Time Capsule: Please Excuse My Rear In Your Face, But I Have To Leave This Presentation: How HIMSS Presenters Can Suck Less

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 March 2009.

Please Excuse My Rear In Your Face, But I Have To Leave This Presentation: How HIMSS Presenters Can Suck Less
By Mr. HIStalk

Here’s my theory: HIMSS knows that most of its annual conference presenters aren’t nearly as interesting as the jaunty and trumped-up descriptions in the program, so they intentionally arrange the chairs in long rows so audience members can’t bail out discreetly. Even the doors are guarded – by throngs of standing attendees not quite sure they’re ready to make a commitment by actually sitting down, but thereby blocking your access to the cool, energizing air of the hallway that smells like … freedom.

(It would be cool if conferences would legitimize buyer’s remorse by leaving the session doors open and encouraging people to drift in and out based on their real-time interest level. The immediate feedback to presenters — both good and bad — would be priceless).

It would be so much easier if speakers did a good job in the first place. Having spent a shocking percentage of my adult life sitting in the dark on bad seats in convention center rooms, I believe I can offer some valuable speaker suggestions.

• Everybody dresses up to deliver their presentation, so suits don’t really make much of a positive impression. Try wearing shorts, an Insane Clown Posse tee shirt, or a kilt. Somebody may mistake your attire as a sign of inherent coolness or quirky genius, at least until you start talking.
• Unless you’re the CEO who’s actually in charge of the whole hospital, don’t lead off with a boring slide full of proud-as-a-peacock statistics about your employer’s ED admissions and annual budget. Audience members immediately drift off trying to determine whether your place is bigger or smaller than theirs.
• Nobody traveled to Chicago in the dead of winter to watch you recite a memorized speech. Add a little excitement by going off-script, under-preparing, or actually interacting with the audience instead of droning to them. Most of the HIMSS presentations are about as spontaneous as a press release and are delivered with a similar lack of enthusiasm (I truly believe presentations would be better if someone was chosen at random from the audience to go onstage cold and just wing it).
• Do not use PowerPoint as a TelePrompter. It’s fairly safe to assume that most of the people going to HIMSS can read. Avoid the Shakey’s Pizza sing-a-long moment (Note: actually, adding the bouncing ball might be kind of fun if you aren’t otherwise entertaining).
• Never put up a slide that requires you to say, “I know you can’t read this.” If our reading it isn’t important enough for you to fix your slide, leave it out.
• Be daring: don’t use PowerPoint, or if you can’t speak without it, use only graphics. A picture is worth a thousand words, so put in the right ones and you won’t have to say anything.
• If there’s any possible way can make your point without a slide, please do. This will shock the audience, however, who have never seen a non-keynote speaker actually speak without using on-screen bullet lists (you could even leave the house lights up, cutting into the sleep of those who stayed out too late the night before). If this seems too radical, you can pretend the AV isn’t working (“darned laptop …”), forcing you to reluctantly go off-script.
• Just because PowerPoint conveniently provides a bulleting function for creativity-impaired speakers doesn’t mean everything should be bulletized. Given the choice between being subject to a dozen PowerPoint bullets vs. .22 caliber ones, I might have to think about it.
• We know you have lots of facts, but we don’t want or need to see them all. Pruning your presentation takes you longer, but your time is inconsequential compared to that of the roomful of people forced to endure flabby prattling. Everybody loves a speaker who finishes early.
• Get out from behind the podium and create some energy for the giant room full of people drowsy from their $12 union-produced Caesar salad. If you can’t hold the attention of 500 or more people, maybe you should be writing articles instead of giving speeches.
• Do not look at the screen, point at it, or wave a laser pointer at it. It’s ours, not yours.
• Use photos in your presentation to remind us about the real life that we are anxious to rejoin once you stop talking. Pictures of people are perfect since everybody looks at those, especially if you slip in ones of celebrities or hotties. Pictures of your kids or pets always buy you at least a few minutes of goodwill (you can sneak those in by making them your desktop background).
• Don’t fiddle with your water or slurp it into the microphone. Attendees resent your having a nice, icy pitcher and a glass all your own, so it will make them thirsty. Or, it will make them have to pee.
• No clipart, no stock photos. One obligatory Dilbert or Far Side cartoon at the beginning and end is acceptable.
• Don’t use time at the end for questions. 99 percent of people in the room just want to head for the bathroom, coffee line, or most importantly, the Middle Eastern bazaar known as the exhibit hall. People charging the question microphone just want to prattle on with non-questions, showing off their knowledge instead of their lack of it. Their punishment is near-trampling as they try to swim upstream to the microphone as everybody else heads the other way toward the doors.
• Don’t mistake the post-presentation charge of business card-waving people to mean you were an outstanding presenter. Some people are natural suck-ups.

HIStalk Interviews Bobbie Byrne, MD, VP/CIO, Edward Hospital

Bobbie Byrne, MD, MBA is VP/CIO of Edward Hospital of Naperville, IL.

Tell me how your Epic project is going.

It’s going really well. I’m really very happy to be on this end of the project 10 weeks after go-live. That period of time is little nerve-wracking. It’s like being very, very pregnant and just wanting to give birth.

But even though it’s going really well, it’s really hard. Expectations of what a good go-live means … it’s important to keep resetting that within the organization, that even though we’re having challenges, even though we’re not quite sure how this workflow is supposed to work, and even though we are making a lot of system changes, that’s expected from a good go-live.

I liken it to the patient who wants to know why they can’t run a marathon 10 weeks after having open heart surgery. Well, you just had open heart surgery. We’re not up to marathon speed yet. I think that’s probably typical.

Has anything been a disappointment so far?

I don’t think there’s anything I’m disappointed in. There’s a lot of things I wish I had done differently. If I get the chance to do this again, I will definitely do certain things differently. There are some things that I thought would work out well that worked out beyond my expectations, and then other things that I thought were going to be really great that have faltered a little bit, but nothing that’s been disappointing.

How much of the Epic decision and the Epic satisfaction going forward is based on the personality of the company rather than the product?

I knew from the beginning and in that period before we went live that I felt 100 percent confident that Epic was going to be there with whatever resources or whoever resources were required in order to get us live safely and effectively. I felt this huge confidence of having the company behind us. I knew they would circle the wagons if we needed it.

In certain areas, we did ask for that. “Hey, you know, we really need some help in this area. We didn’t expect that it was going to be this complicated.” Even after we went live we said, “Please come down and help us with this” and they absolutely did. That was no problem.

But you know, I’m kind of an old development junkie. I really believe that the product is super important. Where we have elegant workflows based on sophisticated and intelligent design, things go really well. Where we have workarounds because the product doesn’t quite reflect the nature of the care that we’re giving here, we have a lot more issues.

So it’s the product and it’s the company. I’m going to say it’s half and half.

What is the biggest differentiator that Epic offers that the competitors don’t?

It’s that 100 percent confidence that they’re going to get us to a successful implementation and they will do whatever it takes to get us there. But they also have all the breadth of products that we needed in order to do a complete rip-and-replace of a hospital. They really do have a very robust surgery system and a very robust medical record system as well as clinical systems and revenue cycle.

Nobody in my organization, no department feels like they got the shaft, like they had to take the immature product or they had to take the worst part in order to give up for the rest of the organization. The product suite is mature across the board. Those two things really made me happy that we chose Epic.

One of the discussions that always seems to come up is that CIOs get fired over Epic for whatever reason. Do you think that …

[laughs] It seems seems to be happening even more lately.

Do you think it’s a problem with Epic? What would it take from your viewpoint as a CIO to get you fired in the middle of an Epic implementation or shortly after?

I don’t want to give anybody any ideas [laughs] Two things that I think were really, really key to our implementation — and not being close to those other situations, I have no idea whether these were impacts those other situations, but for us these were really important — is that number one, our revenue cycle implementation was outstanding. We very quickly got our daily charges out the door, got payment back for care that we were giving one and two and three days after go-live. We did not have a big dip in the finances due to Epic. 

If you think about the way that healthcare is going today, where there’s just declining reimbursement all over the place for a whole host of reasons that have absolutely nothing to do with HIT. You take hospitals that maybe had some financial stress and then you add Epic and a negative impact for Epic on the finances and I can see why the CIO would be blamed, because now we have some real pain for the organization. That did not happen for us. We had an excellent revenue cycle implementation for a whole host of reasons that I won’t get into.

The second piece is setting the expectations. When you first purchase Epic, there’s a great excitement and everybody is very, very excited about, “We’re going to get Epic and we’re going to do all these new things.” There was a period of time when people thought that Epic was going to solve every problem that has ever happened from a workflow perspective in the hospital. 

I started months and months and months ago talking about how hard this was going to be and trying to set the expectations very reasonably. I don’t know if I did it 100 percent and I don’t know if it got through to everybody, but people were saying that all I did for the last three months is walk around saying, “You know, this is really, really going to suck.” So that when there was pain, it was like, “Remember when I told you about how hard this was going to be? This is what I was talking about. This is painful.”

Now we have completely new interactions between nurses and pharmacists, so our nurses and pharmacists get along really well. But now we have these things where the pharmacist says, “I think nurses should do that.” Nurses think, “I think the pharmacist should do that.” These are the kinds of hard choices that we knew we were going to need to make and it’s going to make somebody unhappy. 

I think the expectations for the high of buying Epic and the long implementation and then the high around going live and then you head into that we call the valley of despair, where you realize it’s just really, really hard and it takes really lot of work. When we hit that valley of despair, people were expecting it. They said, ”Oh, yes, you told us so. You told us that this was going to come.”

One of my responses to the idea that Epic seemed to be coincident with the CIOs losing their job was that if you were going to fail, there was a strong likelihood that Epic’s executive status report told you you were going to fail. Did you find that to be true?

It’s probably a matter of degree. We did not expect some of our issues around the high turnover procedural areas and that was a little bit of surprise. We had some challenges with that workflow. But for the most part, Epic was warning us, saying, “You know, your staff is a little bit low on this team. That’s worrisome.” 

When it came down,  those probably were the areas that we should have shored up and maybe would have avoided some of it. But you know, part of this is just a complexity. You think this is thousands of people, thousands of different processes. Epic is really good, but I don’t think even they’re going to be able to totally predict which way your implementation is going to go. And you know, at 36 or 72 or one week or three weeks later, who are going to be the portions of your hospitals that are going to be doing really, really well and who are the portions that are going to be having some challenges. They just don’t have that much of a crystal ball.

One of the other arguments made about why CIOs seem to lose their job after Epic is the huge post-live expense burden. Suddenly the CIO has to try to make things work within the budget that’s allowed when that expense was larger than expected. Do you think there will be surprises in what’s going to cost you to keep running Epic?

No. We talked very extensively at the time that we were doing the purchase and discussing with our board which resources we’re going to stay on. We set the expectations from the very beginning that we were absolutely not going to be able to run Epic on our previous Meditech-level staffing.

The pieces that potentially are coming up as a little bit of a surprise to the organization are the costs of implementing additional modules. The only two things we didn’t implement are the lab product and anesthesia intraoperative documentation. Almost everything else turned over.

When we started to look at what it cost to implement the lab product, there was some surprise. We said, “Wait a minute. I thought we already bought this. It’s part of the enterprise license.” We did have the license fee, but then the additional implementation resources and additional maintenance fee … they thought they were getting a free lab product. We have a joke around here that with Epic, nothing is free, but a lot of things are included.

You have to think about the frame of reference. If you’re trying to do the cheapest IT system you can, Epic is clearly not your vendor, but if you’re trying to think about value for a price and how much we get for how much we pay, I think it seems a little more palatable.

What work is keeping your busiest?

Certainly where we are with Epic is still keeping me busy. We also just closed on a merger with another hospital, Elmhurst Memorial, which is about 17 miles from our core Naperville campus. There’s a lot of work that’s going on in just trying to figure out how these two organizations are going to come together.

We have started to to implement Lawson, which is our ERP system at Edward. We have started that implementation at Elmhurst.

For me, it’s related to stabilizing Epic and getting the Epic mother ship in good shape. Then, how do we extend it out to our new sister hospital?

They are also a Meditech site, right?

Correct.

Is anything going on with the HIPAA changes coming up?

I saw that in some of your talks online. This is something that we have discussed quite a bit internally and felt pretty prepared for. I don’t know whether our compliance and legal team is just maybe a little bit more HIPAA happy than others. It seems like some of your other readers were kind of surprised by this, but these are things that were really were already in play, for us so that’s not something that I am really too worried about.

We continue to have all the worries around how we’re going to grow our data warehouse and how are we going to continue to provide all of the quality data that are required for patients that are medical home. We’ve applied to be in ACO. We have certainly a number of pay-per-performance initiatives going on with different payers. 

Maybe a year ago I would have said that’s really what’s keeping me up at night. Now it is is how do I find and recruit enough report experts and people who can work on our data warehouse to keep feeding this beast of requests for more and more and more information? Which by the way, they all seem to want to be formatted it in a slightly different way and have slightly different requirements and definitions. That has become an operational challenge for that team.

Are you using Epic’s Cogito or do you have some other product that will be your data warehouse?

We have a SQL longstanding homegrown data warehouse that we use for many different purposes and have many feeds that go into them, including all of our historical information. We also feed Epic into there. We would want to keep up with as Epic becomes more sophisticated in their capabilities. We certainly want to make sure that we take advantage of what they’ve developed instead of continuing to develop our own, but right now, I feel like we’re in transition.

Are you planning to buy anything for the possibility of your ACO-type arrangement?

I don’t think the contract is signed, so don’t want to speak about it, but yes, we do have a few add-on analytical products that we need to get implemented in order to feed data in, get comparisons, render it back to our physicians in a way that is helpful, that drives behavior, and allows us to bend this cost curve and try and deliver better care at a  lower price and then hopefully drive back the gain-sharing that all these systems are intended to drive back to the hospital.

It seems like that’s everybody’s first purchase when they contemplate a risk arrangement is to be able to go to their physicians with data in hand and have the peer pressure do the work for them. How are you planning to take that information out?

We have the beginnings of the team. They haven’t fully hired all of the bodies that will do that. We already have a physician liaison program in place. I think a lot of hospitals do, where they are going out to the private offices and so know the individuals in their private offices and have developed those relationships. What we’ll do is expand that model, arming these physician liaisons with the analytics and the dashboards and the … not just the ‘Hey doc, do a better job,” but, “Here’s the key parts of this. Here is how other practices have improved their quality scores.”

I think the first part is to get the data out there to the physicians. Makes a lot of sense. We’ve been working on that for quite a while on inpatient data, saying, “Hey doc, your length of stay in the ICU is much longer than all of your counterparts. What’s going on there? Your medication costs per patient are much higher than all of your counterparts. What’s going on there?”

We’ve been doing that for a while on the inpatient side. Now it’s more of just getting the individuals out of the hospital into the offices to work on the ambulatory data, which is of course where most of the care is delivered and most of the care that we will be at risk for is delivered.

Most of your physicians are mostly community based, right?

We have a relatively large employed physician group, about 135, so a medium-sized employed physician group. We also have a partner medical group, which I believe now almost 400 physicians, that we work very closely with. We share an instance of Epic with them. That means that for our own employed medical group and for DuPage Medical Group, it’s seamless experience for them. That maybe makes up about 55 to 60 percent of our physicians and then the other 40 percent are independent. The DuPage Medical Group is certainly independent, but we have a tight IT relationship with them.

When you look at the problems you’re being asked to solve in general, do you see a need for technology that you don’t either have or doesn’t exist?

I see a need to utilize the technology that we already have invested in to a much greater degree more than I see the need that I don’t have a product that solves this problem. Here actually I have the opposite. Somebody says, I have a particular quality initiative that I want to work on, and oh by the way, I found a niche product and some vendor and salesperson called on me and here, I want to buy this product. 

When you dig in, you say, OK, but wait a minute. Can’t we already do this with the systems that we have today? That’s where it is a constant going back to, say, instead of buying another product, another product, another product, how can we leverage the investment that we’ve made?

I don’t see that there is a lack of products available for what I want to do. I think sometimes that’s not through the organization, because clearly my organization is still looking for these niche products. I think the piece that we really struggle with — and people say they can do it but I kind of I’m a little skeptical — is getting the ambulatory data out of the private physician offices. People go in and say, yes, I can go into 10 different offices running 10 different EMRs and I have a secret sauce that lets me mine each of those 10 different EMRs and feed quality data back so that we can do things like clinical integration or ACO contracting. I just haven’t seen it, so I’d like to see that actually work.

Does having Epic shut the doors for the need for a lot of other systems?

We come back to our core vendor. We’re focused on that core vendor strategy, so for us, it’s Epic, Lawson, DR PACS, and Merge. We really are starting to say, of these systems that we already own, can one of them already do what this niche vendor might do? So it is very often Epic.

Epic also is very good about telling you they don’t have something. They don’t have case management yet, so they’ll say, “Don’t try and take our system and pervert it and put it into some strange configuration in order to make it into a case management system. It isn’t a case management system. When we have it, we will tell you, and then you can implement it.” I don’t feel like we’re trying to do a square peg around hole a lot. I think it’s just a matter of knowing what the full system’s capabilities are.

When you look down the road five years, what do you see is the biggest challenges and opportunities that your department has or your hospital has?

I think the biggest challenges are going to be the new world order of healthcare. How do we take more risk as hospitals, which many of us have never been insurance companies and don’t have that kind of background, so we don’t really understand what that’s going to be? How do we have the higher quality for everyone, not just for certain subsections of the population? How do we do it at a lower cost? 

And then probably most importantly, how do we not go bankrupt between now and that future state? Right now, we still get paid more for doing more. In the future, we will not. But you have to adjust your rate of change with the changes and reimbursement or we won’t even be around in five years in order to continue to serve our community. It’s a very interesting time in healthcare.

Morning Headlines 7/26/13

Healthcare Information Technology and Healthcare Information Services: 2013 Mid-Year Review

Healthcare Growth Partners releases its mid-year M&A review for the health IT market. Mergers and acquisitions were down 29 percent year to date due to a significant increase to capital gains taxes effective January 1, 2013. However, investment activity is up 16 percent and continues at a record pace.

Are We Asking Too Much of Our CIOs?

Harvard Business Review analyzes the expanding role of the modern CIO, asking if managing the mountain of new responsibilities is a realistic expectation from one person.

The World’s Most Outrageous Pension Deal?

McKesson CEO John Hammergren’s $154 million pension is scrutinized in a Forbes article that calls it "utterly absurd." Harvard Law School professor Jesse Fried, who notes that Hammergen is also the highest-paid CEO, says "Hammergren has pulled down hundreds of millions in compensation. Even without the pension, it would be very hard for him to spend all his money before he died."

McKesson beats on earnings, falls short on revenue

McKesson reports Q1 results: net income of $424 million on $32 billion in sales drove EPS to $1.83, vs. $380 million and EPS of $1.58 for Q1 last year. Revenue and EPS both fell short of analyst predictions.

News 7/26/13

Top News

CIOs and CMIOs tell the HIT Standards Committee that Stage 2 MU needs to be delayed a year. They argue that EHR vendors will not deliver 2014 certified software updates in time for hospitals to implement, validate, and train on the changes and meet the July 1, 2014 deadline for starting the 90-day Stage 2 reporting period. The AHA and AMA also submitted recommendations to extend the MU timelines and make them more flexible.

HIStalk Announcements and Requests

Hot stuff this week from HIStalk Practice includes: comments on why EMR selection should not be based on features. MGMA urges HHS to conduct ICD-10 testing with external trading partners, including physician offices. Social media experts offer tips for physicians. Commentary on EHR vendor consolidation and provider dissatisfaction. EPs share their reasons for dropping out of the MU program. Legislation moves forward to to repeal the Medicare SGR payment formula and develop a payment program based on quality and efficiency. Nothing is more refreshing on a hot summer day than an ice cold beverage and a quick perusal of HIStalk Practice. Thanks for reading.

On the Jobs Board: Developer, Full Stack Android (Google Glass), Sales Director.

HIStalk Webinars

Encore Health Resources will present Full Speed Ahead: Creating Go-Live Success on Thursday, August 15 at 2:00 Eastern, presented by Judi Binderman, MD, chief medical officer.

In implementing a new EHR, organizations typically focus on getting the software ready … building workflows, creating interfaces, and performing data conversions. Just as critical as having the software reflect the organization’s needs is having the go-live activities mirror the organization’s culture, goals, and end user support needs. This webinar will give an in-depth discussion of those items frequently overlooked and under resourced in bringing an EHR live. Encore Health Resources will share our experiences and lessons learned in supporting 28 go-lives for 22 facilities and over 10,000 physicians.

C-level HIStalk readers have provided presenter feedback and the session will be moderated by HIStalk. Register here.

Acquisitions, Funding, Business, and Stock

Kareo acquires ECCO Health, a Las Vegas-based medical billing provider.

Compuware’s Q1 results: revenue up 0.6 percent, adjusted EPS $0.10 vs. $0.09. Revenue of its Covisint division was up 17 percent.

VMware’s Q2 numbers: revenue up 11 percent, EPS $0.57 vs. $0.44.

Cerner’s Q2 report: revenue up 11 percent, adjusted EPS $0.34 vs. $0.29, meeting earnings estimates but falling short on revenue.

McKesson’s Q1 results: revenue up 5 percent, EPS $1.83 vs. $1.58,  beating earnings expectations but falling short on revenue. Technology Solutions revenue was up 9 percent, with the company reporting growth in RelayHealth, McKesson Health Solutions, enterprise, medical imaging, and Paragon, which is tracking ahead of projections on getting Horizon customers to switch. Hospital Automation and International Technology have been moved to discontinued operations.

Vitera Healthcare completes its acquisition of SuccessEHS, which was announced June 17.

From the Quality Systems earnings call: the Hospital Systems business unit saw a 52 percent drop in revenue as it sustained a $2.6 million loss. The company said it caved in to the threatened proxy fight by dissident shareholder Clinton Group to avoid being “faced with what would be a two-month period of yet another proxy fight like we had last year.” The company says the proxy issue and rumors of a potential sale of the company hasn’t affected the sales pipeline.

Sales

Sunnybrook Health Sciences Centre in Toronto will implement iMDsoft’s MetaVision clinical information system in its ICUs.

Boston Medical Center selects MModal’s transcription services for its healthcare provider network.

The Denver Endoscopy Center selects ProVation Medical from Wolters Kluwer Health.

Santa Clara Valley Health & Hospital System (CA) will deploy Capsule Tech’s DataCaptor medical device integration software.

Congress Medical Associates (CA) selects SRS EHR for its 21 orthopedic providers and two locations.

The Physician Alliance (MI) expands its use of Wellcentive to include Wellcentive Advance for creating a quality improvement registry.

People

Caremerge hires Greg Silvey (PSS World Medical) as VP of business development.

Direct Consulting Associates names Andrew Tipton (Direct Recruiters, Inc.) project manager.

Announcements and Implementations

CPSI and Sunquest Information Systems join CommonWell Health Alliance.

The Regenstrief Institute and the International Health Terminology Standards Development Organisation will link their global healthcare terminologies LOINC and SNOMED.

Siemens Healthcare releases a series of nine videos recorded at the HIMSS conference in which experts address critical health IT issues using only three slides and three minutes. Above is our own CIO Unplugged and Texas Health Resources CIO Ed Marx talking about social media and the hospital CIO.

SCI Solutions announces the the integration of its Order Facilitator product with the Surescripts Clinical Interoperability network.

Healthcare Growth Partners releases its mid-year 2013 HIT Market and M&A review. It says that healthcare IT buyers will outnumber sellers this year, with competition keen for companies with strong recurring revenue, products that are beyond proof of concept, revenue of at least $5 million, software with strong ROI delivered as a service, and ideally with offerings that fit in risk-based models.

Users of pMD’s mobile charge capture solution increased their Medicare reimbursement by automatically scheduling follow-up visits for discharged patients that are reimbursed under two new CPT codes (99495 and 99496) that pay for transitional or follow-up care if the patient is contacted within two days, the company says. The company says its almost impossible to meet the requirements using a paper-based system because of the tight timelines. If your goal is amusement rather than reimbursement, check out the company’s FAQ page, which in answering a question about the types of reports provided, the answer is “completely, totally amazing ones.”

Innovation and Research

Qualcomm and Palomar Health (CA) launch Glassomics, the first medically-focused Google Glass incubator.

Above is the just-released TEDMED presentation by Harvard’s Isaac Kohane of the SMART Platform, which advocates the use of extensible, open source apps that sit on top of vendor EHR systems.

The commercialization arm of Wake Forest Baptist Medical Center (NC) signs a deal with Charlotte-based app vendor Novarus Healthcare to develop disease management apps.

Philips Healthcare announces plans to start an incubator in Israel, where it has a large development center and has made previous acquisitions.

Other

St. Luke’s Medical Center in the Philippines introduces an online service that allows patients to book their preferred rooms in advance based on price and room amenities. I kind of like the $1,155 per night Presidential Suite, which includes a receiving room, guest room, PC and printer, eight-seat dining area, and three plasma TVs.

The mail processing company for  Clark Memorial Hospital (IN) blames a “processing error” for sending 1,093 billing statements to the wrong address.

Ezekiel Emanuel, MD, occasional White House advisor and chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania, calls the U.S. News & World Report “Best Hospitals” rankings and similar rankings “flawed to the point of being nearly useless.” In an opinion piece published in the Wall Street Journal, Emmanuel says the criteria used for rankings are “unrelated to quality, easily manipulated, and incentivize the wrong choices and behaviors.” Emanuel contends that if hospitals showed more transparency about quality, patients wouldn’t need rankings to select the best healthcare.

A Harvard Business Review article suggests that organizations are asking too much of their CIOs, saying the next generation of CIOs will need to balance four personas: infrastructure management, integrating systems, business intelligence, and innovation, possessing an integrative mind, focus and vision, and a trusting and trustworthy nature.

A Forbes analysis from last month of John Hammergren’s compensation titled “The World’s Most Outrageous Pension Deal?” says the McKesson CEO’s numbers are “utterly absurd”: a $159 million pension if he were to quit today, $131 million in one-year compensation,  a rumored $469 million if he’s fired by any new owners of the company, and $260 million due to his heirs if he dies or becomes disabled. The article says most companies other than McKesson cut back on very high CEO pension plans after SEC rules changed in 2007 requiring them to disclose those deals publicly. It also says the company gave Hammergren credit for years he didn’t work and pay he didn’t receive to come up with the big number, also waiving its early retirement penalty that applies to its other employees.

New analysis of CMS EHR attestation data for May by from Jamie Stockton of Wells Fargo Securities finds that Meditech, Cerner, and Epic hospitals lead the way in total numbers with over 400 attesting hospitals each, while Cerner, Epic, and HMS are the frontrunners in client percentages with 65 percent of their hospital customers successfully attesting. Trailing in customer percentages with 50 percent or less are McKesson (50 percent), Siemens (45 percent), and QuadraMed (25 percent.)

China’s public hospitals would collapse without the rampant bribery involving underpaid doctors and administrators, according to a Reuters review. New doctors earn $490 per month, the same as cab drivers, and without bribes would simply walk away from medicine. Patients are often expected to pay doctors extra in cash to ensure successful outcomes and to skip the line of waiting patients.

Sponsor Updates

• e-MDs recognizes six of its clients selected by ONC as either as an Healthcare IT Champion or Meaningful Use Vanguard.
• Black Book Rankings ranks Vitera the top ambulatory EHR in its user satisfaction survey. Other HIStalk sponsors earning high marks include Care360 Quest, Greenway, GE Healthcare, Kareo, Allscripts, McKesson, and eClinicalWorks.
• First Databank releases the FDB High Risk Medication Module to help users identify medications designated as high risk by the FDA and with a Risk Evaluation and Mitigation Strategy (REMS) requirement.
• Aspen Advisors Principal Dawn Mitchell discusses how to build a technology roadmap for emerging value-based care modules in a CHIME College live Webinar.
• Jessica Clifton, product marketing manager for Billian’s HealthDATA, offers predictions of which healthcare skills will be in demand over the next decade.

EPtalk by Dr. Jayne

My “meeting of the week” award goes to our internal discussion on upcoming changes to the NCQA Patient-Centered Medical Home program, due to launch next spring. New proposed standards call for better integration between behavioral health and primary care. It seems like most of our time in primary care is spent in some flavor of behavioral health anyway – even when dealing with chronic conditions such as hypertension, diabetes, and hyperlipidemia, many of the best solutions are behaviorally driven rather than pharmaceutically derived.

This fifth version of the PCMH recognition program also aims to reduce duplicative testing, focus resources based on patient need, and emphasize outcomes. It sounds a lot like old-time family doctoring, when we aimed to treat what could be fixed as efficiently as possible and not waste resources when they wouldn’t change things.

Somehow I don’t think it’s going to be that easy, though. NCQA accepted comments (limited to 1,800 characters each) until a few days ago. The funniest comment was by my colleague who didn’t find out about the comment period until today, saying he was sorry he missed the opportunity to demonstrate the heightened abbreviation skills he’s mastered after a decade of using EHRs with character limits.

CMS will host a July 30 Webinar on one my favorite topics: Administrative Simplification. All medical students and residents should have to sit through a session like this so that they can see what they are really getting themselves into. If I had any idea how much I would have to learn about medical billing and other non-clinical arenas just to get by, I might have taken my sibling’s offer to pay for the LSAT exam a little more seriously.

Speaking of things that make physicians go “hmm…” the Washington Post runs a piece on doctors’ pet peeves. Items at the top of the list include patients talking on cell phones, late arrivals, no-shows, failure to share all information, lying, asking physicians to commit fraud, and “by-the-way” questions at the end of visits. I recently started moonlighting at a new emergency facility that is very busy and I’m trying to put a positive spin on the exhaustion. Maybe patients talking on the phone when you’re trying to interview them is a good thing – it’s a quick and easy indicator that you have time to run to the bathroom before you see them.

CMS releases the 2015 PQRS Payment Adjustment Fact Sheet, which my billing colleague dubbed “the penalty page.” Read and enjoy!

The MGMA Annual Conference is coming up in San Diego. Inga texted me the other day to see if I was ready to try to beat last year’s record for most parties attended by two bloggers in a single evening. Unfortunately, I’ll be sitting for the new Clinical Informatics board exam that week so I had to let her down gently. Hopefully I made up for it, though, by sharing the happiest bow tie I’ve seen this summer.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 7/25/13

CIOs Call on CMS to Extend Meaningful Use Stage 2

During a Health IT Standards Committee meeting this week, a group of CIOs calls for a one-year delay in MU Stage 2 requirements. They argue that EHR vendors will not deliver Stage 2-certified software updates in time to implement, validate, and train end users.

Partnership to tie LOINC and SNOMED

The Regenstrief Institute (which maintains the LOINC code set) and the International Health Terminology Standards Development Organization (which maintains SNOMED codes) announce a long-term agreement to link the two medical terminology code sets. The decision was made to bring more efficiency to the health information exchange process.

NIH commits $24 million annually for Big Data Centers of Excellence 

NIH commits $96 million to establish eight data centers of excellence, where researchers will develop innovative approaches, methods, and software solutions for data analysis and data sharing.

CommonWell Health Alliance Welcomes New Members CPSI and Sunquest to Support and Advance Interoperability Initiatives 

CommonWell Health Alliance announces the addition of CPSI and Sunquest Information Systems to the interoperability program.

CIO Unplugged 7/24/13

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

The unEXPERIENCED Life is Not Worth Living

The famous phrase by Socrates about “the unexamined life” has made its way into many lectures and speeches beyond its philosophical niche. No, I’m not a philosopher. But as I dug deeper for the sake of this post, I stumbled across a distinction he made between people (Athenians) who watched life and those who experienced it.

Observing an Olympic athlete cross the finish line gave a “semblance of success,” but was it true reality? We love to admire superb performance and bask in a new world record. But what would happen if we personally strove for such experiences ourselves?

I choose experience. It doesn’t need be extravagant or expensive. It can be turning off the soccer match on TV and joining a local team. Signing up for ballroom dance class rather than just watching “Dancing with the Stars.” Putting down the books about the missionary taking care of the poor in India and signing up at your local soup kitchen. Turn off Facebook virtual relationships and instead host a live get-together with living people.

My plan had been to share with you fresh leadership and teamwork insights from a recent climb atop Europe’s highest mountain, Elbrus. That was a victorious experience. But my heart isn’t into writing about climbing because of a tragedy that unfolded two days later.

Tradition calls for celebration following a summit. While touring St. Petersburg, five members of my team, including myself, walked down the bustling main street, Nevsky Prospekt. We traded climbing stories and talked about our motivation to climb. People we met said interesting things about the danger of climbing mountains. Our common response became, “Life is short, and a sheltered life was no life at all. You might get hit by a car while playing it safe, so you may as well embrace risk.”

Still light outside, midnight was approaching as we began the journey back to our hotel. Approaching the intersection at Kazan Cathedral, we formed a quasi column so we could pass pedestrians coming from the other side. I entered the crosswalk, leading my friends and walking immediately behind two ladies age twenty-something. In a split second, tires screeched, headlights blazed, and I instinctively dove out of the way. To my left, I heard flesh hit metal … then glass (windshield).

As I landed on the ground, I viewed the unthinkable out of the corner of my eye—those two ladies cartwheeling through the air. By the time I rolled to a stop, they landed 10 meters away. Unconscious. Contorted. Broken. A surreal scene.

After a few seconds of verbal rage and gathering our wits about us, we jumped into action. JJ, our mountain guide, took command. We became docs, EMTs, and comforters. We had both patients stabilized. The dozen policemen who showed up were completely clueless and just stared at us.

I recall vividly watching my bunkmate Frank clasp one girl’s hand and speak calmly to her. She told us she was visiting from Siberia. Her friend lay unconscious and deformed, with her head held stable by our buddy Zac. At the 10-minute mark, a “first aid” vehicle showed up and a woman wearing scrubs emerged. She was with infection control and had no real medical supplies. Applying smelling salts, she was trying to get both patients up and walking before understanding the severity of their injuries.

Adding to the chaos, a policeman grabbed Zac, thinking he was the negligent driver. Tried to arrest him. Bystanders intervened, and our friend was released. We continued providing support, but our counsel to the “infection lady” and the swarming, interfering bystanders was ignored. Ms. Infection was forcing the second patient, now conscious, to move despite obvious skeletal trauma.

I backed off and prayed over the situation, asking God to send the Holy Spirit for comfort, healing, and wisdom. Not having our passports in hand, we left a few minutes later as the mob grew more aggressive. My team prayed from a distance.

Once back in the hotel room, I buried my head in the bath towel and sobbed. I Skyped my wife and texted a friend. Every time I closed my eyes, I saw those ladies doing cartwheels over me. I slept for three hours and returned to the scene, which had since been cleared. I wondered what happened to the Siberians and how they were doing. Who was looking over them? Who was holding their hands? I spent another 30 minutes just praying and reflecting. I could not stop crying.

Today, my team is still processing what we experienced. As traumatic as it was, we were glad we’d been there and hoped the aid we provided helped save a life. We witnessed firsthand how quickly life can be taken away. In a blink of an eye. Something as safe as crossing a street.

Life is full of tragedy and heartbreak. You can bank on it happening again tomorrow. But does adversity really hold us back in life? I’d venture to say it’s our fear-based belief about painful incidences or the possibility of them happening that paralyze us. Instead of falling prey to that paralysis, experience the depth of heartbreak and then grow stronger from it. Conquer the fear and keep living.

Living life with no regrets means crawling out of the ashes of tragedy and walking stronger. On purpose. Determine to live a life fully experienced. We Live.

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 7/24/13

Black Book’s Satisfaction Index Resolves Highest Ranked Vendors in the "State of the EHR Replacement Market" Study, Eight Firms Share Distinction of the Top 1%

In a recent poll of dissatisfied ambulatory EHR users, 81 percent of respondents reported that they will replace their original EHR solutions within the next 12 months. Practice Fusion, Care360 Quest, Vitera, Cerner, Greenway, ChartLogic, GE Healthcare, and athenahealth were the vendors respondents identified as most likely to win replacement business.

Federal Health IT Strategic Plan Progress Report

ONC publishes a progress report on its Federal Health IT Strategic Plan for 2011-2015. The report outlines the milestones ONC has accomplished thus far in pursuit of its original goals.

World first computer saving lives

In Australia, a new decision support system implemented in the ED of The Alfred Hospital results in a 21 percent reduction in medical errors during a 33-month trial period.

Children’s Hospital Los Angeles to Host 3rd Annual Symposium on the Meaningful Use of Complex Medical Data

Children’s Hospital Los Angeles will hold its third annual symposium addressing big data analytics and emerging use cases in medicine.

News 7/24/13

Top News

A report finds that 81 percent of medical practice respondents who previously said they planned to eventually replace their EHR will actually do it within the next 12 months.

Reader Comments

From Boots: “Re: Quality Systems/NextGen. As a long-time client I don’t know what to make of the situation there. Sometimes the company’s actions make no sense. They seem to be managing to distractions and not to vision or mission. As to the rumors that NextGen is looking for a buyer, I’m not sure they will find one who will meet the shareholders’ often unrealistic expectations.” A couple of industry insiders tell me they believe NextGen is ripe for acquisition, given recent declines in net new software sales and uncertain positioning in the replacement market. A big vendor, such as Siemens, may be interested in them to gain market share. Alternatively a PE firm may pursue them with the intent to clean house, increase revenues, and eventually spin off.

From ShowMe: “Data breach lawsuit. It should be interesting to see what happens in the lawsuit against the federal government following the loss of a VA laptop. Am I the only one who thinks the government is showing a little chutzpah with its argument that the suit should be dismissed since there’s no proof of identity theft … yet?  The government should spend its energy encrypting devices and quit asking our veterans to find a smoking gun.” Details on the lawsuit and the motion for dismissal are here.

Acquisitions, Funding, Business, and Stock

CTG announces Q2 numbers: revenues up 0.4 percent from a year ago, EPS of $0.24 versus $0.25. The company notes that earnings growth in 2013 will be less than originally expected due to hospital clients dealing with “reimbursement reductions caused by the US federal budget sequestration.”

GE reports that its healthcare division logged a five percent increase in Q2 profit, though revenue was flat.

HealthStream reports Q2 results: revenue up 24 percent, EPS flat, but beating estimates by a penny. Shares hit an all-time high Tuesday with an 11.4 percent jump, up 60 percent since mid-April.

Lexmark reports good Q2 results, with revenue of its Perceptive Software business unit up 34 percent as the company transitions out of the inkjet printer business and into services.

Sales

Catholic Health Initiatives selects Conifer Health Solutions to provide population health management and data analytics tools.

Hospital Sisters Health System will deploy iSirona’s device connectivity solution in nine of its hospitals.

Whittier IPA (MA) contracts with Alere Accountable Care Solutions to build a community-wide HIE.

People

Culbert Healthcare Solutions hires Jaffer Traish (Zynx Health) as director of Epic consulting.

AHIMA appoints Meryl Bloomrosen VP of thought leadership, practice excellence, and public policy.

Encore Health Resources names Anne Dillon (Oracle) as client services executive for Southern California, New Mexico, and Arizona.

Announcements and Implementations

Surescripts expands its clinical messaging capabilities to users of Greenway, Inofile, SCI Solutions, and SOAPware.

The Colorado RHIO reports that with the addition of Exempla Healthcare, all of the state’s 100+ bed hospitals are connected to the HIE or are in the process of connecting.

Fairfield Memorial Hospital (SC) goes live on Cerner in September.

Atlantic General Hospital (MD) joins the Delaware HIN, becoming the first acute care hospital in the country to join an HIE located in another state.

Health Catalyst introduces Health Catalyst 2.0, which offers improved automation of metadata gathering from multiple IT systems and includes new content-driven applications for the enterprise data warehouse platform.

Government and Politics

ONC posts a progress report highlighting the steps taken since 2011 to implement the federal government’s strategic plan for using HIT to improve health and healthcare. We aren’t there yet, but in toto, the achievements to date are impressive.

In Australia, The Alfred Hospital reports that a university-created trauma decision support system reduced ED errors by 21 percent. It displays vital signs, captures the encounter on video, and incorporates 40 algorithms pertinent to the first 30 minute of a trauma case.

Technology

The NYC Economic Development Corp. names Kinsa the winner of its Innovate Health Tech NYC competition for its smartphone-connected thermometer that allows patients to track illness history, share details with physicians, and manage their illness.

Children’s Health Fund launches a telemedicine-enabled mobile clinic for underserved children in Miami on Thursday, July 25.

Other

Travis from HIStalk Connect spotted a Nordic Consulting billboard at the Verona, WI exit for Epic. He sees this as the next advertising beachhead outside of the Madison airport security checkpoint and wonders if blimps and skywriting planes are being engaged for Epic’s UGM. The Epic campus photo on the right is from Steve Knurr of Vonlay, just in case you wondered how nice summer days are in Wisconsin.

Sisters of Charity of Leavenworth Health System sues hospital operator Prime Healthcare Services, to which it sold two Kansas hospitals earlier this year. SCLHS says Prime is using its billing software illegally and hasn’t handled patient billing as required by the sales agreement.

Healthcare costs not only bankrupt large numbers of US citizens, they appear to be on track to bringing entire cities to their financial knees. Detroit’s bankruptcy filing raises the possibility that Chicago could be next, with both cities struggling under the weight of underfunded retiree benefits. Chicago probably won’t get much help from the the state since Illinois has a $97 billion pension shortfall of its own. A large chunk of the underfunding is due to medical costs, with a recent study concluding that 61 major US cities have enough money to cover only six percent of their healthcare liabilities. Baltimore’s overly generous retiree healthcare obligations have caused the city to run up a debt of more than $10,000 per household.

Children’s Hospital Los Angeles (CA) will host the third annual Meaningful Use of Complex Medical Data Symposium on August 16-17. It connects clinical researchers and practicing physicians to big data computer experts with the goal of gaining medical insights from electronic information.

Weird News Andy says this doctor failed the “first do no harm” credo and wonders what the second one is. A Nebraska medical resident pleads not guilty to killing four people after being dismissed from the program.

I had some technical problems with Vince’s HIS-tory this past weekend that I didn’t have time to fix for the Monday Morning Update, so here is the belated Part 2 of Siemens.

Sponsor Updates

• Consulting firm The HCI Group is named Northeast Florida’s fastest-growing company of 2013, with 1,301 percent average annual revenue growth since 2010.
• NextGen will offer LDM Group’s healthcare messaging platform to its NextGen EHR clients.
• The Orange County Register profiles Kareo and deems it a “most promising” company.
• ADP AdvancedMD offers an on-demand Webinar outlining ways private physicians can save their practices.
• Nuesoft Technologies changes the name of its Nuetopia product to NueMD Medical Billing Services and its Nuesoft Xpress offering to NueMD for Student Health.
• Ping Identity joins the Cloud Security Alliance Security, Trust & Assurance Registry.
• NextGen will integrate is Ambulatory EHR with Florida Blue and Availity to make patient-specific clinical information available at the point of care to both providers and payers concurrently.
• Gartner places Informatica Corp. in the leaders quadrant in its 2013 Data Integration Magic Quadrant report.
• Intelligent Medical Objects reports that 2,500 hospitals have licensed its interface terminology services, including new customers Catholic Health East (PA), Hospital Corporation of America (TN), Avera Health (SD) and Christus Health (TX).
• Baystate Medical Center (MA) uses data derived from PeriGen’s PeriBirth EHR to calculate reductions in unnecessary inductions, C-sections, and NICU admissions.
• First Databank will provide Geneix with its drug knowledge and clinical decision support solution.
• SGS Life Science Services selects Merge eClinical OS for Phase I-IV studies.
• Coeur d’Alene Pediatrics (ID) shares how its implementation of Vitera’s EHR, PM, and patient portal solutions led to $300,000 in MU incentive payments and resolved business challenges.
• Medicity client Vermont Information Technology Leaders shares details of its successful HIE.
• CoverMyMeds reports that its five millionth prior authorization request was received this week and that the site is now processing 25 percent of all prior authorizations submitted annually in the US.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 7/23/13

HHS auditors target upcoding of Medicare bills via EHRs
 
Federal regulators conduct targeted audits of hospitals following months of speculation that EHR usage may be contributing to fraudulent upcoding.

A Better Online Diagnosis Before the Doctor Visit

The Wall Street Journal covers the online symptom checker market, including a website called Isabel that was able to suggest the correct diagnosis in 48 of 50 complex cases.

Colorado HIE enlists more hospitals

Colorado’s health information exchange now connects 50 percent of the state’s hospitals, including all of those with over 100 beds.

2013 First Half Trends Report – Healthcare Industry

A report on mergers and acquisitions within the healthcare / pharma information technology industry finds that deals are down 16 percent overall for the first half of 2013. However, transaction values are up 58 percent compared to the second half of 2012, from $5 billion to $8 billion.

Readers Write: How Many Licks to the Tootsie Pop Center Versus How Many Clicks to Relevant Clinical Data?

How Many Licks to the Tootsie Pop Center Versus How Many Clicks to Relevant Clinical Data?
By Helen Figge, PharmD, MBA, CPHIMS, FHIMSS

A group of engineering students once reported that it took an average of about 364 licks to get to the center of a Tootsie Pop. For some reason, this was a very important scientific query that needed an answer.

A current healthcare query many are pondering today is: how many clicks are needed to get to the relevant clinical data necessary to support patient care? Clinicians using the various technologies like EHRs and HIEs for data retrieval often times have the same number of steps as getting to the center of a Tootsie Pop. The more clicks it takes to get to the required clinical data, the more time spent away from the patient, and thus eventual loss of productivity, suboptimal patient care, and potentially total clinician frustration. If you speak to clinicians on the front line, many of the technologies are more of a hindrance than a help.

In reality, one wants the right data at the right time and in a comprehensible format without undue effort to retrieve it. Clinicians are yearning for “smart software” that knows what data to fetch and how to properly present it. Data needs to be automatically populated inside the clinician note. Additionally, more than ever clinicians need technology that supports workflow and provides the correct data with minimal effort on the clinician’s part. 

Bottom line, we need “smart software” that knows what data to present while simultaneously having other data immediately available with one click. As an example, if the software recognizes that the patient has diabetes, then certain labs — such as hemoglobin A1C, lipids, and renal function — should be automatically displayed in the note.

Ask clinicians and they will tell you that they are getting drowned in unnecessary data. Data needs to be presented in a way that is easily understood by clinicians. We know a lot about the technologies out there today compared to a few years ago, so clinicians more than ever should expect nothing less from their vendors today than data that is useful, timely, and in real-time.

Clinicians require from their technology enablers the ability to aggregate data from multiple sources and present it in a comprehensible format. For a diabetic patient, the software needs to aggregate kidney function from any laboratory source and plot and trend the data appropriately. Clinicians need to be more vocal in their desires for appropriate data and need to collaborate with the IT departments to get the desired outcomes from their technologies. Clinicians need to engage more than ever before to ensure the software chosen for their organizations delivers what is needed on the front lines.

Right now, clinicians need easily customizable data presentation formats, smart order templates and true data aggregators along with evidence-based algorithms from their vendors. Clinicians must have tools that actually work for them, not against them, and truly support patient care. True “smart software” should support what the clinician needs, not forcing the clinician to adapt to inept software to attempt data retrieval for patient care. IT experts need to continue engaging the clinician in collaborations because right now it’s all about the data and how it is presented.

Organized structured data is the paramount piece to the current healthcare puzzle. We have the answer to how many licks to the center of a Tootsie Pop. Now it’s time to get to the answer of how many clicks to the necessary data that truly supports patient care.

Helen Figge, PharmD, MBA, CPHIMS, FHIMSS  is advisor, clinical operations and strategies, for VRAI Transformation.

Readers Write: The Sequester’s Impact on Healthcare: Dangerous Unintended Consequences

The Sequester’s Impact on Healthcare: Dangerous Unintended Consequences
By Rich Temple

It has been three months since the sequester hit the healthcare industry, and the effects are more profound than they might seem. What’s most troubling is that the budget cuts in many cases will wind up costing the government more money and will have a particularly negative impact on cancer patients and those living in rural areas.

Cost of Caring for Unemployed

Across the healthcare spectrum, providers can anticipate about $11 billion in cuts. A joint study by the American Medical Association and the American Hospital Association estimates the loss of 330,127 healthcare jobs and 496,000 indirect job losses by 2021. Victims of job losses tend to require extra care to sustain their health and well-being while out of work, and the cost of these interventions may wipe out the perceived benefits of the sequester’s capricious cost-cutting.

Another Hit for Providers: Cuts in Medicare Reimbursement

For individual healthcare providers, the 2 percent across-the-board Medicare reimbursement cut will exacerbate challenges for providers who are already struggling to adapt to value-based purchasing and other mandated reimbursement cuts. Mercifully, Medicaid was exempted from this cut, but even Medicare Meaningful Use incentives will sustain the 2 percent reduction.

Particularly hard-hit will be rural hospitals, which according to a study by iVantage Health Analytics are twice as likely to be thrown into the red as a result of these cuts. That’s because rural hospitals treat older, poorer, and less-insured patients and are thus directly dependent on Medicare for their economic sustainability. This financial damage will ripple down to the communities they serve since these organizations tend to be among the largest employers and are likely to be a key focal point of much of the activity in their local economies.

Cuts Disproportionately Affect Community-Based Cancer Clinics

Cancer care is the area most profoundly impacted by the sequester. Reimbursement cuts are making it financially untenable for community-based cancer clinics — one of the more cost-effective treatment sites — to continue to serve many patients, thereby forcing them to either seek care in a more expensive hospital setting or not seek care at all.

Historically, Medicare reimbursement for cancer drugs has been the average price of the drugs, plus a 6 percent administrative fee to cover the cost of providing care. The sequester reduces that fee to 4.3 percent for both drugs and services, which in essence translates to a 28 percent cut in actual reimbursement.

According to a study conducted by the actuarial firm Milliman, the sequester is already resulting in layoffs, closings, cutbacks, and is driving patients into hospital settings. The study also says that the government could pay an average of $6,500 more per year for cancer patients in a hospital versus a community clinic.

Cuts to Cancer Research Means Fewer Clinical Trials

Another area where cancer patients are hard hit involves cuts to research funding. Besides the estimated loss of 20,500 research jobs, NIH research indicates that every $1 invested in cancer research yields over $2 in incremental economic activity. This translates to a $3 billion direct negative hit on overall economic activity.

Significant cuts to cancer research mean that fewer clinical trials will be available to help identify better treatments and thus, more protracted, costly, and painful care for patients will continue.

Most Vulnerable are Hardest Hit

In summary, the sequester’s effects are causing great pain on many levels to some of the most vulnerable segments of our population. And the perceived cost-reduction benefits are actually not likely to be realized since the unintended consequences of the sequester look like they will cost even more than the mandated cuts. These consequences could take the form of:

• More expensive, less efficient care due to patients losing access to primary care physicians
• Incremental unemployment insurance for those who have lost their jobs
• Protracted inpatient stays due to less readily available preventative research
• Other forms of public assistance these individuals will require

The effects of the sequester on healthcare have not been discussed extensively of late in the media. However, it should be noted that there are unintended consequences that we will most likely pay for in the coming years ahead.

Rich Temple is national practice director for IT strategy at Beacon Partners.

Curbside Consult with Dr. Jayne 7/22/13

I mentioned last week that I would be attending our quarterly “All Provider” meeting and had been hoping that Accountable Care would continue to be the focus of physician anger rather than EHR. Although it continued to draw a large amount of complaints (along with ICD-10 and Pay for Performance) EHR was once again in the spotlight. The current issue revolved around system availability.

In a nutshell, providers don’t ever want the system (or any part of the system) to be down. They expect upgrades and patches to be magically applied with no disruption. I don’t blame them – no one wants to be without the information they need to safely (and efficiently) care for patients. We do have to remember, though, that we’re dealing with machines and networks and the people who install, program, and maintain them. Downtime can be minimized but it is not completely avoidable.

One of my providers is really fond of using statements like, “How come you can’t just patch this thing like Microsoft does?” Being a long-time user of Microsoft products, I think that shows a remarkable lack of insight. I don’t think Microsoft is particularly adept at making user-friendly patches.

The average end user typically has no idea what is in them and has to just accept them through the auto-update process without thought and frequently without concerns for timing. I love rebooting after batches – when the system is trying to shut down and it warns you not to unplug, touch, or look funny at the device because “Windows is configuring updates.” There is no estimate of how long it will take or what it’s really doing.

Our department painstakingly combs through vendor release notes to make sure we fully understand everything we’re installing and how it will impact the end user experience. We communicate, re-communicate, and over communicate using a variety of media and strategies and yet it seems to never be enough. Many of our maintenance tasks can be done with users on the system. However, there is one item that has to be done with all users logged off. We typically do this once a month after midnight and it takes about 10 minutes. You’d think that we were asking people to give up an organ they way they respond to this.

People cannot possibly be without the record! There might be an emergency! The sky might fall! I’m not talking about a hospital system here – I’m talking about an ambulatory EHR in a large group that’s about 60 percent primary care. In my experience with having colleagues contacted through the after-hours exchange in the wee hours of the morning, it takes more than 10 minutes for them to respond to texts or calls. One would think that if those 10 minutes were critical, they’d be answering instantaneously and not making the emergency department secretary chat with voice mail. Even better, perhaps they should consider taking in-house call.

Once upon a time in a land far, far away, we managed patients from home without the chart. We used the data we had (patient, nurse, ER physician, resident, intern, exchange, partners, pharmacy, etc.) to give the best advice we could. Certainly there are benefits of having home access to charts, but being without them occasionally is not the end of the world. Patients did well the vast majority of the time. We used things like clinical judgment to treat the patient in front of us, not numbers.

Of course, scheduled downtime and unplanned “events” are two different things. However, with a solid business continuity plan, they should have very little impact to clinicians. Some of my colleagues can access their disaster recovery servers directly. Others have “mini-charts” sent to a network drive every night. Some colleagues have no plan and can’t tell me the last time they actually tested a backup to see if it could be used to perform a system restore.

Despite the crucial nature of clinical data systems, we are at risk of outages and it’s time to be prepared. If you don’t know what your disaster plan is, find out. If you do know your plan, then good for you. If you’re like some of the colleagues I dealt with today who think that clinical systems are the only ones that ever go down, I offer the same challenge I gave at our meeting: take a week and see how many “issues” you have with non-clinical systems. By issue, I mean an instance where the system doesn’t perform perfectly. I think you’ll be surprised at how often they happen and how often we simply move past them and get on with our work.

How do your end users cope with downtime? Do you have processes in place to maximize availability? E-mail me.

E-mail Dr. Jayne.

Morning Headlines 7/22/13

Quality Systems, Inc. 8-K filed 7/17/2013

Quality Systems, Inc., parent company of NextGen, files an SEC 8-K form that includes language suggesting that it may be looking to be acquired.

athenahealth Management Discusses Q2 2013 Results – Earnings Call Transcript

Jonathan Bush discusses athenahealth’s poor Q2 performance on an earnings call held Friday.

New Medicaid computer system doesn’t end errors

New Hampshire’s new $90 million Medicaid computer system has bogged down reimbursement processing significantly, resulting 40 percent of claims being suspended pending further analysis. Meanwhile, some providers say they aren’t getting paid properly.

Veterans in Data Breach Suit Suffered No Harm, Government Argues

In a class action lawsuit filed against Department of Veterans Affairs over a stolen laptop containing sensitive patient information, the federal government is defending itself by arguing that since there is no proof that the thieves ever accessed the data, there is ultimately no proof that an improper disclosure actually took place.

Monday Morning Update 7/22/13

Half of survey respondents say the ongoing DoD-VA EHR discussions haven’t changed their perception of those organizations, while a third day they’ve gone negative as a result. New poll to your right, as suggested by a reader: what’s your opinion of VC-backed companies? The answers are a little bit tricky to tease out the opinions of providers vs. vendors. As always, feel free to follow up your all-important vote by leaving a comment on the poll.

I have a lot of HIStalk Webinars scheduled and could use another person to serve as moderator. If you have healthcare IT Webinar presentation experience, have good speaking skills, and are available weekday afternoons Eastern time, tell me why I’d be stupid not to hire you.

Quality Systems hints in a comment buried in an SEC filing from last week that it may be considering selling itself. The filing describes the company’s acquiescence to dissident shareholder Clinton Group, whereby Quality Systems will bring on the three Clinton Group board nominees to avoid a threatened proxy fight. Clinton Group has successfully used the same threat with other companies.

Microsoft writes down $900 million after its Surface RT tablet flops and the company cuts the price of the 32 GB model from $499 to $349 hoping for potential buyers who have resisted only because of price.

Four college students in Uganda design a smartphone app that connects to a fingertip sensor to allow instant diagnosis of malaria without repeated needle sticks.

Vitera Healthcare Solutions names Jeremy Muench (McKesson) as SVP of client operations.

From athenahealth’s Q2 earnings call, following the announcement of poor results that sent the stock retreating:

• Jonathan Bush proclaims that the company is “very much in the big show” with its Epocrates acquisition and enhancements to athenaClinicals.
• The Ascension Health contract was highlighted.
• Bush claimed that athenahealth is the only vendor that can financially guarantee its customers a smooth transition to ICD-10 and MU Stage 2.
• The move to having recipients of information via athenaClinicals pay for its use rather than just licensing it to an organization is “a hard slog” and has extended the sales cycle and increased sales costs.
• Both athenaCoordinator and athenaClinicals revenues are falling short.
• Bush apologized for comments he had made previously about Epic, saying, “I made some unfavorable comments about Epic, which was a mistake. Epic is a fine company, one for which we have tremendous respect and we are proud to be working alongside of in terms of clinical integration. Soon, any Epic client should be able to connect with athenaNet with a very minor instruction and authentication process.”
• $17 million of increased Q2 revenue came from Epocrates revenue and tenant rent from the Arsenal office complex the company purchased.
• Sales and marketing expense jumped 50 percent in the quarter, while R&D cost was up 66 percent.
• Bush said he thought Ascension went with athenahealth because it sees itself as a national clinical with doctors it doesn’t control.
• Bush sees Epocrates as being enabled with secure provider-to-provider messaging and being given the capability to update non-athena systems with information. “If a doctor is on Epocrates and is chatting on and sharing patient information on athenaClinicals, even though the hospital they’re on maybe on Cerner or Epic, they would love to be able to order prescriptions and then say, ‘Now athena, you deal with updating my Cerner system because I don’t like logging into it or my Epic or my — pick your favorite A Flock of Seagulls system.’”
• More athenaClinicals transactions are being automated, or as Bush says, “Now athenaClinicals with no fax server and no 1,000 people data entering clinical results in India is a very different profit profile than the one we have today.”
• Demand for athenaClarity is so high outside of its Massachusetts origins that Bush says the company can’t keep up.

Mediware will announce Monday its acquisition of home infusion and specialty pharmacy systems vendor CPR+ of Westerville, OH.

The federal government, requesting dismissal of a data breach lawsuit involving a missing VA laptop, argues that no proof exists that anyone has seen the patient information it contained and no identify theft has occurred.

New Hampshire’s new $90 million Medicaid computer system, development of which was contracted to Xerox’s ACS, is causing payment problems due insufficient rules testing according to the CFO of Concord Hospital, which has a $5 million payment backlog. An orthopedics practice reimbursement specialist, noticing wild overpayments, asks for a billing manual and is told it is still being worked on. The HHS commissioner admits that payment of 40 percent of claims has been suspended pending further analysis.

ONC offers a 10-step plan for protecting PHI.

In England, East Kent Hospitals University NHS Foundation Trust blames its just-installed GE Healthcare radiology information system for delayed appointments and results.

The Mount Sinai Medical Center (NY) announces that it will use technology from Real Time Medical to implement teleradiology services in several imaging clinics. I’m curious (and annoyed) as to why the company’s name appears everywhere as Real Time (two words) except in its logo, where it’s one word.

Inga does her best Weird News Andy impression by sending me a link to this story. A British vacationer returning from Peru thought she was imagining the scratching sounds inside her head until doctors found maggots living inside a hole in her ear canal, hatched from eggs depositing there by a fly.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 7/19/13

Athenahealth Slips To Loss In Q2; Backs FY13 Outlook

Athenahealth reports a $12.4 million net loss, or -$0.34 per share in its Q2 results. Despite the poor performance, the company stands by its year end-forecast.

Data show electronic health records empower patients and equip doctors

CMS releases a report touting standout metrics of the EHR incentive program. It says EHRs have sent 190 million prescriptions and 13 million patient reminders electronically.

Bill sets timeline for health records sharing

Sen. Bill Nelson (D-FL) proposes a bill that would set concrete milestones and a firm timeline for the VA/DoD EHR project.

Hospital Denied Access to Its Own Records

Milwaukee Health Service is suing Atlanta-based Business Computer Applications, demanding that the company restore access to its electronic medical records. Milwaukee Health scrapped BCA’s Pearl EMR and migrated to GE Centricity, but BCA says it has not been fully paid.

News 7/19/13

Top News

Athenahealth reports Q2 results: revenue up 44 percent, non-GAAP EPS -$.08 vs. $0.24, beating revenue estimates but missing consensus earnings expectations of $0.22. The company says it stands by previous FY13 guidance.

Reader Comments

From Keen Observer:“Re: Senate Finance Committee on Health IT hearing Wednesday. Here are my notes.” Thanks. Video is here and the transcript of Farzad’s testimony is here. I’m including your notes below.

Farzad and Patrick Conway from CMS fielded a lot of questions about the Meaningful Use program’s benefits and the adoption rate, especially among rural providers. Farzad’s bow tie also took a number of shots, including one from Sen. Pat Roberts advising him not to wear it in Dodge City, KS. Both Senators Baucus and Roberts urged Farzad to get out into rural America and see what the conditions are like before assuming that all rural hospitals and providers should be held accountable to the same IT standards as their urban counterparts.

They asked Farzad about his thoughts on a delay to Stage 2 and he said he didn’t think it would be beneficial to slow the momentum. Senator Thune asked about what Stage 3 will look like and if there will be more stages beyond that. Both witnesses ignored the second part of that question. They also talked a lot about interoperability and evolving standards. Some asked if the bar was too low for interoperability. Senator Enzi really hammered Dr. Conway about the physician drop out rate that was reported for docs who achieved Stage 1 MU.

Next week the Finance Committee will hold another hearing with with Janet Marchibroda from the Bipartisan Policy Center, John Glaser from Siemens Healthcare, Marty Fattig from Nemaha County Hospital which is a critical access hospital and Colin Banas from Virginia Commonwealth University Medical Center.

HIStalk Announcements and Requests

This week on HIStalk Practice: CareCloud introduces an update to its Charts EHR that I believe includes Medicomp Quippe functionality. TransforMED selects 90 primary care practices for a three-year patient-centered medical neighborhood pilot project. CMS highlights key 2014 deadlines for the EHR incentive and other eHealth programs. Physicians in larger states, ER specialists, and pathologist historically experience higher levels of PQRS success. Dr. Gregg shares a scary tale of EMR demos, UXs, and UIs. Join the fun, take a read, and check out the offerings of a few HIStalk Practice sponsors. Thanks for reading.

Acquisitions, Funding, Business, and Stock

Quality Systems reaches an agreement with Clifton Group, an investor that had called for the replacement of the company’s board. Quality Systems will add three Clifton Group nominees to its board.

UnitedHealth Group reports Q2 results: revenue up 12 percent, EPS $1.40 vs. $1.27, falling short on revenue expectations but beating handily on earnings. The company’s Optum segment turned in revenue of $8.8 billion with earnings from operations of $536 million, which contributed significantly to the bottom line. The insurer’s quarterly profit was $1.44 billion.

Sales

Care New England Health System selects Infor Healthcare’s business process automation solutions.

Jefferson Radiology (CT) contracts with McKesson Business Performance Services for revenue cycle management.

St. Joseph’s Hospital Health Center (NY) selects ProVation Care Plans from Wolters Kluwer Health.

Pilgrim Hospital (UK) chooses MetaVision from iMDsoft for its ICU.

People

Extension names Brian McAlpine (Emergin) VP of product management and marketing and Johnathan Salyer (Capsule) director of strategic accounts.

CompuGroup Medical promotes Norbert Fischl to CEO of CGM USA.

HealthAlliance (MA) names Chris Walden, RN, BSN (Flagler Hospital) as CIO.

Former Florida Governor Jeb Bush joins the board of Alpharetta, GA-based healthcare staffing company Jackson Healthcare LLC.

Cleveland-based analytics vendor Socrates Analytics names Jim Evans (McKesson) as CEO.

Industry long-timer Jim Klein, who worked for CompuCare, QuadraMed, InterSystems, Advisory Board, and Gartner, died of prostate cancer Wednesday, July 17 at his home in Great Falls, VA. He was 65.

Announcements and Implementations

ProHealth Care (WI) implements Omnicell’s G4 Unity medication management platform.

The Ottawa Hospital launches Wolters Kluwer Health’s UpToDate Anywhere.

Southeast Hospital (MO) implements Access e-forms barcoding to manage registration packets, order sets, and home health documents.

Navicure reports that it increased revenues 27 percent in the second quarter and added 316 medical practices.

Government and Politics

CMS releases information suggesting that EHR use is helping providers manage patient care and provide more information securely. CMS notes that since 2011, providers have used EHRs to send more than 190 million prescriptions electronically, send 4.6 million patients an electronic copy of their health information, forward more than 13 million patient reminders, check drug and medication interactions over 40 million times, and share more than 4.3 million care summaries with other providers.

During a Senate Finance Committee hearing, ONC head Farzad Mostashari, MD says that pausing the MU program to evaluate whether the bar has been set too low would “stall the progress that has been hard fought (and) take momentum away from progress.”  Incidentally, even senators aren’t immune to Mostashari’s dapper bowties: Sen. Orrin Hatch apparently took a moment to call Mostashari’s cravat “a beauty.”

Sen. Bill Nelson (D-FL) introduces a bill that would impose specific deadlines for the Department of Defense and the VA to exchange electronic health information. The Service Members’ Electronic Health Records Act would require the DoD and VA to use standardized forms within six months of enactment; to exchange real-time information and use a common UI within a year; and to offer service members with electronic copies of their information by June 30, 2015. According to the Senator, “For 15 years, we have tried to fix this problem. In the past five years, the departments have spent around $1 billion, but we are not there yet.”

Innovation and Research

Seamless Medical Systems is awarded a $50,000 grant from the Venture Acceleration Fund of Los Alamos National Security, LLC. The company will use the money to further develop its SNAP Practice patient engagement platform.

Technology

Connexin Software will use Health Language applications from Wolters Kluwer Health to normalize data into standard terminologies within its pediatric EHR solutions.

Tech writers are stalking executives of Apple, hoping to see visual evidence of the wearable body sensors or related devices that the company is rumored to be studying.

Children’s Hospital Foundation (DC) passes on Microsoft SharePoint for its Intranet because of complexity and staffing requirements, instead choosing Igloo.

Tech Crunch profiles ElationEMR, a San Francisco-based startup founded by a Stanford economics professor who says she and her brother “had no prior experience building anything of the sort. And my brother happened to have a knack for design and I kind of had a bit of a knack for engineering and learning quickly to pull things together.” The EMR costs $149 per month, which includes support, e-prescribing, lab interfaces, training, and a patient portal. An ElationEMR user can see all the practices that have seen their patient. Signup for a test account is free.

Other

A majority of surveyed EHR consultants expects the majority of EHR vendors to involved in merger, acquisition, or closure within five years, most often due to delaying usability problems in favor of meeting MU requirements. Do we blame the fallout on opportunistic vendors taking advantage of a hot market, or the government and MU for managing their development priorities? Probably a bit of both. The study concludes that well-funded smaller vendors serving niche sectors may do better than some larger vendors who have failed to resolve “fundamental flaws caused by being all things to all physicians.”

The National Football League says it’s on track to roll out an iPad-based sideline concussion assessment tool next season. The results will be printed and placed in a paper chart, but eight teams will be piloting a program to send the information directly to the patient’s electronic medical record.  The league’s 2011 collective bargaining agreement called for deploying a full EMR this year that would allow medical records to follow a traded player. Safeguards are being put in place to prevent viewing of the records by competing teams, the league itself, and teams for which the player is trying out but is not yet signed. The NFL signed a 10-year agreement with eClinicalWorks in November 2012 to provide its EMR.

Milwaukee Health Services, a Federally Qualified Health Center,  says Atlanta-based Business Computer Applications is endangering 40,000 people by remotely locking the organization out of its own data servers in a billing dispute. Milwaukee Health Services has done business with BCA for 24 years, but says it paid the vendor $3 million to develop an EMR called Pearl EMR that still doesn’t work and isn’t HIPAA compliant. The hospital moved to GE Centricity, claiming BCA promised to give it a copy of its database, but later reneged. It’s suing under the Computer Fraud and Abuse Act. BCA claims to be the largest minority-owned software company in the world and claims it developed the first EMR in the US outside of the Department of Defense. It still sells Pearl EMR, which is certified by CCHIT as a Complete EHR for ambulatory.

Weird News Andy says if you have to be shot, there’s no better place. A patient is superficially wounded by a bullet shot through the window of her room in Crozer-Chester Medical Center (PA).

WNA says this woman doesn’t have a leg to stand on. A Utah woman who says she has wanted to be disabled since she was four years old seeks a doctor who will cut her perfectly healthy sciatic and femoral nerves to paralyze her legs. She suffers from Body Integrity Disorder, which causes her to believe her legs aren’t her own. The woman has tried to paralyze herself by intentionally causing accidents and now hopes that aggressive skiing might do the trick since she can’t afford to pay a doctor to cripple her.

Sponsor Updates

• Allscripts will offer its ambulatory clients LDM Group’s ScriptGuide patient education solutions.
• Sandlot Solutions offers an August 14 Webinar, “Real-time, Clinical & Claims Data at the Point of Care: Reshaping the Way You Deliver Healthcare.”
• Aprima reports that over 1,000 Allscripts MyWay customers have switched to Aprima PRM since October, when Allscripts announced that it would not provide MU or ICD-10 enhancements to MyWay.
• The TrustHCS Academy graduates its class of coding students.
• Ecfirst validates Imprivata Cortext as HIPAA compliant and will perform ongoing audits.
• GetWellNetwork will add patient-education content from ASCO’s Cancer.net patient Website.
• An API Healthcare-sponsored study finds that hospital and health system executives are prioritizing workforce management-related issues to achieve long term fiscal sustainability.
• A Beacon Partners-CHIME survey of  healthcare CIOs examines Meaningful Use progress and challenges.
• Ingenious Med announces impower Mobile 2.0.
• HealthMEDX forms a physician medical advisory board.
• Carl Fleming, principal advisor with Impact Advisors, discusses the evolution of tablets and how they are helping physicians.
• Wellcentive introduces a Network Maturity Model to evaluate the maturity of healthcare organizations.
• Clinical Architecture is recognized as a 2013 Indiana Company to Watch award.
• Sandlot Solutions Director Rosalind Bell discusses information as healthcare’s ultimate business partner.
• Intellect Resources publishes an infographic depicting the use of social media in healthcare.
• ICSA Labs’ Jack Walsh discusses the vulnerability of Android devices.
• Chicago Crain’s Business profiles Care Team Connect Founder and CEO Ben Albert.
• Ping Identity CEO Andre Durand discusses the setting of reachable goals in a New York Times interview.

EPtalk by Dr. Jayne

ONC releases a new “ONC Certified HIT Certification and Design Mark” along with a nine-page guide on how it is (and is not) to be used. I’d show it to you, but that in itself would be a violation of the terms of use, so you’ll just have to check it out for yourself. I did provide a hint above. I’m less worried about the Pantone graphics people coming after me than a hit squad from ONC.

A reader sent me this slide show from a Medscape physician lifestyle report. I’m sad to see that both my primary and secondary specialties are in the top three for burnout. Check out Slide 8, which lists physicians’ favorite pastimes. Non-medical writing ranks at the bottom, but I’d personally put it at the top. Some weeks it seems like being part of the HIStalk crew is the only thing keeping me sane.

From Checklist Diva: “Re: checklists. I was reading your post about checklists and it warmed my heart. Personally, I love checklists. I write things on my lists just so I can cross them off, items like ‘eat lunch.’” I put a block on my calendar every day not only to remind myself to eat lunch, but also in the hopes that someone will show a little humanity and not schedule a lunch meeting. It works a good part of the time, probably because I put humorous titles on the appointments to make it look like I have important meetings. My admin occasionally gets into the spirit and changes the locations or adds ridiculous attachments that make me laugh. He provides support to several of us and I’m pretty sure I’m his favorite because I have a sense of humor.

Speaking of humor, I might not have much left after next week. It’s our regularly scheduled “All Provider” meeting, which usually turns into a freeform complaint session because the (very young) president of the medical group has a hard time moderating his more senior peers. Some of the physicians get pretty far out of control and the audience gets completely restless with audible sighs, vigorous paper shuffling, slamming chairs around, and the occasional demonstrative hand gesture. For years EHR has been the designated punching bag, but we seem to have been elbowed aside by Accountable Care as the villain of the day. Some meetings though I feel like we should be dressed for roller derby instead of the board room.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 7/18/13

Quality Systems to Nominate New Directors to Board

Quality Systems, Inc. parent company of NextGen, has announced that it will add three new directors to its board to avoid a proxy fight initiated by activist investor Clifton Group. The deal will send Clifton Group nominees James C. Malone, Peter M. Neupert, and Morris Panner to the board. In exchange, the Clifton Group will withdraw both its call for the current board to be replaced as well as its series of bylaw proposals that would have been up for vote at the next shareholder meeting on August 15.

EHR Industry Insiders Predict the Demise of Hundreds of Competitors in Black Book Replacement Market Survey

An EHR replacement trends report predicts a 50 percent reduction in the crowded field of EHR vendors by 2017 or the implementation Meaningful Use Stage 3. The study polled 880 EHR consultants, analysts, managers, and support team members on the state of affairs in what it calls the "Year of the Great EHR Switch."

Sen. Hatch calls for pausing meaningful use program

In a finance oversight meeting with Farzad Mostashari, MD, Senator Orrin Hatch proposed a pause to the Meaningful Use program to evaluate whether the program may have "set the bar too low." He says the program should be judged not by how much incentive money has been spent, but on demonstrable improvements in patient care.

PeaceHealth making cuts to close $130 million budget gap

Vancouver, WA-based PeaceHealth is targeting $130 million in spending cuts to account for reduced reimbursement rates and a planned $350 million EHR implementation that will take place across its health system over the next few years. Cost-saving strategies will include voluntary furloughs, early retirement, reduced travel, leaving vacant positions unfilled, and consolidating the number of contractors.