News 1/25/13

Top News

Quality Systems (NextGen) reports Q3 results: revenue up two percent, EPS $0.26 vs. $0.36, missing analyst estimates on both. The company reported a 29 percent drop in system sales revenue as operating expenses rose six percent. The earnings call transcript is here. The results were announced before Thursday’s market open, with shares closing down only 0.16 percent by the market’s close.

Reader Comments

From Kojak: “Re: Intuit Health changes. Medfusion founder Steve Malik is retiring in June and Sanjiv Waghmare is taking over as Intuit Health’s new GM.” The e-mail announcement was attached. Malik (above) was named president of the Intuit Health Group when Intuit purchased Cary, NC-based portal vendor Medfusion for $91 million in 2010. Waghmare is a VP of product marketing.

From WHIMSSical: “Re: booth demo stations. PowerPoint or video? Should vendors use PPT since nobody can hear the video?” I say video and/or a live demo backed by a credible and engaging demonstrator, but perhaps also a fast-paced and highly graphical looping PowerPoint on a big projection screen as a billboard to grab attention as attendees streak by. Readers, what would get your attention?

From Doc Tari: “Re: Allina. Did know if you heard Allina having a bit of restructure. CMIO Shrift left to Cleveland and now CIO over all the IS areas.” 

From Carrie Prejean: “Re: HIStalkapalooza. What exactly does one wear to HIStalkapalooza this year? Bowling shoes? I want to come prepared because I am determined to win the ‘Inga Loves My Shoes’ contest!” When I first heard that this year’s bash was going to be in a (very cool) bowling alley, I was also perplexed on the proper attire. We are fine-tuning things, but suffice it to say that just about anything will go. We will once again have a red carpet, so arriving in stiletto heels and sequins will be totally acceptable. Alternatively, if you own a vintage bowling shirt, this could be the time to pull it out of the back of the closet. The shoe contest will include categories for those partial to high fashion as well as those who choose to adorn more functional bowling shoes. We will also be crowning a HIStalk King and Queen based on their total fashion package. Winners will be awarded amazing prizes, so don’t show up in your “straight off the exhibit floor” attire, especially if the look includes a company logo’d tee shirt.

From RFP: “Re: MD Anderson. Posts an EHR RFP.” The RFP strongly suggests that prospective bidders attend the pre-proposal conference on Wednesday, January 30 just in case you want to thrown your electronic hat into the ring.

From Slim: “Re: Optum. I read your update confirming that Humedica was bought by Optum. Wouldn’t it have to be announced since Optum is part of UnitedHealth Group, which is publicly traded?” I’m not an expert, but I believe SEC disclosure requirements cover only “material events,” meaning companies must file an 8-K form only if a merger, loss of a key customer, or policy change could reasonably be expected to impact share price in the company’s subjective judgment. UnitedHealth Group’s market cap of $58 billion and annual revenue of $111 billion would make all but a huge acquisition non-material.

From Bill O’Plenty: “Re: SB 1275. Crazy law introduced in Virginia.” Virginia State Senate Bill 1275, introduced January 14, would prohibit any organization that stores electronic medical information from (a) participating in the Nationwide Health Information Network; (b) performing analytics on multiple patient records for diagnosis, treatment, or population health management; and (c) processing medical data within Virginia if most of the patients represented live out of state. It also mandates that providers cannot be penalized for refusing to implement EHRs, that patient consent for electronically storing their information is valid only for healthcare coverage purposes, and that the state is prohibited from starting or operating an HIE. I e-mailed the office of the bill’s sponsor, Republican Senator Stephen H. Martin, to ask what he’s trying to accomplish with the bill, but I haven’t heard back. Senator Martin is running for lieutenant governor, which could ironically pit him against Democrat Aneesh Chopra, former White House CTO and advocate for all the items that the bill would prohibit, so perhaps he’s just trying to pick a fight.

From Wearing Dad’s Suit: “Re: Epic’s non-compete. Does it cover this?” Applicants for the head football coaching job posted on the University of Wisconsin’s HR website include a Walgreens pharmacist whose only relevant experience was as a season ticket holder, a Fedex driver who said he’d take $60K to lead the Badgers, and a financial analyst with Epic whose college athletics experience consists of having been a practice player for Tulane’s basketball team. I give our young Epic friend credit for trying even though he lost the $2 million job to a more experienced candidate who responded to the online posting, Utah State Coach Gary Andersen.

HIStalk Announcements and Requests

The latest highlights from HIStalk Practice include: Epocrates says its app has helped clinicians avoid more than 27 million adverse drug events. Farzad Mostashari, MD highlights some of the ONC’s 2012 achievements. Pharmaceutical companies and other businesses embrace advertising opportunities within cloud-based EMRs. E-visits may be as effective as in-person office visits for uncomplicated ailments. Dr. Gregg describes a day in the office in the Year 2063 (quite fun.) You know the drill: catch up on all the latest ambulatory HIT news, click on a few sponsor ads to find a goodie or two that might improve your life, and sign up for the e-mail updates. Thanks for reading.

On the Jobs Board: Cerner Experienced Providers, Product Marketing Manager, Healthcare Strategy Communications Specialist, Project Specialist.

Acquisitions, Funding, Business, and Stock

Healthcare social networking site iMedicor acquires iPenMD, which offers a digital pen solution to capture clinical data. iPenMD apparently bought the intellectual property of nextEMR this past July per a reader’s rumor report.

Merck Global Health provides $6 million in growth capital to eHealth Technologies, a provider of continuity of care solutions.

Praesidian Capital invests second lien debt capital in eTransmedia Technology to replace debt and fund growth.

Revenue cycle systems vendor Recondo Technology receives a $20 million growth investment from private equity firm Bregal Sagemount.

Healthcare Growth Partners releases its 2012 HIT Market and M&A review that summarizes capital markets, M&A, and capital raising activity for the healthcare IT and services sector.

Sales

Tampa General Hospital (FL) selects Merge’s CTMS for Investigators solution for enterprise management of clinical trials.

People

Huron Consulting Group adds Jim Agnew (Navigant Consulting) and Jeffrey McLaren (VHA, Inc.) as managing directors in its Huron Healthcare practice.

HIMSS promotes Thomas M. Leary to VP of government relations, taking the place of Dave Roberts, who was elected to the San Diego Board of Supervisors.

Iatric Systems promotes Frank Fortner from SVP of software solutions to  president.

The Northeast Business Group on Health honors Truven Health Analytics president and CEO Mike Boswood at its 18th Annual Tribute to Leadership.

Clinical data integration provider Apixio hires Jonathan Murray (Aetna) as chief business development officer.

Intellect Resources announces triple-digit growth in 2012 and announces several promotions and hires, including the promotion of Eileen Dick to VP of technology and Cindy Orr to VP of go-live services.

Robert Rowley, MD (Practice Fusion) is named medical advisor for personal health care vendor LifeNexus.

Announcements and Implementations

CareCloud and HealthTronics partner to combine CareCloud’s PM product with HealthTronics’ UroChart EHR and meridianEMR urology-specific EHR platforms.

Fletcher Allen and Dartmouth Hitchcock Medical Center (above) announce the creation of OneCareVermont, the nation’s first statewide ACO that includes 13 hospitals and hundreds of primary care physicians. We announced their plans in September.

Three Ontario hospitals go live on PatientKeeper Physician Portal, Mobile Clinical Results, and NoteWriter, including Alexandra Marine & General Hospital and two hospitals in the Huron Perth Alliance.

The RFID in Healthcare Consortium and Intelligent Hospital.org recognize six organizations for their advanced use of healthcare technology solutions.

GE Healthcare introduces Centricity Practice Solution 11.

Other

Winthrop Resources is conducting a survey on cloud solutions and bring-your-own-device practices. If you’d like to take about 10 minutes to help them out, the survey is here.

HIMSS finds yet another way to offer preferential treatment for its higher-ranking provider members whose purchasing influence makes its vendor members salivate. Healthcare Transformation Project offers “exclusive access” to services, meaning of course that someone has to be excluded (like the rest of us dues-paying members). For example, invitation-only HTPers get “up-front VIP seating at the HIMSS13 Keynote Address by President Bill Clinton” (I was going to insert a cigar joke, but decorum prevailed). The Transformers who are willing to spend $295 of their employer’s money to attend its annual forum at the HIMSS conference get to hear a bizarrely HIT-unrelated group of political speakers – former Florida Governor Jeb Bush, Democratic political strategist Donna Brazile, and former Nixon speechwriter Pat Buchanan. HIMSS says that “participants will make commitments that will translate goals into meaningful and measurable results in their own organization or community,” so we can all look forward to seeing how those work out for patients. Meanwhile, HIMSS offers vendors a bunch of expensive ways to get in or near those decision-making faces, with $50K buying you a podium speaking slot and free tickets for prospects who would be impressed by Pat Buchanan.

Cerner and Sporting KC take heat for failing to keep their promise to build a $35 million youth soccer complex in return for the $200 million in taxpayer-funded incentives they received to build their professional soccer stadium and Cerner office buildings. The youth fields were supposed to in use by now, but work hasn’t started.

Spain’s leading newspaper says it was duped when it ran a fake photo of Venezuelan President Hugo Chavez in his hospital bed, which the paper was told had been taken illicitly by a hospital nurse. The image, widely panned as unconvincing, turned out to be a screen shot of a YouTube surgery video from 2008 featuring an acromegaly patient being intubated.  

The local TV station covers the use by Georgetown University Hospital (DC) of the iPad-based patient data collection system from Tonic Health that replaces paper forms in the doctor’s office. The story says other Tonic users include Mayo, UCLA, the VA, and Kaiser. The company says the product integrates with EHRs via HL7 or can send a CCD record. It offers a free version with limited functionality. Founder and investment information is here.

As tweeted by @Cascadia: a Virginia medical practice charges patients for using its patient portal, billing $125 per year for Gold access to make appointments and refill requests, while the $250 per year Platinum plan adds three electronic visits. That’s the opposite of every other industry, where free online services encourage customers to do it themselves without tying up an expensive employee. This is like banks offering free teller service but charging for ATM access, or maybe McDonalds adding a drive-through surcharge.

A Texas judge orders the deposition of two partners of a CPA firm accused by a medical practice of failing to secure the accounting system it installed in the practice, which the practice says allowed an employee of the practice to embezzle $1 million over five years.

Weird News Andy says this man wears his nose on his sleeve, also wondering if he will pick his nose in public. British scientists are using a man’s own cells to grow a new nose to replace the one he lost to cancer. They have two noses underway (“just in case someone drops one,” the researcher said) and the patient will chose one of them to be implanted under the skin of his arm until it’s ready to transplant.

I had a feeling where WNA’s story was going when I saw his best-ever headline, “Nothing like having a cold one after work,” but I still nearly choked on my soda when I saw the story, in which a male hospital nurse is arrested on suspicion of having sex with the body of a deceased patient.

Sponsor Updates

• Nuesoft Technologies CEO Massoud Alibakhsh discusses data security and Nuesoft’s technology platform in the video above.
• Awarepoint celebrates its tenth anniversary and recaps key successes.
• GetWellNetwork Founder and CEO Michael O’Neil delivered Thursday’s keynote address on interactive patient care technologies at the IPC Symposium at Hasbro Children’s Hospital (RI).

EPtalk by Dr. Jayne

Your tax dollars at work. On Tuesday, the US Supreme Court rejected an attempt to reopen Medicare claims that are more than two decades old. The hospitals assert that CMS miscalculated payments between 1987 and 1994 that were intended to compensate their treating large numbers of low-income patients. Based on the fact that it took my local academic medical center over a year to settle the bill for a routine eye care visit, it doesn’t surprise me that it takes years for hospitals to figure out they’re missing money.

Attention vendors: Mayo Clinic releases a new list of the top reasons for visiting US health care providers. Maybe you should use this as a starting point for your primary care office visit templates rather than some of the bizarre things I sometimes see on your screens. Granted the data is from Olmsted County, MN, but it looks surprisingly similar to my clinic roster this week except for the absence of “flu” and “freaking out that spouse has the flu.”

I received my first HIMSS-related mailing today. It was so underwhelming I can’t even remember who it was from. When I went to dig it out of my recycling bin, I couldn’t find it – which means it was nondescript as well. Great job, marketing team!

A wise man once told me to always spend a small amount of time “looking for your next gig” because things are constantly shifting in the world of medicine. For those of you who think the same way, ONC is looking for a policy advisor “who knows meaningful use policy backwards and forwards.” I was curious, so I checked out the link and got the best laugh of the day. The low end of the salary range is $123,758. Leave it to the federal government to specify it down to a bizarre dollar amount.

I had lunch with four of the smartest women in the world today. Three have been my boss in the past while the fourth who taught me everything I know about billing. Here’s a shout out for leaders who not only know their fields but “get it” as far as motivating employees to excellence. Thanks for keeping me grounded and reminding me that although I currently work in chaos, I can always count on your listening ears. And your unbiased opinions when I text you pictures of shoes I’m thinking of buying. And your assistance with crafting the “Typhoon Jayne” cocktail for HIStalkapalooza. Salud!

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 1/24/13

All the Tools in the Toolbox: How ONC Delivered Value In 2012

Farzad Mostashari, MD responds to a Boston Globe article that characterizes the ONC as “an office whose primary role has been cheerleader” by publicly outlining how the ONC delivered value in 2012.

Prison Time for Health Data Theft

An emergency department registration clerk from a Florida hospital was sentenced to 12 months in federal prison for inappropriately accessing 760,000 electronic health records and then selling contact information of about 12,000 motor vehicle accident patients to a co-conspirator, who used the data to solicit legal and chiropractic business.

Medicare Program; Request for Information on Hospital and Vendor Readiness for Electronic Health Records Hospital Inpatient Quality Data Reporting; Extension of Comment Period

CMS has extended the deadline for public comments on EHR inpatient quality data reporting until February 1.

Association Between Quality Improvement for Care Transitions in Communities and Rehospitalizations Among Medicare Beneficiaries

A JAMA study quantifies the result of implementing evidence-based post-discharge interventions and concludes that while hospital readmissions dropped six percent, so did hospital admissions, resulting in an unchanged percentage of readmissions among overall admissions.

Readers Write: Dueling Myths: Interoperability and Bending the Cost Curve 1/23/13

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!

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

Dueling Myths: Interoperability and Bending the Cost Curve
By David Lareau

We’ve been hearing for so long about how interoperability is going to do wonderful things that we may have lost sight of the fact that it isn’t actually real yet.

Just look at the sharing of patient clinical information between systems. HHS has just come out with a press release in which they highlight that the penalty per incident for HIPAA violations can be as high as $1.5M. Healthcare executives are being told, “Make your system interoperable, but if you make a mistake, you’ll pay.” Is it any wonder vendors have put clinical data in silos with massive protections around it?

Maybe a bit of reality is getting through. At least they removed the requirement to process incoming clinical quality measure data from MU stage 2, although that seems like a moot point since no one is sending it out except to the government.

But even with these mixed messages in our industry, there is hope. Within the next year or so, new companies will enter the market with systems that are being designed from the ground up to share and distribute clinical information using some of the same methods as social networks. One of the key factors in getting to market quickly for these new entrants is that they don’t have to build upon 15 or more years of “already poured concrete.”

A front-page article in the Washington Post this week said that healthcare is driving job growth in the Washington, DC, area. Read a bit further and you get to these tidbits:

• “Northern Virginia’s Inova Health System added about 1,000 positions in 2012”
• “The growth at Inova last year was largely a result of a major initiative to overhaul its medical records program”

OK, I love it that people are gearing up to update their systems and that jobs are being created, but someone please tell me how that helps us bend the cost curve down? I’m not hearing much about clinician productivity increasing, and I seem to remember from Econ 101 that there is an inverse relationship between cost and productivity. Productivity goes down, cost goes up, and vice versa.

Meanwhile, we hear rumors about Meaningful Use Stage 4 when we’re trying to read the crystal ball about Stage 3 and gear up for ICD-10-CM. I must tell you, I don’t know about the cost curve bending down any time soon, but I sure can tell you that my anxiety curve is going up.

David Lareau is chief executive officer of Medicomp Systems of Chantilly, VA.

Readers Write: Mandating Physician Data Entry 1/23/13

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!

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

Mandating Physician Data Entry

We constantly hear about how EMRs slow physicians down in clinic. I’m on the IT side, and while I agree that every EMR needs to work on usability, it seems that part of the problem is physicians have to use the computer in cases when they would hardly touch paper.

Example: the physician used to just dictate his note and tell his nurses about any tests he was ordering. The note goes to a transcriptionist, and later comes back and is filed to the paper chart. The nurses grab whatever paper forms were needed for the tests, which the MD signs so it can be faxed over.

An analogous workflow in the EMR would be: physician dictates his note (not using Dragon, still using a transcriptionist) and the note is interfaced back into the EMR to be signed. The nurses queue up the orders and the MD signs them (or the nurse just places the order and they’re sent to the MD for signing later). This is all technically possible in Epic and I imagine in other EMRs too.

This workflow seems ideal and maintains the original division of labor. Or you could even hire a scribe to write the note and queue up the orders instead of relying on transcription interfaces and forcing nurses to deal with order entry. But it seems that hospital leadership has an assumption that physicians’ hands need to be on the computer constantly. Is there a reason for this, besides health systems not wanting to pay for the extra staff?

In an ideal world I can see mandating that physicians enter data to ensure accuracy, but maybe that’s a goal for later when EMR usability improves.

The author has chosen to remain anonymous.

Readers Write: Vendor Lessons Learned 1/23/13

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!

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

Vendor Lessons Learned

After 10+ years working for a few HIT vendors, here are a few lessons learned:

1. Stop trying to sell half-baked products: new products, upgrades, and old products remarketed. Litmus test: if you wouldn’t sell it to your mom or best friend, it ain’t ready. No amount of sales talent will overcome poor quality.
2. Hiring a strategy firm for a lengthy assignment is a red flag that shows a lack of confidence in the direction of the company. Litmus test: validating information or evaluating a new market is one thing, hiring someone to tell you how to run your business is another.
3. Buying a business at a premium and then inflating prices to customers and prospects to cover the cost of the acquisition is not wise. Litmus test: if your pricing strategy is based on creating value for you rather than your customer, you have it backwards.
4. The best sales talent in the world can’t fix bad products, bad service, and bad strategy. Those problems need to be first addressed at the top before anyone is going to sell anything of value over time. Litmus test: silver bullets don’t work despite the temptation to believe they do.
5. Stop establishing sales quotas that have no basis in reality. Spreadsheets don’t sell deals and prospects don’t care about your budgets, business plans, or quotas. Did you hear Nick Saban talk about winning? He doesn’t focus on results, he focuses on the keys that create the results. Litmus test: if you are not clear on exactly how you expect to generate the leads required to hit your sales targets and/or your plan is solely contingent upon your reps figuring this out you have a problem. Hope is not a strategy.
6. Companies that achieve consistent growth follow basic principles. At the core, they have passionate leaders who have a cause, are committed to being the best, and are dedicated to truly helping their customers (internal and external) win. This is much easier said than done. Litmus test: you know when you have something special. You cannot really explain it, but you have Mojo – Energy, Confidence, and Focus.

The author has chosen to remain anonymous.

CIO Unplugged 1/23/13

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

The Long View

I proposed to Julie on February 1, 1984. I was 19. I’m not sure I really knew what love meant, but I sure enjoyed being around her. I loved listening to her practice piano for recitals as I stole second glances.

Despite our young age, everyone was pretty stoked about our engagement except her parents. Looking back 27 years later, with my own daughter that age, I can’t really blame them.

Julie defined their marriage. She was the apple of their eyes. They wanted to delay giving her away for as long as they could. When they did, they hoped for a doctor or lawyer. At least those were the types they had over to dinner so Julie could meet them on weekends home from college.

I recall pulling into their driveway one Friday. My Chevy Vega with the duct-taped hood cowered next to their lacquered Mercedes. Wearing baggy sweats and tennis shoes with holes, I was the definition of poor. While I grunted away in the Army Reserve as a private, her dad stood tall as a retired WWII naval officer.

They were against the marriage from the get-go and withheld their support. Then came the final meeting, one last chance to talk us youngsters out of a commitment that had failed them both previously. They hired an investigator who reported everything about me from teenage indiscretions to bank withdrawals to employment history. There was nothing new to Julie. 

Out of exasperation came the final plea came. They offered me a handsome amount of money to walk away.

I had no hesitation. I’d already counted the cost. Despite the fast and easy reward, I took the long view. I’d never had that kind of cash, but I knew money wouldn’t make me happy. I immediately said no. They walked away.

We face many temptations in our careers. Most are not so stark, but others manifest themselves in many forms. We all know of colleagues who took bribes from vendors to influence purchasing decisions. Eventually they got caught and lost their careers and reputations. The short-term gain never pays long-term dividends.

Reviewing hundreds of resumes over the years taught me to spot trends where applicants constantly jumped from job to job, each time trying to bank a modest increase. Although a person might receive payola by making so many moves in a short period, they likely won’t land the big one. Who would hire someone whose trend suggests he or she might leave in a year? At some point, all the jumping catches up to you, especially at the highest levels. Think tortoise and the hare.

I do believe there are times you must go to grow. Other times you need to grind through challenges so your character can form and your leadership can blossom. I see too many people run at the first sight of trouble.

Boy, I’ve been tempted myself. I recall one year a while back showing up at a new employer where it was clear I was way in over my head. Way over. Everyone was nice and it was a stellar advancement opportunity, but my insecurities got the best of me. After a few months, I humbled myself and called my former employer, asking to return.

The COO, who had previously served as my mentor, said no. He explained that I needed to stick it out, learn, ask for help, adjust, and succeed. As much as he wanted me back, he knew if I went in reverse, I would never reach my ultimate goal of CIO. I followed his counsel, and today I am living my career dream. Had I taken the short view, I would likely still be working in the same position today.

My in-laws ultimately had a change of heart and helped us with the wedding expenses. I appreciated the fact they wanted to protect their daughter from making such a huge commitment at a young age, not yet even a junior in college. I would’ve handled it differently, but again, I understood the motivation.

We got married and worked our butts off to get through school and start our family. Today we are richly blessed, having taken the long view.

Whenever challenges hits me, I’m tempted by the short view. But one look at my family and my career reinforces the lesson. The long view pays off.

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

Morning Headlines 1/23/13

Missouri, Kansas and Nebraska Connect via Direct Secured Messaging

The Nebraska Health Information Initiative, Kansas Health Information Network, and Missouri Health Connection announce that they are now connected and able to exchange Direct secure messages across state lines.

Naperville’s Edward Hospital to merge with Elmhurst Memorial

Edward Hospital & Health Services of Naperville, IL and Elmhurst Memorial Healthcare announce plans to merge, forming a three-hospital health system with revenues of more than $1 billion.

Providers Get Help From Clinical Decision Support Evidence Vendors but Still Face Obstacles

KLAS evaluates clinical decision support strategies and roadblocks for providers and concludes that third-party order sets, care plans, and drug dictionaries lead the pack in CDS plans but notes that a lack of integration with EHRs is hindering the utilization of these tools.

King Saud University Signs a Strategic Agreement With Cerner for Two Major Hospitals in Saudi Arabia

King Saud University signs with Cerner to implement EHRs for two academic facilities in Saudi Arabia.

News 1/23/13

Top News

The Nebraska Health Information Initiative, Kansas HIN, and Missouri Health Connection connect their exchanges to share Direct secure messages across state lines.

Reader Comments

From Embers: “Re: Humedica. Being bought by Optum, I’ve heard. I wonder what will become of the Allscripts deal that frankly brought Humedica some business, but also had them running in circles (true for anyone dealing with Allscripts in the past few years)? Also, the new Optum research center in Cambridge is gathering steam and they are putting together a nice team to be a healthcare think tank. Hope you had a nice few days off – my imagination puts you on the podium with Obama and not sipping drinks by the pool.” A couple of readers told me they’ve heard that clinical data vendor Humedica has been acquired, one of them specifically saying it happened last week with no public announcement planned. Wednesday morning update: I’ve confirmed via a reader that the company has been sold to Optum. I’m happy to say that my mini-vacation consisted of the latter and not the former, as I took Mrs. HIStalk out of the country for some magnificent and rare downtime sprawling under 80-degree blue skies, swaying palms, and very small paper umbrellas that didn’t protect our white-to-red skin but did make our tropical drinks look even more fetching. I’m paying for the break today after getting home in the early morning, heading off to work just five hours later, and now sitting here with no break or bedtime in sight after 17 hours of non-stop catching up.

From EHR Watchdog: “Re: MedLink. See attached. Unfortunately customers can’t reach the company as its top two executives are being investigated by the SEC. The company’s EHR is certified and customers are no doubt trying to figure out what to do. One physician has a contractual requirement that records for his 6,000 patients will be available digitally, but he’s having to go through them one by one to either print or save to an external device as he shops for another EHR after spending thousands of dollars on MedLink.” The reader attached the SEC’s October 2012 complaint against Medlink and its two executives, Ray Vuono and Jameson Rose. It claims the company filed a Form 10-K audit report bearing the name of an auditing firm that had in fact not audited the company’s books, with that same SEC form bearing the electronic signature of one of the company’s directors who had not reviewed the form or authorized that his signature be attached. Lastly, the SEC claims an investor asked to have his check returned, but the company deposited it instead. In the SEC’s words, MedLink “purports to be a healthcare information technology company” and Vuono is “a recidivist securities law violator.” I know what that word means because Raising Arizona is one of my all-time favorite movies.

From Iconic Reader: “Re: Allscripts. The smoking doc, at least the reflector part of his attire, is apparently the model for the isolation icon in an Allscripts product!” I give them the nod for going old school, with a doc sporting a reflector thingy and a nurse wearing a starched white cap with a red cross on it.

From Pinky Toe: “Re: vendor shakeup. The vendor is Allscripts. Major reorg in the development group, which includes product management and testing, in which 200+ remote employees are being required to move to Raleigh, Chicago, or Burlington VT or face termination. This move not initiated by Paul Black, but he has sanctioned. This is a RIF, but instead of calling it a RIF, management is calling it a consolidation of resources to ‘centers of excellence.’” More convincing (but also unverified) were reader declarations that the vendor referenced in a reader’s earlier comment about employee layoffs is in fact NextGen, but I don’t have confirmation on anything since companies rarely announce or confirm personnel actions.

From Ben Dover: “Re: NextGen. Cutting personal days for employees, sent out the week of January 16 but backdated to January 1, which means employees who took personal days for the holiday will be back-charged for vacation.” Unverified, but the source is non-anonymous and has a copy of the internal communication. The backdating, which adds a bit of sting to the slap in the collective employee face, seems indicative of either an impulsive management decision or inability to get the corporate act together.

From THB: “Re: Edward Hospital & Health Services. Merging with Elmhurst Memorial Healthcare to create a $1 billion system that would be among the largest in the Chicago area. Edward is going through an Epic implementation.” Verified in a Tuesday announcement. I interviewed Edward VP/CIO Bobbie Byrne a year ago. Edward seems to be the dominant would-be partner, so I expect the Epic implementation will continue and Elmhurst will drop Meditech.  

From Idol Observer: “Re: Greenway’s announcement of meeting ONC 2014 criteria as an EHR Module. According to the announcement, they only met two criteria, a safety-enhanced system and a quality management system. The first requires the vendor to simply name their testing methodology for the features already required by the 2011 feature – no programming is required. The second is to just identify the quality management system being used, with no programming required there either. In other words, it’s just meaningless PR that will get physicians even more confused.” I get lost in all the certification minutiae, so I’ll defer to Frank Poggio.

From Rand Reader: “Re: the recent Rand report. It said EMRs remain costly without good outcomes because doctors haven’t re-engineered their workflows to accommodate electronic systems. Why would they want to do that when the change could be averse to safe care? Just an idea for your next poll.” My opinion is that many doctors will never accept EMRs because to do so would implicitly accept the idea of process standardization and repeatable processes everywhere, and doctors are trained to be confident in their individual abilities and wary of any process that doesn’t involve their own brains and hands. Patients are usually on the side of doctors since everybody likes to think they’re getting extra-special treatment and not being managed by a corporate algorithm. I don’t know that either side has proved its point convincingly.

From Just Wonderin: “Re: ONC’s HIT Safety and Surveillance Plan of December 21. The ‘public comments’ solicited by HHS are not so public after all since they are not being presented for the public to see. Is it because HHS and ONC don’t want the public to see the comments offered by the Cerner and Epic ilk?” It appears that comments can be submitted only via e-mail.

HIStalkapalooza 2013, Sponsored by Medicomp

HIStalkpalooza will be Monday, March 4, 2013 at Rock ‘n’ Bowl, New Orleans, LA. Medicomp CEO Dave Lareau, one of the coolest guys I know, wanted to bring you some real New Orleans flavor for Medicomp’s return as HIStalkapalooza sponsor. He’s ably assisted by the ultra-professional crew who engineered the 2011 event: Patrice at bzzz productions, Shannon and Cindy from Thomas Wright Partners, Anthony from Istrico Productions, and of course the Medicomp stars like Roy and James that you saw on the stage and at the Quipstar event on the HIMSS show floor.

Medicomp sponsored the 2011 event at BB King’s in Orlando (video is here, although I doubt anyone has forgotten that bash). They said then they wanted to return this year, so naturally I’m super happy to have them back and expecting them to rise to the challenge of a superb 2012 HIStalkapalooza in Las Vegas courtesy of ESD (I still play their video every now and then because it’s so cool).

Rock ‘n Bowl is equal parts bowling alley, dance hall, live music venue, and old-school Cajun-Zydeco shrine, which sounds kind of low-brow until you notice that it has earned a 4.5 average review on both Yelp and Tripadvisor. Beats the heck out of a cookie cutter hotel ballroom or a Disney-like fake Cajun place. It’s a big place even though the layout makes it hard to tell in pictures. Some details:

• Buses will take HIStalkapaloozans from the convention center to Rock ‘n’ Bowl and back to the key hotels.
• You’ll be offered the chance to once again execute your perfect red-carpet strut while having an Ingatini thrust into your parched palm and being surrounded by industry glitterati.
• You will have the option to sip (or guzzle) the aforementioned Ingatinis and Typhoon Janes, not to mention just a lot of drinks in general. The ladies are providing guidance on how they want their namesake potions prepared (I’ll bet there’s a lot of alcohol involved), so details on those will come later.
• You’ll be entertained by Brian Jack and the Zydeco Gamblers, with instructors leading you in Zydeco dance lessons if you so choose.
• You’ll be fed you authentically and well with red beans and rice, jambalaya, crawfish etouffee, and retro bowling alley food like pizza, wings, and fried seafood. No tray-passed mini-quiches or two-per-person drink tickets here, folks.
• Inga will be overseeing our usual shoe and attire contests, best bowling shirt judging, and some other categories I’m not privy to but that I expect will result me spending excessive money on beauty queen sashes and prizes. She can chime in later on the particulars.
• The inestimable Jonathan Bush will once again preside over the not-to-be-missed HISsies awards at 7:30, the role he created at the first HIStalkapalooza in 2008 and has held since. I have it on good authority that the people you chose for all of the important and serious awards (Industry Figure of the Year, Lifetime Achievement Award, etc.) will be there, which would be quite an assemblage of industry talent.
• There will be a fun bowling tournament, but since I haven’t bowled since college (translation: I’ve never bowled sober nor seen any reason to) I’ll let Medicomp explain how that will work later. I know some of Medicomp’s partner companies will be hosting individual lanes, so I’m sure we’ll have some fun folks there.
• You will have networking opportunities like crazy given the remarkable number of CEOs, VPs, investment bankers, press, and lower-ranking but generally amiable grunts like me who’ll be hanging around and lowering their guard to conduct frank and possibly slightly slurred conversations. Deals will be made, jobs will be offered, and a variety of propositions will be extended and considered. A good time will be had by all.

The registration page is now open. Since demand always exceeds supply, registration puts your name on the “I want to come” list. If we have enough capacity, everybody on the list will get an invitation in mid-February. If not, then I’ll have to channel my velvet rope bouncer technique in choosing who gets an invitation (providers and long-time HIStalk supporters get picked first, then I just try to make it interesting by employer and role). Every HIStalk reader is important to me, so I sure hope we can squeeze everybody in since it’s your night.

Acquisitions, Funding, Business, and Stock

Kareo raises $20.5 million in series F funding led by Stripes Group.

Shares in Scotland-based revenue software vendor Craneware jump after the company said it expects half-year revenue to increase by seven percent.

Compuware reports Q3 results: revenue up two percent, EPS $0.12 vs. $0.10. The company says its Covisint HIE business grew 30 percent. The board says it will make a decision shortly about an unsolicited takeover offer of $11 per share, equal to the current share price.

Sales

King Saud University in Saudi Arabia contracts with Cerner to provide Millennium to two of its hospitals.

Lowell General Physician Hospital Organization (MA) selects HDS, athenahealth’s healthcare data management service for population-based cost and quality data analysis and reporting.

The New Mexico Health Information Collaborative will implement Orion Health’s HIE platform for its statewide exchange.

Henry Mayo Newhall Memorial Hospital (CA) selects Accent on Integration’s Accelero Connect platform to integrate its Philips IntelliVue patient monitors with its Meditech HIS and EDM solution.

Hong Kong and Tsuen Wan Adventist Hospitals select First Databank’s International Drug Knowledge.

El Camino Hospital (CA) chooses data warehouse and analytics solutions from Health Care DataWorks.

People

Mobile health provider Glooko hires Rick Altinger (Intuit Health) as CEO and Dean Lucas (Epocrates) as VP of product development. Glooko, which Dr. Travis included in a recent review of tools for diabetics, just received FDA 510(k) clearance for its mobile logbook device.

Amplion Clinical Communications names Tom Stephenson (Health Management Systems) president and COO.

Wendy Penfield (RealMed) joins Intellect Resources as VP of consulting services.

The Carroll County Chamber of Commerce (GA) names Greenway Medical founder W. Thomas Green as its 2012 Entrepreneur of the Year.

Rich Boehler, MD (MedeAnalytics) is named president and CEO of St. Joseph Healthcare (NH).

Announcements and Implementations

HIMSS awards 10 scholarships to students enrolled in HIT and management system degree programs.

Kansas City area hospitals form the Cerner-hosted Lewis and Clark Information Exchange (LACIE), originally created by Heartland Health.

Wheeling Hospital (WV) deploys PeriGen’s PeriCALM Plus in its obstetrical department.

UNC Health Care’s Rex Hospital (NC) implements Merge Hemo to automate cath lab processes into its EHR.

UPMC Beacon Hospital (Ireland) implements BridgeHead Software’s integrated backup solution for Meditech.

Neighborhood Health Plan and Partners HealthCare (MA) will provide $4.25 million in grants to 49 community health centers to expand HIT systems, train on Meaningful Use and medical coding, and train and build capacity for performance improvement.

HealthSparq launches its consumer health shopping platform (patient reviews, cost estimator, provider search, and social media forum) to health insurers.

The Government of Cantabria, Spain will deploy the initial phase of a European-wide e-health service from Texas-based Prodea Systems.

Other

Brian Ahier and a couple of privacy experts will discuss the new HIPAA rules in a Google Hangout streaming video session on Wedneday, January 23 (which is “today” for most readers) at 2:00 p.m. Eastern.

KLAS looks at clinical decision support tools and finds that more providers are turning to third-party order set and care plan vendors. Key findings:

• Almost half of providers using third-party products previously tried to build a solution from scratch.
• Among providers using third-party order sets, half use for reference content only because of an inability to move built pieces into the EMR.
• Most providers would like more ability to customize medication alerts.

Sponsor Updates

• SRS reports a 94 percent increase in revenues from 2011 to 2012 and the addition of 56 new employees.  
• AT&T Healthcare’s Christine Furjanic will speak at the Western Physicians’ Alliance (NV) January 29 seminar on accountable care.
• Orchestrate Healthcare expands and relocates its corporate headquarters to Carbondale, CO.
• Greenway Medical Technologies, Inc., announces that Greenway PrimeSUITE 2014 (17.0) is compliant with the ONC 2014 Edition criteria and has earned certification as an EHR Module.
• Shareable Ink reports 300 percent year-over-year growth and a twofold increase in employees since January 2012.
• PatientPay CEO Thomas Furr offers advice on managing practice A/Rs and cash flow in a guest articl.
• API Healthcare announces a 60 percent increase in year-over-year sales bookings and record bookings in the fourth quarter of 2012.
• T-System will offer the PayRight Health Solutions patient collection system with its RevCycle+ solution.
• CynergisTek and managed security service provider Solutionary partner to offer outsourced security monitoring.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Curbside Consult with Dr. Jayne 1/21/13

I often make fun of the American Medical Association and some of its initiatives. Despite being a life member (with a lovely crystal paperweight to prove it), I find some of their initiatives extremely whiny and self-serving.

Last week Mr. H mentioned their recent letter to ONC urging review of Meaningful Use Stage 1 and Stage 2 prior to committing to Stage 3. Given some of the murmuring about a potential Stage 4, I’m supportive of this request. The AMA shares key concerns and recommendations from physicians.

First, the requirement for achieving 100 percent on all measures is problematic. Failure to meet one measure by one percent invalidates the physician’s entire effort and opens the door to penalties. I agree, and if Eligible Providers are going to be held to this type of standard, I’d like it to also be applied to federal disability processors, Medicare claims reps, and the people at the Department of Motor Vehicles. I’d also like it applied to my personal insurance carrier. For the four medical claims I had last year, three had processing errors leading to demands that I pay amounts I didn’t actually owe.

In addition to trying to achieve MU perfection, providers are trying to gain Patient-Centered Medical Home recognition, become part of Accountable Care Organizations, submit data for PQRS, and maintain board certification. There are also payer-centric and employer-centric quality initiatives. They all have different rules. I can barely keep up with the CMS FAQs let alone all the other information out there and I have a team to assist. I can’t fathom what it’s like to be a solo physician on this hamster wheel.

Second, one size doesn’t fit all. All specialties are required to meet the same core measures with few exceptions. The document goes on to state that the program is too primary-care focused and asks that specialists be allowed to opt out of any measure that has “little relevance to the physician’s routine scope of practice.” Knowing that my group’s orthopedic surgeons tried to opt out of vital signs (stating that blood pressure wasn’t relevant to their scope of practice), I urge caution here. Personally I think anyone who prescribes medications should be concerned about blood pressures, but quite a few of my colleagues disagree.

Third, the program needs independent evaluation to allow improvement. I agree here as well. Often MU seems like one giant experiment without an Institutional Review Board looking out for the safety of the participants. We’re being used as guinea pigs and the potential outcomes could be disastrous. I’m watching colleagues become increasingly burned out and motivated to leave the profession, which is completely counterproductive.

The AMA asks for an evaluation between each stage prior to finalizing the requirements for the next stages. I completely agree here. The timeline is too tight and is forcing vendors to abandon true usability enhancements and code changes that support clinical care. Development time and effort is instead focused on making sure their system meets the certification requirements regardless of whether those requirements improve patient care or the user experience. In many ways, it feels like Meaningful Use is stifling innovation.

Fourth, usability needs to be addressed and made part of the certification process. I hope that important issues such as alert fatigue receive attention to better support patient safety and clinical quality. Further down in the usability section, the AMA buries a request that ONC should consider requiring vendors of certified EHRs to commit to supporting subsequent MU stages. They also request protection from “excessive vendor charges” for physicians who switch systems. I’ve never seen a conversion project that didn’t generate excessive charges, so this is a great discussion point.

Fifth, IT infrastructure barriers should be resolved to allow improved data sharing. Working in a major metropolitan market, I experience this every day. The patient who showed up in my emergency department in labor had records at another health system that doesn’t communicate with ours. The suspected drug-seeker next to her admits to filling prescriptions at seven different pharmacies, which means she probably uses far more than that. There was no way to see what she was actually on to determine whether she’d have a risk of drug interaction with my proposed treatment.

The document is 20 pages long and you’ll have to jump to Page 10 to see the additional recommendations, which include streamlining regulatory requirements, aligning MU with other regulatory programs, and allowing three years between states to allow adequate time for rulemaking, product development, and implementation.

Considering the amount of change management that needs to go into any successful workflow redesign project, this may be one of the most important suggestions. Practices are not just coping with technology change but a complete overhaul of how they care for patients. Providers need to learn how to be more transparent with patients and how to better coach patients into a true partnership with their care teams. They need to train staff to operate in a new paradigm. They need to figure out how to juggle the constant demands that having electronic records place on them. They need to combat the burnout that comes with those demands and learn how to regain some kind of work-life balance. And if they fail at an initial stage, providers need time to figure out what went wrong and put measures in place to be successful at their next attempts.

I sincerely hope that ONC is receptive and that Meaningful Use doesn’t continue like the runaway train it seems to be. Have you read the AMA letter, and if so, what do you think? E-mail me.

E-mail Dr. Jayne.

Morning Headlines 1/22/13

Rex Hospital Selects Merge Hemo to Image-Enable Enterprise EHR

Rex Hospital, a member of UNC Health Care, has implemented Best in KLAS cardiology solution Merge Hemo to automate their cath lab and integrate data with their Epic EHR.

Physician EHRs emerge as hot advertising venue for drugs

Cloud-based EHRs are increasingly working with drug manufacturers to deliver point-of-care advertisements embedded within the EHR.

49 community health centers win grants to boost HIT infrastructure

Neighborhood Health Plan and Partners HealthCare award $4.25 million in grants divided among the 49 members of the Massachusetts League of Community Health Centers. The grants will help fund the implementation of practice management systems and provide meaningful use training.

Shareable Ink Achieves Substantial Growth and Expands Team

Shareable Ink, a cloud-based clinical documentation vendor, announces that during 2012 it grew 300 percent and doubled its workforce.

Morning Headlines 1/21/13

athenahealth and MedOasis to Provide Comprehensive, High-Value Anesthesia Billing Solution for Hospital Departments and Independent Practices

athenahealth and MedOasis will partner to provide an anesthesia-specific billing solution that combines athenahealth’s claims processing solution with MedOasis’ anesthesia coding, charge-entry, contract management, and compliance capabilities.

UCSF Medical Center throws a great outside curve ball, keeps EMR rollout under wraps

The local paper profiles University of California San Francisco’s $160 million Epic implementation, which quietly reached its completion one year overdue and $100 million over budget. In May of 2011, then CIO Larry Lotenero was shown the door after implementation costs ballooned to three times expectations.

Identifying Personal Genomes by Surname Inference

A group of fifty men who anonymously donated DNA to genome research have been positively identified by scientists who were able to identify the patient, their address, and their relatives by taking the little demographic information maintained on the donors, and supplementing that with the wealth of information extracted from the donors genome.

Allscripts to Announce Fourth Quarter and Full Year 2012 Financial Results on February 19

Allscripts announces that it will report year-end financials during a February 19 investor call.

Monday Morning Update 1/21/13

From Jean Valjean “Re: Vendor shake-up. A major EHR vendor plans to dismiss between 10 and 20 percent of its workforce aimed at development, product management, marketing, and testing groupings. Employees also say the organization is taking initial measures to remove all personal days and compelling employees to use vacation time. Morale is very low and several key employees are leaving on their own. Issues stem from the recent appointment of a key executive whose management style is unknown.” This email contained just enough details (which I removed) to identify the company. However, the accusations are incredibly vague, though if any of it is true, employees may recognize their employer. If you can identify the company and want to share some verifiable details, drop me a note.

A dozen health systems earn a spot on Fortune’s 100 Best Companies to Work For 2013, including Southern Ohio Medical Center (29), Meridian Health (39) , and Mayo Clinic (41). I liked the perk offered by Methodist Hospital System (67): every employee received a $200 debit card to recognize their efforts and to promote the hospital’s ICare philosophy.

Speaking of great employers, Mr. H is taking a few days off so I am flying solo. I’m not sure whether he is sitting on a beach with an umbrella drink or skiing down a mountain, but I am sure he is putting together a few new Spotify playlists for your music diehards. I don’t have a playlist to share, but I can recommend Lincoln and Zero Dark Thirty if are interested in hitting the movie theater.  Especially Zero Dark Thirty, which stars Jessica Chastain as a very smart, tough, and attractive CIA operative committed to finding Osama Bin Laden. Really, who doesn’t love a smart, tough, attractive woman? I’ll also mention for the HIMSS-attending fun seekers that we will be sharing details of HIStalkapalooza this week, including a link to request an invite.

United Airlines did not make the Best Companies list, but offers a nice perk by providing free health services at several of its hubs, including a just-opened employee health clinic at Chicago’s O’Hare airport. It’s one of five Walgreens-managed facilities available for all employees.

athenahealth announces it will offer an anesthesia-specific billing solution for hospitals and independent practices.  MedOasis will provide the capabilities for anesthesia coding, charge-entry, contract management, and compliance.

The VA again awards HP Enterprise Services a $543 million contract for RTLS, three months after IBM contested the original award granted in July. The GAO upheld the protest, saying the VA had made several prejudicial errors in evaluating the original offers from HP, IBM, and four other vendors. The VA re-opened the bid process in October and again selected HP to equip 152 medical centers.

Audax Health, which recently signed a strategic alliance with Cigna to develop a digital engagement platform, raises $21 million through a mix of debt, options, and other securities. The company also names four new executives including Optum alums Doug Celebi, MD (SVP of informatics) and Brian Dolan (chief customer solutions officer).

Saint Anthony’s Health Center (IL) will offer emergency tele-neurological services in partnership with Specialists On Call.

The local business journal profiles UCSF Medical Center and its $160 million Epic EMR, which went live in June. The reporter includes a few details that UCSF would likely rather forget, such as the project taking a year longer than originally estimated and costing $100 million more.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Time Capsule: Process Anarchy: Why Hospitals Buy Off the Rack, But Expect a Tailor-Made Fit

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 May 2008.

Process Anarchy: Why Hospitals Buy Off the Rack, But Expect a Tailor-Made Fit
By Mr. HIStalk

I recently met with a group of employees from one department in a big medical center. So big, in fact, that many of that department’s couple of hundred employees didn’t know each other and had to be introduced. They’re assigned to odd locations, doing highly specialized work, and rarely poke their heads out to see what’s going on anywhere else, even within their own department.

We were talking a software rollout that affected them. That’s where the consensus thing comes into play – how they should use it, what changes they would see, and all the other painful change management stuff that wraps itself around a technology implementation.

Two of them were talking and animatedly gesticulating. It looked like an American tourist trying to get a Moscow local to understand that he’s looking for a restroom by just saying it slower and louder. Finally, one turned around and said (with some combination of wonderment and exasperation), “We work one floor apart, but it’s a completely different world.”

There’s an automation challenge for you. One information system, but two completely opposite groups trying to agree on how it should be configured. From the same department of the same hospital.

That’s a nightmare for healthcare idealists and software developers. In a perfect world, all hospitals would work the same. In a less-perfect world, hospitals might vary, but at least practices within a single hospital would be consistent. In a world that’s in disarray, everyone in a given department would at least follow a single set of rules. And in a world of madness, even small subgroups of individual departments do things their own way, a healthcare version of anarchy.

I’d say most hospitals are somewhere between disarray and madness. That doesn’t even account for IDNs with hospitals from 50 beds to 1,000 beds that face the daunting challenge of getting all of them to agree on a single software setup that reflects their intra-group disarray.

Certain hospital areas are so ruggedly individualistic that nobody else understands them 90 percent of the time (peds, oncology, surgery, ED, and ICU). Experienced nurses who transfer in feel like new grads all over again because everything is different (that’s a big problem right there). They defiantly stick with puzzling practices and dare well-intentioned outsiders (like administrators) to understand what they do, much less change it.

Those practices mimic the medical education of the doctors who work there, which rewards specialization. Each specialty proudly creates its own lingo, methods, and forms. Sometimes they’re necessary extensions, sometimes plainly bizarre and illogical practices used like gang colors – to make sure outsiders know they’re outsiders.

That’s why best-of-breed systems designed for those specialty areas won’t go away in the foreseeable future. That’s also why systems that all areas use, like CPOE and clinical documentation, can turn into an unmanageable stew of configurability options that drive vendors crazy when they’re trying to program and test changes. Instead of delivering strategic new functionality, products keep moving laterally with new options to be chosen once, even though a given client will just set it and forget it without receiving any real benefit.

Vendors have it tough. The respective agendas of current customers vs. prospects are very different. Entire new functionality may interest only a few potential users. The most vocal users are the showcase accounts, like academic medical centers, who demand changes that make no sense to the average hospital. Any resemblance to consensus is accidental.

(And here’s a vendor kudo: what little standardization exists in hospitals can be attributed to three groups: software vendors, the Joint Commission, and professional organizations for specific disciplines.)

Maybe it’s asking too much for vendors to deliver off-the-shelf software that every hospital can not only use, but love. One size doesn’t fit all.

Lip service aside, most hospitals want it their way. Anything less makes them angry. Cost and complexity forces them to buy suits off the rack when, deep down, what they really want is to have a tailor to make them one that fits perfectly.

Morning Headlines 1/18/13

New rule protects patient privacy, secures health information

HHS announces modifications to HIPAA that substantially expand privacy, security, enforcement, and HITECH breach notification rules. The final rule is effective March 26, 2013 and is expected to require an initial economic cost of $114 million to $225 million.

Department of Veterans Affairs Selects HP to Help Improve Operations, Healthcare Services

HP wins a 5-year, $543 million contract to implement RTLS across 152 VA medical center.

Hospital Board Discusses Grade Change By the Leapfrog Group

The Leapfrog Group has retracted the "F" grade it gave 25-bed Texas County Memorial Hospital after an investigation found that the research methodology used was questionable and relied on inaccurate data sources.

A centralized research data repository enhances retrospective outcomes research capacity: a case report

Researchers at Columbia University find that using a data repository to conduct outcomes research significantly enhances overall workflow efficiency.

News 1/18/13

Top News

HHS Secretary Kathleen Sebelius announces the final omnibus rule that substantially changes HIPAA regulations for the first time in 15 years. It (a) expands HIPAA’s reach to business associates such as contractors who will now be directly liable; (b) increases penalties to a maximum of $1.5 million per violation; and (c) clarifies the HITECH breach notification requirements. Patient provisions include (a) the right to request their own information in electronic form; (b) allowing cash-paying patients to instruct providers to not share their treatment information with their insurance company; and (c) limiting the use and sale of a patient’s information without their permission. The 563-page document has considerable detail including a discussion of feedback received, so feel free to leave a comment with nuggets you run across.

Reader Comments

From Digital Probe: “Re: headline. One of the rags ran a headline all day saying Health Information Exchange over a story about health insurance exchanges.” Indeed they did, and they’ve since quietly corrected their mistake, I see. I’m slightly mystified by their confusion, but even more so at their running a lengthy article on health insurance exchanges in an IT publication intended for a provider audience who I can’t image cares one iota about them.

From Android Powered: “Re: TPD’s list of iPhone apps. Anybody want to share their list for Android?”

From Boy Gary: “Re: Anthem CA Blue Cross. Their electronic eligibility system is down, so they e-mailed providers telling them to e-mail subscriber and patient information to check eligibility. They’re asking for the subscriber’s Social Security number to be sent by unsecured e-mail.” That’s such a bad idea that I’ll overlook their less-egregious omission of the apostrophes in the possessive occurrences of “subscriber’s.” They get credit for at least putting a manual step in place to help providers get paid.

From The PACS Designer: “MakerBot at CES. An addition to MakerBot’s product line that TPD posted about was introduced at the Consumer Electronics Show in the form of a 3D plastic design system. The MakerBot Replicator 2X 3D printer uses melted plastic to form objects based on available 3D pattern software. So, for example you want a new coffee mug, you use your pattern design software to create the desired result. Maybe one of our adventurous readers will buy the Replicator to design a new shoe for Inga!” Pretty fascinating – the $1,749 device can replicate household hardware parts, antiques, and who knows what else.

From Lumpy Rutherford: “Re: former NextGen President Pat Cline. He has resigned from the QSI board effective immediately and on his LinkedIn page lists himself as CEO of newly incorporated Delaware corporation Lightbeam Health Information Systems. I don’t know the connection, but I suppose you could draw conclusions.” Indeed you could. I was interested in the corporation’s other officers, but couldn’t turn them up on Delaware’s corporations page (at least not without paying).

HIStalk Announcements and Requests

My inbox has been filling up with inquiries about HIStalkapalooza. Here’s what I can share for now. We will post a link to the invite sometime in the next couple of weeks, so keep reading HIStalk. We will again have the Inga Loves My Shoe contest as well as a crowning of the HIStalk King and Queen for best attire. Translation: if you needed a legitimate excuse for splurging on a new outfit, you now have one. However, you might want to wait for more details on the event because it may influence your final selection. The date again is Monday, March 4 at 6:30 p.m.

The latest goodies from HIStalk Practice include: the HIStalk Practice Advisory Panel discusses the various resources they use when purchasing HIT system to compare vendors and products. Bruce Henderson of Aetna Accountable Care Solutions suggests some factors that practices should consider before committing to an ACO model. Rob Drewniak of Hayes Consulting Management overviews and defines data governance. SRS CEO Evan Steele expresses concern about the future of the EHR incentive program. Proposed legislation would provide SBA loan guarantees for the purchase of clinical IT systems. A study suggests that projected primary care physician shortages could be eliminated if practices used EHRs and shifted more care to non-physician providers. EHR adoption by family physicians is expected to exceed 80 percent by the end of 2013. Most physicians don’t find online physician ratings helpful, though the vast majority believe their own ratings are at least partially accurate. Thanks for reading.

I’m taking a short beach break, leaving Miss Inga in charge of the Monday Morning Update. You can occupy your time by (a) connecting with us via our non-Catfished social not-working profiles; (b) porting intently and clicking methodically over the ads to your right from the folks who underwrite your HIStalk habit, if such a thing exists for anyone but me; (c) signing up for spam-free e-mail updates; (d) reviewing more in-depth sponsor information and filling out a two-minute form to solicit consulting help; and (e) evangelizing to your colleagues who won’t see our slick marketing campaigns and ads since we don’t have any. Seriously, you are the best.

On the Jobs Board: Product Marketing Specialist, Expert Solution Consultant – Revenue Cycle Specialist, Healthcare Vertical Solutions Director, Sr. Applications Engineer – EMR.

Acquisitions, Funding, Business, and Stock

PE firm Primus Capital Funds invests in Emmi Solutions, a provider of patient engagement solutions.

MIT Media Lab spinout Atelion Health will commercialize one of the lab’s project, a care coordination system that’s being tested at Boston Medical Center, Joslin Diabetes center, and Mayo Clinic.

Cleveland-area data archiving vendor MediQuant, which says its revenue is growing at 45 percent per year, moves into a larger space for its 40 employees and the 10 additional it plans to hire this year.

A hedge fund shareholder of Compuware criticizes the company for “intentionally dragging your feet” by not yet responding to a $2.3 billion December 18 takeover offer from Elliott Management Corp. Just after it received that offer, Compuware announced plans to conduct an $200 million IPO of its Covisint HIE business unit by the end of March.

Sales

Centra Health (VA) selects Wolters Kluwer Health’s ProVation software for cardiology procedure documentation and coding.

HP Enterprise Services announces that it has been chosen by the VA for a $543 million, five-year, 152-hospital RTLS contract, being issued the bid again after competitor protests of last year’s award. Subcontractors are CenTrak, Intelligent InSites, and WaveMark.

People

The Society of Health Systems and HIMSS award Dean Athanassiades, senior director of software customer services for Philips Healthcare, the 2012 SHS/HIMSS Excellence in Healthcare Management / Process Improvement Award for leadership in implementing synergies between the process improvement and IT professions.

Symphony Health Solutions names Frank Lavelle (Siemens Medical Solutions, Medquist) CEO.

Doug Cusick (HP, IBM) joins Clinovations as a partner, tasked with leading the expansion of the company’s payer, life sciences, and technology service lines.

Dann Lemerand is promoted to EVP of strategic alliances for The HCI Group.

Announcements and Implementations

Greenway Medical Technologies unveils its interactive Developer Portal and API to facilitate creation of apps that interoperate with Greenway’s EHR and PM platform.

Siemens Healthcare offers consulting services for value-based purchasing, preventable readmissions, and healthcare-acquired conditions.

A Dell-sponsored study finds that the family medicine residency program of Tallahassee Memorial HealthCare (FL) saved $600,000 and enhanced productivity by implementing the company’s Mobile Clinical Computing solution, which includes desktop virtualization, single sign-on, and strong authentication.

Government and Politics

ONC selects four winners of its Health Design Challenge to develop patient-friendly designs for printed health records to help patients better understand and use their EHRs. The winners shared $31,000 in prize money.

ONC publishes several reports on HIEs.

In the UK, Secretary of State for Health Jeremy Hunt calls on NHS to become paperless by 2018, making it “the most modern digital health service in the world.” The physician’s union replied, “The biggest challenges to making the NHS paperless by 2018 are down to funding, resources, prioritization, and the choice of systems in secondary care. Although there may potentially be some efficiency savings, technology will not necessarily create huge cost savings. As well as ongoing hardware and software funding, sufficient resources will be required to support evolving training, IT support and admin support.” Other goals the Secretary set: (a) every patient will have online access to their own records by March 2015; (b) referrals will be paperless; (c) patient records held in different locations will be linked; and (d) records will follow patients throughout NHS and social care.

Technology

A NIH-funded University of Pittsburgh study of four skin lesion apps finds that three of them weren’t very good at diagnosing a test set containing 53 images of lesions known to be cancerous. The apps incorrectly concluded that 30 percent of the lesions weren’t cancerous. The fourth app, which sends the image to a dermatologist for review, missed only one of the samples. The conclusion is to not trust unregulated apps with important medical decisions.

Other

The Leapfrog Group retracts the “F” grade it gave to Texas County Memorial Hospital (MO) after the hospital complains that its score was based on incorrect data. The 25-bed hospital opted not to participate in Leapfrog’s survey because it did not have the resources required to complete the 80-page questionnaire. It says Leapfrog applied “questionable methodology” and used information that was not confirmed by NQF or independently assessed for reliability and validity. The hospitals has retained legal counsel. 

Siemens Health Services CEO John Glaser, who served as an ONC senior advisor helping craft Meaningful Use in 2009 while still VP/CIO at Partners HealthCare, agrees with several member organizations in calling for a slowdown of its rollout. He says, “The pace is too damned high. People are just cramming this stuff in.” Johns Hopkins Vice Provost for IT/CIO Stephanie Reel says the “one size fits all” approach is causing headaches for specialists and the Meaningful Use program needs to be evaluated for effectiveness, saying, “To keep moving ahead with such an aggressive strategy strikes me as foolish. We don’t know what’s working and what’s not working.” Obviously pushback is escalating.

Sporting Kansas City, partly owned by Neal and Cliff of Cerner, parts ways with its charity partner, Lance Armstrong’s Livestrong. ESPN says Livestrong cancelled the stadium-naming deal because the soccer team owed it money, while Sporting KC takes advantage of the Dope Pedaler headlines by loudly announcing the breakup with perfect timing. Livestrong’s name gets yanked down from the Livestrong Sporting Park sign and it loses its percentage of the gate, worth $8-10 million over six years.

An article in a security magazine says Australian security researcher have found “dangerous, unpatched flaws” in the Philips Xper cardiovascular imaging system that allow them free access to patient information. The researchers said they weren’t able to connect with someone at Philips, so they got in touch with the Department of Homeland Security and the FDA instead. They claim Homeland Security told them the agency was taking over all aspects of software vulnerabilities related to medical devices and software. Philips says the flaw is present only in old versions of its software. The researchers also played around with an iPad-based patient monitoring and found problems.

Lurie Children’s Hospital of Chicago sues a web design firm, seeking the return of the $859,000 it paid the company to design a site to promote its new $915 million hospital.

The Dallas paper profiles Robert Abbate, DO, who started One Touch EMR, an iPad-based EMR.   

A reader once swore she would never read HIStalk again if I mentioned the term “fecal transplant” again, so here’s a sad but necessary wave goodbye to her from Weird News Andy, who subtitles the story “May I borrow some Grey Poopon?” A study finds that the unsavory procedure works better than antibiotics for treating diarrhea due to C. Diff. WNA adds, “When they figure out how to put them in a pill, maybe,” which I might argue is even more disturbing.

Sponsor Updates

• Columbia Valley Community Health (WA) chooses Access Evolution for creating and managing paperless forms and workflow.
• Craneware offers VP-and-above healthcare finance executives a chance to win a $250 Amazon gift card if they answer a 10-question Executive Industry Survey by February 5.
• HMS will participate in the HFMA Region 11 conference in Las Vegas January 27-30 and the THA 2013 Annual Conference February 13-14 in Austin.
• dbMotion shares the agenda for its February 7 seminar in Dallas on connected healthcare.
• Emdat adds Carmichael Business Systems, Northland Business Systems, and Integrated Data Technology as resellers of its digital dictation software.
• The Advisory Board Company offers an infographic  that addresses accountability gaps and best practices for improving teamwork among frontline staff.
• The City of Springfield (OH) renews its contract with MED3OOO for EMS billing services through January 31, 2014.
• The US Army Network Enterprise Technology Command issues CommVault a Certificate of Networthiness for its Simpana 9 data and information management software.
• Santa Rosa Consulting’s Carl Jaekel discusses issues practices will need to consider to accommodate PCMHs in a blog post.
• T-System offers its T Sheets flu documentation template free to hospitals to help EDs manage the national flu epidemic.

EPtalk by Dr. Jayne

Every day is a good day to be anonymous, especially for the HIStalk team. Sometimes I marvel that I haven’t been outed at the office. I and am grateful that apparently I have enough of a filter so that my superhero identity isn’t revealed. I do have to be especially vigilant to ensure I’m logged into the correct Facebook and Twitter accounts so I don’t inadvertently post as the “wrong” me.

I’m just one of thousands of physicians using social media and was excited to see this article in the Annals of Internal Medicine. The authors sent hypothetical social media situations to various state medical boards to evaluate whether there was consensus on which situations might lead to a disciplinary evaluation. Not surprisingly, the riskiest posts included misleading clinical or credentialing information, using patient images without permission, and inappropriate contact with patients such as contacting them on dating sites. There was low consensus for sharing clinical anecdotes (as long as confidentiality was maintained) and for “showing alcohol use without intoxication.”

I do have some latent Victorian sensibilities, so I’m not sure photos of anyone drinking belong on Facebook. I have been friended by some of my colleagues and I think that either they have forgotten that their posts are visible to the workplace or perhaps they simply don’t care. Working for a conservative non-profit, I’d be a little concerned that those posts could someday be an issue (if not for the current workplace then for a potential or future employer.)

Many organizations have social media policies or codes of conduct, but it’s not a bad idea to find out if there are “informal” policies in play as well. Is it frowned upon for subordinates to “friend” their supervisors? Is there a difference between connecting on Facebook and connecting on LinkedIn? What about posting to social medial during typical business hours? Depending on an employee’s role and career goals, some of these are less than appropriate.

Having TMI (Too Much Information) seems to have become the norm. I’m not advocating for a return to the days of inkwells and quill pens, but I do miss having a little mystery in the world. I don’t need a photo of your lunch every day, unless of course if includes an awesome martini. If you have pictures of those, feel free to e-mail me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 1/17/13

AHA, AMA, CHIME Challenge Stage 3 Meaningful Use Proposals

The advocacy groups representing hospitals, doctors, and health IT professionals have all submitted comments criticizing Stage 3 MU.

Accuracy of Electronically Reported “Meaningful Use” Clinical Quality Measures: A Cross-sectional Study

A cross-sectional study published by Annals of Internal Medicine measuring the accuracy of electronic reporting as compared to manual review concludes that the quality measurements outlined in MU have wide accuracy variations that should be further investigated.

Are providers ripe for a massive medical records heist?

More than 50 percent of healthcare organizations report medical identity theft among their patients. The World Privacy Forum estimates the street value of a single medical record at 50 times that of a financial record.

The Rise of Electronic Health Record Adoption Among Family Physicians

A study published in the Annals of Family Medicine predicts EHR adoption rates among family physicians increasing to 80 percent in 2013.

Readers Write 1/16/13

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!

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

Lessons Learned from My First HIMSS in 2007
By Bern Werner

Six years ago I set out on a journey from Pittsburgh, flying to Baltimore to be picked up by my young boss (Todd Johnson, the 25-year-old head of our six-person software company, Salar Inc) in his 140,000 mile-worn Toyota Forerunner for a trip to New Orleans. The truck was loaded with precious cargo and our booth for HIMSS07, packaged neatly in three plastic containers. 

On our first day of the journey, we mused over where the healthcare IT industry was headed and whether there was a future in it for our small company.

When I joined Salar a year earlier, we had begun implementing our physician documentation software at 20-hospital system that already had a major EMR (I’m not saying who the vendor was, but the company name has six letters and I met the owner by chance at HIMSS  before I knew that his booth was worth more than our company). I figured the big fish would just look at our success, then “ borrow” our IP and we’d be out of business in a couple of years. 

We made it safely to New Orleans, and I was excited to be on the floor. I was admittedly green, and knowing the value that we could provide, I was eager to sell it to anything that came within two feet of our booth. 

My favorite memory is of one visitor that walked up to our booth just after the convention hall had cleared for morning session. I was tending the booth on my own. He was accompanied by two booth bunnies. I was alone in front of our 10×10 booth with our slick, new, cloth marketing extravaganza. I asked him if he was interested in seeing a physician documentation tool that is better than anything on the market and drives physician adoption, etc. He was very kind and let me finish before saying, “No, thanks. I was looking for that booth that has a treadmill. Know where that is?” I did not.

As he walked away, my boss was just returning to the booth. He said to me, “Do you know who that was?” I said no. He said, “That was Neal Patterson.” Thus began my real HIMSS education.

I now find myself preparing for HIMSS 13 with the same company, but with two million completed forms and over six million captured charges behind me. Though I’m flying to New Orleans this time, there are many parallels to the 2007 road trip (which included driving through tornadoes on the way home and roaches in the non HIMSS-approved hotel) and events of the past year, with our company changing hands three times. 

One thing for sure is that I’m no longer worried about the big guys getting ahead of us when it comes to innovation. They can steal our ideas and they can try to pilfer our content, but they move like the QE2 we’re still zipping around in our speedboat, changing direction as fast as our customers demand.  

If I find HIMSS 13 to be a sales bust, no biggie. Not only will I be able to recognize some of the industry’s biggest icons, I know I’ll have a good time at the HIStalk party.

Bern Werner is VP of implementation with Salar of Baltimore, MD. 

Ambulatory EHR Adoption: Success vs. Failure
By Justin Scambray, MBA

In a New York Times article, In Second Look, Few Savings From Digital Health Records, David Blumenthal, MD expresses his thoughts on the current struggles the US health care system is facing with the successful adoption of the EHR. Technology “is only a tool,” said Blumenthal. “Like any tool, it can be used well or poorly.”

While there is strong evidence that electronic records can contribute to better care and more efficiency, the systems in place do not always work in ways that help achieve those benefits.

Technology is only a tool, and it is true that it’s all in how you use it. However, it’s not just good use of the technology that will yield results. Physicians need to understand that current processes and the way their practice has run for the last 15-20 years must change.

To put a tool like an EHR in place and expect that it will conform to existing systems and workflow is like changing all the rules in a game, but not changing how the player plays it. This is what many practices end up doing, and the very tools put in place that are supposed to help the practice begin to work against it.

After working in the ambulatory EHR market for seven years, selling and being a part of hundreds of implementations, there is one common attribute that I have seen that separates success from failure: the ability to change and adapt systems and processes to the right tools and right people.

The EHR market has been plagued with the thought that this tool — the EHR — will change the medical practice. The fact of the matter is that it is the practice that needs to change for the EHR to work properly. Careful business process mapping and systems redesign needs to take place prior to implementation of any new tool into a business, and it is no different for a medical practice.

If you have ever sat in on a physician EHR demo, they all want to see the same thing. "Show me how I would see a patient in your system from check-in to check-out." All too often, vendors will immediately start to fumble through a canned patient scenario that really has nothing to do with the current office workflow. The physician will watch, ask a few questions in between taking phone calls and signing off on charts, and never really get a good idea of how the EHR will work in their office.

Is it any wonder that a recent survey conducted by KLAS shows that the number of practices shopping for a replacement EHR jumped from 30 percent in 2011 to 50 percent in 2012? Among the top reasons for switching: decreased productivity.

The EHR is only a tool. It is a tool that requires careful integration and mapping between a current state and desired future state design. If the EHR is going to live up to expectations, it’s a focus on change in workflow, processes, and systems that’s going to get it there.

Justin Scambray is VP ofsSales and marketing for Pacific Medical Data Solutions of Paso Robles, CA

Argument for Healthcare Enterprise Project Management Office
By Joe Crandall

Every hospital project is an IT project.

How many times have you heard that in the past few years? A quick look at the evidence and there is little room for argument:

• Hospital budgets remain stagnant while healthcare IT projects grow. Eight of ten providers expect organizational HIE budgets to significantly increase by 2014 (2012 Black Book State of the Enterprise HIE Industry report).
• Unprecedented HIT spending. $40b investment in all IT related services, $8.2b in software services alone (RNCO study).
• The rise of health data analytics (HDA). Almost every aspect of healthcare can be improved through the use of HDA. Terabytes of healthcare data … terabytes!

As the American healthcare industry moves into its own Information Age, the existing IT infrastructure supporting the projects of today must be realigned strategically across the entire organization to support the projects of tomorrow.

The function of a healthcare Enterprise Project Management Office (EPMO) is pretty simple. The EPMO would be the single source of information related to all strategically aligned projects for the entire organization. This creates more accountability, better communication, and data governance.

Along with implementing an EPMO, an organization must look at the portfolio management process. You can’t have one without the other. The EPMO ensures the projects are done right, but the portfolio management process ensures that the right projects are chosen.

With each IT project being considered a major strategic project, the EPMO becomes the communication hub for the organization. It provides timely and effective mitigation of issues, risks, and budgets. The EPMO makes sure communications are the right message at the right level at the right time. The EPMO also standardizes the best practices of project management across the organization so all projects run smoother.

The other byproduct of elevating the PMO to an EPMO is that the CIO and team become true partners within the organization. The IT staff is already involved in the majority of projects already. Why not leverage their skills to benefit the entire organization?

The benefits to implementing an EPMO are clear:

1. Project alignment. All projects introduced are managed through a central resource and aligned with organizational goals
2. Project capacity. More projects in less time. Long-term planning is simpler and efficient.
3. Project focus. Projects are focused on the strategic goals of the institution and embrace lasting change, not the “flavor of the month.”
4. Project execution. Projects are executed with industry-standard processes resulting in project done right, on time, and completely.
5. Project redundancy. One central location has the knowledge to ensure projects are not duplicative or redundant.

One example. In 2008, Catholic Health Initiatives (CHI) established an IT EPMO with the goal of standardizing best practices and improving project success rates across all hospital IT departments within the health system. Since being established, the EPMO has reached its goals and then some. Due to its success, the EPMO was repositioned to support all enterprise-wide projects in 2012. 

Every hospital project is an IT project.

Joe Crandall is director of client engagement solutions of Greencastle Associates Consulting of Malvern, PA.