Morning Headlines 4/16/13

Fulton County Hospital Selects Healthland EHR Technology to Improve Patient Care and Increase Productivity

Fulton County Hospital, a 25-bed critical access hospital located in Salem, AR, has selected Healthland’s Centriq EHR.

athenanet, athenahealth’s suite of cloud-based services for health care providers, certified for Cerner interoperability

athenahealth has received "gold status" interoperability certification from Cerner after passing performance tests that measure athena’s ability to exchange clinical data using Cerner’s architecture and communication protocols.

E-Prescribing Market By Hardware, Software, Services, End-Users, Products & Deployment – Global Forecasts To 2017

The e-prescribing market is forecast to realize sustained 26 percent annual growth over the next five years to become a $794 million market by 2017.

When Your M.D. Is an Algorithm

The Wall Street Journal covers big data algorithms designed to help curb prescription drug abuse.

Readers Write: Five Ways to Improve the Healthcare User Experience

Five Ways to Improve the Healthcare User Experience
By Dan West

Unstructured information — the content that resides outside your organization’s core systems and processes — plagues practically every healthcare organization. For patient care, it’s the 25 percent of patient information – paper or electronic – that exists outside your EMR. In patient finance, it’s the data outside your billing and financial systems. And in accounting, it lives beyond the reach of your ERP system.

But why is unstructured information an issue and how can effectively managing it improve the user experience? Here are five steps to improve user experience at healthcare facilities.

Step 1: Identify it

Before you think of ways to better manage your unstructured content, you first need to understand what it is. For each organization, this content can be a different assortment of documents and information collected from all departments.

For example, in care delivery, unstructured content can be everything from faxed orders and diagnostic images to the actual paper chart. In accounting departments, invoices and the information surrounding specific financial transactions often exist as unstructured content.

The list goes on, but the key here is to understand the nature of the unstructured content each department faces.

Step 2: Get it out of the way

Odds are, paper and other physical content like faxes, EKGs, photocopies, and patient charts are in someone’s way. Sifting through a stack of faxes for that one piece of paper a nurse needs leads to frustration, reduces time spent caring for patients, and increases the likelihood that another piece of information may be lost or misfiled.

Even if your organization’s paper content is safely stored in a central filing location, that storage costs money and space that might be better allocated to patient care. An enterprise content management solution can help by allowing you to capture the diverse range of information and content within your organization – paper, faxes, diagnostic and digital images, insurance cards, patient IDs, and more. Capturing this content eliminates physical storage and management reducing frustrations about finding information and saving on storage and filing costs.

Step 3: Put it somewhere safe

Capturing that unstructured content is only the beginning. Now the question becomes — where you will put that information? An ideal solution will provides you with a single, secure repository for electronic storage of this unstructured content, reducing complexity in your IT environment by eliminating disparate, disconnected content silos.

Unstructured information also poses a security risk. Storing content in a secure location reduces the risk of a HIPAA violation while at the same time providing audit trails that make compliance with Joint Commissions, Sarbanes Oxley, and other initiatives much simpler.

Step 4: Make it easy to find

For this content to be useful, the people who need it should be able to find it easily and quickly. When integrated with an organization’s core applications, ECM solutions provide instant access to content within those systems, often with a simple click of the mouse.

For clinicians, that means finding information once in paper charts quickly within the EMR. For those in patient financial services, it means finding transactional billing data within the billing system instead of on an EOB or isolated EDI transaction. And for those in finance and accounting, it means finding an invoice within the ERP system.

Step 5: Send it where it needs to go

The last and final step helps people work more efficiently. Using electronic workflows will direct content to the appropriate staff based on rules you define is. For example, in HIM, coders and analysts receive electronic charts on the basis of encounter type, complexity, facility, or any other criteria suited to that department. In accounting and finance, invoices route to the appropriate approval channels based on amount or invoice type. Users work more efficiently within predictable parameters, ensuring processes run more smoothly and efficiently.

Conclusion

Unstructured content, regardless of its form, leads to user frustration. Following the steps outlined above will help your organization turn a source of annoyance into a point of efficiency. That, in turn, leads to happy users – users who understand the value of the systems and services your IT department delivers and supports.

Dan West is healthcare solutions manager at Hyland Software of Westlake, OH.

Curbside Consult with Dr. Jayne 4/15/13

The American College of Physicians and the Federation of State Medical Boards recently released a policy statement regarding online medical professionalism. It discusses a variety of online activities with pros and cons. It also recommends safeguards for each type of activity.

Until I read this position paper, I hadn’t really thought about looking up patients on Google. To be honest, when I’m seeing patients I’m too busy trying to actually perform patient care tasks, document until my fingers are numb, and fill out mindless paperwork. I don’t have time to see if there are pictures of them smoking when they say they don’t. On the flip side, I know patients Google us. I’ve had patients in the ER who stalk me online before I walk in the room, and that’s kind of creepy.

I also didn’t know before reading this that the Federation of State Medical Boards has specifically discouraged physicians from “interacting with current or past patients on personal social networking sites such as Facebook.” Thinking about it, the only patients I am connected with on Facebook are nurses that I counted as friends before they were my patients.

The statement includes a section on “airing of frustrations and venting” as having the potential to “undermine trust in the profession.” Specifically it cautions against criticizing late-arriving patients or patients who aren’t following their diets or working on weight loss. Based on the comments of anonymous physicians I follow on Twitter, those are the mildest offenses.

In an informal review of three days’ of Twitter feeds, I found most complaints around: drug seekers; patients who lie; patients who present to the emergency department for extremely minor or nonsensical reasons; patients who abuse or threaten violence against clinicians; and physicians not getting to take a meal or bio break during their shifts. That would seem to me that the FSMB might be a little out of touch with the realities of being in the patient care trenches. I agree that posting patient-specific information is not appropriate. Even if you black out the identifying information, I don’t think medical images belong on Twitter, and one of the physicians I follow has started doing that recently.

The position paper gets a little pedantic when it starts talking about the social contract between physicians and society. Whoever wrote that section must be a subspecialist who trained in the Marcus Welby era, because for those of us younger primary care physicians, I’m not sure we’ve really experienced that degree of social contract. It states, “In exchange for the privilege of caring for patients, as well as the status, respect, and financial compensation that accompanies that privilege…” that physicians must meet societal expectations regarding professionalism.

Although I agree that caring for patients is a privilege, I disagree on the rest of the points. Physician social status is on the decline, as is financial compensation. Frankly, most of the IT managers in my department make more than the starting primary care physician. Until recently, my student loan payment was more than my mortgage. (And no, I didn’t buy a big house – I finally paid off the loans.) When patients became “customers” and we became “providers,” the social contract started to unravel. Don’t get me started on the commoditization of health care.

Patients who are used to trusting Dr. Oz and Dr. Google for medical advice argue with us and refuse to be accountable for their own health. Patients threaten to sue before a diagnosis is even given. Patients complain on multiple social media sites and clinicians are powerless to present their sides of the stories. Expectations are at an all time high – after all, IBM’s Watson can replace us – and respect is at an all-time low. The fact that physicians vent online should be no surprise to anyone.

As an anonymous blogger, I’m used to drawing clear lines in my online behavior, so the release of this position paper isn’t going to change how I operate. What do you think? E-mail me.

E-mail Dr. Jayne.

Advisory Panel: Data Breaches

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

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

This question this time: Has your facility learned lessons from an attempted or actual data breach? Describe your major concerns and what actions you’ve taken.

Some of our breaches have been the result of thefts of computers and storage media that contained unencrypted PHI. We have since encrypted everything we can identify that contains PHI and have instituted mandatory training for protection of PHI as well as incident response. While we continue to suffer equipment losses from theft, we are losing encrypted equipment that does not entail a breach of PHI.

We have been lucky as we have not had an attempted or actual breach. My biggest concern is the "innocent" breach — the resident who manages to copy PHI to a jump drive or cloud drive like Dropbox. We’ve either encrypted or virtualized all of our laptops, so the USB ports can’t be used for this purpose. But clever people can always find a way to defeat our measures. One resident with a smartphone and an Evernote account can do lots of damage.

We lost a home care worker’s tablet (stolen from her car even though the policy is to keep it with you at all times) and we were concerned about the status of the encryption on this department’s devices. The tablet was retrieved quickly and we did determine that the encryption was on and that no PHI was accessed. We then did a complete inventory of our mobile devices and added a new encryption product to ensure we did not have an issue in any of our settings.

Our facility has not identified any major data breaches. We have had violations where individuals have inappropriately accessed protected PHI. On the one hand, I find it frustrating that some people still take a casual attitude towards HIPAA privacy and security when they should know better. On the other hand, it shows me that we still have much education to do.

We’ve worked through a couple of breach scenarios – including what thankfully turned out to be a drill.  Some of our key responses included:

• Escalating the priority and completing a system-wide encryption process
• Updating our BAA to ensure our business associates are taking encryption steps
• Changing policies for how consultants and vendors work with our data (like for conversions and analysis we need)
• Overall our focus has been how can we eliminate the risk – so when/if a device is lost/stolen it’s not a breach.
• Require our business associates to assume all liability for a PHI breach they cause – this can be an interesting negotiation point. I find myself regularly pointing out that as an organization we don’t see it as an effective partnership for us to be legally required to have unlimited liability related to the breach and the vendor partner who caused the issue to have a contractual cap to their liability.

As we work with vendors, it becomes obvious who has either been through a breach or seriously thought through the scenarios. Some of them apparently don’t understand how big of a deal a breach can be from a PR or monetary issue.

I’m somewhat hopeful the new HIPAA guidelines will help address vendor awareness and accountability for a breach they cause.

We have not had traditional breaches. The much bigger issue has been from legitimate employees doing illegal things, like calling in narcotic or other prescriptions for themselves or their friends. Not surprisingly, they are more likely to do this via phone call than via ePrescribing due to both tracking mechanisms and the current inability to send narcotics that way. It still boggles my mind that a pharmacy will accept a narcotic Rx via voice mail from anyone claiming to be a doctor’s assistant, but won’t accept an authorized eRx! If the FDA wants to minimize illegal narcotic prescriptions, they should ban printed and voice prescriptions and insist they should ONLY be done electronically – they literally have it backwards!

We had a potential breach. On investigation, we found no PHI was compromised. However, we were just lucky. The cell phone number of a new physician’s assistant was entered incorrectly into a call list and non-secure text messages were sent to the incorrect number. Luckily no PHI was included and the recipient notified us pretty quickly. We have subsequently identified a secure messaging platform and will be offering it to all community providers at no cost to the providers and requiring all employed providers to use it. In addition, we have used this as a specific example of the problems with insecure messaging in general to raise awareness.

While a secure perimeter is still important, you have to accept that bad guys are eventually going to get past it. One example is that we have seen a sharp rise in “spear” phishing attacks. Each month we are receiving thousands of phishing messages that are becoming more polished and sophisticated. It only takes one slipping through to potentially create a breach. As a result and as a lesson learned, we are focusing more on monitoring internal data traffic and, importantly, patterns. The idea being that if our network is compromised, we want to identify it and take corrective action as quickly as possible. 

Not from any actual event here. However, we have an annual white-hat audit/hack to expose where we are weak in order to stay ahead of potential breaches. I am pretty confident you cannot prevent all of them, but need to perform diligence against what is known and do this on at least an annual basis  We may switch to twice a year due to the security threats ever changing, which our Board and Audit team likes.

No data breach (thankfully) 🙂

No one ever — I mean ever — reports a laptop as stolen to the police. I think it’s the untold rule of HIT right now. You don’t want to be in the paper, so don’t file a public police report. It’s not like any government entity knew you owned that laptop and it is no longer in inventory. Even if you use encryption on the laptops, its still just better to not have the press. 

Other major concerns. The default database usernames and passwords for many of the McKesson Horizon products are still out there in production. Ccdev is normally still the same password and what was said in 2009 is still true — changing the defaults makes for a whole hell of a mess to fix. Also, database fields that aren’t encrypted for personal identifying information. Allscripts Enterprise. No use of encrypted fields at least not in how its implemented by their contractors. Same for McKesson — you get the database,  you get the data, and there are some pretty easy Oracle exploits out there if you are going for HCI. You’d have to do a ton of research to know the server names, but most places don’t block people from plugging into their physical LAN via Network Access Control or other means, so it’s possible. The article this week about HIT’s security situation is coming reminded me of all the easy ways to exploit system databases and installs.

Yes, have a pre-packaged response plan and practice it regularly. The plan needs to cover your organizational reaction, your public response, as well as your technical response and forensics. Establish relations with an identity protection service. Establish relations with a hardcore forensics analysis service that can also provide "white hat" attacks against your system, as a broader threat assessment service. For the sake of optics, provide NAC background checks on all employees that could reasonably present a risk as an insider threat. And for God’s sakes, encrypt every hard drive — desktop and laptop. Also, provide password-protected, encrypted thumb drives to employees. Put them in the cafeteria and hand them out like mints.

The only breaches that we have had are ones that would not have been preventable by any technology or policy prevention efforts. One was a paper breach by someone who was taking records for her defense in a lawsuit and the other was someone who compiled an Excel spreadsheet of research patients and sent it to an unsecured Gmail account. Both were actions by internal ‘bad actors’, so that is my biggest concern. We encrypt most everything possible here, even thumb drives, so the chances of a breach due to theft or negligence is pretty small.

A few years ago we had a virus of the keystroke variety. It basically infects the device, captures keystroke information, and sends data to China. The server in China attempts to create identity information from the keystroke data. Through some quick action by staff, we closed the perimeter before any packets of information were sent. At this time, I wasn’t too concerned since we looked up the type of virus on our virus protection vendor’s website and it said "minimal risk" to corporate users. What I failed to understand is that "minimal" meant minimal chance of getting the virus. Once you were infected, then risk went to "high."

The fun began at that moment. Luckily, the users were unaware of the virus since all applications were not affected. It was basically IS vs. Virus. By the time we started our remediation efforts, this bug had infected approximately 1,000 devices. Our virus protection vendor did not have a patch for this variant, so we were on our own for a while. We collected the packets created by the virus and sent them to the vendor. They quickly realized how nastiness of this virus and dispatched an engineer to assist in remediation efforts. He arrived the following day. In the mean time, the virus was able to deduce that it was being thwarted by our efforts and immediately phoned home for instructions. 

At this point, the virus mutated and we were now fighting two strains. We closed off the virus’s command and control link (port 80 for you geeks) and continued to remediate. After 24 hours, the vendor programmed the patch and eradication efforts accelerated. We realized at this point many of our newer PCs were not managed by the host virus protection software hub. They had virus protection, but it was out of date and could not be updated remotely. These devices (approximately 1,000 devices or 20 percent of total inventory) had to be identified, knocked off the network, and manually remediated. It took 20 minutes per device, so you can do the math.  We also had to contact all laptop users since many of those devices could have outdated virus protection. We set up a depot for laptop users to drop off and pick up. It was a very manual process. 

It took us a couple of weeks of concerted effort before we were out of the woods. I was up for 42 hours straight at one point and totally forgot what day it was and many of the names of my team. Fortunately, I didn’t have to drive home. One of our team members had just started that week (of course we blamed him). I found out later that during a break, he walked around the building, phoned his wife, and told her not to sell the house. Fortunately for us, she did, and he now oversees our infrastructure team. We heard a few weeks later that another healthcare facility contracted the same virus but did not discover it for a week. It took them over a month to eradicate the bug and they ended up in breach notification land.

From a lessons learned perspective, we started with our virus protection. We made sure that every device was being managed by the central server and updates going out daily to all devices. We also deployed Malwarebytes to all devices as a secondary precaution. We accelerated our recruitment of a CISO and centralized our security team dedicated to protecting our assets. As of today we have implemented many of technologies needed in a strong security program. Under the leadership of the CISO, we have encrypted all mobile devices, e-mail, and flash media. We have implemented a Security Information and Event Manager (SIEM) tool, Data Loss Protection (DLP), and soon will have an Intrusion Detection System (IDS). We have a top notch security company on retainer. They also perform audits, safe harbor workshops, penetration testing, assist in remediation efforts, staff education, and assist us in staying up to date on any HITECH security updates. Besides a solid security program, we assume a breach is inevitable and have prepared in advance. 

For my colleagues I understand the cost associated with this type of program can be daunting both in capital and operating. Outsourcing should be considered for some of the areas (e.g. SIEM) to reduce cost. One of the reasons we are seeing so many breaches is based on the costs associated with implementing a solid security program, especially at smaller organizations. It’s tough to get the program through the budget process. It’s akin to waiting to see how many accidents you have at an intersection before a traffic light is installed. Usually it takes a fatal one. My suggestion to colleagues is to walk leadership through a mock breach event using real examples. I used an article from a local newspaper in California. The hospital explained the breach and what they were doing about it. In the article comment section, a reader wrote, "How can you take good care of me when you can’t take care of my health information? Ouch! Also, besides the fine and ending up on HHS website, the CEO typically apologizes to the community. That usually gets his or her attention.

Sorry for the long-winded response, but it is an area of interest and fascination for me.

Two stories. Our clinic system, located at the vendor’s data center, would automatically forward reports to key individuals on a daily basis. These were primarily statistical reports. Using the same approach, reports were designed to include patient information (today’s schedule, etc.) While this was "known," what wasn’t known was that the e-mail path from the data center to the clinics changed e-mail domains, which meant that the reports were being sent unencrypted across the public domain. The resolution was fairly simple, but it came as a fairly big surprise to us.

Confidential data (a little of which was PHI) being on a phone that a disgruntled employee was slow in returning. Exposure was unknown (likely known), but it caused a change in our approach on how personal phone (vs. vendor provided) should be used.

We have not yet experienced a data breach. We did, however, experience a recent virus attack. First one of any significance for this organization. Lots of lessons learned in terms of adequacy of backups and response plan. Overall not a bad experience, though we have many things to correct.

To date, we have not experienced a data breach, but have been trying to learn from the lessons of other healthcare organizations that have in order to avoid their mistakes. Toward that end, we have had improvements in physical security and made strong efforts to assure device and portable media encryption.

Morning Headlines 4/15/13

Outrage as eHealth record sign-up squads hit Australian hospital patients in bid to boost numbers

Australia’s $1 billion eHealth system has sparked widespread criticism after recent reports reveal that only two hospitals are using the system and only 414 patient records have been entered. The eHealth system went live nine months ago.

University of New Mexico Hospital Lays Off 57

University of New Mexico Hospital in Albuquerque will lay of 57 medical transcriptionists after outsourcing transcription services to Nuance.

Computer issues strike at Memorial

Equipment failures result in system downtime and diversion at Memorial Hospital of South Bend’s emergency department.

Florida Hospital Co. Sued Over Scheme To Sell Patient Info

Adventist Health System/Sunbelt is being sued after accusations that emergency room workers have been selling medical records to chiropractors and tort lawyers.

Monday Morning Update 4/15/13

From The PACS Designer: “Re: iRing. As we wait for the Apple iTV later this year, it has been rumored that this new device will have an iRing as a control device. So while you munch your snacks and watch your favorite programs on an iTV, you’ll be able to flip channels, adjust the sound, or also switch to an Internet browser with this new innovation.“

From Low Rider: “Re: barcoding. Saw this – looks pretty cool.“ A Hospira solution scans IV bags to verify them, scans the smart pump to check its settings, and then sends the settings and start time to the EHR.

Internal slides from Optum sent by an anonymous reader suggest that the company will sell its 60-consultant OptumInsight implementation and support business to Accenture effective May 9.

Half of respondents think that the CommonWell members that offer hospital systems haven’t integrated their own products very well. New poll to your right: which of the listed hospital system vendors offer “open” systems, based on how you interpret that word’s meaning? You can choose one, several, or “none of the above” and you can leave a comment as well.

Welcome to new HIStalk Gold Sponsor Institute for Health Technology Transformation, or iHT². The company offers events, research, Webinars, and resources, all described in its newsletter (sign up for a free subscription here.) Upcoming Health IT Summits are in Atlanta, Boston, Ford Lauderdale, Denver, Seattle, New York, Beverly Hills, and Austin. Speaker lineups are good enough that I may attend one myself. Research projects include healthcare analytics, big data, and process improvement. Their Webinar schedule is here. Thanks to iHT² for supporting HIStalk.

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

Ken Mackley (St. Joseph’s Area Health Services) joins Cuyuna Regional Medical Center (MN) as director of IT.

ED system downtime forced Memorial Hospital of South Bend (IN) to go on diversion for several hours on Thursday.

University of New Mexico Hospital (NM) will lay off 57 transcriptionists in outsourcing their work to Nuance.

In Australia, the government’s $1 billion eHealth system holds only 414 patient records nine months after its launch, with fewer than 1 percent of doctors being able to view records on it because they refuse to sign up for a new healthcare ID. The government is sending out teams to recruit patients to sign up, which requires patients to provide their insurance cards and driver’s license. Critics say the government is trying to boost the registration numbers to hide the project’s failure.

In England, an NHS trust admits that it not only accidentally overpaid 791 workers, but also hired debt collectors to try to get the money back from its own employees.

#ONC Budget2006-2008: $61M/yr (slow progress)2009-2012: $61M/yr + HITECH (massive progress)2013: $58M + final HITECH2014: $78M request

— Farzad Mostashari (@Farzad_ONC) April 12, 2013

A class action lawsuit is filed against Florida-based Adventist Health System/Sunbelt alleging that the hospital operator’s failure to protect patient information allowed its ED employees to sell patient information to lawyers and chiropractors.

Google acquires Behavio, whose software harvests anonymous information from smart phone sensors such as location, speed, and the presence of nearby devices. Medical and disaster recovery applications are among its potential uses.

Weird News Andy suggests this weighty problem is waisting patients’ time. A survey finds that both patients and physicians trust the other less if they are overweight, with patients less likely to take advice from a fat doctor.

It’s more on the HIS-tory of Meditech this week from Vince.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Readers Write: Buy or Build: SaaS Can Make Sense for Meaningful Use Reporting

Buy or Build: SaaS Can Make Sense for Meaningful Use Reporting
By John Hotchkiss

The trials and tribulations of Meaningful Use (MU) have given new meaning to the lives of many of us in IT, and often not in a good way. An average 250-bed community hospital submitting its 90-day attestation report must process roughly 3,000 records covering approximately 13,250 patient days, using nearly 300 data elements per record for core and menu measures with up to 600 data elements in each record in support of the clinical quality measures. That’s a tall order.

With a demand for codified and structured data, clearly MU attestation is a different animal than your typical federal report. As a result, most hospitals inevitably face the question of whether to build or buy an MU reporting system, with the possibility of a vendor SaaS-based system taking many of the headaches out of the process.

As a technology professional, I have had exposure to both solutions, and thought I would shed some light on the issues for those still searching for an answer.

Whether for a homegrown or vendor supplied solution, the first steps in report set up are choosing the measures to report and deciding between the various reporting options. To make informed decisions, every data element for Core, Menu, and Clinical Quality Measures has to be reviewed by staff to determine how the hospital wants information to be captured and presented.

Consider, for example, the base population for core and menu measures. Which method will the hospital use for selecting the Emergency Department (ED) patients to include with inpatients in the population? The choices include the Observation Services method, which uses only patients admitted for observation with the appropriate HCPCS code, or the All ED Visits method, using all patients admitting to the ED in the reporting period. The EHR capabilities available in each location inform this decision and drive many others that follow. For example, if the hospital chooses the All ED Visits method, is the ED actually documenting the required BMI and other data elements for all the measures? Must hospital staff be re-trained to do so?

Here’s the fork in the road: to create an in-house solution, IT folks must create a data map to see what fields the MU report needs, determine if those fields currently exist within the modules of the EMR, and then confirm that they are in the required MU format. Very often, IT needs to create new fields or modify existing ones.

Also, multiple modules must be examined because fields often span multiple system components. Without exaggeration, managing that initial data mapping to support the attestation report could take months, not to mention enduring the headaches of ensuring care management staff comply with appropriate data input.

Now finally, your reports are generated. Unfortunately, the first time around, data often fails to meet thresholds. So it must be determined whether this is a problem with the data or whether caregivers are simply not entering the required information in the correct format. This forces IT staff into detective mode to identify and fix the problems.

Applause, applause – the final report is created and filed. Not so fast. This leads to the nightmare of storing hundreds of thousands of auditable data elements and estimating MU storage requirements going forward. Estimates are that a 365-day attestation requires 3.6M to 7.2M data elements. Where will IT store all that data? And, how will the security issues surrounding sensitive patient information be managed? These are the types of issues that keep IT staff up at night.

A SaaS-based MU solution may be a good choice for many hospitals, particularly smaller community facilities without the bandwidth to support all of the above. With multiple challenges, offloading some of that burden makes sense.

Many hospitals will have already determined on their own the measures and reporting options they will use and the information format that required. With that behind them, some SaaS vendors have sophisticated data mapping guides to help hospitals analyze data right from the system itself to identify reporting gaps, to ferret out the problems and to determine information to be added or modified.

Some SaaS vendors can also extract the hospital’s data directly from all system modules to leverage data that the care providers are already entering, thereby eliminating duplicate data entry – a benefit that cannot be overemphasized. Also, some vendors cannot only identify whether measures are in compliance, but can also determine why measures may be failing and help the hospital take steps to correct the issue. As a result, patient care and hospital processes see immediate improvement while the patient is still in the bed.

Of course, with the SaaS solution, users enjoy all the model’s inherent benefits including elimination of software and hardware management, simplification of interface and upgrade management, and unlimited scalability for storage and computational capacity. Obviously some hospitals are just more comfortable with building MU reports themselves and retaining complete control over their data and the process. But for others, SaaS may be just the answer they seek for MU reporting and attestation.

John Hotchkiss is chief technology officer of IHM Services Company.

Readers Write: The Cost Savings Realized by Single-Platform Solutions

The Cost Savings Realized by Single-Platform Solutions
By Deborah Kohn

Medicare cutbacks, increased mergers and acquisitions, and declining revenues and margins are daily realities for healthcare provider organizations. Yet so are costly and often mandatory IT initiatives, such as replacing or implementing electronic health and financial record (EH&FR) systems, integrating and securing the next mobile form factor of computing devices, converting to ICD-10 for reimbursement purposes, and meeting the Affordable Care Act requirements.

How does a CIO not compromise on health information technology (HIT) delivery and still maintain cost containment priorities?

A well-developed, single HIT platform strategy for most applications can realize cost savings by optimizing the IT infrastructure, regardless of whether the platform resides on premise or in the cloud. For purposes of this article, a single computing platform is defined as one that provides a database and set of technologies across a set of heterogeneous applications.

However, still many provider organizations acquire and deploy heterogeneous applications that could be built on a single, common platform. Consequently, this approach continues to generate silos of systems that cannot interoperate and to burn holes in IT operating expense budgets.

Thankfully, no longer is the HIT industry faced with an abundance of best of breed EH&FR applications, typically with each sitting on top of its own proprietary computing platform. Top-selling EH&FR solution vendors finally are offering one or — at most, two — unified platforms for the myriad, structured data-based EH&FR applications.

On the other hand, today, many solutions that complement EH&FR systems remain siloed. Such solutions worth mentioning for this article include but are not limited to Picture Archiving and Communication Systems (PACS) solutions for the storage of image-generating “ology” applications and Natural Language Processing (NLP) solutions for applications such as speech recognition, computer-assisted coding (CAC), and business intelligence (BI). By deploying a single storage platform for PACS solutions or a single NLP platform for speech, CAC and BI applications, chances are that the platform will be around longer than any application an organization has today.

For example, when developing a strategy for managing all the image-generating “ology” applications in the enterprise, it behooves the provider organization to consider a vendor-neutral archive (VNA). This poor choice of name for a storage platform (a more appropriate name might be a PACS-neutral or image file-neutral archive) stores all the heterogeneous, enterprise modality images (DICOM and non-DICOM) in a single, replicated archive. This eliminates the need for each costly, siloed PACS archive and, more appropriately, changes the “A” In PACS from “Archiving” to “Accessing.”

Typically, the platform includes tools to help manage all the different lifecycles of the image data (e.g., retention scheduling and purging mechanisms). And, perhaps the biggest benefit to clinicians is that this platform allows for the creation of an aggregated, patient-centric record of all the enterprise images.

A VNA platform is expensive, requiring a large, complex, capital-intensive project. But well thought out strategies for deploying this platform over time have proven that significant cost savings are realized. Eliminating the organization’s most costly departmental PACS operating expense — recurring migrations with storage media migrations typically occurring every three to four years and PACS replacements requiring massive proprietary data migrations, typically occurring every five to seven years — alone cost justifies this single platform solution.

When developing a strategy for deploying diverse yet complementary EH&FR applications such as speech recognition, CAC software, and BI, it behooves the provider organization to leverage a single NLP platform product that manages each of these technologies well. All NLP engines perform some type of pattern matching, and  to varying degrees, incorporate both rules-based and statistics-based techniques. That means that a plethora of applications can be developed using a single NLP platform.

These applications include but are not limited to speech to text (dictation systems), text to code (medical coding), data analytics (data warehouse systems), foreign language translation (Google Translate), question and answer (IBM’s Watson playing Jeopardy), document classification (Outlook’s spam filtering), candidate identification for clinical trials (determining eligible candidates), adverse events (patients with gunshot wounds), core measures (patients who already had been treated), geographic disease epidemiology, and on and on.

At HIMSS13, several complementary EH&FR application vendors were demonstrating more than one heterogeneous application using a single NLP platform. Currently the challenge is that not one vendor offers most of the above applications or even the same applications. Where one vendor might offer medical coding and data analytics using a single NLP platform, another vendor might offer data analytics and candidate identification using a single NLP platform.

For cost justification and interoperability purposes, it behooves provider organizations to strategically look under the hood and determine where a single NLP platform can be deployed.

Deborah Kohn, MPH, RHIA, FACHE, CPHIMS, CIP is a principal with Dak Systems Consulting.

Time Capsule: Once You Sign the Contract, You’re Just Another Customer Who Used To Have Leverage

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 September 2008.

Once You Sign the Contract, You’re Just Another Customer Who Used To Have Leverage
By Mr. HIStalk

The healthcare software vendor I used to work for geared up for our annual user group meeting like hospitals preparing for pre-announced Joint Commission inspections, i.e. we scrambled frantically for a couple of weeks to make it look like we had done a good job all year.

Those user group meetings were generally cordial. Rank-and-file users with personal bones to pick usually didn’t attend since their bosses used the travel money themselves. It was our suits against theirs, a wary face-off of capitalist warriors on a hotel carpet battlefield under an ominous cloud of expensive cologne.

A few vendor riffraff like me were in attendance to support specific low-level contingencies. We were told: (a) show up only for the events for which you’ve been assigned, then get back to work; (b) don’t admit to any claims of software bugs or unannounced changes in strategic direction; and (c) stay away from the food.

One popular session every year was a "grill the executives" event. Our highest-ranking suits stood on a humbly bare stage and took questions from the audience. Our execs played it close to the vest, so it ended up being a Charlie Brown-like hum of pleasant but indistinguishable MBA-level buzzwords. It passed for sincerity, but an hour later, customers were hungry for information all over again.

I remember when one guy zinged the reigning suit. He waited for his turn at the aisle microphone, smiling and nodding sympathetically, but then grabbing the mike like he was Mick Jagger. Instead of belting out Satisfaction, he proceed to rip us a new one, complaining loudly and bitterly about something we had botched (forgive me for not remembering what, but the list of possibilities is long).

Since I knew that executive better than the customer and, therefore, respected him even less, my fellow flunkies and I secretly cheered the guy on. (It would have been more impressive if he hadn’t reached for his notes mid-rant, but it was still a pretty good job for a guy who spent his days under data center fluorescent lights).

The executive on stage looked like he had just discovered that a miscreant had keyed his mahogany wall, but he quickly got back on track. He oozed sincerity in personally promising the angry guy that someone at a more appropriate level would look into it. I bet he was happy with himself: he had talked the guy down.

Even as an industry newbie, I knew the customer’s plight. He had no leverage, so his only remaining shot was to whine publicly. His hospital had already bought our stuff.

Partnership promises aside, signing the contract of some vendors changes the dynamic from "we’ll do anything you want and put it in the contract” to "we’ll think about it and let you know." Switching costs are high, so most customers aren’t going anywhere no matter how mad they are. Everyone knows this.

If the vendor’s choice is between "do a lot of work for a customer who will pay us no additional money” vs. "do some work and rack up big sales," most (but not all) vendors will go for B every time.

That one-sided vendor advantage is probably being chipped away. KLAS reports give unhappy customers a forum, forcing vendors have to pay at least some attention to them. The few pay-as-you-go software licenses (like subscription models and ASPs) reduce the switching costs and give customers earlier options to bail. Blogs (obvious disclaimer: I write one) level the information playing field and call BS in ways that advertiser-supported magazines traditionally hadn’t touched. Unresponsive vendors are finding it a little harder to hide.

Still, I don’t blame those vendors. They live and die by the big sale. It’s easy to forget that you are actually expected to work for those recurring revenues when everybody is talking about the sales pipeline.

Here’s what our Mick Jagger would have advised. Don’t buy futures. If it’s important, get it in writing before the sale. Get visibility in the industry, which vendors respect because it gives you a platform. Put the vendor at risk by scaling payments to performance. Cheerlead for your vendor so they’ll want to work to keep you happily chirping. And if you have to use public shame to get them to listen, it’s probably a lost cause. It’s likely that (You Won’t Get No) Satisfaction.

Morning Headlines 4/12/13

New ONC fee proposal scares health IT sector

ONC releases its budget plan for 2014, which includes a 28 percent increase in funding and a proposal to introduce a new fee structure for EHR vendors.

athenahealth Inc. vs CareCloud Corporation

athenahealth files a patent infringement lawsuit against competitor CareCloud, citing a 13-year-old practice management patent.

Statistical blunders blamed for death rate scare at Leeds heart unit

In England, The Leeds Teaching Hospitals suspend all children’s heart surgeries after skewed EHR data erroneously spikes mortality rates.

Cerner Hits 52-Week High

Shares of Cerner hit a new 52-week high at $95.54,  a 40 percent increase since its 52-week low on October 23, 2012.

News 4/12/13

Top News

ONC’s proposed 2014 budget calls for $78 million in spending, up from $61 million in 2013. Staffing will increase from 89 to 109 FTEs. Also in the budget is $1 million in user fees that would be paid by EHR vendors.

Reader Comments

From The PACS Designer: “Re: MyChart. It’s nice to see that TPD’s post on MyChart signup generated a Readers Write from Anonymous along with a large number of reader comments. TPD’s view is MyChart is a good start for an online medical record, but much more needs to be done to add to maximum value for each patient using this option. For MyChart to be used, the patient must request a printed copy of the provider’s existing record. At the very end of the printed record you’ll find a unique starting code, which you will enter once you logon to MyChart. As for lab results, you’ll only get those on your record that the provider has interface installed for those other lab systems. What’s likeable is each medication listed on your record has a link to the National Institutes of Health’s NIH MedlinePlus site, which gives you access to the prescriptions purpose and side effects along with much more information you can’t find on your pharmacist’s prescription fact sheet.”

HIStalk Announcements and Requests

Inga is taking the day off, so I’m sure we all wish her well in whatever interesting activities she has arranged. She mentioned earlier that her sixth anniversary with HIStalk is this week, so perhaps she is celebrating. Here’s to her.

We will be presenting some Webinars shortly and I need three hospital CIOs to provide presenter feedback for the first one. Real-time viewing isn’t required since we will have a recorded practice run of the Webinar to review. It will probably run around 40 minutes. Let me know if you can help. I’ll send an Amazon gift card as my thanks.

On the Jobs Board: Solution Sales Executive, Senior Program Manager, Senior Client Representative.

Welcome to new HIStalk Platinum Sponsor QPID Health Record Intelligence. QPID (Queriable Patient Inference Dossier) aggregates EHR data to support real-time clinician-directed queries, analytics, and reporting capabilities at the point of care. Fast queries are supported by caching and indexing the patient record, with structured and unstructured information parsed and tagged. Any number of rule sets (apps) can be used, with examples that include an EHR search portal, an ED patient summary dashboard, a GI conscious sedation intake system, coding optimization, bronchitis screening, OR diabetes alert, and automated determination of smoking status. I interviewed President and CEO Michael Doyle on the day of the company’s February 14 launch. Thanks to QPID for supporting HIStalk.

Acquisitions, Funding, Business, and Stock

Cerner shares hit a 52-week high Thursday, closing at $95.54, up 30 percent in the past year. Above is the one-year share price chart of CERN (blue) vs. the Nasdaq (red).

Athenahealth files a patent infringement lawsuit against PM/EHR competitor CareCloud, claiming that the company violated athenahealth’s 2001 patent for claims processing rules. Several former employees of athenahealth now work for CareCloud. Athenahealth declined to comment on the lawsuit, but CareCloud CEO Albert Santalo provided us with this statement:“ To the best of our knowledge Carecloud is not infringing on Athenahealth’s 13-year-old outdated method and we won’t be making any additional comment at this time.”

Sales

Piedmont Healthcare (GA) will deploy Perceptive Software solutions to integrate data directly into its Epic EHR throughout five hospitals and 45 physician offices.

Hennepin County Medical Center (MN) continues its population health drive for HIV care with Forward Health Group’s PopulationManager.

People

Chris Coburn, executive director at Cleveland Clinic Innovations, will leave that organization to take an unnamed position with Partners HealthCare.

Michael Thompson (Mindray) joins Medstreaming as COO.

Announcements and Implementations

Vocera ships its 500,000th communication badge.

Tennessee-based Parental Health, which offers a care management platform for seniors, will raise $3 million via a Series B fundraising round, with the proceeds going toward the addition of up to 12 full-time employees in sales and marketing.

The Bipartisan Policy Center’s Health Innovation Initiative, Heritage Provider Network, and The Advisory Board company will hold an April 16 discussion on the the use of data by providers, health plans, and states to address healthcare challenges. A big data challenge will be announced. Speakers include Janet Marchibroda (BPC); Senator Bill Frist, MD; Aneesh Chopra (The Advisory Board Company); Karen Ignani (AHIP); and James Weinstein, MD (Dartmouth-Hitchcock Health System). The event will be streamed live.

Intuit Health announces that the seven millionth patient has registered for its health portal.

Practice Fusion launches Patient Fusion, which allows patients to schedule online appointments via the Web with any of the free EHR company’s 27,000 physician users and access their health records online. Mobile versions will follow.

Impact Advisors expands its mergers and acquisitions services for the healthcare IT market.

MMRGlobal files a patent infringement complaint against Quest Diagnostics and its Gazelle personal health records system.

Western Maryland Health System expands its use of Versus RTLS to include a mobile, location-aware call button for caregivers.

Government and Politics

ONC announces internally the hiring of Joe Bormel, MD, MPH (QuadraMed) as Director of Health Outcomes. He will focus on usability, clinical decision, support, and Meaningful Use and certification policy. We reported his hiring as a rumor as ONC medical officer on Tuesday, but did not list his title (“medical officer” in ONC is any physician employee). Bormel will report to Chief Medical Officer Jacob Reider, MD.

The VA requests $3.7 billion for its 2014 IT budget, a 10 percent increase. It includes $252 million for projects related to the VA-DoD shared EHR.

Technology

Athenahealth will provide third-party developer access to its physician network by rolling out an programmer API, allowing creation of an ecosystem of apps that can use its anonymized medical histories, appointments, and billing information through its More Disruption Please program. 

Other

In the UK, a hospital suspends its children’s heart surgery program because of high mortality rates, only to find that poorly produced data that had been fed to its new computer system had produced a false alarm.

Weird News Andy calls this “clear thinking for fatheads.” Stanford researchers develop a method of rendering harvested brain tissue transparent by removing the fat in its cells, allowing them to view structures down to the individual cell and molecule level.

Sponsor Updates

• Good Samaritan Hospital chooses Access and Perceptive Software to create electronic forms on demand.
• Vicki Lucas, RNC, PhD, chief nursing officer of PeriGen, covered strategies to increase OB revenue at the World Congress Leadership Summit on The Business of Women’s Health Washington, DC on April 10.
• UMC Health System (TX) goes live on Cerner CPOE with the assistance of HCI Group.
• GetWellNetwork will serve as a patient engagement sponsor for The Academy Huron Institute’s 2013 program “Developing Innovative Value-Based Delivery and Payment Models.”
• T-System signs an exclusive agreement with X32 Healthcare to offer Lean methodology for analytics and services with the ED.
• Hurley Medical Center (MI) selects Ciber to implement its Infor Healthcare Suite.
• Michele Hilton, GM of medical billing services for ADP AdvancedMD shares the top five challenges for hospitals to get paid.
• Merge adds endpoint and adjudication management to its eClinical OS platform for end-to-end study support in a single platform.
• Aprima Medical Software partners with ClearDATA for cloud hosting of its EHR/PM/RCM software and services.
• e-MDs announces the free Kansas City User Group roadshow on May 2.
• MedAssets honors veterans and humanitarians during the 2013 MedAssets Healthcare Business Summit in Las Vegas.
• DrFirst receives the Surescripts 2012 White Coat of Quality Award for the third consecutive year.
• Ingenious Med reaches the milestone of 25,000 charge capture users.
• Levi, Ray & Shoup hosts a webinar April 16 and 18 on improving performance in an SAP environment.
• CTO Charles Halfpenny of Halfpenny Technologies will present a master level session at the 18th Annual Executive War College on the value of lab data to health plans.
• Walsh College (MI) renews its IT outsourcing contract with CareTech Solutions.
• Confirmit awards McKesson its third ACE Award.
• Beacon Partners is hosting a webinar April 19 focusing on five key issues between Stage 1 and Stage 2 of Meaningful Use.
• HealthCare Anytime CEO Brady Klick served on a patient engagement panel at an April 11 program sponsored by the Northern California HIMSS chapter.
• Orion Health celebrates its 20-year anniversary, having surpassed $100 million in annual revenue, raised headcount my three to more than 750, and implement its solutions in more than 30 countries.

EPtalk by Dr. Jayne

Red Raider Alert: Texas Tech University Health Sciences Center notifies patients of an information breach as a result of a billing error. Apparently patient statements were mailed to the wrong addresses.

Mr. H posted a reader question about job recommendations for new graduates to better understand the HIT environment. Depending on your degree and experience, I’d consider looking for a position as an implementation specialist for a hospital, health system, or large medical group. It’s a great way to learn what the industry looks like outside of the vendor space and once you’ve done a couple tours of duty with complicated practices or hospital departments, you’ll be extremely valuable in the job market. At least in my area, teams are often composed of people that are new to healthcare – one is managed by an engineer and includes not only healthcare veterans, but also a minister and several former retirees.

A recent article in American Medical News notes that volume, not quality, still determines most doctor pay. I would love to see payment reform that rewards not only quality, but customer service, personality, and the time spent with patients. Despite the hard edge sometimes portrayed in my writing, when it comes to actual patient care I tend to be much more empathetic than my peers. When I was in community practice, my patients appreciated my listening skills as well as my ability to partner with them and negotiate long-term outcomes rather than simply lecture. Why shouldn’t I be paid more for that level of service? You want to see true physician engagement? Figure out a way to pay primary care physicians so that they can afford to see 20-25 patients a day rather than 30-35. And figure out a fair way to measure Meaningful Use that isn’t “all or nothing.”

Physician social media site Doximity gets my jeer of the week for its unreadable e-mail. It was so bad that I almost outed myself trying to screen shot it – the white rectangle is covering the black-on-black “insert recipient name here” field that I didn’t see until I pasted it over to send to Mr. H. Seriously, folks, do you really think anyone can read black on black or dark gray on black?

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 4/11/13

Mining Electronic Health Records Reveals Clues Of Harmful Drug Reactions

Researchers at Stanford University, using sophisticated analytics and EHR data looking back 15 years, were able to clearly substantiate harmful drug side effects years before an alert was issued from the FDA. Researchers conclude that data analytics will be a powerful compliment to the FDA’s Adverse Event Reporting System.

NYeC Asks New Yorkers to Help Shape State’s Healthcare Future – Vote on Patient Portal for New Yorkers Prototypes

The New York eHealth Collaborative is turning to state residents to select its final patient portal design. The designs up for vote were all submitted in an earlier eHealth Collaborative design challenge that asked residents to create a patient portal for New Yorkers, by New Yorkers.

Jonathan Bush, Live from TEDMED: Health Care is Broken; Find the Frontiers

Jonathan Bush, athenahealth chairman, president, and CEO, has been tapped to speak at TEDMED next week in Washington DC, where he will discuss alternatives to healthcare’s pay-for-service revenue model.

Electronic Media–Based Health Interventions Promoting Behavior Change in Youth

A recently published article in JAMA Pediatrics correlates substantial behavioral changes to certain mHealth interventions that target adolescent health issues.

Chatting with John Gomez 4/10/13

John Gomez is CEO of JGo Labs.

What’s the big news these days?

It’s over. Epic wins. Not sure that is big news, more like the Emperor’s New Clothes from childhood. Everyone kind of knows they won, but no one wants to point it out.

Why do you think Epic has won?

As the data rolls in, some qualified and some conjecture, the one thing that seems to remain consistent is that Epic is the big winner when it comes to the EMR market. This may seem rather obvious, but for some reason we keep hearing how there is still tremendous opportunity in the EMR market.

I am not sure where that huge opportunity lies or what market is being referenced by the Epic competitors, but from what I see, if we are discussing the hospital market, then Epic has won the lion’s share. Congratulations go to Judy and team. Job well done.

I am often asked by analysts if Epic is the big winner, who is the runner up? My vote would be Cerner. I actually am rather impressed by the company’s turnaround, KLAS scores, and general ability to deliver a quality product at a competitive price point with solid periphery services.

That brings us to the rest of the pack — Allscripts, GE, McKesson, and the niche players trying to carve out a place among the smaller hospitals that haven’t made an EMR partner choice. Mind you that even in the small hospital market of 50 to 150 beds, Epic is making inroads, with CPSI doing a great job of gaining ground. There are some other players, but in my eyes, these are the companies to watch.

What happens now?

Mind you I am often wrong about these things, but there are basically two things that will happen. The first is that we will see continued focus by hospitals to optimize their financials for the new world order. Secondly, we will see a resetting of the landscape.

Where do you think the market is in terms of our maturity?

If we went back to the 80s and 90s, we would find ourselves surrounded by plethora of word processing and spreadsheet offerings. Anyone remember WordPerfect, Multimate, Wang, and Write? How about Quattro Pro and QuickCalc? Today the office productivity market is owned by Microsoft, with some pressure from Google and Open Office, but nothing even remotely close to threatening Microsoft Office’s market share. We have seen the same thing occur with databases (Access, dBase, Clipper, Sybase, IBM-DBM, Gupta) and even accounting packages (JD Edwards, AccPac, etc.) I suspect we are in the early stages of consolidation where we will see some of the EMR market begin to shift and clients moving over time to the market leaders.

Why don’t you think that hospitals will move now instead of saying with their incumbent EHR vendor?

The thing to understand about this market is that for all intents and purposes, it is a very conservative market. I suspect that hospitals don’t just jump ship overnight because there is vast fear of the unknown. By that, I mean there is just enough FUD — fear, uncertainty and doubt — that hospitals stay put. 

I do believe that if there was a very prescriptive means of migrating, hospitals would move, but today there is no clear methodology that shows a hospital exactly how to move, the risks, the plan. and how to be successful in that migration. If someone brought to market a clear migration methodology that was highly prescriptive, I suspect they would be very successful and hospitals would certainly make the move.

We hear a lot about cloud computing, open platforms, and SaaS. Will they allow new companies to emerge and challenge the current market leaders?

I hear that a lot. I have investors who try to convince me that an EMR that is cloud based or has a great new user interface or some new single platform solution is going to make everyone suddenly abandon their EMR of choice and jump ship. I just don’t see that happening.

This market is very loyal and is not enticed by the great new shiny object. Clients in this market move because a vendor just cannot keep its promises and does not follow through. This market is not driven by small savings in costs or the promises of being open. I do think being open is important, but I don’t know of any hospital that is going to move because there is suddenly a new platform.

Many people say Epic is closed.

That is pretty funny. Since leaving Allscripts, I have had the chance to really get to know Epic. I have found that Epic is actually very open and has a flexible platform. They have programs to work with third parties and there are many, many third parties that integrate with Epic.

Much of what you hear about Epic is myth. Much of it is created by their competitors, which is rather telling if your only way to combat Epic is to spread myth.

Give me an example of Epic’s openness.

Actually I can give a bunch of them. For one, they were one of the first vendors to integrate with the DoD and VA seamlessly. That is significant because most of the HIE standards in the country are based on the DoD/VA work. Epic is the leader in this space and what’s more, they use this to help all of their clients exchange data. I don’t know if they did this by design or by accident, but either way the outcome is brilliant.

In terms of third-party integration, they seem to be very open to that in my eyes. A good friend of mine, Matt Sappern the CEO of Perigen, reached out to Epic and asked about how they might be able to integrate. Epic was responsive, and in a few short weeks they had an agreement in place. Perigen, to the best of my knowledge, is now extremely excited and an Epic supporter.

Contrast that to some of the other vendors, even ones with app stores, and you find that it is extremely difficult to put a deal in place and takes weeks and weeks if not months. Epic suddenly starts looking like the nicest company on the planet to work with.

How will the market change?

Over the past several years, what we have seen is inorganic growth in the market. Companies, especially the EMR vendors, really needed to just do what the government required, deliver on their promises, and follow through to be assured of growth. Not to minimize it, but that is what Epic did and does and what Cerner did and does. The companies that had failed leadership, lost their way, or focused on financials rather then quality … well, they kind of didn’t enjoy that growth.

As things settle down, we are going to see a shift from inorganic growth to organic growth. Organic growth is where you must rely on your own innovation and understanding of the market to gain share or preserve share. You need to figure it out and no one, not the Government or anyone else, is going to provide you a checklist, like Meaningful Use.

That shift from inorganic to organic will reset the market. It means everyone — Epic, Cerner, McKesson, Allscripts — all have a chance now to either win or lose. The key will be figuring out what they need to do to take advantage of this reset. It will be easiest for those who own the most market share, but it is not guaranteed. Just because you won the EMR battle doesn’t mean you won the war.

Where do you see the opportunities?

I think that in terms of opportunity there are two categories. The first being add-on opportunities and the second being apple seed opportunities. Add-on are those opportunities where a vendor can bring to market new offerings that they bolt on or integrate with their EMR. The second and most critical to long-term success are apple seed opportunities. These are new offerings that provide new market growth, for example, entering adjacent markets or inventing entirely new products.

Simplify that statement.

I would steal a line from my friend Matt that I mentioned earlier. The go-forward victors will be “those companies that can help hospitals make money or avoid penalties.” I think that regardless of whether we are talking about add-on or apple seed opportunities, the net net is that the clients in this market are going to need to really to focus on optimizing operations. That will drive much of the investment they make in the coming three to five years.

What does Allscripts have to do fix itself?

That answer would make an interview in and of itself. In hopes of not boring your readers, I will keep it short.

The bottom line is that they need to decide what they are. Are they a software company or sales company? To date, they have operated as a sales company. Even when I was there I fought that persona and always felt it was one of the biggest issues we had. They have a long way to go to become a software company.

I also think they need to figure out who is really conducting the orchestra. They have lots of people suited up for opening night, but in my eyes it seems there is no conductor. I am sure they are working hard to get things right, but just seems like they need to get one person who can articulate end to end how it all works, when and how it is all going to come together, and where it is going in the future. In a manner that is clear, market relevant, and based on facts.

I still have a huge soft spot for my former team members and feel bad for them. They have been working day-in and day-out on something they truly believe in, yet time and time again the leadership of the company has let them down.

When I talk to analysts, they focus on 5-10 percent growth models. All they care about is how the company just grows 5-10 percent. This is one case where Wall Street is just as guilty in holding this company back by forcing them to focus on financials rather then building a great set of solutions. 

Going private isn’t the answer. That is just leadership weakness looking for a scapegoat. Cerner turned themselves around a few years ago, as did many other public companies.

The market is going to reset. It is all a matter of if this company takes advantage of that. So far I just don’t see much difference today than anything the previous seven or eight CEOs have done or tried.

What are the biggest market fallacies or myths?

I covered one, that Epic isn’t open. Some of the others are related to what I consider emerging trends. I think there are a lot of buzzwords being thrown around that, as they often do sound great but aren’t actually more than buzz.

Things like population management, clinical trials integration, and outcomes management are catchy, but when you get past all the buzz, they seem to be solutions looking for problems. I would really caution vendors and providers to think very carefully before investing in these areas. I would especially advise providers to see if they can’t solve these issues with the tools they have, inexpensively, before they pull the trigger and buy more technology.

Lastly, I am thinking mobility. Provider mobility, except in some limited areas like wound care for instance, just isn’t there yet and is not going to be the big paradigm shift. It will happen, but probably not as fast as the buzz indicates. I do think on the patient side mobility is huge and growing rapidly with great returns.

What would be some strategies you would recommend hospitals consider over the next few years?

I think that first and foremost, forego best of breed for tight integration. Features can be evolved and hospitals can easily push a vendor to fix the gaps.

On the other hand, integration — regardless of Meaningful Use 3 — is really really hard to get right. Despite vendor best intentions, it’s not going to happen overnight. In the future, I suspect you can live with a small feature gap, but as you need to rely more and more on a holistic view of the patient, you will find that integration is mission critical.

I would also tell hospitals that they need to stop paying premiums for software. This industry is one of the few left where you have pricing models that really make no sense. How does bed count or total caregivers change the value of the software? It doesn’t.

If you want to find an easy means to optimize costs, push vendors to realign their prices and charge intelligently. I think it is cool that market economics allow for $20M software deals, but going forward, clients need to set ceilings and really question the pricing.

Hospitals also need to truly examine the value of the shiny object. Do they need that population management thing? Are they really going to need to integrate with clinical trials? Do they need a huge data warehouse? Maybe, but chances are most hospitals do not. Question the shiny object and invest in practical solutions that drive real revenue and reduce exposure to penalties.

I would tell them to reconsider their departmental systems. I think there are really great new offerings out there that can help drive down costs, improve throughput, and make a difference to the bottom line of the hospital. I also would tell them to look into outsourcing things like their pharmacy and ICU. For smaller hospitals, this can be a serious way to reduce costs, improve quality of service, and drive margin improvement.

I would suggest they consider embracing self-care systems and introduce more case management that is subsidized by their majority payor. That is a little harder to explain here, but basically it is about reducing admissions for non-critical patients and still generating revenue.

Lastly, I would tell them to work really hard at being a business. I know that isn’t politically correct, but I think that focusing on being a business actually would improve revenue, which is ultimately required to make investments in improving patient care.

HIStalk Interviews Phil Kamp, CEO, Valence Health

Philip H. Kamp is CEO of Valence Health of Chicago, IL.

Tell me about yourself and the company.

The company started in 1996 focused on helping providers manage risk. We do three things. We do consulting to help them figure out how to get into the risk game. We provide a bunch of analytic tools to help them succeed under risk. We provide operational support.

That could be anywhere from a risk contract to being their own health plan. We’ve got several clients that are provider-sponsored health plans and we pay claims, member services, medical management, all the functions you would do to run a health plan. It’s the full gamut of providers taking control of how healthcare is delivered. For them to do that, they have to be at financial risk, and we help them through that process.

Do you have to convince them that they need to take that step or are they ready? That’s a pretty big jump from the model we’ve had.

It depends on the client. Some are ready to leap and they know that it’s the right strategy. Others that want to phase it in – a crawl/walk/run kind of process. It depends on the type of client and if they’ve had experiences with what’s going on in their marketplace, relationship with physicians … it’s a whole bunch of different things. Some are ready to jump, some are much slower.

Everybody’s talking about what it takes to take on these risk arrangements. Will there be a point where the discussion will be how to get out of some of the arrangements that have been made?

Obviously back in the 1990s that’s what happened. A bunch of groups got into risk and failed under the risk arrangements. They certainly got out of them.

What will happen now, it’s interesting. I’m hoping that most of them get into risk and stay in risk. I think it’s the only way that we can really manage our healthcare costs. If you continue to pay providers fee for service, you’ve got an incentive to do more stuff while we’re trying to control costs. The incentives just don’t work. But I agree, certainly some will fail and some will get out of it. I’m hoping now with improved technology and understanding how to do this that this time it will work.

If I’m a provider and have never done anything with risk, what steps need to happen between the idea and the execution?

The first step I would normally do would be to do what we would call a feasibility study to understand the market and what type of risk to assume. In certain situations, it would make sense for a provider go all the way to becoming its own health plan in certain aspects of the market, certain products. It may not be commercial — it may be Medicaid or Medicare. There are certain providers that it will make sense for them to pursue one, not all of them. They may pursue risk in different formats. They may become a health plan on Medicaid and do a different type of risk contracting with payers on the commercial side, for example.

To me, that first step is that feasibility study as to what makes sense relative to the market. Understand the gaps for them to succeed under risk and then build a plan as to the strategy around how I’m going to get there, what types of risk, and how do I actually implement it and manage it is going to be key to the process.  

The hardest piece to build is typically the provider network. It’s really around the primary care physicians, so you’ve got a lot of hospitals that have focused extensively on the specialist side. When you’re getting into population health, the biggest piece that you need to drive is primary care. 

Then the question is, how do you relate primary care physicians to a network? Do you need to buy them? Can you put them on the same EMR? There are other approaches to getting them to tied electronically, where you’re pulling data from different sources and you’re clinically integrating the group. It’s around network build and it’s around the strategy and understanding our gaps and how you fill those gaps.

Are there potential land mines of strained relations either with the physicians that hospitals decide to partner with or those that they don’t?

If you decide you’re going to put together a network to assume risk or build a health plan, the physicians or the health systems that you choose to not do that with — you’re obviously drawing a line in the sand relative to those. If those physicians are providing referrals or support to the organization in some format, you’ve got to address those kinds of things. Certainly there are group situations like that that you need to address.

On the payer side, certainly if your strategy is to contract with payers on a risk basis, it’s a fairly neutral process. You can do it with all the payers. If you decide to become a payer, you’re obviously putting a line in the sand also relative to competing with those payers.

Most of the activity is being driven by hospitals and health systems. When they look at their physicians and decide who they want to partner with, I’m assuming they look at more than just their admitting and referral patterns. How is a physician graded on their desirability as a potential risk partner?

Part of the problem right now is any information relative to a physician that doesn’t necessarily practice at hospital a lot is going to be anecdotal. You’re not going to have real analytics behind how they perform. Typically what you’ll see – and I’m thinking of primary care now – it’s physicians with a strong base in a product lines that matter to you, whether it’s Medicaid, Medicare, or commercial.

Usually what happens, at least on the primary care side, it’s around selecting or bringing as many of those players to the table that you can in your network. Then over time, as you get data, you’re maybe weeding out over time based on performance. At the beginning it’s hard to make selections based on any analytics. It’s usually going to be word of mouth or perceptions relative to who you bring in or you don’t bring in.

Are most of these agreements written so that either party has an option to exit?

Yes, absolutely. Then you get into questions like exclusivity and other kinds of things that become critical the success of whether these organizations are going to work, so that plays into it. But usually there is a term agreement. Usually it’s 90 to 120 days, so it’s fairly short term.

Describe how clinical integration is different from a legal standpoint from non-competitive behavior or price-setting in a given market.

I’m not an attorney, but what the Federal Trade Commission has done with clinical integration, they’ve said is if a group of physicians that are independent physicians come together to focus on the management of care, improve quality, and improve utilization of services, that they can work together as an organization and negotiate contracts together. 

What the Federal Trade Commission looks for is several things. One is that you’ve established how care will be delivered – call it protocols. Two is you have data that you can collect and manage how well those protocols are being complied with. Third, you actually are measuring compliance. Fourth, you have processes and procedures in place to address those that are non-compliant. 

The concept is that if you do those things, that you will manage care as a village – call it a village of providers – that you will do a better job, because everybody will have information on the patients and you will improve the care of those patients by working as a group. Then the thought is that you can negotiate and contract together.

Usually what you should be doing is focused on the incentive piece of that program, so if you develop a relationship with a payer, it may not be around increased fees, although you certainly can do some of that, but it may be around significant incentives relative to the performance of the network on quality issues that you agree upon.

At least on the IT side, the emphasis is on the tools that vendors say are all you need to move to an ACO-type model. Do you think that providers are thinking through all aspects of whatever relationships they embark upon and not just, “If I get some tools and I get some data, I’ll figure it out as I go along?”

There’s different approaches. One is going to be a company will have a shrink-wrapped software product that they give to you, and then you’ve got to figure out actually how to do it. Another approach is to provide the software, but work with the group on a consulting basis to become clinically integrated. You’re identifying the things you need to measure, making sure you’re pulling that data, you’re analyzing on a fairly frequent basis, and you’ve got the processes and the organization in place to manage the care.

It’s certainly more than just getting the data. There are a lot of other elements of it to actually work. Those four that I described earlier really drive it. You need an organization that’s providing the support relative to collecting, managing the data, providing support, and it may be care management support on how to help physicians make sure compliance is reached for a majority of their patients on some of these things. It’s more than just a software tool.

How many different ways are there for insurance companies to get involved?

An insurance company could be the back office. Most of the functions that we’re talking about are classically done by the insurance companies, so they can certainly be the back office or administrative support for these types of organizations.

The problem with doing that piece, in my opinion, is around their lack of neutrality. If you have an organization of providers that want to do risk contracting with, say, all the health plans in its marketplace, if it has one of those health plans as providing the back office, how do those other health plans – the competing health plans — react to a back office of one of their competitors? For example, if United or Optum is the back office and Blue Cross is a group looking to contract with that provider group that has United or Optum as that back office, how does Blue Cross feel about an Optum getting access to their data?

To me that’s an issue, but it’s certainly happening out there. Payers can also be the impetus for the contracting. They could certainly pursue providers in getting into those risk arrangements and help them get there. To me it’s typically going to be better if that payer works with or identifies a neutral third party to help the providers manage that care. 

Payers can either be the back office or they can be an impetus for the providers to get into the risk arrangements. Other ways they can be helpful is if they’re getting into risk, re-insurance can be helpful. There are different aspects that payers can ease providers into risk. You can start with something like a shared savings program, move into a risk sharing that moves further into risk. Allowing providers to do this crawl/walk/run and learn as they go through it can be very helpful.

I assume that no parties would get involved in an arrangement like this if they didn’t think it would be financially beneficial for them to do so, either immediately or eventually through market share. Do you sense that the people involved in the ACOs will end up fighting for a smaller piece of the healthcare dollar pie?

The way the Medicare arrangements are mostly set up right now, the shared savings model, is an issue that you’re bringing up. The idea is there is theoretically a budget, and then to the extent that there is an expense lower than the budget, there’s shared savings. Then you reestablish your budget, and then you’re continuing to pull money out of the system. Eventually there’s no money to pull out of the system. That approach creates a problem, although it theoretically works towards driving down the expenses.

The biggest problem I see in the shared savings model is the amount of dollars that you make doing the fee — it’s still a fee-for-service environment with shared savings – you will never save enough money to make up for doing the actual service. The incentives are really not aligned in my opinion. It’s a start, but it really doesn’t align the incentives for the providers to spend less. If they do less, they get a percentage of the savings, but if they keep doing more, they’re getting 100 percent of the dollars that they’re charging for. 
I don’t think it’s sustainable in that regard at this point.

You’ve got to come up with other risk type arrangements that make more sense. The sooner you get into full risk arrangements in which the provider has the opportunity to benefit from the reduction in utilization, the better off you’ll be in that process. Then just allow that budget to establish based on that baseline. I think it can work. The problem is shared savings.

Is there potential to at least redirect some of that administrative cost to something that benefits patients more directly?

Sure, and that’s an interesting question relative to when payers and providers negotiate their deals. The payers are used to getting whatever it is — 12 to 15 percent of the premium, and those aren’t exact numbers — but generally it’s in that sort of range of dollars for administration. If the provider group assumes risk, do they then get some of the dollars being spent on administration for the production of those services? If for example a group takes on full risk and they’re going to do all the medical management work, does the percentage of dollars in the premium that’s utilized for medical management shift from the payer to the provider organization? 

But you’re bringing up another good point, which is there are economies of scale associated with large payers in providing these services. As more provider groups decentralize some of those functions, there’s potential for those dollars to actually increase, where it will make sense for some of these provider groups to outsource some of the services to groups that can provide them more economically.

What are your priorities for the company?

The priority for us is around helping providers succeed in the new world. We believe strongly providers should assume risk. We want to help them provide the highest quality, most efficient care possible. 

That’s our goal — to reduce healthcare dollars, but reduce it in a way that makes sense so that the incentives are tied to providers as the reason to do it instead of fighting it. Align incentives, provide them the right tools, and switch the paradigm right now of insurers in charge and put providers in charge.

If you look down the road five years, what do you see most being changed?

I spend a lot of time with physicians in hospitals right now. I see them mostly focused on what happens in their four walls. I understand that because that’s what they do. The physicians are focused on what happens when the patient sees me.

What I’d like to see happen is that the medical community – hospitals and physicians – come together to manage the population and focus on that rather than managing that patient who comes into my hospital. Focus on reducing the kinds of utilization that they today are incented for. I’d like to see them change their mindset.

Morning Headlines 4/10/13

Administration pushes toward electronic medical records

CMS and OIG both propose rules extending the safe harbor exceptions to both the Stark Law and the Federal Anti-Kickback Law that are set to expire on December 31, 2013. The laws would otherwise prevent hospitals and health systems from subsidizing EHRs for practices that refer patients to the organization.

Tavenner Moves Closer to CMS Confirmation

Marilyn Tavenner, acting head of CMS, received bipartisan support at her confirmation hearing Tuesday, taking her one step closer to becoming the agency’s first confirmed administrator since Mark McClellan, MD, PhD left the post in October 2006.

My first 100 days as Allscripts CEO

Paul Black provides some perspective on the transformation he is leading at Allscripts.

Did Jon Stewart Foil The Pentagon’s Health Records Plan?

Following a groundswell of negative media coverage and the appointment of former VA deputy administrator Chuck Hagel, the DoD seems to be revisiting the idea of adopting VistA in order to more efficiently move toward a central, integrated EHR.

News 4/10/13

Top News

The HHS inspector general and CMS propose rules that would update and extend existing safe harbor exceptions and allow hospitals to continue subsidizing EMRs for affiliated physicians.

Reader Comments

From Wildcat Well: “Re: HIE. ONC announces an interest in a nationwide interoperable HIE. Is this not the same initiative as the CommonWell Health Alliance pilot? CommonWell will be a 501(C)(6), but regardless. Looks like a race of private vs. the government. Thoughts?”  

From Shodan the Barbarian MD: "Re: Shodan search engine. Guess you could easily find the IP address of a monitor, anesthesia machine, ventilator, or IV pump and change the settings. Scary with the virtually non-existent security of these devices.” A CNN article covers the Shodan search engine, a Google-like service that finds any device connected to the Internet such printers, webcams, routers, servers, security cameras, and even medical equipment. Many of those devices have no security protection at all, and many more have the manufacturer’s original password or an easily guessed replacement like “password1” or “1234”. An independent security consultant was able to run a car wash, turn off the cooling system of a hockey rink in Denmark, and access the control system of a French hydroelectric plant.

From Bob Loblow: “Re: QuadraMed. CMIO Joe Bormel, MD has left after 10 years and is now with ONC.” His LinkedIn profile still shows him as an independent consultant, having left QuadraMed in January 2013. Update: readers confirmed that Joe started as ONC’s medical officer on Monday, April 8.

From JM: “Re: healthcare IT resources. What would you recommend a recent graduate do to better understand the HIT environment? Are there specific resources, entry-level positions, or education to seek out?” This question comes up every few months and I always invite readers to provide advice.

From Marie: “Re: at-risk contracts. I am doing research for a master’s program. We hear about at-risk contracts between payers and providers, but why haven’t we seen a similar movement between HIT vendors and providers? Why aren’t providers demanding that vendors go at risk for the cost and quality results they promise? Why aren’t vendors offering it to create competitive advantage?” I can only say that you’d be crazy as a vendor to make a hospital your partner knowing they don’t have the focus and capability to deliver the 80 percent of an HIT project’s value that comes from how a system is used rather than the system itself. That would be like a hammer manufacturer going at risk that you’ll build something nice with their product and pay them if so. I’ve had experience writing at-risk contracts as a customer and either party could get royally screwed just because some idealistic metric (readmissions, medication errors, cost per case, etc.) went up or down over several years because of factors entirely unrelated to the new system. Perhaps you could look at more specific measures such as orders originating from an order set, accepted clinical warnings, or decreased turnaround time, but it’s hard to assign a dollar value to those. But I’ll let readers chime in and help Marie with her project.

HIStalk Announcements and Requests

This week marks my sixth anniversary at HIStalk. Happily I still think it’s the best job in HIT. In fact, every once in awhile I have to pinch myself to make sure I am not dreaming and that I am not about to wake up in the middle of the night to catch a 6:00 a.m. flight for an EHR demo to a bunch of doctors and their transcriptionists(!) Thanks Mr. H for keeping it fun.

Welcome to new HIStalk Platinum Sponsor Xerox, and specifically its Healthcare Solutions business. The company’s provider offerings include system selection and implementation (Meaningful Use, EHR, ERP, revenue cycle, ICD-10), optimization (technology and infrastructure, extended business office, collections, compliance), and analytics (clinical surveillance, decision support, care management, case management, and benchmarking). The company has been serving providers for 25 years, has 1,500 hospital clients, works in 31 states, and does work for 19 of the top 20 health plans. Some of the major vendors supported are Epic, Cerner, GEHC, Siemens, Meditech, McKesson, Allscripts, Infor Lawson, and Kronos. Thanks to Xerox for supporting HIStalk.

Here’s a video I found on YouTube that provides an overview of Xerox in healthcare.

Acquisitions, Funding, Business, and Stock

A Wisconsin newspaper’s article called “Life After Epic: From Epic ‘Grad’ to Entrepreneur” covers companies started by still-young former Epic employees, some of them working from a railroad car converted to co-working space. A local entrepreneur networking group estimates that 50 former Epic employees are working startups in the Madison area, most of them not healthcare related. A new entrepreneur says Epic’s one-year non-compete clause provides a good time to start a company.

Allscripts CEO Paul Black was paid $9 million in his first 12 days on the job, according to the Chicago business paper. Most of that was in stock and bonuses. Glen Tullman, his fired predecessor, made $7.1 million in 2012.

iMDsoft opens a new office in Dusseldorf, Germany that will provide around-the-clock support to its customers in Germany, Austria, and Switzerland.

Sales

Presence Health (IL) will deploy the Medseek Predict CRM solution.

Mississippi Medicaid selects the MedeAnalytics Accountable Care Solution to warehouse claims and clinical data collected from various HIEs.

The Ocean Beach Hospital (WA) board of commissions approves the purchase of Healthland’s EHR.

Planned Systems International and its partner Mediware win a $5 million DoD contract to provide validation services for the Enterprise Blood Management System.

People

Versus promotes Kevin Jackson to VP of technology.

Terry McGeeney, MD (TransforMED) joins healthcare consulting firm BDC Advisors.

MedeAnalytics hires Ping Zhang (Epocrates) SVP of product innovation and CTO.

Paula Sanders is promoted to chair of Post & Schell’s national Health Care Practice Group of 30 attorneys, representing clients on health facility regulation including RAC audits, HIPAA, and fraud and abuse.

Announcements and Implementations

The Joint Commission issues a Sentinel Event Alert after 80 deaths between 2009-2012 are found to be related to medical device alarm fatigue.

Massachusetts General Hospital and American Well announce a telehealth pilot program that will initially focus on child and adolescent psychiatry, heart failure, and neurology.

Christus Health Systems and Legacy Community become the first providers in Houston to share patient data via the Medicity-powered Greater Houston Healthconnect HIE.

Western Maryland Health System implements the Visibility Staff Assist solution from Versus Technology.

The local paper profiles St. Luke’s Regional Medical Center (IA) and its recent transition to EHR. The paper notes that, “The Affordable Care Act, commonly called Obamacare, requires health care providers to move to electronic medical records by 2014” and that, “Epic is not interoperable with hospitals and clinics that use other forms of electronic medical record.”

CIC Advisory announces a Meaningful Use Stage 2 benchmarking tool that includes on-site interviews and reviews followed by a detailed scorecard for a flat fee of $2,500.

Technology recruiter Greythorn offers its first Healthcare IT Market Report. It covers salaries, benefits, consulting , bonuses, and part-time employment.

Spain’s first telemedicine service launches as La Palma and Tenerife Islands offer virtual consultations via Cisco HealthPresence.

MMRGlobal launches a service that will allow providers to offer and bill for telemedicine services via its personal health records system. It has also adding a genomics module. Both will integrate with the 4medica EHR beginning April 15.

Government and Politics

Nextgov reports a rumor that the DoD may be ditching its plans to upgrade its AHLTA EHR system and instead reconsider using the VA’s VistA, with two potential reasons cited by sources: (a) the rise of former VA deputy director Chuck Hagel to Secretary of Defense; and (b) the satirical comments on incompatible DoD-VA EHRs by Jon Stewart in his March 27 “Daily Show,” in which he blamed the DoD for stubbornly following its expensive AHTLA agenda to avoid giving up ground to the VA.

Technology

Johns Hopkins surgeon and patient safety expert Martin Makary, MD, MPH says in a JAMA editorial that hospitals should use the video equipment they already have in the OR to record every procedure to support quality improvement efforts. Patients overwhelmingly support having their procedures recorded, surveys have found, and the recordings could be used for training and for inclusion in the EHR to support less-detailed operative notes.

The Apache Software Foundation moves the Apache cTAKES  project to a Top-Level Project. The open source NLP system, originally developed by a Mayo Clinic team, extracts information from free-text EMR documentation.

Google announces that its Google Fiber gigabit-speed Internet service, originally rolled out in Kansas City with 100 times normal broadband speed, will be live in Austin, TX by the middle of next year.

Other

The big data revolution could reduce healthcare spending by an estimated $300 to $450 billion according to a McKinsey & Company report.

Paul Black blogs about his first 100 days as CEO of Allscripts and reflects on emerging themes, including the need to work closely with customers and patients to transform the industry; the need for population health management across venues for care; and the importance of coordination care tools.

The Wall Street Journal looks at the use of cloud-based storage for medical images, noting that more than half of the country’s health systems are expected to embrace cloud-based image storage over the next three years.

GE Healthcare, which cut 10 percent of its South Burlington, VT staff last year, lists 120,000 square feet of its office building there for lease. The company has 436 employees occupying 142,000 square feet.

Here’s the latest cartoon from Imprivata.

The New York Times covers “a parallel world of pseudo-academia” in which conferences and journals with prestigious-sounding names offer presenters and authors resume-padding exposure in return for cash. It says that universities need to be careful in reviewing resumes and predicts that people will be misled by poorly research publications that appear in credible-sounding online-only journals. A research librarian estimates that 4,000 “predatory open-access journals” are being published because it is “easy money, very little work, a low barrier to start-up.” One physician sent two articles in response to an e-mail from The Journal of Clinical Case Reports and was billed $2,900, with the journal running his articles even after he requested they be withdrawn. A Duke University School of Medicine professor agreed to serve on the board of one such publication and was surprised it solicited him to recruit authors and publish his own papers; when he asked to be removed from the board, the journal just left his name on its masthead anyway.

Jamie Stockton of Wells Fargo Securities provides updated MU attestation information for hospitals. Leading in EP attestations were Epic, Allscripts, eClinicalWorks, NextGen, GE Healthcare, McKesson, Cerner, Practice Fusion, Greenway, and athenahealth, which
as the top 10 vendors accounted for two-thirds of all attesting EPs.

Weird News Andy uncovers this case of texting while flying: the National Transportation Safety Board finds that a contributing factor in a 2011 medical helicopter accident was the pilot’s texting before and during the flight. The helicopter crashed into a field after running out of fuel, with NTSB’s conclusion being that the distracted pilot thought he had more fuel than was actually available. The pilot, a flight nurse, a paramedic, and a patient were killed in the crash. The pilot had sent or received 240 text messages during his shift the day the helicopter crashed, including seven during the flight itself as he made arrangements to have dinner with a co-worker.

Sponsor Updates

• Billian’s HealthDATA offers a white paper on the top integrated marketing priorities in the age of healthcare reform.
• AT&T generated $5.6 billion in revenue in 2012 from healthcare industry businesses implementing one of the company’s cloud and mobility-based solutions.
• AirStrip ONE beats 15 competitors in a mobile health app contest. 
• Brad Levin, GM of Visage Imaging, will participate in a SIIM 2013 session titled “Who do you turn to for help in developing solutions?” in the Dallas area June 6-9.
• Wellsoft will participate in the 2013 Emergency Medicine Update and the e-Health 2013 conferences in Canada during the month of May.
• Emdeon highlights the benefits of e-prescribing and discusses why providers need to embrace the technology.
• Merge Healthcare and Integrated Data Storage will create a hosted private cloud offering for the Merge Honeycomb platform.
• Cassie Sturdevant, a senior recruiter with Impact Advisors, joins a panel of other healthcare recruiting experts to discuss the healthcare job market.
• Surgical Information Systems CTO Eric Nilsson shares his impressions on interoperability and the Intelligent Hospital Pavilion at last month’s HIMSS conference.
• HealthEdge partners with CTG Health Solutions to deliver integration services for customers using the HealthRules Answers BI suite.
• Cornerstone Advisors Group launches its new website.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 4/9/13

Medical device alarm safety in hospitals

The Joint Commission issues a Sentinel Event Alert after it receives 80 reports of deaths between 2009-2012 that were related to alert fatigue.

The big-data revolution in US health care: Accelerating value and innovation

A new report published by McKinsey & Company claims that big data models could lead to $300 billion to $450 billion in reduced healthcare spending annually, or 12 to 17 percent of the $2.6 trillion spent on healthcare in the US.

Catholic Health Initiatives and Accenture Apply Analytics to Identify Health Risks Among Patient Populations

The 78-hospital system Catholic Health Initiatives and Accenture have announced a collaborative nine-month project during which big data analytics tools will be developed to identify at-risk patients within CHI’s patient population. The initiative will also focus on enhancing CHI’s data warehousing capabilities.

AliveCor Names Industry Veteran Dan Sullivan President and CEO

AliveCor, the smartphone-enabled ECG company, announces the appointment of Daniel Sullivan (previously of SuperDimension, Inc.) as president and CEO.