My broker has found nothing other than the usual suspects and none of them are rated all that good. Would be interesting to have your investment banker dude weigh in on investing in a fund or a reasonable combination of individual stocks, with no promises or guarantees, of course.
I’m guessing that would be me, as both a former analyst-dude and I-banker dude.
Here’s my view. While I used to make my living recommending stocks, I’ve come to the conclusion that buying individual stocks is nearly an impossible game to win. Why? There’s a theory known as Market Efficiency, which basically postulates that all information known about a company and its prospects is already reflected in its share price.
Now clearly the readers of this blog know more about this sector than the average stock market participant (and are probably better looking and more fun to party with), but we’re talking about the market as a whole, ranging from little old ladies’ investment clubs to the likes of Raj Rajaratnam (the Galleon hedge fund owner recently convicted of insider trading).
As readers of my debut column will recall, buy-side and sell-side analysts spend their time scouring for “market inefficiencies.” In other words, seeking out stocks that don’t fully reflect their value. They do this by attending HIMSS; reading financial statements; talking to users, consultants and company management teams; and other forms of fundamental research.
Now clearly these market inefficiencies do happen for a number of reasons. Sectors go in and out of favor, companies miss (or exceed) their Street forecasts and are over-penalized (rewarded) as a result, or you just might really believe in what a company you use or saw at HIMSS is doing and so want to bet on them. (The key word here is “bet,” so please behave accordingly.)
Now that I’m done flaming about market efficiency (there’s no zealot like a convert), here’s what I do:
First, my personal investment strategy is based around a core and diversified portfolio of low-cost index funds. That said, sometimes I just can’t help myself. That’s what a “satellite account” is for. If you want to “play” the market (again, notice the word we use), consider allocating 10-15% for that purpose. Mine is in my IRA so I don’t have tax consequences to worry about.
Next, do your homework. You presumably have an investment thesis beyond just wanting to own HCIT stocks (e.g., love Cerner / athenahealth / Allscripts’ product at my hospital / medical group; Jonathan Bush has a great sense of humor; I use ePocrates every day; etc.)
Watch the stocks you’re interested in and look at their valuations relative to other sectors, each other, and their history. I’ll note that these stocks have had a great run over the past few years and, in my view, the easy money might have already been made.
If you can, try to obtain some analyst reports. At the very least, check the company’s SEC filings.
If you determine that there’s a good buying opportunity, for whatever reason, place your trade and hope for the best! I’ve traded these stocks for my own account a few times, with generally good, but occasionally horrid results – your mileage may vary!
If you’re bullish on the entire sector, one idea might be to divide your HCIT portfolio across a number of stocks to diversify away some of the company-specific risk. As I used to say to portfolio managers who asked me to choose between two different competitors: remember, you’re not selecting the best system for your facility / practice, you’re buying pieces of paper that trade. There’s no reason you have to pick just one.
That diversification reduces risk is something even most economists agree on (though there’s the counter-view: “no guts, no glory”). Just don’t put next month’s mortgage payment or your kid’s college tuition into these stocks — they’re volatile at best! As an aside, the best book on investing I’ve ever read is A Random Walk Down Wall Street, by Burton Malkiel.
Did you attend the Health Evolution Partners’ Leadership Summit? What was it like?
For the second year, I was invited to attend this event in Dana Point, CA. While the conference began years ago as a Versant Ventures event, Health Evolution Partners took it over a few years ago. HEP is a billion-dollar private equity fund focused on healthcare, with CalPERS as its lead investor. As readers of this blog likely recall, the fund’s chairman is David Brailer, MD, PhD, the first “Healthcare IT Czar.”
(In the interest of disclosure, I should mention that I’ve known the good doctor since he was the T.A. in a class I took at Wharton while he as earning his PhD over 20 years ago. He’s been a friend and supporter ever since.)
I view this as one of the best work-related events I attend each year. As Dr. B said in his opening remarks, he asked his staff to find the best one hundred minds in healthcare, and about 400 showed up. The event included a number of panels on topics ranging from the future of for-profit hospitals to innovations in primary care, the emerging super-consumer, personalized medicine, risk-bearing medical groups, and more.
The speakers ranged from such luminaries as Michael Dell and Todd Park (athenahealth co-founder, now CTO of HHS) to CEOs of corporations of varying sizes to policy wonks and, truthfully, ranged a bit in quality (as is ever the case). I’d give them a B+ (as high as I ever grade panel events, btw).
Beyond the panels, however, were several other aspects of the event that made it extremely worthwhile. Friday afternoon had two noteworthy components. First, was “strategy sessions,” where senior executives from companies ranging from Kaiser and Optum (fka Ingenix) to Pfizer and Oracle shared their visions and strategies in a small, boardroom-type setting. This was the first time I’d heard the Optum viewpoint and strategy actually expressed, and I walked out nodding my head in agreement with much of it (though the devil and valuations are clearly in the details).
Finally, the event concluded with a round of “speed dating,” where a number of innovative companies were given short sessions with a range of sponsors, including large vendors, health systems, and funders. In effect, HEP is trying to use this “Innovation Network” to bring the smaller (often more creative) companies together with the execs of the larger (always better capitalized) companies to find some areas of potential common interest and, hopefully, accelerate the pace of progress.
As an observer, it appeared to be an outstanding opportunity for both sides, though I do wish there’d been a way for people in neither group (such as this author) to participate.
Best of all, the quality of the attendees and the networking events were simply outstanding, really the best of its sort I attend. There was a great deal of card swapping, as well as reconnecting going on. A highlight for me was a casual introduction I made between two ST Advisors’ clients and learning that one was on the board of a hospital which was in need of the type of solution the other’s company provided! That kind of serendipity can’t be beat. I’m already looking forward to next year.
Ben Rooks is the founder of ST Advisors, a consultancy which has worked with dozens of HCIT companies and investors typically on issues around strategy, financing, and outcomes/exit planning. He enjoys food and wine, debating market efficiency, discussing healthcare, and most especially, reader comments!
HHS issues a proposed rule requiring healthcare providers, health plans, and their business associates to maintain an access report detailing all disclosures of patient information within an EHR or accounting system. Providers must also record every EHR chart access, including details on who opened the patient chart, the date, and the time. The access report must be made available at the request of patients.
Cerner announces a two-for-one stock split, with a June 24 distribution date. Shares closed Tuesday at $120.10, valuing the company at just over $10 billion. Neal Patterson holds $512 million worth. Above is the one-year CERN share price (blue) compared to the S&P 500 (green).
Reader Comments
From All Hat No Cattle: “Re: HHS’s HIT certification. Seems like another needless scam.” ONC announces availability of six Health Information Technology Professionals examinations: (a) clinician / practitioner consultant; (b) implementation manager; (c) implementation support specialist; (d) practice workflow and information management redesign specialist; (e) technical / software support staff; and (f) trainer. ONC is offering vouchers to qualified applicants; otherwise, it’s $299 for the first exam and $199 for each additional. ONC pre-nicknamed the exams HIT PRO, which is trademarked for some reason. I’m not entirely sure what the point is – in the “Why Take the HIT Pro” explanation, they talk about a shortage of qualified HIT workers, implying that passing the test makes someone qualified. There are no educational or occupational prerequisites for taking the 125-question tests, although the target audience is the folks who have finished one of those short, ONC-funded HIT programs that community colleges offer.
From MadCow: “Re: Loma Linda University Medical Center. Pulling an EMR swap, from Cerner to Epic.” Verified. LLUMC’s board approved Epic last week, which will be rolled out through their entire system. Epic will replace Cerner for inpatient and ambulatory clinicals, GE for faculty practice management, and a homegrown registration and billing system. LLUMC will keep their Cerner lab apps because Epic’s Beaker is a few years away from having the capabilities needed for an organization of that size.
From HITuser: “Re: Meditech 6.0. Have they implement any sites running multiple facilities?” A good question, which I will open up to those HIStalk readers who surely know. I’d have to guess yes.
HIStalk Announcements and Requests
A reader asked if I could interview someone from St. John’s in Joplin about their emergency preparedness lessons learned once things settle down there. If anyone is reading from there and would be willing at some point, let me know.
Watching: Life on Mars, a quirky one-season sci fi/cop show in which the lead character is sent back in time to 1973. Harvey Keitel is excellent in it, former Cosby kid Lisa Bonet has a role, and the pop culture (hair, clothes, music, etc.) are cool. Lots of Bowie tunes. It’s the American remake, predictably inferior to the original British version, they say, so I’m hoping the original hits Netflix streaming.
Welcome to new HIStalk Platinum Sponsor Impact Advisors of Naperville, IL. The company’s service offerings include strategic advisory (IT performance assessment, strategy, system selection, contracting, ROI, HITECH readiness, governance, and facilities planning) and strategic implementation (planning, readiness, project leadership, staff augmentation, project oversight, interim management). Impact Advisors has won several awards,including Best in KLAS for Planning and Assessment for three straight years. They’ve also bagged some “Best Places to Work” recognition in case you’re looking for opportunities (I see they need implementation specialists for Epic and Cerner at the moment, as well as HIT strategy folks). Founders Andrew and Peter Smith are HIT long-timers and have boatloads of experience working with hospitals and physician groups and are on the speed dial of quite a few big-name CEOs and CIOs as their trusted advisors. Former FCG President Steve Heck is a VP there, so you can catch up with him when you contact the company. Many thanks to Impact Advisors for supporting HIStalk.
It’s a quiet week by all appearances, which is a relief since I’m trying to catch up after a few days of being semi-off. It seems like about half of the 7,359 HIStalk e-mail subscribers are kicking back an “out of the office” reply this week, so good for everybody who is getting away a bit for the unofficial beginning of summer. It’s a great time to send in your news, rumors, guest articles, or whatever goodies you have that might interest others.
Acquisitions, Funding, Business, and Stock
A London newspaper says that Sage is reviewing its healthcare business and will likely sell it, although it did not provide details or sources.
A Chicago Tribune story on excessive executive pay speculates that McKesson shareholders may push back on the compensation of CEO John Hammergren at this summer’s annual meeting. He’s California’s third-highest-paid CEO at $54.6 million for the year ended last March (the company hasn’t released his FY2011 take).
Announcements and Implementations
IBM announces the expansion of its Dallas-based Health Analytics Solution Center, including the addition of new technology and the doubling of its solution architects and technology specialists. Mobile technologies, remote patient monitoring, and analytics are some of the areas IBM says the Center is addressing.
Health information network provider Availity earns EHNAC recognition for achieving the requirements for the 5010 Readiness Assessment program.
MIM Software introduces the VueMe App for iPad, iPhone, and iTouch. The app allows patients to view diagnostic images that have been sent them from their doctors, or to share those images with a specialist.
Government and Politics
Your tax dollars at work: as of May 19th, the Medicare EHR incentive program had paid providers $75 million; the 15 state Medicaid programs paid an additional $38 million. Including HIT training programs and RECs, HHS says it has doled out a total of $1.7 billion to promote EHR adoption. ONC coordinator Farzad Mostashari also notes that EHR use among primary care physicians increased from 20% in 2009 to 30% in 2010.
ONC publishes a proposed rule that addresses how the agency can remove an approved accreditor of the permanent EHR certification program. The ruling establishes a process to deal with situations where the ONC-AA engages in misconduct or does not perform its responsibilities.
Weird News Andy notes that the Feds are cracking down on healthcare fraud by threatening to file criminal charges against corporate executives whose companies are caught in wrongdoing, even if the executive had no direct knowledge of the illegal activities. Instead of just accepting a fraud settlement from big companies who treat it as a cost of doing business, Uncle is pulling out previous precedents that it says allow it to hold executives personally responsible, noting that several Fortune 500 companies have bought their way out of Medicare fraud several times (can I get an amen?) A quote from HHS’s chief counsel for the inspector general:
To our way of thinking, the men and women in the corporate suite aren’t getting it. If writing a check for $200 million isn’t enough to have a company change its ways, then maybe we have got to have the individuals who are responsible for this held accountable. The behavior of a company starts at the top.
Maybe the government should have cracked down on this guy: a man who used patient information to charge phony narcotics prescriptions to a federal employee insurance plan gets off with a six-year sentence and a fine. He had pleaded guilty to charges of healthcare fraud, HIPAA violations, and identity theft in obtaining the drugs to sell.
In the UK, a member of Parliament says NHS should fire CSC from its $5 billion NPfIT contract since it has implemented only three hospitals in nine years. MP Richard Bacon, always a great source for quotes, says NHS CIO Christine Connelly’s assertion that it would cost more to fire CSC than to let them finish the work is “incredible,” saying if that’s true then everybody involved with Connecting for Health should be fired. Tony Collins reports on a leaked memo that says CSC is proposing to cut the number of trusts it will implement from 220 to 80, but at a rate per trust that’s double what the current contract specifies.
Other
Bizarre: 53% of surveyed teens say they would rather lose their sense of smell than their personal technology, while 47% say they want to be remembered for their social network connections.
Sponsor Updates
Carlos A. Labrador, MD (FL) is named as one of 15 eClinicalWorks clients to receive EHR incentive checks from CMS.
Dell InSite One is managing over four billion diagnostic imaging objects and associated reports with its managed cloud enterprise archive.
Fujitsu names Perceptive Software its Central Region Premier Partner of the year.
T-System partners with Isabel Healthcare to integrate its T-SystemEV EDIS with Isabel’s diagnosis decision support content.
Lawson Healthcare recognizes five provider organizations with its 2011 Customer of the Year Awards.
maxIT Healthcare will provide consulting services for Meditech Magic users who are implementing the OrderEase software from Iatric Systems .
Twenty Meditech hospitals have selected Imprivata OneSign in the last six months, bringing Imprivata’s Meditech client base to 150.
HMS DIRECT, HMS’s remote hosting service division, expands it data center capacity to accommodate the growth of the company’s ASP business.
Molina Healthcare picks GE Centricity Practice Solution as its primary EMR/PM platform.
A Gateway EDI/LarsonAllen study finds that physician practices that have adopted RCM tools have higher revenues and collect more patient payments at the time of service.
NCR is holding a June 16 Webinar called Revenue Cycle: Why Self-Service is Key, featuring Elmhurst Memorial Hospital.
From Pericles: “Re: Allscripts outage at Allegheny General. The article refers to the company’s ‘New Jersey headquarters’ instead of Chicago. Could they have named the wrong vendor?” I assume the problem was with a hosted version of the Sunrise application, which is run from the former Eclipsys hosting center in Mountain Lakes, NJ. That operation and service was turned over to ACS/Xerox just over a month ago in a 10-year, $500 million outsourcing deal.
From Nosmo King: “Re: Nuance. As result of the Nuance partnership with 3MHiS that created CAPD (Computer-Assisted Physician Documentation), there are rumors that Nuance might buy the troubled document creation and management business of 3MHiS, formerly known as SoftMed.” Unverified.
From Mercy IT Gal: “Re: St. John’s Regional Medical Center, Joplin. It’s been a crazy week here at Mercy. A lot of time and effort is going into making sure the patients are taken care of, making sure our co-workers are OK, and securing the assets that were in the hospital. The mobile hospital is pretty wild – looks like a MASH unit (picture attached). The mobile hospital is an attempt by Mercy to show the community of Joplin that we’re not going anywhere. Mercy is committed to the Joplin community and will not abandon them in their time of need, even if it means setting up a temporary structure until we can get something new built. The frustration at work can get pretty high at times, but I can tell you that this week I’ve been pretty proud of working at Mercy. It’s amazing how people have come together looking for a way to help. Probably one of the best stories I’ve heard is from someone who volunteered to answer the hotline assigned to checking to make sure our Joplin co-workers were safe. She said she got a call from someone who had some damage, but was overall OK. She was concerned about her job and stated that she didn’t want to go to Freeman because Freeman is a for-profit hospital. She said her heart was at Mercy and that’s where she wanted to be. I didn’t mean to turn this into a propaganda e-mail touting the virtues of Mercy, but as you can guess, this has been an emotional week and I guess it’s getting to me. Thanks again for all the hard work you do to keep us healthcare geeks informed and entertained. In case you don’t hear it often enough it really is appreciated. I hope you take some time to relax over the holiday weekend with Mrs. HIStalk.”
Update 5/29: the temporary hospital was scheduled to open Sunday afternoon in time for the President’s visit. Above are additional pictures from St. John’s – the photo album is here. The one with the printer in the lower left is what’s left of the data center.
From Sy Alice: “Re: abstract from the American Urological Association meeting. I imagine the good doctor could have phrased this better: “Good treatments are available for all patients and, depending on what the patient is willing to do, every man can get an erection if he sees a physician specializing in sexual dysfunction.” I’m not touching that with a … well, I’m just not touching that.
From The PACS Designer: “Re: CloudFoundry. CloudFoundry is the world’s first open Platform as a Service (PaaS) offering. The CloudFoundry.org Web site is a community-driven open source project that is led by VMware. With the CloudFoundry Beta, you can try for free the VMware Horizon App Manager, which is an open, user-centric management service for accessing cloud applications.”
From Lab Rat: “Re: Epic Beaker. I wouldn’t even think about implementing it until Epic gets back to work on it, especially in a larger hospital. Label printing is way more complicated to set up than with Cerner or Meditech and instruments were having troubles with the labels.” A Beaker site contact I asked agrees that it needs work.
Photo: Patriot Guard Riders
Monday is Memorial Day, a day to honor those men and women who have died in military service to the United States. Try to squeeze in a few minutes among picnics, car races, and the beach this long weekend to remember the fallen who earned that one day of honor the hard way (many of them barely old enough to vote). It’s perfectly fine to be anti-war and anti-military and still be supportive of those in the service – most of the fallen didn’t get to pick the cause they died for, so you can’t hold that against them. I ran one of my favorite poems on Memorial Day 2005 and a time or two since. My flag is flying and I hope yours is too – it’s the (very) least we can do.
Listening: Lez Zeppelin, an all-girl Led Zep cover band (not as weird as it sounds since Robert Plant shrieked like a girl most of the time anyway and cute girl rockers are always better). I’m not a fan of cover bands or even Led Zeppelin in general, but somehow I like their albums (yes, they’ve done two) that are note-for-note covers of the originals. I’m air guitaring to Dazed and Confused right now, wishing I was watching them live. Also: Manchester Orchestra, Atlanta-based emo-ey indie that veers into hard-rocking territory every now and then and sounds just fine.
About two-thirds of provider respondents aren’t so sure their employer has good enough security practices to keep their medical records private. New poll to your right: how loyal are you to working in healthcare?
I was going to run a poll on CHIME’s CIO credential, but I remembered that I did that two years ago. The opinion then was 91% negative (13% said it’s a vanity credential, 33% said it has no connection to competency, and 43% said it’s just another way for CHIME to make money).
Six-employee MobiuSoft of Flint, MI says they’ll hire up to 144 more folks in the next 18 months if their HIE product earns certification (that’s what I’m inferring from the newspaper article, anyway). Former Genesys PHO VP Jerry Van Horn formed the company in 2009.
Quality Systems (NextGen) announces Q4 numbers: revenue up 24%, EPS $0.64 vs. $0.45, beating analyst expectations for both.
Thanks to new HIStalk and HIStalk Practice Platinum Sponsor Gateway EDI of St. Louis, MO. The 30-year-old company’s 85,000 physician users trust its fully integrated tools and proactive service team to monitor their claims, catching and fixing issues before they cause problems for their practices. The fast-growing company’s founder was a physician who created new solutions when existing claims processing tools weren’t doing the job. Users rave about the personal support they get from the customer service department, with one happy physician customer calling them “the Nordstrom of EDI.” Providers get paid faster, big practices enjoy the customization capabilities of the Web-based software, and vendors offering Gateway EDI’s solutions with their PM software give customers an all-in-one solution. Thanks to Gateway EDI for supporting HIStalk and HIStalk Practice.
ED doc Kevin Kitka, DO of Mercy/St. Johns Regional Medical Center of Joplin, MO describes what it was like to be working in the hospital as it was severely damaged by the recent tornadoes. He’s an excellent writer:
A small child of approximately 3-4 years of age was crying; he had a large avulsion of skin to his neck and spine. The gaping wound revealed his cervical spine and upper thoracic spine bones. I could actually count his vertebrae with my fingers. This was a child, his whole life ahead of him, suffering life threatening wounds in front of me, his eyes pleading me to help him. We could not find any pediatric C collars in the darkness, and water from the shattered main pipes was once again showering down upon all of us. Fortunately, we were able to get him immobilized with towels, and start an IV with fluids and pain meds before shipping him out. We felt paralyzed and helpless ourselves.
Speaking of St. Johns, nearby hospitals accepting its evacuated patients had a heavy OB load. The hospitals credit GE Healthcare for rushing a team of employee volunteers to get fetal monitoring set up, one of them driving four hours to get to the hospital and another doing configuration from her laptop while hunkered down in her pantry because her own Dallas neighborhood was under a tornado watch.
Allscripts fires PwC as the auditor of its financial statements. I don’t really understand the reasons or the impact from the SEC filing, but maybe someone can enlighten me.
It looks like Cerner has a new logo and a tag line of “Health care is too important to stay the same.” I like the new one much better – it uses green (my favorite color, and everybody wants to use green these days) and it ditches the robotic-looking, all-caps-shouting CERNER in favor of a cute, non-threatening rounded font that everybody uses when trying to look Web 2.0.
Cerner’s just-published 2010 annual report has a chatty letter from president, chairman, and co-founder Neal Patterson with some fun quotes:
Thirty-one years ago, had we known exactly how hard, how long and how costly it would be, we might have chosen a different industry. I am thankful today for how youth and ignorance can sometimes prevail over conventional wisdom.
In my professional experience, vision is the thing you as a leader use to give your organization the courage and motivation to invest in new ideas years before they produce economic returns.
We view our work over the past 30 years as analogous to building the foundations and laying the electrical grid for a great city that hasn’t been built. Reaching the place where we can actually start to build on top of that foundation is inspiring for us and our clients. Things are starting to get fun.
In the past several years, we have made changes to our health plan, fired our third party administrator (we prefer to think of it as eliminating our first insurance company), launched an on-site new age clinic and pharmacy, incorporated biometric measurements for our population, realigned the economic incentives for associates in our health plan price tags and rolled out a data-based wellness management program that provides personalized health profiles for our associates.
The Cerner of today is known for care; we expect the Cerner of five or 10 years from now will be recognized for health as much as care. As I mentioned, we can see a plausible scenario where health actually becomes the bigger portion of our growth.
This is the start of my fourth decade at Cerner. This is the first decade that I will not finish—at least not in the role of CEO. Unfortunately, there is a direct correlation between years of experience and chronological age. Often when I share Cerner’s age (31 years), I make the offsetting remark that Paul, Cliff and I were all in our 20s when we started Cerner. In my case, I was 29. If you add thirty-something to any age, the numbers start getting large. I don’t intend to end this decade as Cerner’s 70-year-old CEO … which is frustrating because this is going to be the most exciting decade yet.
[This is an entry on his personal to-do list, referring to his sister-in-law Linda, who died of sepsis due to lack of care coordination] Save Linda’s life. Make it systematic that preventable events that harm people are exposed to the appropriate caregivers and eliminated. This will not bring back Linda, but it may prevent the next 50-year-old schoolteacher from rural America from dying unnecessarily from the uninformed, sometimes inadequate, sloppy, delay-ridden thing we call a healthcare system.
Here’s Vince Ciotti’s latest HIStory, which points out the parallel of a 1960s government program that drove financial systems development and sales much like ARRA is doing for EMRs today.
McKesson’s lawsuit against Epic isn’t over. A federal court will rehear McKesson’s case, which claims that Epic’s MyChart infringes on a RelayHealth patent covering patient-doctor communication via the Web. The previous ruling let Epic off the hook, saying that Epic’s customers and not the company itself set up MyChart. The issue at hand is whether Epic encouraged its customers to do so, and if so, whether that constitutes patent infringement.
Rennselaer Polytechnic Institute is awarded a $1.2 million NIH grant to develop patient-specific “phantoms” that can model the organ-specific radiation exposure involved in CT scans.
The new management team at Guam Memorial Hospital finds financial irregularities that include paying $25K per year for software that generates a form that they say could easily be photocopied instead.
Interesting: Regenstrief doctors are developing software that will use EMR data to determine which warnings and side effects are relevant to individual patients, creating dynamic prescription labels.
High-powered venture capital firm Venrock adds Bob Kocher, MD as a partner, expanding to three partners who will focus on healthcare IT companies. He was previously with McKinsey, Brookings, and the Obama administration. Venrock’s previous investments include athenahealth, RelayHealth, Awarepoint, Castlight Health, Coderyte, and Vocera.
Hospital and population health applications vendor Healthways outsources its application development and technology management services to HP in a 10-year, $380 million deal.
GE Healthcare and Thomson Reuters will offer drug companies and other researchers a database that combines de-identified patient EMR data from GE with de-identified claims and prescription data from Thomson Reuters.
A study of 17 physicians in a clinic moving from an old EMR to a new and more powerful one finds that prescribing errors dropped, but mostly because use of unapproved abbreviations was reduced. The total number of other errors increased at the 12-week mark and was identical to baseline at 12 months, suggesting that EMR implementation may cause errors early on and have little effect after a year. Most of those same doctors said the alerts weren’t useful, it was too slow in handling prescriptions and refill requests, and the more sophisticated system wasn’t any safer than the old one.
England’s NHS Direct hotline launches a free mobile app that allows patients to assess symptoms, get self-care advice, and contact NHS’s telephone nurses. It’s Android-only for now, with an iPhone app coming in a few weeks.
Population and risk management software vendor MedVentive raises $1.5 million in convertible promissory notes and warrants. I interviewed Nancy Ham (president and CEO) and Nancy Brown (chief growth officer) last August. I asked some reasonably good questions about technology support for ACOs and whether providers are fixated on EMRs while ignoring potentially more important solutions.
Sponsor Updates
The use of AirStrip OB by Lovelace Health Systems (part of Ardent Health Services, which uses it in all of its hospitals) is profiled in the New Mexico business paper.
Billian’s HealthDATA is hosting a June 8 Webinar calledProviders’ Perceptions: Mobility in Healthcare. They’re also offering a free white paper titled Social Media Strategy for Healthcare Vendors.
In Mr. HIStalk’s Monday Morning Update (5/23/11), Vince Ciotti’s HIStory slide show installment focused on the former Lockheed / Technicon … / Alltel / Eclipsys companies and their health information systems. However, this installment is full of factual errors.
Ron Johnson was NOT one of the original Lockheed engineers. Ron was hired at the Technicon company (1980?) as director of marketing, and he was let go after a brief stint.
In addition, the late George Kennedy was NOT one of the original Lockheed engineers. At Technicon, compared to others, George’s role was thin and short-lived.
Ralph Korpman, MD was involved as a pathologist for the Technicon laboratory information system and famously sold a version of it to the then-HBOC (lawsuits followed; settled out of court).
Jack Whitehead, who owned Technicon Instruments, a laboratory system company (Tarrytown NY), bought the original Lockheed system (along with many of its engineers) and named the company Technicon Medical Information Systems (TMIS), as it was called when I joined the company in 1978. TMIS was set up to take the Lockheed system and commercialize it.
It was pretty clear who drove that vision in those early days. Unsung heroes, such as Sam Virts, Ralph Boyce, Dick Kortum, Chuck Tapella, Bob McCord, Mel Hodge, Stan Grahams, Bob Williams, Dave Brown, Carole Widener, RN, Shirley Hughes, RN, ……….. (and forgive me for leaving out so many who deserve to be included here).
Around the same time that TMIS started, Spectra 2000 Medical Information Systems was started by another group of former Lockheed engineers and initially financed by Transamerica (LA). This company was later bought by Medicus; Richard Jelineck, PhD, et al. The two competing TMIS and Spectra systems obviously were similar. What set the systems apart functionally was Spectra’s MIS provided the first colored screen text. However, Technicon’s MIS was fully installed and used in a hospital based on documented cost / benefits.
In 1975, two reports were written about the TMIS system: One was written by Battelle Columbus (OH) Laboratories – Final Report on Evaluation of the Implementation of a Medical Information System in General Community Hospital. The other was Demonstration and Evaluation of a Total Hospital Information System – El Camino Hospital, Mountain View CA.
El Camino Hospital has never employed physicians nor have physicians ever owned the hospital. ECH was and still is a community-based, district facility. The community physicians from the Sunnyvale Clinic and the smaller Mountain View Clinic were key supporters of the TMIS. Other, key, physician leaders, such as Ralph Watson, were part of smaller physician practices / groups. The fact that these community physicians were not employed and there was success in gaining wide-scale adoption of CPOE during the 1970s is an accomplishment that other companies and products required 25+ years and paid incentives to achieve.
In 1981, Jack Whitehead sold TMIS and the lab system division, Technicon Instruments, to Revlon. TMIS became Technicon Data Systems (TDS). In 1984-85ish, Revlon sold TDS back to Jack Whitehead’s son, John, who again took the company private and renamed the company TDS Healthcare Systems. Technicon Instruments was sold to a number of companies after Revlon, with its legacy now part of the medical division of Siemens. The name “Technicon” was bought by Bayer and cannot be reused.
In 1996-97, John Whitehead sold TDS Healthcare Systems to Alltel. This lasted 2-3 years before Alltel sold it to Harvey Wilson (formerly of SMS) who started Eclipsys with the idea that he would take the Brigham & Women’s home-grown HIS, put it in a “box”, and take the market by storm. Harvey lasted awhile at Eclipsys, but his vision never even came close to fruition.
Yes, a handful of those old Technicon, TDS, … systems still chug away. On the other hand, Mr. Ciotti writes that he is a frustrated English major, and he can’t even use / spell the word "it’s" correctly! Thankfully he wasn’t a frustrated history major, because he really would have had no excuse for all the “HIStory” errors in this installment (and others?).
This reply was composed by the following, former TMIS / TDS / Alltel /……employees, who remain proud having been able to work with the above, early system, company, and exceptional engineers and clinician developers … and who remain alive and well working in today’s world of healthcare IT:
Jane Baseflug, RN Connie Berg, RN Edith Caesar (retired) Ann Farrell, RN Deborah (Debby) Kohn, RHIA Elizabeth West
St. John’s Regional Medical Center (MO) may not be salvageable, according to hospital’s president Gary Pulsipher. He says St. John’s, which is part of Mercy Health System, will open a 60-bed mobile hospital by Sunday and will rebuild. The hospital went live on EHR less than a month ago, but will soon be back online to connect the mobile hospital with other Mercy sites.
Reader Comments
From Easily Amused: “Re: magazine typo. A finance newsletter described a vendor as ‘provider of elf-service and revenue cycle management applications.’ I had visions of Santa’s helpers pitching in to improve collections.” At least they aren’t involved in elf gratification.
From Meaningless User: “Re: attestation. Do you have any info regarding which hospitals have attested to MU and what their success has been? I have not yet heard any announcements or rumors of a hospital achieving MU yet.” I doubt there’s a publicly available list, but some have met the Stage 1 requirements. It would be interesting to know if any have been turned down, but that’s not the kind of news that makes vendor press releases (not to mention that hospitals probably wouldn’t apply unless they were pretty sure they qualify).
HIStalk Announcements and Requests
In case you missed it this week on HIStalk Practice: Kareo lends advice on how to handle medical billing after a zombie apocalypse. Massachusetts eHealth leads the nation in enrolling primary care physicians for its REC. AMA reports a 45% increase in profits for 2010. Dr. Gregg reflects on egos in the industry. And my personal favorite: the fake doctor who used toothpicks to treat his patient. None of this news appeared on HIStalk , so if you follow the practice side of technology and aren’t signed up to get HIStalk Practice e-mail blasts, then you are getting left in the dust.
I’m taking a few days off for fun family stuff and trying to spend minimal time on the laptop, so I’m a little bit disengaged at the moment as I struggle to resist the gravitational pull of work and focus on non-work. I’ll be happy to get back to endless HIStalk hours in a few days.
Acquisitions, Funding, Business, and Stock
Standard Register enters a definitive agreement to acquire 100% ownership interest in informed consent provider Dialog Medical. Terms of the deal were not disclosed.
Resilient Network Systems raises $5 million in Series A funding, led by Alsop Louie Partners. Resilient’s technology facilitates the electronic transfer of health records.
People
Former Healtheon/WebMD CEO Mike Long is named president and CEO of EGHC, of which he was already board chair. The company’s businesses include a health plan, the Lumeris quality management software line, and ClearPractice EMR.
Announcements and Implementations
HIMSS introduces the ICD-10 PlayBook to educate providers on the transition to ICD-10
Allegheny General Hospital (PA) resorts to paper recordkeeping Wednesday after shutting down its Allscripts EMR. The hospital says it upgraded the system over the weekend and began having slowdown problems Monday and Tuesday. The hospital voluntarily shut down the system for about 12 hours while Allscripts fixed the issues.
CHIME reports that 109 individuals have earned Certified Healthcare CIO designation since the credentialing program was launched in July 2009. I said it was a dumb idea then and I’ll stand by that opinion now. Obviously the credential hasn’t exactly gone viral if only 109 out of thousands of hospital CIOs have signed on over two years, voluntarily jumping onto the hamster wheel of spending hospital money on renewals and going to CHIME meetings to earn CE. To each his own, but I’d be embarrassed to use a non-educational credential earned by passing a multiple choice test of job-specific knowledge (designed by asking CIOs what they do on the job, then testing them to see if they theoretically know how to do it). My theory has been that CHCIO appeals to CIOs who feel inferior to their better educated C-level peers because they never expended the minimal effort required to earn a graduate degree by any of a zillion inexpensive, flexible, geography-indifferent programs that are out there.
athenahealth releases its sixth annual PayerView Rankings and awards Aetna the top spot among major players. BCBS-RI was the best overall performer, while state Medicaid providers were the worst in terms of days in AR and denial rates. Compared to last year, payers averaged payment one day faster with 5% fewer denied claims.
RCM provider RealMed announces its integration with Epic’s billing software.
Medicomp Systems announces that its Quippe electronic documentation system SDK is available for licensing to EMR developers. The browser-based, iPad-friendly system (which Dr. Gregg, Inga, Dr. Jayne, and I all raved about after working with it at HIMSS) uses the company’s MEDCIN-powered patented prompting technology to create and present EMR information in an amazingly intuitive way that even a non-doctor like me could use immediately after a ten-minute overview.
NCO Healthcare Services earns the “Peer Reviewed by HFMA” designation for several products related to eligibility, bad debt, and and extended office services.
Government and Politics
More grumblings about the proposed ACO regulation, this time from seven US senators. The lawmakers send Secretary Sebelius a letter urging HHS to withdraw its proposed ACO rules, saying, “the proposed ACO regulation will fail to accomplish its purpose” of better quality care and lower costs. The senators claim the proposed rules do not align incentives and accountability and include requirements that are too complex and an ROI that is uncertain.
CMS clarifies financial incentives for ACOs in rural areas, saying participants would be eligible for a savings exemption. CMS says that ACOs with fewer than 10,000 assigned beneficiaries would be exempt from the 2% savings threshold required of larger ACOs.
Add BIDMC to the list of hospitals claiming to be the first to receive HITECH money, $2.57 million in its case.
Other
Emergency physicians claim the biggest challenge to cutting costs in the ED is fear of lawsuits. An American College of Emergency Physicians poll finds that 53% of ER docs say the main reason they conduct the number of tests they do is fear of being sued.
Sponsor Updates
SCI Solutions is attending and exhibiting this week at the National Association of Healthcare Access Managers conference in San Antonio, providing their traditional “Stress Free Zone” that features massages and cocktails.
ESD heads to MUSE later this month (booth 910) as well as the Canadian E-Health Conference (booth 203). The ESD folks also shared that their KLAS ratings are up should you be interested in taking a look.
Oklahoma Surgicare picks Provation MD software for gastroenterology documentation and coding.
NextGen announces that Springfield Center for Family Medicine (OH) received federal funds for demonstrating Meaningful Use under the Medicare incentive program.
Tim Reiner, VP of revenue management for Adventist Health System, describes that organization’s use of self-service technology from NCR for patient collections in a YouTube video.
Yavapai Regional Medical Center (AZ) contracts for several applications from Lawson Software.
Prime Healthcare Systems, California’s largest for-profit system at 14 hospitals, expands its use of document management technology from FormFast to improve health information, revenue cycle, and patient registration.
Self Regional Healthcare (SC) chooses RelayHealth as its HIE partner to improve care and support the Meaningful Use efforts of its eligible providers.
Tele-Tracking releases Patient Flow Dashboard for monitoring enterprise-wide patient flow and getting more efficient use of existing capacity.
EPtalk by Dr. Jayne
I’ve been fairly critical of the federal Meaningful Use program lately. For the record, I want to mention one piece of the program (even if it did get relegated to the Menu Set) that I’m absolutely in favor of: increasing the number of providers who report syndromic surveillance data to public health agencies.
We’ve seen huge benefits to the field of epidemiology with increasing availability of health-related data. I still like the Google Flu Trend site as an idea even if it’s only search data. And “old school” diseases aren’t going away – the number of measles cases reported across the US just hit a 15-year high.
The ability to track, trend, and prevent killer diseases is one of the cooler things we can do with healthcare IT (and one that’s proven to work, mind you). Can you imagine the TV show Quincy ME if Jack Klugman had population-based aggregate data to work with?
In that same vein, a throwdown to my favorite elected officials. Hey Congress, how about putting together a true “Menu Set” of information technology interventions that have been proven to be effective and incentivizing them individually so that providers aren’t faced with the “all or none” problem with Meaningful Use? Any of us who have had to fill out the awful paperwork from the county health department to report a sexually transmitted disease would be happy to interface it directly from our EHR at the click of a button.
The American Medical Association offers a new app to assist with CPT codes. Only available for Apple users at this point, it allows you to search for, track, and e-mail selected codes. The first problem I had with it is that it apparently ignores the iPad’s gyroscope – it can only be viewed in portrait mode, which is a bummer for those of us that like to prop the iPad on our desk landscape-style so we can stream Netflix while we multi-task.
Navigation to the various sets of codes was pretty easy, but there wasn’t enough information on the screen to make a decision about the right code. The user would have to select each code and read the description. It would be more helpful to have a quick blurb visible on the screen rather than having each entry on the list say “office consultation,” which isn’t very helpful. (It was particularly unhelpful in the preventive codes section, but I couldn’t get a screenshot off my iPad to show, so I clipped this from the AMA Web site.)
I didn’t receive any IT-related checklists for a potential Zombie Apocalypse, but Inga did turn up Kareo’s thoughts on handling medical billing after the fact. I hadn’t really thought about Web-based telecommuting as a strategy to prevent employees from being eaten, but it does make a lot of sense.
Rest assured that due to our decentralized, multi-state virtual office architecture, the HIStalk staff is at significantly lower risk for being decimated by zombie attack than most health IT vendors.
Although Kareo’s piece mentions they didn’t know the code for having one’s brain eaten, I can propose (courtesy of IMO’s Problem IT product): E968.7 Assault by human bite and E979.8 Victim of crime or terrorism.
The Journal of the American Medical Association reports on Navigating the Challenges of In-flight Emergencies. There are apparently minimal standards for emergency medical kits, but kits and employee training vary from carrier to carrier. Airlines also have their own reporting systems and protocols, often relying on physician passengers rather than employed medical control officers on the ground.
The article proposes standardized reporting to the National Transportation Safety Board; expert recommendations for first aid kits (and eventually evidence-based kits based on the data gathered through reporting); enhanced training for flight attendants; and enhanced ground-to-air medical support.
Having had to respond to “Is there a doctor on board” more than once, I’m in agreement. Plus, it looks like an excellent opportunity for vendors to go after another potential customer base. Anyone want to hire a sassy CMIO to write your content for airline medicine? I’d be happy to travel all summer and write code for the most common airline emergencies I encounter along the way.
The market for anesthesia information systems is predicted to increase 50% by 2012 and be valued at $4 billion by 2017. Vendors battling for market share include Picis, GE Healthcare, Draeger, IMDsoft, Merge, and Philips.
Reader Comments
From Baywatch: “Re: UCSF. The CIO is leaving involuntarily. Looks like the board finally figured out that the Centricity debacle was as much of a leadership problem as a software problem. The Epic project is floundering and bleeding money, with poor direction and an incompetent staff.” We asked a UCSF press contact, who replied: “Mark R. Laret, CEO of the UCSF Medical Center, today announced that ‘Last Friday, CIO Larry Lotenero notified me that he will retire at the end of June, completing 10 years of service to UCSF.’”
From TopCrush: “Re: AAOE meeting. I’m at the American Association of Orthopaedic Executives in Orlando this week, along with a few hundred other folks and about sixty exhibitors. ACOs are definitely a concern for these guys. Orthopedic docs are scared of being left out and worried about the financial ramifications. Kind of funny but they have a VIP entrance for participants that have been coming for years or on a chapter board. AAOE set up a fun Sports Lounge in the middle of the show floor – shuffle board and fuse ball included.” Thanks for the update from the field. I wish I had a special door I could walk through every once in awhile, just to make me feel more important.
HIStalk Announcements and Requests
Mr. H semi-left me on my own tonight, just in case you were wondering why there are fewer smoking doctor images that usual. Mrs. H deserves a date night every once in awhile and I hope he is taking her somewhere special.
People
Community Health Network (IN) appoints Ronald Strachan CIO. Strachan is the former CIO for WellStar Health System and for HealthEast Care System.
Shared Health names Hedge Burt VP of sales. Burt has served as SVP of business development with Entrada, as well as VP of provider sales for Kryptiq.
PACSGEAR names Eli Rapaich CEO. Rapaich succeeds company co-founder Brian J. Cavanaugh, who will assume the role of COO. Most recently Rapaich served as VP of sales at Philips Healthcare.
Announcements and Implementations
The DoD awards SAIC a $53 million contract to provide IT and EHR system support to the TRICARE Management Activity MHS.
Gulf Coast Medical Center (FL) will move to Epic EMR next month.
CMS notifies Jefferson Regional Medical Center (AR) that it has met Stage One Meaningful Use requirements and will receive approximately $3 million. Jefferson uses Allscripts’ Sunrise Clinical Manager EHR.
Catholic Health Initiatives selects Beryl to provide outsourced patient experience solutions, including physician referral services.
Hospital EHR vendor eCareSoft, the US subsidiary of Mexico’s largest HIT vendor, embeds task-oriented tutorials and collaborative e-learning tools into its application. Hospital users can share shortcuts and workarounds and provide feedback to the vendor’s support team right from the application.
Trinity Health (MI), Baycare Health (FL), and Jackson Health System (FL) go live on the LegacySuite solution from Legacy Data Access. LegacySuite provides data storage and Web-based solutions for retired HIT applications.
The Federal Health Architecture (FHA) awards CGI Group a one year contract for $5.7 million to support FHA’s CONNECT NHIE Gateway solution.
Swedish Medical Center (WA) picks PRISM contact management software from Aegis Health Group to automate its physician relations management process.
Jefferson County Hospital (MS) selects Custom Software Systems to provide ChartSmart EMR, document management, and lab modules.
Texas Health Resources, where Ed Marx serves as CIO, receives over $19.5 million in Medicare EHR incentive payments for the meaningful use of its Epic system. THR has invested more than $200 million on its EHR initiative.
Innovation and Research
A new study concludes there’s no consistent association between EHRs and clinical decision support in ambulatory patient visits. Researchers looked at data from 2005-2007 so perhaps newer decision support tools might paint a different picture. However, only one of 20 indicators showed superior quality with EHR visits versus non-EHR visits.
Other
The video above is from St. John’s Regional Medical Center in Joplin, MO, heavily damaged after taking a direct hit from a tornado. Its 183 patients were evacuated, but five patients and a visitor died and several employees were injured. Hospital x-rays were found 70 miles away, with the hospital asking anyone finding hospital records to hold them while they figure out a way to collect them. Missouri’s disaster medical team has set up a makeshift 30-bed hospital in a tent, staffed by 40 doctors, nurses, pharmacists, and support staff.
Health IT ranks among the top 10 most popular career path for college graduates, according to a University of CA-San Diego study. Top jobs include healthcare integration engineers, system analysts, clinical IT consultants, and technology support specialists.
Sponsor Updates
DIVURGENT will host a CHIME College Live session June 8th entitled Accountable Care Organizations: Overview and the Role of Information Technology.
Thomson Reuters’ Meaningful Use Quality Manager 1.0 earns ONC-ATCB modular certification from CCHIT.
Voalte signs up to resell the Epocrates Essentials premium clinical suite with Voalte’s communications solution.
CynergisTek CEO Mac MacMillian and Ohio Presbyterian Retirement Services CIO Joyce Miller-Evans will present at the Colorado Health Information Management Association’s Long Term Care Spring Meeting this week.
Geisinger Health System (PA) picks Orion Health Rhapsody Integration Engine as its integration platform.
Vocera CEO Bob Zollars is named a finalist for the Ernst & Young Entrepreneur Of The Year award for Northern California.
The Redwood Falls City Council (MN) approves the $50,000 purchase of Provation software for the Redwood Area Hospital. The hospital will interface the software with its Meditech EMR.
Awarepoint is awarded a patent for its wireless interaction-based tracking system.
MED3OOO announces the general availability of InteGreat V6.4, which includes the components required to meet Meaningful Use standards.
University Hospitals Bristol NHS Foundation Trust implements Imprivata OneSign for its 5,100 users.
Baylor Health Care System (TX) affirms its plans to implement GE Centricity EMR across its entire HealthTexas Provider Network of more than 500 physicians.
Prime Healthcare Services (CA) expands its rollout of FormFast document management technology to its recently acquired facility, Alvarado Hospital.
BridgeHead Software celebrates the 10th anniversary of its partnership with MEDITECH.
Lakeland Healthcare (MI) selects the ChartMaxx Epic integration package to integrate their physicians’ ChartMaxx EMR with the health system’s Epic program.
From The PACS Designer: “Re: SlideRocket. Microsoft PowerPoint has been the dominate force in the presentation arena for business applications, but there are new ideas surfacing that could challenge their market share. One is a Web-based application called SlideRocket, acquired by VMware last month. You can try it by importing an existing PowerPoint presentation to see what a Web-based format can do to enhance your creative abilities.”
From Little Birdie: “Re: [SVP name omitted]. Fired from Ingenix last week.” I’m leaving the name off since nobody likes seeing themselves in unflattering headlines, but the source is a good one.
From Lawdy Mama: “Re: Ford’s in-car medical monitoring. The target is much larger. Truckers include a large population of diabetics and, since they live on the road, have problems managing their disease. It can also be dangerous for diabetics to drive while suffering dizziness or other symptoms.” I’m always fascinated by trucker health since I talked to a guy once who runs a company that provides healthcare services from truck stops – it was truly fascinating to hear about their particular risk factors and the challenges of delivering healthcare services to them when every minute off the road costs them money. I guess I can see the value there, although Ford didn’t mention trucks in their announcement. As long as the built-in device doesn’t require drives to interact with it (or drivers exercise reasonable caution by pulling over when doing so), then there may be some medical value.
My Time Capsule editorial this time deals with missing clinical information, even in supposedly advanced IT systems. A snip: “I can think of only two reasons: (a) command and control is so fragmented within our episode-based system of revolving door specialists that everyone assumes that someone else is watching the big picture, or (b) providers are too busy to do anything more than patch and mend, buried in piles of disjointed facts that are difficult to comprehend and act upon.”
I got a nice e-mail that I need to anonymize quite a bit, but here’s the gist. The author said reading HIStalk for years taught him/her two major lessons that he/she will use directly in his/her new vendor leadership role: (a) move your products up the value chain via application and technology integration, and (b) if your product enhances expensive hospital information systems, then price it accordingly based on the value it delivers. The conclusion: “Your blog sure cut down my learning curve for many things healthcare. I thank Dr. Jayne the newcomer, Inga, and yourself for your commitment to the industry.” I really appreciate that.
CMS may not show a lot of confidence in providers, but the feeling is apparently mutual. New poll to your right, for providers: are you confident that your employer’s security practices will keep your medical records private?
I found this installment of Vince Ciotti’s HIStory to be his most interesting so far, in which he also mentions the EMR that’s 40 years old and still running today (and it’s not Meditech).
Welcome to new HIStalk Platinum Sponsor Kony Solutions of Orlando, FL. They help companies (more than 35 Fortune 500 ones, in fact) get their message out to every mobile device that’s out there, providing a highly configurable out-of-the-box solution that allow companies to put mobile-rich apps (smart phone, mobile web SMS, etc.) in the hands of consumers in as little as a few weeks and at a lower cost than any other solution. These are not cookie cutter templates. Healthcare examples of what they can do: generate outbreak alerts, manage appointments, do prescription refills, and create provider-finder apps. Like their ad says, just putting an iPhone app out there is missing a bunch of consumers who use other technologies. I interviewed Aaron Kaufman, VP of the company’s healthcare and life sciences solutions division, just a few weeks back. Thanks to Kony Solutions and Kony Healthcare for supporting HIStalk.
Thanks to the readers who sent over new Annals of Internal Medicine articles on RHIOs and EMRs. Talking points: (a) only 13 of 179 RHIOs reported that they could meet Stage 1 Meaningful Use requirements, and (b) two-thirds of RHIOs won’t survive financially once their grant money runs out. The RHIO article points out that it’s not surprising that RHIOs can’t wean themselves off the taxpayer teat since free-flowing HITECH money encourages them to start up, but nobody wants to pay for information exchange except for directly beneficial transactions such as lab results. It also mentions that RHIOs are being held back by low EHR adoption (the accompanying editorial says RHIOs struggle “in exactly the same way as a cable company would if no one owned television sets.”) Here’s all you need to know about the article, which comes from its summary: “No RHIO in the nation met our expert-derived criteria for the comprehensive HIE needed to substantially improve care quality and efficiency.” The article had some unintentional humor in the footnotes: the authors who concluded that RHIOs are pretty much a failure were, like the RHIOs themselves, supported by ONC grant money. Doh!
Even Epic’s contractors get big new buildings. The company working on Epic’s never-ending construction projects figure they’re never going to be finished at this rate, so they build a 22,000 square foot building to hold their 65 on-site professionals that oversee several hundred construction workers. The construction company says they will have up to 700 people on site next year as they ramp up work on Epicenter 2, a second on-campus Epic auditorium that will seat up to 13,000 people.
A book detailing the 2004 murder of Cerner nurse Julie Keown by her husband (he poisoned her Gatorade with antifreeze), has been published.
A study finds that hospitals are over-promoting their robotic surgery gadgets and, in 73% of their Web sites, are using word-for-word questionable information provided to them from the manufacturer who sold them the equipment. According to the Hopkins surgeon who led the study, “To me, this is exactly what is wrong with American health care. We are adopting technology without being up front about the outcomes to consumers. And we adopt technology before we properly evaluate it.”
Bizarre lawsuit: a woman sues an Ohio hospital, claiming it mailed her picture of her premature baby who died there. She says she received 154 pictures of her dead baby propped into a variety of poses, including some of his body being held by an unknown hospital employee, even though the mother told the hospital she didn’t want pictures taken.
Sponsor Updates
DIVURGENT’s latest newsletter addresses activation management. The ACO book by partner Colin Konschak is now available on Amazon.
Practice Fusion is hiring at its San Francisco headquarters, looking for talent in account management, marketing, engineering, legal, customer engagement, and executive management.
The UK’s National Audit Office (NAC) says that the billions spent so far on the country’s National Programme for IT has been poorly used and the project needs to be reassessed. The NAC concludes that the investments don’t represent value for the money and officials are not confident that spending more will be any different. The NAC believes the project’s core aim of having an electronic record for each patient will not be achieved.
Reader Comments
From Frank Mac Court: “Re: study on operational RHIOs. Here’s more information on the study.” Earlier this week, I mentioned the report that found only 13 of 75 operational RHIOs met the basic criteria for Meaningful Use. The information was collected in early 2010 and the authors admit that “data exchange could have accelerated in the interim.” It’s likely that today there are more than 13 HIEs exchanging Meaningful Use-caliber data, though admittedly it’s still a pretty small club.
From Certs Two Mints in One: “Re: [vendor name omitted]. One of our sites is under siege by these folks, whose product holds only Modular EHR certification. They told the customer in writing that they ‘will be ONC-ATCB certified as a complete EHR for Meaningful use by July 1st, 2011.’ Vendors are supposed to be prohibited from pre-announcing their status and clearly they are saying something they can’t know is true. Maybe they failed and have made software changes that they assume will earn them certification.” That’s at least a poor choice of words – swapping ‘will’ with ‘hope to’ would have removed all grounds for complaints from either customers or the certifying body.
From Sarah: “Re: ONC and security awareness. If you heard and met some of the so-called IT consultants that standalone providers hired, you would think they needed some awareness. Many of the providers we deal with have IT people that can’t even set up a domain or workgroup correctly without leaving gaping security and permission holes, let alone manage security at a level we implement internally to protect their PHI. In some areas, the only option (no joke) is Geek Squad. They need step-by-step list for the techs and automated verification tools that providers can run themselves during annual security audits.” I think those are great ideas. Hospitals are reasonably good at basic security, but physician practices often don’t even know they need it, much less how to make it happen.
HIStalk Announcements and Requests
Listening: the just-released Rome from Danger Mouse, spaghetti western-style music mixed with a little R&B and played on vintage instruments (the keyboards are amazing) recorded straight to tape, some by the original musicians from The Good, the Bad, and the Ugly and similar movies. Mellow 60s hip with that shimmery, sharp, echoey movie soundtrack sound that makes you think that a guitar-carrying Claudine Longet could wander in looking wide-eyed and pensive in a mini-dress at any moment. Guest Norah Jones sounds sweet and Jack White is pretty good. If you’re in the right mood (and I’ll leave you to decide what that mood is), it’s transcendent.
This week on HIStalk Practice: the irreverent Joel Diamond, MD resurfaces and ponders what HIStalk would be like if it offered with some quaint, Andy Rooney-style observations. Don Michaels, PhD and VP of Hayes Management Consulting makes his premier on HIStalk Practice and offers tips to determine if one’s organization is ready for an ACO. Julie McGovern with Practice Wise shares insight into the high quality talent to be found in the country’s HIT programs. Massachusetts governor Deval Patrick helps eClinicalWorks celebrate the opening of its new office. Computer trumps doctors in detecting acromegaly. The AMA Board of Trustees argues against EMR standardization, claiming it would stifle product innovation. Participants in an ACO demonstration project contend that CMS’s proposed ACO framework is too risky. While you are paying a visit to HIStalk Practice, check out some the Web sites of some of our sponsors and learn more about their nifty products and services.
I had a routine doctor’s office visit this week. I observed perhaps 10-12 employees of the university-owned practice as I waited my turn, ranging from the front desk people to assistants to nurses. Every single one of them, other than my doctor, were somewhere between significantly to massively overweight, while all the patients in the waiting room were pretty much of normal size. I wondered how effective those employees are at convincing patients to change their dietary and exercise habits? That reminded me of the two respiratory therapists I’ve known who smoked constantly, with their cigarette packs prominently sticking out of their shirt pockets as they counseled patients on good pulmonary health. Healthcare is a funny business.
Acquisitions, Funding, Business, and Stock
Israel press reports that Reed Elsevier is in talks to buy Israel-headquartered dbMotion for $250-$300 million. dbMotion officially told me they could not comment. In February, dbMotion and Elsevier announced a partnership to integrate Elsevier’s analytics solutions into dbMotion’s interoperability platform.
Proof that Irrational Exuberance II is upon us even amidst a recession and smothering national debt, only this time limited to just a handful of darling companies. LinkedIn share prices more than doubled in their first day of trading Thursday, opening on the high end of their range at $45 and closing at $94.25. That values the company, which lost money for years until finally eking out a $15 million profit last year, at almost $9 billion. Hopefully the huge ranks of the unemployed will somehow benefit from the trickle-down effect of millionaire secretaries and trade-in VC wives buying Ferraris and McMansions. I hate everything about LinkedIn except that just about everyone is on it.
People
HIMSS runs a bio and interview of its 1990s CEO John Page. Interesting: he says his greatest achievement was splitting HIMSS off from AHA, which he said was essential for its survival. He also mention his greatest challenge – trying not to disenfranchise the management engineers that formed HIMSS as the IT side of the house started invading and eventually pushed them out like greedy European settlers marching red-skinned Americans off their land and into concentration camps called “reservations.” It must be lonely being among the tiny ranks of folks making up the MS part of HIMSS.
Announcements and Implementations
Detroit Medical Center anticipates receiving $40 million in Meaningful Use incentives, including $16-$17 million this year. Meanwhile, Beaumont Hospitals is planning for $26 million, including $10.3 million this year.
Verizon Wireless and Medco Health Solutions release a mobile app to guide patients and doctors to the lowest cost prescription drug. The app gives information on out-of-pocket costs and lower cost options, based on a patient’s specific insurance plan.
Ford will expand its Sync in-car automation to create “the car that cares,” planning to roll out allergy alerts and connected medical devices to monitor blood sugar with the help of its partners Medtronic, WellDoc, and SDI. I don’t get the point, not to mention that the last thing we need is a bunch more marginally skilled drivers screwing around with yet another electronic device instead of paying attention to the road. Maybe Ford can add monitors for bladder distension and grumbling stomachs and fund the whole project by running GPS-localized restaurant and gas station ads.
Government and Politics
CMS announces that the first Medicare EHR incentive payments will be issued this week. Greenway Medical says their client Childs Medical Clinic (AL) was among the first to receive funds Thursday, as was Cerner client Dr. Juan Salazar (TX).
Innovation and Research
An upcoming study in an economics journal claims that higher usage of EMRs would save a lot of babies. You can guess what they did: combined old (2006) data from several sources that include that of HIMSS Analytics, taking a guess at when those systems went live (since HIMSS Analytics reports products bought but not yet installed), did some kind of county-level breakdown, and found that EMRS are “associated” with lower infant mortality (leading to the dramatic title, “Can Healthcare IT Save Babies?”, that in my mind is a question left unanswered.) I would have been more convinced had they looked at infant mortality at individual hospitals pre- and post-EMR, also ruling out related OB-specific systems that don’t really require EMRs. I don’t doubt that hospitals with the ambition and money to buy EMRs may well have better outcomes with newborns (possibly because they aren’t usually in poor, inner city neighborhoods), but its a stretch to say it was the EMR itself that made them better (or to assume, even with everybody and his brother installing EMRs, that we’ll be seeing a drop in infant mortality anytime soon). It’s a free PDF download if someone wants to critique it in more detail.
Other
Officials with Saint Elizabeth Regional Medical Center (NE) say they will hold off on plans to form an ACO, following the release of proposed ACO rules. The hospital fears potential financial risks may not be sufficient to cover high initial investment costs, including IT-related expenses.
KLAS looks at partial and extensive IT outsourcing and concludes that CareTech, Dell, and Siemens rank high in both categories. CTGHS topped all firms for partial IT outsourcing and CareTech led for extensive IT outsourcing.
In the under-200-bed community hospital market, 80% of organizations report confidence in their vendor’s ability to ultimately satisfy Meaningful Use requirements. The other 20% are looking to replace their vendor. All of the Cerner clients participating in this KLAS survey expressed confidence in Cerner’s ability to meet Meaningful Use; at least three customers from each of the other seven vendors felt achieving Meaningful Use with their current vendor would be a long shot or probably won’t happen.
Weird News Andy likes this quote about NPfIT from UK MP Richard Bacon: “This turkey will never fly and it is time the Department of Health faced reality and channelled the remaining funds into something useful that will actually benefit patients. The largest civilian IT project in the world has failed.”
A NEJM editorial says the provider payment system based on CPT and E&M codes forces EMR vendors to modify their programs to create reams of repetitive and clinically worthless documentation instead of doing something useful, like improving clinical decision support. It points out that payments encourage upcoding and over-documenting, but nobody has come up with a better alternative.
Alan Cremer, founder and acting CEO of drug database search application vendor IntelliDex, e-mailed to ask me to mention that he’s looking for a president and CEO for the company. If you have startup leadership experience, preferably in a medical informatics company, check out the job description and consider throwing your hat into the ring.
Sponsor Updates
iSirona demonstrated its integration technology at last month’s Vision User conference in Salt Lake City. The company used its software to upload patient vitals from a Stryker Bed InTouch and a Fukuda Denshi bedside monitor, which were then verified and uploaded into the Siemens clinical suite.
H/P Technologies, which provides staffing and consulting for all Meditech modules, will exhibit at MUSE May 31–June 3 in Nashville.
The MSO Mississippi Health Partners selects RelayHealth to provide health information exchange for its 800 physicians and 13 hospital members.
ESD hires Dan Oberle as VP of business development. His previous employers include Santa Rosa Consulting, CTG, and ACS.
Orion Health and NextGate partner to include NextGate’s MatchMetrix EMPI and Provider Registry products in the Orion Health HIE solution.
Dossia partners with Health Language Inc. to embed HLI’s language engine into the Dossia Health Management System.
API Healthcare announces that it achieved its highest number of deployments ever during the first quarter of 2011.
Ovum, part of Wolters Kluwer Health, introduces OvidMD, a clinical tool that incorporates medical research with Wolters Kluwer’s UpToDate resource tools.
Children’s Hospital of Orange County (CA) selects MobileMD to provide HIE services to its 800 physicians and 1,000 referring physicians.
Healthcare Innovative Solutions co-sponsors a Victoria Era fashion show, which raised over $1,000 for the Seville Food Pantry (OH).
Hayes Management Consulting unveils a partnership with The Coding Network to provide audit and remediation services to physician practices using MDauditComplete.
Capario says it is now processing inbound 5010 claims (Errata version) and providing 5010 ERAs with submitters.
Sage SVP Tony Ryzinski offers up 10 areas for improvement when managing the revenue cycle.
EPtalk by Dr. Jayne
WebMD reports this week that even mild exercise with the Wii Fit game can improve fitness for COPD patients. Big surprise: patients are more likely to stick with exercising at home if it’s fun. I have to admit, the Wii is one of my guilty pleasures and its price point is more realistic for people than some of the other game consoles. If it gets people off the couch for even 10 or 15 minutes a day, I say go for it — although I’m not sure I want to know what my blood pressure looked like when I was trying to find the last three i-points on Island Flyover. But then again, there’s something therapeutic about crashing your biplane into the ocean repeatedly after a long day listening to physicians complain about computers.
I keep getting e-mails from the American Medical Association about their AMAGINE physician portal ,which “offers a low-cost approach to meet the needs of your practice and achieve each level of meaningful use.” If you’re a provider or someone who works closely with a provider, have you checked this out yet? I’d be interested to hear what you think. Featured products on the site when I stopped by included NextGen, Ingenix CareTracker, and Care360 EHR.
I’m still a bit in awe of being a minor Internet celebrity. I wonder if Centers for Disease Control spokesman Dave Daigle was ready for his brush with fame? The normally sleepy Public Health Matters blog featured a new topic this week: Preparedness 101: Zombie Apocalypse. The site has been so popular after being named a Twitter “Top Tweet” that it’s intermittently crashing, so be patient. I’m not sure of the specific impact of zombie apocalypse on IT infrastructure (my medical training was more in dealing with the brain-eating aspects of zombie behavior) but it’s always good to be prepared and make sure you have a disaster plan for each of your critical systems. If anyone has a good zombie preparedness checklist for enterprise EHRs, please share!
I agree with Inga, it was feeling like a bit of a slow news week, at least until I came across this headline: Don’t forget! Your computer job is still killing you. Based on the multitude of upgrades our organization has to complete in order to be ready for Meaningful Use attestation, I was sure the author had been following me around. I’m not sure about their level of medical fact-checking, but I do like their graphics. It’s a good reminder for those of us who have traded walking the clinical halls of academic medicine for a more desk-jockey lifestyle that we need to get up and move.
Finally, having spent some time attending a renowned Southern institution famous for matriculating Mrs. degree candidates, I learned that there are a few things that aren’t fit for discussion in mixed company if one wants to catch a good husband. Since I’ve turned into a grizzled IT veteran (although I do know how to identify a fish fork and exactly how to use it) I’m going to break that rule today. Last November, Mr. H mentioned a UK team that was working on a smart phone app that would instantly diagnose sexually transmitted diseases after urine or saliva was … ahem … applied to a chip that would then be attached to the phone, leading to a quick diagnosis. It seems this product will have an expanded target market after June 1 since Apple has approved a “prostitution-friendly” app aimed at pairing “sugar daddies” with willing companions. I was going to say something pithy about Adam, Eve, and an Apple until I read further to find it’s compatible with Android and BlackBerry devices as well. Instead, to the App Store, I say — “well bless your little heart.”
HHS’s Office of Inspector General spanks its fellow agency ONC for pushing interoperability without mandating security controls or encouraging standards. Examples of what it wants to see: requiring portable media to be encrypted, requiring two-factor authentication for remote access to PHI-containing systems, and mandating timely OS patch application and antivirus updates. OIG based this work on a previous project that looked at providers, in which it found unsecured wireless networks, lack of application vendor support for OS-level changes, poor antivirus practices, lack of event logging, allowing shared user accounts, and giving too many users administrative rights over their PCs.
ONC’s response to this report: (a) we turfed security work off to HITSP and incorporated some of its specs as HHS policy and in EHR certification requirements; (b) Stage 1 of Meaningful Use requires providers to fix their own security problems; (c) our job is to convince providers to use EHRs and we will worry about security later in the process; (d) our chief privacy officer is drafting a plan. It sounds to me like the typical external auditor’s report: their job is to find stuff to make sure you keep hiring them, while yours as the IT shop is to balance their sometimes ivory tower observations with your own realities. My only takeaway is that ONC should spend some of its billions to push security awareness, which you would think highly paid hospital and vendor IT people wouldn’t need, but apparently they do.
Reader Comments
From Mia: “Re: CompuGroup. Big layoffs at Noteworthy Medical (last week, I think) and other of their companies. Will be interesting to see how many of the 420 ONC-ATCB certified EHR companies are around five years from now.” Unverified.
From CPOE Zealot: “Re: medication error. Incidents such as these give CPOE a bad rap.” The parents of a five-week-old premature baby who died after being given 60 times the ordered dose of IV sodium chloride sue Advocate Lutheran General Hospital (IL) for wrongful death. Like most fatal medication errors, CPOE was a non-factor here: — most in-hospital medication error deaths are caused by incorrect IV preparation or administration. In addition, the doctor ordered stat labs and then a re-test after getting a high sodium level back, but nobody drew it, leaving the baby on the hyper-concentrated fluid for 20 hours. There is one good reason CPOE gets a bad rap in cases like these, though: vendors sell and hospitals buy the seemingly logical argument that CPOE prevents patient harm, when what it mostly does is prevent lots of errors that were being caught anyway (like poor handwriting, in which somebody just calls the doctor for clarification). The risk of harm doesn’t change much unless you work at the sharp end of the stick where EHRs fear to tread – medication preparation and administration. The best IT systems in existence (including bedside bar-code checking) couldn’t have saved this baby’s life when hospital employees, despite experience and best intentions, are just as prone to distraction and carelessness as the rest of us humans, especially when they are overwhelmed and tired (sometimes because their peers were laid off to help pay for CPOE systems).
From Wireless Observer: “Re: Cerner. Word on the street is that Cerner is getting ready to announce some big organizational changes and these are not good kind of changes for the employees (may be good for Wall Street, however). This is supposed to hit the CareAware division pretty hard.” Unverified. CareAware is Cerner’s solution for connecting medical devices to EMRs (video above).
Acquisitions, Funding, Business, and Stock
FairWarning will hire 70 employees over the next 24 months.
Salt Lake City-based MediConnect Global announces plans to hire 100 employees across multiple departments.
Cerner names SenSage its “Accelerate Partner of the Year” for demonstrating speed to value for Cerner and its customers. SenSage also an expanded alliance with Cerner to offer a SaaS-based version of P2Sentinel, Cerner’s enterprise clinical system auditing program.
CareCloud partners with Xpress Technologies to launch a combined EMR/PM solution for urgent care facilities and hospital ERs.
Sales
Sharkey Issaquena Community Hospital (MS) selects Custom Software Systems ChartSmart EMR.
Onslow Memorial Hospital (FL) contracts with Language Access Network to provide hospital video language interpretation services.
People
Awarepoint names Ralph Keiser (MedeAnalytics) EVP of sales and Jaime Ojeda (PCTS) EVP of marketing and business development.
Government and Politics
CMS announces plans to release applications for “mature ACOs” interested in participating in its new Pioneer ACO Model and taking part in shared savings. CMS is also seeking input on the idea of an Advance Payment ACO Model, which would give certain ACOs access to their shared savings up front so they could build the required infrastructure. For providers wanting to learn more about ACOs, CMS is offering four free Accelerated Development Learning Sessions beginning in June.
Innovation and Research
Of the 75 operational RHIOs in the US, only 13 meet the basic criteria for Meaningful Use (e-prescribing, clinical data exchange, quality reporting) according to Harvard researchers. I don’t have access to the study, but apparently the findings are based on data from 2009 (so old they use the term RHIOs, apparently). Surely there’s been some improvement since 2009. If you’ve seen the full report, please share your insights.
JAMAreports that the use of telemedicine in ICUs reduces mortality rates and length of stay.
The New Zealand government awards a $252K grant to Vensa Health to conduct further research related to its mobile health reminder system. The company recites an impressive list of technology features, but like just about every mobile health vendor, they have no evidence showing that their product is effective in improving health. Like Bill Gates told me at lunch once (well, OK, me and a huge ballroom full of people at the mHealth Summit), reminders and education don’t necessarily work when it comes to wellness – plenty of fat people own bathroom scales.
Other
I got another “urgent news” e-mail blast today from one of the rags that reinforces my argument that most industry publications either (a) can’t distinguish real news from press releases, or (b) don’t care as long as it draws readers and advertisers. Today’s hot news: a bond rating agency issued a press release claiming their study correlated use of advanced IT to hospital profitability and quality. I downloaded the “special report” from Fitch Ratings and it was, as I expected, not worth the excitement, being even less methodical (and therefore even less useful) than the Most Wired survey. Here’s a summary.
The bond ratings company looked at only the 291 hospitals that use its services. That’s out of maybe 6,000 US hospitals – a tiny, non-randomized, non-representative sample that excludes for-profit and government facilities.
They checked Leapfrog, Baldrige, and Healthgrades and found that 75 of their clients had won a quality award (all awards are created equal in drawing room studies like this that just match Readily Available Data Set A with Readily Available Data Set B).
They checked with HIMSS Analytics and found that 24 were at EMRAM Stages 6/7 (ignoring all other forms of IT except inpatient clinical).
Apparently disappointed to find that only 12 of the 24 EMRAM 6/7 hospitals had won quality awards, they invented an excuse related to “the evolution and maturation of how quality is measured.” (maybe that should have been the headline – that half the hospitals who reached IT Nirvana haven’t won even one major quality award as a result).
They found that richer hospitals won more quality awards and had more IT (neither of which necessarily has anything to do with patient outcomes).
They looked at utilization trends and concluded that higher IT hospitals (meaning richer ones) are improving, although they did not look at their absolute performance (meaning a hospital could still be terrible as long as it’s less terrible than before).
The bottom line: even if the bond ratings firm had conclusively proved any kind of relevant correlation (which they most definitely did not), that still wouldn’t have proved causation. The implicit message in running this yawner of a study as real news is that everybody now has the justification to buy more IT, which is an absurd conclusion for an industry that somewhere down deep is supposedly based on science.
Speaking of questionable studies, here’s another one: do seven percent of doctors really use video chat in patient care? I’m not interested enough to buy the company’s report to evaluate its methodology, but I would have to bet that they surveyed a disproportionate number of telemedicine physicians or tele-ICU intensivists. Most docs won’t even e-mail patients, much less fire up a Skype session for a leisurely and probably unreimbursed Webcam chat.
Quality IT Partners, Inc. announces its Facebook launch featuring a dedication to the Scott Hamilton Cares Initiative, including a song and video written and produced by the company.
Sponsor Updates
Sonoma Valley Hospital (CA) picks ProVation Order Sets.
BridgeHead Software will exhibit at the 2011 International MUSE Conference May 31-June 3 in Nashville.
Emdeon introduces Emdeon Audit Advantage, which will provide real-time prescriber eligibility and patient coverage alerts to pharmacies. The company also wins a five-year GSA contract that allows it to offer products to over 90 government entities.
Imprivata announces GA of OneSign Anywhere for authentication and single sign-on for remote and mobile users.
Delta Health Alliance, one of the country’s 17 Beacon Health communities, collaborates with Medicity to connect participating physicians and hospitals.
Daughters of Charity Health System (CA) expands its partnership with Passport Health Communications and adds three additional RCM solutions from Passport’s eCare Patient Access Suite.
McKesson medical director David K. Nace, MD is named first vice chairman of the board of directors of the Patient-Centered Primary Care Collaborative.
Practice Fusion says it has grown from a team of four in 2007 to 75 today. The company is expects to reach 150 employees by the end of the year and is seeking new office space.
MyHealthDirect assumes a silver-level sponsorship for the 19th Annual Medicaid Managed Care Congress this week in Baltimore. CEO Jay Mason will also participate in a panel discussion on ACOs and patient-centered medical homes.
API Healthcare publishes a whitepaper entitled Achieving Quality of Care and Controlling Costs, which includes best practices for workforce automation.
Concerro creates a Mac versus PC parody that compares healthcare scheduling solutions with paper-based systems.
The City of Philadelphia selects eClinicalWorks to provide an EHR/PM solution for the Department of Public Health, which includes 230 providers and 20 primary care and correctional clinics.
JEMS Technology announces a rental program that allows hospitals to provide smart phone video consultation capabilities (JEMS Consults) to their physicians starting at under $1,000 per month.
From Former CIO: “Re: high price of Epic. In my experience, the price of Epic software is competitive with others (at least the big guys). The difference is that they drive the customer to look at the true cost of implementation and plan for the resources, internal and external, training, etc. The other vendors hope you won’t actually add it all up until you sign the software contract. This is the best part about Epic since it gets the organization to accept the budget, even if difficult. If you are not prepared to spend the money then they may walk away. In the end, Epic is not necessarily more costly than the others would be.” An excellent reminder that I often need. Software license fees are often nearly irrelevant to overall project cost, especially on the often-forgotten cost of internal labor. It would be interesting to survey recently implemented hospitals to find out how implementation budget overruns correlate to specific vendors.
From Judy: “Re: couldn’t resist telling you. I have yet to receive an e-mail from iHealthBeat, HDM, or whomever that had a news flash I hadn’t already seen on HIStalk. Time to unsubscribe from these eJournals promising the latest, greatest news. Keep up the good work (although I do worry about you, truth be told) and help me SIMPLIFY my life! You should have NO doubts about your impact on this industry and I am SO proud of you!! Really.” I’m moved by that. From my vantage point, HIStalk has been eight years (as of June 20) of long evenings and weekends in an empty room, seven days a week (check out the count of my “sent” e-mails above from my HIStalk-only account). Comments like this keep me coming back, even though I’ll probably wonder on my deathbed what the heck I was thinking in spending all this time on what is basically a spare time hobby. At the moment, I’m still having a ball.
From IT Director: “Re: Siemens. At the recent Siemens Medseries4 User Conference in Salt Lake City, it was nice to see a strong message from Siemens leadership that Medseries4 is a go-forward strategy for Siemens. A recently approved five-year development plan increases focus on development already well under way on both the Clinical and Patient Financials as well as a much anticipated ‘spruce up’ of the General Financials. Also touted was a commitment to enhancing the integration of surround applications such as Pharmacy and EDM. This, combined with UHS’s (Universal Health Services) recent commitment to install Medseries4 in all 106 of its newly acquired facilities is certainly a positive note for Medseries4 customers.”
From Your Favorite Uncle: “Re: Lakeland in Michigan — confirmed. They are going up with Epic ambulatory at the end of the summer and inpatient at the end of the year.” Thanks.
From Nasty Parts: “Re: TSI Healthcare in NC. I hear they have been acquired. They are NextGen’s largest VAR.” Unverified.
From HealthCareIdiotSavant: “Re: healthcare IT stocks. My broker has found nothing other than the usual suspects and none of them are rated all that good. Would be interesting to have your investment banker dude weight in on investing in a fund or a reasonable combination of individual stocks, wit no promises or guarantees, of course.” I actually have quite a number of investment banker dudes (and maybe some dudettes) as readers, so if any of them care to advise (anonymously if desired), I’ll let you know. As you’ve found, not all that many pure HIT plays are publicly traded, though.
Poll respondents: next year will be the big HITECH hump for vendors. New poll to your right: do you trust CMS to accurately collect and report provider and quality data?
My latest Time Capsule editorial that hasn’t seen daylight since 2006 and even then only to print newsletter subscribers: Hospitals Need to Learn from Failed Transformation Missions. A snip: “Sometimes imaginary victory is declared at the HIMSS conference, proclaimed by ventriloquist vendors whose lips barely move when their customer speaks.”
Thanks to the following sponsors (new and renewing) that supported HIStalk, HIStalk Practice, and HIStalk Mobile in April (sorry it’s a long list this time, but there’s always a lot of activity right around HIMSS). As a non-professional part-timer, I’m humbled to see this impressive roster of supporters, especially since it represents just a four-week period. Click a logo for more information.
Ohio Valley Medical Center (WV), embroiled in a lawsuit with its former CEO, claims he struck secret deals with doctors that paid them exorbitantly and also diverted all the money from its endowment fund. The health system is laying off employees and says it is “tens of millions of dollars in debt.”
Congratulations to John Halamka, named a full professor at Harvard.
Healthcare Interactive, a Maryland-based vendor of something to do with the cloud that’s impossible to figure out from their buzzword-loaded Web site, looks to raise $10 million. Take your guess from this list of adjectives on their home page: suite, actionable, portal, stakeholders, transparency, engagement, cloud, and workflows. Or maybe this simple description from the CEO’s bio makes it crystal clear: “SaaS-SOA healthcare operating system (H-OS) framework leveraging an Inheritance-based Organic Network architecture using a unique combination of identity management, knowledge management and an application framework on a single cloud based environment.” Ready to sign up?
The next fun history lesson from Vince Ciotti, this time covering the 1960s development of “clinical” software, featuring Kelly Girls entering information dictated by nurses who didn’t know how to type.
Microsoft’s Bill Crounse, speaking in Hungary, gives examples of IT systems that are transforming healthcare: the Healthcare.gov Web site, NHS Evidence, and HealthVault. None of these have had any impact whatsoever on me or anyone I know (and Microsoft has a financial interest in at least two of the three), but I’ll give him the benefit of the doubt.
I’m intrigued by recent top executive hires by Siemens: John Glaser (Siemens Health Services Business) and Greg Sorenson (Siemens Healthcare), both brought in from non-profit Partners HealthCare with no business experience and immediately placed in CEO roles. Contrast that with GE Healthcare Systems, who chose as its top executive last week an internal candidate whose background is automotive, finance, and aviation with no healthcare experience at all. That’s a striking difference in philosophy from conglomerates that offer similar products and services. I have to say that as a customer, I like the Siemens approach a lot better — the idea that provider people who care enough about patients to work for a non-profit might bring something to the table that a circuit-riding GE lifer executive doesn’t.
Here’s the TEDxTHR talk of Ed Marx from this past Friday.
CMS gives General Dynamics a five-year, $95 million contract for claims processing support.
Clinical documentation system vendor Salar makes Fortune’s list of 100 fastest-growing inner city businesses with a 27% annual growth rate over the past five years. It’s in the Fells Point waterfront area of Baltimore.
Don Good, former NextGen Practice Solutions regional president, is named president of Talascend Healthcare, a newly created division of the technical professional placement firm.
VA CIO Roger Baker, who advocates an open source approach, tells a House committee that replacement of its VistA system with commercial software would cost $16 billion. But in a good example of bad timing, the GAO says the VA’s historically weak project oversight caused a $127 million appointment scheduling application to fail.
Reader Comments
From Court Jester: “Re: Society of Hospital Medicine. Here’s a picture of the action at the SHM meeting.” The action looks a bit light, but perhaps the picture is deceiving. SHM expected 2,500 physicians to attend the four-day event in Dallas.
From Bmore: “Re: Johns Hopkins. I know they have an old version of Epic scheduling, but has Epic always been its own job category? Or is this a sign of something to come?” I’d speculate B, despite no announcement so far. One thing I’ve learned about Epic: there isn’t always that dramatic moment of taking the two vendors of choice down to one and then heading off for extended contract negotiations, followed by the big public lovefest. Somehow, everybody sees the Epic demos and just assumes it’s a done deal, often gearing up for the project even before a contract is signed. I thought Cerner’s Vision Center was the ultimate mass hypnosis selling machine until people started telling me about being bewitched by Epic, with any IT-advocated precautions thrown to the wind as the operational people salivate at kicking out the incumbent vendors at any price and maybe taking down what they see as an unresponsive IT department along the way. That may just be my inaccurate perception, so please weigh in if you’ve been run over by the Epic train at your place.
From BadgerGrandma: “Re: Epic. A few weeks ago, attendees at Epic training were told that this was the biggest week ever, with over 1,000 people onsite for training.” It would be an interesting case study to review how formerly tiny, privately held Trojan horse Epic came late to the inpatient game, then in less than 10 years, totally ate the lunch of everybody in their target market of large academic medical centers. Cerner gets an occasional sale and Allscripts is doing recently better than Eclipsys did at selling Sunrise (which isn’t saying a whole lot), but that’s about it, at least unless the only hope of a worthy contender (Soarian) can move from nice idea to significant sales. It violates every economic principle that competitors haven’t developed something equivalent or superior to Epic without its high price. They’ve just handed the market over to Judy without a whimper, with customers happily plunking down dozens or hundreds of millions of dollars, in some cases replacing systems whose contract ink is barely dry.
From Just a rumour: “Re: Epic. Heard that Lakeland in St. Joe, MI signed up. No reference on their site.” Unverified. Actually, I’ll call it verified since I found the item above in their physician newsletter.
From Rodeo: “Re: hospital hiring. Are they going crazy? I’ve had 10 calls and e-mails from recruiters who dug my resume out of the dungeon – it isn’t posted anywhere. Is May 1 a significant date?” My phone is ringing a lot too, and I dread new LinkedIn connection requests because they’re always from recruiters (my magnetism is apparently entirely occupational).
From Clyde Dale: “Re: Siemens. A. Gregory Sorensen, MD. Director, Center for Biomarkers in Imaging Associate Director, Martinos Center for Biomedical Imaging at Mass General. Going to Siemens to head up Med for US/ Canada.” Verified by Siemens.
HIStalk Announcements and Requests
Welcome to new HIStalk Platinum Sponsor Practice Fusion, vendor of the free, Web-based EHR that Brown-Wilson’s Black Book ranks as the #1 EHR product in customer satisfaction among primary care specialties. The company announced last month that its product is now used by 80,000 medical professionals managing 10 million patients, with another one million patients being added monthly. They say “Live in Five,” meaning users can start charting within five minutes of signing up, using the provided test data for practice if they want. Total cost is $0, which includes patient import, specialty modules, lab integration, scheduling, billing, a connected PHR, e-prescribing, and free unlimited US-based support. Thanks to Practice Fusion for supporting HIStalk.
Here’s a Practice Fusion video I found on YouTube, with a user (and Desert Storm veteran – thanks for your service, Doc) doing all the talking.
I mentioned that I would be showcasing (at the suggestion of readers) small, innovative companies you might not hear about otherwise. Around 40 companies applied, my volunteer committee (provider, investment banker, financial services VP) chose nine to participate based on size and perceived level of innovation, and I have the first one nearly finished. The end result will be a company profile, interview, customer statement, and a pitch video. I was already overwhelmed, devoid of free time, and definitely not looking for new work, but this seems worthwhile.
The things you do for love (of HIStalk, hopefully): (a) sign up for e-mail updates to your right, giving me direct access to your brain jack so I can project my electronic power of suggestion; (b) send me news, rumors, secret documents, comments, and guest articles; (c) connect with HIStalk, Inga, Dr. Jayne, and me on your favorite social not-work; (d) peruse with wide-eyed wonderment the mosaic of ads of sponsors who support the “HIT information wants to be free” concept by supporting my endless toil, and who would greatly appreciate in return clicks and/or consideration if you are in the market for that which they offer; and (e) beam occasional positive karma our way since we don’t go public with our fears, mistakes, and disappointments, but we’re loaded with them just like everybody else. And for you, a double-barrel index finger point (I’m thinking Isaac the bartender on Love Boat since I’ll be mentioning Doc down the page) — thanks for reading.
Acquisitions, Funding, Business, and Stock
Cerner will acquire Resource Systems, the 30-year-old Concord, OH company that sells CareTracker, an electronic documentation system for skilled nursing and assisted living facilities.
HCA launches Parallon Business Solutions, a business services subsidiary that will offer services for revenue cycle, workforce management, supply chain, and group purchasing.
Secure healthcare network vendor Ability Network (formerly VisionShare) closes on nearly $20 million venture capital, led by Lemhi Ventures and Bain Capital Ventures.
Cleveland Clinic spinoff Explorys closes $11.5 million in Series C financing. The company’s cloud computing data warehouse aggregates and curates EHR data from multiple systems to allow population analysis, with customers that include Cleveland Clinic, MedStar, Summa, and MetroHealth.
Sales
Anthelio Healthcare Solutions (formerly PHNS) contracts with MedQuist to implement its DocQment enterprise platform at eight of its client hospitals.
The New York City Health & Hospitals Corporation signs a five-year, $20 million support contract extension with QuadraMed for the QCPR inpatient clinical system.
People
GE Healthcare’s Health Systems division CEO Omar Ishrak is named chairman and CEO of Medtronic, replacing the retiring William A. Hawkins. He’ll be replaced at GE by Tom Gentile, moved over from GE Aviation. The division sells medical technology, such as CT, MR, life support systems, and home health. GE also announces that it has created a new business called Global Services that will take over GE Healthcare’s services strategy, to be led by North American services leader Mike Swinford.
Announcements and Implementations
Business analytics software vendor SAS forms the SAS Center for Health Analytics and Insights, an internal incubator that will focus on applying analytics to patient data with the goal of improving healthcare quality and lowering cost. Areas of interest include evidence-based medicine and cost analysis. To which I’ll also add for you PR types: this is how press releases should be written — short, straightforward, chunked into easily readable paragraphs, and not turned into mind-numbing mush by overzealous, trademark symbol-wielding marketing people determined to collectively suck the life out of what started out as something interesting.
Corepoint Health’s integration engine receives ONC-ATCB Modular Ambulatory EHR and Modular Inpatient EHR certification.
Crystal Cruises goes live with Emergisoft Maritime, an EHR specifically for cruise ship crew and guests. I’m picturing the sleazy, shorts-wearing Doc from Love Boat (c’mon, you know you want to sing it with me: “Loooove, exciiiiiiting and new …”) having even more time to letch around with bimbettes half his age, apparently unrestricted out there in international waters of any ethical or legal concerns that would prohibit him from putting his smoove moves on patients.
Government and Politics
CHIME and AMGA announce their opposition to several provisions in the proposed ACO rule. CHIME objects to a privacy provision that would allow patients to opt out of data sharing while maintaining their ability to see primary care physicians within the ACO. It also takes issue with the requirement that 50% of an ACO’s primary care providers must meet MU standards by the ACO’s second year. Meanwhile, AMGA says 93% of its members would not enroll in an ACO based on the proposed framework, which AMGA considers “overly prescriptive, operationally burdensome.” Top concerns center around risk-sharing, static risk adjustment, retrospective attribution, quality measurement, and minimum savings.
In the UK, Prime Minister David Cameron says the government may cancel some or all of CSC’s $5 billion contract to install iSoft’s Lorenzo. CSC has been threatened previously for missing deadlines, and if it finally gets the boot, only BT will be left of the original four big contractors (Accenture and Fujitsu already bailed and were fired, respectively).
Innovation and Research
A University of Arizona study finds that 72% of the software used by retail pharmacies in the state cannot detect all significant drug-drug interactions.
Other
Thirty-four percent of all office-based prescribers were using e-prescribing by the end of 2010. Cardiologists had the highest adoption rates (49%) followed by family physicians (47%.) Providers created 326 million e-prescriptions in 2010, up from 190 million in 2009.
The Triangle/Eastern NC Chapter for the Juvenile Diabetes Research Foundation recognizes Allscripts and EVP Diane K. Adams, who along with CEO Glen Tullman, has family members with juvenile diabetes. Allscripts has contributed over $1 million to JDRF since 2004.
Weird News Andy celebrates what he calls “the breast app ever!” A plastic surgeon develops an app that uses 3D imaging to allow prospective breast implantees to visualize their new protuberances, followed by easy posting of the “check these out” pictures directly to Facebook so that cyber-acquaintances, business associates, and elementary school aged nieces and nephews can weigh in on the proposed alterations.
This came in my work e-mail from some vendor. Somehow I don’t have a lot of confidence in their “HIPPA” wisdom.
SCI Solutions provides laptops and cash donations from its employees to a project run by some surfer buds (one of them SCI SVP Vinnie Whibbs) and some non-profits to provide resources to students and for community projects at Playa Gigante, Nicaragua.
The LBJ School of Public Affairs and the Patient Privacy Rights Foundation will hold the one-day Health Privacy Summit: Getting IT Right: Protecting Patient Privacy in a Wired World on June 13 in Washington, DC, a public forum to address health privacy. Speakers include quite a few folks from government and academia, along with HIT-recognizable names Barry Chaiken (former HIMSS board chair and Imprivata CMO), Mark Frisse (Vanderbilt), Deborah Peel MD (founder, Patient Privacy Rights), Joy Pritts (chief privacy officer, ONC), Michael Stearns (president and CEO, e-MDs), and Latanya Sweeney (the Carnegie Mellon professor who proved that it’s not that hard to re-identify de-identified data when you match it up to a second database). Registration is $100 general, $75 government or academic, and $50 for students. I’d go if it wasn’t tough to get time off from work on relatively short notice, so if you’re attending and want to report from there, do it.
A coroner in Australia rules that a woman’s death after gall bladder surgery was due to medical error. Her gall bladder had been removed 10 years before, but radiology staff misidentified intestinal gas bubbles, the surgeon overlooked the medical history entry about her previous surgery, and everybody noticed but nobody questioned the scar on her abdomen. She died of post-surgical sepsis. Her granddaughter says she hopes the medical system will change so that clinical documentation is shared among physician practices and hospitals.
Sponsor Updates
Onze Lieve Vrouwe Gasthuis hospital in Amsterdam deploys iMDsoft’s MetaVision to provide tele-intensivist monitoring.
Moore Regional Hospital (NC) picks ProVation MD for gastroenterology procedure documentation and coding.
CareTech Solutions launches iDoc Savings Calculator, which estimates savings from implementing its iDoc document imaging and management product.
Universal American Corp., a Medicare health benefits company, collaborates with NextGen to offer participating physicians access to NextGen’s EHR in multiple markets
The Texas e-Health Alliance appoints ICA CEO Gary Zegiestowsky to its board.
The Centre hospitalier Pierre-Janet in Quebec adopts the Vocera voice communication system.
DIVURGENT announces new hires: Matt Curtain (client services VP), Sarah Rourke (recruiter), and Christina Pena Jones, DHA, (nurse educator).
Nashville-based iPractice Group will resell Greenway’s PrimeSUITE.
EPtalk by Dr. Jayne
The Centers for Medicare and Medicaid Services (CMS) recently launched the first phase of its Physician Compare Web site, which is supposed to display physician address information, medical education, credentials, gender, etc. as well as whether physicians reported quality data to CMS.
Like any good Internet junkie, I of course had to search myself. Not surprisingly, my listing has errors, as does the listing which appears below mine alphabetically (it happens to be a former colleague of mine whose details I know as well as my own).
My listing includes a practice address where I haven’t provided patient care for more than four years, as well as practices where I have never provided care. There’s even a location listed for me that belongs to a practice that used to be owned by my group, but was sold more than a year ago.
This does not give me great comfort in the skills of CMS to accurately portray my ability to report quality data (especially since they can’t accurately portray my address). Phase Two of the site will launch later this year and identify whether physicians are e-prescribing or not. Quality data will be available by 2013. I hope in that time frame they can figure out where I practice.
Speaking of government, for those of you who missed it, Newt Gingrich is officially seeking the Republican nomination for President. Gingrich has been dabbling in the healthcare space for some time, largely through his for-profit Center for Health Transformation (CHT), so this should be interesting.
CHT has a white paper about Accountable Care Organizations that features some well-known examples of ACO-type organizations. It’s pretty basic, but a decent read for those that need a quick study of ACO 101.
Newt’s proposed healthcare reforms are detailed on his Web site and include rewarding quality care, incentivizing health behaviors, stopping fraud, and educating patients on price and quality. For those of us in healthcare IT, the good times will continue to roll as there is more and more focus on data mining to support these efforts.
By the time the 2012 election rolls around, I’ll be sick and tired of the politics along with everyone else. On the other hand, I won’t have to worry about having enough material for HIStalk. Round and round health reform goes; where it stops, nobody knows!
Termination Means Never Having to Say You’re Sorry, Right?
A good learning situation sprang to the forefront of my creative thoughts the other day. I was representing a great EHR vendor (a great client and a great EHR) in a substantial deal and ran into a surprising request from opposing counsel regarding the default / termination process and procedure. In the end, the issue was resolved quite simply and quickly by taking a different path, but I will save that for the end.
The provider / customer side did a very good job of establishing certain milestone events, such as the operational date for e-prescribing, the vendor’s EHR certification deadline, and go-live for the then-certified EHR. Kudos to them because they set the bar precisely where they needed it. The vendor realized the importance and accommodated.
You can guess where this is leading. Failure to meet a milestone event gives the client the option to terminate.
A very straightforward default procedure was included in the standard vendor agreement — one party provides written notice to the other regarding any alleged default, then the supposedly defaulting party has 30 days to cure the problem. If the problem is not cured at the end of the 30-day period, the party that alleged the default has the option to terminate the agreement.
Termination was specifically addressed to include terms such as:
All licenses granted terminate and all rights automatically revert to the granting party
Payments due at date of termination must be made within 30 days of termination
Each party returns the other party’s confidential information, including the software and all associated documentation
Simple, no? No.
The other side wanted to bifurcate the issue and create two sets of “termination” procedures. The first (same as above) required that all licenses and rights granted under the agreement return to the grantor and the agreement terminates. Everything is over and done and the parties go their separate ways. The second proposed that there were conditions where the agreement could be terminated due to certain actions of the customer/user, but that the EHR software would remain in use by the customer/user.
It took two document turns, some polite but blunt e-mails, and two conference calls to assure the negotiators on the other side that there was no scenario under which the license could be terminated and the customer could retain use of the software.
For those of you shaking your heads in amazement, there was credible rationale behind the request, which was basically, “We understand the need to terminate absolutely in most situations, but we don’t want the vendor to be able to walk away for seemingly small issues that could rise to the level of default.”
The conversation between us attorneys at the end went very quickly. If I would add language stating that termination of ongoing maintenance support is at the customer’s option, and that terminating maintenance will not terminate the licenses and other rights granted under the agreement, then we would be all set and the default / termination provision would be acceptable as drafted.
That was it. All we needed was a clarification on maintenance cancellation and the whole issue was put away.
As for me, familiarity with an agreement sometimes begets a comfort that anyone picking up the agreement immediately adopts your perspective and interpretation of the terms and conditions. Not always the case — sometimes I need a reminder.
Lessons for the Day
In the SaaS model, there is no separate license fee and maintenance fee. Both are rolled into the recurring subscription fee. Termination means termination. Everything is over. No access to the software, no service, no maintenance.
On the other hand, in the perpetual license model, the ongoing maintenance features and obligations can be cancelled separately.
Note that I used the term “cancellation” to make a point. The customer in this model pays the fee for perpetual use of the software. Cancelling maintenance does not (should not) alter in any way or manner the license of use previously granted to the client. But general termination is the same in both models — terminate the entire agreement and you terminate use of the software.
Finally, what you believe is plain understandable language might not be to everyone. So keep the terms (and with respect to termination, options) clean and clear in your agreements. It saves time and money up front and in the long run by eliminating confusion.
Please note the above was intended to be short and sweet. There are many other issues that pertain to termination, such as transition services, data extraction, and historical system access — the list goes on. My point is straightforward. Keep it clean, clear, and above all, understandable. If termination, then XYZ.
Q2 numbers for Nuance: revenue up 17%, EPS $0.01 vs. -$0.05. Revenue was up 13% in healthcare, its largest segment. The company announced that it will acquire document management and print management solutions vendor Equitrac for $157 million in cash. NUAN shares hit a 15-year high Monday on rumors of a potentially expanded relationship with Apple.
Reader Comments
From MEDITECHer: “Re: Howard Messing. Wins the town’s annual award.” Meditech’s president and CEO wins the annual community service award from Town of Westwood, MA, where he has lived for 21 years and for which he has served on several committees and provided technology expertise. Meditech long-timers are definitely give-back types.
From ArkieHorn: “Re: JPS Health Network. The CIO resigns only a few months after taking on the full-time role from his interim role. The tax-supported hospital in Fort Worth selected Epic to make MU in 2009. Rumor has it they contracted with Accenture for a CIO to manage the Epic project … also being implemented by Accenture. The fox is in the house.” Unverified.
From Anonymister: “Re: Alameda County Medical Center, Oakland, CA. A nice article on turning around a failing public hospital.” Fast Company profiles ACMC CEO Wright Lassiter III and calls him a “medical wonder” in turning around the “shockingly mismanaged” inner city hospital (as its tenth CEO in 11 years), which is mostly remembered for a patient beating one of its doctors to death and “nurses who followed doctors’ orders only when they felt like it.” Lassiter brought in a new management team, cut costs, fired underperformers, and got union concessions (and signed up for Soarian, as we just mentioned). I like that he holds an MHA instead of the more common and less healthcare-specific MBA. His stated goal:
I want to make this place as good or better than the private hospitals. I believe ACMC has to be a real third choice in this community, a place where an elected official or a corporate executive would come for care. It’s not just the quality of medical service; it’s the helpfulness. Are people looking you in the eye and saying, “What can we do for you?” — anticipating your needs, instead of saying, ‘’Just go in the corner and wait. We have too many people to deal with today.”
From Coolio: “Re: physician practices. There is strength in numbers. It is hard for an independent physician to leverage size while negotiating reimbursement contracts (and even larger organizations often do not use their decision support applications well in determining whether a contract makes sense). Independent physicians are just at a disadvantage when dealing with payors. Plus, is it really worth being on call every night or every third night? And not being able to spread back office costs among more providers? That is a question for physician to face. (And it’s the primary care doc who usually loses out.) For years and years, hospitals have focused on physician outreach and links/alliances (for referral business). Software apps are one of those links. Why would a physician want the headache of implementing an EHR with clinical content tailored to her practice when she could share the cost of it?”
From The PACS Designer: “Re: using iPhone for dictation. Another iPhone app that looks interesting is one that provides dictation capabilities. Not sure how accurate it can be, but with the development of an iPhone dictation platform by Integrated Document Solutions called Voice2Dox, it’s probably worth a try in clinical applications.”
HIStalk Announcements and Requests
I thought it odd that Reuters cited “particularly weak” Medical Manager sales in its review of Sage Healthcare’s recent performance. I didn’t think Medical Manager would have that much influence considering that Sage’s go-forward product is Intergy, but I figured Reuters must know something I don’t. Turns out they don’t — my Sage executive contact tells me that Medical Manager hasn’t been actively sold for quite some time, even though Sage continues to support and enhance it. I’m not sure what Reuters was thinking.
Listening: Shinedown, Leave a Whisper. Solid, radio-friendly hard rock from Jacksonville, FL.
Acquisitions, Funding, Business, and Stock
Elsevier acquires Fisterra. com, a Spain-based clinical reference solution.
Microsoft will acquire free phone calls software vendor Skype for $8.5 billion, its largest acquisition ever. My reaction: (a) they’re paying way too much for a company that has always managed to lose money even with high penetration and big revenue, maybe just because they didn’t want Google to end up with it; (b) most Skype users don’t pay anything, and have plenty of free alternatives to prevent MSFT from simply charging for its use, so the best use of it will be as an add-in to other MSFT offerings; (c) it’s kind of bittersweet to remember when Microsoft was the brash innovator instead of the cash-rich, reactionary follower (remember when they wanted to pay eye-popping dollars to buy the hoarily irrelevant Yahoo, which has dropped something like two-thirds in value since then?); and (d) as an occasional Skype user (I use it for doing interviews) and I hope they don’t mess it up.
I’m suddenly getting e-mails from some pay-membership site aimed at healthcare CIOs, but apparently written by folks with limited understanding of healthcare IT and English as a first language. Here’s a sample: “Wolters Kluwer’s Buys Lexicomp: An Acquisition of Importance to The Realm of Meaningful Use. Wolters Kluwer Health (WKH) acquired Lexicomp. What is the big deal? Why is this any different than say Allscripts and Eclipsys?” It misspells both company names in the headline, mangles punctuation in several creative ways, and throws in some truly puzzling choices of wording (you don’t often see “What is the big deal?” in an article aimed at executives – that odd wording made me immediately think of SNL’s wild and crazy guys, “After all, there is no other pair of Czech brothers who cruise and swing so successfully in tight slacks!”). The graphics are randomly chosen stock photos (like a Meaningful Use analysis featuring the Jefferson Memorial). The site takes great pains to provide no information about who owns it, where it’s located, or what the annual subscription costs (even on the signup form where you’re committing).
Sales
Muenster Memorial Hospital (TX) picks Custom Software Systems’ ChartSmart Electronic Medical Record for its critical access facility.
St. Joseph’s Hospital Health Center (NY) contracts with MedQuist for clinical documentation outsourcing services.
Advocate Trinity Hospital (IL) will use PerfectServe’s clinical communication system.
Dallas Medical Center (TX) chooses HMS’s EHR and remote hosting services from its HMS Direct subsidiary.
People
Netsmart Technologies names former Cerner EVP/COO Michael Valentine as CEO. He replaces the retiring James Conway.
iSirona appoints Polly Mulford, formerly of AHA, as VP of account management.
Cape Regional Medical Center (NJ) appoints Dianna Derignan, MD to the role of CMIO.
Precyse names Chris Powell to the newly created position of president. He was previously with GE Healthcare and IDX.
Former Hillcrest Medical Center (OK) CEO Steve Dobbs joins the board of advisors for PSCI, a provider of analytics and decision support tools.
Billing service provider MedData names Frank B. Murphy to is board. He is president and CEO of Perimeter Health Advisors and was formerly president and CEO of HealthPort Technologies.
I see from my LinkedIn updates that HIStalk friend Mark Andersen, former CIO at Yale New Haven who I think is doing consulting work now, is interim chief technology and health information office at University of Virginia Health System.
Announcements and Implementations
PwC earns top ranking in a new KLAS report on extended business office service firms, followed by Firstsource (MedAssist) and Deloitte Consulting. Providers said the most important factor in selecting and keeping a vendor is, not surprisingly, its ability to keep receivables low and cash collection high.
CSC announces that it has brought all prisons in England live on the SystmOne clinical software.
Other
A Florida woman diving for coupons in a recycling bin finds a variety of paper records from an oral surgeon’s office that contain medical histories and Social Security Numbers. The doctor could be penalized even though the documents were placed in the recycling bin in error. Quote from a patient: “Thank God for the coupon lady. Without her, anybody could have gotten their hands on this."
A hospital volunteer sues Longmont United Hospital (CO) after being hit by a food cart during her shift, causing a fall and a compression fracture. She wants more than $100,00 to cover medical expenses and “loss of enjoyment of life.” I personally have felt compelled to sue various folks (a couple of ex-boyfriends come to mind) for loss of enjoyment of life, but never took action.
Sponsor Updates
Culbert Healthcare Solutions hires Jeff Wasserman to lead the company’s strategy and executive services team. He was previously with The Bard Group.
Southeast Eye (GA) selects NextGen EPM PM and EHR for its eight-location practice. TSI Healthcare will provide implementation services.
Surgical Information Systems (SIS) recognizes four clients with its 2011 SIS Perioperative Leadership awards for significant advancements in operational, financial, and clinical initiatives. The company also announces that Huntsville Memorial Hospital (TX) has selected the SIS system to interface with its current Meditech HIS.
The Ohio Health Information Partnership selects Medicity to create the technology infrastructure for its CliniSync HIE.
e-MDs is named a Tier 1 EHR vendor by the Kansas Foundation for Medical Care, the REC for the state of Kansas.
Allscripts makes a strategic investment in clinical analytics company Humedica. The companies will collaborate to market Allscripts Clinical Analytics Powered by Humedica, a new module which Allscripts will integrate into its acute and ambulatory EHRs.
MED3OOO wins 2011 top honors in customer experience and satisfaction among all EMR systems focusing on multispecialty clinics. Other top performers include NextGen Healthcare, Allscripts, Dr. First/Rcopia, Sage, Epic Systems, LSS Data, and Greenway Medical.
Childs Medical Clinic (AL) successfully attests as Greenway Medical’s first client to receive payment for Meaningful Use.
From Ralph Hinckley: “Re: [vendor name omitted] acquisition. Announcement coming very soon on a core HIS vendor acquisition.” Just for fun, above is a tiny bit of the logo of the company supposedly being acquired (left) and that of the acquirer (right).
From CMIO: “Re: Apple iPad 2 commercial. The medical app shown is almost certainly Great Connection, a Swedish company partnering with Qualcomm.” The company’s site says a hospital can deliver and receive medical images with nothing more than an Internet connection to its cloud server that takes five minutes to connect to an ultrasound machine, allowing them to be sent (encrypted and authenticated) to a smart phone or e-mail. It also says that a US entity was founded in San Diego and took over the Swedish entity in the spring of 2010. It also notes that the product is available in a white label version to mobile operators that want to resell healthcare images and related services to consumers.
From Lucite: “Re: Nuance. As a stockholder in both companies, this would be exciting!” Some rumors suggest that Apple will buy Nuance, while others say an expanded partnership is more likely, with the impetus for either being Apple’s interest in including speech recognition technology in the upcoming release of iOS 5. Nuance has a market cap of $6 billion, with its five-year share performance shown above (Nuance in blue, the S&P 500 in green). Those who timed their NUAN purchase just right by buying on the December 2008 dip would have tripled their money in just over two years, and surely will do even better if either rumor is correct.
From Epic Alum: “Re: Epic non-competes. Legal and enforceable or not, Epic has no-hire agreements with clients that they don’t tell you about in the exit interview. Those seem seem to prevent you from working with Epic clients through third parties, including those that aren’t Epic partners (but you might have better luck than I did). Even if you got a job or contract, Epic will instruct its employees to ignore your phone calls, e-mails, and questions at meetings, which would make your job all but impossible. I’d be concerned about retaliation from Epic when it comes to getting and maintaining certification later, although I don’t know for sure that they blackball anyone. As for what you should do now, every else (a) goes to grad school; (b) does non-Epic programming work if they’re a programmer; (c) does non-Epic healthcare consulting; or (d) works outside of healthcare. There will be plenty of work next spring. Advice to prospective employees, most of which are in their first real post-college job with no money saved: when you leave, you will be pretty much locked out of the one industry you have real experience working in.”
From InovaDoc: “Re: Epic at Inova. I wish that IT departments could be more transparent about their decisions. What will happen to those physicians that spent $30K on GE to integrate with the hospital? De-install, then re-install, foregoing their investment?”
A quick poll … please answer if you would be so kind. Thanks. Just trying to get a read on who’s out there.
Listening: Electric Wizard, Dopethrone. I’m the least-likely demographic for this Sabbath-y sludge / doom /stoner music, but I still think it sounds pretty cool. Also: Blackmore’s Night, renaissance faire rock by the former Deep Purple guitarist and the angelic Candice Night. And Watching: Saxondale, a well-made Britcom about a trying-to-stay-cool 1970s rock roadie turned pest control operator who mumbles his wry, psuedo-intellectual monologues like Johnny Depp’s Jack Sparrow.
I think I may have messed up one of the e-mail blasts Friday night, so apologies if you got something confusing. I put in nine hours at the hospital, ran six miles on the trail, and did another seven hours of HIStalk work after I got home, eating only some peanut butter crackers in the 12 hours from lunch until bedtime. I think the combo of hypoglycemia, slight dehydration, and way too much work made me a little woozy.
My Time Capsule editorial from March 2006 covers open source in healthcare, which I prefaced by promising little: “Since my open source knowledge is right up there with most CIOs and health care executives (I have next to none, in other words), I figured my populist opinions might be as useful as the next guy’s (also next to none).”
An article in last week’s San Francisco Business Times confirms that Alameda County Medical Center (CA) is going with Soarian (clinicals and revenue cycle) and NextGen, with CIO Mark Zielazinski giving the price tag as $75 million, including infrastructure upgrades. The hospital expects to receive $18 million in HITECH money.
Community Health Network (IN) names Ron Strachan as CIO, replacing the retired Ed Koschka. He was formerly SVP/CIO at WellStar.
Valerie Fritz joins the RTLS division of TeleTracking as VP of marketing. She was previously with Awarepoint.
NaviNet promotes Michael Ross MD to chief medical officer and David Kates to SVP of product management and clinical strategy. Both came to the company via its Prematics acquisition in December 2010.
It’s a fairly even split of which company’s stock looks good to readers. New poll to your right: when will vendors see the peak of HITECH-generated business?
Kaiser’s Q1 numbers: $12 billion in revenue, $921 million in profit, up 9% and 30%, respectively. Membership rose by 208,000 to 8.8 million. Considering healthcare costs, I can’t decide whether this news is good or bad, although I’m leaning toward the former since Kaiser is just about the only provider out there showing success in controlling costs without reducing quality.
Two Allina hospitals fire 32 employees, 28 of them from Unity Hospital, for snooping in the electronic records of 11 teen partygoers who overdosed on a synthetic drug. That surely is a record number of privacy-related terminations. Allina says it knew the patients were high profile, so it did an EMR access review afterward and discovered the digital intruders.
Q4 numbers for The Advisory Board Company: revenue up 22%, EPS $0.30 vs. $0.32. Two new programs were announced: Crimson Care Registry, which prompts physicians based on clinical care guidelines, and Clinical Denials Prevention Program, a best practices approach to pre-certification.
Quest Software acquires virtual desktop scanning and imaging technology vendor RemoteScan. RemoteScan has a pretty big healthcare presence in providing a scanning solution for providers running EMRs on Citrix or Terminal Server.
Froedtert Health (WI) cancels its HIM outsourcing contract with Pyramid Healthcare Solutions, offering jobs to all but three of 118 contractors. Pyramid was acquired a year ago by an India-based conglomerate.
Britain’s Department of Health will reduce CSC’s scope of work involved on the NPfIT project, specifically cutting back on work related to the Lorenzo system. CSC is in the process of acquiring Lorenzo vendor iSoft.
An interesting fact in a story about union nurses at Tufts signing a new contract: the average salary of a full-time nurse there is $115K.
Omnicare Clinical Research, a contract research organization, will use the clinical trials and clinical trials imaging solutions of Merge Healthcare in a large-scale clinical trial.
Hopefully, gentlemen, you did not forget either your mother or your wife on Mother’s Day. The entirely logical but ill-advised insistence that that, “Hey, you aren’t MY mother” will greatly increase the chances of experiencing a lonely night in the dark visually tracing said soulmate’s vertebral column.
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 acquiresEquiClaim 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.
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.
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.
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 Journalreports 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.
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 Timesreported 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.
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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 Timesbrings 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.
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Cant you sue the F&B company for fraud if they said they paid you money but never did?