CIO Unplugged 12/4/13

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

Identity and the Leader

I vividly recall, at age 17, jumping off the bus at the in-processing station of Ft. Dix, New Jersey, where a drill sergeant greeted me—screaming. By the third day, I was wearing a uniform, had a shaved head, and was organized into a squad and a platoon.

The drill sergeant shouted, “Look to your left, look to your right, and now look down at yourself. In nine weeks, one of you will not be here, because you do not have what it takes to be a United States warrior!” Gulp. He scared the crap out of me.

But looking around myself, I determined I was better than at least one or two of my fellow trainees. Yep, I would be OK.

A couple of weeks after I graduated as Private Marx, I entered freshman orientation at Colorado State University as a poster child for insecurity. I have no recollection of who spoke that day, but I do remember him saying that 80,000+ students had graduated in the past 100 years. I pondered the odds and decided that surely there were other bozos who made it, so I, too could succeed.

Since childhood, the comparison method had been a pervasive mindset. My identity had been in what I was rather than who I was. And I had based my success on what I could create rather than why I had been created. I floundered under that junior-high mentality of “I am significant because you are less significant.”

This warped attitude gave me a false confidence in the workplace. I compared myself to my peers and to those above me. Sometimes I would try to learn from others who were stronger and smarter than I, but more often than not I would pounce on their weaknesses to climb over them and up the career ladder. Sure, my skills and talents have helped boost my success, but I was also counterfeiting my identity and confidence based on others’ deficiencies and weaknesses.

Leaving that mindset behind, I’ve been searching for the real me and trying to live as the genuine Ed—insecurity surrendering to conviction.

After qualifying for the USA national championship Duathlon (run-bike-run) as an average athlete, I had just hoped to finish the darned race. Qualifying for a spot on Team USA was not only about to become a dream come true, but also a test of my desire to be the genuine Ed.

At first, I suffered second thoughts based on my insecurities. The odds for success were not in my favor. In fact, competing at this elite level, I would likely end up embarrassing myself. But there I was already comparing myself again. Yet this was my only shot to compete with the gifted.

When I arrived in Tucson and began the registration process, I started doing what most athletes do—comparing myself to others. That guy has less body fat. Another athlete was clean-shaven all over. The guy next to him had a $10,000 bike. The woman in the corner was sponsored … And pretty soon I stood there mentally defeated with the race a mere two days away. I was still basing my success on how I compared to others, not on who I was.

Damn that warped thinking! I stopped it and chose to walk in the opposite spirit. I decided that what I had—a strong heart, a decent bike, and an OK albeit hairy body—was sufficient. I chose to look forward and not to my right or left. The outcome wasn’t in my hands anyway. As an athlete, what mattered was, how will my stats in this performance compare to my stats in the previous races? Was I improving? Forget the guy racing next to me. If I was meant to represent Team USA at the 2014 World Championships, then that would happen.

Identity is a tricky thing. What is it? How is it formed? How does it impact who we are and our performance? Most of the time, I base my identity on how I believe I compare to others. I suspect most of us are mis-wired to think this way.

I don’t claim to have it figured out; I already proved that. My true identity is squaring who I was made to be and living congruent with this truth. I’m still working on it, but as I approach 50, I’m finally getting close. If these ideas help nudge you in the right direction, I will have accomplished my goal for this post.

Some self-reflection ideas:

1. Is my life/career mission about me, or about the betterment and growth of those around me?
2. What do I stand for?
3. Do my values reflect a desire to see others succeed, or do they revolve exclusively around my personal success?
4. Does my behavior reflect a value for the human soul?
5. What’s my gauge for comparison: other people or stable virtues?
6. Am I able to sincerely rejoice in others’ accomplishments, or do I have to one-up people all the time?
7. Do I go to bed praying that no one finds out how insecure I am?

Who are you really? And are you happy with you?

To view my full reflections in depth, leave a comment with a request and I’ll send you “Identity and the Leader” Part 2.

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 12/4/13

Hearst Corporation Agrees to Acquire an 85% Stake in Homecare Homebase, LLC

Hearst Corporation acquires an 85 percent stake in Homecare Homebase, the #1 KLAS rated home health and hospice software vendor.

Martin Health System Adopts RightPatient™ Iris Biometrics for Patient Identification

Martin Health System (FL) will deploy a new biometric patient identification solution from RightPatient that uses iris scanning to positively identify patients. MHS executives expect that the new system will help stop patient identity fraud, eliminate the creation of duplicate medical records, and reduce billing errors.

KLAS Investing in the Future of Medical Imaging

KLAS forms an imaging advisory board to lead a new project focused on imaging-based research.

Adventist to launch updated system

Adventist (CA) will go live with Cerner across 50 clinics this week, completing a network-wide install.

News 12/4/13

Top News

Hearst Corporation will acquire 85 percent of Homecare Homebase, the #1 KLAS-ranked software provider for the homecare and hospice market. Hearst’s other healthcare IT companies include First Databank, Map of Medicine, MCG, and Zynx Health.

Reader Comments

From N2InformaticsRN: “Re: CAP Consulting. The College of American Pathologists is dissolving CAP Consulting, its informatics consulting practice. This is the group that was doing exceptional work in terminology and standards with a deep understanding of the information needs and challenges faced by providers across the health care delivery and laboratory spectrum. More recently they developed an effective framework to assess and tackle health information management.  The team has unique skill sets and helped us ensure ontological correctness by developing a terminology roadmap. It will be interesting to see who picks these folks up or whether they form a consulting group on their own.” Unverified. We have a call scheduled for Wednesday with CAP Consulting to learn more.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Physician Technology Partners. The physician-owned and led consulting company offers provider-to-provider services that make Epic-using physicians more productive. Its physician champions hold ASAP and EpicCare Ambulatory certifications. PTP’s six-phase approach to building to optimize for quicker ROI includes strategic planning, implementation, build and validation, training, go-live support, and optimization. They’ve done it for customers that include Ohio State, UCSF, Sutter, Exempla, Texas Children’s, Providence, University of Miami, and a bunch more names you would know. PTP’s expertise also includes making Dragon speech recognition work optimally in an Epic environment. Thanks to Physician Technology Partners for supporting HIStalk.

I have an interesting challenge with HIStalkapalooza. Jonathan Bush has a conflict and, for the first time since the inaugural HIStalkapalooza in 2008, we may need to find someone else to present the HISsies awards (travesty, I know.) I need someone who has commanding stage presence, a wicked sense of humor, and a cynical view of healthcare IT (extra points for being able to swig large-format bottles of high-gravity beer while uttering a non-stop stream of one-liners during the otherwise august proceedings.) Let me know if you’ve seen anyone who can approximate JB’s on-stage magic since otherwise Inga’s going to have to get up there and she will be terrified.

Acquisitions, Funding, Business, and Stock

Post-acute care software provider Brightree acquires MedAct LLC, a developer of home medical equipment and DME software solutions.

Entrada, a developer of workflow products that are integrated with EHRs from athenahealth, Allscripts, Greenway, and NextGen, raises $1.12 million in new equity.

Shareable Ink closes $10.7 million in Series C financing and names former Allscripts CEO Glen Tullman to its board.

Lexmark will consolidate four acquired businesses — Pacsgear, Saperion, Twistage, and Acuo Technologies — under its Perceptive Software subsidiary.

Sales

AnMed Health (SC) will implement technology from Iatric Systems to integrate multiple hospital and departmental systems.

The Metropolitan Chicago Healthcare Council selects HIE technology from Sandlot Solutions.

Children’s National Medical Center (DC) will deploy Streamline Health’s OpportunityAnyWare business analytics software suite.

People

Kristina Greene (Proxicom) joins Lucca Consulting Group as RVP.

Acusis names Richard Simonetti (Horiba Medical) VP of strategic business solutions.

Kareo hires Amyra Rand (HireRight) as VP of sales.

Perigen appoints Chip Long (Merge Healthcare) SVP of growth and development.

RCM service provider MedData appoints Paul Holland (QuadraMed) VP of sales and Carl Naso (Aleris International) corporate controller.

Stephen Bernard (Accretive Health) joins Connance as VP of professional services.

Valence Health names Nathan Gunn, MD (Verisk Health) VP of population health and Dan Blake (AirStrip Technologies) SVP of software product development.

KLAS names six members to its first-ever imaging advisory board: Mark Christensen (Intermountain Healthcare), Karen McGraner (Exempla St. Joseph Hospital Denver), Eugene V. Pomerantsev (Massachusetts General Hospital), Peter S. Rahko (University of Wisconsin Hospital), Pablo Ros (University Hospitals HS Cleveland), and Brian Wetzel (Our Lady of Lourdes Memorial Hospital Binghamton.)

Announcements and Implementations

Pro-Laudo, a teleradiology practice in Brazil, implements eRAD PACS with integrated reporting and speech recognition.

PeaceHealth Medical Group in Longview, WA goes live on Epic.

Hospitals and skilled nursing facilities in California’s Santa Clara county will deploy CareInSync’s Carebook platform to coordinate care transitions.

Cheyenne Regional Medical Center (WY) converts patient information and data from seven legacy systems into a single platform integrated with Epic using Hyland Software’s OnBase ECM solution.

More than 50 Adventist Health/Central Valley Network (CA) facilities go live this week on Cerner.

Martin Health System (FL) deploys the RightPatient iris biometrics patient identification system from M2SYS Healthcare Solutions.

Providence Health & Services (WA) opens a clinic without a waiting room in its first go-live of RTLS from Versus Technology.

UCLA Health System (CA) opens the Lockheed Marking UCLA TeleHealth Suite and Lockheed Martin Outpatient Recovery Suites for Wounded Warriors of Operation Mend, which were made possible by a $4 million gift from Lockheed Martin.

GE Healthcare launches Centricity 360, an online clinical collaboration tool that provides real-time sharing of data.

3M Health Information Systems releases 3M ChartScriptMD Software for Radiology, a reporting application that allows radiologists to create, sign, and distribute complete reports and communicate diagnostic findings from a single, integrated system.

Congratulations to Tampa General Hospital (FL), which VP/CMIO Richard Paula tells me has earned HIMSS EMRAM Level 7 with its $90 million Epic system.

Innovation and Research

Researchers from NORC at the University of Chicago will study how Cerner employees respond to cost transparency tools from Change Healthcare. The RWJF-funded study will assess the impact of price, quality, and engagement approaches on consumer choice of healthcare.

Researchers at the University of Pittsburgh create a publicly searchable digital database of infectious diseases cases dating back 125 years.

Other

The Leapfrog Group publishes its annual list of top hospitals based on quality of care.

Carolinas HealthCare System launches analytics capabilities that integrate data for evidenced-based health management, individualized patient care, and predictive modeling. The health system’s in-house analytics group built the data analytics models and are using de-identified clinical and financial information from 10.5 million patient encounters. I interviewed SVP/CIO Craig RIchardville in September.

Happtique certifies 19 health and medical apps, which requires them to meet privacy, security, and operability standards and pass clinical content testing.

WEDI, EHNAC, and DirectTrust partner to promote and accelerate the adoption of a national accreditation program for information “trusted agent” service providers.

The New York Times highlights the insanity of US hospital charges, including pricing that is often arbitrary; wide variations in pricing for the same service across different facilities and regions; and, heavily inflated prices for routine supplies and services. For example, the average cost of treating a cut finger in an ER ranges from $790 in New England to $1,377 in the Pacific. Also noted: the hefty incomes of many executives in non-profit health systems, including 28 Sutter Medical Center officials who each make more than $1 million a year.

 A tone-deaf boy in Denver suffers a concussion playing lacrosse, recovers, and develops the ability to play 13 instruments. His physician theorizes that the musical talent was “latent in his brain and somehow was uncovered by his brain rewiring after the injury.” Sort of gives new meaning to the term, “one-hit wonder.”

Crain’s Chicago Business points out that despite the hoopla around the 34 hospitals MetroChicago HIE has announced as members, it has failed so far to sign at least three of the biggest ones: Northwestern, University of Chicago Medicine, and NorthShore.

Weird News Andy finds himself thankful for piercings after reading this story, which describes a joystick-like device implanted as tongue piercing that allows paralyzed people drive their wheelchairs by flicking their tongues.

WNA may have a new competitor, as a reader provided this toothsome morsel of prose. A Swedish prisoner escapes two days before his scheduled release to have a tooth fixed, having been denied service by the prison dentist. He has the tooth removed and then returns to his cell. The prison gives him an oral warning and extends his stay by 24 hours to make up his time.

Sponsor Updates

• Administrators from Nemours Children’s Hospital (FL) explain how Rauland-Borg Corporation, Versus Technology, and GetWellWork integrated their technologies to inform patients about their doctor or nurse as they walk into a patient room.
• Mike Silverstein and Kasey Fahey of Direct Recruiters, Inc. interviewed 21 healthcare IT executives about trends and predictions.
• Capsule Tech joins the Continua Health Alliance.
• Greenway Medical Technologies will integrate data analytic tools from Inovalon into its PrimeSUITE EHR platform.
• AirWatch develops app reputation scanning technology for its platform in support of corporate-owned and BYOD deployments.
• Vital Images showcases clinical enhancements to its VitreaAdvanced software at this week’s RSNA meeting.
• MedAssets shares a video case study highlighting how it helped the Texas Purchasing Coalition achieve $60 million in cost reductions and increase efficiencies.
• Culbert Healthcare Solutions hosts a December 13 webinar on the ICD-10 impact of revenue cycle operations and clinical workflows.
• Quantros offers a December 11 webinar on quality reporting requirements for inpatient psychiatric facilities.
• Nuance adds speech recognition accuracy and workflow enhancements to the PowerScribe 360 platform.
• Beacon Partners publishes a white paper outlining best practices when connecting affiliated physicians to the health system.
• Merge Healthcare releases iConnect Network, an imaging network for the secure electronic exchange of imaging information.
• FUJIFILM Medical Systems introduces Synapse VNA technology and demonstrates Synapse RIS EHR solution at this week’s RSNA meeting.

RSNA Impressions

Deborah Kohn checks in with a high-level reaction to RSNA.

Based on my observations of RSNA 2013’s multitude of imaging informatics products, radiology (and other image-generating “ology” or department) PACS continue to be “deconstructed”.

For example, the “A” in PACS (for Archiving) remains the focus of many Vendor Neutral Archive (VNA) system products. No noteworthy independent (of PACS vendors) VNA products are being introduced this year, and most of the PACS vendor VNA products are trying to catch up to the independents by highlighting new functionality. This year’s newer focus centers on enterprise viewers, which consolidate provider organizations’ large number of disparate clinical system viewers, such as those of the multi-modality PACS (DICOM), Enterprise Content Management (non-DICOM), and even EHR system viewers.

Also moving to the enterprise level are the image share / image exchange capabilities, which include the taking-along of key clinical content down/uploaded from/into the EHR. An impressive Johns Hopkins Medicine work-in-progress at IHE’s Image Sharing Demonstration included Face Time/Skype-like (yet HIPAA secure) video conferencing for consultations and/or second opinions. The remote providers collaborated on diagnostic-quality views of DICOM images with side-by-side, structured EHR data and unstructured text reports – all in one view at the click of a button.

In summary, traditional PACS functionality continues to be siphoned off into other, more robust and often enterprise components, leaving traditional PACS as the important workflow engines for the modalities.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 12/3/13

Ontario hospital learns that bandaging IT doesn’t work

After ignoring IT department recommendations to upgrade aging infrastructure components, Bryant Community Healthcare in Ontario is paying the price. A power surge that resulted in a system-wide network crash and three days of unplanned downtime prompted hospital leadership to green light a new virtualized server environment that has eliminated unplanned downtime.

HealthCare.gov: Progress and Performance Report

CMS releases a Healthcare.gov progress report outlining the improvements made. A new analytics platform has been installed that is allowing developers to monitor site performance in real time from a centralized war room where decisions are being made on which improvements to tackle next.

Forsyth Tech to offer free job-training program

In North Carolina, Forsyth Technical Community College is launching a free "back-to-work" program that will build up a local supply of hard-to-find talent by training unemployed residents on key skills. One of the three career options students can chose from is an electronic health records specialist. The program will pay for registration fees, books and other incurred costs.

Curbside Consult with Dr. Jayne 12/2/13

Back in the day, I was a Girl Scout. Yes, I sold cookies, which probably prepared me for the sales hustle I’d have to do as a physician, trying to convince patients to do things that were good for their health but that they didn’t always want to do. That sales hustle has also been useful in working with reluctant physicians to convince them the EHR isn’t out to get them. My favorite cookies are the Samoas and Thin Mints, in case you’re wondering. Besides the camping and badges one thing I remember is how we used to close our meetings. We crossed arms and sang a song: “Make new friends, but keep the old; one is silver and the other gold.”

That small song was on my mind this week for a variety of reasons. For many people, the holidays are a time of stress, and Thanksgiving kicks it off. I got to spend the holiday cooking with my grandmother and my mom, who finally let me make the gravy, so I guess I have arrived as an adult. She also shared her secret recipe for stuffing. In yet another stroke of good luck, this year’s Thanksgiving conversations were light on the Obamacare and more focused on whether Thanksgiving shopping is good or bad. Social Security and Medicare weren’t topics either. which made the holiday table even more enjoyable.

This was my holiday to be the on-call executive in the event of an unexpected downtime or problem with a critical system. I was keeping my phone close.  Halfway through the dishes, I heard a text message come in. I’m still a little adrenaline-tuned with message indicators on my phone, so I only use them when I have to – probably Pavlovian conditioning from all the years carrying the code pager in medical school and residency – so when it dinged I picked it up with more than a little trepidation.

The message that came in, however, was just what I needed. A colleague halfway across the country making an ongoing joke that started more than three years ago and wishing me a Happy Thanksgiving.

It was a small thing, yet it got me to thinking about the friendships I’ve made and the relationships I’ve built since I’ve been in the CMIO trenches. Before I went into informatics, my circle of colleagues was pretty small – a handful of friends from medical school and residency, my referral base, and other physicians on staff at my hospital. Now I am grateful to have colleagues across the country and around the globe. I’ve had the privilege of bouncing ideas off of people from rural Iowa to the Arabian Peninsula. It’s heartening to know that no matter where we work we’re all dealing with similar challenges.

It’s not just the other CMIOs, though, for whom I am grateful. I appreciate the relationships I’ve built with our vendors. They haven’t always been easy, but the bonds that are forged in adversity are pretty tough to break. I’ve enjoyed getting to know all the analysts in our department and watching some of them grow from interns to respected leaders on the team. We’ve had weddings, babies, and funerals, and even in the sad times, it’s heartening to watch people genuinely care for each other. Sometimes the day-to-day knowledge makes things fun: knowing who in the office wants the leftover deli pickles nobody else wants; knowing who can be bribed with chocolate cake; and knowing that surprising someone with a cold Diet Coke at the right time can make all the difference.

Having friends in all parts of the EHR universe has been a great experience, though sometimes a challenge. Whether it’s schmoozing developers in the hopes of speeding enhancement requests into code or playing incredibly bad golf in front of the entire IT department, being in this position has taken me places I never thought I’d go, both figuratively and literally. (There are still a few places I’d like to go, but I guess I’ll have to keep holding out for that CMIO gig in Italy.)

Even with the busy holiday week, I had a chance to meet up with a health IT friend I usually see only at HIMSS. The conversation was so easy it was as if we see each other all the time. It was great to share war stories, catch up on family news, and gaze at the crystal ball to see what HIT will bring us in the coming year. This fall has been very good to me. I’ve had the pleasure of meeting great people at a recent national meeting I attended and the comfort of being able to lean on friends both old and new when trouble crossed my path.

As I head towards my fourth HIMSS as a member of the HIStalk crew, I realize what a privilege it is to be part of this team and what an adventure it has been. I never dreamed I would have fans who send me pictures of their favorite shoe finds or even an actual chocolate shoe, but they’re out there and I appreciate each and every one of you and hope to see you at HIStalkapalooza (anonymously, of course). We never know who is going to cross our paths or where things will head, but that is part of the thrill.

While I was looking for a graphic to go with today’s piece, I learned that the song actually has several other verses. One is about a circle being round and having no end, which is touching, but I found another verse that I like even better: “New made friends, like new made wine; Age will mellow and refine.” So I will raise my virtual glass to all our HIStalk readers and to my friends and colleagues old and new. Here’s to the next adventure.

Email Dr. Jayne.

HIStalk Interviews Rob Culbert, CEO, Culbert Healthcare Solutions

Rob Culbert is president and CEO of Culbert Healthcare Solutions of Woburn, MA.

Tell me about yourself and the company.

I started my career in healthcare IT back in 1986 working for what at the time it was called IDS, which later became IDX Systems and now is part of GE Healthcare. I spent about nine years working for them at a time where they were growing fast and furiously, selling large practice management and managed care solutions to the academic medical centers and large physician groups and medical centers around the country. Then for the last 20 years, I’ve been in the healthcare consulting world, with the last eight being on my own with Culbert Healthcare Solutions. 

My history there has covered the gamut of helping large hospitals, academic medical centers, and physician groups through a wide variety of business challenges ranging from IT to revenue cycle to strategic planning, the whole bit. I cover a wide spectrum of areas and our company does the same. 

We broke our business into two pieces. We have a very strong IT consulting component that helps Epic customers, GE customers, and Allscripts customers. On the management and strategic side, we help customers with developing medical groups, fixing a billing operation, creating an central billing office, and a wide variety of management and interim management type needs as our customers look to do different things.

You are privy to those conversations about what hospitals and IT departments are planning strategically. What are the themes?

In an older time, physicians and hospitals operated very separately. In my old IDX days, it was all about control or a fear of control. They went out of the way to keep systems and knowledge very separate. What’s really great is that it has come full circle. In the world of Meaningful Use, PQRI incentives, and focusing on quality outcomes and taking good care of the patient, you have to be able to work together and share. 

What we have been doing along that line is helping hospitals become better partners with physicians, providing better services, whether it’s IT-specific in terms of an EHR that has clinical integration with the inpatient data, so that a physician is able to look at a complete patient chart instead of having to go to an ambulatory system for their office notes and switch over to a different hospital system to get access to the inpatient data.

A good chunk of what we’ve been helping people with and we see over and over is, there are many, many different ways for hospitals and physicians to join forces, either officially or unofficially through IT management services and sharing of clinical data.

In those relationships that may vary from hospitals buying practices outright, some sort of affiliation agreement, or an ACO model, what technology challenges do you see most often?

It ranges quite a bit, but I think the common one is cost. Everyone is extremely price sensitive, and rightfully so. A hospital traditionally has a larger infrastructure. It’s got its own campus or set of campuses. They’ve got a large volume that they can make their IT dollars work really efficiently.

Now you ask that hospital to serve a three doc-practice that’s affiliated with your hospital that’s 20 miles away, They just don’t share the same cost structure that a hospital does. They can’t just hire IT analysts. On their own, they have to be able to share those kinds of resources. They have all kinds of issues with being isolated and having to deal with networking issues and the basic infrastructure before you can even get near the application. Then on top of that, they don’t have the ability to be close to the campus to get access to a lot of the training that might be traditionally available in a larger environment.

There’s a bunch of challenges around getting those affiliated practices up to speed and comfortable using the technology, no different than someone that’s in a hospital setting. The cost of serving a small group that is way out in an outlying area is very different than what a large group environment in a campus setting would look like. Those sensitivities around how you provide good service at a very, very cost-effective way is the biggest challenge for hospitals and those affiliate physicians working together.

Do you see a lot of practices replacing their systems, either because they affiliate with a hospital and move to theirs or they get disillusioned with the one they have?

I do. Some for the reasons you mentioned, but sometimes it has to do with who they’re aligning with from a health system perspective. We’re starting to see, for example, independent Allscripts customers where one buys the other. Do you keep the two separate systems or do you bring the two systems together? 

It’s the same thing in the Epic environment. Epic is typically in very large health systems. It’s not uncommon for us to see small- to medium-sized practices that are aligned with one health system on an Epic practice that for very good business reasons and strategic reasons, chooses to switch their affiliation to a different health system. The first question that comes up is, how do I get my Epic data from the one Epic system over to the second system? Getting the HR data as well as the registration and billing and practice management data.

They talk about that at some point it’s going to be a replacement market in the EHR world because everybody is getting close to being on at least their initially EHR. Switching alignments and having to switch your systems potentially to fit with those alignments is going to be a big challenge for organizations in the future.

What factors will have the greatest influence on the hospital CIO in the next one to three years?

They’re going to get more involved, if they haven’t already, in the physician side of the business. It’s a very different business from running a hospital. It takes different skill sets to run a very effective professional billing office compared to a hospital billing office. The same with setting up a clinical system — it’s a very different environment.

The old mentality of hospital IT is going to change. You need to be able to factor in a physician’s side to the business that’s a more nimble and more sensitive to the fact that the physician side changes more frequently than the hospital side of the world. You have less control, because you could have a physician group today that is a member of a different competitor and an affiliation is created. All of a sudden they’re now in your network and you have to service them as a good customer. 

That’s going to be a challenge for hospital CIOs — making sure they have that good balance of having physician expertise and hospital IT expertise on staff to be able to meet everyone’s needs.

What are their biggest challenges in getting that job done?

Resources. Money. Probably the biggest challenge is that still today, many of the healthcare organizations have a large mix of IT systems that they’re having to maintain. 

In many cases, they have the same system, say for example a GE or an Epic system, and they may have two instances of the same vendor. Potentially those instances could be on different versions. Being able to manage multiple systems and all the nuances of those systems for the various entities within the hospital CIO’s responsibility is going to be a big challenge.

Second is how a hospital CIO can make effective decisions on consolidating some of those systems so that you aren’t managing 20 systems when you ideally maybe should be managing four or five. What is the migration path that you have to go through when you’re consolidating so many systems to one? There are so many business issues that you have to be sensitive to that, unfortunately, it’s not a simple as, “We’re going to turn this system off tomorrow and turn the new system on.” You have to to be able to interact with the entire operation department to make sure that you’re not creating business problems while you’re making those system changes.

Will maintenance costs with these expensive systems change the way hospitals manage their vendor relationships?

In my IDX days — when IDX was growing by leaps and bounds and was grabbing a lot of market share, particularly in the academic marketplace — once we got to a size where we were considered the leader, similar stories that you see today about Epic and expensive and is it going to make sense came up with us that we had to deal with.

I don’t think that’s totally fair to say the vendor is the sole problem an organization could look at supporting their systems and say it’s expensive. There are many savings to be had any time you switch to a new system that a lot of organizations the first time around in implementation don’t get the opportunity to implement, because they’re so busy trying to get the initial system up and running, which is why you hear so often that organizations go back through with these optimization teams to make sure that they’re getting the benefit that the systems are providing.

We did an ROI study for one of our customers that helped them in the process of earning a Davies award where we were able to show that the Epic system where they had spent somewhere in the range of $150-plus million over a 10-year window, their total cost was going to be $13 million. We were able to demonstrate dollar savings of that minus $13 million over a 10-year period. Then if you look at all the patient safety and patient satisfaction opportunities that the Epic system had the ability to create, there’s a lot of intangibles that, one would argue, the $13 million was a very, very good investment for the organization.

What trends would you advise a CIO not to jump on in the next year or two?

The ACO and the population management area certainly has a lot of buzz. There are a lot of things going on that, in the very near future, will be very important to every hospital’s CIO’s agenda. But I don’t know if right now there’s enough bandwidth, with everything else that they have going on, that you can jump into those systems and be able to do an effective job. 

As the next year or two goes by, that those systems will mature. The vendors will be stronger. They’ll be able to provide more knowledge along with the product. 

That’s an area where, given everything else that they have on their plate, one could argue that they’ve got plenty to keep them busy without having anything for the next couple of years.

Do you have any final thoughts?

It’s a very interesting time. Our customers are doing a lot of great things, but they’re struggling with too many big things at one time, whether it’s ICD-10 or Meaningful Use. We talked about where, if they’re trying to consolidate systems, the amount of work that they need to do to upgrade to a new version before they could get access to the ICD-10 technology is definitely creating a lot of angst in the marketplace.

The typical hospital CIO and the IT department have got more than their hands full. It’s a very crazy, hectic time. I view our job as to try to alleviate some of that stress, but I don’t know if there’s really any way to do it other than to plug ahead and do a great job with the projects that they’re working on. Eventually, we’ll be able to catch up to the point where they can have a little more control over the priorities that can really make a difference for the organization.

Morning Headlines 12/2/13

UW Medicine Notice of Computer Security Breach

University of Washington Medicine (WA) reports a data breach after a worker inadvertently opened an email that contained malware. A computer forensics investigation found that the virus accessed the data files of 90,000 patients.

Taking health care down a digital path

Children’s Hospital of Eastern Ontario goes live on Epic in the laboratory and across a portion of its outpatient clinics. Over the next three years, Epic will be rolled out across all acute units, the emergency department, and its ambulatory clinics.

"Patient portals" to soon allow online access to medical data

An upstate New York regional HIE is profiled by the local news as it prepares to launch a region-wide patient portal for residents.

34 Chicago-area hospitals to join health information exchange

MetroChicago HIE, a health information exchange that will service 34 Chicago-based hospitals, will be announced this week and will launch early in 2014.

Monday Morning Update 12/2/13

From The PACS Designer: “Re: Splunk for data. Splunk has an app library for developers of data solutions and uses Hadoop and XML to easily craft viewing platforms for various data solutions. By using basic Simple XML concepts you can experiment and find a data viewing solution for critiquing by your user groups.”

Two-thirds of respondents say they’re OK with entertaining new job possibilities at the HIMSS conferences. New poll to your right: should the FDA regulate clinical software in any way? Vote and then use the poll’s comment link to elaborate.

Listening: Feeder, somewhat obscure (in the US anyway) radio-friendly British rockers who’ve been around for 20 years.

News is slow as it always is over Thanksgiving weekend. I hope your holiday (for those celebrating) was memorable in positive ways. It’s barely more than three weeks until Christmas, believe it or not.

I’ll be writing daily from the mHealth Summit in the Washington, DC area next week. If you’re going, drop by the our first-ever HIStalk booth (#1305) and say hello. Ours will be the nearly bare one because it’s really expensive to furnish a booth. My impression from the last time I attended was that not many hospital folks attend, but the event has grown to 5,000 attendees since HIMSS bought it and may have outgrown its governmental and public health roots.

In Canada, Children’s Hospital of Eastern Ontario announces that it will implement Epic in its hospital and 80 clinics. The budget was reported at $7.7 million, which is surely incorrect except possibly for the clinics only.

MetroChicago HIE will be announced this week and launched early next year, reports say, with 34 area hospitals (listed here) participating initially. The HIE was originally planned in 2009 and announced in April 2011 but stalled when hospitals balked at paying to participate.

Palomar Health (CA) releases a mobile app built with Extension Healthcare that locates patients and lets caregivers communicate.

Speaking  of Palomar Health, here’s a video from the November 5 SoCal HIMSS CIO Forum featuring Chief Innovation Officer Orlando Portale speaking about hospital innovation. He says that only 5 percent of hospitals are innovative; the rest are followers.

University of Washington Medicine (WA) says that information on 90,000 patients was accessed in October 2013 when an employee opened a email attachment that contained malware.

Weird News Andy extends his Thanksgiving best wishes with a story about what he calls “a chip that makes you lose weight.” It’s genetic rather than potato, nacho, or chocolate — an arm-implanted computer chip releases a hormone that sends an “I’m not hungry” message when the implantee has eaten enough.

Vince continues to put a personal face on the confusing string of McKesson acquisitions in this week’s HIS-tory, which covers CyCare.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 11/27/13

Nuance Announces Fiscal 2013 and Fourth Quarter Results

Nuance reports Q4 results: $0.30 EPS on a total revenue of $472 million, missing analyst estimates of $489 million, but surpassing the $0.29 EPS estimate. Stock price fell 18 percent Tuesday due to lower than expected Q1 guidance.

7 Democrats Seek Long-Term HealthCare.gov CEO

A group of seven Democratic senators, led by Jeanne Shaheen of New Hampshire, is calling for President Obama to appoint a CEO over Healthcare.gov  following the expected departure of Jeffrey Zients. Zenits was tapped to fix healthcare.gov shortly after it became apparent that the site had major technical issues, but at the time, he had already accepted a position as director of the National Economic Council which will start in January.

Telemedicine May Reduce Doctor Errors for Kids in Rural EDs‏

The use of telemedicine for pediatric consults in rural emergency departments led to fewer physician-related medication errors according to a report published in this month’s issue of Pediatrics.

Two Kansas health information exchanges to link, improving access

After more than a year of heated disagreements, two competing for-profit health information exchanges from Kansas have agreed to connect and share medical records statewide.

News 11/27/13

Top News

Nuance Communications reports Q4 results: revenue up less than 1 percent, adjusted EPS $0.30 vs. $0.51. Unenthusiastic company guidance sent shares plummeting 18 percent Tuesday; they’ve sunk 41 percent in the past year. Above is the one-year price graph of NUAN (blue) vs. the Nasdaq (red).

Reader Comments

From BR549: “Re: Health Care DataWorks. Laid off 35 percent of its workforce last Wednesday.” HCD CEO Jason Buskirk provided this response to our inquiries: “We do not share specific statistics, but the percentage that you quote is incorrect. Based on feedback from our clients, we are realigning the organization to be laser focused on our software, KnowledgeEdge. HCD will continue to hire the best and brightest technical talent in the industry.” Buskirk was announced as CEO on September 18, replacing founder Herb Smaltz, who had held the CEO position since 2008 but remains on the company’s board.

From TomT: “Re: holiday wishes. It’s that time of year when we should take a moment to give thanks for for all 141,000 new ICD-10 codes coming our way. I hope you and the rest of the HIStalk gang avoid any of these turkey-related injuries and have a wonderful Thanksgiving.” Yet another reason to buy the frozen Butterball. Many thanks to TomT and all the other readers who have sent us holiday greetings!

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Medfusion. The Cary, NC-based company enhances the patient-provider relationship by providing new ways for them to communicate, improving patient engagement and allowing providers to meet MU Stage 2 requirements. The former Intuit Health’s patient portal allows providers to spend more time on patients through the efficiencies gained from online messaging, appointment scheduling, bill payment, payment plans, refill management, and results sharing. Medfusion’s portal also integrates with popular EHRs and provides patients with mobile access. See for yourself – you can test drive the patient portal instantly with no signup required just like I did. I interviewed founder Steve Malik, who bought the company back from Intuit in August 2013. Thanks to Medfusion for supporting HIStalk.

I’ll have details about our HIMSS activities (including HIStalkapalooza) after New Year’s, but here’s something fun: we’ll be having an HIStalk sponsor networking reception Sunday evening, February 23 from 6:30 until 8:30 (an easy walk from the HIMSS opening reception, which runs from 5:00 to 7:00). Sponsor executives always enjoy the chance to lay aside their competitive armor in renewing old acquaintances and making new ones in a relaxed setting, so this should be a fun evening in which business will be inevitably conducted as well. Lorre will be hosting and I’ll provide great food and drinks. Watch for your invitation.

Acquisitions, Funding, Business, and Stock

Patient engagement and education provider PatientPoint completes the acquisition of publishing assets from American Hospitals Publishing Group International, a developer of customized patient guides and communication tools.

Genophen, a developer of a health management platform and clinical support tool, raises $2 million in a third round of funding.

Streamline Health Solutions prices its secondary stock offering of 3 million shares at $6.50 per share for net proceeds of $17.1 million.

Cumberland Consulting Group acquires life sciences implementation firm Mindlance Life Sciences

PM/EMR vendor CureMD acquires medical billing company AviaraMD.

Sales

AtlantiCare (NJ) selects MedCurrent’s OrderRight Radiology Decision Support system, which will be integrated with AtlantiCare’s existing Cerner PowerChart platform.

Madera Community Hospital (CA) will implement Passive Incident Management software from RGP Healthcare.

UK Healthcare (KY) will implement medical image sharing services from lifeIMAGE.

Allina Health (MN) expands its use of MedAssets Contract and Episode Management solutions into outpatient settings.

Bone marrow donor center DKMS chooses registry software from Remedy Informatics.

People

Brigham and Women’s Health Care (MA) names Cedric J. Priebe, MD (Care New England Health System) CIO.

Michael Dal Bello, managing director of Emdeon’s parent company Blackstone Group, resigns from Emdeon’s board.

The Pennsylvania eHealth Partnership Authority appoints Michael Fiaschetti (Highmark) to its board.

Outpatient specialty care software vendor Net Health hires Mary Mieure (Greenway) as VP of training and implementation.

Announcements and Implementations

The Kansas HIN and the Lewis and Clark Information Exchange agree to connect their HIEs, allowing the networks to keep $1 million in federal funding.

Huntsman Cancer Institute (UT) deploys the NLP-based I2E software platform from Linguamatics to extract discrete data from unstructured texts in clinical notes.

ProHealth Care (WI) becomes the first healthcare system to use Epic’s Cogito data warehouse tool, which combines patient data from Epic with information from other EMRs and data sources.

Government and Politics

Several industry organizations ask the House Ways & Means and Senate Finance Committees to ensure that MU Stage 3 includes interoperability requirements for EHRs and remote patient monitoring systems.

Vermont Governor Peter Shumlin reprimands Health Access Commissioner Mark Larson for lying to state representative earlier this month when Larson was asked directly if the state’s insurance exchange had experienced any security breaches. Larson failed to disclose an October incident in which a user pulled up the personal information of someone else due to a reassigned username.

Seven Democratic senators call on the President to name a CEO of the Healthcare.gov website who would report directly to the White House instead of to HHS.

Innovation and Research

Researchers find that rural ED physicians are less likely to make medication administration errors when using telehealth technology to consult with specialists.

Other

The AHA urges CMS to ensure Medicare contractors and state Medicaid agencies  begin end-to-end testing on ICD-10 by January in order to prepare for the October 1, 2014 deadline.

Epic will build two laboratory installations of its EpicCare EHR at Oregon Health & Science University for medical informatics and research purposes. On the research side, the University will have access to Epic’s source code. 

Weird News Andy notes breaking news from Good Shepherd Medical Center (TX), where a male suspect is being held in the Tuesday morning stabbing death of a female nurse in the hospital’s ambulatory surgery center. Another employee and three visitors were also injured.

An Idaho state senator video chatting with her son on her iPhone on Face Time has a stroke, which her son notices from seeing her confusion and facial drooping . He rushes her to the hospital in time for speedy treatment and she’ll make a full recovery. She says, “I’ll always be a dedicated fan of the iPhone,” while her son adds, “If you have adults that live away, you need an iPhone for ‘em. I’m serious, that’s huge. … Seeing their face, you can actually see if something’s amiss.”

USA Today talks up the promise of analyzing large healthcare databases to its audience of hotel guests and airport travelers,  although the article wanders around with a few unrelated facts and no real conclusion other than “it’s coming.” It did contain one interesting factoid: a study found that diabetic hospital readmissions weren’t dominated by older patients who had forgotten to inject their insulin, but rather young female diabetics who had intentionally skipped their dose trying to lose weight.

Sponsor Updates

• Nuance Communications announces the general availability of Dragon Medical 360 l Network Edition 2.0, which allows clinicians to document using multiple devices and provides an accuracy level of 98 percent or higher out of the box.
• E-MDs Solutions Series 8.0 achieves Complete EHR 2014 certification for Stage 1 and 2.
• MModal integrates radiology report measurements from PACSGEAR’s ModLink with MModal Fluency for Imaging Reporting.
• Merge Healthcare will showcase iConnect Access Version 5.0, its universal viewing and imagine sharing solution, at next week’s RSNA meeting in Chicago.
• Iatric Systems announces that Meaningful Use Manager with Clinical Quality Measures Version 3.0 has earned ONC 2014 certification as an EHR Module.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 11/26/13

Analysis of huge data sets will reshape health care

USAToday covers the rise of big data in healthcare, imagining that, " Insurers will soon reassess how they predict costs; patients will let doctors know what medications won’t work with their particular genomes; and researchers will look at hospital records in real time to determine the cheapest, most effective ways to treat patients."

ProHealth adds Epic Systems’ ‘population management’ tool

ProHealth Care, a Wisconsin-based health system and ACO, becomes the first Epic customer to use Cogito, Epic’s population health data miner.

Congress Pushed for Stage 3 Criteria for Telehealth

The American Telemedicine Association, Association for Competitive Technology, Continua Health Alliance, and the Telecommunications Industry Association send a letter to Congressional leaders asking that they ensure that Meaningful Use Stage 3 includes interoperability requirements that address not only data within EHRs, but also data captured via remote patient monitoring systems.

FDA tells 23andMe to halt sales of genetic test

The FDA has ordered personal genome testing vendor 23andMe to pull its services from the market until it proves to the FDA that its tests are scientifically valid.

Readers Write: “To Shag or Not to Shag” is a Really Important Question

“To Shag or Not to Shag” is a Really Important Question
By Shannon Snodgrass

We were laughing about Ricky Roma’s shagilicious request on HIStalk in our staff meeting this morning, but “to shag or not to shag” is actually a really important question. You can spend thousands and thousands (and thousands!) of dollars on your booth and show services. but few things are as important as the staff working your booth.

These are the people who will be telling the story of your company and interacting with your customers and potential customers. Not only do they need to be trained, they also need the tools and support for a successful show. That includes proper flooring that will support them comfortably in the long days that trade shows are famous for. How can you expect your staff to stay focused and upbeat if they are daydreaming about a foot massage while a potential customer is trying to get their attention?

There are many things to consider and plan for when staffing your booth. You need to consider each person, their natural talents, and tolerance and create a schedule for the show that utilizes each person to their best advantage. Shows can be overwhelming with sights and sounds. Even an extrovert can easily be overwhelmed.

Be sure to allow time for breaks to check emails and connect with customers outside of the booth. They also need time to call home and sit down for a minute to enjoy a snack. Even the best booth babes (guys and gals) need a little time to themselves to refresh and powder their noses.

In addition, your staff should be armed with core messages relative to what the company does, each of its products, and also a personal message about their role within the organization. Teach your team to listen and how to use listening as an effective communication and sales tool.

Keeping focused and on message can be tough in the crazy trade show environment, but training your staff ahead of time and providing them with the tools they need will give them the drive and focus to get through the day. Coffee, plenty of sleep, water, and comfortable yet attractive shoes don’t hurt either. 

On the "to shag or not to shag" debate, we have found that a low pile with a premium carpet pad provides support and comfort for most everyone no matter the heel height.

Shannon Snodgrass is senior project manager for Thomas Wright Partners.

Curbside Consult with Dr. Jayne 11/25/13

I’ve seen a lot of articles lately about physicians who are unhappy with their EHRs because they feel they’re being forced to collect too much meaningless data and to do “too many clicks.” I read most of them to see if I can pick up any pearls that will help my physicians and also to prepare counter-arguments for when my colleagues email me links to those articles.

I’ve used quite a few different systems and each has its own little annoyances. Physicians always seem to think the grass is going to be greener on the other side of the fence. If I had a dollar for every time I’ve heard someone say, “It would be so much better if we just had System X,” I could retire much sooner than currently planned.

I know I have a fair number readers who are CMIOs, medical directors, CMOs, or EHR champions. There are quite a few physician leaders I know who are new to the EHR game and haven’t quite figured out all their responses yet, so I wanted to share some of mine. These should also be helpful to anyone who has to work with physicians, train them, or manage physician practices. Vendors might want to take note as well and incorporate some of these elements into their implementation and optimization strategies.

When physicians complain about entry of discrete data, I like to ask them specifically what data fields they are referencing. Our organization has a pretty liberal policy about using free text or voice recognition to enter data in certain parts of the chart. For example, users can enter the patient’s History of Present Illness (why they are seeking care and how their condition has progressed) in a non-discrete way. No drop downs, no picklists, no checkboxes, if that’s how they want it. When you dig deeper, many of the fields they are complaining about are those that are required for Meaningful Use, quality initiatives, or important things like drug-allergy checking. They are often fields that do not specifically require physician entry.

We created a matrix of required data and documented which staff members could be authorized to enter the data after appropriate training. It also includes directions on where and when it should be done in the flow of the patient visit. For example, the patient’s pharmacy and HIPAA contact preferences can be entered by the front desk check-in staff. Neither data element requires clinical training or expertise, just access to the right screens. If a physician has to enter the pharmacy name (and it’s not because the patient changed his or her mind at the last minute regarding where the prescription should be sent) this is a systems and workflow failure, not a “terrible EHR.”

The matrix also explains specifically why each data element must be collected, what our organization plans to do with it, and how it benefits patient care. This has been a helpful reminder for many of our physicians as well as new information for those who tried to skip out on training. It doesn’t make the data gathering less from a volume standpoint, but often understanding why these might be “good clicks” can make them feel less burdensome.

For those physicians who do choose to enter non-required data discretely, the most common mistake I see is feeling the need to ask about something just because there is a field for it. For example, in the social history section under pets, our EHR has a specific checkbox for “reptiles in the home.” This makes sense if you’re a gastroenterologist or infectious disease specialist treating certain symptoms, or if you’re a pediatrician who needs to counsel against risks, but if it’s not pertinent to the user’s specialty it doesn’t need to be asked.

It’s OK to ignore fields. That’s a hard thing to teach people – if you don’t like it or don’t need it, don’t use it. And if you didn’t ask it before EHR ,don’t feel obligated to ask it now just because there’s a box (unless it’s flagged as required).

One of the other things I hear a lot of complaints about is refill management, especially in the primary care setting. Some EHRs are better than others at being able to streamline refills, but the key is to eliminate the existence of the refill request in the first place. This is not really an EHR strategy. Primary care literature has been talking about this for years, but it’s been slow to catch on. The concept of writing for enough medication to see the patient through the next scheduled appointment (or for up to a year for stable patients with controlled conditions) seems hard for some physicians to accept. Of course there are some controlled substances that aren’t inherently refillable and may require paper prescriptions between visits, so practices need systems and rules to handle these so they don’t cause chaos.

In my practice, I took a lot of time to educate our patients that we don’t do refills. If they are out of medication, they need to be seen. Everyone in the office was schooled on the same message so that it could be delivered consistently. Patients were encouraged to schedule their next appointment before they left. We had same-day and next-day appointments available for people who missed the point and ran low on their medications. Worst case scenario, we could get patients in to be seen within a week and at that time they got new refills for a maximum time period based on their status (as well as re-education.)

Another huge time suck is allowing the patients to call a refill phone line at the office and leave messages for the staff requesting refills, or even worse, to speak directly to a staff member. Those conversations were never brief. Patients often brought up other medical issues or wanted to chit-chat. Given the status of electronic refill requests in most systems, it’s much more efficient for patients to request their refills through the pharmacy and let the staff process them electronically in the EHR. The worst case of this I’ve seen is staff who were transcribing the voice mail messages onto little pink phone message slips, then later transcribing them into the EHR. Not only was it double work, but it delayed the refill process for the patient. Again, there are exceptions (controlled substances being one of them) that may merit a call to the office, but these should not be the rule.

Physicians usually push back here and tell me they don’t want to receive requests from the pharmacy because X pharmacy always sends erroneous requests or something similar. I’ve seen this in practice and have found that a quick phone call to the pharmacy supervisor recommending that they get their staff in gear or you might start recommending all your patients have their scripts filled at Competitor Pharmacy Y is very helpful in producing high-quality refill requests with few errors. It may take 10 minutes to make the call, but it will save countless minutes in the future.

For practices that refuse to write medications through the next scheduled appointment, I often recommend a protocol-driven refill policy that allows nurses to refill based on a signed standing order and written algorithm. The key words here are signed standing order and written algorithm. You can’t just let your staff issue refills “because they know what you would want” because in most states that’s considered practicing without a license. On the flip side, you can’t have standing orders in every state and may only be able to do them with a certain level of staff (RN), but it’s worth considering. If a patient who has controlled high blood pressure and high cholesterol is current on labs and has an appointment scheduled, I as a physician don’t need to see that request because my protocol allows the staff to issue scripts through the scheduled appointment.

These concepts stray a little from our healthcare IT focus, but I’m tired of the EHR taking the blame for clunky and duplicative office processes. In what situations do you find physicians and staff using the EHR as a scapegoat? Email me.

Email Dr. Jayne.

HIStalk Interviews David Chou, CIO, University of Mississippi Medical Center

David Chou is CIO of University of Mississippi Medical Center of Jackson, MS.

Tell me about yourself and the medical center.

University of Mississippi Medical Center is an academic medical center. We’re here supporting our research sector, our hospital sector – healthcare, and the medical school. We’re the state’s only Level I Trauma Center and the state’s only children’s hospital. Given that, we are also a state entity, so we are here to provide outstanding care for the state of Mississippi.

I’ve been on the ground here for about almost two months now. I previously came from Cleveland Clinic. I was overseas in Abu Dhabi working on the joint venture project that they had with the government of Abu Dhabi. I was there for almost two years before leaving to come back to the states. I’m originally from southern California in Los Angeles, so I’m accustomed to being in a big city throughout my life until now where I’m in Jackson, Mississippi. Overall it’s going well.

What are your biggest projects and your biggest challenges?

The biggest one now is that we’re looking at optimization. We went live with Epic about 16-17 months ago with a big bang installation. All the hospitals and all the clinics, so campus-wide we rolled out Epic, which is a very great task that was undertaken. Now we’re looking at ways to optimize it.and utilize the system to our advantage. I’ll say that’s probably the number one thing for me right now.

What are your goals for the system and what do you hope to accomplish using Epic?

I would say just utilizing the system to its fullest capability. Right now, we’re utilizing probably about 40-45 percent of the system’s functionality. I want to get it to at least 85-90 percent. In addition to that, some of the main technology initiatives are moving toward the BYOB environment and we’re moving toward virtual desktops. We’re going mobile. I want to get us where we’re one of the very few healthcare players that’s able to support a mobile environment. I want to get away from the traditional client-server setup.

What do you need in terms of infrastructure to support a mobile workforce?

We currently have Citrix as a main partner in terms of supporting Epic. We’re almost there, we’re pretty far ahead. In terms of infrastructure, we just need to take a look at some of the hardware upgrades, then we should be ready. We rolled out Citrix for all of our clients. Everything’s running through our Citrix client. What that means is that we just have to get some of the other healthcare applications to work well with our Cisco container and we should be good to go. We’re very close, closer to what I originally imagined coming on board.

Are other clinicians other than physicians going mobile as well?

Primarily physicians, medical staff and nurses. We have a really big telehealth program here. We have over 85 hospitals on site that are utilizing our telehealth program. Our goal is to get it to over 100+ sites and capture not just the state of Mississippi, but we want to capture the southeastern region of the US and potentially go global. They’re going to be a big player in terms of utilizing the mobile platform.

What’s the vision for global telehealth?

We grew so fast here, in terms of this telehealth program. I think the vision is to be able to provide care for the state of Mississippi and the rural areas first. We want to scale it to where obviously just to be able to service the area of Mississippi, but I think we have the potential to expand it globally. We need to be able to showcase and show everyone what we’re doing here in Mississippi from a telehealth perspective.

It is fast-evolving technology that right now is still very premature, so we’re scrambling at this point. But hopefully we’ll get to stage to where we’re solid and we have a few solid partners that are working with us. Then I think we’ll be able to extend it globally, working with some of the other countries that are in need of telemedicine. You know, given the fact that I was in Abu Dhabi, I see a strong need for healthcare players in North America to boost healthcare globally throughout the world.

Are there specific services that you plan to use in your own institution?

I would say anything. I don’t think the organization has thought about expanding globally, but that’s the sort of the goal that I have in place of the organization, along with my director of telehealth.

Are you doing anything else that you would consider innovative or unusual?

Telehealth and getting solid on a more mobile strategy. Those are the two primary things I would say that’s very innovative right now. We’re still trying to get some of the basics in terms of the basic functionalities in place, but from a healthcare perspective, I would say those are the two biggest areas. From a medical college standpoint, there are a lot of things we want to do as far as mobile strategy as well, but that’s something that’s still a work in progress.

You were a hospital analyst 10 years ago and now you’re the CIO of a large health system. What advice would you give people who are interested in a similar career path?

It’s very important to understand the business side of healthcare. I was fortunate enough to where I was able to roam and understand the various departments. I’ve had various departments report up to me as well, such as supply chain. I have a lot of knowledge from a revenue cycle standpoint. 

I would say really get involved and understand operations, how things work. That’s going to carry a lot of weight in terms of fitting technology into the business side. After all, business drives technology, so it’s very important and very valuable for someone to actually understand how to operationalize the hospital and how to make it profitable.

In terms of educational background as well as experience, what do you think would be ideal for today’s CIO role?

A technology background would be ideal, just to understand how things work and have that foundation. But ideally, someone with a business background, specifically in the healthcare sector. If there’s a passion for that individual on the technology side, that’s a plus, primarily having to be a little more business savvy. Most of the CIOs today have been in technology for a long time and they understand technology, but when you ask them to transfer that knowledge from a technology terms to business terms, there has been a challenge.

How is your relationship with your CFO and how can CIOs improve that relationship?

What’s helped me is the fact that I work closely with my CFO as a partner. He trusts me to help him solve things that are going wrong on the revenue side because I have that knowledge from a business side as far as how to run a business office. That’s helped me tremendously in that relationship to where I’m viewed as a solid partner, not just a technology advisor. I’m there helping from a financial perspective as well. That’s what’s very critical, and that’s what’s lacking these days.

Is the industry is doing a good job of preparing the next generation of IT leadership?

No, I don’t think so. I was very fortunate that at my previous organization, AHMC Healthcare, I was very close to the chairman of the board. I had his trust and he allowed me  roam and take note of the various stakeholders from a business perspective. That was how I was able to understand how healthcare operates from an operational perspective. Without that experience, I don’t think I would be where I am now. I would say that in general we do not do a good job of educating technology leaders on the business side to groom them for the next level.

Your background illustrates that sometimes you have to take jobs that are either geographically unusual or maybe not even desirable jobs to be able to move up. It’s not likely that you’ll just stay in one place and 20 years later you’ll suddenly be promoted. Do people understand that you can’t just stay put and work your way up to the one and only CIO job?

You have a point. You do have to navigate and move around a lot, just to be able to get where you want to be from a career path. Obviously you’d like to stay in one place, but there’s only one role. The chance of someone younger getting that high-profile role is a little bit tougher unless you move around and get some exposure outside the one organization.

I think you brought up a really good point as far as being able to grab on to an opportunity and take the challenge. Once folks get comfortable, it’s hard to get them out of that comfort zone. That’s a big separation divider between someone being able to lead and take on the next role.

Do you think a lot about government decisions about healthcare IT?

I do. I try to stay involved, but that piece is a little bit tougher. But given that we’re a state entity now, I am a little bit more involved than I have been in the past. I did come up from a for-profit institution as well. Now that we’re a state entity, I am heavily involved with the regulatory that goes around in healthcare IT.

Are there lessons you learned on the for-profit side that you can bring to your current employer?

Oh, yes. That was a big separation divider, given that I have a good background in terms of maximizing return on investment and being able to be profitable for an organization. That’s helped coming to this sector, where traditionally from a non-profit, academic standpoint, that has not been the key driver. As healthcare is consolidating, everyone is looking at ways to maximize their return on investment.

You weren’t there when the Epic decision was made, but what return on investment assumptions were built in? What are you measuring and expecting?

Going Epic is the right path. Every healthcare system in the US is trying to get to that consolidated platform. I think they made the right choice. The main drive, the key metric to measure, is how do we look from a revenue standpoint after go-live versus before go-live? I think we’re at the point where we’re above where we were before in terms from a revenue standpoint, but we’re still pretty far from where we can be. We’re looking at a lot of ways to optimize and be that far ahead in terms of from a revenue standpoint.

Do you think Epic will provide a positive return on investment?

We will. We’re utilizing Epic for almost every module. I think we will see a positive return.

People are always asking me what kind of healthcare IT company they should start. What would you say to somebody who’s contemplating that and wonders where the opportunities might be?

The best opportunity is to be a partner and a problem solver. Obviously if they’re not able to solve complex problems, then that niche is not there. Understand the various problems that facilities and healthcare facilities are facing these days and try to find a niche as far as where they can fit in. It’s very easy for someone to be a generalist, but I think focus on a specific area, a few specific niches. That’s where they would stand out.

A perfect example that came to my mind is I worked with a consultant that knew how to help a healthcare facility qualify for and maximize their DSH, Disproportionate Share Hospital, reimbursement. That’s a niche market. There aren’t too many people that can go into successfully and help a non-DSH hospital become qualified for DSH. These are special sort of niches that are valuable. Otherwise, it’s very hard for a small firm that is more of a generalist to be successful in the long run.

Morning Headlines 11/25/13

Tension and Flaws Before Health Website Crash

The New York Times says the White House, CMS, and the prime contractors all knew that Healthcare.gov was not ready for its October 1 launch.

THE HIT GROUP

Sunquest forms The HIT Group, a group of health IT vendors calling for FDA regulation over the health IT marketplace. Sunquest is hoping other vendors join its call for stronger and clearer regulatory guidance. Meanwhile on Capitol Hill, legislators hear testimony from FDA representative Jeffrey Shuren, MD concerning the recently proposed SOFTWARE Act which would restrict the FDA from exercising oversight on EHRs and clinical decision support tools.

Providence moves to save $5M at western Montana hospitals

Providence Health’s western Montana region, which includes St Patrick Hospital and St Joseph Medical Center, will lay off an undisclosed number of employees in an effort to offset the cost of hiring additional staff to support the network’s EHR.

So much data-gathering, so little doctoring 

A Los Angeles Times op-ed piece by gastroenterologist Michael Jones, MD calls EHRs "the latest wrench the healthcare industry has thrown in the way of doctors just listening to their patients." He goes on to explain that he left academic medicine for a small private practice, where he still hand writes all his notes and then calls the referring physician to discuss his findings.

Monday Morning Update 11/25/13

My job is to listen and observe, to figure out who really does have something bad going on and who may simply be feeling the effects of life’s wear and tear. There’s a huge difference between that and the healthcare industry, which is more about industry than health or care. Third-party payors don’t really care what happens in an exam room. The visit that you, as a patient, have been anxiously waiting for could just as easily be shoes or oranges or pork bellies to these folks. It’s just a commodity. It’s just data. And now the industry wants it documented in a format that works for billers and statisticians but not so much for doctors: the electronic medical record.

Sponsor Updates

• Prominence Advisors is named as a “National Best and Brightest Companies to Work For” for 2013.
• Infor announces enhancements for its MediSuite system for hospitals in Canada, including workflow enhancements, the addition of care models, and improved physician integration.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 11/22/13

Children’s Medical Center Selected as 2013 Enterprise HIMSS Davies Award Winner

Children’s Medical Center in Dallas, TX has been named this year’s HIMSS Davies award winner.
Administrators at Children’s used their EHR to introduce standardized clinical pathways that have decrease variation in care and significantly improve patient outcomes.

Cedars-Sinai Taps iPhone For Enterprise Mobility       

Forbes profiles Cedars-Sinai’s roll out of iPhones for its nurses. CIO Darren Dworkin says "The iPhone, while a consumer device, has been the first real platform on which we could see our core vendors, like Epic, and an eco system of new vendors, like Voalte, coming together to deliver the workflow that our nurses and doctors deserve."

Clinovations Launches Center for Population Health Management

Clinovations, a Washington DC-based healthcare consulting firm, announces the formation of a center that will focus on designing and implementing population management and value-based care delivery systems.