Monday Morning Update 9/26/11

From My Little Pony: “Re: Epic. They’re recruiting programmers from Hong Kong.” The job posting says Epic is looking for Hong Kong software developers, with paid relocation to Verona. Epic will have a recruiting team in Hong Kong in November. I found the list of solutions the noobs might be working on interesting: genomics and proteomics, telemedicine, creating software that adapts to the individual user, developing next-generation user interfaces, and adding gesture recognition. Epic always resists the idea of outsiders setting usability standards that vendors would be required to follow, but it sounds as though the company has something potentially big in the works. Another version of the same ad is aimed at developers from Singapore.

From Gluteus Max: “Re: Epic being perceived as ACO ready. Epic is good at storing and presenting data, but it’s not good at doing useful things with it. If the ‘Epic Octopus’ business model theory is correct, that’s very much by design. Analytics and data sharing are two of the most important features ACOs will need, so it’s difficult to believe Epic is ‘close to ACO-ready.’” Unverified.

From Verona Notes: “Re: Epic. Now has 266 customers, up from 224 last year and 190 two years ago. Future vision shows Epic is listening to usability criticism, such as software that understands the physician-patient conversation and readies documentation and orders. Unsurprising stock tip: IBM servers dominate competition in internal Epic tests. Amazing logistics for so many people, but starting late=disrespect.” Unverified. There’s that usability thing cropping up again.

From Bea Fragilis: “Re: Epic. To what extent are Epic-certified people allowed to make changes to local hospital code? My sense is that those changes must be minor, documented, and controlled from Verona.” I’ve heard that Epic will let responsible customers change source code and will even provide them with programming standards and documentation to help, although they don’t encourage everybody to start hacking around. I’m interested in that answer as well, not to mention how the customer gets access to the source code (or the extent to which application behavior can be controlled through external hooks).

From MT Hammer: “Re: front-end speech recognition. A new study finds that it results in 800% more errors in patient reports compared to transcribed dictation.” The study, published in the American Journal of Roentgenology, finds that 23% of reports created with front-end speech recognition (i.e., you dictate into a microphone and your words immediately appear on the computer screen) contained at least one major error vs. only 4% of those created from standard dictation and human transcription. Overall, the error rate with speech recognition was eight times higher than with human transcription. Interestingly, speaker accents didn’t make much difference, but imaging modality was a predictor of error rates. I don’t have access to the full text of the article, so I would be interested in radiologist’s analysis (such as the significance of issues defined as errors, why the radiologist didn’t catch the mistakes on the screen when using speech recognition, etc.) Also keep in mind that this compared only two transcription options, with the third being back-end speech recognition like that of the former eScription (now Nuance), which I believe has much higher accuracy since it can consider context and history rather than just pronunciation (similar to what transcriptionists do).

From The PACS Designer: “Re: Windows 8 tour. Microsoft has revealed aspects of its new Windows 8 platform for developers to peruse. Windows 8 will be tightly integrated with a new Internet Explorer 10 using a next generation internet platform called HTML5.”  The problem with pre-iPhone cell phones is that they worked like tiny, underpowered PCs with crappy keyboards. I’m not sure we need the opposite problem – PCs that work like huge iPhones – especially since touch screens are extremely rare in PC-land and the point is lost anyway since you’re either sitting in front of a desktop keyboard or a laptop. My understanding is that Win 8 will have two user interfaces, one for mobile use and one for desktop. MSFT had better make sure not to screw up the latter in trying to pander to those who yearn for an iPhone clone as their primary device.

From King Coal: “Re: HIStalkapalooza. Which night? Looking forward to it with bated breath.” Don’t count on it just yet. The potential sponsor had some venue contracting issues and won’t have enough space  to handle the historically large turnout (and waitlist.) I may end up cancelling it for Las Vegas, leaving you to read your HISsies winners online instead of seeing Jonathan Bush’s one-man show crafted around them (and that I really will miss).

My Time Capsule this week from 2006: The VA Outperforms Private Hospitals in IT Vision and Resolve. An aliquot: “Like a tailor-made suit, VistA was developed to meet the VA’s needs, not those of a vendor’s ‘average’ hospital customer. Just as hospitals talked themselves into buying instead of building (helped along by vendors and risk-averse CIOs,) the industry’s darling turns out to be a homebrew job.”

Reporters and TV stations have gone crazy with their lazy, press release-sourced coverage of the prospect of turning healthcare encounters over to the Jeopardy-winning IBM Watson (most common lame headline: “The computer will see you now”) but readers here weren’t equally impressed with its announced use by WellPoint, with most saying IBM and WellPoint will get the benefit instead of patients and providers. New poll to your right: now that Sage Software has announced plans to sell its healthcare division to Vista Equity Partners, who will benefit most from that transaction?

I’ve enjoyed Vince’s HIStory series immensely, to the point that I suggested that the pre-1980 industry pioneers get together at the HIMSS conference to reminisce (and knowing some of those folks, perhaps tipple a tad). Shelly Dorenfest, Bob Pagnotta, John DiPierro, and David Pomerance are a few of those who have said they’ll be there. If you know them, you should be there, too. Drop your e-mail info on this form and Vince will be in touch. Think of it as a 30+ year class reunion of the College of HIT Hard Knocks.

This week’s e-mail from Kaiser boss George Halvorson talks up the company’s newly won Davies Award win, also mentioning that Kaiser hospitals make up 35 of the 60 HIMSS EMRAM Stage 7 hospitals and that the remaining KP hospitals are all Stage 6. And despite early reports of HealthConnect availability problems, he says KP has won six awards from the Uptime Institute, the only healthcare organization to ever win (although as a counterpoint, that’s data center uptime, and plenty of ways exist to knock users off systems even though the server is chugging along). He also mentions some employee-recommended technology projects that have been funded by KP’s internal innovation fund: an automatic glycemic calculator, a hospital capacity prediction tool, and an SMS appointment reminder system.

Weird News Andy finds this story about hospital drug shortages and the resultant third-party profiteering scary. I’ll elaborate from experience to scare him more. Even if you ignore the possibility of obtaining counterfeit or impure drugs when forced to buy from secondary channels, the patient safety risks with drug shortages are considerable. Product packaging and sometimes concentrations differ from what nurses and doctors are used to, greatly increasing the chance of wrong drug / wrong dose errors. Sometimes the backup drug is therapeutically similar but chemically inequivalent, meaning doctors are forced to use a drug that wasn’t their first choice and one they may not be all that familiar with, making it more likely that something will go wrong. Shortages come and go all the time, so information systems can’t be kept current to steer prescribers to the one currently being used, sometimes requiring IT workarounds that neuter electronic protections such as dose and allergy checking. Those drugs may have similar active ingredients that are still different enough to trigger unexpected drug allergies and drug-drug interactions. My analogy is always this: suppose you’re about to have open heart surgery, but the drugs your surgeon always uses are on shortage, meaning the surgeon will have to compromise with a less-desirable drug that they’ve rarely or never used. You’d be mad at someone for letting that situation occur. The problem here is that everyone involved claims to be innocent and powerless.

On WNA’s slightly lighter side (it involves death, so it’s still not all that light), he captions this story as “Spinal Tap’s drummer?” Coroners in Ireland review the death of a man whose body was found burned in his sitting room, with no damage to the floor on which it rested, no evidence of foul play, and no signs of the source of the flame.  They conclude that he died of spontaneous combustion. A retired pathology professor ruled out divine intervention, saying, “I think if the heavens were striking in cases of spontaneous combustion, then there would be a lot more cases.”

A good article covers the high cost of children’s hospitals, with the Nemours Children’s Hospital (opening next year) in Orlando leading it off. The 95-bed hospital, being built in a city that already has two large and notable children’s hospitals, will cost $400 million ($4.2 million per bed) and was approved by the state only after the well-funded Nemours called in some political favors. Mentioned about high-profile children’s hospitals in general: lack of financial transparency, fast-rising costs accompanied by big executive paychecks and impressive construction projects, big financial war chests, and only tiny amounts of charity care provided. I can say from experience that those multi-million dollar children’s hospital CEOs have the ultimate weapon to keep the donor and political largesse flowing – feel-good happy ending stories of miraculous medical work accompanied by fuzzy-focus, intentionally heart-tugging pictures of adorable babies and toddlers. Your hospital will lose every time if your particular medical miracles involve less Hollywood-like episodic interventions on behalf of elderly patients, the chronically and incurably ill, psychiatric patients, and that particularly colorful stratum of society that shows up in the ED full of street drugs, hostile microbes, and intentionally inflicted wounds.

Don Berwick says CMS administrator is the best job he’s ever had, but he’ll lose it on December 31 unless the Senate confirms him by then. No confirmation hearings have been scheduled.

The New York Times covers telepsychiatry, where patients receive counseling sessions via Skype or specialized Web apps like Breakthrough.com. Says a psychologist, “In three years, this will take off like a rocket. Everyone will have real-time audiovisual availability. There will be a group of true believers who will think that being in a room with a client is special and you can’t replicate that by remote involvement. But a lot of people, especially younger clinicians, will feel there is no basis for thinking this.”

An OB-GYN subpoenas Bellevue Medical Center (NY), demanding a list of every person who accessed the Internet from the hospital on a particular day in 1999. The doctor is trying to find the person who posted defamatory comments about her on a physician review site, claiming she has reason to believe it came from a particular NYU doctor. The hospital says it keeps access logs for only 30 days, but the doctor’s legal team found a computer forensics expert who claims he knows a sophisticated (and undoubtedly expensive) way to bring back 12-year-old records.

E-mail Mr. H.

News 9/23/11

Top News

The British government says it will “urgently dismantle” the failed $18 billion NPfIT project in favor of locally controlled initiatives after a series of gloomy reports from government auditors, with the final report released Thursday concluding, “There can be no confidence that the programme has delivered or can be delivered as originally conceived.” NHS will keep only the parts that work (e-mail, the appointment system, PACS, and the communications infrastructure). They also admit that the cost of getting out of various big-dollar contracts will probably exceed the cost of just paying out the rest of the money specified in the vendor contracts. The co-director of a patient advocacy group summarizes, “Thank goodness politicians have decided to stop money being poured into a huge bottomless pit. Now we must pray that they don’t sanction pouring it into endless incompatible regional pits.”

Reader Comments

From Steve Stifler: “Re: Epic UGM. Judy’s dreams of world domination are beginning to seem credible. Carl Dvorak was very clear that he doesn’t want videos of the meeting showing up in HIStalk and nobody wants Judy mad at them.” That’s Judy in costume above. Several readers sent over photos and links to unlisted YouTube videos from the meeting. I’ll be nice to Carl and Judy and not run them here, especially since they wouldn’t be all that interesting to anyone without an Epic connection anyway.

From Graying CIO: “Re: Epic UGM. This image says more to me than any other about the power and scope of Epic. Buses for the user group meeting attendees snake into the distance next to a two-acre hole in the ground that will be a future 10,000+ seat auditorium, replacing the 6,000-seat one that is too small. Others were struck by the image as well – I saw at least five people whip out their phones and take the same picture. The interesting thing about the executive overview (two hours of insight opened by Judy Faulkner and closed by Carl Dvorak about Epic, the healthcare IT environment, and Epic product development) is that it was positive and Epic is clearly on a growth tear, but that ICD-10 and Meaningful Use have drawn all of the focus and attention for the past few years and will continue to do so. Epic is responding well, but Carl was very clear that these topics have interfered with innovation both within Epic and by its customers.”

From CommunityHIZ: “Re: HP firing its CEO. I think this whole HP thing is a ruse orchestrated by Hammergren. This is kind of like Alabama thanking God for Mississippi every night before bed. With HP in shambles, nobody will focus their attention on Hammergren’s self-created mess at McKesson. (For those who don’t know, Hammergren serves on HP’s board).” More below, including my slightly critical evaluation of HP’s board (“the most inept board in America”) when they hired the guy not even a year ago.

From NoNeedHere: “Re: Accretive Health lawsuit. Juicy details in the legal documents.” A summary from the proceedings: revenue cycle management vendor Accretive Health hired an SVP over revenue cycle operations at four hospitals even though he had basically zero revenue cycle experience. He was fired and sued the company claiming sexually and racially discriminatory conduct by a mid-level supervisor, while the company said his work was substandard and hospitals were complaining about him. The district court found for the company and the US Court of Appeals affirmed the judgment in favor of Accretive on Wednesday. I’m blurring the names, although they’re in the public record if you really care.

From Larry Leisure: “Re: Sage. Unloads healthcare division. What a mess over there. I’m running for athena as fast as I can.” Thanks to Larry for e-mailing me about the announcement this morning just a couple of minutes after it came out. He probably knows that I like scooping everybody, which I believe I did in getting out a quick news blast since I happened to be at my desk at the hospital at the time. I actually think the news is good for the healthcare group. Let’s be honest, Misys and Sage shared more than their British heritage, financial software focus, and US EMR company ownership – they were never really all that interested in the US healthcare market other than for its potential to boost their predictable but unsexy profits. You’ve got to be kidding me that Sage’s CEO is blaming HITECH and healthcare reform for messing up its PM/EMR cash cow, especially when the unit booked a not-too-shabby 13.5% profit margin in the latest financial report (maybe the healthcare management team could do OK if it weren’t for the transoceanic shackles.) I can only interpret his statement to mean that once customers got a taxpayer-funded incentive to increase their EMR investment, they took the opportunity to look elsewhere. If I were a Sage Healthcare employee or customer, I’d be clinking the champagne flutes that the Brits are turning tail and letting the historically successful Vista Equity Partners take over the franchise, even though it’s likely they’ll be doing some painful but necessary cost-cutting (you can do the math: they’re paying about 1.4 times revenue or 10x annual profit, so a margin boost is needed to justify the price.) Your thoughts (anonymous if you like) are welcome since I’m just a cheap-seater here. What’s good about this deal, what’s bad, and what should Vista do?

From THB: “Re: McKesson vs. Epic. Are we back in court again for this? The issues the parties were asked to brief are: If separate entities each perform separate steps of a method claim, under what circumstances, if any, would either entity or any third party be liable for inducing infringement or for contributory infringement? See Fromson v. Advance Offset Plate, Inc., 720 F.2d 1565 (Fed. Cir. 1983).” This is the case in which McKesson sued Epic for infringing on its patent involving Web-based doctor-patient communication, such as for appointment and refill requests. The district court tossed that case out in April 2011, saying that McKesson couldn’t prove that Epic or any other single party performed all the steps in the claimed infringement by Epic’s MyChart.

HIStalk Announcements and Requests

The latest good stuff from HIStalk Practice: athenahealth and meridianEMR update their Meaningful Use dashboards. Mitochon Systems blasts fellow free EHR vendor Practice Fusion for its “over-reaching claims.” A whopping 90% of physicians say they use at least one social media site for personal use. Julie McGovern shares insights on software upgrades, compassion, and expectations.  Speaking of expectations, I expect you to sign up for HIStalk Practice e-mail updates when you take a peek at these stories. And thanks for reading.

Inga’s away schmoozing around at some conference, so the little red squares will be in scarce supply today. She will be back by the time you read this.

Listening: Opeth, genre-bending progressive metal from Sweden. Not for everybody, but I like it.

We like readers signing up for our e-mail blasts, connecting with us on Facebook and LinkedIn, sending us rumors, and supporting our sponsors. Since you are smart, we will trust you to take that subtle hint.

On Healthcare IT Jobs: Epic Applications Systems Analyst – Ambulatory, Data Warehouse Architect, Business Intelligence Developer, Epic Beacon Consultant.

Welcome to new HIStalk Platinum Sponsor MedAssets of Alpharetta, GA. The company provides solutions for revenue cycle (patient access, charging coding, UM, billing, A/R management, etc.); supply chain management (contracting, sourcing, inventory management, distribution, A/P); resource management (decision support, performance analytics, process improvement, workforce solutions), and consulting services. Their elevator pitch is easy to understand – they will sustainably improve provider operating margins by 1.5% to 5%. Case studies on their site include Fletcher Allen Healthcare ($12 million in benefit from contract management improvements and  data-supported contract renegotiations), Cooper University Hospital (reduced A/R days from 60 to 37 and added $43 million to the bottom line), and Westchester Medical Center (identified $8.9 million in supply chain savings by using analytics to examine costs right down to the individual screws used in orthopedics). Note and appreciate their non-animated ad. Thanks to MedAssets for supporting the constantly clacking keyboards of HIStalk.

Acquisitions, Funding, Business, and Stock

The bumbling HP board fires its equally bumbling CEO Leo Apotheker after 11 ugly months on the job, hiring former eBay CEO Meg Whitman to replace him. Apotheker, the third fired HP CEO in six years, gets a $25 million parting gift to go away. SAP canned him after only seven months before HP inexplicably brought him in on a golden throne, so he raked in dozens or maybe hundreds of millions in his total two-company CEO tenure total of 18 months. I said this when HP hired him in October 2010:

Speaking of SAP, HP and “The Most Inept Board in America” choose the former CEO of SAP to be HP’s next CEO. SAP fired the Germany-born Leo Apotheker after a disastrous seven months as CEO, although some say he was the scapegoat for a terrible company strategy that predated him. HP is paying him like he’s a star: $1.2 million in salary, incentives of 200-500% of that with $2.4 million guaranteed, $72 million in options, a $4 million signing bonus, and $4.6 million in moving expenses (that’s a lot of U-Hauls). I’ll go with the summary of Oracle CEO Larry Ellison: “I’m speechless. HP had several good internal candidates … but instead they pick a guy who was recently fired because he did such a bad job of running SAP.” Their pre-Hurd CEO pick was an ultra-expensive termination, too: HP’s value dropped in half after Carly Fiorina orchestrated the company’s merger with Compaq. She was let go in an ugly fight about the time the company admitted that it spied on the personal phone records of journalists and its own board members trying to find out who was leaking information about its strategy.

Sales

Ellenville Regional Hospital (NY) selects Craneware’s Chargemaster Toolkit-CAH solution to atuomate its charge master management process.

The University of Texas MD Anderson Cancer Center chooses MedQuist’s Speech Understanding and Natural Language Understanding platform from M*Modal for its ClinicStation EMR and RadStation radiology systems.

Swedish Medical Center (WA) signs for Microsoft Amalga for coordinating care and managing populations.

Announcements and Implementations

Biggs-Gridley Memorial Hospital (CA) will go live on the Prognosis ChartAccess EHR in January.

The Gorge Health Connect (OR) HIE creates a video that shows how it’s using the government’s Direct Project (via Medicity) to connect providers in a pilot project.

Vodafone signs a deal with NantWorks to develop mobile healthcare services. That’s the new name for the technology companies owned by Patrick Soon-Shiong, the physician and drug company founder whose $7 billion net worth earns him the #39 spot on the Forbes list of richest Americans.

Innovation and Research

A study published in Health Affairs finds that the Meaningful Use Stage 1 hospital CPOE threshold of 30% of orders probably won’t have much impact on heart-related Medicare deaths, but the proposed 60% Stage 2 threshold should be enough to move the outcomes needle.

David Bates will lead a team of researchers from Brigham and Women’s Hospital in using supercomputer-powered analysis of the hospital’s EMR data to look for complex correlations among patient characteristics, genetics, drug interactions, and outcomes of heart failure patients. They hope to create computer models that can help choose effective heart failure interventions.

Other

Beacon Partners’ ACO Readiness Study finds that only 15% of healthcare organization respondents are “very familiar” with ACOs and 61% say they are “somewhat familiar.”

Speaking of ACOs, providers view Cerner and Epic as the vendors that are most ACO ready. 

St. Rose Hospital (CA) is cutting 10% of its workforce due to problems that include “complications involving a new McKesson computer system that went live in late June, the recession’s impact on the hospital’s fragile bottom line, and managed care contracting snafus, including a two-week period in July when ‘we were not able to get bills out,’ [CEO] Mahoney said.”

Former National Coordinator David Blumenthal, now back at Harvard, talks up EMRs at a Boston event. He talked about his own long-ago personal experience with EMRs, although I’m never clear what kind of practice he had or whose EMR he used. Some of the docs in audience apparently made negative comments about time required to use the EMR. One said, “The computer is really like that third person in the room, and a 2-year-old at that. It’s hard to manage” Blumenthal urged patience, saying, “The current crop of products is not the crop we will have in five years. However, we will be just as unhappy with the crop we have in five years because our imaginations will soar ahead of reality.”

University Medical Center (NV) lost $70 million last year, but the CEO says he thinks next year’s move to electronic medical records will save money in the form of reduced labor costs and errors.

Sponsor Updates

• Indiana University Health Bloomington and Paoli Hospital go live on McKesson’s Horizon Patient Folder electronic document management system.
• Greenway Medical Technologies announces that its PrimeSuite EHR client, Alpine Urology, is the first practice to connect to CORHIO’s HIE. 
• The Pittsburgh Technology Council awards TeleTracking Technologies its Tech Titan MVP award.
• TeleTracking’s user conference will be held next month in San Diego.
• MEDSEEK announces GA release of Quick Response Codes to facilitate the patient marketing programs of hospitals. 
• Anesthesia Business Consultants and iMDSoft announce their partnership to offer a complete AIMS and anesthesia billing solution.
• Joan Coner of maxIT Healthcare is recognized in Strathmore’s Who’s Who Worldwide Edition for her 20+ years of contributions and achievements in healthcare consulting.
• Orion Health announces receipt of ONC-ATCB 2011/2012 certification of its Clinical Portal V7.0.
• Covisint releases a new whitepaper entitled Performance-Based Care for Accountable Care Organizations.
• MediServe clarifies newly announced changes to Medicare Part C Advantage plans.
• GE Healthcare will introduce an HIE in Australia. 
• The Rothman Institute  (PA/NJ) selects the SRS EHR for its 100-provider, 14-location practice.
• Michigan Health Information Network Shared Services engages OptumInsight for its HIE platform.
• Central Penn Business Journal names MEDecision to its list of 100 Best Places to Work for the third straight year.
• MD-IT announces the addition of Quality Transcription Services to its Medical Transcription Service Organization Associate program.

EPtalk by Dr. Jayne

Lots of folks are talking about the recent Department of Health and Human Services plan that would allow patients direct access to their laboratory test results. The proposed rule involves three HHS agencies: CMS, CDC, and the Office for Civil Rights.

Changes to the Clinical Laboratory Improvement Amendments (CLIA) are required to allow this. Patients would be able to receive copies of their lab reports on request. When faced with patients receiving lab results directly (as opposed to receiving them from their physician or another health professional), many physicians react negatively.

The consumerization of healthcare has had profound impacts on how care is delivered. Patients are better able to participate as a member of the healthcare team, which is good. However, the potential impacts of releasing lab (or any other diagnostic testing) data directly to patients should not be overlooked.

These are not uncharted waters. Many health systems already release data directly to patients, often after a delay of a day or two to allow the ordering physician to review the results and contact the patient. Others release results only after the ordering provider has signed off, again presumably to allow a conversation with the patient where needed.

Physicians worry that direct release of lab data to patients (particularly without annotation) will generate a flurry of phone calls. Before I used an EHR, I would mail each patient a copy of their lab results with my notes / comments / care plan written directly on the results. It was efficient and made for clear documentation in the chart. The occasional “abnormal” result of no significant consequence was simply marked “OK,” and 99% of patients did well with this approach. Of course, there was always the occasional patient who would call wondering if their low chloride level (one point below cutoff) was a health concern, despite the “OK.”

Radiology reports are a little trickier. Narrative reports are sometimes less clear and informative, particularly if you deal with (as I have lately) a radiology group that refuses to definitively address what they see and instead dictates a jumble of “might be” and “can’t rule out,” punctuated by the always-present “clinical correlation needed.”

My health system releases both lab and radiology reports to the patient through a secure portal, but only after a time delay. Depending on the nature of the test, the delay is shorter or longer. For example, blood tests such as cholesterol levels are released after a day or two, but CT and MRI scans are held for seven days. This gives us time to contact patients about their situation before they see the results.

Since we’ve been doing this, I’ve had several patients who had significant concerns about what they’ve seen on their reports. Many patients, even after they’ve heard from the team about their results or changes to the care plan, head straight to Google to find out what all those big words mean. What they see sometimes leads to panic and fear.

When patients in this situation call, my recommendation is to add them on to the schedule same-day or as soon as possible. Unfortunately, talking about it on the phone lacks the face-to-face reassurance that patients often need. If they come in, I can pull up the films and we can review them together along with any Internet articles they’ve been reading. The visit is reimbursable and provides an additional opportunity for health counseling or disease management education.

It will be interesting to see how lab vendors decide to handle this. Most will probably go with online patient portals, I’d guess. Depending on how often your insurance carrier or provider changes lab vendors, this could lead to multiple places where patients have to access their data over time, assuming they decide to provide the information in an ongoing fashion vs. a one-time release.

Do you work for a laboratory provider? How is your organization planning to address this? E-mail me.

Contacts

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

Sage Healthcare Sold to Vista Equity Partners

Sage Group PLC will sell its Sage Software Healthcare unit to private equity firm Vista Equity Partners for $320 million in cash, the British company announced this morning. The sale is expected to be completed in November.

Sage CEO Guy Berruyer said in a statement, “The sale of Sage Healthcare allows management in the North American region to focus on the considerable opportunities that exist within our core U.S. customer base.”

He was also quoted as saying, “When we bought this business, we could not have predicted that the Obama administration would change the market in the way it did. This business was contracting and it had moved away from our core strategy. Our North American business has been performing less well overall. Selling the healthcare business will allow our US team to concentrate on our business priorities again.”

Sage said it will take a loss of up to $108 million on the sale of the former Emdeon Practice Services, which it acquired for $565 million in August 2006. In the most recent six-month reporting period, the healthcare division earned profits of $15 million on revenue of $111 million.

News 9/21/11

Top News

Aetna, Humana, Kaiser Permanente, and UnitedHealthcare will pool five billion medical claims records in a data mining initiative to identify trends in cost, utilization, and intensity of care. Beginning in 2012, the not-for-profit Health Care Cost Institute will combine 11 years’ worth of records from the carriers, publish scorecards, and support analysis of aggregate trends to qualified researchers.

Reader Comments

From Wilbur: “Re: Aventura. Did you already get this? You interviewed Howard Diamond for the HIStalk Innovator Showcase. Really neat company, people, and technology.” Denver-based Aventura HQ, which offers a clinician front end for EMRs and other systems, raises $13 million in its first round of institutional vendor funding. I profiled the company in late July. Wilbur isn’t a shill, by the way – he sent this non-anonymously and he has no vested interest in the company (nor do I.)

From Elane Twofer: “Re: UPMC electronic medical records alteration. I’m puzzled why that is central to peer review. Mr. HIStalk, please provide some advice and your wonderful wisdom.” The trial begins in Pittsburgh of a lawsuit brought by a deceased patient’s family against UPMC Presbyterian (PA). The family claims that doctors caring for a 62-year-old inpatient failed to note in his electronic medical record that he would be difficult to intubate. He experienced respiratory distress, exacerbated by a nurse who inappropriately gave him a tranquilizer to calm him down, and doctors could not establish an airway. He died. The family’s attorney says UPMC’s EMR transaction records show that its head of quality assurance tried to add a red-letter “Dif Intub” warning to his EMR three days after he died. The hospital says the entry was for peer review purposes rather than to favorably falsify the records. I know this reader and I believe the hope is that I’ll expound against EMRs from this example, but I’ll take the opposite approach. I’ve been on various hospital committees (death, tissue and transfusion, etc.) and I’ve seen first hand paper charts that were falsified after the fact by doctors and nurses to cover their butts after making mistakes that harmed patients. It wasn’t hard to suspect they did it (the handwriting was clearly different, the change was present only on the original order and not the copy, etc.) but hard to prove. If the family is correct, UPMC’s own electronic records will provide the inarguable evidence. Score: EMR 1, paper 0. I’d like it even better if standards were in place that would physically protect all electronic documentation transactions from database-level changes, journaling every entry, change, and deletion as a permanent record that even IT uber geeks could not destroy.

From Ludmila: “Re: NJ chapter of the American Academy of Pediatrics. Apparently there’s about to be a blowup over its PCORE (Pediatric Council on Research and Education) section accepting money related to referring practices for HITECH, which it isn’t allowed to do as a 501(c)(3) corporation.” Unverified. I e-mailed the organization and received no response.

From Sepulchre: “Re: Meaningful Use. Frequent reader, first time I’m posting a question. No one has been able to answer this. In getting your ‘certified’ system and achieving MU, what happens if the user decides to change vendors? During that kind of transition, you would expect your reporting on objectives could be impacted and you might not meet them for the year. Do you incur penalties from Medicare during that time? Seems like a great setup for vendors. Once you use them and achieve MU, you must keep using them to avoid penalties.” Hopefully my really expert readers will weigh in.

From Reluctant Epic User: “Re: McKesson ad. Do you think they’re struggling in the large hospital market because their marketing department thinks people are still running Pocket PCs?” I like the irony of the “Better Technology” headline right beside some old and not-so-good technology, but their problems are more related to Horizon than what it runs on.

From Space Ghost: “Re: newsletter. Writing headlines must be a tough job.” The mistake is especially notable since it came from Government Health IT, whose parent company has HIMSS (or HIMMS, if you prefer) as a majority owner. The correct spelling is obviously the first word of the article, so someone went out of their way to screw it up.

Acquisitions, Funding, Business, and Stock

Practice Fusion announces that it has received over $6 million in additional funding from several new investors, including Western Technology Investment (an early Facebook investor) and Scott Banister (Idealab, IronPort.)

EMR vendor SuccessEHS acquires the MediaDent practice management, electronic dental record, and dental imaging solution from MMD Systems. SuccessEHS will offer the integrated solution to Community Health Centers, including the 190 that are already its customers. 

Transcription vendor MedQuist raises guidance and announces a $25 million stock repurchase program following its recent acquisitions of M*Modal, All Type Medical Transcription Services, and JLG Medical Transcription Services.

India-based technology vendor Wipro says it’s looking to acquire US-based health and life sciences companies, especially those with analytics and mobility products and companies involved in revenue cycle management. Wipro also says it will benefit from ICD-10 conversions as US work is offshored to India and the Philippines.

The Advisory Board Company launches its new logo and Web site, which emphasize its research work plus newer offerings that focus on technology applications and healthcare support. An interesting history of its logo over the years says it started as a drawing of the townhouse owned by the founder’s mother (the company’s first headquarters, in 1979), followed by the Jefferson Memorial-related logo that was used for 20+years, then finally the new version that’s based on a revolving bookstand designed by Thomas Jefferson to allow him to check multiple references at once, a prototype of the database (which also happens to look like the letter A.)

I keep forgetting that The Advisory Board Company is publicly traded, so here’s how shares have done over the past couple of years compared to the S&P 500 (green) and Nasdaq (red). An ABCO share bought for around $25 two years ago would be worth over $60 today.

People

Meditech announces that family physician Steven Jones, MD will join the company to act as lead its EHR development efforts. He has served on the company’s Physician Advisory Committee.

MedAssets reports in an SEC filing that Neil Hunn, president of revenue cycle technology, is leaving the company to pursue “other career opportunities.” He joined the company in 2001, was promoted to RCT president in January 2011, and leaves with $570,000 in separation pay. Meanwhile, Greg Strobel (above) moves from president of the revenue cycle services business to president of the MedAssets RCM segment.

Bayhealth Medical Center (DE) names Lynn Gold as senior director of information services and telecommunications. She was previously with GE Healthcare.

Announcements and Implementations

Mobility is here to stay. It’s tactical in a sense because it is a device that allows people to do their work differently. Physicians and other clinicians are falling back into workflows that are natural to the work they are doing. They were forced out of that workflow with the advent of technology 25 years ago when they would have to go somewhere to log on to a PC. They had almost forgotten that they used to do rounds at the bedside. Now it’s conceivable and practical for them to be able to do that. The patients feel a higher level of engagement because of the tools.

Ophthalmologists at a UK hospital work on OpenEyes, an open source ophthalmology EMR.

Government and Politics

HHS’s Text4Health Task Force issues recommendations to HHS regarding text messaging and mHealth apps: a) develop and host evidence-based health text message libraries and make them available to the general public; 2) develop further evidence on the effectiveness of health text messaging programs; and, 3) explore partnerships to create, implement, and disseminate health text messaging and mHealth programs. 

In Australia, Queensland Health is negotiating with Cerner for a $249 million (US) hospital clinical systems contract, with the opposing political party claiming that health officials changed an independent report to give Cerner an edge and that the technical information Cerner provided was inaccurate.

Senior executives and physicians from Ireland are visiting the VA this week to learn more about its VistA system.

A newspaper article says patients are somewhere between surprised and offended at being asked for their ethnicity and race during physician visits, newly required by the Affordable Care Act. An ophthalmologist says many patients cross out the “race” question and one patient answered “the Boston Marathon.”

Innovation and Research

Researchers in Spain are working on a “garment-based patient biomonitoring platform,” or smart shirt, that will monitor vital signs and patient location.

AHRQ offers guidelines for future and current EHR users on avoiding unintended consequences. Credit to Joe Conn of Modern Healthcare, whose article about this came up in an unrelated Google search I was doing.

Texas Heart Institute releases a free iPhone and Android app to train medical students in auscultation (listening to the heart). It was developed by James Wilson MD, director of cardiology education.

Technology

I ran across this interesting (and free) tool. Chatter is like a private, secure, and hosted Facebook, a social network for businesses that allows co-workers to push out updates, share files, and solve problems. Signup for the hosted app requires only a company e-mail address, and the network is private to users within that domain. Clients are available for iPhone, iPad, BlackBerry, Android, and the desktop. It’s owned by Salesforce.com.

An article on MIT’s Technology Review profiles speech recognition software in healthcare, specifically Nuance’s Clinical Language Understanding.

Other

Posted on Twitter:  a picture of the opening session at Epic’s user group meeting. The poster notes, “This is a big auditorium!” Epic is expecting 11,500 attendees, including 6,500 customers, for the four-day event in Verona. Another tweet from a Stanford University physician: “35-45% US pop covered by Epic EMR, 2% of world pop covered, $92 billion in claims in 2010!”

Here are more Epic UGM photos from a reader. Thanks for sending them over. Above is the lunch tent built for the conference. They’re offering horse carriage rides and bikes for exploring the back trails. The theme is “Once Upon a Time” and attendees were invited to attend Tuesday’s opening session in musical costume as Judy was to do (I’m thinking Ziggy Stardust drag or Insane Clown Posse makeup). Your updates and photos are encouraged.

The American Nurses Association signs on as partner in Care About Your Care, a healthcare wellness awareness initiative supported by the Robert Wood Johnson Foundation, AHRQ, and ONC.

In what are believed to be the harshest prison sentences ever for Medicare fraud, a federal judge orders 50-year and 35-year sentences to American Therapeutic co-owners Lawrence Duran and Marianella Valera. The company billed Medicare for over $205 million in claims over eight years for mental health services that were either not required or never provided to patients. They were ordered to pay $87.5 million in restitution.

The Honolulu Police Department tries to figure out how to bring criminal charges against one of its officers for posting a hospital bed photo of a suspect on Facebook. The patient had been badly burned while trying to steal copper wire, giving the officer creative inspiration for the Facebook caption, “See when you like steal copper.”

Sponsor Updates

• A 12-member GetWellNetwork triathlon team led by CEO and Founder Michael O’Neil raised $36,000 for The Leukemia & Lymphoma Society in The Nation’s Triathlon in Washington, DC on September 11, 2011. The team’s donations led all national participants as it honored the memory of Justin Thorton, who died of leukemia at 19 earlier this year.
• 3M partners with Clinical Architecture to offer 3M Healthcare Data Architecture, a terminology-mapping interoperability and data standardization solution.
• Iatric Systems adds a clinical quality measure component to its Meaningful Use Manager product and earns expanded ONC-ATCB certification.
• CynergisTek and Diebold will partner to showcase their “Smart Hospital” security model at The Healthcare Facilities Symposium and Expo September 20-22.
• Alan W. Portela, CEO of AirStrip Technologies Inc. will participate as a panelist at the AdvaMed 2011 MedTech Conference September 26-28.
• API Healthcare partners with Role-Based Practice Solutions to track, manage, and develop professional role competencies.
• Colette Weston of ADP AdvancedMD provides a 5010 transactions update based on progress by AdvancedMD and partner RelayHealth.
• CaroMont Health (NC) selects RelayHealth to facilitate HIE among the hospital, employed physicians, and affiliated physicians.
• Healthwise SVP Molly Mettler will moderate a panel discussing shared decision-making at the World Congress Leadership Summit September 22-23.
• Highline Medical Center (WA) selects Wolters Kluwer Health’s ProVation Order Sets for its healthcare campuses and 20 clinics.
• Prognosis HIS clients Parkview Hospital (TX), Stonewall Memorial Hospital (TX), and Throckmorton County Memorial Hospital (TX) qualify for MU incentive funds using the ChartAcess EHR.
• Monongahela Valley Hospital signs a multi-year agreement to use Thomson Reuters Micromedex solutions for evidence-based clinical reference information.
• EHR Scope reports that its free online service EMRConsultant.com has made over 5,000 referrals so far in 2011.
• NYU Langone Medical Center establishes the Joan H. Tisch Center for Women’s Health, which will incorporate Epic’s EMR technology and palm scanning identification from PatientSecure.
• Allscripts is named a finalist for the Chicago Innovation awards.

Contacts

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

Monday Morning Update 9/19/11

From LongTimePharmacist: “Re: CPOE. A clever video done to YMCA. We all need some CPOE laughs now and then.” I like it. I always look for tiny glimpses of hospital reality: the nurse with charge stickers all over her top, the well-used Tabasco bottle on the table in the doctors’ lounge, and the drug shortage list taped to the pharmacy wall. The “everybody in the pool” finale is subtle and appropriate. They did a nice job.

From Cassie: “Re: hospital performance. The hospitals that have spent millions on EMRs and CPOE and have meaningfully mediocre outcomes to show for it.” A New York Times article contrasts hospitals on Joint Commission’s annual quality report (those who were 95% compliant with specific treatment standards) to reputation-based lists. Not even one of the hospitals listed on the US News & World Report Best Hospitals Honor Roll made the Joint Commission’s list, meaning tiny, no-name community hospitals and podunk VA hospitals beat Johns Hopkins, Cleveland Clinic, Mass General, and every hospital in New York City. That latter omission raised the ire of the president of the Greater New York Hospital Association, who said healthcare is complicated and any one list can’t be definitive. Which is correct, but it still illustrates the obvious: big academic medical centers excel in some areas (eye-popping architecture, richly compensated superior diagnostic and surgical talent, and excellent teaching and research capabilities) and lag in others (patient satisfaction, getting meds administered on time and rooms cleaned on schedule, and delivering solid outcomes cost effectively). I’ve worked in both small community hospitals and large academic medical centers and have concluded that for the latter, it’s tough to scare employees into rule-following when mediocre professors get jobs for life under the tenure system, service employees are paid market-excessive salaries to assuage organizational social guilt, and almost nobody gets fired or laid off even when they deserve it.

From Burnt Umber: “Re: new Epic hospitals. [Hospital A] and [Hospital B] are going with Epic.” I contacted the CIOs at the unrelated hospitals, who responded quickly and cordially that they are close to making a decision. They asked that I not run anything just yet since their final negotiations might be messed up as a result (as one of the CIOs said, “I am a dedicated reader and I know the impact that this could have.”) Both offered to talk to me afterward about who they chose and why, which will be a far more compelling read than me just quickly blurting out their rumored choice. I’ll have more in a few weeks.

From The PACS Designer: “Re: innovative IT solutions. TPD salutes Texas Health Resources for being recognized by InformationWeek for developing an innovative IT solution by integrating an automated risk-assessment tool with its electronic records system to cut down on blood clots, which are a leading cause of hospital deaths. Other healthcare IT solutions from Christiana Care Health System, Lehigh Valley Health Networks, and Kaiser Permanente were also recognized for using IT to innovate healthcare processes.“

My Time Capsule editorial from 2006 for this week: Few Threats to Healthcare IT’s Big Three. I named the Big Three inpatient vendors that were leaving competitors in the dust, which just wasn’t said in polite company back then.  A sample: “I don’t see anyone catching up to these Big Three, with the possible exception of dark horse McKesson. GE Healthcare, Siemens, Eclipsys, Misys, and others may get an occasional full-system sale, but they’re mostly fighting over crumbs.”

Vince’s HIStory this week covers Intermountain Healthcare (IHC), Part I of a two-parter. E-mail Vince if you can help him out with fun facts about upcoming historical HIT footnotes AR Mediquest and JS Data.

Most respondents don’t expect HHS to verify Meaningful Use attestation claims all that closely. New poll to your right: who will benefit most from WellPoint’s use of IBM Watson technology?

Dr. Travis covers the use of mHealth by pharmacies and health systems on HIStalk Mobile. 

An article in The Verona Press says that Epic’s user group meeting this week will draw 6,500 guests, with a total attendance of 11,500 counting the company’s 5,000+ employees. It must be like having Woodstock in your tiny farm town. Pictures and reports are welcome. The rain and mid-60s high should give way to sunnier and slightly warmer weather for the conference.

Ten transcriptionists at a Washington hospital, unhappy that their jobs have been outsourced to Webmedx on short notice, want the option to take severance with benefits instead of accepting what they say is a pay cut to to work for Webmedx. The hospital says its contract with Webmedx (the transcription company that was bought in July by Nuance and announced here in June) will save it up to $2 million over five years. The other gripes of the transcriptionists: the jobs they were offered involve sitting in front of a monitor at home waiting for assignments to pop up on the screen when the cheaper offshore transcriptionists aren’t available; they don’t all have broadband connections; some of the work involves editing the output of speech recognition systems instead of transcription (which pays less); and they will be required to transcribe for other hospitals whose doctors and accents are unfamiliar to them. Being squeezed by cheap offshore labor on one side and sophisticated speech recognition systems on the other is not exactly a position of power. That’s a national problem, of course – compared to the old labor-intensive and technology-unaffected factory jobs of yesteryear, we just don’t need as many employees as we have people who need a job.

Last week was the HIMSS Policy Summit, where HIMSS coaches its members to pester Congress to keep spending taxpayer dollars on healthcare technology (aka “advocacy”). Part of their pitch, predictably, was to not derail the HITECH gravy train. Members were also the Charlie McCarthy to the HIMSS Edgar Bergen in asking Congress to support a national patient identifier. You might think that Congress would have more important matters to deal with (a country rapidly circling the drain), as should providers (high costs and lackluster results that are helping cause the aforementioned drain-circling).

UAB Health System (AL) names Jorge Alsip MD as its first CMIO. He was a consultant with Cerner.

Hardly shocking: big organizations that profit from the sale of cancer drugs urge the Joint Committee on Deficit Reduction to reject a Medicare change recommended by the Congressional Budget Office that would save $3 billion (or from their dollar-sign viewpoint, would be a “$3 billion cut to cancer care” that would result in “weakening the nation’s cancer system.”) Like they always say about healthcare – one person’s excessive costs is another person’s livelihood, with every suggestion for eliminating excessive costs triggering cries of wounded anguish from the livelihood side of the same equation.

A British hospital moves a patient’s medical history to another hospital using Patients Know Best, a patient controlled health records system in which the patient uses a Facebook Friend-like function to add new doctors to the clinical team.

Piedmont Healthcare (GA) will spend $180 million on new IT systems that I assume includes Epic, reported here as an unconfirmed rumor in July but bolstered by the presence of a bunch of Piedmont job listings for inpatient Epic people. They’ve been an Eclipsys/Allscripts client for quite some time.

Nine Rite Aid drugstores in Michigan roll out OptumHealth’s NowClinic, which allows people to conduct a 10-minute IM or webcam-based chat with a doctor 24 hours a day for $45, the outcome of which can be a prescription filled by Rite Aid. 

A North Dakota clinic opts out of a Blue Cross Blue Shield medical home program called MedQHome, saying it violates the HIPAA rights of patients by sharing their information with MDdatacor, a third-party consultant, without their permission. BCBS North Dakota insists that patient permission is not required.

University of Michigan Medical School will start a Computational Medicine and Bioinformatics Department.

E-mail Mr. H.

News 9/16/11

Top News

HIMSS announces its acquisition of for-profit so2say communications, a German healthcare IT news distribution company whose European publications include HealthTech Wire and the recently acquired British Journal of Healthcare Computing.

Reader Comments

From No Surprise: “Re: Presbyterian, NM. Epic is in, McKesson loses another account. E-mail went out to employees Wednesday. Also, Lee Marley started as CIO in August, coming from Stanford.” Posted here as a rumor on August 15, but a solid one since I noticed that Presbyterian had Epic inpatient jobs posted on its site. Lee Marley’s LinkedIn profile verifies that she became SVP/CIO at Presbyterian in August after a couple of years as associate CIO at Stanford.  

From Redial: “Re: [company name omitted]. Another shakeup: just days ago, [name omitted] has suddenly left as VP of business development following the sudden departure of [name omitted] in August. Senior VP [name omitted] has been moved to the side following the discovery of his romantic relationship with a subordinate. There have been other significant departments of key management personnel over the past 12 months. Something is definitely wrong at the top.” Interesting, although I’m sure the company won’t confirm most of that except by catapulting litigious lawyers in my direction if I name names. At least I can feel smug knowing who it is.

From Ask Sam: “Re: HIPAA. Obviously they don’t know how to spell it.” They clearly need a new headline writer considering that healthcare is also spelled incorrectly (the article itself spells both words right, so there’s little excuse).

From WhoBuyz: “Re: acquisition. Who could this be? The $300-500 million range sounds very large to go unnoticed.” Sources say huge India-based software and consulting firm Infosys is in discussions about buying a US “public services and healthcare space” firm for $450-500 million, with the unnamed company booking annual revenue of $300-500 million. Infosys has extensive healthcare offerings that include payor analytics, disease management, supply chain, wellness management, Meaningful Use optimization, data warehousing, and infrastructure services. UPDATE: according to several sources, the acquisition will be the healthcare business of Thomson Reuters,  at a price of up to $750 million.

HIStalk Announcements and Requests

Recent tidbits from HIStalk Practice: the 2008 HISsie cartoon revisited. Telehealth saves money  in the treatment of chronically ill patients. US doctors earn more than physicians abroad. Dr. Gregg claims he is a Luddite and embraces his “onesy” status. Jonathan Bush rants about Meaningful Use attestation and his wish for his competitors’ “ethically-based suicide.” Doctors are down on AMA. World peace, a balanced budget, or better knowledge of the ambulatory HIT world are possible if you take 10 seconds to subscribe to HIStalk Practice’s e-mail updates.

Listening: brand new from Wild Flag, all-female low-fi rockers from Portland, OR.

Latest pet peeves: simplistic does not mean the same thing as simple (the former means recklessly oversimplifying complex concepts), nor does opportunistic mean taking advantage of opportunities (it means taking quick action that may be ethically questionable). Vendor CEOs misused both words recently in the national press, which would have cast a negative light on their companies except for the fact that their gaffe sailed right over the heads of the majority of people who didn’t know the difference.

Jobs on Healthcare IT Jobs: Expert MUMPS Developer, Epic MyChart Builder/Analyst, Senior Systems Analyst – Interfacing, Implementation and Account Manager.

Acquisitions, Funding, Business, and Stock

Medical billing and RIS software provider Zotec Partners merges with Medical Business Service, a provider of billing services for hospital-based practices.

Allscripts CEO Glen Tullman, commenting on a share price that is virtually unchanged from a year ago, says integration concerns with the former Eclipsys put MDRX in “the penalty box,” but growth is coming since the acquisition positioned the company well for the changes spurred by healthcare reform.

Shares in Merge Healthcare hit a 52-week high on Wednesday. Above is the one-year share price of MRGE (blue), the S&P 500 (green), and the Nasdaq (red). A year-ago investment would have earned a 151% profit ($2.77 vs. $6.95) if you sold Thursday.

People

HIT services firm Gestalt Health appoints Charles Fazio, MD as CMIO. He was previously CMIO of Medica Health Plans.

Availity names Kelly Heape Parsons CFO, SVP, and corporate secretary to replace retiring Margaret Gomez.

Billing service provider AdvantEdge Healthcare Solutions hires John A. Roberts (InfoLogix) as chief financial and administrative officer and Michael Youmans (Concerro, McKesson) as SVP of sales and marketing.

Announcements and Implementations

Medsphere announces general availability of its latest version of OpenVista EHR, which includes an option for users to customize their views, dashboards, and workflows.

In Maine, Time Warner Cable launches Healthcare Solutions to connect providers and support home health monitoring by offering VPN service, managed security, and web conferencing.

The AMIA 2011 Annual Symposium will be held October 22-26 at the Washington Hilton in Washington, DC. Keynotes include the director of NIH and Farzad Mostashari from ONC. AMIA is a lot more science-oriented than the HIMSS boat show – I looked through the list of sessions and didn’t see any duds, provided you’re of the informatics persuasion, anyway. Full registration is $835 for non-members if you sign up by October 6. Reports from there are welcome.

McKesson integrates its iKnowMed oncology EHR with its Lynx Mobile drug inventory management system, allowing meds to be prepared in advance of the patient’s visit.

Patient check-in company Phreesia announces an electronic Medicare Annual Wellness Visit Form that it claims saves providers 15 minutes per patient in complying with the new Medicare Part B entitlement.

West Texas RHIO wins an Outstanding Program Award from the Texas Rural Health Association. The four founding hospitals, all of them competitors, use the remotely hosted ChartAccess Comprehensive EHR from Prognosis Health Information Systems.

Dell Services Healthcare and Life Sciences wins a Project Management Office of the Year award for its 96% project success rate.

Smiths Medical announces its PharmGuard Anesthesia Software Service, which providers hospitals with a customized anesthesia drug library for their Medfusion 3500 syringe pumps.

Anthelio launches a 24×7 physician-staffed help desk to support hospital clinical systems rollouts. Other types of clinicians are also available to callers.

A CliniComp press release says that on September 11, 2001, its Essentris EMR used by Bellevue Hospital was the only inpatient one that kept running through the events of that day. I’m not sure: (a) if they’re talking about Bellevue only or all hospitals in Manhattan or New York; (b) how they know that; and (c) if using September 11 as a product pitch is in good taste. If you can get past those issues, the press release is a good read.

Athenahealth’s co-founders are mentioned as backers of startup Healthpoint Services, which offers “e-doctor clinics” in rural India. Athena COO Ed Park is a director. Villagers can get a telehealth consult in the office for 80 cents and diagnostic tests for $1, which the company says is affordable to the patients and break-even for it. Vital signs are taken in the office and sent to the physician and to the EMR. The company also offers a water service that gives families the ability to fill their jugs with clean water for $1.50 per month.

Other

Hospital employees and their family members incur healthcare costs that are 13% higher than that of the general population; are 22% more likely to visit the ER; and are more often  diagnosed with chronic medical conditions. Any theories why?

Cook Children’s Medical Center (TX) opens a 106-bed, $51 million NICU with all private rooms, the largest in the country. They cite research showing that babies do better when light and temperature can be individually controlled and when family members don’t have to leave.

SAP will release a tablet-based EMR front end app by the end of October, according to this article.

Sponsor Updates

• Software Testing Solutions shared its booth with an animal rescue organization at the Sunquest Users Group meeting this summer, giving attendees a chance to pet three rescued puppies. All were adopted during the conference and STS matched attendee donations made to the rescue organization. This is the second year STS has promoted the organization in its booth, raising over $4,000 and placing 10 dogs in homes.
• The Axolotl-powered Idaho Health Data Exchange adds St. Joseph Regional Medical Center and Pathologists’ Regional Laboratory to its network.
• Practice Management Associates (VA) selects the ADP AdvancedMD PM for RCM services.
• Citrus Valley Health Partners (CA) and MidMichigan Health (MI) select Allscripts Community Record, powered by dbMotion, and will underwrite and host Allscripts EHR for their affiliated physicians.
• OptumInsight names Ray Ambay, MD (Tampa Institute for Plastic Surgery), James A. Haley, MD (Veterans Hospital, Tampa), David Rossman, MD (Mass General Imaging), and Susan Strate, MD (clinical and anatomic pathologist) to its physician advisory board.
• DIVURGENT is participating in next week’s Epic UGM 2011 and is sponsoring a presentation by Bert Reese, CIO of Sentara Healthcare.
• e-MDs and Delmarva Foundation of the District of Columbia offer free assistance to DC-area e-MDs users wanting to take advantage of PQRS incentives.
• Allscripts, HP, Keane, and NCR are recognized by the InformationWeek 500 2011 list of top technology innovators.
• Kony Solutions shares findings from its Mobile Marketing and Commerce Study, including the observation that 40% of organizations believe the biggest challenge to their mobile strategy is developing applications across multiple operating systems and devices.
• Jersey Health Connect selects RelayHealth to provide HIE technology.
• Imprivata and PhoneFactor announce a partnership to provide phone-based authentication services to caregivers.
• GetWellNetwork’s Team in Training completed in the Nation’s Triathlon to Benefit the Leukemia & Lymphoma Society and raised $36,000.
• CareTech Solutions is promoting its CareWorks CMS Plug-In modules at this week’s SHSMD in Phoenix.
• MyHealthDIRECT CEO Jay Mason will speak at the Health IT Summit in New York September 20-21.
• CynergisTek CEO Mac McMillan expresses criticism of the Federal Health IT Strategic Plan for 2011-2015 in an information security article.
• MobileMD will participate in next week’s joint New Jersey and Delaware HIMSS Conference and Interoperability Demonstration in Atlantic City.

EPtalk by Dr. Jayne

I always enjoy hearing what readers have to say. I was double delighted to find that Daniela Mahoney’s piece on CPOE also included a recipe for profiteroles with coffee ice cream. Sounds like a good project for a quiet fall night (if fall ever arrives). She mentioned upcoming thoughts on adoption and organizational culture – I hope there are recipes included.

The Healthcare Billing and Management Association began its Fall Annual Conference yesterday. Due to horribly slashed budgets in clinical IT areas, which pretty much canceled my ability to attend any meetings this year, I have to live vicariously through colleagues and friends. In the first of these reports from the field, Bianca Biller reports:

HBMA Fall Conference in Vegas, baby. Held at the Bellagio, but actually the overflow accommodations are quite fine. Staying at your fave haunt Vdara Hotel & Spa, right in the midst of CItyCenter. Over 50 new members/attendees to the Fall Conference. Played Vendor Bingo for a chance at $1,425 jackpot tomorrow evening. Best giveaway was from Gateway EDI — decks of cards and gaming instructions. Quite creative for the Vegas venue.

Started the meeting with “Hot Topics in Compliance,” but only billing geeks/nerds would be excited about this session. Good reality check reviewing HIPAA + HITECH, 5010, ICD-10, 2012 Proposed Physician Fee Schedule cuts – all specialties. And let’s not forget the proposed SGR of 29.5% cuts for 2012 along with Medicare revalidation! Is anyone thinking about our patients in all of this? It’s a great day to be in the billing business!

P. S. Only 72 days until 5010!

Despite her feelings on compliance, I’m glad Bianca is my billing geek because she definitely gets the job done. And somehow, she succeeded in NOT getting her conference budget slashed. Maybe I need her to teach me the wicked ways.

MGMA reports that 70% of practices are looking into becoming Patient Centered Medical Homes and more than 20% are already accredited by a national organization. The top five challenges:

• Care coordination agreements with referral physicians
• Financing the transition
• Care coordination for high-risk patients
• Modifying or adopting an EHR to support PCMH
• Projecting financial impact of transition to PCMH

Clinical note of the week: several studies, one of which was published in May’s Journal of Strength Conditioning Research, show that low-fat chocolate milk helps athletes recover from training, especially if you add an Oreo cookie (a favorite of billing software developers, from what I understand.) That’s data I can work with.

MSN has recommendations that should be required reading for many an e-mail user. I’ve seen some e-mail signatures lately that are doozies. For most tech industry players (Voalte excepted), hot pink isn’t a strong corporate branding strategy. Political quotes are definitely a no-no, as are annoying or flashing fonts. The next-to-last paragraph had me laughing:

At public relations group Outside media, Sammi Johnson says she and her colleagues put quotes from fictitious “Saturday Night Live” inspirational writer Jack Handy in their quotes. One employee’s signature is, “Contrary to what most people say the most dangerous animal in the world is not the lion or the tiger or even elephant. It’s a shark riding on an elephant’s back, just trampling and eating everything they see.”

At this point, I’m going to take my Oreo cookies and my glass of milk (alas, not chocolate) and run.

Jayne

“To me, clowns aren’t funny. In fact, they’re kind of scary. I’ve wondered where this started and I think it goes back to the time I went to the circus, and a clown killed my dad.”

Contacts

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

News 9/13/11

Top News

President Obama declares this week to be National Health Information Technology Week.

Reader Comments

From MT Hammer: “Re: All Type acquisition. As you reported earlier, MedQuist makes it official.” Sort of, anyway – the financial advisor  to All Type Medical Transcription Services issues a press release about its role in the transaction. Reported here on August 25 by Hammer, who didn’t hurt ‘em.

From Proud athenista: “Re: athenahealth’s MU dashboards. The other day I was surprised to learn my very own company was going public with our MU transparency and just read the great interview with Jonathan Bush. Whodda thunk it would ever happen? I suggest that all vendors share their numbers.” PA is referring to last week’s HIStalk Practice  interview with athenahealth CEO Jonathan Bush, who discussed the company’s decision to publish the performance of its athenaclinical clients against Meaningful Use metrics. We are happy to share similar information from other vendors, though I can only think of a couple of others that are offering those details.

From Funky Bunch: “Re: Medicare attestation numbers. Here is some information from CMS that you may have seen.” CMS says $149 million has been paid as of July 31, but it doesn’t give a provider count or breakout of hospitals vs. eligible professionals. Medicaid incentive payments total $248 million and registrants for both programs total 77,549. Hospitals would get pretty big checks for their Medicare attestation, so that number might represent a fairly low number of EPs. On a related page, CMS answers the question of whether audits will be performed: maybe, so keep your documentation for at least six years, it says, else the payment “will be recouped.”

From Just Askin’: “Re: Innovator Showcase. Is that paid promotion?” I’m kind of insulted that you would ask that, but no. Interested companies applied and my volunteer review team (investment guys and a hospital person) choose a handful from the several dozen that they felt were truly innovative based on some rather probing application questions. One of those companies happened to be a current HIStalk sponsor by coincidence and all of them earned their spot strictly on merit.

From Farmer Joe: “Re: Meaningful Use incentives. You seem to make a lot of implied negative statements about spending taxpayer dollars on these. Farm belt clinics are faced with closing due to low patient volume and MDs looking to retire, but with no residents who want to join them due to low pay and practices still on paper. These rural communities provide 80% of the food in this country. Every American who eats anything they don’t grow or hunt themselves should be glad to pay money to keep these practices in business to keep young farmers from quitting and moving to cities.” Sounds like a bit of a stretch that farmers will stop farming if the rest of us don’t buy EMRs for their doctors. If we have to subsidize money-losing medical practices, then I’d rather do it directly instead of paying them to adopt a particular technology that isn’t guaranteed to improve either their medical capabilities or their profitability. And I’m nearly always going to be against new government spending like HITECH, stimulus, TARP, artificial jobs creation, or whatever other cause du jour has aroused our debt-happy and votes-desperate Congress. As someone once said, “The American Republic will endure until the day Congress discovers that it can bribe the public with the public’s money.”

Acquisitions, Funding, Business, and Stock

Streamline Health reports Q2 results: a net loss of $7,000 vs. a loss of $76,000 last year; revenue $4.1 million vs. $4.7 million.

Telehealth provider Teladoc secures $18.6 million in funding
.

EDI provider MD On-Line acquires healthcare communications company Strategic EDGE Communications.

Sales

Via Christi Health (KS) purchases QuadraMed’s Identity Management solutions.

Newberry County Memorial Hospital (SC) selects Summit Healthcare to provide interface engine technology for its Meditech system.

Wilmington Health (NC) chooses Humedica MinedShare as its clinical data warehouse.

People

HHS Secretary Kathleen Sebelius announces the appointment of Leon Rodriguez as director of the Office for Civil Rights, replacing Georgina Verdugo. He was chief of staff and deputy assistant attorney general in the Justice Department’s Civil Rights Division. He was nominated by the President last December to be Administrator of the Department of Labor’s Wage and Hour Division, but that nomination was withdrawn last week.

vRad names Sandy Schmitt SVP of Strategy and Development. She was previously with Allina and VHA.

 
AT&T names its first CMIO, rheumatologist Geeta Nayyar MD, MBA. She was previously with Vangent.

MediClick promotes President Mike Merwarth (above) to CEO, taking over for Ron Kupferman, who remains chairman of the board.

Hon S. Pak, MD joins AirStrip Technologies as a senior advisor. He was previously CMIO for the Army Surgeon General and is an innovator in telemedicine, particularly teledermatology, and is a graduate of the United States Military Academy and a former combat medic.

Announcements and Implementations

HIMSS names four additional winners of its 2011 Davies Awards of Excellence: Kaiser Permanente (Organizational / Epic); Fallon Clinic (Ambulatory / Epic); James F. Holsinger, MD (Ambulatory / e-MDs); and Hudson River Healthcare (Community Health Organization / eClinicalWorks).

McKesson introduces McKesson Practice Choice, a Meaningful Use certified, Web-based integrated EHR/PM solution for small, independent primary care practices.  The company also announces McKesson Practice Care, a service line that offers patient-centered medical home consulting in conjunction with AAFP’s TransforMed and available exclusively for practices running Practice Partner, Medisoft Clinical, Lytec MD, and Practice Choice.

Zynx Health will hire 40 new employees, including those with technical and sales experience.

Anvita Health is awarded a patent for a decision support system that can apply a variable medication patient co-pay, which it calls “dynamic, context-specific pricing.” Its intended use is to encourage optimal prescribing by charging the patient extra if he or she insists on getting prescriptions for drugs known to lack efficacy or safety. Co-pays can be reduced if a patient accepts a less-expensive cancer drug that matches responsiveness markers, or if patients are compliant with their prescribed meds.

A group of University of Alabama in Huntsville professors launches Decision Innovations, whose first product is a nurse staffing dashboard started as a 2008 pilot project with Catholic Health Initiatives. The company won the $100,000 Alabama Launchpad 2011 Business Plan competition and is setting up shop now.

Health benefits provider WellPoint signs a deal to develop commercial healthcare applications using IBM Watson technology. Few specifics were given, but the press release suggests that the applications could help physicians choose treatment options and direct patients to providers who have the best track record in treating their condition. WellPoint says it will start pilot projects early in 2012.

Government and Politics

HHS awards $8.5 million to 85 community health centers in Beacon Communities for the adoption of HIT.

HHS Secretary Kathleen Sebelius reports that 80,000 providers have applied to received Meaningful Use incentive payments and 70% of primary care physicians in rural communities have signed agreements with RECs.

A proposed HHS rule would give patients direct access to their own lab test results.

Technology

Microsoft previews Windows 8 (that’s the working name, anyway). This SlashGear hands-on review shows it running on a tablet (assuming someone other than Apple is making them by the time Win 8 hits the streets). The big question for me: how well does a design that looks like it was borrowed from the iPad work on a desktop using a keyboard and mouse? Microsoft is betting the cash cow that consumers and businesses want their desktop and laptop PCs to have a radically different user interface.  

Software that creates natural-sounding news articles from a set of facts could write medical journal articles, the company that developed it says. They claim it can compose a unique, smooth-reading article in about one minute that even experts can’t tell wasn’t written by a human.

Other

The Canadian hospital that refused to name the nurse who breached the electronic records of 5,800 patients, citing her right to privacy, changes its mind after the province’s privacy officer declares there is no such law in a newspaper’s letter to the editor. The hospital now says it will give the nurse’s name, but only to patients who state by letter that she accessed their files.

An interesting article in the Charleston, WV newspaper covers Charleston Area Medical Center’s patient transfer center, an air traffic control-like room with a huge electronic status board showing bed status in its three hospitals.

I awoke this morning realizing I had been dreaming that a network technician was working to maximize the speed of my home network. I gloated when he told me how impressed he was with the labeling of all the devices, and I was school girl giddy when he complimented me on the strength of my passwords. We then discussed the merits of various printers. I am clearly overdue for a vacation.

A former pediatric nurse at NYU Langone Medical Center says hospital employees snooped in her medical records and, from her history and diagnosis of endometriosis, assumed she was a virgin. Her co-workers then kept trying to convince the 41-year-old woman to have sex, she says, with a neurosurgeon making references to “The 40-Year-Old Virgin” movie. She’s suing the hospital for $45 million, claiming it didn’t protect her medical records.

Wake Forest Baptist Medical Center (NC) fires and sues a former administrative director for “unjustified, vindictive, malicious, and gratuitous actions.” His transgression: he alerted the state that it was overpaying his employer under the terms of its health plan. The state auditor agrees, saying sloppy state contracting and oversight allowed the hospital to overbill by $1.34 million. The hospital says it was none of the former employee’s business and its contract allows it to raise prices without notifying the state.

The Wall Street Journal highlights the industry’s transition from ICD-9 to ICD-10 and mentions several of the wackier codes. One of my personal favorites: V91.07XA (burn due to water skis on fire.) athenahealth’s CTO Jeremy Delinsky correctly notes that, “You have millions of transactions flowing in the healthcare system and this is an opportunity to mess them all up.”

  Even Weird News Andy finds this cringe-worthy news item from China “too weird for words.” A man bathing with live eels as part of a spa’s exfoliation treatment is startled when he looks down at his private area and sees a six-inch-long eel disappearing by the obvious method of ingress. The eel found its way to his bladder on its own, but removing it required a three-hour surgical procedure.

Sponsor Updates

• Sandhills Pediatrics (SC) receives $184,000 in ARRA incentives from its use of SRS.
• MEDSEEK announces the availability of ecoSmart Patient Precision predictive analytics technology.
• Practice Fusion forecasts that 5,000 of its eligible provider clients will receive $18,000 in Meaningful Use incentives in 2011.
• Two T-System employees, CMIO Robert Hitchcock, MD and Center for Performance Excellence Manager Janie Schumaker, RN, are elected to the board of the Emergency Department Practice Management Association.
• Aspen Advisors releases a case study on the Epic implementation of St. Anthony’s Medical Center’s (MO). 
• BridgeHead Software announces the successful integration of its MediStore archive technology with  three leading PACS products.
• Ben Michelson of Hayes Management Consulting discusses lessons learned from ICD-9 implementations in a guest article.
• Wolters Kluwer Health releases a ProVation MD module to support participation in the ACC National Cardiovascular Data Registry CathPCI Registry.
• Thomson Reuters introduces MarketScan Treatment Pathways to analyze medical care, outcomes, and costs.
• TeleTracking Technologies announces the availability of its RTLS to the UK healthcare market.
• Cumberland Consulting Group provides a checklist of 10 things hospitals should consider as they undergo EHR implementation.
• MidMichigan Health uses Concerro’s ShiftSelect in its retiree return-to-work program.
• The AHA Center for Healthcare Governance selects CareTech Solutions and its customer San Luis Valley Regional Medical Center as presenters for its Fall Symposium.
• The Massachusetts Department of Public Health replaces its e-Forms system with Access’s electronic forms on demand solution.
• AT&T contributes $100,000 to support a mobile health initiative to use smartphones in diabetes education.
• Elsevier / CPM Resource Center will integrate its evidence-based clinical practice guidelines and documentation solution into the McKesson EMR of Medcenter One(ND).
• Iatric Systems adds the federal government’s Blue Button capability to its PtAccess patient portal, which allows patients to download their health information as a text or PDF file.

Contacts

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

HIStalk Innovator Showcase – Health Care DataWorks 9/12/11

Company name: Health Care DataWorks, Inc.
Address: 1801 Watermark Drive, Suite 250, Columbus, OH 43215
Web address: www.hcdataworks.com
Telephone: 614.255.5400
Year founded: 2008
FTEs: 20

Elevator pitch

HCD provides business intelligence solutions that enable healthcare organizations to improve quality and reduce costs.

Business and product summary

Our products are innovative in that they are an accelerator for organizations that recognize the need to leverage their siloed data to improve their performance, but don’t want to spend years building an enterprise data warehouse (EDW) from scratch. Health Care DataWorks (HCD) brings a pre-built, packaged EDW that is immediately ready to feed data. Our clients are able to see value within months rather than years.

HCD’s EDW Appliance bundles robust hardware, AIX operating system, Oracle 11g database, HCD’s own comprehensive enterprise data model, plus hundreds of pre-built standard reports and a dozen pre-built dashboards with hundreds of key performance indicators with drill-down capability covering quality, Meaningful Use readiness, revenue cycle, operating room, nursing scorecard, to name just a few. 

Our company is innovative in that it was founded and is managed by people that grew up in hospitals and health systems, as opposed to within a vendor organization. Our CEO has been a healthcare CIO for most of the past 20 years at various-sized organizations. Our COO led business intelligence development efforts at a major academic medical center for over eight years. As such, HCD has “walked a mile” in the shoes of its clients and has a unique, first-person understanding of the problems that healthcare executives are trying to solve with integrated data.

Finally, HCD is innovative because — unlike the Goliaths in the industry that it typically competes with, such as Oracle, IBM, and SAP, which have many product lines and foci — HCD has a laser focus on delivering innovative, value-added business intelligence solutions to hospitals and health systems, and as such, can be much more nimble and responsive to its customers.

Strategic Roadmap — for organizations very early in thinking about how they will use BI / analytics / EDW. This process will ensure you have buy-in for whatever decisions you make in this area and takes approximately five months.

Dashboard Appliance — for organizations that want to do a proof of concept for an EDW or to meet a specific need that requires a dashboard solution. Low price allows starting on the path towards an EDW without losing any of work done in populating the dashboards.

EDW Appliance — for organizations that are ready to build an Enterprise Data Warehouse and want tools and technology to accelerate that process.  

Target customer

Large and mid-market hospitals and hospital systems.

HCD’s products allow the users to pull data from multiple source systems making the data accessible in one location. The ability to run reports and drill down using friendly dashboard interfaces gives decision makers the information required to make knowledge-based action plans.

Competitors

Microsoft, Oracle, and IBM are a few of the better-known competitors in the industry.

Advantages over competitors

As a spin-off from the Ohio State University Medical Center, the founders of Health Care DataWorks have developed and worked the product from the ground up.

List five fast facts about the company or product.

1. Ohio State University Medical Center spin-off.
2. All five founders have worked or still work with the EDW at OSU.
3. Won TechGenesis Grant of $50,000 after to a market analysis that determined a large unmet need for the product.
4. Named Gartner “Cool Vendor” 2011.
5. The EDW Appliance was one of the first data warehouse solutions to achieve Stage 1 Meaningful Use certification.

Pitch video created specifically for this Showcase

What problems have you solved using HCD’s product and what has been the overall impact on your organization?

We are in the very early stages of implementation, having just signed a contract. Our vision project vision statement is:

To support our mission and vision, we will implement a set of business intelligence tools and a data warehouse, starting in 2011, that will transform integrated clinical, financial, and operational data from the disparate systems throughout the organization to information that is aligned and driven from the strategy and will support real-time decision-making to enhance clinical care, support research, and facilitate economic and financial forecasting

The impact to the organization has not been profound as of yet, but we are looking for some innovative solutions which will empower our decision-makers with data to make good business and clinical decisions. Having the data at their fingertips vs. having to contact IS for the data or to run a report; providing dashboard capabilities related to their KPIs and quality indicators; looking at predictive analytics to utilize the value of the data as we look at risk-based contracts, etc.

If you were talking to a peer from another organization, how would you describe your experience with HCD?

The experience has been very positive. HCD has been very responsive and knowledgeable about healthcare data warehouse and business intelligence. They have also been very flexible in terms of contracting and even providing a proof of concept phase of the project / contract. It has been a much different experience working with a smaller, more nimble company than some of the bigger players who may dictate how the process will work.

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

HCD is a startup company, and as such, you will be taking on more risk than a mature vendor, but the risk may well be worth the reward given their current products, future offerings, and expansive healthcare knowledge.

An interview with Herb Smaltz, CEO of Health Care DataWorks

A lot of big companies sell dashboards and data warehouses. Why would customers choose to buy from a small, healthcare-only vendor?

We are laser focused on healthcare. Competitors obviously have lots of different product lines, lots of different vertical markets.

The other thing that resonates with our customers is that we all came from the health system. I’ve been CIO pretty much my whole career, dating back to even before you could call it a CIO job. I’ve been doing this for a long time, sitting in that chair trying to solve these kind of problems. Our COO, Jason Buskirk has been working in the BI department building BI apps and solving those problems from a development standpoint inside the health system for eight years. All of us on the senior team that spun this technology out of Ohio State have been doing this for a long time.

We’re a young company. We’re three years old now, but we’ve been harboring this technology over 13-14 years now in a major academic medical center with built-in health system. Again, trying to solve these kinds of problems of data integration and really making sense of really heterogeneous, really potentially dirty data to solve business problems. 

I think those things resonate with our customers. That we walked a mile in their shoes and were one of them, if you will. Even though we are clearly a vendor company, well grew up in health systems and the technology has really been hardened in that kind of an environment.

We went through those years of at OSU where we were stubbing our toes on the best way to build a data model; the best way to build performance; the best way to build query capabilities. For most startups, they’re stubbing their toes with their customers as they build their product.

I think all those things make it a little more comfortable for folks to go with Health Care DataWorks.

You offer your product as an appliance in one configuration. Realistically, what kind of time, effort, and skill set would a client need to connect everything and go live?

That’s one of the things that we offer as a value proposition. We’re really an accelerator for organizations that are right at that precipice of trying to figure out how to get all their data to work together.

If you talk to people like Gartner and others, for the folks who try to build it themselves, it’s a good three-year prospect to build it from scratch. We’ve packaged everything: the hardware, operating system, Oracle 11g database licenses, our own very comprehensive data model, and tons of content. Lots of pre-built dashboards with scorecards and hundreds of reports. 

Essentially, we can just drop that in to an organization’s data center or just use our hosted data center, whichever they prefer. Instead of sitting around a table having discussions about how these tables should be built and what these data elements ought to be called and how the table joins ought to work, they’re immediately just working on populating this packaged data warehouse appliance that we bring to them. Within four to six months, they’re typically using one of the dashboards. They’re using a bunch of standard reports in whatever area they’re focused on.

But one caveat. Source data that comes from those various EMR systems, ERP systems, scheduling systems — you name it, there’s tons of systems in a hospital and health system — they’re notoriously dirty. When you bring that heterogeneous data into an appliance, what it exposes is some of that dirty data. 

One of the things that can cause delays is data governance. Seeing that the data is not good, having to go back to the source systems and the owners of those source systems — whether that be the chief medical officer or nursing or wherever the data was pulled from — and work with them on how to best move forward. Do you want to expose the data as it is, with some asterisks and caveats? Such as, “There are number of blank fields, but from this day forward, we’ve asked our registration folks to fill those fields in.”

That whole data quality, data governance within each hospital is a new core capability that they really need to develop. The ability to take their data from their various systems and help to make that cleaner and cleaner and cleaner over time.

But typically, it’s four to six months from the time that we sign a contract to the time that they can get use of a set of reports or a dashboard or a scorecard.

It’s been a year since you signed Orlando Health. What results have they seen?

Orlando Health is one of those organizations that this issue of data quality and data governance has come up. Very quickly, we were able to get their quality dashboard in place. One of the things they wanted to do to before they exposed it to their users was to clean up all their data.

I’m a fan of, you know, “data gets better with use.” Now to be sure, at a physician level or a patient level, you want to make sure that data is right. There’s that tradeoff. Orlando Health has really focused a lot on their data quality. They’ve been busy for a number of months working on data quality, getting the data quality up to speed. But their dashboard was ready and loaded with data within months of getting the appliance in place. 

With another customer, Essentia Health, we did a proof of concept with them. Just three months later, they got a Top of the Hospital dashboard up. They put in place a data governance group, which has been meeting and working on those sorts of things. 

It’s one of those things where the technology really isn’t the thing that holds people back. It’s the ability to make decisions about the data that it exposes and how they want to deal with that and handle it. In some cases their source system data is very clean and they can very quickly move on and deploy that to users. In Essentia’s case, that’s what happened.

In Orlando Health’s case, they had a number of fields that were blank in their source systems. For example, a referring physician is one of those that was blank. They had 160,000 instances of a blank referring physician. If you want to do analysis on where your patients are coming from, it’s important to fill that in. They had to go back to their registration department and essentially say, “We really need this field filled in.”

Anybody you talk to in the marketplace will tell you there’s no silver bullet technology that can overcome poor source system data quality issues. With all of our customers, we absolutely offer that acceleratory capability, to immediately let them start using the data. The question really becomes is whether the data coming from their source systems is of a high enough quality that they want to expose that to end users to make business decisions on. We very much work with them on that data governance process in making decisions around that and helping them to the point they’re exposing that data to make business decisions.

What do you hope to gain from the exposure?

As you mentioned, we are a small company. We don’t want to take anything for granted. We want folks to get an understanding of the company, the fact we’re laser focused on healthcare providers in particular. We very much appreciate it. Any small company can benefit from people knowing about you. We hope to be included in more RFPs, and we’re getting more and more. We just closed Presbyterian Health System  in Albuquerque, New Mexico and Children’s Medical Center Dallas. Because we’re competing against folks like Oracle, IBM, and Microsoft and the exposure really does help.

Monday Morning Update 9/12/11

From Jimmy Doogan: “Re: McKesson InSight conference September 20-23. Will HIStalk be covering? The tone will be interesting, as I would say the MPT part of the company hunkers down to milk their existing customers.” I wish I had the time to attend conferences, but it’s hard getting time off from the hospital. I’d be keenly interested in reports from everybody’s favorite convention city (Pittsburgh) if someone wants to volunteer be the official HIStalk mole. A key MCK metric will be the number of attendees, since those Horizon sites already announced as moving to Epic or other systems probably won’t bother sending folks to InSight. They will get some offset, though, from the increasing number of users of Paragon and other systems. Key questions I’d like to see answered: (a) how viable is Horizon Clinicals as go-forward strategy for both MCK and its customers; (b) how is the company positioning itself to compete against competitors (notably Epic and Allscripts) that have tied the inpatient and ambulatory sides of the house together; (c) what is the status of Horizon Enterprise Revenue Management as reported by real-life users; and (d) given that most of the MCK products are still mid-performing silos of legacy acquisitions, are they willing to invest in actually building products appropriate for the reality of healthcare reform, or will they just run a prevent defense in trying to keep the maintenance and services revenue stream going as long as possible (or sell the whole MPT package off, if you believe the occasional rumors.)

From Ingram Connor: “Re: The Advisory Board Company. Dave Garets is quietly putting together a dream team of industry heavyweights. Mike Davis, Jim Adams, Jim Klein, Ernie Hood, Peter Kilbridge, Ken Kleinberg, Doug Thompson, and Daphne Lawrence.” I also heard (and I think it’s OK for me to say) that Dale Sanders, CIO of Cayman Islands Health Services Authority, will be joining ABCO this week, although continuing as a senior advisor to the Caymans.  

From Sir Lord Baltimore: “Re: low check number on EHR incentive payment. Incentives are paid the same way an eligible professional receives his or her Medicare or Medicaid reimbursement. Many receive payments electronically, so they also receive the incentive payment electronically.” Makes perfect sense – thanks. I’d still think that as much as ONC and HHS congratulate themselves publicly on how well they’re spending taxpayer dollars that they’d provide specific HITECH payment numbers if those numbers are in fact impressive.

From The PACS Designer: “Re: eMix for image sharing. TPD is all for promoting the sharing of patient image files, and now eMix is available to enhance patient image file sharing. The service is road map to  a Meaningful Use application, provided courtesy of DR Systems.”

From Snidely: “Re: Lucile Packard Children’s Hospital. I’ve heard they’re being forced to adopt Epic since Stanford uses it and Epic is ‘interoperable’ only if everybody else is on Epic. This is the Epic Octopus, where once they get into a system, everybody has to switch to it if they want to talk to each other. That makes Epic much more expensive than the initial quote if you want your systems to communicate.” Unverified. If true, I assume that means Cerner, installed just four years ago and the subject of several Packard articles touting its patient safety features, gets the boot.

Most hospital respondents say their boards make at least a token effort to seem analytical before approving IT projects put before them. New poll to your right, with the idea triggered by Inga’s interview of Jonathan Bush: how comprehensively will HHS audit providers who get HITECH checks by the honor system of attestation?

I don’t know what you were doing back in the innocent summer days of July 2006, but I was writing this week’s Time Capsule editorial, CCHIT’s First Certification List is Unsatisfying, where I said, “I think the federal government will encourage the use of certified EMR products by sweetening reimbursement or making it a requirement for government-related purchases.”

HHS Secretary Kathleen Sebelius will kick off the Consumer Health IT Summit Monday afternoon (September 12) at 1:00 Eastern (the announcement says EST – doesn’t it bug you when people incorrectly say EST instead of EDT instead of just sticking with the always-appropriate ET?) Anyway, Farzad Mostashari of ONC will also be on hand. You can watch via live webcast. Bring your own lunch.

The Kickstarter project for the GAUCHOS open source EMR for volunteer clinicians won’t likely make its $84,000 fundraising goal with only $4,700 raised and five days to go, meaning they’ll get nothing since Kickstarter is all or none. The project continues, however.

Weird News Andy breaches the surface of this subject: a billing contractor for Stanford University is blamed for posting the medical information of 20,000 of its ED patients on a website. Someone posted the Excel worksheet on a tutor-hiring site for students, asking for help with creating a bar graph from the patient information. The worksheet sat there for a year, visible to anyone. The billing company, Multi-Specialty Collection Services LLC, seems to have gone into seclusion since its Web page has apparently been taken down and the owner isn’t returning media calls.

Gerber Alley: The Final Chapter, courtesy of Vince. I’m picturing some Nancy Sinatra-style go-go boots out of frame in the attractive young lady’s picture on Slide 5 (now someone’s grandmother, I’d guess.)

US Rep. Barney Frank (D-MA) tells the Massachusetts Historical Commission to get off Meditech’s back and let it build offices in Freetown, MA, saying he was “unpleasantly surprised” by the group’s demand that Meditech conduct a year-long archaeological study before starting construction. Meditech said they’d take their 800 jobs elsewhere. A local newspaper editorializes: “From their lofty perch in points north, members of the commission — who, on the topic of dirt, sure do know how to muck up a good situation — are strikingly out of touch with the workaday world of the SouthCoast, which holds the dubious distinction of consistently ranking among the state’s highest areas for unemployment.“

It’s a mess at Parkland Memorial Hospital (TX), as the Justice Department launches an investigation and CMS announces termination of the hospital’s Medicare agreement on September 30, although Parkland can keep those privileges by accepting help from outside consultants (gee, wonder which option they’ll choose?) The hospital already announced plans last week to replace President and CEO Ron Anderson, whose held that job for almost 30 years, saying it will create a new job for him next year. To outsiders, Parkland is mostly known — at least by mature audiences — as the place where JFK and Lee Harvey Oswald died nearly 50 years ago (followed by Jack Ruby a few years later).

An employee of Methodist Hospital (TX) is charged with using patient information to take out short-term loans in their names, buying herself a $125K Maserati, a BMW convertible, and some nice Gucci clothes.

Bizarre: a UK factory electrician is nearly killed when a compressed air line goes up his shorts and into his rectum, inflating him like a balloon. “There was air fizzing around inside my back passage and stomach. It was so weird,” he observes. It was reportedly a co-worker’s prank.

E-mail Mr. H.

News 9/9/11

Top News

I reported weeks ago that Beth Israel Deaconess Medical Center was prepared to offer its CEO job to Stanford Chief Medical Officer Kevin Tabb MD, who has spent nearly all of his medical career in informatics roles on both the vendor and provider sides of the house as an IT geek. BIDMC announced Tuesday that he has accepted the position. My assessment then was that “he would be a geeky kindred spirit for CIO John Halamka,” which both FierceHealthIT and DotMedNews quoted and nicely credited to HIStalk.

Reader Comments

From Inquiring Mines: “Re: Medicare stimulus check. A local group got their federal check and its check number was less than 200, an ungodly low number to have been issued. A provider in the group was told only 6,000 providers had filed to date. Am I missing something? The Medicare spigot doesn’t seem to be flowing as expected.” IM sent a scan of the provider’s check and it does appear that, unless CMS has multiple accounts (this one is called “EHR Incentive Payment Account”) they haven’t issued many checks to date.

From Pacman: “Re: Mayo – Elkin lawsuit. A $1.9 million attorney’s fee award for Mayo against Dr. Elkin.” Unverified. This is the suit in which a Mayo doctor (Elkin) sued Mayo over software he developed while employed by them, but then took the source code with him when he left. The jury found in favor of Mayo in April, but also ruled that the doctor is due royalties under Mayo’s royalty sharing policy. As is nearly always the case with lawsuits, the big winners are the lawyers.

From Harvey: “Re: Mediware. Reported a very solid quarter, but indicated that their labor costs have gone up. It would seem that, despite overall job market woes, there’s a bit of a bidding war on for HIT staff.” Mediware’s Q4 numbers, announced Wednesday: revenue up 20%, EPS $0.25 vs. $0.12, with a big DoD blood bank software contract pushing the numbers up. The one-year share price is above, with MEDW (blue) compared to the Nasdaq (red) and the S&P 500 (green). Market cap is $91 million.

HIStalk Announcements and Requests

Listening: Black and White America, the new album from Lenny Kravitz. Retro 60s funky with big horns in places, modern soul elsewhere, and melodic rocking on some tracks. A great sound throughout and lyrics that aren’t the usual dance track drivel. I get quite a few e-mails from readers wondering how to get back in the habit of listening to new music and I would recommend this as easy to enjoy – it’s got a nice beat, it’s not explicit (he’s religious), and it’s original. And Watching: Mercy (a pretty good hospital yarn) and The Good Guys (a funny cop buddy series). Netflix is predictably in full meltdown mode since any fool could see that its content providers like Starz would be holding it hostage once their old contracts ran out, so I’m watching now before the lack of programming (or increase in price) pushes me to cancel.

Jobs on Healthcare IT Jobs: eGate Integration Analyst, Senior Systems Analyst – Physician Systems, Implementation and Account Manager, Pegasus Health IT Director. There’s quite few interesting jobs there.

HIT is a contact sport, so get off the couch and interact with us: (a) subscribe to the e-mail updates so you can be a like Paul Revere galloping down the cubicle rows shouting out the latest shocking news that I’ll deposit in your inbox if only you’ll allow me; (b) do all that friend / like / connect stuff on your choice of social media sites, seeking out HIStalk, Dr. Jayne, Inga, and me so that we might consummate our union electronically; (c) send me news, rumors, or whatever interests you about the industry; (d) behold with wonderment (and perhaps some strategic mouse-clicking) the graphical proof to your left signifying the unlikely fact that impressively powerful healthcare technology firms are willing to support an anonymous muckraker who struggles to keep a hospital job given the extensive time required to keep up with all the HIT windmill-jousting that needs done; and (e) appreciate that our world revolves around patients, no matter how much electronic insulation separates them from us. Thanks for reading.

Acquisitions, Funding, Business, and Stock

Mediware’s Q4 numbers: $16 million in revenue, up 20% from last year; net income $6.3 million vs. $3.2 million.

Private equity firm The Riverside Company acquires Avatar International, which administers patient satisfaction surveys.

Teleradiology firm Virtual Radiologic acquires the 60-radiologist practice Diagnostic Imaging, Inc. (PA/NJ).

Hospital revenue cycle predictive analytics vendor Apollo Data Technologies Health, Inc. changes its name to MethodCare, Inc.

Sales

CHRISTUS Health (TX) selects HiSoftware’s Compliance Sheriff for SharePoint solution for HIPAA compliance with Sharepoint data.

Royal Caribbean Cruises selects eSeaCare EHR for its Azamara Club, Celebrity, and Royal Caribbean International cruise lines. Dang, I sure need to do a site visit.

CMS contracts for ICD-10 code translation technology from 3M Health Systems to assist with the conversion of the agency’s systems, applications, and reports from ICD-9.

People

Zynx Health appoints Bill O’Connor, MD (Allscripts) as SVP of global product management and marketing and David Cerino (Microsoft Health Solutions) as EVP and COO.

CSC promotes David Levitt from account director to VP of HIT solutions for its North American Public Sector Health Services division. 

Healthcare investment bank Leerink Swann names Bill Suddath managing director of the firm’s Healthcare IT and Technology Enabled Services franchise. He was previously with Robert W. Baird & Co.

AHIMA appoints Lynne Thomas Gordon, MBA, RHIA, FACHE as CEO. She was previously with the Children’s Hospital at Rush University Medical Center.

CentraCare Health System (MN) names Amy Porwoll CIO, replacing the retired Charles Dooley.

Announcements and Implementations

Humility of Mary Health Partners (OH), which includes three hospitals owned by Catholic Health Partners, goes live on its $56 million Epic system.

Accenture completes an assessment and plan to support implementation and interoperability standards for a statewide HIE for the Texas Health Services Authority.

The VA will expand its Virtual Lifetime Electronic Record pilot in which the health records of veterans are electronically shared with the Department of Defense aid private healthcare facilities. It says the HIE capabilities will be live this fall.

The ONC launches HealthIT.gov, a new website which includes HIT information for both healthcare professionals and consumers. It’s definitely prettier and easier to navigate that older ONC site, but contains much of the same information.

MetroWest Medical Center (MA) debuts its use of the EarlySense system, which uses motion sensors placed underneath beds to track patients’ vital signs. Massachusetts Governor Deval Patrick was on hand.

TeraMedica introduces a medical archiving solution capable of managing from 25,000 to 10 million medical image procedures.

Free EHR vendor Mitochon Systems announces built-in connectivity from its EHR to Hoag Hospital’s Medicity-powered HIE.

Qualcomm and Life Care Networks launch a Wireless Heart Health 3G mobile health project in China. Components include smartphones with ECG sensors, Web-based EMR software, and clinic-based 3G wireless workstations that give 30 physicians access to the electronic records and ECG data.

Government and Politics

Federal agents arrest 42 people in South Florida for suspected Medicare fraud. Assisted living facilities and related businesses convinced out-of-state elderly and disabled people to come to Florida for a fresh start (and to bring their Medicare cards along). They’re accused of submitting $160 million in phony claims, of which Medicare dutifully paid $90 million without question. The lead FBI agent chastised HHS for not preventing fraud upfront, saying that it takes extensive resources to catch the crooks, who by the time they’re arrested, have usually spent all the money.

Innovation and Research

Albert Einstein College of Medicine of Yeshiva University will use an NIH-funded grant to study advanced retroviral drug therapy in HIV/AIDS patients in Central Africa. Clinics will implement the OpenMRS open source medical record to collect data, also giving governments the option to make its use a national initiative.

Technology

Inova Health System (VA) partners with a genomics company to sequence the genomes of 500 pre-term NICU babies and their parents to identify OB-related diagnoses and treatments. Information from Inova’s EMR will be used to study outcomes.

Other

A physician’s guest editorial in The New York Times makes the common observation that electronic medical records are good as long as the caregiver doesn’t let the computer interfere with their relationship with their patients.

In the old days, when a patient arrived in my office, I laid the paper chart on the desk between us. I looked directly at the patient. As we spoke, I would briefly drop my eyes to jot a note on the page, and then look right up to continue our conversation. My gaze and my body language remained oriented toward the patient nearly all the time. In the current computerized medical world this is impossible. I have to be tuned toward the computer screen to check labs, review X-rays, read prior notes, document the patient’s current concerns. Like most internists, I know that the interview is the most important part of a patient visit. It always yields far more information than the physical exam, which, in many ways, is an afterthought. But now that the computer is impeding the intimacy normally achieved during the talking part of the visit, I find that I rely on the physical exam more. Once the patient and I have broken free from confines of the desk, with its dictatorial PC, we have a more comfortable realm, that of touch. As soon as there is skin-to-skin connection, conversation flows more easily. In the absence of a machine lodged between us, the traditional doctor-patient relationship is restored.

An Ontario hospital notifies patients that an employed nurse inappropriately accessed the records of 5,800 patients. The mother of one of them was upset by the hospital’s  response to her request for details:  they won’t release the nurse’s name because doing so would violate the breacher’s privacy.

Weird News Andy likes this ink: an 81-year-old grandmother gets a chest tattoo that says, “Do Not Resuscitate,” fearing that doctors won’t see the DNR entry in her medical record. “I do not want to be half dead, I want to be fully dead … I don’t want to lie for hours, months or even years before dying. I don’t want my family to remember me as a lump. My mother-in-law lived to be 106 and in the last six years of her life she’d have been much better dead. She was miserable.”

Also from WNA is this story in which England’s Primary Care Trusts are demanding that family physicians reduce their use of ultrasound, MRI, and CT scans. WNA has a cost-saving solution: send them through TSA’s body scanners.

Police in China are investigating the death of a patient during a fire in a hospital OR. Employees evacuated themselves and all patients except one, a man whose leg was being amputated under general anesthesia. When they returned, they found him on the OR table, dead of smoke inhalation.

Sponsor Updates

• The Disposable Film Festival and Practice Fusion launch Disposable Film Festival Health to encourage original short films about health, medicine, patients, or doctors. Participants will compete for a $5,000 prize.
• Orion Health is adding more than 100 new positions, with about two-thirds in New Zealand and the rest in North American and the Asia-Pacific region. Most of the openings are in R&D.
• Ten unaffiliated physician practices connect to the Coastal Connect HIE (NC) and begin the electronic transmission of patient referral data using Medicity’s iNexx technology.
• Radiology Associates LLC (LA) selects McKesson Revenue Management Solutions for practice management and medical billing services.
• Robert Freedman of Hayes Management Consulting will moderate an ICD-10 panel discussion at HCCA’s New England Regional Annual Conference on September 9 in Boston.
• Stockell Healthcare Systems and ZirMed announce a partnership in which ZirMed’s claims management will be integrated with Stockell’s Insight Revenue Cycle Information System.
• Decatur Medical Center (IL) will deploy Wolters Kluwer Health’s ProVation Order Sets. Wolters Kluwer also signs a multi-year contract with Health Shared Services British Columbia for its Lexicomp solution.
• TeleTracking Technologies announces the formation of its RTLS Workflow Consulting Group. The company is also hosting a free webinar, RTLS Asset Management and How to Make the Most of Your Owned Equipment Resources.
• MediServe clarifies the PAI Discharge Window. 
• Cumberland Consulting Group promotes Tom Howard to principal.

EPtalk by Dr. Jayne

JAMA is e-mailing physicians to take part in a survey regarding mobile electronic devices. Questions included: what devices are owned; plans for new device purchases; how much time is spent each day using a mobile device for medical information; when during the day devices are used; how important the device is for various pursuits; and desirability of a medical journal app for full text articles.

Mailbox alert: The Centers for Medicare & Medicaid Services will be mailing revalidation requests to over a million health care providers, more than half of which are physicians. Providers who enrolled prior to the institution of new screening criteria on March 25, 2011 will have 60 days to recertify their enrollment or be blocked from billing Medicare. Providers worry that the already cumbersome Medicare enrollment process will negatively impact honest providers rather than catch the crooks for which it was intended.

This week’s New England Journal of Medicine includes Electronic Health Records and Quality of Diabetes Care. The authors looked at diabetes care data from 569 providers at 46 practices from 2007 to 2010, concluding that the “findings support the premise that federal policies encouraging the meaningful use of EHRs may improve the quality of care across insurance types.” The practices included safety-net providers and publicly reported performance data. On composite standards for diabetes care, EHR locations scored higher than paper-based locations for outcomes and also showed a higher annual improvement (after adjusting for insurance, age, sex, race, ethnicity, language, income, and education.)

The authors note that this is in contrast to other recent studies showing no improvement in quality for practices using EHR. They attribute their favorable results to looking at systems with clinical decision support that is specifically designed to improve care and which include mechanisms for care coordination and provider communication. Additionally, patients had to visit the practice two or more times during the study period for inclusion. The authors propose that this demonstrates a “mutual commitment to longitudinal care” which may have been lacking in other studies.

Medical Economics recommends some LinkedIn groups for social media savvy physicians to join. I was disappointed to not see the reader-created HIStalk Fan Club on the list. With over 1,800 members, it beats all but two of the groups listed.

Several of my friends who are consultants in the health IT realm spend most of their weeks traveling from practice to practice. Since food is no longer served in most parts of the not-so-friendly skies, road warriors are often subjected to the carry-on fare of their neighbors. One former colleague was so offended by his neighbor’s snack he e-mailed me from 30,000 feet looking for sympathy. Normally I’d tell him to “suck it up,” but he snapped a photo of the fare: Ahi tuna jerky. The aroma was bad enough that someone asked a flight attendant to speak with the passenger about putting it away. I’m not sure about the rationale behind dehydrating a perfectly good piece of fish, but to all the road warriors out there, may your flights be fish-free.

Have a health IT road warrior horror story? E-mail me.

Contacts

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

News 9/7/11

Top News

AmerisourceBergen Corporation completes its $35 million acquisition of IntrinsiQ. The company, which offers the IntelliDose oncology dosing application, will become part of AmerisourceBergen’s ION Solutions unit.

Reader Comments

From Auntie Social: “Re: Twitter. I’ve never found much value in Twitter. I’d rather have the Readers’ Digest version of a speaker’s talk versus endless Tweets of every point. Other Tweets are just self-indulgent promotions. However, with the recent earthquakes, hurricanes, floods, and fires, I am finally seeing its value and am hooked.” The fifth hottest Twitter topic in August: Hurricane Irene. Justin Bieber was ranked #2.

From Celerite: “Re: transparency. Vendors should not tolerate employees who use inside testing results to trade stocks of partner companies. Avoid costly mistakes by asking your vendor how they prevent this.” I’m afraid I didn’t really follow this, especially the customer angle, but maybe I’m slow.

From A. Tool: “Re: GE. They’re laying off Americans and moving their X-ray division from Wisconsin to China, but earlier this year, Obama picked Chairman Jeff Immelt as ‘jobs czar’ tasked with figuring out how to create US jobs. Is he really the most qualified guy to be providing employment advice?”

Acquisitions, Funding, Business, and Stock

One Medical Group closes $20 million series E funding, led by Maverick Capital. Epocrates co-founder Tom Lee is the CEO and founder of One Medical, which operates nine physician offices in San Francisco and New York. They use a self-developed EMR and other technology to minimize administrative overhead.

Billionaire Patrick Soon-Shiong forms a new company, NantWorks LLC, that will combine his technology businesses, some of which involve healthcare, under a single umbrella.

Sales

Sandlot adds five Texas Health Resources hospitals to its HIE platform.

People

SRS hires Michael P. Lang as EVP of sales. He was previously with RelayHealth and GE Healthcare.

MedQuist announces new executives from M*Modal, which it recently acquired: Michael Finke (president – above), Juergen Fritsch (chief scientist), and Detlef Koll (CTO.)

John Reiffenberger is promoted to CIO of the VA’s Black Hills Health Care System (SD).

Announcements and Implementations

Rhode Island’s HIE currentcare (highly annoying all lower case and then italics) is capturing clinical data using InterSystems HealthShare.

Covenant Health System and Memorial Hermann develop clinical integration programs, in which independent physicians and a health system collectively negotiate commercial payor contracts that include quality and cost incentives. Both programs use CRIMSON physician performance and population management tools from The Advisory Board Company. Covenant reports reducing their average length of stay by 1.1 days and having no reported cases of ventilator-associated pneumonia for 18 months, while Memorial Hermann’s physician group had a 29% shorter length of stay and 15% fewer complications than non-participating doctors.

Government and Politics

HHS grants $11.9 million to 40 rural health networks to support EHR adoption.

In Australia, New South Wales will spend $115 million this year on healthcare IT projects that include a statewide electronic medication management system, a specialist EMR, a system for ICUs, infrastructure upgrades, and new corporate systems.

President Obama, addressing the American Legion conference in Minneapolis last week, touches on electronic medical records:

At the same time, our outstanding VA Secretary, Ric Shinseki, is working every day to build a 21st century VA. Many of our Vietnam vets are already submitting their Agent Orange claims electronically. Hundreds of you, from all wars, are requesting your benefits online. Thanks to the new “blue button” on the VA website, you can now share your personal health information with your doctors outside of the VA. And we’re making progress in sharing medical records between DOD and VA. We’re not there yet. I’ve been pounding on this thing since I came into office. We are going to stay on it, we’re going to keep at it until our troops and our veterans have a lifetime electronic medical record that you can keep for your life.

Other

Healthcare leads employment growth, adding 30,000 jobs in August. Ambulatory health provided 18,000 positions and hospitals another 7,700.

Varian’s ARIA oncology system moves from last place in KLAS’s 2010 oncology system report  to first, beating out Elekta/MOSAIQ and IntrinsiQ/IntelliDose. Epic Beacon earned the highest overall performance score, but was not ranked because of a limited sample size.

Weird News Andy asks, “Who has the brains, who has the heart, and who has the skin in the game?” as he ponders this story: Britain’s NHS is considering turning over its transplant program to a private German company that pled guilty last year to illegally transplanting human organs. The Netcare subsidiary of General Healthcare Group paid over 100 poor children from Brazil and Romania to donate kidneys for its rich customers, performing the surgeries at a hospital in South Africa.

Sponsor Updates

• Allscripts is hosting a meet and greet career event for its services organization this week in Tampa.
• Aspen Advisors ranks #1 out of 350 firms for consultants’ attitudes on their firms’ business outlook.
• Comanche County Memorial Hospital (OK) selects the eClinicalWorks EHR for its employed physicians and non-affiliated practices.
• AdvancedMD offers free Webinars this month entitled, “Four Easy Steps to Qualify for Meaningful Use.”
• Surgical Information Systems goes live at Battlefords Union Hospital and Lloydminster Hospital in Canada.
• PatientKeeper CEO Paul Brient  will speak at the Stifel Nicolaus Healthcare Conference in Boston this week.
• MD-IT releases MD-IT iConnect for the Android operating system, enabling smart phone dictation, direct access to the MD-IT Platform, and the ability to view patients’ longitudinal history from a mobile device.

Contacts

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

HIStalk Innovator Showcase — Trans World Health Services 9/5/11

Company name: Trans World Health Services, Inc.
Address: 10509 Professional Circle, Suite 102, Reno, NV 89521
Web address: www.transworldhealth.com
Telephone: 775.852.9440
Year founded: 2003
FTEs: 7

Elevator pitch

We provide software and consultancy to help FQHCs, Community Health Centers, and other healthcare providers deliver better, more cost-effective care.

Business and product summary

We offer three product lines – Health Center Accelerator (real-time performance improvement software), Better Care Better Value Suite (comparative benchmarking and analytics software and services), and process improvement consultancy, which all work together to give Community Health Centers and other healthcare providers the tools they need to best manage their activities. We evaluate the client’s operation; apply analytics and experience to correct process flow issues; determine which meaningful measures need to be inspected and monitored; implement the appropriate libraries of performance improvement dashboards, alerts, and interfaces to the source data systems; and train and support the users.  

Users include all levels of management right through to front-line staff within the administration, finance, and clinical areas. Our cost model is based on packaged or risk-based fees for initial consulting and implementation, and a monthly license fee for use of the monitoring software and/or access to the benchmarking service. The system can either be locally hosted or delivered in a SaaS environment. By delivering real and measurable improvements in organizational performance, the return on investment for our
pilot site is greater than 500% on an annualized basis and paid for itself within the first three months of deployment.

Who is your target customer?

While our targets could legitimately be any healthcare organization from a small primary care clinic or physician practice to the largest integrated delivery network or payer organization, our current focus is on Federally Qualified Health Centers (FQHC) and Community Health Centers.

What customer problem do you solve?

We highlight and solve process and efficiency impediments that are preventing Health Centers from delivering optimal service levels so they can use their resources more effectively. This leads to cost reductions per patient encounter and increases the ability of the organization to deliver more care and treat more patients with current or slightly expanded resource levels in line with their core mission.

Who are your competitors?

Excluding competitors that are split between pure practice management consulting and pure complex dashboard, workflow, and analytics software providers (which are many and very expensive), there are few companies that offer pre-packaged, healthcare customer-specific dashboard software including pre-packaged efficiency best-practice consulting. Those that do exist, for example: onFocus Healthcare; DashboardMD; The Advisory Board; and MedeAnalytics; are mainly hospital and integrated delivery network focused. Within the Health Center marketplace, we have only found one that would appear to be even slightly similar in positioning: InterPoint Partners.

Why are you better than your competitors?

Our senior management each has over 25 years of senior expertise in healthcare performance improvement, process redesign, quality improvement, clinical utilization, and software development. That translates into knowing right where to go to uncover meaningful areas to focus and improve. Our dashboard software mashes multiple clinical, financial, and operational data sources and runs in real time, providing users with immediate access and drill-down capabilities to see why and where the problems are occurring either at the moment they can be addressed, or by identifying them through proprietary forecasting techniques to prevent problems from even arising through early warning alerts. Traditional single silo reports that are typically run days or weeks after the fact become irrelevant since they are produced too late to save the critical time-limited resources.

Pitch video created specifically for this Showcase

Customer Interview (CEO of a non-profit, community-owned health center)

Your organization was seeking financial and quality improvements. What results have you seen and how much of that was attributable to Trans World Health Services?

The actual results have been about $500,000 to $700,000 in increased revenue over the last 18 months, and about 70% is directly attributable to processes identified through the use of the accelerator and the consultative services.

Organizations always say they have plenty of data, but little information. Was that your situation before, and how has that changed?

We had an enormous number of spreadsheets and data. We also had data integrity issues. It wasn’t until TWHS did a forensic analysis and helped us to clearly define and analyze the data did we reach a point where we could actually begin making rock-solid data supported decision making. It has removed significant amount of doubt and discussion from our ability to operate.

If you were speaking to a peer from another group, how would you complete this sentence: "You should talk to Trans World Health Services under these circumstances:" 

If you plan on surviving the challenges of healthcare reform. This product and the services offered by TWHS will revolutionize the way Health Centers function and operation in the future. Don’t be caught later wishing you had made the investment.

An interview with Bryan Lang, founder and CTO of Trans World Health Services

Tell me about the company.

The market that we’ve targeted and really gone after in America is the Community Health Center market, Federally Qualified Health Centers, FQHC lookalikes, and rural clinics. This market has been tremendously underserved. They’re under tremendous increase in growth and demands. They’ve never had this technology available before.

We developed this technology that was used in every single hospital in England to be able to visualize and to predict where you’re going. We wanted to make it available to this very cost-effective market segment in America. That’s our focus right now.

What do we do differently from the others? Well, it’s a very underserved market. You have occasional dashboard add-on products to the HER. For example, NextGen has an add-on dashboard product, but you get to build your own using that product. 

Our approach is very different. There are five points in our framework. We want to pull information together so they can see and understand what’s going on. We have the analytics to identify variances and opportunities for improvement. We have the predictive modeling to show where they’re heading. We embed best practices into our software so that rather than building your own, you can see exactly where you are relative to others, relative to your own benchmarks, and what you need to do to make a difference. Finally, the data quality in the health center market is substandard in many cases; we really want to be able to show data quality improvement on auditing capability so they can trust their data. 

A simple example of combining the information from various systems involves patient scheduling. If a Health Center is not fully booking its appointment slots, we’re able to say, “Why is that?” and take a look at where the patterns are. Take a look from their population health management systems or their disease registries to say clinically who should be treated, and to be able to combine that, put a value associated with it. 

For example, “This is the value of your diabetic population that needs to be seen.” Combine that data to put it in front of them, in front of the booking people — the people who need to be seen so they can call them up, fill those empty appointment slots, and run a full schedule. That’s a combination using the practice management system, possibly a population health management system or an electronic medical record, and financial information to say, “This is how you affect a positive change by filling your appointment schedules more.” Ultimately that leads to increased revenue with existing staff, so that that’s better for their financial performance.

I ran across a presentation from Livingston Medical Group that was pretty impressive. Can you describe some of the results that they have realized using your product?

Livingston was a very interesting client. They brought us in originally because of the concern about losing productivity due to the implementation in electronic health record. What they wanted to do was have us make them more efficient.

We originally got into a common measure of productivity, which is their providers were not achieving three patients per hour. Three patients per hour essentially is the baseline that many Health Centers run on. We then were able to take a look in that by pulling the data together showing visually that this wasn’t a function of providers slacking off — this was a function of the fact that they had not filled those appointment slots. They hadn’t even provided the providers with enough patients to be able to see to make their targets.

Right off the bat, we were able to pull this information and change some of their fundamental processes so that they could start filling those slots and achieve better provider productivity and revenue. Unfortunately, about this time, they had a tremendous financial crisis. California stopped paying, and then they had outsourced their billing services. Unfortunately, their billing backlog started climbing. They were not able to generate bills. They were not able to bring in revenue. Their financial system went into a crisis.

At that point, neither the billing company nor they were able to see where the problems were. They just didn’t have access to the information. We were re-tasked to be able to open up the information, show the visibility, provide insight into where the problems were in the process. 

We found a huge number of bills that had never been transmitted. We found reasons for blockages and why they hadn’t been paid. We were able to very quickly open all this up so they could see where the problems were, see what they needed to do to solve the problem, solve the problems, and then see the revenue flowing through. It was a very, very narrowly averted crisis. As John will say, they came within a couple of weeks of not being able to stay operational. That was one of the things that we were able to provide for them.

We also showed them how we could provide a huge additional amount of retained earnings for them. Some were north of 700% was what our estimates showed if we changed a few of their fundamental processes and brought them in line with what best practices would be. You hear all this and you say, “Well, that’s something that systems aren’t going to be able replace consultants,” and, no they aren’t. We really believe that the consultancy component is a big part of what we deliver. However, by building in what a lot of consultants normally would do into the software, embedding those best practices, making it a problem-focused solution, so you can see if you have a problem in a given area. 

You can say, for example, “How financially effective are our letter campaigns – our recall letter campaigns to get patients to come back in?” It’s very, very difficult to get answers to that information. That’s a question that is asked in our system, so you go right to that question and click on that and you can go right down into where you can see letter campaign by letter campaign. How effective are you every time you send out a batch of letters to get patients back in, how many are there coming in, and what value is that offering to the organization as a result of sending these recall letter campaigns out.

That’s some of the things that we did at Livingston. We’ve had a very, very good working relationship with them. We originally came in there at saying, “We’ll work with you as long as you believe us to be effective in helping you out” and added to the library item after library item to our system so that we just keep on building module after module. It’s a very interesting market and we look forward to staying in it for awhile.

Healthcare customers tend to like solutions that have quick implementation and payback. What you’re offering sounds like technology and consulting services that require a commitment to change on the customer’s operational side. How do you sell that?

We sell that in two ways. We sell it in a traditional manner where that’s bundled together, where there’s a package of consultancy based on the problems that they’ve identified and very, very similar problems exist across the spectrum. Based on the problems identified, this is what we’d do for the system to be able to plug our system into the various other systems, to be able to present the information to their executive team, and then to be able to work through the top five problems or issues that they want to focus on. We generally package that in terms of an initial three months’ worth of consultancy as well as the software. From that, they make their own determination on how much consultancy they want to have going forward.

There must be a fair amount of overhead in getting those sales by helping them identify their problems and then convincing them that your combination of services and product can help resolve them. Do you see that as a limiter of your growth potential?

Getting in the door is very interesting. We try to minimize the cost of sales, because these price points are not at all what business intelligence systems would be for hospitals. We try to go to conferences or out where groups of them come together or meet in groups. We also do a lot of WebEx demos.

But the problems are very similar across the spectrum of Community Health Centers in America. Once we have a set of solutions, we can say, “You’re probably looking at this, this, and this. Let’s show you what this would be” and you get head nods around the table very quickly.

What do you hope to gain from this exposure?

We hope to gain a lot understanding of how we can make a difference in helping Community Health Centers. Ultimately, we’d certainly like to go back to our original market, which is hospitals, and take that and step forward from the traditional models, but really build that consultancy behind it to say, “Where are my problems and what do I need to do about the problems now, today, so that they don’t become a statistic tomorrow?”

Monday Morning Update 9/5/11

From It’s All Good: “Re: Sage Healthcare. Tom Chmielewski, VP of product management, leaves to ‘pursue other interests,’ following the recent departures of project management execs Mike Burger (PM/EHR), Rob Price (practice analytics), and Mark Martin (EDI). It’s an interesting time to be cleaning the product management house. Who’s minding the store for Stage 2 and beyond?” A source verifies that Tom Chmielewksi has left the company.

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

Listening: reader-recommended Metric, female-led Canadian indie rock with only a little bit of guitar (reminds me a little of Muse, but more subdued). I was surprised that I missed a band this good, but it turns out I didn’t: I recommended them back in April 2009. Really good stuff, fresh and tight. I’m happy for the reminder to listen to them all over again.

My Time Capsule editorial this week, archeologically excavated from the ash heap of history circa 2006: “Hospitals Want Software to Do The Dirty Work of Changing Physician Behavior.” A free sample of the equally free product: “No software contains a switch that turns resistant physicians into docile, rule-following sheep who make better decisions under the watchful eye of Big Brother’s can’t-miss medical guidelines.”

InterSystems acquires Siemens Health Services France from Siemens, whose Clinicom system is used by 60 French hospitals. InterSystems will pair Clinicom with its TrakCare HIS, which offers electronic patient records, documentation, order entry, flowsheets, patient management, ED, OR, rad, lab, pharm, and billing. InterSystems acquired TrakCare and its Australian developer, InterSystems application partner TrakHealth, in 2007.

The joint VA-DoD EHR will yield an open source results, at least according to VA CIO Roger Baker. That statement didn’t come from DoD, which has a rich history as an intractable, contractor-enriching bureaucracy not interested in giving up control or collaborating outside its walls.

Indiana Secretary of Commerce Mitch Roob will resign to become president and CEO of WoundVision, an Indianapolis company that sells software that performs risk assessment and predicts pressure ulcers. He replaces founder James Spahn MD, who will remain board chair.

Microsoft will work with Social Interest Solutions, a non-profit that connects low-income individuals and families to health resources. Microsoft wants to use the organization’s knowledge to get involved with government health insurance exchanges.

This article says US News & World Report used HIMSS Analytics data to choose their top hospitals, which I thought was bizarre since HIMSS Analytics looks only at IT metrics and US News evaluates death rates, reputation, and several non-IT factors. Turns out the story is not really correct: USN&WR used the HIMSS Analytics information only to create a Most Connected Hospitals list by cross-referencing its own top hospitals with those that are EMRAM Stages 6 or 7.

We are collectively torn on the issue of whether Congress should rescind HITECH money. New poll to your right, for hospital employees: to what degree does your board review and analyze big IT requests before approving or rejecting them? I got the idea from Joel French’s interview, in which he marveled that boards of struggling hospitals approve $70 million system purchases (I assume he meant Epic) without any guarantee the investment will help the bottom line. My experience with hospital boards is that members (community movers and shakers, hefty donors, and a token smattering of social advocates) are mostly interested in the community relations aspect rather than deep diving into operational decision-making. Rightly so, hospital executives would argue. It’s like Congress: the outcome of  big decisions is a foregone conclusion since the execs have persuasively lined up the support they need long before the issue is brought up for a board vote.

This article says hospitals are using doctors with questionable objectivity or even “doctor bots” (example 1, example 2, both using the same doctor name but pictures of different people) to spit out medical advice via Twitter, which gain a following and reap AdSense revenue for the commercial sites they link to. The bots take existing articles of questionable value that have no references or detailed information, swap words using an electronic dictionary to make it look like something new, and then tweet links to it. My first thought was that laws would surely prohibit either falsely claiming to be an MD or dispensing questionable advice as one, but then I realized that (a) someone would have to file a complaint, and (b) those laws are mostly at a state level, so it may not be clear whose domain something like this falls under.

Cayman Islands Health Services Authority CIO Dale Sanders tells me the national healthcare conference will be held November 17-19 at the Ritz Carlton in Grand Cayman. I think I need to be there.

Meditech cancels plans to build an office building in Freetown, MA after the state historical commission overrides an archaeological firm’s recommendations and insists that the company dig, sieve, and log the contents of a two-foot layer of dirt covering 21 acres, which Meditech says would have taken at least a year. Town officials fear the company will look out of state for a substitute location. The mayor of Fall River, where the company already has offices, says his town will beat any Freetown offer.

Healthcare RTLS vendor Versus Technology announces Q3 results: revenue down 15.4%, net income –$15,000 vs. $38,000.

Oroville Hospital (CA) is profiled in a local publication for its impending implementation of the WorldVistA’s EHR, the first US hospital to go live on that particular variant of the VA’s VistA. From the Bob Wentz, the 153-bed hospital’s CEO: “Why do most healthcare organizations and doctors’ offices have software owned by a company? … What if they wanted to change to a different provider? What would it cost them to get out? And they would get no help transferring their data.” On the other hand, he’s not exactly objective – according to the article, he’s associated with Tenzig Corp., which it says offers hospital implementation services for VistA. I don’t know what happened to the hospital’s original plan to implement Medsphere’s OpenVista, announced in 2007, that caused them to switch to WorldVistA. It was announced a few days ago that WorldVistA EHR 2.0 earned ATCB certification as a complete inpatient and ambulatory EHR, with Oroville proving money, enhancements, and coordination.

More from Vince Ciotti on Gerber Alley. Care to share some vendor reminiscing from back in the day? (that being defined as pre-1990, let’s say, involving visionaries or now-defunct companies). E-mail Vince.

Continua Health Alliance releases its 2011 Design Guidelines for personal health devices, with new coverage of Bluetooth Low Energy temperature sensors, ZigBee networks in which a single sensor communications with multiple hosting devices, and user identification over a Wide Area Network interface.

A survey in Ireland finds that almost 50% of people diagnose themselves using the Internet instead of seeing a physician. Nearly half of those surveyed said they would use SMS or IM to communicate with their physician if available.

A hospital in England ditches the “do not disturb” vests that nurses were wearing to prevent distractions during medication administration. Patients hadn’t complained, but newspapers had run quotes from other areas in which visitors claimed to be miffed at being told to leave the nurses alone until they had given all their meds, even though studies have shown significant error reduction when nurses are allowed to focus on the task at hand. One might logically conclude that if it weren’t for the social aspect of being hospitalized, hospital units should be closed off to outsiders just like the psych ward or an auto garage. You’ve got dangerous equipment and drugs being hauled around, bodily fluids flowing, people trying to focus on life-and-death tasks, and patients having life-threatening events, all while visitors are getting in the way, asking questions, and spreading germs. It’s like trying to run a busy restaurant kitchen where patrons are allowed to wander in and out and maybe reach around the chef for a sample.

A futurist’s view of sleep technology and the “hotel room of the future” predicts that within 20 years, sleepers will be able to choose their dreams and share them with others; wear active contact lenses that will deliver 3D TV images directly to their retinas; and participate in virtual lovemaking where feelings and emotions are shared via skin sensors.

Government contractor CSC acquires Baltimore-based Maricom Systems, which provides informatics and data management systems used by HHS. 

Allscripts files suit against Virginia-based consulting company Visus, alleging trademark infringement. Allscripts claims the company used its company and product names without approval to promote EHRs. Visus has removed references to both Allscripts and NuWave from its site (before and after image above) after both companies insist they have no relationship with Visus.

A nursing professor in Canada conducts a telenursing pilot project in which nurses monitor home-based diabetic patients using smart phones and the Internet. Part of the project involved creating an interactive telehealth platform that is being commercialized by McGill University with Magellan Global Health, of which the professor appears to be president and COO after the company was merged with her medical tourism company. Being a professor has to be the best job in the world. You get a substantial paycheck for teaching a few classes a week at a pretty campus that offers lots of entertainment opportunities, you get grant money and eager beaver student research assistants, and there’s plenty of time to run consulting or product businesses on the side.

Jeffrey Kriseman, an Arizona State University PhD student, is profiled for developing an open source messaging system used to exchange public health information for disease surveillance. It’s being used by Nevada providers to submit reportable lab results to public health agencies, qualifying them for HITECH money. Kriseman is finishing his PhD in biomedical informatics.

Strange: the FBI investigates a prosthetic manager at University of Minnesota Medical Center, accusing him of convincing patients to replace their perfectly useful artificial limbs with new ones, after which he would sell their old ones on eBay.

Stranger: a 17-year-old part-time doctor’s billing clerk is arrested in Florida after posing as a physician’s assistant, convincing the hospital’s HR department to give him a PA badge so he could work in the ED where he examined patients, dressed wounds, and performed CPR on a patient in cardiac arrest. He was caught after he pestered HR to upgrade his badge so he could hang out in the doctors’ lounge, but gave the excuse that he was working undercover for the police. He had previously been dismissed from a Sheriff’s Explorer teen police program for wearing a deputy’s badge and bulletproof vest in public.

E-mail Mr. H.

News 9/2/11

Top News

CMS issues its final rule on changes to the e-prescribing incentive program and includes multiple hardship exemption categories for EPs. EPs have until November 1, 2011 to request a hardship exemption for the 2012 eRX payment adjustment.

Reader Comments

From CDH: “Re: Epic trainers. More disgruntled ones, this time at Central DuPage Hospital. Of 27 hired, eight have left. They were told they would be certified, but in reality were only credentialed. The principal trainers have purely HR backgrounds without any go-lives under their belt. Training plans are being revised daily as they have not yet stopped the back-end build for the November 6 go-live.” Unverified.

From Arch Moore: “Re: WVHIN and Thomson Reuters. You reported that deal back on January 24, more than seven months before they announced the contract. I heard contract negotiations hit a big snag in June when Thomson Reuters announced to the world (and Wall Street) that they were thinking of getting rid of their healthcare business. Rumor is it was a surprise to everyone. WVHIN must have been impressed with CareEvolution since the deal went through.” Thanks for reminding me. I was thinking I’d said something about this from a reader’s rumor report back in the winter.

HIStalk Announcements and Requests

Wondering what you may have missed this week because you still haven’t signed up to get HIStalk Practice? Wonder no more: EHRA tells CMS that requiring providers to submit patient-level data for CQMs is too big a burden. I annotate toenails using Healthfusion’s MediDraw. athenahealth launches a PCMH accelerator program.  Retail medical clinics are flourishing.  If it’s fall, then it must be time for user group meetings.

On HIStalk Mobile, Dr. Travis covers all the news about apps, home health technology, and mobile health, but also summarizes what it takes to succeed in developing successful apps for consumer health.

On the Jobs Board: McKesson Consultants, Epic Implementation Project Manager, SCC/SMM Consultants. On Healthcare IT Jobs: Epic Physician Trainer, Clinical Nurse Analyst, NextGen Trainers / Consultants.

Allow me to compress my usual Thursday spiel into one-word imperatives, just for the sake of brevity: (a) subscribe; (b) Friend; (c) report; (d) click; and (e) thanks. Did you get all that?

Listening: Ghost on the Canvas, a moving last studio album from Glen Campbell, diagnosed with Alzheimer’s this year. I was never much of a fan, but maybe I should have been given this album’s outstanding songwriting, vocals, and guitar work. To my ears, the 75-year-old, who has sold 45 million records in his 50 years in music, has never sounded better or benefitted so much from fresh-sounding production and contributions from folks like Jakob Dylan and Billy Corgan. It’s everything you’d expect from someone looking back at a life well lived: reflective and poignant, but optimistic (A Better Place says it all). Glen never got much attention from the music industry because he straddled genres (country? pop?) and was goofy on TV and movies, but somebody must be blackballing him if this album doesn’t reap a truckload of awards even without the sympathy vote.

Happy Labor Day, celebrating the rapidly diminishing ranks of us who aren’t out of work or happily drawing government entitlements while practicing leisure. You fashion purists will no doubt be placing your white clothing and seersucker suits into storage next week as summer unofficially ends. For me, it’s college football, perhaps some well-crafted barbeque, and a beer or two unless Mrs. H unveils plans of her own. I will most likely post Monday Morning Update this weekend since that’s what I do, even though fewer folks will read it (time to slip in something really scandalous!) Enjoy the holiday.

Acquisitions, Funding, Business, and Stock

Despite reporting “disappointing” Q2 results Wednesday, SAIC CEO Walt Havenstein speaks positively about the company’s recent acquisition of Vitalize Consulting Solutions:

The addition of Vitalize will expand SAIC’s health solutions portfolio in both commercial and federal markets to help customers better address electronic health records implementation. The combination of Vitalize’s expertise and integrating commercial off-the-shelf software for electronic health records and systems with SAIC’s information integration data analytics, and cyber security capabilities creates a powerful combination in the marketplace.

SAIC’s Q2 numbers: revenue of $2.6 billion (a 6% y/y drop), EPS of $0.32. Analysts expected $2.77 billion and $0.35. Shares fell 13.5% on Thursday, making it the top loser on the NYSE and hitting an all-time low, after the company said reduced government spending is hurting its top line.

Ingram Micro announces a Healthcare Partner Network of healthcare VARs and managed service providers.

Shares in NextGen parent Quality Systems hit a 52-week high Wednesday before slipping a little on Thursday. Market cap is $2.66 billion. Big holders Sheldon Razin and Ahmed Hussein own $459 million and $423 million worth, respectively.

IV equipment maker B. Braun Medical sues CareFusion for patent infringement, claiming CareFusion’s Alaris smart IV pumps violate its patents that include wireless communication with hospital clinical information systems.

Sales

Twelve Community Health Centers in Puerto Rico choose SuccessEHS EHR/PM for their 190 providers and 26 sites.

People

AHIMA names Lisa Spellman as its representative to lead the health informatics committee for the international standards organization ISO/TC215. She was previously with HIMSS and Allscripts.

Steven Liu MD, founder and chairman of Ingenious Med, is named Physician Entrepreneur of the Year by Modern Physician.

Announcements and Implementations

The Buchanan County Health Center (IA) goes live on its first phase of Meditech.

The Greater Dayton Area Hospital Association and HealthBridge announce the go-live of the Greater Dayton Area Health Information Network, which connects four hospitals and over 200 physicians.

The fishing city of Navotas in the Philippines rolls out EMR at nine health centers and one “lying-in” clinic. Midwives will be equipped with 22 BlackBerry smartphones, allowing them to collect patient data as they make house visits.

Physicians connected to Brooklyn HIE can access patient records via from their ClinicalWorks EHR.

Optum enters a strategic relationship with Monarch HealthCare (CA) to manage the clinical operations of its 2,300 independent physicians.

athenahealth launches athenaCoordinator to facilitate care delivery among hospitals, practices, and other caregivers.

Government and Politics

A scathing and well-written reader editorial about “inane” Maryland Medicaid isn’t too keen on accountable care organizations:

Mr. Ransom seems to think that doctors, including the rural ones, will flock to the idea of reward for cost savings and better care management. The people who are enamored with these payment models are mostly lawyers, journalists, politicians, medicolegal pundits, bureaucrats and software companies, especially the last that endlessly inundate the medical profession with ideas that neither materialize in enhanced care for patients nor in increased income for doctors. Instead these ideas have resulted in jobs and increased income for government auditors, care deniers and people who connect doctors to the care deniers, paper pushers and bean counters; folks who will never set eyes on a patient in their lifetime.

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Innovation and Research

A doctor from Wichita State University (KS) develops an iPhone concussion symptom detection app for high school football teams. Concussion Manager, which costs $25 per player, tests before-and-after balance, memory, and reaction time on the sidelines, allowing coaches to take the player out if warranted.

Other

Insiders are responsible for the majority of PHI breaches, with 35% involving employees snooping on their co-workers and 27% the records of friends or relatives. Loss or theft of physical records or equipment account for an additional 45% of breaches.

Fred Trotter reviews the VA’s recently announced VistA Custodial Agent, concluding that, “it doesn’t suck (much).”

Weird News Andy finds the Yale School of Medicine announcement of a paper-free curriculum a little weird (there’s that word again), balancing the $100K annual savings against the $600K upfront iPad cost, inevitable repair bills, and the likelihood of buying Apple’s hot new model every couple of years as being similar to “federal government thinking.” He likes the idea, but finds predicted print savings to be an unconvincing way to justify the cost.

Weird News Guy sent over this link: if you insist on removing animals from their natural habitat and locking them up thousands of miles from home so humans can stare at them, at least give them iPads like the Milwaukee County Zoo has done for orangutans. They play with apps on the donated iPads and will soon have Skype, which will allow them to videoconference with their inmate counterparts elsewhere. That’s obviously a testament to the iPad’s ease of use. Wonder how they’d fare with an EMR? 

Former Carthage Area Hospital (NY) CIO Skip Edie says he was interviewing an out-of-work CIO for an IT position when the hospital’s CEO called the candidate in Edie’s office to tell him he should interview for Edie’s job. Edie says he saw the writing on the wall and turned in his four-week notice, only to be marched off the property. Two days later, Edie’s wife, a patient accounting manager for the hospital, gave her four-week notice and was also escorted out within 10 minutes, she claims. The CEO says both left on their own and would not comment further.

Strange: the Christmas Eve death of a radiologist from Jackson Memorial Hospital (FL) is ruled an accident by the sheriff’s office, which determined that the woman’s necklace became entangled in the shiatsu massager she was using in her bedroom, strangling her. Her husband, also a doctor, says he found her unconscious. The FDA is advising owners to not only throw the specific massager (above) away, but to break it into pieces and put the parts in different batches of trash.

Great news if you are good looking: more attractive people earn an average of $250,000 more during their careers than those who are less good-looking. Not only do the best-looking third of the population earn 5% more money than the average or ugly, they also get better deals on loans. And if you are a pretty woman, you are more likely to marry a higher-earning man. I’m now wondering if Mr. H would give me a raise if I invest in some “cosmetic upgrades.”

Sponsor Updates

• Merge Healthcare’s OrthoEMR v4.0 receives ONC-ATCB certification.
• Hayes Management Consulting reports that Ohio State University Physicians’ use of MDaudit has helped the practice reduce regulatory risk.
• Lancaster General Hospital (PA) selects Wolters Kluwer Health’s ProVation MD software.
• Healthwise will participate in next week’s The Forum 11  Annual Meeting of Care Continuum Alliance in San Francisco.
• NextGen is offering a webinar September 12 to demonstrate its Inpatient Clinicals.
• API Healthcare is exhibiting at the this month’s ASHHRA Annual Conference in Phoenix and the Healthcare Staffing Summit in Philadelphia.
• Vocera smart phones and badge communicators can now receive alerts and notifications from Extension, Inc.
• Greenway Medical announces that PrimeMOBILE now available on iPad as a native app.
• Healthcare Innovative Solutions will participate in this month’s Kansas Hospital Association’s Meaningful Use Summit in Topeka and the South Carolina Hospital Association / South Carolina Medical Association TAP Conference in Hilton Head.
• The Orthopaedic Institute of Central Jersey and Orthopaedic Spine Institute select SRS EHR for their combined 19 providers.
• 3M Health Information Systems partners with Krames StayWell to encode Krames StayWell’s patient education library using the 3M Healthcare Data Dictionary.
• Imprivata and Teradici announce updates to Teradici PCoIP firmware and Imprivata OneSign software that will provide integration and interoperability of PC-over-IP (PCoIP) zero client devices with authentication management and single sign-on software.
• Medicare awards Faith Community Hospital (TX) incentive funds following its successful Meaningful Use attestation using to Prognosis EHR.
• Aspen Advisors publishes two new case studies: Fairview Leverages Seasoned Project Managers to Ensure Successful EMR Rollouts and University Hospitals Prepares for Meaningful Use Attestation. 
• The Fullerton Radiology Medical Group (CA) picks McKesson’s Revenue Management Solutions for its 10-physician practice.
• The Advisory Board and Mercy Clinics announce their inaugural Health Coach Training course in Des Moines, IA in October and November.
• ZirMed partners with training solutions provider Contexo Media to launch ZirMed University, an online portal that provides training on the ZirMed solution as well as courses for continuing education credits.

EPtalk by Dr. Jayne

Earlier this year, the American Medical Association launched a contest to identify an innovative new application for handheld use. The top ten finalists have been announced and voting is open through an AMA website. You do, however, have to be a member to vote. Finalists are in two categories (Physician and Resident/Medical Student) and include applications for tracking hospitalized patients, surgical equipment preferences, and resident duty hours. Personally, my favorite is “What’s Not Covered,” which helps determine what organisms might escape a patient’s current antibiotic regimen.

Speaking of apps, HHS, through the Office of the Assistant Secretary for Preparedness and Response (ASPR) has issued a challenge for a Facebook application to connect friends who agree to check on each other during emergencies and communicate to the community via social media. “Additional accolades” are promised to entries with a “fun or game-like atmosphere for the user.” Maybe some smart developer can cross Angry Birds with a zombie apocalypse theme. Even smarter Facebookers will be sure to friend Inga, Mr. H, and yours truly.

I mentioned last week that Hofstra North Shore-Long Island Jewish School of Medicine is training their incoming medical students as emergency medical technicians. According to a reader, it’s not as new or revolutionary as it sounds – this was done in 1980 at The Medical College of Pennsylvania:

Bradley K, Anwar RA, Davidson SJ, Mariano J. A time efficient EMT-A course for first year medical students. Ann Emerg Med. 1982 Sep;11(9):478-81. PubMed PMID: 7114594.

Another reader alerted me to news about the Kentucky All Schedule Prescription Electronic Reporting system, or KASPER, which I mentioned as recently announcing it would interface with a similar system in Ohio. Kentucky House Speaker Greg Stumbo is seeking information regarding the system’s use (or lack thereof) by the Kentucky Board of Medical Licensure. Stumbo wants to know why the Board isn’t using data on prescribing habits across various geographic areas to investigate suspect physicians.

The article notes that only 30% of Kentucky physicians are using the system. Let’s see: I’d wager that 0% of suspect (or even slightly shady) physicians would use the system, so I’m not sure how more scrutiny of the data would really be a benefit. It goes on to mention that Public Citizen ranks the state as having the twelfth strictest board for disciplinary actions per 1,000 physicians, having been third and second in previous measurement periods.

September is Women in Medicine Month. I’m thankful for the women who came before and paved the way for the rest of us. I’ve been privileged to have some outstanding women as mentors. We’ve come a long way since Elizabeth Blackwell became the first woman to graduate from a US medical school in 1849. There’s still a bit of inequality out there, however: even with record numbers of women in medicine, my medical class was the first one in our institution’s history where women outnumbered men. We felt this acutely when 60+ women were crammed into a gross anatomy locker room designed to hold 20 women. The men’s locker room had 40 empty lockers. Go figure.

Duplicate Drug Checking
A Reader’s Response

I’m one of those readers who works for a vendor of a clinical drug database, though not the one referenced in the article. For the sake of transparency, I’m in product management at First Databank (FDB).

I agree that duplicate therapy is one of the more challenging domains of medication decision support. In the article under discussion, there was a scenario in which two different physicians wrote aspirin orders five minutes apart for a patient who had undergone a cardiac stent procedure. The authors agreed with the duplicate therapy alert that was fired (though they brought to light that the doctor missed it because it was buried amongst nuisance alerts, which I’ll touch on below).

However, in another context, two orders for the same drug will not warrant a duplicate alert (for instance, when a patient gets a one-time dose in the ED and then the order is continued on the floor). Venue matters. And that’s just one context among a number of different contexts that need to be considered, such as change in level of care, timing of the order, same or multiple clinicians placing the order, etc. Most of these factors are outside the purview of the drug knowledge base.

But I am not passing the buck. It is critical for the drug knowledge base to keep evolving to providing decision support that considers additional context.

One approach is to have the duplicate therapy knowledge driven off of pre-configured orders rather than the drug products. This requires that structured orders be employed by the vendor system, but can more easily identify orders that are intentionally given together, such as a bolus with a continuous infusion, or an order for which the nurse decides on the route (also referenced in the article). One of your sponsors, an MD, uses our structured orders, along with their own logic, and asserts that duplicate therapy does not have to overwhelm. 

Of course, as many have pointed out, dialing back the sensitivity in the content is another obvious component. We have done a lot of work on this over the last year. When I entered some of the key examples in the article into our test system, I found that we matched the authors’ recommendations.

We hit on the previously mentioned example of two aspirin orders, but not on the other alerts which the authors felt were spurious and caused the doc not to notice the true duplicate. Similarly, we satisfied the recommendation to generate a hit for an order for metoprolol IV on top of metoprolol PO.

Mr. H.’s insight that attributing severity for duplicates so that a site can turn off the less severe ones “en masse,” as is done with drug-drug interactions, also needs to be tackled. We do support our users with a solution that enables them to easily customize—turn off, or selectively turn on—alerts even without that attribute. 

We recognize that the volume of alerts is still too high for duplicate therapy as well as other domains and are investing heavily in addressing alert fatigue.

Contacts

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

News 8/31/11

Top News

Prognosis Health Information Systems, Inc. signs a definitive agreement to acquire Creative Healthcare Systems, developers of the financial management and patient accounting system MedGenix. Prognosis will integrate MedGenix with its ChartAccess EHR. Creative Health CEO Steve Everest will stay on board to lead revenue management operations.

Reader Comments

From A Vendor: “Re: Billians Health Data and HIMSS Analytics. Do vendor readers have an opinion of the superiority of one over the other as a source of hospital data? We’re interested both in the database and the networking potential of the organization.” Comments are welcome.

From Antoine: “Re: duplicate med alerts. I’m not sure I agree with your comments. A duplicate check is just a med-med check where the two meds are the same. Whatever deficiencies exist in duplicate checks should exist in med-med checks. The abstract of the article said the number of exact duplicates was high, which I assume is an error, unlike conditions where other factors are different.” The biggest different between duplicates and drug-drug interactions is that the latter are graded by severity at the database level, so they can be turned off en masse and unselectively to suppress noise. Those allowed to display are then almost always clinically significant. The former are triggered by partially or wholly identical drug codes in two or more active orders, but further refinement requires looking at order-specific information such as route of administration, overlapping times, and frequency, and if that isn’t done well, those warnings are rarely clinically useful. In the article, some of the duplicate warnings were appropriate, caused by issues in CPOE such as multiple providers not looking at each other’s orders and entering an exact duplicate. Even exact duplicates may or may not be significant: if one order ends tomorrow and the other starts the next day, the system needs to decide whether that deserves a warning. I have readers who work for vendors of the clinical databases that make these “alert or not” decisions, so I welcome their review of the article. But I’ll stand by my conclusion: duplicate warnings are fairly close to useless, at least as measured by the ultimate yardstick – how many times does the clinician ignore the warning and enter the order anyway?

From ADALMA: “Re: Allscripts. I’m an employee and had two flights cancelled because of the weather. My manager called to say family comes first and not to do anything to jeopardize my family or my safety.” Another reader sent over a company e-mail that, while mentioning safety a couple of times, didn’t explicitly say to take care of family first. I attribute that to the fact that it came from a marketing person, so naturally her focus is on the conference rather than general managerial advice. I’m sure interpretations of what’s between the lines of any e-mail vary based on the reader’s disposition, but it seemed fine to me and I wouldn’t be insulted if I worked there – the company seemed appropriately concerned for the well-being of its employees. I was more interested that the reader told me that company attendees share hotel rooms at the conference, so naturally I had to ask how that works – do you get to choose a bunkmate, and what if one of you snores, is hygienically challenged, or is unusually modest? Answer: you either choose a roomie or have one assigned, or you buy out their half of the room with your own money. Forced room-sharing to save the company money always seems a little bit creepy to me, but I can see why it’s financially attractive when you’re sending hundreds of people to one event (but I still wouldn’t like it). Feel free to send me your first-person stories about that arrangement since I’m sure lots of companies do the same.

From Big Fight Brewing: “Re: 3M. ICD-10 is pushing hospitals to computer-assisted coding. 3M is telling clients that their encoder (used by 4,000 hospitals) will not interface with any NLP or CAC solution other than their own. Big clients are not happy.” Unverified.

From Gilbert O’Sullivan: “Re: UNC Health. Announced to its IT employees Friday that Rose Ann Laureto will be the new CIO. Seems to be a good hire.” She is (or was, if the rumor is true) CIO at University of Illinois Medical Center at Chicago. JP Kichak was UNC CIO until recently and still is on his LinkedIn profile, so that’s all I know.

From TRL: “Re: Cedars-Sinai. Live on Stork and a new fetal monitoring system. I’m a consultant and leadership at Cedars-Sinai might be the best in the country. They demand near perfection, but those of us with high demand skills respect being asked to perform at our best. Far too many places are just happy to follow with some strange comfort that just buying Epic is enough. Make no mistake, Epic is good software, but implementation leadership is EVERYTHING when it comes to success.” Unverified.

Acquisitions, Funding, Business, and Stock

Scotland-based charge master vendor Craneware announces financial results for its 2011 fiscal year: pre-tax profit grew from 2010’s $7.26 million to $8.65 million; revenues increased 34% from $28.4 million to $38.1 million.

Blackstone Group seeks a $1.2 billion loan to fund its $3 billion buyout of Emdeon.

India-based business process outsourcer Ajuba Solutions says US healthcare reform has boosted its business, encouraging the company to spend $5 million on technology and $5 million on a new building. It will hire 700 new employees.

Sales

West Virginia Health Information Network selects Thomson Reuters HIE Advantage for its technology backbone.

Ardent Health Services (TN) expands its use of Surgical Information Systems solutions to include anesthesia documentation.

Reston Radiology Consultants (VA), Washington Radiology Associates (VA), Shady Grove Radiological Consultants (MD), and Advanced Diagnostic Radiology (MD) select Merge Healthcare’s RIS.

PriMed (CT) expands its relationship with MED3OOO by selecting InteGreat EHR for its 28 locations and 75 providers.

People

Brad Levin is named North American GM for Visage Imaging. He was previously with GE Healthcare.

Impact Advisors hires Michael Nutter as its director of firm culture and associate satisfaction, a position it also calls “happyologist.” He was previously with Florida Hospital.

Huron Consulting Group names Michael Cadwell and Andrew Schramm as managing directors in its healthcare practice. They’re from Ingenix Consulting and Tefen Management Consulting, respectively.

Lisa Crymes joins Bottomline Technology as director of healthcare products and strategy. She was previously with Emdeon.

Announcements and Implementations

eHealth Global Technologies deploys Axolotl Image Exchange to provide diagnostic image exchange services for hospitals participating in HealtheConnections RHIO of Central New York.

The American National Standards Institute (ANSI) launches the  Permanent Certification Program for HIT that will accredit organizations that certify EHRs. The permanent program will replace the current temporary certification program in 2012. ANSI is accepting applications through October 7.

Allscripts reports that over 4,700 attendees are taking part in this week’s ACE meeting in Nashville.

Florida providers can now use secure email though the Florida HIE Direct Secure Messaging (DSM) service. The secure messaging service is the first milestone in the HIE’s $19 million initiative, which uses technology from Harris Corporation.

Addington Hospital says it will be the first in South Africa to implement Meditech 6.0.

Travis recently mention on HIStalk Mobile something that I hadn’t heard – Facebook allows drug companies (and only drug companies) to disable or edit comments left on their wall. Facebook announced on August 15 that it will no longer give drug companies that option except on pages created for specific drugs. Several drug companies have deleted their pages, while others allow comments if they adhere to stated policy. The reason for Facebook’s original special handling of drug company pages makes sense – if someone’s public comment suggests they’ve experienced an adverse drug event, the company might have to file a report with the FDA, at least in the absence of FDA policy that says otherwise.

Government and Politics

US CTO Aneesh Chopra will deliver a keynote speech at the Consumer Electronics Association’s Industry Forum in San Diego next month. The press releases mentions the announcement of “a major, new digital health and fitness program.”

Innovation and Research

Researchers at Tel Aviv University create a Facebook game that will help them understand how infections spread. PiggyDemic allows Facebook users to infect their friends, which the researchers say is how viruses really spread rather than being distributed equally across populations.

Technology

Yale’s medical school will no longer provide printed course materials, instead giving students iPads and putting all the study materials on them. They expect to save up to $100K in annual printing cost plus the labor involved. “It really makes the curriculum imminently updateable,” the assistant dean was quoted as saying, although hopefully in his mind — unlike that of the reporter — he spelled it “eminently.” Students get an iPad, apps to manage the reading material and recorded lectures, and a gift card to buy a keyboard. Harvard Medical School isn’t quite there yet, letting students buy whatever mobile device they want and giving them the choice of paper or electronic course content.

Physical therapists at Banner Good Samaritan Hospital (AZ) are using video games to put rehab patients through painful exercises. Patients like Wii Bowling, but the hospital is experimenting with Microsoft’s Xbox Kinect since it covers the whole body.

SeeMyRadiology.com releases a free iPhone/iPad remote viewing tool for its medical image exchange.

Other

Vince keeps digging deeper with his company HIStories, aided by readers who send him memory-jogging historical tidbits, so Gerber Alley turned into a two-parter, with Part I above. If you have Gerber Alley info to share (especially any photos of Urban Gerber, who died in 1984) it’s not too late to contribute to next week’s Part II. I love reading these, especially when I recognize someone’s name or picture. I’m thinking about starting an Healthcare IT Hall of Fame with a panel of voters to choose from the nominees. Wouldn’t it be cool to see them inducted at HIMSS or something? Everybody’s suddenly nostalgic about the history of Apple and Steve Jobs (justifiably), so why not our own industry, which goes back even further? Not to mention the “doomed to repeat history” thing.

In Taiwan, HIV-infected organs are mistakenly transplanted into five patients after a hospital staffer misunderstands “non-reactive” instead of “reactive” when the donor’s HIV test results are called in and not double checked.

Indianapolis Colts quarterback Peyton Manning delivers this great line to reporters after being peppered with a few too many questions about his May neck surgery and ongoing recovery:

“I don’t know what HIPAA stands for, but I believe in it and I practice it.”

Apple gives new CEO Tim Cook over $380 million worth of shares, awarded if he remains an employee for ten years.

El Camino Hospital (CA) hires celebrity nurse practitioner Nurse Barb, who seems to already be a hospital employee although it’s not exactly clear, to develop a televised health series and to increase its social media presence.

Weird News Andy was so moved by this story that he titles it, “Sheer brilliance of doctors” with only a tiny trace of his usual dry humor. An 86-year-old Arizona man drops his pruning shears while gardening. The sharp end sticks in the ground and the man slips and falls while picking them up, jamming the protruding handle through his eye socket and into his neck, pressing directly against his carotid artery. Surgeons at University Medical Center remove the shears and repair the damage with wire mesh, saving his eye and leaving him fully recovered other than some minor double vision. There’s plenty to dislike about the US healthcare system, but if you’ve got a lawn tool jammed into your skull, be glad you’re here.

Hurricane Irene Updates

Forty-three patients from Johnson Memorial Medical Center in Stafford Springs, CT were transferred to other facilities when the hospital lost power from two separate power feeds Sunday morning. The hospital had switched to a backup generator, but it failed.

Staten Island University Hospital was one of several hospitals evacuated in advance of Irene. CIO Kathy Kania reports that the hospital sustained only minor damage, including water in “peripheral” portions of the IT department. All IT systems were restored to full operations between 1:30 p.m. and 9:30 p.m. Sunday.

In the mid-Hudson Valley region of New York, flooding and damaged roads are creating the biggest problems for hospitals. Bridges approaching St. Anthony Community Hospital are washed out, leaving the hospital on an island. Several parking lots at Bon Secours Community Hospital are under water and flooding on local roads is making it difficult for employees to get to work. Meanwhile, St. Luke’s Cornwall Hospital is fully functional, though relying on a backup generator.

Dorchester General Hospital (MD) was evacuated Sunday morning and 30 patients were transferred after wind and rain damaged the roof. By 2:00 a.m. Sunday, the floor was covered in four inches of water and water was pouring from the ceiling. The laboratory sustained the most damage, though the ED, operating rooms, central supply, some patient rooms, and the chemo unit were affected.

SCI Solutions offered its customers free appointment voice reminder calls before the storm hit, working with partner TeleVox. Patients with scheduled appointments got a telephone message of the hospital’s choosing, with one hospital’s chosen message being “Hurricane Irene may disrupt power at the facility your appointment is scheduled. Please contact the facility before you leave home to ensure your appointment is still possible and/or call Central Scheduling for information. Please continue listening for your appointment details.”

Sponsor Updates

• maxIT Healthcare presents the Beads of Courage Beads in Space tour, which is traveling to 10 US cities in honor of September’s Childhood Cancer Awareness Month.
• Consulting Magazine includes Impact Advisors and North Highland on its list of 2011 Best Firms to Work For.
• Billian’s HealthDATA introduces HITR.com, a social networking tool for benchmarking hospital IT satisfaction, at an August 31 webinar.
• ESD rolls out its new branding and Web site at Allscripts ACE. Also at ACE: Awarepoint showcases its Patient Tracking Board solution and Allscripts unveils its Mobile EHR apps for iPad .
• GE Healthcare hosts a September 7 webinar entitled EMR & Quality Management.
• Central Maine Medical Center (CMMC) ranks among the nation’s 25 Most Wired and Most Improved following its partnership with The Huntzinger Management Group.
• Faith Community Hospital (TX) gets its Meaningful Use check using Prognosis ChartAccess. The 41-bed hospital signed a contract in October, started implementation in January, went live in March, and attested on June 5.
• PatientKeeper announces that its user group conference will be held in Denver September 18-20.
• Frost and Sullivan awards Merge Healthcare its 2011 Customer Value Enhancement of the Year Award for Medical Analytics.
• Imprivata announces that several organizations are have adopted its No Click Access solution for VMware.
• TeleTracking Technologies releases a white paper that lists the top 10 reasons that RTLS location accuracy in healthcare matters.

Contacts

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

HITlaw 8/29/11

William O’Toole is the founder of O’Toole Law Group of Duxbury, MA.

Monday Morning Update 8/29/11

With much of the Northeast exposed to potential disruptions from Hurricane Irene, I’ve created a page for reports from the field. Leave a comment on that post or send your updates and I’ll keep the page current. Many folks will read this Saturday evening or Sunday, so I’m interested to hear what’s going on. Above is video of Coney Island Hospital being evacuated.

From NoHelp: “Re: Dell Services. Has laid off over 20 folks in their Meditech Solutions Group, with more to come across the legacy Perot Systems Healthcare. With Berk Smith departing, Meditech is not letting up on the C/S 6.0, which is killing MSG. Without competition, they are not able to break away from Meditech and say no to them on deals. Dell is getting less and less interested in that business because it costs a great deal to run, with a very high exec in Round Rock telling me the ROI isn’t there. They will be evaluating whether to keep it running in January.” Unverified.

From Ima Peon: “Re: Allscripts. Just sent a message telling employees to come early to ACE or drive in case your flight is cancelled. Nowhere does it say to think about your own family to ensure their safety during the most serious hurricane to hit the East Coast in years.” The conference starts Monday in Nashville. Hopefully the message sender didn’t feel the need to state the obvious – secure your family first and then take whatever transportation is available (at whatever extra company expense is required) to get to ACE on time if at all possible. In the mean time, I’m watching The Weather Channel with fascination – I’m pretty sure those hyper-excited reporters talking live from one eroding beach or another are being overly dramatic. Mrs. H just noticed that one looked fine until he saw that the camera was on him, then suddenly did a hugely exaggerated “the wind nearly blew me away” stumbling move as he recited the cliché phrase, “conditions are deteriorating.” On the beachhead was TWC veteran Mike Seidel, who provided the funniest TV moments ever during Hurricane Andrew in 1992 when he tried painfully to address the non-English speaking Miami audience in the most deadpan, white bread, C-student Spanish imaginable. I’m pretty sure he would die of starvation in a tacqueria (which is where I had some stupendous carne asada tacos for lunch, in fact). I think most of his South Florida viewers were laughing too hard to evacuate.

From The PACS Designer: “Re: Steve Jobs. His outlook is grim in this photo, taken Friday. TPD is praying for him and will miss his elegant product introductions once he is no longer with us. Here’s a slide show on his best moments.” I’m not running the photo (which I suspect is fake for various reasons that I’ll explain if that turns out to be the case) since I’d rather not remember him the way he looks in it. I’ve worked with a few pancreatic cancer patients and their outcomes were all about the same – 6-12 months of a fairly normal pain-free existence with no change in appearance, then a very fast, somewhat merciful slide to the inevitable conclusion. His diagnosis was made in 2004, so he has already exceeded my best guess. Nobody who knows him seems to like him much, but they all respect him. An authorized biography is due out early in 2012, which may be too late for him to see, but I’ll buy it.

From Mavrikg41: “Re: Epic. [hospital name omitted] was rejected by Epic in the evaluation process because Epic thought [CIO name omitted] was ‘going to get in the way of the success of the implementation.’ They called that out in the report to the hospital’s executives as to why Epic would not be a good fit at [hospital name omitted].” Unverified. I’ve left out the California hospital’s name, but it’s a vendor low blow to call out an hospital executive by name to his or her peers as an excuse for turning down their dozens of millions of dollars. Unless Epic is trying to get the CIO fired, why not just politely decline the business without naming names? It does seem that Epic’s model is occasionally somewhat anti-IT, with a fair number of CIOs leaving somewhere between selection and go-live. Once the Epic train gets rolling in a given hospital, you don’t want to get in front of it since frontline executives seem happy let Epic 20-somethings tell them how to run their business (especially the IT part) instead of listening to their own vastly more experienced people. One might therefore postulate that Epic is often chosen in an environment where both the existing IT systems and the people who maintain them are held in some degree of contempt, rightly or not.

From King Biscuit: “Re: HIStalk. It’s very slow to load at times.” It’s nearly always the problematic Internet Explorer that’s at fault, usually long-obsolete versions like IE6 or IE7, but that doesn’t stop some readers from sending me nastygrams like the server is slow or that all readers are having the problem (neither is true). I’m even more frustrated since the buggy, bloated IE was causing some users to not be able to pull up HIStalk at all a few months back, with the only solution being to program around it in a way that slowed the site down for everyone. I tested from work Friday with IE7, Chrome, Firefox, and Opera (all except IE were fresh installs with caches cleared). IE took at least five times as long as all the others to display the main HIStalk page, often getting ridiculously hung up and throwing out errors when displaying components such as Vince’s HIStory slides, YouTube videos, and sponsor ads. It did better once the page had been cached: IE7 took 18 seconds to display the page, while the others were all basically instantaneous (that was again the front page that holds five posts – the e-mail link is to a single post, which comes up faster). I just tried it with a cache-cleared Chrome on a plain old broadband connection and I was reading the post exactly five seconds after pasting in the URL. Solutions:

1. Upgrade IE if you can. IE9 is current and IE10 is in beta.
2. Download any other browser and use it instead, even if only to read HIStalk.
3. Read the barebones version of HIStalk by appending /print/ to the URL that comes in the e-mail blast. To compare for yourself, try this page and then this one. You’ll miss some stuff, but the page will display quickly.
4. Read by RSS reader or on a mobile device, which again won’t display everything, but it will come up quickly.

I used to only dislike IE, but the frustration it causes HIStalk readers has made me hate it passionately as easily the worst browser available, with extra points for puzzling ubiquity. It’s good for one thing: after a fresh Windows install, use it to immediately navigate to Firefox.com to download a reliable, standards-based browser.

Listening: reader-recommended Pylon, an Athens, GA jangle-punk band started in the late 1970s and basically defunct after the death of their guitarist in 2009. Both REM and the B52s said  Pylon was the best rock band to come out of Athens, including themselves, although Pylon didn’t come close to their commercial success. Fun factoid: the female singer, known for her snarling vocals and dervish-like dance moves, is actually a shy, soft-spoken Southern belle who’s now a staff nurse at Athens Regional Hospital, which as the reader observes, would probably shock and maybe frighten her patients if they were to see Pylon’s old concert videos.

My last poll elicited a lot of votes but not a clear conclusion – 55% of respondents say Epic CEO Judy Faulkner doesn’t have excessive federal influence, meaning not many fewer than that think she does. New poll to your right: should Congress cut back on HITECH money as it tries to reduce the national debt? The poll accepts comments, so leave yours to argue your position.

My Time Capsule editorial from Independence Day weekend, 2006: Public Trading Leads to Trouble for Merge and Misys. The obligatory teaser: “Merge’s nemesis was that least-exciting of corporate swashbucklers, the unseen accountant, whose pressured blessing of questionable bookkeeping practices ticked like a time bomb — buying desperate executives time to avoid the torch-waving mob of unhappy shareholders, but eventually blowing up in the faces of anyone unfortunate enough to be in the vicinity at the time.”

Intelligent Medical Objects announces the availability of a free standalone version of its IMO Problem and Procedure terminology products for the iPhone and iPad, giving users a portable medical code reference library.

HIMSS is whining that as the debt-happy Congress tries to make even a token effort to cut out-of-control expenses, they might touch its precious HITECH money, thereby forcing providers to actually buy their own business tools instead of charging them to every taxpayer without their consent. Thus the new poll I’m running.

More on the rumor that Epic implementers at Carle Foundation Hospital (IL) walked off the job just days before its go-live. What actually happened is that five of its eight outsourced trainers left. It had nothing to do with Epic, but rather the company to which Carle had outsourced training (I won’t name the company since I’m hearing only the hospital’s side of the story). The original reader’s rumor said their gripe related to not being paid, presumably by their own company, but I haven’t verified that.

Healthcare learning technology vendor HealthStream announces management changes: Kevin O’Hara, SVP and general counsel, has resigned effective September 16 to take a CEO position with an unnamed early state perioperative analytics vendor. He has been replaced by Michael M. Collier. SVP Eddie Pearson (above) has been promoted to SVP/COO.

Mike Sweeney, president of maxIT Healthcare, tells me that the company has made both the INC 500/5000 lists and Best Places to Work. He says they’re up to 850 employees and are adding 25-30 more each month. I’d say they’re either at or near the top of the independent healthcare consulting food chain now that many of their competitors have been acquired. I’m sure Mike’s getting lots of tire-kicking calls.

Scottish hospital revenue system vendor Craneware expects ARRA to give it a big US boost, with big numbers expected for Tuesday’s report. The CEO expects headcount to double to 440 in the next three years.

Baxter International will acquire Baxa Corp. for $380 million. It offers IV-related pharmacy systems often supported by hospital IT departments: the DoseEdge workflow manager, Abacus compounding software, and IntelliFill automated compounder.

Former HP CEO Mark Hurd, recruited to Oracle a year ago, made $78 million from his new employer in that 12-month period. That plus HP’s recent public floundering probably makes dealing with Larry Ellison tolerable.

UPMC announces fiscal year numbers: $9 billion in operating revenue, $406 million in profit, and $3.6 billion in investments.

E-mail Mr. H.