Monday Morning Update 2/7/11

From Secundum Artem: “Re: David Blumenthal. You should do a poll about his replacement.” I’m game. Nominate your recommended replacement here. I’ll put the responses together in a final vote once I get the most-nominated candidates. The result won’t carry any influence whatsoever, but it will be fun while we wait to see who gets the job.

From Asystole: “Re: 100-fold insulin overdose. Sorry, that’s not a function of low pay or working conditions. It’s a function of licensing incompetent people dependent on technology to cover their lack of knowledge. No math skills, can’t calculate a dose without a computer.” I don’t disagree, other than pay does figure into the equation. In many areas, nursing home RN salaries are at bottom of the food chain and, not surprisingly, so are some of their nurses. You have to be really dedicated (or in low demand for clinical or legal reasons) to accept being underpaid while dealing with the number of nursing home patients who are uncooperative, combative, and suffering from dementia. Obviously critical thinking skills were a problem here (“hey, does anybody know where we keep those 10 ml insulin syringes?”) and are no doubt in equally short supply elsewhere in healthcare. And for employees who like having a computer tell them what to do, nursing homes don’t use them much, so that’s another challenge. I don’t hear the technology advocates insisting that LTCs go digital for patient safety and efficiency reasons, probably because the largely for-profit nursing home industry has no money compared to non-profit hospitals (consider the irony).

From Lilliputian: “Re: Epic non-competes. For the folks who say they are illegal, the trick is that Epic swings a big stick with customers and consultants to make sure that folks within their year aren’t hired.” Unverified, but heard often.

From JustBecause: “Re: Ingenix. Charging its customers $25K to stay with them, if you want to upgrade to the claim scrubber version that supports ICD-10.” Unverified, but I’ll leave it to readers to weigh in on the general issue: is it unreasonable for companies to charge existing customers for upgrades necessitated by regulatory changes? Lots of EHR vendors are charging premium dollars for upgrades needed to meet Meaningful Use requirements, but those changes took away development time that could have been spent elsewhere and the timeline was short. I’d guess that most readers agree with me that maintenance fees probably weren’t scaled to cover government-mandated enhancements, but then comes the gray area: what level of surcharge is reasonable?

I’m in full HIMSS mode, assembling the HIStalkapalooza beauty queen sashes, salvoing e-mails with Inga about the work we need to do to prepare, and setting up all of our recently added sponsors. Someone said they envy me because of all the HIMSS fun, but it’s all work for me. The latest I’ve ever stayed for the HIStalk reception was 9:00 p.m. because I have to stay up half the night writing that day’s HIStalk (I ate nothing but Subway the last time the conference was in Orlando). Above is a picture from that HIStalk reception at the Peabody that year (2008) that I ran across. I never get many reception pictures, so I’m hoping I do this time around.

I’m happy to hear that so many readers have found work-life balance, with only around 16% saying they work 60 or more hours per week in their primary job. New poll to your right: what’s your take on the PCAST report’s recommendation of a universal healthcare exchange language based on tagged data elements?

A UK male nurse who prosecutors say killed his first wife and tried to kill his second, both times to collect insurance money, told a former lover that being a Cerner contractor in Saudi Arabia gave him a military rank of colonel. 

Maryland hospital is under fire for its delivery room policy banning cameras and cell phones and allowing no baby pictures to be taken until at least five minutes after delivery and only then with the medical team’s permission. The hospital’s stated concern: the privacy of its employees. The unstated concern: hospitals have lost malpractice lawsuits when videos taken by parents captured evidence of improper care. It’s interesting that some businesses record everything on video everything to protect themselves legally, while hospitals and practices are scared to death that cameras will catch them screwing up. Which they would, no doubt: you could do an interesting medication error study by putting a helmet cam on a nurse or a patient. In fact, I’ve just had one of my can’t-miss business ideas: a malpractice law firm could visit hospitalized patients and offer them a free stuffed animal Nanny Cam for their rooms in return for the inevitable lawsuit business that would result from a review of the images.

Thanks to new HIStalk Platinum Sponsor Merge Healthcare of Chicago, IL. We connected when I interviewed CEO Jeff Surges a couple of weeks ago. Merge is mostly known for RIS/PACS and innovative medical imaging software, but has expanded its product line to include radiology-focused solutions for billing, document management, and operational dashboards; cardiology and cath lab; clinical trials; master patient index; integration tools and services; kiosks; a laboratory information system; MRI; perioperative solutions; and a clinician access portal. Wall Street must like what it sees since the stock price has jumped 45% in the last 30 days. Drop by their booth at HIMSS and they’ll tell you about iConnect, the company’s comprehensive solution for interoperable image exchange and management. Thanks to Merge Healthcare for supporting HIStalk.

The VA announces the first four winners of its innovation competition, which will receive funds to run pilot projects: mVisum (cardiology data on mobile devices), Agilex Technologies (VistA on mobile devices), MedRed (collaboration tools for caregivers of traumatic brain injury patients), and Venture Gain (wearable sensors to detect heart failure).

Billian’s HealthDATA is supporting HIStalk as a Gold Sponsor, which I appreciate. The Atlanta-based company provides healthcare contact and facility data (hospitals, ambulatory surgery centers, and long-term care facilities, for example). I checked out their hospital information, which includes statistics, affiliated organizations, contact names and titles, e-mails addresses, and financial and quality indicators. Most interesting to me is that they also have information on IT installations and upgrade plans (sample here) that I would love to get my hands on since I’m always needing to know who runs which systems, who’s the IT contact at a given hospital, etc. so I may need to find out what that costs. Thanks to Billian’s for supporting HIStalk.

I found this brand new YouTube video from Billian’s that demonstrates the new version of its portal, which covers over 40,000 healthcare facilities. They’ll be showing it at HIMSS.

DrLyle provided some information on the HIT Geeks Got Talent sessions at HIMSS. On Monday at 12:15, eight contestants (vendor coders, spare bedroom programmers, whoever) will do two-minute demos of their cool software, judged by Jonathan Teich (Elsevier), Erica Drazen (CSC), and Dave Garets (Advisory Board Company) and voted on by the audience using cell phones (apparently non-cell users are disenfranchised). The top four will move to Tuesday afternoon’s finals round, where they’ll do 10-minute demos to pick a winner. DrLyle explained that he got the emcee job not only because he runs a healthcare innovation program, but because “I’m a shorter, darker, and hopefully funnier version of Ryan Seacrest.” I like the idea, especially when considering the non-spontaneous “dark room with monotonic, over-rehearsed people reading from slides” sessions that predominate.

Speaking of overly rehearsed speakers, I just now cracked myself up with memories of peering into the Speaker Ready Room at previous HIMSS conferences. It’s hilarious to watch a roomful of suited-up, badge ribbon-bedecked presenters warming up by reciting their presentations with eyes closed and practicing their histrionic podium gestures in a sparsely furnished room in front of nobody in between bouts of anxiety-induced nausea. Too much practice is why 90% of the sessions are like watching a motorized Abe Lincoln at Disney, with speakers moving and speaking awkwardly while losing the audience’s interest in about two minutes (imagine Audio-Animatronics Abe reading from PowerPoints crammed with bullet lists). PowerPoint encourages formulaic Ben Stein-like recitations, but it does allow audience members to just grab the slide printout and run if they don’t need to have the slides read to them books-on-tape style. In fact, if it wasn’t for going to parties, hanging out with pals, and taking an Orlando vacation on company time, you could probably bag HIMSS completely and just buy the audio proceedings for a few hundred dollars, thereby gaining the audio advantages of “attending” every session plus being able to use the fast-forward button that would be ever so handy in those meeting rooms.

McKesson and General Dynamics sign a deal to create a centralized EHR for DoD. The announcement implies that an existing McKesson solution is involved since it references “the proven capabilities of McKesson’s EHR solution.” I’d be interested in knowing which MCK product was so strong that it was an obvious DoD choice (and what taxpayers are paying General Dynamic for bringing it to the table).

A New York hospital named by the state as an overseer of a failing nursing home files suit against the nursing home’s owner, HCA/Genesis. The hospital claims HCA/Genesis is threatening to pull out all IT equipment and services, not too surprising since the hospital was already planning to build a competing facility when asked to manage theirs for 18 months. 

Labor management systems vendor Kronos announces Q1 earnings of $37 million on revenues of $176 million. Which reminds me: why does “revenue” require a plural form? Is “revenues” different from “revenue?” I could look it up in “The Free Dictionary,” but the entry above tells me I might not want to trust the result.

FDA approves the first iPhone/iPad app for viewing medical images, although its 510(k) clearance was qualified in saying it should be used only when workstation access isn’t available (right). Mobile MIM passed FDA’s tests and its review of radiologist usage under variable lighting conditions.

Germany’s big HIT vendor, CompuGroup, reports Q4 numbers: revenue up 9% and net income up 131%. Revenue was lower than expected, primarily due to poor US sales. Its previous US acquisitions include HealthPort, Noteworthy Medical Systems, and Visionary Healthcare Group.

This is unusual: Roundup Memorial Hospital (MT) asks the local clinic to help it run its operations after the hospital ends its contract with a hospital management company. The clinic will help the hospital install electronic medical records. Actually, the clinic already operates a hospital from a 1993 merger, so it’s not exactly just a medical practice. I assume from the hospital’s name that it refers to cowboys, not weed killer.

University Hospital (UT) apologizes to 700 patients whose statements contained a phantom $2 million charge item. I found this funny: before the hospital implemented its new billing system in December, it mailed out a sample of the new billing format to patients, showing a mocked up bill for phony patient Dora Billings. Several recipients sent in checks for Dora’s bill. The article didn’t say if Medicare was one of them.

Aetna beats estimates with its Q4 earnings of $255 million, up 58% over last year. The insurer says it has a $1.2 billion war chest for acquisitions, with an analyst predicting that Aetna will buy other companies like Medicity, for which it paid $500 million a few weeks back.

Sponsor Updates

• Orchestrate Healthcare aligns with L-3 Global Security & Engineering Solutions and its Ingia data translation platform to offer an HIE solution.
• 1450 is named the exclusive North American distributor of Frisbee, a transcription workflow system that routes physician dictation to a transcriptionist and then allows the final Dragon-generated and approved transcription to be sent directly to an EMR. The video demo is here. There’s an iPhone version, too.
• The Anson Group blog has a post called What The FDA Doesn’t (and Does) Regulate May Surprise You.
• Emergency department systems vendor EDIMS has a number of position openings: clinical site support specialist, project lead – application systems and data, senior interface analyst, and senior .NET developer..
• FormFast posts an article called Workflow Automation – Where to Start.
• MEDecision will showcase ACO and patient-centered medical homes technologies at HIMSS.
• Holon’s Central Order Entry Pharmacy medication management solution goes live at all facilities of Greenville Hospital System University Medical Center.
• Sentra Data Systems is attending the 340B Coalition Winter Conference in San Diego this week.
• Carefx and IBM will provide NHS trusts with a real-time patient portal for clinicians.

E-mail me.

Healthcare IT From the Investor’s Chair 2/4/11

Ask the Chair

Why does the financial community attend HIMSS?

The tickets are bought, the hotel rooms booked, and the excitement is near. Time to start the HIMSS prep. Inquiring minds want to know – what do members of the financial community do at HIMSS?

Yes, in addition to vendors and healthcare professionals, Orlando will be swarming with a bevy of equity research analysts, both those who follow stocks for money managers and for brokerage firms (aka buy-side and sell-side); investment bankers; venture capitalists (earlier-stage private investors); and private equity investors (later-stage private investors).

One might wonder. Why do they come? What do they do? What do they hope to get out of it? As with most conferences, the goal is a combination of market intelligence, networking, and seeking business opportunities. Let’s take each attendee group in turn.

When I was a sell-side analyst, I started attending HIMSS primarily to learn more about the sector and those who play in it. I still remember the great San Antonio registration system crash, in fact! Any analyst, buy- or sell-side, goes to major conferences to see products, talk to management of the companies they follow and, ideally, actually speak with users / customers to get information about a vendor’s products and prospects beyond what they hear simply from talking to company management.

As the sector got more interesting to investors, a number of companies started having actual analyst briefings at HIMSS where they could parade not only part of the management team, but often a happy customer or two. Several sell-side analysts (often working together) will host day-long tours, leading groups of investors from booth to booth where they can get personalized demos and presentations from management. The best analysts use this time to build relationships with companies and users to help them with later channel checks to see just how well a product or company is performing.

It’s a long day for the sell-side, with 7:00 AM analyst meetings and late-night receptions. Most then publish a research note (known as a FirstCall) to update their buy-side clients on what companies are doing (and how diligent the analyst is in reporting it).

When a company actually releases earnings during HIMSS, it’s particularly challenging to juggle. Some of my best conversations, however, were held in hotel bars in the wee hours with tipsy company employees. I met one high-profile CEO (whose company I later covered) at lunch near the exhibit floor. I had started chatting, thinking he was merely a young sales exec.

Investment bankers use HIMSS primarily to seek out new business. With all the CEOs in the sector in one place, it’s a highly target-rich environment. As I’ve observed about the recently concluded JP Morgan conference, it’s an ideal opportunity to get together, trade gossip, catch up on a company’s recent performance and goals, and brag about your firm’s recent activities. Not to mention hinting about some "big deals” you have in the market in the hopes of eliciting future transaction business (sales or capital raises).

It’s also a time when bankers can arrange meetings between their current clients for sale and potential buyers. At any given time in Orlando, look around and you’ll likely spot one (their Ferragamo, Hermes, or Burberry ties are a giveaway) looking frazzled and hurrying to their next meeting. Several firms (including my former one) actually spend the money for exhibit space. Why? Partially to demonstrate how seriously they take HCIT, but also to give them 24-hour access to the exhibit hall so they can meet whenever they want. It’s actually a huge time saver given that HIMSS (like Christmas) comes but once a year.

Investors, both venture and later stage, come to assess how their current portfolio companies are stacking up against their competitors and to learn more about the sector. More importantly, they come seeking "ideas", that is to say, investment opportunities.

Investors in both stages of companies will spend time on the exhibit floor, wandering around looking for companies with interesting products or prospects in the hopes of finding a quality (and ideally undiscovered) company which might need venture or expansion capital. In many cases they’ve made pre-arrangements to get demos and to chat. In others, they are simply hoping to broaden their network of potential companies and increase their understanding in general. Much like with the vendor / hospital dynamic, few checks get written at HIMSS, but the road to do so is more smoothly paved.

Ben Rooks is the founder of ST Advisors, a consultancy which has worked with dozens of HCIT companies and investors typically on issues around strategy, financing, and outcomes/exit planning. He has attended HIMSS as an analyst, a banker (albeit with no fancy tie), and on behalf of venture and private equity investors. He also looks forward to seeing everyone in a few weeks!

Blumenthal Resigns ONC Post

David Blumenthal, MD MPP has resigned his position as National Coordinator for Health Information Technology for the Department of Health and Human Services. He will leave office sometime in the spring to return to Harvard University.

Prior to his March 2009 appointment, Blumenthal was a practicing physician and Director of the Institute for Health Policy at Massachusetts General Hospital / Partners HealthCare System in Boston. He was also a professor of medicine and health care policy at Harvard Medical School.

News 2/4/11

From LaBido: “Re: Epic spinoffs. Spinoffs usually involve a better or new way of doing something. EHR vendors typically aren’t innovators of technology. They use someone else’s technology to develop an application. Given the complexity of developing a comprehensive system and the risk in  introducing it into a maturing marketplace, it’s not likely that there will be a lot of new entries in the EHR world. There will be opportunities for new niche systems as long as the major vendors lack the functionality, but I would suggest that most niches have been filled (other than those that don’t have a lot of funding for systems, e.g., home health care and assisted living facilities.)”

From Capezio: “Re: Epic. I recently left Epic. The non-compete prohibits former employees from working with Epic products or competitors for a year. This includes consulting for or working directly with Epic clients as well as for/with clients who use or are implementing Epic’s competing products. Many former Epic employees return to grad school or seek careers entirely different than what Epic offered. After being run into the ground with long hours and hectic travel schedules, the last thing many of us want is more of the same. Epic makes it hard to stay in the game, and hard to want to stay in the game.” Unverified.

From NomsDePlume261: “Re: Super Bowl ED usage.” Interesting – visits dropped to nearly none while the game was on. I’m sure business was good before and after with accidents caused by drinking, spousal beat-downs, heart attacks, and hot wings-induced choking.

Listening: new rootsy soul from Amos Lee with guests that include Lucinda Williams and Willie Nelson.

Humor me, OK? Drop your e-mail address in the no-spam Subscribe to Updates box to your right so I can tell you about stuff. If you’re a early adopter trying out that little site called Facebook, do some Friending of Inga, Jayne, and me and maybe toss in a Like for HIStalk. Click the nausea-inducing green Rumor Report box to your right and securely and anonymously send me news and rumors. And here’s a thought I had on the sponsor ads to your left: they are fun and cool like Twitter because the enforced brevity of the small rectangle tells you everything important in a quick glance, saving you hours of trying to figure it out from their more verbose Web pages, not to mention that those companies follow HIStalk and therefore share something in common with you and me. Thank you for reading.

I sent the e-mail blast about David Blumenthal’s resignation while thinking the obvious question: who’s going to replace him? I bet the snowed-in HIMSS people will be burning the midnight oil to strategize. TPD had interesting conjecture: Blumenthal’s brother Richard is the new Democratic senator from Connecticut (sworn in just four weeks ago) and maybe having a brother running ONC was going to be a political problem for him. Not to mention that the ONC job is a tough one that doesn’t pay a whole lot (despite handing out billions to everybody else) and draws a constant stream of venomous and mostly partisan criticism from politicians.

On the Sponsor Jobs Page: Healthcare Informatics Specialist, Epic Prelude and Resolute HB Consultants, Project Manager – Michigan. On Healthcare IT Jobs: Integration and Support Specialist, Health IT Manager, Application Services Programmer / Analyst, Epic ADT Consultants / Analysts.

Paul Merrywell is named VP/CIO of Mountain States Health Alliance (TN). He was formerly VP of IS of Mercy Health System. 

The HIStalkapalooza invitations haven’t been e-mailed yet, but they will be soon. We had a lot of sign-ups and will invite as many people as we can handle given the venue’s capacity. I always like to scan the job titles, which run something like this: 88 VPs, 72 presidents/CEOs, 26 CMIOs/CMOs, and 19 CIOs.

Speaking of the party, thanks to Medicomp Systems and COO Dave Lareau for not only paying for it, but also sponsoring both HIStalk and HIStalk Practice at the Platinum level. The Chantilly, VA company offers dynamic (non-template based) EMR tools that require minimal clinician training, powered by its MEDCIN clinical data engine, developed by founder Peter S. Goltra going back to the company’s founding in 1978. The company works with academic doctors from big-name hospitals and the DoD to continuously enhance MEDCIN and to develop new EMR offerings. Their product is used by 100,000 clinicians, requires less than four hours of training, handles codes for reimbursement and Meaningful Use, and provides real-time information and clinical decision support. CLINITALK converts voice to data for physician documentation and coding without typing or clicking, using the MEDCIN engine to present and collect patient care information. A new product will be announced sometime before HIMSS. Thanks to Medicomp Systems for sponsoring HIStalkapalooza, HIStalk, and HIStalk Practice. If you come to the event, say hi to Dave and thank him for putting together such a great evening for HIStalk and HIStalk Practice readers.

I said that this week’s statement from eHealth Initiative was predictable in urging House Republicans to not touch HITECH money. eHI sent me a clarification: their concern is that the legislation only goes after Meaningful Use incentive payments since that money isn’t yet committed. Funds for RECs, HIEs, job training, etc. are not being targeted, meaning that the government would have paid for infrastructure without having the carrot needed to get providers to use it for quality improvement.

A reader suggested looking into PCAST documents for evidence that Microsoft Chief Research and Strategy Officer Craig Mundie and other Microsoft-friendly participants may have steered the group to recommendations that favor the company (Amalga, HealthVault). I guess it’s possible, but hard to believe even for a cynic like me. I e-mailed PCAST asking for meeting minutes and got a reply from PCAST Executive Director Deborah Stine, PhD, who sent a link to the webcast page. Those probably won’t help. I don’t have much time or knowledge of government intricacies, so if you do and want to snoop around, let me know.

It always bugs me that the biggest, least-needy hospitals get throngs of deep-pocket donors. The latest example: Stanford Hospital, spending $2 billion for a new Taj Mahospital, gets $150 million from Apple, eBay, HP, Intuit, Intel, and Oracle. Donations always come with strings attached, at least in my hospital experience, so they’ll probably have to buy iPhones to keep Apple happy since Intel wouldn’t like an all-Mac shop. I still argue that since hospitals can’t distribute their big profits to shareholders since they supposedly have neither, their executives build monuments to themselves like Egyptian boy kings.

Mediware’s Q2 numbers: revenue up 22%, EPS $0.21 vs. $0.10 but $0.06 of that was due to a one-time tax benefit.

Healthcare billionaire Patrick Soon-Shiong, MD buys Boston-based Vitality, Inc., which developed the wirelessly enabled GlowCap medication reminder system for drugstore pill vials. I went to the mHealth Summit presentation of Vitality CEO David Rose this past November and was impressed enough to mention it on HIStalk.

Sad: a nursing home is banned by emergency order from accepting diabetic patients after killing a patient with a 100-fold overdose of insulin. Employees admitted that they didn’t have a clue how to manage the patient’s insulin pump, so a one-time IV dose of regular insulin 10 units was ordered. The nurse injected the entire 10 ml vial IV. Employees were even confused when reporting the error to the patient’s doctor, explaining that they had given 100 units of insulin instead of 1,000. You might be surprised that a nurse would not find a 10 ml insulin dose unreasonable, but not if you knew the caliber of nurses LTC facilities get given their low pay and bad working conditions.

E-mail me.

HERtalk by Inga

KLAS takes a look at Meditech consulting firms and finds the highest scores come from maxIT Healthcare customers. ACS ranks a close second, followed by Navin, Haffty & Associates, Dell, and CSC. KLAS also notes that Meditech customers are twice as likely to hire Meditech-focused consulting firms than those that advise on multiple vendor brands.

Also from KLAS: the adoption rate for surgery management solutions in hospitals is almost 90%. Hospitals are expanding their use of these systems beyond basic charting and scheduling and don’t necessarily feel pressed to implement a surgery system from their core EMR vendor. Unibased earned the highest customer ratings, followed by Epic and Meditech.

Ness County Hospital (KS), Tyler-Holmes Memorial Hospital (MS), and Beacham Memorial Hospital (MS) contract for ChartAccess EHR from Prognosis Health Information Systems. Prognosis says its revenues have grown 200% over the last year.

SCIOinspire acquires National Audit, a provider of claims auditing services.

Community Health Network of Central Florida and Parrish Medical Center implement MDI’s Viewpoint Analytics for data warehousing and healthcare analytics.

Parkview Health (IN) will install Zanett’s Clinical Online Delivery System software for order set management.

Chilmark Research investigates the HIE market in a new report, which includes analysis and rankings of 21 HIE vendors. Lead author and HIStalk friend John Moore forecasts more acquisitions in the HIE space over the next couple of years.

Nash Health Care Systems (NC) partners with TeleHealth Services for TeleHealth’s interaction patient education solution.

Nearly 60% of healthcare executives have HIE plans in the works and another 20% are in the pre-planning stage. Other findings from the same Beacon Partners survey: 1) a mere 5% of healthcare organizations say they have not applied for any federal or local grants; 2) over 40% of healthcare organizations plan to enhance their physician and patient portals; and 3) quality reporting is the top concern in hospitals’ efforts to achieve Meaningful Use.

The University of Iowa Hospitals and Clinics fires three employees after investigating the improper access of electronic medical records of 13 UI football players. Two additional employees will receive five-day unpaid suspensions.

AstraZeneca Pharmaceuticals and WellPoint subsidiary HealthCore are collaborating to determine the most effective and economical treatments for chronic diseases. Findings will be based on de-identified patient data collected from EHRs, WellPoint and BCBS insurance claims, and patient surveys.

On HIStalk Practice this week: physician-specific offerings at HIMSS. A low-cost concierge practice that accepts insurance. NCQA issues new PCMH standards that reinforce Meaningful Use incentives. Doctors want to share clinical data electronically with patients. And while you are visiting HIStalk Practice, be like all the cool kids and sign up for e-mail updates.

Starting salaries for female physicians average almost $17,000 less than those for men and the gap cannot be explained by specialty choice, practice setting, work hours, or other characteristics. One theory: women physicians seek greater flexibility and family-friendly benefits at the expense of a lower starting salary. The authors of this Health Affairs study do not rule out other potential explanations, including gender discrimination and that women are not as skilled as men at negotiating salaries.

E-mail Inga.

Sponsor Updates by DigitalBeanCounter

• Billian’s HEALTHDATA launches a new version of its Portal healthcare database that includes over 3,000 data points across more than 40,000 healthcare facilities.
• Design Clinicals releases version 5.0 of MedsTracker, which includes enhanced clinical decision support and meets nearly all Stage 1 criteria for Meaningful Use.
• Microsoft announces new encrypted e-mail functionality that will allow users of the Quest Diagnostic Care360 EHR to transmit clinical information directly to patients. An encrypted copy of a patient’s clinical data is also automatically saved to  patients’ HealthVault account.
• University of Washington Medicine chooses Hayes Management Consulting to provide strategic guidance to the organization.
• Eye Faculty Practice (NY) selects the SRS EHR for its 13-provider practice.
• Orion Health partners with Health Language, Inc. to imbed HLI’s Language Engine into the Orion Health HIE. The combined offering will facilitate data exchange by mapping data from disparate systems to standardized terminologies.
• The West Virginia HIT REC names Sage Healthcare a five-star vendor in its EHR Vendor Recognition Program.
• AT&T & Acuo Technologies announce a strategic alliance to develop vendor-neutral, cloud-based medical imaging storage solutions.
• NextGen announces that Palm Beach Orthopaedic Institute (PBOI) will leverage its revenue cycle management services.
• Charlotte Hungerford Hospital (CHH) selects MobileMD for its HIE and EHR.
• iSirona will participate in the Interoperability Showcase at HIMSS with its software-based medical device integration solution.
• Cooper Green Mercy Hospital (AL) selects Stockell Healthcare’s InsightCS patient access and revenue cycle management software solution

Dr. Gregg Goes to HIMSS
By Gregg Alexander

Reporting – 0, Blogging – 1

I have been given the unique opportunity of being a regular contributor to one of the components of THE industry standard “Healthcare IT News and Opinion” conglomerate, collectively known far and wide in HIT-dom as HIStalk. It is not a responsibility I take lightly.

On HIStalk Practice, the provider-focused offshoot of Big Daddy HIStalk, I have espoused both opinion and news. But to be honest, the news side of my offerings is miniscule in relation to the opinion side. I could never match the skill and wit which Mr. H and Inga bring to reporting healthcare IT news. “Damn it, I’m a doctor, Jim,” not a reporter.

That said, I am preparing to head off to HIMSS with a press pass courtesy of the inimitable Mr. H. Again, this is a responsibility I don’t take lightly. Thus listed with the HIMSS folks as a reporter (he said, using the term ever so lightly), it has been fascinating to see all of the reach-out from industry folks, mostly marketers, trying to get the word out about their product or about their “big announcement” at HIMSS or about their CEO’s scheduled talks, etc. Most have very much the same boilerplate look and feel as the majority of EHR products these days … and are about as inspiring as phlegm.

However, just as with EHRs, a few do stand out as different, as having something special to offer or a unique approach.(Extormity is not included in this assessment.)

One e-mail that particularly caught my eye recently was from a vendor who wrote, “I know you’ve blogged a lot about new EHR demos you’ve seen recently — all the innovations and disappointments, too — so I’ll try to spare you the hype….” Obviously this is someone who has taken the time to do some homework and/or is a regular HIStalk Practice reader. That is one request to which I wrote back immediately. (I hate hype and greatly appreciated the hype-sparing. Plus, I appreciate those who read the HIStalk sites.)

Another was from a “young company with a BIG story” who is taking on IT industry giants – and winning! As a trench grunt, I appreciate the little guy’s approach. They are another I answered quickly and have found very intriguing as I have begun to research their BIG story.

I’ll be providing more on stories that catch my eye or stimulate my curiosity, but please remember I’m from the opinion side; I’m a blogger, and perhaps most importantly, I look with the eyes of an end user. As an end user, I’m looking for that which gets my juices pumping and that which I think will do the same for my fellow providers. I look at the technology, sure, but perhaps just as important to me is the company behind the technology – the people, their philosophy, and how they interact with me and my fellow provider peeps.

I don’t even pretend to be dispassionate about this stuff. If I appear to show favoritism, well, maybe I do some. But, it is never because of kickbacks or payoffs. (Though I sometimes wish it were!) It is because I’ve met people and technologies who inspire my passion and I try to show that in what I write.

So, if while trying to report from HIMSS, my blogger/opinionator nature shows through, please understand. My roots are what they are.

From the trenches…

“Being a reporter is as much a diagnosis as a job description.” – Anna Quindlen

E-mail Gregg.

EPtalk by Dr. Jayne

Dear Dr. Jayne,

We’re a five-physician family practice and my doctors are balking at documenting in the room with the patient. My docs find it distracting and say they have to apologize for using the computer. They also spend too much time at the end of the day trying to finish their notes, or don’t finish them at all, which makes them cranky and causes issues with the revenue cycle.

Sincerely,
Kept Visits Seeking Charges

Dear Seeking,

There is an art to using the computer while seeing the patient. The provider’s ‘style’ of practice pre-EHR needs to be considered as they figure out how they are going to document. And the implementation teams and tech people need to be OK with it if not all providers document in the same way.

I tend to think about it this way: if users previously wrote in the paper chart while in the room, I encourage them to keep this workflow with the computer. They need to know their software well, though. If they are hunting through templates or pecking at the keyboard, it’s not going to flow.

If users didn’t write in the chart before, but instead went out into the hall to dictate, it’s easy to replicate that workflow as well, with workstations in a niche or cubby (provided there’s adequate privacy.) They still need hardware with them in the exam room, though, so they can reference the chart.

Seeing the patient with no computer is not OK. Providers who think they can remember everything about the patient without a chart are kidding themselves.

One exception is a situation where the provider talks to the patient first, then the patient changes clothes and the provider returns to do the exam, then the provider talks to the patient again after he/she dresses. It’s OK for the provider to not have access to the EHR during the exam as long as they have it during the rest of the visit. I provide this example for the non-clinical IT people because I said this once, and had a team member say they had a doctor with “dangerous” habits and this is what it turned out to be.

I do encourage everyone to do as much of their visit in the room with the patient as possible. At a minimum, reviewing the patient’s history and entering any prescriptions and patient assessment / plan information while they are face-to-face with the patient. It’s not just a matter of efficiency – it  also ensures that information is documented so that the patient can leave the office with a printed visit summary for those practices that are working to demonstrate Meaningful Use.

Regardless of the approach, providers need coaching on how to interact with the patient and still maintain eye contact and rapport. During implementation, consider using mock patients (a trainer or a staff member can play the role) and practice how they’re going to sit, how they interact with the computer and the patient, etc.

Finally, a word on typing skills. If your EHR requires providers to free-text, or if your providers plan on using a lot of it because they hate clicking, for everyone’s sanity, please go to Amazon.com and purchase a copy of Mavis Beacon Teaches Typing. The Deluxe edition is $17.95 and eligible for free super-saver shipping, for goodness sake. There are few things more painful than watching someone with a post-graduate degree two-finger type. It’s not confidence-inspiring. And for those providers who say they can’t learn, tell them that if they learned the Krebs Cycle they can learn to type.

Dr. Jayne

Dear Dr. Jayne,

We just signed with a vendor, and my docs are trying to figure out what kind of hardware to select. As pediatricians, is it better to go wireless? Desktops seem cheaper.

Sincerely,
Caring for Kiddos

Dear Kiddo,

When I work with offices that are converting from paper to EHR, I spend a lot of time talking the users through the different hardware options and letting them test drive different configurations whenever possible. Keeping technology from interfering isn’t difficult, but does take some thought.

Practices with “traditional” exam rooms are the most challenging – those where even in the paper world, if the physician tried to use the writing surface, they’d be facing away from the patient. Most of these users held the paper charts in their laps. This becomes hard to do if you’re trying to juggle a laptop or tablet, or … ahem, a paper chart and a computer during conversion.

Practices sometimes cite budget as a reason for not reconfiguring exam rooms, although modifications are probably cheaper than a dropped laptop. Modifying the space is also cheaper than neck pain, carpal tunnel, or other consequences of poor exam room design. I encourage people to think outside the box. Pull-down wall units or pull-out trays in cabinetry work great when tablets or laptops are in use.

When I work with new start-up practices, I try to be involved during the design of the office space so that these issues can be addressed early in the process. Unfortunately, a lot of architects are still cranking out the same tired old layouts and have no idea about wall mounted monitors or pop-up keyboard trays on swing arms.

When practices don’t choose to go wireless, I advocate the smallest hardware possible, mounted under a desk or on a wall so it doesn’t interfere with housekeeping or wind up being interfered with by pediatric patients or children accompanying patients. For monitors, go with the largest size that’s practical and affordable. Patients like looking at lab values or imaging studies and it helps reinforce the idea that they are part of their care.

Make sure your docs understand that whatever they decide, they’ll be using it for several years. This helps them focus on the decision if they are glassy-eyed by this part of the process. It also sets the stage for when you have to come back to them in two or three years and ask for budget for a hardware update.

One more thing: make sure that if they test drive hardware that they do it using EHR software they have selected. Solitaire and word processing look great on everything, but when they figure out the wide-aspect laptop they chose makes their EHR look horrid, you’re going to be the one they call.

Dr. Jayne

Have a question about medical informatics, electronic medical records, or what reflector thingies were actually used for? E-mail Dr. Jayne.

News 2/2/11

From Former CIO: “Re: PCAST report. It seems the PCAST report has been glossed over or dismissed as a bunch of government mumbo jumbo. The HIMSS response is once again laden with not-so-hidden vendor protection. This blog note hits the nail on the head.” Vince Kuraitis describes the organizational reaction to the PCAST report, which basically says we’re going in the wrong direction with today’s HIT systems. Those criticizing its conclusions include the usual turf-protectors: HIMSS, EHRA, AHA, FAH, RSNA/ACR, and IHE. I realized that I hadn’t provided highlights of the PCAST report, so scroll down for my summary and you’ll see why those groups don’t care much for the recommendations.

From AZ: “Re: MyChart. Tucson Medical Center has launched it for Saguaro Physicians along with Epic’s MyChart Mobile App.” Unverified.

From Dolphins Fan: “Re: Epic. There aren’t many spinoffs in the Madison area. Either they retain top talent, people leave Madison to start their businesses, or they have one hell of a non-compete.”

Speaking of unsurprising reaction to political events, eHealth Initiative releases a statement (I don’t have a link) urging that House Republicans keep the HITECH feed trough full instead of exercising fiscal responsibility. “We realize that the Spending Reduction Act represents a principled stand against government spending, but we would encourage Members of Congress to not use the HITECH Act or any of its provisions as a target, as that will only create further uncertainty in the health care sector. Any attempt to repeal funding for health information technology would have severely negative effects on public and private progress now and in coming years.”

Management changes at enterprise visibility vendor Intelligent InSites: president and CEO Mark Rheault resigns and the majority owner, an investment company, puts one of its people in the interim role until a successor is found. That guy is Doug Burgum, who took over Great Plains Software years ago and arranged its acquisition by Microsoft.

Thanks to Iatric Systems of Boxford, MA, joining HIStalk as a Gold Sponsor. The 20-year-old company has provided applications, interfaces and reporting solutions to over 900 hospitals (especially Meditech), has been recognized as one of the country’s fastest-growing companies, and has been named one of the top 100 businesses in the Boston area. Check out their YouTube channel, which features an interview with Denni McColm, CIO of Citizens Memorial Hospital (Stage 7 EMRAM, putting the tiny hospital in elite company), which used Iatric to integrate their Meditech systems with Google Health and a patient portal. They’ll be at HIMSS talking about interoperability, so plan to drop by, say hi, and thank them for supporting HIStalk. And of course for doing the cool HITECH Train parody video.

McKesson announces Q3 numbers: revenue flat, EPS $0.60 vs. $1.19. The company set aside $0.52 per share as a one-time expense for its continuing fight against drug Average Wholesale Price lawsuits that have already cost it a fortune. Without that charge, earnings would have been down but would have hit estimates and the company raised guidance for the fiscal year. Technology Solutions revenue was up 2%, but software revenue was down 2%. Still, that division made $106 million. It had $1.3 billion in unrecognized revenue, which could be great (lots of money coming) or terrible (it hasn’t been recognized because customer contract terms haven’t been met).

The McKesson conference transcript is here. John Hammergren says he doesn’t think ARRA money will be pulled out even if healthcare reform is successfully challenged, but that it doesn’t really matter at this point since customers are already committed.

HIMSS announces the recipients of its clinician IT leadership awards: Liz Johnson RN, VP of applied clinical informatics at Tenet (the announcement calls it “Tenant”) and Michael Zaroukian MD PhD, CMIO at Michigan State University. 

A hospital in Australia doubles its eye tissue donations by monitoring the outbound ADT messages of hospitals to see if any designated donors have died, allowing tissue banks to be immediately notified. The application was built using InterSystems Ensemble.

We sometimes do interviews on HIStech Report when companies want to use the final product in handouts or downloads. I recently interviewed Mitchell Goldburgh from image management vendor InSite One, just acquired by Dell.

Weird News Andy fingers those Down Under: an upcoming journal article finds that Australian medical students are performing exams (genital, rectal, and breast) on unconscious hospitalized patients who have not been asked for consent.

Open source EMR vendor Tolven gets profiled in an article covering venture capital in California. British publisher Elsevier gave the company $3.6 million from its venture fund. The article says the company had $1 million in sales in 2010 and expects $2.5 million this year.

The regular company e-mail from Kaiser Permanente CEO George Halvorson has some interesting 2010 numbers: members logged in to its site 62 million times to get information, patients viewed 25 million lab tests online, doctors conducted 10 million secure message based e-visits, patients had 8 million electronic prescription refills, and 2 million visits were scheduled electronically. He concludes that people want online convenience instead of driving and telephone.

Wolters Kluwers Health is supporting HIStalk as a Platinum Sponsor, so thanks very much to them. The company has quite a lineup of clinician-familiar names: Facts & Comparisons and Medi-Span (drug references and databases); the ProVation ClinicNote custom content and documentation solution for EMR vendors; ProVation EHR for ambulatory surgery centers; ProVation MD for clinician procedure documentation; ProVation Multicaregiver perioperative documentation system with monitor interfaces; ProVation Order Sets, powered by UpToDate Decision Support for CPOE and paper order sets; and the fabulous UpToDate evidence-based clinical decision support system. Clinical content and order sets are important for improving outcomes and meeting Meaningful Use EMR requirements, so give them a look. Thanks to Wolters Kluwer Health for supporting HIStalk. 

This happens all the time: a treatment assistant making $62,000 per year racks up $1 million in overtime pay over 12 years, making the state employee eligible for a pension (if you don’t work for government, you’ll probably have to look up the definition of that word) that will pay 50% more per year than he makes working. 

E-mail me.

PCAST Report Summary

This report was commissioned by the President and created by his Council of Advisors on Science and Technology (real scientists, not vendor people, HIMSS puppets, or the usual talking heads).

Healthcare IT’s potential:

• Integrate technology into practice without forcing doctors to perform data entry
• Provide clinicians with complete information at the time of decision making
• Get patients involved in their care
• Enable public health monitoring
• Speed up clinical trials
• Reduce administrative overhead
• Create jobs
• Support healthcare reform

But it isn’t working:

• 80% of physicians in practice still don’t us even a primitive EMR and interoperability is poor
• Need to take advantage of the network effect, which would require universal data exchange standards
• As a result, the market for new HIT-based products and services is underdeveloped
• Systems are proprietary, don’t work well with physician workflow, and weren’t built to exchange data in non-proprietary formats
• EHR users see their systems as purely internal – they have no incentive to open them up to patients, competing providers, or research organizations
• Privacy concerns are common
• Incentives are misaligned, so the only good reason to invest in HIT is if it improves administrative efficiency

Conclusions:

• Goals can’t be met with the modest interoperability requirements of HITCH and certification
• Putting more non-interoperable EMRs out there via HITECH will just make the problem worse
• Need a universal exchange language – tagged data elements (similar to XML – CDA is an example).
• Cost to develop the universal exchange language would be $20 to $40 million and the cost to vendors would either be a  5-10% increase in EHR cost or a one-time expense of $5-$20 million per vendor
• ONC and CMS need to step up the interoperability game for the 2013 and 2015 Meaningful Use requirements
• Services should be created to send and receive tagged data elements, which would eliminate the need to repose data in a national database
• The universal exchange language would open up markets for new tools and services, improve privacy, eliminate the need for a national patient identifier, and facilitate public health
• HIT is a mix of "the good, the bad, and the ugly"

Also:

• CMS itself has outdated systems and lack of internal knowledge about information exchange and replacement system proposals are just as inflexible (doctors have to submit data twice, for example, once to get paid and once for quality incentives)
• HIE progress is being slowed down by the complexity of developing their member agreements, the lack of financial incentive to improve outcomes, and their unclear capability to scale
• HIEs are "ill-suited as the basis for a national health information architecture" and only a handful have gone beyond the pilot stage once their initial grant money was spent
• Middleware that can extract information from proprietary EHR databases can help (dbMotion, ICA CareAlign, Medicity MediTrust, Microsoft Amalga, Oracle HTB, Orion Health)
• Examples of successful EHR adoption are VA and Kaiser, but even they can’t exchange information outside their organizations and since they are closed systems, they don’t create a market for innovation
• The problem with today’s EHRs: they don’t make the physician’s job easier and force doctors to type in their own information
• EHRs were built to look like electronic versions of paper forms without the involvement of usability experts, so they don’t provide much decision support
• Errors in diagnosis may be far more common than errors in treatment and EHRs don’t help much with that
• Quality measures are too specific and focus on medicine’s traditional emphasis on treating illness rather than coordinating care and maintaining health
• EHRs were built around billing codes, which don’t provide a patient-centered and historical view

Recommendations:

• Federal CTO Aneesh Chopra should within 12 months produce metrics to measure progress toward a national healthcare infrastructure, including pilots, and assess yearly
• ONC should require metadata-tagged data elements to meet 2013 MU requirements, publish standards for services that can access patient data, and work with the Small Business Administration to develop companies that could offer cloud-based services to small physician practices, LTFs, and hospitals
• CMS should move away from collecting data relating to lists of health measures and move toward higher levels of information exchange and clinical decision support
• AHRQ should be given funding to develop a test network for comparative effectiveness research and give medical researchers access to de-identified, near real-time data using data element access services
  

HERtalk by Inga

From Sales Professional: “Re: commissions. Every HIS vendor I’ve worked for (SMS, Data General, TSI, IMS, Eclipsys, HMS, McKesson, AGFA, and Keane) had commission plans that tied payments divided just as the license fees, i.e. you get your money when the client pays his bill. Albeit ‘golden handcuffs’ for the rep, this did link incentives for the rep to selling business that the company could install and get paid for. SMS, I believe, started this in the early ‘80s after a few reps got paid huge commissions and SMS could not deliver. After Sarbanes-Oxley, a lot of the bigger companies claim they need payment terms that the GAAP accounting rules can recognize, and most claim that a ‘holdback’ for post-live payments is NOT a bookable revenue item for them.”

DiagnosisOne appoints Kenneth W. Kizer, MD, MPH to its board of directors. He is former president and CEO of Medsphere Systems, the founding president and CEO of the National Quality Forum, and a former Under Secretary for Health for the VA.

Mediware Information Systems posts its Q2 numbers: net income of $1.73 million, compared to last year’s $783K; revenue of $13.2 million versus $10.8 million.

The board of directors of Harrison Medical Center (WA) approves a $7.6 million, 10,000 square foot data center to support the medical center’s new EMR (Allscripts Sunrise, I believe).

Venture capital investment for medical software and information services grew from $387.5 million in 2009 to $460 million in 2010. That’s a 19% increase.

NCH Healthcare System (FL) anticipates earning $11 million for its meaningful use of (Cerner’s) EHR.

Awarepoint says that 91 hospital sites contracted for Awarepoint’s RTLS products in 2010, a 30% increase over 2009. In addition, annual revenue growth exceeded 100%.

Newark Beth Israel Medical Center (NJ) licenses Meta Health Technology’s electronic clinical documentation improvement software.

The University of Texas MD Anderson Cancer Center purchases Carestream Health’s RIS system.

Streamline Health Solutions appoints Robert Watson as president and CEO, replacing founder and president/CEO J. Brian Patsy. Patsy retired at the request of the board and also resigned as a company director. Watson is the former president and CEO of DocuSys.

CareFusion names Kieran T. Gallahue chairman and CEO, replacing the retiring David L. Schlotterbeck. Gallahue was most recently president and CEO of ResMed.

Harold J. Apple takes over as CEO and president of the Indiana HIE. The HIE’s founding president and CEO J. Marc Overhage will remain on board as chief strategic office and national policy advisor. Apple is the former majority owner, CEO, and president of Vector Technologies.

Fifteen California hospitals adopt InQuickER, which facilities patient appointment scheduling for emergency rooms. Patients wanting to reserve a time in the ER typically pay a $15 to $25 premium for the service. At Lakewood Regional, the hospital pays $3,000 for the InQuick ER  service and charges patients $15 to schedule an appointment. Lakewood’s ER sets aside only one appointment per hour and patients must reserve their spot at least two hours in advance.

Speaking of ERs: between 2003 and 2008, the rate of ER visits in the US exceeded rates in both England and Canada.

OMG. It’s February and I am leaving for Orlando in 19 days. So much to do beforehand! I shared with Mr. H (who couldn’t even feign excitement) that I bought a new dress for HIStalkapalooza, but am still pondering over the shoe selection. Truth be told, I am afraid I’ll be “outed” if I were to were the fab shoes that would really make the ensemble. I am hoping that others attending will take their fashion selections as seriously as I am, especially since this year there are prizes involved. So ladies, find your best shoes and a sassy cocktail dress. And guys: women drool over men in tuxes, especially when the IngaTinis are flowing. And, keep in mind that it’s hard to look hot when you are wearing a shirt that screams your company’s name. Just sayin’.

Versus Technology introduces Enterprise View Mobile for use on the iPhone, iPod Touch, and iPad. The free application gives users access to patient, staff, and equipment locations on mobile devices.

Former Cerner COO Paul Black joins the board of Netsmart Technologies.

Poudre Valley Health System CIO Russ Branzell tells the local press that PVHS will spend between $30 and $40 million on its EHR investment (Meditech). He also admits that their EHR stimulus reimbursement will be “nowhere close to the investment we put in.”

E-mail Inga.

Sponsor Updates by DigitalBeanCounter

• Denver Health engages MEDSEEK to develop and deploy its new patient portal.
• T-Systems and Medicity separately announce the successful validation of their interoperability expertise at the recent North America Connectathon.
• DIVURGENT managing partner Colin Konschak co-authored the recently published book, Accountable Care Organizations: A Roadmap for Success. Guidance on First Steps.
• CynergisTek announces that its revenues grew 33% in 2010, which included a 10% jump in existing client revenues. New client revenues accounted for 48% of 2010 revenue growth and technology partner solutions revenues grew 265% over 2009 performance, accounting for 50% of total revenues.
• Janet Dillione, EVP & General Manager of Nuance Communication’s Health Care Divison, is featured in this week’s Forbes technology section.
• Several EHR vendors, including NextGen and eClinicalWorks, are mentioned in an Information Week healthcare article titled How 7 Vendors of EHR Systems Measure Up.
• Design Clinicals announces its contract with St. Patrick Hospital and Health Sciences Center (MT), where it will implement MedsTracker for medication reconciliation.
• Florida Hospital Celebration Health chooses the interactive patient care solution of GetWellNetwork.
• API Healthcare announces the release of API Healthcare Syngergy, a workforce management solution.
• Forest Park Medical Center (TX) chooses Access Intelligent Forms Suite to replace pre-printed forms with on-demand e-forms that include printed and barcoded Meditech data.
• St. Joseph Medical Center (MD) selects Provation MD for gastroenterology procedure documentation and coding.
• Florida Academy of Family Physicians recommends Ingenix CareTracker to its members.
• MEDSEEK will develop and deploy Denver health’s new patient portal.

EPtalk by Dr. Jayne

What a difference a year makes! This week, I spent time with a family member in a hospital across town, which incidentally has a large integrated clinical system different from my own. I was last there with another family member about a year ago, not long after the hospital went live.

At that point, the staff was still fairly hostile and frustrated, having just come off of weeks of training and feeling very stressed. Knowing that I work for a competitor hospital, and knowing what I do, many of them went out of their way last year to tell me how much they hated the system. This week was the completely opposite side of the pendulum. No one was saying anything about the system. I was puzzled: could it really be that good? Or had they just all been assimilated?

Being the investigator I am (probably watched too many episodes of “Quincy, M.E.” as a kid) I “accidentally” left my name badge from Enemy Hospital on my collar the next day, to see if anyone took the bait. Nothing. Finally, I asked the nursing staff what they thought. Had they reached Nirvana? Had all the issues been fixed?

The answers I received were what could only be described as a completely mixed bag. Although some of them feel that the system has changed for the better, others still perceive it to be largely the same as it was a year ago, but they’ve learned to use it as a patient care tool like any other. One self-aware nurse commented that she didn’t really hate the system at first, it was just the idea of it, and it wasn’t worth the energy to keep complaining about it.

That’s the central challenge of most of us that are in the implementation and support business have to figure out – how to determine which users are going to be like that nurse gradually accepting the system vs. which users are going to rage against it regardless. This is the magic of figuring out which of the 20% of users will ultimately need 80% of your attention, and finding a way to help them adjust.

One thing I found interesting about the experience was that only the health system-owned primary care practices are on the system, and they have no health information exchange with their community and subspecialty docs. The specialty physician caring for my relative walked in with a (gasp!) paper chart from his office, after walking it out the door and across the campus, sans audit trail, sans security, and with wild abandon.

After I recovered from the delirious thought that it would probably spend the night in the trunk of his car, mingling with other deviant charts, I asked him why he was still on paper and whether they planned to switch any time soon. It turns out they are, having finally succumbed to being purchased by the health system after a protracted battle with one of their major insurers.

It will be interesting to see how much difference the next year makes for them. They are not only losing their autonomy to a major health system (and boy, do I wish my system had snapped them up instead — his group is incredibly fun at parties) but also giving up their paper. Theirs is just one of thousands of practices that will go through one or both of those transitions in the next several years as Meaningful Use unfolds. I’m sure I’ll be offering them a shoulder to cry on at some point.

Speaking of crying, those were tears of joy as I responded to a deluge of Facebook friend requests last week. I was starting to have a bit of the winter hum-drums, but my new BFFs seem to be extremely entertaining. I also heard from the team at NextGen, vendor of the system used by my not-so-secret crush, Dr. Robert Murry. They’ve offered to put us in touch. Do I sense an interview in my future?

I’ve received several great “Dear Dr. Jayne” questions this week, but I am holding out for something sassy, so feel free to send those deep, dark questions my way!

Have a question about medical informatics, electronic medical records, or whether nurses ever yell at doctors? E-mail Dr. Jayne.

Monday Morning Update 1/31/11

From Expandable Beltway: “Re: VA. Opens a solicitation for VistA.” I skimmed the document – the VA is looking for help to define an open source structure to support VistA modernization. I don’t know if they’ve ditched their previous plans to buy commercial systems like Cerner’s LIS.

From Epic Employee: “Re: Epic. If you’re a star, you’ll go far. If you’re not a star, you won’t. It’s like a professional sports team – you grab the best college recruits and some work out, some get cut. You are compensated based on your talent, so your subordinates may out-earn you if they’re better at what they do than you are at what you do. You don’t have to be CxO to be financially set. If you need a manager to succeed, you won’t like it here.”

From Merger Pain: “Re: Allscripts. Over 30 sales reps let go this week.” Unverified.

From Philly BlackBerry: “Re: widespread e-mail outage Saturday morning. RIM is not commenting.”

From Lupus: “Re: sponsors. Why do you have so many?” I freely admit that I’m an incompetent, unmotivated, and staggeringly lucky accidental businessperson who just wanted to write work-related stuff for fun back in 2003. I expend zero effort to solicit sponsors. I’ll reply tersely to e-mail inquiries from vendors and the always-nice ad agency and marketing people, but replying to the e-mails is all I’ll do. Every other HIT-related blog you read is written by someone trying to sell something – consulting services, EMRs, conferences, speaking engagements, etc. I’m a money-indifferent guy who’s happy working full time for a non-profit hospital. If I get sponsors, great, I get paid for the endless hours I spend on HIStalk. If not, that’s fine since that was the case for much of HIStalk’s eight-year existence and my hospital job ensures that I won’t starve anyway. I like staying anonymous because it keeps me honest: you can’t get too full of yourself if nobody knows who you are. My About page explains everything.

From The PACS Designer: “Re: cloud basics. FedEx CIO Rob Carter explains cloud basics and how FedEx deploys a private cloud solution to run the giant package distribution system. He explains the cost advantage of private clouds this way: ‘What’s happening, and this is such a big deal in our world, is that for the first time ever, you can make investments in a whole new class of technology for about the same price of just maintaining the base.’ This cost advantage is something to think about in the effort to employ cloud solutions in healthcare settings.”

Thanks to everyone who signed up for the “I want to come” list for HIStalkapalooza. The page has been turned off since it was scheduled to run for a week. I haven’t checked the count to see if we can accommodate everyone, but I’m hoping we can, and anyone we can’t will go on the waitlist in case someone cancels. We’ll be sending out e-mail invitations soon. It’s only three weeks away, as I just now realized in near-panic as I think about all the HIMSS-related stuff Inga and I have to do between now and then. I should take a week off from work just to catch up.

Here’s the HIStalkapalooza agenda for those who need to plan their existence down to the minute. Doors will open at 6:30, starting with red carpet interviews streamed to a big screen on stage (it’s a “big entrance” kind of thing that I thought would be fun, but you can bypass straight to the bar if you’d rather). Eating and drinking commences, with IngaTinis in abundance and beauty queen sashes strutted by a chosen few. The video and photo crews will be plying their trade and I’ll have a roving reporter inside BB King’s covering the event for summarization in HIStalk afterward. The official welcome comes at 8:00, followed by Jonathan Bush and the HISsies awards (special guests are always possible, but I usually get a polite “no thanks” when I ask, so don’t count on it). We’ll have a short HIStalk Queen and King contest with voting by applause (like high school, winners will be chosen based on fashion, poise, and willingness to pander shamelessly to the audience). Inga’s BFFs will choose the “Inga Loves My Shoes” winners while most of the men head off for another beer. Our super sponsor, Medicomp, will offer up some doctor recognition at 9:00. At 9:10, the Insomniacs concert starts, running until 11:30, with food and drink available most of the evening if I remember correctly. Dancing will be encouraged by our HIStalk ambassadors, the band, and the open bar. Inga, Dr. Jayne, and I will probably be in anonymous attendance, overwhelmed and schizophrenic (am I me or Mr. H?) Everybody who works hard all year deserves a little bit of silliness and entertainment and that’s what we’re offering (but I bet that as in past years, important contacts will be made and deals will be struck by high-powered attendees hammered on IngaTinis).

A Weird News Andy graphic moment, in the form of a patient instructions handout.

Listening: Tiamat, because sometimes you need a little depressing Swedish doom metal (Pink Floyd meets Metallica) to brighten up your day. It’s good.

A reader tells me those Extormity EHR parody people will be unveiling themselves at HIMSS, revealing themselves to be sellers of some flavor of PM/EMR. I’d scoop them by announcing it here except I have no idea who they are.

These poll results confirm what people are telling me (not that I didn’t already know since recruiters are burning up my phone and e-mail at the hospital): it’s getting tough to find experienced HIT people. New poll to your right: how many hours per week do you work? I’m curious since the comments from Epic’s employees seemed to raise some curiosity. The poll accepts comments, so add yours if you like. 

Quality Systems, Inc. (the NextGen people) turns in record Q3 numbers: revenue up 23% to $91.9 million, EPS $0.60 vs. $0.46, expectations beaten, dividend raised. Board chair, founder, and former CEO Sheldon Razin holds almost $400 million worth of shares. He started the company in his garage in 1973 with $2,000 in capital and took it public in 1982. Its market cap is now over $2 billion.

I’m happy to announce Symantec as a new Platinum Sponsor of HIStalk. Everybody knows Symantec for their security products (Norton, Ghost, pcAnywhere, Veritas, etc.) but I’ll call your attention to Symantec Health. They offer Symantec Health Safe, a medical image archiving and sharing service designed to complement existing medical imaging infrastructure. Per-TB Storage costs are reduced since you pay for only the capacity you use with no upfront capital expense or data center operating expenses, lowering the total cost of image archiving by 25 to 50%  or even more. Images can be retrieved directly to PACS and shared securely online with any other provider. The trusted leader in online security is offering a free cost savings analysis. Thanks to Symantec for supporting HIStalk.

If you’re interested in more than my brief explanation of Symantec Health Safe, I found the above video on YouTube.

David Darnell, a 39-year-old VP with healthcare data analytics vendor MDI Holdings of Ponte Vedra, FL, died Thursday in car accident. He is survived by his wife and four children ages 1 to 7. Condolences.

UPMC’s insurance division forms a joint venture with UK company Ultrasis to create a US version of that company’s Beating the Blues online CBT (Cognitive Behavioral Therapy) patient tool for treating depression.

University of Iowa Hospitals opens an investigation after determining that the electronic medical records of 13 University of Iowa football players may have been inappropriately accessed. The hospitalized players have been diagnosed with rhabdomyolysis, a kidney-damaging condition caused by damaged muscle and sometimes by nutritional supplements. The university has also launched a separate investigation into the football program’s off-season workouts, which started last week.

The Methodist Hospital (TX) opens a 35,000 square foot simulation-based surgical training center that will teach physicians to use technology such as image-guided procedures and robotic surgery. One tool uses a thermal camera to determine a student’s surgical expertise.

An interventional radiologist who patented the idea behind drug-eluting stents while a medical resident in 1993 is awarded $482 million in his suit claiming that Cordis stole his idea and made $13 billion from it. Bruce Saffran, MD PhD had already settled with Boston Scientific for $50 million after winning a $431 million judgment against that company three years ago.

Mobile drug reference vendor Epocrates plans an IPO next week valued at around $50 million.

I appreciate and acknowledge the support of Perceptive Software of Shawnee, KS, a new HIStalk Platinum Sponsor. The company offers the ImageNow document management, imaging, and workflow solution that ties unstructured documents to the EMR and streamlines paper processes and workflow. The benefit: a comprehensive, hybrid patient record that improves care by offering immediate access to content, provides secure access, reduces the cost and space requirements inherent with paper, and quick implementation. It integrates with any HIT system including those from Meditech, Epic, Cerner, Allscripts / Eclipsys, Lawson, and Oracle. There’s an overview demo series here and they’ll send you a copy of The Top 10 Things You’ll Save with ECM if you mention HIStalk (or if you don’t, for that matter, but maybe I’ll score points with them if you do). Thanks to Perceptive Software for supporting what I do.

Above is video I found on Perceptive Software’s healthcare solutions. It’s just some real-life customers (North Kansas City Hospital, Asante Health System, Citizens Memorial Health) talking in a seemingly unscripted way about how they’re using the ImageNow solution.

Digital Prospectors Corp. of Exeter, NH is supporting HIStalk as a Gold Sponsor and we appreciate that very much. DPC is a fast-growing boutique consulting firm whose healthcare division provides consultants and direct-hire candidates for all areas of HIT, including experts in Cerner, Allscripts / Eclipsys, Epic, McKesson, Lawson, and Quovadx. The company has won several awards (Inc. 5000, top woman-owned business, best places to work) since its founding in 1999. I found a nice profile of the company in a local publication here and also its Facebook page. You can also check out their open positions. Thanks to Digital Prospectors Corp. for supporting HIStalk.

Awarepoint’s 2010 results include 91 hospitals contracted for its RTLS solutions (up 30%) and revenue up over 100% for the third straight year.

Bizarre: a pregnant woman that her husband has impregnated his mistress as well. She decides to kill the mistress’s baby, forging a doctor’s prescription for Cytotec, an ulcer drug that also causes abortions, and calls the woman pretending to be the doctor’s employee and tells her take the medication to protect the unborn baby against Down syndrome. The mistress takes the Cytotec, sending her into immediate labor, but the baby survives in the hospital. The wife then sends a male friend to the hospital with two bottles of poisoned baby milk, which suspicious staff refuse to pass along. Somewhere along the way, the wife pretends to be a hospital executive in an attempt to get the baby’s ventilator turned off. Says her lawyer, “My client was in the last trimester of her pregnancy and was acting irrationally.” The jury didn’t buy it: she’s going to prison for four years. I’m sure she’ll make a stellar mom.

E-mail me.

News 1/28/11

From Whillikers: “Re: vendor receiving a percentage of a hospital’s stimulus money. I don’t see this as necessarily wrong. We don’t know how the contract was worded – perhaps the vendor is sharing risk and reduced license and support fees in return for helping the hospital earn the incentive money, or maybe even faced penalties if they didn’t achieve Meaningful Use.”

From Arliss: “Re: managers not knowing what their employees make. I’ve worked in several large companies over many years and rarely knew what my reports made. Does it really make a difference? Middle management is middle management, sometimes just to manage process that happen to include certain assets called people.” I don’t know if it’s necessary to know, but you’d need a much better appraisal / rating system than places I’ve worked to take that out of the hands of managers. Epic supposedly fires the bottom 25% of its staff each year according to some of the comments I’ve seen, so I’m sure they do have such a rigorous rating system.

From Sporting Group: “Re: mobile app that rocks. Very cool development for first responders. I remember when this was an idea … how to locate AEDs and identify those with CPR training when someone drops with an MI.” The iPhone app, called Fire Department, asks when you first launch it if you’re trained in CPR and would be willing to help a stranger in need. When 911 gets an emergency call, the operator can send a push notification to those volunteers who are near the location, also telling them where the nearest automated defibrillator is. That’s brilliant if you ask me. As screwed up as America seems to be at times, its citizens will usually do anything they can to help someone in need.

From 70HourWeek: “Re: Epic work week. The long hours aren’t unique to Epic. I work 50 hours on a slow week. That doesn’t mean I like it, but our systems are constantly changing and our facilities are 24×7. Where we could improve is to recognize what we do and adopt truly alternative schedules and options to work from home. We all work long hours and are lucky if enlightened managers recognize the need for work-life balance. Epic does have a reputation for favoring young employees, which saddens me both that it exploits new hires right out of college as that it will eventually catch up with Epic.” I don’t disagree, except I’m always skeptical when someone claims consensual exploitation.

From InDenial: “Re: Epic. I keep reading that they set their price and don’t negotiate, but that’s not entirely accurate. I was previously with a large health system and Epic was definitely negotiating with us against their competitors. They didn’t get down the level of discount the others were offering, but they did make an aggressive offer that was much different from their initial proposal.” Unverified.

From Nasty Parts: “Re: eCW not paying commissions. Not true. HIStalk has a responsibility to publish facts and retract inaccuracies.” That statement, just like yours, came from a reader. I don’t claim that reader comments that I run, including yours, are 100% accurate, although they often are. In this case, Inga had confirmed with eCW, who told her that they do indeed not pay commissions, so I ran the item without tagging it as unverified. Several readers sent details indicating otherwise (such as precise commission percentages and specific salesperson income). Inga forwarded that to eCW, who then amended their previous statement to say that the company does indeed pay a few salespeople commissions (I didn’t understand or really care from their explanation which ones get commissions and which ones don’t). I believe I met the test of prudence in obtaining verification, even though it turned out to be incorrect.

From Natty Boh: “Re: Epic employee comments about hours, management, obsolete technologies, and lack of credentials to work elsewhere. How funny – this is EXACTLY what Cerner associates say as well, all except the ‘experienced Cerner resources are hard to find due to selling more big sites’ part).” I tried not to conclude from all the complaining that the upcoming generation of US workers are the marginally motivated, Facebook-obsessed, self-absorbed children of excessive privilege, instead choosing to believe that they’re doing exactly what I and everybody else should have done decades ago in refusing to sell one’s soul to an employer who sneers at paying 40 hours’ worth of salary for 40 hours’ worth of work. Sometimes all of that extra effort pays off, but generally you’re going to end up bitter after being stabbed in the back by someone with better connections, passed over in favor of a co-worker with less distaste for shameless up-sucking, or clueless management. Like the old saying goes, nobody’s epitaph brags on how many hours they spent at work.

Want to come to the HIStalk reception (aka HIStalkapalooza) at the HIMSS conference? Sign up now on the “I want to come” page since it will be turned off in a couple of days. People e-mail me every year after the fact claiming they didn’t know about the sign-up, which tells me right away they don’t really read HIStalk very carefully since I make a big deal out of it for precisely that reason. I can only reiterate: if you want to come, sign up right now, please. I’m especially reaching out to providers, who often get lost in the shuffle among all the vendors who attend – if you are a doctor, nurse, CIO, programmer, help desk tech, field support analyst, professor, or whatever you do for a hospital, clinic, practice, university, or agency, I will do everything I can to get you an invitation, which is why I changed the sign-up process. I’m not prone to hyperbole, so believe it when I tell you that it’s going to be the talk of HIMSS.

Listening: new from The Script, Ireland-based alt-pop. You’ve heard them but just don’t know it: play Breakeven on their MySpace page. It’s a little soft for me, but it’s pretty good and the new album is better.

CareTech Solutions opens a new $5 million, 30,000 square foot operations center and technology hub in Troy, MI to handle its growing business. The company has 1,100 employees, hired 200 in 2010, says it will hire more than that in 2011, serves 155 hospital customers, and expects to quadruple its business in the next three years.

EXR, the enterprise EHR from Reliance Software Systems (aka RelWare), is certified as a complete inpatient EHR and a module outpatient EHR by InfoGard. I don’t have a link, but friend of HIStalk Dann Lemerand sent over the press release. Dann started the HIStalk Fan Club on LinkedIn that’s now up to 1,328 members. I’m slightly embarrassed by having a fan club, but I can tell you without hesitation that it provides a psychological boost when I’m having a crappy day (which is thankfully rare since I have perpetually low expectations). I also admit that when someone wants a favor from me while claiming undying devotion, I often make less of an effort if they aren’t members.

Among the listings on the HIStalk Jobs Page: VP of Sales Central Region, Vendor Partner Product Executive, RVP Sales – Southeast Territory, Meditech ADM B/AR Sr. Consultant. On Healthcare ITJobs: Epic Cadence Application Coordinator, Pharmacy Informatics Specialist, Clinical Data Analyst, Epic ADT Consultants / Analysts. Lots of good jobs there from Vitalize, Marshfield Clinic, Joint Commission, Olympus, Ivesia, and other companies.

Ryann Winn, former IT director at Munson Health (MI), is named VP/CIO of MidMichigan Health.

CPSI’s Q4 numbers: revenue up 28%, EPS $0.61 vs $0.33, beating the bejesus out of consensus estimates of $0.43. The company also declared a dividend, although one might argue that in the rapidly growing HIT sector they might have been better off using the money to grow or acquire instead of sending out tiny checks that non-grandmotherly shareholders don’t usually care about.

The Methodist Hospitals (IN) is suing consulting firms FTI Cambio and HealthNET as well as Meditech for convincing the hospital to abandon its in-progress, $26 million Epic implementation and instead spend $16 million to replace it with Meditech to save money. Methodist wasn’t meeting its bond covenants, so it hired Cambio and subcontractor HealthNET to evaluate its Epic project. The two firms said it would cost $25 million more to install Epic, although the hospital says the real number was closer to $11 million. Methodist also claims that the consulting firms advised them to dial back their security protection, which led to a widespread virus infection. The hospital says it gave up on the Meditech implementation in 2009 after finding that data wasn’t being updated properly, which had forced employees to go back to charting on paper. Interestingly, the hospital claims its own CEO, CFO, and COO were also responsible because they were all Cambio employees. Methodist wants out of its Meditech contract and is asking for $16 million in damages. I guess the lawyers have to get involved when a tanking hospital has spent $42 million on two abandoned IT projects and is still stuck on paper, but I’ll also be interested to hear the other side of the story, which is probably just as believable despite being the opposite of this version. As for saving money with Meditech, I don’t doubt it a bit – I bet if you compared annual maintenance between Epic and Meditech it wouldn’t have taken long to cover that extra $5 million to switch.

The new 289-bed, $1.6 billion UCSF Medical Center at Mission Bay (that’s  $5.5 million per bed, $1,800 per square foot) requires an $80 million contract for wiring alone. It will have a wireless Distributed Antenna System to feed EMR access to touch-screen systems at each bed. The announcement says the new hospital will be a showcase for best practices, presumably not among them being building an affordable structure that won’t require the hospital to milk the healthcare system for generations to pay off the debt. I just don’t get why we need Taj Mahospitals when healthcare costs are already making the country non-competitive globally. I’ll bet money that their Edifice Complex doesn’t improve their patient outcomes a bit (and you don’t even need an EMR-type study to easily find that out).

I’m not going to harp on this, but it’s odd: the rags that e-mail out healthcare IT related news blasts don’t seem to have a clue which press releases they use as sources really relate to HIT. Case in point: Cisco is buying Pari Networks, which offers network management tools. So why is one networking company buying another hot healthcare IT news worthy of an e-mail? Those updates always have unrelated junk about some non-healthcare arm of Siemens, a non-HIT related acquisition by a vendor for whom healthcare is a small vertical (like Cisco), or some pharma executive’s promotion. If you get those updates (and actually read them), I bet you’ll find at least one “why should I care” story written up in breathy excitement in every one of them. If I’m wrong, tell me.

A string of medication errors at Seattle Children’s Hospital, two of which occurred in babies who died, cause the hospital to scramble to regain its credibility. Hiring the Institute for Safe Medication Practices to review their processes isn’t going to do it for them, as ISMP finds many problems, including a “culture of intimidation” in which doctors belittle nurses and senior doctors and nurses alike bully their junior peers. The day before the report was announced, the Department of Health found that the hospital may have killed a baby being transferred by regularly allowing transport nurses to give meds without a doctor’s order.

The former ophthalmology chair of Temple University School of Medicine is charged with insurance fraud by the Department of Justice, which claims he submitted more than $3 million in false charges for patients he didn’t actually see. DOJ says the doctor told employees to bring him the charts of patients seen by other doctors, which he would then alter to indicate that he had evaluated the patients.

E-mail me.

HERtalk by Inga

Mississippi Medicaid contracts with ACS for use of its State Level Registry solution to manage EHR incentive payment applications, including verification of qualified applicants and certified EHR use.

Telehealth provider Teladoc Medical Services secures a $4 million investment from Cardinal Partners and HLM Venture Partners.

Dana-Farber Cancer Institute (MA) selects Versus Advantages RTLS for patient tracking, room utilization, workflow optimization, and reporting. The system will be deployed at Dana-Farber’s new Yawkey Center for Cancer Care.

Three hospital companies and two hospital systems invest in the Heritage Healthcare Innovation Fund, a venture fund targeting healthcare services and HIT. The fund says it can place up to $10 million in early- and growth-stage healthcare businesses.

AirStrip Technologies appoints Alan W. Portela to its board of directors and to serve as the company’s senior strategic advisor. He’s the founder and CEO of Hybrid Clinical Transformation and the former president and current board member of CliniComp.

New from KLAS: providers are planning to purchase more diagnostic imaging equipment in 2011. Radiology departments anticipate spending about $200 million on equipment this year, 10% more than last year. Siemens and GE are the most-considered vendors in the space, but competition continues to grow. MRIs are the most discussed purchase, followed by CTs, ultrasounds, digital X-rays, and digital mammography.

Swedish Medical Center (WA) experiences a four-hour shutdown of its Epic EMR, forcing providers to use pen and paper to document. The system automatically turned itself off upon noticing an error that could have potentially corrupted data. During the outage, users across all Swedish’s campuses could see data, but not add or change anything. The health system is now exploring “more sophisticated levels of backup,” which might include a giant server in a different geographic location.

Laurens County Health Care System (SC) chooses Summit Healthcare’s Summit Scripting Toolkit to automate billing and administrative workflow within its CPSI system.

I’ve enjoyed the dialog this week about HIT salespeople and commissions. I think Mr. H had it wrong, as many pointed out. Most companies don’t pay 100% of the commissions when the sale is made, and thus are highly motivated to make sure an implementation is successful. Car salespeople probably get paid 100% up front, but HIT is a different beast. Salespeople who are in it for the long haul will sell clean and earnestly work to make sure their solution fits their clients’ needs. Those that sell a “bad” deal and leave it to others to clean up lose credibility within their organization and find it difficult to get assistance on the next deal. Customers remember the sales rep who did them wrong and happily share their woeful story with potential customers. Other vendors also learn the names of “sleazy” sales reps and have no interest in hiring them after they’re fired from the  original company. Of course there are a few bad eggs in the business, but, I believe there’s honor in being a commission-based salesperson in HIT.  Every successful salesperson I’ve ever met works 50-60-70 hour weeks, which means they miss miss out on soccer games, birthday parties, and bunco (!) Base pay ranges from 40K to 120K (if you are a superstar.) That means that if you aren’t closing business, you’re not exactly making the big bucks. A big deal may pay a big commission check, but you may only close one or two big deals a year. In the ambulatory world deals are smaller, so a salesperson must close multiple sales a month. To be successful, a sales rep must effectively manage time and resources. If you are a sales rep working on commission, I salute you for your hard work and believe you when you say you’re committed to your customers’ success.

Hill-Rom posts 77% growth in its first quarter earnings and a five percent increase in revenue to $374 million. Revenue from the company’s North America Acute Care segment grew 6 percent to $218 million. Capital sales rose 12%, led by a 22% jump in sales for patient support systems.

Communicating via social networking leads to faster hook-ups, according to a new survey. To test the theory or to just make us feel desired, you can friend Mr. H, Dr. Jayne, or Inga on Facebook; additional foreplay opportunities are available by liking HIStalk. Find us on LinkedIn as well.

This week on HIStalk Practice: pay for performance programs don’t improve outcomes. Dow Jones files suit to allow open access of Medicare records containing provider payment details. Louisiana Medicaid issues the nation’s first EHR stimulus for an FQHC. Dr. Alexander says finding an EHR ain’t easy. Dan Nelson, a practice administrator for a family practice group, discusses his testimony before the HIT Standards Committee’s Implementation Workgroup.

Dr. David Blumenthal posts a new note on ONC site, noting plans to increase REC funding to $32 million and to award $16 million in new Challenge Grants to encourage HIE innovation.

I can’t believe WNA didn’t send us this story. The Florida Supreme court refuses to overturn a slander award against a hospital executive in favor of a surgeon. The surgeon had been denied surgery privileges at the hospital’s open heart institute. The hospital executive, in describing the surgeon’s skill level to another surgeon, said, “I would not send my dog to him for surgery.” A jury awarded the surgeon $5 million in punitive damages.

E-mail Inga.

Sponsor Updates

• St. Patrick Hospital and Health Sciences Center (MT) contracts for the Meds Tracker medication reconciliation system from Design Clinicals.
• Kansas Health Information Network chooses the CareAlign solution from Informatics Corporation of America for all of Kansas and parts of Missouri. It provides a provider and patient portal, secure clinical communication, interoperability, EHR Lite, population management tools, and a patient health record.
• McKesson declares a shareholder dividend of 18 cents. Shares are trading near their 52-week high and are almost back to their pre-HBOC meltdown levels of 1998.
• GetWellNetwork is named among Washington DC’s fastest-growing companies.
• F.F. Thompson Hospital (NY) will replace its existing hospital information system with McKesson’s Paragon HIS.
• Voalté releases a white paper called The Smartphone Tsunami – Will Your Hospital Sink or Swim?

EPtalk by Dr. Jayne

I’ve enjoyed reading some of the testimony from last week’s HIT Standards Committee Implementation Workgroup. My new crush is Robert Murry, MD, PhD, medical director of informatics at Hunterdon Medical Center (NJ). His testimony has given me a host of phrases I’ll be stealing when I next speak with hospital executives who continually expect their IT resources to deliver the impossible again and again. Among my favorites: doing an EHR upgrade in a large organization is like “upgrading the engines on an airplane while it is flying.”

Murry also goes on to say that by interfering with the go-live schedule and causing resource strain, “meaningful use has slowed down our implementation schedule, perversely having the opposite of the intended effect of rapidly rolling out robust EHR technology in our enterprise.” He lobbies for more clinical informaticists to “speak the language of physicians, understand their time pressure, perfectionism, and medico-legal stresses, but also able to understand IT, prioritize development and implementation resources, and construct the amalgam of workflow and software changes that is acceptable efficient in practice.”

CIOs and IT purists, take heed — you need someone like this in your organization, whether you call him/her a CMIO or not. You’re not just slapping a system in a doctor’s office, you’re potentially imploding their entire workflow. The last word: “EHR implementations fail when they became IT projects, as opposed to clinical projects involving technology.”

Dr. Murry, if you’re out there, I hope to see you at HIStalkapalooza. I’m still working my way through a lot of the testimony, so if readers have other favorites, e-mail me and I’ll bump them to the top of my reading list.

Several people have written to follow up on my PQRI to PQRS comments, particularly on how the new acronym can be pronounced. Some of the suggestions are downright hilarious, but I’m too much of a lady to quote them, so feel free to comment below with your thoughts.

I’ve had a pretty harsh week at work, which has led to the need for an unusual amount of vegetative Netflix, Facebook and YouTube activities. I’m a big fan of www.xtranormal.com so thanks to Betty for brightening my day with this one (and yes, I think I did see this patient the last time I had office hours.)

Speaking of Facebook, I just passed the 50-friend mark. Not anywhere near Inga-like status, but it’s helping me feel part of the HIStalk universe. The friend suggestions I’m receiving look like fun people, so don’t be surprised if I start randomly friending you.

Have a question about medical informatics, electronic medical records, or how many pre-meds cheat on their chemistry labs? E-mail Dr. Jayne.

News 1/26/11

From Mandrake: “Re: HITECH. I heard from someone that [vendor name omitted] is writing into their hospital contracts that if the hospital gets stimulus money, the vendor receives 10% of it. I thought these dollars were for hospitals, doctors, and patients, not IT vendors. I hope this is wrong, because it definitely isn’t right.” I e-mailed the vendor in question, which has not replied so far.

From Bobby Orr: “Re: HIMSS. Not only for vendors. Here’s an interview with a community hospital CIO who’s also a HIMSS board member.” Mass High Tech interviews Scott MacLean, CIO at Newton Wellesley Hospital (MA). It’s part of the Partners system, but he says neither his administration nor his docs view IT as anything more than a support function.

From QPFC: “Re: Epic. On Glassdoor.com, ex-employees have some very interesting things to say about Epic. Judy only gets a 58% rating.” Those things are fun to read, but most of the posters have a company axe to grind (and 140 comments out of an always-churning several thousand employees isn’t a large sample). A common thread is that the new grads Judy hires resent the work hours, the not particularly talented middle management, the obsolete technologies used there, and the fact that they leave Epic unqualified to work anywhere else. It might be worrisome that turnover is mentioned often, not a good thing when experienced Epic resources are hard to find and they keep selling more big sites, but all Epic really need is an endless supply of fresh, naive liberal arts grads and three months to train them. Candidates with those minimal credentials aren’t hard to find in this economy.

From IT Director/Informatics Professor: “Re: HIStalk. I really enjoy your blog (it’s the only one I read) and believe you provide a wonderful service to the industry, provide thoughtful guidance on an array of issues, and do so with humor, integrity, and grace. Great job!” Thanks. I need a little encouragement now and then and I appreciate yours.

From Unicorn Rider: “Re: Norton. Partnering with Humana to build one of the four ACO partner sites. They are also a ‘future’ Epic site, which must mean they’re getting ready to start their build.”

Sign-up for the HIStalkapalooza “I want to come” list continues. A few folks reported an error when they clicked the Submit button, so here’s my suggestion: go ahead and sign up again, even if you already did. We’ll de-dupe the list later. I’d rather spend the time cleaning up the list later than have someone miss out because of a technical problem (maybe we overloaded the site or something since lots of sign-ups went through just fine). Response has been, shall we say, brisk. Sign-ups will end shortly (maybe by Friday), so do it now. I always get e-mails right up until HIMSS from readers who claim they scrutinized HIStalk carefully, yet somehow missed the multi-paragraph announcement (with pictures and video, no less) that the sign-up was open. And just to be clear, you will not get an e-mail invitation directly just because you came last year – you still need to sign up.

Huguley Memorial Medical Center (TX) goes live on the Shareable Ink Anesthesia Record, the first of 34 hospitals served by NorthStar Anesthesia to implement the digital pen and paper solution. The company’s technology also powers the T-System DigitalShare ED solution, for which I found the new video above.

The Iatric Systems folks did a really good video parody of Ozzy Osbourne’s “Crazy Train” called “HITECH Train.” They asked my  permission a few weeks back to use HIStalk in the video and lyrics, so you’ll find it there. “I’ve read the objectives, I’ve read all the rules, all eight hundred pages, of Meaningful Use, I’ve read HIStalk, listened to Blumenthal, will we get incentives,  or nothing at all?” The HIStalk part is at 3:03 (the timer counts down instead of up). It may be a 30-year-old song, but I’m still air guitaring to it right now, and parody or not, Iatric’s version rocks.

Yet another study finds that evidence is lacking that EHRs improve outpatient care quality. The definition of “quality” is as slippery as always, in this case tied to simple indicator measures like documenting smoking cessation counseling and routine blood pressure monitoring. The EHR cheerleaders are crying foul since the data set was from 2005-2007, but it’s hard to believe that systems have really gotten hugely better since then (the better argument would be that the indicators themselves weren’t as well accepted that far back). Still, if EHRs can’t move the needle on simple, well-accepted quality measures, they aren’t likely to do much else, either. They’ll get credit down the road, though, since pay for performance will improve those measures coincident with increased EMR adoption (since government incentives simultaneously encourage both). My interpretation is that this study, among the majority of others that try to tie EHR adoption to outcomes, failed to find a correlation, but that doesn’t mean there wasn’t one, just that one wasn’t found using the measures identified. That would be slightly bad news for those with skin in the EHR game, but it’s pretty terrible news considering the billions of taxpayer dollars being spent without rock-solid evidence that patient care will improve in return. But hey, it’s stimulus money, and nobody’s holding anybody very accountable for how it’s being spent.

The Australian profiles New Zealand-based healthcare IT vendor Orion Health, which us running 22 major projects in 12 countries, including a big one in Singapore. The article has a tiny mention at the end that Orion partner Allscripts is vendor of choice for an 80-hospital state EHR project, announced in November. That’s a huge Sunrise deal.

Some updates / corrections to the unnamed reader’s list of new Epic sites sold in 2010. Johns Hopkins is evaluating, but has not committed. More reader-reported recent sales: Kadlec Medical, Resurrection Health – Chicago, Providence Oregon, Providence Washington, Owensboro, and Yale New Haven.

A few more Epic tidbits. The ones I can share, anyway (others I was sent are proprietary and I know Epic would not be happy to have them divulged):

• Epic managers are not allowed to know what their own employees are paid. Epic frowns heavily on sharing salary information.
• Epic does not negotiate price with prospects, but may consider looking at terms in some circumstances. You pay what they say, and even the method of setting the price (volume, whatever the market will bear, etc.) is secret.
• A new sale is celebrated by playing wedding music over the PA and customers are encouraged to send in a video skit or to be played at the monthly staff meetings.
• Epic will not budge on its principles even if a sale is threatened.
• Sales demos are exactly what you’d be buying – they do not demo future releases or vaporware. Demo people are key people with deep clinical experience and product knowledge, but the salesperson disappears as soon as the contract is signed and you get turned over to a project director.
• Epic employee churn is picking up, but technical support continues to be the best of any vendor (this comes from a large site).

EMR vendor gloStream offers practices a full refund on software and services if physicians aren’t back up to their usual full patient load within 15 days of the implementation completion. Sounds good, although I’d want to take a careful look at the wording of the agreement since I’m sure the company has to protect itself against lack of customer initiative.

eCareSoft, a Texas-based company affiliated with Mexico’s largest EHR distributor, launches its certified, SaaS-based inpatient EHR for small to medium hospitals. Details are skimpy (like exactly which modules are being offered), so it’s hard to say if it’s worth a look.

I can’t decide what to make of the response by HIMSS to the PCAST report. This part seems unusually frank for an organization mostly known for exuberant vendor cheerleading: “Most health IT systems are proprietary, do not adapt well to workflow changes, and have difficulty supporting interoperable exchange.” There’s a lot of technical discussion of meta-tagging data. HIMSS also expresses concern that PCAST pitches the idea that we don’t need a universal patient identified given all the pieces of information that can collectively identify a patient positively, but HIMSS says it’s not that easy (citing the fact that the only big EHR implementations in the country all have identifiers – VA, Kaiser, etc.) HIMSS also warns that tagging individual data elements isn’t the right answer, that you need the context contained in the original document. I wasn’t interested enough to scour the response in detail, but I found myself agreeing with the HIMSS position most of the time.

David Brailer will speak at a Brookings Institution discussion on personalized medicine and HIT in Washington, DC this Friday.

Quantros will implement its patient safety and compliance solutions at Oasis Hospital in the UAE.

The Burlington, VT paper profiles PKC Corp. the local 25-researcher company formed in 1991 by Dr. Lawrence Weed. His “Problem-Knowledge Couplers” match patient information to a medical database to generate diagnosis and treatment suggestions. IDX co-founder Rich Tarrant sits on its board.

Philips turns in weak Q4 numbers, mostly due to weak TV sales. Healthcare did OK, with earnings beating estimates slightly and up 15.5% from a year ago.

I ran across LifeBot, which offers telehealth and EMS applications, including its DREAMS ambulance telemedicine system developed with the US military, Texas A&M, and UTHealth (the program is led by world famous trauma surgeon Dr. Red Duke).

In Victoria, Australia, the overdue and over-budget HealthSMART project, which offers Cerner Millennium as its cornerstone clinical system, is rumored to be facing cancellation.

E-mail me.

HERtalk by Inga

From Evan Steele: “Re: Meaningful Use IQ Quiz. I thought you would find these stats on the quiz interesting. Before Mr. H mentioned the quiz on HIStalk January 21st, 692 people had taken it and the average score was 56.9%. After the mention, we had a surge of 164 quiz takers and the average score was 57.3%. Most of my blog readers are from the ambulatory side and I’d imagine that HIStalk readers are more from the hospital / CIO side. The conclusion is that the meaningful use knowledge of the ambulatory and acute folks is about the same.” Quiz here, if you haven’t seen it. If you care to annoy Mr. H, ask him to share my my MU IQ score.

From Svelte Dude”: “Re: Phreesia. Will name a longtime Allscripts/Misys director as VP of sales to run its patient check-in business.”

Clairvia says numerous academic medical centers have recently selected its Physician Scheduler, including Children’s Hospital of Philadelphia, the University of California Health System, and University of Utah Health Care.

UMass Memorial Health Care deploys Merge’s iConnect Access imaging distribution solution, giving affiliated physicians the ability to view medical images from their EHR.

Vermont Blueprint for Health signs an agreement with Covisint for its DocSite solution. Meanwhile, the Greater Tulsa Health Access Network selects Covisint’s ExchangeLink for its HIE infrastructure.

DiagnosisOne partners with ACS to deliver clinical decision support and lab data management solutions to ACS’ pharmacy benefits management and HIE solutions.

TeleHealth Services names Joel Harris VP of corporate development, tasked with identifying and evaluating potential M&A targets and managing product strategy. He’s a former senior director for Pfizer and spent eight years as TeleHealth’s VP of operations.

CCHIT grants ONC-ATCB 2011/2012 to Beth Israel Deaconess Medical Center (MA) under CCHIT’s new EHR Alternative Certification for Hospitals (EACH) program. The EACH program provides testing and certification for hospitals with self-developed software.

St. Joseph Medical Center (MD) selects ProVation MD software for gastroenterology procedure documentation and coding.

MedVentive president Nancy J. Ham joins the board of directors of NxStage Medical, a manufacturer of dialysis products.

Saint Francis Medical Center (NE) implements Interbit Data’s NetDelivery Integration Module, giving it the ability to transfer Meditech lab results to physicians’ EMRs.

The University of Louisville Physicians (KY) will roll out EHR to over 500 healthcare professionals as of February 1. Allscripts, I believe.

By February, all ER physicians at DePaul Health Center (MO) will be using scribes for electronic medical documentation. Administrators hope to improve staff productivity as well as patient satisfaction. Apparently patients were “annoyed” that doctors were sharing their attention with a computer.

Doctors Hospital of Sarasota (FL) chooses EXTENSION’s Cisco and smart phone-integrated healthcare team communications solution.

The US Information Systems Engineering Command awards Harris Corporation a one-year, $10.6 million contract to upgrade the communications and IT networks at 23 US Army Medical Treatment facilities.

HHS Secretary Kathleen Sebelius reports that last year, the government’s healthcare fraud prevention and enforcement efforts led to the recovery of more than $4 billion. In addition, the government filed criminal charges in 488 cases involving 931 defendants, 726 of which were convicted.

Sebelius also announces that an unspecified amount of new grants will be available to help states implement health insurance exchanges.

United Memorial Medical Center (NY) will replace its legacy document management system with Perceptive Software’s ImageNow ECM solution.

E-mail Inga.

Sponsor Updates by DigitalBeanCounter

• OCHIN, an REC and non-profit provider of HIT systems and services to community based clinics, announces plans to resell Allscripts EHR and PM to Oregon physicians.
• Orion Health names Christopher Ward SVP of global marketing. He’s the former chief marketing officer for GE’s Healthcare IT business.
• Greenville Hospital System University Medical Center (SC) goes live on Holon’s Central Order Entry Pharmacy medication order management solution, which will integrate with the hospital’s existing Siemen’s Med Administration Check system.
• South Florida Health Information Technology Regional Extension Center (SFREC) selects Greenway’s PrimeSUITE EHR.
• GetWellNetwork announces its 4th annual user conference, GetConnected2011, which will be held at the Gaylord National Hotel & Convention Center in National Harbor, MD.
• Dr. Cynthia Taylor, an affiliate with Norman Regional Health System, credits eClinicalWorks after being recognized as the first in the nation to receive a reimbursement check from CMS for demonstrating meaningful use.
• Divurgent is co-hosting a cocktail networking event with VAHIMSS during HIMSS in Orlando.
• NextGen partners with Allina Hospitals & Clinics to improve care coordination for physician practices in Minnesota and western Wisconsin.
• Speaking of NextGen, here’s a cool YouTube video highlighting knowledge-base management (KBM) and meaningful use (MU).
• Nuesoft unveils its new logo.
• Nuance introduces Swype and also Dragon Medical 11.
• Imprivata reports 38% growth in its total bookings compared to the same quarter last year, citing demand for its single sign-on and access management solutions.
• PatientKeeper 7.0 earns ONC-ATCB certification as an EHR Module for CPOE, privacy, and security criteria.
• Sunquest is demonstrating its ICE solution (Integrated Clinical Environment) and the new CoPath Plus anatomic pathology specimen labeling and tracking solution at the Arab Health Exhibition & Congress in Dubai this week. The company also announces that its LIS has earned ONC-ATCB certification as an EHR Module.
• AirStrip has a demo of its cardiology app running on an iPad.

EPtalk by Dr. Jayne

The January/February issue of Family Practice Management arrived to a multitude of inboxes last week. It’s time for their annual “Survey of User Satisfaction with EHR Systems” feature. I encourage my physician readers who are members of the American Academy of Family Physicians to complete the survey. Those of you who work with real, live family physicians, please encourage your physicians to do this. It runs through March 31 and can be completed online, or alternatively, they will accept it by fax.

Historically the EHR I use in practice hasn’t done very well on this survey, but the number of respondents for the vendor has been low. Hopefully more people will participate this year. I do think it’s a good system and I’m tired of certain cranky physicians citing the results with their miniscule “n” number as the holy grail of EHR satisfaction data. Besides, they’re giving away an iPad and some other goodies, so it’s worth the five minutes it takes for family docs to register their opinions.

The same issue also has a timely (and physician-friendly) article, “Should Your Practice Participate in a Quality-Reporting Program?” This is a nice summary of how practices are handling four available quality reporting programs (including PQRI, now known as PQRS – what is up with that anyway? Did we not have enough acronyms? Or were they tired of people calling it PICK-ree?)

It looks at the costs of these programs, including staffing, data mining, etc. It should be required reading for anyone in healthcare that thinks Meaningful Use and other programs are just giving away free money. The data is surprising — several of the programs had potential costs that outweighed the financial incentives. Costs per full-time provider ranged from $133 to $11,100 during implementation. (Yes, that’s eleven thousand.)

Thanks to my FP buddies who always make sure I see these articles. I’m always interested in these types of articles in other specialty journals, so feel free to send them my way.

Dear Dr. Jayne,

What is most interesting to me is your IT education… or are you one of those quick learners who likes IT and learned on the job?

The IT Cowboy

Dear IT Cowboy (and I do love cowboys),

Like many other CMIOs, I fall into the quick learner category. Many of us who have been in this role for a while fell into it gradually rather than having a formal education. My medical school had a top-notch informatics expert who was a major influence. Plus, he had a really fun fourth-year elective that didn’t involve actual patient care, which was good for those of us who needed a break from the pleasures of the local psychiatric hospital and being tormented by burned-out residents.

My knowledge of non-clinical IT systems stems from an apparent affinity for “IT guys.” This is how badly medical training warps you — your life is so chaotic that you think someone who does critical systems support has a normal lifestyle. I’m probably the only physician you know who has ever been to the NOC on a date or been out with someone who was wearing more pagers than she was. (Thank goodness for the BlackBerry – so much more chic than the whole Batman Utility Belt pager ensemble.)

Like Anakin Skywalker, I was slowly drawn to the Dark Side. I decided I needed additional education if I was going to live up to the “I” in the title, and after thinking about how much medical knowledge I received in school vs. “the trenches”, I decided to take the hands-on route. I’ve bought many a beer while slowly extracting mounds of knowledge from IT staffers late into the night. I’ve bribed analysts to help me understand what’s going on in the code. I read scads of articles and IT publications and frankly, some of the words that come out of my mouth these days scare me. I’m talking things of the four-letter variety: DHCP, ODBC, ISDN, VLAN, CCOW, LEAP, and many more.

I’ve also learned a lot from vendors, especially working with development teams on creating clinical content. It’s given me a peek under the hood to better understand the limitations of the software so that I can better help my physicians prepare for impacts on patient care as well as to give useful real-world feedback to the vendor. Understanding the underbelly of EHRs gives me more credibility with vendor teams – I’m not just another doc crying wolf, I’m someone they can partner with to fix the issue. (Running my own mini-development shop for certain applications is also helpful — I understand the constraints of release cycles, testing, packaging, distribution, etc.)

There you have it, my IT education in a nutshell. I do hope we’ll be seeing you at HIMSS. Maybe I should ask Inga if she’d be offended if I had a “Dr. Jayne Loves My Boots” award. Wranglers optional, but preferred.

Dr. Jayne

Have a question about medical informatics, electronic medical records, or which specialists are the nastiest? E-mail Dr. Jayne.

Monday Morning Update 1/24/11

From Tom Paine: “Re: reader comments. I appreciate that you don’t seem to censor.” Here’s where I’m torn: all those anti-technology, axe-grinding comments you see posted under a variety of names are coming from the same 1-2 trolls from Pittsburgh hospitals, sometimes posting as a doctor or nurse, who can be counted on like a fine Swiss watch to clog up every post with easily recognizable anti-HIT comments (software is dangerous, experimental, a government conspiracy, etc.) It’s not their argument that I mind, it’s the attempt to make their monotonic mantra look like a populist groundswell by near-constant posting. I resent the dishonesty and I sometimes delete their comments when I’ve had enough, especially when they start pestering Jayne or Inga.

From Linus Pauling: “Re: Epic. Support is going downhill fast with lots of defections and new customers. Look for KLAS scores to be affected. Hospitals are not happy getting a main contact who’s a 21-year-old straight out of college with an economics degree.” Unverified.

From The PACS Designer: “Re: Stage 1 Meaningful Use. CIO John Halamka and Robin Raiford of Allscripts have given us a handy matrix that defines the numerator and denominator required to measure compliance for the rules to achieve the minimum objectives for payment in Meaningful Use Stage 1. Here’s a link to the NIST testing site for MU validation.”

From Ulysses S. Federal Grant: “Re: salespeople on commission. eClinicalWorks does not pay commissions, either.” I like that approach. To do otherwise is to provide incentives for the wrong outcome, like most of medicine in paying for procedures instead of results: commissioned salespeople make more money for enticing someone to sign a deal and then moving quickly on to the next prospect no matter what the outcome. It’s not surprising that salespeople will promise almost anything knowing that they’ll make hundreds of thousands of dollars for getting someone to sign on the line which is dotted, even if it’s not necessarily in that prospect’s best interest to do so.

From Daryle Harmonica: “Re: EMRs. An meta-analysis study in PLOS Medicine (the open-access equivalent of NEJM) comes to the usual conclusions – the evidence of EMR benefits is lacking. Their methods sound pretty rigorous.” For those who don’t know, a meta-analysis is a study of studies, combining their results in a statistical way to reach a broad and possibly new conclusion. This one finds that, despite the theoretical benefits of digital technologies in healthcare, nobody has proven that they are risk free and cost effective, and recommends that technologies should be evaluated against a consistent set of measures throughout their life cycles to make sure they are providing benefit. I like that idea – hospitals rarely evaluate their clinical system projects at all and almost never publish the results when they do, but even if they did, the results wouldn’t be extensible because everybody is measuring differently. Maybe that’s something that ONC or FDA should do – come up with a standard set of clinical system quality metrics (uptime, user satisfaction, system-related clinical errors, etc.) and require annual centralized reporting that’s open for public scrutiny. The study also found that almost all published success came from big academic medical centers, but I would speculate that’s because community hospitals don’t write nearly as many articles as the publish-or-perish ivory tower types living off federal grant money.

From Uncle Fester: “Re: LSS. Lost in the Meditech acquisition news is that LSS’s C/S 5.6 product earned certification.” I didn’t realize that they have the exact same releases as Meditech, so LSS has certification for its MAGIC and C/S lines, with 6.0 next up.

From Buck S. Pearl: “Re: West Virginia Health Information Network. Moving ahead with Thomson Reuters as the prime contractor in their five-year HIE deployment. The company is involved in projects in NC and SC.” Unverified.

From Sgt. Schultz: “Re: Epic. I know nothing more than this except they have a product called SeeMyChart.” Epic files suit against Altos Solutions for trademark infringement. SeeMyChart is a patient portal into the company’s OncoEMR oncology EMR. I don’t know which product came first or who owns which trademark, but if it was Epic’s, I can see why they would claim the potential for market confusion.

From Bill@$200/Hr: “Re: Kettering in Ohio. Rumor is their Epic install is floundering, looking at delaying their second go-live at their largest hospitals. Local talk is there’s a real crisis of leadership, surprising given the sheer number of consultants involved.” Unverified.

I’m a little surprised that 15% of regular HIMSS conference attendees said they won’t attend this year, according to my latest poll. They won’t be offset by the 8% who don’t usually go but who will make the trip to Orlando. If the turnstile count is down, you heard it here first (I’m pretty sure that won’t happen, though). New poll to your right: have you or your employer been affected by a shortage of experienced HIT workers? I’m just checking again.

Welcome to Clairvia, supporting HIStalk as a Platinum Sponsor. The Durham, NC company was built around the concept of Care Value Management, which emphasizes improving patient care, quality, and financial performance by measuring the care needs of individual patients and then assigning those patients the appropriate level of caregiver resources to ensure the best possible outcome. It’s like a 21st century version of traditional patient acuity and staff management systems, with its tools used directly by clinicians instead of bean counters and focusing on the patient instead of rigid, cost-based staffing models. The bottom line is that it helps hospitals tie together care models to outcomes and to the patient experience, ensuring that patients follow an optimal track from admission to discharge with appropriately assigned resources throughout (i.e., get them from the ED to the right unit quickly and have a defined plan to encourage their progress from the expensive ICU to lower acuity units). I interviewed Beth Pickard, the company’s president and CEO, in December, where she explains why prospects are interested: “Almost everyone is looking for ways to ensure that the patient tracks or moves through the organization to the reimbursable plan for cost as well as having a good experience. I would say that it’s not something that we’ve had to sell.” Thanks to Clairvia for supporting HIStalk.

Weird News Andy was sucker for this news. ED doctors treating a woman for a mild stroke and temporary paralysis determine the cause: a hickey that was administered too close to an artery by her overly amorous lover caused a blood clot. She was successfully treated with an anticoagulant. Said one of the doctors with what sounds like a nearly-creepy familiarity with the pathophysiology, “Because it was a love bite, there would be lots of suction.”

I’m always on the lookout for projects that would benefit the little guy in the industry (both providers and vendors). One that came to mind was to develop a freely accessible database of what major systems each hospital uses. Right now, the only folks who know are KLAS and HIMSS Analytics and they aren’t going to tell anyone who isn’t paying big bucks. It would be a pain to collect and update the information, but instead of doing all 6,000 hospitals, I was thinking most people would care only about the 1,200 or so hospitals greater than 200 beds. I have no idea how to go about doing this or whether it’s even something needed, but it seemed like a good idea when it came to me in the middle of the night. I’m open for input.

The Atlanta business paper profiles Digital Assent, which has developed an iPad-based physician office check-in application to replace the much-hated patient clipboard. I didn’t see it mention on the company’s site, but the article says it also displays ads.

Austin, TX-based rehab and hospice operator Harden Healthcare says it will spend $10 million a year over the next several years on IT, including a move to electronic medical records.

The coroner’s office in an Indiana county is taking more than three weeks to issue a death certificate. The culprit: a legally mandated death certificate application that the coroner says is hard to use.

GE’s Q4 numbers: revenue up 1% (the first growth in nine quarters), EPS up 33%. The UK-based GE Healthcare made a billion-dollar profit in Q4, with revenue up 8%. For the year, GE Healthcare took in $16.9 billion and made a profit of $2.7 billion.

A nurse fired by a Florida hospital for looking at the electronic medical records of Tiger Woods is suing the hospital. Health Central says it has evidence proving that the nurse looked at the records three times in 10 minutes, but the nurse says the hospital didn’t secure its computer system, allowing someone else to check out the records when he walked away.

Beth Israel Deaconess Medical Center will buy out the remaining two years of outgoing CEO Paul Levy’s contract, giving him $1.6 million in severance for what continues to be portrayed as a voluntary resignation.

Odd lawsuit: the wife of an Air Force officer files suit against a VA hospital when an Air Force surgeon inserts 270 ml breast implants because the hospital was out of the 300 ml ones she wanted. According to the lawsuit, “Mrs. Haden was extremely disappointed by the size of her breast implants.”

Sponsor Updates

• AHA extends an exclusive endorsement to CareTech Solutions for data center hosting services.
• Overlake Hospital Medical Center (WA) will implement the full Medicity suite, including MediTrust Cloud Services, ProAccess Community, and the Novo Grid.

Epic Sales

Readers sent in quite a few thoughts about the Epic salespeople and sales process. Here are some of those that I found interesting.

• Epic has 6-7 salespeople, all of them women (the reader provided their names).
• Despite company growth, the sales team hasn’t gotten much bigger.
• Almost nobody knows an Epic sales rep, current or former. Even sales recruiters have never spoken to one.
• All salespeople are required to have done installation work at Epic. Epic does not direct hire people into sales.
• Epic does not do traditional marketing. They focus only on a few conferences and don’t run billboards, sponsorships, or ads.
• Salespeople do not earn commissions, although their performance is taken into account at appraisal time for raises and bonuses.
• CEO Judy Faulkner steps in herself for the big prospects or if it looks like Epic will lose the deal.
• Some folks have been forced out. They call it “flying too close to the sun,” with the sun being Judy.
• The job of the salesperson is less about selling and more about managing the process. Epic has separate teams for RFPs and demos, a legal team for negotiations, and budget/pricing teams for managing the implementation timelines and budgets. If sales needs help from anyone in Epic, that person is expect to drop everything and go to a customer meeting or do whatever is needed.
• Those PMs serve as product experts along with clinicians and developers, with much of their role being to demonstrate the philosophy and culture, not to be salespeople with a passing interest in getting a contract signed.
• The entire company makes the sale, not the salesperson. Customers get good implementation support, an individually assigned technical service rep, and a “customer happiness” rep who will escalate any concerns.
• Until 2009, Epic was making just 10-15 new sales a year and many of those were just for ambulatory or inpatient alone, but the percentage of enterprise sales has increased each year. In 2010, they supposedly made around 40 new sales (some of them listed below).

Reader-Reported New Epic Sales for 2010
Johns Hopkins
Catholic Health Services of Long Island
New Hanover Regional Medical Center
Ochsner
Moses Cone
Bronson
St. Joseph Michigan – Lakeland
Martin Memorial
Idaho – St. Luke’s
US Coast Guard
Provena
Aurora
University of Mississippi Medical Center
JPS Health Network
SUNY Upstate Medical University
LSU Health
Rochester General
ProHealth Care
Owensboro
Rockford
Sansum
Access Community Health Network
Bassett Healthcare
Stormont-Vail Health Care
Hurley Medical Center
Temple University Health System
Amphia Hospital (Netherlands)
Memorial Healthcare System
Orange Regional Medical Center
Tampa General Hospital
Wenatchee Valley Medical Center

HIStalkapalooza

The HIStalkapalooza page is live. It works a little differently this year to be fairer to attendees. Your signup gets you on the “I want to come” list. We’ll follow up with an official e-mail invitation to those we can accommodate, assuming there are more people interested than we have capacity (and if not, great, everybody will get an e-mail invitation). Signing up alone doesn’t guarantee a spot, just to be clear. I did it this way to allow a wider variety of people (especially providers in the trenches) to come since some big vendors were having a secretary sign up their entire HIMSS booth team of dozens of people, taking away spots that some poor programmer or nurse who didn’t pounce immediately lost as a result.

HIStalkapalooza is sponsored by Medicomp Systems, makers of such EMR tools as the MEDCIN clinical knowledge engine, the CliniTalk voice-to-data physician documentation system, and a new offering or two that I’ll be talking about later. I’m really impressed with their commitment to providing you with a good time at HIStalkapalooza. They have had first-rate planners (people who have worked on Hollywood award shows!), PR folks, and others who have put a lot of time and energy into making HIStalkapalooza an event that I think will be the talk of HIMSS. They totally get HIStalk and have been phenomenal in running with whatever harebrained ideas I came up with to make it fun and wildly different from the usual marketing-heavy, button-down HIMSS events. Thanks to Medicomp and particularly COO Dave Lareau for supporting the readers of HIStalk by producing HIStalkapalooza.

Just to reflect for a moment, as a hospital employee with limited time and resources, I couldn’t have done any of this without Medicomp (and kudos to event sponsors from prior years as well, Encore Health Resources and Ingenix, who also threw great parties). It’s amazing to see how the event has grown and to see how many companies want to sponsor it, especially since I insist that it be about the attendees and not the sponsors (no commercial pitches, no giant sponsor signs or booths, I control the agenda and approve all decisions, etc.) That’s a pretty big commitment for a company, especially knowing that most of the attendees will probably be from vendors, many of which are their competitors. I truly appreciate the support of both Medicomp and those who attend. For a  guy toiling anonymously and alone on HIStalk the other 364 days a year, it’s a little overwhelming to see it in person.

So what’s happening at HIStalkapalooza? It’s at BB King’s Blues Club at Pointe Orlando, just a few hundred yards up the street from the convention center, on Monday, February 21 from 6:30 until 11:30 p.m. Medicomp has bought out the entire facility (it’s pretty big), so it will just be HIStalkers there. There will be an open bar, IngaTinis, great food, a red carpet entrance, and professional videographers documenting the event so I can run some video here later for those who can’t make it (and stream it live to a huge on-stage screen for folks already in the venue to watch).

This is amazing: Inga and I desperately wanted athenahealth CEO Jonathan Bush to emcee the HISsies awards again (those of you who went last year understand why), but he couldn’t make it because he had scheduled a family vacation around his kids’ school break. Shockingly, he wanted to be with you HIStalk readers so badly that he rescheduled his vacation, so he’ll be chewing the scenery again and I can’t wait to hear what comes out of his mouth. We’ll also have an expanded line of beauty queen sashes since both men and women love wearing them. Inga has twisted my arm to shell out cash for some swell prizes for Best Shoes and HIStalk King and Queen (overall fashion and look, since Inga’s into that sort of thing, and as a guy I’m not entirely against having fashioned-up ladies around). We may have some special recognition for practicing doctors in attendance.

And for your HIStalkapalooza entertainment .. The Insomniacs, the award-winning, crowd-inciting, high-energy Left Coast Blues band from Portland, OR, which Medicomp is bringing all the way down to Orlando just for our event. Sample tunes here. A real band at a real music venue with a real stage and a dance floor … that doesn’t happen often at HIMSS. This is a full-length concert and the bar will be open throughout. I’m pretty sure that’s a formula for a good time to be had by all.

E-mail me.

News 1/21/11

From Leopold Stoch: “Re: Meditech. They finally buy out LSS.” Bill Belichick and other readers tipped us off on January 5 that Meditech would be buying out its ambulatory partner. They were right. Meditech also announces that HCIS version 6.05 has earned certification through Drummond Group, so all three of its platforms (MAGIC, Client/Server, and 6.0) are now certified. Thanks to the several sharp-eyed readers who let us know about the announcements.

From Frank Poggio: “Re: Privacy and Security Tiger Team of the HIT Policy Committee. They’ve started looking at the issue of a unique person / patient identifier, the ultimate US-only conundrum that has been struggled with for decades.”

From Blah: “Re: Verizon hotspot. Tempting, but Verizon’s 3G network won’t allow data and voice at the same time. Will you just miss calls when using the phone as a hotspot?” See tech expert David Letterman’s skewering of Verizon above.

From Doc Martin: “Re: LA County Department of Health Services hospitals. The surgery system install is going badly, with servicers needing to be rebooted several times daily, reports going unwritten, and [vendor name omitted] staff unable to stabilize the system. It has affected OR throughput.” Unverified. Give me something verifiable and I’ll name the vendor.

From Shot Doctor: “Re: Allscripts. I hear they’ll announce a new president of sales next week and it will a big name. I couldn’t get anything more than that.” Hmmm … anybody want to guess who it is?

From Two Down, One to Go: “Re: Cook County seeks to end inpatient care.” The county wants to end inpatient, emergency, and surgical services at Oak Forest Hospital and turn it into an outpatient primary care center.

From Murray the K: “Re: Allscripts. Has brought on a third-party vendor to supply manpower to its remote hosting facilities.” Unverified, but rumor is that ACS is involved in a capacity somewhere between oversight and total outsourcing.

From Guy Who Lives in Midwest: “Re: Rep. Paul Ryan (R-WI). Is he talking about Epic? Starting at 3:10.” He mentions an unnamed, large, privately held, woman-led Wisconsin company with thousand of employees. He says the CEO told him she wants to offer health insurance to her employees, but her two publicly traded competitors have said they’ll dump their employees from insurance and pay the fine instead, saving $15,000 per employee. Since that gives those companies a competitive advantage, she will have to do the same, he reports. I don’t know if it’s Epic, but I’ll say this: the Congressman is a heck of a speaker.

Jobs on the HIStalk Jobs Page: Director of Consulting – Healthcare IT, Epic Credentialed Trainers, Sales Representatives. On Healthcare IT Jobs: Senior Consultant Health IT, Revenue Cycle Project Manager – Arizona, Cerner CareNet and INet Analysts, Clinical Consultants McKesson HPP.

Listening: new from Jamestown Story, because I know the band (indirectly). I predict they’ll be big soon, so check them out and you can brag that you hopped on the bandwagon early. I’m also liking Tennis, summery 60s-sounding garage pop.

Congressman Mike Doyle (D-PA) is fuming because not only did Congress turned down his $500K earmark request to buy an EMR for a local nursing home, the House Speaker says he won’t even allow spending bills on the floor for a vote if they contain earmark appropriations. Says the Congressman, “They were killed by the Senate Republicans. We thought we were going to get an omnibus [spending] bill, but [Senate Minority Leader] Mitch McConnell bowed to the Tea Party.” The nursing home says the EMR is vital and they’ll have to buy it with their own money instead of using federal taxpayer dollars.

Thanks to long-time HIStalk sponsor GetWellNetwork, which is upgrading from Gold to Platinum. The Bethesda, MD company offers TV-based interactive patient care solutions used by 70 hospitals and health systems that provide bedside patient education, entertainment, patient feedback and surveys, care planning, outcomes research, and personalized patient experience driven by integration with HIT systems. Thanks to GetWellNetwork for its ongoing support of HIStalk.

I’d also like to welcome and thank Staffing Angel Software, a new Platinum Sponsor of HIStalk. The company offers one-click, Web-based scheduling and labor management solutions for medical personnel, with specialty applications for nurses, pharmacy, and physician groups. Each application is personalized and can include electronic timesheets, reconciliation, payroll file compilation, and a historic archive. A video demo is here and you can check out the online training videos for more details. Client-reported results include increased employee satisfaction, efficient multi-campus scheduling, improved recruitment and retention, reduced overtime, and better utilization of FTE and PRN resources. The rules-based scheduling allows employees to self-schedule and to be alerted of available shifts. Thanks to Staffing Angel Software for supporting HIStalk.

Inga won’t stop bragging on her perfect score on SRSsoft’s Meaningful Use IQ Test, so I might as well go ahead and acknowledge it publicly and hope she gets over it. Getting a mention on their site got her wound up all over again.

The wacky, anonymous folks behind Extormity (“the electronic health records mega-corporation dedicated to offering highly proprietary, difficult to customize, and prohibitively expensive healthcare IT solutions”) have cranked out a pretty funny video claiming to feature one of its executives testifying before Congress.

Weird News Andy salivates at this story: a suicidal drug user who showed up at a hospital’s ED twice in two days spits in the face of a nurse trying to place him in restraints for his own protection. He is initially charged with attempted murder since he’s infected with hepatitis C, but the charges are reduced to assault.

Thanking you in advance for the following: (a) use the Subscribe to Updates box to your upper right to ensure immediate e-mail notification and triumphant “me first” smugness when I write something new; (b) use that newfangled thing called Facebook to Like HIStalk or Friend Inga, Jayne, and me so we can pretend to me the popular cool kids we always yearned to be instead of HIT nerds; (c) support the companies that support HIStalk by reading over the sponsor ads (to your left) and text ads (to your right) and click excitedly where indicated as acknowledgment that it’s a pretty gutsy move by them considering some of the stuff I write about companies; (d) send in your rumors, news, top secret documents, incriminating photos, or whatever would titillate me using the garish green Rumor Report button to your right (or if you can’t bear to look at it, just e-mail me). Thanks for reading. And for those asking about HIStalkapalooza, the signup sheet should be online and therefore mentionable in my Monday Morning Update (which by some freakish tear in the fabric of time, actually goes out whenever I get it finished after an all-day effort on Saturday while you’re out having fun).

Ad-supported (free) EHR Practice Fusion says it’s the #1 ranked EHR among primary care specialties in Black Book Rankings. 

Meta Healthcare IT Solutions announces MetaCare Event Manager, a clinician task alerting application that works with its EHR, CPOE, and eMAR systems.

A report suggests that the US will continue to lead the world in medical innovation, but will lose some ground to China, India, and Brazil because of expensive FDA compliance requirements and an entrenched healthcare system that favors the old guard.  In a possibly related move, FDA proposes changes it says will streamline medical device approvals.

Sunquest announces a new physician portal for outreach orders and Web results connectivity.

E-mail me.

HERtalk by Inga

From Wowed: “Re: Dr. Monteith’s testimony. Listened to this clip. This  is one of the most eloquent and straightforward comments I have heard that is so dead on that it will probably be dismissed as a ‘naysayer’ or outlier from typical ‘political’ opinion, even though I and probably many others agree completely! Perhaps David Blumenthal and Obama should have heard these intelligent comments!!!” Wowed is referring to Dr. Scott Monteith’s testimony from the HIT Standards Committee Meeting. Link here and cue to 2 hours and 49 minutes.

Cooper Green Mercy Hospital (AL) contracts with Medsphere to implement its OpenVista EHR.

Adreima appoints former Vanguard Health Systems CEO  Ken Howell as COO.

Marin General Hospital (CA) selects ProVation Order Sets as its electronic orders set solution.

The Charlotte Hungerford Hospital (CT) says it has invested over $2.5 million on HIT systems over the last three years and intends to apply for Meaningful Use incentives. The hospital’s  HIT infrastructure includes products from Meditech, Dr. First, Micromedex, Iatric Systems, and Zynx, as well as HIE infrastructure from MobileMD. Future plans include establishing an ACO and clinical decision support system partnerships.

Ingenix forms Ingenix Life Sciences, a newly-organized division that will focus marketing the company’s life science offerings. Meanwhile, Ingenix signs a definitive agreement with  inVentive Health for the sale of Ingenix’s i3 clinical development business. COO Lee Valenta takes over as president of the life sciences unit while Glenn Bilawsky will remain CEO of i3.

The Indiana HIE names Eric Miller VP of information technology and Patricia Ping information security officer. Miller is the former senior director of IT with Ascension Health; Ping previously was the security officer for Wishard Health Services.

HIMSS confirms Surgeon General Regina Benjamin, MD, MBA as a conference speaker. She’ll share updates on her efforts to incorporate the My Family Health Portrait into PHRs and EHRs, and discuss obesity and efforts to improve healthcare delivery for underserved populations. Benjamin intrigues me, given her history as the first woman and/or first African American woman to fill various leadership roles. It’s on my calendar for Wednesday, Feb. 23 from 9:45 to 10:45.

Brooke Army Medical Center (TX) selects Ekahau RTLS to track over 5,000 pieces of mobile equipment throughout its 1.5 million square foot facility.

Lori Evans Bernstein takes over as president of GSI Health, a provider of HIE and management solutions. She’s the former chief executive of provider solutions with ActiveHealth Management and used to be David Brailer’s advisor when he ran ONCHIT.

AHA issues a member-only resource guide that provides a checklist of topics and questions that hospitals should consider when establishing a vendor relationship. The AHA says the guidelines are intended for hospitals running licensed EHR software and related products on their own servers.

This week on HIStalk Practice: Weno Healthcare takes issue with not being named an ONC-ATCB, plus a look at the Weno/Spring Medical press release that inadvertently hit the Web. athenahealth stock hits an all time high after a big sale to Summit Medical Group. For  EHR gurus or guru-wannabes, SRSsoft has developed a tough quiz on the EHR incentive program (I’m happy to report I made a perfect score). Dr. Gregg Alexander provides an update on his EHR hunt. We are still looking for lucky subscriber #1,000, so make sure you sign up for HIStalk Practice e-mail updates.

The Cleveland Medical Mart & Convention Center hosts a ground-breaking ceremony and shares news of its 57 committed tenants and 31 scheduled conventions. It will open in the fall of 2013.

BMC Healthcare (MD) says it has begun implementing various HIT tools and has filed for Meaningful Use incentives. BMC’s IT advancements include CPOE and EHR (Meditech) and PM/EHR (eClinicalWorks) in its physicians offices.

E-mail Inga.

Dear Dr. Jayne,

I admire doctors for what they know and what they do. But I also have to work with them as they learn EMR and have all the understandable reactions to it. I say it’s like telling someone, “OK, now you have to go through life for the next two months doing everything with your non-dominant hand.”

Bignurse

Dear Bignurse,

I absolutely love this analogy and am planning to shamelessly copy it (with the appropriate citation, of course!) There’s a favorite slide I use when talking about EHR implementation that lists the Kubler-Ross stages of grief: denial, anger, bargaining, depression, and acceptance. It seems lately I’m dealing with a lot of bargaining.

I tell them two things. First, CMS doesn’t bargain. Second, you passed biochemistry in medical school (hopefully) and that was a LOT harder than learning to use a clinical system.

There was a lively bit of commenting after one of my posts last week, with a good discussion about the potential limitations of clinical systems and their forcing clinicians to practice cookbook medicine, stifling creativity, etc. Like any piece of software, EHRs are only as good as the programmer and the user (not to mention their sassy CMIO and clinical champions).

I remind my docs when they are implemented that the EHR is not intended to replace their brains or their good judgment. It’s a tool that if misused can be dangerous. Geriatric (and pediatric, for that measure) patients have different needs than typical adult patients. So do transplant patients, immune-suppressed patients, and pregnant patients. And renal patients. And heart failure patients. And on and on.

Systems are limited by the breadth and depth of the order sets, formularies, and protocols that are designed and loaded. If clinicians feel that the systems have order sets that cause harm, likely it’s not entirely the vendor’s issue. If you have an order set that prohibits you from giving an appropriate dose of medication or one that is unsafe, that needs to be addressed. Look behind the curtain to the Committee that specified the order sets and protocols and express your concerns. Or join the Committee and be part of the solution.

Trust me, these things are not easy to design, and if I lock five nephrologists in a room with a patient, I will get seven different treatment plans. If you feel that certain consultants have lost their minds, vote with your mouse or stylus and refer to another group. If there are no alternatives, discuss serious clinical concerns with the appropriate body in your hospital. Sometimes taking the variation out of medicine is good – especially when there are evidence-based, statistically valid treatment approaches that have been proven to have less morbidity and/or mortality than others.

I personally have benefitted from the alerts and limits within the systems I use. Every physician at one time or another has inadvertently prescribed a medication to a patient with a documented allergy. I’d much rather have a system catch that (or warn me that I’m about to dry-clean my patient’s kidneys) than have the pharmacy call me later after they’ve told the patient I missed it, which is still better than harming a patient.

Dr. Jayne

Dear Dr. Jayne

The IT Cowboy

Dear IT Cowboy,

I figured I’d go ahead and tackle this one since I already used the word “evidence-based” entirely too many times. I feel like I’m at a pharmacy and therapeutics committee meeting!

If we’re talking about proving that the use of EHR itself has benefits to morbidity, mortality, patient safety, and other factors, I think the evidence is all over the place. It depends on whose study you look at, on what day, and whether you asked the Magic 8-Ball about it before you started reading.

Bottom line: it depends significantly on the education, training, and proficiency of the users. Many organizations are learning this the hard way as they prepare for Meaningful Use. They have fully capable systems, but staff either doesn’t use them in the way they were designed, or isn’t using them at all. The jury is going to be out for a long time.

On the other hand, sometimes the systems are, for lack of a better word — bad. My first EHR had hard-coded templates whose protocols that were out of date before the software made it out of QA testing. Vendors are getting smarter and are coding to allow rapid update cycles or user configuration on the fly. Still, whatever governance body is responsible for the clinical integrity of the system (and hopefully you have a fun CMIO who shares in that role) has to review it before it goes into production.

In the city where I trained, due to the presence of a certain researcher’s clinical trials, the local standard of care for a condition is significantly higher than the national standard. Woe is the hospital that tries to deploy out of the box. I’ve seen it done and it wasn’t pretty, especially if there wasn’t enough physician involvement. If I wanted to be a consultant, I could fund a shoe habit worthy if Inga with the proceeds of tidying up after the dust settles.

Speaking of shoe habits, barely a month ‘til HIStalkapalooza. I’m getting nervous about my footwear choices and meeting Inga in person, but I’m looking forward to helping with photos of the exhibitors with the best wardrobes.

Dr. Jayne

Have a question about medical informatics, electronic medical records, or that itchy rash that won’t go away? E-mail Dr. Jayne.

News 1/19/11

From CONNECT Development Stalls: “Re: ONC. They have apparently decided to retain the CONNECT development contract with CGI. But since ONC is planning for Harris (the incumbent) to re-file its protest, no work will begin for another 3-4 months. The steam continues to escape from the CONNECT program. No word yet on who ONC has selected to replace the prior program leads, Dave Reilly and Vanessa Manchester.” Unverified.

From HITInsider: “Re: tough times in Verona? First, Epic clients complain about problems complying with Meaningful Use reporting requirements. Now I am hearing that during a recent Epic upgrade at Texas Health Resources, the system was down for THREE STRAIGHT DAYS. Recovery from this took an additional four days, with multiple subsystems failures during that time.” The THR problems weren’t related to Epic – it was a simultaneous Citrix upgrade that caused the problem. Epic was fine, according to CIO Ed Marx – users just couldn’t get to it (not that the distinction matters to users, but it probably does to Epic).

From JustWonderin’: “Re: Allscripts. Hearing it will outsource its TSC remote hospital operations. Not clear if it is just legacy Eclipsys or also legacy Allscripts.” Unverified.

From The PACS Designer: “Re: Verizon iPhone 4. InformationWeek provides us with some more aspects of the Verizon iPhone 4 due for release in early February. TPD likes the Wi-Fi mobile hotspot instance that this iPhone generates for five other devices.”

Thanks to Inga and Dr. Jayne for holding down the HIStalk fort during my short break. I am relaxed, sunburned, well romanced, and still picking Mojito mint from my teeth, all obvious markers that I needed and enjoyed some time off. I’m also way behind on e-mail, so I’ll hold the fascinating comments I received about Epic’s sales process until I have more time to assemble them. For those waiting on something from me, I apologize profusely – I’m in a constant state of overwhelmal (if that’s not a word, it should be, and my pipe-smoking doc’s picture should appear with the definition). 

The HISsies voting is closed – thanks to the 988 readers who took part.

I’ve mentioned New Zealand vendor Emendo, which sells the CapPlan capacity planning software for hospitals. The company, whose sales went from $0 to $10 million in its first three years, expects $50 million in revenue in the next three years and will sign deals with additional US partner companies this year.

Former Cerner COO Paul Black is named operating executive of private equity firm Genstar Capital LLC.

Karl Matuszweksi, MS PharmD joins First DataBank as VP of clinical and editorial knowledge base services. He was previously VP and editor-in-chief at competitor Gold Standard/Elsevier.

Weird News Andy has been busy, for sure. He entitles this find as “She must have been a valet girl.” A woman in labor pains drives herself to the hospital ED at 3:00 a.m., where a uniformed valet offers to park her car as she rushes inside. During her admission, she is given bad news: the hospital does not offer valet parking. The car was later recovered, but the grand theft auto suspect has not been. WNA also snorts at this report: cocaine-like designer drugs that are being sold in gas stations labeled as bath salts for $25 per half-gram bottle are causing suicides, poison hotline calls, and hospitalizations, especially in teenagers. Said a hospital’s ED chief, “They will do stuff that they wouldn’t ordinarily do, like dive from a third-story window into a pool.”

HIStalk’s newest Platinum Sponsor is interesting: IRM (Information Resource Management), part of the 34-hospital Inland Northwest Health Services of Spokane, WA. IRM is an informatics solutions service provider (consulting, implementation, management, and outsourcing, with emphasis on Meditech HCIS) and offers hospitals the services of its 300 IT experts, including the Meditech EMR, Bar-Coded Medication Verification Systems, centralized help desk, software development, and Web development via the shared service model, with an average satisfaction score of 4.89 on a five-point scale and a staff satisfaction score of 96%. For physicians, it developed an ASP model for hosting the GE Centricity PM/EMR, secure e-mail, document management, encounter forms, speech recognition, services for faxing and e-prescribing, and interfacing. I’ll make it a point to learn more since I’m interested in what they’re doing. Thanks to IRM and INHS for supporting HIStalk.

Former Cerner analyst Matt Wenzel is promoted from interim CEO to permanent CEO of Hedrick Medical Center (MO). He started with the hospital in 2006 as an IT analyst.

Bill Hamill, formerly of Picis and developer of the VOCEL Pill Phone app for clinical trials data capture, joins PerfectServe as regional sales VP for the western region.

Apple announces amazing Q1 results Tuesday after the market close, with revenue of $26.7 billion, profit of $6 billion, and a staggering 7.3 million iPads ($4.4 billion  worth) sold in the quarter. Apple also moved 14.1 million Macs, 19.5 million iPods (mine being one – love it), and 16.2 million iPhones, even before they were available on Verizon.

East Alabama Medical Center says it will get about $9 million in HITECH money over the next four years, with the first payment expected this year. They’ve spent $78 million to move to electronic systems.

Another Consumer Electronics Show announcement: BL Healthcare shows its remote Healthcare Access Terminal that offers HD-quality videoconference and sharing of medical telemetry data between patients and providers. It runs on the Verizon Wireless 4G LTE Mobile Broadband Network.

Old news that I might have missed: a network administrator at Pardee Hospital (NC) is charged with stealing $615K worth of Cisco equipment. The federal indictment says Joel Kimble filed false warranty claims, had the replacement items sent to his home address, then sold them on the gray market.

Australian HIT vendors had a terrible 2010 caused by delayed e-health projects, global financial woes, and an unfavorable currency exchange. Everybody knows about the hard fall of iSoft, but other companies with negative news are ISCGlobal (sold its claims processing assets for next to nothing), PHR developer Healthe Solutions Australia (went under in 2009), medical information publisher MIMS Australia (losing money, moving offshore), US-based Milliman Care Guidelines and First DataBank (closing down there, with FDB announcing losses), TrakHealth developer InterSystems Australia (borrowing money from parent InterSystems to cover losses), Global Health (reduced revenue), GE Healthcare IT Australia (reduced profit, was considered for shutdown), and Cerner (slim profits). This is an excellent article in AustralianIT.

KLAS announces a new report on clinical decision support, about which I’ll share all I know (which isn’t much: I don’t have the report). Hospitals say order sets deliver the biggest bang for the CDS buck, integration with third-party content doesn’t work very well, and Meaningful Use requirements are hurting CDS development (interesting since MU touts CDS, but apparently has slowed its progress).

HIMSS and Life Sciences Information Technology Global Institute unify (meaning, I assume, that HIMSS bought the San Diego-based organization but didn’t want to sound crass in the announcement by actually saying so). LSIT is developing references and standards for the life sciences market. It sounds ITIL-like.

Pharmacy automation vendor Swisslog buys Charleston, SC-based Sabal Medical, which sells medication software and and the sabalKOW drug dispensing cart for hospitals, for $9 million.

A survey in Japan finds that 10% of that country’s universities use cloud-based e-mail providers such as Google and Yahoo, raising concerns there that those companies don’t reveal where their servers are located, meaning they are likely outside of Japan and therefore not covered by Japanese law in case of privacy issues.

E-mail me.

HERtalk by Inga

Rush University Medical Center (IL) anticipates earning $28 million in federal incentives for its Meaningful Use of its Epic EHR. It went live in 2009 and will have 90% of its office-based physicians up by the end of the year.

DrFirst announces the establishment of its Hospital Services Group that offers consulting services.

Healthcare Information Xchange of New York completes its implementation of InterSystems HealthShare as its core HIE platform.

Michael Gold joins CareCloud as director of product development. He was previously with Sage Healthcare.

ONC awards Accenture a two-year contract to help identify standards and specifications to facilitate clinical data exchange.

More than a few folks have sent me a note asking if they missed the registration link for HIStalkapalooza. To clarify, Mr. H will post all the registration details on the 21st. Meanwhile, I am pleased to report we have lined up celebrity judges for the second annual “Inga Loves My Shoes” contest and the first annual HIStalk King and HIStalk Queen coronation that will be among the festivities there. The latter will recognize the best-dressed attendees, so don’t forget to pack a tux or sparkly dress. Mr. H has agreed to honor winners with amazing prizes, so it just might be worth that extra $25 checked bag fee to bring your party attire.

Speaking of HIMSS events, I was looking through the conference information and a few items caught my eye:

• Over 70 clinical information systems will be connected as part of the Interoperability Showcase. That’s a whole bunch of vendors making clinical data exchange look easy.
• For a mere $23, you can purchase lunch in the exhibit hall, including a drink and dessert. Menus available here. This is the Bistro HIMSS concept we wrote about last year, where companies can rent tables right in the exhibit area and provide food to their guests.
• One month out and so far, 903 companies are registered exhibitors, including 209 first timers. That’s about on par with last year’s numbers. 
• The annual 5K fun run is Tuesday the 22nd at 4:00. Sounds brutal after a day of walking around a huge convention center in heels. No thanks.

Inova Health Systems (VA) selects a suite of Oracle Health Science products for interoperability and analytics.

In yesterday’s HIStalk Practice, I mentioned a bit of juicy testimony from the HIT Standards Committee meeting last week. A reader forwarded this link, with instructions to cue the recording to 2 hours and 49 minutes to hear what Dr. Scott Monteith had to say. It’s worth taking five minutes to hear why he’s not too impressed with the whole Meaningful Use issue.

E-mail Inga.

Sponsor Updates by DigitalBeanCounter

• Texas Children’s Hospital will become the first pediatric hospital in the country to use iPhones with Voalte’s point-of-care communication solution.
• SCI Solutions is providing its access management solutions to NCO Group, a provider of business outsourcing services.
• Sunquest announces its new Sunquest Physician Portal outreach order and results web connectivity solution.
• Grays Harbor Community Hospital (WA) will use Access Intelligent Forms Suite to improve forms barcoding and version control in the ambulatory infusion services (AIS), cardiac rehabilitation, and diabetes education departments.
• T-System appoints Steve Armond as CFO. He most recently served as CFO of American CareSource Holdings.
• Medicity is participating in the IHE North America Connectathon 2011 this week at the Hyatt Regency in Chicago.
• dbMotion will showcase its latest technologies at HIMSS.
• MEDecision publishes an e-book titled Medical Loss Ratios: Important Implications for Care Management.

EPtalk by Dr. Jayne

Dear Dr. Jayne,

Why is it necessary to have a physician at the C-level or vice president level of administration at an academic medical center for informatics? Do the majority of academic medical centers have such a position or are they using a physician champion? What is the reporting relationship between the CMO and CMIO? What are the main job duties of a CMIO?

PeggyBRx

Dear Peggy,

First, let’s talk about the CMIO title. According to CMIO Magazine’s February 2010 issue (which happens to be lounging on my office credenza with the alumni magazines that I leave around because they have awesome cover art) less than two-thirds of us actually have the title. Some of us are Directors of Informatics, Medical Directors, or something else. Being a direct report to the CIO or CMO are each in the 30% range, with around 15% to the CEO.

Now that I’ve fulfilled my physician-esque need to cite data, let’s chat.

In my opinion, what’s more important than the CMIO title is the CMIO role itself. And that can be filled by either a named CMIO or a physician champion with another title, as long as he (or she, even though that same article said that 93% of respondents were men) has a clearly defined role and enough time to get the job done.

Too many organizations try to do the CMIO role on the cheap and add it to a physician with an already full plate, who may or may not know anything about information systems, and may or may not have good peer relationships. The majority of academic medical centers, especially if they are going to be successful, are going to have the CMIO role, whether they call it that or something else. I know of many mid-size hospitals and large medical groups that have also embraced the CMIO.

So what does a CMIO do? (Warning: literature search in progress! You can take the girl out of the medical library, but give her a laptop and a glass of Cab and she’s right back in it.)

According to the September 2006 issue of the Journal of the American Medical Informatics Association, the CMIO leads clinical IT initiatives, engages in strategic planning, participates in vendor selection, manages clinical IT staff, and leads process redesign. I generally agree with those main job duties, but they left out the more glamorous parts of the job:

1. Mediation between primary care disciplines and specialists. Everyone thinks they are the key to patient care. Welcome to the Village, y’all, and stop posturing.
2. Mediation between the Academic faculty and the Community physicians. Some days, you feel like you’re in a bad high school production of West Side Story, complete with Sharks vs. Jets.
3. Hostage negotiator when physician design committees won’t let the facilitators or subject matter experts out of the room even for a bathroom break, because they are too busy haranguing. (Tip: baked goods. Many physicians still bear the psychic scars of “see a donut, eat a donut” from medical school.)
4. Cat herder. Enough said.
5. Last bastion of patient safety. You put on your riot gear and take on the vendor’s CMO, whose code really might kill someone if they don’t fix it. It’s a rare part of the job, requiring confidence and a thick skin. I tend to psych myself up for this by remembering the most hateful attending who ever yelled at me as an intern. Previous military experience is also helpful. Hooah!

I hope this helps. It sounds like you’re on the way to some serious work – best of luck!

Dr. Jayne

Have a question about medical informatics, electronic medical records, or that itchy rash that won’t go away? E-mail Dr. Jayne.

The MU Hearings: DrLyle Goes to Washington 1/18/11

You may have read some stories about the Meaningful Use Hearings this past week. It’s always interesting to read what the regular press picks up on, but I’d thought I’d give you my "on the ground" report as well.

Background: ONCHIT created the Health IT Standards Committee, which is Federal Advisory Committee "charged with making recommendations to the National Coordinator for Health IT on standards, implementation specifications, and certification criteria for the electronic exchange and use of health information." This committee then has five sub-committees or workgroups: Clinical Operations, Clinical Quality, Privacy & Security, Implementation and the Vocabulary Task Force.

Each of these committees is staffed by volunteers from healthcare organizations and various vendors. I give them a lot of credit for spending the time to do this.

The Implementation Committee held a hearing last week on "Early Adoption of Meaningful Use", meaning they wanted to hear from Eligible Providers (EPs) and Hospitals about their early experience in preparing to meet MU requirements for this year. This makes sense. The government is going to potentially spend tens of billions of dollars on MU. It is smart to get a leg up to see if things are going smoothly from the start. And if not, figure out how they can start fine-tuning.

I was asked a few weeks ago to provide some input at this meeting (as an EP). I figured, hey, this is on my bucket list ("give testimony to a federal advisory committee"), so I’ll do it!

My first responsibility was to send in written testimony answering some questions they provided (e.g. tell us about your successes, your challenges, etc.) Next step was to fly to DC to talk to them in person. We would be given five minutes to provide oral testimony, and then there would be Q&A with the committee.

The first day and the start of the second had various HIEs and RECs commenting. Then came the active EMR users who were planning on applying for MU in 2011 (ten representing EPs, another ten representing hospitals). Most were physicians, along with a few CIOs.

While I was hoping to be in some hallowed marble halls, they did have us in a nice large conference room at a local Marriott. The Committee was in a U-shaped formation. Below that was a table where up to five presenters could sit and behind that was general seating for the public.

The following is my summary of the testimony given by these end users, with a slight bias towards the EP testimony. The following were relatively consistent themes, with my comments intermixed:

The good news is that this bill has indeed "stimulated" many organizations to move forward with various upgrades and focus on how to produce quality reports from the data in their EMRs.

But mostly we heard about the challenges.

• This is hard. It’s not impossible, but it’s a higher bar than many had anticipated because the requirements are not simple, nor are they fully explained. Everyone had at least some questions about interpretation. The worrisome thing is that if it gets to the point where users start thinking this is too hard, they won’t even try. I made it clear that I was thankful to be part of a hospital organization which is helping us with this process, but I feel sorry for those EPs who are trying to do it on their own. If you are one of those, make sure you ask your hospital if they can support you in any way and find out if there is a REC in your neighborhood who can help as well.
• There are lots of questions. For example, many wondered whether we could only use the EMR functions the vendor created or whether we could create our own (e.g. do we have to use a vendor’s "Smoking Status" form if we think we can build a better one). One big question I brought up was getting clarity on whether can we use scribes in the exam rooms to help with documentation and orders, as well as use other intermediaries later on to help with data collection (e.g. clerks or nurses to transfer free text into standardized forms).
• Time crunch. There is a very tight timeframe between the release of the requirements, embedding them into EMRs, the "rollout" of the new EMRs, and the updating of workflows and reports to ensure users are actually meeting the MU requirements. The government does not seem to fully appreciate all the steps involved, especially with large vendors who often need 18 months of lead time for making updates and for larger health organizations who then need a lot of time to do system upgrades. Many felt they really need to consider extending the timeframes for future stages, as rushing these upgrades can have some serious risks.
• Resource crunch. This is often a zero-sum game with resources. I was quoted by some media as saying that working on MU meant that our people could not work on other IT projects. That wasn’t exactly what I said, but rather that spending time on MU meant staff had less time to work on ANY other projects. And this can be an issue since the same people who are on MU committees are often also the ones dealing with operations and quality improvement in general.
• We need more flexibility. Not every practice is the same, and requiring 100% mandate of every requirement is not reasonable. My suggestion is that for Stages 2 and 3, they should create a variety of options like the Menu concept in Stage 1. The result should be that every practice could show they are using an EMR meaningfully, but they don’t all have to show they are doing it the same exact way.
• Functionality is not the same as usability. In other words, there is often a large gap between whether something can be done and whether it can be done in a usable manner. A function might meet the requirement’s definition while being very hard to use. An EMR vendor can get MU certification for their functionality whether their usability is great, good, or poor. Fortunately, the government is starting to look into usability requirements for the certification process, so let’s hope they follow through on that sentiment.
• Data sharing alone is never enough. Dr. Reid Coleman from Lifespan had the quote of the day when he said, "Data is like salt water… you need a filter to drink it". I’d also add that it helps to have good plumbing to connect it to the right facilities, and then also to have plenty of glasses available to make it easy for people to get it to the "final foot."
• Standards. There were lots of people saying they would like the government to make standards for a national MPI and for data in general. I loved the line that many people reiterated, saying "We’d rather have one bad standard we can work with than three good ones without a clear winner." On the other hand, we should make it clear we do NOT want the government to make standards about actual functionality – we can and should be creative in that domain.
• The cost of implementing MU may often be more than the actual monies themselves, when you factor in costs for various software upgrades, consultants, and change management. It also sounded like there were vendors charging significant amounts of money for MU upgrades, that consultants were increasing their fees due to demand, and that some RECs are charging doctors even though they are also receiving money from the government to help. One doctor pointed out that the government needs to either make the requirements easier or pay more (and we know they are not going to pay more).
• Certification requirements don’t always exactly match MU process requirements. Someone has to keep a better eye on this.
• Communication with CMS and ONCHIT has not been easy. The Committee pointed out the five different blogs and websites to get information. I’d suggest they consolidate down to one and create a content management system that can expand on the FAQ concept they currently have in place.
• The result of most of the above is that the biggest and the best are struggling with MU… so you have to wonder, how much harder will it be for others? This is an interesting contrast to the recent reports that "many" hospitals and EPs plan to apply for MU dollars based on a recent survey. My hunch is that most hospitals and doctors like to think they will apply for this, but that is altogether different than actually doing it. Considering that less than 25% of EPs even have basic EMRs in place, it will be interesting to see what happens. And in the end, some limited testimony and lightweight surveys will be long forgotten… the proof will be in the pudding.

Finally, it was concerning was that ONCHIT did not even send a representative to the meetings (one of them called in for the morning only). I do believe that the committee will represent us well, so let’s hope ONCHIT is listening to what they say and take serious the fact that there is increasing concern about the scope and timing of these requirements. If their goal is to make it so just 10-20% of the EPs can meet the MU criteria, then the folks from this meeting would say they appear to be doing well. But if their goal is to get over 50%, then they may need to rethink some of the complexity of the requirements and the timing involved in meeting them.

Full details and testimonies of this Committee Meeting are available online.

Lyle Berkowitz, MD is a practicing internal medicine physician, a healthcare IT consultant (www.DrLyle.com) and founder of the Szollosi Healthcare Innovation Program (www.TheSHIPHome.org). He blogs regularly at The Change Doctor (http://drlyle.blogspot.com/).

Monday Morning Update 1/17/11

HERtalk by Inga

From: Florence Bascom “Re: Selling for Epic. A rumor I have heard about their sales team is that their sales executives are not commissioned – which in itself would make it an extremely unique model compared to other HCSW orgs.” Mr. H mentioned his desire to talk to a former Epic sales rep (anonymously of course.) Comments like the above add to the intrigue.

From: Lu Wolf “Verizon vs. AT&T. David Letterman’s take on why fewer drop calls isn’t necessarily an improvement.” Very fun. Now that Verizon officially announces wireless service for iPhones as of February 10th, a predicted 26% of iPhone owners will likely switch from AT&T over the next year. I won’t be changing carriers, primarily because I live in a region where AT&T has much wider coverage. But seriously folks: why isn’t there an option that includes easy workflow, a fast network, and no dropped calls?

The SEC settles with Reza Saleh, a Perot Systems employee accused of insider trading when Perot announced its sale to Dell last year. Saleh, a longtime friend of Ross Perot, agreed to return all the money without admitting or denying any allegations. The SEC will also ask the court to impose financial penalties which could be as high as $25.8 million.

The local paper recognizes athenahealth’s $5,000 contribution to the Waldo County YMCA (MA). athenahealth donates a portion of its profits to organizations that enrich community health; what I find particularly cool is that athenahealth allows its employees to vote for which charitable organizations receive contributions.

Nearly one-third of malpractice claims are the result of mistakes that could have been caught by a surgical checklist, according to a new study out of the Netherlands. Researchers linked the reasons for 294 lawsuits with specific items on checklists and found matches in 29% of the cases. Could this be correct: checklists have been found to save lives and now money, yet only 25% of US hospitals use them?

Sage Healthcare will participate in  a series of workshops sponsored by the Florida Medical Association. The workshops, which include 18 sessions across nine cities, will offer guidance to doctors selecting and implementing EHR systems to meet Meaningful Use requirements.

Sierra View District Hospital (CA) initiates its $13 million, four-year  Meditech EHR implementation. The hospital plans to go live on its first phase by November.

I’ve been very unsettled the last few days, after learning my zodiac symbol has changed. Could it be that I am not adventurous, energetic, enthusiastic, confident, quick witted, selfish, quick-tempered, impulsive, and  impatient, but instead, compassionate, romantic, imaginative, intuitive, selfless, secretive, weak-willed, and a compulsive workaholic? In other words, am I no longer a self-centered, life-of-the-party diva,  but instead just a nice person who works too much? Unsettling, indeed.

Coastal Connect HIE plans to go live with patient data exchange by mid-February. The alliance, which is sponsored by the Coastal Carolinas Health Alliance, includes 11 hospitals along the coast of North and South Carolina.

Catholic Health Initiatives (CO) CEO and president Kevin E. Lofton says his organization will invest $1.5 billion in EHRs and other IT systems between 2010 and 2015. Cerner systems are deployed in larger markets and Meditech in smaller facilities.

Clinical integration provider Valence Health hires Dan Iantorno as VP of information technology.

In his last post, Mr. H mentioned that he and Mrs. H were escaping for a much needed getaway. He checked in with me long enough to share this: “We’ve been here barely more than a day and we’re totally relaxed and pampered. I needed a break more than I realized.” He also added that he took my advice and is sampling the beer, which seems to compliment the gourmet grub and ease the pain of his overexposure to sunshine. Sounds perfect.

Thankfully WNA never seems to rest, sharing news of gamers who hacked into the server of a New Hampshire radiology practice. Seems the Scandinavian infiltrators were hunting for more band-width to play Call of Duty: Black Ops. Per WNA, “They never saw it coming.”

Baylor Health Care System announces its intent to register for stimulus funds and demonstrate meaningful use of EHR. Baylor CIO David Muntz says his organization has spent over $250 million implementing EHR over the least 10 years and that five of its hospitals have successfully standardized its “processes and technologies based on a certified electronic health record.”  My translation for that statement is that Baylor has fully implemented EHR (Allscripts Sunrise, I believe) in five (of 26) hospitals. The remaining facilities will continue rolling out EHR over the next two years.

E-mail Inga.

EPtalk by Dr. Jayne

I’m shamelessly pandering to Meaningful Use with EPtalk, since indeed I am an Eligible Provider. It doesn’t have the same catchy ring as HIStalk or HERtalk, though. Like many physicians, I take issue with the term “Provider” in general. If they needed a word or phrase to summarize those of us on the front lines, the least they could have done is make us “Patient Care Jedi.”

To those of you emailed your greetings and warm wishes, thank you! After several years as a HIStalk reader with the occasional comment or rumor sighting, being on the other side of the screen is a bit strange. I feel like I know you all personally. As a physician, I’m deluged with information from all kinds of sources, but other than FDA drug recall notices, HIStalk is the only one I allow to deliver to my inbox rather than routing into a folder for later. Clicking that link and finding my own writing is quite a thrill!

Several of you have asked for additional details about my background, specifically related to HIMSS, memberships, vendors, and conflicts. There seems to be a common theme about objectivity. Like my other HIStalk BFFs, being part of this team gives me the opportunity to speak candidly about the products on the market today. I have hospital privileges at multiple facilities, so my user experiences have been diverse. I’ve seen (and been forced to care for patients with) the good, the bad, the ugly, and the horrific.

In the interests of full disclosure: Like Mr. HIStalk and Inga, I’ll be attending HIMSS as a regular attendee. My “day job” employer pays for an individual HIMSS membership (as well as my specialty society, the local MGMA chapter, and the Southern Medical Association). A previous employer made me a Life Member of the AMA. Although I’m not currently on any national task forces or committees, that doesn’t mean I haven’t been in the past or might not be in the future. I do serve at the state/regional level in advocacy efforts. I’ve not been employed by any software or hardware vendor. I have never been convicted of a felony and my blood type is O positive.

Now that we have that out of the way… I saw an invite to an AMA continuing education seminar called “High-Reliability Safety: Applications to Healthcare” that’s being held on Wednesday the 19^th. More info here.  They’ll be talking about embedding a “safety management system” in the healthcare environment. Unfortunately, I’ll be attending another tres exciting Meaningful Use Committee meeting at my institution, so if any readers happen to attend, email me with the interesting tidbits.

Multiple media outlets have been talking about the CDC report on EHRs in physician offices. National Coordinator for Health Information Technology David Blumenthal featured it under the extremely optimistic headline “EHR Adoption Set to Soar.” American Medical News was a little more restrained with “Physician EMR use passes 50% as incentives outweigh resistance.” Blumenthal goes on to celebrate the 41% of office docs and 81% of hospitals planning to apply for incentives, but goes on to note that many small practices “still need to learn about the opportunity they have.”

My thoughts on it: take it with a grain of salt. There are quite a few of my peers who are blissfully ignorant about this whole issue; maybe that’s not so bad. As for the study itself, the data was gathered via a physician self-reporting mail sample. Those of us that interview patients know what happens when patients self-report health behaviors – they either double it (exercise) or reduce it (alcohol) so that there’s no way of knowing what the patient is really doing. I think there might be a little bit of creative reporting by my peers here.

The survey looked at full vs. basic systems and although the headline “Physician EMR Use Passes 50%” sounds sexy, a closer look at the numbers reveals that 25% have a “basic” system and 10% have a “fully functional” system. The data doesn’t quite capture what portion of physicians have a system with bionic capabilities installed but are only using it to do the IT equivalent of crushing beer cans. (I recently visited a physician who was using her laptop as a base to stabilize an avalanche of journals, mail, and catalogs. She owns a gold-plated system. It was a shame.) If you dig deeper into the features that allowed a system to at least meet “basic” requirements, you could meet that with a word processor and some scanning software.

Bottom line: if a patient-care study had results like this, physicians would be extremely skeptical about its conclusions.

E-mail Dr. Jayne

News 1/14/11

From Just the Fax, Ma’am: “Re: CSC’s healthcare group. From the confidential e-mail, ‘The market conditions in the overall economy have impacted our ability to build pipeline and to close on those opportunities we have been able to identify and pursue. As a result, financial performance is far below our commitments and we have been directed to improve our forecasts by reducing costs.’ The action: non-billable employees and those billable with less than 40% productivity must take 10 days of PTO or unpaid leave between January and April. IMHO – significant cause is inability to staff opportunities due to implementation consultants leaving right and left.” Unverified.

From The PACS Designer: “Re: XR-EXpress. An interesting image and data viewing software app for the iPhone called XR-EXpress has been released by New Mexico Software. You can manage cases, orders, and patient records easily and also check patient’s exam results.”

Listening: brand new rock-punk from Cage the Elephant from Bowling Green, KY. They’re barely old enough to shave, but they sound good, with some rawness that hints of the Strokes or Pixies. 

On the Jobs Page: Senior Project Manager, Director of Consulting – Healthcare IT, Allscripts V11 Implementation Consultants, Sales Representatives. On Healthcare IT Jobs: Epic Program Director, Enterprise Architect, IT Systems Analyst, HPP Functional Analyst.

Some of the nicest people you’d ever want to know are with Encore Health Resources, starting at the top with industry long-timers Ivo Nelson (chairman) and Dana Sellers (CEO). Encore sponsored the great HIStalk HIMSS reception at Max Lager’s in Atlanta last year, with Ivo, Dana, and our pal Amy getting elbow-deep in the minutiae with me to make sure you had a blast (Ivo made the executive decision to go open bar instead of drink tickets, which saved quite a few of you a small fortune on the overage). They now want to support us even more by becoming an HIStalk Platinum Sponsor, which I appreciate. Everybody knows Ivo – he founded Healthlink and sold it to IBM in 2005. I’m pretty sure EHR (get it?) is following Healthlink’s trajectory of unbelievable growth, solid reputation, and happy consultants (the company is already racking up awards for being a great place to work, so check out their job listings). Encore provides services such as strategic planning, system selection, implementation, optimization, health analytics, and project management. I interviewed Ivo a year ago when nobody (including me) had heard of Encore — he provided some surprisingly heartfelt and profound answers that are worth a re-read, which I just did. Thanks to Encore Health Resources for supporting HIStalk.

William Beaumont Hospitals (MI) expects to get $10.3 million in HITECH money.

I thought of something I’d like to write about: what it’s like selling for Epic. Surely there’s a former Epic iron-mover out there who would talk anonymously. The company claims they do no marketing and implies that their sales process is simple, but there must be more to that story given the large number of big deals they’re signing.

I’m whisking Mrs. HIStalk away for short hiatus somewhere warm and sandy this weekend (Inga’s terse but sincere directive: “Don’t drink the water. Do drink the beer.”) Inga and Dr. Jayne will be handling the Monday Morning Update so that I might travel laptop-free, although I’ll have the trusty iPod Touch for sneaking an occasional, furtive glance at e-mail.

I’ll be closing the HISsies voting in a couple of days, so if you got an e-mail link, use it soon. If you weren’t on the HIStalk e-mail subscriber list as of last Saturday, you can’t vote, sorry. Tying the poll to an e-mail address prevents the usual Internet vote fraud since only those I’ve e-mailed can vote (it worked the same way last year). I know that method excludes those who read by RSS reader or who just cruise over whenever they feel like it, but that’s the only way I could come up with to prevent companies from urging candidate-specific company voting and to hopefully block robo-voting scripts.

ONC’s David Blumenthal hits YouTube to pitch EMRs, citing survey results in hopes of eliciting the bandwagon effect among fence-sitters.

WSJ covers the growing number of patients ordering their own lab tests online, with heart-related tests being the most popular. One patient’s seemingly backward approach struck me as funny: “She says she would call her doctor if she got a worrisome test result.” Most states require a physician order, but the lab companies are hiring doctors to sign them after a quick review of the online request. Sometimes you do wonder, though: do certain tests or medical items really require a physician’s supervision for safety, or is that just a way to prop up the price?

Welcome to new HIStalk (and HIStalk Practice) Platinum Sponsor MD-IT. The Boulder, CO company is the leader in medical documentation for physician offices and clinics, offering them an alternative to “EMR interfaces that require you to become data entry clerks” in creating an using electronic clinical notes. The big picture includes the preferred form of data entry, a chart viewer, e-prescribing software, Internet access to patient records, and provider-to-provider messaging. Specific options include dictation transcribed by medical language specialists; front-end speech recognition as a standalone application or Word add-in; a Web-based platform for creating, storing, and sharing clinical notes; and several EMR options (built into its platform, interfaced to an existing EMR, or a package including the Ingenix CareTracker PM/EMR) that it says let doctors “dictate your way to Meaningful Use.” The company offers its services through a nationwide network of regional offices. Thanks to MD-IT for supporting HIStalk and HIStalk Practice.

As I’m prone to do these days, I moseyed to YouTube to see if MD-IT had anything there. Above is a demo of a doctor using its software.

HHS will open the 45-day comment period for potential Stage 2 Meaningful Use objectives next week. The proposed objectives and measures for Stages 2 and 3 are here (warning: PDF).

Randall Stephenson, AT&T chairman and CEO, tells a Brookings Institution panel that robust broadband will change the healthcare model, particularly monitoring and diagnostics. The head of Time Warner went for the funny bone in his assessment of healthcare bandwidth needs: “We’re just thinking about making more doctor shows.”

EHR users speaking at the Implementation Workgroup of the HIT Standards Committee are concerned about meeting Meaningful Use requirements, mostly involving timelines, cost of compliance, and lack of government guidance. Some I found in my skimming:

• RECS don’t have consistent standards.
• Using a computer during a visit requires doctors to develop an entirely new approach to the patient visit and the time required to document it.
• One practice couldn’t pay its owners because of the cost of an unexpected server replacement.
• A hospital system said it couldn’t get straight answers about some of the requirements, spending 15 hours per week and tens of thousands of dollars in attorney fees. They submitted 21 questions to CMS, with 10 marked as solved even though only one was answered. They submitted eight to ONC and got four answers.
• Several hospitals and practices had to develop their own reports even though they are paying the vendor for a certified product. Those reports had to be changed as CMS and ONC clarified the requirements.
• Customers are being forced to buy software they don’t need. Example: a hospital has its own integration with Google Health, but interpretation suggests they’ll have to buy the unneeded product of their vendor since it was used by the vendor to earn Complete EHR certification.
• The same hospital interprets the regs as requiring them to re-certify their own tools, such as file transfers, every time they apply an upgrade to their EHR or interface engine, with a cost of $8,000 to $10,000 each time.
• From a recent clarification, hospitals must own software that can meet all Meaningful Use requirements, even if defers those requirements for Stage 1.
• Intermountain Healthcare says they don’t think they’ll make the Stage 1 deadline in time at all hospitals, saying they have “a huge and seemingly insurmountable challenge in front of us as things stand today.” They’re not getting timely answers to their questions from ONC and CMS.
• One hospital using a certified vendor with certified quality reports says they’ve had to create their own reports anyway, which they called “an onerous, difficult and time consuming process.” They added, “It is our understanding that only one Epic customer has been able to successfully run all of the Eligible Hospital MU reports.” They’re delaying their attestation.
• One group’s pediatric practices have too few Medicaid patients to quality for incentives, so they aren’t really incented to use EHRs.
• A hospital informaticist expressed concern that too many EHRs are earning certification for Stage 1 that may not be around to move to Stages 2 and 3. He also suggested that usability should be incorporated into the certification process.
• The most entertaining comments came from James Fuzy of Mississippi Health Partners. He says EMR interfaces are too expensive and not standardized and suggests giving hospitals money to do the connectivity because they have the expertise. He doesn’t like mandatory statewide HIE participation since they would have to pay for it even though they have their own HIE. He suggests a Meaningful Use Guide for Dummies since doctors don’t know what it means and most don’t think they money will ever be paid anyway. He says that insurance companies buying HIEs is like “the fox now guarding the hen house” to use the information to direct care; he instead suggests that if insurers want patient data, make them pay the providers for it.

A Weird News Andy diversion: a hospital in what sounds like a dangerous part of Chicago has decided it will no longer accept ambulance patients, saying it can save $25 million per year and increase its outpatient business.

A self-serving Council for American Medical Innovation poll finds that 58% of respondents want the federal government to spend more on medical innovation. As Inga would say, the same percentage also like babies, puppies, and world peace. Never ask if people want something, especially if it sounds noble; the real test is to ask them to hand over the cash to pay for it.

Interesting: a woman whose Wii Fit Balance Board shows her leaning to one side gets checked out, resulting in a diagnosis of Parkinson’s disease. She said, “It’s quite amazing that a computer game was able to point out there was a problem.”

GE Healthcare’s CEO says “the US has snapped back” and it can grow profits 10% per year, although the snapping back seems to refer to increased healthcare spending, which is really not much of an accomplishment unless you like to watch a country slowly going broke.

Transcription software and services vendor iMedX, fresh off several acquisitions, raises $2.5 million in equity financing, increasing its total to $17 million.

The federal government sues New York City’s government for running a Medicaid mill, saying it authorized 24-hour home care for patients without obtaining documentation of need and costing federal taxpayers tens of millions of wasted dollars.

Drug shortages are driving hospitals crazy, but it’s not just them: FDA intervenes to help prisons obtain imported sodium thiopental after domestic supplies run short, delaying death row executions. They’re testing new drugs for their people-killing power.

E-mail me.

HERtalk by Inga

From Wilbur: “Re: Arizona shootings. Bad news on top of horrible news from out here in the great Southwest. Dumb, dumber, dumbest.” University Medical Center fires three clinical support staff members for accessing the medical records of victims of last weekend’s shooting. Officials say they are not aware that any confidential information was publicly released. The hospital has a zero-tolerance policy on patient privacy violations (cheers).

From Claude Noel: “Re: Manitoba eHealth. Saw a weird negative post about the project. Actually the project is going extraordinarily well. This is a very cool project that has had surprisingly little problems with implementation thus far.”

From Z-man: “Re: Moses Cone. I hear that as part of their contract with Epic, Moses Cone has to hire 92 FTEs that Epic screens and approves. Crazy, but I think it is a formula that works.”

NorthShore University HealthSystem launches Epic’s MyChart application for the iPhone, iPad, and iTouch.

Ten Sisters of Mercy Health Systems hospitals are targeting to begin their 90-consecutive-day Meaningful Use validation on April 1. Mercy says it has invested more than $450 million for EHR across its 28 hospitals and has the potential to earn $140 million in incentives.

Honolulu physicians practicing near Kapiolani Medical Center at Pali Momi are forming an HIE and will use the Wellogic Community solution to connect with labs, pharmacies, hospitals, and other providers.

Also from the Aloha state: The East Hawaii Region of Hawaii Health System Corp. commits to meeting an end-of-year deadline to implement EMR (Meditech, I believe). East Hawaii Region hospitals are eligible for more than $7 million in stimulus funds.

HP wins a 52-month, $30 million contract to create a statewide Medicaid HIE for Texas. The project includes creating an electronic health history system for all Medicaid patients.

Former Surescripts exec Kate Berry is appointed CEO of National eHealth Collaborative. Interim CEO Aaron Seib will continue with eHealth as a senior leader.

Are you curious how Gastorf Family Clinic (OK) managed to get their $42,500 stimulus check just two days after applying? A big thank you to Practice Manager Darrell Ledbetter for sharing details on HIStalk Practice. Bottom line: they were committed; their vendor (e-MDs) had the software in time; and they had solid assistance from their REC. Ledbetter says this initial payment alone almost covers what the practice paid five years ago for their EHR set-up.

Other goodies on this week on HIStalk Practice: an interview with Practice Fusion CEO and founder Ryan Howard, who shares some details of his company’s unique business model. Primary care docs and specialists have communication problems that aren’t necessarily improved with HIT. Nuesoft introduces its Nuetopia service and publishes another fun video. You know the drill: sign up for e-mail updates while you are over there. We are about to hit 1,000 confirmed subscribers. I promise to give you a free HIStalk Practice subscription if you are lucky subscriber # 1,000.

According to ONC, recent surveys indicate that 81% of hospitals and 41% of office-based physicians intend to seek Meaningful Use stimulus funds. Only 14% of office-based physicians say they are not planning to apply for incentives. David Blumenthal says these numbers indicate that the Meaningful Use process is increasing the willingness of providers to adopt EHR systems and that, “we are seeing the tide turn toward widespread and accelerating adoption and use of health IT.”

At this week’s advisory HIT Standards Committee meeting, several HIT gurus spoke out in support of including medical images in the next stage of Meaningful Use. Blumenthal agrees that it raises a number of questions worth tackling.

Alvarado Hospital (CA) sends layoff notices to 249 employees, or about 25% of its staff. The layoffs, which begin March 13th, affect 91 nurses, 10 pharmacists, and 13 technicians. Sad situation, but at least the financially troubled hospital gave workers 60 days’ notice.

E-mail Inga.

Sponsor Updates by DigitalBeanCounter

• HealthTrust Purchasing Group aligns with 3M Health Information Systems to offer clinical documentation improvement consulting services and software and 3M IC-10 transition planning services to HealthTrust’s network of 1,400 acute care facilities.
• Picis receives certification for its EDIS, perioperative, and critical care products – all are  compliant with Stage 1 Meaningful Use measures.
  Edwards Air Force Base (AFB) replaces its PACS with McKesson’s Medical Imaging PACS under a new contract with the DoD.
• Nuance announces that 100% of ED physicians across St. Anthony’s Hospital Group (Centura Health) are using Dragon Medical to document patients’ medical reports.
• Memorial Hospital and Manor (GA) chooses ImageNow document management, imaging, and workflow from Perceptive Software for its HIM and registration departments, hoping to phase out paper medical records weighing an estimated 830,000 pounds.

News 1/12/11

From Chi-Town Native: “Re: HIMSS. Their swearing off Chicago as a site for the annual conference helped trigger an overhaul of McCormick Place operations. Now they’re returning in future years.” HIMSS scratches its cross-town pal’s back by dragging all of us attendees back to Chicago in the bleak dead of winter (they call it "spring” there once the vernal equinox is past, even during the snow storms) in 2015 and 2019. Being a skeptic, I still fully expect to find overpriced hotels, surly workers, and the bad weather that vendors love since it keeps everyone hanging around the exhibit hall. Still, I found a list of proposed changes that sound good on paper: outsourced convention center management, allowing competing electrical contractors, letting exhibitors do some of their own tasks like sweeping or plugging in a monitor without having team of nasty union workers threatening physical violence, cheaper setup and food services, and free WiFi everywhere.

From Jerry MindMeld: “Re: Detroit Auto Show. The Car of the Year is one nobody you know has driven. What’s the car equivalent of your EMR? Bentley? Produces a cloud of smog like a 1981 Le Car? A souped-up ‘74 Camaro that only one guy can fix?” I told Jerry that some applications are like concept cars: they look good when being showed off by hot models, but when you try to buy one, you find they don’t really exist. I drive a beat-up econobox that’s seven years old, so obviously I’m one of those Point A to Point B types.

From Hello Larry: “Re: eHealth Entitlement in Canada. Despite what Canada Health Infoway has said about speeding up the Manitoba eHealth project, it is essentially dead due to mismanagement, poor planning, and lack of vision. The health minister, in the December announcement that IBM will run the project for $22.5 million, said ‘there has been no progress made, no clinical EMR consultants hired, and once again Canada Health Infoway has dropped the ball on Canadian taxpayers.’” Unverified.

From Longtime Informatics Professional: “Re: stop the presses. ONC clarifies the difference between EMR and EHR.” Their definition is the same as mine: EMRs are electronic versions of paper treatment records, while EHRs focus on the broader health of the patient and extend beyond a single provider’s walls to share information from all clinicians who provide that patient’s care. Where we differ is that ONC seems to believe such an animal exists, so they use the term EHR universally. I believe that’s wishful thinking and therefore EMR is still correct in most cases (certification as an EHR notwithstanding since that implies theoretical product capability, not actual use). I might also quibble that the R in both acronyms suggest the records (database), not the application(s) that created those records, so I stubbornly stick to calling those data-creating applications “clinical systems” on the hospital side, with the collective end result being an EMR (you can buy applications, but not an EMR unless a single product covers every single hospital department, including diagnostic images). I’m open to reader suggestions for better names since I dislike both of these.

Healthcare Management Systems (HMS) hires two execs: Jack Holt (McKesson) as VP of client services and Todd Redmon (Dell) as VP of customer support.

A Computerworld article suggests that FDA may start regulating hospital data networks that connect FDA-approved medical devices. It points out the now-legendary four-day network outage at CareGroup (BIDMC) in 2002 would have been much worse had they not run medical devices on a separate network that stayed up. Said a GE Healthcare systems designer, “I’ve been to meetings of biomedical engineers. If you ask them if there are any cases where IT has disrupted patient care, all their hands go up.” I’ll argue from the IT side, though: some of those so-called biomedical experts, especially on the vendor side, don’t know squat about enterprise networking — they’re used to just happily plugging their stuff into whatever open network jack they can find without letting anyone in IT know, then high-tailing it when the campus network starts crashing. Maybe both observations highlight the need for IT and biomed to be a single organization, perhaps with FDA oversight when medical devices are involved.

Calling all data geeks: Heritage Provider Network is offering a $3 million prize for creating an algorithm that can analyze patient information to predict which ones will need hospitalization six months in advance, which would allow providers to intervene and save the health system billions of dollars. Teams of any composition can pre-register now for the two-year competition. If you’ve ever worked with neural network training, it’s kind of like that: teams get three sets of de-identified patient data containing inpatient and outpatient encounters, medication dispensing, and outpatient lab results. They develop their algorithms using the Training Dataset, which contains a binary flag indicating whether or not the patient was admitted. Once teams have fine-tuned their algorithms, they run them against a Quiz Dataset and submit their results to see how well they predicted admissions. Then comes the grand finale: qualified teams run their algorithms against a Test Dataset to see if their algorithms merely regress well against a known result or whether they are actually predictive (most of the time, perfect regression curves and neural networks turn out to be dumb when fed additional data points).

I hear that National eHealth Collaborative (the former AHIC Successor that supports the Nationwide Health Information Network) will name a CEO in Wednesday.

Thanks to new HIStalk Gold Sponsor Elumin Healthcare Solutions, Inc. The Sammamish, WA company offers management consulting (selection, contracting, implementation, technology, and clinical transformation), consulting services related to products from its vendor partners (Allscripts, Cerner, Epic, and HealthWare Systems), and the MyWay PM/EHR and Payerpath claims management as an Allscripts reseller. They’re an official Epic Consulting Partner, in case you were wondering. CEO Mark Williams has a long industry history, including time spent at Intermountain and Siemens Medical, so you’ve probably run across him at some point. Thanks to Elumin for supporting HIStalk.
 
Google CEO Eric Schmidt says if he wasn’t running Google and if he wanted to get involved in healthcare IT, he would go to the major research universities to find existing software that could be open sourced, concluding that , “My guess is that a platform like that would be remarkably different from the platforms we are using today.”

Thanks to the 692 folks on the HIStalk Update e-mail list who have voted in the HISsies so far. I’ll send a final e-mail reminder Wednesday and we’ll finish it up. As I predicted, a few readers complained as they always do that (a) the nominees were not much different than last year; (b) I must be involved in a romantic relationship with Judy Faulkner since she and Epic were on the ballot a lot; and (c) I must be clueless to have missed some obvious nominees. To reiterate: anyone could nominate and all I did was take the top four vote-getting nominees (or five in one case of a tie) in each category and put them on the ballot.

I’ve also received a few e-mails about HIStalkapalooza. You haven’t missed anything: the online “I want to come” Web page will go up somewhere around January 21 and will be mentioned here. A rather impressive roster of specialists is finalizing details, like how to make an IngaTini and what time the band’s going onstage.

An article by the now-merged Huffington Post Investigative Fund and the Center for Public Integrity questions the digital divide that may be created as providers with affluent patients are able to invest more resources in electronic medical records that those that care for low-income patients (although if I were a wag, I’d say rich organizations may find their higher income and productivity going down if they buy and implement unwisely). I hadn’t heard of this group: National Health IT Collaborative for the Underserved, formed almost three years ago by groups such as HHS’s Office of Minority Health, a big government contractor, and HIMSS.

NCHICA (North Carolina Healthcare Information & Communications Alliance) is soliciting abstracts for its annual conference at the Grove Park Inn in Asheville, NC on September 25-28. The Word application form is here and is due February 1.

Former Eclipsys sales SVP Jay Colfer joins Prognosis Health Information Systems as EVP of client solutions. OpenView Venture Partners made an investment in the company last month.

Butler Health System (PA) says it has personalized patient care by using a location-driven patient flow and communication solution that includes products from Intelligent InSites (RTLS), Ekahau (patient and equipment RFID tags), and Vocera (caregiver voice communications).

The Supreme Court will decide whether states are allowed to ban the sale of prescription data to drug companies. Vermont outlawed the practice, but was sued by data mining companies and drug trade groups because that particular lack of privacy protection makes them billions.

HIStalk links to Epic-related stories provided so many incoming hits to website of The Verona Press that its top stories of 2010 had to be separated into Epic and non-Epic lists. They nicely mentioned HIStalk specifically. Epic articles outdrew other big news stories about deer season, a sausage factory fire, and bear sightings.

E-mail me.

HERtalk by Inga

From Not Sheldon: “Re: Project Shoes. Last night’s Big Bang Theory TV show contained an idea for a smart phone application for a program where you can take pictures of cute shoes, and then learn where to buy them. Of course I thought of you.” I don’t know the TV show, but I love the app! It’s Shazam for Shoes! And speaking of shoes, Mr. H asked me if I wanted Dr. Jayne to provide some surgical shoe covers to help protect my shoe identity at our upcoming sponsor lunch at HIMSS. Of course I turned the idea down flat. I suppose he doesn’t see the sense in lugging a extra pair of shoes to Orlando when the shoes may only be worn an hour. I’m sure plenty of readers understand that sometimes it does make sense to pack six pairs of shoes for three days of travel.

Geisinger Health System (PA) will implement NextGate’s patient indexing software to enhance the sharing of clinical data across the organization.

Northeastern Pennsylvania HIE picks Covisint ExchangeLink to provide clinical messaging support for its participating physicians.

Southern Ohio Medical Center implements MetaCare IntelliDocs clinical documentation solution.

Keystone HIE (PA) and partner GE Healthcare announce plans to expand the region’s HIE to augment its chronic disease management capabilities. Area health case workers will have access to KeyHIE functionality to retrieve cross-team communications and receive auto-generated notifications of patient encounters.

IBM and Complex Medical Information Systems implement HIT solutions built on Lotus Notes Domino in several Russian public hospitals .

Spending for EHR by all providers is expected to grow to approximately $3.8 billion in 2015, with ambulatory EMR making up $1.4  billion of that number. A mere $2 billion was spent on EHR in 2009, including $633.5 million for ambulatory EHRs. That’s an overall compound growth rate of 11.5% and a whopping 14.2% in the ambulatory space. Just in case IDC Health Insights’ numbers are anywhere close to correct, you best hold on tight for the ride.

Michael Critelli, the former CEO of Pitney Bowes, is appointed president and CEO of Dossia, for which he had been serving as board chair.

Staggering: treatment costs for diabetes grew from $18.5 billion in 1996 to $41 billion in 2007. That includes $10 billion for outpatient care and $19 billion for prescription drugs. Nineteen million American adults were treated for diabetes in 2007, twice the number as in 1996.

With the hottie Dr. Jayne now on board, I am am more focused than ever on maintaining my youthful appearance, so this new, free iPhone app has come none too soon  Beverly Hills surgeon Dr. Payman Simoni created it to let users to see how they might look with a bit of enhancing. You can upload a photo of yourself and then play around to create a new nose, face lift, or the like. I went for the eyebrow lift. I think it makes me look more surprised than young, so for now, I’ll continue seeking the fountain of youth.

 E-mail (the un-enhanced) Inga.

Dr. Jayne

By now, you’re wondering, “Is Dr. Jayne really a physician? Does she actually see patients? Does she know what she’s talking about? Does she ever go out for cheeseburgers and beer, or perhaps the amusing house wine?” and other questions. The answer to all these (and many more) is yes! And so, Dear Readers, a bit more information about the newest HIStalk correspondent:

By day, you’ll find me in the CMIO trenches. By night — well, we’ll save that for another time. The life of a CMIO is never dull; there’s always a fire to be put out somewhere, and usually an angry physician behind the scenes holding a lit match.

I can’t blame them, though – they’re faced with tremendous changes that sometimes seem to threaten their core identity. Healthcare delivery didn’t change much for decades, but the past fifteen years have been Mr. Toad’s Wild Ride. Not only in the science behind the practice of medicine, but in how we are compensated, the equipment we must use, and the rules we must follow to care for patients. There are few industries that have gone through this pace of change. Physicians claimed E&M Coding was going to be the ultimate downfall of medicine in America. Meaningful Use makes that look tame by comparison!

My colleagues who view the profession as a calling tend to take this just a little bit personally. Each one of you has worked with these physicians. I spend a good chunk of time with docs like these, doing something between hand-holding and crisis counseling, depending on the person and the situation. Thank goodness for those psychiatry rotations that taught me never to sit between the agitated patient (or colleague) and the door.

When I’m not working directly with physicians, I’m exercising my clinical brain, working on evidence-based order sets, protocols, formularies, clinical reporting, training strategies, and making sure anything new is communicated in duplicate and triplicate for my colleagues who still refuse to read their e-mail (although I bet they use Facebook to see pictures of their grandchildren, but just won’t admit it.)

Speaking of Facebook, a shout-out to my new friends! I have a long way to go to catch up with Mr. H and Inga.

I also see patients, in an old-school, white-coat kind of way. I use the same systems that my colleagues claim I am using to interfere with the practice of medicine, force them into retirement, or otherwise torment them.

When I’m not handing out Kleenex or making sure we are doing quality clinical work, I exercise my technical brain. This is the part of me that loves playing “vendor Jenga” to see if we can actually make diverse clinical systems communicate with each other while using an amount of staff resources equal to half of what we asked for. Pull out the lower blocks and stack them on top – without toppling the tower! Tricky but challenging, and extremely rewarding when it works.

I enjoy working with our analysts and technical teams and helping them understand why (or why not) a particular piece of software is going to be accepted by clinicians or if we need to budget for our Implementation Analysts to start wearing Kevlar. And if they’re nice to me, I write my own SQL queries to get at information I want. And if they’re not nice to me, I might just play the “doctor card” and make sure they have no idea that I even know what Management Studio is. I also work closely with our vendors and doing the odd bit of development work and focus groups.

So, Dear Readers, now you know my skill set. Send me your provider-centric thoughts, questions, and conundrums. These will be answered in our new “Dear Dr. Jayne” feature – although I’ll be responding with a glass of wine in hand and you’re on your own for Kleenex.

E-mail Dr. Jayne.

 Sponsor Updates by DigitalBeanCounter

• Voalte partners with Rauland-Borg Corporation to integrate Rauland-Borg’s Nurse Call with Voalte’s iPhone communications solution.
• MED3OOO’s InteGreat EHR V6.4 earns ONC-ATCB certification through CCHIT. MED3OOO also announces the appointment of Jim Altenbaugh as VP of tech services implementation and training.
• Vocera Communications acquires Wallace Wireless, a developer of software to deliver pages, text messages, and alerts directly to smart phones. The acquisition is Vocera’s fourth since October.
• Lancaster Hospital selects ProVation Order Sets from Wolters Kluwer Health.
• Chadron Community Hospital contracts with Keane Healthcare Solutions for the full suite of Keane Optimum applications, including Optimum Clinicals.
• Geisinger Health System is using Precyse’s NLP coding software and  M*Modal’s NLP voice to text technology to enhance its clinical documentation and coding.
• Vermont Information Technology Leaders (VITL) selects Greenway’s PrimeSUITE EHR to leverage its REC; Colorado Regional Extension Center (CO-REC) does the same.
• Greenway also partners with DiagnosisONE to provide clinical decision support for its EHR deployments.
• NextGen releases v.5.6 SP1, offering several new enhancements such as clinical quality measures for Meaningful Use and 5010 healthcare transaction compliance.
• iMDsoft increases its global presence compliments of its MetaVision Suite, which went live at 45 sites, 11 countries, and in seven languages in 2010.
• OSF St. Joseph Medical Center (IL) renews its multi-year contract with GetWellNetwork and goes live with GetWellNetwork’s system integration for its Epic-based EMR.
• San Luis Valley Regional Medical Center (CO) signs a five-year technology outsourcing contract with CareTech Solutions.
• Holon Solutions will participate on an HIE panel at iHT2 Health Summit in Atlanta.
• CapsuleTech is hosting an enterprise device connectivity  webinar on January 19th.
• Nuesoft announces its Nuetopia service that combines its EHR, billing software, and revenue cycle management services.
• Bridgehead achieves a 40% year-over-year income increase for FY2010 thanks to its focus on the healthcare vertical.

Monday Morning Update 1/10/11

From EHR Geek: “Re: Vitalize. Mr. HIStalk, why didn’t you post the Vitalize purchase of Validus on your real page? It’s only on the HIStalk Fan Page of Facebook.” I was torn on that one. I had just blasted out the SIS news and I couldn’t decide if this item was of broad enough interest to justify another e-mail (I don’t want to give readers alert fatigue), so I just posted it as a Facebook status item until the next scheduled post (this one). That’s another good reason to Friend/Like us there since I usually post news blasts there, too. Anyway: Vitalize Consulting Solutions acquires (warning: PDF) Minneapolis-based Validus Consulting, which has around 60 consultants providing strategic advisory and project leadership services. Vitalize, which offers strategy, EHR implementation, revenue cycle, project leadership, and application / technical resources, says it’s now the largest privately owned HIT consulting firm, with more than 450 consultants. I hadn’t realized that former Allina Excellian (Epic) VP Kim Pederson, who I interviewed awhile back, is a Validus principal. I also didn’t realize until Googling something else that industry pioneer Bill Childs, who just won CHIME’s Lifetime Achievement Award, is a Vitalize VP (there might be no HIStalk if Bill hadn’t broken the HIT journalism ground with Healthcare Informatics). I know and like the Vitalize folks and I’m amazed at the company’s growth under CEO Bruce Cerullo, a long-time friend of HIStalk. 

From Jerry MindMeld: “Re: joke of the day. Dr. Blumenthal was at Congress yesterday during the reading of the Constitution. He looks over at the stenographer and realizes they are typing every word spoken for the entire day, every speech and every vote. He leans over to the guy sitting next to him and says, ‘Jeez, I wish we had that in my industry — it would make practicing medicine a lot easier.’" I’m here all week – try the veal.

From The PACS Designer: “Re: Dimdim. Mr. H, since you now can’t use Dimdim collaboration software due to Salesforce.com’s privatizing it, why not go to Yugma, which is another collaboration application on the web?” I will give it a look. The biggest differentiator among the Webinar-type tools is how well they record and archive the session, especially the audio portion. I also liked ReadyTalk. I’m kicking tires because I really like the idea of providing some kind of education at a higher level of quality than you usually see (i.e., less of a commercial pitch).

From Leopold Stoch: “Re: Paul Levy. Stepping down as CEO of Beth Israel Deaconess.” I guess John Halamka’s boss is down to blogging as a job for now, but I’m sure he will have many opportunities.

New HIStalk contributor Jayne (or Dr. Jayne if you or she prefer) introduces herself below. What sold me on her: (a) she writes well and in a non-stuffy HIStalk way; (b) she’s funny; (c) she has a great education and medical experience; (d) she works in an informatics role, but still maintains a medical practice, so she knows a broad swath of the industry; and (e) she’s an HIStalk fan and gets what we do. E-mail her your greetings if you like. We thought a recurring “Ask Dr. Jayne” feature would be fun, so let’s have any questions you’ve always wanted to ask an informatics doc (what does she think of EMRs, how important is usability, how does she interact with the EMR in the exam room, etc.) Her brand new Facebook is looking a bit bare, so I’m sure she could use a friend or two there.

Listening: Young Fresh Fellows, a Seattle-based alt pop band that’s been around for 30 years. I played their 2009 album and immediately bought it for the gym iPod, which almost never happens. Their music is hard to categorize – sometimes its Pixies punkish, sometimes REM jangly, but it’s always fun (extra points for using “bereft” in a lyric and then rhyming with it).  

I’m intrigued by these poll results: 52% of readers plan to keep the same job and employer in 2011, but a full 42% are expecting to land a better job, either with the same employer (18%) or a different one (24%). Only 3% expect to move to a worse job, with about the same percentage saying they’ll retire or quit this year. New poll to your right: what are your plans for the HIMSS conference?

Thanks for your HISsies nominations. I’m e-mailing out survey ballots this weekend, so watch your inbox and please vote. Thanks, too, to readers who nominated Inga and me for several categories even though the instructions said not to.

HIMSS government relations VP Dave Roberts posts the organization’s priorities for the new Congress, the main ones being keep HIT bipartisan and keep the HITECH money flowing despite all the good reasons it shouldn’t. He also lists what he says are the priorities of HIMSS members, such as establishing a Meaningful Use grievance process and spending even more taxpayer dollars, this time on “health IT action zones.”  He asks for feedback.

Say hello to new HIStalk Platinum Sponsor Shareable Ink. The Nashville-based company’s concept should resonate with quite a few hospitals and practices: you shouldn’t have to disrupt clinician workflow to move to electronic health records. Shareable Ink’s enterprise-grade digital pen and paper technology lets clinicians keep documenting the way they like without turning themselves into patient-ignoring keyboard zombies, yet it translates their work into digital, discrete, and shareable EHR data as if they’d labored over a keyboard instead. Anybody can implement it quickly since there’s no software running on site (it’s zero-footprint Saas) and there’s no boondoggle IT project standing in the way of hospitals and practices anxious to move to EHRs and collect their HITECH checks. It integrates (with registration, EHR, CDR, etc), it pre-fills forms from inbound interface data, and it makes paper smart with form-based electronic rules and outbound alerts (e-mail, SMS, page). You don’t have to force behavior change on set-in-their-ways ED docs and anesthesiologists (not to mention that 90% of hospital daily progress notes are, of course, written by hand and that’s a tough battleship to turn). It must be cool since T-System, whose paper forms (T-Sheets) are an ED mainstay, chose Shareable Ink to power its DigitalShare electronic ED encounter documentation system. Shareable Ink also just released an analytics package that lets organizations mine all the handwritten data it converts, so paper documentation from anesthesia, ED, and progress notes can be electronically reviewed for quality and efficiency metrics without chart pulls. Thanks to Shareable Ink for supporting HIStalk.

I turned myself on a little writing about Shareable Ink, so I headed over to YouTube to see if there was a demo. Here’s one from a year ago, as co-founder and CMO Vernon Huang MD (sounds like a fascinating guy: Hopkins biomedical engineering degree and GWU MD, practicing anesthesiologist, worked for Apple, was a Navy flight surgeon) shows how his sloppy doctor handwriting (sorry, Doc) is turned into an electronic record without his doing anything.

The Walgreens drugstore chain, in my mind, leads the way with consumer-friendly mobile apps for their patients / customers (text alerts, patient-scanned barcodes for prescription refills, health risk assessments, kiosks, EMR, e-Prescribing, etc.). The company’s CMO moderated a digital health session at the CES Digital Health Summit. Too bad the rest of healthcare doesn’t have such clearly aligned incentives (invest in technology, sell more stuff as a result, make more money, everybody’s happy).

Drug maker Roche files suit against a software company it bankrolled and intended to acquire. Medical Automation Systems had agreed to be acquired by Roche for $40 million, but then got a better offer from a competitor. Roche sued, saying it has right of first refusal and shouldn’t be required to participate in a bidding war. The company’s RALS software is used in the Accu-Check and CoaguCheck point-of-care monitoring systems to send results to hospital clinical systems. Wish you’d thought of it, right?

The promotional video for the just-announced new version of the Microsoft Surface coffee table thingy shows people collaborating over radiology images and ultrasounds. It reacts to both touch and objects, where it “seamlessly merges the physical and digital worlds.” It works like a massive iPad on four legs, accepting all kinds of gestures and manipulation. I have to say it seems cool and a pretty good deal, with the new version priced at $7,600 compared to the original’s $12,000 price tag. Imagine an EMR built for a screen that size run by touch – docs would love it. It would also be amazing for patient teaching, but you’d have to bring the patient to the Surface instead of vice versa (unless someone invents a SOW – a Surface on Wheels).

Speaking of the Surface, I found this old picture of MEDHOST’s ED dashboard running on it. I found pretty much no information on MEDHOST’s site about it, so I don’t know if they still offer it or if anyone ever bought one. It looks good, though.

Eris Medical Technologies, created in a Youngstown, OH incubator, will provide its erisRX charge capture management software to Florida Hospital Orlando. Founder Jennifer Wexler used to work at FHO as well as Orlando Health, while co-founder Kelly Bucci comes from Deloitte. 

We had a slip-up in Friday’s post due to a bogus news alert (old Web pages sometimes suddenly pop up as news – I’ve been burned by that a couple of times). Mark Briggs is still CEO at HIE solution vendor VisionShare, which he joined in May – the link we ran was to an older (undated) press release from when he took an earlier job.

J.P. Morgan’s healthcare conference runs this week. Ben Rooks wrote about why you should care (or not) in his HIStalk column from a year ago.

e-MDs says CMS’s first HITECH check for a physician practice went to one of its clients just two days after CMS registration opened. Gastorf Family Clinic (OK) got $21,250 each for its two doctors. They told doctors they’d get big checks and that one’s ginormous.

Speaking of HITECH registration, CMS says 4,000 providers registered for EHR incentives in the first four days after its site went live on January 3.

Inga and I have decided that we should have vendor tee shirts made for HIMSS that read, “Want to be profitably acquired? Sponsor HIStalk.” The list of sponsors recently completing successful transactions (these would be listed on the back) includes Medicity, Ingenix, Picis, Sentillion, Eclipsys, eScription, Sunquest, and now SIS. There are plenty more, but those are some of the larger and more recent ones.

Philips buys Pittsburgh-based medSage, developers of an automated telephone-based system for home health patients to reorder supplies. Their executive bios are fun: “Bob is the ‘Old Guy’ on the medSage Team … has been in the healthcare industry for over 30 years (our abacus will not go any higher) … Bob is the ‘Really Big Guy’ on the medSage Team. (If you have met Bob in person, you know what we mean!) For that reason, Bob is to be Mr. October, November, AND December in the 2009 medSage Team promotional calendar.” Let’s hope they keep Bob happy since if they don’t, it sounds like he’s got a couple of potential discrimination suits to choose from.

A judge overturns a community college’s dismissal of four nursing students for posting cell phone pictures of themselves posing with a placenta on Facebook. The instructor of the students told them it was OK to take the picture as long as any identifying information was removed, even though the students told here they planned to post the pictures on Facebook. The student whose case set the precedent for the others is worried about her reputation preceding her for an eventual job. “I am concerned that my name is all over the Internet. All you have to do is Google ‘placenta.’” She’s right – above is my Google News search result, complete with her smiling placenta pose.

E-mail me.

Why Me? 
By Dr. Jayne

Let me just start by saying that I’ve idolized Mr. HIStalk and Inga for quite some time. So when Mr. H posted that he was interested in finding someone to help out, I was tres excited. I put together a few thoughts, crossed my fingers, and clicked “send” with visions of IngaTinis dancing in my head. A few spins of the planet later, here I am, excited to be part of the HIStalk family!

Why did I want to write for HIStalk? First, I wanted to be able to provide a physician perspective on hot topics in healthcare IT. Now that Meaningful Use is finally here, understanding the real impact the new rules are having on patient care is going to be important. Who better to talk about it than someone who is actually seeing and treating patients?

Don’t worry though, I’m a serious IT staffer (also a shoe aficionado, so the chance to work with Inga was a huge part of this, but we’ll save that for later) who lately spends more time talking the IT talk and walking the IT walk than personally caring for patients. But I still see enough patients to be able to regale you with strange-but-true stories about what happens on the other side of the exam room door.

Second, I enjoy expressing my creative side, love writing, and am fluent in a variety of poetic forms. Healthcare IT words are just about as hard to rhyme as medical words; although it might be possible to rhyme “ruptured appendix” with “clustered index” it would have to be a really special poem to make that work so you’ll all just have to keep reading and see what I come up with. (A special shout out will go to the first reader who pulls that one off.)

Third, IT systems and patients are more similar than most people would think. When they’re healthy they’re happy and you enjoy going to work every day, and when they’re “sick” they can drive you mad. I’ve spent the last several years of my career trying to help bridge the gap between “the IT people” and “the clinical people” and being able to do that on a larger scale seemed cool. We all want the same things – and if I can give the “computer guys” and the “doctors that just hate the system” some tips and tricks to better interact with each other, then I’ve helped make all of our lives a tiny bit better.

Finally, a tiny part of me wanted a guaranteed invite to HIStalkapalooza (OK, maybe it was a very big part). Although I suppose as a team member I’m likely excluded from the “Inga Loves My Shoes” and HIStalk Queen contests, I might try anyway, so dust off those shiny taffeta ball gowns and the ruffled tuxedo shirts, and I’ll see you there.

Say hello to Jayne.

Norwest Equity Partners Acquires Surgical Information Systems

Surgical Information Systems announced this morning that private equity firm Norwest Equity Partners has acquired the company from Vista Equity Partners, its owner for the past four years.

“By maintaining our focus on the financial engine of the hospital, SIS has achieved year-over-year growth that significantly exceeds industry averages. We have also enjoyed success in the perioperative area during some of the most challenging economic conditions in memory,” said SIS CEO Ed Daihl. “Demand for perioperative-specific information solutions is rapidly growing, particularly in anesthesia solutions, and our new partnership with NEP represents the continued evolution of the company.”

The 50-year-old Norwest Equity Partners, headquartered in Minneapolis, manages $4.6 billion in capital, focusing on building middle-market companies. Its major limited partner is Wells Fargo & Co. The firm’s other healthcare IT investment is communications vendor Amcom Software. According to the announcement, the SIS executive management team will remain in place.

SIS executives we spoke to said that hospitals are focusing on the perioperative area in preparation for healthcare reform and potentially declining reimbursement since it contributes up to 60% of hospital margins. That makes the OR and anesthesia business of SIS a highly attractive investment, they told us, with anesthesia alone having a 24% annual growth rate.

The Alpharetta, GA company’s growth has been organic, with new customers, exclusive industry endorsements, and expanded technology partnerships. Its perioperative software was recently certified as a modular EHR.

SIS customers were notified by an e-mail today from Ed Daihl, who described the acquisition as “a new phase of growth that will benefit you with the accelerated delivery of new, innovative software solutions that will support your efforts to optimize the delivery of perioperative services.”