HIStalk Interviews Joe Casper, CEO, Sandlot Solutions

Joseph Casper is CEO of Sandlot Solutions of Fort Worth, TX.

Tell me about yourself and the company.

The Sandlot organization has been around for six or seven years, tied to an organization out of Dallas-Fort Worth, North Texas Specialty Physicians, building a health information exchange solution, managing patient risk, and driving connectivity among the physicians.

I became the CEO because I have 12 years of experience in building health information exchange systems. I’m the co-inventor of the first gateway solution that was initially deployed at Swedish Medical Center, two or three of the sites up in New York including Manhattan, the District of Columbia, the state of New Mexico, a couple of million people in Los Angeles, and the province of British Columbia. Needless to say, I got a fair amount of experience.

I’m somewhat of an entrepreneur. This is the fourth company that I’ve been involved in where we build technology or software that I’d either led as CEO or run as president of the company.

You have a somewhat unusual advantage of working directly with North Texas Specialty Physicians. What are the main lessons you’ve learned from that organization?

When you can come at this from the angle of physicians connecting physicians together, the majority of the health information exchanges that were originally deployed connected hospitals to hospitals. They had a flavor that looked very different then when the problem you’re trying to solve is your independent physician organization with tight hospital relationships. You deploy electronic medical records, you try to connect primary care physicians on one platform to specialty physicians on another platform where everyone is bearing risk, you quickly realize that you need to have solution in place that can connect them.

NTSP invested in Sandlot to solve that problem. As they started to solve that problem, they started to solve other problems, primarily increasing their risk business and then understanding the kind of analytics tools that’s required to do that, the sort of information you need to have at your fingertips from claims data merged together with clinical data so that you have a very rich set of data to run analytics against to look for gaps in care and to push on to physicians in a seamless way.

The company has been described as offering a fourth-generation solution. What does that mean?

Having participated in these things since 2001 when I first touched health information exchange, we were off initially just connecting hospitals. The fourth-generation health information exchange starts from the physician end. It creates the connectivity required from hospitals to physicians in a bi-directional way. If you go back to, say, the second generation, they were pushing information out, so discharge notes were being pushed out to the physicians. But you weren’t able to capture that information and ingest it back in.

The fourth-generation product first connects the physicians together in a way that the clinical dataset is not only brought into a repository — where you can run analytics against it, look for gaps in care, report so you can manage frequent flyers, look at your top admissions — but you can then bundle that Continuity of Care Document back up and push it back out into the physicians. When the patient shows up from primary care to a specialist or secondary care, that aggregated CCD is there ingesting data from the hospital visit, from national labs, and from others. This continuum moves us further up the pipeline to say it’s aggregated along the way. What was documents has been broken down now into discrete data.

Where we would immediately differentiate ourselves from many of the folks who are moving documents around, CCDs around, is that they keep that data in that format. You can’t run analytics and gaps in care against documents. You have to break that down. You have to organize that. You have to normalize that.

As you push it back into the hospitals, or as you start to build communities out of that, you have the advantage of a system that was built from the ground up knowing that as you add data to it, you take it, put in discrete data, you merge that together with claims data. When it comes time to run an analytics view, it’s not only the valuable clinical data you’re doing that with, but you’ll also have the ability to look at the claims, where we identify that specific tests have or have not been done as well outside of the system because we see or we don’t see a claim for that.

Most technology vendors offer systems that were designed for statewide and regional exchanges, and sometimes they and their customers are still struggling to make that work. Will those products become obsolete, or is there room both for what Sandlot does and what they do?

That market will break itself up based upon how well the specific states did. There are some states, some of the smaller ones, who have been very successful in this. Very large hospital entities who have a very large market share, they came on board early, and in some cases they were innovators in what they did. Those have stabilized, and many of them have found a sustainable business model, which the HIEs have lacked forever.

Then there are systems that are being deployed right now, dollars being spent, and unfortunately those systems will never make it, because they don’t have that planned for that sustainable business model. We’re seeing private organizations saying, I need to do this. I have to do it for Meaningful Use. I need to do it to run my business. I’m taking on risk and I can’t take on risk if I can’t see both the clinical and the claims data for that patient. I can’t trust the state to get it done, so I’m going to go do it myself.

As a result of that, where we see the folks who really want to drive to make that happen, we’re seeing hospital associations stepping in and saying, “I’ll take that lead. I’ll run that,” or a lead hospital and the community saying, “I’ll take lead, I’ll do that.” We’re seeing that from two sides, where there clearly is plenty of room for us to coexist with the state systems that are out there, and in fact, connect to them as needed.

Insurance companies have jumped on the HIE technology business. Why do you think they were interested, and does that affect your business?

It certainly affects it, but maybe in some cases in a positive way. I’ll try to be kind here and not necessarily name names.

There is one of those entities who spent a fair amount of money — in the hundreds of millions of dollars — for one of those solutions. Unfortunately, the solution platform was near its end of life. As a result of that, many of their clients and many of those systems are really troubled. They’re ready to skip on to the next opportunity here with a richer set of analytics, with a richer set of things that one, aren’t going to cost as much; two, are far more creative with their capabilities; and three, can be turned up in timeframes measured in weeks, not in months, and the larger complex pieces measured in 100 days. I just made a commitment to do something that I will turn up 30 hospitals in 100 days. As a result of that, I think far more agile in that mode.

They are powerful when you find an area where they happen to be the carrier of choice. If you cross one of those paths … the other one on top there that is certainly quite sizeable has very good footprint, and when you look at that footprint and there is a relationship with them as the largest payer in the market and they rear their head. They’re capable, but as I heard, they’re quoting 15 weeks to do something that I can do in a week. The new generation of this drives down the cost significantly. I think they are opportunities for us. We are pursuing those entities knowing that they are quite vulnerable right now, and we’re getting traction.

Is there still an interest in acquiring companies like yours, and do you see that changing?

There is interest. Now we’re seeing others who have interest that see this market is quite rich in many ways. As soon as we start to see the risk markets stratify, there are entities who want to provide product that manages risk, they want to provide product that looks at analytics. Some more of an IT bent than those of a classical insurer, but I’m not having any discussions with any insurers right now.

Do companies try to cobble together a solution using something that’s strictly connectivity and then drop the analytics on the back end?

Of course. You can look at that as one of the insurers that you mentioned came from the other direction. They had those pieces and they tried to cobble on top of it an analytics tool and tried to bolt those pieces together to build something. You can get it to work. You don’t have the efficiency of it if you look at how those pieces are integrated.

If you build it from the ground up, you are smart enough to say that if I have this piece of data and I want to offer a care manager … so one of the things we offer is care manager suite, it’s integrated right into the core foundation platform. If I’m looking at a patient that I’m managing under a care manager, one click and I get to see exactly what the reports would be on that patient. One more click and I can see exactly the medications that patient is on.

It is all pretty seamless, so when you look at it, has a nice look and feel to it. It’s pretty intuitive. It isn’t cobbled together so that somebody working with it has to say OK, this is obviously a different system, and this is obviously a different system. But I think over time, people will recognize they need to build those pieces out and they’ll come back with the products that are similar.

It would seem that the most oversold concept right now is analytics. Everybody says they’ve got it. Nobody really even knows what it means, much less what they’re trying to buy, or in some cases buying without even knowing what they’re going to do with it. What are the most useful or most commonly used analytics parts of your system?

NTSP as an organization was a pioneer. Took a second batch of pioneer, run a book of business through their own health plan, Care N’ Care, and operate a Secure Horizons book of business. By the time they’re done, there are about 80,000 at-risk patients sitting inside there. To climb the stars ranking, they started at three and a half stars. Over the last year, they climbed to four and a half stars. They did it by taking our analytics. The base piece of these are I ingest data such as A1C tests from a primary care physician or directly from a laboratory or from a specialist or from a bill that I’ve paid.

When it comes time to look at, am I compliant with my diabetics, am I compliant with hypertension, am I compliant with the various measurements required for five-star, I take that data, and at the time that the physician or anyone who’s caring for that patient, our analytic set metrics together with the product called Dimensions scans across that patient in milliseconds, identifying the presence of or the absence of whatever that patient needs — based on whether their particular age, whether their particular disease state — and within seconds identifies that these are the appropriate gaps for this patient that need to be dealt with. Then we have a proprietary capability that we’re patenting that allows us to push that message into the EHR platform without regard to who that EHR platform is. It’s something we call the digital envelope.

What are your thoughts on CommonWell?

I think the CommonWell organization is a good idea. We all know why they banded together. There is certainly a particular vendor out there who’d love to see all these things connected together in their own schema. The schema among how the hospitals can connect together when they’re on the same platform works quite well. When they’re on various platforms, a diverse platform doesn’t work at all.

There is defined need there. CommonWell saw that as an opportunity to say, if we pull together, I think we can do this. I think in the end, it’s a good idea. The more we get people out there who are opening these gates up, opening up APIs, making this data available on standards and moving it around, the better healthcare United States will be. I’m all in favor of that piece.

But as we look at it and say, where are the EHR vendors headed, it certainly seems that another round has occurred. I know three or four organizations that started the path with one EHR platform, cut their teeth on it, and now recognize it’s not going to be able to do what they want to do, and so they’re switching. As they switch, that churn seems to give them an uplift to organizations who recognize things that need to be in the next generation of EHR platforms. Some of these folks are seeing their market share go downhill and they’re chomping to see, can they do something in CommonWell that might help that.

At the same time, there are EHR vendors out there who are right on the cutting edge of what they need to with EHR systems to meet Meaningful Use, to be compliant in this area, to push CCDs and CCDAs around so that the information that people want to manage risk can be done without a lot of cost and without a lot of pain.

Some will suffer in this process and some will prosper, but I think the ones that I’m dealing with that I see … I mean, we’re talking large groups, not a doc here and a doc there. This is 116 docs here and 200 docs here, and they’re making those changes. All of that seems to help foster that as we connect to them, they’re ready for that next step. They’re ready to ingest the data that we pull together. They’re ready to have that be part of their system. They can compile whatever they do and send it back to me so I can do the same thing again and again.

Where do you see the company and the market being in five years?

I’m embargoed for about two weeks from the best example that I could give. We’re seeing these entities who had been put together in patchwork in the past and have tried to make that work recognize it can’t work. Consequently, these entities have stepped up. Hospital associations looking to say, I can solve this problem. Larger community rollups that say, I can solve this problem if I put a common umbrella or a common platform around it.

We have grasped this because it’s right in our sweet spot. We have the ability to take the output of another HIE platform — any of those insurance companies or the ones you spoke of or any of the other ones out there — and sit on top of them. As long as they are compliant with the latest standards, our ability to do HIE-to-HIE connectivity exists.

Certainly the ability to go out and connect the physicians where hospitals are really struggling so that they can’t buy physicians any more. They know they need this physician affiliation strategy. They’re going at risk in the community. They need the information to go at risk in the community. They’ve tried to hook up to the state systems, but they’re not cutting it. They see the timeframe that is going to take them, they are not cutting it.

A cloud solution like ours, our base product that can come in and fill it up pretty quickly, is pretty attractive. We’re doubling our sales force in the last month. We’re doubling our capacity. That should give you an idea of the kind of interest that we have in what we’re doing.

We’re doing some very innovative things in Medicaid space. We won a contract to demonstrate that you can manage Medicaid patients in the same way that CMS was trying to manage Medicare patients. The ACO models that drive down cost and improve quality for Medicare are applicable for Medicaid. We’re going to be demonstrating that. We won a contract to do that. There’s great hope in the sorts of things we can do with states that are struggling with lack of budgets largely due to healthcare costs in a Medicaid population. We’re right on the cutting edge of that and excited to be there, too.

Morning Headlines 7/12/13

Defense and VA to Congress on Health Records: It’s The Data, Not The Software

Defense Undersecretary Frank Kendall reports to a House Armed Services and Veterans’ Affairs Committee hearing that the DoD and VA will create a new shared platform that will allow the two departments to pass key clinical information from separate EHRs. The new plan replaces the original iEHR plan that promised a single, integrated EHR for approximately 200 VA and DoD hospitals nationwide. The iEHR program was originally expected to cost between $4 billion and $6 billion but the budget soon ballooned to $28 billion, which is more than CMS is projected to spend on the entire Meaningful Use program.

Allscripts jumps on better 2Q contract booking

Allscripts shares rise more than 16 percent this week when the company reports an increase in contract bookings for the second quarter. The recently announced five-year managed IT contract extension with North Shore-LIJ Health System helped boost the numbers.

Fort Worth hospital reports huge data breach

A Fort Worth, TX hospital is notifying hundreds of thousands of patients cared for during the 1980s that their personal health information may have been exposed after microfiche pages containing names, addresses, birth dates, health information, and in some cases Social Security numbers are found in a local park.

HIMSS Workforce Survey, July 2013

HIMSS publishes the results of its first annual healthcare IT workforce survey, which finds that 85 percent of surveyed organizations had done at least some hiring this year compared to just 13 percent that had experienced layoffs. The most common positions being filled are for clinical application support staff and help desk staff. Seventy-nine percent of respondents say they will add staff next year.

News 7/12/13

Top News

DoD and VA officials tell the House Armed Services and Veteran Affairs Committees that they will focus on creating a system that will display standardized information from both organizations instead of pursuing an integrated health record now estimated to cost $28 billion. DoD also announces that it will tender bids for replacement of its AHLTA, CliniComp Essentris, SAIC CHCS, and TMDS systems. Video of the hearing is here, although a lot of it involves the famous claims backlog. The DoD people are grilled at around 45:00 as to why they are ignoring the President’s mandate for an integrated record and are instead off shopping commercial software for themselves. The answer is not nearly as direct as the question, although in an interesting moment, DoD Undersecretary Frank Kendall disputes a quote about his department’s intentions and criticizes the source as “entirely incorrect,” only to be told that the quote came from the Secretary of Defense.

Reader Comments

From Lance Boyles: “Re: HCA. Just consolidated its IT staffing vendor list to just Zycron, Robert Half Technology, and Insight Global. TEKsystems, shockingly, did not make the cut even with its long-term, high-value corporate relationship.” Unverified.

From Punditry: “Re: Senate Finance Committee. Has called Farzad Mostashari, MD from ONC and Patrick Conway, MD from Center for Clinical Standards and Quality to testify at a July 17 hearing called Health Information Technology: A Building Block to Quality Care.”

From Fresh: “Re: CIOs fired during or after an Epic install. I was curious on your take.” CIOs do indeed get fired during or after their installs of Epic … and Cerner, Allscripts, Meditech, and every other system out there. My take:

• You hear about the Epic ones because, by definition, they are the highest-profile hospitals and CIOs, and the high cost of their implementation projects increases the risk of being made a sacrificial lamb when things don’t go smoothly.
• Epic takes quite a bit of time to install because it’s usually replacing most major systems, and with CIO turnover being what it is, there’s a good chance that some CIOs will leave in those years purely by chance.
• Some hospitals want an Epic-experienced CIO knowing the many millions of dollars that are at risk and — either at their own initiative or because Epic identifies potential problems — decide to make a change.
• I would hope that hospitals don’t put the CIO in charge of the project since that’s a big mistake, but I would also hope that the CIO and IT department don’t let the Epic train roll over them by being anything but ecstatic over a project that has already been embraced with possibly irrational exuberance by operational leadership.
• When you read about high-profile Epic failures, I would bet you any amount of money that the risks were spelled out well in advance in the extremely detailed (and blunt) executive status reports that Epic provides regularly, which means the facility probably either ignored its recommendations or wasn’t functional enough to fix the noted problems. If those chips fall on the CIO, hilarity will not ensue.

From Deep Thoughts: “Re: EHR usability. It’s one piece of a complex puzzle. I’ve worked with EHRs that are loved by physicians, but lack basic capabilities, like allergy checking if a medication name is spelled wrong. Per this quote about the stethoscope from 1834, there is resistance to change, and the key is channeling it into systemic improvements.” The 1834 stethoscope quote: “It will never come into general use, not withstanding its value; it is extremely doubtful because its beneficial application requires too much time and gives a good bit of trouble both to the patient and the physician because its character is foreign and opposed to all of our habits and associations.”

HIStalk Announcements and Requests

Recent highlights from HIStalk Practice include: a reader wonders how EMR requirements differ between small and large practices. The American Academy of Ophthalmology will implement an eye disease patient database. A third of physician executives think healthcare costs rise when hospitals buy physician practices. CMS proposes paying providers for non-face-to-face care of patients with multiple chronic conditions if the provider uses a certified EHR. ONC’s Farzad Mostashari, MD predicts an uptick in full EHR adoption in 2014 just before providers risk penalties for not meeting MU standards. Federal financial incentive programs have spurred e-prescribing adoption. Brad Boyd of Culbert Healthcare Solutions offers recommendations to avoid impacting cash flows when prepping for ICD-10. Reading HIStalk Practice may not be a cure for the summertime blues, but it is a cool way to catch up on the latest ambulatory HIT news. Thanks for reading. 

Earn HIStalk Karma Points by: (a) signing up for spam-free e-mail updates; (b) searching or navigating your way to finding the offerings of HIStalk sponsors in the Resource Center; (c) finding a consulting firm painlessly by blasting your quickly-entered RFI to the companies of your choosing – including all of them as an option – via the Consulting RFI Blaster;  (d) connecting with us on Facebook, Twitter, and LinkedIn, including the HIStalk Fan Club that reader Dann set up in 2008 (happy five years, Dann!) that now has 3,200 members; and (e) sharing my amazement at the impressive roster of industry-leading companies that support HIStalk by perusing and occasionally clicking their ad to your right and telling them in person that you saw them on HIStalk. Thank you for reading, with extra gratitude to that handful of readers who were there with me when I started writing HIStalk in June 2003.

Actually, there may be more than a handful of 10-year readers out there, so if you’re one and would like to tell me how you found HIStalk in 2003 and why you’ve kept reading, that would be fun.

On the Jobs Board: Health Analytics Data Analyst, Senior Healthcare Policy Analyst, Marketing Specialist, Systems Administrator.

HIStalk Connect’s Dr. Travis and Kyle were at the Converge conference in Philadelphia this week, with Kyle on the right sporting Google Glass and Travis jealously wishing his plain old optical glasses were half as cool. A report from Travis is here.

Acquisitions, Funding, Business, and Stock

Allscripts announces that it expects Q2 bookings and contract backlog to increase 3 percent and 13 percent, respectively. That includes the just-announced $400 million services extension by North-Shore-LIJ Health System, which provided important validation that the company can meet the needs of a large health system.

In the same SEC filing, Allscripts announces that EVP of Sales Steve Shute, who joined the company in July 2011, will resign effective August 8, 2013 and will receive as severance his expected one-year compensation of $880,000.

Sales

Kindred Healthcare (KY) selects dbMotion create a single patient record.

Medical Center Hospital (TX) chooses Convergent Revenue Cycle Management.

Gundersen Health System (WI) will implement iSirona’s device connectivity solution.

The Specialty IPA of Kansas retains Wellcentive to facilitate clinical integration, manage P4P programs, and support its integrated network of primary care physicians.

People

Health Catalyst names Scott Holbrook (Medicity/KLAS) as a strategic advisor.

Bill Korn (Antenna Software) joins MTBC as CFO.

Scripps Health names Steven Steinhubl, MD director of its Digital Medicine program, tasked with leading the scientific evaluation of mobile health devices through the Scripps Translational Science Institute.

Systems Made Simple elects CFO Christopher Roberts to its board.

Acusis appoints Robert Parsons (Cerner) VP of strategic business solutions.

Announcements and Implementations

Nuance announces that 750 developers have joined its healthcare developer community.

The health IT program at the University of Texas at Austin and Jericho Systems will participate in an ONC-approved national pilot to explore advanced patient control over shared medical records and how patients can better control the release of their PHI when requested electronically from their providers.

Government and Politics

ONC issues an ONC Certified HIT mark for EHR technology that has 2014 edition certification requirements.

The HIT Policy Committee’s Information Exchange Workgroup issues preliminary recommendations on patient record queries and provider directions for Stage 3 MU.

Innovation and Research

Healthbox partners with BlueCross BlueShield of Tennessee to launch a new health IT accelerator in Nashville, joining its locations in Chicago, Boston, and London. The first class will start in September at the Nashville Entrepreneur Center.

Technology

Pixie Scientific develops a diaper that works with a smartphone app to detect possible UTIs, kidney dysfunction, and dehydration, transmitting its findings to a physician. The developers say the diaper also has potential as a consumer product and would likely cost about 30 percent more than regular diapers.

In contrast to the simple genius of this diaper, I was reminded yesterday just how far behind healthcare is. My new insurance carrier offers online access to an electronic image of the insurance card. I thought it was semi-brilliant of me to take a photo of the online image with my iPhone instead of printing it. It was easy to hand the pharmacy tech my phone so she could enter the numbers into their system. The doctor’s office, however, requires the actual card so they can scan it into their system. I would have been pleased two years ago to have my card scanned for a computer system instead of photocopied for a paper chart. Today I am annoyed because the doctor’s office was unable to think outside the box  and accept my electronic copy.

Other

A HIMSS Analytics survey finds that network/architecture support and security are the jobs that most often require industry certification.

Indiana University School of Medicine and Regenstrief Institute endow a chair to honor informatics pioneer and LOINC inventor Clem McDonald, MD (left in the photo above). The first Clem McDonald Professor of Biomedical Informatics is Titus Schleyer, DMD, PhD, MBA, director of the Regenstrief Institute (right in the photo above).

HHS fines insurer WellPoint $1.7 million for exposing the medical information of 600,000 people in 2009-2010 due to Internet server security issues.

Texas Health Harris Methodist Hospital Fort Worth notifies several hundred thousand former patients that their medical information from the 1980s has been exposed when several microfiche pages are found in a park. The hospital says its disposal contractor, Shred-it, didn’t.

Friends of industry long-timer Milton Antonakos, who died along with his family in a plane crash in Alaska earlier this week, are welcome at a remembrance get-together at the Columbia, SC offices of Allscripts on Friday, July 12 (today) at 3 p.m. Inga will provide the RSVP information and location details if you e-mail her.

Citizens of a small town in Canada whose only doctor will be away on his honeymoon for six weeks are offered telemedicine services in the interim by the province to mixed reaction. According to one resident, “I did the doctor camera thing. Basically I diagnosed myself and he gave me a prescription. It was pretty impersonal.”

PCWorld, the only remaining print edition consumer computer magazine, publishes its last paper issue to focus on its online and digital editions.

Healthcare isn’t behind in technology, we’re just on the leading edge of security. The Kremlin, panicked by the release of electronic secrets by WikiLeaks and Edward Snowden, issues an RFP for electric typewriters of the specific German model above. Retro-secure fax machines and pagers can’t be far behind.

Sponsor Updates

• Covisint expands its partnership program to enable organizations to resell, refer, or white-label Covisint Identity Services.
• Beacon Partners will provide consulting expertise to help organizations using Information Builders’ BI and analytics solution.
• Marshfield Clinic Information Services subscribes to the Capsite Database to assist with health technology procurement and purchasing.
• CIC Advisory launches a blog entitled, “Think.Learn.Care.” or TLC, which profiles hospital leaders who are effectively using technology to improve the efficiency and effectiveness of patient care.
• Emmi Solutions selects Truven Health Analytics as its preferred partner provider of patient discharge instructions.
• Quest Diagnostics provides access to de-identified hepatitis C test results from its Health Trends national clinical laboratory database to the CDC for public health analysis.
• T-System publishes an infographic depicting the MU history of its EV product.
• University of Florida Health and Florida Hospital securely exchange PHI with the Florida HIE Patient Look-Up Service developed by Harris Corporation.
• O’Reilly Strata RX Conference posts the schedule for its September 25-27 conference.
• Surgical Information Systems discusses the role of IT in quality reporting. 
• Billian’s HealthDATA Jennifer Dennard takes on Google and inaccurate hospital data. 
• TeleTracking Technologies looks at patient care satisfaction and its impact on an organization. 
• SpeechCheck’s Ken Schafer discusses the importance of accurately recording narrative data within the EHR.
• Advanced Medical Imaging (CO) discusses how it increased point-of-care patient collections by 315 percent within a year of implementing ZirMed’s Patient Estimation solution.
• Verisk Health announces details of its annual conference September 18-20 in Orlando.
• Optum’s CMO Miles Snowden, MD discusses how to navigate the journey from providing care to managing health.
• HMC HealthWorks will integrate the Healthwise Care Management solution into ProGuide, the HMC care management platform.

EPtalk by Dr. Jayne

Alberta Children’s Hospital has deployed a robot named MEDi to aid children receiving flu shots. Those who engaged with the robot reported less pain and distress than those who didn’t. The study involved 57 children with moderate to severe fear of needles. In addition to distracting patients, the robot also provides instructions for relaxation and deep breathing.

Nearly a third of “Pioneer” ACOs may opt out, with some joining the Medicare Shared Shavings Program instead. Some have been threatening to do so since a dispute over measures in March. Although CMS did make some changes, it may not have been enough. Pioneer ACOs have until next Monday to notify CMS of their plans to leave that model and until July 31 to apply for the Shared Savings Program.

Health Affairs looks at the reasons poor patients prefer hospitals over office-based care. Researchers from the University of Pennsylvania documented patterns where patients using less preventive care were more likely to become acutely ill and/or require hospital care, costing over $30 billion each year. Reasons cited by patients included hospitals being less costly and more convenient with better quality care. That’s a sad commentary on our clinic and safety net ambulatory systems.

Congratulations to HIStalk contributor Ed Marx, who reached the summit of Mt. Elbrus in Russia earlier this week.

Thanks to everyone who sent good wishes for my laboratory orders go-live this week. It went fairly well and the phone lines were pretty quiet. We rarely receive compliments, but sometimes not hearing complaints is enough to know we did the job right. It’s been a tiring week, nevertheless, so I’m keeping tonight’s piece short and going to bed early.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 7/11/13

The University of Texas at Austin and Jericho Systems Launch National Pilot to Advance Patient Control Over Shared Medical Records 

An ONC-approved pilot program at the University of Texas at Austin will explore advanced patient control over shared medical records via a simulated exchange using eHealth Exchange specifications. The pilot’s goal is to add transparency to the PHI exchange process by allowing patients to review requests to view their PHI.

North Shore-LIJ Extends Allscripts Outsourcing Agreement Through 2020

Sixteen-hospital network North Shore-LIJ extends its managed IT contract with Allscripts through 2020, a deal that will result in $400 million in revenue for Allscripts over the life of the contract.

Mount Sinai honored for electronic records system

Mount Sinai Hospital was named a HIMSS Stage 6 hospital last week, just three months after its $120 million Epic go-live.

Readers Write: All Vendors Exit Stage Left

All Vendors Exit Stage Left
By Frank Poggio

Stage 1 product certifications end this year — September 30 for Inpatient products and December 31 for Ambulatory. In many of my conversations with systems suppliers who are considering the next step in ONC Certification, they refer to it as “Stage 2 Certification.” I can’t blame them. I’ve done it myself.

Remember, it all started with Stage 1 two years ago, so naturally you would expect Stage 2 to follow Stage 1. But with the feds and ONC, it could never be that simple.

When ONC issued the final Stage 2 rules last year, they made a very purposeful and distinct break between Stage 2 Meaningful Use and the vendor test criteria. Instead of referring to “Stage 2 Test Criteria,” they labeled them the 2014 Edition Test Criteria. Providers are subject to Meaningful Use Stage 2 rules, while vendors seeking certification come under the 2014 Edition of Test Criteria. There are real differences  — some pretty big ones.

What I usually see is a software firm starts by carefully reviewing the provider MU Stage 2 attestation criteria since they are all over the Web. Next, they try to translate the MU list to product test criteria. Then confusion follows.

Although the MU attestation criteria for Stage 2 resembles the Certification test criteria, there are differences. For example, one big difference is a provider needs to attest to about 25 MU criteria and some Quality Measures to get the Stage 2 money. But you as a vendor need to pass on about 40 certification test criteria and nine QMS elements to become 2014 Edition Certified.

Another example: under Stage 2, a provider would attest to completing a HIPAA compliance risk analysis. That’s just one question (the answer is ‘yes’, subject to audit, of course). But for a vendor completing a certification test under the 2014 Edition, you address eight very specific tests for privacy and security.

ONC now refers to your Stage 1 certification as the “2011 Edition Test Criteria.” No more Stage 1.

A related question ties back to what I said at the top of this piece. Your current Stage 1 certification ends this year. Actually, ONC says your 2011 Edition certification ends and you must test out on the new 2014 Edition to continue to sell certified software.

As of this week, only four vendors have been successful in achieving 2014 Edition Full EHR Inpatient Certifications. Under Stage 1, there were dozens. The 2014 testing is turning out to be a real challenge for many vendors, far more difficult than I think ONC expected.
Some think ONC will extend the Stage 1 vendor certifications if they do not get enough vendors through 2104 Tests by September. That would seem a likely solution. But given Dr. M’s pointed comments about vendors “gaming the system,” I doubt it.

The reason they made the breaks between certification test criteria and MU attestation criteria is that when they decided to extend Stage 1 of provider attestation into 2014 (originally it was to die in 2013) they did not want to extent the vendor certifications as well. Why? I guess they just wanted to keep your feet to the fire.

Which raises the next question. How can a provider attest to Stage 1 in 2014 when all the vendor certifications for Stage 1 die in three or six months? Simple. ONC now allows the provider to MU attest under Stage1 using a 2014 Certified system. If you have clients or prospects that have not attested to Stage 1 and plan to do so in 2014, they must be running your 2014 Edition certified software for at least 90 days in 2014.

It seems that ONC has taken vendors off the Stage, and reduced them to simply an old Edition.

Frank Poggio is president of The Kelzon Group.

Readers Write: Asking the Right Questions: How to Find the Right Technology Development Partner

Asking the Right Questions: How to Find the Right Technology Development Partner
By Lee Farabaugh

We’ve all heard the stories. A hospital implements technology only to discover that it is so complex and confusing that it takes clinicians twice as long to get their work done as it did before, frustrating providers and patients. The hospital tries to work through the issues to no avail, and the organization ultimately abandons the software in pursuit of something else.

Money, time, and resources are wasted, and the organization is still no closer to effectively leveraging technology to improve patient care or streamline efficiencies. On the other hand, there are technology implementations that go smoothly, with providers fully embracing an application and using it appropriately.

What differentiates the good from the bad? User experience design, centered on end user input. Positive outcomes (increased user adoption, for example) occur when end users are actively involved in technology design, development and implementation.

To determine whether your technology partner incorporates user experience into its approach, there are some key questions you should ask. Getting answers to these questions can help you avoid disastrous technology roll-outs and ensure potential applications are a good fit for your organization.

Does your technology partner take a provider-centric approach by involving clinicians as key members of the development team?

These clinicians should be providers who have been actively involved in practicing medicine, so they are aware of the issues clinicians face in their day-to-day work. Getting direct input from providers who will use the system ensures that any potential roadblocks are addressed and resolved. Even if the technology you are considering is more patient-focused, clinicians should still be part of the development team. When people with medical expertise are involved in designing a patient-focused product, they can share the clinical perspective on what is possible and preferable for the technology.

How much of your technology partner’s research and development budget is devoted to garnering information about user experience?

This question can reveal the value your technology partner places on end user input. In other words, are they putting their money where their mouth is and dedicating resources to obtaining and leveraging user feedback?

Have you ever had a usability assessment on your application portfolio?

This puts hard data around your technology partner’s usability claims. By reviewing a usability assessment, you can clearly see whether providers or patients are actually using the software your partner developed on a long-term basis.

Does your technology partner have an end user group to provide ongoing feedback?

This type of forum can be a valuable source for transparent feedback about a solution. Not every software developer has the resources to sustain a user group for each of its clients, but those companies that do communicate their commitment to their customers and end user satisfaction. If your technology partner does have a user group, you may want to ask if you can attend a meeting. Although this may not be possible—some companies prefer to limit the number of attendees at a meeting—it would allow you to gain helpful information directly from other users.

Does your technology partner provide you with easy and intuitive training and support?

While some applications may be “plug and play,” most will require a certain level of training. Getting a sense of how user-friendly the training is can help provide insight around your technology partner’s commitment to user experience design across all of its materials. User-centered training may involve short videos, web-based modules or super-user mentoring. Ideally, you want to avoid day-long didactic training sessions that provide limited value and take providers away from patient care.

User experience design is the linchpin for technology adoption. Technology companies that don’t place value on user experience in the design and development process could offer products that aren’t fully usable and don’t meet the needs of your organization. As such, asking deliberate questions about your partner’s view on the value of user experience is time well spent.

Lee Farabaugh is the chief experience officer at PointClear Solutions.

Readers Write: What to Consider Before Accepting Your Next Healthcare IT Position

What to Consider Before Accepting Your Next Healthcare IT Position
By Frank Myeroff

In a competitive and growing job market like healthcare IT, it might be tempting to accept the next attractive job offer you receive. But before you do, take time to consider certain predictors that could determine whether you will be successful on the job or regretful that you took the job.

Is the organization in line with my values, attitudes, and goals?

You may have heard that people are hired for skill but fired for fit. It’s true. That’s why it’s so important to make sure you mesh with the culture of a healthcare organization. Their culture includes a combination of values, visions, attitudes, beliefs, and habits. These collective behaviors are taught to new organization members and affect the way people interact with each other and the way business is done.

What are the workload expectations?

Ask the hiring manager to address the workload expectations. There’s no doubt if you take the job that your boss will expect you to complete all your tasks on time and accurately. New hires usually want to meet and exceed organizational expectations by going over and above the job. But consider and evaluate if you have the staff support and resources you need to be successful.

Can I handle the commute to this job?

Always consider the commute to your job. Is it too far? How much will it cost? Gas? Parking? Will you need to be a “super commuter,” in other words, fly back and forth? The number of super commuters has increased sharply over the past few years. Be sure to determine your tolerance level and that of your family regarding the job commute.

What is the boss like?

Your career depends on understanding what makes the boss tick. Having a positive relationship with the boss is key to your success, but having a bad boss is the ultimate morale buster. Find out if the boss is a micro-manager or hands-off boss. Know if he or she has realistic or unrealistic expectations for employees. Find out if they foster innovation or discourage it. It’s important to work for a boss who values your efforts and makes it worthwhile to come to work every day.

What are the people like?

There may be a good reason why the job is open. Are the people the kind you want to work with, or are they the type to push buttons? For a workplace to be really great, it’s essential that you have a good relationship with your co-workers since you will see them so often, work with them on projects, or interact with them on a daily basis. For an office to be truly productive, there has to be some sort of harmony and cohesiveness.

What is the career progression?

This is an exciting time in healthcare IT. The demand for talented IT professionals continues to grow and the opportunities for advancement have never been better. The healthcare organization you join should be committed to meeting your current career aspirations as well as foster your future career path.

What is the training offered?

There is a clear, strategic value in continuously training and developing staff. Not only does it enable the healthcare organization to meet its mission, but allows their professional IT staff to stay current and ready for upcoming changes and trends. When considering your next IT position, make sure the organization places a strong emphasis on training and development for all IT levels. Training should focuses on individual needs such as job-related and specialized training and collective needs such as leadership and time management.

Before you jump to accept that job offer, remember that an offer is only half of the equation. The other part is performing your due diligence. Make sure the healthcare IT position and organization match your “must haves” both professionally and personally.

Frank Myeroff is managing partner and VP of business development and operations of Direct Consulting Associates of Solon, OH.

CIO Unplugged 7/10/13

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

Leadership and Reconciliation

I get knocked on my ass every now and again. Okay … often.

The big fall took place a few years ago. Grace and Mercy picked me up, as they continue to do. They changed my life direction, and I still haven’t gotten over it. Made me a thankful person. Taught me to be a builder of others. I try to be more humble, and still fall short (just ask my wife).

I’m very much a work in progress, but I stay on the path, chin up. When I think too long about my journey, I get weepy. Success has come more by grace and mercy than skill or talent. Unmerited in many respects.

All the above experiences set the stage for me to pursue reconciliation as a leadership practice.

I started this with my family years ago. I knew I had hurt those dearest to me, so I went and reconciled. Today, there is nothing left hidden or unsaid, at least on my end. Memories then came to my mind of all the people I had treated poorly from high school, college, and career. I sought them out, told them I was sorry, and asked what I could do to make things right. Most were receptive. Many relationships were restored. Not all. I did what I knew to do and moved on.

The workplace. Where I have sown hatred, envy, bitterness, malice, brokenness, I have been driven to reverse course and make amends. In some cases, extending grace and mercy as I have received it. In most cases, asking for forgiveness and seeking ways to reverse damages inflicted. Not long ago, I failed here big time, and it haunts me now. I’m compelled to share this with you so you can avoid a similar fate.

Damn. My 2005 mentor, Dr. Achilles Demetriou, died this June. I am who I am partially because of his profound influence in my development as an executive. We had an incredible relationship that was disrupted by my departure from University Hospitals in 2007. We were at a critical juncture in our deployment of an EHR, and I knew my decision to leave upset Achilles in particular. He and I were partnered to ensure success. My timing was imperfect; we both knew it. While I received support and encouragement from others when I moved on, Achilles was physically and emotionally absent.

I needed to reconcile. I never did. Now it’s too late. I’m saddened on multiple levels. Foremost, we lost a great man, leader, scientist, and clinician. But the pain cuts deeper for me. I lost the opportunity to talk through stuff, make peace, and continue the relationship that shaped me.

May it never happen again!

What about you? As you read this, do people come to mind? Family? Friends? Co-workers? What relationships are calling for reconciliation?

Making peace with people doesn’t just happen. It takes a pro-active effort. Reconciliation comes down to leadership. If you’re a leader, you make the first move. Don’t wait for the other person because it likely won’t happen. Get out of the emotional prison and implore the other person to break out with you.

I challenge you, my colleagues, as names come to mind, write them down. In the next 24 hours, reach out to each person. Not every attempt will turn out rosy, but you will have done the right thing. In many cases, you will see restoration. Your call, card, or visit might hit the trigger point that causes transformation or breakthrough in someone’s life. Definitely in yours. Leadership at its best and its hardest. Humility.

Reconcile before death happens and you’ll avoid a haunting pain. Recompense your way to freedom.

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 7/10/13

Stinger Medical Merges with Enovate

Stringer Medical, which manufactures mobile workstations, has merged with its primary competitor Evnovate, resulting in the largest mobile workstation producer in the country.

Health Information Technology in the United States 2013

Since 2010, EHR adoption has tripled in the US, with 42 percent of hospitals and 38 percent of eligible providers successfully attesting to Stage 1 Meaningful Use .

CMS mulls payment policy changes on chronic care, telehealth

CMS is considering paying paying primary care physicians for chronic care management services without requiring an in-person patient visit, suggesting that telehealth services may finally become reimbursable.

OFT probe could ratchet up pressure on health IT providers

In England, the Office of Fair Trading is investigating health IT vendors that intentionally limit interoperability to gain strategic advantage.

News 7/10/13

Top News

Mobile clinical workstation manufacturer Stinger Medical merges with competitor Enovate, forming the country’s largest mobile workstation provider that will operate under the name Enovate Medical. Stinger’s CEO and CFO will continue those roles with the new company, as will Enovate’s COO.

Reader Comments

From HIT Veteran: “Re: death of Milton Antonakos. The industry has lost a sales superstar. Milton was always a top performer because you couldn’t outwork him. He was a bundle of energy, had great life balance, and was always encouraging others. Tragic and a reminder to live every day fully.” Milton Antonakos of CareAnywhere, previously with Allscripts/Misys for 23 years, was killed in the crash of an air taxi in Soldotna, AK on Monday along with his wife and three children. Also killed were Chris McManus, MD, a radiologist with Greenville Health System, his wife and two children, and the plane’s pilot. Condolences to family and friends.

From QSII Watcher: “Re: Quality Systems, parent of NextGen. Looks like another proxy battle ahead. The Clinton Group, an activist investor, has filed an alternative board slate that includes former President Scott Decker. He’s the second former exec to try to join the board – Pat Cline was added in the last (failed) proxy battle by the second-largest shareholder Ahmed Hussein. Doesn’t look like Hussein is officially part of this proxy battle, but the SEC filing alludes to conversations with him. You can bet he’ll vote his shares in their favor. Also on the board slate is Peter Neupert, formerly of Microsoft and now at David Brailer’s Health Evolution Partners.” The  proxy statement says the performance of Quality Systems lags its peers in earnings and total return, with share price flat since 2008 while the S&P 500 rose nearly 60 percent. It cites equity analysts in saying that management has no clear strategic plan, keeps chasing distractions, is losing sales, and has questionable potential in the small hospital segment. Above is the five-year share price of QSII (blue), the Nasdaq composite (red), Cerner (green), and Allscripts (brown).  

From Ricardo: “Re: pet health portal. Yesterday I received an e-mail from dog’s vet introducing me to their new Pet Health Portal, where I can log in to see my pet’s health record, request appointments, search their pet health library, view vaccination history, etc. I actually laughed out loud considering I’ve received no indication whatsoever of a patient portal offering from my primary care physician. Thought you might appreciate that.” I do indeed appreciate that information, having been equally impressed by similar systems, often rolled out by veterinary chains like Banfield. Vets also offer Pet Mail to answer questions. Next time someone says they’ve been treated like a dog, congratulate them.

From Keith: “Re: JAMA opinion piece from Dartmouth, of all places. The educational and cognitive purpose of the evolved medical chart has been devalued by EHR.” The editorial by Robert S. Foote, MD of Dartmouth-Hitchcock’s nuclear stress laboratory says, “Discussions of EMRs have tended to be dominated by descriptions of their potential benefits, while less attention has been paid to their potential hazards, among which are breaches of privacy, incompatibility of different systems, introduction of computer-based errors, and loss of productivity owing to cumbersome procedures that EMRs sometimes require. I think it behooves us as well to consider the impact of these systems on a very basic element of clinical practice, namely, how clinicians think.” Among his comments:

• Epic has “68 tabs, many of which lead to numerous subtabs and links” and lists every field generically (like “code report”) even when they don’t apply to the particular patient
• Notes written by all providers, including non-physicians, are jumbled together and often copied and pasted, interrupting the thought process.
• The system tries to force standardization through the use of checkboxes, but often omits important information as a result, saying that he has never seen a checkbox saying, “my daughter died of the chemotherapy you are proposing for me.”
• The medical record is not data or a repository to hold data, but rather information that has been transformed by caregiver knowledge.
• The medical record is a battleground over the future of healthcare, because “as it becomes more difficult to write like a clinician, sooner or later it will become more difficult to think like one.”

From ColonelPeter: “Re: QlikView. Our organization just chose to purchase a BI technology called QlikView after seeing a demonstration of its integration with Epic at HIMSS. The pre-sales guy was a former Epic veteran who said that they were still working through logistics of a partnership with Epic.  Seems if Epic wants to dispel the belief that they’re difficult to work with, they should be trying to fast track a partnership with these guys. We’ve only had the software two weeks and already have gotten a ton of value from just playing with it.” I’ve mentioned QlikView several times and have played around with their free download. You can try their surgery scorecard live demo.

HIStalk Announcements and Requests

The upcoming HIStalk Webinar, “Five Steps to an Enterprising Imaging Strategy,” sponsored by Merge Healthcare, has been rescheduled for Wednesday, July 24 at 3:00 – 3:45 p.m. Eastern.

Acquisitions, Funding, Business, and Stock

Predixion Software raises $20 million in a Series C financing round led by Accenture and GE Ventures.

Coppersmith Capital Management, LLC, which owns 7 percent of the shares of Alere, launches a proxy fight in nominating its own slate of three directors for consideration at the August 7 Alere shareholder meeting. Its letter to shareholders urges the company to sell its Health Management division, which connects diagnostic devices to health management services.

The Italian subsidiary of Germany’s CompuGroup Medical will acquire a majority stake in Studiofarma Srl, which sells pharmacy software in Italy and has 7,000 customers.

Sales

WellStar Health System (GA) selects Besler Consulting to assist with the identification and recovery of Medicare Transfer DRG underpayments.

CareBridge Palliative Care Services(OH) will implement Authentidata Holding Corp.’s Electronic House Call and Interactive Voice Response telehealth solutions for remote patient care.

Alameda Health System (CA) engages MedAssets for A/R services.

The Children’s Care Alliance (PA) will create a health information exchange for underserved children based on HIE technology from Alere Accountable Care Solutions.

North Shore-LIJ Health System extends its managed services agreement with Allscripts through 2020.

People

Truven Health Analytics names Roy Martin (WELM Ventures) COO of its hospital, clinician, employer/health plan, and life sciences customer channels.

Arcadia Solutions appoints Chuck Garrity (Beacon Partners) RVP.

Dartmouth-Hitchcock (NH) names Terry Carroll chief innovation officer. He was previously SVP of transformation and chief information officer at Fairview Health services (MN) and has held CIO roles at Detroit Medical Center (MI) and Baystate Health Systems (MA). 

Christopher Olivia, who was paid $6 million in his last year as president and CEO of money-losing West Penn Allegheny Health System (PA) before Highmark bought it in 2011, is named president of Continuum Health Alliance, a physician management company whose offerings include IT services.

Announcements and Implementations

Doctors May-Grant Associates (PA) and Lancaster General Health’s Women’s & Babies Hospital (PA) successfully exchange CCDs between the practice’s Greenway Medical platform and the hospital’s Epic system.

Greenway Medical will add PatientPay’s online patient payment solution to its PrimeSUITE EHR/PM platform.

Resolute Anesthesia and Pain Solutions begins a nationwide expansion of Shareable Ink’s Anesthesia Cloud for iPad following an initial deployment at the Boca Raton Outpatient Surgery and Laser Center (FL).

Miami Children’s Hospital implements the AnyPresence solution to enhance development of mobile patient engagement apps.

Northern Ireland launches its national patient record system based on Orion Health’s portal and integration technology.

The Brooklyn Hospital Center implements the MedAptus Professional Charge Capture solution for the coding of inpatient and outpatient encounters.

HIMSS will announce its HIMSS Health IT Value Suite in a July 16 event streamed live from Washington, DC. It sounds like a pitch for the ROI of products and services offered by its vendor members.

Government and Politics

CNSI, whose $200 million Medicaid claims system contract with the State of Louisiana was cancelled over alleged bidding irregularities, claims the state will lose $100 million by keeping its old system instead. A state DHH spokersperson responded, “CNSI really is not in any position to be commenting on costs that may be incurred by the state, especially in light of its own actions.” DHH Secretary Bruce Greenstein, a former CNSI executive, resigned after the probe was announced.

In England, the Office of Fair Trading launches an investigation to determine if hospitals become overly dependent on healthcare IV vendors when outsourcing and whether certain vendors try to stifle competition by limiting their interoperability with competitors. Experts suggest that Cerner, McKesson, and Epic will earn lower margins if they don’t open up their systems to third-party products given NHS England’s interest in best-of-breed systems.

Other

Gartner ranks Dell as the leading provider of healthcare IT services globally based on 2012 revenues.

The annual healthcare IT report from Robert Wood Johnson Foundation finds that 44 percent of hospitals had a basic EHR in 2012, up 17 percentage points from 2011, with the number tripling going back to 2010 when HITECH started paying. Only 42 percent of hospitals met Meaningful Use Stage 1, however, with that number expected to drop for Stage 2, and only 27 percent participated in an HIE. The report also concluded that practices weren’t far behind hospitals in adoption percentages, but small practices continue to lag.

Fitch Ratings upgrades the bonds of Beebe Medical Center (DE) to “stable” despite weaker 2012 operating results partly caused by its write-down of the “not sufficiently robust” McKesson system that was replaced by Cerner at a cost of $37 million.

Vermont’s largest employer is now Fletcher Allen Health Care, with 7,100 employees.

Weird News Andy says the nurses were right again. The Syracuse newspaper uncovers an HHS report describing a series of errors that almost resulted in St. Joseph’s Hospital Health Center harvesting organs from a patient who was not brain dead. The doctor ignored nurses who argued that the overdose patient was responding to touch and breathing on her own. The patient survived her hospitalization, but committed suicide two years later.

Sponsor Updates

• Covisint offers a Direct Toolkit that explains how Direct messaging relates to HIEs and why providers should adopt it.
• Aspen Advisors announces the addition of 19 healthcare clients and 18 employees during the first six months of 2013.
• Perceptive Software releases Document Filters 11, which allows software companies and services providers to embed their solutions with technology to unlock unstructured files and extract data.
• Vitera hosts a July 24 Webinar highlighting steps to prepare for ICD-10 success.
• The Healthcare Network Accreditation Program awards Capario full EHNAC accreditation.
• Staffing Industry Analysts names Intellect Resources the fastest growing staffing firm in the US for 2013 based on its 125.5 percent growth rate.
• Twelve CareTech Solutions customers win honors for their hospital websites.
• Imprivata introduces a suite of proximity and fingerprint readers integrated with Imprivata OneSign to provide an end-to-end identity and access management solution.
• The SSI Group aligns with ABT Medical to provide release of information services to SSI’s RAC solution.
• Orion Health moves forward with expansion plans for its Christchurch, NZ development center.
• Bottomline Technologies will honor Joshua Krantz, an employee who died from injuries received in an assault, at a July 15 memorial service when an award in his name will be announced. 
• The FDA lists iMDsoft’s myAnesthesia app as a Class 1 medical device.
• TrustHCS launches the TrustHCS Academy to train and place coding professionals in advance of ICD-10.
• Impact Advisors leads an online CHIME focus group July 16 discussing optimization services.
• Ingenious Med employees provide financial and onsite support to the Zambia Medical Mission, which provides medical assistance to underprivileged Zambians.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 7/9/13

Study: Remote Patient Monitoring Adoption Poised For Robust Growth, Says Spyglass Consulting Group

A new study compiling the opinions of more than 100 healthcare leaders working in organizations that provide telehealth services finds that remote patient monitoring solutions are positioned for strong short-term growth, driven by ACOs beginning to formulate population health strategies and hospitals looking to proactively control 30-day readmission rates.

A shorter wait in the ER is just a click away at hospitals with startup’s virtual waiting service

Health IT startup InQuicker is making inroads working to reduce ED wait times. The company has developed an online waiting service similar in functionality to OpenTable. The software, which is accessed from the hospital’s website, allows patients with non-life-threatening conditions to check in from home and wait there during the time they would normally spend in the waiting room.

Brookings finds healthcare jobs soaring over other industries

The Brookings Institution releases a report on job growth that places healthcare ahead of all other sectors, realizing a 22.7 percent employment growth rate over 10 years compared to an average 2.1 percent from all other industries. Across the 100 largest metropolitan areas in the US, healthcare accounted for more than one in every 10 jobs.

JRMC Formally Announces Agreement with Sanford Health

Jamestown Regional Medical Center (ND) has partnered with 35-hospital network Sanford Health in order to have Sanford’s Epic EHR installed at JRMC. In addition to the EHR agreement, Stanford will help expand oncology services offered at Jamestown. The 25-bed hospital will otherwise continue to operate as an independent critical access hospital.

Advisory Panel: Industry Publications Read Regularly

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

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

This question this time, suggested by an HIStalk reader: What healthcare IT industry publications do you read regularly? (please indicate whether you read online or by printed copy)

Prefer online. HIStalk, Radiology Today, Advance, Healthcare Informatics.

Healthcare Informatics, JAMIA, Gartner.

Healthcare IT News, ONC blog and website, HealthLeaders  Media, User conferences and Government Health IT, FierceHealthIT as well as HIMSS online groups. Your blog remains my favorite.

Aside from HIStalk, I don’t read too much directly online.  I get e-mail updates from ACHE, HIMSS, Modern Healthcare, CHIME, and Healthcare IT News that I skim through and might follow a story if it is a hot topic for me. I skim through magazines and journals from Modern Healthcare, ACHE, Clinical Innovation+Technology, and Health Data Management. 

HIStalk, of course! Online. Healthcare IT News,  online and get printed copy too. HIMSS  Newsletters online.

I read most major publications for our industry, including Hospitals & Health Networks, Healthcare Informatics, Health Data Management, Applied Clinical Informatics, CIO Magazine, Executive Insights, Healthcare Executive, Health Management Technology, InformationWeek, Journal of Healthcare Management (ACHE), AND Journal of AHIMA.

HIStalk, Modern Healthcare, HIMSS, Healthcare IT News, iHealthBeat. And about a million blogs. Everything is read online.

Your esteemed blog. Then HealthsystemCIO online, Healthcare informatics online, healthcareIT online, mobihealth news online.

HIStalk and a variety of other electronic publications.

Healthcare Informatics, CIO and Information Week (some HC coverage), Modern Healthcare, Advance for something or other in healthcare, and HIStalk, of course!

HIStalk is my primary (daily) read. I used to read several others but I can’t seem to find time to stay up with the amount of information available.  I generally peruse Health Affairs as well as Healthcare Executive.

HIStalk of course! Also Healthcare Informatics, Healthcare IT News, Beckers Hospital Review, Healthcare Advisory Board, and HealthsystemCIO.  I read online versions. In addition I get a pdf from Michael Lake on latest technology which I find very helpful.

All online: HIStalk suite of course, Computerworld, Informationweek,Wall Street Journal,CSO. Printed: Healthcare Informatics, Health Data Mgt, CIO, CMIO,Clinical Innovation + Technology. It seems like the analogy of drinking from a fire hose would apply here with all the publications that are available on-line and in print. I would really like to hear others’ perspective as to what pubs they monitor and target in order to stay current.

Other than HIStalk :)  FierceHealthIT (online), Healthcare Info Security ENews (online, with daily emails), 3M Health Information Systems (online), iHealthBeat (online), PHIPrivacy.net (online), and the HIPPABlog (online).

Health Affairs (online and print), Modern Healthcare (online and print), Government Health IT (online), Health Data Management (online and print), Healthcare Informatics (online and print), Healthcare IT News (online and print), Health Leaders Media (online and print), American Medical News   (online), For the Record (online), Information Week (online and print).

HIStalk of course, healthcare it news, Becker’s newsletters, HDM newsletters, Health Informatics technology.

HIStalk, Modern Healthcare’s Health IT Strategist, & Smartbrief all online. I receive a dozen or more paper publications that are placed in the department bathroom that I may flip through if the cover looks interesting.

Online – healthcareit news and blogs.

Modern Healthcare, Advance, Health Leaders, HFMA Journal, Health Data Management (all in print) Healthcare IT News (digital) and, of course, HIStalk.

JAMIA (online and printed), but that’s about all I have time for these days unfortunately.

I always read HIStalk online, healthsystemcio.com, and HDM printed edition. Sometimes other HIT publications from CHIME and others. The CHIME online newsletter has an app that makes it hard to read on my iPhone.

Fewer and fewer it seems.  I would say I routinely scan healthcare informatics, hospitals and health networks, and health data management.

HIStalk, of course.  I skim through the paper copy of Clinical Innovation + Technology (formerly CMIO Magazine).  I receive the email updates from iHealthBeat.

Health Affairs, Modern Healthcare, JAMIA, For the Record.  All print.

HIStalk (love it because we know you keep everyone honest); Healthcare IT News.

Healthcare Purchasing News and many security related pubs, both online and print. At work I prefer online pubs, but when reading at home, I prefer print.

JAMIA (print), JIMIA, (print) ,  the rest on line:  your stuff, i-health, fierce, AHRQ announcements, ONC advt for HIT.

HIStalk (online), Health Data Management, Healthcare Informatics, Scott Mace in HealthLeaders (Scott Mace has been writing in the IT industry forever. He wrote for InfoWorld circa 1980; I think the world of his reporting.) I also read Journal of AMIA, Applied Clinical Informatics (online only) and everything John Moore of Chilmark writes (online). Unless noted as "online" I get these on paper and mostly read them that way.

Curbside Consult with Dr. Jayne 7/8/13

I’ve been working on a major project for the last couple of months and tomorrow is the go live. Tuesday is the traditional day for new releases at my organization. Although the IT staff likes to do things over the weekend, we know that Monday mornings are the busiest day in most outpatient practices and asking users to accept (let alone successfully adopt) changes on a Monday is just a bad idea.

The project involves a unified laboratory ordering scheme across multiple reference laboratories and hospitals, some of which are competitors. As a regional player, our health system took charge of this project with the goal of allowing physicians to more easily order tests from different facilities based on insurance and patient preference. I’m sure the side benefit of being able to see the ordering behaviors of non-employed physicians so that the hospital-owned labs can lobby for greater market share might have played a role in our leadership as well.

It would have been challenging enough to obtain the historical order data from the hospital-owned labs and create the crosswalk to send the proper codes to the designated facilities. We knew from standardizing the lab orders within our own health system that you can’t always map apples to apples. They could be Golden Delicious, or Granny Smith, or Fuji. Sometimes they are eaten via biting, sometimes sliced with a paring knife, and sometimes with one of those fancy gizmos that never quite fits in your kitchen drawer. They may each be an apple, but in the lab world they are entirely different orders.

Throw in the fact that we had to obtain order data from competing facilities and things started to get interesting. One national reference lab was very cooperative . They have 85 percent market share for some of the physicians and are eager to keep it that way. They provided the data exactly as requested and included all kinds of additional data we didn’t ask for initially, such as reference ranges, order entry questions and their expected responses, and even the type of tube needed for blood draws. They also provided it within one week of the request, which was outstanding.

Another national reference lab was less cooperative. They have a decent market share, but tend to act like they are the only show in town, and their response to our data request was handled accordingly. They initially provided data that lacked vital fields and wasn’t even for the time period we requested. They would send different parameters for different physicians on different spreadsheets. We had to explain to them multiple times that we needed consistent data to keep our analysis functional across all the practices and facilities. It took nearly eight weeks to finally receive the data.

The rest of the facilities fell somewhere between those two on the spectrum. Thank goodness I had a health information management intern to help out. As the data started to come in, we began the analysis. What we found was interesting, namely that physician ordering patterns were all over the place. We knew that we would see a wide variety of ordering behaviors given different specialties and geographies. We didn’t expect to see as wide a distribution within a single specialty, however.

Once we started to see some of the outlier tests that were being ordered, we also asked for data looking at how often the labs were contacting ordering providers for clarifications or substitutions. The preliminary analysis led us to increase scope and add the complicating factor that’s making me the most worried about tomorrow’s go-live: we made it easier to order the right test and a bit more difficult to order the wrong one rather than just mapping everything that had been used in the past. Given the fact that many of the participating providers have at-risk contracts or are part of an Accountable Care Organization, most people were on board with efforts to drive ordering behavior. How users respond to it in a live environment may vary.

Even without that particular challenge, managing the data was going to be difficult. We compared the lab-provided data to order data extracted from some of the provider EHRs and found that quite a few providers had test libraries with incorrect or outdated order numbers. We had to compare the tests they were intending to order with the current order numbers and ensure that we didn’t have duplicates or mismatches.

We had to work closely with a diverse group of resources – physicians, office managers, nurses, laboratory technicians, pathologists, interface specialists, software developers, and more. It was interesting to see each group’s perspective. However, I was surprised at how little some groups knew about the end user experience and what providers need to order labs accurately and efficiently.

Right before testing began, I thought I was losing my mind with collating all the different facility and provider approvals. I’m extremely grateful to a colleague who presented me with a delightful addition to Excel that helped me do the final bit of data cleansing. I don’t know how I lived without it. I am thankful not only for a new tool in my belt, but for someone who cared enough to see a problem and offer to solve it.

I’m sure there will be some unhappy providers who can’t find the tests they’re used to ordering. We’ll have a fully staffed go-live war room with not only directions to find the correct test, but an explanation of why the “old” tests were retired. I’ll be manning the phones as well, not only for escalations, but to see how the process is working overall. Wish me luck!

E-mail Dr. Jayne.

Morning Headlines 7/8/13

Outsourced UPMC workers protest cuts

Transcriptionists at Pittsburgh’s UPMC protest the decision to outsource their jobs to Nuance. The workers were offered remote positions with Nuance, but at a significant pay cut.

ONC Patient Safety Webinar

ONC will hold a meeting on its recently announced patient safety plan this Wednesday, July 10, at 3:45pm EDT.

Low sign-up for Australian eHealth records

In Australia, the highly publicized national patient portal is criticized after the one-year anniversary of its launch passes with only two percent of the Australian population having created accounts.

Open Letter to Chuck Hagel: DoD still doesn’t know what the hell they are doing

VistA expert Tom Munnecke publishes an open letter to Chuck Hagel in which he explains why implementing VistA would be a logical choice for the DoD and why a commercial solution would be an expensive mistake. He uses England’s NPfIT failure as an example of what can go wrong when a national strategy is centered around integrating multiple systems and points to the NHS’s recent decision to evaluate the use of VistA as a single, integrated solution as validation of that approach.

Monday Morning Update 7/8/13

From Utopic: “Re: Notice of Privacy Practices. HIPAA 2013 regulations require that the NPP and breach notices be written in plain language. That didn’t happen in the original HIPAA notices and probably won’t happen in this version either. Communicating in plain language doesn’t seem to be an issue for any of your survey respondents. I have a three-page summary if anyone is interested.”

HIStalk Webinar July 17

The next HIStalk Webinar will be “Five Steps to an Enterprising Imaging Strategy” on Wednesday, July 17 from 1:00 to 1:45 p.m. Eastern, sponsored by Merge Healthcare and presented by Steve Tolle, senior VP of solutions management. The US performs 800 million studies annually and industry experts predict steady growth over the next three years. How do you plan to share this information across your organization and your referral network and to securely store it? Implementing an enterprise imaging strategy and archiving data in either the world’s largest VNA or the cloud is your ticket to true interoperability.

C-level HIStalk readers have provided presenter feedback and the session will be moderated by HIStalk. According to one of the CIO reviewers who reviewed the rehearsal session, “I have to be honest, I wasn’t sure if a presentation on enterprise imaging would grab me. The presenter did a great job in covering why an enterprise imaging solution is needed in today’s world and what it could do to alleviate issues in hospitals.” Register here.

The vast majority of respondents think McKesson’s customers should care that John Hammergren will get a pension of at least $159 million, although the comments are equally passionate for both sides. New poll to your right: now that implementation of the ACA employer mandate has been pushed back, should healthcare organizations proceed plans to buy software to meet ACA-driven needs?

Welcome to new HIStalk Platinum Sponsor CoverMyMeds. The Columbus, OH-based company has put the Prior Authorization process for prescriptions into modern decision support workflow. Over 100,000 providers use its service for free with health plans, PBMs, and drug companies footing the bill because CoverMyMeds makes them more efficient. Providers access the service through their EHR or from the company’s all-payer portal and get real-time determination. It’s not just about efficiency – when Prior Authorization takes too long, 30 percent of patients to just give up and abandon their prescriptions, causing all kinds of clinical and cost issues. The average doctor spends six hours per week filling out PA forms. If your company sells a pharmacy or EHR system, you can add the “Best Feature Ever” with APIs that can manage PAs either before they are submitted or after they are rejected. Thanks to CoverMyMeds for supporting HIStalk.

I found this YouTube video on how CoverMyMeds works.

Constantine Davides has updated his popular HCIT Consolidation Chart for HIStalk readers. It lists all of the healthcare IT acquisitions by company. Take a look if you (a) wonder why your vendor’s allegedly integrated products aren’t because they were simply bought and relabeled; or (b) you are creating a healthcare IT trivia contest and need hard questions like, “What was the name of the event notification software vendor that Philips acquired?” (answer: Emergin.)

NHS England publishes “Safer Hospitals, Safer Wards: Achieving an Integrated Digital Care Record” that describes its all-digital goal for 2018 and the $387 million in available grants for NHS Trusts. NHS says it will consider the use of the VA’s VistA, summarizing, “One of the significant products we have investigated is VistA and for reasons described in more detail below we are looking to adopt some of the ethos behind its creation and potentially part, or all, of the technical product, in combination with others to generate NHS VistA. NHS VistA as a concept will focus on bringing together the best of breed capability of Open Source solutions and will be driven by NHS organisations with the support of NHS England and others. The US Veterans Health Administration VistA system was created in the 1980s by clinicians and software engineers from the ground up. It has become renowned across the world as the first truly integrated, clinically owned system. It has been in operation long enough to be able to demonstrate real clinical outcome benefits.”

VistA expert Tom Munnecke’s “Open Letter to Chuck Hagel: DoD Still Doesn’t Know What the Hell They Are Doing” says “DoD is trying to get out of a hole by digging it deeper.” A snip:

Rather than lifting up the VA eligibility problem to a shiny new common information system, you are on the verge of dragging health IT into the same bureaucratic vortex that has already done so much damage in the past. AHLTA was declared “intolerable” in a Congressional hearing four years ago. Yet, not only is it still around (and absorbing $600m/yr operations and maintenance costs), but it is also serving as a template for the next generation of the IEHR – a top down, mega-centralized administrative system far removed from the clinical needs of health care professionals and patients. DoD continues to focus on the organization chart, not the patient, closely coupling their software designs to their bureaucratic stovepipes.  Indeed, it is rare for me to even find the word “patient” in any DoD health IT documents.

Christopher Assad, MD develops a prototype CPR app for Google Glass that walks laypeople through the process of performing CPR effectively following the beat of “Staying Alive,” which coincidentally sets a pace of 100 compressions per minute.  

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

Outsourced UPMC transcriptionists hold a rally outside the health system’s headquarters in the US Steel building in Pittsburgh to protest the transfer of their jobs to Nuance. Their union wants them to receive severance pay, health insurance through Nuance, uncontested unemployment claims, and an apology from UPMC CEO Jeffrey Romoff. All were offered jobs by Nuance, but at $8 per hour instead of their previous $12-15.

ONC will hold a Webinar on its just-released patient safety plan on Wednesday, July 10 from 3:45 to 5:30 p.m. Eastern.

Vince covers the death the death last week of computer mouse designed Douglas Engelbart.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 7/5/13

May 2013: EHR Incentive Program

May marks the slowest growth in eligible professional attestation since June 2011, netting just 892 new EPs and moving total attestation rates from 55.3 percent to 55.4 percent.

Safer Hospitals, Safer Wards: Achieving an Integrated Digital Care Record

In England, the NHS issues a report which confirms that it is evaluating the implementation of VistA to meet its health IT goals in an open source environment.

Lawmakers release comments on call for ‘reboot’ of Meaningful Use program

Six Republican senators have released the public comments they solicited in April regarding a request to HHS to publish a written plan for how it is implementing the HITECH Act.

Indiana FSSA notifying clients of potential information breach

A computer glitch that caused medical records to be erroneously printed and mailed to the wrong patients is being blamed for a massive personal data breach in Indiana that has impacted as many as 187,000 patients.

News 7/5/13

Top News

A Dow Jones article says Intuit not only found its healthcare portal business to be a poor fit in its financial product lineup, the company had to write down $46 million in May after Allscripts bought Jardogs, which offered a patient engagement platform that will likely eliminate the dependence by Allscripts on the Intuit Health patient portal. The customer comments I heard at ACE 2010 (the Allscripts user group meeting) weren’t complimentary about Intuit’s portal, which it had just bought with its acquisition of Medfusion. It will be interesting to see if Allscripts will make a play for Intuit Health since it has already acquired Jardogs as an alternative.

Those with memory deficits might want to study yet another example of how outsider companies throw down big money to buy their way into the healthcare market because it looks easy, then slink off licking their wounds shortly afterward as they dump customers off to any bidder willing to take over the smoking wreckage of what used to be a decent company and product. That might be a fun exercise: leave a comment about which big company screwed up the most in its unsuccessful foray into healthcare. I always vote for Misys, which I’ve always suspected was created solely to amuse the industry with an exaggerated parody of incompetence.

Reader Comments

From RustBeltFan: “Re: HIPAA Omnibus Rule Advisory Panel responses. Scary answers! Maybe you’d be doing all of us a favor by developing a HIPAA Omnibus Rule 101 series for HIStalk!” Most of the CIO/CMIO respondents said their organizations were generally oblivious to the new rule, which kicks in September 23, 2013. If you are an expert on the topic, consider presenting an HIStalk Webinar to enlighten readers. This would be purely educational, with no commercial bias or sponsorship, and I’ll provide the platform and promotion to let you reach an appreciative audience (and it’s not bad for resume expansion and industry exposure besides.) Contact me if you’d like to present on this or any other educational topic.

HIStalk Announcements and Requests

Happy Independence Day. I’m not a fan of calling it the “Fourth of July” since that’s devoid of creativity and as dull as calling Christmas the “Twenty-Fifth of December” or New Year’s Day the “First of January.” About the only good thing about calling it the Fourth of July is that politicians weren’t tempted to make it a Monday holiday and thus destroy its historical significance simply to give Federal workers (and eventually the rest of us) a long weekend. At any rate, my flag is flying outside and I hope yours is, too. I worked a regular day today at the hospital and now I’m writing HIStalk, so I’ll celebrate by watching a few minutes of “A Capital Fourth,” which I’ve actually seen in person on the National Mall once. It was fun but dangerously hot, and while I’m glad I did it once, I have no plans to do it again other than on TV.

Other than HIStalkapalooza, what HIStalk activities, if any, would you like to see at the HIMSS conference in February? Let me know. I’m planning it now before I get swamped again starting in October.

On the Jobs Board: Senior Healthcare Policy Analyst, Epic Project Director, Android Developer – Healthcare + Google Glass, Staff Software Engineer .NET.

People

   

Scott MacLean, deputy CIO and director of operations at Partners HealthCare, starts his one-year term as chair of the HIMSS board. Carol Steltenkamp, MD (CMIO, University of Kentucky Healthcare), is named vice chair; Paul Kleeberg, MD (CMIO, Stratis Health) becomes chair elect; and Pete Shelkin (Shelkin Consulting) is named vice-chair elect.

New HIMSS board members starting their three-year terms this month are Beverly Bell, RN (VP, Health Care Dataworks); Beth Halley, RN (principal advisor, MITRE Corporation); Rick Schooler (VP/CIO, Orlando Health); and Michael Zaroukian, MD, PhD (VP/CMIO, Sparrow Health System).

Government and Politics

The Wall Street Journal apologizes for not having been critical enough of the Affordable Care Act, which it calls “a fiasco for the ages” and a “rolling train wreck.” It speculates that the Treasury Department pushed for delayed implementation (possibly illegally since Congress didn’t approve a delay) of the employer mandate because its own software isn’t ready to handle the changes. Apparently only the WSJ missed the obvious point that employers could bypass new healthcare expenses by either (a) cutting their headcount to drop below the 50-employee minimum; or (b) turning full-time positions into part-time positions. Their conclusion: the whole ACA could go right down the toilet because it was sloppily written, is impossible to execute, and will hurt employment. 

Speaking of the ACA, here are some interesting thoughts from a well-connected reader who knows what he’s talking about: with the announced delay in the ACA employer mandate and the uncertainty about the individual mandate, will hospitals ever really see the influx of newly insured patients they have expected? And if they have any doubt about that (which they should), will they curtail big software investments now?

Other

US Army Sgt. Kyle Patterson and his wife Ashley thank The Aroostook Medical Center (ME) for using an iPad and Skype to create a video connection that allowed him to participate in the March 29 birth of his daughter from his post in Afghanistan. According to Ashley, “Kyle was just over the moon. He told me before the birth that he was not going to cry, but he did. He sure did.” The family presented TAMC with a flag that Sgt. Patterson flew in their honor at Bagram Airfield. The hospital flew that flag on July 4 to honor all members and veterans of the military.

A New York Times article entitled “American Way of Birth, Costliest in the World” says we spend $50 billion per year on four million births, a lot more than other developed countries that provide comparable access to services and technology. It describes a pregnant woman whose insurance doesn’t cover maternity costs trying to figure out how much money she would need, only to be told by the local hospital that it would be between $4,000 and $45,000. Her response: “How could you not know this? You’re a hospital … I feel like I’m in a used-car lot.” 

Maine Medical Center says it has fixed its problems with Epic, with Epic itself issuing a rare statement in saying MMC’s problems weren’t related to software defects. The hospital admits that the computer issues caused budget problems, but says those aren’t related to the buyout offers it will send out to 400 employees this week.   

The bonds of North Mississippi Health Services (MS) are downgraded because of financial losses largely due to $11 million in one-time expenses in implementing Allscripts at its Tupelo campus. Fitch Ratings says the implementation required more staffing and budget than expected and also increased length of stay.

In England, the head of the defunct NPfIT is called out, along with two other executives, for spending more than $100,000 for a consultant to help them look good in a single meeting with the Public Accounts Committee. A Member of Parliament describes their performance at the hearing as “woeful,” and suggests, “Perhaps they should ask for their money back.”

Weird News Andy succinctly titles this photo, “The ‘M’ stands for … “

EPtalk by Dr. Jayne

A Minnesota study demonstrates improved blood pressure readings using telemonitoring technology. Patients also kept their blood pressures controlled six months after the intervention ended. Pharmacists provided consultation and education over the phone once readings were received.

We know that exercise helps many of us deal with stress. Princeton researchers show that exercise creates new brain cells while also creating calm in other parts of the brain. The study involved mice running on wheels, which is a lot like being employed in the health information technology realm, especially during the summer. So many people assume summer is a “slow” time but I’ve found it to be stressful with many co-workers on vacation and the same amount of work to be done. Don’t forget to get your exercise and be glad you don’t have to be immersed in ice-cold water to be stressed (like the mice were.)

Thank you to everyone who sent comments (both posted and e-mailed) regarding my “tale of the ED” Curbside Consult. I’m happy to report that my sweet grandmother was discharged home to continue living independently. Her medications were adjusted, she’ll have some home therapy, and we’re off tomorrow to see if she’s a candidate for an injection of the pinched nerve that seems to be the root of the problem. I’m pleased to report that the care she received on the med/surg unit was both high touch and high tech, which renews my hope that we don’t have to sacrifice one for the other.

Thank you also to HIStalk contributor Ed Marx, who was the first to wish me a Happy Birthday this morning even though he is in the midst of climbing Mount Elbrus. His team is scheduled to summit on the 10th, so please join me in wishing them a safe journey. For our US readers, enjoy the Independence Day holiday. If you’re working in the trenches, double thanks to you.

Contacts

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

More news: HIStalk Practice, HIStalk Connect