Monday Morning Update 11/21/11

From FunFacts: “Re: Newt Gingrich. The 2010 Cerner Health Conference had a speaker from Newt’s Center for Health Transformation, Melissa Ferguson. Any idea what she talked about?” Newt’s business is getting scrutiny from everywhere now that the dearth of decent Republican candidates puts him in front of the pack by default. The Washington Post says his think tank pocketed $37 million from healthcare companies. Not to mention that HIMSS gave him its Advocacy Award in 2005, admiring his “consistent support and insight for the adoption of interoperable health records” as a “key collaborator and advisor with HIMSS and others on healthcare information technology topics.” CHT has locked down its online membership list, but I mentioned some of Newt’s clients back in 2007: GE Healthcare, Siemens, Allscripts, CHIME, and more.

From From the ONC Annual Meeting: “Re: Epic. In the usability session, Janet Campbell from Epic said the government would need to pay Epic to perform usability safety validation. An audience member asked how much more than $27 billion would be needed. Silence from young Ms. Campbell. Is this an indication of the way the EHR industry (or maybe just Epic) is going to react to the IOM report on HIT safety?” Unverified. The shame is that customers aren’t pressing vendors for improvements. That being the case, I can see the vendors’ point of view: why should they (and thus their customers) be forced to pay for an unfunded mandate for changes that customers aren’t demanding? (much like EHR certification.) 

From Quixotic: “Re: Epic moving into Meditech territory. The board of Poudre Valley Health System has approved the decision to move from Meditech to Epic. This comes right on the heels of the Edwards decision you published last week. Both were Meditech 6.0 sites.” Unverified. Poudre Valley is a Baldrige winner and CIO Russ Branzell (above) is a pretty high profile, quoted on Meditech’s site from 2009 as saying, “being committed to excellence also meant being committed to our Meditech system.” It was just this past January that Russ said PVHS’s Meditech implementation would be complete right about now after spending $30-40 million.

Regardless of whether this item is true, what can we learn from recent decisions that have gone Epic’s way?

• It used to only be Cerner who needed to worry about Epic and even then only with its bigger customers. Now it’s every vendor of inpatient clinical systems and hospitals of every size.
• Epic used to be selective about which customers it would take on. Either it has relaxed the requirements or the demand must be overwhelming given the huge ramp-up of customer count, most of it in last two years.
• As hospitals and practices consolidate, Epic’s footprint grows by default since its large customers are usually the acquirer rather than the acquired.
• Everybody said Epic couldn’t scale up to handle a lot of business. They were wrong, at least so far.
• Epic’s revenue is up to around a billion dollars a year. The “small company risk” argument used by big competitors isn’t working.
• Hospitals are so anxious to move to Epic that they don’t care about the money and organizational energy they’ve spent on recent implementations. Hospitals with freshly implemented systems costing dozens to hundreds of millions of dollars are happy to dump them and move to Epic, so incumbents can’t even count on switching costs to protect their customer base.
• If even seemingly happy customers of Epic’s competitors are willing to replace their current systems with Epic, imagine how easily Epic could steal the unhappy ones if it wanted.

Since both Epic and its competitors just keeping doing what they’ve always done, you might suspect the leading team will keep piling on points in this embarrassingly lopsided victory. Time and customer money is running out to mount significant competition, so the only Plan B is to hunker down, try to keep existing customers happy since new ones will be hard to come by, and hope Epic’s dominance causes it to stumble to the point that customers will walk away from their huge investment and go shopping yet again for systems they didn’t want the first time around. That or just cede the core inpatient systems market to Epic and find less-competitive territory, which some pretty cool small companies are already doing.

From Clearing House: “Re: Netwerks. They are our clearinghouse and changed to 5010 on November 7, 2011. The vast majority of our claims have not been processed by payors. We have physicians having to go to their line of credit to make ends meet. Almost two weeks and counting.”

Listening: a rare “highest recommendation” for reader-recommended Zip Tang, the most stunning, heart-racing progressive rock I’ve heard since early Genesis or Kansas. For my fellow prog heads, think Flower Kings or Spock’s Beard without the wimp factor and with regular wisps of Gentle Giant, ELP, and maybe a little Styx thrown in, but stripped of the 70s excesses and with a harder edge, more soul, and catch-your-breath harmonies. They are just stupendously good, to the point that I can’t sit still while listening and I almost got a lump in my throat a couple of times from the sheer brilliance of it. Their version of Tarkus is better than ELP’s. Here’s the kicker: these are day-jobbers, with Passport Health SVP Marcus Padgett on horns and keyboard and Richard Wolfe MD of Resurrection Health Care on bass (but I’m not giving them a mulligan for that – their excellence requires no asterisk.) These guys make me remember why I love prog so much. I’ll be playing Zip Tang’s three albums all weekend and buying them from iTunes for the Nano. Truly awe-inspiring, and I’m not prone to hyperbole.

My Time Capsule editorial this week from November 2006: The Bandwagon Effect and Healthcare IT Purchases. A test dose: “After all, everyone whose organization is as good and well-known as yours is buying Vendor A’s products, they say. Those customers are not only deliriously happy, they’ve formed a high school-like clique that makes fun of Vendor B losers and dates cheerleaders after football practice instead of attending chess club meetings. ”

Thanks to one of my CIO readers for this great idea. He gives HIStalk sponsors first crack when seeking consulting help and suggested I create a single form that allows prospects to contact any or all of them in a single step. The result: the Consulting Engagement Request for Information page. Fill in the very basic information about your needs, add a supporting attachment if you like, check off the companies you want to send it to (one, many, or all) and click Submit. Your work is done – the companies you chose get your information immediately by e-mail. I’ll be adding a linked graphic later, so if you can think of a more memorable name for it (I thought of RFI Blaster, but couldn’t warm up to it) let me know.

OhioHealth selects the athenaCommunicator patient communication service from athenahealth. It’s an odd-looking press release since both organizations surgically excised the logical space between their two names, with one choosing to capitalize both names of their artificially conjoined twins while the other chose to capitalize neither. I blame marketing people run amok.

Want to see Farzad Mostashari and Aneesh Chopra bust a move? I’m not exactly sure who shot this video at ONC’s annual meeting (the screen capture above is the best I could get), but I have to say that the bow-tied National Coordinator Dr. FM is looking good out there on the makeshift dance floor with some nice improvisational and rhythmic movement, while the US’s CTO appears somewhere between bemused and mortified. I like to think that they were pulled to the dance floor by the excellent music, the legendary Meaningful Yoose Rap from Dr. HITECH (Ross Martin, MD.) I like that they loosened up and aren’t afraid to have fun. Inga and I tried to connect with Farzad’s predecessors (Brailer, Kolodner, and Blumenthal) and all of them stiffed us repeatedly like we were unworthy interlopers on sacred ground, but the new boss seems a little more tolerant to riffraff of our ilk.

Speaking of Farzad Mostashari, is it just me, or does he strongly resemble the outstanding actor Enrico Colantoni (Veronica Mars)?

And speaking of ONC, 60% of readers say it will do little in response to the IOM’s healthcare IT safety recommendations. New poll to your right: are HIT Regional Extension Centers worth the $650 million in federal grants designated to fund them?

Two tiny Washington hospitals consider affiliating with Swedish Medical Center, with one carrot being that they’ll get Epic cheap. Jefferson Healthcare, with 25 beds, says they could never afford Epic on their own, while 45-bed Forks Community Hospital says it’s facing a $1 million Meditech upgrade anyway and would welcome Epic at a lower price even though it “may be overkill” for a small hospital.

A Maryland woman says she may sue the hospital where her baby was born after nurses restricted the time she was allowed to spend with her newborn son. The baby had tested positive for drugs, but as an addictions nurse herself, the woman demanded to be tested and was found to be drug-free. The hospital later apologized, saying scheduled computer downtime resulted in erroneous lab results.

Weird News Andy makes a rare weekend appearance, calling out this story in which a woman suddenly goes completely deaf after delivering her third child (and not from the crying, WNA helpfully adds.) The happy outcome: a University of Utah surgeon diagnoses her condition as otosclerosis, a genetic condition in which the hearing bones are fused together. He fixed her problem and she says she’s hearing better than she has in decades.

Another WNA find: a three-year investigation by a group of 21 scientists concludes that there’s not enough evidence to prove that drinking water prevents dehydration, so bottled water companies will be prohibited by law from claiming otherwise. Said a Member of European Parliament, “This is stupidity writ large. The euro is burning, the EU is falling apart, and yet here they are: highly-paid, highly-pensioned officials worrying about the obvious qualities of water and trying to deny us the right to say what is patently true. If ever there were an episode which demonstrates the folly of the great European project then this is it.” 

E-mail me.

News 11/18/11

Top News

CMS announces a 90-day period of “enforcement discretion for compliance” for the HIPAA 5010 transaction set, meaning CMS will not enforce compliance until March 31, 2012. The announcement follows mounting pressure to delay enforcement since many payers, providers, and vendors are reporting they are behind in their internal and external testing. And the rejoicing commences among procrastinators and those dependent on procrastinators.

Reader Comments

From Kaiser-ite: “Re: fixing MU payment mishap. After doing some digging, I have a contact for someone that should be able to correct the issue with the doctor who was not paid her Meaningful Use incentive because it was incorrectly paid to Kaiser. From what I could tell, Kaiser’s  Meaningful Use payments are sought through a combination of different entities, but there is an overall PMO for getting it done. Being a Kaiser-ite, I hate to see the opacity of the org frustrate people.” I have connected Kaiser-ite with Unibroue, who originally sent us the note on behalf of his frustrated client. I’m thankful we have so many great readers that are eager to lend a hand when possible. We hope to hear a happy ending to this mess.

From Beantower: “Re: giant shoe sculpture at Cosmo. This made me think of you. Possible venue for the HISsies.” OMG that is beautiful! If our sponsors hadn’t already secured another Vegas venue, I would be lobbying hard for the Cosmo. Actually, I might be too easily outed if HIStalkapalooza were somewhere close to this shoe as I would be the one trying to crawl into the sculpture with my Inga-tini in hand.

From Little Honey Bee: “Re: Connexin Software. Connexin receives a multi-million dollar investment from Bluff Point Associates. Note the plan for ‘broader clientele’, which is code for ‘no longer focusing on pediatricians’ because there’s no VC company in the world who’d focus on the lowest paid of the specialties.” Connexin offers Office Practicum EHR/PM, which has traditionally been marketed exclusively to pediatricians. The press release makes numerous references to pediatrics, so at a minimum Connexin trying to ease potential concerns from customers that the company’s commitment to pediatrics will be lost in the “next stage of growth.”

From TH: “Re: 5010 enforcement delay. The questions have started pouring in to vendors, payers, and providers on implications.” It seems the government never sticks to a firm date when HIT is involved, which given some of what the government requires is like a death row inmate hearing that the electric chair is broken, but the repair person has been called. I don’t know that a three-month option enforcement period really changes anything, other than to give laggards hope that 5010 will just go away if they ignore it long enough.

From TheBus: “Re: Epic’s reputation. I attended a Minneapolis Collaborative meeting this morning, which focuses on innovation and startups. This one was focused on healthcare innovation, with a great lineup of startup and CEO panelists. Epic was cited specifically by two separate panels as a barrier to progress. Startups and legitimately funded innovators are chomping at the bit to share healthcare data and make it more actionable and Epic’s unwillingness to share and cooperate is a major issue. This group of driven CEOs will move on without Epic if they need to. Epic needs to decide if it’s an innovator or a cash cow. It’s beginning to act like the latter, which is good for its owners, but bad for everyone else.” Just to play devil’s advocate, few companies go out of their way to help their competitors. It’s kind of their job to earn the business on their own. But if we’re talking “healthcare is different than other businesses” even though it really isn’t no matter how often we keep saying it, then it would be nice if Epic played well with others, although as Steve Jobs urged, “Control the user experience.”

From CDSMavin: “Re: UpToDate. A study found that use of UpToDate’s clinical decision support shows shorter length of stays, lower risk-adjusted mortality rates, and better quality performance.”  I don’t find the Journal of Hospital Medicine article impressive. The quality differences were almost imperceptible (LOS 5.6 days vs. 5.7 days, for example) and it was another of those public health-type studies that just matched up a bunch of readily available databases (the UpToDate customer list being one) and looked for differences between customers and non-customers without any attempt to distinguish between cause vs. effect. Were those tiny differences in the cherry-picked numbers due to using UpToDate, or rather due to the differences in characteristics of which hospitals buy UpToDate and which ones don’t? (like if your hospital is hemorrhaging cash and can’t afford to buy medical databases, you’re probably falling short in clinical areas as well.) They didn’t even ask how  hospitals were using UpToDate, so if you believe the authors’ conclusions, all you need to do is buy the product and put it on the shelf. The authors had the data right in front of them that would have provided a more conclusive answer to their vague assertion that UpToDate improves outcomes: show us the mortality rates of individual hospitals before and after they signed up. UpToDate is an excellent product (full disclosure – Wolters Kluwer Health is a sponsor, but I was using UpToDate way before then), but as a vendor of critically evaluated, soundly researched medical evidence, I wouldn’t promote this article too hard if I were them.

HIStalk Announcements and Requests

This week on HIStalk Practice: the Wichita City Council entices Pulse Systems to stay local. Medley Health secures $20 million in Series A financing. gloStream expands it partners program. AAFP’s president encourages members to achieve PCMH recognition. Practice Wise’s Julie McGovern reflects on the similarities between HIT and medicine. In you are curious about the above photo, details here. Stay in the ambulatory HIT loop by signing up for email updates and checking out our sponsors’ offerings. And thanks reading.

Listening: reader-recommended Kevin Salem, a reclusive, commercially indifferent but very talented roots rocker (Tom Petty meets The Replacements) whose modest peak of reluctant fame came in the mid-‘90s. He’s a smart writer on his site, with this fun snip: “In this way, becoming a parent is a lot, I imagine, like being Newt Gingrich: you wake up one day fat and changing your position on virtually everything, blaming your transgressions on the overflow of devotion (in his case, to country, in ours, to our progeny).”

  Go ahead, make Inga’s day: (a) sign up for e-mail updates; (b) electronically canoodle with us via Facebook and LinkedIn; c) send news and rumors by clicking the puzzlingly green Rumor Report box to your right; (d) thank a sponsor since CEOs just gush when a reader tells them their sponsorship is appreciated; and (e) behold in the mirror the face of a rebel, a thinker, a self-directed universe-denter who isn’t afraid to get news from a thoroughly unprofessional site of uncertain provenance, for which I am eternally grateful since it would be lonely here otherwise.

My latest pet peeve: desperate pseudo-news sites that insist on running dumb slide shows or photo galleries, forcing you to click endlessly through unrelated pictures one at a time just to see the crappy list they’ve hastily assembled with dumbed-down headlines that would have easily fit onto a single page, like”12 Great Places to Raise Kids” or “25 Gourmet Ramen Noodle Ideas.” You know, of course, why they do that: every one of your time-wasting clicks counts as a page view, eliciting gooseflesh on the part of Internet-savvy but marketing-stupid advertisers who don’t catch the fact that such mindless clicking, no matter how many impressive statistics it generates, provides them with no benefit whatsoever.

On the Jobs Board: Clinical Applications Analysts, Director Client Programs – HIE Architect, Senior Implementation Project Manager. On Healthcare IT Jobs: SQL/EHR Programmer, Manager IS Enterprise Systems, Epic Revenue Cycle.

Acquisitions, Funding, Business, and Stock

Safeguard Scientifics leads a $7 million Series A financing for Medivo, an HIT company providing data analytics and lab testing services. Safeguard also recently added billing system software provider AdvantEdge Healthcare Solutions to its portfolio.

The stocks of nursing home operators and their landlords have fallen sharply since July, when the government announced a 11.1% cut in Medicare reimbursements. Landlords are concerned that some nursing homes won’t have enough money to pay their rent. Industry analysts believe investors may be over-reacting since many nursing homes have ample cash to manage operations for at least another 12-18 months, and most landlords set rents low enough so that operators have cash available in the event of earnings shortfalls. 

Perceptive Software releases its ModusOne document output management solution for GA.

AirStrip presented at the mHealth Conference in Paris this week as the company prepares for an international launch, with GE Healthcare as its global distribution partner.

  GE announces that it will open a global software center in San Ramon, CA, hoping to speed innovation and commercialization of software technologies in its many business lines and to lead its 5,000 software professionals. The announcement mentions intelligent systems that operate on the “industrial Internet.” Healthcare gets the only customer quote, with Mount Sinai Hospital President and COO Wayne Keathley talking up GE’s tools to manage patient flow and costs. The gratuitous photo accompanying the press release didn’t do the company any favors other than to boost CT scanner usage as readers suddenly come down with unexplained headaches.

New Mexico Software changes its name to Net Medical Xpress Solutions. It offers PACS, a radiology reading service, and a newly announced telemedicine service.

Sales

HANYS Solutions, a subsidiary of the Healthcare Association of New York State, expands its agreement with QuadraMed to include identity management solutions.

Northern Ireland Health and Social Care selects Mediware’s JAC Computer Services Limited technology for enterprise medication management.

San Diego Beacon Community (CA) selects OptumInsight to build its health information exchange.

Huntington Hospital (CA) engages MedAssets for revenue cycle solutions that include tools for charge master management, charge capture auditing, and cost management of drugs and supplies.

People

The  Patient-Centered Primary Care Collaborative announces that Marcia Nielsen, PhD, MPH, will take over as executive director as of January 2, 2012. She is associate dean for health policy at the University of Kansas Medical Center. 

Revenue cycle and PM vendor MedSynergies names Vicki Laurie as CIO. She was previously with Anthelio.

Healthcare Quality Catalyst brings on HIT long-timers Dale Sanders (above) as SVP and Larry Grandia as a board member. Dale was CIO of the Cayman Islands health system and at Northwestern University Medical Center before that. Larry was CTO of Premier, but those who’ve been around awhile remember him from DAOU Systems and Intermountain Healthcare (Vince mentioned him in his HIS-tory recently, in fact.) HQC sells clinical improvement data warehouse solutions; I interviewed co-founder Steve Barlow in August.

Frank Maddux is named chief medical officer of renal therapy provider Fresenius Medical Care North America. Health IT Services Group, the EMR company he founded, was acquired by Fresenius in 2009. It sells the Acumen nEHR nephrology EMR.

  Mary Alice Annecharico, formerly SVP/CIO at University Hospitals (OH), is named SVP/CIO of Henry Ford Health System (MI) in an HFHS internal e-mail forwarded by a reader. The announcement mentions HFHS’s “clinical transformation with Epic,” the impending $350 million project to replace its just-implemented $100 million system.

Announcements and Implementations

The 25-bed Grande Ronde Hospital (OR) enters its initial stages of EHR implementation. The hospital’s IT manager tells the local press that “the electronic health record system doesn’t necessarily save time because physicians will have a lot more data to type into the system, but it’s more efficient and the government is requiring more information on costs and quality.” The article also notes that the EHR could provide other benefits “if the system works.”

CureMD Healthcare launches its HIE connectivity with HCA.

Northern Michigan Regional Hospital goes live on CPOE with Cerner PowerChart.

Massachusetts General Hospital goes live on the Sunquest CoPathPlus 5.0 anatomic pathology solution.

SCI Solutions announces that it signed 53 new clients in FY11, raising its total to more than 450 hospitals.

Sectra’s newly announced RIS v 7.0 includes enhancements to allow radiologists to meet Meaningful Use objectives, including a referring physician portal, a patient portal, and lab test tracking.

Government and Politics

CMS releases the 2012 application for its Medicare Shared Savings Program. ACOs have the option of starting April 1 (applications accepted December 1-January 20) or July 1 (applications March 1-30.)

Technology

Home care software provider Procura launches Procura Mobile for Android, adding that option to its existing BlackBerry client.

Business analytics company Pentaho announces native HL7 support with Pentaho Business Analytics.

Other

HIMSS releases its full agenda for the HIMSS12 educational program, which includes over 300 sessions.

CHIME and eHealth Initiative release an HIE guide for CIOs.

AHIMA expresses disappointment with the AMA’s opposition to the ICD-10 implementation schedule, noting that ICD-10 offers “countless benefits.” AHIMA says it has demonstrated that administrative systems can be easily implemented for most primary care practices and that specialty practices will only be using a small number of codes.

Despite widespread success recruiting  and enrolling providers, RECs have helped relatively few providers attest for Meaningful Use. Of the 90,000 providers enrolled nationwide, only 1,000 have attained Meaningful Use; the goal for RECs is for at least 20% success. Some RECs have faced challenges with staff recruiting and retention, while others complain of difficulties getting software upgrades from vendors on behalf of their clients.

A blogger visiting the Epic campus posts a great collection of photos from her tour of Intergalactic Headquarters. She captures everything from obscure works of art, architecture, and the assorted whatnots.

GetWellNetwork PatientLife System earns the top spot in KLAS’s just-released review of interactive patient systems, beating four competitors. The category covers hospital in-room systems that can provide patient education, on-demand video, patient surveys, entertainment, Internet access, patient requests, and nurse communication.

A laptop stolen last month from Sutter Medical Foundation contained personal information for 3.3 million Sutter Health patients, although that information was benign (patient names, contact information, medical record number, and insurance information.) The laptop wasn’t encrypted, although Sutter says its encryption project was underway and it will now accelerate that effort.

Health Outcomes Sciences posts a free trial of its ePRISM clinical risk modeling software, which provides patient-specific automated consents and outcomes forecasts for angioplasty.

Verizon makes its Fraud Management for Healthcare software available to government and private health insurers. “Makes available” was not qualified with “for free,” so this is apparently a product announcement.

This is a rare two-Newt mention edition: USA Today calls out Newt Gingrich for shilling healthcare vendors who pay fees to his big-money Center for Health Transformation without disclosing his vested interest. Example: he and Sen. John Kerry lauded his Center’s clients Allscripts and Misys in promoting electronic prescribing legislation that would benefit them back in 2008. I’ve ripped Newt’s center here for years because he passes it off as a noble think tank working for the betterment of society, when in fact its primary purpose is to line Newt’s pockets and keep him publicly visible. In fact, here’s what I said in 2008 when I was annoyed at another example of Newt’s shameless pitching:

Newt Gingrich pops up at Silver Cross Hospital (IL) to brag on Misys technology, of all things. Well, mostly about himself and his business, Center for Health Transformation, which the newspaper calls a "collaboration of public and private sector leaders." He’s our Jesse Jackson, sticking his head anywhere there’s a camera, somehow becoming wealthy without ever having had a real job, and working the system for personal benefit. I still kind of like him, but it’s trending down.

 This is one of the most egregious medication errors I’ve heard of: a hospital nurse intending to give Pepcid IV to a patient who is suffering from heartburn instead grabs pancuronium, the muscle blocker most often used for intubation (with respiratory support) and to kill prisoners (without respiratory support, basically smothering them). He dies; the family is suing. An investigation found that the nurse pulled the pancuronium from the secure area in which it was stored, didn’t read the label, skipped the bar code checking step, and then left the patient alone for 30 minutes afterward. She was fined $2,800, received a warning, and still works at the hospital.

A man trying to commit suicide in a hospital’s ED parking lot by mixing deadly chemicals in his VW convertible changes his mind, strolling into the ED at 3 in the morning. The ED had to shut down for over four hours as the hazmat team cleaned up. The man is fine and may face charges.

Sponsor Updates

• Shepherd Center (GA) implements RelayHealth’s MedGift patient gift registry and social media network.
• Buchanan County Health Center (TX) says its implementation of  the Access Intelligent Forms Suite has streamlined the organization’s paper process and facilitated integration with its Meditech 6.0 system.
  Billian’s HEALTHDATA releases its list of the 25 Best & Worst Rated US Hospitals, based on patient experiences at 3,002 hospitals.
• Concerro revamps its website and asks for feedback. Those sharing their opinion on Facebook, LinkedIn, or Twitter will be entered into a drawing for a $100 Amazon gift card.
• Practice Fusion reveals its iPad prototype and roadmap at last week’s Connect 2011 meeting.
• MED3OOO congratulates its client PED-I-CARE (FL) for winning the MGMA/ACMPE Fred Graham Award for Innovation in Improving Community Health.
• Healthcare Management Systems (HMS) announces that 17 additional client hospitals have successfully attested Stage 1 MU.
• Cynergisk Tek CEO Mac McMillan will discuss healthcare privacy and security issues at seven regional HIMSS conferences in Q4 2011.
• David Nace MD and Arien Malec of RelayHealth participated in ONC’s annual meeting this week in sessions related to IT requirements of Patient-Center Medical Homes and interoperability, respectively.
• Elsevier Clinical Decision Support collaborates with ExitCare to integrate ExitCare content into the Elsevier/Gold Standard and MDConsult products.
• NextGen names Port Gabmle S’Klallam Tribe (WA), Drs. Goodman & Partridge OB/Gyn (AZ), and Nautilus Healthcare Management Group (CA) as winners of its sixth annual Best Practice Awards for exemplary use of NextGen solutions.

The Centers for Disease control recently released its final review of the Healthy People 2010 program. The results of its 10-year health goals aimed at improving the health of Americans are mixed. Although targets were met for 23% of the 733 objectives and progress was made in half of the remainder, there was no change for 5% of the objectives and 24% of them actually became worse. Obesity and health disparities targets were among those missed. Now that we have a baseline, I’ll be interested to see if Meaningful Use makes a difference on any of these metrics.

Surprise, surprise: a new study published in the Journal of the American Medical Association finds that physicians who own and bill for nuclear stress and stress echo testing are more than twice as likely to order those tests than physicians who don’t bill for those services.

News of the Weird: enterprising parents who want their children to be naturally infected with chickenpox are apparently using Facebook to arrange shipment of items contaminated by sick children. Pre-licked lollipops, blankets, and other disgusting items were reportedly being exchanged. In addition to being gross and disgusting, it’s also illegal.

Disco isn’t dead: researchers looking at effective technique for cardiopulmonary resuscitation (CPR) compared the chest compression technique of providers listening to either silence or the songs “Achy Breaky Heart” or “Disco Science.” Although the disco beat helped providers give compressions at a more ideal rate, it didn’t improve the depth of compressions.

The AMA announces a series of workshops to assist with the ICD-10 transition. Exciting locations include Baltimore, New Jersey, Dallas, Atlanta, and Las Vegas, all during the first part of December.

To Wear, or Not To Wear: hot on the heels of a UK ban on wearing white coats or long-sleeved uniforms in health care, a pair of articles show that maybe traditional garb isn’t as bad as was thought. A study performed in Jerusalem showed that upwards of 60% of physician and nurse uniforms harbored bacteria, some of the multidrug-resistant variety. Authors note, however, that “it remains to be determined whether these bacteria can be transferred to patients and cause clinically relevant infection.”

A separate study published earlier this year showed no significant difference in bacterial colonization rates between infrequently washed white coats and short-sleeved uniforms which were donned fresh each day. After eight hours of wear, the newly laundered uniforms were as contaminated as the white coats.

Frankly, I think some of the grossest places in the hospital are the computer workstations. I see very few keyboard covers that can be wiped down, and what’s even worse is the food crumbs in the keyboards, meaning someone is actually eating while using a dirty keyboard. Eww. That’s one more reason I carry my own personal tablet on rounds – I know when it’s been sanitized and I know for sure I don’t ever document without washing my hands first.

While researching this topic, I came across a related study which showed that “non-conventional” nurses’ attire (i.e. brightly colored clothing) helped lower children’s distrust of healthcare providers and reduce fear. Maybe Patch Adams was onto something after all. Interestingly, coloured uniforms (honouring the British spelling) also improved parental perception about the reliability of the nurse.

No surprise here: empathy can’t be taught. A study in the Archives of Surgery shows that surgical residents who attended communication training increased their communication scores, but not how much empathy they are perceived to have.

People notes: HIStalk Medicine Cabinet member Micky Tripathi was featured in a Medical Economics piece on Regional Extension Centers.

Have a question on billing practices, keyboard sanitizing, or choosing sassy scrubs? E-mail me.

Contacts

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

News 11/16/11

Top News

The AMA’s House of Delegates votes to “work vigorously to stop implementation” of ICD-10, which it says will create “significant burdens” on the practice of medicine with no direct benefit to the care of individual patients. AMA President Peter W. Camel, MD also notes that physicians are concentrating on EMR implementation and the switch to ICD-10 would “add administrative expense and create unnecessary workflow disruptions.”

Reader Comments

From Big Scout: “Re: NextGen User meeting. Kicked off today with a multimedia presentation including keynote speaker John Foley, former lead solo pilot for the Blue Angels. Some of the key themes so far: Meaningful Use preparation, ICD-10, and high performance teams. Farzad Mostashari is also in attendance.” We love the “from the field” reporting, so thanks for sharing. Big Scout is one of over 4,200 participants at this week’s NextGen user meeting in Las Vegas.

From Unibroue: “Re: HITECH mess. One of my clients just got rejected for her ARRA money because Kaiser claimed her payment earlier in the year. She had supposedly signed a contract with them while still in medical school, though she never actually went to work for them. She has no idea how it happened, but expects a nightmare to undo it. The feds don’t even provide any kind of contact information and have just advised her to ‘get in touch with Kaiser Foundation.’ A billion-dollar conglomerate has her $22K and she’s not happy.” Maybe readers have suggestions on how to resolve. Good luck.

From Not in Kansas: “Re: NHS. The National Health System is a thing to be seen. Of course on the way to seeing it, you have to deal with impossible parking, non-working lifts, a large bucket catching the drips from the ceiling, and hazardous waste parked in the corridor.” Not in Kansas reports that she is across the pond assisting a relative who is having surgery. While some American patients might envy the cost of NHS care (it’s free), the US model does, for the most part, afford us an abundance of well-maintained facilities and other niceties.

From Non-Sequitur: “Re: HIStalk quoted. I just loved the sweet irony of seeing you quoted in the pages of one of those magazines you described, which ran an article on the Colorado HIE cost challenges saying the story was ‘plucked from the HIStalk web site.’” I thought that was darned nice of Health Data Management (or perhaps more accurately, reporter Joe Goedert,) for hat-tipping HIStalk instead of just following my link and pretending they found that story on their own. Joe’s one of the good writers who learned the players and the lingo, sticks to reporting the news objectively and skillfully, and doesn’t confuse being an sideline observer with being a participant who’s qualified to render advice or provide expert editorial opinion (“I’m not a doctor, but I play one on TV.”) The first thing I do when I read an editorial or self-assured comment telling providers or vendors what they should or think is check LinkedIn for the author’s education and experience. I’m usually not impressed.

From Olly Oxen: “Re: Cleveland Clinic. A healthcare market research report says Cleveland Clinic has exceeded Epic’s capabilities for data analysis and revenue cycle tools that will be needed to manage populations in an ACO-type model. Executives there are apparently disappointed that Epic isn’t interested in helping them in those areas, forcing the clinic to bring in other vendors after paying all that money for Epic.” Unverified, but OO provided an excerpt from the report.

From Janga: “Re: NIST’s draft on EHR usability testing. HIMSS provides their commentary.” The HIMSS response expresses concern at having actual usability experts doing the testing, favoring instead “inclusion of individuals with practical clinical experience.” I don’t agree – the document clearly identified steps in which subject matter experts would be involved to provide subjective analysis and comments, but real usability testing is product-agnostic (are menus labeled clearly, how many clicks to complete a task, etc.) HIMSS also thinks testing conditions should reflect real-life interruptions and competing workflow, which sounds nice on paper but isn’t really how usability testing is done (remembering again that usability is a profession with its own literature and standards, not just a bunch of nerds deciding arbitrarily how products should be tested.) Having said that, though, I think HIMSS was admirably restrained in not nitpicking the draft to death and trying to insert itself into the process (like it did for EHR certification.) So I’ll moderate my comments: HIMSS brings up some industry-specific points worth considering, although usability experts and NIST have way more expertise and thus should have the final say.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor NextGate, whose MatchMetrix master index solution manages over 50 million unique entities (patients, providers, terminology) worldwide. The Pasadena, CA-based company was founded by the technical brains behind one of my favorite products of all time, the STC Datagate integration engine (we’re talking mid-1990s here that I was involved in buying it for my health system), arguably the first generation of what eventually became vendor-independent interoperability solutions. The NextGate folks are serious technologists with expertise in EMPI, enterprise registry, enterprise application integration, and service oriented architecture, all vital for presenting consolidated data views and exchanging information. MatchMetrix gets high KLAS scores; is used by both providers (HIEs and health organizations) as well as vendor partners; and offers low TCO, fast implementation, and straightforward management. For those of us who appreciate high-achieving geeks, note that every single member of NextGate’s leadership team has earned their technical stripes. Thanks to NextGate for supporting HIStalk.

Acquisitions, Funding, Business, and Stock

simplifyMD secures $4.5 million in new capital and names Michael Brozino as president and board member. He was previously with McKesson and the McKesson-acquired A.L.I.

PHR vendor MMRGlobal reports a Q3 net loss of $2.1 million, compared to last year’s loss of $1.7 million. Revenues were $352K compared to last year’s $270K.

Nashville-based critical access hospital software vendor Custom Software Systems, Inc. changes its name to CSS Health Technologies. It sells the ChartSmart EMR.

Healthcare learning and research solutions vendor HealthStream opens the public offering of 3,250,000 shares of its common stock, with the sole book-running manager being William Blair & Company, LLC. Proceeds could reach more than $50 million.

Sales

Avalon Health Care Management selects HealthMEDX Vision as its enterprise-wide solution for its 39 long-term care facilities.

Alabama Medicaid and the state of Alabama partner with Thomson Reuters to build the infrastructure for a statewide HIE known as One Health Record.

Barnabas Health (NJ) selects the MedAptus Professional Intelligent Charge Capture solution for its 4,500 physicians.

Healthcare Access San Antonio (TX) chooses Medicity’s HIE technology to connect its providers and area hospitals, initially using the iNexx platform to create a 22-county referral network. HASA is one of only two regional grant recipients to qualify for state funding to start implementing an HIE.

Florida Medical Clinic selects Humedica MinedShare for managing its patient population and improving clinical outcomes.

Catholic Healthcare West signs a three-year, $4.3 million deal to implement AirStrip OB remote fetal monitoring on mobile devices.

University Medical Center (NV) gets county approval to buy an unnamed $31 million clinical system (presumably McKesson.) The hospital said in July that it couldn’t come up with the $60 million needed and had only $25 million to spend with McKesson, its vendor of choice.

The board of Edward Hospital (IL) voted Monday evening to approve the purchase of Epic as its core system along with Lawson for ERP, VP/CIO Bobbie Byrne MD, MBA tells me. She says, “I have a great deal of respect for many of the vendors in our industry and I was impressed with several of the proposals we received. Epic was the right choice for Edward because of the robust integrated products for clinical and revenue cycle across both hospital and physician office settings. One patient, one record, one bill …” You may remember Bobbie from her four years with Eclipsys as SVP of clinical solutions.

The Portland VA chooses Magpie Healthcare’s CareConnect to connect clinicians with on-call staff and to activate care teams. Magpie was one of six organizations to receive funding under the VA’s Innovation Initiative.

People

Mediware CFO Michael Martens will step down effective February 15, 2012 to rejoin a former employer. He joined the company two years ago. The company will conduct a national search for his replacement.

Sean P. Kelly, MD joins Imprivata as chief medical officer. He will continue his practice as an emergency physician at Beth Israel Deaconess Medical Center.

ZirMed names former Culbert Healthcare and GE VP Kent Rowe as VP of sales.

Jack Walsh, formerly with IMS Health, Inc., joins SRSsoft as CFO.

Intelligent InSites names Mary Jagim chief nursing officer.

Carol Simon, PhD is named director of the just-announced Optum Institute for Sustainable Health.

Announcements and Implementations

Henry Ford Health System (MI) launches its $100 million EMR this month (the article says it’s a homegrown product, but I believe it’s actually RelWare’s EXR.) That’s a temporary solution since the health system is negotiating with Epic in a deal valued at $350 million, which based on HFHS’s most recent financial report, will cost the health system six years’ worth of net income.

MRO Corp announces that it is among the first health information handlers to successfully pass all critical integration tests for CMS’s CONNECT Gateway Pilot Program, which facilitates the electronic submission of medical documentation to RAC auditors.

Cincinnati-based HIE HealthBridge selects IBM Initiate Patient software for its infrastructure.

Greenway Medical launches PrimeDATACLOUD, a care delivery platform that recognizes and aggregates data from various EHR and HIS platforms and facilitates health information exchange.

Government and Politics

HHS’s own Indian Health Service is struggling with the transition to ICD-10 for its RPMS, IHS’s version of the VA’s VistA. CIO Howard Hays says ICD-10 is his highest short-term priority.

Florida Governor Rick Scott, appearing on a public radio talk show, seemed to be referring to the Florida Health Information Exchange when saying, “There haven’t been a lot of studies to date that suggest electronic medical records have saved a lot of cost. They’ve increased cost because of the way you have to keep all the records. I’m the one who should be taking care of my information and not relying on the government to do it because I believe it will raise the cost of healthcare without a result.”

Innovation and Research

Researchers in Belgium are developing technology to embed “electronic noses” in mobile phones to verify the freshness of food, test air quality, and measure blood alcohol levels. It’s all part of a human “Body Area Network” (BAN) system that also incorporates wireless sensors for monitoring heart rates and blood glucose levels.

And in other nose news, Grand Challenges Canada and the Bill & Melinda Gates Foundation award The Electronic Nose a $950,000 grant to support further development and testing of its technology for detecting TB immediately and non-invasively from a patient’s breath.

In England, a former Royal Army Medical Corps captain working on his PhD in computer science develops Mersey Burns, an iPhone and iPad app that calculates the IV fluid needs of severely burned patients such as soldiers on the battlefront. His research, conducted with two plastic surgeons, won an NHS innovation award this month.

Other

Michigan Health Connect (MHC) announces that Olympia Medical Services is extending MHC’s HIE solutions to its 500 physician members.

Massachusetts doctors who take patient photos for their EMRs and in reaction to the Red Flags identity theft rule are losing patients who claim the practice is an invasion of their privacy. The practices highlighted say they’ll scan the patient’s own photo or driver license instead of taking their picture if the patient prefers, but the patient interviewed by the local paper says “people are being tracked.” The executive director of the World Privacy Foundation says medical identify theft is usually an inside job that the photos won’t prevent, not to mention that “we don’t want our healthcare providers to become the new airport TSAs.”

In South Korea, the medical doctor who founded the country’s leading anti-virus software company donates $133 million (USD) to educate the children of low-income families. He’s also a top candidate for next year’s presidential election.

ECRI Institute announces its Top 10 Health Technology Hazards for 2012, all related to recent incidents that made headlines:

1. Alarm fatigue / lack of alarm response
2. Exposure hazards from radiation therapy
3. Infusion pump-related medication errors
4. Cross-contamination from flexible endoscopes
5. Change management with regard to medical device connectivity
6. Mixing up enteral feeding lines with IV lines
7. Surgical fires
8. Sharps injuries
9. Anesthesia equipment problems not discovered during surgery
10. Poor usability and design of home medical devices, leading to misuse

Sponsor Updates

• Optum launches The Optum Institute for Sustainable Health to provide analysis and insight on the landscape of healthcare.
• Miami Children’s Hospital’s nursing manager Deborah Hill-Rodriguez, MSN, ARNP, PCNS-BC, will discuss best practices during GetWellNetwork’s November 17 Webinar entitled Leveraging Technology to Support Pediatric Fall Prevention.
• NextGen Healthcare recognizes five client hospitals for successful Stage 1 Meaningful Use attestation.
• David Finn of Symantec Health shares his thoughts on the need to take action on security and privacy in healthcare in the company’s Healthcare Online blog.
• The Detroit Free Press names CareTech Solutions a Top Workplace in the large company category for the third year in a row.
• Apixio announces that its Community Search product has been integrated with Allscripts Sunrise EHR and is available on the Allscripts Application Store and Exchange.
• AdvancedMD announces the availability of its 2011 Fall release, which enables practices to send ANSI 5010-formatted claims.
• Awarepoint is awarded four additional patents for its real-time location systems for hospitals.
• Imprivata wins the Security Projects of the Year award at the 2011 Computing Security Awards.
• MEDSEEK announces that 18 of its healthcare clients received a total of 25 honors at the Strategic Communications eHealthcare Leadership Awards competition.
• The Technology Services Industry Association and Impact Learning Systems designate TeleTracking Technologies as a Certified Support Staff Excellence Center.

Contacts

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

Monday Morning Update 11/14/11

From THB: “Re: Cheyenne Regional Medical Center. Going Epic.” The 218-bed hospital gets board approval to replace McKesson Horizon with Epic in a $19 million deal, saying it will cost about $5 million over five years to implement Epic. It says Meaningful Use money will offset that amount, and after that, Epic will actually be cheaper that McKesson. Epic doesn’t usually sell to hospitals that small, so either CRMC is affiliated with a larger Epic customer or Epic is started to push down into Meditech territory.

From WSDiner: “Re: HCA. At a Credit Suisse Healthcare conference investor dinner Thursday night, HCA’s management said they piloted Meditech 6.0 this year and will pilot Epic next year. They said that no other vendors (i.e., Cerner) were under consideration.” The reader provided a Credit Suisse contact to confirm, but he didn’t respond to my e-mail. This will be interesting if it’s true – my read has always been that HCA just wants to scare Meditech into better pricing by bringing in competitors, but Epic doesn’t walk away without a contract in most cases. HCA is Meditech’s largest customer, contributing 8% of the company’s revenue in 2010.

From Commodore: “Re: Cerner running poorly on the iPad. Do other inpatient vendors have native apps?” The only one I know of is Epic, which has Canto (above.) There may well be others. I tried using a couple of my hospital’s clinical apps the iPad using the Citrix portal and that’s definitely not something that’s workable for clinicians. The shrunken screen is impossible to comfortably read, you have to constantly zoom to hit tiny drop-downs with your finger, and the clicking doesn’t feel sure-footed at all. I think it’s safe to say that for most vendors, there’s not much to brag on if your iPad capability consists of running an emulated desktop screen. Only your marketing people will be impressed.

From The PACS Designer: “iPad viewer. The FDA has now approved an iPad viewer from Carestream called Vue Motion. The application permits the viewing of image files from many different PACS platforms, including cloud-based offerings, and can be integrated into EHR solutions to permit viewing of image files and patient records through a single sign-on.”

Here’s my summary of business lessons learned from the Steve Jobs biography. 

My Time Capsule editorial from October 2006:  Economics 101 and the Healthcare IT Market (that’s a pretty lofty premise to cover in 500 words). A Sam’s Club tiny paper cup-sized sample: “Hospitals can be convinced by questionable claims of product superiority or patient risk, and even more so by seeking vendors just as prestigious as they fancy themselves (no Walmart shopping for big academic medical centers, even though patients are the ones paying.)”

Note the reduced number of animated ads to your left thanks to those overachieving sponsors who have already traded out their animated ads in advance of the January 1 target date. I always feel bad when requiring changes like that, but it will benefit sponsors as well since readers will pay more attention to more subtle ads. I’ll digress by saying that while few things surprise me these days, one that does is the non-financial support I get from sponsors. Not all of them, since a few are purely ad placements without much personal connection, but the majority have executives and regular employees who keep in touch, send me music recommendations, e-mail me a well-timed attaboy right when I’m feeling overwhelmed or under-accomplished, or send off-the-record snarky comments about one thing or another. HIStalk is an after-work hobby for me rather than business and I like that the connections aren’t always business related.

Venture capital superstar and billionaire Peter Thiel, speaking at Practice Fusion’s conference (he’s an investor), says highly paid salespeople can land big businesses as customers and relentless marketing can get consumer sales, but companies that can sell to small businesses (like most medical practices) are rare since those small businesess are reluctant to change. He gave as examples QuickBooks and PayPal (implying Practice Fusion as well, naturally.) Also at the conference: Practice Fusion rolls out its iPad app, although I’m not clear if that’s a new native app or just the LogMeIn remote control version that was announced at HIMSS.

Doctors and hospitals in Boulder, Colorado are questioning whether joining Colorado’s statewide RHIO (CORHIO) is worth the subsidized cost. Small practices say the upfront training costs and $85 per doctor monthly fee are steep, and doctors at Boulder Medical Center says there’s not much value to them since they’re already connected via their NextGen systems. CORHIO’s five-year business plan called for taking in $26 million in federal grants and $19 million in subscriber fees.

Polls that list companies always bring out ballot box stuffers, but they’re fun nonetheless. Epic wins this one handily, with a fairly even spread among the losers. New poll to your right: how will ONC respond to the IOM’s report that criticized patient safety efforts related to electronic medical records?

We already know what HIMSS thinks of the IOM recommendations since Steve Lieber quickly released a statement. He zoomed right past all the patient safety concerns, preferring to focus on one sentence that says paper records are also risky, thereby summarizing the entire work as “a strong endorsement for the path healthcare is on.” Well, OK. He also is somewhat dismissive in saying IOM looked at only at the patient safety aspect of HIT and it’s already fussed about that before (which is exactly what you’d want IOM doing given that there are plenty of loud voices, especially that of HIMSS, extolling the virtues of technology for purely commercial reasons and ignoring IOM’s previous recommendations). A critic might say, “Who’s this association executive  with no credentials in medicine, research, or technology speaking on behalf of his unpolled membership to critique the work of a large group of unbiased and extremely well-credentialed IOM medical experts whose thoughtful opinions were commissioned by ONC?” but to question the authority (audacity) of HIMSS to weigh in on complex national matters is just not done. If you say anything even slightly negative about commercially sold healthcare IT, HIMSS is going to hit the PR airwaves, often cherry-picking a few HIMSS-friendly members to chime in for credibility support. Choose your side: an unbiased group of scientists vs. an exhibit hall-funded trade group. I like some (maybe even most) of what HIMSS does, but its predictable knee-jerk defense of the industry and federal grants just annoys the heck out of me as a dues-paying member, especially given that so many of us members pride ourselves in spotting and debunking shoddy research methods, investigator bias, and inconclusive evidence, all in the interest of improving patient outcomes and reducing healthcare costs just like IOM is trying to do.

Here’s Vince’s latest HIS-tory, highlighting Healthcare Information Systems. I’m cringing a little because he attacks someone at the end, to be named in the next installment. I don’t know who it is, but I’m hoping that person is (a) not a reader; (b) dead; or (c) one of Vince’s pals he’s just joking around with.

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

Epic hosted a college team programming competition in its offices this past Saturday. You wonder how many of the geeky combatants left with job offers, and also how the reporter kept a straight face in writing up details: “Winners and awards will be announced after the 4:30 p.m. conclusion of the competition, which will be held in the Nebula room in the Heaven building. Parking is available in the Yoda underground garage.”

Jackson Memorial Hospital takes part in a quickly assembled telemedicine project that will connect Miami specialists with hospitals in Iraq, part of a $1 billion contractor’s project as the State Department takes over field hospitals and medical care when US troops pull out December 31.

Weird News Andy wonders how many EMRs have edits that would prevent documenting this. In Mexico, a 10-year-old girl gives birth. You have to either admire or detest the creativity of the UK-based newspaper’s accompanying photo of a girl packing a toddler along in some kind of serape, clearly desperate for a visual, yet struggling with the lack of an Enquirer-like picture of a 10-year-old: the photo has nothing to do with the actual story and was “posed by models.” Its readers are apparently so stupid that reading text without even an irrelevant picture is unthinkable.

WNA also notes that health conditions are leaning toward the Third World in the Occupy Wall Street encampment. The unfocused unemployed there are coming down with a variety of respiratory infections as they sleep among their trash, pee in bottles without washing their hands, pass cigarettes and alcohol mouth to mouth, and refuse free flu shots because they’ve concluded that vaccines are a government conspiracy. They have a volunteer-staffed medical tent, but it only stocks herbal remedies.

ONC’s blog (which is actually written by its contracted PR company – it’s not like Farzad’s going to bare his innermost thoughts or music recommendations there) highlights the VA’s Blue Button initiative in honor of Veterans Day.

As Dr. Jayne mentioned, Walmart is denying that it plans to develop some kind of national primary care program, but they might want to check with their RFI people they’re clearly looking for partners to “rapidly create a comprehensive healthcare solution to deliver low-cost, high-quality primary healthcare services nationally.” The RFI lists specifically that partners should be able to offer chronic care services (diabetes, hypertension, etc.), lab tests, vaccinations, physical exams, health screenings, and durable medical equipment support. They say they will consider vendors who offer only “enabling technologies” as well, and the RFI requires prospective vendors to describe their proposed information system and “data sharing model.”

Ed Marx updated his most recent post to respond to reader comments. He’s always gracious, even to his anonymous attackers. And here’s the secret I shared with Ed: I don’t usually delete negative comments because I’d rather let readers provide the majority opinion via their own responses.

Speaking of Ed’s pieces, a few folks howl if I dare run anything that’s not directly related to their jobs, but many (most, maybe, especially at the senior levels) enjoy a mental break with personal stories about patients, working in HIT, or life’s lessons learned. Yours are welcome.

An Investor’s Business Daily article notes that its medical software sector dropped from #2 a month ago to #67, mostly due to the huge drop in CPSI’s share price after it missed expectations. The article says Cerner beat estimates but profit margins slipped in the most recent quarter, while Quality Systems shot itself in the foot in its earnings conference call by implying (but later clarifying) that most of its new sales were coming from replacements, suggesting that the market was past its peak. Athenahealth is mentioned for beating expectations but not by enough (double expectations?) and took a 7% share price drop as a result. On the positive side, shares in MedAssets jumped 14% and later 17% after beating estimates and Allscripts share price took a slight turn north after reporting results. Above is a one-year price chart of the shares of all those companies: Allscripts (blue), Cerner (red), Quality Systems (dark green), athenahealth (yellow), MedAssets (brown), and CPSI (light green). Leading the pack are Cerner and athenahealth. Looking at just the past three months, the clear winner is Allscripts, with MedAssets and Cerner basically tied for #2 but pretty far off the pace. Looking back five years, your best return would have been Cerner and Quality Systems. Always amusing is that ever-vigilant stock analysts flip-flop their recommendations a day or two after unusually good or bad news is announced, providing no benefit whatsoever for the clients paying them for non-retrospective advice.

I’m beginning to be annoyed by research companies selling expensive reports under the headline, “XX Market to Reach $X.XX Billion by XX.” One of these days I’m going to check the accuracy of their past predictions, which I suspect is minimal. Inga loves to run those press releases like they’re real news, along with the splashy results of questionably conducted surveys that are favorable to the companies paying to have them done. She’s usually good natured about my edict that she’s allowed only one survey mention per post.

Inga notes that Sage’s new name, Vitera, is also a band’s name. She and I don’t usually like the same music, but they’re good for an unsigned band, a Latin-style pop with a harder guitar edge, like a Spanglish Guns N’ Roses. Check out this live video and the flying V fiddle, which sounds to me like prog rock meets Texas swing. 

A Jacksonville, FL woman starts a booming business that provides scribes to do patient care documentation for ED physicians. The scribes, often pre-med or nursing students, are contractors billed out at $20-25 an hour, a bargain according to the company’s medical director. “For every hour we spend, we get about 15 minutes at the bedside of patients and 45 minutes of every hour documenting everything … part of it’s insurance. Part of it’s medical-legal. Part of it is a federal mandate to have everything documented electronically.”

Startup accelerator Rock Health signs on UnitedHealth Group as a sponsor. It joins Microsoft, Nike, Qualcomm, and Quest.

Outsourcer and iSoft acquirer CSC reports Q2 numbers: revenue up 1%, EPS –$18.56 vs. $1.19, cutting guidance. The ugliness was caused by a massive $2.69 billion write-down of goodwill and a settlement of a contract dispute with the US government. Shares predictably tanked.

Two nurses file a class action lawsuit against Aurora Medical Center (CO) after being written up for trying to clock in before putting on their hospital-provided scrubs. They say they should be paid for the time it takes to go to the scrubs room, find some that fit, put them on, then go clock in.

History Mingles with Innovation in Atlanta
By Erin Sweeney, Director of Marketing
The Friedman Marketing Group

The “who’s who” on the Atlanta healthcare scene met at the historic Fox Theatre this week to discuss innovation and opportunity—along with military weaponry. The HealthIT Leadership Summit, founded by the Technology Association of Georgia, Metro Atlanta Chamber, and Georgia Department of Economic Development drew nearly 200 attendees and such notables as Drs. Robert Kolodner, Mark Dente from GE, and Kenneth Wilson, a U.S. Army Major who served three tours in the Middle East.

Key takeaways from the eyes of this healthcare marketing guru include:

• There is a whole new generation of healthcare IT experts ready to lead the charge.
• Analytics are a key capability for all healthcare IT systems.
• There are some really cool virtual reality glasses being tested in Afghanistan to help military medics and other first responders save lives—may come stateside soon.
• Vendors that enable ACOs through harmonization of multiple systems will be winners.
• Vendors that are behind can easily get ahead using new technology.
• Cloud computing is here to stay, on-premise is antiquated.
• Patients will spur providers to innovate.
• Boards will be more involved in quality improvement.
• Interoperability must happen between states.
• Average venture capitalist investment in healthcare IT is $3 – $5M.
• VCs are more interested in companies where technology is driving a service; and the two are not treated separately.

Amidst all the innovation, attendees did hear one reality check offered up by a panelist and based on research from Cigna Health: the average patient has 200 documents located in 19 different places.

And finally, Justin Barnes from Greenway Medical painted a gloomy picture for physician reimbursement and suggested groups ask themselves, “Do we interoperate or join an ACO?” Another panelist encouraged groups to look around and decide who they’ll affiliate with instead of waiting until the best dance partners are taken.

Overall, the Summit was interesting and a bit eye-opening. The TAG speakers and panelists added some fun and humor to the discussions. Dr. Dente pointed out that women are caregivers for not only their own elderly parents, but also their in-laws. Doctors’ appointments, prescriptions, transportation to and from check-ups — the women do it all. Looks like the upcoming holiday gatherings will be a walk in the park compared to what’s in store for this gal.

E-mail Mr. H.

News 11/11/11

Top News

National Coordinator Farzad Mostashari says ONC will beat the IOM’s suggested 12-month deadline in rolling out a program to accept and analyze patient safety reports related to computer systems.

Reader Comments

From Duck Hunter: “Re: West Johnson. West Johnson, vice president for healthcare revenue cycle consulting at Huron Consulting Group, is leaving at the end of December. He was an original Stockamp person.” West sent me a note confirming his departure.

From Phone Geek: “HIT Policy Committee meeting. This afternoon I have been listening to the HIT Policy Committee meeting. There’s now a rah-rah session about consumer access to their EHR records. President Obama wants every person to access his personal health record by 2014. I keep wondering if we should be more concerned about every person having access to healthcare and ensuring that rural America has access. And maybe making sure that we have good EHR implementations delivering systems that clinicians like to use and that they and their delivery systems receive value from.” Well, the HIT Policy Committee really has no influence on healthcare accessibility, however important the need. On the other hand, isn’t there a workgroup that focuses on EHR adoption and certification – and presumably considers usability?

From B.S. Walks: “Re: Cerner finally fulfilling the façade prophecy. Look at the stock dump that happened 10/27 and 10/28, dropping from $72.88 to $63.67. They are going counter-market, which isn’t a good sign unless you’re a short seller.” Above is a three-month share price graph of CERN (blue), DJIA (red), and Nasdaq (green). The trend line definitely looks better over a full year, but there was a big dip in August and the second starting in October. It could be more of a reflection on the sector since some of the HITECH luster seems to be wearing off as some companies haven’t met lofty expectations that were built into the share price.

From Horned Frog: “Re: Epic. Salaries are in line with what most new college grads get, or better I suspect since many of them are liberal arts majors. However, their incomes rise quickly, often exceeding what the typical med tech, nurse, or hospital IT person might make, although they typically work more than 40 hours a week. And with regard to requiring everybody to live in Madison, there’s a lot of advantage in having people show up at corporate, sharing knowledge and networking. Corporate offices often had the greatest product expertise, and vendors allow road warriors to travel from wherever. It doesn’t necessarily cost more to travel across the company than to take a shorter trip.”

From Porcini: “Re: Vince’s article on Epic. Hiring fresh grads isn’t new – Cerner started that. I doubt you can attribute cost overruns to training cost since organizations plan for those and it’s a good investment. Regarding ‘the Epic way.’ how do you define success in allowing user to customize – inefficient workflows? Unhappy clinicians? Epic charges so much because it can, and because it delivers what it promises in a timely fashion for a price that customers seem to find justifiable. And if Epic brainwashes its users to earn high KLAS scores, why aren’t other vendors doing that? I’ve never seen anything like Epic’s most collegial user group meeting. The amount of education and information sharing is absolutely astounding.”

From Buffalo Tom: ”Re: IOM report. Maybe I’m reading too much into it, but organizations with internally developed software fall under this definition, at least with regard to certification. I’m involved in the certification program and have seen firsthand how good ideas and intentions can create a lot of extra (and arguably unnecessary), like developing EHR modules that will be never used beyond earning certification. Compounding these recommendations is the discussion of mobile healthcare applications falling under FDA purview. Imagine if all of our clinical projects required certification or FDA approval before go-live. That might push hospitals to third-party solutions exclusively and we know there is no vendor that has a solution for every provider and scenario. I’m for safety checks and resources to help develop safer software are needed and valuable, but with regard to in-house development, I don’t think they need to jump through additional regulations imposed because of some shop that popped up last month to hurry up to get into the healthcare space.”

From Hat Creek: “Re: TEDMED 2012. Are you going?” Probably not – registration is $5,000, the attendee list is “curated” (meaning you don’t automatically get to come just because you have $5,000 to wave around), and it’s not all HIT-related. They had fun speakers last time around, including Dean Kamen, Michael Graves, Tim O’Reilly, Loudon Wainwright III (I could have sworn he was dead, but he’s not), Steve Wozniak, and some semi-celebrities.

From Lugubrious: “Re: Health IT Leadership Summit in Atlanta. SoloHealth won the Intel Innovation Award for their health and wellness kiosk. Bart Foster, the CEO and founder, was a very nice guy who accepted the award with a lot of humility and brought his team up on stage with him.” I found the above video on YouTube. The touch screen kiosk checks vision, blood pressure, weight, and BMI and lists doctors and “valuable offers from healthcare partners” (meaning ads, I assume.) I’d skeptical that a glorified, electronified scale and eye chart can have a significant impact on health (the people who need to hop on the scales tend to steer a wide berth, no pun intended, around them), but the technology itself seems interesting and the direct-to-consumer approach is different. I like the idea that users can create an account and access their information from any of the company’s kiosks. Maybe it should include a one-click connection to a nurse-staffed telemedicine center where you swipe your credit card to get a consultation for $20 or something. Ask Walgreens – they are clearly the leader in putting technology and innovative services right in their existing stores, turning what used to be “the pharmacy” into a “health center.”

HIStalk Announcements and Requests

Wondering what treasures await you on HIStalk Practice? A few gems from the last week: 52% of office-based doctors are e-prescribing. Greenway Medical is named a preferred EHR vendor for at least 10 RECs. MGMA’s Rosemarie Nelson provides great recommendations on improving EMR adoption. athenahealth earns a spot on a list of Top Places to Work in Boston. Brad Boyd of Culbert Healthcare Solutions tackles ICD-10 and 5010 readiness.  Sign up for your HIStalk Practice e-mail updates because you never know what booty you may find there (and I mean the treasure kind, though the foot kind often makes an appearance on HIStalk Practice as well.)

I perused my calendar last night and realized that HIMSS is just over three months away. Wow! Mr. H mentioned that HIStalkapalooza is on the calendar for February 21, which means it’s time to start shopping for the perfect party outfit (new shoes!) Returning this year: our always-popular “Inga Loves My Shoes” contest, sashes for the sassy, and the crowning of our HIStalk King and Queen (for the best-dressed partygoers.) Of course we will name the winners of the HISsie awards and hope that Jonathan Bush will return as emcee (Neal Patterson has agreed to step in if JB is unavailable.) We’re also considering a few new things for both the party and HIMSS in general, so stay tuned.

Friday, which contains the 11th hour of the 11th day of the 11th month that marked the end of World War I hostilities, is Veterans Day. Unlike Memorial Day, which is set aside to honor those who died in military service, Veterans Day is when we honor all American veterans (hopefully we do that on other days as well.) It’s a refreshingly non-commercial commemoration that involves no Hallmark moments, mandatory gifts, or heavily sponsored sporting events, so why not start your own tradition and take the opportunity to tell a veteran that you appreciate their service and sacrifice? If you served, are serving, or have loved ones in the military, thank you.

Listening: reader-recommended Ratatat, a couple of Brooklyn guys with a spare bedroom full of synthesizers (and a few guitars) that somehow make rocking instrumentals that are real songs (not background music) that sound like a non-computerized mad stew of Genesis, Boston, and Muse with some hip hop drum loops for rhythm. Sometimes the occasion calls for soaring, dramatic music free of unskilled singing of uninspired lyrics and these fellas deliver. Like most reader recommendations, this one was spot on with what I like. If I were making a movie, I’d want them to do the soundtrack.

On the Jobs Board: Support Consultant, HIM Coding Manager, Director Client Programs – HIE Architect. On Healthcare IT Jobs: Research Informatics Analyst, Epic Revenue Cycle, eGate Integration Analyst. 

Inga, Dr. Jayne, and I work day jobs, so we do the best we can with HIStalk given the time we have, trying to compete with well-funded armies of full-timers running around and reporting for various magazines and sites. You can help by reading, telling others, and supporting our sponsors. We can always use guest articles, insightful comments, and news tips. There’s the usual stuff I always mention (friending, liking, connecting, and signing up for e-mail updates) but we’re open to ideas if we can figure out how to find the time to do them.

Acquisitions, Funding, Business, and Stock

Emdeon reports Q3 numbers: revenue of $282.1 million (14.7% increase); non-GAAP adjusted EBITDA of $76.7 million (15.3% increase.)

Siemens AG announces that it ended its fiscal 2011 with record operating results that included several orders worth over $100 million for Soarian Revenue Cycle. Siemens Healthcare also just finalized a $28.7 million contract with Hawaii Health Systems.

Millennium HealthCare Inc. completes its acquisition of medical billing and consulting firm Premier Technology Resources.

Vista Equity Partners completes its acquisition of Sage Healthcare Division and renames the company Vitera Healthcare Solutions. Matthew Hawkins, previously CEO of library software vendor SirsiDynix, is named CEO, replacing former Sage Healthcare President Betty Otter-Nickerson. The ambulatory product line remains intact.

Sales

Northwest Michigan Surgery Center selects the Versus Advantages RTLS to automate process flow management for the clinical staff.

SUNY Upstate Medical University (NY) signs an agreement with TeraMedica to implement Evercore Enterprise Vendor Neutral Architecture, which will support integration for SUNY’s Epic EMR. 

John C. Lincoln Health Network (AZ) selects iSirona to connect medical devices to its Epic CIS.

Lakeland Regional Health System (FL) chooses RelayHealth for its enterprise HIE.

Twelve-bed Sedgwick County Health Center (CO) selects the ChartAccess Comprehensive EHR from Prognosis.

Four-hospital Lifeline Hospital Group will partner with Optum to bring that company’s billing and collection systems to Lifeline’s hospitals in United Arab Emirates and Oman. Optum says it will take what it learns there to aid its expansion in the Middle East.

People

Merge Healthcare appoints Peter Urbain (IBM) SVP of partner sales and Steven Tolle (OptumInsight, Allscripts) SVP of solutions management.

Omnicell founder and CEO Randall Lipps is named to the board of outsourced radiology provider Radisphere.

Announcements and Implementations

The Tri-State REC announces that it has met its enrollment goal of 1,739 primary care providers in Ohio, Indiana, and Kentucky.

North York General Hospital (ON), the first hospital in Canada to go live on CPOE and bedside bar code scanning of medications, earns the Innovation in the Adoption of Health Information award from Canada’s Health Informatics Association. The Cerner customer had been previously been recognized as HIMSS EMRAM Stage 6 hospital.

LSU Health Shreveport goes live on electronic medical records (Epic?) The implementation moves on to E.A. Conway and Huey P. Long hospitals.

Web-based PM/billing vendor Kareo launches its electronic patient statements and payment portal for practices.

Government and Politics

HHS’s Office for Civil Rights will begin conducting HIPAA compliance audits this month for office-based physicians, hospitals, and health plans. Twenty audits will be performed in the initial round and selected entities will be notified in writing within 10 days. Officials will visit the audited sites within 30 to 90 days of notification.

A Senate technology subcommittee chaired by Sen. Al Franken (D-MN) frets over recent healthcare data breaches at Minnesota hospitals, with Sen. Franken saying, “The same wonderful technology that has revolutionized patient health records has also created very real and very serious privacy challenges.” Ranking committee member and physician Sen. Tom Coburn, MD (R-OK) opines that maybe electronic records aren’t all that great. “They gotta get into my office to get it when it’s on a piece of paper.” Above is the Senator in his former life as a comic with partner Tom Davis (old timers will remember them from SNL) in an excellent Rolling Stones parody. Franken should get the band back together and run for governor with Davis as his lieutenant.

Technology

Steve Jobs gets his first posthumous nod for being right yet again: Adobe is abandoning its attempts to make Flash work on mobile browsers, and in fact, may be admitting that Flash is obsolete for the Web in general. Steve refused to allow Flash to run on Apple’s mobile devices, saying it’s proprietary, buggy, full of security holes, a CPU pig, incapable of responding to a touch screen interface, and a battery-eater. He said Apple mobile users enjoy videos and games just fine without Flash and that Adobe should dump Flash and focus on HTML5, which they apparently are now doing. Adobe canned 750 employees this week with the usual “restructuring to focus on core business” excuse, taking a $94 million charge for eliminating 7% of its work force.

Indigo Identityware announces iDNA for the iPad, which it says offers password-free strong authentication via a four-digit PIN to access a virtual desktop (including Citrix.)

A CIO article reports that a few clinicians at Seattle Children’s Hospital tested the iPad for running a virtual desktop in patient care areas. The verdict: every one of them returned their iPad, saying Cerner apps that were designed for desktop-and-keyboard users sucked big time on the small touchscreen.

Several states and technology vendors in the EHR/HIE Interoperability Workgroup define standards by which EHRs connect to HIE in a plug-and-play (their words) fashion.

Other

Epic goes before the Verona (WI) Planning Commission to present an expansion project that will add 900 offices and 700 underground parking spaces. Three buildings will make up the “Farm Campus” and may feature barn siding rather than brick, and possibly a silo. Epic, by the way, expects 2011 revenues to reach $1.1 billion, up from last year’s $825 million. A Verona city administrator estimates the new project will cost Epic $75 million.

Kudos to the eClinicalWorks employees who spent time this week volunteering with Habitat for Humanity in Boylston, MA. The eCW folks helped with painting, laying down floors, and assorted other projects.

The rate of healthcare employment fell from 45,000 new jobs in September to only 11,600 in October. Physician offices accounted for 8,000 of the new opportunities in October.

A new report estimates that the combined ambulatory and inpatient EMR market will grow to over $8.3 billion by 2016. Allscripts hold the largest share of the ambulatory EMR market while Meditech leads in the acute care segment.

The Clark County Commission (NV) considers a $30 million proposal for a McKesson EMR system for University Medical Center. The contract includes a one-time fee of $27 million, $4 million in annual fees for the next four years, a $1 million reserve, and $1.3 million to backfill employees and perform ongoing system maintenance.

A three-year study from the RAND Corporation concludes that providers are interested in bundling payments to cut health costs, but find the strategy difficult to implement. Technical challenges include deciding what problems should be subject to bundling and providing clinicians with the information needed to improve care. Cultural issues include convincing providers that cost cutting measures will not reduce the quality of care.

Elected officials urge residents of Freetown, MA to show their support for a proposed Meditech facility to be located in their town, an option Meditech walked away from in September after tangling with the state’s historical commission over preservation issues. Given that the unemployed citizenry vastly outnumber the archaeologically astute, just about everyone is trying to neuter the commission’s authority in their pleas urging to Meditech to reconsider.

Notorious patent troll Acacia Research Corporation announces that EMR vendor Aprima has decided to pay the company off in the form of a “license agreement” rather than spend money defending itself against a nuisance infringement lawsuit. Acacia’s intellectual property is, “The generation of a document utilizing user-modifiable document structures, a database including information to be placed into a particular document structure, and a computing device which combines the particular document structure with relevant information stored in the database.” Legal chest-puffing is good business: Acacia booked $63 million the most recent quarter. The company owns patents for such medical innovations as catheter insertion, cardiac stents, performing laparoscopic surgery, medical monitoring, PACS, and wireless physiologic monitors.

Sponsor Updates

• On the first day of its go-live, Baptist Healthcare System’s (KY) ED exceeds Meaningful Use thresholds using T SystemEV.
• Passport Health releases its November schedule of live demonstration webinars.
• Trustwave’s security and compliance portal TrustKeeper is named a 2011 Chicago Innovation Award winner.
• MED3OOO announces upcoming dates for its webinars featuring InteGreat EHR with Quippe technology. MED3OOO will give away an iPad 2 at each session.
• e-MDs and TMF Health Quality Institute offer free assistance to Texas e-MDs customers interested in earning incentives under PQRS 2012.
• Covisint releases a report on three PQRS misconceptions that could prevent providers from obtaining CMS incentive dollars.
• Scott Besler and Jonathan Besler of Besler Consulting  will present Medicare Hot Topics at the HFMA NH/VT Annual Health Care Reimbursement Seminar December 8.
• The Kansas and Missouri regional extension centers select Greenway Medical’s PrimeSUITE EHR for their combined 2,548 providers.
• Wolters Kluwer Health announces the addition of general surgery to its UpToDate clinical knowledge system.
• Baptist Hospital (TN) is using MyHealthDIRECT to schedule community provider appointments for its discharged patients.
• Healthcare Integration Strategies enters into a Provider Consulting Organization agreement with CapSite, enabling Healthcare Integration Strategies to offer the CapSite service as part of its consulting engagements.
• An Aspen Advisors case study covers its engagement by Indiana University Health to analyze the personal health record market and best practices use of PHRs by health systems.

EPtalk by Dr. Jayne

It seems as though we’ve had a couple of slow news weeks lately, but the past few days have been what you could call a target-rich environment. Of course, the Institute of Medicine report is tops on many colleagues’ minds. Mr. H did a great job with his digest, which thankfully gave me enough talking points to look as if I had read the whole thing, when in fact I had spent my time watching Fast Five rather than doing actual work in the evening at home as I usually do.

Personally, I’m intrigued by the comments about regulating software, but I also think we need to hold users accountable for certain behaviors. I have physicians who regularly strive to defeat EHR safety features and others who complain about every safety feature which is introduced. No matter how non-intrusive the code, they take it as an assault on their profession. Maybe for those physicians who demand to wear the mantle of medicine as it used to be rather than living in the present, I say adepto super is: get over it.

Merritt Hawkins releases the 2011 Survey of Final-Year Medical Residents, which looks at career preferences and plans of those completing their training. Not surprisingly, over the last decade there has been a ten-fold increase in the number of physicians who are looking for hospital employment. Solo practice continues to be a non-starter. The number of residents who owe between $200,000 and $250,000 in student loan debt has grown from 7% in 2003 to 19% in 2001. My take on it: more validation of the impending primary care shortage. It’s much harder to pay off that kind of debt as a PCP than as a radiologist or dermatologist.

Speaking of the primary care shortage, the headline “Walmart wants to be your MD” certainly caught the eye of THIS medical doctor. Just when you thought that we’d seen the worst of the worst ideas in healthcare reform, this one comes along. Apparently Walmart requested information from partners looking to reduce healthcare costs and then had to issue a statement correcting its position, stating it was “not building a national, integrated low-cost primary health care platform” even though that’s what the statement said.

Walmart’s track record of driving jobs out of the economy in the name of low prices is well known. I hardly think a company that hasn’t even figured out how to offer affordable health insurance to its own employees has any business getting into the healthcare fray. Within days of this request, they also announced that they will no longer offer health insurance to new part-timers. As the article states, primary care isn’t what is driving up the cost of healthcare in America. My favorite quote from the article summarizes this as just another retail clinic attempt to gain market share: “If you get someone in the door, you can also sell them milk and a shotgun.”

Speaking of great quotes, I love this one from an article on transitioning from paper to electronic records. When asked what data should be transferred to the EMR, one physician answers, “depends on how anal-retentive you are.” This absolutely hits the nail on the head.

A friend of mine just went through the grueling process of prepping all of her charts for bulk scanning. She quickly discovered that her practice had kept every scrap of paper that ever came into the office, regardless of relevance or utility (and independent of liability as well.) She falls into the “slash and burn” camp and quickly rid her charts of duplicate and meaningless information, but not every provider is that motivated or has that much free time. Most want to keep everything, which often results in simply converting a messy paper chart (where nothing can be found) into a messy electronic chart (where nothing can be found.)

An interesting survey finding mentioned in the article: 44% of organizations are not explicitly measuring the effectiveness of productivity of their scanning process. My final quote of the day comes from Pretty Woman:  Big mistake. Big. Huge.

Considering the massive effort involved in converting from paper to EHR, scanning is one of the places where the work is reproducible as well as being amenable to applying lean manufacturing principles. Unlike work with patients or families, you can look at cycle time, accuracy, and per-page outputs when you look at scanning. Charts CAN be treated like widgets. Unless you just want to spend more money than you actually need to or prefer to be scanning for years, this process should be looked at carefully.

Have a question about milk and shotguns, takt time, or what’s next in my Netflix queue? E-mail me.

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

News 11/9/11

Top News

A remarkably frank Institute of Medicine report commissioned by ONC, Health IT and Patient Safety: Building Safer Systems for Better Care, urges significant government intervention with regard to the safety of healthcare IT systems. It takes shots at both HIT vendors and HITECH incentives, saying in the preface,

Stories of patient injuries and deaths associated with health information technologies (health IT) frequently appear in the news, juxtaposed with stories of how health professionals are being provided monetary incentives to adopt the very products that may be causing harm.

On the committee were researchers, academics, and practicing physicians. Vendors were not represented, although John Glaser of Siemens was a reviewer. These are the most interesting points from my quick read of the report.

• The report recommends that ONC require all health IT vendors to publicly register their products with ONC, starting with certified EHRs.
• It urges HHS to eliminate non-disclosure and limited liability clauses in vendor contracts that discourage users from sharing patient safety-related software concerns.
• It suggests that reviews of software applications be published publicly.
• It recommends that HHS form a council to develop criteria for the safe use of information technology.
• It urges HHS to require software vendors to report IT-related patient safety harm or concerns to a central organization and also encourage users to voluntarily report to that organization as well.
• Software-related problem reports would be reviewed by a new group that would be the HIT equivalent of the National Transportation Safety Board. The report says FDA is not up the task since it’s an oversight body, AHRQ is too research-focused, CMS is mostly good at threatening the income streams of providers, ONC doesn’t have the expertise, and Joint Commission and related organizations are so dependent on income from special interests that they can’t be objective.
• It observes that “poor user interface design, poor workflow, and complex data interfaces are threats to patient safety” and “lack of system interoperability is a barrier to improving clinical decisions and patient safety” once you get beyond lab-related terminologies such as LOINC. Overall, it is quite critical of system usability and observes that vendors don’t have much incentive to make their products interoperable with those of their competitors.
• The report says that the industry has done a poor job of regulating itself with regard to patient safety and suggests turning the whole thing over to the FDA to regulate if the foot-dragging continues: “These and other recommendations would comprise the first stage for action, greatly advancing current understanding of the threats to patient safety. However, because the private sector has not taken substantive action on its own, the committee further recommends that HHS monitor and publicly report on the progress of health IT safety annually, beginning in 2012. If progress is not sufficient, HHS should direct the Food and Drug Administration (FDA) to exercise its authority to regulate health IT.”

Reader Comments

From Pachelbel: “Re: Vince’s article on Epic. Cache’ is not proprietary to Epic as it is owned by InterSystems. It can be an extremely fast database if implemented properly. Ask QuadraMed or any of the hundreds of other HIS vendors that use it. I suspect your gripe is with the way Cache’ was implemented. No database works well if the data structure or queries are malformed. Full disclosure: I’m a Cache programmer who has seen the good, bad, and plenty of ugly implementations of Cache’.” Cache’ is one of few technologies developed for healthcare that was adopted by the financial industry for mission-critical applications, with organizations such as Credit Suisse, Ameritrade, and a couple of stock exchanges using it.

From SouperDooper: “Re: Vince’s article on Epic. I agree with the points made about the Epic way, rookie staff, and high costs. But to say that GE and McKesson have equal functionality is beyond ridiculous.”

From Astrid: “Re: Vince’s article on Epic. This feels like ‘nobody ever got fired for buying IBM.’ I know a hospital where the VP had Epic where he came from and wanted Epic there, so it was a total rip-and-replace without a business analysis or needs analysis. I understand that a strict implementation keeps clients from shooting themselves in the foot, but that usually speaks to their lack of business sense, discipline, and management ability. Having an implementation guided by people without healthcare experience and knowledge seems to guarantee rework later.”

From Lorenzo’s Oil: “Re: Catholic Healthcare West. Hear they’ve scrapped their dual Cerner/Meditech strategy and are moving forward with Cerner system-wide after Meditech problems, with Cerner picking up about 20 sites once they’re done. I also heard Epic tried to jump into the fray, but CHW didn’t like the exorbitant price tag.” Unverified.

From Unbiased Consulting Firm: “Re: Epic. They clearly have a huge lead in implementations over the last 24 months, but the talent pool is not available to support those implementations, nor does the application support this market advance. Meditech, Cerner, and Allscripts … there is much to do with marketing and creating awareness. If you purchase Epic, you need to be able to support and implement it successfully. Each of these applications are market leaders – do not be taken by the media. Make your choice, but consider all the factors.”

Acquisitions, Funding, Business, and Stock

Grant Thornton, LLP acquires Computer Technology Health Associates’ Health Solutions division, including five military healthcare contracts and the staff supporting them.

HMS Holdings Corp. announces plans to buy RAC contractor HealthDataInsights for about $400 million. HMS expects HDI to contribute $85 million in revenue next year.

Days after the SEC releases new guidance on the matter, HCA revises its accounting for the recognition of income from HITECH incentive payments. Last week the SEC indicated that the “gain contingency” accounting model was the appropriate income recognition model for payments. Under this model, HCA will “recognize HITECH income when its hospitals have demonstrated MU and the cost report information for the full cost report year that will determine the final calculation of the HITECH payment that is available.” HCA expects to recognize HITECH income of $100 million to $130 million in Q4 and $190 million to $220 million for the full year.

San Diego-based Perminova, which offers SaaS-based applications for managing cardiac electrophysiologic labs and cardiovascular surgery, gets $7 million in venture funding. Its software is used by UC Sand Diego and Mount Sinai in New York.

Sales

UC Health (OH) selects Ciena Corporation’s 4200 Advanced Services Platform to provide network connectivity across four hospital buildings and its data center facilities.

Iowa Health System chooses Jardogs’ FollowMy Health Universal Health Record to provide online access to its patients.

Conway Medical Center (SC) purchases PatientKeeper’s clinical suite of applications to automate physician workflow and drive physician adoption of HIT.

Kindred Healthcare signs for practice management and revenue cycle tools and services from MED3OOO.

People

IT service provider Systems Made Simple hires Viet Nguyen, MD as CMIO to advance technology initiatives to improve continuity of care and enhance patient safety. He was previously with KForce eGovernment Solutions and the VA Office of Information.

Optum’s Accountable Care Solutions team, led by Todd Cozzens, now includes over 700 cross-functional team members focused on aligning hospitals, physicians, and health plans for integrated care models.

Fast Company profiles Zynx Health Chief Nursing Officer Pat Button EdD, RN.

Announcements and Implementations

Cedars-Sinai Medical Center (CA) launches Voalte’s point-of-care communication solution following a year of research and testing.

Platte Valley Medical Center (CO) goes live on eCareNet, powered by Soarian Clinicals.

Rochester General Hospital (NY) and seven affiliated practices go live on Epic. They will spend $65 million over the next two years to convert the entire health system, which includes two hospitals and 40 practices.

Kronos announces its InTouch time clock that features a color touch screen, gives employees access to their accrual balances and schedules, and supports off-peak use of apps such as employee surveys or streaming of informational videos.

Technology

Panasonic expands its Toughbook line of ruggedized laptops, popular in hospitals, to the Android-powered Toughpad, initially available in 2012 in a 10-inch form factor ($1,299) with a 7-inch version to follow.

Other

CCHIT announces that AOD Software’s Answers EHR and HealthMEDX Vision are the first EHRs to earn its Long Term and Post Acute Care certification.

Home health agencies, by the way, will see a 2.3% decline in Medicare payments next year under a newly released regulation. Opponents claim the cuts will leave half of Medicare home-health agencies operating in the red in 2012.

Community hospitals are progressing with their EMR implementations, with 69% saying they have acquired the technology and 39% of those reporting that their EHR project will cost over $8 million. The same report finds that almost all community hospitals have begun the conversion to ICD-10, though only a quarter are currently undergoing remediation. Forty-three percent of the hospitals say they are participating in HIEs.

The local paper provides an update on Cape Code Healthcare’s (MA) $20 million HIT investment, which includes a replacement of Meditech Magic with Siemens Soarian. Mr. H. interviewed Cape Cod VP/CIO Sheryl Crowley last year.

The HIMSS EHR Association announces its support of iHealth Alliance’s EHRevent, an online system for reporting adverse events. It’s part of the PDR Network, whose CEO Edward Fotsch MD was interviewed on HIStalk a year ago.

Eighty-three percent of clinical informaticists participating in a Billian’s HealthDATA survey report an improvement in quality outcomes from using EMRs.

CMIOs, CNOs, and senior nursing executives believe their roles and responsibilities will continue to evolve as new technologies are developed, according to a research report by Capsule. CMIOs indicate their most basic job function is to bridge the gap between clinical needs and IT, while CNOs and senior nursing execs see their roles evolving to be more inclusive of departments outside of nursing.

The EHR/HIE Interoperability Workgroup issues technical specifications to standardize connections between providers, HIEs, and other data-sharing partners.

Rival health systems HealthPartners and Allina Hospitals and Clinics (MN) claim their collaboration allowed them to shave $6 million in medical costs for patients across two counties. The organizations are participating in a seven-year “learning lab” that involves the pooling of resources, sharing of EMRs, and mining of insurance claims data for about 26,700 people with private insurance.

Kevin Lasser, CEO of JEMS Technology, compares Ford’s smart phone app for owners of the Focus Electric to his company’s own telemedicine app in My Ford Magazine, distributed to 4.7 million recipients.

I featured Aventura in one of my Innovation Showcases and at least two readers have told me they’ve gone to work for the company. CEO Howard Diamond writes a post for Boulder Startups urging entrepreneurs to jump into healthcare IT: “The software and other tools that are supposed to be building efficiencies, reducing errors, and building collaboration and trust across caregivers are actually having the opposite effect; they are creating barriers to efficient quality care.” I like the list of information sources he provides for those interested in the healthcare revolution: Clayton Christensen (the Harvard professor who wrote The Innovator’s Dilemma), Regina Herzlinger (the Harvard professor who wrote Who Killed Health Care?), HIMSS (which needs no introduction), and HIStalk (the non-Harvard, non-professor known mostly for goofy music recommendations and HIT rumor-mongering.) Howard’s just being nice since I profiled his company.

I bet the Harvard people have more time after their day jobs to pursue their side ventures than I do, though. Mrs. HIStalk keenly observed this weekend that “whatever it is you do upstairs all the time won’t get done when you kick the bucket.” That’s the extent of her knowledge about HIStalk.

New York’s state controller nixes a proposed $22 million deal with Allscripts that would have created a call center for SUNY Downstate Medical Center. Allscripts had reserved the right to send work offshore, raising confidentiality concerns.

Practice Fusion is named top EMR for ePrescribing and helping practices achieve Meaningful Use by Brown-Wilson’s Black Book Rankings.

I’m not an attorney, but this ruling by Colorado’s Supreme Court seems to uphold a previous verdict that a man suing Kaiser for malpractice can’t claim physician-patient privilege in denying Kaiser’s lawyers access to his electronic medical records. He had a heart attack while taking a treadmill stress test and is suing Kaiser and one of its doctors, but didn’t want the defense to be able to study his medical records. A footnote in the ruling sounds like a HealthConnect (Epic) commercial: “Kaiser’s integrated electronic medical record is instantaneously accessible by any and all Kaiser healthcare providers and is a hallmark of the services Kaiser provides.”

Next month’s mHealth Summit has added as keynote speakers Surgeon General Regina Benjamin MD and HHS Secretary Kathleen Sebelius. HIStalk (in the form of HIStalk Mobile) is a media partner, so our own Travis Good, MD will be providing daily reports. He’s outstanding at understanding and explaining the business of mHealth, so he’ll provide both health and business perspectives. It’s December 5-7 at the Gaylord National Resort and Convention Center in the DC area. Full registration is $525, or $195 for federal government employees. I had a pretty good time there last year and the venue looks much better than last time, although I’d miss the proximity to the National Mall and all the fun sites and restaurants nearby.

Sponsor Updates

• Mike Marvin of CareTech Solutions and Kara Wingerter of Blessing Health Systems (IL)  will present a case study on increasing revenue with online pre-orders and sales at this week’s Greystone.net Healthcare Internet Conference.
• OptumInsight launches additional capabilities for its Netwerkes EDI service, including integration with Epic PM Systems claim administration and clinical information workflows.
• GetWellNetwork appoints Wellford Dillard as CFO.
• Facilities of Vitalité Health Network (Canada) will go live next week with a pharmacy medication order management system connected to its Meditech system and powered by Perceptive Software’s ImageNow enterprise content management system.
• ICA releases a white paper entitled All Health Information Exchanges Are Not Created Equal.
• Mac McMillan, CEO of CynergisTek and chair of the HIMSS Privacy and Security Policy Task Force, will serve a panelist for Clearwater Compliance’s HIPAA-HITECH Blue Ribbon Panel webinar How to Prepare for HIPAA Audits.
• Tee Green, president and CEO of Greenway Medical, will host a November 15 webinar on future trends in healthcare.
• Beacon Partners receives Epic’s “Community Connect” certification.
• McKesson launches RelayHealth in Canada at the HealthAchieve 2011 Conference.
• University Medical Center of Princeton at Plainsboro (NJ) selects ProVation MD for its GI department’s documentation and coding.
• DST Health Solutions LLC announces an agreement with 3M Health Information Systems to integrate 3M’s ICD-10 Code Translation Tool with DST solutions.

Contacts

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

Monday Morning Update 11/7/11

From The PACS Designer: “Re: iPad. A new, free iPad application called Line2 HD turns your iPad into a phone. This extended feature could increase the penetration of iPads into healthcare environments.” It’s very cool, but it should be noted that while the app is free and so is the service for a seven-day trial, the ongoing cost is $10-15 per month depending on the options chosen. That gets you a new or transferred number, voice mail, and conference calling, all over Wi-Fi or cell. A cool feature: if you’re not connected, it will forward incoming calls to up to six other numbers. This CNET review is positive.

From Lobstah: “Re: Meditech. New executives.” Meditech promotes Chris Anschuetz to SVP of technology and Scott Radner to VP of advanced technology. They’ve been with the company for 36 and 21 years, respectively. 

From Ralph Hinckley: “Re: NextGen. Drops MEDSEEK as a white-label enterprise portal, developing its own.” Unverified. Ralph sent over an e-mail saying that NextGen will release its own enterprise patient portal in 2012, integrated with its HIE platform and physician portal. The companies signed their agreement just three months ago.

Speaking of Meditech, the company releases its Q3 report. Revenue was up 19% to $141 million, EPS was unchanged with profit of $32 million for the quarter.

My Time Capsule editorial this week, gasping for air after being entombed journalistically for five years: Leapfrog’s Leap into Irrelevance. I looked back to Leapfrog Group’s founding: “Predictions were dire back then in the post dot-bomb nuclear winter. Hospitals would be wildly overbedded. Savvy baby boomers, emboldened by buying books and dog food online, would be calling the shots, making shrewd healthcare decisions and choosing providers based on stringent quality measures that would be plastered all over the Web. Unfocused, change-resistant hospitals, which included all the ones I’d ever worked for or heard of, would be road kill. ”

Listening: Frosting on the Beater, a 1993 album by The Posies, alt power pop from Washington with a big, radio-friendly guitar sound. You either found it a guilty pleasure on VH1 or missed it entirely.

Welcome to new HIStalk Platinum Sponsor Henry Elliott & Company of Wellesley, MA. The company operates in a fascinating, high-demand niche: providing certified experts in InterSystems Cache’, M/MUMPS, and Ensemble for almost 20 years. The company offers experts in those technologies (contract, temporary, remote, and direct placement.) Or, if you are skilled in those areas and are feeling under-appreciated, review the plethora of opportunities in case you’re in the job-changing frame of mind and want to connect with a company that understands and values your highly specialized talents. If you need or have Cache’ or MUMPS expertise, Henry Elliott & Company would love to hear from you. Thanks to those folks for supporting HIStalk.

Also supporting HIStalk is Acusis, a new Gold Sponsor. Pittsburgh-based Acusis offers clinical documentation solutions in the form of outsourced medical transcription. Customers choose whether they would prefer US or global CMT-certified transcriptionists. Their Six Sigma-driven processes include a separate Quality Control editing step, and medical language specialists are paired with the customer’s dictating clinicians to give consistently high quality and fast turnaround time. The company’s team of 50 software engineers created dictation options that include telephone, VoIP, digital recorders, and smart phones, also supporting rules-based report distribution (network printing, fax, e-mail), multiple electronic signatures, and integration with just about every HIT system. Back-end speech recognition is offered, providing customers with a lower-cost solution for their more consistent clinicians. An iPhone-based, Dragon-integrated front end speech dictation option was announced a few weeks ago.Customer testimonials are here. Thanks to Acusis for supporting HIStalk.

It’s a 60-40 split that today’s healthcare software cannot or can, respectively, support needed improvements in cost and quality. New poll to your right: a quick read on which vendor is “doing things right” more than the others, which you can define however you like (quality, vision, business, etc.)

Financial performance solutions vendor MedAssets reports Q3 numbers: revenue up 50%, EPS –$0.02 vs. $0.14. Excluding integration costs from its Broadlane Group acquisition, earnings of $0.26 handily beat expectations of $0.16, sending shares flying on Friday to close up 16.7% as Nasdaq’s seventh biggest percentage gainer. I’m not much of a stock-picker and I own no shares in MDAS, but after a year of not-so-good performance (MDAS in blue, Nasdaq in green, and the Dow in red), it looks as though MDAS is moving up out of its trading range on increased volume, which is usually a good thing (duh). Market cap is $712 million.

Weird News Andy can’t decide whether this is a trick or a treat. A man walks into a hospital complaining of leg pain. Astute clinicians postulate that a potential etiology is the bullet lodged there from a Halloween shooting three days earlier. The patient said yes, he did recall that unfortunate eposide, but didn’t think it was a big deal.

New York-based Netsmart Technologies, run by former Cerner COO Mike Valentine, will relocate to Kansas City, creating 130 jobs with plans to hire up to 520 total employees. CEO Valentine never moved from Kansas City since he left Cerner in April 2011 and joined Netsmart in May 2011, so he gets to make all the employees move so he doesn’t have to (those handful willing to leave New York to go to Missouri, anyway, although the company will keep a New York office.) Netsmart sells solutions that include behavioral, public health, substance abuse, and social services.

Here’s Vince’s Part 2 HIS-tory of Computer Synergy.

Medicare’s pilot projects for commercially run disease management programs actually cost taxpayers more money and didn’t improve quality, a study finds. Five of the eight participating companies were losing so much money they paid an exit fee to drop out early. The conclusion is that just calling or visiting elderly patients occasionally doesn’t really accomplish much, and health coaches in such a program need to be given access to hospitals and practices and their patient information to coordinate care.

News I missed: Meditech co-founder and original president Mort Ruderman died October 12 at 75. A tribute video is here.

The DC RHIO is shut down when the city declines to continue funding it. The mayor apparently wants to take the federal grant money and start a new HIE.

The Louisiana Health Information Exchange launches after conducting pilots with Lafayette General Medical Center and Opelousas General Health System. They’re trying to recruit Ochsner, LSU, and Franciscan Ministries to sign up.  Orion Health is providing the technology. The HIE received $10.6 million in federal taxpayer dollars in March 2010.

UCLA Health System notifies 16,000 patients that their personal information was stored on a hard drive that was stolen in a burglary of the home of one of its doctors. The drive was encrypted, but the doctor had written the password on a slip of paper near the drive and that appears to have been taken as well.

Lawrence Memorial Hospital (KS) warns that patient billing and credit card information was exposed on the Internet for more than a month due to “failed security measures” by the Web host of the hospital’s online bill-pay vendor.

Blue Cross Blue Shield of Delaware offers to spend $30 million in charitable projects, including donating $1 million a year for the next five years to support the Delaware Health Information Network, in an attempt to convince regulators to allow it to merge with Pittsburgh-based insurer Highmark. The state’s attorney general says Delaware citizens have subsidized BCBS to the tune of $181 million and he wants at least $45 million set aside to benefit Delaware. 

Massachusetts plans to allow casinos to operate in the state, earmarking 23% of the hefty license fees involved, or around $50 million, toward encouraging the use of electronic medical records in hopes they will help control the state’s rising health costs.

E-mail Mr. H.

HIStalk Innovator Showcase–Caristix

Company Name: Caristix
Address: 1400 St-Jean-Baptiste Avenue, Suite 204, Quebec City, QC G2E 5B7
Web Address: www.caristix.com
Telephone: 877.872.0027
Year Founded: 2009
FTEs: 5

Elevator Pitch

The Caristix HL7 software suite helps healthcare IT vendors and hospitals reduce interface deployment from months of work to a few days.

Business and Product Summary

Caristix develops software for healthcare IT analysts and developers. With a focus on HL7 and data mining, Caristix streamlines the delivery of interfaces that support the flow of data in healthcare. If we look at innovation in this space, we took a leap forward about 15-20 years ago with the introduction of interface engines. The next leap forward is going to come from automating the manual scoping and configuration work involved in interfacing, leaving integration analysts free to add value on other more complex data integration topics.

With our software offering, we help vendors and providers scope HL7 interface requirements more quickly before coding, test more thoroughly before go-live, and troubleshoot over the interface lifecycle. Benefits to vendors and providers include lower interfacing costs, faster time to value, and reduced process waste and risk. We provide annual licenses that include support and maintenance releases. We also offer services, such as creating interface specifications for our customers, and getting them started on documentation and interfacing best practices.

Target Customer

HIT software and service providers, hospitals and IDNs, and HIEs.

Customer Problem Solved

The biggest bottleneck in HL7 interfacing isn’t coding or setting up the interface. With modern interface engines, that’s easy. What’s hard is figuring out what to code. In other words, which data should you handle and what does each piece look like in the real world (not on paper in the spec)? Our software figures out what to code automatically.

The way the industry solves this problem today isn’t going to work for much longer, especially with volume of data enabled through Meaningful Use. Right now, folks are essentially using trial and error. In other words, you set up an interface based on a site survey form and a broad product spec, connect up to a test system to get some data coming in, see what’s broken, then fix it. Rinse and repeat. If you’re lucky, you’ll make your schedule. If you’re not, you might be six months out. If you decide to go live anyway, the vendor and/or the hospital’s IT team will be facing one heck of a support backlog, which in turn, can tank adoption rates.

Trial and error is increasingly problematic with today’s interfacing volumes. It’s certainly going to get tougher to sustain once Meaningful Use forces real data integration, with multiple sources of clinical data coming into and going out of the EHR and other information systems. We’re seeing early-adopter vendors and hospitals moving away from trial and error. We think we’ve hit a sweet spot with our software. We’ve come up with a way to not only get proactive on scoping, but also keep scoping documentation up to date for future integration projects.

Competitors

Our competitors are niche tool vendors and a few of the interface engine vendors. However, that second category includes a little overlap: we also complement interface / integration engines and are working with two vendors in this space. But our biggest competitor is the status quo, folks just going along with business as usual.

Advantages Over Competitors

We integrate data mining so analysts can easily grasp their data and what it means. This can drive up interface quality while driving down project risk. The functionality we provide around HL7 data helps interface analysts to grasp sending and receiving system specifications easily. This enables analysts to identify gaps to be bridged by interfacing and integration early during a project. With complex interfacing and integration projects, project leaders can increase interface quality and confidence without jeopardizing timelines.

Fast Facts

• KISS (Keep It Simple…) If our spouses let us, the founders would tattoo “KISS” on our respective foreheads. At Caristix, we really want to keep things simple for our customers.
• We’re concentrating on HL7 for now. But keep an eye on us for other data standards over the next year.
• We’re an experienced healthcare IT team and we have a shared work history. Some of us even go back 12 years, and our team brings over 50 years of combined experience, in both technical and business areas in healthcare IT.
• The company has a product management focus. In other words, our products reflect market and user needs and where we think the market is going. As a startup, the last thing we’re interested in is the tech fantasy of “build it and they will come.”
• Here is a customer quote: “This is the only tool that provides me with the filter functionality needed to successfully dissect thousands of transactions and find all of the deltas, without jeopardizing timelines.”

Pitch Video Created Specifically for this Showcase

Customer Interview (a system analyst for a large healthcare IT software vendor)

What problems have you solved using Caristix products and what impact has that had on your organization?

We are seeking ways to continuously improve our customer enablement process for our product. An activity in that process is understanding the customer environment. The Caristix Conformance product assist the SME knowledge of their environment and not to rely on outdated documentation and assumptions. Conformance gives us (and the customers) a great visual of their environment.

With this improved visibility, we reduced the rationalization logistic interactions – a lengthy Q/A process (i.e. what systems are involved in the project?  what data comes from that system? <<…implementation period…>> Are you sure? Well, we’re seeing this type of data and it does not agree with the initial statements. Are there any more surprises? etc.). This form of interaction occurs over weeks or months and creates much re-work as information becomes known. Knowing upfront the true reality not only mitigates loss time (and financial expenditures), but also improves customer satisfaction and overall product experience.

Caristix also has other products which we review:

• Cloak, which de-identifies data – another great product in the making. One colleague commented, “… this is the simplest interface I’ve ever used…”
• Pinpoint, which enables what I call “finding a needle in a haystack” simple. Pinpoint cut so much time out finding what’s occurring within the data flow, it’s amazing! One colleague said, “…I wish I had this product when dealing with customer ABC — it would have saved me days of work.”
• Although we have not looked at their other products, based on the ones we did, I’m confident they pointedly address the intended concerns.

What alternatives or competing products did you consider and why did you choose Caristix?

We searched for products that address our specific concerns, but didn’t find any. Also, as we began to use the product, the company was open to our product improvement suggestions. And the most amazing thing occurred — they not only implemented the suggestions, but also saw the general benefits to other users as well. Their turnaround time to implement was truly Agile. We saw results in weeks, not months or worst, year(s). As Conformance continues to mature with new features, plus the incorporation of the suggestions, I foresee retiring some of our legacy tools.

How would you complete this sentence if speaking to a peer? "I would recommend that you take a look at Caristix under these circumstances:"

If you are looking for a company who really wants to work with you to solve the problems that their product set addresses, then certainly call Caristix. They truly try to understand the customer use cases, see how (and which product(s)) can meet those needs. And on the rare occasion when their isn’t a “match,” they are upfront to let you know, but still try to see if it’s possible within their reach.

Their response is impeccable, from showing you mock-up to real running code. They are willing to see how your suggestion can make their product better. The proof is when you see the implemented result! Now that’s amazing! Their Say:Do ratio is on par.

They have a good idea where the market is progressing and are making plans to be there as you review their product roadmap. I believe they are flexible enough to make the necessary course corrections as they occur.

An Interview with Stéphane Vigot, President, Caristix

HL7 interfacing sounds simple, at least on paper. Why do organizations need your products?

HL7 is called a standard, but it’s more of a framework. It’s extremely flexible. You’ve got some guidance regarding the way you could organize the data, but each and every hospital adapts the organization of the data to its clinical workflows.

For example, if you consider the admit status sex of a patient, you can have up to six different possibilities. There are very, very few systems that would use those six possibilities. Most of them will use three or four, and even when they pick only three or four, let’s say for a male and a female, one could say, “OK, a male is designated as an M and a female as an F,” or another will say, “In my organization, we’d rather use an 1 and a 2.” That’s a real example.

For any kind of field, you’ve got a type of flexibility. Even though two hospitals are using the very same ADT system, let’s say –  admission, discharge and transfer — and they use the very same vendor, the very same version of the system, the data will most likely be organized in a different way.

Thanks to our technology, instead of having an interface analyst looking and reading, literally, HL7 messages, we get the feed from the system that you have to connect. In a matter of a few minutes, we do some reverse engineering on the metadata and then we issue a document that will very precisely tell you how the data is organized within a system.

With interfaces, you often just play back a bunch of messages and try to figure out all the exceptions and rules, with an application expert on one side an an interface expert on the other. How would a hospital use your product to create their own interoperability?

They would get the software platform that we have. They would get HL7 logs, so basically several HL7 messages, and they can deal with tens of thousands of different messages. They would put that file into our platform, and then automatically the platform will do a reverse engineering process. It will read the data and issue a Word document that will tell you precisely how the data is organized.

Then the technician, either from their vendor side or from the hospital side, will know exactly how to configure the interface engine. They will know exactly what data is what and how it is organized — the length of the field and everything. That’s basically it. It’s a very straightforward application that saves hours and sometimes days or weeks of work for an interface analyst. We’ve got a customer testimonial where a task that usually took up to eight hours is done in three minutes, thanks to our platform.

Does the typical customer buy your product just for a specific interface problem they’re trying to solve, or is it in their tool chest of things that they end up using a lot?

They end up using it a lot, because an average hospital in the US will usually deal with more than 100 interfaces. Every single time there is an update to any of the systems they’re using, then the interface will need to be adapted to the update. We know hospitals that have up to five persons dedicated to managing the interfaces. That’s what they do all day long. That’s why our platform can be used on a daily basis.

How would a customer use your product to validate the integrity of an interface, either a new one or an existing one to make sure nothing has changed?

They will just get the logs, do  a reverse engineering on the new or existing system, and perform gap analysis between the current interface, or on the old interface if you will, and then the new interface that they want to build. There’s a built-in functionality within our platform that allows you to perform in a matter of a few minutes a gap analysis between two specifications.

You’re based in Canada. Do you see any particular challenges that you’ll face when working with the US?

It’s our target market. In fact, 80% of our customers are in the US. Historically, the team of Caristix worked for a major US vendor for a number of years. The genesis of Caristix was because of a reduction of forces — we had to let go several software developers that were working for that US vendor, so our expertise was really in the US.

Who is it you market to and how do you reach those people?

We market to two segments: hospital vendors and hospitals. We are currently working on a free application for hospitals that will allow the hospital’s IT teams to document the specification of the different systems, again, in a matter of a few minutes. 

We use a lot of white papers, we use a lot of reference, if you will. Since we’ve been working with US companies for years, we know a lot of them, so that’s how we reach out to them. We’re now getting more visibility and we’ve got some consultants — or I’d say gurus — in healthcare IT that are also talking a lot about us.

The nice thing about our platform is that once you see how it works, you automatically understand the benefits and you automatically understand the savings that as a vendor or even as a hospital you’re going to be able to make. I’d say it’s an easy sell. As soon as you talk to people who know and understand the complexity of HL7 Interfacing, it’s almost – and I hate to use this term – but it’s almost a walk in the park from a sales standpoint.

What do you hope to gain from the exposure on my site?

Any hospital is dealing with HL7. You’re extremely visible in the HIT world. I was at HIMSS this year – I’ve been attending for the past seven years – and a lot of people know Mr. HIStalk. You’ve got quite some followers there. I think that’s going to provide us a lot of visibility.

Most of the people who are dealing with HL7 interfacing will definitely take a look at our website. When they take a look, we’ve got a great response and they automatically understand what we do. The savings are very positive. That’s where we see a lot of potential, and thanks to your help, we see a lot of lead generation, thanks to the HIStalk blog. 

The feedback we’re getting from existing customers is that within their first interface project, the return on investment is immediate. You don’t have to be using our platform for months to get to see the benefits. It almost pays for itself with the first project.

Siemens To Acquire MobileMD

Siemens Healthcare announced this morning that it will acquire HIE solutions vendor MobileMD of Yardley, PA.

John Glaser PhD, CEO of the Health Services Business Unit of Siemens Healthcare, was quoted as saying:

The goals behind many of our country’s broad, health reform initiatives are intended to improve the quality of care by doing two basic things: increase utilization of electronic technology, for a variety of benefits, and improve the coordination of care among entities that had previously not shared data well. Patients come into the healthcare system expecting physicians to help them get well by coordinating their care. Patients generally should not need to be concerned with the logistics of how their care is coordinated – they should rightfully expect that it will be coordinated. Siemens was impressed with MobileMD’s capabilities to enable this level of data sharing while maintaining an impressive focus on customer satisfaction. MobileMD customers can expect to continue to experience this same level, or an improved level, of service, commitment and partnership.

MobileMD’s HIE service is used by 110 hospitals and 2,000 physician practices, according to the announcement.

HIStalk interviewed MobileMD CEO Todd Fisher this past January. He named Axolotl and Medicity as MobileMD’s main competitors, both of which had been recently acquired at that time.

Terms of the acquisition, which is expected to close promptly, were not disclosed.

News 11/4/11

Top News

Citing the need for more time, ONC announces it will delay the launch of the permanent program for EHR certification until mid-2012. The timeframe coincides with the anticipated final rule of Stage 2 of Meaningful Use and standards and certification criteria. ONC says it can’t make the original January 1 deadline to approve testing labs and authorize certifying bodies.

Reader Comments

From Viking: “Re: doctors, texting, and HIPAA. This video on how to make a ‘pager scanner’ shows how easy it is for anyone to listen in and breach via texting.” Though I was distracted by the painful-looking lip piercing on the geek chick, I need to get someone to build me one of those. Go to about the 2:45 mark to see her computer screen filling up with pager messages. It’s definitely a target-rich environment at my hospital, although I expect the messages are amazingly dull.

From Megan: “Re: HIStalk page loading improvement. Thank you! I’m new to the industry and like to stay on top of news, but that one little fix made this site so much more reader-friendly.” I’m embarrassed that it was a relatively simple change once Dave Dillehunt suggested it. I wish I’d done it sooner. I find myself pulling up the page several times a day just because I like watching it snap to attention on my command. The beauty of it is that everything still displays, sponsor ads and all, but just in a slightly different order. 

From AnotherDave: “Re: HIStalk page loading improvement. I second, third, and fourth the shout-out to Dave Dillehunt. Instant access to HIStalk: priceless.” This may well be Dave’s finest hour. I mean, sure, he’s a CIO and everything, but how many times do strangers publicly sing his praises?

From NoSleepTillEpic: “Re: Kadlec Regional Medical Center. Live with Epic inpatient, ambulatory went in August, One of Epic’s smallest customers, a PlaneTree hospital with a reputation for doing technology right. JCAHO showed up the week before go-live!” Nice.

From Anon: “Re: ONC budget. Is this something to be concerned about?” I don’t know the source of the attached material and I don’t understand all of it, but it says ONC’s 2011 budget was $61 million and the President requested $78 million for 2012. The Senate Budget Committee recommended holding the budget to $61 million, but supposedly (and this would be the big news, if true) that figure would also include ONC’s HITECH allocation, which was $57 million in 2010 and was scheduled to increase to $499 million and $874 million in 2011 and 2012, respectively. A House subcommittee has proposed only $28 million. If you know more about this, please share since it sounds important if it’s true.

Unrelated, but while Googling the subject, I came up with ONC’s 2012 budget justification, which has key indicators that include the percentage of practices and hospitals using EMRs and receiving Meaningful Use payments. ONC requested 189 FTEs for 2012 with an average cost per FTE of $148,000.

HIStalk Announcements and Requests

This week on HIStalk Practice: Dr. Gregg enlightens readers on the behind-the-scenes coordination for AAP’s Pediatric Office of the Future. A reader comments on providers who seem overwhelmed by Meaningful Use-fueled EHR purchases and rushed implementations. MGMA calls on CMS to establish a 5010 contingency plan in case practices and their trading partners can’t meet the looming deadline. Physicians believe EHRs are safer than paper, but patients disagree. CMS advises providers to report on all clinical measures in their EHR, even if the data is incomplete – and thus meaningless. Shuffle on over to HIStalk Practice, get your ambulatory HIT fix, and sign-up for e-mail updates. Thanks for reading.

Welcome to new HIStalk Gold Sponsor New York eHealth Collaborative. The not-for-profit, formed in 2006, strives to improve healthcare for New Yorkers through the use of healthcare IT. It helps develop policies and standards to help providers move to electronic health records and coordinates connecting providers statewide. It runs a Regional Extension Center and the Statewide Health Information Network (SHIN-NY). They’re presenting the NYeC Digital Health Conference 2011 December 1-2 at Pier Sixty on the Chelsea Waterfront in NYC, with keynotes by HHS CTO Todd Park and journalist T. R. Reid. Registration is $395 general and only $195 for practicing physicians and government employees. I’m running a text ad for them over to your right just in case you want to check it out later. I would loved to have gone, but it was just too hard to get time off from the hospital, which left Mrs. H deprived of the opportunity to enjoy New York near Christmastime. Thanks to New York eHealth Collaborative for supporting HIStalk.

On the Jobs Board: Java Developer, Senior Interactive Graphic Designer, Cerner and Epic Resources. On Healthcare IT Jobs: Research Informatics Analyst II, III, IV, Lab Information Systems Analyst, Regional Sales Executive, Senior Pharmacy Analyst.

Suggestions on how to spend your extra minutes of free time each day now that HIStalk loads faster: (a) seek Inga, Dr. Jayne, and me on Facebook and LinkedIn and consummate our electronic union by Liking, Friending, and Connecting; (b) sign up for spam-free e-mail updates on HIStalk, HIStalk Practice, and HIStalk Mobile; (c) send me scandalous rumors, squelched news, and anything that would interest readers like yourself by clicking the atrocious-looking green Rumor Report box to your right that sends your secure message and an optional attachment right to my inbox; (d) peruse the friendlier-loading sponsor ads to your left and click those that seem fun, or check out the Resource Center to browser and search, pausing to marvel that polished and powerful executives command their underlings to mail a check to a PO box to support an anonymous hospital guy’s amateurish blog; and (e) look yourself in the mirror while giving yourself a little nod and a Bill Clinton finger-pointing recognition gesture to acknowledge your role in reading and doing all of the above, which keeps the vivacious and erudite Inga and Dr. Jayne smiling.

Acquisitions, Funding, Business, and Stock

HealthGrades signs a definitive agreement to merge with CPM Marketing Group, a provider of customer relationship-management services for hospitals.

Mediware announces Q1 numbers: revenue up 24% to $15.5 million and profits up 42% to $1.49 million or $0.18/share.

Medical practice documentation management software vendor Updox gets a $500K loan from the state of Ohio to develop a mobile version of its product, to integrate with more EHR products, and to promote its free secure messaging service.

Advisory Board Co. reports Q2 net income of $5.2 million ($0.30/share) compared to $4.9 million ($0.30/share) last year. Revenues grew 30.7% to $92.9 million.

Allscripts reports Q3 numbers: revenue up 13%, EPS $0.11 vs. $0.01, beating expectations. The company raised guidance on both revenue and earnings. The earnings call transcript is here. Interesting snips from it: (a) CEO Glen Tullman says the new January 1 readmission rule in which hospitals eat the cost of patients readmitted for the same condition within 30 days is driving interest in care management and discharge management applications; (b) he says Allscripts beat Cerner and Epic at Flagler Hospital (FL) because the hospital wanted to connect to a variety of EMRs used by community-based physicians (c) several new hospitals signed up for the EPSi performance management system, among them UC-Davis and Stanford; (d) Glen sees big opportunity from ICD-10 (“you’re going to have to replace every practice management and revenue cycle management system out there”) and analytics; (e) he says Sunrise Clinical Manager is used by “all the best names out there,” saying it’s “open” and “not outdated” and “what the market wants, what physicians want, is one comprehensive patient view, not one database, because they realize you can’t do that”; (f) their most frequent ambulatory competitors are Greenway and eClinicalWorks.

UPMC Health Plan and The Advisory Board Company form Evolent Health, which will offer the Identifi population and health management software developed by the health plan and used by UPMC to manage the health of its 54,000 employees. Each organization capitalized the venture with $10 million. Its first customer will be MedStar Health. Former Advisory Board CEO Frank Williams will serve as CEO of Evolent Health.

Merge Healthcare reports Q3 results: revenue up 33%, EPS –$.01 vs. –$0.06, missing consensus estimates by a penny.

Sales

Health Care Authority for Baptist Health selects MEDSEEK for clinician and patient engagement tools.

Lompoc Valley Medical Center (CA) will deploy Allscripts’ Sunrise Clinical Manager EHR and offer the Sunrise Clinician Portal to it physicians. Also, DMC Children’s Hospital of Michigan selects Allscripts EHR for its employed and affiliated physicians.

Houston Healthcare (GA) selects Wolters Kluwer Health’s ProVation Order Sets for Houston Medical Center and Perry Hospital.

Wake Forest Baptist Medical Center chooses RelayHealth’s RelayCare for readmission management.

Intermountain Healthcare signs a five-year agreement with Accretive Health to manage its revenue cycle. The organizations say they will create a Salt Lake City-based revenue cycle Center of Excellence that will provide best practices, technology, and education.

Harris Corporation wins a $4.5 million VA contract to develop Web-based mental health self-documentation tools for the MyHealtheVet personal health record.

People

Apixio names Darren Schulte MD as chief medical officer. He was previously with Anvita Health.

Availity promotes Russ Thomas from COO to CEO, succeeding Julie Klapstein, who will remain on the board of managers.

Recombinant Data Corp. hires Jason D. Oliveira as managing director of health system consulting.  He previously led the healthcare BI practice at Kurt Salmon Associates.

AMIA President and CEO Ted Shortliffe MD, PhD announces that he’ll be leaving the job he’s held since mid-2009 to pursue other interests. The board will initiate a search for his replacement, expected to be in place by early 2012.

Main Line Health (PA) promotes Karen Thomas to SVP/CIO. She was previously VP/CIO.

Announcements and Implementations

Physician practice marketing and communications company Medley Health partners with athenahealth to integrate its physician-patient communications platform with athenahealth’s suite of offerings.

Guam launches the first phase of its HIE with the deployment of secure messaging and clinical document exchange using the ApeniMED HIE platform.

The Wichita HIE signs up its first two physician practices.

New Hanover Medical Group (NC) goes live on Epic, the first step in a system-wide, $53 million upgrade. The local TV station covers its rollout of MyChart.

Inland Northwest Health Services (INHS) announces that 12 client hospitals have successfully attested for Meaningful Use.

Trustwave introduces its Web application security offerings, including an enhanced version of Trustwave WebDefend.

Three rural Adventist Health hospitals in California will share a $1 million Blue Shield of California grant to implement electronic medical records.

Healthcare IT services provider Anthelio will add 200 jobs in Detroit and Flint, MI to support its area customers, which include Detroit Medical Center and McLaren Health Care Group.

Innovation and Research

Stanford’s Lucile Packard Children’s Hospital publishes a NEJM article describing its use of patient information from its electronic medical records system to choose drug therapy for a patient’s rare disease. The 13-year-old patient had lupus complications and was a candidate for anticoagulants, but cases are so rare that a literature search came up with nothing on the risk-benefit profile. Jennifer Frankovich MD (above) used a research tool to query de-identified EMR data and found the records of 98 patients over a five-year period who had similar conditions and determined that the risk of clots was high enough to justify starting anticoagulants right away. Their conclusion is that a physician probably couldn’t have figured it out otherwise since there were so few patients, recall is sometimes biased, and EMRs have so much information that it’s hard to pick out the important data elements. They also expect that aggregated patient information will be used during rounds to make treatment decisions in the not-too-distant future. I assume the EMR in question was Cerner, which Packard is supposedly having to give up despite publishing extensively about its patient safety benefits (parent Stanford Hospital uses Epic.)

Technology

Toyota announces that it will start selling mobility robots in 2013, one of them being Independent Walk Assist, a computer-controlled mechanical exoskeleton. It was developed at the University of California at Berkeley, where one of its students who is paralyzed was able to walk across the stage to receive his diploma with the help of the technology. Toyota is working on another version that will lift and move patients.

Mobile healthcare apps tools vendor Diversinet is awarded a patent for encryption technology that prevents data from being transferred from one mobile device to another.

Other

From KLAS: over the next five years, almost half of providers will replace their RCM system; 87% of those will make the switch in the next three years. Most providers are looking at a new RCM in terms of how it fits in with a single-source enterprise strategy, often driven by the clinical vendor. Epic and Siemens top the list of considerations for over-200 bed providers, while McKesson and Meditech were the most considered by community hospitals.

A Richmond TV piece covers the use of AirStrip Cardiology at Bon Secours St. Francis Medical Center, in which one of the doctors sheepishly admits that the previous standard of practice for ED doctors to get cardiology consults was to send them an iPhone picture of the EKG.

A Virginia psychiatrist avoids becoming the first physician to be prosecuted for HIPAA violations when the judge dismisses charges against him. Prosecutors claimed the doctor retaliated against a patient who had complained about him by telling her supervisors that she had been involuntarily committed. The doctor says “it could have collapsed the entire system” had he been convicted since doctors would become reluctant to provide such warnings.

The Rhode Island Department of Health investigates four Lifespan hospitals after getting reports they gave 2,000 discharged inpatients prescriptions for immediate-release drugs instead of the timed-release versions ordered by the physician. Lifespan blames “software used to generate medication instructions provided to discharged patients.” State Senator Jamie Doyle says he is “shocked” and wants a review of all Lifespan hospitals and the Rhode Island Department of Health.

Weird News Andy is positively lyrical over this story, which he titles “Crystal Gayle, where are you?” A California doctor (and former entertainment lawyer) develops a laser procedure that can permanently turn brown eyes blue in 20 seconds. WNA provides the soundtrack: “Colored contacts, with you I’m through; That laser beam oh, it’s so brand new; Doctor Gregg now, let your aim be true; And don’t it make my brown eyes blue.”

Sponsor Updates

• Medicomp Systems announces that Quippe, powered by the MEDCIN Engine, is now embedded into MED3OOO’s InteGreat EHR. Medicomp, by the way, exhibited at MGMA and trained seven people every hour on Quippe.
• The latest newsletter from TELUS Health Solutions includes several articles on using data to drive transformational change in heath systems.
• Virtelligence is participating in this month’s VA and Midwest HIMSS conferences.
• Orion Health CEO Ian McCrae calls out his company’s continued success, calling Orion Health the leading healthcare IT software vendor in health information exchange.
• MedAptus President Larry Hagerty discusses the company’s use of Internap’s cloud solution.
• Carefx will participate in the Midwest HIMSS 2011 Fall Technology Conference in Indiana.
• CareTech Solutions is recruiting 60+ people for installation and support of hospital IT systems.
• Concerro opens registration for its November 29 Webinar entitled, “Achieving Compliance with the Joint Commission’s Staffing Effectiveness Requirements.”
• CynergisTek CEO Mac McMillian is presenting “Data Security – Eliminating Imaging Informatics Risks” at the virtual AuntMinnie.com RAD Expo 2011 November 2-3. He will also  present a Health IT Capstone Course at the American College of Physician Executives Fall Institute 2011 November 8-9.
• MyHealthDIRECT CEO and Founder Jay Mason will discuss the changing landscape for Medicaid health plans at the upcoming Medicaid Health Plans of America Annual Meeting in Washington, DC.

EPtalk by Dr. Jayne

This time of year as it starts to get a little chilly, I think fondly of places where sassy CMIOs can go for some fun in the sun. News from the sun belt: Cigna purchases HealthSpring, which runs the Medicare insurance plan for Miami-based Leon Medical Centers. The $3.8 billion dollar deal brings the plan’s 37,000 Medicare beneficiaries to Cigna and is seen as a major move into the Medicare Advantage market.

The AMA claims a win for helping to extend the deadline for providers to file for hardship exemptions to prevent penalties for not ePrescribing. Not a huge win in my book — the previous deadline was November 1 and it was very well publicized.

Mr. H usually reports on health IT vendor earnings calls and I rely on his summaries because I’m usually looking at pharmaceutical and other industry outlooks. Pfizer admits to its plan to work towards marketing an over the counter version of Lipitor. As the company’s best-selling drug goes off patent, they’re obviously trying to resuscitate their cash cow. The concept of bringing this class of drugs OTC comes up periodically – Merck asked the FDA three times over a seven-year period to allow them to take Mevacor OTC and was rejected every time.

When most people think of healthcare IT, they think of hospital and ambulatory documentation software, revenue cycle, laboratory information systems, and the like. In my opinion, one of the more fascinating breakthroughs is the computing power that helps scientists sequence the genome of various organisms. The journal Nature reports success in sequencing the DNA of Yersinia pestis, the agent that caused Black Death in the mid-1300s. Researchers extracted the DNA from teeth of victims buried in 1348.

I hope the HIPAA compliance zombies don’t hear about this one. The Defense Advanced Research Projects Agency (DARPA) challenges techies to reconstruct handwritten documents that have been shredded. Screenshots of shredded documents are on the Shredder Challenge website. Get your decoder rings ready – winners will be announced on December 5. Should emerging technology make it easy to piece together these puzzles, I’m sure we’re all in for compensatory advances in document destruction technology.

In the weirdest research study of the week, Israeli researchers conclude that drinking cold water increases the resting energy expenditure of overweight children, helping them burn calories. The patients drank water cooled to 4 degrees Celsius while watching a movie lying down. Not exactly my idea of a good time, but just illustrates how desperately people are looking at the obesity problem. I’ve got an idea: how about asking the kids to do stretching exercises or even calisthenics while watching? Bet that would work too.

Bad news for social habits favored by the ladies of HIStalk: a study published in this week’s Journal of the American Medical Association documented a statistically significant increase in breast cancer risk among women who drank small to moderate amounts of alcohol – the equivalent of three to six drinks per week. The data comes from the Nurses’ Health Study, a prospective observational study of over 100,000 women which has produced a multitude of findings.

Contacts

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

News 11/2/11

Top News

Hospitals are becoming more optimistic about their Stage 1 Meaningful Use readiness compared to seven months ago. About 41% now say they are well positioned to meet Stage 1. The HIMSS Analytics report also finds higher adoption rates among academic medical centers and larger hospitals.

Reader Comments

From Marquis: “Re: Dr. Jerry Stonemetz. He’s a world-famous anesthesiologist, an expert in anesthesia information management systems, and head of anesthesia services at HCA. All told, he is a very cool dude. He writes a blog about AIMS, but recently incorporated his other passion (wine) into the blog. It’s not exactly HIT, but it is kind of fun. And our industry could use more fun.” I agree that HIT needs fun, as well as more wine. Dr. Stonemetz’s first post includes tips on how to create a wine cellar and is geared to those of us who lack the discipline to accumulate wine ahead of consumption.

From Lee: “Re: new Siemens announcement about Soarian for small hospitals. Looks like the death knell for MedSeries 4. I’m sure they will deny it, otherwise they would be sending 200+ clients to the RFP mill.” One big lesson learned from reading the Steve Jobs biography and Vince’s HIS-tory of failed HIT vendors: companies should not offer products that overlap each other or confuse customers (not to mention products that force a company’s own salespeople to compete with each other).

From LeBronze: “Re: Meaningful Use. Good thing CMS is there to answer our questions.” LeBronze forwarded the transcript of auto-generated responses he received in response to a question he posted on CMS’s EHR Information Center about criteria for maintaining a problem list. His question was filed on August 18. Nine auto-responses and escalations later, he still doesn’t have an answer after more than two months.

From Flow: “Re: Endo Pharmaceuticals. It acquired Urochart recently, and now has acquired its major competitor in the urology EMR space, meridianEMR. Meridian had filed an infringement lawsuit against Urochart.” Verified, apparently. According to Endo’s earnings announcement last week, it has made “strategic investments in Intuitive Medical Software (IMS) and meridianEMR, Inc., two providers of electronic medical records for urologists. Together, IMS and meridianEMR provide access to approximately 1,800 urologists using data platforms that will enhance service offerings in urology practice management.” I always like to read the executive bios and found some fun facts about the folks who run meridianEMR: CEO and Chairman Michael Custode was the designer and architect of the Medic Vision PM product that Misys bought; CMO Herschel Jackson MD developed the ScriptLetter prescription writing system; CTO William Bartlett is a Certified Ethical Hacker; and Chief Software Architect G. Ralph Kuntz MD, MS wrote the link-editor and dynamic linker for the UNIX C compiler for Bell Labs.

From Kaity: “Re: sales job. I’m an avid reader of yours and I LOVE your blog. I’m a software sales rep who likes listening to customers and understanding how the products I’m selling can make their lives better. If you were going to sell software to hospitals, what are your Top 3 target companies? (probably not EMR since that ship has sailed with everybody buying Epic).” I’ve spent almost my whole career working in non-profit hospitals, so I have only limited experience working for a vendor and none working in sales. Luckily, what I do have are smart readers who have my back – if you’re one, feel free to leave a comment giving Kaity some ideas. She put “love” in all upper case, so I figure I owe her.

HIStalk Announcements and Requests

Here’s a shout-out to Dave Dillehunt, CIO of FirstHealth of the Carolinas, who gave me a brilliant idea. He said nobody would mind how long it takes the main HIStalk page to load if there was a way to display the article itself first, with the sponsor ads and other sidebar content loading in the background. I didn’t think that was possible, but after some Googling and fun Javascript programming (not me – I hired it offshore) it’s magic – the article scrolls out almost immediately and everything else quickly follows. Sounds minor, but it’s much more satisfying to start reading so quickly. I may create a HISsies category just for Dave to win.

Acquisitions, Funding, Business, and Stock

Fortune profiles appointment-booking site ZocDoc, which is now available in 12 cities. The company, which has raised $95 million in funding, hints that it collects enough patient information that it could create an application that would allow them to self-register at practices and hospitals.

Sales

Orlando Health’s Physician and Professional Services Group expands its relationship with VisiQuate, a provider of enterprise performance management tools.

Spartanburg Regional Healthcare System (SC) contracts with Wellsoft for its EDIS, which it will integrate with its McKesson systems.

Brown & Toland Physicians (CA) selects the Allscripts Community Record, powered by dbMotion, for its 1,500 physicians.

Central Ohio Primary Care Physicians chooses eClinicalWorks for its 230 physicians.

Centracare Health System’s St. Cloud Hospital (MN) selects Merge Healthcare’s iConnect vendor neutral archive (VNA) and iConnect Share. Also, HealthPartners chooses iConnect VNA for its enterprise-wide imaging strategy.

People

MedHOK appoints Rahul Singal, MD as its chief medical officer. He’s a former president and CEO of WorldDoc and was VP and medical director of Southwest Medical Associates.

Announcements and Implementations

Oakland Physician Network Services (MI) extends Michigan Health Connect’s HIE solutions to its 425 physician members.

Healthland EMR client Glacial Ridge Health System (MN) becomes the first hospital in Minnesota to achieve Meaningful Use under Medicare’s EHR incentive program.

Cerner implements Oracle Enterprise Manager to support cloud-based services.

Children’s Hospital and Health System (WI) begins training users on its new Epic system in preparation for a go-live in late 2012 or early 2013. The project will cost $120 million over five years.

Convergent renames its RCM division Convergent Healthcare (formerly AHC) and introduces its Convergent CARE product line.

Ohio State University Medical Center goes live on iSirona’s device connectivity solution, connecting 700 wired monitors and wireless ventilators to Epic.

Iatric Systems launches EasyConnect Jaguar, an advanced healthcare interface engine.

Denver-based virtual clinician desktop vendor AventuraHQ hires 15 new employees, most of them in sales and marketing, following its first round of institutional venture funding.

Innovation and Research

The Robert Wood Johnson Foundation announces its Aligning Forces for Quality (AF4Q) $100,000 app challenge, designed to encourage the development of easy-to-use online tools that consumers  can use to find quality information on their local physicians and hospitals. The deadline for the competition’s first phase is December 31, 2011.

Technology

Penn Medicine adds a second pilot using its Penn Research Trial Advisory software, a homegrown application that flags candidates for clinical trials. It’s programmed to look for specific patient criteria that fit current clinical trails and delivers a pop-up alert when medical staff enter patient data into the hospital’s EMR.

Other

Peirce College (PA) will use software applications from QuadraMed and 3M in its new Health Information Administration bachelor’s degree program.

A Wolters Kluwer Health survey of physician finds that search engines like Google and Yahoo are second only to professional journals and colleagues as a source of information for diagnosing and treating patients. The same study lists physicians’ top barriers to technology adoption: too expensive, too much data and not enough actionable information, too hard to learn, and too hard to use at the point of care.

Siemens Healthcare announces its commitment to deliver its Soarian solution to small community and rural hospitals. Siemens recently implemented Soarian Clinicals at the 70-bed Platte Valley Medical Center (CO) and at the 202-bed Palisades Medical Center (NJ).

George Reynolds, VP/CIO and CMIO of Children’s Hospital and Medical Center of Omaha, tells me they’ve decided to go with Epic (displacing Allscripts on the inpatient side, I assume.) They were already using Epic ambulatory. Phase 1 will go live in early 2013 with inpatient, ED, pharmacy, and surgery. If you don’t know George, check out his credentials: he’s an MD, has a Master’s in Medical Management, was director of pediatric critical care at University of Nebraska Medical Center, and now is both CIO and CMIO at Children’s. Not to mention that he’s a funny guy. I need to interview him sometime.

What might have been: as Steve Jobs was near death, he was sketching plans for an iPad holder for hospital beds and designs for other hospital equipment.

Doctors  know that text messaging patient information from smart phones may violate HIPAA, but it’s so efficient that they do it anyway.

Researchers find that gastroenterologists who listen to Mozart during colonoscopies improve their precancerous polyp detection rates from 27% to 36%.  Other bodies of research has found that listening to Mozart’s music may result in significant short-term improvement in spatial temporal reasoning.

Weird News Andy finds that this sad story sets the pace. A man living in a Chicago group home tells staff he’s having chest pains and asks them to call an ambulance while he waits in his room. Paramedics arrive, and noticing a puncture wound to his chest, think someone stabbed him. Someone did: the man himself, who cut open his own chest to try to remove his pacemaker. He died in the hospital.

Sponsor Updates

• The Advisory Board Company will host a conference on transforming physician talent development on November 14 in Washington, DC.
• Encore Health Resources will participate in this week’s Louisiana HIMSS 2011 Fall Conference.
• DIVURGENT is attending the Virginia HIMSS 2011 Fall Conference and the Midwest HIMSS Fall Technology Conference.
• API Healthcare will participate in the HealthcareSource User Conference in Las Vegas.
• Florida Hospital Celebration Health implements the GetWellNetwork solution in its new patient care tower.
• Cumberland Consulting Group promotes Lindsay Lopez to executive consultant.
• Hayes Management Consulting announces its new inpatient consulting division, which will be led by Amitav Hajra, formerly of Epic Systems.
• Stockell Healthcare Systems receives ONC-ATCB certification for its InsightCS Revenue Cycle Information System.
• Eastland Memorial Hospital (TX) and Hamlin Memorial Hospital (TX) qualify for Meaningful Use money using the Prognosis ChartAccess Comprehensive EHR. Eastland signed their contract in February, went live in June, attested in September, and got their check in October.

Contacts

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

Monday Morning Update 10/31/11

From What About Bob?: “Re: HIT Stack Exchange. Took a year to get enough people to commit, now we need the masses to ask and answer questions so the site can survive. Give us nerds some love.” HIT nerds or nerd-wannabes should take a look.

From Orlando Cepeda: “Re: Dr. HITECH’s Rainbow Button Initiative Rap. Lyrics are here.” Ross did great with these. Here’s a section where he lyrically explains the VA’s Blue Button medical record download:

I been to far-off lands, tryin’ to do what’s right, I had dreams and plans, when I got caught in a firefight.
Now back in the states, I’m a wounded warrior, all my doctors are great, but sometimes I ain’t sure,
Exactly how to keep it straight, or know just how to navigate, all my meds and lab results, and how they relate,
But now I push the Blue Button, and it’s all there to see, just a click of the mouse, and it all comes to me. 
And it’s not just for this vet, heck that ain’t nuttin’, just see what stuff *you* get, when you hit the Blue Button.

From Arcturus: “Re: exposure. You recently mentioned our company on HIStalk. We got several inquiries from companies wanting to be a VAR for us, several VCs inquired, and it caused some buzz. Very much appreciate your doing this.” My pleasure. If I’ve heard about something and it interests me, I’ll almost always mention it. It does get a bit tough when companies try to press me to write about them and (a) I don’t find their product or service all that interesting, or (b) I’m too busy. People sometimes forget that HIStalk is an after-work thing for me, meaning I can’t chat on the telephone during hospital working hours and I’m not usually willing to give up some of my handful of free hours each week to watch a demo or comment on a white paper, especially if it’s a company or person I’ve never heard of.

Three-quarters of respondents say it’s silly for docs to be required to crank out engaging, unique narrative for every repetitive patient encounter, but a fourth don’t want HHS paying for encounters described in boilerplate. New poll to your right: can healthcare reform’s needed improvements in cost and quality be realized with today’s IT systems?

My Time Capsule editorial from 2006: Misys Lesson: Mama, Don’t Let Your Vendors Grow Up to Be Conglomerates. I don’t like to show paternal favoritism toward my editorial offspring, but I admit this is one of my favorites, with hyper-caffeinated ramblings like, “Why did a British financial software company get into the US healthcare IT market in the first place? Well, let’s just say it wasn’t a noble desire to better humankind. From their Web site, ‘The main objectives were to reduce the Group’s exposure to a single market (insurance) and to increase its size in an already consolidating software sector.’ That’s about as unemotional as an accountant’s nimble calculator fingers determining the net present value of three dinners with Myra the secretary vs. the potential passion-filled payout.” 

Unrelated (mostly, anyway – it does involve exercise and personal motivation) but for a guaranteed Monday morning smile, check out this brilliant commercial for Contrex mineral water, which I can’t get out of my head. I know Inga will like it.

The merry pranksters at Epic put up a Halloween-inspired Web page that includes interactive spider-smashing. I’m sure it will be gone after Monday, so last call.

Encore Health Resources announces that Joe Boyd has replaced co-founder Ivo Nelson as board chair. Boyd has been advising the company for the past 18 months and has worked with Ivo and CEO Dana Sellers before at Healthlink, where Joe was board chair, Dana was president and COO, and Ivo was CEO until they sold the company to IBM in 2005. Encore has been quickly ramping up revenue and headcount and was named the #2 best HIT advisory firm by KLAS. Ivo will remain on the board.

Coincidentally, I’d been thinking for several days about something Ivo told me in my 2009 interview, reminded of it while reading the Steve Jobs biography:

This is nothing more than me doing what I love to do. If it leaves a legacy, I think that’s OK, but I’m not sure what you really get out of that. When I’m hopefully up in my 80s or 90s and I pass away, the people that are going to come to my funeral are going to be my family. It’s not going to be clients. It’s going to be people that are close to me personally in my personal life, my kids and my sisters and a handful of friends probably that I have. That’s a legacy. You say, "What kind of legacy would I want to leave?" and it would be a legacy that’s more related to being a good father to my children and being a good husband to my wife. That kind of stuff. Not anything I do professionally.

Inga encroaches on Weird News Andy air space in summarizing this story as, “I guess the guy wanted the doctor to give him a hand.” A homeless man with a history of mental problems rushes into a urologist’s office gushing blood, saying he had just accidentally chopped off his arm on a homemade guillotine. Nurses call 911 (probably the best course of action for a urology practice dealing with an amputation,) and when police check out his wooded camp, they find a huge guillotine built from scavenged timber, along with his recently severed arm. One world-weary police officer observed, “My goodness, a lot of thought went into this.” One can only imagine the intended purpose of his handiwork given that his self-amputation was accidental.

Vince’s HIS-tory covers a company I’m not familiar with: Computer Synergy. He says its product was so progressive that its still running in dozens of hospitals and its successor firm was just acquired a few months ago, with details coming next time.

Shareable Ink CEO Stephen Hau is named Innovator of the Year by the Nashville Technology Council. They haven’t posted pictures of the winners yet, so I’ll go with a company team lunch pic that I found on Facebook, with Stephen on the right.

CHIME Foundation gives Allscripts CEO Glen Tullman its 2011 Lifetime Achievement Award.

Omaha-based transplant systems vendor HKS Medical Information Systems is acquired by an investment group led by Argenta Partners LLP. Louis Halperin is named CEO and Paul Markham COO.

AventuraHQ names neurosurgeon and venture partner Teo Dagi MD as CMO. How about these educational credentials: Columbia undergrad, Hopkins MD/MPH, Harvard MTS, Wharton MBA, Queens University DMedSc. I profiled Aventura, which offers a virtual desktop for efficient clinician access, in July.

Small hospital systems vendor CPSI announces Q3 numbers: revenue up 2.8%, EPS $0.54 vs. $0.45, missing expectations by quite a bit and falling short of previous guidance. System sales were down, which is not exactly cheery news knowing that the HITECH effect is close to peaking. Shares were hammered, taking a 28.5% haircut at Friday’s close as the Nasdaq’s biggest percentage loser by far. Above is the one-year chart of CPSI (blue, straight vertical line on the right) compared to the Nasdaq (red) and S&P 500 (green). The stock had been climbing nicely, but tanked enough in a single day to barely put it above the indices for the year. Market cap is $564 million.

Speaking of stock, shares in MedAssets jumped 14% Friday, with an analyst attributing “weakness across the rest of the health IT group” that includes Cerner, Quality Systems, and CPSI. Michael Cherny of Deutsche Bank Securities says MedAssets “has no exposure to electronic health records” like those previously mentioned EHR vendors whose earnings reports this week were “disappointing” or “confusing.” That may just be a reaction, however, since after-hours trading shows MedAssets, which reports earnings Thursday, giving back the full amount of its Friday gains. And while MDAS shares had a nice Friday, the past 12 months haven’t been nearly as kind, with shares down 40%. The one-year share price graph shows compares MedAssets (blue), Cerner (green), and Quality Systems (red).

The Rockford, IL paper covers the HITECH status of local hospitals. OSF Saint Anthony uses Epic and has been paid $2.5 million in MU money. SwedishAmerican, with Meditech and Epic, has earned $7.5 million for the hospital and $4.5 million for physician practices. Rockford Health is installing Epic in its practices and hospital and will attest in 2012 and 2013, respectively.

For my techie brothers and sisters: Tom Munnecke (software architect, VistA) has an after-dinner chat with Ward Cunningham (inventor of the wiki) and Ralph Johnson (computer science professor and author) on the subject of “refactoring",” specifically with regard to VistA. Tom’s iPhone made a darned nice video with good audio. It’s kind of like Live from Daryl’s House for geeks. I got myself thinking about my techie sisters reference – nothing’s more attractive than a smart, cynical female programmer, of which there are sadly too few.

Meaningful Use and Beyond, a book by Fred Trotter (healthcare open source expert) and David Uhlman (CEO of open source EMR vendor ClearHealth), is published by O’Reilly.

The Federal Trade Commission will require the parent company of prescription data vendor IMS Health to sell two product lines of its acquisition target SDI Health to receive FTC’s approval for the sale to occur. SDI’s tools for promotional audits (estimates drug marketing costs) and medical audits (analyzes physician prescribing by condition) would give IMS Health a monopoly, according to the complaint by FTC, which must approve the buyer of the two product lines.

I feel like a Facebook stalker for posting this, but I will anyway. I noticed a “Like” for a recent post from Mark Work, IT director at ProMedica Health System in Toledo. Checked out his info, it linked to a site for Madison Avenue Band, a ten-piece cover band with horn section and no computers (thank goodness.) Check the video above – these guys (including Mark, I assume – looks like him on keyboard, but I’m not sure) are real-deal rockers. Check out this smokin’ version of “Vehicle” and here of “Wild Nights.” Not only do I love the music, Mark’s Facebook pics are a trove of cool 70s music history – Foghat, Uriah Heep, ELP, Queen, Foreigner, Heart, Styx, and Yes. Well worth my half hour to watch the videos and check out the pics. My arms are tired from air-drumming.

Cisco CEO John Chambers and the King of Jordan launch the Jordan ICT Task Force, which will promote Jordan’s HIT vendors.

GetWellNetwork is named Emerging Business of the Year by the Montgomery County (MD) Chamber of Commerce, which featured the company in a three-minute overview video.

A state-mandated Web site that allows Ohio consumers to compare hospital performance is apparently going down the tubes. The Ohio Hospital Association is supporting a bill that would eliminate the requirement that hospitals provide their data for the Ohio Hospital Compare site, saying they already send the same data to CMS’s Hospital Compare site that anyone can use.

Texas Health Resources runs an ad campaign around its use of AirStrip Cardiology that includes billboards (“Now Your EKG Gets Here Before You Do”) and TV commercials (above).

Merge Healthcare says 11 radiology practices have bought its RIS v7.0 to achieve Meaningful Use. One of its customers brings up the Complete vs. Modular HER issue, saying, “If you utilize a modular system, you as the provider, the onus is on you to find another product or combination of products that meet the remaining criteria before you can claim to be using a certified EHR and qualify for MU funds.”

Chiropractors are getting their HITECH payments, too.

Medtronic hires Symantec to assess the security of its insulin pumps after a McAfee team demonstrates how a hacker could control them from up to 300 feet away. 

In England, a terminally ill, mostly blind 14-year-old boy has his iPad stolen from his hospital bedside, which had been donated my Make-A-Wish Foundation so that he could enjoy it for the short time until he goes fully blind. All is well, however – a local supermarket was touched and bought him a replacement, with his reaction to it pictured above.

A new poll finds that only 34% of Americans like the Affordable Care Act, while 51% view it unfavorably, the worst numbers since it was introduced last spring.

A Massachusetts court dismisses a lawsuit against Tufts Medical Center, sued by a patient who claimed their faxing of her hysterectomy surgery records to her employer’s fax machine violated her privacy because co-workers read them. The patient had given the doctor instructions to send the records there, but still feels her lawsuit was justified.

E-mail Mr. H.

HIStalk Innovator Showcase–OptimizeHIT 10/28/11

Company Name: ImplementHIT
Address: 4001 S. Decatur Blvd., Las Vegas, NV 89103
Wen Address: www.optimizehit.com
Telephone: 888.457.3332
Year Founded: 2009
FTEs: 20

Elevator Pitch

OptimizeHIT provides an innovative training platform that enables both pre- and post-implementation training to significantly drive clinical adoption via a more comprehensive, yet easy way for physicians to access the training curriculum.

Business and Product Summary

OptimizeHIT offers a sophisticated, physician-friendly, dynamic EHR training portal. OptimizeHIT’s staff, comprised of MD EHR experts and PhDs in education, have developed innovative, patent-pending learning technologies that integrate seamlessly with any practice setting or specialty. With proper EHR training significantly impacting the success or failure of any implementation, OptimizeHIT’s training suite delivers powerful and relevant training that is easy for physicians to access, significantly reducing the time they spend out of clinic to learn how to use the EHR.

With this technology, organizations are realizing higher rates of clinical adoption beyond Meaningful Use, with a bonus of significant cost savings via a reduction in trainer hours consumed during live training time and time physicians spend out of clinic for training. Management can view learner progress on training as well as their productivity in graphical form, using real-time implementation statistics, and objectively understand the status of each site’s implementation. The solution can also allow on-site support to customize each physician’s learning curriculum to their specific knowledge gaps, keeping their learning time focused on what is most needed for them to learn.

Our cost model is based on per month/per user charge, which can accommodate a small physician’s practice or clinic as well as large, multi-location hospitals. Furthermore, we recently introduced a new no-risk pricing model, where there is no cost per user till a user actually completes their basic EHR training. Once a user becomes an intermediate or advanced user, the EHR benefits to patient safety and ROI quickly climb in to the $1000s per provider.

Target Customer

Large academic hospitals all the way through two-physician practices use this solution successfully.

Customer Problem Solved

Clinical adoption. It is when physicians achieve intermediate- and advanced-level use of an EHR that the greatest patient safety benefits and cost savings are realized. Our portal is built specifically for health IT training, recognizing the unique challenges of training physicians and other healthcare professionals with very little spare time. We are not only getting physicians ready for Meaningful Use Stage 1, but later phases and beyond. Customers live with the portal can easily distribute system upgrade training, new best practices, and even ICD-10 training when the time is right.

Competitors

Other groups that provide standard EHR training with go-live being the end point, like most EHR vendors and a few specialized service consultant groups. However, no one else offers a solution that targets post-implementation training, and that is where you achieve the most efficient leaps in EHR use.

Advantages Over Competitors

We don’t recommend moving all pre-implementation training online, but through a hybrid approach that was featured at HIMSS this February in a presentation by one of our customers. We want to minimize the amount of time physicians must spend out of clinic to learn. Furthermore, we know that physicians learn more advanced features of the EHR a lot faster once they have had an opportunity to use an EHR, which is why our portal integrates the more comprehensive post-implementation training. By providing one integrated solution for pre- and post-implementation training, along with enabling implementation management to see learning and productivity progress in real time, we are much better than any competitor.

The system is also task-based, which means it is more relevant to the learner instead of talking about EHR modules that are abstract for beginner users. Furthermore, because it is task-based and since we deliver standard EHR tasks from beginner to advanced — including Meaningful Use for 10 specialties — the effort to customize the learning content down to the physician specialty is greatly reduced, which makes the content far more relevant and meaningful to the learner.

Pitch Video Created Specifically for this Showcase

Customer Interview (an applications trainer for a large orthopedic practice)

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

The first problem solved by using OptimizeHIT’s computer-based training (CBT) modules was improving our training model as we began to prepare our EHR rollout. We were looking at hours of preparation and actual classroom training time with users who were all over the map in terms of PC skills. It was a daunting project and would have required users to be out of clinic and coming in for Saturday training classes as well, which would have meant overtime for some employees. While we still had a few Saturday classes, it was held to a minimum. Our providers never had to take time out of clinic and the overtime was also kept to a minimum.

Anyway, then I was introduced to Andres by a friend, and as soon as I started talking with him, I knew we would work together. His company created customized CBT modules for us using our workflow and screens so that our users were learning how to use the EHR on screens that were our screens – it wasn’t a generic or canned version of training. They worked closely with us to make sure the training modules included great detail. We were able to put much of the responsibility for basic training on the users and they rose to the challenge. We did have to manage the process, checking to see that they were completing the CBTs and where they were weak so we could do focus training with them. But for the most part, our employees did a great job. For those who needed a bit of encouragement, they got “the e-mail” reminding them their CBTs were mandatory.

As far as the impact on the practice, I would say that our users, especially our medical assistants, were well prepared on their first day of live. By the end of the first week, they were fairly confident users. We intentionally designed the training process so that the medical assistants could act as a resource for their providers and they do just that.

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

To be honest, I’d say don’t even try to train your users without really well designed CBTs, and that you can’t go wrong with OptimizeHIT. They are professional, efficient, epitomize customer service, and even more, they are kind and are comfortable with humor. It was just fun to work with this company and we ended up with an excellent product. I have said exactly that to other organizations.

For those of us who have been in this field for a few years, we have recognized for years that end user training/education is the great hole in the process of implementing healthcare software. Vendors have not, historically, educated the clients (there’s a difference between training and education) and in turn, the clients do not understand the importance of educating their users. With healthcare records, you want confident, accurate users and that means educating them to use the system, but to also think about their use of it critically. Andres and OptimizeHIT focus on exactly that – they are combining adult educational concepts with technology and offer it to sites. 

We call it the gift that keeps on giving. Besides training users for our rollouts, we now use the CBTs for new hire training, upgrade training, user review etc. We are also looking forward to using their new tool to create a post-implementation educational process as a continuing education requirement for our clinical staff and providers.

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

If you are a mid- to large-size organization and have a small EHR build/training team, you will simply not be able to meet the demand of build, workflow design, workflow validation, and training. And if you don’t have anyone on staff that has a background in adult education, then you need to consider using this company.

If you’re planning on taking your users through a set of screens and allowing them to do hands-on once or twice – you cannot really consider them educated, and it will show when you take the system live. They will have no confidence and won’t even know when they are making a mistake, so they won’t be able to report it. It could be months or longer until you see that your users are failing to use the system accurately or efficiently.

An interview with Andres Jimenez MD, CEO, ImplementHIT

What’s wrong with the way organizations train physicians to use technology?

There are several issues. Implementation is typically the endpoint of most training curriculums designed for health IT implementations. The challenge is that without the user ever using a system, it’s impossible to teach them everything they will need to know to become an advanced user. Maybe not impossible, but extremely difficult and inefficient.

The challenge with trying to move your training over time to extend it beyond implementation is having a vehicle or a platform like ours to deliver just-in-time training that’s convenient, relevant, and very powerful for end users and extends beyond implementation and builds upon the experiential knowledge that users gain after the first week or two of using an EHR, where learning more advanced features is far more efficient.

Tell me about the technology that you use. I know you have or are seeking a patent.

It runs on Google Web Toolkit, Google Apps Engine. It’s kind of like Gmail for training. It essentially is real-time, Web-based technology. We’ve structured it in a way where it provides real-time statistics to management. It allows us to plug into practice management systems so we can deliver to learners who may be physicians. We can deliver to them real-time productivity metrics, like how many patients are they seeing per day, how is their increase in learning affecting the number of patients they’ve seen per day, how they’re billing, their level of coding. We’re able to pull that data real time. That’s one of the ways that’s very, very unique.

Very often, training and on-site support are two different processes going on in an implementation. We try to combine them, because we feel on-site support is a great opportunity to further the user’s knowledge on the system. We’ve provided input so that the on-site support personnel can continue to assist learners and then they can fine-tune or focus their training curriculum. If the doctor has 10 minutes or an hour to log in to the training programs late at night, they can focus in just on their specific knowledge gaps instead of starting from scratch. That’s another thing that I think is very innovative about the program.

We really feel that it’s going to become the future of health IT training, where it’s task-based, it’s not necessarily module-based. We can assign specific task-based skills that are usually on the two- to three-minute timeframe or are using bite-size training clips. We can assign specific ones to learners based on their role, based on their specialty, and even within two specialties that are different sites. We can customize training at that level. That makes it very relevant, and that’s very important for adult learners.

I’m sure one of the things that you’ve experienced both as a physician and an entrepreneur is that physicians typically don’t like to sit in a classroom with other physicians. Either they get frustrated with the pace or they just don’t feel like they’re being treated individually enough. Is what you’re offering an alternative to that, or is classroom training still a part of their experience? How do you feel about how classroom training works with doctors?

You’re absolutely right. That is one of the challenges that we hear from other physicians. I think on-site training still has an important role. One of our customers at HIMSS this past February presented some results where they were able to reduce the amount of training time, to cut training time in half because they had a Web-based component and a live training component.

Another one of our customers was able to train their physicians without any time out of clinic before the implementation. Now that doesn’t mean that they didn’t do any on-site live training, but what it means is that they were able to move a significant component of the pre-implementation curriculum to a Web-based component through our platform. Then they were able to focus in the on-site session just what the learner needed to go live and do well those first two weeks. Then, since they have the platform, they can allow the users to progress in their use and start learning more advanced functions at their own pace.

So I agree, the traditional on-site training approach has its weaknesses. A curriculum that only relies on that is part of the reason that you see so many implementations failing, because you can’t get that customization. But even on other types of computer-based training, we’re not the only ones that deliver a training online, but our platform allows to do it in a way where it’s very easy to customize it.

One of the other challenges that we see is that many vendors offer e-learning that is just a number of clips by modules in the EHR that are geared towards one specialty. If you’re a cardiologist, the last thing you want is sit down and watch training – especially when you’re having a busy day – with the clinical context of a kid with an ear infection and how to take care of him with the EHR. We make it easy to inject that relevance in training with our platform, which is extremely important for adult learning to get their interest piqued and  their attention level is high. They really learn, and when you want them to perform, they’re able to recall that information.

How do you convince a prospective client who plans to do their own training or pay the vendor to do it to that they need you instead?

We partner with many vendors, so we never want to go necessarily head-to-head with the vendors. They certainly have their place in providing training, but the challenge for most vendors is that they’re scrambling right now just to acquire market share. They haven’t necessarily been able to provide the focus needed on a very specialized approach on training. Not just training that gets them to use the basics, but that drives to Meaningful Use and beyond, where you get the advanced features and the greatest safety benefits for your patients and the greatest return on investment.

We typically tell our customers that we’re providing a platform that is very innovative. It will help your users get to advanced clinical adoption faster with less of an impact on overall productivity. One of our customers was able to get their physicians to full productivity about a week after implementation. That had a huge impact for them. They’re an orthopedic group and some of their physicians see 60 patients per day. We combine our training with the phased rollout approach to make sure that they can return to full productivity. Those are the things that are very important to a lot of customers.

Obviously cost is a factor. We’ve been able to show, for instance at HIMSS this past February, a return on investment of $6 for every $1 invested in our training. 

It’s important for our customers that this platform stays around for awhile. While they may have a cost incurred on just the implementation training, they’re working with the vendors, etc. our platform can stay around. They can start with Meaningful Use functionality and the platform, but right around the corner, there are updates from the vendor, ICD-10, and many other initiatives. They can build into the platform additional training. That’s been very important to our customers. They can do that on their own.

What do you hope to gain from this exposure?

We really feel that our platform is going to be future of health IT training. The fact that not all computer-based training is created equal, that our training specifically drives adoption, gets folks to full productivity faster, and we have a number of customers that have really appreciated and seen the benefits of that. 

What I’m hoping to get from the exposure is actually people getting the chance to hear about us. We’re a small organization, so we don’t have the advertising budgets or the large-scale sales team that existing companies have. Because we’re a smaller group and very innovative, we’ve been able to produce a platform that’s very cutting edge. We’re hoping with this exposure that we can get the word out and more people come on to our site and learn. We’re happy to provide more demonstrations and happy to connect prospects with existing customers, because they’ve been our greatest sales force to date.

News 10/28/11

Top News

Cerner announces Q3 numbers: revenue up 24%, EPS $0.45 vs. $0.36. beating estimates excluding one-time items and raised guidance. The conference call transcript is here. Cerner says customers of an unnamed competitor (Epic) are concerned about their vendor’s ability to keep up with Meaningful Use requirements beyond Stage 1. It also says Epic’s customers are vulnerable to Cerner poaching because of Epic’s deficiencies in ACO readiness, lack of analytics capabilities, and poor total cost of ownership. Recently announced products were mentioned, as was the company’s acquisition of Clairvia and hints that other acquisitions may be forthcoming as “the clock is ticking” in acquisitions starting to look less attractive. It’s also implied that competitors (again, that would have to be Epic) may be getting bottlenecked in their ability to start implementations promptly.

HIStalk Announcements and Requests

This week on HIStalk Practice: daily reports from Las Vegas on MGMA’s annual conference. Mr. H declared I was “full of myself” (harrumph), but you will have to read the updates and make your own assessment. The posts include impressions on various speakers (Dr. Farzad Mostashari and Intel’s Eric Dishman were my favs); assessments of the hottest topics (connectivity, communication tools, and more); the exhibits (nice booths, annoying Elvises, a bit of technology, and the best giveaways); and, of course, hot shoes. Thanks for reading.

Listening: The Black Keys, an Akron-based white nerd duo whose Brothers album sounds like bluesy soul from the early 1960s (but they really rock out on earlier stuff in no-frills ‘70s Ted Nugent fashion). Excellent. And “Not Listening” despite a reader’s calling it to my attention (“Holy Shatner,” he said): yet another hideous and uber-hammy William Shatner non-musical recitation, this time to the tune of Queen’s Bohemian Rhapsody, making his previous masterwork Lucy in the Sky with Diamonds sound like Beethoven by comparison. If you like Star Trek, Queen, music, or your sanity, you’ve been warned because it will bore into your skull like an earwig (entomologically incorrect, I know, but an apt metaphor.) I suppose we can all only dream of being as cornily popular and scorn-immune when we reach Bill’s age (80).

Jobs on the sponsors-only Job Board: Project Specialist I, Account Manager, RVP Sales – Ohio Valley Territory. On Healthcare IT Jobs: Lab Information Systems Analyst, Regional Sales Executive, Epic Security Analyst, Network Administrator.

Acquisitions, Funding, Business, and Stock

Perceptive Software increases its Q3 revenues by about 15%, but less than parent company Lexmark says it expected when it acquired the company last year. Perceptive contributed $23 million of Lexmark’s $1.03 billion in quarterly revenues.

UPMC announces Q operating income of $155 million on operating revenue of $2.4 billion. A year ago, operating income was $93 million. The gain includes $36 million for demonstrating Stage 1 Meaningful Use.

McKesson’s earnings call transcript is here. There wasn’t much new about the technology division, other than profit was up 25% excluding an impairment charge. Analysts who asked questions were more interested in Lipitor and flu vaccine.

Healthcare billionaire Patrick Shoon-Shiong’s NantWorks acquires Ziosoft, a Japan-based vendor of supercomputing software that merges data from a variety of medical images (CT, MR, ultrasound) to allow 3D, 4D, and 5D analysis for diagnosis. The company will be renamed Qi Imaging everywhere except in Japan, where it has 2,000 of its imaging workstations installed.

NextGen parent Quality Systems Inc. reports Q2 numbers: revenue up 32%, EPS $0.35 vs. $0.23. A two-for-one share split took effect Thursday.

Sales

Meditech announces eight new clients.

The Virginia Department of Health awards Community Health Alliance a contract for the statewide HIE. CHA’s strategic and technology partners include MEDfx (IT services), MedVirginia (support services), Troutman Sanders (governance), and Verizon (HIE platform.)

The VA gives Harris Corporation a two-year, $5.3 million contract to transition its billing to ICD-10.

Tucson Medical Center selects MethodCare’s Charge Recovery application to improve coding compliance and identify missed charges.

Shamokin Community Area Hospital (PA) selects ProVation MD for gastroenterology documentation and coding.

People

BridgeHead Software appoints Jim Beagle CEO and president. Former CEO and founder Tony Cotterill will serve as executive chairman of the board and as EVP and chief products officer.

Allscripts appoints Catherine Burzik, president and CEO of Kinetic Concepts, to its board of directors.

MGMA and ACMPE name David Bowman, MD Physician Executive of the Year for outstanding leadership to achieve exceptional performance in healthcare delivery. He is executive director of IPC The Hospitalist Company.

HealthTech Holdings, the holding company that owns HMS, MEDHOST, and Sentry Healthcare Services, names Alan MacLamroc CTO and Geoff Roten CIO.

Announcements and Implementations

Houston Healthcare goes live on Meditech on October 31. CIO Robert Rhodes indicates the organization has invested about $6 million to implement the system.

Springfield Service Corporation and its subsidiary Laguna Medical Systems rebrand into a single organization named SPi Healthcare. The company specializes in RCM, health information management, and ASP hosting.

Piedmont Healthcare (GA) partners with TeleHealth Services to implement TeleHealth’s TIGR system for on-demand patient education and interactive communication.

Aetna President Mark T. Bertolini tells investors that its Medicity subsidiary has a $200 million contract revenue backlog and recently launched its iNexx application store. On supporting the ability of consumers to pay for medical services at the point of sale, “We also can now real-time auto-adjudicate a claim on a smart phone at the doctors office, by the consumer or the provider should they choose to do that, because we’ve now been able to create real-time auto-adjudication connection mobilely. The real issue, the ultimate issue here is whether or not people have the incentive to use it. And I think that’s where plan designs and the accountable care organizations and how they link to these platforms — that’s why we bought Medicity, will create people’s ease-of-use in using the system and using this technology to make decisions at the point-of-sale. And that’s ultimately where this needs to head.”

Olympic Medical Center (WA) signs on as an affiliate of Swedish Medical Center, with OMC’s CEO touting as a key benefit its access to Swedish’s Epic system. He said Epic is “the best” EMR and that 75% of Seattle-area hospitals will be running it.

Government and Politics

US Representative Tom Marino (R-PA) introduces legislation to create a system for reporting potential medical errors that occur when using EHRs. It would include protection that provider-supplied information could not be used as a legal admission of wrongdoing.

The VA announces plans to remove an inappropriate restriction on data sharing with the Department of Defense. The update would allow the VA to share information about treatment for drug abuse, alcoholism or alcohol abuse, HIV status, and sickle cell anemia.

CIO Roger Baker talks up the VA’s use of iPads, starting with access to VistA, but  potentially expanded to include tablet-based access to physiologic monitors, blood chemistry results, and full-motion video to support telehealth.

Innovation and Research

The folks from Project HealthDesign (a project of the Pioneer Portfolio of the Robert Wood Johnson Foundation) sent over an “early findings” presentation on using patient-sourced data in treating chronic conditions. They’re testing apps to determine how to collect “observations of daily living” (ODLs) from patients and how clinicians can use that information to help them manage their health. The five projects involve a smart phone-based inhaler study, iPad tracking of Crohn’s disease ODLs, sensor-based tracking of senior citizen task completion, smart phone collection of ODLs related to high-risk infants and their caregivers, and an iPod Touch study of activity and exercise in obese teens. Caregiver challenges: clinician workflows need to be developed to use the incoming information and EMR limitations make it tough to store information there.

Technology

Finally, a legitimate HIT shoe story. GTX Corp and Aetrex Worldwide are designing an GPS-enabled shoe to keep track of Alzheimer’s patients. If a patient walks outside of a certain geographic region, a device automatically sends an alert to the patient’s caretaker. Hopefully by the time I am completely demented the shoes will be a little more stylish.

Other

Though shoes are my first love, I also have quite a fancy for lattes from Starbucks. Maybe so does Alvin Mingczech Yee, a California doctor who preferred to meet most of his patients in various Starbucks outlets. A federal grand jury just indicted him on 56 counts of prescribing drugs “outside the usual course of professional practice and without a legitimate medical purpose.” It turns out hat Yee’s patients preferred oxycodone and other addictive opiates over espresso drinks.

Less than 10% of providers believe they are over halfway prepared for ICD-10, with most still in the strategy and planning phases of preparation.

Kaiser Permanente takes the top spot on Computerworld’s list green IT organizations. It earned high marks for data center cooling and its “Keep IT Green” program for brainstorming energy-saving initiatives.

HP changes its mind and says it won’t sell its PC division after all, with new CEO Meg Whitman saying the plan of her predecessor, the fired Leo Apotheker, “makes no sense.”

I ran my interview with Aetna’s Charles Kennedy the same day Emory Healthcare announced that it will operate a Patient-Centered Primary Care pilot with Aetna for its employees and some Medicare patients, which he described in general in the interview.  

I ran a link to a Kirby Partners survey on job satisfaction a few weeks back, so they sent over some of the findings. More than two-thirds of hospital CIOs work more than 51 hours per week, but still grade their job satisfaction as 7.2 on a 10-point scale (managers and directors scored 6.8 and non-management staff 6.2.) An amazing 96% of IT employees said their working conditions are stressful, and 74% of the non-CIO respondents say they’ll be on the lookout for a new job in the next 12-18 months. Short-term departmental turnover, however, is expected to be only 0-3%.

Weird News Andy concludes that there’s no good answer to this problem: an uninsured illegal alien who was paralyzed in a Texas workplace accident has been treated by UTMB for three months, but the hospital says it’s time for him to go back to Mexico since their only obligation was to stabilize him. They’ve offered him a free flight back, but he’s not leaving. A local aid group says Texas has the highest level of uninsured residents in the country, Galveston and UTMB are still reeling from 2008’s Hurricane Ike, and financially strapped state government has cut the hospital’s funding.

Here’s a Disposable Film Festival submission involving puppets, the Rainbow Button Initiative, and music by our cult favorite (and puppetized) Dr. HITECH. It would have been better with on-stage microphones (or maybe some directional shotguns), but it gets easier to hear when the music starts. The idea is that in addition to the government’s Blue Button for one-click patient downloading of their health information, there should be a Red Button (lock your record as private), a Green Button (make your de-identified information available to researchers), and White Button (send your information in CCD format directly to a chosen provider).

Yet another study finds few lives are saved when normal-risk women get a mammogram each year.

An anecdotal article picked up by MSNBC concludes that the use of outsourced radiology services can cause miscommunication and patient harm. It cites the example of an ED patient in a small Pennsylvania hospital who had a contrast CT performed. The digital copy was sent to the hospital’s contracted radiology service in a city four hours’ away, but since they were closed, it auto-forwarded to a radiologist in Hong Kong. He found the problem and noted it in his report, but neither the ED doc nor the radiology service followed up. The patient was discharged, her brain abscess ruptured, and the ensuing 11 weeks in a coma left her brain damaged. The article lists several potential problems since nobody actually talks to each other while looking at films in a dark room these days: outsourced radiologists may just rubber stamp their reports, offshore companies may fraudulently sign reports without having them read by a licensed radiologist, and Indian companies offer cut-rate radiology reads of unverifiable quality for radiologists to pass off as their own when billing.

Google donates 100 Web-only Chromebooks to the American Red Cross, to be used by wounded military members being treated at Walter Reed.

Hartford Hospital (CT) is elated to find its name used in the first iPhone 4S commercial, where a woman is shown asking its Siri personal assistant function, “What’s the fastest way to Hartford Hospital?” Says the hospital’s SVP of strategy on being asked early on by Apple to use its name, “We didn’t even know what the product was. We’d never even heard of Siri before. Knowing it was part of Apple, I knew it was going to be a quality commercial.”

A Massachusetts man convinces his doctor and others to invest in his thriving software company, which he said was about to be acquired by IBM. The company was fake — he spent the money of his investors on a second home and a fleet of luxury cars, supplementing his fraud revenues by forging prescriptions for narcotics. He’s been indicted on a long list of charges. The man says he’s the real victim even though the doctor is out $3.5 million.

Sponsor Updates

• Carefx and Tracline will showcase their technology partnership at EHI Live 2011.
• Inland Northwest Health Services (INHS) goes live on its Spokane Connection project, enabling the exchange of information with the Social Security Administration. The initiative is part of the Electronic Disability Benefits Eligibility Determination pilot project and connects data through the Nationwide Health Information Network Exchange.
• GE Healthcare, McKesson, NextGen, Practice Fusion, and Sage Healthcare will participate in a two-year Medical Economics EHR study to determine best practices for PCPs.
• The Great Lakes HIE and University of Michigan Health System announce a partnership to share patient health information using the Axoloti HIE platform from OptumInsight. Also, Optum and Lifeline Hospital Group (Abu Dhabi) launch Optum Middle East LLC to improve RCM processes and performance.
• Imprivata introduces its OneSign Virtual Desktop Access for Citrix XenDesktop at Citrix Synergy Barcelona.
• St. Peters Health Care Services (NY) adds Thomson Reuters Pharmacy Xpert.
• ZirMed introduces SimpleResponse to simplify payer rejection messages.
• TeleTracking Technologies receives designation as a Support Staff Excellence Center by the Technology Services Industry Association.
• Practice Fusion will host a “Doctors of the Future” photobooth during the Bay Area Science Festival.
• eClinicalWorks says its 2011 National Users Conference set a new attendance records with over 3,000 participants.
• Baylor Health Care System (TX) creates an enterprise HIE using AT&T’s Healthcare Community Online platform.
• St. Peters Bone & Joint (MO) says it will save $30K annually by improving its Sage EHR workflow using EMR Optimization software and services from MD-IT, which added dictation solutions and an iPhone app.

EPtalk by Dr. Jayne

HIMSS submits comments in response to FDA’s draft guidance on Mobile Medical Applications. Its key point: lots of groups, including hospitals and health systems, are developing mobile apps while having no experience with the FDA’s regulatory processes. HIMSS calls on the FDA to help educate developers.

Health Services Research publishes an article about readiness for Patient Centered Medical Home initiatives, concluding that nearly half would qualify for NCQA recognition. It cites lack of infrastructure and notes that small practices will need assistance at achieving recognition.

CMS issued guidance last week clarifying attestation requirements for eligible hospitals. I’m not sure it told us anything we didn’t already know, but I give them full credit for trying to make sure that hospitals understand what’s involved in attestation. I continue to be surprised when I speak with colleagues who really have no idea what Meaningful Use is about or how it will impact them.

I’m a little behind in my reading, but a piece in the Journal of the American Medical Association caught my eye as I flipped through my ever-rising stack of paper. Automated Identification of Postoperative Complications Within an Electronic Medical Record Using Natural Language Processing compared coding-based identification of complications to data identified by natural language processing. The authors concluded that natural language processing analysis of electronic medical records at a VA hospital had higher sensitivity “compared with patient safety indicators based on discharge coding.” Contents of EHR notes were mapped to SNOMED for analysis. The authors propose that natural language processing could be used to better identify complications by analyzing documents while the patient is still hospitalized, as opposed to the coding approach, which typically occurs after the patient is discharged.

Weird health technology story of the week: a study in the American Journal of Cardiology suggests that pacemakers recycled from funeral homes could assist patients in the developing world. Although the study involved a small number of patients, 38 of 40 recipients improved after receiving a donated pacemaker. Since pacemakers are approved as single-use devices, researchers are seeking FDA approval to perform a more extensive study.

One of my organizational duties is to work with providers who are struggling with EHR adoption. Usually this involves a fairly painful session with a colleague who really wants nothing to do with the computer and who doesn’t see any benefit to learning. These visits showcase interesting behaviors — avoidance, denial, whining, begging, anger, and hostility. Today I had the privilege (and pleasure) of shadowing one of the most proficient EHR-using physicians I’ve ever seen. He seamlessly integrated the EHR into the patient experience and delivered care far more comprehensively than he could have done with a paper chart. An added bonus: his patients love having their charts in the EHR and are active participants in reviewing their records and assisting with updates. It gave me hope and was a nice recharge for my seriously depleted CMIO battieries.

Bedtime reading: The Final Rule for the Medicare Shared Savings Program, aka Accountable Care regs. Quite the page-turner, with nearly 700 pages of risk-sharing bliss, if you ask me. Changes include a rolling application process, reduced numbers of primary care providers who need to meet Meaningful Use requirements, and fewer required measures. Of course I’ll have to read the whole thing if I want to stay employed, but I’m interspersing sections of it with chapters from my newest chick lit find. I’m pretty sure the cover model is Inga, but it’s hard to know for sure without the shoes.

Contacts

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

News 10/26/11

Top News

ONC names Judy Murphy, RN, FACMI, FHIMSS as deputy national coordinator for programs and policy, the position Farzad Mostashari held until being named National Coordinator. She was previously VP of EHR applications at Aurora Health Care and has served on the boards of HIMSS and AMIA.

Reader Comments

From Legal Beagle: “Re: MedAssets. Cook County, IL is suing them for a salesperson having a laptop containing PHI stolen from his car.” Unverified.

From ShareBear: “Re: Continuity of Care Document. Does Canada use it as well? Just wondering if US patients could carry and delivery a CCD from their ONC-certified vendor.” I thought it was US-only, but experts can chime in.

HIStalk Announcements and Requests

Inga is all full of herself running around at MGMA in Las Vegas (or “Vegas,” as the logo annoyingly states), trying hard not to compromise her stealthy Inga identity while composing her daily summaries for HIStalk Practice, so I’ve given her the HIStalk day off. I’ll still put my little blue icons here and there since I’d miss them otherwise. The red ones will be back Thursday.

I’m a good way through the Steve Jobs biography (reading it on the iPad, not too ironically), so I’m sure I’ll have something to say about it by the weekend. My impression so far: he was an brilliant, rebellious, insensitive jackass who had amazing ideas and who didn’t hesitate to use his overpowering personality and caustic scorn to streamroll over anyone who stood in the way of seeing them realized, either by their intentions or their lack of equally shared enthusiasm. But it definitely worked for him and for Apple. I felt sorry for Steve Wozniak after reading how he was treated, but even Woz admits that there would be no Apple without Jobs. He should be the next to write a book (I have no doubt it’s coming, if for no other reason than for him to tell his side of the story.)

Save the date for HIStalkapalooza 2012: Tuesday, February 21, 7:00 to 10:00 p.m., at the HIMSS conference in Las Vegas. I was losing interest since I had too little time to figure out the details, but a fun sponsor stepped forward to take the load off my shoulders. Actually, several companies volunteered to foot the bill and meet my attendee-centric requirements (which I really appreciate) and in the interest of fairness, I simply chose the first one that met my checklist. We’ve chosen the venue, menu, and entertainment, so now Inga and I have to work out the stage show (shoe awards, beauty queen sashes, HISsies, etc.) Remember that everything is a day behind in Las Vegas: Monday is the old Sunday (pre-conference workshops, opening reception) and Tuesday is the old Monday (opening session, exhibits open). We’ve always had HIStalkapalooza on Monday, so this year is no different except it will be Tuesday (that makes no sense, but neither does the HIMSS schedule.) We’ll get all the registration stuff together later, probably right after New Year’s. Ladies, start your fashion shopping engines.

Admire the animation-free ad of new HIStalk Platinum Sponsor Passport Health Communications of Franklin, TN. The company, founded in 1996, offers business operations and payment certainty solutions to hospitals and providers. It serves over 1,900 hospitals and 8,000 practices and processes 300 million transactions each year through its eCare revenue cycle solutions, making it one of the fastest-growing SaaS service companies in the country. Its eCare NEXT Patient Access Suite is a single solution that handles patient information verification, address checking, and payments, offering (as the animation-free ad says elegantly) Payment Certainty for Every Patient. The company just announced a big deal to provide 27-hospital Providence Health & Services with payer eligibility connectivity services. You can read case studies on its site from organizations such as Vanderbilt Medical Group, UNC Health Care, West Virginia University Hospitals, Meriter, and Advocate Health Care. Thanks to Passport Health Communications for supporting HIStalk.

Speaking of Passport Health Communications, this is a first. To celebrate their HIStalk sponsorship, they got together with their customer Quorum Health Resources and put together the video above, which is pretty darned funny (my favorite part was the last few seconds). As I watched, I was thinking that the guy who played the boarding pass taker was a good actor, then I saw at the end that it’s actually Passport CEO Scott MacKenzie. I’m impressed.

Acquisitions, Funding, Business, and Stock

Health business intelligence vendor Analytix On Demand acquires Integrated Revenue Management Inc. and changes its name to CentraMed, which will offer a BI platform and professional services.

McKesson announces Q2 numbers: revenue up 10%, EPS $1.63 vs. $1.25, beating analyst expectations by $0.24 (excluding a $118 million one-time contribution to litigation reserves related to the drug pricing lawsuits it faces). The company also beat revenue expectations and raised guidance. Technology Solutions had revenue of $825 million, up 7%. The conference call was this afternoon, but the transcript hasn’t been posted yet.

Long-time IBM CEO Sam Palmisano steps down, replaced by sales and marketing SVP Virginia Rometty. Palmisano will remain as chairman.

HealthStream announces Q3 numbers; revenue up 24%, EPS $0.08 vs. $0.04, beating expectations for both. The Nashville company, which offers healthcare learning and staff competency solutions, has a market cap of $317 million. Shares were just mentioned in a Forbes article called Fifteen Small Company Stocks To Buy Right Now. 

A Japanese company says it saved Italy-based pharmacy IV automation vendor Health Robotics from a hostile takeover by unnamed US companies by acquiring a minority stake in the company. Health Robotics and McKesson sued each other after their distribution agreement went sour.

Sales

Seton Healthcare (TX) selects dbMotion Collaborate as its interoperability platform to cover 11 counties.

Walsall Trust (UK) chooses TeleTracking Technology’s TransportTracking system to replace an existing patient transport system.

Scripps Health (CA) selects Allscripts Community Record powered by dbMotion for its 2,600 affiliated physicians and five hospitals.

Memorial Hermann Healthcare System (TX) selects the T-SystemsEV EDIS to automate physician documentation in its nine EDs, including integration with the EMR and computer-assisted coding solution.

St. Peters Healthcare Services (NY) chooses the Pharmacy Xpert clinical intelligence dashboard for pharmacists from Thomson Reuters.

People

Awarepoint Corporation hires Merrie Wallace, RN, BSN, MN (McKesson) as EVP of product solutions; Chris Cosgrove (McKesson) as senior VP of sales; Greg Arthur (Microsoft) as VP of client management; and Carla Gallegos (Cisco) as VP of national account sales.

Healthcare data exchange vendor Proficient Health of Greensboro, NC names Dennis Barry to its board. He is a pharmacist, CEO Emeritus of Cone Health (NC), and a former educator and administrator for the University of North Carolina at Chapel Hill.

Announcements and Implementations

RelayHealth wins the VA’s “Blue Button for All Americans” contest. Its one-click Blue Button download of a patient’s information was implemented on the required 25,000 physician sites. VA Secretary of Veterans Affairs Eric K. Shineski says, “We wanted to give Veterans and their families easy access to their health data with the Blue Button so they can have greater control over the health care they receive. RelayHealth’s contribution to this goal is more than commendable.” The company will donate its $50,000 prize to the Wounded Warrior Project.

Froedtert Hospital implements NCR Wayfinding to improve the patient experience.

El Centro Regional Medical Center (CA) implements the PatientSecure palm vein scanning patient ID system from HT Systems.

Kansas Health Information Network and eHealthAlign merge their two ICA CareAlign HIE contracts to increase efficiencies and reduced cost to providers.

Fujitsu and Osmosyz announce a scanning product suite that converts paper charts to interoperable documents that meet HL7 Clinical Document Architecture standards. They’re demoing the solution in the booth of partner Aprima at MGMA.

In India, Wipro announces a new version of its Hospital Information Management System that’s used by over 100 customers in India, the Middle East, and Africa.

Government and Politics

Rep. Tim Huelskamp (R-KS), in an interview with reporters from The Heritage Foundation, is asked about Epic CEO Judy Faulkner’s role on the Health IT Policy Committee:

Reporter: Congressman, we at Heritage have done some reporting about, specifically, one member of the Health IT Policy Committee sort of controlling where these federal funds are being spent, who seems to be using her position — this is Judith Faulkner at Epic Systems — to advance her company’s interests, using $20 billion in stimulus funds. Have you looked into how the people who are directing this policy stand to gain from this potential conflict of interest, the sort of cronyism at play here?

Huelskamp: We discussed that in our office just yesterday, and saw an article this morning … I appreciate your work about exposing that. You know, you roll back a little bit of history to the Hillary Clinton era, and that’s helped kill that when that was being put together. Given the closed nature of the process … and I’ll tell you, for Congress to say it’s not transparent on that end, while down the street we’ve got 12 folks around a table dictating the entirety of policy, it rings hollow. 

But the point being, I think most Americans are saying, "Hey, wait a minute. That just doesn’t smell right." So I think that’s an angle to talk about and continue to push on that. We don’t have anything to add. You guys have done great research. We’re going to continue to push on that. We are looking for soft spots, and we just talked about that yesterday — where we can find those. Because there’s somebody in there, without a doubt. If I know Governor/Secretary Sebelius as well as I think I do, there’ll be plenty of other places. You follow the money, and you’ll find out where.

This is a multi-billion dollar initiative. I served on the information technology committee in the state legislature for about 10 years. They couldn’t put together a Medicaid system — am I right on that, Brian? I mean, it was millions and millions of dollars. It would fall apart every year, and then they’d start again and again. This is a cash cow, without a doubt. There’s only, in my understanding, two or three companies that could potentially pull that off and they’ve got connections to the administration.

And later in the interview:

Huelskamp: I’m just thinking about Judith Faulkner and her appointed group. They’re not for sure who appointed them? Yeah, surely you’re joking. We know it’s all political appointments, and that’s how it works, and we understand that.

Australia creates an oversight body to identify and manage patient safety risks related to its national electronic medical records rollout. The group will determine the severity of risks and provide guidance on how quickly to resolve them.

Innovation and Research

Graduate students at University of California Merced are developing an avatar-led virtual physical therapy software application to provide physical therapy services to the elderly.

Partners Healthcare Center for Connected Health gets a $25,000 Verizon Foundation grant to develop a wireless pedometer (a sneaker chip) for teens and a text messaging program that sends them health and nutrition suggestions based on their activity. That’s a pretty brilliant idea and the execution looks good.

Sponsor Updates

• Robert Hitchcock, CMIO of T-System is interviewed for a podcast on the survival of hospital EDs and the necessity of EHRs.
• CareTech Solutions is recognized with “Outstanding Website Developer” and “Information Services Standard of Excellence” awards from the Web Marketing Association, while 13 of its clients win WebAwards of their own.
• Modern Healthcare’s Best Places to Work in Healthcare names Aspen Advisors, Encore Health Resources, Hayes Management Consulting, Iatric Systems, Impact Advisors, maxIT Healthcare, and The Advisory Board Company among its top 100.
• Cumberland Consulting Group promotes Jessa Sprenkle to executive consultant.
• Orthopaedics of Steamboat Springs, PC (CO) selects the SRSsoft EHR.
• ZirMed announces the release of its Patient Payment Developer Kit at MGMA.
• ADP AdvancedMD announces cloud integration between its practice management system and Modernizing Medicine EMA-Ophthalmology EHR.
• Carondelet Health and Ascension Health Information Services (KS) select eClinicalWorks PM/EHR and Electronic Health eXchange.
• Coastal Medical (RI) announces that 47 providers have achieved MU using eClinicalWorks.
• MedVentive Inc. closes a $12 million offering of Series D preferred shares.
• Billian’s HealthDATA affiliate HITR.com launches a blog called Nurse Tech Talk – Bridging Nursing and IT.
• Health Language Inc. launches its LEAP I-10 claims analytics module at the Workgroup for Electronic Data Interchange Fall 2011 Conference.
• Greenway Medical releases an analysis of Medicare’s final ACO rule, authored by VP Justin Barnes, who also is co-chair of the national Accountable Care Community of Practice.
• Intelligent InSites will present Getting the Most out of an RFID/RTLS Implementation at the Northeast Healthcare Technology Symposium in Groton, CT next week.

Contacts

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

Thoughts on NIST’s EHR Usability Document 10/24/11

NIST’s EHR usability report, Technical Evaluation, Testing, and Validation of the Usability of Electronic Health Records, can be viewed here. It is in draft status and available for public comments. Comments can be sent to EHRUsability@nist.gov.

ONC has also pledged to review comments left HIStalk. Cllick the link at the end of this article to add yours.

My Disclosures

• I’m not a usability expert, but I have attended usability workshops and possess some familiarity with how software usability is defined and measured.
• I’ve used badly designed software.
• I’ve had to tell clinical users to live with badly designed software and patient-endangering IT functionality because we as the customer had no capability to change it and our vendor wasn’t inclined to.
• I’ve designed and programmed some of that badly designed software myself, choosing a quick and dirty problem fix rather than a more elegant and thoughtful approach.
• My hospital job has involved reviewing reports of patient harm (potential and actual) that either resulted from poor software design or could have been prevented by better software design.
• I’ve seen examples from hospitals I’ve worked in where patients died from mistakes that software either caused or could have prevented.

First Impressions

My first impression of the report is that it was developed by the right people – usability experts. Vendor people and well-intentioned but untrained system users were not involved. Both have a role in assessing the usability of a given application, but not in designing a usability review framework. That’s where you want experts in usability, whose domain is product-agnostic. 

My second impression of the report is that it is, in itself, usable. It’s an easy-to-read overview of what software usability is. It’s not an opinion piece, an academic literature review, or government boilerplate.

The document contains three sections:

1. A discussion of usability as it relates to developing a new application.
2. A review of how experts assess an application’s user interface usability after the fact.
3. How to bring in qualified users to use the product under controlled conditions as a final test to analyze their interaction with the application and their opinions about how usable it is. This is where the user input comes in.

A Nod to the HIMSS Usability Task Force

I was pleased to see a Chapter 2 nod given to the HIMSS Usability Task Force, which did a good job in bringing the usability issue to light. They were especially bold to do this under the vendor-friendly HIMSS, which has traditionally steered a wide berth around issues that might make its big-paying vendor members look bad. I credit that task force for putting usability on the front burner.

In fact, the HIMSS Usability Task Force’s white paper is similar to the NIST document, just less detailed. I’ll punt and suggest reading both for some good background. I actually like the HIMSS one better as an introduction.

Usability Protocol

A key issue raised early in Chapter 3 (Proposed EHR Usability Protocol) is that it’s important to understand the physical environment in which the software will be used. This is perhaps the biggest deficiency of software intended for physician use.

User interfaces that work well for users who are seated in a quiet room in front of a desktop computer may be significantly less functional when used on laptops or other portable devices while walking down a hospital hallway, or on a laptop with only a built-in mouse. That’s a variable that programmers and even IT-centric clinicians who spend their days riding an office chair often forget. The iPad is forcing re-examination of how and where applications are actually used and how to optimize them for frontline use.

The document mentions that ONC’s SHARPC program is developing a quick evaluation tool that assess how well an application adheres to good design principles. Three experts will review 14 best practices to come up with what sounds like a final score. It will be interesting to see what’s done with that score, since it could clearly identify a given software product as either very good or very bad. In fact, the document lists “violations” that range from “advisory” to “catastrophic,” which implies some kind of government involvement with vendors. Publishing the results would certainly put usability at the forefront, but I would not expect that to happen.

The document points out that usability testing “does not question an innovative feature” that’s being introduced by a designer, but nonetheless can identify troublesome or unsafe implementation of the user interface for that feature.” That’s the beauty of usability testing. It can be used to test anything. It doesn’t know or care that what’s being testing is a worthless bell and whistle vs. a game-changing informatics development. It only cares whether the end result can be effectively used (and with regard to clinical software, that patients won’t be harmed as a result of confusion by the clinician user.)

Methods of Expert Review of User Interfaces

Chapter 5 covers expert review of user interfaces. When it talked about standardization and monitoring, I was thinking how valuable a central EHR problem reporting capability would be. Customers find problems that either aren’t reported to vendors or aren’t fixed by them, meaning patients in potentially hundreds of locations are put at risk because of what their caregivers don’t know about an IT problem.

If the objective of improving usability is to reduce patient risk, why not have a single organization receive and aggregate EHR problem reports? It could be FDA, Joint Commission, ONC, NIST, or a variety of government or non-profit organizations. Their job would be to serve as the impartial intermediary between users and vendors in identifying problems, identifying their risk and severity, alerting other users of the potential risk, and tracking the problem through to resolution.

The NIST document cites draft guidance from FDA on usability of medical devices. It could be passionately argued either way that clinical IT systems are or aren’t medical devices, but the usability issues of medical devices and clinical IT systems are virtually identical. Since FDA has mechanisms in place for collecting problem reports for drugs and devices, making sure vendors are aware of the issues, and tracking those problems through to resolution, it would make perfect sense that FDA also oversee problem reports with software designed for clinician use. This oversight would not necessarily need to involve regulation or certification, but could instead be more like FDA’s product registration and recall process.

The document highlighted some issues that I’ve had personal gripes about in using clinical software, such as applications that don’t follow Windows standards for keystrokes and menus and those that don’t support longstanding accessibility guidelines for the disabled.

Choosing Expert Reviewers and Conducting a Usability Review

Chapter 6 talks about the expert review and analysis of EHR usability. So who is the “expert” involved in this step? It’s not just any clinician willing to volunteer. The “expert” is defined as someone with a Master’s or higher in a human factors discipline and three years’ experience working with EHRs or other clinical systems.
 
The idea that clinicians are the best people to (a) design clinical software from inception to final product, or (b) assess software usability ignores the formal discipline of human factors.

Validation Testing

Chapter 7 describes validation testing. It explains upfront that this refers to “summative” user testing, meaning giving users software tasks to perform and measuring what happens. It’s strictly observational. “Formative” testing occurs in product development, where an expert interacts collaboratively with users to talk through specific design challenges.

Validation testers, the document says, must be actively practicing physicians, ARNPs, PAs, or RNs. Those who have moved to the IT dark side aren’t candidates, and neither are those who have education in computer science.

How many of these testers do you need? The document cites studies that found that 80% of software problems can be found with 10 testers, while moving to 20 testers increases the detection rate to 95%. FDA split the difference in proposing 15 testers per distinct user group (15 doctors, 15 nurses, etc.)

The paper notes that EHRs “are not intended to be walk-up-and-use applications.” Their users require training and experience to master complex clinical applications. The tester pool, then, might include (a) complete EHR newbies; (b) those who have experience with the specific product; and (c) users who have used a competing or otherwise different EHR.

Tester instructions should include the fact that in summative testing, nobody’s asking for their opinions or suggestions. They are lab rats. Their job is to complete the defined tasks under controlled conditions and observation and nothing more. They are welcome to use help text, manuals, or job aids that any other user would have available to complete the defined tasks.

The NIST report listed other government software usability programs, including those of the FAA, the Nuclear Regulatory Commission, the military, and FDA.

EHR Review Criteria

Appendix B is a meaty list of expert EHR review criteria. This is where the report gets really interesting in a healthcare-specific way. It’s just a list of example criteria, but if you’re a software-using clinician, you can immediately start to picture the extent of the usability issue by seeing how many of those criteria are not met by software you’re using today. Some of those that resonated with me are:

• Does the system warn users when twins are admitted simultaneously or when active patients share similar names?
• If the system allows copying and pasting, does it show the viewer from where that information was copied and pasted?
• Does the system have a separate test environment that mirrors the production environment, or does it instead use a “test patient” in production that might cause inadvertent ordering of test orders on live patients?
• Does a screen require pressing a refresh button after changing information to see that change fully reflected on the screen?
• For orders, does the system warn users to read the order’s comments if they further define a discrete data field? (example: does a drug taper order flag the dose field to alert the user that the taper instructions are contained in the comments?)
• When a provider leaves an unsigned note, are other providers alerted to its existence?
• Do fields auto-fill only when the typed-in information entered matches only one choice?
• Can critical information (like a significant lab result) be manually flagged by a user to never be purged?
• Are commas automatically inserted when field values exceed 9999?
• Are “undo” options provided for multiple levels of actions?
• Is proper case text entry supported rather than uppercase-only?
• Do numeric fields automatically right-justify and decimal-align?
• Do error messages that relate to a data entry error automatically position the cursor to the field in error?
• Do error messages explain to the user what they need to do to correct the error?
• Do data entry fields indicate the maximum number of characters that can be entered?
• Are mandatory entry fields visually flagged?

My Random Thoughts

Usability principles would ideally be incorporated in early product design. To retrofit usability to an existing application could require major rework, which may be why some vendors don’t measure usability – it would simply expose opportunities that the vendor is unwilling or unable to undertake. 

On the other hand, improving usability doesn’t require heavy duty programming or database changes. The main consideration would be, ironically, the need for users to be re-trained on the user interface (new documentation, new help text, etc.)

Usability can me measured, so does that mean there is “one best way” to do a given set of functions? Or, given that users are often forced to use a variety of competing CPOE and nurse documentation systems, is it really in the best interest of patients that each of those vendor systems has a totally different user interface?

Car models have their own design elements to distinguish them commercially, but it’s in the best interest of both the car industry and society in general that placement of the steering wheel and brake pedal is consistent. With PC software, this wasn’t the case until Windows forced standard conventions and the abandonment of bizarre keystroke combinations and menus.

I always feel for the community-based physician who covers two or more hospitals and possibly even multiple ambulatory practice settings, all of which have implemented different proprietary software applications that must be learned. This issue of “user interoperability” is rarely discussed, but will continue to increase along with EHR penetration.

From a purely patient safety perspective, we’d be better off with a single basic user interface for a given module like CPOE, or even a single system instead of competing ones (the benefits of the VA’s single VistA system spring immediately to mind.) It’s the IT equivalent of a best practice, Usability can be measured and compared, so that means if there are 10 CPOE systems on the market, patients of physicians-users of nine of them are being subjected to greater risk of harm or suboptimal care.

Usability testing does not require vendor participation or permission. Any expert can conduct formal usability testing with nothing more than access to the application. Any third party (government, private, or for-profit) could conduct objective and meaningful usability assessments and publish their results. It’s surprising that none have done so. They could make quite a splash and instantly change the dialogue from academic to near-hysterical by publicly listing the usability scores of competing products.

Conclusion

Read the report. It’s not too long, and much of it can really be skimmed unless you’re a hardcore usability fan. If nothing else, at least read the two-page executive summary. 

For the folks who express strong reaction to the word “usability” while clearly not really knowing what it means, the report should be comforting in its objective specificity.

Even though the document is open to public comment, there really isn’t much in it that’s contentious or bold. It’s just a nice summary of usability design principles, with no suggested actions or hints of what might future actions are being contemplated (if any.)

I’m sure comments will be filed, but unless they are written by usability experts, they will most likely be unrelated to the actual paper, but rather what role the government may eventually take with regard to medical software usability.

It should also be noted that no product would register a perfect usability score. And, that humans are infinitely adaptable and will learn to work around poor design without even thinking about it. In some respects, usability is less of an issue with experienced system users who have figured out a given system’s quirks and learned to work capably (even proudly) around them.

This document really just provides some well-researched background on usability. The real discussion will involve what’s to be done with it.

Let’s hear your thoughts. Leave a comment.

Monday Morning Update 10/24/11

From Mintonw: “Re: NorthCrest Medical Center (TN). It’s the first hospital to receive a Medicaid EHR incentive payment by just using ED patients and an EDIS, in their case Allscripts ED 7.0, the only EDIS certified as a Complete EHR.” The hospital’s press release is here. SVP/CIO Randy Davis says the 109-bed hospital was already in the high 90s percentile and didn’t need to change much. The hospital says it will meet Medicare’s MU requirements later this year.

From Tommy Tune: “Re: Jim Fitzgerald. Definitely no longer at Dell. My source says it was his choice.” Unverified.

From Rigoletto: “Re: GE Healthcare. Says Centricity Practice and EMR can’t generate accurate Meaningful Use reports. See link here to its letter to customers.” It sounds like basic technical stuff, made interesting only because the company admits that there could be problems for clients who have already attested – the corrected reports may show that they didn’t hit the required thresholds after all . GE says they will provide “further instruction on how to work with CMS related to any changes related to attestation.” The recommend changes in practice are: (a) choose specific race/ethnicity codes instead of free text and don’t choose “multi-racial,” “Hispanic,” or “other;” (b) use specific options for describing smoking status; and (c) us prescribing to measure patient medication education since issuing handouts that the EMR did not suggest doesn’t count toward Meaningful use. I don’t see any of this as a slam on GEHC other than they are awfully late in identifying the problems, which seem pretty obvious. Let’s hope the triggering event wasn’t an eligible provider getting in trouble with CMS.

From Dr. Nurse: “Re: McKesson CEO John Hammergen’s $131 million one-year compensation. Their products are a patchwork of jury-rigged acquired code which has never been upgraded and they clearly have no idea what a usability standard is (the joke is, ‘just keep scrolling down and to the right and you’ll eventually find the right checkbox.’) They perform paper-based billing for specialty practices (Fedexing boxes of paper forms to Pittsburgh – really?) and use antiquated reporting systems that cannot be altered (you can’t add columns due to system limitations). His compensation package is obscene considering McKesson’s ongoing loss of market share, discernible lack of innovation, and adherence to outdated methodologies and business practices. He’s not alone – the CEO salaries of third-party payers are off the grid, too.” Above is the five-year performance of MCK (blue), the Dow (red), the Nasdaq (green), and the S&P 500 (yellow). A big chunk ($112 million) of that compensation was from stock options that he won’t get to exercise every year. At least shareholders (including employees) got to make money along with him. Not to mention that IT isn’t the company’s bread-and-butter business, although that product line is still profitable.

From Por Favor: “Re: WNA. I totally love Weird News Andy, but as a Canadian, I’m appalled by the actions of the clinicians at the hospital. There once was a time where it didn’t matter how you came to be in the ER. I was in the ER several years ago when a young man of about 17 was brought in with a terrible leg break. He was from England on a rugby tour with his school. I remember him crying and trying to tell the doc he had insurance and hoped the doc would take care of him even though he couldn’t produce the documents right there. I’ll never forget what the doc said: ‘Son, I don’t care if you have insurance or not. I’m going to take care of you. Rest easy, try to relax, and do not worry. You’re in Canada and under my care.’ That demonstrates why doctors became doctors in the first place – to heal the sick. It is so sad that somewhere along the way, we have lost this. Please tell Andy to keep the weird news coming – it’s always fun!” The example was from Canada, but I’m certain we have at least as many such cases on this side of the border.

From Neil Louwrens, MD FACP: “Re: physician’s malpractice award as a patient at Northwestern. I’m vehemently opposed to the current tort system, but passionately for justified litigation, including substantial earnings to injured patients. I’m equally and passionately against trivial pestering from the legal profession, claiming wrongdoing and pain-and-suffering that runs up ridiculous tabs at this nation’s expense. The physician in this case is a patient and the case must rest on that. When we fight for tort reform, we are asking for some sense of sanity to be infused back into the system. Nowadays, even the best doctors doing the right thing are still sued. It’s a lottery mentality and the nation picks up the tab. Most physicians who have wronged someone are remorseful and wish they could compensate the patient for their wrongdoing, but to watch the lawyers walk away with 50-60% of the winnings is a travesty. Give patients their money back! Wall Street’s wrongdoings pale in comparison with what the Association of Trial Lawyers of America has managed to carve out for themselves in the current system, backed and perpetuated by the preponderance of lawyers in Congress. Tort reform will reform this inequity, but will not touch the earnings to the injured for their costs, such as justified pain and suffering. We need tort reform – not ‘we’ as physicians, but ‘we’ as patients.”

Thanks to Jacob Reider, ONC’s new usability guy, for taking the time to interview. A reader had tipped me off that he’d taken the job, I e-mailed him, and he asked me to hold off for a couple of days (the details weren’t quite finalized, I surmise.) He not only gave me the first interview, but didn’t tell anyone about his new job until I could get back from vacation so we could do the interview and have the scoop here. Above is another interview he did on usability before he took the ONC job. ONC is interested in reaction to NIST’s usability paper, which I’ll be providing once I’ve had a chance to read it over. Hopefully those readers who constantly gripe about poor EMR usability will channel some of their energies into reviewing the NIST document since it’s the best hope so far (short of some super-secret vendor development project that nobody’s seen yet) to improve the healthcare IT usability landscape.

Listening: reader-recommended Elizabeth Cook, who sounds a good bit like Dolly Parton. The youngest of 11 children, moonshiner dad in prison, took dual degrees in accounting and computer information systems, and worked as an auditor for PWC.  She writes most of the songs, which have brilliant lyrics and range from the good old boy rowdy (“Say Yes to Booty”, “Sometimes It Takes Balls to Be a Woman”) to the starkly moving (“Heroin Addict Sister”).  Modern country is one of my least-favorite genres because it’s been taken over by industry-groomed, overproduced pretty faces faking credibility in the pain and loss department while fronting pop music that has the absolute barest minimum of mandolin or steel guitar, but this is the real deal.

My Time Capsule editorial this week, squinting its eyes upon seeing its first daylight since October 2006: GM and Intel are Right: Healthcare Is Too Expensive, but Technology Alone Can’t Fix It. A taste: “Most US job growth since 2001 was in healthcare, and that’s not something to be proud of. We’re leaving an expensive mess for our children to clean up just as Baby Boomers suck the system dry with healthcare demands. If GM doesn’t like it today, they’ll hate it tomorrow, unless they’re watching from China or India.”

Good stuff on HIStalk Mobile, where Dr. Travis Good covers How to Make Money on Consumer Health Tools and Enterprise Provider Apps. He started out covering straight news, but now that he’s comfortable, he’s putting together some really good analysis and opinion posts that I appreciate since I’m learning from them. Sign up for the e-mail update over there if you like what you see. Thanks to our sponsors there, too: founding sponsors AT&T and Vocera and platinum sponsors Voalte, 3M, Thomson Reuters, Patientkeeper, Kony, and Access.

I’ve said before how much I like using speech recognition for certain tasks (composing e-mails and sometimes writing HIStalk, for example). I was about to upgrade my Dragon Naturally Speaking when I found about Windows Speech Recognition. Like DNS, it’s great for dictation and controlling Windows by voice. Advantages: its system performance seems to be better, its accuracy is almost as good (96% vs. 99%), and it’s included free in Windows 7 (you’ll find it in Control Panel.) Well worth experimenting with since everybody can talk faster than they can type and sometimes your fingers just get tired.

Here’s the latest HIS-tory from Vince, this time with Part II of JS/Data, with lots of info about its eventual (many-named) acquirer.

Most respondents (some of them with considerable skin in the game) think HITECH should pay providers for starting their EHR use even before HITECH started. New poll to your right: should HHS require doctors to generate personalized, unique documentation (i.e., no boilerplate or macros) in order to be paid?

Dr. Jayne brought up an interesting point in her latest post: the government seems to want everybody to be fooled into thinking that Medicaid is insurance rather than a social program that takes money away from taxpayers and gives it to non-taxpayers (all warm-and-cuddly positives aside, that’s what it is.) We’ve already taken the shame out of being on the dole courtesy of the ever-fewer working Americans (Social Security and Medicare being the big drains among many), so unless you have a lot more faith than I do that either politicians or voters will start exercising responsibility instead of acting in their own self-interest, keep an eye on what’s happening in Greece because we’re getting close to that point of non-sustainability. Politicians won’t stop handing out financial lollipops and the taxpayer/non-taxpayer ratio keeps shrinking, so something has to give regardless of the indignation and injustices involved. Our lavishly funded healthcare system isn’t exactly helping as it sucks up an ever-increasing chunk of GDP.

ProHealth Care (WI) finishes its implementation of Epic.

GE announces Q3 numbers: revenue flat, EPS $0.31 vs. $0.28, meeting expectations.

Interesting revelations from the Steve Jobs biography, hitting stores Monday: (a) he apparently lied about the extent of his medical problems; (b) he initially resisted having surgery for his pancreatic tumor, so he tried diets, acupuncture, a psychic, and remedies he found online, to his apparent eventual regret; (c) he claimed Google stole iPhone features in creating its Android phone, saying he would “spend every penny of Apple’s $40 billion in the bank to right this wrong.”; (d) his last ambitions, possibly involving Apple products yet to be released, involved developing an integrated TV and taking on the textbook monopoly. He also told President Obama that he was destined to be a one-termer because he is business-unfriendly; described Microsoft as “mostly irrelevant” and struggling like most other companies that put salespeople in charge; and said HP is being “dismembered and destroyed” by poor leadership. Nobody quoted him all that much while he was alive and he stayed out of the limelight for the most part, but now every scrap of writing and video is being assembled into the Gospel According to the Recently Canonized Steve (and I admit being just as fascinated by it as everybody else.)

Speaking of Apple, here’s the first commercial for the iPhone 4S and its Siri voice command system.

Kaiser needs to dig into its Epic database to evaluate this study from Canada. Overweight people (BMI of 25 to 29.9) were found to have the same risk of health problems as normal-weight patients. The study found that the big health problems start with a BMI of 35 (defined as “obese.”) Hopefully the study looked longitudinally at patients rather than just current weight. You can calculate your BMI here.

Washington Hospital Center (DC) and AT&T develop CodeHeart, a mobile collaboration app that provides real-time audio and video contact in critical care situations, such as for ambulances in transit.

A lawsuit against Abbott Northwestern by a kidney stone patient alleges that a drug-addicted nurse stole his ordered narcotics for herself, leaving him to suffer excruciating pain through the procedure. The patient says the nurse told him she couldn’t give him very much medication and that he should just “man up.” During the procedure, he says the nurse was unsteady and slurring her words as she coached him for his pain, telling him, “Go to your happy place, Larry. Go to your beach.”

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