Morning Headlines 10/24/13

Parents want e-mail consults with doctors, but don’t want to pay for them

A study conducted by researchers at the University of Michigan Health System finds that 77 percent of parents would be likely to seek email advice for their children’s minor illness if that service were available, but 48 percent felt that an online consultations should be free.

Administration enlists former CEO to help fix HealthCare.gov

Jeff Zients, former CEO of the Advisory Board Company, has been tapped to lead the tech surge for Healthcare.gov.

Laptop thefts compromise 729,000 hospital patient files

San Gabriel Valley-based AHMC Healthcare (CA) is notifying 729,000 patients of a data breach following the theft of two unencrypted laptops from an administration building.

California HIE taps iBlueButton

California will implement Humetrix’s iBlueButton app as part of a San Diego-based HIE pilot program. The app will let residents review their medical records from all participating physicians.

Readers Write: ICD-10: The Race is On and the Clock is Ticking

ICD-10: The Race is On and the Clock is Ticking
By Honora Roberts

For providers, the reality of healthcare has changed greatly in the past couple of years. Practicing medicine now revolves around an electronic health record, clinical decision support, and analytics. Reality will soon change again with a new and expanded coding “formulary,” ICD-10.

It’s no secret that this coding change spreads across every facet of operations, from clinical care and administration to finance, IT, and more. The move from the ICD-9 code set that has been in place since 1979 to ICD-10 represents a five-fold increase in the number of codes to learn, know, and apply. ICD-10 consists of 69,000 diagnosis codes (up from 14,000) and 72,000 procedure codes (up from 4,000.) Administrators, physicians, allied health professionals, billing departments, coding professionals, IT departments, and more face a new reality. The time to begin embracing this new reality is now, but where do you begin?

This shift to ICD-10 is a lot like “The Amazing Race” TV show in which teams race across cities and continents to find clues to their next required destination. While providers know the destination, they face tough terrain and unexpected obstacles. Start by knowing your greatest exposures – physician education and documentation improvements; loss of reimbursement; coder education; computer system and payer readiness; and regulatory compliance. Then focus on a couple of critical areas to avoid getting lost in this amazing race toward ICD-10 compliance.

Prioritize the 141,000. Despite the spike in number of codes, reality is that providers often will use a small subset of codes. To compress the initial transformation, begin prioritizing the codes most relevant to your institutions, physicians, and specialists. Once these are prioritized, you can begin mapping ICD-9 codes to the new ICD-10 code set. In essence, you’re starting by building an initial cross-walk or critical path between the two coding standards.

Test and remediate. Make sure the technical upgrades perform and deliver as designed, then test and remediate before they are used in the real world. When testing, set up real people in real workflows. Include physicians and nurses, specialists, coders, and others who provide a broad view of the systems and workflows. This testing will allow you to pinpoint common errors so that the technology can be customized to catch errors that can harm patients.

Improve documentation. Physicians and clinicians don’t care about ICD-10. They do care about improving the quality of care and doing no harm. Emphasize documentation improvement and provide the education, tools and process improvements to achieve improved documentation that, by the way, also complies with ICD-10.

Pursue proficiency. Your people will make the difference in success. Making sure they succeed requires training. Be sure to target training programs to your personnel’s specific roles and usage of ICD-10 codes. Role-based learning will improve speed to proficiency, improved adoption rates, and overall sustainability of your organization. Once staff members gain confidence on routine tasks, they will quickly gain efficiency that is sustainable over time. Job aids and reusability of learning are tools that reinforce learning and confidence. Start with your coders, if you haven’t already. Track results — comprehensive adoption requires continuous oversight and measurement.

Optimize beyond the transition. Once you’ve met the deadline, perform a post-deadline assessment and chart review to begin a genuine clinical documentation improvement program. The baseline you established at the start of the process will help you identify problem areas and remediate.

Manage the risk. Knowing your current situation and associated risks is a great place to start. By knowing the risk, you can establish plans to lessen their impact such as:

• Adjust budgets and develop strategies for potential reimbursement reductions
• Plan for lower productivity during the transition, which might take up to a year beyond October 1, 2014
• Developing contingency plans for high-risk areas, such as high-volume departments or adoption concerns.
• Instituting a well-defined and well-communicated governance and escalation process for issues that arise

Lead the change. Acknowledge that this change isn’t a technology or systems integration project alone. It is a significant organizational change. It involves people, processes, workflows, and technologies that extend beyond walls and buildings. A change this large needs to be managed from the very top of the organization and employees need to hear frequent updates to let them know how the organization as a whole is doing.

Ultimately, most providers in the United States are scurrying to execute a plan to make the transition to ICD-10. You still have time, but the clock is ticking. Don’t get lost in the details; focus on the critical few areas that will make or break the transition for your organization. Through support from your internal team—and the expertise from quality vendors, consultants and other experts—compliance is achievable.

Honora Roberts is vice president of health provider services at Xerox.

Readers Write: ONC Mission Reflections

ONC Mission Reflections
By Helen Figge, CPHIMS, FHIMSS

The leadership at ONC will be shifting a bit as Farzad Mostashari and David Muntz return to the private sector, having given the industry another steep dose of healthcare leadership excellence. It has been appreciated for some time now that the Office of the National Coordinator for Health Information Technology (ONC) was meant to be a compass to support the adoption of various pieces of health information technology, to promote a unified health information exchange platform, and to improve health care for us all. But any compass needs great leaders to man the ship. Not only leaders with skills to lead, but character traits steeped in ethical and wisdom offering guidance. Farzad and David were those captains that moved us forward with the national healthcare IT efforts through their decency, ability to lead by example, and just a genuine sense of being a very nice person that anyone would want to follow or work side by side with.

Remembering the inception of ONC, where many of us hold this office with high regard and respect, hoping that policies created for our healthcare delivery will minimize medical errors while simultaneously aspiring healthcare stakeholders to share patient information all to improve patient care. Payer and the government had aspirations these ONC programs would save money by improving efficiency.

We can conclude however that not all healthcare providers have fully embraced these technologies, but many of the healthcare providers have indeed done so and successfully thanks to the leadership of the past ONC leaders but now recently these two respected individuals in healthcare IT today.

So as we see these two individuals depart ONC, their legacies have indeed culminated into an ongoing improvement in the delivery of healthcare and leaving their posts having helped and move forward the agenda for us all in healthcare reform.

Farzad, while intelligent was also extremely charismatic helping to catapult the acronym “EHRs” into our daily healthcare conversations. He talked about EHRs like the latest and greatest gadget we all needed to try. David will leave behind a legacy of true collaboration and mentoring others in the healthcare IT landscape where often times it was a language in and of itself. David made healthcare IT logical and worthy of conversation even to those not so tech savvy. David’s ability of being extremely diligent and insightful while creating the conversation around healthcare technology was welcomed by all the non-CIOs as well as his peers in the industry. That is a true leader.

Often times we hear the phrase “it takes a village” to accomplish something. And yes that is quite true, but a true leader of that village, listens, digests, analyzes, and then reacts to a situation. A true leader does not lead by intimidation or dictatorship, but though consensus and character traits of leaving a place better than how it was found. Farzad and David each had their own attributes, but together created a uniform approach to an otherwise confusing state of healthcare affairs. These two individuals leave legacies of offering leadership through example and while their physical presence will be missed, their polices and professional attributes that have created the current ONC landscape will move forward, with another group of leaders who we all hope have the same level of integrity and respect these two have had from the industry at large.

Remember, someone wise once said, “Tthe world is filled with 99 percent followers and 1 percent true leaders”. Farzad and David fit into the 1 percent group quite comfortably.

Helen Figge, CPHIMS, FHIMSS is is VP of clinical integration for Alere ACS.

Morning Headlines 10/23/13

Paragon Customers Optimistic Despite Functionality Gaps

A new KLAS report finds that McKesson Paragon customers are optimistic about Paragon’s ability to compete in the large hospital market, despite current functionality gaps.

Healthgrades 2014 Hospital Quality Report Reveals Risk of Death and Complications Vary Widely Among Our Nation’s Hospitals

A new Healthgrades report finds that individuals are far more likely to die or suffer complications at hospitals receiving the lowest Healthgrades rating. For example, Healthgrades evaluated 33 hospitals in Atlanta and found that stroke mortality rates were 17 times higher in hospitals receiving one star versus hospitals receiving five stars.

Nearly 10,000 Physicians and Their Practices Are Transforming HIT Systems and Physician Leadership Skills with the Support of Grants Funded by The Physicians Foundation

The Physician Foundation, a non-profit working to help practice physicians, announces that it has issued $3 million in grants aimed at helping practices through the EHR selection and implementation process.

VMware Shares Rise After Third-Quarter Profit Tops Estimates

VMWare reports its Q3 results: EPS of $0.84, beating analysts $0.82 estimate and driving share prices up to 9.8 percent at closing.

News 10/23/13

Top News

The HIT Policy Committee may miss its end of year target date to deliver MU Stage 3 recommendations and begin work on Stage 4, according to the committee’s vice chair Paul Tang, MD. Eleven ONC committees and workgroups, including the Policy Committee, canceled meetings during the shutdown; Tang says his committee is shifting its schedule of deliverables out a month.

Reader Comments

From Friend of Bob: “Re: BOB EDIS. Physicians’ voices were heard again at ACEP. A record breaking number of ED physicians attended ACEP13, over 7,000 reported. Wellsoft noted that at this year’s Scientific Assembly most attendees had a deep knowledge of BOB EDIS functionality and integration capabilities. This echoes the KLAS Specialty Report EDIS 2013: Revealing the Physicians Voice issued earlier this year.”

Acquisitions, Funding, Business, and Stock

DMH International, parent company of Touch Medical Solutions, signs a definitive letter of intent to acquire 100 percent of Virtual Physician’s Network, a provider of an online scheduling platform for surgeons.

VMware reports Q3 numbers: revenue up 14 percent, adjusted EPS $0.84 vs. $0.70, beating analyst estimates of $0.82 and in line with revenue expectations.

CTG reports Q3 numbers: revenue down five percent, EPS $0.23 vs. $0.23. The company says its healthcare business declined from last year because “a number of hospital clients are holding off on system investments” due to sequestration-related reimbursement concerns.

Lexmark reports Q3 numbers: revenue down three percent, EPS $0.95 vs. $0.94. Revenue for Lexmark’s Perceptive Software segment grew 38 percent.

Sales

Rochester General Health System (NY) will replace its existing enterprise content management system with Perceptive Software’s Content and Perceptive Capture solutions across its hospitals, ambulatory care centers, and physician offices.

St. Joseph Hospital (CA) will implement secure texting and on-call scheduling solutions from Amcom Software.

FirstHealth of the Carolinas (NC) selects MModal’s front- and back-end speech recognition, transcription, coding, and clinical analytics for its EHR systems.

Boston Children’s Hospital (MA) selects Strata Decision Technology’s StrataJazz for decision support and cost accounting.

Johns Hopkins Medicine (MD) will integrate Vital Images’ Universal Viewer into Epic.

People

Availity names Stephanie Kovalick (GE Healthcare) VP of portfolio operations.

Navicure appoints Sheridan B. Johnson chief compliance and security officer.

Population health analytics provider Rise Health names Michael Previti (Merge Healthcare) EVP of sales.

Announcements and Implementations

Meditech and Vitera Healthcare Solutions connect to the Surescripts network to provide their users with Direct secure messaging capabilities integrated with their EHRs.

Confluence Health-Central Washington Hospital & Clinics implements Merge Hemo from Merge Healthcare to automate their cath lab processes.

Summit Health (PA) deploys Nuance’s Clintegrity 360 Computer Assisted Coding and Clinical Document Improvement solutions for ICD-10 readiness.

Center Point Counseling (WI) installs ForwardHealth Group’s PopulationManager technology.

Other

Most providers express optimism about McKesson Paragon’s ability to deliver in large hospital settings despite current functionality gaps, according to a KLAS report. In 2012, Paragon secured 11 of the 32 larger hospitals migrating from Horizon; 131 large Horizon hospitals have not yet selected a replacement platform.

Individuals are far more likely to die or suffer complications at hospitals receiving the lowest Healthgrades rating according to the report, Healthgrades American Hospital Quality Outcomes 2014: Report to the Nation.

The Physicians Foundation issues over $3 million in grants to medical society foundations and healthcare organizations to assist almost 10,000 physicians select and implement EHRs.

An Arizona woman says she is the victim of identity theft four months after a University of Arizona Medical Center-South employee posted a workplace photo on Facebook that inadvertently included a computer screen with the woman’s personal information. The photo was removed after 30 minutes when a manager noticed the violation. The hospital’s privacy officer was notified of the incident, as was the patient. The woman recently notified the police after someone used her personal information to apply for food stamps. She also retained a lawyer, saying the incident has “been a nightmare,” that she is afraid to be home, and her life is at stake. Not to diminish the seriousness of the violation, but I can probably think of one or two things more nightmarish and life threatening than a breach of my PHI.

Sponsor Updates

• RazorInsights’ ONE Ambulatory EHR achieves ONC certification and secures 2011 compliance as a Complete EHR.
• EDCO Health Information Solutions will present a session on point of care medical records scanning at next week’s AHIMA Product World meeting in Atlanta.
• T-System names six winners of its fourth annual T-System Client Excellence Awards, which recognize emergency care facilities and physician groups that effectively use T-System solutions to improve clinical, financial, and operational outcomes.
• Emdeon will add full-color printing capabilities for printed communications to its Payment Network during the first quarter of 2014.
• Clinicians at Georgetown Hospital System share how their use of Aventura has saved them time and increased productivity and job satisfaction.
• A local paper profiles Jones & Sciortino Orthopedics (MO) and its use of eClinicalWorks to achieve Meaningful Use.
• Clinicians with Mercy and HealthEast Care System (MN) share how the use of Humedica’s clinical analytics platform from Optum have provided their organizations with health insights to improve treatment outcomes, care coordination, and quality.
• Information analysis firm IHS ranks Perceptive Software’s Acuo VNA the world’s market share leader among independent software vendors with 42.3 percent of total studies managed.
• Chilmark Research recognizes Medicity as a top-tier HIE vendor in its 2013 evaluation of the HIE market.
• HIStalk sponsors earning a spot on Capterra’s Top EHR Software list include: eClinicalWorks, McKesson, Allscripts, e-MDs, NextGen, NueMD, Vitera, and ADP AdvancedMD.
• Beacon Partners hosts a webinar on the steps healthcare organizations should take to form a patient-centered medical home.
• Quantros demonstrates the QPrecision release of its safety event management solution at next week’s ASHRM Annual Conference in Austin, TX.
• VitalWare embeds Atigeo’s xPatterns Clinical Auto-Coding into its CDiDocuMint application.
• CommVault introduces a content-based retention solution that enables enterprises to reduce storage requirements by keeping only data that is important to the business.
• MModal releases the Fluency Flex Mobile app for iPhones, allowing doctors to record clinical notes during patient encounters for integration within EHRs.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 10/22/13

Obama: Health care website problems inexcusable

President Obama weighs in on the failed Healthcare.gov launch, calling it inexcusable and reporting that the nation’s best and brightest from both the public and private sectors have been reaching out and asking how they could get involved to help fix the problems. The same "best and brightest" promise was made in a Sunday blog posted by HHS. No details were provided by either on who these new staffers are, what the additional cost will be, or when the site is expected to be fully operational. Both the president and HHS took the opportunity to publish the most recent Healthcare.gov numbers: 19 million visitors and 500,000 insurance applications filed since its October 1 launch.

How ONC is getting back on track after gov’t shutdown

As ONC’s full staff returns to work, various workgroups are adjusting the due dates of expected deliverables to account for lost time. Paul Tang, MD, vice-chair of the HIT Policy Committee, says that his group would be shifting its schedule of deliverables out by a month, which includes finalizing MU Stage 3 recommendations.

Miami Children’s Hospital Enters Technology Venture With MediTouch EHR

Miami Children’s Hospital forms a strategic partnership with HealthFusion Inc., developers of the MediTouch ambulatory EHR, in which MCH will market a white-labeled, cloud-based, pediatric EHR that comes integrated with MCH’s existing EHR database. The EHR will be available for Southern Florida based pediatric practices.

Curbside Consult with Dr. Jayne 10/21/13

I mentioned a few weeks ago that I had been preparing to sit for the new Clinical Informatics subspecialty board certification exam. Now that the testing period is over, I can talk about my experience. The American Board of Preventive Medicine expressly forbids candidates from discussing the exam content or questions so I’m not going to get myself into trouble, although there have certainly been some pretty significant discussions about it via the virtual water cooler.

The core content outline for the clinical informatics exam includes fundamentals, clinical decision making, health information systems, and leadership/change management. I don’t think there’s anything in the outline that is unreasonable. A major problem in trying to test that fund of knowledge, however, is that clinical informatics is an evolving specialty. Very few of us who have been in the field for any length of time intentionally set out to become informaticists. Of course there are some younger colleagues who decided to pursue it during medical school and attended a masters programs or fellowship, but I don’t believe they make up the majority of the seasoned workforce. The fact of how our discipline has developed (and subsequently exploded during the era of Meaningful Use) means that our field is extremely heterogeneous. That makes any kind of standardized evaluation a daunting experience.

Just look at physician titles as an example: CMIO, medical informatics director, clinical informaticist, medical director of informatics, medical informatics specialist, medical director of EHR, and my favorite: process improvement consultant. All of those titles are held by close friends of mine who are essentially doing the same job. Others have the CMIO title, but do vastly different jobs. Some are almost exclusively administrative, where others are heads-down writing their own code. Most of us are somewhere in the middle. We may practice medicine or not (although to sit for the new exam you do have to be currently certified in another clinical specialty.)

Preparing for the test was a good exercise. learned some things I didn’t know and encountered a lot of minutiae that, although “fundamental,” has very little bearing on my daily work. The thing that struck me most about the actual exam was that depending on your work experience, the difficulty of the questions varied. Like most exams, there were many “which is the best” and “which is the most appropriate” type questions with multiple correct-appearing answers. If you were straight out of a fellowship with little real-world experience, these might be easier. For those of us who have encountered hundreds of different variations on the questions (depending on whether the setting is inpatient vs. outpatient, whether the physicians in question are independent or employed, whether we’re wearing our physician hat or CMIO hat, what kind of system we’re talking about, etc.) the subjective nature of the questions made them difficult. Some of the questions I’ve actually encountered in real life and the answers to them may have been different at different times in the same project lifecycle.

Whether or not I passed (and truly I have no idea because it’s a new test and hasn’t been normed yet) isn’t going to impact my skill as a CMIO or make me less knowledgeable about handling tough decisions in the real world. Preparing for the exam though was stressful and actually taking it was an exercise in lack of user friendliness when you consider the whole electronic test-taking process used a third-party vendor. I was herded into the exam room along with firefighters, real estate agents, aspiring graduate students, and a couple of people who almost got ejected because they wouldn’t cooperate. We had to turn our pockets inside out, lift our shirts to expose our waistlines, raise our sleeves above the elbow, take a palm scan, and pay hundreds of dollars for the privilege. It certainly wasn’t that bad at another facility where I took my primary board exam a few years ago, but I guess things change. They didn’t make me take my glasses off to ensure I wasn’t hiding a chip or camera in them though, but I bet they do next time given the emergence of Google Glass.

Once most people finish taking this kind of test (after several months of preparation and at least some measure of worry) there’s this letdown period where you don’t know what to do with yourself. I did my best to keep busy and not second guess myself, but there comes a point where you just start thinking about the questions and how if you were in charge of the test, you’d do it differently. I couldn’t help but think of all the questions that weren’t on the test. Let’s pose some sample test scenarios and see what HIStalk readers think. It may not be evidence-based, but it is certainly ripped from the pages of real-world experience.

Item 1: As a clinical informaticist, you must often put yourself in the place of your stakeholders and end users as you make complex decisions. Read the following scenario, then select the best response to the associated questions. You are the finance director of a large employed medical group. The IT Director has decided to go to Las Vegas for the bachelor party of one of the IT analysts. He “signs out” authority over the ambulatory EHR project to you while he is gone, because after all, you’re both directors. He does this via email after 5 p.m. on Friday night then turns his phone off.

What is the most appropriate step for your first course of action?

a) Call Human Resources because it’s completely inappropriate for a supervisor to go to a Las Vegas bachelor party with his subordinates.

b) Call the IT director’s supervising VP because you’re not even in the same vertical and it’s not appropriate for you to take responsibility for his IT portfolio.

c) Call the CMIO and the EHR application manager and make sure they have your back.

d) Proceed to the local supermarket, purchasing more vodka than cranberry juice.

The weekend passes smoothly and without incident. However at 4 a.m. Sunday, your cell phone rings. The CMIO’s name is on Caller ID. Which of the following best describes the scenario?

a) This is a bad thing.

b) The clammy sweat you just broke tells you this is a very, very bad thing.

c) Anytime the CMIO calls you in the middle of the night it is extremely ominous.

d) You are glad you went to bed early Saturday night, because you have the feeling it might be days before you sleep again.

The CMIO explains that some cowboy analysts decided to perform an unauthorized “data migration” on your ambulatory database last night. No one was aware of the proposed maneuver as it was absent from the weekly change control discussion. Additionally, contractors were involved and it may not have been tested fully before deployment. It appears there may be some patient charts which have been corrupted, so they called the CMIO for advice. What is the most appropriate next step?

a) Curse the IT director’s name then try to track him down in Las Vegas.

b) Try to stop shaking, and then eat an entire box of chalk to address the heartburn you know is coming.

c) Be glad the CMIO has extensive experience resuscitating patients and staying calm because her demeanor makes you feel like it’s going to be OK.

d) Start making coffee; you’re going to need it.

Item 2: Review the above scenario. You are now in the role of the CMIO. It is 4 a.m. and you have just called your colleague. You calm her down and explain that you’re not that worried about the corrupt data because the organization has a well-vetted backup strategy and the team should be able to restore the database from the nightly backup, then apply the transaction logs up until the point they forced users off the system and started the migration. The finance director approves your plan and you phone the DBA on call. What is the most appropriate information to provide first?

a) Loudly ask, “What were you thinking?” and why he allowed unauthorized access to the production system.

b) Tell him to wake up his boss “because there’s gonna be hell to pay.”

c) Remind the DBA of your no-fault policy for reporting errors. A root cause analysis will be performed later and systems will be evaluated to prevent this from happening in the future.

d) Recommend a good travel agent for a one way trip somewhere far, far away.

The DBA makes some vaguely disturbing comments, so you get all involved parties on a conference line. Using your best patient interview skills (gleaned from years of trying to get the truth from drug-seeking patients) you begin to piece together what actually happened before they called you. Of the following system failures that have occurred, which is the most significant?

a) The team started the untested migration during the nightly backup process.

b) Users were on the system documenting clinical encounters during the migration.

c) The DBA already tried to restore from the admittedly non-reliable backup and it’s been running for two hours, but he neglected to mention it or the fact that he’s not sure the transaction log shipping was running properly prior to the incident.

d) A Level I analyst decided to wait four and a half hours before calling the CMIO for help and only called her because he “didn’t know who else to call.”

You ask for a list of users who were on the system when the incident started in an attempt to determine what kind of documentation they might have been doing and how severe a data loss might be. Should there be an unrecoverable data loss, which user will provide the most severe tongue-lashing?

a) Chief medical officer.

b) Chief of surgery.

c) Self-described “EHR Hater” who will use this as an attempt to mothball the ambulatory EHR project.

d) Your partner, who doesn’t want to be named as actually using the system since he brags to everyone in the physician’s lounge how he refuses to use it.

You invoke downtime procedures and notify the lone urgent care site that will be opening in less than three hours that they should document on paper and use the read-only downtime server for critical patient information needs. You notify all users that the system is down and immediately disable remote login capability so that no one can access the system while you figure out the recovery strategy. What portion of your user base will claim they never received notification?

a) None, as your communication plan is thorough and multi-media with multiple layers of backup.

b) Less than 10 percent, because most users are diligent about checking emails.

c) 20 percent, but they will find the email notifications three months from now when they get caught up on email. They will not apologize for yelling at you, however.

d) 90 percent, because they will jump on the bandwagon and complain about anything EHR-related.

Item 3: Given all the facts above, calculate the odds that the system will be back up with full data integrity before patient care starts Monday morning. Show your work. Estimate the total length of downtime. Conclude by estimating the total cost (in resources, recovery, and lost productivity) of this change control misadventure.

Bonus question: Estimate the number of employees who will be reprimanded for the actions leading up and/or during to the incident.

If you answered “C” to the multiple choice questions, then you just might be a CMIO (or someone who does the job without the title). As for Item 3, the system was indeed back up and ready for business by Monday morning. The total cost of the event was TNTC – as they say under the microscope, “Too numerous to count.” Before it was all over, we had to involve multiple representatives from various vendors, including the regional HIE and other downstream entities that received corrupt information and also had to perform various rollback activities.

I’m not going to give the answer to the bonus question just yet. If you want to make a guess, use the comment feature below. I’ll provide the actual answer later this week. For those of you who sat for the exam, I hope this gave you a laugh because we need one while we wait for the results.

What did you think about the exam? Email me.

E-mail Dr. Jayne.

HIStalk Interviews Tom Gonser, Founder, DocuSign

Tom Gonser is founder and chief strategy officer of DocuSign of San Francisco, CA.

Give me an overview of the trajectory that electronic signatures have gone through.

I started DocuSign about 10 years ago to try to do electronic signatures the right way. Before we started DocuSign, the way that happened is you literally had to have a piece of software on your computer and understand complex things like digital certificates in order to actually do it. It wasn’t working very well for anybody. 

We decided that rather than having people encrypt files and then email them around the Internet, a better way to do it was to turn it inside out and store the files securely in the cloud and then have people authenticate in order to access the documents. What that allowed us to do was not require anybody to have any special software. We could hide the complexity of all the encryption and audit trail and all that in a server. You could sign just using a browser from any device. That is what allowed the market to take off. 

I would say for the first couple of years as we were rolling out this new way of working, we spent most of the time just working with the user interface and making sure it was familiar and easy for people to do. People got both the ability to do it in a way that was easy enough so you don’t have to learn anything new, but also the security and legality so that it would stand up in court if it was ever challenged. And I’d say the last three years, we’ve really started to see it take off pretty dramatically.

You mentioned the legality of signed documents. Was that a challenge that had to be made so that it wasn’t a question?

It’s interesting. In the US, there was an act that was passed, a federal act actually, the US E-Sign act. It basically said if you process an electronic signature using steps — then they described specific things that need to be true — then that signature will have the same legal effect as an ink signature. We had the pattern, we just needed to make it easy. That was really the trick.

Once we did that, in the early days there were still a lot of questions about, “How do you know this is legal?” We had to become experts in the E-Sign act and communicate that to folks that weren’t aware of the fact it has legal since 2000 to do it this way.

Now that said, not every country in the world is governed by the US E-Sign act, obviously. There’s really three main sets of laws that are out there on the planet that deal with what a legally binding electronic signature is. Luckily, most countries have something that is defining in electronic signature. There’s the US, which is similarly adopted in other common law countries. There’s an EU directive, which governs what an electronic signature is in the EU. And then there’s a UN-based electronic signature guideline which is used through the rest of the world. Our job and our role is to make sure that the DocuSign platform can conform to all three of those different types of electronic signature sort of jurisdictions, as it were.

Ink signatures are refutable. You could just say, "I didn’t sign this" and there’s no foolproof way to say you did or you didn’t. Is the electronic version more promising for legality?

Exactly. It’s actually kind of funny. Once you start using DocuSign, people will come back after a month or a year and say, “I can’t believe we were just accepting handwritten scribbles on paper from people we’ve never seen their signatures before. And the documents could obviously be changed. We had no idea.” 

In the DocuSign platform, the signature is tied to the identity of the person using any number of tools that we provide. The whole document is itself encrypted and stored, so that if any changes were made after it had been signed, you could detect it. The whole process is just much more efficient, but also much more believable when you’re done.

We’ve done two mock trials to see what it would be like to go to court, despite the fact we’ve done half a billion documents. We’ve only had eight chances to have customers say that they want to refute it. In all those cases, there’s just too much information about what actually occurred. But the depth of information about all the aspects of what happened during the signing process is all stored with that signature. It doesn’t happen in the paper world. The paper world, you literally have a scribble. A lot of times it’s faxed in. You’re just taking it on faith that it’s actually correct.

I saw the YouTube video in which you were speaking about going to a new doctor and being handed a stack of papers that needed to be signed in a bunch of places to then be keyed in someplace else. When you look at the healthcare market, what opportunities do you see there?

The healthcare market is probably the largest market for DocuSign. The DocuSign platform manages the data and form data and routes contracts around securely to different parties. You can imagine in the healthcare example … we’ve been working with a couple of companies in that space, something called DocuSign for Patient Engagement, which allows literally patient onboarding, with a partner of ours called Kryptiq. 

If your doctor’s office subscribes to this, patients can fill in all the paperwork they need to before they show up. Even make the payment through the DocuSign system before they show up. All the information doesn’t need to be re-keyed. You can verify that it’s accurate. If the patient waits until they get into the office, they can just grab an iPad and fill out the same information. 

You’re dramatically reducing the cost. There’s a statistic we saw the other day that one third of the cost of healthcare in this country is derived by the operational aspect, you know, paper and paper management, all that overhead. You’re looking at billions if not tens of billions of dollars of waste that can be corrected by using electronic signature management like DocuSign.

Is the company an electronic signature company or a workflow company?

Forrester started looking into something they call Smart Process Applications. They define Smart Process Applications as those applications that involve human beings interacting with data and documents and potentially interacting in and outside the firewall. What turns out is that most of the things that are behind the firewall back office, ERP and stuff that you never really see, is highly automated and digitally connected. The challenge is that when you start dealing with those transactions where human beings are involved, either filling out a form or responsible for signing it or sharing with somebody else or it’s going outside the firewall, as you would see if you’re a patient involved with a clinic or something. Those processes typically have not been automated, which is where the paper load comes from. 

What Smart Process Applications are is literally building an application to automate a process that involves people and documents and data that typically span more outside of an organization. DocuSign is a platform upon which companies are building Smart Process Applications. A perfect example of this would be Kryptiq, our partner that’s developed a patient onboarding system that is built on the DocuSign system, in order to make that entire process of getting a patient from pre-registration through to the doctor handled in an electronic form instead of a paper form.

There are obviously lots and lots and examples of these Smart Process Applications in healthcare, but also in real estate, in financial services, all the places where human beings are interacting in a transaction. Forrester looks at that market and says it’s a $34 billion market, so a big, huge opportunity.

Do you consider yourself to have any significant competitors?

If you look at that market, a lot of the competitors are the big iron providers where someone’s going to come in and hand code a process using the traditional IT processes. Those are big, expensive projects, not cloud-based. 

The challenge is, once you build a process like that … let’s say you create this workflow for onboarding a patient or creating a patient payment process or something like that. Then a rule changes – some government agency says you need to fill this form out before you fill that form out, or it needs to be reviewed by the financial team before this. Some change happens because it always does. With those traditional IT engagements, start the clock, you’re out of compliance. It’s going to take you six months or eight months before your IT team can get in and re-code and rewire that thing.

The DocuSign platform, on the other hand, separates the workflow and data and documents. We allow our customers to create what we call templates, which govern the entire process of a transaction, including documents. An administrator could go in and re-sequence the way a transaction happens, or change out a document, or add another one. All of the Smart Process Applications that rely on that particular template are immediately changed. There is no coding re-work to be done. It’s a very, very flexible implementation. It saves a lot of time, not only in getting it going in the first place, but in the whole lifecycle of an implementation. All the changes and tweaks that you know are going to have to be made are much, much easier. 

It’s a new way to do it. It’s all because we’re a cloud-based approach as opposed to the typical, heavy IT software approach.

It was a coincidence that a couple of weeks ago, I got a document that asked me to sign using DocuSign for the first time. It made me wonder then – does interest in the product spread virally as people get something to sign that doesn’t require emailing, printing, signing, scanning, and emailing again?

Absolutely. It’s amazing how viral it is. Typically when someone goes through that process, at the end they’re thinking, I didn’t even know you could do that. That was really cool. I could see a way I could use this in my business, or I’d like to sign all my documents that way. They could go to the Apple store, the Android store, the Windows store and get our mobile application that allows just consumers to DocuSign any document anybody might be able to email them. The ability for even consumers to use DocuSign for anything they want really starts to push the viral spread.

We’ve had a lot of business in real estate, for example. A lot of times, you’ll hear a story from somebody who’s buying a house or leasing a house or renting something. That does create business for us, because typically people who are doing that are employed somewhere and they can take DocuSign to their work.

What’s really exciting to us about the healthcare space is somebody buys a house once every nine years, but I think the number of times you visit a healthcare facility is like three times a year, maybe four times a year. The viral exposure that can be seen in DocuSign in the healthcare space is an order of magnitude stronger than it is in, say, real estate. It’s exciting to us because when you’re a consumer and you buy your house with DocuSign and then you go to the doctor and they use the same exact service, you can use your same signature. If you have an account, you can store all the same documents in the same place. It starts to get a lot of synergy just for that individual consumer.

Is further product development necessary that’s healthcare specific, or is it everything in place and you just need the uptake now?

There are two answers to that. One is that anybody could take the DocuSign platform and create these Smart Process Applications as they sit today to solve pretty much any sort of workflow problem in that market.

With that said, we want to help accelerate that. We’re strongly engaging in lots of partnerships in the industry to connect our DocuSign platform to the platforms that are already in place. We’ve only been really focused on the healthcare segment as a vertical that we really hire people into with domain expertise for about a year, maybe a little more than that. But so far we’ve got some good partnerships going with GE Centricity, NextGen, Allscripts, I mentioned Kryptiq, Greenway, Vitera.

There’s a number of partners, and we believe in this particular market, working with partners that have established of infrastructure in place that we can connect the DocuSign system to is really the best way to really get it to crank up and go. We also partnered with one of the bigger, actually I think it’s the only sort of identity provider for the smart pharmaceutical industry, SAFE-BioPharma. That’s sort of for clinical trials. If you wanted to put on a clinical trial, a lot of them would require that you use this credential from SAFE, and so you can now do that with the DocuSign platform that’s integrated in. It’s such a big market  and there’s so many different aspects to it that we think partnering with the key platforms is really important.

Any concluding thoughts?

The next time you go into the doctor’s office or the dentist or whoever it is and you find yourself filling those forms out over and over, you should stop off at the front desk and tell them there’s a better way.

Morning Headlines 10/21/13

The sad state of EMRs: How they are doing more harm than good

Val Jones, MD, a blogger and advocate for digital health, writes that EHRs have come to the point that they are doing more harm than good. She cites the “enormous time suck” that charting into an EHR has caused for physicians.

CMS planned for paper processing before Obamacare launch

Just days before the launch of Healthcare.gov, CMS extended its contract with UK-based Serco, who had been managing its paper insurance application process, leading many to speculate that CMS knew the insurance exchange enrollment site was going to fail.

Medical Identity Theft: Recommendations for the Age of Electronic Medical Records

The California Attorney General’s office publishes a report on medical identity theft and recommendations for health systems in the age of EHRs, adding that nearly half of medical identity theft cases are actually incidents in which someone loans their insurance card to an uninsured friend or relative to obtain treatment under their insurance.

AMC and VUmc conclude contract with Epic for new joint EPD

Two Amsterdam hospitals, American Medical Center and VUmc, sign up to implement Epic.

Monday Morning Update 10/21/13

From Across the Pond: “Re: Epic. Two large academic hospitals in Amsterdam, AMC and VUmc in The Netherlands, signed a contract with Epic last week.” Academic Medical Center has 7,000 employees, 2,300 medical students, 120 medical informatics students, and an annual volume of 26,000 admissions and 350,000 outpatient visits . VUmc, which cooperates closely with AMC, is affiliated with the other big university in Amsterdam. Wikipedia says The Netherlands has eight university medical centers and 10 large non-university hospitals.

From Jane Jetson: “Re: Weight Watchers. I received an email this morning owning to the fact that they had technical problems. Perhaps I should forward to Kathleen Sebelius so that Healthcare.gov could borrow the wording.” The problem with the government is that nobody is ever individually responsible for anything; the incompetence is collective. It would be unheard of to acknowledge that something isn’t working except for political gain, or to accept responsibility for anything but success. All of the professional bureaucrats are busy trying to hang onto jobs that must be pretty sweet given their ducking and covering to keep them.

From Kittanning: “Re: startups. Why don’t you cover more startups? That’s where the innovation will come from.” I cover startups that have interesting consumer-facing technology, but rarely those who are targeting hospitals. Reason: most of them think their great technology idea will offset the founders’ lack of knowledge (and lack of interest) about how hospitals and doctors work and who just want to cash in quickly rather than helping patients or providers. Newbies can’t come in guns blazing telling everyone in healthcare that they’ve figured it all out as a 30-year-old programmer turned self-proclaimed CEO, insulting those who have more years in healthcare than they’ve had breathing, and nobody in a position of enterprise IT responsibility is going to be impressed by swaggering overconfidence from unpolished newcomers who think they’re the next Steve Jobs just because they are as abrasive as he was. I’ve seen very few great startup ideas that have the potential to turn into anything more than a spare bedroom business, and of those, only a tiny percentage are being run by people on whom you’d make even a small bet as a customer or investor. Creating enterprise technology innovation, unlike writing cute iPhone apps, requires a lot more than a Foosball table and cases of Red Bull. I’ve seen company pitches, most of them naive and unskillfully prepared, and the commonalities are: (a) lack of money and of a realistic plan for profitability that will allow ever bringing their product to scale; (b) a low barrier to entry that virtually guarantees that any degree of success can quickly be replicated by competitors; (c) lack of realization that it takes a lot of skill, money, and time to connect your great idea to hospitals even willing to undertake a pilot, much less buy the product, and the lack of appreciation of just how long the hospital sales cycle is and how imitative their purchases are; (d) having no one on the team who has ever sold technology to hospitals or partnered with similar firms; and (e) lack of understanding that people bet on the jockey, not on the horse, and impressive developers usually don’t make impressive CEOs regardless of their level of hubris. Great ideas are  a dime a dozen; the hard work is the long, expensive slog trying to get traction with them, and if you are new to healthcare selling a product whose target customer is hospitals, it’s a near-certainty that you’re going to justifiably fail, with your only hope that a better company will buy yours before it splats to the ground. That’s not anti-innovation at work – it’s the reality that healthcare attracts a lot of flaky, poorly thought out startups that don’t deserve to succeed. Come back when you hit $1 million in annual revenue.

From The PACS Designer: “Re: Omate watch. Another watch, funded through Kickstarter, is now available for purchase starting at $249. The Omate TrueSmart Watch can be used as a phone with its Bluetooth capability while still being fully functional without the phone. This no-hands phone style of watch will surely be used in healthcare settings.”

From Expense Reports Gone Wild: “Re: consultants. I continue to get bothered by the number of submissions on the bills of consultants for coffee, snacks, lunch, dinner, beverages, protein bars, etc. Why is it that we as a customer are expected pay for all this sustenance? Is the $200+ hour not enough? I am fine with paying for folks to get from home to the location, but why has there been this tradition of paying for other than travel? I think it is time to begin to object to these costs. If we are going to be part of saving health care we can’t continue to exacerbate the issue with rampant unnecessary spending. I have heard all the arguments around inconvenience of travel and this to make up for that but then let the employer of that person eat the cost. The per diem fee doesn’t fly either — when I go to work, I have to pay for my food, just because work means getting on a plane doesn’t excuse one from that obligation. Convince me I am misguided.” I agree, but taking the counterpoint as a consultant might, I could make the same argument for buying $500K hospital CIOs cars, club memberships, travel of a questionably patient-valuable nature, and bonuses for doing the job they were already paid to do. I think the conclusion is that everybody gets to pass the literal buck down to the patient bill, and only recently did big hospitals worry about their inability to create enough charges to pass through the excessive costs.

The problems with Healthcare.gov are either due to (a) screwed-up government software bidding and contractor oversight , or (b) not unexpected for a rollout of that scope, say most poll respondents. New poll to your right: is the influence of private equity firms on healthcare IT positive or negative? Your answer doesn’t provide any context, so after you’ve voted, click the Comments link to explain.

Welcome to new HIStalk Platinum Sponsor Sentry Data Systems, which offers hospital pharmacy procurement, revenue cycle, and compliance solutions. Sentinel RCM manages financials, inventory, charge master, auditing, and order flow, allowing them to track drugs from the point of purchase all the way to billing. Sentrex helps hospitals manage their 340B contract pharmacy relationships to maintain compliance by using a proprietary rules-based engine to apply hospital policies and procedures, supporting both 340B and Own Use programs. These products run on the Datanex infrastructure platform that processes millions of transactions each day. Hospitals running a 340B drug program need specialized technology to avoid running afoul of a maze of regulatory and auditing challenges and Sentry is the company to call. Thanks to Sentry Data Systems for supporting HIStalk.

I cruised YouTube for more on Sentry Data Systems and found this pharmacy director testimonial.

AtHoc is a brand new HIStalk Gold Sponsor. Over 200 hospitals rely on AtHoc for critical communication and personnel safety, turning their IP network into a closed-loop, multi-modal notification and communication system. Examples: protecting home health nurses with a smartphone duress/panic button, communicating with clinicians during IT downtime, and automating shift availability and filling processes. Above is a video on Kaiser Permanente’s use of AtHoc for staffing. Thanks to AtHoc for supporting HIStalk.

Athenahealth turned in unimpressive numbers that fell short of expectations Thursday, some but not all of them related to its Epocrates acquisition, but that didn’t stop shares from going on a tear after the announcement. ATHN hit an all-time high Friday and closed up 24 percent on the day at $130.83, valuing the company at almost $5 billion. Investors apparently ignored the financial results and instead were encouraged by a growing client base and an extended contract with PSS World that will put more salespeople on the ground pushing athenahealth offerings. Above is the one-year chart of ATHN (blue) vs. the Nasdaq (red). Jonathan Bush holds $40 million worth. From the earnings call, which is always informative whether you care about ATHN or not because Bush is willing to say what others won’t:

• One large client, an ambulance company that was never named at that company’s request (but had to be Rural/Metro), went bankrupt even before going to pilot with athenahealth and “new leadership fired us.”
• Like everybody else, athenahealth talks about population health a lot.
• The company will roll out athenaKnowledge in 2014, which will provide financial and clinical decision support to physicians.
• AthenaClinicals  can automatically make a note in the chart when patient prescriptions are filled, although so far that works in only about 23 percent of orders.
• AthenaClinicals users who also use athenaCoordinator can exchange patient information via athenaNet with no additional interfaces or exchanges.
• When asked whether athenahealth would gain or lose hospital business through consolidation, Bush replied, “I don’t know, dude. I assume we’ll win. I mean — the for-profit sector is where most of these mergers are going on that you’re talking about, and it’s a very rational sector. Most of the headwind we face in the enterprise world is with institutions who don’t view their bottom line as all that important. And their reputation as the bringer of great new physicians into the world and their reputation as the provider of procedures that no one else can provide, trump their abilities, their interest in asset efficiency. Now as we’ve said in past calls, we believe that asset efficiency is going to rise in appeal to even the most theoretical of academic medical centers as the pressure builds.”
• According to Bush, “At some point, the idea of information being liquid across people who don’t own each other is a major trump card when you think of this tragic lemming march of acquisitions, doctors and hospitals marrying up in marriages of convenience, nothing wrong with doctors and hospitals marrying up in marriages of love, but this wave of kind of moony, large-scale marriages of convenience just to get information integrated when there is another way, to me, it’s sort of a profound megatrend to watch.”
• When asked about hospitals using athenahealth products to control physician behavior, Bush said, “Well, I’ll tell you every proposal to a new enterprise today include a Google Map of all of the doctors that have admitting privileges at their institutions that are already on athenaNet. And those Google Maps are getting more and more dotty, lots and lots of little dots around their blue H. And the fact that now we don’t say we can direct, but we say, ‘Listen, hospital, do you want to — speaking of manifestos, do you want to get compliance via force or do you want to get compliance via love?’ … be the most high-quality, easy-to-do business with receiver of patient referrals. Be big and successful and survive this drought that’s coming by being the best, and that means being the most integrated, the most available … we don’t even need the tipping point for that, right? We could just show up and say, hey, you’re going to do a go-to-market strategy with your subsidized EMR the way poor Long Island Jewish did with Allscripts banging away, giving it away at red lights, trying to get the windshield wiper guys to give it away. Here, you got thousands of doctors paying for it, wanting it, and all you’ve got to do is light up your logo inside of the order screen.
• On selling athenaClinicals to customers who already have an EMR, “I know the last time I looked, it was 40 percent of our clinical sales today were people throwing one out … you have a huge wave of folks who looked, went out and jammed the EMR thing because Obama told them to, and then they got to Meaningful Use day and they got nothing … Used properly, they’ll get you Meaningful Use. But doctors are not supposed to be using them properly. All they’re supposed to be doing is seeing patients … Nobody wants to go back to their Board of Directors or their Board of Doctor Owners and say, ‘Yes, so sorry but I convinced you spend thousands and at times, millions of dollars on something that I really want to throw out now.’ But it is what it is. It’s a cash-on-cash no brainer. You just have to go through the embarrassment.”

John Lynn did an ICD-10 Hangout on EMR & EHR Videos.

GE reports Q3 numbers: revenue down 1.5 percent, adjusted EPS $0.31 vs. $0.33, but train and plane sales along with aggressive cost-cutting helped the company exceed Wall Street’s expectations, sending shares to a five-year high. GE Healthcare’s sales were flat, but earnings rose 7 percent.

A series of Wisconsin Democratic Party focus group meetings identifies the two favored candidates for governor, one of whom is Judy Faulkner of Epic. The strengths the groups favored were a wealthy, politically outsider woman not from Dane or Milwaukee Counties with name recognition who hates everything about Republican Governor Scott Walker.  I don’t think I’d take the results too seriously since they seemed to favor celebrity status over political qualifications – the group’s other choice was just-retired Green Bay Packer and “Dancing with the Stars” winner Donald Driver.

Eric Topol, MD isn’t impressed with MD Anderson’s use if IBM’s Watson to undertake a “moon shot” aimed at eliminating cancer. He tweeted, “This ‘Ending Cancer stuff, while a laudable goal, is sending a wrong message to public.” He didn’t explain, but I assume he meant that cancer isn’t one disease and the likelihood of eliminating it, with or without Watson, is nearly nil. Prevention is more important than treatment, I conclude, but if MD Anderson thinks Watson can help eliminate cancer (or help it market itself to cancer patients, which bring it nearly $4 billion per year in revenue for treating cancer rather than preventing it), then it’s worth a shot, moon-worthy or otherwise, even if it does encourage minimally intellectual Americans to think that anything less than a cure is a failure.

Val Jones, MD (aka blogger Dr. Val) says that despite her previous support of digital data in medicine, EMRs are doing more harm than good. Her reason: data entry is “an enormous time-suck for physicians” that harms thoughtful interaction with patients that would allow a correct diagnosis and sensible treatment plan. She doesn’t like correcting offshore transcription, hospitals with large IT departments (“40 young tech support engineers were furiously working to keep the EMR from crashing on a daily basis”), and EMR-required data fields (she called out Allscripts, whose system requires the doctor to indicate for every discharge prescription whether the medication comes in a tablet or capsule, which the system knows full well but which has to be entered again to allow the inpatient EMR to accept the information). I think she might have aimed her wrath more precisely at the one hospital at which she apparently had a bad experience since what she describes is certainly not universal, but certainly some hospitals are exactly as she describes.

Peace River Center, a Florida non-profit psychiatric agency, is awarded a $30,000 United Way of Central Florida grant to implement technology that will allow its home case workers and clinicians to remotely connect to its EMR.

In Canada, Victoria County Memorial Hospital loses its telephone service and Internet connectivity when a construction vehicle severs cables, causing the hospital to cancel walk-in diagnostic and lab services.

Twitter’s just-announced November IPO may be tarnished by “Twitter quitters,” those who try the service but abandon it because they can’t figure it out or don’t find value in it. A new poll shows that 36 percent of those who sign up for Twitter don’t use it and 7 percent close their accounts, much worse numbers than for Facebook. According to an active Facebook user who stopped using Twitter, "I didn’t really get the point of it at all. Most of them were people I wasn’t interested in hearing what they had to say anyway.” Twitter is big, but then again so were Second Life and Myspace.

Madison, WI-based 11-employee Wellbe raises $1.4 million in funding. The company’s Patient Guidance System, which it describes as a GPS for health, sends patients emails and information before and after their surgeries.

HHS gave UK-based government contractor Serco, under investigation there for contract fraud, an $87 million contract extension to its existing $114 million CMS contract to handle paper insurance applications just five days before the launch of Healthcare.gov, leading to speculation that the government knew Healthcare.gov was going to fail and paid Serco to handle the inevitable flood of paper-based insurance applications. However, CMS suggests that the Congressional Budget Office had estimated that 20 million people would apply, with 6 million of those doing so on paper, and the 2,000 people Serco hired were necessary to process the paper applications. HHS gave Serco a $1.2 billion contract in July to manage paper insurance applications for 34 state insurance exchanges in its first-ever US healthcare project. The parent company has annual revenue of around $8 billion. Serco took over NHS’s largest hospital pathology laboratories in 2009 in a privatization joint venture worth $1.3 billion over 10 years and was involved in a series of admitted serious patient errors, including losing samples, incorrect computer flagging resulting in administration of inappropriate blood, a software problem that calculated kidney function incorrectly, and a section of blood chemistry equipment that had to be shut down for four days after a computer virus infection. The 1,000-employee JV, called GSTS Pathology, couldn’t control its costs, had to borrow money from the hospitals to continue its operations, and announced that it would need to pull out of certain markets. GSTS Pathology continues to bid on new UK business, hoping to capture 30 percent of the pathology market.

California Attorney General Kamala D. Harris issues “Medical Identity Theft – Recommendations for the Age of Electronic Medical Records.” It cites a recent report stating that nearly half of medical identify theft isn’t really that at all – it occurs when someone with insurance loans their card to someone who doesn’t have insurance. EHR-specific recommendations include:

• Implement role-based access controls.
• Embed a copy of a patient’s photo (but not a government-issued ID) into the EMR.
• Give patients clear instructions on how to get a copy of their information.
• Give patients a copy of Clinical Care Summary documents asking them to verify the information but warning them keep it confidential.
• Set up the EMR to flag suspicious issues (known a “red flags”), such as a patient refusing to show an ID (other than in the ED); presenting an ID whose photo doesn’t match their appearance; presenting an ID with a name or address that doesn’t match the EMR information; giving a Social Security number, address, or telephone number that is already assigned to another patient;  receiving returned, undeliverable mail from the patient’s address; receiving previous denial of payment for situations such as a second appendix removal; bills returned as undeliverable while new charges continue under that same address; patient interview information is inconsistent with the EMR information; observing that a patient is not aware of the information in their record; and finding information in the EMR that conflicts with other information or with the patient’s presentation.
• Develop a process for instantly reporting any of the red flags above to a team that will review all available records and place affected accounts on hold, looking for problems such as erroneous data entry or inappropriate medical records merge.
• Document findings and policies in the EHR where it can be seen.
• Create a database of identities that have been used fraudulently.
• Add a message to the patient portal encouraging patients to review their records regularly, also giving them instructions on how to report discrepancies.
• Audit EHRs for unauthorized access.
• Build demand for provider detection software, which the report says is offered by only a handful of unnamed vendors whose applications are too expensive for all but the largest health systems.
• Correct records as needed, either annotating them or moving them to a specific “medical identify theft” location and then starting a new record.
• Use the Continuity of Care Document to electronically notify business associates and other providers that the record has been corrected.
• Follow HIE rules for correcting information.
• Encourage development of technical standards that would allow Health Information Organizations to exchange red flag information, such as modifying the MPI to indicate the addition of a red flag by a member.
• ONC should include red flag recommendations in Meaningful Use Stage 3.

Weird News Andy titles this story GIGO, wondering, “Who, if anybody, tested this thing?” (answer: government contractors). Not only is Healthcare.gov failing to allow most would-be users to get into the system, it’s also sending erroneous data to insurance companies from those who do. Duplicate enrollments, spouses listed as children, and missing data have been reported.

WNA also files these reports from his Weird Newsroom. Doctors are unable to determine why a Tennessee man has been crying blood for seven years, an unnerving trait that has cost him every job he has held. A Denver woman whose arm was unnecessarily removed after an incorrect cancer diagnosis tries out a robotic arm, but her rare underlying condition remains – any bruise she gets turns to bone, which is gradually transforming her into a human statue who knows she will be fully immobile soon.

A hospital sues one of its patients who refuses to leave because she likes her bed there. The patient was discharged after a four-day stay for pneumonia, but intentionally had her state-provided hospital bed removed from her home so that she could argue that her discharge was unsafe. The hospital says the patient is abusive to staff and fellow patients, complains if her room is at any temperature other than 83 degrees, and repeatedly calls the police department, public health department, and the attorney general to complain about her stay. The hospital wants a temporary injunction to send her packing.

Vince continues his fascinating HIS-tory of McKesson, specifically HBO, with information he received directly from Walter Huff himself. It’s fascinating to read how many early HIT pioneers were hospital CFOs who did programming or other computer work for their hospitals, and how many vendor systems came out of those hospitals.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Time Capsule: My Can’t-Miss Entrepreneurial Brainstorm: Display Computer Data in the Handwriting of the Person Who Entered It

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 October 2009.

My Can’t-Miss Entrepreneurial Brainstorm: Display Computer Data in the Handwriting of the Person Who Entered It
By Mr. HIStalk

I don’t want to brag, but I’m a business genius, one of your classic serial entrepreneurs who is so full of hot ideas that I haven’t found the time to stop working as a hospital wage slave. Each idea is so much better than the one before it that I can’t decide on the best one to pursue, so I’m continuing my decades-long preparation of reading Forbes and MSN from the catbird’s seat, located deep in the bowels of an academic medical center.

(One of these days, maybe when I retire, the world will be shocked and awed by the torrent of pent-up business expertise that I’ll unleash, even more so since I’ve never actually been in business except for a short stint as a paperboy back before Craigslist drove all the newspapers out of business.)

You will no doubt value my latest brainstorm appropriately – healthcare IT data elements displayed in a font created from the handwriting of the person who entered the data. Boo-yah and ca-ching!

Everything needs a serious-sounding name for the newly created genre, like “social networking” (or “social not-working.”) I like to call this “Reverse Handwriting Optical Recognition” (RHOR) or “Character Recognition and Proxy Personalization” (CRAPP). You are hereby non-disclosed.

They say every successful product has to solve a customer’s problem (I’ll believe that when someone explains what purpose the TV show “The Bachelor” serves). So, here’s the one I’ve targeted: clearly wrong information looks believable when you see it on a computer screen or printed report.

My inspiration is the news that Cedars-Sinai overdosed CT scan patients for 18 months because none of the techs noticed that the screen defaults were wrong.

Hospital people usually seem blithely unconcerned when presented with hilariously incorrect computer information, like a pregnant male patient or an ED bill for $12 million. The neat and orderly computer output throws off their radar in the absence of a visual cue that would identify the blithering idiot who entered the information in the first place.

Here’s my technical architecture design. Each user’s security profile will include a handwriting sample that has been scanned to a font. When the computer displays or prints something entered by that person, it does so in their own handwriting.

Brilliant, right? The bad information won’t be so reassuring if it’s displayed in a child-like scrawl or a breezy note punctuated with that smiley thing that tip-seeking waitresses draw on your check. Your radar would say, "I don’t trust a thing that fool says."

Skeptics or cynical venture capitalists might ask me, "What about information that the computer creates, like drug schedules or co-pay amount?" I smirk knowingly as only a world-weary entrepreneur can do. Computers, although good at idiot savant tasks like spitting out lists or calling up historical information, are the dumbest pseudo-people in the room. I’ll display their primitive conclusions in the sloppy scrawl of a 14-year-old who was raised with a keyboard instead of a pen, or maybe as indecipherable teen-like text messages saying something like UR PT IS DED ROTFL .

No longer will doctors and nurses place undue confidence in information just because it looks official. Those worthless clinical observations entered by a co-worker you wouldn’t trust with your drive-through order? Visual elimination made easy by Mr. CRAPP (send me that royalty payment, please, Cedars).

Darn, now I’m getting one of those serial entrepreneur brainstorms that may cause me to skip CRAPP and just go on to CRAPP 2.0. We write an add-on software application that lets users rate each data element for accuracy and usefulness. If someone’s a real bonehead, you answer "Did you find this data element useful?" with “no.” If someone enters an incorrect allergy or creates a duplicate medical record that has to be merged later, you rate them low. When enough people do the same, the user gets anonymous feedback of scorn and ridicule.

I don’t watch “The Bachelor” or other reality TV (except “Shark Tank” and my fellow high-flying capitalists), but I’ve heard of a concept that I might use in CRAPP 2.0. If you enter enough bad information, your co-workers might vote you out of a job.

Morning Headlines 10/18/13

Sebelius Stands Firm Despite Calls to Resign

Secretary of Health and Human Services Kathleen Sebelius is refusing calls for her resignation after the failed launch of Healthcare.gov.

athenahealth, Inc : athenahealth, Inc. Reports Third Quarter Fiscal Year 2013 Results

Athenahealth reports Q3 results: revenue jumped to $151 million, up 43 percent from $105 million during Q3 2012. Epocrates accounted for $13 million of that total.

St. Luke’s expects to spend $200 million on electronic records system

Nine-facility St. Luke’s Health System will spend $200 million implementing Epic across all of its hospitals and clinics. The system is expected to be live across the network sometime after 2017.

HIMSS Analytics Essentials: Virtualization Software and Dictation with Speech Recognition Applications Positioned for Aggressive

Data visualization and speech recognition applications are predicted to see a surge in sales according to a recent HIMSS Analytics report.

News 10/18/13

Top News

HHS Secretary Kathleen Sebelius is reported to have no intention of quitting after Republican criticism of the Healthcare.gov online insurance exchange debacle. Sebelius has acknowledged the problems, but says fixes are being put in place and those who were unable to sign up should try again. Success rates for those attempting to enroll were less than 20 percent the week of its rollout on October 1 and under 13 percent the second week, although one researcher says fewer than 1 percent of those who tried to register were successful. Another report finds that the cost for the system ballooned from the original estimate of $94 million to $292 million, with those payments going to the US federal government division of Canada-based CGI. Other estimates peg the total cost of Healthcare.gov to be more than $500 million.

Reader Comments

From Dr. Travis: “Re: Color me pink. Breast cancer awareness month has jumped the shark this year.” Travis tells me he likes the innuendo of this poster’s message, which I believe was from the Twisted Taco restaurant in the Atlanta area. Thanks for the reminder to support breast cancer research, get screened regularly, and/or encourage your loved ones to be screened.

From Reader One: “Re: from a vendor-specific forum today. ‘We inadvertently assigned 5,000 accounts to a bad debt agency. Is there a way to mass cancel?’ Now that’s what I call exciting.”

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Boston Software Systems. The company offers an error-free workflow automation platform that allows its healthcare customers and business partners to streamline their business processes and improve productivity. Boston WorkStation lets IT departments efficiently solve problems and eliminate performance gaps in existing IT systems – integrating third-party registrations, performing eligibility checks, integrating lab results, posting payments and collections notes, performing mass updates, creating backup databases, running and distributing reports, and managing dictionaries and tables. Existing systems can be enhanced by creating new business rules and workflows and providing real-time access to external applications. IT departments love Swiss Army knife-type solutions that be used to enhance systems without vendor involvement or ongoing labor requirements, such as the hospital that’s saving 125 hours per month using Boston WorkStation to automatically create a pre-registration account at the time of scheduling or another that saves $500K by automating their materials management system to load inventory purchases and manage price updates. The company also offers Cognauto, the next-generation automation platform. The company’s products are used by over 2,500 hospital customers running many IT systems. Thanks to Boston Software Systems for supporting HIStalk and for issuing a very cool press release announcing that fact.

 
 
Thanks to Bonny and Catherine from Aventura, self-proclaimed “HIStalk minions” who volunteered to report from the American College of Emergency Physicians Scientific Assembly (ACEP13) in Seattle this week. They conducted some ED doc interviews about IT that I’ll have up later, but here are some of Bonny’s observations:

• The topic of scribes performing EMR data entry split the group, with some ED physicians expressing satisfaction in offloading tasks to what is often a pre-med student, but others feel guilty about making scribes do what some would say is their work.
• The best-of breed EDIS vendors were there (Picis, T-System, MEDHOST) as were the big enterprise vendors with EDIS, with Epic notably being MIA.
• Education and discharge instructions vendors (Discharge 1-2-3, Elsevier ExitCare, Krames) were exhibiting.
• Bonny says MEDHOST stole the show with a patient throughput solution that pushes preemptive communication about patients from the ED or OR, such as when a patient is likely to be admitted but whose emergency care is still underway. It also offers real-time and forecasted financial operational metrics for executives.
• ACEP rented out the Space Needle, the Chihuly Museum, and the Experience Music Project for attendee events.
• In the all-important vendor swag category, Bonny lauds Interactive Health Massage Chairs, whose booth was across from Aventura’s such that Bonny and Catherine could perform their own first-hand research as well as watch attendees shed their stress and exit happy. Check out the photo above – who wouldn’t want to have a chair massage while covered lightly with a blanket right on the show floor?

Highlights from HIStalk Practice this week include: a local paper profiles two physicians with opposing views on EMRs. CMS pushes a PQRS reporting deadline back three days. A vendor speaks out against shortened exhibit hours at MGMA. Most medical practices are concerned that ACA insurance exchanges will lead to increased collection burdens and lower reimbursements. Epocrates adds a provider directory to help members identify clinicians for consults and referrals. Emdeon will pay its departing CEO $2.4 million over the next two years. Thanks for reading.

Acquisitions, Funding, Business, and Stock

Athenahealth announces Q3 results: revenue up 43 percent, adjusted EPS $0.29 vs. $0.30, missing analyst estimates on both.

IVantage Health Analytics acquires Professional Data Services, a provider of managed care analytics and benchmarking solutions for hospitals.

StartUp Health admits 14 new companies to its three-year development program for health technology startups. Lt. Dan profiles the companies on HIStalk Connect.

Medical practice technology vendor Waiting Room Solutions changes its name to WRS Health.

Sales

Medical Services of America (SC) chooses Allscripts Homecare for its 70 home care service locations.

Elmcroft Senior Living (MO) will install Cerner CareTracker at its 85 assisted living facilities.

The 30-bed Aspire Hospital (TX) will implement clinical and financial applications from Healthcare Management Systems and physician documentation from Patient Logic.

The VA and DoD award Systems Made Simple a re-compete of the iEHR system contract for systems integration and engineering support.

Saint Luke’s Health System selects PeriGen’s PeriCALM fetal surveillance system for seven birthing hospitals in northwest Missouri and northeast Kansas.

The VA awards Harris Corporation a $60 million, four-year contract to design, install, and support the wireless infrastructure at 112 VA medical centers.

Riverside Medical Group (VA) selects athenaCollector for billing and practice management for its 300+ physicians.

The Texas Health Services Authority chooses EHNAC to develop a state accreditation program for private and public HIEs operating in Texas.

Texas Health Physicians Group selects StrataJazz from Strata Decision Technology as its integrated financial platform.

St. Luke’s Health System (ID) will implement Epic at a cost of $200 million and will offer Epic ambulatory to independent practices through an affiliate program.  St. Luke’s, defending itself against antitrust claims for its purchase of Salzer Medical Group, says Epic is a superior system that will allow providers to share information with patients and with each other more easily.

People

Northwest Community Healthcare (IL) names Glen Malan (Cadence Health) VP/CIO.

OpenTempo names Jim Crook (IDX) chairman of the board, Walt Marti (GE Healthcare) chief administrative officer, and John Jordan (dbMotion) VP of sales and marketing.

Announcements and Implementations

Quantros releases IRIS 2.4, a configurable dashboard to view overall hospital performance and display trends, distribution, and variations in performance.

Government and Politics

A California state appellate court rules that providers do not necessarily have liability to patients when medical records are stolen or misappropriated unless they are accessed by a third party. The ruling stems from a 2011 incident in which a UCLA Health physician’s laptop containing medical records on 16,000 patients was stolen from his home. The provider could have been liable for up to $16 million as part of the  class action lawsuit, even though there was never any indication the data had been accessed. The suit was dismissed. Rebecca Fayed, associate general counsel and privacy officer at The Advisory Board Company, tells me the ruling only applies to California, which has its own statute governing the disclosure of medical information and allows affected individuals to sue for damages for certain violations. She adds:

Although the ruling would not apply nationwide at the federal level, other states with similar state laws may look to this case for reasoning and may analogize to it even if it has no precedential value in any state other than California.

The ONC Tweeters seem happy to be back at the keyboard after a 16-day furlough.

Innovation and Research

 

Children’s Hospital of Philadelphia (CHOP) offers Harvest, an NIH grant-funded open source software toolkit that allows biomedical researchers to explore large data sets, such as those from EHRs and genomic databases. Researchers from CHOP’s Center for Biomedical Informatics are testing Harvest against several data collections, including the Longitudinal Pediatric Data Resource that tracks data from children with conditions detected in newborn screenings.

Technology

Deloitte introduces PopulationMiner, a data analytics solution that draws clinical, financial, and operational data from Intermountain Healthcare’s warehouse to support patient-outcome analysis.

ArborMetrix integrates surgical video analysis capabilities into its reporting and analytics platform, enabling healthcare organizations to improve performance benchmarking of surgeons.

Ninety percent of surveyed nursing home physicians say their use of drug references on mobile devices prevented at least one adverse drug event the month before the survey.

Other

Virtualization software and dictation with speech recognition applications are emerging as top areas for growth potential in hospitals, according to a HIMSS Analytics report on the US hospital IT market. The demand for ambulatory EMRs and ambulatory PACS also appears to be growing.

Joint Commission issues a sentinel alert warning for objects left inside surgery patients, which it says has caused 16 deaths in the past eight years. Most of the recommended actions involve processes and communication, but consideration of “assistive technology” such as RFID-tagged counting systems are also recommended.

In Canada, information on 2,000 patients of Parkwood Hospital is exposed when an unencrypted laptop is stolen from the car of a McKesson Automation employee.

Weird News Andy notes that California’s insurance exchange, Covered California, pulled down its online provider directory just eight days after go-live when the California Medical Association noted that obstetricians were labeled as ophthalmologists and doctors were incorrectly identified as speaking foreign languages. CMA also observed that some doctors were listed as exchange providers who didn’t actually sign up since insurance companies were permitted to add their in-network doctors to the list without their permission unless the doctor specifically opted out.

Staff and patients of Unit 5, the children’s cancer floor of the University of Minnesota Amplatz Children’s Hospital, create a video titled “Brave.”

Sponsor Updates

• SRSsoft hosts about 300 customers at its User Summit this week in Greenwich, CT.
• Sunquest and the Association for Pathology Informatics will offer an October 24 webinar on the topic of IT-driven virtual autopsies.
• Clinovations celebrates its five-year anniversary and highlights a few of its awards and honors.
• E-MDs integrates PatientPay’s online bill pay solutions within its PM software. The company will also integrate Phreesia’s point-of-care check-in solution into its EHR .
• St. Elizabeth Hospital’s (WA) use of e-form solutions from Access and hosted services from Inland Northwest Health Services helped the hospital meet HIMSS Stage 7 paperless requirements while eliminating the need for dedicated on-site hardware.
• Greythorn conducts a market survey for HIT professionals to analyze compensation, benefits, job satisfaction, hiring trends, and industry participation. Greythorn will donate $1 to the Boys and Girls Clubs of Bellevue and Chicago for every submission by November 20.
• Ed Bayliss, executive director for ChartMaxx, participates in a panel discussion on data exchange across the continuum of care at the eHealth Initiative 2013 Data Exchange Summit October 30-31 in Washington, DC.
• Humedica publishes a case study detailing how Mayo Clinic Health System prepared for value contracting using Humedica MinedShare.
• ZeOmega will embed Health Language technology from Wolters Kluwer Health into its Jiva care management platform.
• The Drummond Group certifies SRS EHR as a 2014 Complete EHR.

EPtalk by Dr. Jayne

You can tell that fall has arrived when every coffee vendor (including the one in the hospital lobby) is pushing pumpkin spice latte. Unfortunately, it is also the time I start sweating the fact that I need to come up with an extremely creative Halloween costume and come up with it stat. One of my favorite former bosses throws a massive party and the price of admission is a great costume. I enjoy Halloween immensely and have a closet full of costume options, but this party is peopled with brilliant individuals from academia, healthcare, and health IT so throwing on the Princess Leia braids simply will not do.

Maybe I’ll print a bunch of completely random attributes (some of which relate to me and some that do not) and go as my LinkedIn profile. I always laugh when people endorse me for knowledge of vendors I have never even heard of. I know several of the attendees are faithful HIStalk readers. Maybe I can convince my date to adopt a couples costume and we can go as Inga and Mr. H. Of course I could always go as Dr. Jayne, but that might be a little obvious. I guarantee at least one attendee will be wearing a bowtie and a Farzad-worthy grin.

The lobby of our medical school has a wall with pictures of our staff who have won various Nobel prizes. I could always dress as one of them and see if anyone picks up on it. Getting someone to identify that choice might be a little dependent on how far after the start of the cocktail hour I arrive, though, so not entirely a safe bet. I’m leaning towards possibly a World War I nurse just to have an excuse to purchase an awesome vintage cape. In medicine (and nursing) we used to dress more formally and I miss that. I understand that the current culture of scrubs is all about comfort and practicality, but I can’t help but think that if we dressed more seriously our patients (and administrators) might take us more seriously.

I took a course recently that covered communication and corporate culture. We did several exercises looking at how appearance plays a role in group dynamics. Watching several videos, we scored the characters based on believability, authority, seniority, and a host of other factors. Regardless of the scenario, those characters who dressed in traditional business attire scored higher than those who dressed casually. Besides dress, there are a lot of other factors at play with power dynamics, including the position of the participants (same height vs. seated/standing), tone, demeanor, etc.

I had the opportunity to rotate through a hospital in the UK during the late 1990s and was struck by the formality of the nursing staff. They still wore traditional dress whites (with caps) and nursing trainees wore blue. Physicians wore the long white coat and neckties. There were very few female physicians who I interacted with during my rotation, so I can’t particularly remember what they wore.

I trained at an academic medical center with an extremely traditional surgery department. Surgeons were never to wear scrubs outside the operating room. Trainees were not allowed to consume food or drink in the hallways – not even a sip of coffee – and white coats were to be fully buttoned at all times. Conversely, the OB/GYN house staff wore scrubs and sneakers 24×7, which created more than a few resentments. I wonder though if the patients or other hospital staff really perceived the departments differently? Was it a factor of dress code or of other factors that the dress code exemplified, such as discipline, order, and precision?

Scrubs and casual dress have become a way of life for most hospitals and medical offices. My hospital requires care teams to wear certain colors of scrubs depending on employee roles. Nurses wear navy, respiratory therapy wears light blue, patient care technicians wear khaki, etc. This seems to better help patients understand who is caring for them and what to expect. Unfortunately, physicians run the gamut between coat and tie and whatever scrubs they put on at the last hospital they rounded at. Some are so casual it’s hard to take them seriously. In response to a number of male physicians going sockless in loafers, one local facility created a rule requiring that “hosiery be worn at all times.” I’d like to have been a fly on the wall at the medical staff meeting where that was discussed: readmission rates, surgical site infections, ventilator-associated pneumonia, and bare ankles.

In the ambulatory care setting, the proliferation of scrub styles is mind boggling. We see a lot of “hip” medical assistants and patient care techs in low rider scrubs with flare bottoms that drag the ground to the point where they fray. I hope they never have to run to a code or crouch down to provide CPR, and if they do, that they have their waistband firmly in hand. One pediatrician I know has hand painted lab coats for every holiday and season. She’s the only physician on staff who wears a blue coat, so it really stands out. I smile every time I see her in the elevator, but I’m not sure what some of the patients and visitors think.

Generally I think the offices where staff dresses in a more uniform manner appear more organized and professional, but again maybe the dress code is a side product of management rather than a causative factor. Many of our offices provide staff with practice-logo polo shirts to be worn with khaki pants. This can be useful to reinforce an office brand as well as to help patients identify staff members, especially in busy offices with many ancillary services. That might be a great costume idea – maybe I’ll borrow a polo and masquerade as a staffer for a competitor practice.

I didn’t set out to write a fashion review, but perhaps Inga has been a greater influence on my writing than I previously thought. I could write an entire column on sassy patent leather hospital clogs, but we’ll save that for another night. I’m off to the internet for costume ideas. Got a great one? Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 10/17/13

Francisco Partners to Acquire McKesson’s Automation Unit

Private equity firm Francisco Partners acquires McKesson’s pharmacy automation business for an undisclosed sum. McKesson acquired the former Automated Healthcare in 1996 for $65 million.

Pace of EMR Adoption During the Past 5 Years

A HIMSS study finds that 25 percent of US hospitals have failed to raise their standing on the HIMSS Analytics EMR adoption model over the past five years. However, 20 percent of hospitals jumped four or five stages during that time.

Hospital Progress To Meaningful Use: Status Update

Health Affairs reports that as of July 2013, two-thirds of hospitals have achieved Stage 1 Meaningful Use and nearly all are engaged with the program in some way.

Department of Veterans Affairs and Department of Defense Interagency Program Office Awards Systems Made Simple Re-compete of iEHR System Integration Contract

The office responsible for overseeing the DoD/VA iEHR development has awarded a re-compete contract to incumbent iEHR service and support vendor Systems Made Simple. As the prime on the contract, SMS will provide technical support for the iEHR project, working to develop stronger integration between the VA and DoD systems.

Advisory Panel: Keeping Peers Informed About IT

The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a hospital or practice, you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

This question this time: What methods do you employ to keep your executive peers informed about IT initiatives, spending, and plans?

Regular face to face meetings (or a call) are always the best. 

Annual work plan development. Capital budgeting, especially the part of the process where business execs say yes/no to requests and as a result prioritize investments. Monthly leadership report of IS accomplishments to plan.

It’s all about governance. You have to have the structures in place to meet with your peers and have the decision making process completely transparent. I also use our executive meetings as opportunities to get on the agenda on a quarterly basis to give updates regarding IT activities.

Routine updates at Exec Team meetings. Lots of meetings. Annual report.

Multi-year IT roadmap, status reports, status meetings.

Our admin team is right down in the weeds with us since HIT is such a big expense. They have been reasonably agile and able to understand what we are doing, and actually ask good questions. Sorry, not a very Dilbert response.

Historically, there has been a disconnect between what IT sends out the end-user leadership and what actually gets communicated down to the folks in the trenches. If I had a dollar for each time I’ve rounded on floors during downtimes on the weekends and heard, “No one told us the system was going to be down”, I’d be typing this from a warm sunny beach somewhere. To bridge the gap, we have started publishing, at a minimum once a month) a newsletter focused on the team members and what they need to know about  IT initiatives. The plea I have made is for each department leader to discuss the contents at their respective huddles and to place it on the communication boards each department maintains. Thus, any team member who works has an opportunity to review it. (Are they up on all the boards in the hospital? What do you think? ) IT Updates are now a standing agenda item at the Friday weekly leadership huddle attended by senior leaders and department heads. I have two agenda items with the hope that repetition will help them connect the dots: (a) Here is what is happening one to two months out, and (b) here is what is going on next week. Beginning this budgetary cycle, I’m meeting with each department head (instead of their vice presidents) to discuss their goals / dreams / hopes for 2014. Many times IT has been backed into a corner by surprise requests coming from senior leaders that were unaware for whatever reason what their reports were considering. The hope here is if we can deal directly with the department head, we can set up a win/win experience for them and for us in terms of managing expectations.

Monthly updates in executive meetings if within organization – outside organization at regional and national meetings. Email within organization when appropriate. Newsletters to executives when appropriate.

IT leadership directly involved in system leadership councils and directly report to most senior leadership to be sure efforts are aligned with strategy. Involvement of clinical leadership in IT prioritization, governance bodies.

Monthly meetings, inclusion in the distribution announcements, phone calls on surprises, etc. This is most effective if the executive understands the importance of IT and informatics. When they don’t, it’s pretty useless.

IT participates in strategic planning sessions with health system executives. This was not true a few years ago, but is now. IT produces and sends out a monthly dashboard to executives of all key projects, which includes project status and barriers to completion. Each project has a health system executive as the key sponsor.

Lots of financial reports, for one. Those are what matter really, cost projections and cost actual. Outside of that we have a very simply way of showing project statuses. The classic green, yellow, red with only 5-10 lines of detail. There are also numerous meetings with different members of the executive suite on any given week as well. 

CIO Unplugged 10/16/13

The views and opinions expressed in this blog are mine personally and are not necessarily representative of current or former employers.

Thankfulness in Action

During a leadership meeting, one of our chief nursing officers, never nominated for Miss Congeniality, came rushing towards me. Although smiling on the outside, I braced on the inside for the tornado I expected would hit. I extended my hand in greeting, but she went straight for a hug. Not knowing her intentions left me cautious and suspicious.

She released the impromptu embrace. “Ed, you sent me a thank you card for serving in nursing while acknowledging my top 100 nurse recognition, and I was like ho-hum. But what caught me off guard is when I walked into the nurses’ lounge on our med-surg unit. On our community board was another card you sent to one of our floor nurses for her recognition as well. I tracked her down and she was blown away that a non-nursing executive would take the time to acknowledge her contributions in this way. It means a bunch to her, to me, not to mention her peers who all see the card.” Then she chided me for being forced to change her password every six months (j/k).

I’m paperless and proud of it. I have no printer drivers. You’ll rarely find me with a notepad, and I judge people—particularly those in healthcare technology—who still rely on paper. But I have one major exception. I still pen handwritten thank you cards. I always carry blank thank you cards and I send out an average of eight per week.

Here’s why:

Thank you card sales have hit an all-time low. Digital convenience has displaced some of the need, but I think the reason goes deeper than that. I suspect it’s a combination of laziness and lack of training. Growing up in the Marx household, we could not enjoy any gifts received without first having written a thank you card. This became second nature to us kids, and we’ve since passed this tradition down to our kids. I suspect they will do the same with theirs. No thank you cards, no gifts.

It makes a difference. Since handwritten cards are rare, the impact they have is magnified tenfold. People still love to receive snail mail, especially personalized mail. You can open a card and hang it in your office or place it on a desk. You can touch it, smell it, hold it to your chest. As another benefit, thank you cards differentiate you. When interviewing candidates, darn right I pay attention to which interviewee sends a card and which one does not. That little bit of effort speaks volumes and differentiates candidates.

Handwritten thank you cards are a physical expression of the word “care.” Recipients not only see that care, but they feel the effort and time it cost the sender.

What’s the best virtue of handwritten notes? They don’t beg for a response as do email. You send an email thank you, and the person now feels obligated to reply—“Back at ya.” Doesn’t that defeat the purpose?

Techniques:

1. Carry with you a stash of cards, and when you hear of a deserving act, whip one out. The five minutes you spend writing could bring a day’s worth of happiness to someone.
2. Write cards with your leadership team. This is a standing agenda item at our weekly meetings. There is always someone deserving of praise. (Not to mention it’s leadership by example.)
3. When you see or hear of someone who has received honor, send a card. For instance, whenever the top 100 nurse list is published, I target the nurses who work in my organization.
4. After concluding a meeting during which someone went above and beyond, start writing.
5. Each Friday, a task pops up on my schedule that says, “Give thanks.” I reflect on the week and decide who to thank.

Testimonials:

• A grumpy finance executive responded to a thank you card via email. “Thank you so much for the card. The timing was perfect. Had a real rough week. Made everything worthwhile.”
• A physician sought me out. “I have never received a thank you card from administration. This has given me fresh perspective.”
• I was rounding with nurses in one of our hospitals when one approached me during a break. “Oh, you’re Ed Marx? We’ve never met, but you sent me a card two years ago [emphasis mine] for working with your team on an order set. Thank you for noticing and sending the card.”
• Employees routinely stop me in the halls to say thank you for the card, some with tears in their eyes.
• My first platoon sergeant, a tough Vietnam vet, said, “Lt Marx, I was like what the shit, I am just doing my job … and then it hit me, leaders do the little extras. I just sent short notes to my squad leaders.”
• I sent a note to a CEO thanking him for his leadership and for my privilege to serve with him. “…nobody ever sent me a thank you card for no specific reason other than to say thanks for leading.”

I have a confession to make. I do store some paper actually—a pile of thank you cards I’ve received over the years. I can’t toss them. They carry such meaning. I’d wager it’ll be the same for the people who would receive a card from you. It becomes an oasis in the dessert. A Starbucks red-eye during an all-nighter. It’s salve on a wound and the bridge over a chasm. It can make our toils all worthwhile.

For whom are you thankful? Staff, your boss, a peer? Take action. Grab a card now and share your thoughts with that person. If your handwriting sucks, don’t worry, mine does, too. But no one has ever complained about it, and I doubt they even care.

Ed Marx is a CIO currently working for a large integrated health system. Ed encourages your interaction through this blog. Add a comment by clicking the link at the bottom of this post. You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook and you can follow him via Twitter — user name marxists.

Francisco Partners Will Acquire McKesson Automation

Private equity firm Francisco Partners announced this morning that it will acquire Pittsburgh-based McKesson Automation, which offers hospital pharmacy automation solutions. McKesson had announced plans to divest the business earlier this year.

According to a Francisco Partners spokesperson, “McKesson Automation is highly regarded in the healthcare industry for its system-wide approach to and deep understanding of the medication delivery process. We are excited to work closely with the existing leadership team to expand the automation business as a standalone company.”

McKesson acquired the former Automated Healthcare in 1996 for $65 million.