News 2/14/14

Top News

ONC reports that RECs have “far exceeded” their goal to support the adoption and use of HIT by 100,000 small practices, CHCs, and rural and public hospitals, while continuing to support providers to reach MU. The “exceeded” goal must involve something other than the 100,000 figure since only 85,000 PCPs had met the MU milestone by the end of November.

Reader Comments

From No Love: “Re: vendor management organizations. I would be interested in hearing feedback from healthcare organizations that contract with them to manage their consulting needs. Our consulting firm spends endless hours meeting client needs. Through vendor management groups, sometimes months go by before we hear anything about the candidates presented if we get a response at all. I’m amazed at the lack of management, coordination, communication, and relevant industry knowledge that the representatives of some of these firms possess. The only thing we are doing is populating the databases of these vendor management groups with contact information for great consultants.”

HIStalk Announcements and Requests

A few things on HIStalk Practice this week that you may love: ICD-10 implementation costs for physician practices could be almost three times higher than estimates from 2008. Fifty-one Northeast Georgia Physicians Group clinics win Stage 7 Ambulatory awards from HIMSS Analytics. HealthPoint Medical Group becomes the first practice to earn NCQA Patient-Centered Specialty Practice Recognition. Proposed legislation repealing the SGR formula eliminates future MU and PQRS penalties, provide technical assistance for small practices, and require EHR interoperability. Its the season for love, so show me some by signing up for email updates when checking out these stories. Thanks for reading.

Listening: Year of the Rabbit, a one-album (2003) band formed by Ken Andrews, a former member of my current favorite band, Failure (which reunited after a 16-year absence for a live show Thursday night in LA).

Those who are new to healthcare IT may wonder why significant news (which is only about 2 percent of total even in a good week) is so scarce this week. Reason: companies save up their big announcements until the HIMSS conference, which starts next weekend, hoping to draw traffic to their expensive booths. What nearly always happens instead is that their announcements get lost because every vendor is equally unimaginative. For me, the newsworthiness bar is raised a lot during the conference because I’m busier, meaning I won’t mention announcements that I might have this week or next because I don’t have time. Less-earthshattering announcements have a better chance of getting exposure if held until the week after the conference, when there’s nothing left to write about.

Just a reminder: we’ll have our first-ever HIStalk booth (#1995) at the HIMSS conference. Our price range and lack of HIMSS clout means it will be a microscopic, sparsely furnished patch of rental carpet in Booth Siberia near the restrooms, but for intrepid seekers, Lorre will be dispensing trinkets and the occasional visiting celebrity will be on hand to say hello. Lorre will also be tweeting out reports from Inga, Dr. Jayne, and me about who has cool giveaways and which booths are interesting, so follow her if you want to know who is giving chair massages or serving margaritas at 10 in the morning.

HIStalkapalooza

I’ll have more information about the HIStalkapalooza schedule, entertainment, food, and co-sponsors next week. The basics are that buses will run a circuit between the convention center’s Hall F and the House of Blues from 6:30 until 11:30 p.m. We’ll have a full dinner buffet and open bar. Entertainment will include music outside, a live band, our usual red-carpet entrance with video and still photographers, and several activities inside the HOB. There will be IngaTinis and spiffed up ladies wearing hot shoes. Beauty queen sashes will be donned. Handling the HISsies awards will be Ross Martin, MD of AMIA and Missy Krasner of Box. We’ll have the winners of three big categories on hand to accept their awards in person – Most Effective Provider HIT Executive, HIT Lifetime Achievement Award, and HIT Industry Figure of the Year. The long-range weather forecast is looking good so far with highs around 80 degrees. Stay tuned and use hashtag #histalkapalooza if your level of anticipation warrants tweeting.

People who apparently don’t read HIStalk keep emailing to ask if they can bring guests. Answer: no, unfortunately, but we turned down 900 people and it wouldn’t have been fair to hold spots for an undetermined number of guests. Print your invitation and bring it along since the nice registration folks will let you in only if you were invited.

In case you’re wondering what HIStalkapalooza is all about, here’s the official Medicomp video from last year’s event in New Orleans. That’s Jennifer Lyle from Software Testing Solutions deftly handling the red carpet interviews, a role she will reprise this time.

HIMSS Conference Social Events

Send us your event details if it’s a good one (i.e., free food and drinks at minimum) and you promise that all HIStalk readers are welcome to attend, even if they work for your most hated competitor as a given reader might well do.

EHealth Initiative will host a Mardi Gras cocktail reception sponsored by Elsevier Clinical Solutions Monday, February 24 from 6:00 to 8:00 p.m. at the Rosen Centre Hotel. Register here.

Upcoming Webinars

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

February 19 (Wednesday), 1:00 p.m. ET. What is the Best Healthcare Data Warehouse Model for Your Organization? Choosing the right data model for your healthcare enterprise data warehouse (EDW) can be one of the most significant decisions you make in establishing your data warehousing and foundational analytics strategy for the future. The strengths and weaknesses of three primary data models will be discussed: enterprise data model, independent data marts, and late-binding solutions.

Acquisitions, Funding, Business, and Stock

Welltok, developer of the CaféWell Health Optimization platform, raises $22.1 million in Series C funding. IBM was an investor and and will work with Welltok to build a Watson-powered application that will guide consumers through health questions.

Specialists on Call, a provider of specialty physician teleconsult services, closes $32 million in financing.

GetWellNetwork reports 86 percent revenue growth in 2013, as well as the addition of 50 new client facilities and a 60 percent increase in employees.

Sales

The Seniors Wellness Group of Michigan selects WRS Health to provide EMR and PM solutions for its 170 skilled nursing facilities.

Meritage ACO (CA) will implement CareInSync’s Carebook evidence-based mobile care coordination platform and expand its use of the Mobile Care Navigation Network.

Philips Healthcare will provide home monitoring technology to the home care program of Partners HealthCare (MA), including alert and medication dispensing systems.

People

Catholic Health Initiatives names Rand Strobel (UW Medicine Valley Medical Center) CIO of its Franciscan Health System region.

LDM Group hires David Green (Eli Lilly) as VP of payer market solutions, Wes Galbo (A&K Global Health) as VP of product management, and Jim Rockel (The Breakaway Group) as senior director of business development.

Consultant and former Cerner EVP Jack Newman is appointed to the University of Kansas Hospital Authority.

MedHOK appoints Troy Smith (Computer Science Corporation) COO.

Announcements and Implementations

Memorial Medical Center (IL) upgrades to the Carestream Vue PACS and Vue for VNA.

Hilo Medical Center (HI) and its outpatient clinics launch the East Hawaii Patient Portal.

The Tiger Institute Health Alliance (MO) and Lewis and Clark Information Exchange (MO) begin sharing patient information.

Scribes STAT, which offers scribe programs and EMR implementation services, rebrands as Essia Health and appoints Matthew J. Kirchner (Medtronic) president and CEO.

University of Michigan startup AlertWatch earns FDA marketing clearance for its anesthesia monitoring system.

AirStrip launches an Innovation Marketplace program to push evidence-based research results into clinical practice, extending its initial partnership with Palomar Health that resulted in the development of AirStrip ONE.

Box says healthcare was its fastest-growing sector of 2013, up 400 percent.

Government and Politics

A group of 111 lawmakers urges HHS Secretary Kathleen Sebelius to reform the auditing system for Medicare claims, citing a massive backlog of more than 460,00 claims and an audit system that gives contractors an inventive to deny claims.

A Congressional panel investigates how the government is safeguarding MU funds following the recent indictment of Shelby Regional Medical Center’s (TX) former CFO for falsely attesting to MU.

Other

Epic ranks number five on Glassdoor’s annual report on the “25 Highest Rated Companies Hiring Interns.”

John Lynn did a Google+ Video Hangout with Elsevier CMIO Jonathan Teich, MD, PhD this week on the topic of clinical decision support.

@IngaHIStalk Farzie award goes to @histalk for being only media publication that mentioned survey methodology (“seemingly self-selected”)

— Farzad Mostashari (@Farzad_MD) February 12, 2014

Farzad Mostashari gives HIStalk and HIStalk Practice kudos (a Farzie, actually) because on both sites we questioned the validity of a physician EMR survey performed by MPI Group and Medical Economics. The magazine loaded up the hype machine in screaming out its questionably obtained conclusions, calling it “physician outcry” that will “shake the health information technology sector.” However, the survey’s methodology was this: “Physicians were invited to respond to an online questionnaire.” Who was invited and from what information sources were there names obtained? How were the questions worded? Was participation limited to those invited or were haters emailing each other the link to pile on? Did anyone follow up with respondents to verify their identities? What was the response rate? What was the spread by geography, practice setting, and specialty? Online surveys are self-selecting and therefore are close to worthless, which is why I almost never run their results. The same publication did a “Top 100 EHRs” report a few weeks ago in which they contacted 549 vendors to ask them to self-report their annual revenue, received only 56 responses back, and then just winged it with phone calls and Web searches to finally SWAG it to the magic number of 100 EHRs (since Americans only like round numbers.) Plenty of sites and publications jumped all over both “studies” with their own catchy and uncritical headlines, desperate for eyeballs and hoping readers won’t question the value or validity of their story.

Pittsburgh-based hospital and insurance operator Highmark lays off 132 employees, 120 of them from its insurance business’s IT department, but says it will add 96 IT jobs in the next few months. Highmark acquired West Penn Allegheny Health System in April 2013 for $604 million, but that system is losing ground to UPMC, which says its hospitals won’t accept Highmark’s members after their contract runs out at the end of this year.

Weird News Andy opines that this pharmacist put the “harm” in “pharmacist.” A Tennessee pharmacist is charged with attempted murder after visiting his wife’s hospital room and injecting her with an unknown substance.

Sponsor Updates

• HMFA extends the “Peer Reviewed by HFMA” standard to The SSI Group’s billing product.
• ICSA Labs extends 2014 Edition Modular EHR ONC Health IT Certification to ChartMaxx, the enterprise content management solution from Quest Diagnostics.
• RelayHealth Financial achieves full EHNAC HNAC accreditation for the 14th consecutive year.
• Four Ellis Medicine (NY) primary care locations deploy PCMH transformation management and analytics tools from Arcadia Healthcare Solutions to earn Level 3 NCQA PCMH recognition.
• The Drummond Group certifies Merge Healthcare’s Merge PACS, iConnect Access, and Merge RIS for MU under the 2014 criteria.
• Consulting magazine recognizes Aspen Advisors with its 2014 Small Jewel award based on the company’s growth, culture, and accomplishments
• Accreon partners with LCN Services to deliver technical integration services to hospitals and healthcare providers.
• Predixion Software releases Predixion Insight 3.2.
• SimplifyMD offers up to $5,000 for customer referrals.
• Virtelligence posts its list of 2014 events.
• Medhost officially adopts the EHR Developer Code of Conduct.
• Truven Health Analytics announces the global availability of its Micromedex Pharmaceutical Knowledge solution to improve research for non-hospital environments.
• Optum Labs, the healthcare research initiative created by Optum and the Mayo Clinic, adds seven new partners with interests in public health, pharma, and the biosciences.

EPtalk by Dr. Jayne

Saturday was National Girl Scout Cookie day. I admit I look forward to the time every year when the cookie order forms go up on the sides of people’s cubes or on the doors of those lucky enough to have doors. Office policy prohibits solicitation for fundraisers other than United Way, but employees can hang them as “decorations” in their personal work spaces as long as they don’t talk about them. Most of our readers know that Inga and I enjoy a nice glass of wine, so I was thrilled when I came across this article about pairing wine and Girl Scout cookies. I’m definitely going to try some port with my Samoas this year. Another site recommended Madeira to go with Tagalongs – another option to consider.

Speaking of my BFF, we’ve been working hard to put together our HIStalk Ladies’ Social Schedule for HIMSS. On Monday, we hope to hit an event or two prior to HIStalkapalooza. For those of you who didn’t receive invitations this year, there are a couple of other good events, including the Perceptive  party at Margaritaville that is open to readers. Tuesday night is extremely packed, so we can’t promise that we’ll make it to every event we have on the schedule. If you attend any evening vendor events, feel free to be our roving reporters and share your opinion of the social scene.

I wanted to attend the IBM SmarterCare lunch on Monday, but it’s apparently full. Sunday is looking pretty light as well, so if you have an event where sassy bloggers are welcome, please let us know. On the other hand, it might be a good thing that Sunday is low key since I’ll be running the Disney Princess Half Marathon in the morning. I’m raising funds for Children’s Miracle Network Hospitals and have an outstanding princess costume, so it should be a lot of fun. It starts bright and early at 5:30 (possibly dark and early depending on how you look at it) so I might be dragging later in the day. It’s also influencing my choice of hot shoes since I know I want something comfortable — suggestions are welcome.

Now that I have the fun social items out of the way, I’ll share a bit about my week as an end user. In two words, not great. I do beta testing for our EHR vendor, so I keep a local install of the application on my laptop. I ran into some issues applying a recent patch and needed some assistance. You know it’s bad when they ask, “Do you have any patient data in here that you really need?” I actually didn’t since it was full of test patients, but forgot to specify that indeed I did have a lot of provider-specific macros, defaults, and short cuts saved. That little tidbit would come back to haunt me later.

The analyst who was helping me out seemed very thorough and eager. He camped out in my office trying to fix it. Unfortunately, since it wasn’t an actual laptop problem, I wasn’t eligible for a loaner. I made do with my iPad and a Bluetooth keyboard. Although it’s a great setup for taking notes in meetings, I missed the full functionality of a laptop as well as all my files and data.

After nearly two full days’ of work, he had the database back up and running. I was ready to log in and get back to work since I owed the vendor some quick feedback on a new feature.

Unfortunately, I couldn’t log in. The analyst had changed my password to “something easier” but didn’t tell me what it was. After tracking him down and finding out it was changed to “password,” I changed it back and started testing. That’s when I found my macros and defaults were gone.

I called him on it and was informed that he had to do a “clean install” and it was all removed. It would have been nice to have that discussion while he was working on it rather than being surprised. I could have exported them somewhere that would be easy for me to pull them back in, but wasn’t given that chance. It felt like a patient must feel when they wake up from surgery to find that a slightly different procedure was performed than the one discussed.

I finished up my testing despite the challenges and got ready to email our vendor. The Desktop looked strange, but couldn’t put my finger on what it was. Not resolution, not font. After 15 minutes of digging, I figured out that the ClearType text settings had been manipulated. Why in the world would an analyst need to change my font appearance?

That was only the tip of the iceberg, however. Everywhere I turned I found something that was altered – window layout, window organization properties, default folders for searching, and more. He even renamed my C: drive. It took another 20 to 30 minutes to get everything back just the way I like it.

This isn’t the first time I’ve had an analyst adjust settings while they were working on my machine. Sometimes it makes sense, like when they extend the screensaver lockout interval so they don’t have to keep logging back in while they’re watching an upgrade). That’s OK as long as they change it back. This guy was all over the place however.

I asked our IT department if there is any policy on analysts adjusting end user settings. The answer was no. I would add creating such a polity to my to-do list if it wasn’t already so full that I’ll never complete it.

Does this happen at other places? Do you have a policy or is everyone kept on an institutional standard? Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect

Morning Headlines 2/13/14

The Cost of Implementing ICD‐10 for Physician Practices

A study published by the American Medical Association predicts that ICD-10 conversion costs will end up at least three times higher than originally predicted, with a typical medium size practice investing $200,000 – $800,000. The study includes the cost of purchasing or upgrading an EHR system.

Creators Still in Demand on Health Care Website

The federal government is negotiating with CGI, the now notorious Healthcare.gov contractor, for several months of continued technical support while its replacement, Accenture, gets up and running. Meanwhile, Accenture is aggressively recruiting the CGI employees who had worked on the Healthcare.gov project.

Congressional panel investigates stimulus funds after TX hospital boss indicted

Representative Michael Burgess (TX) has launched an inquiry into the audit process in place for the EHR Incentive Program after last weeks news that the former CIO of Shelby Regional Medical Center defrauded CMS of $800,000 by attesting to MU without actually implementing and using the necessary technologies.

Top HIE vendors of 2014 named

Black Book names the top HIE vendors of 2014, with Covisint, ICA, Cerner, Allscripts, and Infor all taking top spots in their respective segments.

CIO Unplugged 2/12/14

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

Mentoring 2.0

Next week, I will accept the 2013 HIMSS/CHIME John E. Gall Jr. Award for CIO of the Year. At my table will be three of my mentors. I chose them because these men coached me during various phases of my personal and professional life. Mentoring is everything to me. Everything.

Two-plus years ago, I wrote on this subject. The Lost Art of Mentoring quickly became one of my most popular posts. I have given a dozen speeches around the country on mentoring. I am passionate on the topic because it shaped who I am today and where I will be tomorrow. I want to share with you one method to accelerate the adoption of mentoring in your organization and get you to 2.0.

We started the Business Technology Leadership Academy (BTLA) two years ago. Its purpose is to accelerate and enhance our pipeline to produce business technology leaders at all levels of our organization. The curriculum is designed to prepare candidates to take on positions of increasing responsibility by developing and sharpening their leadership skills. Major props to our People & Culture (HR) division who helped the BTLA vision become reality.

Format

The Academy lasts 10 months during which my direct reports and I serve as mentors.

Seminars

The Academy meets once per month for two hours. The first meeting focuses on developing relationships and establishing the rules of the road. Student goals are agreed upon based on 360-degree feedback, developmental needs, and career objectives. Both mentor and mentee sign a contract. This covenant identifies the specific roles and responsibilities of both parties, and outcomes are clearly identified.

The next eight seminars focus on the eight BTLA “Success Factors.” Mentors co-teach the specific subject areas along with their mentees. Success factors vary from setting strategy, value realization, leadership, and life balance. The final meeting is run by the cohort, where the mentees present their capstone BTLA projects.

Individual Sessions

Each month the mentor and mentee meet privately for 90 minutes. There are few rules here, but the time is focused to help the mentee meet defined goals and to talk about real-world situations they face. Some of this time is also used to develop assigned presentations and special projects.

Shadow Opportunities

Students have opportunities to spend additional time with their mentees through shadowing. This provides more time for coaching and gives the mentee a chance to see their mentor in action. Often, the best mentoring is when nothing is said, just observed. At any time, we will have mentees participate in our leadership meetings, offsite retreats, and attend conferences or our own presentations.

Professional Development

Students are automatically enrolled in any special development activities we might have during their course. Examples include high-impact presentation classes and personal development courses.

Special Projects

Students are expected to volunteer for special projects. These will vary and must be agreed upon by both mentor and mentee. A student might help lead our annual TEDx event, while another leads our organization’s annual employee giving campaign. These projects provide real-world opportunities for leadership while under the careful eye of a mentor and are ideal for real-time coaching.

Selection

Selection is a highly competitive process. Every employee is encouraged to apply. We have an average of 100 applications. We open up an online questionnaire consisting of roughly 20 questions. There are no right or wrong answers, but some answers receive a higher point value than others, which remain unknown to the prospective students. The questions, point values, and criteria change each year dependent on our target cohort. Our leadership needs change, so the tool is built to allow us ultimate flexibility in the selection process.

Typically, the top 25 scoring submissions are selected for the next round, which consists of a 360 peer and manager review. Once the results are in, we look at the final 12 or so candidates. Our People and Culture team runs special reports for us based on the questionnaire and 360 to allow us further insight into each prospective student.

With all the data points in hand, my team holds a vigorous debate about which candidates to select for that year’s cohort. We try to ensure a diversity of individuals with respect to title, responsibilities, and gender. After the finalists are decided upon, we debate further to decide the mentor/mentee combinations. Again, we use leadership judgment to make the best matches possible. We have few rules here, but we do ensure that the mentor is not already in that person’s chain of command. The side benefit is significant cross-pollination. For instance, we may have an applications vice president as a mentor to a technical analyst or our CTO may have a governance manager as a mentee.

Criteria

Everyone wants to know the specific criteria and scoring formulas we utilize. We purposely do not share these. We do not want candidates applications focused on maximizing point values.

Expectations

Clearly we are making a material investment in the students. Joining BTLA means the person is making a long-term commitment to our organization. It also means that, when calls for volunteers are made, BTLA graduates should be the first to respond. There is nothing worse than investing but getting no return. Mentors are expected to make their mentee a top priority and are making a significant time and mind investment.

Outcomes

We have observed tremendous growth in our inaugural cohort. They are more confident and effective. As we continue this program year after year, we will have multiplied the leadership capabilities of our IT organization tenfold.

But here is another reason we do BTLA. We the mentors learn. We may in fact learn more than the students! My hope is that one day a few years from now, one of our graduates will be accepting an important award and their mentor will be sitting at the table cheering them on! Just as mine will be next week.

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.

HIStalk Interviews Justin Dearborn, CEO, Merge Healthcare

Justin Dearborn is CEO of Merge Healthcare of Chicago, IL.

Tell me about yourself and the company.

I’ve been in enterprise software for approximately 16 years, all at public companies. I joined Merge in June 2008.

Merge has been around since the late ‘80s to early ‘90s. I gave a range because it was a much smaller company that merged with another company a few years after it started and formed what Merge is today. It has been focused on the radiology solution space since its inception.

Imaging has become unbundled over the years, with modalities separate from the image storage and software separate from both. How will that play out?

It has. Part of what has driven that is corporate purchasing groups. On the GPO schedules we are on, everything gets line-itemed out and identified separately. The days of bundling an MRI with a PACS solution can still happen, but those are mostly in the past. Purchasing groups want to see what they’re being charged for — each line item. The software’s not free. If it is free, then it’s not worth much. So it has been unbundled.

We’ve integrated with 65 different PACS companies even though we’re a PACS company. We’ll be in multi-vendor situations as well. With the state of integration, that’s not much of a challenge. It used to be a little more challenging, but with standards and with the integration across the board where it is today, doesn’t pose much of a problem. 

We do see buyers looking for best-of-breed across the board. Most hospitals, even if they’re an Epic or a Cerner shop, so to speak, still have numerous, numerous other best-of-breed clinical applications they will plug in.

Describe a vendor-neutral archive and how Merge addresses that market demand.

It’s not a very creative name, but pretty descriptive. We would go into a situation and our ROI is to be an essential repository for all imaging. Not imaging data, but heavily the values in imaging data and DICOM data, DICOM being the format of medical imaging.

We would pull in DICOM data. If it wasn’t DICOM data, we’d wrap it in a format that stored it as such. We would be able to pull in from many different styles in a hospital — cardiology, radiology, dermatology, pathology. They can all be local PACS systems in that siloed environment from different vendors and we could pull in all that data, normalize it, and keep track of it. Make it available in a unified format to any other groups within or outside the four walls of the hospital.

That’s been accelerated a little bit. There have been stops and starts in the market, but interoperability and then being able to share information tying into some of the ACO payment models and some other new bundle payment models, and the overall pop health management buzz you hear — it’s all about sharing data and having a vendor-neutral archive that allows for that to happen much easier than if you’re pulling data from six or seven different siloed environments within a single hospital.

How important is interoperability to customers and what are the advancements that could be coming that now that it’s available?

It’s very important, but there have been other things in the last few years that have taken budgetary priority, ICD-10 being one of them right now. But putting that aside, there’s always a few speed bumps in healthcare, but interoperability is on every CIO’s road map. They’re being asked to share information with additional constituents. Early on, sometimes it was just to consolidate the data with any hospital or the hospital network. Now it’s making sure the data’s available in a secure, HIPAA-compliant manner to partners. Everybody in every hospital is partnering with outpatient groups and being required to share data and pull data in from other sources. 

Interoperability is extremely important through our vendors that of course just focus on the data flow. We focus on that, but shine in situations where there’s imaging involved. Your file format’s a little more sophisticated routing and that’s where a Merge solution would excel.

Part of that also is not only having the data, but making it available. We make it available in two formats. We can just make the image itself available in a hosted manner, so with any Web browser, a user could log in and access an image and they would just be accessing a piece of the image or the slice that they need to view at that time. Or we can make it available to download. There are different privacy concerns and security concerns. Every hospital has their own policies around that. But either format allows the referring physician or the patient to access a DICOM quality or a diagnosis quality image. 

It is becoming more relevant, absolutely. Where it started as just a way to make the hospital itself more efficient internally because it was fairly siloed, now it’s external or partner facing. Most hospitals and most large groups have these issues. Some of the vendors, the bigger EMR vendors, have solved it if you’re 100 percent on one solution, but we haven’t run across too many situations where it’s Epic everywhere. If it were, they have a nice solution for that. But any other partners you share or other data you’re pulling in, you need to be able to look at in a vendor-neutral manner.

Once people have moved their data and images that you described into a vendor-neutral archive, what patient care improvement opportunities are available?

Everyone would agree that having a full patient record, and by that I mean all the priors — and we would focus on the imaging priors, of course – but all the priors, all the radiology reports, all the special reports. We are involved in radiology, cardiology, ophthalmology, and orthopedics. Having all that information available for the next visit is incredibly important. 

As you think about the ACO models and a provider willing to take on total financial and clinical responsibility for a patient, they’re going to want to know everything about that patient, have access to all the prior data, even down to the simple thing — if you had an MRI last year out of network or out of this particular payer’s network, that payer is going to want to grab that and not reimage you.

Part of it is around patient safety as well. If it’s a CT scan, you’re obviously exposed to radiation, so you can limit that. Limit the duplicate imaging that goes on. There’s no ill intent there right now, but there’s a lot of duplicate imaging that goes on in this country because there’s not access to the prior images. I’ve seen the number as high as 30 billion dollars and that’s not lost on the federal government. There are going to be some new restrictions around paying for duplicate imaging. I’m not sure if Medicare or Medicaid will be driving that or the payers themselves, but it’s a hot topic and it’s one that’s the most easily solved. There are solutions to help solve that. Technology will not be the barrier.

What technical steps can help prevent over-ordering of images and making sure that previous images are available at the time new ones are being considered?

A couple of items. There’s one self-serving comment. We have a solution called the iConnect network that we rolled out last month. This solution will store images in the cloud. Always assuming proper security and authorization, we will have an archive of all the images that go through our network in a cloud solution, easily accessible from a technology perspective. Once that gets populated, we think that will be pretty powerful. 

There will be constituents that want to query that before they approve the next MRI or the next CT scan. They’ll be going out and asking that question of multiple repositories. Merge iConnect network will be one. The state or local health information exchange. One of the goals of the HIE is to have all the patient data available. There’s different adoption levels there across states and regions, of course. But ultimately, that was one of the goals of the federal government handing out the money — to make patient data available to those authorized to receive it. Between an HIE once it gets up and running. 

There might be a local ACO that has put some tools in place from vendors like us or other vendors that just focus on HIE-like technology or the iConnect network. It will be easy to go and query those and pull in all the prior results because it’s better at clinical care, but also if you did have an MRI or a simple X-ray within a reasonable amount of recent history, grab that, look at that. It helps with the comparisons, as well as it might alleviate the need to have another image.

How do you see consolidation, both hospitals buying each other and buying medical practices, changing your business?

Positive and negative. The negative side would be when you’re working with a group and the communication goes silent. M&A is a sensitive topic, so nobody likes to speak about it. Of course they typically don’t share that with the vendor, so we’ll find out about it after the fact. There’s been some fairly significant, large IDN transactions. I’m sure there were a lot of things in the works a year before those big deals were announced and probably filled in a lot of gaps and blanks we had as to why communication ended in some of those. So it’s disruptive.

It’s impacting the hospitals, but it’s more impactful on the outpatient or the ambulatory side because you’re dealing with owner-operators of businesses and it’s very meaningful to their lives. With hospitals, there are incentives to do acquisitions with other hospitals, but it doesn’t hit home as much as when you own the practice. They’re all facing reimbursement constraints and figuring out how to operate more efficiently. Traditional M&A rules apply – synergy, bigger is better, and build better relationships with vendors, and in this case, with payers. It’s impacting sales cycles for sure.

On the positive side, when those do transpire, there are opportunities. There’s a lot of integration and interoperability opportunities, because rarely do the large groups go in and rip and replace the existing systems. They need to be able to connect to it and share information. It plays into the VNA strategy and our iConnect network strategy. But absolutely disruptive on the front end. Again, it’s usually something that they’re not at liberty to share with you for obvious confidentiality reasons. But it does create some opportunities for us. There’s always going to be M&A in this space.

What do you see as the market’s biggest opportunities and threats?

Opportunities … I don’t want to keep pointing to the iConnect network, but we think we’ve solved a real problem in report delivery and order delivery. It’s handled pretty rudimentarily right now. We think we’ve solved a real problem in the space. Anything that can help work flow. 

Our core business is around radiology, ophthalmology, and orthopedics. Those are practices that rely on referrals and need to focus on ease of doing business on top of the clinical care they provide. But in addition to that, they are reliant on primary care physicians for referrals right now. It is about ease of doing business and generating additional volume and then having the tools to be able to improve work flow, which we do with our solutions. I think we play into the work flow efficiency. 

Everyone in healthcare’s trying to figure out how to do more with either the same or less. We have solutions that play to that. It’s a trend that’s unfortunately hit radiology probably earlier than a lot of other specialty areas. We started to see it in 2007-2008. Some of the cuts, the results from the Deficit Reduction Act, hit radiology a little harder than other practice areas. Unfortunately, the industry’s conditioned for further reimbursement cuts and I think those are coming. 

It is about doing more volume with the same team you have, and I don’t know of any other way but technology to do that. We have solutions that enable teleradiology in a positive manner. If you own 10 physical sites, you can have less than 10 physicians covering those by using teleradiology. It’s a simple example of how you can handle the volumes more efficiently with software solutions.

Merge has had challenges with financial results and share price. You’ve been on the job since last summer. What is the plan and the priority going forward?

Good question. I’ve been at Merge for about five and a half years in different roles. Our challenge over the last few years has been relying on large enterprise license transactions.

We have struggled to change our pricing model. We have per-transaction pricing model and we can deliver our solutions in a hosted manner, but hospitals are not buying that way right now and I don’t know when that will change, if it will change. I think it’s because of the capital budgets. All budgets are tight, but capital budgets are a little bit easier, I believe, so they’re still buying a perpetual license. Pay once, then pay annual maintenance. That leads to lumpy quarters if we have a miss. 

When we’ve had poor quarters, it’s been the result of three, four, five opportunities we thought were going to close in the quarter that pushed out a quarter or two. It looks dramatic because the last deals are usually heavy software, good margin. When you look back over three or four years when we’ve had really good quarters, I could point to three or four deals each quarter and say, those are the deals that really moved the top line and all that dropped to the bottom line.

We have been challenged. We went out with a per-study pricing and transaction model. It didn’t take at all. So with our new solution, iConnect network, we’re only going to price it in a transaction fashion. That has been well received. We’re going to continue to do that. That’s going to build recurring revenue. 

That’s been the issue for the company. We only have about 60 percent recurring revenue. That means every quarter we have to go find 40 percent. If there’s any pauses in the market driven by the sequester or some employer mandate pushed off or what have you that causes a pause in the market for a quarter, we’re left holding the bag. It’s tough to operate that way. The companies that are performing really well have high recurring revenue — and I point to athenahealth as probably the best at that right now — have done a great job and been very disciplined on how they go to market. They built a nice recurring revenue model. 

We’re to some degree emulating that. The market’s accepting of charging to deliver an order and to deliver a report. There’s small fees that will add up due to the size of our installed base. That’s what we talked about quite a bit on our earnings call. We’ve done a couple of great press releases around relationships with athena, Surescripts, and the largest imaging group in the country for the solutions. 

That’s where we need to get to as a company to increase performance. Once we start executing that, the stock price will follow. Obviously we’re cognizant of it, but doesn’t drive the decisions right now. We think we’ve really landed on a great white space opportunity for the company and we’re focused on executing on that.

What are your priorities for the next one to three years?

On top of continuing to improve upon on our enterprise solutions, I’ll say non-iConnect network, which we’ve done and we’ve actually overspent in the industry, I feel like sometimes we’re on the bleeding edge, so sometimes we’ve been ahead on MU for radiology and that didn’t really buy us much. But we were out there evangelizing, making sure radiology qualified, making sure our solution was MU1 certified. We were the first one for full certification. Then it quickly became table stakes. 

We’ll continue to do that, to take care of our installed base. We were just named by KLAS as number one in cardiology and number one in hemodynamics. We’re a few percentage points ahead of our competition, we think, in investment on the R&D side. We’ll continue to do that. To grow the business in a repeatable, scalable manner, the recurring revenue has to be there. 

The iConnect network leverages a lot of the technology we’ve built and leverages our installed base. It all plays hand in hand. Growing that recurring revenue stream is the future of the business. Number one product in cardiology according to KLAS, which we do think is a great, great report card. They beat us up when appropriate. They’re very objective, as you know. With the number one product, we didn’t grow that business that much last year. We’ve outgrown the market a few times and a few quarters, but you can’t do that consistently. 

What do you next? We think we’ve innovated a really, really interesting, compelling solution and we’ll continue to invest in those core solutions because they bring the customers and there’s the opportunities for those customers then to participate in the iConnect network. But it’s really driving the transaction revenue of the business. The next one to three years, seeing that 60 percent number I gave you approaching and then eclipsing 70 percent. That makes it a lot easier to run a business when you have a little more predictable revenue.

Morning Headlines 2/12/14

Physician outcry on EHR functionality, cost will shake the health information technology sector

Medical Economics publishes a survey of 1,000 US physicians in which 45 percent of respondents say patient care is worse since implementing an EHR and 79 percent of respondents report that they do not believe that EHRs have been worth the resources, cost, and effort of adopting them.

Medical Information Technology, Inc: Investor Insert

Meditech reports that it will delay its Q3 SEC filing while it sorts out a revenue recognition issue that goes back more than a decade, but that its auditors just now caught. The company says that customers will not be affected and that, other than possibly hiring new auditors, its future plans remain the same.

Behind the ballooning medical e-records cost

A local news outlet covers Hawaii Health Systems Corporations struggling Siemens implementation. The behind-schedule project was originally budgeted to cost $50 million, but is now projected to cost $109 million.

Welcome to the NIST EHR-Randomizer application

CMS and ONC launch a new web-based tool called the EHR randomizer that will allow providers to demonstrate cross-vendor health information exchange capabilities required in MU2.

News 2/12/14

Top News

I’ve confirmed with several sources that Epic will soon offer consulting services beyond implementation work, very much as described in the original rumor report from EpicConsulting. Epic employees with at least four years’ experience will be allowed to live somewhere other than Verona to take on more post-live consulting work. My sources say the consultants will offer work that isn’t strictly even in the systems domain, such as implementing clinical programs and doing Lean Six Sigma work for clients. Many questions remain: (a) how will this decision affect Epic’s relationships with consulting companies?; (b) how will Epic price its services?; (c) will skilled Epic people really want to stay with Epic, or just leave as they’ve been doing to take higher-paying jobs with consulting companies?; (d) is Epic going this route because customers want it, to try to reduce project cost by offering lower-priced consulting, to avoid losing experienced employees, or because they know implementation work will eventually dry up and the market will move toward other services?

Reader Comments

From Anonymous Health System CIO: “Re: HIStalk RFI Blaster. I recently used your RFI Blaster to solicit consulting company proposals. I have found your sponsors who responded to be capable and professional. Compliments to these companies that have good skills and follow-through: Aspen Advisors, Encore Health Resources, Impact Advisors, Leidos, Lucca Consulting, and Santa Rosa Consulting.” I created the RFI Blaster as suggested by a CIO who wanted an easy way to give HIStalk Platinum Sponsors a chance to earn his business. Filling out the short online form blasts your request out to companies of your choosing, and I specifically didn’t make “contact telephone” required since not everybody wants to be called about their request. I appreciate the report and the shout-out to the sponsors who were good to deal with.

From Jay: “Re: Melanie Pita, chief product officer and general counsel of Prognosis Innovation Healthcare. Has left the company.” Unverified, but her bio has been removed from the company’s executive page.

HIStalk Announcements and Requests

We’ve posted our annual guide to HIMSS meet-ups, which includes details on how to connect with HIStalk sponsors that are not exhibiting but are available for one-on-one meetings. We will publish our full HIMSS14 guide this weekend, which includes details on over 100 vendors (all which happen to be sponsors). Look for our guide to exhibitor giveaways next week so you’ll know where in the exhibit hall to find the best free coffee, fun trinkets, and cookies during the day and of course cocktails before heading out on the town.

Speaking of HIMSS, I’ll be participating in Medicomp’s Quipstar HIT Quiz show Tuesday, February 25 at 3:00 p.m. and looking forward to having a big crowd in the live studio audience. Even though I came in last when I played a couple of years ago, I agreed to give the game another go because Medicomp is making a generous donation to my favorite charity.

Fans of the Smokin’ Doc now have another reason to drop by HIStalk’s HIMSS Booth 1995 and say hello to Lorre, who will selectively dole out these potentially collectible (probably not) HIStalk pins from her treasure trove of cool things that were in our price range.

I mentioned that I agreed to run a new short-term ad at the top of the HIStalk page only so I could donate most of the proceeds to the DonorsChoose charity that helps financially strapped classrooms (to which I’ve donated personally for years.) I fully funded the following projects totaling $2,870 on behalf of all HIStalk readers this week, all projects submitted by Teach for America teachers because I respect that organization’s work just as much as I do that of DonorsChoose. I’ll be funding more projects shortly thanks to the sponsors who have booked the ad space: VMware, InterSystems, GetWellNetwork, Aspen Advisors, IngeniousMed, Billians HealthDATA, and Greenway. Above are excerpts from some of the notes the teachers sent in response to the help we as readers provided to their students. We funded:

• $604 for a New York City eighth grade teacher for a podium and certificates to create a National Junior Honor Society ceremony for her students in the poorest Congressional district in the US
• $506 for a Glendale, AZ teacher to provide interactive math stations for her sixth graders
• $255 for a La Place, LA teacher, whose second grade class is meeting in a trailer after their school flooded last year, to expand their Listening Learning Center of read-along books
• $234 for a Baltimore teacher who needs a Chromebook to access learning websites that offer classroom practice
• $226 for a Chicago teacher whose elementary school students need non-fiction books that the school can’t afford
• $201 for a North Charleston, SC classroom whose high-poverty, at-risk students need white boards and supplies for interactive activities
• $185 for a Jackson, MS elementary school class for write-and-wipe markers and erasers
• $187 for a Rosedale, MS high school for toner and a file cabinet for printing college applications and practice standardized exams
• $167 for notebooks and pencils for a Chicago teacher’s 35 freshman girls to create College Bound Journals
• $185 for a Memphis teacher’s need for pencils for her third graders
• $249 for a Salt Lake City, UT teacher’s need for fourth-grade books

A reader notified a friend who happens to be a DonorsChoose executive team member that I was donating on behalf of HIStalk readers. That DonorsChoose executive donated to a project of her own choosing in honor of HIStalk’s readers, which is pretty cool.

Welcome to new HIStalk Platinum Sponsor PDS. The Madison, WI-based company, founded in 1986, offers an ITIL-compliant, 24x7x365 Patient Portal Support Service Desk to assist patients with Epic MyChart, Medseek, and other patient portal systems. PDS offers HIPAA-trained analysts, transparent service, and a first-call resolution rate above 90 percent. Check out their site to see a list of health systems PDS supports across the country and to read a success story from Bon Secours Health System. Thanks to PDS for supporting HIStalk.

HIMSS Conference Social Events

Send us your event details if it’s a good one (i.e., free food and drinks at minimum) and you promise that all HIStalk readers are welcome to attend, even if they work for your most hated competitor as a given reader might well do.

Physician Technology Partners is hosting a dinner Tuesday, February 25 at Roy’s Fusion Cuisine to introduce a new Epic MyChart implementation and help desk solution. RSVP online or by email.

Perceptive Software will host an event at Jimmy Buffet’s Margaritaville at Universal CityWalk on Monday, February 25 from 8:00 to 11:00, with shuttle service provided to and from the major hotels. They will have food, drinks, and a live Caribbean band. RSVP here.

Upcoming Webinars

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

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

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

February 19 (Wednesday), 1:00 p.m. ET. What is the Best Healthcare Data Warehouse Model for Your Organization? Choosing the right data model for your healthcare enterprise data warehouse (EDW) can be one of the most significant decisions you make in establishing your data warehousing and foundational analytics strategy for the future. The strengths and weaknesses of three primary data models will be discussed: enterprise data model, independent data marts, and late-binding solutions.

Acquisitions, Funding, Business, and Stock

Nuance Communications reports Q1 results: revenue flat, adjusted EPS $0.24 vs. $0.35, beating estimates.

Employee health management site Castlight Health, co-founded by US CTO and athenahealth co-founder Todd Park, files for a $100 million IPO that values the company at $2 billion. Castlight reported a net loss of $62.2 million last year on revenues of $13 million.

The Advisory Board Company announces Q3 results: revenue up 13 percent, adjusted EPS $0.26 vs. $0.28, missing estimates.

Virtualization technology vendor Sphere 3D will acquire V3 Systems, which offers desktop cloud management solutions.

I wondered why Meditech was so late in posting its Q3 SEC report since I’ve been watching for it for months and now I know: the company reports that it improperly recognized revenue and is figuring out how to keep its auditors and the SEC happy. In the mean time, the company can’t issue new stock or complete its filings. Meditech isn’t publicly traded, but still has to comply with SEC rules. The issue sounds relatively minor and accidental – revenue was recognized in cases where the company’s implementation employees didn’t complete all the contractually required visits. Customers paid and the work got done, but 100 percent of visits must be completed to book the revenue. The company refreshingly concludes:

We are less embarrassed than you might think. There is no question of fraud or malfeasance here. We acknowledge we should have been following the revenue recognition rules as specified by our own policy, but one of the reasons we have auditors is to find issues like this promptly. They didn’t do it. However, because of the urgency of resuming our SEC filings, we’ve decided to put our unhappiness with them into abeyance at this point, and deal with that later. From an operational point of view, there should be absolutely no effect on the company, other than the additional expenses we are incurring with the auditors and the outside analysis firm to fix the problem (not to mention the huge amount of extra work our accounting and implementation staff are undergoing to provide the required information). The cash is still in the bank, free to be used – the only question is how the revenue was supposed to be reported on our filings. Customers should not be affected in any way. Our plans for the future remain the same.

Sales

Christus Health selects Wellcentive’s population health management platform.

MaineHealth chooses MediQuant’s DataArk active archiving system.

Privia Medical Group (VA) will implement athenahealth’s PM, EHR, patient communication, and care coordination services for its 154 providers and affiliated ACO.

Blanchard Valley Health System (OH) will deploy Merge Healthcare’s VNA interoperability and cardiology solutions.

Humana will implement CoverMyMeds to allow physicians to submit drug prior authorizations directly to Humana via an online portal.

Georgia Physicians for Accountable Care selects eClinicalWorks Care Coordination Medical Record.

Dean Health Plan (WI) chooses Health Language for terminology management.

People

AtHoc names Mary-Lou Smulders (Oracle) VP of marketing and Matthew Gloss (Mellanox Technologies) general counsel.

Healthfinch hires Sanaz Cordes, MD (Cogent Healthcare) as COO.

Kevin Fickenscher, MD, formerly of Dell and AMIA, is named president of health services for remote patient monitoring company AMC Health.

LDM Group names Paul Hooper (Emdeon) as VP of retail innovations and product commercialization.

Announcements and Implementations

Ontario’s Hôpital Montfort uses Summit Healthcare’s InSync and SST for dictionary migration to Meditech 6.0.

Healthcare Access San Antonio, Holon Solutions, and the Texas Organization of Rural and Community Hospitals will connect area hospitals, clinics, physician offices, and other providers to a regional HIE across 22 South Texas counties.

Memorial Health (CO) launches its $30 million Epic implementation.

Athenahealth announces that it has integrated drug monographs from its Epocrates acquisition into athenaClinicals.

Government and Politics

CMS and ONC introduce Randomizer, a tool that allows providers to exchange data with a test EHR in order to meet measure #3 of the Stage 2 transitions of care requirement.

ONC launches a challenge to develop a Javascript/HTML-based, easily understood Notice of Privacy Practices that can be incorporated into websites. Submissions are due by April 7 and the winner gets $15,000.

CMS announces that Healthcare.gov won’t accept new insurance enrollments this weekend because the Social Security computer system has a planned 62-hour maintenance downtime starting Saturday, which is also the deadline for applying for coverage that will become effective March 1.

Innovation and Research

A screening program for abdominal aortic aneurysms integrated into an EHR reduced the number of unscreened at-risk men by more than 50 percent within 15 months, according to a Kaiser Permanente study.

Penn Medicine (PA) announces that it will work with analytics vendor Teqqa, LLC to provide real-time antibiotic sensitivity information to physicians via a mobile app as part of its antimicrobial stewardship program. Penn received equity in Teqqa as part of the agreement.

Technology

I may have missed this article from a week or so ago even though I see Inga picked it up on HIStalk Practice. Walgreens clinics will use ePASS software from Inovalon (formerly MedAssurant) that prompts its clinicians to ask patient-specific questions based on data from 100 million patient visits and records of the patient’s own behavior. The software will suggest problems that the patient might have, walk the clinician through asking questions, and then create a SOAP note that goes back to the EHR. The same software is integrated with Greenway, NextGen, and Allscripts.

Other

The local paper highlights the struggles of United Hospital District (MN) in implementing Meditech. Administrators blame internal workflow problems for registration-related pains and interface issues for difficulties exchanging data between Meditech and the hospital’s NextGen system.

A TV station in Hawaii reviews the cost of implementing Siemens Soarian at taxpayer-supported Hawaii Health Systems Corporation (HHSC), originally budgeted at $50 million but now estimated at $109 million. The health system’s regional CEO says IT and support staffing estimates were so far off that headcount had to be doubled. The hospital workers’ union expressed concern that a Siemens employee serves as HHSC’s CIO, saying, “It’s like the wolves watching the henhouse,” but the health system responded that it hired another consulting firm “to oversee Siemens.” Siemens responded that the scope of the work of the original $29 million contract hasn’t changed, but HHSC keeps asking for more modules, services, and staffing that weren’t in the contract.

A survey of 1,000 physicians finds that 70 percent don’t think the HITECH program was worth its cost, 45 percent say EHRs have made patient care worse, and 43 percent say EHRs caused them to lose money. A third say they doubt their current EHR will even be around in five years. A key fact was omitted in the press release – what was the survey’s methodology? In other words, how were respondents selected; how were the questions presented; what was the demographic, specialty profile, and practice type of respondents, etc.? The findings are pretty big news if the survey’s methods were sound.

John Lynn hosted a Google+ video hangout on cloud technology and data centers that can be streamed from his site.

OCR files a HIPAA complaint against a Las Vegas hospital and Dignity Health, claiming the hospital used its medical records to contact former patients to get them to switch to the health plans the hospital accepts. The hospital denies the charge, saying its contacts were intended to be “informative.”

OK, who proofed this press release’s headline?

Sponsor Updates

• HealthLogix from Certify Data Systems passes numerous Integrating the Healthcare Enterprise profile tests at the 2014 IHE North America Connectathon.
• TeraMedica will debut its zero-footprint universal viewer for its Evercore vendor-neutral archive at the HIMSS conference.
• ICSA Labs issues Passport’s CareCertainty service 2014 inpatient module ONC Health IT Certification.
• Arcadia Healthcare CEO Sean Carroll discusses the struggles facing hospitals in a Boston Business Journal article.
• MedAptus releases a risk severity toolkit to help provider groups with coding of patients covered under risk-based contracts.
• Memorial Healthcare (MI) uses Iatric Systems Meaningful Use Manager to access data for a Meaningful Use audit.
• An API Healthcare-commissioned survey reveals that the majority of Americans age 30 and older are concerned with the impact of healthcare reform on the quality of patient care and staffing at hospitals.
• Providers have collected more than $10 million in CMS reimbursements over the last five years using the Covisint PQRS submission process.
• Richard W. Zollinger, II, MD shares how Capario has helped his practice to accelerate cash flow, improve profitability, and remain independent.
• Sandlot Solutions launches a channel partner program for healthcare consultants, software vendors, and payers.
• iHT2 announces the details of its San Francisco summit on population health management and analytics.
• FeedHenry and AirWatch partner to offer a joint solution that enables enterprises to quickly and securely create and manage multiple apps and devices.
  

  ---

REST and FHIR
By Brian Weiss
CDA PRO

REST is a techie thing. It’s another way for computers to talk to each other. Another flavor of API (application programming interface.)

What matters in this context is not how it works or why it’s better or worse than anything else, just that it’s a very well established and widely deployed standard that software developers are using today (and have for the past few years) to develop applications that work over the Internet, like smartphone applications that reflect data from Web servers in the cloud or Web servers that talk to each other.

FHIR uses REST as its technical underpinnings to do the same kinds of things that HL7 has always done — enable the exchange of healthcare information (patient clinical summaries, lab orders end results, etc.) between systems.

When most people say, "We’re using HL7," they usually mean HL7 version 2 messaging, which defines a format for one system to send healthcare information to another over a network. It’s a point-to-point communication (think email) between two systems, though often there is a specialized message router that sits in between to help translate the variations in the message format that each side understands.

The Meaningful Use (MU) regulations have ushered in broad use in the US of a newer generation of HL7 standards focused on something called CDA — clinical document architecture. In CDA, what gets transferred between systems is a document (think word processor file) that contains the same kind of information as HL7 v2 messaging, but using XML format. XML is a document format that is used a lot on the Internet when data is exchanged in document format. The HTML exchange between browsers and web servers today is a form of XML.

CDA is part of version 3 of HL7, which is a very broad framework that describes the underlying theoretical model for how data should be represented and encoded, regardless of whether it’s communicated via messages like HL7 version 2 or CDA documents (version 3) or other formats. There is thus a version 3 messaging protocol that replaces the version 2 messages, but it hasn’t caught on much, especially in the US. So as a practical matter, HL7 version 2 usually means point-to-point messages and HL7 version 3 usually means CDA documents.

HL7 data interchange today for most people is either version 2 messaging or version 3 CDA documents. The specific flavor of CDA called out in Meaningful Use Stage 2 today is termed C-CDA, which stands for consolidated CDA, so named because it "consolidated" various CDA-derived standards that came before it.

Though I speak on behalf of nobody other than myself and am not taking sides, there is a oft-cited position that HL7 standards historically have been a bit too formal and academic and also too open to varying interpretation. Even if both sides of an exchange are using HL7 v2 messaging or HL7 v3 CDA documents, there’s still a lot of work to do (one integration at a time) to ensure that what the receiver understand is what the sender intended.

FHIR is also part of HL7 v3, only instead of using XML documents like CDA does, it uses REST interfaces.

FHIR looks like it has passed the "shiny new object to get excited about" phase and is being worked on actively by many vendors and other clinical data interoperability stakeholders. Relative to the early stage of its lifecycle that it is currently in, FHIR has significantly more momentum than any previous HL7 standard. In addition to using REST (which makes it a great way to exchange healthcare data for things like mobile applications), the folks working on FHIR are doing their best to learn the right lessons (good and bad) from past generations of HL7 standards.

It will be a while before we can know for sure if FHIR delivers on its promise and even longer before we know for sure what it means for the evolution from the entrenched HL7 v2 messages or the currently MU-mandated CDA documents. Some of that probably depends on if, when, and how future editions of MU mandate the use of FHIR, but also how quickly it achieves critical mass of application developers.

I think for most HIStalk readers who work at healthcare providers and non-vendor stakeholders, FHIR is more something to be aware of than something that requires action right now. In the software development side of vendors and consultants (and IT groups within other healthcare interoperability stakeholder organizations,) more concrete action is required to learn FHIR, work on prototypes, and participate in some of the connectathon testing between servers and applications that are taking place.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

HIStalk Advisory Panel: Analytics Success

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 are examples of major operational or clinical successes your organization has experienced in the past year from using analytics or data reporting tools?

No operational successes of any kind as our medical staff as well as administration does not even know the meaning of analytics nor what to do with it. We lack even the basic reporting capabilities needed to know our observation and LOS. We did well with core measures and scored high and used that as a marketing tip, however we did not use any sophisticated tools to get there. The physicians do not get any personal performance data to look at to compare with their peers and are not used to looking at their own data at all. It is part of the reason why I believe the institution failed so miserably and ended up being acquired by a lager hospital chain.

Improved GI lab throughput. Reduction in the use of blood products. Improvements in GI Billing process. Improvements in GI DNKA.

None.

Hard to know what success we have had from using analytics. If we decide, based on environmental scans and analytics to to focus on, say, total joint replacement, there will never be a time when we can say, "Ah, that was the right decision", even if your hospital is still afloat, or doing well. It may be that another service line or focus or workflow or supplier would have been better. Analytics comforts us into thinking we aren’t making a WAG, but there aren’t answers in the back of the book. On the more micro level, cost-benefit does help balance the budget.

Over the past year we deployed reporting tools to our front-line providers, departments, sites, divisions and company-wide providing actual results compared to our goals for people, service, cost, quality, access, and primary care flow. Particularly in service and access we improved performance compared to baseline and moved closer to (and in some cases exceeded) goals. Patients report improved experiences and appointing wait times have come down. There’s probably a link between the two improvements. 

We used some basic reporting tools to identify high risk patients who are overdue (e.g. diabetic with A1C over 8 not seen in six months). We then tried multiple methods of outreach and found email, letters and robocalls had minimal impact on this group. We finally found  success with having our call center staff call them during the late afternoon when there was low incoming call volume. Turns out they responded very well to real people calling them who could make their appointments right then!

No use of data beyond mandated reporting: MU, Core Measures, etc.

Using a SaaS population health data analytics tool, which blends CMS claims and EMR clinical data, to identify leakage of ACO patients outside our Network, which identifies opportunities for providing services not currently offered by our network in order to capture the lost revenue and reduce the expense to the CMS Medicare program.

We’ve been able to push an Analytics Dashboard to each member of our clinical leadership team that allows them to have real-time data as to the patients on their units, the patients that were discharged yesterday, and so on. Dramatically reducing the turn-around time for actionable data and ‘teaching them how to fish” has resulted in greater satisfaction amongst them and allowed my folks to focus on other projects instead of grinding out repetitive reports.

Minimizing the readmission rates in our high risk population such as those who had an MI or uncontrolled diabetic states  – two major clinical categories. Minimizing ER visits of high risk patients

We have set up a few transitional care clinics where we try to work with patients, post discharge, to ensure that they get/take their meds, get in to their PCP’s office as ordered, and generally try to get them compliant with their treatment plan in order to keep them out of the hospital again. (Basically, trying to prevent re-admits). We are using a number of tools and reports to generate data to assist with this process, but we are investigating new ones (e.g., PHM systems) that are specifically designed to do this.

Data on our clinical initiatives to improve clinical performance on readmissions, VTE prevention and early recognition of clinical deterioration have been very helpful in terms of showing benefits of these projects.

Morning Headlines 2/11/14

Why the EHR Market Is Poised for Disruption

An EHR market analysis from CIO.com concludes that both the inpatient and ambulatory EHR market’s are poised for disruption and consolidation.

Key number in today’s Castlight IPO filing

Castlight Health discloses its financial performance in an updated IPO filing, revealing multi-million dollar net losses during each of the past two years. The new financial data raises into question Castlight’s hope of a $2 billion public valuation.

EHR-based screening program for AAA cuts the number of at-risk men by more than half

A study conducted by researchers at Kaiser Permanente finds that by implementing EHR-based clinical alerts, abdominal aortic aneurysm screening rates can be significantly improved. The alerts prompted providers to order a screening anytime an unscreened 65-75 year-old male with a history of smoking was seen. The alerts led to a system-wide reduction of unscreened patients from 51.74 percent to 20.26 percent.

Stage 3 MU now in the making

The ONC’s MU workgroup will submit its draft recommendations for Stage 3 on February 14th.

HIStalk’s Guide to HIMSS14 Meet-Ups

We are pleased to share information on HIStalk sponsors that are not exhibiting at HIMSS14 but would be happy to schedule one-on-one meetings during the conference.

Accreon, Inc.  

To schedule a meeting:

Contact: Gareth Kenton, sales leader
gareth.kenton@accreon.com
617.899.5394

We do look forward to connecting with you in our meeting space at the conference. Accreon is a healthcare technology and business services firm focused on integrating and managing health information.

We assist healthcare organizations to: achieve interoperability by integrating their IT eco-system; establish an analytical environment that empowers learning, agility, and performance resulting in improved outcomes, finances, and satisfaction; and enhance IT innovation by providing knowledgeable healthcare expertise and tools to bring solutions to market faster.

Accreon has delivered services and built solutions across North America for healthcare provider organizations, government entities, medical device companies, and EMR vendors.

Mention you were referred to Accreon through HIStalk and receive 15 percent off any resulting business established at HIMSS.

ADP AdvancedMD   

To schedule a meeting:

Contact: Jim Elliot, vice president of marketing
jelliot@advancedmd.com
435.729.0343

ADP AdvancedMD executives will be available at HIMSS to discuss the impact that big data and business intelligence will have on the private physician and how ADP AdvancedMD is addressing the needs of medical practices. They also will be available to address what key challenges doctors are facing in 2014, including Meaningful Use adoption, weathering the implementation of ACA within the industry and its impact on patient population and reimbursements, preparing for the switch to ICD-10, and juggling everyday issues and challenges to ensure today’s claims will get paid in a reasonable amount of time.

Aspen Advisors   

To schedule a meeting:

Contact: Dan Herman, founder and managing principal
info@aspenadvisors.net
800.697.4350

Aspen Advisors is a world-class professional services firm dedicated to helping healthcare delivery organizations enhance processes and streamline operations through the strategic and effective use of technology.

From strategy to execution to optimization, our core services have been tailored to help address industry priorities:

• Reduce operating costs
• Implement and realize the full benefit of Electronic Health Records
• Transition from volume to value
• Harness the power of data and analytics
• Enable the connected community
• Position for the future of revenue cycle management

Ultimately, our goal is to help you realize the value of your IT investments and continue to improve the effectiveness of your organization in improving the patient experience of care and the health of populations, while reducing the per capita cost of healthcare.

BlueTree Network  

To schedule a meeting:

Contact: Nicole Meidinger, VP of sales and business development
nicole@bluetreenetwork.com
574.360.9029

BlueTree has built a network of over 400 specialized and trusted healthcare IT experts. Our fresh model attracts and supports the best talent and allows us to offer customized and flexible solutions to health systems.

Here’s an overview of our unique model which has helped us to become the premier Epic consulting group:

• Quality verification – BlueTree employs a thorough process to vet quality and identify niche expertise. We secure targeted recommendations from clients and peers to ensure the excellence of all BlueTree consultants and identify perfect matches for our clients’ needs.
• Remote support network – BlueTree created a unique web platform that connects consultants and customers, helping them share expertise and engage each other in remote support or targeted small projects. This provides a cost-effective, flexible alternative to the standard onsite consulting model.
• Specialized service lines – BlueTree helps consultants innovate valuable new service lines and share in all revenue they generate. This attracts the very best talent and allows BlueTree to offer unique, customized solutions that keep up with the ever-changing world of healthcare IT.

At BlueTree, our philosophy centers on providing and recognizing value. We have some of the strongest healthcare IT people around and have been fortunate to work with incredible healthcare organizations. We enjoy collaborating with our clients to create custom solutions to difficult problems. Feel free to get in touch by phone or email with any questions or opportunities.

Caristix  

To schedule a meeting:

Contact: Stephane Vigot, president
stephane.vigot@caristix.com
877.872.0027 ext.153

Caristix technology serves to simplify the development, deployment, and maintenance of healthcare applications for hospitals. We’re building products that help vendors and hospital become more productive. Carisitix enables interoperability and gets your software systems playing well together.

Visit us at the Interfaceware booth 2229 to get a look at out latest software and discuss how we help you get control of the HL7 interface lifecycle.

Coastal Healthcare Consulting  

To schedule a meeting:

Contact: Amy Noel, CEO
Amy.Noel@coastalhealthcare.com
206.321.9840
Gay Fright, EVP of Business Development
gay.fright@coastalhealthcare.com
760.333.0294

Coastal Healthcare Consulting, Inc. (“Coastal”) has been a premier provider of healthcare IT consulting services since 1995. We are a national firm based in the Seattle area. We have a proven track record of performance having completed more than 850 projects, for more than 80 clients, and were awarded “Best in KLAS,” clinical implementation, supportive for 2005-2009.

We began the company with a focus on  providing EMR implementation services for healthcare clients. We have expanded our services to include the major EMR vendors, additional vendor partnerships, legacy support, and project management.

Connance, Inc.   

To schedule a meeting:

Contact: Brian Graves, vice president of marketing and communications
bgraves@connance.com
617.512.6971

Connance brings world-class predictive analytics and insights from hundreds of clinical settings to transform the performance of financial processes at hospitals, physician groups, and outsourcing organizations. Connance solutions sustainably increase cash flow, reduce operating costs, and improve policy compliance in self-pay, denial management, charity, and outsourcing processes. With clients like Centura Health, CHRISTUS Health, Florida Hospital, and Geisinger Health System, Connance is changing the expectations of financial executives.

Craneware   

To schedule a meeting:

Contact: Ann Marie Brown, EVP of marketing
a.brown@craneware.com
913.548.2810

Craneware (AIM: CRW.L) is the leader in automated revenue integrity solutions that improve financial performance for healthcare organizations. Craneware’s market-driven, SaaS solutions help hospitals and other healthcare providers more effectively price, charge, code, and retain earned revenue for patient care services and supplies. This optimizes reimbursement, increases operational efficiency, and minimizes compliance risk.

By partnering with Craneware, clients achieve the visibility required to identify, address and prevent revenue leakage. Craneware Revenue Integrity Solutions encompass four product families: Access Management & Strategic Pricing, Audit & Revenue Recovery, Revenue Cycle, and Supply Management. To learn more, visit craneware.com and stoptheleakage.com.

Culbert Healthcare Solutions   

To schedule a meeting:

Contact: Brad Boyd
bboyd@culberthealth.com
857.919.2003

Culbert offers comprehensive management consulting services for physicians, hospitals and healthcare systems to improve the delivery of patient care in today’s challenging environment.

Culbert’s seasoned healthcare professionals possess strong patient access, clinical and revenue cycle operations experience combined with IT vendor focused expertise which uniquely qualifies the firm to select, implement, and optimize technology solutions in complex healthcare organizations.

Cumberland Consulting Group   

To schedule a meeting:

Contact: David Vreeland, partner
david.vreeland@cumberlandcg.com
615.335.5272

Cumberland is hosting a hospitality suite at the Hyatt Regency (formerly the Peabody) during the conference. Cumberland Consulting Group, LLC is a national technology implementation and project management firm serving ambulatory, acute, post-acute and long-term healthcare providers, health plan and payors, and life sciences companies. Through the implementation of new technologies, Cumberland helps health organizations nationwide advance the quality of services they deliver and improve overall business performance.

For more information on Cumberland, visit http://www.cumberlandcg.com.

DataMotion   

To schedule a meeting:

Contacts:
Bob Janacek, CTO, bobj@datamotion.com, 973.452.5321
Andy Nieto, health IT strategist, andyn@datamotion.com, 502.905-0230
Hugh Gilenson, director business development, healthcare, hughg@datamotion.com, 201.417.1090

DataMotion provides HIPAA-compliant solutions using strong encryption techniques for secure email and file transfers containing PHI. We are also an ENHAC accredited Health Information Service Provider (HISP) delivering Direct Secure Messaging services via 18 EHRs including EPIC’s EMR.  We help EHRs and HIEs certify for 2014 ONC-ACB using DataMotion Direct as “relied upon software”.

The DataMotion Direct solution allows vendors of certified health IT products to rapidly certify their solutions and enable providers to meet MU2s Direct Secure Messaging requirements. Capabilities include:

• Interoperability for Direct Secure Messaging
• Support for both incoming and outgoing messages
• Routing of CCD/CCDAs through DataMotion’s HISP and exchanged via XDR

You can meet with us at HIMSS by contacting Bob Janacek, Andy Nieto, or Hugh Gilenson.

Etransmedia   

To schedule a meeting:

Contact: Connie Smith, marketing
sales@etransmedia.com
518.283.5418

Since 2000, Etransmedia has developed and delivered integrated cloud-based software and services to hospitals, health systems, and physicians nationwide. Etransmedia’s solutions include revenue cycle management service, the Connect2Care software platform which includes an integrated EHR/PM, financial analytics, care coordination, and patient engagement.

Etransmedia is committed to providing the right solutions to build an effective community of care, driving revenues and efficiencies for ambulatory, acute and diagnostic facilities, and increasing the availability of information to providers making critical care decisions. Etransmedia serves over 12,000 providers and 40,000 users.

Etransmedia is the recipient of seven consecutive Inc. 500/5000 awards, and three consecutive Deloitte Technology Fast 500 Awards. http://www.etransmedia.com.

Greencastle Associate Consulting   

To schedule a meeting:

Contact: Joe Crandall, director of client engagement solutions
crandallj@greencastleconsulting.com
856.685.0737

Greencastle consultants are agents of change. Our people have the skill and the experience necessary to assume leadership and take responsibility for the success of large-scale clinical projects and business initiatives.

Founded by US Army Rangers in 1997, Greencastle specializes in bringing a sense of purpose to the task of furthering the missions of hospitals, health systems, acute care centers, clinics, medical practices, ambulatory care providers, and other healthcare organizations. We realize the potential of change through disciplined teamwork, innovation, and systematic methods.

With loyalty and integrity as our compass, we partner with healthcare organizations to complement the existing expertise and passion of your teams. Our change agents inspire people, help them perform, and get results. We maximize the value of change for healthcare organizations. By implementing mission-critical solutions, Greencastle helps hospitals increase revenue, reduce costs, and improve patient outcomes.

Hayes Management Consulting 

To schedule a meeting:

Contact: Pete Butler, president/CEO
pbutler@hayesmanagement.com.

Hayes Management Consulting is a leading, national healthcare consulting firm focused on healthcare operations. This includes strategic planning, interim leadership, revenue cycle optimization, clinical optimization, project management, IT consulting, and preparation for federal initiatives such as ICD-10, Meaningful Use, and HIPAA compliance.

We also provide software such as MDaudit and other proprietary tools to ensure our clients are operationally efficient. We won’t have a booth but would like to meet you!

LightSpeed Health, Inc.   

To schedule a meeting:

Contact: Michael Justice, president
mjustice@lightspeedhealth.com
305.799.0990

LightSpeed Health is a healthcare software and services company focused on solving IT related issues for ambulatory practices. We are experts in archiving and migrating EMR/EHR and PM systems, our archive systems have been deployed in the largest physician networks in the country, in over 15 states. We work with health systems to develop and execute the IT strategies related to physician practice acquisition – data migration, clinical and financial interfacing (HL-7 and X-12), implementation support, training, workflow analysis, and ongoing user support.

Our team has particular expertise in Allscripts Enterprise and GE Centricity EHR and PM systems.

Specialties: EMR/EHR data archives and migration, Allscripts Enterprise EHR and PM systems, GE Centricity EMR and PM systems, EMR/EHR selection and implement support, and EHR/PM facilities management agreements.

The Loop Company

To schedule a meeting:

Contact:  Gino Johnson, founder and managing director
info@loopcompany.org
802.857.5464

The Loop Company is a research advisory firm with more than 20 years experience helping healthcare technology organizations grow their business. Our focus is on delivering actionable strategic and tactical learnings to help your organization successfully launch new products/services, enter new target markets, win more new business, and build loyal customer relationships.

What we do:

• Collaboratively design customized qualitative feedback loop mechanisms to help your organization understand how it is being perceived in the marketplace, by your customers and prospects.
• Advance organizational improvement across all areas of your business including: sales, marketing, positioning/messaging, brand awareness, product development, roadmap validation, operations, installations/implementation, support, account management.

MedAssets   

To schedule a meeting:

solutions@medassets.com
888.883.6332

MedAssets (NASDAQ: MDAS) is a healthcare performance improvement company focused on helping providers realize financial and operational gains so that they can sustainably serve the needs of their community. More than 4,200 hospitals and 122,000 non-acute healthcare providers currently use the company’s evidence-based solutions, best practice processes and analytics to help reduce the total cost of care, enhance operational efficiency, align clinical delivery, and improve revenue performance across the care continuum.

For more information, please visit www.medassets.com.

nVoq   

To schedule a meeting:

Contact: Debbi Gillotti, vice president and general manager
deborah.gillotti@nvoq.com
206.465.1765

nVoq provides a cloud-based speech recognition platform (SayIt) exclusively endorsed by the AHA. We support real time dictation for any EMR as well as voice-enabled workflow through automated shortcuts and scripting. SayIt can be used on both Windows and Mac OS computers.

SayIt in Healthcare is sold exclusively through channel partners. Unlike other vendors in this industry, nVoq has no direct sales force and does not provide transcription services.  We want to grow, not compete with, our reseller network.

We welcome inquiries from app developers, EMR resellers, and HIT services firms interested in becoming channel partners. We’re also happy to make contact directly with providers or IT leaders to discuss your requirements and connect you with one of our certified resellers.

Talk to us about building a SayIt practice or using the SayIt SDK to voice-enable your applications platform. Learn why SayIt from nVoq is the sensible alternative for your organization.

Visit http://www.nvoq.com for more information.

pMD   

To schedule a meeting:

Contact: Chrissy Braden, director of business operations
sales@pmd.com
800.587.4989

pMD develops software that is powerful, flexible, reliable, and easy-to-use. pMD’s mobile charge capture solution enables physicians to enter billing charges anywhere, at anytime from iPhone, iPad, and Android devices. pMD eliminates the tedious paper processes and administrative elements that burden doctors and their practices, while reducing charge capture lag from weeks to less than a day.

Charge capture is unbelievably easy with pMD’s advanced code search functionality, which gives providers a quick and convenient way to select customized codes. pMD’s ICD-10 Converter automatically maps codes in one click and allows customers to incorporate the ICD-10 code system instantly or incrementally. Additionally, pMD’s secure messaging allows physicians to send sensitive information quickly and securely, all directly from within the pMD app.

The pMD team is committed to developing the best solution on the market and providing superior customer service.

Prominence Advisors   

To schedule a meeting:

Contact: Bobby Bacci, president and CEO
HIMSS@prominenceadvisors.com
bobby.bacci@prominenceadvisors.com

Prominence Advisors will be hosting an event for current and prospective customers on Tuesday evening. Anyone interested in attending can get details by using the email HIMSS@prominenceadvisors.com

Refreshing: that’s the word that comes to mind when talking about Prominence Advisors. This fast-growing healthcare IT consulting firm is doing things differently and finding new ways to apply technology, strategy, and analytics within the healthcare industry.

Proximare Health   

To schedule a meeting:

Contact: Shawn Wagoner, president
swagoner@proxhealth.com
512.635.4059

If patient access, leakage, and referral management are words you are hearing a lot of lately please take time out to learn how Proximare has helped several organizations with these challenges. Our product was developed in collaboration with clinicians and operations leaders over a decade ago at one of the largest systems in Chicago and has managed over two million patient transitions to date.

Sample Client Results:

• Referral processing time was reduced from three months to 5.5 days
• 22 percent of referrals were screened out as inappropriate
• Referral volume increased sevenfold with fewer employees needed to manage it.

QPID Health   

To schedule a meeting:

Contact: Amy Krane, marketing
amy.krane@qpidhealth.com
617.308.5476
Connie Thompson, sales
connie.thompson@qpidhealth.com
404.964.1478

EHRs offer huge promise and great challenges. But as any clinician will tell you, it’s frustrating and time consuming to get the patient story you need for a specific clinical encounter. QPID solves that problem.

Developed and proven through use by thousands of clinicians at the Mass General and other leading hospitals, QPID finds and delivers digests of relevant patient history from anywhere in the patient’s record. From structured data fields and free-form text notes. And across EHRs, HIEs and other data repositories.

Learn why QPID users say “I can’t believe I ever practiced without this.” If you’re ready to optimize your EHR, let’s talk.

Virtelligence, Inc.   

To schedule a meeting:

Contact: Akhtar Chaudhri, CEO and founder
achaudhri@virtelligence.com
Nicole Francen, marketing communications specialist
nfrancen@virtelligence.com
952.548.6601

Virtelligence, a national healthcare and IT consulting firm, offers a unique consulting model that provides a results-driven partnership with clients and a work environment that offers colleagues a path for professional growth unequaled in the industry.

Key Service offerings include:

• Strategic guidance and project management
• Software implementation and optimization
• Software development and integration
• Revenue cycle optimization
• Clinical transformation
• Meaningful Use and ICD-10 projects

Virtelligence consultants have practical hands-on expertise and training with major healthcare and technology vendors, including: Allscripts/ Eclipsys, Cerner, Epic, MEDITECH, Microsoft, Oracle, SAP, and Lawson.

Virtelligence has earned national recognition and numerous awards for being a rewarding work place and delivering lasting client successes: Best Places to Work in the Minneapolis/ St. Paul area, HCI 100, Inc. 5000, and the Minnesota Business Journal’s Fast 50.

Vonlay LLC       

To schedule a meeting:

Contact: Casey Liakos, director of client relations
casey@vonlay.com
612.209.8255

Since 2009, Vonlay has been handpicking the best application, technical service and development experts from across the HIT ecosystem to work with our clients. And we are proud of the results: a creative, supportive, hardworking company that has a deep commitment to client success.

Vonlay has a unique focus on technology, leadership, and design in the Epic space and beyond. We’ve helped new clients build strong foundations with their implementations. We’ve helped established clients innovate and create a competitive edge with staffing, portals, development, and reporting services.

For more information visit http://www.vonlay.com

Readers Write: Little Data

Little Data
By Greg Park

Today’s topic is the methods by which employees and partners obtain information to perform their function, or as I like to call this, the Push vs. Pull method of information dissemination.

Let’s step inside the way-back machine to observe how this was accomplished in 1986.

I was cutting my HIT teeth first as a computer operator and then as “do-everything” guy at a mid-sized hospital in Philadelphia. There were few standards and no one with HIT degrees. You learned from the vendors, by reading technical manuals, and by putting out fires.

My first big hospital project was implementing Shared Medical Systems Spirit platform, which was SMS’s first turn-key mini platform. This led to managing other tertiary clinical applications and methods of creating information.

Each new platform we installed was bundled with standardized reports focused on daily activities, DNFB accounts, and payments by patient type. All reports were QA’d by vendor and staff prior to go-live to certify accuracy. These standard out-of-the-box reports were the lifeblood of staff’s workflows, and believe me, I would hear it if they weren’t delivered by 6:00 a.m.

Reporting exploded as data became richer and tools emerged to create specialized ad-hoc reports. Soon we were creating ER patient flow analysis, profitability by attending physician, nurse staffing by patient acuity, and then linking data between disparate platforms.

Life was good, but we were killing thousands of trees each month. End users were happy because the process of creating these ad-hoc reports was very personal. I would sit with end users to analyze their needs against the data collected. When required, we would add new data fields and workflows to collect that information accurately in our various platforms. Finally we would validate output structures, ensure accuracy, and finally schedule the reports for the desired timeframe.

Each day or week or month, the report would print. As time marched along into the 1990s, we downloaded all reports into our content management platform. Now all reports were readily accessible and audit trails let us know exactly who was (or was not) reviewing their reports.

My formative years were spent in this way understanding need, locating data, and constructing formats to enable user workflows. These were the “Push” years, because it was our responsibility to ensure the report, spreadsheet, or database was created and pushed to users and business partners in a timely way.

Somewhere in the mid-1990s it became clear that something was changing. During a PeopleSoft implementation, I noted that disk space and CPU resources were significantly more robust than the platforms I had encountered. Data could be kept almost indefinitely and sophisticated queries could be run in real time rather than waiting for a day-end process. The writing was on the wall, but the major HIT platforms would take years to catch up. Many hospitals still operate like its 1985, some with basically the same HIT platforms.

The rest of this writing involves relaying the conversations I have had with my customers, so if this is not your experience, please chime in.

Most new EMRs are fashioned with limited standard reports. End users have become the focal point in the process of generating all reports. Generating reports and pushing them to their intended audience has become an anachronism. Let’s call this new method the “Pull” method, because users are expected to pull the data themselves. In this Pull method, users access report writing tools and pull data on their own terms as needed. To the system designers, this must have been intended as empowerment, but for many users it is a speed bump that did not exist before.

This Pull method can be implemented in various ways. In some, the IT department creates general templates for users to enter query parameters. This works fairly well, but does not address those reporting situations where the timing of data generation is critical. The report will look different if run on August 31 as opposed to September 10, and sometimes this is a problem.

Another method is to provide the user with a full query interface. Now end users are playing the role of IT analyst. Maybe this is fair and is a reflection of how IT is part of everyone’s jobs today, but it can be problematic when users select the wrong data or create a query that is particularly taxing to the EMR or its reporting database. In this world, we have a real problem of focusing on the wrong data, or worst yet, not focusing on the data at all.

For the moment (because I know that once HIT is exposed to big data this will change) patient accounting and general finance are your biggest data consumers. From my perspective, they seem particularly annoyed with this new Pull mentality. Many of these users access these new systems exclusively to generate their own reports.

For me, life is always about balance, and I think both the Pull and Push methods have their place. Pull methods are fine in some scenarios, assuming your end users know how to data mine and construct data exports. But when the situation is time sensitive, I want tools that Push information to responsible parties. This means end users are immediately notified the information exists, that it is readily accessible, and that they are expected to review it immediately.

I know this topic is not at the top of your mind considering MU, ICD-10, and all of your other requirements, but think about it during some downtime and consider whether you are doing your best to get the right information to the right people at the right time.

Greg Park is director of enterprise solutions for Dbtech of Edison, NJ.

Readers Write: How Many More Reasons Do You Need?

How Many More Reasons Do You Need?
By Tom Furr

The US Postal Service recently raised the cost of a first class stamp to $0.49, a 6.5 percent increase. Darrell Issa, the Congressman chairing the committee that approved the rate hike, admits, "This rate hike and the ones sure to follow will only push more and more private sector customers to stop using the mail altogether. The rate increase poses a direct threat to the 8 million private sector jobs that are part of the mailing industry as businesses shift from paper-based to electronic communication and mailers are priced out of business."

Think about it. If you had a supplier that said, “We are losing money because nobody really needs our product any more, but we are raising our prices so we can try to hang on a little longer,” how much longer would you stay with them? Or if I told you that your COGS was going up 6.5 percent and you had no alternative in vendors or processes, you might start looking at your business model and thinking about a way to work around that vendor.

In addition, bulk paper costs are expected to rise 2.5 to 6 percent over the next year. I can promise you that your vendors are not going to absorb those costs. If you are responsible for collecting payments from patients on behalf of hospitals and practices, it is a stone cold fact that you are going to see your costs rise next year. I wish I had better news for you, but unless you change something soon, you are going to have some very hard choices to make.

Once choice you can make now is to look at shifting to an online solution that allows you to present patient statements and collect payments easily. It’s not just what you need, it’s what patients want. I was talking to Allen Warren of A&H Billing last week and he explained that he adopted online bill pay because that’s what he prefers when he pays his bills. “When I talk to folks in this business, I ask them, ‘How do you pay your bills?’”, he said. “The funny thing is they all sort of laugh when they think about it. It seems so obvious when you step back from it.”

It’s no secret that I have been looking to drive online payments for our partners, but when the USPS admits that today more than 60 percent of Americans are paying their bills online and their response is to raise rates, how is that good business? It’s going to make consumers look for ways to not use their service. The question is do you want to go for that ride to the bottom with them? I know I don’t, and while I used to look at companies that offered online bill pay as innovative, I now just look at them as sensible.

The cost of postage is going up, the cost of paper is going up, and consumers want to pay their bills online. How many more reasons do you need?

Tom Furr is founder and CEO of PatientPay of Durham, NC.

Readers Write: The Symbiosis of Care: The Re-Emergence of Professionalism and the Patient Satisfaction Impact

The Symbiosis of Care: The Re-Emergence of Professionalism and the Patient Satisfaction Impact
By Paul Weygandt

As a physician, it’s second nature for us to make sacrifices for the betterment of others, whether that entails missing the first half of your daughter’s soccer game to listen to a husband who is losing his wife to cancer or working 80 hours a week.

Having been in these situations, I can honestly say – and I believe the vast majority of physicians would agree – it doesn’t feel like a sacrifice. It is an unconscious reaction to another person who is in emotional or physical pain. In many ways, being a physician is instinctual – you automatically prioritize others’ needs over your own. And again, quite honestly, in my many years of practicing medicine, I rarely had to deliberate on where I needed to be – when you’re a physician, you just know.

The ability to provide care may come as second nature, but things like using ICD-10 compliant clinical documentation do not. It is no secret that changes in regulatory policies are placing new pressures on physicians and taking our focus away from patient care and practicing the art of medicine. Regulatory requirements are directly impacting the physician-patient relationship. 

While capturing data on the patient experience is important, evaluating the physician experience and then acting on that data is of equal value. According to a recent American Medical Association/Rand study on physician satisfaction, quality of care is inextricably tied to professional satisfaction, and many obstacles to high-quality care are seen as major sources of dissatisfaction. The converse is also true. Any major source of physician dissatisfaction is an obstacle to high quality care.

We’ve found ourselves in a Catch-22. Government regulations are designed to improve patient outcomes, but they are doing so at the expense of those who are providing that care. The two most visible groups in healthcare are patients and physicians, and right now both are suffering under the burdens of a poorly designed system. Patients feel neglected and physicians feel like cogs in a wheel or workers on the healthcare assembly line, devastating medical professionalism and negating the patient benefits of that professionalism.

The ramifications of this situation are severe. After all, everyone has a breaking point. When 60 percent of physicians admit they would retire if they had the means to do so, it’s no longer just an isolated incidence of one or two hospitals’ poor processes or a few old physicians struggling to embrace new technology that is causing the problem. This has become an epidemic that is threatening to decimate our physician community across the country. It isn’t just a handful of luddites refusing to change with the times; it is something much deeper that is cutting at the very core of the medical profession and the physician’s vocation.

Now we’re back to that second nature ability that physicians possess. Physicians willingly made the conscious decision to dedicate their lives to others — to sacrifice for others. They didn’t pledge themselves to filling out onerous paperwork or to looking at a computer screen instead of into the eyes of their patients. It is time for the innovators, particularly those in the health IT community, to listen to physicians, conduct pain tests or do an Apgar score of sorts to closely monitor the health of the profession, and suggest new solutions that can begin to alleviate the discomfort of a sick healthcare system.

If non-essential busy work and non-patient demands can be decreased or eliminated, I think we will find that, once again, that physicians are able to spend their days caring for their patients. Addressing and fixing the myriad of non-clinical issues facing physicians will allow a rebirth of professionalism. That professionalism is, in turn, the basis for high quality care and patient satisfaction.

Paul Weygandt, MD, JD, MPH, MBA, CCS, FACPE is vice president of physician services of Nuance Communications of Burlington, MA.

Curbside Consult with Dr. Jayne 2/10/14

I’ve made some really good friends in health IT over the last couple of years. One of them shared a great story from a recent get-together he hosted. It made me chuckle enough to want to share it.

We had another family over for a the Super Bowl last week, which was really just a kid-friendly play date and some chatting as the game was awful and the adults were slap-happy from being snowed in with their kids for the last several days. 

“So I am thinking about interviewing for for the new chief medical information officer job at the hospital" said one of the docs, who is a hospital-based physician.

"You mean informatics, right?" said the pernicious techie, cringing at yet another sentence starting with “so.”

"Yeah, sure. So that would be exciting. I am just afraid of being the complaint desk for all Vendor issues. Do you think there is a way to integrate Vendor A and Vendor B?" he said, looking at me, even though the two other adults (which makes three out of four) are employed physicians at the same hospital.

"You can integrate any two things, but the question I would ask is, ‘What things do you feel need to be concatenated for the benefit of patient care and physician happiness?’ since just combining data recklessly can be worse than what you currently have," said the now aghast techie, who wonders whether current employees are being paid to interview for positions they are unqualified for.

"Well, it is a part-time job and I think it would be cool to help improve workflow at the hospital," said the hospitalist.

"Sure, I mean, great. It is really progressive for the hospital to go after a CMIO position. I mean, for them, this is big stuff. I have some friends who are CMIOs that maybe you can speak to. One even finished her sub-specialty Boards recently. The other is an ER doc, but he also has a degree in computer science."

My friend concluded that there is a significant gap between what needs to happen in clinical informatics and what will likely happen. I see this more often than I would like.

I recently helped a local hospital craft a job description for a CMIO-type position. Like many others, they refuse to call it what it is, and instead are hiring for a “Medical Director of Informatics – Ambulatory.” The job description looked good and they posted it. I was shocked when they immediately narrowed the field down to two in-house candidates, both of whom are hospitalists with virtually no ambulatory experience.

Only one had any formal informatics training and that was a three-day continuing education course focusing on public health informatics. The hospital has over 150 employed ambulatory physicians and I was surprised that none of them made the short list. They have been on EHR for half a decade and have a handful of strong physician champions who would have been great in the role. I’m sure there are other political factors at play, but I can’t imagine what they would be that the organization would risk going with an unproven commodity with minimal experience.

My friend had the same sentiment about his party guest. “Why would a hospital that has invested over $20 million in the past five years in inpatient and outpatient technology, keeps buying up practices, and is undergoing a shift to PCMH & ACO across the board leave its CMIO position up to people who have absolutely no idea what they could do, should do, or can do in that role? When do we accept that the needle won’t be moved very far in improving any of the triple-aim’s intended targets?”

Since it was Super Bowl Sunday, he drew the analogy that it is similar to thinking that a baseball player is also a good ping-pong player because they are both sports. I agree with his conclusion that this is a problem for physicians who lack real representation in technology and for administrators who are clueless to the practical requirements of IT in their environments.

I’ve seen a couple of articles recently on the importance of developing effective leadership in healthcare organizations. Leaders need to not only be confident and inspiring, but they also need to know the material at hand. That’s difficult to do when you’ve never practiced in the environment you’re trying to lead. I’m not saying you can’t learn it, but starting in a position where the deck is stacked against you is a challenge.

Let’s suppose my local hospital chooses to hire one of the hospitalist candidates. He is being set up to fail, as the employed physicians will immediately claim that his lack of ambulatory experience makes him unqualified. Even as a practicing outpatient physician, my first physician champion role led to claims I was inadequate because I didn’t see as many patients as my peers or my patients weren’t as sick as theirs. I can’t imagine what it would be like to be thrust on the scene as a hospitalist.

My initial advice for this physician who thinks that part-time informatics work might be “cool” would be to dig deeper into the job description and determine areas of strength and weakness. Even though this physician would be just beginning his informatics career and therefore would not be eligible to sit for the Clinical Informatics board exam, I would encourage him to attend the AMIA board review course, as it is does a great job illustrating the breadth of material that falls into our realm. He could also choose one of their 10×10 courses to dig further into areas where his employer wants him to focus.

Should he actually be offered the job, I would recommend pushing to have these kinds of courses paid for as part of the informatics role, as well as dedicated time for continuing medical education (CME). When I took my first informatics post (part-time), I was able to use standard physician continuing ed hours and funds to accomplish this. However, when I went full time, that week of CME time and the money that went with it vanished in their initial offer and had to be negotiated back into the agreement.

It was good catching up with my friend. I usually see him at HIMSS but he’ll miss it this year unfortunately. He did have some good advice for me, however, in response to my recent question about how administrative physicians decide whether it’s time to give up practice:

You asked if you should give up treating patients recently. My advice: no, you should not stop treating patients. You should instead redefine who your patients are. No longer should you spend time with booboos and flu shots and diabetes. You should now look at the sick hospitals, clinics, and IPNs (there are still some out there) that really need a checkup, a care plan, and an intervention. Your patients are out there and your patients are very ill. They may even compensate you, and like the great feeling you get when you catch appendicitis early, you will change the health of your patients in ways we will benefit from for years to come.

I really appreciate the pep talk and have to say it came just at the right time. Listening to his story, I remember what it was like being a fledgling informaticist. It makes me want to go out and win one for the Gipper.

Have a health IT pep talk to share? Email me.

Email Dr. Jayne.

Morning Headlines 2/10/14

athenahealth Management Discusses Q4 2013 Results – Earnings Call Transcript

athenahealth holds its Q4 earnings call, during which CEO Jon Bush discusses plans to start marketing products to hospitals, and outlines future projects for integrating services with Epocrates.

Leading Pharmacies and Retailers Join Blue Button Initiative

The BlueButton+ network grows to include data from a number of major retail pharmacies including Walgreens, CVS, Rite Aid, and Kroger.

CMS extends 2013 EHR attestation deadline for EPs, certain hospitals

CMS extends Meaningful Use 2013 attestation for EPs by one month. The new deadline is March 31, 2014.

Monday Morning Update 2/10/14

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

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

Upcoming Webinars

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

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

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

iHealth 2014 Report

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

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

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

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

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

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

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

From athenahealth’s Friday earnings call:

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

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

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

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

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

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

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

Sponsor Updates

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

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 2/7/14

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

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

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

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

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

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

Gov sees fix for failed Mass. health care website

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

News 2/7/14

Top News

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

Reader Comments

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

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

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

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

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

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

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

HIStalk Announcements and Requests

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

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

Here’s an overview of CitiusTech.

HIMSS Conference Social Events

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

Upcoming Webinars

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

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

Acquisitions, Funding, Business, and Stock

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

Praesidian Capital invests $8.3 million in Etransmedia Technology.

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

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

From Cerner’s earnings call:

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

Sales

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

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

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

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

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

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

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

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

People

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

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

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

Announcements and Implementations

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

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

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

Government and Politics

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

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

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

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

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

Other

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

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

Sponsor Updates

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

EPtalk by Dr. Jayne

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

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

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

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

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

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

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

Contacts

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

More news: HIStalk Practice, HIStalk Connect.