News 5/6/11

Top News

Q1 numbers for Allscripts: revenue up 82% , EPS $0.06 vs. $0.12, but beating expectations by $0.01 excluding non-recurring items. The company announces a $200 million share buy-back.

Alembic Foundation announces the availability of Aurion 4.0, its first release of the open source HIE software based upon CONNECT from the Federal Health Architecture.

Reader Comments

From RC: “Re: Inova Health System. They’ve announced that they will be going with Epic. They were previously with IDX since before the GE acquisition.” Unverified since I couldn’t find any mention on the Web, but I believe it for two reasons: (a) an official-looking press release was included, and (b) I had little doubt after interviewing CIO Geoff Brown a few weeks ago, even though he didn’t come right out and say anything. Actually, I did just now find a tiny mention in an undated message from the peds chair at Inova Fairfax: “The Joint Commission (TJC) now requires all inpatient chart entries to be dated, timed and signed, with either a provider code or legible name present. This is evolutionary. The Electronic Medical Record will automatically contain this, and many of its other benefits will be transformative in nature. Inova is now going with the EPIC system.”

From Fixer Upper: “Re: Judy Faulkner. Is she selling her house? This must be it – it’s the same architecture and artwork as the Verona campus.” I see the resemblance, but from what little I could find by sleuthing, the $3.9 million, 8,000 square foot home on 173 acres (top) in Oregon, WI is being sold by an owner that isn’t Judy. The same sleuthing suggests that the house in the bottom picture, worth about 10% of the the Epic-looking one, is hers, which would strike me as being more in character. But that’s just casual Internet detective work. Maybe someone who works there knows, not that it’s all that important anyway.
From Maven: “Re: not news, not rumor … just venting. As an HIT industry insider, I get so discouraged when I am a patient. I just registered for a minor procedure at a major teaching hospital that’s a beacon for HIT adoption. I was handed a two-inch, three-ring binder and was told by the clerk to take it with me when my name was called. Only nurses entered information into the computer, while the MDs and CRNAs did their documentation in the binder. I saw no evidence of innovation over what I implemented in 2002. I bet their EMR is mostly a document imaging system. I’ve seen progress behind the scenes at most hospitals, but bedside technology lags far behind.” I’ve worked in big places and IT is usually advanced in some areas, but a disaster of paper and poorly interfaced, outdated legacy systems in most. I’ll stick with my assessment that the big hospitals buy gazillion-dollar systems overseen by huge IT shops and highly compensated magazine-cover CIOs, but it’s often the tiniest ones that deliver the most impressive results from the systems they can afford. The main reasons: (a) fewer prima donna doctors and executives; (b) a more focused environment, both culturally and geographically; (c) better connection to their local community and patients; (d) more urgency to make IT projects succeed since they don’t have the bloated budgets to take a mulligan and buy them all over again a few years later when fads change. All of that offsets the lack of cash and the preponderance of community-based physicians whose EMR participation can’t be mandated.

From Jen: “Re: ex-Epic employees. I’m within the ‘exile period"’ of a year and am curious about my realistic job options. Recruiters lose interest when I explain I can’t staff for a few more months. Any tips on where I should put my considerable skills to use? Perhaps readers who have been in a similar position can offer advice.” Comments welcome. I’ve heard of employers taking on Epic-certified folks even with their mandatory time out, figuring they can let them do general project work until they are allowed to leave the penalty box. It depends on their project timeline and how desperate they are to land experienced people. It may be that recruiters just don’t want to be bothered with explaining your situation even though potential employers might be OK with it. But I’ll shut up and let those who have lived it first-hand chime in.

From California Dreaming: “Re: Alameda County Medical Center. Deep into a Soarian install, I hear.” I found the above in its 2010 annual report.

HIStalk Announcements and Requests

This week on HIStalk Practice: Micky Tripathi shares insights on Meaningful Use Stage 1’s Nasty Little Surprises in his Pretzel Logic column, about which a reader posted, “Adding Micky Tripathi to the HIStalk crew is further evidence of why HIStalk is one of the most worthwhile reads on the Web.” Emdeon acquires EquiClaim for $41 million in cash. St. Jude Medical integrates its Merlin.net Patient Care Network with GE’s Centricity EMR and Scottcare’s Oneview CRM. AMA introduces online tutorials to help physicians select and implement HIT systems. Only about 21% of eligible providers participated in the 2009 PQRS program and only 12% earned bonuses. If you are thinking to yourself that you don’t recall reading any of these stories on HIStalk, you are correct! Sign up for HIStalk Practice updates so you don’t miss a thing.

Jobs on the Sponsor Job Board: Segment Marketing Manager, Product Specialist – Physician, Software/Implementation Engineer. On Healthcare IT Jobs: Senior Systems Analyst – Financial Systems, Director, IT Business Services, Epic Reporting Specialist, Metadata Administrator.

Acquisitions, Funding, Business, and Stock

Start-up eMerge Healthcare receives $650K in investment commitments, including $250,000 from the Ohio state-supported venture development group CincyTech. The company was founded by a group of Cincinnati gastroenterologists who developed intra-operative voice command software to document surgical procedures.

British software vendor Sage reports improving numbers for the six-month period ending in March, although its healthcare business fell 5%, with especially weak sales of its Medical Manager PM/EMR. The CEO declined to comment on rumors that the company is planning to sell Sage Healthcare, expressing a belief that stimulus money will eventually boost demand for Intergy.

Sales

St. Joseph Healthcare (CA) will use Emerge.MD’s OnePlace virtual clinic to support its telehealth pilot project and to expand services into other remote care services.

Downey Regional Medical Center (CA) signs a multi-year agreement with MedAssets to manage its patient financial services, including billing and collections for self-pay and third-party insurance accounts.

Conifer Health Solutions secures a multi-year contract to provide revenue cycle services to Memorial University Medical Center (GA).

Camden-Clark Medical Center (WV) signs for Allscripts Sunrise Enterprise and Enterprise Performance Management for recently acquired St. Joseph’s Hospital, replacing Meditech. Its Camden-Clark Hospital is already using those products.

Salem Hospital (OR) is mentioned as an Epic customer, with a rumored price of $48 million and an expected HITECH payout of $14 million over five years. It’s hard to determine exactly what was being announced, but I think they were Epic before, at least on the ambulatory side, and they did just go live with MyChart.

People

Harris Corporation promotes Jim Traficant from VP and GM to president of Harris Healthcare Solutions. An interesting quote from CEO Howard L. Lance: “Jim’s personal healthcare experience as a two-time liver transplant survivor drives his passion for transforming healthcare and informs his ability to understand the complex needs of patient and provider."

Skylight Healthcare Systems, a provider of interactive patient care systems, appoints Carla Hilts, previously with McKesson, as chief clinical officer.

MedSynergies adds Aaron Garinger and Amy Hartt from Baylor and Wellspring+Stockamp, respectively, as managing directors of its consulting services group.

MEDecision promotes Carole Hodsdon to EVP/COO, reporting to CEO Deborah M. Gage. She was previously EVP/CTO.

Kent Rowe, a former GE Healthcare VP/GM and IDX sales VP, joins Culbert Healthcare Solutions as VP of information technology services.

Announcements and Implementations

CIO Shafiq Rab ceremoniously flips a switch symbolizing the EHR go-live of Orange Regional Medical Center (OH) EHR. It’s moving its two hospitals to Epic as part of a $30 million HIT initiative.

The Varian ARIA oncology EMR receives ONC-ATCB certification as a complete EHR.

In New York, North Shore-LIJ and Montefiore announce a strategic alliance to share best practices, with Montefiore citing one of its own strengths as IT systems that support care management.

Government and Politics

The HIT Policy Committee suggests delaying Stage 2 Meaningful Use one year until 2014. Providers and vendors have told the panel, ONC, and CMS that they need the extra year to develop and implement the new technology since the final Stage 2 rule is not expected to be released until mid-2012. An added benefit of the date push-back: more providers might participate in the Stage 1 qualification process since they would have an additional year to qualify.

Innovation and Research

Interesting healthcare technologies are mentioned in an Indian newspaper: (a) a hospital’s smart card that can be used as a debit card and to store patient information in its 4 KB chip; (b) a Web service that allows finding blood donors by sending an SMS text message, with the same service also posting a message on Facebook and asking users to tweet it; (c) a smart phone-based personal case management system in which teams of experts monitor diabetics, send text reminders and advice, and intervene as needed; and (d) an online results service (Web, e-mail, SMS) offered by a chain of diagnostic centers.

UPMC and Alcatel-Lucent will jointly develop a telemedicine platform, extending their agreement that goes back to 2006. The “virtual exam room” will reach the commercial market in early 2013. UPMC will consolidate its telemedicine offerings, which are used in 16 service lines and 19 facilities.

Technology

The new iPad 2 TV commercial features medical imaging as one of its key uses. I’d guess it’s AirStrip’s app that is shown since Apple features them in nearly every promo, but I don’t know for sure.

Other

Twenty-four percent of hospitals will invest invest in new transcription services, according to a new CapSite study. The report also finds that 61% of study participants currently take or plan to take a hybrid approach to capturing physician documentation to meet MU requirements and 53% would consider their current transcription vendor for data extraction and analysis needs.

KLAS’s latest report looks at the challenges and benefits of an anesthesia information management system (AIMS) and the most talked-about AIMS vendors. The vendors with the largest market share are Cerner, Draeger, GE, Philips and Picis. Similar to findings with other modalities, hospitals tend to prefer enterprise integration over best-of-breed.

Vince Ciotti says you should watch his HIStory Part 7 (above) if you want to know the connection between IBM, men’s hair, and miniskirts.

Weird News Andy can’t decide if a proposed New York law intended to reduce infections is “typical bureaucratic overreaching or actually a good idea.” It would prohibit doctors from wearing ties on the job.

Kaiser Permanente finds that its use of health IT has allowed it to avoid using 1,044 tons of paper for medical charts annually; to eliminate 92,000 tons of carbon dioxide emissions by replacing face-to-face visits with virtual visits; to avoid 7,000 tons of carbon dioxide emissions by filling prescriptions online; and to reduce the use of toxic chemicals by 3.3 tons through the use of digital imaging. Kaiser also claims that despite the increased energy use and waste associated with PCs, its use of HIT has had a net positive effect on the environment.

The ratio of the length of a man’s ring finger to that of his index finger is linked to facial attractiveness, according to researchers in Switzerland (who must have extra time on their, um, hands). Apparently, the longer the ring finger, the hotter the guy. It all has something to do fetal testosterone. I can’t wait to test the theory next time I am at a cocktail party.

Sponsor Updates

• Catholic Health Initiative’s use of the Clairvia Care Value Management solution is presented as a case study in the latest issue of HFMA’s Leadership report. A quote from CHI’s SVP/CNO: “Instead of just sitting there with a list of nurses and a list of patients and trying to figure out how to match them, this system will make assignments that are not only best for the patient, but better for the nursing staff, too.”
• Maury Regional Medical Center (TN) selects ProVation Order Sets as its electronic order set solution.
• CynergisTek will showcase its on-demand and managed security solutions alongside partner Diebold at next week’s 2011 Amerinet Member Conference in Orlando.
• Medicity expresses support for the ONC’s Direct Project specifications.
• Voalté is hosting a one-hour Webinar on May 19 entitled 3 Steps to Get Your Smart Phone Strategy Rolling. Sarasota Memorial Hospital’s CIO Denis Baker is the featured presenter.
• Mobile Anesthesiologists (IL) implements the Shareable Ink Anesthesia Suite for capturing clinical data and streamlining billing.
• Lakeway Regional Medical Center (TX) selects Allscripts’ Sunrise Enterprise suite, including EHR and CPOE.
• Olmsted Medical Center (MN) chooses the Access Intelligent Forms Suite to generate on-demand, pre-filled patient forms from its McKesson Series 2000 system.

EPtalk by Dr. Jayne

I recently attended a conference where I presented to community-based physicians on Meaningful Use. Now that we’re a good chunk of the way through 2011, it still surprises me that some physicians don’t seem to know much about it. Specialty and advocacy groups have done a good job of trying to educate the general physician population and CMS is also running journal ads, so even those folks who read print journals should have a rough idea what’s coming.

On the other hand, they could be like my colleague who insists on getting the print versions of all his journals even though he never reads them. His office is straight out of an episode of Hoarders. When we first went to tablet PCs for our EHR, he complained about the accuracy of the stylus. Turns out he had the tablet balanced on a giant unstable mound of mail on his desk, causing the tablet to wobble every time he tapped the screen. I jokingly moved the cardiac arrest crash cart next to his office because I’m sure I’m going to find him one day trapped under twenty-odd years of JAMA.

Back to Meaningful Use. I was not only surprised by these physicians’ lack of understanding of MU, but their lack of understanding of the operations of their practices in general. They were a mix of employed and independent physicians, all of them at a minimum on electronic practice management systems and about half of them on an EHR already. Several didn’t have any idea whether they’d even qualify for either of the incentive programs, with no idea of the size of their Medicaid or Medicare panels.

One of the challenges of technology is not just the implementation and adoption, but also optimization. I used existing software systems as an example in a breakout session. We talked about what several referred to as “billing systems” and how the practices use them. One physician sheepishly admitted that he had used pegboard billing until sometime in 2002, but had finally embraced the 1990s after payers forced his hand.

There was an overall lack of understanding of the role of a true practice management system as opposed to just a billing system. These physicians were not using on-board reporting, panel management, disease registry, or revenue-enhancing features of systems that had been in place for years.

If the practice is only using a small percentage of their capabilities, how in the world are they going to be able to implement, adopt, and maximize patient outcomes with an EHR? I guess that’s why consultants do so well. There are plenty of groups poised to drag these folks (kicking and screaming or not) into the Brave New World of healthcare IT.

I sent the group home with some basic homework to discuss with their practice management teams:

• How big is your panel of active patients?
• How big are your Medicare and Medicaid panels?
• What are your top five payers, and are there any problematic trends?
• What percentage of your patients are self-pay, and has it shifted in the last year?
• What is your first-pass “clean claim” rate?
• How many of your active patients have diabetes, coronary artery disease, hypertension, obesity, or another one of the Top 10 chronic diseases based on ICD-9 codes assigned at the time of billing?

Hopefully this homework will spur some important discussions and will set the groundwork for them to determine if Meaningful Use is worth the time and effort in their specific situations. With or without an EHR, these data points provide important information on the health of a practice. Physicians should be conversant about these metrics.

Understanding the “clinical” data already available in their practice management systems can position them to dip their toes into disease registries, quality reporting, and a wealth of other incentive programs that can be put in place with or without Meaningful Use, some even with (gasp!) paper charts. And better understanding of existing technology might just put a few more dollars in their pockets.

Contacts

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

News 5/4/11

Top News

McKesson’s Q4 numbers: revenue up 8.6%, EPS $1.62 vs. $1.26, beating earnings expectations by $0.02. Technology solutions sales were up 7%, but the Horizon Enterprise Revenue Management write-down in Q2 hurt the numbers, as did “continued investment in the Horizon product line.” CEO John Hammergren said in the earnings call:

Overall, our Technology Solutions financial results did not meet our expectations as our Horizon product line profitability fell below our anticipated level. It’s important to recognize that this financial performance is not an indication of problems or product functionality … I think that our view is that we’re quite pleased with the progress of the organization, and you know we’ve made many changes in our leadership team there. And frankly, if you go into the organization, we’ve made great progress in our development organizations and our implementation team. So I think we’re doing, frankly, a great job of getting after the issues that we would have faced two or three years ago that are now rapidly behind us. I think from a go-forward perspective, the clinical products are going to be a little less profitable than we had expected primarily because of the work required to make sure that our customers got them installed, got them installed quickly and are getting to Meaningful Use.

Reader Comments

 

From Ms. Blackwell: “Re: golf course fashion. I thought you would appreciate a few pix from yesterday’s GAHIMSS annual golf tournament. The Billian’s HealthDATA team took first place, with a little help from a last-minute recruit from GNAX. Attached are some pix snapped of two guys who were definite standouts in the fashion category, including Mike Mosquito, president and CEO of HealthNovation.” I agree with Ms. Blackwell. There are few things I appreciate more than guys who know how to show some flair at business events.

From David StockMan: “Re: Cerner ‘underperform’ rating from Oppenheimer. That particular analyst has been very negative on HCIT stocks since ARRA was passed. He likes to garner attention by being a contrarian, but conveniently changes employers from time to time and re-initiates coverage with a fresh start.” Unverified.

From Sun Myung Sun: “Re: Cerner. I enjoy this blog like something crazy. We’re a Cerner outpatient site looking into getting kiosks for patient check-in, but the insanely high quote from Cerner made that DOA. Do you know of any places that have implement kiosks with Cerner and like them?” Your non-commercial comments are welcome if you have experience to share with SMS. 

From Wikileaks: “Re: nextEMR. They are displaying the CCHIT 2011 logo on their site even though they only achieved ONC-ATCB certification, not comprehension. That’s a clear violation of CCHIT’s trademark and is confusing to providers.” I forwarded your comment to CCHIT and they say you are correct – nextEMR is using the wrong seal and CCHIT has told them it has to come down immediately. They should be using the one on the left, but are using the one on the right.

HIStalk Announcements and Requests

Welcome to new HIStalk Gold Sponsor AirStrip Technologies of San Antonio, TX. The company gets a ton of buzz for its cool mobile device apps, which give clinicians real-time access to waveforms, alarms, and patient data from patient monitors and other devices. Its FDA-approved systems include AirStrip OB (maternal/fetal waveforms, annotations, meds, progress notes, etc.); AirStrip CARDIOLOGY (12- and 15-lead waveforms), and AirStrip PATIENT MONITORING (waveforms for cardiac, SPO2, ventilator, arterial lines, plus vital signs, meds, labs results, and other EMR data). Hospitals are finding that plain old remote access pleases some users, but not physicians in high-acuity specialties who want easier and more convenient access to data they need to manage critical patients from anywhere. Benefits include tighter physician alignment and higher satisfaction, quality gains, increased efficiency, and reduced risk. Not to mention that its products always show up in Apple’s commercials and you know docs like cool stuff. I interviewed co-founder Cameron Powell MD just over a year ago. Thanks to AirStrip Technologies for supporting HIStalk.

Here’s a live, Steve Jobs-type AirStrip demo I found on YouTube, which I note earned Cameron Powell spontaneous applause (which seemed to embarrass him a little) when the waveform screen came up on the iPhone.

TPD updated his list of iPhone apps, which I moved to a new page. You can find it here.

Acquisitions, Funding, Business, and Stock

Merge Healthcare posts Q1 numbers: revenue $52.7 million, up from last year’s $20 million. EPS -$0.04, unchanged.

Texas-based EDIS vendor MedHost will move its headquarters to a a larger facility after increasing headcount from 90 to over 130 in the past six months.

Q3 numbers from Mediware: earnings of $1.4 million ($0.17/share) compared to $891,000 ($0.11/share) last year. Revenues were $13.8 million, up from last year’s $12.8 million.
 
Meditech hired 618 people in the last year, a 20% increase in employees. The company is planning a new 180,000 square-foot facility on a 135-acre tract in Falls River, MA. A former city councilman estimates that the land cost $80-$100 million.

MEDSEEK acquires Third Wave Research Group, a predictive analytics company specializing in healthcare applications.

Precyse Solutions changes its name to just Precyse, along with a new logo and Web address (precyse.com). The company says the new identity is “designed to more accurately reflect the breakthrough technologies and comprehensive and holistic blend of services that are sparking true innovations in the flow of health information throughout the hospital environment, significantly improving the flow of revenue, work and patient data.” As Bard liked to say, “What’s in a name, that which we call a rose.”

Consulting firm Arcadia Solutions will acquire Concordant, which also provides consulting services.

Sales

eHealthObjects chooses Elsevier/Gold Standard’s Alchemy as its drug database for eHealthObject’s ThinkHIE, ThinkEHR, and ThinkCDM products.

Otto Kaiser Memorial Hospital (TX) picks ChartAccess EHR from Prognosis Health Information Systems. The 25-bed hospital will begin implementation this month.

The 44-bed Tippah County Hospital (MS) purchases Healthland’s EHR.

People

PNC appoints Marlowe Dazley as SVP and senior managing director to lead the company’s new revenue cycle advisory group. He was previously with Premier Consulting Solutions.

HIT consulting firm WPC Services appoints Rebecca Jones (InterComponentWare) VP of sales, Patrick McGrath (MedSolutions) director of technology services, and Larry Watkins (Qaledix) director of business services.

Streamline Health Solutions hires Gabriel Waters (Carefx) as VP of business development.

Former Partners HealthCare CEO James Mongan MD died Tuesday of cancer. He was 69.

Announcements and Implementations

The HealtheConnections HIE in New York says it has connected its first five facilities. Fifteen other community hospitals across Central and Northern New York will eventually join Community General, Crouse, St. Joseph’s and Upstate University hospitals, as well as the Laboratory Alliance of Central New York.

Logansport Memorial Hospital and Woodlawn Hospital (IN) join the Indiana Health Information Exchange.

Singapore goes live on the first phase of its $144 million national EHR system, which will provide a central repository for clinical data collected from different hospitals. Accenture, Oracle, and Orion Health are providing  technology.

The folks at Shareable Ink tell us that Gartner has named them one of five cool vendors in healthcare for 2011. Click on the link if you like, but have $20K ready if you want to actually read what’s behind the teaser page. Congratulations also to another HIStalk sponsor, AirStrip Technologies, for making the list, along with AxSys Technology, DisastersNet, and Health Care DataWorks.

Omnicell announces its G4 platform, which will integrate 11 of its medication and supply automation products onto a single database. New products include a biometrics-capable console with a built-in medication label printer, a redesigned anesthesia workstation, a new controlled substances system, and a system (video above) for delivering meds from the dispensing cabinet to the bedside. The company also announced Q1 numbers: revenue up 5.5%, EPS $0.02 vs. $0.03.

Government and Politics

CMS issues a simplified final rule for credentialing and privileging physicians who provide telemedicine services. Hospitals and critical access facilities can use credentialing and privileging information from the hospital that’s providing telemedicine services instead of making their own privileging decisions for the consulting physicians.

NIST is holding a workshop on EHR usability on Tuesday, June 7 at its Gaithersburg, MD campus. I don’t quite understand the registration page since it says registration closed 6/1/11 (a few weeks from now – maybe it was supposed to say “closes”), there’s no pricing information to allow completing the “amount due” field, and it misspells “usability,” but I’m sure you can work it out with them if you want to attend (it’s not a very usable registration page for a workshop on usability, but that’s just me nitpicking). I didn’t recognize the names of many speakers since most are from NIST, but I did see Charles Friedman from ONC, Arien Malec from Direct, and DrLyle on the list.

The two physician founders of a South Florida software company unleash lobbyists and contribute $3 million in one year to state political groups, hoping to kill a bill that would stop doctors from dispensing medications directly to workers compensation patients at markups that far exceed what pharmacies can charge. Automated Healthcare Solutions sells software to support direct physician dispensing to those patients. A state senator drafted a veto-proof bill to kill the practice, but was told by the senate president’s office not to bring it up for a vote. “I’m just doing what I was told,” the senator says, dashing the few remaining hopes that politicians do the right thing and not what someone with money or power tells them.

Technology

HL7 publishes a standard that will allow insurance companies to transfer a patient’s personal health record information among themselves. They call it P2PPPHR – plan to plan personal health record.

Apple acquires a paging system patent that one expert believes will be used for in-hospital iPhone and iPad communication without using cellular networks, reducing power consumption and potential interference in the same way that RIM pagers work. Why does the expert think it’s intended for hospital use? Because they’re the only ones using digital antiques like pagers and fax machines.

Other

HP commits to spending $25 million over the next 10 years to support the expansion of Lucile Packard Children’s Hospital (CA).

The Office for Civil Rights says more than 10 million patients have been affected by 260 data breaches since September 2009.

A special thank you to the reader who saw this desk plate and sent a photo my way. It brightened my day immeasurably.

Weird News Andy, invigorated after his hiatus, provides his penetrating commentary for this story as, “It might be a little deep.” The cause of the bad cough of the former president of South Korea is found to be an acupuncture needle stuck in his lung. WNA also chimes in on an article observing that it’s going to get a lot harder to see a doctor given that Medicare is paying them less while giving more patients insurance, concluding, “When you lower payments without lowering costs, you get less supply. It’s been that way forever even if you don’t understand Econ 101. The most telling part is the average wait times going from 33 to 55 days in the home of Romneycare.”

I can never figure out why supposedly smart companies (especially ones with cool names themselves) give their products names that can’t be pronounced or remembered, seemingly choosing names intended to make everybody in a conference room full of marketing types happy to get a little piece of the final, unmemorable, Frankenstein-like compromise. Case in point: the new mobile results application of Halfpenny Technologies: ITF-GoDoc MobileOE. It looks like someone’s cat was stretching itself on the keyboard. Know a lot of buzzworthy nine-syllable brands, do you?

Sponsor Updates

• Hayes Management Consulting promotes Robert Drewniak to Director of Strategic & Advisory Services.
• The Anesthesia Quality Institute designates Surgical Information Systems as a preferred vendor.
• Karl Graham of CareTech Solutions co-presented with Brett Norgaard of Kinetic Data at the Technology Services World 2011 Silicon Valley conference this week. Their case study was The Intersection of IT Outsourcing and Healthcare: How CareTech Solutions Achieved Top 20 Best in KLAS Awards Distinction.
• Center for Diagnostic Imaging adopts Merge Healthcare’s RIS v.7.0 to meet Meaningful Use certification requirements.
• 3M introduces its Mobile Physician Solution that integrates coding technology to provide advice to physicians as they enter charges.
• Diversified Clinical Services, a provider of wound care management services, to will use Allscripts EHR and PM products as part of its i-heal 2.0 clinical productivity solution.
• Cumberland Consulting Group promotes Memory Baker to executive consultant.
• Nuesoft posts a video called Reworking Workflow to Maximize Revenue.

Contacts

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

Monday Morning Update 5/2/11

From Kelli: “Re: Epic Beaker lab system. Epic isn’t much help in installing this application. Neither the technical or application side is a font of knowledge. I know it’s not a seasoned app, but I would still expect the company that coded it to have more knowledge about it.”

From Madeleine: “Re: immunization registry EMR interface. After multiple communications with [vendor], they decided that if the test submission of the Immunization Interface to the I-CARE registry fails, they will still charge us the full price of the interface. I asked for a refund if it fails and they declined to do so. The cost to our practice with be $6,000 for the interface and $900 for interface support, unfortunate since our three-provider practice already invested heavily in hardware to be able to upgrade to the vendor’s MU version. Even if all three providers are awarded MU in 2011, we will have paid more into the system to obtain MU than we will get back from the EHR Incentive payment.” We forwarded the comment to the vendor, giving them a chance to explain or maybe change their minds even though we (and possibly they) don’t know who you are. In the mean time, I’ll leave their name to give them time to respond. Hopefully you didn’t implement for the money alone because it won’t be the pot of gold you might have thought (as you are now finding out).

Nearly 3/4 of respondents to my last poll don’t think Meaningful Use will improve patient outcomes and patient safety. New poll to your right: given Oppenheimer’s initiation of coverage of certain healthcare IT stocks, which company’s shares would you buy today for long-term appreciation?

Meanwhile, the newly issued “underperform” rating that Oppenheimer gave Cerner didn’t dampen investor enthusiasm after the company posted strong quarterly numbers after Thursday’s market close. Shares closed Friday at $120.18 after touching on a new all-time high of over $124 in mid-morning. Cerner’s market cap is just over $10 billion, pushing the value of Neal Patterson’s holdings to beyond the half-billion dollar mark.

The Boston Business Journal reports that athenahealth’s SEC filings indicate that CEO Jonathan Bush earned $4 million in total compensation in 2010 and made another $4.4 million from exercising stock options. ATHN shares are at $46.21, double their July price and valuing the company at $1.6 billion.

From Meditech’s just-filed SEC quarterly reports: revenue up 20%, EPS $0.77 vs. $0.60. Product revenue made up $15.6 million of its $20.2 million increase in revenue. Meditech paid $13.7 million to acquire the remaining of shares of ambulatory EMR vendor LSS in February, with its total cost to buy the company just over $17 million.

This week’s Time Capsule editorial, revived from the slumber it has enjoyed since I wrote it in 2006: Just Back from HIMSS? Finish Implementing Yesterday’s Fads First. A sample: “Newly-minted experts fill HIMSS meeting rooms with audiences of the mildly curious, the crassly opportunistic, and consultants desperate for a fresh horse to ride.”

Weird News Andy is back after a break, entitling this find as “Here I sit, broken-hearted” and in Rohrshach test fashion, observing that the photos look like Jelly Bellies to him. Scientists genetically engineer E. coli bacteria to release specifically colored pigments in the presence of various maladies, turning bowel movements into a color-coded diagnostic tool.

Helen Devos Children’s Hospital (MI) creates My Baby View, which allows parents of newborns (who have an average length of stay of 27 days) to view their babies remotely. Parents ask for live video by calling the nurse, who positions the camera and e-mails back instructions for logging in to a secure Web site to view the video stream. The system was funded by a $25,000 grant from Ronald McDonald House Charities of Outstate Michigan.

Welcome to new HIStalk Platinum Sponsor dbMotion of Pittsburgh, PA. The company’s service oriented architecture (SOA)-based interoperability and HIE solution gives caregivers a real-time view of integrated patient information from disparate clinical systems and multiple facilities, providing the benefit of integrated patient records without system replacement. Providers get better information to make decisions and less time searching for important information, reducing unnecessary procedures and poor integration between acute and primary care settings. Its Semantic Framework enables information exchange across diverse systems. It also supports clinical effectiveness through population management, turning mountains of information into meaningful information for use by clinicians, for health surveillance, and to enable disease management. Thanks to dbMotion for supporting HIStalk.

India’s newest export: American babies, carried there by Indian women willing to become birth surrogates for cash in an arrangement called “rent-a-womb.” India’s minimal regulation and low prices encourage doctors to manage the high-profit process and for women to carry the babies of foreign strangers in return for several thousand dollars. A couple from Canada complain that the Indian doctor jacked up the price right before their baby’s due date, saying the original proposal was the “base price,” then billed them for the hospital stay at triple the usual price without paying the hospital its share. The couple paid the hospital directly, but the doctor’s staff prevented them from getting an exit visa to leave the country. It ended costing about the same as it would have in the US.

Driscoll Children’s Health Plan (TX) chooses Sandlot for its HIE, connecting it with Driscoll Children’s Hospital.

Mary Anne Leach, VP/CIO of The Children’s Hospital (CO), is named by the Denver Business Journal as its CIO of the Year for non-profits.

Sad: the Seattle Children’s Hospital critical care nurse and 27-year hospital employee who killed a baby with an overdose of calcium chloride last year after making a calculation error hangs herself.

Michael Dell speaks at the Health Evolution Partners Leadership Summit, saying the “insights gleaned from working with healthcare organizations around the world” have convinced him that higher-quality care is correlated to higher-quality information. He encouraged healthcare leaders to unlock healthcare information (buy Dell EMR solutions), empower caregivers (buy Dell mobile devices), improve business processes (buy Dell revenue cycle services), and use information for innovation (buy Dell medical archiving solutions).

API Healthcare and Kronos have explained why they cancelled merger plans, but the Department of Justice offers an explanation of its own, saying Kronos would have controlled 70% of the time and attendance market in healthcare and that “the abandonment of this transaction means that consumers will continue to receive the same benefits of competition, including greater innovation and lower prices, they’re now receiving.” That would make a great quote for API’s marketing collateral if you ask me.

More on the $4 million lump sum retirement package (plus $150K per year for life) given to the president and CEO of Salinas Valley Memorial Healthcare System (CA), which has one 269-bed hospital. The payouts were apparently structured into seven different plans to skirt IRS rules, with the board president justifying the amount by saying the payouts were OK’ed by an outside executive compensation firm and that the hospital has to pay big bucks to compete with for-profit companies. The union president says the district should be ashamed since the hospital is cutting 25% of its workforce and that the consulting firm who recommended the layoffs was paid $10 million in the last year to “do the job (the executives) should be doing.”

Strange: EMTs are called to the home of Doctor #1 to transport Doctor #2, who the inebriated partygoers thought was having a heart attack. During the ride, Doctor #2 unfastens his seat belt and starts hitting the EMT’s female co-worker. Doctor #1, riding shotgun, swore at the EMT and told him he would have his EMT license revoked. At the hospital, Doctor #2 unfastens his seat belt again, so the EMT holds him down to prevent the cot from overturning, inspiring Doctor #1 to rush over and punch the EMT in the jaw. Doctor #1 later pleads guilty to battery; the EMT files suit against him and wants his medical license revoked.

E-mail Mr. H.

News 4/29/11

Top News

Wolters Kluwer Health will acquire Lexicomp, a provider of drug information and clinical content for pharmacists and clinicians.

Toshiba will buy medical imaging software company Vital Images for $273 million. Toshiba Medical Systems is the largest customoer of Vital Images. Toshiba America Medical Systems also announces that Donald L. Fowler, a former VP of Siemens Medical’s MR business unit, will be the division’s GM and SVP.

Cerner’s Q1 results: revenue of $491.7 million, up 14% from a year ago. Profit was $64.6 million or $0.75/share compared to last year’s $0.59/share. Cerner also says it signed a record $524.9 million in new bookings, a 30% jump over last year.

Reader Comments

From Sam Adams: “Re: GE and tax protests. Did you see the pictures of people protesting outside the GE/IDX building last week on tax day?” Thanks to Sam for sending the link. GE Healthcare’s Burlington, VT facility was the chosen site for protestors rallying against the US corporate tax code, which they believe unduly benefits large corporations. Earlier this month, The New York Times reported that GE paid zero federal taxes on $14.2 billion in profit.

From Epicwatcher: “Re: Epic. I’ve heard from three sources that Epic might go for an IPO. It would be a good time to go to market, but I doubt Judy would go for it.” Unverified, but agreed on both arguments. It would be a great time but it probably won’t happen.

From Keep em Honest: “Re: Cerner. Interesting coincidence that Cerner COO Mike Valentine resigned within 48 hours of the first Siemens customer attesting for MU. HIT sleuths will recall that Valentine’s signature was on a letter penned to rival Siemens customers back in 2009 that claimed Siemens would not be able to get their customers to MU in time. As it happened last week, Siemens was the first of the major HIT vendors to have a customer attest.”

From JD: “Re: cloud backups. Your readers might be interested to learn about GNAX, a company in Atlanta that provides data center and cloud hosting services. Its customers include a number of hospitals in the Atlanta area. I toured their facility a few months ago and was very impressed by the many backups they had for their backups in case of things like power outages, floods, etc. (though I readily admit I am still learning when it comes to the cloud).” I found the video above on YouTube, which is fun as well as educational because there’s a great keg party going on right behind the speaker in the HIMSS11 exhibit hall. I should mention that I know JD and this isn’t shilling – she’s in an unrelated healthcare business.

HIStalk Announcements and Requests

This week on HIStalk Practice: Dr. Gregg contemplates dancing stars and easy EMRs. Rob Culbert debuts his Consultant’s Corner column with suggestions for the successful development of medical groups. CaroMont Health partners with athenahealth. Greenway Medical helps out the Boys & Girls Clubs. Triangle Capital Corp. bets big on house-calls. A urology group asks a judge to evict a hostile doctor. While you are visiting, join 1,063 of HIT’s coolest kids and sign up for the e-mail updates. You know you wanna.

Thanks to new HIStalk Gold Sponsor JEMS Technology of Orion, MI. This is cool stuff: a physician can perform a HIPAA compliant JEMS Consult via smart phone or tablet. Examples: consulting on a patient who’s on the surgery table, conducting a stroke evaluation from any location, getting or giving a second opinion, and safely evaluating prisoners without entering facility. The on-site person chooses the camera feed, the remote consultant presses the JEMS icon on their smart phone and enters their password, and the consultant is instantly participating in a live JEMS Consult from wherever they are, including the ability to carry on a conversation with those on the other end over the video stream. Benefits include making surgeons happier, decreasing OR time with on-the-spot consultations, and potentially reducing lawsuit risk. AT&T chose JEMS as its partner for handheld video streaming in healthcare. Thanks to JEMS Technology for supporting HIStalk.

Preaching to the PR people, continued: everyday is an adjective, not a phrase. You might wear everyday shoes, but you wear those shoes every day, not everyday. That was in a press release I got today and I was appalled. On the other hand, I was happy just to receive it since Yahoo Mail was down all afternoon and is still acting flaky even though the mail’s going through. Maybe this cloud thing is overrated.

On the other hand, I was beaming at the simple fix to my slow wireless Netflix streaming to the TV via my Roku box: powerline network adapters. I was skeptical, but they worked right out of the box: plug an adapter into a wall jack and connect it by network cable to your router, plug the other in the wall jack next to the TV and run the network cable from there to the Roku. Two minutes and $85 later, no more wireless bottlenecks – it’s like I had Cat 5 wiring right to the TV.

Listening: new from Augustana, straight-ahead Springsteen-type rock.

Jobs on the sponsors-only job board: Director, Revenue Cycle Solutions – Virtual Office, Product Specialist – Physician, Inside Sales Executive/Telesales, Systems Engineer. On Healthcare IT Jobs: Business Development Manager, eGate Integration Analyst, Epic Clinical Applicataions Specialist.

Your honey-do list: (a) sign up for e-mail updates to your upper right; (b) visually inspect HIStalk Practice and HIStalk Mobile as my quality assurance specialist to make sure Inga and Dr. Travis are doing a good job; (c) Friend, Like, or Connect everything HIStalk-y on Facebook and LinkedIn to help Inga, Dr. Jayne, and me feel like immensely popular celebrities, which offers some illusory consolation as we contemplate our reality of toiling in solitude like monks copying scripture on papyrus; (d) avail yourself of the Rumor Report function to send me whatever you know that is scandalous, insightful, or funny; (e) intently observe the impressive lineup of sponsor ads to your left, paying them homage with an occasional click in recognition of their sometimes misplaced confidence that sponsoring HIStalk means their days of worrying about being the subject of negative news or snotty commentary are over. And thank you for riding shotgun in the HIStalk weenie wagon by reading what we write since it would be pointless otherwise.

Acquisitions, Funding, Business, and Stock

A federal jury finds that a former Mayo Clinic researcher misappropriated trade secrets and violated his employment contract when he left Mayo for a job at Mount Sinai Medical Center. However, the jury ordered Mayo to pay Dr. Peter Elkin $143,222 in royalties for record-keeping software that was eventually sold by the company, LingoLogix, to Cerner for $5.7 million. Elkin and Mayo have been battling the issue since 2008. Mayo says Elkin tried to undermine the commercialization of the software. We profiled the technology (pre-Cerner) back in 2008. A Mayo representative sent over their summary of the verdict, saying the amount awarded to Elkin was money they had already planned to pay as his share even before the lawsuit was filed. The non-profit Mayo requires all funds that result from commercialization of its intellectual property be returned to it.

Telehealth provider iMetrikus changes its name to Numera. The company says its new brand “reflects the company’s focus on developing high-quality, low-cost methods of collecting objective patient health and biometric data and integrating this into popular electronic medical records, care management, and personal health records .” I don’t get how a name change “reflects” any of that, but then again I majored in economics and not marketing. The company also appoints Tim Smokoff CEO “to spearhead the newly branded company.” Smokoff is the former GM of Microsoft’s World Wide Health Industry Solutions Group.

athenahealth reports Q1 earnings of $69.9 million, a 28% increase over last year. Net income was $3.3 million, or $0.09/share, versus 2010’s $0.01/share.

Oppenheimer, which just started coverage on Cerner with an “underperform” rating, initiates coverage of Allscripts with an “outperform,” setting a $25.00 price target. Shares closed Thursday at $20.61, giving the company a market cap of $3.9 billion. Above is a one-year share price chart showing Allscripts (blue), Cerner (green), and the S&P 500 (red).

Sales

McLeod Health (SC) picks MedeAnalytics’ Patient Access Intelligence product for front-end patient collections and insurance verification.

The VA awards telehealth system provider Robert Bosch Healthcare a new contract for its Health Buddy System.

Reference lab PAML (WA) selects 4medica for clinical pathology lab ordering and results reporting.

Three HCA hospitals in South Florida sign up for AirStrip Cardiology to allow physicians to read ECGs on their smart phones.

People

IGI Health hires Lee Barrett as president and CEO. Founder Arthur Kapoor will assume the role of chairman. Barrett has previously served as executive director of EHNAC CEO of Claredi.

Streamline Health Solutions appoints Stephen H. Murdock as CFO.

Harry Greenspun, MD joins the Deloitte Center for Health Solutions to focus on health sciences and government clients, leaving his position as EVP and CMO at Dell Healthcare Services. He came to Dell as part of its Perot Systems acquisition.

Former Misys Healthcare CEO Vern Davenport is named to the advisory board of public health consulting firm SciMetrika.

PenRad Technologies hires Dan Bickford as EVP of sales and business development. He was co-founder and EVP of Confirma, now Merge Healthcare.

University of Wisconsin-Madison gives Judy Faulkner and four other alumni its Entrepreneurial Achievement Award.

John Glaser of Siemens is mentioned as being on the board of KEW Group, a Boston-area startup that is buying and partnering with community cancer centers that will use its personalized medicine and clinical IT platform. According to the company’s site, he is a founder.

Garrick Palmer, formerly of Oracle, IBM, and Cerner, joins Fujitsu to lead healthcare sales of its biometric solutions, such as the PalmSecure palm vein scanner.

Announcements and Implementations

AHA gives its exclusive (paid) endorsement to nVoq’s SayIt in the category of healthcare voice recognition. I have to say that I’ve never heard of it. I didn’t know that Nuance even had competitors that it hasn’t already acquired.

Sharp HealthCare uses Oracle’s SOA Suite and Weblogic to create its patient portal.

Government and Politics

HHS is considering a “mystery shopper” program to assess primary care physicians on their willingness to accept new patients and to provide them with services in a timely manner. The Office of the Assistant Secretary for Planning and Evaluation will contact 465 PCPs and simulate requests for appointments for both privately and publically insured patients. I have just two words to summarize my opinion: budget crisis.

CMS announces that it will offer conference calls next week to provide information about the Meaningful Use attestation process. They are scheduled for Tuesday for hospitals and Thursday for EPs. Signups close the day before the session.

The LA Times brings to light public pensions, including those of healthcare executives. The president and CEO of a public hospital district received a $3 million lump sum retirement payout when he turned 65, worked two more years at $688K per year, will get another $900K when he retires for a second time this week, and will get a pension of $150K per year for life. “I think I’ve earned it,” he says.

Other

Road warriors take note: Columbia University researchers find that extensive travelers are 260% more likely than light travelers to rate their health as fair to poor. Extensive travelers are also 92% more likely to be obese and have higher cholesterol and blood pressure.

Thieves steal $100,000 worth of copper from the Cerner campus and cause “a substantial amount of property damage.” The copper was in a building under renovation.

An internal audit at University of Iowa Hospital and Clinics finds “flaws” involving its $61 million Epic system, including inconsistent use and information being incorrectly entered or not at all. One pediatrician had not switched to Epic for prescriptions and was using an outdated system that lacked audit controls. Significant lag times were noted in three departments and 32 bills were missed in November as physicians were not entering charges in a timely fashion. One regent noted that “younger staff are more comfortable with the new technology but older staff have a harder time adapting.” So is it flawed software or flawed workflow?

Imaging the World wins a $100,000 grant from the Bill & Melinda Gates Foundation for its low-cost rural ultrasound project for areas of high maternal and neonatal mortality. The founders are Kristen DeStigter, MD (Fletcher Allen Health Care associate professor and vice chair of radiology) and Brian Garra MD (chief of imaging systems and research at the Washington DC VA and associate director in the imaging division of the FDA).

Employees of the Allscripts office in Raleigh, NC used Thursday’s “Take Your Daughters and Sons to Work Day” to prepare kits of personal items for victims of the April 16 tornadoes, which will be distributed by the Salvation Army.

Pompare Technologies files suit against Hospira, Cerner, and Epic, claiming those companies infringed on its patent for controlling an IV infusion pump. Pompare doesn’t come up in a Google search. Its patent was granted Tuesday and it set the lawyers loose on Wednesday, seeking to recover damages “but in no event less than a reasonable royalty.”

A couple’s lawsuit against a hospital in which the woman claimed she suffered marital problems and traumatic anxiety after a physician’s assistant stole the narcotic from her epidural pump is thrown out by a skeptical jury. The woman claims her motivation was purely to improve hospital safety, saying she wanted to make sure “this was something that wasn’t hid in the closet.” The jury foreman found her intentions less noble, saying “Every time we got to a particular count, it was like Swiss cheese. I almost felt bad for their attorney.”

Sponsor Updates

• Grant Memorial Healthcare (WV), a 45-bed facility, selects HMS’s clinical and financial applications.
• Iatric Systems receives ONC-ATCB certification from CCHIT for its Public Health Immunization Interface solutions.
• Wake Endoscopy Center (NC) will implement ProVation MD software for gastroenterology procedure documentation and coding and ProVation EHR and patient charting.
• Brazosport Regional Health System (TX) picks the e-Forms Repository downtime registration solution from Access.
• RelayHealth announces the general availability of ProSMART, an on-demand pharmacy claims adjudication reporting product for payers. Pharmacy benefits manager Restat is deploying the solution.
• Sunquest Information Systems is honored for its development of a CRM system that integrates sales and support functions.
• Heartland Regional Medical Center (MO) implements Voalte’s iPhone communication solution. The company also gets a story in its hometown Sarasota, FL paper for the pilot program, mentioning that nurses there can use their Voalte-powered iPhone to access the hospital’s GE call system, Philips Emergin alarms, Cisco wireless, and Siemens telephone system. It also notes that the company will hire developers to port its application to Android smart phones.
• Childs Medical Clinic of Samson, AL becomes the first Greenway Medical Technologies PrimeSUITE 2011 customer to attest and receive payment notice for Stage 1 Meaningful Use incentives.
• Billian’s HealthDATA adds contact information for more than 10,000 long-term care executives to its online market intelligence portal, which now includes more than 3,000 data points covering more than 40,000 US healthcare facilities.
• The Vancouver Clinic (WA) goes live on Epic ambulatory, with implementation assistance from the Epic practice of Culbert Healthcare Solutions.

EPtalk by Dr. Jayne

Dear Dr. Jayne,

Do you plan to attest for Meaningful Use in 2011 or 2012?

Dave the Healthcare Bean Counter

Dear Dave,

Are you a plant from my day job? Seriously, I get this question all the time. And the answer is, “most likely 2012.” We’re going to play the game under the Medicare rules, so we can’t ask for a check just for having purchased a system.

Like many other organizations across the US, we will have to upgrade to our vendor’s certified product before we can attest. Even though we’re able to do 90% of what Meaningful Use intends us to do, without the certified version, we may not be documenting in the precisely specified field that’s used for the certified version.

I alluded to this last week when I talked about tobacco use documentation. Do I ask every patient about their tobacco use and counsel those who use tobacco that they need to quit? Do I have a reportable discrete field in which to document? Absolutely. Am I documenting using one of the six required data points? Not so much, until I upgrade.

Additionally, after the upgrade, we’ll want to allow time for our providers to transition to the new fields (and some of the slick new workflow that comes with the upgraded version, independent of Meaningful Use) as well as to benchmark where our physicians stand.

I work for a large health system, which (news flash!) had priorities established long before MU was a blip on the horizon. We have a multi-year strategic plan that we’re trying to execute, with important outcomes like reducing length of stay, preventing medical errors, and providing care to the underserved and indigent. We’re targeting diabetes and obesity. We’re delivering thousands of babies and providing preventive care.

Needless to say, our IT department is fairly busy supporting all those initiatives. Although a fair amount of resources has been shifted to achieving MU, we don’t get to stop working on those priorities just because someone is handing out cash.

I’m grateful that our organization has gone with this approach. I think there are enough rational folks here who understand that MU is a bit of a shell game and will most certainly cost providers more than the payments they receive. But they’re also savvy enough to know that we don’t want to miss out on any of the money. Although we had plans to do the technology anyway, it’s definitely nice to have our friend Uncle Sam pick up part of the tab.

There was a recent discussion in the doctor’s lounge that revolved around whether Congress would repeal the provisions of health care reform and whether there would be any money available. Several independent physicians were discussing their plans to attest as soon as possible, just in case the funding dries up. Others lobbied for not even bothering, fearing or hoping that the program will disappear.

They asked my opinion, and it was this. If you plan to attest this year, keep going. Make plans to run interim reports to see how you’re doing and where you stand on the metrics, and implement programs and processes to get your numbers up if needed. Don’t let the fact that you can do it in either year delay you from your plans.

If you planned to attest in 2012, keep chugging away as well. If you meet your metrics early, you can always go ahead and submit and be ahead of the game.

Dr. Jayne

Contacts

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

API Healthcare Terminates Kronos Merger

Workforce management technology vendor API Healthcare announced this afternoon that it will terminate its previously announced merger with Kronos. API will exercise a right contained in the January merger agreement that allows either party to terminate if regulatory approvals were not obtained by mid-May. The Department of Justice had made a second request under antitrust laws.

API President and CEO J.P. Fingado stated in the announcement, “This process has been challenging, but it has also reaffirmed that our vision for healthcare-specific workforce management is solid. During the HSR review process, we heard the strong reaction of our healthcare provider clients from across the country as they spoke out with passionate support of our solutions, services and strategy.”

Fingado contacted HIStalk about the announcement, saying, “This may sound odd, but it is the right thing for our clients and employees, and that is what API Healthcare has always been about. I am very happy moving forward and very excited about our opportunities. We released ‘Synergy’ just before this all happened and now we can work even harder to roll that out to our existing and new clients. The support from our clients during this process has been amazing.”

Ezra Perlman of Francisco Partners care was quoted in the announcement as saying, “When we acquired API Healthcare two years ago, we saw the opportunity for long-term growth of a great healthcare-specific workforce management technology company. While the merger offer from Kronos certainly validated API Healthcare’s strong value proposition, Francisco Partners is looking forward to continuing to provide strong support to the API Healthcare management team and associates as they continue on their aggressive growth path as an independent company.”

News 4/27/11

Top News

  The VA and DoD agree to “buy” rather than “build” a joint EHR in an apparent change in direction from their last announced plans. They will round out missing departmental modules by looking first at any available internally developed systems and will develop their own applications only as a last resort.

Reader Comments

From Professor Paul MD: “Re: Amazon cloud downtime. For those who didn’t know, their northern Virginia data center that hosts EC2 and RDS services went down hard for 24 hours last week and didn’t recover all volumes until late Sunday. A small company that apparently does ECG monitoring repeatedly begged for help on Amazon’s public online forum, bringing up good points on what to consider when hosting health apps on the cloud. I like the Halamka shout-out, too.” Someone immediately questioned why they would be running a mission-critical life-or-death system on the cloud, to which the original poster answered, “Well, it is supposed to be reliable.” One of several uncharitable responses was:

If you were smart, you would have a disaster recovery plan for just this kind of thing. Judging from your lack of said preparations, you lot figured the cloud never goes down, and got greedy by not wanting to spend money on hot standby machines on a different infrastructure. Good going. Hope none of your cardiac patients croak because you’re going to get sued into next week…

That news item does encourage good discussion. If your organization runs cloud-based apps, please share what actions you’ve taken, both contractually and technically, to prevent and mitigate outages. What happens if your Internet connectivity dies (killed in most cases by the proverbial cable-shearing backhoe excavating for some minor project outside your facility using erroneous city-produced utilities maps?) What is required to maintain a hot swap site? How often do you test? Send me what you can and I’ll share it here.

From Olivia: “Re: McKesson. Gio Colella and Pam Pure might have a different opinion about how big winning that patent lawsuit against Epic would have been. That was just a place to start. Think Kaiser. Then think about all the other vendors with similar solutions. That sure would have helped to justify the purchase of the original RelayHealth company, which happened not long before the lawsuit was filed. Another intriguing story for cocktails and dinner sometime.” Is that an invitation? 

From Puts and Gets: “Re: Cerner. More changes in the plastic hair lineup. The stock has had an artificial ride up since investors don’t have a decent, large-scale pure play in health IT, so they get the default money. They are going down the other side of that first roller coaster hill later this year.” I’ll steer clear of this debate and mark it Unverified.

 From NotAnEpicShill: “Re: Epic. Another Epic employee here. What Lucy Gucci describes may be true for some Epic employees, but there are plenty of us whose jaws drop when we see things like that on the Web. I myself work about 45 hours a week (50-55 a few times a year during a crunch) and have a pretty good balance of life to work.The same holds true for many, many people with whom I work. I just wanted to get it out there that though certainly not everything at Epic is sunshine and roses, the rumors of our misery are greatly, greatly exaggerated.”

 From Madrigal: “Re: Neil Pappalarado. Just announced at the Meditech shareholder’s meeting that he had a minor stroke last week. He’s still in the hospital, but is expected to make a full recovery.”

From Human Factors: “Re: ONC usability meeting. The general consensus was that EHRs are difficult to navigate, time-consuming, frustrating, cluttered and disorganized, and unsearchable. They lead to fatigue and ultimately burnout, do not adequately support disabled users, do not adequately support clinical workflows, and they disperse and bury critical information. Most of the discussion was around provider pleas to either make usability standards part of certification or mandate a common user interface. There was also a call for EHRs to be held to accessibility guidelines, to support easy data migration from one to another, and for vendors to be more transparent about their internal usability guidelines. A Cerner spokesperson contributed this interesting insight: ‘The tools [EHRs] are designed for the volume of documentation instead of the value of the information.’”

 From Private Pyle: “Re: ONC usability fireworks last Thursday. You have to listen to the recording and read through the testimonies on ONC’s site. The docs told vendors their systems sucked, then consumers told them they were disconnected electronically and don’t have the information they need to be an engaged member of the care team, the vendors whined about new requirements and said that certifying usability would kill innovation, and the usability experts tore up the crappy vendor systems. A heated exchange ensued. The vendors tried to use the analogy of cars and that it makes no sense to put parts from three different makers together, but the committee trashed that, saying monolithic platforms have such a high barrier to change that customers are at the mercy of the vendor. I truly believe the monolithic vendors will not disrupt themselves and we will see some serious challenges that will provide capabilities and price points that will destroy the current market.” I wrote a few thoughts at the end of this post about the meeting. Usability measurement and any new federal involvement in it is obviously a big topic that gets a lot of folks stirred up. Comments from all viewpoints welcome.

HIStalk Announcements and Requests

Readers occasionally tell me they’re having trouble reading HIStalk because of errors or slow load times. The culprit in 100% of those cases so far has been long-obsolete versions of Internet Explorer. IE is a far inferior browser to begin with (feel free to check page load times on any media-rich site if you don’t believe me), but it’s really trouble-prone in old versions. Here are some suggestions.

1. If you must use IE, upgrade if possible to the latest version your operating system will support – Version 9 if you have Vista or Windows 7, or Version 8 if you’re on XP.
2. If your computer isn’t in IT lock-down mode, download Firefox or Chrome, at least to read HIStalk. You can still leave IE on your PC for any purposes for which it’s required.
3. HIStalk is supported by the sponsors whose ads you see on the left, which means we all benefit when you read the site normally. If you can’t load the page, however, add /print to the link you get in the e-mail update to view a text-only version (so instead of this link, use this one instead, for example). Or, read via RSS reader (I use Google). You’ll miss a lot of other stuff, too, though – polls, links to the latest comments, upcoming events, etc.

I had to re-send an e-mail update that failed on the server for some reason, so if you got the same e-mail on both Friday and Tuesday, I promise I’m not intentionally spamming you. There was no way to pick up where it left off or to even tell how far down the list of 7,311 subscribers it got, so I started it over.

Acquisitions, Funding, Business, and Stock

Halfpenny Technologies says 13 new clients have signed up for its integration technology framework for delivering interfaces among hospitals, labs, and EMRs.

Huron Consulting announces its Q1 financials: revenue up 11.9% to $143 million and diluted EPS from continuing operations up 46.2% to $.19/share.

Keystrokes Transcription Service acquires competitor MTS of Texas, including its TxMTI online transcription school.

Oppenheimer initiates coverage of Cerner with an “underperform” rating, saying the company is “showing signs of age” with flat software sales even as HITECH brings buyers to the market, lower margins as services replace software sales, and a price-to-earnings multiple more appropriate for a software high flyer than a low-excitement services business. They also didn’t like the fact that the departure of COO Mike Valentine was announced on April 22 when the stock market was closed, saying “the timing of his departure is curious” unless he turns up almost immediately as CEO of a good-sized company (and if anyone knows where he’s going, let me know). 

EncounterPRO chooses Intuit Health’s patient portal to offer its 300 pediatric practice EMR customers.

Consulting firm Computer Task Group (CTG) reports Q1 numbers: revenue up 22%, EPS $0.17 vs. $0.11. Healthcare revenue was up 30%, mostly from big EMR projects.

Sales

The Metropolitan Chicago Healthcare Council announces plans to develop the MetroChicago HIE using Microsoft’s Amalga and technologies from CSC and HealthUnity Corp. Seventy percent of the hospitals in Chicago are participating, with the notable exception of NorthShore University HealthSystem.

The Missouri Health Connection picks Cerner to build a statewide HIE, although they’re still negotiating the price.

The Missoula, MT paper reports that St. Patrick Hospital, part of Providence Health System, is moving to Epic. Cross-town competitor Community Medical Center is implementing NextGen for outpatient and will add Cerner inpatient next year.

Dundy County Hospital (NE) purchases Healthland’s EHR for its 14-bed critical access facility, anticipating a Q3 2011 go-live.

Salina Regional Health Center (KS) will implement Summit Healthcare Downtime Reporting System as part of its disaster recovery strategy.

People

Ben Foster rejoins Huron Consulting as managing director of  its healthcare practice and will work with providers to improve their revenue cycle.

MetroSouth Medical Center (IL) names Steven H. Rube, MD as medical director of the hospital’s seven community health centers and CMIO for the hospital. He’s the former CMO and EVP of EmpowER Systems.

UC Health (OH) appoints Anil Jain, MD as the organization’s first CMIO and SVP. He was a senior executive and physician at Cleveland Clinic.

eHealth Initiative founding CEO Janet Marchibroda is named chair of the Bipartisan Policy Center’s Health IT Initiative. She has also worked as chief healthcare officer of IBM and was COO for the National Committee for Quality Assurance. BPC, a non-profit think tank, launched its health project in January, led by former senators Tom Daschle and Bill Frist and former governors Mike Rounds and Ted Strickland.

Robert Barber, 64, director of financial services at Carolinas HealthCare System (NC), was shot and killed last Friday morning by an unknown assailant in an apparent robbery attempt while walking outside a coffee shop near his home in Charlotte, NC. He was a retired Air Force Reserves colonel, held a doctorate in health administration from the Medical University of South Carolina, and was a part-time instructor for several universities. He had held several executive positions in his 19 years with CHS, including stints as CFO and CEO in affiliated hospitals, and was a former president of the North Carolina chapter of HFMA.

Government and Politics 

Norton Healthcare (KY) agrees will pay the federal government $782,842 to settle allegations of Medicare overbilling. Federal prosecutors contend that Norton submitted charges for evaluation and management services that were never performed.

Dartmouth-Hitchcock Medical Center (NH) will pay over $2.2 million to state and federal agencies for improper Medicare, Medicaid, and Tricare billing. The payment includes over $344,000 to a former Dartmouth-Hitchcock physician who blew the whistle on the improper billing, which allegedly included charges for services delivered by unsupervised residents.

The American Telemedicine Association (ATA) calls for CMS to remove restrictions on telemedicine for ACOs. Recommendations include more medical videoconferencing access in metropolitan areas, home-based videoconferencing, and delivery of therapy services via telehealth.

Other

Performance scores for the four top interventional lab providers tighten to within five points of each other, according to KLAS’s latest report. KLAS notes that GE,  Philips, Siemens, and Toshiba have slowed down the delivery of market-changing developments. In addition, healthcare reform and reimbursement pressures have resulted in increased provider innovation and the move toward multi-use labs.

A former employee of Carthage Area Hospital (NY) says its systems vendor CPSI was “thrown under a bus” when the hospital blamed the company for its billing problems. She says the problems started before CPSI was implemented, the hospital declined to send employees to Alabama for training because of the expense, and they replaced the business office manager who had received training right after they went live. 

  In case you have been living under a rock (or perhaps you’re just a normal guy) there’s a big wedding coming up Friday morning. I can’t decide if I will watch it live or set the DVR. Maybe both so I can relive the moment a few times. I did buy a special hat for the occasion, since I hear hats are an essential fashion accessory for royal weddings. And of course, some new shoes. Maybe Mr. H can come up with a Union Jack theme for next year’s HIStalkapalooza so I’ll have a chance to wear these beauties again.

Sponsor Updates

• Sunquest’s Physician Portal 5.1 earns modular  ONC-ACTB certification from CCHIT.
• Mark N. Bair, MD, R.Ph and Jordan L. Schlain, MD join Ingenix’s independent advisory board. Bair is and ED physician and CEO for Emergency Medical Services, Inc. in Utah. Schlain practices internal medicine and is medical director and founder of Current Health Medical Group (CA). 
• Culbert Healthcare Solutions completes the implementation of Epic’s ambulatory suite of products at the 200-provider Vancouver Clinic (WA). The project took less than 12 months to implement from kickoff to go-live.
• TeleTracking Technologies releases its Patient Flow Dashboard, powered by TeleTracking XT application, which monitors the real-time status of enterprise-wide flow operations.
• Capario names Stephen Garcia as CFO.
• Orthopaedic Surgery Associates (MI) selects SRS EHR and CareTracker PM for its 13 providers.
• Vocera Communications announces that its first quarter revenues grew 56% compared to 2010. Vocera also added its largest client to date, a Department of Defense hospital.
• The iDoc document imaging and management solution from CareTech Solutions earns certification as an EHR module.
• Aspen Advisors is highlighted by Consulting magazine as one of “Seven to Watch” consulting firms. The magazine cited the company’s doubling of headcount and revenue since 2009 and the fact that 40% of its employees have at least 20 years of healthcare experience.

Thoughts on ONC’s Certification / Adoption Workgroup’s April 21, 2011 Meeting on Usability

I haven’t had time to listen to the audio, but I got a few interesting nuggets from skimming the meeting materials:

1. What folks are calling “usability” is really more “suitability to task,” not just counting clicks and seeing if on-screen terminology is consistent, but measuring how long it takes to do common tasks. In other words, ugly screens don’t matter too much as long as experienced users can get their work done quickly and accurately.
2. Because of that, vendors are worried about new “usability” requirements that may go well beyond usability, not to mention the need to have a consistent, unbiased way to measure usability in whatever way it is defined.
3. To compare usability among products requires definition of a perfect EMR, which puts the government in the position of designing systems.
4. Vendors claim they have all kinds of formally trained usability experts who have design authority over applications, but customers don’t seem to think the final product reflects that fact.
5. Users working with the same application rarely agree on the number and significance of usability problems.
6. Any measurement of usability needs to take place in a real-life work setting, not in a lab.
7. Some safeguards built into EMRs would be considered negatives by usability experts, such as the requirement for providers to review existing patient data, avoiding the dangers of “auto-complete” functions, and inclusion of the government-required signoffs and notifications that users resent and don’t find useful.
8. According to one practitioner, systems don’t work as well as paper in her practice. Examples: ordering a routine mammogram electronically takes 10 minutes, entering a family history on paper takes 24 seconds on paper and two minutes in the EHR, systems don’t highlight important information from the electronic clutter they create, and EHR information (such as with scanned documents) may be “in the record” but not easily accessible.
9. A provider urged the government to require vendors to design systems around a common schema to allow easy switching from one product to another, and also to require them to follow an app store model that supports picking and choosing from among competing functions.
10. Several presenters said the government itself makes usability worse by requiring entry of generally worthless information, such as IV end times.
11. Jacob Reider MD of Allscripts admitted that as a frustrated EHR user in 2004, he wrote a blog post blasting Allscripts for designing a system that took 40 seconds to enter a patient’s blood pressure. He said “the president of the company that had developed the EHR I was using to request that I delete the post, as it was costing the company sales.” He went to work for the company 18 months later (he must have either impressed them with his insight or inspired them to put him on the payroll to keep him quiet).

And some interesting comment snips from ONC’s usability committee blog:

• If the Federal government wants to really accomplish they goals they list, every medical entity needs to be on the same system so it is seamless and information can be shared. Usability experts need to be brought in ASAP before the entire project fails. This should have been done before the project was ever launched!
• Developers tend to follow what they know, retreading what’s been done before and packaging it with sharp marketing.
• I truly don’t understand the arguments against standardization, when data exist to support it. Standardization has saved countless lives with respect to mission-critical systems, and EHRs are decidedly mission-critical systems. In fact, standards often originate as a response to accidents and disasters that occurred because of a lack of standardization. To say that having standards regarding font sizes, color contrast, and a host of other usability-related variables clearly related to human performance “stifles innovation” is a weak argument.
• The current failure to act responsibly on this and other safety-related issues in health IT is an important ethical question that needs badly to be publicly discussed. It is wonderful that ONC has raised the issue, but unfortunately, it is several years too late, as care delivery organizations are currently too busy installing what’s available today in order to get the stimulus money to really attend to usability; and vendors are too busy managing these new installations to invest in the sort of thoroughgoing redesign that is needed.
• I am horrified when I look at the design of HIT which violates standard, well-known usability principles. When I tried to publish a paper on a particular EMR design that was particularly horrifying, the lawyers stepped in and said we were not allowed to publish any screen shots (which would show the issues) as this **violated the contract with the vendor**. In discussions with them, the vendor argued that their design was user-centered because it was successfully transitioned from the company’s prior use of the software as a restaurant management system!
• I hate my wonderful EMR. It has decreased my efficiency, decreased my face time per patient, not eliminated errors and resulted in significant employee dissatisfaction. In addition, it is not information-ful: when I read outside records on a complex patient and have to wade through page after page of meaningless review of systems, immunization histories, pharmacy records, vital signs, etc., etc. and never find what the patient was really feeling or what the reasons for the referral are, I have just wasted another 10 minutes that I could have spent with the patient – finding out relevant stuff! However, all important components of billing and compliance have been duly fulfilled (excuse my misapprehension that this was supposed to have something to do with patient care).

Contacts

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

Golden Gate Capital To Acquire Lawson

Lawson Software announced this morning that it has agreed to be acquired and taken private by Golden Gate Capital and software vendor Infor for $2 billion cash. Lawson has a significant hospital presence with products that include financial management, supply chain, human resources, the Cloverleaf integration line, a master patient index, and electronic health records.

Infor offers solutions that include customer relationship management, enterprise resource planning, supply chain, financial management, and workforce management. Infor CEO Charles Phillips was quoted in a statement as saying that the acquisition “will extend our existing portfolio, particularly in areas such as healthcare, public sector, manufacturing and human capital management.”

The acquisition is expected to close in the third quarter.

Monday Morning Update 4/25/11

From A Friend: “Re: McKesson. Did you see they lost their appeal for patent infringement to Epic? The products affected are what is now called RelayClinical Communicator vs. MyChart.” I did see that, although the verdict was filled with a lot of legalese and dissenting opinions, which probably means the fat lawyer hasn’t sung yet. McKesson’s original patent was for putting visit-specific information on a Web page for patients, including offering online scheduling and refill requests. The judge found that Epic doesn’t make those capabilities directly available in MyChart, which requires patients to request the service and physicians to approve their request. On that basis, Epic is off the hook – for now. The ruling doesn’t really hurt MCK all that much since it only prevents them from insisting that Epic pay up.

From Cantankerous: “Re: videos on HIStalk. Is there a way to view them on the iPad?” I don’t think so. Apple refuses to work with Flash, which is how YouTube videos stream. You could use the YouTube app that’s included in the OS, but I don’t think you can do that without searching for the video all over again from YouTube. All of that’s good news for companies selling Android-based phones and tablets.

From Ishmael: “Re: Meditech 6.0. I was hoping for something that would improve my workflow, but all I got was a new graphical front end to the exact same functionality as 3.0 and 4.0 except that it now takes 50% longer to do it. Time is all I have and anything that takes it away without compensating me for it is my enemy. It’s not helping me, the doc who has to use it, and it’s taking nurses away from my patients so they can spend more time staring at a screen.”

From Outside Insider: “Re: iPad not being revolutionary. The device weighs just over a pound, you can access your network and systems, you don’t need an input device other than your fingers, and your developers can write apps that will let you access your data any way you want. Would you be as comfortable carrying around a laptop or rolling a PC on a cart? Those who don’t recognize the advantages to change are typically the last to implement and are behind the curve in realizing the benefits.” My iPad has a great screen and very cool apps written specifically for it, but I’ve found the iPod Touch to be the real game-changer since I don’t carry an iPhone. It’s always on and has a huge battery life and quick recharge time, so I check e-mail, CNN, and the weather last thing before bed and first thing in the morning. Sometimes I stream Netflix over it while sitting outside or in the kitchen. For both devices, the key to my satisfaction was to buy a cheap non-USB charger so I could top off the batteries quickly from a wall socket anywhere. The Touch costs only around $200 and carries no recurring expense since it hops happily onto the WiFi at home or work. My record still stands: I use the Touch all the time, and even though it’s primarily a music player, I’ve yet to play an MP3 on it.

From The PACS Designer: “Re: Microsoft Office 365 beta. Now that Microsoft has launched its online version of Office, those of you who could enhance your business practices by incorporating Office can contribute to further refinement of the Office 365 release by participating in the improvement process for this product, and also possibly improve your day to day operations for the future.” It starts at $6 per user per month, which is $6 per user per month more than Google Docs (although to be fair, you’d have to pay Google $4 per user per month for Google Apps for Business to get the uptime guarantee that’s probably not needed anyway). The Microsoft offering includes stripped down versions of Word, Excel, PowerPoint, Outlook, OneNote, and parts of SharePoint. Personally, I find Microsoft’s offerings confusing: there’s also Windows Live SkyDrive (free)and Office Web Apps, all to replace Office 2010 (which you can buy in a three-user license pack for $120 and with no stripping down or need for Web connectivity). I find Google Docs to be pretty clunky and not all that intuitive, so maybe that’s a market for whatever Microsoft ends up releasing. It should be most attractive to small business that haven’t already bought Office and don’t want to manage servers. Maybe I’m naive, but I just don’t see the average user needing to collaborate to an extent that e-mail doc swap doesn’t address, so I personally wouldn’t use either service enough to justify paying for it.

From GoTooSlow: “Re: Valley Medical Center, Renton, WA. Has signed with Epic to replace many modules.” Verified, apparently, since I found the above in the minutes from the hospital board’s December 13, 2010 meeting. It seems to me (without any hard data to prove it) that McKesson is losing more Horizon Clinicals customers to Epic as a percentage than any other vendor, which might have been expected given that those customers were the only ones with significant doubts that their vendor and product would get them ready for MU requirements in some survey I recall from a few months back.

From Lucy Gucci: “Re: Epic. They gave me a great start in healthcare IT (I didn’t exactly have recruiters pounding on my door as a fresh liberal arts graduate), but it’s truly a sweatshop for most people because of 70-80 hour weeks, lack of work-life balance, and travel. I got sick during a Monday-Saturday work trip and had to go to urgent care. The PA there said they see Epic staff constantly because they travel during normal appointment hours and need antibiotics since they can’t take time off to recover. In our March 2011 staff meeting, Judy spent five minutes going over the HIStalk awards and seemed to be tickled pink with her ‘industry figure with whom you’d most like to have a few beers’ award, although she said the would have to drink a chocolate milkshake since she doesn’t drink – at corporate events, we have ‘mocktails.’ As is obvious, sales are through the roof and we dread hearing the wedding music playing over the PA to indicate a new sale since Epic truly does not have the experienced implementation staff to support all the new customers. Experienced employees used to have two customers, now 3-4 are the norm. Please keep me anonymous – Judy warns us every single month at the staff meeting not to post anything about Epic to blogs.”

This weekend was an almost-first: I whisked Mrs. H away to a beach mini-vacation and didn’t touch the laptop until we got home. There was mango sangria, walking in the surf, watching a horrible Burt Reynolds movie (was that redundant? – well, it was Stroker Ace, which is bad even by low Burt standards, but I couldn’t look away given the mammoth thespian talents of Jim Nabors) while drinking wine in front of the TV with the sea breeze wafting in, and eating some excellent fish tacos and goat cheese with mango salsa (it was a two-mango weekend). I’m sunburned, behind in my work, and not a bit regretful about either. 

The feds aren’t exactly wowing those of us in the industry with their Medicare and Medicaid fraud-fighting record, with 95% of respondents saying they’re doing something less than a good job. New poll to your right: will the Meaningful Use requirements significantly improve patient outcomes and patient safety?

My Time Capsule editorial from 2006: Joe Sixpack’s Concerns About Privacy and Security Need to be Taken Seriously. A snip: “Odd, isn’t it, that a physical break-in seldom reflects poorly on the company being victimized, but an electronic one immediately triggers outrage and disbelief?”

Cerner COO Mike Valentine resigns the job he’s held for three years for unstated reasons, although the company claims it has nothing to do with its upcoming earnings announcement. He will be replaced by Mike Nill, EVP and chief engineering officer, who oversees the company’s solutions and technology management. Nill, who joined Cerner in 1996, holds a bachelor’s degree in computer information systems from Rockhurst University and was previously with Andersen Consulting.

In addition to the COO change, Cerner also announces that SVP Zane Burke has been promoted to EVP over the client organization that covers the Americas and the Pacific Rim. He joined Cerner in 1996.

More HIStory from Vince Ciotti.

The New Mexico REC accepts Sage Intergy Meaningful Use Edition as a qualified product.

Adena Health System (OH) chooses MedsTracker 5.0 from Design Clinicals for medication reconciliation.

The CDC-funded Lab Interoperability Cooperative is recruiting hospitals to participate in a program that will connect their labs with public health agencies as required by ONC’s Meaningful Use criteria. LIC will provide educational and technical assistance to at least 500 hospitals help them electronically transmit lab results. The underlying technology is the Surescripts Network for Clinical Interoperability. Participants include AHA, the College of American Pathologists (and CAP-STS – SNOMED Terminology Solutions), and Surescripts. A readiness checklist is here.

MedPlus puts a cool green bus on the road to demo its Care360 EHR. I should tag along since it’s as close to a rock star tour as we’ll get in this industry, although there was no mention of groupies or trashing hotel rooms.

Big Boston physician groups Atrius Health and Fallon Clinic are in talks to merge, with their common software platforms for EHR, PM, and patient scheduling being cited as a reason that action makes sense.

Banner Health and Poudre Valley Health System will participate in the Colorado RHIO, which awkwardly calls itself the CORHIO HIE since a substantial part of its name came from a fad that has already become passé.

Stupid: a former Ohio neonatologist pleads guilty to signing up for a child pornography Web site using a hospital computer. He has surrendered his Ohio medical license, was fired from his most recent job as a Massachusetts researcher, and will serve 27 months in prison.

E-mail Mr. H.

News 4/22/11

Top News

CPSI reports Q1 net income of $5.37 million ($0.49/share) compared to $2.92 million in the prior-year period. Analysts were expecting $0.46. Sales revenue grew from $31.54 million to $40.38 million.

GE’s Q1 numbers: revenue up 6%, EPS $0.31 vs. $0.17, with $1.8 billion in profit from GE Capital. GE Healthcare put up good numbers.

Reader Comments

From Ishmael: “Re: Meditech. I am just loving being a Meditech beta tester for CHW’s rollout. It’s great when my livelihood and patients’ lives are on the line, especially when I’m not getting paid for it! I actually don’t mind the software as much as my median doc or nurse colleague, which are about an 80-20 split on hate/don’t mind. No one loves it.” I guess to be fair users almost never love enterprise software like they might Facebook or something. My armchair psychologist theory is that having software imposed on you with mandatory use is a reminder that you are subservient to management, and no matter how benevolent, nobody likes to give up control (and that’s what work software is – a package of rules, controls, and monitoring tools). Another problem I can cite from experience is that Meditech is the hardest system I’ve ever had to replace, and we’re talking the old Magic product – users hated anything that wasn’t Meditech. We took an IT black eye for replacing it in the hospital we acquired.

From St. Pauli: “Re: kudos. When I moved from medical practice to an informatics role, I researched any and all sources of information. HIStalk was one of the first I found and continue to read regularly. I admire anyone’s ability to write well and regularly and the expansion of HIStalk to include Inga, the reader polls, Dr. Jayne, Readers Write, and Ed Marx have increased HIStalk’s value logarithmically. I was recently promoted and would like to thank those responsible – my family, bosses, and employees. HIStalk is included in that list. This is not a lame attempt to get mentioned – I just want you and others that contribute to HIStalk to know the benefits you have given one of your readers.” Thanks – that made my day.

From Rango: “Re: HCRAP. Inga mentioned it, now I have to know what it means.” A couple of huge companies e-mailed to say, “We want to spend a ton of money and sponsor your site at a higher level than anyone else” (I’m paraphrasing slightly). I don’t do that – sponsorships are relatively inexpensive and everybody gets the same treatment – but I wanted to yank Inga’s chain. I first told her I was studying the Periodic Table of the Elements to find metals higher than Gold and Platinum and was feeling good about the Roentgenium Level and would calculate the price of that sponsorship based on its atomic number relative to those of the other metals. I then told her about the brainstorm I’d just had about two new sponsorship programs. The HS program (Hollywood Squares) allows a sponsor to not only run their own ad, but to buy the spots of their competitors (at a 50% premium) to block them from doing the same. The second option carries a 100% surcharge, for which we will send every news and rumor item about a company for their approval before we run it, which I dubbed the HIStalk Company Reputation Assurance Program (HCRAP). She was suitably amused, or at least pretended to be.

From iFad:”Re: iPad. It’s cool, but does anybody really think it’s revolutionary? We’ve had PCs for going on three decades and are still trying to figure out how to use them in healthcare. Call me a cynic, but there aren’t many paperless healthcare organizations and pie-in-the-sky simplicity and streamlined workflows remain just that. Reality check poll: if you own an iPad, do you really expect improved outcomes or productivity that you couldn’t get from a PC?”

HIStalk Announcements and Requests

  Several dozen companies have asked to be featured in the innovation showcase I’m starting up. As usual, my reach exceeded my grasp given that my time is almost non-existent between my hospital job and HIStalk job. Despite my being the rate-limiting step, it’s underway, albeit in a more controlled manner than I’d like. Stay tuned. I hadn’t heard of several of the companies that are interested, which I think is great since I’ll learn about them along with everyone else.

Welcome to new HIStalk Platinum Sponsor HMS of Nashville, TN. HMS provides Meaningful Use-ready enterprise solutions for 680 hospitals, focusing on the often-forgotten community and specialty hospitals that deliver much of the care out there in the real world. They’ve been around since 1984 and offer a broad line of products: EDIS, LIS, PACS, pharmacy, radiology, surgery, AP/GL/MM, payroll/T&A, HIM, quality management, transcription, CPOE, eMAR, device integration, clin doc, patient accounting, claims, document management, and a bunch more I left off since the list is obviously comprehensive. The company’s inpatient EHR, EDIS, and ambulatory EHR all earned ONC-ATCB certification in 2011 and HMS clients are already receiving inventive payments for using them, which can be run locally or hosted by the company. Thanks to HMS for its support of HIStalk.

Jobs on the job board, where sponsors post free: RVP Sales. On Healthcare IT Jobs: IS Clinical Systems Analyst II Nursing, SAN Administrator / Engineer, Epic Ambulatory Specialist.

Acquisitions, Funding, Business, and Stock

The State of Wisconsin awards Merge Healthcare $500,000 in JOBS Tax Credits and a $500,000 loan from the department of commerce to consolidate operations at its Hartland, WI facility. The project is expected to create 100 jobs and represents a $2 million investment.

Quest Diagnostics reports a 13.3% drop in net income compared to last year, falling from $162.4 million to $140.8 million ($0.86/share). Analysts expected $0.99 to $1.05. Revenue was up 1%.

Here’s the Cerner video presented by the ADP and the Small Business Administration, featuring co-founder Cliff Illig. It’s good.

Israel-based EarlySense, which sells a continuous patient monitoring system whose sensor resides under a bed mattress with no direct patient contact, announces that it will locate its US headquarters in Massachusetts. MetroWest Medical Center was also announced as the company’s first Massachusetts hospital customer.

Canadian vendor PatientOrderSets.com, which I mentioned last time, gets $750K in funding from a government-funded accelerator.

Sales

Emerus Hospital Partners (TX) selects InsightCS patient access, patient accounting, and revenue cycle information solutions from Stockell Healthcare Systems.

Allina Health System chooses Micromedex from Thomson Reuters as its drug information vendor after a month-long bake-off.

In Canada, Ottawa Hospital orders 1,800 iPad 2s for its physicians, saying they will pay for themselves through increased productivity and reduced errors.

NextGen gets a $6.7 million contract extension to provide an EMR to Maryland’s prison system.

People

Sad news: Craig Maszer died on April 11, 2011 at Brigham and Women’s Hospital after a long battle with multiple myeloma. He was a resident of Andover, MA and a principal at Champions in Healthcare, where he worked alongside his mother, industry long-timer Stephanie Massengill. Others may remember him from his time with Sentillion and Eclipsys. Craig Maszer was 46 years old. Condolences.

Omnicare names Randy Carpenter to SVP/CIO. He was previously CIO of HealthSouth and had hospital CIO experience before that.

University of Arkansas for Medical Sciences (UAMS) names David Miller as vice chancellor and CIO. He was formerly with University of Chicago Medical Center. I think I probably mentioned that awhile back — he and I swap e-mails occasionally and he let me know as soon as it was official.

OB-GYN PM/EHR vendor digiChart names Phil Suiter as president and CEO. The former president and CEO, founder and Vanderbilt professor G. William Bates MD, will remain with the company as board chair.

Former HealthPoint Medical Group CIO Steve Fisher joins MD Solutions as SVP of advisory services.

Announcements and Implementations

 

McKesson Horizon Enterprise Visibility earns top marks in KLAS’s new report on patient flow solution. TeleTracking and Allscripts Sunrise Patient Flow earned the next highest ratings. Only 20% of hospitals are using a patient flow system, but 85% of those say they provide benefits, especially in terms of resource collaboration and communication.

Denver Health (CO) implements Microsoft’s Chronic Condition Management platform to facilitate communication between providers and diabetic patients and promote better self-management of chronic conditions.

Wayne Memorial Hospital (NC) goes live on EXTENSION’s HealthAlert for Nurses for nurse call messaging.

The Methodist Hospital System (TX) will use the Rothman Index for scoring patient condition from EMR information into a dashboard.

Two Siemens Soarian customers successfully attest for Meaningful Use Stage 1: MedCentral (OH) and Riverside (VA).

Government and Politics

Indian Health Service becomes the first federal agency to have its EHR (the IHS Resource and Patient Management System, or RPMS, based on the VA’s VistA) certified as a complete EHR.

Other

A Sage Health survey finds that patients believe EHR use increases care quality and results in a more accurate health record. Eighty percent of patients have a positive perception of EHRs, compared to only 62% of physicians; privacy and security is a concern for 81% of patients but only 62% of  doctors. Both groups agree that the biggest benefits of EHRS are real-time access to records and  the ability to share information among providers.

A Texas hospital tries to convince county voters to create a hospital tax district after it experiences financial losses, layoffs, and wage freezes. The new tax dollars will pay for a  new EMR, which will cost $1.2 million plus $18,000 per month maintenance.

Strange: the family of a patient who died after heart surgery is suing the surgeon and hospital after an anonymous caller told them that the surgeon’s 7-year-old daughter was showing a video of the surgery to her friends. The family claims the surgeon was so interested in making the movie for his daughter that he left the OR before the revascularization procedure was complete, allowing a non-physician to close and monitor the patient. The family also claims they found out only after the surgery that the surgeon has the worst outcomes of any surgeon in the state for the procedures he performed.

Sponsor Updates

• Healthcare Growth Partners releases its Q1 2011 market and M&A report, which summarizes the capital market, M&A, and capital raising activity for the HIT and services sector.
• Salar’s TeamNotes and Charge Capture software products earn ONC-ACTB EHR modular certification from Drummond Group. 
• Central Illinois HIE picks ICA as its vendor of choice to provide the HIE’s technology and infrastructure.
• ZirMed and e-MDs partner to offer eMD clients ZirMed’s RCM services.
• MEDSEEK obtains CCHIT ONC-ACTB EHR module certification for its eHealth ecoSystem, Version 3.4.
• The Huntzinger Management Group posts a video of its HIMSS presentation Discussing the Future Viability of Hospitals.
• Hartford Hospital (CT) reports it has increased its early discharge rate nearly threefold by offering its clinicians access to Carefx’s business intelligence dashboard.
• Harrison Medical Center (WA) is live on GE Healthcare’s eHealth Information Exchange.
• EMRConsultant.com adds more than 100 EMR products to its database, a free service used by over 12,000 practices.
• Mission Hospital (CA) has implemented Meditech C/S 5.64 CPOE at both its Mission Viejo and Laguna Beach campuses, assisted by H/P Technologies, which has been involved with Meditech and Epic go-lives at Cedars-Sinai, Mission Hospital, and University of Chicago.

EPtalk by Dr. Jayne

Earlier this week, the College of Healthcare Information Management Executives (CHIME) addressed a letter to new National Coordinator for Health Information Technology, Dr. Farzad Mostashari. It summarizes CHIME’s comments on ONC’s Federal Health IT Strategic Plan.

After the introductory pleasantries, CHIME delves into key areas close to many of us:

• Consent issues for health information exchange, not only clarifying how consent will be stored / transmitted, but how it will integrate with personal health records; unifying the patchwork of laws across various states; and national standards to pull it all together and fix the problem created when HIPAA allowed states to preempt federal regulations.
• Making movement to Stage 2 Meaningful Use requirements contingent on having a certain percentage of providers and hospitals compliant with Stage 1.
• Clarifying disagreement between HIPAA and HHS (Department of Health and Human Services) regulations on timely release of information and making sure that granting patients instant access to health information will not be harmful.
• Greater focus on the usability of technology.

As a practicing physician, the last one has the greatest impact in my day-to-day practice. There have been some unfortunate downsides to the speed of the Meaningful Use timelines. The relatively short time between the publication of the final rule and implementation has stressed vendors intent on incorporating items that may or may not be clinically helpful, yet cannot be ignored if they are seeking certification.

Let’s just look at a simple measure, documentation of tobacco use. Prior to the Meaningful Use hubbub, many EHRs did a perfectly fine job of collecting the information physicians needed to do appropriate health interventions. Physicians saw patients, counseled them, documented their findings, etc. However, MU required the documentation to meet certain standards of compliance. Was there any randomized, controlled study that showed that documenting tobacco use in a certain way changes patient outcomes? Or was it just nebulously decided that it should be “this way” going forward?

I’m certainly not privy to how it was all worked out, but vendors did a fair amount of retooling to make sure all the MU items were documented in the prescribed fashion. Don’t get me wrong, I support uniformity, the ability to report data across disparate systems, etc. But I also can’t help but think that the amount of development, testing, and implementation resources that were focused on making software changes that don’t materially benefit physicians (or patients) could have been better spent on making systems more usable.

This doesn’t even take into account the amount of time and resources spent by EHR customers to upgrade perfectly functional/serviceable systems to “certified” versions, regardless of pre-existing organizational priorities. A CMIO friend of mine laments the sheer number of projects (many of which would really have provided benefit to his physicians and their patients) that have been placed on hold so that all resources can focus on achieving Meaningful Use. The pursuit of MU has put his organization back a year or more on its five-year strategic plan.

I hope that ONC gives some thought to these comments as well as the thoughts of many others in the trenches who have submitted their thoughts. Do you have an interesting comment submitted to ONC? E-mail me.

Contacts

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

News 4/20/11

Top News

CMS’s EHR Incentive Program attestation process is live.

Sad news: industry longtimer Marc Holland died suddenly on Saturday, April 16, 2011. He joined HIMSS as VP of market research four months ago following positions with System Research Services, several market research firms, and Montefiore Medical Center. He wrote a nostalgic reflection of his 30+ years as a HIMSS member in January, including his optimism that healthcare IT’s future is bright. Marc Holland was 62.

Reader Comments

From Petra: “Re: first-day Meaningful Use attesters. Why aren’t more vendors promoting customers who have successfully registered? They’ve hyped this for a year, so I would expect a flood of news. Where’s the beef?” I haven’t seen anything mentioned. It may not be all that newsworthy, but you know at least some of the rags would run the story anyway and vendors don’t usually turn down free PR.

From HIS Fan: “Re: UW Health (University of Wisconsin health). Announced yesterday that CMS has accepted its Meaningful Use data for Stage 1 as submitted. They are an Epic shop and achieved Stage 7 last year.”

 From Dr. Victor EHRlich: “Re: Epic’s mammography module. Two customers are planning to de-install in favor of niche vendors.” Unverified.

From WildcatWell: “Re: Dell’s aggressive EMR marketing efforts. I called and the phone kept ringing and ringing, redirecting a caller to sales and then ringing … well, I stopped after five minutes. How do you think support calls will be handled?” I tried the number and it was not necessarily a pleasant PBX experience, but someone did pick up after six rings or so. I’m not listing the number since someone will surely shriek that I’m pandering to a sponsor (via Dell’s acquisition of InSite One), but it’s easy to find. I would try again since maybe you just caught them at a bad time.

From Kerplunk: “Re: Zite for the iPad. It’s a content discovery app that I’m in love with and it’s free.” It’s a personalized magazine that gets smarter as you use it, the developer says (and the 4+ rating seems to indicate that users agree). One of my first and favorite iPad apps was Flip, so I’ll try Zite to see if it’s similar.

From Susan: “Re: Concerro. They released a video at AONE that is racist, a takeoff of the Apple vs. IBM commercial in which a disheveled black woman represents paper scheduling and a well put together represents electronic scheduling. As a black nurse, I find this reprehensible.” I watched the video and didn’t have that reaction since companies can never seem to please everyone with their well-intended attempts at representing diversity or by just treating everyone (like actors) equally. However, since I’m seeing it through white male eyes, I invited Concerro to respond.

Thank you for taking the time to express your concern about our new video. The Concerro marketing team went to great lengths to find the best actors for each of the roles in all of our videos. Our “paper” actor was selected because she played an excellent frazzled nurse and a younger person was needed to play the role of a “less experienced” nurse. It’s unfortunate that this has been taken out of context and we sincerely apologize for offending anyone. Concerro stands by these videos and we are proud of our actors.

 From NonCredentialedTechie: “Re: from Slashdot. The head of a clinical division at an academic hospital sets up his own server at work, asks IT to allow people to access it through the hospital network, and is ‘taken aback’ when they say they’ll need an account on his server. The best part are the comments.” I love this, even though it may be a troll and not a real clinician writing it. The author claims he’s miffed that IT isn’t thrilled about his server and says he’s considering “taking this up the chain” and asks readers if they think he should give IT an account. Here’s the best response from the many hundreds posted:

What you’ve done would cause any professional IT group to get out the hot tar, feathers, and rail. Or at least come into your office and ask you politely to remove the damn server from their facility. And never do this again. You must have missed all the security briefings, the issues with HIPAA, and whatnot when you were looking at systems. What you’ve done is to create a ‘rogue system’. Imagine one of your kids sets up a server in your house. You don’t understand it, you don’t know if it’s happily sniffing network traffic to steal passwords so pizza can be ordered using your credit cards, serving up pr0n, or just running minecraft. Would you willy nilly allow the kids to open a port on your firewall without the ability to audit what they’re doing ? Of course not. Personally I’m amazed that they only asked for an account on your little server. I would have gone over and watched while you removed it from the facility and put in in your car.

HIStalk Announcements and Requests

  Listening: new Foo Fighters. I never paid them much attention, but I should have … Wasting Light sounds great first time through. It was recorded directly to analog tape in Dave Grohl’s garage, yielding a sound that I nostalgically remember as “music” before lesser talents hijacked the term sometime in the late 90s to define computer-created dance tracks. This is amazingly good and gets a rare highest recommendation from me.

Acquisitions, Funding, Business, and Stock

Cerner is one of six companies profiled in a new video series by the Small Business Administration. Cerner vice chairman and co-founder Cliff Illig shares details of how he and fellow entrepreneurs Neal Patterson and Paul Gorup created the company in 1979 and how Cerner has evolved over the last 32 years.

Healthcare disclosure management provider MRO Corp. acquires the assets of Keystone Management Solutions, a provider of release of information services.

Community Health Systems files a motion to dismiss the lawsuit filed against it by Tenet Healthcare, which claims CHS admits ED patients for purely financial reasons. CHS, whose December bid to buy Tenet for $5 per share in cash and $1 in stock was rejected as insufficient, changed its offer to a $3.3 billion all-cash offer, saying that move eliminates the basic for Tenet’s lawsuit against CHS, which alleged securities fraud. This pair is like hot-blooded lovers who can’t decide whether to kill each other or to make passionate love (or maybe both simultaneously). I think I’d be cautious about waving $3.3 billion in cash around right as the public tries to figure out where to cut healthcare costs.

Sales

HealthInsight selects Axolotl’s Elysium Exchange infrastructure for the Nevada HIE.

Physician management services organization TeamPraxis (HI) chooses Microsoft Amalga to facilitate the sharing of patient information.

Presbyterian Intercommunity Hospital and Bright Health Physicians (CA) will implement the Shareable Ink documentation system as part of its rollout of Allscripts Enterprise PM/EHR.

Five hospitals in Canada will implement order set management tools from PatientOrderSets.com, increasing the Canadian vendor’s client list to 140 hospitals. The company changed its name from Open Source Order Sets in January, explaining that its collaborative network is cloud-based, but not open source in the software development context.

Lutheran Medical Center (NY) contracts for Service Desk healthcare-specific IT help desk services from CareTech Solutions. The company started up 24×7 services within three weeks to support Lutheran’s EMR rollout.

People 

University HealthSystem Consortium (IL) hires Mike Hebrank as VP and CIO. His previous employers include Helix Health and Greater Baltimore Medical Center.

Announcements and Implementations

  Seventy Hawaii physicians on the island of Oahu form Health Information Helping Others (HIHO) as a pilot project for the Hawaii HIE. HIHO will use Wellogic’s Direct Project technology for data exchange and secure messaging. Got to love the happy acronym, which is far less cynical than some of the ones that recently concocted by Mr. H (HCRAP comes to mind).

Roche introduces a new EMR interface for the VA that transmits patient diabetes data into the VistA computerized patient record system. JResultNet allows providers to automatically transfer patient blood glucose test results from the ACCU-CHEK 360 Diabetes Management system to VistA.

Thomson Reuters announces Micromedex Drug Interactions for the iPhone. It’s free to Micromedex customers, $50 per year otherwise.

PenRad announces plans to develop the next generation of its PenVasc Vascular Data Management System for vascular labs.

General Dynamics becomes the first healthcare application service provider host to earn HITRUST certification, which documents that its hosting service meets HIPAA and HITECH security requirements.

Government and Politics

Lawmakers in Maine are considering legislation that would give patients the ability to control what portions of their medical record could be included in the state’s HIE.

Without any clear explanation, ONC extends the comment period for the Federal Health IT Strategic Plan: 2011 – 2015 from April 22 to May 6. Comments can be made or reviewed here.

The Kansas Board of Pharmacy will require pharmacies to use the NPLEx system, which alerts store personnel when customers try to buy products like Sudafed from multiple locations to skirt sales limits imposed to thwart methamphetamine production. The system is provided nationally by the National Association of Drug Diversion Investigators and paid for by the drug companies whose products are involved.

Innovation and Research

A BBC article says that governments like Britain’s spend billions on ambitious electronic medical records projects, but small upstarts are tackling much smaller problems with greater success. The CEO of a company that offers a smart phone-based communication system says that hospitals have spent a fortune on IT, but caregivers still can’t monitor patients with it. “Cans of tomatoes are being treated better than patients,” he says, referring to the more advanced technologies used by the average grocery store. Another company is piloting a cloud-based hospital management system in a 2,000 bed hospital in India, saying that it’s a poor part of a world, but patients there get “more efficient, more high-tech service than patients in the UK” because they didn’t have to work around legacy systems or government policies.

Do you run a small and innovative healthcare IT company? Does it offer a product (not a service) and have at least five employees and one referenceable site? If so, a team of volunteer HIStalk readers and I will consider giving you a national audience right here on HIStalk. This isn’t like a venture fair, where you have to fly somewhere, pitch to an indifferent audience of allegedly interested investors, and then go home with nothing to show for it. We’re offering you the chance to reach HIStalk’s readers directly and at no cost, just because I like to shake things up a little by giving the little guy a chance to earn customers and investors (and because readers keep asking me to showcase those little guys). If your company would like to be the guinea pig, e-mail me and we’ll work through some simple details. I’ll post your story, an interview with you and your referenceable site, and your video pitch.

Old news that I just ran across: MediAngels says it has launched the first 24×7 Global eHospital to serve patients anywhere in India and elsewhere over the Internet. It has 300 physicians, including those from 85 super-specialties, who will render consultations and second opinions. The maximum fee, which is charged only if an international panel of physicians is involved, is $100 US. It claims to meet HIPAA standards (which is says were “enacted by the USA FDA”) and can also arrange medical tourism.

Here’s a fun and interesting video featuring Halle Tecco, a new Harvard Business School grad who founded non-profit HIT accelerator RockHealth (mentioned here last week) with medical partners Mayo Clinic and Cincinnati Children’s Hospital. “I didn’t even go to Recruitment Week or apply for any of the big jobs because I knew it could be really tempting because they pay probably like five times as much as I’m going to make, but at the end of the day, I’m more concerned about doing something interesting and meaningful with my time on this earth, whether that’s right out of business school or ten years down the road.”

Other

Ten percent of ambulatory providers are switching PACS or RIS vendors due to market consolidation or poor vendor performance, according to a new KLAS report. KLAS also noted that providers will generally forego some functionality for solid PACS/RIS integration, though single-side vendors do well in their respective markets. Intelerad IntelePACS was the highest rated PACS and MedInformatix the top RIS.

The Rhode Island Board of Medical Licensure and Discipline reprimands a physician who posted details of her ER experiences on Facebook. The postings did not include any patient names, but the nature of the injuries described allowed at least one person to identify a patient. Alexandra Thran was found guilty of unprofessional conduct and ordered to pay a $500 administrative fee.

American Medical News runs an interesting question on its Ethics Forum: is it ethical for doctors to use their IT systems to “cherry pick” or “lemon drop,” meaning choosing only the healthiest patients to maximize pay-for-performance money while increasing costs overall? It gives interesting examples of Medicare HMOs, which have been caught recruiting only patients from affluent areas and discouraging sick patients from re-enrolling by charging high co-pays for dialysis and cancer treatments. It theorizes that the EMR could be a powerful profit-making machine since doctors could theoretically just drop patients whose performance targets would be difficult to meet. It’s an interesting article — if a system can be gamed, you can bet it will be, both legally and illegally (see: tax laws).

 Sponsor Updates by DigitalBeanCounter

• Vitalize Consulting Solutions held its all-company meeting at Hyatt Lost Pines Resort in Austin, TX earlier this month, including a build-a-bike team exercise that surprised 34 children of the local Boys and Girls Club with brand new bicycles, hlemets, and locks.
• Nathan Littauer Hospital (NY) selects ProVation Order Sets as its electronic order set solution.
• Cumberland Consulting Group promotes Amy Meiners to principal.
• Presbyterian Intercommunity Hospital and Bright Health Physicians (CA) sign an agreement to deploy Allscripts Enterprise EHR and PM solutions. The ambulatory systems will integrate with the hospital’s existing Sunrise inpatient EHR/RCM system.
• St. Joseph Health System (CA)  will implement MedPlus’s ChartMaxx electronic document management product.
• Cognify, Inc. selects Greenway’s PrimeSUITE to further integrate and advance its Web-based participant tracking system that monitors care plan continuums.
• The Rules-Based Charging solution of Surgical Information Systems earns the “Peer Reviewed by HFMA” standard for the fourth consecutive year.

Contacts

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

Awarepoint Acquires PCTS

Real-time location system vendor Awarepoint announced this morning that it has acquired Patient Care Technology Systems (PCTS), a vendor of software that helps hospitals track people and physical assets. Terms were not disclosed.

Charlotte, NC-based PCTS has 60 hospital customers that include New York-Presbyterian, Advocate Health Care, Providence Health & Services, and Aurora Health Care. It will continue operating from its current office, with the PCTS executive team reporting to Awarepoint CEO Jay Deady at the company’s corporate headquarters in San Diego.

Deady was quoted as saying that the combined solutions will allow the company “to capitalize on an enormous untapped RTLS market” in which US market penetration is estimated at 10-12% and around 5% internationally. The company’s value proposition includes reducing medical equipment rental costs, reducing procedure time and nurse labor involved with in locating needed equipment, and ensuring that equipment is correctly reprocessed between patients.

We spoke to Jay Deady on Monday after running a rumor from RTLS Battle predicting that the acquisition would be announced this week. He said Awarepoint’s 93 hospital customers, having realized significant return on investment from the company’s asset management and tracking capabilities, were pressing the company to move quickly into patient workflow solutions that can support discharge planning and real-time monitoring.

“Integrating a workflow engine into our software and building out the workflow library was going to take 18-24 months,” he told us. “At our recent user meeting, our customers told me they are ready to go right now. Awarepoint and PCTS have three shared accounts — Christiana Care, Aurora, and Advocate Good Sam. I visited those clients and got rave reviews about PCTS’s workflow engine and content library. It just seemed logical to meet the needs of clients in accelerating to market and not taking two years to develop.”

Deady says that completing the transaction required “a very fast close” due to competing bids from private and publicly traded companies and a private equity firm.

PCTS’s relationships with other RTLS vendors will continue, Deady told us. “This is not a one-size-fits-all environment. We will continue to work with other technology partnerships. A lot of our clients were asking us about other RFID technologies, such as passive RFID for inventory tracking. PCTS has an RTLS integration engine and can integrate that in being able to play well in the sandbox with other active and passive players. That was a big decision point for us to merge with PCTS.”

Deady summarized the benefit to customers as being similar to the consolidation of hospital clinical systems starting in the late 1990s. “Customers don’t want to go to different companies for technology, inventory management, asset management, hand hygiene, and temperature monitoring. Up until a year ago, a hospital that wanted to deploy all these technologies would be doing business with seven or eight different companies. Our goal in merging with PCTS is to give them one place to go.”

Monday Morning Update 4/18/11

From RTLS Battle: “Re: Awarepoint. Word is the company outdueled Merge to buy PCTS, a workflow software vendor in Charlotte, NC, with former Allscripts VP Jay Deady (Awarepoint CEO) beating out another former Allscripts VP Jeff Surges (Merge CEO). Deal to be announced next week. Wonder if they’ll split deep dish pizza in Chicago any time soon?” Unverified. PCTS offers the Amelior product line that includes ED and OR asset and patient tracking, hand hygiene systems, and temperature monitoring. They are a business partner of Awarepoint.  

From The PACS Designer: “Re: net collaboration. InformationWeek has compiled a list of the 15 Top Collaboration Apps that promote working together using the Internet. With all that is going on with Meaningful Use, this compilation of collaboration tools is good for institutions who want to progress to the next level of efficiency, which is meaningful structure.” Most of the apps listed involve some flavor of project management in what would have been called a hosted Intranet a few years ago (I guess that’s not a commonly used word these days). I notice that Cerner is listed as a user of Jive Engage (a social media monitoring tool) for its “social network experience,” since the whole point of social media is to sell stuff, of course.

From Katrina: “Re: Healthcare Informatics Executive Summit. I work for a vendor and registered, but was told I needed to either come up with $7,000 of program sponsorship or bow out, which I did. I’m warning other potential attendees about the small print stipulation.” The keynote speakers that Healthcare Informatics won’t allow you see for your $1,095 registration fee are Farzad Mostashari of ONC and Carolyn Clancy of AHRQ, both paid with your tax dollars, so that’s a bit insulting. Maybe you could just register as yourself at XYZ Consulting, pay with your credit card, and put it on an expense report. That brings up another gripe: the registration form requires entry of your job title and employer. Why should someone paying their own registration fee have to provide that information? If my employer isn’t willing to pay for my attendance, why should they (and the conference organizer) enjoy the benefit of having their name on my badge?

From KS: “Re: Epic. Consultant advertisements are popping up at MSN airport. They, of course, also spell it EPIC. Wonder what they think EPIC stands for?” Maybe they’re just shouting the name because they’re so excited about the money they’ll rake in if they can just find some consultants.

From Tango Charlie: “Re: Epic. Duke will announce next week and Wake Forest is suppose to go Judy, too.” Unverified. Duke is going with at least Epic ambulatory, it seems (and as history has shown, hospitals don’t often stop there). Wake Forest (above) was on the list of hospitals attending Epic training for unnamed modules a couple of weeks ago that a reader sent my way.  

Nearly two-thirds of respondents like the idea of biometrically verifying the identity of those claiming Medicare and Medicaid healthcare benefits. New poll to your right: how is the federal government doing against Medicare / Medicaid fraud?

My Time Capsule editorial from 2006: RHIOS Are Taking Away Resources From Better Projects. A snip: “Do you like insurance companies enough to let them control patient information?”

Three free press release tips for you PR and vendor types: (1) always put out press releases in PDF format rather than .DOC, for about a thousand reasons that I hope I don’t have to explain to people who supposedly are experts at media; (b) never put a press release out on a national wire service but not simultaneously on the company’s own site – isn’t that kind of the point? and (c) if you’re going to mention a hospital, include the city and state it’s in. I could add dozens more, but these came up today.

Above is the latest history (is that an oxymoron?) from Vince Ciotti.

Shares in for-profit hospital operator Community Health Systems drop 14% in after-hours trading Friday after the company announces it has been subpoenaed by HHS in conjunction with an investigation of its Medicare and Medicaid billing. Rival Tenet Healthcare, which in December rejected an acquisition offer by CHS, accused CHS of billing fraud in a lawsuit it filed against CHS. HHS wants to review CHS’s ED practices and the algorithms in its Pro-MED ED physician documentation software, which may test that company’s claim that it “Meets and exceeds all CMS Physician Evaluation and Management Documentation Guidelines, ‘maximizing’ reimbursement” depending on how CHS set it up.

CMS is threatening to stop payments to University of Chicago Medical Center after finding that conditions there pose an immediate threat to patient safety. A prominent patient died after a medical error involving a dialysis catheter-caused embolism. Not to be cynical, but oversight organizations react a lot more forcefully when patient harm involves someone wealthy, famous, or the subject of splashy media stories. I’ve worked in hospitals involved in high-profile medical error cases and it was obvious that organizations such as Joint Commission, state hospital inspectors, and HHS don’t like having the hospitals they oversee embarrass them in the press, so their reaction is sometimes overly hostile and critical. I would question the effectiveness of any watchdog group that pronounces conditions dire only after they read about them in the newspaper.

A Rhode Island physician will be in line Monday morning when CMS opens the virtual doors for Phase 1 of the Medicare ARRA incentives. Douglas Foreman DO, a family practice physician who uses the Ingenix CareTracker EHR and its Meaningful Use dashboard, says he has met the 15 Core requirements and seven of the 10 Menu Set items (of which five are required to qualify for the incentives).

UCSF says it’s turning on Epic outpatient, with a price tag of $160 million vs. the originally estimated $60 million due to an expansion of the project’s scope (there’s more to the story I can’t see since I don’t subscribe to the San Francisco business paper).

My new favorite iPad app: the just-released Bing search (the irony of a Google-competing Microsoft app written exclusively for an Apple device duly noted). Not only is it stunning to look at, you touch the microphone icon and can immediately speak your search terms with good accuracy.

The Florid-based developer of the Electronic Medical Assistant software for dermatologists gets a $4 million investment from the British company that owns the Speedo swimsuit product line. Modernizing Medicine was founded by a dermatologist and the co-founder of the Blackboard online learning system used by colleges. The EMA software costs $6,000 upfront and $650 per month. One of its users says he can create 30 notes in 25 minutes.

The military’s TRICARE system team announces that its Blue Button functionality has been expanded to allow users to download include lab results, patient history, and visit history.

A post on Geek.com nominates this as one of the most inopportune times for a Windows update. It’s a picture of a woman’s hospital monitor during labor taken by the dad-to-be, a computer science professor. Perhaps the hospital’s biomed folks should take a look at the device since enabling automatic Windows updates on an FDA-regulated system doesn’t seem like a good idea.

Michael Kirsch, MD, is a pretty funny writer (he even looks a tiny bit like Jeff Foxworthy). His list of Apps I Want includes: “Medical Coding App. This turns your iPhone into a high voltage device, similar to the Invisible Fences that are used to restrain pets to a given area. Tap the App and then place the iPhone in your front pocket. After seeing a patient, if you code higher than you should on your EMR, you will get a light shock. The intensity will increase until you have expressed remorse, atoned and coded properly. I expect that Medicare will provide incentives for using this technology in the coming years.” 

A $5 million malpractice judgment against a Canadian hospital is thrown out when the hospital’s lawyers notice that 321 of the 368 paragraphs of the Supreme Court justice’s ruling were copied directly from the closing arguments of the plaintiff’s attorney. There appears to be some legal debate as to whether the judge crossed some unspecified line or whether that simply means the plaintiff’s legal team did the job they’re paid to do – create sound, well-referenced arguments that, if they win, must have had significant influence on the verdict.

Bizarre: the Texas patient who received the first US face transplant obtains a restraining order and files suit against a British tabloid that insists he sold them his story rights for $2. The man, who lost his eyes in the accident that necessitated the surgery, admits that he signed a document from the company, which told him they wanted to write a human interest story to be run in a women’s magazine. The tabloid has created TV programs that include “Is This China’s Fattest Kid” and “Legless Dancer TV Hit.” Maybe the biggest question is why a face transplant warrants tabloid coverage. How big of a page-turner could it be, especially when Charlie Sheen is out there spreading his Adonis DNA?

The OR of River Park Hospital (TN) goes live on Shareable Ink after a two-week project (kickoff meeting to go-live). They plan to expand its use.

Former iSoft CEO Gary Cohen files proceedings to delay the $188 million sale of the company to CSC, saying the company is required to give his family investment group four weeks’ notice before selling it. He previously said he was considering making his own offer to buy the company.

NPR runs a fun piece criticizing ACOs that includes four ACO jokes: (a) I don’t know how to define an ACO, but I know it when I see it; (b) We have tried ACOs already — they were called HMOs; (c) The three greatest mythical creatures are the abominable snowman, the Loch Ness monster, and ACOs; and (d) the true meaning of ACO is Awesome Consulting Opportunities.

Rochester RHIO says it’s the first HIE to allow patients to upload their advance directives and healthcare proxies so they can be viewed in an emergency.

Everybody’s fighting to protect their healthcare profits, it seems. Case in point: for-profit ambulance companies are fighting with the powerful firefighter’s union over who gets to provide those ultra-expensive (and often Medicare-paid) ambulance rides when people call 911 for whatever conditions they personally deem worth spending someone else’s money on. It would be interesting to study the outcomes of ambulance-transported patients to determine how often their medical needs justified it.

In the UK, designated early adopter Pennine Care Foundation Trust pulls out of NPfIT after years of delays in adding mental health capabilities to iSoft’s Lorenzo.

E-mail Mr. H.

News 4/15/11

Top News

Healthcare IT is one big reason that private practice docs are taking down their shingles and going to work for hospitals, according to experts interviewed by The New York Times. Unlike the Hillarycare era, there’s no turning back this time since reimbursement is encouraging that kind of vertical integration. The predicted result: less competition, leading to higher prices (although Kaiser is a mentioned as a disrupter in offering cited higher quality at lower cost). The experts seem pretty sure that quality will improve (like in Mayo or Kaiser, with salaried physicians), but not so sure costs won’t go even higher.

Reader Comments

From Hypocrisy: “Re: Judy Faulkner. She was quoted as saying at an ONCHIT Policy Committee meeting, ‘What is showing up in blogs — I have seen and sometimes been told about this — is that we have to be careful of an apparent conflict of interest. That is if, in fact, the primary spokesperson for PCAST does have products that would benefit tremendously by this, do we get into — and I know we’re not supposed to judge — the uncomfortable position of an appearance of conflict of interests.’ She’s apparently talking about Microsoft’s Craig Mundie, discussed a lot on HIStalk as a PCAST committee member. Presumably she does not see a conflict of interest herself in serving on the committee.” I didn’t see the quote, but it’s interesting if accurate. Just to clarify for those who don’t follow the confusing cast of government players, Judy wasn’t actually on the PCAST committee that made recommendations to the President that pretty much had HealthVault or Google Health written all over them – the only for-profit company employees on it were Craig Mundie from Microsoft and Eric Schmidt from Google. Judy is on the HIT Policy Committee, which has for-profit members from Kindred Healthcare, WellPoint, Gastroenterology Associates (a private doctor), and Epic (Judy). I wouldn’t think she carries the level of influence over that group that some have said Craig Mundie had over the PCAST report.

From Ludacris: “Re: rogue Meaningful Use. A vendor is e-mailing consultants offering a ‘private label’ EHR they can sell under their own name for a split of the revenue.” The company’s address appears to be a mail drop and the principals aren’t listed, although I found the CEO’s name elsewhere. The vendor’s Version 1.0 product is certified as a Complete EHR Ambulatory and the offer claims companies that want to private label it get their own name on the list of certified products. I suppose ONC didn’t address that issue – where the same product could be sold by multiple vendors under multiple names, each rightfully claiming to be offering a certified product. Certification was intended to reduce buyer risk, not buyer confusion, and some would argue that it has accomplished neither.

From Dingin: “Re: Epic. You mentioned Oakwood and Singing River. Both were at a recent class in Verona, along with others you probably already knew about: Nebraska Medical Center, Providence Anchorage, Contra Costa, Norton, MUSC, Wake Forest Baptist, University of Cincinnati, and Driscoll Children’s.” I confirmed with MUSC that they’re going only with the ambulatory products, dropping McKesson Practice Partner since it doesn’t work well with MUSC’s TELUS Oacis Health Data Warehouse, but keeping Horizon Clinicals on the inpatient side.

From Lorenzo: “Re: ICA. What’s going with them? Rumors of problems.” Not so, according to our Informatics Corporation of America contact. “We have just won Wyoming Medicaid HIE through our partnership with ACS, just selected as VOC with Central IL HIE, and we are hiring as fast as we can to keep up with recent wins of Middle TN eHealth Connect and KHIN. We’ve grown by 100% since the beginning of the year and we expect to grow by another 50% by year’s end in employees. Our funding is solid through our primary owners and we are working as hard as ever to meet customer demands. Go-lives of major clients are scheduled over many of our clients in the near future. Nothing could be further from the truth.”

From HISwalk: “Re: magazine. Does anyone else think this slide show paints a ridiculously rosy picture of several vendors given their current situations?” I’m not a fan of online slideshows when a simple list would have been much easier to read, but this one’s OK (the information it contains was provided by Vince Ciotti’s firm, so I’d trust it more than if the usual sideline reporters undertook their own analysis). I would say the list contains some opinion, some analysis that’s not quite current, and focuses on revenue (which was the point) and not necessarily profit or market trends. I don’t link to other HIT sites or rags since I don’t use them as sources, but you can probably Google your way to it if you’re determined to check it out.

From FACA: “Re: ONC Policy Committee. There’s a Webcast meeting on EHR usability and accessibility on April 21 at 9 a.m. It’s a public hearing, so questions are welcome.” The agenda is here. The presenter list is interesting. For some reason, the government, like others, capitalizes Epic (Epic does not spell it EPIC).

HIStalk Announcements and Requests

This week exclusively on HIStalk Practice: PracticeWise, a new  column by practice consultant Julie McGovern (who stirs up some discussion in her first post). Reefdiver weighs in on the value of certification in the EHR selection process (readers are opinionated on that topic, too.) KLAS  extends a free offer for HIStalk Practice provider readers. AMA tells CMS what physicians find most burdensome. Dermatologists ask patients for fashion advice. Americans want their physicians to use EMRs. So far, only six states have issued MU incentive checks. In honor of Leonardo da Vinci’s 558th birthday and because it makes me happy, please sign up for the e-mail updates while you are catching up on the latest HIT ambulatory news.

On the sponsor-only job board: Clinical Project Specialist, Software/Implementation Engineer, Healthcare Implementation Project Manager. On Healthcare IT Jobs: EHR/ePM Implementation Project Administrator, Coordinator Clinical Trials.gov, Project Manager – NextGen, Software Product Development Manager.

Acquisitions, Funding, Business, and Stock

Allscripts CEO Glen Tullman earned nearly $8.5 million between June 1, 2009 and December 31, 2010. That breaks down to $4.1 million for the 12 months ending May 31 and $4.5 million for last seven months of the year.

Streamline Health Solutions reports Q4 earnings: a net loss of $1.8 million compared to a profit of $1.6 million a year ago. Revenue fell from $6.3 million to $4.9 million.

In India, Michael Dell chats with local reporters on a number of topics, including healthcare IT:

We are #1 in healthcare IT globally. We acquired a company called InSite One, the leader in cloud-based archiving of medical images. We have taken that expertise all the way back to our product groups and created new offerings. IT in the healthcare industry is siloed. The CIO can’t make them work together. We have created vendor-neutral archives by speaking to medical equipment makers. We capture all the data and store locally or in our cloud archive.

Add Medicomp Systems to the long list of EMR vendors that have been sued by Prompt Medical Systems over the years. PMS has no Web presence, so I assume its primary output is legal rather than technical. It appears to be the brainchild of Bernard Milstein MD, an ophthalmologist, UTMB professor, and founder of The Eye Clinic of Texas who patented the use of CPT codes in computer systems in 1994 (even though AMA holds the copyright to the CPT codes themselves). He appears to be backed financially in his litigation lottery by an investment banker and securities company founder. None of the previous cases made it to court from what I can tell, so I’m sure PMS is banking (no pun intended) on the EMR vendors paying them to go away rather than risk being tied up endlessly in an expensive legal action.

Sales

The US Military Health System selects Mediware’s blood transfusion management system for 68 military health sites worldwide. MHS will also deploy Mediware’s LifeTrak and InSight to track donor records and product inventories in 28 blood donor facilities.

Palomar Pomerado Health (CA) chooses GSI Health’s HIE solutions to connect PPH hospitals and affiliated physicians.

Cooper University Hospital (NJ) awards a contract to MedQuist for computer-assisted coding technology and outsourced coding services.

Girard Medical Center (KS) signs with Cerner.

Regional Medical Imaging (MI) chooses Merge Healthcare’s radiology information system, expecting to receive $600,000 from Meaningful Use incentives for its 13 radiologists. Merge says 90% of radiologists are eligible for MU money and it will pursue certification for its RIS to help them earn it.

Announcements and Implementations

Kaleida Health (NY) says it is actively adding EMR capabilities across it hospitals and clinics. Its $20 million Cerner implementation should be complete by the end of 2012.

Tift Regional Medical Center (GA) goes live with RTLS temperature monitoring and asset tracking from AeroScout.

athenahealth creates a “burn unit” to handle physician practices that have been burned by old EMR systems and are looking for new solutions. CEO Jonathan Bush says about 35% of his company’s new EMR clients are replacing old EMRs.

ODIN announces EasySpecimen, an RFID-based pathology specimen management system, licensing the technology from Mayo Clinic.

England’s Department if Health announces completion a project to move all prisons to a single electronic medical records system, allowing them to transfer records when inmates are moved. The article takes jabs at NPfIT, saying the prison system has more detailed information than NPfIT’s Summary Care Record.

Government and Politics

CMS’s healthcare fraud enforcer (a pediatrician and lawyer) says he’s going to crack down on criminals, many of them working out of South Florida, who are scamming Medicare and Medicaid for up a quarter trillion dollars per year. Much of his arsenal involves smarter payment software that can detect fraud more quickly, needed since the fraudsters are using electronic billing systems to commit their crimes. Says one expert, “The crooks know now that these computerized payment systems are their best friend. They will study carefully the art of billing correctly, they will produce electronic transactions that are perfect on their face, but it’s just a pack of lies.” An irony: Florida Governor Rick Scott was CEO of the company (Columbia HCA) that admitted to extensive Medicare fraud, costing the company $2 billion to settle.

ONC’s got some job openings for a program manager and three policy analysts.

Innovation and Research

CalPERS claims its integrated healthcare pilot saved $15.5 million between January and October 2010. Pilot participants include Blue Shield of California HMO, Catholic Healthcare West, and Hill Physicians Medical Group. The organizations’ combined efforts led to a 17% reduction in patient readmissions, a half-day reduction in the average LOS, and a 50% drop in stays of 20 days and longer.

West Wireless Health Institute awards its $10,000 developers’ challenge prize to a skin cancer detection app. The physician developer, who is a veteran and a melanoma survivor, created the iPhone app for his own self-examination.

Other

CIOs say their organizations will qualify for Meaningful Use incentives, but not as early as they predicted a few months ago. In an August 2010 CHIME survey, 28% of responding CIOs predicted qualifying for funds by April 1 compared to 7.5% of CIOs participating in a survey last month. About 32% of the CIOs expect to qualify by September 30, 2011 and an additional 58% anticipate Stage 1 qualification by the end of the 2013 fiscal year. Only 26% of community hospital CIOs believe they will qualify for stimulus funds by September 30, 2011.

Strange: a “stunning blonde” in her 20s, bidding over the Internet, buys more than $50,000 worth of items ranging from a stuffed owl to furniture at an auction in England. The auctioneer called her to arrangement payment, only to have the telephone answered by a doctor, not surprising since she’s a hospital inpatient committed under the Mental Health Act. Her credit checked out, but the hospital won’t let her pay, so the auctioneer says he’ll sue the hospital.

Umass Memorial Healthcare pulls 10 employee kiosks out of service when they discover that anyone walking up to the kiosk could view pay stub information from the previous user. The IT people changed the software and removed bank account information, then put the kiosks back out.

Associated Press gets punked: a couple of anti-corporate troublemakers float a phony press release with GE’s name on it, saying the corporation will donate its $3.2 billion tax refund to the US Treasury since the American public is upset at learning that GE paid no taxes on $14 billion in profit. AP ran the story without doing anything more than clicking on the link to the convincing-looking but phony Web site, only to pull their news item down less than an hour later.

A reader sent this in for Inga and her shoe-loving followers.

Sponsor Updates

• Advanced Endoscopy & Surgical Center (NJ) contracts with Wolters Kluwer Health for its ProVation MD procedure documentation and coding software.
• Design Clinicals and the AHA are hosting a Web demo April 21 entitled Electronic Medication Reconciliation: Achieving Stage 1 Meaningful Use and Full Compliance Joint Commission Standards with MedsTracker. 
• Concerro creates a cute video that compares workforce management tools to paper-based systems, à la the Mac versus PC commercials.
• eClinicalWorks announces that 2,000 practices have successfully upgraded to Version 9, eCW’s ONC-ATCB  certified MU version.
• Access announces a new version of its e-Signature solution to help providers create paperless registration and bedsid consent processes.

EPtalk by Dr. Jayne

This week marks the 150th anniversary of the start of the American Civil War. What does that have to do with healthcare IT, you ask? Maybe more than you think.

I was listening to NPR when Adam Goodheart, author of 1861: The Civil War Awakening, was interviewed. Charleston, South Carolina (which I’d love to visit if the right invitation presents itself) was the scene. Miscalculations on both sides about who would flinch first ultimately pushed events past the point of no return.

Towards the end of the interview, Terry Gross asks, “Some states today want the right to basically be able to nullify federal legislation in their state and not obey it. For example, not to follow the new health care policy that Congress passed. Do you see that as like a contemporary expression of similar divisions dating back to the Civil War?”

This was just a tiny part of the interview, but it really struck me about how divisive things are in health care politics right now. I certainly don’t think we’re on the brink of Civil War, but we are a house divided.

Acceptance of recent federal legislation is love/hate. There’s confusion on whether Meaningful Use will be repealed, revamped, or replaced. For the first time, I recently heard physicians (who had previously stalled on implementing an ambulatory EHR because they weren’t sure the Meaningful Use final rule was ever going to be final) state that they were holding off on going paperless because they feel healthcare reform (and the accompanying MU legislation) will be repealed.

I think many people agree that this train has somewhat left the station. There’s no guarantee that it might not stop somewhere along the tracks, but it already has pretty good momentum. (Anyone seen the movie Unstoppable with Denzel Washington? Watched it recently — a good diversion from reading yet another stack of documents about forming an Accountable Care Organization.)

It will be interesting to see how quickly challenges (to not only federal, but various state legislation) make it to the United States Supreme Court. Given the current makeup of the Court, I wouldn’t lay odds on any outcomes just yet.

Most large healthcare organizations that depend on Medicare payments aren’t willing to take chances or play the game of wait and see. They need to implement certified systems now and demonstrate Meaningful Use so that they can not only receive incentive payments, but prevent the stick that will ultimately follow the carrot. Whether incentive legislation will be repealed or only partially implemented, we don’t know, but I’m pretty sure the Centers for Medicare and Medicaid Services won’t forget the idea of cutting reimbursements by using lack of technology as an excuse (at least not any time soon).

A lot of people are excited about the billions of dollars flowing into the health IT industry. I envision industry lobbying that will rival Big Pharma in intensity and scope if the effort to repeal recent legislation gains any serious traction. There are plenty of consultants waiting to deal with the things that happen when physicians and hospitals select and implement hastily, not to mention vendors that will be poised to sell replacement systems as the industry consolidates.

There you have it. If you’re ever confronted with an SAT-style question asking for a modern-day analogy to the Civil War, please feel to plagiarize, no citation needed. And if you can recommend a conference that will give me an excuse to visit South Carolina, let me know.

Contacts

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

News 4/13/11

Top News

  UnitedHealth Group unites its health services businesses under the Optum brand and renames Ingenix to OptumInsight. In addition, Prescription Solutions becomes OptumRx. UnitedHealth says the brand unification makes it easier for the market to understand the company’s full capabilities and helps align market engagements. I say the name change makes it easier for me to be confused and I’ll need awhile to align the name in my head. Mike Mikan will serve as CEO of the Optum group, while the CEOs of each company will remain the same.

HHS launches a $1 billion patient safety initiative aimed at making hospital care safer, more reliable, and less costly. The Partnership for Patients is a public-private collaborative and will work to decrease hospital-acquired infections 40% and reduce hospital readmissions 20% by the end of 2013. If successful, HHS predicts $50 billion in Medicare savings over the next ten years.

Reader Comments

  From P. Cockroft-Gault: “Re: open source biology. Love this guy’s drive and motivation.” Stephen Friend, MD, PhD, a former Merck SVP of cancer research, quits his job to start a non-profit to turn genomic analysis into a “wisdom of the crowds” type project, putting more intellectual horsepower behind unlocking genetic secrets and making the results non-commercial. “Our hallowed academic institutions have become factories for people who are trying to keep their own employment, their tenure … the whole reward structure keeps people from sharing the data that makes that connection …We’ll make it or not depending on whether our community of interest goes viral,” he says. In the TEDx talk above, he says the era of defining a disease by its symptoms is over since much more information is available at the molecular level.

From Veronica: “Re: Epic. Judy’s making noise in Wisconsin.” An article says the Greater Wisconsin Committee PAC is funded by children of George Soros, labor unions, and “Madison liberals who don’t unionize their own companies” (that would be Judy).

From Harold: “Re: John Caswell. I thought it would be nice if you mentioned his passing. He was with Compucare/QuadraMed for more than 28 years and will be missed by many in the industry.” Sorry it took so long to get this up, but I was waiting on confirmation from QuadraMed since I found nothing online. John David Caswell, 53, died on April 1, 2011. Details, guest book, and memorial contribution information can be found on the funeral home’s site. They did a nice job on his tribute video, set to Steppenwolf’s Born to be Wild. Condolences.

From Ling Cod: “Re: Black Swan moment. That book suggests that humans are wired to explain complex, chaotic events with simple theories that make them sound plausible even though they don’t predict anything (like reasons that stock markets crash). I challenge your readers to think about the Black Swan moments that may affect the alleged rapid adoption of EHRs and the possibility that, within a couple of years, providers will find the compliance wasn’t worth the aggravation. Possibilities: (a) some or all of the stimulus could be revoked, or (b) CMS may make EHR adoption mandatory with no further incentives if you want Medicare / Medicaid money.” The gauntlet has been thrown down. Feel free to add your thoughtful comments or submit something to me directly. The Black Swan reference, by the way, is the title of a book taken from the fact that experts had all kinds of convincing reasons that swans are always white (chief one being that they’d never seen a black one), which sounded great until a black swan was found.

HIStalk Announcements and Requests 

Listening: Royal Hunt, a Danish progressive band. Hits the spot in a Dream Theater kind of way.

Bored? Feeling as though the whole world is a tux and you’re a pair of brown shoes? My suggestions: (a) put your e-mail address in the Subscribe to Updates box to your right and feel immediately spiritually connected to the 7,288 folks who get my spam-free e-mail updates the instant I write something new; (b) do all those friendy / likey / connecty things on Facebook and LinkedIn, which will let you ride the vast social network that Inga, Dr. Jayne, and I enjoy (not really since we’re anonymous, but we get some superficial satisfaction as long as we don’t think too much about it); (c) send me news and rumors suitable for mongering; (d) peruse the sponsor ads to your left or their links to your lower right and investigate their offerings while feigning deep interest; and (e) use your considerable interpersonal influence to send new readers my way by telling people how the information you regularly glean from HIStalk has made you wealthy, self-actualized, and simply irresistible. Thanks for reading.

Acquisitions, Funding, Business, and Stock

EMR/PM provider ClearPractice forms a strategic partnership with Prognosis Health Information Systems. The companies are collaborating to offer an integrated SaaS-based EMR solution for rural and community hospitals and their affiliated physicians.

A quote from the CEO of Aetna provides some insight into the company’s $500 million acquisition of Medicity:

We recently bought Medicity, a health information exchange (company). We’re using that as a platform to create a data exchange. We will shift risk (financial responsibility for medical costs) to the provider system. We’ll provide them cover with capital as re-insurers. We will be the Intel-inside, if you will. We have dozens of these conversations going on with major systems. We spend $400 million a year on new developments: We are as much a health information technology company as an insurer.

Sales

The VA selects Authentidate Holding Corp.’s Electronic House Call solution as part of its home telehealth program.

The 49-bed Seymour Hospital (TX) purchases ChartAccess EHR from Prognosis.

Oakwood Healthcare (MI) signs a $60 million Epic deal, at least from what I can tell from the half-sentence teaser that Crain’s Detroit Business allows non-subscribers to read.

Methodist Dallas Medical Center chooses RemedyMD for its joint registry.

People

The Indiana HIE hires James S. Hill as VP of sales, tasked with managing sales operations, including market competitiveness, pricing, and strategy. I have to admit I was surprised the HIE world has matured enough to warrant a VP of sales.

Resurrection Health Care (IL) names Bradley Howard, MD its first-ever CMIO to lead its Epic EMR implementation.

Kent McAllister joins fellow Sage Healthcare alum Lindy Benton at Medical Electronic Attachment / National Electronic Attachment (MEA/NEA). McAllister, a former VP of client solutions for Sage, is MEA/NEA’s new CIO. Benton is Sage’s former COO and now serves as MEA/NEA’s CEO.

Healthcare analytics vendor Sg2 names Steve Lefar as president. He previously founded compliance and risk management software vendor MediRegs (acquired by Wolters Kluwer in 2007) and was an Allscripts SVP before that.

Capella Healthcare (TN) names Alan Smith as VP/CIO. He was formerly with Vanguard Health Systems and Cerner.

Announcements and Implementations

El Centro Regional Medical Center (CA) implements eMix for the secure transmission of radiology images and patient reports.

Dell launches a mobile clinical computing solution for Meditech. The product leverages technology from VMware and Imprivata’s OneSign SSO technology.

Here’s what happens when you let HITECH drive your IT projects instead of common sense. Carthage Area Hospital (NY) replaces its Meditech system with CPSI, saying it had to “move quickly to ensure we would receive the $2.8 million in stimulus funding.” So quickly, in fact, that they didn’t have time to train staff or work out billing kinks, resulting in a flood of complaint calls from patients. They say they’ll get everything fixed within a few months.

Government and Politics

The Foundation for the National Institutes of Health brings in HIMSS to help it run the mHealth Summit conference, the third of which takes place in Washington, DC in December. I have mixed feelings about that. I went to the last one and while it wasn’t nearly as fun as the HIMSS conference, it was refreshingly wonky and geeky, with mostly academics and non-profit developers sharing ideas with barely a break between sessions and a small, low-key exhibit hall. I’m sure the HIMSS involvement will bring the glitz, vendors who will dominate the entire conference, and the booth babes. I may go since I haven’t been to anything this year other than HIMSS and I like to get out of the house on occasion.

A proposed but floundering bill in Florida would require insurance companies to cover telemedicine services.

Innovation and Research

HCA Johnston-Willis Hospital (VA) wins a patient care innovation award for its Cancer Survivorship Program, which includes specialized software developed with Varian Medical Systems to generate care plans, schedule visits, and create a comprehensive summary based on evidence-based care. Above is their quite nicely done Pink Glove Dance.

Technology

 

Nashville Medical News profiles Shareable Ink, which moved its headquarters from Massachusetts to Tennessee a few months ago. Shareable Ink President and CEO Stephen Hau provided this comment on the local tech talent pool:

We’ve built an impressive team in Nashville with top-notch, local talent. On the technology front, there are strong candidates in Nashville, but they are few and far between. While I’m not worried about finding the next five strong engineers, sourcing the next 50 will be a challenge.

Other

In honor of National Volunteer Week, 15,000 McKesson employees will build 28,000 care packages for deployed military in Iraq, Afghanistan, and other regions. The initiative is in affiliation with Operation Gratitude and is part of McKesson’s annual Community Days corporate volunteer program.

Singing River Health System (MS) seeks to borrow $37.5 million to upgrade its EMR. Jackson County supervisors are considering issuing a bond to finance the purchase.

Occasionally readers will forward me photos or links of interest. I enjoy most of the items, especially since I work out of my house and some days those e-mails are my only link with the “real” world. Quite often the submissions have little to do with HIT, but serve to assure me that I am not the only one who reads the stuff I write.  Thus, thank you to the thoughtful HIT traveler who enjoyed this bottle of wine and thought of me. Good to know I am not the only one who believes shoes and wine are two of man’s best creations.

Here’s the latest installment of Vince Ciotti’s HIStory.

Fortune’s list of “ridiculous job interview questions” includes one from Epic: “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?” Pretty easy, and not as ridiculous as my favorite ones, from Intel (“Explain quantum electrodynamics in two minutes, starting now”) and Capital One (“Using a scale of 1 to 10, rate yourself on how weird you are.”)

Sponsor Updates by DigitalBeanCounter

• Consulting magazine names Aspen Advisors one of “Seven to Watch” in 2011 and beyond. Mr. H interviewed Aspen’s founder and managing principal Dan Herman earlier this year.
• Clairvia adds Care Value Analytics, a new tool that aligns data from individual patient experiences with an organization’s clinical and financial objectives.
• Capario partners with Data Media Associates to offer customers customized patient statements, statement mailing, and a  payment portal.
• Hawaii’s Public Safety Department selects eClinicalWorks for its EMR at its seven correctional facilities.
• Bridgehead Software will provide data backup and protection solutions for The London Clinic.
• MD-IT merges with MDnetwork.
• Brad Swenson, VP and national healthcare leader for Winthrop Resources Corporation, is participating in the American Bar Association’s Spring Meeting this week in Boston. He’ll serve on a health law roundtable.
• PatientKeeper releases a white paper entitled Toward Meaningful Usability: Five Keys to Creating Physician-Centric CPOE.

Contacts

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

Monday Morning Update 4/11/11

From Man on the Street: “Re: Association for Clinical Documentation Improvement Specialists conference in Orlando. They expected 575 attendees for their fourth conference and actual attendance was 660. An overwhelming majority of attendees are either on Epic or say they’re moving to Epic.” MOTS included some photos, which I always like.

From Ogie: “Re: ISH. Acquired by PwC.” Unverified, but I’m really hating those company names. They aren’t universally recognized brands like GE or IBM, so hacking down a perfectly good and understandable name into gibberish doesn’t seem like much of an accomplishment, especially if your name (like that of ISH) results in a scattershot of unrelated Google search hits.

From EMRconsultant: “Re: acquisition. A Minnesota / Louisville-based HIS is being acquired soon.” Unverified.

From The PACS Designer: “Re: Nimbula Director. It’s a new class of cloud infrastructure and services system (IaaS) that provides a flexible and secure public cloud with advanced data center security tools.”

It’s the weekend (at the time I’m writing this, anyway) so that means less formality as I use the “old” format instead of the new one. It feels like Hawaiian Shirt Friday.

My Time Capsule editorial this week, once again from 2006: Do Technology Surveys Rate the Hammer or the House? These are fun reading for me since I wrote them so long ago it’s like reading someone else’s work.

Results of my Quick Poll on the departure of John Gomez from Allscripts: 39% of respondents said it will have little or no long-term company impact, 30% said it will have some, and 31% said it will have a lot. I’ll be running these polls when big news comes up. Poll results plus the usual reader comments will provide a quick and interesting industry reaction to events.

Congratulations to Boston, hereby officially named the Capital of Healthcare IT (as it should be, in my opinion). Perhaps I should start a drive to have it commemorated with a monument or something, maybe on the Meditech campus. New poll to your right: should Medicaid and Medicare require biometric identity verification of patients seeking healthcare services?

Kaiser CEO George Halvorson talks up the new Care Connectivity Consortium it formed with Mayo, Geisinger, Intermountain, and Group Health to share patient data. I’d say it’s more of a demonstration project than a true patient benefit since those organizations probably don’t have many patients in common. Here are some excerpts from George:

We are all using our EMRs to improve care and support the delivery of care. We are all learning how to use that wonderful new tool — and we are all interested in sharing what we are learning with the world … The problem with electronic is that when patients go to different doctors for their care, they still tend to have separate records — and that can create electronic silos instead of paper silos … So we are now committed to creating similar linkages with the new set of elite medical groups to create a process that works first for our patients and then — if we do it well — for the world … This is important work. If someone doesn’t figure out how to create links between electronic medical records, those records will not be linked. It will not be done until someone does it. Who better than us to do it? We are patient-focused and we know what can be done and we know what should be done with an EMR. Almost all other care sites are just getting their toes in the water. Some are getting their feet wet. We are swimming. So this is a good contribution for us to make. Instead of keeping our advances and our learning secret and special only to us, we are sharing what we know because we want care to be better for everyone.

By the way, I can’t find a Web site for Care Connectivity Consortium, which seems strange. I searched and careconnectivityconsortium.com is not registered, although the .org variant was grabbed by an anonymous registrant on the day of the announcement.

I ran across a copy the IRS form for HIMSS for 2008, the newest one on file so far. Steve Lieber’s total compensation: $731K (slightly out-earned by Dave Garets, who was running HIMSS Analytics at the time). I’ll have to remember to check back to see if they file a new form soon. The annual conference represented $19 million of its $41 million total revenue.

Those DoD people just can’t stop disagreeing with decisions made elsewhere, but at least they’re finally willing to make fat cat contractors rich in ways other than developing custom software. The VA announced plans to move forward with developing an open source system to be shared by both organizations, but DoD says they’ll look first at commercial software and will consider in-house development only as a last resort.

Six-campus, 305-bed Central Texas Hospital (TX) chooses inpatient EHR and revenue cycle systems from the US affiliate of Mexico-based eCareSoft, expecting to meet Meaningful Use requirements for 2011-2012. eCareSoft says small hospitals can go live on its products in 120 days.

Merge Healthcare appoints Cheryl Whitaker MD, MPH, FACP as its first chief medical officer. I assume that’s the same Cheryl Whitaker, MD who, along with her physician husband (there’s an interesting story and comments behind that link), is a close friend and advisor of the Obamas, not that there’s anything wrong with that. Merge is in Chicago, a city known mostly for dead people electing ethically challenged politicians, at least until the apotheosis of its junior Senator Obama.

The local paper in Middletown, OH runs down the status of electronic health records in local hospitals: West Chester Hospital, implementing Epic. The Fort Hamilton Hospital, implementing Epic. McCullough-Hyde Memorial Hospital, live on CPSI. Atrium Medical Center, live on Epic. Mercy Hospital Fairfield, live on Epic.

Shares in for-profit hospital operator Community Health Systems gained only 9% from 2008 to 2010, but CEO Wayne Smith’s total compensation nearly doubled in that period, rising to $21 million in 2010.

E-mail Mr. H.

Mostashari Named ONC Head

Farzad Mostashari, MD, ScM has been named National Coordinator for Health Information Technology effective immediately, according to an announcement on the ONC Web site and ONC’s Twitter feed. He was Deputy National Coordinator for Programs and Policies under David Blumenthal.

Mostashari was previously with the New York City Department of Health as an assistant commissioner. He holds a medical degree from Yale and master’s in population health from Harvard.

News 4/8/11

Top News

I’ve run reader-provided hints over several months that Allscripts EVP/CTO John Gomez was planning to leave the company. That became official on Wednesday, when Allscripts announced his resignation, effective May 31. He’ll be available to the company for 18 months afterward as a consultant. An internal e-mail from CEO Glen Tullman says that Gomez wants “to focus on a number of areas outside healthcare and perhaps running a company himself.” Allscripts shares dropped 6.8% on Thursday following that news and a downgrade by Auriga, which expressed concerns about his resignation, the level of attrition of Eclipsys employees after the acquisition, and recent KLAS rankings of the Allscripts Enterprise ambulatory product.

I’ve been planning to use quick polls to gauge industry reaction to major news, so here’s your first opportunity to weigh in. Feel free to vote and add your comments.

Reader Comments 

From Year of the Cat: “Re: John Gomez. This could really hurt Allscripts. It’s a very sad day for HIT as one of its most innovative minds exits.” He was arguably their least-expendable employee, at least to anyone interested in the former Eclipsys Sunrise and how it will integrate with other Allscripts products. I hope he’ll stick with the industry in some capacity. It wouldn’t surprise me if he doesn’t start his own company since he’s entirely capable, he has great vision, and his developers have always been able to run circles around just about everybody else’s.

HIStalk Announcements and Requests

I mentioned using polls to get a quick read on industry reaction to major news. I’d also like to get comments from a fixed group of readers like Dr. Jayne does with her Medicine Cabinet. When something big happens, I would e-mail that group and ask for their comments, which I would then run (anonymously) at the next opportunity. If you are a provider CIO, CMIO, or other provider C-level reader and would like to participate, let me know.
I see that CCHIT’s Sue Reber, writing for the organization’s EHR Decisions site, mentions my January 2006 editorial that I ran here recently called CCHIT Should Provide More Information to Purchasers. She even found humor in my making fun of their name almost before the ink was dry on the incorporation papers (“whose phonetic sounding-out always gets yuks from the watercooler crowd”) by adding her own observation that it is “an elegant name with initials not even a mother could love.”

On the Jobs Page: Inside Sales Executive/Telesales, Clinical Software Instructor, Healthcare Implementation Project Manager. On Healthcare IT Jobs: Client Relationship Manager, Healthcare Software Product Manager, Test Analyst.

Acquisitions, Funding, Business, and Stock

MyHealthDirect closes $4 million in a Series B investment round. Arboretum Ventures and Chrysalis Ventures provided the funds, which will be used to expand sales, client services, and technical resources. The company’s Web-based solution allows hospital EDs and other high-acuity providers to search open appointments in the community to generate a patient referral.

CVS Caremark signs a deal with Advocate Health Care and its physician group that will install Advocate physicians as medical directors in 23 MinuteClinic locations in the Chicago area and Bloomington, IN. The organizations will integrate their electronic medical records systems.

CareFusion acquires Vestara for $17 million. The Irvine, CA company offers a drug disposal system that reads drug NDC bar codes and provides advice on how to dispose of the products to conform with all laws and regulations. CareFusion will rebrand the offering as Pyxis EcoStation.

Sales

Henry Ford Health System (MI) selects Health Care Compliance Strategies’ COI-SMART system to manage its conflict of interest disclosure process.

Allscripts will outsource its Sunrise hosting to Xerox subsidiary ACS in a 10-year, $500 million deal. Allscripts expects the business to grow rapidly and needed outside expertise to manage it. My insiders tell me that Allscripts did a good job in being fair to their existing employees so that they’ll be offered their same jobs, pay, and benefits by ACS. While ACS will run the operation, an Allscripts governance team has control. The only casualties so far appear to be some members of the Allscripts remote hosting management team, with a couple of folks already gone. In an interesting twist, Allscripts remote hosting personnel in India are being told they will be let go if they don’t find another position within the company since ACS will not be using offshore resources. I mentioned on January 21 that ACS was being brought in for a role somewhere between oversight and total outsourcing.

Rush University Medical Center chooses Zix for secure e-mail.

Open source software vendor Mirth Corporation launches its InformaCare care management platform for Patient Centered Medical Homes and ACOs. It originally developed the cloud-based product for Pfizer more than ten years ago for Florida community projects and has licensed it back for a wider release.

People

Former Carestream Health GM Todd McNitt joins DICOM Grid as SVP of sales and marketing.

Nuance names Stefan Herm as VP and managing director for Europe, Middle East, and Asia. He comes from McKesson, which of course amused me endlessly since his last name is the same the acronym for Horizon Enterprise Revenue Management.

Insurance company Arcadian Health hires Prudence Kuai as CIO. She was previously with TriZetto.

Government and Politics

“The eHealth boondoggle continues,” according to one Canadian official voicing his objection to the the $673,000 paid to former health deputy minister Ron Sapsford in 2010.

UK Secretary of State for Health Andrew Lansley says fast broadband will improve NHS’s quality and efficiency by enabling greater use of telehealth, mobile computing, and access to information.

Proposed legislation in New York would require Medicaid recipients to have their palms scanned to receive services, saying the identification technology would cost $20 million to implement but would save $5 billion a year while being no more intrusive than electronic toll road payment systems. The state dropped a finger scan requirement in 2009.

Innovation and Research

A four-member Brigham Young University team makes the finals in Microsoft’s Imagine Cup 2011 student competition with their ultrasound application. It allows physicians to download images and them move them to the cloud for collaboration, lowering the cost of medical imaging so that third-world countries can afford to use ultrasound technology. They built their prototype for less than $8,000 using a Microsoft tablet and an ultrasound probe. You can vote for them (or one of the other healthcare-related entrants) here.

Technology

The iPhone is the mobile device of choice for healthcare providers, according  to analysis by the online medical journal Bulletin Healthcare. Almost 30% of healthcare providers access daily medication information with mobile devices and over 90%  of the devices are iPads or iPhones. ER docs and PAs are the biggest mobile device users.

Medicomp has created an online demo of its MEDCIN-powered, browser-based, iPad-ready Quippe EMR documentation system. Sign up and you can play around with it online, provide feedback, and keep yourself busy until the software development kit comes out next month.

Skype has many uses, including for telemedicine and allowing overseas military personnel to watch their babies being delivered stateside. Still, I found this fascinating: police officers are using it from their patrol cars to connect with judges to get warrants issued, especially in time-sensitive cases such as DUI where blood alcoohol levels need to be drawn quickly. One of these days I’m going to sit down and make a list of potential healthcare uses (like checking drugs remotely, walking someone through a procedure, etc.)

Verizon and MEDfx launch a Richmond, VA-area pilot program in which a medical practice scans the paper documentation of diabetic patients and sends it to a physician portal for widespread access. The practice, Dominion Medical Associates, is still paper-based, so the records can be printed and stored in their charts and later migrated to an EHR. The project uses both The Direct Project and NHIN Exchange technologies from ONC.

Other

From KLAS: one out of five community hospitals will switch EMR products within the next couple of years. McKesson and Meditech C/S clients have the highest level of confidence that their vendors will get them to Stage 1 MU by 2013. Healthland and Siemens MS4 clients are the least confident. McKesson was the highest rated vendor, followed by Meditech and Cerner.

Microsoft adds former HHS Secretary Michael Leavitt to the agenda for its Connected Health Conference.

Sponsor Updates by DigitalBeanCounter

• FormFast will host an April 19 Webinar on best practices in hospital process improvement, featuring hospital panelists.
• BridgeHead Software and Laitek Inc. form a strategic partnership that leverages Laitek’s PACS data migration services with BridgeHead’s data and storage management tools.
• Forbes profiles Medicomp Systems and its Quippe tool.
• The University of Kansas Hospital Authority will implement McKesson’s PROmanager-Rx automated medication dispensing system.
• The Ohio State Medical Association (OSMA) will offer Greenway’s PrimeSuite 2011 EHR in its Preferred Partner Program.
• Arkansas Department of Health chooses AT&T’s TotalMobile solution to help gain efficiencies in the transmission of flu vaccination records across the state.
• Health Language signs an agreement with the Chicago-based BCBS Association (BCBSA) to facilitate ICD-10 transition.
• Navicure and the American Academy of Professional Coders (AAPC) form a strategic alliance to educate the industry transition to HIPAA 5010 and ICD-10.
• TeleTracking Technologies joins the American Hospital Association.
• Several 3M products, including ClinTrac and Health Data Management, earn ONC-ATCB certification as EHR Modules.

EPtalk by Dr. Jayne

Dear Dr. Jayne,

Do your patients know or care about IT?

Curious George

Dear George,

Some patients are openly curious about the system we use and how it integrates with the hospital and other offices. I’ve found, though, that many patients just assume that we’re fully integrated, and because we’re computerized, that I can see everything in every chart of every physician they’ve ever visited.

I remember when HIPAA first came to pass how concerned everyone was about the records release provisions.

(Don’t get me wrong, some consultants still play this game. Even though a release is not required for us to collaborate on the treatment of a patient, they demand one before sending consult letters. That’s usually the last time I’ll send a patient to one of those types, unless they are something really special in which case I’ll call them personally and re-educate them on HIPAA and what a pain their staff is causing).

What struck me funny at the time was that patients already thought we had all the information, whether from an active consultant or from an old chart 15 years ago. Many had no concept of what HIPAA was designed to do or how it would impact access to information. When asked to sign releases, they were surprised to learn that we didn’t actually have everything at our fingertips.

If I thought the desire for information sharing was high then, it’s even higher now. With the advent of Web-based patient portals, electronic refill requests, e-visits, and more, the expectation on many fronts is that we have 24×7 access to the patient’s chart.

When seeing colleagues’ patients in the hospital, physicians used to be able to plead ignorance because the paper charts were locked up at the office. Now patients expect cross-covering partners to have in-depth understanding of what’s been going on with their care. Although a bother to some of my peers, personally, I think this is a really, really good thing.

I remember being petrified taking weekend call, having to talk to my partners’ patients and knowing absolutely nothing about them. Now, I can keep my secure VPN connection and pop into the EHR when someone calls at 4:30 a.m. with questions about whether they really need to go to the Emergency Department or whether they can wait until the office opens in the morning. Those of us who use nurse triage services can allow them to have limited access to charts. Reducing the number of people in the Emergency Department who don’t actually need to be there is a significant cost savings, which all of my patients definitely care about.

Ten years ago, I was one of the first in my area to trade e-mails with patients. At that point there wasn’t a tremendous interest in it and we actually ended up stopping. (Despite the Mother of All Disclaimers, patients e-mailed inappropriately about urgent issues and the hospital felt the risk was too great).

These days, many health systems and private practices are marketing their services around technology and improved access to physicians and care teams. And if you’re still not convinced that patients care about IT, check out the video below.

Dr. Jayne

Contacts

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