Morning Headlines 1/28/14

Where Are We on the Diffusion Curve? Trends and Drivers of Primary Care Physicians’ Use of Health Information Technology

EHR adoption in the practice environment hit 69 percent in 2012, but a large divide still exists between solo practices, which have only reached 50 percent adoption, vs. large practices of 20 or more physicians, which have reached a 90 percent EHR adoption rate.

ACOs struggle with data sharing

The National Association of Accountable Care Organizations publishes the results of a survey that solicits the opinions of 35 ACOs. Respondents report that the average cost to transition to an ACO model was $2 million. The ACO organizations rated their IT satisfaction at 6.4 on a 10 point scale, with an “overwhelming number" of participants reporting that learning to access and process CMS data was a significant hurdle. Predicted gains from the transition range from a $9 million increase to losses of $10 million.

Epic launches at Yale Health

Yale Health (CT), a three-hospital health system, goes live on Epic, replacing Allscripts.

Curbside Consult with Dr. Jayne 1/27/14

To practice or not to practice, that is the question. Among the other CMIOs I talk with regularly, it’s a nearly 50-50 split as to whether they continue to actively practice medicine or not.

For some of them, the decision was made based on factors related to medical specialty. Others gave up licensure when they pursued administrative work and found it too difficult to go back. Some chose informatics as a way to escape patient care. But it’s not always straightforward. It seems that those of us who are earlier in our careers are more apt to try to continue seeing patients, with those in the primary care disciplines hanging on longer than others.

I’ve been lucky because my EHR background has given me experience with multiple vendor systems. This allows me to work as a locum tenens physician and fill in for a week here or there in a traditional family medicine practice. Seeing how different practices function is interesting and I often get ideas for performance improvement projects or bring back tips and tricks that can help my providers.

I’ve also worked for the last several years in various emergency departments and urgent cares. Although I do a fair amount of “real” emergency medicine, it’s mostly the same kind of conditions that I’m used to handling in the family medicine office.

I try to work consistently, but it has been more and more difficult to find opportunities that will work with my ever-expanding CMIO work. My “day job” is full time and my hospital doesn’t provide much accommodation for my clinical work. Now that we’re in the throes of Meaningful Use and preparation for ICD-10, it seems like there isn’t enough time to do anything else.

During the last six to eight months, one of the hospitals where I worked has closed their fast track area in the emergency department. Another replaced all the part-time physicians with nurse practitioners and physician assistants. I took some time off while I was preparing for informatics boards and that impacted my seniority on the scheduling board at my remaining facility, which has made it harder to get back in the rotation.

Continuing clinical work doesn’t yield a lot of income compared to the cost of being an independent contractor. Although I don’t pay for professional liability insurance, there are many other costs: board recertification, maintenance of certification, state licensure, Drug Enforcement Agency registration, state drug enforcement registration, hospital medical staff dues, hospital recredentialing fees, and more. There’s also the cost of professional society memberships and continuing medical education.

Continuing education has been a thorn in my side the last couple of months. For emergency department work, I have to maintain certifications in basic, pediatric, advanced cardiac, and advanced trauma life support. They’re all due this spring, and trying to work them in with everything else that is going on has been enough to make me think twice about seeing patients. Thank goodness I finally got to stop maintaining the obstetric life support credential because I’m not entirely sure I’d be able to fit it in.

For most of the classes, I’ve been able to find programs that offer at least part of the course online, although all of them require a practical component. Some are sponsored by national organizations and others are modules that have been purchased by one hospital or another. I figured doing them online would give me more flexibility but I’m not sure it’s doing much good. The differences in quality are tremendous. When I compare it to what we’ve been trying to achieve with e-Learning for our EHR program, it’s even more striking. Some of the “e-Learning” is little more than written textbook sections punctuated by the occasional embedded video.

They vary greatly in the length of the modules and whether users can pause at any time or only at pre-defined points in the course. One of them was so restrictive that I might have been better off using a vacation day and attending an all-day course rather than trying to fit it in as time permitted. The cost of the courses is the same as what I have paid in the past for in-person courses except for the basic life support. It used to be free when our hospital education department offered it, but now that it’s offered online by a third party, we have to pay for it.

Despite being an attending physician, I couldn’t even register for the class until my check cleared. Rumor has it that employees have to sign up months in advance so a purchase order can be processed and a check delivered. Another negative is the lack of interaction with colleagues. I enjoyed meeting nurses, patient care techs, therapists, and other colleagues during the classes even if it was just for some chit-chat over lunch or a break. I know the hospital is saving money with the online classes because they require staff to complete them during non-working hours; previously, hourly staff members were paid for attending class.

I’m starting to feel like this might be the last time I do this. Although I enjoy seeing patients, it’s getting harder to manage. There are many things competing for what’s left of my free time after I leave the office. I’m thinking about exploring volunteer opportunities where I could use my healthcare skills but where there would be less overhead than I currently have trying to maintain half a dozen certifications.

I’d be interested to hear from other CMIOs whether they’ve hit this point in their careers and what they decided. Is there a right time to hang up the white coat? How do you know? Have any creative ideas for trying to do it all? Email me.

Email Dr. Jayne.

HIStalk Interviews Alan Rosenstein, MD, Disruptive Physician Behavior Consultant

Alan Rosenstein MD, MBA is an educator and consultant in disruptive physician behavior. He welcomes contact by email.

 

Tell me about yourself and what you do.

I’m a physician. I also have an MBA. I still do a clinical practice in internal medicine a couple of days a week. I do a lot of consulting work around care management.

One of my other positions is being medical director for a company called Physician Wellness Services, which is in Minneapolis, although most of my career has been involved on getting physicians around best practice care.

You’ve done a lot of work with disruptive physician behavior. How is that defined or evidenced?

I got into this as vice president and medical director for the VHA West Coast. We would always look at how we could help the medical directors focus on the issues that they think are important. The usual span of issues are quality of care, cost of care, and physician relationships with the hospital. 

I started noting that they were putting down disruptive behavior as one of their key issues. This really got exacerbated during the nursing shortage. That’s when I started the original survey on what is disruptive behavior? Are you witnessing it? Who’s doing it? Where is it occurring? That led to all the research about how significant an issue it is and then what we can do about it.

We describe disruptive behavior as any inappropriate behavior that can negatively impact patient care. That’s the simplest definition.

When you look at other professions, are physicians more likely to be disruptive, or it just more easily perceived because of the work environment they practice in?

It’s a combination of both. There are certain personality traits that lead people to go to medical school. It’s very competitive. They’re very ego-centric. During the medical school process, you’re taught very autocratic, independent, autonomous types of behavior. Physicians give orders. There is that personality that’s built in. 

Healthcare is a very hierarchical system. Physicians are on top of the totem pole. They’ve usually had their free way in giving orders and not taking any responsibility for their actions, although their actions are really aimed at best patient care. 

That in combination with the fact it’s a really stressful environment. In fact, if you look at where disruptive behaviors occur most frequently, it’s in either stressful areas — such as surgery, the emergency room, or OB — or in very stressful situations where the patient is having a negative outcome or the severity is increasing and they’re taking a turn for the worse and the physician needs to get involved. Sometimes they don’t do that in the most cordial manner.

In my experience , physicians who staff perceive as problematic and prone to explosive tempers are often respectful to their patients and even have great bedside manner.

I’m not sure they have great bedside manner with the patients. I think their intent is 100 percent, “I want to do the best for you, and in a crisis situation, I’m the one who knows best and I really need to take control.” That’s all appropriate, but many of these physicians are not good. 

in our research and others, we’ve shown that three to five percent of physicians — and nurses, actually — are truly disruptive. This can have a significant impact on the organization. But what we also found is that 40 to 45 percent of them are ineffective communicators. If you go back to that medical school, you’re trained in technology, you’re trained in knowledge competency, but you’re not trained in personal skill development. 

Now with healthcare being so complex, there’s many physicians in on a case, many other providers who are not physicians. The physician needs to better communicate and coordinate with them and also to present it effectively to the patient. 

I’m not sure that they have the best bedside manner, but they certainly are doing it with the intent of, “I need to take control.”

Is that behavior rewarded more readily for certain specialties, like cardiothoracic surgeons versus pediatricians?

Why do people act disruptively? First of all, many people act disruptively and they don’t even know they’re doing it because they don’t understand the downstream effect. A lot of the research has shown there’s a significant downstream effect where patient care is actually compromised.

They’re acting disruptively because they need to take control. They feel like they need to give the orders and get the best patient outcome. They’re doing it to try to provide best patient care, but they don’t realize what they’re doing or how it’s impacting, or most importantly, the long-term impact of what they’ve done. 

Eventually it gets to the point where you antagonize a person so much … in the short term, they’ll hopefully do what you’re asking them to do, but moving further down after the crisis, they don’t want to communicate with you any more. These communication gaps lead to problems with the patient outcomes of care.

Does medical training encourage or at least support disruptive behavior? Do you see that changing as newer generations of practitioners emerge who have been trained more as a team member rather than a single player?

Yes, absolutely. What we’re finding right now in medical schools is that they’re beginning to realize how important personal skills, communication skills, and teamwork skills are. 

Three things are happening. One is the MCAT, which is the Medical College Admission Test. They’re now posing more questions on the humanities, not just math and science. Two, as far as the people who are majoring, they used to major in chemistry or biology, now they’re looking for people who major in sociology and philosophy. Three, and most importantly, a lot of the more progressive medical schools are beginning to teach communication, collaboration, and personal skills during the freshman year of medical school to get away from this autocratic or independent behavior.

For physicians trained under that different model that no longer applies, it must be difficult when hospitals are acquiring practices, exercising more control in ACO-type arrangements, and mandating use of EHR systems that impose standardized care guidelines and require doctors to document themselves in ways that don’t benefit them. Does that feeling of loss of control elicit disruptive behavior?

Absolutely. One of the things that I talk about is why do people behave the way they do. I talk about the internal things. Age — those different values and attitudes based on your age and your generation. There are gender differences between men and women in how they view stress and how they handle stress. There are differences from culture and ethnicity, power, issues related to gender, issues related to dominance. Then there’s all the stuff from your life, upbringing, what you’ve been exposed to.

Those are the internal factors. Those can be addressed, maybe by sensitivity training or communication skills training. 

The external events — one of them you hit on — is from healthcare reform and initiatives and the electronic medical record. There’s now more and more pressure on providers, not just physicians, to be able to demonstrate and document good value care based on what other people think, not necessarily what they think. More adherence to guidelines telling you what you can and you cannot do. Taking people away from the bedside, spending more and more time on fulfilling all the requirements of the documentation. That gets everybody very frustrated because they just want to practice good care. 

One of the key concerns right now is the significant amount of stress, burnout, and frustration that’s hitting our physician workforce as well as others. A lot of them are trying to change jobs, get out of the profession, or retire early. That’s a real issue right now, because we are — if not currently, tomorrow — going to have a workforce shortage. 

One of the things that organizations need to do as they acquire physician practices and as they get them to adhere and be compliant with their protocols, their electronic medical record — they have to work with them to help them bring them up as a precious resource and not tell them, “This is what you have to do or else.”

What tips would you have for CIOs and CMIOs on the most constructive way to deal with physicians, especially those who have a reputation of being disruptive or resistant?

On the global level, physicians needs to understand why you’re asking them to do certain things. You need to raise the business case of why reducing variation and improving efficiency is going to get you the best patient outcome. That’s what you really want in the end, whether it’s a quality issue, whether it’s a cost issue, or whether it’s a satisfaction issue. Our goal is to make the patients get the best value out of a healthcare interaction and no one, no matter where they’re coming from, is going to say that’s not an appropriate goal. So you need to set the business case.

The second thing is you need to talk about what protocols and what enhancements you have, either technological or care management, and explain to them why we’re doing this — the idea that you reduce variation, we’re trying to do best-practice care, this will give you the best practice outcome. 

The most important thing is they want us to sit down and talk to them and listen. One of the frustrations from physicians is, “I have a concern, I have a problem, I have an issue, but no one is taking the time to talk to me about what my individual concerns are.” 

One of the key steps is that you need to sit down and talk to the physicians and find out what their resistance is based on what their barriers are. If you can potentially address some of those barriers, that’s something that the organization really needs to do. 

The last piece is that besides the business case and the support, you want to provide ongoing training. When you implement or you go live, make sure that you have these work groups that are readily available to help the physician get through what they really need to get through.

Pushback against systems like CPOE seems to have lessened. Are people learning how to deal more constructively with physicians or are physicians just resigned that they have to do it?

A combination of both. People are being resigned. Remember, for physicians, it’s not just the inpatient record, it’s also the office record. With Meaningful Use and with billing, you need to get into the electronic, so there is a business reason for them. I think the technology is there.

Certainly with the newer physicians who were brought up on technology, this is not an issue. It’s mostly the physicians who have been in practice for 20 to 30 years. They’re very used to their ways of doing things and don’t understand why they need to change. With the growing need that everybody is going to have to be up and running on electronic medical records, the physicians are recognizing that this is something they really need to participate in. 

The organizations do realize this, and as they implement these new medical records, they are very concerned about getting them on board and doing the appropriate training.

Do you have any final thoughts?

Part of it is the electronic medical record and part of it is the way the physicians behave. Physicians are a precious resource. I really do believe that all they really want to do is to do their job. Everything seems to get in the way, and some of those things are right.

Reducing variation, improving efficiency and productivity, and maximizing best patient outcomes is an absolute right thing to do. But I think organizations need to recognize that physicians are frustrated, they’re angry, they’re burned out, and they’re stressed. They need to spend more time in working with the physicians to prevent the inappropriate and truly disruptive behaviors, which can have a profound, negative impact on the organization.

Morning Headlines 1/27/14

Athenahealth Seaholm deal faces tough questions at City Council

Several Austin (TX) City Council members are questioning the decision to offer athenahealth incentives to open a new office in its busy downtown business district. The council members hold the opinion that the city is capable of attracting new jobs and filling office space in the business district without offering perks.

Dynamic modeling of patient and physician eye gaze to understand the effects of electronic health records on doctor–patient communication and attention

The International Journal of Medical Informatics publishes a study that correlates EHR use with a drop in doctor-patient eye contact when compared to practices that use paper charts.

UK ministers cap government IT contracts at £100m

In England, new rules published Friday limit government IT contracts to $165 million unless there is an "exceptional reason", eliminates automatic contract renewals, caps hosting contracts at two-years, and requires that software be implemented by a company other than the software or hardware vendor.

BIDMC Aims To Engage Patients and Families in Effort to Eliminate Preventable Harm in Intensive Care Units

Researchers from Beth Israel Deaconess Medical Center receive a $5.3 million grant from the Gordon and Betty Moore Foundation of California to develop an IT system that will help monitor for, and reduce, preventable harm in ICU patients.

Monday Morning Update 1/27/14

From Brute Forceps: “Re: Leidos Health. President Steve Comber is stepping down.” Unverified, but BF included a purported email from Steve to his team announcing his departure. “Our Executive Leadership, along with the Board of Directors, have made a decision to further invest in health by adding a recognized & proven industry leader at the forefront of our health business. As such, in the very near term a search will be underway for a health expert / leader who will be chartered with the responsibility of taking our health business to the next level.”

From Cabana: “Re: [company name omitted.] They are blocking access to your site after you wrote something uncomplimentary about them.” It’s my crowning achievement when a company blocks access to HIStalk. Given previous examples involving clueless, egotistical executives intent on guiding their enterprises right into the ground, I can say with confidence that employees reading factual information on HIStalk should be the least of their worries.

From Scooper: “Re: Martin Hospital. You scooped the main media on their EHR crash.” I just happened to have a reader with a friend who was admitted at the time and he passed the information along to me. CIO Ed Collins was nice to provide a response. The contact said it was chaos in the hospital, with confused employees assigning random numbers to patients, runners delivering paper copies of everything, medication errors occurring, and unhappy family members threatening to sue everything that moved (all unverified, of course.) The hospital says the problem was hardware, not Epic, and claims (as hospitals always do) that patient care wasn’t impacted. Of course patient care was impacted – the $80 million system that runs everything went down hard. It would be interesting for Joint Commission or state regulators to show up during one of these hospital outages anywhere in the country to provide an impartial view of how well the downtime process works. All that aside, downtime happens and the key is preparing for it, just like Interstate Highway construction and lane-closing accidents. It’s not a reason to drive a horse and buggy.

From Keith: “Re: UCSF death in the stairwell case. Four caught snooping.” San Francisco General Hospital announced for the first time Friday that a routine audit of the electronic records of high-profile patients turned up four employees who looked at records of the patient who was found dead in a hospital stairwell in October 17 days after she disappeared from her inpatient bed. Two of the employees have been fired and two were suspended. The hospital announced changes Friday as mandated by CMS after the incident, in which the hospital performed an incomplete search, alarms and cameras were found to be out of order, an incorrect description of the patient was issued to searchers (the hospital said to look for a black woman in a hospital gown, but the patient was white and wearing her own clothes), and the sheriff’s department failed to follow up on a report of a body lying in the hospital’s stairwell.

From The PACS Designer: “Re: Windows upgrades. The decision to upgrade from Windows XP, which will go off support in April, will be a challenge for most of us. Do we go to Windows 7, 8.1 or wait for Windows 9? Most likely Windows 7 will not be that choice due to its limited future with Windows 9 coming. Windows 8.1 with its rumored Upgrade 1 will be a likely choice since it will be easier to make the move to Windows 9 when its ready for release.” Windows 8 has been an amazing success with one group – the companies that sell add-ons to hide the absurdly annoying tile-driven Metro user interface. It’s probably fine if your computing needs are so basic that you can use a touch screen, but if that’s the case, you might as well just use a tablet, preferably one not running anything from Microsoft.

No clear trend exists for vendor layoffs, respondents said. New poll to your right: how often do you check your work email after hours and on weekends?

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.

HIStalkapalooza last chance: registration to request an invitation ends Wednesday. We’re planning to email invitees the following Tuesday, February 4. Thanks to Imprivata for sponsoring the event – it’s going to be a big deal.

Welcome to new HIStalk Platinum Sponsor Greencastle. The Malvern, PA-based company was founded in 1997 by two former US Army Rangers who brought to the consulting world the military concepts of sense of purpose, discipline, teamwork, and systematic methods. They make it a point to hire junior military officers (among others) and help them apply their skills to the corporate world. Greencastle consultants are ready to take responsibility for large-scale clinical and business initiatives to help healthcare organizations maximize the value of change. Services include clinical systems implementation, application consulting, project management, and system selection. The company did a CHIME focus group presentation on building a business case for analytics and offers white papers. Thanks to founders Celwyn Evans and Jacob Kretzing for their military service and to Greencastle for supporting HIStalk.

Listening: Failure, deeply lush, ambitious, influential, and prophetically named 1990s alt-rock (Pink Floyd meets Radiohead) that nobody’s heard of despite their stunning 1996 concept album masterpiece “Fantastic Planet,” which they played great live. They broke up in 1997, but are reuniting this year. 

South Nassau Communities Hospital (NY) adds dbMotion and FollowMyHealth to its Allscripts portfolio, joining Sunrise.

Beth Israel Deaconess Medical Center (MA) receives a $5.3 million private grant to develop IT-driven ICU tools that include a patient-specific clinician checklist dashboard and a patient-family communications display. BIDMC joins Johns Hopkins Medicine, UCSF, and Brigham and Women’s as part of the Libretto ICU Consortium of the Gordon and Betty Moore Foundation.

A federal judge orders St. Luke’s Health System (ID) to divest itself of the Saltzer Medical physician group it bought last winter, saying the hospital’s ownership of 80 percent of the primary care doctors in Nampa, ID would give the health system an unfair bargaining position with insurance companies even though the intent of the acquisition was motivated only by improved patient outcomes. St. Luke’s had defended the acquisition in responding to a lawsuit brought by competitors and the Federal Trade Commission, arguing that the merger would support new risk-based care models and that its $200 million Epic system will be better than anyone else’s when implemented.

NHS Hack Day was held this past weekend in Cardiff, Wales, bringing together people with healthcare-related problems and developers ready to build rapid software prototypes to solve them.

A eye movement study of 100 primary care patient visits finds that EHR-using doctors spend a third of their time looking at the computer monitor, making it hard for patients to get their attention and reducing the physician’s ability to listen and think. The study also found that patients look almost constantly at the EHR screen instead of their doctor even though they have no idea what anything on it means. The author suggests that vendors design EHR displays that both physicians and patients can use.

Several members of Austin’s city council question the city’s plan to offer athenahealth incentives to move one of its operations there when demand for Austin commercial space is already high. Said one of the council members, “While it’s great that the company is looking to hire locally, we don’t have 336 software people that are unemployed right now. That’s not a target area and it could be an onus on companies that we already here.”

In England, ministers vote to limit government IT contracts to $165 million other than for an “exceptional reasons,” also barring vendors that provide hardware and software from implementing their products themselves. Contracts will also be limited to a two-year term with no automatic extensions. According to Cabinet Office Minister Francis Maude, “Big IT and big failure have stalked government for too long. We are creating a more competitive and open market for technology that opens up opportunity for big and small firms.” Maude drove the government’s “digital by default” effort to centralize government websites and use technology to make its services more efficient.

The board of Cookeville Regional Medical Center (TN) approves a five-year, $1.5 million expenditure for RelayHealth’s patient portal.

Puget Sound Blood Center (WA) issues an emergency appeal for blood donations after a regional telecommunications outage forces it to cancel blood drives and donor collection.

A man cleaning the vacated office of an Ohio family practice physician finds an old computer containing the electronic records of 15,000 patients. The doctor had told the man to keep anything he wanted and send everything else to the trash. The doctor says the PC was left behind by mistake and he wants it back, adding that it is password protected, but the local newspaper found the desktop icon above that opens a Word document containing the names and passwords of all the practice’s employees.

Weird News Andy titles this story “Jailhouse Rock” and adds a guitar pun in proclaiming the protagonist to be “high strung.” A 54-year-old male patient  claims to be Pink Floyd’s David Gilmour and Rush’s Alex Lifeson during several hospital stays, telling the hospitals that his agent would take care of his bill. Obviously not only did hospital staff not ask for ID, they don’t know either band very well because the man’s resemblance to either guitarist (above) is slight.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Time Capsule: HIMSS10: Party Like It’s 1999

I wrote weekly editorials for a boutique industry newsletter for several years, anxious for both audience and income. I learned a lot about coming up with ideas for the weekly grind, trying to be simultaneously opinionated and entertaining in a few hundred words, and not sleeping much because I was working all the time. They’re fun to read as a look back at what was important then (and often still important now).

I wrote this piece in March 2010.

HIMSS10: Party Like It’s 1999
By Mr. HIStalk

Healthcare is different, everybody says, Well, it sure is when it comes to throwing the excessive bacchanal that is the HIMSS annual conference.

Most citizens are shell-shocked from economic devastation. Most industries are reeling. But at HIMSS, it was 1999 all over again.

Sprawling exhibitor booths are burning electricity like a third-world country! Bring on the big-name entertainment! (OK, I admit that I hadn’t heard of Colbie Caillat and singing in a building full of fish tanks is new to me, but her Grammy Award seemed to get people’s attention). Cocktail hour in the exhibit hall are just what stressed hospital executives need to make informed, responsible IT decisions!

The most common phrase I heard in the exhibit hall other than Meaningful Use was Ruth’s Chris.

It was a Las Vegas time warp in Atlanta. Everybody slept in expensive hotel rooms and wore pricy clothes and screwed around with party schedules on expensive smart phones and fretted over dinner reservations and wine lists at expensive restaurants. The neon and booth babes were out in force, everybody loaded up on overpriced Starbuck’s coffee, and hired cars and limos lined up to transport captains of the HIT industry and their minions to and from the convention center.

In the back of my mind, though, was my hospital’s ED. I was thinking of the people patiently waiting there, those using it as their primary care provider because they can’t afford insurance. If I randomly chose one of those patients and took them to HIMSS, what would they think of the free-wheeling technology funfest?

I worry that hospital executives have decided that they are far superior in every way to the average patient they supposedly serve. They have more education, make more money, and enjoy life benefits that the randomly chosen ED patient cannot comprehend. When they travel, they travel in style, and thus supposedly struggling community hospitals will reimburse executives for $250 hotel rooms. And when they go to HIMSS, self-sacrifice is hard to find. In fact, so is any mention of real, live patients, many of whom would probably cause the suit-wearing crowd to physically recoil because they don’t look or act like them.

The other irony is that the key element of discussion, the topic that packed the conference rooms, was getting hands on taxpayer money. All those highly paid and highly expense accounted people were getting together to talk about hitting those economically shell-shocked people and companies a little harder in the pocketbook, making the choice on their behalf that their personal income would be better used to fund EMRs through higher taxes.

Maybe the local TV stations should send video reporters to conferences like HIMSS, just to show the folks back home who make it all possible how their healthcare and tax dollars are being spent.

I could be naïve. Maybe the HIMSS spectacle is so over the top that everybody gets the irony. In fact, I bet they were discussing it at Ruth’s Chris.

HIStalk Interviews John Kass, VP of Healthcare Strategy, Bottomline Technologies

John Kass is vice president of healthcare strategy and business development for Bottomline Technologies of Portsmouth, NH.

Tell me about yourself and the company.

Our go-to-market strategy is twofold, both on the direct front and as well working through Tier 1 ECM vendors. As healthcare changes and there’s a lot of consolidation in the market, we’re seeing a movement toward procurement being something that they want to simplify in that supply chain. 

I spent four and a half years at Hyland Software prior to coming to Bottomline. We were taking many people from paper to electronic and linking that information into the electronic medical record. But one of the things that really stood out is that paper has been holding back the power of ECM for quite some time. 

Logical Ink was an e-capture, mobile capture, e-data solution. There was a lot more you could get out of paper and changing the process was key. We signed a private label partnership with Hyland Software. Really being able to go back to customers that I’ve worked with for quite some time and improve the value in technology they’ve already purchased.

Describe what Logical Ink does and how you incorporated that acquisition into the product line.

We acquired that technology several years back. It was called Logical Progression. Chris Joyce, who is our director of product development here today, is the developer of the solution.

When Chris invented Logical Progression, the market looked very different. The biggest change is that we’re seeing much more connected healthcare brought on by Meaningful Use. We’re seeing EMR adoption growing. The goal is, how do we create a longitudinal view into the patient?

What’s really changed is, when I came on board, taking the focus around the strategy of… this is something that ECM became a very natural marriage. The product is a much more connected solution today. It’s an enterprise, what we call a standardized one capture platform, any downstream system. In addition to moving and capturing the form, we have the ability to capture discrete data elements in the form and map that downstream. You can have one encounter, capture that information, send it to a Hyland Software OnBase, link that to an electronic medical record, and simultaneously send discrete elements of data down to a population health system or another system discretely. 

The other change is that four years ago, solutions like the iPad did not exist. They’ve revolutionized the way we interact with technology in a way that I can hand my 70-year-old mother an iPad and she immediately gets it. We’ve got a native iPad application. We’re also on Windows. The ability to have devices that are much affordable and usability being much higher has changed the game in the last several years.

Can you explain what Hyland OnBase does and how you tie into it?

It stands for “one database.” OnBase is an enterprise content management system. In the patient-related world, there are things inside of that electronic medical record that you’re capturing as discrete data elements, but there are all kinds of things that generate from paper or other people’s systems that have no meaning to it. It’s called unstructured content.

Hyland can quickly bring that content in, capture it, and then put meta-data or key words around that content. Once they add meaning to that content, they have some very slick opportunities to link that contextually into an electronic medical record, or even on the ERP side in the non-healthcare world.

One of the things that we saw was having the ability to not have to scan physical paper into a physical device. There are too many documents going down to HIM to batch scan, so the burden on HIM is still very, very heavy. The goal is, how do we decentralize the capture in a seamless way and how do we optimize the ability to ultimately know what that form type is, because we’re starting electronic in a way that’s very meaningful with the patient?  

We can simplify all of that, the scan queues and hiring people to work and help index that content. We can immediately send that to OnBase through an API and they can immediately place those hyperlinks contextually within the electronic medical record. When you look at it from a workflow and a patient engagement perspective, it’s a game-changer in how you interact with that content.

HIM does batch scanning, indexing, and QA to link the scanning of paper. Is electronic mobile capture a better way, and will that process eventually go away?

You’re seeing quite a few trends in the industry. I’ll categorize it in a couple of ways.

There’s always going to be that external content. A patient walks in with pieces of paper that originated in another facility. I call that third-party content. We’re seeing that as an area that you still typically have to scan. If you’re a large IDN, you’re seeing a lot of the banks starting to offer the ability to scan that for you and create an index file as a value-added service. That’s number one.

We’re seeing more things captured discretely as a result of Meaningful Use, tying EMR adoption to reimbursement. But more importantly, certain stages of Meaningful Use are required. In other words, the government said these EMRs need to be certified and they have to do certain things. That’s certainly gotten rid of some of the paper.

There’s that remaining paper. There’s that remaining interaction. Those are things that start inside your own facility. It’s the consents. It’s the patient history. It’s the ABNs. It’s sometimes taking a photo and being able to embed that photo and have the patient or clinicians fill out information about that photo. Prior to Logical Ink, you would have to literally plug a camera into a USB, go out and find that photo, and attach it and attach meaning. With Logical Ink on an iPad, a clinician can take a photo with the embedded camera, embed that photo instantaneously in a form, and fill out information or have the patient fill out information. When we hit submit, it can automatically be linked into the downstream system.

Do you think that the increased use of electronic medical records has expanded rather than contracted the content management market?

Certainly it has. There is absolutely no doubt about it that. There was a mandate, there was reimbursement tied to it, and there was a timeline. These were all very compelling events to moving people forward. It’s an impetus to a range of people adopting technology at different times. We’ve seen an industry movement across the board through this mandate that’s been very big. 

Certainly with the enterprise content management piece being a component … I always tell people, your goal isn’t to buy an enterprise content management system and an EMR. Your goal is a longitudinal record of the patient where you can see every action and encounter through one viewer. So Epic becomes that viewer, for example, or Cerner. But what’s great about ECM with the embedded nature of it, when you’re viewing some of that content through the core EMR, many times folks don’t even realize that the ECM portion of that is not just an extension of the actual core system.

Thinking about gaps in functionality or gaps in usage that electronic medical record systems have, what can automated or online forms add?

HIMSS came out recently and talked about with so many EMR vendors moving so quickly to try and fill the mandates of the different stages of Meaningful Use, while they focused on the functionality, usability’s probably something that has not taken a front seat given the time.

The other thing we’re hearing is that early productivity reports are showing that with clinicians having to do so much charting in front of the patient, productivity is going down. As you can imagine, part of diagnosing a patient is observing that patient. One of the things that we have been focusing on is the ability to have the patients fill out on an iPad, for example, all of these required forms. That’s unvalidated data at that point.

Now imagine as you walk into your doctor, having the doctor on an iPad asking you questions and updating and editing that information to validate that. Then capturing in that one encounter, moving the form into an ECM solution, but moving the data elements and mapping them discretely into the electronic medical record. We see that that is absolutely key.

The other thing is that while the EMR encompasses probably 80 percent of the overall enterprise technology around clinical and financial applications, there’s all kinds of “ologies” and patient disease management systems. People talk about data silos in healthcare. I would argue that what we really have is vendor silos. We’ve become that unified front end despite where the information is going with a simplified front end that they’re used to, applications like a Windows tablet or an iPad. We’ve focused on those areas to help augment and improve the usability and the optimized workflow.

What are some ways that customers are using your technology to improve their core hospital systems?

We’ve got a facility in California that is capturing various forms, but also simultaneously feeding discrete data from Logical Ink right into their disease management system, their population health system. They saw an application that we believe is a differentiator. We’re not just capturing signatures on forms — we’re having a very interactive process with that data. We came up with a concept of you have one encounter, so you capture once with the ability to push to any downstream system.

This is a paradigm shift for them. Before, they were scanning that piece of paper and somebody was entering the discrete information manually into a system. The ability to automate that process in a way that happens very natural with the interaction was a real game-changer from both a workflow time to get information in and certainly from a cost perspective, removing the manual process of having to hire people to manually do that.

Do you have some ideas about best practices for improving the satisfaction of patients with the intake process?

There are areas that you’ll go into, a very static patient access area, where there are stations of people working. You literally are going to go in there, check in, and sign all your forms. The fact that our solution can be a desktop solution, can be a web solution or can be a tablet solution means that we offer a very, very compelling licensing model where we don’t differentiate. A device is a device. It gives you the opportunity to use many different platforms for many different uses. 

Where things become very compelling is healthcare – unlike, for example, an accounting job, where you log in and you may not move all day long — many healthcare workers are roaming throughout the facility for different encounters and what have you. The ability to take what used to be maybe a computer on wheels with a scanner on a cart, wheeling that around, physically having to take a packet of 10 forms and physically putting 10 forms through a physical device called a scanner, is a lot of work. Sometimes that gets in between you and the patient. 

If you’re out there wheeling that cart around and your role is to wheel that around all day, changing that from walking with an iPad, scanning a patient’s wrist band, having the ability to pull that patient, pack it up because we’ve got all the integration on the back end with the ECM and all of the different document types and the levels of those document types already being pre-set to the EMR, your ability to walk in very pervasively and have that ability to capture things in a pervasive or untethered way is something that again is a paradigm shift. It allows people to be much more natural and upright and  a tablet doesn’t get in the way between you and the patient.

Most people didn’t see the potential for enterprise use of tablets when the iPad came out, but now everybody wants to use them. WiFi connections are decent and tablets are cheap. Will more opportunities come up?

I think so. Like you said, we’ve got bandwidth today. We’ve got devices. I look at an iPad as a productivity tool, more an appliance than a computer. That’s where you can draw a line in the sand. It really does simplify the way in which you interact with technology, for example. 

Four years ago, you look at where bandwidth was. We had no Meaningful Use. You were talking about a tablet that might cost $1,500 and it really wasn’t enabled for the touch experience. The market wasn’t there to take advantage of the applications.

Fast forward to today, looking at being linked to those Tier 1 vendors, looking at really tying and anchoring into investments that have been made there, and putting the engine behind the ECM in a way that paper has held ECM down for years. If you look at all of those factors, we’re at a time where the market’s there.

People are using these tablets in their personal lives. There’s a very consistent, constant look and feel. People don’t want to use a device at work that’s more of a barrier than the one they use at home to look up an article on the Web. We believe that we’ve bridged that gap in a way that the same simple tools they use in their personal life, they can absolutely start to use in their professional life.

What are the company’s plans for healthcare over the next few years?

The timing is right. The market is right. We’ve got the right platform. We think we’ve got the right strategy. We want to be heads-down focused. The company is always looking for potential acquisitions, so that’s something that I would say is ongoing. But we’re looking to do the right thing for the right time and the right reasons. I’ve been on board a year. 

I’ve gotten very, very comfortable in my role and I’m at a point where I feel like we’re optimizing some of the things that we’ve done over the last year. For the time being, we want to keep focused on the opportunity we have right in front of us.

Morning Headlines 1/24/14

Quality Systems, Inc. Reports Fiscal 2014 Third Quarter Results

Quality Systems Inc., parent company of NextGen, release their Q3 results: total revenue decreased five percent compared to the same period last year. Adjusted EPS was $0.11 vs $0.26, a 62 percent decline. Still, shares rose eight percent on the results by the end of trading.

Best-of-breed oncology vendors hold their own

KLAS finds that McKesson is leading the medical oncology market, while Cerner and Epic continue to improve. Best of breed vendors are still leading the radiation oncology market.

US and UK working to strengthen use of health IT for better patient care

HHS Secretary Kathleen Sebelius and U.K. Secretary of State for Health Jeremy Hunt sign a bi-lateral agreement between the nations committing to: share medical data, share and co-develop quality indicators, promote the adoption of EHRs, and foster innovation in health IT.

Healthcare Information Technology and Healthcare Information Services: 2013 Year-End Review

Healthcare Growth Partners publishes its annual review of the healthcare IT market, and its current and predicted future financial drivers.

News 1/24/14

Top News 

At ONC’s annual meeting on Thursday, HHS Secretary Kathleen Sebelius UK Secretary for Health Jeremy Hunt sign a collaboration agreement between the US and UK that calls for sharing quality indicators, exchanging data and interoperability ideas, maximizing healthcare IT usage, and encouraging health IT innovation.

Reader Comments

From Freedom Rock: “Re: Martin Health System, Stuart, FL. A friend who is there says their $80 million Epic system is down throughout three hospitals and many other facilities and physician offices. They’re calling in off-duty nurses and clerks to go back to paper.” I asked CIO Ed Collins, feeling guilty as I did so knowing as an IT person how annoying it is to field questions about downtime when you could be fixing it instead, but he was gracious to provide a response Thursday afternoon:

“Martin Health System had a hardware failure that has resulted in our network being down. The failure occurred the evening of Jan. 22 and we are continuing to work on rectifying the situation. Epic is among the systems being impacted by this hardware failure, however, it was not the genesis of the problem. We are continuing operations as scheduled, while strictly monitoring any potential patient safety concerns or issues that would require appropriate care determinations to be made. Our patient care teams are following downtime procedures and protocols to ensure patient safety and proper documentation is provided.”

From Macke: “Re: Dave Henriksen. The former SVP/GM at McKesson who left to become president of healthcare information solutions at Carestream Health in July 2013 has left Carestream.” Verified. A Carestream spokesperson says Henriksen has left the company for an unspecified opportunity.

HIStalk Announcements and Requests

Some of this week’s highlights from HIStalk Practice include: EMRs helped improve the identification and follow-up of infants born infected with hepatitis C. Connecticut IPA Medical Professional Services selects athenahealth’s Population Health Management platform. Provider engagement and administrative issues present the biggest challenges to practices adopting and implementing EHRs. The biggest complaint patients have about their physician: waiting in their office. CMS seeks EP participation in the 2013 PQRS-Medicare EHR Incentive Pilot. Twelve HIT vendors discuss emerging technologies expected to have the biggest impact on physician practices over the next 12-18 months in the second of a three-part series. Dr. Gregg ponders if HIT has jumped the shark. Thanks for reading.

I like it when companies issues press releases announcing their HIStalk sponsorship, so thanks to Coastal Healthcare Consulting for doing just that.

On the Jobs Board: Principle Clinical Healthcare Consultant, Marketing Manager, Sales Engineer – Boston or Raleigh.

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.

Acquisitions, Funding, Business, and Stock

VMware will buy mobile technology management vendor AirWatch for $1.54 billion. VMware gains secure mobile device credibility to its story for enterprises, including hospitals, that are shifting from fat client desktops to virtualized and mobile devices.

Quality Systems reports Q3 results: revenues down five percent; adjusted EPS of $0.11 vs. $0.29, missing estimates on both due to previously announced problems with its hospital software division. Shares rose 8.4 percent Thursday after the announcement before the market opened.

Microsoft announces Q2 results: revenue up 14 percent, EPS $0.78 vs. $0.76, beating estimates of both.

Proteus Digital Health, a developer of patient-care and self-health management technologies, closes $31.6 million in debt financing expansion. The company had previously raised around $160 million in funding. Proteus sells miniature medication tracking sensors (smart pills) that are activated by gastric contents, sending the information to skin patches that then forward the information via mobile device to a central service and allowing clinicians and family members to track oral medication intake.

Telehealth services and software provider MDLive raises $23.6 million.  It offers around-the-clock consumer access to doctors. An individual plan costs $15 per month and includes one-day physician response to emails; phone or video visits cost $20. The company’s previously announced partnerships include Cigna and Sentara Healthcare (VA). One of its financial backers is former Apple CEO John Sculley, best known for firing Steve Jobs from Apple.

Sales

Parkview Health (IN/OH) will implement business analytics and denials management solutions from Streamline Health.

The District of Columbia Primary Care Association joins The Guideline Advantage quality improvement program, which uses population health management tools from Forward Health Group.

OSF Healthcare (IL) chooses Strata Decision Technology’s StrataJazz for budget and management reporting.

People

EDCO Health Information Solutions promotes Lynne Jones to president.

The Pennsylvania eHealth Partnership Authority HIE names the state’s HIT coordinator Alexandra Goss executive director.

HIMSS names Emanuel Furst (Improvement Technologies) the recipient of the 2013 ACCE-HIMSS Excellence in Clinical Engineering and Information Technology Synergies Award.

Announcements and Implementations

Philips Healthcare launches a Healthcare Informatics Solutions and Services business group to be led by Jeroen Tas, who previously served as CIO for Philips. It will offer hospitals clinical programs, analytics, and cloud-based platforms. The company also reorganized its North America Healthcare sales organization.

Mississippi Gov. Phil Bryant announces the launch of the Mississippi Diabetes Telehealth Initiative to improve disease management and health outcomes for diabetic patients. The program, which is a joint effort between the University of Mississippi Medical Center, GE Health, North Sunflower Medical Center, and C Spire, will use telehealth technology to connect UMC providers with diabetic patients in the Mississippi Delta.

Santa Clara Valley Medical Center (CA) goes live with RTLS asset management from Intelligent InSites.

Government and Politics

In his annual budget address, New York Gov. Andre Cuomo proposes a $95 million plan to digitize patient records using $65 million in state funds and $30 million from the federal government’s Medicaid program.

New National Coordinator Karen DeSalvo kicked off ONC’s annual meeting Thursday morning, mostly providing some background about herself and talking yet again about Hurricane Katrina like it was yesterday instead of eight years ago. HIMSS marketed the heck out of that disaster as a call to arm for electronic medical records (as sold by the vendors who provide most of its income, and when that didn’t help sales much, along came HITECH) and now KD has ridden it into the National Coordinator chair as her primary credential even though I haven’t seen any proven Louisiana outcomes that resulted. Her EHR experience isn’t clear, but she has a great public health background. I liked that she characterizes HITECH money as the involuntary taxpayer gift that it was, referring to it as “major investments by the American people.” She seems nice enough and her speech was friendly if not particularly powerful, although her uptalking made her sound less authoritative and is sure to drive mellifluous members of Congress who are used to polished oratory crazy. Nitpicking aside, I like her so far.

In England, Secretary of State for Health Jeremy Hunt urges hospitals to treat patients like people and for clinicians to work together as teams, suggesting that British doctors to behave like US hospitalists in taking responsibility for the patient’s entire stay from plan to handoff, including putting their names up on the wall of the patient’s room as being responsible. He also urges adoption of information-sharing technology, studying whether medical specialties are too specialized, and reducing patient transfers. I don’t know much about him or his politics, but I like him.

Technology

A Microsoft research project uses Kinect to help stroke victims recover.

An irrationally exuberant and painfully breezy INC Magazine article declares mHealth to be “the trillion dollar cure” and “the miracle cure for the rising cost of health care in America” in which “smart startups are already cashing in” and that mHealth is “up for grabs, providing an extraordinary opportunity for medically minded entrepreneurs.” It quotes HIStalk Connect’s Travis Good (“a physician and influential blogger on health care technology”) and Palomar Health Chief Innovation Officer Orlando Portale, both of whom contributed just about the only thoughtful content amidst the hype. Like mHealth itself, the article is all over the place with a hodgepodge of apps ranging from weight loss to vital signs monitoring. It isn’t convincing in the slightest that most of them are either effective or destined for financial success, much less the cure for healthcare’s quality and cost problems, but business magazines like to make everything sound like a sure thing.  

Speaking of mHealth, you know it has jumped the shark when former basketball player Shaquille O’Neal gets involved. Shaq says he’s working with Qualcomm on wireless and health technologies (I hope that won’t interfere with the making of Kazaam 2 or the next “Shaq Fu” album). Cynicism  aside, Shaq actually has meaningful comments, not surprising since he’s a smart guy (he earned an Ed.D doctoral degree in 2012):

I have been using a FitBit, a connected activity monitor, to manage my fitness levels and am finding motivation in the real-time data I can collect on my movement—or lack thereof! Not only can mobile health technologies be engaging, social and easy-to incorporate into your everyday lifestyle, but using them for health monitoring will actually save between $1.96 billion and $5.83 billion in health-care costs worldwide by 2014. The latest technologies can’t solve all of our problems, though. Throughout my career I have found that when individuals come together for a common goal, whether it’s to win an NBA championship or reduce the number of people with chronic disease globally, greater results are achieved. We are on the verge of a new wave of breakthroughs in medical and wireless technologies, legislation and more, but unless we all come together to collaborate across public and private sectors and across educational systems and research institutions we will not see significant change and improvement.That’s why I am joining forces with the World Economic Forum, who are encouraging a global shift towards healthy living and supporting healthy, active lifestyles at individual, community and societal levels.

A Wall Street Journal report says IBM’s Curam eligibility software is responsible for problems with health insurance exchanges in Maryland and Minnesota.

Other

Cerner and Epic are making inroads in the medical oncology market, but product immaturity is leaving providers with a lack of functionality, according to a KLAS report. Radiation oncology is still a best-of-breed market with Elekta and Varian as the main competitors.

A HIMSS heads up: I didn’t realize that the Peabody Hotel in Orlando, across from the street from the convention center and the favored gathering place for well-heeled HIMSS attendees (meaning I’ve never stayed there, although we did hold the first HIStalkapalooza there in 2008), was sold in October for $717 million. It’s now the Hyatt Regency Orlando and is being marketed to mouse ears-wearing tourists. The famous ducks are gone, and given the prohibitive expense of shipping them back to the only surviving Peabody in Memphis, they may well have ended up as a l’orange.

A study finds that the use of EHRs improves the follow-up in identifying and treating babies born to mothers with hepatitis C. Identification of at-risk patients increased from 53 percent to 71 percent, while appropriate follow-up jumped from 8 percent to 50 percent.

Healthcare Growth Partners releases its 2013 Year-End Review report, which is as insightful, rich in detail, and downright eloquent about healthcare in general as it is healthcare IT investments. I would say it’s a must-read for anyone interested in the business side of healthcare delivery. An excerpt:

HGP remains very bullish on the health IT sector. Creating an environment of connected networks and transparency is core to addressing the structural flaws of the U.S. healthcare system, and IT is critical to enable the reform initiatives underway and any reform initiatives that may follow. The need is high, the runway is long, and the consequences are significant – as long as we get out of the way of ourselves, health IT stands to completely redefine not only the delivery of healthcare but also the management and sustainability of health.

The dearth of HIT fashion-related news is finally over, thanks to B-Shoe, a start-up company that is testing a walking shoe that helps prevent falls. Designed for seniors or the physically challenged, the shoe incorporates pressure sensors and an algorithm that detects imbalance, plus a motion device that rolls the shoe slightly until the wearer regains his balance. Perhaps there will be a stiletto version by the time I’m in need.

Weird News Andy makes a Roman numeral pun in calling this story “The 4th Doctor.” A company called IV Doctor makes house calls in New York to deliver a $200 hangover-curing IV solution, even providing a sales video. Those who attended the HIMSS conference in Las Vegas will recall my mentioning a similar service in that city.

WNA also turned up this story. A Nashville opera singer says a nurse-midwife’s episiotomy incision ended her mezzo-soprano career when it caused her to experience incontinence and excessive flatulence. She’s suing the federal government for $2.5 million since the treatment was provided by the Army, in which her husband was serving at the time.

Sponsor Updates

• Solstices Medical will use Infor Cloverleaf to integrate its DOCK-to-DOC platform with clinical, financial, and supply chain systems, including Infor Lawson Enterprise Financial Management and Chain Management for Healthcare.
• Vonlay adds 4,000 square feet in office space to its existing Madison, WI headquarters.
• CCHIT awards Iatric Systems Meaningful Use Manager ONC HIT 2014 certification for all 29 clinical quality measures.
• Kareo integrates its PM application with the Nexus EHR.
• Connance CEO and Co-Founder Steve Levin and Gwinnet Hospital System (GA) VP Cathy Dougherty author an HFM Magazine article, “A New Imperative for Patient Relationship Management.”

EPtalk by Dr. Jayne

A recent post on the Harvard Business Review blog discusses research indicating that smartphone use after 9 p.m. can make workers less productive the following day. Their work concludes that phone use causes sleep disturbances that impact work performance. Their two studies will be published later this year and I’m looking forward to seeing the details.

In the first study, they used a survey approach where each participant’s survey response data was analyzed individually over a two-week period. It had a relatively low number of participants (fewer than 100) but showed that increased phone use impacted sleep, creating work issues the next day. The second study had twice the number of participants with more diverse occupations. In addition to daily surveys, they measured use of phones, laptops, tablets, and televisions. The data indicated that smartphones had a greater impact than other devices.

As a physician, I enjoy being able to remotely access my patients’ charts, handle refill requests, process lab results, and take phone messages without being tethered to the office or to a PC. For me, however, using my phone to handle these tasks is a choice. Since my physician income is based on an “eat what you kill” model, I understand the value of my time and can make an informed decision to work outside the office or not.

Our ambulatory EHR has a great mobile product. Logging in and accessing a patient chart takes just a couple of seconds. This has made cross-covering after-hours call for colleagues much easier. I provide better care because I know more about the patients. I don’t have study data, but it would seem to be safer (not to mention more convenient) for the patient if I can address the issue based on the information in the chart rather than sending patients to urgent care. It also makes documenting those phone calls a snap.

Putting on my CMIO hat, however, I worry about the prevalence of working outside the office. Despite various office policies and customs encouraging staff to stay off email after hours, we’re having increasing challenges with staffers who continue to work long after the work day is over. Many of our employees are able to use flex time to accommodate family issues and expect to see some after-hours access in that circumstance. We’ve had some significant weather events with multiple school cancellations this winter, so quite a few parents have been working at home.

Barring flex time arrangements, however, I don’t expect to see people online at 8 or 9 at night unless it’s a scheduled maintenance event, and in that case, it would be happening after 11 p.m. Why is this behavior growing, then? Our health system has been through a couple of rounds of downsizing in the last couple of years and I wonder what impact that has had on people working after hours. Are employees trying to work longer and harder to distinguish themselves from their teammates in the event of another reduction in force? Are they young motivated analysts trying to get ahead? Are they just workaholics? I’d be interested to hear if readers in the trenches are seeing the same trends and what they’re doing to address them.

I beat Weird News Andy to the punch on this one. A Wisconsin medical examiner agrees to a plea deal after being accused of stealing body parts. According to the Wausau Daily Herald, she is accused of taking a piece of cadaver spine and human tissue “to train her dog.” Next time I’d suggest a Milk Bone or possibly a package of Snausages.

Earlier this week in Curbside Consult, I mentioned that I’m going to need roller skates to maneuver through everything we need to accomplish in 2014. Thanks to @SmyrnaGirl who found me the perfect pair. I bet Inga will be jealous.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 1/23/14

Results of Health IT Research Review Positive Overall, but Some Topics Need More Focus

An ONC EHR literature review finds that the number of EHR-related studies is increasing about 25 percent each year, most of them focused on clinical decision support and CPOE. Other important EHR functions, such as e-prescribing and interoperability, were the subject of fewer studies.

VMware to buy mobile security firm AirWatch for $1.54 billion

VMware announces plans to acquire mobile security company AirWatch for $1.54 billion, allowing VMware to offer PC-level security solutions for smartphones and tablets used by employees.

Government health data sharing may break EU law

In England, a plan to collect health information on all citizens, store it in a centralized database, and share it with care providers across the nation may hit a roadblock as the European Union drafts a data protection law that requires citizens to opt in for data sharing.

CIO Unplugged 1/22/14

Morning Headlines 1/22/14

GE to Acquire API Healthcare

GE announces that it will acquire workforce management software vendor API Healthcare for an undisclosed sum. API Healthcare’s administrative solutions are used by more than 1,600 hospitals and staffing agencies in the U.S. The company’s time and attendance solution has been rated by Best in KLAS for the last 10 years.

Three EMRs lead the pack in the midsize-practice space

Epic continues to lead performance scores in the midsize physician practice market, with athenahealth and Greenway rounding out the top three.

Use and Characteristics of Electronic Health Record Systems Among Office-based Physician Practices: United States, 2001–2013

In 2013, 78 percent of office-based physicians used some form of EHR, but only 13 percent reported using systems that comply with Stage 2 Meaningful Use. In total, only 69 percent of respondents report that they intend to participate in MU.

‘Defect’ on VA benefits site shares vets’ personal details online

The VA’s online eBenefits program is suspected of exposing thousands of veterans personal information after an upgrade-related defect causes other veteran’s data to be erroneously presented to users when they logged into the system. Exposed data reportedly including past and current medical conditions, bank routing numbers, and social security numbers. The VA has shut the eBenefits system down pending an investigation, and will provide credit monitoring for affected users.

News 1/22/14

Top News

GE will acquire API Healthcare, a provider of healthcare workforce management software and analytics solutions.

Reader Comments

From Brian: “Re: Advisory Panel ‘2014 will be the year of …’ patient relationship management. Spanning not only the clinical realm, but the financial realm as well. Every touch, clinical and financial, influences the patient’s attitude towards the health system, impacting satisfaction and their willingness to return for elective services or recommend to friends and family.”

From Keith: “Re: HHS. This issue needs Meaningful Use guidelines.” OIG finds that HHS paid $172 million in claims for 474,000 vacuum erection systems (penis pumps) from 2006 through 2011, spending twice as much per unit as the VA paid or what online retailers charge.

From Across the Pond: “Re: interesting article from Isala Hospital, Netherlands. It’s in Dutch, but explains the positive outcomes (reduced hospital mortality and others) realized from introducing an extra pre-procedure safety check beyond the usual time-outs before open heart surgery. Results are remarkable: 95 percent vs. 55 percent of professionals now feel the treatment is a team effort and the post-surgical hospital mortality rate was reduced from 15 percent to 1.7 percent. Doctors plan to share the results with US colleagues.”

From MDCIO: “Re: Windows XP computers after its retirement on April 8. Can you be HIPAA compliant and qualify for Meaningful Use if your system is not receiving security updates?” At minimum, you could interpret that running an obsolete OS for which no security updates are available means you aren’t protecting PHI to the best of your ability. I’m interested to hear from readers, especially CIOs whose hospitals are still running some XP PCs. Hard and fast rules aside, I wouldn’t want to be deposed to provide post-breach “why were you still using XP” justification to OIG or a plaintiff’s attorney. According to HHS:

The Security Rule was written to allow flexibility for covered entities to implement security measures that best fit their organizational needs. The Security Rule does not specify minimum requirements for personal computer operating systems, but it does mandate requirements for information systems that contain electronic protected health information (e-PHI). Therefore, as part of the information system, the security capabilities of the operating system may be used to comply with technical safeguards standards and implementation specifications such as audit controls, unique user identification, integrity, person or entity authentication, or transmission security. Additionally, any known security vulnerabilities of an operating system should be considered in the covered entity’s risk analysis (e.g., does an operating system include known vulnerabilities for which a security patch is unavailable, e.g., because the operating system is no longer supported by its manufacturer).

From NurseJane: “Re: Prognosis HIS. Did you know it was acquired? We are concerned as we are going through a MU audit and we are on their system. They laid off over half the company last year and replaced the CEO. I would appreciate you finding out more and reporting on it.” CEO Jim Holtzman provided a quick response to our inquiry:

In 2013, Prognosis completed a transaction in which it was acquired by two of its original founders who have since rejoined the company, with the common goal of enhancing its ability to provide the best software and services to our customers in their dedication to provide excellent healthcare services to their patient base.

As a bit of history, In 2012 I joined Prognosis as CFO. At that time, I rapidly joined with our team in a process of improving Prognosis’s financial position, while also taking on a venture/PE fundraising effort that had started shortly before I joined the company. Through 2012 and into May of 2013, our management team worked to enhance our financial position, part of which included a restructuring and initial reduction in force. On May 15, 2013, I took the role of CEO and continued our mission of managing through our challenges. At that time, we implemented one more, final reduction and began the process of completely revising how we approach our business processes to better and more efficiently serve our customers. Over the remainder of the year, we radically improved our support processes, closed new business and continued to guide our company through some difficult waters.

Then, three weeks ago on December 30, 2013, Prognosis closed an investment transaction with AO Capital Partners, LLC, a private equity firm and financial investor. As part of their investment, AO Capital Partners acquired Prognosis through an asset acquisition and made an initial cash investment in the company in the form of working capital.

It is important to note that AO Capital is led by two of Prognosis original founders, Dirk Cameron and Isaac Shi.  Previously, Mr. Shi was the Chief Architect of our software when it was originally designed and built back in 2006. We are extremely excited to have both Mr. Cameron and Mr. Shi back in the Prognosis fold and as members of our leadership team. We are already actively exploring new pathways of product development that include innovative new features and functionality, as well as innovative methods of delivery. We also continue to focus on enhanced customer support and professional service models to better support our customers. We look forward to sharing the fruits of this new partnership with our customers and prospects in the very near future. The simple fact of this transaction is that our customers will feel essentially no difference aside from our efforts, with new development and support resources to further enhance our processes that we have worked on so hard this last year.

We continue to work toward completion of our MU2, 2014 software certification which will be completed in multiple waves. The first of those waves was completed in December and we crushed the certification process, completing our certification, in one day of testing, of more modules than we had originally scheduled. I am confident that we will perform as flawlessly in the remaining waves as we did in wave one. We are now modularly 2014 certified following wave one and continue along the pathway of full EHR certification by end of the first quarter of 2014.  Our customers are going to feel nothing more than continued improvements. 

The only minor change that we will be making beyond the comments above is a tweak to our name, which will now be Prognosis Innovation Healthcare, reflecting our commitment to innovative software that serves the healthcare community.

As always, I welcome calls and questions and will be happy to answer any questions about our company and our products and services.

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HIStalk Announcements and Requests

I was looking over the HIMSS conference schedule today and was intrigued by the new Startup Showcase, which features 40 startup and early stage HIT companies. It looks like the showcase will be in the exhibit hall and participating vendors will have a chance to demo their offerings. Could be fun.

Another fun option might be the HIMSS14 Wellness Challenge. Participants wearing a Misfit Shine activity tracker can compete in different daily challenges such as steps taken, calories burned, and distance walked. I always feel like I walk 10 miles a day, so maybe I should sign up.

Reminder: sign up by January 29 if you want to be considered for a HIStalkapalooza invitation. Not everyone who signs up will be invited, but on the other hand, everyone who is invited will have signed up (this sounds like one of those logic problems from the SAT, but it’s really not hard.) We will email invitations to the folks we can accept on February 4 or thereabouts. We have hundreds more requests than we have spots, so not everybody will get an invitation, unfortunately.

Welcome to new HIStalk Platinum Sponsor MEDHOST. The company offers solutions for ED (MEDHOST EDIS); patient flow (MEDHOST PatientFLow HD); perioperative (MEDHOST Advanced Perioperative Information Management System); patient portal (MEDHOST YourCareCommunity); public health reporting (MEDHOST YourCareLink); clinicals, patient access, revenue cycle, and financials (Enterprise Solutions); BI (MEDHOST Business Intelligence); hosting and managed services (MEDHOST Direct); and services for outsourcing, consulting, and optimization. The 30-year-old Franklin, TN-based company, formerly known as HealthTech and serving more than 1,000 hospital customers of all sizes, unified its corporate identify and product line under the MEDHOST name last month. It pledges to deliver unparalleled value and easy-to-use technology for managing care and the business of healthcare. Customer case studies are here. Thanks to MEDHOST for supporting HIStalk.

I found a YouTube video describing MEDHOST Direct hosting at Valley Regional Hospital (NH).

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.

Acquisitions, Funding, Business, and Stock

Kareo secures $29.5 million in growth capital.

UnitedHealth Group’s Optum health services business grew revenue 35 percent in the fourth quarter.

Etransmedia Technology acquires Medigistics, a Columbus-OH based provider of RCM and AR management services for the healthcare industry.

Sales

RegionalCare Hospital Partners (TN) will deploy AirStrip ONE OB and AirStrip ONE Cardiology across its eight-hospital system.

Medical Professional Services selects athenahealth’s population health Management platform for its 450-provider IPA.

Healthstat will implement eClinicalWorks EHR across more than 350 sites.

Nexus Health Systems (TX) selects Summit Healthcare Express Connect interface technology.

Scotland County Hospital (MO) chooses Access electronic patient signature and e-forms solutions to complement its Meditech 6.x EHR implementation.

Summit Healthcare selects Secure Exchange Solutions as its Health Information Service Provider for secure healthcare information exchange.

People

VisionWare names Paul Roscoe (The Advisory Board) CEO and board member.

Medhost names Lionel Tehini (Acuitec) president of the company’s professional services division.

Telemedicine software vendor REACH Health names Steve McGraw (SAI Global) as president and CEO, replacing the retiring Richard Otto.

AtHoc appoints Karen Garavatti (Ericsson) head of human resources.

Salar appoints new members to its clinical documentation advisory board, including Neri Cohen, MD (Greater Baltimore Medical Center), Brian Houston, MD (Johns Hopkins Medicine), Don Levick, MD (Lehigh Valley Health Network), Eric Radler, MD (Lifespan), and Jenson Wong, MD (San Francisco General Hospital.)

Announcements and Implementations

Michigan Health Connect and Great Lakes HIE will merge their operations later this year to create one of the country’s largest HIEs.

AirWatch opens a Miami office.

University Hospital Southampton NHS Foundation Trust in the UK expands the rollout of its personal health record, which is based on Get Real Health’s InstantPHR patient engagement platform.

France-based IT services vendor Atos launches an enterprise content management system for healthcare based on EMC Documentum.

Aventura will integrate its instant-on awareness computing technology for clinicians with virtualization offerings from Varrow.

Government and Politics

About 69 percent of physicians intend to participate in the MU program, according to CDC survey conducted in mid-2013. At that time, 13 percent of them were using an EHR capable of supporting 14 of the 17 Stage 2 Core Set objectives. Half of office-based physicians were using at least a basic EHR, up from 11 percent in 2006.

An IT security expert says that Healthcare.gov is not secure, claiming that he can extract thousands of database records directly from the site without even hacking it. He listed 20 security issues weeks ago and says  they haven’t been fixed. HHS says it doesn’t believe him and the site is fine.

The VA says that the medical and financial information of more than 5,000 users of the VA/DoD eBenefits military benefits site may have been exposed to other users last week due to a programming error.

Other

“123456” tops Splashtop’s list of the of most commonly stolen passwords for 2013, beating out longtime favorite, “password.”

A new KLAS report says Epic, athenahealth, and Greenway lead the 11-75 physician practice segment. Allscripts, McKesson, and Vitera have the highest percentage of unhappy customers who will stick to the EMR they bought even though they wouldn’t buy it again.

A study finds that the leading online source of medical information for both providers and patients is Wikipedia.

Tim Moseley and Ron Hedges of the IT department of Memorial Hospital of Gulfport (MS) are presented a certificate of appreciation and Seven Seals Award for setting up a Skype session that allowed Air National Guard Staff Sergeant Drew Bynum, deployed overseas, to see his newborn daughter. Major Jeff Wyatt of the 255th Air Control Squadron told the men, both of whom are veterans themselves, “It’s hard enough being over there and doing your job in trying circumstances, but you’re never totally over there. There’s always a part of you that is back here with your family and friends. It takes people like you, supporting us, to enable us to do our job overseas.”

Weird News Andy provides a quote for this story: “There is not one blade of grass, there is no color in this world that is not intended to make us rejoice.” A 70-year-old man who was born color blind can suddenly see colors after experiencing a fall. Doctors can’t explain it since color blindness is a retinal cone defect, but postulate that it’s the man’s perception of colors that has changed.

Sponsor Updates

• More than 150 Surgical Information Systems employees participated in the company’s first community service day in metro Atlanta.
• NextGen Healthcare reports that its Ambulatory EHR version 5.8 meets the latest ICD-10 standards, adding that it will offer customers ICD-10 educational and testing tools.
• Harry Greenspun, MD, senior advisor for healthcare transformation and technology for the Deloitte Center for Health Solutions, discusses the four dimensions for effective mobile health in a blog posting.
• Quest Diagnostics certifies CompuGroup Medical’s LabDAQ LIS as a Gold Quality Solution under Quest’s Health IT Quality Solutions program.
• Wolters Kluwer Health collaborates with the Academy of Medical-Surgical Nurses to review the core procedures in the Lippincott Procedures software application.
• RelayHealth’s RelayClearance, RelayAssurance, RelayAnalytics, and RelayPayer Connectivity Services achieve a Level 2 appraisal rating under CMMI Institutes’ Capability Maturity Model Integration.
• Beacon Partners hosted an analytics roundtable on establishing an analytics-driven healthcare culture.
• EDCO Health Information Solutions sponsored a presentation by HIMSS VP John H. Daniels on the HIMSS Analytics EMR Adoption model at a New Jersey Hospital Association meeting last week.
• Surgical Information Systems and QlikTech renew their agreement to expand the use of QlikView with SIS Analytics.
• Adventist Health (CA) shares how it reduced its revenue cycle by two days after implementing The SSI Group’s RCM solution.
• A Nuance Communications study finds that 71 percent of physicians would be more responsive to clinical documentation improvement clarifications if they were delivered in real time within their EHR workflow.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

GE To Acquire API Healthcare

GE announced this afternoon that it will acquire workforce management and analytics software vendor API Healthcare. Terms were not disclosed.

GE will incorporate API Healthcare’s offerings into its Hospital Operations Management product line that includes asset management and patient flow optimization solutions.

GE Healthcare Services President and CEO Michael Swinford was quoted in the announcement as saying, “Labor costs represent over 50 percent of hospital operating budgets. With this acquisition, GE Healthcare will be able to address a significant portion of hospital operations costs – assets, patients and labor – with a mix of software, real-time data, powerful analytics and professional services.”

The Hartford,WI-based API Healthcare offers solutions for staffing and scheduling, patient classification, human resources, talent management, payroll, time and attendance, business analytics, and staffing agency. The company’s solutions lead the KLAS rankings in the time and attendance and staffing and scheduling solutions categories. 

Private equity firm Francisco Partners acquired API Software in November 2008, naming former Cerner executive J.P. Fingado as president and CEO. The company’s name was changed to API Healthcare in February 2009. Workforce management systems competitor Kronos announced plans to acquire the company in February 2011, but that agreement was scrapped in April 2011 after the Department of Justice expressed antitrust concerns. The company acquired hospital staffing and scheduling systems vendor Concerro in February 2012.

HIStalk Interviews Lyman Garniss, Pathology Project Director, Partners HealthCare

Lyman Garniss is project director for Partners Enterprise Pathology at Partners HealthCare of Boston, MA. He was interviewed by Lorre Wisham of HIStalk

Tell me about yourself and the organization.

I’ve been here at MGH and Partners for 25 years this month, primarily working with the clinical laboratories and anatomic pathology folks at the MGH. However, in the past year, I’ve been working with Partners HealthCare, the larger system, to roll out Sunquest lab and some of the blood bank systems and other products across all of Partners and also integrating that with Epic. 

Epic is going in across all of Partners, and everyone’s getting a standardized HIS. We’re also at the same time moving everyone to a standardized LIS.

What are your thoughts about the future of genetics and genomics in terms of data and whether it comes from the HIS or the LIS?

The LIS really needs to own that space. It’s where the data is generated today. At least 70 percent of the data in a patient’s medical record in the HIS is coming from pathology, from the labs, from anatomic pathology, and blood bank. There’s some 10 billion lab tests that are performed in the US each year. We produce a ton of that data. 

It’s going to get much larger with the genetic information, proteomics, and all the variant information that goes along with those data points. There’s no easy way to manage that today. The lab owns the specimens and some of the reporting of that, but they really need to own the data itself, the mining of that data, and the curation of the information related to the genetic variance and the proteomic data.

You’re saying lab needs to own it, which suggests they don’t now. What has to happen?

It’s a collaboration of the LIS vendors, companies like InterSystems or IBM that manage large data sets well, as well folks from the academic and medical area. A three-way collaboration that has to happen.

The lab information vendor knows the lab space really well and the lab processing and the specimen processing, but their niche really isn’t large data sets and mining large data sets. That’s where they’ll need some help from some of the large database companies, as well as some input and advice and boots on the ground from some of the folks that are actually performing these tests.

You mentioned Epic. What do commercial electronic medical record systems have to do long term to keep up with medicine on the lab side?

The breadth and scope of HIS vendors are so large that it’s very difficult, if not impossible, for them to be experts or to be best of-breed in every single area or every single domain that they touch. They may have some expertise in specific areas, but they would have to invest a lot of money in the lab space and really be focused on that. It’s difficult for large vendors like Cerner and Siemens and Epic to be experts at the lab and also manage that large breadth and scope. Their domain is huge.

Why are you not choosing to implement Epic’s Beaker LIS instead of Sunquest?

There’s a number of reasons for that. The first one is the Beaker product just doesn’t seem mature enough for our needs. That’s one data point. The second data point is we have a rich history of collaboration with Sunquest. We’re working on integration between the laboratory system and the anatomic pathology system. 

The walls between AP and CP are breaking down. The type of work that is happening in the lab information system is starting to look, in some instances, more like anatomic pathology — large, rich textual reports that the CP system doesn’t do well but AP does well. The reverse is true. We’re doing more instrumentation and instrument testing on the anatomic pathology side. The AP systems really don’t manage instrumentation and stuff well, where the lab system does.

Sunquest is moving forward with us on breaking those walls down so that the integration between AP and LIS, the APLS, and the LIS is much more robust and streamlined, much more integrated.

What do you think a hospital CIO should know about lab or pathology informatics?

I was invited to speak to several different groups of my peers here at Partners.The message that I was trying to get across to folks in IS and to other areas is that, again, we’re providing 70 to 75 percent of the data that’s in that HIS. The lab information system is large, it’s complex, and we’re producing a lot of data, a lot of rich data. We’re going to continue to produce even more of it in the future.

How are you using your EMR for clinical decision support to guide physicians in ordering labs?

Poorly. [laughs] We have a current provider order entry system. It’s a homegrown system. We are able, with that homegrown system, to customize it to some degree to help steer clinician ordering away from expensive send-out tests.

I’ll give you an example. We show dollar signs next to the test. We don’t actually say how much it costs, but we provide alternative tests that would be cheaper to keep the costs down, especially as we move towards that ACO market. We’re starting to look on the lab side how to steer clinicians towards tests that may be just as effective, but may be less expensive. Epic doesn’t really do that today.

Clinical analytics for population health management is a hot topic. What is Partners doing to standardized data and enable better reporting?

The first step is moving to Epic. I believe that the folks at Partners are working with Epic to work more on some of those outcome models and patient care models moving forward.

How do you see personalized medicine based on patient genomics moving into everyday practice?

It has to start with the discrete data that’s in the laboratory. We can’t possibly send all the genetic information to the HIS. It would be overwhelming for the clinicians. It would be overwhelming for the HIS system itself. 

The role of the LIS vendor is going to be looking at all these rich data sets and mining, looking for patterns for outcomes to figure out both on the CP side for predicting potential disease states based on genetic variance, but also on the anatomic pathology side, looking at outcomes and survivability for specific types of cancer to figure out.

It’s probably best if I use an example. Something like pancreatic cancer, where the survival rates of that are horrific. Once you’re diagnosed with pancreatic cancer, usually you have weeks or months to live. But there’s probably people that survive longer than others, and we have their specimens. We have a rich biorepository of anatomic pathology specimens, where we can look at what’s the genetic variance in a particular type of that outcome versus somebody that didn’t survive as long. Then we can start targeting therapies based on that. 

The example that everyone’s using today is the HER2. There were one or two treatments for breast cancer in women. Depending upon the treatment, sometimes it killed the patient quicker, but sometimes it cured them. But there was no rhyme or reason until folks figured out that we could base the therapy on specific genetic markers in the tumors.

HER2 is a perfect example and more and more of those examples are going to come forward. But the only way to find those models or find those differences is to be able to mine the data. The laboratory owns that data. It doesn’t reside in the HIS. Mining of that data has to happen in the LIS space.

How can the average hospital involve the lab people in their EMR decisions and setup?

I have attended the Sunquest User Group for many years. There’s now Epic roundtables at SUG, the Sunquest User Group. Those have been very enlightening. 

What we’ve seen at those meetings are basically two camps of folks. There’s folks that Epic was installed at their site and the laboratory was not involved. In speaking with those lab folks now, Epic has become a nightmare for them because they were not involved with a lot of the decision-making process. They don’t have access to a lot of the way that the system was designed or built. Supporting the lab information system and integration with Epic has been extremely problematic for those sites where lab was not involved up front and early with the HIS vendor with that integration and testing process.

Then there’s the other camp, where the LIS folks — both IT and the actual people that are doing the science in the laboratories — were involved early on with the HIS implementation. Those folks are happy with Epic. They’re happy with their HIS and things are going extremely well. We learned from that at Partners early on. My team and others on the lab side are working really closely with the Epic folks in installing the systems here and doing the integration work. It’s been absolutely fabulous. A lot of decisions are being made that make sense for both sides of the equation. Again, we’re providing 70 to 75 percent of the data that’s in the HIS. The lab has to be involved early on with the design, setup, and decision-making process that goes on with the HIS build.

How is Partners exchanging information with other facilities outside of your group?

We’re part of the Mass HIway. That interchange is still being rolled out. I wouldn’t say it’s in its infancy, but it’s in its adolescence. 

We send quite a bit of information to the Mass HIway. We do all of our state and city reporting to the Mass HIway. Data that has to go to the state for state-required reporting, like some of the blood management things and the microbe reporting.

Partners HealthCare provided the seed money for an exchange years ago called NEHI. It was for medical centers in the New England area to exchange information with the insurance companies. We’ve been doing that for years. Instead of just having the Partners facilities manage that, we invited other institutions as well because we thought it would be in everyone’s best interest to share the cost of that insurance exchange with them.

What are your biggest challenges and opportunities at Partners over the next year?

There’s a few things that we’re working on. Expanding the LIS into areas that they typically haven’t worked in. One is research and managing the research specimen flow; the second is biorepositories. There’s a lot of rich specimens flowing through our systems, but we’re not able to track cohorts or manage consented patients in the LIS, so we don’t know when their specimens are flowing through the system to be able to move those specimens elsewhere or inform a researcher that specific, unique specimens are available. We’re throwing tons of these specimens away and they’re actually quite valuable in some instances. The biorepository area is something that we’re working with the LIS vendors on and we’ll expand in the future.

And then of course the genetics, genomics, and proteomics, and the rich data set … curating the data that goes along with those. The variant information. It’s a huge challenge for all of the institutions that are doing genetic testing to be able to track and update the most recent information about specific genes or gene variants. It’s a huge challenge for folks. There’s no straightforward tool sets that manage that rich data set today. It’s one of those things that the lab, the LIS needs to own and need to expand their role in.

Morning Headlines 1/21/13

EDs with HIE more likely to avoid repeat imaging

One of the first large-scale studies on the links between HIE participation and imaging in hospital emergency departments finds that redundant CT scans, x-rays, and ultrasounds decreased significantly, with savings in the millions of dollars, at hospitals connected to an HIE.

How Data Analytics Helped Spark a $36.5M Turnaround at Boston Medical Center

Boston Medical Center President and CEO Kathleen Walsh attributes a data analytics project to the hospital’s financial turnaround in which it went from a $32 million loss to a $4 million surplus in two years.

Survey says: EHR incentive program is on track

National Coordinator Karen DeSalvo, MD outlines the progress made thus far under the EHR incentive program.

St. John embraces digital records

A local paper covers St. Johns Medical Center’s (WA) Epic go-live. St John’s is Part of PeaceHealth’s system-wide Epic install.

Curbside Consult with Dr. Jayne 1/20/14

Last week, Mr. H polled his HIStalk Advisory Panel regarding their top priorities and concerns for 2014. I laughed out loud at the response above. Not only is it extremely direct, but in the case of my hospital, it’s entirely true.

Like many facilities, we spend a lot of time going through various exercises to define the various projects we need to work on during the year. We also expend a great deal of effort reviewing our personnel and their capabilities while we determine the overall capacity for work.

I looked back at our timekeeping system, and during 2013, I spent nearly 100 hours in various project evaluation and prioritization efforts. That doesn’t include the time spent looking at team members and whether or not they can take on additional projects. At most of those meetings, there were between six and 12 attendees, so that means we spent close to half a person-year trying to figure out what we need to work on and in what order.

We have over 100 prioritized projects on our ‘to do’ list. Being “prioritized” means that a project fits certain business criteria. For example, it might be in support of our Accountable Care or patient outreach efforts. It might be a process improvement project which requires modification of existing systems or addition of a new system. It might even be something that enhances the user experience or the overall usability of an application. Bring prioritized, however, does not mean that a project is funded.

There are a lot of things on the list that the requestors believe we need to do, but are not willing to commit funds to actually accomplishing. They want us to find funding out of some nebulous IT pot of gold which simply doesn’t exist. Because these projects aren’t funded it means they languish on the prioritization list, which adds to everyone’s frustration. The IT department feels like it can’t ever move things off the list and our departmental customers feel like the IT department doesn’t do anything.

When a project is actually funded, we can knock them out pretty quickly. For example, one of our outreach clinics recently applied for and received grant money for a very specific clinical reporting project. The requested a suite of reports and a dashboard for monitoring. We created a proposal and they approved it. The IT chargeback item was opened and the scope document created and finalized. We had their dashboard live in beta in under 30 days and in production a week or two after that. We probably could have done it faster, but there were some delays with accounting and paperwork and we’ve learned the hard way not to start anything until all the paperwork is in place.

Looking at the actual IT discretionary budget that we have to work with, it’s going to be nearly impossible for us to do anything that isn’t MU-2 or ICD-10 related. If it’s not regulatory, it’s not going to happen unless D.B. Cooper drops a mysterious bag of cash from the sky. We have enough in the budget to handle various hardware and infrastructure upgrades so we can stay ahead of the vendor requirements game.

Like many other hospitals, we’re struggling with the fact that our vendors aren’t delivering the MU-2 and ICD-10 software as quickly as we want it. I hope what we ultimately receive is high quality because we can’t afford endless rounds of testing or delays when what we receive requires patch upon patch. We need to get the MU software in so we can free up the environments for ICD-10 testing. If there are delays, we can’t afford to stand up extra testing environments to handle what the vendors should have taken care of during beta testing.

At least our ambulatory vendor has delivered its software package, which includes both MU-2 and ICD-10. We’ve got it in testing and it looks pretty solid, but there are a couple of fixes we’re waiting for that are fairly specific to our environment. We should have them in the next week and then the real fun will begin. Our physicians are very nervous about the ICD-10 transition and we’re using a third-party vendor to augment the mapping provided by our vendor, but that’s one more thing we’ll have to test.

We’re only a couple of weeks into the year, but I already need a vacation. We plan to attest for MU-2 in the third quarter so we can coast towards ICD-10, but I doubt it will be a smooth ride. In the mean time, we’ll be on-boarding new practices and adding several dozen physicians to existing practices. I think I’m going to need roller skates. If you’re a CMIO what are your priorities for the year? Email me.

Email Dr. Jayne.