News 3/15/13

Top News

Wells Fargo Securities slices and dices CMS Meaningful Use data to arrive at the 2012 year-end table for EPs above. It finds that 65 percent of physicians have registered and 25 percent have attested.

Reader Comments

From TechTalk: “HIStalkapalooza. Are there video or stills of HIStalkapalooza expected?” In case you missed this last week in the midst of HIMSS craziness, here is the link to the video. We also have a few pictures on our HIStalk Facebook page. We appreciate Medicomp Systems for sponsoring the event, with the help of a production team from Patrice Geraghty (bzzz productions), Cindy Wright and Shannon Snodgrass (Thomas Wright Partners), and Anthony Istrico (Istrico Productions).

From Close but Not Inside: “Re: Voalte. What happened to Rob Campbell, CEO and founder? Erased from the site.” Voalte just announced that Trey Lauderdale has been moved to president and four new VPs have been hired: Phil Fibiger, engineering (Canonical, Ltd.); Bob Porterfield, product and alliance management (Capsule Tech); Frank Watts, sales and marketing (F. Watts & Associates); and Don Fletcher, chief architect (Google). No word on Rob.

From Carly: “Re: Howard University Hospital. Brought its first unit live on Soarian CPOE earlier this month. Rollout to general medicine coming later in the month. Physician participation has been strong and enthusiastic.”

From Natalee: “Re: Nordic Consulting. We have not been sold. We’ve enjoyed a recent surge in growth, and continue to be focused on helping our clients successfully install and support their Epic system. Perhaps your readers are referencing an investment partnership Nordic made last October.” Natalee is from Nordic Consulting and responded to a reader’s rumor report from right before HIMSS. Here’s a statement from CEO Mark Bakken about the October investment:

We’re thrilled to have partnered with three IT investment groups who share our vision and commitment to excellent customer service. One of the most exciting things we’re doing with the help of their resources is developing new strategic lines of business, branded Nordic’s SUMMIT Series of Epic Solutions. These new services, focused on Optimization, Upgrades, Remote Services, and Reporting/Analytics, provide strategy and execution expertise to clients enabling them to achieve peak performance from their Epic system and realize the business value and patient care benefits that are now within reach.

From Moe Betta: “Re: New Orleans airport delays caused by TSA cutbacks. BS. After over a dozen visits to New Orleans, they can’t do anything efficiently. Aside from the sometimes intriguing and tasty cuisine, the city operates in a third-world atmosphere. It was that way long before Katrina and will be forever. Sunday in and Thursday out has always been a HIMSS disaster at the airport. Yet, that is part of its ‘charm,’ a trip outside – but inside – the US.” Most interesting to me was that the long security line was divided into two lines, but once you got around the corner, they merged back into one line. Queuing theory experts and Disney fans would have been horrified. Seth Frank, VP of investor relations for Allscripts, agreed in an investor presentation: “Last week at HIMSS conference, the big healthcare IT annual powwow, which was in New Orleans, hopefully, never to go back there again — I love New Orleans, great town, just not for 35,000 people.”

HIStalk Announcements and Requests

This week’s HIStalk Practice highlights include:  over 13,000 pharmacies now accept e-prescriptions for controlled substances. A survey of 2,600 primary care physicians reveals that 87 percent of doctors believe they receive too many EHR-based alerts. Emdeon begins working with CMS to map new HIPAA 6020 standards. HHS wants 50 percent of doctors online with EHRs by the end of the year. The average physician could lose over $43,000 over five years with EHR adoption. Culbert Healthcare Solutions’ Brad Boyd offers suggestions for the best ways for organizations to incorporate external data into their BI efforts. Dr. Gregg imagines the future of healthcare. It’s all good stuff so pop over and catch up on the latest ambulatory HIT news, check out a few of our sponsors’ offerings, and sign up for the e-mail updates. Thanks for reading.

On the Jobs Board: SCRUM Master, Healthcare Technology Project Manager, Practice Management/EMR Sales Executive, C-Level Healthcare Technology Sales Executive.

Sales

Integris Health (OK) will implement Phytel’s population health and care management tools at its physician practices.

South Jersey Healthcare (NJ) selects Surgical Information Systems Perioperative Management to work with its Soarian Clinicals.

People

Arcadia Solutions names Sean Carroll (Nuance) CEO.

Announcements and Implementations

The NHS invites Humetrix to present its iBlueButton platform at the NHS Innovations Expo 2013 in London.

iMDsoft releases MVpanorama for actionable cross-patient information and allocation of nursing resources.

Hawai’i Pacific Health goes live at its first of four locations with iSirona’s medical device integration solution.

NTT DATA is recognized by Canada’s Top 100 Employers program.

SuccessEHS goes live with a production connection to the South Carolina HIE (SCHIEx) as one of the first ambulatory EHR vendors to do so. 

Cerner will add symptom-specific patient questionnaires from Primetime Medical Software to its patient portal.

St. Joseph Mercy Oakland (MI) implements the latest version of Voalte’s iPhone for clinical communication.

Other

Fired Allscripts executives Glen Tullman and Lee Shapiro say they will be starting a mobile healthcare company.

WellStar Health System (GA) leases 21,000 square feet of an off-campus data center to handle its Epic implementation.

Strange: authorities say a homeless man was able to live in a Louisville hospital because he always wore scrubs, a lab coat, and a surgical mask. He was caught after using a restricted computer system, which a helpful doctor helped him access by logging in under his own password.

Weird News Andy christens this story “Fickle Finger of Fake.” Five doctors in a hospital in Brazil are suspended for using fabricated silicone fingers to clock in their colleagues on fingerprint-reading time clock readers. One TV network says the ringleader was the head of the ED, whose daughter was paid for three years despite never actually showing up. Authorities say up to 300 paid employees may exist only in silicon finger form.

Sponsor Updates

• Alesco Medical becomes a channel distributor of e-MDs.
• Thousand Oaks Radiology Group (CA) chooses McKesson Revenue Management Solutions.
• KBQuest will showcase the Kony Solutions mobile platform at the Microsoft Tech Days conference in Hong Kong.
• The British National Formulary offers direct access to the DynaMed evidence-based clinical information resource to its subscribers.
• Commonwealth Orthopaedic Centers (KY) selects SRS EHR/PM for its 17 physicians, 10 physician extenders and 2 PT locations.
• Ping Identity is showcasing PingOne Single Sign-On at the Ultimate Connections Conference in Las Vegas this week.
• Cancer Treatment Centers of America expands its MedAssets relationship to include Capital and Construction solutions to drive construction costs down.
• GetWellNetwork CEO Michael O’Neil shared his personal experience as a cancer patient and how patient engagement improves outcomes and satisfaction at The Thirteenth Population Health and Care Coordination Colloquium in Philadelphia this week.
• Aycan, GE Healthcare, Siemens Healthcare, TeraRecon, and Vital Images participate in the European Society of Radiology’s Face-off.
• Ingenious Med releases a white paper on the breakdowns in communication during patient handoffs and offers best practices.
• Emdeon begins mapping HIPAA 6020 standards for CMS.
• Informatica adds support services to its MySupport portal including eService apps Call Me, simple online escalation and online bug tracking.

EPtalk  by Dr. Jayne

The National Rural Health Resource Center offers an HIE tool kit that includes guide to Direct connectivity standards and an ROI calculator.

Through the retrospectoscope: CT scans on mummies from various parts of the world reveal evidence of heart disease. The presence of vascular disease was independent of the presumed diet consumed in the socioeconomic groups represented by the mummies. Several media outlets are using this to counter the theory that fatty diets and our modern lifestyle cause atherosclerosis. Bring on the curly fries!

Death by smart phone: researchers from West Virginia University are proposing that cell phones be rendered inoperable in moving cars. Drivers using cell phones cause more than 330,000 injuries per year including 2,600 deaths. Texting may account for more than 16,000 deaths between 2001 and 2007. I shudder every time I am cut off by a chatty driver who has no idea I’m in the lane. Of course blocking phone use in a moving car would also impact passengers. This may be responsible for a sharp uptick in teenagers forced to carry on a conversation with their parents which I definitely support.

A recent survey published in Health Affairs suggests that the majority of practices will lose money when adopting electronic health records. Major drivers of positive return on investment included the degree to which providers used the EHR to increase revenue and ceasing use of paper records. I continue to be amazed each time I step into a practice that professes to use EHR yet continues to either document on paper and scan, or document on paper and then key in the findings. Usually the providers are lamenting that they’re slower since they are on EHR and I wind up giving them a free informatics consult.

Speaking of EHR practices that still use paper, I had a patient appointment earlier this week at a rival academic medical center. Following the visit, I was given the opportunity to sign up for the patient portal. I was impressed by the ease of signing in using the combination of my Yahoo credentials and a token code given at the office. I was unimpressed that my chart has my name spelled wrong and a work phone number that I don’t recognize. Since my demographics were correct at the office, I sent a secure message to ask for a revision. The office again confirmed the accuracy of the outpatient chart and responded back that they had no idea who to contact or how to get it fixed. Since the Terms of Use included the vendor’s information, I know it’s a solid and highly regarded one. Just goes to show how a poor implementation can wreak havoc for patients.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 3/14/13

Arcadia Solutions announces Sean Carroll as CEO

Sean Carroll (SVP healthcare at Nuance) has been named the new CEO of strategic consulting firm Arcadia Solutions.

South Jersey Healthcare Selects Perioperative Management By Surgical Information Systems

Two-hospital South Jersey Healthcare signs with SIS to provide a perioperative management solution to complement its Soarian Clinicals EHR.

PwC finds HIT worker shortage bigger than expected

A recent study released by PwC finds a larger than expected shortage of qualified HIT workers, leading many to look outside the industry to fill gaps.

ICD-10 transition to move forward, CMS says

CMS announces that October 1, 2014 is a firm and fixed switchover date for ICD-10 codes and that no additional delays will be considered.

Time to Stop Tyranny in Medicine

Time to stop the tyranny in medicine is the general theme of the spring issue of the Journal of American Physicians and Surgeons, citing ICD-10 mandates, Meaningful Use requirements, e-prescribing, and Physician Quality Reporting System as indicators that things have gone too far.

Readers Write: A Balanced EHR Copy Forward Solution

A Balanced EHR Copy Forward Solution
By Kyle Samani

There’s been a recent wave of media coverage surrounding the topic of EHR copy forward functionality. Many have suggested that this function should be outright banned. The reasons vary, but in general most of the problems cited are related to the fact that the copy forward function in EHRs creates garbage and bloat in the patient’s record.

As someone who has experience designing and programming EHRs, who has deployed an EHR in inpatient and outpatient (PCPs and specialists) environments, and who has talked to hundreds of doctors about the subject in various presentations, I have a unique perspective to offer.

Lyle Berkowitz, MD, CMIO of Northwestern Memorial Hospital in Chicago, recently posted on the subject. He’s right. EHR copy forward is a great tool if used correctly. The problem is that EHRs make it too easy to abuse. Most of the copy forward functions in EHRs look at the last note and quite literally copy every field forward into the current note. This is problematic because full-note copy forward allows the doctor to copy forward too much information before all of it can be digested and understood.

There are easily dozens if not hundreds of data points in a given note. Doctors shouldn’t be encouraged to copy hundreds of data points into the current note before having a chance to complete the current assessment. It’s too much, too early in the examination process. The EHR should make it easy to copy forward information in manageable pieces.

I lead the original design of a function in my company’s EHR called Copy to Present in the latter part of 2011. It’s similar to the copy forward feature in most modern EHRs. The primary difference is that it doesn’t copy the entire note forward, just the active area of focus. The function is available in conjunction with a date dropdown on all major sections of the chart.

For example, the physical exam page contains a date dropdown at the top of the page. When a doctor visits the physical exam page, the date dropdown defaults to the current date. Doctors can quickly review an old physical exam summary by selecting from a date in the dropdown, which is populated with dates of previous physical exams for the active patient. When looking at an old date, the Copy To Present button appears. Clicking it copies forward the selected physical exam to the current note. The Copy to Present button doesn’t affect any part of the chart other than physical exam; all other areas are left intentionally untouched. After clicking the Copy to Present button, the physical exam data is editable as if the doctor had entered the data by hand.

A video demonstration of Copy to Present is above and here.

Copy to Present and the date dropdown are useful for data points that need to be collected and updated during every examination. Examples include chief complaints, physical exams, review of systems, and assessments and plans. In these scenarios, the Copy to Present function allows the doctor to understand what they recorded last time before copying forward to the current note. It provides the quick copy-forward function doctors want and need, while still allowing fine-tuned control over what’s copied forward.

However, Copy to Present is irrelevant when dealing with other types of information. For example, allergy lists, medication lists, problem lists, lab results, medical history, and surgical history. The most up-to-date versions of these data points should always be shown regardless of who last updated the list across any care setting (inpatient, outpatient, ED). EHRs should understand (but most don’t) that these pieces of information aren’t part of a particular note as much as they are relatively static pieces of data about the patient. Once labs and allergies are recorded, they should be available to any clinician that needs access to them, and they should always be up to date independent of any clinical note.

EHRs need to understand the kind of information they’re handling. Different pieces of information should be handled differently depending on what the information is, who is accessing it, and what that person needs to do with it. EHR vendors have a responsibility to ensure they provide the tools to make sure clinicians can get what they need, when they need it, and understand it as quickly as possible.

Kyle Samani is inpatient deployment manager at VersaSuite of Austin, TX.

Readers Write: Practice Management Software, Payment Portals, and the Merchant Service Account Problem

Practice Management Software, Payment Portals, and the Merchant Service Account Problem
By Tom Furr

The more than 300 practice management software vendors in the United States help practices that range in size from individual doctors to multi-office groups made up of thousands of health care professionals manage their most important operations, both clinically and financially.

Attuned to the government’s drive to capture critical data and make it available online along with providing greater cost transparency, these practice management software providers are offering payment portals tangential to their core software. These electronic mail slots are intended to let patients see their statements online and then pay their bills through this technology using their debit or credit cards.

Unfortunately, with every payment portal that comes online, every practice is required to establish a merchant service account. In simplest terms, a merchant service account is a specialized account provided by a bank or other financial institution to enable online transactions. This account, which enables credit card transactions, is an agreement between the practice and the bank that contractually binds the practice to obey the regulations established by the bank.

To secure the agreement, a practice needs to complete an MSA application form which, amazingly typically numbers 18 pages or more. Imagine the office manager of a medical practice taking time out of his or her day to handle that. The list of questions that must be answered run the gamut from the practice’s address to its checking account number, the principal’s SSN, employer ID Number, and much more (and those are the easy ones). Let’s not forget the need to get a voided check on the account to be used, a copy of the driver’s license of application signatory, a detailed list of services offered, credit card processing statements of the previous three months, a copy of the articles of incorporation, as well as business tax returns and business financial statements. All in all it’s almost as much paperwork as that which you waded through when you closed on a house, and you remember how much work that was.

In the end, the unfortunate reality is a practice management software vendor often sees a deal come unraveled because of the obvious problems associated with getting an merchant service account in place. It doesn’t have to be that way. There has to be a better solution.

My issue isn’t with the role of a merchant service account or with the very real need to provide patients with a safe, secure, and simple way to pay for healthcare services online. My problem is with the process of setting up or, for that matter, going through nearly the same time-consuming process should changes occur that relate to an merchant service account.

A solution that can work for all involved resides within the practice management software itself where it has a universal merchant services account, like PayPal or Square, for all its practices and automatically receives, posts, and reconciles payments back into the system. This eliminates the merchant services account set-up problem and makes the practice management software all the more useful to the practices using it. The best part is such an approach could cut down on the amount of paper and time used to bill patients, reconcile patient balances, and more.

For the sake of the practices using their software and their potential clients, practice management software vendors should find and fit the sort of solution I’ve sketched out above into their systems. Their practices and their patients will thank them for it.

Tom Furr is CEO of PatientPay of Durham, NC.

An HIT Moment with … Belinda Hayes, VP/GM Mobile Products, Imprivata

Belinda Hayes is vice president and general manager, mobile products, of Imprivata of Lexington, MA.

What are the biggest opportunities and challenges with mobile technology in healthcare?

Mobile technologies improve the way care providers communicate and collaborate on patient information and how they provide patient care. Almost every provider is armed with a smartphone that they use to communicate patient information, so we enable them to do that securely and for free.

However, it’s not just about the providers and how they access and share information. It’s about the entire ecosystem of healthcare professionals, like technicians, hospice workers, EMTs, etc. Mobile technologies have the potential to transform healthcare communication across boundaries that traditional communication could not.

These opportunities are not without challenges. Information is always at risk of becoming stove-piped or siloed. How do you take patient information from all these independent clinical systems and create a holistic view of a patient record? How do you decide what goes into the EMR? At what point does a medical record leave the EMR? Who has access to it and how is that tracked? How can that information be viewed across devices and clinical workflows?

Many hospitals restrict who can use smartphones today. Nurses may not have access to smartphones, for example, so mobile solution providers may need to support other forms of access, such as browsers. You’ve got to not only cover all relevant new devices, but give options for information access to the right people wherever its need.

The end of hospital pagers seems near. What will differentiate the products that are competing to replace them?

We hear this consistent theme from our customers. Smartphones will replace pagers. Providers are consumers just like you and me. They want the same experience communicating with their clinical team as they do with their kids. They want to use the latest technology. It complements our work and personal lives – we do our banking, schedule meetings, text our family, and communicate socially from our smartphones.

Providers want to similarly communicate with patients using their device. But it’s more than analog communication. It’s about collaboration. For example when a physician wants to communicate a patient’s status to a colleague, they first need to find a call list, then a phone, send a page to a different device, and wait around for a callback. This is terribly inefficient. Why is healthcare still relying on technology created over half a century ago?

Care providers want and deserve a better experience and pagers are limited. Pagers can’t provide you with a list of all your colleagues synced from the organizations directory. Pagers can’t see your colleagues’ status or send them a picture. Pagers can’t send group messages with conversation history and bridge communication across affiliated hospitals. Mobile phones and applications can. This experience, availability, and costs are driving providers to replace pagers with smartphones today.

What’s the business case for Imprivata Cortext?

Imprivata is fortunate to have a customer base of over 1,300 hospitals for our access management products. We frequently speak with our customers’ CIOs and clinical leadership about the next big thing. What problems are they facing? What is their long-term strategy and how does technology support it?

About a year ago, we heard an overwhelming need for secure texting from many of these customers. We ran our own survey across our base and found that over 81 percent of physicians have smartphones and 40 percent of physicians are already texting. CIOs told us this was a big risk that needed to be addressed. We launched our solution, called Imprivata Cortext, in October of this past year, and the response has been overwhelming. The application is completely free, including basic support, but we offer paid premium support options. We’re adding over 100 healthcare organizations a month and ended 2012 with over 400 enrolled in just three months.

We’ve learned a lot over the last 10 years in healthcare. It’s like no other industry. You have to nail the experience. We invest a lot of time talking to customers. Listening to what they need and collaborating with them early in and throughout the product design process. Care providers love Imprivata Cortext because it lets them communicate more efficiently. There is much more to secure texting than just a text message. A good solution will meet the basic requirements. But a great solution is actually built by clinicians, for clinicians. Its value will be self-evident to them.

For example, we found that a simple task such as locating a clinician on a phone wasn’t so simple. It needed to be easy and seamlessly incorporate the hospital’s corporate directory so providers can find one another with as few clicks as possible. It also must support group communication so that care teams can collaborate efficiently. And most importantly, it needs to enable providers to communicate across all of the healthcare organizations at which they work – all from a single application.

CIOs tell us they love Imprivata Cortext because it’s not only technically secure, but we back it up with a business associate agreement. There are many vendors in the space that call themselves “HIPAA compliant” but won’t back that up with a BAA. Our customers also care about where we are taking Imprivata Cortext. Texting solutions must provide a robust platform so that providers can support the evolving needs in healthcare such as the patient engagement requirements in Meaningful Use. Interoperability with clinical systems is critical.

What lessons about physician usage and preferences have been learned by their use of mobile devices that could be applied to other IT systems?

Physicians no longer work at one location. In fact we just did a study that shows over 50 percent of providers state they work at more than one location. Providers travel between their affiliated hospitals and practices, from nursing homes to even a patient’s home. So the power of mobile devices is the personal nature of the device. The power of mobile applications is that they enable you to be fully connected at all times. Now the only issue is how you bridge the desktop and the mobile device.

Let’s pretend a physician is treating a patient at the bedside and is viewing their current patient history. They need to get a consult from the patient’s specialist, which means they need to communicate directly with that clinician, sometimes in the form or an e-mail or text message. How do they compose that information? How do they transmit it securely? What if they want to add a photo, or video or audio of the patient’s heartbeat?

Smartphones have the potential to complement workflows that are today done from a workstation. This is what we’ve learned over the last 10 years from experience and a deep understanding of healthcare workflows. IT systems must bridge this gap. They must provide care providers with the ability to share and add to information from wherever they are. And do it securely.

We incorporated this thinking into the latest release of Cortext, which we announced last week at HIMSS. We designed a new capability that enables care providers to communicate across multiple organizations while still viewing a unified inbox of all their conversations. We heard loud and clear that IT wants to manage their own user policies and archives, but we had to balance that with a streamlined experience for the care providers. Early customer feedback is very positive.

Clinicians have embraced mobile technology, but hospital and medical practice systems don’t necessarily support those platforms very well. What’s the future for mobile-enabling enterprise applications?

There is a perfect storm happening in healthcare IT. On one front, you’ve got an industry that has been a slow adopter of technology, but HITECH and Meaningful Use have changed the game. Meaningful Use incentives have funded CIOs with investments to refresh their infrastructure. Not only are they deploying better EHRs and other clinical applications but the computing infrastructure is going virtual. Virtual desktops offer unique benefits to clinical workflows. You also have care providers and patients demanding and adopting technologies that they use in their everyday lives, like iPhones and iPads. Doctors and nurses are driving the BYOD revolution in healthcare.

Clinical applications have to incorporate mobile technology or their solutions won’t be complete and compete long-term. This idea that the EMR is the single-source of all information clinical is starting to change now that mobile applications are processing PHI. This needs to be part of the patient record. This provides a great opportunity for innovation. Take Imprivata Cortext. The concern around secure texting didn’t just happen. IT knew that their providers were already texting. Why? Because the convenience of communicating with their colleagues from their personal device greatly outweighed whether it was secure or not. Care will always trump security. Less than 24 months later, we are in a tornado of a market with over 30 vendors trying to solve the secure texting problem in healthcare. And in two years this number will be three or less. We like our odds with Imprivata Cortext.

Morning Headlines 3/13/13

Venture-Backed Appature Sells to IMS Health

Seattle-based Appature, a cloud-based marketing service that likens itself to the salesforce.com of marketing, is acquired by IMS Health, a health data distributor that helps define effective target markets within a population. The goal is to deliver an end-to-end marketing campaign tool to help hospitals increase brand awareness and manage patient engagement. Details of the deal were not disclosed, but rumors place the sale price north of $100 million.

athenahealth Completes Acquisition of Epocrates

athenahealth completes its $293 million acquisition of Epocrates and will begin working collectively to redesign its physician tool sets.

Web health records firm expands to Boston

Cloud-based ambulatory EHR vendor CareCloud will open an office in Boston joining athenahealth, eClinicalWorks, and a host of others in a growing EHR epicenter.

JCHC Transition To EHR, New Attendance Mostly Positive

Nurses at Buffalo, WY-based Johnson County Health Center go live with CPSI this week, physicians will follow suit in May.

News 3/13/13

Top News

Healthcare data vendor IMS acquires six-year-old, 60-employee Seattle startup Appature, which sells software for tracking drug company marketing activities to physicians. Rumored price was more than $100 million.

Reader Comments

From IT Dad: “Re: porno nurse. The company was Onyx. I’m a 50-year-old male and I was shocked when I saw it and shocked that someone thought this would be a good idea. I just kept on walking. I was insulted that they would treat women that way and immediately though of my daughter and my female co-workers. I would not even consider stopping at their booth as I did not want to be seen there.” I e-mailed an Onyx contact for a comment and received no response. I was torn whether to run the reader-submitted photo above (taken by a real nurse, I might add) since that might seem equally chauvinistic, but decided readers need to see at least a small-scale version to understand what the fuss is about. The China-based Onyx sells medical displays, of which the scantily clad phony nurse appears to be one.

From Odla: “Re: Neal Patterson. Funny that Neal was seen at several booths at HIMSS. He was at the Optum booth for a bit until an exec recognized him and politely suggested he might want to return to the Cerner booth.”

From The PACS Designer: “Re: ECM. TPD will be posting interesting apps that address Big Data concerns in our path to enterprise content management (ECM). As a lover of what Hadoop can bring to healthcare, there’s an app that employs Hadoop called Platfora.”

From Captain Ron: “Re: HIMSS. I witnessed a classic moment at HIMSS last week that I had to share. I visited the QlikView booth to watch CHOP present on self-service analytics. Very impressive stuff and they’ve integrated QlikView in Radar. So the funny part … multiple folks there from Epic and one guy in particular decided he should interrupt and share how Epic can help solve this problem. I wonder how Epic would feel if QlikView came and interrupted their customer presentation? #BOUniversesarenottheanswer.”

From PartyReviews: “Re: HIMSS parties. Hit a few parties at HIMSS. Yours was the best of the bunch. Funny how a blog is out partying the big vendors. Consulting firms all had more of a reception format. Deloitte was kinda stiff as you’d expect, Impact Advisors and a few others were OK. Encore had their traditional and apparently popular Pub Night which I hit two times during the week. Each night there were over 300 people there. Guess people really like the free beer, wine, and mixed drinks. No vendors were over the top as has been normal in the past. I got into bed Mon-Wed at 2 a.m., 1 a.m., and 3 a.m. respectively. Only in New Orleans. And we wonder why HIMSS is a burn out?”

Acquisitions, Funding, Business, and Stock

Athenahealth completes its acquisition of Epocrates.

TeleTracking Technologies reports a 42 percent increased in booked revenue in the 2012 fiscal year.

ISirona announces revenue growth of 172 percent for 2012.
 
A proxy advisor firm urges HP shareholders to give the boot to two of the company’s directors at its upcoming annual meeting for their role in the disastrous acquisition of Autonomy in 2011, one of them being McKesson Chairman, President, and CEO John Hammergren. A group of New York City pension funds also urges voting against the re-election of Hammergren and G. Kennedy Thompson for their involvement in acquisitions that caused HP to lose $17 billion in the past year and for the quick hiring of CEO Leo Apotheker, who was then fired less than a year later.

Ireland-based bedside computing vendor Lincor Solutions receives a $9.5 million investment from Edison Ventures, which it will use to relaunch the company in the US by moving its headquarters to Nashville, TN and creating 30 jobs. The MediVista platform offers access to clinical applications, bed status management, patient entertainment and education, and communications.

Medical supply vendor Becton Dickinson & Company acquires Austria-based Cato Software Solutions, which offers oncology planning, monitoring, and drug preparation software.

Lexmark acquires two companies that will be rolled into its Perceptive Software unit. AccessVia sells software that allows stores to print electronic shelf tags, while Twistage provides media management software that its CEO says could be used to distribute medical images and attach video to a patient’s EMR.

Sales

East Texas Regional Healthcare System selects Siemens MobileMD HIE to coordinate care among its 15 facilities.

The Salisbury, Wight and South Hampshire Domain NHS Trust  Consortium (UK) awards its VNA and data migration contract to Acuo Technologies.

Coastal Medical (RI) adds the eClinicalWorks Care Coordination Medical Record to advance its ACO-related objectives.

Iowa Health System will implement a suite of Infor applications, including Infor Lawson Supply Chain Management and Enterprise Financial Management.

The Virginia Department of Behavioral Health and Development Services selects Siemens Healthcare’s Soarian clinicals and financials and the MobileMD HIE platform.

People

Suzanne Cogan (Shareable Ink) joins Orion Health as VP of sales.

Conifer Health Solutions names Allen Hobbs (MedAssets) chief client officer.

The AAFP’s TransforMED subsidiary names Russell Kohl, MD (OU School of Community Medicine / Oklahoma College of Medicine) medical director.

Infor names Barry P. Chaiken, MD (DocsNetwork) CMIO.

Ping Identity hires Michael J. Sullivan (IHS) as CFO.

HHS Secretary Kathleen Sebelius names new and continuing members to the US Technology Standards Committee including Jeremy Delinsky (athenahealth) and Eric Rose, MD (Intelligent Medical Objects).

Announcements and Implementations

CareCloud opens a Boston office, where it expects to house 35 to 40 employees by the end of the year.

Johnson County Healthcare (WY) goes live this week with CPSI.

PatientKeeper deployed its CPOE solution at 19 community hospitals during the first 60 days of 2013.

Eight vendors participated in the inaugural IHE 2013 North American Connectathon, which performed testing to specified requirements for the IHE USA Certification pilot conducted by ICSA Labs.

Final HIMSS conference stats: 34,696 total attendees, 13,985 professional attendees, 1,158 exhibiting companies.

The New Orleans airport warned travelers last Wednesday of expected delays on Thursday due to the conclusion of the HIMSS conference and sequester-driven TSA staffing reductions.

e-MDs launches a cloud-based EHR/PM solution and introduces Solution Series 7.2.2, an updated version of its client-server suite of EHR/PM products.

Government and Politics

Hello Twitterverse. I’m looking forward to reaching out to you and talking about the great work happening at @hhsgov twitter.com/Sebelius/statu…

— Kathleen Sebelius (@Sebelius) March 11, 2013

HHS Secretary Kathleen Sebelius fires up her Twitter.

Lt. Dan called this perfectly. Internal VA documents reveal that the agency is taking much longer than it reported to process service-related benefit claims by veterans, with delays averaging more than 1.5 years in major cities. The number of veterans waiting for more than a year for their benefits jumped from 11,000 in 2009 to 245,000 by the end of 2012. Despite spending $537 million on a new computer system, the VA still process 97 percent of claims on paper.

Other

Billian’s HealthDATA finds that medical records-related costs of hospitals typically account for less than three percent of total general-service operating expenses and almost seven percent of total general-service salary expenses.

The University of Mississippi Medical Center will expand its telehealth program to improve access for smaller hospitals and clinics and will create 201 new jobs over the next three years.

Sponsor Updates

• Divurgent’s Signature Drive at HIMSS raises $5,000 for the Children’s Hospital of New Orleans.
• Aspen Valley Hospital (CO) increases front office payments and reduces payment processing administrative time by 65 percent after deploying InstaMed’s healthcare payment network.
• Hyland Software and Merge Healthcare expand their partnership to include an integrated image viewing and storage solution.
• CareTech Solutions introduces CareTech Solutions Pulse, an integrated IT monitoring service that integrates monitoring of hospital clinical, business, and ancillary applications, as well as the infrastructure on which they run.
• The Virtual Influence Planning group, Medseek’s independent consulting firm, expands its services to include patient portal adoption and marketing plans for healthcare organizations. Medseek also introduces its Influence platform, which will provide hospitals with a comprehensive view of individual patients.
• Orion Health and NexJ Systems will distribute joint capabilities and technologies, such as NexJ Connected Wellness and the Rhapsody Integration Engine.
• CCHIT certifies NextGen Ambulatory EHR version 5.8 compliant with the ONC 2014 Edition criteria and certified as a Complete EHR.
• The Advisory Board Company announces the agenda and keynote speakers for its Crimson Clinical Advantage Summit May 20-22 in Scottsdale, AZ.
• Picis announces that is annual Exchange conference will be consolidated with the Optum Provider Exchange Conference September 23 in Orlando, FL.
• Philips Healthcare introduces its IntelliSpace eCareManager 3.9 patient management software, which includes the ability for staff to get a patient population level view of data.
• The NCQA awards SuccessEHS client Scenic Bluffs Community Health Centers (WI) the highest level of recognition for its PCMH program
• CAP Professional Services and the Lab Interoperability Collaborative look at the top 10 challenges facing hospitals seeking to report lab results electronically.
• GetWellNetwork debuts myGetWellNetwork, a digital platform to help patients and providers manage recovery, chronic conditions, and preventative care online. 
• Ephraim McDowell Regional Medical Center (KY) shares how Accent on Integration helped the organization integrate its Philips OBTraceVue platform with its Meditech HIS.
• Surgical Information Systems announces the availability of SIS Com Version 3.3, which includes enhanced functionality and a more streamlined look.
• Imprivata launches Cortext 2.0, its free HIPAA-compliant texting solution.
• St. Barnabas Medical Center is using Access’s e-forms and wristband bar-coding solution alongside Cerner Millenium and Siemens Invision to enhance its EMAR process.
• Visage Imaging will exhibit at the SIIM Philadelphia Regional Meeting on March 18 in Philadelphia, with Director of Solutions Architecture and Customer Experience Director Bobby Roe co-leading a roundtable session entitled “Cool Technologies in Imaging Informatics.”
• Vitera Healthcare releases a hosted version of its Medical Manager practice management platform.
• McKesson Canada’s RelayHealth aligns with QHR Technologies to integrate QHR’s Accuro EMR System with RelayHealth’s services.
• SC Magazine names Trustwave the Best Network Access Control product.
• The HealthLogix HIE platform from Certify Data Systems passes numerous Integrating the HIE profile tests at the 2013 IHE North America Connectathon.
• Nuance launches Clintegrity 360, a computer-assisted system for clinical documentation improvement and coding.
• RazorInsights integrates Patientco’s patient financial engagement billing software into its HIS system.
• MetroHealth Medical Center, an affiliate of Case Western Reserve (OH), will deploy Wolters Kluwer Health’s ProVation Order Sets as its evidence-based order set solution.
• Kareo lists the top six EHR features that small practices need.
• Ingenious Med reports a 380 percent increase in the usage of its impower mobile applications in 2012. Twenty-one percent of its licensed impower clinicians now use mobile devices.
• Deloitte interviews 12 CIOs in major health systems about the challenges of managing their IT departments.
• InstaMed projects triple-digit growth in the wake of healthcare reform and reports having processed more than $60 billion in healthcare payments as of March 2013.
• GE Healthcare is developing Guided Analytics and AutoBed applications for the Caradigm Intelligence Platform.
• AT&T CMIO Geeta Nayyar discusses mobile health and how it can provide care where needed.
• Cerner will integrate Nuance’s clinical documentation improvement technology into its Millennium EHR and RCM solutions.
• Advanced Orthopedic Center (FL) selects SRS EHR for its nine physicians.
• Access extends its relationship with Inpact LLC, a provider of online and social media communities for HIT, to include sponsorship of Siemens Healthcare Social.
• As part of its $80 million healthcare integration contract, Harris Healthcare receives authorization to deploy a solution that enables the VA and DoD to share EHRs.
• Johns Hopkins Hospital shares how LRS helped the organization simplify document management in a March 14 Webinar.
• Capario announces a three-part Webinar series called Mastering the Art of Getting Paid starting March 20.
• Covisint will feature Andras Cser with Forrester Research in a March 13 Webinar detailing the benefits of cloud-based identity and access management.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 3/12/13

UConn Health Center Warns Patients of Privacy Breach

The University of Connecticut Health Center is notifying patients of a privacy breach that could affect around 1,400 patient records, saying that a former employee inappropriately accessed patient records that were beyond the scope of the employee’s responsibilities.

Electronic discharge tool helps rein in HF readmissions

Analysts at Intermountain Healthcare in Salt Lake City designed a retrospective study that evaluated heart failure discharges between January 2011 and September 2012.Their goal was to assess whether the use of electronic discharge orders affect adherence to core measures and 30-day, all-cause readmissions of patients with HF. At the conclusion of the study, the readmission rate for patients whose discharge involved the electronic tool was 15.5 percent compared with 18 percent when the tool was not used.

CHS, Cleveland Clinic Form Strategic Alliance

Cleveland Clinic announces a strategic partnership with Community Health Systems’ network of 135 affiliated community hospitals. Cleveland Clinic will help CHS establish clinical integration programs at its affiliated hospitals, which will provide a mechanism for the sharing of data and in time will support predictive modeling initiatives.

In Pursuit Of Interoperability For The Common Good

Forbes publishes a guest article by Arien Malec, VP strategy and product marketing at RelayHealth, and David McCallie MD, VP medical informatics at Cerner, regarding CommonWell. The article is short on details and concludes by broadcasting an open invitation to all vendors to join the alliance.

The Skeptical Convert 3/11/13

Four-Letter Words

An EMR can work well but it can work not so well. I want to try to show you what I mean and not tell you, so I will do this with no words that are long, no more than 4 type hits per word. Why do this? In my head I know why but it is hard to say here just yet. And you can see now how hard it can be to work this way, but I will try to keep to my task.

When you use an EMR to pick out words you want to pick them off of a list. This can be easy if you do not know how to type, but it is not easy to say what you mean all of the time. A list may take you down a road you do not want to go onto, and the way they set an EMR up, a word down the line may not fit with the word up at the top. I see this all of the time when I do my work on the gut and find  a word that is what I want to say, but up over top of it is a word I do not want to say and I can not get out of it.

But what is good when you use a list like that is that all who use it have some way to do it in the same way. They may not all do that but they can do it if they want to. Thus there is some way to make the word sets look and feel the same, so that when you look at it you know where to look to see what you want to see when you want to see it. I also like it, when I work, when I can see what I do, and go back and fix it when I want to say more of what I get in my head as I work.

The idea here is a very big idea and many have had much to say on it for many a year, back more than the year one AD in fact. But I go on too far away from my goal.

On one side I want all the word sets to look and feel the same, but on side two I want to say what I want to say that only I can say. What to do, EMR man? I see that you set it up so that I can do them both if I want to. Is that good? Do we do more good if we all look the same, or do we do more good if some do it a way that they want to and some do it a way that they want to. Is it good to read talk in a way you do talk, or to read some talk in a way you do not talk? I do not know.  

But it can be a good thing to work with a limit.

Oh hell wait…

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

Collective Action 3/11/13

The views and opinions expressed are those of the author personally and are not necessarily representative of current or former employers.

What Do You Stand For?

I just couldn’t believe it. There was no way you could convince me when I was 18 that I would live to 21. My lifestyle was so self destructive that I knew I wasn’t going to make it. I was riddled with addictive behaviors. Self-pity absorbed my every thought, and future plans included my funeral and not much more. I literally was standing on what I thought was the truth that I would not see 21.  

It wasn’t until I started to share this with a few people that an orchestration of events happened. I was led into a recovery program that launched me into a new life. I stand on something much different now, a different set of truths that I base my life upon.

Things change and we as people change. Thought processes come and go. Belief systems come and go. You might stand for something one day, receive some different or additional information and your mind changes, now you stand for something else.

There is a saying that bears some thought: if you don’t stand for something, you will fall for anything. There has to be something, however, that we can stand on, something that will not change with new information. I would like to offer a change to that saying because I believe that if you do not stand ON something, you will fall for anything.

The core values for my life are much different today than when I was 18. I was falling over everything, grasping for anything that could give me hope. I didn’t realize I was looking in all the wrong places until I became beat up enough to ask for help. As I found the help I needed, there began to arise in me a foundation for life resulting in a set of core values for my life.  

As I matured,  the core values emerged definable. Today they are Honesty, Integrity, Unity, and Transparency.  

As a leadership team at work, we have incorporated these core values at a departmental level and try to emulate them for our staff. We hold staff accountable to these and ask them to hold us accountable to them as well. They are more than ground rules for behavior, they are a platform that we all can stand on. While there is hierarchy in the department from an org chart perspective, these core values transcend the org chart. In other words, no one should operate and behave outside of the core values.  

Core values are considered before everything we do: decision making, budgeting, staff meetings, difficult conversations, and status reports. Most often they are not considered verbally, it is more instinctual than anything else, regardless, those values are present. Core values alone do not lead to a Utopian environment where everyone is whistling, but they do allow us to move about our day with confidence that we are doing our best and making the best decisions that we can.

Recent events caused me to look at these values as people questioned my decisions. I am confident in my decisions, but I have to admit that I do not always have all of the information. It is impossible to be a decision maker and always have all of the information – that would be way too easy.  

When someone questions a decision, I look at it and see if there is additional information. Perhaps there is a correction either to an assumption I made or to information that was provided. One thing I do not have to do is cover my tracks or try to hide my motives. Core values give me an unshakable foundation to stand on. That’s right, an unshakable foundation. These values do not change based upon any individual circumstance.

Do I adhere to them all the time? No. That is why I have people I trust in my life who have permission to point this out to me and help me humbly apologize and get back on track. They are not designed for a perfect life — they are designed to keep me on a specific path.

Do you have a set of core values that you can verbalize off the top of your head? The truth is that if we don’t know what our core values are, that doesn’t mean we do not have them. We are not even the best person to verbalize our core values. Others around us are better at it because they are more aware of our actions than we are.  

Ask my wife what my core values are. Ask the members of my leadership team, those who work with me day in and day out, what my core values are. Core values are more than just words. They are the way you live, act, play, work, shop, or do anything in life. Core values are behind everything you say and do.

What does this have to do with healthcare? Why do I continue to harp on principles when we have so many other things to be talking about?

I say it again — if we do not stand for something, we will fall for anything. During sweeping change, stability is important. Great focus is needed to guide us through this period of healthcare reform. Define your core values.  If you are not currently living by them, ask some trusting people around you to help. You will be surprised at the response you get.  

If you have them defined, use people around you to help keep you accountable to them and encourage others to do the same  These times are critical and the next generation is depending on us to get this right.

Bill Rieger is chief information officer at Flagler Hospital of St. Augustine, FL.

Curbside Consult with Dr. Jayne 3/11/13

Lt. Dan’s inclusion of “Cisco Study Reveals 74 Percent of Consumers Open to Virtual Doctor Visit” in this morning’s headlines caught my eye. According to the summary, “given a choice between virtual access to care and human contact, three quarters of consumers find access to care more important than physical human contact with their care provider and are comfortable with the use of technology for the clinician interaction.”

I’m not opposed to virtual visits – in fact I’d love to do them for certain patients or for certain conditions. In my market, however, clinicians contracted with the majority of commercial payers are not able to bill for these visits, and patient willingness to pay out of pocket is extremely low. Several of my colleagues have attempted to bill patients for after-hours telephone visits and the practice has been the subject of scorn, not only in the physicians’ lounge, but also with the local medical society.

A true virtual visit is more than a phone call. It’s a scheduled time to talk about the patient’s issues, review medications, review home vital signs, blood sugar readings, diet logs, and other patient data points. Based on a careful history and these elements, changes to the regimen can be made and behavioral interventions can be supported. The history elements, data, care plan, and goals still need to be documented in the patient chart, however, and that takes time. Unless you’re operating under a capitated model where you’re being compensated for these services through a per-member/per-month payment, you can’t perform these services without some sort of compensation.

Virtual visits also generate real liability. They can allow for physicians to care for greater numbers of patients which can increase risk if there is not close adherence to protocols and guidelines or if patients are not well known to the clinician. This makes the need for appropriate scheduling and documentation even more important. Virtual visits aren’t something physicians should be expected to cram onto their schedules in lieu of overbooks to the office schedule.

I do find Cisco’s findings somewhat contrary to my experience in solo practice. When I employed a nurse practitioner to care for my patients as my informatics duties grew, there was a lot of resistance to the team-based approach by some of my elderly patients, who grew up in an era where seeing the doctor was something special and had a unique value outside of the actual medical care. Some patients chose to wait weeks to see me rather than accept same-day appointments with someone other than “my doctor.”

This attitude is somewhat borne out in a later statement in the piece where it was noted that “consumers will overlook cost, convenience, and travel, to be treated at a perceived leading healthcare provider to gain access to trusted care and expertise.” I’m not saying I was a leading healthcare provider (in fact, when I was first in solo practice, I was a fresh grad with a bit too much idealism) but I was a good listener and genuinely cared for my patients. I’m not sure that level of empathy can be easily translated to the virtual experience. I had the privilege of truly getting to know my patients, who also felt they were able to know me.

We exchanged more than symptoms and diagnoses. We also swapped recipes and baked goods, stories of our small community, handicrafts, and more than our share of heartache. I had the distinct privilege of being able to function as an “old school country doctor” in the middle of the suburbs. This was mainly because the opening of my practice solved an access problem, but also gave patients a place they could think of as their medical home, whether it was a designated Patient Centered Medical Home or Center of Excellence or any other buzzword of the day.

I miss having continuity patients and I think about some of my favorite patients often. Every once in a while I will run into one while working in the emergency department and that is a rare treat. Although virtual visits may be cheaper (if they are ever reimbursed where I live) and more expedient, I don’t think they’re going to be as good for building that level of “trusted care” that patients expect when they’re faced with a life-threatening condition. What do you think about virtual visits? E-mail me.

E-mail Dr. Jayne.

Morning Headlines 3/11/13

Department of Veterans Affairs Review of Alleged Transmission of Sensitive VA Data Over Internet Connections

An audit report released by the Office of the Inspector General validates earlier rumors that the VA has been routinely transmitting sensitive patient information across unencrypted telecommunication networks, including patient names, Social Security numbers, birth dates, and EHR data.

Business news briefs: Human error the cause of UPMC electronic issue

A system-wide problem with UPMC’s EHR (Cerner) resulted in all facilities shifting back to paper charting for three hours. Human error was identified as the root cause.

Cisco Study Reveals 74 Percent of Consumers Open to Virtual Doctor Visit

Cisco releases a press release, blog post, and infographic advertising the findings of its Customer Experience Report on health care. The study concludes that 74 percent of consumers are OK with virtual doctor visits.

Health Care Providers Give Cloud Vendors High Marks on Security

KLAS releases a report on cloud-based software solutions. Security and reliability were the two primary factors identified as preventing widespread adoption, despite high marks in both areas from actual users.

HISsies 2013 Winners

HIMSS Wrap-up 3/8/13–Dr. Gregg’s Update

Walking Tale #HIMSS2013

You look upon a road, a long road down which you must travel. You can see the end, but it’s distant. You realize that you’d better get started because, even though it isn’t “a journey of a thousand miles,” it still will only be accomplished by taking the first step.

You begin, taking that first step, and then another, and then another. But before you’ve traveled even one thousandth of your beckoning road, you’re sidetracked by a road sign that calls to you. A way station along your path has already halted your progress and you spend the next twenty minutes partaking of the fare they offer.

Back out on the road and five more steps down the path before yet another beacon beckons your eye and begs you to stay and see. Another quarter hour passes before you rejoin your sojourn.

Each time you attempt to complete your travels, you find yourself halted after a mere few paces. Your goal of reaching the end of the road seems nearly unattainable. Still, each wayside stay brings interesting information that would be hard to otherwise glean. Each halting advance along the path adds something new to your mental arsenal.

Still, you have your goal. The end of the road seems as distant as when you started, yet on you travel.

Every few steps you notice a passerby who’s noticing your gleaming white tennis shoes. Some simply look, others grin, and more than a few pass with commentary which runs typically along the lines of, “You’re smart.”

“I’m not as slow as I look,” you reply (referring to your sagaciousness in choosing footwear suited to the trek you take, not to the speed with which you progress.)

You stride on, rarely feeling as if the snail’s pace of your excursion will ever bring the end within sight. Way station after way station, chit after chat…you always seem to be gaining something, but never seem to gaining ground.

Some of the way stations bring insights that you can use; others bring insights into things you know you’ll never use. Some show coolness and prescience; others show staleness and “catch-up-manship.” Some of the way station attendants are kind and courteous; others are neglectful and rude. (Most seem to wish they could have your footwear.)

Traveling on, you see mountains of the mundane. Many way station aides appear more interested in each other or in their digital social networks than in entertaining passersby. It worsens as the day drags on; their lassitude and languor grows driving your desire to try to disengage their disinterest down. Yet on you slog.

Occasionally, you see flashes of brilliance interspersed amongst the merely repetitive. This helps to keep you going, helps to keep you moving along toward your destination. It’s hard to know which way station will spark your imagination, but there are enough moments and methods of intrigue to keep you seeking the next. You look past the boastful, the bored, and the blatantly bland; you keep searching for the next truly bright idea or engaging way station assistant.

Finally, just when you think your feet can’t stand one more step, you realize you’ve reached the end! You’ve traveled the entire trail, meeting the brilliant and the meek-minded, seeing products superb and those barely-breathing, finding wise counsel and fulsome folly. You’ve seen it all and now you can rest…

…until, that is, you turn to walk down the next aisle.

From the trenches…

“The only exercise I take is walking behind the coffins of friends who took exercise.” – Peter O’Toole

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, an HIT and marketing consultant, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).

Monday Morning Update 3/11/13

From Beth: “Re: athenahealth. My little brother just got a job at athenahealth in Boston. Should I congratulate him, or give him stolid advice on keeping a work-life balance? What are the differences between Epic and athenahealth for an implementer?” Good question, which I will defer to readers since I have no first-hand employee knowledge of either company having spent my working life in non-profit hospitals.

From Cat’s Eye: “Re: Neal Patterson. Let’s start a game of Where’s Waldo? with him. Here he is in the UpToDate booth.” I have to admit that I like Neal’s look.

From Boy George: “Re: HIStalk. HIStalk has not been a HIMSS booster and I know as a fact that HIMSS is acutely aware (and envious) of your sponsorship exposure and HIStalkapalooza.” I would hope HIMSS has other HIT worlds to conquer without worrying about my microscopic corner of it. I’ve been writing HIStalk for 10 years while working in a non-profit hospital, so I work pretty hard for whatever success I get, and that success wasn’t (and isn’t) my motivation anyway. As for HIStalkapalooza, I’ll give credit to the companies that sponsor it and the folks who spend the evening with us each year. I do greatly admire the companies that sponsor HIStalk since for most of them, it’s not just a traditional ad buy but rather their interest in truly supporting what I do. I had none for the first few years of HIStalk and I don’t take any of them for granted. I seem to vaguely remember AMIA or CHIME or some group wanting to work with me years ago, but they realized that I’m a loose cannon.

From HIMSSed Out: “Re: booth experiences. Jeff at eClinicalWorks gave a very concise perfectly targeted presentation of their software doing a sore throat visit. No excess, no droning on, just answered my questions in a timely manner. Well done. Lyndsey at athenahealth did a very nice sore throat demo showing me what I needed and answering questions expertly. AND she blew me away when escorting me to be scanned and then handed me a KINDLE to read their material on. Put me down as impressed by the demo, low key attitude, and rocking gift!” I criticize the folks who use the booth as their employee lounge without naming names, but I like calling out those people who do a good job. There is no reason reps need to use their phones during booth duty – assign someone to monitor and return their calls and e-mail if need be, but if you give anyone under 40 a smartphone they’re going to be screwing around with it nearly constantly because that’s what they do off the job and they can’t resist its lure.

From Frank Poggio: “Re: MU. Farzad Mostashari recently said the MU Incentive bonus was safe. So much for political promises. The sequester cuts include an across-the-board reduction in Medicare payments of 2 percent effective April 1 and include cuts to MU bonus money. In my opinion, this will be just the beginning. Big deficits usually mean big cuts for providers. The Obama administration sold the HITECH act to Congress based on a projected savings of $800 billion per the original Rand study, which just a few months ago Rand said was full of errors.” Government doesn’t have “get smaller” in its vocabulary, so I’m pretty sure agencies will apply their sequester reductions in the most publicly visible way possible, i.e. shutting down national parks and closing offices early in the hopes of creating public outrage. There is no way that the government is so efficient that a 2 percent cut should even be noticeable, but they will make it so in protest.

From Guy with the Funny Accent: “Re: HIStalkapalooza. No longer talking to Bonny Roberts as she wouldn’t let me wear the Mr. HISTalk ‘Secret Crush’ sash on the final day of the exhibition.” I like that my secret crush is protective of her regalia. I think I may have blushed a bit as she read her poem on stage and I’m not so sure Bonny didn’t as well since she wasn’t planning to recite her work in front of a bunch of people. She figured out who I am when I lauded her demo style in the Aventura booth a couple of years ago, and with minimal provocation, recited my comments verbatim as we were entering Rock ‘n’ Bowl. She is, as they say, a trip.

From A. Vendor: “Re: HIMSS. It was a wonderful experience for a first-time vendor. HIMSS staff were absolutely wonderful in making preparations and taking care of our needs during the show. It couldn’t have been more effortless. Other than a modest case of booth envy, things went very well and exceeded my expectations. People who were looking found us. We met many interesting colleagues and a number of old friends. In addition to a few good leads, we stumbled into some unexpected opportunities we hadn’t expected. I’m definitely up for 2014, and maybe a little wiser.” I think part of being happy with the exhibitor experience is setting reasonable expectations, like having a central location to meet with clients and prospects, maybe picking up some foot traffic even in the hinterlands, and having access to other vendors in the hall during off hours. Non-vendor HIMSS attendees miss the point that many deals are struck between vendors during the show – marketing agreements, signing up to help with consulting and staffing needs, and perhaps finding an investor if that’s on the agenda. One vendor told me that the VC folks were rapid-firing from one booth to another without regard to what company occupied it, barking out a series of questions about their business in hopes of finding companies to invest in.

From Data Sharing Optimist: “Re: CommonWell. Started six months ago when Arien Malec (now Relayhealth/McKesson, but remember he did a stint with ONC and developed Direct) connected with Dr. David McCallie (VP, medical informatics at Cerner) – they are both very good guys and they decided to create some standards for this type of data sharing. They just finished the standards a few weeks ago. Neal and John H. loved the concept, because even though it might have some competitive issues, they both truly want to see the healthcare system improved, as do all the major CEOs. They went to a small group of folks they believed would hop right on board so they could get a press release out by HIMSS. They did not ask everyone, including Epic, but are talking to them now. From what I heard, they didn’t mean it to sound like Epic refused. That was not their intent, but with two weeks to pull things together, they had to limit things. I talked to Carl about it and got the sense that Epic needs to learn more and see if it is real, but would likely join eventually. Use cases will involve a specialist being able to view and even accept data from an outside hospital on a shared patient, as well as pharmacists being able to bi-directionally communicate with doctors.” Someone who knows all the players told me the same thing – it had to be Malec and McCallie since those are the guys smart enough to make it happen and sell the idea to the suits. I think it was a mistake to rush the announcement and play up the participants without having even invited major vendors like Epic and eClinicalWorks, but apparently the PR urge was strong. So far its accomplishments involve press releases and a Web site. One might logically ask questions like: (a) who pays for the service since infrastructure is required? (b) does the EMR user have to buy or install anything? (c) what are the queries running against? and (d) how is this better than companies like Epic and others that already allow sharing information outside their systems? I like the idea of a standard way of doing things without having a particular vendor owning the platform, so we’ll see if it happens or gets smothered in the bureaucracy of these not-always-nimble big companies.

From Ole: “Re: We are in discussions with EmergeMD regarding telemedicine and would like your unbiased opinion.” I don’t know anything about the company, but perhaps readers who do will weigh in. I would have kicked tires on your behalf at HIMSS but I ran out of time. Actually I didn’t run out of time, but I was so tired of traipsing the exhibit hall by early Wednesday afternoon that I went back to the hotel well before the exhibits closed, had a very early dinner, and finally took my shoes off to write HIStalk. I was really tired, although I now know that I was coming down with a bug at the time.

Here’s to you, IT foot soldiers who will be wide awake at 2:00 a.m. Sunday to make sure systems don’t choke when their clocks spring forward. I’ve been there.

Two-thirds of poll respondents say we’re experiencing and EHR backlash. New poll to your right: why do you think several vendors formed CommonWell Health Alliance?

Speaking of CommonWell, I noticed that they’ve populated the FAQ section of their site. They say the organization won’t actually be established until a 12-18 month proof of concept is completed, making you wonder why it was necessary to announce so early other than to put a stake in the ground.

I hope everybody got out of New Orleans OK. I left Thursday afternoon and the airport was an absolute zoo, so I can only imagine what it must have been like Wednesday evening. Security and check-in lines wound throughout the terminal, the concession vendors ran out of pretty much everything (including cream for the coffee), and the little airport didn’t have enough seats so people were sitting on the floor. It is clear that New Orleans, for all of its virtues, just can’t handle a conference the size of HIMSS without a lot of snafus.

I got home only to be hit with a respiratory infection that sent my temperature soaring and kept me up hacking all night, so I’ll just clean up some loose ends and get back to my Tylenol and Halls cough drops.

UPMC goes to paper for three hours when its patient care systems go down due to human error.

Ernest Health will work with NTT Data to create new post-acute care capabilities in its Optimum product suite.

Heritage Groups makes an unspecified investment in coding services and software vendor Aviacode.

I mentioned several days ago that I received advance word that several EHR vendors would be announced as working with Michelle Obama’s Partnership for a Healthier America in adding obesity-related features to their products. “Several” turned out to be “three”: Cerner, GE, and Physician’s Computer Company. I like the idea and I’m not sure why other vendors didn’t sign on, except maybe because they’re already diverting much of their development budget into complying with federal requirements instead of delivering user-requested enhancements.

Just to clarify a reader’s comment last week: GE Healthcare sold its outsourced physician billing service, not software products like its EMR.

Another MyWay-related lawsuit is filed against Allscripts. Cardinal Health pre-paid $5 million for 1,250 MyWay licenses for resale in April 2009 and is stuck with the 994 of those licenses that it hasn’t sold and are now valueless since MyWay won’t be made ICD-10 and MU compliant. Cardinal looked at Allscripts Professional and passed because of cost, complexity, and the fact that Allscripts sells it directly and they don’t want any part of that as a substitute. Cardinal is suing for beach of contract and wants the $4 million back for its unsold MyWay licenses.

KLAS releases a very small study (100 providers) of cloud computing perception. It says vendors are sloppy with their terminology, calling products cloud-based that are really just hosted and using Citrix or other emulation services instead of true Web services. I like the graphic above.

TeraRecon introduces iNtuition Review, which I’ll describe in the company’s words since it’s a little over my head: “iNtuition has always complemented PACS with advanced functionality to resolve specialized use cases and workflow challenges not adequately addressed by existing PACS solutions. This role is now expanded and enhanced with the new, powerful iNtuitionREVIEW client, designed to complement PACS with multi-monitor display of multi-modality data, in specialized use-cases such as cardiac (CT, MR, Cath, Echo, EKG) or breast (MR, Mammo, Ultrasound). iNtuitionREVIEW is also designed with co-operation and collaboration in mind, with specialized features for the preparation and execution of physician conferences, demos, and multi-disciplinary team meetings.”

Weird News Andy titles this story “An Arresting Development.” A Florida OB-GYN e-mails a patient, threatening to have her arrested if she doesn’t come in for an emergency C-section for her week-overdue delivery. WNA also says he’s not surprised by this 30/70 rule: a third of VA primary practitioners say they’ve missed critical lab results in the EHR due to being overwhelmed with alerts. PCPs said they received an average of 63 alerts per day, with 87 percent saying that’s too many and 70 percent say they can’t manage them all.

Arcadia Software will expand the use of ICU patient monitoring software it developed for Boston Children’s Hospital by collecting data from a network of hospitals to develop insights into treatment decisions and outcomes.

Vince covers the origins of HIMSS in this week’s HIStory.

Final HIMSS Conference Thoughts

Inga liked this: the Vonlay folks prepared a welcome package for newly anointed HIStalk Queen Sarah, who works there (note the labeled cupcakes). Some companies were planning to frame the sashes their employees wore and some folks were supposedly going to wear their sashes to the conference on Tuesday although I didn’t see any first hand.

A low-key announcement during the HIMSS conference involves the formation of the HIMSS-backed accelerator Avia, which is supposed to help provider organizations implement innovative technologies. I don’t really understand what they’re trying to do even after reading the information on their site. Nor do I understand why HIMSS is involved. HIMSS might as well bite the bullet and just buy some vendors and peddle their products directly since they’ve encroached into almost every other aspect of the market.

Brian Ahier got Karl Rove to talk about healthcare IT on camera at the conference.

Vendors have told me that it’s so expensive to dismantle, ship, and store components of their HIMSS booth that a lot of the glitz you see in the exhibit hall goes right to the trash afterward. Good idea by Orchestrate Healthcare, which bought furniture for its new two-story booth and donated it after the show to the New Orleans chapters of Habitat for Humanity and Ronald McDonald House. There’s even a patient aspect: Ronald McDonald House was planning to convert part of its dining room into a conference room where and families can meet with caregivers and Orchestrate’s donation of tables and chairs made that room immediately available for its intended purpose since they had no furniture otherwise.

This reader-supplied HIStalkapalooza photo appears – by virtue of an optical illusion — to have captured Jonathan Bush ticking the chin of an unamused Farzad Mostashari.

The majority of people who left the conference Wednesday missed the most electrifying and informative presentation I’ve seen at a HIMSS conference. I was walking over Thursday morning and a fellow attendee warned me that Farzad Mostashari is a dry presenter because he’s a data guy. I could not disagree more – he is a really good speaker who uses data to support his statements. ONC posted his 2012 keynote on YouTube and I hope they do it again for the 2013 version since everybody needs to hear what he had to say.

Inga and Dr. Jayne are still swooning that the PatientPay folks sent them each a chocolate high heel, thus combining two of their most cherished vices into a single package.

HIStalk traffic was heavy during the conference as it usually is, with visits and page views peaking on Tuesday at 11,000 and 19,000 respectively. Inga, Dr. Jayne, and I were posting and occasionally tweeting from New Orleans, of course, while Lt. Dan kept the home fires burning with daily HIStalk headlines and HIStalk Connect posts. It’s a bit of a potpourri during HIMSS week since we cover whatever is interesting to us, which is almost everything.

More HIStalkapalooza pictures by Istrico Productions. Lots of smiles. I always feel strange seeing my logo (the new one in this case) put on buses, shirts, signage, and electric lights.
 

HIMSS Takeaways

Attending the HIMSS conference is like trying to simultaneously watch every channel on satellite TV. You choose what looks good in the guide, but invariably there’s a lot of crap among the good finds in both the education rooms and the exhibit hall. Even then you’ll see maybe 5 percent of what was offered. At any tableful of people, the only shared experiences may well be the keynotes and perhaps a large social event (looking at you, HIStalkapalooza).

That makes it really risky to summarize the experience and draw relevant inferences from it. Here are my thoughts, which may differ wildly from yours.

• The CommonWell Health Alliance announcement delivered the burst of fireworks that everyone expected, but whether it’s a new commitment to patients or simply an expedient anti-Epic marketing strategy developed by marginally committed members remains to be seen. We don’t really know what will be delivered, whether it will work as described, and how hard it will be for providers to connect to whatever communications infrastructure is developed. If it succeeds, will it put yet another nail in the HIE coffin? Can it be successful without the participation of vendors like Epic, eClinicalWorks, and others? Can vendors really deliver the needed technology along with their ICD-10 and Meaningful Use enhancements, and if so, how will they prioritize the work? It’s easy to get wrapped up in the feel-good, patient-friendly marketing prose and characterize non-participants as patient haters, but let’s see what they can deliver and which companies dominate the process before waving the CommonWell flag.
• Analytics doesn’t make good booth demos, so it’s hard to have a solid takeaway. Everyone knows they need better data, but approaches range from technical toolkits to turnkey systems complete with algorithms and reports for common requirements. We’re past the multi-year, big-expense data warehouses of just a few years ago, but it would still be easy to make a misstep in the zeal of preparing for ACOs and other delivery changes for which the data requirements are still fuzzy. This may be yet another area where providers will wish they had measured twice and sawed once.
• New Allscripts CEO Paul Black has wasted no time in trying to erase the painful memory of a series of Keystone Cops-like corporate gaffes that left the company as a punch line. Remarkably, some recent Sunrise sales and the acquisition of Jardogs and dbMotion provides validity to their claims as a serious player, although it’s early in the recovery.
• The industry is quickly transitioning from the traditional hospital and practice system model, which emphasizes transaction entry and charging, toward a public health focused emphasis that requires heavy consideration of non-episodic patient activity and cost management. This will require yet another round of vendor technology investment on top of ICD-10 and Meaningful Use requirements, polarizing the market even more into those vendors positioned for the future vs. those just trying to milk what market is left selling old-school systems.
• HIMSS finally recognized the role of patients in the healthcare system, at least superficially. You’ll know the movement is real when real patients and their advocates lead significant sessions, hold non-token HIMSS roles, and are actively represented on vendor advisory groups and even company boards.
• More and more of the healthcare IT market direction is driven by the government in general and ONC in particular. Vendors and customers aren’t talking a lot about incremental enhancements or product tweaks. It’s all about analytics, transparency, interoperability, and outcomes. It will be a challenge to turn these somewhat vague concepts into concrete development plans.
• The audience for usability seems to be selective. Lots of people are talking about it, but nobody’s doing much despite government report emphasizing the need to make systems safer and easier to use.
• The market for consulting services is going to be very strong, but it will shift from system selection and implementation to system optimization. That will drive consulting firms to further specialize into specific practices, most notably for Epic and Cerner. IT systems are necessary but not sufficient to drive the needed changes, and that will favor CIOs who have a good working relationships and reputation outside of IT.
• mHealth has a decent chance of improving health in nations where the problem is lack of basic health needs and medical services. It doesn’t seem to have the required impact in countries challenged by prosperity-fueled problems like obesity, lack of exercise, and time-challenged citizens who don’t put their health first.
• The HIMSS conference keeps getting bigger, but nobody knows if the proportion of actual practicing caregivers (rather than former caregivers turned IT cheerleaders) is increasing or decreasing. It’s easier to be irrationally exuberant when the front-line naysayers aren’t in the building.
• My assessment of the educational program and the CE submission process is that it continues to go downhill, making it almost an afterthought to the cash cow, the exhibit hall.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

HIMSS Wrap-up 3/8/13 – Inga’s Update

From Brian Ahier: “Re: HIMSS.  Aside from HIStalkpalooza (which was awesome and thank you very much for inviting me!) where I got to spend over a half hour having a fascinating and detailed conversation with Judy Faulkner. A couple of other highlights were the interviews I got with Jeb Bush and Karl Rove. They are not your usual HIMSS attendees. I even got Rove to make a statement on health IT for YouTube.” Love the picture of Judy holding her HISsie award for Best Leader of a Healthcare IT Vendor or Consulting Firm. Mr. H doesn’t want to run the photo because he knows Judy doesn’t enjoy having her picture published, but she looks happy holding her HISsies award. Thanks for sharing the YouTube of Rove, who claims he is a big fan of HIT.

From Fashion Conscious: “Re: porno nurse. I’d like to contact the vendor who had the nurse in the porno get-up. Do you know or can you find out who that was? The picture has gone viral and nurses are not amused and want to let them know. I’m less prudish than anyone you know and a good sport but if they had an MD in a G-string or CEO in his undies people would be aghast. It amazes me that this Neanderthal thinking continues. It plays out in disrespect to nurses by IT.” I am totally with Fashion Conscious on this one. It’s not only offensive to nurses, but to women in general. And while some marketing type (male, I am sure) thought it would be a great way to attract all those male CIOs, I am certain plenty of men agree that the look works far better at Hooters than HIMSS. I am not certain of the vendor because someone sent me the picture. If you can identify the vendor, please share.

From H2O Lover: “Re: New Orleans. We should never have HIMSS in NOLA again. The city can’t support this many people!” Sadly I have to agree. I was one of the lucky ones with a hotel room two blocks away and didn’t have to mess with overfull buses or long taxi lines. I know Jazzfest and Mardi Gras bring bigger crowds than HIMSS, though more I assume more folks are local and don’t need hotel rooms. Still, I love New Orleans (even though I didn’t see much of it this visit) and found the convention center much easier to navigate than the Sands in Las Vegas.

Through Thursday morning, total HIMSS attendance was 34,696, which included 13,985 professional attendees. At the same point in 2012, registration was 36,586 with 15,262 professional attendees.

HIMSS annual leadership survey finds that nearly two-thirds of HIT professionals in provider organizations surveyed have already qualified for MU Stage 1 and three-fourths expect to qualify for Stage 2 in 2014. Eighty-seven percent of respondents expect to complete their conversion to ICD-10 by the October 2014 deadline.

I loved the final keynote featuring James Carville and Karl Rove. I don’t think they figured out the answers for the economy, healthcare, or any other issues, but the two were entertaining. Rove was witty and supported his arguments with a lot of data. Carville supported his views with a different set of data, of course, and also sometimes rambled, but had a number of laugh-out-loud one-liners, including:

This ain’t Fox News. You can’t just make stuff up.

Prices on a hospital bill mean as much as a price tag on a rug in Istanbul.

I may not be from Wisconsin, but I am going to milk this thing pretty good.

Wednesday I waited about 30 minutes in the Starbucks line (it was more about catching up with a friend than the coffee.) As we neared the front, a representative from Iatric (Judy, I believe) handed out $2 off coupons for the next 12 people in line if we agreed to wear an Iatric slap band. It was a brilliant and effective marketing idea and I bet I wasn’t the only one who stopped by the Iatric booth to say thanks.

I primarily work out of my house, ,and during the work day, I rarely talk to anyone in person or on the phone. However, I can be a Chatty Cathy and enjoyed bantering in the Starbucks line with Julie from RF Ideas, who happens to wear the same perfume as me and likes the same brand of flats that I was wearing.

Sometimes I forget that not everyone goes to HIMSS to check out the bleeding edge stuff. I talked with the purchasing manager for a large health system who said her primary mission was to find a good source for batteries and power supplies for her COWs. I guess that is why fax vendors still shell out money to exhibit.

I was disappointed that so many of the exhibitors were packing up their booths two hours before the floor closed. I was with a physician friend who was interested in an EHR solution for a niche specialty and had identified the exact vendor he wanted to see. When we got to the booth, everything was boxed up, though the rep did open his laptop and show us a few things. The same guy told us that you can’t “clone” previous chart notes and insert them into new notes because it was a violation of HIPAA. My friend quickly advised him that whether or not cloning was an acceptable practice had nothing to do with HIPAA.

I love to ask other people their impression of the convention and what people were talking about. I was surprised that no one I asked mentioned ICD-10 as a big issue. I am not sure if that’s because organizations already have identified their ICD-10 solution or because ICD-10 is simply not their area of concern. I didn’t find anyone overly impressed with the CommonWell announcement, though I somewhat disagree. The only other big announcement was the Allscripts acquisitions of dbMotion and Jardogs, which wasn’t exactly earth-shattering news.

After five days of HIMSS, I am left with the impression that the industry is moving past the emphasis on core EMR and HIS systems and looking for solutions that make existing systems work better. The exhibit hall was full of vendors offering integration and interoperability solutions. Even more vendors were promoting data analytics and population management tools. Other smaller vendors were demonstrating niche solutions that bolted on or worked behind the scenes with core applications to improve the user experience (such as a more user-friendly user interface) or to add functionality (e.g., clinical decision support tools.) Patient engagement tools were also hot.

I think Farzad had it right in his keynote speech when he noted that the transformation process is far from complete. Organizations have implemented many of the basic EMR functions, but now providers are just beginning to take the collected data and consider ways to use it to improve the care process. Usability is still hindering adoption, so providers mush push vendors to improve usability. At the same time, providers need to develop and embrace more efficient and effective workflows.

E-mail Inga.

From HIMSS 3/7/13–Dr. Jayne’s Update

Wrap-Up

Although I had to leave early and missed today’s keynotes, I unfortunately didn’t miss some major hassles trying to depart. Let this serve as a warning for those of you who haven’t checked out yet. And I mean checked out of your hotels – there are certainly plenty of people who have checked out already and we saw lots of them working the booths.

My hotel bill this morning didn’t show the deposit I paid last September and they wouldn’t believe the printout I had with me. The staff tried to use a calculator to figure out what I would pay but couldn’t get it to add up, so they adjusted the bill manually and charged it through (after they also adjusted off the bag of Fritos that I certainly didn’t pay $5 for on the day I checked in). While I was at the desk trying to resolve the issue, at least five other people tried to check out and the hotel didn’t have them on record as leaving until tomorrow, which was causing problems.

At least I got good story material – while waiting I witnessed what had to be the winning performance in the “Worst Behavior by an Exhibitor” category. A woman (again trying to check out early according to the hotel computers) was trying to settle her bill to two different credit cards, one of which did not belong to her. The very patient clerk split it exactly as she asked, then she turned around and asked to have it split a different way and went into a very long diatribe about her company’s expense policies and how they fired a VP last year for expensing something that wasn’t real, even dropping the company’s name in front of the 20-odd people who were now in line trying to check out while the two available clerks were dealing with increasingly aggravated customers.

Folks in line were grumbling about the hotel staff generally not knowing there was a convention in town and not staffing accordingly. I had been having a pretty pleasant stay until now, but I returned to the room and checked my credit card online, finding they had charged all kinds of different amounts that made no sense, including the $5 Fritos as a separate line item. I was tired of dealing with the desk and will call their accounting department and On Peak tomorrow to get it resolved. I’m sure I’ll also be dealing with our internal expense auditors who will no doubt see the excessive charges coming through the corporate credit card and flag me for interrogation.

I headed for the airport with a smile because a very sweet vendor friend offered me a ride, for which I am grateful. Thanks for taking pity on a non-profit hospital staffer and sharing your car service. Flights were being delayed due to the snow in the north east, so be sure to check your status before you leave. At least with the computers thinking everyone is staying a day longer than they actually are, you shouldn’t have a problem getting a room if your flight is canceled.

The airport was packed with people trying to depart and the limited restaurants in our terminal couldn’t keep up. Seating was at a premium and the empty gate area with no seats whatsoever was a nice touch. I returned home safely (and with my magnificent chocolate shoe unscathed) despite the weather. I know that the rest of HIMSS is in good hands with Inga and Mr. H covering the remaining events.

In honor of all the Shoe Divas out there, I offer a picture from my home town airport. She’s definitely working it with the sneakers complimenting her full-length mink.