Readers Write: Shame on Health IT

Shame on Health IT
By Tom Furr

I’m willing to bet were I to ask anyone even remotely associated with healthcare IT, that person would wax poetically about how collective efforts are helping to advance the speed and quality of healthcare. I’d hear boasts of breakthroughs in all areas of medicine, drug discovery, imaging, lab procedures, and surgery as well as recovery and rehabilitation methods.

Be it ambulatory- or hospital-based care, all those advancements have made a big impact on the care and treatment of the patient. I can find nothing wrong with initiatives that yield a faster, better end result for any man, woman, or child who requires medical treatment.

Why, then, after having benefitted from 21st century state-of-the-art healthcare, does the patient get time-warped back to the 1950s when it comes to providing the bill? If the last impression left with a patient after receiving state-of-the-art care is an antiquated management and billing process, could s/he not question everything that’s happened in the examining room?

My point is simple: shame on the health IT industry as the advancements made on the clinical side of patient care have far outpaced the comparably meager improvements that have been made on the financial side. Don’t deny it, especially when you know that healthcare providers have played a major role in maintaining the existence of the US Postal Service, printer companies, toner suppliers, envelope makers, and a bunch of related entities.

Yes, shame for not embracing technology on the business side with the same determination so dramatically shown on the clinical side. What’s worse, the underpinnings for an automated patient bill and balance management system has been in place almost as long as practice management software has helped run practices, from the individual doctor to multi-office physician groups and multi-state hospital networks.

The need for every software vendor and billing company to get to the point where they are actually helping the patient manage and meet her/his financial obligations is very great and very much of the here and now. Not to mention the disservice that they are doing to the very clients who they claim to help … by not providing a tool to help medical practices keep their accounts receivable in check and drive them towards profitability instead of languishing with large back office overhead.

The high deductible health plan (HDHP) isn’t going away. Rather it is only going to grow, bringing with it change that must be dealt with in the business offices of healthcare providers and the homes of all their patients. The shift of the primary payment responsibility coming from the health insurer to an even split with that organization and the patient is here now and not helping practices collect those balances is negligent on health IT’s part.

As a practice’s A/R gets out of hand, one of two things will happen: the practice will be sold, either to a large physicians’ group or a hospital, or the doctor takes down her/his shingle and ends a career. Either way, the practice management software vendor and/or the billing company lose a customer.

But it doesn’t have to be that way.  Unless, of course, you want to continue to keep medical business offices operating like it’s still “Happy Days.”  Keep that attitude and there’s a good chance your company won’t be happy or healthy, especially if it makes practice management software.

Tom Furr is founder and CEO of PatientPay of Durham, NC.

Time Capsule: Software Usability: A Great Idea Whose Time (At Least in Healthcare) Will Never Come

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 April 2009.

Software Usability: A Great Idea Whose Time (At Least in Healthcare) Will Never Come
By Mr. HIStalk

It seems that everyone (other than software vendors) is talking about software usability these days. A long-delayed light bulb finally went off somewhere that suggested, “Say, these systems we have are cryptic, ill-suited to match real-life work flows, and maybe should have had some human factors review before they were shipped prematurely as usual.”

Usability is a hot topic mostly for ambulatory EMRs. It’s a logical (or, some would say, convenient) reason that doctors don’t use them. The problem vendors have is that those private doctors actually have a choice, unlike their hospital counterparts who have IT people making EMR decisions without their input (except maybe the rubber stamp approval of the gadget-happy, CIO-reporting, doc-turned-CMIO who hasn’t practiced in years.)

Hospitals are willing EMR buyers (although inconsistent EMR users.) Vendors in that market sell to the C-level who are wowed by a “cue the music, the future is now” video, a visit or two from top vendor suits, and maybe a promise of extra-special hospital representation on vendor committees or to provide allegedly welcome input on how to make the marginally useful product marginally better (meaning: sign here and we’re out of this hick burg for good.)

That’s the dilemma of PM/EMR vendors. Doctors who are mostly an annoyance in hospital sales (critical, interrupting know-it-alls who check their watches constantly) are the people who actually make the “buy” decision in practices. They have to actually use the product, so they are as critical as anybody would be when it comes to the tools of their trade. Poor design can’t be glossed over. There’s no big-picture visionary willing to ignore product realities and make a decision based on a futuristic video.

Hospitals are so intent to buy that they’ll just pick the best of the worst and live with it. Doctors in practice will hold their ground and buy nothing (which they have, in droves.)

Government payola will probably get a bunch of those unwanted systems sold, but not necessarily used beyond the “minimum necessary” to get a check. The government subsidy will be long spent, but the product will live on and be cursed frequently. Users will get used to the irrational design like they do in hospitals, although their productivity may never recover to the level it was using paper.

The problem with usability is that you can’t just bolt it on after the fact. It’s part of design, not last-minute touchup. The ARRA gold rush will be a faint memory by the time a system launched today would ever reach the market.

None of that matters anyway. When’s the last time you saw a new, built-from-scratch clinical or practice EMR system? You don’t take a 1985 MUMPS-based system and suddenly embrace modern usability concepts. It’s not an iPhone that will not only steal market share but create its own market. Healthcare software has a limited market, limited competition, and product lifecycles that span generations.

Here’s what will happen with software usability discussions. People will gripe about how bad current products are. Vendors will do a little bit of pig-lipsticking so that products at least look more usable in demos, even when they aren’t. Private doctors will, like their hospital counterparts, be enticed or forced by higher authorities to use the admittedly non-usability centered products and they will learn to work around their quirks.

Usability, for all the passionate discourse, is a lost cause that will have minimal impact on the stodgy healthcare IT market.

Morning Headlines 6/14/13

Lucile Packard Children’s Hospital notifying 12,900 after laptop stolen from secured badge-access area

Lucile Packard Children’s Hospital at Stanford is reporting a stolen laptop with unencrypted personal health information affecting nearly 13,000 patients. This is Stanford’s fifth data breach since 2010. In 2011, Stanford was sued over a data breach in a suit that sought $20 million in damages. In 2010, they were fined $250,000 for failing to report a breach.

‘Jeopardy’-winning supercomputer helping Maine doctors in cancer research

IBM’s Watson supercomputer has completed its installation at The Maine Center for Cancer Medicine and is now helping doctors create individualized care plans for lung cancer patients. Watson is being beta tested while engineers continue to enhance its ability to interpret clinical information and weigh treatment options.

Indian Health Service sets ambitious plan to upgrade health record system

The Indian Health Service is spending $10 million upgrading its EHR system to one integrated platform. Indian Health Services EHR was the first federal agency to have its EHR certified for Meaningful Use and received more than $50 million in EHR incentive payments thus far. They are first focusing on integrating across their network, and then will tackle larger interoperability projects with the VA and CMS.

Sonora Regional Medical Center Embarking on Major Technology Upgrade

Calif-based Sonora Regional Medical Center, an Adventist Health System hospital, has been selected as the pilot site for Adventist’s system-wide Cerner implementation. Sonora will go live September 4th, with Adventist’s remaining 18 hospitals scheduled to go live by the summer of 2014.

News 6/14/13

Top News

The FDA urges medical device makers to protect their products against hackers and malware and offers guidance for developing security controls that would protect the confidentiality and integrity of data and limit malfunctions in the event of computer viruses.

Reader Comments

From Biker Dude: “Re: HIStalk Practice. What do I win if I am your 500,000th visit?” Thanks for noticing that HIStalk Practice is about to hit a milestone in the next couple of weeks. No prize for making the visit counter hit 500,000, though every reader has my undying gratitude for the support.

From Mojo: “Allscripts. I heard they are scheduling a conference call Friday to announce another reorg. Have you heard anything like this?” No, although another reader shared news that Allscripts had sold off its forms division (who knew they still had a forms division?) Unverified but neither piece of news would not be surprising given that CEO Paul Black has now had six months to get a lay of the land and the company reported a loss in Q1.

From Zee: “Re: inbox. I want to do a prototype on how we could improve the old-style physician inbox so that read-only information can be delivered in a meaningful way on a tablet. Replicating the current functionality as is isn’t innovation.” Sounds like a fun challenge to visualize how an improved inbox might work. Send me your ideas and I’ll run them here.

HIStalk Announcements and Requests

 HIStalk Practice highlights from the last week include: CMS pays out $547 million in PQRS and e-prescribing incentives in 2011.  Physician compensation is increasingly tied to measures of quality and patient satisfaction. AHRQ offers a guide for primary care physicians connecting to RHIOs. As of the end of April, one out of two Medicare EPs were meaningful users of EHRs. MyMedicalRecords ends a lawsuit with Emdeon but initiates a new one with Jardogs. Emdeon CEO George Lazenby discusses his company, the industry, and potential opportunities. Rob Drewniak of Hayes Management Consulting looks at healthcare data governance and data stewardship. Thanks for reading.

On the Jobs Board: Compliance Program Manager, Software Engineer, Territory Sales Manager – South Eastern US.

Welcome to new HIStalk Platinum Sponsor Sagacious Consultants of Lenexa, KS. Sagacious means smart and having good judgment (I had to look it up), and the company applies those qualities to its singular focus: Epic. A full 97 percent of its employees came from Epic, collectively holding every Epic certification. The company has worked with 40 Epic hospitals and physician practices on full implementations, big bang installs, upgrades, and rollouts. It can provide build analysts, team leads, project managers, trainers, and go-live support. KLAS ranks it #1 in satisfaction for staffing and implementation support, with 100 percent of clients saying it keeps its promises and 100 percent saying they would hire the company again. Consultants work from their homes nationally, reducing travel billing and making them happier besides. Thanks to Sagacious Consultants for supporting my work.

The next HIStalk Webinar will be “Using Clinical Language Understanding & Infrastructure Planning as Key Strategies to Ensure Clinical Revenue Integrity with ICD-10” on Tuesday, June 25, 2013 from 1:00 – 1:45 Eastern time. It is sponsored by Nuance Healthcare and will be presented by Mel Tully MSN, CCDS, CDIP, senior vice president at J. A. Thomas and Associates. Register now.

A reader provides this photographic evidence of a pop-up HIStalk presence in Paris, as evidenced by a “I Could Be Mr H” banner in the shadow of the Eiffel Tower. Snap a picture with something HIStalk showing HIStalk in an interesting location and I’ll run it here.

Listening: new Black Sabbath, with “13” being the first new studio album since 1995 and the first with Ozzy in 35 years. I’ve listened to it at least 10 times and it’s a perfect 1970s sludge metal sound. It’s magnificent.

Acquisitions, Funding, Business, and Stock

Allscripts prices a private offering of $300 million aggregate principal amount of its cash convertible senior notes due 2020. The conversion price represents a 30 percent premium to June 12’s closing price of $13.22 per share.

Emdeon acquires Goold Health Systems, a provider of pharmacy benefits and related services to state Medicaid agencies.

Sales

Christus Health selects McKesson’s suite of documentation management solutions for integration with the health system’s existing HIS.

Swedish Covenant Hospital (IL) selects eClinicalWorks EHR and RCM solutions for its 150 employed physicians.

The DoD awards PSI and partners TechWerks and Mediware a $9.2 million follow-on task order to sustain and maintain the DoD’s enterprise blood management system.

People

Aneesh Chopra,  former US CTO and one of technology’s most beautiful men, loses his bid to be Virginia’s Democratic nominee for lieutenant governor.

Quantros names Dmitri Daveynis (HP) SVP of engineering.

US Surgeon General Regina Benjamin announces her resignation after four years in the post. Benjamin does not provide specific details on her future plans, but Democratic Party officials have identified her as a potential candidate for a Congressional seat being vacated in her home state of Alabama.

Announcements and Implementations

Healthix and the Brooklyn Health Information Exchange will merge into a single RHIO and retain the name Healthix. A new board of directors will govern the entity and leadership and staff from both RHIOs will continue to support the organization.

Salford Royal NHS Foundation Trust implements Allscripts Sunrise Clinical Manager three months ahead of schedule and on budget.

KershawHealth (SC) implements a paperless clinical data bridge solution from Access to transfer EKG traces and other clinical data into its EHR.

Marshfield Clinic (WI) will form Marshfield Clinic Information Services, a  separate for-profit subsidiary that will support the clinic and technology and services to other customers. The clinic’s 350 IS employees will join the new entity.

IBM, the Premier healthcare alliance, and four healthcare systems launch the Data Alliance Cooperative, which will allow members to share experiences and co-develop solutions that integrate data across the care continuum. Initial focus will be on reducing medication non-compliance and readmissions through predictive modeling.

Innovation and Research

Interested in Google Glass? Kyle, who writes for HIStalk Connect, is part of Pristine, a startup that’s developing Glass apps for physicians. He has received his pair and invites readers to give them a try at a party in New York City on Thursday, June 20 from 6 to 9 p.m. at Galway Pub. E-mail Kyle to RSVP and bring friends if  you like.

Technology

Nuance releases a new version of Dragon Medical Practice designed for smaller practices that includes voice shortcuts to aid searches for medical information and more than 90 specialized medical vocabularies.

Other

Care Logistics sues Ohio-based Catholic Health Partners of Cincinnati and Mercy Health Systems of Toledo, claiming it has lost $50 million after the health systems reneged on a 2008 deal to serve as reference sites for the company’s bed management software in return for royalties. 

Inga is so proud of beating Weird News Andy to this story. A trucker sues a urologist for what he claims was a botched penile implant that caused him to have an erection for eight months. The doctor says the man should have told him when his scrotum swelled to volleyball size, but the man says he was told to expect swelling. The patient, who changed his wardrobe to baggy sweatpants and long shirts, made his case to the jury: “I could hardly dance, with an erection poking my partner … It’s not something you want to bring out at parties and show to friends.”

Sponsor Updates

• CollaborateMD will add educational content from Elsevier into its ClaimGear solution for medical billing and coding education.
• NoMoreClipboard will integrate ICA’s HIE offerings with its PHR and patient portal.
• Vitera Healthcare releases Vitera Medical Manager EHR, a Web-based EHR, analytics, and transaction platform for its customers.
• Ingenious Med integrates Wolters Kluwer Health’s Health Language code search engine into its point-of-care charge capture solution.
• Impact Advisors Principal John Stanley discusses analytics as it relates to HIE.
• Emdat publishes a case study highlighting Illinois Bone and Joint Institute, which reduced its documentation costs by 50 percent after implementing Emdat’s medical documentation platform.
• Porter Research discusses the role of NLP technology in healthcare transformation with Nuance CMIO Nick van Terheyden.
• Perceptive Software CTO Brian Anderson offers five predictions for business process management, enterprise content management, and capture and search.
• The office manager for Summersville Pediatrics (SC) shares her practice’s experience migrating from MyWay to Aprima.
• PeriGen publishes a case study featuring Summit Healthcare’s (AZ) experience of implementing advanced perinatal technology.
• David Laureau, CEO of Medicomp Systems, discusses the importance of giving providers the data required to better manage the health of individual patients in real time and at the point of care.
• VitalWare’s VP of Compliance Jill Wolf will discuss the benefits and limitations of predictive modeling at next week’s HIMSS ICD-10 Forum Washington, DC.
• Wolters Kluwer Health’s customer advisory board says that improving clinical outcomes through expanded integration of clinical decision support is a top priority.
• iSirona will remain in Panama City, FL after the county and state promise $1.8 million in incentives. The company will 300 new jobs in the next three years.

EPtalk by Dr. Jayne

The United States Supreme Court ruled this week on Oxford Health Plans v. Sutter. Essentially this paves the way for physicians to use class arbitration to resolve issues with payers. Dr. Sutter, a pediatrician, alleged that Oxford systematically bundled, downcoded, and delayed patients for more than 20,000 network physicians but Oxford claimed physicians had to participate in arbitration as individuals. The case has been in the courts for more than a decade. I like to see the little guy stick it to the payer at least once in a while.

Medicare will be issuing a redesigned Medical Summary Notice to beneficiaries. Aimed at preventing fraud and abuse, it will show the services and supplies billed to Medicare during the past three months, the amount paid, and the patient responsible portion.

I’d like to see all payers take this approach. I’m still getting Explanation of Benefits statements from a procedure last year that the practice erroneously billed yet keeps trying to hit me up for the insurance balance. Guess what, not paying it. And to my orthopedic surgeon – guess what, you’re going to be refunding me all the co-pays you’re making me pay for follow-ups in the global period. Dr. Jayne has her summary plan description and knows how to read it. And if you cross me, I might just demand an electronic copy of my record, which I know will cause much consternation in your office. Welcome to the era of patient empowerment.

Athenahealth offers an ICD-10 Guarantee for practices that are live by June 30, 2014. Additionally, practices experiencing cash flow disruptions may be eligible for cash advances against outstanding claims. There’s a fair amount of fine print involved, but I like the idea.

Apple announced this week that the next generation of its mobile operating system will contain a virtual “kill switch,” or activation lock to allow stolen devices to be deactivated.

A couple of my friends convinced me to sit for the Clinical Informatics subspecialty certification from the American Board of Preventive Medicine. In reading through the various requirements I have one major concern (other than the cost of the exam, which is substantial). The criteria require current certification by one of the other ABMS specialty boards. This is problematic for informaticists who have let their clinical certifications lapse. I understand why they’re doing it, but the thought of maintaining two certifications isn’t a happy one. I’d be interested to hear from others who are planning to take the exam.

E-mail Dr. Jayne.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 6/13/13

GE Healthcare To Spend $2 Billion On Data Analytics And Other Tools

GE Healthcare has announced that over the next five years, it will spend $2 billion creating data analytics and patient population tools that will enable hospitals to effectively shift to a performance-based payment system.

Mostashari: Slow but steady interoperability progress

National coordinator for health IT Farzad Mostashari, MD discussed interoperability and the path moving forward at the HIMSS 2013 Government Health IT Conference this week where he summarized the current state of interoperability in saying, "Today, my last visit doesn’t contribute to my next visit in healthcare. Most discharge summaries don’t get to the primary care provider; most referral summaries don’t get back to the provider who ordered them.”

Marshfield Clinic to launch new information services company

Wisconsin-based Marshfield Clinic, a two-hospital health system, announces that it will begin offering health IT support services through a wholly-owned spinoff business, Marshfield Information Technology Services .

Maine Medical Center moves closer to $40M expansion

Maine Medical Center has won approval to move forward with a $40 million expansion project that will add five new operating suites, in addition to preparation and recovery areas. The news comes just a month after MMC announced a hiring and travel freeze in an effort to plug a $13.4 million deficit in the hospital’s operating budget.

An HIT Moment with … David Engelhardt

An HIT Moment with ... is a quick interview with someone we find interesting. Dave Engelhardt is president of ReadyDock of West Hartford, CT.

What problems do hospitals have with iPads that ReadyDock solves?

Hospitals deploying a pool of tablets for distribution to patients or healthcare personnel need a place to securely store and charge them. In addition, these tablets also need to be periodically disinfected. If a patient touches a tablet, the device should be disinfected before providing it to another patient, especially if a patient is known to be on precautions.

The ReadyDock platform serves as a home base for these tablets. You know when you grab a tablet that it is charged, disinfected, and safe for use.

What evidence exists that tablets used in hospitals require disinfection?

Tablets used in the clinical environment are roaming high-touch surfaces. They require the same consideration with respect to cleaning and disinfection of other high-touch surfaces. These high-touch surfaces can serve as reservoirs for dangerous microorganisms and can harbor them for days, weeks, or even months. This in turn can cause infections in patients and healthcare workers. 

It is for this reason that significant R&D has gone into developing an engineered solution that integrates with the existing workflow of secure storage and charging while at the same time provide a process to consistently and automatically disinfect tablets without the use of chemicals. The efficacy of the system’s general-purpose disinfection has been validated in controlled studies by Yale-New Haven Hospital’s microbiology lab.

How would hospitals that allow staff and patients to use their own devices use ReadyDock?

ReadyDock can disinfect an iPad in less than 60 seconds. ReadyDock can serve as a disinfecting processor for tablets and other mobile devices such as smart phones upon entering the building, between patients, and before going home for the day.

Describe the process and time required to run an iPad through a disinfection cycle.

When a tablet is placed in a ReadyDock for secure storage and charging, the system puts it in a disinfection queue and the tablet is automatically disinfected.  If a user only needs to only disinfect their device, they have the option to have it disinfected immediately. Total cycle time to disinfect in this mode is about one minute.

How does the CleanMe app help improve user compliance?

CleanMe is an easy to use software app available free in the iTunes store that allows users to setup their own personal cleaning and disinfection policy. Users can configure what days and hours they work within a clinical environment and how often they would like to be reminded to clean and disinfect their devices. For instance, they can insure that they are reminded to clean & disinfect before they go home, clean twice a day, etc.

Of course, when it tells them to disinfect, the app documents that they did.  This in turn will help users improve compliance. By design, the workflow of storing a device in a ReadyDock unit will ensure that disinfection occurs automatically along with secure storage and charging. 

Readers Write: Accent on Objects

Accent on Objects
By Woodstock

It has been many years since I acknowledged patient record subpoenas for medical malpractice lawsuits and other legal actions as an HIM professional and designated custodian of records (COR). But the process was memorable.

During the 1970s, one was not able to reproduce analog paper and photographic film or send records by postal mail or courier to the courts. Rudimentary paper and film photocopy machines only recently were introduced into healthcare organizations, and the courts required the personal delivery of “original” source documents and records by a COR.

Consequently, upon receiving patient record subpoenas, I took a large cardboard box and collected from each department the “original” source documents required by the subpoenas. The contents included the patient’s paper financial and medical records. The medical records also included all film-based diagnostic images, tape-based medical dictation, cine-based ECGs, and pathology slides.

During the 1980s, when I established my related career in HIT and because of my COR experiences during the “analog” years, I knew well that electronic patient records consisted of more than just the structured data typically found in electronic patient financial and medical records. Structured data are the record’s binary, discrete, and computer-readable data elements that, typically, are stored in relational databases with predefined fields. Electronic medical records (EMRs) also consisted of digital diagnostic images, audio file-based dictation, and ECG waveforms.

In fact, such unstructured data make up at least 75 percent of all the data in a typical patient’s EMR. Unstructured data are the record’s non-binary, non-discrete, and often human-readable data elements that, typically, are contained in text-based reports, e-mails, and Web pages and include symbols, images, video clips, and audio clips. In some vertical markets, unstructured data are referred to as a record’s intellectual substance or content. In technical arenas, unstructured data are referred to as objects.

My 1990s published chart below (note: not to scale) depicts a typical EMR’s structured and unstructured data. Thus began my affinity for marrying the two data types in healthcare provider organizations.

Frequently Mr. HIStalk receives comments and questions relating to an EMR’s unstructured data, particularly digital diagnostic image data around the time of the annual RSNA or SIIM conventions. Since The PACS Designer has been busy developing a growing list of mobile apps, I plan to contribute a Mr. HIStalk column relating only to patient record unstructured data or “objects.” I plan to focus on news, acquisitions, sales, people, implementations, and government, just like you are accustomed to reading in other HIStalk venues. I hope you will find this column important to your work and will reply with many comments and questions.

I’ll begin with a brief opinion piece, which is related to my above comments and subtitled:

When the Writ Hits the Fan

Just like healthcare organizations, the courts finally have entered the digital age. Today, secured electronic files of “original,” electronic source documents and records as well as “copies” of original, electronic source documents and records are admissible in courts as long as the healthcare organization can substantiate (1) the trustworthiness of the system(s) used to store and retrieve the documents and records; (2) the accuracy of the organization’s records management policies and procedures; and (3) the documents and records were not created (or altered!) just for a court case. (NOTE: Always one must verify the courts’ acceptance of digital records on a state-by-state basis.)

Large cardboard boxes have been replaced by EMR (or other system) features that promote single points of personalized access through which to find and deliver electronic information, applications, and services. As such, in either hybrid or full EMR environments, designated CORs, Release of Information professionals, and even patients—after rigorous authorization and authentication processes—merely click on hyperlinks and instantaneously retrieve “original” electronic source documents and records required by subpoenas or other requesters.

While our industry continues to pursue the best “highways” to securely transmit the documents to and acknowledge receipt from requesters, today’s day-to-day challenges involve the current mechanisms used to transmit unstructured data and the shameful output of structured data generated by most EMR systems.

For example, the transmission of the large and ever-growing number of patient diagnostic images (primarily radiology images), which remain hand-carried or sent by postal mail or courier from hospitals, physicians / groups, specialty (e.g., cancer) centers, etc., to other hospitals, physicians / groups, and specialty centers on CD storage media, is completely unmanageable. Many of the CDs containing (e.g., radiology) diagnostic images cannot be imported into the receiving radiology PACS due to the way the images were burned into the CDs. Although most of the CDs include the senders’ viewers for measuring, window / leveling, etc., often the CD files arrive corrupted. Frequently the CDs are misfiled and / or lost.

Consequently, transmitting diagnostic images on CDs has lead to duplicate testing with more patient exposure to radiation. In addition, when the CDs contain diagnostic images other than radiology images, often the receivers have no corresponding PACS for these other, “ology” images.

Thankfully, popular, standard, inbound (i.e., CD ingestion and electronic receipt of diagnostic images) and outbound (i.e., report and image distribution to referring physicians, referral centers, etc.) image sharing solutions exist. However, most are too expensive for the healthcare provider masses. In addition, few, if any, non-standard image sharing solutions exist, whereby direct connections are established between two or more organizations for readings, consultations, and second opinions and inbound and outbound electronic reports accompany the images.

Also, there is not a healthcare professional that has not experienced the reams of paper output generated by EMR systems because the systems’ structured data are not report-formatted for output. This is one reason why a patient still cannot receive his or her entire patient record from a portal. Not that I promote hard copy printing; however, healthcare providers still must maintain a legal archive from which to generate the electronic document presentation as proof for exception and dispute handling. In other words, providers must have the document presentation for legal purposes and not an informational statement or data representation of the document, which, unfortunately, remains common in today’s electronic patient record system output.

Yours truly,

Woodstock

Readers Write: What’s More Useful Than Hospital Pricing Data?

What’s More Useful Than Hospital Pricing Data?
By Data Nerd

An HIStalk reader challenged my recent post, “Hospital Pricing Data: Another Step Down the Rabbit Hole” by asking what healthcare data should be publicly available to help consumers make better choices, not just from CMS, but from providers and private insurers.

I cannot fault anyone for their enthusiasm. Trust me when I say I know how demoralizing it is to come up with a data solution that just doesn’t fit the need. That’s precisely why I felt compelled to speak out on the subject. After setting high hopes and expectations of the analytical possibilities from data in CMS’s pipeline, the solution fell drastically short of what I had hoped it would accomplish when it was finally released.

Having said that, the ideal data solution for me as a consumer would use the same or similar claims data sources, but aggregate the data two different ways to come up with a predictive solution that can be tweaked to assist the patient in their own cost containment efforts. This type of solution would involve:

• Risk-adjusted cohorts. Grouping the data not just by DRG, but by patients with similar risks (age, co-morbidities, etc.) to chart out the most likely course of treatment for someone of my age and health facing the same diagnosis. Ideally, this dataset would include all payer types, but the next-best offering that is within CMS’s reach is to combine Medicare and Medicaid datasets to account for a broader age distribution. Data would not be aggregated by hospital, simply by patient characteristics across the country.
• Once we have an idea of possible treatment routes, we can then couple that with charge data. And, yes, I want that broken down by procedure at each hospital. Like there is no such thing as bad data, there is no such thing as too much data. I’ve never seen OSCAR’s backend, so I’m not sure if it’s possible to break apart every claim and get a procedure-level charge, but I do know with the data as it is today, claims with only one procedure can be isolated and charges or reimbursements tend to have low standard deviations. Since I am not insured by Medicare or Medicaid, knowing what hospitals charge or are reimbursed by CMS does me very little good, though. I would need my own insurance company’s network rates with the hospital to analyze how soon I’ll meet my annual deductible, etc. Or, if I have the luxury of time to make a decision, evaluate if I’d be better served investing in an HSA and initializing treatment in the next fiscal year. But, for the millions covered under Medicare and Medicaid, such an analysis based on the data today would assist in forecasting when deductibles will be met and/or what other amounts will not be covered during the course of treatment.
• In the event that I have a long-term illness or a more drawn-out treatment plan, I would want an analysis of whether or not it would behoove me financially to have different procedures performed at different facilities. Outcomes data would be useful here as well.

All of these data components would need to be dynamically updated and processed, probably using software to evaluate each step of the way, much like the way a simple tax form is completed online. Play with one number and see how it affects the final bill, and in this case assess the risk factor involved in hospitals with poorer outcomes. Ideally, the solution would also interject preventative challenges over time to help the patient meet their health goals in a way that saves the health system money as well, but that is more the quantified-self realm than the (current) data realm.

So, to recap the data offerings that would satiate my current appetite for price transparency:

• Claims data, aggregated by DRG and patient characteristics to obtain expected procedures
• Claims data, aggregated by hospital and procedure charge
• Combine these two alongside insurance reimbursement rates to give a patient’s total estimated personal expense at every hospital
• Hospital procedural outcomes data to evaluate cost savings and determine at which hospital(s) to have the necessary procedures performed

This is the type of data that would be useful to me as a consumer.

Morning Headlines 6/12/13

EHR Developer Code of Conduct

The HIMSS EHR Association, a trade group representing more than 40 EHR vendors, publishes its long-awaited EHR Developer Code of Conduct. The document focuses on truth in advertising principles, patient safety guidelines, data security standards, and a vendor agnostic commitment to interoperability.

Some companies pay executives extra to fly on their own private jets for vacation

Cerner is profiled in an investigative reporting piece on private jet usage by large corporations. Cerner spent $193,759 last year on flights leased through a company controlled by Cerner’s own vice chairman Clifford Illig.

ROI Calculator for Heart Failure Monitoring

The Center for Technology and Aging and the Partners Healthcare Center for Connected Health have developed a return on investment calculator to help health care organizations assess the intrinsic financial benefits of implementing remote patient monitoring technologies.

Sutter Health patient information turns up in drug bust

A recent drug bust in Alameda County, CA turned up more than sheriffs were expecting as officers found the personal health information of about 4,500 patients from Sutter Health.

News 6/12/13

Top News

The HIMSS EHR Association announces the EHR Developer Code of Conduct, which is available for companies that develop complete EHRs. Principles include (a) communicating product information accurately; (b) designing products with patient safety in mind; (c) participating in a Patient Safety Organization for reporting and reviewing patient safety problems; (d) sharing product-related best practices with customers; (e) notifying customers of software bugs that could impact patient safety; (f) excluding contract language that prohibits customers from speaking up about safety concerns; (g) supporting interoperability through use of standards; (h) giving customers their data if they switch vendors; and (i) documenting how the product handles coding and quality measurement. It’s nicely done, and while I’d rather see these items in my contract instead of in a voluntary set of principles issued by a trade association, I like the idea of laying them out publicly.

Reader Comments

From Nick Carraway: “Re: TeraRecon changes. Longtime president Robert Taylor is gone. CFO Lakshmi Lakshminarayan is serving as interim CEO.” We requested confirmation from TeraRecon and haven’t heard back. Lakshminarayan is listed as interim CEO on the company’s Website.

From Georgia Peach: “Marketing gimmick. I got a HFMA ANI postcard from an exhibitor in the mail that made me laugh out loud, especially because I’m a parent.” Now that’s a genius marketing promotion. Any parent who has felt the pressure to return from a trip with goodies for the kids will appreciate this giveaway, which includes two iPad minis so the winner can keep one for himself and give the other to a spouse or “favorite child.”

 From Becky Badger: “In case it’s not on your radar, the Digital Health Conference is here in Madison this week and Judy Faulkner is a speaker this year. That’s notable because she rarely strays from the standard circuit.” Judy will participate in a panel discussion Wednesday morning on interoperability and information exchange. The other panelists are both Epic customers (Kaiser and St. Mary’s Hospital), so don’t be surprised if third-party EHRs fail to get much airtime in the interoperability discussion. Epic is also sponsoring the event.

From SNOMED Junkie: “Re: resignations. Both the CEO and chief technical architect of IHTSDO resigned today. That’s the non-profit that manages SNOMED content and distribution.” The announcements suggest that the Denmark-based organization made the change as part of a review of its long-term direction.

From Chas Incharge: “Re: McKesson Provider Technologies. They have lost market share but haven’t downsized marketing. Now it appears they want the marketing and sales team that oversaw the huge market share loss to do marketing for all technology business units. I’m a long-timer worried about my stock value. Harumph!” Unverified.

From Big Datty: “Re: Atlantic article. BKA in the EHR repeatedly, but the patient had both legs. Doesn’t anyone examine the patient any more?” “The Drawbacks of Data-Driven Medicine” mentions an intern presenting a patient on rounds as having a below-the-knee amputation that had been noted on three previous discharge summaries. When the rounding team actually looked at the patient instead of the computer screen, both legs were intact. The incorrect information had been caused by speech recognition, which misunderstand DKA (diabetic ketoacidosis) as BKA (below the knee amputation) and nobody noticed.

Acquisitions, Funding, Business, and Stock

Great Point Partners makes a $10 million growth recapitalization investment in iVantage Health Analytics, a provider of healthcare informatics and business analytics solutions.

Parallon Business Solutions, a provider of business and operational services for the healthcare industry, will acquire The Outsource Group, a healthcare RCM company.

Ivo Nelson (IBM/Healthlink, Encore Health Resources) launches Next Wave Health, which will provide management advice, operational support, and capital to healthcare IT startups. Working with him will be Mike Davis, formerly of HIMSS Analytics and The Advisory Board Company.

Sales

Centra Health (VA) selects HealthMEDX Vision and the Exchange platform to manage post-acute patient care and facilitate patient data exchange.

Methodist Le Bonheur Healthcare (TN) will deploy McKesson’s enterprise medical imaging products.

Horizon Health Center (NJ) expands its relationship with eClinicalWorks to include its  Care Coordination Medical Record.

Piedmont Eye Center (VA) selects SRS EHR.

The Veterans Benefit Administration awards Harris Corp. a four-year, $37 million contract to provide technical services for the agency’s enterprise data warehouse.

Partners HealthCare (MA) will implement the Health Catalyst Late-Binding Data Warehouse across its two academic medical centers and community and specialty hospitals. Partners and Health Catalyst will also co-develop new clinical applications for the warehouse platform.

Hospital for Special Surgery (NY) contracts with SCI Solutions for its rules-based referral management system.

CAQH selects Passport Health to develop a national COB solution to improve the sharing of patient coverage data between healthcare providers and payers.

People

iSALUS Healthcare promotes Kimberly Poland to VP of client engagement.

Delta Health Technologies hires Lorraine Lodigiani (MedAct Software) as VP of marketing.

Zachary Landman, MD (Massachusetts General Hospital) joins DoctorBase as CMO.

Intellect Resources names Susan Williams (High Point University) VP of recruiting services.

Shareable Ink will on Wednesday name former Allscripts Chief Customer Officer Laurie McGraw as CEO, taking over for company co-founder Stephen Hau, who will transition to CTO.

Announcements and Implementations

VitalWare and Panacea Healthcare Solutions will co-market their CDM and pricing systems.

King’s Ridge Christian School (GA) becomes the first student health clinic to implement simplifyMD’s EHR software.

Yale New Haven Saint Raphael Campus and 63 practices and clinics went live on Epic on June 1, which followed the February 1 go-live of Yale New Haven Health System and the Yale School of Medicine, Epic’s third-largest go-live ever. CIO Daniel Barchi credits the Epic teams of the hospital and medical school and the clinician preparation at YNHHS Saint Raphael Campus for the smooth transition. The two remaining go-lives are Bridgeport Hospital and Yale Health, with the $293 million project targeted to finish ahead of schedule and under budget.

Urgent care provider CareSpot implements the PatientPoint Care Coordination Platform, including PatientPoint electronic check-in tablets, in 40 locations.

LifeNexus announces iChip, an insurance card chip that retrieves a patient’s personal health record.

San Joaquin General Hospital (CA) implements the Logical Ink mobile data capture solution from Bottomline Technologies to automate patient registration and identify trends in population health.

Het Oogziekenhuis Rotterdam (Netherlands) goes live with iMDsoft’s MetaVision in its OR, holding unit, and PACU.

AirStrip’s applications earn DIACAP certification from the US Air Force, indicating that their use of authentication and encryption meets Department of Defense security requirements.

Lake of the Woods Hospital (Ontario) goes live on Meditech.

GE Healthcare will invest $2 billion over the next five years to develop software for hospital operations, clinical effectiveness, and care optimization.

Salem Community Hospital (OH) implements the PatientSecure biometric patient ID system.

HIMSS will release a healthcare IT value model on July 15 that will incorporate user satisfaction, care delivery, user education, prevention, and financial return.

Government and Politics

The Justice Department and Securities and Exchange Commission, investigating a suspicious surge in insurance company stock prices, find that hundreds of HHS employees had early knowledge of an impending Medicare change and could have tipped off investors.

Innovation and Research

The Boston newspaper covers startups working on healthcare application for Google Glass, including an app for hospital rapid response teams and another for patients and families.

Technology

Verizon launches the Blackerry Q10, which it claims is tailored for the healthcare market. It will use the BlackBerry Enterprise Service 10 Regulated Service to help providers remain HIPAA compliant.

Other

Six of the eight women allegedly sexually assaulted by former Epic project manager Brian Stowe are identified as his Epic co-workers, according to the criminal complaint. He’s accused of drugging them and filming the assaults. He was charged with 62 counts of felony and posted $500,000 in bail within 90 minutes of his May 31 arrest, but was re-arrested Monday on federal charges of sexual exploitation of a child. He has lost his job with Epic.

An Alameda County (CA) drug bust uncovers drugs along with personal information on about 4,500 Sutter Health patients. Officials are unclear about how the information got there, but say the data may contain patient demographics, including financial details and Social Security numbers.

Cerner paid $193,759 last year to a company controlled by its vice chairman Clifford Illig for use of its aircraft, also paying $184,579 to a second company owned by an Illig-controlled trust for fuel. Meanwhile, CEO Neal Patterson’s employment agreement promises him up to $110,000 for personal flights on aircraft that Cerner owns or leases and cash for any unused portion.

Weird News Andy says, “Soy vey!” A case study in NEJM describes a 19-year-old who drank a quart of soy sauce on a dare, leading to a hypernatremia-induced coma that lasted three days.

Sponsor Updates

• ICA donates $6,000 to Pryor Ministry Center in the name of Lisa Lyon, clinical informatics coordinator at Cherokee Nation and recipient of ICA’s HIMSS13 booth giveaway. ICA partners HealthCare Anytime and CSC also contributed to the donation.
• Ping Identity announces PingFederate7, an upgrade to its identity bridge software and cloud identity management platform that provides standards-based user provisioning, authentication, and authorization with support for cross-domain identity management and OpenID Connect identity standards.
• Midas+ names 24 hospital customers as winners of its Midas+ Platinum Award based on a data analysis of utilization efficiency and outcomes.
• PatientKeeper offers a June 27 Webinar on voluntary physician adoption of CPOE featuring the IS director and chief hospitalist of Community Memorial Health System (CA.)
• VitalWare introduces VitalSigns, a claims auditing and ICD-10 financial risk assessment tool.
• Ingenious Med reports that clients using its PQRS registry had a 100 percent reimbursement rate in 2012.
• Medicity publishes a white paper on engaging patients within an ACO.
• TELUS Health Solutions releases a white paper on the value of using and approaches for implementing home health monitoring solutions.
• Frank Grella, director of patient financial services for T-System customer Conway Medical Center (SC), will discuss how his organization increased collections using a specialized ED billing solution during next week’s HMFA13 conference in Orlando.
• Direct Consulting Associates interviews Michael Elley, CIO/VP of support services for Cox Medical Center (MO), who shares his thoughts on HIT leadership and management challenges.
• iMDsoft and Anesthesia Business Consultants (ABC) partner to offer iMDsoft’s mobile solution for electronic documentation with ABC’s F1RSTUse EHR platform.
• The Philadelphia newspaper interviews InstaMed Founder, President, and CEO Bill Marvin, who shares details of his company’s business model and history.
• Park Place International joins the Citrix Solution Advisor program, allowing the company to offer Meditech-approved Citrix solutions to hospitals for three-tier connectivity.
• SIS offers suggestions on choosing the right mobile device for OR use.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Curbside Consult with Dr. Jayne 6/10/13

I’m a sucker for 1960s and 1970s pop culture. Whether it’s the vintage lunchboxes at the National Museum of American History or watching “Scooby-Doo, Where are You!” with my nieces, I’m in. You’ve got to appreciate that level of kitsch, the likes of which I’m not sure we’ll ever see again.

I’m glad to work with IT leadership that believes in developing our employees. We tend to hire quite a few relatively young grads who may or may not be “computer people,” but are critical thinkers who want to transform health care. Before I get accused of age bias, we also hire a fair amount of older workers who may be on their second careers and demonstrate the same level of malleability. I enjoy introducing both ends of the spectrum to some of the crazier things I’ve seen on my quest to find the kitschiest thing ever.

One of my favorite TV shows was “The Six Million Dollar Man.” I love the initial voiceover: “Gentlemen, we can rebuild him. We have the technology… Better than he was before. Better…stronger…faster.” That’s the way I like to think about some of the seemingly lose-lose projects our team is assigned. They are things that no one wants to deal with that can make users’ lives more complicated and can be generally annoying. The challenge is to work your way through the muck to find the one piece of the project that can bring positive benefit, and then try to build on it. Sometimes this has positive results and sometimes it just results in silliness, which happened this week.

We’re working on some projects to look at resource planning and employee time allocation. Like most organizations, we have more work to do than can be accomplished by a team that is not bionic. Our goal is to look at productivity patterns and try to figure out how to not only maximize what the team has to offer, but reduce the waste and inefficiency that happens despite our best efforts. The problem is that our enterprise resource management software isn’t that great. We’re not able to do a lot of customization to it and certainly don’t have budget to replace it, so we were brainstorming.

The idea on the table was finding the best way to manage meetings to ensure that required attendees are present, no extraneous people are pulled in, and no more time is spent in a meeting than is needed. Even with all the different productivity tools and add-ons that are plaguing our employees in Outlook, the team came up with one that I’d seriously like to see: the Relative Meeting Cost (RMC) analysis widget.

We would need to add some additional fields (hidden, of course) to the contact data to track an employee’s equivalent hourly wage as well as the billable rate for chargeable employees. It would look at the invitees and meeting length and display the RMC value not only in dollars, but with big tacky graphics to make it clear whether the event was a BEM (Big Expensive Meeting) or a PCM (Pretty Cheap Meeting).

Functionality would be added to create security options that would prevent people below a certain status from scheduling BEMs without review or approval. You could even prevent a BEM from being scheduled if more than a predetermined number of required attendees had conflicts.

Of course this will never happen, but it was a great way to blow off steam. Somehow the thought process circled back to being bionic, which led to a wide open debate on whether Steve Austin or Jaime Sommers was tougher. We’re not going to have a technology solution just yet that will let us avoid booking a Six Million Dollar Meeting, but we did bond as a team, which is no small feat. Maybe next time we’ll try some macramé owls.

E-mail Dr. Jayne.

Morning Headlines 6/11/13

Stanford Hospital Trims Use of Blood Supplies 

Stanford Hospital reduces its use of red blood cells by nearly 25 percent after building a pop-up window into their CPOE system which outlines the guidelines on blood use and asks the physician to explain the reason for the request.

IBM Partner Puts Big Data To Work At Seattle Children’s Hospital

Seattle Children’s Hospital reports significant performance improvements after integrating ten disparate data sources into a single, analytics-driven business intelligence system running in an optimized big data environment.

Doctors embrace the digital workplace

In Canada, 56 per cent of physicians have switched to electronic medical records, up from 23 per cent in 2006.

HIMSS Analytics Honors Legacy Health’s Hospitals and Ambulatory Clinics with Stage 7 Award

Six Legacy Health hospitals and their ambulatory clinics in Portland, OR and Vancouver, WA have achieved HIMSS Stage 7 designation. Legacy Health runs Epic in both the acute and ambulatory environments.

Morning Headlines 6/10/13

When e- stands for enemy: Installing e-medical records systems costly, frustrating

An office manager from a solo practice in North Carolina discusses the growing cost and frustration HITECH is having on managing a small practice.

Parkland researchers develop system to flag those in danger of death

Researchers at the Parkland Center for Clinical Innovation are profiled by a Dallas newspaper for their work with  predictive surveillance and population health management.

Olympic Medical Center: Progress made in digital conversion

Port Angeles, WA-based Olympic Medical Center CEO Eric Lewis discusses the hospital’s recent Epic go-live, describing the experience as “kind of like going from a landline to an iPhone.”

April 2013: EHR Incentive Program

According to a monthly update released by CMS, $14.6 billion has been paid to hospitals and providers since the EHR incentive program started in 2011.

Monday Morning Update 6/10/13

From CIO Reader: “Re: Webinars. I am thrilled you have put this type of process in place. I need to attend many of these Webinars to stay abreast of industry trends, yet many of them are sales pitches or poorly presented. Nothing is worse than having the presenter read slide after slide. A topic I’d like to see covered see is data governance, with real-life examples from hospitals that have developed a structure.” If you are a CIO who has implemented an effective data governance program, why not present your experience as an HIStalk Webinar? It’s just as gratifying as speaking at a conference without the logistical headaches and it makes a nice resume addition besides. Contact me if you are interested.

The vast majority of poll respondents, 82 percent, would avoid using a hospital whose clinicians are complaining publicly that its clinical systems are compromising patient safety. New poll to your right: should an EHR vendor be allowed to sell a patient’s de-identified data without their permission?

We’re doing an expansion of IT pay bands/job descriptions at my hospital, which caused me to recall how many times I’ve overseen that process at other hospitals I’ve worked in. The cycle involves: (a) deciding that IT has way too many job descriptions that don’t make sense and it would be better to collapse them into generic pay bands such as Analyst I/II/III; (b) everybody gets slotted with a lot of complaints, and the smart employees realize that the lower the band the better since their salary won’t decrease but they have more opportunity to move up; (c) the good IT people start leaving for greener pastures because there’s not much future upside if you’re already at the top of the grade with nowhere to go except into soul-sucking IT management, causing (d) HR and IT to agree that more job descriptions and pay flexibility would be just the ticket and it’s time to add a bunch of new job descriptions. This entire cycle gets repeated every 4-5 years, providing the illusion of effectiveness to IT and HR management.

Welcome to new HIStalk Gold Sponsor Alere Accountable Care Solutions. The company was formed in January 2013, made possible by Alere’s 2011 acquisition of Wellogic and integrating Alere’s offerings to help ACOs and provider groups improve outcomes and reduce costs. It offers interoperable HIE and EHR solutions developed with an emphasis on the physician-patient connection, physician usability, and innovation. Specific products include an HIE platform, EHR, PHR, connected biometric and diagnostic devices, decision support, real-time analytics, population analytics, wellness and health coaching, and evidence-based care management. Recently announced customers include Virtua, Triad HealthCare, and the MedVirginia HIE. Thanks to Alere Accountable Care Solutions for supporting HIStalk.

Supporting HIStalk at the Platinum level is Vital Images, part of Toshiba Medical Systems, which offers next-generation advanced visualization software that’s #1 ranked by KLAS and used by 5,000 customers in 83 countries. The software enables visualization and analysis by radiologists, cardiologists, and oncologists of 2D, 3D, and 4D images using CT and MR scan data. Its vendor-neutral Vitrea Enterprise Suite allows enterprise-wide sharing of images and functionality, providing consistent user interfaces and tools that that improve adoption and reduce support requests. The VitreaView universal viewer gives physicians fast access to DICOM and non-DICOM images from any archive via a zero-footprint browser or tablet, while VitreaAdvanced offers a wide range of best-in-class clinical applications such as stent planning, colon analysis, EP planning, and liver analysis. Check out their on-demand Webinar that explains how to image-enable the EMR using a universal viewer. Thanks to Vital Images for supporting my work.

Analysis of March-April MU attestation data by Wells Fargo Securities finds that Cerner has pulled slightly ahead of Epic in the percentage of clients achieving MU while McKesson has improved a lot. Meditech still leads the overall attestation count, while Epic is so far ahead in physician attestations that the analysis concludes, “… no vendor looks above average other than Epic.”

A newspaper editorial written by the manager of a North Carolina solo medical practice says the practice’s EMR implementation hurt its efficiency without improving patient safety. It also calls out state programs that chose the mothballed Allscripts MyWay as their foundation, the big financial losses experienced by Wake Forest Baptist Medical Center and Cone Health during their Epic implementations, and the failure of the state’s $484 million Medicaid system. She says that implementation of ICD-10 “would be the tsunami that derails our healthcare system.” Obviously she isn’t a fan of healthcare IT.

Here’s a video on the Blue Button Design Challenge from Health Datapalooza IV.

I take a mild blood pressure med that my doctor says I don’t really need but he likes me on it anyway. There was some screw-up with Express Scripts, so I decided to refill my 30-day supply at Walgreens. I thought I’d give their iPhone app a try and it was amazing. It located the pharmacy since it was nearest to me, then had me scan the prescription label’s barcode using the phone’s camera. A message said when it would be ready for pickup and I was done. You could literally request a refill in 10 seconds. The app also provides pill reminders, prescription transfer by taking a picture of another pharmacy’s label, loyalty card points tracking, the aisle layout of the store, and online shopping and weekly ads. I’m impressed. It makes “find our nearest hospital” apps seem pretty lame in comparison.

Perhaps ONC will learn the how hard it is to design usable software by introducing its “Health IT State Summaries” widget. States are arbitrarily divided into geographic regions that each have their own dropdown with resulting wasted space, words are misspelled (“state’s,” “South Caronlina”), and it’s an awfully big widget to embed on a website.

Researchers at the Parkland Center for Clinical Innovation, part of Parkland Memorial Hospital (TX), get a write-up in the Dallas paper for their work in developing a model called PIECES that analyzes EMR data to flag patients at risk for cardiac arrest. A randomized controlled study of the software’s effectiveness will start later in the summer. The Center has 35 employees and a $6.7 million annual budget. PIECES use information that includes monitoring data, lab results, MEWS, unit assignment, and orders to predict clinical deterioration 16 hours in advance on average. The original article in BMC Medical Informatics and Decision Making, published in February 2013, is here.

Hello Doctor introduces an iPad app that allows patients with complex medical conditions to organize their medical records for conversations with their physicians. 

New York City’s 911 operators are forced to use handwritten notes delivered by runners when the city’s new $88 million emergency dispatch system goes down for several minutes on at least three occasions.

A patient at the Bronx (NY) VA hospital dies when a gamma camera collapses on him during a radiology procedure.

Sue Fischer, a nurse who works in the Cerner practice of Encore Health Resources, recently saved the life of a man who had gone down in cardiac arrest in a Phoenix airport jetway by giving him CPR.

John Alexander (Optimum Healthcare IT) joins ESD as Epic practice director.

Glenn Cole (The Ghafari Companies) joins Nordic Consulting as CFO.

An Ohio medical practice’s letter to the editor of the local newspaper requests the understanding of patients as it transitions to an EMR, saying, “For the most part we are not computer savvy so this has been a real challenge. While we struggle with this change we are just not able to see the number of patients we had previously.”

Vince Ciotti has been a longstanding critic of what he sees as Epic’s cult of Kool-Aid drinkers, so did a personal audience with Judy Faulkner change his tune? Find out in this week’s HIS-tory.

Sponsor Updates

• HCA will present its experience implementing identity and access management solutions in a Monday, June 17 Webinar sponsored by Caradigm.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

The Skeptical Convert 6/7/13

Silos vs. Holes

I hear a lot about data silos on this site, but not about data holes.

We talk about silos in reference to problems with data sharing resulting from differently designed information systems. As a negative metaphor that makes sense (although when you think about it, silos project a certain optimism about plentiful supplies stored away for future use.) But ever since my hospital system adopted a single-vendor comprehensive information system (whose name  shall not be mentioned,) I’ve been thinking about a different problem that needs a different metaphor. 

Consider the following scenario. A specialist — perhaps but not necessarily one at a tertiary facility — performs services on a patient that reveal a serious diagnosis, one clearly not resolved at the time of discharge. In keeping with computer training, said specialist has entered some discrete, mainly compliance-oriented data like med reconciliation in the system.  

But critical information about the diagnosis and interventions are put in traditional dictated reports. These reports are, by traditional standards, excellent– comprehensive and authoritative. And they were probably sent to the referring office-based primary practitioner.

But a few weeks later, the patient shows up in an ER of the same hospital system, with a problem that the patient herself thinks is new and unrelated. But it’s a problem that might lead a fully informed ER doctor, hospitalist, or consultant to conclude otherwise. But they don’t, at least right away. Because what they really need to know is in a hole. 

What do I mean? After all, the information is all there. Somewhere. But the system prominently displays listed summary information that’s supposed to be useful, information that the busy practitioner is inevitably going to rely on for initial decision-making. But nobody edited those lists during the previous hospitalization to include new and vital facts. 

Yes, way down on a list of, um, let’s see, progress notes, nurse notes, resident notes, consultant notes there’s an operative note and, um, what did they find? OK so let’s try to find the pathology report…let’s see….chemistry, micro, imaging, it’s here somewhere. It can be a while before a stranger looking at all this realizes that the patient has something new, and evidently, bad. It certainly doesn’t come across in the headlines the system displays. It’s in a hole. 

It’s funny — years ago I made my local reputation as a diagnostician mainly by asking for all the fat folders of the patient’s chart and going through them. There was a lot hidden away there if you took some time. Of course things were more leisurely then. Was I naive to think that computerization would be a time saver in today’s sped-up medical world? Seems like a lot of the advantage of having the system in the first place is being sacrificed. 

So what to do? People react very negatively to more written rules and policies that can get them into trouble, and those paper documents or PDF’s tend to sit ignored in their drawers or folders. Ultimately a sea change of everybody’s thinking has to happen if this sort of a system is going to work. Everybody has to think more about the big picture and the next step down the line and take the responsibility to get important information up where people will see it. 

Right now I’m just trying to get people’s attention. If they realize the problem with data holes, maybe they’ll recall that famous first rule about them. And first of all, stop digging.

Robert D. Lafsky, MD is a gastroenterologist and internist in Lansdowne, VA.

Time Capsule: Buying Doctors Systems They Don’t Want: Why Even Detroit’s Bailout is More Progressive than the HIMSS EMR Welfare Program

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 January 2009.

Buying Doctors Systems They Don’t Want: Why Even Detroit’s Bailout is More Progressive than the HIMSS EMR Welfare Program
By Mr. HIStalk 

I must be getting old. I can actually remember when the most-feared words you could hear were, "I’m from the federal government and I’m here to help."

That has recently changed to, "We’re such terrible businesspeople that we desperately need Uncle Sam as a business partner to survive."

HIMSS is right there in the bread line, begging for $25 billion of taxpayer dollars to help loosen up prospects that haven’t shown much interest in buying the EMRs that its vendor members sell. That’s not too surprising; as a trade association (its words), the #1 job of HIMSS is to help its big-paying vendor members make money, of which Uncle Sam’s is as good as anyone else’s (which isn’t saying much these days since the overheated currency printing presses will probably deflate the dollar’s value as quickly as they’re printed.)

That’s what "advocacy" is all about (don’t you DARE call it "special interest lobbying" because that doesn’t sound as noble, just like the annual conference is an "educational event" rather than drawing in captive provider prospects for the vendor members to woo.) Obama’s got lollipops for everybody, even justifiably failed dinosaurs like venture capital owned Chrysler, proud purveyor of bad cars that even rental car companies avoid. So, why not a nice, round $25 billion to move a few EMRs?

(Prospects don’t have the money for these desperately needed systems, HIMSS intones, yet it rails against free EMRs, whether open source or government created. So, HIMSS is apparently pro- EMR only when its vendor members profit.)

At least Detroit is keeping a straight face when it says it will make much-needed product and efficiency changes with our money. The HIMSS program doesn’t say that the EMR vendors who get the money will change anything at all. To them, the dust-gathering EMR products aren’t the problem, it’s those darned chintzy doctors who won’t buy them. And unlike Detroit, nobody’s offering taxpayers any equity or oversight in the companies that will rake in all the freshly printed money. It’s the EMR version of George Bush’s "everybody go shopping" stimulus package all over again, which did — well, nothing at all except run up the federal debt.

What’s also lacking is any kind of context in the recommendation. With all of healthcare’s problems, is $25 billion for the same old systems really the best investment? If healthcare needs dramatic reform (of which there are few doubters except those who profit from it today), then is this the right time to automate? Are EMR trailblazers having such great success and positive ROI that massive rollout is sure to be worth it?

That last item is the biggest bugaboo in the HIMSS EMR welfare program. Without provider skin in the game, there’s no assurance that we’ll see anywhere near $25 billion worth of patient benefit. "Having" is a long way from "using optimally," especially when one vital fact is brought back by cynics like me: these are systems that most doctors have already assessed as not being worth it. And, in Cynicism Round II: free isn’t cheap enough for systems that take more doctor time to use without giving them any benefit. How about a show of hands of all of you willing to stick around at work for a couple of extra hours each day to use a new computer system that doesn’t benefit you or your employer?

HIMSS has got politicians moistened up at the concept of interoperability as the big payoff for all of this acquisitive action. Sounds great, right? That’s what all those failing RHIOs said, too. "Interoperable" is a theoretical systems capability, quite a long way from overcoming the governance, privacy, and cost problems that stand in the way of actually interoperating. Instead of pushing "interoperable" systems, why not use the $25 billion jackpot to reward providers who actually exchange predefined data instead of just funding their technical capabilities and hoping it will somehow just happen?

That’s my pitch for Uncle Sam. Don’t use my money to fund stale tactics and failed market participants. Use it (if you must) to set the goals of what we really need (improved quality, outcomes, and efficiency), create rewards for meeting them, and let the market decide which tools are best suited for getting the job done. If your EMR can do that, it will fly off the shelf under its own power without requiring HIMSS to fling it at doctors like Cupid’s arrows.

Let’s hope the Detroit equivalent of HIMSS has less self-serving ideas than to simply hand out taxpayer dollars so people can buy Chrysler Sebrings.

Morning Headlines 6/7/13

Ambulatory Physician Leadership Reports a 30-Point Usability Gap between EMR Vendors

A new KLAS report looks at ambulatory EMR usability by measuring performance across various common tasks such as e-prescribing, physician documentation, and medication reconciliation. Athenahealth come out on top, followed by Epic.

China’s PLA Among Eight State-Sponsored Groups to Hack VA, Ex Official Says

Former VA chief information security officer Jerry Davis reports that eight different state-sponsored organizations have been hacking into VA networks and databases that contain millions of veterans patient information. The continued breaches are due to weak user authentication and a lack of encryption of VA databases.

Cleveland Clinic Making Electronic Medical Records More Transparent To Patients Online

Cleveland Clinic will add physician notes, images, and results to its MyChart patient portal. A recent Robert Wood Johnston trial concluded that giving patients unrestricted access to physician notes led to increased patient engagement rates.

Dozens of health groups to create massive gene database

More than 70 medical, research, and advocacy groups are joining forces to create a massive databases of genetic and clinical data that will be accessible to doctors and researchers worldwide.