News 1/17/14

Top News

Streamline Health will acquire St. Louis-based patient scheduling and surgery systems vendor Unibased Systems Architecture.

Reader Comments

From Salient Point: “Re: vendor layoffs. I’ve never had so many colleagues (most of them older), including high-performing salespeople, being let go. Seems like more than the usual Q4 pruning. Are you seeing this?” I will defer to readers. It does seems as though companies are cutting back, maybe because the HITECH boom is pretty much over unless you are Epic, Cerner, or a consulting company.  The EMR dance partners have largely been chosen, other than the likely ambulatory rip-and-replace caused by unmet expectations and acquisitions.

From Eclipsys Gal: “Re: Chad Eckes, chief strategy officer at Cancer Treatment Centers of America. Replacing Sheila Sanders as CIO at Wake Forest Baptist University Medial Center (NC).” Unverified. Sanders resigned after four years at WFBUMC in May 2013 following a disastrous Epic rollout, although the hospital said her departure was unrelated.

HIStalk Announcements and Requests

A few highlights from HIStalk Practice over the last week include: CareCloud reports the addition of 520 new clients in 2013, including the 20-provider Urology Austin (TX). The PCMH model leads to lower cost, better access to care, higher patient satisfaction, and fewer avoidable or unnecessary services. Practice Fusion achieves 2014 Complete EHR certification in time to beat its December 31 “guarantee” deadline. More than half of providers say they have not yet estimated the impact of ICD-10 on their cash flow. Doximity claims it has more physician members (250,000) than the AMA. SureScripts adds almost two dozen vendors to its clinical network for secure HIE. A dozen HIT vendors share opinions on the biggest challenges facing physicians and physicians practices in 2014 in part one of a three-part series. Thanks for reading.

Welcome to new HIStalk Platinum Sponsor MBA HealthGroup of South Burlington, VT. The company’s consulting services include Epic, Allscripts, ICD-10, EHR optimization, Meaningful Use, and RCM. They’ve trained and supported more than 5,000 physicians on Allscripts EHR, trained 3,000 users on Epic 2012, and provided RCM services to 400 physicians in 38 states. Fletcher Allen CIO Chuck Podesta mentioned using the company’s Epic 2012 upgrade services when I interviewed him earlier this week (the case study is here.) I noticed a new company blog post on the benefits and pitfalls of personalizing Epic that contains good nuts-and-bolts advice. Thanks to MBA HealthGroup for supporting HIStalk.

Listening: The Neighbourhood, a new California-based five-piece that skillfully blends alternative music with R&B. The singer is 22, which must be the coolest thing ever.

HIStalkapalooza and HIMSS

HIStalkapalooza registration will continue for several days. Everybody who wants an invitation has to register individually (that includes Inga and me, so don’t expect sympathy after the fact if you didn’t bother). We would love to invite everyone, but that’s not possible given that we had more than 750 requests in the first few hours, so watch your inbox for invitations on February 4 or so and follow #HIStalkapalooza14 on Twitter. Imprivata is doing an amazing job to make it the best event possible, as you’ll see if you score an invitation. It’s hard to comprehend that this will be the seventh version, going all the way back to Orlando in 2008 when it was 200 or so people in a Peabody Hotel conference room. I was thrilled because I was secretly hoping for 100 but expecting 25.

HIStalk sponsors: let Lorre know if you’ll be attending our sponsor-only networking reception on Sunday evening, February 23 at the HIMSS conference. It’s going to be pretty cool and a nice way to finish to the pre-conference weekend. Contact Inga if you haven’t sent your information for our HIMSS guide.

Acquisitions, Funding, Business, and Stock

The price of Allscripts shares climbed nine percent Wednesday following the company’s prediction of five to eight percent adjusted revenue growth per year from 2014 to 2016. Analysts were expecting five percent growth in 2014. Above is the one-year chart with MDRX in blue and the Nasdaq in red, with shares rising 60 percent.

Valence Health reports revenue growth of 35 percent for 2013 and a 65 percent increase in bookings.

Craneware says its first half earnings are expected to be up five percent over last year.

Mercom Capital Group issues its healthcare mergers and acquisitions report for 2013, reporting $2.2 billion and 571 deals in 2013 vs. $1.2 billion and 163 deals in 2012. The top five VC-funded companies for the year were Evolent Health ($100 million), Practice Fusion ($85 million), Fitbit ($73 million), MedSynergies ($65 million), and Proteus Digital Health ($45 million). Above are the largest M&A transactions of the year. The full report costs $599.

Sales

Center for Diagnostic Imaging (MN) extends its use of Merge Healthcare solutions to include the iConnect Network interoperability platform.

Long-term care provider Grace Healthcare (TN) selects the Daylight IQ disease management system from COMS Interactive.

NorthBay Healthcare (CA) selects Health Catalyst’s Late-Binding Data Warehouse and Analytics platform.

WakeMed Health & Hospitals (NC) will implement population health and final risk management solutions from Evolent Health.

Kaiser Permanente (CA) renews a multi-year agreement with MedAssets for strategic sourcing and spend analytics solutions and to serve as Kaiser’s exclusive GPO for its nationwide facilities.

People

ISalus Healthcare hires Jason McDonald (Kareo) as chief sales officer.

HIMSS names its former board chair Willa Fields (San Diego State University) the winner of the 2013 HIMSS Nursing Informatics Leadership Award.

Rick Roycroft (MedAssets) joins Huron Consulting Group as managing director of the company’s healthcare practice.

Cureatr names Vik Shah (Medidata Solutions) as EVP of client services and operations.

Announcements and Implementations

Johns Hopkins HealthCare (MD) and BlueRush Media Group will co-develop an online portal that provides information for employers and their employees who are undergoing or have gone through cancer treatment.

The City of New Orleans EMS integrates its EMS Service Bridge electronic patient care reporting system from ImageTrend with the Greater New Orleans HIE.

In Canada, Cerner completes deployments of its ambulatory EMR  at three Ontario ambulatory clinics, supported by Canada Health Infoway.

Compass Oncology (OR) pilots My Care Plus, a patient portal designed specifically for cancer patients by McKesson Specialty Health.

The VA deploys Health Level’s critical case management platform for all its VA National Teleradiology Program medical centers.

The Ministry of Health of the Kingdom of Saudi Arabia launches nationwide open access to Wolters Kluwer Health’s UpToDate for the country’s 80,000 physicians and nurses.

Lincoln Hospital (WA) and Community Wellness (WA) use the INHS TeleHealth system to offer diabetes and pre-diabetes education to rural communities in northern Idaho and eastern Washington.

Government and Politics

ONC releases the Safety Assurance Factors for EHR Resilience (SAFER) Guides, which include checklists and recommended practices to help providers assess and optimize the safety and safe use of EHRs. The set of nine guides are High Priority Practice, Organizational Responsibilities, Contingency Planning, System Configuration, System Interfaces, Patient Identification, CPOE with Decision Support, Test Results Report and Follow-Up, and Clinician Communication. Each starts with a checklist of recommended practices for optimizing EHR safety. The guides were developed by Joan Ash, PhD (OHSU), Hardeep Singh, MD (Houston VA, Baylor), and Dean Sitting, PhD (UT Health Science Center). This is some really good work.

ONC announces the beginning of a 30-day period for organizations to submit requests for ONC-Approved Accreditor status, which is valid for up to three years. This the organization that accredits EHR certification organizations, with ANSI as the incumbent since the role was first defined in 2011.

CMS and ONC select McKesson and Meditech as its first designated “Test EHRs.” In order to meet the transition of care objective in Stage 2, EPs, EHs, and CAHs must successfully exchange an electronic summary of care document with a CMS-designated test EHR or with an EHR technology different that the provider’s EHR technology.

Several North Carolina doctors file a class action lawsuit against the state for delayed Medicaid payments, claiming that the the state’s Department of Health and Human Services and its contractors — CSC, Maximus Consulting, and SLI Gobal Solutions — were negligent in their rollout of the state’s $484 million NCTracks payment system.

Brian Ahier provided this audio of Karen DeSalvo’s introduction of herself to the HIT Policy Committee earlier this week. She sounds kind of fun, but for some reason her voice goes up in tone at the end of some sentences like she’s asking a question when she isn’t.

Other

A HIMSS Analytics report predicts accelerated growth for patient portals, clinical data warehousing and data mining, and radiology barcoding applications. The number of patient portal vendors rose from 28 in 2009 to 62 today.

CTG will add 300 jobs in its home city of Buffalo, NY in a medical informatics partnership with University of Buffalo’s Center for Computational Research in a genomics and big data initiative. The company helped create UB’s Institute for Healthcare Informatics in 2010 and contributed funds for Roswell Park Cancer Institute’s Center for Personalized Medicine.

A California highway patrol officer stops a California software developer for speeding, also citing her for wearing Google Glass. He considered the device to be covered under the same laws that prohibit playing video in the driver’s field of vision.

Texas and the city of Austin offer athenahealth $5.7 million in incentives to open an R&D center that would create 607 jobs with a capital investment of $13 million. The company is also considering locations in California, Massachusetts, and Georgia, the latter two of which have previously provided athenahealth with similar incentives.  

BIDMC CIO John Halamka says he has written two books, one a reflection on his blog writings and other a fictional thriller. He’ll be signing the former at HIMSS. He really is a Renaissance man now that he’s turned into a gentleman farmer (I’m hooked on his “Building Unity Farm” series.) I just can’t understand how he finds the time to get so involved in so much, maybe because I’m lazy.

The governor of Guam signs a bill approving a $25 million loan to Guam Memorial Hospital to help it repay its previous bailout loan and to pay the support fees of NTT Data, which threatened to cut the hospital off from software support.

Michael Gilbert, MD, a family medicine physician with St. Joseph Health (CA), writes a good ONC post for practices called “How to Use a Patient Portal.” As an Allscripts Enterprise user, he says the company pushed him to use Jardogs FollowMyHealth after they bought that company, resulting in a 40 percent drop in registrants from their previous portal (presumably Intuit Health). Current problems include the large number of pending registrations that never become active (which throws off the MU Stage 2 denominator), the requirement for users to install the Microsoft Silverlight graphics browser plugin (which hangs up my browser regularly, so I can understand that), and  the need for providers to motivate patients to participate. Interestingly, the practice bought a software development company and will build its own portal and HIE (!!!), but in the meantime seems fairly happy with the Allscripts product:

[providers] participate in secure online clinical communication, schedule appointments, refill medications, and answer routine questions with and for patients. The new portal automatically uploads all results within minutes of being verified by the provider and patients can directly schedule into providers schedules, ask for medication renewals and pay bills. The portal also offers a computer, iPad and iPhone application with all of the above functionality to patients. We have over 30,000 patients registered, and have achieved 10 percent penetration of all registered patients across both medical groups. Some providers have almost half of their patients registered. Our physicians encourage their patients to message them via the portal.

Weird News Andy appropriately finds this story sad. An ambulance takes 18 minutes to arrive at the scene of a shooting in a mall parking deck, unable to enter the facility because of the low ceilings. The crew had to roll the gurney up the ramp to get to the male victim, who had refused to hand over his keys to four carjacking assailants, who then shot him as his wife sat beside him in the car. He died.

An Iowa state prison psychiatric hospital employee is fired for downloading patient photos from the hospital’s computer, Photoshopping them, and emailing them to co-workers, who often responded with additional requests (some of those folks were also fired, apparently.) One of his works involved patient faces superimposed on a “Star Wars” poster whose title he changed to “Tard Wars.” He was also found to have used work PCs to visit adult site including “Heavy Hotties.” The man said his job mostly involved playing cards or Wii with patients, which enabled him to “Photoshop at the same time I am changing lives. It’s called multi-tasking.”

Sponsor Updates

• The coreANALYTICS health system performance improvement system from Encore Health Resources earn ONC 2014 certification as an EHR module. Catholic Health Initiatives is using it.
• Allscripts announces that its KLAS scores are on the rise, with Allscripts Enterprise EHR up 11 percent for the 12-month period ending December 2013 and Sunrise Clinical Manager up four percent.
• Coastal Healthcare Consulting introduces Convergence, a patient identity management solution that uses NextGate’s Enterprise MPI.
• NextGen will map its EHR directly to the IRIS eye disease registry.
• Josh Byrd, Patientco’s director of marketing, shares his perspective on why the patient experience matters.
• Joseph Petro, SVP of healthcare R&D for Nuance, explains how clinical language understanding is critical for helping providers drive productivity while remaining focused on patient care. 
• TriZetto’s Provider Solutions Business unit introduces the Top Codes Report, which allows providers to chart their most frequently billed procedure and diagnosis code pairs in preparation for ICD-10.

EPtalk by Dr. Jayne

ONC releases SAFER Guides to aid providers in safe use of health information technology. The Safety Assurance Factors for EHR Resilience Guides contain best practices for EHR use and include checklists for practice assessment. ONC Chief Medical Officer Jacob Reider discusses the nine guides on his “Health IT Buzz” blog.

There was a lot of discussion in the physicians’ lounge this morning regarding the suggestion that medical school could be reduced to three years. Certainly the idea of saving a year’s worth of tuition and living expenses might be attractive to those who already know what residency they want to pursue. Several of the programs currently in place reduce electives and require summer classes in order to meet required educational standards.

My medical school’s fourth year curriculum was all elective, and in hindsight, I’m glad I had it. Being at an urban academic medical center allowed me to see things I wouldn’t have been exposed to in residency and also allowed me to practice my clinical skills with less focus on competing against my peers. Coupling reduced medical school experiences with resident work hour limits could create a rocky start for some physicians entering practice.

The other hot topic in the lounge has been the recent New York Times article on scribes. After reading the article, several of my colleagues now think scribes are the be-all, end-all answer to their EHR problems. I enjoy moonlighting at a local emergency department that uses scribes, but physicians need to understand the limitations of the scribe model. Although they’re very popular for episodic care (emergency, urgent care) there are challenges in office-based medicine. One of the major issues is that using a scribe doesn’t relieve the physician of the need to learn the EHR. He or she will need to be able to access the system to view data and to handle after-hours patient contacts such as hospital admissions, phone calls, cross-coverage, etc.

Scribes hired from third-party agencies are expensive – up to $28 per hour in my market. It’s hard for physicians to cover that expense in primary care. The alternative chosen by many physicians is to train a medical assistant to scribe. That approach can be effective as long as the medical assistant is relieved of their other daily responsibilities. It is extremely difficult to try to play both roles in a busy primary care practice. The article says physicians using scribes can see up to four extra patients per day. That’s not been the experience of physicians in our community, who are lucky to see one or two extra patients per day. Scribes may not be as helpful with telephone messages, provider-to-provider communication, and other administrative burdens that impact physicians.

Physicians also need to spend time reviewing the scribe’s notes for accuracy. At my site, there is a pool of scribes and we may work with three or four during a single shift. Although the overall quality of their work is acceptable, the work of some is much stronger than others. Their work requires careful review, especially when they are new. Scribe training programs may be only a few weeks long. If you get lucky and have one who is a pre-med student or a nursing student, it can be a lot of fun since you can do some teaching along the way and they are generally very motivated to do a good job in the hopes they will be able to ask for a recommendation. If you get unlucky and have a scribe who has been up late the night before cramming for exams, it can be a challenge.

Speaking of challenges, today HIMSS invited me to attend a focus group. How could I resist their opening line: “Are you a CIO with a bed size of 150-400 or an IT Director/Manager with a bed size above 300 and not a practicing physician?” Why do they keep demographic files on members if they aren’t going to use them? Between that and the overall lack of HIMSS social invites, I’m starting to wonder whether this meeting is going to be more work than play. I’m confident, however, that with Inga’s vast social network, things will turn around. What are your HIMSS social plans? Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Advisory Panel: Top 2014 Priorities and Concerns

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

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

This question this time: What are your organization’s top three IT priorities for 2014 and the concerns you have about executing them?

(1) ICD-10.
(2) Data center relocation to a CoLo.
(3) Complete enterprise EHR rollout.

The only one I’m really concerned about is ICD-10. There are just so many uncertainties around how the providers and the payers will make the transition.

Our top three IT priorities for 2014 all revolve around our Epic platform.

(1) We need to finish our enterprise-wide Epic implementation.
(2) Once we survive our go-live, we will enter into an extended period of optimization of the system, which I anticipate will take at least three to four months.
(3) Subsequent to that, we will begin to develop the capabilities within IT to begin to extend our Epic platform to other entities across our state.

My biggest concern for all of these is the ability to maintain my current resource levels as well as adding new resources in order to address the organizational strategic outreach initiatives.

(1) We are determining whether to stay on our current EMR platform or to switch.
(2) ICD-10 is looming.
(3) We are also focused on getting our remaining hospitals to Stage 7.

(1) ICD-10. Significant work needs to be completed on all facets of this mandate. Vendor testing and validation, staff education (HIM, physicians, and billing), reporting requirements, and many more. Payors are not ready, IS vendors are not ready, and our staffs are stretched thin, so it remains my greatest concern in 2014.
(2) MU Stage 2. So much is still not known. How will we meet the patient engagement goals (absurd for a community hospital with independent medical staff that also must meet the portal goal)? What will the CQMs require for new data collection? How will the medical staff deal with electronic medication reconciliation and the requirements of the Transitions in Care electronic documentation at the hospital while also dealing with a different system and set of requirements in their office? These questions remain and the vendors will not be ready until the last quarter leaving no room for error.
(3) Pending affiliation. During all of this, we are entering into an affiliation that will dramatically change our organization and will, at some point in the near future, require a conversion to a new ERP system and EHR.

After the massive expense of our EHR and in the face of ongoing financial financial struggles (real or perceived), there will be great pressure to hold down costs, perhaps even to find a revenue-generating activity for IT. The concern is that needed education and training will be shortchanged and clinician workflows that should be corrected promptly will be allowed to calcify, requiring even more resources in the future. Many of these workarounds reflect inadequate technical support (I never knew it could do that!) or training (I never knew it could do that!)

(1) Ensuring readiness for regulatory items like ICD-10 and Stage 2 Meaningful Use).
(2) Continuing to optimize our EMR investment via new high-value clinical decision support projects. 
(3) Implementing new enterprise-wide revenue cycle solution.

(1) ICD-10. 
(2) Operational cost reductions (both IT and non-IT).
(3) Growth through acquisition.

(1) ICD-10.
(2) MU Stage 2.
(3) Financial resource management (conservation).

The three are not compatible. I’ll need resources for both of the first two while being asked to use less at the same time. 

(1) Our top IT priority is moving from Cerner to Epic, with the obvious concerns about data migration and workflow changes slowing us down initially.
(2) Appropriately using analytics (from identifying high-risk patients for outreach, to looking for otherwise hard to find adverse events), with the dual concerns of (a) not having enough report writers, and (b) not having enough people to execute on what we find. 
(3) Figuring out telehealth at our organization, with the concerns of (a) finding a technical model that works efficiently, and (2) finding a business model that makes sense (who will pay for it!)

(1) Epic optimization. Hiring and retaining qualified Epic analysts is becoming very challenging in our region. Standard now is  work from home and significant yearly salary increases due to the local competition from institutions out of build phase so analysts are free to jump ship.
(2) Windows XP support (lack thereof). The March 2014 move to Windows 7 has us very nervous – Epic and scores of integrated applications cannot be tested enough to quell the unease.
(3) ICD-10. Ouch… how am I going to get providers that don’t document well to do an even better job next October? We discovered quite quickly that Epic support is still just nudging up their own learning curve.

(1) MU Stage 2. 
(2) ICD-10. 
(3) Integrated financial and clinical systems.

(1) ICD-10. Since ICD-10 success is based on physician documentation, it’s a wildcard as to how well you will do regardless of the education effort. 
(2) MU Stage 2. MU Stage 2 criteria related to transitions of care will be particularly difficult since there are three components (i.e. 50 percent of discharges, 10 percent using CDA format, and a transaction to a different EHR.) Items 1 and 3 are easily achievable but 10 percent using CDA format could be difficult depending on where your patients transition (both inpatients and ambulatory). Many post-acute settings, for example, do not have an EHR capable of receiving this format.
(3) Privacy and security. Privacy and security is just a matter of keeping up with the regulations. Competing for resources is difficult since this area doesn’t  get enough attention until you have a problem. With the final Omnibus rule in place, fines have increased, as will audits. Business associates will be particularly vulnerable, as well they should be. There are a considerable amount of other priorities for 2014 (e.g. ACO IT, EHR optimization) but these may have to wait.

(1) Government regulations compliance.
(2) M&A integration.
(3) Growth initiatives.

My main concern is having too many top priorities competing for finite resources, both in IT and operations.

I’d be very surprised if anybody answers anything but:

(1) MU2.
(2) ICD-10.
(3) Keeping the place running.

(1) MU Stage 2. Vendor delays, expectation of patient engagement.
(2) ICD-10. Inability of vendors to deliver on time; excessive fees (CAC).
(3) Volume to value mandates (reporting, data exchange, etc.), a market mess.

(1) Meaningful Use Stage 2 and 3. Concern about areas where we don’t have full control.
(2) Expanding use of mobile and connected care connecting our enterprise and our community through mobile devices.
(3) Maintaining security in a rapidly changing environment. Expecting more and more security breaches.

Morning Headlines 1/16/14

Surgical Information Systems Acquires Healthcare Software Leader AmkaiSolutions

Surgical Information Systems, a perioperative specialty EHR vendor, acquires AmkaiSolutions, an ambulatory EHR vendor that provides software for ambulatory surgery centers. The partnership extends SIS’s reach into the ambulatory space within its niche EHR market segment.

Allscripts rises after giving 2014-16 outlook

Allscripts reports that it expects five to eight percent annual growth per year through 2016, while analysts were expecting the company to report a flat five percent growth rate. The aggressive forecast drove Allscripts’ share prices up seven percent by the end of the trading day Wednesday.

HHS makes progress on Health IT Safety Plan with release of the SAFER Guides

The ONC releases a set of guides and tools to help healthcare providers and organizations assess and optimize EHRs for improved safety. The guides represent a part of the Health IT Patient Safety Action and Surveillance Plan, which was published in July of 2013 to address EHR safety concerns.

HIStalkapalooza 2014, Sponsored by Imprivata

HIStalkalooza 2014, sponsored by Imprivata, will be held Monday, February 24, 2014 from 7 p.m. until 11 p.m. at the House of Blues Orlando (Downtown Disney) during the HIMSS Annual Conference & Expo.

Clay Ritchey, Imprivata’s chief marketing officer, said in a company announcement, “HIStalkapalooza is perhaps the most high-profile, premier social event in healthcare IT, and Imprivata is proud to be this year’s sponsor. We plan to uphold the annual traditions that attendees expect at HIStalkaplaooza as well as add some new, exciting surprises that will make this one of the most memorable events yet.”

Attendance is by invitation only since the facility capacity is limited and demand is always high. Those interested in attending complete an online form. Invitees will receive an emailed invitation around February 4. 

The seventh annual HIStalkapalooza, dubbed “Healthcare’s Night Out,” will include the usual events such as the “Inga Loves My Shoes” contest, crowning of the HIStalk King and Queen, and presentation of the annual HISsies awards. Other activities include:

• A live band
• Cartoon artist, magician, and other fun activities and entertainment
• Great food and an open bar

Transportation between the Orange County Convention Center and the House of Blues will be provided.

HIStalk and Imprivata will provide more details as the event draws closer. Keep up on Twitter using #HIStalkapalooza14.

Imprivata is a leading provider of authentication and access management solutions for the healthcare industry that enable fast, secure and more efficient access to healthcare information technology systems to address multiple security and productivity challenges. For more information, please visit www.imprivata.com.

Readers Write: Next Steps at ONC

Next Steps at ONC
By Helen Figge

The new leader, Karen DeSalvo, MD, has been appointed at ONC. It is anticipated that ONC is set to continue  the creation of an interoperable, private, and secure nationwide health information system  with the ultimate goal of supporting widespread distribution of data. More importantly, widespread implementation of Meaningful Use of healthcare technology.  

Many, however, still struggle to gauge what ultimately will be developed to facilitate the electronic exchange of health information. How will we launch the system, maintaining high quality along with security so that patient records are impenetrable to tampering?

The nirvana of the ONC program was to improve healthcare delivery alongside reducing healthcare costs.  But with uncertainty of where Obamacare eventually will land, and with all the other moving pieces like ICD-10, additional worries play into the overall scheme of just what the final healthcare landscape will look like. Not only to the healthcare providers, but to the consumer of healthcare, like you and me.

Besides the obvious conversations that we all hear centered around Meaningful Use, ONC has many opportunities to improve healthcare globally, most notably stressing and promoting early detection, prevention, and management of chronic diseases, which account for most of the healthcare expenditures we see today.

As we continue to see ONC evolve, let’s hope that the emphasis will not only zero in on Meaningful Use,  but also be energized for promoting such things as staying well through good health habits – wellness – in the various stages of our life cycles. Regardless of the technologies in play or the governmental regulations already set in motion, the key to the healthcare game is for consumers to stay healthier longer and be rewarded for maintaining a healthy state versus dealing with the aftermath of illness. 

This plays well into the ONC mission of eliminating health disparities among different populations and ensuring best practices regardless of geographic confines as well. There is a lot on the ONC table to continue to execute. Hopefully ONC will also affirm the need to have promotional campaigns for promoting early detection and prevention more effectively in the marketplace. This seems still to be void or at least not very noticeable from some vantage points.

Let’s not forget the ONC charge of establishing a governance for the Nationwide Health Information Network (now coined the eHealth Exchange), which when successfully executed, would be a Web-services based series of specifications designed to securely exchange healthcare related data.  

Independent of the leaders named at ONC, the arduous task of moving healthcare to the next level of quality will be at the forefront. A big sigh and a long pause will be needed to start the conversations with enthusiasm for sure, but in the end it will be just another day in the life of a CIO and the technology teams along with all of the healthcare providers in this era of Obamacare.

Helen Figge, CPHIMS, FHIMSS is is VP of clinical integration for Alere ACS.

Readers Write: Alerts versus Alarms – Not Just Semantics

Alerts versus Alarms – Not Just Semantics
By Brian McAlpine

We often hear references to “alerts” in the context of clinicians experiencing overload or becoming fatigued. For example, alert fatigue is a well-known problem whereby clinicians are constantly bombarded with multiple types of alerts, each designed to get their attention.

Alerts can come from many different sources, including the EMR/EHR, lab systems, CPOE, medication administration software, imaging systems, nurse call systems, and many other sources. Almost any system in the clinical environment can generate an alert.

For the purposes of limiting the scope of this discussion, let’s limit the definition of “alerts” to the patient care environment and direct patient care. Using this working definition, I would also say that a nurse’s phone that receives alerts or can process text messages can also generate alerts (i.e. via a beep or vibrate) that let the nurse know when a new message has arrived.

Recently there has been increasing industry discussion and focus on “alarms” and the problem of alarm fatigue. The Joint Commission’s NPSG06.01.01 has raised the awareness of this problem and now hospitals must start to pay close attention to which medical devices and corresponding alarms are contributors to alarm fatigue. 

Both alerts and alarms interrupt the clinician and can be a source of distraction that leads to critical errors, so what’s the difference? There is a big difference, especially when provider organizations attempt to get their arms around these problems.

This is really a problem where healthcare as an industry needs to focus and prioritize what is most critical. When you look at the key differences between alerts and alarms, you can further appreciate why the Joint Commission has taken action for the second time in the last 10 years, the first time being here with the National Patient Safety goal for managing audible alarms.

Alarms are typically derived from medical devices and often communicate an immediate life-threatening patient condition. Think a v-fib or asystole alarm from a patient monitor. Alarms are always more time sensitive and a delay of a few seconds may matter to the safety of the patient. Another key characteristic of alarms is that they are almost always intended for nurses or respiratory therapists (i.e. non-physicians). Physicians do not deal with alarm response – that is for nursing to handle. Finally, alarms are always regulated by the FDA from both the medical device side (alarm generation) and from the perspective of an alarm management middleware. The FDA regulates the alarm management middleware vendors through the 510k process. As a result, only a few vendors can offer an alarm notification capability because of strict FDA 510k regulations.

But what about alerts and vendors that integrate alerts? Shouldn’t these be regulated just like alarms? The answer lies in the definition of alerts and the key differences as compared to alarms. Alerts are usually not associated with medical devices and are not immediately life threatening, but could be very serious. A big difference is that alerts are not always immediately time sensitive — a delay of 30 seconds or even several minutes often does not matter like it does with a patient monitoring alarm. In terms of who typically receives alerts, these can be intended for any clinician, and often physicians receive alerts generated by systems such as the EMR. Another major difference is that alerts are generally not regulated by the FDA like medical device alarms are.

Because of these differences, many vendors can (and do) offer an “alerting” capability. The barriers to developing an alerting or alert notification feature are simply a lot lower when compared to developing alarm management middleware. But what does this mean in practical terms to a hospital looking at the diverse set of vendors that blend alarms and alerts all together into one confusing message about what their solution is really capable of? One key way to cut through all the hype is to follow the Joint Commission’s lead and focus on medical device alarms as a key starting point.

The Joint Commission just recently released its R3 Rationale report in response to its NPSG.06.01.01 for alarm system safety. A key statement in this report outlines clinical alarms as being more critical and a higher threat to patient safety as compared to “alerts”. In fact, the report explicitly states that the NPSG does not address “items such as nurse call systems, alerts from computerized provider order entry (CPOE), or other information technology (IT) systems.” It is obvious that the Joint Commission thinks the best starting point is with an evaluation of medical device alarms.

This is clearly only the starting point because we have to go back to the bigger problem as stated at the beginning of this post . Alerts and alarms interrupt the nurse and increase potential for errors in the care environment. You have to start somewhere, and by starting with alarms, you can get a handle on addressing a very key issue. This will lead to a foundation and framework that will enable you to more effectively address the alerting problem in the future.

What do you think? Are alarms the right place to start?

Brian McAlpine is VP of product management and marketing at Extension Healthcare.

HIStalk Interviews Laurie McGraw, CEO, Shareable Ink

Laurie McGraw is president and CEO of Shareable Ink of Nashville, TN.

Tell me about yourself and the company.

I’ve been in healthcare for 20 years. I started way back when at IDX in Burlington, Vermont. In the late ‘90s, they broke off a subsidiary called Channel Health. I was running development at the time. That got bought by Allscripts. I was part of the Allscripts team from 2000 up until the time that I left in January of last year. 

When I started at Allscripts, we had five customers doing the EMR. It was called EMR back then. When I left, it was a $1.5 billion company that was pretty large. Those 12 years were a blast, just an absolute blast for me. 

This past summer, I joined Shareable Ink. I am the CEO of Shareable Ink today. It is a young and vibrant company that was founded by a brilliant innovator named Steve Hau who took a common sense approach to doing clinical documentation.

Shareable Ink does clinical documentation and we do it really, really fast. We take existing paper forms, tag them, digitize them, and preserve workflows for physicians to document, Again, very efficiently, very fast. We have these analytic tools where people can get great insights from the data that they’ve put in and drive financial outcomes and quality improvements.

Part of the appeal of the digital ink option for data input was that CPOE adoption was pathetic and electronic physician documentation wasn’t common two or three years ago. Usage of those has improved. Is there still a need for an alternative form of input?

I think so. I’ve worked with physicians all these 20-plus years. I’ve been in front of hundreds of physicians, physician audiences from physician groups to hospitals to whatever. What I know is, physicians don’t hate technology. They don’t. They love technology.

But what they hate is they hate being slow. Everyone appreciates getting quality data at the point of care. They want all that information. They just hate being slow. 

With Shareable Ink, we can extend the investment that’s already been made in electronic health records, or we can just simply replace paper that still exists in lots of different places in the healthcare system. Just making that physician fast, it’s very valuable. People have already made significant investments in clinical technology, but when physicians are slow, there are a lot of things that need to be done to improve that for them.

Part of your value proposition is the concept of clinically rich documentation. Does the typical electronic medical record product support that?

Fundamentally, the answer is yes. Electronic health records — and I’ve worked on them for all 20 years — are good products. Whether it was ones that I had worked on previously or other companies who are putting out electronic health records, they’re fundamentally good products.

Where the electronic health record falls short for physicians, in terms of what I’ve seen, is where they start to slow the physician down. It doesn’t mirror workflows that previously worked, either in the paper world or in the newly adopted electronic world. That’s where I see the need to either augment or go back to workflows that were previously really fast.

I know I keep saying fast, fast, fast as a theme here. I say that because all of the benefits of electronic health records, everybody still wants them. Many, many organizations are achieving them. But they’re still falling short. Everything in healthcare is driving towards more need for data at the point of care. That’s where we’re focused.

Is it common for hospitals that have successfully implemented CPOE and clinical documentation for physicians to add a product like Shareable Ink or do they usually use it before they are ready to adopt those EMR tools?

It’s pretty rare that an organization is completely on paper. Usually Shareable Ink is in a place that is supplementing some already automated clinical workflows. We’re either extending an EHR investment that’s already been made by some specific workflows in a particular specialty or we’re replacing some existing paper forms that are still being used because those particular paper forms capture all the data in a really efficient manner for the clinician. 

For example, we do a lot of work in the area of anesthesia, where a lot of paper still exists. We’re replacing the paper. But in many other places, we are replacing paper where clinical technology already exists.

I made the observation when I interviewed Steve Hau four years ago that the higher you go up the specialization chain of physicians, the more reliant they are on very specific forms rather than the general documentation that an internist might us. What areas of the hospital are most reliant on those specialized forms that don’t translate well to an EMR?

A couple of years ago, I would have said specifically areas like cardiology or orthopedics or something of that nature. The discussions that I’m having today, it’s back to areas — surprisingly to me — like primary care, where, quite frankly, there’s a lot of documentation needs, but organizations are still needing to supplement what their primary care physicians are doing because the speed at which they need to document in the electronic health record isn’t fast enough because of the tools that they’re using. They’re going back to things like paper to supplement it and scanning it in, or they’re looking at hiring scribes to help those physicians meet their productivity objectives. 

The premise of “the more specialized you are, the more likely that there are paper forms to supplement that” … it’s not that that is not true, it’s just that there are more general areas like primary care where there still is a lot of paper because of the productivity needs of those clinicians.

Hospitals put in systems, find them to be a burden to productivity, and then come to you for an alternative?

Absolutely. There’s opportunity to extend that electronic health record. The investment has been made and everybody is driving their quality programs based on what they can get out of their electronic health records, but they have to also meet certain productivity objectives within their organization because the volumes for these physicians and clinicians are increasing. 

Shareable Ink can help expand an electronic health record in those areas where you hear of physician dissatisfaction with their electronic health records. That’s a pretty common complaint. The reason is rarely because they don’t believe in the electronic health record. It’s always because of the speed issues and the productivity issues or how they’re encumbered because of using the technology. They just feel it slows them down. I’ve heard this directly for such a long period of time.

Most of the new hospital EMR sales are by either Cerner or Epic. What are some examples of integrating the Shareable Ink offering into those products?

We can integrate through interfaces so we can provide data into those systems, whether they’re Cerner or Epic, in the hospital. We have partnerships with vendors like Allscripts, like Greenway, where we use their open APIs to send discrete data into the electronic health record. 

Those are ways that we can extend the electronic health record investments organizations have made with those vendors. We’ll be looking to do more extensions like that in the coming year.

For a company like Epic that hasn’t offered too many hooks into their application, what would be a functional view of an Epic hospital implementing Shareable Ink?

We’re exploring those workflows now. Shareable Ink is a young company, but where we’ve implemented today is in specific areas where we’re replacing paper forms that already exist. They go into a McKesson system, a Cerner system, through a document viewer within that other system. Shareable Ink preserves the view of the form that has been filled out as well as all of the discrete data that is under the covers of that paper form.

There’s a lot of richness involved with what you can write on a piece of paper, even including the way you write it, where you write it, or what you draw as a picture. Are people realizing that that sterility of a set of fields that are extracted into an electronic medical record may lose some of the patient context?

I think that is a problem. I think that is an issue. I believe Shareable Ink can help solve some of that by bringing some of that richness back.

I’ve seen the discussions and been in the discussions with physicians who feel like they’re looking at a SOAP note or a clinician note that may be complete, but it’s so sterile they’ve blocked all the nuances of the care that was provided to the patient. Can Shareable Ink help in that regard? Sure, it can help — but not necessarily in the same ways as speech – through different pictures or notations or things of that nature. But I don’t want to pretend for a second that getting to that specific discrete data is still incredibly important for all of the quality metrics and everything else that an organization’s trying to drive toward.

Can you hand forms that have been turned into Shareable Ink to someone with no training and turn them loose?

You can. It is a stretch to say no training. There is some training required, but it is simple training. 

With Shareable Ink, when clinicians adopt it, they are not clearing their schedules. They’re not reducing their patient volumes to then adopt this additional clinical technology. What they’re doing is taking some additional time. The paper metaphor or what they’re used to with a form — that’s the workflow that’s preserved. 

It’s already a workflow that they’re familiar with. Now they’re just doing it on an iPad, or that same form on an iPad, or they’re doing it with a digital pen.

How is Meaningful Use affecting your business?

I’m hoping that it will increase the need for tools from Shareable Ink because Meaningful Use means a whole lot of additional data is required at the point of care. Just simply voice recognition into blobs of text is not going to be enough in terms of all the data that’s required for Meaningful Use. 

Shareable Ink can provide that additional rich data at the point of care while still keeping that clinician very, very fast. I’m expecting Shareable Ink to again be a great addition in complement to the EHRs that are out there.

Do you have any final thoughts?

I’ve spent 20 years in healthcare. While it has been awesome in terms of paving the clinical information highway, today what I see is that we spend a lot of time on all of the challenges that are out there: adoption, physicians being slow, needing better data, the challenges of Meaningful Use and ICD 10. What all that points to is really the need for better data at the point of care. 

I am optimistic that what we’re doing at Shareable Ink in terms of providing that rich data at the point of care and by doing clinical documentation in a way that is fast and efficient for the physician that we’ll be able to deliver on the promise of data-driven healthcare.

Morning Headlines 1/15/14

NantHealth Unveiled at J.P. Morgan 32nd Annual Healthcare Conference

Healthcare billionaire Patrick Soon-Shiong, MD, launches his long awaited healthcare IT startup NantHealth. Soon-Shiong spent $800 million on 60 acquisitions in preparation for the launch. His company will focus on population health management, cancer care coordination, care transition management, in–home monitoring, and personalized wellness.

Navicure Announces Key Findings from Second ICD-10 Readiness Survey

A new ICD-10 readiness survey of physician practices finds that 74 percent have not started their ICD-10 preparations, with 27 reporting that they are unsure of how or where to start preparing for the transition.

Providers seeking more strategic integration of CDS tools

KLAS evaluates clinical decision support systems which survey respondents reported are not integrated enough with core EMR systems to deliver the kind of strategic direction providers are looking for.

New Peer-Reviewed Study Shows Mixed Results in ACO Medication Readiness To Achieve Quality, Cost Goals

A new study published by the Journal of Managed Care Pharmacy questions whether ACOs are ready to be held accountable for medication prescribing and adherence, as the report finds that most ACOs do not have policies in place to prevent duplicate medications from being prescribed, and do not have the ability to notify physicians once prescriptions have been filled.

News 1/15/14

Top News

Healthcare billionaire Patrick Soon-Shiong launches health IT company NantHealth at the JPMorgan Healthcare Conference, which will offer the “intelligent Clinical Operating System” (iCOS) that will integrate information from molecular science, computer science, and big data to deliver solutions for population health management, cancer care coordination, transition management, and wellness. The company also announced a partnership with the Clinton Foundation to implement iCOS in two areas of the country. The company says iCOS is running in the country’s largest oncology group that covers 150 practices, 22 EMRs, and real-time data feeds moving 50GB per day; its Cancer Decision Support Engine is used by over 50 percent of oncology practices; and its EMR is running in 12,700 facilities in 13 countries. It talks about DeviceConX device connectivity, which is the iSirona’s product it gained when it acquired the company effective January 1, 2014.  Most of the other offerings are also previous NantHealth acqusitions, including the GlowCaps medication reminder system, home monitoring devices from Boston Life Labs, and Ziosoft medical imaging. Soon-Shiong spent $800 million on 60 companies and research projects that make up iCOS, which he says can be purchased right now. I’m never quite sure whether to take Soon-Shiong seriously, but having $7 billion gives him at least some instant credibility.

Reader Comments

From Holly S: “Re: Jonathan Bush’s leave. He’s going on an extended vacation from February to April. He’ll be spending time with friends and family, both travelling and hunkering down. His agenda is to play and experience some things he’s always wanted to do. He has never been so energized about the business, its ability to effect change in health care, the marketplace’s receptivity to change. He’s all-in on what’s ahead.” Thanks to athena for providing this update in respond to a reader’s inquiry. JB told me he hates to miss “the boat show” (the HIMSS conference) and especially his MC duties at HIStalkapalooza, but as he also confided, “I am honored to have been your MC these past few years and hope dearly that whoever replaces me in 2014 will be a bomb so that you will have me back in 2015.”

HIStalk Announcements and Requests

Thanks to Greenway Medical for sending this note in response to recent rumors of employee layoffs:

We’d prefer to not comment on rumors. We have, in fact, been working through a very thorough review of our organization since completing the merger of Greenway Medical Technologies and Vitera Healthcare Solutions, which includes Vitera’s SuccessEHS. That process includes aligning our resources to most effectively serve our customers, which we’re accomplishing by delivering our innovative7 industry-leading solutions, delivering data liquidity through our powerful interoperability engine, and leading our customers through what will be an awesome change from production medicine to outcomes-based medicine through our clinically driven revenue cycle management solutions. Our mission at Greenway remains the same.  We believe healthcare will continue to electronify, the consumer will become more engaged and demand change, and we will improve population health by delivering smarter solutions.  We’re privileged to serve such a large provider base, clinical professionals who provide care to millions and millions of patients. 

Voting for the HISsies awards is underway, as follows:

• I pleaded for nominations on HIStalk over several days and, as happens every year, didn’t get many nominations even though anyone can nominate. If you don’t like the choices on the ballot, blame those few hardy readers who actually submitted nomination since everyone who has complained so far didn’t.
• The most-nominated entries made it onto the final ballot, which was emailed directly to the addresses in the HIStalk update list (which prevents ballot box stuffing since the voting is tied to the email address.)
• So far, 765 of the 10,000 email recipients have voted.
• The results will be revealed at HIStalkapalooza and on HIStalk.

On the Jobs Page: NextGen Activation Consultant, Epic Activation Consultant, Epic Certified Builder.

Listening: new (released today, in fact) from Sharon Jones & the Dap-Kings, brilliant and amazing 1960s-style revivalist pop soul with lots of horns recorded on good old analog. Treatments for Sharon’s pancreatic cancer (diagnosed June 2013) left her bald but unbowed in the video.

Welcome to new HIStalk Gold Sponsor Accreon. The company is a leader in system optimization, information integration, and software solution development. They worked on Canada’s clinical information highway and have built tools for US-based vendors for population health management, remote patient monitoring, and workflow optimization. Services for providers include strategic planning, project management, implementation, integration, analytics strategy and optimization, and HIE architecture and sustainability. They can also help vendors with near-shore solutions, software development, integration, and analytics projects and they also do work for payors, pharma, and government. Eric Demers is the Boston-based president of Accuron USA and not only is an industry long-timer who you may know, he even has a MHSA degree, which always clearly signifies that “I’m a healthcare person” since just about everybody else gets a general MBA instead. Thanks to Accreon for supporting HIStalk.

Upcoming Webinars

January 16 (Thursday), 1:00 p.m. Advanced Efforts to Identify and Eliminate Waste from Healthcare. Sponsored by Health Catalyst. Presenter: David Burton, MD, executive chairman, Health Catalyst. Based on a breakthrough analyses using several large healthcare data sets as representative samples, Dr. Burton and team will present insights designed to help executives struggling to identify, quantify, and extract waste from their systems.

Webinar questions? Contact Lorre.

I’ll post a separate HIStalk article Wednesday afternoon with the link to the registration page, so watch for the email update. There’s no need to rush – we’ll leave the registration page up for several days and then invitations will go out February 4. Above is a bit of a hint about the sponsor and location. Meanwhile, I’ll say just once more that I think the primary sponsor has one co-sponsor slot open, so email me if you want more information.

Acquisitions, Funding, Business, and Stock

WellDoc, provider of a Type 2 diabetes mobile device management program, raises $20 million from Merck Global Health Innovation Fund and Windham Venture Partners.

Surgical Information Systems acquires ambulatory surgery EMR and management software vendor AmkaiSolutions.

Online employee health shopping systems vendor HealthSparq acquires ClarusHealth Solutions, which offers a provider search function for consumers. HealthSparq’s president is Scott Decker, formerly of NextGen and Healthvision.

Transcription and speech recognition vendor MModal, acquired by a JPMorgan private equity arm in a leveraged buyout worth $1.1 billion in August 2012, hires a restructuring firm, according to sources cited by The Wall Street Journal. Sales are dropping and  the company is paying high interest charges on its debt of $750 million, which has tripled since the acquisition.

Post-acute care software provider Brightree acquires Strategic AR, a provider of private-pay billing and collection services.

Sales

Rush Health (IL) contracts with Caradigm for healthcare analytics and population health software to support its private HIE. Rush Health’s CEO says the HIE is the largest investment the organization has ever made, adding, “We want to use this infrastructure to connect and exchange real-time information so we can do a better job coordinating care.” Rush Health will also offer to cover the first-year of EHR expenses the 10 percent of its doctors who are still using paper, moving them to Epic, eClinicalWorks, or athenahealth.

Contra Costa County Health Services (CA) engages Vonlay to support its Epic 2012 upgrade.

The 22-hospital St. Vincent Health (IN) will pilot Acupera’s population health analytics and clinical workflow management platform in one of its physician offices.

Catholic Health Partners (OH) will implement Epic’s MyChart Bedside at all of its hospitals following a successful pilot at its St. Rita’s Medical Center (OH) location. Patients and family members access their health information, labs, caregiver team member information, and educational materials on a hospital-issued tablet.

Geisinger Health System (PA) selects Besler Consulting to identify Transfer DRG underpayments.

CMS awards Optum/QSSI a contract to serve as a senior advisor on the HealthCare.gov website following its interim engagement as general contractor after the site’s October 1 meltdown. The company’s press release, oddly enough, includes testimonials from HHS Secretary Kathleen Sebelius and CMS Administrator Marilyn Tavenner.

People

CHIME names HIStalk’s own “CIO Unplugged” Ed Marx (Texas Health Resources) as its 2013 John E. Gall Jr. CIO of the year.

Arcadia Healthcare Solutions names Sam Adams (Accretive Health – above left) SVP of sales,  Jonathan Rider (Jetstream Consulting) SVP of technology and engineering, and Sandi Molettieri (UTC Aerospace Systems – above right) director of HR.

NavigatorMD appoints Alexander Poston, Jr. (Entrada) CIO.

Artemis Health Group names John Doulis, MD (MedCare) president and CEO, replacing Phillip Suiter, who resigned.

Andrew Baker (Intuit Health) joins Culbert Healthcare Solutions as VP of business development.

Mike “The PACSMan” Cannavo (McKesson) returns to his PACS consulting business.

Kim Bahrami joins government contractor Acentia as VP of business development over the company’s expansion into DoD and VA healthcare.

CMS appoints Acting CIO Dave Nelson as the agency’s permanent CIO.

Announcements and Implementations

CECity and athenahealth will offer a health data exchange integration and reporting service to automate information flow from athenaClinicals to national clinical registries using CECity’s clinical quality data gateway.

Dubai’s Mediclinic City Hospital and Mediclinic Welcare Hospital will install Oneview Healthcare’s patient engagement software.

Varian Medical Systems will expand its existing Salt Lake City facilities in anticipation of creating 1,000 full-time jobs over the next 15 years.

Heart Imaging Technologies provides Merge Healthcare access to its portfolio of healthcare information patents, including zero footprint technologies to provide access to diagnostic-quality images in a standard web browser. The agreement also settles litigation initiated by Heart IT against Merge for patent infringement related to internet-based image viewing.

MedHOK, which just closed $77.5 million in funding, will increase its 100-person staff by about 35 percent over the next year. 

Government and Politics

CMS announces it will consider on a case-by-case basis requests made under the Freedom of Information Act for information to find out much Medicare pays individual physicians.

VA CIO Stephen Warren says that for 2014 his agency will be focusing on improving its system baseline practices and procedures, configuration management, patch management, and elevated privilege review.

A GAO report criticizes CMS, the VA, and six other agencies for their inconsistent implementation, policies, and procedures for responding to data breaches involving personally identifiable information.

Innovation and Research

A report finds that ACOs are competent in offering e-prescribing, a single database containing medical and prescribing information, and formulary options that encourage the use of generic drugs, but lack tools that notify physicians when prescriptions are filled, prevent duplicate drug therapy, measure quality, and demonstrate the value of appropriate medication use.

Technology

Alere Connect receives FDA 510(k) market clearance for its Alere HomeLink platform, which also earned CE Mark certification which will allow it to be marketed in Europe.

Other

Cerner Middle East expands its office in Riyadh (Saudi Arabia) in support the company’s growth plans.

Products from EBSCO, Elsevier, Wolters Kluwer, Truven Health Analytics, Isabel, and Logical Images earn the highest rankings in a KLAS report on clinical decision support resources, including tools for disease reference, drug reference, nursing reference, and diagnostic decision support.

An ICD-10 readiness survey by Navicure and Porter Research reveals that 74 percent of physician practices have not yet started implementing their ICD-10 transition plan, though most don’t anticipate any disruptions from their EHR, PM, or clearinghouse vendors. A couple of alarming stats: 27 percent of survey practices are unsure how or where to start preparing for the transition, while 22 percent claim they don’t have the staff or resources to begin preparing.

The former CEO of two-hospital, 350-bed Cape Cod Healthcare (MA) who resigned abruptly in 2010 remained the organization’s highest-paid employee for the next two years, earning over $1 million in each year, and was still being paid in 2013. The hospital’s board chair said, “A lot of executives have post-employment benefits,” while a business ethics expert says it’s no wonder that US healthcare is so expensive. The CEO is also a physician and was disciplined by the state medical board after he left the hospital for inappropriately writing prescriptions for family members.

Weird News Andy notes, “Hipsters, beware” about this story in which a man in China stretches and yawns so hard that he collapses his own lung. WNA provides his targeted warning because the at-risk group is “tall, slim young men.”

WNA also likes a story that he titles “Clean Booze,” in which a man steals 12 bottles of hand sanitizer from a hospital by hiding it in his arm sling and then goes back twice more for additional bottles. He told the police who finally nabbed him that he makes a cocktail by mixing the alcohol-containing cleaner with orange juice.

Sponsor Updates

• HealthMEDX announces that it will be the first long-term and post-acute care EMR vendor to participate in the Interoperability Showcase at HIMSS14.
• McKesson’s MED3OOO division expands its Dayton, OH office space from 10,000 to 12,000 square feet and will increase its local employee head count from 110 to 122.
• Allscripts will incorporate the Adheris DirectStart medication adherence communication program into its EHR.
• Gartner positions InterSystems as a Challenger in its Magic Quadrant for Operational Database Management Systems.
• Clinovations consultant Matt Lambert, MD publishes a book that includes his reflections on healthcare and the push for change in the midst of healthcare reform.
• Wolters Kluwer Health expands use of Lippincott’s Nursing Procedures and Skills to include hospital-based clinicians and renames the product Lippincott Procedures.
• Doctors Community Hospital (MD) shares how its use of GetWellNetwork improved patient education and entertainment while generating revenue.
• The Rochester Business Journal names eHealth Technologies to its Rochester Top 100 list based on dollar and percentage revenue increases over the past three years.
• Loran Cook, product evangelist for Billian’s HealthDATA, considers the future of partnerships, payers, and a loophole in the ACA.
• Rock Health names Health Catalyst CEO Dan Burton to its list of Top 50 Digital Health Entrepreneurs.
• RelayHealth releases the second generation of RelayAnalytics Pulse for comparative analytics.
• Emdeon achieves CAQH CORE Phase III Certification, which certifies the company accurately and efficiently exchanges healthcare electronic funds transfer and electronic remittance advise information.
• ICSA Labs certifies InteHealth’s patient and physician portals with 2014 Edition Modular EHR Inpatient and Ambulatory ONC HIT Certification.
• Cornerstone Advisors founder and president Keith Ryan advises Bartlett Regional Hospital’s (AK) planning committee on its EHR options. 

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 1/14/14

Vocera Acquires mVisum to Address Alarm Fatigue

Secure mobile communications vendor Vocera acquires mVisium for $3.5 million. mVisium markets an FDA approved, mobile optimized, closed loop alert management platform.

OhioHealth and IBM Scientists Join Forces to Prevent Infections in Hospitals

OhioHealth pilots a new RFID monitoring system that is integrated into the hand washing stations and tracks hand washing compliance of individual hospital employees, as well as compliance of overall units, and shifts. The new technology led to a 90 percent hand washing compliance rate within the hospital, a 20 percent increase from before the system was installed. 

Edward Marx Named CHIME-HIMSS 2013 John E. Gall, Jr. CIO of the Year

Ed Marx, a frequent HIStalk contributor that writes CIO Unplugged, is awarded the 2013 John E. Gall Jr. CIO of the Year Award by HIMSS. Ed is the CIO of Texas Health Resources, a 25 hospital ACO that has achieved HIMSS Stage 6 or Stage 7 EMR adoption across all of its acute facilities, and has been recognized as a leader in pioneering population health practices. Congratulations Ed!

Curbside Consult with Dr. Jayne 1/13/14

This is the last of a three-part response to a reader’s comments on EHRs (Part 1, Part 2.)

What is meaningful for the government is not meaningful for the patient. We sacrifice good care so the government can collect statistical data for free.

I’ve written on this topic before. It’s easy to play armchair quarterback and to dissect things through the retrospectoscope. Surely parts of the program might be different if the creators had it to do over again. I personally don’t like to be penalized for poor outcomes. It doesn’t matter how motivationally I interview, how well I design care plans, how well my team works with the patient, etc. – sometimes patients simply don’t want to do the right things for their health. Sometimes they are genetically doomed regardless of what we do. Sometimes they can’t afford to do the things we recommend, or choose to prioritize other needs or wants.

Most physicians are genuinely motivated to help people live longer, healthier lives (sometimes to the detriment of quality of life, but that’s another topic for another day) and are personally burdened when we can’t make someone better. Adding financial penalties for things which are not entirely under our control is offensive to those of us who work our tails off trying to do the right thing.

You want to ding me for failing to put someone with proteinuria on an ACE inhibitor or an angiotensin receptor blocker? Fine, I deserve it. You want me paid less because I write bad prescriptions that no one can read? Great. But don’t penalize me because Uncle Sal won’t get a colonoscopy despite a decade of counseling, discussion, debate, and downright begging. I’ve done all I can do.

As far as the “free” factor, technically we’re being compensated for our data through the various quality reporting initiatives, as well as through MU, so saying we’re giving it away for free may not be entirely accurate. Most of the clinical quality metrics revolve around good care, so it’s hard to argue that quality is sacrificed. But I respect the comment.

I’m generally not a fan of the conspiracy theories, but I wonder if the government wants to slow us down so they pay for less visits and care? We’ll never know the truth, but what better way to slow us down than Meaningful Use?

I admit I’ve had this thought before. Nationally, many physicians are refusing to accept Medicare, refusing new patients, or limiting their panel sizes, but it depends on your market. We have a lot of people that limit Medicare in our region because other insurers pay better and there’s plenty of demand, but that’s not the case everywhere. There are plenty of markets where Medicare is the top payer and physicians can’t afford to stop participating. The same applies to Medicaid. Several of my blogger friends hypothesize that it’s a ploy to get rid of primary care physicians and replace us with midlevel providers who are cheaper.

On the other hand, in our organization (and many others) we’ve figured out ways to comply with Meaningful Use and not slow down. This involves some extra clinical staff (funded by increased office visits and clinical quality payments as well as crafty negotiations with payers to embed care managers in our group) and a ton of additional training, but we’re generally still seeing the same number of office visits as we have. There have been fluctuations due to the recession when you look at our five-year vs. 10-year data, but most providers still have capacity to expand and we’re still hiring physicians.

I love computers and believe in the EHR concept, but it has to be done right. I’ve yet to see a good EHR. Computers are not smart machines. They are very fast and very loyal to the programmer. The main problem with EHR design sits in the knowledge and experience of the designers, who are:

a) Programmers without medical knowledge

b) Physicians without programming knowledge

c) Reputable professors with lots of published papers without ward clinical experience

d) Physicians who have graduated medical informatics programs but without clinical knowledge

e) Physicians who have clinical experience and some programming knowledge

f) Good physicians with good programming knowledge, which is ideal, but I don’t know if there are any involved in EHR design at this time

I saved this comment for last because it’s my favorite and the most near and dear to me. Although the gulf is closing, there are still significant gaps between clinical needs and programmers. It’s a challenge for vendors to hire people who can translate a physician business case into something the programmers can address, and to translate the limitations of the product into something to which users can respond.

Although there are some good physicians out there who have formal informatics training but minimal clinical experience, I’m always leery of them. When I meet one who didn’t complete an internship and never had a license, that’s a red flag for me. Whether justified or not, I feel that completing an internship and having had an actual medical license at least once in your career is essential. It’s even more essential when you’re going to be in a role where you tell other physicians how to behave.

Having been board certified at least once is nice too. You don’t have to keep your license forever and I don’t care if you maintain your board certification, but I want you to have gone through what the rest of us have gone through just as a point of understanding.

I’d also add another element – product management teams that respond to sales feedback preferentially over the feedback of existing users. Those who haven’t purchased an EHR don’t know what they don’t know, where current users definitely know what bites them on the posterior every day. I’ve seen good products decline when prospects demand functionality that although sexy isn’t built for the long haul.

As a farm girl, I think about it like I think about buying a truck. Although the quad cab with heated and air conditioned leather seats and a bus-load of chrome looks really good to someone who’s not a farmer, it’s kind of silly when you think about the fact that you’re going to be climbing into it with mud on your jeans and manure on your boots. When the motor on the power window dies, I’m going to be wishing I had a crank because I’ll be roasting to death driving while the younger cousins throw hay bales on the trailer.

Regarding the lack of good physicians with programming knowledge being involved in EHR design – as recently as three to five years ago I would have said the same thing. It’s still true at some vendors, but thank goodness ours have seen the light. Both our ambulatory and acute vendors have significant physician participation in design with both employees and clients involved. The staff physicians have substantial clinical experience and programming knowledge and work to translate user needs to the developers and to make sure what is coded actually works. Existing customers are becoming more savvy and vendors have to respond. It’s embarrassing to have physician users who know the product better than the vendor does, but I’ve seen it. A smart vendor will hire those physicians to be on their development teams if they can lure them away from practice, but it’s rare.

I’ve seen more vendors doing formal usability work throughout the design process, but it’s still not enough. What I’d really love to see is a vendor create a “model practice” that it can use for its development test bed. It should be a medium-sized multi-specialty practice. 

For starters, they could learn what practices have to go through even before they think about EHR including licensing, credentialing, professional liability, OSHA, CLIA, and the rest of the alphabet soup it takes to get the doors open. They can fully understand the staff dynamics of a medical practice (which seem different from many other industries) and what it’s like to be responsible for people’s lives and livelihoods. They can feel what happens when payers are slow and see how well their system does managing all the insane scenarios we deal with on a daily basis. And only when those physicians sign off on the content and usability should it ever be allowed to proceed to even a beta installation at a paying client.

I’ve not heard of a vendor doing this but if you have please, let me know. I’d love to get a dialogue going with my vendor about why that makes sense. I might even be crazy enough to volunteer for it. And if you’re a vendor, I’d enjoy hearing from you about how you use physicians in development. It would make a great topic for a future Curbside Consult. I’ll run your comments openly or anonymously if needed. Got docs? Email me.

Email Dr. Jayne.

HIStalk Interviews Chuck Podesta, SVP/CIO, Fletcher Allen Health Care

Chuck Podesta is SVP/CIO of Fletcher Allen Health Care of Burlington, VT.

What lessons did you learn as your single hospital expanded into a health system?

I’ve worked with systems in the past, so I was prepared from a due diligence standpoint to understand what we were getting into. The interesting thing has been is being at the beginning of a system being born as opposed to going to work at an organization that already had created the system. That part has been really, really exciting.

From a learning standpoint — and I’ll just speak from an IT perspective right now — it’s how you merge the cultures of the different organizations, both from a leadership perspective and staff perspective. We haven’t merged all four hospitals’ IT under IS from a cost center perspective, but I am the system CIO over those organizations. 

I work very hard to get our leadership within IS to work with their leadership in their organizations and staff-to-staff communication as well. We’re geographically disparate from each other, so it makes it a little bit more difficult. That part has gone really well. That’s been the biggest thing that we’ve done.

We created an IT council that’s a high-level group of the high-level IT folks. Then we did a sub-group that’s made up of low-level managers but also some staff that are working together across the system and looking at things like linking email and some of the nuts and bolts things that need to be done behind the scenes. 

That’s brought these teams together, working on the same projects. What we’re finding is that the more and more that you do that, it’s going to make it easier as we get to the more difficult projects of implementing different types of technologies in these organizations.

Every hospital has the challenge of trying to look at new tools to support risk-sharing arrangements and population health management, but you’re also faced with trying to combined the financials to give a view that makes sense and to understand the physician relationships.

Absolutely. If you look at the last time we talked in July 2009, we were Fletcher Allen Health Care academic medical center, Burlington, Vermont. Now we’re a four-hospital system. We also are 50 percent owner of OneCare, which is a Medicare Shared Savings Program with Dartmouth-Hitchcock. There’s 14 hospitals involved in basically the entire state of Vermont, about 50,000 covered lives that are under that right now. A very large Medicare Shared Savings.

We’ve got the issues around exactly what you mentioned — the data analytics, advanced population analytics that we’re implementing. We’ve got some unique stuff going on there, along with working with two health information exchanges, because we are not only in Vermont, we’re also in northern New York. We work closely with VITL in Vermont and Hixny in northern New York. They’re working together to link their two HIEs together to benefit us as well.

On the advanced population analytics side, we’ve joined a group called Northern New England Accountable Care Collaborative. That’s made of Eastern Maine, Maine, Dartmouth-Hitchcock, and now ourselves. It’s a unique opportunity. They take our CMS claims data in and using VITL, we move our EHR data into that data warehouse. We can also have access to the de-identified data of the other organizations. Instead of just looking at populations of 300,000 or 600,000, now we can look at populations that are in the millions. The bigger the denominator, the better off you’re going to be.

People claim that healthcare is behind technologically, but we have business models that seem to change every five years, government involvement and reporting, and insurance company requirements. Everybody wants something different on the back end and yet you’re trying to keep the front end running. Is that sustainable? I can’t think of any other industry where there’s so much change that isn’t to support the business, but to meet new minimum external requirements.

I think over the next year we’re going to find out whether this is sustainable or not. If you look at the priorities that we have right now, we have ICD-10 coming. We’ve got Meaningful Use Stage 2, then Stage 3. Privacy and security is huge with the passage of the final Omnibus Rule and we’ve got to spend a lot of time there. We’ve got our system IT priorities that we need to put in place, and then also our OneCare ACO IT priorities that need to be put in place.

You add all those up and just look at the care and feeding of an Epic EHR and the priorities that go into that, it’s daunting. I joke a little with my senior leader that in the past, we were able to do a business planning session, have the IT strategy follow the business plan, and do a three- to five-year IT strategic plan. That’s no longer the case. I can’t even do a six-month strategic plan. 

What I’m trying to get my organization to do is to talk a lot about how do you survive, how do you manage, how do you lead in an organization that every single priority is a high priority? In the past, you could make a list and start at one and go to 10. You might have four or five projects that are twos. But in this particular case, they’re all ones. The federal government deadlines on a lot of these things are all coming to a head. 

How do you get your organization to work in that type of environment? That’s been amazing from a cultural standpoint. What you’re going to see across the country is some organizations will be nimble enough to do that and then others won’t.

Given the low likelihood of success and the fact that CIOs aren’t typically given extra resources, will it be harder for CIOs to keep their jobs?

Absolutely. If they don’t set the expectations with their senior leader colleagues …  even though I mentioned earlier that I make a joke about not being able to do a six-month strategic plan, I’m actually pretty serious about that. If my senior leader colleagues — my boss, my CEO, the board – are expecting a three-year plan and I’m not clear on what our priorities are, even over the next couple of months, and to get them to understand, then I’m setting myself up for failure. I know that has happened to other CIOs across the country. 

This coming year, year and a half, I think there’s a lot of CEOs out there that expect all this stuff to get done. If the CIO is not clear with the individual that they report to, that based on the resources that they have, these are the things that we can get done and these are the things that we can’t get done. We’re also in a situation where you can’t add any more resources. I can’t go to my boss and say, give me 10 more FTEs and I can do 10 more things. It’s just unsustainable from that standpoint. 

It will be interesting. I think there will be a lot of turnover in the next year to 18 months or so as the Medicare penalties kick in as well in 2015. There will be a lot of CIO turnover, I believe.

In the past, that type of environment is where health systems start thinking about outsourcing their IT departments because consulting firms claim they can do more with the same resources and still make a profit. Do you think the environment is going to swing back what seemed to be a diminishing trend of health systems looking outside to have their IT run by someone else?

Yes. What you’re going to see first, though, is just from the healthcare industry in general, the mergers and acquisitions that are happening. I firmly believe that within the next five years, there’s probably going to be 100 to 200 health systems in the United States. They will be regionally focused. Bigger is going to be better in this new world of population health management. That’s happening all over the United States. 

What you’ll see first is merging the IT shops. How that all shakes out will take a little bit of time and outsourcing may play a role in that. But I see those IS organizations working hard to come together first. They may look at outsourcing, but I just don’t think that’s going to be as high a priority as merging these various organizations.

What types of health IT-related businesses do you think will benefit from that consolidation scenario and which ones do you think will suffer from it?

The call center can be outsourced and consolidated probably fairly easily. We’re doing that now across our system. That’s probably one of the easier ones. If you look at field service, network, server management, and data centers, for example, there’s a lot of savings there. Looking at how you merge your data centers and cut some costs there. That’s the easy part.

The harder part is on the application side. If you’ve got more than one Epic organization coming together … you’ve seen one Epic organization, you’ve seen one Epic organization. They all have their different nuances. But most of the systems are coming together. You have an Epic organization and the other one might be a Cerner, and you’ve got to go through a process of, are you going to keep them that way, or are you going to put Cerner in the other organization, or are you going to choose Epic? 

That is going to be much more difficult to do. The application people that support those applications, the retraining associated with that, is just going to be really, really difficult to do and very costly. For these large organizations coming together, you’re talking hundreds of millions of dollars. You’re seeing it now — some of the bigger organizations are doing implementations and mergers and acquisitions at the same time.

There was a lot of buzz recently about your health system announcing plans that it expected to lose a lot of money but also that it would be doing a lot of hiring to support Epic. Internally, is Epic providing the expected benefits and return on investment, or are executives privately questioning whether the cost was worth it?

If you had asked that question a year ago … to be honest with you, I was questioning it. A lot of that was self-inflicted. It didn’t have to do with Epic. We had implemented Epic. We had gone live. We spent a lot of time on the ambulatory side and really got that humming. 

Then we didn’t take care of the inpatient side of things. The inpatient side got very stale. It got very customized. I think we had 70 different flowsheets across the organization. Data wasn’t landing in the database where it should be to get reports out. We ran into that with Meaningful Use. It was very difficult for us.

About a year and a half ago, I hired a CMIO. He came in and one of the ideas he had was that we needed to go to 2012 upgrade. He said, why don’t we just take all 7,000 enhancements and go back to model as close as we can? Originally when we thought about that, we were like, what are you, crazy? Typically when you do an Epic upgrade, you look at 50, maybe 100 enhancements. You never get to all the enhancements from an Epic upgrade typically. 

This was a radical change from that. When we approached Epic, they were really noncommittal on whether we should do that. But the more we talked about it, they gave us the green light. Last spring, we started that process. We went live in October. It completely changed. It was a non-event over a weekend. The training wasn’t too difficult. It became a better system.

Now we’re relying on Epic to do the R&D instead of us building things that Epic’s already building in future releases. We found ourselves doing that when we looked at 2012. We were building things in 2010 that already existed in 2012. It just didn’t make any sense at all.

We got creative on the how we used consultants during that period. We needed some help and we used some firms come in and help us from a resource perspective, because you imagine a whole change going from an 80-20 customized system to more of an 80-20 in the opposite direction model versus a custom system. The changes that we needed to make were huge. 

We worked with a national company, but their local headquarters are here in Vermont. It’s a perfect marriage. They were Allscripts at the time. Their name is MBA HealthGroup. They were nervous based on where Allscripts was going and we needed help, so they came forward. We started talking about us sponsoring them with Epic so that they could create an Epic practice. In return, they would send people, get them certified, and bring them on site at a very reduced rate, about a 50 percent reduction in what you normally would pay. 

After a six-month period, we would have the right to hire, which we thought was great. We view that as a creative win-win situation with them. They’re offering it across the country now to certain organizations. We used them for our training in the Epic space. We hired two of the individuals at the end of the project. We were able to pick the best and brightest out of the group and hire them. That was a win all the way around.

We’re also reaching out to the local colleges and universities here and getting lists of engineering, math, and science majors with 3.5 and above and encouraging them to apply for open positions. We’ve hired a couple of kids right out of college. They have been amazing. The productivity is just … they learn so fast. What we’ve found is you can’t give them a deadline, because if you do, they’ll wait up until the last minute and then get it done. They can do it a lot faster than the deadline that you give them. Just give them the work and don’t give them a deadline and you’ll get much more out of them. That’s been fantastic and we’re continuing that type of program as well.

What are your biggest challenges and opportunities over the next one to two years?

Looking at the next year,we’ve got ICD-10. We’ve got Meaningful Use Stage 2. Privacy and security, which is constant vigilance on that.

Every time you turn around, you see another breach. Everybody’s going to have a breach at some point. At some point, somebody’s going to do something stupid and it won’t be malicious and you’re going to have a breach. But the ones that I see that could be avoided, those are the ones that really get me going. The non-encryption of a mobile device. It makes no sense to me as to why people haven’t done that.

The breaches that are happening, those are the only ones we know about. There’s so many out there that we don’t know about. It’s going to be more and more difficult because OCR is certainly going to ramp up the audits and the fines are going to start coming out. That’s a big one. 

Then the accountable care IT infrastructure that we’re building with the health information exchange and population analytics. Then trying to look at synergies across our system from an IT perspective and where we can save some money and increase services across the four hospitals. My expectation is that the next time we talk, we’ll be larger than a four-hospital system. 

All that stuff has to get done in the next 12 months. Otherwise we’ll be behind the curve on what we need to get done. A lot of other organizations are in the same situation whether they realize it or not. They have these same priorities, especially if they have an ACO or are part of an ACO. Whether they realize it or not, all that stuff is coming to a head over the next 12 months.

Do you have any final thoughts?

I can’t say enough about the privacy and security side of it. A lot of the technology that we use today enables physicians and nurses and clinicians to take care of patients. These systems are helping to give us higher quality, eliminate errors, and impact patient safety. That’s been great and it’s been worthwhile.

But we have a mission — we should have a mission — to protect the privacy of the information within these electronic health records. I can’t go to a bedside and take care of a patient directly, but I can certainly involve myself directly in the privacy and security programs of this organization. I think more and more CIOs that do that and get directly involved in the privacy and security, understand it, make sure you have a chief information security officer, get the tools that you need, figure out a way to justify those, and get those in. For our patients, that’s the one thing that a CIO can directly impact.

Vocera Acquires mVisum

Vocera announced this morning that it has acquired mVisum, which sells hospital patient alarm management software, for $3.5 million in cash.

According to Vocera President and CEO Brent Lang,

”The acquisition of mVisum is another step in our strategic roadmap to solve one of healthcare’s biggest challenges: communication. Communication breakdowns caused by alarm fatigue have become a top patient safety concern and a regulatory priority. mVisum’s alarm management technology instantly delivers data to clinical decision makers and complements our secure, mobile communication solutions to help improve patient care, safety and satisfaction."

mVisum’s closed loop Alert Alarm Management System has earned FDA’s 510(k) clearance. The company settled a patent lawsuit brought against it by AirStrip in April 2013 by agreeing not to stream or display real-time patient physiologic information on mobile devices.

Morning Headlines 1/13/14

Obama administration to end contract with CGI Federal, company behind HealthCare.gov

CGI Federal, the Canadian contractor responsible for developing Healthcare.gov, will lose its contract for the job because of the failed rollout, and ineffective performance since. Accenture, who developed California’s insurance exchange, is expected to sign a one-year $90 million deal to take over responsibility for fixing the site.

NHS data move opt-out ‘damaging’

In England, the NHS is sending pamphlets to all households to educate the public on its care.data program after widespread public concerns over privacy resulted in an increase in opt-out requests. The care.data program connects NHS databases with private practice offices to help the government assess diseases, examine new drugs on the market, and identify infection outbreaks.

Quality Systems, Inc. Announces Expected Impairment in Its Hospital Solutions Division

QSII, parent company of NextGen, announces that it expects to record a loss on its Q3 financial reports once its Hospital Solutions Division completes a long-lived asset impairment analysis. The company could write down as much as $30 million depending on the results of the review.

IBM Set to Expand Watson’s Reach

In an effort to increase profitability of its Watson business unit, IBM announces that it will invest $1 billion in the project. The money will be used, in part, to expand its sales and marketing force, and to launch a $100 million VC fund aimed at kick starting Watson-based development efforts.

Monday Morning Update 1/13/14

From Yogic Flyer: “Re: Merge. How could a sales rep hide being paid for non-existent contracts unless there are absolutely zero controls in place in that company?” Merge announced last week that a former sales rep created phony contracts worth $15 million to meet his or her sales quota, earning the rep more than $250,000 in sales commissions. The rep worked in the eClinical OS business, which sells clinical trials software to drug companies. It’s hard to believe that some level of collusion (individual or corporate) wasn’t required for a sales rep to just make up contracts that were used not only to pay commissions, but also to be rolled into the corporate orders backlog of a publicly traded company. It’s also interesting that customers weren’t billed for the amounts specified in the contracts, so Merge’s internal processes must be majorly disjointed. MRGE shares dropped more than 10 percent on the news, decreasing the company’s market capitalization to just over $200 million. The share price is down nearly 70 percent from February 2013. Chicago-based vendors Merge and Allscripts seemed likely at one time to cause a worldwide shortage of feet to shoot themselves in.

From It’s a Sledgehammer: “Re: Allscripts. [sales exec name omitted], another former IBMer hired by Glen Tullman, has been terminated. Paul Black’s master plan of putting the Cerner band together takes one more step.” Unverified.

From Willing Participant: “Re: HIStalkapalooza. I enjoyed last year’s event and read that invitations will be sent next Wednesday. Do I need to do anything to be eligible?” The registration page will go live Wednesday, January 15 (CGI isn’t building it, so hopefully we won’t have problems.) Sign up  then if you want to come. We will email invitations on around February 1 to those we can accommodate since we always have a lot more demand than supply. The most important thing to remember is that you have to register if you want to attend. Every year I get emails from people ranging from pleading to angry who didn’t register and who apparently expected the Official HIStalk Psychic to divine their attendance intentions and send them an unsolicited invitation. It doesn’t matter if you are a swaggering CEO, a sponsor executive, or a self-identified industry celebrity – you have to register (just like I do) to be considered for an invitation. Please don’t embarrass both of us by claiming I didn’t mention it on HIStalk since I clearly do multiple times, and once the spots are assigned, it’s too late. I can say this so far having had several conversations with the sponsor: HIStalkapalooza (#HIStalkapalooza14 on Twitter) is going to be amazing.

Upcoming Webinars

January 16 (Thursday), 1:00 p.m. Advanced Efforts to Identify and Eliminate Waste from Healthcare. Sponsored by Health Catalyst. Presenter: David Burton, MD, executive chairman, Health Catalyst. Based on a breakthrough analyses using several large healthcare data sets as representative samples, Dr. Burton and team will present insights designed to help executives struggling to identify, quantify, and extract waste from their systems.

Webinar questions? Contact Lorre.

Respondents think ICD-10 will challenge hospital CIOs more than other high-profile issues in 2014. New poll to your right: how much impact will IBM’s Watson computer have on healthcare?

Speaking of Watson, IBM announces plans to spend $1 billion to improve Watson’s slow sales progress, with most of the money earmarked to bring in more salespeople and consultants and to create an app store program. The smothering hype after Watson’s “Jeopardy” performance obviously set unreasonable expectations, so there’s a little bit of desperation as it slides in the Trough of Disillusionment. At least it’s being used: Elsevier will employ the technology to enhance the online search capabilities of its medical journals and textbooks, allowing users to search by natural language questions rather than a list of keywords.

Welcome to new HIStalk and HIStalk Connect Platinum sponsor Voalte (that’s pronounced “volt,” in case you were wondering.) The Sarasota, FL-based company provides caregiver-connecting mobile technology that includes Voalte One (all-in-one smartphone communication including VoIP calling, alarm notification, and text messaging), Voalte Me (secure texting that can be used securely on personal smartphones), and Voalte Connect (mobile device management, powered by AirWatch). Available case studies include Cedars-Sinai, Texas Children’s, and Sarasota Memorial. I interviewed Trey Lauderdale, president of the company, in September and we talked a lot about pagers, medical device alarms, and BYOD. Thanks to Voalte for supporting HIStalk.

Here’s a demo of Voalte One that I found on YouTube.

Stuff you can do to support HIStalk: (a) sign up for email updates, thereby entering an exclusive club of 11,194 well-informed and slightly offbeat healthcare IT experts; (b) connect with us on Facebook, Twitter, and LinkedIn so that Inga, Dr. Jayne, Lorre, and I can pretend we are socially active despite the reality of spending most of our time alone in front of a computer; (c) join the HIStalk Fan Club that reader Dann started in 2008, which now has 3,349 members who are all above average and cute besides; (d) send me news and rumors so I don’t miss something important; and (e) peruse a few ads of sponsors and their listings in the Resource Center, confident that despite your differences with their role as vendors and yours as a prospect, you all show your innate coolness by reading HIStalk for sophomoric humor and scandalous rumors.

Listening: Ozma, serving up Pasadena-based power pop since 1995 and best known as being Weezer’s tour mates (not to mention sounding a good deal like them). They are better than you might expect.

Quality Systems announces that it will review certain assets in its NextGen Hospital Solutions division and record a charge against those assets in Q3. The announcement mentions the division’s poor performance and implementation backlog. The company also announces that its Q3 results will fall short of expectations due to poor Hospital Solutions Division results, a reduction in capitalized software development expense, and higher expense amortization related to new versions of NextGen Ambulatory. The hospital division is made up of the acquired Opus Healthcare Solutions and The Poseidon Group.

The White House fires Canada-based CGI Federal from the Healthcare.gov project, handing Accenture a one-year, $90 million, no-bid contract. The outcome of that should be interesting.

I’m getting a little bit annoyed by carefully cloaked Twitter bragging disguised as humility, i.e. “Thanks to all my great co-presenters at XXX conference” or “I’m honored that XXX Magazine has chosen to run my article.” We get it, you are wonderful and way better than the rest of us. 

Andrew Ury, MD, who founded Practice Partner and sold it to McKesson in 2007, raises $1.9 million in funding for his new venture, ActX. The Seattle startup is working on technology to incorporate patient genomic information into medical practice.

Five University of California medical centers test the use of game-based clinician education sent to their smartphones in small sections over a three-month period. It’s delivered by Harvard-based Qstream, whose primary offering supports sales rep coaching. 

Harvard Business Review finds that the impact of potentially disruptive retail clinics has been disappointing, with slow growth, little expansion to underserved areas, and an unclear impact on healthcare spending. Reasons: (a) poor people would rather go to the ED for free than pay even low retail clinic prices; (b) the clinics are usually staffed by nurse practitioners , whose reimbursement is less than that of physicians; and (c) Medicaid doesn’t want to pay for services delivered by retail clinics. In other words, hospitals are so unwilling or unable to make ED abusers pay that the market can introduce no acceptable alternative. It’s tough to compete with “free.”

ONC is looking for someone to lead its EHR certification team.

In Australia, an anesthesiologist says he’s being harassed by his hospital employer after complaining that a study of blood transfusion patients failed to de-identify them properly, allowing him to easily determine their names via an Internet search.

Spending time studying where the Internet intersects with healthcare. If you have ideas and want to chat, contact me: health@benchmark.com

— Bill Gurley (@bgurley) January 10, 2014

Bill Gurley, a partner in Benchmark Capital (Uber, Zillow, OpenTable, and Yelp) is looking for  “orthogonal/disruptive” approaches that don’t “partner closely with current players.”

Phoebe Putney Memorial Hospital (GA) fires two employees over two PHI-containing laptops that were stolen from one of its clinics in November, hinting that the terminated employees violated the hospital’s policies.

@Farzad_MD tweeted this table from an Annals of Internal Medicine “study of studies” article showing good historical outcomes for healthcare IT, leading me to accept his broadly issued challenge of, “I bet the next negative study of some bad health IT implementation gets more ink.” I pondered this and concluded that negative articles are more popular because:

• With the money and effort involved with implementing systems, it shouldn’t be newsworthy that they work and provide ROI and patient value. It should instead be newsworthy when they don’t.
• It’s still hard to convincingly prove that healthcare IT saves money or improves outcomes, and experience is still inconsistent because of not only lack of standardization, but even the lack of consensus that standardization is a good thing.
• Successful implementations often don’t have any conveniently easy lessons to learn since they often involved big organizational commitment and slow, steady progress. The closest thing to a magic bullet is not what to do, but what to avoid doing, and the negative articles call out those potential potholes.
• Technology is incorrectly viewed by technologists as the solution rather than a way to enhance the effectiveness or ineffectiveness of a given organization. Amazon doesn’t make you smarter – it just makes it easier to buy the kind of books you already read.
• The industry is small and there’s always animosity toward a given vendor or provider organization based on personal or organizational history.
• People feel superior when someone else fails in ways they are convinced they themselves would never be guilty of doing.
• Organizational HIT success often is accompanied by selective user discontent, so it’s common for a physician to write emotional editorials against the intrusion of technology (as well as government, health systems, and insurers) into the practice of medicine while their employer can demonstrate positive improvements from that very same technology. The “organizational good” story gets buried if it’s written at all, while the “public good” story gets even less exposure.
• Most of the people writing don’t have any direct experience with healthcare IT or reading peer-reviewed journals and find it easier to make names for themselves with sensationalistic or negative headlines pulled from questionably newsworthy source stories. 
• Organizations with successful HIT outcomes don’t get any benefit from telling the world about their experiences, while those that fail are usually mad at someone they blame instead of themselves and are happy to talk about it.

HIMSS exhibitors, take note of “Confessions of a Former Booth Babe,” written by a “brand representative” assigned to the huge CES in Las Vegas. Her summary: (a) at $25-$50 per hour, it pays better and was at least less demeaning than being a shot girl or go-go-dancer; (b) it’s the hiring company and not the attendees that sets the level of lewdness; and (c) you know what you’re being hired to do if the application requires full-body photos rather than sales experience. Another expresses discomfort with photo-seeking male attendees who are far right on the horndog-pervert continuum: “You kind of wonder where your picture’s going to end up. I had someone ask to take a picture just of my feet. One guy asked to take a picture of me while I was wearing nude fishnets. Then, after he took the photo, he wanted to talk to me about his pantyhose fetish.”

Weird News Andy titles this story “Right Bullet, Wrong Gun.” A couple finds via DNA testing that their daughter, born by artificial insemination in 1992, was fathered by a fertility clinic employee rather than the husband who provided sperm. Testing suggests that the part-time employee may have swapped out his own sperm sample for that of hundreds of prospective fathers. The couple is urging former clinic patients to have the DNA of their children tested.

WNA says he can’t put his finger on what’s wrong with this story, which he names “Proctally Perfect in Every Way.” Researchers develop an artificial robotic butt for teaching medical students to perform prostate exams. It warns them not only if they press too hard, but also if they don’t make enough eye contact beforehand. I can think of far more lucrative consumer applications.

Vince is wrapping up his HIS-tory series after a several year run on HIStalk, which leaves me disappointed since I enjoy the heck out of them. His next-to-last one tries to untangle the remaining hairball of McKesson’s acquisitions that turned into 200 products.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Time Capsule: Meaningful Use in the ED: Get Outta My Emergency Room

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 February 2010.

Meaningful Use in the ED: Get Outta My Emergency Room
By Mr. HIStalk

At my hospital, we worry a lot about ED satisfaction scores. No matter how well we do in areas such as OB or surgery, the ED scores always drag everybody else down. It always seems that the best and the worst aspects of our hospital’s care happen there.

We can only do so much to raise those scores. It’s not a democracy in ED, even though patients think it should be. You might have arrived first, but if the guy sitting across from you has a butcher knife sticking out of his neck, your abscessed tooth is just going to have to wait.

The ED is aptly named since it exists to serve patients with emergent medical issues. If you aren’t one, feel free to enjoy that second half-hour of “The Price is Right” on the “please don’t change the channel” TV because, as Samuel Shem said in The House of God, you are a GOMER – get outta my emergency room.

I’m not really sure why we want our ED satisfaction scores to be high, anyway. We tell everybody how much money we lose there. We use it to park patients who need beds that we don’t have. It doesn’t seem like a good idea to make patients so happy about their ED experience that they keep using our services and recommend them to others. The last thing we need is for them to return with their next ingrown toenail.

I also wonder about the fad of plastering emergency department wait times on highway billboards. It would seem that we are encouraging patients who might be tempted to drop by on a whim. I would interpret thusly: if you aren’t sure if you are sick enough to be willing to wait an hour, come on over because, at this moment, we can see you in 15 minutes.

I’m as much of a hard-driving entrepreneur as anybody who has always worked as a non-profit hospital wage slave. That’s why I’m sure my latest idea is a winner:  modifying ED software to show wait times that are multiples of the real number.

Here’s what my company will offer. We will erect huge, blinding electric wait time signs over the ED entrance, out on the street, and right beside your blue hospital sign on the highway. We inflate the actual ED wait time ridiculously (in fact, we can probably just use a randomization routine instead of measuring anything since we’re just making it up anyway). Our artificially enhanced wait times will discourage people to stay the heck out of our ED unless they are truly sick enough to not mind the wait.

This should be an easy sell to the ED doctors, who didn’t take an emergency residency to perform primary care. The really ill patients will appreciate not having to grimace in pain while the seemingly healthy extended family in the next row over settles in for a loud, impromptu gin rummy game and sends out for fast food.

Best of all, hospital executives could tout their high number widely, eliciting sympathy and support from taxpayers who otherwise resent their million-dollar salaries. Who would feel sorry for a hospital that manages to see ED patients in 20 minutes?

For a slight additional fee, I would modify the garish signs to proudly display an inflated number of patients who have left against medical advice. Those are the kinds of patients who need to be gently pushed back into less-expensive medical venues – the ones who found it inconvenient to wait their turn. This is not a metric of inefficiency, but rather a measure of triage success.

I have another flavor of my business model that I think will be quite attractive. I will hack the billboard system of the other hospital in town in what I’m calling my patient flow maximization solution. If your ED gets backed up, you push a secret button that drops the wait times on the other guy’s billboard to five minutes. I am naming that enhancement the Elective Diversion Module.

Morning Headlines 1/10/14

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