks to Rockstar HIStalkapalooza correspondent Evan “Velvet Jacket” Frankel for making my day. See you at HIMSS.

Contacts

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

John Gomez 1/11/12

Recently I developed a Leadership Cheat Sheet for clients and friends. The document provided guidance on how to evolve your leadership style and suggestions on avoiding common leadership mistakes. As we move into 2012 (wow,  2012 sounds so Buck Rogers, doesn’t it?) I started thinking about a cheat sheet for HIT executives that helps them evolve their strategies and hopefully avoid technological mistakes in the coming year. By no means is this cheat sheet a comprehensive end-all, be-all, but rather a high-level guide of what to consider in the coming year.

Let me start by saying that not everything in this article is going to be applicable to every organization. You may also find that some of the items in the article are not necessarily new or all that leading edge. In some ways, much of this is a return to the meat and potatoes of HIT. Yet there are some new fancy, out there, Star-Trek gizmos that most of us love to envision included for you mavericks. With that disclaimer, let’s get started.

If I were on the hospital side of the equation (not the vendor side,) I would see 2012 as year to rework foundations and drive strategies that grow revenue and/or margin. I believe these two things go hand in hand. Although it may seem obvious, I find that Meaningful Use has in some ways become a huge distractor to allowing HIT to build an organization’s margin and revenue.

In my eyes, all IT organizations — not just those in healthcare — should be indirect profit centers, able to demonstrate that their strategies are driving organizational growth and financial stability. To do this, many organizations need to consider their foundational systems and begin making bets on what to invest in during the coming year, so that over the next three years, they can demonstrate that IT is a strategic partner to the business, not just a cost center. Sounds rather basic, doesn’t it? Yet it is such as difficult thing to execute upon, and that challenge is the reason for this little cheat sheet.

OK, so first things first. You can’t really get around your continued MU efforts or ICD-10 adoption. Yes it is draining, taxing, distracting, painful, lethargic, and about as exciting and forward thinking as watching wall paper erode. Most of your resources are going to be tired up on MU/ICD-10, yet you need to really think about how you rebuild your technology foundation and drive corporate revenue growth. After all, healthcare is a business.

My first suggestion to you is to establish an “imagineering” team. This can be a small team (depending on your budget) comprised of multi-functional talent, empowered to make decisions, drive change, and most of all, execute upon their decisions. If you want further details on how-to build an imagineering team, let me know, but the key tenets are (a)small team; (b) self-learners; (b) self-starters (c) highly passionate; (d) cross-functional; (e) full-time assignment; and (e) only looking at changes that can be accomplished without the need for board or finance committee approval. The reason for that last item is that you don’t want this team to get bogged down with big, complex changes and projects. Secondly I believe you will see greater returns from smaller strategic investments than big multi-year projects.

The Cheat: Carve out some resources and create an imagineering team. Keep your MU/ICD-10 work moving forward and make progress on the little things that provide big returns.

Recently I had the opportunity to meet with some rather smart and very talented software developers. We were discussing a new product that they are trying to bring to market. The discussion quickly turned to object orientation, software as a service, cloud-based computing, etc. They were pretty shocked when I said that really doesn’t matter – it’s all just drivel. What matters, I said, is getting your product to market and solving the client’s problem, doing those things really, really well, better then anyone else. Why does that matter to you?

I believe in 2012 you need to really consider evolving your departmental systems. Why? Because there is gold hidden in those departments. Want to improve throughput? Lower costs? Drive better ROI? Deal with future challenges related to genomic and personalized medicine? Then you should evaluate your departmental solutions and start thinking about how upgrading or replacing them (yes, replacing) could yield much higher returns. Solving your client’s problems is what matters.

OB/GYN, cardiology, optometry, ED, oncology, pathology, lab, advanced surgical, and other lines of business are highly specific workflows. Although some of the EMR/EHR vendors do a good job at this, you will find that your return is much higher by going with niche vendors who have systems optimized for these areas. The landscape of offerings in these areas is changing and you may find great deals, with short implementation cycles that create huge downstream returns.

The key to improving your revenue and margin is lowering operating costs and seeing more patients (yes, a no-brainer.) Yet to make that happen, you need to consider new systems and consider looking at some of the smaller players in these spaces that are doing some truly amazing things with really new technology. This is the perfect type of project for an imagineering team.

The Cheat: Review your 2012 departmental portfolio to determine if by evolving or upgrading you can improve patient throughput and lower costs.

“You can’t get there from here,” said the farmer along the side of the road.

“Why not?” I asked.

“Because they ain’t built a road, you fool,” he snapped.

Are you building roads in 2012? In my eyes, the next three years will see a tremendous shift in technology within HIT. You can only embrace these changes by laying foundational infrastructure that allows you to not only take advantage of those shifts, but also assure that you can do so at a cost and pace that yields strong ROI.

Throughout 2012, you should come to terms with mobility, patient tracking, resource tracking, analytics, security, and data integration/exchange. I consider this your infrastructure portfolio. Just like you have a departmental portfolio, you should consider developing a portfolio of your infrastructure to better understand how you are positioned for the future. Each of these items in the portfolio should provide a set of “roadways” which allow you to digitally get to anything or anyone in your organization and system.

Key investments in RTLS, HIPAA compliance management, privacy and security management, and the other areas are critical. If you have not deployed directory services and EMPI systems, you need to get that done. Why? Because I believe that over the next three years, we will see more and more focus on the integration of devices and humans. This will drive a tremendous need for an underlying infrastructure that allows you to orchestrate an ecosystem. Evaluating and investing in your infrastructure portfolio is critical to long-term success, reducing costs and driving revenue.

The Cheat: Develop and evaluate your 2012 infrastructure portfolio. Develop key plans for at least RTLS, PRM, HIPAA compliance, and privacy and security. Focus on technologies that improve patient throughput, reduce costs, and drive long-term ROI. If you have not deployed directory services and EMPI, get on it.

Little by little, the world of retail is changing. More and more retailers are evaluating or deploying self-service systems that allow consumers to do more for themselves and get help from a sales associate only when they need or want help. Airlines are also embracing the self-service mentality for passengers and crews, providing access to tools that allow greater access to what was once complicated processes that required human intervention. Developing a “healthcare self-service” strategy in 2012, which puts more power in the hands of the patient, is a key means to drive greater throughput and gain financial upside for the healthcare organization. The self-service strategy should include patient relationship management, patient access, and other tools that allow the patient to take greater control. Although human interaction is vital to patient care, there are a variety of processes that patients can do for themselves and actually would champion to be allowed to do, if they had access to the tools.

The Cheat: Drive higher patient satisfaction, better patient throughput, and ROI through the development of a 2012 self-service strategy. Also consider how self-service can be applied to hospital employees.

“To boldly go where…” you know the rest of the line, I am sure. So what about the cool Star Trek stuff? Well, I do think that you will see subtle shifts in 2012 that have long-term implications, but I am not sure if we are going to remember 2012 as the year that changed the face of healthcare forever. That said, for those leading edge organizations out there, I do think that there are some things you can start evaluating.

Some of my things to watch are DDS (diagnostic decision support), healthcare gaming, robotic aides, and large-scale data analysis, as well as the application of social graphs to patient care and collaboration. Each of these has a backdrop of affecting patient throughput and managing costs. For instance, DDS can help drive better decision-making in shorter amounts of time, freeing up clinicians to see more patients or spend time with patients. Healthcare gaming provides the opportunity to reduce readmissions, improve wellness, and educate patients. Robotic aides will at some point help drive care, though challenges with battery life and size make this a long-term realization. Large-scale data analysis, social graphs, and related technologies are also very much in their infancy, but there is promise and opportunity for those organizations looking for leading-edge game changers.

The Cheat: Pick one or two leading edge technologies that can provide long term differentiation to your organization.

ACO, ACO, ACO. OK, so we are making some progress and little by little, it seems to be coming together. But what is coming together is still a mystery. Developing an ACO strategy is important and probably a good thing to do in 2012, but I would caution you that there are probably other items you can focus on that will drive higher returns. That said, there is some low-hanging fruit an imagineering team can go after in regards to the world of patient financials. That fruit includes asking your current patient financial vendor to outline their strategy to address patient financials over the next three years (not just ACO.) I would not suggest changing vendors unless you are either having serious issues with your current vendor or your current vendor has no strategy for the next three years. If your satisfied with your vendor strategy, then focus elsewhere and monitor the evolution of ACO and its impact to your organization. Wait for the dust to settle, learn from the mistakes of others, and take a crawl-walk-run approach. If you must change vendors or your vendor doesn’t offer a strategy, then this is a project way too big for an imagineering team.

There are a ton of more cheats I can offer and probably some things you might be surprised not to see in the article. My goal, though, isn’t to cover it all. I realize that many of you may find that much of this is already known, which is cool if you are already on it. My goal is to help you think about the little things you could be doing to move your organization forward while you and your team drive greater revenue and, hopefully, margins.

The Last Cheat: If you agree with each of the cheats in this article, you can copy them to a PowerPoint (just the cheats) and present them to your leadership team. You will have an instant outline of your key goals for 2012.

John Gomez is CEO of JGo Labs.

News 1/11/12

Top News

Federal defense contractor ManTech International acquires federal healthcare system integrator Evolvent Technologies. You may remember Evolvent from HIStalkapalooza in Atlanta a couple of years ago, which they co-sponsored with Encore Health Resources and Symantec.

Reader Comments

From Stacy London: “Re: HIStalkapalooza. I have registered and hope to make the official invite list. I haven’t been before, so I am not sure what to wear. Thought it was better to ask you than Mr. H.” Indeed. You will see everything from the dreadful “straight from the exhibit hall” company logo shirts to glitzy gowns and tuxedos (seriously.) However, if you’d like to be in the running for HIStalk King or Queen, I suggest some serious cocktail party attire, complete with great shoes and lots of bling. Because we are in Vegas, we are including two special categories: Best Elvis Impersonator and Best Left in Vegas Attire. Ideally, the winners of the Vegas categories will actually be trying to win. All winners, including those crowned in the Inga Loves My Shoe contest, will be awarded fabulous prizes from the generous Mr. H (who may not know fashion, but who knows this stuff makes me happy so he puts up with it.) Our esteemed judges are pictured above.

From Is It Just Me: “Re: HISsies survey. Of all the silly questions and odd choices, I thought listing John Hammergren as an ‘HIS industry figure’ was the biggest stretch. And shouldn’t ‘guest contributor of the year’ between Vince Ciotti, Ed Marx, Ben Rooks, and Mr. H’s Epic id merit a question?” The silly questions have been the same for years, so there’s nothing new there. Readers chose the nominees, so any quibble about the odd choices should be directed that those who submitted nominations (or more accurately, the vast majority who didn’t despite my exhortation, saving their input until it was too late.) Inga advocated for adding a “best HIStalk contributor” item, but I didn’t want to diminish the accomplishments of those who didn’t win since they’re all good. If you received an e-mail HISsies ballot link, please vote soon since I’ll probably finish it up this weekend. About 1,000 votes are in and there are some surprise leaders so far. We’ll invite some of the winners to join us at HIStalkapalooza, although they usually turn us down.

From Ed Amame’: “Re: UMMC layoffs. Some folks on the right aren’t happy about it. Hot Air, as I understand it, has a pretty big readership. Wonder what waves this will create in HIT policy discussion outside the niche?” Right-wing site Hot Air quotes my mention of University of Mississippi Medical Center layoffs that were implied to be related to its $80 million Epic cost  (a story I just picked up from a newspaper there) and turns it into another vast conspiracy of Obamacare-loving liberals. A few thoughtful comments were left (one basically just pasting in my discussion from the original mention), but many are wildly tunnel-visioned, hysterical, and hateful. It’s no wonder the government is paralyzed by partisanship and an unwillingness to compromise – the politicians are unfortunately representing their intellectually lazy and often ill-informed electorate perfectly, so thoughtful democratic process has turned into a bad reality TV show.

From Spanky: “Re: unions. Why they’re bad for healthcare.” An ambulance technician in Scotland ignores an emergency call because he’s eating lunch. The patient dies. The union last week rejected a salary increase that would have paid paramedics $150 every time an emergency causes their break to be interrupted.

HIStalk Announcements and Requests

HIStalkapalooza invitation signups will be closed Friday evening, so if you have an interest in attending but haven’t filled out the online form, now’s the time.

Acquisitions, Funding, Business, and Stock

Consumer health site WebMD gives up trying to sell itself, its CEO quits, and the company warns of “significantly lower” profits in 2012 because drug companies are moving away from buying its advertising and competition from Facebook is increasing. Shares dropped 29% on Tuesday.

Healthcare apps developer Novarus Mobile Technologies changes its name to Novarus Healthcare. The company also hires Tom Hearn, formerly SVP of ambulatory services with Novant Health (NC), as managing principal.

Shares in Scotland-based charge master software vendor Craneware drop by a third after the company warns that performance of its acquired US revenue cycle software business ClaimTrust will not meet expectations. The company also says it may sue after it lost a large ClaimTrust InSight contract that was being handled by a third party and complains that US hospitals are buying HITECH-subsidized clinical systems instead of its financial ones. 

Ascend Learning acquires Advanced Informatics, a Minneapolis-based vendor of clinical education systems.

UnitedHealth Group forms strategic partnerships with three mobile health companies: CareSpeak Communications (patient medication communication by text message – above,) Lose It! (a weight loss app,) and Fitbit (pedometer and sleep monitor app.)

Sales

Hamad Medical Corporation (HMC) and Cerner sign an agreement to digitize the public health system of Qatar, including all HMC hospitals and primary care centers.

BCBS of North Carolina and Kansas City form Topaz Shared Services and choose TriZetto Group to provide claims, enrollment, and billing services.

People

Sandata Technologies, a provider of IT solutions for the home care industry, names Tom Underwood (Alere Health) CEO.

ApeniMED (formerly MEDNET) elects Charles D. Birmingham, VP of corporate development for CareMore Medical Enterprises, to its board.

Carestream hires Barry Canipe (American Standard Brands) as CFO and promotes Jianqing Bennett to VP of global medical sales and services.

Surgical Information Systems promotes Kermit S. Randa to COO.

Streamline Health Solutions appoints Michael K. Kaplan (Altos Health Management) to its board.

Healthcare consulting firm Equation hires Howard Salmon (Premier, ReHab Care, Phase 2 Consulting) as principal.

Three Kansas hospitals that are affiliates of Sisters of Charity of Leavenworth Health System name Mike Malone as project manager for their Epic implementation. He was previously with the parent organization.  

Capella Healthcare names Magda Osburn BSN, RN as director of medical informatics. She was previously with McKesson Provider Technologies.

RCM company Medistreams hires Marcia McLure Hardy as national director of business development.

Announcements and Implementations

The local paper (which apparently does not use spell-check) highlights the EMR use of Takoma Regional Hospital (TN), which just received a $1.3 million check for its meaningful use of Cerner’s EMR. When I shared this with Mr. H, he got all nostalgic on me, reminiscing about a consulting gig he had at the hospital years ago, the nice people there, and the great grub at Stockyards Cafe.

While I was trying to figure out which EMR Takoma had in place, I found Cerner’s list of clients that have attested for Meaningful Use, which includes 136 hospitals and 238 EPs.

Omaha Imaging (NE) implements Avreo RIS/PACS.

Four Mercy Health (OH) hospitals go live on Epic’s Care Everywhere, allowing hospital staff to view the chart of any patient whose provider is also using Epic and Care Everywhere.

Zynx Health announces a software enhancement that improves integration of ZynxOrder order sets with MEDITECH CPOE.

BryanLGH Medical Center (NE) implements the Pharmacy Xpert clinical surveillance and intervention solution from Thomson Reuters.

Three Ohio hospitals implement InQuicker, software that allows patients to make ED appointments online and “skip the ER waiting room.”

Government and Politics

The latest Meaningful Use numbers, captured in December and presented at Tuesday’s HIT Policy Committee Meeting:

• 172,974 EPs and 3,077 hospitals registered for either the Medicare or Medicaid MU programs.
• Medicare paid $275 million to EPs and $1.1 billion to hospitals.
• 33,515 EPs attested, 355 unsuccessfully.
• 842 hospitals attested, all successfully.

Aaron Berdofe analyzes the November Meaningful Use attestation report using IBM’s Many Eyes tool, finding that (a) Epic has 6,330 attestations, more than triple the #2 vendor; (b) Epic’s strength is concentrated in a few states where it dominates almost totally; and (c) Complete EHR attestations outnumber Modular EHR attestations 21,765 to 1,196.  

  ONC launches its Healthy New Year Video Challenge, offering $5,000 in prizes to consumers who submit a short video explaining their health-related New Year’s resolution and how they will use technology to accomplish it.

  Newt Gingrich, speaking at Dartmouth-Hitchcock Medical Center, says bureaucracy crushes healthcare innovation and that treatment protocols based on statistics interfere with the doctor-patient relationship. Peter Merrill, DHMC IT director, grilled Gingrich on his role in government gridlock, but wasn’t impressed with Gingrich’s answer. “I thought it was an incredibly articulate and well-reasoned defense of his actions in response to my characterization of him as responsible for the current gridlock in government. It was in no way an answer to my question of how to get past the current gridlock. My personal belief is that he is one of the major people responsible.” Merrill says he’ll probably vote for Obama again unless Republicans come up with a better candidate.

Technology

First-year medical students at the NYU School of Medicine use an interactive, virtual 3D cadaver to complement the traditional anatomy instruction, exploring the digital content with projected images, 3D glasses, and iPads. A free online version is here.

Other

  US health spending grew 3.9% in 2010, which was only .01 percentage points faster than the 2009 rate and the second-slowest rate in 51 years. The slower growth is blamed on high unemployment, loss of private health insurance coverage, lower median incomes, and higher patient deductibles and co-pay. Total 2010 spending was $2.6 trillion, or $8,402 per person, of which the federal government paid a record 29% and the combination of federal, state, and local governments paid 45% of all health spending.

The Bureau of Labor Statistics reports that healthcare added 22,600 jobs in December, including 9,800 in hospitals and 11,300 in ambulatory health services. Healthcare employment grew by about 315,000 jobs for the year.

A study finds that nurses using a basic EMR reported better outcomes and were less likely to report adverse patient safety issues, frequent medication errors, and low quality of care.

Cerner, dbMotion, Epic, Medicity, and RelayHealth are the vendors winning the most private HIE deals, according to KLAS, while Axolotl, InterSystems, Medicity, and Orion Health are leading in public HIE selection. Affordability is the top consideration in vendor
selection.

  Fast Company covers mHealth. It’s not particularly conclusive or insightful (at least not compared to HIStalk Mobile,) but does mention some interesting technology work: Best Buy is researching earbuds that can monitor heart rate, J&J has invested in sleep monitoring technology, and AT&T and Qualcomm are working on mHealth projects.

Two English hospitals struggle with error-filled surgical case lists, warning employees to double-check them. The North Bristol NHS Trust blames user error. One surgeon said his case list included patients from outside his specialty.

  Weird News Andy likes this Baby Beyonce’ Lockout story. Beyonce’ and Jay-Z have their daughter (named Blue Ivy) at Lenox Hill Hospital (NY), but at least one other new parent says the hospital locked down the NICU to accommodate Beyonce’s visitors, preventing everybody else from seeing their lesser-pedigreed babies. The hospital denies reports that it was paid $1.3 million to give the celebrities an entire floor to themselves. Gossip sites claim the hospital installed bulletproof glass in the delivery area, taped over security cameras and confiscated employee cell phones to prevent pictures being taken, and kicked people out of nearby waiting rooms. The couple is supposedly worth something like $750 million.

WNA also says he’ll “take a flyer” that the da Vinci medical robot people didn’t count on their robots to be used to make paper airplanes, even in Boeing-centric Seattle.

Guess which company is looking for a senior sales manager. The candidate must cold-call, hit sales targets, negotiate contracts, create sales campaigns and models, persuade prospects, and “aggressively solicit new customers by telemarketing and formulating follow up plans.” The answer: HIMSS, which needs someone to push corporate memberships and organizational affiliate memberships.

An IT specialist with an Atlanta medical practice is sentenced to 13 months in prison for hacking into the server of his previous employer, a competing practice located in the same building. He download patient information from his former employer’s system, deleted it from their server, and then launched a direct mail campaign touting his current employer.

Sponsor Updates

• Kindred Healthcare Inc. selects MED3OOO’s RCM services and InteGreat PM for its partner physicians.
• PatientKeeper CEO Paul Brient will speak this week at the JP Morgan 30th Annual Healthcare Conference.
• Fred Pennic, a senior advisor with Aspen Advisors, suggests six ways for healthcare organizations to use business intelligence software.
• HealthEdge and Keane announce a strategic partnership to deliver a performance-based business process outsourcing service to the healthcare payor community.
• Imprivata releases a white paper on preparing for a HIPAA audit.
• RelayHealth hosts a live HFMA webinar January 11 on patient consumerism.
• Nuesoft announces its podcast series “2012 Billing Trends: What’s on the Horizon.”
• A Texas hospital selected for the OCR’s pilot HIPAA audits contracts with CynergisTek for preparatory consulting and advisory services.
• McKesson Specialty Health offers a free webinar on the selection and implementation of EMRs in oncology practices.
• eHealth Global Technologies Inc and OptumInsight will deploy a medical image exchange service for HEALTHeLINK, a New York RHIO.
• Idaho Health Data Exchange signs an agreement with Greenway Medical to provide interoperability between Greenway’s PrimeSUITE EHR and the OptumInsight-powered HIE.
• Community Health Network (IN) says consulting services and technology from MedAssets improved its cash position by $26.7 million, reduced denials by 47%, and increased patient access employee productivity by 100%.
• Aspen Advisors ranks third in Planning and Assessment in the Best in KLAS awards.

Contacts

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

Monday Morning Update 1/9/12

From California Girl: “Re: CareFusion. Has done some executive trimming of late and more layoffs may be in the offing.” Unverified.

From Lucitania: “Re: Gerry McCarthy of McKesson. Confirming that he’s leaving for HealthMEDX to work with Pam Pure again. The internal announcement didn’t give his new role.”

From RS: “Re: Kathleen Sebelius. Op-ed in The Washington Post this evening.” One might quibble with her assessment that the Affordable Care Act is “putting consumers back in charge” by (a) requiring insurance companies to provide an explanation when they increase premiums by 10% or more, and (b) also requiring them to spend 80% of premiums on health care services, which of course still lets them make their big money by investing prepaid premiums until services are actually rendered, which allows them to put their signs on tall buildings and to sponsor sporting events. The problem with reducing healthcare costs is that it would require (a) patients who are conscientious about their consumption of healthcare dollars paid by someone else, which hasn’t worked well historically; and (b) politicians with non-partisan political backbone who are willing to rile big organizations that are loaded with lobbyists and campaign donations, which never happens. And in the way of counterpoint, here’s a comment left on the article:

Tired talking points. Where do I start? Funding was shifted from the Medicare program and the doctor SGR fix was intentionally omitted to make this law "bend the cost curve down", but ACA does nothing to lower costs. Savings were based on finding fraud and abuse, which could have been done in the current system. The rising costs of premiums cited by Sebelius are going to insurance companies who squirrel it away in profits hidden as loss reserves. Any increases in payments for the last 9 years to doctors and hospitals have been lower than the same inflation rate. Her state-based "competition" is dependent on states participating. The "80-20" rule doesn’t apply to AARP plans in exchange for their support. For AARP it is really a 65-30. Lastly if it is so great, why has the administration granted so many waivers to unions and large contributors?

It’s HISsies voting time. I’ve placed the most-nominated entries on the final ballot, which I’ll e-mail out Monday evening. I won’t send an e-mail reminder (since I always get a few complaints about wasting 0.5 seconds of someone’s time to read and ignore the e-mail subject line vs. the five minutes it takes to complain about it), so watch your inbox and check your spam filter if you don’t receive yours. Voting is limited to subscribers to the e-mail update as of this past Saturday morning when I had time to create the ballot e-mail list.

Vince’s HIS-tory this week goes micro – it’s all about the early days of PCs in hospitals. Quite interesting as always, and fun to read of the one example where Apple took a hospital beat-down from the old-guard IBM.

Listening: Veruca Salt, mid-90s, unpolished hard-charging chick rock. And while Mrs. HIStalk and I were having lunch today at the local hipster taqueria, I bet I was the only person there who could identify the music playing over the sound sytem – Portishead’s “Glory Box.” Mrs. H applied minimal effort in pretending to be impressed.

Around two-thirds of readers aren’t buying it when a hospital’s post-mortem on computer downtime claims that patients weren’t harmed as a result. New poll to your right: are business conditions better now than a year ago?

Welcome to HEI Consulting, a new Platinum Sponsor of HIStalk. The KCMO-based company provides expertise all over the world in everything related to Cerner Millennium on both the clinical and revenue cycle sides of the house, including assessments, selection, implementation, workflow analysis, revenue cycle, EDI, CCL scripting, Cerner Open Engine integration, data extraction, and optimization. They offer experienced analysts who have been involved with Millennium implementations worldwide, including in the UK, Middle East, Canada, and of course the US. If you need help with Meaningful use, workflow optimization, ICD-10, give them a call. Thanks to HEI Consulting for supporting HIStalk.

My Time Capsule editorial from five years ago: Happy 2007 – Now Get Back to Work! An extract: “Hospitals, too, get busy after months of letting IT projects lie fallow. No wonder ROI is hard to come by — projects come to a screeching halt because of non-IT staff refusal to get involved during (a) the November to January holiday block; (b) summer vacations; (c) school spring breaks; (d) impending JCAHO or state inspection visits; and (e) local, state, or national conferences involving anyone remotely involved in projects. No wonder implementations take forever – they’re on hiatus half the year. ”

The perennial underperforming and unimpressive Yahoo pays $26 million to secure the services of its new CEO for one year, although that’s a pay cut from that of the previous CEO, who made $47 million in one year before being fired over the telephone. I like Yahoo Finance and I use their e-mail because I like it better than Gmail, but otherwise I couldn’t tell you anything they offer and I don’t really want to know.

John Snyder MD of Mayo Health System in Eau Claire, WI is named as a Mayo MacMillan Scholar. He’ll continue his work with workflow and electronic medical records.

A new Vanderbilt study by Josh Denny MD, MS (above) and Dana Crawford PhD links DNA samples with electronic medical records to examine the genetic basis of hypothyroidism.

CMS takes a bold step to curb high levels of Medicare fraud in 11 states (FL, CA, MI, TX, NY, LA, IL, PA, OH, NC, MO) in allowing RACs to review claims before providers are paid instead of the “pay and chase” standard of pay first-ask later. Orthopedics specialists, as you might expect, aren’t thrilled at that policy, suggesting also that CMS should spend some effort cutting back on direct-to-consumer advertising for free motor scooters and sleep apnea machines, which it says only two countries (the US and New Zealand) allow.

National Coordinator Farzad Mostashari lists ONC’s accomplishments for 2011 and invites comments on the biggest health IT trends for 2012. On his list:

1. Launching Meaningful Use
2. Taking the Direct Project live
3. Releasing the National Quality Strategy to use technology to reduce hospital-acquired conditions, heart attacks, and strokes.
4. Running the Standards Summer Camp.
5. Developing software contests.
6. Issuing grants and curricula for healthcare IT education.
7. Implementing breach reporting requirements as part of HITECH.
8. Launching a consumer e-health program that includes regulations making it easy for patients to access their lab results.
9. Exceeding the enrollment goals of RECs.
10. Measuring the growth in EHR adoption.

Rural doctors in Australia, eligible for $6,000 each in telehealth grants but offered minimal assistance and incompatible software modules, are often just giving up and using Skype instead. According to the president of the rural physician’s association, “In many cases, it works much better than some of the more sophisticated things out there. There is a whole range of technologies and, in establishing video-conferencing, [doctors] are not going to go out and buy some extravaganza of a system, they are going to stick with the simple stuff. Inevitably, there will be shonky players coming into something like this. Doctors have concerns about people putting together hardware and software and calling it a video-conferencing solution.”

E-mail Mr. H.

News 1/6/12

Top News

HHS introduces streamlined rules governing electronic fund transfers from health plans to doctors, which it says will cut approximately $4.5 billion in administrative costs over the next 10 years. The new rules require remittances from health plans to include tracking numbers, making it easier for doctors to match payments with bills.

Reader Comments

From NoVegas: “Re: animated ad. When reading yesterday, I noticed that there are still some animated ads up. I thought they were going away?” A handful of well-intentioned sponsors missed the deadline to switch out their banners, but have assured us their new ads are forthcoming. Meanwhile, join me in a collective “thank you” to those who were happy to comply with readers’ requests to retire the flashing ads.

From Swami: “Re: MedPlus. An RFP posted by New Mexico HIC says they’re exiting the HIE market. Are you aware of their plans?” We asked the company, which provided this response:

MedPlus, the healthcare IT subsidiary of Quest Diagnostics, has made the decision that the company will no longer enhance or further develop the product known as the FirstGateways Clinical Portal or Centergy Clinical Portal. MedPlus continues to satisfy its support and contract obligations to each customer of this product. When all such support and contract obligations expire, however, the product will be permanently sun-setted.

From Birdie Little: “Re: McKesson Provider Technologies. [executive’s name omitted], a 20-year veteran SVP of product management and marketing, is leaving, supposedly to take a small company CEO job. The Horizon fallout had influence.” Unverified, with the name omitted for that reason. Another person reported a similar rumor about the same person, but gave the new employer as HealthMEDX, which former McKesson EVP Pam Pure joined as CEO a few weeks ago.

From The PACS Designer: “Re: Apple’s 2012 launches. The rumor mill from the Far East is heating up again, with info circulating that we may see the launch of Apple’s iPad 3 with the LTE communications upgrade. Since Steve Jobs’ birthday was February 24, the launch may happen then. Later this year, we’ll see the launch of Apple’s iTV, not to be confused with the current $99 Apple TV product.” February 24 would be a lousy date since vendors will be giving away bunches of iPad 2s that very week at the HIMSS conference, just in time for them to be rendered obsolete. That happened last year, as the iPad 2 was released on March 2, a week after the conference. As an alternative, how about the above as a giveaway to Apple fanboys (most of us, I suspect): a creepily lifelike 12” Steve Jobs action figure (that’s an actual photo of the doll above). The manufacturer provides free accessories: two pairs of glasses, a chair, two apples (one with a bite taken out of it), and a backdrop that says “One More Thing.” It goes on sale next month as long as Apple’s lawyers can’t figure out how to shut down a company operating in China.

From Rumble:

“Re: Partners HealthCare. The earth shook in 1994 when MGH and Brigham and Women’s joined to form Partners. Rumor has it that they’re definitely going commercial for their clinical systems – the end of home-brewed. They spent $200M for Siemens ADT before Glaser became CEO of Siemens. Several sources, none official, are confident they’re going Epic. I feel the earth moving again.” Unverified, but I would be shocked if they decided otherwise.

From Roots Fan: “Re: Burlington, VT. Men’s Health just listed it as the #1 Best City for Men, with emphasis on the local hospital’s implementing of Epic, especially MyChart.” The real objective is to sell magazines, and junk stories based on a numbered list (often presented via a lame slideshow) to bait intellectually lazy readers. They’re the literary equivalent of fast food restaurants, providing overly processed, nutrition-devoid fat calories (“The 15 Hottest Actresses You Will Never See Naked On Film” “10 Humor Sites to Make You LOL” … notice they always start with a number to make it clear that minimal mental effort is required to skim them.) I’m not sure having MyChart available is that big of an advantage and Burlington is hardly unique in that regard, but the magazine was mightily impressed, suggesting that doctors just needs your encouragement to implement Epic so you can play with MyChart on your iPhone:

“Our major medical center recently introduced electronic medical records, which will hopefully further boost rates of preventive care,” says Dr. Vecchio. Doctors will soon be able to program preventive-care reminders into patients’ e-records so they never miss screenings. Ask your M.D. about switching to digital records, and then download the MyChart app, which lets you use your smartphone to view your medical file and any screening reminders.

From HIPAA Hound: “Re: doctor’s perspective on end-of-life care. Exactly what I’ve often thought, but never heard much like this, especially from a physician. Adherence to this treatment philosophy would surely save the country billions each year.” I’m glad you sent the link since I read and enjoyed the piece, but forgot where I’d seen it. The gist of the article is contained in a quote from it: “… Doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little.” It argues that doctors are expected to recommend care that they themselves wouldn’t want, with procedures that are not only futile, but painful or degrading. It’s restrained in barely mentions the huge cost taxpayers bear as all the stops are pulled out for Medicare patients in their final days of life, with minimal benefit to anyone.

HIStalk Announcements and Requests

  One of our creative sponsors suggested a new and fun event for HIMSS this year: the HIStalk Booth Crawl. More details will be coming soon, but it’s likely that Crawl participants will have a better chance of winning an iPad 2 than they would hitting it big in the $1 slot machines. If you are a sponsor and have not received details on the Crawl, drop me a note ASAP. Potential players, stay tuned.

  After last week’s getaway in the part of the world Mr. H called “The Land Without Broadband,” I am back in full force. If by chance you failed to peruse HIStalk Practice over the last couple of weeks, here are a few gems you missed. Who to contact to appeal 2011 PQRS or e-prescribing payments. A family practice doctor’s use of social media includes posts entitled, “Are You Smarter Than a Medical Student?” My secret indulgence and 2012 predictions and resolutions. CareCloud adds a director of clinical technologies. Don Michaels offers excellent insight into EMR attestation in 2012 (it’s going to be crazy) and ACOs (the jury is still out.) Dr. Gregg and the percolating e-patient revolution. It just takes a few minutes to be enlightened on happenings in the HIT ambulatory world, so come join the fun.

Over 500 people have signed up for HIStalkapalooza invitations in the first couple of days, so if you are contemplating attending, click here or on the graphic in the upper right column. We always get an interesting mix of executives, unsung in-the-trenches grunts, students, investment people, and semi-celebrities, and this year’s event was designed to encourage them to network (lots of conversation-friendly small spaces, for example, not to mention an open bar.) We’ll close down registration in a few days and e-mailed invitations will follow. It’s only a handful of weeks away, shockingly.

I mentioned that I’m not a fan of year-end industry predictions, given that (a) many of the pundits don’t have the credentials and experience to be making them; (b) nobody wants to look stupid in print, so they predict the obvious; and (c) their predictions are often tediously defended with shallow and unconvincing reasons they believe themselves to be right. Not true of our own Travis on HIStalk Mobile, whose 2012 predictions are specific, bold, and concisely convincing. I like his attitude: “I’ve tried to be specific with some of them, not because I necessarily have any inside information, but because I’ll look good if I’m right and people will likely have forgotten if I’m wrong.”

Listening: reader-recommend Arkells, Canadian semi-hard rockers with a blue-eyed soul sound and strong vocals (think Hall & Oates meets Kings of Leon meets Springsteen.) I’ve listened to the album a couple of times and it’s really good. Nice call by the reader. I’ll definitely be giving it several more listens.

Acquisitions, Funding, Business, and Stock

MedAssets announces that is has paid the $120.1 million deferred purchase consideration due to the former owners of the Broadlane Group as part of the acquisition completed in November.

Frontier Capital invests inHealthx, an Indianapolis-based vendor of health plan portals for patients, employees, and physicians.

Sales

Iowa e-Health selects ACS to implement and manage its HIE.

Summit Medical Group (TN) signs a three-year contract renewal with Zix Corporation for its e-mail encryption services.

The Illinois HIE awards InterSystems a $7.25 million contract to implement its HealthShare HIE technology platform.

North Shore LIJ Health System selects Wolters Kluwer Health’s ProVation Order Sets as its electronic order set solution.

Prognosis HIS announces new sales to Colorado-Fayette Medical Center (TX), Biggs-Gridley Memorial Hospital (CA), Plumas District Hospital (CA) and Shamrock General Hospital (TX).

Mammoth Hospital (CA) will deploy Allscripts RCM services and EHR at its 11 outpatient clinics.

Independence Blue Cross (PA) selects Kony Solutions’ Write Once, Run Everywhere as its mobile application platform.

Mental Health Partners (CO) chooses Stockell Healthcare Systems’ InsightCS RCIM to integrate with the MindLinc behavioral EMR.

Pacific Eye Specialists (CA) selects SRS EHR for its 10 providers.

Doctor’s Medical Center (FL) signs up for Vitera Intergy Meaningful Use Edition for its 23-physician practice.

People

Olathe Health System (KS) hires George Dix as CIO. He was previously with Cape Fear Valley Health System (NC).

Andrew Ziskind MD, previously with Accenture, joins Huron Consulting Group as a managing director in the company’s healthcare practice.

Announcements and Implementations

St. Joseph’s Medical Center (CA) implements PerfectServe’s clinical communication and information delivery system.

Continua Health Alliance and some of its member companies will exhibit personal connected solutions at the International Consumer Electronics Show (CES) in Las Vegas next week. That show outdoes HIMSS in terms of celebrity sighting potential, with Dennis Rodman, Justin Bieber, Snooki, and 50 Cent among the glitterati collecting big corporate paychecks for serving as set dressing for booths.

athenahealth announces that it proactively sought and received a favorable Advisory Opinion from HHS’s Office of Inspector General relating to athenaCoordinator, a fee-based offering that would provide order transmission and coordination services to providers. The opinion clears the way for athenahealth to offer a per-transaction pricing model that charges fees to parties that are exchanging clinical data, but steering clear of anti-kickback statutes.

Government and Politics

HHS announces two winners of its contest to create HIT applications using public data for cancer treatment and prevention. The ONC awarded $20,000 each to the developers of  Ask Dory!, submitted by Applied Informatics, and My Cancer Genome, submitted by Mia Levy PhD, MD of Vanderbilt University Medical Center.

Other

Serbia’s health minister says the introduction of an electronic health card system has turned doctors into scribes, forcing them to fill out forms instead of taking care of patients. He offers a solution: “When a doctor finishes examination, he/she enters data into computer and then takes a health card and fills it in manually. I asked them why not printing the findings and attaching them to the health card. That would speed up the process.”

University of Mississippi Medical Center lays off 115 employees and cuts 90 unfilled positions, saying it’s struggling with increased charity care and coming up with the $80 million it needs to implement Epic.

An Iowa public policy analyst discussing the pre-caucus healthcare climate there says the governor accepted $7 million in federal HIE grants while calling it a government takeover of healthcare. “The practical side of that is that many don’t want the government telling them what to do, and the only way that can happen should this continue forward is by setting up your own exchange, otherwise the feds will set up their own.”

Sponsor Updates

• Free EMR vendor Practice Fusion streamlines its e-prescribing workflow.
• Greenway Medical Technologies and NextGen will join MedAllies at the HIMSS12 Interoperability Showcase to demonstrate MedAllies’ Direct HISP patient data exchange solution.
• Computerworld includes Ugo Mattera, VP of information technology operations at McKesson Health Solutions, in its 2012 class of Premier 100 IT Leaders.
• MED3OOO announces a free webinar regarding its PQRIwizard powered by CECity.
• McKesson introduces its cloud-based supply chain solution to support supports multiple materials management information systems.
• Southern Tier HealthLink (NY) expands its use of Lawson Cloverleaf Hosted HIE.

EPtalk by Dr. Jayne

An article in the Journal of the American Board of Family Medicine discusses barriers to use of formulary information by physicians who e-prescribe. It wasn’t a huge study and the authors claimed it looked at eight practices of varying size and specialty, but a closer look finds the practice size to range from one to four physicians, which I would generally consider to be small practices. Each was using a standalone eRx program. Information was gathered both through observation and through interviews.

Some interesting points. The study included the use of a standalone EHR program, which I bet that made it easier for providers to consider a paper-based workaround. I wonder if the results would have been different if the eRx solution were part of a reasonably robust EHR or if larger practices were reviewed. The researchers had backgrounds in medical anthropology and labor relations, which is certainly an interesting combination.

Although few users were using formulary and benefit references prior to the study, there was a central theme of provider distrust of the electronic resources due to inaccurate data. Providers continued to use paper-based workarounds to find information. Three key difficulties were noted: (a) health plans aren’t required to provide a full set of formulary information; (b) some software packages “normalize” the data, creating groups such as preferred, formulary, or off-formulary which really don’t mean anything; and (c) some payer information is group-level rather than plan-level, which can mean a huge difference in insurance coverage information.

In my market, only 70% or so of the patients have valid formulary information accessible through the EHR despite our attempts to make provision of formulary information a part of our contract renewal process with payers. I agree that the coverage groupings are confusing, but they were confusing in the paper world as well. Personally, I’d like to see some realistic ideas of coverage such as “covered and dirt cheap” vs. “covered but crazy expensive” or even “don’t even think about it.” That would certainly help me be a more Meaningful User.

In addition to immunization and disease surveillance registries, some states are offering registries for Advance Directives, with Virginia being the most recent to head online. I love the idea of patients being able to document what kind of healthcare they want in the event they are no longer able to make their own decisions, and putting it online is a lot more helpful than stashing it in a file cabinet at home or in a bank lockbox. State information exchanges may eventually allow physicians access.

Unfortunate things can happen when patients lose the capacity to indicate their wishes, especially if they haven’t communicated those wishes to family members. Whether you have an online registry in your state or not I, encourage everyone to talk to your loved ones about what you might or might not want done should the situation arise. Some nurses made fun of me when I arrived for an elective procedure (as a sassy 20-something patient) with my advance directive and healthcare power of attorney documents in hand, but I wanted to make sure that in the event of something horrible, it was clear how I wanted my care to proceed.

Speaking of cheery topics, the American College of Physicians recently released its update to its Ethics Manual. The sixth edition features new guidelines that address the issue of cost effectiveness and efficiency in care delivery. Other new or expanded sections include: confidentiality and EHRs; health system catastrophes, social media and online professionalism; pay for performance and professionalism; and patient centered medical home.

Websites like Groupon that offer daily deals are increasingly prone to offer health-care related services. Patients without coverage use the discounts to receive dental care, while others may take advantages of bargains on elective or non-covered services such as Botox or laser vision surgery.

Contacts

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

Acquisitions for Mediware, Cumberland Consulting, and TriZetto

Mediware has announced its acquisition of the assets of Transtem, which sells software for managing adult stem cell collection and transplantation. Mediware President and CEO Thomas Mann said in the announcement, “This is cutting-edge healthcare that is pursuing cures for such large patient population diseases as myocardial infarction (MI), critical limb ischemia (CLI), Parkinson’s disease, diabetes, cancer and many others. Importantly, there is a growing demand for a comprehensive software solution to effectively manage the collection and preparation of the therapeutic cell solutions as well as streamline donor, patient and treatment data management.”

Cumberland Consulting Group has been acquired by members of its management team and private equity firm Tailwind Capital, with participation by investor and former HCA Chairman R. Clayton McWhorter. Tailwind Managing Director Geoffrey Raker said in a statement, “This transaction represents a tremendous opportunity for Tailwind to invest in a proven platform that provides high quality services to a dynamic industry in the midst of an IT transformation. Cumberland has a very experienced management team and is well-positioned for future growth and expansion. We look forward to supporting Cumberland as it pursues future organic initiatives and acquisitions.”

TriZetto announced this morning that is has acquired Medical Data Express, which offers Medicaid and Medicare encounter management software. TriZetto Chairman and CEO Trace Devanny said in a statement, “By acquiring MDE, TriZetto is cementing its ability to offer customers a proven, comprehensive and reliable solution that helps payer organizations meet federal and state requirements for medical encounter data processing. We are committed to continuing to enhance our suite of solutions helping Medicare and Medicaid plans leverage the efficiencies they gain for strategic advantage while maintaining compliance.” 

2012 Mobile Clinician Voice Challenge 1/4/12

The Problem

Clinicians and their mobile devices are everywhere. Doctors, nurses, and other licensed professionals are interpreting clinical information and making clinical decisions right now using smart phones and tablets, often from locations outside the four walls of the hospital, clinic, or medical practice. They need better ways to interact with these systems beyond tiny keyboards.

The Solution

Give mobile clinicians a voice by speech-enabling your applications, both Web-based and mobile, with as few as two lines of code and in as little as a couple of hours. Free them from the limitations of poking at keyboards that are too small for normal fingertips –let them document on the go using their voice.

Link.

The Challenge

The 2012 Mobile Clinician Voice Challenge offers over $25,000 in prizes for most innovative, speech-enabled healthcare application (Web-based or mobile) developed using the HIPAA-secure, cloud-based Nuance Healthcare Development Platform. The contest runs through February 3, 2012, with winners to be announced at the HIMSS conference.

The Prizes

Full Details

Information is available on the contest page. See the text ad in the right column of HIStalk as well, which will run throughout the contest.

Not a Developer?

Tweet about the contest using @NUAN_Healthcare and #2012mobilechallenge and you’ll be entered in a daily giveaway for contest tee shirts and an iPad 2.

Contest Video

Link.

An interview with Jon Dreyer, senior manager of mobile solutions marketing, Nuance Communications, Healthcare Division


Describe Nuance’s philosophy about the mobile clinician.

The “mobile clinician” is quickly becoming synonymous with the modern clinician. In fact, physician smart phone adoption, which is currently at 72%, outpaces the general U.S. adult population by more than 50%.  And by the end of 2012, mobile device adoption among healthcare professionals is expected to reach 85%.

Whether racing from exam room to exam room or working remotely, mobile access to clinical information and mobile collaboration tools are essential for caregivers. This new breed of healthcare professional is in need of better experience-enhancing technologies, such as speech recognition that is available on any device at any time, in order to be completely untethered, yet still be fully plugged in to interact with and contribute to the care delivery process.

With voice-powered applications becoming common, especially on smart phones, do you see that as becoming a standard for systems designed for clinician use?

Absolutely. Voice will continue to grow as a primary form of input into mobile devices for consumer markets as well as within healthcare. Touchscreen devices with small onscreen or physical keyboards will never catch up to the speed of data entry on a desktop environment. Speech recognition overcomes the challenges associated with touch typing and bridges the gap to provide a ubiquitous experience for all users on all devices and platforms.

Keep in mind that speech recognition software designed specifically for healthcare professionals has been in use for more than a decade. On a daily basis, hundreds of thousands of clinical users across all healthcare specialties rely on the technology to reduce turnaround times, cut costs, and improve the overall delivery of patient care.

Given the dramatic rise in mobile device adoption over the past few years, and its projected growth, it’s only natural that the speech recognition experience clinicians have come to appreciate on their desktop is something that they will expect from their mobile and web-based apps as well.

Give me some cool ideas or apps you’ve seen that would be a good choice to speech enable just in case developers out there need some inspiration.

We have more than 100 partners in our evaluation program today. Healthcare app developers are rapidly embedding secure, cloud-based, medical speech recognition in point-of-care documentation/mobile EMRs, reference and content databases, disease management, clinical trial, pharma, and specialty-specific reporting tools. The applications run on a variety of devices and operating systems that are supported by the development platform, including iOS, Android, Web Browser (Internet Explorer, Safari, Firefox, Chrome), and native desktop applications.

Examples of clinical scenarios and apps that use speech recognition powered by Nuance Healthcare include:

• Mobile EMR access. With speech recognition as part of the workflow, physicians can easily voice document findings and clinical notes without having to return to a workstation or office.
• Interactive patient-side care. Specialists using mobile applications can now visit patients post-surgery and retrieve, as well as document using their voice, all relevant information on their mobile devices.
• Trauma communication and coordination. With specialized, speech-enabled mobile apps, clinicians can capture in their own words the patient story without delay. In a trauma scenario where every minute matters, this streamlined mobile approach helps to speed communication across care teams while expediting prep time for surgery.
• Diagnostic image view and reporting. Radiologists can now access patients’ diagnostic images via their mobile device and dictate reports from anywhere and at any time. The time in which patients receive feedback and care can be significantly shortened.

Do you have any words of encouragement for those who are thinking about entering the challenge?

Healthcare app developers should join the challenge because there’s really no reason not to participate.  Not only is it free to evaluate the Nuance Healthcare cloud-based medical speech recognition technology, but it’s also easy to integrate, deploy, and maintain. It requires minimal development effort (most evaluation partners have their integrations up and running within a few hours of registering) and clinical end users will benefit greatly from having access to medical speech recognition from their mobile and web-based apps.

Contest Notes

• The contest is open to any developer who is a legal resident of the US.
• You can submit multiple entries.
• Apps do not need to be live and/or commercially available.
• Apps do not need to be written specifically for the contest – it’s OK to integrate the speech service into an existing app.

Links

• Contest page
• Press release
• Nuance Healthcare’s ‘For the Health of IT’ blog
• Twitter
• Facebook

QuadraMed Acquires NCR Healthcare Solutions

QuadraMed announced this morning that it will acquire the healthcare solutions business of NCR Corporation, whose products include a patient access kiosk, patient and physician portals, and a payment solution. Terms were not disclosed.

NCR acquired the product portfolio when it bought Maitland, FL-based Galvanon in December 2005.

QuadraMed CEO Duncan James was quoted in the announcement as saying, “This addition to QuadraMed’s portfolio is a logical extension of our existing Access and Identity Management offerings. NCR’s healthcare solutions will improve our clients’ ability to meet the increasing demand for patients to control and self-direct their healthcare experience at hospitals, clinics and physician practices.”

NCR’s healthcare workforce in Lake Mary, FL and Hyderabad, India will become QuadraMed employees on January 5, 2012.

News 1/4/12

Top News

The District of Columbia, armed with $1.06 million in ARRA money, issues an RFP for an HIE technology platform. Bids for the one-year contract are due on January 13. The District decided to support the simpler Direct Project rather than a traditional HIE last year, putting the DC RHIO, which was expecting to get the grant money, out of business.

Reader Comments

From Sunshine: “Re: new hire. Mike Mieure from Sunquest and Misys is the director of IS for Vitera Healthcare.” Confirmed via LinkedIn.

  From Tipsy: “Re: tips for meeting with reporters. Joseph Goedert has some great advice for vendors scheduling meetings with the press. My personal favorite: don’t send your marketing manager to talk to the reporter.”  Mr. H does far more interviews than I do, but I am sure that if anyone attempted to give us a lesson on HITECH basics, we’d be making fun of them later. If you handle media relations for a vendor or PR firm, do yourself a favor and give Joe’s blog post a quick read.

From AnotherDave: “Re: Dr. Jayne’s 1/2/12 post, What Gets Measured Gets Managed. To quote Nick D’Onofrio, ‘You can expect when you inspect.’” Dr. Jayne outdid herself with her post this week, which is getting tweeted and mentioned all over the place. It was informative while being fun to read. She enjoys using reader feedback for future posts, so if you have something you’d like her to write about or comment on, e-mail her.

From Pyorrhea, IL: “Re: a second Judy Faulkner article. Does this include any new information, or is it just the same thing over again?” The first article seemed merely politically biased and sloppy with facts, but the second one by the same author ventures into pure nut-job territory, claiming “a de facto alliance between Epic and the Service Employees International Union” because some of Epic’s hospital customers employ SEIU-organized labor, which is hardly shocking given that Epic’s core customer base is academic medical centers in big cities. I have one positive comment about the article: it was short.

HIStalk Announcements and Requests

  Mr. H seems to have survived without my assistance last week. No surprise, of course, but I like saying it so he’ll take a moment to reflect on how much more fun it is to have me around pinging him with e-mails all day. In my absence, I have noticed almost all our sponsors have now replaced their animated ads, giving the site an almost Zen-like peacefulness (thank you, sponsors.) Now that I am back, Mr. H and I are heads down in our HIMSS planning and are excited about a couple of new fun projects in the works. In addition to the more serious stuff, we are addressing details for the annual Inga Loves My Shoes contest, as well as the crowning of the HIStalk King and Queen for the best-dressed HIStalkapalooza party-goers. I predict an exhaustingly good time will be had by all.

It’s the New Year, so it’s time for HIStalkapalooza signups. Our amazingly gracious, creative, and fun event sponsor ESD has been working tirelessly for months in planning a memorable Las Vegas event for you. It’s at First Food & Bar in The Shoppes at the Palazzo (ESD bought the whole place out for the evening) on Tuesday, February 21 at 6:30 p.m. ESD is a consulting firm, so let’s go over the deliverables. Great food – check. An award-winning bar plus specialty drinks such as the IngaTini, the Mr. H Incognito, and the ESD Activation Sensation – check. Fun contests involving shoes and people dressing up – check. A special performance by Elvis – check. And of course, Jonathan Bush and the HISsies – check and mate. Click the graphic above, the button to your right, or here to request an invitation. If we get fewer requests than we have capacity, then beautiful – everybody who signs up will get an e-mailed invitation. If we’re overbooked (which has happened every year so far, and often quickly), we’ll invite the number of folks we can handle. HIStalkapalooza is held in honor of those involved with HIStalk, HIStalk Practice, and HIStalk Mobile in any way (reader, sponsor, contributor, etc.) and we gratefully acknowledge the support of ESD in making it possible. More to come once we get the signups finished.

Here’s some background about ESD (they didn’t ask me to talk them up, but it’s the least I can do considering they’re paying for HIStalkapalooza.) The Toledo, OH consulting firm provides expertise that includes clinical transformation, go-live support, legacy system maintenance, staff augmentation and training, system optimization, and help with ICD-10 and Meaningful Use projects. Clients often (always?) need healthcare experience and workflow expertise that’s way over the head of freshly minted vendor implementers. That’s where ESD’s expert clinical consultants can save the day, helping CIOs sleep at night by reinforcing their front lines to complete projects, generate ROI, and optimize processes. Founder and President Joe Torti started the company as a solo consultancy in 1990 and has grown it to over 400 clinical IT consultants (nurses, physicians, pharmacists, etc.) and 30 corporate employees. If you’ve been around awhile, you’ll no doubt recognize some of the management team names as I did: Joe Mason, David Tucker, and Dan Oberle, to name a few. ESD not only brings you HIStalkapalooza 2012, but is also a Platinum Sponsor of HIStalk. I greatly appreciate the ongoing support of ESD.

Acquisitions, Funding, Business, and Stock

Chicago-based solar products company SoCore Energy LLC raises $3 million in an equity offering. Among its investors is an investment fund run by Michael Ferro (Merge Healthcare). The company’s chairman and co-founder is Allscripts CEO Glen Tullman. I Googled hoping to find that Epic’s mammoth solar installation used solar panels from SoCore, but nothing came up, dashing my hopes for perfect irony.

Sales

San Jacinto Memorial Hospital (TX) selects PerfectServe’s clinical communication and information delivery platform.

The Premier Healthcare Alliance awards a group purchasing agreement to Authentidate for its Electronic House Call Kiosk and Interactive Voice Response solutions.

Stanford Medical Center (CA), HealthEast (MN), Oakwood Healthcare, and McLaren Healthcare (MI) prepare for the ICD-10 deadline by utilizing OptumInsight’s A-Life Medical computer-assisted coding.

Albany Area Primary Health Care (GA) selects eClinicalWorks EHR suite for its 14 locations.

People

MedQuist hires Michael Raymer as SVP of solutions management. He was previously general manager of Microsoft’s Health Solutions Group.

Announcements and Implementations

Tuomey Healthcare System (SC) partners with Advanced ICU Care to deliver remote tele-ICU monitoring by intensivists and critical care specialists.

Regional Health Services of Howard County (IA) launches Cerner at its 25-bed acute care hospital.

Canton-Potsdam Hospital (NY) begins installation of MEDITECH 6.0.

AirStrip Technologies earns CE Mark certification for its FDA-approved mobile patient monitoring applications, allowing them to be sold in Europe and other areas.

Intelligent InSites integrates the TempSys Fetch real-time locating technology into its RTLS system. The InSites RTLS software solution works with several sensing systems, including active and passive RFID, ultrasound, WiFi, and ZigBee.

Pike County Memorial Hospital (MO) goes live on McKesson Paragon, earning the hospital a story in the local paper.

George C. Grape Community Hospital (IA) will hold a Virtual Ribbon Cutting next week to celebrate the completion of its EHR implementation and Meaningful Use attestation. The 25-bed hospital had to deal with Missouri River flooding through the summer as it accelerated its Meaningful Use timelines as a beta site for Healthland’s Centriq small-hospital EHR.

Government and Politics

Washington’s state prescription database goes live, but previously supportive doctors and pharmacists line up against it when the US Department of Justice tells the state not to expect to get federal money for the $530K annual operating costs. State health officials ask lawmakers to remove the portion of the law that bans charging providers for its use, which would entail yearly per-provider charges of $11 to $15.

In Canada, the leader of Ontario’s democratic party calls for a hospital CEO salary cap of $418K – double the premier’s salary — after hospitals release their compensation contracts following a ruling that they are covered by freedom of information laws.

Other

The US Patent and Trademark Office issues a patent to DR Systems for technology that tracks the resolution (or other parameter) for a displayed medical image.

Indiana University Health Physicians misses its 1,200-physician year-end employment target by 350, with some of the slowdown attributed to physician delays in committing to a common EMR and approving common treatment protocols.

Joslin Diabetes Center (MA) partners with Alliance Health Networks to participate in that company’s Diabetic Connect social network.

Sponsor Updates

• Phoenix Children’s Hospital shares how deployment of the Vocera wireless communications solution has improved communication in its NICU.
• NextGate profiles Hartford Hospital (CT)and its use of  NextGate’s matching technology to identify patients in Connecticut’s HIE.
• Besler Consulting announces the general availability of BVerified Transfer DRG and BVerified IME proprietary solutions.
• Concerro adds VLOG, a video blog option, to its Concerro University client learning center.
• Intellect Resources is holding Big Break New Orleans on January 21, a one-day audition for folks who want to help Ochsner Health System implement Epic as trainers.
• Independence Blue Cross chooses Kony Solutions as its mobile application platform.

The Iowa Caucuses and the Stakes for Healthcare
By Donald Trigg

How should we feel about an anonymous force driving US policy? Does it serve our interests to have a beef-loving sovereign dictating our national conversation? Should a single player carry such outsized influence?

We are talking, of course, not about Mr. HIStalk, but the first-in-the-nation caucuses this evening (Tuesday) in Iowa. And in the less harried first days of the New Year, a moment offers itself for a primer on the quadrennial contest and a short exposition on how it might inform the health policy dialogue this fall.

Forty years ago, an obscure McGovernite orchestrated an early start date for the Iowa caucuses. Four years later, a peanut farmer named Jimmy Carter leveraged a “win” (finishing second to uncommitted) to vault to national prominence, a party nomination, and then the White House. Iowa’s outsized role in the nominating process has been set ever since.

The number of delegates at stake in Iowa toward the 1,143 needed for nomination is modest. GOP aspirants are looking, instead, for what George H.W. Bush in 1980 called the “Big Mo.” In our vernacular, Iowa is not a supplier of choice designation. It is a down select.

Indeed, since 1972, the eventual GOP nominee has finished in the top three in Iowa with only one exception. But unlike the definitively predictive South Carolina primary, Iowa does not decide the GOP nominee. It is the “winnower” of the field.

The mechanics of the caucus process are straightforward. Voters gather in roughly 800 locations, typically in a church basement or a high school gym. After electing a temporary chair and a secretary to record the proceedings, Republicans rise to speak on behalf of their preferred candidate. Then, votes are cast. The results are aggregated and a late evening winner is declared.

If the process is fairly unambiguous, the fate of the six candidates contesting Iowa is less clear-cut. Historically, the GOP has nominated by primogeniture — falling in lockstep behind the next person in line. The 2012 race has been marked from the outset by the absence of an overwhelming front-runner.

Instead, the so-called Exhibition Season has seen a series of volatile swings from candidate to candidate in an elusive search for an alternative to former Massachusetts Governor Mitt Romney. Michelle Bachman. Rick Perry. Herman Cain. Newt Gingrich. Now, we are seeing a late “Santorum Surge” that may put the former PA Senator within striking distance this evening.

It has been said that there are only three tickets out of Iowa. Romney, Paul, and Santorum appear to be clutching them, according to the final Des Moines Register poll. But with 41 percent indicating that they could still change their mind, the Register’s Kathie Obradovich rightly characterized the race as “a moving target.”

The stakes for healthcare are large. David Blumenthal wrote last month in the New England Journal of Medicine, “The 2012 election will be the most important in the history of the health care system.” For all the potential implications in 2013 and beyond, however, the topic has featured only modestly, even comically, thus far.

We had, to the chagrin of public health advocates, Herman Cain advisor Mark Block silently smoking into the camera –reminding us that a 20-something staffer, a video camera, and free time are the campaign equivalent of whiskey, car keys, and teenage boys. We had Romney’s Massachusetts bill, and its common features with the Accountable Care Act, as consistent debate fodder. And we had the criticism of Gingrich amid his Q4 rise for his paid advocacy through the Center for Health Transformation to his vocal backing of Part D in 2004. But neither deep policy substance nor deep debate has featured to date.

One reason, beyond the constraints of the modern campaign, is that the US economy looms so large. An NBC/Facebook poll of early state voters out Sunday put the economy at 59 percent as the top voter concern ,with the federal deficit at 19 percent and with healthcare a distant third at just 11 percent. There is little reason to think that mix will shift this autumn.

The impact of that framing for healthcare finance is that the “second phase” debate will be centered almost exclusively around cost and predominately within the context of the current FFS model. We are headed toward a moment akin to the 1997 Budget Act and it may come as soon as 113th Congress.

But first we will need a GOP standard-bearer. Iowa, “the purest of prairie states,” is an opening step in that drama. It is a good and decent place where Winenrenner properly wrote the politics are “clean and competitive” and, just like HIStalk, “the arena is fair and open.”

Donald Trigg is chief revenue officer for CodeRyte. He worked for then-Governor George W. Bush during the 2000 presidential cycle in Austin, TX. He has traveled to all 99 counties in Iowa, suffering chilly winds and an unsettling amount of chicken fried steak.

Contacts

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

Monday Morning Update 1/2/12

Happy New Year!

Given the lame (and guardedly vague) healthcare IT predictions for 2012 that I’ve seen, written by reporters and other non-combatants, I’ll pass on giving my own. Some of the pearls of predictive wisdom: (a) companies may consolidate; (b) consumers will be engaged; (c) ACOs will be formed and will need analytics; and (d) social networks will be used to encourage good health.

My Time Capsule editorial from this same week of 2006: Can EMRs Sweeten their ROI by Moonlighting as Research Databases? A random sample: “Repurposing that existing information by making it available to those willing third-party customers, even when motivated purely by mission-supporting cash, is at least more beneficial to society than running a McDonald’s or building medical office buildings.”

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

The HIT bubble is here to stay, most readers believe, which must mean it’s not really a bubble in their minds. New poll to your right: when a hospital says having its clinical systems offline for several hours resulted in no patient harm, do you believe them?

We’ll give the HISsies nominations just a few more days before moving on to the actual voting, so this is last call to get your candidates on the ballot. Some obvious choices haven’t been nominated, I should say.

Here’s Vince’s HIS-tory on outsourcing.

Geisinger Health System (PA) says it will not hire smokers starting in February, when job applicants will be required to take a nicotine test.

Reading Hospital (PA) retools its executive team to put clinicians in key roles. The new CEO and COO are nurses, while the new CMIO, chief medical officer, and VP of academic affairs are physicians. The CEO, COO, and CFO all came from the consulting company the hospital had engaged to review best practices. The hospital says it’s also implementing a management process that includes physicians in every decision. Also mentioned is the hospital’s $180 million decision to implement Epic, which the hospital’s board chair says “will explode the quality of care and increase patient satisfaction.”

Cleveland, OH health systems Cleveland Clinic and MetroHealth are sharing electronic patient records and Kaiser Permanente will join them shortly. They’re using Epic’s Care Everywhere rather than an HIE, meaning they can access the records of patients who have opted in from 300 hospitals and 4,000 clinics.

Stanford researchers develop an application that allows technicians to control MRI machines from HP’s TouchPad tablet, which was discontinued within two months of its launch and sold off for $99. The researchers liked it because HP helped them remove its metal parts, a requirement for operating near an MRI magnet.

A British physician advisory group proposes that NHS allow patients to review their own electronic medical records by 2015, including the ability to review physician notes and request prescription refills and appointments online. Expected roadblocks are patient confidentiality concerns, physicians who don’t want patients to see their documentation, and NHS’s potential inability to provide such a service.

A California hospital investigates one of its contracted employees who allegedly posted a photo of a patient’s medical record, including the patient’s name, on Facebook with the comment, “Funny, but this patient came in to cure her VD and get birth control.” Several people scolded the employee on Facebook for violating the patient’s privacy, to which he replied, “People, it’s just Facebook … Not reality. Hello? Again … It’s just a name out of millions and millions of names. If some people can’t appreciate my humor than tough. And if you don’t like it too bad because it’s my wall and I’ll post what I want to. Cheers!”

A man who rear-ended a parked fire truck and then sued the firefighter who saved his life gets nothing in the settlement of his lawsuit. The fire truck was parked in the opposite lane as firefighters were responding to an accident. The driver had a long record of traffic offenses, had been ordered by a court not to drive, was not carrying insurance, and was taking three judgment-altering drugs. He lost control while speeding on the rain-slicked road, crashed into the fire truck, and had to be flown out by medical helicopter. He wanted $300K to settle his suit that claimed the fire truck was parked in his lane, which the crash scene photo appears to show is not the case. The city paid $47,000, of which the man’s children will get $20,000 and lawyers $27,000, claiming it was cheaper to pay the money than the cost of a trial. Since the accident, the driver has been convicted of two additional crimes, one of them a felony that will likely send him to prison.

I’ll have full details on HIStalkapalooza mid-week, so watch for that if you’re interested. Readers always like to guess a company given a tiny section of their logo, so above is your challenge.

Also coming mid-week is information about an application development contest that we’re helping promote. Here’s the story.

One of our sponsors asked us if we had additional promotional opportunities available, i.e. they wanted to buy a featured post or access to the e-mail list. They were running a fun-sounding contest with some pretty cool prizes, right down the alley of HIStalk readers who have written medically related software (vendors or providers alike.) We said no, we don’t do that – all we offer is sponsorships, all sponsors get the same benefits, and we will never make the e-mail list available to anyone. We always turn down requests to provide more exposure for cash.

Inga and I were noodling around on how we might help in a non-commercial way that would benefit someone other than ourselves, so instead of just saying no, we told them, “Make a big donation to charity and we will help get the word out to our readers as long as we can do it our way.” They agreed. We suggested the charity and the dollar amount, to which the company also (surprisingly) agreed.

Receiving the company’s ample donation was Homes for our Troops, a top-rated charity (98.5% on Charity Navigator) that builds specially designed houses for severely injured and disabled veterans who receive them at no charge, with the assistance of donated labor and supplies. Our designated recipient is Marine Staff Sergeant Jack Pierce of Temple, TX, paralyzed from the chest down in his third deployment in Afghanistan when his vehicle drove over a 200-pound bomb, killing two other occupants and severely injuring six. The apartment in which he, his wife, and their young son live is not wheelchair accessible.

I’ll be sending the contest information out around Wednesday.

HIT Vendor Executives – Part Two of Two 12/30/11

We asked several HIT vendor executives the following question: Where do you plan to invest your research and development dollars over the next 1-2 years?

Tim Elliott, Founder and CEO, Access

We are focusing on three technologies that every hospital needs: electronic signature, a data bridge between clinical devices and systems and EHRs, and paperless, online e-forms.

The next generation of e-signature not only enables patients to quickly and securely authorize e-form registration packets and bedside consents, but also offers administrators the convenience of a server-based model. A clinical data bridge can capture and standardize output from devices (such as EKG traces and surgery images) and systems (perinatal documentation, COLD feeds, etc), and interface these directly into EHRs – with no paper or manual indexing.

Finally, we’re giving hospitals a way to transform slow, inefficient paper-based processes – such as onboarding, capital requests and physician referrals – into fast, collaborative, paperless ones. Users will be able to access electronic forms from their browser, add attachments, apply digital signatures and send through the proper channels, and to track each stage of the process. Upon completion, a copy of the form is archived in the ECM system and data posted to business and/or clinical systems. With healthcare facilities shooting for full EMRs, we’re doing our part to create technologies that fill the gaps, and are focusing our R&D on removing paper from as many processes as possible.

Ray Dyer, CEO, Acusis

As a clinical documentation solution provider, we continue to look to our customers and healthcare IT market drivers. Given the many transformations underway, driven to a large degree by healthcare provider behavior, we are planning on investing our R&D funding in user intelligence tools including decision support and patient care analytics as well as mobile solutions development. We believe these areas will continue to be driven by customer need and demand, requiring data availability with strong privacy and security provisions. Acusis is poised and preparing to meet these challenges.

Dan Herman, Founder and Managing Principal, Aspen Advisors

Aspen Advisors’ investments will be focused on the expansion of our current services to address the needs of our clients:

• Adoption of EMR technologies and clinical informatics;
• Healthcare reform in support of “accountable care” delivery and financing models;
• Operational integration of Business Intelligence and Data Warehousing solutions to enhance care delivery, improve quality, reduce costs; and
• Improved reliability and cost effectiveness of technology infrastructure through the implementation of structured IT service management processes.

We will continue to invest in the development of structured, repeatable, yet flexible methodologies for planning and assessment, implementation management, and operational performance improvement.

We will also continue our investment in training programs for our consultants, so that our clients will continue to see the consistent application of expertise and delivery of service as our firm continues to grow.

Don Graham, General Manager, Billian’s HealthDATA

Our R&D investment will focus primarily on improving our data on outpatient care, and the better use of social media internally to communicate who we are and what we have.

With outpatient surgical visits now accounting for almost two-thirds of all surgical visits in the US, it is an area that our customers – healthcare vendors – are paying more and more attention to. We in turn must provide them with the data they need to best address this trend, which doesn’t show any sign of slowing down in my opinion.

As for social media, it’s proving to be the most effective way to distribute the news. That includes, of course, healthcare news. We realize that our customers and their provider customers are increasingly using social media as a means of communication and self-education, not to mention public relations and marketing. Patient referrals, good and bad, will have an ever-increasing influence on healthcare-related decisions made by the public, and the public’s migration to social media is obvious.

We, of course, want to be where our customers are, whether that be Twitter, LinkedIn, or blogs like HIStalk, so we’ll be ramping up our social media presence internally to make sure that staff are engaged and conversant in the healthcare discussions taking place online.

Stuart Long, President, Capsule

As the leaders in device integration, we’ve always been in the data business. Yet data needs are rapidly evolving. We are going well beyond the basic connectivity of data into information system(s). Basic connectivity is actually well understood as a necessity at this point; hospitals get that automating the vitals collection process is critical to recovering nursing hours, reducing charting hours and improving patient care. What they really need is better, more useful data to help improve decision making, to alert them to impending conditions faster and to improve the quality and safety of patient care overall.

We’ve reached a tipping point; hospitals are starting to scream “information overload.” Our customers are saying “we get so much data, from so many sources, that we need help sorting through it all; we need it presented in a meaningful way so we can act upon it faster.” We hear them loud and clear and will therefore be investing heavily on data; on how we increase the value of data so we can manage and disseminate the discrete data and communicate additional relevant context and meaning of that data to the right caregiver, at the right time, about the right patient. It’s a tall order and will take a lot of work with our EMR partners as well to make it a reality, but I think we are in the right place, at the right time to make it all happen.

Mac McMillan, CEO, CynergisTek

That’s easy — on the areas of privacy and security representing the greatest challenges for our customers.

We have always prided ourselves on staying out ahead and anticipating the needs of the industry and the needs of our customers in privacy and security. Five years ago, that meant attacking things like data leakage, encryption, and log management/auditing. Today it still involves finding better ways to monitor activity in the enterprise, but it also includes things like securing the cloud, defining managed security services for healthcare, managing the risk associated with the proliferation of mobile devices and medical devices that are not secure, and finding ways to better manage the security requirements with Business Associates.

Healthcare has enough complexity in its environment and more than enough on its plate with HIE, ACO, ICD-10, etc. It needs practical security strategies and solutions that work and are effective at stemming the tide of breaches like we have seen this year. We believe that in order for healthcare to win the battle with privacy and security, it’s going to take an investment in the right technologies and integration of Managed Security Services into compliance programs. We understand that technology alone is not the answer, and so the focus should be on implementation strategies and building the right processes around these technologies that enable them to be successful.

Michael O’Neil, CEO, GetWellNetwork

In recognition of the emerging reality that healthcare will be delivered anywhere and everywhere, no matter what the time, device or location, GetWellNetwork will sustain its investment in innovative Web-based, mobile phone and cable television technologies. When used properly, such technologies will support communication, education and even engagement throughout a patient’s care journey — from the home to the physician office, hospital, imaging center, or pharmacy and back to the home once again.

Platform-agnostic, technology-enabled patient engagement will be indispensable to providers, payers, and vendors as they work collaboratively to reduce hospital readmissions, promote self-care, boost patient and member satisfaction, and decrease cost per case. At GetWellNetwork, we are making significant investment in helping providers fulfill Stage 2 and 3 Meaningful Use requirements, and address the evolving challenges of medical home, accountable care and bundled payments.

Peter J. Butler, President and CEO, Hayes Management Consulting

At Hayes, we plan to invest R&D dollars in our hospital billing compliance software, MDaudit Hospital. It is designed to give auditors access to billing data to support revenue integrity, helping them to eliminate the errors for which CMS routinely recovers payments through its integrity programs such as RAC, MAC, and the efforts of the OIG.

However, we are finding that our clients are increasingly asking us about using this tool for other strategic projects such as ICD-10 documentation improvement, Meaningful Use, and data mining. Therefore, we are exploring related tools to use for these additional purposes. For example, via our recent integration with MediRegs clients can look up diagnosis and procedure codes and documentation requirements while in MDaudit. Additionally, some of our auditors are using MDaudit as a physician training tool on ICD-10 documentation.

Tiffany Crenshaw, President and CEO, Intellect Resources

Intellect Resources is investing in identifying and breeding new talent for the healthcare IT industry, with emphasis on training and go-lives.  In 2011 we debuted Big Break, a high-energy recruiting event designed to select an entire training and go-live teams in short period of time. Big Break is marketed towards individuals with no or minimal healthcare IT experience who have the right attitude, enthusiasm, and potential.  In an intensive one-day recruiting event, job applicants must complete a series of rigorous tests – one-on-one and panel interviews, extemporaneous public speaking, group work and classroom presentation skills – designed to identify only the best training and go-live talent.   

Once selected, Big Breakers complete an intensive course with classroom and hands-on learning, credentialing them in the appropriate EMR. As a result, a hospital system is able to select an entire training and go-live team in just a few days. Because Big Breakers do not typically have prior industry experience, they can often be secured at a fraction of the cost. As a result, hospital systems are able to breed and retain this new talent at a fraction of industry costs in a short amount of time.

Doug Burgum, President and CEO, Intelligent InSites

In our pursuit of improving care while lowering costs, we’ll be investing in three primary areas in the next 1-2 years.

First, one of Intelligent InSites’ most important objectives is to improve caregivers’ ability to spend more time at the patient bedside. To this end, we’ll be continuing our R&D investment in automating non-value-added manual tasks—including EHR data entry and finding available, clean equipment through easy-to-use applications—to give caregivers more time to spend with patients.

Second, as our solution utilizes RTLS and RFID technologies to know the location, status, condition, and interaction of all tracked equipment, patients, and staff throughout the hospital, we collect a massive quantity of operational data, every minute, every day, month after month, year after year. Through our Business Intelligence solution, we help our customers harness this “Big Data” to produce actionable insights critical to making sound and timely decisions, by utilizing flexible, high-impact, easy to create reports.

Third, because real-time data is generated from a wide variety of data sources, and because real-time intelligence can empower multiple healthcare IT systems, we’ll be continuing our investment in our partner ecosystem. We will continue to integrate with the expanding set of RTLS hardware vendors, and we’ll continue to expand our interfaces with EHR solutions, communications platforms, asset management applications, building management systems, and nurse call systems.

We are excited about investing in the future of RTLS, the “magic” of enterprise RTLS software, and helping our customers to truly improve the care they deliver, while simultaneously lowering their costs.

Tom Carson, CEO and President, MD-IT

MD-IT has traditionally developed and delivered software functions that provide or support practical use of technology for physicians and patients, and that will continue to be our focus. Like most vendors, we will keep an eye on Meaningful Use requirements and other market developments, but identifying specific features beyond the near term is tough, as the HIT market is quite volatile at this point.

We expect to see evolving demands as the industry moves from what we think of as effectively an EMR version 1.0 environment to a more mature EMR version 2.0 environment that is more sensitive to the needs of physicians and patients as the primary users of these systems. Certainly near-term efforts will be directed to expansion of our popular mobile functionality that streamlines physician workflows, as well as continued broadening of our interoperability functions that link providers, patients, and payors.

Patrick Hampson, Chairman and CEO, MED3OOO

We are focusing our investments and resources in numerous areas. MED3OOO has committed to focus our knowledge, products and services with a MED360 view of healthcare delivery. We are not like most vendors just supplying systems. Our investments will continue to expand our current operational and technical capabilities and offerings. We will continue to integrate our proprietary systems, and continue our investments in capturing and using data of populations. We will continue to invest in tools that providing information across the entire spectrum of care focused on: efficiencies wherever we can find them, the patient and provider experience, the cost and most importantly the quality of care delivery. We want to be the best partner to providers that is in the industry.

Our investments in point-of-care capabilities will also create a great differentiation for the providers using our proprietary systems. As part of this, we are investing in the area of clinical decision support. “CDS” in an Electronic Health Record can take many forms. It is certainly more than providing guidelines to a provider. We want to focus on the user experience and want to spend a lot of effort with physicians reviewing workflows to determine how CDS can truly add value to the provider and patient when care is being delivered. Our addition of Quippe is just one example of these efforts. Quippe is the state-of-the-art documentation tool in the industry and is the basis of enhanced CDS within our InteGreat EHR offering.

These efforts are also critical to the physicians and hospitals we have partnerships with, but who are on older technologies or legacy systems even though they come from today’s brand vendors. Physicians already have investments in these systems. They too, need these higher level capabilities and they too need knowledge-based solutions. While these systems may be older and not web- based, MED3OOO, as their operating partners we work to provide solutions to improve on the capabilities these older systems just do not have. A system agnostic approach allows us to not just throw them out and waste physician’s precious capital. We try to maintain those systems and it is somewhat like the BASF commercials, “We don’t make things, we make things better.”

Lastly we will continue to expand our significant M3IQ data warehousing capabilities, capturing data from disparate systems, continuing our focus on the promise of combining financial claims and clinical data, and turning that data into actionable, predictable intelligence.

Robert Connely, Senior Vice President, Medicity

We are going through a period of enormous change in healthcare, and it’s clear that healthcare IT will play a critical role in that change. Medicity is focused on a strategy that will enable rapid adaptation to changing requirements while realizing a more cost-effective model that we believe will lead the next generation of information technologies.

Today, we’re building out the underlying IT infrastructure required for tomorrow’s healthcare, including integrating EHRs, building data exchanges, and standing up repositories. We are expanding our analytics capabilities and are involved with developing standards like ONC Direct. 

Many of our R&D efforts are targeted at integrating and improving our family of products. The strategy levers common technology platforms, modular apps, and cloud services. We believe that by porting much of our current functionality into apps designed to run on a platform like iNexx (Medicity’s individual network exchange), we can reduce time to market for new features, control development costs, and provide a greater opportunity to adapt to new needs quickly. 

We believe that technology is evolving to the point that it can adapt to people as opposed to people adapting to the technology.  Towards this end, we continue to invest in emerging technologies and markets.  For example, our efforts range from pioneering pervasive analytics that employ software agents to better analyze information at the source, to enabling consumer platforms to drive better health.  We are also focused on building solutions that leverage payer, provider, and consumer interactions to create more effective care.

Peter Kuhn, CEO, MEDSEEK

MEDSEEK has always been ahead of the curve, developing strategic patient engagement and management solutions that help healthcare executives realize cost savings by improving care collaboration within existing workflows and find new revenue streams by finding and engaging patients. We were among the first to deploy our enterprise solutions to assist hospitals in finding, engaging, activating, and managing patient populations, and we’ll continue to invest in developing those solutions to allow hospitals to better prepare and position themselves in the rapidly changing world of healthcare reform.

Additionally, the strategic use of predictive analytics will ultimately become the market differentiator for hospitals, which is why we acquired Third Wave Research, Ltd, in 2011 and have been working on integrating their advanced predictive analytics expertise into our existing solutions. We will continue to invest in analytics technology that enables our clients to position for patient engagement, wellness and disease management. The rapid adoption of patient portals and the shift away from fee-for-service in favor of outcome- and quality-based reimbursement models will place more emphasis on finding new cost savings and revenue streams. To differentiate themselves from the competition, hospitals must find ways to personalize the patient experience and better manage the patient population. Effectively promoting profitable services to high-value patients and engaging them in wellness programs will influence healthy behaviors to positively impact outcomes.

Jay Mason, CEO, My Health DIRECT

It has been painfully obvious over the years that our solution was a bit ahead of it’s time. While very successful in directing patients to appropriate care settings in an ER, there wasn’t a pressing need to interact “outside of the walls” broadly or routinely. What we have seen in 2011 and see as our chief role moving forward is to serve as a health scheduling exchange. We will continue to invest our R&D in staying ahead of the curve. Today we can provide true Enterprise  Application Integration (EAI) with any willing trading partner via our own platform’s ability to leverage HL7, API, or CRM-based communication protocols.

So the next year will be more of the same for us — creating the integration tools, onboarding methodologies, and consumer engagement services that will allow our clients to redefine the way they interact and guide their patients and members.

Janet Dillione, Executive Vice President and General Manager, Nuance Healthcare

Going into 2012 the pressure is on for healthcare organizations to increase the quality of care delivered while reducing cost and complying with federal mandates. Nuance could not be better aligned to help healthcare organizations succeed in light of such pressures as Meaningful Use and ICD-10 and to ensure that clinical data is created in the most efficient way possible and is built from rich information that can be analyzed and intelligently used to drive broad healthcare enterprise change and improvement.

Over the next 1-2 years, we’ll continue to invest in areas that fundamentally improve the capture phase of clinical documentation, by which I mean empowering clinicians to document anytime, anywhere on any device in the most effective, natural way possible – via voice.  In 2011 we went to the cloud, offering SpeechAnywhere services to development teams across the industry.  Speech-powered clinical documentation is widely in demand and will continue to expand to encompass the complete healthcare enterprise and the mobile clinician workflow.

We’ll also continue to heavily invest and innovate in the area of language understanding and analytics technologies, which make it so clinical data can be extracted from unstructured documents and intelligently leveraged to drive better clinical and business decisions. Through work with 3M, IBM and UPMC, Nuance is making tremendous traction against its mission to transform patient stories into high-value information. Our speech-driven clinical understanding solutions will increase the quality of documentation, improve efficiency and drive better care – all while putting less burden on clinicians.

Todd Cozzens, CEO, Accountable Care Solutions, Optum

I heard someone say the other day that ACO = HMO 2.0 But With Data. It is indeed all about the data. I empathize with health system CEOs who, after spending anywhere from $100 million (average medium size IDN) up to the $3 billion Kaiser spent on installing EMRs in the last ten years that all they really achieved was computerizing paper records. Little has been achieved in actually doing something with the data. That’s what the next ten years is all about.

• Population Analytics: EMRs and the early data warehouses being developed on top of them are good at managing a census – sick people that visit hospitals and doctors. Population Analytics manage entire patient populations across all of their interactions with the health system. EMRs rely mostly on clinical data and some financial data. Population Analytics incorporate claims data, clinical data, financial data and actuarial data across ambulatory, in-patient, post acute and home care. We are in the top of the first inning of the biggest wave of change in our healthcare system any of us will see in our lifetime. These tools are also in their 1.0 versions and will evolve. Optum was almost purpose-built to bring all of these capabilities together into one cloud-based, integrated solution.
• End-to-End (E2E) Financial Efficiencies: Hospitals leak revenue more than any other business in any other industry – with the average health system collecting only 33% of what they actually bill under the current fee-for-service (FFS) system. And on top of this we’re now going to burden hospital finance departments by introducing new fee-for-value (FFV) payments starting with bundled payments and pay-for-performance measures right on up to full risk-bearing entities. In the forward-thinking health systems, we’re seeing the realization that they cannot do this all themselves. Many see FFV as the future so they want their current finance teams to be the experts in the new system. These same health systems are increasingly outsourcing their FFS financial systems to experts who know how to recover lost revenue, realize much higher collection rates and know how to drive cost takeout. We acquired Executive Health Resources to help hospitals drive revenue integrity for the big potential loss area of reimbursable admissions. The Lynx ED coding tool returns an average of $2.5 million lost revenue per medium size hospital. We combined those tools plus others around collections, billing, and Financial Health Record (FHR) to form our E2E solution set and we will invest more in these capabilities in 2012.
• ICD-10: Health systems are so encumbered with Meaningful Use compliance, RAC compliance, and facing the coming huge cuts in Medicare/Medicaid that they have largely been in denial about the impending ICD-10 deadline. With the introduction of up to 155,000 new reimbursement codes and less than 10% of healthcare providers halfway to ICD-10 readiness, ICD-10 could be an insurmountable challenge. We made a large investment in what we believe to be the best technology available to meet this new challenge. Because of the time caregivers will spend hunting for the right code, ICD-10 will actually make the health system much less efficient unless groundbreaking new technologies emerge. The natural language processing technology that we acquired from A-Life is exactly what’s needed to automate this laborious process. We’ve seen tremendous traction for this solution in the last six months and expect that to continue. Our R&D investment has increased so we believe we will keep and extend our technology lead here.
  

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  Paul Brient, President and CEO, PatientKeeper Inc.

  PatientKeeper’s number one priority is to deliver healthcare applications that improve the physician workflow. This means that we save physicians time, we help them provide higher quality care, and we help them get paid for more of the services they deliver.  

  We are still spending heavily in R&D to round out our suite of 13 fully integrated applications. Our near-term focus is to continue to add features to our CPOE product, complete our Medication Reconciliation product, release a next-generation charge capture application, and give our tablet/iPad applications feature parity with our desktop applications. The emergence of the tablet as a “first class” device has been eagerly anticipated by the healthcare IT community for nearly a decade and is finally here.  In fact, we have a small but growing number of our 40,000 users who use their tablet/iPad as their only computing device.

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  Todd Johnson, President, Salar

  While we have always been focused on "the physicians experience," the merger between Transcend Services and Salar has intensified this focus. In the months ahead, we are going to be able to address a physician’s workflow in ways never before thought possible. Understanding all of the external pressures applied to physicians, how remarkable it will be to offer solutions that offer either zero impact on their day-to-day, or better yet, offer drastic improvements to their workflow that they didn’t even realize were achievable? Not only will we be able to satisfy a physician’s interests for time, speed, and efficiency, but we will also be able to free the physicians from those same external pressures. By offering to our hospital customers clinical documentation solutions that meet the needs of coding, compliance, quality, billing, RAC audit mitigation, communication, and patient safety while doing so in a zero impact methodology to the delivery of care, we truly meet the needs of all parties at the table.

  To realize the benefits of this "enhanced physician experience," we will be investing heavily in our web-based platform to complement our existing thick client solutions, natural language processing tools, front end speech solutions, ICD-9 and ICD 10 GEMS mapping solutions, front end computer-assisted coding features, and even an improved workflow for traditional transcription services. We will continue to deliver all of the above through our "have it your way approach," thereby meeting the needs of both our physician users and our hospital customers.

  It’s been a long-time objective of Salar to become the de facto clinical documentation module within a host of HIS systems. We are closer to realizing that objective than ever before. Through some new and unique customer engagements, we will be integrating our platform into industry-standard information systems and, in turn, reaching out to an even broader customer base. The marriage of these solutions and the seamless nature of their delivery are incredibly important to us. Our customers count clicks–and so do we. We will continue to work over the next 1 to 2 years to streamline usability across systems and, ultimately, enhance a physician’s day-to-day experience.

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  Stephen Hau, CEO, Shareable Ink

  Everyone wants innovation, but no one wants to change.

  It is well understood that the healthcare industry must become more electronic and data-driven. However, we also know that change is hard. Market data reveal that, while most clinicians enjoy the accessibility of patient information that EHRs deliver, the majority does not prefer the Windows 95-style “point and click and drop down list” style of documenting that the standard EHR user interface requires.

  We believe that there must be a better way to extract information from a physician’s head without forcing them to become typists, tap a screen or mouse 30 times to create a “cookie cutter” note, or hire prohibitively expensive scribes out of desperation.

  As such, we have begun to invest aggressively in machine learning and natural language processing. Our system does not require user training. Instead, it has begun to learn from clinicians’ handwriting, gestures, and other natural inputs. The ambitious goal is to deliver innovation without requiring clinicians to alter time-tested workflows.

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  Ed Daihl, CEO, Surgical Information Systems

  Our R&D focus supports improving the management of perioperative services, the area of the hospital that continues to drive the financial success of the hospital. A recent survey by SIS shows an increased focus on reducing perioperative costs, with 78% working on cost reduction efforts – a 34% increase since 2010. Additionally,  the survey indicated another shift from 2010 with cost reduction efforts being prioritized over reimbursement concerns. In 2010, 25% of hospitals cited maximizing reimbursements as their top financial concern. In 2011, that number dropped by 56%. We believe that perioperative specific analytics is a powerful tool to help hospitals control costs — their top concern — and will continue to work to improve this management tool.

  Additionally, we see the adoption of anesthesia information management systems as a growth area in the industry. Electronic anesthesia documentation streamlines this process and provides accurate and legible anesthesia records. This equates to significant benefits, such as more accurate charge capture, quality improvement, and allows for the anesthesiologist to spend more time with the patient and less time documenting.  The addition of clinical intelligence with anesthesia analytics provides even more value to hospitals and anesthesia providers by unlocking powerful decision making data to help improve both care quality and financial return.

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  Evan Steele, CEO, SRS

  Over the next couple of years, SRSsoft will evolve to accommodate the acquisition and sharing of increasingly greater volumes of patient health information, as relevant to our specialist and primary care clients.

  We will remain focused on productivity (naturally!) as we evolve our data capture interfaces. This means that user interfaces will be implemented using techniques that are both ergonomic from a personal user perspective and accommodative of the actual workflow that takes place in the clinical office environment.

  We have put into place, and will continue to enhance, our own dedicated platform for data sharing and interoperability. Our Continuity of Care Exchange (CCX) platform manages connectivity and the physical transport of files, while our Discrete Data Exchange (DDX) components handle the import and export of discrete data to and from our system. We will continue to evolve CCX and DDX over the next couple of years to support increasingly higher levels of interoperability.

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  Rick Stockell, President, Stockell Healthcare Systems

  Over the next 1-2 years, Stockell Healthcare Systems will be devoting a significant amount of R&D to ongoing regulatory compliance.  In addition, we will continue our ongoing focus on client business process improvement through the development of advanced analytics and information management solutions.

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  Richard Atkin, President and CEO, Sunquest

  Sunquest is increasing its investment in product development across the board. We now have over 35% of our total resources dedicated to product development and product quality. We will have a particular focus over the next 24 months on developing new functionality in the converging areas of molecular pathology, anatomic pathology, and digital pathology. As a founding Gold Sponsor of the Digital Pathology Association (DPS) and through our partnership with Massachusetts General Hospital, we will be building the next generation of pathology workflow solutions.

  The incorporation of digital images of all sorts into the pathology workflow will drive significant growth, change, and efficiencies throughout our clients’ operations. Sunquest will work closely with our clients to enable them to take advantage of the coming changes in science, medicine, and technology. The ongoing evolution of molecular testing is driving a convergence between anatomic and clinical pathology. As healthcare delivery evolves to a more integrated, regional model and incorporates more personalized data, Sunquest will provide the solutions required to thrive in a new age.

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  Sunny Sanyal, CEO, T-System

  To meet clients’ current and evolving needs, T-System in the next 12-24 months will focus R&D investment on enhancing our emergency department information system, The T SystemEV. Our top three R&D priorities are as follows:

  • Support for regulatory mandates, including Meaningful Use and ICD-10. T-System will seek ONC-ATCB certification for Stage 2 Meaningful Use measures as soon as HHS finalizes the requirements. T SystemEV, already certified for 2011/2012 criteria for Stage 1 Meaningful Use requirements, will be compliant with ICD-10 in 2012, a year before the deadline. Our goal is to give clients maximum flexibility to address clinical, business and regulatory needs
  • Enhance interoperability. T-System will continue to invest and partner with other vendors to ensure that clients can seamlessly connect T SystemEV with disparate inpatient EHRs and other information systems outside the ED.
  • Continue to provide innovative and new functionality. As the care transition hub and starting point for a high volume of patient handoffs, the ED plays a critical role in ensuring the continuity of care. Supporting smooth patient transitions with efficient communication will become even more important as facilities and practices form accountable care organizations (ACOs). T-System will develop solutions and functionality that will help EDs lead the ACO model of healthcare delivery. Additional offerings will continue to improve clinical and financial outcomes that start in the ED and benefit the entire hospital and community.

News 12/30/11

Top News

CSC says it will have to write off almost the entire $1.5 billion it spent trying to install iSoft’s Lorenzo in the defunct NPfIT project in England. The government has apparently declined to give CSC the new scope of work the company had requested. CSC has also withdrawn its financial forecast and stepped up plans to replace its CEO. It posted a loss of almost $3 billion in its Q2 report filed September 30, mostly due to a write-down of goodwill. The company’s market cap is $3.7 billion. Shares are at $23.68, off more than half since the beginning of the year.

Reader Comments

From Zafirex: “Re: hardship exemption for e-prescribing. Looks like so many providers are claiming it that CMS is having difficulties. Wonder how many are truly hardships? I doubt CMS could ever verify since it looks like they’re having trouble even producing a list.” Exemption categories include a practice area with no broadband coverage or that has too few participating pharmacies, practices that applied for Meaningful Use before requesting an exemption, practices that prescribe mostly narcotics that are not eligible for e-prescribing, practices that don’t prescribe regularly, or practices that e-prescribe but not for qualifying visits.

From Search Boy: “Re: searching HIStalk. Thanks for the explanation to King Salmon. Is there a way for retrieved searches to be indexed chronologically rather than as a percentage of keyword match?” I haven’t figured out how to do that. Since the pages are stored in a database, I don’t think the search function can determine the original publish date even though it’s in the title.

From Lilies: “Re: Epic. They’re #17 on the list of 25 oddball job interview questions, with ‘You have a bouquet of flowers. All but two are roses, all but two are daisies, and all but two are tulips. How many flowers do you have?’ There are two distinct valid answers.” Three is the obvious answer (one of each flower) that took me about two seconds to get. I assume the second answer depends on the question not stating explicitly that there are no other kinds of flowers in the bouquet (i.e., you could have two Venus fly traps only, making two a correct answer.)

From Stats Fan: “Re: readership stats. You haven’t given your readership stats lately for me to track.” Good timing since I realized a couple of weeks ago that I’ve been undercounting all along. I had forgotten to add the hit-counting Javascript to the mobile display that you see on iPhones and iPads. That hit me a couple of weeks ago, so I dug around the code and figured out how to fix it, also noticing that a surprising 30-50% of readers use Safari, most of them presumably on iPhones and iPads, which is a lot more mobile readers than I would have guessed. So far for December, it’s 96,250 visits, 148,218 page views, and 22,029 unique people reading (but that’s lower than the real number since I didn’t make the change until the middle of the month.) January and February will be good indicators since the HIMSS conference really pegs the needle on readership. Inga pays a lot more attention to the numbers than I do, so I will await her analysis. Above is where the visitors are from, just in case you are interested. Among cities, it’s Madison, Stone Mountain, Atlanta, New York, and Chicago making up the top five, but the major metro area is Boston with 8.41% of visitors. It’s a 62% male audience, so ladies, tell your friends.

From HIMSS Envy: “Re: HIMSS points. Got me wondering – it would be nice of HIMSS published an annual report for public review. It might not change a thing, but transparency is a powerful motivator. Come to think about it, Mr. H, how about you, too?” I thought HIMSS did a report, but I couldn’t find one. You can get their Form 990 from GuideStar, which always has interesting factoids (like that HIMSS FY 2009 revenue was $44 million and CEO Steve Lieber’s total compensation was $711K). I don’t know what I’d put in an annual report that isn’t already on the About page or contained in the list of sponsors … other than my hospital job, I don’t have any ownership in anything, I have no other income, and I don’t shill stuff like speaking or consulting under the delusion that I have value beyond what you’re reading right here.

From Peds Envy: “Re: tired of writing only good things about Epic. Private practice peds are the worst type of users for Epic. No surprise there. Someone who knows Brown & Toland told me the reaction is 100% unanimous – they hate it.”

From Anonymous Epic Fan: “Re: tired of writing only good things about Epic. Here are a few issues with their implementation methodology and support that even the Kool-Aid drinkers would have a hard time disputing.” Here’s the list from AEF:

• Epic’s implementation planning materials are weak. They have to be re-worked for each new application / scope mix, and after that is done, little to no effort is made by Epic to customize them based on organization specifics. If you want the project plan to be useful and to have sufficient detail, expect to spend a lot of time and effort re-working what gets initially delivered.
• Epic suggests you go live on Model workflows as quick as possible. As painful as it may be, it is definitely better from a cost perspective. Then, you plan to do the bulk of the ‘real’ implementation after getting live. This can/may work if the bulk of the existing documentation / orders workflows are paper based and you are implementing all of Epic’s applications, but this approach is suicide if the existing system being replaced has been customized for the end-users and they are happy with them or if you have to rely on the timelines of other vendors to build/test/implement interfaces and data conversions.
• The Epic Model does not work well for any hospital or outpatient units that are more complicated  then the most typical med/surg units and general practice specialties. Specifically, hospital outpatient departments that bridge the inpatient and outpatient void.
• The Epic Model completely breaks down if you are not implementing all of Epic’s applications and workflows rely on interfaces to/from legacy systems.
• With Epic’s implementation team constantly turning over, being spread across more and more customers, and the increasing pressure to implement faster, attention to detail is lacking. In my experience, they are over promising and under delivering more than they did years ago.
• Time estimates are always low. Everything takes much longer than anyone anticipates. Medication build, consolidating charge masters, cleaning up supply/pick lists, mapping lab components, consolidating multiple sources of payor/plans, cleaning up the provider / credentialing information, getting physicians to agree and sign-off on order set/documentation template content, and working down duplicate patients in your EMPI or mapping data elements for conversions etc.
• Epic implementation tools / deliverables are often shared just before an upcoming trip for when they are to be used. Though effort is made to customize them based on application mix/scope, they never really get updated to reflect the actual workflows discussed and validated early in the process – especially if they differ in any amount from the ‘model’ workflow. The delivered product if very inconsistent from application team to application team and integrated areas/workflows often get overlooked. So just like the implementation planning materials, expect to spend a lot of time re-working these deliverables to make them useful.
• All application teams involved in the implementation are siloed, and in addition, the Epic implementation teams, technical support teams, and development teams are also siloed. This causes issues for organizations live on one set of applications, rolling out another set, and implementing a third set.
• The silos mean that there are application experts, but very few Epic staff have cross-application experience / knowledge and if workflows are interface-dependent, very few have true integration experience.
• Epic’s training only scratches the surface. The true training is the implementation process and go-live. The shorter the implementation timeline, the more unprepared the customer IT staff is to support the applications when they go live – thus the demand for lots of consultants.
• The system documentation is very inconsistent and virtually impossible to search on the UserWeb. Unless you know where to find what you are looking for, you often have to e-mail Epic to ask if documentation exists. I is not uncommon to be sent an ‘unofficial’ document created by a frustrated Implementer not being able to rely on the system administration guides themselves. In fact, all of the implementation documentation / guides were historically written and maintained by implementers, but due to the inconsistency between applications and un-sustainability of keeping it up to date. no implementation documentation/guides exist today.
• Epic’s end-user training materials are great if you are implementing all of Epic’s applications and you are using all Epic model workflows. If anything changes, these are not so great – expect to have to overhaul them.
• Same goes for the testing scripts. An OK start, but definitely not something that can be used out of the box.

HIStalk Announcements and Requests

How Apple wins customers for life: I had a five-year-old, first-generation, 1 GB Nano that I only used for the gym. I heard Apple was recalling a few of them because of some explosion-prone batteries, so I put in the serial number on their Web page and darned if mine wasn’t on the list. They sent a postage-paid Fedex box to return it. Today I got back a brand new sixth-generation, 8 GB Nano, which now comes with a color display, gestures, FM radio with live pause, pedometer/accelerometer, and a bunch of other features, all in a package barely bigger than a watch face (in fact, you can buy a watchband that holds it, turning it into a watch.) It’s super cool, and so is Apple. You did good, Steve Jobs – RIP.

It’s time to wrap up the HISsies nominations soon, so contribute yours now to the blank slate that will be distilled into a handful of choices for the real voting that starts shortly. I’m particularly happy with one nomination for Smartest Vendor Action Taken: “HIStalk sponsors that replaced blinking ads before the deadline.” Well done, and a good observation. My sponsors really are the best – as much as I hated to spring the change on them since it requires work and expense on their end, they’ve been great about it. I’ve enjoyed the nominees for the Beer and Pie categories, as always, and there are some good nominees for the Lifetime Achievement Award.

Speaking of the HISsies, full details and signups will go up next week for HIStalkapalooza in Las Vegas. And also speaking of the HISsies, if you plan to vote (and I hope you do), sign up for the e-mail updates since I e-mail the voting link out to prevent ballot box stuffing that was as rampant as in a third-world dictatorship until I took that step. For that reason, if you aren’t on the list, you can’t vote.

Listening: new from The Roots, which even though I’ve only sampled it so far due to limited time, is just blowing me away. It’s extraordinarily music in the form of a concept album, making it impossible to label as rap, soul, or hip hop even though it includes strong elements of all of those. The accompanying short film is here. Their talent is mind-boggling. Down it goes to the new Nano, which contains only my latest favorites since I intentionally started from scratch: Genesis And Then There Were Three, two albums from Gooder, one from Metric, and Luminiferous Ether by the never-gets-old Zip Tang.

It’s just Dr. Jayne and me tonight as Inga is sojourning in the mythical Land Without Broadband. She will return soon. But in the mean time, Dr. Jayne is doing her usual fabulous job. I’m pretty darned lucky to have two smart, funny, hard-working, and undeniably cute ladies with whom to share the page, don’t you think? I will raise a glass in their honor for New Year’s (probably of Duvel beer since I got some for Christmas and I like it a lot.)

I’m not telling you Happy New Year yet because I’ll be posting a Monday Morning Update this weekend as usual, even if nobody’s around Monday to read it.

Acquisitions, Funding, Business, and Stock

Board members and executives of document management vendor Streamline Health Solutions will buy $400K worth of the company’s stock, news of which sent shares up 9% on Wednesday.

Healthcare alerting system vendor Extension, Inc. announces what it says is record quarterly growth, adding 17 new hospitals in the third quarter and quadrupling its headcount to 40 over the past two years. They might want to budget for a public relations or media person next since this is easily one of the worst-written press releases ever, starting off with a clumsy opening sentence that sounds as though someone whose native tongue was not English (or at least not good English) sweated over it until nothing interesting remained. It doesn’t get better as you read on.

Announcements and Implementations

Tampa General Hospital (FL) goes live on its $120 million Epic system, which works out to $118K per bed. The hospital says $40 million of that was for hardware and software, with the rest going for staffing and training.

Other

Weird News Andy sounds like a fortune cookie in summarizing this story as, “Foot in mouth results in mouth in foot.” A man shows up in the ED with a swollen, infected foot, claiming he stepped on a piece of glass on the beach a couple of weeks before. The beach and timeline part of his story were accurate, but not the glass part: doctors removed a tooth embedded between his toes, lodged there during a beach fight when he kicked his opponent in the jaw while wearing flip flops.

Several readers were interested in John Halamka’s post about his wife Kathy’s newly diagnosed breast cancer. The first of regular updates, posted Thursday, is here. Reading his thoughts and analysis of their situation makes you realize that HIT stuff aside, he’s probably a fine doctor as well, not to mention the kind of supportive partner we would all want if faced with a life-changing diagnosis and gearing up to fight it.

A big health-related software sale you probably didn’t hear about: General Cannabis, which operates the medical marijuana dispensary finder WeedMaps, acquires MMJMenu, whose software for marijuana growers and dispensaries tracks inventory “from seed to sale,” basically an ERP for pot growers. General Cannabis had revenue of $10.4 million in the first nine months of the year and paid $4.2 million last month to buy the Marijuana.com domain.

John Newman, MD PhD, a UCSF physician and legal scholar, worries that medical copyrights will threaten patient care, citing a recent case in which a company offering a licensed cognitive screening tool threatened legal action against a similar but free online tool. The implication is that tools based on published research, which could be anything from a pain scale to a hip fracture risk predictor, could be claimed as proprietary by a fast-moving company. The author speculates that without new forms of copyrights, “… as physicians walk down the hallway interviewing patients, they’re tallying up the licensing fees they need to pay for doing their day’s work, and hospitals are suing each other or making cross-licensing arrangements to manage each other’s intellectual property.”

A power surge caused by monthly back-up generator tests at Aspirus Wausau Hospital (WI) takes all communication and computer systems down for five hours, forcing the hospital to go on ambulance diversion. As is always the case, the hospital says patient safety was never at risk, which you might interpret as meaning that those systems contribute nothing to patient safety. They’re on Epic, I believe, not that the hospital’s Wisconsin location didn’t already make that fairly likely.

GE Healthcare agrees to pay $30 million to CMS to settle a False Claims Act charge that it encouraged hospital and cardiology laboratories to overbill Medicare for Myoview, its form of technetium 99 that shows areas of decreased blood flow in the heart.

Sponsor Updates

• Rockford Orthopedic (IL) announces that 21 providers have successfully attested for Meaningful Use using eClinicalWorks EHR suite.
• Baptist Health Line (KY) receives its third ICARE award from RelayHealth for work with Western Baptist Hospital’s transfer center.
• Paul Rooke, CEO of Lexmark, discusses how the company’s acquisition of Perceptive Software and Pallas Athena puts them in a unique position in his interview with All Things D.
• Health Choice Arizona, achieves a 44% improvement in its completion rate for preventive services pilot program using MyHealthDIRECT.
• AmkaiSolutions will offer revenue cycle solutions from ZirMed to its outpatient surgery provider software customers.

EPtalk by Dr. Jayne

Where have all the drug reps gone? With significant cuts in the budgets for Big Pharma, many reps have been “made available to the workforce,” as they say. It seems hospitals and health systems are hiring former drug and device reps to sell their facilities to physicians. A recent article discusses how they’re using infection data and patient satisfaction scores to drive business rather than the drug pricing and formulary data of yore. In my book, this is just another thing that sucks up valuable time that we need to care for patients, not to mention sucking up budget dollars that could be better spent on those patients.

I wonder how many physicians who refuse to see drug reps also refuse to see these new “physician liaisons?” And how many health systems place rules around having these reps in the office? At some large integrated health systems, policies ban providers from seeing reps or liaisons from any facility or service provider that competes with a system-operated service line. This includes home health agencies, remote cardiac testing providers, reference labs, and the like. Other health systems restrict the hospital privileges of their employees (prohibiting credentialing at competitor hospitals,) so I’m not sure how big of a target pool these new reps have.

Weird News from one of my favorite places: South Carolina sports a giant mound of tires that can be seen from space. At least it’s not burning like the one in my favorite fictional town. But kudos to Lee Tire Company, Inc. of Jacksonville, Florida for waiving the usual fees to shred and recycle the tires in an attempt to clear the 50-acre mess.

Inga and I are well into our pre-HIMSS preparations. As you’re thinking about traveling to fabulous Las Vegas, consider this recent article that discusses continued concerns about backscatter scanners at the airport. Until I read this piece, I didn’t know they had been banned in Europe. As someone who has to wear a badge to track my exposure to radiation in the hospital, I do worry about frequent flyers. Many of my friends who work for vendors fly two to four times a week. There’s enough radiation from just being in a plane, let alone adding to it with scanners. I’d love to see the cumulative dose numbers for some of those flyers. Maybe frequent flyer programs should start issuing radiation monitoring badges with their airlines’ logos as a promotional item.

Each time I sit to write for HIStalk, I’m still amazed to be part of this team. It’s particularly amusing when I’m just reading through my “normal” e-mail and find a mention of us – most recently a blurb from MED3000 regarding Mr. H’s recent piece asking vendor leadership about the biggest HIT-related news items of 2011. I hope I don’t have facial leakage when I see these blurbs (yes, I have a bad habit of multitasking during meetings) because I know I feel like smiling.

Speaking of multitasking, one of my Facebook friends shared another article on docs multitasking during critical procedures. Medical schools are apparently having to actually instruct students to focus on the patient instead of the smart phone. Looking at some of the examples given in the article, it sounds like some IT teams need to revisit the websites they allow users to access. I can’t think of too many medically legitimate reasons to be on Facebook, Amazon, or eBay in the operating room or in the ICU.

I mentioned earlier this month about my inability to keep up with Inga where shoes are concerned. I think I win this round though – I seriously doubt that Santa left a glass slipper filled with Cosmopolitans at her house.

Have a question about managing pesky sales reps, maintaining the perfect poker face, or the best way to garnish a Cosmopolitan? E-mail me.

Contacts

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

News 12/28/11

Top News

UPMC’s Cerner systems go down for 14 hours at most campuses last Thursday and Friday, forcing them to go back to paper. The PR person blamed “a database bug,” which makes the above Oracle press release from this past summer a particularly fun read. Cerner and UPMC have an atypical vendor-customer relationship since they’ve invested big money together in innovation projects and UPMC runs a Cerner implementation business overseas.

Reader Comments

From King Salmon: “Re: search. Is here a way to search HIStalk by keyword?” You can use the search box that’s in the right column. It’s not visible on mobile devices, though, in which case you can do a Google search by keyword, then click the gears icon at the upper right of the results screen (that’s where Google has moved the advanced search options, which used to come up on the main search screen.) Then, qualify your search down to the specific HIStalk site as shown above.

From Booth Boy: “Re: MEDITECH and Cerner. As I predicted, see the attached Las Vegas floor plan. Since they lost their HIMSS points by sitting out a few years, they are way back in the corner by the freight doors. If it’s cold on setup day, they’re going to freeze their butts off because the doors never close.” Just about every year I run the link to the rules of how HIMSS awards its much-coveted Exhibitor Priority Points, which rewards vendors who spend a lot with HIMSS by allowing them to buy bigger and better located booth space. Points can also be earned by buying sponsorships, booking hotel space through their housing company, signing up for corporate membership and paying your dues early, and buying services from HIMSS Analytics. Because they didn’t exhibit, MEDITECH is way down the list in the #727 spot (behind mostly companies you’ve never heard of and even some universities) and Cerner is at #429 (two notches below University of Alabama at Birmingham.) Needless to say, prime exhibit real estate isn’t happening for them this year, so you’ll need to seek them out.  

HIStalk Announcements and Requests

Inga’s taking a short break, so it’s just me (Mr. H) this time around.

Sales

The board of 125-bed Powell Valley Healthcare (WY) approves the purchase of NextGen EHR to replace its “dysfunctional” and old Healthland system, saying the hospital is getting a bargain because the company offered to drop $400K from the $2.65 million cost if the hospital signed by December 31. The hospital plans to collect $1.5 million in Meaningful Use incentives, which it says it could not have done with Healthland because, according to the IT manager, “The system we have now is not good. It’s terrible. It crashes. I can’t imagine being a nurse or a physician and working with it every day.” The money-losing hospital says buying a new clinical system probably means that other projects, such as needed renovations in surgery and the ED, may not get done, but a board member says the new system is even more important. “This is a have-to. We have to do this. I remember going into the lab a few years ago, and the lab girls were crying, and it was over Healthland (the current system). It needs to be replaced,”

People

Saint Francis Care (CT) names Linda Shanley as VP/CIO. She was previously with Stony Brook University Hospital.

Announcements and Implementations

Pikeville Medical Center (KY) goes live on Wellsoft’s EDIS, which is integrated with its McKesson applications.

Innovation and Research

An Ohio ED doctor develops NARx Check, which calculates a drug abuse “credit score” using Ohio’s prescription monitoring program data and alerts ED staff of patients likely to be abusing drugs. The application has generated positive comments from the state pharmacy board and local hospital association.

West Wireless Health Institute says that less than 1% of hospitals have deployed fully functional tablets, mostly because clinical systems vendors haven’t developed iPad-native apps, but also because wireless connectivity is spotty, iPads don’t fit into the pockets of standard-issue lab coats, and typing on an iPad is a pain when PCs are always close by anyway.

Other

The western regional chapters of HIMSS are putting on the one-day Women in Healthcare Information Technology Conference in San Francisco on Friday, January 20.

An insurance company sues the former COO of Christus St. Vincent Regional Medical Center (NM), trying to recoup the $3 million it reimbursed the hospital for fraud losses. The COO allegedly funneled hospital IT payments through corporations that were run by a woman with whom he was having a relationship. He supposedly even paid a part-time student to impersonate an engineer with the phony company when the hospital got suspicious. The hospital fired the COO for cause in early 2008 and says it’s still waiting for authorities to charge him with a crime.

Jacob Goldman, the former chief scientist of Xerox who created the famous Palo Alto Research Center (PARC) in 1970, died last week at 90. Xerox was happy making money from copy machines and didn’t commercialize PARC’s research, but those discoveries, such as the graphical user interface and ethernet, created the personal computer industry when further developed by Apple, Microsoft, Cisco, Adobe, Sun, and other fledgling Silicon Valley companies.

A new KLAS report says that while only 10-15% of hospitals use real-time location systems, 95% of those that do say they increased operational efficiency.

Several readers sent over a link to this article, in which another conservative publication takes some unfocused political shots at Epic’s Judy Faulkner using healthcare IT as its weapon of choice (actually, they aren’t new shots, just the same old ones recycled yet again for a new audience.) Her oft-recited transgressions:

• She donates to Democratic political candidates.
• She represents vendors on the Health IT Policy Committee.
• She’s anti-competition and anti-innovation, at least according to the unbiased opinion of Allscripts CEO Glen Tullman, an Epic competitor, quoted from an interview we did with him on HIStalk Practice (being a conservative publication, they had to be grasping to quote a long-time supporter and friend of President Obama who had a lot more influence than Judy Faulkner in getting billions in HITECH money included in the stimulus package.)
• She could have benefitted from politician meddling in which a group urged the VA to buy instead of build systems, mentioning as their argument successful clients that happen to be all Epic users. That’s true, but perhaps a fact worthy of inclusion is that the VA ignored the unsolicited advice and is sticking with its original plan to develop an open source replacement for VistA, so the net benefit to Epic was zero.
• Epic clients (Geisinger and Cleveland Clinic) were named by President Obama as being good technology users.
• Epic clients, like those of all vendors, have had some unrelated IT incidents that were listed.

The article concludes, predictably and with no facts whatsoever to back it up, that Epic is preventing patients from getting good care because of “partisan politics” (meaning beliefs that differ from the ones held by the authors.) You would think instead of just Googling up some old articles they could have turned up an actual expert in a hospital somewhere instead of just quoting a competitor’s CEO and a reporter. I’m a conservative more or less (fiscally, anyway) but this is just lazy political editorializing pretending to be reporting, indiscriminately throwing out loads of unrelated mud in the hopes it will stick to someone of a different political persuasion.

Surely someone could build a better case against Epic, although it’s probably hard to write around the inconvenient facts (its customers are among the best hospitals, they are voluntarily buying Epic given the other available options, and Epic tops every industry statistic by a mile, such as big-hospital sales, KLAS rankings, and hospital customers that have been awarded HIMSS EMRAM Stage 7.) Or maybe they can’t. The anonymous anti-Epic comments I get are almost always long on emotion and opinions and short on facts and first-hand knowledge (and they often come from the same handful of posters using different names, which makes me suspect that they are unhappy former Epic employees, spurned job-seekers, or employees of struggling competitors.) I don’t know that I’ve ever seen a negative comment about Epic from someone who actually uses it in a provider role, and I don’t recall hearing remorse from any of those users about losing the systems that Epic replaced. I get tired of writing positive things about Epic and keep hoping someone who’s actually in the game and not on the sidelines will provide an intelligent and convincing counterpoint to why they aren’t as great as the Kool-Aid drinkers say. I’m still waiting.

Sponsor Updates

• Weed Army Community Hospital (CA) chooses T-System for paper-based ED documentation.
• Salar suggests three New Year’s resolution in a blog posting.
• Nuance releases a case study on Emerson Hospital’s (MA) use of Nuance Transcription Services powered by eScription.
• Digital Prospectors Corp., which offers embedded systems engineering and healthcare information systems consulting services, is featured in Bloomberg Businessweek.
• Jeff Wasserman, VP of Culbert Healthcare Solutions, discusses physician employment opportunities, job culture, and interview skills in an American Medical News article.

Contacts

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

Monday Morning Update 12/26/11

From Hospital IT Guy: “Re: HIStalk. I don’t know how you produce such insightful and well-written news and comment as a part-time gig. Your posts give me a reality check and enhance my position as an HIT expert charged with leading us into a very uncertain future. Thanks for the body of work you produced this past year and for the work you hopefully will continue to produce in the year to come.” Thanks for those nice comments – they made my day. I have the luxury of being subsidized by hospital day job, which allows me to do whatever I want without pandering for a buck. New Year’s Day is a good time to take stock of where you are, so if you have ideas of how I could provide a better service to the industry (especially providers and patients), send them my way. I’m constrained by time (not to mention by being rather lazy and risk-averse) but I’m fairly creative in getting help and other resources when I need them. I don’t want to be sadly reflecting back from a nursing home bed, “I could have done so much more” and having only my bank account to produce as evidence that I wasn’t a total waste.

One of the first to-dos of the yet-unnamed HIT spawn of Microsoft and GE Healthcare should be to communicate to a skeptical market audience, with only 12% of poll respondents finding the announcement positive. New poll to your right, inspired by John Gomez’s article: if there’s a healthcare IT bubble, when will it burst?

My Time Capsule editorial from five years ago: 2006 Product Rankings – Pay Some Attention, But Not Too Much. It inadvertently highlights just how much Epic has changed the industry with its lengthening roster of top-ranked applications: “The most discouraging point is that no vendor does everything well, if you believe the scores. If you look at KLAS’s 15 main general solutions categories, you’d find 13 top-ranked vendors. If you’re a best-of-breed shop, you’ll end up with a lot of interfaced systems if you chase the winners. If you’re a single-vendor organization, some of your departments are going to be stuck with systems far short of being the best. And of course, in the next survey, they may all shuffle around anyway. ”

Weird News Andy wonders how much the patient was charged for the tape. Two ICU nurses at Utah Valley Regional Medical Center (UT) are fired for telling a moaning patient to shut up, then taping her mouth and laughing about it.

Listening: new from Phoenix-based Gooder, a cross between the infectious power pop of Gin Blossoms with hard-driving guitar and drums (Rush? Van Halen?) They have a really big, well-produced sound for a three-piece. The reader who recommended them has a relative in the band and didn’t really talk them up much (“I’m obliged to like them”) but I really like their sound.

Here’s the latest from Vince, who takes a break from profiling long-gone companies (and sadly, sometimes long-gone people who worked for them) and addresses how HIT vendors throw down at holiday party time. I like Slide 3, in which Vince, one of his company buds, and their wives are dressed to the nines in their hideous 1960s party fashions ready for a big night on the town. If you’re a 20-something industry noob, you will in 20 years or so look back with an equal mix of nostalgia and a little tinge of sadness when faced with images from your long-gone youth, which involved fewer wrinkles and pounds and visually obvious humble surroundings, yet beaming with both delight and surprise to have found a place in productive society and brimming with optimism about the endless future that lies ahead. You’ll know you’ve done well if looking back now is just as satisfying as looking ahead was then.

BIDMC CIO John Halamka announces on his blog that his wife Kathy has been diagnosed with breast cancer. He’s approaching it as you would expect for someone who’s both an engineer and a physician: he is reviewing her medical information, he has assembled a team of renowned experts, and he will be documenting the process with a weekly blog post. I had two immediate reactions: (a) I was surprised that I was affected by the news since I don’t know either John or his wife. I used to assume he was a self-promoting gasbag since he kept popping up everywhere, but the couple of times I’ve met him for a few seconds (as myself, not Mr. H) and interviewed him, he seemed to be a nice guy without much ego. Hearing about his wife was a bit of a blow. (b) as much as I’m happy that he has limitless resources available to him as a Harvard physician with a vast industry network, I kept thinking – what if it was my wife or mother? Why does his wife get better odds because of where he works and where they live?

That’s not a criticism of him at all, but rather an observation about how US healthcare works – it unfortunately helps to go to renowned facilities, to have enough time and money to demand the best when nobody’s offering it to you, and to challenge physicians for the best, personalized answers since healthcare is a cottage industry that is primitive if not indifferent with regard to standardized processes, best practices, and outcomes. Those of us who work in the system know that, while the majority of Americans get their care in undistinguished hospitals from undistinguished doctors whose treatment choices are often anything but evidence-based. I say that having worked in small-town hospitals that had the most incompetent physicians you could possibly imagine with a handful of pretty good ones thrown in, but all of them running thriving practices with patients who lived and died never knowing the difference. To this day, if I were to keel over in the waiting room of a small-town, for-profit hospital, the only medical instrument I want touching me is an ambulance gurney that’s taking me somewhere else in a hurry.

Update: John replied to me Christmas morning. I don’t know if I was clear in my brief writeup above, but he’s been very cool in my brief dealings with him, never too busy despite a superhuman scheduled to drop a few words of encouragement or deflect credit for some HIT development to someone else, which I think is the ultimate mark of a leader – he’s more than happy to let someone else have the limelight. He took the time (as did his wife Kathy) to respond to my comments above. Think about what must be going through their minds if you think this is trivial. There’s never a good time to receive sobering medical news, but imagine having it delivered just a few days before Christmas, with the expectation of being cheery around friends and family.

John writes:

At the same time I’m focused on Kathy’s care, I’m also deeply committed to quality, safety, efficiency, and equity in healthcare across the country.  In the upcoming weeks, I’ll describe how the electronic records that coordinate Kathy’s treatment provide the same protocols to every BIDMC patient, regardless of insurance status, profession, or income. My goal is the "right care" – not too much nor too little – that follows best practices from evidence. Decision support driven "right care" is the only way we can hope to improve outcomes while bending the cost curve of healthcare spending that threatens the US economy. Universal healthcare supported by universal adoption of electronic  and personal health records must be our guiding vision.

Kathy writes:

My life with John has been entwined for 32 years, so to say "we have cancer" cannot be more completely and utterly correct. True that physically, only one of use has the obvious organic symptoms, but our close partnership has been irrevocably changed by the diagnosis. Whatever lies ahead, it is impossible to go back to that innocent moment before hearing the word cancer.

I am luckier than most – I have health insurance, and access to a major urban medical center that is also a teaching and research hospital. But, in encouraging John to follow our progress publicly in his blog, I am keeping the memory of a friend close to my heart. She did not have health insurance (as a part time adjunct instructor of art). With this financial barrier, she unwittingly waited until the cancer had spread before seeking medical care, and although she fought bravely, she lost her battle with breast cancer.

Throughout my life, I have not needed medical care beyond occasional primary care visits and the birth of one child.  My first weeks negotiating the barrage of new terminology, new tests, new doctors has been significantly eased by my access to a complete electronic medical record. Even more important to me, my doctors can work as a team with open access to all the same instant information to help me make the best decisions for my health. As I think about my lost friend, I also am thinking of all others with a breast cancer diagnosis, or other serious illnesses, and about how they manage to work toward their cure if they worry about health insurance, or have no access to an electronic medical record.

Health Information Partnership for Tennessee releases some well made HIE videos that anybody who needs to talk up the HIE concept can use. CEO Keith Cox sent over the link.

One more update about sponsor charity work. Iatric Systems can’t bring its dispersed workforce together for a company party, so it allows employees to payroll deduct charitable contributions that the company then percentage matches. More than $19,000 was donated this year to Save-a-Limb, Relay for Live Japan Earthquake, Alzheimer’s Association, and London Marathon (since they have UK employees.) |

The 21-year-old who posed as a surgeon while counseling patients in the public areas of two Oregon hospitals is sentenced three years in prison. He also claimed to be a Microsoft employee, porn producer, and credit counselor.

A point I’ve been pondering for years, fanned back to life by a reader’s comment. Hospitals enjoy quite modest (if not negative) revenue increases each year, almost wholly driven by what the federal government decides it’s willing to pay them. The country is insolvent and there’s no political will to fix that, so it’s a certainty that the government will be paying less. How, then, can hospitals afford to lock themselves into IT contracts, especially maintenance ones, whose percentage cost increase each year exceeds the revenue increase the hospital expects? That’s especially true of IT systems (most of them) that generate minimal return on investment. I guess that’s why someone had to invent the “IT is like plumbing” argument to justify buying technology without questioning return on investment, but I’m wondering how that rationalization will stand as the going gets tougher. IT departments have the same challenge – how do you justify a 10% IT budget increase when the organization is only expecting a 2% revenue increase, or why does IT keep growing when front-line employees are having their hours flexed or their jobs eliminated? The folks at the top who approve IT purchases and budgets often forget that there’s an ongoing cost to the systems they want to buy.

The pending absorption of Alamance Regional Medical Center (NC) by Cone Health raises IT questions: what will happen with Alamance’s Allscripts Sunrise system given that Cone and the other big systems nearby (Wake Forest Baptist, Novant) are on Epic? The respective CEOs say they’ll probably just try to connect the systems in some way since it’s too expensive to implement Epic at Alamance.

Both MEDITECH and Cerner announced that they will be returning as HIMSS conference exhibitors after an absence of several years. I asked both companies about that decision, with responses from Paul Berthiaume (public relations manager of MEDITECH) and Zane Burke (EVP of Cerner’s client organization.)

Cerner and MEDITECH stopped exhibiting at HIMSS at about the same time and announced their return at about the same time. Were the companies expecting competitors to follow their lead and are coming back now because they didn’t?

MEDITECH
MEDITECH’s decisions regarding HIMSS participation were and are influenced solely by our needs and the needs of our customers. We don’t concern ourselves with our competitors, and we’re not trying to set nor follow any "vendor trends." We’re doing what works for us. This year, we have a particularly compelling story to tell as a leading EHR vendor. We want to share our customers’ successes reaching Stages 6 and 7 as well as achieving Meaningful Use Attestation, and we want to congratulate another Baldrige Award winner. Best of all, we’re going to debut an exciting new Web-based ambulatory product.

Cerner
When we made the decision to not exhibit at HIMSS, we shifted to other strategies to engage with our clients and the marketplace. Since then, one consistent request across our client base was to have a presence at HIMSS for a more personal interaction with our executives, IT support staff, and other clients. Over the years, we continued our HIMSS engagement across the Interoperability Showcase, demos with our industry partners and by supporting the educational components of HIMSS. This year, we will participate in these activities again, and we are excited to be able to meet our clients’ request and have a presence on the exhibit floor.

What will the company’s exhibit hall presence be? Do you have enough HIMSS points for the big, prime location booth, or do you have to work your way back up?

MEDITECH
We’ll be unveiling a new 40×40 booth at HIMSS, which we are excited about, and we’ll have members of our physician team in the booth meeting with customers. We encourage everyone to visit us at Booth #774.

Cerner
We have confirmed a sizable amount of floor space. We’d be happy to share additional details closer to the event.

Both companies say their customers wanted the company to return to the exhibit hall. If that’s the case, was it a mistake to pull out in the first place? What influence did a tough, competitive market and the peaking of HITECH-related system decisions have?

MEDITECH
I believe you’re referring to an earlier interview I gave, where the emphasis of our return was placed on customer demand. The focus is truly more on the timing being right for us; it’s the right time for us to allocate these resources and dollars. Our customers did miss us, and we certainly paid attention to that. In particular, our return to HIMSS gives our customers an opportunity to see our new products and to meet our team of physicians.

Cerner
Cerner and our clients have made significant advancements over the last few years and we are looking forward to participating at HIMSS to showcase these advancements with our clients more broadly. Our decision to come back to the HIMSS tradeshow floor is driven by many factors, including what we all can acknowledge is a strong health care industry making huge strides to improve quality and reduce cost. The diverse HIMSS audience gives us a chance to reconnect with our current clients and showcase to the broader health care community some of the exciting advances we’ve made in recent years.

Merry Christmas, Happy Hanukkah, and a belated Happy Festivus to all. Thanks for everybody who reads, sponsors, or otherwise supports HIStalk. I hope your holidays are amazing and that 2012 is your best year ever.

E-mail Mr. H.

John Gomez 12/23/11

Since establishing JGo Labs, I have had the opportunity to speak with many of the key decision makers in the world of HIT. It has been a rather eye-opening experience, one that has created a new understanding and appreciation for the challenges this industry faces long term. My discussions have involved hospital leadership, physicians, nurses, employees, leaders of HIT companies, and industry analysts.

One of the consistent things I hear from everyone I speak to is, "You know John, we just aren’t sure about this market. When we talk to the vendors and industry analysts, they all paint this awesome picture of their companies with strong financial performance and huge upside. Yet when we talk to the clients and ask about their future plans, they don’t match up with the vendors’ and analysts’ views. What do you think?"

This polar view of HIT, specifically in the EMR sector, may seem typical of the client / vendor perspective. But when you dig deeper, you find that it is all but typical. Vendors will paint rosy pictures and clients are going to be cautious of vendor claims. That is normal.

What isn’t normal is that when you probe clients (IDN, academics, community and physician groups) you quickly learn that their hope is to get through Meaningful Use certification as fast as possible and then get back to what they know best. That often means not investing in EMR products.

Most clients I speak with state that the biggest issue they have with HIT products is that they don’t deliver on the promises. They may improve patient safety to some extent and help streamline some processes, but clients aren’t seeing those products as a means to cut their operating costs or improve their revenue. Why this is the case would make great content for another article, but what is important here is that there is a general feeling among clients that the EMR is a distraction, not something they want to continue evolving over time. Simply stated, they want to meet the guidelines and focus on the things in their business which drive real revenue and change.

In speaking with the vendor leadership side of the HIT world, what I typically find is a world of fear, with many leaders confidentially stating that, “I am not sure how we survive the long term.” Keep in mind that my discussions are with middle and senior managers, not the executives. My experience is that speaking to those on the ground gives you a much more realistic view of what is happening in a company than what you learn from executives, boards of directors, and financial filings.

The last area of input is the sector analysts. Although they typically focus on public companies in the HIT sector, many of them will evaluate all companies as means to gauge opportunity and test the claims of those companies in which they are considering investing. More and more analysts are finding that over the long term, the return on investment for HIT companies is not as promising as hoped. There are some shining stars and if you use diligent tactics you will make a return, but if you compare HIT ROI for public companies versus other industries, the return is not glowing.

As you can see, this doesn’t paint a really exciting picture of the market. Although I believe we are seeing a mini financial bubble, I do think there is hope, and I’ll address that shortly. Right now, I want to continue to flush out why a bubble may exist and provide some insight into the dynamics of this market and how it affects vendors, which ultimately affects healthcare institutions and their decisions.

Most healthcare vendors operate in a US market, or at least their portfolio is dominated by US clients. The US healthcare market, from an HIT perspective, does not grow each year as do other industry sectors. There are more patients every year, but unless the vendor’s licensing model increases their payment for each patient visit or transaction, the majority of HIT vendors don’t see this upside.  

The market size for the vendors is typically the number of beds in the US.  If we want to translate this to a math formula, it would be

Total US Hospital Beds – Already Committed Beds

That is your market. Committed beds are those where the institution has already selected an HIT vendor for that line of business offering.

Most hospitals have made a commitment to, say, an EMR vendor (with Epic and Meditech having the lion’s share) and are facing sheer difficulty in successfully implementing the systems. This is not a very transient market — clients will stick with their choices for years or decades. This makes vendor growth difficult and impedes new vendors from entering the market.  

Secondly, not many new hospitals are being added each year. Not only is it a limited market opportunity, it is also a limited market in terms of its organic expansion.

Those two points alone are cause for concern. We have companies struggling to make their way in a rather limited market. Just like in the real world, if you put a few predators in a pond that exhaust the food supply, they either turn on each other (merger) or they die off (stalled growth, no innovation, go on life support.) These foundational characteristics  establish the foundation for our bubble. Lots of excitement, sudden infusion of growth, tons of market hype, very limited market.

The next challenge is that many of the companies in HIT are experiencing extremely rapid growth. You might be thinking, “Wait, John. Isn’t rapid growth a good thing?” It is if the growth is balanced.  

If a company is growing its top side (new profitable sales) while slowly expanding its costs (people, infrastructure) then growth is great. But if you pay attention to the vendors in HIT, they are growing their costs at a rate that outpaces their top line.They are adding tons of people for services and support, yet you don’t see a tremendous number of net new sales. They are offering this expanded capacity as proof that they are in demand, but without net new sales, it is probably because they misjudged their products’ quality and capabilities, not because the company is gaining market share.

Secondly, if you aren’t seeing a company hire an incremental number of engineers and product people, then they aren’t adding new products to fuel the future. Healthy companies have a long-term focus, which is critical for surviving a bubble — growing and investing in their future products.

The concern here is that eventually, given a limited market (pond), vendors will eventually need to slash costs to continue operations ( the first pin prick in the bubble).

Slashing costs can be termed many different things: optimization, efficiencies, consolidation, synergy, and reorganization. Fancy terms aside, it is simply good old fashioned cost-cutting in hopes of making a financial plan  People lose their jobs and the company is in the first throes of trouble.  

As an industry, we have seen a few companies begin to take this tack and go into maintenance mode. Others will not cut costs so as not to signal the market that they are having challenges, but their margins will dwindle or their stocks will stagnate. No matter how you slice it, these are the outcomes of a limited market and companies with limited innovation.

So what does this mean to you? What should you be thinking or asking?

As a client, investor, or employee of an HIT vendor, you need to make long-term bets and evaluate whether a particular vendor is truly positioned for the long term. Now more then ever, you need to verify that your vendor is transparent about their finances, operating plans, and roadmaps.  

A vendor shouldn’t just talk about their history. It’s more important to know how they are financed and structured for the future. Be careful of fancy talk regarding reorganization, the use of external consultants, or restructuring. This is often the first sign that a company is in flux, either poorly positioned for growth or unable to understand their own market.

(Also, as important as cash reserves are to any company, if any company continues to point to their cash reserves as part of their long-term survival strategy, I would be concerned, but that’s just me.)

If the company is publicly traded, look at how Wall Street has rewarded their stock over several years. A stock that doesn’t have a history of long-term incremental and sustained growth reflects a company that hasn’t earned Wall Street confidence, but rather is a company that most analysts use to do short sales. This is not a company whose products you want to own for the next decade. 

Consider also that many companies put a lot of time and thought into their analyst calls — to the point of scripting them, hiring PR firms, and using other tactics to paint a glowing picture of poor performance. Don’t get fooled by fancy words and great presentations. Look at the long-term stock performance and discount what you hear on analysts calls. They are like first dates — everyone is on their best behavior and most analysts don’t ask hard questions. Your time is better spent elsewhere.

Simple math can give you clues to your vendor’s position for the future. Ask how many new new sales they have made in the past three years. 

I am defining net new sales as those that bring completely new clients to the table — clients with which the vendor has no preexisting relationship. Many vendors will classify a new sale as any new item bought by an existing client. If you listen to the analyst calls or sit in a vendor presentation, you might hear them say, “We had 50 new sales last year.” You think, “Wow, these guys and gals are on fire. Let me get some of that!” 

In actuality, they may not mean “net new sales,” they mean, “We sold stuff to the clients we already have.” This is important. You want existing clients to buy from their vendors. But if a vendor isn’t breaking out sales between net new clients and existing clients, it’s sleight of hand, often used to hide that the vendor isn’t expanding their market. That isn’t good.

Vendors love to talk about their sales pipeline and product roadmaps. This is good, but in a market with limited number of clients, a vendor needs to really talk in detail about their product pipeline. What products are they bringing to market? Who will buy them? If they are just offering the same products they have for the past several years or decades, be wary. If they are talking about new products in the pipeline but aren’t hiring tons of engineers and domain experts, be wary.

Look for details about when, how and why. Does their pipeline make sense? How much are they investing? Is it a committed investment? What do they need to do keep investing in the pipeline?  I bet it is linked to net new sales. If new sales stop rolling in, the company will either cut their costs or cut the product. Neither is good for you.

Why do cuts matter to you? If a vendor is cutting people, you may be in for a bumpy ride when it comes to service levels, which affect you the client directly. It also may mean that the vendor couldn’t predict accurately how to manage their business through the economic challenges of the industry.  

Look behind the marketing and get a clear understanding of why the vendor is cutting costs. Cost-cutting because of a new process may make sense. Adding robots to an assembly line would provide the same level of service with a need for less humans and less costs over time, but just cutting people or taking a quarterly write-off are not signs of a healthy company.

Listen closely to your vendor for signs of cannibalization. Be wary if they plan to grow their business by going after the business of stagnant companies that are closing, downsizing, or freezing their products. What the vendor is saying is, "Thank God those other guys screwed up, because without that, we would be in trouble."

Again, look for the totally net new sale. If clients are buying the vendor’s products without a sentient event — such as other companies going into maintenance mode — chances are the vendor is doing great. If a vendor is relying on the failure of others to keep growing, that’s a big warning signal.

Look over there and ignore the man behind the curtain. The industry relies on KLAS, Gartner, and others to evaluate vendor performance, client satisfaction, and overall product quality. I don’t believe any of these organizations is perfect. They should not be the ultimate voice of your decision. Still, when any vendor asks you to ignore these reports, you should have serious concerns.

No consumer or vendor reporting agency is perfect, but you can make it close to perfect. Take the report cards offered by these agencies and do your own analysis. Ask your vendor to answer the questions in the report. Randomly sample their client base, employees, and partners. It’s just like buying an appliance or car — if you bring the Consumer Reports article with you and ask about the report on your own, you will get better facts to help you make a decision.

So what’s the net?

I believe that we are in the early formation of a bubble. Whether it bursts or not, I don’t know. As an industry, we need to be wary and proactive. At the end of the day, the companies with strong product pipelines, net new clients being added to the roster, and growing conservatively will be the ones left standing. 

We will see consolidation, experimental business models, and some vendors fading away as the market settles and government funding levels. Don’t get taken in by mergers and consolidations. Most vendors don’t have the ability to successfully pull them off, although some have succeeded.

I have been wrong about more things in my life then right. I hope I am wrong about the future of HIT and the landscape of companies. There are real people that walk the halls of those companies, with families and dreams. My hope is that the leadership of those companies think long term, put aside vanity and ego, and do the right things to weather the storms.

Is there hope?

Yes. I don’t believe that this industry is doomed. I do believe there are going to be some serious growing pains, some flushing out of the industry (which has already started – Google, Microsoft, etc.) and unfortunately, many people losing their jobs as Meaningful Use levels out.

Once the industry works through that, I think we will be left with a really strong base of companies that are highly innovative, financially stable, nimble, and led by really smart professional leaders who truly understand the needs of the client and have a long-term focus. There is tremendous opportunity in this industry. We just need to separate fact from fiction.

John Gomez is CEO of JGo Labs.

News 12/23/11

Top News

It was announced Thursday evening that the 27% Medicare physician pay cut that was scheduled to take place January 1 will be delayed for at least two months.

HIStalk Announcements and Requests

Mr. H and I are already working on our HIMSS-related details, including our Must-See Vendor listing, our sponsors-only luncheon (where Mr. H, Dr. Jayne, and I will make personal but disguised appearances if we get brave,) our first-ever HIStalk Booth Crawl, and HIStalkapalooza. And then there is the charity shoe drive, which I hope results in hundreds of pairs of donated shoes. Mr. H says he also wants to schedule a HIStalk flash mob doing The Wobble, but who knows if he is serious. If you are a sponsor, look for my name in your inbox so you don’t miss any important details. And if you enjoy dressing to the nines and winning fabulous prizes, keep reading here for HIStalkapalooza details. In the mean time, shop those after-Christmas sales to find some hot new shoes and your party attire.

Looking for last minute gift ideas? You won’t find them on HIStalk Practice, but you will find plenty of other goodies to stimulate your mind as you nourish your body with fruitcake and other treats of the season. Some highlights: Canadian EMR Nightingale Informatix purchases US-based PM company Medrium. A troubling headline. A CIO seeks recommendations for EHRs suitable for surgery-based practice (send your recs my way.) ARHQ releases a guide for EHR implementations. Still on the naughty list? If you sign up for e-mail updates on HIStalk Practice, I promise to put in a good word for you with the jolly guy in red. Merry Christmas, Happy Hanukkah, or best wishes for whatever holiday you may be celebrating!

You may have noticed considerably less visual assault when reading HIStalk lately, as sponsors are busily swapping out their animated ads by the January 1 target date. We appreciate their support of the new policy and hope you do as well.

We need your HISsies nominations. It’s like a primary election: those with the most votes get on the final ballot to run for Most Influential, Most Effective, Worst Vendor, etc.

On the Jobs Board: Clinical Systems Analyst, Cerner and Epic Resources. On Healthcare IT Jobs: Pharmacy Business System Analyst/SME, McKesson STAR Analyst / Consultant, Cerner PathNet Consultant.

Online life is not a cabaret, old chum. What good is sitting alone in your room in front of an HIStalk keyboard if you can’t hear the music play, in the form of the pathetic metrics that Inga, Dr. Jayne, and I focus on in the absence of any other source of validation of our questionable societal worth? Right this way, your table’s waiting: (a) subscribe to the e-mail updates; (b) Friend and Like us in the appropriate places (on the Internet I mean, not our actual bodily places); (c) send us news and rumors; (d) give the Resource Center and Consulting RFI Blaster a look if you are in need of products or services; (e) admire and occasionally click the decreasingly animated sponsor ads to your left, marveling along with us that real companies with suit-wearing employees working in fancy offices support pajama-clad, crotch-scratching spare bedroom bloggers not only financially, but personally as we toil deep into the night after working hospital day jobs. We’re not naïve or full of ourselves , though – we fully understand that we’re just the convenient conduit for our desirable readership, so thanks for being included in that number.

Listening: jangle rockers The Connells, which flamed brightly but briefly over the 1980s global skies from Raleigh, NC. Even less appreciated than the band is Bandwagon, the tune-filled 1996 movie they had a hand in. I strayed on it and loved it this week on Netflix. Its total gross was $22,000, so it’s a safe bet you haven’t seen it. 

I will be working as usual this weekend, so there will indeed be a Monday Morning Update even though few folks will be reading it Monday. My handful of readers and I will be huddled like weary travelers making small talk in an out-of-the-way diner during a Christmas Day snowstorm. I don’t expect much news to report, but you never know. Regardless, Merry Christmas, Happy Hanukkah, or a joyous whatever it is you celebrate this weekend. If you’re out next week, Happy New Year as well (not to offend those who follow the Chinese calendar, who won’t be celebrating until January 23.)

Acquisitions, Funding, Business, and Stock

Citing challenging economic conditions, Thomas Reuters announces that it has changed its mind about selling its healthcare business.

Nuance Communications signs an agreement to acquire rival Vlingo, a Siri alternative for Android smart phones that offers better social networking capabilities. That company was found not guilty of infringing on a Nuance patent earlier this year and later sued Nuance for unfair business practices, alleging that Nuance’s CEO offered three Vlingo executives $5 million each to persuade their boards to approve an earlier acquisition offer. All pending lawsuits are now “stayed.”

PatientKeeper raises $6 million in growth capital from existing investors to support product development. Chip Hazard of Flybridge Capital Partners has been named chairman of the company’s board.

The company behind MyMedicalRecords.com announced a $30 million sale of its patents last week, but the newly filed 8K indicates that the transaction is not quite that straightforward (not surprising given that the company’s market cap is only $16 million and its products don’t seem particularly innovative.) Expert interpretation welcome.

Sales

Biggs Gridley Memorial Hospital (CA) selects the Prognosis Health Information Systems ChartAccess EHR and HIE.

INTEGRIS Health (OK) selects MedVentive Population Manager and Risk Manager to manage risks and quality performance.

People

Charles Anastos, Jr. joins PwC US as a principal in PwC’s Health Industries Group and co-leader of the firm’s EHR/HIE practice.

The Indiana HIE appoints Josh Nelson, MD as CMO. He was a physician executive fellow at WellPoint.

Announcements and Implementations

Bayada Nurses completes implementation of Homecare Homebase across its 50 home health service offices.

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Government and Politics

The VA announces that it has established Facebook pages for all 152 of its medical centers. It has also created 64 Twitter feeds, a YouTube channel, a Flickr page, and the VAntage Point blog.

CMS warns that its computer systems could crash under to a backlog of claims unless Congress stops the scheduled Medicare pay cut at the end of the year. The agency is advising contractors to hold physician claims for the first 10 business days of 2012.

ONC will build an online database to measure the effectiveness of grants given for a variety of HIT purposes, including those to individual physicians and hospitals, RECs, state HIEs, community colleges for HIT training, and vendors tracking HIT adoption.

The government project to develop a single EMR system for the VA and Department of Defense gets a $100 million appropriation even though the agencies’ request came in after the deadline. The VA gets $3.11 billion to spend for IT in FY2012, of which $580 million is for software development that includes a benefits management system ($107 million), veterans relationship management ($70 million), Virtual Lifetime Electronic Record ($50 million), and miscellaneous applications ($48 million.)

FDA goes on record in suggesting that it’s not really a good idea to buy another mother’s breast milk for your baby, even though Web sites offer it and some mothers make up to $2,000 per month selling their excess supplies. Breast milk is theoretically healthier for babies, but only if it doesn’t come from HIV and hepatitis-infected crack addicts anxious to feed their habit by selling whatever body product commands street value. Hospitals get sued regularly for mixing up breast milk, to the point that several vendors offer bar code scanning solutions to match milk to baby.

Other

athenahealth’s Jonathan Bush takes some direct swings at Allscripts and CEO Glen Tullman, calling him a symbol of “atrophy” and likening Allscripts to an “Orwellian bureaucracy.” In an article in the online investor publication Minyanville, Bush positions athenahealth as nimble and cutting edge, compared to the behind-the-times Allscripts. I’d say it’s pretty safe to assume that Tullman will not be sending Bush a Christmas ham this year.

The local paper writes up the self-implementation of the VA’s VistA by Oroville Hospital (CA), which earned it a $2 million Meaningful Use payout. We wrote earlier about that project, citing Roger Maduro’s Open Health News, which said Oroville spent $10 million on the project (which included hardware, replacement lab and medical equipment, and iPads) and $500K to have VistA enhanced to meet its needs.

Lee Memorial Health System (FL) gets a story in its local paper for implementing Epic’s bedside barcoding.

A network switch outage at Upstate University Hospital (NY) forces a several-hour return to paper systems and hand-rung patient bells.

An article says Cleveland Clinic’s fifth-highest-paid employee made over $1 million in each of the last two years despite having left the organization under “cloudy circumstances” in 2009. The Clinic declined to answer questions about David Strand’s severance or whether he’s still on the payroll. He and his also-resigned wife founded patient satisfaction and quality consulting firm ExperiaHealth (sold to Vocera) and he’s now CEO of LifeNexus, which sells consumer PHR smart cards.

KLAS says more providers are taking advantage of application hosting services to reduce capital expenditures and to tap into a higher level of technology. At the same time, more hosting providers are providing hosting services to applications other than their own.

All 69 IT workers in Louisiana’s Department of Health and Hospitals are notified they will lose their jobs early next year. The University of New Orleans and the University of Louisiana at Lafayette have been contracted to provide IT services for the state agency and may hire 50 of the displaced workers.

The sale of the Chicago Sun-Times to an investment group led my Merge Healthcare chairman Michael Ferro, Jr. has been completed.

A new non-profit, Patients for Fair Compensation, proposes a worker’s compensation-like system that would replace lawyer-enriching malpractice lawsuits with an administrative process by which patients would receive reasonable compensation quickly without turning most of the money over to attorneys.

Weird News Andy says he had a friend with an experience similar to that of this story, in which a man partying hard with two hookers at a Knights Inn motel in Orlando takes an AK-47 round to the chest. Doctors treating his wound find a large mass, removing part of his lung but likely saving his life.

WNA calls this story “Crack Cocaine.” Police car video records the back seat conversation of two handcuffed brothers as the older one implores the younger one to eat the one-ounce cocaine stash hidden in the older one’s rectum, telling him, “I can’t get no more strikes. Eat that sh*t so I can get out.” The younger brother eats the cocaine, tells the older brother he loves him, and dies of cocaine intoxication.

A Chicago malpractice law firm, cheered by the recent article suggesting that doctors are screwing around on their smart phones during critical medical procedures, says anyone who suspects they were injured by “distracted doctoring” should give them a call (probably while driving.)

Sponsor Updates

• Healthwise offers a white paper entitled Patient Response: Giving Voice to the Patients.
• Tom Stephenson, president and CEO of HMS, discusses healthcare technology as a tool for better patient care in a blog post.
• Passport Health Communications will participate in next month’s MEGA and HFMA MA-RI conferences.
• eClinicalWorks and the American Society of Plastic Surgeons (ASPS) announce a three-year initiative to provide eCW’s products to ASPS members.
• HealthStream and GE Healthcare announce a partnership to offer Centricity University, a subscription-based service for online and classroom training on Centricity products.
• Microsoft will participate in the 2012 Military Health System Conference January 30 – February 2 in National Harbor, MD.
• Brian Woods MD, chief medical officer of NorthStar Anesthesia, wins a magazine’s award for implementing Shareable Ink in the hospitals that his group serves. Prognosis CEO Ramsey Evans was also named for his work creating the Prognosis HIS.

EPtalk by Dr. Jayne

The hot news around the doctor’s lounge the past few days (other than the fountain soda machines that were recently purchased to feed the habits of those non-coffee drinkers on the medical staff) is the Medicare pay rate debacle. As most of you know, the House of Representatives rejected a Senate bill this week that would have avoided the pending 27% cut in Medicare rates. As a result, pay rates are in limbo and CMS responded by saying it would suspend claims processing for the first 10 business days in 2012 to avoid having to deal with retroactive reprocessing should Congress remedy the situation.

Make sure you don’t use it as an excuse to slack on your charges, though, because come January 17t, CMS will start processing those claims (at the reduced pay rate if Congress doesn’t act) on a first-come, first-served basis.

And for the curious, they installed both Coke and Pepsi dispensers, but my southern sensibilities are highly outraged by the lack of respect shown to my esteemed colleague, Dr. Pepper.

Interestingly, one of the stories I read that covered this issue was right next to an article titled Physicians Must Make Any Changes to Medicare Participation by December 31. That means if you’re tired of all the shenanigans, you have the opportunity to opt out of Medicare if you wish. The AMA offers a Medicare Participation Kit that offers more information on the various options.

I love it when Inga sends me snarky comments about stories she’s reading, and this week she didn’t disappoint with this one. To Get Meaningful Use Payments, Urologists Must Address Workflow. I wholly agree with her that the words “flow” and “urologist” should never go in the same headline.

Sending more happiness our way, CMS also released a proposal for rules around the Physician Payment Sunshine Act. The rules require that gifts, consulting fees, travel reimbursements, payments, grants, and pretty much anything worth more than $10 that is given to physicians or teaching hospitals be disclosed by manufacturers annually. For those of you who may not know, this is part of the Affordable Care Act, which really does seem to be the gift that keeps on giving. CMS also announced a comment period open through February 17, 2012, so be sure to weigh in. HIMSS has also released a fact sheet and plans to convene a working group to formally respond.

NCQA releases a “save the date” for the 2012 Health Quality Awards to be held March 27, 2012 at the National Building Museum in Washington, DC. Nothing on their website yet that I can find, but I did get a nice e-mail soliciting sponsors.

The Wall Street Journal runs a nice piece on researchers who are using “virtual patients” to leverage technology to test medical devices and procedures when real patient testing isn’t practical. Computerized modeling can help with estimates of radiation exposure to a fetus or with technologies which may perform differently in children (who aren’t typically the subjects of very many research protocols) as compared to adults.

Sometimes low-tech is best: Archives of Dermatology publishes a study that shows that maggots debride non-healing wounds “significantly faster” than traditional scalpel-based techniques. Additionally, there were no differences in pain or crawling sensations between the two treatment groups. Maggots have been approved for medical therapy since 2004, but availability of so-called “bagged larvae” varies. Out of curiosity, I checked with our pharmacy and am happy to report that yes, we’ve got maggots in our arsenal.

I’ve enjoyed seeing the pictures of holiday giving and charity activities submitted by our readers. I recently heard about WorldScopes, a philanthropic project of the AMA Foundation that distributes new and gently used stethoscopes to clinics and hospitals world-wide. If you donate more than 20, the AMA covers your shipping costs. My package is already on its way. If you decide to participate, put HIStalk on the shipping label since we’re a lot more fun than the other choices for identifying where you heard about the project.

That’s it for me tonight. I’m off to bake some holiday cookies with my main man. Have a question about automated patient recalls, why baking soda and baking powder aren’t interchangeable, or what those little silver metallic balls are on holiday cookies? E-mail me.

Contacts

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

HIT Vendor Executives – Part One of Two

We asked several HIT vendor executives the following question: What was the biggest HIT-related news or event in 2011 and why?

Ray Dyer, CEO, Acusis

The industry has experienced continued mergers in 2011 (Allscripts/Eclipsys and Medquist/M*Modal, to mention a couple), the federal government has come to a ruling on how ACOs should work, MU payments were issued, and we have seen a rise in the use of and demand for mobile devices in healthcare, including new medical students being issued iPads.

I don’t think a singular event could be identified as the biggest moment in HIT in 2011. However if mapped across a timeline, we could certainly mark these as significant highlights during this past year.

Dan Herman, Founder and Managing Principal, Aspen Advisors

McKesson Provider Technology (MPT) division’s Better Health 2020 strategy announced on 12/9/11. MPT has publicly announced what has been rumored for some time – that it will curtail further development of its Horizon software product line and invest heavily in its Paragon product. This decision affects hundreds of hospitals throughout the country. Some long-term McKesson customers have already seen the writing on the wall and have made strategic and financially significant decisions to move away from McKesson’s non-integrated Horizon clinical platform. However, many other customers (medium-sized community hospitals and multi-entity integrated delivery networks) are faced with a critical decision: do we stay the course with McKesson or rethink our EMR strategy and pursue an alternative course?

Reading between the lines, this change in direction will have a huge financial impact on current McKesson Horizon customers, and it brings McKesson’s credibility in the EMR market into question. Although the market for EMR technologies has grown, the Horizon product line has experienced decline in market share, system development delays, poor product integration, and significant customer dissatisfaction.

On one hand, I laud MPT for coming clean on the challenges it has had with the development and support of the Horizon product. However, it appears that MPT’s go forward strategy is “déjà vu” – a poorly thought out approach to integrate disparate platforms, enhance a product that has experienced success in a focused market place (Paragon), and promise customers that MPT is committed to delivering “a fully integrated core clinical and revenue cycle IT system.”

Regardless of McKesson’s direction, healthcare providers need to evaluate their needs against the software available to support them and make decisions that are in their best interests.

Jay Deady, CEO, Awarepoint Corporation

The biggest HIT-related news of 2011 is that 1,211 eligible hospitals and 21,425 eligible professionals (EPs) have successfully attested and collected $1.84 billion from Medicare and Medicaid through the end of November for meeting Stage 1 meaningful use of electronic health records (EHRs).

The news, disclosed at the December 7, 2011 meeting of the Health IT Policy Committee, is significant for several reasons. First, it indicates the transformation of the health system and national commitment to improve access, quality, coordination, and efficiency of care through information technology have begun in earnest.

Second, it ensures providers adhere to baseline quality standards that can be measured and compared, including: using CPOE for medication orders, implementing decision support rules, exchanging key clinical information, and protecting electronic health information.

Third, attesting hospitals and EPs had to meet reporting requirements that some providers have characterized as challenging, onerous and time-consuming. Those that haven’t attested or plan to attest to Stage 1 in 2012 will benefit from lessons learned by early attesters.

Fourth, the payments demonstrate the meaningful use program is real, which will motivate providers to automate sooner rather than later in order to subsidize or recoup the cost of an EHR. As they automate, however, providers must remember that EHRs alone won’t address every problem afflicting healthcare. To accomplish that and aid throughput, they must complement EHRs with other technologies such as real-time location systems.

Don Graham, General Manager, Billian’s HealthDATA

I would have to say it’s been the extreme focus providers seem to be putting now on enterprise healthcare analytics and business intelligence, especially when coupled with the recent release of final ACO regulations. They realize that healthcare transformation requires more than the implementation of an EMR. As providers move more towards the coordinated care model (PCMH, ACOs and beyond), the challenge will be to meet the analytical needs to support this model. It will be critical to deliver an integrated view of clinical, financial and operational data not only across the enterprise, but across the community as well. Access to this data will enable providers to move into new areas of care.

In acknowledgement of the importance of analytics and its role in healthcare transformation, Billian’s HealthDATA and affiliate Porter Research have decided to focus one of our Provider Perception studies on Enterprise Analytics early next year. It’s something that our healthcare vendor customers are in turn paying more and more attention to, and appreciate the insight into.

Stuart Long, President, Capsule

I think the biggest HIT-related news this year is ARRA. It seems that all hospitals are just looking at how they are going to meet the criteria and qualify for the stimulus dollars. They are looking for any and all news on the topic. They are looking for help in sorting through and interpreting the legislation and what they specifically need to do to qualify. They are setting up cross-functional teams within the hospital to sort through it all. And they are looking to their vendor partners to prove how their technology and solutions fit within ARRA and therefore whether or not they will make it to the hospitals short list or not.

In fact, it’s one of the biggest areas we’ve been working on at Capsule and with our EMR partners — to help define where device integration fits within meaningful use and CPOE. I believe that ARRA and CPOE have hit all areas of the HIT space, from hospitals, to vendors, to system integrators, and to the publishing community at large – whether that be new publications, journals, trade shows, blogs, and even social media.

I just believe that the entire healthcare IT world has been turned upside down with ARRA. And of course it’s not over. We will all continue to be focused on it as Phases 2 and 3 roll out in the years to come. It might be a bumpy ride, but all we can do is hold on tight and keep on moving forward.

Mac McMillan, CEO, CynergisTek

I’m sure from an overall HIT perspective the answers will be quite different, but from a privacy and security perspective, it had to be one of two announcements from the federal government.

The first is OCR announcing it will finally initiate its regular audit program to conduct routine, random compliance audits of organizations accountable to HIPAA. The initiation of the audit program completed OCR’s menu of compliance and enforcement-related activities by adding to its existing practices: investigation of breaches and response to complaints. The OCR will likely disclose more information about these audits and their outcomes next year.

The second candidate for the biggest HIT-related event is the ONC announcing a delay in Meaningful Use Stage 2 in order to give organizations more time to meet Stage 1 requirements and to further support adoption of EHR technologies.

Both of these have a direct impact on the industry and its move to privacy and security readiness. We at CynergisTek are working with a lot of healthcare organizations to achieve compliance goals and improve their overall security posture. We’ve seen Meaningful Use increase attention to security and work to provide the support covered entities need to accomplish their risk analysis and implement the security features of their EHR/EMR effectively. This approach is consistent with OCR’s guidance on risk analysis and produces a step-by-step action plan that guides remediation efforts. In addition to that, we understand the partnership model desired in healthcare and we provide ongoing advice and assistance throughout the remediation process and beyond.

Michael O’Neil, CEO, GetWellNetwork

2011 was the year that the healthcare industry fully recognized patient engagement as a business imperative. Driven generally by the reality of a shift to a value-based US health system — and specifically by the requirements for patient engagement in Stage 2 Meaningful Use and the push by ONC to support consumer health IT adoption — leading providers moved aggressively to develop strategies, find partners, and adopt solutions to help.

Due to the confluence of regulatory, business, and technology transformation underway, patient engagement emerged as a core strategy for performance improvement for providers. Leveraging HIT, patient engagement solutions can take the form of Web-based portals and interactive patient care (IPC) education and communication solutions, or as simple as an online patient guide or patient bill of rights. It’s education. It’s entertainment. It’s empowerment. In fact, it’s all aspects of being involved in care.

One thing is sure: providers must work to ensure that the principle of patient engagement permeates clinical and business workflow and every aspect of care delivery. In 2012, there is no doubt that a focus on patient engagement will take greater hold throughout the continuum of care.

Peter J. Butler, President and CEO, Hayes Management Consulting

Attempting to identify the biggest HIT-related news item is difficult. However, based on research from the Ponemon Institute, which  conducted detailed interviews with executives at 72 healthcare organizations, the economic impact of information breaches can be far reaching and should be considered one of the top news items. Consider the following breach survey results:

• On average, organizations surveyed have had four data breach incidents in the past two years, up from three in last year’s study.
• The average number of lost or stolen records per breach is 2,575, up from 1,769 in the previous study.
• The top three causes for a data breach are lost or stolen computing devices, third-party mistakes, and unintentional employee action.
• Insufficient budgets and inadequate risk assessments are cited as the two greatest breach prevention weaknesses.
• Some 81% of those surveyed use mobile devices to collect, store, or transmit patient information, but 49% say they’re doing nothing to protect these devices.

There hasn’t been a slow news day in healthcare this year, but the topic of breaches is the alarm bell for the industry. With the onslaught of new technology, the most important data – patient health information – is not safely secured. It reflects the cracks in the frantic attempt to catch up with all the unintended byproducts of the industry changes.

For example, just when the industry secured all its laptops, mobile technology took off. Now, smart phones, mobile carts, tablets, and thumb drives need to be monitored and secured. Not a day goes by where a laptop has been lost or stolen. HIPAA’s reporting policy means that the clock is ticking when the breach happens, organizations are responsible for business associates’ breaches, and the fines pale in comparison to the impact on reputation.

Healthcare organizations must put privacy and security at the top of their 2012 priority list. They must develop policies and procedures for reporting in a timely manner on breaches. Further assessments need to be conducted on a timely basis – annually at least.  This protocol must be understood by every employee and monitored to ensure compliance across the enterprise. Training and communication of HIPAA regulations need to incorporated within each healthcare organization and monitored. Micky Tripathi’s blog post on this topic gives a stunning insider view to what it’s like to have a breach happen in your organization. No one is immune – and it takes a village to rectify it.

Tiffany Crenshaw, President and CEO, Intellect Resources

Meaningful Use and ICD-10 are what everyone is talking about, but surprisingly, no one is talking about what Meaningful Use and ICD-10 mean from a human resources standpoint.  Incentive deadlines have created an industry-wide shortage of experienced healthcare IT professionals, specifically those with Epic experience. Think about it — everyone in the industry is working towards the exact same deadline!

Countless planning hours are put forth to ensure a successful go-live and meet incentive deadlines. Technology, equipment, infrastructure, training and other task related functions are all meticulously planned in advance with the intention of those tasks being carried out by future experienced healthcare IT hires. But what if you can’t find those future hires? What happens to your plan then?

Meaningful Use and ICD-10 have created a huge demand for experienced healthcare IT professionals and there simply aren’t enough experienced individuals to fill these much-needed positions. Now is the time to think creatively about hiring solutions and start planning.

Doug Burgum, President and CEO, Intelligent InSites

The biggest healthcare IT event in 2011 was the Department of Veterans Affairs’ decision to improve healthcare efficiency with a national investment in Real-Time Location Systems (RTLS.)

The VA has the nation’s largest integrated healthcare system: over 150 medical centers, almost 1,400 community outpatient clinics, and 53,000 independent licensed healthcare practitioners, serving more than 8.3 million Veterans every year. Eric K. Shinseki, Secretary of the VA, has identified 16 transformational initiatives for the VA. One of these initiatives, Health Care Efficiency, directly includes RTLS to improve care while lowering costs.

The Government Executive reports that the VA views a planned $550 million National RTLS implementation as a way to improve efficiency, track equipment, and properly sterilize medical instruments.

We are thrilled that our industry has the opportunity to contribute to this groundbreaking effort. Intelligent InSites’ customers have improved patient satisfaction and patient safety, while decreasing hard-dollar expenses, through their use of RTLS solutions for asset management and patient flow. They do this by automatically collecting real-time data from throughout the hospital, processing that data, then using actionable intelligence to make fundamental improvements to how they run their hospitals. By using RTLS, they can process the location and status of every critical piece of medical equipment, patient, and staff in a healthcare facility, then use this data and intelligent workflow automation to improve their healthcare processes.

The next few years are going to be amazing—not just the RTLS industry, but also for the transformational benefits to the delivery of care.

Mike Sweeney, President and CEO, maxIT Healthcare

This was such a busy year in the HIT industry, it would be difficult to name just one event, so I will limit myself to three.

First, Epic’s continued dominance in new account sales along with the recent trend of their customers’ rolling the Epic applications out to their affiliate networks (acute and ambulatory) has had a major impact this year. Second, McKesson’s announcement of their product direction with Horizon and Paragon will have a significant ripple effect in the market as we get into 2012. Finally, the government mandates and programs surrounding Meaningful Use, ICD-10 and ACOs are driving so much demand and activity in the market, those can’t be left out of top events for 2011.

It’s definitely an exciting time to be in our industry, and I can’t wait to see what’s in store next year.

Tom Carson, CEO and President, MD-IT

The clear emergence of physician preferences for mobile applications to interface with their HIT systems has huge implications for systems criteria and future workflow demands. Most legacy HIT systems were developed with the idea that physicians would sit in front of desktop computers for their documentation and care-planning tasks. After years of physician reluctance to adapt to these defined work processes, the relatively rapid increase in popularity of applications for smart phones and tablets suggest that doctors are beginning to participate on their terms in EMR adoption and use, and that HIT vendors are due for a re-think in their approach to product solution design and delivery.

This is significant because it marks a maturing of the EMR industry in that products will have to be more customer-driven going forward, as opposed to regulatory-driven to succeed.

Patrick Hampson, Chairman and CEO, MED3OOO

The biggest news related event was just recently announced by the Kathleen Sebelius, the HHS secretary. By relaxing the time frame for meeting Meaningful Use Stage 2 requirements, physicians, EHR vendors, HIE projects, and most all operators of healthcare will all get more time to adapt to the rapid expansion of electronic health care delivery.

Changing healthcare to a more seamless, interconnected health system in the US is absolutely critical. Doing it right and not just doing it fast is even more critical. Why have providers go from a paper mess to an electronic mess? Why just add technologies without the strategy, knowledge, and planning needed and the provider level knowledge necessary to actually get a return on your investment? How about a return in care for your patient?

Physicians and hospitals were forced to scramble to adopt new work flows, new processes of care delivery, and at the same time, implement new technologies (EHR systems) and install patient portals to meet the requirements for Stage 1. If these same providers want to stay viable, they have to maintain productivity, fight competitive forces in their markets and pre-pay, for most of this while the government gives them an IOU. Throw in the current economic conditions of our depressed economy and it is all too much for providers. Great for vendors, not so great for providers.

Relaxation of the Stage 2 requirements deadline is less about not wanting to get somewhere, but it is more about getting there efficiently. A pet peeve of mine is why have financial penalties should you not do it fast? Why not financial incentives for doing it right?

Hopefully we will all take this delay as a continued opportunity to improve the designs of technology, not just to process a bill or serve as expensive transcription, but provide technology that can really support providers and the coordination of care across the populations they serve. While Accountable Care is touted as the next big step for many, MED3OOO as a healthcare management and technology company has provided technologies and operations for physicians and hospitals and communities are already accountable for care and for managing risk and been doing it successfully for more than 15 years.

For those that haven’t, the learning curve and the costs are steep. These organizations will require more than just production systems like accounting systems, practice management systems, and electronic health records. Organizations will require and we will provide strategies, systems, and operations economically. Organizations will need to have capabilities that include integration of disparate systems and disparate centers of data. Organizations will need the ability and systems to disseminate population data and then distribute that same data efficiently back to the point of care for its best use.

MED3OOO is uniquely position to partner with providers and provide our existing packages of system, software, and knowledge infrastructure to make this next journey a successful one for new Accountable Care providers. In doing this, we will continue our mission and make absolutely sure that the patient has a better outcome. We do believe that outcomes matter!

Peter Kuhn, CEO, MEDSEEK

With Microsoft partnering with GE, Google exiting the PHR market, and more payers entering the provider market, the events of 2011 have significantly changed the healthcare industry. How patients respond to payers acquiring providers depends on whether they perceive an improvement in care coordination or feel that quality of care is mitigated by payers influencing physicians. With access to both risk models and clinical information, how well these acquisitions work also depends upon the ability to analyze that data to create effective business strategies.

Analytics, particularly predictive analytics, has been in the healthcare news this year. At MEDSEEK, we understand that analyzing data and creating actionable strategic plans will help our clients set themselves apart. That’s why we made the decision to acquire Third Wave Research, Ltd. We’ve subsequently integrated what we believe to be the most advanced predictive analytics technology into our strategic patient engagement and management solutions.  With the commoditization of patient portals and patient outcomes and wellness driving revenues, the major market differentiator will be how well hospitals engage new and existing patients, manage costs, and coordinate care.

Hospitals’ success will increasingly hinge on using predictive analytics to match high-value patients with appropriate, profitable services when and where they need them and make informed investment decisions based on population health propensities. Combined with factors such as demographic, financial, and insurance data, predictive analytics will play a larger role in executing cost-effective, personalized marketing campaigns that influence patient behavior and improve population health.

Jeff Surges, CEO, Merge Healthcare

With new federal policies to reduce reimbursement and foster information sharing, the question is not if, but when a healthcare system should implement an enterprise imaging strategy that focuses on providing electronic access to medical images. Hospital CEOs, CIOs and physicians can no longer ignore:

• Patient safety issues around radiation exposure
• Competition to attract and retain the best physicians
• Compliance with Meaningful Use guidelines
• Support for an ACO strategy
• The push for interoperability in EHRs across healthcare systems and HIEs

These issues are driving the need for a new paradigm of image sharing and enterprise-wide imaging strategies.

An enterprise imaging strategy must focus on image storage, the ability to ingest images from outside of the enterprise, and provide accessibility to any type of medical image, anywhere across the continuum of care, anytime, by anyone. It should include three components:

• Storage. A vendor-neutral archive (VNA) to create a patient-centric record of images across all sites and modalities.
• Gateway. An intelligent DICOM gateway, capable of receiving and morphing studies from outside the enterprise.
• Viewer. A universal viewer that can be used in any environment on any device and is accessed via the browser, thus requiring no software to be downloaded.

There really is no wrong way to proceed with an enterprise imaging strategy as long as decision-makers fully understand the capabilities of each technology component, relate the capabilities to meeting their top business challenges, and look at the enterprise imaging strategy as a solution that can grow and evolve over time.

Jay Mason, CEO, My Health DIRECT

I see the roll-out and clarification for Accountable Care Organizations this year as being a significant event or turning point. While there is yet to be much to determined in how they will play a role in reimbursement and delivery, it has forced organizations — both payers and providers — to rethink how they function and how they look at themselves. Infrastructure, resources, and relationships will be reshaped.

This means they must commit to new ways to work together as providers, as well as how they are engaging, informing, managing, and directing patients. The silos that have been built up over the past decades will soon come crashing down.

Janet Dillione, Executive Vice President and General Manager, Nuance Healthcare

ICD-10 came onto the scene in 2011 in a big way. It received enormous attention throughout the year and has even been compared to Y2K. In short, it’s a monumental shift from what is documented, coded, and billed against today in healthcare and what level of specificity will be expected to be documented, coded, and billed against come 2013.

As a result of this major transition in medical coding, the reimbursement process will get more complicated and will expand. At Nuance, we believe that ICD-10 success begins with the physician at the point of documentation. In turn, over the past year we’ve allocated resources to develop, in partnership with 3M, next generation ICD-10-ready clinical documentation and coding solutions. In 2012, we’ll bring to market Computer-Assisted Physician Documentation, a new category of solutions that will interact with physicians at the point of documentation to review and prompt for the level of specificity required to achieve reimbursement in correlation with ICD-10 standards. Simply put, it turns clinical language (doctor’s spoken words) into codable language.

By combining Nuance’s speech recognition and Clinical Language Understanding (CLU) capabilities with 3M’s experience in developing and implementing coding products and services around the world, we’re well positioned to deliver solutions that will substantially improve physician workflow and will facilitate more precise, complete coding, and more accurate claims.

Todd Cozzens, CEO, Accountable Care Solutions, Optum

This past year has been filled with game-changers – from Meaningful Use to ICD-10 – but the biggest milestone in healthcare IT had to be the CMS final rule on the Medicare Shared Savings Program, which I believe will be looked back at one day as the event that spawned a whole new generation of health information technology.

Notice that I’ve not include the “care” ending to health. This next generation of IT solutions will focus not just on patients currently seeing doctors and being admitted to hospitals. It will cover a much broader spectrum of wellness and prevention products to comprehensive management of patient populations. The final regs set the tone for the industry and made a statement: accountable care is here to stay.

When I talk about accountable care these days, I am quick to point out I’m talking about the general idea of healthcare providers taking on some form of risk – i.e. being responsible for the outcome AND the cost of that outcome. McKinsey thinks there will be around 750 MSSP ACOs within five years. That sounds about right. But when we at Optum talk about the broader concept of sustainable health communities, we believe that every health system in the country will adopt some form of risk taking – whether it be bundled payments or new risk-sharing health plans with payors, all the way up to fully capitated networks.

Healthcare reform was the catalyst that started the dialogue. The budget deficit, with its inevitable cuts in entitlements, created the sense of urgency. The Medicare MSSP program signaled that CMS is 100% behind the effort. We all know that when CMS coughs, the US healthcare industry has a cold, and that’s why this final rule is such a game changer.

Paul Brient, President and CEO, PatientKeeper Inc.

One of the biggest HIT-related news stories in 2011 was the extension in the effective date of Stage 2 Meaningful Use. At some levels, this was a non-event. ONC’s decision to push back the Stage 2 start date for Stage 1 “early attesters” by a year (to Oct. 1, 2013) corrected a flaw in the original plan that effectively penalized hospitals for being on the ball and attesting for Stage 1 early. Yet the move created a fair amount of confusion in the market and headlines in industry media, and paused some Meaningful Use activity.

That is largely behind us now. The Stage 2 proposed rule will be published in the next month or so, and many hospitals are beginning to focus on the challenge of getting widespread physician adoption of CPOE and documentation software that will be required by Stage 2 and 3 objectives.

Todd Johnson, President, Salar

In a conference this past summer with chief medical information officers and physician informaticists, a physician’s panel was convened to consider the next big challenge for their hospitals. Without question, the conversion to ICD-10 topped the list. As discussed in that conference in Ojai, California, and paraphrased here: “ICD-10 is entirely a physician documentation issue.” While this statement does not to suggest a minimized importance for consultative services, back-end billing systems, or payer reform, it does call to light the critical nature of a physician’s clinical note. All coding starts from the note. Indeed, the note itself justifies all other pieces in this puzzle.

Going into 2011, we believed (as did many others) that Meaningful Use would continue to dominate all discussions. In retrospect, we’ve been surprised to see how quickly ICD-10 has become a front-burner issue though so poorly addressed by the healthcare market. Both hospitals and the vendor community alike seem woefully ill-prepared to address this issue which simply fuels the anxiety and paranoia of this “great unknown.” Just as Meaningful Use taglines blanketed the banners at HIMSS this year and MS-DRG coding dominated the banners in years before, you won’t be able to walk 10 paces without seeing ICD-10 lingo at HIMSS 2012.

Stephen Hau, CEO, Shareable Ink

The growing acceptance of enterprise cloud computing in healthcare has been a persistent and recurring theme of 2011. We are excited by this development because it will help accelerate much needed innovation in healthcare IT.

Hugely successful IT projects in our industry are relatively rare. Some may feel that this reputation is unfair and not deserved. However, who can deny that the industry has a track record of protracted implementation projects, lengthy development / release cycles, and expensive hardware investments that can quickly become obsolete?

Enterprise cloud computing represents an approach that is compelling for small physician practices (with no in-house IT support), large health systems (that require scalability, minimal administrative burden, and stringent uptime commitments), and organizations in between. We have observed shorter deployments, transparent and non-disruptive updates, and removal of hardware obligations from the customer. A cloud-based distribution model allows software providers to respond to market demands more nimbly – and healthcare organizations to take advantage of rapid innovation.

Taken together, enterprise cloud computing has the power to provide a very positive IT experience, allowing healthcare organizations to focus on the benefits of technology and creating a better environment for innovation.

Ed Daihl, CEO, Surgical Information Systems

Hospitals and anesthesia providers are facing reimbursement changes, shifting payment models, increased regulatory reporting, and Meaningful Use. We believe that hospitals will continue to focus on achieving ARRA funding to help combat these challenges.

It is important to us at SIS to ensure that we help our clients respond and prepare for these changes. We were the first perioperative healthcare software provider to achieve ONC Meaningful Use certification in 2010, and more recently, our Anesthesia Information Management System (AIMS) achieved Meaningful Use certification as well.

Evan Steele, CEO, SRS

One of the biggest HIT-related events was the recent announcement by HHS that it was postponing the implementation of Meaningful Use Stage 2. It was important, not because it will directly and significantly impact very many providers, but rather because of what it acknowledges and the positive message it sends.

All that the delay does is to reward early adopters by giving them access to three years’ of incentives under the easier rules of Stage 1 and to remove one of the reasons that might have discouraged some of them from attesting in 2011. Contrary to Secretary Sebelius’s contention, it can do nothing to speed adoption since the announcement came too late to impact any providers who have not already implemented—and been successfully using—a certified EHR.

What the delay does accomplish, however, is to send a heretofore unheard message—one of flexibility and of an acknowledgment of the significant challenges that Stage 1 is posing for many providers and vendors. By delaying the schedule for Stage 2, the government has let them know that the rules are not set in stone, that some things are negotiable, and that it is willing to work with providers and vendors in the interest of accelerating EHR adoption. If this same message is conveyed in the release of the actual rules for Stage 2, the likelihood of the program’s ultimate success will be greatly enhanced.

Rick Stockell, President, Stockell Healthcare Systems

As we have seen and experienced with our customers, the impact of prepping for and addressing Meaningful Use and ICD-10/5010 compliance on the healthcare industry was certainly significant in 2011, and it will continue to be a major factor into 2012 and beyond.

Richard Atkin, President and CEO, Sunquest

Over the past several years, structured reporting of laboratory results has been promoted as a public health priority. Its inclusion as a Meaningful Use objective is helping to drive the accelerated adoption of EMRs.

This past January, Sunquest Information Systems became the first and only dedicated laboratory information system vendor to achieve 2011/2012 Meaningful Use compliance and certification as an EHR Module by the Certification Commission for Health Information Technology (CCHIT.)

Sunquest continues to lead the industry with regard to the HITECH Act and Meaningful Use regulations. Meeting with government officials and continuously monitoring client preparedness are just two of the ways that Sunquest helps its clients complete the three steps for earning incentives: adopt certified electronic health record (EHR) technologies, achieve Meaningful Use objectives, and apply for incentive payments.

In addition to meeting many of the Meaningful Use modules, Sunquest solutions provide the capability to improve the overall safety, quality, and efficiency of healthcare. Our comprehensive Meaningful Use plan includes expanding the use and management of LOINC and SNOMED-CT codes. This initiative is a critical priority for our clients as they plan their LOINC strategy.

Sunny Sanyal, CEO, T-System

The recent decision by the US Department of Health and Human Services (HHS) to delay by one year the start date of Stage 2 Meaningful Use of certified electronic health records (EHRs) is by far the biggest HIT-related development of 2011.

By pushing the compliance deadline from Oct. 1, 2013 to Oct. 1, 2014, HHS recognized that the original timetable was too aggressive. Many hospitals planning to be ready for Stage 1 in 2011 or 2012 would have faced little lead time to prepare for Stage 2 requirements, which will not be finalized until July 2012. This deadline would have made it extremely difficult for both facilities and vendors to upgrade and install Stage 2-compliant EHRs by October 2013.

Prior to the delay announcement, we were beginning to hear rumblings from hospitals about potentially abandoning efforts to qualify for Meaningful Use incentives, instead waiting to attest until 2015 to avoid Medicare reimbursement cuts. The one-year grace period will enable providers who attest to Stage 1 Meaningful Use in 2011 to qualify for three payment years and those attesting in 2012 two payment years. It will give them and their EHR vendor partners additional time to develop a plan for Stage 2 compliance and design and implement optimal software. More importantly, it buys hospitals time to drive adoption of EHRs intended to improve the quality, safety and cost-effectiveness of care.