Monday Morning Update 2/10/14

From EpicConsulting: “Re: Epic going into the consulting business. What’s being said internally at Epic is that the program will be limited to employees with 4+ years of experience, it will provide some location independence, and the intention is to undercut in price most of the Epic consulting industry. It’s an attempt to give Epic employees less incentive to quit, sit out their one-year non-compete, and then come back doing the same job making twice the pay for half the hours. Epic has talked about doing this for years, formerly calling it Ongoing Services, but hasn’t actually gone this far until now. Consulting firm reaction has been, ‘Why would you want the same person who dug you into a hole to be the one to dig you out?’ but can they compete when Epic sells services at $75 per hour and they’re billing $150? Would a CIO pay double for a non-Epic voice? Will hospitals gain negotiating power with another option in the market? Fun question, too: will KLAS rate Epic’s consulting and will companies like Nordic, Sagacious, etc. score higher than Epic itself?” All unverified, but interesting.

From Please Please Me: “Re: HIStalkapalooza. I’ve never requested an invitation, so I’ve never been refused. But it sounds like fun and you guys are great to do that – don’t let the poor souls who don’t get in discourage you.” Inga reminded me that despite reader Gary’s insistence that he didn’t get an invitation for three years straight, we sent one to every single person who registered in 2013 and 2011, and I’m pretty sure we invited everyone in 2012 as well. Gary either didn’t register in time those years or his company’s spam filter trashed our emailed invitation, which happens a lot (and creates extra work for us because people always email us wanting individual assistance.) Demand this year was unprecedented – it will be the largest HIStalkapalooza yet, but around 900 more people asked for invitations than we have available. And to address the most commonly asked question, sorry, but we have no way to accommodate guests even though I’m sympathetic to those who want to attend with a spouse or friend – we’ve already had to turn away hundreds of loyal HIStalk readers.

Upcoming Webinars

February 12 (Wednesday) 1:00 p.m. ET. Healthcare CO-OPs and Their Potential to Reduce Costs. Sponsored by Health Catalyst. Presenters: David Napoli, director of performance improvement and strategic analytics, Colorado HealthOP and Richard Schultz, VP of clinical care integration, Kentucky Health Cooperative. Consumer Operated and Oriented Plans (CO-OPs) were established by the Affordable Care Act as nonprofit health insurance companies designed to compete in the individual and small group markets. Their intended impact was to provide more insurance options for consumers to pay for healthcare.

February 13 (Thursday), 12 noon ET. Advancement in Clinician Efficiency Through Aware Computing. Sponsored by Aventura. In an age of information overload, a computing system that is aware of the user’s needs becomes increasingly critical. Instant-on roaming for virtual and mobile applications powered by awareness provides practical ways to unleash value from current HIT investments, advancing efforts to demonstrate meaningful use of EHRs and improve clinical efficiencies. The presenters will review implementation of Aventura’s solution at Orange Coast Memorial Medical Center.

February 18 (Tuesday), 1:00 p.m. ET. Epic 2012 Training and Support: Building Your Team. Sponsored by MBA HealthGroup. The webinar will present a case study of creative staffing solutions for an Epic 2012 upgrade at an academic medical center, describing the institution’s challenge, its out-of-the-box solution, and the results it obtained working with a consulting firm.

iHealth 2014 Report

The only conference I attend regularly is HIMSS for a variety of reasons  — cost, time required, and often because I don’t even know when or where a given conference is being held with enough lead time to plan. I always invite readers to provide a summary of their experiences.

Here’s ADG’s writeup of AMIA’s iHealth conference:

iHealth 2014 was a good excuse to get away from the cold and snow of wherever you were and come to Orlando for some warm rain. Farzad Mostashari in particular was seen immediately after the PBS-style fireside chat of the four previous national coordinators without a bowtie and in the company of a couple of cute kids. Getting the four on the same stage was a logistics coup and they were immensely personable. The two with the initials “DB” — David Brailer and David Blumenthal — cheerfully referred to each other as DB1 and DB2. Their themes included the coming penalties for non-compliance with MU, and DB1’s very sharp insights, which included the observation that he expects FDA regulation of EMRs within “single digit” years. Their advice to the current ONC coordinator Karen DiSalvo seemed to be a version of “buckle up.” DB1 in particular was praised by the others for his sharp organizational and entrepreneurial skills in getting the office started on the right foot.

We came to Orlando to get practical advice (and to get out of the cold, see above) and there is some comfort that all are struggling — large and less-large, academic and less-academic — with rapid change. Most noticeable was a sharp divide between the academics and the operational types, with the academics suggesting that if you do the right things, the “regulators will catch up,” which is an actual quote. The operational types knew that regulators will deny payment for any failure to cross the T and dot the i and that their organization would be out of business for lack of money by the time the regulators “caught up” to the “right thing.” There was a terrific dinner hosted by AMIA for recent diplomates of the board of Clinical Informatics, and we discovered we all have frighteningly similar backgrounds and tastes. Blackford Middleton, chair of the board of directors of AMIA, gave an excellent short toast. There were no grand insights, but lots of one-on-one incremental gains from each other, and HIStalk was mentioned at least a couple of times from the stage(s).

Jim Hansen of Lumeris / Accountable Delivery System Institute knows I like what we call “Judy-isms,” little nuggets of cynical wisdom from Epic’s Judy Faulkner. He culled these from last week’s HIT Policy Committee meeting:

• “Be careful about prescriptive standards. If there was a usability committee for the iPhone, there wouldn’t be one.”
• “We see a huge international move to EHRs without incentive money. We can’t test it here, but would it have happened anyway?”
• “With regard to Meaningful Use and providers saying, “I paid for an EHR, therefore you as the government owe me,” I think of girls on dates and I don’t think that’s a good idea.”

Brian Ahier provides the full text of the SGR Repeal and Medicare Provider Payment Modernization Act that proposes to move the Meaningful Use program into the Merit-Based Incentive Payment System.

From athenahealth’s Friday earnings call:

• Jonathan Bush talked up athenaCoordinator for Enterprise, “our first truly hospital-facing service” that will tie together the company’s services for pre-certification, pre-registration, scheduling, and population health management. It will cost hospitals 1 percent of revenue.
• “The on-ramp that is turning out to be Epocrates” will be enhanced to include secure text messaging, a provider director, and clinical decision support tools and the rollout of Epocrates Prime that will allow non-physician secure messaging participants and referral capability.
• New company locations include Austin, Atlanta, and San Francisco.
• Sales to small hospitals, the only underperforming area, will be better supported by teams that include operational analysts rather than just a single salesperson.
• Bush, responding to an analyst’s question about how cost-shifting to patients will affect the company, said, “As long as they don’t become uninsured self-payers and they keep their financial selves tangled up in impossible-to-understand bureaucratic health plans, which is now the law of the land, it doesn’t hurt us.”
• Bush says the company may need to create a patient-facing division because patient portal use is low industry-wide.
• In describing the company’s patient engagement efforts, “The goal is to just do everything possible for the doctor over the cloud, to the patient, at home where they get better answers to clinical questions. Like tell me about your diet and your life and all the things you need to know for the doctor, all your smoking, your seatbelts, your sex life. All those things are much easier to talk about at home or in private than sitting in the freaking waiting room, or worse, on that butcher paper with your knickers off. So we’re going to use the social good created by all of our increasingly sophisticated patient outreach to be way better than we are.”
• Enterprise Coordinator will include the patient facesheet from athenaClinicals and clicking on the patient’s name, even by a practice that doesn’t use athenahealth, will launch a session of the hospital’s EHR.
• Bush described the company’s future strategy as, “The goal here is to get into the front door and the back door of the hospital and work our way through the wards and departments with cloud-based services that allow them to virtualize, get business from more places, and focus more of their resources on actual clinical care. Other places we need to go is we need to go to patients. So every patient in America needs to have something in their wallet and something on their wrist, some sort of 2D barcode or in their iPhone that says, ‘This is me. Zap this thing and pull me up on athenaNet if I’m unconscious.’ So that’s some sort of patient outreach. I don’t know if it’s a partnership with the big dogs out in California, the Facebook or whatever — maybe I have to meet the Zuck, who knows. And then the other one is to get into the finance side. So health plans have been largely kind of strapped down and held still by regulation. They can’t be responsive to their customers. They need new ways of underwriting healthcare and a partner that could bring a claimless healthcare network where nobody sends a claim or receives a claim. All of this is instantaneous intelligence built into the wire. That should be us.”
• In summarizing 2013, Bush said, “That wraps up a fantastic year. And over the last few days, we have given out beautiful crystal things, checks, and stock options. And if that wasn’t enough, we gave a few people hangovers so that they knew that what they had done in 2013 and then we took all their needles and returned them to 0. And we noticed last night that you all got excited about how the year went and the stock went up. And we want you to know that we have turned our needles with you to 0. We have a very long way to go and it is only to us about how we journey. There will be a healthcare Internet and we will be the ones who have created it. ”

Speaking of athenahealth, ATHN shares jumped 25 percent on Friday, the second-largest percentage gain on the Nasdaq, after Thursday’s earnings announcement, valuing the company at $6.5 billion. A $10,000 investment five years ago would be worth $52,000 today.

CMS extends the deadline for EPs to attest for MU 2013 by a month to March 31, 2014.

The White House Office of Science and Technology Policy announces that several drug chains have pledged to support or expand their use of the Blue Button initiative to allow patients to access their prescription information: Walgreens, Kroger, CVS Caremark, Rite Aid, and Safeway. Walgreens, always the technology leader in retail pharmacy and arguably in healthcare, says it will adopt BlueButton+ guidelines to allow customers to share their data and use third-party health applications.

The Federal Trade Commission approves a settlement with IP-based video camera vendor TRENDnet over a software vulnerability that allowed anyone to view a camera’s live feed over the Internet without a password. One marketed use of the secure video systems is monitoring hospitalized patients.

In England, a privacy group criticizes West Suffolk Hospital after it reports 20 documented breaches since 2010, including seven in 2013. All of breaches last year involved paper records that were filed or mailed incorrectly.

Weird News Andy includes an actor’s name pun in titling this story, “He’s a Lauriette.” A German doctor diagnoses a patient’s cobalt poisoning caused by a broken artificial hip after recognizing its symptoms from an episode of the TV series “House.” The doctor says he’s not thrilled at being called “the German Dr. House” since he finds rude behavior unacceptable, but concedes, “It’s important to be nice, but you don’t get patients healthy just by being nice.”

Sponsor Updates

• Clinical Architecture announces Symedical for the iPad, which provides mobile access to map administration.
• John Gomez of JGo Labs is working with investment bankers interested in investing in healthcare IT companies with $5 million to $30 million EBIDTA, a proven business model, and good revenue growth. He’ll be available to meet with interested companies at HIMSS. 

Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis, Lorre.

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 2/7/14

athenahealth, Inc. Reports Fourth Quarter and Full Year 2013 Results

athenahealth reports Q4 and full year 2013 results: $595 million total annual revenue, representing a 41 percent increase year-over-year. A Q4 adjusted EPS of $0.57 vs. $0.29 beat analysts estimates and drove shares up 19 percent in after hours trading.

Former TX hospital CFO charged with health care fraud in Tyler court

The former CFO of Shelby Regional Medical Center (TX) has been indicted by a federal grand jury and charged with health care fraud violations for falsely attesting to Stage 1 Meaningful Use.

Army, Air Force Tap Goodwill Industries to Scan and Send Records to VA

The Army and Air Force have contracted with Goodwill Industries to begin scanning and transmitting copies of departing service members’ medical records to the VA.

Gov sees fix for failed Mass. health care website

Massachusetts Governor Deval Patrick apologizes to residents over the states problematic health insurance exchange website. Development of the site was managed by CGI Group, the same company that was responsible for Healthcare.gov.

News 2/7/14

Top News

Athenahealth reports Q4 results: revenue up 48 percent, adjusted EPS $0.57 vs. $0.29, beating analyst expectations for both and sending ATHN shares up 19 percent in after hours trading Thursday. Above is the one-year performance of ATHN (blue) vs. the Nasdaq (red).

Reader Comments

From OnTheFringe: “Re: KLAS. Sponsoring a Best in KLAS TweetChat Friday. Oh my, I think I might have a few beers and fire up my Twitter account.”

From Faithful Sponsor: “Re: HIStalkapalooza attire. While I did not make the cut to attend HIStalkapalooza 2014, one of my executives did and I wanted to touch base to see what the theme was this year.” Let me start by saying that no one is sadder than Mr. H and me that we were not able to accommodate all our faithful readers and sponsors due to capacity limitations. The only HIStalker more sad than us is probably Dr. Jayne, who was unable to score an invite for her “+1,” a gentleman that Dr. Jayne assures me  is terrific, even if he did just cancel his HIStalk subscription over the perceived snub. Next year I am proposing we rent Soldier Field so we have plenty of room for anyone (though I suppose we might need to wear snow suits.) As for this year, we will once again be seeking contenders for the Inga Loves My Shoe contest, so please bring your A game. Overachievers who are able to pull off the whole package may be in the running for HIStalk King or Queen. If that’s not specific enough, here’s a good rule of thumb: leave the “just off the exhibit floor” company golf shirt in your hotel room and come adorned in something fun, flirty, and suitable for sipping Ingatinis. You’ll see some long gowns, a tux or two, plenty of cocktail dresses, and the occasional pair of blue jeans. It’s going to be fun.

From Gary: “Re: HIStalkapalooza. Rejected third year in a row. I have concluded that this is a hand picked, very political event, your own version of the Good Ole Boy network.” Every year I swear I’ll never do another HIStalkapalooza because of the endless complaining about who gets invited and the time and energy it takes to wade through hundreds of emails begging for (or demanding) invitations, insistence on bringing uninvited guests, or asking me to personally repeat event details that have already appeared several times in HIStalk. The event is a really nice, free party for maybe 1,000 people and neither the sponsor nor I get anything out of it except a ton of work, but somehow we end up being the bad guys when demand for invitations exceeds supply. The invitation process is clear and hasn’t changed since 2008: employees of non-profit providers (hospitals, practices, universities – hardly “political”) who request invitations come first. This year a huge number of providers signed up, leaving around 1,000 others without spots no matter how cool they are or how much I like them. It’s no different than a popular show or sporting event – not everybody is going to get a seat. Next thing you know scalpers will be lined up outside of the House of Blues.

Speaking of HIStalkapalooza, every year at least 40 percent of those invited don’t show up. This year I’m keeping a database of no-shows who don’t let me know in advance so that I can give someone else their spot – that will be the last HIStalkapalooza invitation they’ll get. A few invitees have already emailed to say their plans have changed and I really appreciate that.

From Reader: “Re: HIStalk. Thank you again for the wonderful service you offer our healthcare industry. So many of us wake up each morning to stay informed to the latest news via HIStalk. I am amazed at how well your content remains timely, fresh, and complete. We hope to see you at HIMSS, where we will release the next generation of our solution. Wishing you continued success in 2014.” Thanks. I don’t usually have enough time to watch demos at the HIMSS conference, but I will try to swing by at least briefly and anonymously.

From Silent: “Re: Epic. Going into the consulting business. This will greatly disrupt the current vendor marketplace.” Unverified.

From WildcatBelievers: “Re: The University of Arizona Health Network’s Diamond Children’s Hospital. Went live on Epic in November, recently put together this fantastic video with special guest band American Authors to celebrate the tremendous and impactful work they are doing to improve the lives of the children of Arizona.”

HIStalk Announcements and Requests

A few HIStalk Practice highlights from the last week include: Epic, eClinicalWorks, and Allscripts own 30 percent of the physician EMR market. Physician practices are far from ready for ICD-10. HHS finds that few health centers have the capacity to meet MU data sharing objectives. Reimbursements remained flat in 2013 for existing patient visits and declined for new patients. EHR alerts show promise in changing physician behavior when treating obese and overweight children. Dr. Gregg recommends taking time to step across the divide to reinvigorate your viewpoint. Culbert Healthcare’s Brad Boyd offers tips for optimizing clinical documentation. Thanks for reading.

Welcome to new HIStalk Platinum Sponsor CitiusTech, a leading healthcare technology services and solutions provider with 1,400 professionals (including 500 certified in HL7) serving over 50 leading healthcare organizations. The company has grown 55 percent year-over-year for the past five years and has won awards for being a great place to work. Its BI-Clinical healthcare business intelligence and clinical decision support system has been deployed at over 1,200 provider locations, with pre-built clinical, financial, operational, and regulatory reporting apps and 600 pre-built KPIs. Services include software product engineering, professional services, QA and test automation, and technology consulting. Specific practice areas are Meaningful Use compliance, interoperability, BI, consumer health, care management, and cloud and mobile health.  The company serves all healthcare markets – vendors, hospitals, medical groups, medical device companies, HIEs, health plans, and pharma. Thanks to CitiusTech for supporting HIStalk.

Here’s an overview of CitiusTech.

HIMSS Conference Social Events

Aventura, Nordic Consulting, Avent, and IHS Consulting will host the Row 1800 block party from 4:00-6:00 p.m. on Tuesday, February 25. All will be serving food and drinks and Aventura will feature a magic show at booth 1831. All hated competitors are welcome.

Upcoming Webinars

February 12 (Wednesday) 1:00 p.m. ET. Healthcare CO-OPs and Their Potential to Reduce Costs. Sponsored by Health Catalyst. Presenters: David Napoli, director of performance improvement and strategic analytics, Colorado HealthOP and Richard Schultz, VP of clinical care integration, Kentucky Health Cooperative. Consumer Operated and Oriented Plans (CO-OPs) were established by the Affordable Care Act as nonprofit health insurance companies designed to compete in the individual and small group markets. Their intended impact was to provide more insurance options for consumers to pay for healthcare.

February 13 (Thursday), 12 noon ET. Advancement in Clinician Efficiency Through Aware Computing. Sponsored by Aventura. In an age of information overload, a computing system that is aware of the user’s needs becomes increasingly critical. Instant-on roaming for virtual and mobile applications powered by awareness provides practical ways to unleash value from current HIT investments, advancing efforts to demonstrate meaningful use of EHRs and improve clinical efficiencies. The presenters will review implementation of Aventura’s solution at Orange Coast Memorial Medical Center.

Acquisitions, Funding, Business, and Stock

Private equity firm Thoma Bravo acquires supply chain solutions vendor Global Health Exchange.

Praesidian Capital invests $8.3 million in Etransmedia Technology.

Alere announces Q4 results: adjusted revenue up two percent, ajusted EPS $0.68 vs. $0.55, beating estimates. Net product and services revenue from Alere’s health information solutions segment was flat.

Bottomline Technologies will pay $8 million for Rationalwave Analytics, an early-stage predictive analytics company.

From Cerner’s earnings call:

• The company signed 25 contracts over $5 million in the quarter
• President Zane Burke says half of the market will reconsider their EHR supplier in the next few years, most of them will choose Cerner or Epic, and Cerner’s win rate against Epic has doubled in the past three years.
• Cerner says it replaced 18  ambulatory competitors in signature accounts.
• It says it sold an HIE to a 600-bed Epic hospital because Epic was “was unable to effectively connect to other systems.”
• The company says providers are consolidating and Cerner hospitals are buying smaller ones at quadruple the rate of Epic hospitals.

Sales

FirstHealth of the Carolinas selects Truven Health Unify for population health management.

Bozeman Deaconess Hospital (MT) will implement Merge Healthcare’s VNA and interoperability solutions.

Metro-North ACO (PR) selects eClinicalWorks Care Coordination Medical Record to advance its physician-led ACO objectives.

Adventist Health System selects HealthMEDX to automate Adventist Care Centers, its long-term care division.

Genesis Medical Center (IA)  will implement Wolter Kluwer Health’s ProVation Medical software for cardiology procedure documentation and coding.

Covenant Health Systems (MA) adopts MedeAnalytics’ analytics platform to manage population health for its employees.

Athens-Limestone Hospital (AL) selects Besler Consulting to assist in the identification of Medicare Transfer DRG underpayments.

Providence Health & Services and Swedish Health Services (WA) will implement care transition and utilization review solutions from Curaspan Health Group, as well as Xerox’s Midas+ Care Management platform.

People

Axiom EPM hires David Janotha (Loyola University of Chicago Medical Center) as VP of healthcare.

Parallon names Scott Armstrong (OptumInsight) SVP and Wendy Penfield (Intellect Resources) as AVP, both in revenue cycle consulting services.

Surgical supply chain software vendor Solstice Medical hires Todd Melioris as CEO.

Announcements and Implementations

Geisinger Health System (PA) deploys Courion’s identity and access management solutions.

St. Luke’s University Hospital Network (PA) implements Get Real Health’s InstantPHR patient portal, which will be connected to Caradigm’s HIE platform.

HIMSS announces a Latin American version of its annual conference that will be held September 18-19 in Sao Paolo, Brazil.

Government and Politics

The Army and Air Force contract with a division of Goodwill Industries to scan and transmit to the VA the service treatment records of veterans discharged this year.

The DoD and VA collaborate to develop a way for the VA to review the scanned images of the DoD electronic medical records of disability claimants.

Farzad Mostashari tweets out a section of the proposed SGR bill that would roll Meaningful Use and PQRS incentives into a new value-based payment system that would start in 2017.  Additional language would require EHRs to be interoperable.

The former CFO of Shelby Regional Medical Center (TX) is indicted for Medicare fraud, charged with falsely attesting that the hospital met Meaningful Use requirements for 2012. The hospital was mostly paper-based, but ordered its software vendor (eCareSoft) and employees to manually enter information into the EHR months after discharge to earn $786,000 in incentive payments. The hospital was part of a now-defunct for-profit chain that collected $18 million in Meaningful Use payments before being dismantled after reports of serious patient care issues.

The governor of Massachusetts apologizes for the state’s dysfunctional insurance exchange website as a non-profit research firm finds the site loaded with “technical infrastructure and data stability problems.” The governor says that contractor CGI, which was also responsible for Healthcare.gov, was  not reliable and relieved CGI overseer University of Massachusetts Medical Center of further responsibilities.

Other

New York officials report that the state’s online database for drug prescriptions has reduced doctor shopping by 75 percent since its August 2013 implementation.

The World Health Organization postpones the rollout of ICD-11 until 2017, two years later than planned.

Sponsor Updates

• AirWatch opens an Australian headquarters in Melbourne.
• Allscripts announces the general availability of Sunrise Version 14.1.
• Jed Shay, MD shares how his use of AdvancedMD’s EHR and PM services have contributed to improved cash flow, productivity, and patient tracking.
• T-System files a patent application for an ICD-10 feedback feature that helps clinicians document for ICD-10 without an interruption in workflow.
• Huron Healthcare will integrate predictive analytic technologies from Connance into its revenue cycle solutions.
• Russell Green, VP of research operations and engagement manager for Porter Research, discusses the mixed messaging of HIEs in a blog post.
• Kelsey Creveling from Sagacious Consultants clarifies changes in the Safe Harbor regulation in a blog post.
• MyCatalyst will use Liaison Healthcare’s Data Management platform for its myCatalyst Provider Portal and Population Health Reportal solutions.

EPtalk by Dr. Jayne

The pre-HIMSS mail bonanza has started. It seems a little earlier than last year. Today’s winner is GCX Mounting Solutions, whose “scratch and win” card fell victim to the Postal Service’s automated mail handling machines. A fair number of mailings arrive mangled every year. I wonder if the marketing and promotional companies ever consider doing a test mailing to make sure their items will arrive as intended?

Several vendors have shared invitations to their client appreciation parties and I’m looking forward to writing them up. I haven’t heard from very many EHR vendors, so either they don’t want sassy women in fabulous shoes to attend or they’re just behind. Inga will be sharing invitations from those vendors willing to open their events to HIStalk readers. I appreciate their willingness to let everyone share in the fun. After slogging through 500,000 square feet of exhibit space and 1,200 exhibitors, the opportunity to unwind and partake of a cocktail is more than welcome.

Something I’ll be on the lookout for in the exhibit hall: devices that use the new Corning antimicrobial Gorilla Glass. When I think about all the devices I come into contact with each day in the hospital compared to the variable handwashing behavior of some of my colleagues, it seems like a good idea. I see more people wiping down equipment at the gym than I see on the wards and that’s not a good thing. I haven’t seen any evidence-based reports on how well it works, so if you have any inside scoop, let me know.

The World Health Organization is postponing the rollout of ICD-11. Originally slated for 2015, it will be delayed until 2017. Hopefully this will quiet those voices advocating that we skip ICD-9 and go straight to ICD-11. ICD-10 was approved in May 1990 and first came into use in 1994, so based on the historical timeline, the United States should be ready for ICD-11 in 2038. Thank goodness I’ll be retired by then.

Several readers emailed about this week’s Curbside Consult on wearable tech. One mentioned the lack of interest in a mobile healthcare enterprise device. Manufacturers are focused on selling directly to the masses, but it would seem like there is a place for enterprise devices in the Accountable Care or HMO spaces. Another lamented the lack of integration among devices — “I feel like a nurse with 50 devices being a kangaroo.”

When I was in residency, we used to refer to the group of pagers that you had to wear when you were on call as the Batman Utility Belt. There was the on-call pager, the code team pager, and your personal pager. You also had to carry the elevator keys (because who wants to run up 17 floors when a patient needs CPR?) Throw on a bulky cell phone, and if you were extra lucky, the labor and delivery pager, and you were ready to go. I almost forgot – some also had a Palm Pilot, although I was partial to the Pocket PC.

We’ve certainly come a long way. Some of us are down to one device if we work in a BYOD environment. I’m still toting a corporate phone and a personal phone, but it certainly could be worse. Have you been able to shed the utility belt? Email me.

Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis, Lorre

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 2/6/14

New MGMA research: industry coordination lagging; less than 10 percent of physician practices ready for ICD-10

According to a new study from MGMA, less than 10 percent of physician practices have made significant progress on their transition to ICD-10.

EHR incentive payments soar beyond $19 billion

$19 billion in EHR incentive payments have been distributed thus far, with 88 percent of all eligible hospitals and 78 percent of eligible providers having received a share.

Innovative Collaboration to Address Shared Challenges in Health Care

Kaiser Permanente and the VA have announced that they will pool resources and develop best practices for key emerging fields such as genomics, population health, and telehealth.

A.G. Schneiderman Applauds Success Of New York’s Innovative Program To Prevent Prescription Drug Abuse

A law in New York that requires pharmacists to update on online database anytime a narcotic prescription is filled, and then requires physicians to check the database prior to issuing new prescriptions to patients, is being credited with reducing "doctor shopping" by 75 percent. The same law mandates state-wide e-prescribing by March 2015.

Morning Headlines 2/5/14

Castlight Health Files $2 Billion IPO

Castlight Health, a health benefits management vendor working to increase cost transparency with web-based consumer tools, has filed IPO registration paperwork with the SEC for a stock offering expected to reach a $2 billion valuation. Castlight was founded by athenahealth co-founder and current US CTO Todd Park.

Imprivata Confidentially Submits Registration Statement with the Securities and Exchange Commission for Initial Public Offering of Its Common Stock

Imprivata, a KLAS leading for Single Sign-on solutions vendor, confidentially files IPO registration papers. A press release from the company reports that they will execute the stock offering once the SEC has finished its review.

2013 Healthcare Provider Innovation Survey

A recent HIMSS survey measuring the state of innovation within provider organizations finds that cost reduction is the focal point of innovation initiatives for most respondents. With EHR optimization in full swing, providers are now reportedly making progress implementing systems for population health management, patient follow-up, predictive analytics, clinical decision support, and care coordination.

Cerner Reports Fourth Quarter and Full Year 2013 Results

Cerner announces Q4 and 2013 year end results: Full year bookings were $3.77 billion, up 20 percent from 2012. Adjusted Q4 EPS $0.39 vs $034, meeting analyst expectations.

News 2/5/14

Top News

Castlight Health files plans for an IPO that values the company at $2 billion. The employee health management software company was formed in 2008 with now-US CTO Todd Park as a co-founder.

Reader Comments

From Jack Flash: “Re: Dick Derrick. The HCIT world will miss the smiling face of Dick Derrick of eClinicalWorks, who announced his retirement after 40 years in our business.” Dick was kind enough to share with Mr. H and me that he remains “addicted” to HIStalk and will continue reading in between his travel, volunteering, and family time. He also asked us to send his best to his industry friends.

HIStalk Announcements and Requests

Supporting HIStalk as a Platinum Sponsor is Aperek (pronounced uh-PARE-ik) which you may remember as Mediclick (with earlier roots in Global Software) since the healthcare-only, all US-based company changed its name along with introducing new products in November 2013. The Raleigh, NC-based company offers highly ranked solutions for supply chain, financials, mobile, technology, spend aggregation / contract management, and implant tracking. CEO Mike Merwarth explained in my interview last week that 80 percent of a hospital’s supply expenses are managed by clinical people rather than materials management professionals (particularly in the OR, where high-dollar implant products are used) and thus aren’t touched by typical ERP packages. A new Aperek solution is Pulse, an iPad app designed for clinicians who record implant item usage in the OR. Hospitals are looking at the supply chain and thus to Aperek to get their costs under control. Thanks to Aperek for supporting HIStalk.

HIMSS Conference Social Events

 Send us your event details if it’s a good one (i.e, free food and drinks at minimum) and you promise that all HIStalk readers are welcome to attend, even if they work for your most hated competitor as a given reader might well do. Inga and Dr. Jayne especially like free cocktails and are happy to give your company a shout-out if we have the chance to stop by.

Divurgent will be sponsoring a Havana Nights themed event at the Funky Monkey (International Drive) Sunday night at 8:00 p.m. on Sunday. Click here to register.

Upcoming Webinars

February 5 (Wednesday) 1:00 p.m. ET. Healthcare Transformation: What’s Good About US Healthcare? Sponsored by Health Catalyst. Presenter: John Haughom, MD, senior advisor, Health Catalyst. Dr. Haughom will provide a deeper look at the forces that have defined and shaped the current state of U.S. healthcare. Paradoxically, some of these same forces are also driving the inevitable need for change.

February 12 (Wednesday) 1:00 p.m. ET. Healthcare CO-OPs and Their Potential to Reduce Costs. Sponsored by Health Catalyst. Presenters: David Napoli, director of performance improvement and strategic analytics, Colorado HealthOP and Richard Schultz, VP of clinical care integration, Kentucky Health Cooperative. Consumer Operated and Oriented Plans (CO-OPs) were established by the Affordable Care Act as nonprofit health insurance companies designed to compete in the individual and small group markets. Their intended impact was to provide more insurance options for consumers to pay for healthcare.

February 13 (Thursday), 12 noon ET. Advancement in Clinician Efficiency Through Aware Computing. Sponsored by Aventura. In an age of information overload, a computing system that is aware of the user’s needs becomes increasingly critical. Instant-on roaming for virtual and mobile applications powered by awareness provides practical ways to unleash value from current HIT investments, advancing efforts to demonstrate meaningful use of EHRs and improve clinical efficiencies. The presenters will review implementation of Aventura’s solution at Orange Coast Memorial Medical Center.

Acquisitions, Funding, Business, and Stock

Cerner announces Q4 results: revenue up 12 percent, adjusted EPS $0.39 vs. $0.34, meeting analyst expectations.

ZappRx, developers of a mobile e-prescribing platform, secures $1 million in additional funding.

Imprivata confidentially submits a draft registration statement with the SEC to conduct an IPO.

Streamline Health Solutions completes its acquisition of Unibased Systems Architecture.

Endo Health Solutions completes the divestiture of HealthTronics to Altaris Capital Partners for total consideration of up to $130 million.

BlueStep Systems, a clinical platform provider for the long-term and post-acute care market, merges with  BridgeGate Health, a system integration provider.

Sales

Spectrum Health (MI) selects PerfectServe’s Clinician-to-Clinician and DocLink platforms for direct and secure clinician communication.

The 14-hospital Baptist Memorial Health Care System selects Voalte smartphones for system-wide caregiver communication.

People

HIMSS awards CACI International’s Keith Salzman, MD its 2013 Physician IT Leadership Award.

AT&T appoints Eric Topol, MD ((Scripps Health) chief medical advisor.

CTG Health Solutions hires Linda Lockwood (Encore Health Resources) as its advisory services solutions director.

HIMSS names Pauline M. (Hogan) Byom (Mayo Health System) the recipient of the 2013 SHS/HIMSS Excellence in Healthcare Management Engineering / Process Improvement Award.

Colette Weston (ADP AdvancedMD) joins Aviacode as VP of client services.

Emdeon hires Randy P. Giles (Coventry Health Care) as CFO/ EVP of finance, replacing Bob A. Newport, Jr.

Announcements and Implementations

The University City Science Center in Philadelphia begins accepting applications for its Digital Health Accelerator, which will provide up to $50,000 in funding and other benefits for as many as six companies in the digital health or HIT sector.

Fleming Island Surgery Center (FL) goes live with Anesthesia Touch from Plexus Information Systems.

Bread for the City (DC) and the Family and Medical Counseling Service (DC) implement The Guideline Advantage, a quality improvement program that leverages population health management tools from Forward Health Group.

Government and Politics

CMS authorizes laboratories to provide patients with direct access to their lab reports, rather than requiring patients to obtain results from their physicians.

A veterans advocacy group calls on the VA and DoD to take aggressive steps to reduce the remaining backlog of 400,000 disability claims, deliver on the long-promised joint VA/DoD EMR, to standardize VA claims forms, and to encourage VA raters to process claims correctly the first time.

Innovation and Research

Hospitals rank cost reduction as their top innovation priority, according to a HIMSS/AVIA survey on healthcare provider innovation. The report also reveals that chief innovation officers are not yet mainstream roles within hospital and health systems, though 64 percent of organizations with annual revenues of at least $5 billion have a chief innovation officer. Though dedicated funding for innovation is modest, providers are making progress implementing innovative solutions related to population health management, patient follow-up, predictive analytics, clinical decision support, and care coordination.

Other

HIMSS expects more than 1,200 exhibitors at this year’s conference and will offer longer exhibit hall hours with more overlap between education sessions and no mid-day break.

Weird News Andy titles this story “A Shot for a Shot.” A startup invents a device that it claims can stop bleeding from a gunshot wound in 15 seconds. It injects dozens of tiny sponges into the wound, or as the article breezily written for those skimming rather than actually reading, “like a tampon for bullet wounds.”

Sponsor Updates

• PACS blogger Dr. Dalai banters with Brad Levin of Visage Imaging about the latter’s suggestion that a savvy hospital IT department could assemble its own PACS system from off-the-shelf components.
• NCQA certifies that Verisk Health’s Quality Intelligence solution contains HEDIS Certified Measures that are ready for 2014 HEDIS reporting.
• Oracle Health Sciences will integrate medical speech recognition technology from Nuance Communications with its e-clinical software.
• MedHOK achieves NCQA certification for its HEDIS Certified Measures in 360Measures.
• TriZetto launches a collaborative care solution powered by Wellcentive to facilitate payer/provider collaboration in accountable care initiatives.
• PeriGen introduces Category II Management Algorithm, a free web-based tool to support the management of patients in labor during FHR category II.
• Coastal Healthcare Consulting introduces Convergence, an offering that combines NextGate’s Enterprise Master Index with Coastal’s project implementation.
• HIMSS selects InterSystems HealthShare as the official health informatics platform for the Intelligent Hospital Pavilion at the HIMSS14 conference.
• Gartner positions Informatica as a leader in its January 2014 Magic Quadrant for Enterprise Integration Platform-as-a-Service report, based on ability to executive and completeness of vision.
• Elsevier introduces MethodsX, a concept methods journal that provides researchers a home for their unpublished works, allowing them to receive public credit and citations.
• First Databank commences publishing of an initial draft of New York State Acquisition Cost drug prices.
• CareSync is selected as a finalist in the Community category for the 2014 SXSW Interactive Awards for its efforts in building meaningful communities for patients, their families, and care teams.

Contacts

Mr. H, Inga. Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis, Lorre.

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 2/4/14

HHS strengthens patients’ right to access lab test reports

HHS announces changes to both HIPAA and the Clinical Laboratory Improvement Amendments of 1988 that will result in patients being able to access their laboratory results directly from the lab, rather than from the doctor that ordered the tests.

Can Healthcare IT (HIT) Deliver Value? (Part II)

David Levin, CMIO of Cleveland Clinic, discusses the ROI of health IT projects and concludes that health IT project planning tends to focus on building ideal workflows rather than realizing cost reductions or outcomes improvements. He says “if you don’t know where you expect to achieve value and you don’t have a specific plan to get there, you probably won’t.”

Health information for more than 40,000 Unity members missing

Researchers at University of Wisconsin lose an unencrypted hard drive containing the personal information of 40,000 Unity health insurance customers. The researchers had the hard drive because they were working with Unity on a benefits analysis project.

Exploring the Value of Health IT on HIMSS14 Exhibition Floor

HIMSS releases new details on the HIMSS14 Exhibit hall. New exhibits include: a startup showcase hall for first-time HIMSS exhibitors, an Intelligent Medical Home model demonstrating home monitoring solutions and real-time data exchange between the medical home and a mock hospital unit, and a revamped interoperability demonstration.

Curbside Consult with Dr. Jayne 2/3/14

News is always pretty slow leading up to HIMSS, but I’m pleased to see things are picking up a little. We learned over the past couple of days that Apple leadership met with the Food and Drug Administration to talk about mobile medical apps. Rumor has it that Apple is working on a health-monitoring smart watch. Insiders are debating whether this was a fact-finding mission or a mission to try to push an existing application through the process.

Neither Apple nor the FDA have responded to comments as far as I can tell, but the news just broke on Friday, so there’s still time. We’ve heard the iWatch rumor before from a couple of different angles. Reports last year covered the announcement by Corning Glass Technologies that it had created bendable glass. Other companies have developed Bluetooth watches. Most speculate that the watch will link to an iPhone and will run iOS. Some sources have the number of product developers working on the project at more than 100.

Apple better get it in gear because the recent patent agreement between Google and Samsung might make Android devices more competitive. There are already several on the market. Having the companies play together nicely rather than litigate each other to death will put an interesting spin on things. Samsung also struck a licensing deal with Ericsson that addresses patent issues with GSM, UMTS, and LTE standards for both networks and devices.

As I’ve mentioned before, I’m interested in wearables, but they have to look good. After years on the wards and in the emergency department, I finally gave up my waterproof dive watch for something more grown up looking. Even if it was cool, I don’t think I’d want to wear something that looks like I’ve strapped an iPod Nano to my wrist. I don’t want to look like an old Dick Tracy cartoon. Most of the current offerings fall into that category.

Hot news this week, though, is that there will be new offerings for Google Glass including prescription-ready frames and detachable sunglasses. They’ve also partnered with eye health insurer VSP to train eye care providers how to fit the device and attach it to frames. I might consider trying if it I could get it mounted on my own sassy frames rather than the relatively sci-fi looking standard Google Glass platform.

Speaking of less-fashionable tech, it may not look glamorous but I’m intrigued by Fin, which is a ring-like accessory worn on the thumb to capture gestures meant to control phones, radios, TVs, and other Bluetooth-enabled devices. It reminds me of vintage Bakelite jewelry. I’m not opposed to wearing something a little more towards the geeky side if it’s not intended to replace a “normal” accessory.

A photo on the Fin site showed a child wearing it as a substitute for a gaming joystick. That got me interested in the potential for wearables for children. One interesting device that was shown at the Consumer Electronics Show was Sensible Baby’s SmartOne real-time sleep monitor, which can relay information on a baby’s temperature, sleep position, and movement to a smartphone or tablet. Alerts can be customized for the infant’s developmental stage. Unfortunately, the product’s blog features a photo of a man watching a baby sleeping on his stomach, which flies in the face of current medical advice that babies should be put to sleep on their backs.

I think my favorite wearable tech of the week is June, a monitor for ultraviolet exposure. It can be worn on a bracelet or attached to clothes or other accessories. It ties to a smartphone app and alerts the wearer when a particular UV exposure threshold is reached. I’ve been devoted to my SPF 70 for years because I have a fine line between being ghostly pale and turning into a lobster. If it’s released before summer, I’d consider giving it a try.

What’s your favorite wearable tech? Email me.

Email Dr. Jayne.

Morning Headlines 2/3/14

Castlight Health files secretly for IPO

Castlight Health, a web-based healthcare benefits management platform, files for an initial public offering. The company was founded by Todd Park, former US CTO and Athenahealth co-founder, in 2008 and is rumored to be seeking a $2 billion valuation.

Athenahealth accepts incentives deal, picks Austin for expansion

Athenahealth finalizes plans to open offices in Austin, TX after agreeing to a 10-year $670,000 incentives package offered by the City of Austin and a $5 million in incentive package from the State of Texas.

iWatch + iOS 8: Apple sets out to redefine mobile health, fitness tracking

Apple will introduce a new core health and fitness app in its next iOS release. The app will reportedly track activity, calories burned, vitals, hydration levels, and blood glucose levels. While current iPhone’s do not have the hardware necessary to capture some of the metrics reported, like blood glucose, there have been persistent rumors suggesting that the iWatch may introduce this hardware.

Monday Morning Update 2/3/14

From The PACS Designer: “Re: Apple’s solar iPhone. As we head deeper into 2014 ,you will be hearing details on the next generation of iPhones. The rumored solar iPhone 6 that will be introduced in second half of 2014 will use the tough sapphire outer casing as a solar panel. Apple was granted a new solar touch screen patent that will allow the solar panel to operate without the need of a boost converter, thus providing optionality in the use of a power charge or a solar charge.” I was on the fence between the iPhone 5 and the Samsung Galaxy last time. Now that I’ve used an Android tablet at a fraction of the cost of the Apple equivalent, I think my next phone will be a Samsung. Apple seems to be moving into that mature product phase where everything gets more features and interesting tweaks without blazing any new ground. I’m not willing to pay a premium for that.

From Country Girl: “Re: Stage 2 quality measures. In 2014, quality measures did change for both EP and EH regardless of where you are in the attestation  stages. More measures have to be reported and they must also be tied to the national quality goals. This information was published in the Stage 2 rule, not in December. However,  many of the measures are aligned with PRQS for reporting guidelines. The final rules on PQRS was published in December and the reporting requirements came out December 31. As a result, it appears some vendors are still working on their reporting methodology to incorporate the changes. The problem for many organizations will be understanding where the data has to be recorded in the system to pull properly for reports. We are having trouble getting this information from the vendor as well. If you are trying to attest in the first quarter and don’t have the requirements, you could find the reports do not accurately capture your measures when you get the 2014 reports.”

From HIMSS EHR Association: “Re: Stage 2 quality measures. The required format for electronic submission changed for hospitals (EHs) in November, and in January for physicians (EPs). These changes, as well as Spring 2013 versions of the quality measures which are required for electronic submission, will require further development and implementation at the same time that EHR developers are pushing hard to implement the 2014 certified edition for their customers. More generally, there have been many changes to the methods, requirements, and process to submit CQMs electronically over the last year, and they continue changing. Some changes were promulgated in other CMS rules, such as the annual hospital and physician payment rules, and other changes were not part of rulemaking. And this does not take into account all of the significant changes that have occurred in certification over the last year, as well as additional updates to the CMS quality programs using electronic CQMs. In part because of the extent of these changes, CMS is permitting manual attestation on clinical quality measures for meaningful use in 2014, as has been done through 2013, not just for those in their first year. The EHR Association has been in dialog with CMS on issues with the requirements over the past several months. We understand that CMS will be issuing a CQM submission Tip Sheet within the next couple of months. We welcome any further discussion and explanation of these facts, in order to help our customers understand the current requirements for reporting CQMs to CMS.”

 

From Frank Poggio: “Re: CCHIT and certification. It’s a movie I’ve seen many times. A member organization wants to push the industry forward and generate some revenue, so they get in bed with regulators. Members get upset and view the association as part enemy, so the association wakes up and drops out of the program they helped start. CCHIT had the best tools and knew healthcare, so their interpretation of test rules and steps was sometimes different from the other ATLs. It was clear to me that they were overwhelmed. This had to be a money-losing effort for them given the Stage 2 (2014) complexity and the expanding complexity coming with the new 2015 Test Edition. Interestingly, all the remaining ATLs are non-healthcare companies and are learning the healthcare nuances as they go along. That should make for some interesting results.” Certification was created to reduce the risk of buying an EHR, which it arguably hasn’t done since the biggest risk isn’t misjudging functionality that you can plainly see or lack of interoperability that you don’t care about, but rather the possibility that your vendor will stop delivering high-quality enhancements and support. Which ironically some have because they are off chasing the government’s other “optional but not really” programs, Meaningful Use and ICD-10. Plenty of certified EHRs have unhappy customers, inadequate R&D budgets, and crappy support. You’ll see a bunch of them opt out of not only certification, but the EHR market in general as the HITECH teat dries up and those with no particular healthcare allegiance wander off seeking greener pastures.

From Albi Qeli, MD: “Re: EHRs. As a computer friendly practicing physician, I find the current vintage EHR software not only inadequate, but disgusting. The fundamental problem is that the software is not designed around physicians and patients’ requirements. Current systems try to replicate the paper forms that they are trying to replace, thus recreating a very faulty system and adding a few other defects to it. Add in the mandates and the penalties, and EHR has now become a dirty word. In every other field of human endeavor, computers solve specific problems and increase productivity. In a physician’s office, the EHR creates new problems (hackable, insecure, expensive, unwieldy, data silos) and increases staff requirements. All in the name of progress. People like me might be able to solve some of the practical and technical issues, certainly in order to have a workable efficient record keeping system for use in my own clinic. But such a system would not satisfy Uncle Sam.” As I’ve said many times, medicine is the only area in which the highest-paid resource is expected to perform data entry into a system whose benefit to them personally is coincidental at best. The EHR at its worst is a manual entry black box recorder for the government and insurance companies. Doctors who took HITECH money as a bribe to impulsively buy and use EHRs they now hate hasn’t helped push the market in a doctor-pleasing direction. Today’s systems reflect the financial reality for insurance-accepting practices — your customer isn’t the patient and you aren’t the boss. It would be interesting to review the systems used by cash-only practices, assuming they use any at all.

From One Tin Soldier: “Re: Best in KLAS. We won but weren’t included in your list.” The company in question didn’t actually win Best in KLAS, but it’s confusing enough to warrant an explanation. That title is reserved for products listed in the first two pages of the “Best in KLAS 2013” report, which lists solutions that “lead the software and services market segments with the broadest operational and clinical impact on healthcare organizations,” however KLAS defines that. Less rationally, the same report also includes Category Leaders 2013, defined above, but those don’t earn the title of Best in KLAS. Allscripts is the only vendor I’ve seen so far to incorrectly label a Best in Category win as Best in KLAS (had they included the word “in” after “named,” the headline above would be correct.) All of this is needlessly confusing – KLAS should use the term Best in KLAS for only the award, not as the title of a report that also includes other results. Either that or extend the Best in KLAS label to the category winners as well. The way they are using that title now seems a bit fuzzy, but then again some folks say that about the entire KLAS process. 

Upcoming Webinars

February 5 (Wednesday) 1:00 p.m. ET. Healthcare Transformation: What’s Good About US Healthcare? Sponsored by Health Catalyst. Presenter: John Haughom, MD, senior advisor, Health Catalyst. Dr. Haughom will provide a deeper look at the forces that have defined and shaped the current state of U.S. healthcare. Paradoxically, some of these same forces are also driving the inevitable need for change.

February 12 (Wednesday) 1:00 p.m. ET. Healthcare CO-OPs and Their Potential to Reduce Costs. Sponsored by Health Catalyst. Presenters: David Napoli, director of performance improvement and strategic analytics, Colorado HealthOP and Richard Schultz, VP of clinical care integration, Kentucky Health Cooperative. Consumer Operated and Oriented Plans (CO-OPs) were established by the Affordable Care Act as nonprofit health insurance companies designed to compete in the individual and small group markets. Their intended impact was to provide more insurance options for consumers to pay for healthcare.

February 13 (Thursday), 12 noon ET. Advancement in Clinician Efficiency Through Aware Computing. Sponsored by Aventura. In an age of information overload, a computing system that is aware of the user’s needs becomes increasingly critical. Instant-on roaming for virtual and mobile applications powered by awareness provides practical ways to unleash value from current HIT investments, advancing efforts to demonstrate meaningful use of EHRs and improve clinical efficiencies. The presenters will review implementation of Aventura’s solution at Orange Coast Memorial Medical Center.

A HIStalkapalooza update: registration has closed and invitations will go out on Tuesday. Demand was high, so unfortunately more than half of those who signed up will be getting a “sorry, we’re full” email instead. We always give priority to providers, who registered in overwhelming numbers. Please don’t email Inga or me if you didn’t get an invitation because there’s no secret stash of them for us to hand out no matter how much we like you.  

Eighty percent of poll respondents check their work email in the evening and on weekends, with 20 percent checking it at least hourly. New poll to your right: when were you last promoted?

My latest grammar peeves: (a) people who start sentences, especially written ones, with the word “so”; (b) the bizarre omission of the word “of” following “couple,” as in, “So I had a couple beers.”; (c) rampant overuse of pointlessly emphatic words such as “really,” “actually,” and “frankly,” which I excise by the dozens from some interview transcriptions.

Welcome to new HIStalk Platinum Sponsor InteHealth. The Malvern, PA-based employee-owned company connects patients, doctors, hospitals, and health plans cost effectively. InteHealth Exchange is a cloud-based, vendor-agnostic integration platform that is flexible and extensible; rapidly deployable; comes complete with a clinical data repository, data map library, and a messaging and alerts engine; and is MU2 ready. The company’s certified patient portal allows patients to view their records, make payments, schedule visits and tests, receive reminders, request refills, and share and download information. It is Stage 2 certified, integrates with 100 EHRs, has full CCD capability, and connects to the Direct exchange. The physician portal allows remote access and eliminates faxing and calling nursing and medical records for information. Hospitals can use InteHealth Exchange to solve problems related to information management, ACO care delivery, and discharge management. The company’s solutions are used by 1,900 sites and 20,000 physicians each year, processing 82 million transactions. Thanks to InteHealth for supporting HIStalk.

TeraMedica is supporting HIStalk as a Gold Sponsor. The company’s Evercore Clinical Enterprise Suite connects and manages a healthcare system’s digital image infrastructure all the way from the modality to the EHR and clinical desktop. It is vendor neutral, flexible, and scalable as an enterprise archive that manages both DICOM and non-DICOM (photos, videos, PDFs) clinical content. Its architecture features a scalable database, parallel application services running on enterprise-scale servers, n-tier storage, image storage and distribution rules, and tools to migrate legacy data, all architected to handle the explosion in imaging volume that’s coming, all with a lower total cost of ownership and true vendor independence. Thanks to TeraMedica for supporting HIStalk.

I found this YouTube video describing Duke’s TeraMedica VNA setup that’s integrated with Epic. It’s a very good overview of image management by Christopher Roth, MD, assistant professor of radiology and director of imaging informatics strategy at Duke Medicine.

Starting this week, you’ll see a single, short-term ad for various companies at the top of the HIStalk page, to the right of the logo. I’ve always turned down requests for “special” ads like this, but I agreed under these terms: (a) I’ll donate a big chunk of the proceeds to DonorsChoose to support students and teachers in need, reporting back here the projects that we (as HIStalk readers) funded as a result; and (b) it will be single ad that will run for only three days at a time so we don’t get tired of looking at it. Companies always want a burst of extra exposure for specific events, especially right before the HIMSS conference, and I can live with that since it will support classrooms.

Here’s a photo tweeted out by AMIA VP Jeff Williamson from iHealth 2014. This is like one of those fan convention photos of all the “Star Trek” captains together, only for a different variety of nerd: former National Coordinators Brailer, Kolodner, Blumenthal, and Mostashari. I would welcome a report on the conference if you attended. Orlando is in the low 80s every day, so I’m sorry to have missed seeing all of those informatics people in shorts and tee shirts.

A rumor suggests that Apple’s iOS 8 will include Healthbook, a fitness tracking app that will not only measure steps taken and calories burned, but also blood pressure, heart rate, and blood glucose (although the rumor doesn’t say how it would collect glucose levels.) The app will supposedly allow the user to enter medication schedules to allow the iPhone to issue reminders. All of that is related to the upcoming iWatch wearable computer. Apple has hired several health experts in the past year and has met with the FDA on undisclosed topics.

Athenahealth chooses Austin, TX for its R&D office, pledging to create 600 jobs that will pay an average salary of $132,000. The company will receive $680,000 from the city and $5 million from the state in incentive payments over 10 years to occupy the Seaholm Power project that’s under construction on West Cesar Chavez Boulevard. 

Vince Ciotti is one of the most hilariously cynical people in healthcare IT, so even he recognizes the irony in this HIS-tory episode in which he lustily guzzles the Epic Kool-Aid right at the factory. Epic fans will not be surprised that Judy invited Vince to present some industry history to several thousand Epic employees too young to remember it. This is a great episode that also includes a fun fact: one of Judy’s early mentors was Neil Pappalardo of Meditech, so when she started Human Services Computing in 1979, she targeted only large hospitals to avoid stepping on Meditech’s turf.

Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis, Lorre.

More news: HIStalk Practice, HIStalk Connect.

HIStalk Interviews Mike Merwarth, CEO, Aperek

Mike Merwarth is CEO of Aperek of Raleigh, NC.

Tell me about yourself and the company.

My dad was a physician. He went to Duke. My mom was a nurse. She went to Duke. My wife was a nurse. She’s still my wife, but she’s no longer practicing. My older daughter is getting her RN degree in May. My younger daughter is taking the MCAT this Thursday. All of which is to say, I have been immersed literally since the minute I was born over at Duke in a healthcare’s aura. It affected my life and continues to affect my professional life as well.

I was diagnosed with adult onset type 1 diabetes at 41 out of the blue. Every quarter I go over to Duke to see an endocrinologist. Between that and customer visits, I’m in hospitals a lot. The potentially strange thing about that is I feel at home in hospitals. That’s why I bring the level of commitment and passion I do to Aperek.

Aperek is focused on the healthcare supply chain. We do not offer services or product to any other industry other than healthcare, which distinguishes us from some of the other vendors. We changed our name from Mediclick to Aperek this past November.

Who’s buying your systems and why do they choose Aperek instead of non-healthcare specific vendors?

In the ‘90s when we were still part of Global Software and in the the early 2000s after we had spun off and formed Mediclick, hospitals were buying ERP solutions. General ledger, accounts payable, fixed assets, payroll, human resources, and last and unfortunately least, materials management. That would be the typical package.

It was largely a financially-driven decision process. The materials management system was what we call in this industry a drag-along, in many cases. In other words, they would — not throw it in for free, that’s a little strong – but they would offer it as part of the package at effectively no additional charge.

It’s also interesting that two of the companies that now have significant market share brought a distribution system into healthcare from non-healthcare markets or industries — specifically distribution and retail — and added some capabilities like par management. Frankly, they were the only game in town and they did an admirable job of capturing market share.

Those systems were OK for a number of years – let’s call it a decade — where the fundamental job was to manage a perpetual inventory of stock items, replenish the par levels on the nursing floors, and do the purchasing. All the clinical areas largely did their own buying.

That limitation of focus on the scope of what they needed to do for the hospital was  fine. Today, it’s not fine because now there’s a cost crisis. There’s a bunch of crises we could talk about, but there’s certainly a crisis of getting costs out of the system. One of the remaining ways to do that is in the supply chain. These systems and companies are not adamantly and singularly focused on doing that, at least in the way I think they should be.

In hospitals, the real experts and professionals in materials management are buying tissues and bedpans, while people with no training are buying the most expensive items that represent most of the overall cost.

That’s the irony or tragedy, pick your word. Roughly 80 percent of dollar value is purchased in the clinical areas. These multi-million dollar systems that were painful to install preside over only 18 percent, give or take, of the dollar value of the product that comes in the door. That’s a general statement and there are exceptions, but you are absolutely right.

How does your system control those higher-cost items that clinicians buy?

Technically, there are capabilities in these products to manage multiple inventories. You can have pars up in the OR, for example, and they could theoretically be managed by the decent systems out there. But there’s a significant usability issue that comes with the the necessary interaction at certain points with the clinicians. They rightfully resist anything that unnecessarily distracts them from their main job, which is taking care of patients. That’s where the usability of the traditional materials management functionality falls completely apart.

The reason I would advocate buying Aperek supply chain solutions would be, number one, there’s merit to focus. We live and breathe healthcare, specifically the acute care market but we also have several clinics as clients. Our clients span from single 200 bed-hospitals up into the 20- and 30-hospital IDNs.

Second, we recognize that the 80 percent that is spent on the clinical area is where the focus needs to be. I have referred to it as the Wild West, with stories about OR nurses hiding product up in the ceiling tiles and the bottom desk drawers. I know; I’ve actually seen that. It happens because they ran out one time and there are negative consequences to that. Maybe it’s just the surgeon yelling at them. But for whatever reason, they’re not going to run out again. There are millions of millions of dollars of inventory in the clinical areas that, if properly managed, does not need to be there.

Fundamentally, what this company is working very hard to complete is a set of capabilities that allow the supply chain professionals to do their job in the clinical areas. That requires some new tools that aren’t available from most vendors. Most importantly, it allows the clinicians to do the supply chain management they need to do in as non-disruptive a way as possible. We’re obsessively focused on the user experience here in what we’re developing right now.

A specific example is a product that we’re just now installing in two initial sites called Pulse. It’s implant tracking. It’s on the iPad. In my 25-plus years in this business, I have never bonded with clinicians like I have in the last year because of this product. I have never been so gratified by the excitement that I see that they have a visceral attraction to the ways that we allow them to record product.

With another company in the industry, it’s all barcode driven. We’ve got a Bluetooth barcode capability. It’s great. It reads all the bar codes and it’s intelligent and can discern what lets you go where. But the nature of implants is that there are screws and plates, thousands of parts. Those parts are not going to have bar codes associated with them in the near future. It’s going to take a new and cheaper technology to either embed or somehow associate those with a bar code that could be read, or RFID or whatever it is.

Those are three-figure to four-figure items relative to cost. They have to be recorded. Today, they’re often recorded on sheets of paper. They’re recorded on sleeves of surgical gowns. They’re yelled out to the surgical nurse to hand write.

What we have provided is a multitude of ways that they can quickly record the usage of the product that doesn’t have a bar code. Once the tension of the case is over, you can quickly come back and resolve the identity of the product that’s been used. You can have a little Bluetooth headset on and speak a description and the translation software in the iPad writes it out. You can go in and scribble it and hand write it. You can take a picture of it. You can do a combination of those things and move on, but you know you’ve got enough data such that when the case is over, you can come back and capture it.

Hospitals that are trying to cut costs, which is pretty much all of them, usually look at labor and then try to do something with patient utilization. Do they pay less attention to supply chain other than just trying to negotiate favorable pricing? Are they missing something?

Tragically, yes. I’m not sure I understand why. It’s not simple,  but it’s doable and it’s a progression. Nobody’s going to reach perfection in my lifetime. It’s going to take some naming standards like GS1 to come into fruition before perfection can even be approached. But there’s a lot of things that can be done.

If you think about the flow of product in the OR, it’s largely driven by physician preference cards, the list of stuff that they want on the case card that goes into the room. Those physician preference cards are maintained in the OR system, when in fact they’re the key to standardization. Elimination of product that goes up the clean elevator and down the dirty elevator every day. Basically 50 percent of the product on case carts is never used. It’s put on there just in case.

There are so many opportunities to reduce SKUs, to standardize on the implant products that cost thousands of dollars, and to lower the cost of the inventories that are managed in these areas if it’s put in the hands of people whose job it is to do that. You can’t expect the clinicians to do it. They’ve got their hands full already. Everything we’re doing is devoted to that.

Are hospitals looking at choices they didn’t find politically expedient before now that they’re under the margin gun, such as perpetual inventory and true cost accounting?

Sophistication in areas like cost accounting will continue to be looked at and be increasingly pertinent. But the example that immediately comes to mind is in product standardization. For example, you’ve got five orthopods who use three different knee implants, three different companies, because that’s what they were trained on in school. If they get together and realize that the outcomes of all three are virtually identical and the cost of one of the three is significantly less than the other two, and either through competitive motivation or collaborative motivation they agree to standardize, they’ve certainly simplified inventory management.

But from a purchasing perspective, and this is our product called Ellipse, you can standardize to say a single vendor for total knees. Then you can commit unprecedented volume to that particular supplier. That means a tremendous amount to them and you’ll get better pricing. There are those types of things that can be done with the right tools. The good news is for us, selfishly speaking for the growth prospects of Aperek, it hasn’t been done.

As hospitals acquire practices and also each other and take on financial risk, how do you see that dynamic changing supply chain and contract management?

The surgeons clearly have a direct interest in improving outcomes, standardizing outcomes, standardizing treatment protocols, and standardizing product. It’s in their self interest because in the ACO environment, to the degree that ever takes real hold, they will be getting paid out of the pot of money that is left over when the costs are subtracted from the reimbursement.

What are the priorities for the company in the next one to three years?

We’ve got a supply chain system today, as well as a GL and AP, that are ranked number one by KLAS and MD Buyline. They’ve been number one for five years. We’ve got that spend analysis tool that I mentioned that can show you volume and market share. We’ve got the Pulse product going in to its initial sites. That Pulse product will in the next six months be expanded into full product capture so you can get a full product cost per case.

As we progress into that, I’d like to take control of the preference cards and manage those. Put those capabilities in the hands of the supply chain professional. Along the way, I want to optimize the management of product inventory in the clinical area. I can do that with much of my existing supply chain system logic.

We’ve got a lot of the pieces, but we want to bring — you could say best practices — harmony, if you will, into the clinical arena and cut significant, millions of dollars out of the expenditure that’s taking place there today. Not just by reducing the price of things, but by standardization of products and standardization of treatment protocols.

Morning Headlines 1/31/14

DoD Healthcare Management Systems Modernization (DHMSM): Draft Request for Proposal

The DoD publishes an open solicitation for a new EHR that will replace all of its existing legacy systems. The usability testing scenario’s outlined within the proposal describe a medic calling up evidence-based guidelines and documenting care while providing emergency treatment to a wounded marine in the field. Subsequent scenarios describe field surgeons using the system to coordinate care delivery once the Marine arrives back at the forward operating base, then medications being administered by nurses during an air medevac to a larger hospital in the US, and finally the transfer of care from the DoD to a VA rehabilitation facility. The last scenario requires vendors demonstrate the exchange of medication lists and narrative care summaries between DoD/VA facilities.

Thousands of providers rank healthcare software and services in annual Best in KLAS report

athenaHealth dethrones Epic from the top spot on the Best in KLAS 2013: Software and Service report. Epic had held the number one position for the past eight years.

eHealth Exchange Survey Reveals Dramatic Increases in Participation and Online Transactions

The eHealth Exchange, a non-profit, public-private HIE collaborative, reports that its membership has grown to include 800 hospitals, 6,000 mid-to-large medical groups, 800 dialysis centers, and 850 retail pharmacies.

Hospital’s new IT system ‘has increased waiting times and led to lost patient data’

In England, staff at Croydon University Hospital are blaming their recent Cerner go-live for increased waiting times and lost patient information. The university’s director of quality maintains that the implementation of Cerner went well in technical terms, but members of the board were not convinced and are insisting that "patient care has definitely suffered."

News 1/31/14

Top News

The Department of Defense opens bidding to replace all of its EHR systems, saying the new system will use off-the shelf technologies running on ONC-approved standards. The VA solicited bids Tuesday for the next step in its replacement of VistA. Evidence is scant that the two groups plan to work together to implement a single EHR systems as mandated by the President and Congress, with their only obvious common ground being a willingness to separately enrich the usual government contractors with massive taxpayer dollars.

Reader Comments

From Silversand: “Re: MU Stage 2 CQM measures. In meeting with our vendor, we were told they can’t submit them electronically yet because the standards changed in December and their software hasn’t been updated. I can’t find anything on a standards change. Is this true? Are other vendors running into the same issue? I would love to know what your readers think.” So would I (cue readers to chime in.)

From Ockham: “Re: vendor market share. KLAS estimates by bed size, i.e. ‘Meditech has 18 percent of hospitals over 200 beds.’ This is meaningless. It should be expressed as the number of beds in all hospitals using a system, which would be easy to calculate using information from HIMSS Analytics. Having a lot of beds means having a lot of clinician users, which pushes product development. Epic blasted into a leadership position is because having 400 hospitals that are large and larger trumps having 2,000 hospitals that are small (Meditech).” That’s true, as long as your product is suitable for large hospitals and you have the competence to sell it to them. Epic’s timing was perfect because soon those big, Epic-using hospitals will have bought all the smaller ones and replaced their incumbent systems, putting Epic in hospitals that couldn’t have afforded or supported it on their own. It’s like the political system – you’ll see all kinds of parties on the ballot, but only two of them get a significant number of votes.

HIStalk Announcements and Requests

A few HIStalk Practice highlights from the last week include: physicians prefer smartphones to tablets to perform most professional tasks. Practice Fusion offers free Google Chromebooks to new users. CMS reminds EPs of pending deadline to attest to MU for the 2013 Medicare EHR incentive program. In part three of our series, HIT vendor execs share details about technologies on their company’s roadmap for the next 12-18 months. Thanks for reading.

Welcome to new HIStalk Platinum Sponsor Optimum Healthcare IT. The Jacksonville Beach, FL-based full-service consulting firm provides expert consultants at competitive rates. Services include EHR deployment (all major vendors); integration services (interface development and integration engines); staff augmentation (program directors, project managers, application builders and testers, clinical experts, analysts, security experts, trainers); security and identity management; and regulatory guidance (Meaningful Use, ICD-10.) The company provides small-business flexibility with large-business stability, but without the high cost. Thanks to Optimum Healthcare IT for supporting HIStalk.

Upcoming Webinars

February 5 (Wednesday) 1:00 p.m. ET. Healthcare Transformation: What’s Good About US Healthcare? Sponsored by Health Catalyst. Presenter: John Haughom, MD, senior advisor, Health Catalyst. Dr. Haughom will provide a deeper look at the forces that have defined and shaped the current state of U.S. healthcare. Paradoxically, some of these same forces are also driving the inevitable need for change.

February 12 (Wednesday) 1:00 p.m. ET. Healthcare CO-OPs and Their Potential to Reduce Costs. Sponsored by Health Catalyst. Presenters: David Napoli, director of performance improvement and strategic analytics, Colorado HealthOP and Richard Schultz, VP of clinical care integration, Kentucky Health Cooperative. Consumer Operated and Oriented Plans (CO-OPs) were established by the Affordable Care Act as nonprofit health insurance companies designed to compete in the individual and small group markets. Their intended impact was to provide more insurance options for consumers to pay for healthcare.

February 13 (Thursday), 12 noon ET. Advancement in Clinician Efficiency Through Aware Computing. Sponsored by Aventura. In an age of information overload, a computing system that is aware of the user’s needs becomes increasingly critical. Instant-on roaming for virtual and mobile applications powered by awareness provides practical ways to unleash value from current HIT investments, advancing efforts to demonstrate meaningful use of EHRs and improve clinical efficiencies. The presenters will review implementation of Aventura’s solution at Orange Coast Memorial Medical Center.

Acquisitions, Funding, Business, and Stock

GNS Healthcare, a provider of big data analytics products and services, completes a $10 million Series B financing round led by Cambia Health Solutions.

VMware reports Q4 results: revenue up 20 percent, adjusted EPS $1.01 vs. $0.81., beating earnings estimates.

CommVault releases Q3 results: revenue up 20 percent, adjusted EPS $0.54 vs. $0.39, beating estimates on both.

Quest Diagnostics announces Q4 results: revenue down one percent, adjusted EPS $1.03 vs. $1.01, beating estimates on both.

McKesson announces Q3 results: revenue up 10 percent, adjusted EPS $1.45 vs. $1.44, beating revenue expectations but missing expected earnings of $1.84. CEO John Hammergren said the results of Technology Solutions was disappointing (revenue up 6 percent, margins 8.55 percent) because the company had to  “take action in response to the anticipated timeline for Meaningful Use 3 and to size our organization in Horizon Clinicals appropriately” and took a $42 million restructuring charge to reduce headcount.

CPSI anounces Q4 results: revenue up 7 percent, EPS $0.90 vs. $0.83.

Sales

Texas Children’s Hospital selects OpenTempo’s scheduling and workforce management solution.

Valley Health (VA) selects Capsule Tech to integrate medical devices in operating rooms with Epic EMR.

Greater Regional Medical Center (IA) implements PeriGen’s PeriCALM fetal surveillance system.

People

Cumberland Consulting Group promotes Greg Varner and Mike Penich from principals to partners.

Community Health Network (IN) names Ron Thieme, PhD (AIT Laboratories) chief knowledge and information officer.

Population health management vendor Welltok hires Michelle Snyder (Epocrates) as chief marketing officer and Vance Allen (Pearson eCollege) as CTO.

Charles Denham, MD, accused by the Department of Justice of accepting $11.6 million in kickbacks from CareFusion to promote its skin disinfectant product at the National Quality Forum, resigns from the board of The Leapfrog Group. The DOJ has assessed a $41 million fine against CareFusion; Denham says the allegations are false. There’s a healthcare IT connection: when Dennis Quaid started limelighting  for patient safety after his newborn twins were overdosed with heparin at Cedars-Sinai (he had breezy good intentions, but minimal knowledge even for an actor), HIMSS put him on stage at the 2009 conference and inexplicably donated to his foundation. Dennis apparently found another shiny object and merged his foundation a year later with Texas Medical Institute of Technology, which was founded and run by Chuck Denham (who didn’t live in Texas, but instead in a $14 million oceanfront estate in Laguna Beach, CA.) Denham claimed that TMIT’s “national research test bed” involved 60 percent of US hospitals, although few people seemed to have heard of it. the other healthcare IT connection is that CareFusion sells Pyxis drug dispensing machines and Alaris smart IV pumps, just in case your hospital feels the urge to buy something from a company willing to bribe its way to the bedside.

Microsoft’s board is rumored to be preparing to name Satya Nadella, VP of the company’s cloud and enterprise group, as CEO as soon as Friday. The board is also discussing the possibility of replacing Bill Gates as their chairman with an unnamed candidate. Nadella would be the company’s third CEO following Gates and Steve Ballmer.

Announcements and Implementations

More than 800 hospitals and 6,000 medical groups are participating in the eHealth Exchange, a group of government and non-government organizations that agree to support interoperability standards to exchange information.

Scott & White Memorial Hospital (TX) goes live on Epic.

Greater Baltimore Medical Center (MD) goes live with the PatientRoute Systems patient flow solution.

Other

Members of the governing board for the UK’s Croydon University Hospital raise concerns that the hospital’s new Cerner system has led to increased waiting times and has lost patient information. Despite Cerner’s assurances that the system issues have not harmed patients, at least one board member expressed doubts:

You say that no harm has occurred, but while we’ve had no direct incident so far, patient care has definitely suffered. You talk about increased waiting times and there’s a risk that harm may occur because of the difficulty in getting in touch with clinicians who actually know what is going on with the patient. I’m very concerned from a quality point of view that our main provider has a serious problem with its information systems.

CCHIT announces that it will no longer offer ONC testing and certification and will change its business model to become a certification consulting firm. CCHIT recommends that its customers work with ICSA Labs for future testing and certification services.

Federal prosecutors charge former Allscripts director of internal audit Steven M. Dombrowski with insider trading, alleging that in 2012 he used a secret account in his wife’s name short MDRX shares ahead of a poor financial report, netting him $286,000.

The Wall Street Journal describes the analytics challenges of Memorial Hospital of Gulfport (MS), which can’t get much useful information from its separate inpatient and outpatient EHRs now, but hopes things will improve after a Cerner go-live in March followed by implementation of Health Catalyst analytics afterward. The hospital selected Allscripts EHR/PM in 2009.

In Israel, the health ministry launches a medical data sharing project for health fund clinics and hospitals.

Recently released documents from the antitrust lawsuit against St. Luke’s Medical Center (ID) reveal that its merger with Saltzer Medical Group could have raised pricing for outpatient visits by 60 percent and increased insurance rates by about 30 percent. Last week a federal judge ordered St. Luke’s to divest itself of Saltzer, saying the acquisition would give the health system an unfair bargaining position with insurance companies.

Epic is unseated for the first time since 2008 as the top overall vendor the 2013 “Best of KLAS” awards, with athenahealth leading the pack. Winners (with links to HIStalk sponsors) include

Athenahealth athenaCollector (practice management 1-10 physicians)
Athenahealth athenaCollector (practice management 11-75 physicians)
Athenahealth athenaCommunicator (patient portal)
CareTech Solutions (IT outsourcing, extensive)
CareTech Solutions (IT outsourcing, partial)
Cerner (application hosting)
Cerner CommunityWorks (community HIS)
Cornerstone Advisors (planning and assessment)
Cymetrix (extended business office)
Dolbey Fusion Speech (speech recognition)
Epic Care Everywhere (HIE)
Epic EpicCare (acute care EMR)
Epic EpicCare Ambulatory (ambulatory EMR 11-75 physicians)
Epic EpicCare Ambulatory (ambulatory EMR >75 physicians)
Epic OpTime (surgery management)
Epic Radiant (radiology)
Epic Resolute (patient accounting)
Epic Resolute/Prelude/Cadence (practice management >75 physicians)
Epic Willow (pharmacy)
Impact Advisors (clinical implementation principal)
J2 Interactive (technical services)
McKesson ERP Solutions (financial/ERP)
Merge Healthcare Cardio (cardiology)
Precyse (transcription services)
PwC (revenue cycle transformation)
QlikTech QlikView (analytics)
Quest Diagnostics ChartMaxx (document management)
Rays (teleradiology services)
Sagacious Consultants (clinical implementation supportive)
Sectra PACS (PACS)
Siemens Novius Lab (laboratory)
SRSsoft EHR (ambulatory EMR 1-10 physicians)
Thornberry NDoc (homecare)
Unibased USA RMS (enterprise scheduling)
Wellsoft EDIS (emergency department)
ZirMed (claims and clearinghouse)

Weird News Andy says this doctors has it. A New Zealand doctor spearfishing with friends is attacked by a shark, fights it off with a knife, stitches his leg wound on the beach, and heads to a bar for a beer. He goes to the hospital for more stitches only after bar employees notice him bleeding onto the floor.

WNA uses his less-cynical alter ego “Wonderful News Andy” in this story of medical dedication. A neurosurgeon working at an Alabama hospital is called to a cross-town hospital to perform emergency brain trauma surgery. His route is blocked by snow-related traffic, and as his cell phone signal fades, the second hospital’s neuro intensive care unit nurse hears him say, “I’m walking.” Which he did, covering six miles in a trek of several hours and then heading straight to the OR with the patient, who had a successful outcome.

Sponsor Updates

• HIStalk sponsors winning KLAS Category Leaders 2013 awards include Siemens (Soarian Clinicals), GE Healthcare (Centricity Perioperative Anesthesia), Merge Healthcare (cardiology hemodynamics), Elsevier (CPMRC), Wolters Kluwer (Sentri7, MediRegs Comply/Track), PatientKeeper (Physician Portal), 3M (360 Compass, Codefinder), Allscripts (EPSi), Phillips (IntelliSpace Portal), lifeIMAGE (image exchange), GetWellNetwork (interactive patient system), iSirona (DeviceConX), MedAptus (Pro Charge Capture), Passport (IntelliSource), TeleTracking (Capacity Management Suite), McKesson (EnterpriseRX Outpatient), Xerox (Midas+ Solutions, financial ERP implementation services), Fujifilm (Synapse RIS), Craneware (Bill Analyzer, Chargemaster Toolkit), Imprivata (One-Sign), API Healthcare (Staffing and Scheduling, Time and Attendance), VMware (vSphere), Emdeon (eligibility services), Encore (go-live support services), and Aspen Advisors (ICD-10 consulting).
• McGraw-Hill Professional partners with RelayHealth to make the AccessMedicine online medical platform available to providers.
• AirWatch adds a professional certification level to its Enterprise Mobility Certification Program.
• Besler Consulting publishes a white paper focused on Medicare Transfer DRG underpayments.
• AT&T sponsors a series of articles that explore how hospitals and health systems are addressing the care continuum in their strategic and operational plans.
• ReadyDock founder and president David Engelhardt discusses when and how to clean and disinfect mobile devices in a blog post.
• Extension Healthcare founder and CEO Todd Plesko explains the future of secure messaging app in a blog post.
• Passport Health posts a white paper discussing the benefits of front-end patient financial patient triage.
• A Virtelligence case study profiles Allina Hospitals and Clinics (MN), which implemented Epic with support from the company’s consultants.
• SimplifyMD publishes proof statements highlighting various successes and stats as of the end of 2013.
• QPID offers a case study highlighting Massachusetts General Hospital, which saw improvements in clinician productivity, higher throughput in the GI suite, and improved outcomes by avoidance of adverse events following the implementation of QPID’s automated record review.
• Predixion will provide academic institutions with the free use of Predixion analytics software for students and teachers of data science.
• NVoq highlights what’s new in its version V8.3.
• Culbert Healthcare Solutions discusses the optimization of Epic work queues in a company post.
• LifeIMAGE offers a series of customer testimonials highlighting their use of lifeIMAGE technology for image sharing.

EPtalk by Dr. Jayne

Mr. H published a rumor earlier this week about CCHIT leaving the EHR certification business. As many HIStalk rumors are, it was confirmed a few days later. CCHIT cites the complexity of testing and changing federal requirements as contributing factors. They plan to move into the consulting business.

This seems to be the big news of the week, which isn’t surprising considering we’re in the run-up to HIMSS. Major vendors aren’t going to be announcing much of anything, and instead will be saving any upcoming news for release at the big show.

I guess I’m also not surprised to see CCHIT exiting the testing business. Keeping track of the constantly changing testing criteria can’t be easy. I can barely keep track of the provider-based Meaningful Use requirements and the ongoing parade of CMS Frequently Asked Questions that cause ongoing re-interpretation of how we need to comply. If you haven’t seen the testing criteria, I’d recommend taking a look – they make some of the most complex projects I work on look like a cakewalk by comparison.

I know some of the people who participated on our ambulatory vendor’s certification testing team. The process sounds like it’s about the same level of fun as going through med school, trying to make sure you know everything, and then being an intern and having the worst call night ever – sleepless, stressed out, and having to deal with endless minutiae. I would imagine that being on the other side and having to deal with an ongoing parade of vendor teams who are similarly at their wits’ end may not be the most satisfying or stress-free job.

I’m not sure about the direction they’re taking. It seems like the consulting world is already saturated with Meaningful Use advisors, stakeholders, and other thought leaders. They plan to have a “series of summits and events to support that work,” but I’m not sure who will attend. Most of us in the trenches don’t have the budget to attend conferences and meetings we attended in the past and want to keep attending, let alone add other meetings to the docket.

The first CCHIT Summit will be held on Wednesday during the HIMSS conference. It will feature several former National Coordinators reviewing health IT during the last decade. It will be followed by an audience participation session to discuss what role health IT should play in the next decade. If they keep the CCHIT Summit events as part of existing conferences, they will definitely increase their chances for meaningful participation.

Along with the change in mission, CCHIT has restructured its board of trustees and will be replacing the CCHIT commissioners with stakeholder advisory groups. CCHIT was a leader in EHR certification and it will be sad to see them go, but I’d bet they’re not the only one that exits the business. At this point, there are fewer EHRs certified for MU2 than there were for MU1, and as more vendors abandon the Meaningful Use arms race, there won’t be as many products going through the process.

What do you think about CCHIT leaving the certification business? Leave a comment or email me.

Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis, Lorre.

More news: HIStalk Practice, HIStalk Connect.

HIStalk Interviews Dean Sittig, PhD, Professor, UTHealth

Dean F. Sittig, PhD is professor of biomedical informatics at The University of Texas Health Science Center at Houston and a co-author of the SAFER (Safety Assurance Factors for EHR Resilience) Guides that were developed for the Office of the National Coordinator.

Describe the SAFER Guides and their purpose.

Following the IOM report in 2012 on patient safety and health IT, ONC promised that they would create some guidance to help organizations improve the safety and utility of their EHRs. The SAFER Guides were their attempt to do that. They contracted with us to develop them.

What do the Guides contain and  how would you recommend that a hospital or health system use them?

There are some complex organizational structures, but mostly the Guides have about 10 to 25 recommended practices that are very general. Something like, “You need to back up your mission-critical hardware and software.” The Guides also have examples to help people understand what that means, so for a backup, that ought to be an encrypted, offsite backup taken on a daily basis.

There is also a rationale to help people understand why they would do that particular practice. There are a lot of references to link people to different aspects of the scientific literature from where those ideas came from. If the items on the list were either from the HIPAA guidelines or the Meaningful Use guidelines, we link those to give people a renewed emphasis on why they need to do certain aspects.

As to the answer to how an organization would use them, we think that in a large organization, you would convene a multidisciplinary team with someone from IT, some clinical people, some nursing, some of the ancillary services, maybe medical records people. Try to bring all those stakeholders together. Some people know the answers to certain questions and know the nuances of those. In smaller organizations, you’d probably have to contact your EHR vendor or your IT consultant that’s helping you to get the answers to these questions.

It looks like some of the items could be incorporated into an RFP.

While we were doing this, we started out going to a lot of different healthcare provider organizations and talking to them about what they were doing and trying to understand what things were working and weren’t. Some of them, we realized that the EHR vendor really has to do these things. 

When we say something like, “The patient’s name should be on every screen and maybe it should have a picture of the patient,” the EHR vendor has to make that capability available. Then the organization has to implement that capability. You’re right; some of these things are very particular and only the vendors can do them.

How do you think the average hospital would do? Are these stretch goals, or would a hospital that’s competent in IT do fine?

Of the leading organizations — I think about the Scottsdale Institute members, for example, IHC, Mayo Clinic, and Partners in Boston, those kind of places –  I would expect they’re doing between 50 and 75 percent of the recommended practices. Of the 25 percent that they’re not doing, probably half of them they’ve consciously decided not to do them for one reason or another.

Some of these things are still a little bit controversial in terms of whether they’re really a good thing to do or whether an organization can really do them. For example, not allowing a user to open more than one chart for a patient on the same computer terminal. Most people would agree that that’s a good safety measure and would reduce wrong patient orders. But most clinicians would say, “I can’t survive if I can’t look at two charts at once.” 

Then it becomes a push-pull at the organizational level of whether the organization’s administration is going to make that kind of a proclamation to make that happen. If you look at a company like Epic, for example, they limit you to only opening five charts on one screen, but that’s a user-configurable parameter. You could say only one chart is allowed to be open on one screen.

A parallel would be hiring an external auditor to do a hospital IT audit. They evaluate their checklist of things that are important. You don’t have to do all of them, but since the report goes to your management, you would at least justify why you don’t. Would a rational use of the SAFER Guides be not necessarily checking every box, but at least recognizing that you should have a good reason for not checking them knowing they affect patient safety?

That’s a good way to say it. You need an explanation. If I were a CEO reading over the results and you were the IT person that came to me, I would want an explanation for why you think you should open more than one chart on it. You can say that the clinicians disagreed and we’ve decided to limit it to two. We could talk about that and decide whether that was reasonable or not. 

Intelligent people who are safety conscious could agree to disagree on certain of these items. But it’s something you definitely need to think about and understand why you’re doing it.

The beauty of an external IT audit report is the accountability. It seems as though like the audience that would be most interested, from an exposure from a patient care or legal liability standpoint, would be a hospital’s CEO.

I agree completely. We are really hoping that that’s the way they’re used. Either insurance companies will pick these up and ask organizations whether it’s doing this, or someone like the Joint Commission might take these up. 

We’re hoping that this is something that starts a conversation between what I’ll call the clinician, the EHR vendors, and leadership within your organization. That conversation is the key to improving the safety.

The IOM’s To Err is Human brought a lot of activity with regard to medical errors. The IOM’s EHR patient safety report was the genesis of the SAFER Guides. Will that make the idea easier to sell?

I would think that reasonable people would agree with these recommendations. The problem is that these recommendations generally are going to cost some extra money and some extra time.

Right now, with everyone thinking about Meaningful Use Stage 2 and ICD-10 coming up, I’m sorry to say that I think patient safety has been pushed to number three on the list. That is going to be the biggest struggle with these Guides and trying to get patient safety moved up to a high level of awareness within an organization.

Meaningful Use gets you a check, ICD-10 makes sure you keep getting checks, and patient safety doesn’t get you anything except possibly a lawsuit avoided. Is ONC going to market this like they do their other programs?

We’re hoping they’re going to do that. If they can keep their focus on this, I think that will happen. But like you said, this is really a cost avoidance thing. The organizations that seem to do the best in terms of meeting most of the recommended practices are those organizations that have had the biggest accidents. It’s like you don’t get religion until you need the religion.

In some of the organizations here in the Texas Medical Center after Hurricane Ike, they really got some newfound impetus to make sure they had better backup systems in place. They were ready for bad weather. It was Hurricane Alison that was like around year 2000 where we realized we couldn’t have our data centers in the basements any more in Texas Medical Center when they all flooded. It turned out the first floor of our buildings flooded, too. Now all of the hospitals in Texas Medical Center have their data centers at least on the third floor. 

It was interesting to me that when they had Hurricane Sandy in New York City that New York City still hadn’t learned that lesson about putting data centers and power generators and backup systems in the basement. Because when there’s a really big flood, the basements flood. It seems like we should be able to learn those things from other organizations. You shouldn’t have to experience them yourself. But for some reason, people always think that it couldn’t happen here. Like, do they think that New Orleans was a one-off, Houston was a one-off, and now you think New York City was a one-off? The important points are that these things can happen to anyone, anywhere.

What kind of resources would be required to complete the series and come up with a conclusion for an individual hospital?

It depends what you start with. We’ve had some pushback when we mentioned that you ought to have all your hardware systems backed up and you ought to have duplicate hardware. Sometimes that means two servers running in parallel and another one sitting off to the side, so when one of those that are running in parallel breaks, you have one to replace it. Some people say, “We can’t afford to have three of them on site all at one time.” We hear them say, “Our vendor promises 24-hour delivery.” A lot of it are those kinds of expenses and there are a lot of examples in the contingency planning about warm site backups, for example.

That’s just a matter of how much money you want to spend to get the kind of response and get the kind of availability that you think you need. You can always spend way too much money on any aspect of your process. You’ve certainly got to balance the amount of money you spend with the safety that you need. That’s a hard question to answer. 

The other way to answer it is, there are some other guides that would recommend that, for example, when you’re doing physician order entry that you ought to have all of your orders go through the physician order entry system. This idea of trying to get 30 or 60 percent of your orders through the order entry system — we think that sort of partial implementation of CPOE is a real danger because then you have some orders on paper and some on the computer system. 

That’s not really a cost in terms of money. That’s a cost in terms of the political capital of the leadership of the organization, of how much pressure they can put on the physicians — those final holdout physicians who aren’t using it. How much pressure can you put on them to incentivize them to use the system? There’s cost, both financial cost as well as a political cost.

If a hospital downloads the Guides, how much effort does it take for them to get far enough into the process to know where they stand?

In our preliminary evaluations, if you have either a very knowledgeable person or a group of knowledgeable people together, you can go through a Guide in under 30 minutes. There are nine Guides, so we’re talking four or five hours. If you took a half day, you could go through and get a pretty good feel for where you stood on these different items.

The obvious question without an obvious answer is that the government is paying incentives to get people use electronic health records. Now the government has issued a set of guidelines that says, “This is how you keep them safe,” and yet those factors are not tied to any incentive. Who’s supposed to run with this?

We’re not really sure right now what’s going to happen with them. Like I said, I’m placing my bets on insurance companies. The payers are the ones that can really enforce this. 

In one sense, the federal government is a payer. You could imagine CMS incorporating some of these recommendations in their Conditions of Participation and then making the Joint Commission responsible for looking at them. You could imagine public health departments saying something like this, or insurance companies saying, “We’re not going to approve this, or maybe we’ll incentivize you to use the SAFER Guides and give you a little more money if you have completed the SAFER Guides.”

We’re in the midst of negotiating with a lot of different organizations to try to get them to see who will step up and say, “This is a good idea. The people  we are working with ought to explain to us why they are or aren’t doing these kinds of things that are in the Guides”.

Are there other phases planned?

We have work planned, but we don’t have funding to do the work. Most of the criticisms we get fall into two categories. One is that there’s too much stuff on the Guides and they need to be shorter. The other criticism is, you left something out. When they say that we’ve left something out, they say, “We really need a Gguide for clinical documentation that would help people to understand how much copy-and-paste is allowable in a document.”

There’s also a lot of people who have been talking about a Guide for how to do  the patient engagement aspects of it — how should you configure your personal health record and what policies and procedures should go around the patient portal and their access to information. We certainly know there are at least two more Guides that would be very well received and are needed, but right now there’s no funding to develop them.

Do you have any final thoughts?

I would strongly encourage organizations to take a look at these Guides. They can really help an organization understand where they are and understand what the issues are.

A lot of people think that they’re unique and that things that they hear about don’t apply to them. When they see these Guides, they’ll realize that a lot of people are going through and struggling with these same issues. The leading organizations have pretty well come together and decided that backups are a good idea, for example, or physician order entry is a good idea. An organization would learn a lot by going through the Guides and seeing where they stand.

Morning Headlines 1/30/14

CCHIT Announces New Strategic Direction With Global Focus

CCHIT announces that it will exit the EHR certification business. The company will pivot to a consulting model that will offer services to both hospitals and HIT vendors.

Former Allscripts CPA charged with insider trading

Steven Dombrowski, former Allscripts director of corporate audits, has been indicted on 16 insider trading charges. Federal prosecutors allege that in Q1 2012, Dombrowski opened a trading account in his wife’s name, and then made $286,000 short selling Allscript stock.

Proposed Law Would Give US Chief Technology Officer Oversight Of Major IT Projects

Representatives Anna Eshoo and Gerry Connolly introduce a bill that will require the federal CTO to review all major IT project undertaken by the federal government. The CTO’s office will have the authority to manage, or co-manage, the project on behalf of the initiating agency. The bill was drafted in response to charges that CMS lacked the technical expertise to properly manage the Healthcare.gov project itself.

U-M Kellogg Eye Center performs first two retinal prosthesis implants in U.S. since FDA approval

Surgeons at the University of Michigan implant the first FDA-approved prosthetic retina which is expected to restore enough vision for the otherwise blind recipients to be able to see objects, light, and people standing before them.

Readers Write: Ominous Outlook for Meaningful Use

Ominous Outlook for Meaningful Use
By Evan Steele

CMS passed up a golden opportunity to stave off the potential demise of the EHR incentive program when it failed to delay the start of Stage 2. What was already a complex program in Stage 1 becomes exponentially so in Stage 2, and its pace is outstripping the realities of medical practice and of software development. The facts speak for themselves:

• 17 percent of the physicians who successfully attested to 90 days of Meaningful Use at Stage 1 in 2011 walked away from the second incentive ($12,000) in 2012, which required a full year of Meaningful Use. I find this dropout rate very surprising. The requirements were exactly the same as the first reporting period for these physicians, so they and their staffs had already established the necessary workflows. The fact that many of these first attesters were early EHR adopters and therefore already more adept at EHR use than the average physician makes this statistic even more alarming. When surveyed by CMS, many of the dropouts cited the program’s complexity as a key reason for their failure in Year 2. Physicians who gave up on Stage 1 will likely not even attempt Stage 2.
• 12 percent of attesters who used one of the top 25 EHRs to demonstrate Meaningful Use in Stage 1 do not yet have access to a 2014-certified EHR, according to a January report issued by Wells Fargo Securities, while this year’s reporting period must begin within nine months. Some EHRs will never achieve 2014 certification. The first announcement of a vendor abandoning Meaningful Use came a few weeks ago, leaving its physicians out in the cold. Of the 49 ambulatory EHRs that have been 2014 certified to date — winnowed down from a Stage 1 field of 472 — very few have yet been deployed to physicians. This is clear evidence of the complexities associated with Stage 2 and the significant challenges facing vendors in making their EHRs compliant yet practical.
• I would estimate that at least another 15 percent will walk away from Stage 2 because of its dramatically increased complexity, added costs, and impact on productivity, particularly when weighed against the declining incentives (as little as $4,000 and $2,000 for physicians whose first year of Meaningful Use was 2011) and penalties that will average only a few thousand dollars.
• How many additional physicians will be driven to cry “Uncle” and abandon Meaningful Use because they are besieged by the demands of so many other programs at the same time—ICD-10, PQRS, Value-Based Payment Modifier, ACO participation, etc.? Physicians and their clinical teams are weary and can only do so much.

If you add these numbers together (acknowledging some overlap), the conclusion that 40 percent of past attesters will give up on Meaningful Use is inescapable. Then there’s the 37 percent of eligible professionals who have never earned an EHR incentive, including 18 percent who—if failure to even register is an indication of lack of intent—are so overwhelmed by the program that they have no interest in participation even in the “easiest” first stage (Source: CMS Presentation to HIT Policy Committee, January 14, 2014).

The delay of Stage 3 will be too little, too late. What was needed was a more reasonable approach to Stage 2.

Evan Steele is CEO of SRS, Montvale, NJ.

Readers Write: Once a Nurse, Always a Nurse

Once a Nurse, Always a Nurse
By Lisa Cannon

We all wear various hats in our lives, but some experiences are never forgotten. Through the years, I’ve been the road warrior healthcare consultant and then moved to positions supporting consulting operations. Yet nothing remains in my heart more than my early days as a nurse. I never knew how much I would appreciate having been a nurse until my mom’s health took a sizeable downward turn last year.

My mom’s chronic cardiac condition resulted in several hospital visits and treatment by various specialists in her last months. At home, coordinating her care among her medical team was no easy task. Keeping her out of a nursing home meant visits from home health nurses, nurse aides, and multiple therapists. This was a great deal of care synchronization for my aging father to deal with, but he welcomed it, knowing the alternative. He organized her medications and had everything written down. Thanks to my nursing background, I trained him in the art of taking her blood pressure, doing daily glucose checks, and measuring her oxygen saturation.

I was constantly running cover on what was being prescribed for Mom and monitoring how Dad was delivering the recommendations. Sadly, we hit an issue that in hindsight makes me question if it was the action that ultimately caused her death. Could information technology (IT) have made a difference? Perhaps. Maybe the application of common sense and additional family education could have.

Mom’s renal specialist ordered a diuretic water-releasing medication to be given once a day for seven days with a quantity prescribed of 14. The discrepancy between the dose and the quantity wasn’t realized immediately. After Mom fell twice, at a subsequent visit to her primary care physician, my dad indicated he was still giving this medication. That’s when we realized we had a serious issue. This was Day 13, well past the seven-day mark. Mom had received the medication for almost a full week more than had been intended. We realized it was significantly lowering her blood pressure.

I questioned the pharmacy that filled the prescription. They indicated they just did what the physician had written. I was outraged. Could they have provided some family education and made that clear? Since there were still pills in the bottle, Dad merely was continuing to give the medicine. Could a computer system combined with standard operating procedures prompt alerting of education requirements for a time-limited dosing medication helped? I think so.

After subsequent falls, my mom ultimately was admitted to the hospital, where a CT scan showed she had developed a massive brain hemorrhage. Dad and I were told that the combination of falls and blood-thinning medication resulted in a weakened blood vessel in her brain, which finally gave out.

Afterwards, when the renal specialist was asked why the prescription was written the way it was, she remarked that it was so we wouldn’t have to return to the office should we have needed to continue it. In her mind, she was doing us a favor.

This experience made me wonder how patients without involved family members manage their medical care journey as their health deteriorates. While I may have forgotten all of the details of the ICU setting I spent so much time in years ago, I am very thankful for the skills I learned and my ability to recognize the situation regarding the healthcare needs that come to the surface.

Having witnessed firsthand patients struggling with understanding their care requirements, it reiterates to me the imperative that health professionals do their part in educating patients and their families and communicating specifics. Training my dad to take blood pressure and glucose checks was possible (and these days, essential). His recognizing a perfect storm of low blood pressure, over diuresis, and blood-thinning medicines was not.

As healthcare IT professionals, we can’t forget that the role of IT is to supplement common sense and standard operating procedures, not to replace it. There is no fail-proof means to ensure mistakes don’t occur, even with the best of intentions and systems. We must remember that the people, process, and technology changes we’re making impact real people every day. Are we making healthcare better? We must –our families are counting on us. 

Lisa Cannon is director of resource management for Aspen Advisors of Pittsburgh, PA.