Morning Headlines 1/13/14

Obama administration to end contract with CGI Federal, company behind HealthCare.gov

CGI Federal, the Canadian contractor responsible for developing Healthcare.gov, will lose its contract for the job because of the failed rollout, and ineffective performance since. Accenture, who developed California’s insurance exchange, is expected to sign a one-year $90 million deal to take over responsibility for fixing the site.

NHS data move opt-out ‘damaging’

In England, the NHS is sending pamphlets to all households to educate the public on its care.data program after widespread public concerns over privacy resulted in an increase in opt-out requests. The care.data program connects NHS databases with private practice offices to help the government assess diseases, examine new drugs on the market, and identify infection outbreaks.

Quality Systems, Inc. Announces Expected Impairment in Its Hospital Solutions Division

QSII, parent company of NextGen, announces that it expects to record a loss on its Q3 financial reports once its Hospital Solutions Division completes a long-lived asset impairment analysis. The company could write down as much as $30 million depending on the results of the review.

IBM Set to Expand Watson’s Reach

In an effort to increase profitability of its Watson business unit, IBM announces that it will invest $1 billion in the project. The money will be used, in part, to expand its sales and marketing force, and to launch a $100 million VC fund aimed at kick starting Watson-based development efforts.

Monday Morning Update 1/13/14

From Yogic Flyer: “Re: Merge. How could a sales rep hide being paid for non-existent contracts unless there are absolutely zero controls in place in that company?” Merge announced last week that a former sales rep created phony contracts worth $15 million to meet his or her sales quota, earning the rep more than $250,000 in sales commissions. The rep worked in the eClinical OS business, which sells clinical trials software to drug companies. It’s hard to believe that some level of collusion (individual or corporate) wasn’t required for a sales rep to just make up contracts that were used not only to pay commissions, but also to be rolled into the corporate orders backlog of a publicly traded company. It’s also interesting that customers weren’t billed for the amounts specified in the contracts, so Merge’s internal processes must be majorly disjointed. MRGE shares dropped more than 10 percent on the news, decreasing the company’s market capitalization to just over $200 million. The share price is down nearly 70 percent from February 2013. Chicago-based vendors Merge and Allscripts seemed likely at one time to cause a worldwide shortage of feet to shoot themselves in.

From It’s a Sledgehammer: “Re: Allscripts. [sales exec name omitted], another former IBMer hired by Glen Tullman, has been terminated. Paul Black’s master plan of putting the Cerner band together takes one more step.” Unverified.

From Willing Participant: “Re: HIStalkapalooza. I enjoyed last year’s event and read that invitations will be sent next Wednesday. Do I need to do anything to be eligible?” The registration page will go live Wednesday, January 15 (CGI isn’t building it, so hopefully we won’t have problems.) Sign up  then if you want to come. We will email invitations on around February 1 to those we can accommodate since we always have a lot more demand than supply. The most important thing to remember is that you have to register if you want to attend. Every year I get emails from people ranging from pleading to angry who didn’t register and who apparently expected the Official HIStalk Psychic to divine their attendance intentions and send them an unsolicited invitation. It doesn’t matter if you are a swaggering CEO, a sponsor executive, or a self-identified industry celebrity – you have to register (just like I do) to be considered for an invitation. Please don’t embarrass both of us by claiming I didn’t mention it on HIStalk since I clearly do multiple times, and once the spots are assigned, it’s too late. I can say this so far having had several conversations with the sponsor: HIStalkapalooza (#HIStalkapalooza14 on Twitter) is going to be amazing.

Upcoming Webinars

January 16 (Thursday), 1:00 p.m. Advanced Efforts to Identify and Eliminate Waste from Healthcare. Sponsored by Health Catalyst. Presenter: David Burton, MD, executive chairman, Health Catalyst. Based on a breakthrough analyses using several large healthcare data sets as representative samples, Dr. Burton and team will present insights designed to help executives struggling to identify, quantify, and extract waste from their systems.

Webinar questions? Contact Lorre.

Respondents think ICD-10 will challenge hospital CIOs more than other high-profile issues in 2014. New poll to your right: how much impact will IBM’s Watson computer have on healthcare?

Speaking of Watson, IBM announces plans to spend $1 billion to improve Watson’s slow sales progress, with most of the money earmarked to bring in more salespeople and consultants and to create an app store program. The smothering hype after Watson’s “Jeopardy” performance obviously set unreasonable expectations, so there’s a little bit of desperation as it slides in the Trough of Disillusionment. At least it’s being used: Elsevier will employ the technology to enhance the online search capabilities of its medical journals and textbooks, allowing users to search by natural language questions rather than a list of keywords.

Welcome to new HIStalk and HIStalk Connect Platinum sponsor Voalte (that’s pronounced “volt,” in case you were wondering.) The Sarasota, FL-based company provides caregiver-connecting mobile technology that includes Voalte One (all-in-one smartphone communication including VoIP calling, alarm notification, and text messaging), Voalte Me (secure texting that can be used securely on personal smartphones), and Voalte Connect (mobile device management, powered by AirWatch). Available case studies include Cedars-Sinai, Texas Children’s, and Sarasota Memorial. I interviewed Trey Lauderdale, president of the company, in September and we talked a lot about pagers, medical device alarms, and BYOD. Thanks to Voalte for supporting HIStalk.

Here’s a demo of Voalte One that I found on YouTube.

Stuff you can do to support HIStalk: (a) sign up for email updates, thereby entering an exclusive club of 11,194 well-informed and slightly offbeat healthcare IT experts; (b) connect with us on Facebook, Twitter, and LinkedIn so that Inga, Dr. Jayne, Lorre, and I can pretend we are socially active despite the reality of spending most of our time alone in front of a computer; (c) join the HIStalk Fan Club that reader Dann started in 2008, which now has 3,349 members who are all above average and cute besides; (d) send me news and rumors so I don’t miss something important; and (e) peruse a few ads of sponsors and their listings in the Resource Center, confident that despite your differences with their role as vendors and yours as a prospect, you all show your innate coolness by reading HIStalk for sophomoric humor and scandalous rumors.

Listening: Ozma, serving up Pasadena-based power pop since 1995 and best known as being Weezer’s tour mates (not to mention sounding a good deal like them). They are better than you might expect.

Quality Systems announces that it will review certain assets in its NextGen Hospital Solutions division and record a charge against those assets in Q3. The announcement mentions the division’s poor performance and implementation backlog. The company also announces that its Q3 results will fall short of expectations due to poor Hospital Solutions Division results, a reduction in capitalized software development expense, and higher expense amortization related to new versions of NextGen Ambulatory. The hospital division is made up of the acquired Opus Healthcare Solutions and The Poseidon Group.

The White House fires Canada-based CGI Federal from the Healthcare.gov project, handing Accenture a one-year, $90 million, no-bid contract. The outcome of that should be interesting.

I’m getting a little bit annoyed by carefully cloaked Twitter bragging disguised as humility, i.e. “Thanks to all my great co-presenters at XXX conference” or “I’m honored that XXX Magazine has chosen to run my article.” We get it, you are wonderful and way better than the rest of us. 

Andrew Ury, MD, who founded Practice Partner and sold it to McKesson in 2007, raises $1.9 million in funding for his new venture, ActX. The Seattle startup is working on technology to incorporate patient genomic information into medical practice.

Five University of California medical centers test the use of game-based clinician education sent to their smartphones in small sections over a three-month period. It’s delivered by Harvard-based Qstream, whose primary offering supports sales rep coaching. 

Harvard Business Review finds that the impact of potentially disruptive retail clinics has been disappointing, with slow growth, little expansion to underserved areas, and an unclear impact on healthcare spending. Reasons: (a) poor people would rather go to the ED for free than pay even low retail clinic prices; (b) the clinics are usually staffed by nurse practitioners , whose reimbursement is less than that of physicians; and (c) Medicaid doesn’t want to pay for services delivered by retail clinics. In other words, hospitals are so unwilling or unable to make ED abusers pay that the market can introduce no acceptable alternative. It’s tough to compete with “free.”

ONC is looking for someone to lead its EHR certification team.

In Australia, an anesthesiologist says he’s being harassed by his hospital employer after complaining that a study of blood transfusion patients failed to de-identify them properly, allowing him to easily determine their names via an Internet search.

Spending time studying where the Internet intersects with healthcare. If you have ideas and want to chat, contact me: health@benchmark.com

— Bill Gurley (@bgurley) January 10, 2014

Bill Gurley, a partner in Benchmark Capital (Uber, Zillow, OpenTable, and Yelp) is looking for  “orthogonal/disruptive” approaches that don’t “partner closely with current players.”

Phoebe Putney Memorial Hospital (GA) fires two employees over two PHI-containing laptops that were stolen from one of its clinics in November, hinting that the terminated employees violated the hospital’s policies.

@Farzad_MD tweeted this table from an Annals of Internal Medicine “study of studies” article showing good historical outcomes for healthcare IT, leading me to accept his broadly issued challenge of, “I bet the next negative study of some bad health IT implementation gets more ink.” I pondered this and concluded that negative articles are more popular because:

• With the money and effort involved with implementing systems, it shouldn’t be newsworthy that they work and provide ROI and patient value. It should instead be newsworthy when they don’t.
• It’s still hard to convincingly prove that healthcare IT saves money or improves outcomes, and experience is still inconsistent because of not only lack of standardization, but even the lack of consensus that standardization is a good thing.
• Successful implementations often don’t have any conveniently easy lessons to learn since they often involved big organizational commitment and slow, steady progress. The closest thing to a magic bullet is not what to do, but what to avoid doing, and the negative articles call out those potential potholes.
• Technology is incorrectly viewed by technologists as the solution rather than a way to enhance the effectiveness or ineffectiveness of a given organization. Amazon doesn’t make you smarter – it just makes it easier to buy the kind of books you already read.
• The industry is small and there’s always animosity toward a given vendor or provider organization based on personal or organizational history.
• People feel superior when someone else fails in ways they are convinced they themselves would never be guilty of doing.
• Organizational HIT success often is accompanied by selective user discontent, so it’s common for a physician to write emotional editorials against the intrusion of technology (as well as government, health systems, and insurers) into the practice of medicine while their employer can demonstrate positive improvements from that very same technology. The “organizational good” story gets buried if it’s written at all, while the “public good” story gets even less exposure.
• Most of the people writing don’t have any direct experience with healthcare IT or reading peer-reviewed journals and find it easier to make names for themselves with sensationalistic or negative headlines pulled from questionably newsworthy source stories. 
• Organizations with successful HIT outcomes don’t get any benefit from telling the world about their experiences, while those that fail are usually mad at someone they blame instead of themselves and are happy to talk about it.

HIMSS exhibitors, take note of “Confessions of a Former Booth Babe,” written by a “brand representative” assigned to the huge CES in Las Vegas. Her summary: (a) at $25-$50 per hour, it pays better and was at least less demeaning than being a shot girl or go-go-dancer; (b) it’s the hiring company and not the attendees that sets the level of lewdness; and (c) you know what you’re being hired to do if the application requires full-body photos rather than sales experience. Another expresses discomfort with photo-seeking male attendees who are far right on the horndog-pervert continuum: “You kind of wonder where your picture’s going to end up. I had someone ask to take a picture just of my feet. One guy asked to take a picture of me while I was wearing nude fishnets. Then, after he took the photo, he wanted to talk to me about his pantyhose fetish.”

Weird News Andy titles this story “Right Bullet, Wrong Gun.” A couple finds via DNA testing that their daughter, born by artificial insemination in 1992, was fathered by a fertility clinic employee rather than the husband who provided sperm. Testing suggests that the part-time employee may have swapped out his own sperm sample for that of hundreds of prospective fathers. The couple is urging former clinic patients to have the DNA of their children tested.

WNA says he can’t put his finger on what’s wrong with this story, which he names “Proctally Perfect in Every Way.” Researchers develop an artificial robotic butt for teaching medical students to perform prostate exams. It warns them not only if they press too hard, but also if they don’t make enough eye contact beforehand. I can think of far more lucrative consumer applications.

Vince is wrapping up his HIS-tory series after a several year run on HIStalk, which leaves me disappointed since I enjoy the heck out of them. His next-to-last one tries to untangle the remaining hairball of McKesson’s acquisitions that turned into 200 products.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Time Capsule: Meaningful Use in the ED: Get Outta My Emergency Room

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

I wrote this piece in February 2010.

Meaningful Use in the ED: Get Outta My Emergency Room
By Mr. HIStalk

At my hospital, we worry a lot about ED satisfaction scores. No matter how well we do in areas such as OB or surgery, the ED scores always drag everybody else down. It always seems that the best and the worst aspects of our hospital’s care happen there.

We can only do so much to raise those scores. It’s not a democracy in ED, even though patients think it should be. You might have arrived first, but if the guy sitting across from you has a butcher knife sticking out of his neck, your abscessed tooth is just going to have to wait.

The ED is aptly named since it exists to serve patients with emergent medical issues. If you aren’t one, feel free to enjoy that second half-hour of “The Price is Right” on the “please don’t change the channel” TV because, as Samuel Shem said in The House of God, you are a GOMER – get outta my emergency room.

I’m not really sure why we want our ED satisfaction scores to be high, anyway. We tell everybody how much money we lose there. We use it to park patients who need beds that we don’t have. It doesn’t seem like a good idea to make patients so happy about their ED experience that they keep using our services and recommend them to others. The last thing we need is for them to return with their next ingrown toenail.

I also wonder about the fad of plastering emergency department wait times on highway billboards. It would seem that we are encouraging patients who might be tempted to drop by on a whim. I would interpret thusly: if you aren’t sure if you are sick enough to be willing to wait an hour, come on over because, at this moment, we can see you in 15 minutes.

I’m as much of a hard-driving entrepreneur as anybody who has always worked as a non-profit hospital wage slave. That’s why I’m sure my latest idea is a winner:  modifying ED software to show wait times that are multiples of the real number.

Here’s what my company will offer. We will erect huge, blinding electric wait time signs over the ED entrance, out on the street, and right beside your blue hospital sign on the highway. We inflate the actual ED wait time ridiculously (in fact, we can probably just use a randomization routine instead of measuring anything since we’re just making it up anyway). Our artificially enhanced wait times will discourage people to stay the heck out of our ED unless they are truly sick enough to not mind the wait.

This should be an easy sell to the ED doctors, who didn’t take an emergency residency to perform primary care. The really ill patients will appreciate not having to grimace in pain while the seemingly healthy extended family in the next row over settles in for a loud, impromptu gin rummy game and sends out for fast food.

Best of all, hospital executives could tout their high number widely, eliciting sympathy and support from taxpayers who otherwise resent their million-dollar salaries. Who would feel sorry for a hospital that manages to see ED patients in 20 minutes?

For a slight additional fee, I would modify the garish signs to proudly display an inflated number of patients who have left against medical advice. Those are the kinds of patients who need to be gently pushed back into less-expensive medical venues – the ones who found it inconvenient to wait their turn. This is not a metric of inefficiency, but rather a measure of triage success.

I have another flavor of my business model that I think will be quite attractive. I will hack the billboard system of the other hospital in town in what I’m calling my patient flow maximization solution. If your ED gets backed up, you push a secret button that drops the wait times on the other guy’s billboard to five minutes. I am naming that enhancement the Elective Diversion Module.

Morning Headlines 1/10/14

Merge Revises Previously Announced Subscription Backlog Totals

After an internal audit at Merge uncovers that 25 percent of its backlog contracts were fraudulently submitted by a salesperson attempting to collect unearned commissions, the company is forced to republish its previously reported subscription backlog. Merge stock prices have dropped 16 percent since Wednesday’s announcement.The salesperson has since resigned and offered to pay restitution, and incident has been reported to the US Attorney’s office.

Are drug companies using your health records to sell you stuff?

According to a Reuters report, pharmaceutical companies are partnering with freeware ambulatory EHR vendors to push medication ads into the exam room and, in some cases, are even emailing patients refill and vaccination reminders in the physicians name.

AHIMA: Board of Directors

AHIMA members elect Angela Kennedy, EdD, MBA, RHIA as president and chair of the board of directors. Kennedy is the chairman of the department of health informatics and information management at Louisiana Tech University.

News 1/10/14

Top News

Merge Healthcare discovers in an internal review that a former sales employee falsified the existence or amount of certain customer contracts. Merge had not invoiced any of the customers or recognized revenues, meaning previously reported results are not affected. However, the company reduced its non-GAAP subscription backlog totals over 25 percent from prior statements. The sales rep, who had been paid about $250,000 in commissions on the invalid contracts, has admitted to falsifying the orders and has offered to pay restitution. Merge has referred the matter to the US Attorney’s Office. While the rep’s actions are reprehensible, I am sure that plenty of sales veterans (me included) in HIT and other industries are aware of other instances of  “creative accounting” in order to hit quotas.

Reader Comments

From Politico: “Re: Greenway. Major layoffs this week.” Unverified, but reported by several readers, one of whom gave a number of 80 affected employees.

From Nasty Parts: “Re: Carrollton is cratered. Rumor is 150 people downsized at Greenway’s former HQ, including the VP of HR. This comes on top of an exodus of sales executives, including two VP. Approximately 10 of the top reps have left, many because they did not want to sign the feared Vista non-compete. Also, word is that the HQ of SuccessEHS, another Vista acquisition, was also cleaned out today.” Unverified, but Nasty Parts has been right several times in the past. We didn’t receive a response to our inquiry.

From Xflo-Bee: “Re: Cerner. I’m hearing a lot of buzz on the wire about Cerner being the focus of a big lawsuit over a state reporting SNAFU. Can anyone verify?”

From Bob A. Booey: “Re: MU attestation. We’re having an awful time trying to attest for 2013 MU on the CMS website. Here is the response from CMS. ‘We have been notified that the Registration and Attestation Application is experiencing technical difficulties. This is currently being investigated. At this time, we do not have an estimated time for resolution. Please try again later. We apologize for any inconvenience this may cause.’”

From MT Hammer: “Emdat. A new banner on Emdat’s website points to another Nuance acquisition.”

HIStalk Announcements and Requests

Here’s some HIStalk Practice highlights from the first week of 2014: doctors who Google patients. CMS wants to ban abusive prescribers from government programs. Free app Figure1 allows physicians to share de-identified photos of medical conditions. Patients from practices affiliated with University Hospital (GA) embrace the health system’s Epic portal. Montana requires insurers to reimburse telehealth visits at the same rate as in-person visits. Brightree and athenahealth will share patient referral data. Dr. Gregg provides insight on why some physicians choose to remain independent. While you are stopping by, sign up for the email updates so you don’t miss a post. Thanks for reading.

We sent our sponsors an email earlier this week about our activities at the HIMSS conference, so if you should have seen this and didn’t, email me. 

Speaking of HIMSS, I ran across this infographic depicting the importance of social media during HIMSS14. Mr. H, Dr. Jayne, and I will be providing occasional updates on Twitter, but you’ll also want to make sure you are following Lorre (@Lorre_HIStalk). She’ll be manning our HIStalk booth (#1995) and passing along our impressions of the exhibit hall’s best and worst booths, as well as tips for finding the coolest swag, free cocktails, and good coffee.

Last chance: HISsies nominations will close shortly, so nominate your choice for Best Vendor, Best CIO, etc. ASAP.

HIStalkapalooza details and registration will be available next Wednesday, January 15. We’re getting a bunch of emails every day asking about it, so please save us some time by hanging in there until next week. Our primary sponsor still has spots for two more co-sponsors who will be recognized in a variety of ways, so email me if your company is interested.

Welcome to new HIStalk Gold Sponsor Wide River Consulting. The Lincoln, NE-based company offers healthcare IT consulting services with an emphasis on serving hospitals in rural and underserved communities. Wide River has helped 50 Critical Access and Rural Hospitals that were struggling to keep up under the weight of ICD-10, MU, EHR upgrades, and PQRS reporting, often with vendors that find it challenging to send people to their locations. The company offers a wide range of technical and engineering services through a partnership with Sterling. Executive Director Todd Searls tells me that with the REC grants ending, PPCPs and CAHs need a low-cost way to keep forging ahead with Meaningful Use and Wide River can help. The company’s ICD-10 services are a big hit as well. CAHs can get a one-year subscription to Wide River’s Meaningful Use Help Desk for $175 per month and providers can sign up for $60 per month, gaining access to experts who can help with MU-related questions ranging from patient portals to exclusions. The company’s goal is to help teach small and rural hospitals to succeed with the resources they have, even helping them form mini-HIT co-ops. Thanks to Wide River Consulting for supporting HIStalk.

Upcoming Webinars

January 16 (Thursday), 1:00 p.m. Advanced Efforts to Identify and Eliminate Waste from Healthcare. Sponsored by Health Catalyst. Presenter: David Burton, MD, executive chairman, Health Catalyst. Based on a breakthrough analyses using several large healthcare data sets as representative samples, Dr. Burton and team will present insights designed to help executives struggling to identify, quantify, and extract waste from their systems.

Acquisitions, Funding, Business, and Stock

Shareholders of Health Management Associates approve the previously announced $3.9 billion sale of the hospital chain to Community Health Associates.

Endo Health Solutions will sell its HealthTronics business to Altaris Capital Partners for total consideration of up to $130 million, including $85 million in cash upfront. HealthTronics is a provider of urological products and services, including the UroChart EHR and meridianEMR systems.

Lumiata, formerly known as MEDgle and the developer of a predictive analytics platform for healthcare, closes a $4 million Series A round led by Khosla Ventures.

Sales

Dameron Hospital Association (CA) selects Allscripts Sunrise clinical products suite.

Presbyterian Senior Living (PA) will implement AOD Software’s long-term care EHR across its 23 locations.

People

VMware promotes Ben Fathi from SVP to CTO.

Telehealth solution provider AMC Health names John Larus (Clinipace) SVP of solutions development for the clinical trials division.

RCM provider Encoda names Michael Kallish (RemitDATA) CEO, replacing co-founder William Cox, who will assume the role of president and CTO.

Impact Advisors appoints Steven Schlossberg, MD (Yale School of Medicine) VP/CMO.

Surescripts announces that CEO Harry Totonis will step down effective March 2014 and that it has hired an executive search firm to find his successor.

AHIMA members elect Angela Kennedy (Louisiana Tech University) as president/chair of the board of directors, a role she has held since June following the death of Kathleen A. Frawley. Members also elected Cassi Birnbaum (Peak Health Solutions) president/chair elect; Jennifer McManis (Crowley Fleck Attorneys) speaker of the house; and Zenethia Clemmons (HHS OCR), Virginia Evans (Emory Healthcare), and Colleen Goethals (Midwest Medical Records Association) directors.

Southcoast Health System (MA) hires Greg Robinson (AltaMed Health Services) as executive director of enterprise informatics.

Announcements and Implementations

ICUcare and IEEE will collaborate to develop a universal industry standard/specification and a free web-based middleware API to help healthcare providers map data from medical devices to EHRs and other health information systems.

Advocate Eureka Hospital (IL) implements electronic patient and e-forms technology from Access.

Other

The Institute of Medicine proposes a standard framework to help providers identify and quantify the costs and benefits of EHR implementations.

Non-profit hospitals paid their CEOs a mean compensation of $594,781 in 2009, according to a JAMA Internal Medicine-published report. Hospitals with high levels of advanced technologic capabilities compensated their CEOs $135,862 more than hospitals with low levels of technology.

A Reuters article says that drug companies, with newly limited access to doctors per PPACA requirements, are moving their sales efforts to EHRs. It mentions Practice Fusion, which sells EHR pop-up ads, and EHRs that email refill and vaccine reminders that don’t clearly state if the message is sponsored by a drug company.

Weird News Andy says the appropriate ICD-10 code is “X59.9 or X12 or combination thereof.” At least 50 people are scalded from emulating TV weather people who tossed boiling water into cold Midwestern air to watch it freeze.

Sponsor Updates

• AirWatch wins three 2014 Compass Intelligence Awards in the enterprise mobility category, while AT&T was named the best service provider in the health and wellness category, as well as a winner in multiple non-healthcare related categories.
• Lexmark’s Perceptive Software launches Perceptive Media Connector, which enables the cloud-based capture, management, and access of video content with the Perceptive Content client interface.
• Ping Identity opens registration for Cloud Identity Summit 2014, scheduled for July 19-22 in Monterey, CA.
• KLAS extends a high early-performance score to Health Catalyst for its healthcare-specific analytics platform.
• ChartWise Medical Systems and TrustHCS partner to offer ChartWise’s CDI software with TrustHCS’s coding services and ICD-10 education.
• Ellis Medicine (NY) cut overtime costs by $721,000 during the first six months after deploying API Healthcare’s workforce management technology.

EPtalk by Dr. Jayne

After several extremely slow news weeks, I’m glad to see things are starting to heat up. I’ve heard a lot of buzz about the Consumer Electronics Show, which is taking place this week in Las Vegas. Several readers have sent me blurbs about wearable tech. I’m not nearly as much of a fashionista as Inga, but I do like to keep an eye on the trends, especially when they’re related to health IT.

The first product I looked at was the wearable ambulatory blood pressure monitor from iHealth. It’s both USB- and Bluetooth-enabled and allows for blood pressure readings at intervals of 15-120 minutes. Most home blood pressure monitoring units are bulky and patients are not as compliant as they might be. It is compatible with both iOS and Android and can store up to 200 measurements. It reminds me a bit of a futuristic version of the shoulder holsters worn by 1980s television cops, but with a touch of neoprene.

The company also has a wireless ambulatory ECG device that looks pretty cool. Instead of having multiple sticky leads attached to the patient, it has a single unit that is worn under clothing. In keeping with the throwback 80s vibe, it reminds me of the handset of a vintage rotary phone, although it doesn’t appear to come in avocado green or harvest gold. Bluetooth connectivity to iOS allows for real-time transmission of readings. Both it and the blood pressure monitor are still awaiting FDA clearance and pricing isn’t yet available, so put your credit cards away.

Another reader sent me an article about the need to design tech wearables for women. I was excited to read about Ringly, which is creating jewelry and accessories that receive notifications from the wearer’s mobile phone. Being alerted by jewelry would be much nicer than the incessant phone checking I see. After recently working in an office where the front desk staff notified the back office of patient readiness using an extremely loud intercom (“patient for Dr. Jayne!”) I wonder if we could tie it to the EHR patient tracker. Ringly’s goal is to create jewelry that looks like jewelry rather than gadgets and also to allow users to leverage its app to prioritize the alerts they receive.

Don’t get me wrong, gadgets can be cool. I wear a Garmin when I run that screams, “Hey, I’m a GPS! No way you’re mistaking me for a watch!” I’m not crazy about how it looks, but its function makes it tolerable. On the flip side, there’s Everpurse, which can charge a cell phone on the go and looks nice as well. Although they’re sold out of virtually everything except the persimmon leather clutch, I might have to keep an eye on the site for new offerings.

Looking back at some of the promotions from the Consumer Electronics Show, Intel has launched its Make it Wearable contest to help identify the next generation of accessories. Maybe someone will develop a white lab coat with a sensor to track the level of dirt on the cuffs or the time since it was last laundered. I can think of a couple of physicians who would benefit from that functionality.

How about a patient hospital gown that alerts you when your backside is flapping in the breeze or one that self-adjusts to prevent unintended exposure? The video clip on the Intel website showed a dress that appeared to be zipping itself, so it might just be in the realm of possibility. Maybe next year Inga and I should include the Consumer Electronics Show in our meeting and convention plans. Have a connection that can help us register? Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 1/9/14

The HIMSS Health IT Value Suite

HIMSS launches a platform designed to help hospitals substantiate the value of healthcare IT investments by collecting hundreds of case studies that demonstrate EHR related safety, quality, or financial improvement, and then creating a nice data visualization that lets you explore the information.

A Standard Model For Evaluating Return On Investment From Electronic Health Record Implementation

Citing a wealth of conflicting studies that base their findings on non-standardized research methodologies, the Institute of Medicine proposes a standard framework to help providers identify and quantify both the costs and benefits of EHR implementation.

FDA Wants to Leverage Electronic Medical Records to Probe for Adverse Events

The FDA is looking for contractors to help it begin mining EHR data for signs that a post-market drug may be causing unknown adverse events.

Cincinnati Children’s Hospital Reaches Stage 7

Cincinnati Children’s Hospital, an Epic hospital, earns HIMSS Stage 7 designation for both its hospital and 14 of its associated ambulatory offices. 2.2 percent of US hospitals and 1.2 percent of ambulatory practices have now achieved Stage 7 designation.

CIO Unplugged 1/8/14

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

Leadership and Identity—It’s All About the Title! (Part 3 of 4)

In our office lobby display case, the theme of the month was “pets.” David had a picture of his beautiful hunting dog, but what caught my eye was the castle ruin in the background. “Oh, that’s Bective Abbey, right across the street from my parents’ home in Meath. The remaining cloisters were used in scenes from ‘Braveheart.’” Jokingly I said, “Beautiful. Let’s go.”

Four weeks later, David and I were standing in the actual spot, walking the castle ruins. Although “Braveheart” was about Scotland, many of the movie shots took place in Ireland, in David’s backyard. To prepare ourselves, we watched the movie three or four times.

“Braveheart” is full of leadership lessons, but the following interchange between Robert the Bruce and William Wallace stuck with me. Here is the script and the video (3:30).

Robert the Bruce: “I’m not a coward. I want what you want, but we need the nobles.”
William Wallace: “We need them?”
Robert the Bruce: “Aye.”
William Wallace: “Nobles. Now tell me, what does that mean to be noble? Your title gives you claim to the throne of our country, but men don’t follow titles, they follow courage. Now our people know you. Noble, and common, they respect you. And if you would just lead them to freedom, they’d follow you. And so would I.”

The same is true in life. Screw the title, focus on leadership. Title holds significance when it’s earned through performance.

People want to follow leaders, not titles.

Look at the 2013 Time Man of the Year, Pope Francis. Did Francis suddenly transform into the unique leader because he became Pope? No! If you know his history as a Cardinal and Arch Bishop, nothing he does as Pope should surprise you. Did he become Pope because he sought title? Oft called “the reluctant Pope” tells us that seeking title was not on his goal sheet. Serving people had always taken precedence. In fact, look at his warning against careerism.

I am not naïve to suggest this is always the case. We know plenty of people who gained titles by stepping on others, a Machiavellian winning-at-all-costs approach. But I can tell you the most successful leaders never sought titles, they sought to humbly serve. The former are easy to spot and get little respect.

One of my directors — I’ll call her Tracy — was a damn good analyst. She didn’t seek a title. She just pursued her role and responsibility with vigor. She accomplished great things and we gave her more. We saw the results and potential so we promoted her to a director. She is awesome.

In another instance, I was struggling to fill our chief security officer role. One day, I asked this recently retired Marine what his defining moment was. He described how, as a staff sergeant, he stood down a full bird colonel. You see, he cared about doing the right thing despite anyone’s title. That’s moxie. It’s leadership. I hired him on the spot. You think he will stand down from an executive or his manager if our security posture is compromised? Never! Title is secondary to effective leaders.

Do you possess your title or does it possess you?

A good test: Do you ever use your title to get things done or get your way? I rarely refer to myself as senior vice president or CIO. When I am in meetings, I tell people I serve as a leader in leveraging technology to enable superior business and clinical outcomes. I do what I can to not to let title get to my head. Humility is the key. Watch for the slippery slope. It will take your title and life if you are not careful. I know.

Much of what I’m writing is logical and intuitive, but not often practiced. We are driven and ambitious and we seek instant gratification. We toiled well for a few months, so we think we deserve that next promotion. But I tell you the truth, gaining titles before you are prepared is very dangerous to both you and your organization. Stop the pursuit. Focus on being the best at whatever you do. The rest will follow.

Some of you are thinking, “Ed, I do all that. I don’t seek crowns. I seek to serve and the title never comes. In fact, I see others being promoted over me that offer half the value I do.”

I get it. It happens. The world is not fair. Continue to work your ass off and double down on your efforts. Find other ways to increase your value to the organization. Expand. Ask for more responsibilities. Volunteer. But if at some point, over multiple years, you’re doing all these things consistently and still nothing? Yep, time to bail.

Again, I’m a work in progress. Some of the things I write are aspirational for me. I struggle with the same things as you. Pride, arrogance, achievement orientation, instant gratification, etc. But I am slowly catching on to this identity thing. Taken me all of about 50 years. Hopefully it will stick for the next 50.

Damn, this is easy to write but hard to internalize, yet it is truth.

For me, identity is not rooted in title, looks, or what I do. It is who I am and what I stand for, believe in, and practice. I am trying hard to forge my identity in my faith in God. I like the sound of CEO, but His title is what I desire. “I am free. I am new. I am a saint. I am alive. I am all He says I am. I am His own.”

My detractors are right in the sense I fall short of the above list. However, only One’s opinion about me counts—and they’re not the One.

I will wrap up the Leadership and Identity series with, “Identity & Recognition” in my next post. I will specifically identify the keys to identity that resonates with who I am becoming.

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.

Morning Headlines 1/8/14

Governor Blames IBM For Minnesota’s Troubled Obamacare Website

Minnesota Governor Mark Dayton blames IBM for the state’s health insurance exchange problems. IBM was not the main contractor of the $46 million website, but is taking the brunt of the blame because it provided the critical components that failed.

Providers Look For Next Level of Healthcare Analytics

KLAS evaluates the the healthcare analytics market, which it says has yet to deliver products that offer robust functionality while being easy to use.

Whidbey General Hospital billing system gets pricey

Coupeville, WA-based Whidbey General Hospital’s $7.5 million Meditech implementation caused billing issues that prevented claims from being sent out, leaving the hospital with just 2.5 days of cash on hand at one point.

House leader unveils exchange security act

Representative Joe Pitts (PA) will introduce The Health Exchange Security and Transparency Act, which would require that HHS notify individuals of any data breach on the health insurance exchanges within two business days.

News 1/8/14

Top News

Two healthcare-focused private equity firms will invest $77.5 million to take minority positions in MedHOK, which offers care, quality, and compliance software.

HIStalk Announcements and Requests

Welcome to new HIStalk Gold Sponsor Coastal Healthcare Consulting. The Mountlake Terrace, WA-based company has completed 850 engagements and won numerous KLAS clinical implementation awards since its founding in 1995. Most of its consultants have been with the company for at least 10 years. Offerings include Catalyst (SWAT team project crisis response), Convergence (reducing denied claims), Fusion (linking technology to clinical processes), and Wave (application support, workflow analysis, system build, and activation). Product expertise includes Allscripts, Cerner, Epic, GE Healthcare, and Meditech. Industry long-timer Amy Noel, RN is CEO of the company. Thanks to Coastal Healthcare Consulting for supporting HIStalk.

Upcoming Webinars

January 9 (Thursday), 2:00 p.m. Beyond the Summits. Sponsored by HIStalk. Presenters: Ed Marx, SVP/CIO, Texas Health Resources, and Elizabeth Ransom, MD, FACS, EVP/clinical leader North Zone, Texas Health Resources. Everyday healthcare executives share leadership and teamwork principles they learned from climbing some of the world’s highest peaks over the last four years.

January 16 (Thursday), 1:00 p.m. Advanced Efforts to Identify and Eliminate Waste from Healthcare. Sponsored by Health Catalyst. Presenter: David Burton, MD, executive chairman, Health Catalyst. Based on a breakthrough analyses using several large healthcare data sets as representative samples, Dr. Burton and team will present insights designed to help executives struggling to identify, quantify, and extract waste from their systems.

Acquisitions, Funding, Business, and Stock

Press Ganey acquires On The Spot Systems, developer of a real-time data capture system for patient feedback, and launches Point of Care, a solution that allows providers to capture patient feedback via tablets and mobile devices.

Sales

Mount Sinai Health System (NY) selects MU Assistant from SA Ignite to automate its MU attestation process.

The Guam Regional Medical City hospital will deploy Allscripts Sunrise EHR and Financial Manager platforms when it opens in late 2014.

The Department of Defense awards Carestream Health a  one-year, $70.2 million contract for medical imaging technology.

People

McKesson Specialty Health and the US Oncology Network appoint Jeffrey Kao (Coventry Health Care) CIO/SVP of information and technology services.

T-System promotes Mark Horner from VP of client services to SVP/GM of RevCycle+ and  expands CFO Steve Armond’s duties to include leading the company’s documentation solutions.

Jacob Nguyen (Craneware) joins VitalWare as EVP of business development and operations.

Vocera names Rhonda Collins (Fresenius Kabi, USA) chief nursing officer and promotes Steve Jackson from COO of its ExperiaHealth division to chief strategy officer.

David Cerino (Zynx Health) is named CEO of WiserCare.

Announcements and Implementations

Fairfield Medical Center (OH) goes live this month with a fingerprint ID system from CrossChx.

Harrison Medical Center (WA), which affiliated with Franciscan Health System last year, will switch to Epic this summer.

Riverside Medical Center (IL) implements the DebMed electronic hand hygiene compliance monitoring system.

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

McKesson announces the general availability of its Paragon Ambulatory Care Practice Management solution, which is an extension of its single database HIS for inpatient facilities and designed for hospital-owned practices. I understand the PM module was developed internally, as opposed to a bolt-on of one of McKesson’s acquired products, and that an EHR module is also in the works. Sounds like McKesson is positioning itself to compete with Epic and Cerner in the IDN market.

Government and Politics

The Office for Civil Rights proposes an amendment to the HIPAA privacy rule to allow certain entities to disclose the identities of individuals with mental health “prohibitor” status to the gun background check system. The change would apply to individuals who have been involuntarily committed to a mental institution; found incompetent to stand trial or not guilty by reason of insanity; or otherwise deemed by a lawful authority to be in danger of themselves.

CMS reports that more than 30,000 hospitals, physicians, and medical equipment providers are using its online esMD documentation system instead of mail or faxes for auditor medical record requests and prior authorizations requests for power mobility devices.

A new OIG report says CMS and its contractors haven’t done enough to address Medicare fraud related to EHRs. It recommends that CMS provide guidance to its contractors on detecting fraud and suggests they review provider EHR audit logs. The report identifies inappropriate EHR copy-pasting and creating of false documentation to support higher charges as key fraud issues. CMS responded by saying it will develop copy-paste guidance and identify best practices for its contractors to detect fraud associated with EHRs.

Innovation and Research

South Dakota philanthropist T. Denny Sanford donates $125 million to Sanford Health (SD) to support the incorporation of genomics into the health system’s primary care programs, including added genetic testing information to the EHR to allow clinicians to personalize drug therapies. Sanford has donated $1 billion to the health system that bears his name.

Other

QlikTech’s QlikView earns the top spot among business intelligence products in a KLAS report on the healthcare analytics market.

According to a JAMA-published study, not too many physicians are joining Mr. H’s smoking doc for smoke breaks. Only about two percent of physicians admit to smoking, compared to 16 percent of the general population and 25 percent of licensed practical nurses.

A local paper profiles Whidbey General Hospital (WA), which experienced critical cash flow issues during its transition to Meditech. The hospital claims its billing process was abnormally slow after the system went live in May and caused A/R levels to climb and cash on hand to decline. The hospital, which expects to spend $7.5 million on its Meditech installation, is recovering. The paper incorrectly blames the ACA rather than than HITECH for requiring the use of EMR to avoid financial penalties.

A federal judge dismisses a patient’s lawsuit that charged a healthcare provider violated HIPAA laws when an employee’s laptop was stolen. The judge ruled that only HHS can enforce HIPAA and individuals do not have the right to bring lawsuits for its enforcement.

The Pittsburgh paper profiles hospital pharmacy automation vendor Aesynt, the former McKesson Automation / Automated Healthcare that was sold to Francisco Partners in November. It says the company has developed new hospital drug management software being tested by UPMC and Intermountain. President and CEO Kraig McEwen says the company has introduced more products in the past 12 months than in the past five years. He also says the company is looking for acquisitions  that will help it expand its offerings for reducing hospital drug costs.  

IBM’s “Jeopardy”-winning Watson computer is falling far short on the company’s revenue targets. Healthcare is its most promising market, but a $15 million M.D Anderson cancer genomics project is “in a ditch” according to the IBM executive in charge. A Watson oncology regimen project at Memorial-Sloan Kettering could go live later this year. IBM’s business plan calls for Watson to contribute $1 billion in annual revenue by 2018, but it has only generated $100 million in its three-year existence. The main problem is the effort required for engineers to program Watson for each business case so that it can learn from available information.

Massachusetts will launch the second phase of the Mass HIway HIE Wednesday at Beth Israel Deaconess Medical Center. The HIE  has received $55 million in federal funding.

E-Health Ontario, the provincial agency tasked with creating EHRs for all Ontarians, will share $2.3 million in performance bonuses across its 704 staff members. The payout follows a court settlement that restored payouts that were cancelled in 2011 as part of a controversial wage freeze.

John Lynn of EMR and HIPAA is producing an April 7-8 Las Vegas conference covering healthcare IT marketing and PR.

James Parks, former COO/CIO of Box Butte General Hospital (NE), is indicted on seven counts of child pornography after the hospital reports finding explicit content on his computer.

The governor of Minnesota blames IBM for problems with its state-run health insurance exchange that launched October 1. Minnesota Governor Mark Dayton sent a highly critical letter to CEO Ginny Rometty last month that blamed the company for a laundry list of items:

Your product has not delivered promised functionality and has seriously hindered Minnesotans’ abilities to purchase health insurance or apply for public health care programs through MNsure…. your product has significant defects, which have seriously harmed Minnesota consumers.

Sponsor Updates

• CCHIT certifies that the Arcadia Analytics Meaningful Use Calculation Engine v1.0 is compliant with the ONC 2014 Edition criteria as an EHR module.
• PeriGen recognizes Barbara LaBranche, senior director of clinical informatics design and usability, for being named an EHR Game Changer.
• Muhammad Chebli, interoperability product manager for NextGen Healthcare, discusses the importance of interoperability in achieving MU2 objectives, particularly summary of care.
• Liaison Technologies reveals its top predictions for 2014, including the dramatic growth of data integration complexity and the normalization of mass customization.
• Nuance Communications demonstrates wearable devices with Dragon Mobile Assistant and Swype keyboard for smartwatches at this week’s CES 2014 in Las Vegas.
• Prominence Advisors is named one of the 50 top Chicago employers of Generation Y employees (those aged under 33).
• Visage Imaging releases a demo video shot at RSNA of its Visage 7 Enterprise Imaging Platform.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 1/7/14

IMS Health files for potential billion-dollar offering

IMS Health, a health care data analysis and consulting firm that works primarily in the pharmaceutical industry, filed initial IPO paperwork Thursday. Analysts estimate that the company should raise between $500 million and $1 billion with the offering.

McKesson Introduces Paragon Ambulatory Care Practice Management Solution

McKesson extends its Paragon HCIS footprint into the ambulatory space with a new practice management solution that promises scheduling, billing, registration, patient education, and health maintenance support along with an enterprise-wide integrated database and a unified look and feel.

Usability of EHRs remains a priority for ONC

Jacob Reider, MD, acting national coordinator for health IT publishes a blogpost calling for a renewed emphasis on EHR usability, saying "But as a physician who has used an EHR in my clinical life since 2001, I worry that some of the usability challenges that we early adopters tolerated “for now” (a decade ago) remain unresolved."

Senators press for EHR interoperability

Senators John Thune (SD) and Mike Enzi (WY) added an amendment to the recently passed short term budget deal that calls for meaningful EHR interoperability to be achieved by 2017. A separate, more specific, amendment was also added that directs HHS to adopt a common interoperability standard by 2017, as part of the rules for Meaningful Use Stage 3.

HIStalk Interviews Joseph Mayer, MD, CEO, Cureatr

Joseph Mayer, MD is founder and CEO of Cureatr.

Tell me about yourself and the company.

I started Cureatr when I was a resident at Mount Sinai here in New York City. Prior to that and during my residency, I’ve always been a clinical research guy. I did med school at Columbia and focused on clinical operational workflow research. How you optimize consults, communication between the floors and pharmacy, and even looked at inter-organizational workflows like PCP into the hospital, etc. This is an area I’ve been passionate about since I started my training. 

I started Cureatr with a guy that I had gone Stanford undergrad with, Alex Khomenko, about two weeks before I started my residency. I had formed this idea during the last couple of years of medical school and worked closely with Bob Sideli at Columbia. I got together with Alex who, at that time was director of engineering at 23andMe on the West Coast, flew out and met with him, and said, “I’ve got this idea. I’m starting my residency in a couple of weeks, but let’s work on this together. I’ll be in a great environment to get feedback to understand what our users need, also what the administrators need.”

One thing led to another. We built out Cureatr  during the first year of my clinical training. Our first real launch was in the medicine department at Mount Sinai in January 2012. 

It’s been really a whirlwind since then. We were part of this New York Digital Health Accelerator program, with 20 leading payor-provider orgs in the state which works closely with companies like ours to make sure there’s a product fit for what their needs are. We just closed our Series A financing with Cardinal Partners and Milestone Venture Partners. It was a $5.7 million around in October of this year.

Many companies are suddenly offering secure messaging for clinicians. Who are your biggest competitors and how is your product different?

We’re running into the guys you would expect, the TigerTexts of the world on the lightweight messaging side of things and on the nurse-first device side of things, Voalte and the legacy guys like Vocera and Avaya.

When I started Cureatr, I was interested in messaging as a part of some of these workflow problems. If you look at what a workflow consists of, you’ve got the communication piece. That’s a huge part of it, probably about a third of your time. You’ve got the documentation piece and CPOE documentation — that’s probably another third of your time.The last third is management, getting access to actual data. Obviously, unfortunately, you probably spend less time on implementation than you do in a lot of other areas of the care process. When I started Cureatr, I was interested in how do we build a tool for the whole part of this. 

Let’s start with messaging. There probably are a lot of messaging companies, but the penetration of these types of modern communication and workflow tools is incredibly low in this market. There’s no clear leader. It’s still a very green market.

We’re trying to differentiate ourselves by coming at this from the angle of, let’s find a couple of specific use cases or workflows that are highly repeated in your organization or for your patient population. Let’s deploy this combination of communication plus some task management plus some basic integration with other systems. Routing and care team mapping is a big part of that. That’s our differentiator. That’s the way we’re looking at helping our customers. 

The other big thing is more and more of our customers are interested in inter-organizational use cases. They need to think about what goes on beyond the four walls of the hospital, because from their perspective, the care episode no longer ends with discharge. We’ve gotten some early customers, like the DaVitas of the world, who are thinking a little bit ahead of the curve on cross-continuum care management and want to apply our tools to those areas. We are focusing on customers who are interested in that today because we think that’s going to be a growing need in the future where we can build some expertise.

Is the model that an enterprise would pay for the system, but there’s an individual app that people can download for free?

We are very hands on around implementation, very hands on around working closely with the enterprise and finding these specific use cases. But we get contacted all the time by folks like my father, a small private practice who want to use it. We obviously see value in letting them, but above value to them, the value to the bigger hospital customers we work with making the onboarding experience for the smaller organizations very easy, very lightweight. But our customers are mostly large enterprise guys like Sinai.

It’s same product that could be downloaded for free, just with more enterprise-type services bundled?

It’s modular. We have our core messaging piece. Then we have something we call structured messaging, which is a feature that the enterprise needs to create a step-by-step workflow for a specific use case. There’s a core, very lightweight messaging piece that’s very easy to download and get up and running within a couple of seconds, but if you want to get those other modules, if you want to get single sign-on, if you want to get documentation or tie in to your ADT or EMR or lab system, that’s what our enterprise customers will get.

What kind of numbers do you have using just the standalone free version versus those that are using it via enterprise?

It’s almost all enterprise customers. We wanted to get the product right. We wanted to build the infrastructure of a company before we started doing a lot of marketing. We haven’t done a lot of this “are your docs texting?” replacement-type marketing. We’ve mostly focused on talking to thought leaders and rolling it out to larger enterprises. I would say 90 percent of our customers are through an enterprise customer, any organization that’s purchased 500-plus licenses.

How many organizations do you have as customers?

We have about 10 large enterprise customers and then some large primary care groups, some larger multi-site practice groups. But in terms of large paying enterprise customers, we have about 10.

You offer read receipts and the ability to attached a photo securely. Is that unusual?

That stuff’s great and useful, but it’s what our customers expect. I would think anybody who is a serious company in the states does have that type of functionality.

The things that are really different between us and the product are, first of all, we built this from the ground up in a hospital and a health system. Our products have been optimized for clinical users. We have status and presence, which is a big thing in a clinical space.

The way I look at the world, and I think the way most providers do, is that there are only probably four or five pieces of information at any given time that are actionable and valuable to the care team. We are trying to create a shared view of the patient around this in real time as much as possible for the care team. It’s tying into those other systems and understanding how to smartly separate the signal from the noise around very actionable information is what we’re trying to optimize the product. But also maintaining a very good, solid, secure messaging user experience. 

That’s why things like read receipts, directory integration, scheduling integration, photo sharing, document sharing …  we have the wound care company that’s piloting our product, and it’s revolutionary for them because all of a sudden they can, instead of having to fax the face sheet from the patient when they’re discharged where they’re going to follow up with wound care or with vascular, they can send the PDF or even send a photo of the face sheet and have a very real-time, two-way back and forth to make sure that that patient is getting the right follow-up care. We’re starting from almost ground zero in healthcare, so things like that can have a very large, positive impact on workflow, on efficiency, on provider and patient experience, and satisfaction and experience.

You have data from Mount Sinai that was self-reported from a survey. Do you have any more specific analyses of either outcomes or anything more than just what the users report?

We’ve got a study that just came out that I can share with anybody who’s interested in following up privately, but we don’t have permission yet from this large academic health center to share that data because it’s literally fresh off their presenting at a conference. But we have some very exciting data around time saved, efficiency linked to earlier time of discharge, i.e. length of stay reduction and HCAP impact. We do not have randomized, evidence-based clinical trial data at this point. Very few companies in healthcare IT do.

We have two customers we’re partnering with to run some 12-month longitudinal studies looking at outcomes on specific clinical hospital performance metrics, both on the inpatient and outpatient side.

How did working with an accelerator help the company?

I am very grateful to the NYeC because we got unique exposure to the best hospitals in New York. Even more than that, everybody who was doing this program was very invested in trying to create a new ecosystem around where … Hospitals are just not used to working with startups. As a startup, time is your most valuable resource. Hospitals don’t move quickly. The thing that we got from the accelerator — more than the money and more than the PR — was literally a very accelerated access and  feedback to the C-suite and users.

The big challenge for anybody in healthcare IT today is, how do you think through the ROI story and how to measure the ROI for your product? There are a lot of companies right now in this healthcare IT space sprouting up. The death of many them will be not thinking about that piece, not having access to the right folks in the big health systems and the healthcare world in general to think through that piece.

That’s what we got out of this accelerator much more quickly than we would have from one customer or from going and talking to your friend’s dad who’s some executive at a hospital. We had invested folks giving us that kind of feedback through this program. I would recommend that program for anybody and I would do it again.

Where do you see the company going in the next few years?

There’s real value in secure texting or replacement pager stuff, but we’ve come up with what I think is the most effective, repeatable process for deploying secure messaging leveraging mining of the data for optimizing secure messaging in these larger enterprise customers. The next 12 months is really about what’s coming after messaging. Optimizing the care team mapping side of things, i.e. routing of messages to the right person at the right time, or routing information at the right time beyond messaging, task management.

These are the workflow tools. That’s what customers are telling us that they want. When you look at the most successful implementations of technology in healthcare IT and most successful companies, they’re very much focused on a couple of specific use cases or clinical use cases or workflows where they’re doing that better than anybody else. Our goal is, let’s find those use cases, let’s deploy messaging and these other tools around it, then let’s actually measure an ROI and let’s actually make it very clear for our customers how to achieve that ROI in future implementations. 

Building the product and the implementation and services side of the business to support that is the most critical thing right now, because from a sales side, there’s great demand for this right now. It’s almost a function of keeping up with that demand and making sure that our product is truly adding value to our customers.

Curbside Consult with Dr. Jayne 1/6/14

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I wrote in Monday’s Curbside Consult about a reader’s comments to my recent EPtalk piece. His comments were similar to those shared by many physicians I meet, so I’m responding to some of them. As background, my organization is seven years into its ambulatory EHR journey (many more on the hospital side) so we’re definitely not new to this game.

There is no infrastructure for EHR outside of big groups. CMS subsidized us to buy Ferraris and then we have to drive them in a corn field. A bike would be much faster in a corn field. Meaningful Use should have required EHR vendors to provide infrastructure to connect all the computers involved in a patient’s care. Our EHR doesn’t talk to our hospital and the vendor wants $100,000 to write an interface for a single clinic. Who can afford this?

It’s great that MU requires interoperability, but the infrastructure is still a challenge for many, especially independent groups. We’ve been struggling with this for years as we’ve watched RHIOs go bankrupt, competing HIEs squabble within the same state, and more. My own state was one of the last to have an immunization registry.

Other competing factions make interoperability more difficult even if the infrastructure is in place. Our health system gave away access to our HIE and we still struggled with physicians reluctant to participate due to privacy concerns. Patients are eager to participate, but don’t get me started on the complexity of the whole patient identity problem and data integrity. I’m pretty sure it has taken years off my life.

Some of our rural clinics are still regularly taken down by well-meaning guys with backhoes. A cut T1 line doesn’t help patient care at all, and that’s assuming you can even get a line there in the first place. One site took nearly six months to get an appropriate line installed.

Trying to get all the vendors to work together is an adventure. More money earmarked specifically for physician connectivity would be helpful. I think there were a lot of physicians out there that thought $44,000 in MU money would actually pay for their EHRs. The true cost of doing an EHR (and doing it right) is far more than that, and considering maintenance, the expanding burden of Meaningful Use requirements, and other costs, I don’t see a long-term ROI over paper. Depending on how much you leverage the system you purchased and how much potential it has, you might be neutral at best.

I like your “bike in a corn field” analogy, especially being a farm girl. I may have a good story involving a broken leg and trying to take a motorbike across a corn field, but it will cost you a martini to hear it. Providers were lured into purchasing EHRs with more bells and whistles than they can understand, let alone use.

The late adopters are at a huge disadvantage because vendors now have thousands of customers to get ready for MU Stage 2. There’s not enough time to do phased implementations like we used to do. Everyone is rushing towards October 1.

As for that charge for an interface (knowing the vendors in question, although keeping their names out of it since I can’t confirm it) that’s exorbitant. Look outside the box for other strategies, like exchanging CCDs or doing a daily extract. You could hire contractors to double-key the information in both systems for several years and still be revenue neutral.

Our EHR is ranked near the top, so I wonder what kind of disasters the rest of the EHRs are? When I read about people who use them and say how good they are, I wonder what is behind their enthusiasm? Is it bribes or just pure ignorance and/or ego of the ones who refuse to see the truth?

There are plenty of disasters out there from all vendors, and plenty of good installations as well. I’m a user of five vendors at the moment (on staff at three different hospitals plus one system I use in the office and one ER I work at makes me use two different systems.) Two of the hospitals use the same system and one works well, yet the other drives me batty. Those kind of situations make it hard for me to understand tarring and feathering any vendor based on anecdotal reports.

As far as enthusiasm, I can understand where a lot of groups are coming from. When you have a good system and it’s running well, it can make a tremendous on patient care, especially where population health is concerned. On the other hand, I’ve been a user of one of those “disasters,” and when it happens to you, it’s not pretty. My previous EHR vaporized parts of nearly six months’ of chart notes because it wasn’t set up properly and there were some database issues that kept the problem from being detected.

Before someone asks how many people might have been harmed from faulty charts, I’ll say it’s far less than the number who might have been harmed had I lost all my paper charts in a fire, flood, or tornado. I’m grateful for EHR because unless it’s a cataclysm that takes out our two data centers 35 miles apart plus the offsite backup vault in South Dakota, we’re OK.

I lived through a year of hell after that while we went through the entire purchase process again. I’m convinced that clinical conversion and reconstructing parts of all those charts took years off my life. I use those experiences to motivate me as I help other users and provide feedback to vendors in the hopes that no client will ever have to go through something like that again. I’m pretty much my vendor’s QA nightmare. If it’s broken I’ll find it. They actually include some of my real-life patient scenarios in their testing process now. It’s much easier than having me yell at them if I find defects later.

As for the results, however, we’re not delusional. We’ve had great clinical outcomes (data proven) but we’ve worked really hard to get there and it hasn’t been easy. For us the key has been emphasizing people and process much more than the technology, which needs to be seen as the tool that it is. Too many groups view the technology as the be-all, end-all and that can be detrimental to their success. Vendors don’t help this perception and need to be spending more time helping customers work through policy / procedure and workflow issues before they implement rather than dealing with train wrecks after.

As to your last comment. there certainly are some egos out there. Our ambulatory vendor once brought a client with a failed implementation to visit our organization. We went through our standard site visit presentation, basically gave away thousands of dollars in free consulting on how to be a success, gave them our implementation plan, etc. and showed them how we did it.

Their CMIO was one of the most arrogant people I’ve ever met. His response was, “I’m sure that worked for you, but we have our own plan.” I wanted to jump across the table and ask him why he was even there. Why did his team of ten fly hundreds of miles and take up three days of my team’s time? If he was so successful with his own plan, why was he starting his implementation over? I had over 150 live docs at full productivity at the time. He had 10 docs who tried to go live and who were only seeing 60 percent of their desired volume and his vendor was paying other customers to try to help his team save their implementation.

I’ve got one more set of questions I’ll answer next time. Tune in to hear my thoughts on Meaningful Use vs. meaningful patient care. Wouldn’t you like to see that in a steel cage match? We’ll also talk about conspiracy theories and whether real live physicians have anything to do with EHR design.

Email Dr. Jayne.

Morning Headlines 1/6/14

Biotech Firm: We Will 3D Print A Human Liver In 2014

Organovo, a San Diego-based biotech company, says it will produce functional 3D printed human livers by the end of 2014. The organs will be used for pharmaceutical testing, not implanting.

Online Doctor’s Notes a Hit with Patients, Study Shows

A study published in the New England Journal of Medicine follows three hospitals as they go live with patient portals that include unedited physician notes. The year-long study found that 80 percent of participating patients had read their physician’s notes, and that "large majorities reported having better recall and understanding of their care plans and feeling more in control of their health care. Moreover, two thirds of patients who were taking medications reported improved adherence."

Computer failure adds to ambulance patients’ pain

In Australia, an ambulance service is seeking a government bailout after its electronic billing system malfunctioned and left it with $7.5 million in unbilled services.

Monday Morning Update 1/6/14

From The PACS Designer: “Re: Google Apps starter. With the continued growth of mobile devices, Google has exploited this trend with a mobile app landing platform for the iPad, iPhone, Android Tablet, and Android Phone. Now and in the future it will be easier to get apps to play on no matter which mobile device you may have in your possession as Google expands this landing platform with even more mobile solutions.” Google is everywhere these days, but I’m finding their apps less capable and more annoying. They tie everything into your Gmail account even when you don’t want them to, and the initially intriguing minimalist design of all Gmail-related apps is now just as annoying and clunky as a 1980s Invision screen (example: Gmail doesn’t support using the Delete key to delete an email, instead going the proprietary/obscure route by using the E key instead.)

Poll respondents find Medicare’s fraud-sniffing efforts to be unimpressive. New poll to your right: what will be the biggest challenge for hospital CIOs in 2014? The length of the list suggests the challenges inherent in that job.

Upcoming Webinars (Times are Eastern) 

January 7 (Tuesday), 1:00 p.m. Clinical Analytics for Population Health Management. Sponsored by HIStalk. Presenter: Cora Sharma, principal analyst, Chilmark Research. As providers move from fee-for-service to value-based payment models, they must not only comply with ever-proliferating quality metrics, but also transition from a cost-plus business model to one of cost containment. 

January 9 (Thursday), 2:00 p.m. Beyond the Summits. Sponsored by HIStalk. Presenters: Ed Marx, SVP/CIO, Texas Health Resources, and Elizabeth Ransom, MD, FACS, EVP/clinical leader North Zone, Texas Health Resources. Everyday healthcare executives share leadership and teamwork principles they learned from climbing some of the world’s highest peaks over the last four years. 

January 16 (Thursday), 1:00 p.m. Advanced Efforts to Identify and Eliminate Waste from Healthcare. Sponsored by Health Catalyst. Presenter: David Burton, MD, executive chairman, Health Catalyst. Based on a breakthrough analyses using several large healthcare data sets as representative samples, Dr. Burton and team will present insights designed to help executives struggling to identify, quantify, and extract waste from their systems.

HIStalk-sponsored webinars are non-commercial presentations of broad interest. I appreciate our pro bono presenters, who get a sizeable audience and recognition without the frustrations involved with presenting at a conference. Contact me if you’d like to present.

Welcome to new HIStalk Gold Sponsor The Loop Company. The Williston-VT-based research advisory firm helps companies launch new offerings, enter new markets, win more business, and create customer loyalty. They design programs to help companies understand how the market perceives them and can help improve sales, marketing, product development, and operations. It’s a new venture from old HIStalk friend and industry long-timer Gino Johnson, who created the excellent CapSite healthcare IT research and advisory firm that HIMSS acquired and rolled into HIMSS Analytics in October 2012. Thanks to The Loop Company for supporting HIStalk.

HISsies nominations continue, so please submit yours now. It will only take a couple of minutes and you can skip categories you aren’t interested in.  I’m enjoying reading the early nominations for worst vendor, Lifetime Achievement Award, and the always-popular “industry figure with whom you’d most like to have a few beers.” Long-time readers may remember years ago when Jonathan Bush won that category (as he often does) and agreed to let me auction off an evening with him as a charity fundraiser.

Listening: Blue Coupe, made up of hard-rocking 1970s legends Dennis Dunaway (the shamefully underappreciated bass player and principle songwriter for Alice Cooper when it was a real band) and the Bouchard brothers Joe and Albert (key members of Blue Oyster Cult), thus the band’s name as a nod to the respective histories of its members. The band started out playing Alice Cooper covers, but earned Grammy attention for new material in 2011/2012.

Thanks to the following sponsors, new and renewing, that recently supported HIStalk, HIStalk Practice, HIStalk Connect, and HIStalk Webinars. Click a logo for more information.

In Australia, the ambulance service of New South Wales requires a government bailout after its aborted EMR and billing system project left it with $7.5 million in invoices it couldn’t send out.

North Carolina, which just passed a law requiring hospitals treating Medicaid patients to participate in the state HIE, sends out nearly 50,000 new Medicaid cards to the wrong people.

Intelligent InSites names investor and executive board chair Doug Burgum as interim president and CEO, replacing Margaret Laub, who has left the company. Burgum founded accounting software vendor Great Plains and sold to Microsoft in 2000 for $1.1 billion.

Weird News Andy likes the story that he titles “Print a Liver – 2014,” to which he adds a “Silence of the Lambs” pop reference in wondering if they can also print a nice Chianti (although I seem to remember that the book instead said “big Amarone” before Hollywood dumbed down it down for less oenophilic  moviegoers.) A California biotech firm says it will successfully use 3D printing to create a human liver (or more precisely, a working model of a human liver suitable for drug company research) by the end of this year.

“Taking from Peter to Pay Paul” is WNA’s assessment of a survey of doctors in England, in which a third of them want to charge each ED patient $16 to to discourage usage for minor complaints. The patient counterpoint would be that appointments are hard to get and practices are closed nights and weekends. We have similar challenges here, obviously: the ED is always open and free if you can’t or won’t pay, while urgent care isn’t always open and they expect money upfront.

Strange: a medical student examining a standardized patient (an actor playing the role of a patient) pretending to have an abdominal aortic aneurysm detects the actual condition, alerting the instructing physician to urge the man to see a cardiologist. He does and is found to require stent replacement surgery. According to the patient’s wife, “Jim’s life was saved by a UVA medical student, no doubt about it.”

Vince covers the $14.5 billion acquisition of HBOC by McKesson in this week’s HIS-tory. I think he’s planning to wrap up his HIS-tory series after the next couple of installments. I will miss them since I have enjoyed every one.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Time Capsule: Notice of Proposed Rulemaking: Everybody Must Watch Jay Leno at 11:35 Eastern

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

I wrote this piece in January 2010.

Notice of Proposed Rulemaking: Everybody Must Watch Jay Leno at 11:35 Eastern
By Mr. HIStalk

I’m excited about the government’s encouragement (or mandate, depending on your perspective) that doctors use electronic medical records. Mandatory progress must go on despite the gripes of a few malcontents (i.e., the majority of doctors, patients, and taxpayers).

It is a travesty that more healthcare providers don’t use computers. Software can make healthcare as transparent, efficient, and consumer-driven as other organizations that have spent billions of taxpayer dollars on technology (such as the IRS, the military, and Medicare). The federal government must intervene when minimally educated and technologically illiterate doctors refuse to adopt EMRs voluntarily in their private businesses.

(It worked for TVs. The government decided that Americans should enjoy the benefit of watching cultural programming such as “Judge Judy” and “America’s Next Top Model, in visually stunning high-definition glory. The FCC ordered broadcasters to switch exclusively to HDTV, thus stimulating the economy by selling tons of imported flat panel TVs, enriching lenders as financially strapped citizens let the balance ride on their high-interest credit cards, and increasing landfill employment to bulldoze now-useless tube models.)

In fact, I believe that this “cure all ills” administration needs to take a step further. It’s time to support the most visible employee of the biggest EMR vendor company – Jay Leno.

Jay’s audience, like that of EMRs, has been pathetic in number and more indifferent than loyal. Hype and gimmicks weren’t enough to entice viewers (even the large number of unemployed ones with nothing better to do) to sit through an hour of his cheaply produced and repetitive nightly show.

Jay is a national treasure, too important to be left to the whims of fickle TV viewers. It is therefore essential to mandate, for the economic good and the image of America worldwide, that every one of those new LCD TVs must be tuned to NBC’s “Tonight Show” every night once Jay comes back.

(NBC’s owner GE bought back Jay’s 11:35 slot with $40 million of its own cash. Admirably, it did not ask for a federal Conan bailout.)

To encourage the development of cultural refinement in appreciating Jay’s hilarity and keen interviewing skills, it will be necessary to equip cable and satellite receivers with sensors that will detect households that are not compliant at least four of five consecutive weeknights. Those tuning in will receive a rebate on their bills that non-watchers will forego. After a few years, those non-adapters will have a “Jay support surcharge” included on their bills.

Each viewer must also be a Meaningful Viewer, jotting down Jay’s bon mots for repeating later, paying attention to the commercials, and laughing with significant amplitude at Jay’s latest carefully constructed John Edwards quip (rim shot!) This, too will be monitored electronically.

Jay is an experienced late-nighter, so it would not be prudent to spent taxpayer money on untested hosts such as Conan O’Brien. Therefore, Jay alone has been certified for the 11:35 slot. All other programs, such as the Magic Jack infomercial or “Cake Boss” marathons, are not permitted even when Jay has on dull guests such as Paris Hilton or Larry the Cable Guy.

Lastly, it is imperative that Jay receive feedback about which of his jokes and sketches are working. Technology will be added to the set-top box to solicit constant feedback about the quality of Jay’s humor, which will be de-identified and aggregated quarterly for analysis by the same crack NBC executives who couldn’t make his show work before. With this information, Jay can develop monologue templates that the government will mandate for use by up-and-coming comics, thereby protecting viewers from edgy humor from fresh newcomers.

All of this government spending will actually prove profitable to taxpayers, according to bailout expert Timothy Geithner. While Jay’s show will probably never make money, it will provide an effective advertising platform for the upcoming Chevrolet Volt. What’s good for GM is good for the country, given that the country now owns 61 percent of GM.

Does Jay think this bold, essential plan will work? You bet! His new sidekick Triumph the Insult Comic Dog (merged from a previously retired product line) says you can “bank” on it (rim shot!)

Morning Headlines 1/3/14

President Obama Announces More Key Administration Posts

Leon Rodriguez, director of the Office for Civil Rights of HHS, will be nominated to take over as the Department of Homeland Security’s director of the United States Citizenship and Immigration Services.

Other new NC laws taking effect with the new year

In North Carolina, a law that took effect on January 1 requires that all hospitals connect with the North Carolina HIE and submit data on any services paid for by Medicaid.

Pentagon Kicks Off Procurement To Maintain Current Health Record Until 2018

The DoD initiates a procurement process that will allow it to stick with its existing EHR until 2018.

Cerner ‘seals the deal’ on $4.3 billion office plan at Bannister site

Cerner completes its purchase of a 237-acre property outside Kansas City where it will build a $4.3 billion campus over the next 10 years, eventually providing office space for 15,000 employees.

Digital Health Funding: A Year In Review

Health IT startups raised $1.9 billion in VC funding during 2013, a record breaking year and 39 percent increase over last year. Most money went to EHR vendors, big data startups, population health tools, wearable biosensors, and patient engagement platforms.

News 1/3/14

Top News

President Obama announces that he will nominate Leon Rodriguez, director of the Office for Civil Rights of HHS that enforces HIPAA, for Director of Citizenship and Immigration Services in the Department of Homeland Security.

Reader Comments

Photo: Brian Snyder/Reuters

From DZA MD: “Re: Baystate Medical Center. Cerner PowerChart crippled with record inpatient census and Nor’easter in full effect. Unable to process timely discharges before brunt of storm arrives.” Unverified. As I write this Thursday evening, Massachusetts is about to get nailed by a winter storm that will bring up to 30 inches of snow in places with wind chill as low as 20 degrees below zero and even colder Friday night.

From Dirk Benedict: “Re NextGen lawsuit. Mountainview Medical Center in Montana sues NextGen, saying it didn’t install its $441,000 EHR system as promised.” The six-bed hospital contends that NextGen was to install a system “which would permit MVMC to demonstrate ‘meaningful use’ of such electronic health records through all stages of applicable federal regulations” and was to complete implementation by October 1, 2013. According to NextGen’s website, NextGen Inpatient Clinicals EHR 2.6 is 2014 Edition certified as a modular EHR, so it’s difficult to determine what the exact issue(s) might be. NextGen provided us with this statement:

We cannot comment on the pending litigation, other than to say that we firmly believe the allegations made by Mountainview Medical Center are without merit and we will defend against them vigorously. We confidently stand behind the quality and performance of our products and offerings.

From Intractable Vermonting: “Re: Vermont health insurance exchange. The cost overruns have been tremendous and the politicians responsible pass it off as ‘changing project scope costs money.’ 99 percent of all IT leaders in the US would be fired if they managed a project in this fashion. Also, security is the last thing that is built into the technology before it goes live and I am sure there were shortcuts taken with all these exchanges. The hackers know that most sites require Social Security number to register.” The Vermont Health Connect insurance exchange website is the most expensive IT project ever undertaken in the state, running up a tab of $172 million, of which the federal government contributed $48.7 million. One big contractor was the ever-present CGI, which managed to turn its $42 million contract into $84 million worth of billables while missing key deadlines that kept the site from being ready on October 1. CGI was smart: the state says the delays cost $26 million, but CGI’s contract says it can be penalized a maximum of $5 million.

HIStalk Announcements and Requests

It’s time for the HISsies nominations. What’s your choice for “Stupidest Vendor Action Taken,” “Most Overused Buzzword,” “Industry Figure With Whom You’d Most Like to Have a Few Beers,” and “HIStalk Healthcare IT Industry Figure of the Year?” Enter your nominations, from which the most-nominated choices will go on the final ballot in a week or so. That means no complaining if your choice isn’t on the ballot and you didn’t nominate them.

HIStalkapalooza registration will open up the week of January 13. Read HIStalk religiously for the link to the signup notice in the next couple of weeks. We fill up really fast every year. Above is a photographic hint of the venue for those wondering. The primary sponsor has a couple of co-sponsors whose support will allow the event to be even bigger and better. If your company is interested in getting exposure as a HIStalkapalooza co-sponsor, let me know and I’ll connect you since they are willing to take on two more.

Welcome to new HIStalk Platinum Sponsor healthfinch (they tell me it’s supposed to be all lower case). The company offers RefillWizard, which improves doctor efficiency as a “Team-Based Decision Support System” that improves patient safety while reducing refill turnaround time by up to 95 percent. They begin by preparing a customized savings document like the one above and making recommendations to optimize the refill process. They have found that 62 percent of refills can be selectively and safely delegated to clinical staff, reducing the staff time to 34 seconds (some PCPs spend 1-2 hours per day just managing refills.) RefillWizard, which just won the Allscripts Open App Challenge, works either with paper protocols or integrated with the EMR. HIStalk readers probably know DrLyle (Lyle Berkowitz, MD), the company’s chairman and chief medical officer. Thanks to healthfinch for supporting HIStalk.

I found this healthfinch RefillWizard overview on Vimeo.

Upcoming Webinars (Times are Eastern) 

January 7 (Tuesday), 1:00 p.m. Clinical Analytics for Population Health Management. Sponsored by HIStalk. Presenter: Core Sharma, principal analyst, Chilmark Research. As providers move from fee-for-service to value-based payment models, they must not only comply with ever-proliferating quality metrics, but also transition from a cost-plus business model to one of cost containment. 

January 9 (Thursday), 2:00 p.m. Beyond the Summits. Sponsored by HIStalk. Presenters: Ed Marx, SVP/CIO, Texas Health Resources, and Elizabeth Ransom, MD, FACS, EVP/clinical leader North Zone, Texas Health Resources. Everyday healthcare executives share leadership and teamwork principles they learned from climbing some of the world’s highest peaks over the last four years. 

January 16 (Thursday), 1:00 p.m. Advanced Efforts to Identify and Eliminate Waste from Healthcare. Sponsored by Health Catalyst. Presenter: David Burton, MD, executive chairman, Health Catalyst. Based on a breakthrough analyses using several large healthcare data sets as representative samples, Dr. Burton and team will present insights designed to help executives struggling to identify, quantify and extract waste from their systems

Acquisitions, Funding, Business, and Stock

Healthcare Data Solutions acquires StratCenter, a provider of healthcare provider data.

Stryker Corporation will acquire surgical sponge counting technology vendor Patient Safety Technologies, Inc. for $2.20 per share. The company’s market cap is $85 million.

Sales

In the UK, King’s Mill Hospital signs a five-year, $5.9 million EHR contract with Specialist Computer Centres and McKesson.

Medical billing company Medorizon Partners selects InstaMed’s patient payment plan technology.

The Defense Logistics Agency awards TeraRecon a maximum $30 million fixed-price contract for the procurement of radiology systems and services.

Central Georgia Health System will implement Infor’s healthcare business automation applications.

People

CareTech Solutions hires Daniel Lincoln (Palace Sports & Entertainment) as corporate controller.

CMS announces the retirement of COO Michelle Snyder, who supervised development of HealthCare.gov. The agency says Snyder had originally planned to retire in 2012 but stayed on at the request of CMS chief Marilyn Tavenner.

CareView Communications, which offers patient flow and safety solutions, promotes Steven G. Johnson from president to CEO, taking over for Samuel A. Greco, who is retiring for health reasons. Careview also names Sandra K. McRee (McRree Consulting) COO and appoints Jason T. Thompson to the board, replacing his father, Tommy G. Thompson.    

Direct Consulting Associates promotes Frank Myeroff to president.

Announcements and Implementations

Baptist Memorial Health Care (TN) goes live on Epic this week at four minor medical centers and at its Baptist Medical Group clinics. Four Memphis-area hospitals are scheduled for a March 11 go-live.

Government and Politics

A new North Carolina law requires hospitals with EHRs to connect to the state’s HIE and submit data on services paid for with Medicaid funds.

The Department of Defense issues an RFP to keep AHLTA and CHCS running through the end of 2018 after plans for a joint DoD-VA EMR were scrapped last year when costs were estimated at $28 billion. The value of the new contract is estimated at $250 million to $1 billion. DoD is looking at a commercial replacement for contractor-developed AHLTA, whose estimated cost to taxpayers was up to $5 billion.

Innovation and Research

A study of 295 smartphone apps that claim to prevent, detect, or manage cancer finds no published studies that prove their usefulness, effectiveness, or safety.

Technology

The FDA extends the Kinsa Smart Thermometer the first-ever 510(k) clearance for a smartphone-connected thermometer.

The US Patent and Trademark Office issues CommVault Systems a patent for efficient data management improvements, such as docking limited-feature data management modules to a full-featured data management system.

Other

Riverside Health System (VA) announces that a now-terminated LPN inappropriately accessed the records of 919 patients over a four-year period.

Cerner completes the purchase of the 237-acre tract for its planned $4.3 billion office development in south Kansas City.

Sponsor Updates

• Sunquest releases new versions of Sunquest Laboratory and Sunquest Molecular.
• The Boston Globe profiles Sumit Nagpa, CEO of Alere Accountable Care Solutions.
• Jason Fortin, senior advisor for Impact Advisors, discusses the impact of Meaningful Use in 2013.
• EDCO Health Information Solutions posts a Point of Care Scanning Process video.

EPtalk by Dr. Jayne

I received a lot of feedback about this week’s Curbside Consult. I’ll be posting more responses to the original reader email in the next Curbside Consult, but wanted to share some quick responses in the interim.

One reader asked for more detail about how we’ve tied the physician bonuses to EHR use. I can’t claim credit for the approach since we copied it from another organization, but it has worked well. It only applies to employed physicians using the group’s EHR platform. We have a couple of practices that we have acquired that are on other systems and are not yet converted, so they are exempt for now.

Physician bonus amounts are determined by three factors: patient satisfaction, clinical quality scorecard results, and productivity. A sliding scale is used for each element. For example you might receive 100 percent of your patient satisfaction and productivity bonuses but only 80 percent of your quality bonus.

The EHR plays into that in two ways. Since we’ve been fully adopted on EHR for many years, all of our quality reporting is now derived from EHR data (no more manual chart reviews). If providers are not documenting in the EHR, their scores will be low. We initially did a hybrid approach with both manual chart review and EHR reporting while physicians were adopting, but that has been phased out. Our staffing for compliance reviews has dropped significantly. They used to take three full work days per physician and now they take two to three hours per physician.

The major way that EHR applies to the bonus, however, is simple. All visits must be documented in the EHR and must meet our minimum data standards. These aren’t a lot different than the paper chart. The visit has to be complete within 24 hours of the patient visit and has to include certain critical data elements that essentially align with CMS coding requirements. For example, documentation has to have a chief complaint, history of present illness, review of systems, review of pertinent patient history, physical exam, and an assessment and plan.

We expected this to be present in the paper world and now it’s actually easier since the data is shared across the multispecialty group rather than living in separate paper charts by location. Providers can review histories with one click rather than having to dig for histories that may have been mentioned in various progress notes. Our physicians were not particularly good at keeping the paper problem list and past / family / social history face sheets up to date on paper.

For some practices that were challenging implementations, we actually had to physically visit the practice and make sure they didn’t have shadow charts. One site didn’t have charts, but had “jackets” for each patient. We didn’t just fail them outright but gave them three months to remediate, then audited them again. Over the last few years that the EHR requirements have been attached to the bonus structure, we’ve been fair about doing pre-audits so people know where they stand, then allowing enough time for them to remediate before their final audit.

The reader also asked about the “standards” that I mentioned our physicians have to meet to stay employed. Some are pretty simple – no OSHA or CLIA violations, favorable scores on coding and compliance audits, and getting along with their partners and staff. Some are more rigorous. We have high standards for clinical quality, and physicians are graded on blood pressure control, appropriate use of drugs for coronary artery disease, cholesterol control, influenza vaccination, cancer screening (colorectal, breast, prostate), diabetes management, and a couple of others. Physicians who can’t keep their scores in the desired range are remediated (as are their office staff – many of the metrics can be improved by leveraging staff and using standing orders including vaccination and screenings).

Finally, physicians are expected to be productive – specifically, to be above the 75th percentile based on MGMA data. That’s a lot to ask, but the group makes it clear when physicians join and it’s actually spelled out in the contract. Our compensation parallels this – our physicians consistently earn salaries in the top 20 percent based on MGMA data. If they choose to work less than full time, the productivity expectations are scaled accordingly. Our retention rate has been very good. Most of the providers who leave within five years of joining have a family reason. For example, they may only work with us for a year or two while they wait for their spouse to receive a residency or fellowship appointment that requires relocation.

In addition to their bonuses, our providers also received a hefty chunk of their Meaningful Use payments as a cash bonus. This differs from most organizations I’ve talked to that tend to keep the MU payments at the corporate level. I think the way we shared them is especially surprising given the fact that our providers don’t pay anything for EHR software, training, or maintenance. The only EHR-related charge that the practices incur is for hardware, which averages $8,000 – $10,000 per provider every three to four years.

Another reader asked how we handle the EHR records with a physician who chooses to leave the organization (or is let go) yet wants to keep his or her patients and office location. It’s actually pretty easy. We have a subsidized EHR offering (under the Stark exception) so we already have local private physicians on our EHR database with independent practice data. We simply copy the charts of active patients (those seen by the provider within the last three years) into a new practice in the EHR. Only clinical data is copied, no financial data and no accounts receivable.

If the provider is on staff at one of our hospitals, he or she may be eligible for a subsidy. Otherwise they pay fair market rate and we host it similar to a SaaS model offering. Although the providers can still share data with the employed practice, they have to do it through our private HIE rather than sharing a direct chart within the multispecialty practice. Providers are charged $0.50 per chart for the copy. That’s a holdover from our old contract when we had paper charts and they paid that much for the paper charts. I have no idea where that number came from — it’s been in place for at least 15 years.

If they choose not to stay on our platform, we have a third-party consultant perform an extract based on the new vendor’s specifications. It’s the same very skilled consultant we use when we acquire practices and bring the data into our system. Once the drive goes into the Pelican case and enters the physical transport protocol, though, it’s out of our hands.

I’ve seen two physicians treated poorly by their new vendors. One took several months to move the extracted data onto the new EHR. Another simply turned the data into PDFs and parked it in the new EHR’s scanning system, which is pretty sad considering the level of discrete data we can provide. Providers can also buy a system directly from our vendor and we’ll do the extract in that situation as well.

I’ve shared a lot of fairly specific information this week, so I hope it doesn’t come back at me. Stay tuned for the next Curbside Consult. I’ll be sharing my thoughts on infrastructure and interoperability as well as what happens when you try to drive a Ferrari in a corn field.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.