Monday Morning Update 1/24/11

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Sponsor Updates

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

Epic Sales

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

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

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

HIStalkapalooza

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

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

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

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

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

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

E-mail me.

News 1/21/11

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

E-mail me.

HERtalk by Inga

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

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

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

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

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

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

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

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

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

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

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

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

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

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

E-mail Inga.

Dear Dr. Jayne,

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

Bignurse

Dear Bignurse,

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

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

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

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

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

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

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

Dr. Jayne

Dear Dr. Jayne

The IT Cowboy

Dear IT Cowboy,

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

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

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

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

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

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

Dr. Jayne

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

News 1/19/11

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

E-mail me.

HERtalk by Inga

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

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

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

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

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

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

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

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

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

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

E-mail Inga.

Sponsor Updates by DigitalBeanCounter

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

EPtalk by Dr. Jayne

Dear Dr. Jayne,

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

PeggyBRx

Dear Peggy,

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

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

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

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

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

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

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

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

Dr. Jayne

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

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

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

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

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

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

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

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

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

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

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

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

But mostly we heard about the challenges.

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

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

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

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

Monday Morning Update 1/17/11

HERtalk by Inga

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

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

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

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

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

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

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

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

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

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

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

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

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

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

E-mail Inga.

EPtalk by Dr. Jayne

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

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

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

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

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

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

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

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

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

E-mail Dr. Jayne

News 1/14/11

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

E-mail me.

HERtalk by Inga

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

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

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

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

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

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

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

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

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

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

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

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

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

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

E-mail Inga.

Sponsor Updates by DigitalBeanCounter

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

News 1/12/11

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

E-mail me.

HERtalk by Inga

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

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

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

Southern Ohio Medical Center implements MetaCare IntelliDocs clinical documentation solution.

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

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

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

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

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

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

 E-mail (the un-enhanced) Inga.

Dr. Jayne

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

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

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

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

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

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

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

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

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

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

E-mail Dr. Jayne.

 Sponsor Updates by DigitalBeanCounter

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

Monday Morning Update 1/10/11

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

E-mail me.

Why Me? 
By Dr. Jayne

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

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

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

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

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

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

Say hello to Jayne.

Norwest Equity Partners Acquires Surgical Information Systems

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

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

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

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

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

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

News 1/7/11

From Clarence: “Re: HIMSS. Isn’t the conference in Orlando?” Looks like someone copied over last year’s e-mail announcement for this year’s HIMSS Annual Leadership Survey. Doh!

From Lizzy Thin: “Re: GE Healthcare. Rumor is that several workers in Seattle were shown the door today.” Verified, thanks to my GE media contact, who proactively e-mailed me to tell me the following: “As a part of the continuous review of our priorities and opportunities, we’ve eliminated a limited number of positions due to overlapping responsibility. The majority of the impacted roles are based out of our Seattle office. This does not in any way signal a change to the updates that I’ve given you in the past few weeks. Though a difficult decision, we remain committed to the success of our customers and employees.” Condolences to those affected, with my rare positive counsel being that as bleak as it seems when the career rug is pulled out from under you (it’s happened to me), you are likely to eventually end up being glad it did because it forces you to re-evaluate and focus. Kudos to GE Healthcare for at least waiting until after the holidays and for being honest about it.

From John in the UK: “Re: shares in Fletcher-Flora Health Care Systems. Please, could you inform me of their value?” I contacted CEO Neal Flora, who says to e-mail him so he can verify that you are on their list of shareholders. He’ll then provide the information. His contact information is here.

From Student: “Re: Northwestern University. It’s considering changing the format of its online MS in Medical Informatics from live, synchronous meetings (with instant feedback and collaboration) to asynchronous. Students are concerned about the respectability and quality this will provide. What do you and your readers think of an asynchronous format only?” I think it’s fine as long as the pedagogy is made clear to the faculty, i.e. this isn’t just putting lecture notes online and giving online tests, which I’m sure they already know since the program isn’t moving from classroom to online for the first time. Synchronous learning isn’t convenient to students or professors, especially with the considerable number of non-US based students taking HIT-related coursework (the time zone challenge is tough, as are hospital people who don’t work day shift). Technology supports asynchronous learning quite nicely, with podcasts and video lectures being well suited for it. The key is student collaboration and engagement through asynchronous discussion, projects, and learning that supports multiple learning styles (especially tactile/kinesthetic, which in my experience is tougher in an asynchronous environment, but that just means the instructor needs to plan for it). My conclusion: it’s not only OK, it’s a good idea, provided the proper expectations for student engagement are given to instructors. I’ve always thought that synchronous learning was more show than substance, often mandated by highbrow educational institutions that were not only slow to move online, but anxious to show their superiority over competitors who actually make learning accessible. Today’s synchronous is yesterday’s sage-on-the-stage.

The first sizeable acquisition of the new year will be announced Friday, so look for my news blast as soon as I get the green light to send it out. I’m hoping I’m not tied up at work since that’s always my nightmare – I’m stuck in some meeting sitting on hot news that’s congealing while I impatiently check my watch every ten seconds. I’ve also been given a heads up that a consulting company will be making an announcement tomorrow. If you don’t get my e-mail blasts, now’s the time to put your name and e-mail address in the spam-proof Subscribe to Updates box to your upper right. Tomorrow will be another chance to one-up that smart-alecky colleague down the hall.

eHealth Initiative announces its new board members, including new chair William Jessee of MGMA and Micky Tripathi of Massachusetts eHealth Collaborative.

Motion Computing announces the CL900 Windows 7 ruggedized tablet at CES. Available in Q2 starting at under $1,000, Motion says.

This article impacted Weird News Andy, which he titles “You have WHAT in your colon? I don’t even want to think about how it got there.” A woman undergoing a routine colonoscopy for abdominal bloating is found to have a Blatella germanica in her transverse colon. For you lay folks, that means they found a cockroach in her large intestine, presumably accidentally eaten by her in her infested home. I would have included the picture, but I’m sure your mental one is graphic enough.

HISsies nominations will close soon … make your nominations now. Voting will start this weekend if I get time to put the ballot together and e-mail it out to the HIStalk subscriber list.

I was playing around with Webinar tools the other day and liked Dimdim, which has a goofy name but pretty cool technology. I just got an e-mail from my signup that it’s been acquired by Salesforce.com.

Jobs on the sponsor-only job board: VP Sales Central Region, Senior Software Engineer, Software / Implementation Engineer. That reminds me that I need to figure out why people who don’t work with engines are still called engineers. On Healthcare IT Jobs: Project Manager, McKesson HEO Analyst, Assistant Health Services IT Director.

Travis, the tech-savvy doc who writes HIStalk Mobile for me, is putting up some good stories. Up now: hospital support of mobile devices, next generation iPad speculation, Skype for telemedicine, practices offering online appointment scheduling, Sutter and MyChart, IDEAL LIFE’s health tablet, and more. Drop your e-mail in the Subscribe to Updates box on that page to make sure you don’t miss anything, and if you’d like to contribute guest articles, news, how you use your favorite health-related iPhone apps, etc. give Travis a shout. Thanks much to our sponsors there: AT&T, Vocera, Voalte, 3M, Access, Thomson Reuters, and PatientKeeper. Some of the most interesting technology in healthcare involves smart phones, messaging, clinical communication, health management via technology, etc. and we cover it all there.

I’ll have a new HIStalk contributor to announce shortly. She’s a practicing physician and informatics expert who nonetheless described herself in offering her services as a long-time HIStalk fan and “young, blonde, and love shoes, making the perfect bookend for you with Inga.” I knew her lofty credentials, lack of pretension, and obvious sense of humor would raise Inga’s professional jealousy, which they did, as Inga sniffed to me that our new BFF is “too smart and young and cute and perfect.” They are both wonderful, so readers will benefit as we are able to explore even more issues and offer more useful information. She will be contributing to all three sites (HIStalk, HIStalk Mobile, and HIStalk Practice) and will be on the ground with us at HIMSS. Since Inga is often insecure, I should say that I don’t value or love her any less just because we’re getting help to hopefully achieve higher levels of pretty-goodness. I may need your assistance in reassuring her, though.

LifeIMAGE, which offers a medical image sharing platform, finishes its second funding round with $12 million, raising its total to $17 million. I interviewed Hamid Tabatabaie, president and CEO, a few weeks ago.

4Medica’s Inpatient Cloud EHR and integration engine earn CCHIT certification as an EHR module using hospital criteria.

I don’t find this to be true, do you? A reporter claims that Microsoft Making Name in Lucrative Health Care Records Market. The article suggests that HealthVault is profitable, which it isn’t as far as I know. It also touts Amalga HIS, overlooking the fact that the company shut it down not long after it bought it. The sweeping, big-finish conclusion: “Whatever the reason, Microsoft’s strategy seems to be working – it’s making a name for itself in a sleeping giant of a market that’s only now awakening to the power of business technology.” I’m not saying they aren’t doing some interesting things, but I’d hardly say they’re leading a sleeping market, and some of what they are doing is more in life sciences than healthcare. At my hospital, Microsoft means Windows, SQL, Office, and now Sentillion.

Some scumbag steals three Internet Cafe computers from Brockville General Hospital (Ontario) over the holiday, shutting it down and leaving users (some of them palliative care and rehab patients) without. The hospital doesn’t have the money to replace them, but a local travel agency donated one and is challenging other local businesses to do the same.

I still think this software should win awards: still another patient is saved by a kidney transplant made possible by an application that figures out a complex series of transplants that gives the greatest possible number of donor-recipient marches from the available pool.

University of New Mexico Hospital is reviewing its emergency alert system after a gunman fires a shot inside, but the employee text and e-mail alert took 32 minutes to get out after police had showed up en masse. The hospital says their incident people couldn’t get logged into the Web-based alerting system. They also couldn’t get executive approval to blast the message. The hospital says it will  hire a consultant. Something to think about before the reporters show up. I bet employees were already burning up Twitter and Facebook.

The local paper covers IT raises at University of Missouri and the hospital, noting that 52 employees were promoted with raises in December alone. It suggests that a just-opened IBM facility in town may have forced the university to give raises to keep staff.

E-mail me.

HERtalk by Inga

From Joe Walsh: “Re: HISsies. I am aware that the HISsies are just a bit tongue-in-cheek, but how serious is the proposal for a Lifetime Achievement Award?” I’d say all the categories are as serious as readers want them to be, but that one in particular is totally serious. As Mr. H often mentions, 100% of the nominations and final voting come from readers. Many of our past winners have been touched by the recognition. Todd Cozzens, for example, was quite appreciative of Picis’s Best HIT Vendor award a couple of years ago, and even the irreverent Jonathan Bush seemed to love winning HIT Industry Figure of the Year. We also know some organizations stuff the proverbial ballot box in favor of the home team (at least before we starting sending ballots directly to the HIStalk subscriber list last year instead of letting anyone vote), but ever that suggests that folks consider the HISsies an honor. 

From Elmer: “Re: Kudos. Love your blogs. You guys are the glue to what’s going on in HIT.” Thanks, Elmer. As Mr. H will tell you, I’m chronically insecure and need loving encouragement every now and then, so your words are appreciated.

From AA CoolNeal: “Re: A MEDITECH rap song. Funny rap song composed (supposedly) by former MEDITECHers. I worked there for 10 years and the song does hit all the highs and lows.” Very clever. And reminds me of many things I don’t miss about working for a big company.

From Eero Saarinen: “Re: Cerner win. Columbus (IN) Regional Hospital has signed a contract with Cerner. No surprise; they’ve been in negotiations for many weeks. CRH has used Cerner PathNet and Apache for several years but the new deal is a near-total McKesson replacement.” Unverified.

University of Kentucky Healthcare and Central Baptist Hospital are among the first recipients of Meaningful Use incentive checks. Kentucky Medicaid has already issued a $2.8 million check for UK and $1.3 million for Central Baptist. An additional 25 Kentucky providers have begun the application process.

Partners Healthcare is borrowing $420 million for EMR improvements and debt refinancing.

Healthcare represented 17.6% of the US economy in 2009, with total spending of $2.49 trillion (with a “t”). That’s up from 16.6% of GDP in 2008. Reminds me of when I was interviewing for my first job in HIT. I wasn’t sure I wanted to leave my budding career in finance, but my soon-to-be new boss convinced me that the business of healthcare and computers was going to become increasingly important. Obviously he was right.

I see that Bill O’Toole, an occasional HIStalk contributor, is offering a complimentary white paper to providers considering the purchase of an EHR. He’s founder of the O’Toole Law Group, spent 20 years as corporate counsel for MEDITECH, and has a friendly writing style.

Spectrum Health (MI) launches its MySpectrum smart phone app created with the InterSystems Ensemble integration and development platform.

Saint John’s Health System and St. Vincent Jennings Hospitals join more than 80 hospitals as part of the Indiana HIE.

Maricopa Integrated Health System (AZ) renews its agreement with MedAssets for multiple Web-based, revenue cycle tools.

New on HIStalk Practice this week: a peek at Cerner Ambulatory. Hospitals buying up practices. A physician review of the Motion J3500 tablet.  A couple of my New Year’s resolutions. Health reform may boost house calls. HIStalk Practice traffic, by the way, grew 25% in 2010. If you haven’t stopped by yet, it’s time to check out what you have been missing.

Jennie Stuart Medical Center (KY) implements ChartWise:CDI for clinical documentation.

LinkedIn is rumored to be going public this year, making it the first social network to do so. Which reminds me: I am pretty social, so feel free to connect with me on LinkedIn or Facebook. Mr. H is not quite as social as me, but seemingly better connected, so make sure you friend and connect with him as well. And don’t forget to join the HIStalk Fan Club on LinkedIn and to like us on the HIStalk Facebook page.

Cleveland Clinic and MetroHealth Medical Center say they will begin sharing patient records using Epic’s Care Everywhere program.

Dr. Lyle Berkowitz, MD, another occasional HIStalk contributor and medical director of clinical informatics at Northwestern Memorial Physicians Group, asked us to give a plug to HIT X.0 (Beyond the Edge). That’s a new sub-conference that will run during HIMSS and focus on innovation and the future. One session that looks particularly fun is called HIT Geeks Got Talent.  Eight companies will be given 2-5 minutes each to show off their coolest, newest technology. A panel of judges will give feedback, then audience members will have a chance to text their vote for the best product. The call for contestants is still open If you have some bleeding edge technology you’d like to demonstrate. There’s no extra charge for the HIT X.0 sessions, but Dr. Lyle said attendees are advised to pre-register to get a guaranteed seat. Mr. H tells me he’s in and planning to sit on the front row.

A patient drives his Chevy Blazer through the doors of a Kelowna General Hospital (BC) after being told he’d have to wait 45 minutes to see an ER doctor. The hospital estimates damages of $15,000. I wonder if the hospital is now checking into one of those Web-based apps to display ER wait times.

E-mail Inga.

Sponsor Updates by DigitalBeanCounter

• Imprivata OneSign is named a premier solution in SC Magazine’s 2011 Reader Trust Award competition, which honors best-in-class security products and services.
• maxIT Healthcare promotes Mike Sweeney to president, reporting to CEO and Chairman Parker Hinshaw. maxIT also names Reese Gomez executive vice president of solution management.
• McKesson takes top KLAS honors in eight separate categories, including Best in KLAS in Community HIS for its Paragon solution. Horizon Practice Plus also wins Best in KLAS for  Practice Management (26-100 physicians).
• The MED3OOO-owned CPU Medical Management Systems partners with Revenue Advantage to provide hosted interactive voice recognition applications to billing companies and healthcare providers.
• Allina Hospitals & Clinics chooses Greenway’s PrimeSUITE for providers in Minnesota and western Wisconsin largely due to Allina’s Epic-based EMR.
• YouTube Video: Using RXHub and External Med History in eClinicalWorks v 8.0.
• Carefx expands its presence in the UK by partnering with Northgate Managed Service, and agrees to deploy its Fusion healthcare interoperability platform with Cambridge University Hospitals.  Trillium Health Centre (Canada) also goes live with Fusion.
• AT&T includes MedApps as part of their ForHealth telehealth products and solutions.
• maxIT Healthcare appoints Mike Sweeney to President; he will manage day to day operations and will report to Parker Hinshaw (CEO).
• SC Magazine Awards names Imprivata as a finalist in the Best Multifactor Product category for the Reader Trust Award competition.
• CentraState Healthcare System chooses MobileMD for their HIE.
• Frank Stellato is announced as myHealthDirect’s Chief Financial Officer; he’s been with the company since July 2010 and was most recently CFO of MedAssist. Doug Cobb also joins myHealthDirect’s board of directors.
• Ochsner Health System (LA) goes live with Orion Health HIE.
• Lake Medical Group selects GroupOne Health Source to implement eClinicalWorks EMR system for its roughly 50 healthcare providers.
• Nuesoft has a nice entry on their blog asking the question: Are more doctors adopting EHRs?
• CynergisTek CEO Mac McMillian will present at the HIMSS Southern California Chapter meeting on January 13th in Orange, CA.
• North Highland acquires Insight Solutions Group.
• OnePartner selects MobileMD for its HIE.
• Nason Hospital (PA) will use tablet-based e-Forms completion from Access, integrated with MedSeries4 and the Soarian document management application.

News 1/5/11

From Stan: “Re: article in Applied Clinical Informatics on why people discount personal experiences with HIT. I think your readers might find the free download worth reading. Best regards from Switzerland.” The author, Jon D. Patrick from the University of Sydney, Australia, took heat for publishing user reports of ED system problems. His editorial says the problem reports of experienced system users are dismissed as unscientific anecdotes to protect IT interests, the organization’s investment, or its executives from criticism instead of treating those reports as an early warning system. While I don’t buy the idea that user IT perceptions should always be taken at face value, he’s right about the weird dynamic: the IT department and all the suits who signed off on the deal shoot the messenger because they are emotionally invested in it. They honestly believe that complaining users are troublemakers or fools who aren’t blessed with their big-picture vision (specific, serious IT problems are often dismissed on the basis of the greater good, of course). That’s like blaming a patient for daring to develop a post-surgical infection since it makes the surgeons look bad (which wouldn’t surprise me either).

From The PACS Designer: “Re: iPad 2. Sometime later this month, we’ll be seeing Apple’s next version of the iPad, being called the iPad 2 or 2nd Generation. Business Insider gives us an early look on what might be in the iPad 2 and what will probably be done to  the current iPad price. Sources in Japan are reporting that early production models seem to indicate that the iPad 2 will have two cameras, with the rear camera having the ability to record a movie when needed by users.”

From Healthcare Idiot Savant: “Re: Missouri State Senator Brad Lager from North Missouri (R-12). Recently started a new job — wait for it — in Government Affairs for Neal Patterson’s Cerner Corporation. Certainly there can’t be any conflict of interest there, right?” According to a bio in the KC business magazine, A bit of advice if you want to reach Missouri state Sen. Brad Lager: Try to give his e-mail inbox a break. ‘Between my Senate e-mail and my e-mail at Cerner, it’s about 1,000 messages a week,’ says the time-starved 34-year-old. As a measure of Cerner’s good corporate citizenship, the Northland medical software giant makes concessions to allow Lager the four-day legislative schedule he keeps from January through May. He’s back in the office at Cerner on Fridays as a senior strategic analyst in the Health-e Services group. I found some old documents that said Neal’s wife Jeanne donated $25,000 to his 2008 campaign for state treasurer.

From DigDug: “Re: taxes. We are hearing a rumor about tax changes for consultants who pay their own travel costs up front and are reimbursed by the client. There should be no tax implication, as the consultant is not claiming any deduction or tax relief for the travel, but we are hearing that the government now considers these reimbursements as taxable. Any insights?” I’ll use a reader lifeline here since I don’t know. Anyone?

From Lori: “Re: HIStalk. I’m writing to express how much I love and enjoy reading HIStalk! I stumbled upon it on Facebook and have been on it ever since! I enjoy looking at the industry as it continues to unfold. I’m able to do that now with HIStalk! Thanks again!” Thanks.

From NoName: “Re: evidence of an EMR implementation improving patient safety.” An article from East Carolina University and academic medical center Pitt County Memorial Hospital (NC) in Journal of Antimicrobial Chemotherapy finds that its inpatient Epic EMR implementation was accompanied by a 29% reduction in antimicrobial use. Clostridium-caused nosocomial infections dropped by 19% and MRSA infections went down 45%. The EMR doesn’t get all the credit, though: the article suggests that better pharmacist oversight of antibiotic usage, made possible by having immediate electronic access to patient information and orders, allowed them to intervene more effectively. However, order sets built into Epic did reduce the ordering of excessively high antibiotic doses. The good news is that all EMRs can support these efforts if hospitals use them appropriately, so not having Epic isn’t an excuse.

From Roy G. Biv: “Re: weird interview questions. One from Deloitte: how many ridges are there on the edge of a quarter? From my own experience, I’d say that’s about right as far as the average Deloitte consultant’s contact with reality is concerned.”

Listening: The Jessica Prouty Band, which I’m giving special attention since I know her mom, who spent time in HIT. This is a teen band, but you’d never know it since they play hard-rocking prog-metal (to my ear, anyway – think Within Temptation or Evanescence). They’ve toured, won a bunch of contests, and are playing Downtown Disney in California on January 15. I like their sound a lot.

I’m really excited to introduce a new HIStalker, DigitalBeanCounter. DBC e-mailed after seeing my cry for HIStalk help and will be doing some interesting things with us, starting with collecting and writing up sponsor news items in the Sponsor Update section. He’s got a ton of energy and a great attitude (the opposite of me, in other words). It’s great to have DigitalBeanCounter on our little team. I’ll hook him up with an e-mail address soon, but he was anxious to jump right in.

Speaking of which, thanks to the amazing people who e-mailed offering to help out. I’m still sorting through them, but as Inga told me, they’re all so good we want to work with every single one of them (seriously). My several hundred daily e-mail count has swelled lately to the point that I’m behind even after working through the holiday. Any perceived slight is unintentional – I just don’t have a lot of time left between my full-time jobs (hospital and HIStalk).

Former A.D.A.M. CTO Keith Cox is named (warning: PDF) CEO of the Health Information Partnership for Tennessee, which is using a $11.6 million federal grant to connect Tennessee’s RHIOs. 

Advocate Lutheran General Hospital becomes the second Advocate hospital to sign up for PerfectServe’s clinical communications system.

Reminder: HISsies nominations are open, so let’s have yours, please. Every year someone squawks when the final ballot comes out, claiming that I was clueless in omitting some obvious nominee for Best CEO or some other category. I remind them readers do the nominating – I just choose the most-nominated items for the ballot. For example, only one person has nominated Neal Patterson for the “Pie in the Face” award so far, so either Neal has changed considerably in your mind from his unbroken streak of past wins or everybody’s assuming someone else will keep the wheels of democracy turning.

I mentioned a new story about new Cerner contracts in tiny Idaho hospitals. Vince Ciotti of H.I.S. Professionals e-mailed me some thoughts and agreed to let me run them here.

Your Web site is so good and read so much, please don’t take this as a criticism, but as an attempt to set the record straight for your many thousands of readers…

Regarding your piece on Cerner’s $1.3M "deal" for a hospital in Idaho, I’ll bet that is capital (one-time) costs, which are rather low with Cerner’s "remote hosting" approach. This would include primarily implementation fees, and maybe some on-site hardware (e.g: med scanners).

Operating costs are another matter, since remote hosting (also known as ASP or SaaS) usually has a hefty fee per month for processing and storing data at one of Cerner’s two data centers in KC. It is probably six figures per year, and could approach seven figures depending on how many apps were purchased..

So, the TCO (total cost of ownership) over five years should be right up there with the fees most other large vendors charge (e.g.: Meditech, McKesson’s Paragon, Siemens Medseries 4, etc.) for a 14-bed hospital. The best bargains for such a small site are the "Big 3" in the small hospital market: CPSI, Healthland, and HMS. Their TCO over five years should be far less than Cerner, Meditech, McKesson, etc.

In addition, these small-hospital vendors have all apps a small hospital needs, including ERP, which Cerner usually turns to someone like Lawson or Microsoft, increasing their TCO even more. CPSI can even include an integrated PACS and Time & Attendance system, all extra with the "high-end" vendors like Cerner, Siemens, McKesson, etc.

Are the "high-end" EMRs any better? That answer could be a PhD thesis of 10 pages, but the bottom line is: one can achieve Meaningful Use with any one of them! Yes, Cerner probably has far more features than CPSI, but can a 14-bed hospital ever afford the IT and clinical staff to implement them? I doubt it…

This is not to knock Cerner. Millennium is an excellent clinical system, a worthy competitor to Epic in the large and Medietch in the mid-size hospital markets. But for a 14-bed facility, it’s like a newlywed couple starting out with a BMW. They’d be much better off with a Honda, and spend the difference on their kids (patients)!

Former Parkland Hospital SVP/CIO Jack Kowitt is named EVP of outsourcing vendor PHNS.

I mentioned a while back that I was surprised by a British survey that found that 84% of people there use their smart phones as alarm clocks. I bet they’re sorry now: a New Year’s-related software bug causes iPhone alarms to stop working at midnight, causing people to oversleep. At least most of them were off Saturday, I assume.

German mega-vendor CompuGroup acquires Belgian practice software vendor Belgiedata, continuing its worldwide expansion.

Care Innovations, a telehealth and independent living joint venture of GE and Intel, is operational with management in place.

Cleveland, desperate to replace lost manufacturing jobs, kicks off construction this month on the $465 million Medical Mart & Convention Center, hoping it can ride the coattails of Cleveland Clinic to bring high-paying jobs there (like every other city wants to do, but this one’s backed by clinic CEO Toby Cosgrove). Locals get stuck with the tab in the form of a quarter-penny bump in the sales tax. The project, which has yet to sign any tenants, will cost taxpayers up to $840 million over 20 years and competes with a similar project in Nashville that already has landed HIMSS as a renter.

Open source integrator EHR Doctors, which holds a contract to provide the Social Security Administration with its HIE platform for exchanging disability claims documents, says the agency has approved its C32 Continuity of Care Document.

AliveCor’s iPhone ECG is a snap-on back for the iPhone 4 that turns it into an ECG machine. Amazing, but not yet FDA approved. 

E-mail me.

HERtalk by Inga

From Bill Belichick: “Re: Meditech. They will be buying out ambulatory partner LSS and will oversee future product development and business planning. I believe it will most likely be announced by Meditech following their next board meeting this month. This will get Meditech right into the ambulatory market and add much credibility to the product line with the new Meditech branding. It will likely offer customers much more competitive pricing.” Unverified, that but sounds like a good strategic move.

Vitality’s GlowCaps are made available for $10 a cap on Amazon. The AT&T wirelessly-connected GlowCaps are intelligent pill vial caps that use light and sound as patient reminders. Adherence data is recorded each time the pill bottle is opened, then compiled as periodic compliance reports.

Telecare, a provider of wireless communication tools for chronically ill patients and their physicians, secures $4.46 million in a mixed securities offering. The company is headed by CEO and founder Jonathan Javitt, who has a pretty good track record of aligning with and/or building growing companies. Some of his previous enterprises include CodeRyte and Clinitek (now Siemens). He was also the founding national medical director and SVP for the United Healthcare division that is now Ingenix.

Imaging outsourcing firm Foundation Radiology Group raises $3.5 million, bringing its 2010 fundraising efforts to $9.5 million. The new funds come from Chrysalis Ventures and Health Evolutions and will be used for unspecified growth.

I’ve been amused and confused by all the responses to the Epic interview question about the cost of a pear. Mr. H and others used their programming logic to calculate the cost, based on the known prices for an apple, orange, and grapefruit. I would have replied totally differently, I guess, since I  have a much simpler sales brain and an IQ that’s a good 30 points lower than Mr H’s.  Anyway, I would have said that we don’t have pricing for the pear, then pose the question, “How much do you think the pear is worth?” Or perhaps, “If you are willing to buy all the fruit today, I am sure we can come up with a package price that would be acceptable.” Incidentally the question was originally posed to a project management prospect and not for programming or sales job. Maybe a PM would do a SWOT analysis on the pear to develop the right answer.

MEDHOST says that 12 facilities have now purchased OpCenter, the company’s executive decision support solution that was introduced a year ago.

CHIME and HIMSS name Charles E. Christian the winner of their 2010 John E. Gall Jr. CIO of the Year Award. Chuck is CIO at Good Samaritan Hospital (IN).

Texas Health Resources acquires the 420-physician MedicalEdge Healthcare Group, which marks the second-largest purchase of an independent physician practice in the US. THR can now boast more physicians than its chief rival, Baylor Health Care System (620 versus 500). THR is where HIStalk contributor Ed Marx serves as CIO.

Patient flow software provider Central Logic hires Jeff Porcaro as VP of engineering and technical services. He previously served in senior management for Symantec and Novell.

I sent an e-mail over the weekend about the HIStalk-hosted, sponsor-only lunch at HIMSS and another just now about our other activities during the conference. If the e-mails did not find their way to the correct contact, let me know. And if you aren’t a sponsor, I bet you’re wishing you were because you just know that what we’re planning is bound to be fun.

ONC issues a final rule to establish the permanent certification program for HIT. For the permanent program, organizations must be accredited and authorized by the National Coordinator and must conduct post-certification surveillance. I didn’t look into all the nitty gritty details, but you can find more specifics here.

Four nursing students are expelled from Johnson County Community College (KS) after photographing themselves with a human placenta and posting the picture on Facebook. The school’s director of nursing said the students’ “demeanor and lack of professional behavior surrounding this event was considered a disruption to the learning environment and did not exemplify the professional behavior that we expect in the nursing program.” One of the students is now fighting back in federal court, seeking an injunction against the school. The 22-year-old claims her future earnings from her chosen profession are at stake because of a “momentary lack in judgment.” As one who committed a least a minute’s worth of judgment errors at that age, I hope she is allowed to finish her degree.

In an another Facebook-related story, a thief displays more than a momentary lack in judgment by stealing a flat-screen TV from a gas station’s restroom (I will refrain from making comments about the stupidity of having a TV in a gas station restroom). A customer uses his credit card to pay for gas, then hides the TV under his shirt and takes off. The gas station manager uses the credit card information to look up the thief in Facebook and sends him a friend request. Thief accepts request, despite not knowing manager (clearly not the brightest bulb on the tree). Manager tells thief that if he returns the TV, he won’t call the police. Thief ignores the request and before long ends up in jail.

E-mail Inga.

Sponsor Updates by DigitalBeanCounter

• Informatics Corporation of America is named a Top Healthcare VAR by Everything Channel’s CRN Magazine.
• Cancer Centers of North Carolina – Ashville implements iKnowMed EMR. iKnowMed is a division of US Oncology, which is now a division of McKesson.
• CynergisTek CEO Mac McMillan is presenting at the upcoming Security/HITECH conference sponsored by the SoCal HIMSS chapter. January 13th in Orange, CA, if you are in the area.
• MED3OOO announces a strategic partnership to form the Jersey Health Alliance. The Alliance, which includes a network of physicians and hospitals from Hudson County, NJ, will utilize MED3OOO software, consulting, and services.
• Cool video: Allscripts Android Patient File Overview.
• Sentry will attend the seventh annual 340B Coalition Winter Conference in San Diego.
• NTT DATA completes its acquisition of Keane.
• Aetna completes its acquisition of Medicity.
• Vermont Information Technology Leaders selects Greenway’s PrimeSuite as a preferred EHR partner.
• Michigan Health Connect (MHC) chooses Medicity to carry out its HIE.
• Nuance announces its Dragon Dictation voice technology is the secret sauce behind the LG Voice-to-Text app; offered free via the Windows Phone Marketplace.
• AT&T ramps its their presence in the HIT space.
• Payment Processing, Inc. partners with AdvancedMD, citing integration and security advantages.

Monday Morning Update 1/3/11

From Mighty Mite: “Re: HISsies Lifetime Achievement Award. I like that proposed category. The name that comes to mind is Rob Kolodner, MD for his incredibly important work at the VA, his ONC work when Bush gave him a mission and no money, and his open source work, where he’s trying to build systems for poor countries that can’t afford $100 million systems (can we either, really?)” I can’t quibble with your pick. In the interest of offering choices, other names that come to mind are Octo Barnett, Neal Pappalardo, Paul Egerman, John Glaser, Bill Childs, and many more from the provider side, although their work maybe hasn’t been quite as non-commercial as that of your nominee. I’ll be interested to see who readers suggest. The HIT industry has finally been around long enough to have a history worth recognizing.

Nearly 2/3 of my survey respondents say their software vendors focus on releasing enhancements that help sales instead of current users (we could have another debate about why those desires differ). New poll to your right: what employment changes do you see for yourself for 2011? The poll takes comments, so leave yours if you want. My vote: same employer, same job. I get recruiter calls all the time like everybody else, but I’m really happy at the hospital where I work.

It’s hard to believe it’s 2011. It’s comforting that the person I kissed as the ball dropped was the same as last year and presumably will be the same next year (I like romantic predictability). I lost Internet connectivity for nearly a day starting Friday afternoon, but the broadband company was good enough to send a tech out on New Year’s Day to replace my modem while I was making chili and whipping up killer guacamole (probably because I have business class service paid for by the hospital). I was lucky during that Netflix-free period to accidentally spot an IFC marathon of the funniest TV show in history, The Larry Sanders Show, which is being DVR’ed as we speak. Hey now!

You know what 2011 means: it’s HISsies time. Nominations are open here. In a week or so, I’ll use the nominations to create the final voting ballot, which I’ll send to HIStalk e-mail subscribers only to prevent ballot box stuffing. I’ve deleted some tired categories and added some fun new ones. Winners will be announced at HIStalkapalooza and I always invite some of the big category winners to say a few words there (they usually pass since they don’t get the HIStalk thing, but what the heck – at least I offered).

Inga e-mailed sponsors about our little appreciation lunch at HIMSS and is sending out RSVP information this week. If we missed you somehow, contact Inga.

I need your advice as readers for my New Year’s resolution. I’m fortunate to not need to make a living from HIStalk since I work full time and have little interest in money, which gives me the freedom to do work that’s not necessarily commercial in nature (or even projects that cost me money, if I think they are useful to the industry as a whole, especially the provider-siders). What projects should I be working on? Education, sharing of best practices, innovation, social networking, charitable work, etc. purely for the benefit of hospitals, practices, and patients? I have limited time, but I do have connections and resources that could be put into play for the right initiatives. I need your help in identifying those possibilities. E-mail me if you have suggestions.

Cerner must be throwing out some low prices lately, even based on per-bed license charges. This article on Idaho hospital EMR projects describes Cerner, being implemented at North Canyon Medical Center for $2 million, as “an economical system that works well for smaller rural hospitals.” Syringa Hospital (a strangely satisfying hospital name) paid $1.3 million.

A reader mentioned not being able to find a 990 form (the IRS tax form for for non-profits) on the Patient Privacy Rights Web site. I asked Deborah Peel, MD and she says they’re putting it up, but she sent over a copy anyway. I’ve given it my usual look-over and there are no secrets: income and expense of around $200K, it pays one relatively modest salary to a full-time executive director, and Deborah Peel takes no salary, In fact, she’s the organization’s biggest individual donor, so it’s costing her money, not to mention time. I’m disappointed that HIMSS didn’t invite her to speak at the conference this year. I don’t necessarily agree with her in every case and sometimes she provides more emotion than hard data, but I’m glad she crusades for privacy and security since without her there might be no rational compromise. She’ll be the keynote speaker at the Computers, Privacy , and Data Protection conference in Brussels, Belgium (January 25-27). I spent time with her at HIMSS last year and she’s a hoot, not just smart and sincere, but cynically funny in an HIStalk-approved way.

New announcements from Medicity: (a) Children’s Dayton chooses Medicity’s Novo Grid to connect with its partners and affiliated physicians, sending out results, reports, and face sheets from Epic clinicals and McKesson patient accounting and receiving back lab and rad orders; (b) CHRISTUS Health will expand its use of Novo Grid to include ProAccess Community, MediTrust Cloud services, ambulatory orders initiation, referrals, and CCD exchange, all across seven states and extending to an additional 900 physicians; (c) Hoag Memorial Presbyterian Hospital (CA) announces that it connected 250 providers to its HIE in five months using Novo Grid; and (d) Medicity’s iNexx platform has been certified as a modular EHR by Drummond Group, qualifying its users for Meaningful Use.

Hospitals always announced their first baby of the new year, so I’ll proudly flash the picture of the first new HIStalk Platinum Sponsor of 2011: Marietta, GA-based Nuesoft (not to mention that they’re also supporting HIStalk Practice at the Platinum level, too). You saw their fun Lady Gaga parody video and the pic of their booth people dressed in hideous 70s fashions, but that’s not all they do. Their offerings include NueMD PM and billing software; NueMD EHR (CCHIT certified); Nuesoft Express management software for college health clinics; Nuevita student health clinic management and EHR; RCM and billing services for college health; and the Nuetopia medical billing service in which the company provides an EHR, PM, billing, EDI, clearinghouse, and services. NueMD, they note on their site, is Internet based, not just browser based. Thanks to Nuesoft for its support of HIStalk and HIStalk Practice.

Speaking of Nuesoft, they’re darned good at making videos. I ran across the one above on YouTube. If you’ve seen other fun, HIT-related videos, let me know.

A job site’s annual list of weird interview questions that gets picked up by newspapers everywhere includes one from Epic: “An apple costs 20 cents, an orange costs 40 cents, and a grapefruit costs 60 cents, how much is a pear?” You figure it must have something to do with logic and formulas since it’s a programmer test. Nothing related to word length or consonant count makes sense (since the first two fruits have the same number of each but different prices), but the formula of (vowels-1) x 20 works, which would price a pear at 20 cents. I’m lazy and immature, but the college tested my IQ as 162 back in the day, which offers no real benefit except I can answer questions like this.

A hospital in England starts conducting patient satisfaction surveys via iPads.

MedTech Publishing, which publishes Healthcare IT News in a business relationship with HIMSS (and also Healthcare Finance News), takes over the HIMSS-acquired Government Health IT. I wouldn’t consider that good news since I’m a semi-fan of the latter but not at all of the former (even though I don’t read either, so I probably shouldn’t have an opinion at all). HIMSS will continue running the Government Health IT Conference and Exhibition. Also part of the deal: MedTech will take over the dead tree publications related to the HIMSS conference that it has previously printed under contract (those papers that are always being thrust at you by cute girls in ball caps every 15 feet as you try to traverse the convention center, necessitating hilarious evasive maneuvers). Neil Rouda, MedTech founder and chairman, is being replaced, and rather vague wording suggests that HIMSS is buying a majority interest in the company. It’s not like they were running a lot of hard-hitting, industry-unfriendly stories anyway.

E-mail me.

News 12/31/10

From HISJunkie: “Re: SureScripts as an ATCB just for e-prescribing. How an e-prescribing clearinghouse be an objective judge about a vendor’s functionality? If I don’t use their clearinghouse, where does that put me? I think the certification process is going to get much stranger in the new year.”

From Athenahealth Win: “Re: win. They just took out a huge Allscripts/GE-IDX install. Should be announced soon.” Unverified.

From Limber Lob: “Re: Maryland Board of Physicians newsletter article on e-prescribing of controlled substances. I really enjoyed the first two and last two sentences. Another EHR skeptic!” It reads: “The health care community has lived through the initiation of electronic health records. They will, we are told, save time and money and reduce medical errors … Use of the term ‘interim final’ by the DEA suggests that this field, and the concomitant federal records, are evolving. For more information, go to the Internet.”

From Promises Promises: “Re: gag clauses. None here.” This document lists Allina’s terms and conditions for practices that want to use its Excellian (Epic) system. It says Excellian isn’t a substitute for human thinking and requires practices that want to use it remotely to: (a) verify its behavior; (b) don’t rely on it for anything critical – ask the patient instead; (c) don’t use it to communicate any important results; (d) look out for programming errors; (e) test it before letting users on; and (f) don’t disclose Epic’s trade secrets. You’d think they didn’t have much confidence in their $250 million implementation from all the disclaimers, but I’m sure that’s just the Allina and Epic lawyers expensively talking.

Listening: new from Ryan Adams (just to be clear, not Bryan Adams – this one’s from North Carolina instead of Canada and is married to Mandy Moore). Actually, the new double album consists of three-year-old tracks that had been gathering dust until he started his own record label and released the 80s-theme concept album a couple of weeks ago. Sometimes it sounds like U2, sometimes like Tom Petty, sometimes like The Cars or Spandau Ballet. I guess those are the 80s musical references at work. And Watching: Doc Martin on Netflix, which is a very nice British dramedy. If it’s realistic, the Brit GPs store paper medical record folded into a little 5×7 or so envelope, so they must not churn out the insurance- and lawsuit-required documentation like here. I could spend hours looking at and listening to Louisa (Caroline Catz).

I have Uri Geller sitting right here beside me and he’s telekinetically moving your fingers to the Subscribe to Updates box to your upper right, forcing you to type in your e-mail address and name so that you might live a fuller life in HIStalk one-ness. You will receive no spam since I don’t care about money enough to sell or rent the subscriber list to the many companies that keep asking. You will, however, get everything important in HIT as soon as Uri or I push the “send” button.

A family member got an iPad. I played around with it for a few minutes and liked it a lot (amazing display), although I think smaller tablets sold by competitors might be more my speed. It was nice to have a display larger than that of my iPod Touch but a bit much to haul around. I like the idea that you can get a no-contract AT&T data plan for it for $25 per month for 2GB (cheaper than an Aircard, but that’s in addition to your smart phone plan, unfortunately). I’m really happy with my iPod Touch despite still not having played any MP3s or videos on it (I take a second-generation Nano to the gym since I’m rough on stuff there). It is amazingly handy to grab the Touch from the nightstand and be checking e-mail or Web browsing at WiFi speeds within five seconds of having the urge to do so. Mrs. HIStalk probably hates it since on those rare occasions I watch TV with her, I constantly pounce on the Touch to recite trivia from IMDB about whatever she’s trying to watch or do the “alive or dead” quiz about some actor on the screen. The shows she watches aren’t very cerebral, so I think I may be more fascinating anyway, although I don’t have the nerve to ask if she agrees.

Ed Marx has updated his Why I Fired and Rehired Myself post, which he’s good about doing in response to your comments (even the nasty ones).

Here’s a shout-out for HIStalk pal Michael Christopher and CarePrecise, which offers a variety of ways to access the federal government’s healthcare provider database with data points on three million providers that include UPINS, Medicare IDs, state license numbers, phone numbers, separate tables of newly added and newly dropped providers, etc. They also have medical marketing tools for you vendor types. Michael’s a genius, so you get to talk to him if you buy something (I talked to him once as Real Me and not Mr. H and was mightily impressed, which doesn’t happen too often).

I wasn’t quite prepared for the immediate response to my casual blurb about maybe needing to hire someone to help Inga and me out. I expected to get an e-mail or two, but not from household name type people (VPs, retired CIOs, people who have published or edited magazines, etc.) Let’s just say I’m honored that folks at that level read HIStalk, much less want to help with it, and I want to hire every one of them because they all sound great. It’s a low-rent operation here, so we’ll see how it turns out (I’m behind on responses, but I’ll get there). Several did the same as Inga when she first contacted me years ago: listed 10 sassy, cynical, funny reasons I should hire them. Here are some of the ones I liked as showing a deep understanding of the HIStalk (anti) corporate culture:

1. I am considered a pain in the ass by 95% (or more) of people who know me.
2. I know the industry, the jargon, and where some of the bodies are buried.
3. I really, really want a cool avatar like Inga has, although I firmly insist on a bit of virtual Botox.
4. Smart-ass, I am (much more fun if you say it like Yoda). Above all, this is the personality trait that appears to be the key to the HIStalk inner sanctum.
5. I am certain that you’ll get more impressive volunteers to write for you than me. That being said, you shouldn’t pick them because they’re too busy and they suck in their own perceptions of HIT.
6. My husband says, “I’d hire you. You are smart and cute.”
7. But enough about me, let’s talk more about me.
8. I am a passionate sports fan, mainly that of European soccer. I will defend to the end the reason for soccer not blossoming in America is that our social fabric is built on competition, not community, and therefore we cannot support soccer on a national or regional scale. It has nothing to do with boredom or slow-moving play, as we support baseball and American football, which border on tedium with the amount of time-outs, commercials, and gratuitous jock-adjusting. Soccer is like the ballet — no matter how much you hate it, you know it will end at a reasonable hour.
9. Actually, in all candor, my experience makes me a perfect fit for this role, not OJ and the leather glove, but an honest-to-goodness Isotoner glove-type fit.
10. I always attend HIStalk events at HIMSS!

I think I’d need one of my attorney readers to help decipher the legalese, but it sounds to me like Cerner and Mayo Clinic prevailed in an intellectual property lawsuit they brought against a former Mayo physician. Mayo said he took his knowledge of a natural language processing application that Mayo was commercializing to Merck, which may or may not have planned to commercialize NLP software (depending on who you believe). Cerner apparently licensed the software from Mayo and sells it as Discern nCode. He wrote it in MUMPS for you haters out there. I lost interest at this point (earlier, actually), but if you didn’t, here you go.

Wolters Kluwer Health buys EMR training software developed by a research team at University of Tennessee. Its intended audience is schools of nursing for training students on EMRs. UT gets a cut of sales. The iCare web page is here.

Geisinger Health System (PA) notifies 3,000 patients of a data breach that occurred when a former doctor at one of its hospitals e-mailed information about his patients to his home e-mail account. Geisinger says it notified patients because the information wasn’t encrypted even though it’s almost certain that nobody else saw it. So there’s your first HITECH-related action and one that doesn’t involve EMR bribes – it requires providers to send breach notices to affected patients.

Thirty-six top-earning executives at the University of California are threatening lawsuits against the UC system if it doesn’t increase their retirement payouts. The university is changing its pensions (most of us would need a dictionary to know what those are) since they were underfunded by $20 billion by the perpetually fiscally irresponsible state. Among those signing the demand: UCSF CIO Larry Lotenero (paid $377K) and UCLA health system CIO Virginia McFerran ($477K), along with mostly hospital and investment management people. The bank bailout is going to look like a child’s allowance as states start going broke over wildly generous salaries and pension plans, loading their payrolls with double-dipping “retirees” and employees jockeying their positions for their last year before retirement since guaranteed lifetime payments are based on final salary.

Strange lawsuit: a mentally ill patient who had spent years in a psychiatric facility sues its operator, the State of New York, for nearly letting him die with an untreated infection. He wins, but the state asks the judge to give it his $1.7 million award in return for treating him without payment for 10 years. The judge agreed, so the patient got nothing.

Happy New Year!

E-mail me.

HERtalk by Inga

ONC names Surescripts its sixth Authorized Temporary Certification Body, but only for e-prescribing and privacy and security.

Central Florida RHIO names Jeanette Schreiber its new chair. She’s associate dean and chief legal officer for the UCF College of Medicine.

One week after hitting a last-minute snag, McKesson completes its acquisition of US Oncology.

I am back at home after a week of holiday merriment in the land of No Internet. I had intended to make it a working vacation, but underestimated how very slow my connection would be. After two days of pulling my hair out each time the connection dropped, I finally had to fess up to Mr. H that my escape from civilization was not going as planned and that, alas, HIStalk Practice would have to skip a day. Now, as I sit at my desk using lightning-fast Internet, I must say that I am surprisingly happy to back at work. I promise that my renewed attitude has nothing to do with the Help Wanted sign Mr. H posted during my absence, nor the fact that two dozen people more qualified than me are vying to become Mr. H’s new BFF. Actually I am pleased that so many people “get” how fun this job can be and I am hoping it will give both Mr. H and me more time to work on some other fun projects.

Speaking of fun projects: the upcoming HIStalkapalooza event during HIMSS. Mr. H spilled the beans on a few details and I must also make a couple of comments. First, I have high expectations for contestants in the “Inga Loves My Shoes” contest. It’s quite easy to participate – just pick out the most fabulous pair of shoes from your closet and wear them to the party. A trusted Inga stand-in will eye your feet and select the winning footwear. If shoes aren’t your thing but you want to impress the HIStalkapalooza universe (and definitely me), dress your very best and you will automatically be in the running for HIStalk King or Queen. Here is a tip for the soon-to-be-legendary King and Queen contest: if you are wearing a straight-from-the-booth vendor tee shirt,  you will not win this incredible honor. Those wearing tuxedos and chiffon will automatically make the semi-finals. Wearing pirate costumes or pink pants may only get you a Mr. or Ms. Congeniality award. I am trying to convince Mr. H that we need some amazing prizes for our lucky recipients, but no decisions yet. Meanwhile, I am dreaming of IngaTinis, red carpets, and dancing the night away.

An Ohio surgeon is sentenced to a year in prison for having his office manager pose as a doctor while he was out of the office. The office manager for Dr. Charles C. Njoku had previously been sentenced to three years of probation, including one year of home confinement. The two also must pay restitution of $131,000 for billing Medicare and Medicaid as if the office manager were the doctor seeing patients.

I would love to know which EMR this doctor uses. An internist treating a complicated patient complains that her EMR will not allow her to write an evaluation exceeding 1,000 characters. When the physician calls the EMR help desk for assistance, the tech replies, “Well, we can’t have the doctors rambling on forever.” And the industry wonders why doctors resist EMR adoption.

The mHealth market continues to boom, with over 200 million apps now in use. About 70% of people worldwide are interested in owning at least one mHealth application and are willing to pay for it. Countries with large populations and limited healthcare options, such as India and South Africa, are the most interested in mHealth. Look for the number of mHealth apps to triple by 2012.

Puget Sound Blood Center (WA) is launching the GCI ConnectMD private medical network to connect with Swedish Medical Center, Cherry Hill Campus.

Government auditors report that the CDC lost or misplaced more than $8 million in property in 2007, including a $1.8 million hard drive and a $978,000 video conferencing system. Whoops. The CDC says it has now instituted better controls and that 99% of its property was accounted for in 2009.

A computer tech in Michigan is arrested for allegedly violating state hacking laws and gaining access to his then-wife’s e-mails to confirm his suspicions that she was having an affair. Turns out she was, with her ex-husband. The wife (who is now actually the alleged hacker’s ex-wife) realized the computer had been hacked when personal e-mails showed up in a child custody pleading involving her first husband (hacker was husband number three). Computer geeks, lots of husbands, and adultery – it just doesn’t get much juicier than that.

Sponsor Updates

• Greenway Medical Technologies announces a new web site covering EHR adoption incentive programs.
• PatientKeeper is moving to new headquarters in Waltham, Massachusetts in a building adjacent to the Massachusetts Medical Society and the New England Journal of Medicine.

E-mail Inga.

News 12/29/10

From BeKind: “Re: Texas patient privacy breaches. Mentioned in this article.” It also mentions that JPS Health Network is spending $94 million on its Epic implementation.

From Jennifer: “Re: QuadraMed QCPR. Now fully certified!” CCHIT certified QCPR as a hospital EHR on December 23.

From Skinny Minnie: “Re: vendor gag clauses. A billing vendor’s new customer did a YouTube testimonial about why they switched from their previous vendor (service and cost). The previous vendor told the customer they were violating the terms of their contract, which says they can’t ‘disparage or denigrate’ them, and insisted they make their new vendor take the video down.” No link was provided, but I found a YouTube video featuring a customer of the same ‘new’ vendor explaining why they replaced the same ‘old’ vendor, specifically mentioning the monthly cost of each. Either the ‘old’ vendor missed this one or it didn’t get taken down after all.

From Alfonso: “Re: healthcare IT tools for Accountable Care Organizations. I ran across an article touting two companies that are attracting VC and private equity interest – MedVentive and AmalgaMed. Investors are looking at the next two years as being critical for capturing market share as payment reform in the form of ACOs restructures healthcare delivery.” AmalgaMed is a new startup founded by a couple of entrepreneurs with benefits management experience.

Genesis HealthCare System (OH) sells $20 million worth of buildings to pay for an EMR system, freeing up cash flow to fund mission-critical projects.

TPD has updated his list of iPhone apps.

Who knew that Tom Selleck was a cheesy-mustached technology thought leader way back in 1993? Or at least he sounded that way as he read the script that AT&T gave him for these old commercials. I ran across a mention of this compilation video on something called Dvice, from Syfy.

Inga and I have been swamped lately, with a ton of new sponsors, interviews, HIMSS planning, etc. I’m thinking I need to hire someone part-time to help out. I could use someone who knows the industry, writes really well, and enjoys dealing with cool people like our sponsors and contributors by e-mail and telephone. Pay won’t be impressive, but it’s a good chance to learn and to get your name out there. Those interested should do like Inga did years ago: e-mail me and tell me why I should hire you since my natural inclination is to just suck it up and work more hours myself.

Registration for CMS’s Medicare and Medicaid EHR incentive programs starts next week. Instructions and the link to the registration page (when it’s turned on) are available here. You can register now even if you haven’t implemented anything yet.

Weird News Andy notes that of the 20 least-efficient charities in the country, only one relates to healthcare: Charleston Area Medical Center Foundation (WV), which runs an administrative expense ratio of 49% and earns one star from CharityNavigator. In comparison from the most-efficient list, Brother’s Brother Foundation, which includes medical supply donation among its projects, runs an expense ratio of 0.0% and has earned a four-star rating from CharityNavigator (which is where I always look first before donating). I have to be honest: having worked for hospitals nearly all of my life, they’d be last on my list of organizations to which I’d donate. Charity is big business at that level, with highly paid foundation employees, lots of private club donor schmoozing, and constant trading of favors (like donors making their contributions contingent on hiring their company as a vendor or giving their worthless kids phony jobs). Not to mention that I would never fund a charitable cause that pays executives $1 million or more like many hospitals.

Cerner shares are continuing their generally upward trend, closing Tuesday at $96.01. You could have bought shares for $72 in September (or $16 in 2003).

India-based NIIT Technologies Limited acquires the Preferr patient referral system, developed by Visions@Work of Clermont, FL.

E-mail me.

HERtalk by Inga

Manatee Health System (FL) will spend $2.5 million to implement Cerner, with Manatee Memorial Hospital and Lakewood Ranch Medical Center making the switch in August.

St. Joseph’s Hospital Health Center (NY) will hire at least 25 people "with considerable information-technology (IT) experience, preferably in the health-care field." The additions will double the size of the existing IT department.

UPMC introduces a mobile version of MyHealth Connect, giving users smart phone access to UPMC Health Plan information. The initial phase includes details on UPMC’s provider directory. Future versions will include a virtual ID card and access to members’ PHRs.

US Oncology names Karen Gibson SVP and CIO of its technology services, reporting to EVP Asif Ahmad. She was previously CIO of Life Technologies and of GE Healthcare Information Technologies.

Sponsor Updates

• Cumberland Consulting Group promotes Mary Francis Shaw, Dao Dang, and Chris Wolfert to executive consultant.
• Allscripts CEO Glen Tullman will join the founders of Wikipedia and eMedicine to discuss the impact of the Internet on healthcare on January 6 at the University of South Florida Alumni Center in Tampa.
• CareTech Solutions offers a money-back guarantee to hospitals that try its Solution Found service desk offering.
• Picis will incorporate the AORN Syntegrity framework into its perioperative suite.

E-mail Inga.

Monday Morning Update 12/27/10

From The PACS Designer: “Re: Flock. As the number of social web sites continues to increase, it becomes a challenge to keep up with all the goings-on amongst your web friends. Now you can have all your social web sites in one browser with Flock. You can view HIStalk’s Facebook and Twitter sites in one place to keep your browsing activity from consuming too much of your time. TPD hopes everyone had a Merry Christmas and wishes all a Happy New Year!”

From Nicole: “Re: Merry Christmas. My kids like reading HIStalk with me and often ask me to read them the news clips. My son (the oldest) likes the business news, my daughter liked the story about Zsa Zsa’s husband.” That’s fun. I’m hoping HIStalk isn’t your story of choice because it puts them to sleep faster at bedtime. I’m a fan of  “out of the mouth of babes” wisdom, so I’m picturing them at HIMSS passing judgment on speakers and booths. I bet they would have priceless observations.

From FamilyPhysician: “Re: instant messaging. Doximity lets you find any healthcare provider in the US (not just your hospital system) and communicate via text securely if they agree. I use it from my iPhone, but you can also use it from the web. Hospitalist groups in my area are using it as well as outpatient docs like me.” This isn’t quite the objective testimonial it seems since it came from a Doximity co-founder, but I’ll allow it since the product seems pretty cool. You can only give it a test drive if you’re a doc since the sign-up form checks your name against a list of licensed physicians.

From ChiefCookandBottleWasher: “Re: Jim Stalder. You interviewed him a few years ago. He has joined Cook Children’s Health care System in Fort Worth as their new VP/CTO. They’ve gone through a number of IT leadership changes over the years.” Verified, according to his LinkedIn profile. I assume he replaces Tracy Waller, who left in August to work for an oil company services company as an IT consultant. Jim was CIO of Mercy Health Services (MD) when I interviewed him three years ago.

I expected readers to vote their preferred form of FDA regulation of clinical systems in order of least- to most-comprehensive. That wasn’t how it played out, although survey topics stirring up more emotion seem to generate less reliable results. For whatever reason, the most-restrictive choice (vendors must prove safety and effectiveness the same as drug makers) was the #1 choice. New poll to your right, for providers: is your software vendors’ enhancement road map more focused on making new sales than meeting the needs of existing customers? You are welcome to leave comments.

Listening: Patto, described by the reader who suggested it as “raw, bluesy rock n’ roll with a jazz twist.” The band was obscure even its 1970-73 lifespan and tracks are hard to find on the Web, but it still sounds good (to me, it’s UFO meets Steppenwolf). Check out the guitar solo on this one. The namesake founder, who also started up Boxer, died in 1979 at 36.

John Stone is named CIO at Fairmont General Hospital (WV). 

It’s eight weeks until the HIMSS conference, just so you know. I’ll be starting up the HISsies in the next couple of days. Below are the results from last year. I’ve already decided to add two new categories, Most Fun Vendor and Best Informatics Professional, but the floor is open for your ideas of additional categories. I like to change them up a little each year. I’m thinking about adding a Lifetime Achievement Award as a serious award.

2010 HISsies Winners

Smartest vendor strategic move
athenahealth guarantees Meaningful Use

Stupidest vendor strategic move
GE Healthcare loses enterprise clients

Best healthcare IT vendor
Epic

Worst healthcare IT vendor
GE Healthcare

Best CEO of a vendor or consulting firm
Jonathan Bush, athenahealth

Best provider healthcare IT organization
Cleveland Clinic

Provider or vendor organization you would most like to work for if salary, benefits, and job title were not factors
Epic

HIS-related company in which you’d love to be given $100,000 in stock options that can’t be cashed in for 10 years
Epic

Most promising technology development
Smart phone apps

Most overrated technology
Speech recognition

Biggest HIS-related news story of the year
ARRA/Meaningful Use

Most overused buzzword
Meaningful Use

When _____ talks, people listen
David Blumenthal

Most effective CIO in a healthcare provider organization
John Glaser, Partners

HIS industry figure with whom you’d most like to have a few beers
Judy Faulkner, Epic

HIS industry figure in whose face you’d most like to throw a pie
Neal Patterson, Cerner

HIStalk Healthcare IT Industry Figure of the Year
David Blumenthal

Each year right about now, I start getting more e-mails asking about the HIStalk event at HIMSS. We plan to have the sign-up page live by January 15 or so. I can tell you this one’s going to be memorable – the sponsor, [name coming soon], is going crazy with super-fun ideas that the 500 or so lucky attendees will enjoy (Inga and I keep trying to probe their upper limits: How about we shine a giant HIStalk logo on the outside of the building? Done. Say, wouldn’t it be cool to bring in a professional video crew so I can run party video on HIStalk afterward? You got it, Mr. H.) So for you as a prospective attendee: Did you ever want to feel like a celebrity on Oscar night, making a dramatic entrance on the red carpet while sipping an IngaTini and being interviewed on live camera? Do you like great food and an open bar? Do you like the idea of a full-length concert at HIMSS with a real band playing on a real music hall stage? Did you enjoy the “Inga likes my shoes” contest last year, all the other fun beauty queen sashes, the HISsies, and surprise guests? Would you enjoy special recognition for physicians in the audience, beautiful ladies in their best party fashions as orchestrated by Inga, and maybe even a King and Queen winner just like at your prom? It’s so big and crazy that the sponsor convinced me to use the name to which I was jokingly referring to it as our plans got more ambitious: HIStalkapalooza, sponsored by [name coming soon]. So there you have it: HIStalkapalooza, Monday, February 21, 2011, 6:30 until 11:30 p.m. Eastern at BB King’s Blues Club in Orlando. Thanks very much to [name coming soon] for helping me honor HIStalk’s sponsors and readers in a soon-to-be-legendary way.

Weird News Andy’s radar picks up this story: Beth Israel Deaconess Medical Center (MA) admits that its surgeons miscounted vertebrae in three surgeries in the past three months despite taking the usual precautions, causing them to operate on the wrong part of the spine. The hospital says human error was involved and it can’t find a connection, although two of the three surgeries were performed by the same surgeon. The hospital also admits that it is working to fix problems found by inspectors, including using a checklist developed by another hospital to help surgeons mark their site correctly.

RAND had glowing things to say about CPOE in its 2005 study paid for by Cerner and other HIT vendor. Its new analysis, sponsored by a non-vendor group, finds that healthcare IT hasn’t generally improved the Core Measures scores of hospitals using it. However, the conclusion of the study’s lead author isn’t that HIT isn’t effective, but rather that outcomes measures are too broad to show HIT-related improvements. It was the usual drawing room type study that linked readily available but questionably useful information together to draw new conclusions: the HIMSS Analytics database, the AHA survey, and Core Measures numbers. It would be great if the effects of HIT were so dramatic that overall outcomes improved (not just Core Measures ones), but that’s probably not realistic, especially over a short timeframe. You’d have the same problem trying to make a quality case for almost anything: management changes, process redesign, policy changes in the use of drugs or devices, or better credentialing of staff. Measuring quality isn’t as easy as measure drug safety and effectiveness, where it’s not that hard to set up control groups, measure specific and immediate physiologic changes of effectiveness in patients, and monitor for easily recognized adverse reactions.

Thanks to Imprivata for its support of HIStalk, joining us as a Platinum Sponsor. I think you may infer from the above that the Lexington, MA company is justifiably proud of its #1 rating in KLAS’s Single Sign-On category. The company offers the OneSign single sign-on suite (say that three times …), OneSign authentication management, and the Imprivata PrivacyAlert system that detects and audits EMR snooping. Resources: a OneSign webinar, an overview of OneSign VDA for virtual desktops, and a data sheet covering PrivacyAlert and its out-of-the-box data support for Millennium, Sunrise, Meditech, and other healthcare apps. You might also want to check out Identity 360, the company blog. I don’t recall if I mentioned this, but OneSign Secure Walk-Away won the Security Innovation of the Year award from the British Computer Society two weeks ago. It uses a webcam to detect when a clinician walks away from their logged-in workstation, forcing a new user log in with their own credentials to improve security and avoid medical mistakes. I interviewed CMO Barry Chaiken just a few months ago.  Thanks to Imprivata for keeping the HIStalk wheels turning.

Strange lawsuit: a neuroradiologist and an endocrinologist playing a round of golf take their second shots of the first hole and head off to find their balls. The endocrinologist finds his and takes his shot, shanking the ball into the head of the neuroradiologist, blinding him. The neuroradiologist sues the endocrinologist, saying he should have yelled “Fore!” The appeals court throws out the case as had two previous courts, saying that the neuroradiologist was standing 15-20 feet from the endocrinologist at a 50-80 degree angle, making it unreasonable to expect the other golfer to yell “Fore!” before swinging since nobody was even close to his expected line of fire. The neuroradiologist’s attorney probably did little to elicit sympathy for his client, who has been unable to practice full time since the original 2002 incident, by claiming his eight-year lost income is “more than you and I will ever make in a lifetime.”

Canada-based healthcare document management solutions vendor Accentus acquires two transcription companies: ZyloMed (FL) and Transolutions (IL).

Virtual Radiologic completes its all-cash, $170 million acquisition of Nighthawk Radiology, paying a 100% premium to the market closing price of NHWK when the deal was announced in September.

A gastroenterologist’s editorial in the Cleveland Plain Dealer says EMR should stand for End of Medical Rapport, an unwelcome technological intrusion into the doctor-patient relationship being pushed by insurance companies, the government, and EMR vendors. I don’t buy this a bit since my doc is a big EMR user and, if anything, it makes our time together more valuable to me. As in most of life, it’s not what you have, but how you use it. His method: (a) we chat for a couple of minutes before he even looks at the screen since the assistant or nurse has already entered my vitals and chief complaint; (b) the monitor is placed on the desk beside the patient chair, so we’re still sitting close to each other and the monitor is to our side instead of between us; (c) he quickly looks up the information he needs, then turns back to me for the rest of our session; (d) he doesn’t type while we’re talking and generally hardly at all while I’m in the room; (e) if we’re talking about something, like my lab values, he pulls them up on the screen and we go over them together. Now my doc is great overall: he doesn’t wear a white coat because he thinks it’s too authoritarian, he always leads off with a friendly handshake and some chit-chat, and he is highly supportive of helping patients find their own healthcare answers, so it could be that his patient style is just so good that the EMR can’t overcome it. Maybe someone should write a how-to guide for docs on how to minimize EMR disruption since I’m pretty sure it can be done.

I don’t think I’ve ever watched a soap opera even once (being a non-viewer of Unemployment TV, I didn’t even know they were still on), but apparently on All My Children last week, someone named Greenlee got into a hospital’s computer using a stolen password to find out that someone was pregnant. Scenery-chewing overacting and hammy dramatic gestures ensued, I’m certain.

E-mail me.

News 12/24/10

From Donde Esta: “Re: hands-free interface. Interesting.” A group in Switzerland uses Microsoft’s Xbox Kinect 3D motion controller to enable voice and gesture commands with PACS.

From Woody the Wabbit: “Re: Allscripts. As positions EMR and PM positions open in Raleigh, they will be moved to India.” Unverified.

From AccidentalCIO: “Re: Meditech. On a conference call last week, they said customers will need to purchase their data repository to meet the requirement for electronic capture of quality measures. Nothing on their site, no press release. No other customers that I know have been made aware.” Unverified. I e-mailed the Meditech press contact, but haven’t heard back.

From Vanilla Ice: “Re: GE Centricity Enterprise. I hear they’ve told customers it’s going into maintenance mode.” Not exactly, according to my GE contact who tracked down “conversations” the company is having with customers (I’m quoting that since I don’t know exactly what it means, so I’ll use their word). GE says that, to demonstrate their commitment to the success of existing customers, priorities have been changed to help them rather than going after new sales. Not many were buying anyway, of course, and I can’t imagine there are more than a few dozen existing customers left, but GE is at least promising to support them in their quest for HITECH money and other benefits.

Testing 1-2-3 … can you hear me? OK, maybe we were silly to post the day before what is a holiday for most folks. But Inga and I are hard-working, salt-of-the-earth types who don’t want to let our equally dedicated readers down just because most people are sleeping late, shopping, and preparing to overeat. We’ll keep it short, but we’ll make sure to include something useful or entertaining that the less industrious will miss.

A CEO sent me this today, wanting to renew their HIStalk sponsorship: “We absolutely want to continue our support and participation with HIStalk. In fact, I personally believe it’s the most valuable marketing dollar we spend.” Nice! I appreciate that very much. And from another CEO, “Thank you again for all you do. I do not know of anyone who does more to keep everyone honest in this less-than-honest business of healthcare.” I know it’s like a tiresome grandparent whipping out endless pictures of a shriveled, newborn grandchild while everybody rolls their eyes, but I promise to brag only infrequently.

The VA finds that employees are using Web-based applications to store patient information, which CIO Roger Baker says is both a security challenge and a call for the VA to offer something similar. They discovered residents and employees using a Yahoo calendar and Google Docs to store patient information, going back to 2007. Apparently it was a primitive interoperability project: the residents covered multiple hospitals and needed to see VA patient information while off campus. The VA blocked access and sent letters to those whose information was stored there, even though it was secured.

Weird News Andy offers this Christmas gift to all. A woman sues her surgeon, who she claims was negligent in performing her hemorrhoidectomy. The gas she passed during the procedure was ignited by the surgeon’s electrosurgery pen, setting her genitals on fire. She lost the case.

Pinnacle Health (PA) reports exposure of patient information when its contracted transcription vendor inadvertently opens up its server to the Internet.

Verizon provides a $100,000 grant to UMDNJ-University Hospital for the STAT-MI system, which allows ambulances to send ECGs directly to a hospital cardiologist’s smart phone so that patients having a heart attack can be transported directly to the cath lab.  

Jobs on the Sponsor Job Board: Senior Software Engineer, VP of Sales, Application Consultant. On Healthcare IT Jobs: RN Clinical Informatics Transformation Leader, Senior Clinical Analyst, Enterprise Integration Architect, Meditech EDM Consultant.

CCHIT certifies Ingenix CareTracker as a Complete EHR.

Just a suggestion: sometimes I use the HIStalk mailing list to offer benefits to those readers on it (first notice of stuff, HISsies voting privileges). If you haven’t signed up, that “Subscribe to Updates” box to your upper right is your ticket to paradise.

The news that Dell is acquiring InSite One caught me by surprise since I had just finished interviewing the company’s CEO. I’ll have it up soon.

Strange: Zsa Zsa Gabor’s husband (her eighth) is admitted to the hospital after he apparently mistakes Zsa Zsa’s nail glue for his eye drops and seals his eye shut. I figured he might be a bit old to be taking care of himself since she’s 93, but he’s only 66 and planned to run for Governor of California this year until Zsa Zsa’s health became an issue.

Vermont’s REC adds Greenway’s PrimeSUITE to its list of preferred EHR partners.

A hospital in Canada loses $1.5 million to a minimally supervised accounts receivable clerk responsible for loading its ATM machine with cash. The $40K per year employee treated nine friends to a trip to Hawaii and had blown $400K on slot machine gambling at a local casino.

I hope your Christmas is just peachy and that Santa brings you whatever you want. All is right with the world when the marathon of A Christmas Story is on, gift wrap is strewn everywhere, and the smell of turkey or beef or tofu or whatever traditional food you cook is wafting over the Cowboys on the big screen. Once the holidays are behind us, HIMSS looms, so you know it’s going to be a whirlwind (for me, anyway). Thank you for being involved with HIStalk in whatever fashion. I’ll be here with the usual Monday Morning Update, which probably means working Christmas Day, so don’t forget to come back.

E-mail me.

HERtalk by Inga

From Zebedee: “Re: St. Joseph’s. Merry Christmas, Inga, thanks for an educational year. I heard this story on NPR this morning.” The Catholic church strips St. Joseph’s Hospital and Medical Center (AZ) of its religious affiliation after providers terminate a pregnancy. Hospital officials insist the surgery was in line with Catholic teachings and was performed to save the mother’s life; the local bishop disagrees and severs the church’s tie with the hospital (facility excommunication?) St. Joseph administrators insist the move will have little effect on its ongoing operations or hurt donor contributions.

From Sam the Snowman: “Merry Christmas, Inga. You never seem to age in your pictures. Keep it up.” Thanks for noticing, Sam. Clean living.

Florida’s Agency for Health Care Administration awards Harris Corporation a four-year, $19 million contract to implement a statewide HIE infrastructure.

Also from Florida: Good Samaritan Medical Center and West Boca Medical Center are using the RF Surgical Detection System to prevent and detect foreign items inadvertently left inside patients during surgery.

Let the registration begin. Beginning January 3rd, eligible providers and hospitals can apply for participation in the Medicare EHR incentive program. Eleven states will open Medicaid registration the same day; other states will begin accepting Medicaid applications in coming months. David Blumenthal says, “It’s time to get connected,” which is kind of a hokey statement at this point in the game. But heck, maybe he is just in the holiday spirit.

Rhode Island MSO Polaris Medical Management selects DiagnosisONE as its exclusive provider of clinical decision support for EHR deployments.

McKesson wins anti-trust approval to complete its $2.16 billion purchase of US Oncology on Tuesday, the same day an interim court order stalls the acquisition. The Supreme Court of the State of NY puts the purchase on hold, based on a case filed against McKesson by the Cancer Clinics of Excellence. The network of oncology practices claims the deal breaches an existing contract it has with McKesson.

In India, seven health department employees are suspended after allegedly organizing a “vulgar dance” program at work. I bet Mr. H’s holiday party outlook would be greatly improved if his hospital hosted a similar program. He might even wear a Santa hat to show his support.

From Luke O’Cyte: “Re: Santa and shoes. We know that’s not you sitting in Santa’s lap because the real Inga would never have posted a photo that didn’t show her fancy shoes!  Obviously this photo was one of a woman wearing inappropriate shoes, which necessitated the cropping of the photo, lest it clue viewers in that this wasn’t the ‘real’ Inga! Here’s hoping that Santa brings you lots of fancy footwear for under the tree, and with that note, I give you The 12 Shoes of Christmas:

On the twelfth shoe of Christmas,
my true love sent to me
Twelve sandals peeking,
Eleven flip-flops flopping,
Ten pumps a-pumping,
Nine loafers dancing,
Eight moccasins a-walking,
Seven slippers slipping,
Six golf shoes putting,
Five golden boots,
Four peep toes,
Three Mary Janes,
Two canvas runners,
And a high heel in a shoe tree!”

Brilliant. Thank you, Luke, my newest BFF. Wishing all readers a lovely holiday!

E-mail Inga.

Dell To Acquire InSite One

Dell announced this morning that it will acquire InSite One. The Wallingford, CT company offers cloud-based, vendor-neutral medical image storage and archiving, with 800 clinical sites as customers. Its InDex enterprise architecture is based on the IHE framework and supports recovery and migration services.

Dell says the company’s technology will extend Dell’s Unified Clinical Archive solution.

Berk Smith, Dell’s vice president over healthcare and life sciences, said, “As the first company to bring cloud technology to the medical archive space, InSite One will help Dell’s healthcare customers take advantage of the economics and scalability of the cloud for medical archiving and retention. And looking beyond archiving, the cloud will also be a valuable tool for information exchange which is foundational to the transformation of healthcare.”

Terms of the acquisition were not announced.