EHR Design Talk with Dr. Rick 4/1/13

The Text-Based Workaround

We have been considering two fundamentally different designs for presenting a patient’s past and present medical issues over time — the Snapshot-in-Time design and the Overview-by-Category design.

I have tried to make the case that the Snapshot-in-Time design, although rarely used as a high-level EHR paradigm, does a much better job than the widely adopted Overview-by-Category design for two reasons:

1) Clinicians think of the patient’s health as a story – a narrative of how things got to be the way they are. Each patient’s story is rich, complex, and unique. By presenting the patient’s story as a series of snapshots in time, this rich narrative gradually unfolds, a little like turning the pages of a picture book.

2) The Snapshot-in-Time design, when combined with assigning each category of data to a fixed location on the screen or page (see Why T-Sheets Work), allows us to take it in and process information using the fast visual processing part of our brain. In contrast, the Overview-by-Category design compels us to use slower cognitive processing.

In my last post, I wrote that perhaps due to the limitations inherent in the Overview-by-Category design, most EHRs that employ it also provide a workaround solution. This workaround is nothing other than a text-based chart note generated by the EHR.

For each patient encounter, the EHR can generate a single, relatively comprehensive text-based document assembled from the previously-entered structured data.

These text-based documents are typically in Microsoft Word or PDF format. They can be viewed on the monitor from within the EHR application, printed, or sent electronically as PDFs.

Although these text-based EHR chart notes are snapshots in time (unlike the Overview-by-Category EHR screens), they usually have significant problems, including:

• low data density
• non-interactive design
• poor spatial organization and layout

In this and the next several posts, I will address these issues by presenting mockups of text-based chart notes, based on the design of several well-known EHRs.

The mockups use the same patient database that I used for the Snapshot-in-Time and the Overview-by-Category mockups. While these examples are for an ambulatory patient, similar designs are common in hospital-based EHR systems.

In order to see the mockups and read the accompanying text, enlarge them to full screen size by clicking on the ‘full screen’ button in the lower right corner of the SlideShare frame below.

Rick Weinhaus MD practices clinical ophthalmology in the Boston area. He trained at Harvard Medical School, The Massachusetts Eye and Ear Infirmary, and the Neuroscience Unit of the Schepens Eye Research Institute. He writes on how to design simple, powerful, elegant user interfaces for electronic health records (EHRs) by applying our understanding of human perception and cognition. He welcomes your comments and thoughts on this post and on EHR usability issues. E-mail Dr. Rick.

Curbside Consult with Dr. Jayne 4/1/13

Every time I am invited to present at the hospital’s quarterly medical staff meeting, I feel like I should wear personal protective equipment. No one is hurling rotten tomatoes when we talk about EHR, but the verbal assault can be equally messy.

I was asked to present at the recent meeting with the goal of discussing our ICD-10 transition plan. Despite previous mistakes by our (now-disbanded) ICD-10 Task Force, our new team is confident that our vendor is ahead of the pack. I thought I would escape without too much drama. Thoughts of melting snow and approaching spring weather must have tricked me into forgetting the tendency of my colleagues to go completely off the agenda.

When we implemented EHR, we carefully audited the coding/billing functionality to make sure that not only did it adhere to CMS guidelines, but to the stringent standards of our auditors. We manually audited behind any computer-assisted coding for a period of time until we were comfortable that the algorithms were appropriate. At that point we discontinued full audits, but continued spot audits on high-dollar or high-risk episodes of care. We also continued our regular audit protocol where each physician had a set of charts audited each quarter with coding feedback delivered from our teams.

When the EHR was initially deployed, we saw a shift in the distribution of ambulatory Evaluation and Management codes, but this was expected. It also matched with published data that showed primary care physicians tend to under-document the care they deliver. We were happier with our increased documentation of the care we were appropriately providing.

Over time our EHR has matured and has had added to it a variety of individualized order sets, care plans, patient instructions, and documentation macros that allow our users to personalize their notes. Our coders have stayed on their toes, making sure visit documentation continues to be individualized despite these labor-saving features. We definitely don’t want to fall victim to the problems that can arise from cloned documentation or any other inappropriate use of the EHR.

Since we’ve been live so long and our medical staff has grown so much, many of our newer colleagues didn’t go through this initial auditing process and don’t understand the ongoing auditing that is in place. Without this comfort level with the EHR, they are extremely nervous about what will happen with ICD-10. Our EHR is moving to a new level of assisted coding to aid with the transition. 

People are, for lack of a better description, freaked out. The question and answer period following my ICD-10 presentation spiraled into paranoia and outright fear.

Providers have long been worried about audits that would demand large repayment sums based on a sampling of charts. Now they are worried about criminal prosecution on top of financial penalties and potential exclusion from federal health care programs. Several more vocal colleagues demanded that we go back to 100 percent chart review by certified coders, which is just not tenable given recent budget cuts. Others asked the medical staff to consider endowing a legal defense fund.

Fear of law suits has led to exorbitant health care costs through the practice of defensive medicine. Fear of audits will lead to more spending on non-patient-facing services such as chart reviews and coding audits. I for one would rather spend my healthcare dollar lowering the patient-to-nurse ratio and decreasing preventable harms. What do you think about the increase in audits related to the increase in EHR documentation? E-mail me.

E-mail Dr. Jayne.

Morning Headlines 4/1/13

Death of patient at Royal Derby Hospital leads to new system ‘to alert staff of medication needs’

In England, the Royal Derby Hospital implements an eMAR system after a patient’s DVT prophylaxis medication was skipped three times over nine days. During her stay the patient fell, broke her hip and then subsequently developed a fatal pulmonary embolism.  The coroner found that even though the appropriate fall precautions had been in place, the omission of DVT prophylactics "more than minimally contributed to the development of the DVT and was therefore a contributing factor in her death."

Hospitals Question Medicare Rules on Readmissions

An article in the New York Times questions the fairness of CMS’s new readmissions penalties, citing critics that say hospitals should be looking for ways to improve care for patients who are still in the hospital rather than managing the patients’ personal lives post-discharge. The article also questions the fairness of using readmission rates as a basis for penalizing hospitals. It does, however, acknowledge that since CMS’s October initiation of penalties, readmission rates have dropped from 19 percent to 17.8 percent.

Hospital implementing new electronic health record system

49-bed Keokua Area Hospital, of Keokua, IA, goes live with CPSI.

Tablet Computers Acceptable for Reading EEG Results, Mayo Clinic Study Says

Mayo Clinic physicians in Arizona have shown that tablet computers can be used to analyze EEG results. The objective of their study was to determine whether a tablet is an acceptable alternative to a laptop for remote EEG interpretation. The findings showed that the tablet cost significantly less and weighed less and had a comparable screen resolution as compared to the laptop.

Monday Morning Update 4/1/13

From DailyShowFan: “Re: Daily Show. Did anyone see the 3/27 segment where Jon Stewart, a steady advocate for veterans’ rights, takes on the interoperability challenge with AHLTA (DoD) and VistA (VA)? Sad reality, but it’s good to see him bringing this specific healthcare IT issue to wider attention.”

From KB: “Re: St. Mary’s Hospital, Waterbury, CT. Finally pulled the trigger to put down their awful, botched [vendor name omitted] LIS after being live only eight months. They just signed a $1million+ contract for Sunquest.” Unverified.

From The PACS Designer “Re: Qubole. A next-generation cloud service focusing on building a new cloud data platform is Qubole. Their solutions use Hadoop, Hive, and Pig software to solve Big Data issues for cloud services.”

Half of readers have contacted their primary care provider via e-mail or secure messaging. New poll to your right: do you expect to stop working for your current employer in the next 12 months?

Meditech specialist Park Place International leases space in Worcester, MA for what will apparently become the company’s US headquarters, logically positioned near Meditech.

ONC seeks public input as it updates the Federal Health IT Strategic Plan, allowing reading and adding comments for 10 topics related to consumer e-Health

In the UK, Royal Derby Hospital implements an electronic MAR after an inquest determines that a contributing factor to the fall-related death of an 89-year-old patient was three missed doses of enoxaparin.

A Mayo Clinic study finds that tablet computers can be used to analyze EEG results outside the hospital or clinic.

A New York Times article questions whether hospitals should be held financially responsible for managing readmissions by, as it says, “managing the personal lives of patients once they are released” instead of focusing on other ways to improve care. Experts drily note hospitals with high mortality rates would appear to be more successful in managing health since dead patients can’t be readmitted. A health policy expert says readmission metrics are convenient, but not accurate.

Keokuk Area Hospital (IA) goes live on CPSI.

Medseek’s Client Congress will be held in Austin, TX April 15-17.

A former Apple employee recounts in a story called “2 Letters from Steve” the touching story of e-mailing Steve Jobs in 2010 to ask if he could take an iPad, which had not yet been released and thus was highly secured, to show a terminally ill friend who was not expected to live out the week. He received the above response three minutes later.

Vince continues with the HIS-tory of Meditech this week.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Readers Write: Get Ahead with Mobile Job Hunting

Get Ahead with Mobile Job Hunting
By John Yurkschatt

According to a recent report from The World Bank, three quarters of the world now has access to a mobile phone. In addition, ownership of multiple mobile devices is becoming increasingly common, suggesting that their number will soon exceed that of the human population. Unbelievable, right?

Recently, at HIMSS, I encountered numerous people who were there to network about jobs in the industry. While speaking with many, I couldn’t help but notice that they were checking their smartphones often during our conversation. It became apparent that they were engaged in mobile networking at HIMSS as well. In fact, today’s job seekers are avidly using the following job related functions on their smartphones:

1. Search for jobs

2. Receive e-mail job alerts

3. Read about recruitment process and tips for interviewing

4. Apply for jobs

5. Share content on social networks such as Twitter

In the age of mobile technology, the job hunt is only a click away. The rise of mobile technology is changing the face of how job seekers conduct their search and how employers and recruiters are reaching out to top talent.

Savvy job seekers are using a number of mobile apps. I found three apps to be extraordinarily powerful for the job hunt and for meeting those people who have the jobs:

Hidden Jobs

This app provides you with job opportunities that are not posted on the company website. It tracks close to 2 million unadvertised jobs from companies that are growing and making headlines. In addition, if you are ever seeking a job at a particular organization, or within a geographic area, you must try Hidden Jobs.

LunchMeet

According to its site, LunchMeet is a great tool for talent hunters; job seekers; career development professionals; entrepreneurs; people who seek or offer free consultation over lunch or drinks; business school students; business development, sales, and marketing people; and anyone who is interested in strengthening and expanding their professional network.

Sonar

While this app is not necessarily a job search tool, it is the ultimate app to have while attending a conference. In fact, some job networkers at HIMSS found this app handy. Having Sonar enables like-minded individuals to easily connect while attending a conference, or within a certain geographic location. If I were in a networking frenzy, I would turn on my Sonar app and look for folks with similar interests. It is a great way to meet people you may have not known prior to arriving at the conference.

Let’s face it, mobile technology is changing the way people search for jobs and the way companies search for talent. It will only grow in popularity. Get a step ahead, or maybe, don’t get left behind. Take your job search mobile.

John Yurkschatt is project coordinator with Direct Consulting Associates.

Time Capsule: The Olympics as a Project Management Lesson: Those Chinese Would Have Had Your Clinical Systems Live By Now

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

I wrote this piece in August 2008.

The Olympics as a Project Management Lesson: Those Chinese Would Have Had Your Clinical Systems Live By Now
By Mr. HIStalk

I don’t follow sports much. In fact, I might be the only American who didn’t watch any of the Olympics, other than a little of the women’s nude … uhh, beach … volleyball (I think the US beat some other teams, but I’m not really sure since they kept running back and forth under the net while I was distracted).

Actually, I did watch the closing ceremonies, having little choice because I had bartered away my evening TV rights to Mrs. HIStalk in return for being allowed to watch an Andy Griffith Show mini-marathon that preceded it (“The Pickle Story” episode was a key bargaining point in the protracted negotiations).

I’m glad I tuned in to watch the torch get snuffed. It held a valuable lesson (beyond the inevitability of aging, as evidenced by Jimmy Page’s frightful-looking gray hair).

The lesson is this: given resources and strictly followed project management principles, human achievement is nearly limitless.

Evidence was everywhere. China spent $40 billion on everything from infrastructure to costumes. The closing ceremony was so tightly scheduled and scripted that the elaborate equipment and cast of thousands could not be assembled until right before the show, with no time for on-site practice. Clips of memorable performances (all of victorious Americans, given the homer TV coverage) were a reminder of the incredible logistics of transportation, construction, lodging, computing, scheduling, media support, and preparation that rivaled and maybe even exceeded the obviously impressive human performance of the competitors.

If there was a project management Olympics, this Olympics would have brought home the gold. Everything was finished on time, it worked, and there was little evidence of what must have been hundreds of backstage arguments, compromises, and last-minute changes over several years. There were no excuses, extensions, or exclusions.

I bet you wish your last big project went that well. Me, too. In fact, I jotted down some thoughts about why China can orchestrate a picture-perfect Olympics while the average hospital can’t get its IT projects finished:

• Ruthless project management. Chinese leaders aren’t generally known as laid back cut-ups, so I’m assuming the pressure to deliver was excruciating.
• Unlimited budget. There’s no way costs could have been estimated accurately, so it must have boiled down to “whatever it takes.”
• Tons of dedicated employees and volunteers. China has over a billion people to choose from, none of whom have the “no, thanks” option.
• Individual and national pride was on the line.
• Would-be naysayers who were too scared to whine about the impossibility of it all, which left just shutting up and doing what they were told.
• A hard-stop, no-excuses, immovable deadline with the highly visible result beamed to the entire civilized world.

IT leaders probably shouldn’t rush out and declare themselves supreme ruler or demand billions of dollars just to get a project finished. Still, the Olympics would have failed if the goals were unclear, the money tight, or people stretched.

The lesson is that CIOs can do anything if given the right resources, requirements, and control. That is, if they bring highly polished expertise in planning, communication, and project management to the table. Anything less isn’t the Olympics; it’s more like professional wrestling.

My beach volleyball game would have suffered without these things. It might have been played on asphalt instead of sand because someone forgot to order it. It might have resulted in a tie because inexperienced scorers forgot to write down the points. And, it might have featured players wearing track suits because incompetent security guards allowed the team’s uniforms to be stolen from the coach’s wallet.

Morning Headlines 3/29/13

Lahey Health Invests in New Electronic Health Record System for Better Coordinated Care

Lahey Health announces that it will implement Epic across its health system beginning in June of 2013.

MEDHOST Names Barbara Bryan Vice President of Consulting

Barbara Bryan (Bryan Advisory Group) joins MEDHOST as VP of consulting. She will initially focus on integrating consulting services into the sales and delivery cycle of MEDHOST’s new patient throughput solution PatientFlow HD.

Empower Individuals through Health IT to Improve Health and Health Care

ONC launches the Planning Room, a website designed to collect public input on the federal health IT strategic plan.

Wolters Kluwer’s online move injects life into health business

Wolters Kluwer is seeing promising returns as it moves its health publishing content sales from paper to the web.

News 3/29/13

Top News

Caradigm will integrate Orion’s HIE solution with its Caradigm Intelligence Platform (CIP, formerly Amalga) and resell the Orion product. Orion will resell and provide services for CIP and Caradigm’s identity and access management solutions in New Zealand, Australia, and certain Asian countries. Orion will also develop decision support, population health, and quality improvement for CIP and promote CIP to its HIE prospects and customers. Caradigm has also decided not to commercialize the Qualibria knowledge solution product and will instead incorporate it into CIP, which will result in elimination and reassignment of an unspecified number of employee positions in product planning and engineering operations. The Salt Lake City newspaper says 70 percent of the company’s Utah employees, about 40 to 50 people, were laid off Wednesday.

Reader Comments

From Jasmine Gee: “Re: athenahealth’s attestation numbers. To answer readers’ doubts about how many of our Medicare Part B physicians using athenaClinicals are participating in MU, the answer is about 70 percent. That’s over 5,000 total Medicare Part B physicians. The remaining 30 percent are Medicare Part B physicians who bill so few Medicare claims that their incentive check would be tiny, so they’ve declined to pursue Medicare MU. Remember: the maximum Medicare MU incentive payment is 75 percent of billed Part B charges for the program year, with a cap based on when you start.” Jasmine is the product marketing director for athenaclinicals and was responding to recent comments from readers questioning the legitimacy of athenahealth’s claim that 96 percent of its participating providers have successfully attested for MU.

From ForEclipsii: “Re: delayed go-live at the new Royal Adelaide Hospital in Australia. I believe that the application in question is actually the brand-new Sunrise Financial Manager which rolled out a few months ago. People working on it were told to drop everything and work on a version for Australia.” Unverified, but that makes sense based on the newspaper article, the mention of billing issues, and the earlier Allscripts contract.

HIStalk Announcements and Requests

We opened a HIStalk Practice reader survey, which is different than the HIStalk survey we ran a couple of weeks ago. If you are a HIStalk Practice reader (and you should be!) please take 60 seconds to give us your input. Thanks.

Some of the HIStalk Practice goodies from the last week include: hospital-owned physician practices in Kentucky are losing as much as $100,000 per year per doctor. The Wall Street Journal examines patient-physician e-mail communications. The NCQA extends its PCMH recognition program to specialty physicians. The average turnover for physicians in 2012 was 6.8 percent, compared to 11.5 percent for PAs and NPs. Michael Brozino, CEO of simplifyMD, discusses his company, its technology, and the state of the EMR industry. DrFirst President G. Cameron Deemer shares insights on e-prescribing, EMR vendor consolidation, and the impact of government incentive programs. Take a moment and click on an ad or two – one of our sponsors may have a product or service that makes your life better. Thanks for reading.

On the Jobs Board: Senior Director Clinical Project Management, Product Manager, VP of Sales and Channel Development.

I’m looking for someone who can help produce Webinars and perhaps do some other paid part-time work. Industry experience would be nice but probably isn’t essential, although excellent writing, speaking, marketing, and organizational skills are. E-mail me.

Acquisitions, Funding, Business, and Stock

ReadyDock will receive $150,000 in pre-seed funding from Connecticut Innovations to continue development and marketing of its devices for disinfecting, charging,and storing computer tablets.

Bankrupt Raleigh, NC-based EMR vendor E-Cast, which had annual revenue of $4 million as late as 2006, is winding down after the business is sold to Global Record Systems LLC for $100,000.

Sales

Safeway will roll out the SoloHealth Station kiosk to 700 of its stores, giving customers access to free health screenings and personalized assessments.

Kettering Health Network extends its relationship with MedAssets for its revenue cycle management and workflow services.

Philips earns a fourth-year option worth $77 million to provide patient monitoring systems and training to the Department of Defense.

Lahey Health (NH) announces officially that it has signed with Epic, which will apparently replace Allscripts in both its hospitals and practices.

People

MEDHOST hires Barbara Bryan (Bryan Advisory Group/Eclipsys) as VP of consulting.

David Joyner (Blue Shield of California) joins Hill Physicians Group (CA) as COO, replacing the recently promoted CEO Darryl Cardoza.

Mobile Heartbeat names Jamie Brasseal (Dell Healthcare and Life Sciences) as VP of its western region.

Announcements and Implementations

Drchrono will incorporate digitized patient education material developed by Mayo Clinic into its EHR.

Five healthcare organizations will participate in the pilot phase of Tennessee’s Health eShare Direct Project, spearheaded by the Tennessee REC.

Children’s Hospital at London Health Sciences Centre in Ontario implements Upopolis, a social networking tool for children receiving care in hospitals that is powered by TELUS Health.

Vibra Healthcare completes the first phase of deployment of PatientKeeper NoteWriter electronic documentation software across four of its long term acute care hospitals.

Cerner will integrate print spooling software from Plus Technologies into Millennium to streamline print operations.

ACS MediHealth will work with Troy Group to develop prescription printing solutions for Meditech.

Government and Politics

ONC announces Planning Room, a Website launched in collaboration with Cornell University to allow public input on the federal HIT strategic plan.

Two North Carolina state senators introduce a bill that would require hospitals to post on the state’s HIE their pricing for common procedures and their typical reimbursements from health plans.

Other

An NPR article covers the massive increase in the number of Americans who are receiving government disability payments for often questionable reasons such as unverifiable back pain or mental illness, with 14 million citizens now being mailed a monthly federal check without even being counted among the unemployed. The article concludes that disability “has become a de facto welfare program for people without a lot of education or job skills,” with fewer than 1 percent of recipients from early 2011 having returned to the workforce.

CNN profiles St. Louis-based Advanced ICU Care, which offers tele-ICU services.

A Reuters article finds that Wolters Kluwer is able to make good profits in healthcare because its medical references are moving from printed to electronic form, with 100 medical journals offered as iPad apps. The company says demand is increasing because apps allow teaching procedures by video, which also allows the company to sell more targeted advertising.

Studies published in JAMA find that not only has a mandatory reduction in medical resident working hours failed to improve their depression rates or sleep patterns, it has also been associated with an increase of medical errors of up to 20 percent. One possible explanation is the unintended consequence of hospitals expecting their residents get the same work done in less time.

In Canada, an Alberta ED doctor is suspended for looking up the electronic medical records of patients she wasn’t treating. She was caught when a patient asked for a copy of his access log and found that nine doctors, none of whom were treating him, had looked at his files. The hospital determined that the ED doctor was using workstations that her colleagues had left logged on.

The New York Times says radiology residents are beginning to realize that the heyday of big money for minimal work is over due to Medicare cuts, technology-driven competition, teleradiology, and demands to move public money from specialties to primary care. Financially motivated medical students pursing the high-paying, procedure-based ROAD specialties (radiology, ophthalmology, anesthesiology, and dermatology) are all seeing average incomes dropping steeply with the exception of the less Medicare-dependent dermatology.

The NHS pays for a woman’s $7,260 breast implant operation after convincing doctors that her 32A chest size had put her in a state of emotional distress that could be alleviated only by an upgrade to 36DDs. The mother of two now intends to leave her children with her parents, move to London, and pursue a modeling career. She referred to TV star Katie Price in her statement: “I want the world to see the new me and want money and fame just like Katie. I can’t thank the NHS enough for giving them to me.” I can’t claim emotional distress, but perhaps I should consider moving to the UK so I could be a more successful anonymous blogger.

Weird News Andy says “some might call it murder.” A doctor in Brazil is charged with seven murders and is suspected of hundreds more as a hospital’s ICU team routinely freed up beds by administering muscle relaxants to patients and then turning off their oxygen supply. Prosecutors released the doctor’s wiretapped telephone conversations that included, “"I want to clear the intensive care unit. It’s making me itch. Unfortunately, our mission is to be go-betweens on the springboard to the next life.” WNA is also curious who approved a patient’s breast enlargement procedure when 1,200 people have starved to death in NHS hospitals “because nurses are to busy to feed patients.”

It’s like the postmortem version of fake Facebook friends: a UK company offers rent-a-mourners to families who want the funerals of their loved ones to be better attended or to “increase perceived popularity.” Actors, who are billed at $68 for a two-hour funeral or wake, are briefed about the deceased and trained to chat convincingly with real family and friends.

Sponsor Updates

• Minnesota Public Radio profiles Intelligent Insites and how its real-time operational intelligence software will be used in 152 VA hospitals.
• Regions Hospital (MN) reports that its use of Besler Consulting’s BVerified Transfer DRG and IME tools have resulted in significant revenue recoveries.
• The LDM Group discusses the rapid growth rate of e-prescribing across healthcare.
• API Healthcare’s President and CEO J.P. Fingado shares tips on increasing operational effectiveness with the healthcare workforce information exchange in an April 2 Webinar. 
• The Albuquerque Journal spotlights Seamless Medical Systems and its SNAP iPad app for capturing patient data.
• Eric Venn-Watson MD, AirStrip’s VP of clinical transformation, discusses how private healthcare could benefit from the US military’s cutting-edge health technologies.
• Gary Palgon, VP of healthcare solutions for Liaison Healthcare Informatics, discusses how data integration can help organizations reduce readmission rates.
• eClinicalWorks opens a website for its 2013 National Users Conference in San Antonio October 11-14.
• Frost & Sullivan publishes a white paper on the impact of ClinicalKey, Elsevier’s clinical insight engine.
• Impact Advisors Principal Laura Kreofsky discusses the privacy and security risks of social medicine and Senior Advisor Ryan Ulteg offers insight into the financial implications of ICD-10 implementations for physicians.
• ADP AdvancedMD launches a website that provides a timeline for practices as they prepare for the ICD-10 transition.
• Access chooses CoSentry as its cloud and data center services provider.

EPtalk  by Dr. Jayne

I didn’t have a lot of time to search for newsy tidbits this week because I was heads-down in CMS FAQs. As usual with government programs, now that money is flowing, audits have been introduced to try to recoup any inappropriate payments. My hospital is very concerned by the answers to the “Will there be audits” question, so I thought I’d share the highlights:

• Yes, there will be audits.
• You will need to have scads of documentation and it needs to be retained for six years.
• Contractors will be involved in auditing. If you already have post-traumatic stress disorder from heavy-handed RAC audits, I feel for you. They’re leaving the door wide open for abuse: “The level of the audit review may depend on a number of factors, and it is not possible to include an all-inclusive list of supporting documents.”
• Audit requests will come via e-mail from a CMS address. The e-mail used when registering for the EHR Incentive Program will be used for the initial request. If you put your physician’s e-mail address in the box, make sure she or he knows to be on the lookout for this and check your spam filters. Further communication will be through a secure communication process.
• You need to maintain documentation that supports the values you used for CQMs and payment calculations.
• Individual patient records may be requested for review.
• On-site reviews at the practice or hospital, including a demonstration of the EHR system, may be requested. For those of you gaming the system by turning on features just for your attestation period, this could come back at you unless you can re-create exactly the way you were configured at the time of attestation.
• Separate audit processes apply for Medicaid.

One of my CMIO colleagues received a hospital request in the fall. It was a spreadsheet that seemed pretty simple, but ended up requiring a ridiculous amount of data. She shared it with me confidentially. I loved the request that the reports include the EHR vendor’s logo to “prove” that it came from the EHR. If people are going to be fraudulent, I think they would be smart enough to dummy that up.

Despite clearly worded responses, the auditors didn’t understand the hospital’s answers or the math behind the calculations. They rejected spreadsheet data and insisted on screenshots from the application, or alternatively screenshots that showed a user exporting the data to spreadsheet. Again, do they not think screenshots are easy to fake? Maybe the hospital needs to film the user running the report and post it on YouTube for the auditor’s viewing pleasure.

From her recount, the auditors had all the power, and even having the vendor step in to provide supporting documentation didn’t help. MU is all or none – if there is a single discrepancy, you have to return all the money. It’s the equivalent taking a class and being expected to score 100 percent on every quiz, paper, and exam, including the final.

I hope CMS understands a simple principle about perfection that we learned in medical school — it doesn’t matter if all the lab numbers look great but the patient is dead.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 3/28/13

Caradigm Kills eHealth, Partners with Orion

Caradigm, the Microsoft and GE Healthcare collaboration, announces a partnership with Orion Health wherein Caradigm will go to market with Orion Health’s HIE solution rather than its own poorly performing eHealth HIE solution, which will be sunset.

‘Big Data’ for Cancer Care

The American Society of Clinical Oncologists announces that it is joining a Big Data movement by compiling data from hundreds of thousands of cancer patients to bring a new searchable resource to oncologists looking to review treatment strategies for their patients.

Healthcare Workarounds Expose EHR Flaws

A Journal of American Medical Informatics Association study explores workarounds frequently adopted by clinicians using EHR software and studies the various reasons that the workarounds were needed in the first place. Often, the study found, they were needed due to a lack of functionality within the the HER. Sometimes, however, it was just more efficient to employ the workaround than to follow the designed workflow. Other workarounds were built into the clinicians’ workflow to help them remember to complete tasks or to allow them to bring information into the examination room, where they would sometimes be without a computer.

CMS Focuses On Fraud Associated With Increased Use Of Electronic Health Records

Acting CMS Administrator Marilyn Tavenner reiterates that CMS will conduct audits of the billing practices of EHR-using providers. These "small, targeted audits" will take place in parallel with the Meaningful Use audit program that started in July 2012.

CIO Unplugged 3/27/13

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

Panel Pitfalls and How to Avoid Them

Have you ever attended a panel with anticipation but then ended up wanting to walk out? Well, I’ve participated on a panel and I have walked out.

Panels carry great potential, yet the benefits are seldom realized.

Not long ago, I was part of a panel for a prestigious graduate school career day. The moderator asked us to prepare a five-minute oral overview on our respective organizations and roles. He knew the students would have ample questions and preferred that the panel react to student interests.

We all stayed inside the time boundaries until the final participant. He approached the lectern and began a forced march, death-by-PowerPoint presentation. After 10 minutes, I started catching up on e-mail and Twitter. After 20 minutes, I left the panel and sat in the audience, incredulous. When I left the room at 30 minutes, the panelist was still pontificating and the students had long since checked out.

Shortly thereafter, I was on another panel testifying before the Texas Senate. My fellow panelist asked me beforehand to stay within my time limit because she wanted a fair shot to share her views. That was brash, but I admired her approach. We agreed to split the time, each taking 20 minutes. I also deferred to her, and she spoke first.

At the 25-minute mark, I became slightly annoyed and made subtle motions to get her attention. At the 30-minute mark, I was scrambling to rewrite my script. In the end, I had five minutes. I suppose her earlier brashness should have tipped me off.

I’m sure you have similar stories as an observer or a participant. When a panel hits the mark, I leave fulfilled. When they don’t, I feel as if I’ve squandered my most precious resource.

What’s worse than listening to a bad panel? Participating on a bad panel. Here’s a sprinkling of ideas to help avoid panel pitfalls:

• Moderator. Like an orchestra conductor, the moderator is the key to making the panel work. Ensure the moderator is qualified and skilled to keep the panel focused and effective.
• Practice. I noticed that professional moderators engage panelists, individually and as a group, long before the actual event. They query questions in advance and discuss them in warm-up meetings. Ground rules are established.
• Debate I. I want to pound my head on the table when a panelist says, “I agree with (insert name)” and then goes on to repeat the same point. The value of the panel is in its diversity and getting multiple opinions. If you have nothing new to add, don’t talk.
• Debate II. An alternative approach is to have the moderator present an opinion and and encourage contrarian viewpoints.
• Sound bytes. Strong responses need not take longer than two minutes. Short, to-the-point answers are always best and memorable.
• Size matters. The ideal panel size is three or four. Anything less becomes a speech; anything more becomes annoying.
• Move on. Not every question requires a response from each panelist. See “Debate.”
• PowerPoint. No.
• Furniture. A panel is about the panelists. Tables are a distraction. A row of chairs facing the audience is ideal.
• Clarity. Keep the panel objective in mind throughout the discussion. Some freedom of discussion is good, but it is very easy to then to head down a rabbit trail.
• Panel bios. Less is more. The audience can read about how great you are in supplemental materials.
• Diversity. Individuals should be knowledgeable and articulate, and the group needs to be at least somewhat diverse.
• Distribution. Ensure each panelist has equal opportunity to respond. Corral pontificators.
• Timekeepers. Timekeeping ensures focus and keeps panelists from rambling.
• Parking lot. An effective way of avoiding rabbit trails. “That is a great question; let’s put it on the parking lot.” And then never discuss it again.

While I see the value of a panel, I have to admit I cringe when I’m asked to participate on one. Just because I take personal measures to avoid pitfalls doesn’t guarantee everybody else will.

What ideas do you have on avoiding panel pitfalls and ensuring nobody walks out — including a fellow panelist?

Ed Marx is a CIO currently working for a large integrated health system. Ed encourages your interaction through this blog. Add a comment by clicking the link at the bottom of this post. You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook and you can follow him via Twitter — user name marxists.

HIStalk Reader Survey Results 2013

I survey readers every year right after the HIMSS conference. I use the information I receive to plan what I want to do with HIStalk for the next year. I always share those results and indicate which ideas I will implement. I should mention that the most common suggestion by far was “don’t change anything.”

I appreciate all the responses and the nice comments left along with them.

Key Responses

• The most important elements of HIStalk, in order on a 5.0 scale, are news (4.8), headlines (4.5), rumors (4.4), humor (4.3), and reader comments (4.0). Nice job by Lt. Dan in having his newly added headlines identified as the #2 most important feature.
• “I have a higher interest or appreciation for companies when I read about them in HIStalk.” 87 percent said yes.
• “Over the past year, reading HIStalk helped me perform my job better.” 86 percent said yes.

Sample “Say Anything You Want” Comments

• It’s just about impossible to put a price on honest, informed, and unbiased news and opinion no matter the industry. HIStalk has a sincerity, a sense of humor, and an earnestness that genuinely sets it apart from the glossy, imperious press release distribution "news" publications that you can find in just about any industry (including ours). All that to say, please don’t ever lose that pluck and spirit that sets you (way) apart from the ample blather found elsewhere… (But I know you won’t!)
• I have only been CIO of a large academic hospital for less than five years following a career as a physician leader. I love HIStalk. I read it first thing in the morning before the NYT and WSJ (and the unmentionable local paper) even on vacation. My directors read it as well. You are the most comprehensive and unbiased source of all kind of IT information. It helped me tremendously when I transitioned. Keep up the great work! I don’t know how you do it along with your regular job! Kudos!
• Been reading since the very beginning when you started, and every single day it makes me happy to see someone having success at doing what they love.
• Thanks for offering a chance to learn about events before they might become public, to learn about Federal initiatives in plain English, to hear generally unfiltered commentary and reaction to rumors, current events etc. Great forum with no bias – I appreciate your position and hope you can maintain it as such!
• I absolutely love the work you guys do. I know being in the industry for only a year, reading HIStalk every day has brought me up to speed to where I understand what is going on in the marketplace. I actually have senior members my team and management come to me to see what is happening in the world.
• HIStalk helps me feel connected with healthcare IT in a way that publications, webinars, conferences, and industry white papers do not. It provides insight that helps me understand the drivers behind vendor behavior when I interact or negotiate with them. As Dr. Jayne or a clinical user expresses their wisdom, I get insight as to how clinical adoption of technology might be improved. It is those “ahah” moments that I have reading the comments, opinions, and reactions that help me understand my own organization better, which in turn help to drive better decisions around our technology solutions. Sometimes the solutions I deliver have nothing to do with technology, they are simply a dose of HIStalk insight that I can dispense as needed.
• HIStalk is basically my source of healthcare IT info. You never miss anything important and you’re usually ahead of the game, so I don’t feel a need to look anywhere else. HIStalk is the first site in my Favorites list and part of my morning work ritual is: check calendar, check e-mail for urgent stuff, HIStalk. Thanks for providing a much-needed, balanced view!

Ideas I Will Try to Implement

• Create a weekly roundup of major stories on Friday or Saturday with its own e-mail list for those weeks where I don’t have time to read daily. This is a great idea and it won’t take too much extra work. I will do it.
• Be more opinionated. It feels like you had stronger and more frequent opinions years ago. Right now Dr. Jayne has the strongest opinions, even though you are the thought leader. This is always a point of reader contention – some are incensed when I stray from straight news reporting and demand impartiality, while others want more personal and opinionated commentary. Inga and I will interject more of our opinions when we think we can add value.
• Make it possible to click on a link to reader comments at the end of the section. Already done as a result of this suggestion.
• Get an Android app. I will look at what’s involved with creating a custom app with push notifications. Right now there’s an automatically detected iOS-friendly layout, but it’s not all that hard to create a custom app that can be distributed through the various app stores.
• Increase the price of Platinum sponsorships and reduce the number of ads. Other suggestions were to eliminate graphical ads and go with text links only, but then feature each sponsor once per year. I haven’t changed the sponsorship fees in the 10 years I’ve been writing HIStalk, so supply-and-demand wisdom would suggest raising the price to reduce the number of sponsors. I’m not a huge fan of the idea, but I will consider it in some form. Most of the “too many ads” concerns went away with the site redesign and the recent changes I did to the ad serving system, which loads the ads faster and in the background after the post itself displays.
• Bring back the smoking doc logo. It IS the original logo and also subliminally communicates how many of us feel about this site. The site gives us the real information we want without the overly controlling censorship that other sites employ. Dare to return to the past logo and display it with pride – you earned it! The old logo had some serious size, color, and layout issues since it wasn’t really designed as a logo. I may, however, start putting the smoking doc back at the beginning of each post or something like that. Like you, I enjoy that it annoys some people.
• Engage the advisory panel more, if possible. I don’t want to burn them out, but I will try to stick to a monthly schedule. I could also use ideas of what issues I should ask them about.
• I love physician workflow discussions (Dr. Jayne or Dr. Rick). Gimme more! I’m open to new contributors since practicing docs can write only occasionally.
• If you could, devote full time effort to this and provide more depth and analysis. It’s amazing what you’ve accomplished on a part-time basis. I’m still waffling since I like working at the hospital, but the ability to dig deeper with more available time is appealing, although I would lose some of my credibility as a trench warrior. I’ll think about it.
• I would love it if the e-mails give a hint about the topics, particularly News. That’s possible. I would need some extra time to summarize the important items in the e-mail update, maybe the top five stories or something like that. I’m not ruling it out.
• I would like someone with an academic bent to do a literature overview on a weekly basis. It would highlight the good, bad, and ugly of informatics articles. I can see hiring someone to do this, perhaps a grad student or researcher, if anyone wants to declare their candidacy. I’ve thought of this before and agree that it needs done since so little of what passes for news is supported by clinical evidence.
• Get more practicing physician input like Dr. Gregg, Dr. Jayne, and Dr. Travis. HIStalk can help bridge that gap between clinicians and informaticists. I’m happy to do that if I can get contributors. 
• I always feel slightly guilty when I read your comments about how overworked you are. How can we help change that? I mention when I’m a bit overwhelmed only to set reasonable expectations, but I’m not complaining since I enjoy every minute. I’m my own worst enemy in some ways because I have a need to be directly involved in everything, right down to editing every word. It’s also hard to find people with the right skills who can help me without my direct supervision.
• Add links to the other HIStalk sites at top. Done just now as I was reading this. Good idea.
• Can you "fix" Vince Ciotti’s slides? Half the time they seem to cut off on the bottom mid sentence. Vince crams a lot of information into his PowerPoints and sometimes the conversion to SlideShare isn’t perfect. I will suggest he spread the information over more slides. You can also try click the “expand” at the lower right to see if the full screen view fixes the problem.
• Too many spinoffs will dilute your brand, impact, and reader interest. I think I’m set in that regard, although readers keep suggesting new offshoots of HIStalk that I probably won’t do.
• What about a patient advocate as a regular contributor? I’ve been knocking this idea around, but as always the challenge is finding someone with the knowledge, time, and writing ability to do it.

Ideas That Require More Reader Feedback

• Name a “Top Five Areas of HIT Concern” and keep it in the industry’s eye for the year. Use your influence to create change. I don’t know how effective this would be or how I would create the list. Possibly via reader survey.
• Establish a vendor scorecard that only hospital CIOs and practice physicians could anonymously complete so that vendors would understand exactly where they needed to improve after losing deals. I like the idea, but I don’t know if I would get enough responses for the results to be meaningful.
• Eliminate Readers Write. Many of the posts are self-serving vendor pieces, but some gems do get posted. I don’t get many submissions from providers or others on the front line, unfortunately. I could enlist a panel to approve the usefulness of the submissions in advance, I suppose.
• Get more health system CIOs to make high quality contributions like Ed Marx. I’ve tried, but it’s hard to find willing and capable contributors.
• You should adopt another alter ego and write a separate, less frequent, more critical blog. I’ve actually considered doing this, perhaps modeling it after The Onion or Fake Steve Jobs. If I get more time, I might. I have a lot of snark to share.
• Allow searching posts by company in newest to oldest order. I have investigated this many times and there’s just no technical way to do it automatically. The only option would be to pay someone to manually index each post into searchable database. I’m happy to do that if the interest is sufficient.
• Put together something that could be used for learning and understanding for the next generation of individuals that will need to step up and push for change within the healthcare industry. I get quite a few e-mails from industry newbies who appreciate what they learn from reading HIStalk, so I like this idea. I would need help from someone in that target audience, probably.
• Offer a forum for CIOs and salespeople to communicate based on CIO needs and priorities. I’m not getting a good mental picture of how this would work.
• Please be tougher on things that need to held accountable. Healthcare is 18% of GDP with no signs of slowing. Call out the waste and abuse. I run interesting items I see along those lines, but it’s a bit outside my core competency.
• Continue your HIStalkapalooza. It’s becoming a non-HIMSS-sponsored annual tradition. Apparently your sponsor companies are willing to pay for the privilege of doing it. I would press (ever so gently) for greater HIStalk exposure in their booths. I’d be interested in how far you can go before HIMSS gets pissed and says something. Sponsors have volunteered to underwrite the event for the next two years, at least, so it will apparently continue. It’s very cool that nearly 100 of our sponsors put our signs in their booths.

Ideas I Probably Won’t Implement Immediately

• Reduce the frequency of regular contributors. Some also suggested enlisting more contributors. Each contributor has their own followers and the posts are easily ignored by those who aren’t interested, so I probably will not do this. I try regularly to get other folks who have an interesting voice to contribute, but I am rarely successful since they are by definition busy.
• Reduce the “People” section and eliminate the photos. I like that section and I think readers like seeing occasionally familiar faces in a post.
• Add more coverage of (revenue cycle, analytics, payor, etc.) I appreciate the confidence, but I don’t really have the knowledge or time to do a good job covering these topics in detail.
• Do news daily. I think the headlines do a good job of keeping readers current on the non-news days (Tuesdays and Thursdays).
• Maybe link out to education sessions or industry rags? But they troll your information, so why do it? My policy is that I don’t link to other industry publications with few exceptions (Government Health IT and E-Health Insider are two of few). I can easily get any information they have by simply going to the same original source they used.
• The number of interviews is too much and too often appears catering to sponsors. I often interview interesting people who make themselves available, which often means vendors in general and sponsors in particular. I never know which ones will be interesting until they are done.
• Add a recruiter’s corner. Providers are looking for good talent, and some of the readers might just be interested in positions open with providers. I’m not sure HIStalk is the right place for that.
• I would write less often. How the heck you keep up is beyond me. I could write less often, but readership has gone constantly up doing what I’m doing, so I’m hesitant to change.
• Start being a little more careful about the rumor reports and getting some more verification either way before publishing stuff. I usually try to get confirmation, but many times companies ignore my inquiries, which makes me then assume there’s a pretty good chance the rumor is true. I try to be responsible based on what I know about the rumor reporter and the company, but it will never be perfect unless I stop running rumors entirely, which would then eliminate the third most popular feature of HIStalk.
• If there is any way you can get more info about go-live activity, that would be great. I report everything I can find, which is a tiny fraction since companies and customers don’t usually issue public announcements of go-lives.
• Add international perspective – who’s doing what overseas on a routine basis. I run interesting items occasionally, but I don’t have good sources for a regular feature.
• I like Dr. Travis a lot and am surprised he was not on the list above. He writes thoughtful pieces and he is on the money with a lot of his comments. Travis writes for HIStalk Connect, so I didn’t include him on the survey.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 3/27/13

Rough landings: DOD, VA sluggish helping returning veterans, study says

An Institute of Medicine review criticizes the VA and DoD for using scientifically unproven diagnostic and therapy tools to treat depression and TBI and for faltering on plans to integrate medical records in the coordinated care of transitioning veterans.

OHSU has third data breach

Oregon Health & Science University will notify around 4,000 patients of a data breach stemming from an unencrypted laptop that was recently stolen, marking the third time in the last five years that OHSU has had a data breach affecting more than 500 individuals.

FDA 101: A guide to the FDA for digital health entrepreneurs

Rock Health publishes a SlideShare presentation on the path to FDA clearance and the criteria that regulators are looking for.

GPs only act on 2% of computer prescribing alerts, says study

A study commissioned by the UK’s NHS concludes that providers only act on two percent of drug alerts while prescribing. The problem, the study suggests, is that alerts are presented at the end of the prescribing process rather than at the beginning where they would be more likely to alter medication selection.

News 3/27/13

Top News

An Institute of Medicine review finds that the military’s assistance programs for veterans are not meeting the needs of service members who served in Iraq and Afghanistan, with half of the 2.2 million former troops struggling to adjust to civilian life because of the stigma associated with mental health and substance abuse issues, use of an unproven tool to assess post-injury brain function, lack of proven efficacy of the VA’s depression treatment protocols, lack of policies that would prohibit veterans exhibiting suicide risk from owning weapons, and poor integration between the EHRs used by the VA and DoD.

Reader Comments

From Emmie Yoo: “Re: MU2 attestation timing. I’m curious whether you have a feel for when in 2014 hospitals will likely begin attesting for Stage 2 MU. I know it opens on October 1, 2013, but do we really think many hospitals will try to meet MU2 in the first half of federal fiscal year 2014?” Hospitals and consultants, please leave a comment with your thoughts.

From Raptor: “Re: athenahealth. Has anyone questioned the legitimacy of their claimed 96 percent MU rates? I think the key word is ‘participating,’ which is only a fraction of their usership. It’s not hard to reach 96 percent when you don’t think a majority of your physician users are even trying to make MU.”

From Non-Sequitur: “Re: help me find a sponsor! I scoured the Resource Center this morning but have not been able to locate one of your new sponsors that was profiled in the past six weeks. They had developed a niche solution for licensing and access challenges with legacy systems when moving to next-generation applications, allowing legacy data to be accessible without paying extending licensing for the replaced systems. MANY thanks for your amazing site. I am enjoying having introduced a relative healthcare novice to your site. He shows up at my cubie every few mornings to discuss one (or more) of your postings. You guys absolutely rock!” Two new HIStalk sponsors offer data archiving options: Legacy Data Access and MediQuant. You’ve also motivated Inga and me to reach out to sponsors to make sure they’ve sent us their Resource Center listing since that’s the easiest way to find them. Thanks for the nice comments.

From Amish Avenger: “Re: hacker article. This is a great Onion-like article title.” It sure is – World’s Health Data Patiently Awaits Inevitable Hack says the high-profile hacks of major sites like Twitter and Evernote make it obvious that healthcare’s turn is coming, especially since small companies don’t have the expertise to properly secure their niche systems. The security researcher quoted might have overstepped his expertise in declaring that Google Health was shut down due to liability concerns. “What the hell happened to Google Health? Gone! They didn’t want the liability. The complexity of this is mind-boggling. Heath care is really in for a beating from the security side… if Google can’t stop this, how is a hospital going to stop this?”

From Primary Care Doc: “Re: Eric Topol’s highly publicized use of an iPhone app on the way home from his HIMSS keynote.” I’m running the comments below because I had the same reaction to the Twittersphere’s instant arousal by Dr. Topol’s use of an iPhone EKG app to diagnose a fellow airline passenger on his way home. First, the cynic in me found it to be an awfully strange coincidence and an opportune PR moment. Second, diagnosing fib is not hard since the signs are straightforward and patients usually have a history of it. Third, diagnosis is a snap compared to treating it, and treatment isn’t even usually necessary in an acute situation. The value added by EKG apps is to save the cost and inconvenience of having a technician run the test, which isn’t relevant in this case. But I’m usurping Dr. PCD’s forum:

He was keen on sharing with us how he saved a patient’s life while on the plane by using technology. He diagnosed a man’s heart condition as a rhythm problem, atrial fibrillation, by using his phone. He was short on details in saying exactly what he did with the diagnosis. Did he have his paddles with him and shock the man’s heart into normal rhythm or did he have a syringe loaded with a beta blocker in his pocket and gave the man a shot right then and there? To those technology fans out there who feel that they can replace the stethoscope with an app or iPhone, I can also tell you that just pressing one’s ear to the patient’s chest or feeling the pulse should suffice. It is what one does with the information that matters, not merely obtaining it. Last week one of my patients was upset because his ophthalmologist cancelled his cataract surgery because of an EKG read by machine showing atrial fibrillation. I looked at the EKG and it was completely normal even when repeated. The machine had read it wrong. This is the difference that Ed Park was talking about between the "promise and the reality.”

HIStalk Announcements and Requests

I’ll be sharing the results of my latest reader survey shortly, but I’ve already acted on one suggestion from it. I added a “comments” link at the bottom of each post, so you won’t need to scroll up to click it.

Another reader survey response asked about comments that are submitted but that I don’t run. Those are few in number, but they include comments that:

• Disparage an individual by name or recognizable position in a way that could be considered libelous
• Seem to have been posted primarily promote the commenter or their company
• Make unverified statements about the financial performance or business prospects of a public traded company

Welcome to new HIStalk Gold Sponsor The SSI Group. The 25-year-old Mobile, AL-based revenue cycle company offers industry-leading claims management, EDI technology, document management, revenue cycle analytics, attachment processing, RAC tracking and defense tools, and business process outsourcing  to its 2,400 customers. Its ClickON technology has more than 200,000 built-in edits that deliver Claredi-certified transactions. SSI’s EHNAC-certified clearinghouse has 800 payer connections and processes over 350 million transactions per year valued at more than $700 billion in claims revenue. See the customer testimonials and case studies from Adventist Health, Baystate, Carilion, Lee Memorial, and others. Thanks to The SSI Group for supporting HIStalk.

Acquisitions, Funding, Business, and Stock

Technology-driven concierge medical practice One Medical Group raises $30 million in funding, increasing its total to $77 million. The company accepts insurance with an annual membership of around $200.

Hospital physician scheduling technology startup QGenda will move its headquarters and 30 employees from the Perimeter area of Atlanta to Buckhead. The company’s revenue has doubled every year since its founding in 2008

SAIC announces Q4 results: revenue up 8 percent, EPS $0.54 vs. –$0.49, beating on earnings.

Sales

Presbyterian Homes of Georgia selects Health Care Software’s Interactant suite of EMR and financial solutions.

Medical University of South Carolina Health System chooses Elsevier’s CPM CarePoints care planning and documentation solution.

Molina Healthcare (CA) will implement Elsevier’s MEDai Navigator analytics solution to manage its Medicaid population.

Centegra Health System (IL) signs a multi-year contract with MedAssets for group purchasing, supply chain optimization, and construction services.

People

Mount Sinai Medical Center (NY) promotes Bruce Darrow, MD from interim CMIO to CMIO.

Cornerstone Advisors names Patty Guinn, RN (Dearborn Advisors) as director and practice leader of clinical informatics.

ONC promotes Chief Grants Management Officer Lisa Lewis to deputy national coordinator for operations.

Announcements and Implementations

Edward Hospital & Health Services (IL) implements several Infor Lawson applications to accompany its existing Infor Human Capital Management solution.

New York’s State Health Information Network (SHIN-NY) goes live with its first electronic transmission of secure EHRs information using Etransmedia Technology’s Direct Care Coordinator solution.

Allscripts and Integrated Health Information Systems will jointly develop a Singapore-based technology laboratory to accelerate IT solutions for public hospitals in Southeast Asia.

Government and Politics

VA Secretary Eric Shinseki says his organization will clear a backlog of veterans’ disability claims by the end of 2015. Seventy percent of the VA’s  895,000 pending claims are older than 125 days. Shinseki blames the backlog in part on the large amounts of paper-based claims and records that require conversion to an electronic format and the lack of synchronization between the VA and DoD.

Innovators & entrepreneurs, throw your hat in the ring to demo at the next Health Datapalooza! Deadline: Apr 5 bit.ly/10cINl8

— Todd Park (@todd_park) March 26, 2013

Several new rules that expand and update HIPAA’s security provisions will go into effect this week, though compliance for most of them will not be required until September 23.

Innovation and Research

Technology

McKesson launches ANSOS2Go, an Android-based mobile app for its ANSOS One-Staff workforce management suite.

Ingenious Med will combine inpatient and outpatient functionality into its impower charge capture platform.

Other

Boulder Community Hospital (CO) reports that its Meditech system is back online following a two-week downtime caused by an unspecified malfunction of both its primary and offsite secondary servers. The hospital was able to recover all of its data except that entered during the eight hours after the last good backup and has now moved to creating hourly incremental backups.

Granger Medical Clinic (UT) suffers a possible data breach when 2,600 paper appointment records awaiting shredding disappear.

Johns Hopkins Bloomberg School of Public Health recently offered a free eight-week data analysis course via Coursera that covered using big data to find the answer to a given question. The first session just concluded and further sessions haven’t been announced, but Coursera has other statistics courses available. You’ve seen all the articles and companies about analytics and business intelligence, so if you want some career insurance at no charge and with minimal inconvenience, Coursera might be the way to go.

In England, an NHS study finds that physicians ignore 98 percent of drug safety alerts, which it concludes is because prescribing systems don’t issue the warnings until the end of the prescribing process and starting over is too much trouble.

Only about 11 percent of healthcare dollars paid to providers are tied to performance instead of fee-for-service, according to analysis by the non-profit Catalyst for Payment Reform.

In Australia, Victoria University’s Centre for Applied Informatics develops software that processes incoming streams of physiologic data and predicts vital signs 20 seconds into the future, also providing real-time warnings and retrospective reviews of patient condition in surgical cases.

Also in Australia, EMR go-live at the new Royal Adelaide Hospital is delayed due to difficulties in modifying the unnamed $427 million US system to handle complex South Australia billing requirements. I believe the system is Allscripts Sunrise Clinical Manager judging from previous announcements.

I’m fascinated by Andy Enfield, the 43-year-old coach of NCAA Sweet 16 overachieving underdog Florida Gulf Coast University. He was high school valedictorian, played college ball at Johns Hopkins, took an MBA from Maryland, coached in the NBA, and co-founded TractManager, a Chattanooga, TN-based healthcare contract management company that’s worth $100 million. He’s also married to a former Maxim magazine cover girl.

The University of Pennsylvania seeks a declaratory judgment against St. Jude’s Children’s Research Hospital, which sued Penn last year claiming that the university violated its patent for genetically modifying immune cells to treat cancer. Penn turned the process over to a drug company in a $20 million deal, but St. Jude’s says it holds the patent.

Sponsor Updates

• Michael Elley, CIO of Cox Medical Center (MO), describes his hospital’s use of T-System to redirect patients from the ER to primary care.
• Allscripts offers a sneak peek at the education session planning for its 2013 Allscripts Client Experience.
• GetWellNetwork previews agenda items, speakers, and panel participants for its GetConnected 2013 user conference April 15-17 in San Diego.
• The CRN Partner Program Guide awards Trustwave’s channel program a 5-star rating.
• Loren Russon, senior director of product management with Ping Identity, evaluates the 3Scale API conference.
• InstaMed releases its 2012 Trends in Healthcare Payments Annual Report.
• HealthMEDX CEO Pamela Pure relates how her personal experiences with post-acute care facilities led her to HealthMEDX.
• eClinicalWorks introduces private payer incentive consulting services to advise providers on incentive revenue opportunities.
• Beacon Partners hosts a March 29 Webinar on the risks business associates pose to healthcare organizations.
• Ingenious Med opens a customer support office in Nashville, TN.
• Huntzinger Management Group hosted Palo Alto Medical Center’s Paul Tang, MD, MS at its event during the HIMSS conference.
• MED3OOO names Judy Stovall from PriMed the winner of its video case study contest.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 3/26/13

Boulder Community Hospital computer records back on line – The Denver Post

Boulder Community Hospital is back online after more than a week operating on hospital-wide system downtime procedures. A preliminary investigation concluded that a severe hardware failure on a critical server brought the system down. IT staff were able to restore to a clean backup point captured eight hours prior to the failure. At that point, however, the task of re-entering and validating all the missing clinical information from that eight-hour window began, which added to the delay in a full return to service. A root cause analysis is underway and a full report is expected within a few weeks.

Lisa Lewis, Chief Grants Management Officer, has been tapped to become the Deputy National Coordinator for Operations

ONC has promoted Lisa Lewis to the position of deputy national coordinator for operations.

Healthcare data has become ‘the new oil’

An Information Daily article discusses the business end of stolen healthcare data, calling it the “new oil” for hackers and identity thieves. The article suggests that stolen databases of patient information are being monetized by stripping out suspicious information and selling the partial databases to marketing firms as legitimately collected contacts.

VA Secretary Eric Shinseki renews vow of claims backlog fix by 2015

In his first nationally televised interview in four years, VA Secretary Eric Shinseki reiterated his longstanding promise to reduce the VA benefits claims backlog to reasonable levels by 2015, despite the strong unlikelihood of accomplishing the task. The interview followed a highly publicized demand calling for the firing of VA Undersecretary of Benefits Allison Hickey which was made last week by Rep. Jeff Miller, chairman of the House Committee on Veterans’ Affairs.

Curbside Consult with Dr. Jayne 3/25/13

I’m lucky to have started my career in health IT on the leading edge of ambulatory EHR adoption. My health system was forward thinking and data driven, so we’ve been in the game a long time.

When we decided to implement a system-wide health record, the group quickly realized they’d need a dedicated clinician to help steer the project. I applied for the job and my career in informatics began.

I quickly realized that although I knew a great deal about implementing EHR in my own practice and using it to drive evidence-based care, there was much I had to learn about doing it on a broad scale. I thought SQL was something that followed a blockbuster in an attempt to squeeze cash out of the movie-going public. I had no idea what lurked in the heart of a legacy app that was trying to be more than its architecture allowed.

The first move I made was to seek out a half dozen smart clinicians who had come before me. It was hard to do – most of us were starting our projects at a similar point in the product’s evolution and frankly my health system was the largest customer our vendor had signed to date. I decided that I was going to learn everything I could, regardless of the size of my the organizations of my peers. If they were successful in what they were doing, I figured I’d work with my team on how to scale it.

I ended up with a core group of five close friends, all of whom knew more than I did regardless of their size as a customer. We had that “we’re all in this together” attitude and quickly bonded through many a late night e-mail blast. We recognized that everyone had something to offer.

Half a decade later, I still count these fellow travelers as some of my closest friends. Some have moved to other vendor platforms, but not a week goes by that I don’t find myself thinking about something I learned from them. New faces have joined the group. There are quite a few weeks I still reach out with those, “When this happened to you, what did you do?” type questions. Sometimes they’re EHR related sometimes not, but I know my circle of “phone a friend” colleagues have my back.

Our primary EHR vendor knows this group of leading CMIOs well. We were recently asked to mentor a new client that was converting to our product after a failed pilot with another vendor. The new customer reminded me a lot of myself – they are a relatively large customer compared to the rest of us and I thought our group would have a lot to offer them.

Introductions were performed and one-on-one sessions were arranged at a regional user group meeting. We were poised to share everything we had with this client – from detailed conversion plans and assessment tools to the sacred “known issue” lists that we had compiled. We looked forward to having a new kid on our block to continue to push our mutual vendor to excellence.

We were not, however, prepared for the new customer’s reaction to our efforts. We were completely shot down. The prevailing attitude of, “You can’t possibly understand because you’re not as large as we are” made it impossible to communicate. The new CMIO was convinced that unless a live client looked exactly like their hospital, we had nothing to teach her. She used every opportunity to belittle our efforts despite our demonstrable outcomes.

Had this been middle school, I’d have dropped this new “friend” like a hot rock. Not only was she failing to take advantage of what we had to offer, but she was acting ungrateful and downright rude.

Several months have passed since the new CMIO blew us off. I spotted her recently at HIMSS. Not surprisingly, she’s been “made available to the workforce.” Her implementation never got off the ground and has been outsourced to a consultant.

I wish her luck and hope she’s learned something. Like Mark Twain said, it’s not the size of the dog in the fight, it’s the size of the fight in the dog. There is always something to learn and we can’t be afraid to open ourselves to the possibility.

I’m fortunate I had some great friends in my corner. I hope one day to pay it forward to someone who will appreciate it.

E-mail Dr. Jayne.

Morning Headlines 3/25/13

Allscripts statement regarding the New York City Health and Hospitals Corporation

Allscripts drops its lawsuit against HHS and Epic. Filing the lawsuit in the first place was a questionable strategic decision and won the EHR vendor HIStalk’s "Stupidest Vendor Move" earlier this year.

Nearly 200 Former Customers of Allscripts MyWay Are Currently Live on Aprima EHR and PM

Aprima announces that it has converted nearly 200 Allscripts MyWay customers to its product in the six months since Allscripts announced it would not develop the MyWay enhancements required to comply with Meaningful Use and ICD-10.

Switch to e-records causing pain for Ontario doctors

Clinicians in Ontario are pushing back against EHR implementations that are resulting in familiar end user complaints: slow system response, poor usability, and substandard interoperability.

Olympic Medical Center to hire extra staff for electronic records launch

Olympic Medical Center will spend $850,000 to hire three dozen travel nurses to support their $1.8 million Epic install. The nurses will train end users as the hospital leads up to its May 4 go-live.

Monday Morning Update 3/25/13

From Someone: “Re: Allscripts. Looks like they dropped their lawsuit against HHS and Epic. No one has broken the story yet – I’d like to hear more details.” Our Allscripts press contact provided this statement about the legal action, which had earned Allscripts the “Stupidest Vendor Move” in the 2013 HISsies:

Allscripts Healthcare Solutions, Inc., has discontinued its legal action against the New York City Health and Hospitals Corporation regarding the award of the Integrated Clinical Information System contract and looks forward to having the opportunity to work with HHC on other matters in the future. The NYC Health and Hospitals Corporation is pleased that Allscripts has withdrawn the lawsuit.

From McLayoffs: “Re: McKesson. Big layoffs coming 3/28, so big that corporate communications is driving the talking points.” Unverified.

From The PACS Designer: “Re: GSMA Mobile Awards 2013. A mobile app that just won the Judge’s Choice – 2013 Best Overall Mobile App from the GSM Association is Waze. The app helps the commuting effort each day through sharing real-time traffic and road info, saving everyone time and gas money on their daily commute. Also of note is that HIStalk sponsor AT&T won in the category of Smartphone Application Challenge with its app called Application Resource Optimizer (ARO).”

From TickedOffBassets: “Re: Basset EMR icons for suicide risk from Dr. Jayne. As the proud owner of two very happy, albeit sad-looking Basset hounds, I have to stand in protest to associating their images with suicidal risk. When my two wake up from their fifth nap of the day,  they will be planning their official protest before their sixth nap of the day.” Mrs. HIStalk’s brother has a pair of Bassets, which means that when we visit, each of us has 80 pounds of licking, squirming, moaning dog draped across our legs. I wouldn’t say they are particularly fun, but they are affectionate, and neither seems to be a candidate for self destruction given the amount of energy that would be required.

Around 40 percent of poll respondents gained a better perception of Allscripts since Paul Black took over three months ago. New poll to your right: have you ever contacted your primary care provider via e-mail or secure private message?

Welcome to new HIStalk Platinum Sponsor Patientco. The Atlanta-based company’s solutions make it easy for patients to manage and pay their healthcare bills online just like they do for consumer products and services. They access their easy-to-read statements using their personal SecureHealthCode that is printed on every statement and choose from several payment options via PatientWallet – online, telephone, interactive voice response, or mail. They can track all of their healthcare expenses in one place and question the provider about their bill using secure messaging. Providers enjoy submission of bills electronically or on paper, faster payments, iCash credit card processing, daily funds deposit, automated assignment of payment plans to patients who need them, and reduced time required for manual processing. Thanks to Patientco for supporting HIStalk.

Listening: The Letter Black, Flyleaf-style sexy hard rock is actually a Christian band fronted by a husband and wife from Uniontown, PA.

Nathan Lenyszyn joins Billian’s HealthDATA as director of new business development.

Aprima says it has converted nearly 200 former MyWay customers to its EHR in the six months since Allscripts announced that it would not be enhancing MyWay to meet MU and ICD-10 requirements. Aprima CEO Michael Nissenbaum says he expects the company to gain up to 1,500 provider users, nearly half of those who had implemented the Allscripts product.

An ONC brief on healthcare IT in long term post acute care emphasizes partnering with companies that offer ATCB and CCHIT LTPAC-certified EMR solutions. According to CCHIT’s site, there are four of those: HealthMEDX, AOD Software, Optimus EMR, and American Data.

Allscripts shares are up 50 percent vs. a relatively flat Nasdaq in the three months since the company replaced Glen Tullman with Paul Black.

The UK’s largest NHS Trust will deploy Microsoft’s Windows to Go on USB sticks rather than buying laptops for remote employees. Employees plug in the encrypted USB stick to start a secure Windows 8 desktop session from any compatible device. Local data storage is on the stick.

Healthcare payment exchange platform vendor PaySpan relocates its headquarters from Jacksonville, FL to Atlanta, GA.

A nurse supervisor at a New York jail resigns after an investigation of jail employees viewing the hospital electronic medical records of corrections officers and their families. The jail’s system provides access to the systems of Samaritan Hospital in Troy, NY. The nurse’s attorney says she didn’t perform the searches herself, but inadvertently allowed others to do so by taping her password to her desk.

A former medical resident at University of Michigan Hospital is sentenced to at least three years in federal prison for possession of child pornography, discovered when he left his USB drive plugged in to a hospital computer. The hospital didn’t report the incident to police until six months later.

Doctors in Ontario, Canada complain about their move to electronic medical records, citing response time problems and system lockups as 1,000 users who were added to their Nightingale Informatix EMR over the past year overwhelmed the system. 

A British Columbia doctor complains about lack of interoperability among the province’s network that connects the disparate and often outdated systems managed by individual local health authorities. A previous auditor’s review found that implementation of the $252 million system was poorly managed.

The board of Olympic Medical Center (WA) approves spending $850,000 to bring in three dozen traveler nurses to cover staff training on its Epic system, scheduled to go live in both the hospital and clinics on May 4. The hospital budgeted $1.8 million for the conversion to Epic, which is used by its affiliate Swedish Medical Center, and expects to earn $7.6 million in Meaningful Use payments.

Weird News Andy says, “I got your back.” A Canadian man is stabbed five times in a fight and is sewed up in the ED with no X-rays taken. Three years later as he scratches an itchy spot on his back, his finger catches the tip of an embedded three-inch knife blade.

Vince’s HIS-tory installments always hold my rapt attention and this is one of his best – some background you probably didn’t know about the pioneers who started Meditech.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.