News 11/9/12

Top News

Allscripts reports Q3 results: revenue down 1 percent, EPS $0.23 vs. $0.24 excluding special items, missing consensus revenue estimates by 4 percent but beating adjusted EPS estimates by a penny. Earnings were down by more than 50 percent on asset write-downs and slipping margins. CEO Glen Tullman confirms earlier reports that the company is evaluating strategic alternatives, adding that the company will not comment further on the issue and will not issue financial guidance for the next quarter.

Reader Comments

From Curious in Cleveland: “Re: Lyman Sornberger, executive director of revenue cycle management at Cleveland Clinic. Two confidential informants confirm that he’s out – any idea why? I’m a loyal reader and ex-Epic. Judy had me scared stiff to report anything to any blog, so this is a real thrill for me even if you don’t publish it.” Unverified. We’ll see if anyone confirms. I get basically no reports from anyone at Epic, so you’re not alone there.

From Coyote: “Re: McKesson. Half verified – they will acquire Greenway and athenahealth.” Unverified and unlikely given that those are two publicly traded vendors of competing systems with market caps totaling more than $2.5 billion. However, experience has taught me to at least mention even bizarre rumors just in case they happen to come true. If this rumor is accurate, it would easily be the most bizarre. Color me even more skeptical than usual.

HIStalk Announcements and Requests

This week’s HIStalk Practice highlights include: CMS adds a couple of new hardship exemptions for the e-prescribing rule. As more hospitals buy physician practices, facility fees for routine office visits are expected to increase Medicare spending $2 billion a year by 2020. The number of physicians in independent practices is predicted to drop to 36 percent by 2013. Occasional HIStalk  contributor Lyle Berkowitz, MD earns a spot on the list of Top 25 Clinical Informaticists. The most commonly deferred Stage 1 menu objectives by EPs include providing patients with a summary of care at transitions, using EHRs for reminders, and reporting data to public health agencies. NYeHC Executive Director David Whitlinger provides an overview of his organization and its initiatives. Stop by HIStalk Practice to get the latest ambulatory HIT updates, and while you are there, check out a few of our sponsor offerings and sign up for e-mail notifications. Thanks for reading.

On HIStalk Mobile, the talented and knowledgeable Lt. Dan is putting up several news items each day, while Dr. Travis has written an immediately popular post called Where I Would Invest. We don’t want to overload your inbox with the news posts, so you’ll get notification only of Travis’s longer posts if you sign up for updates. Thanks to HIStalk Mobile’s sponsors: 3M, Access, AT&T, Imprivata, Kony Solutions, Truven Health Analytics, Vocera, and White Plume.

Welcome to new HIStalk Platinum Sponsor Clinovations. The advisory practice of the DC-based company targets ambulatory and inpatient provider organizations, non-profits, and federal and state government. Their expertise includes patient safety, quality, and all phases of electronic medical records implementation. I mentioned Pitt County Memorial as one of the North Carolina academic medical centers running Epic and I’ve learned two things about that since yesterday: (a) Clinovations provided go-live support, EMR optimization, and physician engagement services for their implementation; and (b) the hospital changed its name earlier this year to Vidant Medical Center, with the 10-hospital system now going by the name of Vidant Health. I first connected with Clinovations a few weeks ago when I interviewed CEO Trenor Williams, MD, recommended to me by Travis from HIStalk Mobile, who knows him. More than half of the company’s 100 employees are clinicians, Trenor told me. In fact, read the interview to get a feel for how the company works (hint: they’re big on upfront optimization planning, wringing value from EMR implementation, and using data to improve care delivery). Thanks to Clinovations for supporting my work.

On the Jobs Board: Systems Engineer, Epic and Cerner Resources, Senior Certified Epic Analyst, Senior Quality Engineer. HIStalk Platinum Sponsors post their jobs for free, while everybody else watches enviously because they aren’t allowed to post jobs there at all.

It’s unfortunately unfashionable to divert one’s attention from self-absorbed activities to take a moment to think about members of our military, living and dead, whose sacrifices (ranging from modest to ultimate) provide us with the illusion that the world is full of caring people who wish us no harm. Sunday is Veterans Day, the eleventh day of the eleventh month that is set aside to honor every man and woman who has served this country in uniform. It’s a real shame that most cities don’t bother to have Veterans Day parades any more, but chances are you know a veteran or will see someone in uniform this weekend who would be grateful for nothing more than a nod and a “thanks for your service” instead. If you served, thank you. If not, thank them.

Acquisitions, Funding, Business, and Stock

Cerner will acquire Anasazi Software, Inc., a provider of behavioral health technology.

Accretive Health’s Q3 numbers: revenue up 2 percent, EPS $0.03 vs. $0.07. They signed some new revenue cycle management deals despite being run out of Minnesota for harassing ED patients to pay up. Amusing: their AR days jumped from 48 to 56 due to “delayed payments from a few customers.” They must not have strong-armed their own customers like they did those of their hospital clients, although they did take “action relative to the resources that were local in the market and focused on the clients in those areas,” i.e. fired their Minnesota employees once the company got the boot from there.

A Reuters article says that Merge Healthcare has attracted the interest of at least five private equity firms as it contemplates taking itself private. Named as suitors Thoma Bravo LLC, GTCR LLC, Welsh Carson Anderson & Stowe, Francisco Partners, and Avista Capital partners. Sources say the company hopes to have offers by today (Friday).

For-profit hospital operator Vanguard Health Systems announces that it will consolidate its IT operations in San Antonio. They will move to the Inner City Reinvestment/Infill Policy zone, which sounds great for corporate tax credits but lousy for night shift computer operators.

Sales

SAIC subsidiaries maxIT Healthcare and VCS close a combined $102 million in contracts from several North American hospital and clinics.

Summit Radiology Associates (NJ) selects Merge Healthcare’s radiology suite.

The DoD awards Evolvent Technologies a $20.5 million contract to build additional coding, database uses, and mobile applications into AHLTA-Theater.

People

Lakeland Regional Health System (FL) names J. Scott Swygert, MD chief quality officer and CMIO.

Vermont Information Technology Leaders appoints John K. Evans (Strategic Alliance Advisors dba s2a) president and CEO of its statewide HIE.

Announcements and Implementations

Wellmont Health System (TN) will begin file building for its Epic implementation in January and will phase its go-live throughout 2014.

The 17-provider Reedsburg Physicians Group (WI) goes live next week on GE Centricity EMR.

Park Nicollet Health Services (MN) goes live with Levi, Ray & Shoup’s VPSX software solution for document and printer management.

RamSoft will integrate MModal’s Speech Understanding technology into its PowerServer RIS/PACS, PACS, and Tele Plus Systems.

Government and Politics

CMS releases updated reference grids for Stage 1 and 2 MU requirements, including details on how MU objectives align with EHR certification criteria.

HRSA (Health Resources and Service Administration) offers a November 16 Webinar called Patient Charting and Documentation in an Electronic Health Record for Nurses and Allied Health Professionals, with presenters that include practicing nurses.

El Camino Hospital (CA) considers a legal challenge after voters narrowly pass Measure M, which will limit the pay of its executives to twice the governor’s annual salary, or around $350K. CEO Tomi Ryba, CFO Michael King, and CMO Eric Pifer, MD would all see major pay cuts if the legality of the measure is upheld. Meanwhile, an SEIU-UHW union steward admits that the union proposed the measure only because hospital officials declined to meet with its leadership in last year’s labor negotiation in which the union was unhappy that its members were no longer being offered free healthcare (that perk has since been reinstated).

Innovation and Research

A study published in the Journal of General Internal Medicine finds that clinical decision support tools in EHRs can help reduce the inappropriate use of antibiotics for acute respiratory infections.

Chicago startup MetisMD offers radiology second opinions for $75 (report review) to $250 (MRI, CT, PET, mammography, nuclear medicine, echocardiograms). Patients get a copy of their study, upload it to the company, and get a written report and a conversation with the radiologist within 1-2 days.

Technology

We are going from fee-for-service to not-quite-fee-for-service, in a pretty broad way, where you are paying fixed amounts for cases. Hospitals don’t know how to deal with that. The profit now will come from being efficient instead of being prolific. So they will need tools and programs and analytics to help them make that transition. The other area is the whole “retailization” of insurance. There is a huge, fundamental shift in the business, as individuals are driven more and more to buy their insurance from exchanges. Insurance companies don’t sell that way. They don’t have good brands from a consumer-satisfaction standpoint; in fact they have some of the worst brands in the world. So organizations that work on consumer brands are coming into the marketplace.

Motorola Solutions rolls out the HC1 Headset Computer, a self-contained wearable computer with a boom-mounted viewer that simulates a full-sized monitor, a two-way headset, and the ability to respond to voice or head-movement commands. It came out too late for making a fashion statement at AMIA.

Other

Aprima announces that it has settled the lawsuit brought against it by Allscripts, which had claimed that the wording of Aprima’s advertised “MyWay Rescue Upgrade Program” violated state and federal laws. Aprima agreed to changed its advertising, but will continue to market its product to users of the Allscripts MyWay EHR. Allscripts previously announced that MyWay will not be upgraded to handle ICD-10 or Meaningful Use Stage 2, but customers will be offered a free conversion to its Professional product.

Athenahealth Chairman, CEO, and President Jonathan Bush appeared  on CNBC Thursday morning in a discussion about healthcare reform.

You’re going to get more rules and innovation anyway when the healthcare costs are going up faster than GDP. Everyone is going to force some innovation. In this next stretch, it will come from the government … Medicare first and the commercial health plans are falling nervously behind the tank that is Medicare … If you’re a buyer of healthcare, an employer or consumer, you’re going to see two things. You’re going to see some markets where hospitals rally around and buy up doctors. We’ve seen half the doctors in the country become employed in the last three years in preparation for this. And then jack up commercial rates and say, “I got this huge group of Medicaid rates coming in, I’m going to jack up” … we saw this in Massachusetts, the first state that did this. Commercial rates went up 50 percent for the same coverage over a five-year period just for the commercial side … The hospitals bought all the doctors and said, “You can’t have any of us unless you go up.” There will be others who figure out how to get cheaper. They’ll get more efficient. They won’t need to raise rates. And then the third group will be the ones who go bust … they’re supposed to go bust. Please, no bailouts for the hospitals that go bust.

Here’s a new video on the Texas approach to a statewide HIE that involves 12 local HIEs.

Heisman winner runner-up and Indianapolis Colts rookie quarterback Andrew Luck signs his first big endorsement deal … with Riley Hospital for Children.

A new study finds that doctors, like most people, are subconsciously biased against the two-thirds of Americans who are overweight. If you’re obese, your best bet for compassion is to find a fat female doctor, the study results suggest.

FDA urges that providers writing prescriptions write neatly, minimize the use of abbreviations, and consider using e-prescribing instead. The practitioners being addressed are veterinarians.

This is nuts: genital injuries send 16,000 men and women to the ER each year.

Bizarre: a California couple lose a real estate fraud lawsuit when the husband, the director of pathology and clinical laboratories of Community Regional Medical Centers, admits that he faked the death of his wife, a former National Raisin Queen. The purchaser of their horse ranch, an anesthesiologist, says the couple faked her death to increase the value of their property to $2.3 million. The wife, a former waitress, changed her name from Genevieve Sanders to Genevieve Marie de Montremare and claimed to be a physician and French-born royalty. Their transgressions will cost them $1.55 million.

Sponsor Updates

• API Healthcare CEO J.P. Fingado offers insight on how the results of the presidential election will affect the healthcare workforce.
• Prognosis maintains its 100 percent success rate among its eligible clients achieving and attesting for MU.
• GetWellNetwork launches Transformative Health, an online publication covering the intersection of patient engagement and technology.
• 3M hosts a Webinar on the critical need to start ICD-10 education now.
• White Plume offers advice on creating interoperability in preparation for the ICD-10 deadline in a blog post.
• The IT director and a senior systems analyst from Henry Mayo Newhall Hospital will lead a November 14 Webinar on their use of solutions from Access to create a paperless admissions and bedside consent system, send completed forms automatically to their Meditech system, and maintain electronic registration and clinical activities when the hospital system is down.
• Shareable Ink hosts a Webinar on preparing anesthesiologists to qualify for MU.
• An article by T-System VP Greer Contreras highlights the need for physicians to describe their thought process when documenting to help prevent denial of payment.
  Bottomline Technologies publishes a case study that highlights Alamance Regional Medical Center (NC) and the efficiencies it has gained since implementing the Logical Ink e-form solution.
• The Canadian Health Informatics Society honors Orion Health and eHealth Saskatchewan as Project Implementation Team of the Year for the successful integration of Orion Health’s Clinical Portal with four eHealth Saskatchewan applications.
• Liaison Healthcare’s Gary Palgon, VP of healthcare solutions, discusses cloud-based solutions for big data during this week’s 12th Annual BMS IT Symposium in Princeton, NJ.
• Robin Mitchell, MD (WA) shares how her practice has improved patient care by leveraging EMR support services from INHS in a company profile.
• Ingenious Med becomes one of the most downloaded apps for Android.
• SAIC subsidiaries maxIT Healthcare and Vitalize Consulting Solutions will exhibit at the NextGen User Group Meeting next week.
• Fulcrum Methods recognizes new Meaningful Use-EP Tracker users, including Duke  Private Diagnostic Clinics (NC), Greenville Hospital System (SC), Lucile Packard Children’s Hospital at Stanford (CA), Physicians Medical Group of Santa Cruz County (CA), and University Hospitals-Cleveland (OH).
• IT staffing company Digital Prospectors Corp ranks #9 on “Top 100 Private Companies for 2012” by Business NH Magazine.
• Besler Consulting will participate in the HFMA Region 9 conference in New Orleans November 11-13.
• Carl C. Jaekel of Santa Rosa Consulting offers five ingredients for successful ICD-10 activation in the company’s team blog.
• Jason Fortin, a senior advisor with Impact Advisors, weighs in on meeting Stage 2 menu objectives.
• MModal’s chief scientist Juergen Fritsch discusses ways for healthcare organizations to obtain a holistic view of patients’ health in an article published in the Allscripts Newsletter.
• The latest version of Imprivata’s OneSign technology includes Fade to Look walk-away security for shared workstations, No Click Access for Citrix XenApp, and support for Epic 2012.
• Florida State University student Bill Blough takes first place and a $1,500 prize in iSirona’s e Code-A-Thon competition.
• Bottomline Technologies hostted a November 8 Healthcare Customer Insights Exchange to foster collaboration between healthcare organizations using its technology.
• Wellcentive highlights Borgess Health (MI) and its use of Wellcentive’s Advanced Outcomes Manager solution for population health management and clinical analytics. 

EPtalk  by Dr. Jayne

I worked double shifts in the emergency department this week as a result of another physician defection. In case there’s any question, I can attest to the fact that the front-line physician shortage is very real, especially if patients are on Medicaid or are uninsured. Out of an entire day’s work, only two patients actually belonged in the ED – a child with a laceration and an adult with a fully dislocated finger. There were multiple patients there for medication refills, work notes, and plenty of malingering.

I think stationing a Boy Scout with a first aid kit outside the door of the hospital would have not only have provided great cost savings, but also also would have helped patients learn that many of their conditions could be treated at home with basic first aid training and a little common sense. Until we figure out how to educate patients on these things, we will continue to have unnecessary ED visits.

Other countries seem to do a better job with this. A friend who lives in Germany keeps telling me about the baby nurse that comes to her home to do basic parenting and health education (how to handle fever, why babies are fussy, what to do when your child falls and hits his/her head, etc.) Having something like that here would be fabulous. However, that would require what many interpret as government intrusion and it would certainly require government funding, so I don’t see it happening here anytime soon.

Here are some pearls of wisdom from last night’s adventure:

• Influenza season is here. If your child has a fever, doping them up on Tylenol and sending them to daycare to infect everyone else is a bad idea.
• When your child shoves something in her ear, do not try to get it out with a cotton swab. You will jam it in further. What I could have removed quickly and painlessly has now become a procedure that requires us to sedate your child and quadruple your hospital bill. And BTW, please do not call an ambulance for this.
• Pain in a wrist you broke 10 years ago is not an emergency condition. I will screen you and send you home.
• Asking me to diagnose a rash that is no longer present is just silly.
• When you’re a homeless guy who just wants a warm place to hang out and a sandwich, it’s best not to strip naked and sexually harass the nurses and physician. We will call security. But if you keep your clothes on, we’ll board you for a little while.

I did have some downtime in the wee hours of the morning and tried to keep up on the massive stream of social media and correspondence that was flowing my way. One of my Tweeps mentioned that BlackBerry 10 looks “promising.” Unfortunately, the hospital firewall blocked my attempts to read the article. but I did find a blurb on YouTube. Anyone seen it and have good intel? It sounds like it has a slick camera feature that lets you go back in time to modify faces when someone blinks.

Inga’s not-so-secret admirer Dr. Lyle Berkowitz makes Modern Healthcare’s list of Top 25 Clinical Informaticists. Of all the honorees, he’s got one of the best-looking head shots. Being an anonymous blogger, I know I will never make the list, but it’s fun to see lots of HIStalk friends on it.

I ran across another first-hand account of the evacuation of NYU Medical Center, this time from a medical student. It depicts situations which would make great scenarios for your next disaster preparedness drill.

There have been lots of good tweets coming from attendees of the AMIA 2012 Annual Symposium. Lots of thoughtful ponderings on “real” interoperability and what data elements really need to be tracked across disparate care settings. Not a lot of photos, though. If you were there and have some good ones to share or general thoughts about the meeting, feel free to send them along.

Speaking of meetings, the NextGen Annual Users Group Meeting starts Sunday in Orlando. Hope to see some good pics and tweets from readers who are enjoying the warm weather and getting in some quality time with The Mouse.

Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg.

More news: HIStalk Practice, HIStalk Mobile.

HIStalk Advisory Panel: Reducing Annual Maintenance Fees for Software

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

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

This month’s question: Are you feeling pressure to reduce your software maintenance fees?

• Yes. We are talking to our large vendors about reducing or limiting increases. Many have stayed flat, which is helpful. In addition, we are looking at utilization of niche products and determining if we can turn them off.
• Overall, yes. As we increase products and functionality to meet Meaningful Use, IS is under pressure to control our operating spend. We’re trying to smooth out our maintenance fees by either negotiating fixed fees for a time period, evaluating longer support contracts (when appropriate) to get further reduced pricing, or taking advantage of timing opportunities where both new product licensing and support renewal agreements are all on the table. I have three situations where our support contracts are up for renewal with vendors that have capital projects in consideration for next year. Not surprisingly, they seem to be more malleable in price discussions.
• Haven’t been asked yet. We’re a revenue department with MU. We’re getting most of what we want right now.
• I have been asked to assess what applications can go to time and materials vs. annual maintenance. Which is a problem, as most software vendors do not offer T&M for software. In addition, I have negotiated lower maintenance fees.
• (from a vendor employee) We are being asked by 90 percent of our customers to reduce our software maintenance fees due to increased pressure on their end from administration.
• All or the management team has been asked to push back on our vendors. We cannot continue to see expenses grow as revenues decline. There is no formula mandated, but we have looked at eliminating contracts that we feel we can get by without, and I have continued to negotiate on maintenance more than ever before. In addition to maintenance, I have looked at the many clinical support services like UpToDate and Micromedex. Utilization of these is high, but so is the price. These subscription vendors also need to stop the skyrocketing increases in their renewals or we will need to move to lower cost providers of clinical content.
• No particular pressure, but we certainly are looking harder at them to determine if we are getting value for our investment.
• There will always be pressure and it is our responsibility to maintain or reduce cost run rates for same store application support and maintenance. Cost creep is unacceptable.
• Yes, though pressure is not coming from our organization, but rather simply as we look to align the value of the solutions — what we’re paying and incremental value we obtain each year as we continue to pay maintenance. Essentially we repurchase the software every five years or so given maintenance dollars, but the most value to the organization came upon initial installation, the "first" time we purchased the solution. Continue to reduce our maintenance amounts through standard term renewals, additional purchases and scope expansions, maintenance holidays on new purchases, etc.
• Yes, we are feeling pressure to reduce our software maintenance fees. We are handling this in two ways:  consolidating functionality where possible on our large vendor systems if the module they offer satisfies our requirements. Additionally, we are working to take advantage of any discounts offered by the vendors where possible.
• No pressure thus far.
• Yes, and we have become quite successful in doing that. I also use a third-party negotiator to help to secure better deals. I’ve actually saved about $2 million on maintenance and equipment purchases since changing my approach and doing this. (That’s over and above our initial discounts.)
• Not per se. We are replacing our best-of-breed platform with an enterprise vendor and will actually have about a $2M reduction in my operating expense in maintenance. Of course I hope to keep those savings in IT because I need it for other things. We are a ridiculously low 2 percent of the operating budget and most academics are about 3.5 percent.
• (from a vendor employee) We are not feeling this pressure, but I think that is because we have a pretty satisfied client base and have been able to show the value and return of our service. 
• Yes. However, the pressure is coming from me rather than outside of IT. I am aware of the organization’s finances, so I’m always looking for ways to positively impact the bottom line. I’m aware that there are duplications of coverage in our applications. I’m also aware that some of our applications are not being used to provide the maximum benefit to the organization, and in some cases, barely at all.  One of my personal goals over the next 18 months is to reduce our costs by identifying and targeting those applications for removal.
• We are trying to reduce maintenance fees by reducing the number of niche vendors and getting to a core vendor strategy.
• Between Medicare and Medicaid reductions (about $20M) the pressure on IT was about $2M, so yes, we asked long-time vendor partners for stated fee reductions, which they conceded in return for commitments to act in their behalf with new sales opportunities and existing customers. This is something new. It will be interesting to see how they use us (me and my CEO).
• A huge initiative for us is application rationalization. We are enforcing selection of standard systems and partner vendors for each functional area to drive out variation and have assessed our portfolio of applications for those we are developing
  active retirement and decommission plans. We are also actively negotiating with existing strategic partner vendors to freeze maintenance increases or actually reduce future maintenance costs – not an easy task with vendors such as McKesson, however we have had some success.
• This has been a very very big deal for us over the past five years. We are becoming aggressive negotiators (and we are re-negotiating contracts) to ensure we get lower-than-market maintenance fees. I am somewhat suspect that it’s a “zero sum game,” and if we push the balloon at one spot, it will bulge elsewhere. My CFO doesn’t agree. He remains focused on reducing maintenance and support fees independent of the impact it may cause on other costs or relationships.
• No one on our executive team or board is asking me to cut software maintenance fees, so I’m not necessarily feeling any pressure. I’m taking on that responsibility myself and welcome the chance to squeeze our vendors for price reductions. Having been a vendor, I totally understand the need for vendors to make a decent living and stay financially viable themselves, so I don’t squeeze harshly or unfairly. The reality is, it’s the right thing to do because, speaking from first-hand experience, vendors need to feel the pressure of price reductions or they will never be motivated to be internally efficient or innovative themselves. Also, every dollar overspent on IT is one dollar less that we can pay a nurse, hospice, pharmacist, respiratory tech, or savings passed to patients and employers. I handled this by simply adding up the total cost of ownership for my major software products (including internal costs of labor), shared those details and numbers openly with my vendors, and asked, "What are you going to do to help me reduce these numbers?" If vendors push back, I ask them to "show me your numbers" and be transparent, too. If they still don’t open up the books, I re-compete their contracts. At the end of this process, we will reduce our IT TCO by 25-30 percent over three years without any reductions in service levels, and in some areas, our service levels and capacity will actually improve.
• The pressure is to develop a long-term support model that delivers increased value and innovation at an affordable cost while continuously improving price/performance. Not just software maintenance — everything we do.
• We pay outrageous software maintenance fees that seem to escalate regularly for no good reason. However, it’s the CIO currently paying most of the bills, not me, and I’m not hearing about any specific pressure to reduce them (as opposed to just cost-cutting pressure in general).
• We are under enormous pressure to "get to break-even with Medicare rates." We are looking at cutting back on systems and renegotiating fees with vendors. We have not stopped paying fees.
• Yes, resisting where we can. So far are cuts have been more on the hardware side, where we’re able to use third parties.
• We are under pressure to reduce all costs. Software maintenance fees seem to be less emphasized in discussion than the fees for new software modules and features (even when needed for Meaningful Use or for enhancing the workflow and efficiencies for clinicians) and the need for ongoing personnel for production support, which is always under-budgeted. Clinical informatics resources are another group of personnel who are absolutely essential to maintaining a usable software product for a large hospital but they are also underestimated in their value and need for sufficient manpower. [Disclaimer: I am not a member of hospital IT or clinical informatics and am not even paid by our hospital — just a front-line doc and academician.]
• Yes, we are working on this in addition to our Supply Chain department working non-software expense reduction. Overall, we are working to reduce spend by 5 percent across IT (to the degree possible). We are focused on the elimination of the annual increases in maintenance and hosting fees for next year (generally 3-4 percent average increase across vendors). Back in 2008/2009 we made a pass at maintenance reduction and had some success. With our major contracts, we were not able to reduce existing contractually committed fees, but several big vendors did waive their annual fee increases, which in total saved significantly more than $200K. We are making a pass at doing that again, not sure if we will get it again, but worth trying for. Also, we are extending the refresh life cycle of some our hardware and networking components. Instead of purchasing maintenance on hardware (Kronos time clocks), we are buying replacement hardware and becoming our own depot (estimated $75K savings). We are going off-contract for Microsoft support for some technology and going to time and materials support calls (estimated $100K savings).

Collective Action 11/7/12

An HIT Moment with … John Vaughan, MD, Sharp HealthCare

An HIT Moment with ... is a quick interview with someone we find interesting. John Vaughan, MD is director of medical informatics at Sharp HealthCare of San Diego, CA.

What are Sharp’s most important projects and biggest challenges?

We are engaged in implementation of dbMotion with our associated multi-specialty group, Sharp Rees-Stealy, and will also be engaged in implementing our HIE with our independent physician group at Sharp Community Medical Group. In addition, we have been in discussions with Family Health Centers of San Diego, a private nonprofit community clinic, for collaboration on patient discharge data. 

Also, we are working with the Beacon project of San Diego, facilitated by UCSD. We are in the process of connecting our EDs with the county Emergency Medical Services for near real-time receipt of electrocardiograms in our emergency departments. We are also resolving single sign-on issues for implementation of the Beacon interface.

What technologies are you using to connect with your affiliated practices and to prepare for an accountable care model?

Most of these technologies are involved with the projects I mentioned. In addition, we are also looking at ways in which we can simplify our analytic data analysis across the continuum of care.

What are your thoughts about recent concerns that EHRs encourage copy-and-paste physician documentation?

We have been actively involved in discussions with our health information management supervisors regarding this issue. We will continue to monitor this concern as further regulatory oversight rules are published.

What are some innovative projects you’ve been involved with at Sharp?

We are actively involved in a clinical documentation improvement project. In addition, we will be adding front end speech for improvement of our documentation process over the next several months.

What technologies have made the most positive difference in how your physicians practice?

We are continuing to see improved efficiencies for inpatient care as medical records become more unified. By making the right information available in the right place at the right time, we hope to enhance the overall physician experience.

News 11/7/12

Top News

ECRI Institute’s “2013 Top 10 Health Technology Hazards” report includes several patient issues that are IT-related or potentially IT-solvable: alarm hazards (#1); IV infusion pump errors (#2); data mismatches in clinical IT systems (#4); interoperability failures between IT systems and medical devices (#5); and caregiver distractions due to mobile devices (#9). The nonprofit organization’s report, which contains good assessment tools and recommendations, is available as an immediate and free download with registration.

Reader Comments

From Ron Strachan: “Re: Community Health Network in Indianapolis. I’m happy to report that we’re live on the final wave of Epic sites. Community is an Enterprise customer and now has four hospitals and over 200 sites of care live on EpicCare. The install started in April 2011.” Congratulations to the team there and to the CIO, which happens to be Ron. Epic “waves” of ambulatory go-lives within an organization are like an army’s push into enemy territory – cause for concern beforehand, but worth celebrating after the careful planning pays off.

From Karl: “Re: for Inga and Dr. Jayne. Beware … you are about to lose substantial time and money too.” The Pinterest page is shoe porn for the ladies, or possibly for cash-eager healthcare providers who specialize in treating the foot and leg damage that some of the more bizarre models surely cause. But as they say, it’s better to look good than to feel good.

From Tarheel Ingenue: “Re: UNC Health Care. Named Epic vendor of choice on Friday.” Unverified, but hardly surprising given that not only is Epic getting just about every big-hospital deal, they have several of UNC’s academic hospital neighbors as customers (Duke, Wake Forest Baptist, Pitt County in Greenville, and probably others I’m forgetting.)

From JB: “Re: soft drinks. Mayor Bloomberg isn’t the only one banning the sale of sugary drinks.” Children’s Mercy of Kansas City, MO will stop the sale of all sugar-containing drinks on January 1, including sugar-loaded faux healthy fruit juices. The hospital cafeteria emphasizes healthier food choices, encourages purchase of fruits and vegetables, and plans to trash their deep fryers by 2015. They will also switch all IVs from dextrose to normal saline starting in 2015 (OK, I made that part up). This is an admirable step in trying to lead by example. Outsourced food service departments of hospitals are big-time nutritional offenders in serving whatever is easy and cheap, although in their defense they’re selling what people unfortunately want. It would be interesting to see how many overweight people suck down sugary drinks regularly, which are surely the least-satisfying calories you can take in. Put your finger a third of the way up the side of a soda can – that’s how far the 140 calories’ worth of sugar would pile up if you removed the colored water.

HIStalk Announcements and Requests

I plan to get comfy on the couch tonight in front of the TV to watch the election returns. Hopefully by the week’s end I can unhide a few of my more politically passionate Facebook friends whose various posts have raised my blood pressure in recent weeks. I’ll then be happy to ignore all politics for awhile – at least until Bill Clinton keynotes at HIMSS.

We like reading tweets from conferences, so we’re offering sponsors a free tweet box from their annual user meetings. The one from Imprivata’s HealthCon is running to your right.

Speaking of meetings, AMIA’s seems to be going well judging from the tweets. Your report is welcome since we aren’t there.

Acquisitions, Funding, Business, and Stock

NexJ pays $5.5 million to acquire Broadstreet Data Solutions, a provider of data management, analytics, and mobile solutions.

Shareholders of Streamline Health Solutions vote to convert $5.7 million in convertible notes to preferred stock in order to reduce company debt and reduce interest expense.

Hearst Corporation, whose holdings include Zynx Health and First Databank, will acquire Milliman Care Guidelines LLC, a provider of evidence-based clinical healthcare databases.

Tenet Healthcare subsidiary Conifer Health Solutions, which provides business process management services to 500 hospitals, acquires Dell’s revenue cycle management business for hospitals and healthcare systems.

Vocera reports Q3 results: revenue up 27 percent, EPS $0.07 vs. -$0.25, beating estimates on both and raising earnings guidance.

As we reported earlier, McKesson announces that it will acquire Emendo Ltd., the New Zealand-based vendor of the CapPlan hospital capacity planning solution. Its customers are in New Zealand, Australia, the UK, and Canada, with some US hospitals signed since it began marketing here through partners in 2010.

Sales

Legacy Health (OR) contracts with Explorys for its platform and enterprise performance management applications to power Legacy’s PCMH and ACO initiatives.

Altru Health System (ND) selects Perceptive Software’s content and process management solutions to complement its Epic patient registration, HIM, and patient finance processes.

Baptist Health (AR) chooses the Patient Access Intelligence and Revenue Cycle Intelligence solutions from MedeAnalytics.

First Choice Health Centers (CT) signs with eClinicalWorks for its six-location community health center organization.

Coosa Valley Medical Center (AL) selects Merge Healthcare’s iConnect Enterprise Clinical platform, including Merge PACS, iConnect Access, and iConnect Enterprise Archive.

HomeTown Health buys McKesson’s CareEnhance-Review Manager Enterprise technology to increase the accuracy and efficiency of medical necessity review and documentation among its network of rural hospitals and providers.

People

Kaiser Permanente promotes President and COO Bernard Tyson to chairman and CEO, replacing the retiring George Halvorson.

Stuart Nelson, MD (US National Library of Medicine) joins Apelon as chief innovation officer.

The TriZetto Group hires Jeffrey Rose, MD (Ascension Health) as CMIO.

The Georgia CIO Leadership Association names Emory Healthcare CIO Dee Cantrell its CIO of the Year.

Tony Fonze, CIO of Carondelet Health Network (AZ), is named president and CEO of Carondelet’s St. Joseph’s Hospital of Tucson.

Announcements and Implementations

NYU College of Nursing and Rubbermaid Medical Solutions combine resources to develop and enhance clinical technology solutions for nursing education that will  include scholarship programs, telemedicine projects, and educational initiatives.

The executive director of HealtheConnections reports that about 1.2 million people in central and northern New York are now connected to its HIE.

First Databank releases the ICD-10 code set within its FDB MedKnowledge clinical decision support drug knowledge.

nVoq and Mi-Corporation will collaborate to deliver voice-enabled versions of commonly used templates for the home health and long-term care industries and will develop additional voice-enabled e-Forms for other healthcare settings.

One of my Advisory Panel members mentioned using Vendormate to review the financials and sanction record of prospective vendors. The healthcare-specific company recently announced Medzo, an online service that matches the needs of buyers with seller offerings, potentially eliminating the RFI process. Vendormate’s network covers 70,000 companies, 660,000 provider-vendor relationships, and 48,000 users. Hospitals get free access and vendors get a free basic listing in Medzo.

Government and Politics

A Masachusetts law went into effect this week that prohibits employers from requiring nurses to work overtime.

Innovation and Research

A Rand Corporation study finds that physicians with fewer than 10 years of experience account for 13.2 percent higher overall costs than physicians with 40 or more years of experience.

Other

GE Healthcare issues a field safety notice to physicians warning of a potential defect in its Centricity PACS imaging systems that could result in the loss of images when sending exams from one Centricity PACS to another.

Eleven vendors own 80 percent of the HIE market, according to a new KLAS report. Epic, ICA, and Siemens MobileMD earned the top scores for overall connectivity and satisfaction, though scores for all HIE vendors except Cerner have declined over the past year.

Social workers in British Columbia are startled when their computers display the home page of the US Department of Homeland Security and an entry form labeled “Co-Conspirator.” Their new, problem-plagued software was modified from Homeland Security’s system by a contractor at a cost of $194 million and counting. The government shut down an $89 million student information system last year after giving up that its problems could be fixed.

Strange: a doctor tells a British couple who aren’t having any luck conceiving that the problem might be the husband’s laptop, which he props in his lap for several hours each evening to use Facebook. Three months after the husband starts using a table instead of his lap, his wife becomes pregnant.

Sponsor Updates

• The Sandy Relief Drive of SRS generated almost $5,000 in employee donations, which the company then matched in purchasing supplies for affected employees. The balance of the money will be donated to the Red Cross and Governor Christie’s Relief Fund.
• GetWellNetwork completes its 350th interface in US hospitals.
• CHMB (CA) partners with Ingenious Med to expand its RCM service offerings to hospitalists.
• Intelligent InSites announces that its software platform integrates with the ultra wide band RTLS from PLUS Location Systems.
• iSirona offers a $1,500 prize to the winners of a Code-A-Thon programming challenge at Florida State University.
• ICSA Labs calls for qualified EHR technology developers of both complete EHRs and EHR modules to participate in a pilot program for the 2014 Edition certification criteria.
• Orion Health CEO Ian McCrae discusses the growth of his company and its approach to software integration in a video interview.
• Imprivata is ranked 26th in the medium company category of 2012 Top Places to Work in Massachusetts.
• eClinicalWorks receives full NCQA certification as a CAHPS PCMH survey vendor to conduct NCQA HEDIS surveys.
• Philips SpeechMike Premium earns a perfect score of six dragons on Nuance Communication’s recording accuracy test for assessing compatibility with the latest version of Dragon Naturally Speaking.
• Dawn Mitchell and Kathy Krypel of Aspen Advisors will co-present break-out sessions at next week’s HIMSS Midwest Fall Technology Conference in Des Moines, IA.
• Eye Health Services (MA) selects SRS EHR for its 21 providers and 11 locations.
• Quality IT Partners sponsored the 13th Annual Scott Hamilton CARES Initiative Gala and hosted a patient from the Cleveland Clinic Taussig Cancer Institute last week.

Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg.

More news: HIStalk Practice, HIStalk Mobile.

McKesson To Acquire NZ-Based Emendo

Mckesson announced this afternoon that it will acquire Emendo Ltd., the New Zealand-based vendor of the CapPlan hospital capacity planning solution. Its customers are in New Zealand, Australia, the UK, and Canada, with some US hospitals signed since it began marketing here through partners in 2010.

Curbside Consult with Dr. Jayne 11/5/12

I’ve written before about the difficulty I sometimes have reconciling the high-tech tools I’m responsible for with the low-tech situations that physicians deal with on a regular basis. Many of us are confident we live in a wondrous age where innovation and technology are both the means and the end. Stories coming out of areas devastated by Hurricane Sandy, however, tell a different tale.

In New York City, the decision was made (based on storm predictions) to evacuate several hospitals prior to the storm, but not all. I don’t doubt that there was a lot of deliberation involved and careful weighing of the risks of evacuation vs. sheltering in place. New York has experience from Hurricane Irene and used that knowledge to inform its decision. Sometimes even the best plans go awry, as detailed in a New York Times article about the hospital situation.

As a physician (and as a first responder before medical school) I’ve been through my share of disaster drills. We don’t have hurricanes where I live, but we do have more than our fair share of fires, tornadoes, earthquakes, and floods. (Last year we even had locusts, but I digress.) I know in the event of an emergency what I’m supposed to do. I also count on hospital administrators and others to make good decisions.

Despite significant preparation, there were some misses in Bellevue’s disaster plan:

• Although fuel pumps were in flood-resistant housings, they were in the basement, which flooded. Residents, nurses, and administrators ferried fuel up 13 flights of stairs to the backup generators.
• Electrical control systems were also in the basement.
• Elevator, oxygen supply, and water systems failed.
• Disaster drills did not include actual practice of the scenario of carrying patients down the stairs to evacuate.

I cannot even fathom the conditions that caregivers and patients endured this week. And it wasn’t just at Bellevue. Speaking with some of my colleagues, conditions at several facilities were horrendous, with sanitation issues, sewage problems, and more. When evacuations were finally ordered, patients were carried or dragged down 10-15 flights of stairs, often with someone manually ventilating those patients who could not breathe on their own.

The Times article details the conditions at other hospitals. Patients were given minimal dialysis because private dialysis centers were closed. Facilities were only prepared to be on backup power for days rather than for a week or more. Food supplies ran low. Communication plans failed.

Due to a quirk of scheduling, I happened to be in the New York area this weekend. I am shocked by not only the devastation, but by the disparities across the region. New Yorkers are being urged to return to business as usual even though hundreds of thousands of people are without power and bodies are still being recovered. The devastation that occurred is a life-altering event for those affected. Psychologically, people need to grieve and come to terms with the past week rather than launch back into “business as usual.”

Not all of New York City was affected equally. Staten Island was hard hit, yet parts of Manhattan were relatively unscathed. A controversial decision was made by Mayor Michael Bloomberg to go ahead with the New York Marathon. Community advocates worried that emergency workers were already stressed by evacuations, fires, and rescues and that their efforts should be focused on rescue and recovery rather than recreation. Residents were furious that generators (albeit privately funded ones) were powering media tents when nearly half a million people were without power. Ultimately, Bloomberg responded to criticism by canceling the race Friday evening.

When this decision was announced, I was on a flight with a mix of marathoners and people who were returning home to the devastation. Conversation topics included everything from “what kind of generator should I buy for next time?” to lamentations of the race cancellation. I was surprised by the lack of empathy from runners/tourists who felt that New Yorkers had bullied the mayor into canceling. I hope their tone changed when they left the airport, because what I saw when I hit the roads was dramatic. Lines at gas stations were two to three hours long with significant power outages, lack of traffic signals, and many people who are still in shock.

It’s not over yet, however. This weather event and the subsequent tragedies will add to the healthcare burden not only in exacerbation of existing illness, but in a short term surge of respiratory, gastrointestinal, and other infectious complaints. In addition, there will be longer-term cases of post-traumatic stress disorder, anxiety, and depression.

Regional health authorities, hospitals, and disaster preparedness experts need to carefully learn from the events of this week and prepare their teams with careful planning and practice. Plenty of people were touting the benefits of HIEs to assist with natural disasters this week, but an HIE doesn’t do you a lot of good when you lack food, water, and basic sanitation. Does it really matter if the servers fail over gracefully if generator failure causes a hard stop a few hours later?

It seems that despite all our technology, people have become less prepared for events like this, as well as less resilient when they occur. In our post-Katrina world, people need to be ready to help themselves and not rely on government agencies. I urge each of you to use this as an opportunity to revisit your own personal disaster plans as well as those for your workplace. Emergency preparedness isn’t just for doomsday preppers, but should be for all of us.

No matter where you live, make an effort to have a week’s supply of food and water on hand (if nothing else, invest in some energy bars and a case of bottled water) and have a plan for where to go if you’re displaced from your home. You don’t have to be a secret agent to keep a “go bag” with a few clothes and essentials packed and in the closet or under the bed. Be aware of chronically ill or elderly relatives and neighbors. Ask them what their plans are and know whether you are willing to assist if the time comes. Know what your role would be if you are at work and disaster strikes. Be willing, be able, and be prepared.

E-mail Dr. Jayne.

Guest Article: Hurricane Sandy Report from a Disaster Recovery Firm

Note: I offered to run an article from a disaster recovery vendor because I thought their perspective on Hurricane Sandy would be interesting. This is not an endorsement of that company, but I appreciate their article.

Extreme power outages and widespread flooding may wind up making Superstorm Sandy the second most expensive storm in US history, according to the forecasting firm Eqecat. Losses from the storm could total up to $50 billion, and according to Moody Analytics, an estimated $30 billion will come from physical storm damage split evenly among households, businesses, and public infrastructure. The remaining loss comes from lost business activity.

In addition to the financial challenges, several hospitals, nursing homes, and assisted living facilities failed a fundamental test of preparedness during Superstorm Sandy: they lost power. Their backup generators failed or proved inadequate, forcing thousands of patients to evacuate. Doctors, nurses, and medical practitioners were unable to access electronic health records and communication lines were down with no backup plan in place to redirect or re-establish phone lines.

Days after the storm, many businesses were up and running despite infrastructure failures because of disaster recovery and business continuity plans provided by Agility Recovery. Agility Recovery, a former division of General Electric that has been rescuing businesses impacted by disasters for over 23 years, offers a disaster recovery solution endorsed by the American Hospital Association.

In the aftermath of Sandy, Agility is responding to over 1,300 businesses, including several healthcare organizations. Agility is currently delivering assets to 95 businesses. Another 1,210 businesses are on alert, meaning Agility is pulling down assets, waiting for the go-ahead from the business to ship them.

The main Sandy-related response activities include:

• Power loss. The company has shipped out generators to dozens of members and provided electricians to connect the generators and fuel to keep them running.
• Downed phone lines. We have conducted over a dozen telephone and voice mail redirects so businesses can continue to communicate with employees and clients.
• Computer or server failure. Agility has shipped out computers and servers to several clients who have experienced damage to their existing technology or need extra technology for employees working from alternate locations.
• Structural damage. We have completed several full office recoveries, shipping out a mobile office, a generator to power the office, satellite to establish phone and Internet connectivity, phones, computers, servers, printers and faxes, desks, and chairs.

Although significant gains have been made in healthcare industry with regards to preparedness post 9/11, Georges Benjamin, executive director of the American Public Health Association, warns that austerity budgeting threatens these gains. “People presume that we have greater capacity than we have. When we get the big ones, we throw everything at it. We need to make sure we have the same capacity on the shelf at all times,” Benjamin continued, "I remain worried about the infrastructure.”

Most Common Recovery Plan Vulnerabilities

• Access to generators in the absence of a predefined relationship.
• Failure of backup generators due to poor location or lack of testing.
• Access to generator fuel.
• Establishing communications, as employees and clients left in the lurch as they receive busy signals.
• Incomplete planning for alternate facilities, where those locations are either impacted by the same disaster or have inadequate technology.
• Inadequate business insurance coverage. Of the estimated $50 billion in Hurricane Sandy damage, $10-20 billion is predicted to be insured losses.

Having a flexible and executable plan that accounts for many eventualities is critical to resuming operations following a disaster. Of course, revenue is an issue. A healthcare industry study found that one in 20 hospitals is unprepared for power disruptions, and a power outage may result in more than $1 million in lost revenue and other costs. Another study of a 16-hour power failure in New York in 2003 found that of 120 hospitals impacted, one was forced into bankruptcy and 10 others suffered significant revenue loss.

But more importantly beyond revenue is the need to provide high quality, continuous patient care. Patient safety is always the biggest concern hospitals and healthcare organizations face. Following the high-profile failure of several hospitals hit by Sandy, it is time for everyone to take another look at their disaster response and recovery plans.

Bob Boyd is CEO of Agility Recovery of Charlotte, NC.

Humana Acquires Certify Data Systems

Health insurer Humana Inc. announced this morning that it has acquired HIE technology vendor Certify Data Systems. The San Jose, CA company, which offers the HealthLogix HIE platform, will operate as a subsidiary of Humana.

Humana VP/CIO Brian LeClaire was quoted in the announcement as saying, “Humana remains focused on leveraging the power of technology to provide a more coordinated patient experience for our members that will enable quality, affordable health care. With the health information exchange platform from Certify we can move closer to creating a virtual integrated delivery health care system that can help us deliver this value-added, simplistic [sic] experience to our members.”

Terms of the transaction were not disclosed.

I interviewed Certify CEO Marc Willard in February 2012. He reported at that time that the company had 70 health system customers.

HIStalk Advisory Panel: How Do You Use Information from KLAS?

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

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

This month’s question: How do you use KLAS reports or scores to choose and monitor your vendors?

Generally Negative Comments

• I place almost no value in the KLAS scores. Years ago I took a class on research methods and the professor used them as an example of bad methodology. What is great about them is they know all the products from all the vendors, so when I’m looking for that niche departmental system, I can go to them for a list of vendors.
• (from a vendor employee) I believe that KLAS has a very flawed system, which has been brought to their attention time and time again with no changes. There is inaccurate information, and when brought to their attention, no changes are made. We are a vendor, and the information they continue to have on us is actually so inaccurate that it’s ridiculous. They list us as "small volumes" and every company but two on the list that is ranked (we are not because of this "small volumes" designation) is much smaller than we are. They will not correct it, so we have decided that it is not worth the hassle to continue to correct them, only to have them continue on as previous. On speaking with customers, we have been told that they have run into the same things in all categories and no longer give any weight to the rankings. A few even think that it is possible to pay for your ranking and rating.
• We use KLAS reports (if available) to supplement MAJOR capital purchases. Most of the reports are too expensive to justify unless the expected purchase is one in which we have no experience and is a major capital purchase.
• I review KLAS reports, but I do not have a clear sense of the validity of their review or ethics of their process.
• Sometimes KLAS is helpful for decision makers who know nothing about the vendor/product landscape. Otherwise, I never use it.
• I rarely if ever use it.

Generally Positive Comments

• We use KLAS as a data point in selecting a new vendor, but it is not the primary driver unless there are a significant number of negative comments or scores. We also monitor our current vendors to ensure they are keeping up with the market.
• I am using KLAS with a grain of salt and not as a gospel. For lack of a better reference frame, we all go to it, but I would not make decisions on KLAS alone. It is pretty much like the board certification for physicians: we all know that it may not reflect the best quality in a physician, but we all look it up and diligently go and take it to stay current.
• I view KLAS as just being one gauge on a dashboard when evaluating vendors.  For new vendor selections, KLAS is used to populate the initial list of potential vendors. Through the selection process, their rankings are used as a single data point, primarily as a reflection of market penetration, customer service, and overall satisfaction. I have to admit that I rarely refer to KLAS for vendor products we’ve implemented unless we’re experiencing issues or entertaining a product switch.
• I have used KLAS as a data point when evaluating vendors. For me, it represents a general standing in the marketplace and the comments are valuable in identifying areas to question.
• I view KLAS as a consolidated reference check. I provide feedback to KLAS on products and services once or twice a year and I know that how I replay can vary depending upon the most recent encounter with the vendor in question. As with any reference check, you get a good picture of how one or many are currently viewing the company. KLAS will never be the final word, but is a good place to go to get a consolidated view of how customers are feeling about the vendor.
• We use the KLAS scores as a starting place. We also use them as a resource to understand what other hospitals are doing. Adam Gale and his team are great about answering questions. They obviously have a great network of contacts and can often point us to other organizations who have addressed similar challenges.
• When private physician practices contact me for advice on EMR vendors that they are reviewing, I share with them the publically available KLAS reports as well as other industry reports on EMR metrics. I also use these reports to see if there is correlation between what is being reported and what is said in private and on HIStalk about the vendors.
• We incorporate the results as part of our customer communication and status updates. Specifically, we ask the leaders of our IS teams over each area (e.g., surgical services) to routinely incorporate market feedback from KLAS during their standing customer meetings. This is typically only done twice per year, not at each monthly discussion. It also helps us confirm/deny trends that we may or may not be seeing locally at our organization.
• I’ve used KLAS to identify competing products in a space if we are looking to meet a need. We’ve referenced some of the reports when going through vendor selection, but it has not been the deciding factor. I’ve also found the reports to be an encouragement that we’re in the same boat as others.
• I routinely review KLAS reports on all current vendors and ones we are looking at. It’s helpful to get updated information. Because I participate in KLAS reviews, I am able to get detailed reports related to vendors and trends. I’m usually looking for details on satisfaction with implementation and ongoing support. Love their question: would you buy from this vendor again?
• I review KLAS findings and typically drill down into the individual comments from other users to find information or concerns that I use with the vendors in order to get more specific information. For example, if a number of users complain about some aspect, then I may spend more time than I might otherwise have done drilling the vendor about that aspect. I can also occasionally find out what the vendor has problems with, and if I’m convinced it won’t be a problem for us (and that we want to go forward with them), I can occasionally use that to negotiate a better deal.
• I use KLAS primarily in the selection process for software and services and in that regard I find them very valuable, especially the user comments both pro and con. They give me some good direction in term of things I make sure I follow up on in the selection process. Recently they have also created some additional functionality around the creation of affinity group and other functional that gives me a platform to share directly with other organizations who have similar products or are similar to me in structure (academic, for example) that I have found some good utility in.
• (from a vendor employee) As a vendor, we do yearly, in-depth, anonymous, customer surveys to see how we truly stand in all areas of our solution, service, and support. That said, KLAS is incredibly helpful for us to get even further information on our performance. I find KLAS gets better executive level feedback than we get on our own (our surveys usually get more responses from managers/directors/end-users). It’s a great way for vendors to see objectively where they’re doing well and where they might have opportunities for improvement. I always tell folks, I love hearing all the great stuff about our company and solution but I’d much rather hear the “tough” stuff as that’s the gold that helps you become better and better.
• I use the KLAS reports to come up with a short list of vendors before the application/service search. The reports provide information that I use to educate my customers as to what is available, what others use in similar markets (e.g. practice EMR pool is different for 1-6 providers as compared to a practice of over 100 providers), as well as what applications others are moving from (always good to show there are no perfect vendors). I do peruse the vendor alerts as they come in but to this point I’ve not seen anything that was news to me.
• I use KLAS for independent ambulatory physicians who are looking for a system — it is excellent for them and they often do not know it exists. I also use it to go to battle when an operations person wants to buy a niche vendor system that I don’t want. (of course that only works if the KLAS scores are bad). Occasionally use it for our own purchases that I am trying to investigate, but unfortunately many of the systems we are looking to buy are not rated in KLAS (population health, analytics etc.)
• Used as one of the tools as part of vendor and system selection or standardization efforts. Also use Gartner info such as magic quadrant and we now ask IT vendors to register on VendorMate and pull reports on financial and sanction info from that resource and use Gartner for contract negotiation market analysis.
• I use KLAS infrequently, but it has served as a way to educate and inform our leadership about specific vendor offerings and their comparative value to the market. 
• KLAS scores and reports are critically important to me in my decision making process. They are my single most influential source of external advice and insight, followed by The Advisory Board and Gartner. KLAS’s integrity is unshakeable and their influence on the industry is invaluable.
• I review KLAS to identify top vendors meriting consideration and to yield additional insights into strengths and weaknesses when selecting vendors.
• Flawed, but extremely valuable given there’s no better alternatives in many cases. We used it a year ago to help determine whether we should go with a particular vendor on the outpatient side (we didn’t as their product was rated in the bottom of the rankings). The one area where KLAS is lacking is in specialty-specific EMR evaluations, as the niche products that are great don’t show up on the KLAS radar because of lower volumes. 
• I participate in KLAS surveys because the lady who calls used to work for me and I like her style and that of the company. I find the reports insightful and they help confirm our assessments and sometimes point out weaknesses. I am aware of some of the criticisms of KLAS and certainly recognize their limitations. It is also helpful in working with the senior team, who may see only the glitz. It helps when I show our own vendor’s ratings, with which they usually agree, as a means to establish a level of credibility in KLAS reports.
• I don’t have real decision-making power (e.g., authority, monetary control) over HIT purchases. However, as a physician end-user and member of our institutional EHR committees, I have used the KLAS reports as a "reality check" when my personal impression of a particular product is dramatically different from the party line that’s being perpetuated by our hospital IT group and C-suite. They say "This software’s perfectly reasonable, but the doctors are being resistant." It’s nice to be able to say, "I don’t think it’s just our doctors who view this software as having problems…." I would say that the KLAS reports are helpful in encouraging greater honesty and reality checking when too many folks are drinking a LOT of Kool-Aid.
• Use it on a limited basis for specialty systems and needs. Good reference point to check and confirm which vendors we should consider for a selection

Key Themes

• KLAS uses questionable and non-transparent methodology.
• KLAS is far from perfect, but has little competition.
• The negative comments and scores are more meaningful than the positive ones.
• It’s good for a quick check on what customers think.
• KLAS reports can help determine if a trend you’re seeing locally is broad.
• It’s a good starting point for researching a vendor or product type, but is not the deciding factor.
• New service to allow members to contact each other is useful.
• Use KLAS reports to identify available products of a particular type.
• Review the scores of IT-recommended systems to make sure they are being considered on merit and not IT department convenience.
• Use the reports to educate and influence users involved in selection.
• Show negative reports to users who are convinced that they want a particular system or to remind users that all systems have negatives and that implementing them is hard work.

Monday Morning Update 11/5/12

From The PACS Designer: “Re: iPad Mini. TPD told you about the iPad Mini awhile ago, but didn’’t expect its arrival until early next year. Now that it’s here, you will see a rapid deployment in the healthcare field. Healthcare IT departments need to be on alert as the expansion of iPad mini users will could quickly overload already busy networks.”  

From Japandroid: “Re: MMRGlobal. I spent 30 minutes reading their press releases after your item and was floored. They crank out what seems like one per day, like the one mentioning that they shipped 25 more PHR licenses to a reseller (congratulations!) Check out their YouTube video – the company’s spokesperson is a former Playboy model, soft porn movie star, TV producer, and the trophy wife of company founder Robert Lorsch, who has a long list of business and philanthropic accomplishments.” Looks aside, Kira Reed is polished and engaging in the video, although not enough to make PHRs interesting (she says PHRs are “exploding,” which I would agree by my definition of “exploding.”) Vendors: is anybody planning to reward the company’s patent trolling by licensing its EHR-related intellectual property, which will be celebrating its one-week birthday in just a few days?

From Epic Pawn: “Re: Epic. The contract they sent me for the privilege of consulting with one of their clients will require me to end my HIT career!” Interesting points:

• Apparently a hospital can’t hire a consultant to help with Epic until that person signs a lengthy contract with Epic.
• If the consultant develops any kind of enhancement to Epic software and doesn’t sign over the rights to the hospital, the enhancement is automatically owned by Epic.
• You are obligated to report anyone you know who has accessed anything related to Epic without authorization, even if you didn’t have anything to do with their access.
• You can’t hire or contract with a former Epic employee until they’ve sat out a one-year waiting period.
• You can hire an Epic customer’s project team employee only if you don’t assign them any Epic-related work for two years, and they are considered to be a project team employee until three months after go-live.
• Your employees can’t perform any activities that compete with Epic – design, sales, consulting — for two years after they leave your employment.
• You agree that Epic is a third-party beneficiary of the agreement your employees must sign, which gives Epic a right to enforce the agreement even though those people don’t work for Epic.
• You agree that any legal actions will be heard in Wisconsin courts.
• I’m sure there’s more, but it’s a long read and I’m getting numb.

From Lambrusco: “Re: Allscripts. I think they’ll get a private equity deal announced by the earnings announcement on Thursday. Otherwise, they will have to put out an ‘exploring strategic alternatives’ addendum to the announcement if they miss on revenue or earnings (which is likely) to cushion any fall. Worse than allowing word of the PE deal to leak out was the MyWay announcement, which clued every potential PE buyer to dig more closely into attrition rates, which are sure to rise. They could have waited a month or two before putting a bullet in MyWay. The company is incredibly inefficient and the CEO was given carte blanche by the board to do M&A himself to buy his way out of trouble after avoiding tough product decisions in 2008 and 2010, so the cash flow and margins are probably understated and the PE guys can put in a management team that can execute. This week will be interesting.” Indeed it will.

From Coolmaker: “Re: vaccine refrigeration. They can make a zeer pot refrigerator that only requires water to function.” That might be an interesting project – a couple of flower pots and some sand and you can make a rudimentary refrigerator, although I don’t know if it will get cool enough to keep vaccines.

From Tarheel Ingenue: “Re: UNC Health Care CIO. Leaving.” Verified, apparently, based on an internal e-mail sent my way. Rose Ann Laureto, who’s been on the North Carolina job just a year, is moving to Promedica as CIO of the 11-hospital system that’s closer to her original home.

It’s pretty much all KLAS when providers use paid information sources to evaluate vendors according to my poll, although Gartner and “none of the above” had minimally respectable showings. New poll to your right: how much will patient empowerment and mobile apps change the healthcare system? After you’ve voted, click the Comments link on the poll to try to sway the undecided voters.

Instead of doing a “Listening” recommendation, Lt. Dan of HIStalk Mobile and I put together a Spotify playlist with some new and old stuff we’ve been following (our musical tastes overlap quite a bit). Spotify offers high-quality free streaming, so download it and you can play through the 39 tracks and three hours. Examples: new Neil Young, Wild Belle, Seapony, and older stuff from Frank Black, the BellRays, Public Enemy, and Operator. Feel free to create your own playlist and send me the link – if I like it, I’ll run it. If anyone seems to care, I’ll put out a new playlist every week or two, maybe focusing on specific genres.

Thanks to the following sponsors, new and renewing, that have recently supported HIStalk, HIStalk Mobile, and HIStalk Practice. Click a logo for more information.

A colonoscopy is not only an unpleasant procedure — a fact the voice failed to mention — but an expensive one. Hospitals don’t list their prices — no, that would make way too much sense — but independent cost-comparison websites suggest you can count on paying an average of $2,025 for a colonoscopy in St. Louis. The anesthesiologist will bill you separately. Why? Because he can. The facility may bill you separately. Why? Because it can. Also, if the colonoscopy actually finds a polyp or some other anomaly, it becomes a “diagnostic” procedure and not a “screening” procedure and it will cost you more. Why? Because it can. That $2,025 price applies if you have insurance. The voice was happy to suggest a colonoscopy because (a) voices don’t have colons to be scoped and (b) the insurance company would rather pay its share of the discounted price of the procedure than pay out hundreds of thousands of dollars for colon cancer treatment. Insurance companies have many faults, but stupidity is not one of them.

California state HIE overseer UC Davis releases HIE Ready, a buyer’s guide for providers interested in the interoperability capabilities of EHRs they are considering. It’s mostly a set of technical specs and an invitation for companies to participate.

Former shareholders of critical test reporting system vendor Vocada file suit against Nuance, which acquired the company and its Veriphy product in 2007, claiming Nuance has failed to make $7 million in earned payments. The shareholders say an arbitration panel has already unanimously ruled that Nuance fraudulently induced Vocada’s board and shareholders to agree to an acquisition whose terms included $20 million in cash or stock for shareholders, $4 million in cash or stock for employee retention and management bonuses, and $21 million in earnout consideration contingent on three-year revenue targets. An earlier Nuance SEC filing states that the financial targets were not met.

Is the iPad mini the killer form factor for medical professionals? #iPadmini #Epocrates

— Epocrates (@Epocrates) October 23, 2012

An Epocrates survey finds that one in three physicians plan to buy an iPad mini since it fits into a lab coat pocket.

The Raleigh, NC newspaper covers local EHR efforts. Tidbits:

• A local doctor who took the Allscripts MyWay plunge two years ago is not happy that it won’t be further enhanced. “We bought what we bought thinking it was a stable company and it was their newest package. You spend all this time transitioning to a program, and they come back and say, ‘Sorry guys, we’re not going to do this after Jan. 1.’” Allscripts has 1,200 employees in Raleigh, the home of the former Misys that it acquired.
• About 50 percent of NC doctors surveyed said EHRs haven’t improved care or aren’t worth the cost.
• WakeMed will spend $100 million on its EHR, while Duke’s Epic implementation will cost $500-700 million and will earn $50 million in HITECH incentive payments. UNC will choose a vendor this month to replace several hundred applications.

Time Capsule: Cerner Layoffs In Review: Why Marching People Out Makes Sense, But Sickouts Don’t

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 January 2008.

Cerner Layoffs In Review: Why Marching People Out Makes Sense, But Sickouts Don’t
By Mr. HIStalk

Cerner laid off a bunch of people last week. Since I’m a typical 401K investor (not in Cerner stock) but also a wage slave, I can’t decide whether I’m a bourgeois capitalist pig or an oppressed member of the unpropertied proletariat. So, I’m waffling on how I feel about it.

It was only 97 people out of 7,800 employees worldwide (sorry, “associates” as Cerner calls them, although that feel-good term rings a bit hollow after hearing them admit to canning a bunch). That’s just over one percent of the workforce, probably a few weeks’ worth of resignations. Rumors put the real number much higher, and I believe them since I’m a conspiracy theorist when it comes to big corporations.

On the other hand, Cerner came clean by announcing it voluntarily. Antsy investors smelling “growth slowdown” leapt from their Google Alerts to their online brokerage accounts to dump the stock, sending share prices down eight percent. It wasn’t quite as bad as the aftermath of Neal Patterson’s infamous “tick, tock” e-mail of 2001, which dropped CERN nearly 25 percent, but was the opposite reaction than you might have expected given that shareholders usually love cost-cutting announcements.

Here are the gripes I’ve heard from current and former associates:

• Cerner marched the former employees out after giving them news. Of course they did, and rightly so. How many workplace killings involve separated employees who seemed normal until they cracked? There’s no way to forcefully end the employer-employee relationship that doesn’t involve loss of dignity. March them out while they’re still in the first stage (denial) before they hit the second (anger). It’s cold, but responsible.
• Cerner targeted management and older workers. Layoffs are about bang for the buck, which means going after expensive and often marginally value-adding middle management. Lots of those folks are mid- to late-career. Voluntary demotions take too much time and energy. It’s easier to cut the cord. Cerner is smart enough to have had HR test the list to make sure federal discrimination laws weren’t broken.
• The Chief People Officer betrayed employees. Only the hopelessly naïve would mistake an HR person to be an employee advocate. Cerner is guilty of using the trendy, stupid, and overly chummy Chief People Officer title that may have misled some slow learners, but make no mistake: the CPO is a top-ranking company executive, not a friend of the working man or woman. Workers, by definition, are oppressed to some degree.
• Management kept people who were well-connected, including obvious incompetents, while marching out good employees. Painting targets on backs is an inexact science. Managers are told how many casualties to create and then quickly make a list. Fairness isn’t guaranteed, even when it’s sought.
• The company was hiring at the same time it was marching people out. Companies want quick contributors, which means hiring for very specific experience (which is probably how most employees got their jobs in the first place). That’s sad, but reality. The door revolves.
• Unaffected employees should have a protest sickout to bring Cerner to its senses. That seems rather stupid given that the company just axed a bunch of people. Those paper tigers are just as terrified of losing their Cerner paychecks as those laid off were. An effective protest would be to leave Cerner and go to work for a competitor.
• Clueless VPs who are exactly like Dilbert’s point-haired boss are the problem. No news there.
• Customers will rise in protest at the cuts. That’s a comforting myth often expressed by those canned as they huddle in awkward and temporary support groups. It never happens, but the thought keeps people sane until they finally realize that they aren’t going to be returning to Cerner and should instead look for wonderful opportunities that will make them glad they got axed (which for some strange reason is often exactly what happens.)

Personally, I’m blaming Meditech. They’ve dominated the industry for 40 years by hiring cheap, obedient new grads and giving them skills with minimal market value elsewhere. More directly related to Cerner, Epic Systems does the same thing. Cerner is getting heavy competition from both, so that strategy appears to be working.

Perhaps Cerner is simply rebalancing its people portfolio to allow it to compete effectively, shooting for some predetermined kids-to-gray-hairs ratio that seems to work elsewhere. As a bourgeois capitalist pig, I don’t blame them, as painful as it unfortunately is to those affected.

News 11/2/12

Top News

AHA and four hospital systems file suit against HHS, claiming Medicare isn’t paying for reasonable and necessary care as required by the Medicare Act. The issue: Recovery Audit Contractors are second-guessing physicians long after an inpatient stay, claiming that patients should have been treated as outpatients and demanding that payment be returned. The RAC gets a nice bounty for denying the hospital’s payment, the hospital gets next to nothing.

Reader Comments

From Lee Shapiro’s Shoe Lifts: “Re: Allscripts General Counsel Jackie Studer. Has she left? Her pic and bio are gone.” She’s gone, sources tell me. Unrelated to her departure, the company announces results next week, and I have this feeling that they’re trying hard to get a PE deal ready to announce before then for reasons you might speculate.

From Michael: “Re: RazorInsights. Thanks for the mention. I wanted to confirm our customer attestation numbers – 83 percent have achieved Stage 1 Meaningful Use as of today and several outstanding filings are being finished up by clients.”

From Bucket Head: “Re: Sandy. We have about 50 clients in private practices on the East Coast without power and/or Internet. In our world, the big deal for them was finding a safe home for vaccines. If you have $50K (or more!) of stock in your fridge, it’s not like the milk. A couple of our customers will be without power for five to 10 days at least, so we’re expecting to turn on virtual servers in our offices for them to access. We have three or four customers on the Jersey shore from whom we’ve heard nothing and haven’t returned a call, text, or e-mail.”

From Evan Steele: “Re: Temporary command center, post-Sandy. We are settled into our ‘MCC’ (Marriott Control Center) and everyone not at the MCC is working virtually from home, a friend or relative’s house, or office with Internet access. We have 42 servers (physical and virtual) in a co-location facility, so everything is available and every SRS’er with an Internet connection has access. We are doing a great job keeping pace with support requests considering our less than ideal circumstances.” Evan, who is CEO of the Montvale, NJ-based SRS, reports that his company’s headquarters remains without power. Access to remote servers and a cloud-based phone system has enabled staff to continue working, either from a local Marriott hotel conference room or from home. Thumbs up to technology and adaptability.

From Millerbarber: “Re: Infinitt. The NJ-based PACS vendor has been down for two days.” Unverified.

From Lead Sinker: “Re: NYU. Servers are down, basically underwater. We have an enormous go-live scheduled for 12/2 – not sure how this will affect that date.”

From Capo Crusader: “Re: NYU Langone admitting that its generator was old and poorly located. I hope everyone is OK, but I smell lawsuits with this admission. With all that has been written about Katrina, how can a hospital this size not be better prepared?” The hospital says it spent millions of dollars after Hurricane Irene on backup power improvements that included a flood-resistant pump house, sealed fuel tanks, and rooftop generators, but they apparently overlooked the fact that the electronic system driving it is located in the basement that flooded. At least the staff behaved admirably: four NICU respirator babies were carried down a nine-flight stairwell in the dark while a nurse manually bagged them to keep them breathing as volunteers and medical students lit their way with flashlights.

From Ex-McK: “Re: McKesson. Moral compass broken at the top. We highlight to the company that employees are breaking the law to ensure that the bottom line is met, renting ambulances to ensure we can sneak our profits through.” A purported e-mail from McKesson Chairman and CEO John Hammergren lauds employees of one of the company’s distribution centers for renting ambulances to make deliveries to New York, which prohibited non-emergency vehicles from using bridges.

HIStalk Announcements and Requests

Wondering what you may have missed on HIStalk Practice over the last week? Highlights: an AHIMA-published article suggests that cloud-based computing and smart mobile platforms are making ambulatory EHRs more affordable and attractive to physicians. CMS names 24 qualified vendors for the 2013 PQRS program year. Digichart’s founder and CEO assumes title of chairman emeritus. An Impact Advisors consultant provides recommendations to measure EHR success. NYeC Executive Director David Whitlinger gives an overview of his organization, its goals, and current success. Dr. Gregg (and his dog) fantasize what the world would be like if HIT had started with a grand plan. All I have to say is that if you aren’t reading HIStalk Practice, your HIT news world is incomplete. Thanks for reading.

We have a new contributor on HIStalk Mobile who I’m calling Lt. Dan since he (like me) works full time in the industry and probably wouldn’t find his employer to be receptive to the idea of his writing potentially controversial material under his own name. Lt. Dan is and industry pro who will be posting several news items each day, adding to the excellent analysis and commentary from Dr. Travis. We’ll also be revamping the site’s design shortly with a more modern look, and most likely renaming it to indicate broader coverage than I originally anticipated (we’re now writing about telehealth, startups, consumer health, and social media). In addition to the expanded coverage, Travis will be on the ground at the mHealth Summit December 3-5 in the DC area, of which HIStalk Mobile is a media partner, so you can expect lots of information from there. How you can get involved with HIStalk Mobile: subscribe to the spam-free e-mail updates, follow our tweets, write a guest post, and tell us who we should interview. Most of all, read HIStalk Mobile and participate by sending us interesting news and rumors.

Speaking of HIStalk Mobile, thanks to new Founding Sponsor Imprivata, which offers Cortext, an easy-to-use mobile app that replaces outdated texting and paging with HIPAA-compliant messaging for smartphones (Android and iOS) and PCs. Imprivata now supports both HIStalk and HIStalk Mobile at the highest levels that I had available, which I appreciate.

On the Jobs Board: Senior Certified Epic Analyst, Healthcare Analyst – Security Tester, Community Health Center Sales Executive, System Software Engineer.

A lot of readers dropped by in October, in fact more than in any month in the almost 10 years HIStalk has been around, for reasons unknown: HIStalk had 130,254 visitors and 241,599 page views.

The weather’s cooling down, leading to the bane of the cubicle dweller: where are you supposed to hang your coat?

Acquisitions, Funding, Business, and Stock

Merge Healthcare announces Q2 results: revenue up five percent, EPS $0.01 vs. $0.06 a year ago, missing analyst estimates by $0.02.

Carestream Health acquires Genesis Digital Imaging, a developer of software for diagnostic imaging systems.

Meditech’s Q3 numbers: revenue up 7.8 percent, net income up 4.6 percent.

Greenway announces Q1 results: revenue up 28 percent, EPS $0.00.

Sales

Intermountain Healthcare (ID) selects SA Ignite’s MU Assistant for EP Meaningful Use automate attestation of EPs using Intermountain’s proprietary EHR.

Medical Mutual of Ohio chooses the mobile application development platform and Mobile Health Plan application from Kony Solutions to provide members with account management, access to physicians, electronic ID cards, and claims information.

Health Fidelity will use the terminology solution of Intelligent Medical Objects in its Reveal natural language processing service for extracting data from unstructured medical narrative information. IMO will use Reveal for its solutions.

Alameda County Medical Center (CA) engages MedAssets to oversee several cost reduction projects involving physician preference items, supply and services sourcing, and workforce management.

People

Cerner appoints Justin Whatling, MBBS (BT Health) senior director of strategic consulting for its European advisory practice.

The US Chamber of Commerce names Peter Tippett, MD, CMO of Verizon and VP of its incubator, as the recipient of its first Leadership in Health Care Award for his efforts to advance health HIT innovation.

As a reader leaked to us a couple weeks ago, Pulse Systems co-founders and brothers Basil and Alif Hourani resign their posts as CEO and CTO, respectively. CFO Jeff Burton takes over as president and CEO. The French technology company Cegedim purchased the company two years ago for $61 million.

PerfectServe names Cary Smith (Allscripts) as VP of sales for the western region.

Avalere Health names Protima Advani (The Advisory Board Company) as VP of its healthcare networks practice.

CHIME President and CEO Rich Correll will move to a COO role with the organization, saying CHIME’s board worked with him to develop an operational management role required by its growth. They’re seeking an experienced CIO to replace Correll as “ambassador to the industry.”

Announcements and Implementations

UPMC expands its telemedicine services to rural hospitals.

Sparrow Hospital (MI) rolls out Epic’s MyChart for patient use on mobile devices.

Wellcentive announces the release of Proactive Data Quality, which allows healthcare organizations using its population health management system to detect data delivery and mapping issues.

Siemens Healthcare expands its relationship with TIBCO Software, which provides the business process management technology used by Soarian. Siemens says it will use TIBCO’s next-generation technology to provide Soarian customers with on-the-fly analysis of current and historical data to allow them to become what TIBCO calls the Event-Enabled Enterprise.

Brown & Tolan Physicians (CA), a Medicare Pioneer ACO, goes live with Humedica’s MinedShare analytics platform.

UK sensor vendor Toumaz starts the first US pilot of its disposable, continuous wireless vital signs sensor at St. John’s Health Center (CA). Patients in any location can be monitored with the Sensium system, eliminating the need for them to be kept immobile in the ICU.

In Michigan, Beaumont Health System and Henry Ford Health System announced months ago that they expected to merge in some fashion. They’ve signed the papers to start discussions on the merger details, which would create an organization with $6.4 billion in annual revenue and 42,000 employees. Both use Epic.

MMRGlobal, which always puts out bizarre press releases that make it sound like a big company instead of a minimally known PHR vendor, decides that lawsuits pay better than trying to sell a personal health record. The company was awarded a vague patent for a method of giving patients access to their electronic medical records. That was on Wednesday. By Thursday, the company was sending threatening letters to hundreds of EHR vendors, demanding that they start paying licensing fees.

Innovation and Research

MIT researchers develop a system for disambiguating the senses of words used in physicians’ freeform notes in EHRs. The researchers say their method, which identifies relationships between words while also drawing correlations between words and syntax, is 75 percent accurate and thus markedly better than previous methods.

A study in Ireland finds that 40 percent of handwritten ICU orders contain an error, although “error” was loosely defined to include missing pager numbers and illegible signatures. Articles like this always alarm laypeople who can’t distinguish between “preventing an error” vs. “preventing patient harm.” It’s like saying that 99 percent of drivers make at least one error per day while intentionally not mentioning that most of those are of no consequence whatsoever and are thus not worth a prevention effort.

Technology

Researchers from the engineering and media arts schools of Drexel University design the Belly Band, which contains an antenna that allows remote monitoring of pregnant patients. The band, which does not require batteries or electricity, transmits radio signals to indicate changes in the shape of the uterus and can be picked up with an ultrasound. Maybe once they complete work on all the functional aspects Dr. Jayne and I can advise on the fashion design.

Other

The National Health Information Sharing and Analysis Center (NH-ISAC) activates a 24/7 emergency response system to support healthcare critical infrastructure protection, mitigation, response, and recovery. The response system is intended to address situational awareness, facilitate information system, and provide incident response support.

Lake Health (OH) performs a routine EMR audit and subsequently fires several employees for inappropriately accessing a patient’s health information.

Cleveland Clinic and GE Healthcare join 25 companies that have committed to lease space at Cleveland Medical Mart, raising the building’s committed tenancy to 50,000 of its 95,000 leasable square feet.

Exeter Hospital (NH) is denied a court order that would have prevented the state HHS from accessing the hospital’s electronic medical records as part of an investigation into a hepatitis C outbreak. The hospital argued that such access would violate state and federal laws, but the court said the state proved its need to review the records and has proven it will do so in a professional manner. The cause of the outbreak is suspected to be a contract radiology technician who is accused of stealing fentanyl syringes and replacing them with ones contaminated with his blood. After being fired from UPMC for exactly that offense, he went on to work in 10 hospitals, including Exeter, since UPMC didn’t report him for fear of not being able to prove he did it even though they had caught him red-handed.

Bellevue Hospital Center (NY) evacuated about 500 patients Wednesday after fuel pumps for its backup generators failed. Despite pumping out 17 million gallons of water, the basement remained covered in two and a half feet of water.

British Medical Journal institutes a new policy that require researchers and drug companies who submit drug clinical trials articles to make all patient-specific data used in the study available to individual researchers on request. Drug companies are notorious for shining the most favorable light possible on questionable data, so this change will allow independent researchers to double-check their conclusions. BMJ hopes other journals follow suit.

Weird News Andy captions this article as “Starving for Cash.” Two-thirds of NHS hospitals in the UK have earned bonuses for following the Liverpool Care Pathway, which can require them to stop providing food and water to terminally ill patients. The Department of Health says the protocol ensures that dying patients are treated with dignity, while opponents say the practice is “euthanasia by the back door” that is sometimes employed without involving the patient’s doctor or family.

Sponsor Updates

• Allscripts CMO Toby Samo, MD discusses improving public health with EHRs in a blog post.
• East Bay Eye Specialists (CA) will implement the SRS EHR.
• ICSA Labs seeks qualified candidates to help pilot test the test procedures and test tools for the 2014 Edition Certification.
• Greater Baltimore Medical Center (MD) creates a paperless admission and consent process using Access e-Signature and signature tablets.
• Huron Consulting Group releases a case study that highlights how it helped the University of Arizona Health Network improve its RCM operations.
• OTTR Chronic Care Solutions will participate in the National Marrow Donor Program Council Meeting next week in Minneapolis.
• The Nashville Technology Council recognizes Passport Health Communications as Technology Company of the Year for 2012.
• MedVentive hosts a November 15 Webinar on critical technology needed to support ACOs.
• Intelligent InSites will host the InSites Build 2012 conference on November 14-15 in Fargo, ND. Speakers include President and CEO Margaret Laub and AMIA President Kevin Fickenscher, MD,

EPtalk by Dr. Jayne

The HIMSS/AMDIS Physician Community issues a call for posters for the 3rd annual Physicians’ IT Symposium to be held Sunday, March 3, 2013 at HIMSS in New Orleans. The deadline is November 30. Selected presenters must also submit a 5-7 page technical paper after the conference.

CMS offers a second chance to physicians who missed the June 30 deadline to file for a Medicare ePrescribing hardship exemption to avoid the 2013 penalty. They will now have until January 31, 2013.

I’m always having issues with Medicare patients who don’t want their insurance information on lab requisitions and other key paperwork because CMS still uses the Social Security number as its patient identifier. CMS is seeking provider input on new Medicare ID cards that would remove the SSN to reduce the risk of identity theft. Its survey will be available until November 7.

Nashville-based Entrada raises $1M in new equity. Its products, which integrate with a variety of EHR platforms, allow dictation into the EHR through synchronization to the appointment list. I heard some buzz at MGMA that they also have a fax-related product, but I haven’t seen it yet (hint, hint).

Physician Edward Pullen MD shares his frustration with the Washington State Electronic Death Registry System.

Dr. Travis from HIStalk Mobile shared this story about Walmart boosting domestic medical tourism. As of the New Year, its employees will have access to heart and spine surgeries at health systems like Cleveland Clinic, Geisinger Medical Center, Mayo Clinic, and others. Additional companies that are negotiating bundled rates for employees include Boeing Co., PepsiCo, Lowe’s Companies, and HCR ManorCare. Personally I’d like my employer to negotiate a deal here.

Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg.

More news: HIStalk Practice, HIStalk Mobile.

News 10/31/12

Top News

From Velveteen Rabbit: “Re: NYU Langone and Sandy. My cousin is a neuro fellow at NYU Langone. Was in the middle of surgery when all power flickers and then goes out. Closed via flashlight and then patient was transferred to another hospital.” Sounds like an episode of MASH. A backup generator failed at the height of the hurricane, forcing NYU Langone Medical Center to evacuate at least 215 patients to other hospitals. Other facilities forced with forced evacuations include Coney Island Hospital (NY) and Palisades Medical Center (NJ). Numerous hospitals relied on backup generators and many facilities reverted to paper systems when EHR access was lost. Billionaire and Home Depot co-founder Kenneth Langone was an inpatient in the hospital bearing his name (courtesy of his $200 million gift) at the time and had to be evacuated with everybody else. A board member says the hospital knew its generators were old and poorly located; they’re planning to spend $3 billion to upgrade the facility.

Reader Comments

From Halsey A. Fredrick: “Re: Allscripts. The Mountain Lakes data center attempted and failed to move to generator power Monday evening. Approximately 50 Sunrise customers were down for at least seven hours, including those hosted at the company’s other data center in New Jersey. Some reportedly came back up overnight, some were still down as of Tuesday morning.” Unverified, but HAF forwarded a purported company e-mail update indicating that power was being restored. As any of us who have run IT during a weather disaster can vouch, backup generators work maybe 50 percent of the time, and that’s assuming you’ve been diligent to test the cutover regularly and have stockpiled an adequate supply of diesel fuel.

From Inspired but Concerned: “Re: Connected Health Symposium in Boston last week. I listened to great speakers and met people with truly great ideas, but few will address the elephants not in the room (i.e., Epic and Cerner). Conferences focusing on eHealth and connected health have a grassroots feel of empowering patients and consumers, but I rarely see big vendors participating unless it’s incognito to get new ideas. Providers are increasingly becoming part of IDNs and ACOs that use those large vendors and their non-open, non-easily integrated systems. Will consumer-based healthcare IT and their innovators suffer against these big vendors and providers?” My cynicism is predictable, but I’ve always said that these conferences and their self-selecting, charged-up evangelists are buying the illusion that patient empowerment is increasing when it’s really not. Few examples exist where customers have convinced big businesses to change their ways, especially when those changes threaten their profits, and I can’t think of even one where it happened when those customers had little buying power discretion and in fact aren’t even paying with their own money. It’s going to take a lot more than some feel-good conferences attended by the same familiar faces and featuring demos of the latest cool app to change healthcare, if in fact it can be changed at all. Healthcare reform may end up making it worse, as the massive consolidation it has triggered means a lot more physicians are now just another cog in a faceless corporate wheel whose bargaining power just went up several notches through market-dominating mergers (Partners Healthcare, which puts on the conference you attended, is a good example of using size and brand name to command high prices). In that regard, their choice of IT systems is way down on my list of concerns.

From BK: “Re: hospice-specific EMRs. What’s a good source of information? Most seem to be focused on the in-home aspect and we’re a 50-bed inpatient unit not affiliated with any major hospital or health system.” I know the names of a few companies that offer hospice EMRs but I’m not familiar with any of them, so I’ll ask readers to jump in.

Acquisitions, Funding, Business, and Stock

Online physician communication platform vendor QuantiaMD closes a $12 million expansion round.

Hospice and home health software provider Homecare Homebase lands a $75 million senior secured credit facility to refinance debt and fund a dividend payment to shareholders.

Deloitte Consulting acquires Recombinant Data Corp., a provider of data warehousing and clinical intelligence solutions.

CommVault Systems reports Q2 results: revenue up 21 percent, EPS $0.29 vs. $0.17.

McKesson announces Q2 numbers: revenue up

Relexion Health, developer of interactive software that uses Microsoft’s Kinect system to help physical therapy patients, raises $4.25 million in seed funding.

McKesson says in its earnings conference call that Technology Solutions had flat revenue in Q2, but performed a bit better than expected. The MedVentive acquisition provides a technology asset that will bring other McKesson products together to manage populations, the company says, while its MED3OOO acquisition will allow the company to add capabilities to its market-leading revenue cycle management business. CEO John Hammergren hinted that McKesson might work with athenahealth given that a third recent McKesson acquisition, PSS World Medical, sells athenahealth’s products and appears to still hold some portion of the $96 million worth of ATHN IPO shares (at today’s price) that it acquired in 2007 and partially sold in 2008-2009. Hammergren also said that McKesson has experienced some attrition of its Horizon customers who declined to migrate to Paragon because of functionality shortfalls, but the company is on track to deliver the ambulatory capabilities Paragon users need.

Sales

The American Association of Endocrine Surgeons selects ArborMetrix to provide clinical performance analytics for its national clinical outcomes registry.

The hospital board of governors for Fulton County Hospital (MO) approves a $1 million contract for Healthland’s EMR.

Eastern Connecticut Health Network signs a multi-year agreement with MedAssets for its RCM solutions and process improvement consulting services. Also contracting with MedAssets is Sharp HealthCare, which will implement its Spend and Clinical Resource Management solutions, including group purchasing services.

Mountain States Health Alliance (TN) selects Streamline Health Solutions and its OpportunityAnyWare solution for business analytics and automated workflow.

Resurgens Orthopaedics (GA) chooses Merge Honeycomb as its patient image archiving and long-term disaster recovery solution.

The Ohio State University Wexner Medical Center chooses lifeIMAGE for medical imaging sharing.

People

InTouch Health, an acute care telemedicine provider, elects Siemens Healthcare exec John Glaser to its board.

AirStrip Technologies adds Todd Cozzens (Sequoia Capital, Picis) and Keith Pitts (Vanguard Health Systems) to its board, with Cozzens named as chairman.

CommVault Systems promotes Brian Carolan to VP/CFO. He replaces Louis Meceli, who was named SVP of finance.

The Dallas Business Journal names T-System CFO Steven J. Armond as CFO of the Year in the technology segment.

SPi Healthcare appoints Brian Mitchell (GE Healthcare) as SVP of sales.

Announcements and Implementations

The Asian Centre for Liver Diseases & Transplantation announces an agreement with UPMC to develop a transplant center in Singapore. The facilities already share medical and technological expertise, including telemedicine and EMR.

Saint Agnes Medical Center (CA) goes live on Cerner.

Document Storage Systems and GetWellNetwork bring two VA hospitals live on GetWellNetwork’s interactive patient system integrated with the VA’s VistA.

IBM partners with the Cleveland Clinic (OH) to enhance the medical knowledge of its Watson supercomputer.

Government and Politics

The Indian Health Service is building a PHR populated with data from existing IHS clinical, administrative, and billing systems.

CMS publishes the final 2014 clinical quality measures for MU reporting.

AHRQ will conduct a 14-month, $800,000 observational study at six Vanderbilt University Medical Center clinics to look at how EHRs affect workflow at various phases of implementation. The work might have had more applicability had AHRQ chosen a more typical site than Vanderbilt, which developed its own ambulatory care model and EHR.

Wells Fargo Securities has updated its list of hospital EHR attestations by vendor. Small-hospital vendors CPSI and Healthland, along with Cerner, top the list of attestations as a percentage of customers. Trailing the pack are GE Healthcare, QuadraMed, NextGen, and McKesson (interestingly, three of those four are publicly traded companies, and QuadraMed was too until it was taken private in 2009). Also interesting: we’ve talked recently about upstart RazorInsights and I see they’re right in mid-pack with 30 percent.

Innovation and Research

A study finds that whole-genome sequencing will cost the US healthcare system $25 billion annually by 2021 even with steadily dropping prices, with the virtual certainty that the cost of those tests and the patient demand for treatment of conditions they suggest will dwarf the relatively small savings they create from earlier treatment of a few specific conditions.

Other

Dale Sanders (SVP of Healthcare Quality Catalyst and also holding senior roles with The Advisory Board Company and Cayman Islands National Health System) develops a HIMSS EMRAM-type model for measuring a hospital’s analytics capabilities. The Healthcare Analytic Adoption Model, he says, is the key to delivering value from the country’s big EMR investments.

Robert Schwab, MD, chief quality officer for two Texas Health Resources hospitals, adds a new Meaningful Use-related verse to his “Go-Live Ballad,” recorded live at the National CXO Summit last week in Dallas.

Cerner CEO Neal Patterson and his wife celebrate his company’s record quarter by buying the $100,000 grand champion market steer at the Junior Premium Livestock Auction in Kansas City.

A Colorado hospital’s lawsuit claims that it hired WebMD Health to evaluate its wellness programs, only to find that the company used its confidential information to launch a competing service.

A Texas woman is charged with aggravated assault with a deadly weapon after striking a man in the eye with her high-heeled shoe in a fight among 17 female employees of the Hot Body strip club. The man may lose his eye; the deadly weapon’s condition is unknown.

Sponsor Updates

• Steven Waldren, MD MS, director of the AAFP Center for Health, explores the HIT environment during Care360’s Nov. 14 webinar.
• Access releases case study videos featuring employees from Texas Regional Medical Center (TX) and Henry Mayo Newhall Hospital (CA).
• Billian’s HealthDATA introduces its healthcare sales and marketing portal, which includes over 3,900 data points on more than 40,000 US healthcare facilities.
• Emdeon launches its EDGE solution to detect inaccurate healthcare claims and prevent inaccurate payments.
• TELUS Health Solutions reviews the financial and strategic implications of attestation timing for Stage 2 MU in its fall newsletter.
• The Phoenix Business Journal profiles Desert Ridge Family Practice (AZ) and its effective use of NextGen’s EHR.
• InterSystems recognizes 3M Health Information Systems with its Breakthrough Applications award for the 3M 360 Encompass system.
• Kony Solutions announces that its KonyOne mobile application development platform now supports Microsoft’s Windows 8 operating system.
• CIC Advisory launches its new website.
• T-System CEO Sunny Sanyal discusses overcoding and upcoding in the ED in a guest article in a Dallas healthcare publication.

Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg.

More news: HIStalk Practice, HIStalk Mobile.

Readers Write 10/29/12

Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

Note: the views and opinions expressed are those of the authors personally and are not necessarily representative of their current or former employers.

It’s Only One Extra Click
By Jonathan A. Handler, MD

Clinicians swear an oath to put patients first, so why is it so difficult to get them to adopt new processes and technologies designed to improve care? Perhaps my experience during the SARS outbreak can provide some insights.

In the middle of the SARS outbreak, I was the director of emergency medicine informatics at a large hospital in the heart of a major city. A tourist with SARS would likely come to our ED. SARS disproportionately affects caregivers, and our ED nurses serve as our first line of defense when working in triage. Since I had written our ED’s tracking system, they begged me to add a SARS screening tool. I refused, saying it would add work and they wouldn’t use it.

Persistent, they mounted a campaign to convince me. The screening required only a few questions. Only the first question needed to be answered if the patient had no fever. I could build it right into their existing workflow. It might save patient and caregiver lives. A compelling argument.

So I did it. We added just a single click to the workflow in the vast majority of cases.

Of the thousands of patients triaged the next week, on what percentage did the nurses do the single click needed to answer that first question on fever? One percent. What was the click rate for patients with a chief complaint of fever? Zero.

In a world of increasing patient volumes and decreasing staffing, time spent on health information technology (HIT) is largely an “unfunded mandate.” Many caregivers are overwhelmed, with literally not a second left to spare. Each second spent on an additional click must be stolen from something else. Faced with the choice of clicking a button to note that the current patient does not have a rare disease versus triaging the next acutely ill patient, the extra click loses almost every time. And rightly so.

Early HIT efforts (e.g. digital labs and EKGs, PACS) dramatically improved care and saved time for caregivers. More recent HIT (e.g. electronic documentation) has largely stolen time from caregivers without improving outcomes. Our hubris has been our belief that all HIT offers enough value to justify encroaching on direct care activities such as talking to patients, administering medications, and performing life-saving procedures.

Despite clearly proven benefit, for 150 years we’ve been unable to get clinicians to consistently wash their hands. Now we take away fast and easy paper and dictation, replace them with electronic health records (EHRs) driven by slow and clunky keyboard and mouse, ask clinicians to document more than ever, and we expect rapid adoption?

Not going to happen. When asked, clinicians will agree to anything that might improve care. When time is short, they will prioritize tasks in order of perceived importance. Care will supersede documentation and quality initiatives that are not relevant to the immediate need.

One therapeutic prescription: things that save time for clinicians – such as badge and biometric login, single sign-on, context management, transcription services, speech recognition with natural language understanding, analytics, mobile access, and seamless integration with the local health information exchange – must be considered “mandatory pre-requisites.”

Right now, most consider these “nice to have some day.” The issue is much more than clinician resistance: patients are suffering from delays in care due to EHRs, and too often the promise of HIT is not being realized. When we recognize that one extra click is nearly always one too many, we (and our patients!) will have taken the first step on the road to recovery.

Jonathan Handler, MD is chief medical information officer at MModal.

Prepare Now for More Patient Requests for Medicare’s Annual Wellness Visit
By Averel B. Snyder, MD

Medicare records show that less than seven percent of people aged 65 and older have taken advantage of the Medicare Annual Wellness Visit (AWV). While it’s surprising that so few patients are receiving this important benefit, what’s even more alarming is that many seniors don’t know the AWV is even available. In fact, another study conducted by the John A. Hartford Foundation found only 32 percent of seniors are even aware of the benefit.

As more seniors become aware of the AWV and its benefits, these statistics will undoubtedly rise—and quickly. There’s no better time to prepare than now, as Medicare’s Open Enrollment period is now underway, and more than 49 million Medicare beneficiaries are being inundated with literature about all Medicare benefits, including the AWV. Physicians must be prepared not only to answer patient questions about the AWV, but also to provide the service efficiently and effectively.

The AWV includes specific components that address all aspects of a senior’s health status—physical and mental. A comprehensive AWV involves not only a review of a patient’s medical history and medications, but also a conversation about his or her functional ability and lifestyle issues that impact health. A list of risk factors, conditions, and treatment options must be established. Cognitive function must be assessed, and a 5-10 year preventive screening schedule created.

Until now, many physicians have been hesitant to offer the time-intensive AWV. That’s certainly understandable, given the challenge the hour-long visit poses to physicians who have limited time to visit with patients, especially when ongoing acute care visits are a priority. Fortunately, there are steps that can be taken now to get ready to accommodate a growing number of patient requests for this benefit.

• Step 1: Use a non-physician practitioner (NPP) to conduct the AWV. The Affordable Care Act allows NPPs to deliver the service—which in turn enables physicians to focus on problem-oriented visits.
• Step 2: Automate the process as much as possible with an electronic solution that identifies age- and gender-appropriate health screenings based on the patient’s health risk assessment (HRA). This solution can also dynamically generate a personalized prevention plan, order screenings or tests indicated during the AWV and make necessary referrals. If you have an electronic medical record (EHR) system, the solution should be integrated. This reduces documentation time, ensures an accurate patient health record, and prompts physicians to ask questions at follow-up visits based on the wellness visit recommendations.

Because a key component of the AWV is a personalized preventive health plan that’s updated each year, it’s also important to use a solution that provides recommendations for areas such as nutrition and exercise that are based on accepted guidelines and protocols. That way, you don’t have to have a number of staff members on hand who are trained to address those specialty areas.

Every year, the government spends $500 billion to treat Medicare patients impacted by chronic conditions. Many of the most costly chronic conditions — including heart failure, coronary heart disease, and diabetes — can be easily prevented with routine screening, which is what the AWV is designed to ensure. NPPs and technology can help physician practices offer this valuable benefit to patients in an efficient and cost-effective manner, and as a result, improve the quality of patient care and the level of patient satisfaction.

Averel B. Snyder, MD is co-founder and chief medical officer of Senior Wellness Solutions

Throw MU Out the Window!
By Darius LaGrippe

I don’t watch the presidential debates because they are irrelevant. I already know who I am voting for, and I’m certain the adorable concerns of swing voters are of no interest to me.

On the other hand, I sure do like to start a debate from time to time. Like right now.

It could be argued that the introduction of MU has destroyed more jobs than it has created. MU might be the cause of incredible amounts of lost patient information. MU might even be taking technology backwards.

Let’s face it. Smaller vendors with tighter budgets don’t have the free cash flow like that of larger corporations for development and marketing expenses, which denies startups and small vendors competitive resources for meeting the newest regulatory mandates, not to mention the Meaningless Use requirements that reimburse physicians for adopting electronic health records.

Unfortunately, those small, down-to-earth, client-focused private vendors ultimately dissolve or are absorbed. In my opinion, the products being acquired often are better than the larger companies’ product offerings, but when you answer to the stockholders, the
clients are there for your benefit. So who cares about the product?

Adopting electronic health records is very costly. Especially when the chief benefactors are ultimately the larger EHR vendors sucking up the stimulus milk shake through the government straw. With all these EHR products on the outs, who is responsible for maintaining that software and database you paid eleventy-thousand dollars for three years ago?

Not the vendor, because they are off the hook when your maintenance agreement expires, and they are not offering a renewal for your product. What kind of crappy loophole is this? During this realization, you might scream out loud like me, exclaiming, “This should be unlawful!”

The vendors are bound by the same HIPAA requirements as doctors and can be held accountable for HIPAA breaches. Last I knew, HIPAA had a six-year retention requirement, which follows federal statute for limitations for civil penalties(42 CFR Part 1003). If the physicians are required to maintain those records, shouldn’t the vendors be held to the same standard? Of course they should. Vendors should be required to either support and maintain those records for six years from when the product is shelved during “end of life cycle” or provide a comprehensive migration path for those clients at very little cost.

However, being a victim of an acquisition shouldn’t automatically force the physicians into a product they don’t want. The physicians shouldn’t be pigeonholed into a downgrade, upgrade, or migration. They should have the option to refuse the new product and seek a new one. Physicians should be able to demand their patients’ data from the vendor in a reasonable amount of time. Vendors should relinquish ownership of the patient data to the clients so they can at least explore their own migration path.

We’re talking about people’s health. Their lives. The records shouldn’t suffer the same attrition as the employees of the acquisitions, and the demise of the EHR shouldn’t be an albatross around physicians’ necks.

If the intentions of the HIT stimulus were to engage patients in their healthcare, provide physicians means to better electronic systems, and possibly even boost the economy, they are doing it wrong. That $19 billion should have been invested into the smaller companies to help produce better, cheaper technology at a faster pace and to keep the industry competitive. Instead we see attrition, poorly integrated products with no better standards than we had four years ago, and innumerable amounts of lost patient records.

Curbside Consult with Dr. Jayne 10/29/12

Trick or Treat.

I’m not sure if it’s a trick or a treat, but there’s no question that we’re seeing some interesting cooperative partnerships among hospitals and health systems. Last fall Sentara Healthcare, Novant Health, and MedStar Health united to form MNS Supply Chain Network, LLC. Although the groups are in reasonably close geographic proximity (Maryland, the Carolinas, Virginia) they’re not in significant competition in their respective markets.

The press release highlights the purchase of more than $3 billion in supplies and services across the new organization as motivation. Even the name indicates a focus on supply chain efficiency and volume-based contracting. On the face, this would seem to make sense in almost any industry, particularly one with decreasing margins and increasing regulation.

The announcement in June of a similar collaboration in Iowa had a slightly different tone – a healthcare alliance to advance care in addition to group purchasing power. The addition of buzzwords in the coverage such as “clinical integration” and “streamlined and coordinated care” put a different spin on things, although the groups were clear to state their plans to maintain their independence.

This makes a bit more sense since all the member organizations are located in a single state, particularly one that has a reputation for close-knit communities and a stable population. Over 70 percent of Iowa residents were born in Iowa. Anecdotally, my med school friends from Iowa assure me that there is some kind of force field that only allows them to leave for four years before they are pulled back to the heartland. Given the growth in Medicaid rolls across the country, this could be a very strategic move.

The Iowa plan specifically calls out plans to share “expertise and operational costs associated with development of ‘accountable care’ initiatives.” It also mentions “sharing the high costs of the information systems and experts needed to analyze clinical data and convert it into information that can be used by physicians and others to improve care and better manage populations of patients with chronic diseases.”

That surprised me a little, especially since at least one of the four organizations is part of a larger multi-state health system. Although a larger group would certainly be able to negotiate better deals on hardware, I’m not sure what the implications are for software.

Buying software isn’t like replacing a fleet of PCs or negotiating a better deal on linens. Especially when you’re dealing with health systems that are already the result of multiple mergers, there are tons of legacy systems to deal with. Looking at their histories and missions, these groups are not likely to be flush with cash or ready to rip and replace.

I hadn’t thought about these cooperatives much until this week when a colleague sent me notice of a deal in the Midwest that seems to be a hybrid of the previous two approaches. Four hospital systems in Missouri and Illinois have announced formation of The BJC Collaborative LLC. Participants include BJC HealthCare (St. Louis), St. Luke’s Health System (Kansas City), CoxHealth (Springfield, MO), and Memorial Health System (Springfield, IL). One system’s CEO explained the somewhat geographically disjointed arrangement: “It’s hard to do that with systems in your own community because they’re each working for their own advantages.”

There could be more to this partnership as well. St. Luke’s competitor Ascension Health is negotiating to sell two hospitals in Kansas City to HCA Midwest. BJC competitor Mercy is making some interesting moves in Missouri and Arkansas, one of which is to sell St. Joseph’s Mercy in Hot Springs to Capella Healthcare. Perhaps the collaboration is an attempt to shore up the walls against a for-profit incursion.

They’re clear to say it won’t impact how hospitals deal with insurance companies (no one likes to be accused of collusion or restraint of trade). Talking points again included supply chain, but information technology was also called out – there is a mix of Epic, Cerner, Allscripts, and McKesson in play among the participants.

One CEO stated that “backup servers, data warehousing, and disaster recovery systems” could potentially be shared. I’d love to see the architecture schematic of a backup data center for an organization like that, but I wouldn’t want to see the legal fees for the governance documentation it would take to make it a reality.

The increasing frequency and size of these arrangements certainly counts as a trend in my book. If you have information on who might be next, you know how much Mr. H, Inga, and I adore rumors and juicy tidbits. If you’re an insider at one of these collaboratives and want to share your thoughts, we’ll keep you anonymous. If you’re an outsider, what do you think? Are these arrangements good, bad, or indifferent? E-mail me.

E-mail Dr. Jayne.

Monday Morning Update 10/29/12

From The PACS Designer: “Re: iPod’s 11th anniversary on November 10. The four versions of iPod are Shuffle, Nano, Classic, and Touch. While primarily a storage device for music, they can be used as a storage device for other data elements. Can there be a use in healthcare for the iPod? Let’s have some discussion on the subject.” My Touch is like an iPhone without the calling capability provided you’re in WiFi range, so I would say yes. You would think that a hospital might look at the Touch as a pager replacement for nurses for in-hospital use – it’s cheap and portable, it doesn’t require a cell contract since it works on WiFi, it comes with a camera and Facetime, and it runs most iPhone apps.

From Fertile Imagination: “Re: clinical raffles. I’m speechless that providers would turn this into a contest.” A New York in vitro fertilization clinic runs a contest offering IVF free services to contestants who submit the winning emotional or entertaining essay or video explaining why they deserve the prize. One winner was notified on the day after Labor Day in a scene worthy of a Publisher’s Clearing House commercial: a doctor carrying balloons knocked on her door. Another winner earned her prize by running in a 5K race, where each registration came with one raffle entry. CDC says 1 percent of American-born babies are conceived by IVF. A Harvard Medical School ethics professor concludes, “I think it’s a good parody of the unfair system in which important medical services are only available to those who can afford them. Nevertheless, sometimes these raffles exploit the despair of couples or their misunderstanding of statistics to extract money from them.”

From HITEsq: “Re: Craneware. Being sued by the American Hospital Association for copyright infringement regarding its unlicensed use of the UB-04 codes. My personal take: none of these codes, as codes, should be the subject of copyright, especially when they are used only for functional purposes for which they were created which the AHA helpfully explains in paragraph 7. What’s more, they go on about all the work in maintaining them. Of course, in copyright law, ‘sweat of brow’ does not make something copyrightable.”

Listening: Real Estate, gentle and summery pop music featuring jangly, liquid guitars with a lot of nice vocals and instrumental work hiding behind the obvious hooks so that you can play it repeatedly without getting tired of it.

Only one survey respondent reported that his or her PCP uses Twitter for medical purposes. New poll to your right, for providers: which sources do you find valuable when evaluating vendors? Feel free to choose more than one or check “none” of you don’t find any of them useful. Your comments are welcome as well – after you vote, you’ll see a Comments link.

I’m healthy and fortunately get few chances to evaluate healthcare IT as a patient, but my annual physical last week provided an opportunity. Thinking about it afterward, I was surprised at how many positive technology elements have crept in. I had changed my appointment online a couple of times using the practice’s online portal instead of wasting time on the telephone. I pre-paid my co-pay online and printed a barcoded itinerary. I scanned that paper at the kiosk when I arrived and didn’t need to wait in line since that checked me in. My doc pulled up the EMR screen after the usual chit-chat (the practice just switched to Epic a few months ago) and noticed my weight was the lowest in the seven years I’ve been going to him, so the EMR information allowed him to reinforce that behavior effectively. He did medication reconciliation and reviewed my history over the past year while we looked at the EMR’s screen together. My one and only maintenance med (hydrochlorothiazide, since I used to have high blood pressure) went out to the pharmacy by e-prescribing. I received an e-mail this weekend saying my lab results were available on the practice’s portal, where I could review them in printable PDF format along with a reassuring note from my doc (“Wow, these all look great!”) Also on the portal was a printable visit summary for future reference. We IT types may argue incessantly about the clinical value value of technology in care delivery, but as a patient, I’m sold on the convenience factor. Not to mention that my doctor knows exactly how to use technology to support the way he practices medicine instead of allowing it to dominate either the encounter or our relationship.

I don’t know of many hospitals that developed their own clinical systems, and the cost and torrid development pace required to keep up with Meaningful Use and changing care models have led most of those to cry uncle and replace their old stuff with commercial products. Vanderbilt is apparently hanging in there according to an article in the VUMC newsletter that says they’ve made some nursing documentation enhancements to StarChart/StarPanel, VUMC’s clinical data repository that holds electronic and scanned paper patient documentation. Vandy offsets some of the expense by licensing its creations to vendors: McKesson bought WizOrders (relabeled as the marginally successful but dying Horizon Expert Orders) and Informatics Corporation of America commercialized StarChart/StarPanel.

I’ve read several articles lately about the rapidly increasing cost of the bipartisan-supported, pseudo-socialist American government in which fewer and fewer workers subsidize those who aren’t contributing (either because they can’t or because they choose not to). I don’t always agree with George Will, but his editorial on disability payments mirrors what I’ve read elsewhere. Disability payments are now going to 8.6 million people, more than half of them claiming unprovable mood disorders or back pain. The ratio of workers to those receiving government disability checks has gone from 134:1 in 1960 to 16:1 today even as the number of physically strenuous jobs dropped significantly. The healthcare connection, according to George: “The radiating corruption of this entitlement involves the collaboration of doctors and health care professionals who certify dubious disability claims. The judicial system, too, is compromised in the process of setting disability standards that enable all this.” I’ll take a broader societal view: there’s no longer any shame or embarrassment involved in cashing the many forms of automated government checks that career politicians and indifferent bureaucrats dole out like vote-seeking lollipops, so the only thing standing between unmotivated or unprepared Americans and the government food trough is ever-dwindling personal responsibility. Check the federal deficit and entitlement spending if you want to see how that’s working for us.

Cerner shares jumped 13 percent on Friday following a good earnings report. The company said in the earnings call that its clients acquired 75 hospitals in the past 18 months, potentially expanding Cerner’s customer base with minimal effort required. They also predict an “acceleration in the displacement market” (i.e. replacements of Epic) over 5-7 years as organizations look at “the horse they bet on and make a decision to go in a different direction.” Neal Patterson dropped by at the end to say that Cerner has “reinstated a boldness around here” and declared the company to be “the most significant innovator in healthcare.”

The Detroit business paper says that Henry Ford Health System may be acquiring Beaumont Health System.

Mark Clark (Poudre Valley Health Care) is named CIO of Great Plains Regional Medical Center (NE).

Quality Systems (NextGen) announces Q2 results: revenue up 8 percent, EPS $0.26 vs. $0.35, missing consensus estimates on both. Shares closed Friday at $17.19, down 3 percent and now 60 percent off from their price in April. System sales revenue was down by 15 percent, but was partially offset by implementation revenue (warning sign: reduced sales now means less implementation revenue down the road). The usual obvious reactionary steps were announced: restructure the sales organization and consolidate development efforts (always begging the equally obvious question: if it’s such a good idea, why wasn’t it done before?)  The hospital division sold to six new hospitals, but still lost money. The company will continue paying dividends to shareholders but won’t institute a share buy-back program, saying they would rather use the money to fund possible acquisitions of several companies they’re talking to (they hinted at revenue cycle, hospital products, and ACO-type service offerings). They also say that they expect many of the 462 Stage 1 EHR vendors to fail at achieving Stage 2, leading to a big replacement market. NextGen won’t issue guidance this fiscal year, citing rapidly changing market conditions and the proxy fight it recently endured.

Here’s the five-year Quality Systems share price vs. the Nasdaq in red. QSII was on a nice run, but all that’s been wiped out to the point that performance would have been just as good buying a Nasdaq index fund (“just as good” being relative – you would have done little better than break even either way).

CPSI’s Q3 numbers: revenue up 8 percent, EPS $0.63 vs. $0.54.

A Senate investigation finds that medical device manufacturer Medtronic paid millions to surgeons who put their name as authors on journal articles that were actually written by the company’s marketing team. Medtronic paid $210 million to doctors over 15 years related to its Infuse spine surgery product, including $34 million to University of Wisconsin orthopedic surgeon Thomas Zdeblick (who is himself the editor of a medical journal, Journal of Spinal Disorders & Techniques). Medtronic hired Yale University to review Infuse and his comments don’t sound nearly as pro-Medtronic as the allegedly shilled articles: “This sounds eerily familiar to many of the transgressions we’ve read about from the pharmaceutical industry. It paints a picture of a company very heavily involved in the science; marketing contaminating the science; and the medical profession and researchers being complicit. It’s no wonder the public has lost confidence in the drug and device industries.” My question, as always: Medtronic’s annual sales are $16 billion and its market cap is $42 billion, so how big of a fine would be needed to send a clear message if indeed they’re guilty? I’m thinking $5 billion and some jail time for the scumbag executives who were involved, but that’s just me. And for that matter, why not hit some of those greedy docs with some mega-fines and maybe suspend their medical licenses for producing phony medical research? This business of Uncle Sam settling out of court with mega-corporations for a financial slap on the wrist needs to stop. Medtronic paid a measly $24 million a few months ago to get DOJ off its back over paying kickbacks to doctors and $85 million to settle shareholder suits claiming it made misleading statements about Infuse.

Another argument that paying providers for quality doesn’t really work: the rate of catheter-related infections didn’t go down when Medicare stopped paying for them. That’s great news if you’re a fan of well-intentioned incompetence.

eClinicalWorks held its user group meeting this past weekend at the Gaylord National Hotel and Convention Center in the DC area, with 4,500 attendees and keynote speakers Surgeon General Regina Benjamin, MD and former eCW customer National Coordinator Farzad Mostashari, MD (who used eClinicalWorks, Epic, and NextGen when he worked for NYC’s Department of Health).

Weird News Andy must be brewing over missing this sad story, sent over by a worthy competitor. A new student nurse in Brazil accidentally kills an 80-year-old woman by somehow hooking up her IV to a cup of coffee. She explained on national TV: “As they were next to each other, anyone can get confused. I injected the coffee and I put it in the wrong place."

The Florida office of HHS’s Office of Inspector General says that thieves are stealing claims data from companies that administer Medicare claims. Scammers prefer Medicare records because CMS has balked at the effort required to change its identifier from Social Security number like everybody else has done, which allows the thieves to file fraudulent tax returns and collect refunds since IRS, like CMS, pays first and ask questions later (or never). In other words, one federal agency’s electronic data is used to create another agency’s electronic data for larcenous purposes, like interoperability for crooks. Did you ever get the feeling that government is the only organization where the more technology it uses, the more vulnerable it becomes to fraud because of poor oversight?

Athenahealth is negotiating with Harvard University for the purchase of Arsenal on the Charles, an 11-building office campus and former US Army arsenal in Watertown, MA that includes athena’s headquarters. The company seeks 1 million square feet, while the Arsenal property, estimated to cost about $200 million, has 765,000 square feet.

Vince checks in from Europe with good news about John Sacco (founder of JS Data) and sad news about Ed Meehan (Keane/NTT Data). As always, if you have memories, photos, or ephemera from healthcare IT companies of old (from before 1990 or so, let’s say) then Vince would enjoy hearing from you, especially if you have e-mail addresses or phone numbers for some of the long-lost folks who ran them.

Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg.

More news: HIStalk Practice, HIStalk Mobile.