Time Capsule: Why Put Monitoring Cameras Only in the OR? Improving Your Career Outcome with an eCIO

Why Put Monitoring Cameras Only in the OR? Improving Your Career Outcome with an eCIO
By Mr. HIStalk

Rhode Island’s health department recently ordered an error-prone hospital to install video cameras in all of its ORs. They will be monitored by a non-surgery employee who will oversee all the cases to make sure the surgical teams do the mandatory time-outs and site marking.

(They didn’t do it before because they were they were too busy harming patients. Here’s a clue the situation was all fouled up: in one case, surgeons were supposed to repair two fingers, but instead operated on the same finger twice. Doh!)

I like this monitoring idea. It’s like having a guardian angel looking over your shoulder, ready to whisper into your ear when you’re about to do something unwise.

In fact, I’m proposing that this observational benefit not be limited to that one hospital’s OR. We IT people need help, too, because we sometimes make embarrassing mistakes. What about a CIO-cam?

I hereby lay claim to the eCIO business model, in which centrally staffed consultants (probably in India, although I haven’t worked that out yet) monitor the plush offices of hospital CIOs to prevent them from doing something stupid.

Imagine this. Contract negotiations are winding down. The final change-tracked document has been printed off, pens have been produced, and the vendor’s executive sales VP (your best pal today who won’t take your calls as soon as the ink dries on your signature) is back-slapping anything that moves, anticipating a tropical vacation and home remodeling courtesy of the elephant (you) he or she has just bagged.

Suddenly, the CIO (you) looks away, frowning and clearly troubled. Mahesh the eCIO has just whispered in your ear from the opposite side of the globe. "You are NUTS if you sign that deal without a penalty clause, change-of-control terms, and striking through the arbitration and jurisdiction clauses. Take a time out and think about it."

Just like in the Rhode Island OR, the observer may have just saved a life. Or a career, anyway.

Mahesh can ensure that the layoffs and promotions aren’t mixed up, urging you to mark an X on the head of the otherwise indistinguishable employees who are about to receive their final wishing of well in their future endeavors on their escorted stroll off-property. The eCIO can monitor your heart rate and respiration, making sure that calm prevails when the network is down and angry surgeons are lining up with scalpels and the intent to first do serious harm. The eCIO can even monitor dangerous conditions at the HIMSS conference, where a few too many reception drinks might invite disaster (like saying what you really think about your vendors or the opening speech read laboriously from the TelePrompter).

I’m pretty sure Mahesh can even cover your vacation, wiring up to the not-to-be trusted IT directors and sending them advice (or maybe a few punishing volts) if they get too full of themselves in your absence. ("No, Steve, you are not authorized to create new positions or to move to a nicer office. Put down that pen and step away.")

Best of all, the rock star CIOs who already dominate every conference and publication could extend their celebrity reach even further in an inshoring model variant. Instead of wiring up Mahesh from India, the eCIO company could strike a deal with John Halamka, Martin Harris, or other bigwig CIOs who never seem to be at work anyway. Pay them, say, $2 million a year (only a slight raise) and make them the CIO of everywhere!

Even poor and rural hospitals could then afford to get a timeshare piece of John Halamka’s satellite-borne emanations, strutting him proudly around town in his half-day visit once per year. The rest of the time, he’s sitting in his eCIO center, keeping a watchful eye on his far-flung underlings who do the real work with the confidence that he’ll warn them when they are about to screw up.

I need to cut this short. The publisher of Inside Healthcare Computing just whispered in my earpiece that, from what she’s seeing on my screen, I need to dial it back a little.

Morning Headlines 11/1/13

Overrides of medication-related clinical decision support alerts in outpatients

A study published in JAMA looks at the value of clinical alerts within CPOE systems and finds that alerts are overridden 52 percent of the time. The most common alerts were duplicate drug (33.1%), patient allergy (16.8%), and drug–drug interactions (15.8%). The most likely alerts to be overridden were formulary substitutions, age-based recommendations, renal recommendations, and patient allergies.

MEDSEEK Acquires SymphonyCare to Expand Presence in Emerging Population Health and Care Management Market

Physician web portal and HIE vendor MEDSEEK acquires population health vendor SymphonyCare as part of a broader strategy to diversify its portfolio.

Merge Reports Third Quarter Financial Results

Merge reports Q3 results: revenue dropped to $57.7 million from $60.4 million during the same quarter last year,  missing analysts estimates on both revenue and EPS.

WebMD buys startup Avado to connect patients and physicians

As part of a strategic makeover aimed at rebranding itself a patient engagement platform, WebMD acquires Avado, a startup that develops cloud-based software that helps physicians and patients interact online.

News 11/1/13

Top News

Health and Human Services Secretary Kathleen Sebelius apologized Wednesday to Americans for the “miserably frustrating experience” caused by problems with the Obamacare website. Congressional leaders grilled Sebelius for 3-1/2 hours about the troubled website rollout and raised security concerns. The secretary said she felt confident the website would be updated and “optimally functional” by November 30.

Reader Comments

From C’mon Mane: “Re: Another Epic sale. Allegheny Health Network is ditching Allscripts Sunrise for Epic. The deal is worth many millions. They think there will be better connectivity as they put the private doctors out of business and hire hospitalists to run their programs.”

From Jessica: “Re: AHIMA buzz. Had to pass along this wicked shot of our GM, Don Graham, introducing Freddy Krueger to his fist at the Billian booth at the AHIMA conference (where our theme was something along the lines of ‘laying your health market data nightmares to waste’).” Thanks for the great Halloween imagery.

HIStalk Announcements and Requests

Just a reminder that Mr. H is still out of pocket so today’s post is all me. Well, me and my BFF, Dr. Jayne.

A few treats from HIStalk Practice this week include: CareCloud will integrate ZocDoc’s appointment booking app into its platform. Physicians are still uncertain how the ACA will impact their workloads or wallets. I’m looking for a few vendor types to participate in a survey.General practice physicians were 1.5 times more likely than specialty practice physicians to have been awarded a MU incentive payment in 2012. In 2011, office-based physicians using EHRs were more likely than non-EHR users to exchange clinical data electronically. My idea of a perfect Halloween treat is having new readers sign up for HIStalk Practice email updates, so thanks in advance. Thanks for reading.

Acquisitions, Funding, Business, and Stock

Merge Healthcare reports Q3 results: sales down five percent, adjusted EPS $0.07 vs $0.13.

MEDSEEK acquires the Madison, WI-based SymphonyCare, a provider of a population health and care management solution.

WebMD acquires Avado, a developer of patient relationship technologies, including a patient portal for messaging, reminders, and appointment scheduling tools.

CommVault files Q2 numbers: revenues up 20 percent, adjusted EPS $0.48 vs. $0.38, beating estimates.

People

TeraMedica names Nick Donofrio (Merge Healthcare) director of client services, taking over for Greg Strowig, who was promoted to COO.

Post-acute software provider Procura Group promotes Scott Overhill from VP of product management to president. Warren Brown, the former president, has assumed the role of chairman of the board and Bill Bassett (Deyta) joins the company as VP of product management.

Allscripts names Rich Berner (Caradigm) president of Allscripts International and promotes Stuart Miller to managing director of EMEA.

Deloitte names retired Air Force general and former Air Force surgeon general Charles Green, MD a director in Deloitte Consulting and CMO for Deloitte’s federal health practice.

CommonWell Health Alliance announces its board of directors, including Jeremy Delinsky (athenaHealth) as chairman, Rich Elmore (Allscripts) as vice chairman, Bob Robke (Cerner) as treasurer, Rod O’Reilly (McKesson) as secretary, Scott Schneider (CPSI), Justin T. Barnes (Greenway), and Keith Laughman (Sunquest).

Announcements and Implementations

San Diego Regional HIE changes its name to San Diego Health Connect and announces that Sharp Healthcare and Scripps Health have agreed to participate in directing the exchange.

Memorial Healthcare implements Hyland Software’s OnBase ECM solution integrated with its Meditech HIS.

Mille Lacs Health System (MN) goes live on GE Centricity at its physician clinics.

The eight-year-old nonprofit organization LCF Research, which is building New Mexico’s HIE, announces that it is now profitable and will be sustainable after its federal grant expires on January 1.

HCA deploys Ingenious Med’s impower platform to more than 4,000 hospital users nationwide.

Nuance Communications opens its mobile innovation center in Cambridge, MA to house its R&D employees dedicated to voice recognition, natural language, and user interface technologies.

Government and Politics

The Defense Health Agency plans to extend the life of AHLTA though 2018, signaling it will take that long to implement a new EHR.

The House passes a bill that would streamline the VA’s disability claims appeal process and would establish a 15-member commission to seek advice from veteran service organizations, technology companies, and the insurance industry.

Innovation and Research

A pilot demonstration for the ONC successfully demonstrates the use of patient privacy controls over shared medical records. The demonstration showed how externalized patient consent directives can be automatically fetched and applied during the exchange of EHRs.

About half of clinical decision alerts are overridden by providers and about half of overrides are classified as appropriate, according to a study published in JAMIA. The most common alerts to be overridden were formulary substitutions, age-based recommendations, renal recommendations, and patient allergies. While 53 percent of all overrides were classified as appropriate, the likelihood of overriding an alert varied widely by type. The authors recommend refining alerts in order to reduce alert fatigue.

Technology

Nuance introduces an intelligent virtual assistant that uses voice recognition technology to take directives for administrative tasks like ordering medications and labs. “Florence,” which will won’t be launched for another year, will understand the intent of a doctor’s request, actively listen, and respond with facts about how a particular medication or test may affect a patient. Think of the potential if Nuance could tweak this technology to work with spouses.

Other

Healthcare providers outside of the US claim that functionality and support are the top reasons that Cerner Millennium PowerChart exceeds their expectations, according to a KLAS report. Respondents say that despite high costs and contracting concerns, PowerChart is part of their long-term plans.

The Michigan Health & Hospital Association Keystone Center reports that various patient safety and quality initiatives across the state’s 117 hospitals saved more than $116 million (less than one percent) in healthcare costs between 2011 and 2013.

The global market for cloud computing in healthcare is predicted to reach $3.9 billion in 2013, representing 21 percent growth over 2012.

A third (1,099) of Joint Commission-accredited hospitals achieve Top Performer status in the Commission’s annual report on quality and safety. That’s a 77 percent increase over the number of top performing facilities in 2012.

Sponsor Updates

• The Advisory Board reports that YTD it has extended $1 million in skills-based volunteering to pro bono partners with participation from almost 100 percent of its employees.
• Vonlay managing partner Aaron Carlock presents a session on portal strategies to improve patient care and business at next month’s HIMSS Midwest Fall Technology Conference in Milwaukee.
• The Technology Services Industry Association recognizes TeleTracking Technologies  as a Certified Support Staff Excellence Center.
• England’s Alder Hey Children’s and Liverpool Women’s NHS Trust share details of their implementation of Perceptive Software’s ECM integrated with Meditech.
• Johnson Space Center will implement Fujifilm Medical Systems’ Synapse Radiology and Synapse Cardiovascular to support NASA’s in-flight and ground clinical care operations.
• DIVURGENT employees raises $5,000 for Partnership for a Healthier American during its 2013 company retreat in Washington, DC.
• Vitera announces the availability of Intergy Mobile 2.0 in the Apple Store.
• Billian’s HealthDATA offers a Porter Research whitepaper on the evolution of consumer engagement in healthcare.
• Emdeon releases an HTMS whitepaper on modernizing core administration systems and planning a system implementation.
• CareTech Solutions website security expert James Hunter shares his expertise in a pre-conference education session at next week’s Greystone.Net Healthcare Internet Conference in New Orleans.
• CTIA-The Wireless Association recognizes AirWatch with MobITS Awards for mobile device management, application development and platforms, and cloud storage and collaboration.
• HealthMEDX implements INTERACT Tools into its Vision solution to improve early identification, assessment, documentation, and communication about changes in the health status of residents in skilled nursing facilities.
• Intelligent InSites clients share how tracking software has improved healthcare delivery at their facilities.
• Levi, Ray & Shoup hosts a secure printing webinar November 5 and 7.
• Compuware is recognized as one of Michigan’s Healthiest Employers.
• Vitera introduces Vitera Clinical Exchange, an electronic connection between Florida practices and the state’s online immunization registry, FloridaSHOTS.
• Impact Advisors principal advisor Laura Kreofsky discusses the two most challenging areas for MU Stage 2.
• ­­­RazorInsights announces its November conference schedule.
• Meditech highlights the role of DrFirst in providing its customers e-prescribing functionality.
• Wellcentive CMIO Paul D. Taylor, MD outlines three mission-critical pieces of network maturity to ensure value-based care.

EPtalk by Dr. Jayne

I got a chuckle earlier this week when Farzad Mostashari Tweeted about an article on using data to support accountable care efforts: “give MDs info on pts who need A1c, they look at you as though they’re drowning & you’ve just given them a baby.” The line comes from a piece about Memorial Hermann Physician Network (MHPN)and its work to use data to drive population health management.

The network has over 2,000 physicians and functions as an ACO under both Medicare and private-payer frameworks. MHPN is working to bridge the gap between claims-based data and EHR data and I don’t envy them. In working with those two data sources in my own organization, there are plenty of gaps. We continue to deal with practices and service providers that don’t bill in a timely fashion which can skew the claims data. I may have an ophthalmology report back from my colleague so I know I’ve satisfied the patient’s need for diabetic retinopathy evaluation, but the payer hasn’t seen a charge yet therefore the patient’s status is in limbo.

It continues to amaze me that practices can’t bill in a timely fashion even when they are using EHRs. I’m fortunate enough to have very good insurance not only from the patient perspective but from the provider perspective. It reimburses at the top of my fee schedule and also pays timely and accurate claims in a matter of days. As a patient I usually have a paper Explanation of Benefits in my mailbox within two days of when the payment check is cut to the provider, which typically happens within days of the claim. After my recent orthopedic surgery adventures, it took months to receive the first EOB. Based on some of the happenings in the office (such as being charged unnecessary copays during a global period and general disarray with scheduling) maybe I shouldn’t have been surprised. As lean as practices run though it surprised me they wouldn’t do everything possible to get their payments sooner.

In talking to some of my colleagues about the challenges of running an independent practice, it makes sense why so many have been purchased by hospitals and health systems during the last few years. Hospitals sell the vision that they are will deal with practice headaches including OSHA, CLIA, HIPAA, Human Resources, and a host of other issues. Although there are good organizations out there that get the job done, it feels more and more like physicians are being sold a bill of goods.

One of my residency colleagues is part of a small primary care group that was recently acquired. They had a successful EHR installation and were moving forward with Patient Centered Medical Home and other initiatives. Since the hospital medical group was on the same EHR as they were, they figured it would be a smooth transition once their data was migrated. Unfortunately the nightmare was just beginning. The employed physicians had done some significant customization to their version of the EHR, often damaging clinical workflow in the process. Required fields were added in a way that didn’t make sense with how physicians document.

Being a power user of the EHR previously, my friend questioned the way the group was using the system and who had been making the decisions to add the customizations. The group has a policy on change control and decisions are to be made by an IT Committee. Unfortunately its leader is a political appointee who is not actually a user of the system and his chief mode of management revolves around making sure there are no squeaky wheels. When the Compliance department asked for required fields to be added, he complied. When risk and legal made demands, he acquiesced. When specialists wanted fields hidden because they weren’t relevant to them, they vanished. Ultimately a system that could have been highly functional turned into a Frankenstein.

Her new colleagues inundate each other with strings of emails complaining about the system and demanding the administration rip it out and find a new vendor. The EHR has become the scapegoat for a number of problems in the offices, many of which are simply due to poor management. The leadership won’t hit the problem head-on because they are part of the problem. Revenues are down yet many practices have a substantial charge lag. It appears the group doesn’t have a policy on how quickly providers must document their patient visits or when charges are submitted. There are no metrics gathered to show how poorly practices are performing and no accountability to force anyone to change.

I suspect my orthopedic practice is probably managed in the same manner. This brings me back to the quote about giving a practice reports to manage when they’re already drowning. How can we expect a practice to perform population interventions when they can’t finish their documentation? Why can some primary care physicians on a given EHR see forty patients a day and others balk at seeing sixteen? Practices need active (and often aggressive) management to be able to achieve the high goals that are being set out for them. It’s not going to happen automagically and certainly not without a tremendous amount of work.

Medical group management teams need to make sure their physician offices know how to crawl before they push them to run a marathon. Otherwise they’re just setting them up for failure. There is a great quote in the piece that I think I’m going to use to illustrate this point as I discuss these issues with my colleagues: Big data is just making the haystack bigger and not making the needle better. It doesn’t make sense to hand a practice a sheaf of reports to work when they can’t even answer the phones or keep up with refill requests. Why send communications encouraging patients to schedule appointments when the providers have a three month scheduling backlog?

Technology can do wonderful things but it can’t do everything. It doesn’t remove the need for management, structure, and accountability. It won’t replace the basics and we’ve all seen how technology can make dysfunctional processes even more so. If you weren’t billing timely in the pre-EHR world there’s no magic wand that will make it happen just because you implemented a system. Hopefully by now you have some chills running down your spine. After all, it is Halloween. Do you find poor practice management as horrifying as I do? Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

CIO Unplugged 10/30/13

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

Secret to Great Sex…and Other Faux Pas Along My Journey

Skipping the rank of manager, I catapulted from physician relations coordinator to director of information technology. I had worked plenty with a cadre of nurse directors at my former employer, so I expected the same stereotype when I landed at Parkview. Boy, was I wrong!

My first week post-orientation, I attended a mandatory leadership class on counseling employees using a new behavioral technique. After the theory lesson, we were randomly partnered with a peer to practice our newly acquired skills. My partner was the director of surgical services, and she was a young knockout. I had expected someone seasoned in looks and experience, but this woman made me nervous.

I hate to disappoint any readers, but I was struggling. I was afraid that my subconscious might win over my conscious and say something bad. I was coaching myself to not say any word that might even remotely sound sexual or land me in trouble. I recall moving into her personal space, per instruction, locking eyes and going through our training script, fumbling for words. I started to sweat but made it through. Phew! Deep breath.

She then began. She moved in, locked eyes and with all sincerity asked me, “What is your secret to great sex?” She quickly spewed, “secret to success,” but it was too late. Our uncontrollable laughter lasted a good 15 minutes. The instructor moved us to the corner of the room because we were disrupting others. It was the hardest I had laughed, ever. We eventually regained composure, and a great working relationship was born. Adding to the drama, the next morning at 7 a.m., I presented to the surgical committee and she was sitting there smiling, thinking the same thing as I was. I looked away.

Over the years, I created many faux pas or bloopers. Here’s my best:

• I regifted some chocolates only to learn from the recipient that when they opened the confection, the originating thank you note meant for me was inside.
• I managed a rock band on the side. Late one night while working at the office, I inadvertently sent the band contract and operating agreement out to the entire IT department. Not only was it full of financial information, but moreover, a code of conduct that was very personal.
• I replied to an “email” from our CMIO that had been generated inside of our internal collaboration software. He relayed his concern regarding a public posting from another physician that might have violated our solicitation policy. I replied that not only was it a gross violation, but that the doc had frequently done this on my Facebook page as well. About five minutes later, another colleague sent me a note asking me if I knew that my reply was posted to every employee instead of just my CMIO.
• I was speaking with two fellow officers when a third one joined our conversation. I said with utmost sincerity, “Hey, here is our best hospital president in the entire health system.” As soon as I let that loose, I realized the other two were also hospital presidents.
• Our COO was wrapping up his closing remarks after an all-day leadership meeting. The technical aspects went without a glitch. I instant messaged the admin who was running the operation when, lo and behold, my IM popped up on the screen on top of the presentation. “Phew, so glad the technology worked for once.” I shrank in my chair as the audience chuckled.
• I was dancing the night away at an after work party. While I prefer ballroom and Argentine Tango, I can hold my own freestyle. Or so I thought. The people who could clearly “move like Jagger” later told me that I “danced like a white man.” I don’t know if that’s an offensive statement to anyone else, but to me it said that I danced like a dork, or at least that’s how it made me feel.
• One of my nurse managers had been asking to go out to lunch and I was forced to cancel twice. Finally, my schedule opened up, so I teasingly messaged her “Our time has finally come to be together.” She agreed to meet me in our lobby at the appointed hour. I was shocked when a different nurse manager showed up and realized I had asked the wrong person out. Talk about an awkward lunch.
• Sexting to the wrong person. I have not done this yet, but know it’s only a matter of time. My wife and I exchange all sorts of texts from “pick up some eggs on the way home” to … well use your imagination. Someday I am certain it will go the wrong person. Hopefully not my HR colleagues.

Over the years, I’ve learned to laugh at myself. My foibles and blunders will be around as long as I’m alive. It’s called being human, and we can’t take ourselves too seriously. Ever. Do you have a work faux pas that needs a good laugh?

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.

Morning Headlines 10/31/13

Sebelius: ‘I apologize, I’m accountable’ for Obamacare website flaws

Amid growing demands for her resignation, HHS secretary Kathleen Sebelius testified before congress today where she took full responsibility for the healthcare.gov rollout and reported that to date the site has cost taxpayers $174 million, which includes $56 million for support. In an unfortunate timing of events, the site crashed again in the middle of her testimony.

HIPAA framework could be expanded, privacy expert says

Modern Healthcare reports that growing concern over the impact mobile health apps and patient portals are having on health information security could lead to another expansion of HIPAA.

NM’s massive electronic health record project finally in the black

After eight years in operation, the nonprofit that built New Mexico’s health information exchange is operating in the black. CEO Bob Mayer reports "Our federal grant runs out in January and we will be sustainable on Jan. 1.”

CommonWell Health Alliance Announces Board of Directors

CommonWell Health Alliance introduces its board of directors which includes: Jeremy Delinsky, Board chairman (AthenaHealth CTO); Rich Elmore, Board vice chairman (Allscripts VP); Bob Robke, Board treasurer (Cerner VP); Rod O’Reilly, Board secretary (McKesson VP); Scott Schneider (CPSI EVP); Justin T. Barnes (Greenway VP); and Keith Laughman (Sunquest EVP).

Morning Headlines 10/30/13

Obamacare website official: Sorry for problems, but system working

CMS Administrator Marilyn Tavenner apologizes for the problems associated with healthcare.gov, promising that it "can and will be fixed," and reporting that a vast majority of consumers would be able to successfully use the site by the end of November.

Registry data standards may need to catch up before Stage 3

ONC members working to establish MU Stage 3 requirements are running into significant technical barriers as they work to facilitate the framework for integrated public health registries.

ZocDoc and CareCloud team up to streamline services for doctors

Ambulatory EHR vendor CareCloud partners with ZocDoc, an online doctor review and appointment booking website.

athenahealth Partners With Quantros; Proactively Brings Safety Solutions to Its Nationwide Cloud-Based Network of Medical Providers

athenaHealth, in partnership with cloud-based analytics vendor Quantros, launches a patient safety reporting platform that will allow end users to report patient safety concerns as well as share best practices to enhance safety and improve care.

News 10/30/13

Top News

CMS Administrator Marilyn Tavenner tells the House Ways and Means Committee on Tuesday that contractors for the HealthCare.gov website “have not met expectations” but that the  troubles were being resolved and the overall program was working, albeit slower and less successfully than hoped.

The problem-plagued rollout of the insurance marketplace website suffered another hiccup Sunday when the data center for HealthCare.gov experienced a connectivity issue, causing the website to shut down for several hours.

Reader Comments

From Swoop: “Focus groups. I’m wondering if you would be able to recommend any market research/focus group companies in the HIT vertical?” Readers, do you have any recommendations?

From Cookie Monster: “Re: AHIMA. We all thought ICD-10 would be hottest topic here. So far, I think the hot topic is clinical documentation improvement.” Cookie Monster also shared that several vendors were showing mobile versions of their products; one she particularly liked was a mobile clinical documentation app from HUFF DRG Review. If you are at AHIMA, tell us the buzz.

HIStalk Announcements and Requests

   Mr. H is busy with his day job this week, so I am flying solo. I have a feeling he’s a little behind on his email, too, so please be patient with him. If you have burning HIT issues to discuss in quick order, feel free to drop me a note. I especially love email that contains entertaining news, insightful commentary, and/or flattery. 

Acquisitions, Funding, Business, and Stock

Dell completes its $24.9 billion buyout by founder and CEO Michael Dell and the investment firm Silver Lake Partners. Michael Dell will own about three-quarters of the newly private company.

Alere turns in Q3 numbers: revenues up 9 percent; adjusted EPS of $0.59 vs. $0.43, beating analyst estimates. Net product and services revenue from Alere’s health information solutions segment fell less than 1 percent.

Kryon, a start-up focused on medial data analytics, closes $3 million in funding from Khosla Ventures.

Sales

A local newspaper reports that Highmark will replace the Allscripts system at West Penn Allegheny Health System with a $178.3 million Epic implementation. In 2011, West Penn Allegheny renewed a contract with Allscripts to provide its record system through 2018 for an undisclosed price; Highmark officials say they “reassessed” the contract after purchasing the hospital network in April. A West Penn Allegheny spokesperson added that the organization was “transitioning to Epic to meet the changing nature of our broader enterprise.”

Carilion Clinic (VA) selects Orion Health Rhapsody Integration Engine to connect its existing HIT infrastructure across 195 facilities.

Sinai Health System (IL) will implement Merge Healthcare’s VNA, radiology, cardiology, and imaging platform. Imaging Healthcare Specialists (CA) will also deploy Merge Healthcare solutions for RIS, PACS, VNA, and interoperability solutions.

Rush Health (IL) endorses the eClinicalWorks EHR solution for its 300 affiliated private physician members.

Prognosis announces several new customers including Rankin County Hospital (TX), Red Oak Medical Center (TX), Winkler County Memorial Hospital (TX), and three Jane Phillips Medical Center’s satellite hospitals in Oklahoma and Texas.

The VA Midwest Health Care Network selects Visage Imaging’s Visage 7 Enterprise Imaging Platform for diagnostic interpretation and referring physician image access.

Phelps County Regional Medical Center (MO) will implement standardized order sets from Motive Medical Intelligence.

Memorial Hermann Health System (TX) selects ClinIntell as it technology partner for ICD-10 physician education.

Emerson Hospital (MA) will replace its legacy surgical documentation system with Surgical Information Systems’ perioperative platform.

New York Methodist Hospital selects workforce management solutions from Kronos.

People

Telehealth solution provider AMC Health adds Hon S. Park, MD (Army Medical Department) as CMIO; J. Mark McConnell (Verizon) as SVP of sales, account management, and marketing; Joanne Russell (Optum) as VP of clinical operations; and, Frank Tucker (MicroHealth) as CIO consultant.

Mike Cromika, director of IT services at Baptist Healthcare and a HIMSS Kentucky Bluegrass chapter board member, died Monday at the age of 56. Condolences to his family.

Richard J. Gilfillan, MD, the former director of the Center for Medicare and Medicaid Innovation, is named president and CEO of CHE Trinity Health.

Bruce Bagley, MD, interim president and CEO of the AAFP subsidiary TransforMED, assumes the role of president and CEO.

CynergisTek names David Holtzman (HHS/OCR) VP of privacy and security.

Announcements and Implementations

AHIMA presents Truman Medical Centers (MO) its Grace Award for its innovative approach to using health information management to deliver high quality healthcare.

Montefiore Medical Center (NY) and Streamline Health sign an exclusive 15-year licensing agreement enabling Streamline to commercialize Montefiore’s clinical analytics platform.

FirstHealth of the Carolinas goes live with Wellsoft’s EDIS at Montgomery Memorial Hospital (NC) and Moore Regional Hospital (NC).

The Great Lakes HIE and Michigan Health Connect collaborate to share medical records between their HIEs.

France’s Hôpital Européen implements the first ICU alarm management system in Europe using medical device connectivity technology from Capsule Tech.

Sutter Health (CA) announces it will go live with the ICD-10 code set on May 31, 2014, though it will not start submitting claims with ICD-10 codes until October.

Baylor Health Care System (TX) upgrades to Allscripts Sunrise Clinicals 6.1.

Government and Politics

A Government Accountability Office report finds a large increase in MU incentive payments made to eligible hospitals and EPs in 2012 compared to 2011. EHs and EPs were awarded $6.3 billion in Medicare EHR incentives in 2012, compared to $2.3 billion in 2011. The percentage of EHs awarded payments jumped from 16 percent in 2011 to 48 percent in 2012.

Technology

Park Place International announces its Secure Access and Mobility (SAM) solution, a desktop virtualization offering for Meditech hospitals with VMware Horizon View.

Other

An estimated 95 million US residents use mobile health applications, representing a 27 percent increase over last year.

Results from an ICD-10 HIMSS/WEDI pilot project indicate that healthcare coders were accurate only 63 percent of the time, on average, in their documentation from medical records. The study, which ran from April 2012 to August 2013, also found coders averaged two medical records per hour, compared to four per hour under ICD-9. Translation: there is still a lot of readiness work to be done.

Children’s Healthcare of Atlanta fires and sues its former corporate audit advisor for allegedly taking the hospital’s proprietary information, including PHI and license numbers of over 500 providers. Two days after announcing her resignation, Sharon McCray began emailing the proprietary information to her personal email account. When confronted, McCray stated the information was to be used “as backup records for her new employment with an unidentified employer to use as a reference.” Children’s fired McCray and has asked a federal judge to force her to return the information.

Sponsor Updates

• Athenahealth will implement Safety Event Manager, a safety reporting solution from Quantros, allowing athenaClinical users to submit patient safety data as part of their EHR workflow to the federally sanctioned Quantros Patient Safety Center
• Inc. names AirWatch, GetWellNetwork, HCI Group, Imprivata and iSirona  to its Top 100 Job Creators list.
• Black Book recognizes McKesson’s RelayHealth RCM as the top-ranked RCM, based on customer satisfaction.
• SuccessEHS will integrate the DataMotion Direct secure messaging service into its EHR platform.
• HIStalk sponsors named 2013 Top 100 EHR companies based on revenues include Allscripts, NextGen, eClinicalWorks, McKesson, Merge, Vitera, Greenway, Optum, T-System, Aprima, e-MDs, ADP AdvancedMD, Kareo, Wellsoft, RazorInsights and SimplifyMD.
• The Drummond Group tests and certifies the Summit Express Connect interface engine from Summit Healthcare for MU Stage 2.
• Nuance introduces enhancements to its Clintegrity 360 platform that integrates clinical documentation improvement and CAC into a single process.
• HCS will showcase its Interactant platform at this week’s LeadingAge Annual Meeting & Expo in Dallas.
• DVIDS highlights the Naval Health Clinic Hawaii online system, which uses RelayHealth software for messaging, appointment scheduling, and medication refills.
• Business Cloud News features Inland Northwest Health Services in an article highlighting the growing use of cloud services in healthcare.
• Access integrates support for the Wacom STU-530 and STU-430 Signature Pads into its electronic patient signature offering.
• Bottomline Technologies releases its Logical Ink solution for the iPad.
• Greenway Medical Technologies is named a finalist for the 2013 Intel Innovation Award in recognition of its PrimeMOBILE app for Windows 8.
• In an interview, eClinicalWorks CEO Girish Navani shares various observations and predictions for the industry.

Contacts

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

More News: HIStalk Practice, HIStalk Connect.

HIStalk Interviews Neal Patterson, CEO, Cerner (Part 2 of 2)

Part 1 of the interview is here.

Neal Patterson is chairman of the board, CEO, and co-founder of Cerner Corporation of Kansas City, MO.

Are EMRs the center of the universe, or would a better model be more open systems that support an ecosystem of components?

I think there needs to be much more openness. Because of the complexity of healthcare, nobody, no company, is ever going to do 100 percent of the needs. There’s just too much complexity to healthcare to think in terms that you’ll have a 100 percent. 

I love seeing innovation done at the edge, whether that’s coming out of clients that have committed enough resources to do development or where we put out pockets of developers to work specifically at the client edge. There’s all kinds of needs for our systems, Cerner’s included, to be more open so that we can have an ecosystem developed around our systems.

I don’t think, though, that core chassis  of the 80 to 90 percent of the requirements that are driving the clinical enterprise … I don’t think openness evolves that back to best of breed. I think those are the core capabilities of integration are going to win over in the center of the needs. The edges should be open. There’s too many things to work on to think of it all coming out of one top-down driven organization.

If you were starting a healthcare IT company today out there on the edge, what problem would you choose to solve and how would you go about creating a business from it?

I’ve thought about that recently, not that I’m out to start another one. Somebody was starting an accelerator in Kansas City and the question was, do we as a company want to be part of it? The short answer was, we’re supportive, blah blah blah, but we stepped back one step. In that process, I actually pondered that question.

Historically, there have been a lot of niches. All of us started in a niche somewhere as a company. I’m a big fan of innovation that gets done at the forest floor. The forest floor that I talk about is when you go to HIMSS, you see the big towers at the boat show, but there’s always a whole bunch of the smaller stuff. I love the forest floor because all trees in the forest started as a little sapling somewhere. The advantage of small is you can be highly focused. You’re all in. You’re putting in all your innovation skills. 

But the reality is that in the past, a lot of people created business models and niches around all of the peculiarities of healthcare and how inefficient it has been in the past, particularly around the payment system. There’s always niches to go develop around on the delivery side. I think the inefficiencies in healthcare are slowly going away. There’s fewer targets to go start the companies at, although there’s still probably another 15 years .. find the spot in the billing system that you can help increase your revenues. I’d be real smart around NLP, around coding in this subspecialty. I think those ultimately go away. 

I think the opportunities are less. I think the home, the integration of the devices… devices, I think, are still reasonably wide open because everything is now so smart. I would try to find some edge condition around the result of that condition where it’s probably outside the enterprise. That’s what I’d invest in.

When you look at that forest floor of those companies that are trying to get a foothold, what do rules do you apply to them to determine whether you think they’ll be successful or not?

Jim Macaleer of Shared Medical Systems happened to be a neighbor of my older brother. Or my brother was a neighbor of Jim, or they knew each other back in Pennsylvania. When we did our very first venture round in 1983,  I asked my brother whether he wanted to be involved. Without asking me, he took our business plan over to Macaleer and showed it to him. And Macaleer basically goes, according to my brother, "I’ve seen so many of these and they’ve almost all failed." So I’m afraid that I might be becoming Jim. I hope not. [laughs]

I later got to know Jim a little bit and he was an outstanding man. I mean, he really was. But he had his beliefs. When he got to be a certain size, he looked back and didn’t create a lot of credence. I have a lot of respect for what people are doing. I don’t know that I’m smart enough to give you the formula which one will survive and which one won’t. It’s all hard. There’s a lot of serendipity to success, too. More serendipity typically than brilliance. Right time, right place. The art’s in the timing. It’s not so much in the idea.

Could someone today do what you did at Cerner in taking the company from an idea drawn at a picnic table to a huge, publicly traded company while retaining control after all those years?

The art’s in the timing. The window has to be there. There are these waves. As a small company, you don’t create the wave. You have to be able to see it, sense it, and then … I’ve never surfed, but it seems to fit my vivid description of what you have to do … you have to be there at the right time, at the right place. The wave has to be there, too. The wave’s got more energy than you ever can create. Somewhere you’ve got to create this leverage point of being able to get up and ride. 

You can’t take the Cerner wave because everything is unique. It was point in time stuff. You can’t use our pattern. It’s the same skill set, though. You’ve got to see the wave and you’ve got to find those convergence points of where technologies and needs and industries match. Then you’re there. You’ve got the skills. You’ve got enough to make enough payrolls to get far enough down the road.

I love entrepreneurs. I love the entrepreneur spirit. Entrepreneurs love this country. I think those pilgrims that came over were entrepreneurs of sort. They were certainly avoiding something they didn’t like in the old countries, but they were mutants where they could handle risks that most people abhorred. The skill set was common. The patterns, though, are all individually or unique to the time.

It would be a very good time. There’s more change that will happen in healthcare in the next seven years as we finish this decade than has happened in the last 70 years. This thing has to change. Change is what creates opportunity. And my gosh, this intersection of healthcare and IT … just look at the innovation in IT over the last seven years and look at the change in healthcare over the last seven years and then just say, well, if there’s even similar trends of the past equals the future, there’s going to be huge fundamental opportunities over the next seven years. 

It’s a great time to be where we are. We’ve made plenty of mistakes, but we fix mistakes. We learn from them. We also get better from it

How do you think private equity firms influence the industry?

It’s probably a little negative. My experience in that era is relatively dated. It just seems to me that there’s a lot of leashes that come with money nowadays. As an entrepreneur, the last thing you really want is a leash.

The hospital system market has boiled down to Cerner and Epic. Did Epic’s growth surprise you, and how do you see that competition shaping up over the next few years?

The first part was a surprise. They might have been a little bit surprising. They were very fortuitous in the way the market developed. Again, the art’s in the timing. Their strengths matched up very well with how decisions got made.

I think we have inherently greater strengths on a much broader basis. We don’t stay static. What you may view as a weakness today will be viewed as a strength tomorrow. That’s how we work. I’m pretty sure I was the first to use the word “duopoly” and there were people who cringed when I said it, but it’s relatively descriptive. Healthcare in IT is huge because it’s worldwide. I personally believe competition is the best thing ever invented. Competition drives, accelerates innovation, it creates value for our clients. If you don’t respond to competition, you’re eliminated. It deals with the survival of the strong. 

We are strong and we will get stronger. In every era, we’ve had major competitors. We go back to the lab days. I cannot tell you what exactly happened to Sunquest. I didn’t track it all. I’m just finishing a note, what I call a Neal note, to our associates. I have the HBOC story in there. We usually do our town halls right after our health conference. The associates we could get, we’d get them all together and we had basically a town hall format with a question and answer period. We were using an outdoor stadium and it rained on our town hall so I had to call it off. I told the story that the last time I had to call a town hall off because of weather was back in 1998. I went on to talk about the head-to-head match with HBOC and how tough a competitor they were and how many people declared them the winner. We’re going to do fine.

Epic draws the contrast saying that they don’t do sales and marketing and the product just flies off the shelf on its own. What is your thought about the role of sales and marketing in something like selling healthcare systems?

Frankly, I think there’s a lot of things that have been stated by that company … I think sales and marketing are healthy parts of an economic enterprise. I don’t know if they’re trying to make that bad or evil.

This business ends up being a relationship business, because I don’t know of another relationship or healthcare delivery organization formed that’s more important to them than the relationship we end up with. You’ve got to start that relationship somewhere and people have to learn about you. I don’t know what you call that. I don’t believe any company that has grown a lot doesn’t have that.

How would you describe your management style?

I make sure I have a great team around me. I mean, a really great team. Then my objective is, in the perfect world, that the organization is so well designed that there’s nothing for me to do. Now I’ve never even gotten close to the perfect world. I say that somewhat jokingly in a sense. Goal One is to create a great team that can operate without you. 

Then I do two things. I look at chunks of my time, usually about 100-day chunks, and I say, what do I need as the leader to get accomplished in that 100 days? Then I design everything about me to work on what comes at the top at the list for the next 100 days. That’s how I do my calendar stuff. The test is that the rest of the organization is working well. 

I’m kind of a free safety. I touch the things that I think that need to move internally, that I go then drill down. Another style I have is that I get very deep. When I want to understand something internally, I’m not going through the chain of command. I’m going down to where the work is and I get pretty deep. I tend to be in the room when we’re defining the three-, five-, and 10-year views of what we’re going to accomplish, too.

Intermountain Healthcare had an agreement with GE Healthcare similar to the one Cerner just signed. That didn’t seem to produce anything much for either organization. How will the company work with Intermountain in developing something that’s both useful to them and that has market value for Cerner?

I think they learned a lot from their GE endeavor. Their intent wasn’t to go develop something unique. Their intent was to basically go to a marketplace and build a relationship around a company that can meet most of their needs today. The foundation of that relationship wasn’t to go build something, it was to deliver something. 

The flipside of that is that this is a very innovative, creative organization and entrepreneurial organization. We’re going to go build the first real costing system this industry’s ever had, working with Brent James and his institute, around building an activity-based cost system for healthcare. There are some specific things we’re going to go innovate together with them. Their large body of work over the last couple of decades around process models will certainly be a source of content for us and our other clients. 

They changed what they were trying to accomplish with the relationship significantly. They wanted to go to the current marketplace and buy the best solution for them that’s available in the marketplace today. That was how they made that decision. It’s a neat organization.

I assume it’s similar to the agreement or the arrangement that you have with UPMC with also a lot of innovation and entrepreneurship coming out of a non-profit group.

UPMC is a great client and great innovators. They are amazing as well. We have a good relationship with them, but we’re at different points in time between the two. I don’t try to compare the two.

When these agreements are struck, it’s always between large, prominent healthcare systems and vendors. Do you think that that’s the right kind of information or outcome that will be useful to the average 300-bed community hospital, or should somebody be forming a relationships with smaller places that are more prevalent in number if not in stature?

I’m extraordinarily pleased with the level of collaborations we are doing throughout the industry. It’s not all with the megas. The work we’re doing with Advocate, a large system, around population health is real cool. I mean, that’s the largest ACO in this country. They pioneered the whole concept of clinical integration, which is the backbone to how you manage the care side of a population health system. They have 500,000 lives where they’re risk for, defined risk of a population attributed to their health system and down to individual doctors in their health system. 

The other side of it is we announced recently an institute at Children’s National Medical Center, which is really this notion of development at the edge. We’re using them around pediatric populations. We have an institute at the University of Missouri, which wouldn’t be considered a mega client, but it’s a three-year-old collaboration where we are focused on the adult population. Then we have an institute up in Canada, I think they recently rebranded their health system but it’s Island Health in Vancouver, that focuses on the elderly. If you think of those three institutes, those aren’t your megas that you referenced.

We love where we clearly create an alignment between us and another organization and there is a specific area of interest and they have an attitude that toward innovation and development inside their health system. We jump on that. We have a whole model around that. I’m just very pleased with the depth of that and how productive that’s all been. Intermountain fits into that broad category of defining strategic relationships.

What’s the long-term plan for Cerner and for you personally?

There is a new layer of information, a new information model and technologies and platform around it, that’s growing up above the EMR that’s fundamentally designed to manage the health in a population and to support enterprises that can get closer to the first dollar. If you compiled that fairly concise set of three or four items we covered, it gives you what I believe we’re going to have. 

I think we can synchronize the activities of a complete system around health and care and synchronize it and be able to through different organizations deliver predictable, guaranteed levels of care. I call them SLAs, the same as what we do in our data centers. Here’s the performance that you can expect from that system. Here’s the measurements that are useful.

There’s a new middle that has to be created in healthcare. Healthcare is this inverted thing — it’s all delivered local. You can get on an airplane and fly someplace, you can change the ZIP code, but it’s delivered local. From the ZIP code up, there’s just a huge amount of opportunity in healthcare. It’s the largest sector of the US economy. It’s typically the largest sector of every economy in the world, the exceptions being India and China where the investments haven’t been yet made. The needs are very, very similar worldwide. I think Cerner’s got a huge future.

As regards to me personally, I said at the beginning of the decade that this is the first decade that I start as CEO that I don’t expect to end as CEO. That’s a function of age, not a function of desire or anything else. It’s just kind of a reality. There are things in nature you do not change. It’s also a statement of confidence of how strong a team I think we have at Cerner.

Any concluding thoughts?

As we finish this decade, I think we’ll look back and say, this was the key decade that many people predicted over the last three decades, that there was going to be fundamental change and transformation in healthcare. I believe it happens inside this decade. My basis for that will be repeats of what I said previously, but I think the ability to finance an ever-growing expenditure of healthcare is decreasing rapidly. I think the need to transform it is here and I think the largest lever that you can have to change healthcare with IT. 

This country and many other countries have invested significantly in IT, and we as providers of IT will collaborate with our clients around using that lever to fundamentally change the cost structures and the quality that’s produced. I also believe that there will be a fundamental change in business models, and providers will be much more integrated on vertically on how healthcare is financed, and they’ll be more accountable for the health of populations. 

This is a significant industry and I’m extremely excited to be part of it. I feel very privileged.

Curbside Consult with Dr. Jayne 10/29/13

Last week ONC released another game-based security training module. “CyberSecure: Your Medical Practice” is aimed at providers and staff and focuses on disaster planning including data backup and recovery. I didn’t realize that October was National Cyber Security Awareness Month; most of my focus the last few weeks has been on educational pushes around breast cancer awareness and watching the budget fight unfold.

I played it through and as a CMIO it was pretty easy. In each round there are a number of actual questions and also several pop-ups that represent questions or comments made by patients. Several of them made me laugh:

· Wait! I know I had a coupon in here somewhere…

· Honey, don’t forget to tell the doctor about how your you-know-what went you-know where.

· These shoes are pretty heavy. Mind if I take them off and get weighed one more time?

· A virus? Are you sure you can’t give me some antibiotics?

· One second… I’m almost finished with the hardest level of this new racing game.

I’m not sure some of our office staff would receive as high a score as I would hope and it would provide some good review for front-line office staff as well as a humorous break from normal office activities. I didn’t remember playing the other game so I gave it a go as well. It’s focused on Contingency Planning and the questions were pretty entertaining. When you provide a wrong answer, you lose a key office resource such as an exam room. When you have multiple right answers you are rewarded – at the end of Round 1 I received a new vending machine for my break room.

Although there were too many questions where “all of the above” was the right answer, there were some funny possible answers on what to do in the event of a disaster:

· Send all the patients home, there is nothing you can do.

· Smile and hope that no one notices.

· Yell at the doctors for not agreeing to get a back up generator when you suggested it.

My favorite question though was the last one. “We never tested our EHR data backups. Now I can’t retrieve patient information that appears to be lost after an application upgrade. What do I do now?”

· Find out if anyone has backed-up the EHR on tapes or disc drives.

· Contact your EHR vendor to request assistance in rolling back the upgrade or recovering as much of the database as possible from backup media starting with the most recent media.

· Re-boot your server; this typically will resolve the problem and your EHR data will be recovered.

· Try to recover from a previous backup; the data should not have changed very much.

I intentionally answered wrong and was penalized by having a roof leak at my clinic. I guess as they say: when it rains it pours. The detailed answers and feedback that can be viewed at the end of each section has detailed citations from the HIPAA Security Rule including the pertinent Code of Federal Regulations documentation. I’d recommend the contingency planning module for office managers and other business leaders but I don’t think it would be that helpful for end users or front-line office staff.

Gamification can be an entertaining method of communicating information for mandatory review but I’m not sure the modules are interesting enough that I’d do them if it wasn’t required. I enjoy the humor that ONC interjected though and the appreciation of some of the things we encounter in daily practice. I’d like to see our in-house training teams adopt more of this approach. Unfortunately they’re too partial to non-interactive modalities. I was actually glad of the changes to HIPAA because it forced them to update the tired “gangster theme” video they had been showing for years. What do you think of game-based learning? Email me.

Email Dr. Jayne

Morning Headlines 10/29/13

Sutter to go live with ICD-10 early

Sutter Health announces that it will go live with its ICD-10 program on May 31, 2014. The health system clarifies that it will not be submitting claims with ICD-10 codes, but all elements of the system will be live and physicians will be able to start using it.

AHIMA annual convention begins in Atlanta

At the 85th annual convention of the American Health Information Management Association, CommonWell discusses the work it has been doing building its privately operated HIE. Thus far, the organization has created an enhanced method of matching patients to their records, about which Patrice Wolfe, senior vice president and general manager of RelayHealth, says "we think we have a better mousetrap.”

Measuring The Outcomes Of Health Reform: Opportunities For Federal And State Policymakers

A Health Affairs article discusses the performance metrics that will be used to measure the effectiveness of the state and federal health insurance exchange marketplaces.

Morning Headlines 10/28/13

St. Rita’s first in country to pilot tablet technology

Lima, OH-based St. Rita’s Medical Center announces that it’s piloting a new Epic product designed for patients. The tablet-based application is an acute care-based patient portal that lets admitted patients see their care plan, review their lab results, and even see pictures and details for their entire care team.

Hundreds of thousands click on Healthcare.com after Healthcare.gov launch

The easily mistaken site healthcare.com, which sold to a Miami-based entrepreneur seven years ago for $2 million, has received millions of hits since the October 1 launch of healthcare.gov. The site owners monopolized on the traffic by putting up an official looking webpage and accepting health insurance quote requests, of which it’s already received 100,000.

Major Conflict of Interest with QSSI, the Contractor for the Health Insurance Exchange

QSSI, a general contractor working to fix healthcare.gov, is being called out on a potential conflict of interest because it is owned by parent company UnitedHealth Group which also owns United Healthcare, the largest private insurance company in the country.

GAO Appointments to Health IT Policy Committee

The Government Accountability Office names three new members to its Healthcare IT Policy Committee: David Kotz, PhD (Dartmouth College), Devin Mann, MD/MS (Boston University School of Medicine), and Troy Seagondollar, MSN (Kaiser Permanente).

Monday Morning Update 10/28/13

From FL IT Guy: “Re: HMA. CIO Ken Chatfield and two other IT VPs were separated Thursday night. I don’t know the details.” Unverified, but Ken’s bio has vanished from the for-profit hospital company’s leadership page. He took the job in 2010. HMA replaced its board a month ago and is reconsidering its planned $3.9 billion sale to Community Health Systems.

From Levon Helmet: “Re: interface engine selection. Consultant John Traeger put together a really great guide that includes a grading system. He presented to our user group conference and said he put the guide together because people are using dated questions on their RFPs that often lead to the wrong selection.”

From The PACS Designer: “Re: SAP and the cloud. TPD is very familiar with SAP AG and their database solutions from previous development experiences in healthcare. What is surprising for a stodgy company that SAP is the success they’ve had moving customers to the cloud. It wasn’t that long ago that they announced their desire to sell cloud solutions and they’ve already achieved over $1 billion in Hana cloud business.”

From Twitterpated: “Re: US CTO Todd Park. Hasn’t tweeted since the week before Healthcare.gov went live.” Todd’s last tweet was September 25. I don’t know if that means anything, but his tweets were somewhat regular at 5-10 per month before then, so his month-long absence is unusual. A Reuters article says that like most White House officials, nobody’s saying what is role was in developing Healthcare.gov and the White House has declined to make him available for interviews. A couple of influential Republican members of Congress seem to have him in their sights. Bizarre conservative columnist Michelle Malkin wonders, “What Happened to All of Obama’s Technology Czars?” in ripping the administration along with former US CIO Vivek Kundra, his replacement Steven VanRoekel, former US CTO Aneesh Chopra, David Blumenthal, Farzad Mostashari, and Todd Park. Where were all the critics when BearingPoint’s $500 million CoreFLS nearly shut down the Bay Pines VA hospital in Florida and was trashed after returning zero value to taxpayers? Affecting live patients seems to be more important than limiting sales of insurance policies.

It’s a toss-up for survey respondents trying to decide if private equity firms are a positive or negative industry influence. My opinion: sometimes the purely business decisions PE firms make aren’t pleasant for employees and sometimes even customers, but they’re trying to save companies in trouble or at least make them return more value to improve their chances of survival. Employees can find new jobs more easily than customers can choose new vendors, unfortunately. New poll to your right: would you buy hospital applications from a company that doesn’t have much hospital experience?

HIStalk Webinars

Two really good upcoming HIStalk Webinars will feature industry-leading CIOs speaking on interesting topics. I saw the rehearsal sessions for both and they are worth your time.

Marc Probst, VP/CIO of Intermountain Healthcare, will present “Fostering Innovation Through Appropriate Government Regulation” on Thursday, November 14 at 1:00 p.m. Eastern. I enjoyed learning about Intermountain and its informatics history as well as Marc’s thoughts about the government’s influence in setting standards and the need for innovation in healthcare. Marc’s presentation is sponsored by Sunquest Information Systems, which commissioned the initial version of this talk for one of its recent executive forums. 

Ed Marx, SVP/CIO of Texas Health Resources, offers “The Lost Art of Mentoring” on Thursday, November 21 at 2:00 Eastern. You know Ed from his “CIO Unplugged” writings on HIStalk, His mentoring posts resonated with many readers and Ed graciously agreed when I asked him if he would provide expanded thoughts on that topic. He will explain how mentoring saved his life, saved his marriage, and transformed his career. You’ve read Ed’s words on the page and now you can hear them live.

I started this Webinar series in the hopes that leaders like Marc and Ed would step forward to bring a new type of inspiring education to a wide audience. Not everybody speaks at conferences or attends them, and this is a way to put new ideas and new voices in front of HIStalk readers. It’s free, paperless, and  greener than flying in planes across the country to watch the same presentation on a screen in a big room. Let me know If you have non-commercial ideas to share on any topic (technology, care delivery, business, informatics, self-improvement, etc.) that would interest my audience. We’ll help by reviewing your presentation, taking you through a rehearsal, providing the online platform, moderating your session, making the recorded Webinar and slide PDFs available afterward, and of course hopefully assembling an appreciative audience. You’ll get exposure and a resume credential if you want those things, but mostly you’ll get the satisfaction of having given something back to the industry. A lot of people who are new to healthcare IT could benefit from your experience and wisdom.

The General Accounting Office appoints three new members to the Health IT Policy Committee: David Kotz, PhD (computer science professor, Dartmouth College); Devin Mann, MD, MS (assistant professor of medicine, Boston University School of Medicine); and Troy Seagondollar, MSN, RN (regional nursing technology liaison, Kaiser Permanente). They will fill positions as a privacy and security expert, researcher, and labor union member, respectively.

Anthelio Healthcare Solutions names Ken Roderman (Beacon Health Partners) as VP of sales.

HIStalk sponsors earning a spot on “100 Best Places to Work in Healthcare for 2013” are Aspen Advisors, CTG Health Solutions, The Advisory Board Company, iSirona, Health Catalyst, Santa Rosa Consulting, Divurgent, Innovative Healthcare Solutions, Encore Health Resources, Cumberland Consulting Group, Sagacious Consultants, Impact Advisors, Cornerstone Advisors Group, Imprivata, Iatric Systems, ESD, and Hayes Management Consulting.

St. Rita’s Hospital (OH) says it’s the pilot for Epic’s MyChart Bedside, a tablet-based app that gives patients and family members access to their health information, lab results, care plan, care team information with photos, and educational material.

HIT seed funder Rock Health perhaps unintentionally emphasizes the generational and cultural gap that exists between its youthful West Coast team and us experienced non-hipsters who work in hospital IT by quoting an R. Kelly song in a tweet pitching some kind of hackathon.

Bruce Friedman of Lab Soft News points out the potential conflict of interest in hiring QSSI as a major contractor for Healthcare.gov. “It’s owned by UnitedHealth Group which also owns United Healthcare … the general software contractor now for Healthcare.gov is owned by the holding company that also owns the largest health insurance company in the country, UnitedHealthcare. Does the fact that UnitedHealthcare seems to be not participating the healthcare exchange, as most other private insurance companies are doing, change the equation? For me, the answer is no.”

One person is really happy about Healthcare.gov – the entrepreneur who bought the domain Healthcare.com for $2 million seven years ago and who now runs a vaguely governmental-looking advertising site to get people to request insurance quotes. Clueless Web users have requested 100,000 insurance quotes there so far this month alone. The same guy also owns Healthcare.net and Healthcare.org, the latter of which went from zero visits to 60,000 on October 1 alone. He had originally planned to create a WebMD-like site, saying, “We are not healthcare guys, we are online marketers. But we knew that health care accounted for more than 26 percent of the U.S. GDP.” He says the feds made some dumb mistakes, like requiring visitors to register before searching for quotes. His site is probably giving more quotes than the one the feds put up, so maybe they should make him part of the tech surge. He might be the most brilliant domain squatter since Whitehouse.com was set up as a porn site until the government shut it down in 2004, depriving the electorate of the opportunity to see a whips-and-chains bearing Hillary Clinton leading Bill around by a dog collar right above the porn links.

Venture capitalist Michael Greeley has left Boston-based Flybridge Capital Partners, which he co-founded in 2001, to join VC firm Foundation Medical Partners. He holds board a board seat at Valence Health. Current HIT investments by Foundation Medical Partners include Explorys (healthcare big data), Predilytics (healthcare analytics), and Rise Health (population health registries). FMP’s previous HIT-related  investments include Humedica and Valence Health. Greeley says early-stage need to be experts in specific sectors, especially in healthcare, and he wants to work with the IT side.

Vince continues his HIS-tory of McKesson some some fascinating background on Peoria-based HBO (before they moved to Atlanta and became HBOC) that includes some first-hand reports as well as personal photos from HBO’s #14 employee, Dan Mowery. This is a labor of love for Vince, so if you enjoy his HIS-tory posts as much as I do, I’m sure he would appreciate it if you’d leave a comment to say so.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Time Capsule: The Latest Stimulus Package for Healthcare IT and a Wheezing Economy: H1N1 Reporting

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 November 2009.

The Latest Stimulus Package for Healthcare IT and a Wheezing Economy: H1N1 Reporting
By Mr. HIStalk

You are nobody as an HIT vendor unless you’re doing something fancy with H1N1 flu reporting, including spewing self-congratulatory press releases that brag about your civic contributions.

Cerner started it by sending customer ED data to Washington, supposedly giving Uncle Sam real-time H1N1 outbreak reports, even though H1N1-specific data elements are hard to come by, the vast majority of US hospitals don’t use Cerner, and the vast majority of flu sufferers don’t go to the ED. Not to mention that there’s nothing the government can do anyway except observe ("Man, Lockhart, Texas is really getting pounded.")

You would think H1N1 tracking is right up there with an actual H1N1 cure. Google has its own outbreak map generated from Web searches (they can also assess the prevalence of enlarged mammary glands and propofol overdoes, I’m guessing). Web sites loaded with AdSense ads are hoping for a quick buck from providing questionably useful maps and graphs.

Even Harvard Medical School and Children’s Boston have released their own competing iPhone H1N1 trackers ($2 and free, respectively). It’s not really clear what marginally coherent yet mobile consumers are supposed to do with their newfound information. Wear surgical masks? Do that point-and-wink thing instead of shaking hands? Head to their bomb shelters and fight off infected interlopers like the guy in “Night of the Living Dead?”

(Note to self: have my people contact Harvard to IPO a mash-up between their H1N1 tracker and traffic-enabled GPSs, allowing paranoid motorists to avoid entire swaths of geography where H1N1 is around).

H1N1 is a deadly, hand-wringing pandemic (according to TV people anxious for something somber to talk about between inane banter), even though only about 1,000 Americans have died of it so far compared to the 30,000 to 50,000 who die every single year from the plain old unsexy flu and its complications. Drug companies are licking their chops. Panicked citizens not typically known for following a healthy lifestyle or paying attention to seasonal flu vaccines are fighting each other to get the hyped H1N1 version, with the resulting shortages making them even more hysterical.

The government, meanwhile, is saying the one thing that’s guaranteed to send people into a full-fledged panic: "Don’t panic."

(This is actually Swine Flu II, of course. Gerald Ford got everybody excited about it as his presidential candidacy was flailing in 1976. The pandemic never happened, but 40 million people got the swine flu vaccine at a cost of $135 million, 30 died of its side effects, $3 billion in legal claims were filed, $50 million worth of vaccine was destroyed, Ford lost to Jimmy Carter, and Chevy Chase lost the subject of his only funny bit. It was the lowest point of the year, other than when "Convoy" went to #1 on the pop charts).

So what if you’re a small HIT player without the resources to accurately track (or even claim to track) H1N1? Here’s a plan: hire a bunch of unemployed telemarketers to just call up houses and ask whoever answers if they or anyone they know has H1N1. Put out press releases claiming it was your advanced technology, create a fancy Web page, and find yourself a politician to thank you publicly for your valuable services to a grateful nation.

Just be aware that people exaggerate their own illness for maximal sympathy or as justification for skipping work, so any kind of sniffles or tiredness will convince people to say they have H1N1 because they heard about it on Oprah ("headaches" become "migraines", "a cold" becomes "the flu", and "getting sick from too much Super Bowl beer, wings, and guacamole" becomes "food poisoning"). That’s actually a good thing, though — your H1N1 numbers will be higher than everybody else’s since most flu sufferers don’t need hospital treatment like Cerner is measuring, so you will be widely cited by people trying to prove that H1N1 is the next Black Death.

Those inflated H1N1 numbers are good. When it comes to healthcare IT and the economy in general, you just can’t have enough H1N1 stimulus. It’s what I call "viral marketing."

HIStalk Interviews Neal Patterson, CEO, Cerner (Part 1 of 2)

Neal Patterson is chairman of the board, CEO, and co-founder of Cerner Corporation of Kansas City, MO.

We have somewhat questionable healthcare costs and outcomes even though we’re spending a fair amount on information technology. What are we’re doing wrong as an industry?

I believe that IT is the single most strategic lever that healthcare can use to fundamentally change the cost structures and the quality of the service and the solutions they provide. It’s a lever that needs to have an impact.

If you look at other systemic things that are not working right in healthcare, the other one would be how healthcare gets paid. There’s not a business model for health. This all reinforces the reactive, volume-based care model.

So one side is broadly a policy change that could be effected through policy; it could be effected through the marketplace, too. The other side is this huge investment that our clients around the world are making in healthcare. We need it to be more of a strategic lever to change the fundamental results of their business. Those are two things that come to mind as to if you could change something in a relatively short time that would have the biggest impact — how people get paid and how they strategically use IT.

Are you encouraged by the change in policy direction?

We’re in an era that does create a bit of chaos, but it’s an era where there’s a lot of experimentation. I’m fairly optimistic that it will formulate into a cohesive policy. We have to get through this era. Our government is out of money, as evidenced by the news from last night, last week, last month, around the deficit we’re running. We’ve got to get through that era where real policy could be formulated. But I certainly do like the experiments that have been run around accountable care, around value-based care, even around bundled payments. We do need change in how healthcare is paid.

Healthcare is political, and one person’s excessive costs is another person’s livelihood. How would you fix it, given that so many special interests that are fighting over those dollars that everybody hates to spend, but that everybody likes to take in?

It unfortunately has a lot of politics in it. I don’t like this part, but it’s fixable, because there’s the single buyer.

Wal-Mart’s impact on retail, we have the same thing … we have a Wal-Mart in healthcare. Our federal government buys so much of healthcare that if they get it right, it will change. Even though it’s a complex system and there’s an unbelievable amount of variables, there’s a single leverage point that would create a huge incentive.

At the Cerner Health Conference, I did what I openly called a few Neal rants. [laughs] I said that some of them are going to be directed at my dear clients. In reality, most of the progress, certainly the rapid progress, made on the IT side has been because they were paid to do it. That’s my broad criticism I make on healthcare — unless somebody pays you to do it, you really don’t. There isn’t the strong instinct to fight the barriers to make the fundamental change.

Just take sepsis as an example. The algorithm to predict that someone is going septic has been available for decades, We’ve for decades known the variables in that algorithm, and it’s fairly well published. With many IT systems, certainly ours included, you could implement those predictive models, and with the current decision support, fire off the alerts and actually save lives. Much of that didn’t happen until there were strong external incentives. 

I’m optimistic in the sense there’s a single leverage point to fundamentally create systemic change in healthcare. The investment in IT gives the capability of making systemic changes to healthcare. There are two leverage points. Unfortunately, one of them is tied up in politics, which isn’t my favorite subject. [laughs]

Along those lines, the federal government dominates the R&D agenda of Cerner and every other vendor because of the requirements for Medicare and Medicaid billing and now Meaningful Use and ICD-10, not very much of which has any positive impact to patients. Do you see that changing?

I’ll speak for Cerner. The federal government’s requirements through Meaningful Use, ICD-10, and the much larger list of compliance when you add all the FDA and all that, that doesn’t drive our investment agenda around IP. We certainly have to cover that.

We had a new business client make the comment that with the other companies they went to, their focus was Meaningful Use requirements. it was a multi-day session with us and the guy says, “We have not heard the word Meaningful Use once from you guys.” It’s because it isn’t that we didn’t have work to do — because when you get the specific requirement, you’ve got to convert to the specification – but I didn’t think Meaningful Use was that high a bar. We’re not being driven by that. 

Frankly, ICD-10 was in our systems in Australia 10 years ago. Was it embedded in all of the third-party reimbursement and documentation methodologies and impact or revenue? No, but our core capabilities were there 10 years ago.

I was in a session within the last year, I think it was last spring. There were like 20-some counterparts or near counterparts in the room. Whatever the good fortune was, I ended up being the last to speak. [laughs] I didn’t plan, I wasn’t exactly driving it, but it was the way it worked. Everybody else in the room, all the other companies — and it was a government-based meeting — everybody went around and said, here’s the impact of all this on themselves, on their companies. Everybody basically was whining. I’m the last to speak. I turned to my counterparts and said, I don’t get it. We’ve been given a gift. There has been a huge acceleration in adoption of IT. There’s huge progress around standards. If we are good, we’re about to create a golden era, the next golden era of healthcare.

I don’t know why everybody’s complaining. It was a gift. Now I’m probably going to get myself in more trouble. [laughs] We’ve been given a gift from the IT side. It’s not a burden. These are not that high of bars. The opportunity to create this golden era is sitting there. That’s what excites the heck out of me and drives me. Because when we do get the new business model, where you’re really responsible for the health of a population, not reacting to the care needs, that’s an exciting era. We’re investing heavily in it. And it’s not a Meaningful Use requirement. [laughs]

Do you think in that change toward that population health-type model that patients will gain leverage instead of being almost a bystander in their own care?

I’m going to take an indirect route to answering that. I think one of the positives of the exchanges is that it basically connects the person to a marketplace. It’s a marketplace of decisions around healthcare, what level of benefits do you want, blah blah blah. In essence, it’s creating connections of individuals to making decisions healthcare. I think it’s fundamentally important.

I do believe Meaningful Use requiring fundamentally a patient portal to get access is really a nice step, too. Increasingly, I think people have higher expectations of being able to get minimum access to a record.

Then I’ll hit the third leg of the stool. I think you probably know this, but we do a fair amount of work at the employer level. We certainly have used Cerner in our workforce, in our health plans in this country, as a laboratory on how to create engagement at the employer-employee — in our terms, associate – level and their families. I think we’re part of this pre-era of getting people involved in healthcare.

We’ve got three important legs playing out right as we speak. It isn’t a solid platform yet. I believe that we’ll never get to true interoperability without a service that will provide identification across providers and across IT platforms. Our purpose for being involved in CommonWell is interoperability.

We’re in a pre-era of having alignment around forces that will create an environment where those who choose can be fairly engaged at low-cost, low-friction ways of being engaged in their own healthcare. All the way from trying to be well, to making this economic decision, which is one of the things that has been missing. The exchange is that part of the stool. Down to the Meaningful Use patient portal, even though it doesn’t solve the ID issue.

The important era we’re in, I think it comes together this decade. The reason I strongly believe that is it goes back to the deficit. We have no fundamental choice other than to socialize the system in the US. Our choice is to produce higher quality at lower unit cost and to start focusing on health-related ways of minimizing the prevalence of highly costly conditions and patterns in society.

Vendors and providers really have never been trained to think in terms of managing a population. They were raised in an era of managing an episode of care. Is that going to be a tough transition?

Not really. There’s been a lot of change since the ‘90s. Health systems have gotten to a more appropriate scale. They have better management leadership. Many of the leaders have a vision of a direction this size. They’ve got size, scale, and better leadership. The IT investments they’ve made and the degree which they have been driven into the clinical process is significantly different this decade than it was back in the ‘90s. Twenty years has made a lot of difference.

The problem is the layer above them. The providers have been conditioned to let someone else aggregate their populations. That’s been the insurance companies.

With their size and scale of providers and if you change the incentive structure, I think many of them will be positioned in the last half of this decade to get most of the first dollar of healthcare. Then they have the incentive.

It’s bipolar. Once you have the first dollar, your incentive is to keep people out of your facilities, out of your emergency rooms. Keep them as healthy as you can, because you’ve got the dollar. It’s bipolar. It screws up your behavior. But I don’t see any other way out.

Do you believe the hype around big data and what value it will provide in this transition?

Yes and no. You certainly have to give Amazon credit for knowing their customer, knowing what they’ve done in the past with that customer, and making sure that they create as little friction as possible to repeat business. Is that big data?

I think big data is a grossly overused term. It is understanding patterns, finding algorithms that you can embed that predict repeating those patterns. Is that big data? I’m OK calling it that. It’s not my favorite term. I’d love to hear your answers to all these questions. [laughs]

We’re not as population health-based as most other countries. We like the idea that our healthcare is individualized and personal, that we don’t want algorithms or even to some extent evidence-based medicine. What will take to get people to buy into the concept that there are certain things that make perfect sense to society, such as the science that said mammograms are not effective in certain groups, and yet everybody threw up their arms and said, no, we want them anyway?

I think that’s pretty clear. When you don’t have information about the members of a population, all of your rules, all your algorithms, have to be based on the entire population. There’s no personalization of it. That’s where you get the mammograms at 50 problem. All of us, being part of the population … having two daughters and a wife and one granddaughter, I want the algorithm, but I want it personalized to every individual in my family. I don’t want the algorithm that has to treat the entire population as one.

I want the algorithms. I desperately want the algorithms. I was thinking deeply about this yesterday, because I was involved in the care system with my wife. I was sitting there talking to really smart people about the response to this drug and this type of case. This broad pattern, it’s not her, she’s in a population. But the reaction of this drug to that population, it’s not just probabilistic. I mean, 70 percent of the time it works, 30 percent it doesn’t.

I know for a fact that most of that could be much more precise, much more precision in that if you go down to the genetic level. Take that phenotype from the genetic record that you have and build your models at that level. It won’t be us as consumers because I don’t want the mammogram at 50. I want the algorithm that says for you, for my daughters, here’s when you should start having mammograms. We’re going to get there. It doesn’t seem like big data to me. It’s finding the patterns and then building the algorithms.

The group that’s going to have the problem with it isn’t the consumer, because we will as consumers eat up the fact that you’ve taken that drug and you can predict its response against me as an individual because you have my DNA and you know what pathway that thing activates down at my genetic level. The people that are going to have trouble with this is the medical profession, because to them evidence is simply graded opinions and the highest-graded opinion is a blinded study with an adequate population that has a certain standard deviation that has been run and vetted through an editorial system. That’s the Grade A evidence. Well, these algorithms are never going to go through that process.

How do you see that being incorporated into electronic health records?

The first thing that has to happen is, as I’ve always said, you have to take the phenotype and the genotype and put it into a common data model. We broadly did that well over a decade ago. We’ve got to get a common data model.

The other piece of it, though, is going to be above the clinical or personal or health record. There’s a lot of other data about us and about our health that need to be included in the broader model and need to be included in the patterns.

I admit that I spent several decades arguing the case that said the EMR itself was much more powerful and predictive set of data than the claims data. I for the most part have won that argument. But that doesn’t mean that the claims data shouldn’t be in the data model itself. Because of the surveillance capabilities of other data sets –claims, PBM data, and frankly employer enrollment data, the stuff that’s generated out of my home.

We’re in the middle of a weight loss contest. My scale in my bathroom, when I stand on it, it hits my personal record and it also updates the competition that I’m in. That record itself is going to end up being larger than the EMR.

The other data is going to be included in many of the algorithms, plus the GIS-type data. If my son was asthmatic, they should know the level of the pollen count and other measures of pollution in the community, which will be included in the prediction of how good a day he’s going to have and whether he should be taking an inhaler to school or not. Or should he actually take the inhaler, because it’s easy to predict you’re going to have an adverse event without the inhaler.

That other data doesn’t go back down to the EMR. It doesn’t fit. It wasn’t ever designed. What I said at our conference was that at the end of this decade, your view of the EMR — yours being our clients’ view of the EMR — will be similar to the way you in the audience view our laboratory system today. I grew up doing laboratory systems, I love laboratory systems, we still do laboratory systems. It’s exciting, but it is not strategic to the enterprises that they are members of. It is not the strategic system. 

The strategic system in the future is going to allow you to manage the health in populations as well as predict the care needs they have. When people do arrive, you have the resources there. I probably went as far to say the actual EMR is going to be kind of like, “I can’t tell you for sure what lab systems that many of our clients use” because they’re integrated into the data flow, the trigger events or the mapping has been done to convert to a standard nomenclature.

There is this new layer that’s coming in our industry. It will have a profound effect on people’s view and strategic view of information systems, it will change quite a bit.

I went broad there, but the genotype does belong inside the record. It is different kinds of data. It’s enormously different kinds of data. We have to merge the genotype and the phenotype, but we’re going to also conduct the instrumentation of the home, my wearable instrumentation, the data that is relevant to different health needs coming out of the environment in my community as well as other systemic systems that can trigger key information such as claims, PBMs, whether I get my prescription. I know from the EMR that I wrote the prescription. I need to know whether it was filled today. That data we may bring back into the EMR, but the reality is that it will all blend together.

Part 2 of the interview will include EMRs as the center of the universe, how to start a business today, the influence of private equity firms, thoughts about Epic, management style, the Intermountain partnership, and long-term plans.

Morning Headlines 10/25/13

Cerner shares drop on revenue miss, outlook

Cerner reports Q3 results: EPS of $0.35 vs $0.30, revenue increased 7.6 percent but missed expectations leading to a three percent drop in share price after hours. Cerner shares are up 43 percent year-to-date.

The Wellness Network Acquires LOGICARE Corporation

The Wellness Network, a media company that owns several in-hospital TV channels, acquires patient instruction and education vendor Logicare.

Representatives Blackburn, Green, Gingrey, DeGette, Walden and Butterfield Introduce SOFTWARE Act

A bipartisan group of legislators have introduced the Sensible Oversight for Technology which Advances Regulatory Efficiency (SOFTWARE) Act, a bill written to clarify the role the FDA will take in regulating medical software, including mobile health apps and EHRs.

Boston Children’s Hospital Researchers Launch Start-up to Offer Enterprise-grade Software Solutions and Services Across the Digital Healthcare Ecosystem

Boston Children’s Hospital announces the launch of Wired Informatics, a spinoff startup that will market an NLP product to hospitals and other healthcare organizations.

Fighting Healthcare Fraud Using Whistleblower Statute Returns $20 For Every $1 Invested

A report by the Taxpayers Against Fraud Education Fund finds that for every dollar spent investigating and prosecuting government fraud, more than 20 dollars are recovered. Health care economist Jack Meyer notes “If all costs and benefits are accounted for, the benefit to cost ratio of False Claims Act law enforcement now exceeds 20:1. Civil health care fraud is one area where federal and state governments are recovering far more than they are spending."

News 10/25/13

Top News

Cerner reports Q3 numbers: revenue up 8 percent, adjusted EPS $0.35 vs. $0.30, falling short on revenue expectations. From the conference call:

• Domestic revenue was up 8 percent, while global revenue increased only 1 percent.
• The company sold its sixth French client and its first one in Brazil.
• Cerner says that by the end of the decade, the EMR will provide just one feed into a population health management system, and the company is already selling solutions and services to customers who don’t use a Cerner EMR.
• Cerner and Epic are distancing themselves further from their competitors, and Cerner says it is gaining momentum against Epic.
• Cerner says its clients have acquired hospitals at six times the rate of Epic’s, giving the company more potential users.
• Cerner has been approved by Apple as the only non-carrier company allowed to sell the iPhone, and it will offer an unlocked, no-plan iPhone for CareAware Connect, which can replace pagers and other communications devices.
• Cerner says its work with Intermountain Healthcare will disrupt the industry and accelerate clinical computing by a decade, reducing healthcare costs by up to 20 percent. Projects include using Intermountain’s Care Process Models as an EMR-agnostic “clinical navigation system” and blending content with the EMR to provide activity-based costing as a resource management system.
• EVP Jeff Townsend compared Epic to Kodak for its suggestion that Meaningful Use be delayed for five years, suggesting that both Epic and Kodak spent too much time selling profitable old technology and trying to delay the inevitably changing future.
• An analyst noted that “Intermountain has a history of chewing up and spitting out vendors” and asked how Cerner can keep them happy. Townsend said Cerner will do an accelerated Millennium implementation so they can get to the “fun stuff” more quickly.
• Cerner says it was chosen over Epic at Intermountain because of population health and the ability to influence cost, saying, “This is not a project. This is a decade, if not a two-decade-type relationship.”

Reader Comments

From Digital Bean Counter: “Re: million dollar question. Why hasn’t the government asked any of us health informaticists about fixing the Healthcare.gov website?” It’s not an informatics problem, so that would be pointless. Nobody in healthcare (nor in government contracting, apparently) has the experience needed to plan for the kind of scale Healthcare.gov needs and there’s nothing there at all related to informatics. It requires people who have built monster-sized e-commerce sites, the kind who live in the Silicon Valley instead of the beltway. It’s a shame that the site has turned into a political football – nobody seemed to mind when the VA, DoD, and HHS were burning through millions to billions of dollars in poorly planned and poorly managed IT projects and the website is only marginally related to Obamacare. Nobody can say anything about any topic these days without someone screaming about a perceived political agenda, and politics isn’t the same as the government, which is comfortingly inefficient and wasteful no matter which party is involved. I think I remember a stat that 50 percent of US government software projects are utter failures and a complete waste of taxpayer money and almost all of the rest don’t deliver the expected value.

From Alexis Nexis: “Re: expense reports gone wild. There’s no understanding of what someone on the road experiences:  a hotel room and bed, no ability to cook some eggs in the morning, no ability to pack a sandwich for lunch, doing laundry just on the weekend, etc. Not to mention the additional six to 25 non-billable hours of travel (above the commute between hotel and office) typically incurred every week by road warriors. I can assure you that there’s no road warrior getting rich off his meal expenses. I am quite surprised that snacks and coffee are being included. IRS guidelines view meal expenses as breakfast, lunch, and dinner. Shame on the commentator for not having negotiated a contract accordingly. And shame upon those contract administrators who insist upon receipts for when IRS guidelines don’t require them. To have to save my receipt for the toll on the highway or for my $7 of breakfast in the morning is ludicrous. It burdens everyone with additional unnecessary overhead. I routinely put into my contracts the IRS per diem rate for the locale. Perhaps we should wonder about what it is that makes healthcare in the United States the most expensive in the world without our getting the best return what we spend. I would suggest that it’s not the relatively incidental amounts being referred to. By the way, where could I sign up for that $200 an hour rate?” This is one of those “don’t sweat the small stuff” issues. Line item living expenses are annoying because you get into that pointless mental debate over whether a consultant who buys a $4 coffee on the way to the hospital every morning must be screwing you in other ways as well, and yet sometimes that same employer doesn’t give the consultant a clear picture of what work needs to be done or doesn’t have the required internal people lined up. At $200 per hour, that $4 coffee represents just over one minute of billable time, and I’ve seen consultants trying to find things to do for hours each day because they were just shown a cubicle and abandoned because nobody had the time to manage them.

From Bignurse: “Re: Yann Beaullan-Thong of Vindicet. You interviewed him a few weeks ago. The 2013 McKnight Technology Award in the Transitions category was awarded to a Vindicet client for implementing its patient management system. The organization says the system cut admission time to its skilled nursing settings to less than 1 hour.” Yann’s HIStalk interview from December 2012 is here. The company offers referral management and discharge managing systems.

From Boy Oneder: “Re: Epic’s Healthy Planet. It’s population health management and is robust – wellness, chronic disease registries, population outreach, high risk care management, and risk stratification algorithms.” I heard the term “Healthy Planet” and asked Boy Oneder what it was all about. Boy Oneder also says that Epic had documented clinical workflows in the Netherlands years ago in preparation for sales like the two that just happened to two large Amsterdam hospitals. I don’t think Epic is joking when it talks about world domination.

From Player: “Re: Epic hospital. You should interview a CFO, anonymously or otherwise, about how they looked at the cost justification for implementing Epic.” That would be fun. Volunteers?

From Boy Lee: “Re: innovative companies. You profiled some of them years ago.” I ran a series I called Innovator’s Showcase in 2011, which took a ton of work. I invited startups to apply to be profiled on HIStalk, but they had to have an original product, real customers, real revenue (although not too much of it), an a short time in business. I had three folks review their brief applications and we chose seven for the Innovator’s Showcase. We thought these had the best chance of success. None have failed as far as I can tell. They were:

Aventura (clinician computing experience)
Health Care DataWorks (analytics)
OptimizeHIT (which was connected to ImplementHIT in some way that confuses me to this day, which offers EHR training)
Caristix (HL7 and interfacing software)
Logical Progression (acquired by Bottomline Technologies – offered mobile documentation)
Trans World Health Services (benchmarking and analytics)
Health Nuts Media (learning games and educational material)

From DrLyle: “Re: your comments about physician-focused startups with no clue how to make solutions for doctors. I loved your answer. I just wanted to make sure the key word is ‘most’ and not ‘all.’ Some of us are actually making some good stuff that truly uses HIT to automate and delegate care, saving time for docs and improving quality for patients.” I was amused at the number of folks whose brains blocked all but the words they get emotional about, firing them up to argue about what they perceived as an anti-innovation rant. I very specifically mentioned only companies that don’t care about patients or providers and that are clueless, arrogant, insulting, and badly planned. If I were CEO of one of those I’d keep quiet, and if I was one of the better startups, I’d be happy that my unworthy competitors had been called out publicly. I’ve been the hospital IT guy who heard these pitches and I’m fairly certain most of my peers think similarly – don’t come knocking until you’ve done your homework. Hospitals may seem like local businesses that need help, but they are massive enterprises. Getting your fledgling product in the door means someone internal is going to have to go to bat for you, meaning their job is on the line if you can’t deliver. Do you have documentation, an implementation plan, around-the-clock support, and sound technology that isn’t dependent on your one Romanian programmer not finding a better contract?

I should mention that part of my rant came about is because I resent any company (big or small) that barges into healthcare without showing respect for patients and the people who have been involved in taking care of those patients all along. Healthcare is a vendor’s Vietnam, as Misys or Sage or any number of other half-hearted former dabblers can explain. They saw themselves swooping in from other industries with massive firepower and a hearts-and-mind campaign that would ensure a quick and painless surrender by the peaceful, primitive locals. A handful of years later, their thoroughly defeated and demoralized salespeople and executives were climbing over each other’s backs desperate to squeeze onto that last available helicopter ride to safety.

From Lazlo Hollyfeld: “Re: Healthcare.gov. At least the CD version is slated for a ‘16 release.” The Onion is brilliant as usual in its satire about Healthcare.gov.

HIStalk Announcements and Requests

Some goodies you may have missed this week on HIStalk Practice include: Practice Fusion defends its practice of emailing patients to request physician reviews. Parents want to email their pediatricians and they want it to be free. The Rothman Institute will implement White Plume ePASS. Female doctors provide better quality care than their male counterparts. A physician is charged with breaking and entering after she broke into an office, set up a temporary practice, and began seeing patients. Hayes Management Consulting VP Rob Drewniak outlines a process to prevent breaches with HIPAA compliance. Dr. Gregg offers a Top 10 and a Bottom 10 List on HIT adoption. Linda Fischer, EMR manager for Boulder Community Hospital Physician Clinics, discusses her Greenway Medical EMR implementation, including details on the selection process, EHR data migration, obtaining physician buy-in, and quality care initiatives. In lieu of sending Halloween candy, please treat me to your email address to subscribe to the latest HIStalk Practice updates. Thanks for reading.

Here are a couple of on-the-spot interviews Bonny and Catherine of Aventura conducted at ACEP13 in Seattle last week. They just turned on the video recorder and let the folks say whatever they wanted about IT.

From an ED physician:

Technology is struggling to match what physicians and other clinicians actually want to have happen. When people say all the time, “Is this a great system?” then yes, it’s a great system, but not in this particular setting. There’s many, many, many times a mismatch between what the clinicians want to have done and what the technology can do. There’s innocence on both sides. That’s what my experience has been with this technology. This innocence of mismatch, where the technical people are extremely good at what they do, the hospital people and clinicians are very good at what they do, but this matching of the two is really not working nearly as well as everybody thinks it is. As an example of why there’s this disconnect between documentation and clinicians is my assessment of a patient begins way before anybody thinks it does. It begins when I hear that patient screaming out of the corner of my eye as he’s brought in. I’m not documenting then. I’m not even seeing the patient yet, but that’s when my assessment begins. When I walk into the room, the smells and everything, that’s all part of my assessment, but many times that does not get documented.

From a resident:

I’m a fourth-year EM resident. Our workflow is that we will typically sign up for patients at the doctor’s station and go and see the patient, which takes about five to 10 minutes. Then come back, put our orders in, see other patients, and then we’ll frequently come back and either document or dictate in between patients. Aventura seems like a good application. Friendly, very fast. Sounds like it would be helpful.

Acquisitions, Funding, Business, and Stock

Microsoft turns in Q1 numbers: revenue up 16 percent, EPS $0.62 vs. $0.53, beating expectations.

McKesson files Q2 numbers: revenue up 10.7 percent, adjusted EPS $2.08 vs. $1.79, beating expectations on both. Technology Solutions revenue was up 7.7 percent although software revenue was down 9 percent. The company also announced that it will acquire a majority stake in Germany-based drug wholesaler Celesio for $8.3 billion “to form a global leader in healthcare services.” John Hammergren, asked about whether the company will keep the technology business, waffled by saying results are good and there are no plans to change the mix, but MCK isn’t married to any particular strategy and has a responsibility to revisit that decision constantly.

Covisint reports its first quarterly results after its recent IPO: revenue up 19 percent, adjusted EPS –$0.08 vs. –$0.15.

Hospital health information management provider IOD Incorporated acquires ApeniMED, a Minneapolis-based company offering healthcare interoperability solutions.

Accelera Innovations secures a $200 million equity investment agreement from Lambert Private Equity. I’ve never mentioned Accelera even once on HIStalk and I admit I’ve never heard of them. Their website looks like something kid with FrontPage might have created in 2002, playing annoying music (unless you’re an “Arrested Development” fan, in which case you’ll enjoy Europe’s “The Final Countdown” because it will remind you of a G.O.B. magic trick ) following someone loudly and pedantically reciting a company pitch. Frankly, I’m struggling to believe the accuracy of the story that someone invested $200 million in this operation.

Quality Systems reports Q2 results: revenue down four percent to $118 million, EPS $0.22 vs. $0.31, missing analyst estimates on both. CEO and President Steven T. Plochocki says the results are indicative that the reorganization plan put in place during fiscal 2013 is beginning to gain traction. He also notes that revenue, bookings, and system sales were up from the first quarter.

The Wellness Network acquires hospital patient education software company Logicare.

Cureatr, which offers secure messaging solutions for providers, secures $5.7 million in Series A financing.

Miami Children’s Hospital signs a deal to allow HealthFusion to offer South Florida pediatricians an MCH-specific version of the company’s iPad-based MediTouch EHR that will connect to the hospital’s systems.

Sales

Trinitas Regional Medical Center (NJ) selects EDCO Health Information Solutions to implement Solarity technology and indexing services for medical records scanned at patient discharge.

Elmwood at the Springs Healthcare Center (OH) selects VersaSuite for EHR/PM for its long term acute care facilities.

Rush Health (IL) endorses athenahealth’s EHR and PM services for its 300 affiliated private physician members.

The State of California Office of Health Information Integrity selects iBlueButton from Humetrix for its HIE pilot.

The Berlin Visiting Nurse Association (CT) will replace McKesson Homecare with Brightree’s home health platform.

Children’s Hospital of Philadelphia signs a five-year contract with OnPoint Medical Diagnostics for its MRI Quality Assurance software.

VA Midwest Health Care Network chooses Visage 7 Enterprise Imaging Platform enterprise viewer for regional diagnostic interpretation and image access throughout its 11 hospitals. The organization also chooses Medicalis for enterprise workflow and Acuo for its vendor-neutral archive.

People

Athenahealth names Amy Abernethy, MD, PhD (Duke University Medical Center) to its board.

Vermont IT Leaders elects Paul Harrington (Vermont Medical Society) chair of its board.

Announcements and Implementations

Care at Home (CA) deploys AtHoc’s Home Care Alerts emergency mobile solutions.

Spectrum Health (MI) automates the exchange of patient information via CCD between its HealthMEDX post-acute care EMR and its Cerner and Epic platforms.

HIMSS names Texas Health Resources a winner of the 2013 Enterprise HIMSS Davies Award of Excellence for its use of HIT. CIO Ed Marx is a regular contributor to HIStalk.

Boston Children’s Hospital launches Wired Informatics to provide enterprise-grade NLP solutions for hospitals and other healthcare entities and introduces its flagship product Invenio, which extracts and leverages knowledge contained in clinical notes.

Partners Healthcare’s Center for Connected Health launches Wellocracy, a clinically-based source of self-help technologies for consumers, including health and fitness trackers and mobile apps.

Government and Politics

Finally some good news from the government: every dollar invested to investigate and prosecute healthcare fraud returns at least $20, based on data collected from 2008 to 2012.

A bipartisan group of House lawmakers introduces the Sensible Oversight for Technology  which Advances Regulatory Efficiency (SOFTWARE) Act  that would clarify regulations for mobile medical apps, EHRs, and other HIT technologies. The legislation builds on the FDA’s final guidance on mobile healthcare apps.

Healthcare.gov contactors tell a Congressional panel that it’s not entirely their fault the site doesn’t work as well as hoped – the government should have supervised them better and tested more thoroughly before setting the go-live date. An SVP of Canada-based CGI stuck with the story that user volume was greater than expected and said it was CMS’s job to do end-to-end testing, not the company’s. Andy Slavitt of Optum, which owns contractor QSSI, said the government decided late in the game to require users to create an account before viewing insurance plans and the company’s function for that didn’t work well in the site’s first few days. Rep. Anna Eschoo (D-CA), who represents the Silicon Valley, said blaming user volume is a “lame excuse” that “really sticks in my craw,” adding that Amazon doesn’t crash the week before Christmas.

John Halamka’s conclusion about Healthcare.gov: “… Nine women cannot create a baby in a month. There is a minimum gestation period for IT projects and our policymakers should learn from the lessons of the Health Insurance Exchange and re-calibrate the timelines shown in the graphic above [the CMS reform timeline] so that everyone is successful.” Or as one of my hospital programmers always told me years ago when pressed to make a delivery date, “You can take the cake out of the oven any time you want, but don’t blame me when you don’t like it.” 

The VA’s Office of the Inspector General finds that three ED patients died at the Memphis VA after receiving substandard care, one because the doctor violated policy by hand-writing an order for a drug to which the patient was allergic, a situation that CPOE would undoubtedly have warned about.

Innovation and Research

The Merck | Heritage Provider Network Innovation Challenge offers $240,000 in total prizes for creating tools that help people with heart disease or diabetes follow their care plans. Submissions are due November 10, 2013.

A peHUB article called “Disrupting healthcare – on whose terms?” says that companies with no healthcare background who jump into healthcare IT investments have a big performance disadvantage. It concludes, “These data clearly show a massive advantage for firms with healthcare expertise when making healthcare investments. And why shouldn’t they? Don’t we assume, for instance, that energy investors do better at energy investments vs. those firms without any energy focus or experience? Healthcare is at least as complex and regulated an ecosystem as energy and yet it repeatedly experiences cycles of outsiders driving up investor frenzy.”

Technology

Verizon Enterprise Solutions releases Converged Health Management, a remote patient-monitoring platform that allows patients to use biometric devices to capture vital signs and automatically transmit details to their providers.

Other

Providers rely on telephone calls, letters, and face-to-face conversations more than any other method to communicate with patients, despite the increased use of newer technologies such as text messaging, social networking sites, portals, and emails.

HIMSS announces keynote speakers for the mHealth Summit in December: FDA Commissioner Margaret Hamburg, Qualcom CEO Paul Jacobs, Denmark’s Minister of Health, and Nobel Peace Prize Winner Muhammed Yunus. I’ll be reporting from the conference, as will Travis from HIStalk Connect. HIStalk will have a microscopic, sparsely furnished booth in the exhibit hall because they were nice enough to give us one, which will be capably manned (or womanned) by the fabulous Lorre.  She may have nobody to talk to since I’m not certain the mHealth Summit draws a lot HIStalk readers, but if you’re going, find our micro-booth (#1305, right beside a slightly larger booth and company called AT&T) and say hello. 

More on the summary of KLAS’s report on McKesson Paragon, which concluded that the product isn’t ready for big hospitals in important areas (like clinical functionality and an integrated ambulatory system) and has experienced a pretty big drop in KLAS scores since 2010, but customers seem satisfied to wait for the three-year roadmap to bring it up to their expectations. The graphic above shows that 32 large hospitals bought Horizon replacements in 2012, with 10 each choosing Cerner and Epic and 11 choosing Paragon, with cost being a big driver for the Paragon wins. Among smaller Horizon hospitals, Epic was the big winner, probably through acquisition if I had to guess since I doubt those hospitals could afford Epic otherwise except though an affiliate agreement. Allscripts, Meditech, and Siemens didn’t get a single Horizon replacement deal, with the most startling fact in that statement being the inability of Meditech to execute in what should be a receptive market.

Brian Stowe, the former Epic project manager charged with taking sexually explicit photos of passed out women (of whom six of the eight were his Epic co-workers,) pleads guilty to taking photos and video of a 17-year-old girl asleep in his bed and will be sentenced  in January to a minimum of 15 years in prison. He still faces 62 felony counts.

A thief breaks into the offices of AHMC Healthcare (CA), making off with two unencrypted laptops on which was stored the information of 729,000 patients. The hospital has expressed a sudden interest in encryption, which the near-certain $1.5 million fine might have covered. Apparently hospitals are unable to muster the technical expertise and financial motivation to encrypt computers until after they’ve been inevitably burned and fined, so it costs them even more. Police arrested a vagrant for the theft on Wednesday, but the laptops are still missing.

After reading Tweets and news stories about all the folks who have been able to find more affordable healthcare coverage options on the Healthcare.gov website, I decided to once again attempt the application process. Unfortunately I did not get farther than the second screen, which contained a lot of gibberish. I guess I’ll give Jeff Zients, Verizon, and all the newly recruited techies a bit more time to fix things.
Weird News Andy says he is singing “La Cucaracha” to himself as he enjoys this story: cockroach farming is booming in China as the country finds them both delectable as a culinary treat and miraculous as a a basis for drug development, with hospitals using them to treat burns and a pharmaceutical manufacturer claiming its cockroach syrup cures ulcers and TB.

Sponsor Updates

• NVoq announces the general availability of its SayIt 8.2 release.
• Strata Decision Technology hosts 400 attendees in Chicago this week at its annual summit.
• Wolters Kluwer Health introduces Lippincott’s CoursePoint, a digital course solution for nursing education.
• DocuTAP will integrate Wolters Kluwer Health’s Health Language applications into its EMR solutions for the urgent care environment.
• Intelligent InSites will hold its InSites Build 2013 conference October 29-30 in Fargo, ND.
• Greythorn will offer an October 29 webinar on Radiant implementation and optimization.

EPtalk by Dr. Jayne

Let’s face it, consultants are a fact of life in our industry. Most of us are trying to do more than we possibly can with the staff we have in place. We’re trying to cope with an ever-changing regulatory landscape. We’re feeling the squeeze between immovable deadlines and vendors who aren’t delivering required code as early as we want them to. Sometimes we can’t hire new FTEs quick enough or we may not have anyone with the skill sets needed to help us stay compliant. And so, we turn to consultants.

A reader mentioned last week that his or her company was not in favor of paying meal and incidental expenses for consultants and asserted that the consultant’s employer should pay those expenses since it is already charging a hefty per-hour fee. The comment sparked several replies, so I decided to reach out to some of my friends who are consultants to see what they think. I’ve been on both sides of the story as I’ve hired consultants and been one, but I’ll hold on my thoughts for now.

Most of the consultants I talked to this week feel that their clients have a skewed view of what consultants actually are paid. Even though a consulting firm or vendor may charge $200 or $300 an hour, it’s unlikely that the individual field consultants are taking home even a third of that. Although many senior consultants do quite well, many junior consultants spend up to 50 weeks a year away from home. Divide the pay by the hours away from home and family and the paycheck starts to look even less great.

Companies have to cover for the time that their consultants are engaged in non-billable activities such as training, staff development, continuing education, and maintaining competency with EHR vendor software. Increasingly clients are refusing to pay for consultant travel time (or imposing ridiculous travel caps that don’t even cover flying time) and that has to be covered as well. One consultant I’ve used repeatedly tells the story of going to a small town in a remote western state, where he had to take four flights (to stay under the client’s air fare cap) and then drive four hours to get there. The total travel day was close to 18 hours and then of course he had to get home. The client had a three-hour round trip travel cap. I’m pretty sure the client knows they’re a four-hour drive from the nearest airport.

One of my favorite niche firms works with a single EHR vendor and maintains a very small group of consultants. All of them are nurses and the CEO is a nurse as well. Most of them continue to maintain their licensure and attend CNE so they can stay current with clinical topics. It makes them extremely effective and I’m happy to pay a higher per-hour fee for them because I know I’m getting the quality input I need for projects that need both nursing or other clinical expertise and a high degree of vendor-specific knowledge. I’m also happy to pay more for a small firm that I know runs lean and has little administrative bloat because I know they pay their workers well.

Unfortunately, the health system I work for has what can only be described as Enron-style accounting and they are constantly late in paying the consulting invoices even when all supporting documentation is provided in a neat and timely package. I wish the accountants understood the value of these consultants – they are super busy and don’t need my business to stay afloat and I’m afraid eventually they’ll stop working for me because it is simply too much of a bother.

Due to the size and scope of some of our projects, I’ve had engagements with the 800-pound gorillas of the consulting world as well. Although there have been a handful of consultants that have tried to take advantage of expense policies, the majority have been fair in what they submit for reimbursement. For those who have been a little too cavalier with their spending, it’s been fairly easy to address it with management. I haven’t yet run across anyone operating like the George Clooney character in “Up in the Air” where he pushes his expense reports to maximize his airline mileage. If you’ve ever been a road warrior and haven’t seen the movie, I’d recommend it.

The best defense against ridiculous expense reports is negotiating a good contract with the consulting firm. Know what you are willing to pay for, but be fair. Know what typical hotel rates are in your area and make sure you are allowing your consultants to stay somewhere that you would consider staying yourself. I’ve heard horror stories (and seen pictures) of “client recommended” hotels that I can’t imagine a hospital administrator would expect his own family to accept. If you have a corporate discount, make sure consultants have the codes, and if there is a limit to the number of rooms that can be booked at the corporate rate, that they book well in advance.

As far as meal allowances, they seem fair for the companies I’ve worked with. I don’t begrudge my consultants the coffee and snacks they submit because they’re working their tails off for me. Some of them can deliver in a week what my IT department takes a month to deliver, so the expense is well worth it. One of our IT buildings is away from the main hospital campus and there aren’t any close restaurants. I always have lunch delivered for the consultants so they don’t have to waste time trying to find food and worry about their logistics. But when I negotiate engagements, that is taken into account and their maximum daily meal reimbursement is adjusted accordingly. If you don’t want to pay for alcohol because you’re a faith-based organization, write it into the contract or hire a consulting firm that doesn’t allow alcohol to be submitted.

As I’ve mentioned before, I did a fair amount of consulting while I was building my CMIO skills and still do a couple of jobs a year with the full permission of my hospital. Ethics and professionalism are what keep consultants from abusing the system. Having been in those shoes, if I find someone milking it, I’m going to send them packing. On the flip side, I’ve been abused by clients and it’s never pleasant. At one site where I was engaged for a couple of months, my “handler” would routinely book my schedule with 10-hour days containing back-to-back meetings that didn’t allow for restroom breaks, let alone lunch breaks. I would hit the local supermarket before going on site and stock up on granola bars, fruit, and drinks. The same client didn’t even have cups or utensils in the break room, so I had to travel with my own mess kit if I brought restaurant leftovers.

Another client scheduled a business dinner after a full work day. The agenda was for me to meet with providers and address their concerns regarding an upcoming implementation. It was at a fairly expensive celebrity chef restaurant and I was looking forward to it. However when the bill arrived, the client asked for separate checks and made me pay for my own. Needless to say that blew my expense account for the day (actually three days’ worth) and I had to cover it out of pocket. Had I been on my own that evening, I probably would have had a turkey sandwich and a handful of grapes. Maybe some chips if I was feeling wild and crazy. Most of would agree these examples are pretty extreme, but unfortunately I’m not the only one who has had those experiences.

If you’re looking to cut down on consulting expenses, look at whether you really need consultants on site. Those who work projects remotely don’t submit meal or travel expenses and often they are more productive when your staff isn’t interrupting them or trying to pick their brains on unrelated projects. One consultant friend keeps me laughing with stories of his prowess at slaying scope creep since his client’s analysts are hell-bent on involving him in work that has nothing to do with his engagement just because they know he has the skills. He could probably deliver his analytics build faster if he was working from his bachelor pad than sitting in your cube farm among squeaky chairs, gossipy employees, and those who bring colds and flu to the office.

That’s another thing – nice clients have a plan for when consultants get sick or have family emergencies. They are understanding. They don’t make you feel bad when your daughter breaks her arm and you have to accompany her to the operating room (true story from a former grad school roommate.) They may even offer to have a physician evaluate you and make sure you aren’t near death alone in your hotel room after you get food poisoning at a dinner they catered. I’ve written prescriptions (with appropriate examination and documentation, of course) to treat minor illnesses and helped consultants get care after sports injuries. Just because they’re consultants doesn’t mean they’re invincible.

If clients really have a problem with consultant expenses because they object to having to pass them on to patients, I recommend they look at their own policies as well as consulting policies. One hospital where I’m on staff provides a 64-ounce mug to each new employee, who can then fill it with free beverages throughout the work day. Although it was instituted as a staff perk, I can’t help but wonder what the patients think as they see staff slurping their way through the day from mugs that are less than clean. You can bet that’s being passed onto the patient bill, as are the employee health care expenses from obesity and diabetes since I rarely see people filling up with diet pop, that’s for sure. Then there’s the lost productivity for the trips to refill.

While we’re at it to cut costs and save healthcare, let’s cut out frivolous marketing, overkill signage, and anything having to do with “centers of excellence.” I bet we could lower some hospital bills right there. But let’s not take it out on consultants who are working hard on our behalf.

What do you think about consultants and their expenses? Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

The Wellness Network Acquires Logicare

Patient instructions and teaching systems vendor Logicare announced this morning that it has been acquired by The Wellness Network, which owns an in-hospital TV network that it says is used by 2,000 hospitals.

According to Matthew Davidge, president of The Wellness Network, “Patient education is at the center of healthcare reform. With the acquisition of Logicare we will be able to measure and record both patient comprehension and consumption of patient ed materials for meaningful use and better patient outcomes.”

Logicare’s 25 employees will continue to work from the Eau Claire, WI office.