If your hospital or other work location is being affected by Hurricane Irene, send me updates and photos. You can leave a comment on this article, e-mail me whatever you have, or use the Rumor Report form (which can also accept attached photos).
Top News
Cerner reveals plans for two stainless-steel and glass office towers for its new Kansas City, KS office complex. The exterior design of the buildings is based on a digitized image of human DNA. Construction of the 660,000-square-foot development, which will house 4,000 employees, is expected to be completed by mid-2015.
Reader Comments
From Beau Tocks: “Re: healthcare’s most influential. Not sure that is the real list of movers and shakers in healthcare, so maybe it says something that Mr. H is not on the list!! Did Judy have some airbrushing .. or go under the knife?” The 100 Most Influential list was developed based on votes from the publication’s readers. I’m sure HIStalk readers would have compiled a totally different list. BTW, Mr. H’s insights extend well beyond HIT — he, too commented that Judy’s new headshot looks a little Photoshopped.
From Dr. Nick Riviera: “Re: ExR. In a sales call yesterday, a physician said, ‘I do not want to buy an EMR. The federal government is only paying people that have an EHR. I am going to buy one of those.’” Scary, on many levels.
From EpicBlackEye: “Re: Carle Foundation Hospital. Heard their Epic consultants walked off the job before next week’s go-live.” Unverified. I e-mailed for confirmation, but didn’t get a response. I’m skeptical pending further information.
From MT Hammer: “Re: All Type medical transcription service, North Brunswick, NJ. Acquired by Medquist. Employees notified by e-mail.” Unverified, but also reported by several All Type employees on an MT discussion board.
From St. Eligius MD: “Re: half of physicians practicing with NPs and PAs. Hallelujah! The AMA must be gnashing their teeth. What wonderful news for a new dawn in medical care for the future – MDs actually working with extenders, rather than trying to keep them out of practice. The sun will have actually risen when NPs, PAs, and CNMs can actually open their own practice.”
From Alabaster: “Re: Medify. I know someone in their focus group, which was mostly clinicians with heavy healthcare advocacy experience. None of them found it intuitive, it covers few conditions, and its goals were unclear. I heard they mostly just scratched their heads.” It looked like they found some cool information and built a nice GUI around it without having a clear vision of who would use it and why. It’s like reading one of those slick HIT articles cleverly written by a reporter with no subject matter expertise, where you’re first impressed because it reads so smoothly and authoritatively, but then you realize only in hindsight that it didn’t really say anything useful.
From Porphyria: “Re: Medify. I searched for ‘autism,’ but the treatments suggested had nothing to do with the condition, suggesting several cancer drugs. Very confusing and inaccurate.”
From OhNoPerot: “Re: Dell Services. Another 200+ person layoff today, all in the legacy Perot teams. Healthcare team continues to take most of the hits as the legacy Dell leadership takes over all key roles.” Unverified.
HIStalk Announcements and Requests,
Are you current on all things ambulatory HIT? New this week on HIStalk Practice: Dr. Gregg applauds collaboration between EHR vendors and specialty societies. An EMR vendor promotes transparency with its Meaningful Use Tracking Board. Healthcare costs may rise as hospitals employ physicians. The AMA gives a thumbs-up to Bundled Payments. If you follow ambulatory HIT, make sure you remain in the know by signing up for e-mail updates on the site.
Also, have a look at HIStalk Mobile and sign up for those e-mail updates if you want, which is full of good mobile health news and analysis by Dr. Travis (example: he was the first I’ve heard mention a special deal given to drug companies by Facebook, where they’re allowed to selectively block objectionable postings to their walls).
Listening: reader-recommended Richard Ashcroft, his latest solo CD (he used to be in Verve). He’s apparently wildly full of himself and some of the reviews have been savage (mostly because it doesn’t sound like Verve), but I like it quite a bit. It’s got a nice orchestra-backed, pop-oriented hip-hop vibe, although it’s a bit repetitive and inconsistent. I probably like it better than Verve, which was known for big-sounding, trippy psychedelic lushness — you would instantly recognize their Bittersweet Symphony, although you probably thought it was U2 when it came out in 1997.
If you’re in need of JFK-like “ask what you can do for your HIStalk” ideas, here’s a few off the top of my head: (a) sign up for e-mail updates to your right so that you don’t miss anything and so Inga can brag on the number of folks like you who have done so (7,468, since I know you were about to ask); (b) connect with Inga, Dr. Jayne, and me on Facebook and LinkedIn, giving us a Like if you’re so inclined, and joining the HIStalk Fan Club on LinkedIn like our BFFs have done (1,792, since I know you were about to ask once again); (c) send me rumors, news, or other stuff by clicking the big green Rumor Report monstrosity to your right; (d) check out the sponsor ads to your left, which are becoming less animated day by day, and click on any that tickle your fancy; and (e) do some carefree navigating and searching of sponsor-land in the Resource Center. I get the whole passive reader concept, but a little interaction on your part goes a long way when I’m sitting here alone for very long evenings after work trying to be scintillating using the written word alone. Thanks for reading.
On the sponsor-only Job Board: Epic Implementation Project Manager, Epic and Cerner Consultants, Regional Sales Executive. On Healthcare IT Jobs, which is back online but a little behind on new job postings: NextGen Workflow Process Consultants, Senior Pharmacy Analyst, Manager IS Clinical Applications.
Acquisitions, Funding, Business, and Stock
Trend alert: the growing number of hospital-based physicians, along with stock market uncertainty, are fueling investments in practice management companies for hospital-based physicians.
RTLS vendor Awarepoint secures $27 million in a Series F financing round led by Kleiner Perkins Caulfield & Byers. The company will use the capital for growth and to drive adoption of its aware360Platform.
Canada-based aviation simulator company CAE acquires Sarasota, FL-based medical simulator technology vendor Medical Education Technologies Inc. (METI) for $130 million.
Sales
Ipswitch Hospital NHS Trust (UK) will deploy Microsoft’s Vergence single sign-on and context management solution to improve clinician access to systems.
People
Microsoft announces the appointment of Michael Robinson as GM of US Health & Life Sciences and Dennis Schmuland to the newly-created position of chief health strategy officer. Robinson previously served as GM, public sector for the Middle East and Africa. Schmuland is Microsoft’s former national director of Health Plan Industry Solutions.
Voalté hires Teresa Anderson as its chief nursing officer. She was previously an independent consultant for the American Nurses Credentialing Center.
Announcements and Implementations
HIMSS names two Davies Award winners in the public health category: the Florida Department of Health, Bureau of Epidemiology for its electronic surveillance system for early notification of community-based epidemics; and the NYC Department of Health and Mental Hygiene for its Primary Care Information project.
The Healthcare Business Solutions subsidiary of New Jersey Hospital Association partners with Artificial Medical Intelligence to offer its member hospitals the EMscribe’s Coding Assisting Coding product to facilitate the ICD-10 transition.
Medicomp announces the initial distribution of ICD-10 mappings and functionality in the new version of its MEDCIN Engine. It includes a new user interface to make it easier to use ICD-10 within EMRs, providing clinically contextual, problem-oriented views of incoming data using standard reference terminology.
QuadraMed announces a new version of its Quantim Facility Coding that will support both ICD-9 and ICD-10, allowing users to test ICD-10 transactions while coding live encounters in ICD-9.
WoundVision announces the launch of iNSIGHT, Web-based risk assessment software that supports prediction and prevention of pressure ulcers.
Crestwood Behavioral Health (CA) deploys the OpenDNS Enterprise intrusion-blocking system in its 23 locations.
Innovation and Research
Healthcare costs are lower when clinicians use an HIE to care for ED patients, thereby avoid ordering duplicate services due to lack of information, according to Humana.
Emory School of Medicine establishes a biomedical informatics department, led by Emory Healthcare CMIO Joel Saltz MD, PhD. He’s also a professor in Emory’s departments of pathology, biostatistics and informatics, and mathematic and computer science (his PhD is in computer science).
Other
GE Healthcare informs Milwaukee-area employees of its intention to cut 81 manufacturing jobs, primarily in assembly operations for GE’s diagnostic imaging business. Those affected likely include some who participated in the company’s annual Community Service Day this week by sprucing up 400 classrooms in area schools.
Kirby Partners is conducting a survey on hospital IT employee retention, with results to be presented at the CHIME CIO Fall Forum (and here first, they’ve promised, in return for my mentioning it). I looked it over and the questions are good. To take the survey, click the appropriate variant: CIO, manager/director with people management responsibilities, or staff member with no people management responsibilities. UPDATE: I changed the survey links because their setup is a bit goofy – the original links forwarded to a specific link that gave the “you already took this survey” message. Try again if you’re interested.
Despite an overall trend towards enterprise solutions, Dimensional Insight’s Diver Solution earned top markets in a KLAS report on business intelligence. Information Builders’ WebFOCUS, IBM Cognos 8 Business Intelligence, McKesson’s Horizon Business Insight, and SAP XI Data Analytics were also ranked.
The Texas prison system has saved almost $1 billion over the last 10 years by implementing a statewide EMR and leveraging telemedicine, according to a press release issued by its EMR vendor (BCA) that cites a Gartner study.
Minnesota Health Information Exchange (MN HIE) quietly shuts down, merging its operations into a Duluth-based Community Health Information Collaborative (CHIC). CHIC’s president and CEO says their work overlapped and there wasn’t enough grant money to go around. MN HIE focused on EDs, with some big-name players that included Allina, BCBS, HealthPartners, and the state’s Department of Human Services. The splashy 2007 announcement of the formation of MN HIE, in which the governor said it would be one of the largest in the country, is here.
An Indiana prosecutor will ask the Office for Civil Rights to investigate the apparently intentionally circulated medical records of a city judge (and election candidate) following his stay at IU Health Ball Memorial Hospital.
Fellow shoe enthusiasts: a friend of mine wore these beauties to a party we attended last weekend. Sadly, I was unsuccessful at stealing them. They come from Turkey, so if you happen to be traveling that way, let me know.
Sponsor Updates
EPtalk by Dr. Jayne
I’m surprised it hasn’t happened before now — the marketing people have apparently found my e-mail address. Today was apparently Send Jayne a Press Release Day. Leading the pack in the “why bother” division was the American Medical Association with an absolutely banal statement about its stance on bundled payment initiatives at CMS. Blah, blah, blah. The AMA is increasingly seen as irrelevant, and if they hope to counter that sentiment, they really should step it up.
As usually I’m a bit behind in my e-mail, so I was going through it during an extremely boring Grand Rounds presentation. Direct-to-physician marketing group Physicians Interactive wanted my opinion about something. Usually I ignore those messages, but this one invited me to participate in an 8-10 minute market research study about my “use of ePrescribing and Electronic Medical Records.”
With the promise that my opinions would “assist in understanding the potential for reaching Health Care Professions through ePrescribing/EMRs” as well as “help to evaluate the value of integration of clinical reference materials at the point of ePrescribing” I decided to give it a whirl. Unfortunately, the survey was closed by the time I responded. Maybe that’s an incentive to keep up with my e-mail. I’d love to see how companies are thinking about marketing through EHRs. Just what we need – more distractions that are incorporated into our workflows for secondary gain.
In follow up on an item I mentioned earlier this month, the South Carolina man who was denied Medicaid coverage for his breast cancer treatments has been granted coverage by the state Department of Health and Human Services. Director Tony Keck states, “If the federal lawyers choose to deny those claims based on a discriminatory policy, that is their choice and our department will appeal the decision.” I’m no Constitutional lawyer, but score one for states’ rights and general human dignity.
This week is National 5010 Testing Week. Are you ready? From talking to my colleagues, it seems there are quite a few practices out there that aren’t even on compliant software yet.
Hofstra North Shore-Long Island Jewish School of Medicine began classes this month. As a brand new medical school, faculty are putting some interesting spins on how physicians are trained. One of these initiatives includes training incoming students as Emergency Medical Technicians. The goal is not only to teach students valuable skills, but to reinforce the team care concept of medicine.
The school is holding off on its traditional “white coat ceremony” (where students are presented with the white trainee’s coat and often take the Hippocratic Oath) until after the students take the New York state EMT exam. I’ll be looking forward to seeing how these students progress and how a new medical school incorporates healthcare IT in training. If you’re on faculty or involved in this program, I’d love to hear from you.
Contacts
Mr. H, Inga, Dr. Jayne, Dr. Gregg.
Top News
HHS announces its Bundled Payments for Care Improvement initiative, a new CMS program that allows hospitals, physicians, and other clinicians to bill their services as a single package instead of as separate items, giving them incentive to manage care better. Applicants can share in the savings over traditional fee-for-service costs, defining their episode of care as one of four models: hospital stay only, hospital stay plus post-acute care, post-acute care only, or a single all-encompassing bundled payment.
Reader Comments
From BubbasChili: “Re: healthcare reform. I have the answer – legislatively re-categorize insurance companies to non-profit status and require that profits over a given amount be distributed back to consumers. I would also push tort reform, but my first idea is the fix. Just my two cents.” Maybe that requirement should be applied to non-profit hospitals first.
From GladItsNotMe: “Re: Lehigh Valley, PA. Has started the evaluation process to replace the old Carecast system. Rumor has it being replaced by that little ol’ vendor out of Madison, WI.” I was too busy at work today to ask Harry Lukens, so I’ll leave this as unverified for now.
From PHEye: “Re: CDC’s Public Health Informatics conference in Atlanta. A speaker complained that HIStalk doesn’t cover public health.” I sometimes touch on public health topics that don’t get much attention otherwise, but those news items aren’t always that interesting to me and probably wouldn’t be to my predominantly hospital-based readers either. And while I appreciate the confidence the unidentified speaker places in a part-time blogger, full-time hospital employee to branch out into an entirely new discipline, I do need to sleep occasionally. I’d be happy to start up a fun, informative public health version of HIStalk as a public service if CDC wants to spend some of its legendary grant money to allow me to quit my day job, but otherwise I don’t have the time to take on new challenges.
From Reporting In: “Re: RelayHealth. Here’s Jim Bodenbender’s e-mail announcing that sales SVP Mike Lang has resigned to work for an EHR vendor. Jeff Gartland replaces him.” I’ll mark this as verified since RelayHealth already updated its management page with Jeff as sales SVP.
From 11YearHITVet: “Re: consulting with less travel. I’m burned out and would like a 50% or less travel schedule. Some of said go into interface work or designing Cerner PowerNotes. Ideas?” I think it depends on how you define “consulting.” Certainly you could do build work remotely, working either for someone else or yourself. Vendors do most of their work of this type offsite given ubiquitous and fast broadband (some of it remotely from Asia, in fact.) But that’s probably not the sexy, high-paying work you’re doing now as the PowerPoint-wielding, suit-wearing expert from afar. If you’re doing general management or operational consulting, it’s really a completely different line of work to do remote technical or functional application support (or to just hire on permanently with a client, for that matter). If you are willing to make that change and have experience, there’s work out there, especially if you know the hot packages like Epic or Cerner. I’ll let readers chime in since I’ve never been a full-time consultant.
Acquisitions, Funding, Business, and Stock
MedAssets gets approval from its board to repurchase up to $25 million of its stock.
Sales
Presbyterian Healthcare Services (NM) signs a multi-year agreement with Health Care DataWorks (HCD) for its Enterprise Data Warehouse Appliance.
Geisinger Health System chooses Altosoft Insight for Pathology for real-time clinical and AP lab reporting.
Montfort Jones Memorial Hospital (MS) selects NextGen’s inpatient clinical and financial systems.
People
CHRISTUS Santa Rosa Health System (TX) hires George Gellert MD for the newly created position of regional medical informatics officer.
Joyce Hunter, CEO of government healthcare IT consulting firm Vulcan Enterprises, joins HavServe, a volunteerism service for developing countries, as CEO. She has volunteered with a number of healthcare IT organizations, including the local HIMSS chapter, HITSP, Maryland’s CRISP HIE, and Cal eConnect.
Announcements and Implementations
Jersey Shore Hospital (PA) and Fulton County Medical Center (PA) team up to implement Meditech EMR. The critical access hospitals expect to save about $300,000 each by sharing hardware at a hosted facility and scheduling training and implementation at the same time.
Anoto Group announces implementations of its digital pen and paper technology, including Shareable Ink’s implementations with Allscripts, Cerner, Epic, McKesson and Meditech. Other new partnerships directly with Anoto or its resellers include NextGen Healthcare, Intelligent Medical Objects, Waiting Room Solutions, Nightingale Informatix, and Bayscribe.
The Community Health Information Collaborative (CHIC) announces plans to consolidate its operations with Minnesota HIE, resulting in a single state-certified entity named HIE-Bridge.
Ministry Health Care (WI) will implement EHR Doctors’ Medibridge.net HIE technology to enable the exchange of patient information and provide patients with access to their health information.
The Electronic Healthcare Network Accreditation Commission (EHNAC) develops an Outsourced Services Accreditation Program for HIE technology service providers. The program will evaluate HIE vendors to verify they meet industry standards of quality for PHI; follow appropriate privacy and security regulations; and meet acceptable standards for technical performance, business processes, and resource management.
The governor of Guam announces the launch of its first HIE, mentioning that Guam Memorial Hospital will get $5 million in federal incentive money and another $21 million is available for doctors who sign up.
Government and Politics
UK health secretary Andrew Lansley calls on developers to create applications that relate to one of five healthcare themes: personalization, improved outcomes, autonomy and accountability, improving public health, and improving long-term care. NHS is running a developer’s contest, but offering no prizes or funding. Consumers are also encouraged to submit their favorite health apps (“maps and apps”) or those they’d like to see developed.
Other
Once again Mr. H was robbed of a spot on this list of the 100 Most Influential People in Healthcare. Representative Paul Ryan tops the list, followed by Vermont Governor Peter Shumlin and President Obama. Donald Berwick, Kathleen Sebelius, and Farzad Mostashardi were included in the top 10, while Judy Faulkner (with an updated head shot) earned the #44 spot.
A watchdog organization finds that only 15 of the largest 100 HIT firms participated in HIT lobbying efforts between October 1, 2010 and March 31, 2011.
The Department of Homeland Security is soliciting vendors to provide an EHR to store medical data on undocumented residents across 22 immigration detention facilities.
Memorial Hermann Healthcare System (TX) launches Houston’s first HIE. Patients must opt in, with 96% of those that have been asked so far saying yes.
Weird News Andy says he can’t top the quote in this article: “a felony case of stupidity.” A workers’ compensation billing company puts detailed medical information on 300,000 California residents on a server that it thinks is visible only to its employees. Someone Googling discovers that the entire database is wide open on the Internet. The “felony stupidity” comment was in reference to the fact that the company didn’t password-protect the information and didn’t include the “noindex” HTML meta tag that tells search engines to skip indexing that page.
A reader sent over a new JAMIA article called Factors Contributing to an Increase in Duplicate Medication Orders After CPOE Implementation. It looked at the impact of implementing Epic’s CPOE in a 400-bed hospital’s adult and cardiac ICUs (Geisinger, I believe). The number of duplicate med warnings quadrupled, which the study found was caused by (a) multiple providers entering orders at the same time; (b) lack of hand-offs; (c) design problems that caused false alarms; (d) poor data display, where providers entered a new order because they didn’t notice an existing one; and (e) poor local design of order sets that contained pre-built duplicates. Providers both pre- and post-study were neutral about the value of duplicate therapy alerts. The study also found that some potentially duplicate orders weren’t flagged, such as duplicates with differing routes of administration and serial orders where the same therapy was ordered at slightly different times. I didn’t see anything surprising here: duplicate warnings are the ‘stupidest’ of the usual medication screening types (drug, dose, allergy, interaction, drug-lab, drug-disease, etc.) and usually make up at least half of the useless warnings that providers see. There’s no really smart way to tell whether two PRN meds that both contain acetaminophen will be a problem – if the patient gets one or the other but not both, then there’s really no duplication (but that can’t be determined until administration time, not when the order is entered). Smarter systems ignore route differences (IV vs. topical gentamicin) and maybe skip PRN duplicates and those from the same order set completely, but otherwise it’s almost impossible to separate intentional duplication vs. unintentional. Give the high percentage of provider overrides, one might postulate that duplicate warnings do more harm than good, masking significant problems of other types with their sheer volume and rarely resulting in DC’ing one of the alleged duplicates. I’m not optimistic that it’s a solvable problem – you won’t get a useful answer if you ask providers to sketch out a universal decision tree of when to trigger a duplicate alert, so you can’t expect the computer to improve a process that can’t really be designed. Turning duplicate alerts off completely might be the best strategy.
Seattle startup Medify, staffed with former employees of airfare prediction company Farecast, is creating a searchable consumer database of vetted research study information covering side effects, treatments, and symptoms with social networking connections to similar patients. I struck out on my first search when it didn’t recognize “congestive heart failure” as a medical term, but got a lot of information on “cellulitis” (which talked a lot about maggot therapy for debridement). It’s aimed at consumers, but it looks to me like clinicians would find it useful to get current thought on treatments (not to mention that consumers aren’t going to pay out of their own pockets, but the usual pharma/insurance companies might if it could improve outcomes or cost). Besides, a lot of what it returns is barely understandable even to providers, like when I clicked “clindamycin” for cellulitis and got, “A semisynthetic broad spectrum antibiotic produced by chemical modification of the parent compound lincomycin. Clindamycin dissociates peptidyl-tRNA
from the bacterial ribosome, thereby disrupting bacterial protein synthesis. (NCI04)” Not exactly a compelling Facebook post like the maggots would have been.
The Washington Post highlights an interesting conflict: Medicaid is trying to reduce overuse of EDs as free doctors’ offices to save taxpayer dollars, but much of the potential savings isn’t being realized because hospitals are aggressively marketing their EDs for routine care, hoping to pump up profitable admissions. A quote from South Carolina’s Medicaid director: “When you are advertising on billboards that your ER wait time is three minutes, you are not advertising to stroke and heart attack victims.” For-profits HCA (which runs wait time billboards) and Tenet (which runs billboards and also accepts online ED appointments) claim they haven’t seen a significant increase in Medicaid visits.
Hospitals in Wales are testing university-developed software that can reduce wait times and analyze the cost-effectiveness of medical treatments. It uses simulation and queuing theory, which the project’s director likens to a 1990s computer game called Theme Hospital that allows what-if analysis.
Here’s the kind of lawsuit lunacy that forces hospitals to hire expensive lawyers. A (barely literate) former patient claims a hospital surgeon, while removing his tonsils, implanted a GPS tracker into his armpit.
Sponsor Updates
Contacts
Mr. H, Inga, Dr. Jayne, Dr. Gregg.
From Hot Off the Press: “Re: Cal eConnect. President and CEO Carladenise Edwards PhD steps down.” HOTP forwarded her e-mail from late Friday afternoon announcing her transition to senior advisor of the HIE organization due to “personal reasons.” Cal eConnect was created when California’s HHS department, overseer of $39 million in federal HIE grant money, decided to form a new statewide oversight organization instead of supporting CalRHIO, effectively shutting that organization down in January 2010. TechLeader obtained information suggesting that earlier last week, Cal eConnect suspended its RFP for a provider directory service, with no bidder selected.
From THB: “Re: tax-exempt hospitals. A potential trend?” Three non-profit Chicago area hospitals express shock that the Illinois Department of Revenue has denied their tax-exempt status requests, ruling that they aren’t owned by charitable organizations and aren’t being used for primarily charitable purposes and therefore must pay property taxes like any other business. The state said the hospitals didn’t list uncompensated care on their requests, but did in their own records: Prentice Women’s at Northwestern (1.85% – pictured above), Edward (1.04%), and Decatur Memorial (0.96%). The state says it won’t set a minimum charity percentage, although one legislator is sponsoring a bill that would require at least 3.5% of total revenue. Just for fun, I checked the IRS forms of Edward Hospital: it made a profit of $25 million in the most recent year, paid the CEO $1.6 million, and claimed it provided $45 million in charity care.
From The PACS Designer: “Re: IBM’s 100th anniversary. Most all of us have encountered business relationships with IBM in our work careers. TPD first learned about IBM solutions in the early 1960s while getting educated to be an electronics engineer by being trained on the use of an IBM vacuum tube computer. Later in my electronics career, I worked with IBM to interface the IBM Shark information storage system to a PACS to create one of the first central archives for all hospital information including imaging files. InformationWeek recently published a video history of IBM’s 100 years.”
Thanks to a few of my overachieving sponsors who have already swapped out their animated ads with a static replacement, well in advance of the January 1 deadline I set to allow them plenty of time. I appreciate it, as do those many readers who requested that change.
Over 60% of respondents agree with the recommendation of Congresswoman Renee Ellmers that HHS study EMR effectiveness and impact on patient safety. New poll to your right: does Epic CEO Judy Faulkner have too much influence on federal government healthcare IT decisions?
Listening (and watching): reader-recommended Live from Daryl’s House, a fascinating Internet program created by (and paid for by) the first half of Hall and Oates. I hated the 80s poofy-haired, “blue-eyed soul” dreck they did and was kind of hoping he’d been reduced to unpaid gigging at the Paducah Holiday Inn, but I now want to be Daryl Hall: inviting all kinds of big music names to jam with him in a barn-like room of his $16 million spread, drinking wine, bringing in guest chefs to cook for them, having scintillating dinner conversations, and recording the whole thing as a homebrew reality show. The audio and video quality are amazing, the guests compelling. My favorites so far have been Grace Potter and the Nocturnals and Krieger / Manzarek of The Doors, with whom Hall does just fine vocal work on my favorite Doors tune, The Crystal Ship. He’s 64, rich, and living large, just playing his music to an Internet audience. I’ll grumblingly admit that even the versions of Hall and Oates tunes he and his guests covered (like the insipid Sara Smile) sound amazing and fresh. I wish I could be that cool.
I swear that Vince Ciotti is digging deeper into company histories with every new HIStory chapter, finding veterans willing to share their previously untold stories. This time he covers a company I don’t remember: Sentry Data. Upcoming are these vendors: AR/Mediquest, JSData, and Gerber-Alley, so if you have war stories to tell about them, Vince is your guy.
Urology EHR vendor meridianEMR files a lawsuit and gets a restraining order against competitor Intuitive Medical Software (UroChart), claiming UroChart cloned one of its servers and thereby gained illegal access to meridianEMR’s product and the protected health information stored by its clients.
The weekly employee e-mail from Kaiser honcho George Halvorson talks up their first iPhone app, KP Locator, which he says is “the next connectivity path on a journey that is turning into a superhighway of connectivity over time.” He says it’s the first of many that will be built and invites employees to send him ideas for the next round.
An article in Silicon Valley / San Jose Business Journal details how much local hospitals are spending on EMRs. Factoids: (a) 403-bed Mills-Peninsula Hospital spent $50-75 million; (b) six Daughters of Charity hospitals spent a total of $80-90 million; (c) Stanford says it’s spending 30% of its total available capital each year to implement EMRs; (d) Stanford also spent $13 million to hire a 100-member temporary go-live team for three weeks, which must be a misprint or an incomplete description since that’s over $800 per hour; (e) O’Connor Hospital spent $2-3 million on EMR training; (f) Mills-Peninsula expects to spend 2.5% of the hospital’s entire budget each year in perpetuity for EMR maintenance.
Beth Israel Deaconess reportedly offers its CEO job to Kevin Tabb, chief medical officer at Stanford Hospitals and Clinics, who would replace the ousted Paul Levy. He’s an internist, but went into healthcare IT straight out of residency as a clinical informatics analyst for iKnowMed, a data director for MedicaLogic, president of clinical data services for GE Healthcare, and then chief quality officer / CMIO for Stanford. Sounds like he would be a geeky kindred spirit for CIO John Halamka there.
Asante Health System (OR) chooses Epic, saying “only one vendor had an integrated solution for hospitals and physician offices, and that was Epic.” They also added that Epic puts 47% of earnings back into R&D and has less than 2% of its workforce involved in sales and marketing.
Thirteen Danish hospitals announce plans to migrate their 25,000 employees from unnamed proprietary office software (care to take a guess?) to the open source LibreOffice, a fork of OpenOffice.org.
A computer professor in England enlists the help of his colleagues to create a computer game to help his four-year-old daughter, who has cystic fibrosis. She can control on-screen graphics by breathing into a PEP mask, which forces her airways open, an otherwise monotonous exercise that kids don’t enjoy. Her doctor can review her game results to determine how her lungs are doing. The group hopes to have the game tested and available to the public within a year.
Former Allscripts COO Ben Bulkley is running Fluidnet, a Massachusetts-based IV infusion control system vendor that just raised $25 million in investment capital.
HP wants out of the consumer computer business, but its systems work isn’t such a hit in Ohio either, where the Medicaid Information Technology System that went live on August 2 is inappropriately denying payments to providers, improperly kicking patients off assistance programs, and causing prescriptions to go unfilled by rejecting the Medicaid bills from pharmacies. Rep. Dennis Kucinich will meet with CMS administrator Don Berwick on Tuesday.
Regulation of EMRs by FDA
By Tim Gee
In the HIMSS top nine trends to watch in health IT, they missed a big one: the regulation of EMRs and other applications by the FDA, and potentially transforming providers into medical device manufacturers.
Between the final MDDS rule (which called out hospitals as potential regulated medical device manufacturers) and public testimony by Jeff Shuren, director of CDRH at FDA that the FDA intends to regulate at least some EMR software, healthcare IT is going to be coming to grips with FDA regulations for some time to come.
How many hospitals have written software to acquire data from medical devices? I’d guess over 100. I’ve heard estimates from sources that FDA expects to be regulating thousands of new manufacturers in the near term.
Since the final MDDS rule was published, four providers have registered with FDA as medical device manufacturers and listed their MDDS products with FDA. The providers are Partners, Gundersen Lutheran, Intermountain Health, and the Alaska Native Tribal Health Consortium.
And when FDA regulates portions of EMRs (they’ve set their sights on decision support systems first), providers who modify their EMR applications may be transformed into medical device manufacturers and become regulated, too. How many early adopter hospitals have have written their own DSS from scratch? They, too are likely to become regulated medical device manufacturers.
The MDDS rule was the shot across the bow. Expect a draft guidance document from FDA on regulating EMRs late this year. Yes, FDA will go slow, but responding will be like turning a battleship – it will take a while and require substantial effort in some cases.
In the next two or three years, I’ll bet most hospitals will be looking to hire regulatory affairs / quality assurance directors, and many hospitals may be rethinking their wholesale modification of HIT apps they purchase, not to mention foregoing rolling their own apps.
Top News
General Dynamics will acquire federal healthcare software vendor Vangent for $960 million, the company announced this week. Says the General Dynamics chairman and CEO, “Vangent is a well-regarded, fast-growing company that will add significant depth and breadth to General Dynamics’ healthcare IT organization, creating a Tier 1-level healthcare IT business unit with the scope and scale to compete in markets that are receiving high priority in current funding and entitlement-reform initiatives” The Arlington, VA-based Vangent, which has 7,500 employees, does work for HHS and the military. It developed the Army’s MC4 battlefield EMR. Kerry Weems, SVP and GM of Vangent’s Health Solutions business, joined the company in 2009 when he left his government position as head of CMS. He was also vice chairman of the American Health Information Community.
Reader Comments
From Watchdog: “Re: HIMSS. Pictures of its new headquarters in the financial district of Chicago. They also hired Steve Rosenfield as executive vice president / managing director of HIMSS Media, a new position and department, and seek an associate manager of social media to improve the society’s ‘positive visibility.’ All that was required is an Associate’s Degree.” Steve doesn’t appear to have a degree, but did write co-write this book documenting the late 70s history of an influential Long Island club that includes photos and an audio CD of the folks who performed there (Springsteen, Aerosmith, Rick Derringer, Stanley Clarke, etc.)
From One Of Their Hospitals: “Re: MDG Medical. The support numbers are no longer in service.” I ran this reader’s rumor last week, in which he said his hospital’s pharmacy got word from the pharmacy dispensing automation vendor that they would close their doors last Friday. I said I wouldn’t name them until I checked to see if the phones were disconnected. Sure enough, the support number and PBX option now give a fast busy. The Israel-based company opened an office in Beachwood, OH in 2001 and moved its corporate headquarters to Aurora, OH in 2010. It claims to have 150 hospital customers and was announcing expansion plans as recently as October. I can’t verify anything other than that their support numbers aren’t working and they didn’t respond to my earlier e-mail asking about the rumor.
From Wildcat Well: “Re: RECs. There have been claims that healthcare IT will be the primary sector for job creation. Does it count when a REC receives funds from ONC, the REC coordinator contracts for systems integration work with ‘local’ vendors, and the jobs are filled through the overseas facilities of those vendors? We may just be stupid enough to deserve the mess we are in.”
From Hate Manual Entry: “Re: Sage Healthcare. Rumor is they bought a SaaS-based HER from a recently bankrupted company. Any others hearing the same?” We asked Sage, which said that for competitive reasons, they don’t comment on acquisitions or technologies that may or may not be under consideration.
From Laura: “Re: Joplin. I’m sure you’ve seen that Mercy has announced plans to rebuild in Joplin. They have kept employees on the payroll since the May tornado and raised $500 million in a co-worker fund to help with expenses.” The 28-hospital Mercy (formerly called Sisters of Mercy) will spend $950 million to build a new 327-bed hospital in Joplin. They’re an Epic shop, I believe.
HIStalk Announcements and Requests
Check out the good stuff on HIStalk Practice: Don Michaels of Hayes Management Consulting and the Harvard School of Public Health weighs in on ACOs and the results of CMS’s demonstration project. Julie McGovern of Practice Wise offers recommendations for providers upgrading their software. Rob Culbert of Culbert Healthcare Solutions suggests key performance indicators to assess a practice’s financial health. CMS provides a breakdown of EMR Meaningful Use payments by specialty and provider type. The GAO advises CMS on how to improve physician quality reporting. I’m a simple gal with simple needs and I’ll be simply thrilled if you sign up for e-mail updates while visiting HIStalk Practice.
On the Job Board: Project Manager I, Epic and Cerner Consultants, Senior Enterprise Sales Executive.
Acquisitions, Funding, Business, and Stock
drchrono closes an additional $650K in seed funding and announces the release of OnPatient, a free patient check-in app for the iPad.
Deloitte acquires the assets of Intrasphere Technologies, a New Jersey drug safety and regulatory consulting company that also offers R&D informatics software for registering clinical trials.
HP announces a restructuring that includes ceasing production of tablet computers and smart phones, trying to sell its PC business, and spending $10 billion to acquire British search technology vendor Autonomy at a 64% premium to its share price. The HP Touchpad has barely been on the market for a month. The announcement probably signals the inglorious end of Palm, which HP bought last year for $1.8 billion before phasing out the brand.
Sales
The University of Chicago Medical Center will implement Omnicell’s Inventory Management Carousels with WorkflowRx software for inventory management and Omincell’s automated dispending system.
Imprivata announces that 12 Siemens customers have chosen its OneSign single sign-on.
Stamford Hospital (CT) will implement SmartRoom technology in all of its patient rooms, which provides real-time patient and RTLS information on an in-room monitor and provides touch-screen documentation capability. SmartRoom was developed by UPMC, which owns the company.
Evergreen Healthcare (WA) chooses Cerner clinical systems.
People
Healthcare software vendor Net.Orange names Rob Beardall MD, MPH as EVP/Chief Medical Officer and Troy Roth as SVP of solutions strategy. They come from Health Synectics LTD and MedAssets, respectively.
Paula Guy, CEO of Georgia Partnership for TeleHealth, joins the board of the Georgia Health Information Exchange.
Announcements and Implementations
Arkansas critical care hospitals Piggot Community Hospital, DeWitt Hospital, Delta Memorial Hospital, and Chicot Memorial Medical Center select Healthland.
Nine hospital systems in Western Pennsylvania partner to create the ClincalConnect HIE. dbMotion will supply the infrastructure for the $4 million project.
The radiology department of University of Utah Health Care reports that its use of artificial intelligence resource management software from Allocade reduced overtime cost by 90% and overall FTE expenses by 10-15%.
Miami-based EMR vendor CareCloud says it has tripled headcount in the past year to 80 and will bring on another 30 employees by the end of the year.
Government and Politics
The VA issues an RFI for cloud-based collaboration tools for its entire workforce. They plan to pilot document sharing and calendar applications with 5,000 physicians, potentially replacing Outlook and Exchange, SharePoint, and Jive Software for all of their employees if the pilot is successful.
Other
I got an earful from my doctor and his office manager today about their “horrible” EMR. Since purchasing it a year and a half ago, they’ve suffered through performance issues, upgrades problems, inadequate templates, and many unexpected expenses. The Meaningful Use money, which they’ll receive this month, covers the EMR’s cost but not the $10K per year for maintenance. The doctor blames the vendor, which has been around for less than five years, for releasing an immature product. I checked their Web site and it looks like the latest and greatest. I wonder how often providers opt for bleeding edge, only to later regret not buying the tried and true option?
Here’s a video showing the Texas Health Resources group that climbed Mount Kilimanjaro (including Ed Marx) opening a medical clinic in a Tanzanian village a few weeks ago.
A drug company’s laid-off IT tech pleads guilty to extracting his revenge by wiping out most of the company’s electronic systems while he still had access as a contractor. The drug company lost e-mail, inventory systems, and payroll capabilities, crippling it for several days at an estimated cost of $800K. The tech faces 10 years in prison.
The FBI subpoenas Parkland Memorial Hospital (TX) and its IT department, seeking records related to a former Dallas County commissioner and a telecommunications system business owned by a close friend. According to the Department of Justice, the investigation involves “allegations of public corruption, tax evasion, and money laundering.” The telecommunications company got $3 million worth of consulting work from Parkland and UT Southwestern Medical Center. Another of its customers, the local toll authority, paid $47,500 for a no-bid consulting report that basically said “your equipment needs to be replaced” and included graphics lifted directly from another company’s 12-year-old product manual.
In Ireland, an interim examiner is appointed to review three hospital software vendors that have claimed insolvency, putting the electronic records of 10 million patients at risk. The companies operate under the name IMS Maxims.
French software vendor Atos Healthcare, whose software is used in England to evaluate disability claimants, investigates two employees (one of them a nurse) for their Facebook comments about those claimants, which they characterized as “down and outs” and “parasitic wankers.”
Sponsor Updates
EPtalk by Dr. Jayne
I returned home from my most recent sojourn to find the only thing I hate worse than filing my taxes or a root canal — a re-credentialing packet for my hospital privileges. Despite our health system’s large IT department and our belief that we are high tech, the credentialing process is decidedly low tech.
When I was a practicing physician, my practice manager took care of the application and applied sticky flags to areas that needed review or my signature. But now that I’ve crossed to the dark side of information technology, there’s no one in my organizational tree who has any idea how to do these, so I have the pleasure. I think next year I might just ask my former staffer if she’d be willing to do it for cash (as an independent contractor, of course — I’m not about to run afoul of the IRS.)
Under the 26-page “standard” credentialing form was an additional 22 pages of forms to be completed. They had been photocopied so many times they were practically illegible. Lurking at the bottom of the stack were several nearly identical sets of privilege forms for the different hospitals at which I am on staff, one for each facility (heaven forbid they share information from a central repository or from the master application itself.)
I find it slightly humorous that I still hold privileges for OB labor and delivery as well as operative circumcision despite having not performed either procedure in quite some time. Oh yes, and I can also pierce the earlobes of inpatients if I so choose.
In addition, they want a copy of my Curriculum Vitae and documentation of my Continuing Medical Education hours, which along with everything else has to be returned on paper and by mail. Seriously. Everything else we do in the hospital is electronic – CPOE, patient recordkeeping, even patient meal selections done on a touch-screen at the bedside. Except this.
When it comes to the concept of ensuring that physicians have accurate and up-to-date data before approving them to start or continue seeing patients at a facility, we’ve gone back to 1956. (Actually, 1956 was probably easier – you could most likely have just hung your diploma on the wall and started seeing people.)
If this would have been an online process, I’d have knocked it out right away while lounging on the sofa with some quality Netflix and recuperating from my travels. But instead, it goes on the dreaded ‘pile’ somewhere between the bill from the local lawn care guy and the student loan payment coupon, both paper-based businesses.
Turning to health IT news, legislators on the House Energy and Commerce Committee have asked the Government Accountability Office to review Federal Communications Commission efforts to ensure the safety of wireless medical devices. Their request featured discussion of the recent demo where an insulin pump was hacked and hijacked. As I was reading this piece, I envisioned a flashing “As Seen On HIStalk” seal of approval.
Finally, a reader question. It’s been a long time since we have had one and I do enjoy them (hint, hint).
Dear Dr. Jayne,
Is the new Chest-Compression-Only method of CPR taking hold, or is there some resistance to it? I still see classes offered in the older method and have to wonder… why? What do you think?
Breathless but Hearty
Dear Hearty Reader,
I think overall, more data is needed. When I completed my certifications for CPR and advanced life support (both cardiac and trauma) as well as pediatric life support a few months ago, traditional CPR was required. The American Red Cross issued a statement last year about compression-only CPR, stating:
“…Compression-Only CPR until an AED [Automated Extermal Defibrillator] is available is an acceptable alternative for those who are unwilling, unable, or not trained to perform CPR.”
I tend to agree with them. The idea of CPR is that you want to prevent brain death, and unless you’re oxygenating the blood by getting air into the lungs then circulating it with compressions, you’re not going to be as successful if oxygen levels remain low.
On the other hand, if it’s the difference between CPR not being done because a bystander isn’t sure how to do it correctly or is worried about communicable diseases or some of the more unpleasant side effects of bystander CPR, then I think compressions alone are better than nothing.
The American Heart Association offers a trademarked “Hands-Only CPR” method that’s demonstrated on their website. I like their bullet point: “Don’t be afraid. Your actions can only help.” Regardless, knowing the legal world, I offer this advice — if you’re trained in traditional CPR and have no other reason not to do it, traditional CPR should be your first choice. I’d hate to get into a “standard of care” discussion on this one.
Jayne
Have a question about LOINC codes, the Russell Viper Venom time assay, or whether snakebite extraction kits really work? E-mail me.
Contacts
Mr. H, Inga, Dr. Jayne, Dr. Gregg.
Top News
The VA has been on-again, off-again on whether it will build or buy a replacement for its VistA system, but former deputy CIO Ed Meagher says the VA and DoD may pay companies billions to write a new open source system. He now works for CSC, one of the contractors hoping to get the VA’s business. I knew the VA recently issued a $5 million contract to create an open source community for the VistA replacement and had previously announced plans to go that route, but I haven’t heard a definitive final word, especially when a group of Epic-friendly politicians is pushing the VA to look at commercial systems. The article’s choice of experts to quote about vendor products is questionable: Allscripts has done a great job creating an open architecture platform (according to an investment firm analyst who just put a Buy rating on MDRX shares) and GE Healthcare could work well in the VA’s environment (according to a government sales guy from GE Healthcare).
Reader Comments
From Too Big for my Breaches: “Re: yet another data breach. I’m getting tired of hearing about these.” St. Francis Hospital (DE) apologizes for a doctor’s loss of a thumb drive containing information on 474 maternity patients. He lost it in the spring, but someone mailed it back to him on June and he didn’t report it until then, pushing the hospital’s 60-day deadline to report the loss. The doctor was authorized to copy the information but violated hospital policy by not encrypting the drive. He must have been researching old cases — the hospital says the in utero babies whose records he copied are now nine or 10 years old.
From Victory at Sea: “Re: UAB. I believe that most people in healthcare are honest and want to help people, but there’s a lot of money rolling around inside these organizations (vendors too) and temptation is always to be found for those who are open to it.” The FBI launches an investigation into Alabama’s only organ donation center, UAB-run Alabama Organ Center, after discovering that its director and associated director had an “improper financial relationship with a vendor.” UAB has fired the employees and parted ways with the unnamed vendor.
From TxPathDr: “Re: Jason Dufner. Anyboy else notice that he had a Greenway Medical logo on his chest for the PGA tournament in Atlanta this week? I can’t remember ever seeing an EMR company logo on a golfer before.” Greenway struck a deal a few weeks back to have him wear their logo and be available for marketing and company-sponsored events. The green logo really pops on his pink shirt.
From A CEO: “Re: our interview. Questions I get from healthcare trade rags and the financial press are vanilla – my sense is the editors / journalists are just trying to get their stories written vs. trying to arrive at insights relevant to their readership. I found your questions intellectually stimulating. Keep doing what you are doing – we appreciate it.” Thanks, both for doing the interview and for the nice words. I don’t like asking stupid questions, at least when I can help it, so I treat my interviews as a conversation. As in most conversations, not everybody is fascinated by every interview of the hundreds I’ve done – it depends on their area of interest. As for me, everybody I’ve interviewed has taught me something.
From Bruce Werner: “Re: interview with our CEO, Mark Debnam. The HIStalk interview was a big success. Our Facebook ‘likes’ jumped significantly. We are proud to be part of the HIStalk family.” Mark of Quality IT Partners and I are both progressive music nerds, so we were nearly breathless in discussing the latest tours and albums from Yes and Asia, which I omitted from the interview transcript since, puzzlingly, not everybody is a fanboy for semi-obscure bands whose heyday was a couple of generations ago.
From Chillicothe: “Re: Epic. Wondering if you saw this?” Several readers sent over a link to that story in The Examiner, a free, conservative DC-area newspaper. It’s all rehash: Judy Faulkner of Epic was appointed to the HIT Policy Committee and Epic employees have given $300K to Democrats since 2006 (doesn’t sound like much for a company of that size). Surely nobody’s shocked that donors get some reciprocal back-scratching, like being appointed, but her spot was set aside as a vendor rep, so why not her? The article takes a somewhat slanted position that Epic isn’t open to interoperability (the article’s one quoted source to back that statement – CEO Glen Tullman of Epic competitor Allscripts, who is himself a lot better connected politically than Judy will ever be). The rag finds a hidden Obama agenda — the examples he’s given of well-run hospitals (Geisinger, Kaiser, Cleveland Clinic, and Mayo) are all Epic customers. One thing I might agree with: it would indeed be a bit suspicious if Epic got the VA’s bid (which doesn’t seem to be happening, at least at this moment) but otherwise, they’re getting plenty of business without government help. And yes, the Obama administration was mighty generous with our money in bribing providers to use EMRs they weren’t spending their own money on.
From The PACS Designer: “Re: Toodledo. Will Weider of Candid CIO blog fame recently posted about a to-do listing app called Toodledo. You can get Toodledo versions for your mobile phone, as well as an app to add it to your e-mail, on your calendar, and integrate it directly into your web browser.” I’d be interested if it does recurring events and reminders. I don’t use Outlook at home and I’m finding Google Calendar to be pretty sucky when it comes to reminders. In fact, I’m becoming slowly annoyed at most things about Gmail and Google Docs – the spare design was cute at first, but everything feels clunky and I still don’t like the “conversation” design of Gmail since I’m always deleting entire message threads by mistake.
Acquisitions, Funding, Business, and Stock
Intermedix, a provider of RCM services for emergency healthcare services, buys the assets of RCM-provider Comprehensive Medical Billing Solutions of Oklahoma City.
Axiom Systems acquires Ivertexo Internet Solutions, a provider of administrative software solutions for healthcare providers.
MedQuist Holdings announced Q2 numbers Tuesday morning: revenue flat, EPS $0.11 vs. -$0.06. Its acquisition of M*Modal gets clearance to be completed in August. MedQuist shares made the list of biggest Nasdaq losers Tuesday, down 18%. The company says it’s pushing more work offshore, but is being negatively impacted by customers sending work offshore themselves, by customers using speech recognition instead of transcription (which I’m sure is why they are buying speech recognition provider M*Modal for $130 million) , and by providers focusing on EHRs.
Vocera files SEC paperwork for its $80 million IPO.
Sales
Cooper County Memorial Hospital (MO) will spend $2.5 million for Meditech, which it selected over Cerner and Healthland. Hospital CEO Allen Waldo says, “Meditech won the contract because the hospital’s clinicians thought it was more user-friendly and had a better data recovery system.”
The VA awards ICS Nett and Beacon Enterprise Solutions Group a $3.4 million contract to provide the management and installation of an RTLS solution for tracking equipment, supplies, implants, and surgical instruments.
St. Joseph’s Medical Center (CA) selects PerfectServe’s voice, mobile, and Web-based clinical communications system.
The Australian government chooses a consortium of eight firms to participate in the infrastructure build of its $466.7 million personally controlled electronic health record (PCEHR). Winners include Accenture ($47.8 million), Oracle ($17.8 million), and Orion Health ($11 million) along with sub-contractors Telstra, Cerner, ThinkPlace, Extensia, and Ocean Informatics.
People
Lehigh Valley Health Network promotes Donald L. Levick, MD, MBA to CMIO.
Former McKesson Health Solutions CFO and VP Peter P. Csapo will join VHA as CFO.
Beebe Medical Center (DE) names Jeffrey Hawtof, MD VP of medical operations and informatics.
Kevin Groskreutz is promoted to CIO of Hospital Sisters Health System Western Wisconsin.
Bassett Healthcare (NY) names Scott Groom VP/CIO. He was previously with Cabell Huntington Hospital (WV).
Announcements and Implementations
Resurrection Health Care (IL) goes live on its system-wide Epic implementation with the activation of billing and scheduling at 20 ambulatory care clinics. The practices will add EMR over the next six to eight months; the first of six hospitals will begin go-lives in the fall.
Zynx Health announces two enhancements to its clinical decision support technology: Workflow Management to streamline content development and Export Validation to allow Cerner CPOE users to validate order sets before exporting them.
Vital Images / Toshiba gets 510(k) clearance for its VitreaView browser-based universal patient imaging viewer, which allows EMR and HIE users to view all patient images. It was announced in June.
Government and Politics
President Obama announces new economic initiatives to spur growth and create jobs in rural areas, including loan programs to enable hospitals to purchase HIT. The administration also announces a loan repayment program for more than 1,300 small, rural hospitals to recruit new physicians. The White House estimates that the addition of one new primary care physician in a rural community generates $1.5 million in annual revenue and creates 23 jobs annually.
FDA will hold a public workshop seeking input on what types of mobile medical applications it should regulate on September 12-13 in Silver Spring, MD. This follows FDA’s July draft guidance on that topic.
Other
A proposed compost facility in Freetown, MA is stinking up Meditech’s plan to develop a new office building that could bring 800 jobs to the area. The city is looking into the issue.
CEO compensation at Boston’s nonprofit teaching hospitals is leveling off, with 2009 pay equal to or less than the previous year’s. Elaine S. Ullian, the former CEO of Boston Medical Center experienced one of the biggest declines: $1.8 million in 2009 compared to $4.8 million in 2009.
About 40% of EDs in urban areas e-prescribe compared to just 6% in rural areas.
I’m loving the site (sites, actually: this one and this one) of Atlanta anesthesiologist Michelle Au MD, author of This Won’t Hurt a Bit (And Other White Lies): My Education in Medicine and Motherhood. She’s darned funny, describing her book as: “It contains ‘pages’ and ‘words.’ I done wrote it.’” But if you’re on the fence as to whether she’s wickedly humorous, click the graphic above to enlarge. Brilliant. I think I’ll buy the book.
Vince Ciotti (and I) would approve: McKesson joins The IT History Society as a corporate member.
Another highly paid non-profit hospital CEO: the head of a 326-bed Brooklyn hospital made $4 million in 2009 while laying off employees and closing clinics that served its predominantly Medicaid patient population. The board gave the usual “market rate” excuse.
Sponsor Updates
Contacts
Mr. H, Inga, Dr. Jayne, Dr. Gregg.
Quality Systems, Inc. announced this afternoon that it will acquire CQI Solutions, Inc. of New Braunfels, TX, which offers hospital systems for surgery management and patient scheduling. CQI will become part of the NextGen Inpatient Solutions business of Quality Systems, with its applications offered as both standalone and integrated products.
Steve Puckett, executive vice president of Quality Systems, was quoted in the announcement as saying, “We are pleased to extend our portfolio to meet these cross-departmental needs, demonstrating our commitment to the community and rural hospital marketplace. With the additional integration of our award-winning ambulatory solutions, our inpatient and ambulatory clients are now collecting critical data across the care continuum, helping them meet requirements of quality of care initiatives and current business drivers such as Meaningful Use, where clients have already earned in excess of $5 million in incentives.”
From Big Ragu: “Re: HHS CTO Todd Park. Gave a great speech at the Health 2.0 NYC meetup Friday. He was a really dynamic and engaging speaker and showed off some amazing projects from Health Data Palooza, sponsored by IOM and HHS.” He’s at the 51-minute mark of the video here.
From Wanderlust: “Re: [vendor name omitted]. Lackluster replacement for [former VP 1], internal political fights over who owns product strategy, no progress on new revenue cycle product, offices being consolidated, open platform not what was promised to partners, and a shaky start to integration as employees freak out about their long term job prospects. This employee is putting down my copy of Visual Studio and checking out Monster.com. But wait, another rumor is making the halls of the office that does create some hope. That rumor is that [former VP 1] and [former VP 2] may be returning.” All unverified. I’m doing some liberal expunging since obviously there’s no way the company can confirm or deny so I’m not comfortable just throwing it out there, but I’ll say that Wanderlust was mostly right on some items sent my way earlier this year. I just talked to [former VP 1] this week and didn’t get any feeling that a return was imminent, so I’ll attribute that last sentence to wishful thinking.
From HappyNotToBeAMcKessonite: “Re: McKesson. Loses another large system, this time in Albuquerque, to guess who? Good luck finding Epic specialists through job boards. This health system has been cheap in the past, so it’s interesting they have allocated $90 million for the project.” Unverified. The health system wasn’t named, but I assume it’s Presbyterian, which signed a much-touted $22 million Horizon and homecare deal way back in 2001, the same year McKesson bought the rights to Vanderbilt’s WizOrder and called it Horizon Expert Orders. Presbyterian has a lot of Epic jobs posted that look like inpatient, so you can draw your own conclusions.
From Melina: “Re: Siemens. Signed some new deals.” Listed in the announcement: Regional Medical Center (TN) signs up for Soarian Clinicals and Financials; Jefferson Regional Medical Center (PA) goes with Soarian Clinicals; St. Joseph’s Healthcare System (NJ) will migrate off INVISION to Soarian Clinicals and Financials; and University of South Alabama will move from INVISION Clinicals to Soarian Clinicals.
From PumpDoc: “Re: IV pump design errors. I think you have given readers the impression that my company’s Plum A+ pump was the cause of the errors and that’s not true. Can you please clarify? Ours doesn’t have the start button next to the zero and decimal point. I’m guessing someone just picked a stock pump picture to go with the story. Thanks – I am an avid reader!” Correct – I just put up a general picture of an IV pump that didn’t really have anything to do with the article, other than for someone who didn’t know what an IV pump looks like. The article didn’t implicate any particular brand of pump, so it wasn’t the Hospira pump, which as the full-sized picture above shows, has the Start button on the upper left.
From Lodi: “Re: new HIMSS certification. Seems to duplicate the HIT program.” The National Science Foundation is apparently paying HIMSS to develop an entry level certification program, Certified Specialist in Health Information & Management Systems, kind of a junior CPHIMS, which is itself kind of a junior everything (advanced degree, relevant experience, useful specific certifications like PMP or CISSP …) Would you really hire someone on the basis of a credential proving that they are “entry level?” I’ve yet to see any general certification that’s worth anything other than to ease the sometimes justifiable anguish of the resume’-insecure, but it’s their money.
From HIStalker: “Re: salaries. A $6 million hospital CEO!” A hospital CEO salary survey covering only the Midwest finds the pack led by 314-bed Children’s Mercy Hospital and Clinics (MO), which paid its CEO $6 million in the most recent year. Must be a terrible place to work if that’s what it takes to get someone to run it. Mercy Janesville paid $4.5 million, Advocate $4 million, and Northwestern $3.4 million. It’s bad enough when private industry CEOs make massive multiples of what the worker bees are paid, but absurd when talking about non-profit hospitals, all of which ironically anguish publicly over escalating healthcare costs. If public school systems or soup kitchens could bill Medicare, I suppose they’d be unnecessarily run by $2 million administrators.
Honky Cat was moved to wax poetic about HIStalk:
An Ode to HIStalk
It’s 9pm and my bourbon glass in reach;
Mouse, keyboard, email, and alas,
An alert from HIStalk breaches the still.
Curse your anonymity!
Show your face and be criticized.
Yet the rhythm of my heart accelerates.
For I know the contents will amaze and amuse;
I may learn one morsel of data,
One shard of vendor information,
That cuts deeply to the quick
And such as a participle, hangs with an airy loft.
Or, perhaps a CIO interview that portends the strategy versus the reality;
Inga and her shoes.
Could she be the muse?
What have I to lose?
There is meaningful use.
This week’s Time Capsule editorial from 2006 lauds the hard-nosed vendor negotiation style of former NPfIT head Richard Granger. A snip: “Granger holds firm and goes public when he has to, unafraid to rip recalcitrant vendors by name. I like to picture him as a Gordon Ramsay-type scrapper, happy to take someone down a notch when they need it.” Knowing now that NPfIT is pretty much ash-heaped, you might smirk that I was way off base, but I argue no: the real problem was that, despite all that aggressive negotiation and multi-billion dollar contracts, there just were not any contractors or vendors who could pull off their part of the project. They overcommitted and under-delivered, but in this case, poor performance hit them hard financially and they walked away. Granger’s threats were a bit hollow since there were only so many potential contractors out there and the pioneers were coming back with arrows in their backs.
Listening: Big Big Train, recent British progressive rock that sounds like 1970s Genesis before Phil Collins ruined it by selling out to make teen dance tracks. Think And Then There Were Three, from which “Undertow” is one of my favorite songs of all time with amazing music and lyrics. Big Big Train is right up there with them.
A slight majority of poll respondents think hospital CIOs wield undue influence over clinical system selection and implementation. New poll to your right: should HHS study the effectiveness of EMRs and their impact on medical errors as Congresswoman Ellmers has urged? Click the Comments link on the poll widget to explain your rationale if you are so inclined.
Am I the only one getting weary of announcements proclaiming that XX hospital or practice is the first in some state to get Meaningful Use money? I figure there are 50 states, you have both EPs and hospitals, and MU comes in both Medicare and Medicaid flavors, so that’s a potential crap-load of self-congratulatory vendor press releases to wade through, none of which really mean a whole lot. Far more interesting would be a list of certified EMR vendors who don’t yet have even one customer that has received a check. It wouldn’t be any more meaningful, just more fun.
Iowa Children’s Hospital develops a Facebook medication reminder system for teens, especially transplant patients. The patient clicks on which meds they’ve taken and the information is sent back to their PCP.
Some excellent posts you might want to check out: Don Michaels concludes on HIStalk Practice that providers shouldn’t move too quickly to sign ACO contracts given demonstration group’s lack of success in earning payment, while Dr. Travis dissects WellDoc’s consumer health apps on HIStalk Mobile.
The Army tests its MC4 battlefield EMR on iPad, iPod Touch, iPhone, and Android devices, expecting approval to replace their outdated Motorola handhelds with tablets later this year. What they like: larger screen, gestures, the ability to run common apps, the ability to access the Internet, and patient lookup by their ID card. Above is a 2008 video of MC4 running on the Symbol (acquired by Motorola in 2006).
It’s been a crazy stock market week, so I thought I’d check the current vs. month-ago prices of some HIT stocks:
Allscripts: $15.27 vs. $19.74 (down 22%)
athenahealth: $53.00 vs. $45.16 (up 17%)
Cerner: $58.18 vs. $62.29 (down 7%)
McKesson: $79.02 vs. $83.04 (down 5%)
Nuance: $18.04 vs. $21.07 (down 14%)
Quality Systems: $79.77 vs. $89.10 (down 10%)
A conservative political group in Kansas called SOCK (Stop Obama Care in Kansas) wants the state’s Republican party chair to quit, saying that Amanda Adkins has a conflict of interest because she’s an employee of Cerner, and as such has a vested interest in both Obama Care and the government’s push of healthcare IT.
As you must know, Cerner Corporation is not taking a passive stance in hopes of remaining a key player and profit taker in the HIT industry but is very aggressively working, including to influence the government, to ensure its leading position in the HIT industry is maintained if not enhanced. The position of your employer, Cerner Corporation, is diametrically opposed to that of the State of Kansas, the current KGOP platform and the vast majority of the GOP rank and file as well as other Kansans.
SAS hires Graham Hughes MD as the first chief medical officer for its Center for Health Analytics and Insight think tank. He was previously CMIO of GE Healthcare IT.
In the UK, workforce management solutions vendor Allocate Software acquires Zircadian Holdings, a vendor of software used by hospitals to manage physicians (scheduling, locum, and evaluation).
Ridgeview Medical Center (MN) partners with Healthbox to launch a three-month mentorship for up to 10 HIT seed-stage company entrepreneurs.
One of the inventors of the IBM PC says PCs in general are extinct, just like the typewriter and vinyl records. He replaced his own PC with a tablet, but says the devices themselves are not innovative – it’s the social spaces they access where people and ideas meet.
The fascinating story of SAI and its family tree in both directions, in this week’s HIStory from Vince Ciotti (he’s the hirsute lad on Slide 9, wearing a sofa-patterned, suspender-supported plaid suit and flanked by an avocado green touch-tone telephone). He loves your feedback and input, such as suggesting which long-gone companies he should write about (my list: Atwork, Continental Medical Systems, HealthQuest, Health Data Sciences, Phamis, and TSI).
Children’s Hospital Colorado is hit with a federal equal opportunity lawsuit for rejecting a job applicant for a staff assistant position who they found to have fibromyalgia, meaning she can’t sit at a desk or work on a computer for long periods. She wants the job, back pay, compensation for emotional distress, and punitive damages.
Dan Moriarty, founder of HIStalk Gold Sponsor Stimulus Search, has joined Health Data Specialists as recruiting manager. They focus on resources for Epic, Siemens, Cerner, and Meditech.
Stanford bioinformatics researchers mine the electronic patient databases of Stanford University Hospital, Vanderbilt, and Partners HealthCare to discover a drug-drug interaction between the heavily prescribed drugs pravastatin and paroxetine. Said the study’s lead author, “We’re bioinformatics people, not clinicians. We can develop ways to mine these huge data sets for interactions that have escaped attention, but you have to start with a clinical expert to curate a set of drugs and effects so you’re looking for something that actually matters in the real world. I’d love to hear from pharmacists about the kinds of questions they would like answered with data-mining. Their drug knowledge is invaluable to this kind of program.”
West Penn Allegheny Health System (PA) will partner with Highmark, Allscripts, and Accenture to offer EMRs to private practices. A local physician says WPAHS is obviously trying to keep its beds occupied: “If a hospital comes into your office and offers to front you $250,000 for an electronic medical records system, they’re not doing it out of the goodness of their hearts.”
Florida’s multi-millionaire Governor Rick Scott is criticized for paying low rates on state-provided health insurance, which he says is appropriate since he has the same plan and cost as everybody else. State big shots (all 32,000 of them) apparently get family medical insurance for premiums of less than $400 per year. Wildly generous state and federal government employee benefits and retirement plans somehow never seem to come up in all the zeal to control the cost of entitlements.
In India, a former hospital COO is arrested for stealing the hospital’s patient data and selling it to other hospitals through a consulting company he started. The hospital got wind of what was happening and installed keylogging software that showed him e-mailing information from his personal account.
Top News
Rep. Renee Ellmers (R-NC) asks HHS Secretary Kathleen Sebelius to study the adoption, benefits, and cost effectiveness of healthcare IT, including its impact on medical errors. She’s a nurse and her husband is a physician; she ran for Congress as a critic of government-run healthcare. She chairs the Subcommittee on Health Care and Technology. She was quoted in a March press released as saying this about PPACA waivers:
As a nurse of twenty years, wife of a surgeon and owner of a wound clinic, I am not only aware of the problems that currently exist in the American health care system, I have seen them up close as a caregiver, a patient and a small business owner in the health care industry. Unlike the remedy we were promised, ObamaCare has done nothing to improve the quality of health care in our country, and has already done significant damage to the economy. I join Chairman Graves in asking for a full explanation of the waiver process, to ensure that individuals and small businesses are treated fairly.
Reader Comments
From Data Dump: “Re: [vendor name omitted]. Loses years of patient data at an Epic facility, is technically unable to recover data from the backup.” Unverified, so I’ve omitted the name of the enterprise content management vendor. I’d be interested in hearing from the client, though.
From CagneyInMillerton: “Re: Yale. You are missing a big story on their not rolling out Epic. Big negative money angle and someone going after Harvard CIO position.” I asked CIO Daniel Barchi, who reports that (a) they are two months away from their first practice go-live; (b) they are under budget; and (c) the three hospital go-lives have been moved up, with the first going up in April 2012 and the last in June 2013. They are implementing Epic in three hospitals, the School of Medicine, the 800-physician Yale Medical Group, and several independent community physician practices. Daniel says if the Harvard rumor was about him, it’s not true.
From One of Their Hospitals: “Re: [vendor name omitted]. Based on a phone call our pharmacy received, they are closing their doors Friday.” Unverified. I asked for confirmation from the company, but got no response. This Ohio-based vendor offers medication and supply management systems, mobile carts, and software. I think the source is solid, but I’ll give the vendor a little extra time to respond (or call this weekend to see if the telephone has been disconnected).
From Ronnie James Dio: “Re: Computerworld article on HIT job growth. The author says SimplyHired has 7,200 HIT jobs posted out of 4.9 million. That sounded way too low, so I contacted SimplyHired to find out how they arrived at this number. Their answer: they just searched for the specific term ‘healthcare IT,’ which does not even remotely identify all healthcare IT positions. Downright goofy.”
HIStalk Announcements and Requests
![8-10-2011 2-23-21 PM_thumb[2]](http://histalk2.com/wp-content/uploads/2011/08/8-10-2011-2-23-21-PM_thumb2.jpg "8-10-2011 2-23-21 PM_thumb[2]")
This week on HIStalk Practice: legislation is proposed to allow PAs and NPs to qualify for Meaningful Use funds. Aprima Medical acquires an RCM company. AAFP posts its EHR survey results online. Meaningful Use incentives drive physicians to adopt EHRs. Sage Health employees volunteer at CHCs in honor of National Health Center Week. Integritas President Mary Stroupe explains why even “ineligible” providers should adopt certified EHRs. When you are catching up on your ambulatory HIT news, show some love to our loyal HIStalk Practice sponsors by clicking on their banners and learning what they are all about, Heck, they could be offering some good stuff you didn’t even realize you needed. Thanks for reading.
On the Jobs Page: Director of Public Relations, Project Manager – Healthcare Implementation, Developer I. Healthcare IT Jobs is temporarily offline while some administrative and technical work is completed to move it to a new hosting service, but it will be back soon.
You know who’s cool? You, for reading – thanks. To take cool to the next level, consider: (a) signing up for e-mail updates; (b) socially attaching yourself to Inga, Dr. Jayne, and me on Facebook and LinkedIn (Dann’s HIStalk Fan Club has 1,751 members, so you might as well join that while you’re at it); and (c) checking out the sponsor offerings by clicking the lovely (and soon to be non-animated) ads to your left or delving deeper in the searchable, categorized Resource Center. We can’t promise to always be the most informative and entertaining site in HIT, but it’s not for lack of trying.
Acquisitions, Funding, Business, and Stock
An Emdeon shareholder sues Emdeon and Blackstone Group, charging that Blackstone’s $3 billion buyout offer for Emdeon undervalues the company.
Nuance announces Q3 numbers: revenue up 20%, EPS $0.13 vs. –$0.01, or $0.35 vs. $0.30 excluding one-time expenses, beating analyst expectations of $0.34. Healthcare revenue was up 22%.
CSC’s Q1 numbers: revenue up 3.1%, EPS $1.17 vs. $0.91, but the earnings jump was partially due to a one-time tax benefit. The company restated guidance, but both analysts and shareholders reacted negatively. Revenue is projected to be flat even with the contribution of newly acquired iSOFT. In the earnings call, the CEO declined to speculate on the potential future of NHS’s NPfIT, a big customer of CSC and its former subcontractor, iSOFT.
Sales
The VHA awards Apelon a multi-year blanket purchase agreement for its terminology and data interoperability solutions.
The Wisconsin HIN selects ABILITY network to provide electronic messaging services for its connected stakeholders.
Flagler Hospital (FL) chooses Allscripts Sunrise Enterprise, also endorsing the Allscripts PM/EHR for its 130 affiliated physicians.
People
Genomind hires former MEDecision CEO Scott Storrer as COO.
Decision Resources Group names John Ho, MD president of its Decision Resources Consulting.
Health Language Inc (HLI) promotes April Yoder to VP of professional services.
Navigant adds eight senior consulting professionals to its healthcare practice.
Announcements and Implementations
UPMC and Nuance sign a 10-year agreement to develop EMR information capture technologies related to speech and clinical language understanding, as well as natural language-powered data repository searches. UPMC will also standardize on Nuance to provide speech and natural language processing tools for its 20 hospitals, 30 imaging centers, and 400 outpatient sites. Nuance says the co-developed solutions will be generally available by the end of the year.
Government and Politics
Two years after to agreeing to merge their EMRs, officials from the DoD and VA admit it could take up to six more years to complete the project. VA insiders acknowledge that the process has been complicated by bureaucratic infighting, as each agency is unwilling to give up its legacy health system. The departments have now agreed to slowly upgrade both networks into a new shared system over the coming years.
![8-11-2011 3-28-12 PM_thumb[1]](http://histalk2.com/wp-content/uploads/2011/08/8-11-2011-3-28-12-PM_thumb1.jpg "8-11-2011 3-28-12 PM_thumb[1]")
Kansas Governor Sam Brownback returns a $31.5 million HHS grant, saying he had doubts the federal government would be able to maintain its promised future payments. Kansas was one of six states awarded grants to establish HIEs that other local governments could use as a model; Oklahoma also rejected funds for the project. Critics say the move was politically motivated.
Other
Hospitals tell KLAS they need more comprehensive and integrated systems for pharmacy inventory management. Providers report that the biggest functionality gaps for these systems involve formulary database integration, expiration date tracking, and reporting.
A British physician risks being “struck off the medical register” for bad behavior that includes self-prescribing medications, asking an employee to shred hospital correspondence related to an ongoing investigation, and biting a police officer.
In Australia, a software error causes the deletion of prescription records for more than 140 patients, with the conditions of 14 of them found to have worsened during that time.
Canadian researchers blame poor IV pump design for the 4.5% of medication errors that involve children receiving 10 times the intended drug dosage, often in PICU/NICU. They point out that IV pump keypads have the decimal point, zero, and confirm buttons side by side.
|
Mayo Clinic opens a high-tech consumer wellness information storefront in the Mall of America, intending it to be a gateway to its services. Features include wellness evaluations, symptom checkers, “trained health experience navigators,” and unnamed products for sale. Mayo says they have no plans to replicate the project in other malls, but wants to “learn about adapting its services to other settings.”
Another part of Mayo’s mall experiment: an iPhone-powered scavenger hunt.
The team of GAUCHOS, an Open Software electronic charting application developed for volunteer clinicians (homeless shelters, the Operation Smile cleft palate repair organization, etc.) launches a Kickstarter project. They hope to raise $83,800 in crowdsourcing funds to complete the Operation Smile rollout and to develop a tablet version that does not require Internet connectivity. Like all Kickstarter projects (including a couple that I’ve donated money to), swell prizes are offered — $1,000 gets you a launch party invite and Web recognition, but just $15 earns a logo coffee mug.
A Sage Healthcare survey finds that non-EHR using physicians have different expectations than those actually using EHRs. Physicians already using an EHR say they’re happy if it tracks outcomes and reduces errors, while the holdouts say they expect the EHR to increase their revenue.
A computer-on-wheels catches fire at Uniontown Hospital (PA), requiring firefighters to air out the third floor.
Sponsor Updates
EPtalk by Dr. Jayne
As of last month, the American Academy of Family Physicians is no longer offering a paper mail-back card for its Continuing Medical Education quizzes. Participants will need to complete the quiz online. Definitely a step in the right direction as far as encouraging computer literacy at a basic level. Despite what those of us in the IT space might think, there are still quite a few docs out there who haven’t used a computer. Usually when those folks are integrated into our health system, I have the privilege of training them one-on-one. You’d think it would be exasperating, but it’s often very rewarding as you see one of these physicians start to realize the power of computers.
A 26-year old South Carolina man was denied participation in a federal assistance program for breast cancer patients because he’s a man. Approximately 1% of all new breast cancer cases each year involve men. This gentleman doesn’t have health insurance and didn’t qualify for Medicaid. The Breast and Cervical Cancer Prevention and Treatment Act is a federal law designed to help patients in this category; unfortunately, you have to be female to qualify. South Carolina has tried to cover male patients under this provision in the past but has been denied. The Centers for Medicare and Medicaid Services state they’re working to find a solution.
Speaking of CMS, it recently launched the Hospital Compare website to go along with the Physician Compare website that we’re all so fond of. There is much more information available to look at for hospitals: process of care measures, outcomes measures, etc. Of course, hospitals have been more transparent about this information than individual physicians, so it’s not surprising.
In other South Carolina news, Greenville Hospital System is offering “speed-dating” events to try to match young adults with physicians. Realizing that health reform legislation will increase the number of young adults with insurance coverage (by allowing them to stay on parents’ policies, purchase through exchanges, or enroll in Medicaid) they’re using Facebook and more social events to draw these patients in.
Sometimes I receive e-mails I just can’t believe. Here’s what came from the American Medical Association the other day:
Find out how you can achieve meaningful use without an EHR. Learn about a unique approach to meeting federal meaningful use guidelines at less cost than an electronic health records (EHR)-based approach by viewing a webinar at noon Eastern time Wednesday from Amagine, Inc., a subsidiary of the AMA, and WellCentive. The program will feature a demonstration of WellCentive EHR-M.
Really? The marketing folks behind this blurb should be fired. The product demonstrated has EHR in its name. How does that make it not an EHR? Is it really any cheaper than the cheapest certified system out there?
A quick visit to the WellCentive website looks like it’s just another modular product. And I bet once you get done buying WellCentive EHR, WellCentive PQRS, WellCentive e-Rx, WellCentive Patient Outreach, WellCentive Registry, and WellCentive Connect (you get my point) you might as well have bought a top-shelf complete EHR.
The Department of Veterans Affairs is sponsoring a contest (complete with a $50,000 prize) to use its Blue Button download tool to develop a personal health record and place the technology on 25,000 physician websites. Over 300,000 veterans have used the Blue Button on MyHealth.va.gov to download data in the last year. The goal is to expand this functionality to the 17 million vets receiving care from non-VA providers. The contest runs through October 18 unless someone wins it sooner.
A shout-out to all of you at Community Health Centers since this is National Health Center Week. You are vital to the healthcare of so many people. I’m continually amazed by the ability of some CHCs to deliver high-quality care to a challenging population on a shoestring budget. Keep up the good work, and thank you!
Contacts
Mr. H, Inga, Dr. Jayne, Dr. Gregg.
Top News
IBM and nine other vendors file protests with the VA for not being chosen to participate in its $12 billion technology program. All the protests except IBM’s have already been denied.
Reader Comments
From Observer: “Re: Flagler Hospital, St. Augustine, FL. Replacing Meditech with Allscripts Sunrise, which beat Epic and Cerner as well. It’s a 300-bed HealthGrades Best 50 hospital.” Unverified, although I had heard that an unidentified hospital had signed on.
From Otoscope: “Re: hospitals that have successfully attested. Is there a list somewhere that includes which vendors they use?” I haven’t seen a list like that. If you have, let me know.
From Unlisted: “Re: shakeup at ONC. Arien Malec, coordinator of NHIN Direct, is returning to RelayHealth. Dr. Doug Fridsma will leave his current post and take over Dr. Chuck Friedman’s former position as Chief Scientist. All of this will leave ONC-sponsored interoperability efforts lost at sea.” Arien tells me that he announced his departure from ONC on Monday – his nine-month RelayHealth leave had turned into 18 (he was not an ONC employee). He reports that it was already announced that Doug Fridsma is covering the Office of the Chief Scientist role in addition to Office of Standards and Interoperability. I wouldn’t say that any of this necessarily qualifies as a shakeup, though.
HIStalk Announcements and Requests
You may have read last week that I was traveling a bit, leaving Mr. H to carry an even heavier load than usual. In addition to some shoe shopping (a mere two pair), I paid a visit to eClinicalWorks and athenahealth. If you care to learn details about eCW’s nifty new headquarters, or see some pictures of Jonathan Bush’s office, you’ll find the write-ups on HIStalk Practice.
Acquisitions, Funding, Business, and Stock
Private equity firm Halyard Capital invests in RCM provider Practice Insight.
At least five law firms file class-action lawsuits against WebMD, alleging that the company misrepresented its financial position to shareholders and failed to make timely disclosures about projected drops in advertising revenues. CEO Wayne Gattinella lowered revenue guidance for 2011 in July and the stock price fell 30%; however, company insiders sold $44.7 million in stock in the months following the issuance of WebMD’s February financial statements.
SAIC completes its acquisition of Vitalize Consulting Solutions.
Emdeon reports Q2 net income of $5.8 million, up from $4.2 million a year ago. Non-GAAP adjusted net income was $31.8 million ($0.26/share) which beat analysts’ expectations of $0.25/share. Revenues were up 16% to $282.1 million. The company announced last week that it will be taken private by a Blackstone Group fund.
Symphony Corporation, a Madison, WI-based technology provider, acquires JGI, a New Jersey human capital management consulting firm. Both companies claim a significant healthcare presence.
Sales
Stormont-Vail Healthcare (KS) selects TeleHealth to provide interactive patient education services.
Mille Lacs Health System (MN) contracts with Indigo for its Identityware SSO and access management solution.
Iowa Health System will use Medicity’s HIE technology to connect its hospitals and clinics.
People
LSU Health Shreveport promotes Marcus Hobgood to CIO.
SCI Solutions names Joel French managing partner and CEO and Jeff Anderson managing partner and chief sales officer. Founder John Holton will serve as managing partner and COO. French was most recently VP/GM Healthcare of Motion Computing; Anderson was managing director at Huron Consulting Group. SCI also announced that The Wicks Group of Companies and New Enterprise Associates have invested in the company to support its expansion efforts.
RedBrick Health, a Minnesota vendor of technology-driven online wellness services, names Daniel Ryan as CEO.
Announcements and Implementations
Taiwan goes live on its nationwide EMR initiative in November, allowing physicians across the country access to patients’ clinical information.
Cerner says that all 18 Major League Soccer teams have implemented its HealtheAthlete health management platform. During the 2010 season, 621 players were tracked in the system and 1,500 injuries were logged.
The Christ Hospital (OH) implements a real-time interface that captures data from hemodialysis treatments and imports it into its Epic EMR.
Stillwater Medical Center (OK) integrates its the vital signs monitors in its same-day surgery unit with its Meditech HIS using Accent on Integration’s Acceleor Connect technology.
Dell and NextGen announce plans for Dell to sell and support NextGen’s ambulatory and inpatient solutions and to provide hosting services for NextGen clients. Dell also becomes the platform of choice for NextGen solutions and for NextGen’s internal use.
LA Care Health Plan (CA) will spend $1.5 million to develop and implement an eConsult system at 47 LA County safety net sites. It will handle provider communication and referral requests. A previous pilot program was claimed to reduce face-to-face specialist visits by up to 48%, depending on the specialty.
Government and Politics
New Hampshire Governor John Lynch signs legislation that establishes the state’s Health Information Organization (NH-HIO.)
HHS issues a Notice of Proposed Rulemaking regarding the use of metadata standards to support health information exchange.
In Australia, standards work for the government’s eHealth program is stopped when the non-profit Standards Australia fails to secure a new government contract.
Other
The Colorado Department of Public Health and Environment fines Heart Check America $3.2 million for a variety of violations, including performing diagnostic scans without the order of a state-licensed physician. The company was also cited for failing to monitor employee radiation exposure and not having policies and procedures to ensure safe CT scanner use. The company closed its Denver facility in May following a state inspection.
HIT jobs will grow 20% annually through 2018, according to the US Bureau of Labor Statistics. Because of particularly strong demand for CIOs and CTOs, individuals from banking, manufacturing, and other industries are now being hired into healthcare.
KLAS reports that Cerner’s Millennium PowerChart has the most hospitals live on CPOE, followed by Epic. An average of 81% of orders are being entered via CPOE in Cerner hospitals and 83% at Epic sites. The third-ranked McKesson had 90 installations of Horizon CPOE at the end of 2010, with an average of 45% adoption, plus 11 Paragon sites with 25% average adoption. Overall industry adoption of CPOE was still less than 22%.
Doom and gloom from Down Under: The Australian Medical Association warns that the federal government’s online medical records system is “doomed to failure” because not enough people will sign up for it. Patients are required to opt in to participate; the medical association wants the government to make participation mandatory unless the patient opts out.
Strange: an health board IT technician in New Zealand is fired by the CIO for departmental theft. His loot: one blank DVD.
Weird News Andy is nuts about this premature discharge story: a man tucks his girlfriend’s pink pistol into his waistband as the couple enters a grocery store, accidentally pulling the trigger and shooting himself in his private parts. The girlfriend calls 911 and the emergency operator tells her to apply pressure, but not to look at the wound. “I did look at it and it’s pretty bad,” she admitted. The local police department turned the unfortunate incident into a teaching moment, helpfully advising locals to use holsters rather than jamming weaponry down their pants Hollywood-style.
WNA also turns up this story: a 26-year-old with breast cancer and no health insurance is denied coverage by a Medicaid program specifically created for that condition. The reason: he’s male. Above is CMS’s special coverage conditions, which exclude the several thousand men who are newly diagnosed each year.
An Ann Arbor, MI couple who owned hospital inventory software company Ariel Software are indicted for failing to pay taxes to the IRS over a 12-year period. They are accused of withholding $880,000 in employment taxes, but spending most of the money on the business instead of sending it to the IRS. The husband was also charged with failing to file personal tax return for several years.
A former VA data warehouse manager is sentenced to 11 years in prison for extracting patient information from the VA’s system and using it to file 800 fraudulent tax returns through his home tax preparation business.
Doctors in Estonia complain about the HP-developed EMR used there, saying that entering data for a single patient requires 50 mouse clicks and opening dozens to hundreds of documents one at a time.
General Cannabis announces that its WeedMaps marijuana dispensary finder took in $1.1 million in July. Its patient management system will complete beta testing shortly and offers patient self-scheduling, electronic medical records, and an appointment reminder system. According to the CEO, “Our technology is applicable beyond cannabis and we are already in development on our next medical niche.”
Members of a Florida ministry’s medical bill-sharing program join together to pay each other’s “responsible” medical bills, eliminating the administrative expense of for-profit insurance companies. The program, which the ministry insists is not insurance, pools expenses for members to share as they wish. It also offers healthy living rewards and helps its parishioners adopt healthy lifestyles. Its interactive tools include a 24×7 Twitter-like Prayer Stream for prayer requests and offers of encouragement.
The parent company of a West Virginia nursing home will appeal a jury’s $91.5 million medical negligence verdict that claimed its understaffing caused the death of an 87-year-old resident.
Sponsor Updates
Contacts
Mr. H, Inga, Dr. Jayne, Dr. Gregg.
From Carlos: “Re: State of Connecticut HIE. Likely to hire Axway, a French company with headquarters in Arizona, to provide the platform. Too bad they didn’t commit to an American company.” Unverified, but it’s like car makers: tough to sort out whether you’re really buying American given that the executives, employees, subcontractors, and taxes paid are scattered around the globe and you don’t really know which country benefits the most. Axway is a publicly traded company (on the NYSE Euronext) spun off from IT services firm Sopra this past June. The CEO is French.
From Leisure Suit Larry: “Re: hospital EHR adoption. Have you seen 2010-2011 numbers? I haven’t seen anything since the 2009 AHA IT survey.” Maybe someone can help out.
From The PACS Designer: “Re: DICOM’s expansion. The stability of the DICOM Standard has been solidified with its expansion into the test and measuring field of practice. The ASTM DICONDE Committee has recognized the value of DICOM as a standard in healthcare, and adapted a version for test equipment called the E2339 Standard titled Practice for Digital Imaging and Communication in Nondestructive Evaluation. There are standards for various test methods which include Digital Radiography (DR), Computed Radiography (CR), and Computed Tomography (CT).”
From Bang Bang Shrimp: “Re: for-profit hospitals. I helped open HCA West Paces Ferry Hospital in Atlanta in 1974. We attached Addressograph charge slips to single Band-Aids at an unconscionable mark-up. We bought disposable ventilator tubing for $1.25 and charged Medicare $22.50. It took the federal government 20 years to realize they were being raped and not even receiving a kiss – thus the Dartmouth Study and prospective reimbursement.”
Thanks to the following HIStalk sponsors that started or renewed their sponsorship in July. Click a logo for more information.
HIMSS got mixed grades on last week’s poll, with 62% saying it deserves a B or C and more respondents giving it a failing grade than an A. New poll to your right: do hospital CIOs have too much influence in choosing clinical system vendor or implementation strategies?
Listening: reader-recommended (from Lake Hartwell) Heartless Bastards, a no-frills, hard-rocking Dayton bar band with a deep-voiced female singer (think Chrissie Hynde of The Pretenders meets Johnette Napolitano of Concrete Blonde) who also writes the songs and plays a mean rhythm guitar. Nothing phony or computer-enhanced here. Excellent.
The British government is expected to officially kill the 10-year, $18 billion NPfIT project next month after reviews conclude that the massive undertaking, the largest non-military IT project in history, is “beyond the capacity of the Department of Health to deliver.” Deadlines have been missed, contractors have pulled out, benefits are unclear, and reviews have concluded that project officials didn’t get enough input from physicians and other clinical users. An editorial reminds that there’s plenty of blame to pass around, including ministers for approving the use of custom systems without requiring small-scale trials, civil servants for approving questionable contracts, and vendors (notably CSC and BT) for continuing to collect taxpayer money despite not meeting their contractual obligations. The project is expected to turn into an HIE-like federated data sharing system, where local health trusts and hospital can buy whatever systems they want rather than those mandated by NHS.
Australia’s struggling, over-budget $425 million HealthSMART system is blamed for faxing hospital discharge summaries to physician practices that included clinical information for different patients. The Health Department says faxing software attached the wrong information to the fax header, acknowledging 13 incidents that had no known patient impact.
The VA awards 15 prime contracts for its technology and telecommunications program called Transformation Twenty-One Total Technology. The value of the contracts could reach $12 billion.
Kaiser Permanente’s nonprofit hospital and health plan business announces Q2 profit of $663 million, up 64% from a year ago. Revenue was $11.9 billion and membership increased to 8.8 million. An e-mail to employees sent Friday from its COO and CFO says KP will begin implementing videoconferencing technologies to link providers and also systems that can send monitoring device data directly to the patient’s EMR. I wondered about the salary of CEO George Halvorson, so I looked it up: for 2009 (the most recent year available), $6.7 million in total compensation.
My Time Capsule editorial this week from the 2006 archives: Vendors Seek to Diversify as the Hospital Systems Market Matures (this was pre-HITECH, when hospitals bought systems because they wanted them, not because the government bribed them to). A snip: “Business will sizzle in ambulatory systems, various forms of telemedicine, data analysis, payer intelligence, genomics, interoperability, consumer health, drug research, home health, and medical device connectivity.”
Brigham and Women’s Hospital announces that a doctor left an external hard drive in a cab in Mexico, potentially exposing the medical records of several hundred patients that had been downloaded to it. The doctor said the information had been deleted, but the hospital announced the loss anyway since it couldn’t verify that the information was unrecoverable.
Adventist Midwest Health names Chet Robson, DO as regional director of medical informatics, ambulatory systems.
Dr. Sam (Bierstock) and the Managed Care Blues Band, self-billed as “The World’s Most Reluctant Band,” release their latest — HITECH Blues. Sample lyrics: “I’m sitting here in prison, I’m living in a life of tears, I could be in my office, but they gave me 20 years. I never should have hacked into, the PHR of Britney Spears. I used to have to deal with, 4 different kinds of EMRs, I had one in my office, the ED, hospital, and the OR. Just ‘cause I saw that information, I’m sittin’ behind bars.”
Here’s the latest HIStory chapter from Vince Ciotti, covering Keane.
Speaking of Vince, he’s looking for stories and information about his next featured company, Charlotte-based SAI (1988 coverage above), if you want to pitch in.
European hospital pharmacy technology vendor Health Robotics is granted a motion to dismiss McKesson’s lawsuit that sought to rescind their joint distribution agreement.
ESD rebrands itself with new graphics and a tagline, “IT Consulting Rooted in Healthcare.”
Twenty-nine Penn State pre-med students are deployed at Mount Nittany Medical Center to coach physicians on its EHR transition. CMIO Stephen Tingley came up with the idea to give students the summer job. A cardiologist expressed his appreciation for the help, saying, “The system is not easy to figure out. It’s so different, like a maze. I’m dreading the day when they’re not here.”
Strange: a rural health center nurse in Pakistan, who claims a dental surgeon sexually harassed her and had her salary withheld for a full year, goes to a press club and pours gasoline on herself. Bystanders step in before she can get it lit. And stranger: a passenger on budget air carrier RyanAir goes into cardiac arrest during a flight and stops breathing, with his wife shouting for someone to bring oxygen. The flight crew, concluding that his blood pressure was the problem instead, brings him a sandwich and soda. After he revived, they came back to collect payment for the snack.
Top News
A diabetic computer security researcher proves that hackers could theoretically remotely control medical devices such as insulin pumps and glucose monitors, which don’t have enough battery power to encrypt their wireless signals. The same threat had already been demonstrated for defibrillators, but no real-world examples have surfaced.
Reader Comments
From Gary: “Re: drchrono free EMR. I can’t find anything on their site about their revenue source other than VC funding. Is it advertiser supported?” The company says they’ll get back to me on that. Their free product is limited in storage and support and doesn’t include some functions (e-prescribing and electronic billing), so I assume they hope users will move up to a paid version. I don’t know much about the product, but their website is one of the slickest ones around.
HIStalk Announcements and Requests
Listening: a new lost album from The Screaming Trees, a 1990s Seattle band with a fresh roots rock sound (even now) that mixes light grunge with dark twang and psychedelia, like minor chords REM meets Alice in Chains. They never made it big, but should have. I’m kind of loving it as I contribute my air drumming to the mix.
I made a decision last week after careful deliberation: I’m phasing out animated sponsor ads on HIStalk on January 1. Sponsors are responding positively to Inga’s e-mail describing the change, which I appreciate – I think they know intuitively that everybody will benefit from less distraction and faster page loads, which will result (ironically) in more ad views and clicks. That’s the theory, anyway.
Inga will be back to full HIStalk duties shortly. If you want to make her return even more joyful, consider: (a) signing up for e-mail updates on HIStalk and HIStalk Practice; (b) give us the electronic version of the insincere Hollywood air kiss by friending us on Facebook and connecting with us on LinkedIn; (c) send us cool stuff like rumors and secret information; (d) click some sponsor ads to check out their offerings since I turfed off the “no more animated ads” sponsor e-mail to her to send and she probably needs to regain her stature in their eyes for being the messenger; and (e) use subtle peer pressure to send new readers our way since she loves poring over the readership stats.
Acquisitions, Funding, Business, and Stock
ZocDoc, a provider of an online physician locating service, raises $50 million in Series C funding from DST Global. Other ZocDoc investors include Marc Benioff (Salesforce.com) and Jeff Bezos (Amazon).
Sales
St. Vincent’s Medical Center (CT) signs a seven-year agreement with GE Healthcare to upgrade to the SaaS version of several Streamline Health products for HIM.
Centegra Health System (IL) will implement iMDsoft’s MetaVision critical care system for all 113 of its monitored and ICU beds, integrating it with ADT, labs, CPOE, billing, scheduling, PACS, LDAP, and its GE EMR.
People
Paul Ruflin, former CEO of Eclipsys and Noteworthy Medical Systems, joins software tools vendor PreEmptive Solutions as president and COO.
Integrated Healthcare Strategies announces that William F. Jessee, MD will join the consulting firm as a SVP and senior advisor following his October 2011 retirement as MGMA’s president and CEO.
Surgical Information Systems (SIS) appoints Gary S. Long (above) to VP of North American sales and Jonathan C. Lujan to VP for Business Development & Strategic Planning.
David Kissinger, regional VP of maxIT Healthcare, is appointed to the board of directors of Southern Ohio HIMSS, also serving as its public relations committee chair.
ZirMed names former IDX/GE executive Thomas W. Butts president and CEO. He replaces Jerry Merritt, who stepped down “for personal reasons.”
Announcements and Implementations
North Colorado Medical Center goes live with CPOE as part of Banner Health’s $250 million Cerner EMR initiative.
Swedish Health Services (WA) expects the former Stevens Hospital to be live on Epic’s EMR by the fall of 2012. Swedish took over management of Stevens last year and is making $150 million in infrastructure upgrades.
Royal United Hospital Bath NHS Trust goes live on Cerner Millennium three years later than planned, caused by Fujistu’s termination as the local service provider.
RCM software provider Avisena partners with Intuit Health to make the Intuit Health portal available to Avisena practices.
NextGen confirms the earlier rumor I ran – the company is working with MEDSEEK to create a new NextGen Enterprise Patient Portal for hospitals, allowing patients to access staff, review test results, make appointments, and request prescription refills in a single view. It’s business as usual for the existing NextGen Patient Portal – this is an alternative for a different audience.
Ouachita County Medical Center (AR) chooses Healthcare Management Systems for its financial and clinical applications, including EDIS. Meanwhile, CMH Regional Health System/Clinton Memorial Hospital begins its implementation of HMS.
Oroville Hospital (CA), which uses a version of the WorldVistA EHR 2.0 that it customized, helps WorldVistA get it certified for outpatient Meaningful Use by contributing its self-developed e-prescribing module. They say it’s the first version of VistA to be certified for outpatient use. Oroville says it has spent $4 million hospital-wide on implementing the open source product, but did it all with internal IT resources.
Midland Memorial Hospital (TX) connects to the Nationwide Health Information Network and the Social Security Administration MEGAHIT project using the Medibridge.net HIE platform from EHR Doctors. It generates Continuity of Care Documents from VistA/CPRS like the Medsphere version that Midland uses.
Government and Politics
CMS reports that about 77,000 providers have registered for the Medicare and Medicaid EHR incentive program as of July. A total of 2,383 EPs have verified they met MU requirements; 137 attested unsuccessfully (though it’s unclear why.) CMS has issued almost $400 million in incentive payments.
Other
US physician practices spend nearly four times as much per physicians Ontario in dealing with health insurers and payers. Though much of the difference stems from Canada’s single payer system versus the US’s multiple payer model, the authors of the Health Affairs-published study suggest there are ways that US health insurers could reduce costs and increase efficiencies.Other
An article in an Indian business publication says that companies there will get a lot of business from ARRA and ICD-10, quoting Bronx-Lebanon CIO Ivan Durbak. The hospital says it is saving at least 50% of the cost of its EHR project by issuing its $30 million contract to a Chennai-based outsourcer.
In Canada, Ontario Telemedicine Network is expanding by adding an Internet-based videoconferencing solution that participants can access on any PC.
Emergency personnel in western North Carolina paid their respects Tuesday to Asheville Fire Department Captain Jeff Bowen, who died in a medical building fire last week after helping save an oncology clinic’s computers and electronic records.
Max Harry Weil MD, PhD, who in the 1950s developed the “shock ward” concept of today’s ICU, including crash carts, stat labs, and computer-monitored vital signs, died last week at 84.
Odd lawsuit: the family of a man killed by his chemist wife, who poisoned him with the diagnostic agent thallium, sues her drug company employer, the hospital where he died, and six doctors. The suit claims he would still be alive “if only one of the world’s biggest drug makers and an accredited medical center had just done their jobs.”
Sponsor Updates
EPtalk by Dr. Jayne
Nominations are now open for the 2011 HIMSS Award and Recognition Program. Too bad Mr. H is anonymous, because he certainly meets some of the criteria for service to the industry. Nominations are open through October 14.
Weird drug news: the first FDA-approved treatment for scorpion stings has arrived. That’s good news for those of you in Arizona, which plays home to most of the poisonous scorpions in the US. I’ve spent enough time in the southwest to be freaked out by these little buggers. Although most adults don’t need treatment if stung, this is good news for children who might have a too-close encounter of the Centuroides sculpturatus kind.
Like many of you, I’m pretty tired of US politics and healthcare reform being flogged during the debt ceiling discussions. One bright spot in government though is the “Restoring Access to Medication Act” introduced as H.R. 2529 and S. 1368. This would allow patients to use their flexible spending accounts and health savings accounts to purchase over-the-counter (OTC) medications without a physician order, as they could prior to 2011.
I can attest that this issue has caused quite a bit of patient angst and increased healthcare spending as patients come in for office visits to obtain prescriptions for OTC drugs, not to mention healthcare IT spending as many practices created custom order sets and forms to be able to rapidly order a broad spectrum of OTC drugs for patients in a single click. I shuddered the first time I had one of these visits as I wrote scripts for Tums, hydrocortisone cream, and a pregnancy test. (Even worse is the fact that a pregnancy test is not an OTC drug and that a script isn’t required – but my patient had a letter from her benefit administrator demanding a script and stating that they wouldn’t honor the examples given in the FAQ section of the Internal Revenue Service website.) It’s about doing what’s right for the patient, regardless. Let’s hope Congress gets this one right.
I’ve mentioned my thoughts on sunscreen and tanning before, as well as my appreciation for a good glass of wine. A recent study from the Journal of Agricultural and Food Chemistry notes that “A compound found in grapes and grape derivatives may protect skin cells from skin-damaging ultraviolet (UV) radiation.” Maybe Inga and I can sign up for the follow-up study.
There are days when I joke about needing to wear body armor to work, but I’m usually referring to the need for protection from the slings and arrows of my colleagues. The LA Times reports on this, noting that 10% of emergency department nurses had been assaulted in the week prior to being surveyed. Most violence is from patients and family members.
I was recently at a training techniques class with a group of professional Health Informatics trainers. There were a few newbies in the group, and the topic of physicians “getting physical” during EHR training came up. Nearly all trainers reported having something thrown at or near them – from pens and paper to coffee cups, all the way up to laptops. One even reported a physician tipping over a computer-on-wheels in frustration. Seriously, people. It embarrasses me that physicians behave like this. Discipline for these kinds of infractions should be the same as that for surgeons that throw instruments in the operating suite. The fact that EHR or CPOE training is involved is no excuse.
Last, our nominee for quote of the week: This gem is from CMIO magazine and William F. Bria MD, President of the Association of Medical Directors of information Systems (AMDIS). “Another usability problem is the expectation of some physicians that the whole point of these systems is to make them more efficient and happy.” If you’re a project manager out there selling technology as a way to increase physician satisfaction, please think of another marketing bullet point. How about patient safety? That’s something we should all be able to get behind.
Contacts
Mr. H, Inga, Dr. Jayne, Dr. Gregg.
The Blackstone Group will buy Emdeon for $3 billion, with the private equity firm taking the publicly traded Emdeon private, it was announced this morning. For the past year, Emdeon earned $19.5 million in profit on $1 billion in revenue.
Nashville-based Emdeon offers revenue cycle solutions for providers, pharmacy benefits transaction processing, and claims solutions for payers.
Rumor of the acquisition was reported here on July 29.
Top News
Atlanta-based transcription vendor Transcend Services announces that it has acquired electronic clinical documentation and charge capture vendor Salar Inc. in an $11 million cash for stock transaction that closed last week. According to the announcement, Salar had $1.2 million in operating income on $4 million in revenue last year. Transcend says it will migrate its speech recognition technology to Salar-based templates for users who prefer that form of documentation, allowing it to offer customers a hybrid solution that will help them meet Meaningful use requirements. Salar, founded in 1999, will remain in Baltimore as a business unit of Transcend. They are the latest in an amazing string of HIStalk sponsors to be successfully acquired, for which we congratulate Todd Johnson and his fun band of pirates — we call them that since they attended our HIMSS reception in swashbuckling regalia a couple of years ago.
Reader Comments
From E-Reader: “Re: NextGen. Will announce later this week that it will partner with Medseek for a new enterprise patient portal for hospitals.” Unverified, but reported by several readers.
From CIO: “Re: HIS vendor quote. This is my new favorite, just received from GE: ‘While we do our best to eliminate as many crashes as possible with each release, we did not expect crashing to go away with DP7 entirely, only to be reduced.’” Unverified. I actually admire that they came clean technically. While everybody’s #1 preference would be for a vendor to fix all technical problems (and cause none), the #2 preference is for the vendor to at least disclose when a problem exists so it can be mitigated in ways that don’t make the client’s IT department look stupid.
From Amish IT Guy: “Re: EMR. Take a look at this one and see how long it takes you to realize something funny is going on. It’s an EMR for marijuana dispensaries. Do you get a medical necessity button that always says, ‘ Duuude, go for it?’” An LA TV station went undercover last to film some of this vendor’s EMR clients using the system to illegally issue marijuana cards without any physician involvement, causing the company to threaten those users with termination of their accounts so they wouldn’t “blemish the good practices of everyone else.”
From Epic Guy: “Re: overseas expansion. There’s a small office in Abu Dhabi now.”
From CERNest Goes to Camp: “Re: Cerner’s executive cabinet. The most recent annual report showed 10 executives, with Gorup and Illig as mostly inactive honoraries. That leaves eight execs, of which three have left in the last few weeks (Wing, Herzog, and Valentine) even as the stock was doing very well. If they really do need to go after acquisitions or new business to offset the business that Epic has taken from them, the second order churn at the VP and director level may hurt the traditionally well oiled machine.”
HIStalk Announcements and Requests
Inga has been doing a bit of traveling, so her contributions this time around are mostly straight news, thus the absence of her cute little red icon to indicate opinion, snark, or insight. I expect the ratio to improve next time.
Acquisitions, Funding, Business, and Stock
Mobile healthcare communications vendor Vocera files plans for an $80 million IPO, with shares to be traded on the New York Stock Exchange. Some big securities firms are involved: JP Morgan, Piper Jaffray, Robert W. Baird, and William Blair. The company had $69 million in sales for the year just ended.
NLP provider Coderyte raises $2.5 million from nine investors, including Polaris Ventures and Solstice Capital.
MedAssets reports Q2 net revenue of $147.4 million, up 55% from last year, primarily due to its acquisition of Broadlane in November 2010. Acquisition costs attributed to a quarterly loss of $2.5 million ($0.04 per diluted share) versus $3.3 million in 2010 ($0.06 per diluted share.)
Allscripts reports Q2 numbers: revenue up 11%, EPS $0.08 vs. $0.09, meeting consensus earnings expectations excluding one-time expenses.
The Allscripts conference call transcript is already up. Nuggets:
Automated Tracking Solutions files a patent infringement lawsuit against a number of healthcare RFID/RTLS vendors, including Awarepoint, TeleTracking, and RadarFind. ATS sells no competing products that I can tell – its only assets are patents (the oldest being from 2005, with one of the technical illustrations above) and its lawyer owner.
CSC completes its acquisition of Australia’s iSOFT Group.
The COO of Humana mentions EMRs in the company’s earnings call:
And then finally, in the Stars and quality area, EMR investment. You may have seen some press releases that we’ve done here recently with companies like Allscript and Athenahealth and others where we’re trying to get a lot more information in electronic medical records going forward, in line with what the government’s doing. We think there’s a real opportunity there. And finally, in the clinical area, the Care Hub, something that we talked about with all of you in the past. Our clinical messaging system and workflow system, more rules, engine and accelerating IT spend there. Mike talked about hiring more Humana Cares nurses throughout the United States, field nurses throughout the United States in areas where we anticipate growing. And then finally, we did some work here recently to in-source all of our DM programs, and we’re going to accelerate that because we’re seeing some nice results there.
Sales
UW Health Partners Watertown Regional Medical Center (WI) selects GetWellNetwork’s interactive patient care solution.
USC University Hospital and USC Norris Cancer Hospital (CA) choose MedAssets as their exclusive provider of technology-enabled business office outsource services.
People
Tele-ICU provider Advanced ICU Care names Bradley Green VP of sales.
Sandlot LLC, a Texas-based subsidiary of North Texas Specialty Physicians, names Kimberly Alise as CEO. She was previously CEO and co-founder of EHR vendor Empower Systems.
Former Sandlot CEO Telly Shackelford is promoted to CIO of North Texas Specialty Physicians.
Alex Veletsos, formerly of Orlando Health, joins Ascension Health Services as CIO of St. Mary’s of Michigan and St. Joseph Health System.
Announcements and Implementations
In an SEC filing, Cerner discloses it paid $36.3 million for its May acquisition of Resource Systems, a provider of long-term care software.
Integrated Document Solutions partners with SourceMedical to provide document scanning and outsourced paper imaging services to SourceMedical clients transitioning to EHR.
Healthland launches Healthland Centriq, an EHR solution for rural clinicians.
Delaware Valley Hospital (NY) uses professional services from Accent on Integration and the Siemens OPENLink interface engine to integrate and share data with the Southern Tier Health Link RHIO.
Kareo announces the availability of free support to all its customers. The company also notes that internal surveys show that customer satisfaction is up 325% as a result of several recent improvements.
Clinical communications technology vendor Voalté signs its first reseller agreement. Houston-based Halco Life Safety Systems will offer its Voalté One smart phone solution to hospitals there.
Florida Hospital and Cerner will work together on a system that facilitates communication between patient care physicians and their researcher counterparts, connecting Cerner’s clinical systems with its PowerTrials and Discovere applications to automate and integrate diabetes research activities.
Phytel introduces its Hospital Readmission Management solution to automate post-discharge care processes and reduce readmission rates.
An AIDS prevention group in India is finishing its software to track HIV-positive pregnant women and their babies, necessitated by hospitals that don’t bother filing their reports.
Spain-based technology vendor Andago, which offers government and eHealth software (including Continua-compliant mobile health applications for wellness, disease management, and independent living) leases space in a University of Miami research building adjacent to Jackson Memorial Hospital for its first US office.
The Government of Jordan launches a regional health clinic that will use Cisco’s Care-at-a-Distance HealthPresence technology to link specialists from two hospitals for consultations.
Government and Politics
AMIA weighs in on the proposed HIPAA Accounting of Disclosures rule. Their concerns:
Other
We mentioned a couple of weeks ago that Cayman Islands Health Services Authority CIO Dale Sanders told us they would be re-competing their Cerner contract. Here’s more. The bid document says the Cerner system costs $2.7 million per year, but users find it cumbersome and are “largely unhappy with the workflow and user interface.” The hospital is seeking a less-expensive alternative that is free from the “dysfunctional influence of the US financial and economic model” for healthcare.
HHS Secretary Kathleen Sebelius gives EMRs a plug during a tour of the tornado-damaged St. John’s Regional Medicine Center in Joplin, MO. Says Sebelius:
"There’s no question that … the availability of an electronic record may have actually saved lives. They were able to immediately go into the treatment phase and not spend a lot of energy trying to reconstruct (records)."
Georgia’s second annual Health IT Leadership Summit will be held on November 8 at Atlanta’s Fox Theater. Entries for its first innovation awards are due August 24.
Pocatello Family Medicine (ID) sends potential breach letters to its patients after finding that a technician forgot to reactivate the firewall after maintenance work, leaving its EMR wide open on the Internet for several months. The practice says it doesn’t think anybody accessed the patient records, although someone did park some movies on their server.
Weird News Andy reproduces this article from India, which describes the surprise of surgeons in finding that a male patient admitted for a suspected hernia had a complete set of female reproductive organs in his abdomen. He’s recovering well from his hysterectomy.
I love this Epic ad from a 1984 MUMPS journal, as sent over by Limber Lob. Here is his explanation:
Attached is an advertisement from Epic that appeared back in 1984. I had set this ad aside so I could someday ask Judy about the comment at the bottom, which reads, "All Epic software is written in the MIIS dialect of MUMPS."
But a colleague just reminded me that it was all about speed, as Meditech’s MIIS dialect of MUMPS was very fast and ran circles around all other early MUMPS implementations, such as those from Digital Equipment Corporation (DEC) and InterSystems.
As you know, Neil Pappalardo, who founded and still owns Meditech (which still uses MIIS), was the original developer of the MUMPS programming language when he worked for cardiology researcher Octo Barnett at the Massachusetts General Hospital in the mid-1960s. As MUMPS moved slowly towards (ANSI) standardization, Neil wanted to pursue his own ideas at a faster pace, and left MGH to develop MIIS and found Meditech. Back in 1984, when minicomputers were slower than today’s slowest desktop machines, Judy used the MIIS dialect of MUMPS for Epic’s software because it was the fastest game in town But as the other (standard) MUMPS implementations got faster, the benefits of using ANSI Standard MUMPS dominated the language selection decision, and Epic switched to the ANSI/ISO Standard MUMPS that virtually everyone but Meditech uses today. This ad surprised me, as I hadn’t remembered the details, but it’s good to be reminded that system speed has been an Epic priority since the beginning.
Sponsor Updates
Contacts
Mr. H, Inga, Dr. Jayne, Dr. Gregg.
From ACC_Champs: “Re: NCHICA’s response to Accounting of Disclosures. By getting input from all sides of the issue, they have drafted a great response.” Some of their concerns:
From Quaid: “Re: Siemens. Hawaii Health Systems Corporation just signed a $28.7 million deal for Soarian.” Verified.
From Anony: “Re: Piedmont Healthcare, Atlanta. Can’t believe I haven’t seen it here yet, but they’re moving from Allscripts to Epic.” As usual, the best way to verify is to check the hospital’s job postings since the Epic implementation method requires hiring a ton of people fast, including posting all jobs instead of just reassigning current staff. Piedmont listed several inpatient Epic positions on July 12, so I’d say that’s confirmation. I should also mention that Johns Hopkins signed its Epic contract this week. Both will apparently be Allscripts Sunrise losses.
From Anonymous: “Re: Allscripts. Continuing to reduce workforce in Raleigh as jobs are offshored, with 15-20 folks gone in the last week or two.” Unverified.
From Nasty Parts: “Re: Compugroup. Heard on the street that they’re buying the Sage Healthcare business. Folks at Compugroup USA HQ openly talking about it.” Unverified.
From KnowurCMIO: “Re: Cerner and Epic. Epic has indeed started expanding overseas — they have a satellite HQ in the Netherlands and have already installed there. I suspect they will begin seeing rapid growth once the implementations stateside slow down. Spaarne Hospital was the first EpicCare client in Europe in 2007.”
From Bob: “Re: shoe hoarder. I read this and thought of Inga.” A Philadelphia mom who happens to be a big-money poker champ owns 1,200 pairs of shoes (one pair worth $4,000) stored in four closets, one of them a converted sitting room. She’s profiled in a film about shoe nuts, which concludes that such compulsion is related to seduction and sex. I’ll let Inga to clarify her own motives.
Here’s the latest HIStory from Vince, this time covering Dynamic Control.
Listening: the new CD from teen rockers Jessica Prouty Band, sent over by her mom, who has a lot of history in HIT. Their sound has matured a lot over the years I’ve followed them, putting them right up there with Evanescence, Within Temptation, and some of the other female-led metal rockers. Big sound for a four-piece, with singer Jessica handling the bass very well. This is a really polished production – you would never suspect that the members are barely old enough to drive to their gigs. Video here.
My Time Capsule editorial from 2006 this week: When CIOs Are Under Pressure, “Man of Action Syndrome” Kicks In, snipped herein: “From my limited experience, I would say that CIOs overrule the concerns of nurse informatics people nearly 100 percent of the time and IT-based physicians at least 50 percent of the time.”
Most respondents believe that HITECH’s legacy will be increased EMR adoption, although the “waste of taxpayer money” camp was right on their heels. New poll to your right, spurred because I got a HIMSS member survey recently: how would you grade your satisfaction level with HIMSS? As always, you are able and encouraged to add your comments by clicking the Comments link on the poll, visible after you’ve either voted or clicked the View Results link.
HIMSS moved its Chicago headquarters this weekend.
Sage announces Intergy v7, which includes user enhancements, certification of all 44 ONC-ATCB clinical quality measures, and 5010 support for the PM/EMR system.
NHS Scotland contracts with Imprivata for its OneSign single sign-on and password reset solution.
A reader sent over the full text EHR articles that were just published in the July issue Journal of Oncology Practice. Here’s a brief rundown of those I found interesting.
From McKesson’s earnings call:
My sideline analysis of the MCK call (your comments are welcome):
The local paper covers the $36 million Epic system that will be in place when Orange Regional Medical Center (NY) moves to its new hospital next week. It says that stimulus money will cover half the cost.
In Canada, Nova Scotia will implement a $27 million system for sharing patient medication information, with all pharmacies expected to be linked by 2013.
Hawaii Governor Neil Abercrombie announces that Thomas Tsang, MD will join his healthcare transformation leadership team. He is ONC’s medical director over Meaningful Use, but it’s not clear from the announcement whether he’s resigning that post.
GE Healthcare Performance Solutions acquires Medical Event Reporting System, a Web-based system that helps hospitals collect and analyze patient safety events. It was developed by Columbia university with AHRQ support. The company, also called MERS, had been a GE Healthcare JV partner since 2008. A white paper on its use by Mount Sinai Hospital (NY) is here. GE says it’s working on rollouts to 16 hospitals.
From Cerner’s earnings call:
Shares in Omnicell touched off a 52-week-high Friday after turning in good numbers after the market close Thursday: revenue up 6.6%, EPS $0.08 vs $0.02. The one-year share price (blue) against the S&P 500 (green) is above. Market cap is $567 million.
Meditech filed its quarterly report Friday, with revenue up 25% and EPS up 33% ($0.86 vs. $0.64). The cost of acquiring the 78% of shares in ambulatory vendor LSS that it didn’t already own was given as $13.7 million in cash, with LSS’s first quarter performance being $0.8 million in net income on $5.4 million in revenue.
Strange: the former head of Alberta Health Services (Canada), who left his job in November after repeatedly telling reporters at an emergency meeting that he was too busy eating a cookie to answer their questions, gets $735K in severance. He seemed overly peeved, but made sense in pointing out that maybe the eager beaver talking heads should attend the scheduled press briefing that was being held in 30 minutes instead of chasing him down the street for their own personal on-camera moment.
Top News
Cerner’s Q2 numbers: revenue up 15%, EPS $0.42 vs. $0.33, beating earnings expectations by a penny after excluding one-time items.
Reader Comments
From AzEMRGuy: “Re: Tucson Medical Center. Hiring for multiple Epic positions.” Above is the hospital’s recruitment video, which talks up Epic opportunities. I assume that means Allscripts Sunrise is egressing unless TMC switched systems since the last time I was there. CORRECTION: reader Zaphod Beeblebrox correctly notes that I confused University Medical Center in Tucson (a Sunrise client) with Tucson Medical Center. TMC is already an Epic customer.
From Instamatic: “Re: displaced CIS vendors. This chart from the KLAS newsletter says 2010 sales volume remained about the same as 2009. Would you assume that most of the displacements are Epic’s?” I would assume so, especially given the win/loss numbers that KLAS put out along with the graphic (almost two-thirds of sales to 200+ bed hospitals went to Epic, with Horizon customers being especially ripe for the plucking). I’ve been saying for a year or two that Epic is dominating the market of mid-size hospitals and up (say, 300+ bed community hospitals, but also academic medical centers and IDNs), putting a big-time hurt on Cerner, non-Paragon McKesson, and the former Eclipsys. Not to mention as the healthcare system inevitably consolidates under healthcare reform, more organizations will hit Epic’s sweet spot of size and scope as they look to standardize. Vendors such as GE, QuadraMed, and Siemens weren’t much of a sales factor anyway, so that would seem to leave Epic on the high end and Meditech and Paragon for everyone else as the only vendors booking significant net-new customers. That’s not considering rural and critical access hospitals, which would look at Meditech, Paragon, HMS, Prognosis, and a few others. I think you’ll see the others trying to make their numbers with hosting, upselling, and services – in other words, they’re in a mature market, which can throw off some nice profits while waiting for the inevitable downward slide to accelerate. They all have other business lines, so they’ll be fine. I’m not saying that’s good or bad, just how it looks to me.
From Mathemagician: “Re: Cerner. They can’t compete with Epic any more for hospitals of more than a couple of hundred beds, so they have three ways to drive growth: (a) sell to very small hospitals that don’t already have systems; (b) provide outsourcing services to existing customers, such as IT outsourcing and revenue cycle management; and (c) sell outside of the US where Epic doesn’t tread.” I would agree, adding also Cerner’s apparent interest (possibly Epic-motivated) in providing actual healthcare and healthcare management services rather than just IT products and services. Cerner’s biggest competitive weapon is its market cap, which provides options that the company appears to be tentatively exploring.
From rsm2800: “Re: Journal of Oncology Practice. The July issue contains 12 articles about EHRs in oncology.” Only subscribers can read the full text articles, but the titles relate to CCHIT certification; Memorial Sloan-Kettering’s chemo ordering system (which must be the amazingly cool Allscripts Sunrise work I saw at HIMSS last year); CPOE in peds oncology; standardized CPOE order sets; EMR-based checklists; use of natural language processing to extract clinical information from free text documentation; chemo medication administration systems; patient-physician e-mail; EMR effects on culture; CPOE outcomes; and the interest in sharing information by those with cancer. The topics sound excellent.
HIStalk Announcements and Requests
Have you kept up with HIStalk Practice this week? A few highlights: MGMA joins CHIME and other professional organizations in calling for HHS to withdraw its proposed HIPAA accounting of disclosure rules. DrFirst intros an e-prescribing option for controlled substances. The American Academy of Ophthalmology publishes a list of EHR requirements for ophthalmologists seeking to achieve Meaningful Use incentives. Salaries for physician practice managers remained flat in 2010. Sign up for the e-mail updates while you are passing through and thanks for reading.
I featured Aventura in the latest Innovator Showcase this week. Just to recap the process: several dozen companies nominated themselves to be included; my expert team of investment bankers and providers chose eight of them after reviewing their application materials; and those companies will complete a video, a customer testimonial, and a telephone interview to be presented with their showcase article. Two of the eight have been featured so far. It’s quite a bit of work for the companies and for me, but readers have asked me repeatedly to give creative vendors a chance to be seen.
Keep an eye on the swinging pocket watch … you are getting sleepy … when you awaken, you will feel happy and rested. You will immediately sign up for e-mail updates to your upper right … your legs and arms are getting heavy … you will make the inevitable electronic connections offered by Facebook and LinkedIn to Inga, Dr. Jayne, and Mr. H … you can barely keep your eyes open …. you love HIStalk’s sponsors and will feel fulfilled by clicking their ads … going into a deeper sleep as you pledge to send me news, rumors, articles, or anything interesting … you’re become a little more alert … when I count three you will awaken rested and refreshed, feeling better than you’ve ever felt … one, two … and almost forgot, you’ll bark like a dog every time you hear the word “interoperability,” you’ll never embarrass yourself again by writing trite Internet phrases such as “wow, just wow” or “Best. Wine. Ever” and you’ll send love notes to Mr. H and Inga … three. Thanks to readers for reading, sponsors for … sponsing, and caregivers for caring.
McKesson reports Q1 results: revenue up 9%, EPS $1.13 vs. $1.10, meeting Wall Street revenue expectations but falling short on earnings. Technology Solutions revenue was up 6% with adjusted profit of $119 million. The earnings call transcript should be out tomorrow and it usually has some interesting nuggets about the company’s software business.
Private equity firm Blackstone Group is rumored to be in discussions to acquire Emdeon for more than $3 billion. Shares jumped from less than $13 to over $16 on Thursday, closing at $15.49.
Healthcare learning and employee competency platform vendor HealthStream announces Q2 results: revenue up 26%, EPS $0.08 vs. $0.06.
NextGen parent company Quality Systems, Inc. reports Q1 results: revenue up 21%, EPS $0.65 vs. $0.42, beating estimates on both. Shares will split two for one on October 27.
CPSI’s Q2 numbers: revenue up 30%, EPS $0.72 vs. $0.39, blowing through estimates.
Revenue cycle management company Precision Revenue Strategies renames itself MediRevv.
Medicity’s performance is featured in Aetna’s earnings call Wednesday, which said its contract backlog is $200 million. Aetna made $537 million in profit on $8.3 billion in revenue for the quarter. Also stated about Medicity, which it acquired on January 3 for $500 million:
Our strategy is to grow our footprint in this space and to deliver clinical and administrative content through Medicity’s installed base of health information exchanges. For example, Medicity has developed and is beginning to distribute a suite of applications that are certified as being compliant with the federal meaningful use standards. Medicity’s application development expertise and patented distribution technologies are great examples of how the company combines content and connectivity.
At Aetna, we are excited about our role in promoting health information technology because we believe it has tremendous potential to improve the quality of health care and to make health care more affordable. We continue to build a portfolio of businesses that simultaneously generate high growth fee revenues and improve the performance of our health plan businesses.
Sales
Texas Health Resources contracts with Streamline Health for its Epic Integration Suite.
The Tehachapi Valley Healthcare District Board of Directors (CA) approves the purchase of Healthland’s EHR. The local paper reports that the $400K five-year cost of HMS was one-fourth that of competitor McKesson.
HealthSouth selects Cerner to provide EHR for its 97 inpatient rehab facilities.
Memorial Hermann chooses CodeRyte for computer-assisted coding.
Hoag Memorial Hospital Presbyterian (CA) signs for Unibased ForSite 2020 Resource Management System for enterprise scheduling and a patient portal.
People
Former Wipro Technologies CIO Laxman K. Badiga joins Anthelio as COO.
Pat Cline, president and board member of Quality Systems, announces that he will retire this year.
Accretive Health names Joseph Bellini chief revenue officer.
Shared Health hires former WebMD founding COO Michael Heekin as CEO.
Announcements and Implementations
Misys Open Source Solutions wins the international “Best Use of Open Source Technology” award for its Misys Connect HIE solution.
The Rhode Island REC accepts ABILITY Network as an health information service provider to provide its member secure health information exchange.
Epocrates announces first phase availability of its Epocrates EHR mobile and Web-based EHR, designed for primary care practices with 10 or fewer physicians. The company will also offer a license to a native Apple iPhone app that supports remote patient look-up, schedule access, and e-prescribing capabilities.
Other
CMS’ Office of the Actuary predicts that national healthcare spending will hit $4.6 trillion by 2020, up from this year’s $2.7 trillion. The biggest increase in spending (8.3%) will occur in 2014, when many federal health reforms take effect.
The Salt Lake City paper observes the challenges of connecting physician practices and hospitals via Utah’s Clinical Health Information Exchange, with incompatible EMRs leading the list. An interesting tidbit that may have been inadvertently disclosed by a University of Utah Health Care spokesperson: they’re using Cerner on the inpatient side and Epic for outpatient, but will soon migrate to a single system. You’ll want big odds if you’re betting on Cerner to win that deal.
The Town of Freetown (MA) lays out the requirements Meditech will need to meet to develop a five-story, 186,000 square foot office building there that could bring up to 800 jobs to the area. Meditech’s costs are estimated at $80-100 million.
Tampa General Hospital (FL) files a $9.2 million claim against the estate of a deceased 29-year-old patient who had spent five years as an inpatient. Maybe they should use any proceeds to hire case managers or buy equity in a skilled nursing facility that will accept transfers.
Sponsor Updates
EPtalk by Dr. Jayne
Quite a few organizations are using scribes as part of their EHR. A local hospital (which happens to be an Epic client) recently started using scribes in the emergency department, with the goal of having scribe coverage for all emergency physicians by early next year. According to a PR piece, several companies provide scribes and offer scribe training, with an estimated 200-plus hospital emergency departments starting to use scribes over the last two years.
Our group experimented with scribes several years ago when there weren’t as many formal opportunities for scribe training. We mainly wanted to use scribes in physician offices to aid EHR adoption and provide a safety net for older docs who were close to retirement and resistant to EHR implementation, but who still needed to get data into the system for patient safety and care continuity purposes.
A medical assistant or medical secretary would typically receive additional training, but it was rare for the practice to go the distance and hire someone to do the staffer’s usual work while he/she was scribing. As you can imagine, it doesn’t go well when you take a full-time employee and add another full time job to his/her plate. The program was dead before it ever left the gate.
Scribe staffing firms target pre-medical and pre-nursing students who are looking for experience in the healthcare field who are willing to work cheap. Starting salary for a scribe is $8 to $10 an hour. After preclinical training, the firm that’s staffing our local hospital includes a 100-hour “apprenticeship” with a senior scribe before new scribes are allowed to work independently.
The non-profit American College of Clinical Information Managers (ACCIM) recently emerged to hopefully help the rapidly proliferating scribe programs develop standards and monitor themselves. A visit to their website revealed an online training program and an exam leading to certification as a Clinical Information Manager, which can be taken after as little as 100 hours of work with a minimum of 100 patients documented. The exam costs $40 and an annual certification costs $20.
I like the idea that they require certified scribes to complete 20 hours of continuing education a year. Our state medical board only requires 25 hours for physicians and I think that’s pretty sad. Although the website said it would have a list of individual certified scribes, I wasn’t able to find it. Corporate members of the ACCIM include Scribe America and Emergency Medicine Scribe Systems.
As a physician, I’d love to know that all my data is being captured the way I like it while I can focus on the patient in front of me. From experience, though, I know it’s hard to have that level of teamwork and trust when you’re in a shift-work environment. I’ve done my share of emergency department work, and unless the scribes are remarkably consistent, I think it would be hard to have a different one for every shift.
The local paper profiled this change, noting that the scribes “win” by seeing jobs first-hand as they are “attached to the hip of a physician.” Do they really? I wonder what the average shelf life of a scribe is?
Depending on what they see, it might send them running in the opposite direction of actually entering the healthcare field. Most pre-med students are pretty smart cookies who will quickly figure out if they truly have a calling for days where you stand for 12 hours without a meal or a trip to the bathroom in exchange for taking on upwards of $250,000 in student loan debt.
On the other hand, it’s a great way to get experience and actually get paid. Back in the dark ages when I was an undergrad, unless your parent was a doctor and would hire you to work in the office, the only experience you could get was as a volunteer. I’d certainly rather have had the opportunity to do scribe work than to do what I did, which was to edit a medical textbook written by an extremely cranky researcher who had chosen someone without a firm grasp of the English language to do a first pass on her book before firing him. Although frustrating, I must say it prepared me for some of the technical manuals and white papers that grace the ever-growing stacks on this CMIO’s desk.
Do you have scribes at your hospital or health system? Do they make for happier EHR users? E-mail me.
Contacts
Mr. H, Inga, Dr. Jayne, Dr. Gregg.
Company name: Aventura
Address: 1001 17th St. Suite SL-100, Denver, CO 80004
Web address: www.aventurahq.com
Telephone: 888.484.4643
Year founded: 2008
FTEs: 25
Elevator pitch
Aventura overcomes technical hurdles that exist at the intersection of where your caregivers use your computer systems to deliver the computing experience that doctors and nurses demand.
Business and product summary
Aventura is in the business of making caregivers happy and IT look like heroes. Aventura’s revolutionary new platform fundamentally improves the usability of computing systems for doctors and nurses, leading to increased productivity. Aventura also centralizes and standardizes many aspects of the enterprise environment, saving IT significant time and headaches. Our software is licensed to hospitals through enterprise agreements, and our raving fans are the caregivers that use our solution every day.
The best way to understand Aventura is through a quick example of a user’s experience. A doctor or nurse logs on at a new terminal in a patient room using dual-factor authentication (smart cards, proximity cards or biometric). Based on who this person is, their new location, and any other pre-defined set of rules established by the hospital, Aventura begins updating this person’s existing desktop session (which has been securely locked from their last location) before displaying it.
For example, printing defaults are updated, some applications may be hidden, necessary ones pop up automatically, and some URLs (including already open ones) may be restricted or hidden. This updated desktop and all appropriate applications are then presented to this caregiver.
What is most important about this process is that it all happens in less than five seconds. Log-out is as instant as removing his card. Access is simple and secure. Usability for doctors and nurses is significantly increased because they are no longer wasting time logging in and accessing the right applications and data, and instead can focus on the job they signed up to do: provide incredible patient care.
Who is your target customer?
Today Aventura sells its services to small, medium, and large size hospitals. In the future, Aventura will be delivering its services also to physician practices.
What customer problem do you solve?
Aventura is a small company focused on solving one enormous healthcare IT problem. All the billions of dollars being spent on new IT systems and improving clinician productivity will never realize their full potential because of a “weak link” at the intersection of where doctors and nurses have to access these systems. Adoption of these new systems, including CPOE, suffers not because of the applications themselves, but because of the painful process and useless time wasted by doctors and nurses trying to access these new applications 50 to 70 times a day.
That is simply unacceptable for us, so we’re doing some pretty amazing things to fix it. Aventura has designed something totally new, an architectural framework that delivers what caregivers need in order to do their job from any location, securely, in less than five seconds every single time.
Aventura architecture (click to enlarge)
Who are your competitors?
Today, there are no other companies in the market providing the breadth and depth that Aventura delivers when it comes to delivering a dynamic computing environment. While there are a number of folks piecing together clinical desktop solutions using various virtualization and SSO solutions, these projects don’t overcome the technological barrier and the associated issues of roaming a static desktop session.
Why are you better than your competitors?
The idea for Aventura was born in a hospital. We understand that doctors and nurses want instant access to the right data and computing services from any computer at any time. However, in order to make this happen, we recognized that there are significant architectural limitations in today’s computing environments, and that the only way we were going to be able to address this problem is with an architectural solution.
Other companies have partial fixes; single sign-ons, roaming desktops, expensive one-offs, but they are all still based on a static operating system that was never designed to serve people who work on dozens of different computers in a single day.
Aventura’s new platform called Enterprise Operating Framework allows us to dynamically update clinicians’ computing sessions, and respond to their needs based on who and where they are. Access is intuitive and consistent and completely respects the way clinicians want to work. Further, Aventura is designed to provide this improved caregiver experience using whatever computing infrastructure a hospital currently has in place.
In other words, we can deliver our dynamic computing experience using any virtual desktop technology, or what is even more cool, leveraging only the existing PCs that most hospitals have in place.
Pitch video
Customer interview (infrastructure and customer support manager for a two-hospital, 300-bed system)
What problems have you solved using the Aventura technology and what has been the overall impact on the hospital?
Aventura has allowed us to extend the refresh cycle of the hardware inventory and still take advantage of new software technology that requires greater processing power and memory. The smart card solution improved the security and authentication process, which helped meet HIPAA requirements. The ease of use and ability to move the user’s desktop from workstation to workstation has greatly improved the clinician’s workflow.
If you were talking to a peer from another hospital, what would you say about your experience with Aventura?
We have had a very positive experience with Aventura. Their staff has been responsive to requests for enhancements and is readily available to provide technical support when needed.
How would you complete this sentence in summarizing for them: “I would recommend that you take a look at Aventura under these circumstances:”
If you would like to reduce the cost of your hardware refresh and provide a secure, standardized desktop solution for your end user.
An interview with Howard Diamond, CEO of Aventura
Hospitals seem pretty happy with single sign-on and technologies like Citrix that allow wireless users to stay connected even though their connection may drop temporarily as they move around. Why do they need your product?
I probably don’t accept your basic premise. Most of the customers that we have and most of the pilots we’ve got going are people that are probably already using an SSO and are already using virtualization like Citrix or VMware or Terminal Services. They still have significant problems in terms of caregivers getting access to the different systems and applications they use.
The average nurse logs in 50 to 70 times a day. Even with an SSO, the amount of administrative burden on them is pretty dramatic.
This would be a fairly key piece of infrastructure if your technology sits between the clinicians and their systems. How do you convince hospitals to trust that aspect to a relatively small company?
That’s a challenge, without question. The approach we take from a sales perspective is we have three phases of implementation.
Our first phase is what we call a lab pilot. If somebody is seriously interested in our technology, for $15,000, we come and show them how it would work in their specific environment to connect it to their specific infrastructure. They get to play with it for three to four weeks in a lab environment.
Once they’ve done that, they opt to go into what we call a production pilot. They try the technology in a real unit of the hospital with real caregivers interacting with real patients.
Based on those two experiences, they then make the decision to buy the software. We set up a pretty sophisticated try-and-buy in their environment.
Sounds like that’s good for the customer, but difficult for the company since hospitals have a long buying cycle anyway. Is it difficult to plan your business around a long-term pilot?
There are two different pieces to it. First of all, we charge $15,000 for the lab pilot. We charge $40,000 for the production pilot. We’re not doing it for free.
We have a hospital doing their production pilot right now. One week into the production pilot, they called us up and said, “All right, we’re convinced. We want to buy the software now.” Even though the theory is that it can lengthen the sales cycle, what is actually does is truncate it, because once they get the technology in front of the caregivers, the caregivers who are not using the technology see the caregivers who are and say, “Wait a minute, you’ve got to be kidding me. We’re not going to wait three months to get access to that. We want access to it now.”
Who is it that makes that decision and what objectives do they have when they come to you or you come to them?
Our point of entry is usually a CMIO if they exist. A lot of time we work directly with IT, but our focus is to get caregivers directly involved pretty quickly because the core of the technology really dramatically addresses things from the caregiver’s perspective. So where there isn’t a CMIO, we work with both CMOs and their like and influential doctors. We definitely get the caregivers involved very early in the process.
Has anybody done studies of the benefits?
Yes, pretty dramatic. Caldwell, which is actually just finishing up their lab pilot and moving to a production pilot, has actually already done a research study where they claim that their analysis showed that doctors would save over 40 minutes per shift and nurses would save over 80 minutes per shift using our technology.
What’s your method of pricing the solution and how do customers justify its cost?
The approach is it like a SaaS charge. Our base price is $15 per user per month.
The ROI actually is pretty easy to do. We show dramatic productivity gains on the caregiver’s side. Because of the fact that we do things like manage printing and provide them with a significant amount of self-help from a printing perspective, we actually show some pretty quick specific gains for IT, particularly in terms of reduction of calls to help desks.
I saw your Web site mentions the roving printer concept. I guess that’s a weakness in a lot of clinical systems. Is that a big draw for customers?
Yes. I’ll be honest with you — when my staff first built it into the product, I thought it was pretty boring. It was not an area that I had particular interest in. It’s turned out to be a dramatically important thing.
It turns out that pretty much every back-end system out there, particularly the EMRs, are horrible when it comes to managing the printing. The fact that we fixed that has actually become an enormous positive for us, even though as CEO, I was too stupid to understand that for a while.
You mentioned a couple of customers on your site, Denver Health and Alegent. Where are they in their implementation and how many clinicians do they have using the devices?
Thousands. Denver Health has been using the technology for a few years and they use it everywhere. The same thing is true of Alegent at their 10 hospitals. If you talk to Mike Westcott, who’s the CMIO at Alegent, he’s actually an embarrassingly great evangelist for us. Greg Veltri, who’s the CIO at Denver Health, is as well. In both cases, they’ve got literally thousands of caregivers using our technology every day.
I was curious why you sell only to healthcare. It seems like that the solution that you have would be of interest to other industries. Is healthcare just the entry point, or is there something unique about healthcare that makes this more attractive than it would be elsewhere?
You’re pretty on top of it. I’m impressed. The reality is that we work with a lot of virtualization partners. The very first thing they ask us whenever they get to know the technology is why we’re not bringing it into other industries.
This technology was born in a hospital, it was developed in a hospital, and the founder started it there. I came and took over the company a little over a year ago. We will go more horizontal in the next year and a half, but I believe that small companies fail a lot because of lack of focus.
Since the heart of the company is in healthcare, we’ll establish our beachhead in healthcare pretty strongly before we move horizontally. But there are a number of other industries that are appropriate for it, and a lot of the virtualization partners we work with want to bring it into places like manufacturing and legal right away.
What do you hope to gain from this exposure?
When we get in front of caregivers, they are blown away by the technology. It literally is something that every time we do a bake-off comparing our technology with anything else out there. Caregivers give it a dramatic grade.
The exposure is just a really important thing. It’s a very small company. We’re just starting out. The technology has just been released in its new form as we talked about some of the stuff we submitted to you. Getting exposure is just great for us.
HIStalk Sponsor Announcements Webinars
I hear you, and I agree—HIMSS is definitely facing some big challenges right now. The leadership and governance issues you…