News 7/17/13

Top News

A Massachusetts eHealth Collaborative-sponsored study finds that EHR adoption by doctors in three communities generated no statistically significant per-member, per-month cost savings, although EHR usage appeared to be associated with less-rapid cost increases. Participating communities were chosen as having the highest likelihood of EHR success by MAeHC, which also paid most of their system and implementation costs. The most commonly used systems were from Allscripts, GE Healthcare, eClinicalWorks, and NextGen. Insurance cost information from 2005-2009 was used.

Reader Comments

From Jessica: “Re: speakers. I love HIStalk and am an avid reader. Can you recommend speakers that you’ve seen and liked?” I haven’t heard many lately, so I will defer to readers. Who stood out?

HIStalk Announcements and Requests

HIStalk’s seven millionth visit was logged Tuesday morning. Thanks for contributing to that number.

Welcome to new HIStalk Platinum Sponsor CareWire. The Excelsior, MN-based company’s mobile solution improves outcomes and loyalty by engaging patients in timely communication that is tailored, thoughtful, and relevant. It sends mobile messages that are encounter-specific, personalized, and perfectly timed: patient instructions, arrival information, and links to services or provider-specific content. The result for providers is a reduction in the cost of no-shows, fewer manual interventions, and improved outcomes and reduced risk. According to the executive director of an outpatient surgery center, “CareWire is like air traffic control for my patients.” The SaaS-based solution requires minimal interfacing – just send it a daily flat file and it’s happy. CareWire’s proprietary rules engine identifies the patients and their mobile numbers, determines the appropriate messages to send, and allows authorized users to send their own messages directly to patients. Templates are provided for appointments, procedures, and case-based episodes that span visits and procedures. Thanks to CareWire for supporting HIStalk.

I’m really enjoying Pepperland, a fun novel about music, anarchy, computers and sexual freedom in the 1970s. The Amazon reviews include a quick one I wrote that compares its detail, in-jokes, and pop culture to something Stephen King would have written without his bloated excess and often ridiculous supernatural themes. The author is the amazing Barry Wightman, writer, musician, voiceover guy, and VP of marketing for Forward Health Group. I hardly ever read fiction because it usually annoys me and I have a microscopic attention span, but Pepperland is a blast.

I usually notice when a company is proud enough of sponsoring HIStalk that they say so on their Web page. The iHT² folks do and I appreciate it. I keep thinking I’ll attend one of their Summits since readers have told me good things about them.

Acquisitions, Funding, Business, and Stock

Healthcare analytics provider ArborMetrix closes $7 million in Series B financing.

Ping Identity closes a $44 million investment round.

Caremerge, a developer of communication and care coordination apps for seniors, raises $2.1 million in Series A funding.

Reed Elsevier Group will move  Elsevier/MEDai to its LexisNexis Risk Solutions business unit, where it will join the acquired EDIWatch as a fraud and abuse solution.

NPR profiles Cerner in an EHR series it’s running, pointing out its HITECH-fueled employment boom in which 3,000 employees were hired in the past two years.

Sales

Winthrop-University Hospital (NY) chooses PeriGen’s PeriCALM Plus charting and fetal monitoring system.

Celebration Orthopaedic & Sports Medicine Institute (FL) selects simplifyMD’s EHR/PM system for its 10 providers.

Pacific Alliance Medical Center (CA) will implement Summit Healthcare’s Express Connect interface engine.

Wishard-Eskenazi Health (IN) selects eClinicalWorks PM for 385 providers across eight locations.

Harris Corporation will use Symedical Server from Clinical Architecture to enhance terminology management, interoperability, and data normalization in its HIE and clinical integration solutions.

The Scarborough Hospital (Ontario) selects SIS.

Canada’s Fortius Sport & Health will implement EMR and PHR technologies from Telus.

Georgia Regents Health System (GA) signs a 15-year, $300 million contract with Philips Healthcare for consulting services, medical technologies, and operational performance, planning, and maintenance services.

People

Anthelio appoints Asif Ahmad (McKesson Specialty Health, Duke University Health System) CEO, replacing co-founder Rick Kneipper, who will remain as chief strategy and innovation officer and chair of the company’s healthcare innovation council.

Bruce Brandes (AirStrip) joins Valence Health as EVP for growth and innovation. David Kirshner (Boston Children’s Hospital) also joins the company as VP of corporate and business development.

PathCentral, which offers a online information exchange and digital consultation forum for pathologists, names David Frishberg, MD chief medical advisor. He will continue in his pathology roles with Cedars-Sinai Medical Center.

Announcements and Implementations

Michigan Health Connect becomes the state’s first HIE to transfer infectious disease lab reports from hospitals to the state health department.

HIMSS introduces the HIMSS Health IT Value Suite, a knowledge repository that classifies, quantifies, and articulates the clinical, financial, and business impact of HIT investments. In reading the press release and details on the HIMSS Website, it appears that HIMSS is positioning it as an industry resource as opposed to a product or service available for purchase.

MModal rebrands its Philippines-based medical transcription provider MxSecure to MModal Global Services.

Southern Health NHS Foundation Trust deploys SEIM and content security technology from Trustwave.

Open Door Center for Change (WI) installs Forward Health Group’s PopulationManager.

NCH Healthcare System (FL) completes its implementation of Cerner this week.

Deep Domain releases Version 3.0 of its EHR reporting software. It charges $78 per provider per month for a reports subscription.

AHIMA and CHIME announce plans to join forces in conducting HIM/HIT research, presenting sponsored Webinars, co-presenting sessions at CHIME’s Fall CIO Forum, and working together on advocacy issues.

Government and Politics

Only 18 of the 32 first-year Pioneer ACOs reduced Medicare costs in their first year, though all improved their quality measures. Seven of those that did not produce savings say they will switch to the Medicare Shared Savings Program, while two others will leave the program entirely. While the Pioneer program rewards providers for shared savings, the majority of a provider’s patients are likely still covered by traditional fee-for-service contracts.

National Coordinator Farzad Mostashari, MD, interviewed by NPR: “Paper works just fine if you want to deliver healthcare the way you sell shoes. If you want to wait in your office for the door to open and say, jingle, jingle, and you say, can I help you, and pull a chart and deliver care, and then when you close that chart, that information is dead, paper works just fine. If you want to coordinate care with other providers, if you want to share information with the patient and engage them as partners in their own care, paper doesn’t work just fine.”

Innovation and Research

A video by Vonlay’s Steve Knurr, Google Glass Explorer, records cycle racing using the device. He plans to help develop a heads-up cycling display that will include bike telemetry, biometrics, and race information.

It’s not all Google Glass in the computing eyewear field. Italy-based GlassUp, running its launch campaign on Indiegogo, will offer a camera-free and more stylish alternative that will cost only $399 ($299 as a Indiegogo donation, or $1,500 for 10 pairs right off the first production run.) They will also offer a prescription version for those who already wear glasses.

Other

A Wolters Kluwer Health survey finds that changing reimbursement, financial challenges, and finding time to spend with patients are the top challenges facing doctors.

The healthcare business intelligence market lacks a clearly perceived leader, according to a KLAS report. Large BI vendors such as IBM, SAP, Microsoft, and Oracle command the largest mindshare, but the lack of sufficient healthcare focus leaves most providers with unmet needs.

US News & World Report releases its annual hospital rankings. Johns Hopkins (above) reclaimed the top spot, followed by Mass General, Mayo Clinic, Cleveland Clinic, UCLA Medical Center, Northwestern, New York-Presbyterian, UCSF, Brigham and Women’s, UPMC, HUP, Duke, Cedars-Sinai, NYU, Barnes-Jewish, IU Health, Thomas Jefferson, and University Hospitals Case Medical Center.

The top administrator of a Georgia cancer treatment center files a whistleblower lawsuit claiming its health system owner overcharged the government by upcoding claims. It also charges that Columbus Regional Healthcare System essentially pre-paid a referral kickback by intentionally overpaying for a local cancer center it bought for $10.5 million; that its medical director modified the medical record to justify higher charges because he was upset at a potential income loss caused by regulatory changes; and an insurance company executive who sat on the hospital’s board threatened to withdraw his financial donations to the hospital if the medical director were to leave in a contract dispute.

A Wall Street Journal article covers hospitals that use big data, specifically The Advisory Board Company’s Crimson platform, to encourage higher-quality, lower-cost physician behavior by showing doctors how they compare to their peers. 

A labor publication editorial written by a union-represented RN complains that EMRs “are getting in the way of the fundamental work nurses do.” She says that the union understands benefits of EMRs, but doesn’t want nurses “to become lost in the land of acronyms, drop-down menus, non-existing options, and endless grey pages in which endless boxes must be clicked.” She concludes that her employer needs to replace McKesson Paragon with a system that “fulfills both the legal compliance needs and the needs of the patients who are hospitalized for competent, attentive, and effective nursing care” The author has previously argued that nurses should work for independent agencies rather than directly for hospitals.

The Judy Maple Foundation will hold a charity golf tournament on July 27 in East Springfield, OH hoping to raise money for the Charity Hospice of Wintersville to replace outdated computers for use with its EMR.

Sponsor Updates

• Aventura is named as one of 10 Denver startups with cool offices, complete with pinball machines, a gym, and healthy food. 
• Beacon Partners hosts a July 26 Webinar on optimizing clinical systems.
• IHE USA and ICSA Labs certify eight HIT products under its pilot certification program to test security and interoperability in the IHE Patient Care Device or IHE IT infrastructure domains.
• InstaMed announces the availability of its InstaMed Network, which allows providers to accept electronic payer and patient payments.
• Levi, Ray & Shoup finalizes its purchase of Capella Technologies.
• Kareo outlines five ways it can help users prevent denials.
• Emdeon will integrate the Simplicity Settlement Services by ECHO into the Emdeon Payment Network. The company also introduces Virtual Card Services, an electronic payment option to reduce payment distribution costs and payment processes.
• KLAS Research adds MModal Fluency Direct to its customer rankings.
• BayCare Health System CIO Tim Thompson shares his organization’s experience implementing Medicity’s HIE platform.
• The Nashville Business Journal profiles Shareable Ink CEO Laurie McGraw.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 7/16/13

Personal health record vendor MyMedicalRecord announces that it is on the verge of securing a patent for what is essentially e-prescribing technology. The patent describes "providing a user with the ability to access and manage prescriptions online by providing features that include sending prescriptions to a pharmacy, accessing prescriptions from a pharmacy, scheduling prescription refills, sending reminders regarding prescription refills including by text or email, and identifying adverse drug interactions by analyzing prescription medications."

Readers Write: The Enterprise Content Management Adoption Model

The Enterprise Content Management Adoption Model
By Eric Merchant

There have been numerous publications recently about the amount of unstructured content that exists (80 percent of all content) in a non-discrete format outside of the electronic medical record. This unstructured content exists as digital photos, scanned documents, clinical images, and faxes and e-mails.

The challenge of capturing this information as close to the source as possible — managing it effectively and ultimately delivering it to the necessary physician, nurse, or other provider in a timely manner at the point of need — is a continuous uphill battle. There are varying degrees of being able to manage unstructured content and make it available to decision makers in a meaningful way to improve patient care, drive operational efficiencies, and improve financial performance in the healthcare market.

In developing a content strategy, the challenge is greater than simply buying a software suite and thinking your problems are over. As content grows in volume and complexity, the strategic plan needs to be flexible to be able to grow and adapt accordingly.

To do this, a reference is needed to determine where we were, where we are now and where we want to be. I began creating an Enterprise Content Management (ECM) adoption model as an internal point of reference, but also as a strategic guide for the industry. In practice, it would function similarly to the seven stages of the EMR adoption created by HIMSS Analytics.

ECM Adoption Model

This adoption model can serve the healthcare industry well by allowing us to keep focused on the outcomes we want to achieve and the systems that would provide them. The adoption model also intertwines patient care initiatives (capture content and deliver within the EMR), operational efficiencies we need to achieve (federated search and analytics) and outcomes that will directly benefit healthcare organizations’ financial performance (intelligent capture, VNA and Image Lifecycle management).

In addition, this strategy also delivers on the commitment to support Meaningful Use and IHE data-sharing initiatives with the ability to share and publish unstructured content to information exchanges.

EMR systems have received the bulk of the attention the past few years due to the value they bring and the public policy and reimbursement implications of getting them successfully implemented. However, as the healthcare market becomes more electronically mature, we cannot lose focus on the larger picture and the bigger challenge and ultimately the patient. This picture is incomplete without bringing together both the unstructured content created outside the EMR and the discrete information within the EMR.

To do this, the ECM adoption model, in conjunction with the EMR adoption model, must both be used as a roadmap to reach that goal. ECM vendors must take the same approach that EMR vendors have taken and work hand in hand with healthcare organizations to provide the solutions to achieve Stage 10 of the ECM adoption model and ultimately move closer to a complete patient record, which subsequently creates better health outcomes delivered efficiently and in a financially solvent manner.

Eric Merchant is director of application services, health information technology, for NorthShore University HealthSystem of Skokie, IL.

Readers Write: Requirements Versus User Experience: The MU Design Impact on Today’s EHR Applications

Requirements Versus User Experience: The MU Design Impact on Today’s EHR Applications
By Tom Giannulli, MD, MS

Since the first electronic health record (EHR) applications, the federal government has been looking for ways to leverage EHR technology to improve the quality and cost of healthcare delivery. A decade ago, President George W. Bush declared that every American should have an electronic health record within 10 years. While we’ve come a long way, almost half of all medical providers are currently searching for an EHR, installing one now, or looking to switch out the one they have in place.

This is an eye-opening situation given the investment of billions of dollars in EHR technology by healthcare providers, technology suppliers, and the government via incentive programs. Why is this? One contributing factor is that the government incentive programs have excessively focused on features over user experience and outcomes.

When the current EHR incentive programs emerged in 2009, EHR suppliers with existing products were faced with the challenge of meeting Meaningful Use (MU) requirements. It’s not easy to retrofit new functional requirements into an existing product, and it’s commonly understood many suppliers had to focus on achieving functionality requirements however possible given the potential impact of government incentives. The time-bound goal was simply to get X feature programmed in Y weeks so that version update or hot fix could be applied to meet customer certification timelines.

Function ruled over form, often resulting in degraded user experience and sub-optimized workflows. In hindsight, it may have been better to have fewer incentive program requirements with broader definitions and simpler tests to validate compliance.

For example, assume a general requirement for physicians to be able to share standardized clinical documents with basic tests of compliance. With this more general goal, technology suppliers would have greater freedom around how to solve the requirement resulting in a greater range of solutions—some of which likely would have superior usability. The market would then reward the company that best met both the requirement and the associated usability and user satisfaction.

The overall goals of MU are sound; it’s simply that in practice the extent and specificity of the requirements often overemphasize feature content and prescribed usage at the expense of user experience and the innovation that comes with flexibility. A doctor on HIStalk a few weeks ago highlighted this reality:

“When you’re used to using very clean designs—a MacBook, an iPhone, Twitter, Facebook—and you sit down on an EMR (electronic medical record system), it’s like stepping back in time 15 or 20 years.”

I had the opportunity to build an EHR after MU Stage 1 had been established. This allowed us to take a more comprehensive approach in terms of meeting our overall design goals, including usability, as well as MU requirements. We wanted to make it possible for the physician to use the application to chart patient visits and the required data and reporting were generated as an by-product of normal use.

Now, we are facing changes for MU Stage 2, integrating those into an existing product, tying them to user needs in a way that makes sense. We have developed a process that uses a lot of user feedback and testing and we try to iterate quickly with releases at least monthly.

But the fact is that the specificity of MU and the rigorous testing don’t provide for the best user experience. Ironically, these really specific requirements—a number of which dictate the user experience to a large degree—are supposed to be creating improved usability when in fact they are detracting from user-friendless and improved workflow.

I believe that without MU, many EHR features would be similar, but there would be notable differences resulting from the focus on user feedback versus government direction. As a physician and an EHR designer, I would still want to track health maintenance and have tools to manage people’s care. The big change would be the ability to focus on some market-driven elements that we haven’t been able to spend as much time on because they aren’t MU requirements.

We would be spending more time looking at how we could use the practice data to highlight workflow problems or areas where the practice isn’t using best practices. By leveraging our large pool of operational and clinical data, we could generate more recommendations for practice optimization and patient care. These are very high level concepts that we are exploring, but are at a lower priority given the resources required to implement MU2 in a way that is well integrated and results in a positive user experience.

In a perfect world, current MU2 requirements would be replaced with just few high-impact goals related to interoperation and communication. Current MU2 requirements have added little new incremental value while creating a significant burden for vendors and end users. This situation is even more challenging in that the requirements are becoming more specific and dictate user interaction in some cases. The structure is in place to capture discrete data, measure quality, and communicate standardized data.

At this point, I believe the market should drive the process of advancing features and expand-on the valued features outlined by the MU requirements.

Tom Giannulli, MD, MS is chief medical information officer at Kareo.

Curbside Consult with Dr. Jayne 7/15/13

A Tale of Two Lists

I’ve been a big fan of making lists even before people like Atul Gawande raised the collective consciousness with The Checklist Manifesto. One of my former co-workers used to make fun of those of us who were “list-makers” and said that we lacked spontaneity and a certain sense of fun due to our fondness for lists. Personally, making lists has kept me sane.

There’s too much going on in most of the working world today and especially in healthcare. Everyone is trying to do much more (remember Meaningful Use?) with the same level of staffing or even less. People are overworked, under-inspired, and fatigued. These are factors that allow near-misses (or actual misses) for patients. Making lists helps one ensure nothing is forgotten and that every precaution was taken to ensure care was delivered as intended.

Checklists aren’t just for the front lines of patient care. I use one when I’m wearing my IT hat as well. They can be simple – I have a checklist I use before presentations to make sure I have e-mail, instant messenger, and other applications shut down so they’re not distracting. I make sure my desktop background is neutral and my screen resolution is adjusted.

They can be complex and multi-faceted. We use checklists extensively in our EHR implementation framework. They ensure that every user in every specialty and every practice setting receives consistent training. Signing the completed checklists after training documents the users’ receipt of training and has reduced the incidence of “nobody every showed me that” complaints to near zero.

I had a chance to revisit our training checklists today when one of our implementation specialists went out on family leave earlier than expected. With it in front of me, I was able to deliver solid training to a couple of specialists even though it’s been several months since I’ve covered their particular discipline. After the session, I made sure to compliment the implementation manager on ensuring that the lists are kept current and used consistently by everyone on her team.

She joked back at me that the training lists are the only ones that seem to be working for her right now. She’s in a bad cycle of making lists for implementation projects that continually get put on hold by the leadership. Once providers figure out that their pet projects are on hold, they raise a political ruckus and the projects are reactivated. She pulls up the lists and updates project plans, only to be put on hold again when the projects are not funded.

It’s a vicious cycle and to the point where she’s not even updating them anymore, just changing the date in the header. I don’t blame her. The best list in the world can’t be successful if no one is able to activate it and carry it through to completion. I think the leadership needs a better checklist to ensure projects are funded before trying to get them up and running. Or maybe they need a checklist for when they try to put them on hold, making sure they are not political hot potatoes before they are placed on hold.

How does your organization view checklists? E-mail me.

E-mail Dr. Jayne.

Morning Headlines 7/15/13

Practice Fusion raising $60M, sources say

Ambulatory EHR freeware vendor Practice Fusion is rumored to be within days of announcing $60 million in new funding from an undisclosed New York-based investment firm.

Sutter’s New Electronic System Causes Serious Disruptions to Safe Patient Care at E. Bay Hospitals

Nurses with the California Nurses Association working at Alta Bates Summit Medical Center (CA) have gone on strike, citing patient safety concerns with the hospital’s newly implemented Epic system. Alta Bates, a Sutter Health facility, becomes the third health system to fall victim to an EHR-related nursing strike in the past few months after Affinity’s nurses hit the pavement in June over what they called a "hurried" Cerner implementation and Martin General Hospital (CA) nurses went on strike in May to delay a upcoming McKesson implementation. Sutter Health is reportedly spending $1 billion on a system-wide Epic implementation.

Athenahealth soars on Ascension deal

Athenahealth stock rose 20 percent Friday after the company announced a deal with Ascension Health Network worth as much as $42 million. Athena will implement its practice management solution to more than 4,000 Ascension providers.

Do Clinical Trials Work?

An op-ed in the New York Times questions the validity of clinical trials for new medications.The use of Avastin to slow the development of aggressive brain tumors is discussed. Researchers have not been able to link Avastin to improved survival rates through clinical trials despite growing anecdotal evidence that suggests a relationship does exist.

Monday Morning Update 7/15/13

From Flyswatter: “Re: Practice Fusion. Running out of money, expanding, or both?” Free, ad-supported EMR vendor (are you a vendor if your product doesn’t cost anything?) Practice Fusion is rumored to be raising another $60 million after a $34 million round held less than a year ago.

Three-quarters of respondents say healthcare organizations should continue with their plans to buy software in preparation for Affordable Care Act-related changes even though the future of the ACA is uncertain. New poll to your right: how has the DoD/VA discussion about a shared EHR changed your perception of those organizations?

I mentioned last week that it would be fun to hear from folks who have been reading HIStalk since the beginning 10 years ago. Some replies:

• ”I know I’ve been reading your stuff since the beginning for sure. I think a friend of mine referred the site to me, but I can’t remember who and/or exactly when… all I know is that now you can’t get rid of me.”
• “I count you as one of my celebrity acquaintances.” [this tongue-in-cheek comment came from someone who knows me]
• “I found HIStalk while searching for a primary source of unbiased information about the healthcare IT world. I found HIStalk to be one of the few outlets at the time willing to publish all things healthcare IT (good, bad and the ugly) and provide value to sponsors and readers alike. It’s been wonderful watching HIStalk grow with the healthcare IT industry. Congratulations!”
• “In 2003 I worked for Eclipsys, and one of our sales reps asked if I read HIStalk. He said it was the best blog about the industry he had ever read, and that if I wanted to be in the know and feel hip at the same time, I should check it out.  And so I did. And stayed. Congratulations!”

HIStalk Webinar Monday, July 29

Jonathan Teich MD, PhD of Elsevier will present “Clinical Decision Support: The Promise, Pitfalls, and Practicalities” on Monday, July 29 from 2:00 to 2:45 p.m. Eastern. He will provide practical insights into the key success factors for selection, design, management and rollout of CDS interventions and will describe 10 types of CDS and how to apply them. My CIO reviewers who provided feedback on the rehearsal gave this Webinar rave reviews, with one of them saying he was so engrossed by the CDS examples that he wished it had lasted 30-45 minutes longer (when’s the last time you heard that about a Webinar?) I thought it was really well done myself. You can register here.

Also upcoming: “Five Steps to an Enterprise Imaging Strategy,” presented by Merge Healthcare, on Wednesday, July 24 from 3:00 to 3:45 p.m. Eastern.

These Webinars meet HIStalk’s standards for quality, clarity, and attendee value. They have been critiqued by experts and are moderated by folks who work with me.

Six people lose their jobs for inappropriately viewing electronic patient records at Cedars-Sinai Medical Center, possibly those of Kim Kardashian. Four employees of community physician practices were found to have been using the login credentials of their physician employer and were dismissed, along with a medical assistant and an unpaid student research assistant. The journalistically rigorous TMZ decided that a phony quote and Photoshopped picture were the perfect way to illustrate its uncredited rumor, which was repeated by traditionally privacy-indifferent press anxious to jump on the celebrity gossip bandwagon without appearing to be pandering to intellectual lightweights.

Another nurse union uses an EMR implementation to publicly criticize a health system. The California Nurses Association cites 100 reports from RNs claiming Sutter Health’s $1 billion implementation endangers patients of Alta Bates Summit Medical Center. The nurses say the system requires too much nursing time, delays care, and isn’t clinician friendly. The union wasn’t nearly as concerned about patient safety eight weeks ago when it ordered its nurses to walk off the job for seven days in those same Sutter East Bay facilities to protest a reduction in their health benefits.

Intermountain Healthcare says it has developed an EHR module that allows state death certificates to be completed automatically.

A Silicon Valley business newspaper profiles former professional quarterback Steve Young, now a private equity deal-maker for HGGC (formerly Huntsman Gay Global Capitalist). The article says he was involved in that private equity firm’s investment in Sunquest, which it later sold to Roper Industries.  

A dozen employees from the Raleigh, NC offices of Allscripts volunteered to help clean up tornado damage in Moore, OK and presented the local hospital with a check for $50,000. Allscripts covered all of their expenses and paid their full salaries.

Ivo Nelson’s Next Wave Health advisory and investment firm will announce Monday that former Steward Health Care CIO Drexel DeFord has joined the company as a principal advisor.

Shares of athenahealth jumped 20 percent on Friday after the company filed SEC documents disclosing a June 30 deal with Ascension Health Network’s physician segment, which will deploy the company’s system to its 4,000 providers and affiliates. Athenahealth’s market cap is now $4 billion, with Jonathan Bush holding shares worth $33 million. A $10,000 investment in ATHN shares on this day three years ago would be worth $48,000 today.

Also earning a spot on the Nasdaq’s top percentage gainers for Friday were WebMD (up 25 percent on its sales outlook) and Quality Systems (up 12 percent on an analyst’s upgrade).

Showing his HIStalk colors at the top of Mt. Bachelor in Oregon is Dean Sitting, PhD, professor of biomedical informatics at UT Health Science Center in Houston.

Maybe it’s just me: every time I get an e-mail survey from HIMSS, I dutifully start completing it, but then bail out in annoyance just a few questions in. Every HIMSS survey is way too long, has endless answer choices but often not the one I need, and uses a stiff and authoritarian tone that makes me feel like I’m dealing with IRS instead of an organization to which I voluntarily pay dues out of my own pocket.

Blue Cross Blue Shield of North Carolina is called out for sending out live patient data to software developer DST Systems for testing its systems. Cigna went on record saying it would never do that, while Aetna said it shares data in similar situations.

Brown University researchers create software that can analyze the cries of an infant, hoping that the 80 auditory parameters can detect developmental problems.

An interesting New York Times opinion piece questions whether clinical drug trials work, wondering if disease and response is so individualized that mass testing creates more frustration than usable knowledge. It says drug companies are just playing the lottery in testing drugs they don’t expect to be effective, hoping for a statistical miracle. It also says that nearly every study is biased from the outset because drug companies pay for them, turning them into a “straw-man comparator” of drug vs. placebo instead of a real quest for finding the best treatments. The healthcare IT connection: genomics, which could effectively match patients with drugs likely to benefit them.

Vince starts his history of Siemens in this week’s HIS-tory. He is trying to find the lost history of the IBM SHAS (Shared Hospital Accounting System), so if you know more than what’s on Vince’s slides, he would enjoy hearing from you. Vince loves this stuff and his enthusiasm and fun memories come through loud and clear in his HIS-tories.

Sponsor Updates

• Intelligent InSites will host a July 25 Webinar, “The Hospitality Environment” – Improving the Patient Experience with Innovative Technology.”
• O’Reilly’s Strata Rx Conference, “Data Makes a Difference,” offers HIStalk readers a 20 percent discount on registration through August 15. It will be in Boston September 25-27 and feature speakers from athenahealth, Valence Health, HHS, and Humedica.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Time Capsule: Healthcare Transparency 2.0: Using RHIOs to Rate, Criticize, and Publicly Rat Out Idiot Patients Wasting Everybody Else’s Healthcare Money

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

I wrote this piece in February 2009.

Healthcare Transparency 2.0: Using RHIOs to Rate, Criticize, and Publicly Rat Out Idiot Patients Wasting Everybody Else’s Healthcare Money
By Mr. HIStalk

I’ve always made fun of those “Get a Free Medical (wink, wink) Scooter” commercials that run during the fake judge TV shows that are watched religiously by homebound, unemployed, and intentionally deadbeat people while the rest of us are at work. I see them occasionally while getting my oil changed, waiting to have labs drawn, or getting a haircut. I feel like I’m peering into a sociology experiment gone horribly wrong.

The scooters don’t really look all that fun, but apparently “free” makes them a blast, at least to that latter category of people (since so many of us are joining the “unemployed” category involuntarily, I’ll focus on the intentional deadbeats). “When did you realize your mobility was impaired, Mr. Jones?” “Why, when I saw that sweet scooter model that looked like an ATV with a beer can holder and a ‘Free with Medicare’ sign on it, sir.”) I suspect it’s the same people who borrow someone else’s handicapped sticker to get the best parking place.

Apparently that “intentionally deadbeat” demographic is a rich vein to be mined by semi-scrupulous companies who know that “Jerry Springer” moves some medical iron while “Meet the Press” doesn’t. Now comes mesothelioma time, valiant ambulance chasers channeling Robin Hood by taking money away from anyone who has it and redistributing it (minus the 90 percent legal fees) to the daytime TV audience not quite up to the subtle nuances of General Hospital.

My solution is either simply brilliant or brilliantly simple (I can’t decide). Use RHIOs to turn healthcare professionals into a constantly communicating network of fraud- and sleaze-sniffers and pay them for turning people in (the government is terrible at detecting Medicare fraud, yet is puzzlingly world class at snooping on citizens). Everybody wants transparency, so let’s make it work both ways. Patients ought to have some skin in the game.

Anybody can rate doctors and hospitals anonymously, even to the point of adding vicious, unsubstantiated comments. If Mr. Smith rips Dr. Jones on a public doctor rating site, Dr. Jones should be able to, as on eBay, add a blistering response, such as, “This lard-butt patient smokes, ignores my advice, has sued three doctors so far, and has never paid a dime of what he owes me.”

RHIOs could be the interoperability platform for exchanging information about those crackpots who ruin the system. Doctors, nurses, pharmacists, and dentists could flag patients who stiff them on co-pays even though they drive Jags, who use someone else’s insurance card, or who are just plain nasty. Let the doctor check their credit report, criminal record, IQ, and work history while they’re at it. They’re the ones who will be facing them naked (the patient, not the doctor) in an exam room, so it shouldn’t be Mystery Date in there. Like the stockbrokers say, “Know your customer.”

Patients who have filed more than one malpractice suit would get tagged so other doctors can avoid them. It would be like the NFL: patients get one medical challenge with no hard feelings, but frequent malpractice flyers get marked as trouble, as do drug-seekers and scooter-wanters.

Forget evidence-based medicine. If you really want to save healthcare dollars, give doctors the tools to identify and avoid those who seek to use them dishonestly and irresponsibly. That fruit is abundant and low-hanging. Plus, it’s not like the RHIOs are really doing anything anyway.

Post the information publicly and let’s put some shame back into dishonesty, criminal behavior, and irresponsibility. It could even be made cost-neutral by charging the public to peek at the postings. I bet people who make “Cops” or “Dog the Bounty Hunter” could figure out how to monetize it.

Now if you’ll excuse me, I think I’m coming down with a touch of mesothelioma, so I’ve got a scooter to order while they’re still free.

HIStalk Interviews Joe Casper, CEO, Sandlot Solutions

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

Tell me about yourself and the company.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What are your thoughts on CommonWell?

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

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

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

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

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

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

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

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

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

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

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

Morning Headlines 7/12/13

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

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

Allscripts jumps on better 2Q contract booking

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

Fort Worth hospital reports huge data breach

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

HIMSS Workforce Survey, July 2013

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

News 7/12/13

Top News

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

Reader Comments

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

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

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

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

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

HIStalk Announcements and Requests

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

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

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

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

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

Acquisitions, Funding, Business, and Stock

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

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

Sales

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

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

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

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

People

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

Bill Korn (Antenna Software) joins MTBC as CFO.

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

Systems Made Simple elects CFO Christopher Roberts to its board.

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

Announcements and Implementations

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

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

Government and Politics

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

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

Innovation and Research

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

Technology

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

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

Other

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

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

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

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

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

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

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

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

Sponsor Updates

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

EPtalk by Dr. Jayne

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

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

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

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

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

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 7/11/13

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

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

North Shore-LIJ Extends Allscripts Outsourcing Agreement Through 2020

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

Mount Sinai honored for electronic records system

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

Readers Write: All Vendors Exit Stage Left

All Vendors Exit Stage Left
By Frank Poggio

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

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

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

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

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

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

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

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

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

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

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

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

Frank Poggio is president of The Kelzon Group.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Lee Farabaugh is the chief experience officer at PointClear Solutions.

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

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

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

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

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

What are the workload expectations?

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

Can I handle the commute to this job?

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

What is the boss like?

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

What are the people like?

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

What is the career progression?

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

What is the training offered?

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

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

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

CIO Unplugged 7/10/13

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

Leadership and Reconciliation

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

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

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

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

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

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

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

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

May it never happen again!

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

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

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

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

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

Morning Headlines 7/10/13

Stinger Medical Merges with Enovate

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

Health Information Technology in the United States 2013

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

CMS mulls payment policy changes on chronic care, telehealth

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

OFT probe could ratchet up pressure on health IT providers

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