News 8/23/13

Top News

Steve Malik, the Cary, NC entrepreneur who sold his Medfusion patient portal startup to Intuit in 2010 for $91 million, acknowledges that he has bought the business back from Intuit, which had announced its intention to divest Intuit Health Group to focus on its core tax and financial software business. Intuit wrote down $46 million earlier this year when partner Allscripts decided to look elsewhere for a portal solution. Revenue was down to $16 million in 2013. Malik says he looked at healthcare IT startups before realizing that his former company held the highest potential. Malik, the sole owner of the company, says he hasn’t decided whether he will revive the Medfusion name (my vote and expectation would be yes even thought the name isn’t descriptive.)

Reader Comments

From Boy Wonder: “Cerner and Epic. Are you aware of any health systems that have switched or are in the process of switching from Cerner to Epic? Just wondering.” I was thinking that Aurora had done so. I assume the specific interest would be those that switched voluntarily rather than being forced by acquisition. Readers?

From Vendor Venting: “Re: McKesson Horizon. As a customer, we have noticed that support and services have steadily declined since the ‘Better Health 2020’ announcement in December 2012. The average tenure of support employees supporting us has dropped severely with resignations. We have to run a gauntlet of triage and bottom-tier support before most of our issues are escalated to a rare senior resource. They are exerting pressure for us to migrate to Paragon while failing in their commitment to support us on Horizon. In the BH 2020 announcement, we were assured that there would continue to be a commitment to Horizon customers, but the executives who made those commitments have moved on. Actions speak louder than words and customers have been left to deal with the fallout.” Unverified. I would be interested in speaking to a customer that has moved from Horizon to Paragon since those mentioned by the company seem to be happy.

From CDiff: “Re: ICD-10 codes for High Life in the ER. Wondering if Weird News Andy has reported the need for five ICD-10 codes for beer?” A Johns Hopkins Hospital study of the one-third of ED visits that are alcohol-related finds that the beer brands most often involved are those most appropriately consumed from a paper bag koozie rather than a tulip glass: Budweiser, Steel Reserve, Colt 45, Bud Ice, and Bud Light. They’re planning to extend the study to see if it’s just a Bal’more thing.

From Pacific Girl: “Re: CIO Unplugged 8/12/13. Mr. HIStalk, that is by far the most moving post I’ve read from your site, and it couldn’t have come at a better time. Thank you, thank you, thank you.” I think people sometimes underestimate how hard it must be for Ed Marx to write soul-baring articles like “Falling from Grace” and post them publicly for his peers with his name on them, opening himself up to criticism from folks who enjoy the benefit of anonymity. Ed doesn’t seem to mind as long as he makes them think.

From Boston Beans: “Re: John Halamka. Why do people feel the need to run him down? He’s doing his job at BIDMC or they wouldn’t keep him.” Long-time readers may recall that I was unflaggingly cynical about him years ago given his ubiquity, but that changed when I met people who know him and then met him myself (as me, not Mr. H) He’s the real deal and I detected no self-serving agenda at all. He won’t take money for doing work external to BIDMC because he considers his time paid for by them, he is patient in explaining what he knows when I’m sure I wouldn’t be, and I think he really cares about patients more than anything else. I interviewed him in 2010 and was impressed at his lack of pretension or ego. I may or may not agree with every IT decision he’s made and he’s got some biases unique to Harvard and Boston, but he’s a good guy. Folks who say he isn’t usually haven’t actually met him. If you’re looking for egotistical douchebag CIOs or executives, you have many more deserving choices.

HIStalk Announcements and Requests

Some HIStalk Practice highlights from the last week include: MGMA urges HHS to not penalize physicians who have met Stage 1 MU requirements but may miss the Stage 2 deadline. The Air Force’s 62nd Air Division highlights its use of RelayHealth’s secure messaging platform. An AHRQ report concludes that the use of HIT in ambulatory care settings has a positive impact on care delivery and provider satisfaction. Physicians can expect an average salary increase of 2.4 percent in 2014. Thanks for reading.

Inga needed a new laptop and asked me if this one from Office Depot was OK (Toshiba Satellite C55-A5286). I was shocked that an Intel-powered 8GB memory Windows 8 laptop with a memory card reader, USB 3.0, a decent screen, and a DVD drive could be bought for $380 after rebate, to the point that I joined Inga in buying one and so did our newest HIStalk colleague. I’m extremely happy with it after doing the usual setup tasks: opening Internet Explorer long enough to download Firefox and Chrome, de-installing all of the bloatware that the manufacturer gets paid to include, and installing a utility that bypasses the new (and confusing) Metro interface in favor of the old Win 7 start menu.

Listening: the entire catalog of Portland-based indie band The Thermals. Also, new Superchunk.

Ed has updated his CIO Unplugged “Falling from Grace” post with a response to the comments left by readers.

Acquisitions, Funding, Business, and Stock

Bottomline Technologies reports Q4 earnings: revenue up 5.86 percent, adjusted EPS $0.32 vs. $0.26, beating analyst estimates of $0.29.

Nuance adopts a poison pill defense, hoping to prevent investor Carl Icahn from taking control of the company and selling it off in pieces.

Orange Health acquires the software assets of ExtendMD, which offers patient-physician communications technology.

Connecticut Innovations, which provides funding for Connecticut technology startups, extends a $200,000 follow-on funding commitment to tablet computer sterilizer manufacturer ReadyDock.

Sales

The Lott AQ Group, a healthcare IT quality assurance and consulting firm, will use VitalWare’s VitalSigns auditing and financial risk assessment tool for ICD-10 testing.

People

Jim Jirjis, MD (Vanderbilt University Medical Center ) is named chief health information officer for HCA.

St. John’s Riverside Hospital (NY) appoints Daniel Morreale (Kingsbrook Health System) VP/CIO.

Denis Connaghan (etrials) joins clinical trials network provider Clinverse as CEO.

The San Francisco Department of Public Health names Bill Kim (Dignity Health) to the newly created position of CIO.

Announcements and Implementations

EHNAC releases updated and final 2013 criteria for the electronic exchange of clinical data.

The Southeast Michigan Beacon Community names Quest Diagnostics its first provider of diagnostic information services for its HIE, BeaconLink2Health.

Allscripts names healthfinch the grand prize winner of its Open Apps Challenge for its automated prescription renewal request app. We interviewed healthfinch CEO and Co-Founder Jonathan Baran on HIStalk Connect last year.

AirStrip and Vivify Health will develop a remote care platform for the AT&T mHealth Platform.

Innovation and Research

Robert Wood Johnson Foundation offers $100,000 in prizes for entrants who combine healthcare with public health data to improve community health.

Other

The CVS drugstore chain notifies 36 prescribers that it will no longer fill their controlled substances prescriptions after an analysis of its million-prescriber database indicates a high likelihood of improper prescribing.

In England, the final tab for the failed NPfIT project is tallied at nearly $16 billion, having delivered an estimated $4 billion in benefits.

Meditech announced to employees this week that it has acquired a six-story, 108,500-square-foot office building from Adobe Systems in Waltham, MA on Route 128. The company will fully occupy the 400-seat, three-year-old LEED Certified Platinum building when existing tenant leases expire in late 2015.

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Peer60, which offers customer intelligence tools, has put together a pretty funny downloadable e-book called “Executives Are Idiots,” which pokes fun at getting executive feedback.

A major national health system work group studying copy-and-paste issues in EMRs recommends monitoring the practice within existing documentation audits, according to an internal PowerPoint presentation forwarded by a reader.

Dubai Health Authority orders 3,000 Android tablets, vowing to provide one for every patient bed toward its plan to use “the latest IT technology to enhance customer service experience.” The hospitals will roll out their EMR in the next 2-3 years.

UMass Memorial Medical Center (MA) pays $66,000 to settle fraud charges in which it was accused by a whistleblower of intentionally mailing bills to a homeless shelter so it could then bill the state for the unpaid amounts.

Weird News Andy says of the story headlined German Doctors Remove Tumours From Liver Using an iPad that he would have used a scalpel instead since it’s sharper.

WNA also likes this story, which he titles “Herniating Money.” A man is told by a hospital that his hernia surgery will cost $20,000 upfront with his insurance company covering the rest. Instead, he heads over to another hospital and has the surgery done the next day for a total price of $3,000 without using his insurance at all. The surgeon who penned the article concludes, “It was clear to both of us that the only way to make health care more affordable is to diminish the role of third-party payers. Let consumers and providers interact through market forces to drive down prices and drive up quality, like we do when we buy groceries, clothing, cars, computers, etc. Drop the focus on prepaid health plans and return to the days of real health insurance—that covers major, unforeseen events, leaving the everyday expenses to the consumer—just like auto and homeowners’ insurance.”

In England, a patient dies after employees omit the an apostrophe in her last name while looking up her electronic records, causing them to miss her history of depression. She was discharged and killed herself with a sleeping pill overdose shortly after.

Sponsor Updates

• Sunquest held its annual Executive Summit last week in Scottsdale, AZ at the beginning of its SUG annual user group conference.
• Emdat releases a video highlighting the advantages of using its medical documentation system within an EHR.
• LG Electronics will integrate Imprivata’s OneSign authentication solution into its V-Series zero client systems.
• Zirmed partners with Catch Data Systems to provide GE Centricity customers integration with ZirMed’s RCM, clinical communications, and analytics solutions.
• The Washington State Hospital Association endorses Besler’s Transfer DRG and IME revenue recovery services.
• Vitera Healthcare Solutions announces details of its VIBE 2013 user conference, to be held September 10-13 in Orlando.
• Forbes features Xerox in an article about 3-D printing in healthcare.
• Two KishHealth System hospitals advance their EHR initiatives with the implementation of Access’s e-form on demand solution.
• Care Team Connect hosts an October 8 Webinar highlighting the implications of Medicaid expansion on care management.
• Greenway Medical adds Krames Staywell’s Integrated Patient Education solution to its online Marketplace as a certified API.
• T-System CMIO Robert Hitchcock, MD discusses an all-in enterprise model for data needs.
• Sunrise Women’s Medical Group (CA) shares how its use of ADP AdvancedMD PM/EHR improved workflow and coding and billing.
• Cornerstone Advisors is named to Inc. 500’s 2103 Fastest Growing Companies in America. Also on the list is Intellect Resources.
• Direct Recruiters made the Inc. 5000 list announced this week.

EPtalk by Dr. Jayne

I’ve heard a lot of complaining recently about the Medicare Physician Compare website. The AMA and other physician advocacy organizations have complained about the redesigned site and its errors, which include problems identifying physician location, hospital affiliations, board certification, and other practice information. I searched for myself and even broadened the criteria to a 100-mile radius around my hospital but still can’t get myself to display, so yes, I would agree it’s inaccurate.

I seem to be running into more and more physicians who are integrating scribes into their practices. Some cite EHR as the reason, feeling like it has turned them into data entry clerks. Others see the scribe as a key partner in team care, freeing up the physician to perform cognitive work rather than data gathering and results tracking. I found this nice document from the American Academy of Family Physicians that outlines the potential duties of a scribe (which they expand on using the concept of a clinical assistant) during a routine office visit.

Having implemented EHR with several hundred physicians, I know the importance of helping physicians realize that the support staff is a great asset in prepping both the chart and the patient for the office visit. The document points out the staff role in collecting any recent lab/diagnostic test results and updating preventive care information before the physician ever sees the patient. Whether you use scribes or not, seeing patients in the age of Accountable Care, Pay for Performance, and Meaningful Use definitely takes a village.

AAFP also offers its Family Practice Management Toolbox, which was one of my favorite sites when I was in traditional primary care. Check out their section on practice improvement tools for some interesting practice assessment and improvement worksheets.

The American College of Emergency Physicians will be hosting its annual Scientific Assembly this October in Seattle. I had hoped to attend, but I have an unavoidable conflict that week. I don’t see a huge number of ED physicians in the informatics realm, but I am interested in what products ED docs think are hot and which are not. Ever thought of seeking fame and fortune as a roving reporter? If you’re a HIStalk reader and planning to attend, I’d love to hear from you.

Speaking of the emergency department, quite a few of you reached out to offer your condolences after I wrote about the closing of the quick care unit at one of the facilities where I was seeing patients. I’m happy to report that another facility has offered me a part-time position, although I’m not sure how much inspiration it will provide for writing since its physicians document on paper. Going electronic isn’t an impossible dream, however, as our paper system is provided by HIStalk sponsor T-System. I was happy to see the smoking doc logo on their website.

My email inbox is always deluged with invitations to various webinars, symposia, and conference calls. Some are from vendors and others are from professional organizations, but nearly all suffer from lack of lead time. Some arrive less than two days before the event being promoted. Word to the wise, marketing people — if you’re really trying to reach CMIOs or other C-levels, you should allow at least two weeks notice. Happily Mr. H advertises our HIStalk webinars well in advance – I’ll be listening in on the ICD-10 webinar on September 12. Hope to see you there!

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 8/22/13

Allscripts Announces Winners of the Open App Challenge

Allscripts announces the launch of the Allscripts App Store along with the winners of its Open App Challenge during Wednesday’s kickoff of the 2013 Allscripts Client Experience. The contest challenged developers to create a revolutionary app that integrates with the Allscripts EHR. The winning app is healthfinch Refillwizard, which automates prescription renewal requests.

The Highway to Better Healthcare is Open: Missouri Health Connection Rolls-Out Statewide Health Information Network

Missouri launches its statewide health information exchange network, providing services to more than 7,000 physicians, 62 hospitals, and 350 clinics. Missouri contracted with InterSystems in July 2012 to design and deploy the network.

Emergency Clearance: Public Information Collection Requirements Submitted to the Office of Management and Budget

A Federal Register post by CMS calls for an emergency review of its recently proposed rule that would require breach reporting for health information exchanges to be capped at a one-hour limit between the time an HIE breach is discovered and the time it is reported, stating that the proposed rule is essential to public security and failing to approve it quickly would likely result in public harm.

Readers Write: Fund Healthcare Modernization and Innovation – Retire Legacy Applications

Fund Healthcare Modernization and Innovation – Retire Legacy Applications
By Julie Lockner

The American Recovery and Reinvestment Act of 2009 (ARRA) provided the healthcare industry incentives for the adoption and modernization of point-of-care computing solutions including electronic medical and health records (EMRs/EHRs). Now that these funds have been allocated and invested in new information systems, hospital and patient care provider CFOs are checking in on the return on those investments. Many are coming up short.

These mega EMR/EHR applications are taking longer than planned to implement leaving a number of legacy applications running in parallel. In addition to hardware and software maintenance costs for both environments, costly resources with skills to maintain aging technology platforms drain IT budgets – funds needed to support new systems.

This challenge is not unique to the healthcare industry. A recent survey [1] of companies with over 50 IT staff shows that on average, 70 percent of the IT budget is spent on existing systems. If half of the applications are redundant, this represents a major opportunity for cost savings or reinvestment.

Why are so many legacy systems still running? An industry research report [2] indicates the #1 reason is that users still want to access data. As creatures of habit, many hospital staff continue to use familiar systems to look up patient information and records out of convenience. Unfortunately, this comes at a cost.

Another reason is because entire legacy data sets are not always migrated to new systems. Data with assigned records retention schedules require collaboration between stakeholders and compliance teams. Without a programmatic approach, application retirement projects can be significantly hampered.

Many providers have overcome these hurdles and successfully implemented an application retirement strategy while migrating to a new system saving millions.

For example, the nation’s largest children’s hospital expects to save $1.8 million annually from retiring legacy applications. Their IT modernization program replaced applications running on aging platforms such as HP Turbo Image, SQL Server, Oracle, and MUMPS with an EPIC implementation. Patient clinical data needed to be retained for compliance reasons, so they deployed an application retirement strategy that allowed them to keep that data and eliminate dependencies on legacy systems and applications. Hospital staff was given online, convenient access to data in a secure archive and compliance teams could track retention.

Key to success, they claim, includes a platform with the following capabilities:

• Archive support for a variety of data types, systems and platforms
• Automated validation to confirm data had been completely and correctly archived
• Ability to assign retention policies during or after the archive process
• Automate data purge workflow when retention periods expires with legal hold support
• Mask sensitive data in case a clinical trial is reopened

[1] NCC survey companies with over 50 IT staff

[2] Enterprise Strategy Group Research Report, Application Retirement Trends, October, 2011

Julie Lockner is vice president of product marketing for Informatica.

Readers Write: Good Product Design is Preventive Medicine for your Software

Good Product Design is Preventive Medicine for your Software
By Ryan Secan, MD, MPH

As a practicing hospitalist physician, I see many patients with untreatable or difficult-to-treat disease that could have been prevented with care before their illness took root. From the lifelong smoker with emphysema who might have quit smoking to the patient with end-stage colon cancer who should have had a screening colonoscopy, dealing with the issue before it started would have potentially prevented their problem.

As a practicing informaticist, I also see parallels between the preventive situations described above and common issues that I’ve faced in healthcare IT. When it comes to healthcare IT, it seems that like patients, too many companies are ignoring preventive care for their product.

As an employed physician, I have limited to no choice regarding what software I use for clinical care. Even as an informaticist, I have inherited my share of decisions regarding software that took place before I had a chance to offer input. Often these software choices that my colleagues and I are forced to use appear to be designed without ever considering the workflows of the clinicians who would use them. It just doesn’t seem possible that any physician involved in product development would allow something this difficult for a clinician to use to be rolled out.

One simple example involves ordering medications in an unnamed product. After typing in a medication name, clicking on it to select it, clicking on a prepopulated order string, and clicking OK (already too many clicks), the pop-up window cycle starts. A click to confirm that I understand that the medication requires dosing based on kidney function, a click to confirm that I know that the kidney function is X (or unable to be calculated), and another click to confirm that the appropriate dose for this level of kidney function is Y (it remains unclear why all of these notations couldn’t be in one window).

Worst of all, if the correct dose is different from what I’ve ordered, it doesn’t offer to change the order or allow me to cancel my already entered order. I need to cancel the old order and order the medication again, remembering the correct dose, and once again going through the multiple windows telling me that the medication must be dosed for kidney function, etc. This is a completely absurd process and a missed opportunity.

Instead of having unhappy customers and trying to repair the damage after the fact, HIT companies need to invest the time and effort in product design. Seek advice from experts (you know, the people who will be using your product) and make sure your product fits into your clients’ workflow. Build customization into your product so it can be adapted to the particular workflows of your individual clients, and make the customization more than just cosmetic. When you get feedback from one client regarding problems, make changes for all of your clients so your entire user base can benefit from each other’s experience.

This preventive medicine will prevent difficult (or impossible) to fix problems down the road.

Ryan Secan, MD, MPH is chief medical officer of MedAptus.

CIO Unplugged 8/21/13

Falling from Grace

If you read Unplugged, you know I practice transparency, perhaps to a fault. This post is the deepest view into my soul yet. I believe intense introspection is the way to exponential growth. Yet as I write, my conscience fears what it will discover. The truth will come out.

I recently received an endearing card from my godson that sparked my self-examination. I’ll share excerpts first, and then I will answer him publicly because I believe it matters.

“Uncle Ed. Thank you for being such great, if not the best examples of a Christian . . . of a marriage . . . of a man . . . you motivate me and my brothers to be the best we can in athletics, faith and relationships . . .”

Dear Josh,

I received your thank you card yesterday. As your Godfather, I am proud of you. First and foremost, you are a man of great character. You love God. You are accomplished. In high school, you worked diligently to attain Eagle Scout while earning the standing of class valedictorian. Your recent election as student body President pro Tempore at the University of Denver did not surprise me. All of this made the admonitions you wrote about me so special, and they truly made my year! However, your extravagant praise and your interpretation of my external “face” have pushed me to reexamine my life from the inside. As a husband, father, executive, and (former) army officer, there are covenants and codes of conduct I have to put into practice. Combined, these rules and responsibilities have weighed heavily upon me.

…to be continued.

Each week, the headlines highlight how so-and-so leader has fallen from grace. I am scared to be next. No leaders start out purposing to do something that will land them in trouble. The politician never thought he would be sexting. The pastor did not go through seminary aspiring to have an adulterous affair. What executive ever dreamed of climbing the corporate ladder and becoming an alcoholic? The clinician didn’t expect to take meds to quiet his own pain. No accountant ever thought to embezzle through slight of numbers nor did the businessperson ever think she would entertain a bribe in exchange for wealth.

What is the trigger that leads a leader down this path? I suspect it’s a gradual slide, and if unchecked, this slide will get too steep to catch ourselves.

As our careers grow, natural barriers of protection fall away. An increase in disposable income opens the door to accessibility on the path. We come to expect perks. Rules no longer apply to us. Success can become a drug, and we begin to think, “I am invincible!” We take advantage of options that allow us to elude accountability.

Success can become a vice in itself that creates an unquenchable thirst for more. We lose touch with reality in a gradual process that goes undetected. Before long, we’re overconfident and no longer count the costs of our indiscretion. We take our base for granted, assuming they will catch us when we fall.

Continued . . .

So Josh, my blessed Godson, thanks for the reminder of why I need to live a life beyond reproach. To you and your brothers, I offer the following wisdom:

Shore up home base. Ensure your home life is solid; build a foundation strong enough to withstand the storms and temptations.

Engage a counselor. Asking for help is a sign of strength, not weakness. The best ball players all have coaches.

Aggressively secure an accountability partner. Find someone who will speak truth to you and not let you get away with crap. Someone willing to put their friendship on the line if needed to keep you living right.

Live humbly. Pride comes before a fall.

Spiritual. Let your faith be your source of strength, comfort, and significance. Seek purity of mind, body, and soul.

Embrace fear. Healthy fear initiates boundaries. It’s a great motivator. (I recently listened to Magic Johnson recount the story of confessing to his pregnant wife that he had AIDS. Heart-wrenching. Don’t do things you’ll later regret.)

Live transparently. No secret email addresses, phone numbers, or bank accounts.

Set boundaries. Don’t mentor the opposite sex. Sounds draconian, but it protects both sides. Where appropriate, meet in public places or invite others to join you. Don’t go to bars if you are prone to drink too much.

Reality rocks. Ground yourself in reality. Shake yourself out of the fantasy by mentally carrying out your actions to their logical conclusion. (You will eventually get caught).

Resistance. Some will find this advice offensive and poke fun. That is OK. I have watched lives get ruined and I’ve cried with those who’ve fallen. Do whatever it takes to protect yourself.

To my leader friends. Are you climbing the slippery slope? I am.

Step off. Tell someone. Get help. Cut the ties that are pulling you down.

Don’t be next.

Update 8/22/13

Someone asked for the definition of the slippery slope. The slippery slope: a leader’s circumstances and (usually) stature helps define their slope. No accountability = slope. Rocky home base = slope. Pride = slope. Secret b-accounts/addresses (etc.) = slope. Ignoring need for intervention = slope.

Put these all together and you’re probably already sliding. Ask someone you trust how you’re doing.

I stand by my personal conviction on mentoring. If you have read my posts on mentoring, you know this is a very formal (contractual) relationship outside of the typical office environment.  I am not talking about a leader’s responsibility to develop leaders of all kinds. I am talking about an intimate and transparent relationship, often with individuals outside of your workplace.

I won’t go there with everyone. That is my choice. There are plenty of wonderful mentors out there for everyone, yet less than 5 percent of people have one. Those who know me understand that my primary focus as a leader has always been to develop others. If you read my posts, this is self-evident.

I am proud of all the different people I have had the honor to serve with and see grow. I don’t care about gender, orientation, religion, or whatever. I invest equally in the workplace. 

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 8/21/13

First Databank Acquires Design Clinicals

First Databank announces the acquisition of Seattle-based Design Clinicals, the developers of a clinician-friendly medication reconciliation software.

Intuit sells Intuit Health Group back to Raleigh entrepreneur Steve Malik

Intuit Health Group, which went by Medfusion before being acquired by Intuit in 2011, has been sold back to its original founder Steve Malik for an undisclosed sum.

Say Hi To Oscar: The New Kid That May Change Health Insurance

New York City-based health insurance startup Oscar is trying to re-engineer the relationship between insurance companies and patients. Oscar’s goal is to leverage technology, like telehealth visits, patient portals, and mobile wellness apps, to be such a value adding insurance company that patients chose them before they chose a doctor. Oscar will formally launch when New York’s health insurance exchange launches on October 1st.

Allscripts Introduces Population Health Analytics

Allscripts launches its new population health management solution which provides point of care interventions to reduce readmission rates and help control costs associated with chronic disease management.

News 8/21/13

Top News

From Left Tackle: “Re: Intuit Health Group. Was bought back Monday by Stephen Malik, who founded Medfusion and sold it to Intuit in the first place.” Verified. He was saying just a few weeks ago that he had no interest in buying back the Cary, NC-based company he sold to Intuit for $91 million in 2010. That probably means the asking price and/or the number of interested suitors dropped since then.

Reader Comments

From MoJo: “Re: Allscripts reorg. Allscripts made an internal announcement of (yet another) reorganize to ‘further improve accountability, performance.’” Some of the changes noted in a company memo: the addition of new business units (international, Sunrise, and enterprise); the hiring of Greg White (Cerner) and Ricker Berner (Caradigm) to head the enterprise and international segments, respectively; the addition of new client sales regions and changes to leadership; and the realignment of the client advocate and solutions management teams.

From Partner: “ACE. Dozens of companies are spending big marketing dollars to exhibit at ACE.” The Allscripts annual conference kicked off Tuesday in Chicago. Attendance hasn’t been announced, but the exhibitor directory includes at least 50 vendors.

From Broadway Joe: “Re: North Shore LIJ. Buying a stake in Allscripts.” Unverified.

From Turk: “Re: Rose Harr. Interesting news about the CEO of BlueWare, a small imaging system that claims to be an EHR.” The former Brevard County, Florida Clerk of Court is arrested on a variety of corruption charges that include approving $8.52 million in county scanning contracts with BlueWare for personal financial gain. State law enforcement agents say that BlueWare didn’t own any scanning equipment at the time and 75 percent of the records they were paid to scan could have been discarded without scanning. BlueWare CEO Harr turned herself in was arrested for bribery and bid tampering, but is out on bond. She has an interesting LinkedIn profile that includes running companies that are flipping properties, making a cartoon about Boston Terriers, and selling big imaging deals to NHS hospitals in England.

From I’m Not Creative: “Re: Siemens Soarian customers. Only getting six weeks to upgrade from version 3.3 to 3.4 due to the number of clients who need to get upgraded to meet MU2 requirements. Talk about feeling the burn.” Unverified.

From TexasHeart: “Re: ONC Blue Button announcements. Is this smoke and mirrors because state HIEs are failing and most docs, include a fourth of them in Epic, don’t want to trade? Why would people use Blue Button as a portal? Will docs even accept records sent by a patient?”

From Escapade: “Re: CIOs. You should do some CIO interviews and leave them anonymous so they can be brutally honest and vent. “ That’s a brilliant idea. I would happily do that, as well as running anonymous blog posts (either one-time or ongoing) by CIOs who want provide uncensored opinion without fear of reprisal.  Contact me if you’re a CIO who likes the idea as much as I do.  The anonymous interview would be a super easy and great fun.

HIStalk Webinars

 

Beacon Partners will present “The Transition to ICD-10: Building the Bridge as You Walk on It” on Thursday, September 12 at 2:00 Eastern. With the transition to ICD-10 only 15 months away, healthcare organizations will have to find inventive ways to create their roadmap and execute on their plans. Rather than taking valuable time to complete a gap analysis and then create the plan, leaders and project managers should consider how to do these tasks concurrently. Examples from healthcare organizations will provide ideas for choosing the right partners, defining program strategies, and incorporating ICD-10 work into already existing teams. Even if you assemble the plane as you fly it – or build the bridge as you walk on it – it’s time to move forward and make the ICD-10 transition a reality. The target audience for this presentation is mid-senior level financial, clinical and IT, CFO, COO, CIO, ICD-10 program manager, and ICD-10 team leads. The speaker will be Chris Kalish, national practice director in the Strategic Advisory Group. One of my reviewers summarized, “With approximately only one year to go and a lot of work still to be done, this Webinar provides hospitals with strategies to prepare for ICD-10 if the hospitals are late starters.”

Speaking of Webinars, there’s a list of those upcoming in the column to your right. Clicking on one brings up the full calendar.

Acquisitions, Funding, Business, and Stock

Summit Partners invests $14 million in specialty EMR provider Modernizing Medicine.

Champion Medical Technologies, which sells tracking software for implanted medical devices, receives an unspecified investment from Jump Capital.

The SSI Group acquires Medtelligence, dba Medibis, a provider of analytic, dashboard, and mobile applications.

Greenway reports Q4 earnings: revenue down 2.34 percent, adjusted EPS -$0.08 vs. $0.10, missing analysts’ estimates of -$0.02. Shares rose 3 percent Tuesday after Monday’s announcement. CEO Tee Green notes that the results reflect the company’s continued transition from a one-time system sales and training model to a recurring revenue model. From the earnings call:

• Greenway is live with CCD exchange at Epic and Cerner sites
• Up to 80 percent of new customers are choosing cloud solutions paid for via the subscription model, which is driving training revenue down
• Only 10 percent of users are using the company’s mobile EHR access app
• The company’s growth is expected to be driven by EDI and services
• Greenway says it expects to lose $5-6 million in FY14, with system sales down 50-60 percent

Above is the one-year GWAY stock chart, with Greenway in blue, Allscripts in red, athenahealth in green, and the Nasdaq composite index in brown.

Teleheath software provider SnapMD raises $600,000 in a seed round led by Shea Venture and Whittier Trust.

First Databank acquires medication reconciliation software vendor Design Clinicals. More information and thoughts from Design Clinicals CEO Dewey Howell, MD, PhD are available in the Tuesday morning announcement on HIStalk.

Sales

Wahiawa General Hospital (HI) will implement MEDHOST’s EDIS.

The Healthcare Access San Antonio HIE will offer consumers access to a portal developed by Intellica Corp.

The Defense Logistics Agency awards McKesson a $29.9 million medical imaging technology contract.

Community Health Information Collaborative (MN) selects Orion Health to power its statewide HIE.

Arcadia Solutions selects the Compuware Application Performance Management platform for EHR infrastructure performance optimization.

People

AHRQ names Richard Kronick (HHS) director, replacing the retiring Carolyn Clancy, MD.

Lisa Stump is promoted to VP/associate CIO of Yale-New Haven Health System.

EBSCO Information Services hires Elizabeth Jones (American Medical News) as VP of medical product management and chief content officer.

Announcements and Implementations

UnitedHealthcare adds online electronic bill payment services to its plan participant portal via the InstaMed payment network.

The Liverpool Heart and Chest Hospital (UK) and Robinson Memorial Hospital (OH) go live with integrated OnBase ECM and Allscripts EMR solutions.

Qstream announces new clients for its mobile healthcare education platform that include Boston Children’s Hospital, Partners HealthCare, Mayo Clinic, and Baylor College of Medicine.

Vivature EHR chooses Liaison Healthcare for connecting its Oracle-based EHR to more than 120 labs and imaging departments via Liaison’s EMR-Link hub.

HCA says in an entrepreneur workshop that it likes doing business with Boston-area companies that have an MIT or other academic connection, including Meditech, PatientKeeper, eClinicalWorks, and EMC.

Government and Politics

Florida Senator Arthenia Joyner introduces a bill that would force insurers to pay for telehealth visits. Critics say the bill is flawed because the state’s Board of Medicine allows telemedicine consultations only when a patient relationship has already been established and it also would require insurers to pay the same amount for a telemedicine visit as an in-office visit. Similar bills have failed previously.

Innovation and Research

Via @cascadia:  Intermountain Healthcare looks at the “Personalized Patient Room,” including an in-room camera; a server to support teleconsultations by pharmacists and interpreters; and video chat for bringing in remote family members to participate in the patient’s care. They’re also considering using touchscreens instead of pillow speakers for pushing educational content, entertainment, and information in languages other than English.

Three entrepreneurs form Oscar, a technology-powered insurance company that hopes to reform healthcare via the PPACA-mandated health insurance exchanges. Users of its application can enter their symptoms and click a button that will let them find nearby providers or speak live to a doctor through a partnership with TeleDoc. Patients can request prescription refills through a Twitter-like timeline. The company is analyzing large data sets to guide patients through rational medical decisions. They’ve raised $40 million in funding and will launch in 2014.

Technology

Greenway Medical launches PrimePATIENT, a patient portal integrated with PrimeSUITE.

Allscripts introduces Population Health Analytics, a real-time chronic disease management solution that provides comparative analytics at the point of care. Allscripts also announces the GA of its native iPad app Wand 2.0 for Enterprise EHR.

Other

Virtual Radiologic and its NightHawk Radiology subsidiary file a lawsuit claiming patent infringement by Tandem Radiology related to its teleradiology and order creation technologies.

Mayo Clinic’s Center for Innovation offers $89 Web stream access to its Rochester, MN-based Transform 2013 conference September 8-10.

An Oracle survey finds that 84 percent of CFOs are working more closely with their CIO peers as technology becomes their second-highest focus area, placing behind only industry knowledge.

A Nebraska woman lands in the ER after a post-baby shower brawl in which another woman stabs her in the face with her own six-inch stiletto heel. Police said the altercation resulted from the stabber’s “relationship with the father of the victim’s child.” Once again I am reminded how mundane my life is.

Weird News Andy urges, “EMT, heal thyself.” A Detroit EMT performing in-transit CPR on a patient has a heart attack himself, ending up recovering three hospital beds over from his patient after both receive identical stents.

Sponsor Updates

• iHT2 releases details of its August 21-22 Health IT Summit in Seattle.
• A Triple Tree report, ACOs: The Accountable Care Opportunity, says the organization was impressed by population management and clinical analytics solutions from Forward Health Group.
• Jennifer Dennard of Billian is appointed to the board of the Technology Association of Georgia.
• The Massachusetts eHealth Institute awards eClinicalWorks a $150,000 grant to advance the use of EHRs with the state’s HIE.
• Helix Health Solutions will distribute Wolters Kluwer Health’s Provation Medical software to healthcare organizations outside of North America.
• Greenway Medical adds Seamless Medical Systems to its online Marketplace as a value-added partner.
• The Truven Health Advantage Suite healthcare data and analytics platform version 5 achieves Oracle Exadata Ready status through Oracle PartnerNetwork.
• Laura Kreofsky, principal advisor with Impact Advisors, discusses Stage 2 MU challenges.
• HIStalk sponsors named to the 2013 Inc. 5000 list of fastest growing companies in America include Beacon Partners, Clinovations, Cornerstone Advisors, CoverMyMeds, CSI, Culbert Healthcare Solutions, Cumberland Consulting Group, DIVURGENT, eClinicalWorks, Enovate, ESD, eTransmedia Technology, Forward Health, Iatric Systems, Impact Advisors, iSirona, Intellect Resources, Kareo, Kony, Santa Rosa Consulting, SRSsoft, Strata Decision Technology, and Virtelligence.
• Clinical Architecture introduces Symedical Content Portal, which acquires and maintains clinical and administrative vocabulary files.
• PatientKeeper hosts a September 24 webinar explaining how to make the ICD-10 transition a non-event for physicians. (sent to us)
• T-System CMO Tom Ward, MD discusses ICD-10 compliance in the ED.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

First Databank Acquires Design Clinicals

First Databank announced this morning that it has acquired Seattle-based Design Clinicals, which offers the MedsTracker clinician-friendly hospital medication reconciliation solution. FDB says the acquisition will support its ability to help hospitals meet the medication reconciliation requirements of Meaningful Use Stages 1 and 2. Terms of the acquisition were not disclosed.

According to Chuck Tuchinda, MD, MBA, executive vice president of FDB, “I am very impressed with the success that Dewey Howell has been able to achieve so quickly with Design Clinicals and MedsTracker. He has helped solve a vexing industry problem. We will now work together to develop an embedded solution so that our health information system partners can more easily integrate this medication reconciliation functionality within their systems.”

Seattle-based Design Clinicals has 40 hospital customers. The company was started by Dewey Howell, MD, PhD in 2005.

FDB will offer MedsTracker beginning immediately.

We spoke with Dewey Howell ahead of the announcement, who says the companies share a vision of reducing medication errors and improving patient safety. Design Clinicals built its modern Web app around FDB’s data capabilities. “The problem with med rec is that it involves nurses, pharmacists, and physicians,” Howell says. “All have important but distinct roles, and if any player doesn’t do their job, it all falls apart. We took three complex workflows and merged them into one so that each person has their role.”

“When medication reconciliation first came out, it was all about documenting lists and looking for drug duplicates and interactions,” Howell told us. “With Meaningful Use Stage 2 and beyond, a hospital might get feeds from an HIE or outpatient EMR and will have to decide what to do with these disparate sources of medication data. How will the meds get reconciled? It will be a much bigger problem a couple of years from now.”

FDB is transforming itself as more than just a data supplier. The company has developed Web services, widgets, and end user applications, with the customizable alerts tool AlertSpace being its first product. I interviewed Gregory Dorn, MD, MPH — now EVP and deputy group head of Hearst Business Media and president of First Databank — in September 2012, who described his vision for FDB and its new focus on raising the company’s visibility with end users.

The five-employee Design Clinicals team will stay on with FDB, with Howell taking a San Francisco-based role as VP of clinical applications. FDB will use the team’s knowledge to develop new tools for medication reconciliation at the point of care.

Morning Headlines 8/20/13

Patient Engagement: Blockbuster Drug Or Snake Oil?

A recent Forbes article discusses patient engagement strategies along with some of the notable success stories reported thus far.

Delaware considers statewide ACOs

Delaware Governor Jack Markell is working with policy advisors and CMS to draft plans that will bring all of Delaware’s payment and provider systems under the ACO model.

Greenway Reports Fourth-Quarter and Fiscal 2013 Results

Greenway reports its Q4 and 2013 year-end results: -$0.08 EPS on the quarter, which missed analysts estimates of -$0.02. The company ended the year in the red, reporting a net loss of $5.1 million. Shares traded flat during after hours activity.

Curbside Consult with Dr. Jayne 8/19/13

During the last month or so, I took a little vacation from Twitter. I found it was taking up too much of my day and I never had enough time to follow up on things I wanted to read, which was annoying.

I’ve been easing back into it this week – culling the list of people I follow, making sure that I’m not just seeing a bunch of noise, etc. I had to unfollow some people I really liked because of the sheer volume of things they retweet from others that really weren’t things I wanted to read.

It’s hard to find the right mix of news and entertainment without being overloaded. This tweet from Jonathan Bush’s account caught my eye, as did the associated article. 

The first thing that struck me is it didn’t sound like the Jonathan we’re used to hearing. It was calm, low-key, and didn’t have his usual push of speech. Whether it’s actually from his keyboard though doesn’t matter as much as the content.

The title of the piece is “Stepping Away, So Others Can Step Up.” I agree with his premise. It’s important for leaders to be able to trust their teams enough to step away. A strong team will run well with the leader absent because its members understand what needs to be done and have the skills to accomplish those tasks. They will have been given clear direction from above and will be ready to execute it.

Each time I see the “when the cat’s away the mice will play” phenomenon, I know there are likely to be problems with the team dynamic. Members may resent the leadership or not understand the roles they’re supposed to be playing. They may have been running on empty and stressed out by their leader and use the opportunity of his or her absence to decompress. Alternatively, there may be issues with succession planning and lack of clarity of who is supposed to lead in the leader’s absence. Managers may have been given pieces of a larger task but are unsure how they fit together or who is actually in charge.

The best leaders I’ve ever worked with made sure they had multiple trusted team members who could mind the store when they were gone. With this strategy, each of us knew that if we were the one temporarily in charge, we had others to rely on who would support our efforts.

The worst leaders I’ve worked with had a tendency to either alienate their direct reports or to ignore infighting among them. This creates an unstable and often unproductive atmosphere when the leader is away.

Another phenomenon I see too much of lately is people who have a trustworthy team but are afraid to step away. Some corporate cultures don’t place appropriate value on allowing employees to rest and recharge. I worked with one service line director who now works at a health system where he is afraid to take all of his vacation time each year because he feels leadership will view him as weak. The hospital has been through several restructuring efforts and most of the upper level management is afraid to be away lest they miss the beginnings of another round of house cleaning.

This is the same facility where staffers are welded to email day and night. If they don’t keep up with the daily spin cycle of news, they are considered “behind” when they walk in the office door in the morning. When the leaders don’t know how to stop working in the evenings, it makes it hard for the staff to draw boundaries.

In the most recent round of layoffs at this hospital, managers were not permitted to choose who on their teams to keep and who might be “made available to the workforce.” Those decisions were handled by consultants. The resulting culture of fear will likely destabilize the facility for many months to come and may also result in the departures of smart people who don’t want to be around when it happens again.

I hope each of you has the opportunity to work for a hospital, company, or leader who values time away. If you have that privilege, take advantage of it and enjoy every minute away. If you don’t work in that kind of environment, consider being a positive agent for change. There are likely others who believe in the value of stepping away and there might be an opportunity to make a difference.

As for Jonathan, if he ever needs a volunteer physician to help look after that “large family of kids and cousins,” he knows where to find me. I’m handy at putting elbows back in place after games of sibling tug-of-war and can remove an errant fish hook in nothing flat. I’ve never attended a clambake, but there’s always time to learn.

What do you think about taking time away? Email me.

E-mail Dr. Jayne.

HIStalk Interviews Bob Watson, President and CEO, Streamline Health

Robert E. Watson is president and CEO of Streamline Health of Atlanta, GA.

Tell me about yourself and the company.

Streamline was founded in 1989 and went public in 1996. The fundamentals of the business are really about capturing the unstructured data around the patient care experience, integrating that information with the record, providing a series of workflow solutions around coding, clinical documentation improvement, and analytics to improve financial outcomes. 

I’ve been in healthcare for 30 years, originally as an investment banker, unfortunately. It seems like I have to apologize for that. I’d been the founder and CFO of a company in the ambulatory surgical center business that we took public in the 1980s and sold that business to HCA. I’ve spent the last 13 years in the healthcare technology space.

Speaking about unstructured data in general, what’s new in that area, and how is the co-existence with EMRs going?

What people find when they deploy a record — and we hear this all the time — is that there’s an abundance of information that’s outside of the core record. Most of it’s unstructured. Historically, it had been paper.

Today, if we look at our own business, the percentage of that unstructured data that’s paper is dropping into the mid-80s. You’re seeing things like images that don’t for some reason interface with the RIS or PACS, .WAV transcription files, and other pieces of information that are important for the quality of patient care. Also important, frankly, to the financial outcomes. You have to get that information in order.

Are hospitals, even those that claim to be paperless, still getting a lot of external information from places that aren’t?

Yes. There is tremendous amounts of information that comes in externally. We have a client in metropolitan New York that 95 percent of the inbound physician order referrals for surgical events come in via fax. I don’t foresee that changing in the near term.

There was some enthusiasm for the hybrid EMR, which made the best use of paper records moved to an electronic form such as scanned images. What can people do with information in your system that they can’t do with paper?

It depends on the construct on how you get that information and unstructured data into the EMR. At the very basic, you can view that information inside the EMR. For example, if you’re in an Epic facility and there are prior visits, those prior visits may have been outside of the electronic version of Epic that’s in place. You can click on a tab and look at the PDF of those versions.

Where we’re seeing the market got today is a much broader use of OCR technologies and other ways to make that unstructured data actually actionable inside the record. We see it as taking unstructured data and turning it into knowledge to help not only clinicians, also but the financial side of the provider to make better decisions.

The criticism of scanned text documents is that nobody’s ever going to look through a bunch of PDF files. Is the OCR technology and your ability to build that into the workflow changing the usefulness of that data that previously nobody would have even looked at?

We’d like to think so. It has to. There are pieces of information that exist outside that core record that are important to the quality of the care of that patient. 

I realized clinicians are pressed for time, but there’s information that’s critical. You want to make sure they have it in a form that’s actionable. If you can search it and deliver that information to them at the point of care, you’ve made a big advancement over simply viewing a PDF where you’ve got to read it and look for the pieces of information.

Much of the agenda of both providers and vendors has involved chasing after the Meaningful Use requirements. Are those having an effect on your business?

It has. Less so in Stage 1 than as we start looking in Stage 2. There are parts of the Stage 2 process that the things that we happen to do at Streamline would give them proof points to get their payments along those lines. For example, release of information, a very critical part. Historically, as you and most of your readers probably know, a lot of the release of information processes have been outsourced. Some of the vendors like ourselves have built that release of information process into the technology that we sell.

The acquisition you did in 2011 of Interpoint Partners to create the OpportunityAnyWare product changed the company’s footprint drastically, along with the Meta Health acquisition. How do you think the analytics market looks and who do you compete with most often?

That acquisition of Interpoint was transformational for Streamline. We would not be where we are today had we not been fortunate enough to be able to complete that transaction, and for a variety of reasons.

But fundamentally, if we think about the analytics space today, if you were at HFMA a few weeks ago at the ANI meeting in Orlando, every other booth had big data or analytics, probably every booth actually. It’s a realization in the marketplace that there is an abundance of information that’s generally available — in EMR systems, in the claims systems, in the billing systems, in the coding systems — that has not historically been used to the best advantage of the payers, the providers, or frankly even the patients. I think that gets lost in this, by the way.

We see analytics as the cornerstone of everything we’re going to do at Streamline. But more importantly, the market itself in general has realized that there is great information that sits in these systems. We need to get it out and we need to get it in form that is actionable. It’s one thing to present a KPI dashboard. It’s another thing to give someone actionable information. We think that’s a key part of what we’re trying to do.

Competitively, it’s the usual cast of characters you’d expect us to be competing against – The Advisory Board, MedAssets, MedeAnalytics.

I think I heard you say that the benefit to patients is often lost and the marketing is aimed at hospitals trying to get control of their physicians. Is there enough emphasis on what the individual patient can immediately get out from all that data?

Do I think there’s enough emphasis on the patient side of it? No, absolutely not. I think it’s going to take a long time to get there. 

The financial challenges and operational challenges that providers face today are staggering and they’re only going to get worse. The first step in the lifecycle of analytics is to address the financial and operational components of the enterprises. Along the way, what comes out of that is an understanding that there is an enormous amount of rich clinical data that can have an impact on the patient either at the point of care or post-care. If you’re able to provide a patient with positive information that’s going to help them once they’re discharged — that prevents readmissions, for example — that’s a piece of information that we should get in the patient’s hand. Or just helping the hospitals understand their patients better.

For example, if you have 70-year-old patient taking 12 different medications, lives in a third-floor walk-up in the Bronx, and has mobility issues, do you think that patient is going to actually get those scripts filled? Pulling that kind of patient information out and being able to present that in format that the care management team can say, this patient is likely to be readmitted because they’re not going to fill their medications — what do we do as part of the care management plan to make sure that he or she gets those medications? That’s the patient part I’m talking about.

It sounds like what you’re saying in terms of who is looking at analytics is that there may be some desperation involved. Hospitals are trying to save the ship financially and desperately trying to find tools that can help do that. Do you sense that hospitals need a solution that they can’t necessarily define because they are facing the uncertainty and aren’t really sure how to react to it?

Yes. They can’t define what it is that they want when it comes to analytics. That’s why you see so many vendors saying, “We’re the next generation in analytics vendors. We can help solve all your financial problems.”

The reality is I don’t think anybody has cracked the crystal ball of what’s the right amount of information and how to deliver and how to make it actionable for our clients. None of the vendors have. But I think we all have the right intention in mind, which is to ensure that our clients are getting meaningful, positive return on investment that’s ultimately going to translate into that provider IDN’s ability to provide quality care in the community. We have to keep the hospitals alive.

I was looking at the STRM stock chart today and noticed that the share price has gone from in the $1.50 range in early 2012 around to $7 today. Do you think that the industry, in all its excitement about the bigger and better-known companies, has missed a pretty big success story?

Streamline flew under the radar for a long time. Over the last couple of years — really starting last May – the investor marketplace started to pay attention to what we were trying to assemble here, I think. A lot of investment dollars chased the big EMR vendors. Look at Cerner’s stock charts or anybody else – they’ve all done fairly well in this period, for the most part.

At $1.50 per share, our market cap was about $16 million. It’s hard to find institutional investors, but lot of retail people want to own that kind of stock where we trade by appointment. I think in 2010 we were trading 5,000 or 6,000 shares a day.

We’ve invested a considerable amount of effort in telling our story to the marketplace and it has responded favorably. Frankly, our team here has performed very well. Our sales organization delivered, our operational teams delivered, the technology folks delivered. We’re getting a little better recognition in the marketplace at the moment.

My first reaction to the market cap was the value of being publicly traded is marginal compared to the expense and headaches involved, but it was a lot worse when the market cap was smaller. Will you be able to grow better at this point because you’re publicly traded? 

I don’t think there’s a person on the face of the earth that wakes up one day and says, you know, I want to be CEO of a microcap public company, so I can assure you I did not.

That being said, our current position being public offers us some advantages. The obvious one, you have better access to capital and the capital markets, but beyond that, the cost of being public is still quite burdensome. It was clearly excessively burdensome when we were a $50 million market cap company.

You used the term a couple of minutes ago that investors were responding to what you are trying to assemble. The two acquisitions made the company a lot more attractive in different ways. Do you see that the company’s growth will be based on further diversification or acquisition?

We gave our guidance to the analysts earlier this year. Our growth guidance in terms of revenue and Adjusted EBIDTA were entirely based upon organic growth. We think we’ve assembled a set of assets today where there’s inherent meaningful organic growth in an orderly fashion and have really focused our teams on that.

That said, when I get asked the acquisition question in every earnings call, I try to give the same answer. One of the things we’ve tried to create culturally here is building deep, meaningful relationships with our clients. Those relationships give us ideas and point us in directions of where our clients think there are either weaknesses in other vendors or challenges they don’t see being met by their current set of vendors, where they come to us and said, hey, can you do anything along these lines? Have you thought about being in this business? So when we think about the potential to do additional inorganic growth opportunities, that thought process is really frankly driven by our relationships with our clients.

What’s your plan for the company over the next five years?

When we came here in early 2011, we had a vastly different plan than the plan we have today. Plans are iterative, as you’d expect. The original plan was, let’s try to stop the cash losses and grow the business modestly. 

In early to mid-2011, we went back to the board of directors and said, we think there’s an opportunity for a mercurial growth here. We want to set out a plan where we put forth a five-year strategic plan, which we redesigned again this year to take another look at the next rolling five years now that we’ve been here but little over two years. We think we have meaningful runway in front of us, an opportunity to build something that’s exciting. We’ve been able to culturally create an environment where our clients understand our commitments.

One of the things we use internally culturally is something called the three Rs, which is respect, responsibility, and results. The cornerstone of those three R’s is building those relationships with those clients. We think those client relationships put us in a position to grow a meaningful business over the next four to five years.

Our current five-year plan starts every morning when I get up. It’s the first day of that five-year plan.

Do you have any concluding thoughts?

First, thank you very much for thinking of Streamline. We’ve flown under the radar for 20-plus years, so I appreciate the opportunity to tell a little bit of our story.

Secondly — and I think this is an important generic comment about this space — as we all know, we’re entering another series of challenges for the whole healthcare ecosystem. The one question that we all need to ask ourselves is, what can we do to ensure that we have a healthy healthcare system for the generations that follow us?

I think that’s really an important question. Every day we challenge our associates to think about what can we do to make sure that the health system survives all the challenges that are in front. 

Thanks again for thinking of us and our team here at Streamline.

Morning Headlines 8/19/13

Forbes ranks Cerner among world’s most innovative companies

Forbes ranks Cerner #13 on its list of the world’s 100 most innovative companies, as measured by the difference between its market capitalization and the net present value of cash flows from its existing businesses.

Jeremy Hunt plans sale of confidential patient medical records to private firms

In England, the General Practice Extraction Service will send de-identified electronic patient records from NHS to a central database, where they can be bought by private companies performing research.

NSF invests $20 million in large projects to keep the nation’s cyberspace secure and trustworthy

The Trustworthy Health and Wellness Program will receive a five-year, $10 million National Science Foundation cybersecurity grant to develop tools for authentication and privacy, malware detection, and medical IT auditing.

Bingham Memorial Hospital CEO pleads guilty to stalking charge

Louis Kraml, CEO of the Idaho hospital, pleads guilty of ordering the IT director to tap the telephone of a former hospital physician. Kraml received a suspended jail sentence, probation, a $1,000 fine, and 100 hours of community service. Charges were dropped against two other IT employees, but a warrant has been issued for the arrest of IT Director Jack York after he failed to appear in court.

Monday Morning Update 8/19/13

From DanburyWhaler: “Re: Norwalk Hospital. No longer hooking up with Western Connecticut Health Network, now part of Yale-New Haven. Stay tuned for lots more consolidation in Connecticut” That would be interesting since Norwalk just signed up as a WCHN affiliate in January.

From Jon: “Re: HIMSS. They emailed members about the ICD-10 Playbook, and when I click the links, I get the infamous registration form before I can view it. It is sponsored by vendors, which is appropriate, but it should be available to all members with no strings attached for all the money we spend on dues. Now we will be bombarded with sales calls. No, thanks. I think my HIMSS membership days are over. Hopefully others will join me in sending a message.” HIMSS has gotten so commercial and so intertwined with its vendor members that I treat them like any other vendor, i.e. I always assume anything they send is spam. I’m rarely wrong on that. All the resources that require registration are on the site of MedTech Media (Healthcare IT News, Government Health IT, etc.), a private company of which HIMSS bought the majority position of shares in 2011.

The more important debate to me is this: are vendors doing themselves a favor by hiding their promotional material behind a registration form? Vendors think this way: we need leads, and any names we can get, even of people with marginal interest, make us feel more successful. I think this way: why in the world would you make it harder to see your advertisement? Nobody wants to be cold-called just because they took a quick look at a white paper. I would bet people often do as I do in just inserting phony contact information to avoid the dreaded phone call (note to vendors: if you are trying to reach a CIO named Scatman Crothers who used a phony email address, that’s me.) Don’t listen to your marketing and sales people – put your stuff out there where everybody can see it. Do the right thing and the HIMSS problem goes away with it.

Two-thirds of respondents say it’s OK if Farzad Mostashari’s replacement isn’t a physician, although most of the respondents probably aren’t members of Congress who may expect to see an MD in charge. New poll to your right: will the FDASIA report help improve patient safety with healthcare IT? Vote first, then click the Comments link at the bottom of the poll to explain your thoughts because “yes” or “no” votes don’t create rich debate.

Speaking of FDASIA, I made that the lead item in “This Week in HIT,” a partly serious, partly snarky weekly news update that I’ll do on Fridays. It will focus on the most important stories of the week, which admittedly aren’t all that fascinating at the moment given the summer doldrums before the inevitable September pickup (hint to vendors: it’s a great time to make announcements.) Long-time readers will remember the format from the Brev+IT weekly newsletter I used to send out until the volume of work overwhelmed me, much of which went toward coming up with Onion-like headlines. People have asked for a weekly summary of just the major news items, so this is it.

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

Wake Forest Baptist Urgent Care – Clemmons goes live with UrgentQ, a “fastpass for healthcare” that lets patients choose an open visit time and receive text message updates of when to come in. It’s from Lightshed Healthcare Technologies, a new company founded by Dialog Medical Founder Mike Burke.

Cerner will develop the biggest office project in Kansas City history if its plans for the former Bannister Mall are approved. The campus will cover 4.5 million square feet on 251 acres and will be valued at $4.1 billion upon completion. It will house up to 15,000 employees. Cerner wants $1.2 billion in tax incentives to build it, offering to chip in $2.9 billion of its own money.

Readers have asked for an update on the HIPAA Omnibus Rule, for which enforcement begins in just a few weeks. I publicly solicited pro bono volunteers to to review the changes via Webinar. Doing so will be a couple of excellent presenters from The Advisory Board Company: Associate General Counsel / Privacy Officer Rebecca C. Fayed and Information Security Officer Eric Banks. Sign up for The HIPAA Omnibus Rule: What You Should Know and Do as Enforcement Begins, which will be held on September 10, 2013, from 2:00 to 2:45 p.m. Eastern. I reviewed their slides and they are excellent in the usual Advisory Board fashion – very meaty and to the point as they cover changes related to business associates, breach thresholds, and everything else covered entities need to know and do. This is a non-commercial presentation offered strictly to benefit readers by Rebecca and Eric. I appreciate their involvement.

The West Virginia Health Information Network has added several hospitals recently, bringing its total to nine.

Louis Kraml, CEO of Bingham Memorial Hospital (ID) pleads guilty to stalking charges for illegally wiretapping a former hospital physician, aided by three of the hospital’s IT department employees. Charges were dropped against two of the employees because they were following the instructions of IT Director Jack York, who had been accused last year of running a bogus consulting company that was charging the hospital for IT services. The court has issued a warrant for the arrest of York, who didn’t show up in court. The charges aren’t mention on LouisKraml.com, the CEO’s official website.

HIMSS urges HHS to start Meaningful Use Stage 2 as scheduled, but suggests extending the attestation window to 18 months.

The Fort Lauderdale, FL newspaper covers the use by several hospitals, most of them VA facilities, of the GetWellNetwork patient engagement solution.

The National Science Foundation issues a five-year, $10 million cybersecurity grant to Trustworthy Health and Wellness program that will develop tools for authentication and privacy, malware detection, and medical IT auditing. Experts from Dartmouth, Johns Hopkins, University of Illinois at Urbana-Champaign, and University of Michigan are on the team.

Sidney Health Center (MT), a 25-bed critical access hospital, will implement Epic as part of an agreement with Sanford Health (ND).

Vince commences his HIS-tory coverage of Cerner, aided by Neal Patterson (who responded quickly and warmly to Vince’s inquiry) and the archives of Cerner’s April Martin. The details they provided are fascinating.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Time Capsule: Despite What Vendors Say, Offering a Payment Plan Doesn’t Make Their Product SaaS or You Their Partner

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

I wrote this piece in April 2009.

Despite What Vendors Say, Offering a Payment Plan Doesn’t Make Their Product SaaS or You Their Partner
By Mr. HIStalk

There was a time, before software vendors and consultants, when the word “partner” was pretty clearly defined. Partners signed a contract to be in business together, sharing profits and losses. They worked side by side, using their respective strengths to meet agreed-on goals. Their interests were aligned.

(Partnerships as business entities are usually a bad idea, even though they sound civil and synergistic. You don’t get any tax breaks, nearly all partners end up fighting much of the time, the actions of one partner legally bind the other, and ownership is illiquid. Just so you know.)

Vendors and consultants always want to “partner” with you, at least by their definition of the word (“sell you stuff under the pretext of being a trusted associate looking out for your best interests instead of our own, which is clearly a bald-faced lie.) The word itself is uttered with such phony conviction and heartfelt emotion that you just might believe it anyway, just like when a frat boy whispers “I love you” into the ear of a drunken sorority queen hoping equally fervently to consummate a transaction that is beneficial to at least one of the parties involved.

As a thought leader and futurist (I’ve decided to call myself those vague terms and you should anoint yourself with them, too – the people I’ve seen using them without embarrassment don’t seem all that insightful), I’ve observed permutations of the already-bastardized “partner” moniker. Here are the flavors I just saw at HIMSS, for example.

• When talking to the IT geeks, vendors trot out the “Software as a Service” buzzword, even though they’re often selling the same old products that are priced the same old way. Despite the buzzword, I saw no evidence that most of those Johnny-come-lately vendors are offering the theoretical advantages of SaaS: lower prices, an open market for plug-in functional components, or a scalable and highly reliable/recoverable hosting model requiring nothing more than a browser-equipped PC. (If SaaS sounds familiar, that’s because you’ve heard it before under the then-cool buzzwords of Application Service Providers, hosted services, or if there’s a little snow on your chimney, time-sharing systems. It was and often still is a pretty good deal from some of those non-Johnny-come-lately companies).
• Some vendors, wanting to ride the buzzword gravy train but hamstrung by old technology and inadequate hosting infrastructure, turned SaaS into a financial concept. Subscription pricing is a way to sell the same application to the same user, only in a no-money-down pay scheme. You sign a contract and pay either a fixed amount or a fee that varies by usage. Most vendors, sweating nightly over revenue recognition, don’t give customers one of the key benefits, though: the option to cancel at any time. You might be paying monthly rent, but the lease is ironclad. (The best thing about subscription pricing is that what you pay is based on your level of usage. The worst thing about subscription pricing is that what you pay is based on your level of usage. You get in the door cheaper, but if you’re your project beats the odds and enjoys significant use, you’ll probably pay more than if you’d just bought it upfront. So, you’re betting against yourself.)
• The third (and for the customer, the best by far, which also makes it the least common) option is the “We Make Money When You Make Money” model. This is where the vendor puts their money where their mouth is, actually going at risk with you instead of just cooing sweet words into your ear, drop-shipping their wares, and then starting the hunt for the next sorority girl. Now you’re partners – you either sink or swim together. Interests are aligned. Most vendors wouldn’t dare offer that deal to hospitals. Hospitals aren’t very good at implementing products, mandating their use, and getting serious about reaping their ROI. No wonder vendors want to take their money and run.

So, let’s just drop this laughable pretense that hospitals and vendors are partners. Partnerships don’t involve one partner writing a check to the other. You might have a partner on the golf course, on the dance floor, or in bed, but when it comes to healthcare IT, there are only sellers and buyers.

Advisory Panel: What Technologies Are You Using to Reduce Hospital Readmissions?

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

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

This question this time: What technologies are you using to reduce hospital readmissions?

Midas+

We currently have manual analysis and reporting processes in place to look at readmission reduction. However, we are talking with a number of vendors about solutions they offer. These vendors include our HIE, predictive modeling vendors (like Predixion), EHR vendors, and niche software vendors focused on supporting case management / continuum of care.

Unfortunately, this is currently done mainly through brute force, due to the outdated systems we have now. After our big-bang hospital go-live in March of 2014, we will have a very robust platform and tools to accomplish this through our EMRs. We are also collaborating with our state-based HIE to help in this regard.

The task is daunting. We have worked with the hospitalists and our owned practices to identify potential readmissions and aggressively intervene where possible with PCMH staff. No specific technology solutions except analytics/ reports that look for a variety of potential readmits such as late labs that indicate problems and chronic conditions requiring check ins to be sure the patient is compliant. It really is down and dirty outreach. I’d like to hear of a magic technology solution but I have not see one yet.

Our focus has been on leveraging our EMR and patent portal to make discharge instructions as clear and user friendly as possible. The rest of the process is very low-tech: follow-up phone calls to every family.

Other than standard case management tracking and the EHR, not much at the moment.

We have some simple but accurate, home-grown predictive analytics tools that risk stratify patients for readmission, but they are, for the most part, not that helpful in reality. It’s not the predicting that’s the hard part; it’s the intervention. You don’t need a sophisticated predictive analytics algorithm to realize that a post-CABG, 75-year old man with DM, living at home alone, is likely to be readmitted. Many of our patient profiles for high-risk readmission are that obvious, and even more so. The hard part is having the cultural will and clinical processes in place to intervene when we identify a high risk patient. It’s not rocket science. Many readmissions occur because of simple causes at discharge time or at home– surgical site infections, poor adherence to medications after discharge, poor discharge instructions, no discharge medications administered, etc.  In addition to the simple interventions at
discharge, patients come back to the hospital and ER because we offer them no healthcare alternative such as a skilled nursing facility, or family education or other assistance at home.

I believe it is mostly manual process that includes determining root cause of readmission (can’t afford prescription, can’t get to follow-up appointments, etc.) and then attempting to provide solutions at time of discharge.

We are using an electronic version of the LACE score that we developed in-house.

No special technologies… just good old fashioned time and attention. We make sure every patient has a follow-up appointment with their PCP or appropriate specialist. If they don’t have a PCP, we created a clinic specifically to take care of these patients (usually Medicaid or non-insured), and help transition them to an FQHC or similar.

Use of LACE index to identify patients at risk for readmission, alert generated on registration in the ED prior to the triage/clinician encounter, remote patient monitoring/telehealth.

We participate in various collaborations between physicians and hospitals looking at the outcomes of claims billing related to cardiovascular remittance  Technologies employed are interfaces and data analytics solutions such as Hyperion, SSRS, and Cognos.

The readmission programs from various randomized controlled trials. The technology that generally can or should support it comes from analytics platforms found either in the EHRs or possibly the HIE but often times is manual

Technologies is too narrow a question; however, keeping to your question we flag recent discharges at ED and clinic visits in the record so the physician can consider opportunities for intervening other than by admission. Total Care Management a broader, non-technology driven program (early follow-up, calls, home visits, et. al.) focused on congestive heart failure patients–a big cohort of readmissions in our environment.

Timely question. While we need to do what’s right for our patients, we are not ready to cut these out entirely as we need to accept as much business as we can as volume is down across the region. That said, we are evaluating this in the context of analyzing our position on Bundled Payments. Our approach is not all that sophisticated – focus is doing all that we can to identify high risk patients upon admission, using workflow technology to make sure someone will be paying attention, assigning to appropriate care managers and doing what we can to make sure they leave as healthy as possible, re-designing our dc summary output to be as comprehensive as possible and enabling dissemination via our CCD, secure mail, fax, etc – anyway our external providers want it! We are working on strengthening our post acute care relationships and determining how we incorporate our ambulatory care management programs into our pre-dc planning. Connecting the dots sounds so easy but is not pretty….

Good question… we are starting to utilize some ambulatory / outpatient case management strategies that can follow the patient via phone calls for high risk (for readmission) diagnoses. We utilize home health’s involvement whenever possible. In our service area, we have seen the biggest hurdles in avoiding high readmission rates is (a) did the patient get the proper follow-up with a physician and (b) did the patient get (or continue to take) his/her medications. Our patient demographics include highly seasonal farm workers, a high unemployment rate, low / no insurance coverage, and so forth.

Real time alerts when a Medicare patient is admitted to one of our hospitals, triggering rapid intervention by a health coach. Telephone for follow-up calls.  Encouraging patients to enroll in our patient portal to increase engagement.

This Week in HIT 8/16/13

FDASIA Minor

Facts and Background
The 2012 Food and Drug Safety and Innovation Act (FDASIA) requires HHS to evaluate the patient safety risk of healthcare IT in the context of encouraging innovation and avoiding regulatory duplication. The FDASIA committee released its draft report this week, which concludes that FDA regulation of healthcare IT is not necessary, but better surveillance of live systems and post-implementation testing is needed.

Opinion
The committee likes the status quo a lot. Vendors can breathe a sigh of relief that the draft suggests only better communication about product safety issues and potentially a move away from product certification. 

Musings

• The committee found it frustrating that definitions of healthcare IT and specific functionality that would trigger FDA oversight are not clear.
• The report calls for creating a surveillance mechanism to track patient harm and near misses for unregulated software. Surveillance is an easy first step, but somehow it never seems to get done successfully. Who would a practicing physician contact when faced with a patient-endangering software defect?
• The report wasn’t a big fan of product certification, saying it pushes vendors to meet the same checklist, gives prospects no way to compare products since they all pass, and focuses on features rather than outcomes. It recommended marketplace transparency instead.
• The committee agreed with an earlier IOM report in saying that the federal government should discourage vendors from interfering with the free flow of product safety information.

Epic Has a Cow (Campus)

Photo: Amber Arnold, State Journal

Facts and Background
Epic Systems is finishing up construction of the third office complex on its 950-acre Verona, WI campus. The Farm Campus will house 1,000 employees.

Opinion
Whimsy is a strong attraction for candidates not overjoyed at the prospect of moving from a major metro area to Wisconsin farm country. The company needs the space and can afford it, employees and customers like it, construction costs are way less in Verona than many places, and building a cool building probably doesn’t cost much more than putting up a drab one. Non-profit hospitals and thus patients (and taxpayers via the federal government) are paying for it, but healthcare waste and extravagance is a target-rich environment.

Musings

• Epic has 6,500 employees, hired 1,000 people in the past year, and took in $1.5 billion in revenue.
• Construction of a fourth campus will begin almost immediately, expected to have a Harry Potter-type theme.
• The 11,000-seat Deep Space auditorium will be ready for Epic’s user group meeting in three weeks.
• Cost of the Farm Campus and Deep Space was estimated at $400 million by the city, with the total value of the property estimated at $800 million.
• The company has 4,500 offices on the Verona property.

Merge Purges Surges

Facts and Background
Merge Healthcare fired CEO Jeff Surges after another bad quarter in which revenue fell and losses increased, replacing him with former CEO Justin Dearborn.

Opinion
Merge has a lot of problems as a company. Jeff Surges may or may not have been one of them. He gave a pretty rosy outlook during last quarter’s earnings call, so poor results forced the company’s hand.

Musings

• Surges joined Merge in November 2010, but was a director of the company since May 2010.
• He came from Allscripts, where he had been president for three years. Both Chicago-based companies have struggled with proxy fights, management turnover, and poor financial performance.
• Surges was named as one of Modern Healthcare’s “Healthcare’s Hottest” fluff award at #21 in September 2012, although perhaps they were referring to his seat.
• MRGE shares have dropped almost 50 percent in the past week.
• MRGE share price tripled during Justin Dearborn’s previous stint as CEO from 2008-2010.

Health Plan’s Leased Copy Machines End Up Costing $1.2 Million

Facts and Background
Affinity Health Plan pays $1.2 million for failing to erase the hard drives of leased photocopiers it returned to Canon Financial Services, which were later found to contain the protected health information of 345,000 patients.

Opinion
It’s likely that most hospitals have made the same mistake, either because they didn’t think of copiers as containing PHI or wrote unenforced policies for their disposal. It’s interesting that Canon Financial Services didn’t erase the drives themselves just like a seller of refurbished computers would – while not all customers copy PHI, all of them copy confidential information.

Musings

• Talk about bad luck – one of the returned copiers was then sold to CBS, giving its news people an easy story to hype.
• The Federal Trade Commission offers a reminder that “digital copiers are computers” and provides advice on how to secure their information.
• Affinity should sue Canon Financial Services for failing to exercise reasonable care to prevent exposure of its data.

EHRs Aren’t Disruptive

Facts and Background
A blog entry by the Clayton Christensen Institute for Disruptive Innovation says that EHRs aren’t disruptive.

Opinion
Who said they were or should be? EHRs were primarily designed make data retrieval more convenient for regulators and insurance companies, not to provide innovative benefits to clinicians or patients. EHRs, rightly or wrongly, reflect what the market requires, excepting of course the skewing of that market by HITECH.

Musings

• The article says that 80 percent of hospitals now have EHRs, yet none of the $81 billion per year in healthcare savings predicted by the vendor-funded 2005 RAND study have materialized. Nobody believed that study other than Presidents Bush and Obama, so that’s hardly a surprise.
• It points out that “disruption” means small companies with cheaper, simpler technologies that target small customers or non-customers, but then move upstream to threaten entrenched competitors. That’s not the case in healthcare, where EHRs are a “sustaining innovation” that offer more features at a higher cost, but within the same customer business model.
• “Implementing new technology to sustain the way you already make money almost always keeps costs high and prevents true disruption.”
• The article recommends building systems that are based around doctor workflows instead of replicating paper, but that’s a lazy conclusion that assumes doctors are in charge rather than the government, insurance companies, and employers. The real problem is the lack of motivation for disruption and the absence of possible disruptors. There’s nobody to arm with technology to topple the status quo.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 8/16/13

Investor digital-health darling CareCloud raises another $9M

The additional funding raises the company’s total to $55 million.

Penn State Employees Protest Wellness Effort

A professor’s petition calls for the university’s wellness program to be cancelled, saying employees shouldn’t have to answer health questions and commit to receiving an annual physical exam in order to avoid a $100 per month insurance surcharge. The university says it’s trying to hold down healthcare costs in the face of a projected 13 percent cost increase in the next year alone and voluntary health and wellness programs have drawn minimal participation.

EHR costs outweigh financial benefits, doctors say

An athenahealth physician survey finds that while only 18 percent of them have an unfavorable opinion of EHRs and 68 percent of them say EHRs improve patient care, 51 percent say EHR costs outweigh their benefits. The survey also found that fewer physicians plan to buy an EHR in 2013 since 98 percent of them already have one.