Monday Morning Update 7/25/11

From Give Me a Break: “Re: press releases. Do readers find it as annoying as I do when a vendor issues a press release congratulating its customers for making a list of some kind? The average health system has over 240 apps from 70 vendors.” I do indeed find that particular practice somewhere between pointless and annoying, right up there with those announcements that “applaud” some government decision that benefits the vendor directly. That’s especially true when the award the customer has won comes from a for-profit company looking for publicity (see: Most Wired, any company’s customer awards). I’m generally hostile toward press releases that contain no discernible news, even of the self-serving variety. They’re lucky that lazy magazines and sites are so desperate for free content that they’ll foist crap like that on their readers anyway, hoping that hyperventilating headlines and cutesy writing will keep readers from noticing the waste of their time.

From DeeDee: “Re: University of Missouri Health Care. The video with their being named HIMSS EMRAM Stage 6 has some marketing polish, but interesting. Buy-in of the Tiger public/private venture seems impressive.”

From Tooter: “Re: Webmedx. You didn’t mention that HIStalk ran the Nuance acquisition rumor before the announcement was made.” True enough: I ran MT Hammer’s rumor report on June 24, while Nuance announced the acquisition on July 14.

From Lucy Gucci: “Re: Epic new hire blog posting on WSJ. I remember feeling this way about starting at Epic, too – excited to be a business traveler and still glossy-eyed over the architecture. Also, I’ve heard that Judy is talking about the June new hire class making up a certain percentage of the national job growth for that month.” A 21-year-old new grad (business administration, Asian studies) gushes with enthusiasm about being hired as an Epic project manager, ready to “improve patient care, create better processes, and in general aid hospital systems” as she “moves rapidly toward adulthood.”

Most respondents say the government shouldn’t get involved with EMR usability, although not by a large margin. New poll to your right, from a reader’s comment: what will HITECH’s legacy be?

Listening: reader-recommended Big Head Todd and the Monsters, straight-head soulful rock with thoughtful lyrics and an unchanged member lineup (and relatively unchanged musical style) for 25 years.

Unrelated, but music again: singer Amy Winehouse is found dead at 27, joining other notoriously drug-abusing rock stars to expire at that age (off the top of my head, that list includes Jim Morrison, Janis Joplin, Jimi Hendrix, Kurt Cobain, and Brian Jones).

This week’s Time Capsule editorial from 2006: Your Co-Workers Are Your Biggest IT Security Problem. A snip: “A hospital’s internal documents and policies probably aren’t all that interesting to competitors, but you might reconsider storing Social Security and credit card numbers.”

I hung on every word of Vince Ciotti’s HIStory this week since it covers Compucare, IBAX, and other faded names from yesteryear that still seem recent to HIT long-timers (the notepad cover I use every day is a Compucare one, so I’m just realizing how long I’ve had it). He got help this time around from pioneers Ed Gavin, Sheldon Dorenfest, and David Pomerance. Given the great response Vince is getting, I’m thinking he should reprise his SMS reunion of a couple of years ago, except open it up to anybody who worked in HIT in the old days (before 1980, let’s say) and do it at the HIMSS conference. Then he could really tap into some first-person memories for future installments. Vince is willing to take his show on the road for interested classes or groups (like regional chapters of HIMSS or HFMA) – just e-mail him.

Dell confirms the rumor I ran Thursday from Jamie that healthcare VP Berk Smith, brought over in its Perot acquisition, is leaving to start a healthcare-related company.

Thanks to the folks at Preceptor Consulting of Fort Myers, FL, supporting both HIStalk and HIStalk Practice at the Platinum level. Preceptor offers design, build, testing, and training support for all the top clinical systems (Epic, Cerner, McKesson, etc.). Their name comes from what they do: provide licensed clinicians (physicians and nurses) to get those systems live, which they’ve done in more than 500 healthcare facilities over the past five years. Their motto will be familiar physicians: See IT. Do IT. Teach IT. You’ve spent a lot on that shiny new clinical system, so spend a little more to engage authoritative, experienced clinician experts who will make sure it’s built right, tested as safe, and accepted by well-trained users (think of it as cost-effective CIO/CMIO job security insurance). Find out why the largest health systems get clinical implementation support and healthcare IT expertise from Preceptor Consulting. Thanks to Preceptor for supporting HIStalk and HIStalk Practice.

Here’s a really well done video about Preceptor Consulting I found on YouTube, with some of the “preceptors” talking about working on site at hospitals and some of their clients talking about their experience. “Any time you had a question or an issue, they were right there to help. I don’t think you could make the transition without the preceptors. I don’t think it could be done.”

Athenahealth sues AdvancedMD, claiming the company violated an athenahealth patent. The patent number cited suggests that the suit is related to athenahealth’s centrally maintained insurance billing rules engine.

John Halamka will resign his part-time position as CIO of Harvard Medical School, saying it needs someone full time, but is staying on at BIDMC.

A former EVP and general counsel of Children’s Hospital of Philadelphia pleads guilty to charges related to his embezzlement of $1.7 million from the hospital, accomplished by submitting and approving fake invoices. He bought himself a yacht with its own captain.

CodeRyte will make some announcements this week about a new Natural Language Processing system for computer-assisted coding in hospitals, which a few customers have already signed up for. Fun executive team facts: CEO Andy Kapit taught autistic kindergarten children. Chairman and President Richard Toren invented the EpiPen, which has saved the lives of countless allergic patients. COO Glenn Tobin and Chief Revenue Officer Don Trigg are fairly recent hires from Cerner (COO and UK GM, respectively).

GE announces Q2 numbers: revenue down 4%, EPS $0.35 vs. $0.28. GE Healthcare revenue was up 10%, with profit up 8% to $711 million.

Hospital of St. Raphael (CT) fires three employees after one of them takes cellphone pictures of the fatal gunshot wounds of a 17-year-old ED patient and sends them to other employees.

A hospital in England, which pays the travel expenses of some family members visiting patients in its mental health units, suggests that the family members use Skype instead to save money.

Eighteen former employees of insurance company Molina Healthcare file a lawsuit against their former employer, its former CIO, and outsourcer Cognizant, claiming they were discriminated against as the IT department brought in increasing numbers of Indian workers to the point it was called “little India.” They say the department celebrated Indian holidays while making employees work Thanksgiving and Christmas, promoted only employees from India, and conducted meetings in Indian languages. They charge Molina with firing 40 technical workers the day after Cognizant was approved to bring in 40 H-1B employees. The former employees also claim that Molina regularly violated HIPAA requirements when the H1-B workers would send full, unencrypted patient files to their counterparts in India.

E-mail Mr. H.

News 7/22/11

Top News

Athenahealth will acquire Proxsys, a Birmingham, AL-based vendor of front-end revenue cycle tools that include medical necessity checking, insurance verification, pre-certification, referrals, and facility scheduling. The all-cash deal is worth up to $36 million. Athenahealth says it will use Proxsys technology in its newly announced athenaCoordinator service, which will move patient and insurance information between hospitals and their affiliated physician practices in return for a per-transaction fee. ATHN shares are up almost 10% Thursday in after-hours trading following the release of positive Q2 numbers and news of the acquisition. Share price has nearly doubled in the past year, giving the company a $1.69 billion market cap.

Reader Comments

From Scrambled CIO: “Re: software conversions. We are in the middle of a lot of system replacements and consolidation. I am amazed at the estimates and fees associated with a flat file conversion from SCC Soft Computer. Three hundred hours for a pathology conversion.” I assume you’re converting “from” rather than “to” SCC, in which case they have little incentive to give you a deal knowing you don’t have an option and your wounded former-customer indignation won’t matter anyway. It’s funny that I was describing exactly that scenario to someone at work today, where you’ve told your vendor that you’re dumping them down the road and they stop returning your calls and price everything at list-plus-larceny. It’s like an ugly divorce – if you had known how cold and vindictive your spouse could be, you’d have insisted on a pre-nup or maybe married someone else. But I don’t know the particulars in this case, so in fairness to SCC, I’ll just say “unverified” and assume there was a rationale for the price quoted.

From Crabby: “Re: ARRA’s legacy. it will not be widespread adoption of EHRs. but rather the technical standards that ONC has laid out. They will do more for our industry, patient safety, and adoption than any sexy interface or legislation could ever do. Access to complete patient data across the continuum of care will be enough of a reward for a provider to login. Once logged in, we must make it easier for him/her to click the buttons than to bark at the nurse.” No one expected ARRA to be a panacea and fix all of HIT’s flaws, but incorporating standards should reap some benefits. Yep, there is still more work to do.

From Jamie: “Re: Berk Smith. The Dell Healthcare VP/GM resigned Wednesday after 22 years at Perot Systems and Dell. He’s leaving for a startup.” Unverified. I e-mailed a Dell press contact, but haven’t heard back.

From Emily: “Re: 3M Health Information Systems. Another round of layoffs last week following another poor quarter of sales.” Unverified.

HIStalk Announcements and Requests

Highlights from HIStalk Practice this week: the ever-witty and irreverent Dr. Joel Diamond reflects on technology over the past decade. Highlights from AAFP’s 2011 EHR User Satisfaction Survey. digiChart’s new CEO suggests the company is prepping itself to be acquired some day. Patients feel disrespected by their doctors.  Canadian docs express familiar-sounding complaints about EMRs. Almost 70% of practices are looking to become a PCMH. In honor of Oscar de la Renta’s 79th birthday (or just because), feel free to sign up for the e-mail updates while you are checking out the hottest ambulatory HIT news.

I am now on Google+, though I haven’t figured out what it’s going to give me that I don’t already have with Twitter, Facebook, and LinkedIn. However, if you feel the need to be in my circle, send me an invite.

Unrelated except to music fans: an influential but seldom-acknowledged musician of the 60s and 70s died this week. Grass Roots lead singer Rob Grill was 67. I actually saw them live well past their heyday in a bar holding maybe 25 fans and chatted with them while getting a beer. They still sounded good playing I’d Wait a Million Years, Temptation Eyes, Sooner or Later, and Midnight Confessions.

On the sponsor-only job board: Senior Enterprise Hospital Sales Executive, Senior C#/.NET Developer, Configuration Architect. On Healthcare IT Jobs: Informatics Analyst, Senior Systems Engineer – Windows Server Technology, Senior Director of Applied Clinical Informatics, Vice President of Client Services.

Acquisitions, Funding, Business, and Stock

athenahealth reports Q2 revenues of $77.9 million, up 33% from 2010. Non-GAAP adjusted net income was $7.9 million ($.22/share), compared to 2011’s $4.1 million. The company beat analysts’ estimates of $.18/share and revenues of $75.08 million.

The provider of MyMedicalRecord PHR announces an agreement that gives a Chinese venture partner warrants to purchase up to four million shares of its stock. Sounds impressive until you notice the share price is $0.04, valuing the big international deal at $160,000.

Private investment firm Veronis Suhler Stevenson acquires hospital financial analytics software vendor Strata Decision Technology, which claims 800 hospital customers that include Allina, Catholic Healthcare West, and Cleveland Clinic.

Express Scripts will acquire its prescription drug benefits competitor Medco in a $29.1 billion deal. The companies, whose combined revenue is $110 billion, say they’ll be able to lower costs and improve health with their combined drug purchasing power.

Microsoft’s Q4 numbers: revenue up 8%, EPS $0.69 vs. $0.51. beating consensus earnings estimates of $0.59. Windows revenue slipped for the third straight quarter, while Office revenue was up 8%.

Sales

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Parkview Health (IN) signs an agreement with Streamline Health Solutions to upgrade six of its hospitals to accessANYware v1.9.

Northrop Grumman will partner with Verizon and Wellpoint subsidiary National Government Services to develop predictive modeling technology for CMS’s National Fraud Protection Program. CMS announced last month that it had awarded Northrop Grumman the $77 million fraud detection contract.

People

Clinical integration and search technology provider Apixio names Steve Roberts its VP of sales and Jenny Field its director of product marketing. Roberts is a former VP of sales for NextGen; Field was director of ambulatory medical informatics for Salinas Valley Healthcare System.

Former Healthland president and CEO James Burgess takes over as CEO for Advanced Health Media.

HFMA president and CEO Richard L. Clarke will retire on July 31, 2012.

Jason Bray is named CIO of Oklahoma State University Medical Center. He was previously CMIO of the OSU Center for Health Sciences.

Announcements and Implementation

Summa Health System (OH) deploys BIO-key’s fingerprint biometrics for authentication with Allscripts Sunrise Clinical Manager platform.

PHR vendor Dossia announces its Health Manager health management system, which it says will improve the health behaviors of its users through personalization involving games, social dynamics, incentives, and messaging. Dossia chair Craig Barrett says it represents the next generation of PHRs.

Government and Politics

CHIME chimes in on proposed changes to HIPAA, saying the standards would be difficult for providers to meet and should be scaled back. CHIME claims the rules rely too much on technical capabilities that are not widely available and fail to acknowledge the amount of human intervention necessary to achieve compliance. Of particular concern is the proposed requirement for providers to create a consolidated report that documents all incidents of PHI access within a designated record set.

The VA and Department of Defense were charged with developing overall integration between their organizations at a Chicago demonstration project for the first Federal Health Care Center, with some EHR integration due October 1, 2010 (single sign-on for clinical staff, single patient registration, and orders portability). A GAO report says they missed the date for the first two items but those are live now, but they’re struggling with lab orders. Pharmacy order integration has been “indefinitely delayed” and five pharmacists were hired to manually verify orders between the two systems and to check for drug-drug interactions. The GAO says they’re struggling because of the same old problems that always come up: “lack of an integrated and comprehensive project plan from VA and DoD.”

Other

The Women’s Health ABU at Cerner breaks out into a dancing flash mob during lunch at Cerner headquarters. Diners included Cerner associates, about 100 new hires, and over 40 clients. All I have to say is I want to be part of a dancing flash mob one day.

Core Health is running its annual HL7 Interface Technology Survey for CIOs/CTOs, IT managers, and HL7 professionals. They did a nice job last year. Respondents are entered in a drawing for a ThinkPad tablet.

Weird News Andy is on the tail of this story, which he summarizes as, “His butt, her end as a CNA.” A nursing assistant is fired from her job at a transitional care facility and faces voyeurism charges after taking pictures of a male patient’s buttocks, which she described to a co-worker as “too funny,” and posting them on her Facebook.

WNA also fell for this story from England: a disabled man who falls out of his wheelchair in a hospital’s parking garage just 100 yards from its ED has to wait 25 minutes for paramedics to be sent from the other side of London. A bystander claims hospital nurses refused to help and said they aren’t allowed to treat patients outside their areas, although a hospital spokesperson says no such rules exist and nurses have responded to garage emergencies previously. 

Data integration software vendor Informatica and the IT division of Hospital Corporation of America are embroiled in a legal squabble over software license fees, with Informatica claiming HCA owes it $6.3 million following a license audit. HCA interprets the scope of its license differently and disputes the claim.

Cayman Islands Health Services Authority CIO Dale Sanders tells me that they’re re-competing their Cerner contract, with the core vendor tender here. If it were me, I’d plan the install for January and watch the resumes flood in from cold-haters more than willing to spend the winter there at discounted rates.

A 34-year-old Australian woman who died immediately after visiting a physician for an ear infection is found by coroners to have experienced an allergic reaction to the antibiotic Ceclor, prescribed for her by an 85-year-old “computer illiterate” doctor who did not notice her documented allergy on the screen. The doctor has since given up his license and sought psychological counseling. 

An indicted New Jersey couple who sold medical students and licensed physicians a $5,000 medical licensing exam test prep course that included stolen questions remains on the run, while their student-customers, most of them foreign medical school graduates, are being asked to defend their scores by re-test. Several have already failed and may lose their medical licenses. The National Board of Medical Examiners got suspicious when the wife took the USMLE exams several times and scored low, with a surveillance camera review showing her taking pictures of the computer monitor.

Researchers in Brazil find that tweets containing the word “dengue” correlate to local outbreaks of dengue fever, the disease that kills hundreds of people each year there, allowing authorities to identify geographic areas of outbreak and respond more quickly.

A 27-year-old hospital nurse in England is arrested after insulin was injected into IV bags in a storeroom, killing five patients.

Sponsor Updates

• Sunquest Information Systems hosted a “Build a Bike” team-building event at its user group meeting last week. Fifteen bikes were donated to local Tucson charities.
• United Regional Health Care System (TX) signs an enterprise license agreement for iSirona’s device connectivity solution.
• TELUS expands its Canadian EHR ecosystem with the connection of Optimed Software Corporation’s AccuroEMR to TELUS Health Space.
• CareTech Solutions announces that 14 of its clients were named Most Wired 2011 Hospitals. Five more were named Most Improved.
• Billian’s HealthDATA interviews Gail Donovan, EVP/COO of Continuum Health Partners about the economic challenge of providing high quality care and outcomes.
• Besler Consulting’s George Porette offers analysis on Medicare DSH and uncompensated care reimbursement in The Besler Beacon, the company’s quarterly newsletter.
• Awarepoint’s Q2 bookings beat 2010’s numbers, increasing its hospital client count to 153.
• Medicity’s Novo Grid is ranked the #1 private HIE solution by KLAS, the position it has held since the category was first reported last year.
• Porter Hospital (IN) will install the iConnect image operability solution from Merge Healthcare.
• Tulsa Spine and Specialty Hospital (OK) selects ProVation MD for physician point-of-care documentation.
• Jennifer  Lyle, CEO of Software Testing Solutions, will serve as a Meaningful Use panel presenter at the iHT2 Health IT Summit in Denver next week.
• Southwest Mississippi Regional Medical Center chooses Wellsoft’s EDIS for its two hospitals.
• Thomson Reuters and CareEvolution expand their partnership to deliver the Thomson Reuter’s HIE Advantage solution, which leverages CareEvolution’s secure interoperability solutions and Thomson Reuters’ analytics expertise.
• The 40-provider Philadelphia Hand Center contracts for the SRS EHR.

EPtalk by Dr. Jayne

I was intrigued by the item in Monday’s Sponsor Updates regarding the Surescripts White Coat of Quality program. I have to admit not being familiar with it, but was able to find its Web site. Frankly, I’m surprised to see that only four vendors were given this recognition for 2010. To quote directly (including grammatical and spelling errors) from the Surescripts website:

The criteria for earning a White Coat in 2010 was, by design, very straight forward:

1. Provide a signed commitment from company leadership affirming their organization’s commitment to quality.
2. Measure quality metrics as specified in the published industry guidelines and report those metrics each month to Surescripts.
3. Implement changes to software that address issues identified in quality reporting. Take steps to eliminate any issues measured in #2 above.
4. Raise prescriber awareness through training.

As a provider, this seems like a slam-dunk. I’m not sure why more vendors aren’t on the list, especially some of the larger ones.

I was flipping through Health Data Management while watching HIPAA training and a McKesson ad aimed at independent physicians caught my eye. It grabs the reader with “I didn’t survive my residency to be an I.T. Manager” and says solutions are “arriving fall 2011.” The ad features an older gent with some pronounced hair loss.

To me, this ad seems aimed at either (a) physicians who are the last-ditch holdouts for putting off EHR implementation, or (b) those that hoped they could retire before someone forced them to bite the bullet and go electronic. Nothing new on the Web site, so I suspect this is just marketing rather than something truly transformational. Maybe it’s a discount for AARP members.

Speaking of independent spirits, a colleague cornered me in the doctor’s lounge waving an article on usability from American Medical News, reminding me how much he reveres his paper charts.

(I still don’t quite understand what the AMA is doing with this publication. They offer it in both print and digital versions, but the same article has different publication dates. I understand the Web version is going to come out before the snail mail version, but can’t we at least use the same dates, hmmm? This was dated June 20 online and July 11 in print for those of you who are playing along with the home game.)

Anyway, the article doesn’t tell us anything we don’t already know regarding usability. Guess what? Vendors are trying to reduce click counts, de-clutter screens, and save us from alert fatigue among other not-so-small feats like being certified for Meaningful Use, transitioning to 5010 and ICD-10, and so on.

The piece mentions CCHIT’s five-star usability rating as a tool some vendors use to differentiate themselves. Wondering if this is anything like the above-mentioned White Coat of Quality, I wanted more information. (I’ve been deployed on stable systems for some time and have a low tolerance for boastful sales practices, so it’s been a while since I’ve played the system / vendor selection game looking at it through the eyes of the average user.)

The CCHIT Web site seems clunky and vendors are not in alphabetical (or any other seemingly rational) order. I never did find a list of those products that had received the five-star usability rating, although a Google search brought up lots of individual vendor listings, many of products I wasn’t familiar with. Maybe my search skills are deteriorating or maybe it was the effects of too much fruit of the vine while watching what might be the saddest web-based HIPAA training I’ve ever seen in my life as I apply for staff privileges at a new hospital. Still looking for the list – can anyone help a girl out? E-mail me.

Contacts

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

SAIC To Acquire Vitalize Consulting Solutions

Vitalize Consulting Solutions has signed a definitive merger agreement that will make the company an independent, wholly owned business unit of Science Applications International Corporation (SAIC), the McLean, Virginia-based government contracting firm. Terms will not be disclosed in the announcement, to be issued later this week.

Vitalize CEO Bruce Cerullo told HIStalk that SAIC pursued the acquisition to support its strong position in government healthcare IT. The Department of Veterans Affairs is considering commercial healthcare IT products, while the Coast Guard has already contracted for software from Epic Systems. Vitalize, with 600 consultants and annual revenue of over $100 million, runs one of the country’s largest independent Epic practices, Cerullo said.

”Meaningful Use will normalize, but will follow with ICD-10, HIPAA 5010, and Accountable Care Organizations. We want to play hard in that arena,” Cerullo said. “SAIC has great tools and methodologies they want to bring into the commercial world and we want to move into government.”

Cerullo said Vitalize’s leadership team and organizational structure will not change. Its headquarters will stay in Reading, MA with offices in Kennett Square, PA and Santa Ana, CA.

“We’re committed to bringing together the best of Vitalize with the best of SAIC,” Cerullo said. “We’re going to go slow. SAIC is growing at 8-10%, while we’re growing 100% year over year. They know what we’re doing is working.”

He added, “Vitalize has been part organic growth, part acquisition, and I suspect we will do more of both. We’re swapping private equity owners for a strategic owner. Our organizational structure, benefits, compensation, sales, and practice-oriented structure will remain.”

Completion of the transaction is expected in August.

News 7/20/11

Top News

The FDA releases draft guidance on the oversight of mobile medical applications. The two categories of apps that would qualify for oversight include those that serve as an accessory to an FDA-regulated device (for example, one that connects with a PACS) and those that turn a mobile platform into a mobile device (the smart phone is used as an EKG device.) In some cases, software developers would have to demonstrate that their mobile apps work comparably to their non-mobile versions.

Reader Comments

From Vince Ciotti: “Re: Epic’s 75 wins in 200+ bed hospitals. All of Epic’s clients are multi-hospital IDNs since ‘normal’ community hospitals simply can’t afford their epic fees. Judy won’t even condescend to bid to single facilities under 200 beds. If the typical multi has 5-10 hospitals, that represents about 10 wins for Epic. Still, at their incredibly high prices, this was enough to drive Epic to over $800M in revenue last year. Add in the hundreds of millions in hardware fees even bigger implementation ‘consulting’ fees they generate and Epic alone may represent our long-lost economic recovery!”

HIStalk Announcements and Requests

Thanks to Inga for capably holding down the fort while I was away. It was good to be gone and almost as good to be back. I’m behind, but that’s not unusual – the only change is that I’m determined to stop feeling guilty about it since it’s too many jobs, not sloth or lack of time management skills, that’s responsible. I’d go part time at the hospital if that was feasible.

Listening: the first new Yes album in 10 years. I’ve been a fan for much of my life and I saw them live not long ago, so I like it even as I acknowledge that prog rock isn’t everyone’s cup of tea. Reading: Life by Rolling Stone Keith Richards (excellent, either he and/or his hired gun co-author is a genius), so I may need to crank some B-side Stones.

Acquisitions, Funding, Business, and Stock

Healthcare Growth Partners releases its quarterly HIT market report, with merger and acquisition activity recovering well from low activity a couple of years ago. Here’s a quote:

Generally, sub $100 million companies have three valuation inflection points: proof-of-concept, initial scalability, and expansion scalability.  Proof-of-concept is value created when a company shows that its product can be successfully sold and deployed in a commercial setting.  This inflection point is generally of more value to venture investors than it is to acquirors, as companies at this stage tend to be too early to realize significant value through a sale.  Initial scalability occurs when an earlier stage company begins to show strong profitability at high levels of growth,  although the organization is still small and lean. Expansion scalability takes place after a company has matured to a level where it takes on real infrastructure, and the company begins to show strong profitability after building out a mature corporate organization. 

Although the size of a company at each inflection point can vary significantly based on a company’s product or services and sector, the general rule of thumb in HIT is that proof of concept occurs at revenue of less than $1 million, expansion scalability in the $5 to $10 million revenue range, and mature scalability in the $20 million revenue range.

Philips reports Q2 numbers: revenue down 2.6% and a loss of $1.9 billion, with the CEO announcing cost reductions and share buybacks. Its healthcare business fared better than the company overall, with an 8% sales increase.

Apple announces Q3 numbers: revenue up 82%, EPS $7.79 vs. $3.51, wildly beating analyst expectations of $5.82. The company sold more than 20 million iPhones and 9.25 million iPads in the quarter.

Shares in WebMD Health recovered a bit on Tuesday following Monday’s drop of more than 30%, which was triggered by the company’s announcement of lowered revenue expectations. The one-year share price graph looks merely unimpressive until you notice that the straight vertical line to the right is not the margin of the graph.

Lawson Software, whose $2 billion acquisition by Golden Gate Capital and Infor was completed last week, has begun restructuring and employee layoffs.

Australia’s federal court approves CSC’s acquisition of iSoft for $202 million after 97% of shareholder votes were cast in favor of the proposal.

A major player in HIT consulting will announce its acquisition later this week. I’m holding back specifics until the announcement comes out. It’s going to be a pretty big deal (no pun intended).

Sales

ADVANTAGE Health Solutions signs an agreement with IGIHealth for its ORBIT Clinical Exchange and portal to support ADVANTAGE’s ACO infrastructure.

Children’s Medical Center Dallas selects the Enterprise Data Warehouse business intelligence tool from Health Care DataWorks .

Final Support chooses EMR-Link from Ignis Systems to provide lab-EMR integration for its GE Centricity customers.

People

The board of Franciscan Hospital for Children (MA) fires CEO Paul J. DellaRocco, citing financial irregularities that include the inappropriate submission of expenses.

Former Allscripts COO Eileen Martinson is named CEO of Sparta Systems, a provider of quality and compliance management software.

RTLS vendor Versus promotes Susan Pouzar to VP of sales.

Practice Fusion hires Zachariah Gursky as its first VP of ad sales. He was previously with Coupons Inc.

Todd Cozzens is promoted to CEO of Accountable Care Solutions, a new business unit of Optum. He was previously with the company’s OptumInsight business, the former Ingenix that bought Picis, of which Cozzens was CEO. He mentions his new job and some thoughts on “virtual Kaisers” and their data needs in his latest blog posting.

Announcements and Implementations

The Georgia Health Information Technology REC selects Halfpenny Technologies to develop a lab hub demonstration project for the exchange of clinical data.

Banner Health (AZ) completes its pilot of MyHealthDirect and will be implementing the service across all its facilities. This news clip explains how Banner is using MyHealthDirect to book appointments at low-cost clinics and thus reduce unnecessary ER visits and wait times.

Middle Park Medical Center in Kremmling (CO) begins implementation of Healthland’s EHR and anticipates a go-live by the end of the year. The 19-bed hospital expects to qualify for up to $250,000 in EHR incentives.

Johns Hopkins Medicine begins recruiting for over 60 people to implement Epic. Positions for the initial ambulatory rollout will focus on clinical documentation, analytics and research, and scheduling and registration.

LodgeNet Interactive restructures LodgeNetHealthcare into an independent but wholly-owned subsidiary. Gary Kolbeck, who was previously GM of LodgeNet Healthcare, will serve as president.

Microsoft establishes a Web page for Google Health users interested in transferring their data to Microsoft’s HealthVault record. The site includes step-by-step instructions on how to move the data.

Government and Politics

HHS’s Office of Inspector General finds that 12 of 13 states do not plan to verify all the eligibility requirements for paying Medicaid EHR incentives to doctors and hospitals . The reason: most states lack the data necessary for complete verification because data collection requires too much effort and too many resources.

The federal government files a complaint against a Kentucky nursing home for fraud, but also alleges that five residents died from “worthless care.” Nurses were accused of failing to administer diabetes meds, diapering patients who had normal bladder function, ignoring physician orders, and not showing up at all for one 2.5 day period in which the nursing home had no RN coverage at all.

Innovation and Research

The Industrial Designers Society of America awards Silver recognition to Seattle-based Artefact for its design work on the prototype of the Seattle Children’s Patient Information System.

Use of a real-time alerting system for patient deterioration reduced LOS 9.7 to 6.9 days and increased clinician response from 29% to 78% in a UK study. The $1.5 million Patientrack system was developed by an intensivist in Tasmania, but no Australian hospitals were interested in trying it. The weak link seems to be that it requires the nurse to manually enter the vital sign values.

The VA offers a $50,000 prize to a developer who implements Internet-based technology similar to the government’s Blue Button program, which allows patients to download a summary of their health records. The competition started Monday and ends when a winner is chosen or on October 18, whichever comes first.

Other

According to the local paper, independent physicians wanting to tie into Lee Memorial Health System’s Epic EHR would have to pay $15,000-$16,000 for the software license plus $25,000 to $80,000 per practice to cover implementation fees. Annual maintenance is an additional $4,500 per provider. Depending on the size of the practice, that could be a hard sale. Independent physicians in the area control about 84% of outpatient care.

UPMC removes 29 of its 51 directors following a consultant’s recommendation for improving the board’s effectiveness. Its membership had swelled over the years as representatives were added from acquired hospitals.

Memorial Health System (CO), the hospital whose electronic patient records were breached by a city-employed nurse and part-time psychic, says it has fired 22 employees in the past three years for privacy issues. One of them was caught looking up the records of friends so she could create a birthday database.

Odd: a woman sues a Pennsylvania hospital and the county child protection agency when her newborn baby is turned over to foster care after testing positive for opium, which the mother blames on her own ingestion of poppy seed-containing salad dressing. Both organizations had been sued by another mother a few months ago for exactly the same thing, except that particular mom blamed a poppy seed bagel.

Sponsor Updates

• MEDSEEK announces its fifth consecutive year on the HCI 100 list, based on its 2010 revenue performance.
• Sentry Data Systems CMO William Kirsh DO, MPH participated as a writer and editor for a HIMSS Revenue Cycle Task Force white paper.
• Surescripts recognizes  Allscripts as one of seven vendors to achieve Gold Solution Provider Status for e-Prescribing. Surescripts also awards e-MDs its White Coat of Quality.
• AdvancedMD announces the release of its ONC ATCB-certified EHR 2011 solution that includes an enhanced patient portal, new Meaningful Use reporting tools, and utilities for submitting immunization and health surveillance data.
• API Healthcare is offering a variety of sessions on creating more effective workforce management at its annual user group meeting this week in Milwaukee.
• Orion Health’s Rhapsody Integration Engine and Rhapsody Connect earn ONC-ATCB EHR module certification .
• Providence Health & Services selects Elsevier / CPM Resource Center as its vendor of choice for evidence-based clinical content.
• Concerro releases a series of white papers collectively called the Workforce Management Wellness Series.
• Kony hires Peter Buscemi to lead the company’s global marketing efforts.

Contacts

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

HITlaw 7/18/11

Who’s On First?

Recent O’Toole Law Group engagements have raised a critical issue that’s worth passing on to HIStalk readership.

When providers contract with vendors, they expect certain products and services. This much is obvious. The issue presented here arises as a result of all the distributing, bundling, packaging and rebadging of products.

Vendor A may offer Vendor B’s product alongside its own products. In this case, Vendor A is a distributor (and usually a reseller) of Vendor B’s product. Typically this type of collaboration exists when the two products perform related tasks for the provider. Like ice and your favorite drink, each is good, but together they are great!

Vendor X may offer a product called “TurboEMR” that also has some type of label like, “powered by HISware” or something to that effect. This probably means Vendor X has HISware’s software embedded in its product, and the “powered by” refers to this fact. In this case, Vendor X is sublicensing technology developed by HISware.

In each situation, the provider gets the package deal and the functionality it is seeking, which would not be possible with only Vendor A or Vendor B in the first instance or with only Vendor X in the second.

So everyone wins, right? Hopefully, but maybe not.

When things go well and you have a great prime vendor that really steps up and fills that role, life is good. The provider gets precisely what they signed up for. They have a single point of contact for resolution of problems with any of the products involved.

But what happens when things go wrong? Are the responsibilities and procedures clearly set out? Key contract components that must be addressed fully by all vendors involved include support obligations, copyright / patent protection, indemnification, and liability provisions, to name a few.

How does the provider determine exactly what they are getting and precisely whom they are dealing with?

One simple way to determine the “who” part is to look for the warranty of ownership. Something like, “Vendor warrants that it owns the software.” Once you find that section, really analyze it. It is probably not more than a sentence or two, three tops.

If the vendor warrants that it is the developer and sole owner of the technology being licensed, then you are dealing with a single vendor and its products. This is the cleanest, most simple scenario.

(Quick sidebar here: it must be a warranty, not a representation. Warranties have certain protections and remedies that representations do not.)

If the vendor warrants that it is the owner of the technology OR that it has the right to license it, that is your red flag duct taped to a flashing light. This is not bad, but it means the product contains or is packaged with third-party software. You need to be aware of this and you must obtain certain crucial contract terms for your protection.

The best-case scenario (keeping in mind that there is another vendor involved that is not a party to your agreement, which is the reason behind this article) is a warranty from the vendor that you are contracting with that it has warranties of ownership, operation, and error correction (for example) from the other vendor. This is critical because it can then be used to back up the same warranties from your selected vendor to you.

The biggest warning flag you could ever encounter is where there is a disconnect in the protection(s) offered. If the vendor warrants that “all software is great and works fine and they will fix everything, but this warranty does not apply to a certain line item or product,” then you have a problem. What happens if there is a failure with the excluded software?

If you have no answer while reviewing contract language, just imagine the discomfort you will feel if your system is down and all indications point to the excluded product.

OK, stay with me here. All the legal stuff aside, what those in IT really want to know is what happens if there is a problem with the products.

As stated before, with a solid prime vendor you are in good shape. But what about those unfortunate situations where fingers get worn out from all the pointing?

To try and avoid heartburn later, fix the contract up front. Try this simple exercise. Remember connect the dots, those partially finished pictures in coloring books with numbered dots? Connect them in numerical order and complete the picture! Give it a try with your software agreement.

If you have more than one vendor involved, just imagine a system crash, and then try to connect the dots to all the vendors, especially the vendor behind the scenes. Do you have adequate warranty protection? Do procedures exist for escalating a software problem to the correct level at the vendor? Can you get to the vendor at all??

Make clear for each product included, or component thereof, which vendor is responsible for support, updates, fixes, etc.

Make certain that you have contract pathways to obtain that service. Assume vendor A is first point of contact. When the problem ultimately is identified as residing in Vendor B’s product, then what? It may be that the responsibility remains with Vendor A, but it also may be that Vendor A is only responsible for “Level 1 Support” and then you go to Vendor B for the difficult stuff. Ideally Vendor A stays involved and shepherds the issue through to resolution, sort of like a new car warranty. Inga’s Cadillac dealership did not build the car, but when the car breaks down, you take it back to Inga’s to get it fixed. Inga’s then takes care of the work required and is backed up by the manufacturer.

Taking the car analogy a little further, in terms of your contracted vendors, while you may know who is in the driver’s seat, you may not know who else is along for the ride. It could be an awesome two-seat Tesla roadster with two great vendors, or it could be the mud-covered SUV with a bunch of buddies all saying they work together just fine (and the driver is wearing really dark shades.) Due diligence in contracting pays off, and lack of diligence can really sting you later.

Vendors, please make it clear. You know best what is going on. Put it right out there.

After 20+ years doing this, I still remember a situation where an executive at a monster hospital chain felt something had been “snuck in.” In reality it was not, but the impression stuck hard and fast in this executive’s mind and we had to face extra scrutiny for several years to follow. Kind of like a dog that gets whacked by something at one of those birthday parties where twenty kids are running around screaming and things get zany and someone hands a whiffleball bat to the kids for the piñata. Anyway, the dog gets whacked (accidentally, of course) and never forgets the kid that did it. Don’t be the kid with the bat!

Tangential issue: get a warranty that states no other software is required, from your prime vendor or any other vendor, for operation of the software products being licensed. If other software is required but not included, require a listing in the agreement of all such products. Failure of your prime vendor to include something on this list should mean the vendor has to pony up and pay for it. That will bring all the fine details right to the top.

Finally, once you get everything above all set, make sure that all your hard work does not blow away in the wind because a vendor subcontracts work or assigns the agreement to another vendor. Include provisions prohibiting assignment or subcontracting without the customer’s agreement. That way you know what you are getting, from whom you are getting it, and that things will stay that way unless you agree otherwise.

Please take care in your interpretation of this article. I have been involved in countless good situations involving multiple vendors and very happy customers. When the provider does get a good prime vendor that truly takes on its role, you win. No question it works well in the right situations. My point is to be diligent and try to avoid bad situations by at least having good contract language on your side. The combination of a poorly performing vendor and weak or lousy contractual support will really ruin your day.

Big takeaways:

• Contract language, warranties, and obligations should be consistent as applied to all products and vendors involved, even if designated to a prime vendor. Watch for disconnects in supporting language.
• The contract should map out clearly the support chain and obligations of the vendors involved, again, even if designated to a prime vendor.
• Require listing all software required for operation of the products being licensed and obligation for the vendor to provide whatever they failed to list.
• Prohibit assignment and subcontracting by the vendors without your consent.

This article is intended to provide general advice and is not by any means exhaustive on the issues or language required and must not be taken as specific legal advice. Hopefully HIStalk readers enjoy the presentation and take away a valuable lesson or two.

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

Monday Morning Update 7/18/11

From Brass Tacks: “Re: Danbury Hospital. They fired the CFO over this.” Former Danbury CFO William Roe is sentenced to 33 months in federal prison for embezzling $200,000 from Danbury Hospital (CT) and former employee St. Rita’s Medical Center (OH) by approving invoice payments to a fake software consulting company he had set up. Roe, who made $594K in 2009, blamed poor judgment and begged for a light sentence. The judge, unimpressed by his two court order violations, said, “Your primary concern is for yourself and your family, who have already benefited from the funds you’ve stolen.”

A New York Times article on usability of clinical systems highlights the usual arguments: usability experts say there’s no question that today’s systems are measurably poorly designed to the detriment of clinician users and patients, while vendors strongly resist the imposition of usability standards or mandatory usability testing.

Most poll respondents say the person running the company that employs them is honest and honorable. New poll to your right: should the federal government measure and report the usability of clinical systems?

Essentia Health (ND) goes live on Epic’s EHR July 31th.

Gartner positions mobile application development platform provider Kony in the “Visionaries” quadrant of the Magic Quadrant for mobile consumer application platforms.

David Roberts, HIMSS’s VP of government relations, says it is unlikely that Congress would vote to eliminate future funding for EHR Meaningful Use incentives, despite the current current stalemate in federal budget negotiations. To eliminate the incentives, Congress would need to specifically vote to narrow the scope of the program or eliminate the program entirely. Roberts believes that legislation lacks adequate support to be passed in either houses of Congress.

The weekly e-mails of Kaiser Chairman and CEO George Halvorson are often HIT-related, with this week’s no different. Kaiser researchers have published autism-related studies made possible by its extensive patient data warehouse. They found that pregnant woman who used certain drugs greatly increased the odds of having an autistic baby, but vaccines were not among those drugs. They also found that children are dying of whooping cough because they aren’t being given pertussis vaccine.

Here’s the latest installment of HIStory from Vince Ciotti, this time covering vendors of minicomputer systems.

Greenway Medical Technologies files registration to raise up to $100 million in an IPO. Underwriters include Morgan Securities, Morgan Stanley, William Blair, Piper Jaffray, and Raymond James.

Caristix is offering a free beta program for software that helps hospital integration analysts identify and document custom HL7 interface segments and values.

Indian River Medical Center (FL) hires as its first CIO Bill Neil, formerly IT director at Presbyterian Healthcare Services (NM).

Scripps Health (CA) chooses Meddius to provide Integration as a Service, replacing its Sybase integration engine.

Yale New Haven licenses the Rothman Index, which uses real-time clinical systems information to generate a patient score that helps clinicians identify patients whose condition is deteriorating.

UPMC’s living donor kidney transplant program was shut down in May because up to six transplant team members failed to notice a Cerner EMR lab result alert indicating that a donor had undiagnosed hepatitis C. Her kidney was transplanted into a patient who did not have the disease, resulting in the temporary shutdown of the program. The surgeon who did most of the procedures was removed from his position, joining his equally high profile colleague who was fired in an earlier UPMC transplant scandal. A highly regarded transplant nurse was suspended for two weeks. Outside experts blamed generally poor EMR design, saying that UPMC administrators had a “knee-jerk reaction” in removing the surgeon, who had been under pressure to increase procedure volume, instead of examining the system that allowed the error to occur.

Seven former nurses from Valley Regional Medical Center (TX) sue the hospital, alleging they were fired in retaliation for making good faith reports of unsafe patient conditions. The nurses were terminated for "insubordination" after opposing assignments they claimed endangered critically ill patients. One nurse explained the situation as follows:

"It’s about standing up for your patient. We got into this profession to advocate for our patients… Patients who can’t speak up for themselves… And that’s what we’re trying to do here."

EHRs provide more comprehensive information on health services received than do Medicaid, according to a study published in the Annals of Family Medicine.

Mayo Clinic announces it is close to completing the development of tools that can identify and sort digital health information from any EMR, regardless of file format and data organization. Mayo’s project is funded by the HHS through its $60 million Strategic Health IT Advanced Research Projects (SHARP) program.

Next month CMS will roll out a pilot program for the electronic transmission of documents to support claims. Designated “health care handles” will serve as intermediaries between CMS and providers.

Strange: a city-employed nurse is fired for inappropriately accessing the electronic medical records of hospital patients. She says the real issue is her part-time job as a psychic, where she told patients they were about to experience heart attacks and claimed to be speaking to deceased co-workers from beyond the grave.

Contacts

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

News 7/15/11

Top News

Nuance Communications acquires transcription services provider Webmedx. Both companies offer outsourced transcription services with speech recognition capabilities and offer NLP technology to extract information and convert it into discrete data. It’s been a busy week for the transcription services and speech technology segment: earlier this week, MedQuist announced plans to acquire M*Modal for $130 million.

Allscripts adds four senior execs to its leadership team including Cliff Meltzer as EVP of solutions development, Steve Shute as EVP of sales, Jackie Studer as SVP and general counsel, and John Guevara as CIO. Meltzer is an Apple, Cisco, IBM, and CA Technologies veteran and replaces the now retired John Gomez. Long-time IBM-er Shute replaces Jeff Surges, the current CEO of Merge Healthcare. Studer (GE Healthcare) takes over for Kent Alexander, and Guevara (Microsoft, Intermec, Siemens) is Allscripts’ first CIO.  Allscripts also announced the department of COO Eileen McPartland, who is leaving to become CEO of a private company outside of the healthcare industry.

Reader Comments

From Charlie Brown “Re: Worried. Hey Inga. No push e-mail this AM for HIStalk and no new postings since yesterday. Did HIStalk break?” Thanks for your concern, Chuck, but nothing is broken (well, nothing that I know about, anyway.) Alas, Mr. H didn’t set up anything in advance for posting Wednesday, so we went a rare mid-week day with no Readers’ Write or interview. Mr. H promised me he’d eventually return from vacation, so look for an in-box full of HIStalk blasts next week.

From Boozers “Re: 2010 market share. Wow. Look at how Epic is hurting McKesson.” This table from KLAS shows Epic won 75 deals last year in the 200+ bed hospital market and had no legacy losses. The next best performer was Cerner, with 14 wins and six legacy losses. At the bottom: McKesson Horizon with four wins and 24 legacy losses. Ouch.

From Court Jester “Re: From the floor at AMDIS. Lots of interesting discussions and speakers and talk around the evolution of technology adoption by physicians. The hottest topics center around  CPOE and clinical documentation and the need for good workflow and ease of use.” AMDIS’s 20th Annual Physician-Computer Connection Symposium is wrapping up Friday in Ojai, CA. I must admit that if I were Court Jester I would be hanging by the Ojai Resort’s gorgeous pool rather than in the back of one of a meeting room.

HIStalk Announcements and Requests

This week on HIStalk Practice: Dr. Gregg dialogs with Stupid Simple and S&M. Sermo intros Sermo Mobile and iConsult. A whopping 76% of physicians with smart devices utilize iPhones. Physicians increased their ability to generate registries after implementing EHRs. Telepsychiatry is not catching on as fast as other telemedicine services. If you sign up for the HIStalk Practice e-mail updates, the budget crisis might be resolved and the US women might crush Japan. With stakes like that, how can you not sign up? And thanks for reading.

Acquisitions, Funding, Business, and Stock

drchrono closes $675,000 in its first round of institutional financing. Investors include several VC firms, plus Gmail creator and FriendFeed cofounder Paul Buchheit and Google’s principal engineer Matt Cutts. drchono offers a free EHR for the iPad.

Sales

Nevada Rural Hospital Partners, a 14-hospital alliance, partners with Anthelio (formerly PHNS) to provide business office solutions and coding services to member hospitals.

People

Progress Software appoints Philip M. Pead to its board of directors. Pead is the current chairman of the board for Allscripts and the former president and CEO of Eclipsys.

Dominick Bizzarro, the CEO of the Healthcare Information Xchange of New York, resigns to join InterSystems as business manager for the HealthShare HIE platform.

Announcements and Implementations

Nevada-based HealthInsight launches its HIE using Axolotl’s platform. Providers will begin sharing patient information in September.

Cheboygan Memorial Hospital (MI) outsources its IT operations to Phoenix Health Systems, who will implement Meditech’s EHR and provide IT leadership and service desk support.

Government and Politics

A bipartisan group of Congressmen introduces a bill that would amend the EHR incentive program to benefit multi-campus hospitals. The legislation would give each hospital campus the opportunity to earn Meaningful Use incentives.

Innovation and Research

The US Patent and Trademark Office awards Epic Systems a patent for “a system and method for providing decision support to appointment schedulers in the healthcare setting.”

Other

Directors of the Kingsport, TN-based RHIO CareSpark vote to cease operations this fall, citing an unsuccessful effort “to transition from a grant and contract based nonprofit organization to a user subscription and revenue sustained entity.” CareSpark was formed in 2005 after receiving $600,000 in funding from the Foundation for eHealth Initiatives and local partners.

Sponsor Updates

• Greenway Medical and PGA Tour Golf Pro Jason Dufner debut their new partnership at the British Open. Note the Greenway logo on Dufner’s jacket.
• The Drummond Group awards SRS EHR ONC-ATCB certification as a complete EHR.
• GE Healthcare releases a new white paper discussing the annual cost of healthcare-associated infections in terms of dollars and lives. GE Healthcare also announces the formation of MIND, a coalition to help physicians detect, diagnose, and manage neurodegenerative diseases.
• The Entrepreneurs EDGE awards Lexicomp, a Wolters Kluwer Health subsidiary, its fourth Crain’s Leading EDGE award for creating economic value in Northeast Ohio.
• Blanton Godfrey, Ph.D. and board chairman of the Institute for Healthcare Improvement will be the featured speaker at TeleTracking Technologies annual client conference in San Diego in October.
• Sage awards Peter Christensen Health Center (WI) its Healthcare Best Practices award at the Sage Summit conference in Washington DC.
• Practice Fusion announces Practice Fusion Connect 2011, a free EMR event for its 100,000+ clients, November 11th in San Francisco.
• AirStrip Technologies expands its leadership team, promoting Bruce Brandes from chief sales officer to EVP and chief strategy officer. Also, AirStrip was named InformationWeek magazine’s Most Transformative Healthcare Application at this week’s Healthcare Leadership Forum in NYC.
• Emmi Solutions selects Health Language, Inc. to enhance the usability of its patient engagement programs.
• North Highland announces an expansion into Japan through a partnership with GENEX.
• Iatric Systems earns ONC-ATCB certification for three more products. Iatric is also hosting a slew of free Webinars over the next three months, covering a variety of clinical and technical topics.
• Precyse hires Kristen Saponaro as VP of marketing. Saponaro was the principal of Saponaro Communications, LLC, the consulting firm that supported Precyse in its recent rebranding efforts. Precyse was also recently awarded a medical transcription services contract with Community Medical Center (PA).
• Anson General Hospital (TX) leverages its ChartAccess EHR from Prognosis to successfully attest for Meaningful Use.
• NextGen execs Charles Jarvis and Tony Landauer are scheduled panelists at next month’s CompTIA Breakaway 2011 in Washington, DC.
• Allscripts provides its preliminary Q2 financial numbers, which include expected bookings of about $240 million and profits and revenue above analysts’ expectations.

EPtalk by Dr. Jayne

It’s been difficult to get back to the routine with me returning from the beach and Mr. H vacationing, but the lovely Inga has been doing a fantastic job holding down the HIStalk fort. Although I’m still somewhat achy from the gut-busting laughter that accompanied Dr. Gregg’s recent comments on the EHR selection process, I didn’t want to miss the opportunity to share some newsy tidbits and random thoughts.

HHS releases a proposal to revise HIPAA and harmonize it with HITECH provisions. The AMA states: “The proposed rule seemingly goes beyond what is required by laws and would pose significant burdens on physicians if finalized.” The comment period ends on August 1, so let your voice be heard.

The Sage Summit is being held this week at the Gaylord National Hotel and Convention Center in Washington DC. Partner Days are July 10-15 and Customer Days are July 12-15. I understand the Wednesday evening event was “Night at the Museum” at Smithsonian Air and Space. Anyone attending? Let us know what you are seeing and hearing.

A recent survey shows consumers have a higher opinion of facilities using the word “Hospital” as opposed to those who have gone to the ritzier-sounding “Medical Center.” Respondents felt Hospitals provided better care and were more cutting edge. What’s in a name? It reminds me of when a previous employer named their brand new facility the “Cancer Center of Excellence.” Not only was it just tacky, but as far as Centers of Excellence go, it was a new service line that hadn’t gone anywhere near proving itself through outcomes or peer recognition. Personally, I’d like to see a survey on “Information Technology” vs. “Information Services” vs. “Information Systems” departments. A rose by any other name…

For those of you who have been eagerly awaiting implementation of new DEA rules for e-prescribing controlled substances, you’ll probably have to wait on your medical marijuana scripts. The DEA has stated that cannabis “has no accepted medical use and should remain classified as a highly dangerous drug.” Advocates can now appeal to federal courts after a nine year delay. DEA Administrator Michele Leonhart states that “the known risks of marijuana use have not been shown to be outweighed by specific benefits in well-controlled trials that scientifically evaluate safety and efficacy.” How hard do you think it would be to enroll patients in THAT study?

Thanks to Mustang Sally, who sent an article on physicians who use Twitter anonymously. It has some interesting examples, but closes with a mention of the American Medical Association’s ethics policy on social media, which warns that “actions online and content posted… can undermine public trust in the medical profession.” I don’t agree with physicians griping about patients on Facebook or Twitter, but you can imagine that I do see a benefit in anonymity. The full text of the Policy, approved in 2010, can be found here.

Interesting piece from the Kaiser Family Foundation: “Why It’s Okay that EHR Adoption Will Fall Behind 2011 Goals.” The authors cite “cleaning house” as a cause, meaning “older, costly, and difficult-to-implement legacy EHRs will be replaced by less expensive, more agile systems that have been developed specifically for meaningful use and are deliverable in the cloud as Software-as-a-Service.”

I’m off to sample my employer’s mandatory online training offerings, which apparently I must complete or I won’t get paid. After a week of fuzzy umbrella drinks, I’ve decided that Workplace Harassment, Personal Protective Equipment, and Privacy 101 go best with a nice Cab from Joseph Phelps. Have any other suggestions for excellent educational wine pairings? E-mail me.

Contacts

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

News 7/13/11

Top News

The Government Accountability Office reports that the federal government’s systems for analyzing Medicare and Medicaid data for possible fraud are inadequate and underuse, making it difficult to detect the $60 to $90 billion in fraudulent claims paid out each year. The GAO also notes that:

• CMS spent $150 million on new systems that went live in 2009, yet crucial pieces are missing.
• The current systems don’t include Medicaid data and CMS’s plans to share Medicare and Medicaid data with states and implement new software have been delayed.
• Of the 639 analysts who are suppose to use the system, only 41 have been trained so far.

CMS’s top anti-fraud administrator was scheduled to testify for a Senate subcommittee Tuesday to discuss the findings.

Reader Comments

From Bamma Bubba “Re: UCLA HIPAA violation settlement. Hospital snoops will never stop – it’s a people problem, not an IT problem. Could be a way to increase federal revenue, but then hospitals just pass the costs on to patient and insurers.” Yep, even though our mothers told us to mind our own beeswax, humans are generally just plain nosy. And at HIStalk we also like to make fun of people that can’t spell HIPAA.

HIStalk Announcements and Requests

Mr. H is still vacationing for a few more days. Either Mrs. H has banned him from the computer or he is in the Land of Bad Internet (I’m betting the latter) because I’ve hardly heard a peep from him in two days. Until his return, feel free to send any hot news my way. Or, if you don’t have hot news, just drop me an e-mail for the heck of it.

Sales

When Sidra Medical and Research Center (Qatar) opens in 2012, it  plans to run the Cerner Millennium platform and be the first fully digitized medical facility in the country.

People

Mediware hires Michael Anania as VP and GM of the company’s Blood Center Technologies product group. Anania’s previous employers include Roche Diagnostics and Baxter Healthcare.

MGMA names Susan Turney, MD its president and CEO, succeeding the retiring William F. Jessee, MD. Turney, who is an internist, has served as CEO of the Wisconsin Medical Society since 2004 and founded and chaired the Wisconsin Statewide HIE.

Apollo Health Street beefs up its sales force with the addition of four regional VPs: Ken Bartlett (SSI, McKesson), Dan Contilli (Healthation, SunGard), Troy McCormick (Invikktus, Emdeon) and David Richards (Dell Services, EPBS-Internedix.)

PointClear Solutions, a provider of HIT product development services, names Rodney Hamilton, MD, CMIO and managing director of its product strategy practice. Hamilton most recently was chief strategy officer for Vanguard Health Systems; he also spent time as a physician liaison with McKesson.

Announcements and Implementations

Predixion Software collaborates with the development team of Clinical Looking Glass to create a predictive model for reducing patient re-admissions. Clinical Looking Glass is a decision support tool that was developed at Montefiore Medical Center (NY).

Chelsea Community Hospital (MI) goes live next weekend on its $12 million EMR system. Chelsea is part of Trinity Health so I am assuming it’s a Cerner implementation.

The Indiana HIE reports that 70 distinct hospitals, long-term health facilities, and health systems were connected to the exchange as of the end of 2010. For the full year, IHIE delivered 3.3 billion pieces of clinical information, which is about 1.1 billion more than 2009’s totals.

Government and Politics

Arizona, Connecticut, Rhode Island, and West Virginia have now launched their Medicaid EHR incentive programs, bringing the total number of live state programs to 21. Only 14 of those states states have issued incentive checks.

Other

Cerner is sponsoring a 10-week weight-loss competition aimed at helping Kansas City residents drop a combined 100,000 pounds. The KC Slimdown Challenge is expected to involve about 20,000 people. For the calculator-challenged, that’s about five pounds a person.

Corepoint Health is the top-rated vendor in KLAS’s just-released interface engine report. Corepoint has the largest presence of any vendor in smaller healthcare facilities but very few clients in facilities over 500 beds. InterSystems was ranked a close second, though almost all InterSystems Ensemble customers are in 500+ bed facilities.

Sponsor Updates

• Cumberland Consulting Groups promotes Erik Howell to principal. Howell has managed multiple HIT projects for Cumberland since joining the company in 2004.
• Surgical Information Systems is hosting a July 13th webinar on how social media affects healthcare.
• PatientKeeper’s 2011 User Group Conference is scheduled for September 18-21 in Denver.
• Lori Prestesater, RelayHealth’s VP of strategy and business development, will be discussing ACOs and Meaningful Use as a panelist at the Institute for HIT’s summit July 26-27 in Denver.  Also at the summit: Software Testing Service CEO Jennifer Lyle, who will join a panel discussion on strategies to achieve Meaningful Use.
• URAC awards accreditation to MEDecision’s Alineo health utilization management platform.
• Cancer Treatment of America  selects CareTech Solutions’ Service Desk to provide 24x7x365 IT support for its national network of  centers.
• Concerro is offering a July 23rd webcast on nursing documentation and reimbursements. Coding expert Glenn Krauss will lead the discussion.
• Karen Knect of Encore Health Resources will overview e-Measures during a online session July 13th.
• The Los Angeles County Department of Health will implement Wellsoft Emergency Department Information Systems at its Los Angeles County and USC Medical Center hospitals.
• Vocera Communications names John McMullen to its board of directors. McMullen is a SVP and treasurer at HP and will serve as chairman of the audit committee.
• GE Healthcare launches its fully integrated EMR/PM system, Centricity Practice Solution 10.
• CynergisTek CEO Mac McMillan will be a panelist for the launch of Clearwater Compliance’s HIPAA-HITECH Blue Ribbon panel July 14th.

Contacts

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

MedQuist Holdings to Acquire M*Modal for $130 Million

MedQuist Holdings announced the signing of a definitive agreement to acquire M*Modal and its Speech Understanding technology for total consideration of $130 million, which includes $77.2 million in cash and 4.1 million shares of common stock.

Former Misys CEO Vern Davenport was appointed chairman and CEO of the new entity. He will replace Peter Masanotti as CEO and Bob Aquilina as chairman. Aquilina will continue to serve on MedQuist’s board. and Masanotti will remain a consultant to MedQuist through the end of September.

MedQuist has already been using M*Modal’s technology for its medical transcription business. The company intends to enhance further the integration of M*Modal’s front-end speech recognition technology with MedQuist’s clinical documentation platform.

M*Modal has a current annualized revenue run rate of $24 million, about $7 million of which came from MedQuist.

Monday Morning Update 7/11/11

From 4merMCK: “Re: McKesson. USA Today reported that MCK’s Hammergren made $150m in 2010, a sizable increase. The gap in salary alone for MCK-IT employees is approximately 375x, and merit increases in the former HBO were 2.5%, or around $2,000. Under Hammergren’s leadership, MCK shares have risen around 20%. At the end of the day, it is shareholder value that drives CEO compensation. Whether that’s worth his increase, only shareholders can answer. Rumor in Alpharetta is that the HIT business was shopped around, but based on the asking price and a declining base, there were no offers. Now they are trying to determine what a ‘growth’ strategy would look like.” Unverified.  

From The PACS Designer: “Re: Internet2 and healthcare. Rural healthcare facilitated through the use of telemedicine solutions is a trend that is gaining more attention. One new area that can accelerate the adoption of telemedicine applications is Internet2, which offers higher speed communications tools. The FCC’s Rural Health Care Pilot Programs (RHCPPs) have been in the past a funding source for employment a rural EHR and telemedicine experiments. State-by-state license requirements for physicians has been one of the roadblocks to further expansion of the concept.”

From Mr. HIStalk: “Re: holiday woes. Funny that I’m reading this on a plane to vacation.” The referenced article includes suggestions for prepping the office in advance of taking R & R to avoid “vacation interruptus.”  Coincidentally, Mr. H just skipped town for some well-deserved time off, leaving me (Inga) as the designated second-in-command. The same article notes that 30% of workers are like Mr. H and intend to contact work while on vacation. Mr. H barely opened his first beer before checking in (and contributing to this post), but Mrs. H and I are hoping he’ll get into the chillin’ mode soon.

Technology vendors and the healthcare system are most responsible for disconnected patient information, readers say. New poll to your right, just to change it up a little: is your company’s CEO honest and honorable?

The Tennessee Comptroller of the Treasury releases an audit reporting finding that Community Health Network (CHN) lost or misused $1.26 million between 2007 and 2009. CHN is a non-profit organization that provides medical technology to rural communities, often through grants. Auditors claim the company’s former CEO, Keith Williams, improperly received more than $80,000 by paying himself unapproved bonuses, making personal purchases with CHN’s credit card, and claiming reimbursement for meal purchases that were paid for with CHN’s credit card. Former CFO Paul Monroe was found to paid over $10,000 in unauthorized pay. Auditors also say that Williams and Monroe falsified grant invoices and grant reports and misused proceeds from a state grant to purchase almost $600,000 in unauthorized software. The software vendor later hired Williams as a consultant while he was still employed at CHN.

Georgia Governor Nathan Deal will speak Monday morning from the Alpharetta headquarters of McKesson Provider Technologies, pitching the state’s campaign to lure technology jobs. It will be streamed live at 8:30 a.m Eastern.

More from Vince on minicomputers, this time focusing on the companies that wrote software for them, one of the biggest of which was started in the proverbial garage.

The VA reveals plans to allow clinicians to use  Android devices, iPhones, and iPads, in addition to the currently supported BlackBerries.

This week’s Time Capsule editorial from 2006: USB Drives Would Help Consumers Quickly Access McClinics. Its conclusion: “This system of having patients walking around with their own information ready to plug into a provider’s system seems like the best solution for now.”

Morris Hospital & Healthcare Centers (IL) names Cassie Brown manager of health information management. I like that Brown worked at Morris Hospital as a medical records file clerk while in high school school and college and before learning the ropes at a couple of other medical facilities.

Healthcare jobs grew by 13,500 in June, though the hospital sector declined 0.1%. Ambulatory healthcare added 16,500 jobs, including 5,000 in physician offices.

HIStalk Practice’s own Dr. Gregg gets a shout out in the Columbus (OH) business journal for being the state’s first doctor to get an EHR stimulus check from Ohio Medicaid.

Broadlawns Medical Center (IA) becomes the first medical center in the state to use PatientSecure’s biometric patient ID system.

British Columbia’s former deputy minister of health Ron Danderfer pleads guilty of fraud in relation to benefits he received between 2004 and 2007. Danderfer, who oversaw the creation of the province’s $222 million EHR system, admits he accepted the use of a vacation condominium and a job for his wife.

Surescripts and the authors of JAMIA-published article, “Errors associated with outpatient computerized prescribing systems,” issue a joint statement to clarify the study’s use of the term “e-prescribing.” The authors point out that their use of the term “e-prescribing” does not reflect the way the term is used today, nor does it match the federal government’s definition. The study examined what was considered e-prescribing back in in the old days (2008); that is, prescriptions generated by a computer, faxed to a pharmacy, and then printed. You’ve got to admit that “E-Prescribing Doesn’t Make The Grade” is a far more compelling headline than one that says, “The Way Things Were Done Three Years Ago Wasn’t All That Great.”

Contacts

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

News 7/8/11

Top News

The start of Stage 2 Meaningful Use will likely be pushed back a year, now that ONC head Farzad Mostashari, MD agrees the current timeline is too aggressive. Stage 2 requirements won’t be finalized for another year, so the growing consensus is that a January 1, 2013 start date would not give EPs, hospitals, and vendors adequate time to prepare.

Reader Comments

From WildCat Well: “Re: Comcast. Considering offering an EMR system at no cost to physicians who subscribe to Comcast Metro Ethernet services. Physicians have their choice of six-plus EMR preferred providers.” Unverified, although readers have been suggesting that a deal of this type has been in the works for some time.

From Man in the White Suit: “Re: Shoe Beacon. You should really be more discrete about where you live.” There’s nothing better than good yard art to express one’s obsessions.

HIStalk Announcements and Requests

Check out the new HIStalk Resource Center. Our new reader-requested tool gives you an easy way to search for products and services in over 100 HIT-related categories. Fifty-two HIStalk sponsors have provided details of their offerings and quick links to request more information. To get there: (a) click on the link at the top of this page; (b) click the small banner below the Founder sponsor banners to your left; or (c) click the link on the Related Sites listing to your right. We will continually update the Resource Center, so check it out regularly and let us know what you think.

Ever find yourself wondering what the heck is going on in the ambulatory HIT world? If so, make sure you are a HIStalk Practice e-mail subscriber. Here are some highlights from this week’s posts: Rob Culbert offers tips for documenting operational and functional workflows to boost customer satisfaction and cash flows. MGMA reveals the top challenges for practice managers. NextGen parent company Quality Systems brings homes three Stevies. AHRQ offers a toolkit to analyze workflow before, during, and after and HIT implementation. Thanks for stopping by.

Listening: angry 1970s punk from Cleveland’s Dead Boys. Arguably better than the Ramones.

Sales

Aria Health (PA), Norton Healthcare (KY), and St. Luke’s Health System (ID) contract with Hyland Software for its OnBase enterprise content management software.

Aria also selects Allscripts Community Record, powered by dbMotion, to enable data sharing between the hospital’s Allscripts Sunrise, the employed physicians’ Allscripts Ambulatory EHR, and third-party EHRs used by other regional providers.

The State of New Jersey posts an RFI for the New Jersey Health Information Network, requesting “a single, complete solution” and suggestions of how it can sustain itself financially.

People

SmartBusiness profiles EnovateIT’s Fred Calero, who leads his company “by treating others as they would like to be treated.” He notes that many of EnovateIT’s employees started on the company’s assembly lines building medical carts.

NCO Group promotes Michael Albrecht to lead its Healthcare Services sales team.

UnitedHealth Group names Larry Renfro as CEO of its Optum business unit. He replaces Mike Mikan, who is leaving to run a private equity fund. Renfro was CEO of the company’s Ovations group.

Richard Noffsinger joins Aetna subsidiary ActiveHealth as president and CEO. He was previously with Anvita Health, Amicore, and Microsoft. He replaces Gregory Steinberg, who will head up clinical innovation for Aetna.

Bob Zollars, chairman and CEO of Vocera since 2007, is profiled in Smart Business of Northern California. He was previously with Wound Care Solutions, Neoforma, and Cardinal Health.

Announcements and Implementations

University Physicians Hospital (AZ) goes live with EmergisoftED.

CareCore National announces that its TouchMED prior authorization application for physicians is available on the Cisco Cius tablet. You might expect that this announcement and product information would be available on the company’s Web site since they went to the trouble of issuing a press release, but you would be wrong.

Cerner’s uCern customer collaboration platform wins an award from Jive, the company whose technology powers it.

University Medical Center (NV) says it has $25 million to spend for system upgrades needed to qualify for HITECH money, but needs $60 million. Its county owners say they don’t plan to make up the shortfall. The hospital is negotiating with McKesson.

Government and Politics

UCLA Health System settles with HHS for $865,500 for alleged HIPAA privacy and security violations. Two celebrities accused hospital employees of peeking in their charts.

CMS says it won’t be ready to electronically receive quality outcome data for Meaningful Use in 2012 as originally planned. That means that in 2012, EPs and hospitals can report outcome data via attestation and data calculations, just like they’ve done for the 2011 payment year.

The president of the Ontario Medical Association says political party leaders should forget about the scandal-ridden and expensive eHealth Ontario and include electronic medical record programs in their platforms anyway.

Innovation and Research

A JAMA-published study finds that critical access hospitals lag other hospitals in survival rates for heart attack, heart failure, and pneumonia. The author suggests telemedicine as a possible solution.

Technology

A Florida doctor who came up with the idea for his iMobile Health Record in 2001 is finally getting it to market. Users key in their medical history and med and get a health score in return. It will sell for 99 cents. If it’s the guy I’m thinking, though, he is loaded with credentials: orthopedic surgeon, president of the hospital medical staff, CMIO for a clinical guidelines vendor, researcher, and entrepreneur. I was prepared to make fun of the idea, but he’s got enough credibility to keep me quiet.

Other

A fired medical data technician sues University Medical Center (NV) for failing to accommodate her claustrophobia by forcing her to work in a cubicle. She has medical documentation backing her claustrophobia claims, so the hospital settled for $150,000.

Physician-run hospitals score 25% higher in quality measures than those where the CEO is a business school type, although the study can’t explain why other than perhaps physicians are truer to the core business of health.

KLAS reports that the number of live HIEs has more than doubled since last year, with private HIEs increasing more rapidly than public HIEs. The lack of traction of public HIEs is attributed to more complicated governance and concerns over long-term funding. Among HIE vendors, Medicity, RelayHealth, and Cerner ranked highest for private HIEs.

Weird News Andy is atwitter at this news, which he tags as “researching in 140 characters or fewer”: Hopkins researchers run two billion public tweets through software to extract those related to health, then analyze patterns related to allergies, flu, obesity, cancer, and other conditions. They believe tweets can help uncover public health information, but they recognize that users don’t get into much detail, they are usually younger and US-centric, and they probably won’t tweet about some health issues.

A federal appeals court upholds the 2009 conviction and 10-year prison sentence of former McKesson chairman Charlie McCall. His lawyers claimed he signed public filings and auditor letters without knowing that his acquired HBO & Company (McKesson paid $14 billion for it) was inflating revenue figures by improperly recognizing software revenue, but the appeals court ruled 3-0 that he knew exactly what was going on. MCK shares dropped almost by half the day the company announced its findings and still have not regained their pre-Charlie price more than 12 years later.

Somehow I missed this: Dennis Quaid keynoted at the 2009 HIMSS conference, talking about the heparin overdoses that nearly killed his newborn twins, but merged his Quaid Foundation with the non-profit Texas Medical Institute of Technology a year later.

Sponsor Updates

• Kansas City Business Magazine recognizes Perceptive Software as one of the city’s top 10 companies for global growth. Selection was based on company culture, community involvement, plans for growth, and commitment to employees. The company has grown its employee count by 40% in the last year.
• Aventura Hospital and Medical Center (FL) selects ProVation, a division of Wolters Kluwer Health, for gastroenterology and procedure documentation and coding.
• Sunquest is hosting its 2011 User Group conference July 11-15 in Tucson. New to this year’s meeting: an executive two-day conference, a session by the College of American Pathologists,  and a discussion of the lab’s role in ACOs.
• MD-IT is searching for a VP of sales and marketing.
• West Virginia Regional Health Information Technology Extension Center selects Greenway Medical’s PrimeSUITE as a prequalified EHR. 
• GetWellNetwork adds Jeff Fallon as VP of business development and national accounts.
• Capsule  is exhibiting at the 2011 HMS Regional Training and Exposition July 12-13 in Austin, TX.
• Holon Solutions appoints Worth Roberts to VP of sales for its eastern region.
• OptumInsight partners with RemitDATA to offer Remit Advice Professional, a Web-based analytics service for physician offices that analyzes health plan remittance notices and provides coding and reference tools.
• Symantec and Allscripts partner to offer an online privacy and risk assessment tool for identifying potential gaps in HIPAA and HITECH compliance.
• Wayne Memorial Hospital (NC) selects the Access Enterprise Forms Management suite to integrate electronic patient forms with its Meditech system.
• Webinar alert: a clinical analyst from Jefferson Regional Medical Center will share how his hospital used iSirona’s device integration solution to connect more than 40 devices to Sunrise Clinical Manager. It’s on July 20 at 1:00 PM EDT.
• The use of the AirStrip OB smartphone monitoring system by Rowan Regional Medical Center (NC) is profiled on a Charlotte TV station, with one OB-GYN predicting that its use could become a nationwide standard of care. AirStrip Cardiology goes live at Cedars Sinai and Texas Health Resources.

EPtalk by Dr. Jayne

I received a lot of feedback about Monday’s Revolutionary-themed Curbside Consult, including some historical corrections and the hilarious photo of Colonial Kermit. HIStalk readers are the best!

Dr. Jayne,

Terry

Duly noted. My reference used the word “adopted” to describe what the Continental Congress did on July 4. A handwritten draft was signed by John Hancock and Charles Thomson that day and was sent to be printed for distribution. As for the final product, the National Archives says that most signed on August 2, 1776. The Archives also notes that t “one of the most widely held misconceptions about the Declaration” is that everyone signed it on July 4, so I guess I’m not alone.

I’m glad to encounter another Molly Pitcher fan. I shamelessly admit that I dressed as her once for a patriotic event. Everyone thought I was Martha Washington, though. Maybe I should have put a cannonball wound in my skirt.

Dr. Jayne,

Weird News Andy

Andy always delivers and provided multiple links for my reading pleasure, which I will of course share. I remember this fact from World History and probably a Monty Python movie, but being in Colonial Mode must have suppressed it.

Emergency Medicine covers plague
EyeWitness to History and The Black Death
Attacking a Castle – also includes excellent coverage of fire, battering rams, and other mayhem

Several readers responded to my recipe solicitation. Here are a few submissions mixed with my personal favorites. And thanks to Janice – I took your advice,but instead of vodka/cranberry on ice with a blue umbrella (apparently my cocktail accessories are lacking),I threw in some blueberries.

Fourth of July Cocktails
Patriotic Cocktails
Twenty Red, White & Blue Cocktails
Five Red, White and Blue Cocktails (including the one pictured above)

No one seemed eager to share a potato salad recipe (what does the proportion of cocktail recipes to side dish recipes say about the average health IT reader, I wonder?) but one reader did share this link — and who doesn’t love a Web site called Killer Salad anyway?

Now, back to our regularly scheduled HIStalk feature …

It is the month of July, and the usual articles about avoiding medical mistakes and the perils of new interns starting rotations at academic medical centers (the “July Effect”) have started to show up. Prevention leads with  14 Worst Hospital Mistakes to Avoid, noting that most mistakes are medication-related.

MSN jumps right in with Don’t Get Surgery in July…, citing a 10% spike in fatalities in teaching hospitals during the month “confirmed by a new Journal of General Internal Medicine study,” but then saying the spike isn’t due to surgery anyway. It’s basically a hack of the Prevention article, so don’t bother going there. The article is actually from 2010 and the original source is available in PDF here.

Internship was bad enough when all you had to do was write your orders on paper, I can’t imagine walking in with CPOE on top of it. I’d love to interview a PGY-1 to get his/her impressions on healthcare IT but obviously can’t do it with one of my own housestaff. Anyone with friends just starting internship or are you a faculty member willing to serve up an intern? E-mail me.

Contacts

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

News 7/6/11

Top News

Management consulting firm Beacon Partners will announce Wednesday that it has acquired Healthcare Innovative Solutions (HIS), which offers consulting services related to clinical system implementation and workflow redesign. The ten-year-old HIS gives Beacon additional Siemens capabilities, adds to its CPOE expertise, and boosts its revenue and headcount by 15%. I did an HIT Moment With interview with HIS CEO Daniela Mahoney RN a few weeks ago. Congratulations to HIS as the latest in a long list of HIStalk sponsors to be successfully acquired.

Reader Comments

From NAFTA Doesn’t Work: “Re: Ontario. Healthcare informatics is at an all-time low here, with contracts based on who you know. I applied for a NAFTA-defined TN-Visa for professionals after being hired for a US contracting gig. No problem if you are a US citizen coming into Canada for EMR work, but if you try to go into the US, you are in for a chop-busting. Bring your degrees, transcripts, licensure, immunization records, and first-born child. An immigration officer berated me for being an RN and computer science graduate, saying ‘Seems like an odd combination, doesn’t it? Who would hire you anyway? Why are you trying to take jobs from Americans?’ Like it’s my fault your country can’t find enough people qualified to implement clinical systems based on the $19 billion ARRA commitment. Nothing like being stuck between a rock and a hard place.” We’re not very visitor-friendly here, that’s for sure, but that’s a 9/11 thing. We have a massive Homeland Security bureaucracy, along with a close-the-borders mentality that has caused quite a drain in technology expertise. I know from limited travels out of the country how unwelcome even US citizens are made to feel at immigration after short-term travel, so I can only imagine being a non-citizen trying to relocate here. I felt more welcome and respected in Russia than Newark.

From Mr F: “Re: The PACS Designer’s WebGL blurb. Key point left out: Microsoft won’t be implementing it in IE because they think it is inherently insecure.”

From Dakota Dan: “Re: Henry Ford Health System SVP/CIO Arthur Gross. No longer on their Web page.” His bio page has been removed, but that’s all I could turn up since I don’t have contacts there that I recall.

From Collard Greens: “Re: KLAS. To consolidate their ambulatory EMR categories, also looking to consolidate/drop research for other ‘non-profitable’ research segments.” I contacted Adam Gale, president of KLAS, who says you are partly right. KLAS is planning to reconfigure their ambulatory EMR categories to better map how those solutions are actually sold to the market. Something like, let’s say, small practices (1-10 docs), medium (11-50), and large (51+). Adam says the other half of your statement isn’t true, though: market need rather than profitability drives the research segments KLAS covers and they’re planning to continue rating mostly the same categories ongoing. It almost seems the opposite to me: they keep adding interesting categories.

HIStalk Announcements and Requests

Someone asked me at work today about the Stage 1 Meaningful Use rule for hospital clinical decision support. Since I had to look it up anyway to make sure I hadn’t forgotten something, here’s the summary. You have to implement at least one real-time alert and it can’t involve drug-drug interactions or drug-allergy contraindications. It must use information from the meds list, allergy list, demographics, or lab results. The rule must address something that’s of high clinical priority to the hospital and you have to be able to track compliance with the rule. If the rule is of the “don’t enter this order under any circumstances” variety, then the numerator could be calculated as: (number of times the rule fired minus the number of orders entered anyway) divided by the number of times the rule fired. Otherwise, you would need to electronically ask the provider if they changed their intentions based on the rule’s recommendation since you can’t assess compliance or rule effectiveness otherwise, unless you’re comfortable looking at overall ordering patterns for changes (and I wouldn’t be).

Thanks to new HIStalk Platinum Sponsor McKesson Paragon HIS. If you follow the industry, you know that Paragon is pretty hot stuff, named for five straight years as Best in KLAS in the Community HIS category. It’s certified, runs on a single database, is fully integrated (including clinical and financials), has low hardware costs, is intuitive and easy to use, and runs on pure Microsoft technologies (including SQL). Clinical modules include clinical assessment, CPOE, care plans, order management, meds, and results reporting. On the financial side, there’s patient management, AP/GL/MM/FA, payroll, resource scheduling, HIM, transcription, utilization review, and release of information.  Ancillary apps include pharmacy, OR, ED, rehab, radiology, lab, mobile phlebotomy, and micro. If you are a Meditech customer or prospect, McKesson would be happy to send you a white paper describing the benefits of Paragon for your consideration. I’ll throw in an observation that even though KLAS ranks it under the Community Hospitals category, I’ve heard from users first hand that it scales well to facilities up to at least 400 or 500 beds even though you don’t need a lot of IT people to run it, so don’t let that label scare you off. Thanks to the McKesson folks involved with Paragon HIS for their support of HIStalk.

Acquisitions, Funding, Business, and Stock

Cerner shares hit an all-time high Tuesday (at least it looks like it as I’m eyeballing the share price graph), closing at $63.00 and pushing the company’s market cap to $10.6 billion.

Chicago area- based Resurrection Health Care and Provena Health will merge their twelve hospitals.

Sales

University Hospitals Case Medical Center (OH) will deploy athenaCollector for its 1,000 providers. Its MSO is already an athenaCollector client.

Presbyterian Intercommunity Hospital (CA) signs a services contract with Zotec Partners to manage its radiology department’s revenue cycle.

People

Blount Memorial Hospital (TN) names Clay Puckett CIO and assistant administrator. He was previously senior director of IS for Carolinas HealthCare System.

Mathematician Robert Morris dies at 78, leaving a biography that should be made into a movie. He helped develop Unix, was a master cryptographer for the National Security Agency, led a 1991 cyberattack against Iraq before the first Gulf War, developed Unix security protocols in the 1970s that are used on Apple devices today, developed software that tracked enemy submarines and astronomical bodies, and warned Congress in 1983 that computer viruses were a risk but not likely to be created by children. He was proven wrong in that last assessment five years later when his own son’s worm program spread out of control and took down 6,000 Department of Defense computers (the lad is now an MIT computer science professor).

Announcements and Implementations

Legacy Salmon Creek Medical Center (WA) will go live on its $110 million Epic EMR by the end of September.

Government and Politics

CMS issues its proposed fiscal 2012 Medicare payment rules and suggests minor increases for most facilities and a whopping 29.5% decrease for physicians. Outpatient payments would increase 1.5%, ACS’s 0.9%, and dialysis facilities 1.8%.

Technology

Radiology site AuntMinnie runs an article on biometric ID,  mentioning palm vein scanning (PatientSecure), physician mobility (Imprivata), fingerprint ID (Digital Persona), and proximity biometrics (Proxense).

Other

Here’s Vince’s latest, this time on minicomputers and complete with names you haven’t heard in quite some time, like Burroughs, DEC, and Four Phase.

Epic ranks #1 in new HIT contracts for hospitals of greater than 200 beds. KLAS calls Epic’s track record of successful implementations “unmatched” despite lagging technology and a large price tag. Cerner was #2, with many of its new contracts involving new facilities for existing customers. The report finds hospital consolidation is increasing the interest in system integration.

Johns Hopkins Hospital (MD) will eliminate 160 clerical positions by the end of the year as the hospitals switches to electronic medical records. The hospital will try to reassign the workers, who had been responsible for order transcription and creation and maintenance of paper charts. A reader sent a note last week saying Johns Hopkins was moving to Epic for its ambulatory clinics; Mr. H predicts the move to Epic will be system-wide.

USA Today profiles Banner Health’s (AZ) five year-old eICU network, which relies on remote critical care specialists to provide guidance to onsite providers. Banner has invested $11.3 million in equipment for the telehealth system and estimates that over the last four years, the program has helped prevent 600 deaths, reduced days in critical care by 26,000, and cut hospital stays by 100,000.

AMA will draft model legislation for HIEs that will spell out who owns clinical information and who can view it. They seem concerned about insurance company ownership of HIE technology vendors (Aetna and UnitedHealth Group, which own directly or indirectly Medicity and Axolotl, respectively).

Would you trust your HIPAA compliance education to this company?

I thought of Dr. Jayne’s observations about the unhealthy lifestyle choices her patients often make when I read this article. A motorcyclist flips his Harley and dies of a head injury during an organized ride protesting mandatory helmet laws. Experts said the helmet he was illegally not wearing would have saved him. The event organizers, the state chapter of American Bikers Aimed Towards Education, announced that the rider “risked his all for freedom.”

Sponsor Updates

• Aaron Kaufman, GM and VP of Kony Healthcare, will speak at World Health Congress (MA) July 28-29.
• Clairvia leads the market segment in Staff/Nurse Scheduling according to KLAS 2011 Mid-Term Performance Review.
• CareTech Solutions launches its Zero Worries campaign to promote the company’s hospital IT help desk services.

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

Monday Morning Update 7/4/11

From Michigan Wolverine: “Re: Munson Healthcare downtime. At least the administrator was truthful about the ‘chaos,’ if not about the patient care.” The three-hospital Michigan system loses all connectivity to the world when a planned switch to a backup fiber optic circuit fails. Applications, paging systems, wireless devices, and their IP telephones all went down hard, requiring 4.5 hours for recovery.

From The PACS Designer: “Re: 3D Web browsing. WebGL permits 3D viewing if you use Google Chrome (coming soon to Firefox 6 ). TPD thinks healthcare may find the web 3D feature helpful in following the diagnosis of conditions, such as viewing a colonoscopy result along with healthcare treatment videos. An excellent example to view in 3D on Chrome is the WebGL Iceberg Demo. ”

From Peter: “Re: thoughts on Google Health. Brilliant, lucid, and real. Thanks, Mr. H :)” This comment came all the way from New Zealand, so I figured I could at least mention it (especially since I appreciate it).

From Ilya: “Re: Johns Hopkins. Going with Epic for ambulatory to start in a project called Ambulatory First, with a statement from the JHM CEO that ‘we will continue to look for systemwide opportunities for the Epic system to support our health care reform initiatives and goals.” Ilya sent over the CEO’s e-mail announcement, which also points out that Hopkins has more than a dozen patient records systems that are going away. I’m sure additional planning and approvals will be required, but the tea leaves seem to say that Epic will replace a bunch of Hopkins systems very soon, most notably Allscripts Sunrise.

From A CIO: “Re: job change. You recently mentioned my new job. Your reach across the industry is amazing. I’ve heard from people I haven’t been in contact with for years.” I really love hearing that since it’s a blast to get people reconnected just by mentioning them in some way. Maybe I should profile one reader each week with a mini-bio and a photo just to see who reaches out to them.

From McOffice: “Re: executive offices. I was in the office of McKesson CEO John Hammergren a few years ago. It was understated and functional like a working manager’s office, but the view of the Golden Gate Bridge was pretty sweet.”

From Lusitania: “Re: executive offices. McKesson executives in Westminster, CO have very modest offices. Only a few have line-of-sight to the Rocky Mountains – most just see cubicles or walls. The cubes on the west side actually have a better view. The largest offices only have room for an additional four-top conference table. Otherwise, even our lowest directors have offices that match in size and furniture quality (basic Office Depot mahogany).”

From Cam: “Re: executive offices. We’re in an old mill right on a river between two waterfalls with 20-foot ceilings, wood, and brick. We fish out the window. The CEO’s office is filled with Legos.” I love old mills on rivers, with rough brick and massive wood beams. Somehow it feels right to be working on something high tech in historical, industrial surroundings. Cam was less philosophical when I made that flowery statement in responding to his e-mail, replying with tongue in cheek that, “except our history has to do with exploiting children in a mill setting and we work for pediatricians .”

From Delbert: “Re: executive offices. Judy Faulkner’s is big, but unassuming. Prairie style with a desk area in one part and an almost living room seating area. It’s right by the entrance to one of the buildings, so visits arrive via a sidewalk that goes right by her windows. Definitely no evidence of pretense of wealth and power in her digs.”

From Antoine: “Re: executive offices. NextGen’s two executives share a single office. No parking space, no special bathroom, they swipe the same security card to get into the building. The SVP has the exact same office as her managers – no windows. Very much the NextGen vibe, modest and unassuming.”

From IntelliDoze: “Re: IntrinsiQ. After looking for several years, it finally has a buyer in ABSG (AmeriSource Bergen Specialty Group). The press release will come out Tuesday. All of the employee options are under water, but on the bright side, they will be asked to sign two-year non-competes! The only folks making money are private equity firm Accel-KKR, not a huge return, but happy to get any return after buying at the top of the market.” Unverified. IntrinsiQ makes the IntelliDose chemotherapy protocol management tool and oncology-specific data mining applications.

From Fess Up: “Re: nextEMR. Those guys are still showing the CCHIT 2011 logo on their site even after you reported that CCHIT ordered them to take it down. They simply didn’t receive that certification.” They now have both the ONC-ATCB and CCHIT logos on their site, so I guess that’s some improvement – they added the correct one, but failed to take down the incorrect one.

Happy Independence Day to my fellow Americans. Some contrarian US history: the Declaration of Independence was signed on July 4, 1776 when the 13 insurgent colonies that were at war with their own British government announced that they were illegally breaking off and starting their own country. It’s very much like when the Southern states announced their secession from the Union in the 1860s, except the British weren’t quite as brutal in using scorched earth force against civilians to keep their empire intact. It was their Vietnam, a humiliating defeat at the hand of cunning rebels that we celebrate annually with hot dog eating contests and China-sourced pyrotechnics. My flag is waving today to celebrate our country, even though its history (both old and new) is uncomfortably less virtuous than they teach in school. But in any case, happy Fourth of July, if you must call it that (and Merry Twenty-Fifth of December).

My Time Capsule editorial from five years ago this time around, squinting in the bright sun after being buried since 2006: Vendors Should Make Software That Crusty Night-Shift Nurses Can Love. I veered into an overly broad generalization about nurses and computers that will probably raise hackles all over again: “Looking over their computer shoulder is like watching your kid play tee-ball – you try to help them by sending powerful telekinetic messages (‘Press Shift-Tab … Shift-Tab’) or with surreptitious body English.”

Listening: Skins, almost new from Buffalo Tom, a Boston alt rock guitar band that has drifted in and out of obscurity since 1986, but has always been good. Great road trip music that also wins my highest and rarely awarded honor: it has gone on my gym MP3 player. 

A good Google Health epitaph from Zak Kohane at Children’s Boston: “Google is unwilling, for perfectly good business reasons, to engage in block-by-block market solutions to health-care institutions one by one and expecting patients to actually do data entry is not a scalable and workable solution.” Let me be clear in saying that Zak is brilliant (and not just because I know he reads HIStalk and would make a fine writer for it, hint hint). Check out this provocative  article in which he suggests that computers could replace doctors for a lot of the protocol-driven work doctors do, which probably elicited predictable “doctors aren’t fry-slinging teens working at McDonalds” knee-jerk reactions instead of thinking about his point – do we really need doctors to do a lot of what doctors do instead of more important stuff? (and he’s a doctor, so his opinion counts double, not to mention that the military already delivers a large amount of care, including that on the battlefield, using non-physicians who have undergone focused training):

We want our healthcare providers, and particularly our physicians, to be completely up-to-date across the exponentially growing knowledge base of medicine, from drug side effects to genomics. Yet, in this era of  “evidence-based medicine,” we also expect these same physicians to follow well-defined protocols (algorithms on paper or on in electronic medical record systems) so that each patient receives the care that panels of experts have determined to be best. Just as McDonald’s follows sophisticated but regimented systems to make and sell its French fries and shakes.

So, which is it? Is each patient encounter a potential virtuoso tour of the medical arts and biomedical applied sciences? Must each doctor be the equivalent of Todd English? Or is it enough that each patient receive an honorable, workman-like execution of the best guidelines that are available? It is becoming increasingly apparent that we cannot afford a model that claims both kinds of performance delivered by the same person with the same job description.

Welcome to new HIStalk Platinum Sponsor Covisint, part of Detroit’s Compuware. The company enables “information ecosystems” that allow all healthcare players to securely communicate and collaborate. Its ExchangeLink platform connects hospitals to other providers (physicians, post-acute, referrers) by supporting workflow-driven fax solutions, a secure inbox for online delivery, and document exchange with practice EMRs. It has all the pieces and parts built in: identify management, MPI, and record locator service, and is used by states and HIEs to share information on a large scale to improve quality and coordinate care. Covisint’s App Cloud offers third party apps for e-prescribing, lab orders and results, referrals, disease management, EMR/PHR, and others from names such as Epocrates, DocSite Registry, Ingenix CareTracker, Allscripts, Dossia, and DrFirst. The company just won a MSHUG innovation award for its work with Vermont Blueprint for Health in providing a central registry, clinical decision support, and a care team portal. Many thanks to Covisint for supporting HIStalk.

Here’s a Covisint overview video that I found on YouTube.

A Bloomberg Businessweek post by business intelligence expert Leonard Fuld reminds everybody that his war game simulation predicted that Allscripts needed to merge with another company to avoid becoming an also-ran (it’s not mentioned whether the simulation gave Allscripts the idea). Like many prognosticators, he doesn’t mention other predictions that may not have panned out, like those involving McKesson and GE Healthcare in the same scenario (or his March 2007 statement that “the all-powerful MySpace, with its 130 million-plus members, seems invincible.”) Still, he seems to know his stuff when it comes to competitive intelligence.

Texas Health Presbyterian Hospital Dallas begins RFID equipment tracking, citing studies indicating that nurses spend up to 15% of their time tracking down needed equipment. The 898-bed hospital says it’s saving $30K per month by avoiding equipment rental. The vendor is Intelligent InSites tied into a Skytron ZigBee wireless network. The hospitals plans to use more RTLS apps tied into its systems (Epic, TeleTracking, and Siemens Invision).

Tampa-based software vendor MedHOK releases 360ACO, an analytics solution for complying with proposed CMS ACO rules.

A reader sent over the JAMIA article that looked at “errors” with e-prescribing. I’d take it with a large grain of salt. The study did indeed use prescriptions from 2008, even though it’s just now being published. Since the retail pharmacies faxed over the de-identified prescriptions, they had no way to know which were truly e-prescribed vs. just printed off from a computer system. Potential ADEs included the potential of harmless issues, like rash or nausea. Most of the “errors” involved omitted or unclear information, such as how long to take the med (which was probably already discussed with the patient and assumed from the quantity prescribed). They also could not make any conclusions about particular e-prescribing or pharmacy systems and had no way to assess how practices implemented their systems or how physicians were trained to use them. To me, the only valid conclusion is that doctors could turn on more edit-checking capabilities of their e-prescribing systems to reduce inefficient clarification callbacks from pharmacies. I don’t see much patient safety impact. Unfortunately, the rags often pick up a story like this and run with it, adding misleading but sexy headlines and trying to make the conclusions seem more dramatic.

The numbers are unchanged from my 2007 survey: a scant 13% of the most healthcare IT-savvy people on the planet keep their medical information in a PHR. New poll to your right: who is most responsible for the lack of sharing of patient information?

This is strange: Walmart is donating the time of its 142 in-house lawyers to Medicaid patients of Arkansas Children’s Hospital, taking on the government agencies and schools that don’t provide those patients with the benefits to which they believe they are entitled. The company says it will be “facilitative” rather than “adversarial” to Medicaid. If you’re a taxpayer unhappy with the huge entitlement programs you’re funding through your labor, this is probably not the best news you’ve heard today.

Thanks to the companies that supported HIStalk in June by starting or renewing their sponsorship. I do nothing to solicit sponsors except to e-mail a little handout PDF that Inga and I threw together when someone asks for one, so I appreciate those that persist in overcoming our appearance of indifference to support what we do.

Unrelated, but kind of amusing: the hammy, preachy host of the endlessly re-run, 2008-cancelled To Catch a Predator (“Have a seat over there. What do you think would have happened if I wasn’t here and a 14-year-old girl was home alone?”) is himself caught on hidden camera as he engages in nocturnal hanky panky with a hot TV anchor 58% of his age and 100% not his wife. Unlike the sickos his show entrapped for almost-honorable reasons (not to mention ratings), he wasn’t unnecessarily pounced on by a dozen camera-hogging, Taser-wielding police officers as he tried to leave the hotel.

E-mail Mr. H.

News 7/1/11

Top News

  Third-party firms that implement vendors’ applications outperform the vendors themselves – except in the case of Epic. Deloitte earns the highest overall marks among third-party firms in KLAS’s survey. Coastal and Peer Consulting outscored GE in overall customer satisfaction by 30 or more points; ACS and Vitalize beat Allscripts by 20-plus points, and Encore and Vitalize outscored Cerner by 20-plus points. Epic outperformed them all.

Reader Comments

 

From Johnny “Hot Rocks” Garcia: “Re: making appointments online. Check out ZocDoc and take note of its investors!” ZocDoc allows searching for doctors within a ZIP code by specialty and accepted insurance. It’s pretty cool, although available only in eight metro areas so far. They have an iPhone app. Investors include The Founders Fund (run by the founders of PayPal, Napster, and Facebook), Jeff Bezos (Amazon) and the chairman and CEO of Salesforce.com. 

From Glenergy: “Re: Allscripts. A new general counsel – Jackie Studer from GE.” Unverified.

From Jordan: “Re: copied medical records. Kind of expensive for an electronic copy.” Texas Health Resources charges state-mandated fees for medical record duplication: $42.05 for the first 10 pages of a paper record, $64.07 if they’re on microfilm, and a flat fee of $76.20 for electronic records requested in electronic form. The state may set the price, but I would have to guess hospitals had input into the rather large numbers. That makes the paper statements of banks look like a great deal, although their free online option isn’t even offered by hospitals. Charging more for an electronic dump is odd, although if you’ve looked at a hospital chart, your $42.05 isn’t going to go far considering the stacks of paper that go far beyond 10 pages. Maybe they should just charge law firms 10 times that amount and let patients have copies of their own information at no cost. Most hospitals think they’re doing patients a big favor by letting them see what they’ve written about them.

From Viking: “Re: GE Healthcare. A marketing director friend had their job eliminated this morning, saying there’s a sweeping org change underway.” Unverified. GEHC doesn’t respond to personnel rumors, so I didn’t even bother asking.

From Terminator: “Re: PHRs. I wonder if their functions are gaining ground as standalone apps that people actually do use? For example, Walgreens keeps all my prescription records and I can access them from anywhere, so I have no reason to import them to a PHR. I use an online tool for diabetes logging, although it would cool if it were updated automatically from any meter I use. If I see a glucometer that allows batch uploads of data to a site like this one, I’m grabbing it! That’s all I want in a PHR except for lab data and the ability to communicate with providers, but patient portals are adding PHR-like features as well, some of which have access to data and have appointment-setting tools.” That’s the big debate – would consumers prefer an independent but minimally functional tool like Google Health or one that’s rich in function and data, but tied to a specific provider? So far, they seem to be saying B (and who can blame them, given that both are free?) Notice above that Walgreens even offers online pharmacy chat right from the public Web page, although it would be interesting to know who’s on the other end.

From LaidOffInDallas: “Re: UT Southwestern Medical Center. Just laid off several IT employees.” UT Southwestern just announced that, due to the loss of $31 million in state funding, it has cut 350 staff positions, laying off 105 employees.

From Former CIO: “Re: Epic art. I would suggest that Mr. Ciotti’s opinions about wasting client money are focusing on the wrong target. The vendors who are wasting money are those that spend more on marketing and less on development, thus producing products that are not integrated and do not support patient care needs. Perhaps the artwork enhances employee attitudes and they get more work done for the money. The cost of the product is a fraction of the true cost of ownership when one considers clinician time and effort. Even so, the cost of the product is still competitive.” At least Epic is sharing the investment with employees instead of hogging the goodies for its executives in a “we’re better than you” kind of way, such as companies that give the suits reserved parking spaces, private bathrooms, and offices that would hold 20 of the veal pen cubicles that the real workers toil in. I can’t vouch for Judy’s office since I haven’t seen it, but I picture it as quirky but modest. That’s a fun challenge: e-mail me with a description of the top dog’s office wherever you work – I will run them anonymously. If they have really splendid digs, make sure to snark it up some.

HIStalk Announcements and Requests

Stuff you’ll want to check out this week on HIStalk Practice: Micky Tripathi details the difficulties associated with tracking and reporting clinical quality measures for Meaningful Use. HHS halts its mystery shopper program for measuring access to primary care. Experts suggest reasons practices are behind schedule for the HIPAA 5010 transition. Dr. Gregg struggles with HITECH guilt and living on the dole. Costco jumps into the EHR world with deals on Allscripts MyWay. AAFP launches its $90/year clinical messaging system. While you are over on HIStalk Practice, sign up for the e-mail updates like the rest of HIT’s coolest kids.

Listening: reader-recommended Belle and Sebastian, 70s-style indie pop from Scotland. A nice sample is here, if you can overlook the fact that the preachy announcer sounds like Mike Myers playing the Scottish dad in So I Married an Axe Murderer.

I’m thinking about refreshing the look of the site and maybe even changing the smoking doc logo in some way. I’ve been using this layout for years, and while I don’t really care all that much one way or another, I guess it’s time for an update (I think Inga is interested). If you have ideas, let me know. Most of the responses I’ve received in the past have been of the “don’t change anything” variety, so that’s the default course of action to challenge. 

I’ll probably publish a Monday Morning Update even though it’s Independence Day (please call it that rather than the Fourth of July). You can amuse me over the weekend by connecting on LinkedIn and Facebook, signing up for e-mail updates, or just checking in to let me know that I’m not the only one with HIStalk on my mind. Have a great holiday. I’ll be taking a few days off starting next weekend, leaving the fabulous Inga and Dr. Jayne in charge.

Jobs on the sponsors-only Job Board: Director of Marketing – Hospital Segment, Director Sales Operations, Senior Enterprise Sales Executive Hospital Southeast. On Healthcare IT Jobs: CEO & President, Clinical Nurse Analyst, Epic Resolute Consultant.

Sales

Aspirus (WI) signs a clinical documentation contract for MedQuist’s DocQment EP.

University of Utah selects Authentidata Holding Corp. for its three-year telehealth project that includes health information exchange, workflow management services, and remote patient monitoring solutions.

University of Oklahoma chooses OmniMD as a preferred provider for medical transcription services.

VHA signs an agreement with Deloitte to offer RCM consulting services to its 1,350 not-for-profit community hospitals.

Ochsner Health System (LA) signs up for Philips VISICU, which will make it the first eICU program in the state when implementation is finished next year.

Announcements and Implementations

InterSystems names Gila River Health Care (AZ) the winner of its Breakthrough Applications Award for using InterSystems DeepSee BI technology with its Diabetic Analysis Management System.

Scripting automation vendor Boston Software Systems celebrates its 25th anniversary.

Medtronic announces a free smart phone app for its CareLink telemetry system for implantable cardiac devices.

Innovation and Research

Cisco announces its Android-powered Cius tablet, due out at the end of July, with the video above featuring Palomar Pomerado Health Chief Innovation Officer Orlando Portale (starting at around the 41 minute mark). The Cius will cost $700, has no 4G connectivity, has only a few dozen apps available from Cisco’s own store, and is sure to bring up the puzzled question, “Why would I want this instead of an iPad that costs less?”

Technology

Oracle will buy storage startup Pillar Data Systems for an undisclosed price. That company’s CEO and majority shareholder: Larry Ellison, who also happens to be the CEO of Oracle. He claims he recused himself from the acquisition discussions, although he didn’t mention why a guy with an Oracle-generated net worth of $40 billion was off running another company on the side.

Other

The developer of Nashville’s Medical Trade Center says it will not break ground until at least 60% of its space is leased. The developer anticipated this goal would have already been met, but a mere 20% of the space is under contract. Committed lessees so far include HIMSS, Steelcase, and mdi Consultants.

  A Florida doctor who moved to a cloud-based EMR a year ago loses access to the records when his Internet connection goes down. He’s been treating patients blindly for three days so far while Comcast tries to fix his broadband. I’ll predict that ONC won’t make his experience the focus of one of its feel-good EMR stories: “If can’t access a patient’s medical records, I’m afraid in the rush of things I might miss something or not do as good a job as I normally would.” His phones are down, too.

Note to companies seeking to become “leading” suppliers in healthcare: your message tends to be more powerful when you reference the correct vertical market in your press release (unless there’s a connection I missed between vehicle dealers and healthcare). 

I saw a press release about a survey claiming that more than 50% of consumers would choose a hospital based on their Facebook and Twitter presence. I found that hard to believe, so I e-mailed the company to ask for the methodology. They offered to provide it if I bought the report for $1,250. I guess I’ll just remain skeptical.

The coroner says mistakes made at Marin General Hospital (CA) helped kill an ICU patient. A doctor, a respiratory therapist, and three nurses were identified as putting the patient on a ventilator, then leaving the room without making sure it was working. It wasn’t.

A study of electronic prescriptions finds that about 10% contain at least one error, the same percentage as paper prescriptions. I only have access to the abstract, but I notice that (a) the electronic prescriptions reviewed were form 2008 for some reason; (b) the study treated all errors equally, with the most common being omitted information (which causes no patient harm); (c) it looked at “potential adverse drug events,” which could indicate lack of decision support on the e-prescribing end, but not necessarily (for example, I don’t know if they counted potential drug interactions as “errors” if the electronic prescriber of Drug A was the same one who prescribed Drug B, which is not necessarily either prescriber’s fault).

Weird News Andy says this man couldn’t have picked a better place to have a heart attack. He complains of chest pain during a cardiologist’s lecture on heart disease at Central Maine Medical Center, then collapses with no pulse or respiration. One of three cardiac nurses in the room jump starts him with a defibrillator, whereupon he is treated in the ED and is doing fine.

Strange: a former managing director of bankrupt investment banking firm Lehman Brothers is busted for trying to pass photocopied prescriptions for Oxycontin and Ritalin at the local drug store. Police follow his Range Rover to his $35 million home and arrest him.

Not healthcare related, but an indication of pervasive technology. The Pope tweets on an iPad to help launch a media portal. Yes, that Pope. You might want to friend him.

Sponsor Updates

• T-System celebrates its 15th anniversary with a five-video series about the history of emergency medicine and of the company.
• ADP AdvancedMD will expand its workforce by 45% this and add up to 100 new jobs in the Salt Lake City area.
• West Penn Allegheny Health System (PA) will continue its rollout of Allscripts EHR to its employed physicians and begin offering Allscripts MyWay to its 2,000 affiliated physicians.
• East End Health Alliance (NY) and its member hospitals choose MedVentive’s Population Manager for sharing clinical information and monitoring performance against evidence-based medicine. MedVentive also announces that former Massachusetts HHS Secretary Charlie Baker is joining its governing board.
• MEDSEEK enters a strategic alliance with Diebold to offer an automated patient check-in, co-payment, and appointment scheduling solution utilizing Diebold’s self-service kiosk.
• ZirMed earns its highest-ever rating in the most release KLAS rankings. In addition, 100% of its surveyed clients indicated they would buy ZirMed again.
• Indiana University Health Centers select eClinicalWorks for two campuses.
• Iatric Systems announces that its PtAccess, Patient Discharge Instructions, PHR Connect, Clinical Document Exchange, Visual Flowsheet, and PHI Interface solutions have received ONC-ATCB 2011/2012 Certification.
• Capsule’s DataCaptor medical device integration software earns a KLAS score of 90.5 with three Konfidence Level check marks in the 2011 mid-term performance review.
• Washington and Idaho Regional Extension Center (WIREC) includes e-MDs as one of the seven vendors chosen for its initial Group Purchase Program.
• LawLogix joins Perceptive Software’s partner developer network to offer a central document repository with forensic-level audit controls using Perceptive’s ImageNow software, allowing HR departments to manage I-9 and E-Verify compliance requirements.
• A new KLAS report on HIEs names MobileMD as the highest-rated vendor serving the private HIE market segment.

EPtalk by Dr. Jayne

Multiple news outlets (including HIStalk Practice) picked up the announcement that the Department of Health and Human Services is scrapping its “Mystery Shopper” initiative, originally aimed at determining whether physicians’ acceptance of new patients depended on type of insurance. Observant folks will notice they left the door open to bring this one back later though, stating, “we have determined that now is not the time to move forward with this research project.”

I don’t need a bunch of grant money to tell you the answer to the question of “can you get seen quicker with good insurance” is “yes.” And if we’re talking about specialist physicians, the answer is “double yes.”

I practice in a major metropolitan area with multiple health systems, numerous tertiary referral centers, and some topnotch medical schools. From experience, if you are a Medicaid patient who needs to see an orthopedic surgeon or a neurologist, there less than a handful of places that will see you at all, and even then you’re going to wait. Most likely, you’re going to wind up being seen in a residency clinic.

I’m fortunate to work for a health system that doesn’t force employed physicians to cap Medicaid patient panels — we have a mission to care for those in need. As a result, I do more than my share of Medicaid care compared to my private practice colleagues, who may cap at 150-200 Medicaid patients if they even take Medicaid at all (and many don’t). Reimbursement doesn’t cover the cost of the visit, and frankly, I don’t remember the last time my practice made a profit. If not for the mission of the health system and their generous subsidy, I’d have had to go out of business before I ever had a chance to make a go of it.

There are some patients who are working the system, but the majority of my Medicaid patients are folks that have fallen on hard times or have had other life-altering events such as an unplanned pregnancy or a severe medical issue impact their lives. Some of the most rewarding patient relationships I have are with these patients, who are genuinely appreciative of the care they get.

I practice evidence-based medicine and don’t refer unless I have to. It breaks my heart to have patients waiting six months or more to see a specialist when I know that if they had a commercial payer, I could get them an appointment within a few weeks. I’ve been forced to expand my scope of practice because specialists won’t see Medicaid patients. It’s almost like being the Little Doctor on the Prairie when in fact, I’m just a few doors down from Starbucks.

(And thank you to my “generous” specialty colleagues willing to proctor me in expanding my procedural techniques because you didn’t want to actually see the needy patients yourselves. Guess what? I don’t just do them on Medicaid patients now — I keep all the procedures in-house.)

I’d be happy to charge CMS, HHS, or anyone else willing to listen a hefty fee to tell them how to increase access for Medicaid patients. States such as Colorado are already at critical shortages of primary care physicians. Articles such as this should be required reading for the politicians deciding how to carve up the healthcare pie. Some ideas:

• Increase the attractiveness of the primary care specialties by increasing Medicaid and Medicare payments for primary care and other cognitive (non-procedural) specialties. The relatively low primary care salaries — coupled with hefty administrative burden, constant on-call and hospital work, and rising patient expectations — are no match for the financial lure of other specialties.
• Increase loan-repayment plans for primary care and/or offer more zero-interest loans for these disciplines. Most of my classmates came out of training with at least a quarter of a million dollars in student loans. Unless you have a vocation for primary care, a salary of $300-$400K each year looks a lot more welcoming than the $130-$140K primary care starting salary when you’re sporting a student loan payment that’s more than most mortgages.
• Increase the availability of case managers, care coordinators, dieticians, health coaches, and social workers for Medicaid patients at no cost to the physician. Don’t tie it to some ACO-type scheme. I promise with this infrastructure, if you build it they will come. (My apologies to William Kinsella for shamelessly poaching your line.)
• Remove administrative barriers for care of medically and/or socioeconomically needy patients, regardless of payer. In addition to the above, remove the requirement that physicians pay for translator services for patients and reimburse this through payers, public or private. I’ve paid over $450 for interpreter services for a visit that I was paid $24. And this is a patient that needed to come in every month because they were complicated – it was a minimum of $150 to get the interpreter to come. Thank goodness my health system is willing to subsidize this, because most private docs don’t have the luxury.
• Reduce the administrative burden related to health IT initiatives. If you’re going to require something (like submission of data to an immunization registry or submission of syndromic surveillance data) ensure that the states actually have an infrastructure to receive the data. Do not send me on a pointless mission to contact department after department across multiple states trying to find someone who has any idea what I’m talking about, only to find out my state can’t accept either kind of data.
• Make quality initiatives make sense. Micky Tripathi’s Pretzel Logic: The Quality measure Conundrum says it all. Most clinicians want to give good quality care. But when it becomes so complicated that the average physician is torn between the spirit of the incentive program and the somewhat malleable calculations to demonstrate it, there are a good chunk of docs that decide it’s just not worth it.
• Understand that the push for healthcare IT has actually made it easier for providers to “cherry pick” the healthy patients or “lemon drop” those that are non-compliant or have poor payers. Back when we had paper charts, it was a lot of work for providers to weed those patients out. Now docs can report on them on a monthly basis with the click of a mouse and decide which patients are too difficult to manage. Probably not what was intended, is it?

So even though it’s dead for now, I’m taking bets on how long it takes the Mystery Shopper program to show itself again. Any takers? E-mail me.

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

News 6/29/11

Top News

French IT services vendor Capgemini is looking for IT services acquisitions in the US, particularly in the healthcare sector. Says the CEO, “We are a marginal player in several of the key markets. For instance, we are non-existent in healthcare in the US, which I think is a mistake. So we need acquisitions.” You may recall that Cap bought Ernst & Young Consulting in 2000, stuck their name on it (above), then sold it to Accenture five years later after losing a ton of money. I worked with E&Y quite a bit at a previous hospital employer back in their heyday and they were excellent for strategic planning, IT governance stuff, and security work. I had a couple of occasions to work with Cap and they were clueless.

Reader Comments

From Susan: “Re: Kettering Medical Center (OH). Went live on Epic May 1 on inpatient, ambulatory, and revenue cycle.” The video is here.

From CloseToEpic: “Re: Epic. Heard from a Madison, WI apartment owner that Epic has hired approximately 2,000 new employees who will be starting end of summer. Apartments filling up around Madison.” Unverified, but reasonable.

From WildcatWell: “Re: Google PHR dead. Told ya so. Give a brother some love! Your EMR/EHR insight is THE industry leader. Let’s get all your readers together – I’ll buy the first round.” WCW is a good information source, but I notice that his drink offer was made anonymously.

From Academic CIO: “Re: HIStalk’s eighth birthday. You have really created a resource that, on top of the insight, information, and perspective you deliver, has replaced the trade mags we used to read to try to get a handle on what was happening in the industry (and which were really only giving the vendor-approved view anyway).” I really appreciate those kind words – thanks. The best part about it is getting to connect with some really interesting people and to help bring a variety of opinions to the table.

HIStalk Announcements and Requests

Inga’s taking a semi-break, so I’m soloing this time around. She’ll be back shortly.

Vince Ciotti poses this (easy) question: “What vendor spends (wastes?) the most of its clients’ money on extravagant architecture and frivolous artwork?” Examples above from Vince’s collection.

Ed Marx added an update to his June 15 post with responses to reader comments.

Sales

Sentara Healthcare (VA) contracts with TeleHealth Services for its interactive patient education solution.

SSM Health Care (MO) contracts with revenue cycle solutions vendor Passport Health Communications for SaaS-based eligibility and financial screening solutions and services for its 15 hospitals.

People

Practice Fusion names Cora M. Tellez to its board. She’s the former president of Health Net and CEO of Blue Shield of California-Bay Region.

Mark Lederman, formerly VP/CIO at Interfaith Medical Center (NY), has been named VP/CIO at Chilton Hospital (NJ). We swap e-mails occasionally and he sent over the update, so congratulations to Mark.

Announcements and Implementations

UMass Memorial Health Care (MA) integrates MyCareTeam’s MCT Clinical diabetes management system with its Allscripts ambulatory EHR, enabling patients to upload their glucose readings.

Chicago mayor Rahm Emanuel announces that Allscripts will add 300 new jobs in the city by the end of 2012. The company will also host its annual user convention at McCormick Place starting next year.

UPMC implements Oracle GoldenGate with Cerner’s 724Access software to help reduce potential EMR downtime.

A Bama Buddy find: a hospital reports that a batter’s box-type outline made of duct tape outside the rooms of infected patients helps reduce infections, reminding employees about contact precautions and giving them a safe zone in which they can still interact with patients without gowning up.

Allscripts announces Allscripts RCM Services at HFMA, which it describes as a cloud-based, outsourced business office for physician practices that is charged as a percentage of monthly collections.

Government and Politics

CMS selects The Lewin Group for a project to reduce the number of hospital readmissions for Medicare beneficiaries and improve quality outcomes for patients transitioning from hospitals to other care settings. The company, which is part of OptumInsight, will receive $2.3 million for the first year of the five-year program.

California lawmakers put together a bill that would require clinicians to flag any information they change in electronic medical records. The bill originally required all changes to be identified by user and to let patients see changes to their own records, but those requirements were removed after big healthcare organizations expressed their opposition that California’s standards would then differ from federal standards.

Innovation and Research

Deborah Peel MD of Patient Privacy Rights sent a link to this story about Personal, a soon-to-be-launched site that lets consumers store information about themselves and then sell it to commercial organizations willing to pay for it. It’s 100 “gems” include such information as when your next oil change is due and what kind of food you like, which they’ll broker on your behalf for 10% of the proceeds. It has some big-time financial backers. Her interest: something like that could give consumers control of their healthcare information, which is being freely sold without their consent for purposes not necessarily in their best interests. It could be used like a PHR, where people enter information that could be made available to sell (to companies) or to providers (for free).

Technology

The Robert Wood Johnson Foundation introduces an online directory that includes performance measurements for hospitals and doctors. It links 197 reports with information on outcomes, cost of care, and whether patients received recommended tests and treatments.

Other

The LA Times picks up the story reported here awhile back, in which a premature baby was killed by sodium chloride overdose due to a data entry error into a hospital pharmacy’s IV compounder software. The article tries to link that human error to IT safety in general, but the problem really was a lack of IT: Advocate Lutheran General Hospital apparently had no interface between its pharmacy system and the compounder software, so they let unlicensed personnel (pharmacy techs) do the manual data entry, where it’s pretty easy to accidentally swap the values of the electrolytes (although properly installed software should have given a warning). I’ve seen that problem first hand (unfortunately) and developed a simple but elegant solution (fortunately). If you’re a CIO, e-mail your pharmacy director and ask how IV formulas get to Abacus or whatever IV compounding software your hospital uses and whether they have warnings set up in it.

1-800 Labwear brings out a lab coat with outside pockets specifically designed to hold an iPad (which they spell incorrectly).

Sponsor Updates

• Kony is named the Most Innovative Company of the Year by the American Business Awards in the technology company category.
• Hayes Management Consulting adds a Regulatory and Compliance services division that will focus on federal healthcare mandates, HIPAA billing and security policy, EDI V5010, and ICD-10. Anita Archer will lead the division.
• Northeast Valley Health Corporation (CA) and Community Health Center Network (CA) are among 32 community health centers to select NextGen EHR solutions.
• Vitalize Consulting Solutions earns an average score of 88.62 in its five service areas as measured by KLAS in its mid-term performance review.
• T-System celebrates its 15-year anniversary.
• Northern Virginia Regional Health Information Organization (NoVaRHIO) launches a pilot program with Picis that will allow ED clinicians from Inova Alexandria Hospital ED clinicians to quickly access prescription information.
• Medicity’s Health Information Exchange Solution for hospitals receives Federal Certification for meaningful use.
• Inland Northwest Health Services announces that the Spokane Virtual Lifetime Electronic Record (VLER) pilot is now enabling the secure exchange of electronic health information using the Nationwide Health Information Network (NwHIN) Exchange. The use of VLER improves the portability of health information to Veterans and active duty Service members in the Spokane, WA area.
• CMS awards the Medicare Part D Transaction Facilitator contract to RelayHealth.
• Orthopedic Institute (SD) chooses the SRS EHR  for its 38 specialty providers.
• East Liverpool City Hospital (OH) goes live on ChartMaxx by MedPlus.
• Thomson Reuters launches Infection Xpert, a clinical intelligence dashboard that combines real-time clinical surveillance information, patient information, and patient-specific reference content from Micromedex for reducing and managing hospital-acquired infections.
• Nashville’s 211 Call Center health navigator program, operated by Family & Children’s Service, chooses MyHealthDIRECT to allow operators to connect callers with available area providers specific to their needs, including the ability to search available provider appointments.
• Ness County Hospital (KS) goes live on the ChartAccess Comprehensive EHR from Prognosis Health Information Systems just four months after its selection. The hospital plans to meet Stage 1 MU requirements by the end of the year.
• Main Line Health (PA) signs a five-year extension with MobileMD for its 4D health information exchange service, which it has used since 2007 to connect four hospitals and more than 30 practices to create a virtual complete medical record.
• Workforce management software vendor Concerro licenses two labor analyses tools from Workforce Prescriptions to allow it to offer labor efficiency review services that cover scheduling practices, agency use, care delay causes, and policies that impact labor ability. Hospitals average $7 million in annual realized savings from labor misalignment. The company’s take on labor management is covered in its blog, with the latest topic being the complexity of managing hospital labor costs.
• NCR is exhibiting at HFMA this week (Booth 1420), talking about self-service solutions that improve efficiency, cost, and revenue cycle.

More Thoughts on Google Health

Nobody’s really disappointed or even surprised that Google Health is dead (actually, few have even noticed, which tells you all you need to know about its problems). The only surprise is that such an unenthusiastic effort came from one-time paradigm-buster Google in the first place.

Actually, maybe the biggest surprise is that Google is shutting Google Health down in an embarrassingly public raising of the white flag. It would be one thing if they were spending a lot of R&D money on it, but there’s no evidence of that. The app is somewhere between simple and ugly, announcements of new functionality or connectivity have come along once in a blue moon, and no lofty promises were made that it would ever be anything more than it was. Given that GOOG’s market cap is $156 billion, and that pretty much nobody was using Google Health anyway, maybe they should have just abandoned it to die quietly instead of convening a very public funeral, raising ugly questions about the cause of death.

The only real traction Google Health got was among folks who wanted to see a brash, smart, and well-funded upstart barge its way into the healthcare IT vendor mix, elbowing out the companies that have been around for decades to shake them out of their maddening complacency. In that respect, Google ironically did what the non-healthcare IT vendors are sometimes blamed for doing: it laid down a smokescreen of rosy PR, under-delivered on even modest promises, ignored the advice that users and experts were giving, and then just cut and run when the going got tough, another healthcare dabbler that should have known better.

I thought Google Health would do OK, if for no reason other than the company seemed committed to hanging in there, at least initially (they threw the stereotypical launch party at HIMSS, then went silent). But the signs were there. The inexperienced folks they put in charge were replaced by even less experienced folks. Their HIMSS booth was a joke, an empty table with a few black-and-white photocopied half sheets of paper handouts. They didn’t make any acquisitions; they didn’t create any innovative technologies; they didn’t differentiate themselves publicly from HealthVault; and they made no apparent attempt to flex their muscle with the providers, EMR vendors, and insurance companies that were sitting on the key asset needed to make their product fly: data.

Sometimes visionary companies can create a market by thinking big and solving a problem consumers didn’t even know they had (MP3 players and Facebook, for example). This wasn’t one of those times. Google Health was a solution looking for a problem, much like its high-flying and equally dead stable mate Google Buzz. If nothing else, Google Health proved that Google is just as fallible as arch-rival Microsoft in thinking it understands what customers want without bothering to actually ask them.

Here’s my epitaph for Google Health, not as a PHR expert (which I’m not, since I have little interest in them) but as an average consumer/patient.

1. Google knows just one business: pushing ads in the faces of users willing to tolerate them in return for getting free access to some reasonably useful Web tools. Without large numbers of eyeballs, Google wasn’t interested, and without those useful tools, neither were the eyeballs.
2. The Google Health model required massive uptake to be successful by its standards, but it was designed to address the health needs of the vocal 2% rather than the indifferent 98%. Hospitals learned that lesson long ago – if you want doctors to use CPOE, you aim your technology at the average doc (busy, struggling, and administration-suspicious), not the geeked out, administration-friendly CMIO who has little in common with them other than wearing a white coat but who sometimes can dangerously convince everyone else they speak for the majority (not like Dr. Jayne, in other words, who actually practices medicine and uses the systems she supports).
3. When it comes to healthcare, consumers are not empowered, and no amount of technology will change that. They have a tiny bit of discretion when it comes to choosing a doctor, but almost none when choosing a hospital or insurance company. Cool Web tools or not, Joe Sixpack has no leverage over the massive bureaucracies of the average academic medical center or insurer.
4. Those massive bureaucracies suck big time at managing their own data. The last thing they want to do is (a) share their crappy and unreliable information with patients, or (b) import unvetted patient information from some other source and then have to figure out what to do with it since they are paid for piecework, not thoughtful reflection of piles of information.
5. “Health” is a good thing that everybody wants for everyone else, but “healthcare delivery” is a cutthroat fight for the financial pie. Collaborative tools are tough sell when the folks at the table are trying to stab each other in the back without being noticed, but especially so when Google didn’t even seem interested in working with them.
6. The average person (be careful who you picture – the masses are not healthcare- or IT-savvy) sees his or her own healthcare as someone else’s problem. They get sick, they use someone else’s money (insurance) to see a provider, they want immediate gratification from pills or surgery, they aren’t interested in information or recommendations of lifestyle changes. Few of them study the government’s dietary recommendations, interface their bathroom scale to a computer program, or participate in online support groups. They just want to be left alone, secure in the knowledge that their poor health choices can be overcome by an insurance-assigned doctor or hospital. Any suggestion that electively unhealthy folks pay more for their healthcare than electively healthy ones is met with cries of discrimination. The only way to get their attention would be to pay them to take better care of themselves, just like giving your kid $10 for each A on their report card.
7. Only a tiny number of zealots will accurately and consistently enter their health information into an online shoe box. Not only is it work, there’s no apparent payoff since most providers don’t have the time or interest to read what those folks entered (partially because the technologies they use don’t play well with others any more than those providers themselves).
8. Consumers use technology for three reasons: it provides them with emotional satisfaction (Facebook), it offers them convenience (Amazon, paying bills online), or it saves them money (eBay, Groupon). Google Health and most PHRs offer none of these benefits.
9. Addressing the convenience aspect requires removing the friction of healthcare delivery system transactions. They are horribly inefficient, often because the doctors, hospitals, and insurance companies themselves are horribly inefficient (which lends credence to the argument that arming either Joe Sixpack or providers with a lot of technology doesn’t necessarily make things better, particularly when it comes to patient outcomes).
10. Nobody really trusts big companies all that much, and people are especially suspicious of who sees their health information. Geeks might trust Google with their entire identity, but the average person probably won’t.

Now is probably a great time to retire the term Personal Health Record. It had a questionable premise to start with, but now Google has tainted it as being a plain, static Web page that’s about as fun to use as TurboTax and a whole lot less useful.

I’m an average patient and I want nothing to do with a Google-like PHR. What I want is to be able to:

1. Make electronic appointments, including being able to search for openings at multiple locations or among competing providers. I don’t want to have get on the telephone or compose an e-mail.
2. Request prescription refills.
3. See my lab results as soon as they are available, with a personalized explanation of what they mean.
4. E-mail my doctor and get a timely response.
5. Get specifically requested information to my doctor efficiently, and know that he’ll ask for the information he needs, it will remain on file in case it’s needed again, and I’ll have a say in the decisions made from it.
6. Get automatic reminders for EMR-triggered events (vaccinations, next physical exam due, etc.) but with the option to suppress those that aren’t helpful.
7. Manage someone else’s health with their permission, such as a child or parent.
8. Earn an insurance or treatment discount for following recommendations that result in measurably improved health.
9. Solicit bids or search prices for services not covered by insurance.
10. View any health information recorded about me with an efficient mechanism to correct any errors.

The average PHR doesn’t do most of these things. They can’t unless providers, insurance companies, and EMR vendors can be convinced to work together. Patients don’t have the sway to make that happen. Employers might, or perhaps some kind of government mandate.

Short of that, PHRs are going to struggle since, by definition, they are trying to bring competing parties together electronically without giving them an incentive to do so. That leaves PHRs as little more than a spreadsheet on which a few consumers can record their own information that nobody will look at.

Many folks who cheerlead for PHRs do so with a vested interest instead of as a consumer. So here’s the challenge to those inclined to comment on this post: instead of the usual pedantic posturing about PHRs as a technology or a business, tell me how YOU PERSONALLY use a PHR, what benefits you’ve received, and what you wish it would do. The “experts” can’t stop talking about Google Health, but none of them so far has admitted actually using it or any other PHR.

Contacts

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

Experian To Acquire Medical Present Value for $185 Million

Ireland-based financial information and technology vendor Experian announced this morning that it will acquire Medical Present Value for $185 million in cash. The Austin, TX-based MPV offers revenue cycle services to providers that include eligibility verification, patient-friendly statements, credit scoring services, and claims software.

MPV, which has annual revenue of $45 million, will become part of Experian’s North America Credit Services division, which offers services for running small businesses. The company’s other healthcare product is SearchAmerica, a 2008 acquisition that evaluates patients for their likelihood of payment and eligibility for financial assistance programs.

Dan Johnson, president of Experian’s Healthcare Services, was quoted in the announcement as saying, “Healthcare providers in the US face growing challenges when it comes to billing and collecting payments for services. With the addition of MPV, Experian is able to provide a more comprehensive set of products and services across the healthcare payments life cycle and help clients manage multiple vendors through a single point of contact”

MPV was founded in 1998 and serves more than 75,000 providers. Its principal investors are Rho Ventures, CenterPoint Ventures, Star Ventures, and Care Capital.

Monday Morning Update 6/27/11

Google makes it official: the company is shutting down three-year-old Google Health on January 1, 2012. Google predictably did what its know-it-all technology company predecessors have done over the years: dipped an arrogant and half-assed toe into the health IT waters; roused a loud rabble of shrieking fanboy bloggers and reporters (many of them as light on healthcare IT experience as Google) who instantly declared it to be the Second Coming that would make all decades-old boring vendors instantly obsolete or subservient to the Googleplex; and then turned tailed and slunk off at the first sign of lackluster ROI, leaving the few patients and providers who actually cared high and dry except for those same old boring vendors who have stuck it out for decades instead of chasing whatever sector looked juicy at the moment.

Why did Google Health fail? Simple and obvious: consumer demand for personal health records is close to zero, which has always been the case and probably always will be. Convincing patients to take the time and effort to maintain PHRs is as tough a sell as convincing doctors to voluntarily use CPOE, and for the same reasons: those doing the work don’t get much benefit. Patients don’t want to maintain their own records and clinicians aren’t about to trust patient-maintained information for making treatment decisions (not to mention that taxpayer-incented HIEs and Epic’s MyChart are stealing their thunder by not relying on patient-powered sneakernet in the first place). PHRs aren’t fun. They don’t accrue Farmville points, you can’t put pictures of your cat or a funny YouTube video on them, and you don’t get HITECH money for typing in your weight every now and then. The only model Google knows involves near-universal adoption that gets advertisers salivating, not having a tiny contingent of wellness buffs and savvy chronic disease suffers using their free online service. Ultimately, Google’s problem is that an awful lot of Americans care about reality TV and celebrity gossip more than their health. They’re more interested in patch-me-up-doc “healthcare” than I-need-to-make-better-choices “health” that requires proactive electronic tools. The most shocking aspect of Google Health’s announcement in 2008 was either that Google hadn’t figured that out or that they thought they could succeed anyway.

Want to bet that Google will come crawling back to healthcare one of these days when earnings start to slip? That’s what generally happens with those short attention span technology vendors. Like Microsoft before it, Google has gone from a dominant force that can do no wrong to a clearly fallible company that makes a ton of money, but that often is more of a follower than a leader with surprisingly routine and easily predicted product failures. And speaking of Microsoft, I’m not sure whether Google Health’s timely death is good news or bad for HealthVault, a better product, but still facing the same uninterested market even with the loss of its only high-profile competitor (advantage: Dossia?)

It’s OK to include scanned documents in an EMR, say 86% of respondents, while a less-forgiving 14% of purists say no way, electronic doesn’t just mean electronic, it means discrete data only. New poll to your right, in honor of the dearly departed Google Health: do you keep a current and medical reliable electronic Personal Health Record? I asked that same question in 2007, when 88% of the most technologically and medically savvy people in healthcare said they did not (maybe Google should have taken those results as one of those warning cow skulls in the desert).

Suggestion to anyone claiming to be an insightful Epic expert: your credibility will be enhanced if you spell the company’s name right (it is not EPIC).

A company approached me about sponsoring the HIStalk reception at HIMSS next year (I love that I don’t have to troll to get companies interested since I don’t have the time or inclination to do that). I found out from those folks something I hadn’t noticed: HIMSS has completely screwed around with the Las Vegas conference days, with the pre-conference stuff starting on Monday (Saturday is now Monday, in other words) and the sessions run Tuesday through Friday (so everybody will need to bail out for home on Thursday instead of Wednesday). Great – now you can’t do a Saturday night stay when trying to find a cheap flight and we’ll either have to travel with all the other business schmos on Monday or fly out a day early. They’ve moved my cheese and I’m unhappy, but I’ll get over it. So, despite my concluding HISsies slide from Orlando, the reception is probably not going to be Monday night if I decide to do another one. If you’re slotted to present a Friday session, you might want to plan for a roundtable instead of an auditorium.

I am absolutely loving Vince Ciotti’s HIStory series. He’s getting lots of e-mails and kudos, even from 20-something HIT sprouts who understand the “doomed to repeat history” thing and figure they can learn from the pioneer diaries. Vince recently had calls from Jim Pesce (McAuto) and Mike Kaufman, who are following his series and contributed to the installment above (I’m really impressed with Mike’s history since I didn’t realize his deep roots when he and I have exchanged e-mails over the years).  E-mail Vince if you have some history inside your head or on paper that would round out his recollections. The industry goes back to the late 1960s (Meditech was formed in 1969), so with 40-plus years having gone by, it’s time to document some of this stuff.

Speaking of Mike Kaufman, in Googling to see what he’s up to, I see that he, along with fellow former Eclipsys SVP Hans Boerma MD and money guy Frank Panaccio formed KBT Partners, which offers advisory services to healthcare IT and related companies.

I’m also quite enjoying the work of Micky Tripathi in his monthly Pretzel Logic column on HIStalk Practice. His writing is fluid and personal (not to mention entertaining) and he’s obviously an expert in all things EMR (fortunately, since he’s the president and CEO of the Massachusetts eHealth Collaborative). I just posted his Quality Measures Conundrum piece and it should be required reading for anybody who cares about EMRs or Meaningful Use.

My Time Capsule editorial this week from 2006: Medical Equipment Sales Boom While Health IT Struggles. A snip: “The takeaway message is that, science aside, doctors and hospitals will utilize the hell out of something when they’re paid to do so (equipment, drugs, supplies, and for-profit referral centers). While it’s nice if patient care is improved, it’s only mandatory that it not be worsened.”

A Harvard Business Review working paper covers why creative tension among company executives can be a good thing. One of its examples is Misys CEO Mike Lawrie, who in 2008 insisted that the company’s open source division not be rolled into Allscripts but rather allowed to compete with it for resources, which supposedly benefited both groups.

Speaking of Misys, the company offering to buy it is revealed as Fidelity National Information Services, a Jacksonville, FL-based bank technology firm that has a healthcare division (benefit administration, PHR, consumer health portal, ID cards, lockbox, revenue cycle).

Weird News Andy revives this story: mourners filing past the coffin at a Russian woman’s funeral are startled when she raises up and begins screaming, not nearly as dead as the local hospital had said. The funeral-goers’ time wasn’t wasted, however: the woman had a heart attack from all the commotion and died minutes later in the same hospital.

A survey finds that no surveyed physicians in the UK, New Zealand, Canada, and Sweden said they practice defensive medicine, compared to the 92% in the US who admit to letting fear of lawsuits drive their medical decisions.

CapSite releases the Lite version of its database, strictly for providers and hospitals. The Web-based tool provides access to thousands of contracts and proposals from peer institutions, complete with pricing and T&C covering 800 vendors in HIT, imaging, medical devices, and services. It’s free for 30 days and the company is signing me up to check it out, so I’ll be interested to snoop around since I love looking at contracts.

Athenahealth buys Point Lookout Resort and Conference Center, 396-acre, $7.7 million property near its Belfast, Maine operations center, which it will use for client and employee training. The facility overlooks Penobscot Bay and has 106 cottages, a bowling alley, and a beach. I’m thinking we need an HIT geek summer camp, complete with marshmallow roasts, snipe hunts, and furtive ukelele-inspired groping around the campfire.

OptumInsight (formerly Ingenix) is awarded a patent for its LifeCode natural language processing technology, which can extract content and context from electronic medical records. That technology runs the company’s computer-assisted coding applications,  which the company says can ease the transition to ICD-10.

I’m pleased with this find since I’m thrifty (cheap, some might say, including someone with whom I share a bed). I take low-dose lisinopril for blood pressure (my BP is only 115/55, but my doc likes me to take it for some reason). I thought Walgreens offered $4 generics, but they don’t any more, so they charged me $10 for 30 tablets. I looked for alternatives and found that not only does Walmart offer a long list of maintenance meds for $10 for a 90-day supply, but mail delivery to your door is free. That is Walgreens Strike 2, the first being that they charge almost $50 for a vial of Canine HIStalk’s insulin while Walmart sells their custom-relabeled Novo Nordisk insulin for only $24.88. We may have a healthcare crisis in this country, but it would be a heck of a lot worse without Walmart (at least now that they offer health insurance to more of their employees).

Atlanta-based startup Digital Assent, which developed the PatientPad ad-powered patient check-in tool for practices, raises $7.5 million in a Series B funding round. The founders came from Sythis, which developed an interactive selling solution that licensed its technology for PatientPad.

Sad: a hospital-based physician finds that someone is checking out porn and Googling phrases such as “rat poison symptoms in humans” on his office computer. It turns out to be the hospital’s night shift security guard, who has since confessed to trying to kill his family by poisoning them and who is now charged with beating his pregnant wife, his father-in-law, and his five-year-old daughter to death with a baseball bat and then burning down his house.

Cleveland’s MetroHealth System, getting heat from the county council about no-bid consulting contracts and excessive spending, takes positive action: it hires a $300 per hour PR company (without bidding, I assume) to help its executives practice for their appearance in front of the investigating committee.

Another Weird News Andy story that has me in stitches is this story, which he entitles Four Inches? Just a Flesh Wound. An 11-year-old girl trimming her horse’s mane opens up a 10 cm gash in her chest when the horse bolts. Her mother calls emergency response for an ambulance, only to be told to clean the wound, apply pressure, give aspirin, and then drive to the nearest hospital within eight hours or so. The hospital’s first question when she arrived: “Why didn’t you call an ambulance?”

E-mail Mr. H.