The HIT Productivity Paradox — It’s Gonna Be OK

The New York Times publishes another article about how spending money on EMRs is a waste since the benefits are not obvious. Like so many media cycles, they build you up (HIT is great) and then tear you down (HIT is a waste of money). 

Fair enough. Are EMR’s worth it? Was MU worth it?

I’ve said before that I don’t think I would have spent the $30-40 billion that way (remember, they use the $19 billion figure because they assume $10-20 billion in savings). I would have focused on mandating standards and trying to push for a uniform data model platform upon which vendors could then build their more external facing products.  

However, I will happily admit that MU has done its job. It has stimulated the adoption of EMRs. It won’t be the 80+ percent they were hoping, but it still got a lot of people off their asses and moving.

Next question: will EMRs provide all the great things we are hoping for?

Certainly we’ve got some issues. EMRs are still not mature, nor is our understanding on how to best use them. But no technology, from cars to computers, started out perfect.  

I’ve been reading "The Signal and the Noise." Very early on, it reminds readers of "the productivity paradox," which helped explain why the early computer age (1970s-1990s) actually saw a lower productivity as everyone was figuring out how build them well and how to use them. Sound familiar?

From Wikipedia:

The productivity paradox was analyzed and popularized in a widely-cited article by Erik Brynjolfsson, which noted the apparent contradiction between the remarkable advances in computer power and the relatively slow growth of productivity at the level of the whole economy, individual firms, and many specific applications. The concept is sometimes referred to as the Solow computer paradox in reference to Robert Solow’s 1987 quip, "You can see the computer age everywhere but in the productivity statistics." The paradox has been defined as the “discrepancy between measures of investment in information technology and measures of output at the national level.” It was widely believed that office automation was boosting labor productivity (or total factor productivity). However, the growth accounts didn’t seem to confirm the idea. From the early 1970s to the early 1990s there was a massive slow-down in growth as the machines were becoming ubiquitous. (Other variables in country’s economies were changing simultaneously; growth accounting separates out the improvement in production output using the same capital and labour resources as input by calculating growth in total factor productivity, AKA the "Solow residual.")

If and how can this best be applied to healthcare IT? It turns out that some smart authors actually addressed this exact issue in a June 2012 NEJM article entitled. “Unraveling the IT Productivity Paradox — Lessons for Health Care.” The authors explain that sure, we are seeing problems with HIT, but it is as expected, just like every other new industry has to evolve. They conclude with the following paragraph:

The resolution of the original IT productivity paradox suggests that current conclusions about the value of health IT investments may be premature. Research suggests three lessons for physicians and health care leaders: invest in creating new measures of productivity that can reveal the quality and cost gains that arise from health IT, avoid impatience or overly optimistic expectations about return on investment and focus on the delivery reengineering needed to create a productivity payoff, and pay greater attention to measuring and improving IT usability. In the meantime, avoiding broad claims about overall value that are based on limited evidence may permit a clearer focus on the best ways of optimizing IT’s use in health care.

Clearly we are not at perfection. HIT can affect efficiency and quality in both good ways and bad.  But rather than try to create some artificial polarization that it is all good or all bad, let’s continue doing our job (for the medical informatics professionals reading this) to keep making HIT better serve our providers and patients, while educating those who get freaked out every time a new stat or story comes out pointing out its imperfection. 

Lyle Berkowitz, MD is associate chief medical officer of innovation, Northwestern Memorial Hospital; chairman of healthfinch ("The Doctor Happiness Company"), author of the Change Doctor blog, and editor of the new book, Innovation with Information Technologies in Healthcare, which has a whole bunch of good stories about organizations who have succeeded with EMRs and healthcare IT by thinking innovatively about the best way to use them in their settings.

News 2/22/13

Top News

An article in The New York Times called “A Digital Shift on Health Data Swells Profits an an Industry” takes direct shots at the HITECH act, particularly emphasizing the “behind the scenes lobbying” that Allscripts, former CEO Glen Tullman, and other unnamed vendors employed to get it passed. It points out that Tullman was health technology advisor to the Obama campaign, a personal donor of $225,000 to Democratic political candidates, and a seven-time White House visitor after Obama took office. Cerner doubled its lobbying dollars to $400,000, with almost all of it going to Republicans.

Athenahealth’s Jonathan Bush weighed on “the Sunny von Bülow bill” that he says kept his stagnant competitors “alive for another few years.” In a seemingly random quote, the ED chair at UCSF Medical Center said Epic is “mediocre” on a good day but “lousy” most of the time, while a counterpoint from UCSF’s CMIO saying that most doctors there like it receives less-sensationalized coverage. The article also points out that Neal Patterson’s stake in Cerner is worth $1 billion and mentions that a letter from Steve Lieber of HIMSS urged President-elect Obama to set aside at least $25 billion to increase EHR adoption.

In other words, the article is all over the place. The only new material appears to be a handful of quotes that were allowed to run unchallenged, with everything else looking more like a set of Google search results than a thoughtful and balanced piece. Its conclusion is hardly startling: the federal government wastes enormous amounts of taxpayer dollars in scratching special interest backs and a few people get really rich as a result (fun fact: Glen Tullman is now running his solar energy company, reaping the benefit of another big federal spending program.) Far more interesting than the article itself are the reader comments:

• My impressions of the vendors can be described in two words: Welfare Queens. The systems are glorified billing and scheduling systems. Vendors were “certified” before they actually created the upgrades that supposedly met MU criteria.
• Regardless of how much customization you do to the form and how many drop-boxes there are for entering data, the result is medical records which look very similar from patient to patient, and omit nuances and details which are specific for individuals.
• It is interesting that so many commenters complain about a lack of privacy (signing my life away on consent forms!!), while others complain because not all providers in the country have easy, fast access to their medical records.
  You must realize that these things are at odds, and affected more by HIPAA than limitations of technology.
• EMR 1.0 = islands of information, designed for billing and documentation. EMR 2.0 = system of engagement – Key information summarized and shared. Saves time for the users. It’s coming!
• Try telling countries like Canada, New Zealand, Netherlands and Japan that they should give up all of the EMR systems that are unusable despite the fact that the majority of their docs are using EMR systems today. Just because a few people in an article determined a system to be unusable doesn’t make it so.
• The EHR has become the patient. It is sicker than you and more complicated, taking more time. You, the real patient, can just lay there waiting in a state of abject neglect.
• There is a lot more to this movement than this article suggests — and it is good. “The clear winners are big companies” — yes, in some ways, but the even bigger winners are patients and the doctors who care for them. In my family, this record-keeping already has resulted in a life-saving developments.
• In our office we have had three over 50 early retirements due to the EPIC system.
• Think if America had as many electric outlet types as Europe (free markets!) This mishmash of EMR will take a generation to unravel and cries out for a centralized system & format.
• I’m a primary care physician working at Kaiser Permanente. We’ve been using the Epic system for years. While it isn’t perfect, I’d never go back to paper … the real reason this system works for us is because we are an integrated system. If we weren’t, it wouldn’t work well at all. The real problem is lack of integration in US medicine.
• Banks and many other industries already embrace efficient and effective computerized systems. Where your life is at stake, wouldn’t you want your doctor to have the same advantages as your bank?
• This is a very one-sided article, and almost reads like a smear in some places.

For a counterpoint, see DrLyle’s post, The HIT Productivity Paradox — It’s Gonna Be OK.

Reader Comments

From Ms. HIM: “Re: X-Rays. Inga, did you report to someone at the facility that you were able to see the patient data in the hallway?” Ms. HIM is referring to my recent visit to a radiology practice that had patient data prominently displayed on several monitors in common areas. I did e-mail the CIO and included my stealthily-taken pictures. No response yet.

From Disappointed: “Re: HIStalkapalooza. I want to give kudos to Shannon at Thomas Wright Partners. I am unable to attend HIMSS due to a family thing, but she promptly and cheerfully changed my confirmation to my boss who had neglected to sign up (what can I say?) She also said if things changed and I was able to attend, she personally would ensure I would get in and gave me her cell phone number. What great service!!!” Medicomp is working with the same team (Thomas Wright Partners, Bzzz Productions, Istrico Productions) that brought you HIStalkapalooza 2011 in Orlando. They are indeed efficient and responsive. I had no qualms about putting my name on the event and leaving the details to them.

From Letter of the Law: “Re: Allscripts Meaningful Use Guarantee. Doesn’t sound like MyWay will meet Stage 2 MU or get 2014 ONC certified as a Complete EHR. Does this mean MyWay clients get a 12-month support credit or refund? Seems like the guarantee was written to be purposefully vague and has now mysteriously disappeared from the Allscripts site (convenient) except in the Investor area.” Allscripts told us they would respond, but they haven’t so far.

From Tom: “Re: Epic. An electrophysiologist wrote a satirical post about Epic and used screenshots to convey the problems he experienced. He says Epic contacted his hospital administrators and asked him to take the screenshots down. He is now concerned about legal ramifications.” It should be noted that the doctor sells software on the side, although it costs only a few dollars and is specific to electrophysiology. Still, Epic has made it clear in the past that it won’t tolerate posting screen shots, documentation text, or almost anything else publicly. I’m thinking I remember (but could be wrong) that they warn UGM presenters not to post their slides publicly if they contain anything that Epic might deem proprietary. Says the doc (with some of his preachy indignation removed):

I’m just a physician who uses their software … No software is perfect however and I think the Epic bosses should be more interested in using feedback and criticism from health care professionals to improve the program rather than spending their time worrying that a screenshot of their user interface is available on the web … these massive companies who have benefited enormously from our tax dollars have the nerve to threaten those who criticize their software and publish a few bland screenshots. Unfortunately though, with their cash reserves and cadres of lawyers, there is little that EP Studios (cash reserves = $0) can do to stop their bullying.

From Say What?: “Re: HIMSS in Cleveland. Surely you jest. What is moving 345 miles from its Chicago base going to do for HIMSS? At least Nashville made sense from a different geographic, cultural, and transportation point of view, as would Phoenix, San Francisco, or Seattle.”

From Richard: “Re: HIStalk. Thanks for one of the most concise, relevant online healthcare IT publications out there. Your work is an excellent balance of current news, pertinent insight, and subtle (or sometimes hot so subtle) humor. Please pass on my compliments to the entire HIStalk crew for their excellent contributions. P.S. I admire your team’s ability to present a meaningful contribution and at the same time party like college freshman at HIMSS.” I did indeed pass along your much-appreciated comments to the crew, which got me trapped in the e-mail crossfire as Inga and Dr. Jayne tried to one-up each other with their claimed partying capacity beyond freshman level. I stopped reading once they escalated to grad school.

HIStalk Announcements and Requests

This week on HIStalk Practice: MGMA introduces a Web-based tool that allows organizations to benchmark themselves against peers using national MGMA data. The RI REC offers EHR adoption assistance to specialists. Researchers devise an AI tool that may outperform physicians in making cost-effective clinical decisions. Michigan lawmakers consider legislation requiring a single universal prior authorization form for prescriptions. PCMHs deliver slightly better patient satisfaction and preventative care but may not result in cost savings. Dr. Gregg shares details of the meeting between Focus and Byproduct … heck, it’s a great story, so give it a read. Greenway Medical CEO Tee Green discusses the company and industry and makes some predictions for the future. Thanks for reading.

Maybe I’m the only one who didn’t know: Word, going back to the 2007 version apparently, has a “Save as PDF” option that’s easier than PDF print driver products like CutePDF or PDF995. And in another Andy Rooney meets Larry King kind of non sequitur, I heard programmers repeatedly pronounce two words oddly in a meeting today: DISplay and REfresh. I am monitoring further accent-switching occurrences.

I got an e-mail today that HIMSS has kicked me out of my reserved hotel and put me in a lower-rated one because of “an oversold situation,” adding that they “wanted to inform you before you arrived in New Orleans.” How thoughtful, especially considering that I booked in September.

Welcome to new HIStalk Gold Sponsor Greythorn, whose healthcare IT practice places candidates in the specific high-demand market segments of Epic, Cerner, and ICD-10. Greythorn has offered specialty IT staffing solutions for more than 30 years. Check out their LinkedIn Epic and EHR Professionals group, or seek their folks out at HIStalkapalooza since they told me they’re going and I sense they’re a fun bunch. For clients, expect nice people, a big pipeline of candidates including international ones, and a zeal for understanding your business and your needs. Job candidates should read their Resume and Interview Tips document (“Questions to Be Prepared For” contains just about all of the HR-mandated behavioral interviewing questions I’ve ever asked). Stop by Booth #5358 at the HIMSS conference and pass along my thanks to Greythorn for supporting my work.

Here’s a “Working at Greythorn” video I found on YouTube.

HIMSS Conference Social Events

If you registered in advance, your official HIStalkapalooza invite should have hit your inbox Wednesday (check those spam folders!) Make sure you’ve arranged your schedule to be there in time for the Inga Loves My Shoes contest and the crowning of the HIStalk King and Queen. The highly coveted beauty queen sashes and prizes will return.

Speaking of sashes, we decided to give readers a chance to win one, along with stage recognition and a $25 Amazon gift card. All you have to do is declare Inga, Dr. Jayne, or Mr. H as your secret crush and explain why. We’ll choose the most convincing entries, so feel to free to lay it on thick and shamelessly in an obvious appeal to our vanity. Winners (who must be at HIStalkapalooza) will be sashed on stage with “Inga’s Secret Crush,” “Dr. Jayne’s Secret Crush,” or “Mr. H’s Secret Crush” as a token of our reciprocation.

Aventura is participating in a booth block party at the conference on Tuesday from 4:00 until 6:00 p.m., with beer and margaritas.

Speaking of Aventura, they’ve sent the best e-mail promotion so far with their serious-sounding “HIT Survival Handbook” that includes some dry humor. I forwarded the e-mail home from work just to run it here.

I always scan down the HIStalkapalooza attendee list to see who’s coming and what titles they hold. Eyeballing it, it looks like over 100 presidents/CEOs, 200 VPs, 24 CIOs, 13 CMIOs, and eight financial and equities people. That’s a fraction of the total invitations, so obviously many other titles were represented.

Here’s a list of our HIMSS-related pages and their downloadable/printable PDF equivalents that will tell you what our sponsors are doing at the conference:

HIStalk’s Guide to HIMSS13
HIStalk’s Guide to HIMSS13 Meet-Ups
HIStalk’s Guide to HIMSS13 Exhibitor Giveaways

Acquisitions, Funding, Business, and Stock

Shareholders of PSS World Medical approve the company’s agreement to merge with McKesson, clearing the way for a Q1 closing.

GetWellNetwork reports 30 percent growth in revenues and a 90 percent increase in orders from 2011 to 2012.

MedAssets reports Q4 results: revenue up 4.5 percent, adjusted EPS $0.27 vs. $0.32.

Sales

The New Hampshire Health Information Organization selects the Massachusetts eHealth Collaborative to provide executive director management services for the implementation of its statewide HIE, which will utilize Orion Health’s technology backbone.

NYU Langone Medical Center contracts with Accenture to support its ICD-10 implementation process.

Intelligent InSites wins a $543 million contract to implement to RTLS at 152 medical centers, as reported here previously. We interviewed President and CEO Margaret Laub last week.

Numera selects AT&T to be the wireless network and location services provider for Numera Libris, a mobile home health management and personal emergency response system.

Banner Health expands its portfolio of 3M products to include the 3M 360 Encompass System for computer-assisted coding and clinical documentation improvement.

Memorial Sloan-Kettering (NY) chooses Orion Health’s Rhapsody Integration Engine for communication and data sharing between the hospital’s different IT applications.

Phoenix Children’s Hospital (AZ) selects Allscripts Sunrise Financial Manager, Sunrise Ambulatory, and Allscripts Community Record.

Mid-Valley Hospital (WA) selects e-forms and electronic electronic patient signature solutions from Access to use with its Meditech Scanning and Archiving system.

Fairview Health Services (MN) will implement Strata Decision Technology’s StrataJazz for decision support, operating budgeting, strategic planning, and capital planning.

People

Avere Systems appoints Michael McMahon (CommVault) as VP of business development.

Tom Giannulli, MD (Epocrates) joins Kareo as CMIO.

VA CTO Peter Levin, who led the Blue Button initiative, announces his resignation.

As reported here last week. Health Catalyst names Brent Dover (Medicity/Aetna) as president.

Wolters Kluwer promotes Kevin Entricken from CFO of the Wolters Kluwer Health division to CFO of the parent company.

Harris Interactive names Matt Knoeck (TNS North America) SVP of healthcare and Sharon Albert (TJ Sacks) VP of marketing for its healthcare group.

Announcements and Implementations

The Rochester RHIO partners with area ambulance companies to allow physicians to see critical patient information gathered in the field during ambulance calls.

Medical equipment provider Skytron upgrades six of its customers to CenTrak’s clinical-grade RTLS technology.

SuccessEHS connects with MyHealth Access Network HIE (OK) to send clinical care documents from its EHR.

Aker Eye/Vision Source (FL) implements RTLS from Versus Technology.

The Joint Commission begins offering a PCMH certification for accredited hospitals and critical access hospitals.

SCI Solutions launches Readmission Minimizer to track and monitor post-discharge processes.

The Utah Health Information Network offers Direct secure messaging labeled as cHIE Direct, using technology from Secure Exchange Solutions.

Enovate announces two new products, the e5000 telemedicine cart and colorful peds-oriented Emagination Stations.

Humetrix introduces cross-platform capability for its iBlueButton app that allows consumers and patients to exchange clinical information at the point of care regardless of which smartphone they use.

Kareo launches a free cloud-based EHR that can be used as a standalone application or integrated with the company’s PM and billing services. It was developed using technology acquired from Epocrates, which exited the EHR business a year ago. Kareo notes that the EHR is “advertisement free” and says it will provide support and updates at no charge. The company hopes that the free EHR offering will attract more clients for its PM and billing service products.

Government and Politics

ONC is accepting applications from those interested in serving on a new workgroup, the HITPC Food and Drug Administration Safety Innovation Act Workgroup,  that will provide recommendations for a risk-based HIT and mobile device regulatory framework.

Worth a read: The Advisory Board Company publishes “How Stage 2 Raises the Bar on Stage 1 Organizations.” Like everything Advisory Board, it’s fluff-free and to the point.

Innovation and Research

Researchers from the University of Cincinnati find that physicians using an EMR are more likely to order routine screening tests for women.

Processing a prescription drug order through a CPOE system decreases the likelihood of error with that order by 48 percent according to a study supported by AHRQ. Researchers say the findings suggest CPOE can substantially reduce the frequency of medication errors in the inpatient setting, but it is unclear whether that translates into reduced harm for patients.

Christiana Care Health System is awarded a $10 million grant from CMS’s innovation grant program for its Bridging the Divides program that uses predictive analytics to target patients who would benefit from intervention. CMIO Terri Steinberg, MD, MBA (above) tells me that analytics can be run against the patient’s entire data set even if it originates from a different health system. I may follow up for more information.

Other

Healthgrades says Dayton, OH, Phoenix, AZ, and Milwaukee, WI have the lowest risk-adjusted hospital mortality rates in its list of America’s Best Hospitals 2013.

Express Scripts sues Ernest & Young and one of its former partners for stealing trade secrets and corporate data to boost E&Y’s healthcare business. The lawsuit claims Donald Gravlin, who was working on the Express Scripts-Medco merger, entered an Express Scripts facility several times  to forward confidential company e-mails to his personal account.

Black Book Rankings releases the results of a survey to identify the top hospital EHR vendors based on client satisfaction. Winners include:

• CPSI (under 100 beds)
• Cerner (100-249 beds)
• Epic (academic teaching hospitals and major medical centers)
• Cerner (healthcare systems, hospital chains, integrated delivery networks)
• Picis (ED)

UnitedHealth Group announces the creation of 1,000 new jobs in North Carolina by its UnitedHealthcare and Optum businesses.

Weird News Andy waxes poetic on the news that Cornell researchers have created a realistic 3-D printed human ear. WNA says, “Poems are make by this fool right here, but only Cornell can make an ear.”

WNA finds this item both odd and sad: a suspended Johns Hopkins gynecologist accused of secretly taking photos of hundreds of his patients using a pen camera commits suicide.

Sponsor Updates

• Aspen Valley Hospital (CO) shares how it increased front office payments and cash on hand and reduced administrative time and costs by using InstaMed solutions in a case study.
• Covisint extends its cloud identity services to include small and medium-sized organizations.
• US Secret Service Special Agent Erik Rasmussen and Trustwave SVP Nicholas Percoco will lead a keynote address on cybercrime at next week’s RSA conference.
• Halfpenny Technologies adds Altosoft’s BI dashboard to its ITF-Hub solution for clinical laboratories.
• API Healthcare offers a Webinar series focused on effective employee recruitment and retention.
• HealthMEDX expands its support of LeadingAge, a non-profit committed to providing care and services to the aging.
• eHealth Technologies releases a zero-footprint, Web-based image viewer that uses the eUnity platform of Client Outlook.
• Informatica releases Cloud Spring 2013, the latest release of its integration and data management applications, and will hosts a February 25 Webinar to introduce its features.

EPtalk by Dr. Jayne

Clinicians can now diagnose leprosy (Hansen’s disease) more than a year before patients are symptomatic. The new test uses a smart phone, a test strip reader, and a single drop of blood. Each determination will cost $1 or less.

This week President Obama announced an initiative to map the human brain, citing the Human Genome Project as a precedent. The brain is a fascinating thing and I’m excited about the role that information technology will play in making it a reality. Even better was the adrenaline rush I got since I read the announcement while I was hopped up on cold medicine watching “The Bourne Legacy.” Hopefully the CIA isn’t waiting in the wings to create neurologically engineered killers with the resulting data.

I’ve enjoyed the reader comments about travel arrangements for HIMSS. I apparently waited too long to book my hotel room (silly me for thinking three months in advance was enough) so I am arriving a day later and leaving a day earlier than I’d have liked. The idea of having to split between two different hotels to cover the entire stay was not very appealing. The comments about venues for future HIMSS meetings are spot on as well. I mentioned the HIMSS rotation to a dental colleague today and learned that there IS something worse than HIMSS returning to Chicago: The Chicago Dental Society Midwinter Meeting, which is held every February in the Windy City. The schedule of events lists a Fashion Show Luncheon. I wonder if they feature parkas, boots, and mittens?

Twitter served up an item from @ONC_HealthIT celebrating a physician who built his own EHR in response to budget cuts. A read of the actual article reveals that “eventually he turned to Cerner.” Unfortunately Meaningful Use has stifled grassroots innovation like building a custom EHR for your practice. I also like the line about practice administrators scanning paper test results into the EHR. If they actually have practice administrators feeding the scanner, I can recommend some additional overhead cost cutting for them.

In addition to the paper mail and tchotchkes enticing me to various booths at HIMSS, I’ve started receiving e-mail invitations to focus groups. Today’s gem promised to “present 4 innovative clinical strategies that leverage technology to reduce cost and improve all quality metrics.” Wow! They improve all quality metrics? That’s impressive. Even more impressive is the honorarium offered: a “Personalized tour of Walgreens Flagship Location – TBD.” Sheesh.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 2/21/13

Top Hospital Electronic Health Records Vendors Rated by Client Satisfaction, Black Book Rankings Announce 2013 Inpatient EHR Leaders

Black Book Rankings, which provides vendor satisfaction reports, gives CPSI the under 100-bed market, Cerner wins in the 100-249 bed range, and Epic takes the 250+ bed market. Unlike KLAS, Black Book’s methodology includes an external audit of data by independent statisticians.

VA CTO Peter Levin to leave agency

VA CTO Peter Levin announces his resignation just days after VA CIO Roger Baker made his own announcement. Levin led the Blue Button initiative and was a key advisor to the iEHR program. Both Levin and Baker were scheduled to appear before the House Veterans Affairs Committee next week to answer for the abrupt halt of the iEHR program.

Express Scripts accuses Ernst & Young of stealing trade secrets

Express Scripts sues Ernst & Young after discovering that an E&Y health information technology partner stole confidential documents related to pricing information, business projections, and strategy while working on the Express Scripts and Medco Health Solutions merger. Express Scripts claims the E&Y employee emailed more than 20,000 confidential documents to his personal e-mail account with the intention of using the information to secure future business with both Express Scripts and its competitors.

Health System Chief Information Officers: Juggling responsibilities, managing expectations, building the future

Deloitte releases a whitepaper on future challenges within health IT according to hospital CIOs. Respondents largely report being comfortable with their ability to handle MU and ICD-10 requirements. Goals moving forward included integrating independent medical practice IT systems, protection of PHI in a quickly growing digital environment, and transitions from fee-for-service to value-based models.

The Skeptical Convert 2/20/13

Angry Birds vs. The Fruit Altimeter

A man’s reach should exceed his grasp, or what’s a metaphor? Marshall McLuhan

I love a good metaphor as much as the next wetware-based concept processor, and Jonathan Bush’s labeling of Epocrates as “Angry Birds for healthcare” was a particularly clever one. But is it a useful one?

I was an early adopter of Epocrates on my Palm III (now bricked, and yes, there I go) and it quickly became indispensable in my everyday professional activities. For decades before, the only way to look up a drug information you didn’t have memorized was to haul up your giant copy of Physician’s Desk Reference and tediously turn pages. 

What you got there was a small-print version of the complete prescribing information, with every lawyer-generated factoid laid out horizontally. Useful things like the, uh, dose were hidden deep inside somewhere. So yes, I get the metaphorical point — quick, intuitive, easy to use, everything you need right there.  

The difference between Epocrates and Angry Birds, though, gets to the fundamental reasons for their popularity. The actually better comparator for the avian slingshot game would be Windows Solitaire. Because in both cases, new operating system technology required the use of new tools and/or techniques for on-screen manipulation, and both applications made learning of these techniques fun, although in both cases, unfortunately, time-wastingly addictive. Nobody sits for hours mesmerized by ePocrates. But that’s because Epocrates wasn’t about technique, it was about information.  

Which gets to that other metaphor you hear so much, the one about the tree with the fruit on it. We speak of “going after the low-hanging fruit” as an opportunity to get or accomplish something worthwhile and/or profitable with a relatively low level of effort. In this context, I suppose you can argue for applying that metaphor to Epocrates.

For the practitioner, drug information was well up in the middle of the tree, not difficult to understand per se, but difficult to reach. Epocrates put that information in your pocket and organized it the way a doctor thinks. Most drugs you prescribe are not new to you, but you need to check the dose quickly, or the pregnancy warnings, or answer a question about side effects. They organized perfectly for that, with categories that were clear and logical for us. At a basic mechanical level, they made it lower-hanging fruit for the doctor, which made it worth so much to Mr. Bush.

But there’s another side to this.  I doubt that the fruit was hanging quite so low for the developers. I’m sure designing the program, writing the code, and debugging it took a lot of work. I don’t know how much effort it was to take existing data and put it into a format that could be used by the new app. But the information had been digitized already, and to the practitioner it seemed like everyone else had digital access to it and was using it against you — the outside pharmacist telling you you wrote it wrong, the hospital pharmacist telling you it wasn’t on the formulary, the benefits person saying it wasn’t covered. Endless pages. They were throwing the fruit at you. At least if you could grab some and fire it back, you had more of a fighting chance.

With a slingshot motion, I guess?  OK, the fruit’s fermenting and I’m getting dizzy.  But I often wonder why the argument for improved control over already-digitized processes isn’t used more to motivate doctors to embrace CPOE. I’ll work on that one when the fire department comes to get me out of this tree.  

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

HIStalk Interviews Keith Ryan, President, Cornerstone Advisors

Keith Ryan is president and founder of Cornerstone Advisors Group, LLC of Georgetown, CT.

Tell me about yourself and the company.

I’ve been in healthcare IT for over 20 years now. I’ve played on both sides of the desk, so to speak. I spent over a decade of my career early on as a provider of professional services, both in Andersen Consulting and subsequently at First Consulting Group. Later in my career, I spent about half a dozen years consuming professional services as an executive-level CIO in a large teaching medical center on the East Coast, and then again at a relatively progressive community hospital outside of Chicago.

What I’ve learned as a result of those first 16 or 17 years is perspective and empathy for the CIO. The role of the CIO is without question the most challenging in healthcare today. It’s a big job. Partnerships are critically important. Having an organization – a consulting firm, if you will — you can trust and rely on and know is committed to your success is necessary. We strive at Cornerstone every day to be that firm for our clients.

Our services are largely focused in two areas — advisory and planning. In this capacity, we help our clients and their organizations elevate their decision-making process regarding IT. From an implementation perspective, which is the second area, helping lead, manage, and staff those implementation or transformational initiatives for them.

We’d like to think that these two service competencies enable us to be holistic, offer thought leadership, and evaluate our ability to effectively enhance the relationship with our clients. We focus on solutions and the effective execution of those solutions and try and work in that space rather than focus on the task of implementing systems.

What kind of engagements are clients calling you about most these days?

We probably spend about 30 percent of our time in the advisory and planning space, and then let’s say 60 to to 65 percent in the implementation space. Implementation obviously is the fastest-growing component of our business. It’s not unique to us. The remaining five percent, we do what we would call interim staffing engagements. It’s a bad label because people often mistake it as a staffing service, but truly interim leadership. We’ll do interim CIO or interim CMIO type work.

On the advisory and planning side, It’s largely Meaningful Use and compliance planning and road mapping. We do a fair amount of systems selection work and we’ve been recently getting engaged in a number of turnaround efforts. Organizations obviously now are elevating IT or the contribution of IT and that’s finding itself on the radars of CEOs and CFOs and COOs. As a result, they’re recognizing they need more out of their IT organization. We often play a role in helping them define what that looks like.

It seems that more consultants are being used for implementation work, where previously much of the work was planning and system selection. Do you get the feeling that almost everybody uses consultants now?

There were always downstream opportunities. It was really bringing more of a process and discipline to the table, whereas now I think the agendas for IT are so significant, largely driven obviously by Meaningful Use, that many of them are just looking for help.

It is largely focused right now on implementation. It’s about building infrastructure and getting some of the foundational elements in place. Organizations are largely consumed by that, and as a result, they’re reaching out more to consulting firms.

As a component of that, everybody’s now in the consulting business. What we traditionally referred to as staff augmentation firms are often calling themselves consultants. There are many more buyers, and a lot of those buyers are blurring the lines between traditional consulting firms — or what I would call solution-based firms — and more contemporary consulting firms, which often look like staff augmentation firms. 

I think it’s fair to say that now there is a lot more activity and it’s largely built around implementation. But I think there’s a question of sustainability for some of these firms who have built themselves around this model of supporting clients strictly from an implementation perspective.

CIOs used to choose consulting firms based on on how likely they were to transfer knowledge to their IT department instead of just selling it to them indefinitely. Has years of that knowledge transfer raised the level of expertise in hospital IT departments?

We as an industry are becoming smarter about our trade. CIOs have elevated themselves within their organizations over the course of the last two decades and hopefully will continue to do so. I’m not sure that that’s a result of them getting intelligence from consulting firms. It’s them just growing with the expectation of the organization.

Organizations now more than ever before, certainly in healthcare, are starting to recognize that IT has the ability to add value and contribute it to the success of the organization, Historically for many — not all, but for many – organizations, IT was always recognized as a cost of doing business and a necessary evil.

With that evolution, so has grown the contribution that the individual is making to the organization. I’m not sure I would draw a parallel that that’s a result of CIOs relying on consulting organization. I think it’s more as result of them responding to the demands of their organization in light of where the industry is going.

Are there a lot of people like you who get experience on the provider side, then go into consulting, and then come back?

No, I don’t think it is. It’s one of the things that differentiates us as an organization and our philosophy and our approach to our clients. I’ve mentioned earlier that we value more than anything our partnership with our clients. I don’t think that we’re bringing a higher degree of intelligence to the engagement. What we’re bringing to the engagement is a broader degree of exposure to what works and what doesn’t work within the industry, because we’re engaged with multiple organizations and we’re going through similar efforts on multiple fronts.

That’s what I consider to be thought leadership — the value of experience. In addition to that, CIOs are recognizing that the job is just so big they need to rely on partners that they can trust and they know will have their best interest at heart and bring to whatever effort that they’re working on some of the best resources that might be available to them in the industry. That’s what we’re trying to do for our clients and that’s what we try and focus on. To suggest that we bring more than that seems to be perhaps arrogant.

I assume that the range of engagements has narrowed, with a bunch of organizations doing projects like Epic implementations, analytics, Meaningful Use, or ICD-10 all at the same time. Do you think the breadth of consulting engagements has narrowed?

Yes, I think it has. When you look at advisory services as an example, most of that is built around system selection, ambulatory integration, and compliance planning. It used to be strategy.

Strategy now is, “How do I meet the regulatory requirements of Meaningful Use, for not just Stage 1, but Stage 2 and Stage 3?” That now has becomes the two- to three-year agenda for just about every organization in the industry right now. So I do agree. I think it has narrowed the scope of services.

But some things that fundamentally remain the same is the fact that organizations want partners who can be holistic, who can help them understand how to focus on the solutions rather than tactics. They want someone who is going to be committed to them to work in their best interest.

When prospects choose a consulting organization, what are their most common criteria and why do they choose Cornerstone?

Every organization is different. We’re perhaps unique in that if you look at our client portfolio, you would see organizations with a range in size from 25-bed critical access facilities to 500-plus-bed teaching medical centers. Each of them are looking for something different in a partner.

Organizations that traditionally have not had the resources or the sponsorship within their organization to think strategically about IT are now starting to ask themselves those questions, and are wanting help and finding those answers. They’re looking for a partner who can bring that to the table and can also offer them resources to help execute whatever that solution is.

Organizations on the larger side of the spectrum probably feel for the most part that they have a lot of the blocking and tackling issues under control. They’re looking two or three years out and they’re focusing on other things. They’re focusing on how do we drive our competitive advantage within our organization through the use of IT? How do we drive physician engagement? How do we support ACO efforts and the like?

Our KLAS ratings were a proud moment for us last year. It was validation of who we are and the type of firm that we’re striving to become. Obviously we were touched by our clients’ commitment to us in return for the services that we’ve offered them. Client satisfaction is obviously the hallmark of success in this business. Our goal which, we try and strive for every day, is to exceed the expectations of every client, every time. KLAS was helpful in objectively validating that we’re doing that on a regular basis.

It’s tough to wring a high “money’s worth” score out of anybody’s customers. What did you do to get a nine on a 10-point scale?

Part of this is our evolution and part of this is where the industry is going, which is frightening perhaps at times. There’s tremendous amount of pressure to commoditize these services. The lines between traditional consulting firms and modern-day staffing firms are blurring, at least from the perspective of many buyers. Probably not from our perspective, but that’s not the one that always matters.

For us, recognizing that we’re a smaller organization and in many cases less-familiar player, we often find ourselves competing across the broader spectrum. In some cases, we’re competing with staff augmentation firm rates while delivering a higher value. That’s being recognized by our clients. Not only are we helping them get the job done, we’re bringing a broader focus to the table and helping them execute on a solution rather than just the tactics of installing a system. That probably has a lot to do with it. Our challenge obviously is going to be continuing to sustain that.

Are hospitals still interested in return on investment?

Without question, probably more so today than ever before because the amount of investment is far greater than it’s ever been. We often find that many organizations anticipate that Meaningful Use will provide them the return on investment. We spend a lot of time educating organizations on what the true total cost of ownership is and what it takes to deliver good IT services to the organization.

When they look at those numbers and realize that it represents now more than ever before, it is obviously an increasing number as a percent of operations, but hovering in the four to five percent range now, which represents a significant investment. They are looking to make sure that they can get a return on that.

Meaningful Use made it easy to measure at least some aspects of return on investment because you know what it costs to get a one-time check for a specific dollar amount. But are organizations paying enough attention to their operating expenses relate to the capital expense?

It’s still difficult to measure, but having those metrics in place — whether they’re qualitative or quantitative — are important. It drives a degree of alignment and a degree of sponsorship, which is important within the organization. Oftentimes when these projects don’t bear the results that organizational leaders are looking for, it’s often as a result of governance or the lack thereof. 

What I mean by that is making sure that you have all the right members and all the stakeholders within the organization understanding the purpose and the objective of the project, aligning incentives so that people recognize that their contribution to this is important and critical, and making sure that the entire organization is rowing in the same direction. Nine out of ten times, the reason for projects not meeting their objectives is because you don’t have that kind of alignment established within the organization. 

We spend a lot of time working on this. We have developed a methodology we call e-Methods. It has five components to it – evaluate, educate, engage, execute, and exchange. Three-fifths of the methodology, as you can imagine, is focused on building alignment, making sure that the organization is fully bought into the exercise and that they understand the objectives and that they’re committed to it. If you can accomplish that, half the battle has been won.

Big IT projects other than infrastructure are really big change management projects. How do you assess a client’s capabilities to manage change on a large scale?

It’s change management, or culture management as we often like to refer to it. Most would recognize that culture eats strategy every time. That’s an important key that you need to focus on. It’s built into our methodology. We address it that way and we spend a lot of time upfront evaluating culture, trying to understand the barriers to adoption and what might get in the way of success. 

We build that into our model. We spend a lot of time educating the organization and helping them understand what we foresee as cultural barriers. We’ll educate the executive team. In many cases, we’ll even include the board in some of those discussions. You can push this change from the top down throughout the organization so that you have the right kind of sponsorship and leadership from the get-go.

What if you find that their culture really isn’t amenable to change management for a project of that level? Do you tell them to not sign that deal or tell them what they need to change?

We try and bring a level of awareness to the issue. We often rely on them to help us understand what we can do to contribute to that. First and foremost, we want them to understand that the issue exists and that it’s a potential risk to the project if we don’t address it. We will sit down. We will collaborate on ways to do that.

What should CIOs be doing right now to prepare for the future five years down the road?

It’s always interesting when you think about the timeline of three to five years, because that’s what we often look to as the future. In probably three to five years, we’re going to be on the tail end of us implementing all these infrastructure that’s being acquired right now. The focus is going to be, now that we’ve put all these technologies and tools in place and we’re capturing data, how do we use it to drive improvements and outcome? 

Data analytics is largely going to be the focus probably five years from now. It’s going to take us a decade as an industry to really figure that out and get it right.

Any concluding thoughts?

In other interviews, you often ask what differentiates once consulting firm from another. My reaction to that is simple. It has everything to do with relationships ­ – the relationship we have with our clients, the relationship we have with our associates.

We have two philosophies that we live by. First is clients for life. Second is associates for life. Although these are simple in words, these two things shape our actions almost daily. They impact our hiring process. They impact our retention and associate development commitment, our culture, how we approach engagements, how we support clients, and how we develop and maintain those relationships with our associates and our clients.

We believe, perhaps maybe even naively, that if we focus on these two simple principles rather than success metrics themselves, success often becomes the by-product.

I think it’s an exciting time to be in healthcare. It’s good to be here. There is a commitment to revolutionize the industry like never before. It’s going to take time.

Information technology will play a vital role. Right now we seem to be largely focused on elevating the IT agenda while also implementing basic infrastructure elements. I look forward to these tools and technologies helping our clients drive value, improve outcomes, and empower patients. I think the future is bright and I’m excited to be a part of it.

Morning Headlines 2/20/13

Allscripts Healthcare swings to loss

Allscripts reports Q4 results: revenue was down 10 percent, EPS –$0.14 vs. $0.14. CEO Paul Black said that both the quarterly and annual results "did not meet our expectations." The company plans to close 12 offices and take other measures to reduce product development costs.

Merge Reports Subscription Backlog Up 82%

Merge reports Q4 results: revenue up 1 percent, adjusted EPS –$0.13 vs. $0.04 on sales of $65.1 million. The board rejected valuations placed on strategic alternatives and reiterates 2013 guidance of sales range of $265 – $275 million.

iMedicor Announces Two Acquisitions, Four Corporate Appointments

iMedicor announces the acquisition of HITS Consulting Group and the appointment of HITS CEO Henry Denis to president.The company also acquired data mining firm ClarDIS and founder Joshua Brimdyr was appointed as COO.

Bayada prescribes 4,000 Samsung Galaxy Tabs for homecare nurses

Bayada issues Galaxy tablets outfitted with the SwiftKey Healthcare dictionary to home health nurses for use with clinical documentation. A pilot program found that a typical nurse reduced documentation time by 30 minutes every day by using a tablet rather than a laptop or pen and paper.

News 2/20/13

Top News

Allscripts reports Q4 numbers: revenue down 10 percent, EPS –$0.14 vs. $0.14. The company’s reported revenue of $350.9 million fell short of expectations of $368 million on weaker sales and a deferred revenue provision, while the loss of $0.14 per share missed expectations of a positive $0.20 per share. President and CEO Paul Black says both the quarterly and annual results “did not meet our expectations.” Shares are up 6 percent in after-hours trading due to higher-than-expected bookings. From the conference call:

• Reception to the MyWay to Professional program “has been strong.”
• Two Sunrise acute care agreements have been signed so far this year, one of them with an existing client.
• The four key areas of focus are client alignment, unlocking competitive advantage, reducing costs, and reporting consistent financial results.
• Two-thirds of developers will be located in either Raleigh, NC or Boston after office consolidation.
• The company plans to expand its hosting business.

Reader Comments

From UAHN Rocks: “Thanks for all the great work you to.  I am writing to share a video made by patients, clinicians, and executives from The University of Arizona Health Network’s Diamond Children’s hospital to celebrate the amazing work that they do to improve the lives of children in the community. UAHN is in the midst of an enterprise implementation of Epic, covering Diamond Children’s as well as all of our adult and outpatient facilities, with a go-live later this summer.” The video contains a medley of music, so keep playing, including a big finish with the magnificent Electric Light Orchestra at 3:00.

From HIMSS Bound and Gagged: “Re: flights to New Orleans. Costs are out of control, causing us to scale back our attendees. Have you heard anything?” According to Travelocity, the round-trip cheapest flights are $1,767 (Chicago), $1,142 (Atlanta), $1,582 (Los Angeles), and $1,687 (New York). Those include some really crappy connections as well, like going through Denver from New York. I seem to recall that the HIMSS post-Katrina booking of New Orleans in 2007 had similar problems, where flights were not sufficient to get people in and out. HIMSS was supposed to have narrowed down its conference cities to just three – Orlando, Atlanta, and Las Vegas – if I’m remembering right from a few years ago. All three are easy to get to, cheap, and have endlessly available hotels, restaurants, cabs, service workers, etc. Then came the charitable addition of New Orleans (whose infrastructure clearly wasn’t up to the challenge despite the HIMSS pitch) and the hometown reach-around to Chicago (where everything, especially union member surliness, cost twice what it would have in those other three cities and it was cold and snowy besides). Both were HIMSS low points in my opinion, yet here we are going back to New Orleans this year and Chicago in 2015. The best city (San Diego) and the cheapest (Dallas) were dropped from the rotation years ago. I’m pretty sure that if HIMSS actually listened to its members, or even asked them for that matter, they would not favor returning to New Orleans or Chicago even though those cities are perfectly fine for personal travel. I booked my flight on January 23 and was griping about paying $300 and now it’s over $1,300. If you don’t already have a flight, aren’t within driving distance, and aren’t a fan of Amtrak or Greyhound, you’re screwed.

HIStalk Announcements and Requests

In case you missed it we published the HIStalk Guide to HIMSS13 over the weekend. More than 130 vendors (all of whom happen to be HIStalk sponsors) provide details on the products and services they will be featuring this year. We also created HIStalk’s Guide to HIMSS13 Meetups, which includes contact information on about 30 vendors that are not exhibiting but happy to schedule meetings with interested folks. Finally we developed HIStalk’s Guide to Exhibitor Giveaways to help you find the best swag.  When you chat with these vendors, please tell them thanks for supporting HIStalk.

I accompanied a family member to get X-rays yesterday and stood outside in the hallway during the actual scan. While waiting, I was able to read all sorts of patient-specific information on two different monitors, as well as on the computed radiography reader (Mr. H tells me that’s the name of the thingy on the left.) Why worry about privacy, right?

Welcome to new HIStalk Platinum sponsor Legacy Data Access of Marietta, GA. It’s refreshing that the company’s mission is not only easy to describe, but is even contained in its name. Legacy Data Access provides customers with access to all of that data that’s locked away in their retired legacy applications. The company eliminates the hassle and cost of keeping the old app running solely for occasional lookups or reports. Clients don’t need to pay apps vendors for support, maintain aging servers, chew up big chunks of their disaster recovery plan, and tie up high-level talent keeping an abandoned system running after Legacy has moved data from that old system to a shiny new database and given users a slick Web-based front end and extemporaneous reporting tool for their inquiries. Think of LDA as a retirement home for apps, which might include revenue cycle systems (clients still get receivables functionality), PM/EHR, nursing documentation, and ancillaries. LDA can even provide a Legal Medical Record. Some of the company’s customers are UCSF, Parkland, Stanford, Trinity Health, and others that are so recognizable that it would be just name-dropping on my part to continue reciting them. If your IT stroll down memory lane includes Carecast, Invision, STAR, MedSeries4, Series 2000, ESI, Premis, EMstat, Midas, or others whether they’re on LDA’s list or not, they can help. Once an app is ready for full retirement, LDA will move everything to its LegacyVault, where information will be available indefinitely (like in the case of a lawsuit). Move on to your new-system life by letting LDA help you move gracefully away from the old one. Thanks to Legacy Data Access for supporting HIStalk.

HIMSS Conference Social Events

At least in my mind THE social event of HIMSS is HIStalkapalooza. Here are a few vital details for those attending:

• Invitations will go out starting Wednesday. Make sure to check your spam filters. We’re inviting twice the usual number of folks, so the odds of getting an invitation are favorable.
• Medicomp is once again sponsoring HIStalkapalooza and they know how to throw a party, as those of you who attended the 2011 event at BB King’s in Orlando can attest. Guests will be greeted on the red carpet and handed a Hurricane Inga or Typhoon Jane. How’s that for hospitality?
• The Inga Loves My Shoes contest is back by popular demand, so pack your best zapatos. Since HIStalkapalooza is at the Rock ‘N’ Bowl, we will have a category for Best Bowling Shoes, as well as Hottest Men’s and Women’s Shoes.
• We will again crown a HIStalk King and Queen for the best-dressed guests, so bring your bling. We’ll also recognize the Best Bowling Attire for those opting for the ten pin look. If you haven’t figured out what to wear, here is a tip: nothing says sexy like a bowling shirt, except maybe sequins and a tux. I expect to see plenty of stilettos and Farzad-inspired bow ties. Feel free to leave your company-logoed shirt in the hotel room.
• The party starts at 6:30 and the contests (followed by the HISsies) will begin about 7:30. Our esteemed judges will begin selecting contest finalists as soon as the doors open, so don’t be late.
• After the HISsies, the Zydeco band and the fast-paced bowling tournament get going. Bowling teams currently include keglers from athenahealth, Bumrungrad International Hospital, CareCloud, Clinical Architecture, Northrop Grumman, Orion, SuccessEHS, and Vitera.
• The party goes on until 11:30, so join us late after your fancy dinner at Emeril’s.

Acquisitions, Funding, Business, and Stock

Liaison Technologies acquires Ignis Systems, a provider of clinical data integration solutions for lab and radiology orders and results.

Allscripts discloses in a regulatory filing its plans to close 12 offices and implement other changes to reduce costs associated with product development. The company estimates that it will spend $10 million for employee severance, $16 million for relocation costs , and $3 million for lease exit costs.

Merge reports Q4 results: revenue up 1 percent, adjusted EPS –$0.13 vs. $0.04, missing consensus earnings estimates. The company also announced that its board has unanimously rejected the valuation placed on the company in strategic alternatives proposals and will instead continue to execute its own plan. In the conference call, the company pointed out strongly increased bookings, increasing subscription revenue, increased acceptance of its iConnect enterprise archive, and growth in specialty areas such as cardiology and orthopedics.

Social network platform vendor iMedicor acquires HITS Consulting Group (HITS CG) and the data mining firm ClarDIS. The company also appointed HITS CG CEO Henry Denis president and ClariDIS Founder and President Joshua Brimdyr as COO.

Clinical research services vendor Quintiles announces plans for a $600 million IPO. The company was taken private by Bain and TPG in 2008 for $3.8 billion and is $2.4 billion in debt. The founder, Bain, and TPG each own shares worth around $500 million.

Sales

Triad Healthcare Network (NC) will implement Alere Accountable Care Solutions for its HIE.

Cardiovascular Care Group selects McKesson’s Paragon HIS for use at its Bakersfield Heart Hospital (CA) facility.

Pioneers Memorial Healthcare District (CA) will deploy Medseek’s self-service portal tools.

People

Kimberly Labow (NaviNet) joins ZirMed as VP of marketing.

Clinithink appoints Russ Anderson (Availity) VP of product management.

Roland L. Surprenant (Allscripts) joins Patient Safe as a regional VP.

Hal Andrews (Mainland Morgan & Co.) joins nTelagent as CEO, replacing founder Earl Winter, who remains on the board.

The SSI Group names Terry Pefanis (Healthtech Holdings) as CFO and promotes Mary Hyland to VP of regulatory affairs/chief privacy officer.

Brian Graves (Picis) joins Connance, Inc. as VP of marketing and communications.

HCA Gulf Coast Division (TX) names Carl Vartian, MD to the additional role of CMIO. He will continue as chief medical officer of Bayshore Medical Center (TX).

Alan Huffman (Healthcare Management Systems) joins Shareable Ink as VP of engineering.

Announcements and Implementations

Benjamin Russell Hospital for Children (AL) goes live on the Versus Advantages Asset Tracking solution, which includes two-way HL7 integration to Four Rivers Total Maintenance System.

Data analytics and natural language processing vendor Health Fidelity is awarded a National Science Foundation grant to develop technology to identify patient cohorts using EHR data. 

Government and Politics

HHS names Marshfield Clinic Research Foundation the winner of its Million Hearts Risk Check Challenge for its Heart Health Mobile app and awards the Foundation $100,000 for maintenance and updates.

CDC releases Solve the Outbreak, a free iPad game.

Technology

Palomar Health will announce this week that it’s the first customer of a new wireless vital signs monitor for tablets and smartphones. The phone-sized, wrist-attached ViSi Mobile by Sotera Wireless will send continuous information on heart rate, blood pressure, and oxygen levels directly to the electronic medical record, allowing non-invasive monitoring from any hospital location.

Bayada Home Health Care issues 4,000 Samsung Galaxy Tab tablets to its professionals following a 20-person pilot project. They’re using SwiftKey Healthcare ($3.99), which speeds up documentation with an on-screen keyboard, terminology dictionary, and auto-fill capability. More than two-thirds of Bayada’s nurses who use SwiftKey said they would rather document on the tablet instead of on the laptop or on paper. It doesn’t work on iOS devices, though, since Apple doesn’t permit third-party keyboards.

Other

HIMSS will lease 25,000 square feet in Cleveland’s Global Center for Health Innovation (just renamed from Medical Mart at the request of its tenants) to be used for exhibition, education, and demonstration as well as the HIMSS Innovation Center, presumably replacing its planned presence at the defunct Nashville Medical Trade Center project.

I think I remember a reader’s earlier question about Epic’s Meaningful Use Stage 2 certification status (it involved a claim that they wouldn’t be ready, as I recall). Both EpicCare Inpatient and Ambulatory are now listed on CCHIT’s site as being certified for the 2014 criteria.

A bomb scare-triggered lockdown this week at Natividad Medical Center (CA) proves the value of its electronic medical record in an emergency. According to the hospital assistant administrator, “We have an electronic medical record, so we are able to see where the patients are and what kind of service they need.”

A Black Book Rankings provider poll finds that up to 17 percent of physician practices may be planning to change EHRs in the next year, which it blames on vendors who are too busy selling and implementing their products to address unmet client needs. Of those practices contemplating a change, more than half said they would prefer a hosted solution. Specialists expressed strong dissatisfaction with their current systems, with more than 70 percent of ENT, immunology, orthopedics, gastroenterology, ophthalmology, urology, and nephrology practices saying their current EHR doesn’t meet their needs.

A trauma center in India implements a new system that eliminates readability issues with physician documentation and reduces the time required to document 30,000 accident cases per year. The self-developed, template-based new system is solely for “medico-legal cases,” i.e. it’s not for patient care, but rather to document cases that may eventually initiate a lawsuit.

Sponsor Updates

• SCI Solutions adds 93 hospitals in 2012, achieves sequential sales growth of 37 percent, and maintains an attrition rate below two percent.
• Ping Identity showcases its next-generation cloud and mobile identity management solution during next week’s RSA conference in San Francisco.
• Greenway’s PrimeSUITE (V17.0) receives 2014 ONC HIT certification as a complete EHR. The company will also integrate the Physicians Interactive eCoupon voucher and coupon distribution system into  the system.
• Covisint releases its Direct solution that provides secure, scalable point-to-point email-like messaging. 
• ICA selects Health Language from Wolters Kluwer Health to support its HIE platform.
• MedAptus VP of Client Services Rick Little shares details of MD Anderson Cancer Center’s use of MedAptus for charge capture.
• NIH experts validate PeriGen’s fetal heart rate interpretation, which was presented this week at the Society of Maternal Fetal Medicine in San Francisco.
• Aspen Advisors becomes a Premier CHIME Foundation member.
• iSirona will be featured in the Interoperability Showcase at the HIMSS conference after passing the interoperability requirements at IHE North America Connectathon.
• Beacon Partners will offer a session entitled “Habits of Highly Meaningful Users” at the HIMSS conference on March 6.
• Healthpac will embed PatientPay’s online bill management services into its practice management system.
• ICA and Futurix Health partner to offer payers, ACOs, and providers enhanced data analytics and benchmarking tools coupled with ICA’s interoperability and informatics platform.
• DynaMed and Isabel Healthcare partner to allow mutual customers linkage from Isabel’s differential diagnosis tool to DynaMed’s evidence-based clinical information resources.
• An Iatric Systems video describes the company’s vision for comprehensive healthcare IT integration.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 2/19/13

Speech Recognition Tools Look to Play a Crucial Role within EMR

KLAS reviews front-end and back-end speech recognition systems including Nuance, Agfa, Dolbey, and MModal. The latter saw a significant increase in satisfaction with its back-end solution, but a significant decrease in satisfaction of with its front-end solution.

Obama Seeking to Boost Study of Human Brain

The Obama administration is planning to announce plans for a decade-long scientific effort to build a comprehensive map of the human brain, seeking to do for the brain what the human genome project did for genetics.

A sensational breakthrough: the first bionic hand that can feel

Researchers announce a prosthetic hand that will receive command instructions from the brain and send back tactile information about the environment in what will be the first prosthetic capable of bi-directional communication with the brain.

Curbside Consult with Dr. Jayne 2/18/13

In the last several months, I’ve been involved in a lot of conversations around the concept of unique patient identifiers. A considerable amount of it has been due to our hospital’s participating in an accountable care organization.

We have a very good master patient index (MPI) in place, as well as other tools that allow most of our applications to use CCOW to share patient context as well as user context. Now the ACO is requiring us to tightly integrate with providers external to our owned facilities and employed medical group. That is giving a lot of people in our organization a fair amount of heartburn.

During nearly a decade of practice acquisitions and mergers, I’ve seen how people in various practices may (or may not) correctly identify patients. I’ve seen people perform patient searches using: the first three characters of both first and last name; first name, last name, and Social Security number; first initial, last name, and phone number; and various combinations of name, address, and date of birth. In consulting work, I’ve seen clients with both pristine MPIs and those clogged with duplicates.

The health of the MPI depends on not only the actual data integrity, but how the information is governed. The logic of the matching algorithm also plays a major role in minimizing erroneous matches or missed matches. If person merges are not performed in a timely manner (or if users don’t know how to request a merge when they find a duplicate patient) patient safety can be in jeopardy. In large health systems that have let their MPIs get out of control, it can take months to years for a cleanup effort to be successful.

Our organization is all too familiar with what happens when data isn’t as tightly governed as it is within our MPI. We’ve dealt with the pharmacy intermediaries that use ZIP codes for matching, which is a challenge for our transient patients. We’ve dealt with Sandy vs. Sandie vs. Sandi when the patient’s legal name is Sandra. We’ve dealt with marriages and divorces and the ensuing claim denials that result when names may not match.

There has been a lot of debate in the past about a national patient identifier. As fiercely independent Americans, we seem to fight it as an intrusion into our privacy. However, we willingly submit to a government identifier in order to pay taxes or receive government benefits (the Social Security number) or when we want to drive a car (the state-issued driver’s license number) or go to the Caribbean for spring break (the passport). Yet for the most personal situations (and possibly life-saving or life-threatening, depending on how you think of it), we resist a unique identifier.

I have to have a National Provider Identifier number if I want to receive anything other than a cash payment for my professional medical services. It took time and effort to update clinical, administrative, and payer systems with fields to track the NPI, but somehow we all survived. The same type of update would be needed to track a patient identifier, but the demands of Meaningful Use have proven that vendors can and will update systems based on government regulations.

There would also need to be a new government infrastructure created to issue identifiers and maintain the information. Meaningful Use has also demonstrated a willingness to accept additional layers of bureaucracy in the name of intended reform, so why not for a patient identifier?

Having a unique patient identifier would certainly make interoperability easier. It would also provide significant benefits to patient safety by reducing the possibility of duplicate or conflicting charts. Knowing exactly who we’re treating can also assist in preventing drug diversion and reducing healthcare and insurance fraud.

The original HIPAA Act of 1996 allowed for the creation of unique patient ID numbers, but Congress quickly blocked funding, citing privacy concerns, existing numbering systems, and concerns about government involvement in health care. A decade and a half later, however, those trains have long left the station. It’s time to reconsider.

There is significant support among the professional community. The American College of Cardiology has a nice position statement. Many other organizations cite the 2008 RAND Corporation study titled “Identity Crisis” in calling for support.  The RAND study also discusses the need to use both statistical matching and a unique identifier during the implementation process or if participation is voluntary.

Correct patient identification is essential for effective health information exchanges. There’s a lot of discussion around the Direct protocols for Meaningful Use Stage 2. Privacy rights advocates are pushing for patient-defined identifiers where patients can choose different identifiers in different situations depending on what data they want shared. Although this may allow some data to remain siloed in an effort to protect privacy, it also prevents creation of a true comprehensive patient record.

I support the ability of patients to receive care anonymously, but when patients do so, they should not be surprised that physicians and caregivers may not have the full picture of the patient’s health. Physicians and hospitals should not be held liable for negative outcomes when information is sequestered by the patient. For the rest of us, however, who want to ensure that our physicians have our entire health history present so we can receive the best care possible, this can’t happen too soon.

What do you think about a national patient identifier? E-mail me.

E-mail Dr. Jayne.

HIStalk Interviews Margaret Laub, CEO, Intelligent InSites

Margaret Laub is president and CEO of Intelligent InSites of Fargo, ND.

Tell me about yourself and the company.

Intelligent InSites is 10 years old. I think about us as being the operational intelligence platform that essentially leverages real-time data from both EMRs and other HIT systems as well as sensory tags. Our goal is to increase the efficiency of health systems while improving care.

I joined Intelligent InSites in August. I have a background in healthcare services and technology for the last 15 or so years. I spent some time at McKesson, where I ran the “not the distribution business” and “not the hospital technology systems”, but what I call the “all other businesses.” Everything there has a technology component to it and a services component to it.

I’ve been in technology and services in healthcare for a long time. I grew up in the accounting field. I was an accountant back in the day with Coopers & Lybrand, which is partly what really interests me in Intelligent InSites and operational intelligence.

One of the reasons I’m here is to see the value of knowing what’s going on within your hospitals. Really seeing what’s going on and being able to make immediate decisions about those activities that can provide value from the standpoint of improving satisfaction, saving money, meeting compliance regulations, or improving quality. Back in the day when I was growing up, I did things like activity-based costing, which is essentially looking up what’s going on in your business, applying inputs and outputs to those things, and being able to make decisions about how better to improve your processes.

When I saw Intelligent InSites and the fact that we were a platform that was looking to accumulate data from a number of different data sources — sensory tags and/or HIT systems — and actually apply it at the point of service as well as being able to look at data providers over a period of time, I got very excited. I said, “Wow, that’s a great thing for me to do.” I’m here and very excited about helping us create this market.

It doesn’t seem that long ago that an RFID project involved expensive door frame sensors and passive tags. You got just enough software to turn out a primitive tracking log and maybe saved some money by tracking equipment instead of renting it. What’s the current state and how did we get here?

Many things coalesced. They all came together at one time. The population and customers probably started demanding more service. I don’t want to be treated like the old days, where I had to go to an old hospital and have things done to me. I would like to know what’s going to be done. I would like to be part of that process. I would like to comment on the value of the service I got. There is the whole consumer quality driving aspect to the environment that we didn’t have 10 years ago.

New reimbursement models are coming down, both from the standpoint of the regulatory environment as well as just the fact that populations are growing and everybody needs to use their resources in a much more efficient way. There are fewer physicians. There are fewer nurses. There are fewer dollars to be spent on things. All of these things are coalescing all at the same time, which is going to cause folks to say, “Wait a second. I really, really, really have to look at how I’m operating the business.” 

More importantly, as the volumes of patients or services are being provided, every single thing has to be done for an individual. Healthcare is individual. Each one of us is going to be treated a bit differently, and yet we’re going to have to find ways to treat people consistently and in a standardized way just because we’re going to have to do it from a financial standpoint.

That’s what’s changed. People need to get insight and visibility into how to do that. It’s not just about the hard dollars any more. It’s not just about finding pieces of equipment. It’s how are we using an equipment, to whom are we applying that equipment, why are we doing it, for how long are we doing it, is there a different way to do it? All of those things need to be looked at, because all these influences are coming together at once.

Certainly accountable care has even moved that far up. Meaningful Use, accountable care, all of those things are just driving it. Hospitals and IDNs really do need to start thinking of themselves in a bit of a different way. I think it’s the larger IDNs, the ones who are leading, who have done the EMRs, and who have taken big steps in looking at the clinical side of the business. Now we’re going to start looking at, how do I take the clinical piece and how do I integrate that into my operation so it’s not only clinical delivery that’s efficient and effective and valuable and satisfactory, but it’s also how I actually deliver it?

Many times people find creative uses for a technology once the infrastructure investment has been made. Do you have some examples of some high reward type customer projects?

One of our customers has used our technology to do their workflows in a very different way. In clinics generally and in hospitals, the patient goes to where the services are. One of our clients has changed the way they deliver the service. They take the services to the patients. The workflow has changed. It gets more efficient. It gets more effective. 

What they’ve been able to do with our enterprise platform as well as one of our workflow apps that we’ve worked with them on is change the way that that service is delivered. Instead of the serial nature of it, essentially the services are going to the patient. That’s very, very different. I think they’re one of the folks that won an award or will be winning an award at HIMSS in the near future.

The other I think that’s very innovative is what we’ve done with the VA. We recently — along with our partner HP — were awarded the VA national contract. They will be doing a couple of things. They will be using our enterprise software, a platform across all of their hospitals. They will have one unique view across the 152 sites that they have, as well as have that unified view at the hospital level. It’s a very innovative use. It’s not just a point solution. It’s not just being used in one department or for one hospital. It’s being used across the whole entire enterprise.

The VA’s announcement was, in my mind, a turning point for RTLS. It suddenly was not only validated, but being deployed in a widespread implementation by an organization that’s been good at changing around their technology. What did the VA have in mind when they decided that RTLS was the way to go?

The VA’s ultimate objective, and they very clearly stated it, is better care for the veterans. They looked at it as yes, there is value as that relates to tracking hardware and patients and where they are, but ultimately what they’re looking at is how do we deliver better care to the veterans?. Their decision, at least from our understanding, was based across a couple of things. How can I see that across everything that I’m doing, and more importantly, how do I plan for the future when there are many things that I don’t even know that I’m going to use down the road? What kind of platform do I need that will grow with me, that I know is not going to be something that I’m going to be replacing in five years? What kind of platform can I get that can integrate with the systems that I currently have, including VistA, which they’ve talked about and we will be integrating with them. How can I use all of those things? 

They are really forward thinking in terms of not just thinking of it as RTLS software, but as  software that allows them to collect data from a number of sources, apply some contextual information to it that will come out of their VistA system, and be able to translate that into better care at the point of service.

Some of the more promising projects in the early days involved tracking employees, which got a lot of pushback. Are those projects still off the table?

I haven’t run into that in my tenure here at this point. In fact, one of those other examples that I didn’t give you before was that we have a client who is a family medical clinic. They are using badges to track translators at the clinic that supports a customer base of 25 or 26 different languages that are spoken. When someone comes into the door, rather than wasting time in searching for that person, they can use the badge to track down the appropriate translator and get that translator right to that patient and as soon as they walk in the door.

In the VA, it’s not even a question at this point to my knowledge. It’s something that they’re a bit concerned about, but I don’t think it’s something that’s causing them major issues right now. They do have unions and they’re going to be working through that, but we haven’t heard that being a major problem. The customer that I referred to before that’s using a new process in the clinic, I do think they are badging some their folks. They’re just saying, “Hey, when can I get badged?” because it actually helps them in their processes. I’m not saying that that is not an issue that is going to be dealt with, but I don’t believe that’s going to be a bigger issue as it might have been even 10 years ago.

Even some simple things where you take pieces of information out of an EMR. If a patient has an allergy and if you can give that information real time to a nurse when they are in the room and they can make sure that there is not something that they might be inadvertently doing that would cause a problem in allergy, all of a sudden what you’re doing is you’re actually helping that nurse do their job rather than worrying about, “Gee, was she in the room for a period of time?” I think most caregivers are in the business for care giving, and if we can show them both kinds of values rather than “Hey, we’re trying to figure out if you went out and had a cigarette and went to the ladies’ room or whatever you did, you didn’t punch in or punch out” or whatever it is — I think that that’s going to change the acceptance of it.

Some of that information has to come from a traditional EMR. Do you find a happy coexistence with EMR vendors?

EMRs are a great source of the contextual information that we need to leverage. Over time, they’re going to be willing to share pieces of information. Are they going to open up their whole entire databases to folks like us? No, but I do believe over time, as we say, “Hey, can we just have pieces of information? Can we get that from you?” they’re going to be willing to do that.

Probably more importantly, what we can do is give them back automatically collected information. Instead of a physician or a nurse keying in when something happened — it happened at this point in time, the person went from this process to that process — if we can, use tags and locating information to automatically update the EMR, that makes the EMR itself much more useful and valuable. Again, this is not something that’s happening right now,  but I think over time as these pressures are applied from all angles, from the client, from external sources, to maybe make some of that information available.

Who are your main competitors and how do you differentiate yourself from them?

We are purely an enterprise software and services company. We are focused exclusively in healthcare. Because we’re only focused on providing real-time operational information and we can take it from a number of sources, we’re neutral. We can take it from all the different tag providers, we can take it from databases, we can take it from anywhere. It’s really hard to say who a traditional competitor might be. I don’t know that there’s anybody that does exactly what we’re doing right now.

That being said, we do tend to be to get grouped with the other RTLS vendors even though RTLS is only a component of what we do. If they are looking for somebody, they probably find us more through the RTLS. But if we do get grouped in with the RTLS, it’s probably Stanley at this point in time from their acquisition of AeroScout. Even then I’m not sure that is a fair comparison because we have an open platform. We’re totally focused in healthcare and again, we are neutral as it relates to any not only RTLS or sensory system, but also any other kinds of databases.

Where does the company go from here?

I hope that maybe five years from now we are no different than a CRM system, than a lab system, than a scheduling system. We’re just a component of what every IDN does. We are their operational intelligence platform. We’re the folks that notify when things go not as planned. Healthcare is individual. Every person is unique. Everybody wants to be treated appropriately, yet we have to have a consistency of how we deliver.

Hopefully we’re the ones at that point in time who are giving the alerts at the point of care that something different needs to be done here. An action needs to be taken. We’re the value provider in that sense. We will continue to be in healthcare. We will not be external to healthcare. We will always be a healthcare-focused company.

Morning Headlines 2/18/13

Veterans Affairs CIO Roger Baker Plans to Resign

VA CIO Roger Baker announces his resignation in an internal VA memo, leaving as his legacy a reputation for accountability and oversight. However, as he walks away, he leaves behind a faltering VA/DoD iEHR program, a $260 million GI Bill claims processing project which has grown to double its original budget and has yet to achieve its desired result, and a separate $500 million disability claims process automation project that has slowed the approval process for disability claims to a rate slower than when the work was done manually on paper, pushing an already ballooning backlog of disability claims to historic levels.

Monitor blasts Rotherham’s EPR programme

Rotherham General Hospital halts its Meditech 6.0 implementation due to issues with coding, patient booking, staff acceptance, and usability. Rotherham, one of the first NHS sites to select an EHR system outside of the National Programme for Information Technology, went live on the system last summer, two years behind schedule.

Hospital ready to ditch £30m computer system

The Royal Berkshire Hospital is preparing to walk away from its $46 million Cerner Millennium install due to a higher than anticipated TCO after budgeting $2.5 million per year but spending closer to $8.5 million. CEO Edward Donald has announced plans to meet other NHS trusts using Millennium to form a united front.

Bellevue Hospital Reopens Trauma Service After Brief Computer Outage

Two weeks after reopening from damage sustained during Hurricane Sandy, Bellevue Hospital was again forced to close its doors and divert trauma patients due to an electrical problem that briefly shut down its computer systems.

Monday Morning Update 2/18/13

From Man Show: “Re: VA CIO Roger Baker. Resigning, just heard it on a conference call.” Verified, although not by the VA, which didn’t respond to my inquiries Friday. An internal memo says he’s resigning for unspecified reasons at an unnamed date. We could take bets on which government contractor will end up hiring him, like his previous employers Dataline and General Dynamics. He’s done a good job and will be hard to replace.

From Friend of ONC: “Re: RECs. Innovative shift from government seed capital to sustainable operating models. ONC is starting to work with the 62 RECs to co-develop sustainability models, business plans, and new service lines for the post grant-funded era and the 140,000 providers they work with.” Weaning organizations (and citizens, for that matter) off free taxpayer money has been a challenge, most notably with HIEs. It will be interesting to see if the same problem arises with HITECH-motivated medical practices since everybody assumes that once you’re on an EMR, you won’t go back to paper, although the Medicare penalty stick may provide the necessary motivation after the MU carrot has been consumed.

From Joshajust: “Re: [vendor name omitted]. In contract disputes with multiple hospitals in South Carolina over the failure of their computer-assisted coding module, which doesn’t appear to work.” It wouldn’t be fair to run the company’s name without some kind of proof of the specific disputes. If you have any, please send it over.  

From LinkedIn Stalker: “Re: premium membership. I was grandfathered in with a lower-cost premium membership which allows me to see who’s viewed my profile, as well as an expanded range of searches. As a sales and marketing executive, I find it invaluable as a means of research and connecting to people of interest, although I am always sure to personalize my connection request.” LinkedIn has had more luck than most freemium sites in getting users to pony up for optional services. Facebook seems to be losing the attention of its users to some degree, so while it waits to be marginalized by a trendier newcomer like MySpace before it, it could always use LinkedIn’s model of charging people to see who’s checking out their Facebook, which might be a lot more lucrative given its higher population of psychotic former lovers, stalkers, and narcissists.

From Telluride Tom: “Re: your day job. Why don’t you quit? You’ve done it long enough. Sponsors and consulting could offset.” I like working for an academic medical center and I really believe that patient outcomes would be at least a zillionth of a percentage point less positive if I left. I would also be loath to leave the playing field to join the healthcare-inexperienced commentators blabbing endlessly from the safety of the announcer’s booth. I don’t know that I could make HIStalk better by devoting even more time to it since I already have people who help me, but I would if I needed to. I’ve been doing what I enjoy doing for 10 years without regard to workload, money, etc. and it’s mostly working OK except it doesn’t make very interesting obituary material.

From LabRat: “Re: University of Iowa. Rumor is their Epic Beaker LIS install isn’t going well so far. Beaker needs a big win in a complex academic environment for market credibility.” Unverified. Epic seems to have been forthright in identifying appropriate candidates for Beaker, which if it follows the trajectory of all previous Epic modules, will quickly move up the food chain from barely usable to top rated as Epic sends in its cadre of youthful ground troops to earnestly learn from early adopters. Lab is probably the toughest market to crack given well-established workflows, FDA oversight of instrument interfaces, and the department’s full use and utter dependence on its technology, all of which have been well served for decades by best-of-breed LIS vendors and long-perfected interfaces. Lab also covers broader territory than outsiders appreciate, including microbiology, anatomic pathology, molecular diagnostics, cytology, blood bank, outreach, transfusion, and a host of activities that I don’t claim to understand. Folks frustrated with sketchy usage and questionable benefits of other hospital systems should visit the lab to see what can happen when you combine a small group of motivated, analytical, and focused employees performing repetitive tasks using purpose-built technology that achieves both increased task efficiency and improved patient care. When it comes to improving patient care with technology, the showcase hospital departments are always lab, pharmacy, and radiology. Those areas are small in number, focused in mission, and are not only accepting of technology but fans of it.

UPDATE: UI Health Care CIO Lee Carmen provided a response:

Regarding the reported rumor of issues with Epic Beaker install at University of Iowa Hospitals and Clinics. I am the CIO for UI Health Care, and I can report the project is proceeding as planned. There are a few aspects of this project that Epic has not dealt with at other Beaker sites, but we have a positive, constructive dialogue underway and I am confident we will find a way to meet the needs of our laboratory operations and have a successful Beaker install.

From HIMSSGoer: “Re: HIMSS vendor propaganda. Today HP sent me 45 M&Ms in a large Fedex box.” Funny you mention that — the same box was dropped on my doorstep, and before I read your e-mail, I also took a photo and counted the M&Ms. My photo above hardly does justice to HP’s massive waste of packaging and carbon. Inside the large Fedex box was an expensive-looking inner box, shrink wrapped and packed with air pillows. Inside that was a pill bottle, and inside that was a tiny bag of HP-imprinted M&Ms that was so resistant to opening that I had to use the same knife I needed to hack through the shrink wrap. Mrs. H did a double-take at the kitchen table full of junk as though I had just opened a package containing a human ear. I bet the whole matryoshka doll-type package cost HP at least $30 to send out, which is a lot for a small bag of M&Ms that bled blue ink over my fingers since imprinted M&Ms don’t have the usual “melts in your mouth, not in your hand” waxy coating. The subject of the pitch was the new ElitePad, an alternative to the iPad that (a) costs more; (b) runs Windows 8; and (c) is made by a famously struggling company that yanked its consumer tablet off the market six weeks after its launch in 2011. All three factors will probably reduce consumer interest to near zero, but maybe HP will sell a few to Apple-phobic IT shops willing to support Windows 8. If so, I don’t think it will be because of the M&Ms.

I’ve been too busy to do a music playlist lately, so I’ll recommend just one band this time: The Thermals, highly listenable and tight indie punk from Portland, OR. Kudos to the three-member band for recording live straight to tape and directly mastering from it instead of screwing around with computers and overdubs. My legs are doing faux kick pedal drumming as I listen to their excellent KEXP videos on YouTube and every one of their 60 or so tracks on Spotify. Best music I’ve heard in some time.

HIMSS Conference Social Events

Omnicell will offer beer and wine in Booth # 8141 Monday and Tuesday from 4:00 to 6:00. Betsy told me she can’t comment on the quality of the beer, but she says the price is right.

Three-quarters of poll respondents say the government should issue a national patient identifier, although few of those respondents have ever sought the votes of wary constituents. New poll to your right: is the amount of HIMSS-related vendor contact you’re getting too little, about right, or too much?

For the HIMSS vendor contact, I’m going to go with “about right” since it’s easy for me to toss mail-out cards without even looking at them, which I’ve done with every one of them that have arrived. I always toy with the idea of choosing some vendor at random from the HIMSS list who’s exiled to a tiny booth in the Siberia part of the exhibit hall and then imploring my readers to show up there at a designated time just to give them hope. Every year I purposely walk those seldom-trod paths and chat with the untouchables, although in many cases they’ve already given up and either left their booth unattended or repurposed it as a place for their reps to sprawl back and play with their phones. Inga, Dr. Jayne, and I are good mystery shoppers, telling you the good and the bad booth behaviors we observe during the conference.

Welcome to new HIStalk Platinum sponsor InstaMed. The Philadelphia-based company’s integrated healthcare and payments network has been chosen by 400 hospitals and 60,000 practices who wanted to collect more patient payments, get paid faster, and reduce the time and complexity involved in collecting what’s owed to them. Everything from eligibility to claims can be managed on the company’s cloud-based portal, while patients get their own portal for receiving electronic statements, making payments, and setting up payment plans. Other tools include eligibility, a patient payment estimator, converting scanned checks to eChecks, claims management, remittance management, and electronic remittance. A just-issued case study describes the experience of Aspen Valley Hospital (CO), which used InstaMed to increase front office payments by 124 percent over five years and reduce payment processing administrative time by 65 percent. Good Samaritan Hospital (IN) cut statement costs by 25 percent and reduced administrative time in handling credit card payments by 90 percent. Lots of testimonials, including names, are here. Thanks to InstaMed for supporting my work.

England’s Rotherham NHS Foundation Trust halts new go-lives of Meditech, citing “persistent serious issues” that include “clinician and staff acceptance and usability.” Overseers say The Rotherham is falling short on financials because the system can’t book appointments effectively, also saying they can’t trust Meditech’s coding, case mix, and activity data. The trust went live last year two years behind schedule, expecting to spend $62 million over 10 years on Meditech as one of the first trusts to bypass NPfIT-provided systems in choosing their own. Excellent reporting by eHealthInsider.

Also in England, Royal Berkshire Hospital is reported to be close to shutting down Cerner Millennium because of higher-than-expected ongoing cost and productivity losses that have frustrated staff and bottlenecked patients. The hospital expected ongoing costs of $2.5 million per year, but the actual annual run rate of the $46 million system is $8.5 million. Patient delays have been so extensive that the hospital offers them parking discounts, free refreshments, and quizzes with which to amuse themselves while waiting.

Our Investor’s Chair guru Ben Rooks weighs in on why companies adopt a majority voting policy for their directors as Allscripts did last week:

This is actually quite shareholder friendly and has become much more common in corporate governance. In contrast to the way boards typically were retained (plurality voting), this says that if most shareholders don’t actively want the director to serve, they need to resign. In effect, inertia and indifference cease to become as powerful forces in retaining directors. I’d view both this step and the expiration of the shareholder rights plan as positive for MDRX shareholders.

The recently reopened Bellevue Hospital Center (NY) diverted trauma patients for 90 minutes Thursday evening when an electrical problem shut down its computer systems for several hours.

Covisint will announce next week an out-of-the-box solution to connect with the Direct Project, which will include Web services APIs to manage message routing, administration, and a secure inbox. Covisint Direct will be market to hospitals, states, RECs, and EMR vendors as a quick way to create a Direct solution for sending CCDs, care gaps, and alerts.

The newly appointed president of the Allegheny County Medical Society (PA) says doctors are spending too much time completing electronic medical records, also noting that her own plastic surgery practice has been forced to change EHRs three times. 

A Zimbabwe family’s home remedy of treating wounds with sugar is being tested in British hospitals with some degree of success. Weird News Andy says they use the same sugar on both left and right limbs … because it’s ambidextrose (I won’t rain on WNA’s pun parade by pointing out that table sugar is sucrose rather than dextrose). It’s also not a new practice – hospitals I’ve worked in have used sugar on wounds on rare occasion, sometimes in conjunction with Maalox. Unlike most treatments, at least these are cheap and cause no harm even when they don’t work.

Sponsor Updates

• Intermountain Healthcare will feature TeleTracking’s RTLS solutions in an interactive hospital patient room display in HIMSS Booth #1810.
• HFMA member Dan Mandy of Winthrop Resources is featured in a peer-reviewed HFMA article that describes funding options for IT capital expense.
• Philips Healthcare CMIO/CTO Joseph Frassica, MD will speak at the HIMSS Interoperability Showcase on Tuesday, March 5 at 11 a.m. I interviewed him last August.
• Intelligent InSites is chosen by en-Gauge as the locating solution for its fire extinguisher and medical oxygen monitors.
   

Time Capsule: Doctors Mostly Ignore Primitive Clinical Decision Support: Help Them Do Right Instead of Warning Them They Might Be Wrong

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 June 2008.

Doctors Mostly Ignore Primitive Clinical Decision Support: Help Them Do Right Instead of Warning Them They Might Be Wrong
By Mr. HIStalk

Anyone who has worked with hospital clinical systems knows that so-called “clinical decision support” for physicians has been a bust in many (most?) cases. You turn on all those high-falutin’ warnings that were the primary reason you bought CPOE. The doctors scream bloody murder at the interruptions. You dial it back, they still gripe. C’mon, Doc, we bought this to help you practice good medicine.

Finally, you learn an expensive lesson. From the doctor’s perspective, the optimal decision support setting for your CPOE system is to shut off everything except (a) dose range alerts at the “you’re about to kill this patient” level, and (b) allergy warnings, which they will still ignore 95 percent of the time. (The docs would have told you that upfront, but clinical systems arousal means not asking questions whose answers reflect imperfect reality).

Your shiny new system might (if you’re lucky) save a patient once or twice a year who would have been in big trouble pre-CPOE. Otherwise, the average patient isn’t getting much benefit. Check your stats – an ignored warning is a useless one.

Today’s clinical decision support is mostly old-school, mainframe stuff, simple lookups and algorithms like “do these two drugs interact” and “this test is not recommended, please use this one instead.” It was designed from the paradigm of finding something the physician might have missed and providing a pesky error message, no different from crude screen edits that catch keystroke errors.

In other words, the computer just tells doctors when they might be wrong instead of helping them be right in the first place. May I repeat? The computer just tells doctors when they might be wrong instead of helping them be right in the first place.

The more useful paradigm might have been, “Let me give you some carefully and intelligently mined information that might help you diagnose or treat, not scold you afterward.”

Today’s hospital systems contain a heck of a lot more useful information than they did back in the 1980s when allergy alerts were hot stuff. The challenge now is separating the good stuff from the noise. What subtle trends are occurring with this patient? What correlations exist that humans might miss? What information from the patient’s longitudinal record could help make the right decision now? Can anything be gleaned from the hospital’s vast database of past therapies and outcomes that would improve this particular patient’s care?

If you’re a vendor looking to gain an edge in next generation’s sales wars, look no further. This is stuff that doctors would actually use. This is information that would decrease clinical variation and help apply cutting edge knowledge to individual cases. Information saves money and lives, so hospitals would pay for that result.

This is not simple programming work or a subscription to some expensive third-party drug database. In fact, making something like this work with yesterday’s architectures would be a big pain. It would require a lot of information about a particular patient, including some not readily available today (like an easy way to specify, “What do you think’s wrong with this guy, doc?”)

That level of guidance would also require customization capability since doctors aren’t interchangeable. Urologists don’t focus on the same information as cardiologists. Doctor A might pay a lot of attention to respiratory data points, while Doctor B might be a blood sugar man. Let each flag suggestions as “helpful” or “not helpful” so the system can learn what to offer next time (yes, computers can learn.)

Once vendors figure all that out, the next logical step would be to tie literature to practice. Journal knowledge shouldn’t be hidden away in libraries and online subscriptions. Specialty content vendors are already evaluating and grading that new information into decision support applications for immediate, routine patient use. That’s pretty cool and would be even cooler if undertaken under the open source banner to encourage broad participation and to minimize financial barriers to adoption.

The industry’s efforts to create electronic clinical decision support have largely misfired, as evidenced by its half-hearted use and unimpressive impact on outcomes. Surely some smart folks out there can come up with a better plan that will help make all these systems worth their cost.

HIStalk Interviews Adem Arslani, Director of IS/Clinical Informatics, Advocate Good Shepherd Hospital

Adem Arslani is director of information systems and clinical informatics at Advocate Good Shepherd Hospital of Oak Brook, IL.

Tell me about yourself and the hospital.

I’m the director of information systems and clinical informatics at Advocate Good Shepherd Hospital. I recently transitioned here from another Advocate hospital. For four and half years, I served at Advocate Illinois Masonic Hospital in Chicago as a director of IS and informatics.

Advocate Good Shepherd is a community based-hospital. It’s smaller, licensed for about 169 beds,. The real challenge is that 80 percent of our physicians are private physicians, whereas Advocate Illinois Masonic Medical Center was an academic environment and actually a little easier to work with the EMRs and adoption.

Not many people in IT leadership roles have nurse credentials as well as being a veteran. How has your background made you more effective?

Understanding the clinician stakeholders and having that experience of working out on floors and understanding first hand has had a profound impact on my ability to do the work.

In the military, I served under the Signal Corps. That’s where I was introduced to mobile subscriber equipment and worked with technology. Our mission was to deploy anywhere and essentially set up communications within 24 hours in a total mobile environment. That was just an incredible experience.

Back in my days as a nursing student in University of Michigan, I was in the National Guard Signal Corps and ROTC. I was at the right place at the right time. At University of Michigan, we had a ubiquitous interactive TV system that was developed by a professor of engineering and the School of Nursing. They couldn’t get the equipment running. One of my instructors knew I had a military background. They invested some money and time and in six months they couldn’t operationalize this videoconferencing system.

I took a look at it and then had it up and running in a couple of days. The professor of engineering wanted to meet with me. She offered me a job over at the School of Computer Engineering, where I became a teaching assistant for a graduate-level topic course, Visual Communications. My work at the University of Michigan was, “How can we leverage technology to advance the practice of medicine?” That’s when I really became interested and intrigued in the role of informatics.

In a project that I implemented — and this was back in 1997 — I worked to design alternative nursing therapy for an 11-year-old bone marrow transplant patient. She was very sad, very emotional and on kind of a roller coaster ride. Having a nursing experience and empathizing with that patient and having some technology experience, the alternative therapy that I elected was PC-based videoconferencing over the Internet to help her deal with the coping and isolation. CU-SeeMe was one of the first videoconferencing applications. it was developed at Cornell University from a physician that wanted to share images. This was a free application. I contacted the school, they had it. They were an Apple environment, the University of Michigan was a PC environment, but that was the beauty of this application — it didn’t matter what platform you were on.

We established Internet videoconferencing out of a patient room. Bone marrow transplant patients are high risk of infection and she expressed that she missed her friends. She was isolated for six months and it was just sad. When we did this, her school friends in support of her, shaved their heads. They mailed her a T-shirt that she wore. They were able to see this. She was interacting via a modem connection and the video was very effective. That’s what gave me the recognition into the world of informatics. The American Journal of Nursing found out about the project. It was published through Sigma Beta Tau in quite a number of countries and I presented it at an American Journal of Nursing conference. From there, I landed my first informatics position at Mercy Health System in Laredo, Texas.

The military does an excellent job in leadership development and they have standardized methodologies around risk management, problem solving, and the Military Decision Making Process, MDMP. These processes and methodologies are second nature and are used with every problem or challenge leaders face. I have found that this approach has served me well when implementing IT and informatics solutions or leading teams. These methodologies and skill sets are atypical in information technology structures.

Nursing curriculum stresses utilizing critical thinking skills and problem solving. In addition, we understand how to operationalize technology, and often IT is removed from the day-to-day operations of a nursing unit, for example, failing to understand the kinds of impact certain decisions can have.

You’ve worked for several years with EMR speech recognition. What experience do you have from the work? How do you see speech recognition involving clinicians changing?

One of the imperatives — especially with the government mandates with Meaningful Use and HITECH – is that everybody is on the march to improve the EMR adaption for clinicians. That was the whole emphasis of why speech really intrigued me. When you take a look at the consumer market out there, it’s being introduced in the TVs we buy today. With my children, they’re experiencing gesture technology and speech with Wii consoles and with Microsoft XBox 360. This is the generation that’s going to expect this technology in the future. They’re already familiar with it. 

When you take a look at the healthcare setting, we’re always behind in the implementation and adoption of a lot of technologies that could make us more efficient and improve the workflow, patient safety, and all of those good outcomes that we’re striving for. When I came to Masonic, we were doing pretty good with physician order entry, but we weren’t doing so well with adoption of the structured physician documentation system from Cerner’s PowerNote, for example. We were just starting down that path.

The complaint from physicians were that there are a lot of clicks. You have to navigate a lot, and it just doesn’t lend itself really well to physician documentation of how they like to write physician notes. We embarked on a pilot, just for a proof of concept, with Nuance to see how physicians reacted to it. We targeted seven hospitalists and they went very well. Our chief of surgery and some other folks that had never utilized the EMR found out that we were piloting Dragon. Right away, the message to myself and CEO and finance was, “I don’t use the EMR, but you guys are piloting Dragon and I would love to use Dragon. I will try to use the EMR if I have access to Dragon.” 

That was very powerful and sent a very loud and clear message to our leadership. I got great support to target the Department of Surgery. We executed a license for that department. A short time after trialing this, it became clear in my mind that the only way you can really make an impact is through a site license. We wanted to give everybody access to this technology. The haves and have-nots limited our ability to leverage the full capabilities of Dragon. I have plenty of data to prove my point. When we have a site license, anybody can use Dragon. That gives a lot more flexibility from how we deploy a technology and how we can support it.

Oftentimes these products get implemented 50 licenses at a time. Who’s going to get that license? From a training perspective, if you have all these different work flows as part of 50, you’re really spending the same amount of time and resources as you would have implementing a site license. From my perspective, I did not want to go down that road — it was either a site license or we’re not going to do it.

We were paying about $45,000 a month in dictation and transcription costs, which was outsourced. We had about 6.5 FTEs internally that managed some of the dictation and transcription as well. Within 12-18 months as we implemented by service, we were able to reduce that cost to $5,000 to $8,000 per month. It was going so well that the organization eventually mandated the EMR. At Illinois Masonic, we had 100 percent EMR adoption by our physicians. We didn’t have physicians walk away. They didn’t leave. The strategy was we wanted to give our physicians options of how they document and make it as efficient as possible. 

As part of our license, we had 800 PowerMics. The PowerMic is very key if you want really good accuracy. In addition, we had Dragon installed just about everywhere in hospital. It was very conducive to the work flow. You didn’t have to compete for a PC with Dragon on it. For those reasons, it was adopted very well. Not everybody used Dragon and it was not our intent to force everybody to use Dragon. In an academic environment, we had a lot of residents who were fine with typing. The attendings absorb most of the dictation and transcription. That’s what we were really targeting. We wanted to identify who are high utilizers of dictation and transcription were.

We had about two services we went live with every month. We analyzed our work flow, we built templates, we tested those templates and commands. At our fifth week, we went live with that service. That’s how we were able to make an incredible impact on physician documentation and adoption.

I have never seen a physician get so excited about a technology. You don’t see physicians get excited about an EMR or physician documentation, but they did get excited about Dragon and the ability to have access to that. Some of the true benefits of speech is that it allows you to standardize all of the documentation through template creation right within Dragon that you can easily call up. On the EMR side of things, when you take a look at the physician documentation systems, there’s a pretty cumbersome change control process to make any changes to that physician documentation. Then you have reach some kind of consensus throughout the organization, and especially with a large healthcare system like Advocate, that takes a very long time to see any of those changes. That’s where you get a lot of frustration from physicians. 

With Dragon, it takes it out of the mix. We can create templates specifically to how they work at a service level, then you can drill down to that individual level. You can call up your H&P or any document type you wish and then dictate and then integrate that right into the EMR.

What’s interesting with the other healthcare organizations here within Advocate that have had that approach with buying bundles of licenses, over time, they had wound up spending more money than what I’ve invested in a site license. They did not realize the same impact that I have in such a short period of time. Within 12-18 months, to have that kind of impact and to get all of the physicians to be able to adopt the EMR is pretty incredible.

Dragon is not a competitor of the EMR. It’s another input device to make them much more efficient. When you take a look at just the keyboard and mouse, that itself is a barrier to the adoption of the EMR. When you watch a physician get in front of a computer with a mouse and keyboard, you can see that it hampers their work flow. It takes a long time for them just to get in the system and to navigate through the application. All these things are barriers.

Looking back at your responsibility for both IT and informatics, when you look at all of the opportunities for technology to improve patient outcomes, which ones do you see as the most promising?

I am definitely excited about speech and gesture technology. Anything you can do remove these barriers for adoption, that’s the key. My intent here is to integrate speech and gesture technology to at least minimize or eliminate the use of the keyboard and mouse.

One product that has captured my interest is a product from Leap Motion. I’ve already pre-ordered their device, which is slated to come out here pretty soon. The whole idea is to use a combination of single sign-on to tap in and  tap out, which we’re getting implemented here for the physician. Once they log into the system, they use gesture technology to navigate to wherever they have to navigate. When they navigate to the physician documentation piece, they turn over to speech and dictate directly into the EMR. I’m most interested in specialty areas that are most challenging anywhere you go, in surgery and with anesthesiology. A sterile environment doesn’t lend itself very well to the work flow.

We are one of the first healthcare sites to pilot Dragon in the cloud, Dragon 360 Direct, Nuance’s new offering. We are excited about this, as it will give us the ability to provide speech recognition to physicians anywhere, to be used with any EMR. In large integrated healthcare organizations, it is not uncommon to find more than one EMR that is being utilized.  For example, at Advocate, we have Cerner on the inpatient side, and depending what physician group you are a part of, they might be using Allscripts or eClinicalWorks.  An independent physician may use even another EMR. 

The challenge is that the different physician groups and the hospital are on different physical computer networks. The traditional Dragon implementation does not lend itself well to this type of environment. The real value proposition Dragon 360 Direct is that it allows the physician to use a common tool across a variety of EMRs, significantly enhancing and accelerating adoption. For example, a physician can easily access the same history and physical template from the cloud and use it with whatever EMR they happen to be using at that time. 

I am looking forward to utilizing gesture and speech recognition and leveraging Nuance’s Speech Anywhere SDK to allow the physician to interact with the EMR via voice. For example, with this technology, the physician could say, “Show me my patient list” and the EMR will respond and display the patient list without the physician having to use the mouse or  keyboard. 

Morning Headlines 2/15/13

QPID Launches EHR Search Engine

QPID, an EHR search engine, analytics, and real-time reporting tool for EHRs, launches appropriately enough on Valentine’s Day. The venture is a Massachusetts General Hospital spinoff and will be led by CEO Mike Doyle, formerly of Medsphere.

North Memorial Health Care Reduces Unnecessary Early-term Deliveries by 75 Percent with Adaptive Data Warehouse from Health Catalyst

North Memorial’s use of Health Catalyst technology reduces its rate of elective pre-39 week deliveries by 75 percent in just six months, from 1.2 percent to 0.3 percent of all births.

TeraMedica Signs Agreement with Vanderbilt University Medical Center for its Evercore Vendor Neutral Architecture

Vanderbilt University Medical Center will implement TeraMedica’s Evercore Clinical Enterprise Suite to archive radiology and cardiology images across the health system.

PeriGen, Inc. Names American Journal of OBGYN Editor-In-Chief Thomas J. Garite MD, Chief Clinical Officer

Perinatal clinical decision support vendor PeriGen appoints Thomas J. Garite, MD as chief clinical officer. He is editor-in-chief of the American Journal of OBGYN.

News 2/15/13

Top News

Massachusetts General Hospital spinoff and EHR query platform vendor QPID chooses a timely Valentine’s Day launch. I interviewed President and CEO Mike Doyle earlier this week about the company.

Reader Comments

From DrLyle: “Re: LinkedIn. Looks like I have more stalkers than you.” DrLyle and a few other folks sent me notes saying they were among the millions in the top five or even one percent of LinkedIn users with the most viewed profiles in 2012. DrLyle, by the way, posed an interesting question: is there value in paying LinkedIn for one of the professional versions? I defer to readers since I have no interest in paying $20 to $75 a month for premium options.

From Geographically Challenged: “Re: HIMSS13. Will you be attending this year’s HIMSS13 Annual Conference in Las Vegas from March 3-7?” Note to vendors and PR firms pitching for media time: messaging is far more effective when you get the name of the city correct. Not to mention that we already suspected that HIMSS13 would be held this year. Maybe it was a trick question.

From Skunk Baxter: “Re: Stanford Hospital CIO. She is out.” Carolyn Byerly’s LinkedIn profile shows that she just started a new job as managing partner with Platinum Advisory Services, LLC.

HIStalk Announcements and Requests

A few highlights from HIStalk Practice over the last week: CMS provides guidelines for EPs for avoiding the 1.5 percent PQRS penalty in 2015. CVS dominates the retail medical clinic market. Athenahealth earns a spot on FastCompany’s list of the World’s Top 10 Most Innovative Companies in Healthcare. SRS CEO Evan Steele discusses Thoma Bravo, EHR usability, and Meaningful Use. Thanks for reading.

Coming soon: HIStalk’s Guide to HIMSS 2013, which includes essential details on over 100 vendors, all of which in a remarkable coincidence happen to be our lovely sponsors. You won’t want to miss it if you need the scoop on who to contact to schedule meetings or where to find the best booth giveaways.

The always-creative folks at Vonlay steered me to a humorous Dear Abby-type blog post they’re running in honor of Valentine’s Day, but I was more amused by the graphic on their main page.

I’ve been getting several calls at the hospital each day from vendors pitching their HIMSS presence, more than I remember in previous years. They’re easy to spot on Caller ID, so I just let them go to voicemail and delete them later. Today a company (I’ll be nice and not name them) left a lengthy voice mail, with the rep (badly) reading a canned script that ended with, “we’re scheduling meetings with people” (nothing like making a prospect feel special). Worst of all, she was reading it over her speakerphone. I pictured her as a bored phone sex operator.

Welcome to new HIStalk Platinum Sponsor Halfpenny Technologies. The Blue Bell, PA company specializes in data interoperability, such as laboratory information systems communicating with EHRs, health plans, or each other (reverse reference labs). Point-to-point interfaces push data around inefficiently and without normalization, making them a sitting duck for Halfpenny’s ITF-Hub, which serves as air traffic controller to manage the flow of orders and results among all participants (hospitals, independent labs, HIEs, health plans, practices, and public health). Everybody knows you can’t do much of anything for a patient without lab results. The company has been around since 2000, having worked with more than 200 EHR vendors since then and embedded its technology into some of their products as well. They offer portal and mobile access, which of course makes docs happy, especially the ones who aren’t using EHRs. Their CMIO will tell you how Meaningful Use Stage 2 affects the clinical lab. Drop by HIMSS Booth #5223, tell the folks you read about them here, and drop subtle hints about signing you up for some swell prizes. Thanks to Halfpenny Technologies for supporting HIStalk.

On the Jobs Board: Project Manager – Government, Business Intelligence Architect, Software Product Development Manager, Requirements Engineer.

HIMSS Conference Social Events

Send us your event details if it’s a good one (i.e, free food and drinks at minimum) and you promise that all HIStalk readers are welcome to attend, even if they work for your most hated competitor as a given reader might well do. Don’t blame us if throngs eat you out of cocktail weenies and tortilla roll-ups. I would be especially interested in companies serving really good beer as I ran across a couple of conferences ago.

Jardogs will host a happy hour on Monday, March 4 and Tuesday, March 5 from 5:00 to 6:00 pm in Booth 4659. Dr. Jayne and Inga have noted this in their schedules.

Acquisitions, Funding, Business, and Stock

Allscripts adopts a majority voting policy for directors and announces that its annual stockholder meeting is set for May 21. We’re not astute financial analysts who actually know what that accomplishes, so Ben Rooks of the Investor’s Chair has promised to render his opinion.

Sales

Vanderbilt University Medical Center (TN) will implement TeraMedica’s Evercore Clinical Enterprise Suite for vendor neutral archiving. 

SCL Health System selects the technology platform of Lumeris for its accountable care initiatives.

Community Memorial Hospital (CA) contracts with Cymetrix for revenue cycle services.

DeKalb Health (IN) selects e-MDs Solution Series for its 19 providers.

Bali Royal Hospital in Indonesia selects Wolters Kluwer Health’s UpToDate as its evidence-based clinical decisions support system.

Mee Memorial Hospital (CA) will use Access-eforms on demand and e-Signature technology with its Meditech Magic Scanning & Archiving system .

People

PeriGen names Thomas J. Garite, MD (American Journal of OB/Gyn) chief clinical officer.

Nancy Ham (McKesson / MedVentive) is named CEO of Aetna’s Medicity subsidiary. She replaces Brent Dover.

Brent Dover (Aetna / Medicity) is named president of Health Catalyst, which will announce his hiring on February 19. Brent says the irony isn’t lost on him that he left an HIE company to lead an analytics vendor, while Nancy Ham left an analytics vendor to replace him at the HIE company.

Announcements and Implementations

Baylor University Medical Center (TX) goes live on Allscripts Sunrise Clinical Manager.

North Memorial Health Care (MN) reports a 75 percent reduction in unnecessary early-term deliveries using Health Catalyst’s Adaptive Data Warehouse technology.

Integration and data management services provider Liaison Technologies announces that its healthcare division grew 83 percent and its headcount more than doubled in 2012.

The CalHIPSO Regional Extension Center launches service offerings that include Meaningful Use tracking, EHR readiness, and eligibility registration attestation.

Cleveland Clinic (OH) signs up for the CliniSync HIE, joining the previously announced University Hospitals Health System.

Perceptive Software announces an upgrade to its Perceptive Search applications, the first since it acquired the technology last year. It searches documents, e-mail, websites, intranets, databases, social networking sites, and local computers.

Government and Politics

President Obama calls out patent trolls in a Thursday afternoon Google Hangout session dubbed Fireside Hangout. “They don’t actually produce anything themselves. They’re just trying to essentially leverage and hijack somebody else’s idea and see if they can extort some money out of them.”

Innovation and Research

NeuroCare Tech launches BrainAttack, a $5.99 decision support app for evaluating ED stroke patients as candidates for tPA.

The free Qpid.me service allows potential romantic partners to share their sexually transmitted disease status directly from the medical records of their doctors. Concerns about the site are that practices won’t have the time to send patient records if it really takes off, not to mention that once those records arrive at the company’s servers, patients are no longer protected by HIPAA.

Technology

Four Rivers Total Maintenance Systems integrates Versus Technology’s RTLS within its asset management software.

A study’s questionable conclusion claims that Microsoft’s Kinect videogame controller could reduce healthcare expenses by $30 billion by replacing expensive telemedicine systems (which of course Skype and other video chat tools can do for free). Kinect’s advantage is that it can be used hands-free in a sterile field, but I haven’t seen a lot of telemedicine originating in the OR. One of the study’s two authors works for Microsoft.

Other

Patient Privacy Rights provided links to its federal Form 990 for 2010 and 2011 in response to the inquiry from Alert Reader. They’ve been there all along on the “Why Donate” page. UPDATE: my mistake, they apparently were just added from the reader’s inquiry. I didn’t see any smoking guns if that was the expectation – the organization took in around $105K in donations in 2011 (half what it received in 2007-2009), spent a small amount on its one FTE, and the rest went to professional fees and office and travel expense. Deb Peel was paid nothing.

Froedtert Health (WI) warns that a virus that penetrated an employee’s computer may have exposed the information of 43,000 patients to unknown parties.

A San Diego publication profiles Chris Van Gorder of Scripps Health, a former beat cop turned hospital security guard and now CEO who is determined to reduce unnecessary variation to cut costs. According to the article, “Van Gorder trusts that sharing financial information, especially on costs, along with data on treatment and outcomes, will usually lead doctors to the best-outcome-at-lowest-cost decisions.”

People always send me funny stuff because they know I’m a sucker for it, and the video above from customer engagement and total cost of ownership services vendor PeerIntel is good one, with the smarmy doc playing it straight all the way. I notice the hospital name is actually that of the company’s R&D VP, described on its site as a “scruffy Armenian.” The other bios are pretty funny, too, with the marketing guy’s saying that he came to the company due to “a series of (now-broken) promises” by the top guys. The company used to be called Katalus Advisors. I interviewed Chairman Jeremy Bikman in October 2011.

A laid off MedQuist director shares her experience in “losing my job to technology” as speech recognition technology replaces transcriptionists.

The second spokesperson for Heart Attack Grill in Las Vegas dies of, you guessed it, a heart attack. He weighed only 180 pounds, a wisp compared to his 575-pound predecessor. The restaurant fries in pure lard, sells beer and cigarettes, offers a 10,000 calorie burger, and  provides free meals to patrons weighing over 350 pounds. Their employees are scantily clad “nurses” that critics say places it in the Hooters-created category known in the trade as “breastaurants.”

I see that passengers on the Carnival Triumph are suffering bad food, long lines, and rude fellow passengers. Sounds about like our experience on a week-long cruise on Triumph a few years back, except ours was just a normal cruise. Everybody’s fretting about underfed passengers, but nobody seems worried about the 1,000 foreign crew members working around the clock in miserable conditions trying to keep passengers safe, comfortable, and norovirus-free for their princely wages of maybe $150 per week, not to mention that tips will be few this time. As the ambulance chasers and sensationalistic news reporters line up to prod the vacationers into a state of righteous indignation (even though they’re already receiving a nice package of reparations from Carnival), someone should raise some money to help the crew, who will probably get nothing for what they’ve been through.

Scotland’s NHS hospital employees, like ours, share passwords, post questionable information in Facebook, curse in e-mails, and install unauthorized software on their hospital devices, according to disciplinary records.

Weird News Andy says this woman really did have a HERnia, in the form of a baby girl. A 44-year-old woman complaining of bloating is X-rayed by hospital doctors, who are startled to find a full-term baby in her womb. They did a C-section and she’s now a first-time mom.

Sponsor Updates

• NextGen Healthcare adds ITelagen as a VAR.
• VersaSuite participates in this week’s Rural Health Care Leadership Conference in Phoenix.
• TrustHCS representatives will speak on ICD-10 readiness during the April AHIMA ICD-10 CMS/PCS and CAC Summit in Baltimore.
• SuccessEHS sponsors a February 28 Webinar on the patient-centered EHR and quality improvement.
• CIC Advisory offers suggestions on implementing and adopting a health IT safety program.
• CardioNet and AirStrip partner to develop and co-market an integrated solution for mobile patient monitoring.
• Agilum Healthcare Intelligence publishes a case study on business intelligence strategies for small and mid-sized hospitals.
• AdvancedMD offers a guide to improve patient experience with EHRs.
• Intellect Resources posts a  Gotye parody video about recruiters.
• Imprivata adds Aura Healthcare as a VAR to resell its single sign-on solution.
• Best of Staffing recognizes CSI Healthcare for its outstanding reviews from clients and job-seekers.
• Data Trade Solutions will offer nVoq’s SayIt speech recognition technology to its physician clients.
• NorthWise Services (UK) partners with Merge to offer clinical trial services.
• Wellcentive participated in the 2013 IHE North America Connectathon earlier this month.

EPtalk by Dr. Jayne

The Workgroup for Electronic Data Interchange survey remains open through next Wednesday. Any individual associated with health care organizations (vendors, health plans, providers, etc.) may participate. I’m a little offended that they listed providers last and even after health plans, but I took the survey anyway.

Speaking of surveys, a senior at Washington University in St. Louis conducted one on hip replacement prices. As part of a research project on healthcare costs, Jaime Rosenthal called 100 hospitals (two in every state) and asked for cash prices for a hip replacement surgery for her fictional grandmother. Despite pushes for transparency, only half the hospitals could provide an estimate and those that did ranged from $11,000 to $125,000.

A related commentary discusses the disparities in “sticker price” of health care and tells the story of the automobile window sticker, stating, “A 2013 hip replacement looks a lot like a 1954 Buick.”

Just when I thought I had seen it all, Dr. Mostashari’s bow tie opened its own Twitter account yesterday. You can follow its exploits @FarzadsBowtie while “Putting the Bow-Tie in Health IT.” I’ve had crushes on some famous people, but never on one whose apparel had its own social life. What’s next: @IngaHistalksShoes?

Speaking of shoes, Inga beat me to the punch with the chocolate shoes, but they’re too good not to mention here as well. My favorite is the red stiletto with the dark chocolate filigree, although the pink with white polka dots is cute too. Maybe a certain someone will take the hint.

If not the shoes, I’m definitely liking this lovely ring from MF Jewelry, created from your own EKG tracing. 

Considering my recent piece on handwritten thank you notes at the hospital, Inga sent over this ER doctor’s note that’s been circling the Internet. Now this is meaningful use of a handwritten note. Kudos to New York Presbyterian’s fine and caring staff member.

I’m starting to put together my serious (i.e. “non-cocktail party”) agenda for HIMSS. I was a little bitter to see that Inga and I were not invited to the #HITchicks Tweetup event on Monday. I can’t think of more fun #HITchicks than us. I’m hoping to see some new and innovative things rather than more of the same. Have something that I shouldn’t miss? E-mail me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

QPID Launches EHR Search Engine

QPID, a startup that will commercialize technology developed by Massachusetts General Hospital (MA), announced its launch today. We spoke to President and CEO Michael Doyle, formerly of Medsphere, ahead of the announcement.

Doyle says that QPID, which stands for Queriable Patient Inference Dossier, was created five years ago by a Mass General interventional radiologist working with a computer scientist. The radiologist found the time required to manually look up patient information on the EMR was prohibitive. The pair automated the process using natural language processing that can search both structured and unstructured data.

Doyle says that the demand from other Mass General radiologists and then gastroenterologists pushed QPID’s usage to an eventual 15 hospital departments. Gastroenterologists, for example, perform a search on all patients scheduled for colonoscopies 30 days before the procedure to look for problems such as active anticoagulant orders or sleep apnea that would require the patient to bring their CPAP machine for use during the procedure.

“Twenty percent of the colonoscopy procedures at Mass General were identified by QPID as patients needing additional pre-procedure preparation,” Doyle told us. “The system crawls the medical record looking at both structured and unstructured data. Conceptual queries have been built around it and it searches for relevant things in the patient history that will make a difference in the procedure that’s being done.”

According to Doyle, “We’ve got 5,000 physicians using this at Mass General Hospital, Brigham and Women’s Hospital, and Newton-Wellesley Hospital. We touch 7,000 patients per day and do 50 million searches each month. It creates meaning from EHRs, which are really a data repository that is extremely difficult to get information out of in a form factor that’s timely for the physician to make a clinical decision.” 

Doyle says the NLP engine was developed internally and can handle misspelling and inconsistent terminology, providing the user with user confidence intervals along with its findings. He says Mass General physicians call it “Google for the EHR,” but Doyle emphasizes that QPID’s results are derived from clinical relevance rather than simple popularity. QPID can operate with any EHR, requiring a read-only connection via HL7 feeds or Web services.

QPID will be targeted to academic medical centers, initially to radiologists. “If we go into the CIO’s door, they’re inundated with Meaningful Use and everything else. We’ll go to department chairs in radiology, gastroenterology, or surgery. They will get it immediately,” Doyle told us.

Doyle says QPID will eventually help health systems position themselves in a market shifting away from transactional systems and fee-for-service reimbursement. “Mass General is never going to compete on cost,” he says. “But they can compete on the most appropriate care for the patient. Let’s say we know, based on the type of procedure, there’s national data that says there’s a 15 percent mortality rate. QPID can look at the current state of that patient, compare their index to national numbers, and allow surgeons to recommend a different procedure that’s less invasive.” That, Doyle says, will allow hospitals to justify their treatment plan to patients and insurance companies based on the condition of individual patients.  

QPID is backed by Boston-based Matrix Ventures as its first healthcare investment, with additional investment from the Partners Innovation Fund and the Massachusetts General Physicians Organization.