Curbside Consult with Dr. Jayne 12/24/13

I’ve seen this graphic about the interpretation of scientific jargon multiple times. It seems to turn up on Facebook or in an email every now and then. I read a fair amount of scientific literature and thinking of the alternate meanings always makes me smile. You could use it to play a kind of Mad Libs substitution game to liven up whatever article you’re reading.

As a medical informaticist (Now improved! With Board Certification!) I read the literature with a pretty critical eye. That probably goes back to my medical school training when I learned the importance of understanding whether the patient population in a clinical study was similar to the patient in front of me before deciding whether to use its data to alter my treatment plan. I’ve also read far too many studies that lack statistical validity or pursue therapies that although clearly proven are just irrelevant in real-world medicine. I’ve spent most of my medical career in the community rather than in the academic space and know that they can be vastly different environments.

As part of my preparation for taking the American Board of Preventive Medicine Clinical Informatics certification exam, I attended the AMIA Clinical Informatics Board Review Course. Although it was great to actually sit down and discuss informatics with others in the field, it was a little surreal at times. I’m used to working in a bit of a vacuum – most of the time I’m the only clinical informatics professional in any given meeting – so being surrounded by scores of my peers was a bit overwhelming. The fact that several people in the room were the authors of the texts I had been reading to prepare added to the intellectual climate.

By listening to some of the questions asked during the class, one could tell that some of the attendees were significantly more academic than others. I ended up spending most of the breaks off to the side with several attendees who were more community/clinical-based like I am. After the course, AMIA launched a listserv for attendees and being a silent participant has been entertaining. Watching highly-intelligent physicians interact over minute details of one thing or another can either be educational or mind-numbing depending on the topic and the people involved. Since we’re in a fairly new field, the group is very good about bouncing ideas off one another and one recent series of posts revolved around the idea of the environmental scan.

In a nutshell, an environmental scan is a review of the political, environmental, social/cultural, and technical factors around a business, industry, or market. Organizations benefit from doing an environmental scan periodically to understand the factors influencing their business and the challenges they may face now and in the future. One member was looking for evidence demonstrating a clear return on the efforts of doing such a systematic review. Her employer wanted it proven before they agreed to conduct one. Respondents quickly piped up with examples of business practices that may not be evidence-based but are good ideas, such as paying bills on time (which is pretty funny in and of itself) but one response had me laughing so hard I had to physically get up and walk around after reading it.

This particular scholarly work was published in the British Medical Journal and is titled “Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomized controlled trials.” Although it’s subscription-only, the abstract is available. The authors set out on a systematic review of randomized controlled trials “to determine whether parachutes are effective in preventing major trauma related to gravitational challenge.” Essentially they did searches of Medline, Embase, the Cochrane Library, and other sources to try to find literature proving parachute use is a good idea. Not surprisingly, they could not find any randomized controlled trials of “parachute intervention.” The conclusions are what pushed me over the edge (somehow the more formal-appearing British spellings make it even more humorous):

As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials. Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute.

It just goes to show that even those among us who are most academic can still have a sense of humor. It also reminds me (along with the original “show me the money” question about the environmental scan) that there are a lot of administrators and other people out there who still don’t understand what we do or what we can bring to the table as part of this new discipline. I’ve got a couple of people in mind that I’d like to enroll for that parachute trial. Perhaps you know a few candidates?  Email me.

Email Dr. Jayne.

Morning Headlines 12/23/13

Navy to VA: We Printed Out Health Records and Mailed Them

According to a NextGov report, despite millions invested in DoD/VA integration, when a sailor is discharged from the Navy a paper copy of their entire medical record is printed out, put in an envelope, and mailed to the VA where it is then, eventually, batch scanned into their system for benefits processing.

Our Epic Journey Begins With You

New Bedford, MA-based Southcoast Health System, a three-hospital system, will implement Epic across all of its hospitals and clinics.

‘Let the Crime Spree Begin’: How Fraud Flourishes in Medicare’s Drug Plan

A  ProPublica investigation uses Medicare’s own data and finds widespread fraud by analyzing the prescription data of physicians whose prescribing behaviors over time showed the hallmark signs of having been used for by scammers for fraud.

Monday Morning Update 12/23/13

From Kris Crinkle: “Re: Epic. The bells rang for a new contract signing. Southcoast Health System (MA). Replacing Meditech Magic, eClinicalWorks, athenahealth, and Cerner homecare. I’m an avid reader and love the format, especially Dr. Jayne.”

From JG: “Re: musical stocking stuffers, best of 2013. The Growlers, Dean Wareham, The Men. Thank you for everything you do!” I listened to all three bands and liked all three.

From The PACS Designer: “Re: all-digital solutions. A truly remarkable event took place at this year’s RSNA. Philips Healthcare introduced the world’s first all-digital diagnostic treatment solution in the form of a CT/PET Scanner. This event should be of great interest to Doctor Dalai as he’s been contemplating the purchase of such a system for quite some time.”

A ProPublica investigation uses the federal government’s own Medicare databases to find evidence of rampant Medicare drug plan fraud, with organized groups either stealing the identity of doctors or bribing them to write prescriptions. Medicare’s process is so poorly managed that they rarely catch anyone. Example: Medicare paid $3.8 million in one year to fill the prescriptions of a psychiatrist, most of them for drugs unrelated to his specialty, when someone stole his identity. Pharmacies and insurers say they’re reporting suspicious behavior to Medicare but are being ignored. The series of articles concludes that newspaper reporters can easily detect fraud from Medicare’s databases, but the agency itself isn’t doing it.

Fraud rings use an ever-evolving variety of schemes to plunder the program. In one of the most popular, elderly, broke, disgraced or foreign-trained doctors are recruited for jobs at small clinics. Their provider IDs are used to write thousands of Medicare prescriptions for patients whose identities also may have been bought or stolen. Once dispensed, the drugs are then resold, sometimes with new labels, to pharmacies or drug wholesalers. In other schemes, investigators say, pharmacies are active participants, billing Medicare multiple times for prescriptions they never fill. Doctors can readily disavow the prescriptions as forged, investigators say. And because the schemes don’t always involve painkillers, a law enforcement focus, they can escape notice.

Weird News Andy delivers this story, which he titles “Yes C-Section, No C-Baby.” Doctors in Brazil perform an emergency C-section delivery after failing to hear the baby’s heartbeat, only to find that their patient wasn’t pregnant. The woman showed up with proof of her prenatal care and a protruding abdomen, but she was having a false pregnancy, her second of the year. The hospital suggested she seek mental care instead.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 12/20/13

DeSalvo Named National Coordinator

Karen DeSalvo, MD, MPH, MsC will be the next National Coordinator for Health Information Technology. She will take over on January 13, relieving Jacob Reider, MD, who has served as interim national coordinator since Farzad Mostashari, MD stepped down in October.

Workgroup for Electronic Data Interchange ICD-10 Survey Results

Vendors, hospitals, practices, and payers are all behind in preparing for the ICD-10 conversion, according to a new report.

Reps Matsui (CA) and Johnson (OH) Introduce Bipartisan Legislation Creating a Federal Definition of Telehealth

Representatives Doris Matsui (D-CA) and Bill Johnson (R-OH) have introduced the Telehealth Modernization Act of 2013, which would help standardize telehealth reimbursement policies amid inconsistent state legislation.

Kansas’ online medical records networks to connect, starting Thursday

On Tuesday, the Kansas Health Information Exchange will connect with the Lewis and Clark Information Exchange. The HIEs are for-profit competitors and initially fought the state’s mandate that they share records, going so far at one point as to threaten to charge each other transaction fees for each shared record.

News 12/20/13

Top News

HHS names Karen DeSalvo, MD, MPH, MsC National Coordinator for Health Information Technology. DeSalvo, health commissioner for the City of New Orleans, will start on January 13, succeeding Farzad Mostashari, MD, MsC. According to an internal email from HHS Secretary Kathleen Sebelius, “Throughout her career, Dr. DeSalvo has advocated increasing the use of health information technology (HIT) to improve access to care, the quality of care, and overall population health outcomes –including efforts post-Katrina to redesign of the health system with HIT as a foundational element.”

Reader Comments

From MC Scanner: “Re: Apple commercial. The video for ‘Misunderstood’ that will air on TV next week brought tears to my eyes. It’s amazingly powerful – even better than their ‘1984’ ad.” Maybe I’m just being a Scrooge, but it seemed to me like a lame, Microsoft-style attempt to make people believe that their lives are incomplete unless they experience it using consumer technology. This commercial features a kid who chooses not to participate in family holiday activities with everybody else, instead messing around with his phone and recording everything for the big reveal when he shows the edited video to the family on the big screen TV. The message appears apt for the self-obsessed Facebookers of the world who can’t turn their smartphones off long enough to participate in the world instead of documenting it in Kodak moments for public display. I was creeped out when the family stopped doing everything warm and loving about the holidays and instead stared at themselves on TV, suddenly overcome with affection for the kid who couldn’t relate to them otherwise (probably because he never stops staring into his phone). Here’s my alternative, non-Apple approved holiday message: put down your electronic pacifiers, spend time with people you love, forget the always-beckoning fantasy world of your phone for just one day, and live like a human instead of an online avatar.

From Unnamed: “Re: [company name removed]. Laying off US employees right before Christmas, moving jobs to India, cutting budgets by 25 percent, and disregarding outstanding financial commitments. Sounds like a HISsies ‘Stupidest Vendor Move’ category.” We had some financial problems with that company, too.

From Jack: “Re: Orion Health’s list of best healthcare reporters and blogs. I saw this and figured either your actual name was on here (gasp) or whomever wrote this doesn’t actually read HIStalk. But how in the world do you get left out of that list?” HIStalk gets left off quite a few of the “best HIT sites” lists for several reasons: (a) it competes with the interests of whoever created the list; (b) it’s based on an Internet metric like Alexa or Klout scores; (c) they can’t figure out whether to consider HIStalk a blog or something else; or (d) they think other sites are better, which is perfectly fine and maybe they’re right. I never look at those lists and I often haven’t heard of the sites they proclaim as the busiest or best, but all I know is that Orion Health sponsors HIStalk, which seems to indicate they think it’s OK even though it’s not on their “Five Healthcare IT Reporters You Need to Follow” or “Health IT Thought Leaders” list.

HIStalk Announcements and Requests

From HIStalk Practice in the last week: a few moonlighting suggestions for physicians. CMS offers informal reviews for EPs and group practices who will be subject to the 2014 eRx payment adjustment. CMS confirms that providers who assign their reimbursement and billing to a CAH under Method II are now eligible to participate in the MU program as EPs. A solo physician does a commendable job addressing a data breach. Salaried GPs in the UK face declines in compensation. My favorite gift, regardless of the holiday, is having new readers, so please take a moment and stop by. Thanks for reading.

Listening: The Honorary Title, a Brooklyn-based indie rock band that flamed out in 2009 without a lot of success. I’ve been obsessed with Nada Surf lately and they sound a good bit like them.

Welcome to new HIStalk Gold Sponsor (and HIStalk Connect Platinum Sponsor) CareSync. The Florida-based company offers a family health record and the mobile-based Visit Manager that provides access to a family’s medical records, organizes questions for providers, and stores to-do lists and notes, all to get family members organized before, during, and after their medical appointments. Information can be selectively shared with providers and family and friends who are helping with health needs. It allows tracking of health goals, prescriptions, emergency contacts, and providers. The company’s team of medical records specialists will even help assemble and organize the health information. It is reasonably priced and could make a nice Christmas gift for a family member. You probably know some of the industry long-timers who are involved – Travis Bond (Bond Technologies) and Amy Gleason, RN (Allscripts), to name two. Thanks to CareSync for supporting HIStalk.

I found this CareSync video on YouTube that explains it much better than I just did.

Sales

Mercy Health Physicians (OH) will implement PatientPoint’s patient engagement solutions.

Queen Elizabeth Hospital King’s Lynn (UK) selects iMDsoft’s MetaVision for its ICU.

Children’s Medical Center (TX) engages PCCI to build predictive analytical models to identify children at-risk for asthma crises and to develop an information exchange between pediatric and social services providers.

People

ClearDATA names Scott Whyte (Dignity Health) SVP for growth and innovation.

Ryan Donovan (Visa) joins Practice Fusion as VP of corporate communications.

CareInSync hires Cheryl Cruver (The Advisory Board Company) as SVP of provider solutions.

Rainu Kaushal, MD, who holds a number of roles including informatics at Weill Cornell Medical College and New York-Presbyterian Hospital, is named chair of the college’s Department of Healthcare Policy and Research.

Announcements and Implementations

Arch Health Partners, a medical foundation affiliated with Palomar Health (CA), deploys Phytel’s population health management platform.

Kansas HIE and the Lewis and Clark Information Exchange connect their networks.

University of Colorado Health migrates 17,000 mailboxes from three disparate healthcare organizations on multiple legacy email platforms into one single consolidated Microsoft Office 365 environment. The consolidation is expected to save the organization $13.9 million over 11 years.

Landesklinikum Amstetten (Austria), AZ Sint Lucas (Belgium), Hospital La Pitie-Salpetriere and Centre Hospitalier Regional De Metz-Thionville (France), and Medway Maritime Hospital (UK) go live with the iMDsoft MetaVision platform.

Wesley Medical Center, Cypress Surgery Center, and Surgery Center of Kansas go live on Anesthesia Touch from Plexus Information Systems.

Lehigh Valley Health Network (PA) implements Salar’s TeamNotes, which sits on top of GE Centricity EMR to facilitate ICD-10 compliant documentation.

Government and Politics

A report by the Senate Commerce Committee highlights minimally regulated data brokers that buy and sell patient data, including disease-specific patient lists and in one case, lists of rape and domestic violence victims.

The VA’s ongoing cybersecurity problems are the subject of a Federal News Radio series, which points out the material weaknesses listed in its financial statements. Among them: failing to revoke network access of terminated employees, failing to keep unauthorized software off the network, and improperly securing Web-based applications. An unnamed government official says the VA CIO’s office has developed a siege mentality against Congressional inquiries, concluding,

“I find it disingenuous in how they are responding to this and the degree of contempt they have in how they are approaching this. They feel it’s a witch hunt. There is a marked lack of respect for the committee by the IT leadership. How they are managing the process is indicative of the lack of respect for Congress and particularly the Veterans Affairs Committee. They think it’s a game so they will evade, obfuscate and they will basically come back with just the bare minimum so as not to be out of compliance.”

The Oregon government official in charge of the state’s trouble-prone health insurance exchange website resigns. The state had bragged that its marketplace would be one of the most advanced when it opened October 1, but it still can’t handle electronic applications and required hiring 400 workers to process paper forms. Carolyn Lawson, CIO of the Oregon Health Authority and Department of Human Services, stepped down Thursday for “personal reasons.”

Representatives Doris Matsui (D-CA) and Bill Johnson (R-OH) introduce the Telehealth Modernization Act of 2013, which would create a federal definition of telehealth based on an earlier California definition with the hopes of standardizing inconsistent state-level policies. It addresses patient-provider relationships, informed care,  provider documentation, sending documentation to other providers, and prescribing requirements.

Technology

Scripps Health launches a pilot of the Sotera Wireless ViSi Mobile vital signs wrist monitor, which measures ECG, heart rate, pulse,  oxygenation, and temperature.

MMRGlobal is awarded another patent, this time for just about everything a person can do to access health information on a mobile device.

Other

The healthcare industry is making slow progress on preparing for ICD-10, according to a WEDI readiness survey. About 20 percent of vendors claim they are halfway or less complete with product development, while about half of providers have yet not completed an impact assessment. Meanwhile, about one-third of health plans have not initiated internal testing; two-thirds have not started external testing.

The Orlando newspaper profiles Automated Clinical Guidelines, which offers some kind of clinical pathway guidance product whose company-provided description is obfuscated by a writhing nest of unintelligible HIT-related cliches that marketing people dream about when you naively ask what a particular product does and 20 minutes you still have no idea:

ACG has developed an innovative healthcare ecosystem that is patient-centered, operates in real-time, is language-independent, and serves up evidence-based medicine for application on a worldwide basis. The ACG expert system represents a breakthrough in processing structured clinical information utilizing automated clinical guidelines. ACG software is a patented, smart, internet-based, and platform independent solution to the medical crisis in a demographically aging world faced with a severe shortage of physicians. ACG is NOT an EMR or an EHR product and in fact operates in a product space that is totally EMR/EHR independent. ACG revenue streams come from annual renewable institutional contracts, physician patient visits on a per click basis, and by medical products advertising. The ACG ecosystem is an elegant design that requires little or no training and guides the user by use of Symbolic and Boolean logic clinically correlated algorithms, as opposed to current attempts to use database centered templates and report writers.

The Houston newspaper writes up Decisio, which formats information from patient monitors into an electronic triage system. Says CEO Bryan Haardt, who was COO of Prognosis Health Information Systems until June 2013, “Today’s thermostats have more intelligence than most medical monitors.”

Cottage Health System (CA) discloses that the information of 32,500 patients was exposed when a vendor inadvertently opened up one of its servers to the Internet. As is nearly always the case, the problem was discovered by someone who found the information while Googling names. Surely there must be a monitoring service that can ping a supposedly secure server from outside the firewall and raise an alert if it gets in.

AMIA runs a list of its members who passed the first clinical informatics subspecialist exam in October.

A 66-year-old man files a lawsuit against Advocate Condell Medical Center (IL), claiming that hospital security guards threatened him, beat him, and bit him as he attempted to discharge himself from the ER. The main waited six hours for treatment of his TIA before trying to depart for another hospital, at which time he says seven security guards verbally and physically attacked him. Following the altercation, he claims he was injected with narcotics, strapped to a gurney, and kept in the hospital for six days.

Weird News Andy offers a list of items “for all the HIStalk techies in your life” from this article, cynically saying of an anesthesiologist robot, “What could go wrong?”

WNA will be sorry he didn’t see this first. A Chicago ED doc says he deals with sex-related accidents twice per week, enough to make him the star of a stupid new reality show (was that redundant?) called “Sex Sent Me to the ER.” Some of the cases he’ll cover involve people who fell on penetrating foreign objects (right), broken penises, and a 440-pound male virgin so focused on his first sexual experience that he pushed his girlfriend’s head through a wall. It looks stupid, sensationalistic, and poorly made, which of course means it will be an instant hit.

Sponsor Updates

• Visage Imaging lists the top five trends it observed about enterprise imaging at RSNA 2013.
• QPID releases some funny, holiday-themed training videos for its customers (1, 2, 3).
• The MarketsandMarkets research firm ranks Perceptive Software’s Acuo VNA platform the world market share leader among all independent and PACS-affiliated VNA solution providers.
• ICSA Labs awards CliniComp’s Essentris v213.01 software 2014 Edition Inpatient Modular EHR ONC Health IT Certification.
• Deloitte includes Kareo on its Technology Fast 500 list of fastest growing technology, media, telecommunications, life sciences, and clean technology companies in North America based on its 797 percent growth over the last five years.
• Gartner positions Informatica as a leader in its 2013 Magic Quadrant for Data Masking Technology report.
• University College London (UCL) and Elsevier will establish the UCL Big Data Institute to explore innovative ways to serve the needs of researchers by providing analytical data for scientific content.
• The Drummond Group certifies Alere Analytics Clinical Quality Measures Services version 2.1 and Public Health Electronic Laboratory Reporting and Communication Portal version 3.2 for ONC-ACB MU as Modular Inpatient and Modular Ambulatory solutions respectively.
• T-System offers free T-Sheets flu documentation templates to hospitals and healthcare providers.
• Greenway Medical Technologies wins the 2013 Intel Innovation Award for its PrimeMOBILE app for Windows 8.
• Besler Consulting releases a review of the Hospital Outpatient Prospective Payment System 2014 final rule.
• Experian integrates its identity proofing and risk-based authentication platform Precise ID for health care portals with Epic’s MyChart patient portal.
• Impact Advisors principal Laura Kreofsky discusses HIT in 2014.
• E-MDs Cloud Solutions v. Cirrus achieves ONC-ACB certification for MU Stage 1 and 2 and is compliant as a Complete EHR 2014.
• Huntzinger Staffing Solutions expands its offerings to include Cerner staffing and sourcing services.
• Carolyn Brzezicki, senior clinical specialist for Healthwise, challenges readers to behave as if they have Type 2 diabetes for one day.
• Billian’s HealthDATA hosts a January 16 #HITchicks Tweet Chat.
• HIStalk sponsors winning Fierce Innovation Awards include Health Catalyst for Best Problem Solver and Data Analytics; Patientco for RCM; QPID for Best Cost-Saver and Clinical Information Management; and CoverMyMeds in the HIE category and an overall award in Best in Show: Best New Product/Service.
• Australia’s Adelaide Research and Innovation names Wolters Kluwer Health an Innovation Champion based on its ongoing partnership with Joanna Briggs Institute to bring evidence-based practice resources to healthcare institutions globally.

EPtalk by Dr. Jayne

I keep my eye on Twitter for interesting health IT items. A mention of “24 Outstanding Statistics on How Social Media has Impacted Health Care” caught my eye, mostly because of the use of the number 24. Usually articles will feature a top 10, top 20, maybe a top 25 but I thought going with 24 was an interesting choice. The statistics are drawn from some interesting sources from advertising and media firms to Mashable.

The first two numbers weren’t surprising: 40 percent of consumers say social media impacts how they deal with their health, 18-24 year olds are more likely than 45-54 year olds to use social media, and so on. The third did surprise me: 90 percent of those 18-24 said they’d trust medical information shared by others on their social media networks. This little tidbit doesn’t give me a lot of hope for humanity since my “official” practice persona is Facebook friends with a number of our patients in that age bracket. Let’s just say that most of the posts from that demographic are not exactly systematic literature reviews.

I wonder if they also buy into links for “one simple way to lose belly fat” or “avoid this one food to lose weight?” Behind the closed door of the exam room, I’ve heard a lot of things that 18-24 year olds say about health issues and can confidently attest that most of them have been bogus. Typically those conversations have been in the realm of reproductive health, which probably adds to the mystery of some of their statements, but I’m not sure I’d trust most of the advice these teens have been given by their peers.

Back when the Internet was all we had, I used to counsel patients that the Internet is like the world’s largest bathroom wall. There are a lot of things written on it and some of them are certainly true, but it’s hard to figure out which. The number and volume of sites, apps, and sources available now makes keeping track of the truth even more challenging.

Only 31 percent of healthcare organizations have written guidelines for social media, which I think is low, especially if the respondents were organizations of any size. A good friend of mine is a plaintiff’s attorney and regularly licks his chops at the prospect of litigating cases where medical advice was inappropriately given via social media or where patient-specific information was inadvertently released. Another statistic later in the piece states that 26 percent of hospitals participate in social media, so perhaps the relatively low rate of those online makes the guidelines percentage look a little better.

I liked the statistic that 54 percent of patients are “very comfortable” with their providers using online communities to aid in treatment. It’s validating for me personally since I was once yelled at by a hospital VP after being quoted in a newspaper interview about using the Internet to search for information while seeing patients. He told me it was “unseemly” to admit that you didn’t know everything the patient needed you to know and would undermine confidence. I’ve always found patients appreciated the fact that I admit I don’t know everything and am willing to make sure I have the correct approach before I apply it to their situation.

Although 41 percent of people claim social media would impact their choice of a physician or hospital, I’d like to see the numbers if we asked which was more influential: social media or insurance coverage. I’m pretty sure reimbursement trumps reputation and quality much more often than most of us would like. Among resources used to health information, Wikipedia was at 31 percent. Since I personally use Wikipedia to validate information fairly often, that felt low to me.

I was heartened to learn that 60 percent of people trust physicians’ social media posts over any other group. In real-life clinical practice, it felt like I was often competing against Aunt Betsy or the neighbor up the street, so six out of 10 isn’t bad. Given this number in light of the statistic about the 18-24 year olds being so trusting of items seen on social media, I should probably start posting “safe sex” advice on my professional Facebook page. I’m sure my grandmother would be scandalized, but I can say I’m doing it in the name of science.

The final statistic mentioned is that Facebook is the most popular for hospitals that have an online presence. I must admit, my professional self no longer follows my hospital’s Facebook presence because I simply couldn’t take it any more. Rather than being a good source of health information and patient advocacy, it had become little more than a marketing vehicle. If I read one more congratulatory back-pat for earning some bogus “Top Whatever Hospital Center of Excellence Patient Choice Satisfaction” award, I was going to need anti-nausea medication.

What would Mark Twain think of the information age and its lies, damned lies, and statistics? Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

DeSalvo Named National Coordinator

Karen DeSalvo, MD, MPH, MsC has been named by HHS as National Coordinator for Health Information Technology. DeSalvo, health commissioner for the City of New Orleans, will start on January 13.

According to an internal email from HHS Secretary Kathleen Sebelius, “Throughout her career, Dr. DeSalvo has advocated increasing the use of health information technology (HIT) to improve access to care, the quality of care, and overall population health outcomes –including efforts post-Katrina to redesign of the health system with HIT as a foundational element. ”

Morning Headlines 12/19/13

How mandated reporting set infection rates on the decline 

Six years after New York’s Department of Health started publishing hospital-acquired infection data, the rates of most infections are trending downward.

GAO report says CMS’ rule on quality reporting system may be too vague

A GAO report finds that new CMS rules designed to boost participation in PQRS reporting are too vague to have a meaningful impact on participation. The report’s authors suggest that one solution could be to require EHR vendors to develop reporting tools that make it easier to extract the data that the PQRS registry needs.

Saint Francis debt: $50 million

Poughkeepsie, NY-based St.Francis Hospital files bankruptcy after billing issues associated with its recent Meditech implementation leads to millions in unrecoverable lost revenue. CEO Art Nizza took ownership of the problem, saying that the clinical systems worked well because proper attention was paid to their implementation, and that had the same attention been given to the revenue cycle implementation, the problems might not have grown to the point that bankruptcy was necessary.

Ryan Donovan Departs Visa For Late Stage Start-Up

Ryan Donovan will leave his position as head of global PR for Visa to join Practice Fusion as the VP of corporate communications.

CIO Unplugged 12/18/13

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.

Advisory Panel: HIMSS Booth Reps

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: When you are approached by a rep at a vendor’s booth at the HIMSS conference, what factors (their mannerisms, appearance, actions, handouts, etc.) make you most likely to pay attention?

He or she needs to be very outgoing and engage me. I’m generally exhausted and numb from all the activity on that floor. I have trouble sorting the wheat from the chaff.

It’s important that the booth signage and setup communicate something about the products or services the company offers. Weird, techy names and generic descriptions like, "Biodynametric. We enhance interoperability and efficiency across the continuum," and I pass on by. Second, the guy who lunges at me from the booth is another non-starter. Professional dress and demeanor combined with a pleasant introductory line usually works. "Are you having a good show?" Or, "Good afternoon. Are you interested in learning about our new line mobile device integration software?" Something like that.

A drug rep once told me, when I asked her to not waste my time and to tell me something that I did not know already, that in sales training they are told that it takes a doctor eight times to hear a message before they start registering and remembering to write their drug. Needless to say she never set foot in my office again, but later I learned  that Big Pharma  calls this "the rule of seven touches.” It is indeed believed that it takes that long to build a relationship based on trust. Having said that, I like to see a vendor who does not ask for my email after we just got introduced, only to bombard me with their white papers. Who does not act as if they would rather be somewhere else, but who also makes me want to see or speak to again. Who understands that I will not sign a contract at their booth and that I will not be impressed by the size of their booth or the amount of useless goodies but by their humility and knowledge. Also, since the number of doctors walking the hallways at HIMSS is dwindling and the decision and buying power is being stripped away from them, if the vendor sees an MD who is still practicing and  took the time to be there, maybe he or she should listen to him before throwing a sales pitch as it may teach a thing or two about how doctors think and operate. It is ultimately the doctor who is the end user of IT and unless we talk about patients treating themselves( there seems to be no shortage of solutions for "do it yourself" under the disguise of "patient engagement") we cannot take our eyes off that ball or soon the HIT vendors will sell to …each other. And in my exam room it is getting pretty crowded.

A non-salesy and personally engaging approach works well for me, particularly ones that don’t make me feel like I’m trying to be picked up in a bar. Don’t glance at my badge before you look me in the eyes. And I particularly dislike the sales pickup lines like, “Do you have any concerns or issues about or around [fill in your self-serving topic]…” They are quite the turn-off and I will say no even if I do. Engage me and let the conversation go where it may. If there is an opportunity for a fit, things will take care of themselves.

To be honest, I generally avoid the stalkers. I put on my “don’t talk to me” face and it’s been pretty successful to date. Also, I don’t generally use HIMSS to research new products. I use it as an opportunity for face time with my current vendors.

If it actually starts with a conversation rather than a sales pitch. (How are you enjoying the show? What have you found interesting so far?)

Personally, I rarely react well to being approached by a vendor rep. My preference is to walk through their booth to get a feel for what I’m seeing on their screens or promotional details, and if I find something I find interesting, I’ll ask a rep to explain it to me then. And when they do, my preference is that they skip all the BS and just hit me with the major points, key facts, concepts etc. of their solutions. I don’t need to spend time hearing how we all understand XYZ (e.g, reimbursement, big data, ACOs, HIEs, whatever). I don’t want to spend any time chatting or building a relationship with them. Suggestion to vendor reps:  think "speed dating," but focusing on your solution, not each other. You don’t really need to know what issues and challenges we’re facing — we’re all facing the same ones. I have 1,000 vendors to see today — make your few minutes count and maybe I’ll come back for more.

I know it sounds superficial, but the first impression is very important. If the person looks dirty or sloppy, I will not take time to talk to them. I feel that if they cannot put their best foot forward when representing the company, then they will not put their best foot forward with me as a customer. I also want someone who is friendly and makes eye contact. My biggest complaint at HIMSS or any show is that a lot of booth reps act like they don’t want to be there or want to be bothered talking to anyone. Friendly, energetic, and knowledgeable wins every time in my book.

Unfortunately, appearance matters. The best sales pitch is lost if  you don’t look like you represent a vendor with its stuff together. I seldom visit booths at which I have not made an appointment, but taking that walk around and getting inundated with pitch after pitch can be fun sometimes. When I do,  I first look to someone who appears like a professional (neat in whatever booth attire they have chosen – but I prefer business attire to the casual polo shirt.) Second, they have to be able to give me the “what we sell” pitch in two minutes or less. If they can accomplish this, the chance of me stepping into the booth to look at the product is greatly increased.

I tend to be uninterested in or entirely put off by being approached at all. The most annoying vendor hall experience I had was a vendor rep that caught sight of my badge and followed me for a while and then approached me by name as if he were another attendee. Very off-putting. I go to the vendors that I want to talk to on my own — don’t approach me. I do my homework ahead of time to determine who will have something I want to learn more about or a possible solution to a problem we have, but I will also skip them and mark them off the list of potential partners if I cannot quickly get a friendly and informed representative to pay attention.

I avoid anyone in stilettos or sexy outfits. I’m not there for sex – I’m there to learn. Someone who looks genuine and actually has a pedigree is someone I walk towards. Sex does not sell in HIT, only when trying to sell Viagra or something. Get rid of the sexy pots at HIMSS booths.

If I don’t know anything about the vendor, I need to hear a compelling elevator speech about what they do. During that speech, if they are articulate and passionate, I may stay longer. If I do, then appearance and mannerisms help keep my attention. If all they know is the elevator speech, I move on. A stunning blonde with nice legs overrides all these professional considerations. If I do know something about the vendor, I would probably just move on.

This falls into two categories. (1) I already know I want to see the vendor, in which case I will look for someone who is experience and can give me the real details. Or said another way, I avoid the young kids who look like it’s their first conference as well as the high-level VPs who can only give me high-level answers. (2) An unexpected surprise… maybe it’s a vendor I had heard about somewhere, or maybe they have a slogan that is intriguing or better some stats that stand out (e.g. "We save our practice 10 percent of costs a year!") Usually these are the smaller booths and there are only 2-3 people there, and they are always very helpful and grateful and give a good talk.  

I’ve never been to HIMSS but I’ve been to plenty of other professional conferences where pharmaceutical reps were trying to lure me into their booths and I’ve been to the user conference of my hospital’s EHR software vendor which has their own reps and those for affiliated products lying in wait. Thus, I’m fairly confident that HIMSS would be similar. In general, I walk up the middle of the aisle slowly, feigning disinterest to get a sense of whether I have any interest at all in the products being offered. Part of my reconnaissance involves watching the interactions of the booth reps with unsuspecting passersby. Then I go back up the aisle and stop at key booths of interest. If the reps do not look professional or are cloying or annoyingly pushy, their product is crossed off my list of stops unless it’s REALLY amazing. When I stop at a booth of interest, I’ll glance at their materials if they’re with someone else (and sometimes move on if it’s not of interest). If they’re available, I’ll ask them to tell me a bit about their product. If they are straightforward, answer questions reasonably, and let their product sell itself, that’s a big plus. If they come on too strong with buzzwords and marketing hype or start asking too many "friendly" personal details (e.g., "Oh, I see from your badge you’re from Badger Falls — my Aunt Bessie’s ex-husband grew up there") I’ll say that I just wanted to get their materials and that I’m not in the market right now. Then I hightail it off to the next booth. This dramatically improves my efficiency and lets me spend quality time at the booths that are of greatest help. Even if I’m really interested in a product, it’s not efficient to deal with a rep who’s not knowledgeable or just trying to sell me a bill of goods (sometimes I’ll go back to such a booth later when a different rep is there.) When I do get a handout, if it’s pure marketing pablum, it goes straight to the circular file. I want to see details that will help me make a decision. With software-related products, a key to try to product for 10 days or a sample CD to get an actual feel for the program gives multiple bonus points in my eyes. Again, the booth is confident enough in its product that it knows it can sell itself.

I try to ignore all sales people as much as possible while waking the halls.

I am rarely approached by vendors, and when I am, I feel I am being treated like the the last girl in the bar at closing time. When I seek out a vendor (I do my homework) or I am attracted by a display, I want the elevator pitch, some literature, and contact information. I pick the person that seems most likely to give me what I am looking for without being clingy. Mannerisms? Professional. OMG, no flirting. Appearance? Sorry, but the middle-aged white guys or the person that the other boothies defer to  is the person with the most efficient pitch. If it helps, it is harder to pick out who is in charge than it used to be.

When I’m asked a question. “Are you interested in learning more about _____ ?” Not a brand name, but rather a function or feature –I can see the brand name since I’m right at the booth. Pitch your product with a question, and I don’t mean of the form, “What are you currently using for _____?” In short, don’t sell—teach.

Mannerisms, appearance, first sentence.

I have found that the art of navigating the HIMSS hall is to have a plan. Know what you are looking for, perhaps even the vendors you are interested in, and so forth. I have found the hall to be more beneficial if you add intentionality to your visits. I do not like gimmicks, but a free beer, water, snack, or other food item helps. I also like vendors that provide trash bags (oh, I mean, brochure bags,)  I do not like vendors that “attack” a passerby.

If I’m in their booth because I haven’t heard of their product or don’t know much about it, then I’m focused on how quickly and clearly they can explain their product’s practical application and how it can provide value to my organization. If I’m there because I have decent knowledge of their product, then my goal is most likely to get specific questions about how their product works answered. In this case, the last thing I want to hear is them talk about the practical application and value proposition of their product. I’m focused on the knowledge of the person I’m speaking to. If they quickly say that they cannot answer my question, kudos. I’ll give you a second chance. If they blow smoke, then I may blackball them when I get home. In either case, if the sales person talks about a partnership or attempts to get to know my personal interests, then they immediately lose points in my book. Their job is to take as much of my health system’s money as they can while ensuring that they provide good enough service for us to perpetually pay upgrade and maintenance fees, not buy me tickets to the World Cup (which would be the right way to bribe me). My advice to the sales folks — open our conversation by asking me why I’m there, what I know about their product, and if I have any specific questions for them. As I answer those questions, ask clarifying questions about my business situation (facility size, location, etc.), and then tackle the problem at hand. It will work way better than the gibberish your marketing person wrote.

A mild manner is preferable (Jimmy Stewart over John Wayne). A working demo of their product and the knowledge to use it – amazing how often this is not available (Alfred Turing over Don Knotts). I am a fan of understanding the challenges of a community hospital and not quoting how they solved a problem at Johns Hopkins or UCLA (i.e. Fred MacMurray over Roseanne Barr).

Appearance and mannerisms. Down to earth “real” people versus salesy used car salesman type folks make me want to stop and talk. The booth babe costumes really turn me off. Because there are so many booths at HIMSS, the signage is also one of the things that gets me to stop for a look.

Readers Write: Santa Claus, Flying Reindeer, and the HIPAA-Compliant Data Center

Santa Claus, Flying Reindeer, and the HIPAA-Compliant Data Center
By Grant Elliott

This holiday period will see a rerun of many classic holiday movies, with one of my particular favorites being Miracle on 34th Street. A delightful film about the importance of retaining faith, even in the absence of any evidence – in this case, whether Santa Clause is real. As C.F. Cole puts it in the 1994 remake of the movie, “We invite you to ask yourself this one simple question: do you believe in Santa Claus?” following which all across the city people start putting up signs proclaiming, “We believe.”

As I walked around the exhibition floor of the 2013 mHealth Summit last week, I felt I was being asked to take a similar leap of faith. Specifically, that every company there was HIPAA compliant simply because they said so. For most, it would be part of their sales pitch. The term “HIPAA compliant” would be sprinkled liberally throughout the description of their service. For some, it was actually emblazoned on their wall posters. “HIPAA Compliant Data Hosting” and “HIPAA Compliant Mobile Development” are two I specifically recall.

When I challenged them on what they were actually doing to be HIPAA compliant, the answer was too often limited to, “We store our data in an encrypted database,” or, “We use a HIPAA-compliant data center.” Therein lies a key challenge within the SMB health tech marketplace. Too many companies simply do not know what it means to be HIPAA compliant. That is a particular concern given that recent changes in the law mean they are now federally required to be so.

Why is simply storing data in an encrypted database an insufficient response?

The objective of HIPAA is to protect the “confidentiality, integrity, and security” of electronic Protected Health Information (ePHI). While encrypting data can certainly be a part of this, it does not cover the many other aspects also required, including determining who has access to the data; how and where the data is being shared; who can edit or delete the data; and so on.

The HIPAA security rule alone contains 42 standards and implementation specifications spread across three groups – administrative, physical, and technical. This is separate from the HIPAA Privacy and Breach Notification Rules, both of which are part of the overall HIPAA compliance requirements.

Even if you scratch a little deeper into the companies that claim to offer HIPAA-compliant hosting services, you should pay particular attention to the wording they use. While they may be willing to sign a Business Associate Agreement, they deliberately stop short of promising to provide a HIPAA-compliant solution. This is because they do not control access to the application — the solution provider does.

The next time a company tells you they are HIPAA compliant because they store their data in a HIPAA-compliant database or data center, you are certainly welcome to take a leap of faith. In the movie, after Judge Henry Harper is presented with evidence that the US Postal Service is delivering letters addressed to Santa Clause, he declares that, “…since the United States Government declares this man to be Santa Claus, this court will not dispute it.” However, I doubt that the enforcement arm of the Office for Civil Rights will be as liberal in its judgments.

Grant Elliott is founder and CEO of Ostendio of Washington, DC.

Morning Headlines 12/18/13

Former Microsoft Executive Kurt DelBene To Replace Jeff Zients

CMS taps recently retired Microsoft VP Kurt DelBene to take over Healthcare.gov. DelBene was formerly in charge of the Microsoft Office division. He will take over for Jeff Zients, who stepped in to oversee the immediate fixes needed just after the October 1 launch.

HealthTech Unifies Brands as MEDHOST, Names Herrod as President

HealthTech, the parent company of MEDHOST, HMS, and Patient Logic, consolidates all of its businesses under the MEDHOST brand name and names Craig Herrod president of the new organization. Herrod was formerly the president and CEO of MEDHOST.

Paulsen Introduces Legislation to Streamline and Enhance U.S. Healthcare Delivery

Congressman Erik Paulsen introduces a bill that would require the use of clinical decision support tools by physicians when ordering imaging studies on Medicare patients.

New Approaches for Delivering Primary Care Could Reduce Predicted Physician Shortage

A RAND study looks at alternative models for delivering primary care services that would help alleviate the growing physician shortage. Researchers focused on the patient-centered medical home (PCMH) and the nurse-managed health center (NMHC) models and found that projected PCP shortages could be substantially reduced by increasing the use of these models.

News 12/18/13

Top News

The 2014 defense authorization bill, which has been endorsed by both the House and Senate, requires the DoD and VA to develop by the end of January “a detailed plan for the oversight and execution of the interoperable electronic health records with an integrated display of data, or a single electronic health record.” If the agencies miss the deadline they risk losing their ability to spend more than 25 percent of the estimated $344 million in funding needed for the project and will be required to notify military and veterans committees before dispensing any project funds in excess of $5 million. The system deployment deadline is end of 2016.

Reader Comments

From Lion: “Re: LinkedIn. OK, I’m curious. What is the deal with your profile picture?” There’s no faster way to peg yourself as a HIStalk Newbie than by asking Mr. H why a healthcare-related website features a smoking doctor or why I have hot shoes on my LinkedIn profile. I shared with Lion that I used to have the Inga avatar on my profile, but the LinkedIn police took it down, saying only photos were acceptable. I feel like such a renegade every time I see the sexy shoe photo on LinkedIn, though I’m now thinking it’s time to feature a new pair. Stay tuned.  

From Leaving T-System: “Re: big changes at T-System last Friday. Sunny Sanyal will leave the company in January, now looking for new CEO. Mikael Ohman, COO will be working on special projects only. Jim Mullen, SVP Sales is leaving to join Allscripts. Mark Horner is now SVP & GM over RevCycle+, already updated his LinkedIn page.” Varian Medical Systems has already announced that Sunny Sanyal will be taking over as SVP and president of its Imaging Components businesses as of February 7, 2014.  We appreciate T-System’s response to our inquiries:

It is with mixed emotions that we can confirm those changes are accurate. Sunny made the decision based on a personal need to work closer to his family and spend more time with his wife and three children. Sunny was very well-liked and respected at T-System and we will truly miss him. Sunny will remain as the CEO of T-System until the end of January. On a positive note, we have some additional, exciting changes that we would like to share with HIStalk readers. John Trzeciak, a long-standing board member and principal at Francisco Partners, will help with the transition and step in as the interim CEO of T-System while we search for a replacement. John has an extensive background in leading healthcare organizations and helping companies manage leadership transitions, and is already engaged in the T-System business through his role on the board. We are excited to announce that Tom Dunn has been named as Executive VP of sales and marketing. Tom had tremendous success as the sales and marketing VP at QuadraMed, helping the company achieve double-digit growth. We anticipate that he will drive further alignment of our new revenue cycle and documentation solutions. Jim is leaving to pursue new opportunities and we’re grateful for his contributions. Additionally, Mark Horner was promoted to senior VP and GM of our revenue cycle solutions while Steve Armond, T-System CFO, was promoted with additional responsibilities that include operations for client services and performance solutions.

From Dr. L: “Re: technology tip. I appreciated your review of the Asus MeMo Pad and the tip to find it on sale at Office Depot! I checked immediately and snagged the last one at my local store. I’m in a similar situation with an aging device, and it’s helpful to follow someone you trust to wade through the plentiful options. I was considering one of the new iPad Minis, but I agree the Asus delivers a lot of value and doesn’t feel like I’m skimping. You’d have a lot of grateful followers if you included a regular Personal Technology section on your blog. I recall a comment several years ago about your strategy to use your iPod Touch on WiFi instead of an iPhone, and I adopted that idea, too. Many thanks to you and your team for all you do each week. You’re the highlight of my day!” I appreciate those nice words and I’m still loving the Asus, especially for $120 (try playing this movie on it to appreciate the HD display.) I don’t buy a whole lot of technology, but I usually get excited about it when I do, because I’m a nerd, obviously, and a bargain hunter besides. It would be fun to have readers weigh in on their latest purchases and the deals they’ve found.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Lincor. The 10-year-old Nashville-based company’s patient engagement technology portfolio includes PatientLINC (touch-screen, in-room access to clinical information for caregivers and  patient tools, communication services, and entertainment such as on-demand video and games); ClinicalLINC (secure bedside EMR access via wall-mounted terminals);  MediaLINC (in-room patient access to educational materials and entertainment); and MobileLINC (patient access to medical information, educational materials, and entertainment on their mobile devices). All of these increase patient satisfaction and improve outcomes, helping hospitals meet Medicare-funded requirements for patient satisfaction, readmissions, and Meaningful Use. The company’s systems are used by 120 hospitals and 25,000 beds all over the world, and the world headquarters have been moved from Cork, Ireland to Nashville. Just this week the company announced another funding round, this time of $3 million, to expand in the US and EMEA. Thanks to Lincor for supporting HIStalk.

My YouTube cruise turned up this new and well-done video overview of Lincor’s LINC technology.

Acquisitions, Funding, Business, and Stock

HealthTech Holdings, which includes the HMS, Patient Logic, and Medhost brands, changes its name to Medhost and names Craig Herrod president. He previously served as president and CEO of the Medhost division.

Juniper Networks will acquire WANDL, a provider of software solutions for multi-layer networks, for $60 million. 

Sales

At Home Healthcare (TX) selects Procura Homecare software as its home and community care platform.

The Louisiana Senior Care Coalition chooses eClinicalWorks Care Coordination Medical Record as its population health management solution for advancing ACO objectives.

The VA St. Louis Health Care System will implement LiveData PeriOp Manager and integrate it with its existing VistA EHR.

Hospital Sisters Health System (IL) chooses Passport to provide RCM solutions and services to its 14 hospitals and network of affiliated facilities.

Intermountain Healthcare (UT) selects Elsevier ClinicalKey to provide electronic medical reference and knowledge-based information to its clinicians and medical libraries.

People

Medfusion names Vern Davenport (MModal) president and an equity partner.

Jack Redding (Mount Sinai Medical Center) joins Halfpenny Technologies as SVP of sales and marketing.

Oncologist Susan Desmond-Hellman, MD, MPH (UCSF) is named CEO of the Bill & Melinda Gates Foundation. One of her key policy recommendations to the National Academy of Sciences was creation of a knowledge network that would allow sharing patient data across research and clinical practice to tailor treatments to individual patients.

T-System appoints Tom Dunn (QuadraMed) EVP of sales and marketing.

Kathleen Sebelius announces the appointment of former Microsoft executive Kurt DelBene as senior advisor to lead and manage the Healthcare.gov project. DelBene was president of the Microsoft Office division, leading me to wonder if he’ll be typing many of his own memos in Word and if the memos will ever include the term “EHR.” Wouldn’t it be great if he were able to lobby his former employer to fix that annoying EHR/HER auto-correct issue?

Announcements and Implementations

HIMSS and HHS are recruiting for an “Innovator in Residence” to serve a two-year term to develop and implement a nationwide patient data matching strategy.

Susquehanna Health (PA) implements Summit Provider Exchange technology to provide bidirectional integration between its hospitals and physician practices running NextGen EMR.

Bay Area Medical Center (WI), which recently signed a letter of intent to partner with Aurora Health Care (WI), begins implementation of Epic, the platform already in place at Aurora.

The Illinois HIE and Missouri Health Connection will share clinical patient data.

Essentia Health-Virginia (MN) goes live on Epic.

Polk County Human Services (WI) adopts Forward Health Group’s PopulationManager to track and analyze the progress of patients with substance abuse disorders.

Palomar Health (CA) goes live with AirStrip ONE for remote EKG access, co-developed by the organizations based on Palomar’s MIAA (Medical Information Anytime Anywhere) platform that AirStrip acquired in mid-2012.

Oncology EMR vendor Altos Solutions and outcomes and analytics vendor COTA announce a partnership to sell value-based cancer care systems in the US.

In the UK, the Department of Health opens bidding to choose a new outsourcing provider for its Oracle HR management system, planning to replace McKesson after 13 years. The contract is valued at up to $730 million over six years.

UPMC’s Children’s Hospital (PA) will make its physicians available for second opinions to members of MDLIVE, which offers secure online access to physicians.

In England, NHS’s clinical research group uses QlikView to review clinical data quality and find unusual patterns.

Government and Politics

Medicare publishes a list of the 97 best and 85 worst hospitals for hip and knee replacements based on post-surgery complications and readmissions.

Congressmen Erik Paulsen (R-MN) and Jim Matheson (D-UT) propose legislation that would mandate the use of clinical decision support software by physicians receiving Medicare and Medicaid reimbursement when they order diagnostic imaging tests. The goal is to provide doctors with immediate feedback and recommendations for the appropriate tests to order. Sounds like a great idea that would likely create a few administrative nightmares.

Big pharma wants an independent investigation of the FDA’s computer security after a database containing clinical trial results and drug marketing plans submitted by drug companies was hacked last month. The drug companies are afraid their confidential information could end up in the hands of a competitor. FDA says the attacked system didn’t contain such information.

Other

ReferralMD Founder and CEO Jonathan Govette, like others, says that EMRs will become unbundled the same way that a myriad of Craigslist features turned into much better individual platforms started by others. Above is how he sees that happening (click the image to enlarge). Tip from @ForwardHealthGP.

HIMSS will hold an mHealth Summit Middle East in Abu Dhabi in May 2014.

StartUp Health and AARP release a report on digital health in consumers over 50. Like much of what’s packaged as mHealth, it’s mostly aimed at investors rather than consumers.

Saint Francis Hospital (NY) says its Meditech implementation forced it into bankruptcy with $50 million in debt, but adds that it was the hospital’s own poor financial implementation and not Meditech that cost it “tens of millions of dollars” of uncollectible revenue. The hospital will sell itself once it exits bankruptcy.

A group of New York City parents files suit against the city and the Department of Education, claiming that disruptive 6- and 7-year-olds are being sent by ambulance to area EDs in violation of the Americans with Disabilities Act solely because the schools can’t handle them. According to one mom, “It has caused a financial and emotional strain for me and my entire family. I feel that they sent my son to the emergency room as an excuse to not do their job. If my child acts up at home I cannot send my son to the hospital emergency room.”

A California newspaper profiles 20-employee, Sebastopol-based E-Health Records, which develops EHRs primarily for use in developing nations. It runs on Android-powered tablets over Amazon cloud services.  

A former HHS investigator shares tips for preparing and responding to a fraud and breach investigation. The investigator says one of the biggest mistakes an organization can make during an on-site visit is to make the investigator wait. I’m guessing he’s never had to be on hold forever while trying to follow up on a Medicare claim. Now that’s waiting.

Weird News Andy summarizes this story as, “Makes it easy to put on socks.” Doctors in China reattach a man’s severed hand to his ankle for a month while he regains strength for hand surgery. I’m not entirely buying it – the story sounds suspicious and the picture looks a bit Photoshoppy.

WNA also notes this non-weird story, which describes November’s US hospital admissions as the lowest in a decade, with the survey sample of 98 hospitals reporting that admissions were down more than four percent.

Sponsor Updates

• LRS releases the Mobile Connector for VPSX software, which allows users to print documents from any mobile device to any VPSX-defined output destination.
• Athenahealth will integrate Merge Healthcare’s iConnect Network into its athenaClinicals EHR to allow users to receive and view exam results and diagnostic-quality images.
• Wolters Kluwer Heath integrates its Health Language Provider Friendly Terminology with Epic EHR for mid-size to large practices and for hospitals.
• Greenway Medical adds Digital Assent, a provider of patient satisfaction survey solutions, to its online Marketplace of value-added partners.
• McKesson Episode Management releases 22 new episodes based on the PROMETHEUS Payment Evidence Informed Case Rate definitions, making it the first automated bundled payment solution to support the latest PROMETHEUS model.
• InstaMed has grown to 1,000 providers and has processed over $30 billion in healthcare payments in 2013.
• Razornsights employees celebrate the company’s Founder’s Day by building shoebox gifts in support of Operation Christmas Child.
• Minnesota’s Office of the Commission of Health certifies Sandlot Solutions a health data intermediary, authorizing the company to provide HIE services in the state.
• Maryland hires Optum/QSSI to provide project management and operational support for the Maryland Health Connection website.
• A Nashville paper spotlights Lincor Solutions and the launch of its patient engagement technology for hospitals and health systems.
• Health Catalyst board member and former Intermountain CIO Larry Grandia wins the 2013 Utah Governor’s Medal in Science and Technology.
• Fujifilm demonstrated its Synapse products and the showed the MU Stage 2 capabilities of its Synapse RIS at RSNA
• T-System authors a case study featuring its facility coding customer Memorial University Medical Center (GA), which boosted its ED revenues 20 percent through its coding initiative. 

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 12/17/13

athenahealth, Merge Healthcare Partner for Data Exchange

athenahealth and Merge Healthcare announce a strategic partnership that will connect Merge’s iConnect Network with athenahealth’s ambulatory EHR. The partnership will enable athena customers to view high-resolution images and exam results coming from Merge within their EHR.

Congress demands no more iEHR delays

Next year’s National Defense Authorization Act has language in it that requires the DoD and VA to develop an acceptable iEHR plan by the end of January 2014. The bill further stipulates that “Not later than October 1, 2014, all health care information contained in the Department of Defense AHLTA and the Department of Veterans Affairs VistA systems shall be available and actionable in real-time to health care providers in each Department through shared technology.”

HHS seeks an innovator to attack patient matching

HHS CTO Bryan Sivak says that the departments next innovator-in-residence will lead the search for better patient matching technologies to help HIEs return the correct patient chart in the absence of a national patient ID system.

Curbside Consult with Dr. Jayne 12/16/13

The vast majority of ambulatory organizations have either implemented EHRs or in the process. There are different challenges for large organizations and small practices. In talking with a couple of my peers in the physician lounge over the last few weeks, one challenge is the same: determining whether EHR projects should be clinical, operational, or IT initiatives.

When I went live on my first EHR nearly a decade ago, the project was under the IT department. It was run by analysts who knew very little about what happens at a medical practice other than what they had experienced as patients. I was in a solo practice situation at the time, but part of a larger ambulatory group who wanted to use me as a pilot for the EHR system they were planning to roll to everyone else.

The vendor was well known, however, more in the billing space than the EHR space (as was common at the time.) I was busy running my practice and seeing patients, so just went along with what the IT department recommended. At the time, I didn’t know much about project management and lacked the experience to know that things were going very badly.

The vendor sent a trainer who taught us on a different version than what we had installed, and no one caught it before I was in training. There was no training around how to modify office workflow or transform practice. It was merely a parade of templates and how to use them, hour after hour, until our minds were numb.

We struggled with the system for the first six months. It wasn’t just the software, but issues with wireless connectivity, signal interference from the tenant next door, hardware failures, and a lack of a support structure. Eventually we discovered the software had been omitting data during the note-signing process. That was what allowed us to put a nail in its coffin.

I didn’t know at the time how visible the project had been since I was just trying to muddle through while also growing a new practice and seeing patients. When we started the Request for Proposal process for a new vendor, however, it became clear that many eyes had been on the project. Based on the events of the failed pilot, hospital leadership ordered that the next ambulatory EHR initiative would not be IT driven.

The project team that was ultimately assembled had leaders from operational and process excellence disciplines. They quickly hired a physician champion who was in place before the system selection was final. One of the key drivers of the project was clinical transformation rather than just a paperless transition. This required a lot more work than a simple EHR installation. I didn’t understand at the time how important that was, but I certainly do now. By focusing on outcomes from the beginning, we were able to drive adoption in a way that we could not have otherwise.

Our IT resources reported to our project leadership through a charge-back arrangement, but it was clear that they worked for us. They were tasked with supporting the infrastructure and helping us maximize the application and its capabilities. The rest of the team focused on understanding clinical workflow and practice operations. At the same time, they learned the system so that they could pull it all together and identify the best ways to implement various features.

The arrangement served us well and allowed us to deploy the platform to several hundred physicians, but I’m not sure we could make it work in a different organization with different leadership. With that in mind, when people ask me the question about where ownership of EHR projects should sit, my answer has to be, “it depends.” It really does depend on the organization, its goals, its strengths and weaknesses, and the people involved.

Small practices see this acutely, especially those who are trying to implement EHR at this stage of the game. We’re clearly in the realm of the late adopters, and I suspect many of them wouldn’t be doing it at all if not for the Meaningful Use money or the fear of penalties.

I’ve seen a couple of my colleagues fall prey to the idea that these are IT projects and don’t need much operational or clinical involvement. I was recently asked to assist a practice that had signed up for a hosting arrangement which only covered infrastructure. They had a complete lack of understanding of what it takes to maintain a system even if they were using it in a vanilla fashion.

They didn’t understand the difference between an upgrade and a software patch, so needless to say, they hadn’t applied any since going live, yet were baffled when things in the system weren’t up to date. They didn’t attend any of the complimentary training their vendor offered. They have no idea what it takes to attest for Meaningful Use, yet plan to do so in the first quarter of 2014. I hated to break it to them that they didn’t even have all the required components installed, and that based on their continued use of paper telephone messages and dictation of office visits, they are a long way off from being true meaningful users.

I’d like to see EHR vendors perform an “informed consent” process for new EHR clients, especially the late adopters. They should spell out what it takes to be successful and warn clients of the risk if those precepts are not followed. They should explain the need to have involvement from clinical, operational, and technical leaders even if they all happen to be the same people in a small practice.

When clients fail to heed this advice, they should not demand that the vendor move heaven and earth to get them back on track. Although vendors have a vested interest in the success of their clients, practices have to bear a large part of the responsibility for success.

Over time and as our project has gone into maintenance mode, management of our EHR has transitioned to shared ownership between its clinical and operational owners and the IT department. The leadership has matured and learned from its experiences and we’ve all become stronger as a result. It hasn’t been easy, and I have colleagues at different institutions that have had completely different experiences, but I would never trade what we’ve been through together. What do you think of EHR project ownership? Email me.

Email Dr. Jayne.

Readers Write: My First Experience at the mHealth Summit

My First Experience at the mHealth Summit
By Kevin Lasser

I was inspired by Mr. H’s comments regarding his experience at the fifth annual mHealth Summit. So much so that I want to share my experiences from a little different vantage point.

I was kindly invited to not only speak on the topic of return on investment,  but also to talk to the press about my participation in mHIMSS Roadmap V2.0. Honestly, I am not sure I would have gone otherwise, but I am happy I went. Here are my thoughts.

Exhibit Hall

It was filled with very large and small companies with a few exceptions. I did not get a sense that the large companies were really doing much in the mHealth space. However, they were happy to be at the Summit because they may be able to form ventures with some of the smaller companies.

Those smaller companies seemed to be primarily looking for three things:

• Validation of product
• Money from “bankers”
• A venture with a larger company

Unabashed Product Pushes

These were also called breakout sessions and executive spotlights.

I did a breakout session on ROI. The thing I was most proud of was the number of audience members who approached afterwards who said, “I have no idea what you do. Can you tell me…..” I considered that a great compliment.

I witnessed one session where a panelist had company logos and diagrams in his slide presentation. He turned every question from the audience into a product pitch. Based on those in the audience rolling their eyes and lack of people who approached this individual afterwards, I would say I was not the only one sick of his vendor pitch.

When are people going to learn that being a self-serving shill pitching your products under the guise of education works exactly the opposite way? (i.e. nobody cares about you or your product – YOU TURN PEOPLE OFF.)

State of the Industry

As a synopsis, I believe the following as it pertains to the mHealth industry:

• There is a lot of confusion. It is hard to distinguish one app from the next.
• Exhibiting a “real” ROI to prospective clients is a must. If a vendor answers a question regarding ROI with, “Imagine if …” that is not a real ROI.
• That HIMSS designated talented people and monetary resources to mHealth is a very encouraging sign for the future.
• Technology needs to be invisible. Nobody really cares about the technology. It is what the technology can do to lower costs, keep costs contained, and improve healthcare.

Lastly, regarding Mr. H’s comment that he snickers any time she sees someone wearing Google Glass, personally, I get a little nauseous.

Kevin Lasser is CEO of JEMS Technology of Orion, MI.

Readers Write: Musical Commentary on Mr. H’s mHealth Conference Summary

Musical Commentary on Mr. H’s mHealth Conference Summary
By DJ LooptyLoop

I have to say, your synopsis of mHealth sounds a little grim indeed. Chain restaurants lacking personality? Boring. Destination developments? Depressing. Terrible weather? Bearable when inside, but energy-zapping nonetheless.

If you’ve listened to Arcade Fire’s 2010 album “The Suburbs,” you would immediately relate the above description to my favorite track on the album, Sprawl II. “Sometimes I wonder if the world’s so small that we can never get away from this sprawl,” sings frontwoman Régine Chassagne. “Living in the sprawl. Dead shopping malls rise like mountains beyond mountains, and there’s no end in sight.”

But the most disappointing of all is the abandonment of the African public health project speakers. Actually, the abandonment of all global health issues in general is pretty appalling. The mHealth slogan reads, “Where technology, business, research, and policy connect.” One would think the policy research might actually be reflected via keynote speakers who speak to global solutions at this scale. But then again, maybe they don’t exist yet.

Arcade Fire’s new jam from their 2013 Reflektor album “Here Comes the Night Time” touches on this global health issue abandonment. “And the missionaries tell us we will be left behind. We’ve been left behind a thousand times, a thousand times,” cries frontman Win Butler. “If you want to be righteous, get in line.” Well, I suppose it’s back of the line for the emerging countries at the mHealth Summit, though I did see an announcement that mHealth Alliance plans to transition its base of operations in 2014 from the UN Foundation in DC to South Africa, so let’s scratch that and bump them up to the middle of the line.

And, there’s NO MUSIC? I guess conference attendees could throw on Reflektor with just one earbud in whilst walking from speaker to speaker so as not to be completely antisocial. The album hooks listeners at the initial beat-drop with a catchy Talking Heads vibe mixed with the fearless imagination of Daft Punk. Though I’d be careful with the feedback from other conference-goers, if Win Butler’s prediction holds true. “And when they hear the beat coming from the street, they lock the door. But if there’s no music up in heaven [or in our case, the mHealth Summit], then what’s it for?”

On a separate note, I would like to think that LCD Soundsystem and Reflektor producer James Murphy would be beaming to know his music has had a far-reaching impact. He did turn down a job as a writer for Seinfeld to make music, after all. He clearly wanted to make an impact elsewhere – and that impact has reached all the way into the world of healthcare IT.

Morning Headlines 12/16/13

Cerner Corporation : Cerner Announces Stock Repurchase Program

Cerner announces a stock repurchase of $217 million, which at current stock prices would allow it to buy back 1.2 percent of the company’s outstanding shares.

Virginia Man Pleads Guilty to Mail Fraud in Scheme That Cost His Employer More Than $100,000

A former employee of The Advisory Board Company pleads guilty to fraud after cheating the company out of more than $100,000.

How Long Will Athenahealth Investors Keep the Faith?

According to Barron’s, athenahealth stock dropped last week because the company lowered its 2014 expectations and Jonathan Bush announced that he would be taking a two-month sabbatical. The company also announced that it will sell hospital clinical software to compete with Epic and Cerner.