From HIMSS 3/2/13

From AlohaSally: “Re: acquisition. Word on the Street is that Epic consulting company [company name omitted] just sold for $40M. Not shocking as I’ve heard stories owners were focused on building to cash in. Will they maintain culture under new identity?” We asked the company, which said they would provide a response but haven’t so far. The wording of their reply and the timing of the rumor give me the feeling that something is indeed afoot. A transaction in that price range would probably warrant a Monday morning announcement, especially assuming that companies with $40 million to spend know how to publicize themselves. As to your question, I don’t know if I’ve seen an example yet where an acquired company’s culture isn’t replaced almost immediately with that of the acquirer, sending some of the consultants and sometimes the clients themselves fleeing depending on the degree of change. It’s like a software vendor forcing clients to migrate from a retired product to another company offering – it may be perfectly fine, but it’s not what you signed up for.

Perhaps I should title this “From New Orleans” since the conference hasn’t started yet as I write this Saturday. In any case, I arrived with no problems. The airports were teeming with spring breakers headed to Mexico and other warm climes. The New Orleans airport, which seemed to me to be small and old, was already overwhelmed even though most of the ingress will be Sunday. Taxi lines were running 30-45 minutes, so who knows how bad it will get Sunday since the number of cabs is finite. 

The cab fare to downtown is a fixed $33 for 1-2 passengers, and don’t even be tempted to save a few dollars by taking the shared shuttle, which earns nearly universally negative reviews. Single travelers, which I would guess make up the majority, would be better off to self-organize the line into groups of two or three folks going to the same or close-by hotels, thus not only saving time and money, but freeing up a cab for someone else. Thank goodness a new law (which the taxi companies threatened to strike over) requires cabs to accept credit cards, which any city hoping to lure visitors should do.  

My impressions of the ride from the airport to my hotel, courtesy of the billboards lining the rather unattractive route: people come to New Orleans to eat, buy hot sauce, and visit strip clubs.

I mentioned that HIMSS dumped me off to a hotel I didn’t reserve when mine became oversold even though I made my reservation in September (how did that happen?) Note the fine craftsmanship on the bathroom door that $200 a night gets you (yes, that’s a half-inch of nothingness between the knob and the closest available wood). The “we care about the environment, so don’t make us wash your towels” sign is adjacent to a faucet that leaks in a constant stream and the full-length mirror threatens to fall off the door since two of its six holders have broken off. At least the Internet speed is good (until everybody else checks in Sunday), the bed and TV are huge, and the location is excellent.

Weather wise, it’s around 50 and mostly cloudy (downright gloomy at the moment) with a freeze warning in effect for tonight, with similar weather predicted for Sunday before a big warm-up Monday. It’s slightly springy with green grass and early leaves.

I’m patting myself on the back for my wise decision after suffering through too many HIMSS conferences trying to write voluminous HIStalk posts using the Chiclet-style keyboard of my intentionally small laptop. This time I prepared by buying a USB-powered trackball and full-size keyboard, having realized that the screen size isn’t the main challenge, it’s the input devices, and they take up almost no luggage room. 

Sunday is open for me since I didn’t sign up for any of the paid workshops, so I’ll just stroll around a bit, drop by the convention center to pick up by badge, and stop by the opening reception. It’s not only cheaper to fly in on Saturday, it makes Sunday a relaxing day.

I see on Twitter that bunches of HIMSS attendees are limbering up their fingers preparing to unleash a non-stop barrage of tweets about everything they see and hear all week. The online noise will be deafening, so I would guess that nobody’s going to read most of what’s being indiscriminately spewed.

Inga, Dr. Jayne, and I will be posting all week. Send us anything we should include – photos, rumors heard, and insightful observations. We never seem to get enough HIStalkapalooza pictures to satisfy everyone, so snap some shots there Monday evening. Help us figure out the prevalent themes of the conference since attendees often miss the forest for the trees (and the social distractions.) News and rumors will abound and we like hearing reader reactions.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Readers Write: The Art and Science of HIMSS Networking

The Art and Science of HIMSS Networking
By Jodi Amendola

By now you have scheduled your meetings, RSVP’d to all your party invitations, and if you’re a Type A personality, you’ve probably already packed your briefcase and most of your suitcase. But you still have some prep work to do if you want to maximize the benefits you receive from attending HIMSS, which remains the best annual forum for networking with prospects, customers, the media, industry analysts, and potential partners.

To achieve success with your networking efforts you must:

1) Know what you want to accomplish (e.g. networking, media interviews, intelligence gathering, lead generation, scouting new partners and/or business opportunities, etc.;

2) Be prepared; and

3) Follow up on your leads after the show.

Sounds pretty simple, right? But the key isn’t accruing a stack of business cards, reciting well-rehearsed talking points, or sending follow-up e-mails before your plane touches down at your local airport. Those activities will probably yield some results, but to achieve the greatest possible success you should think quality vs. quantity.

Just between us… the real secret for getting the most out of HIMSS is getting people to listen—not just hear—you, and to remember you and some of what you discussed. Ideally, you will provide at least one “light bulb” moment that resonates and sticks with your audience. And that’s not simple–or is it?

Below are my secrets for building relationships with the movers and shakers at HIMSS. Remember, you will be competing with lots of noise, hype, giveaways, competitors claiming they’re as good or better than your company, short attention spans, and overstimulated brains. Here’s some tips:

• You never know where your next lead or opportunity will come from. While it might be a pre-planned meeting, you may meet your next business partner or client in the elevator, waiting for or sharing a taxi, or like one of my colleagues, waiting in line at Starbuck’s. Don’t be shy. Smile and take the opportunity to prospect, but do so in a friendly, conversational manner.
• Industry pundits, analysts, and editors are overwhelmed with people and pitches. To break through the trade show tinnitus, you need to be different and compelling. That doesn’t mean you have to be a comedian, the ultimate social butterfly, or the next Steve Jobs. You do have to be you authentic and passionate in certain areas – no one wants to talk to a robot — but be concise and to the point. Why? Because, in reality, you are selling yourself first and your product or company second.
• Get organized. Plan ahead and figure out what you want to say to the various types of professionals who attend HIMSS. You may want to stress different information and benefits depending on whether you’re talking to a CIO, a CMIO, the head of contracting services, or the vice president responsible for performance improvement. Remember you may only have 30 seconds to deliver your elevator pitch and capture someone’s attention so make it relevant. It’s okay to weave in humor if it feels natural, but don’t force it.
• Explain what your company does in simple terms. No marketing fluff — just tell them what you offer and explain why they should care. Be specific about the pain points that your product or services address. This information, framed within a question and answer format, is often an effective means to capture their attention. “How much time do providers waste trying to reach patients about lab results? An average of six calls back and forth. In addition to that time drain, patients become frustrated as they wait for days to hear their diagnosis. With our solution, patients are instantly alerted with a text or e-mail the moment their lab results are available.”
• To break the ice or establish a personal connection, learn and share something personal during your meetings. What’s their best stress reliever during HIMSS or their trick for enduring flight delays? If they are more reserved, start by sharing a story about you, such as how much you’re looking forward to your daughter’s nightly rendition of “If You’re Happy and You Know It” via Skype.
• Try to include easy-to-understand metrics. “Our hospital clients have seen a 40 percent average increase in patient satisfaction within six months of implementation. Patients love it. Providers love it. It’s a win-win.” You can always follow up with more complex data after HIMSS.
• Do some research to prepare for scheduled meetings. For example, if you have media interviews, review their 2013 editorial calendars for relevant future article topics and weave those specifics into your conversations. “Our Chief Technology Officer is deeply involved with helping our customers achieve Meaningful Use Stage 2 requirements. We’d be happy to provide her as a resource for your August Roundup on Meaningful Use or as a sidebar to your October article on EHRs.”
• Express appreciation for their time, reiterate the calls to action, and leave them with a smile. “Thanks again, Bob. I’ll contact you next week regarding the August and October columns,” or, “Great to meet you Steve. I’m impressed with your commitment to ongoing performance improvement. I’ll be in touch next week to go over how we can help.” It’s always a good idea to let them know that, “If you ever need my help, just give me a ring or send an e-mail.” Remember, networking is a two-way street.
• Fulfill your promises. Follow up with an e-mail within a week regarding the opportunities discussed. Don’t forget to mention at least one of the personal aspects that surfaced, such as, “Did you enjoy your tour of the Garden District as much as you expected?” or, “Were you able to get your Starbuck’s before your important meeting?” They’ll notice and appreciate that you cared enough to pay attention.

Truly connecting with people is both an art and a science, as any great leader will tell you, but it’s less daunting if you remember that you’ll mostly be relating to one or two people at a time. The important thing is to be yourself. Smile and they will smile with you. Networking doesn’t have to be a chore or intimidating. Showing up prepared with the right attitude can even make it fun as well as profitable. Have a great HIMSS!

Jodi Amendola is CEO of Amendola Communications of Scottsdale, AZ.

Time Capsule: Want Doctors to Use EMRs? Find a More Effective Strategy than Shame

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.

Want Doctors to Use EMRs? Find a More Effective Strategy than Shame
By Mr. HIStalk

Doctors are generally pretty smart. We agree on that, right? So why does the healthcare IT industry keep treating them like idiots?

A new, ultra-expensive study found that doctors aren’t exactly flocking to EMRs (it took an expensive study to determine that?) The hidden message: somebody has to do something to get those dummies to buy EMRs.

EMRs are, in other words, so darned compelling that prospects should be shamed or maybe even forced into buying them for the public good, kind of like seat belts (imagine some models of seat belts that cost $50,000 and require 30 minutes extra every time you start your car.)

In America, doctors are business owners, even though some people think that’s a distasteful concept. They have customers, employees, overhead, and equipment. They make good business decisions or they go broke. You can’t help patients if your practice tanks.

Many of those smart business owners don’t see the value of EMRs. They understand that EMRs might improve patient care in some cases, but the practical and immediate considerations of their cost, support, and time requirements win every time.

Doctors won’t use EMRs just because non-doctors preach at them. They will not be shamed for sticking with paper when it makes personal economic sense. Societal benefit aside, they have to protect their income and their time (which are synonymous).

EMRs, in other words, are no different than any other piece of medical equipment that the doc/business owner might buy. It’s a logical decision made by a smart person. If I’m a doctor, my decision tree might look like this.

First, can it make me money? Doctors buy fancy imaging equipment because they can bill the heck out of it under current reimbursement rules. EMR assembly lines would have to run night shifts to crank enough of them if docs could bill for their use. They can’t, which means payors (including patients) aren’t convinced about EMR benefits, either.

Second, would having an EMR give me competitive advantage? Here’s a question that gives you the answer: would you go find a new doctor just because your old one, who just happens to be the greatest doctor you’ve ever known, doesn’t use an EMR? Neither would all those Joe Sixpacks who are prodded by industry polls into saying that EMRs are essential, but who in reality don’t care whether their own doctor uses one or not.

Third, will using an EMR get me sued less? You’ll know that’s true when medical malpractice insurers give significant discounts to EMR-using doctors.

Fourth, when it breaks, who do I call? Doctors are not hospitals, with their separate department of nerds anxious to tackle the latest problem due to operating system quirks, software upgrades, driver incompatibility, and user errors. The Geek Squad guy is not only expensive and not found in most American towns, he also doesn’t know much about EMRs.

Sticking with the “how we do things here in America” theme, here’s how you get doctors to use EMRs. Make them faster, easier to use, and better supported to the point they provide inarguable business and clinical value, no different than a fax machine or an office PC. In other words, don’t just complain about paper — beat it in a fair fight.

And once you figure out how valuable EMRs are, make the person who gets that value pay for them.

Readers Write: Remote Control: Why Remote Consulting Works for HIT

Remote Control: Why Remote Consulting Works for HIT
By Casey Liakos

With the recent proclamation by Yahoo’s CEO Marissa Mayer that all company employees must work in a Yahoo office, the business world and Internet have been abuzz with arguments for or against this decision. Remote work is something that is on our minds often since it is a service our consulting firm offers in the EHR/Epic space. We haven’t seen anybody join the debate with a specific focus on EHR or Epic consulting, so we thought we’d chime in.

What Yahoo is requiring is really an apples-to-oranges comparison to the onsite/remote debate in EHR consulting. These are two different industries with two different sets of circumstances, and Yahoo’s decision clearly has no direct bearing on the HIT world. But there are corollaries between the two, and we think this is a good time to spur some discussion.

It should be pointed out that we are big fans of Mayer. She’s an inspirational figure in many ways, and above all, she’s from Wisconsin. So we have her back.

Time will tell whether this decision will benefit Yahoo, and there’s no shortage of people who feel strongly about it one way or another. But when we look at remote vs. onsite strictly through the lens of EHR/Epic consulting, we think that the logic Yahoo used in this decision is all wrong.

Why EHR projects are a natural fit for remote consulting

We are not advocating for all HIT consulting to be handled remotely. But we strongly believe that there are certain project phases and key areas where it just makes sense.

By now there have been countless philosophical points made on both sides of the Yahoo debate. But to our company, there are two factors that need to be considered, and these are the only two that truly matter when it comes to assessing value of a consulting purchase: productivity and cost.

Productivity

The remote services model that we offer to our clients has several key advantages when it comes to productivity. First, it puts resources on your team for the entire week. Traditional consulting practices have resources working Monday through Thursday – but of course your business doesn’t stop on Friday. Remote consultants can work a schedule to match your team’s hours, which brings an instant productivity boost.

Another factor that people may forget is that the technology available to us today makes remote work nearly seamless. I don’t need to go into detail — we all know many technologies that can put someone “in the room” when needed. With widespread remote system-access tools and file collaboration products already implemented in your organization, the remote consultants don’t miss a beat.

In fact, there are strong arguments to be made that communication can actually improve with a remote services model. A recent Harvard Business Review blog entry about working remotely makes some nice points:

• Proximity breeds complacency. I’ve worked with leaders who sit in the same office with those they manage but go for weeks without having any substantive face time with them. In fact, they may use e-mail as their primary source of communication when they sit less than 50 feet away. It’s even worse if they sit in different parts of a building or all the way on another floor. This is not to say that these leaders are in any way lazy, just that because the possibility of communicating is so easy it is so often taken for granted.
• Absence makes people try harder to connect. When I managed a team of professionals in nine locations, I made a point of deliberately reaching out to each of them by phone at least once a week and frequently more often. I’m not an anomaly here. Most leaders I work with make an extra effort to stay connected to those they don’t ordinarily run into. They can see that taking even a few minutes to talk about what’s happening in their respective worlds before addressing the tasks at hand makes a difference in maintaining the connection with a colleague. What’s more, because they have to make an effort to make contact, these leaders can be much more concentrated in their attention to each person and tend to be more conscious of the way they express their authority.

Note: we’re not necessarily advocating working from home, which can potentially present its own set of distractions. Our remote teams work together in client teams, primarily from our company offices. This minimizes distractions, encourages collaboration, and helps solve customer issues quickly.

Cost

The most obvious cost savings with remote consulting is the rate. When priced correctly, this model can save your organization a boatload of money over the course of the engagement.

The other key savings with remote work come with eliminating travel expenses. Flights, hotels, rental cars, meals… these are very real and often prohibitive factors when your project requires outside help. With tasks like build, testing, and system bug/incident resolution, the work can almost always be done remotely if managed well. Why pay a huge premium to stick the resource in a cube down the hall all day?

The cost savings of using remote consultants go much deeper than just hard dollars saved on rate and expenses. Easy administration indirectly saves you money. Managing office space, computers, telephones, security badges, etc., all carry a cost that you can eliminate. With remote consultants working from their firm’s offices, these costs are incurred by the firm, not the client.

There’s inherent stability associated with remote consultants as well. Turnover is much less of an issue when you have happy team members sleeping in their own beds every night. The cultural and organizational learning curves associated with consultant turnover carry a large cost that can be eased greatly with a remote model.

Most importantly, we feel remote consulting is the most cost-effective way to find and hire the best consultants for the job. Think about it in the context of Epic. Many of the very best Epic minds and most experienced resources are former Epic employees. A great number of these folks no longer work there because of the travel burden associated with being at customer sites every week.

Epic is a great place to work for a million reasons, but it should be no surprise that the #1 reason cited for leaving Epic is the heavy travel. Hiring remote consultants is the best way to gain access to these resources. They still want to work on Epic projects, they just don’t want to travel or can’t due to family obligations.

Tips for making remote engagements successful

Even if the consultants work remotely, you are still the manager. Speak with consultants or get a status report at least weekly. Any resource that is ignored, whether onsite or remote, has the potential to be working on the wrong things at the wrong time.

You and your team should be responsible for funneling work to consultants. This is the #1 hurdle we’ve seen: getting hyper-productive consultants enough work to stay busy. When all else fails, give them a brand new project to plan and execute from the ground up and watch what they can accomplish with a little support from your team and SMEs.

Make remote workers part of your team. Make sure they’re involved in all team meetings, e-mail lists, and communications.

You are not Yahoo

Many have attributed Marissa Mayer’s decision to the need to foster more innovation within Yahoo. Time will tell whether this move helps achieve that goal. HIT projects require organizations not only to be innovative, but to move quickly and get things done in a cost effective way. For this, a remote consulting solution can be an excellent option.

Casey Liakos is client relations director of Vonlay LLC.

Monday Morning Update 3/4/13

From HyWay: “Re: Costco. They sent an e-mail to customers who purchased Allscripts MyWay through Costco’s program saying they are working with Allscripts to ‘offer solutions for members who do not feel the move to Pro is right for them.’ In the mean time, Costco has initiated arbitration proceedings against Allscripts to make sure its users get the service they expected when they bought MyWay.” Unverified, but the forwarded e-mail appears to be authentic. Its tone was amicable.

From The PACS Designer: “re: iWatch. While we wait for the anticipated Apple iTV later this year, there’s something else to look forward to and that’s an Apple iWatch. TPD posted about the Pebble watch, and speculation is that the so called iWatch will be much more innovative and unique in its style and features. Apple has a patent requesting pending on a Amoled flexible wristband device to consider as the possible final product launch, or it could still be a traditional watch similar to the Pebble.”

I’m actually writing this Friday night since I’ll be traveling to New Orleans on Saturday, so don’t be confused when I also post on Saturday and/or Sunday and the days look goofy. Inga, Dr. Jayne, and I will be writing profusely from the HIMSS conference, and to avoid giving you inbox fatigue, I’ll collect the individual links into a single e-mail blast each day.

People of Groupon, after four and a half intense and wonderful years as CEO of Groupon, I’ve decided that I’d like to spend more time with my family. Just kidding – I was fired today. If you’re wondering why… you haven’t been paying attention … As CEO, I am accountable. You are doing amazing things at Groupon, and you deserve the outside world to give you a second chance. I’m getting in the way of that. A fresh CEO earns you that chance … For those who are concerned about me, please don’t be – I love Groupon, and I’m terribly proud of what we’ve created. I’m OK with having failed at this part of the journey … If there’s one piece of wisdom that this simple pilgrim would like to impart upon you: have the courage to start with the customer. My biggest regrets are the moments that I let a lack of data override my intuition on what’s best for our customers. This leadership change gives you some breathing room to break bad habits and deliver sustainable customer happiness – don’t waste the opportunity! I will miss you terribly. Love, Andrew.

Secure Threads introduces bring-your-own hospital gowns intended to prevent medical errors by having the patient’s name, blood type, allergies, age, medical conditions, and emergency contacts embroidered into the fabric.

Safe travels and an enjoyable and productive week for all those traveling to New Orleans. For those who aren’t attending, feel free to goof off all week while your boss is away.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 3/1/13

House panel blasts DoD for overlooking VistA

After cancelling iEHR plans, DoD is facing pressure to consider VistA as an alternative that would allow DoD and the VA to continue with plans of adopting a single system. DoD has instead issued a RFI for a commercial solution, leaving many speculating that they will follow the Coast Guard’s path toward Epic.

Why Vocera Communications Shares Tumbled

Vocera announces Q4 results: revenue increased 24 percent to $27 million, EPS was $0.10 vs $0.07. Stock dropped almost 10 percent after guidance was adjusted for first-quarter forecasts. Vocera reported guidance of $23 million to $25 million, far less than analyst expectations of $28 million.

Kaiser Permanente Ventures and CHV Capital Participate in $8M Extension of $41M Series B Investment in Health Catalyst

Health Catalyst adds $8 million toward its $41 million Series B round, with contributions from Kaiser Permanente and CHV Capital.
 
Resolute Health selects Allscripts Electronic Health Record

Currently in construction, Resolute Health Hospital, of New Braunfels TX selects Allscripts as its EHR in preparation for its spring 2014 opening.

St. Vincent’s Health Partners, Inc. Selects McKesson To Help Reduce Risk and Drive Better Health

St. Vincent’s Health Partners will implement McKesson’s new population health application, recently secured through the McKesson’s acquisition of MedVentive.

Making The Transition: What the iEHR Failure Means for Veterans

This article was written by Lt. Dan,who writes for HIStalk Connect and provides daily headlines on HIStalk.

After eight years of service — during which I traversed seven countries across three continents, lived in three states, and had the privilege of working alongside the very best, brightest, most dedicated, honest, and sincere men and women I have ever known — the time finally came in November 2009 for me to walk away. I signed my discharge papers on November 11 (Veterans Day), got in my car, and drove off base for the last time. I was sad, scared, and very excited.

Fast forward three months. I am sitting in a doctor’s office, about to have a physical from my new PCP. The office was clean; the staff was polite. This was nothing like sick call, where all ailments were treated universally with a prescription for Motrin 800 and a return-to-work slip. During the appointment. my doctor told me to send him my medical records from the Army.

I tracked down the clinic on the base I’d been assigned to and asked for my medical record. They told me it had been forwarded to the US Army Human Resources Command. I called them. They said that they didn’t have my records, didn’t know where my records were, were not responsible for processing requests to access said records, and suggested that I call the VA.

Undaunted, I did call the VA. They told me that US Army HRC was probably misinformed because they should have my records, but to be certain, I would need to fill out some forms, mail them in, and wait for an estimated 90+ days.

At this point, it was beginning to sound like my medical records were having a far worse go of it in civilian life than I was. I told them never mind, the whole thing seemed pointless since I knew everything that was in them and could just tell my PCP the history myself the next time I saw him.

When I went for my first civilian dental exam and was asked if I had a dental record, I was smart enough to just say no. To date, I still don’t have my military medical records and probably never will.

Transitioning out of the military is not easy. It’s moving long distance back to your home town and finding a new job. It’s changing the way you talk so you don’t accidently swear in a business meeting, or call a 22-year-old co-worker “ma’am.” It’s learning to make friends with people you don’t have something intimately in common with. It’s a good bit of doubting yourself and whether you are going to be good at this very different new life.

This stress is exacerbated by an estimated 35 percent prevalence of PTSD in returning veterans, and an estimated 20 percent prevalence of traumatic brain injury, which along with more traditional disabilities, has resulted in nearly 50 percent of departing veterans requiring disability services from the VA.

When that 50 percent of discharged veterans leave the military, their healthcare is transitioned from DoD facilities to VA facilities. The hope is that this will one day be seamless. For now, before the VA will provide services, soldiers submit a disability claim to receive approval to start receiving benefits.

Herein lies the problem. It takes an average of 277 days from the time a claim is submitted until the time a decision is made, much higher than the VA’s stated goal of 125 days. During this waiting period, veterans are left in limbo without access to services or entitlements. There is new policy in place that will allow a departing soldier to submit a disability claim with the VA prior to exiting the military, but currently they can only submit 180 days prior to their discharge date. Helpful, but another example of the needs of the veterans getting lost in translation with the policy makers.

The enormous disability claims backlog has made national news for more than a year now because it is larger than it has ever been in our nation’s history, approaching 1 million claims. Veterans who are leaving the service are usually dealing with a new job, a long distance move, and basic emotional transitions and simply do not have the energy to tackle another exhausting problem in their lives. But the VA’s disability claims process has become exactly that, an exhausting problem in the life of veterans who need services.

Over the last several years, the VA has put in place a plan to correct the disability claims backlog. It was a two-tiered technology implementation plan that involved developing iEHR, which would reduce the time it takes for veterans’ medical records to make their way to disability claims processors. A new disability claims automation system was expected to reduce the time and resources required to process a claim. These two projects were expected to solve the backlog, and so they were heavily funded and highly prioritized.

The disability claims system, called the Veterans Benefits Management System or VBMS, was a $500 million system that began its implementation this past summer. It hit the ground with a loud thud despite the fact that a significant portion of its allocated funding was spent.  The implementation has been mired in delays and functional issues that have repeatedly sent engineers back to the drawing board.

In June 2012, VA CIO Roger Baker acknowledged the issues in an interview, saying, “In mid-December, the volume of VBMS usage grew rapidly as users from the 18 [regional offices] were added. VBMS began to experience dramatic slowdowns in response time for some users, especially during peak usage hours. A root cause analysis determined that the issues were due to the way data is being read from disk storage. Since the impact was considerably more read/write work for each transaction, it had a greater impact as more users attempted to perform work on VBMS.” The initial recommendation was to halt any non-critical tasks, but the permanent fix will require a significant redesign.

VBMS was initially scheduled to complete its implementation across all VA processing centers by the end of 2012. At the close of 2012, just 5 percent of claims processors were using the new system. The implementation timeline has now been pushed out until the end of 2013.

iEHR was also conceived as a way of tackling the benefits backlog. The overriding goal of iEHR was to bring all stakeholders in the transition of veterans’ healthcare under one system to allow for a fundamentally more streamlined process for both soldiers and benefits processing for the VA. Summarized best by California House Representative Jeff Dunham during a recent hearing, “Those who have volunteered at a time of war … if they come home tomorrow, they ought to be in the (electronic-record) system tomorrow, knowing what benefits they will receive … and that it doesn’t take a 5-day or a 50-day system.”

iEHR was halted on February 5 after officials within DoD and the VA realized that the total cost to develop the system had grown to more than $12 billion, more than double the original $4-$6 billion estimate CIO Baker quoted at the onset of the program. Following the announcement, the VA and DoD went back and forth over whether it would be feasible for DoD to implement the VA’s VistA EHR as a Plan B that would allow both organizations to operate within one EHR and maintain the overall goal of a unified system that could streamline the transition process for veterans.

In response to this idea, the Assistant Secretary of Defense for Health Affairs said “The current VistA system is a generation 1-plus-2, in terms of how we look at electronic health records. Industry is already at a generation 3 and moving to a generation 4. We would need to assess what’s required for us to bring VistA over, modernize it, and (calculate) what the total cost of ownership would be over time." On February 8, DoD announced that it was launching a vendor search, ending any hope that iEHR would be revived.

Within the past 30 days, CIO Baker along with VA CTO Peter Levin have been called before the Veterans House Services Committee multiple times to answer to outraged representatives over delays, cost overages, and systematic failures within both programs. For four years, the disability claims backlog grew with no improvement in the pace at which the VA processed new claims. Baker and Levin were the project owners for the two projects that were targeted to address the disability backlog issue. They drafted their plans, spent the money, the projects failed, and all that was left for them to do was resign, which is ultimately what they both did.

Now we have a growing disability claims backlog weighing down the VA. The proposed solutions have failed and the money is spent. Further complicating matters, the government is staring down the barrel of a federal budget sequester that is going to further limit the VA’s options to fix the disability claims backlog.

Meanwhile, a veteran population dealing with almost 10 percent unemployment and an unprecedented 22 suicides a day is going without disability benefits because the system that was designed to support them is fundamentally broken and programs intended to fix these problems are back to square one.

News 3/1/13

Top News

A House panel, obviously fed up by the DoD’s cavalier attitude toward the VA’s VistA system compared to its own AHLTA EHR, demands to know why DoD won’t adopt the highly successful VistA. DoD says it’s looking at VistA yet again, but says it will evaluate it against commercial systems in attempting to “skate where the puck will be” and is concerned about multiple VistA versions and lack of conversion documentation. Congressman Jeff Miller (R-FL), as puzzled as the rest of us about whether VA-DoD will adopt a single EHR or try to cobble their respective systems to merely look like one, summarized as, “It sounds to me like we’re doing a U-turn and going back to the exact same thing again.” Outgoing VA CIO Roger Baker says estimates to develop the integrated system had doubled to $12 billion. One might assume that given Epic’s previous rumored involvement, its Coast Guard EHR experience, and its track record in large and diverse organizations, it might enter the picture in some fashion as the words “commercial systems” are uttered in polite company.

Reader Comments

From Jardone: “Re: Jardogs. A sale to Allscripts is imminent. Layoffs began yesterday, which appear to be across the board. Since Jardogs is owned by Springfield Clinic, no severance will be paid. Today is the last day for many, including myself.” Unverified. I e-mailed our contact at Jardogs inviting a response, but haven’t heard back. Jardogs, which offers patient engagement and health management solutions, is an Allscripts partner.

From Looking Deeper: “Re: MU Stage 2 requirements. Do your readers have tips for getting clarification for questions that aren’t resolved in the documentation? We would like to contact CMS. It’s a shame they don’t have an e-mail address or form.” A reader reports having successfully used this form, selecting “EHR Incentive Program” as the topic. She got a response in three weeks.

From Festus: “Re: coding issues. Jail time?” A 63-year-old cardiothoracic and vascular surgeon is serving a 10-month sentence for Medicare fraud, convicted for upcoding his cases. The US Attorney says his case sends a message to doctors, while professional organizations say that message is that doctors shouldn’t accept Medicare payment because nobody can comply with its complex requirements and now they could be imprisoned for making mistakes. According to the Association of American Physicians and Surgeons, “This precedent criminalizes false statements in a private setting without any proof of billing fraud and a greater interference with the day to day practice of medicine is difficult to imagine.” The doctor’s dictated reports from 10 years ago were found to have specified the wrong kind of graft in two of 2,400 operative reports. He says he was too busy to keep up with the reports and had been told to use a code that was similar if he couldn’t find the right one. AAPS says the irony is that he could have justifiably billed a lot more than he actually did even with the mistake. The charges say the surgeon did more than just choose the wrong CPT code – they say he also falsified his progress notes. It would be interesting to see if those were generated with computer assistance since that’s the only reasonable excuse.

From CEO: “Re: HIStalk. I start every day by catching up and reading HIStalk. It really is a wonderful source of content that helps me keep a good pulse on the industry. Thank you for serving so many of us!!!” Inga was happy to read this CEO’s e-mail in response to receiving his HIStalkapalooza invitation as one of few positive comments we’ve received lately, as most of our recent e-mails are from people complaining about not being invited to HIStalkapalooza because they didn’t register. I suppose I should be flattered that people care that much about attending.

From CatsEyes: “Re: three tidbits. Did you mention that Dr. Tonya Hongsermeier (above) left Partners CIRD to become CMIO of Lahey? Lovely and very smart person. And with Partners, Boston Medical Center, Lahey, and Lifespan all going to Epic. From New Haven to Mid coast Maine – Epic rules.” I left out Tidbit #1 since it involved a sales VP whose new job I couldn’t immediately confirm. I’m dating myself by admitting that when I hear Tonya’s name I still think of her being at Cerner, which she hasn’t been forever.

HIStalk Announcements and Requests

I took an unplanned three-hour field trip to the ER on Wednesday. Of course I asked the staff all sorts of questions about what technology they had in place (and why they were using so much paper.) Turns out I am just fine and my stress over selecting the perfect pair of shoes for HIStalkapalooza does not seem to be a contributing factor. Mr. H, however, thinks all the e-mails begging for last-minute HIStalkapalooza invites may have put me over the edge.

Have you stayed current with HIStalk Practice? If not, some of this week’s highlights include: only 60 percent of physicians are interested in participating in ACOs. ISALUS Healthcare introduces a new version of its OfficeEMR. Memphis Obstetrics & Gynecology Association goes live on MED3OOO’s InteGreat EHR. Practices have an increased need for population patient health tools. I love new e-mail subscribers, so take a moment to register for updates when checking out these stories. Thanks for reading.

Welcome to new HIStalk Platinum Sponsor Forward Health Group, located on Capitol Square in Madison, WI. The orange above looks juicy and that’s no coincidence – the company’s PopulationManager tool serves up QI and outcomes data to health systems that’s fresh, never frozen, squeezing it from your current systems, claims data, or administrative data. It’s accurate, actionable, complete, and timely, not to mention physician accepted at the individual patient level. The founders started out working in public health reporting back in 2004, meaning they had to figure out early on how to extract and aggregate data from a veritable science fair of disparate IT systems to create apple-to-apples measurements (that’s my second fruit analogy if you’re scoring at home.) It’s a fruit punch (fruit reference #3) of advanced informatics, population health best practices, and elegant visual explanations. They’ll set up a meeting or come to you at HIMSS or at HIStalkapalooza to tell you more – just e-mail them. Thanks to Forward Health Group for their berry (#4) much appreciated support of HIStalk. I have a feeling they’re a lot of fun, so you might be on the lookout for CEO Michael Barbouche or docs John Studebaker, MD and Sean Thomas, MD Monday night at Rock ‘n’ Bowl.

I found this Forward Health Group video that talks more about Fresh Data.

Thanks to Levi, Ray & Shoup, which not only issued a press release calling out my recent interview with SVP John Howerter, but used most of it to say nice things about HIStalk. I enjoyed talking with John because I consider myself something of an expert on print spooling-related problems in hospitals (having gotten myself hopelessly stuck in the middle of those problems many times over the years, unfortunately) so I was asking questions from my own experience.

Verisk Health is supporting HIStalk as a Platinum Sponsor. The company builds solutions for every payer type, including medical cost management, government reporting, payment accuracy, and revenue compliance. They can help identify risk, save money, and improve care. Providers interested in accountable care programs need tools for cost control, quality improvement, and population health management, and that also means you would probably benefit from getting a free copy of Verisk’s provider toolkit. Edward Hospital (IL), for example, is using PopulationAdvisor (through Premier) to monitor its clinical and financial performance, combining Premier’s comparative provider database with Verisk Health’s risk-based payer analytics to gain a better understanding of outcomes and cost of care provided both inside and outside the hospital. Verisk Health President Joel Portice has been around the industry for a long time, holding executive roles with Intelimedix, HCI, Enclarity, and Fair Isaac (not to mention that he’s also a novelist). Thanks to Verisk Health for its support of HIStalk.

HIMSS Conference and Social Events

Wen Dombrowski, MD, who tweets under @healthcareWenF, forwarded me this list she compiled of socials, Tweetups, and physician exec events. She is doing a Segway tour Saturday afternoon that sounds particularly fun.

I’m posting this shoe porn for Inga and Dr. Jayne, sent in by the (male) president of a new sponsor who clearly understands their fixation. Very hot.

The weather forecast for New Orleans looks pretty darned good. The mild temperatures suggest open-toed shoes as a viable option. Heavy coats can remain at home, or at least in the hotel room.

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

Acquisitions, Funding, Business, and Stock

Practice Fusion buys 100Plus, a startup co-founded by Practice Fusion CEO Ryan Howard that provides analytics-drive personalized health predictions.

Health Catalyst increases its Series B round by $8 million with participation from Kaiser Permanente Ventures and CHV Capital.

Revenue cycle solutions vendor Cymetrix Corp. acquires analytics vendor CareClarity.

Sales

Resolute Health (TX) selects Allscripts Sunrise Clinical Manager EHR and Allscripts Community Record for HIE and analytics.

Physician-hospital organization St. Vincent’s Health Partners (CT) chooses McKesson Population Manager and McKesson Risk Manager to manage the health of high-risk populations.

PeaceHealth will integrate Streamline Health’s AccessAnyWare enterprise content management solution with Epic ambulatory.

Evolution Health will deploy Greenway Medical’s PrimeSUITE across its national network of house call providers.

Northeast Georgia Health System (GA) will implement McKesson Paragon.

Daughters of Charity Health System will implement CliniComp’s Essentris Fetal mobile EMR in all of its hospitals.

People

API Healthcare names Daryl Joslin (Defran Systems) chief marketing officer.

WorldOne, the parent company of Sermo, names Kerry Hicks (HealthGrades) chairman.

Press Ganey Associates adds Ralph Snyderman, MD (Duke University Health) to its board.

Beverly Bell (CSC) joins Health Care DataWorks as chief nursing officer and VP of implementation services and business performance management.

Announcements and Implementations

City of Hope (CA) implements Harris Corporation’s BI Practice Variation dashboards to identify opportunities for improving clinical outcomes, safety, and documentation.

Other

Athenahealth will invest up to $10 million and lease up to 60,000 square feet of office space in Midtown Atlanta for more than 700 employees.

A CHIME survey finds that the average base salary for healthcare CIOs in 2012 was $208,417, with respondents holding the EVP/CIO title averaging 50 percent more. More than half held a master’s degree, earning 10 percent more than those with a bachelor’s degree. Three-quarters of the CIOs reported receiving a raise of less than five percent in 2012.

The Nashville business paper profiles Shareable Ink President and CEO Stephen Hau. The 50-employee, 82-hospital software company relocated there from Boston in 2010.

Security researchers using CyberCity, a military-developed model city used to study cyberattacks, find that the city’s electronic medical records system is full of security holes. “OpenEMR from a security perspective is a disaster,” overlooking the fact that few if any US hospitals use that particular open source system.

I’ve gotten wind of an upcoming announcement from Michelle Obama’s Partnership for a Healthier America in which several EHR vendors that I won’t name (mostly the usual suspects, with some surprises) will pledge to add five anti-obesity features to their products at the March 6-8 PHA summit in Washington, DC. The features are BMI and weight classification percentiles, activity and dietary assessments, weight goal monitoring, referral to providers and community resources, and the ability to create a Healthy Weight Plan.

In Australia, Canberra Hospital will upgrade its ED system security after several employees were found to be altering patient data to make wait time statistics look more favorable. Most of the employees could not be identified because the EDIS was set up with generic user IDs like “nurse” and “doctor,” with managers claiming that the department could not function if users had to sign on and off individually. The upgrade will include quick logon/logoff. A server crash of the same EDIS caused the hospital to go on diversion Wednesday as the ED went back to paper.

In Canada, doctors in Nova Scotia complain of system crashes and response time problems with their $4 million Nightingale Informatix EMR, for which they were paid $10,000 each in government incentives to use. The company acknowledges software problems.

Cerner is among four dozen medical device and supply vendors that will pass along the new PPACA-mandated 2.3 percent medical device excise tax directly to their hospital customers.

Weird News Andy wonders if Meaningful Use statistics could be similarly fudged. The acting CEO of an English hospital resigns after an investigation finds that Royal Bolton Hospital coded its patient deaths due to septicemia at quadruple the expected rate, with interim findings indicating “cause for concern.” Hospitals get paid more for treating septicemia.

Researchers find that drinking red wine may protect against noise-induced hearing loss. When not drinking Hurricane Ingas, I will make a point of sticking to red wine when club hopping in the Big Easy.

Sponsor Updates

• PatientKeeper will feature a number of hospital executives in Booth #2210 at HIMSS.
• Wellcentive will join the Accountable Care Community of Practice.
• Santa Rosa Consulting will feature The Honorable Tommy Thompson and Fred L. Brown at its customer and industry appreciation event at HIMSS next Tuesday.
• Gates Hospitalists (MO) secures Medicare reimbursement using Ingenious Med’s PQRS Registry.
• Nuance leases an additional 28,000 square fee of office space in Cambridge, MA to accommodate about 175 employees.
• A local paper profiles Lyster Army Health Clinic (AL) and its use of RelayHealth’s secure messaging solution.
• Iatric Systems adds CynergisTek as a reseller of its Security Audit Manager and Medical Records Release Manager solutions.
• Lifepoint Informatics will sponsor the G2 Pathology Institute Conference February 28 – March 1 in Fort Lauderdale, FL.
• CSI Healthcare IT spotlights Evan Ritter, its top sales performer of 2012.
• University Health System (TX) reports a cost savings of over $13 million within a year of contracting with MedAssets for consulting, analytics, and process improvement services.
• Covisint will integrate Milliman’s opportunity-based population analytics capabilities into its healthcare platform.
• AT&T lists six questions to ask healthcare cloud vendors to ensure data security.
• eClinicalWorks  shares details of how Coastal Medical (RI) achieved a 200 percent return on its original investment and improved care coordination utilizing the company’s EHR.
• A Nuance Communications’ survey finds that 80 percent of US doctors believe virtual assistants will change how they interact and use EHRs and will benefit patients by making them more engaged in their own healthcare.
• McKesson names the Bread of Healing Clinic (WI) the company’s first recipient of its Practice Choice EHR software as part of the McKesson Give Back initiative.
• Impact Advisors Principal Rob Faix is featured in a podcast discussing PHI data breaches.
• St. Luke’s Cornwall Medical Group (NY) shares how it increased cash collections by 17 percent utilizing Greenway’s PrimeRCM.
• Mitochon Systems will integrate drug safety information from PDR Network into its Electronic Medical Office platform.
• Merge Healthcare will bundle MModal Fluency for Imaging and MModal Catalyst for Radiology with its Merge PACS portfolio.
• Signature Sleep Services, dba Sleep360, will market and integrate ZirMed’s RCM solutions with its platform of sleep medicine tools.
• Georgia-Pacific Professional introduces the SafeHaven monitoring system, which combines Versus RTLS technology with Georgia-Pacific’s dispensers and skin care products.

EPtalk  by Dr. Jayne

Several readers have asked Inga and me for HIStalkapalooza fashion advice. DO wear sassy bowling shoes or a cool retro bowling shirt. DON’T wear anything from MSN’s list of ugliest shoes of all time.

With HIMSS starting in a few days, my inbox is really filling up. If you’re exhibiting, that means you are a technology company of some kind or at least peripherally in the technology sphere. Up your game (and the chances that your message will actually be read) by proofreading your content and removing tags like that in the e-mail above prior to sending.

Even with a relatively full inbox, it’s a slow news week as everyone saves up their big news to announce at the show. You don’t have to make a big splash at HIMSS to be a success. Vendors are quietly certifying their products for Meaningful Use 2014 and I salute them.

I’ve had a lot of questions about what I’ll be looking at during the show. Rest assured I’m making my list and checking it twice. I plan to spend plenty of time in the far reaches of the exhibit hall looking for the next big thing, so stay sharp because you never know when we might come by your booth.

I’m off to the Crescent City tomorrow and will bring you the news and happenings of HIMSS. For those of you unable to attend, thank you for keeping the availability high, the loads balanced, and the issue resolution times low. We’ll raise a glass in your honor at HIStalkapalooza. Laissez les bons temps rouler!

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 2/28/13

House committee worried DoD, VA ‘moving the goal posts’ on e-health records

VA CIO Roger Baker made his final appearance before the Veterans House Services Committee Wednesday to answer for the cancellation of the iEHR project. He reported that the program was large, complex, and difficult to control. He also acknowledged that both the VA and DoD, could have done a better job communicating changes across the departments. Baker, along with VA CTO Peter Levin, resigned their positions last week.

M*Modal and Merge Healthcare Bring Speech Understanding to Imaging Solutions for Improved Workflow and Reporting

Merge and MModal announce a strategic partnership that will allow Merge to sell MModal’s natural language understanding tools baked into Merge’s imaging and radiology PACS solutions.

Predicting out of intensive care unit cardiopulmonary arrest or death using electronic medical record data

A recent study measuring the ability of EHR-backed predictive surveillance tools to predict cardiac events concludes that the automated model outperformed both manual risk assessments and human judgment-driven risk response teams. The automated model predicted cardiac events 15.9 hours before they occurred and 5.7 hours earlier than rapid response team activation.

Why Telemedicine Is Finally Ready to Take Off

CIO.com points to advances in technology, pressure to reduce costs, and bipartisan political support to substantiate its prediction that 2013 will be a flash point for telehealth adoption.

CIO Unplugged 2/27/13

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

Five Degrees of Separation

I’ll be the first to value talent and experience over education. But let me stir the waters. For those with a degree, you might skip this post. For those without, let me persuade you to stop making excuses and get back to school.

Although not always popular, the fact is that possessing a degree provides separation and increases the likelihood of upward mobility and salary for those with such desire. Bill Gates or Mark Zuckerberg are walking proof to the contrary, but they are also outliers. So get back to school.

I was about to get my MBA when my favorite college professor pulled me aside. Dr. Drennen said MBAs were “a dime a dozen” and to get a unique degree that set me apart. She helped persuade me by throwing in a graduate teaching assistantship and other incentives. With a baby at home and mounting expenses, I enrolled in Consumer Sciences (business from a consumer vantage point).

As the university contracted from 11 colleges to eight, Consumer Sciences was pooled with four other orphans: Apparel Design, Merchandising, Interior Design, and Housing. Preparing for graduation after one intense calendar year, the assistant of this newly formed division was unsure how the diplomas should read. Since I’d been required to take a class in each of the disciplines, I suggested it should reflect this. Sure enough, I was essentially conferred all five degrees. Just don’t ask me to pick out your suits or decorate your home!

Are degrees themselves so important? I suppose you can argue yes when it comes down to being a physician or nurse or engineer. Other times, the course content has little correlation with our eventual work or skill requirements or how well we perform. We all know people with lots of books smarts that can’t find their car in the parking lot. I get that. But something of more fundamental value arises from obtaining a degree than just the diploma.

I entered college at 17. Completely clueless, I ended up with a 1.6 GPA my freshman year. While I had some modest grants and loans, I had to work my rear off to live. I was dirt poor. But I stuck to it. I learned how to study. I learned discipline. I learned budget. I learned goal setting. I learned achievement. My grades improved, and I graduated.

My first roommate was an Italian rocker from the Bronx. I was a shaved-head punk. Our suite mates were nerds, and the guy across the hall a dork. Down the hall lived jocks and geeks with punch cards. Some students worked two jobs like me, while others were on Daddy’s dole. We had drinkers and druggies representing every walk of life. You learned to survive and form partnerships.

Life became complex. Unplugged from home. On your own. Mom wasn’t there to wake you up. You had to make tough choices on majors and classes. You had to multi-task, set priorities for studying, and balance a social life. You became immersed and familiar with management. Each decision forced you into rapid maturity.

Few of us escape school without encountering unrealistic professors and drama with jobs and administration. Coordinating with the financial aid office, admissions, guidance counselors, department managers, etc. We learn life is not fair. We learn to fight for ourselves. We develop confidence as we come face to face with politics and negotiate our way.

Between the varied undergrad classes, and moreover as a graduate student, I was exposed to many new ideas, concepts, and experiences. Whether working with lab rats (which in a clandestine early morning operation, I rescued my albino and set him free) or studying business, computers, poetry, design, etc., I was exposed to a world I would’ve never otherwise had the freedom or time to explore.

I have an open door policy and the welcome mat is worn. A common question I’m asked revolves around degrees. Should they go back to school, and if yes, what degree to pursue?

My answer to the first part is almost always, yes! You learn much more than the degree content itself and it opens up doors for advancement. The type of degree depends on career goals and long-range objectives, but you can hardly go wrong with an undergraduate in business or related field. For post-graduate work, I often recommend an MBA or MHA. No matter what, a safe bet is to follow your passion, even if the degree doesn’t seem to fit. I once had a history major run my data centers well. My five-degrees-in-one have nothing to do with IT.

I have written about my parents before. My mom never completed her secondary schooling because of the bombs that rained over Southern Germany for several years. She obtained her GED, enrolled in community college, and graduated the same year I graduated from high school. My dad’s schooling was short circuited by his unique circumstance. But when he retired from the Army, and with seven of us kids still at home, he jumped in and obtained his business degree before starting his second career.

I know many people have tough circumstance that might keep them from getting their degrees. Kids, time . . . all the pressure of the day job. It may need to wait a couple of more years. But for others, you need a kick in the pants.

I hope that after reading this, you’ll explore again. Don’t let pride interfere, nor the specific degree you really want. This is a great opportunity for self-evaluation and reflection. Jump in and separate yourself.

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

HIStalk Interviews Rich Helppie, CEO, Santa Rosa Consulting

Richard Helppie is chairman and CEO of Santa Rosa Consulting.

Tell me about yourself and the company.

I’ve been in IT since 1974. I’ve been exclusively in healthcare since 1981. I founded Superior Consultant in 1984 and took that through the entire life cycle from a one-person startup through a fast-growth private company to a public company, where we did pretty well there. Then I sold it to a Fortune 500 company.

I’ve done some other things along the way. Lately I’ve been investing in driving Software-as-a-Service companies outside of healthcare. And then of course where my passion lies, with Santa Rosa Consulting.

A little about Santa Rosa. We are a consulting firm with a full range of services — strategic advisory services, implementation, and integration. We have a staffing arm in recognition of the commodity basis of some of the things that used to be high differentiation. We have a solutions arm, and in our solutions arm today, we have Sandlot Solutions.

How would you differentiate Santa Rosa from your competition?

Santa Rosa is that trusted advisor and the strategic partner to get the work done.

The driver for starting the company was that I’d sold the company, Superior, in 2005. I had attempted retirement. I was terrible at retirement, by the way — I was just not good at it that all. I started growing other companies, again mostly in cloud-based computing.

But I kept hearing from my clients that, “Hey, I don’t have that trusted advisor, that go-to partner anymore. If you ever get back in this, call me.” Similarly, I heard from many of the colleagues that I’d had the pleasure working with over that Superior run and they said, “You know, I’m working but I’m really not inspired. If you ever get back into this, call me.”

Then we saw that there was a bifurcation in the market. In those acquisitions in the early part of the decade — with Superior going to ACS, now Xerox, and First Consulting going to CSC — you had this barbell. You had some very, very large firms on one end – Dell, IBM, Xerox, Deloitte, Accenture. All good firms, but firms that also need very, very large engagements to feed that engine. On the other end, you had a lot of very good firms that were maybe $5 to $40 million in revenue. Good at what they did, but not really big enough to move the needle for a client. 

Where Santa Rosa comes is that we’re in that sweet spot in the middle, where we are large enough to move the needle, yet we don’t need the $80 million engagements in order to run a good business.

The lifecycles of both consulting firms and also the people who started them is fascinating, where someone starts a firm, sells it to someone bigger, sits out a bit, then comes back and does it again, sometimes more than once. It happened with three of the best companies back in the day — Healthlink, Superior, and FCG. What’s the message when people want to follow the founder of the firm rather than the acquired firm itself?

I think people are going to response differently to that. My experience has been that people like the passion. They like the commitment. They like the institutional knowledge and the comfort of working with somebody that’s been around a few decades. I had 3,000 clients at Superior and I think I could go back to 2,999 of them and they would be happy to see me coming. 

Superior was a breakthrough company in its time. When I formed that company, the consulting business was set up like the CPA model. You had offices. The Tampa office didn’t talk to the Washington, DC office and so forth. I remember going to the shootouts early on in that business. The question would be planted by my competitors, you know, “How many offices do you have?” and I’d say, “I don’t have any.” That was considered breakthrough thinking at that time, that we had literally built that company from the computers to be connected electronically. E-mail was a competitive advantage.

We also did a number of other things that were considered breakthrough. The consulting business at that time was all about advising and writing papers. When I founded Superior, I said, “Anything that we advise on, we’re going to be able to implement.” That “advise and do” model was a breakthrough. I wish I had saved them, but I had editorials written against me at that time, and the established consultants criticizing me from the podium because consultants shouldn’t actually be doing work. 

Why do people turn to us? Trust factor. Competency. Longitudinal view. Those would be some of the answers.

Superior arguably created the independent healthcare IT advisory business back in the 1980s. Now everybody wants to move away from that to implementation and staff augmentation. Are you happy with the way consulting has transformed?

Yes, I am. I think that we’re going to a new business model. I’ve done due diligence on companies. I’ve looked at it from the bonus structures and those types of things and I say, gosh, I wrote this thing. I remember one fellow looked at me and said, “Oh, it’s an industry standard,” but it was all the stuff that we had to create back at the time.

I think all businesses are going to be a mix of service and solutions. The client wants a job done. They want a result. They want to be able to say, we’ve partnered with or delegated responsibility for a particular result, and we are looking for a group to do it. I think you’re going to see further blurring. 

All the traditional independent software providers have big service arms. When you look at the first wave that we’re seeing finally of cloud computing, there’s a heavy service component around that. I think it’s going to be more and more blurred as we go to this next wave of consulting.

When I think of Superior, I think of really sharp thought leader type people who would help you with the vision and then let you decide what to do with it. Does that still have value, or are you sorry if it doesn’t?

I believe that model has value. I always believe that you give the client the choice. 

We only get hired as a consultant for one of three reasons. One reason is as you described — help me with an analysis, an objective opinion, help frame a decision for me. The second reason you get hired is the client says, “Hey, I’ve got the expertise, but I don’t have the workforce to pull this off. My people are busy.” Then the reverse of that is the third reason, “I’ve got the workforce, but I don’t have the expertise. I need some experts to come in, work side by side with my people, do knowledge transfer, and get me to a quality endpoint.” 

I believe you do the work for the client, you deliver the value to the client, and you don’t try to take a canned approach and cram it down a client’s throat. Some clients just want advice and that’s what you do. If some of them want you to go shoulder to shoulder with them, that’s what you do.

It seemed in the old days that only the largest hospitals were paying for shoulder to shoulder work, at least the ones I worked for weren’t doing that. Now it’s almost a given that if you’re doing a big implementation, you bring in a bunch of bodies from one or more consulting firms to cover the hump of work needed to go live. I assume people realize it’s valid to pay a premium for that expertise knowing you’ll need it only for a limited time.

Exactly. Our clients are considerably more sophisticated and considerably more capable.

I hate to keep going back to the early days of the pioneering in this industry, but when I formed Superior, one of the drivers was that I saw independent software products being sold and I knew that the body of work that the software supplier was going to do and what the health system could do was going to leave a big gap. I went and marketed to folks who would look at me kind of quizzically and say, “Well, why would I even need a firm like yours?” They turned out, of course, to be some of my biggest clients.

Another thing that we had pioneered was actually going to the software suppliers and saying that, look, you’re going to need us as a partner. We’re going to be objective. The way we’re going to make sure we’re objective is going to work with everybody. You guys don’t want to get tied up doing the intricate work it takes to blend your product into the workflow of every one of those individual clients. 

Back then, we had to evangelize that. Today, people expect that they’re going to use a consulting firm. Therefore, some of what we do is frankly quite commoditized. People know how to buy it today. There’s lot of folks who know how to build a company to deliver it. It’s always going to be about price and delivery, and oftentimes it’s about price.

What work are you doing most of these days at Santa Rosa?

A lot of it’s in the strategic advisory services. If you would have asked me that 18 months ago, it was absolutely heads-down for Meaningful Use 1. It was get Epic implemented, get Meditech implemented. That was the lion’s share of the work.

Today, it’s more of what’s coming on the next horizon. It’s ICD-10. It’s what you’re going to do about HIE. How are you going to be an accountable delivery system? How are you going to be able to manage risk?

I think there’s two megatrends that are running through the industry right now that I think bode well for consultants. By the way, I’ve read the whole Obamacare bill, the Patient Protection and Affordable Care Act officially. You’ve got providers that now need to manage risk, and whether they know it or not, fee-for-service is drilled deep into the DNA of their organization. They might employ 10,000 people and everybody is operating like it’s a fee-per-service world. All their technology support is designed around a fee-per-service world, yet they’re going to have to now manage risk and manage a population.

Coming  around the other side, the health plans — which much of their value has been obviated by the Act — they’re now seeing their future. They have to be good at helping the providers manage clinical flow. And guess what? They don’t have that in their DNA, either. They’re good at claims management after the fact, saying, “This care shouldn’t have been delivered,” or, “This medication should have been prescribed.” But they aren’t very good at managing that clinical flow. 

That’s where I think their huge opportunity is over this next immediate horizon.

If you look out five to 10 years, what industry changes do you expect to see?

I expect to see our health system much more like every other phase of our lives. I carry a smartphone. More and more and my life is inside that device, yet very little of my interaction with the healthcare system is there. I think the combination of the ubiquitous Internet, generations getting comfortable operating in the cloud, the cost pressures … I think you’re going to see healthcare look more and more like any other industry, and I think that will be a good thing.

Morning Headlines 2/27/13

TELUS Health to become Canada’s largest electronic medical record provider

Telus Health announces the acquisition of EMR vendor MD Practice Software, which will expand its reach to more than 9,000 Canadian physicians and make Telus the largest EMR provider in Canada. This is the third EMR vendor Telus has acquired, spending more than $1 billion on acquisitions over the past 10 years.

Accretive Health Postpones Fourth Quarter and Full Year 2012 Earnings Release

Revenue cycle optimization vendor Accretive Health announces that it will delay the release of fourth quarter and full year financial statements. The company says it is concerned with its own revenue recognition policies and needs to evaluate the process before releasing financial statements. Share price dropped 20 percent in after hours trading Tuesday following the announcement.

Craneware H1 Profit Rises

Craneware reports a half-year profit of $4.5 million, up from $3.8 million in the same period last year. EPS was $0.12 and revenue grew seven percent.

Kansas Health Information Network and ICA Launch Pilot to Share Immunization Data with State Registry

Kansas Health Information Network has successfully transmitted immunization information through its ICA CareAlign HIE to the Kansas Immunization Registry.

News 2/27/13

Top News

Telus Health will acquire MD Practice Software, which will make Telus the largest EMR vendor in Canada. The deal is scheduled to close Monday.

Reader Comments

From Spell Checkeroff: “Re: HIPAA. The Miami Herald did something you don’t see often – spelled out the law’s name correctly, then derived an incorrect acronym!” I’ve noticed that as newspapers continue their slow swirl down the toilet, they keep losing their better people who might be able to actually investigate a story, proof read, or write editorials that express original thoughts. About all they’re good for now is sports scores, Hollywood gossip, and funny stories with zero news value. On the other hand, that’s about all their declining audience wants to read anyway.

From NoPhone: “Re: Booth etiquette. Last year you ran an article about HIMSS booth etiquette and we would love to share it with our sales team.” The Readers Write by Rosemarie Nelson offers tips for vendors on the trade show floor.

From Moe Money: “Re: PQRS submissions. See forwarded e-mail.” Above.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Ping Identity, also known as “The Identity Security Company.” Its identity and access management platform provides one-click access to any application from any device, with over 900 enterprise customers including 45 of the Fortune 100. The company’s health solutions make it easier to run cloud-based applications and to meet compliance requirements, offering single sign-on to improve user satisfaction. They also provide a seamless, secure platform for internal and external collaboration and customer engagement. Ping Identity’s solutions help protect PHI and allow users of federated applications to be quickly disabled in the event of a breach. A free trial of PingFederate is available for download. Pay them a visit at HIMSS Booth #2470 and tell them you read about them on HIStalk. Thanks to Ping Identity for supporting my work.

My YouTube hunt was successful, turning up this educational Ping Identity video on Identity Management 101. It’s a really good and easily understood overview.

HIMSS Conference and Social Events

I have been hunting for a HIMSS mobile app that includes the schedule and meeting rooms. Has anyone seen one?

If you signed up to attend HIStalkapalooza before registration closed on Monday, February 11 and did not receive an invitation by e-mail, drop me a note by Thursday and I’ll check your status. Otherwise, we are totally full even though Medicomp doubled capacity to 1,000 this year, which means we unfortunately can’t invite you even if you’re one of the folks who are pleading that your HIMSS experience might be a bust if you are unable to participate in the “Inga Loves My Shoes” contest, drink Hurricane IngaTinis and Typhoon Janes, and hobnob with the coolest folks in HIT.

For those who received HIStalkapalooza invitations, here is transportation information:

• The good folks at Medicomp have put together a pocket-sized card with transportation details. You can pick it up from their Booth #3068 on Monday or get one from one of the human directionals that will be in the main hallway of the convention center starting at 5:30 PM on Monday. Look for the HIStalk/MEDCIN Engine tee shirts and signs.
• Buses will leave convention center for HIStalkapalooza from 6:15 p.m. through 7:00 p.m.
• If you are driving, Rock ‘n’ Bowl is located at 3000 S. Carrollton Avenue and has plenty of free surface parking.
• Return bus service to specific downtown hotels starts at 9:00 p.m.
• Bus service is complimentary, as is coat and bag check at the venue.
• A Transportation Concierge will be located at the front of Rock ‘n’ Bowl to answer any questions. They can help you get a taxi if you’re in a hurry to leave and don’t mind paying.

Inga, Dr. Jayne, and I (Mr. H) will be covering HIMSS in great detail starting this weekend. Let us know if there’s anything you would like is to report on beyond the obvious (booth snark, making fun of people who deserve it, spilling the dirt we overhear in coffee lines and restrooms, and our jaded assessment of what’s important and what clearly isn’t). We intentionally avoid one-on-one appointments and demos since those are usually a waste of time, preferring to do our reporting from the ground as regular, anonymous attendees. Contact us from there if you run across anything interesting.

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

Acquisitions, Funding, Business, and Stock

Shares in Accretive Health drop 20 percent in after-hours trading Tuesday after the company announces that it will delay reporting Q4 and FY2012 results while it evaluates its revenue recognition policies for its revenue cycle management agreements. Any change might require restating prior-period financial statements, management added.

Cerner announces that it will acquire PureWellness, which offers a health and wellness platform for corporate wellness programs and insurers, strengthening its position in the population management market.

Craneware reports half-year profit of $0.12/share compared to $0.10/share a year ago. Revenues were up seven percent.

OCHIN, which operates Oregon’s REC, acquires the Oregon Health Network, a non-profit focused on improving quality and access of healthcare through HIT and other initiatives.

Informatica acquires process automation company Active Endpoints.

Sales

Graham Hospital (IL) selects Merge Healthcare’s iConnect Enterprise Clinical Platform and Honeycomb Archive solution.

Summit Healthcare Regional Medical Center (AZ) chooses Ingenious Med’s impower charge capture solution to improve documentation and communication.

People

Vocera Communications appoints Sandra Miley (Juniper Networks) VP of corporate marketing.

Elsevier names Jim Nolin, MD (Ascension Health) editor-in-chief of InOrder,  an Elsevier order set solution that’s scheduled to launch in March.

Beacon Partners promotes Kevin McKittrick (above) and Scott Freeman to principal.

Cornerstone Advisors Group names Kristi Lane (Stage 7 Consulting) VP of talent management.

Charles C. Corogenes (Toshiba) joins ChartWise Medical Systems as VP of sales and marketing.

Announcements and Implementations

Kansas HIN transmits immunization data from the Community Health Center of Southeast Kansas to the Kansas Immunization Registry through the ICA CareAlign HIE platform.

Rockcastle Regional Hospital (KY) goes live as the first user of Patient Logic’s physician documentation system.

You might think managed services vendor ClientFit would spell the name of its new partner athenahealth correctly in its press release announcing that relationship. You would be wrong, although I might be inclined to side with them because their version is at least properly broken out into separate words and capitalized correctly. I grit my teeth and follow The Associated Press Stylebook, which says to use the company’s made-up lower case version except when athenahealth begins a sentence, in which case capitalize it even if they wish you wouldn’t.

Albany Medical Center will become the first healthcare provider in New York to utilize Direct Messaging through the Healthcare Xchange of NY.

QuadraMed announces that Avita Health System (OH) attested for Stage 1 Meaningful Use through its use of the company’s QCPR EHR that the health system implemented last year.

Winona Health (MN) says its implementation of Cerner’s revenue cycle solutions for acute and ambulatory services fueled a 25 percent decrease in clinic coding turnaround time and consolidation of hospital and clinic billing.

Legacy Data Access introduces LegacyCompleteClinicalView and LegacyRemitBank to enhance clinical and revenue cycle functionality for retired healthcare applications.

Jardogs releases version 1.5 of its FollowMyHealth universal health record.

CommVault launches Simpana 10, which offers an open, scalable platform and advances in data and information management.

LDM Group’s ConnectSys 3.0 achieves 2014 Edition Ambulatory and Inpatient EHR Module Certifications by ICSA Labs.

McKesson announces that more than 90 percent of physician users of its iKnowMed oncology EHR have successfully attested for Meaningful Use.

McKesson and Cerner will announce their unspecified collaboration (presumably related to cooperative interoperability in trying to derail the Epic juggernaut) from HIMSS on Monday, March 4 at 11 a.m. Central.

Microsoft-GE joint venture Caradigm will announce next week its selection by Continuum Health Partners (NY) to provide tools that will support the health system’s care coordination and population health strategy. Caradigm’s products include the Caradigm Intelligence Platform (the new version of Amalga), applications from both Caradigm and third parties for population health management, Caradigm Health Information Exchange, and identity and access management solutions.

MMRGlobal, featured in my interview with CEO Bob Lorsch, will launch a health and wellness app at the HIMSS conference that will work with its MyMedicalRecords PHR. The company also says it has started notifying mobile healthcare app vendors that their products appear to infringe on its patents.

MModal and 3M Health Information Systems collaborate to link MModal’s voice-enabled clinical documentation platform with the 3M 360 Encompass computer-assisted coding system.

VitalWare files a provisional patent for Sherpa, a physician documentation ontology engine that automatically presents physicians with clinical concepts and their related categories at the point of care.

Technology

An India-based startup announces Uchek, a urinalysis app for smartphones. You pee in a cup, not on the phone, and then take photos of dipped chemical strips to monitor diabetes, UTIs, and kidney and bladder problems. I might be concerned that its display shows “keytone” since I get nervous when medical software contains misspellings.

I mentioned the Android-only Swiftkey on-screen keyboard and medical dictionary ($3.99) that gets rave reviews for clinical documentation. The company announced Tuesday that it will launch a healthcare-focused typing app for the iPad. Apparently the new BlackBerry 10’s all-touch keyboard runs Swiftkey, although neither company will confirm.

Other

Massachusetts General Hospitals offers its 22,000 employees a $250 bonus for watching an 11-minute video on customer service. About 98 percent of the employees thought it was worth $22 per minute to score some cash, meaning the hospital shelled out more than $5 million to teach them how to be nice. 

The Robert Wood Johnson Foundation awards PatientsLikeMe a $1.9 million grant to create the first open-participation research platform for the development of patient-centered health outcome measures.

I mentioned in introducing new sponsor MediQuant in the Monday Morning Update that I was enjoying the Legacy System Blues song on its site. Apparently I caught it early — a new press release just announced it, also mentioning that the band is led by MediQuant Founder and President Tony Paparella, who has had the track pressed on vinyl 45 RPM records.

Security volunteers who find an unnamed hospital’s data exposed on the Web are perplexed when their phone calls, service desk ticket, and e-mail to the hospital’s CEO are all ignored and nobody has taken the data down. A technician at the hospital’s outsourced help desk told them he doesn’t have an e-mail address. The group suggests that hospitals include a dedicated, monitored e-mail address and telephone number on their home page so they can be notified quickly of security problems.

Weird News Andy says he bet the surgeon was heard to say, “Awww, nuts” in this story of a patient suing a British hospital after surgeons removed the wrong testicle. Surgeons performing the cancer surgery realized their mistake 40 minutes in and “tried to correct the mistake in an emergency procedure,” but it was too late.

Strange: police in India arrest the son of a hospital CEO after he threatens to post to the Internet a homemade sex video featuring himself and his wife unless she agrees to pay for the hospital’s new trauma center. Also in India, 35 specialty physicians protest their hospital salaries by threatening to kill themselves.

Sponsor Updates

• The Johns Hopkins Hospital and Levi, Ray & Shoup discuss the simplification of document management processing in Webinars March 12 and 14.
• Hyland Software validates integration between its OnBase enterprise content management and Nuance Communications’ eCopy ShareScan scanning and workflow solutions.
• The AMA and McKesson agree to a licensing arrangement that allows for the mapping of molecular diagnostic testing codes in McKesson’s Diagnostic Exchange software to the AMA’s CPT code set.
• Greenway Medical Technologies achieves PCMH 2011 Prevalidation status from NCQA for its PrimeSUITE EHR platform.
• Wolters Kluwer Health adds a Patient Safety Programs File to its Medi-Span solution.
• MedAssets CEO and President John Bardis will ring the NASDAQ closing bell February 27.
• Bottomline Technologies announces the GA of Logical Ink 4.6 and MedEx 4.0.
• Marion McCall of Surgical Information Systems reviews considerations when selecting perioperative analytics solutions.
• Santa Rosa Consulting adds Clearwater Compliance’s HIPAA-HITECH compliance tools to its portfolio of services.
• Truven Health Analytics releases its annual list of 100 Top Hospitals based overall organizational performance.
• CTG Health Solutions announces that it increased revenues 18 percent from 2011 to 2012 and expanded its IT consulting team.
• Direct Recruiters, Inc. offers an interview called “Hiring Game Changers.”

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

HIStalk Interviews Chris Belmont, SVP/CIO, Ochsner Health System

Chris Belmont is system vice president and CIO of Ochsner Health System of New Orleans, LA.

Tell me about yourself and the organization.

I joined Ochsner about six years ago as an employee. Prior to that, I worked with them in the vendor world. Ochsner is 10 hospitals and 38 clinics located in southeast Louisiana. I joined Ochsner following Katrina, when we went through our growth. We acquired several hospitals that were abandoned after Katrina and that’s when I came on board.

Can you give me a brief history of what has happened since Katrina in the hospital industry in Louisiana?

Obviously it was devastated. When New Orleans was hit by Katrina, most of the city was under water. Ochsner continued to operate even through the flood and the recovery process. 

Several hospitals, mainly in the Tenet organization — we elected to purchase them and help them recover. We purchased originally three hospitals in 2006. Then we ended up purchasing another hospital that wasn’t Tenet, it was another organization in Baton Rouge. Then we purchased our final Tenet facility over in the Slidell area. which was also devastated by Katrina, in 2010. 

Ochsner used to be just one hospital with a large physician group practice. Following Katrina, we became more of a health system. As you can imagine, we went through a lot of growing pains with the city recovering and at the same time we were trying to grow. It’s been an interesting ride.

The last time HIMSS was in New Orleans, it wasn’t long after Katrina, and while there was recovery in the obvious areas like the French Quarter, a lot of hotels and restaurants didn’t have enough labor and there was still plenty of devastation not far off the beaten track. How would you characterize the state of the recovery in general?

You will see a drastically different New Orleans. It’s much improved. A lot of the infrastructure was repaired following Katrina. Other than the light outage in the Super Bowl, the city’s going strong. A lot of people are moving in. A lot of young folks are deciding to settle in here and start up their professional lives. Things are coming back.

The other interesting thing – and most people don’t know this –is since Katrina, we’ve had two other significant hurricane events. One of which was last summer, in which we also had a great deal of flooding. Not in the New Orleans area, but in some of the outlying areas. We’re still in the bullseye.

Maybe the only good thing to come out of Katrina was that people started pushing for electronic records when they saw manila charts floating down the street. It seemed like that was the point where people started to realize that paper records were vulnerable to any kind of natural disaster.

Yes. And not only the paper charts, but the fact that following Katrina, we couldn’t even get clerical help to locate the charts even if we wanted to on our own file room. Luckily we had our own electronic medical record that was built here by Dr. Witherspoon over the last 20 years. When I talk about EMR adoption, I tell them all you have to do is throw a Category 5 hurricane in your city. It’s amazing how EMR adoption ramps up.

I would say prior to Katrina – I wasn’t here, but I hear our adoption was probably a little bit less than 50 percent. Obviously post-Katrina it shot way up and it stayed there, which put us in a good spot to  tackle the new EMR that we’re implementing now.

Tell me about where you are with Epic.

We started our Epic journey in 2010. Late 2010, we went to the board. We stepped back and said, will the tools we have today support us going forward as we continue to grow and expand and potentially go global? Will they allow us to do some of the things we want to do, like offer EMRs to our community physicians, offer additional services, get into the ACO world? And then some of the bells and whistles around kiosks and portals and so on? 

We just realized the platform we had wasn’t going to make it. So in 2010, we made a decision and moved to Epic, hired about 120 folks, and went live with our first site in December 2011. We’re about 80 percent done. We have five hospitals left, two of which will go live the weekend after HIMSS. Our last site will be going live in July. We’re moving along quite briskly. 

We’re doing the whole thing – revenue cycle, clinicals, everything. It’s been tough, but it’s going really well. It’s just been a lot of change and a lot of healthy disruption to the point where 100 percent of our eligible physicians achieved Meaningful Use in their first year. That’s been a big win for us. We’re very pleased where we are, but we still have a little ways to go, and then the optimization is obviously beginning as well.

What benefits and results have you seen so far?

When we went live, we started monitoring our Meaningful Use metrics — literally on Day One — just because of the way we implemented the system. We hit the vast majority – I think all but one of our metrics – on Day One in the hospital. That was a huge win for us because some of that funding and some of those incentives we were going to use to back our project. That’s been a big win for us.

We have much better visibility of what’s going on in the organization now. We talk about it a lot that Epic sheds a lot of daylight on our processes. That’s been good and bad. We discovered some processes that let’s just say were less than optimal that we’ve had an opportunity to improve. 

We improved a lot of the things in the safety space, too, as far as barcoded med administration. Some of the things we’ve wanted to do, but we just didn’t have the tools to do it. We’re seeing some real strong benefits there. Rev cycle as well — we’re starting to see our gross charges are going up and our ability to manage the rev cycle is in a much better shape than it was under the legacy environment.

It’s an advantage that a homegrown system reflects your processes exactly, but also a bad thing that you aren’t getting challenged by the knowledge a vendor brings to the table having seen how things work in many other hospitals. Did you find that Epic brought a lot of ideas to the table?

Yes. The other problem with the homegrown system is you tend to miss a lot of the little things that are very important, like reports, like analytics. You focus on the feature functionality of the system and you don’t think about all of the surrounding things you need — upgrade utilities, system monitoring tools. Things like that’s not on the top of mind when you’re developing software from the ground up. Bringing that stability has been a huge win for us. 

Then like you said, a lot of the model functionality and a lot of the expertise that’s built into the tool allowed us to address certain areas that we just didn’t get to with our homegrown EMR, like ophthalmology, transplant, dermatology – some of the specialty areas. Ochsner, with an 850-physician group practice, has a lot of those specialties that we just didn’t service well with our Legacy platform. Epic has allowed us to get there.

What kind of data conversion were you able to accomplish from your legacy system to Epic?

Informatica was critical in getting us there. We learned on the first site. We thought it was a good idea to go in there with an empty slate and say, let’s just build it all from scratch and start with a clean slate. Let’s make sure the record’s in good shape. We quickly realized that was a bad idea. Not just in the clinical areas, but in the registration area. 

Then we had to more or less scramble prior to go live and say, OK, let’s move more of that data in. We used Informatica to write a lot of the extracts and then loads. Then we used a lot of the tools that Epic has available. Mainly their HIE tools, interestingly enough, to more or less treat our legacy platforms as a foreign system. 

We applied a lot of the health information exchange technology built into Epic to move the data from one system to the other. That’s actually still working out well today because we still have our legacy platform running and physicians are still practicing over there while we’re finishing the rollout. Informatica was huge in helping us quickly move that data once we discovered we had missed some things.

Will you be using the Informatica platform going forward?

Oh, yes. We use it daily. One of the things that we’ve done is not just move data into Epic, but we have a very large data warehousing initiative that’s been going on for about four years. Luckily it started before Epic. Our plan is that we’ll move all of our legacy platforms in there. 

We use the Informatica tools to do a lot of those ETL — those extract, transform, and load — functions to move that legacy data into our warehouse, with the plan of retiring about 38 different systems sometime around the end of the year when we fully have Epic up and running. 

That’s going to be a big win for us. In fact, we’re targeting about $13 million in operational benefit when we turn off those legacy platforms. Informatica is going to allow us to get there. Most recently, we just purchased Informatica’s Master Data Management tool, which will allow us to do a much better job in managing our master data across the organization. Not just patients, but employees and physicians.

Are you using Epic’s Cogito or are you bypassing that completely and working directly from your own data warehouse?

We’re watching it, but frankly it will be a while – and I would argue never – that we’ll be 100 percent Epic. A lot of the data that we have that Informatica allows us to get our hands on and load into our warehouse is non-Epic data.

For example, we use data directly out of our phone switch. By consolidating our phone switch data along with our Cadence patient scheduling data – again, you’re going to say, “Oh wow, that’s not a revelation” — but we were able to show the operators that when you don’t answer the phone, patients don’t book appointments. You’re going to say, “Uh, of course, duh,” but the reality is we weren’t watching it that closely. Now we’re watching it on a daily basis and we’re monitoring and making adjustments along the way. 

We’re correlating a lot of data, not just from Epic, but I think right now we have like 25 different systems that we’re running through Informatica and into our warehouse. The gold nuggets that are coming out of that data are just tremendous.

Tell me more about that. Everybody’s interested or talking at least about analytics and business intelligence, and Epic itself throws out a ton of information. What are some of the things that you think you’ll be able do on the basis of what you learn from your data warehouse?

We do a lot of things. Provider productivity. We’re looking at kind of RVU activity in real time, watching physician productivity but balancing that against the scheduling. We’re looking at labor, so we probably improved our labor performance several million dollars a year just by watching – almost like an acuity model if you think about it. We flex our labor based on patient volumes. We load our productivity data, we load our time and attendance data so we know who actually punched in yesterday. Then we load our patient volume data.

We consolidate that and have that in front of the operators by ten o’clock every morning. Then they adjust their schedules for the rest of the week to get back onto their labor target. That’s been a huge success for us. We’ve all but eliminated our agency because of those kind of initiatives. Then we have several others, quality and other dashboarding things as well.

What are you seeing for the future as far as population health management or accountable care arrangements?

We’re using it for our HCCs, for our Hierarchical Condition Categories. We’ve been using the data warehouse and using the tools within Epic to do a much better job, and that’s showing huge success. 

With ACOs, we’ve worked it out with two of our biggest payers that they provide all of the claims data for us. Now that we’re one of the ACOs that was approved for this year, we’re getting outside information on the population that we’re watching. I think we’re monitoring about 28,000 lives. By taking that payer information and then using the Informatica tools to get it into our warehouse, we’re able to look at our population much better. We started that last year and we didn’t even get approved to start our ACO until January of this year. We’re hitting the ground running with it.

That’s pretty cool to be able to get claims data and then merge it with your own internal data. How will you use the information you’re getting and some examples of how you’ll manage those patients based on all of this information you have?

We’re going to manage readmissions. If one of our members that we’re responsible for is admitted, even at another hospital, we won’t know that. But if they’re in our claims files, we’ll know that they were readmitted, so we can watch those readmissions.

The other thing that is a direct impact is managing outside provider expense. Our physicians may write an order, but the patient may elect to go somewhere else — a non-Ochsner clinic or a non-Ochsner facility — and have the services rendered. We have a little bit better visibility of those patients if they go elsewhere. That’s been a huge win for us. There’s a lot of cost that leaves the organization for not only our covered patients, our capitated patients, but even some of our employees.

What are the biggest challenges and opportunities that you see both within the health system as a whole and in your department?

I think it’s going to be, how do we do more with the data we have? I think the EMR and the implementation days — we are assuming all of those are going to go well and they are going well. I think that ability to predict the future is going to be important as we try to drive down costs, drive up quality, manage patient safety, manage more of a population. 

Having that data in a format that’s easily, quickly, and very accessible is going to be key. Gone are the days where you can throw an army of analysts in a room and say, “Give me this report” and you wait three weeks and they give you something that’s less than optimal. I think the days of, “Tell me what I need to know before I even know that I need to know it” — I think those are the days that we’re looking forward to. With the tools we have with partners like Informatica with their tools, I think we can achieve it.

There’s no lack of data. We’re approaching two billion rows of data, which in some industries is small, but for us, that’s a pretty significant amount of data. We really think we can move the needle on a lot of metrics just by supporting it and monitoring it through the data we have.

Cerner To Acquire PureWellness

Cerner announced this morning that it will acquire PureWellness, which offers a health and wellness platform for corporate wellness programs and insurers, strengthening its position in the population management market. The company will rename the offering to Cerner Wellness.

Cerner SVP Matthew Swindells said in a company blog posting that the combination of Millennium solutions, Healthe Intent, and the PureWellness platform will provide comprehensive support to population health management and to allow individuals to manage their chronic conditions and reduce their health risks.

In this post-EHR world, where sophisticated organizations have already made the major step of removing most of the paper from their processes, the new challenge is how you realize benefits for your organization, patients and membership. Population health management has become an imperative for health care organizations driven by extreme market pressures to achieve better outcomes with less overall spend. This story is unfolding around the world, thanks to a series of common market pressures.

PureWellness is located in South Burlington, VT. Co-founder and CEO Ken Kaufman is a veteran of several healthcare IT companies, including IDX, Allscripts, A-Life Medical, and McKesson. Co-founder Ron Keen has worked for Allscripts, GE Healthcare, and IDX.

The company’s offerings include tools for health assessment, risk advisor, nutrition, team challenges, incentive programs, health coaching, condition management,

Morning Headlines 2/26/13

Cerner To Buy PureWellness

Cerner announced this morning that it will acquire PureWellness, which offers an online health and wellness platform. Cerner said in a blog post, “We think the combination of our Millennium solutions and Healthe Intent platform with PureWellness’ engagement platform creates the most comprehensive set of capabilities on the market to support an individual’s health and care needs. Individual engagement is an important piece of a comprehensive approach to population health management, a concept we see playing a vital role in the evolution of health care.”

CIOs say lack of security pros leads to more breaches

In a survey released this week, CIOs report that a shortage of qualified IT security professionals is directly impacting network security within healthcare.

Rural Health Information Technology (HIT) Workforce Program Funding Announcement

HHS announces a $4.5 million grant that will be awarded in $300,000 increments to rural health networks engaged in recruitment, education, training, or retention activities aimed at developing and sustaining a population of health IT professionals in rural areas.

HealthEdge adds Arik Hill as Vice President of Customer Support

HealthEdge, a software vendor which provides an integrated financial, administrative, and clinical platform for healthcare payers, announces that Arik Hill (CIO, FirstCare Health Plans) has joined the company as vice president of customer support.

SAIC Announces Names For Planned New Companies

SAIC announces the names for the businesses that will be created later this year following its planned split into two independent companies. The national security, health and engineering business – to which acquired health IT consulting firms maxIT and Vitalize will belong — will be named Leidos, a coined word clipped from “kaleidoscope.” The technical services and enterprise information technology business will continue to carry the SAIC name.

Readers Write: What is Product Training Really Worth?

What is Product Training Really Worth?
By Lorre Wisham

“Every line is the perfect length if you don’t measure it.” Marty Rubin

Too often, healthcare information technology (HIT) vendors treat training as a last-minute “check the box” obligation to be met as quickly as possible with the smallest investment possible. It shows. Low KLAS scores and slow or partial product adoption are just two results of this approach.

What’s far worse, though, is the lost opportunity for vendors to differentiate themselves from competitors by showing the direct and measurable results that effective training can bring to their customers.

Smart vendors use proven evaluation methods to demonstrate these benefits:

• Reduced time to competency
• Increased consistency
• Greater and more meaningful product use
• Fewer help calls
• Better support for future employees

What kind of evaluation methods work? I recommend Kirkpatrick’s four-level evaluation model.

Level One

Assess participant reaction to the course.

Rather than wait for KLAS scores, use surveys to find out immediately what end users think about the training, and then modify it as needed to improve results. Capture this data over time to prove to customers that your training is well received.

Level Two

Assess what participants learned.

Build pre- and post-tests into your courses so you can demonstrate increased knowledge and skills. Track scores, run reports, and ask customers whether their other vendors can offer the same.

Level Three

Determine whether participants are able to apply their learning on the job.

Understand what comprehensive product adoption looks like for your customers and assess how your training helps deliver it. For instance, examine the rates of product use or the number of technical support calls among employees who complete training and those who do not.

Level Four

Gather data from customer executives or management to determine the impact the training has had on their organization. Using surveys over time, you can begin to answer key questions like these:

• Has the availability of an online training solution helped the organization manage employee turnover?
• Did training help the organization meet Meaningful Use criteria?
• Did the time available for patient care increase along with HIT proficiency?

As learning professionals, we know organizations that evaluate their training outperform those that don’t. Vendors who work with customers to evaluate training success set themselves apart from those who don’t. After all, training is just an activity if you don’t bother measuring its impact.

By taking the steps described here, you can demonstrate added value to your customers. You can show that you not only know how adults learn, but how they do so within the challenging context of a healthcare environment. Because you measure results, you can show something more — your unique ability to help healthcare professionals translate learning into actions that benefit hospitals, providers, and patients.

Lorre Wisham is president and CEO of Health Technology Training Solutions of Tucson, AZ.