HIStalk Interviews Robert Lorsch, CEO, MMRGlobal

Robert H. “Bob” Lorsch is president, CEO, and chairman of MMRGlobal of  Los Angeles, CA.

Tell me about yourself and the company.

I sold my business in 1998 for several hundred million dollars to AT&T. After the company was sold, I have spent many years focused on philanthropic activities – California Science Center, Cedars-Sinai Medical Center, St. John’s Hospital, and a variety of other organizations.

In 2000, I myself was diagnosed with a rare form of thyroid cancer. Despite the fact that I was extremely connected to doctors, hospitals — both as someone who’s been in the Los Angeles community for many, many years and as somebody who had supported these organizations — I was personally subjected to the task of selecting the guy that was going to be the surgeon who was going to go into my neck and deal with my cancer.

In the course of that, I quickly realized that having the disease was only one aspect of what I had to deal with. But the real aspect of what I had to deal with was the emotional trauma of what goes with being diagnosed with the disease and the challenges that are placed in front of a patient in terms of collecting and getting information so they can get competent physicians to give them knowledgeable and informed information to deal with their situation.

I must tell you that I’m not sure that dealing with the cancer — which was a six-hour operation where I was completely out of it — was probably easier in the long run than the months of agony and emotional torture of trying to figure out if I picked the right doctor, how was I going to get copies of my medical records, what the diseases meant, etc.

In 2005, someone showed up at my house and said, “I think you should go in the electronic medical records business” because Bush had signed an executive order in 2004 suggesting — or ordering — that everybody in America have an electronic health record within 10 years. I took a look at that and I said, “You know, interesting concept. I’m not interested, though, in competing with GE, Cerner, Allscripts, McKesson, and all the giant companies in the industry.”

But nobody had focused on the personal health records side of the house. I decided that that would be something I was interested in and we formed MyMedicalRecords.

Everybody assumed that that would be a really hot sector because people were Googling medical issues, symptoms, and drug side effects, yet for the most part personal health records didn’t do very well. Google shut theirs down, presumably because patients don’t really want to enter that information themselves manually. How have you found that to be with your personal health record?

Our personal health record doesn’t really require the patient to enter anything manually. We have a completely different perspective on what goes into a personal health record and the ease of utilizing a personal health record. 

We give a patient what we call a lifeline number, which is a 10-digit telephone number. We basically have a personal health record that is completely connected, completely interoperable with not only any hospital, physician, or medical professional in the United States, but any hospital, physician, or medical professional in the world based, on the backbone of the telecommunication system.

If you go to a doctor, you have a right to get your medical records in the United States. All you have to do is tell them how you want them. You give him or her your lifeline telephone number, and when you leave the office, they fax your record or e-mail the record to you so you can upload the record and it goes right into your account.

As a patient, when I look in my account, I’m seeing medical records from my physician. I’m seeing medical records from Cedars-Sinai. I’m seeing medical records from St. John’s. I’m seeing medical records from Long Beach Memorial. I’m seeing medical records from private practices. I’m seeing medical records from my orthopedic guys. I’m seeing medical records from my father. All consolidated into one place that requires me to actually input nothing but look at the document and select the file folder I want to insert it into.

It doesn’t require somebody to sit down and start typing in stats and results and information that in all likelihood will be plagued with typographic errors, wrong and not reliable. When somebody goes into my emergency view, they see my most recent laboratory tests on Cedars-Sinai or Quest lab forms with the phone number, the physician, and the lab that ran the tests. Exactly as they would see it in their office, regardless of where it was originated.

That’s a pretty fascinating approach. Other organizations advocated that health records be exchanged as PDFs, but nobody really ever bought into that concept too much. By doing that, you eliminate the concerns about what data you can accept and the standard interchange formats and all that. You just take everything that looks like a fax or an e-mail and it’s just stored in that exact form. Is that correct?

Part of that’s correct. We also have in the site a patient history. Assuming the patient actually wants to go in and enter data, there’s a form with simple drop-downs where they can say, “I want to input my maternal grandparent’s health history.” You just hit the button that says “grandparents.” It drops down and says is it a condition, an allergy, or a surgery, and gives them some categories. You click on that, write what it is, write the doctor and any information that you want, and save it. Then you can go in and put in your mother, your father, yourself, or your children.

Basically what’s happening is you are building through data entry your personal health record, but all you’re really building is that form that you’re going to fill out in the doctor’s office anyway. When you go to the doctor, you hit a button that says “print my record.” You just bring it in and pretty much everything you’re going to need for that form is with you on the spot and can go right into the doctor’s file. If it’s a medical record or chart note or handwritten note, or in my case, my eyeglass prescription … 

Each account works for 10 family members. In my case, I have my son, my father ­– may he rest in peace – my dog, my wife. Everybody’s in this kind of system. Depending on the emergency password that a physician or a paramedic or emergency room representative would put in there, it brings up the medical records, photo, insurance information, and prescription and labs for that individual. From any Internet-connected computer anywhere in the world, no questions asked for the quality of the form, because the person looking at it can basically reach out to the lab and confirm it’s accurate.

One of the problems of personal health record is you may get a patient that’s embarrassed about something. They may kind of redact something from data. We do not give the patient the ability to do that, because there is no data in the actual record. There is data in the health history.

I believe I understand right that it’s priced for families at somewhere around $100 per family per year.

There are multiple pricing programs. Direct online, somebody can go and pay $9.95 a month or $99.95 a year and set up and have their account. They can also pay for what we call personal touch — $80 more — and we find a nurse practitioner to go to collect forms for them. We contact all the physicians from throughout their life and we update the medical records in the account for them.

And then there’s the employer programs, where an employer with 1,000 employees can pay us less then $2 a month per employee and every employee in a company would have access to an account. And then there are associations, much larger groups, where they would pay an annual fee for every member in the association and it becomes an affinity benefit, much like a LifeLock or other similar service — whether it be lost baggage, a personal health record, insurance services — that are embedded into the benefits of that organization.

I don’t want you to tell me anything that’s proprietary, but can you give me a feel for how many active users the service has?

We define users in two different ways. We have members and we have users. For example, if you’re part of a company that has 5,000 employees, every one of those employees is a member. The actual user, depending on the type of company, can range anywhere from 5 percent to as much as 28 percent, and so we define members from users separately.

At last count, we had I think 750,000 members, although that does fluctuate up and down. We had from those members approximately 8 or 9 percent what I would call heavy, heavy users. But it doesn’t really matter, because if you work for that company, you have the ability to go in and set up your account at any time.

You might take some medications. You might have something going on in your life. But you take somebody who’s 30 years old. They get a personal health record, they don’t even think about it. They’re not as aware of it. Until one day they go to the doctor and he says, “You know, you need to have appendicitis operation or your cholesterol is too high or for some reason we’ve got a little spot that we want to deal with or some type of MRI.” All of sudden then, the person is, “Oh my gosh, I’d better start collecting my information and building my medical record.” We find that as people have their record over time, more and more people will come in and start adding things into the record.

The other thing that we find is attrition. Since we’ve been in business — which is almost eight years now and with the product out there a little more than six — attrition is less than 2 percent. The real-world attrition, we think, is less than 1 percent. The difference is that is people who have passed away or for whatever reason aren’t getting the benefit any more. It’s not really the attrition in the account, because once somebody gets their information in the account, they don’t want to give up the account.

In the account are 16 file folders. You have complete control over what those file folders are called. Four of those file folders are actually password protected. You can call them an e-safe deposit box. You can call them a real estate file. You can call them advance directives. If somebody gets into your medical record on emergency basis, they won’t see those files, because they are password protected through the administrative side of the site.

I could be anywhere in the world and I would have passport, driver’s license, advance directives, emergency documentation, inventories of all the furniture, fixtures, and materials in my home, etc. It’s not only a personal health record, but it’s an emergency disaster preparedness medical record. You’re in a community, a tornado comes in, you’re wiped out, you need your medical records. You also need your driver’s license, your banking information, your advance directives, the articles that were in your home, your insurance policies. They are all in password-protected files that are embedded into the account.

The other reason we do the password-protected files is when a child becomes 16 years old, they are entitled to have privacy to their personal health information. This way, a family can have a MyMedicalRecords account and they can allow a one file folder to be assigned to each of the teenage members of the family so that the parents can’t have access to what’s in that account. If you have a daughter that, for example, decides they want to take birth control pills, their medical record could be separate from the family’s medical record and password protected so the parents cannot get into that account.

I want to ask you a question about patent licensing. You’ve made some statements that licensing is the future of the company’s growth and a lot of the press releases involve that. Is it fair to say that a long term plan is that the licensing fees will be the majority of the company’s income?

If I may push back a little bit, I’m not sure that I’ve said licensing is the future of the company anywhere. I don’t think that’s actually a quote that I made. What I have said is that as a result of Meaningful Use Stage 2, hospitals, healthcare professionals are obligated if they sign on the dotted line and tell the federal government that they are requesting reimbursement under Meaningful Use Stage 2, there are certain things they have to attest to. One of them is to provide a certain percentage to their audience with a personal health record. Under Stage 3, it will be more severe, because under Stage 2, they have more time. They’re talking about bringing that down to less than a day in Stage 3. Those records are required.

If somebody complies with that Stage 2 Meaningful Use, we believe that they will infringe on one of seven patents that we have issued in the US Patent Office an additional patents that we have issued in 12 additional countries around the world. What we have done is we’ve gone to the hospitals, providers, vendors, laboratories, and we’ve said, “Look, if you’re going to comply with Stage 2 Meaningful Use or you’re going to offer products and services that enable healthcare professionals to meet Stage 2 Meaningful Use, they’re probably going to infringe on one of our patents.”

We’re suggesting that they license those patents at very reasonable license fees, such that whatever they decide to do to comply with Stage 2, Stage 3 Meaningful Use, they have a license – a safe harbor — that they’re grandfathered in, where they never have to be concerned about infringement on any of our patents or other intellectual property. If those same hospitals say, “Are there any other ways to address this?” they could also use our products — our MyMedicalRecords products, our professional products — which are embedded with licenses for the technology.

What we’re essentially saying is if a hospital wants to comply with Stage 2 Meaningful Use … and I want to be very, very clear, I’m not saying they’re definitely infringing, but we believe with nearly 400 claims, that there is a high degree of likelihood that they will infringe on our patents and other intellectual property — we will, as cooperative a way possible, reach out to them to offer them licenses, the ability to utilize their product, prior to bringing any form of legal action if we believe the infringement is direct and on point.

Have you ever taken someone to court for infringement?

We currently have four matters that are of interest. Approximately two or three weeks ago, we filed a lawsuit against Walgreens. Last week, we filed a lawsuit against WebMD. We currently have identified in Australia that the Australian government actually built a $1.1 billion personal health record system that blatantly, we believe – and I would appreciate it if you would always qualify it with “we believe” – infringes on our patents almost totally. The irony of the whole thing is that the government actually appears – and I want to say “appears” – to have used our attorneys who got us the patents in Australia to review and give them an opinion on the intellectual property.

We have found the same thing in Singapore, where the health department in Singapore and other companies — including a very, very large company out of China — are infringing on our patents there. 

We have begun the process of pursuing Australia. We would hope to settle it very, very quickly, because they have a billion-dollar system that is basically given away to everybody who lives in Australia, which completely, completely destroys the ability for us to sell our product.  We would hope that they will be objective in entering to some type of licensing agreement with us. Our patents go far back before they ever actually looked at the system that they built subsequent to the issuance of the patents, which we believe they were aware of.

I forgot to ask that earlier. What years were your patents granted?

The patents have been granted throughout the last seven years. I mean, originally they were filed … I think originally the first filings were in 2005. The US patents mostly were issued at the very, very end of 2011 and throughout 2012. We continue to have numerous applications on file, both pending applications and continuation applications on existing patents.

Your patents were filed in 2011. What was new in 2011 in your patents that hadn’t already been marketed by someone prior to that?

It has to do with what we originally invented in 2005. The patent is like three legs of a stool. You plant the first leg and the stool is going to be a bit wobbly. Then you plant the second leg and the stool is going to be solid. Then you plant the third leg and the fourth leg and you build on intellectual property. The original inventions were true inventions at the time they were filed in the patent office. They’re all based on the original art. Then over time, you amend those applications to bring in different features and functionality that rely upon the original prior art.

But the original prior art when we file these patents or the amendments to these patents or additional patents or continuation patents on,  the Patent Office is very, very thorough. I mean, very, very thorough. It took us close to seven years to issue the first patent. It took us, I think, five or six years to issue the first patent internationally. It took almost eight years to issue patents in Mexico. It’s not a simple process. They look at everything. It costs this company millions of dollars in fees, expenses, and attorneys on a global basis in order to prosecute this portfolio.

Most patents are written to be as broad as the patent office will accept. Can you just describe in general what the patents cover? Maybe the top one or two that are in question now with other people infringing.

There is a valuation that was done which I can send you the link to. It was actually covered in a news release by the company when it came out about a month, a month and half ago. That valuation identifies every one of the patents around the world by its name, description, and number. I don’t want to answer a question that really has the potential of narrowing the scope just by the fact that I can’t properly answer it in an article like this. What I would do is I would refer people to that valuation summary and they would be able to go to the patent office and look up everything.

There’s claims that deal with how the patients get personal health records. There’s claims that deal with telemedicine. There’s a broad spectrum of claims. Like I said close, to 400 in stage, with more patents and additional claims pending and a lot of claims around the world. It wouldn’t be fair to you, me, or the reader to just say, “The basics of it is this.”

They are a method and system for providing personal health records, electronic health records, and other forms of electronic documents. They run the gamut of e-safe deposit box, which could mean personal information like we discussed with advance directives and maybe a copy of your passport all the way to your medical records.

Some of the recipients of the potential infringement letters have been hospitals, most of which are non-profit. I don’t want to ask you a proprietary question, but when you say the fees are reasonable, what kind of terms would you offer them to license?

Every one of the agreements and licenses that we’ve entered into is confidential. If you look at me or you Google me, I spent the last 13-14 years of my life dedicating it to giving away money to charity. Prior to that, I probably have raised more money for organizations using what was called cause-related marketing, where a portion of a dollar that a company like Procter & Gamble would get would go to Special Olympics or the Heart Association or D.A.R.E. America. So when it comes to non-profit charity and giving, it’s in my DNA.

When I say reasonable, I mean in a way that protects the hospital, gives them a benefit so that they can provide a broader service to their patients. It’s not the kind of dollars that you’re looking at from all these lawsuits with Samsung and BlackBerry and Apple. It’s not that kind of a thing.

We look for a win-win situation with the hospital. The best way I can  explain it is our primary business is personal health records. A lot of people have tried to paint the letters we’ve sent to the hospital as if we’re patent trolling. A troll is somebody who has rights to a patent, but basically goes around suing people and demanding royalties. A troll is not the original inventor of the patents, of which I am on every patent that’s been filed anywhere in the world.

We invented those patents so that we would have the opportunity to go into the market and compete and create a barrier to entry for our competition. By ignoring our rights under those patents, we are essentially being denied the ability to compete in that marketplace, because other people will just go in and sell their product at the expense of infringing on our patents. 

What’s fair and reasonable in our mind is something analogous to the amount of money that we would have made had we were providing those products and services. But if somebody is going to say we’re going to preclude you from providing those products and services, then they should pay us something reasonable for infringing on our intellectual property.

In our case, we don’t care if somebody licenses or somebody buys. They win and we win either way. The objective here is to not do something that makes it impossible to make a deal, but also do something that is fair to our shareholders in the sense that we’re not denied access to the marketplace just because somebody said, “The heck with them. We don’t care about their patents,” which is what is happening in Australia. I mean the Australian government in a macro example — macro being huge, but one country — they basically said, “We’re going to make a personal health record. We’re going to give it away to 20 million people free and we’re going to infringe on IP and we don’t care.”

I had a meeting with a group of Congressmen last week in Washington, DC. Ironically, we focused on stimulus, and some of the things were covered in the Page 1 article in The New York Times. These Congressional representatives who are on the oversight committees have said that intellectual property –the right to own property, the right to own a home, the right to own what you create, eat what you sow — is a fundamental right of every American, and it’s probably a fundamental right of everybody wherever they are anywhere in the world.

These are rights that we built products for, we created things for. When somebody takes away your right to compete in the open marketplace, they pay a royalty or a license fee. In those rare cases where you unfortunately have to go to litigation, maybe they’ll pay more. But the objective here is to create reasonable relationships with hospitals.

I have said to our shareholders, there’s 5,000 hospitals out there. It doesn’t take a lot to figure if every hospital gave you some reasonable amount of money for every 250 beds, the hospital would win based on the quality of our product and we would win for our shareholders.

There was a rumor that there was some interest by the National Coordinator or some part of HHS about what was going on with the patents and the letters that were being received by hospitals, and possibly by somebody in California, maybe the Attorney General, as well. Has there been any official interest or discussion about what you’re doing from any government or oversight-type body?

When we originally sent out the letters, some of the hospitals apparently forwarded them to the California Hospital Association and the AMA. I received a copy of a letter that was sent by the California Hospital Association legal counsel Jana Du Bois to every hospital general counsel saying, “If you get a letter from a company called MyMedicalRecords, we think they’re some kind of patent troll. Let us know.”

When I got a copy of that, we contacted her, and we explained to her that, “Hey, it’s our primary business. We invented it. We did not buy these patents. We are not trolling with these patents, and by the way, we are very, very anxious to enter into reasonable business relationships with the hospitals to license the patents or utilize our products and services.”

She turned around and basically sent out what I would – I’m not going to say it was an apology letter — but she definitely sent a letter out to everybody to set the record straight. To the point that I just found out last week in one state on the East Coast, meeting with their association, actually discussing the possibility of saying, any hospitals in the state, we will negotiate through the association one license agreement so that the hospitals can get the benefit of the lowest possible rate, and as long as the hospital is a member of that association, they would get the license agreement.

In addition to that, we — meaning MMR — would take 30 percent of those license fees, put them into a non-profit managed by that association to provide healthcare and philanthropic services to underprivileged in their communities through their hospital network. So in essence, we would say, State XYZ is kind of like a safe harbor for,  I think it’s 10 months. We would negotiate a license agreement with that association. The license agreement would be based on the beds in the hospital. They would offer it to everybody in that state.

If they accepted it, they got that rate. We would take 30 percent of the money, give it back to the community to provide healthcare and other services to the community through those hospitals. If the hospital did not sign on, then we would see what happens after that period of time. That is as recently as last week. It was very well received. We are already in the process of signing agreements to facilitate those conversations.

The associations are very aware. The associations hopefully will understand that we’re trying to be reasonable about the whole thing.  As for the AMA, I know they’re aware of it. We’ve not communicated with them.

As to the National Coordinator, my days with the National Coordinator go back to Dr. Brailer, when Mike Leavitt was Secretary of Health. Mike Leavitt knew about MyMedicalRecords and our intellectual property in the early, early days. Dr. Brailer knew about MMR and our IP in the early, early days. The Small Business Administration acknowledged what we were doing after Katrina, because we had the ability to not only provision personal health records, but emergency safe deposit boxes for victims of natural disasters – they presented us an award. Subsequently, I meet with Dr. Blumenthal and William Yu, when he was in the office, went through the products, service, patents, the intellectual property. There could be no surprises to anybody about what we have been doing.

I think I read that you’re sending – maybe it’s not the right figure — 250 letters a week. I’m just curious how much response you’re getting from those letters or what hospitals are doing when they receive those letters?

We’ve sent out somewhere between 600 and 750 letters. Many of them respond. Some of them don’t respond. When they don’t respond, we reach out and try to communicate with them.

There are maybe additional letters, but at this particular point in time, we’ve had a lot of success with everything from the association I described to numerous hospitals in California that have opened the door for meaningful negotiations. If somebody opens the door for meaningful negotiations, we’re basically going to take the time that’s necessary to make them comfortable that they’re making the right decision.

Meaningful Use Stage 2 really starts in February 2014, I think. And so, if the hospital wants to understand this, vet the product, vet the service to understand the IP, we’re anxious to work with them in a businesslike manner.

Any final thoughts?

We’re looking forward to HIMSS. There are a lot of people that have gotten letters from us. We’re looking forward to more patents being issued. There are a lot of people that have contacted us and arranged to meet with us at HIMSS to discuss a variety of business opportunities from strategic partners, licensing. We’re going to be previewing wellness applications connected to our personal health records. We’re going to be focused on integrating our personal health record with the output from all the apps that are coming in on iPhones and Android phones.

We’re looking forward to meeting people in the booth who may have the wrong perception of the company. If the perception they have is it’s some guy sending out letters trying to get royalties who is not entitled to them, we’re not those people. There may be some of those people out there. We’re not those people.

We have a real product that we invented that we would prefer to sell people. But if people are not going to buy it and they’re just going to work around it or they’re going to ignore us … the most reasonable thing to do is to license, because that way everybody wins. Should they decide that, you know, it’s really not such a dumb idea to attach a 10-digit telephone number to every one of our patients’ personal health records so that they can go anywhere in the world, and if they’re on vacation in Israel – where, by the way, we own the patents — they can literally get a lab test, have it put in their account, and seen by their physician at New York Pres in three minutes.

I’m a big believer in supporting hospitals so that if, God forbid, I go into the emergency room and I need something, the little green light goes on and says, “He’s a good guy." But hundreds and millions of dollars have recently been spent in this community by Cedars-Sinai Medical Center and UCLA. They both have Epic systems. They can’t talk to each other. Here I’ve got a health savings plan. I’m in the emergency room at Cedars-Sinai, but next time because I’m closer to UCLA or the Cedars emergency room is full, all the tests that I had at Cedars now have to be redone at UCLA. Why?

Kaiser is  a classic example. The rumor is more than $6 billion has been spent on EMR and PHR. Right now, I’m not a Kaiser member. If I get sick anywhere and I need my medical records, yeah, I have some kind of a patient view. But that emergency physician in Sheboygan, Wisconsin or in Deer Valley, Utah, where I just came off at a ski slope with a pain in my arm or my chest or broken bone — they can’t get that data. They’ve got to completely rework me up before I go into surgery. If I’m unconscious, these people don’t know today that I’m a thyroid patient. I don’t have a thyroid. I have to take certain medications. If I’m unconscious, I can’t tell them that. 

If you start asking around about how much money has been spent on a state-by-state basis trying to create a regional health information system — I’m going to be kind — It’s probably $20 to $50 million a year, and I don’t think you can find a working model. If you do find a working model, I don’t think you can find a handful of hospitals that talk to it, because they’ve all got their own EMRs. There’s no interoperability, despite the fact that this whole effort from Bush was designed to empower the patient and create interoperability. So basically we’re at $11 billion and counting — maybe 12 now, I don’t even know, it goes so fast — and the original selling proposition of why we needed this has not been met.

Curbside Consult with Dr. Jayne 2/25/13

I’m fairly addicted to Twitter, mostly because some of the people I follow provide a humorous break from reality. I recently saw a tweet about a hospital bill for childbirth. The year: 1951. Ever since I was an intern, I’ve found the history of maternity care in the US to be fascinating (most likely due to all the long hours spent on the labor and delivery floor). I’ve delivered a couple hundred babies and know what charges look like today, so decided to see what this bill would look like in 2013 dollars.

The good people at Dollar Times offer a nifty inflation calculator that helped me with the “today’s dollars” numbers for this five-day hospital stay:

Delivery Room: $91.84
Anesthesia: $91.84
Laboratory: $18.37
Dressings: $32.14
Medicine: $92.30
Formula: $2.76
Circumcision: $18.37
Room and Board: $482.16
Baby Care: $137.76
Telephone: $22.96

Of course, you can’t truly compare apples to oranges against a modern hospital bill, because there is no way you’d be allowed to stay for five days for a normal, uncomplicated delivery. Most commercial payers in my area require patients be discharged no later than 48 hours after a non-surgical delivery and many encourage only a 24-hour stay.

You also can’t compare apples to oranges because payment was made on the day of discharge. No billing or insurance was involved. Paying this bill at discharge would be equivalent to asking a patient to pay nearly $1,000 today and most patients would balk even at that. We’ve become dissociated from the true cost of medical goods and services to the point where if it costs more than a $20 copay or $500 deductible, we can’t fathom paying it.

What do cash patients pay today? A quick Google reveals a two-day labor and delivery package at Tucson Medical Center for $2,300, but only if paid in advance. My hospital offers a similar package that’s priced about the same. Still, that’s more than double the expected price given inflation alone.

Incidentally, while researching this, I learned that my hospital refuses to accept cash as a form of payment. That’s a sad commentary on modern life. Of course there’s a theoretical risk of counterfeiting and you have to have cash-handling policies, but I’d rather have that than the risk of a bounced check or have to bill patients who don’t have credit cards.

I don’t want to get into a debate about natural childbirth here, so let’s assume you’re a patient who wants a “standard” hospital birth. When you consider the modern technology associated with today’s labor and delivery experience, it doesn’t look like such a price hike. In 1951, the anesthesia used at our hospital was Twilight Sleep and was likely to result in maternal amnesia and infant breathing problems.

Today, patients who want it can have continuous fetal monitoring, epidural anesthesia, and highly skilled nurses who are experienced with challenging deliveries and resuscitating depressed infants if needed. Laboring mothers can move from bed to shower to chair to bathtub to labor ball rather than just lying on a gurney. Whole families can share in the delivery experience and babies are able to instantly bond with their mothers.

How then do we translate this to the exorbitant bills we’re seeing from hospitals today? The key difference (besides patient care technology) is the rise of the insurance company and our resulting detachment from the cost of the care we’re receiving. Hospitals and offices must maintain armies of coders, billers, processors, and all manner of clerks, insurance follow-up representatives, patient accounts representatives, etc. just to stay in business. This in turn drives up costs and perpetuates the hamster wheel on which we run.

I have a few good friends who have gone to cash-only practices. I’m not talking about “concierge” or “retainer” practices where the patient pays an annual fee for access to the physician. I’m talking about physicians that know the true cost of their services and what income they want to achieve and charge accordingly.

It’s surprisingly affordable, with office visits in the $40-$50 range. They’re bringing home good money with a higher quality of life. Payment is required at the time of service and no bills are generated. One of my colleagues does provide a copy of a superbill for the patient to submit to insurance, but the others do not. One has a nurse, one has a medical assistant, and the other has no staff at all.

Interestingly, despite being “off the grid,” all three have electronic health records and demonstrably high quality of care. They use their EHRs to enable their workflow rather than to count bullet points and participate in regulatory nonsense.

I’d love to spend some time looking at the true cost of hospital care and modeling what it would look like if third-party payers (and the resulting bureaucratic bloat) were out of the mix. Patients would be closer to the actual costs of procedures and would be better able to determine if it’s worth it to keep grandma in the ICU for her last weeks or whether it would be better to spend a fraction of the money on a hospice nurse tending her in her own bed.

Of course, there would be those crying out that we’re refusing to care for the poor or elderly if we did that. I would argue that some of our high tech interventions aren’t done so much in the name of “care” as much as “because we can.” I’m not arguing that we should deny care to those who can’t afford it, but merely suggesting that if patients (and facilities) were more in touch with the actual cost of care that we’d be in a very different situation than we are now.

As a family physician is wont to do, I’ve told the patient’s story from cradle to grave. I’m interested to see what the tale looks like for the next generation.

E-mail Dr. Jayne.

Morning Headlines 2/25/13

Bitter Pill: Why Medical Bills Are Killing Us

Time magazine’s special edition report on rising healthcare costs is the longest article the magazine has ever run, but it is short on offering meaningful solutions.

Grace Cottage blames federal law for job cuts

19-bed Grace Cottage, of Townshend, VT, defends its $2.5 million Cerner implementation, as well as other major capital expenses, after firing 10 percent of its workforce which officials say was necessary due to steadily declining reimbursements and increased expenses. In perhaps related news, the only job opening posted on the hospital’s career page is for a new CEO.

Huge Decision Coming for Doctors Who Sued EHR Company

A group of doctors suing Allscripts over the discontinued MyWay EHR platform will find out Tuesday whether they the lawsuit will be allowed to continue or whether they will be forced to honor the binding arbitration clauses in their contracts.

MModal and Intermountain Healthcare Collaborate on Industry’s First Speech-Enabled Computerized Physician Order Entry (CPOE) App for iPhone and iPad

MModal will partner with Intermountain Healthcare to develop a speech-enabled CPOE app for iOS devices. The app is expected in the fall of 2013 and will be integrated within EHR systems not yet named.

Monday Morning Update 2/25/13

From Grizzled Veteran: “Re: Stark Act/Anti-Kickback Relief. It’s scheduled to expire on 12/31/13. What are the thoughts on it being extended or not? What happens to hospitals and practices if it isn’t?” The floor is now open. Feel free to leave a comment stating and perhaps defending your opinion.

From CPAhole: “Re: CMS. Has anyone raised the issue of the CMS PQRS site being down for days at a time just when everyone is trying to submit and there is a 72-hour turn on submissions? CMS is trying to come up with a Plan B to fix their system.” Unverified.

From The PACS Designer: “Re: mobile ECG Monitor. TPD is intrigued by AliveCor’s FDA-cleared Heart Monitor & AliveECG app for the iPhone. An iPhone app that can benefit both the patient and the physician brings health monitoring to a new level of care. This app will be added to TPD’s List of iPhone Apps with the next update.”

From Marrioutta Here: “Re: HIMSS hotel. Just got a call from Marriott. There was an error in their website and they are overbooked. Moving folks 35 miles away and paying for the rooms.” At least when HIMSS e-mailed this week to tell me I was bumped out of the hotel I had booked in September they put me in another one that’s a little bit closer, a little bit cheaper, and newly added to the shuttle route. I don’t like the rooms as much from the description, but it’s walkable to the convention center and closer to restaurants. Some hospitals force employee groups traveling together to share rooms or pay the different for a single room themselves, which would probably greatly reduce the number of rooms required since it’s like a commuter highway – single occupancy is the rule.

The majority of poll respondents say they’re getting too much HIMSS-related vendor contact, although a solid 36 percent are happy with the volume and a disappointed 12 folks wish they’d get more. New poll to your right: what city would be your choice for holding the HIMSS conference?

Welcome to new HIStalk Platinum Sponsor MediQuant of Brecksville, OH. MediQuant offers Data Transition Management Solutions. Almost every healthcare organization keeps orphaned systems running just because someone might need access to the data they contain at some point. MediQuant’s DataArk active archiving solution allows those systems to be decommissioned with savings of up to 80 percent (using their data center or yours), providing ongoing easy access to clinical, financial, or ERP data. It’s always a pain to work down patient accounts after a system conversion and balance-forward conversions are notoriously risky (why junk up your new system with iffy data?), but DataArk customers can still bill those accounts, post payments, add notes, defend audits, and produce itemized statements with even easier access than the retired system offered. Clinical systems conversions are equally tricky with legacy data and chances are you’re not living in a “no lawsuits after discharge” bubble that allows walking away from years’ worth of patient data, so DataArk allows moving that historical information to its clinical repository module. Turn off the old system and the cash drain required for its upkeep. Other MediQuant products include FirstComply and AccuRules for medical necessity/ABN compliance. The company’s client base includes more than 700 facilities (examples: UPMC, Baptist Louisville, Dignity Health, Kettering Health Network, and West Virginia University Healthcare.) I’m rocking out to their Legacy System Blues by The DeCommissioners on their home page. Drop by Booth #5649 at HIMSS and say hello and thanks to MediQuant for supporting HIStalk.

On the Jobs Page: Demand Generation Specialist, Sales Effectiveness Consultant, Healthcare ECM Sales Executive, Account Manager – Government.

Listening: new from Nick Cave & the Bad Seeds, lush and powerful brooding from one of music’s most tortured geniuses. New live concert video here.

Want to win a $25 Amazon gift card and be sashed on stage at HIStalkapalooza? Tell us why you have a crush on Inga, Dr. Jayne, or Mr. H. We’ll pick the best entry for each crushee and recognize them on stage with an Inga’s Secret Crush, Dr. Jayne’s Secret Crush, or Mr. H’s Secret Crush beauty queen sash as a token of our mutual affection. Speaking of “crushed,” Inga is exactly that so far because all of the entries have been for me (Mr. H). I’m on standby to pledge my affection for her and Dr. Jayne if need be. Mrs. HIStalk assembled and packaged the sashes when they came in the mail last week and was less than thrilled when she got to the “Mr. H’s Secret Crush” one. I told her it was Inga’s idea.

Encore Health Resources will announce this week its Value-based Performance Improvement (VPI), an analytics software and services program developed with Catholic Health Initiatives that includes Meaningful Use reporting, population analysis, clinical analytics for care coordination, and financial analytics. The company says the program will transform EHR data to help organizations focus on quality and performance data at a low cost of entry. Components that can be implemented individually or fully include an analytics engine, an ETL tool, and dashboards.

Georgia Regents Medical Center (recently renamed from Georgia Health Sciences Medical Center) selects Besler Consulting’s BVerified – Transfer DRG tool to identify and recover transfer DRG underpayments. It automates the required review of the Medicare Common Working File and creates workflow tasks that guide the provider through follow-up steps.

Yavapai County, AZ admits that its printing of death certificates was delayed by more than a week due to computer problems following a software upgrade.

The longest article ever published in Time magazine is this week’s cover story on high healthcare prices, Bitter Pill: Why Medical Bills are Killing Us. The basic conclusion is that the US needs to set healthcare rates in a Medicare-type national system instead of letting the so-called free market do so. Most of the criticism is aimed at hospitals, so it’s worth a read even for those of us who working in them even though we were numbed long ago to $2 Tylenol tablets and $300 chest x-rays. The fact that the author couldn’t come up with recommendations less invasive or more likely to succeed than simply letting the government run all healthcare as it does the wasteful, political, and fraud-riddled Medicare program is a bit of a letdown.

Medical practice plaintiffs who filed a class action lawsuit against Allscripts for its decision to not enable the MyWay EHR for future MU stages or ICD-10  will learn Tuesday whether they can continue with their suit or will instead be forced to accept binding arbitration. If the complaint is certified as a class action, Allscripts will be required to provide the names of all MyWay customers to the plaintiff’s attorneys, who say all 5,000 MyWay physician users would then be automatically included in the suit. Attorneys for Allscripts have filed a motion to block the suit, arguing that the doctors signed a contract requiring their differences to be settled by binding arbitration. Some of the specific complaints, remembering of course that they represent only one side of the argument:

• ”Our EHR is a piece of crap,” said an anesthesiologist and “buggy” according to others involved with the lawsuit, each of which paid up to $40,000 per physician to implement what they claim is a defective system.
• Anesthesiologists claim they were promised a pain management module that was never developed.
• A client who bought MyWay in June 2012 was assured by their Allscripts sales rep that the product would be enhanced to meet MU Stage 2 and ICD-10 requirements, with the company announcing otherwise four months later.
• Users say MyWay, originally developed by iMedica as a client-server product, was sold by Allscripts as a cloud-based offering that performed poorly.
• The lawsuit says that a “free upgrade” to the Allscripts Professional EHR isn’t an upgrade at all since it’s a different product and requires a complicated and costly conversion.

Facebook apologizes to a 104-year-old woman who found that she could not enter her real date of birth on her page. The company changed its date edits to allow birth years before 1910.

Robert Lorsch, chairman and CEO of PHR vendor MMRGlobal, briefs members of a congressional subcommittee on HITECH payouts and what he says is its failure to ensure standardization, interoperability, and PHR access. He demonstrated his company’s PHR product, telling the audience that it could be made available to all Americans for less than the money one large hospital would spend on an EMR. MMRGlobal has sent infringement letters to healthcare IT vendors and hospitals in the US and elsewhere claiming that they are violating the company’s patents that cover a variety of online services.

Vermont’s smallest hospital will lay off 15 employees, 10 percent of its work force, blaming cost pressures created by the Affordable Care Act and its new ACO relationship with OneCare Vermont. Officials with the 19-bed Grace Cottage Hospital defended spending $2 million on an EMR, saying ARRA money paid for it and it needed the system to participate in the ACO.

MedSnap releases an iPhone app for medication reconciliation that allows the provider to place a patient’s pills on a tray and use the phone’s camera to take a photo, which the app then analyzes to display the name and strength of each drug along with drug-drug interactions, drug-disease contraindications, and allergies based on the patient’s medical records. I would characterize this as brilliant. Future offerings include medication reminders and caregiver monitoring. The company is looking for volunteers for its Pill Mapping Project, whose submissions will improve its recognition database. Co-founders Patrick Hymel, MD and Stephen Brossette, MD, PhD founded MedMined, the infection surveillance software company acquired by Cardinal Health in 2006.

MModal and Intermountain Healthcare will jointly develop a speech-powered CPOE app for iOS devices. The app’s vocabulary will recognize terms related to the ordering of meds, labs, imaging, and nursing. They say it will be completed by fall.

Supporting HIStalk at the Gold level is ReadyDock. Everybody’s walking around hospitals carrying tablets these days, which means they’re also giving a free ride to microorganisms to spread from one patient to another. ReadyDock:UV is the world’s first solution for one-step disinfecting, charging, and securing of tablet PCs and iPads. It’s UV powered, which means no messy wiping down with disinfectant (and no voiding the manufacturer’s warranty by fluid contact). Tablets are often part of normal workflows and charging and disinfecting them needs to be equally user friendly. The device takes up a lot less space than a standard docking station, frees up power outlets, and eliminates a tangle of wires. You can see it yourself at HIMSS in Booth #3879. Thanks to ReadyDock for supporting my work.

I found this brand new ReadyDock video on YouTube featuring Louise-Marie Dembry, MD, MS, MBA, infectious disease professor from Yale-New Haven Hospital.

Thanks to a rumor report from reader Smarty Marty, we reported on February 13 that Aetna was rebranding its health and technology unit (ActiveHealth Management, iTriage, and Medicity) as Healthagen. The official announcement went out Friday.

First Databank promotes Bob Katter and Charles Tuchinda, MD to EVP following the recent promotion of Gregory Dorn to EVP/deputy group head of Hearst Business Media.

Wired profiles stealth startup Smart Scheduling, which identifies patients who are likely to be no-shows for their appointments based on past behavior. The company went through Healthbox’s accelerator program and connected with athenahealth to fine tune its algorithms. The application is being piloted by Steward Health, which uses athenahealth’s scheduling system. The software suggests the optimal time slot for a given patient based on the likelihood they won’t show up. Steward says the program is 95 percent accurate, allowing them to schedule around possible no-shows to hit their overall patient targets.

A mini-study in a Letter to the Editor in NEJM finds that about 12 percent of US physicians have attested to Meaningful Use under the Medicare program, making it likely that many practices will face financial penalties starting in 2015. Specialists have about half the adoption rate of primary care providers. Physicians working with Regional Extension Centers have only a slightly higher attestation rate at 16 percent.

The e-mail system of Ohio State University’s Wexner Medical Center was down for 42 hours through Friday morning, with “replaced infrastructure” identified as the culprit.

UCLA’s medical school is the subject of a snarky Los Angeles Times article that criticizes its cozy relationship with nutritional supplement manufacturer (and accused scam multi-level marketer) Herbalife, which donates a lot of money to the school and drops the school’s name at every opportunity to give its products the scientific credibility that nutritionals sorely lack. UCLA’s cellular and molecular nutrition lab is named for the company’s founder, or as the article says, “The lab is named after Herbalife’s founder, who died in 2000 after a four-day drinking binge — not the greatest advertisement for healthful, active living.” Several medical school faculty members serve on the company’s board, with one of them being paid $17.8 million over 10 years through his consulting firm in return for product endorsements that include his signature on the label. Both he and the company can make almost any exaggerated claim they want since nutritional products escape FDA oversight. The article concludes, “When torrents of cash fall upon people like Heber and Ignarro — especially when the payments promote interests fundamentally in conflict with their responsibilities for thorough, objective research — it’s proper to ask whether the recipients should be viewed primarily as university professors with an income source on the side, or as agents of industry exploiting their academic titles for show.”

Vince wraps up NextGen’s HIStory this week. He starts the long history of Meditech next time and welcomes your contributions.

HIMSS Conference

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

Sponsor Updates

• At the HIMSS conference, HITPC member Gayle Harrell will present a session titled “Leading Change through Health Information Technology” on Monday, March 4 at 2:00 p.m. at Sunquest’s Booth # 911.
• Edward Fotsch, MD (CEO, PDR Network) and Douglas Gentile, MD, MBA (CMO, Allscripts) will present “Turning Patient Portals into Major EHR Assets” on Wednesday, March 6 at 8:30 a.m. in Room 288 of convention center. The session will also be streamed live.
• PatientPay is named by PYMNTS.com as a finalist for a 2013 Innovator Award in the Best Debit category.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Readers Write: Now That We Have Data, How Do We Improve Patient Care?

Now That We Have Data, How Do We Improve Patient Care?
By Cynthia Davis

I’m a former ICU/ER nurse with three decades in and around healthcare delivery. I understand first hand why we need technology in operating rooms, in the ER, at the patient’s bedside and during clinic visits. It is because technology can have a significant impact on improving care and outcomes. Patients are safer. Doctors have access to data on medical history and allergies when they are making decisions that can save the life of someone’s mother or sister or aunt.

Today we are at a critical juncture. Institutions finally have the right technology tools in place. The question is, how do we make that collective leap from data collection to better care? I think it starts with validating and analyzing the data that we are all so busy collecting.

This should be easy. Isn’t that the promise of technology? In my experience, the answer is both yes and no.

Technology is not magic. It does not fix processes. If you have a patient with impending sepsis and the EHR alerts for potential sepsis through vital sign documentation, assessment data, and labs, it doesn’t tell you the process once the alert triggers. It’s a shift in perspective, but for technology to actually improve care, we need to listen and think as clinicians and reexamine workflows and data points as a basis for care decisions.

The first step is going back and reviewing whether we are capturing data at the right time and point of care. The data that is collected needs to be reliable and clean. This sounds simple and straightforward, but in a clinical setting, the challenges can be enormous.

Recently I asked various departments heads what they considered the source of truth for their clinical information for decision making. Six department heads gave me six different answers. They were all using their department reporting tool as the best source of data. As they went along and identified data discrepancies, they fixed these in their own departmental systems, but problems in the original source data were neither corrected nor investigated. Each thought the problem was that the nursing teams had entered the data incorrectly. No one had focused on the data integrity in the primary system.

This breakdown in the data management process highlights the fundamental importance of adopting an overall data governance structure to support data decisions. It reminds me that we all need to examine data design and data management processes to make sure we are capturing the right information at the right time. This critical analysis can point out workflow problems like the one my client encountered, where well-intended workarounds had compromised the integrity of their whole system

Talking to and observing frontline staff is a great way to discover workflow problems that may be undermining the success of your EHR. For example, I once watched a nurse scan a page full of labels before administering a new medication. He did not scan the wristband where the patient identification data was stored until after he had administered the medication. Therefore, he was using the system and accessing stored data, but the order was out of sequence.

This kind of problem will not turn up in a status report from your CIO, which may be more focused on the number of support tickets generated or the ratio of downtime. Clinical leaders have to get to the front line – to the hospitalists or nursing managers – to find out how well the system is working and where there are difficulties.

Finally, fixing workflow issues that compromise data integrity requires a continual emphasis on training. People can only learn so much when you first bring your system live. On an ongoing basis, organizations must invest in management skills training to help clinicians more effectively use these new tools.

Whether it is helping a nurse manager better monitor the nurses who are capturing electronic data or working with a chief medical officer so that they can look at reports and understand what’s happening with their medical staff, training is essential and goes far beyond your go-live.

Cynthia Davis is a principal with CIC Advisory of Clearwater, FL.

Readers Write: What Would Steve Jobs Say?

What Would Steve Jobs Say?  
By Tom Furr

When you purchase a song on your iPhone, do you have to search for it in one application then toggle over to a different application to pay for the tune and then toggle over to another application to listen it? The answer is no. The brilliance of iTunes is that you can do it all within that one application. It is a single application that performs multiple tasks.

What iTunes is and how it works did occur to me while at a conference on “healthcare innovation.” All the speakers there talked about how users would have to exit out of or toggle from the practice management software to log into a payment portal after having downloaded data.

I wondered what Steve Jobs would say about the user experience in healthcare? I imagine it would not be favorable. I asked my fellow attendees this very question. The standard response was, “This is just how healthcare works.” To me, this is just unacceptable.

There are about 300 vendors offering practice management software. I suspect most of those applications require users to toggle out to access a partner’s application. All this raises the question: why don’t practice management software vendors make the user experience a selling point?

A little reconnaissance will show that your users do not like to toggle from application to application. Case in point: moving from your practice management software to a billing application or a clearinghouse portal and then to a reconciliation spreadsheet. Toggle. Toggle. Toggle. Users want to see and do everything on one screen within the practice management software. Have it all in one place.

If you’re not attuned to the usage preferences of those dealing with your software every day, you are putting your long-term viability at risk. A kludgy user experience puts vendors at risk with the rise of new, innovative vendors willing to address design and usability as Steve Jobs did religiously.

Usability is what differentiates and provides an edge when competing for users and market share. I would suggest you look at how BlackBerry is doing today versus Apple or Samsung to see just how much value your consumers place on ease of use.

Like Apple has done, how do you keep your current customers fiercely loyal to your product, attract new ones, and drive your competitors crazy trying to keep up? Keep their experience with your product in mind at all times and move quickly to embed all functions of their day into your practice management software and eliminate the need to toggle. You create a unified user experience, put up significant barriers to switching, and drive greater revenue as your customers become your greatest salespeople. Just like Apple.

It’s worth noting the words of Steve Jobs: “Innovation distinguishes between a leader and follower.” It’s time for you to be the innovator.

Tom Furr is CEO of PatientPay of Durham, NC.

Time Capsule: If Uncle Sam Doesn’t Like Healthcare Administrative Costs, Why Did He Create Them?

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

I wrote this piece in June 2008.

If Uncle Sam Doesn’t Like Healthcare Administrative Costs, Why Did He Create Them?
By Mr. HIStalk

Want to defraud Medicare? Apparently it isn’t very hard. A recent high school dropout started punching in fraudulent claims from a kitchen table laptop and didn’t stop until she hit $100 million worth, many of them paid without question. Another news story talked about hospitals that have been charged with overbilling the government, insinuating they did it intentionally.

Certainly there are plenty of crooks in healthcare and I hope they’re all locked up. On the other hand, the payment system is extraordinarily convoluted and complex. Put a microscope to the high volume of transactions submitted by the average hospital and a sharp auditor could no doubt find a few inaccurate ones. It’s just electronic claims Nintendo, moving imaginary paper back and forth with little added value, so it’s not perfect.

It’s like the tax system. Magazines used to take fictitious family situations and ask big-name accountants to figure their tax liability. The results were all over the place, with each accountant defending his or her interpretation of the tax code. Nobody could say for sure what the right answer was. You can bet, though, that if you’re audited, that low-ranking civil servant who’s making you sweat will pick a big number and it’s up to you to argue otherwise. They don’t see it as your money at all.

The common element is the federal government and its entourage of special interest groups, lobbyists, and consultants. They don’t have an incentive to make anything simple, especially if that would result in claims getting paid more generously or quickly.

Besides, the government is going broke, mired in national debt that would take generations to pay off even if the federal budget were balanced today. Paying less than providers bill or deserve buys the politicians a little more time before the economy goes up in flames.

Old-timers remember that hospitals first bought computers to support complicated Medicare reimbursement. It was like an arms buildup, though. Once Uncle Sam got computers of its own, we were back to square one. The government demands the most tedious, obscure, and hard-to-capture information from providers, even though nothing useful ever seems to come from it.

They created the nightmare that is healthcare billing, a nasty by-product of what a lot of folks back then called a socialist experiment in which politicians inserted themselves between providers and patients. With that came insurance companies and a never-ending increase in costs.

Think about that the next time a gasbag politician starts whining about the administrative costs of healthcare and the huge chunk of GDP they consume. Uncle Sam, as the biggest payor, is the also most demanding, bureaucratic, and arrogant. On top of that, it blames providers for being inefficient. Can you imagine?

I’m glad the government is occasionally and uncharacteristically prudent. Sometimes it seems it has gone beyond that in healthcare. You get the feeling that it can’t afford the care that politicians have promised to voters and the only way to hide that fact is to intentionally pay providers less than they are entitled.

On the other hand, be careful not to make a mistake. Once you hit $100 million or so, somebody might start asking questions.

Morning Headlines 2/22/13

A Digital Shift on Health Data Swells Profits in an Industry

The New York Times runs an article criticizing the HITECH act as government waste lining the pockets of special interest groups. It goes on to villainize vendor executives, specifically Allscripts CEO Glen Tullman, suggesting that lobbyists for the industry pushed the legislature through Congress.

GetWellNetwork Achieves Record Growth for Third Consecutive Year

GetWellNetwork announces 30 percent growth in revenue, 50 percent growth in employees, and a 57 percent increase in new beds during 2012.

Sunrise Portfolio’s Open Architecture to Help Enhance Patient Care in an Integrated Environment

465-bed Phoenix Children’s Hospital adds Sunrise Ambulatory, Sunrise Financial Manager, and Allscripts Community Record to its existing Allscripts platform.

Reduction in medication errors in hospitals due to adoption of computerized provider order entry systems

A systematic literature review of the effect of CPOE on medication errors finds that processing a medication through a CPOE system decreases the likelihood of an error occurring by 48 percent.

The HIT Productivity Paradox — It’s Gonna Be OK

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

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

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

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

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

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

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

From Wikipedia:

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

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

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

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

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

News 2/22/13

Top News

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

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

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

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

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

Reader Comments

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

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

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

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

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

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

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

HIStalk Announcements and Requests

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

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

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

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

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

HIMSS Conference Social Events

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

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

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

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

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

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

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

Acquisitions, Funding, Business, and Stock

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

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

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

Sales

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

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

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

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

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

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

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

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

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

People

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

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

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

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

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

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

Announcements and Implementations

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

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

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

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

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

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

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

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

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

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

Government and Politics

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

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

Innovation and Research

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

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

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

Other

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

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

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

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

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

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

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

Sponsor Updates

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

EPtalk by Dr. Jayne

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

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

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

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

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

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 2/21/13

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

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

VA CTO Peter Levin to leave agency

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

Express Scripts accuses Ernst & Young of stealing trade secrets

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

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

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

The Skeptical Convert 2/20/13

Angry Birds vs. The Fruit Altimeter

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

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

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

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

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

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

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

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

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

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

HIStalk Interviews Keith Ryan, President, Cornerstone Advisors

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

Tell me about yourself and the company.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Are hospitals still interested in return on investment?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Any concluding thoughts?

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

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

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

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

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

Morning Headlines 2/20/13

Allscripts Healthcare swings to loss

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

Merge Reports Subscription Backlog Up 82%

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

iMedicor Announces Two Acquisitions, Four Corporate Appointments

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

Bayada prescribes 4,000 Samsung Galaxy Tabs for homecare nurses

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

News 2/20/13

Top News

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

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

Reader Comments

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

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

HIStalk Announcements and Requests

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

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

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

HIMSS Conference Social Events

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

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

Acquisitions, Funding, Business, and Stock

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

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

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

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

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

Sales

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

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

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

People

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

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

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

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

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

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

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

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

Announcements and Implementations

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

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

Government and Politics

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

CDC releases Solve the Outbreak, a free iPad game.

Technology

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

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

Other

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

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

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

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

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

Sponsor Updates

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

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 2/19/13

Speech Recognition Tools Look to Play a Crucial Role within EMR

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

Obama Seeking to Boost Study of Human Brain

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

A sensational breakthrough: the first bionic hand that can feel

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

Curbside Consult with Dr. Jayne 2/18/13

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

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

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

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

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

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

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

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

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

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

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

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

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

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

E-mail Dr. Jayne.