CIO Unplugged 9/18/13

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

Executive Success – The Secret Unplugged

(Actual Unplugged posts indicated this blog have been renamed for the sake of humor.)

The wealthy York Pepperdine, president of the distinguished Pepperdine Software Corporation, had just finished attending his 30th high school reunion with his wife. Their former classmates embraced these high school sweethearts and offered the executive kudos for his success. Afterward, the couple enjoyed a drive through the town, dropping by their old hangouts and reminiscing their teen years.

Mr. Pepperdine asked his wife, “Did you talk to Gunter?”

“Do you mean Gunter Hockledorfer, the man I dated before I went out with you?” His wife’s Mona Lisa smile made him nervous. “We exchanged greetings. Why?”

“It’s sad that he didn’t do much with his life. He manages the gas station on Main Street.” Mr. Pepperdine winked at his wife, hoping his smugness didn’t show in his expression. “Just think, honey. If you had married Gunter you’d be a gas station manager’s wife today.”

She patted his leg. “Trust me, dear. If I had married Gunter, I would be Mrs. Hockledorfer, wife of the nation’s most successful gas corporation president.”

The above tale, though fictional, reflects the saying, Behind every successful man is a strong, or good, wife. (Feel free to switch around the genders to suit your scenario.)

If that adage is no longer politically correct, then how about this old proverb: He who finds a wife finds a good thing. Darn it, that’s still cliché and too traditional for “CIO Unplugged.”

Chill. You’ll get over it.

I’ve overheard people closest to Ed say, “Boy, it’s a good thing Edward Marx has Julie for a wife.” I laugh at this, not at the cliché implication within the wording, but because I know what it takes to keep things running behind the scenes in the Marx household—a sense of humor.

What really goes on behind the scenes, you ask?

Climbing mountains, running races, Ironman, Tango, speaking at every healthcare function between New York and LA … Does Ed ever slow down? Not really. Part of that is because God wired him to be a virile force within his circle of influence. The other part is Ed simply over-pushing the envelope and forgetting his Margins. Purposeful and radical trying to co-exist.

Where do those interesting and provocative blog messages come from? Disrupt the Heck Out of Your Workplace or Kill the Devil’s Advocate. Does he live that way at home, too? Yes. Life is never boring or stale.

What about the posts he regrets writing: Multitasking—Killing 50 Tasks in One Hour on the Treadmill? To which I said, Bad idea, honey. And that led to the post: I Take That Back. This all comes with the learning process. Few people, like Ed, aggressively seek to learn and grow, and growth requires making mistakes.

With the exception of the two-piece suit, Ed Marx is genuinely the same in private as he is in public. Ninety-eight percent of the blogs he writes spring from what he’s currently dealing with at work. “CIO Unplugged” is his method of working through his issues. A therapy of sorts.

Here are survival tips from how this executive’s wife manages behind the scenes:

• Balance. At all costs, avoid falling into the same trap. Life is meant to be enjoyed not glanced at while constantly on the run. Be the smiling example where Mr./Mrs. Do-it-All can see your stark calmness amid his/her self-made storms. Gently express concern for his/her health (mental/physical) but realize they might have to pay the consequences before learning this lesson. When he comes to you with the suggestion that you both should slow down and enjoy life, just kiss him and tell him how brilliant he is.
• Support. I belong to the Edward Marx Support Group. Seriously, we’ve been meeting once a month for five years. We share stories and sympathize with one another over the pressure Ed doesn’t realize he’s putting on us. Then we conspire how to change his course through prayer and by governing his calendar. Trust me, his executive assistant and I do our best behind the scenes to keep Ed from derailing himself.
• Genuine. We spend very little time together with other exec couples because Ed is busy mentoring and serving those under him, and I prefer it this way. We’re both mentors, and we look at our joint role as one that complements and serves. Joy is found in serving, not being served, so I eagerly open our home and try to be real with his peeps. (Hospitality isn’t your strength? Take a Dale Carnegie Course.)
• Identity 1. Knowing who you are is essential to thriving under corporate-ladder pressure, especially when the exec’s spouse is often referred to as “Ed’s wife.” Not to mention how we’re stereotyped as unapproachable, stuck up, and superficial. Ignore all the nonsense and find your source of true identity. For me, it’s in God.
• Identity 2. A person’s source of identity should never be found in the temporal or the materialistic, in nothing that fades or rusts with use. The money any exec makes will never satisfy, so don’t bother finding yourself there. Never look to your exec for fulfillment or personal significance. Instead, look to something bigger than life, unchanging, and solid as stone. Pray constantly. And learn to laugh.

I’m not sure what motivated Ed to ask me to write this post—except that perhaps he’s behind on all his blogs at the moment. Do I consider myself his sole secret to success? No, it’s a team effort. His admin, his 600-person department, his boss, mentors, direct reports, and—whether or not you realize it—you the readers help make up that team. So I thank all of you, including the adversarial and accusatory readers. Possessing the solid identity mentioned above helps us clip the thorns while inhaling deeply of life’s roses.

Edward Marx’s wife writes suspense novels. Her hobbies are fitness and nutrition, which help her keep Ed healthy. You can find Julie and her traditionally-published books at http://online.jamarx.net/

Morning Headlines 9/18/13

The Forbes 400 Richest People in America

Judy Faulkner ranks #243 on Forbes 400 richest people in America. Cerner CEO Neal Patterson comes in at #352.

Government Seeking Inclusion of ‘Social and Behavioral’ Data in Health Records

CMS is looking into adding of social and behavioral data elements as mandatory structured data elements of Meaningful Use Stage 3. The National Academy of Sciences is studying how best to add social and behavioral data within EHRs.

New Telemedicine Bill Floated in the House

The US House of Representatives is considering a proposal that would help clear some of the current barriers to telemedicine by enabling doctors to treat Medicare patients over video across state lines.

News 9/18/13

Top News

Here’s a news item that Judy Faulkner probably won’t mention when addressing the Epic masses in Verona this week. She earns the #243 spot on the annual “Forbes 400 Ranking of the Richest Americans” with an estimated net worth of $2.3 billion. Terry Ragon of InterSystems, which sells the Caché database that runs Epic and other healthcare IT systems, also makes the list, tying Cerner’s Neal Patterson in the #352 position with a net worth of $1.5 billion.

Reader Comments

From Spacey: “Re: Epic UGM. Over 15,000 people in attendance including 8,500 customers and 6,600 Epic employees. They now cover over 50 percent of US patients!” We reported in 2010 that attendance was 5,500 versus 3,800 in 2009. At the rate the Epic UGM is growing, it could surpass the HIMSS conference in a few years.

From GomiesGone: “Re: Nuance. Dropped the ball by failing to release Dragon Medical Network DM360 v2.0 as promised on September 16. Word is upper management is arguing over logistics.” Unverified.

From Curious: “Re: Epic. Looks like they’re no longer hiring project managers / installers for their US locations. Does anyone know why?”

From Reluctant Epic User: “Re: HIStalk. If you’re ever in my town and willing to blow your anonymity, I’d be thrilled to buy you a beer or two for the great work you do. People in my health system routinely think I’m a genius simply because of knowledge I have gained by reading your site faithfully for the last six years.” I appreciate both the nice comment and the six years of reading. I do like beer, so that just might sway me.

Acquisitions, Funding, Business, and Stock

In England, Emis, which provides physician practice systems, will buy hospital systems vendor Ascribe for $95 million.

A UK report says that CSC will pay $98 million to settle a class action suit in which shareholders claim the company knew its Lorenzo EMR, developed by iSoft, could never be implemented in the NHS’s NPfIT program long before a Department of Health breach of contract charge sent shares down sharply. Meanwhile, a watchdog’s report says costs continue to pile up for the failed NPfIT project because of ongoing liabilities and vendor termination fees, leading it to conclude that the project is “one of the worst and most expensive contracting fiascos in the history of the public sector” as updated cost estimates are revised upward to $15.5 billion vs. an estimated benefit of $6 billion.

Sales

Hunt Regional Healthcare (TX) will implement T-System PerformNext Care Continuity.

Tift Regional Medical Center (GA) will deploy RelayHealth’s RelayClinical platform for its HIE.

NYC Health and Hospitals Corporation selects Elsevier’s ClinicalKey to provide electronic medical reference and knowledge-based information to its clinicians.

CentraCare Health (MN) selects Strata Decision Technology’s StrataJazz for costing accounting, operating budgeting, capital planning, and rolling forecasting.

People

The Massachusetts Technology Leadership Council names athenahealth CEO Jonathan Bush CEO of the Year and Nuance Communications CTO Vlad Sejnoha CTO of the Year.

Voalte hires Kenda West (Johns Hopkins Medicine) as COO.

Amazing Charts names John Squire (Microsoft) president and COO.

Coastal Healthcare Consulting hires Gay Fright (Pivot Point Consulting) as EVP of business development.

Virtual Radiologic names Shannon Werb (Acuo Technologies) as CIO.

Bill Keyes (Allscripts ) is named SVP of sales of CoCENTRIX.

HIMSS recognizes Farzad Mostashari, MD, Congressman Tim Murphy, CMS Administrator Marilyn Tavenner, and Rhode Island State Representative Brian Patrick Kennedy with HIT Leadership Awards in recognition of their work to improve health with IT initiatives.  

WHITEC, the Wisconsin REC, provides a bow tie tribute to outgoing National Coordinator Farzad Mostashari, MD.

Announcements and Implementations

Mid Coast Hospital (ME) implements Gemalto’s Sealys MultiApp ID smart cards and LifeMed ID’s SecureReg solution to enable secure patient authentication.

Children’s Medical Center Dallas (TX) launches its TeleNICU, which will provide regional hospitals with access its neonatologists.

HIMSS awards the University of California-Davis Medical Center its 2013 Enterprise HIMSS Davies Award of Excellence.

HealtheLink connects three other New York state RHIOs to provide sharing for 5.4 million patient health records and links to 44 hospitals.

VitalWare introduces VitalCoder, a coding and compliance resource that includes real-time, automatic updates for organization-specific coding, regulatory, and financial data.

Nuance Communications announces an Epic-optimized version of its Dragon Medical 360 | Network Edition that contains 1,000 customized commands to enhance physician productivity in a Citrix environment.

PDR Network launches PDR+ for Patients, which incorporates drug  information into EHRs so that prescribers can discuss proper use with patients during the encounter.

Government and Politics

ONC releases online tools for providers and HIEs to educate patients about the electronic sharing of health information. 

ONC also publishes models for Notices of Privacy Practices for healthcare providers, which reflect the Omnibus Rule regulatory changes that go into effect September 23.

CMS commissions the National Academy of Sciences to study how best to add social and behavioral factors to EHRs without compromising privacy.

GAO identifies 12 potentially duplicate investments at three federal agencies that over the last five years have accounted for $321 million in IT spending, including $256 million for four HHS information security systems.

The House of Representatives is considering the TELEmedicine for MEDicare (TELE-MED) Act of 2013, which would allow Medicare providers to treat patients across state lines using telehealth technology without requiring them obtain medical licenses in multiple states.

Innovation and Research

A study published in The Journal of Maternal-Fetal & Neonatal Medicine finds that neonatal depression can best be predicted not only by common excessive uterine contractions, but also the concurrent presence of fetal heart rate deceleration. The study used tracing data from PeriGen’s PeriCALM system, which allows real-time detection of the condition.

Technology

PatientPoint releases PatientPoint Tracker, a patient engagement tool for tracking patients across the care continuum.

Caradigm releases Care Management, a population health management tool developed in partnership with Geisinger Health Plan.

Other

Canada becomes the thirteenth country to issue a patent to MMRGlobal’s MyMedicalRecords  subsidiary for its online medical records technology. In an MMR press release, the company notes it is negotiating an agreement with an investment fund specializing in financing the enforcement and licensing of global intellectual property rights which would “maximize MMR’s ability to exploit its global health IT patent portfolio.” “Exploit” sounds like an appropriate term to describe MMR’s apparent  modus operandi.

An Accenture survey finds that 40 percent of Americans would switch doctors to gain online access to their electronic medical records. That sounds like a suspiciously high number and no doubt it is – Accenture conducted the survey online.

CHIME President and CEO Russ Branzell pens a National Health IT Week piece called “HIT Capabilities – They Are Personally Important to Me.”

MU Stage 2 is accelerating EMR-specific patient portal adoption, though the trend is negatively impacting best-of-breed vendors that are not as well equipped as EMR offerings, according to a KLAS report on patient portals. Athenahealth, Epic, and Allscripts were the top-performing vendors.

A population health management report created for institutional investors by equity research firm JAAG Research concludes that the big PHM market opportunities are at least 10 years away; that lack of data standardization, timeliness, and completeness makes a “Big Data Mess;” and on the CommonWell Alliance “Maybe it’s just us, but all of this soft, ‘.org’ alliance, love-in, ‘we’re in this together for the good of the patients’ blather sounds more like a plan for each vendor to appear collegially engaged from a public policy perspective while keeping the government from forcing a solution on the market. Meanwhile, each ‘member’ works on its own, potentially more profitable solution, outside of the auspices of the happy ‘.org’ shell.” It concludes that “PHM will require a reengineering – almost a complete rebuild – of the healthcare payment and delivery process as we know it.” It’s an excellent report and a tremendously fun read.

R&D spend by major EHR vendors. #Epic #UGM2013 pic.twitter.com/wMfMREgfmx

— Jon Palma (@jonpalma) September 17, 2013

Me & 15,300 others. #UGM2013 pic.twitter.com/AwFx59cFu2

— Melissa MT (@LissaMinnesota) September 17, 2013

I found the Epic UGM tweets and photos above using the cool page that Vonlay built to curate the event. Look carefully and you’ll see Judy in her Avatar outfit.

Weird News Andy titles this story as “Doctor Gives Patient the Finger.” A Florida doctor grows back a man’s amputated finger by using a pig’s bladder as a mold.

Sponsor Updates

• CCHIT certifies that Wellsoft’s EDIS v.11 is compliant with the ONC 2014 Edition criteria and certifies it as an EHR Module.
• NCQA awards Case Management Accreditation to Alere and OptumHealth.
• Quantros hosts its first annual Pharmacy Quality and Safety Summit September 25-26 in Sarasota, FL.
• Valence Health launches its Pathfinder Accelerator Grant program, which makes $1 million available to hospitals and health systems to apply towards Valence Health’s Pathfinder services for transitioning from volume-based to value-based care.
• Vocera Communications CMO Bridget Duffy, MD will discuss improving the patient experience at two upcoming industry events.
• 3M Health Information Systems will offer its suite of ICD-10 and CDI consulting services and software integrated with MedPartners HIM’s credentialed and clinical documentation improvement staffing resources.
• Consulting magazine recognizes Aspen Advisors, Cumberland Consulting, and Impact Advisors on its list of “Best Small Firms to Work For 2013” and Deloitte Consulting on its list of  “Best Firms to Work for 2013.”
• Frost & Sullivan presents Vitera Healthcare Solutions its 2013 North American Customer Value Enhancement Award for outstanding performance and success, which recognizes the company’s focus on implementing strategies to create customer value.
• ReadyDock partners with IT provider Red River.
• Managed Health Care Associates will launch MHAuthorizeRx, a solution powered by CoverMyMeds and designed to streamline the drug prior authorization process for pharmacies.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 9/17/13

Customized Version of Dragon Medical for Major EHR

Nuance announces a customized version of its Dragon Voice Recognition product designed to streamline physician workflow within the Epic HER. Nuance’s tailored voice recognition program can launch more than 1,000 functions within Epic based on voice recognition commands.

Digitize patient records

James Noga, CIO at Partners HealthCare (MA), writes a Boston Globe article outlining the importance of implementing a single, integrated EHR (Epic) across Partners HealthCare’s two flagship organizations: Brigham and Women’s and Mass General Hospital.

Study finds $321 million in wasted technology spending

A Government Accountability Office report released last week finds that $321 million in taxpayer dollars has been wasted on federal technology projects over the past five years, including $256 million on HHS projects that were deemed "duplicative" and unnecessary.

Rural areas striving to meet health records requirements

In a local OpEd, Senator John Thune argues that Meaningful Use requirements may be unrealistic for some rural hospitals to achieve and that the law should include more flexibility when penalties kick in.

Curbside Consult with Dr. Jayne 9/16/13

I mentioned in last week’s EP Talk that I’m preparing to sit for the Clinical Informatics board exam next month. At the board review course I attended recently, there were several comments about the recommended reading list published by the American Board of Preventive Medicine. At some point during the last few months it grew from something like six books to a dozen, plus relevant journal articles. Luckily I came into the process a little on the later side, so the list has already been its current length. Being the compulsive over-preparer that I am, I had decided a couple of months ago to at least make the attempt to read all of them.

The first challenge was cost. Many of the books on the list are textbooks. Renting them, buying them used, or getting the Kindle editions would have been over $1,000. I hit my local library website and found that only one was available – John Kotter’s Leading Change. If you deal with IT implementations, project management, or anything related to healthcare or healthcare IT and haven’t read this book, you should add it to your list. It’s quick – only 200 pages – and explains some key elements of projects that involve change. His eight reasons that change efforts fail are often visible in projects I encounter, which continues to surprise me when no one seems to have made attempts to remediate them.

Although the overall cost was a concern, so was the cost of some of the individual texts. I didn’t want to get stuck with a bunch of expensive books that I’m not sure I would use again (even if they were electronic and wouldn’t be hanging out on my bookcase) so I decided to go old school with my studying. I’m a good 25 miles from my nearest academic medical library, so I decided to request them through my local public library. Allow me to just say that Inter-Library Loan is a thing of beauty. Before long, I had many happy emails telling me that books were ready. The first one came in from the University of Nebraska at Omaha and it soon became a little game to see where they would be coming from. Unfortunately their arrival was a little unpredictable, and receiving three thick texts at the same time was giving me unpleasant flashbacks of my first year of medical school.

The second challenge in reading some of the materials was their age. Some of the books on the list were written more than 15 years ago. I enjoyed taking a ride in the Wayback Machine while skimming through the chapters on how computers became part of the healthcare landscape and learning more about some of the foundational systems for clinical care. Except for when I was a Candy Striper, computers have always played a role in patient care during my career even if it was just a lab information system. It was fun to see the pictures of some of the early information systems as well as the sideburns that went with them.

Nearly all of them were written in a world before Meaningful Use. In some ways, that was a less complicated age, even if the tools were less sophisticated. Some of the texts are more targeted towards administrators or non-clinicians and it was interesting to see what people on the other side of the street think or know about what we do.

The third challenge was dealing with the fact that I had the readings in textbook format. It’s been a long time since I turned the pages of anything thicker than a good mystery novel. After a week or so of reading, I had a muscle spasm in my neck that didn’t do much for my concentration. One of my Australian colleagues had given me The Book Seat as a gift and I have to say it was a lifesaver for propping those 800-page books at an angle that made them easy to read. I also ran across one book about informatics in public health that was printed in a typeface that was blurry and distracting. I’m not sure if it was just the copy I had and since it was from the University of Ontario it wasn’t like I could just run out and get another copy, so I had to power through it.

Forcing myself to try to read all the books was an experience in discipline. It reminded me how often all of us have to multitask and how little time most workplaces allow for intellectual pursuits. I thought about a couple of presentations that I had given over the last year or so that could have been more powerful had I included some of the concepts from the readings. Although some of the books were more general than I expected, it’s nice to know about them and to be able to recommend them when people ask about “getting into informatics” or how computers impact healthcare. I’d recommend Thomas Payne’s Practical Guide to Clinical Computing Systems: Design, Operations, and Infrastructure for physicians and other clinicians who have been volunteered as the clinical champion on a project or who don’t have a lot of experience with computers.

One of the books I most enjoyed reading was one of the ones that came last – Health Care Information Systems: A Practical Approach for Health Care Management. In addition to some IT fundamentals, authors Wager, Lee, and Glaser include a lot of information about structure and management of IT organizations. That topic won’t necessarily be on the test, but it should be required reading for groups who have trouble delivering solutions on time and on budget. There are some solid discussions of project management, goal setting, and accountability in there that are worth the time to read and share.

Several of the books I ended up skimming through because I felt comfortable with the material – I should do well on the architecture and infrastructure parts of the exam. Others I read a little slower because I needed to do some brushing up or because they had chapters by people I know in the real world. It’s always more interesting to read something a friend has written, especially when you find quirky phrases or descriptions that remind you of how they speak in person.

The major benefit of doing the formal board review course and reading the texts was being able to link the knowledge I’ve built from experience back to the scholarly material describing it. I can rattle off a lot of real-world information about change management, but I’m sure being able to link various techniques back to their formal names and methodologies will be helpful for answering boards-type questions. A couple of us joked about whether they should have offered an oral board exam. That would really help an examining body determine whether we’re qualified to handle the trickier situations we encounter on a daily basis.

I promised some informatics humor, so I’ll leave you with this quote from Thomas Payne at the University of Washington. It’s such a simple assessment, but given the things I’ve seen in the last week, it makes me laugh: “It’s great to have an EMR. It’s even better if you use it.” Here’s to all the great users out there and a special thanks to the library staff across the country that helped the books find their way to Casa Jayne.

E-mail Dr. Jayne.

University of Iowa Health Care’s Pager Replacement Project

University of Iowa Health Care has been receiving a good bit of press after a local TV station ran a story called “Bye-Bye Beepers” that implied the health system is eliminating pagers. I spoke to Patrick Duffy, administrative lead of the technical operations division, who says that isn’t quite the case.

The health system still hasn’t figured out how it can replace pagers for off-campus use, but it has moved inpatient nursing unit communication to Voalte running on iPhone 4S phones. “We’re doing what we said we wouldn’t do – adding a device – while eventually moving off the paging system,” Duffy says. “Also integrating with nurse call, and hopefully eventually monitors and Epic.”

The hospital has 8,000 pagers with extensive workflows based on their use. But according to Duffy, “As good as they are at doing what they do, we were having more and more issues with not being able to close the loop and have that acknowledgment.”

The health system went through several technologies before deciding on Voalte. They tried several hundred proprietary NEC devices, but ran into problems with network access. Cisco Voice gave them full Wi-Fi coverage throughout their 4 million square feet, but users kept asking how to send text messages on the Cisco 7925 wireless phones. Some users favored Vocera’s hands-free capabilities, while Microsoft Lync was also considered.

”We wanted more of a platform and not just a pager replacement – two-way, secure, and with message acknowledgment,” Duffy says. “Voalte made sense since we wanted to make a decision right away.”

I asked Duffy how his department determined which pager users were candidates for iPhones. “We talked to the nursing managers and medical directors. We asked, who do you communicate with? We got a list of who had pagers, who had Cisco phones, who gets all of their pages during the day on the unit, what are the needs for external paging outside the facility.”

Wholesale replacement of pagers may occur down the road, but the health system has no specific timeline or plan. UI is looking at Voalte Me, which runs on personal iPhones and possibly eventually on Android phones. Hospital operators use Amcom for paging and it has its own mobile app that can run on personal devices. Users who don’t need alarming and alerting capability could get by with simpler paging capabilities running on their personal phones. For users who send messages via Amcom’s Smart Web paging application, messages can be sent to pagers, personal iPhones, and Outlook email, although guaranteed delivery of the message is up to the carrier. UI is also looking at HIPAA-compliant secure texting.

Eliminating nursing unit pagers has provided other benefits. “It’s quieter,” Duffy says. “Pagers aren’t going off, phones aren’t ringing. We’re trying to reevaluate the model for our wired phone presence and the impact of mobility on our legacy systems.”

Advisory Panel: Patient Portals

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: Do you have a patient portal, and if so, what can patients do on it?

We have a new patient portal from Epic that was implemented as of August 1. Currently, you can view results, appointments and prescriptions on-line or on your mobile device, send messages to your provider, and pay your bill. It also has health maintenance alerts. Future functionality will include self-scheduling of appointments.

We’re working on the policy & procedure of what we want patients to do in the portal before we start actually implementing.

We currently have a patient portal from our outpatient EHR vendor. Over the next year we anticipate migrating to an enterprise patient portal that will cover both our hospital and physician practice arenas. Currently patients can: see basics of their medical information, request appointments, request medication refills, send a medical question, receive documents, pay their bill, and research health information using a provided library.

Yes – custom built. Patients can see lab results, see their meds and allergies, request changes to these, request appointments, pay bills, send a message to their PCP. 

We have been live for many years and focus on what we think patients want to do most: Communicate with their doctors, Communicate with admin staff (e.g. billing, referrals), and request appointments. We will eventually add in the ability to view their EMR data, but it has not actually been a big request from most patients. The key has always been around communication. 

We use Epic’s MyChart. It went live last September. In the first release, patients have access to refill requests, appointment requests, and portions of their medical record, visit history, and upcoming appointments. Future releases will increase functionality and data access.

We do but for Allscripts/Clinic services only. Not much right now, scheduling details, and that’s about it. Not all offices have the feature enabled.

Yes but it is not yet live. Includes: access their billing statements; pay bills online; request and manage appointments; view, print, and securely email their medical information; access discharge instructions to improve patient care;  update their information and manage their medical history.

MyChart of course. Pts can: request appts, send messages, view all sorts of stuff (visit summaries, letters, etc.). We are just now going live with questionnaires (health summaries) and health maintenance reminders.

We have a patient portal for the hospitals but due to having disparate systems (hospitals vs ambulatory clinics) will require multiple portals or will use our HIE.

Yes. View lab results, delayed until released by the physician, and browse patient education material, tailored to their age, gender, ICDs and CPTs. Editorial: our patients should be able to see their entire record, and lab results as soon as they are available, not pending review by the physician.

Morning Headlines 9/16/13

Allscripts CFO: ‘We’re not a rehabilitation case’

Allscripts CFO Rick Poulton responds to a local news article that calls Allscripts a struggling EHR company and a poor example to smaller health IT startups in the Chicago area. Poulton cites the 2010, $1.35 billion Eclipsys acquisition as well as “a lot of self-inflicted wounds in 2011 and 2012 that we’re still digging out from” as the source of the company’s problems, but defends the more recent decisions and trajectory.

LexisNexis Acquires Enclarity

LexisNexis announces the acquisition of Enclarity, which collects billing and quality data for US providers that will be added to the LexisNexis clinical analytics platform.

Tullman, Keywell take aim at health care

Former Allscripts CEO Glen Tullman will partner with Chicago entrepreneur Brad Keywell to form health IT company Zest Health, which will offer a consumer-oriented mobile health app and an employer-oriented benefits manager.

#UGM2013 Guide to the Galaxy

Vonlay publishes a guide to the 2013 Epic User Group Meeting being held this week in Verona, WI.

Monday Morning Update 9/16/13

From Thinking UGMs: “Re: user group meetings. Our company is getting large enough to be considering holding our first user group meeting. Do you have ideas?” It’s a great question – quite a few companies are getting big enough to consider throwing a UGM. Let’s crowdsource the idea – take the survey I created and I’ll collect and publish all the ideas right here on HIStalk. What factors would help make a company’s first user group meeting successful?

From Neutron Jack: “Re: HealtheWay. It’s supposed to be the national backbone for clinical data traffic, but maybe it’s not ready for prime time production.” A reader forwarded an email detailing abysmal technical support from the public-private collaborative that supports the eHealth Exchange, formerly the ONC-run program known as Nationwide Health Information Network Exchange (NwHIN, although technically it should have been NwHINE).  A simple support ticket didn’t get a response for a week despite three requests and an email to the CEO.

From Keeping the News: “Re: MEA/NEA. Did you see the company that Lindy Benton runs has been acquired by Accel-KKR? MEA has grown with their esMD participation. This could take the company to the next level.” Lower middle market private equity firm Accel-KKR takes a majority position in EA Holdings, which owns National Electronic Attachment (NEA) and Medical Electronic Attachment (MEA). The companies offer a platform for the electronic exchange of medical and dental claims attachments.

From The PACS Designer: “Re: Big data. Recent comments on HIStalk about big data deserve a response. TPD never uses big data in early conversations with customers since it is so vague and can falsely represent giving data viewers valuable information about their practices. For big data to add the value proposition, you need to transform your data through vendor partnerships so the greatest gain in value can be achieved. Only when you impress intended users can the real value be realized for storage of big data.”

From Informatics Professor: “Re: HIPAA Omnibus webinar. Best information I have gotten on the topic. As always, HIStalk is the best source of info on anything related to HIT.” Thanks for those nice words, and thanks to Rebecca Fayed and Eric Banks of The Advisory Board Company for doing their presentation pro bono for HIStalk’s readers.

Webinar

 

Health Catalyst will present “Predictive Analytics: It’s the Intervention That Matters” on Tuesday, September 24 from 1:00 to 2:30 p.m. EDT. It’s a great topic: predictive analytics aren’t worth much if an organization doesn’t have the culture and process to intervene effectively to help the patient. Presenters will be Dale Sanders (SVP) and David Crockett, PhD (senior director of research and predictive analytics). Both are amply credentialed to speak on the topic — Dale’s been a CIO and data architect, while David is a PhD in biomedical informatics and pathology expert. I’ve signed up.

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

I’ve had two recent needs met by one free (for personal use) software tool: TeamViewer. It’s really cool for remoting into someone’s PC to fix problems and also for transferring files from their PC to yours. I leave my desktop PC on all the time and Dropbox is good if you know in advance what files you might on other devices (like a laptop or phone), but TeamViewer allows navigating the entire hard drive in a password-protected session. It can also be used like GoToMeeting to run desktop sharing, as in online meetings and training.

Welcome to new HIStalk Platinum Sponsor MedData and its company MedDirect. The Brecksville, OH-based MedDirect provides reimbursement for outstanding patient balances while improving the patient experience. Utilizing proven patient segmentation and outreach strategies that educate, engage and communicate with patients in a way that drives results, MedDirect ensures that patients are treated with dignity and respect, exceeding patient expectations throughout every interaction. MedDirect services include innovative solutions for outstanding patient balances, patient satisfaction services, appointment scheduling and reminders, registration Point of Service payment portal, and patient billing. Thanks to MedDirect for supporting HIStalk.

Former Merge Healthcare CEO Jeff Surges will be named Monday as board chair of population health management systems vendor Strategic Health Services. Co-founder Tasso Coin will continue as a director.

GetWellNetwork will on Monday announce that Karen Drenkard, PhD, RN (American Nurses Credentialing Center) will join the company as chief clinical/nursing officer.

Medical provider database vendor Enclarity is acquired by LexisNexis Risk Solutions, joining previous acquisitions MEDai (analytics) and EDIWatch (fraud detection technology).

Texas Health Presbyterian Hospital Rockwall is implementing patient engagement technology from Emmi Solutions.

Thousands of Epic users are in Verona, WI this week for UGM. Madison-based Vonlay provides a user guide for attendees that includes useful tips, such as how to get to a local brewery using the hotel shuttles and where to rent bikes.

It’s only slightly HIT-related, but fun. Jeff Travis, a biomedical engineer who developed the database architecture of the Premise Patient Flow solution years ago, is now a filmmaker. Dragon Day, his first feature-length film, will premiere in theaters on November 1. It’s an ingenious plotline and looks like a fun watch if you like doomsday thrillers (and I do).

A Covisint-Porter Research study to be released Monday finds that provider executives are comfortable with the concept of cloud computing. Also: a third of respondents say their EHRs lack population health management capabilities and accountable care is on the radar or providers but isn’t a reality for them yet. The fact that jumped out at me is that most providers are still getting most of their inbound information by fax. Healthcare: the retirement home for 1980s technology.

The Congressional Budget Office says that replacing Medicare’s sustainable growth rate (SGR) reimbursement formula will cost $175 billion of your taxpayer dollars. CBO also found that very few Medicare demonstration projects actually reduced Medicare spending.

The local paper profiles Mary Carroll Ford, SVP/CIO of Lakeland Regional Medical Center (FL), although it manages to misspell her name in its headline.  

Allscripts CFO Rick Poulton, responding to a Chicago business paper’s dismissal of the company as a poor example for the city’s healthcare IT sector, says Allscripts is recovering from “a lot of self-inflicted wounds in 2011 and 2012” but concludes that, “We may not be as pretty as we could be, but we’re not a rehabilitation case.” Poulton blames the company’s problems on its 2010 merger with Eclipsys. He says Allscripts is still trying to integrate its hospital and ambulatory systems to compete with Epic’s “one patient, one record” architecture. Poulton has been with the company for less than a year.

The respective investment firms of former Allscripts CEO Glen Tullman and Chicago entrepreneur Brad Keywell form Zest Health, which will offer mobile apps that include Talk to Me (mobile phone access to clinicians), Schedule Me (booking medical appointments) Inform Me (patient education), and Track Me (a personal health record). Tullman’s company includes former Allscripts President Lee Shapiro. Zest Health’s CEO is Karen Ferrell, former CEO of Apollo Health Street.

Weird News Andy calls this Migration Malfunction. Patients of a Tacoma, WA non-profit breast center find that their electronic medical records contain information from other patients after a system conversion going back to September 2012.  A medical record number glitch caused problems, especially with scanned documents, in converting to the center’s radiology information system. The patient who complained to the state found that her 900-page chart contained 141 pages of information that wasn’t hers.

WNA also likes this item, which he clarifies isn’t about chastity belts, but rather security “breaches.” An employee of Minnesota’s new health insurance exchange releases the confidential information – including Social Security numbers – of 2,400 insurance agents by accidentally sending the file to an insurance broker’s office.

Vince’s HIS-tory of Cerner Part 5 covers HNA and acquisitions.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Time Capsule: Who Wants to Be a Healthcare Millionaire?

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

I wrote this piece in June 2009.

Who Wants to Be a Healthcare Millionaire?
By Mr. HIStalk

I’m a conservative capitalist, but I’m inherently distrustful (jealous?) of anyone who is obscenely wealthy (like most people, I define that as anyone making more than me). For that reason, I can’t decide how I feel about the $30 million in compensation that McKesson paid CEO John Hammergren last year.

As a capitalist, I say more power to him. The board sets his compensation and they should know what he’s worth to the company. That’s how the free market system works (recent spectacular free market failures aside). Greed is good.

On the other hand, I’d be miffed I owned MCK shares, which dropped by a third during that same year. They’re still worth less than half of what they were when McKesson paid $14 billion for HBOC in 1998, only to find out its books were stored in the fiction section. Why is the CEO raking it in but shareholders and 401K employees are losing their nest eggs? (I can’t see from SEC filings that he evens owns any shares, which probably doesn’t inspire much confidence in those who do).

I might be upset as a customer, seeing where my McKesson products fall in the rankings and not getting much innovation for my investment. Heck, Steve Jobs only made $15 million in 2007 and the man invented the iPhone and changed the world, for goodness sake.

I’d be furious as a general critic of CEO compensation. Hammergren’s comp is something like 1,000 times that of the average employee, actually hitting a reported 5 percent of total company earnings last year when he supposedly took home $59 million. He’s also got what magazines have said is the largest going-away nest egg of any American CEO at $85 million (companies spend a fortune getting a CEO and then another one to get rid of them). Surely the financial and automotive industries taught us that companies have no backbone when it comes to paying their executives rationally.

I’m personally upset is as a healthcare purist working stiff. All we on the ground hear is how we have to sacrifice and put the brakes on endless healthcare price increases. No more generous 3 percent pay raises, cafeteria discounts, or travel budgets. The hospital CEOs telling us that are often making $1 million or more a year, as breathtakingly excessive for a non-profit as Hammergren’s $30 million. The people on the wrong end of the decision are wearing scrubs and actually delivering the only service the hospital is paid for – too bad they toil in the non-carpeted areas of the hospital.

Who should be most miffed, though, are consumers watching their medical insurance get more expensive even as it covers less. McKesson basically resells drugs, a manufacturer’s middleman holding and distributing inventory. Is that really such a valuable service? And is running a hospital really such hard work that nobody would to it for less? Is running a mid-sized IT department really worth $300K?

If we get serious about healthcare reform, we cannot avoid debate about who, personally, is making what. I don’t know if the average citizen wants to finance $30 million middleman CEOs, $2 million hospital CEOs, and $1 million doctors. Healthcare must not be much of a calling if nobody in it is willing to work cheaper.

But here’s where I really get confused. Equally debatable are $300K CIOs, $150K IT directors, and $100K programmers. The salary is less, but there are a lot of us. Who’s to say what value we IT types add to healthcare vs. what we’re paid to do it?

I’m no accountant, so I look at healthcare costs as a black box. Profits have to end up as some kind of payment or equity earned by individuals. Lots of people on that list are making more than they are worth, at least judged from the value they appear add to patient outcomes. Still, I don’t see any of them offering to give it back.

So who’s on that list of the massively overpaid people making healthcare so expensive that it threatens the future of the country? John Hammergren for sure, but maybe you and me, too.

HIStalk Interviews Craig Richardville, SVP/CIO, Carolinas HealthCare

Craig Richardville is SVP/CIO of Carolinas HealthCare System of Charlotte, NC.

Tell me about yourself and the health system.

Carolinas HealthCare System is the largest healthcare system in the Southeast. We are about 3,000 providers, about 40 hospitals, many post-acute care services. We have about 12 million encounters a year.

I’ve been at the healthcare system for 17 years. Prior to that, I was with Promedica Health System for 12 years. Then I was in general industry for a couple of years.

What have you learned in creating a cohesive IT environment that span all those entities and practice settings that you mentioned, plus the complexity of acquisitions?

That one size does not fit all. We’ve been able to build a core competency around interoperability and the ability to connect disparate information systems — whether they’re business, administrative, or clinical –and bring those together in a single unified environment, but with the source systems being very varied. That’s been what we feel is a secret to our success.

What are the tools and the techniques that have made you successful at that?

First and foremost, it’s making sure you have the right people on board. People who understand how to work with others, how to come across as being very much a change agent, but understanding of the change management process as we go through and try to bring things up to a higher level.

There’s a variety of different tools that are available to us, but if you look at your classic people, process, and technologies, typically it’s the process that causes you most of the issues. You can get the technology, you can hire great people. Putting it all together along with our customer base is really where the challenge comes in. 

What we try to do is minimize variances across our system, which is pretty standard other than we do that regardless of what source system that you’re using. We’re big on ensuring that we get a return on the investments that people have made, that companies have made. When they become part of the system, we don’t rip and replace and put them on the same platform, but we do present what we would call a single unified enterprise with everybody having common goals. We’re working together with the tools and the techniques that we have in place.

Leaving those systems in place is an unusual strategy. How do you make it appear that they are tied together?

The patient is the core of our strategy. As you follow the patient across our system, people have access to the relevant administrative, clinical, and business information for that patient. Then we also present that information to the caregiver in that unified fashion. We have wrappers, wraparounds that go around the different systems so that as you move through our healthcare system, you are easily accessible and your information is available.

You use Cerner, but you’re far from being an all-Cerner shop. When you’re tying those pieces together to create that single patient-centric view, is it with tools or technology that you’ve developed, or do you have help from the integration standpoint?

A combination of all of them. We have 14 hospitals. If you’re looking at only the core clinical systems, we have a handful of hospitals that run Epic. We have 14 hospitals that run Cerner. I’ve got 10 hospitals that run McKesson Paragon. Another six, seven hospitals that run McKesson Horizon. A few other one-offs in between. 

We are very typical of a lot of the large communities in our health system in that we have varied platforms. Our opportunity that we can do within our health system and the communities we serve is to tie these different systems together, including the ambulatory systems that are either associated with or that they’ve installed separately. That is pretty much many of your large communities. They have a variety of different systems, especially when you get into the ambulatory environment and the home health environment and the post-acute care services, skilled nursing facilities or otherwise.

There’s a lot of different systems that need to be pulled together. We’ve partnered with several companies, but health information exchange is a big part of our strategy. The patient engagement, which is a larger based portal more at the information exchange level versus at the provider level. That’s part of our strategy, and certainly data analytics and data management above and beyond what the different feeder systems are is a key component of how we’re looking at managing and predicting the future.

How are your systems changing as you move toward managing population health rather than just encounters?

We definitely have moved toward the understanding of what the future lies for us in moving from the volume base to the value base and have positioned ourselves to be very successful in our communities.

Another big piece for us is also telemedicine or telehealth. We just classify all that as virtual care. Whether you’re talking about provider-to-provider or provider-to-patient or even patient-to-patient, allow them to communicate with each other if they have similar illnesses or diseases. Establishing those platforms within North and South Carolina has really been successful for us.

We’re looking forward to the changes in the law in the future that will allow us to even penetrate outside of our existing borders into other parts of the country as we become a true leader in the transformation of healthcare delivery.

Can you describe the telehealth offerings?

There are tools that we utilize that allow patients to have what some might term to be a virtual visit. That virtual visit would be very similar to a face-to-face visit by using videoconferencing and communicating back and forth between the provider and the patient. 

We also have the ability to have protocols be delivered to the patient or prospective patient as well, where he or she can go online and answer a set of questions. Within a certain period of time, we would then get back with that patient as to what we believe the diagnosis would be, and/or any follow-up that would occur as a result of it. That’s a little bit more of an asynchronous method to communicate. 

If  you look at our specialty services that we offer, probably one of our classic examples is Levine Cancer Institute. We utilize that to connect specialists within oncology that are based here in Charlotte with the other oncologists in our system that may be geographically located in Charleston, for example, and be able to pull the patient into those conversations as well and have a three-way conversation with the oncologist specialist here in Charlotte as well as the patient. 

The nice part of an example like that is historically — and you still see that today with a lot of the other cancer centers — is they want that patient to come into that main center, that home center. That usually would require travel and time to get that patient there. The program that we developed allows the patient, for the most part, to stay at their home where their needs can be better met. Outside of medical needs, the social needs and other aspects of their care can be met much easier and also reduce the anxiety of the travel.

You used the term “feeder system" in referring to the EMR. Is that the next level of IT maturity, where the EMR/EHR is not the center of the universe that we’ve grown to think that it might be?

Yes. There’s a lot of good clinical support built into the EMR. There’s a lot of aspects, and certainly it’s a core system. But it’s not really the data that becomes competitive. It’s how we use the data. That’s what we believe would be our competitive advantage. 

Everybody is going to have the data, but it’s what you do with it is what’s going to make a difference to how you treat your patients and be looked at within the communities that you serve. For us, it’s really doing things above and beyond and outside of that. 

If  you look at many providers, how they’re established today, most of the core information they have is the information that is attainable and available from when they were seen at those locations, but not outside. That’s why, at least right now for us, the next level for us is this whole information exchange, the community-based type services so that we can get information from the disparate other providers that are providing care have that access to that, so when the patients do present themselves, it’s the holistic view of the patient, not just the holistic view that happens within that single provider.

Our critical mass allows us to have statistically significant outcomes of what we’re doing with the data. Whether we’re looking at readmissions or length of stay or other aspects that you’re trying to resolve for your healthcare system, having that mass allows you to be able to start understanding and writing the evidence versus purchasing a lot of the evidence that is out there. I think you’ll see us aggressively moving toward having top-decile performance and being able to do things that others may be currently learning from. 

It’s a challenge for the whole industry and everybody has their own method. I don’t think our plan is all that different than others. It’s just the approach that we’re taking and the aggressiveness of pursuing it really is a delta for us.

What are your top IT challenges over the next several years?

I wish I had a crystal ball to allow me to clearly know what all those challenges are. For me and my peers across the country, it seems like every day there’s a new challenge or two that seems to be presenting itself.

If you look at things that are material, the biggest piece for us is to be able to help our clinical caregivers with the predictive analysis of what’s going to be happening to their patient population and migrate away from individual episodic care into managing populations, which is a very different way of looking at it. For us to be able to help them to understand the transition from being volume-oriented to being value-oriented. 

I look at the analogy of what’s happening with the banks. Many of us are very proud that we’re able to handle most of our finances from home with even better service than what we had 10 years ago when we used to go into banks. Many people say, when was the last time you’ve gone to a bank or gone to a branch? They’re proud to say that. 

In our industry, we have to clearly move ourselves away and have a lot of tools to make access available remotely and virtually and allow our patients to help manage themselves. You’d like to at some point to say, when was the last time I need to go see my doctor, because I’m getting all my services and then something above and beyond without the physical travel and the physical aspect of seeing the provider. 

That’s the whole transition, a different way of looking at it. People have been educated and trained and been very successful in the world. The new world is a whole different way of looking at that relationship.

Any final thoughts?

The only thing I would like to say is, it’s a pleasure meeting you. I read HIStalk literally when I get out of bed, and one of the first emails I get I’ll click on that link and at least browse through it, then when I get in the office, read a little bit deeper. It really is a very nice service. I’m somewhat surprised when I talk to some of my peers and even members of my team that a lot of their information is sourced off of what you’re able to uncover. Some of it’s true, some of it’s reality, some is an anonymous person that threw this tip out there. It’s really a great source. You’ve really built something that … it was almost like a solution looking for a problem, and everybody now is focusing on it. It’s kind of how KLAS was a few years ago. Everybody always quoted “Best in KLAS”, “Best in KLAS.” Now it’s like, “Well, you know, this was in HIStalk.” It’s like the gospel. [laughs]

Morning Headlines 9/13/13

Vanderbilt Medical Center hit with Medicare fraud suit

A lawsuit unsealed this week alleges that Vanderbilt University Medical Center has been engaging in Medicare fraud for more than a decade. The suit alleges that Vanderbilt developed a surgical billing and documentation tool that "schedule attending physicians to be in multiple places at once, while continuing to bill their services as if they were actually present and personally performing the services at each place.” The software, which also facilitated surgeon documentation, pre-populated fields in order to qualify for higher charges and required its physicians, in all instances, to document that they met Medicare’s conditions for payment.

Decision-support tool reduces deaths from pneumonia in emergency departments

Findings from a study presented at the European Respiratory Society Annual Congress claim that clinical decision support tools implemented in an emergency department EHR helped to reduce deaths from pneumonia by up to 25 percent.

Compuware’s Covisint sets terms for $64 million IPO

Covisint plans to raise $64 million in its IPO by offering 6.4 million shares at a price range of $9 to $11. At the midpoint of the proposed range, Covisint would command a fully diluted market value of $395 million.

Morgenthaler partners form new $175M fund to invest in cloud, fintech, & health IT

Three partners from Morgenthaler raise $175 million for a new investment fund, Canvas Ventures Fund, which will focus on early stage health IT startups.

News 9/13/13

Top News

A newly unsealed Medicare fraud lawsuit against Vanderbilt University Medical Center claims that its internally developed Vanderbilt Perioperative Information Management System (VPIMS) was used to bill services for physicians who were not physically present. Documents filed with the lawsuit, which claims the fraud spanned more than 10 years, include a Vanderbilt email telling surgeons to avoid documenting which rooms they were actually covering because “it only confuses and complicates the billing and documentation process.” The lawsuit concludes, “VIPIMS’ purported improvements in billing efficiency are, in fact, largely a function of Vanderbilt’s development of mandatory default software settings that require its physicians, in all instances, to document that they meet Medicare’s conditions for payment.” VUMC says its own investigation has uncovered no billing irregularities and vows to defend itself vigorously.

Reader Comments

From Bronwyn: “Re: Cerner Dynamic Documentation. Do you know of any hospitals currently using it who would be willing talk to a CIO about their experience?” Readers, send Inga a note if you can help.

From Reviewer: “HIPAA violation. If this isn’t the most egregious HIPAA violation ever, I don’t know what is!” A parent of a three-year-old patient posts a negative review on Yelp following a visit to a Phoenix plastic surgery clinic. The practice’s operations coordinator posts a reply that includes significant details about the patient and the office visit, as well as some harsh criticism of the mother and her parenting skills. Rebecca Fayed, associate general counsel and privacy officer at The Advisory Board Company, provided us her assessment:

I think that providers (or any covered entity or business associate for that matter) need to be particularly careful when posting anything online, whether it be on Yelp or other social media sites, that could be interpreted as a disclosure of protected health information. In this post,  HHS-OCR could view the response by the provider as a  disclosure of protected health information not permitted by the HIPAA Privacy Rule.

From Former Employee: “Re: Experian Healthcare, formerly Medical Present Value. Underwent its third round of layoffs this week, including its entire SME group and other client support staff. Sales are significantly down under Experian.” Unverified.

From small_data: “Re: misuse of the ‘Big Data’ buzzword. Simply storing data for archival purposes without intent of using that data for any kind of quantitative analysis is surely not ‘Big Data.’” The solution in question stores medical images. Everybody with a database now has “Big Data.” If they can export that information to Excel, they have enterprise analytics and business intelligence. If that worksheet can be emailed, they offer interoperability. If the worksheet can be stored on a Web server, it’s scalable and cloud-based. These are no longer technical terms with precise meanings; they have been hijacked by the sales and marketing people.

From Over It: “Re: Jody Albright, CIO, Overlake Hospital. Internal email says her position was eliminated and chief compliance officer will take on CIO duties. She had limited involvement with the Epic project and the go-live was a firestorm on several levels.” Unverified, but above is a purported internal email forwarded my way.

HIStalk Announcements and Requests

The latest news from HIStalk Practice includes: use of an EMR that includes automated growth monitoring helps doctors pick up on cases of possible growth disorders among kids.The AMA offers a toolkit (perhaps a little late) to help physicians prepare for upcoming HIPAA changes. HIT expenditures in physician offices jumped 28 percent from 2008 to 2012. Will cloud-based EHR/PMs really save practices from acquisition? Patients from Advocate Medical Group file a class-action lawsuit following the theft of unencrypted computers. Rhode Island primary care practices can earn up to $10,000 to connect to the state’s HIE. Culbert Healthcare Solutions VP Brad Boyd offers some advice for defining and measuring an EHR’s ROI. Thanks for reading!

Welcome to new HIStalk Platinum Sponsor EXTENSION. The Fort Wayne, IN company offers contextual alerting, secure messaging, and care team collaboration technologies, including specific solutions that address Joint Commission’s 2014 National Patient Safety Goal, “Improve the safety of clinical alarm systems.” First-generation systems just throw out a lot of alerts, but EXTENSION’s next-generation platform combines alarm safety software with a secure text messaging solution to optimize the workflow involved with clinical event response. The company’s HealthAlert solution solves the challenge of getting important clinical event notifications in the hands of clinicians, routing critical lab results, stat orders, staff assignment, patient monitoring, and patient nurse call requests. The system prioritizes the alerts, escalates based on defined rules, announces the event verbally to the recipient, and maintains an audit trail. It works with Android, Apple, Ascom, Cisco, Spectralink, and Vocera devices, including a mobile app that can run on a clinician’s own smartphone.  Thanks to EXTENSION for supporting HIStalk.

I found this short introductory YouTube video from EXTENSION called “The Power of the EHR-Extender.”

On the Jobs Board: Manager North America Professional Services West, Implementation Engineer (East Coast), Services Operations Manager.

HIStalk Webinar

Informatica will present “Best Practices for Delivering Better Quality Care and Reducing Preventable Patient Readmissions” on Thursday, September 26 from 1:00 – 1:45 p.m. Eastern.  Speakers are George Brenckle, PhD, SVP/CIO of UMass Memorial Health Care and Richard Cramer, chief healthcare strategist of Informatica (I interviewed him awhile back). Register here.

I recorded the HIPAA Omnibus webinar given by Rebecca Fayed and Eric Banks of The Advisory Board Company earlier this week and posted it to YouTube. The slides are here. Thanks to Rebecca and Eric, who stepped up when I asked for volunteers to run through the changes with HIStalk readers. We had a nice turnout, and in typical Advisory Board fashion, not a second was wasted due to inadequate preparation or lack of focus.

Acquisitions, Funding, Business, and Stock

Covisint will raise at least $64 million in its IPO by offering 6.4 million shares at an expected price of $9 to $11. The company generated $94 million in revenue for the 12 months that ended June 30.

Three partners of Morgenthaler Ventures create a new management company and the $175 million Canvas Venture Fund that will focus on early stage investments of $5 to $15 million in mobile, health IT, financial technology, and enterprise technology. The parent VC company invested in physician social network Doximity and free EMR vendor Practice Fusion.

The CSI Companies acquires Atlanta-based IT staffing firm Anteo Group.

Lincor Solutions moves its headquarters from Ireland to Nashville.

Sales

Estes Park Medical Center (CO) will implement HealthCare Anytime’s patient portal technology at its hospital and outpatient clinic.

The Valley Hospital (NJ) selects Merge Healthcare’s CTMS for Investigators to manage its clinical research operations.

UHS-Pruitt Corporation, a provider of post-acute care services, will implement healthcare analytics and population health solutions from Caradigm.

The 110-provider Prima CARE (MA/RI) selects Ingenious Med’s mobile revenue capture technology.

Washington Orthopaedics & Sports Medicine (DC/MD) selects SRS EHR for its 11 providers and three locations.

People

Wellcentive names Tom Zajac (Elsevier) CEO.

Health Catalyst appoints David K. Crockett, PhD (ARUP Laboratories) senior director of research and predictive analytics.

Robert Porr (Accenture)  joins Sandlot Solutions as EVP of sales and marketing.

Nancy Killefer (Department of the Treasury, IRS Oversight Board, McKinsey & Company) joins the board of The Advisory Board Company.

University of Missouri-Kansas City hires Mark Hoffman, PhD (Cerner) as director of bioinformatics core and associate professor to establish its Center for Health Insights informatics program.

Stanford Hospitals & Clinics (CA) promotes Pravene Nath, MD to CIO and Christopher Sharp, MD to CMIO.

MGMA-ACMPE names Garth Jordan (EDUCAUSE) COO.

Prime Healthcare Services (CA) will implement  Infor financials, supply chain and human capital management, clinical bridge, and analytics.

Announcements and Implementations

Quest Diagnostics joins LabCorp and almost all of Colorado’s large hospital laboratories in connecting to the Colorado RHIO.

The HIEs Michigan Health Connect and Michiana HIN will share health records between Michigan and Indiana providers.

The Patient-Centered Outcomes Research Institute board of governors issues 71 awards totaling more than $114 million to fund comparative clinical effectiveness research, including studies to improve the applicability of data collected through EHRs and social media sites and methods for engaging minority patients and caregivers in patient-centered health research.

Ivo Nelson’s Next Wave Health forms Smart Social Media, Inc., a software company that will develop a healthcare social media platform. Next Wave Health acquired the OneXPage social media platform from Digiapolis, Inc., founded by Minneapolis entrepreneur Eric Lopez, who will be CEO of Smart Social Media.

Gastroenterology EHR vendor gMed will use behavior-based prescription management messaging from LDM Group to improve medication adherence and highlight therapy options.

Government and Politics

ONC launches a patient matching initiative to seek common denominators and best practices being used by private healthcare systems and federal agencies.

Innovation and Research

The use of an electronic decision support tool linked to patients’ EMRs helped reduce deaths from pneumonia in EDs by up to 25 percent according to researchers from Intermountain Healthcare and the University of Utah.

An athenahealth analysis of EHR data from its user network reveals no signs of a national decline in childhood obesity over the last three years. Athenahealth obviously has a wealth of clinical data at its disposal and this type of analysis is interesting and arguably beneficial. However, are practices and patients aware of how athenahealth and other EMR companies may be using personal health information? More importantly, should they? To the latter question I say yes, and mechanisms should be in place to allow practices and patients to opt in or out.

Technology

AirStrip will develop and optimize its AirStrip ONE solution for Samsung tablets running Android and Windows 8.1 operating systems, as well as Samsung convertible and all-in-one desktop and laptop PCs with touch screens.

Lt. Dan covers the iPhone 5S announcement in his excellent HIStalk Connect analysis, “Apple Comes Up Big On The iPhone 5S Unveil: What it Means for Healthcare.”

Other

The Tax Increment Financing Commission of Kansas City approves a $1.635 billion incentive for Cerner’s proposed plan to develop a 4.5 million square foot mixed-used campus.

VA psychiatrists and researchers are using natural language processing and query searches of doctors’ free-text notes to flag patients who present a clear risk of suicide.

Crittenton Hospital (MI) will provide free electronic copies of medical records to the families of patients treated by Farid Fata, MD. Fata is the Michigan Hematology Oncology physician accused of deliberately misdiagnosing patients and improperly administering chemotherapy as part of a $35 million Medicare billing fraud scheme. The hospital provides records free only to medical doctors, but reversed its policy after the doctor’s patients staged a protest.

The New England Journal of Medicine gets banned from posting pictures on Facebook after running a medical image of a patient with scrotal calcinosis, which Facebook found pornographic. Facebook changed its mind shortly after.

Sponsor Updates

• Aventura publishes an informative and entertaining HIT Survival Handbook.
• Allscripts will add Inovalon’s quality improvement and risk score accuracy analytics  to its EHR platform.
• Health leaders in Leeds, UK will evaluate whether outcomes can be improved by using Alere’s healthcare platform.
• Medseek Empower 5.0 earns CCHIT certification as an EHR Module and is compliant with the ONC 2014 Edition criteria.
• Campbell Clinic (TN) reports that its use of Emdat’s medical documentation solutions has improved documentation completion, workflow, and transcriptionist productivity.
• Billian’s HealthDATA interviews Collin Searle, social media manager for Intermountain Healthcare (UT), about the health system’s social media strategy. 
• Clinovations CEO Trenor Williams discusses the need for pharma companies to  use technology and think more strategically about communications with health providers and patients. 
• Innovative Healthcare Solutions offers a white paper series that includes tips for a successful project outcome.
• Hot jobs on the site of Henry Elliott & Company, which specializes in Caché and M/MUMPS technology positions, include Senior M/Caché P/A, Caché M/Mumps Web Developer, VistA Analyst, and .NET/Caché Developer.
• Cleveland Clinic’s use of BI dashboards from Harris Healthcare has driven significant ROI and performance improvement, including a $10 million increase in net income.
• Intelligent InSites announces details of InSites Build 2013, an RTLS learning event October 28-30 in Fargo, ND.
• Sunquest Information Systems and the Association for Pathology Informatics will host a September 26 educational webinar on pathology informatics featuring Walter Henricks, MD of Cleveland Clinic.
• Florida Hospital Celebration Health realizes increases in key HCAHPS categories since implementing GetWellNetwork’s Interactive Patient Care and Clinical Practice Design solutions.
• UnitedHealth reports its use of InstaMed online payment option has resulted in over $3 million in payments since its late July rollout.
• Trinitas Regional Medical Center (NJ) enhances staff safety with Versus Visibility Staff Assist RTLS technology.
• Hayes Management Technology adds its go-live support and legacy support services to its website.
• Divurgent and Medix will host a Retro Arcade Event during Epic UGM. Readers may RSVP here.

EPtalk by Dr. Jayne

Mr. H mentioned that PatientSafe Solutions has joined us as a Platinum Sponsor, but I wanted to offer my own shout out for its PatientTouch system. I first saw it at HIMSS13, and as Inga can attest, was really geeked out about it. I’d love to see it installed at my institution, so maybe I’ll “accidentally” leave their information on my boss’s printer.

I spent the earlier part of this week at the AMIA Clinical Informatics Board Review Course in Chicago. There were enough sassy young female physicians in attendance, so I feel fairly safe in admitting it while being able to still remain anonymous. I even saw some sassy shoes, so I felt like I was in good company.

Why a board review, and why now? This fall marks the first opportunity for physicians to actually seek board certification in the subspecialty of Clinical Informatics through the American Board of Preventive Medicine. There’s also a pathway through the American Board of Pathology – based on the number of pathologists in the class I don’t want to neglect to mention that because I know if they’re reading they’ll correct me – but the majority of informatics physicians I know are not pathologists.

As a new specialty, they’re offering a “practice pathway” for those of us who are not fellowship-trained to seek certification, through 2017. Candidates in this pathway have to demonstrate at least 25 percent practice in clinical informatics during three of the five years preceding application. In 2018 and later, candidates will have to have completed a minimum of 24 months in an ACGME-accredited Clinical Informatics fellowship program.

Many of us are not fellowship trained. Instead we’re homegrown informaticists who have been at this quite a while. We may have done some coursework in informatics or had intensive mentoring in order to reach our level of performance. In my case, the thought of trying to go back and do a formal training program on top of working the number of hours I do currently made my skin crawl, as did the idea of spending $40,000 or more on a degree that wouldn’t raise my income or the level of respect from my peers.

After a little cajoling from a colleague, I decided to aim for certification in the first round through the practice pathway. It’s a bit daunting because it’s a brand new exam. None of us really knows what to expect, and although the Board has published an “examination content outline,”  it’s pretty daunting since the level of detail they could be expecting could be all over the map. The application process was also daunting, as I had to track down former bosses who could best attest to the time I’ve spent in the field. I’ve had five bosses at three jobs in the last five years and only one is still working at the hospital where we were colleagues.

I’ve never taken a board review course before, so this seemed like a good time to try it given the breadth of the material. The class was a nice mix including average working CMIOs and high-powered names from major academic institutions. The VA and military were well represented, as were ambulatory organizations, payers, and vendors. I’m happy to report a Bowtie Index of 3.67 bpd (bowties per day) with one attendee having particularly fetching choices.

The group was pretty social and there were some key themes heard during the cocktail hour and various breaks. One is that there are quite a few institutions out there that still don’t value the contribution that a CMIO brings to the table. Many CMIOs are forced to try to do the job without the title or the appropriate level of authority. If you’re at one of those facilities who still question whether you need a CMIO, check that exam content outline to learn more about what we do and what we can bring to the table.

Another key theme is that there is never enough money to do the work that needs to be done. That goes right along with the theme that there are always more projects to be done than can be humanly accomplished. I also learned that many physician informaticists are very driven and devoted to the field – so much so that one physician sitting near me said his colleague’s inhuman level of work product clearly means that she’s a cyborg.

I’m unfortunately having to play catch up for the days out of the office, so you’ll have to wait until Monday’s Curbside Consult to hear about the rest of the course and some fun things I learned including some informatics jokes. I’ll leave you with this one in the interim:

A programmer is asked by his spouse to get some groceries. She asks, “Can you pick up a loaf of bread, and if they have eggs, get a dozen.” He returns home with 13 loaves of bread. She asks, “What happened?” His response: “They had eggs.”

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Advisory Panel: PHI on Mobile Devices

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

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

This question this time: What policies, practices, and tools are you using to control the use of PHI on mobile devices and apps?

Policies titled “Data Encryption” and “Mobile Device Safeguards” provide the basis for protection regarding mobile devices, emphasizing the requirements for encryption (storage and transmission), not saving PHI to mobile devices unless necessary, deleting the PHI when finished, and basic physical protections. Tools utilized are various methods of VPN, McAfee EMM and ActiveSync, native and container encryption methods, whole disk encryption, complex passwords, training and publications, Citrix, VM View, and custom applications that provide connectivity without storage or print.

We require any device that connects to our mail server to be encrypted.  If the device isn’t encrypted, the server won’t allow a connection.  We’re still working on a secure communication system with our non-employed providers, since they want us to send SMS messages rather than emails. 

We use Good Technology to provide secured access to our corporate email, contacts, and calendar on mobile devices.  Our policies limit the users who can have access by role. My perspective is that we use Good to mitigate our risks, but it has not increased satisfaction among our users.

We force a password protection on mobile devices and enforce a "10 attempts" wipe policy.

The health system adopted an encryption policy as a  CYA effort. We officially prohibit the use of personal computers for health system business, but I can’t see any way that we can control or even police this activity. Employees have external hard drives at home that they use to backup their laptops, at least they should have some backup mechanism. Therefore, when any of these home-based devices is stolen, the health system does not have to report the event, but the patients’ data are still compromised.

Likely not a surprise with all the recent news around this subject, we recently are about to launch the following: (1) Automatically encrypting all outgoing emails which contain PHI (based on whatever detection system the IT team is using). I hope ours is accurate and does not create a painful process in non-PHI circumstances;  (2) Automatically enforcing that any smart phones syncing to the system for emails/calendar have a four-digit device PIN, an inactivity timeout under 15 minutes, and remote wipe ability if device lost or stolen – I did not realize they could do all this automatically (but hopefully most of us do all this already!)

We have a policy that prohibits storage of PHI on mobile devices. We use a mobile device management software tool (MDM) that enables us to securely deliver e-mail, calendar, and contacts from our Exchange environment to iPhones and Android smart phones.

Must enforce passcodes, that is blocking and tackling/101 stuff. All too often you’ll see misconfigured policies for iOS / Android / BlackBerry that are missing that simple setting. Then you must encrypt. We are using a cloud service MaaS360 that segments the device into a personal and a business side. The solution has device encryption and very nice GUIs for policy management. You can deploy your own applications through the solution and it’s been stable. Cheaper solution compared to other MDMs.

DLP for flash drives and any data moved to a mobile device or external drive. The use of computers as kiosks in all patient care areas. These are locked down so that no data can be downloaded. Encryption on phones though this is a self-reporting/self-enrollment process at the present. By policy we require all portable devices to be encrypted. This is difficult to enforce on non-organizationally owned devices.

Currently only supporting Epic apps (Haiku) and don’t require UDID management. Rather we control by security (if you’re a provider, you can use). We just force 5 minute logouts and logout immediately upon exit. We are looking at bringing up policies for mobile management of any device that wants to connect to our Exchange as well. Should be live by end of year. BlackBerry Enterprise server offers these controls.

In the process of implementing an MDM solution, and evaluating DLP solutions.

If employees choose to store PHI on their mobile devices, the device must be protected by encryption and strong passwords; they must fall under central device management, which means we can erase the device, remotely and enforce password policies; and they must agree to declare a "lost PHI device" incident within 1 hour of first realizing the device was lost. Interestingly, we experienced one of these incidents recently. A physician reported his device lost, as required, and we erased it– everything on it. Later, he found it and was angry that we had erased his personal pictures and address book.

We are in process of rolling out a mobile device management strategy utilizing Airwatch. In addition, we limit the individuals and roles that can access particular information already (even a bit more granular/more tightly controlled than the typical role based access) with regard to mobile devices/apps.

Morning Headlines 9/12/13

ONC Launches Patient Matching Initiative

ONC launches a collaborative initiative that will focus on developing highly reliable patient matching techniques for use in health exchanges to ensure that patient records can be correctly identified across disparate systems.

Effect of Pay-for-Performance Incentives on Quality of Care in Small Practices With Electronic Health Records

A study published in the Journal of the American Medical Association finds that pay-for-performance programs implemented in EHR-enabled small practices modestly improve care for cardiovascular patients, compared to care received at EHR-enabled fee-for-service small practices. The study was conducted between 2009-2010 and spans only a year of trended outcomes, which resulted in researchers noting that longer-term studies would need to be done to determine whether the changes increased or decreased over a longer timeline.

Electronic Medical Records Hold Clues to Suicide Risk

The VA is researching the use of natural language processing, in conjunction with its EHR system, to automate a risk profiling program designed to alert for potential suicide risk. The NLP-based program searches non-structured clinical narrative in a patients record for key signs that would indicate that the patient is at risk.

SAIC Outlines Business Objectives For Leidos, A National Security, Health & Engineering Solutions Leader

SAIC leadership presents the strategic objectives of Leidos, SAIC’s healthcare and national security spinoff business. The mission of the health sector of the business will be to "optimize the use of electronic health records, apply data analytics and behavioral health research to help enable customers to improve healthcare quality and patient outcomes, detect and prevent diseases, enhance scientific discovery, and reduce costs to the healthcare system."

HIStalk Interviews Anna Turman, CIO/COO, Chadron Community Hospital

Anna Turman is CIO/COO of Chadron Community Hospital of Chadron, NE.

Tell me about yourself and the hospital.

I’m the CIO as well as the COO of Chadron Community Hospital. We’re a small, critical access 25-bed hospital. Not for profit, of course.

As the CIO and the COO, a good explanation is having to do more with less. I am the more with less. I do have to run both roles. I find that very complicated a lot of the time. I don’t have enough time in the day for it.

We do trauma, we do babies, we do lab, we do surgeries. We have just about everything. I think we are exceptional for a critical access hospital. The next closest hospital to us, which is another critical access hospital, is 53 miles. The next what we call hub hospital or larger hospital is 100 miles north or 100 miles south. The one north is in South Dakota and that’s where we ship a lot of our patients. We usually stabilize and ship, so like hearts or other big traumas, we stabilize and ship.

You were a graphic designer, which is probably the least likely background to get into either CIO or COO roles, much less both. How did you transition into what you’re doing today?

I used to live in the city, got married, and my husband wanted to move back to this town of 500 people that he was from. There’s not a lot of graphic design necessary here, and so I had to reinvent myself and go back and get some education. I’m a highly motivated Type A personality, so it is what it is.

How is your job different from those of other CIOs, especially those from larger facilities?

On the governance level, it’s quite a bit different. We have our strategic plans and run our IT strategic plans off the business strategic plans, but we’re so much smaller that our communication seems a lot easier than having to deal with the complicated governance that you can see in some larger facilities. Our governance is much more simplified in communicating. I think that’s huge.

I took on the COO role and wasn’t able to give up the CIO role because I guess I did well enough at it that he didn’t really feel that it was necessary for me to give it up. I do balance that. It is difficult to balance. The responsibilities are just the same as any other hospital. I’m in charge of the business office and medical records.

What makes it nice is that I can see every aspect of the business. I can help from the IT perspective as well enable those parts of that business to get somewhere, be more efficient, or find the goals that they need to. I think that helps. It ties in. It’s a beautiful tie-in, actually. It helps me communicate better. I don’t have that “one more person” that I need to communicate with to find out what we need to do to enable other goals because I already know everybody’s goals.

What systems do you run?

I run NTT, complete NTT. We did a full-blown, big bang, six-month complete implementation everywhere from HR to financials to clinicals to pharmacy to radiology. Everything is NTT.

Are you doing OK with Meaningful Use, ICD-10, and everything else that’s coming down road?

Yes. I think we’re an exceptional facility. We have an exceptional group of people who are hardworking, pioneer-type people. We are a small facility, small area, small community, so they’re pioneers, they are hard workers. They do more with less. It’s just natural ability.

Because of that we, have been very blessed to have the capability of meeting Meaningful Use Stage 1. We are going to attest to Stage 1 year one and we are working on Stage 2 right now.

We won “Most Wired.” For a small-town, 25-bed critical access hospital, we really are exceptional. That is me patting them on the back, not myself.

How is your IT team structured?

I have one clinical informaticist. He’s a pharmacist. I have a data manager. He runs data, can help us with any reporting, helps us get everybody’s reports out for our data mining and all that stuff. It’s all one database, so that helps tremendously. We have the network manager and he runs all the networks. I have the clinical manager, who runs the clinical informaticist and updates all the systems. He’s also the applications manager.

What IT accomplishments are you most proud of?

It was probably “Most Wired.” That is pretty hard for anybody, let alone a small facility.

How are the IT needs of critical access hospitals different from the average 300- to 400-bed community hospital?

They aren’t. It simply comes down to, we just have to figure out how to do more with less. We have the HIPAA security laws. We have to encrypt all of our emails going in and out. We have to encrypt this, we have to encrypt that. We have to do all the same security. We have single sign-on. We have thin clients at the bedside, med administration at the bedside. Technically, to keep up with everybody else to have Meaningful Use, meet Meaningful Use, and to get Most Wired, we have to have the same needs.

For a while there, our biggest issue was Internet and speed and fiber. Rural Nebraska Healthcare Network is made up of eight or nine hospitals. Eight of them are critical access hospitals. One of them is Regional West Medical Center, which is the one that is 100 miles south of us. We have through grants been able to put redundant fiber into those smaller hospitals. We’re able to coordinate and collaborate backups to each other. Three of them have the same electronic health record, Healthland. They back up to each other’s offsite location and we use the fiber for that. There is a lot of business continuity we can work out through that fiber.

That was probably the biggest thing that was different in the bigger facilities. We didn’t have that access to high speed broadband or anything like that. Now that we do, it’s been a lot better. I can transfer my radiology results to and from. We can do our radiology here. We send them to our radiologists, who are actually in Denver, and we can use our fiber for that. We get quicker response for that because mammograms, for example, take a lot of bandwidth. We couldn’t do it with the T1s we were using originally, so then I had to buy 10 megs of fiber. That still wasn’t enough for the mammograms. When we got this grant that we can have redundant fiber, it’s a gig throughout all of our hospitals. We were capable of doing the mammograms and now we can do digital mammograms. It has to do with me being so much more rural more so than the technology that’s different.

Do you think Meaningful Use set the direction that’s best for patients or would you have done anything differently had that not been the carrot that was in front of you at that moment?

Oh, boy, you’re going to ask for my soapbox, aren’t you? [laughs]

I don’t know. I think there could have been some better ways to go around it. For example, I’ll give you my soapbox.

Everybody is throwing out this patient portal. There is not a lot of collaboration. People are trying, don’t give me wrong, but there are still clinics everywhere like ENT clinics or hospitals who are competitors and things like that. We are trying to communicate and share the data. We do that with our Rural Nebraska Health Network. I have an ENT clinic appointment up in Rapid and they give me a patient portal to access their information and do things there. Now I have their patient portal with a user name and password. I log in and help them meet their Meaningful Use.

When I go to the ER across the state in Lincoln because I was watching the football game and I ended up in the ER by breaking my arm, they get me on the patient portal, give me a user name and password, and now I have that one. Then if I go and visit over here, I have to go to a dermatologist or something, I have their patient portal and their user name and password. Then they come to this hospital where the actual physician is and their clinic here. I have their clinic and the hospital’s patient portal.

How many patient portals does that patient have to have? How many user names and passwords do they have to have? It really does come down to that exchange of information. That is going to be a key player.

What have you done that’s innovative?

I like that we use our televideo for mental health. We really do push because we are so rural. For our home health and hospice, they really do travel a 100-mile radius to reach those patients. We’re trying to push our televideo now to start doing the home health and hospice that way as well. But we do use it for mental health. We use it for dialysis patients so they can see their dialysis nephrologists through the televideo. We used it once when the baby was sent to another facility and they had to stay here because the baby was in danger — we used it so they could see the baby.

We use the televideo quite a bit. That’s a key feature for us rural people. It’s important. Innovative? I don’t know if we’re able to be as innovative and on the brink of things, but we really do try to.

Did you ever look at a big hospital and either wish you there or be glad that you aren’t?

No. I usually try not to see “grass is greener” anywhere else. I usually just try to be happy where I’m at. [laughs]

Communications in bigger facilities is so much more complicated for them. I am very happy that we have the communications that we have here and that we work so well together and work hard to get things done as a team. I think it’s a lot harder to do that in a larger facility. We see each other face to face so much more than anybody else would.

What opportunities and challenges do you see from an IT perspective of keeping up with reimbursement and regulatory changes?

To be honest with you, that is probably one of our biggest sticky points in a small facility. Larger facilities will have a HIPAA privacy officer. Well, I’m the HIPAA privacy officer. A larger facility will have a HIPAA security officer. Well, I’m also the HIPAA security officer. Having to know everything, know it well, and be very successful at it is very hard because so many roles get put under one person. Right when you think you’ve got it down and you could do it well, they change it again.

It does make it very complicated. Right now, I’m just cleaning up the Omnibus. Omnibus came out, changed out the privacy stuff, so I had to go and make sure we got all that taken care of. Every time they make a change, whether it’s technologically or patient privacy, it’s complicated for us because we have to know everything. One person has to know so much more and wear so many hats than a larger facility. It’s hard to keep up. It really is.

Do you think that economy of scale will lead more hospitals to acquire each other because they can’t go it alone?

The survival rate of the critical access hospitals is hard now. As we move more towards the future, it’s going to get harder. I don’t see it getting easier.

That is probably not typical of my perspective. I tried to look at everything from positive perspective, but no, it’s not getting any easier. The sequester makes it harder. Things like that just make it harder to survive as a small hospital. Even in Nebraska, governmentally they are looking at how to get rid of some of those critical access hospitals.

For a CIO who wants to do as you have in becoming a COO, what would surprise them most about what it’s like?

It makes being CIO a little bit easier except for the “more work” part. [laughs] You get a glance at the business goals and you can align the strategic plan so much easier. But that’s because I play dual roles, so I don’t know. That is kind of difficult.

For me, it was easier because I can see everybody else’s plans and I can coordinate with them and collaborate a lot better. I’m trying to think what the biggest surprise is. To be honest with you, CIOs are less just technology and more business structured anyway, so it was a fitting role to move into the COO position. I think CIOs have been moving away from just technology for some time. They have to understand the business strategy. They have to be a business person.

Most CIOs see it differently, but other people may see CIOs as just a technologically knowledge base. In reality, we are also a business knowledge base. It’s a good transition to go from CIO to COO.

Any final thoughts?

I should say a little bit about ICD-10. As small as we are, we only have a few coders, so the training is a little easier. But then again when ICD-10 does switch around, the bulk of the problems are going to come down on just a couple of people. If it all is smooth, great, but we have to have expectations for the worst. We don’t have that many people, so resources, when it comes down to going live, will be a little different for us.

Morning Headlines 9/11/13

Nashville’s HealthStream buys Pensacola health care consultants

Nashville-based HealthStream, an software-as-a-service vendor focused on delivering professional development and educational tools to hospital employees, pays $8.5 million to acquire Baptist Leadership Group, a healthcare consulting firm offering programs aimed at increasing patient satisfaction, employee engagement, and quality outcomes.

Implementation of an Outpatient Electronic Health Record and Emergency Department Visits, Hospitalizations, and Office Visits Among Patients With Diabetes

A study published in the Journal of the American Medical Association following the implementation of EHRs across outpatient clinics between 2005 and 2008 found a small but statistically significant drop in ED visits and hospitalizations after EHRs were introduced.

Six Reasons Why Nuance Needs To Put Icahn On Its Board Now

Forbes covers Carl Icahn’s increasing shareholder position in Nuance, arguing for why the company would be better off adding him to their board than continuing with their poison pill defense.

Certification Guidance for EHR Technology Developers Serving Health Care Providers Ineligible for Medicare and Medicaid EHR Incentive Payments

ONC publishes an integration guide for EHR developers building applications for clinical environments that fall outside the scope of Meaningful Use.