Readers Write: The Changing Physician-CIO Relationship: Do You have a Strong Partnership?

The Changing Physician-CIO Relationship: Do You have a Strong Partnership?
By Rob Culbert

Building a relationship is hard. Managing a successful and long-term partnership is even harder.

That’s what most healthcare chief information officers (CIOs) are finding out as they examine their rapport with physicians. Productive relationships take effort and a commitment to change. Successful healthcare organizations can strengthen the physician-CIO dynamic by making a concerted effort to involve physicians in their technology adoption efforts.

Consider these questions as you determine how your organization stacks up in fostering positive interactions with your physicians and what you need to do to build a stronger physician-CIO partnership.

What’s driving the changing relationship between your CIO and physicians?

In most healthcare organizations, physician and CIO responsibilities have historically been siloed—the CIO drove technology, physicians drove clinical care. Now the relationship is changing as physicians expect the hospital to provide greater technology support, which in turn allows the physician to provide higher quality care. More than ever, physicians demand a system that provides full access to both ambulatory and inpatient clinical data.

Yesterday’s hands off approach with physicians no longer works. Healthcare CIOs must employ an intentional strategy to involve their physician partners and meet their new requirements for support and information.

What specific roles are physicians playing in your technology deployment?

Technology is becoming more directly linked to patient care, so much so that physicians now expect systems that seamlessly support their work and improve efficiencies. This is even more the case with younger physicians, who grew up using technology and can’t imagine delivering care without it.

To capture physician opinions and requirements for technology, organizations may want to create a physician steering committee, which involves physicians in major decisions about system design, functionality, and content. Organizations are using these committees to fix and improve specific technology. For example, working as a subset of the steering committee, a physician ICD-10 committee may focus on the required workflow changes and corresponding system changes needed to support a smooth implementation of the new code set. After implementation, physician practice user groups can be leveraged to educate physicians on advanced features and to gain feedback for system adjustments.

Are you providing opportunities for physicians who don’t want to be heavily involved in technology?

It’s a fact: some physicians simply want to be doctors, not IT gurus. Yet, they still can provide a wealth of information through their frontline system knowledge. Avenues for feedback include physician surveys, informal focus groups, or even hallway conversations. Site visits to physician practices can clearly reveal how the system is being used and highlight opportunities for improvement. Garnering involvement and feedback from as wide an audience as possible leads to a healthy and dynamic physician-CIO rapport.

What benefits can your organization realize through physician-CIO alignment?

Perhaps the biggest benefit of physician-CIO alignment is that it’s just good for business – for the physician and the healthcare organization. Most practices don’t have the resources for a sophisticated IT structure with 24/7 support, clinical system protection, disaster recovery, and guaranteed uptime performance. However, healthcare organizations often have extensive IT capabilities and can provide the needed support and resources at a reasonable cost.

Healthcare organizations benefit because strong alignment between physicians and technology leaders can ultimately improve patient care and foster greater efficiency. In addition, it can positively impact a physician’s choice where to practice. Because most physicians want to partner with an organization that is responsive to physician involvement, this strengthened relationship allows organizations to be more competitive in recruiting and retaining physicians.

Strong physician-CIO interactions can also help a healthcare organization strategically position itself for quality improvement and agility with the coming healthcare legislation, ultimately improving payment and reimbursement rates for both parties.

Establishing and maintaining strong partnerships between physicians and technology leaders is essential to navigating the evolving healthcare landscape. As information technology becomes more critical to care delivery, the strength and resiliency of the physician-CIO relationship will determine your organization’s ability to successfully deliver quality care and maintain financial viability.

Rob Culbert is president and CEO of Culbert Healthcare Solutions.

Time Capsule: Lessons from Shark Tank — Beware of Vendors Borrowing Money or Going Public

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 August 2009.

Lessons from “Shark Tank” — Beware of Vendors Borrowing Money or Going Public
By Mr. HIStalk

I don’t watch a lot of TV, but lately I’ve been watching this show called “Shark Tank.” It’s a reality show from Mark Burnett, the Survivor guy who made TV 100 times more of a vast wasteland than anyone thought possible, killing lame dramas and comedies in favor of cheaper and even lamer junk shows that make Dead Billy Mays infomercials look like Shakespeare plays.

The premise of “Shark Tank” is this: small business owners who need funding pitch their business idea to a panel of private investors who critique it nastily (it’s reality TV, after all) and maybe begrudgingly offer to loan the owner money at quite unfavorable terms (such as demanding half of the company in return).

So, the businessperson has three ways to look stupid: they can be turned down cold, they can take the offered money at usurious rates, or they can voluntarily walk away as the investor panel agrees among themselves just how stupid the business owner is for not wanting to throw in with whiz kids like themselves.

The last show had a guy who had invented a folding guitar. He had sold a few hundred of them at $500 each and, by applying some questionable math, decided his company was worth $10 million (the expressions on the faces of the money lenders when they heard that figure were priceless).

One sympathetic money man (sympathetic on a greedy bloodsucker scale, anyway) asked him an excellent question, though: do you want to make really great guitars or do you want to make a lot of money?

His message was clear. Big profits and quality just don’t mix. The idea of actually making a great product was incomprehensible to the money man. The real money was to be made in licensing the folding neck idea to other guitar companies. Instead of being an engaged, driven entrepreneur making guitars he’d be proud to sell, the guy could just sit on the porch and cash checks.

This made me sad. The money man was right – people like him don’t care about quality, customer benefits, or long-term value. They don’t even care about the product or service. Everything they need to know is contained in the financial and marketing numbers. And if the visionary founder takes money from them, he or she will be elbowed aside as the business is pillaged to yield the biggest, quickest return possible. So, forget that great product – wouldn’t you rather get rich instead? All of the money people, it turned out, made their pile selling out to some bigger company (which often regretted it, I found out from Googling).

It makes you wonder how many great innovations have been pushed aside because a dollar-fixated money man didn’t see the point. It also makes me wonder how many dull, average companies got that way because they took someone’s cash, put the founders out to pasture, and set all the fun, smart ideas aside and turned themselves into a bad mutual fund run by second-tier MBA school graduates.

My hospital got burned once when the vendor we had just chosen went public and the obligatory new gunslinger corporate executives suddenly became more worried about the company’s quarterly numbers than my hospital or their products. I’ve had vendors that were bought by GE and were never heard of again. Others borrowed themselves to the hilt and had to put the money men in charge as collateral, which naturally meant the answer to every problem was to charge us more, give us less, and sell of chunks of the company to anyone interested.

I like to think the time for change is at hand. The financial industry melted down because of that kind of short-sighted greed. The government will either have to live within its new lesser means or keep selling the country off piecemeal to foreign debt-holders. People want to shop local, keep it simple, and live green. Rich people and monolith corporations suddenly don’t look so infallible any more.

So while you’re out their driving your Prius and eating organic apples, give this a try. Every now and then, buy an IT product or service from a low-debt, founder-led company that thinks creatively, has fun, and cares about its customers. The last thing we need is more faceless widget factories run by money-lending Sharks.

In fact, I kind of hope Shark Tank gets cancelled.

Morning Headlines 10/4/13

Lexmark acquires PACSGEAR for $54M

PACSGEAR, an EHR/PACS integrator that transmits images, videos, and supporting documentation between PACS systems and EHRs, is acquired by Lexmark for $54 million in cash.

Providers Demand More Than Just Regulatory Reporting From Quality Management Systems

A new KLAS report evaluates quality management systems, which customers say should be doing more than just automating regulatory reports. The expectation is that quality management solutions will drive operational and financial improvements across the organization, leading to better outcomes. Xerox Healthcare comes out on top in the survey.

Google Glass in hospitals? Royal Philips, Accenture think so

Philips showcases a new Google Glass app that displays data from its surgical solution so that surgeons can review real-time patient data intraoperatively on a hands-free form factor.

HIMSS Analytics Releases 2013 Inpatient Revenue Cycle Management Study

A recent HIMSS Analytics survey about inpatient RCM solutions finds systems used for pre-certification, address validation, and bill estimation are lagging and likely to be replaced. Advisory Board, Emdeon, Experian, RelayHealth, and Recondo are among the vendors with the highest mind share.

News 10/4/13

Top News

Lexmark International acquires PACSGEAR, which provides connectivity solutions for sharing medical images with PACS and EMRs. The price was $54 million in cash. The acquisition will be operated from Lexmark’s Perceptive Software.

Reader Comments

From Frank: “Re: certification scoreboard. A check of the certified inpatient systems still shows some big names missing. For full EHR certified systems missing are two biggies, Cerner and Siemens. Also no shows are Healthland, QuadraMed and NTT-Keane. A week ago Dr. Mostashari was quoted as saying that two-thirds of the systems in use were already 2014 (Stage 2) certified. That’s hard to believe with Siemens and Cerner still out, and McKesson only certified for Paragon. That’s got to cover at least half the hospitals in the country. Also somewhat ironic is Siemens is not certified. Remember John Glaser was a key member on the HIT Committees that set up the criteria for Certification/MU program. I remember him being quoted two years ago in an HIStalk interview saying that the program was not going to be easy and some organizations just won’t make it. Well he’s proving himself a prophet now!”

HIStalk Announcements and Requests

Some news you might have missed this week from HIStalk Practice: CareCloud and Box integrate Box’s content-sharing capabilities into the CareCloud platform. My top educational session pick for MGMA, plus my tentative party agenda. Most physicians are satisfied with the e-prescribing workflow for controlled substances. Medicare awards Arch Systems a contract to validate the accuracy of data submitted to the eRX and PQRS programs. Physicians claim EMR use is stressful. If you are headed to MGMA, you’ll want to peruse our annual list of Must See Vendors. The guide includes essential details such as vendor booth numbers, product offerings, and fun giveaways. Thanks for reading.

I’ll be reporting from MGMA beginning on Sunday so keep reading HIStalk Practice (or sign up for email alerts) for all the conference updates. Feel free to email me if you have any recommendations for conference sessions, exhibit booths, or after-hours festivities.

On the Jobs Board: Chief Medical Officer, Clinical Analyst, Epic Revenue Cycle Project Director.

Acquisitions, Funding, Business, and Stock

Mobile healthcare communications provider Duet Health secures an undisclosed investment from Baird Capital.

Sales

PIH Health (CA) selects Allscripts Sunrise EHR for its newly acquired PIH Health Hospital-Downey and extends its hosting and managed services agreement.

Southern Regional Medical Center (GA) engages MedAssets for A/R services and revenue cycle consulting.

People

AirStrip promotes Matt Patterson, MD from chief transformation officer to COO.

MaineHealth names interim CIO Andy Crowder as CIO.

Farzad Mostashari, MD will join the Engelberg Center for Health Care Reform of The Brookings Institution as a visiting fellow.

NorthCrest Medical Center (TN) promotes Randy Davis as president and CEO. He had previously served as VP/CIO.

Shelia Mitsuma, MD, who holds positions with Brigham and Women’s Hospital and Massachusetts General Hospital, joins EBSCO Information Services as deputy editor of its DynaMed clinical reference tool.

Announcements and Implementations

Newton Medical Center  connects its Meditech EHR to the Kansas HIN using ICA’s CareAlign interoperability platform.

Cerner announces a strategic relationship with Shawnee Mission Medical Center and TMC Lakewood and designates the organizations “Certified Maternity Partners” for its KC-area employees. Cerner says the arrangement is designed to “improve infant and maternal health outcomes,” while “managing rising healthcare costs for its associates.” I suppose that means that many Cerner employees or their covered spouses may need to change providers in order to receive full maternity benefits. I’ll be curious to see how receptive Cerner employees are to this change since my experience is that women in particular prefer to exercise maximum control over their own health issues, including their choice of providers.

The Georgia Department of Community Health launches its statewide HIE network with the Truven Health Analytics platform, powered by CareEvolution.

Government and Politics

ONC reports that as of July 31, 1,115 critical access hospitals and small, rural hospitals had attested for MU, which exceeded ONC’s goal of 1,000 by 2014.

The VA warns that the federal government shutdown will reverse its progress on decreasing the backlog of disability claims because claims processors cannot be paid overtime.

Innovation and Research

Inpatient providers report a high level of adoption for eligibility and scheduling solutions from RCM vendors, according to a HIMSS Analytics study. Many respondents say they intend to replace or purchase new RCM solutions to handle pre-certification, address validation, and bill estimation. The most-considered RCM vendors include Passport, RelayHealth, Emdeon, and MedAssets.

Technology

Athenahealth and Epocrates introduce Bugs + Drugs, a free app to identify the most common bacterial infections recorded in a geographic region using data collected  from athena customers.

Royal Philips and Accenture demonstrate a proof of concept for the use of Google Glass to aid in surgery. Researchers successfully transferred patient vital signs from Philips Intellivue software to Google Glass, giving surgeons continual access to patient data hands free.

Other

Xerox, provider of the Midas+ product,  is named the “vendor to beat” in a KLAS report on quality management solutions. Nuance and Premier earned the next-highest performance scores. Providers say they want more from their vendors than just regulatory reporting functionality and are looking for solutions that will facilitate operational and financial improvements to drive better outcomes.

A multi-day systems outage at a Scottish hospital trust that forced cancellation of hundreds of appointments is blamed on a corrupted Microsoft Active Directory.

A man who gave a phony name in his hospital admission rips out his IV, steals another patient’s iPhone and iPod, and slips out of the hospital. The man is a suspect in several similar incidents at other hospitals.

Sponsor Updates

• CTG Health Solutions publishes a white paper with recommendations and steps for setting up executive dashboards to manage EHR implementation project issues or risks.
• Elsevier names five winners of its third annual Mosby’s Suite Superheroes of Nursing contest.
• Vocera Communications previews its Vocera Collaboration Suite at the ANCC National Magnet Conference this week in Orlando. Also at ANCC: GetWellNetwork will demonstrate its new patient user interface.
• Levi, Ray & Shoup opens a Paris, France office to provide support for its LRS Output Management software.
• Truven Health Analytics establishes a Singapore-based regional office as its Asia Pacific headquarters.
• Infor CMIO Barry Chaiken, MD and Infor customer Joel Vengco, CIO at Baystate Health, will discuss learning to leverage social networking and user experience optimization tools to drive patient-centered clinical workflow at next week’s CHIME 13 Fall CIO Forum in Scottsdale.
• Aventura earns Gold status in the Golden Bridge Awards for its innovative, secure, and effective IT awareness computing platform.
• Forward Health Group reports it is poised to nearly double the number of deployments of its PopulationManager platform within a matter of weeks.
• HCS will exhibit at next week’s AHCA/NCAL 64th Annual Conference and Expo.

EPtalk by Dr. Jayne

The past week has been uncharacteristically low key for me.  Our IT teams have been working hard to knock out strategic projects because we know our EHR vendor is on the cusp of releasing their ICD-10 ready package to the general public. Once that happens, it’s going to be all hands on deck and full speed ahead.  Luckily we’ve been more efficient than usual so we have a bit of a lull while we wait.  It feels a bit like they describe the eye of a hurricane as we wait for the beating that’s surely coming.

I’ve been catching up on email, reassuring providers that we’re going to meet all our deadlines, and trying to stay away from any new projects the operations people try to sneak in. We’ve had a terrible time prioritizing new initiatives and finally have a good process in place, but there is one administrator who is always pushing a pet project. It usually doesn’t have funding or a well-defined scope, so I’m avoiding him at all costs.

I guess I shouldn’t be shocked anymore at how far some of his initiatives make it before someone finally says no. It seems like our hospital administration is increasingly reactive, responding to the squeakiest wheel or the sparkliest thing dangled in front of them regardless of its lack of purpose in context of our long term goals. There were a lot of strategic planning apple carts upset over the last few years as hospitals struggled to plan for upgrades and other initiatives around Meaningful Use and ICD-10. The only unknown on the horizon now is Meaningful Use Stage Three and I think we can at least make some reasonable plans based on what we think will make it in the final requirements.

I have appreciated the opportunity we’ve had to roll up our sleeves and take care of all the things we put on hold over the last few years. On the technical front we’ve expanded interface capabilities for our ambulatory sites, implemented some great new reports, and increased our patient outreach efforts. On the workflow front, we have had fewer new implementations so we can actually spend time going back to retrain staff and reinforce best practices. Our operations teams have actually had time to do some process redesign work and build on the clinical transformation we started with EHR.

Of course, we’re still doing all the day to day “care and feeding” activities such as maintenance and patches but it’s been nice to feel like we’re making up some of the ground we lost with all the focus on MU. Our compliance teams are starting to train ICD-10 in earnest and I’ve enjoyed fielding questions from colleagues who seem to have been under a rock or locked in a biodome for the last few months. Somehow they missed all the demos we did showing that yes indeed the system will be capable and ready come October next year.

I wonder if vendors are experiencing any of the lull that we are. It would be great to know that they’re able to focus on greater usability, expanded content, and designing the next best way to document patient visits rather than checking the box on regulatory requirements. Many of our vendors have been through the wringer during the last couple of years. It will never be the way it was before Meaningful Use, but I’m looking forward to a new normal where we can again collaborate rather than scrambling madly in the same general direction.

I figure I’ve got about two weeks of the good life left and then I’m going to be back in an upgrade cycle with all the standing meetings that entails. I’ll be back in the trenches testing workflows and trying to find defects as quickly as possible so that our vendor can roll them into patches before we go live. Every time we upgrade it reminds me more and more of some kind of military assault. I’m not sure if it’s just the way we run them or a little bit of post-traumatic stress. Maybe it’s a little of both.

Are you in the calm before the storm? Planning an upgrade or just trying to stay afloat? Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 10/3/13

As Demand Stays High, Officials Try to Address Problems in Exchanges

Federal and state health insurance exchanges are struggling with numerous glitches and unexpected traffic volumes. The federal HIE, Healthcare.gov, crashed Tuesday after receiving one million visitors before 7am. The federal site is back up, but is still plagued with glitches and long delays.

Epocrates Bugs + Drugs App: Big Data for Better Care

Epocrates launches its first new app since being acquired by AthenaHealth. The app uses infectious disease information pulled from Athena’s 40 million de-identified patient charts to provide physicians with real-time information on which antibiotics are working best to kill different organisms in their communities.

VA warns disability claims progress ‘at risk’

The VA issues a warning that gains made to reduce the disability claims backlogs will be lost during the government shutdown due to an inability to pay claims processors overtime. The overtime program was established in May and has resulted in a 30 percent drop in outstanding claims.

Introducing the Box + Dignity Health Patient Education App Challenge

This week during the Health 2.0 conference, cloud-based file sharing vendor Box announces a $100,000 innovation challenge soliciting app designs that will help extending the patient education process into the post-acute environment.

HIStalk Interviews Anonymous CIO 1

This is the first CIO interview I’ve done with the intention of protecting the subject’s identity. This reader-suggested format allows an unusual level of candor. If you are a health system CIO and want to get your viewpoint in front of the industry risk free, let me know.

What are the good and bad parts about being a health system CIO?

The very best part of it is how lucky we are that we’ve selected a trade in information technology. I got into it out of college. it wasn’t at the dawn of IT, but it certainly was when it broke out and became ubiquitous within just about every industry and every business. It was the advent of the personal computer, the advent of file servers, and it just exploded at the right time. There’s no end in sight, so you pick the career trade where it’s constantly evolving. There’s all kinds of growth. If anyone as an IT professional is bored, that’s on them, because there’s so much that you can pick to expand your own horizons from a technical standpoint.

The second part of that is the fact that it’s at a crossroads between IT. You pick IT and how dynamic and ever-changing that is, and then then you pick healthcare as the industry vertical, and holy smokes. Look at all the change that’s happened and all the change that will continue to happen. IT’s in the middle of it. 

It’s anywhere from the more somewhat mundane. Take ICD-10. Organizations can’t convert and be compliant with ICD10 without the IT component. Meaningfully Use, that’s mostly around IT enabling it. And the list goes on. It’s going to keep on going, especially now with payment reform and all the pressures that we all have to be able to deliver quality care for less money. IT’s going to be right in the thick of that, at the very least from measuring it to make sure that you’re hitting the mark and making improvements all the way up into making process improvements that IT will enable.

Do you think CIOs are fairly compensated?

You know, I think we are, because you can’t run the business without us, and there’s all kinds of pressure on keeping up and getting ahead, and especially when you have things like, “We’re going to replace about 70 percent of our systems and we want to do that in 24 months.” That’s a lot of heavy lifting, and even once you get that accomplished, you have a new need for support that you have to figure out. You’re doing this all the while that the business is still operating. Hospitals are still running, the clinics are still running. It is a balancing act that not everyone is cut out for.

If you look at other industries, healthcare leaders aren’t exactly paid the same as what they are in manufacturing and financial services. I cringe when I hear people say that CIOs or other healthcare leaders are overpaid. You don’t hear that about the other C-suite in other industries, general health. I don’t think we’re overpaid at all because it’s a very stressful job.

Even under best circumstances, it’s stressful, albeit the stress sometimes is self-imposed because we’re all very conscientious professionals and we know what we do is important to the organization. We know that mistakes can eventually harm people. It’s fairly rare, thank God, but it still can happen. Then you throw in the constant change. Then if you work in an organization that is, let’s say, less than ideal, then everyone is a critic. Everyone is a critic of IT. Everyone thinks they can do it better. And it’s a fairly risky position from a political standpoint.

So no, I don’t think we’re overpaid at all. Not at all.

What’s the most common reason that you’ve heard that CIOs get fired?

It’s typically around missed expectations. I’ve heard that a lot, especially in the last five years. Some CIOs are really big on marketing their programs and marketing themselves within their organization, sometimes even outside their organization. In doing so, they’re setting the expectations of what IT can do rather high. Sometimes it’s almost like a self-fulfilling prophecy where they’ve gone and worked hard at getting the word out about IT and perhaps they’ve made some promises that they’ve not been able to keep. There are expectations that are missed. That happens more often than what we hear about.

But then the other part that is, even if you’re not actively doing that and are trying to deliver at what’s reasonable and what you can commit to, there are still times where people get taken out because it’s perceived that they’ve not done enough. It’s a pretty slippery slope and it begins with the CEO of the organization. I’ve seen CEOs that are passive about IT. Sometimes the other members of the C-suite will not be passive about it, meaning that the CEO will be somewhat engaged, but they’re not going to be on you all the time. They spread their attention out fairly evenly across all the different divisions, so IT’s not singled out necessarily. And some of your colleagues then will take an interest in it. 

CFOs are probably the most guilty of this, just doing their job and they’re trying to manage to the bottom line. It’s more of a financially-driven thing. They feel that there needs to be a check and balance in IT. Other times, I think CFOs believe that they’re smarter than the CIO and IT should be reporting to them because they can really control those costs. They do this sometimes without regard to understanding the value of what IT can deliver. They look at it as just the cost center that is just something else to be controlled. Those are bad situations.

I worked at a place where the organization’s financial standing was in very good shape. The CFO that we had there had retired, and this guy coming into it didn’t have a lot to do. He didn’t have to work very hard for the organization to look good from a financial standpoint. I am fairly confident through his boredom, he decided to stick his nose into other parts of the organization, including IT, and it really wreaked hell, challenging everything that we were doing. Finally we had to ask the CEO to intervene, which he did. That further pissed off the CFO, which I thought, well, too bad, dude, why don’t you stick to your knitting? Everyone’s a critic and sometimes people become active from outside of IT and try to manage and get into your business about it. I’ll never understand it.

It’s always interesting to me that a lot of the people who are IT critics approved the systems, but then resent IT having the maintenance expense in its budget.

Here’s an example of that. A hospital selected Epic while they were recruiting the CIO. They committed and got board approval for $80 million. The CIO gets on the ground, figures out where the restroom is and where the water cooler is, and is like, “Can I take a look at the budget for the Epic project just to make sure everything’s up to snuff?” The CIO asks the program director, "Is it your understanding that this budget in front of us is to cover everything?" They said yes. The CIO says, "We’re in trouble, then." Based on a crosswalk from similar Epic organizations, the hospital was about $32 million short.

The board approved the extra money, it gets implemented, and it’s done on time. Six or seven go-lives, inpatient and outpatient. Then the CFO says, “We’re not spending $18 million a year to support Epic.” The CIO says, “With all the stuff you guys missed going into it, let me guess that no one has had the conversation with you that to support Epic, it takes more. It takes more people, costs more money than whatever you’re coming out of.”

The CFO says he just assumed it would be less because the hospital was consolidating all these systems. That’s one of the dirty secrets of Epic. If you don’t talk to the right people and if you don’t ask the right questions, the support does cost you more money.

The CFO is fit to be tied. He wasn’t happy about going to Epic. He wasn’t happy about $80 million and he sure as heck wasn’t happy about $120 million. Then he’s looking at 18 or 19 million bucks a year on top of the 16 to 17 million a year in non-Epic IT. He’s just fit to be tied.

People are all yippy skippy about getting the new platforms. It’s going to be great and we’re going to spend this money. Then you get through it and the financial reality hits you. Then they’re not so crazy about it because now they’re spending more money in some cases on support, which then doesn’t allow you to do other initiatives. The spotlight remains on IT, and I think very unfairly. 

If you’re a decent CIO, the big decisions as far as financial commitment to do major projects and everything that goes with that … if you’re doing a good job, the organization is deciding and committing the resources. You’re not. Good IT programs, for the most part, are working at the will of the organization and working on their priorities. The only thing that IT should be doing that most of your peers of the CIO are not going to care very much about it is the infrastructure stuff. You’re still getting the right approval, you’re still informing, you’re still making sure that, yeah, if we’re going to move from HP servers to Cisco servers and we’re going to spend $8 or $10 million over two or three years, here’s what we’re going to get for this. 

It’s a very weird phenomenon. You don’t necessarily see that in any other part of the business.

What companies are doing a good and not so good job in your eyes?

Epic does a good job as long as you know what you’re getting into and you ask the right questions. MedAssets does a good job in what they do. I’ve worked with them a few times and I think they’re a pretty upstanding organization.

We’ve had very good experience with Nordic Consulting. Very good people and they stand behind their folks and we’ve not had a bad person from there. Trying to think of bad experiences. I’ve been pretty lucky, because what I consider a bad experience is usually something that the organizations brought on themselves.

There have been people that have shown up for consulting work that we’ve had to turn around and after a week or two and they’ve not qualified, but that’s not the end of the world. That happens. There’s plenty of firms where I’ve seen that happen. maxIT, it’s happened with once or twice. I don’t hold it against them because sometimes it’s a misunderstanding of what we were looking for. Sometimes the hiring manager hasn’t been able to articulate the skills that they’re needing. It’s usually a mismatch. It’s not usually they’ve sent us a bum or they’ve sent us someone who’s just not competent. They’ve sent a competent person, but they just don’t have the skillsets that we thought we needed. I don’t get too worked up about that.

When you look at what vendors are hyping, what do you think’s the most overhyped stuff that’s out there that could be a landmine?

Certainly anything cloud and some of the risks that come with that.

I think one of the things that Microsoft is doing right now without telling too many stories that Microsoft will get pissed off about, but we had our enterprise agreement renewal come up. It was about $1.8 million net increase for the next three-year agreement and we weren’t buying anything in addition to the previous three-year agreement, so it was a net zero difference on stuff. We had some exposure if we acquired or merged or whatever, but that’s business as usual. We figure that in.

We knew he had this $1.8 million no matter if we didn’t add a single seat to the agreement. They came back and they said, if you go to Office 365, we’ll waive that $1.8 million. We get that in front of the CFO and he’s like, yeah, done, we’re going to do this. I’m like, whoa, whoa, whoa, whoa, wait. 

I said, "Do you really understand what that means? All of our email, Exchange Server, Outlook, everything goes to Microsoft facilities. Everything goes to the cloud. We have PHI in our email and there’s nothing we can do about that. That’s always going to be there. We’re completely trusting Microsoft to have our back for any PHI disclosure when it comes to email, right? And if we have a breach and it goes public, you know that $1.8 million is going to look like chump change, right?" 

He still did it. He went to the CEO and said, "We can save this money." I’m like, oh good Lord, OK. Microsoft held a gun to our head. Maybe they were gambling a little bit and they felt that our financial position was such that we’d take the bait. They were right. Even after my emphatic pleas in trying to get people to understand what a risk that was that we were assuming, they’re still doing it. I wasn’t happy about that at all, and I think that at least in the case of Microsoft, we’ll see more things like that. From a financial standpoint, it makes it hard to say no, but from a business standpoint, especially innate to healthcare, we have to be good stewards and be aware of what our risks are, especially with patient information. That it puts us potentially in a bad spot.

People overlook how much of the IT budget is made up of ongoing maintenance. It sounds good upfront, you spend your money, and then suddenly you’re locked into these forever contracts that have price escalators built in.

You ran a piece from Frank about big data and the hype around that. I thought it was a pretty good piece. In fact, I copied that and put it in a Word file for future reference.

I think that’s kind of a slippery slope right now, too. Even though there are plenty of organizations in healthcare that have not done a really good with decision support and with business intelligence and they do need to catch up a little bit and it will make them more effective, some organizations are going to go into this headfirst into the deep end. They’re going to be looking at companies and buying product from SAS, which is good stuff, but you  have to have smart, very well-trained people in order to get the most out of it. The list goes on. 

Some organizations have figured out that you don’t have to invest $5 million or $8 million or $10 million to have good analytics to be able to drive the business. It’s going to continue to heat up and we may see a bit more hype around big data. You’re going to see organizations overspending a bit.

Do you think hospitals even use the data that they already have? The problem often isn’t that they don’t have enough data, but are lacking the will or the capability to do something with it.

I think that’s correct. There’s so much good data available that is just dormant. But again, some of the tools are not the best.

For example, Epic took a big step last year at UGM when they announced this whole Cogito thing. They have the ability where you can do ETL data transfers into the Cogito platform from non-Epic systems. If you’re an enterprise customer, you get the platform for free, you just have to pay to stand the thing up. I know it’s a step in the right direction, but I think that until an organization has a platform where they can have data from any part of their system infrastructure, they’re going to be leaving a little bit on the table. 

Of course you can get it done through much simpler tools like Access and, God forbid, Excel worksheets, but you’re always going to be prone to missing something or having a transcription issue when you take data from your key and from one place to another. I don’t believe you have to bet the farm on BI and spend $8 million just to get what you need. I think there’s some risk. I think there’s some hype there that we’re all going to have to deal with.

Would you as a CIO be comfortable in being the data and quality lead for the whole health system?

There are some CIOs that could do that. I’ve met plenty out there that have had more training than I’ve had in statistics and data management. That’s the luck of the draw. We’re all exposed to different things throughout our career and we all have different parts of what we do that are more interesting than others. I can see some CIOs doing that.

For me, I would take it on, but boy, I would make sure that I had a very strong individual or data jocks that really know and understood what the data was telling the organization and understood the relationships and understood what it meant to have high integrity in the data and the source of truth. There’s plenty of people who don’t understand the fundamentals and then you end up making decisions on bad data.

If you had a blank check both organizationally and financially to run IT any way you wanted, what would you do differently?

The first thing that is anything that has to do with IT would be under the IT umbrella. Too many organizations have allowed different parts and different departments too much leeway and have their own IT staffs and they end up sometimes with an uncoordinated mess. If there’s a bit or byte involved, it comes into central IT so it can have a much better coordinated effort. 

I’d probably invest a little going back to the whole data thing. I think most organizations from the people standpoint don’t have enough of the right people. No matter what the decision support BI tool is, that’s almost not important if you have really good data people in the organization. I’d invest a bit more there. I think it’s becoming much more important given where we are and where we’re headed as an industry. The organizations that are going to be successful are those that understand their information and their data, act on it appropriately, and use it to make the improvements they need to make be it quality, cost reduction, or process improvement.

I guess the third thing is, I always am very transparent as far as what IT does, but I certainly would continue to say, “Look, Mr. CFO, Mr. Fill-in-the-Blank, just keep your nose out of our business and don’t try to run IT. Leave it to the professionals.”

How do you as a CIO feel about HIMSS and the HIMSS conference?

I have found that I don’t go to the sessions. I spend my time networking with people I know in business, especially vendor partners. That’s the one time of year where you can get caught up. It’s a pretty good setting. People are more open and honest at HIMSS. For whatever reason, it’s just a more relaxing environment than just having one-on-one meetings throughout the year.

I think it’s still relevant to the industry, especially for staff to go. There are good presentations. There’s good information to be had. Of course, there are some that are not so good, but that’s been ever since I’ve been going.

I think the exhibit all is helpful if, of course, if you’re in a buying mode where you can do one-stop-shop and compare products, but also learn about new products, which is pretty helpful. In New Orleans, I spent all my time in the exhibit hall and meeting with colleagues and with people that I know that are in different aspects of the industry. I didn’t go to a single session. I’ll still go, but I don’t go for the full event. I’ll go for three days.

Any final thoughts?

Those of us that work in the business, we’re all just very fortunate to have these dynamic times with our industry and the dynamic times as technology evolves and how we can figure out how to apply it to the work we do. Continuing to work on getting organizations to understand what the potential value is and how we can deliver it and strengthen how IT is being viewed versus just a cost center.

CIO Unplugged 10/2/13

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

Connecting with Staff

Own up. Once you leave staff and move into management, you cease to add productive value. Staff is the engine; it’s where work happens. Management is overhead and owes any success to staff. Our calendar is now their calendar. They come first. Management second.

Never forgetting my roots makes it easy for me to connect with staff. Back in the day, I started as a clinic janitor, an experience that sparked my healthcare career. Later, after working some god-awful assembly lines and toiling to fill sandbags, I made a commitment to move into management. My goal was to reinvent staff work to make it more meaningful and efficient. After my lousy experiences, I promised myself I would treat staff as I would’ve wanted to be treated. As I worked my way through management, I observed and took notes. Tucking away all the good things from that experience, new inspirations sprouted, and I committed to the idea of remaining connected to staff.

Management that loses touch begins a downward slope towards mediocrity.

Even today, I observe my peers and management and look for gems. I actively seek to relate and stay linked. The day I lose touch is the day I become impotent.

Here are some best practices I presently deploy:

• Major Life Events. Be there. Remember what matters—your presense, not presents.
• Hands-On Visits. Go experience their work environment. I spend significant time traveling to our various facilities and hang with staff. I worked the service desk. Email and texting are false forms of relationship building.
• Drop In. I drop by unannounced into various meetings and just listen and answer any questions.
• Personal Parties. I am always looking for a reason to host a party, especially in our home. We host several annual parties as well as impromptu. We have about 200 staff and family each year in our home.
• Other’s Parties. I love getting invited to department parties, and I make them a priority. Nothing feels freer than ripping off the suit and let out the real me.
• Unique Venues. Not everyone feels comfortable coming to my house. So I’ve started picking cities in the metroplex and going bar hopping. We publish schedule to give plenty of advance notice. Remember the beer summit? Well, it’s better than that.
• Sport. I lead triathlon teams, adventure race teams, and climb teams. These provide tremendous opportunity for time together. Sometimes, I mountain bike with staff. I can’t golf, but I drive a mean cart on the course.
• Open Door. Staff can view my schedule and drop in whenever I’m around our offices.
• Meals. When I have free time, I actually publish these offers to see if anyone wants to go to breakfast or lunch. Impromptu meals are a lot of fun.
• Exercise. We have spin/cycling and treadmill conference rooms and I let staff know when I’m in one. They’ll throw on a pair of tennis shoes, and we talk while exercising indoors to avoid the 100-degree Texas weather. Now that’s efficient multi-tasking!
• Volunteer. We volunteer together. We’ve served in food banks, Habitat for Humanity, and other various organizations.
• Town Halls. We do these once or twice per year. Too stuffy for me, but I do them.
• Department Meetings. Whenever I’m invited, I’m there.
• Social Media. For sure I connect with any interested staff on Facebook, Twitter, etc.
• Collaboration Tools. I microblog daily to staff and share what I’m working on plus general, organizational news. Staff can reach out numerous ways to include IM, Txt and Yam. Email if you must.
• Book Studies. We do these quarterly. Eight-week sessions, one hour each. Great team building.
• Holidays. My wife and I make a point of serving my Service Desk staff on Thanksgiving and Christmas. We cater in all the food and have a giant feast.

I love my staff. It is a privilege and honor to serve them. They make things happen, and connecting is one way I can add value back to the system.

How do you connect with your staff?

Ed Marx is a CIO currently working for a large integrated health system. Ed encourages your interaction through this blog. Add a comment by clicking the link at the bottom of this post. You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook and you can follow him via Twitter — user name marxists.

Morning Headlines 10/2/13

Q&A: Mostashari Reflects as He Prepares to Exit ONC

Health Leaders publishes the second part of its interview with Farzad Mostashari, MD.

Fourth Annual Xerox Survey Shows Slow Progress in Patient Knowledge of Electronic Health Records

A recent Xerox survey of 2,000 US adults finds that 83 percent have concerns with EHRs, and that less than one-third want their medical records to be digital.

Tenet Healthcare Completes Acquisition Of Vanguard Health Systems

Dallas,TX-based Tenet Healthcare completes its acquisition of Vanguard, bringing Tenet’s organization to 77 acute care facilities and 173 outpatient facilities.

Baylor Health Care, Scott & White finalize merger

Baylor Health Care System completes its merger with Scott & White Healthcare. The merger creates a 43-hospital, 500-clinic health system, the largest not-for-profit system in Texas.

Innovative Healthcare Company Acquires Substantially All Assets of Healthrageous

Partners Healthcare spinoff Healthrageous closes shop after four years and $15 million spent trying to monetizing a health portal marketed to health systems, payers, employers, and pharmaceutical companies.

News 10/2/13

Top News

All but four of 184 ONC staffers are furloughed as a result of the October 1 government shutdown, along with about 40,000 (52 percent) HHS employees. ONC has also put on hold its Standards and Interoperability work, privacy and security policy activities, clinical quality measure development, and maintenance of the Certified Health IT Product List. Tweeting is apparently considered a non-essential service.

Reader Comments

From Ole: “Re: David Muntz. He won’t be returning to Baylor Scott & White. Matt Chambers is the new CIO, reporting to COO Bob Pryor. Both are from Scott  White. Vic Richey is the newly appointed CIO for the Baylor (Northern) division.” Verified from the LinkedIn profile of Matt Chambers (above).

From HIT Pundit: “Re: Leidos, the former maxIT-Vitalize. Major changes in leadership. The website confirms that people are gone.”

From Clafouti: “Re: Dr. Jane’s comments about Greenway. It was not only biased toward sponsors (which I understand to a point) it was verbatim of what Tee says in his speeches. Next time you claim to be independent, don’t quote the CEO and call it your own words.” Dr. Jayne has never met Tee or heard him speak. She wrote that post a year or so ago and decided it wasn’t appropriate to run at the time, but the Greenway acquisition made it more timely.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor pMD. You may note and appreciate, as did I given the dearth of it in healthcare IT, pMD’s appreciation for whimsy. The San Francisco company lets doctors record charges in seven seconds on a mobile device, or as one hospitalist says, “If you can hold a beer, then you can use pMD”  (many testimonials are here). Users report an increase in Medicare payments for post-discharge follow-up appointments and improved care coordination driven by its handoff tools. Native apps are provided for Android, iPhone, BlackBerry, and iPad and support is provided 24×7 by actual employees. Thanks to pMD for supporting HIStalk.

A YouTube cruise turned up this video describing pMD’s mobile charge capture solution.

Acquisitions, Funding, Business, and Stock

Evolent Health, which offers a population health and risk management platform, secures $100 million in Series B funding led by The Advisory Board Company and UPMC Healthcare, bringing the company’s total funding to $124.5 million.

Baylor Health Care System (TX) and Scott & White Healthcare (TX) complete their merger and form Baylor Scott & White Health, the state’s largest not-for-profit health system with $8.3 billion in assets.

Tenet Healthcare closes on its $4.3 billion acquisition of Vanguard Health Systems.

Healthrageous, a Center for Connected Health spinoff that offered patient engagement tools, sells off its assets to an unnamed “leading healthcare companies.” Even the website is gone.

Sales

Knoxville Comprehensive Breast Center (TN) will implement Sectra breast imaging PACS and RIS.

Adirondack Health (NY), Baylor Health Care System (TX), Mission Health (NC), North Shore Long Island Jewish Medical Center (NY), and University of Chicago Medical Center (IL) select Vocera’s Care Experience Suite.

People

Emdeon appoints Neil E. de Crescenzo (Oracle – on left) president and CEO, replacing George I. Lazenby, IV (right), who will become a senior advisor for Emdeon’s majority investor, Blackstone Capital Partners.

McKesson names James A. Beer (Symantec) EVP/CFO.

Johanna Epstein (Mount Sinai Doctors Faculty Practice) joins Culbert Healthcare as VP of strategy and executive leadership services.

PeriGen hires Rebecca Cypher (Madigan Army Medical Center) as chief nursing officer.

eHealth Ontario appoints its chairman Ray Hession to serve as interim CEO following the departure of Greg Reed, who quit six months into the job and left with a $406,250 severance package.

SRS names Peter Bennfors (Asset Control) CFO.

Infina Connect names Mark Hefner (Allscripts) as CEO.

MedData appoints appoints Stephen Ghiglieri (NeurogesX) CFO and Dustin Whisenhunt (Prognosis) VP of client services and sales.

Amy Amick (MModal) joins MedAssets as president of the company’s RCM segment.

Announcements and Implementations

The 25-bed Cobre Valley Regional Medical Center (AZ) goes live on Meditech 6.0.

The New York Giants converts the medical records of its players to eClinicalWorks.

Saint Luke’s Health System (MO) goes live on Covisint’s cloud engagement platform.

Family Service of Madison (WI) implements Forward Health Group’s PopulationManager to identify and monitor progress in patients with substance use disorders and depression.

Summit Healthcare adds Summit Care Exchange to its interoperability suite, allowing hospitals to exchange PDQ and XDS messages in sending continuity of care documents to external entities.

AirStrip announces the launch of AirStrip ONE Cardiology for Windows 8.1.

Health Catalyst receives the highest grade in the clinical analytics market in a Chilmark Research report.

Other

A Xerox survey (conducted online, and therefore with shaky statistical certainty)finds that more than two-thirds of American adults don’t believe their physicians gave them a good explanation about the switch to EMRs. Most are also concerned with the security of their records and less than a third want their records to be digital. However, 62 percent believe that EHRs will reduce healthcare costs and 73 percent think they’ll get better service from practices that use EHRs. In case it wasn’t already obvious, Americans are confused.

Cerner expects more than 10,000 attendees at its 25th annual conference in Kansas City that runs October 6-9.

John at EMR & EHR Videos will conduct a Google+ Hangout with Kareo CMIO Tom Giannulli, MD, MS on Thursday, October 3 at 1:00 Eastern.

An MGMA survey finds that medical practice IT spending has risen from $15,211 in 2008 to $19,439 in 2012.

I don’t know why this bothers me so much, but I continue to be annoyed by articles in the main stream press that suggest EMRs are a requirement of the Affordable Care Act. I’ve even noticed recently a few vendors have made this statement in their marketing materials. As a reminder: ARRA (specifically the HITECH ACT) was the legislation that included the requirement for EMR adoption and provided the groundwork for incentives and penalties. Maybe some of the confusion stems from the fact that the ACA includes provisions for the secure exchange of electronic health information. Regardless, I have read so many articles that tie ACA to EMR and Meaningful Use that I had to do some fact checking just to be sure I hadn’t incorrectly rewritten history.

While I am ranting, I am self-insured, so I decided it might be worth my while to investigate available options on the Health Insurance Marketplace. I first attempted to get on the site at 8:00 a.m. EST and despite multiple attempts, I’ve yet to be able to create an account (the security questions never appear). Several hours later, I’ve still not gotten a response from anyone using the online chat feature. I realize it is only Day 1, but so far I have to call the online process a failure.

On a much happier note, my veterinarian sent me an email to inform me that I can now set up a PHR for my pets. It took about three minutes to register and now I can see health histories online. I’m not really sure why I need online health records for pets, but it’s still cool to say it’s there.

Someone please assure me that none of my tax dollars were used to fund this study that developed BAPS (Belief About Penis Size Scale).

The family of newborn delivered at 24 weeks gestation creates a video thanking Fletcher Allen Health Care. I’m trying to preserve the feel-good moment by not thinking about the healthcare resources consumed by a 98-day NICU stay and the fact that similar babies are intentionally aborted at that same 24-week mark.

Here’s an Intermountain video describing its Cerner selection.

Sponsor Updates

• ESD sponsored Sunday’s Northwest Ohio Susan G. Komen Race for the Cure, with participating employees raising $1,500 in donations.
• Medseek partners with Vitals to help healthcare organizations connect consumers with providers and facilities.
• The Web Marketing Association recognizes CareTech Solutions with an Information Services Standards of Excellence Award and presents 2013 WebAwards to 10 CareTech customers.
• NCQA awards GE Healthcare’s Centricity Practice 11 Solution PCMH pre-certification status.
• Gartner places Perceptive Software in the Leaders Quadrant for enterprise content management solutions.
• INHS reports that its use of IBM server and storage technology has improved its delivery of cloud-based EHR services to physicians and medical facilities.
• Predixion Software launches an OEM program aimed at embedding its predictive analytics solutions into BI and analytics programs.
• Beacon Partners hosts an October 17 webinar on using data to optimize clinical and financial systems.
• Summit Healthcare adds Summit Care Exchange to its interoperability suite and introduces enhancements to its current Express Connect and Provider Exchange products.
• Divurgent will participate in the CHIME13 Fall Forum October 8-11 in Scottsdale, AZ.
• Hospitals that have implemented ProVation Order Sets by Wolters Kluwer Health report clinical benefits and ROI in as little as 13 months.
• Seamless Medical Systems posts a case study highlighting how a geriatrics practice streamlined patient workflow, reduced operational costs, and improved the patient experience though its use of SNAP Practice.
• Wellsoft will exhibit at the 2013 ACEP Scientific Assembly October 14-16 in Seattle.
• Dave Himes, IS group director for Billian’s HealthDATA, delivers a Letterman-style list of top ten CRM integration tips.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 10/1/13

Evolent Health gets $100M to ‘change the way we care for patients

San Francisco-based Evolent Health raises a massive $100 million series B investment round for a suite of population health and risk management tools being designed to help health systems transition from fee-for-service to ACO reimbursement models. The investment round was led by The Advisory Board Company. Advisory Board Vice Chairman of the Board Frank Williams will serve as CEO of Evolent Health.

Siemens Aiming for 15,000 Jobs Cuts

Newly minted Siemens CEO Joe Kaeser (former Siemens CFO) announces that the company will cut 15,000 jobs in an effort to reduce overhead costs after missed profit targets led to the former CEO being dismissed. The healthcare division will be spared because it completed a restructuring last year that has served as the model for the rest of the company.

Contingency Staffing Plan for Operations in the Absence of Enacted Annual Appropriations

Until Congress succeeds in passing a federal spending bill, HHS will transition 52 percent of its staff to furlough. All but four of ONC’s 184 full time employees will be sent home, while those that stay on will oversee the orderly suspension of activity.

Surveys find even the uninsured are unaware of HIX openings

As health insurance exchanges go live, a recent survey of the uninsured reveals that 75 percent are unaware that the exchanges are about to open.

HIStalk Interviews Trey Lauderdale, President, Voalte

Trey Lauderdale is president of Voalte of Sarasota, FL.

Tell me about yourself and the company.

I’m the founder and the president of Voalte, founded in 2008. We’re about to celebrate our five-year anniversary. We focus on deploying and enabling smartphones at the point of care and outside of hospitals to enable secure text messaging, interfacing to alarms and notifications, and voice over IP communication within the hospital.

We’re installed over 30 sites and we’re nearing about 10,000 iPhones deployed in the field,which is a great milestone for the company. Beyond the software that’s offered, we provide all the service, accessories, really everything that is required to bring smartphones in as a shared device model.

Can smartphones finally kill pagers?

I think we’ve made a tremendous amount of progress over the last few years. We are not quite there yet. I think people always forget that while pagers are simple devices, the message or the notification that is sent to that pager can come from many, many different sources.

I’ll give a few examples. You have your shared pagers, which are using an in-house pager network to send notifications. Maybe those are used for a code blue or rapid response team. They’re passed on between caregivers at the beginning of shift. You have someone’s personal pager, which is used outside or inside the hospital, mainly to receive a notification and let someone call back in or just to notify someone of an urgent situation.

When you’re looking at a holistic pager replacement strategy, you need to segment off the different type of pagers and then figure out what’s the system that’s generating the alarm, whether it’s a manual alarm or someone is dialing a number and sending out for notification. While pagers are simple, the workflow behind them could be very complex. We’ve made tremendous strides as an mHeath industry in getting smartphones to replace pagers.

At Voalte, we’re focused at the point of care, getting rid of those shared devices whether it’s the legacy voice over IP phone or the shared pager model. With our solution, we can pretty much remove all the pagers that work predominantly inside the hospital.

When you start getting to someone’s personal pager that they are assigned, there are different technologies that can enable smartphones to be a virtual pager. Those are being rolled out as well, but across the board, we haven’t run into a hospital yet that’s been able to fully remove or replace all the pagers.

I feel a lot of the infrastructure and plumbing is in place. We still have a little bit of work to do from a workflow perspective. In healthcare in general, we tend to be resistant to change and people have grown to rely on their pagers. People have faith in that pager that the message is going to come through. I think we still have a few more years, but we’ve made a tremendous amount of progress since the last time we spoke. We’re getting there.

Pagers are cheap and cover a large area, but there’s some awful workflow when you get a page and then go find a phone or use your own phone to call someone back and then hope that they’re at the number that they paged you from.

That is probably one of the largest areas where pagers cause issues of workflow. I’m a nurse and I need to reach a physician, so I page that physician. Let’s say that they are using a legacy voice over IP phone. I’ll page them my extension. That physician that needs to receive the notification needs to find a phone, then call in to that nurse. A lot of times that nurse isn’t busy. That is just one example of how workflow can break down and then the physician will end up leaving a message with unit secretary. The unit secretary had to overhead page the nurse. The nurse might be in a patient room and misses the overhead page.

You can just see how you get in this vicious cycle. That’s a combination of issues that are caused from legacy pager technology but also legacy phone technology being used at the point of care.

Where you would establish the correct workflow is the nurse would use a shared device, a shared iPhone model, where they can come in, see a physician that is logged in, and simply send them a message and then the physician can respond back. If you look at what we’re doing, it’s not that complicated. It’s enabling the communication functionality that you and I use in our personal lives right now, enabling that in a very secure, controlled, and regulated manner.

People who haven’t worked in a hospital would be surprised on how much people rely on Amcom Smart Web. Users call it texting, where you’re going to a PC, composing and sending a message either to an individual pager or functional pager, and walking away. That person gets the message, they go back to a PC, and respond back to you through Amcom Smart Web. It’s pretty amazing when you think of all the steps when the pager is the only device you have.

Oh, it’s incredible. I can’t imagine an industry that is more important than healthcare. We’re dealing with people’s lives, saving people from all sorts of terrible conditions. In healthcare, communication, even today, just hasn’t been paid attention to. We still have lots of pockets and silos of communication.

At companies like Voalte, our goal is to start breaking down those walls. When we started the company, our real focus was at the point of care, removing the legacy VoIP phones. Now as we continue to grow, we see that reach expanding not only the inside of the hospital, but inside and outside the hospital as well.

What do people do with your platform?

Voice communication is the most difficult to get to work well, mainly because there are so many moving parts with voice over IP. There is a device, our application, and the wireless network. Voice tends to be used the least amount on the Voalte solution.

Beyond voice — the second two letters in our name, AL, is for alarms and notifications — we interface with all of the leading middleware providers. The creator of that space was Emergin, but we also tie to Connexall, Amcom Extension, and Cerner Alertlink. We can receive notifications from those different middleware providers with different priorities and then play different ringtones on the device based on the priority of those notifications.

We then enable workflow off those alarms, such as accepting a notification or rejecting a notification, or other functions such as calling back to the nurse call system if the nurse call enables call-back functionality. It’s the capability not just to receive the notification, but to take some type of simple action upon the alarm or notification that sent.

The final component is the secure messaging. Inside each hospital where we’re installed, we have a directory of all the users based on units, roles, and where they’re logged in. You can see who’s logged in at your specific unit and send secure messages back and forth.

We have all sorts of features built into our messaging to make it very simple and easy and intuitive to use. We borrow heavily from our friends at Apple from a user interface standpoint, so it’s very clean and easy. You can see when the message is sent, when the delivery of that message hits the device, when it’s read. It’s very easy to have a conversation back and forth.

We said it three years ago in our last interview and I’ll say it again. Text is used usually at a nine-to-one ratio compared to voice calls. The reason for that is texting is an asynchronous form of communication. I can message you. When you’re available, you can then message me back, whereas voice is real time. For you and I to talk like we’re doing right now, I have to be available and you have to be available. Our caregivers are just so busy taking care of patients. It’s very rare they have time to make a phone call.

Our infrastructure enables those real three foundations of communication to be put in place. What we see happening now, really it’s been over the last year, is the leading electronic medical record companies, the leading EMR vendors, are all either developing or they have developed their nurse-centric application. They need a way to deploy that, provision it, get it out to a shared device model. We’ve been able to partner with the leaders in that space to enable the EMR application to live alongside of Voalte. Then we figure out ways to integrate tighter with the EMR and more advance functionality on the iPhone. I think the EMR vendors jumping into this space has really been a great catalyst for our growth over the last year or year and a half.

The alarm issue is important because it’s now a National Patient Safety Goal. Are people calling you specifically to talk about that?

Yes. We get contacted about the National Patient Safety Goal, alarm fatigue, different issues with receiving alarms and notifications in a user-friendly format. However, looking specifically at the National Patient Safety Goal of improving response to clinical alarm and overall management, I feel the alarm management space is very much in its infancy.

My previous employer was Emergin, which is now a Philips company. Michael McNeal, who was the CEO of Emergin, created the alarm management space within healthcare. Over the last probably seven to eight years, what we’re saying is a lot of the plumbing and integration is being put in place. Being able to tie it to Philips monitor with the Rauland nurse call, your GE monitor, the infusion pumps, the capability to receive those alarms … a lot of work has been done there.

However, what we’re ending up with this is a situation where we can pass the alarms, we can route them to the right caregiver or the right care team, but we still have the issue of too many alarms and too many notifications still going to our end user. Even on a Voalte device, we can do a great job of displaying these alarms and associating ringtones with these notifications, but if we get blasted in with 10 alarms in a one-minute period, we’re still going to dispatch – we being Voalte — those 10 alarms and notifications. It’s going to be overwhelming for the end user.

To our knowledge, and what I’ve seen in the space, is no middleware company or no alarm management company has tackled the problem of creating smart alarms or building algorithms based on the different types of alarms that are coming in and finding a way to reduce those alarms to just what is relevant to the caregiver. I think that is a tremendous opportunity. I’m not quite sure who’s going to tackle it, but I think we’ve made a lot of strides in getting the notification to the right person in the right place at the right time. What we have to do now is get smarter about sending the alarms.

There’s a lot of responsibility in intercepting those alarms and deciding which ones to squelch out. Is that a concern as far as regulatory or legal exposure if something goes wrong?

Absolutely. That is one of the reasons that we haven’t seen as much innovation in that space — if your people are very afraid of not sending an alarm that actually does need to get sent. We haven’t seen anyone ready to tackle that big, hairy, audacious problem. But as the founder of a startup in the health IT space, my recommendation is someone needs to tackle that. Someone needs to go and figure out how to do that in the FDA regulated format. Whoever does it is going to create a very successful company.

I’d love to go do it except I’ve got my hands completely full of Voalte right now. But I do think that’s one of the limitations we see, but it will get solved and it’s going to get solved in the next few years. I think it’s going to be a very exciting time for alarms and notifications. It’s a space that we watch very closely.

Are the monitor vendors generally cooperative and interested in working with other companies?

We don’t have the relationship with Philips or GE that we would know if they’re working on tackling this problem, so I really can’t speak to what progress they have made. But I would be under the assumption that hopefully they are putting work or resources towards those problems.

When I talked to Pat at University of Iowa Health Care, he mentioned Voalte Me. Tell me what that is.

Voalte Me is a product that we haven’t formally announced yet, so Pat got to announce our product. [laughs] In essence, what we’ve done is take the messaging and alarm functionality which is living within Voalte One to a shared device model space. We’re enabling that outside the hospital to support more of the BYOD — bring your own device — model, much more geared towards physician communication.

What we’ve found is communication inside hospitals is broken in two main segments. You have your shared device model, which is what Voalte One focuses on. Voalte Me is a product that we’re releasing in the next few months that enables a caregiver to use their personal phones to receive notifications and messages in a secure format. We’ve added extra security encryption into our application to enable that outside the hospital over the cellular network.

Do you see that as a trend where the personal phones of clinicians will be used for more corporate type applications?

Absolutely. The whole BYOD phenomenon — especially with the support of different mobile device management vendors that have come about, such as AirWatch and their capability of secured and controlled applications on someone’s personal device — has definitely opened up that whole space of letting a user or letting a clinician use their personal device for enterprise functionality.

From our standpoint, we feel that the Voalte One product line and what we built has a very specific use case. We’re getting rid of legacy voice over IP phones. We’re removing the legacy voice badges. We’re enabling a smartphone platform at the point of care that hospitals want to completely control, to be able to select what applications are put on the device such as the EMR application, Epocrates, calculators, etc.

Those caregivers who are using a shared device model and need to communicate with one another in the hospital, but they also have the need to send messages or to send notifications and alarms to those that are outside of the hospital with someone who is using their personal device. That is where the whole Voalte One, Voalte Me breakdown comes together.

AirStrip was an Apple darling, showing up on stage at some of the Apple announcements. Is Voalte that tight with Apple?

We actually have a phenomenal relationship with Apple. A lot of people like to coin Apple as a consumer-only company. They’ll say that Apple isn’t enterprise, they aren’t ready for enterprise, etc. From our perspective, it doesn’t have to be black and white. You don’t have to be consumer-only or enterprise-only.

I think Apple has done a great job at balancing that. If you look over the last few years, Apple has enabled lots of mobile device management functionality to add different layers of security to the iPhone and to the iPhone operating system. In addition, we at Voalte have worked very actively with Apple. We can’t sell iPhones directly to hospitals, but we work with specific business units within Apple. We have a great partnership where Apple will directly sell the iPhone without a cellular plan to the hospital. Apple has been very active from an AppleCare perspective with support of devices that had been damaged or broken and adding extra warranty protection of those devices.

In addition, as of recently, Apple has aligned with us from a wireless perspective. We at Voalte will go on site with our WiFi team and with Apple’s WiFi team in our larger installations to make sure that the devices are working properly in a wireless environment.

From our standpoint, Apple has been a phenomenal partner, from service, support, and also application development support. Our engineers get to work directly with Apple’s engineers. They have been a great partner in the enterprise. We hope to see that relationship continue to bloom.

Tell me about the size of the company and how you see it growing.

Just to give you a scale of our growth, at the beginning of this year, we were about 50 employees. As of August, we were 120, so we’ve already more than doubled in size. We’ll probably end this year around 150.

Over the past 12 to 18 months, the growth that we’ve experienced has just been incredible. It is as if a light switch suddenly turned on in our customer base and users and the hospitals are not accepting proprietary communication devices any more – the voice badges, the legacy voice over IP communication devices. The expectation our end users have is a smartphone type of communication because it’s what they use in their personal life.

Because of that, they have that same expectation and their professional communication at the point of care. No one except Voalte has been able to successfully deploy smartphones in a shared device model, get them to integrate to these clinical systems, and do that successfully over and over and over again.

Because of that and also our successful relationships with the EMR vendors, we’ve just seen tremendous growth. We’re definitely in that exponential growth phase. We’re hiring as quickly as we can. We recently moved to a new office and we’re already starting to fill it out, so we have to figure out where we continue to put all these employees. We’re getting ready to launch our West Coast office.

Across the board, we see our install base growing almost exponentially. We see our sales growing about the same rate. It’s just a really exciting time. When you hear about young companies who are startups going through that tornado phase of growth, that’s what we are in right now. It provides a lot of challenges, but it’s also very exciting.

The average company that is like yours would have taken outside money and then the dynamic of the company would change through all that growth as they brought in professional managers. Has that been an impact or will it be?

I can’t speak for the board, but I will say that I have been able to hold a phenomenal relationship with all of our board members and our investors. Part of it is building a great plan and being able to share with your board and with your investors where your immediate goals and your tactical goals that you want to achieve and what are your long-term strategic vision is. Then show success against that plan over and over and over again.

As we continue to look at our different options from a fundraising standpoint to continue to fuel the growth of the company, it’s all about execution. It’s about bringing the right people on board, such as Kenda West, our new COO that just came on. Making sure that these people have the right tools and the right resources to do amazing things. Really it’s just been about us executing our plan that has enabled us to be successful.

You started the company when you barely out of grad school. What have you learned?

The number one piece of advice I give to anyone who is looking at starting a company in this space is it’s all about the team. It is really about putting the right people in the right place. Make sure you foster your employees and build a culture of excellence. That trumps everything because “A” players will hire more “A” players and it just creates this upward momentum. That becomes unstoppable in the market.

The next thing is specifically looking at the acute care healthcare setting. It’s very, very difficult to get traction. What you need to do is find the early adaptors or innovators who are ready to embrace new and emerging technology. I can tell you for a fact that without Sarasota Memorial, Cedars-Sinai, University of Iowa, Texas Children’s, Mass General, without our early adaptors and development partners who helped us build this technology out, we would not be here. They were the ones who let us pilot new technologies. They were the ones who in some cases let us fail and didn’t give up on us and kept working with us to build the solution.

I think the two key pieces of advice are get the right team and build the right culture, and then on top of that find the right partners. You need the right customers who can embrace that type of risk and innovation. Then work like crazy from there because it’s a tremendous amount of work.

Do you have any final thoughts?

This is without a doubt the most exciting time to be in the communication space. We see smartphones being embraced like they’ve never been embraced before. We have the 800-pound gorillas in the health IT space, the EMR vendors, all embracing smartphones as well, so there is tremendous uplift.

On top of that, there are opportunities to improve physician communication, patient engagement, point-of-care communication, barcode sleeves for the iPhone. Across the board there is disruptive innovation and opportunities everywhere. I would not be surprised if in the next five to seven years, companies that are like Voalte or in Voalte’s position could have the potential to be the size of some of today’s large EMR vendors or other billion-dollar companies in the space.

The change is going to happen very, very rapidly. I feel Voalte is very well-positioned to capitalize on this opportunity and provide a really compelling and wonderful solution to our customers. We could not be happier. It’s an exciting time.

Thank you for the opportunity to talk to you. As always, your site is my favorite blog, and I’m not just saying that because you’re interviewing me. I’ve followed you since the Michael McNeal interview, my first day at Emergin, and I’ve read it ever since. I really appreciate all you do.

Curbside Consult with Dr. Jayne 9/30/13

Being an anonymous blogger can be very isolating, which is why I think I enjoy following other anonymous bloggers. One of my favorite, Skeptical Scalpel, recently penned a satire about a website where clinicians could rate their patients. Most of my colleagues are less than thrilled about websites where patients can rate physicians. Some have faced negative reviews for patient outcomes that were beyond the physician’s control. Others have been criticized for inability to meet unrealistic patient expectations.

Although it will never happen, the idea of being able to rate our patients is an interesting one. I’m not talking about gathering data for cherry-picking the healthiest patients or dropping those that are the sickest. I’m talking about using data based on previous patient-physician experiences that could better inform how we care for patients. As a PCP, I would occasionally have patients come to my practice because they had been fired from a previous physician for missing appointments. I didn’t have enough staffing or funding to do close follow up on all my patients, but I could immediately assign this patient to a variety of reminders and services to make sure he or she makes it to scheduled appointments as soon as he or she joins the practice rather than waiting for enough missed appointments to see a pattern.

The proponents of patient engagement don’t talk a lot about this, but patients are sometimes inaccurate about their histories and behaviors. It’s simple human nature – we all want to be doing a better job with our health than we might actually be doing, which often leads people to under-report their alcohol consumption or over-report their exercise behaviors.

There are a fair number of diligent and dedicated patients that are as honest as they need to be. Their ranks may grow as records become more transparent and more portable. I don’t know any patient though who comes in and says, “I miss one out of every three appointments I schedule.” That kind of data isn’t anything that mainstream practices are currently sharing with HIEs or CCD exchange.

These non-medical health factors are a huge deal when you’re trying to function as a patient-centered medical home or accountable care organization. Often there is not a good way to figure it out unless the previous caregivers documented that level of detail in the chart. Sometimes when records are transferred, those items are specifically left out because they may fall under behavioral health, which in many states requires a special authorization for release. Rarely does the patient volunteer those details during the initial visit.

I’m a big fan of patients bringing in their data, but only if it’s honest and valid. Technology is a great help with this. Having a patient bring in an exercise log from Garmin Connect is pretty solid because unless they’re strapping the GPS unit to their dog and letting it run the neighborhood, it’s not easy to fake. On the other hand, when patients bring in their handwritten log that shows they’ve walked 60 minutes a day every day for the month and have been compliant with their diet yet have gained 10 pounds for no medically explainable reason, it’s likely that the fudge factor was involved in logging the data.

As an added bonus, being able to rate patients would also provide an opportunity for something that is becoming more and more lacking – physician engagement. I am working with an increasing number of physicians who are burned out, apathetic, and considering other careers. Many practices can’t afford to have health coaches and care coordinators. It’s a Catch-22 where you have to provide the care to get the incentives, but you can’t afford to provide the care without having the incentive payments. Because of that, many physicians take on the work themselves.

You can easily run the return on investment numbers and show them that if they could see two more patients a day (which they could easily do if they delegated more work) they could afford another staffer. Most independent physicians aren’t willing to take the interim pay cut while a new staffer gets up to speed and they can get to the point where they can add those two visits a day. Employed physicians are often locked in to arbitrary staffing numbers their health system forces them to meet regardless of case mix or panel size.

For even the most burned out and disgruntled among us though, I bet I could get them to participate in a patient rating site. If not a patient rating site, there could be other ways of actually gathering objective data about real vs. reported patient behaviors. What do you think? Email me.

E-mail Dr. Jayne.

Morning Headlines 9/30/13

Intermountain and Cerner Announce Strategic Partnership

Intermountain Healthcare will implement Cerner’s EHR and revenue cycle solutions across all of its hospitals and clinics. Financial details were not disclosed, but the multi-year strategic partnership goes far beyond the traditional vendor-health system agreement. Cerner Executive Vice President Jeff Townsend and a dedicated team will relocate to Salt Lake City to work side by side with Intermountain stakeholders.

Staff at one of Britain’s worst hospitals told to use Facebook and Twitter on wards in bizarre bid by bosses to improve communication

Following public criticism and increased federal oversight for having unusually high mortality rates, administrators at United Lincolnshire Hospitals NHS Trust decide the time is right to reverse their ban on at-work use of Facebook and Twitter. In an internal email, administrators outline a broad corrective action plan, including a list of "quick wins," one of which promises open access to social media for staff moving forward.

Obamacare Coders Working Down To The Wire To Fix Online Glitches

Programmers are working around the clock to address functional deficiencies within the infrastructure that will support state health insurance exchanges when they go live on October 1. The exchanges, a central piece of the Affordable Care Act, were designed to provide uninsured consumers a place to shop for health insurance and to introduce consumer demand dynamics to the health insurance market.

KKR to buy Panasonic’s healthcare unit in $1.67 billion deal

Panasonic sells its healthcare unit to US-based private equity firm KKR for $1.6 billion. Panasonic’s healthcare division primarily sells glucometers and a version of the ToughBook designed for use in clinical settings.

Monday Morning Update 9/30/13

From Cerner Rules: “Re: Intermountain. Finally the Epic backlash has begun.” I wouldn’t make that assessment without a review of the Cerner-Intermountain agreement since I don’t know the price or the concessions Cerner gave to earn the business. We heard similar partnership hype in 2005 when Intermountain struck a 10-year, $100 million collaboration deal with GE Healthcare to develop new technologies around Centricity that would “set the standard for the industry to follow.” The net result is that nothing ever happened, Centricity slid even deeper into irrelevance, and Intermountain bailed out early over dissatisfaction with the result and courted its next bedmate. Intermountain is a development shop with a long IT history and an unhealthy allegiance to its antiquated HELP system, which I would bet makes them a pain as the development partner of a bureaucratic and publicly traded vendor like either GE or Cerner. I don’t recall many examples like this where the vendor ended up with commercial software with wide appeal, not to mention that it’s the federal government that’s driving the development agenda anyway with prescriptive rules for Medicare payments, Meaningful Use, and ICD-10, most of which provides no benefit to patients at all. It’s a good deal for Cerner from a PR perspective and they may fare better than GE Healthcare, but I wouldn’t hold my breath in anticipation of a flood of amazing new Millennium functionality since Intermountain is hardly Cerner’s only smart customer (that’s another risk – alienating the lesser-anointed longstanding customers). Probably the best bet is analytics since Intermountain is strong there and Epic got a late start. I’m talking to Neal Patterson this week, so I’ll let you know what he says. Intermountain Health Care changed its name to make the “Healthcare” part one word and eliminated the previously acceptable “IHC” designation later in 2005, so the GE Healthcare announcement spelled it right even though it looks wrong. Now if we could just convince the “HealthCare” holdouts to spell it right …

From BigMoneyInPatient Portals: “Re: patient portals. A report says the market will jump from $280 million to $900 million in the next five years. I guess HCIT corporate development people have found their next acquisition target.” I don’t pay the slightest attention to those come-on press releases from market research firms that claim to know how big a particular market will be, information they will gladly share with you for several thousand dollars. I don’t see many follow-up press releases extolling the accuracy of their previous predictions, the reason for which you can probably infer. I think the patient portal hype is overblown given that every vendor offers one, meaning patients are supposed to log on to several depending on what system their providers use. Kaiser can do great things with MyChart because most of the encounters are within their system and the patient can get everything in one place, but I don’t think the concept will work in most areas. Imagine if your bank had separate portals for deposits, checks, loans, and investments, all with their own look and feel and log-in credentials. Not only would nobody use them, the banks would irritate their customers for even suggesting that they should. Portals are a proprietary distraction to interoperability, not a solution for it.

From Raj: “Re: UMass Hospital System. Missed the deadline to go live with CPOE and missed out on millions of dollars from the taxpayers. They have unionized nurses who stood up and demanded HIT accountability like in Ohio and California.” Unverified. I will say that I’ve worked rather uncomfortably with unionized nurses and that’s an experience I’d rather not repeat (or experience as a patient). The visual memories of watching nurses trashing hospital equipment and blocking ambulance access during an ugly labor dispute soured me for good on their concern for patients.

From IsItTrue: “Re: David Muntz. Rumor is he will return to Baylor to lead the newly merged Baylor Scott & White IT organization.” I wouldn’t be surprised. Quite a few of the departed ONC folks have gone back to their previous jobs after finishing their abbreviated government service. Baylor Health Care and Scott & White Healthcare agreed to merge in late June to create Baylor Scott & White (I’m really annoyed at the omitted commas), which will have 40 hospitals, $6 billion in annual revenue, and 34,000 employees.

From Patient Advocate: “Re: EHRs. My ophthalmologist appoint ran 90 minutes late. The doctor said it was because they were converting to a computer system, but nobody told that to the waiting patients. She started whining that it had been a month, they were still delayed, and she was working until 6 every night. I told her the practice should adjust the patient load to reflect the number they can actually see. She said, ‘We have to see patients’ and didn’t seem to agree as she stashed her iPad mini into her lab coat. I finally left two hours later, and as I fought rush hour traffic, I thought, you chose this profession. I did not choose to need an eye specialist. Don’t tell me how rough your life is with a computer system implementation for which someone set the wrong expectations. I left without making a follow-up appointment since I couldn’t find the energy.”

Most poll respondents expect population health and analytics opportunities to kick in within four years. New poll to your right: which customers benefit from combining Vitera and Greenway under a single private equity owner?

Upcoming HIStalk Webinar: “Strengthen Financial Performance: Start with Lab Outreach” on Wednesday, October 16 at 2:00 p.m. Eastern. Presented by Liaison.

Friday’s quarterly report from BlackBerry will probably form its epitaph as it announces a $1 billion quarterly loss, almost all of it due to unsold Z10 touch phones on which the company had bet the farm. It’s hard to believe people still actually work there, but the former RIM (renamed in January to distance the stench of failure) will hack another 4,500 jobs and move its focus to corporate customers. The one-hit-wonder company has evaporated $75 billion in market value in the past five years.

A Toronto surgeon develops an “OR Black Box” that records every aspect of surgical procedures by video and audio, although he points out that it probably couldn’t have happened in the lawsuit-happy USA.

Bridgeport Hospital goes live on Epic, completing Yale School of Medicine and Yale New Haven Health System’s $300 million project on time and under budget as CEO Bill Jennings throws the ceremonial switch.

Administrators at  at one of England’s highest-mortality hospitals open up staff access to Twitter and Facebook, with the intention of promoting “openness and transparency” but causing critics to warn that “the last thing this hospital and its patient needs is staff getting distracted by Facebook and Twitter whilst at work.”

Government subcontractor programmers are being pushed to fix the health insurance exchange software that is scheduled to go live October 1 whether it’s ready or not. Known problems include delays in the Spanish version, specific exchanges that can’t calculate federal subsidies, and erroneous displays. Oregon is so worried that it won’t let anyone try to enroll in insurance plans without the help of a trained agent. The system integrator is India-based Infosys. The saving grace is polls that show two-thirds of Americans have never heard of the insurance exchanges anyway.

Truven Health Analytics names Mason Russell (inVentiv Health) as VP of strategic consulting.

Private equity firm KKR will acquire Panasonic’s healthcare unit for $1.67 billion

Weird News Andy provides a “Man Bites Dog” story. A 33-year-old medical student falls onto a Boston subway track in a drunken stupor after celebrating passing his board exams. Onlookers jumped down to pull him to safety.

Sponsor Updates

• PeriGen will demonstrate the PeriCALM fetal surveillance system at the MedAassets Technology & Innovations Forum in Orlando this week.

Vince’s HIS-tory this week is about the people who founded and ran the early healthcare IT vendor firms. If you’ve been around for awhile and are good at matching names to faces, Vince is looking for help in identifying some of the industry pioneers pictured.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Time Capsule: A Harvard Vision of One-Stop Shopping: Why Someday You Might Buy a Michael Jackson Ringtone, a “Pull My Finger” Game, and CPOE from the Same Vendor

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 July 2009.

A Harvard Vision of One-Stop Shopping: Why Someday You Might Buy a Michael Jackson Ringtone, a “Pull My Finger” Game, and CPOE from the Same Vendor
By Mr. HIStalk

The software my hospital uses is the same as everybody else’s – old. We still have musty mainframes running character-based applications. We use oddball servers running systems whose vendors have changed hands several times or closed up shop completely. Some of our systems, like the gray-haired employees who support them, haven’t changed their look since Reagan was in office.

So here’s my thought. The only significant, computing-related change I’ve seen in my hospital in several years came about because of infrastructure, not applications. The expensive and painfully implemented software applications had only modest impact on creating information and even less on its consumption.

Those ground-breaking technologies at my place were:

• Wireless connectivity that made systems portable and therefore clinician-friendly.
• PACS and related imaging technologies that changed the entire paradigm and workflow of managing and using patient images.
• Physician portals that took information we already had (mostly in the largely ignored clinical data repository) and made it universally available and easier to use.

(I’ll eliminate the Crackberry since peon employees aren’t allowed to have them, but executives are fixated with them to the point I’m thinking about trademarking the name VPacifier).

You could argue that these weren’t new technologies at all. Years before we put them in, our employees had already been screwing around with WiFi, digital photography, and Internet pages at home. They didn’t have to be prodded to use their equivalent at work.

So, as my previous hospital employer’s chief medical officer always said after rambling pointlessly, where am I going with this?

The most promising innovation in physician systems won’t come from for-profit software vendors like Cerner and Epic, who aren’t thrilled at the prospect of rewriting their cash cows. Instead, it will come from the iPhone, and I’m not just talking about mobile applications, I’m talking about software architecture.

A couple of geeky Harvard professors are pushing the concept of “an iPhone-like platform for healthcare information technology.” They’ve written a journal article and are convening a tiny, invitation-only conference of non-vendor people to flesh out the concept later this year. If they can overcome the back-scratching CIO-vendor-consultant troika that keeps the status quo in place, their idea could be big.

What they’re saying isn’t new: monolithic, scripted applications sold by soup-to-nuts vendors don’t work well (can I get an amen?) A better architecture model for healthcare involves tightly focused, substitutable, turnkey, plug-and-play applications that run on the same basic platform. The customer can use whatever combination of mini-apps that works best for them, with one flip of the switch bringing one of them online (or offline in the case of buyer’s remorse — gee, I wonder why vendors would have a problem with that?)

Like the iPhone, in other words, with its ridiculously well-designed user interface, its App Store, and its portable form factor. People get the iPhone without going to class, studying a stack of manuals, or hiring a consultant to explain what they just bought. They also aren’t held hostage to the single vendor to which they’ve sold their souls.

It does not take a Harvard person to tell you who would love this (customers) and who would hate it (the troika, although CIOs might surprise me and embrace the idea). Those who love it have additional ammunition: the cheap consumer gadget known as the iPhone will be rearranging healthcare IT priorities even if the Harvard guys flop, most likely soon taking the #4 spot on my list.

So can the Harvard guys succeed? Beats me. They have a fun idea that needs a ton of fleshing out to even be discussed publicly. Lots of ivory tower stuff fails. And, nobody’s paying much attention since the HITECH gold rush has them hypnotized.

Still, I’m cheering for them since it’s about the only radical platform change out there that could shake the HIT applications business back to life. Open source has elicited nothing but yawns. Vendors are consolidating without new entrants to threaten them. Hospitals haven’t shown any interest in manhandling their vendors into updating their last-millennium wares. Same old, same old.

I think it’s darned interesting, although being an industry pessimist, I’ll root for the Harvard guys while betting against them.

Intermountain Healthcare Chooses Cerner

Intermountain Healthcare announced this morning that it has chosen Cerner as a strategic partner for its 22 hospitals and 185 clinics. Intermountain will install Cerner’s clinical and revenue cycle applications.

Intermountain announced in January 2013 that it would not renew a much-publicized relationship with GE Healthcare because the systems they were building together were deficient in CPOE, clinical documentation, and coding/billing integration.

I spoke to Don Trigg (SVP and president of Cerner Health Ventures) and Neal Patterson (chairman and CEO) from Utah following the announcement. Trigg says the partnership may go well beyond electronic medical records specifically, potentially developing into a significant “accelerator for clinical computing in pursuit of high quality, low cost care.” Toward that end, Cerner will relocate several of its executives and employees to Salt Lake City, UT, including EVP Jeff Townsend.

Trigg and Patterson report that Brent James, MD, MStat, executive director at Intermountain Institute for Health Care Delivery Research and Intermountain chief quality officer, will present a keynote address at Cerner Health Conference. CHC will be held October 6-9, 2013 in Kansas City, MO.

I will interview Neal Patterson during the conference.

Morning Headlines 9/27/13

Jacob Reider Named Acting National Coordinator for ONC, David Muntz Resigns

ONC Principal Deputy National Coordinator David Muntz, who many predicted would take over when Farzad Mostashari departs, has tendered his resignation. Chief Medical Officer Jacob Reider, MD has been named acting national coordinator while HHS seeks a permanent replacement.

HIMSS 2014 Keynote Speakers   

HIMSS announces that former Secretary of State Hilary Rodham Clinton will take the stage as a 2014 keynote speaker, following her husband’s performance last year.

Regions Hospital, Red Cross partner to reduce unnecessary blood transfusions

Regions Hospital (MN) reduces its use of red blood cells by 14 percent after implementing a clinical decision support tool within its CPOE system. The decision support tool alerts physicians at the point of order if a patient’s most recent hemoglobin values do not substantiate a transfusion, and also cautions against administering more than one unit of blood at a time.

Premier shares jump after IPO raises $760M

Group purchasing organization Premier raised $760 million during its IPO Thursday, with shares closing 13.5 percent up from their $27 initial price.