Time Capsule: RHIOs 2.0 Dying Uglier Deaths than 1.0, but Hardy Survivors Guarantee Another Round

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

I wrote this piece in January 2008.

RHIOs 2.0 Dying Uglier Deaths than 1.0, but Hardy Survivors Guarantee Another Round
By Mr. HIStalk

I’m a contrarian. When everybody ignored reality and jumped on the RHIO bandwagon, I enjoyed being the bubble-bursting cynic who loudly predicted that they would all go up in flames. Yet another dumb idea, I said, slyly orchestrated by stake-in-the-game consultants, member organizations, and ad-happy magazines instead of market realities.

Some folks wanted to argue with me. I bet a few wanted to punch me. I was a real buzz-kill, raining rational thinking onto the frenetic, obedient parade of RHIO trough-lappers.

Instead of basking, I’ll continue my contrarian ways with another shocking, out-of-the-box prediction: some RHIOs will succeed, thereby embarrassing everyone.

RHIOs typified what is most wrong with healthcare IT: money and energy wasted by naïve providers easily led astray by slick salespeople touting an illogical but personally profitable pipe dream. I’m not proud of predicting the demise of RHIOs because it was just too easy, like shooting fish in a barrel or observing that most doctors won’t use CPOE unless you pay them or require it by law.

Not all RHIOs are created equal, though. Funding and governance differ. So does architecture. National trends aside, RHIOs are a purely local effort, connected to national trends only to the extent that they followed their simultaneous, ill-conceived creation.

If you’ve seen one RHIO, you’ve seen about 90 percent of them. That still leaves 10 percent that could mutate into a survivable form.

It stands to reason that some RHIOs will eventually exchange data, find ongoing operational funds, settle bitter turf disputes, and actually improve patient outcomes. It won’t be many of them, but even if it’s just one, we’ll finally have a living laboratory.

A living, breathing RHIO? That’s quite a leap from what started this whole mess: worshipful jawing about how wonderful David Brailer’s Santa Barbara project was, right up until the time it self-destructed without benefiting anybody at all except David Brailer.

Once we have a working RHIO, then what do we do? The bar will have been raised, making it obvious that the RHIO concept itself wasn’t the problem — it was the shortcomings of those running them.

Who wouldn’t want interoperability? The technical challenges are demonstrably solvable. Insurance companies want data sharing. Government wants it. Patients want it. Having one working example means everybody else needs to come back to the table and try again, no matter how embarrassing the whole RHIO 2.0 thing has been (I consider CHINs to be RHIOs 1.0).

Healthcare IT often chases fleeting dreams, then moves on to something else and never looks back once the going gets tough. There’s always low-hanging fruit elsewhere that needs picking, especially if you’re scared of heights.

Lack of real, working interoperability is inexcusable. For that reason, it’s a given — there will be a Round 3. Maybe it’s a Nationwide Health Information Network or a takeover of the RHIO concept by insurance companies. Regardless of what form it takes, you haven’t heard the last of interoperability.

Somewhere out there, right now, some HIMSS committee or consultant is trying to come up with a new name that will distance Round 3 from those embarrassing first two, mostly by calling it something different and hoping for new operating concepts driven by experience and Darwinism. Better technology, smarter governance, more clearcut operating parameters. Mark my words: RHIO Redux is coming soon.

News 10/26/12

Top News

Cerner reports an 18 percent increase in Q3 revenues from a year ago, with EPS of $0.56 versus 2011’s $0.45. Net earnings grew 25 percent and the company’s $769.9 million in third quarter bookings represent an 18 percent jump over last year.

Reader Comments

  From Weird News Andy: “Re: MGMA write-ups. This is too good a post not to have a comment.” WNA is referring to one of the four updates posted to HIStalk Practice this week covering the MGMA meeting in San Antonio. If you are interested getting the scoop on the conference, check out the writeups from  Monday, Tuesday morning, Tuesday evening, and Wednesday. I covered an assortment of topics including educational sessions, exhibit hall happenings, and parties. Other publications may offer a more in-depth look at some of the specific sessions, but I bet none published a photo of mariachis with Ronald McDonald.

From Junior Birdman: “Re: MGMA. The athena rep told me that two-thirds of the demos they were doing were for current Allscripts and GE customers.” Unverified.

From Empire Statesman: “Re: Allscripts. A totally unverified rumor is that they filed the HHC protest just in case a New York-based private equity company turns out to be their buyer and can then exert local influence on HHC to change its mind. The slim hope they will prevail may also delay the market’s reaction long enough to get them sold before the decision is announced.” Unverified. Another reader’s unverified rumor is that Allscripts had a big meeting with a PE firm on Thursday.

From CIO Reader: “Re: CIOs reading HIStalk. You’ve taken a good first step in running the excellent work of Ed Marx and Bill Rieger. Perhaps include other writing from insightful and innovate CIOs and/or CMIOs?” I’m happy to do that. If you’re both interested and interesting, there’s a place for you here.

From King Biscuit: “Re: RazorInsights. I’m telling you, these guys are going to leapfrog everyone … so cool!  Best engineered software, by far.  Blows Epic and Cerner away.” Unverified, but KB is a non-anonymous expert whose name you’d instantly recognize and who has no horse in this particular race, so I respect that opinion. Some company communication I intercepted says they are #2 in KLAS (behind Epic) and #1 in the community hospitals category, with 64 hospitals in the pipeline.

From HITesq: “Re: Allscripts. You can confirm the unhappy Allscripts issue. Allscripts sued Aprima in the Northern District of Illinois.  Complaint attached. Alleges trademark infringement and unfair competition.” Allscripts demands that Aprima stop using the MyWay name in its advertising and stop insinuating that Allscripts is sunsetting the product. I’ll side with Allscripts. I’m not a lawyer like HITesq, but I assume Aprima can continue to target its advertising to MyWay customers as long as it doesn’t imply that Allscripts is forcing those customers to change and perhaps adds the common disclaimer that MyWay is an Allscripts trademark and product. Kudos, by the way, to HITesq for always finding these interesting legal nuggets from sources the rest us don’t have access to.

From AnotherOneBitesTheDust: “Re: GE. Will be sunsetting it Oracle-based Centricity product – the old Logician – after upgrading it for MU 2 next year.” Unverified. 

HIStalk Announcements and Requests

I get several e-mails each week imploring me to take advantage of the many ways I could make more money from HIStalk (recent ones: drastically raise the admittedly low sponsorship costs, rent the mailing list, make it a pay site, sell consulting services to vendors). I’ll be honest in saying that I have no plans for any of those since I do it for fun, not money, and the more it would become a real business, the less I’d like it. All I need is the satisfaction, and that’s where you come in: (a) sign up for the e-mail updates since Inga loves seeing that number increase; (b) connect with us on Facebook, Twitter, LinkedIn, and Dann’s 2,821-member HIStalk Fan Club; (c) cruise the ads of our loyal sponsors, check out their listings in the Resource Center, and shoot out your consulting RFIs to several companies at once via the RFI Blaster; (d) send us news, rumors, guest posts, or ideas of how we can help the industry and patients; and (e) tell your colleagues you read here since the only way we get new readers is via word of mouth and Google. Thank you for spending time with us.

Acquisitions, Funding, Business, and Stock

McKesson will acquire PSS World Medicine Inc. for about $2.1 billion. PSS is primarily a medical products distributor, but is also an athenahealth reseller. Analysts estimate that PSS’s athenahealth sales represent less than five percent of athena’s new customers per year.

AdvantEdge Healthcare Solutions, a provider of billing, practice management, and coding services for specialty physicians and hospitals, acquires Medrium, a Delaware-based billing and PM company.

HIT raised $194 million in VC funds from 37 deals during the third quarter, according to Mercom Capital Group.

Compuware reports fiscal year 2013 Q2 financials: revenues down 15.4 percent, net income down 53.3 percent, and EPS of $0.05 versus $0.10. Analysts were expecting $0.06/share. Compuware’s Covisint division reported a 17 percent increase in revenues from a year ago.

Sales

In Australia, Queensland Health expands its use of iMDsoft’s MetaVision ICU system by purchasing a statewide enterprise license.

University Physicians Group (NY) will implement the PatientPoint Care Coordination platform and its electronic Check-In/Check out process.

Johns Hopkins Medicine expands its relationship with MModal by rolling out its Natural Language Understanding to all facilities.

Hi-Desert Medical Center (CA) selects iDoc from CareTech Solutions for document imaging and management with Meditech’s EHR and health information management systems.

Partners Healthcare (MA) renews its contract with Omnicell for pharmacy automation.

MedVirginia signs a multi-year contract extension with Alere Wellogic, the creator of the HIE’s technology infrastructure.

The Defense Health Services Systems awards an $11 million prime contract to SAIC for support of the TRICARE Online system and expansion of Blue Button capability.

Holston Medical Group (TN/VA) selects Performance Clinical Systems and the Symphony platform for care coordination.

Queens Long Island Medical Group (NY) chooses MU Assistant from SA Ignite to automate MU reporting and enable one-click electronic attestation to CMS.

Rochester General Health System (NY) purchases Carestream Vue for Cardiology PACS.

Prime Healthcare Services (CA) selects FairWarning Patient Privacy Monitoring for privacy auditing with its Meditech system.

People

Phreesia appoints Ralph Gonzales, MD (UC San Francisco) as chief medical advisor.

Convergent Revenue Cycle Management names Mark Schanck (HBCS) SVP of sales and marketing.

David Bates, MD, the SVP for quality and safety at Brigham and Women’s Hospital, joins the EarlySense medical advisory board.

Announcements and Implementations

Family Healthcare (ND/MN) goes live with RTLS from Intelligent InSites to track patients, staff, and equipment.

Van Buren County Hospital, an affiliate of Iowa Hospital and Clinics,  goes live on Epic.

Government and Politics

OIG says in the video above that among its planned 2013 work is to “identify fraud and abuse vulnerabilities in electronic health records (EHR) systems.” I assume the HHS/OIG survey I ran earlier this week was the first step in that effort.

The VA announces plans to get its VistA system Meaningful Use certified, but says that probably won’t be completed until 2014.

CMS publishes a document containing minor corrections to the Stage 2 MU Final Rule.

Innovation and Research

KLAS finds that 70 percent of providers are using mobile devices to access clinical applications. Physicians using McKesson and Epic applications are more likely to view data on a mobile device than providers running other EMRs. Providers and healthcare organizations say their biggest concerns with mobile devices are preserving the security of patient data and managing and tracking devices.

Other

Most healthcare data breaches occur in facilities with less than 100 employees, according to a Verizon study. The majority of attacks on healthcare systems are financially motivated and target personal and payment data.

The Australian federal government terminates a $23 million contract with IBM to build the National Authentication Service for Health, citing missed deadlines and delays.

Sponsor Updates

• Informatica introduces PowerCenter Big Data Edition, which allows organizations to leverage data for advanced analytics.
• Eugene Gastroenterology Consultants (OR) selects ProVation MD for GI from Wolters Kluwer Health.
• Surgical Information Systems renews its HFMA Peer Reviewed designation for its rules-based charging product.
• Tigermed Consulting Co selects Merge eClinical’s CTMS solution to streamline clinical trial management.
• ROI is not the primary measurement used by organizations to gauge the success of their EMR systems, according to a Beacon Partners survey. The report also finds that quality management and IT departments are the ones most often responsible for EMR performance measures. Beacon also hosts a Webinar featuring a discussion of navigating unknown risk in a practice.

EPtalk by Dr. Jayne

Inga and I are back from MGMA. She is drowning in e-mails I am drowning in the sea of humanity that is a double shift in the ER. I recently started watching Doc Martin on Netflix and sometimes wish I could channel his bedside manner to those folks that think that every ER visit comes with a meal tray and a complimentary can of Sierra Mist.

Like Inga, I was underwhelmed by the lack of buzz both in the meetings and in the exhibit hall. I’m chalking it up to the fact that practices are simply beaten down. Those that have already gone to EHR have spent their available cash and are focused on optimizing what they have. It might have been a good sales opportunity for consulting groups to peddle their skills.

I only saw a handful with booths, but I did run into several consultant colleagues who were there as attendees. There were a lot of complaints about sessions being too full and one Central Business Office Director told me she was skimping on the exhibit hall to make sure she had a seat in sessions.

As you can see, Inga and I were not the only celebrities in town.

San Antonio Banderas responded to my comment about the bottles and trash I saw on the Riverwalk during my morning jog. “I have attended many conventions in San Antonio in my last career, and always referred to the Riverwalk as the Sewerwalk. And Inga said she was walking barefoot back to the hotel? Ick! Have you experienced having a snack or drink at one of the nasty riverside restaurants or bars and have the pigeons land on your table, only to shed feathers and dander all over you when you shooed them away? Ick, ick!” Luckily I haven’t had the pigeon experience, and I’m happy to relay that most of Inga’s shoeless wandering was in hotel lobbies and the occasional restaurant. As her personal physician, I do try to look after her health and welfare, offering the above cowboy-style galoshes as a potential solution.

I wanted to get a better photo of these guys and their sassy purple paisley pants, but I could never find their booth. I assume they were exhibitors rather than two friends who share a stylist. The “Cushiest Carpet” award goes to Pulse. Although they wouldn’t give Inga a pair of green sneakers, they did try to buy our love with coffee at a time when we sorely needed a pick-me-up.

We spent some time cruising the hall together. I admit that I still have to stifle a giggle every time I see my signature on the HIStalk placards. I had the chance to get to know some of our sponsors better and to hear more about the plans for the upcoming HIStalkapalooza. Let me just say it’s going to be something to remember, and based on the theme, I have the perfect wardrobe for the event.

I’m looking forward to next year’s MGMA in San Diego and hope to be joined by Bianca Biller for even better perspective. I seriously doubt, however, that I will find any pastry in the shape of California in 2013. God Bless Texas!

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

CIO Unplugged 10/24/12

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

CIO, Wake Up and Lead

Alexander the Great, one of the greatest military generals who ever lived, conquered almost the entire known world with his vast army. As the story goes, one night during a campaign, he couldn’t sleep. He left his tent to walk the campgrounds.

He came across a soldier asleep on guard duty – a serious offense. The penalty for sleeping on guard duty was, in most cases, death.

The soldier began to wake up as Alexander the Great approached. Recognizing who stood before him, the young man feared for his life.

Alexander the Great looked down at the soldier. “Do you know what the penalty is for sleeping on guard duty?”

“Yes, sir.” The young man’s voice quivered.

His features hardened, and Alexander the Great put a hand on his hilt. “What’s your name, soldier?”

“Alexander, sir.”

Alexander the Great studied the young man with a searing gaze. “What is your name?”

“My name is Alexander, sir.” The soldier’s knees shook.

A third time, Alexander the Great demanded with force, “What is your name?”

Breathing heavily, the young man replied, “My name is Alexander, sir.”

Alexander the Great then came face to face with an intense look. “Soldier, either change your name or change your conduct.”

True or not, the story brings out the point that it’s our duty to walk in the authority of our calling. As CIOs, we continually lobby for our voice at the table. We want to be seen and treated as a peer by our C-suite counterparts.

After interviewing several CEOs and CIOs, I wrote a post for Modern Healthcare last summer about this precise dilemma. In our quest to be recognized by the first letters of our title – typically VP (vice president) or SVP  (senior vice president) — we ultimately back down when opportunity presents itself.

A few notable exceptions exist. We all know CIOs who lead business areas of their organizations such as human resources, strategy, finance (yes, finance), and construction, or have gone on to become CEOs. But these are absolute rarities.

Here is a quick pulse check to figure out which one you are:

• Are you presently leading something outside of IT?
• Do you speak as a business person or a techie?
• Do you routinely showcase the business value of IT investments?
• Are you known to resolve challenges or do you run for cover?
• Do you frequently say, “There is no such thing as an IT project” and punt responsibility?
• Do you tell people you “lead from behind?”

Let’s take an example many can relate to. Most CIOs are already on an EHR journey or preparing to embark on one. What an opportunity to lead! Certainly you are not to lead alone, but nor should you abdicate your leadership on this one. And here lies the irony. The majority of troubled EHR initiatives were not led by CIOs, yet the CIO was often the first to go.

Don’t get caught up in my specific example, but rather the heart of the situation described. You might as well take the lead whenever available, because one way or another — despite your best attempt to disassociate — the CIO is integral to almost every action taken by the business. You will take the fall! I advocate that you lead alongside, not in front or behind.

What factors position you so that the coach puts you in the game?

• Excellence. Ensure your credibility is rock solid based on the operational performance of your team. The trains must run on time.
• Intentionality. Have a routine in place where you are getting face time with your peer suite. Throw in a mix of one-on-one time.
• Transparency. Operate and conduct your interactions as openly as possible. Build your own site where peers can get self-help information on what’s taking place in your areas. Publish your budget and show the costs for supporting each business unit down to the application level. Give no one reason to accuse you of hiding anything.
• Knowledge. Success is predicated upon continuous learning. Read the materials popular with your C-suite peers, not just IT.
• Potted or planted. Are you and your directs potted in the organization or planted? When planted, it is hard to tell IT from any other business unit because of the purposeful integration. I want the business units to think my directs work for them. If potted, not planted, the plant does not take root, and eventually withers and dies.
• CEO agenda. Know the agenda of your CEO and your peers and you will start connecting the dots between business strategy and IT. You will become a trusted advisor.

How can you turn to broaden your insights?

• Networking. Continuous interactions with other business leaders, inside and outside of healthcare.
• External connections. Leverage other influences by serving on advisory boards and universities. We bring my team together with IT leadership from a non-healthcare organization annually (see a previous post). i.e. Last month we compared notes with Kimberly-Clark.
• Partnerships. Leverage your organizations partnerships with other companies and vendors. We bring our strategic partners together routinely to learn and grow.

We are all set to lead. Here are some critical success factors to consider:

• Passion. It is contagious. No passion = no energy, and nobody wants to follow a lifeless leader.
• Visibility. Be seen and heard. We rotate our leadership meetings inside of all of our business units. Each time, business and clinical leaders are our special guests, and they are excited to see us on their turf.
• Trust. You know the old adage: do what you say you will do. It’s tough to build trust, yet that trust so easily falls when we stray from the truth.
• Boldness. Being a CIO is not for the faint of heart. Based on advice from my new team, I stopped an EHR implementation so we could regroup before the project went south. This timeout paved the way for a very successful implementation and enabled the kind of returns we had originally hoped for.

Let me close by asking you: what is your name? Or better yet, what is your title? If you are not leading, then downgrade your title. Either start acting like a vice president or senior vice president or give someone else the opportunity. Healthcare is desperate for strong leaders, especially CIOs.

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.

News 10/24/12

Top News

Pam McNutt, SVP/CIO of Methodist Health System of Dallas, tells me that she has received a detailed fraud survey from OIG that covers a lot of territory. She will send it over if the hospital’s legal department gives the OK, but in the mean time, she provided a summary of what’s on OIG’s mind:

• Computer-assisted coding
• HIPAA security practices related to access to the EHR, both remote and internal
• Numerous questions on practices and protections involving allowing patients and non-employees to access EHR data
• Seventeen questions about audit log capabilities and how audit logs are monitored
• Thirteen questions on clinician progress notes, whether cut/paste/copy is allowed, and how record changes are performed
• General HIPAA privacy compliance questions

OIG Survey

UPDATE: Thanks to another reader who provided a copy of the survey, which is specific to hospitals. I found Question #44 involving patient access to their EHR data to be the most interesting given that this is a fraud questionnaire. Not only is allowing patients to see information about them a good thing in general, they can be on the lookout for questionable billing for services on their behalf. Click here for larger, printable version of the survey from my original upload.

Reader Comments

From THB: “Re: Sherman Health in Chicago. I’ll bet a dollar to your favorite charity that they join Cadence since it’s an Epic shop.” Drop a buck into a Salvation Army kettle: Sherman chooses the other suitor, Advocate.

From Back from CHIME: “Re: HIStalk. As a long-time HIStalk follower, I think everyone should know about it for keeping current. Few of my peer group seem to. How can that gap be bridged?” Let’s crowdsource some reader ideas: what should I do to make HIStalk imperative CIO reading or make them more aware of its existence?

From Michael: “Re: EHRs in the NFL. I thought HIStalk would appreciate this.” Indeed I did. A New York Times article talks about NFL teams that use technology to maintain the health of their expensive biological assets (players). Among them: electronic medical records, concussion evaluation apps, sideline video replays so trainers and doctors can quickly figure out the source of a player’s injury, and iPads for viewing player X-rays. The league hopes to move all teams to a cloud-based EHR system soon so that prospects won’t need to be X-rayed by every team that’s considering their services. According to the SVP of medical services for the New York Giants, “Electronic medical records league wide would save a player from a lot of unnecessary radiation. All of this helps on so many levels from before the game to during the game to after the game. It all just makes it easier to help the players stay healthy.” ”

HIStalk Announcements and Requests

Inga and Dr. Jayne are having quite a time for themselves at MGMA, apparently. Inga’s posts (with lots of pictures since she’s determined to wave her iPhone 5 around at every opportunity) are up from Monday,  Tuesday, and Tuesday Part 2. Inga is #4 on the list of Twitter influencers using the #mgma12 hashtag, she told me proudly.

On the Jobs Board: Systems Implementation Engineer, Billing Services Manager, Database Administrator (Oracle).

Welcome to new HIStalk Platinum Sponsor Craneware. The company is all about revenue integrity: charge master management solutions, business intelligence, and revenue cycle management. I was startled to see its growth from the days long ago when my hospital signed up as an early adopter, and now I see that 25 percent of US hospitals are its customers for a variety of products: Chargemaster Toolkit,  Bill Analyzer, Physician Revenue Toolkit, InSight Medical Necessity, Patient Charge Estimator, Pricing Analyzer, and even more solutions for supply management, denials, audits, payment variance analysis, and a broad line of professional services. Thanks to Craneware for supporting HIStalk.

Acquisitions, Funding, Business, and Stock

Health education systems vendor HealthStream acquires provider enrollment and credentialing system vendor Sy.Med Development. Both companies are located in the Nashville area. HealthStream also announces Q3 results: revenue up 28 percent, EPS $0.08 vs. $0.08. 

Perceptive Software saw a 78 percent revenue increase in Q3, according to filings by parent company Lexmark.

Vocera shares were the biggest percentage decliner on the New York Stock Exchange Friday, down 6.7 percent. They regained 2.32 percent Tuesday amidst a big market selloff, however.

Sales

Memorial Hospital (CO) will deploy SIS Analytics across its three facilities.

Beaufort Memorial Hospital (SC) selects Wolters Kluwer Health’s ProVation Order Sets.

Vanguard Health Systems (TN) will deploy AirStrip’s complete mHealth platform throughout its 28 hospitals.

Samaritan Health Services (OR) will use Passport Health’s Patient Access and Payment Certainty solutions throughout its enterprise.

Huntington Medical Foundation (CA) selects Allscripts RCM for its 50 providers to integrate with its Allscripts EMR.

HealthEast Care System (MN) chooses the Wellcentive Advance Outcomes Manager population health management solution.

Carroll County Memorial Hospital (KY) chooses OfficeEMR from iSALUS.

Announcements and Implementations

eClinicalWorks launches an all-inclusive RCM service at MGMA that includes its PM/EHR and services for 2.9 percent of monthly revenue collections.

Vitera announces Intergy Stat, a pre-configured subscription- and cloud-based PM/EHR system for independent physicians. Also announced: Vitera Intergy Mobile, an iPad app that provides mobile providers with read-only access to Vitera Intergy v8.00.

Oncology solutions vendor Prowess will incorporate tools for e-prescribing, medication adherence, and communications from DrFirst.

Government and Politics

Northern Ireland’s health minister is attending a Boston conference to urge healthcare vendors to test their products in his country, touting its single integrated health and social care system. Among the American speakers at the EU-US eHealth Markeplace are Anand Basu (ONC), David Seltz (Massachusetts governor’s office), Dave Whitlinger (New York eHealth Collaborative), Doug Fridsma (ONC), Farzad Mostashari (ONC), Joy Pritts (ONC), Judy Murphy (ONC), Katherine Luzuriaga (UMass), Laura Raimondo (UPMC Italy), and Bill Hersh (OHSU).

The VA hasn’t made much progress on encrypting its computers since a high-profile 2006 data breach, a report investigating an anonymous tip finds. The agency bought 400,000 encryption licenses for almost $6 million, but has installed the software on only 65,000 devices. The VA’s technology office says they had compatibility problems with older computers and stopped the encryption program until the computers were upgraded. The OIG report says they don’t even know if the software meets the VA’s needs and blames poor planning and project management for the outcome.

Technology

Apple announces the slightly smaller iPad mini, pricing it surprisingly high at $329 for a Wi-Fi only model. Concerns are that it still can’t compete with the $199 Kindle Fire (subsidized by the Amazon product sales it generates) or the $199 Google Nexus (sold at cost.) It could, however, take away from sales of its $499 big brother. Also announced: yet another generation of the iPad to make the one(s) you already have obsolete, thinner MacBook Pro laptops featuring the Retina display, and upgrades to the iMac and Mac Mini. Apple shares closed down 3.26 percent.

Diagnotes wins an Indiana innovation contest for its On Call program that connects hospital staff to offsite physicians who can view medical records on their smart phones and send orders back via secure messaging. The company’s CEO is Dave Wortman, who I interviewed many years ago when he was running Mezzia,  the healthcare budgeting company he formed in 1999. It was sold to VFA in 2006.

Other

A University of Wisconsin-Madison biochemistry professor whose research involves the flowering of plants is arrested after police find that the specimens in his lab are actually marijuana. My first reaction: sounds like “Breaking Bad” since I’m watching that on Netflix.

In England, a hospital blames an unspecified technical issue in apologizing to 120 breast cancer patients whose incorrect estrogen receptor biopsy results caused them to miss potentially needed hormonal therapy. The hospital is also on shaky financial ground, saying it could run out of cash in January.

An internist’s Wall Street Journal opinion piece on electronic medical records concludes:

At first I thought EMR sounded like a good idea. Then our practice started using one … checking patients into the office is an odyssey involving scanners and the collection of demographic data—their race, their preferred language, and so much more—required by Medicare to prove that we are achieving "meaningful use" of our EMR … it seems as if this is all about taking care of the chart, as opposed to taking care of the patient … With all the data entry the electronic system requires, my laptop presents a barrier between my patient and me, both physically and metaphorically. It’s hard to be both stenographer and empathetic listener at the same time.

Life Sciences Angel Network will present a November 20 conference, “Healthcare Information Technology: Change, Outlook, and Opportunity,” at Beth Israel Medical Center in New York. Investor Esther Dyson will deliver the keynote; program panelists include representatives from Aetna, Nike, Continuum Health Partners, Castlight Health, and the FDA. Registration is $120.

Medical students from Johns Hopkins University and the University of Maryland who volunteer at Baltimore Rescue Mission develop an EMR system for the free clinic using open source software. They plan to expand it to similar organizations and connect it to Maryland’s CRISP HIE. They’ve formed an organization called Networking Health.

Here’s a music video from the recent CHIME conference. I recognize quite a few of the stars.

Sponsor Updates

• Imprivata announces the agenda of its first annual user conference in Boston.
• Gartner positions Informatica in the leaders quadrant in its 2012 Magic Quadrant for Master Data Management of Customer Data Integration report.
• GetWellNetwork experiences a 125 percent growth surge year over year as patient engagement becomes an imperative component for MU reimbursements.
• First Databank releases its enhanced drug knowledge to support interoperable medication management.
• Iatric Systems receives ONC-ATCB 2011/2012 Certification for its PtAccess V1.0.11.
• QlikView expands its mobile access with QlikView for iOS, available for the iPad.
• NextGate signs 15 new clients during its third quarter for its EMPI and Provider Registry solutions.
• Park Place International introduces its Sustaining Healthcare IT blog to assist Meditech hospitals in achieving sustainability.
• Anesthesia Healthcare Partners chooses to McKesson Revenue Management Services for 30 locations across eight states.
• AdvancedMD releases its survey results at MGMA indicating that only 26 percent of physicians feel they are in control of their finances, while more than half expect their patient load to increase because of the Affordable Care Act.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Curbside Consult with Dr. Jayne 10/22/12

I mentioned last week that I was hoping to find a way to attend MGMA. In a stroke of good luck for me, one of our revenue cycle staff had a situation crop up that prevented her attendance, so I promptly agreed to fill in for her.

I actually enjoy dealing with practice management and revenue cycle issues and knowing more about those topics has been helpful in my work as a CMIO. Not to mention, I like San Antonio and needed a warm getaway after several weeks of chilly rainy weather in my hometown.

Today’s attendance wasn’t as high as I anticipated. That might be due to pre-conference socializing, however. I was surprised that in the years since I last visited, San Antonio’s Riverwalk has become somewhat of a Tex-Mex version of the French Quarter. The revelry going on below my hotel went well into the wee hours of the morning, and I couldn’t believe the amount of bottles and trash I saw on the Riverwalk during my morning jog. (Seriously people, there are recycling containers all over the place here – use them.)

Today featured a variety of specialty-specific preconference activities as well as the exhibit hall, which held a “tailgate party” event with food and drink served in the aisles which made it fun and casual (although I’m sure the booth staffers wish they could have shared in the drinks part). My favorite booth of the day was VaxServe, which was giving out free flu shots to willing takers.

As the industry consolidates, there are so many people moving around. I saw several vendor reps who are now with different companies than they were with just a few months ago at HIMSS. There’s quite a focus on ICD-10 and lots of people in the booths asking pointed questions about when vendors will be ready.

There are some good panels and education sessions scheduled and I hope to attend as many as possible. Hopefully I will run into Inga and catch some sponsor get-togethers as well. Be sure to follow us on Twitter @IngaHIStalk and @JayneHIStalkMD for the play by play.

What do you think about MGMA this year? E-mail me.

E-mail Dr. Jayne.

Monday Morning Update 10/22/12

From MyWay or the HyWay: “Re: Aprima. I hear that Allscripts is upset that Aprima is offering MyWay customers a free conversion to Aprima. I don’t understand the situation there.” Unverified, but that’s surely the case. Here’s some history for the industry newcomers. Misys was a train wreck in 2007, a clueless British company stuck with a bunch of badly aging practice EMRs that could not compete with newer, better, and cheaper competitors that were flooding the small practice market. Instead of developing a new product, Misys took the questionable step of paying iMedica for the source code to its EMR product in a non-exclusive agreement that allowed each company to do its own development going forward, with Misys relabeling its copy as MyWay and selling it through resellers instead of the traditional sales channel. The relationship got ugly, with all kinds of legal actions and maneuvering.

Misys then merged with Allscripts in 2008, its old HealthMatics EMR product was renamed Allscripts Professional, and iMedica changed its name to Aprima in 2009 (for a first-person historical snapshot, see my 2008 interview with Aprima CEO Michael Nissenbaum and my 2010 interview with Glen Tullman and the since-departed Phil Pead from Allscripts.)

Fast-forward to 2012: Allscripts tells customers it won’t enhance MyWay to meet ICD-10 or Meaningful Use Stage 2 requirements, but will support their continued use of their product as-is or convert them to Allscripts Professional for free. Aprima, sensing opportunity, offers those customers a similar deal to move to its product, which is a lot more like MyWay than Allscripts Professional (Aprima’s product isn’t ICD-10 or MU Stage 2 ready either, but the company has said those enhancements are on its roadmap.)

MyWay customers have four options:

1. Keep using MyWay, realizing that while Allscripts support will continue to be available, the product is moving into maintenance mode with no planned ICD-10 or Meaningful Use Stage 2 capabilities. Practices that don’t need those enhancements don’t need to make any change at all right away. Historically, however, vendors usually don’t continue to indefinitely support maintenance mode products, so this option is realistically more of a decision deferral than a long-term strategy.
2. Accept the rather generous Allscripts offer of a free conversion and no-change maintenance cost in moving to the arguably more comprehensive but also more complex Allscripts Professional. That’s a great deal on the surface, but with a caveat: even free EMR conversions to an entirely different product are painful and productivity-sapping, not to mention that the Allscripts conversion schedule is ambitious and they’ve previously struggled with even same-product upgrades (TouchWorks).
3. Convert from MyWay to Aprima at no charge. The Aprima product should look and feel more like MyWay than Allscripts Pro. The switch involves signing up with a different company, which could be good or bad depending on how you feel about Allscripts as a vendor. I don’t know if Aprima has ever done a conversion of that type, but I would suspect they haven’t.
4. Buy a competitor’s product instead of accepting a unwelcome migration to either Allscripts Pro or Aprima. That option makes sense only for a limited subset of customers given the effort and expense required for an on-your-own switch. However, kicking tires doesn’t cost anything, so some customers will probably at least explore competitive products, driving their sales reps crazy since “free” is a tough selling point to beat.

In comparing products, KLAS customer respondents score them about the same:

Aprima beats Allscripts significantly in the all-important “would you buy it again” number from real-life customers, which I consider to be the most important KLAS measure since it summarizes both the product and the company:

I’d want assurances from either vendor:

1. How much productivity will you lose during the switch?
2. Can you talk to reference sites that converted before yours? You don’t want to be the first one.
3. What information will be converted automatically? “Conversion” is not necessarily a generic term.
4. What’s the cost of any required third-party product licenses, hardware upgrades, optional maintenance costs, after-hours support availability, on site training if you think you’ll need it, etc.? Both companies suggest minimal changes, but I’d want that in writing.
5. Will they guaranteed maintenance costs with limited escalation?
6. Will they send you a sample project plan for the conversion?
7. What if something goes wrong? Every factor that’s important to your practice should be covered by a contractual promise from the vendor and a contractual penalty if they fail to meet it.

I’m a cheap-seater on this issue, so comments from Allscripts and Aprima users are welcome.

From Now Seriously: “Re: Paul Levy’s Stockholm syndrome comments about Epic. For some reason in his mind, it’s a bad thing that Epic skated to where the puck was going and got there first with string of solid installs that are successful models for the industry. His poor judgment and lack of clear thinking must have helped him achieve the title of ‘former CEO’ and his blog’s title change to ‘Not Running a Hospital.’” Paul is certainly entitled to his opinion even when it’s uncharacteristically negative, but he (and the pedantic EHR-haters that posts like this one always attract) would carry more credibility with actual experience using Epic or any other commercially available product. It’s the height of arrogance to dismiss the first-hand opinions and experiences of hundreds of hospitals and thousands of actual users of Epic or any other clinical system by writing them off as collectively deluded, like a know-it-all nosebleed-section sports fan shouting out naïve advice to a professional athlete. Paul finishes on a wild tangent in predicting that any Epic error (of which the documented incidence is apparently zero) will cause “a bunch of Congressional committees to come down on the firm like a ton of bricks.” That didn’t happen with Cerner at UPMC Children’s Hospital, the homegrown CPOE system at Cedars-Sinai, or Eclipsys at El Camino Hospital, where IT problems definitely threatened patients. Or for that matter, at Paul’s former employer BIDMC, where a multi-day network outage in 2001 that included its homegrown EMR surely exposed its patients to harm. The crux of his message seems to be that someone should stop Epic’s domination of the hospital systems market (like their competitors, maybe?) and the FDA should regulate clinical software, which always elicits passionate, conflicting opinions about whether government intervention generally improves a given situation.  

From HIPAA Girl: “Re: Blount Memorial Hospital. The Tennessee hospital’s stolen laptop contained information on 27,000 patients.” The laptop stolen from an employee’s home contained only basic demographic information. The hospital says the laptop was password protected, which usually means not encrypted.

From Virtual Virtuosity: “Re: copying and pasting of patient information in EHRs. Is Dr. Mostashari aware that this is how most EHRs work? Does HHS and ONC really expect providers to individually enter every piece of data from a clinic visit? We had a doctor join our practice from the same Kaiser office I used to work at. She had been using Epic for eight years and I asked her how she did it. She said it was initially hard, but she and most of her colleagues finally just made 20 templates and copied them for the vast majority of patients. EHRs from Epic and everybody else were designed to improve efficiency by copying and pasting. If HHS and ONC really expect providers to manually enter every piece of data from every patient visit, we’ll need double or triple the number of primary care providers to keep up with demand. That also brings up another point: as we read the rah-rah press reports about how Kaiser is a shining beacon on a hill for gathering and collecting data to improve healthcare, aren’t they just analyzing the same data constantly if their doctors are just using those 20 templates over and over? How does that reduce costs or improve efficiency?” My opinion is that providers have met every expectation as long as each patient’s EHR information is accurate. If HHS wants providers to craft innovative and individualized prose just for the sake of making every patient record pointlessly different, then they need to set a payment rate for creative writing. First they wanted discrete data, then they decided that what they really want is lots of plain text to assure them that they aren’t being defrauded since they are apparently powerless to determine otherwise. I’ve said it before: the reason that EHRs haven’t improved patient outcomes is because HHS and other payors have forced vendors to focus their development efforts on administrivia enhancements to meet needlessly complex payment requirements that have nothing to do with patients. You could develop a kick-butt EHR if you weren’t required to get bogged down in the Vietnam-like quagmire of billing documentation requirements that allows payors (Uncle Sam included) to avoid writing checks. Unfortunately, that situation is getting worse instead of better as the government insinuates itself even deeper into the practice of medicine. I bet you could design a really cool EMR for cash-only practices, except you’d have few prospects to sell it to.

From Minor Key: “Re: Michigan HIEs. Talk to providers and practices in the state and you’ll hear a different story. They’re realizing benefits now, with little jeopardy or delay in the HIE’s work toward the longer-term goal of interconnection.”

From Jock Ewing: “Re: FDA and biomedical system OS, antivirus, and software patches. This 2005 article says it’s a common ploy for vendors to tell customers that applying software patches would require re-approval by FDA. FDA has clearly said that this is not the case. The bottom line is that manufacturers are supposed to be validating patches and the only issue with getting that done is their willingness to dedicate resources to the task. It’s up to their customers to demand that they validate patches in a timely manner.”

From The PACS Designer: “Re: busy week ahead. Both Apple and Microsoft plan to introduce new hardware and software next week. First, we hear from Apple on the 23rd with the expected offering of new smaller versions of their product line, and on the 26th we will hear from Microsoft on the introduction of Windows 8. Windows 8 is the big deal of the week because it is projected to be the key operating system that will replace Windows XP, and will be used in many upgrade efforts across all of industry, academics, healthcare, and home computing. One of the first apps in healthcare space will be Pariscribe’s Windows EMR Surface (above), which should draw some interest from practitioners.”

From LaRusso: “Re: Fast Company. Several pages on healthcare IT are in the current issue.” It’s mostly the usual oversimplified geek piece on how tiny software startups you’ve never heard of are going to not only disrupt healthcare IT, but healthcare itself because they have brash founders, a few thousand dollars of VC or incubator money, and cool Web pages. I don’t recall many industries that have been disrupted by apps or websites, other than retailers outflanked by competitors who started selling first via the Web, so I’m skeptical that most of these companies will even survive, much less single-handedly transform the highly profitable, political, and parochial healthcare system into a consumer-driven and transparent industry where good defeats evil. Companies get my attention once they hit $5 million in revenue since that’s the point where the concept has been validated, initial development and scaling has been completed, the organizational culture has been defined, and skilled management has been brought in to protect the VC’s investment from the managerial whim of the inexperienced founders. That’s when companies become worth writing about, if for no other reason than the strong possibility that some old-school company will just buy them outright, making the founders as rich as they’d hoped while usually ruining what they created.

Now that I’ve been predictably curmudgeonly in dismissing wide-eyed startups and their naïve faithful who really believe that every David will inevitably rise to defeat his personal Goliath, I’ll take my own counterpoint in reminding myself that I ran a successful series of profiles awhile back called Innovator’s Showcase that introduced several companies to the more traditional side of the industry that most of us work in. I want those small companies to innovate and succeed and that was my way of trying to give them a boost, choosing those that seemed to have predictors of success. Some of them have done quite well since then from all appearances. If your healthcare IT-related company is less than five years old, has sold your offering to real customers, and brings in revenue of less than $2.5 million from selling a truly innovative product or service, e-mail me and tell me why my readers should be interested — I might include it in future posts. Those companies I’ve showcased previously include Aventura, Caristix, Health Care DataWorks, Health Nuts Media, Logical Progression, OptimizeHIT, and Trans World Health Services. There’s work for both of us to do if you’re chosen, so don’t take it lightly.

Widespread interoperability is limited because (a) technology or standards are limited, and (b) because providers have no incentive to share the data they keep. New poll to your right: does your PCP use Twitter for medically related tweets? I don’t really care so I wasn’t sure if mine did, but I’m guessing no since he doesn’t turn up in a Twitter search.

Welcome to new HIStalk Gold Sponsor HealthTronics, which offers a wide portfolio of urology-specific services (mobile lithotripsy, laser prostate treatments, cryotherapy, equipment services) that includes IT solutions such as its market-leading, urology-specific EHR used by over 2,100 providers seeing 18,000 patients daily and who have received more than $12 million in HITECH incentive payments. Its UroChartEHR and MeridianEMR were among the first EHR products to earn certification. Features include hundreds of templates and treatment plans specific to urology, pre-programmed urology terms, an easily understood user interface that requires minimal training and offers a one-screen patient encounter, PQRI, eRX, a sketch pad, device integration, built-in practice analytics and economics analysis, and remote access via iOS and the Web. HealthTronics joined Endo Health Solutions in 2010. Thanks to HealthTronics for supporting HIStalk.

Mrs. HIStalk dragged me to my once-a-year trip to the mall this weekend since I needed some new cooler weather clothes. I noticed that a Microsoft Surface kiosk is scheduled to open there shortly (in the mean time, it was serving as a place to deposit partially consumed cups of coffee and food court trash). The tablet is scheduled to ship on October 26, but pre-orders have sold out. Microsoft is getting killed as iPads have eroded sales of Windows-using PCs (Apple is the #1 PC maker in the world if you consider an iPad a PC as many consumers apparently do) and they need Surface to stop the bleeding. It comes in two versions: one that’s priced similar to the iPad running Windows RT (which has a micro-percentage of the number of apps as the iPad and a questionable apps ecosystem to compete with iTunes) and an expensive Surface Pro running Windows 8. I don’t see it making a dent in consumer iPad sales or even those of Android devices, but Microsoft’s one advantage over Apple is enterprise credibility. I would say their best chance for Surface success is that companies push off employees demanding to use iPads by offering Surface as an less-desirable but acceptable enterprise alternative. Otherwise, I expect few consumers to pony up $499 for a Surface RT tablet (not including the $100 keyboard) with they can get an iPad for the same money. If you can’t beat Apple on price, you’re screwed, because they own the customer experience.

T-System is on a roll with its funny HIT-related e-cards.

John Glaser of Siemens Healthcare wins CHIME’s lifetime achievement award. Above is a photo of the occasion taken by Ed Marx.

Also at CHIME, Ed Martinez, SVP/CIO of Miami Children’s Hospital, is awarded CHIME’s Innovator of the Year award.

A newspaper covering the highly publicized opening of the Massachusetts HIE provides a good reminder of where healthcare stands compared to other industries: “To those in fully automated industries, like banking, the state’s rollout of a new health information network last week must seem sadly behind the times … the experience can leave anyone who has ever used an Internet driven technology like Facebook or even simple email wondering just how exciting it can be to send one file electronically from one organization to another? Very exciting, say those in the health care profession.”

Athenahealth shares took a dive Friday as investors reacted to earnings that were improved, but increased less than expected following its Proxsys acquisition. ATHN closed at $73.31, down more than 8 percent to levels last seen in June. In the earnings call, Jonathan Bush blames Epic for extending the company’s sales cycles and a lowering its close rate:

They go out and sort of do some Bush Doctrine, saying, “In three years, we’re going to be live with this thing, and it’s going to slice and dice and bring world peace. You’re either going to be on it or not allowed in our hospital … you’ll be cut out of our ACO. You’re going to not be clinically integrated with us if you’re not on this thing.” … I believe that all of the banks in America may not be on one instance of one software, and yet all of us can stumble up to any cash machine we want and exchange information. It’s a ludicrous, pre-Internet idea.

El Camino Hospital (CA) provides most of the funding for a group that’s trying to defeat a November 6 ballot measure called Measure M, which would cap ECH’s executive compensation as a tax district-supported hospital. ECH’s CEO makes $700K and can earn a 30 percent bonus. The measure was proposed by the SEIU labor union, which says it’s less interested in that topic now since another bill has earned its undivided attention – one that would limit the ability of unions to raise money for political candidates.

Quite a few readers are fans of snarkmeisters The Onion and feel-good TED talks that tend to be long on inspiration but short on applicability, so here’s what happen when they meet. “I’ll be your visionary, and you do the things I come up with.”

The parents of an 8-year-old boy sue a Chicago hospital for pronouncing their son dead and taking him off life support for five hours until the patients insisted on a cardiac ultrasound that showed he was actually alive. Family members said doctors told them that the boy wasn’t actually opening and closing his eyes – it was just the medications he’d been given that made it look that way. The hospital says he really was dead, but they’re happy that his heart function returned spontaneously.

Sponsor Updates

• Medicomp hosted the two-day MEDCIN U for 32 EHR developers and vendors last week in Reston, VA, teaching attendees about integrating the company’s MEDCIN engine and Quippe into their applications. That’s Medicomp CEO Dave Lareau and Clinical Architecture CEO Charlie Harp above.
• EHR vendor Prowess will use the OrdersAnywhere CPOE product from Ignis Systems for lab orders, results, and lab integration. OrdersAnywhere has been integrated with 120 lab and radiology systems and is being used to satisfy Meaningful Use Stage 2 orders requirements.
• Quest Diagnostics announces that it has certified the first 20 EHRs under its Health IT Quality Solutions program that recognizes EHRs that share data with Quest’s clinical laboratory system. The full list is here.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

HIStalk Interviews Trenor Williams MD, CEO, Clinovations

Trenor Williams, MD is is CEO and co-founder of Clinovations of Washington, DC.

Give me some background about yourself and the company.

I’m a family practice physician. I’ve been in healthcare for about the last 20 years and in healthcare consulting for the last 11, working with large IDNs and government organizations both in the US and abroad. I left a clinical practice that I loved at a ski resort in California because I truly believe that clinicians — and specifically physicians — need to have a role and be a part of the solution rather than just bystanders along the way.

I’ve had the opportunity to work with large management consulting firms like Healthlink IBM and Deloitte. Five years ago, with Anita Samarth, I started Clinovations as a collaborative, really a networking group of clinical leaders, CMIOs, CMOs, and operational leaders in the DC and Baltimore area. It was an opportunity for us to share our thoughts, solutions, and struggles, sometimes, with a bunch of like-minded individuals. 

In 2008, Anita and I started Clinovations as a clinically-focused advisory consulting firm,  working with IDNs, federal organizations, pharmaceutical companies, payer organizations, and technology vendors. I really believe that we’re at the intersection of healthcare and healthcare delivery. We act as integrators, translators, and guides between those multiple different groups.

Companies often have a clinical person or two on staff, but I don’t know of many large ones that are all physicians and clinicians. What do you do differently than you did for the firms you left?

When Anita and I started it, it was just the two of us. We’ve been able to grow the company to 100 employees and consultants, and 60 percent of those people are clinicians – physicians, nurses, physical therapists, and other clinicians. We’re fortunate that half of our team live here in the DC region, but we’re delivering work around the US. 

Because of our clinical focus and our understanding of care delivery, clinical workflow, and the impact of technology, we believe that that practical on-the-ground experience is unbelievably valuable for our partner clients who are going through some of the most diverse and challenging experiences from a healthcare delivery standpoint. We have healthcare executives, CMIOs, CIOs, practicing physicians, hospitalists, emergency medicine doctors, nurse executives, management consultants, and trained researchers all together. I truly believe that that combination of skills helps us focus on the strategic for our clients, but then roll up our sleeves and provide on-the-ground tactical support to execute the approaches that we help them develop.

There’s mixed opinion on whether software vendors adequately use clinicians in roles where they can be valuable. Are they as good at using their clinicians as Clinovations?

I think that’s a “depends” answer. Many of the software vendors have a really nice focus with clinicians. I see them used in three ways.

One is from a technical development standpoint — software development. Another is sales, so demo docs and demo nurses. The third is management consulting and helping with clinical engagement and delivery. The vendors that use physicians specifically and nurses in those positions do well.

My experience has been that they don’t have the bandwidth to do it for all of the clients that they would like to. We’ve been able have some really nice relationships with vendors and have been able to partner with them to provide some of that clinical leadership.

Most of the people running vendor companies came from the sales side of the organization instead of having a technical or clinical background. Clinicians may take a vendor role not knowing that in some companies, the focus is going to be on selling and implementing product rather than worrying about the clinical considerations after it’s live.

I couldn’t agree more. Where clinicians want to make an impact is on the care delivery side. Whether you’re at a vendor, a consulting firm, an IDN, or in a practice, it really is about how you effectively use that technology, and ideally, how we deliver better care at an individual level and for populations of patients. For us and our  vendor partners, that’s our goal — how can we help organizations design a system and design processes to deliver better care at the end of the day?

You worked on a medication clinical decision support book that HIMSS published. What were some of the findings that came out of that?

There are several. Jerry Osheroff did a great job of organizing a large number of individuals to help support the most recent book a few years ago.

One is helping to make sure that organizations have governance. I don’t mean an organizational structure, but truly a way to prioritize their decision making and then formally and structurally think about how they’re going to get value from the decision support that they use. I don’t think that that is common. It’s easy to fall into the trap of looking to an alert or a reminder as the solution in electronic health records for a specific disease or a group of patients.

Jerry and the other authors, I believe, would agree that if you start with which questions you’re trying to answer and problems you’re trying to solve, prioritize your decision support and whether that links to evidence — whether it’s patient education or provider education materials — and then as a last resort use an alert or reminder to help a provider at the point of care, you can develop a comprehensive solution to treat that individual patient better and that type of patient better as well.

Do you think that consideration of the evidence and attention to the content usually happens after go-live because nobody wants to hold up the go-live to build it upfront?

I think that there is some focus prior to go live. One of the things that we’ve been able to do is focus a lot on evidence-based content development – specifically, order sets or Interdisciplinary Plans of Care (IPOCs) — and develop those ahead of time.

I think in some respects, clinical content development is like a Trojan horse for a clinical engagement. One of our most recent clients had over 1,000 clinicians involved from seven different hospitals to develop over 350 evidence-based order sets in a 10-month period. That’s unusual, but I also that that focus leads to developing the foundation for them to move forward. To have gotten that many clinicians — physicians, nurses, pharmacists, therapists — involved in a process also was a great way to get them engaged in the project.

I would think that a lot of your future stream of work will come from that optimization, when the bolus of hospitals that have gone live in the past two years or that will go live in the next two years will need to use that platform to get the expected benefits, meaning they’ll need to move to practices that are more evidence based.

Three things there that you said. One is optimize. I think you’re exactly right, especially with the acceleration of implementations around the country. The expectation, and from the vendors as well, is that if you just get it in, you can optimize later. We think that organizations have to have a structured plan around that. It’s not just going to happen on its own. But you’re right — the opportunities to help organizations optimize the technology, their workflow, and the reporting will be unbelievably important.

The other thing that you said was value — getting value from these implementations. We expect and are seeing boards, chief executives, and chief financial officers asking about the return on investment from these implementations. When I say return on investment, I mean clinical, financial, and operational return on investment. That work is going to have to happen after the implementation, even if you build the foundation from the beginning. 

The third really is around what do you do with the data, thinking about analytics. There are plenty of folks that talk about big data, but for us it’s how organizations effectively utilize the data, review it, analyze it, and then help change the way that they deliver care dynamically. 

I think all three of those things are going to be really important as we move forward.

Organizations need both the IT capability to get systems in and also the relationship with clinicians to be able to ask the to change the way do business, which is why they bought the system in the first place. How hard will it be for the average hospital to convince physicians to change just because they have data suggesting they need to?

I think it can be challenging. One of the ways to counteract that is having clinicians involved from the beginning in systems design, evidence-based content development, evaluation of clinical workflows, review of training materials, and design of support plans. Engaging clinicians, helping them, and helping the implementation process be done with them and not to them is a huge piece of it. But even as you do that, there will be a large number who won’t be involved in that process.

Then it becomes after the fact. What’s in it for me? It goes back to that idea of return on investment, even on an individual clinician level. Clinically, how can you help me take better care of my patients, whether that’s providing evidence at the time of care or helping me looking at a population of patients? Operationally, how can you help me be more efficient?

The last thing I want to in an ambulatory practice is to spend an extra two hours after my busy clinic going back and documenting in the electronic record, or in an inpatient system, having to round on countless patients. How can you help improve that workflow, leveraging and utilizing technology to support better interaction and communication with all the different stakeholders?

When you’re called into a hospital to consider an engagement, what are some warning signs that things won’t go well?

If it’s only an IT department – CIO or director of IT leading the project– that we’re meeting with, that’s an immediate red flag. I believe that successful implementations are a partnership between IT leadership, operational leadership, and clinical leadership. That would be one of the first ones.

The second is evaluating and understand the experience of their team. Many times an organization’s folks on the ground are going through this for the first time. They don’t have experienced leaders — I’m not talking about outside consultants necessarily — but if they don’t have experienced leaders and project managers who’ve been through the trials and tribulations before, that’s usually a red flag. 

Thirdly, how much involvement does the vendor have? A lot of these vendor contracts are different, but I think the most effective vendors have truly become partners with the health systems, providing the right level of assistance — not nickel and diming their health system and practice clients.

Do you think the CPOE battle has been won?

I think it’s more of a war. I think some of the initial battles have been won, but I also think that there’s a long way to go. I think the expectation for physicians will appropriately continue to increase. 

Having physicians place orders electronically, we’re seeing consistently — and I think we as the industry — right above 90 percent in most places now. I think the systems are getting better and providing more efficiencies, but there’s still a lot of room to grow. The more that we implement these systems, the higher the expectations are going to be from our physician partners out there in the field.

What are some surprising or fast-moving trends you’re seeing that you wouldn’t have predicted a year or two ago?

Starting to think about how we leverage different technologies to support the continuum of care. This has been a real change in the last 12 to 18 months . The shift from just thinking about “my practice” or “my hospital” to now having to proactively think about the care that’s going to be delivered outside of my four walls. How do we start to leverage technology to support those improved communications — whether that communication is to an outside specialist, a primary care doc,  to patients or caregivers, or home health organizations — and helping to leverage some really new, innovative tools to do that.

I think the other interesting one has been the collaboration of differing partners — health plans, insurance companies — setting up NewCos with IDNs to provide and leverage some of the tools that they have to provide better care across the continuum. Pharmaceutical companies partnering with IDNs and analytics companies to look at public health management and how they can better support a large population of patients and pharma helping to support that. We’ve been fortunate to do that work with a couple of top organizations around the country, thinking about how you manage a population of patients and leverage technology to do that differently.

Do you have any concluding thoughts?

The world and the landscape of healthcare is changing so dynamically right now. We know that our clients are facing more and unmet challenges than they ever have before. We think it’s important to treat our clients like partners. We end up saying “we” more than “they.” 

We are passionate as individuals and as a company. I take pride in the work that we do and understand the responsibility that goes along with that. Our goal is to think strategically yet practically and deliver creative solutions. I’m proud of the team that we have in place and the work we’ve been able to do with our partners around the country.

Time Capsule: How the Layoff Grinch Stole Christmas: Clueless Management 101

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

I wrote this piece in January 2008.

How the Layoff Grinch Stole Christmas: Clueless Management 101
By Mr. HIStalk

You had a pretty good holiday, I bet. Lots to eat, good company, and that slow, post-Christmas week to revitalize (even if you were “working” … wink).

Some industry folks didn’t enjoy it. They found lumps of coal in their stockings. Actually, it was pink slips, courtesy of Scrooges in suits who laid them off right before Christmas.

I’ve both given and received the “your position has unavoidably been eliminated” speech. Neither was enjoyable. Losing a job (and taking one from someone, for that matter) is shameful and energy-sapping. You head home in a nauseating haze, pitiful work belongings in the trunk, trying to find the right words to tell your significant other and maybe your kids and your parents. Imagine doing that right before Christmas. False cheer and optimism abounds, at least until the stark winter sun goes down early and the panic sets in all over again.

Companies hand-pick employees to march out, of course. The official excuse is that the outstanding managers have skillfully discovered duplication and cancellable projects, leaving nothing but good times ahead once the unfortunate smoke has cleared.

Here’s how it really works. Some manager’s budget or sales projection proves to be wildly inaccurate. Nobody can come up with anything better than payroll cuts. The suits draw up a list of employees who appear to be unproductive, whiny, or rebellious, using the chance to make up for previously unaddressed problems. Extra points are assigned if the victim doesn’t seem like the sort to argue, sue for discrimination, or return with armament (the worst part of being laid off is realizing that management put you in the same league as those losers who got axed with you.)

Only shareholders and competitors love layoffs. Great management and sound strategic planning seldom involves headcount-cutting your way to profitability. Before you know it, quality slips a notch, cheaper but less experienced workers are hired, and management hunkers down to desperately manage one quarter to the next.

I’d buy a toaster from a company like that. Maybe toothpaste. Probably not multi-million dollar enterprise software where the future value of support and R&D has been built into the large upfront cost.

How a company handles layoffs tells you a lot about its competence and humanity. To do it right:

• Don’t use layoffs instead of setting and managing performance expectations.
• Cut the use of contractors and consultants first.
• Do it quickly, fairly, humanely, and not during November or December (duh).
• Don’t hide on Mahogany Row before, during, or after.
• Explain to the survivors how you’ll avoid doing it again.
• Sacrifice management’s bonuses and perks since they’re the ones who failed.
• If you have to lay people off more often than once every two years, lay yourself off and bring in better management.

For employees, layoffs are the new reality. We’re all contractors. Sometimes you get insurance and a badge with your name on it, but nobody’s getting the gold watch. So, think like a contractor:

• Immediately start looking for another job if your company violates any of the rules above.
• Keep your skills current, on your own time if necessary.
• Keep up with the industry, make contacts, and market yourself to find the next gig.
• Invest your money and try to develop secondary income stream so you aren’t one employer’s paycheck away from a financial crisis.
• Don’t neglect any of the above to work massive hours thinking that your loyalty will be reciprocated.

I worked the bluest of blue collar jobs during summers in college (I wore a hard hat and a uniform with my name on the pocket). The militant union ran the show, but one of its bigwigs told me in confidence, “Workin’ man don’t need no union.” I’d like to update his wise words with this century’s version: “Workin’ man or woman don’t need no permanent employer.” Defer your gratification at your own risk … there are lots more coal-bearing Grinches out there, but lots of opportunities as well.

News 10/19/12

Top News

AirStrip Technologies wastes no time in filing a lawsuit claiming that clinical mobility vendor mVisum is violating its remote monitoring patent, awarded September 11, 2012. Travis wrote about the patent on HIStalk Mobile at that time, musing about its potential effect on innovation against the backdrop of Apple’s $1 billion patent victory over Samsung. Travis said:

There isn’t an answer yet as to exactly how this patent will protect AirStrip or how it will affect other mobile health vendors developing solutions to enable remote, mobile viewing of physiologic data by providers. As a methodology patent, can AirStrip use it to protect the experience of viewing a EKG, zooming into specific leads, accessing relevant additional data at the at point in time? … It’s interesting to consider the potential of a company’s defining and protecting the experience of mobile patient data viewing. As we start to see more intuitive user experience design for providers, will a standard emerge and can it be protected, enabling a patent holder to require licensing of the its patents to mirror the user experience?

Reader Comments

From Iguana: “Re: MED3OOO leadership conference. I was pleased to hear McKesson exec Pat Leonard suggest that InteGreat may be the go-forward ambulatory EHR product for hospitals implementing Paragon. Another highlight was former Highmark CEO Kenneth Melani, who provided a terrific synopsis of healthcare reform and where it’s heading.” The MED3OOO folks say several hundred clients participated in last week’s National Healthcare Leadership Conference and Users Meeting in St Thomas, USVI.

From Ms. Kravitz “Re: HIStalk’s Must See Vendors for MGMA 12. How do vendors get on this list?” The“Must See Vendors” lists for MGMA and HIMSS includes those HIStalk, HIStalk Practice, and HIStalk Mobile sponsors who chose to be included (there’s no charge) and provided exhibit information. The MGMA list includes over 50 vendors. Most of them will have a booth on the exhibit floor, while a few others aren’t exhibiting but will have people available for one-on-one meetings.

From F. Jackie: “Re: LogiXML fake 1960s TV commercial. Totally cheesy, but I needed a good laugh and it delivered.” I like it.

From Awkward Debates: “Re: degrees. I’m considering a post-grad education and wonder how the industry, particularly the vendor side, views degrees. MBA? Health informatics? Finance?” Vendor side, I’d go with an MBA unless you’re interested in sales or the executive ranks, in which case degrees (advanced or otherwise) matter little and many folks in the job don’t have them. Health informatics is a good advanced degree or certificate program, but less useful if you don’t already have a clinical degree to pair it up with. My experience is that if you have good qualities (ambition, smarts, relevant experience) and make early connections then a degree doesn’t matter all that much, especially the higher you go up the ladder, and there aren’t many cases where the degree itself is going to get you a job that you couldn’t get otherwise except in technical areas. Personally, I’d say an MBA was my best investment, but the one I admire the most in healthcare specifically is an MPH plus a professional degree (physician, nurse, pharmacist, PT, etc.) We’re going to need public health expertise since you can’t fix healthcare while ignoring health.

From Academic CIO: “Re: Allscripts protest of NYHHC’s Epic selection. We had a similar experience with Cerner. After losing on all counts, including price (Cerner’s five-year cost of ownership was twice Epic’s), Cerner had the audacity to aggressively pursue a Freedom of Information Act request for all of our e-mails, notes, meeting minutes, and Epic-supplied documents in an obvious attempt to get competitive information on Epic. At the end of day, we didn’t have to give it them, but it cost us a great of taxpayer-supplied resources to comply with their request. This was one of many attempts they made to circumvent the selection process. I would never do business again with them under any circumstances.” As I wrote previously, it’s a high-reward, high-risk strategy for a vendor to try to force itself on a customer who prefers a competitor’s product. Maybe you get a desperately needed new client and keep Wall Street off your back for one quarter, but who’s going to invite you to bid in the future knowing your history of being a sore loser?

From In the Know: “Re: Arcadia Solutions and the Azara Healthcare spinoff. The Pohlad family will sell them to a private equity firm, with the deal expected to close November 1.” Unverified. Arcadia is a consulting firm, while Azara offers analytics. The Minneapolis-based Pohlad Family Companies, which made its founder one of the richest people in America, bought Arcadia in 2007, adding it to holdings that include the Minnesota Twins, real estate, car dealerships, and banks.

From Oh MyWay – Dust in the Wind: “Re: MyWay. Here’s the Allscripts letter sent to each MyWay client with the grim confirmation. Interesting that the letter wasn’t from Glen, but rather Laurie McGraw. I guess he has bigger issues trying to find a buyer for his company.” It’s a good deal (free) for those MyWay customers who want Pro, but it’s anybody’s guess as to the percentage of MyWay customers in that camp, not to mention that changing systems is always tough. Allscripts says everybody will be upgraded from January to September 2013, which seems ambitious given the tendency of practices to delay until the last minute. I’m curious: if you attended ACE in August, what was said about MyWay then? I assume MyWay clients weren’t forewarned even though Allscripts surely had already planned its strategy. Given that Allscripts says MyWay isn’t ready for Meaningful Use Stage 2 or ICD-10, what were customers led to expect? Still, it’s probably a good decision – Inga asked Glen Tullman an insightful question when she interviewed him on HIStalk Practice in April 2010:

It seems almost as if Allscripts really has two businesses, one that’s focused on the selling the inexpensive MyWay option to small practices through resellers and the other focused on selling to the large, integrated delivery networks and hospitals that subsidize the small practices and offering them the Allscripts EHR products. Explain the strategy and tell me how you avoid channel conflicts.

From Lady Pharmacist: “Re: National Health-System Pharmacy Week next week. It’s time for the annual shout-out to pharmacists and pharmacy technicians, who from an IT perspective are helping their organizations attest for Meaningful Use, closing practicing gaps, and helping with medication-related safety initiatives related to CPOE, medication reconciliation, barcode medication administration, and e-prescribing.” Consider it shouted out.

From Patty Melt: “Re: HIEs. This article from Crain’s Detroit reminds me of the Rodney King line – can’t we all just get along? Do you ever wonder what the cost to society is for lack of consensus and cooperation?” The article says that the state’s two biggest HIEs (Great Lakes HIE and Michigan Health Connect) are competing to become the statewide exchange and aren’t sharing patient information with each other. The CEO of Oakwood Healthcare says they’re happy with Epic and not interested in joining an HIE until there’s just one because they could connect with one that won’t survive. Beaumont, also on Epic, said the state needs to get more involved but healthcare reform will force information exchange in any case.

HIStalk Announcements and Requests

Highlights from HIStalk Practice this week include: Mount Sinai Queens (NY) implements Epic at its ambulatory care locations. MED3OOO and SRS provide updates on their user conferences. Patients who are comfortable accessing and understanding their health information online will use PHRs more willingly. A REC advocacy organization defends the Meaningful Use program. CBS Morning News profiles a pediatrician’s use of social media. Dr. Gregg ponders whether HIT is becoming passé. And as mentioned above, our HIStalk Must See Vendor Guide for MGMA12 is a must-read for anyone heading to MGMA in San Antonio this weekend. Nothing says I love you like a gift of Lucchese cowboy boots (since I am Texas-bound) or your e-mail address for our HIStalk Practice updates. Thanks for reading.

Speaking of MGMA, I will be posting conference updates starting Sunday night or Monday morning (depending, of course, on the quality of the Sunday evening parties.) Our exhibiting HIStalk sponsors will have signs indicating their support of HIStalk, so please take a moment to tell them thanks on our behalf. If you have any suggestions for sessions or exhibits I should peruse, let me know. Please also take a moment to share any conference comments you might have, as well as your photos. See you in San Antonio! E-mail me.

I was initially startled and then pleased to receive this HIStalk sponsorship announcement at my hospital e-mail address. I finally realized that it went out a broad audience, not just me. Inga got one too, and we agreed that it’s nice when a sponsor is publicly proud of supporting our work (as most seem to be). It made our day.

Welcome to Aprima, sponsoring both HIStalk and HIStalk Practice at the Platinum level. The company offers a certified, fully integrated, single application, single database EHR/PM solution along with RCM services. The template-free design is chief complaint-driven with adaptive learning capability. The company, which has a 14-year track record, is offering a timely deal (free license and data migration with a signed support agreement) to users of Allscripts MyWay, for which it provided the original code in 2008. A partial list of the nearly 1,000 enhancements Aprima has made to the product since then is here. MyWay customers and resellers can connect with the Aprima folks at MGMA next week or AAFP this week. Thanks to Aprima for supporting HIStalk and HIStalk Practice.

Welcome to new HIStalk Platinum Sponsor SuccessEHS. The Birmingham, AL-based company offers a Certified Complete EHR and PM that it says can prepare practices for Meaningful Use within 60 days, not to mention that its clients experience an average 11 percent in visit increases and a 19 percent increase in collections in the first six months. The company has been in business for 15 years and is profitable and debt free, with 425 clients and 4,200 providers. Calling support gets you an in-house employee sitting in Birmingham. They’ll be at MGMA next week, also presenting the results of their new practice survey on maximizing revenue. They’re also offering a white paper on healthcare reform (e-Prescribing incentive, Meaningful Use, ICD-10, PQRS). Thanks to SuccessEHS for supporting HIStalk.

I always hit YouTube to see what a new sponsor has out there, so here’s an introductory video from SuccessEHS.

Listening: new from Brooklyn-based Woods, sometimes labeled as folk, but to my ear is more 1970s-influenced trippy, jangly guitar rock with lots of hooks and thoughtful lyrics. I liked it even from the first listen. Best song to me: “Find Them Empty,” featuring wailing psychedelic guitars and keyboard work that could pass for paisley ‘70s bands like Strawberry Alarm Clock or Vanilla Fudge.

On the Jobs Page: Product Manager, Regional Sales Executive.

Acquisitions, Funding, Business, and Stock

Microsoft’s Q1 numbers: revenue down 7.9 percent, EPS $0.53 vs. $0.68, missing earnings estimates on continued weakening in PC demand and a corresponding drop in Windows sales.

Shares in Google dropped precipitously Thursday when the company’s financial printer filed its 8K report in the middle of the trading day instead of after hours as intended. Trading in GOOG was temporarily halted, but shares still ended up down 8 percent at the market’s close because of slowing revenue growth.

Trinity Health and Catholic Health East announce plans to merge, forming a new system with annual operating revenues of about $13.3 billion and 87,000 employees. Trinity’s president and CEO Joseph R. Swedish would head the new organization and Catholic Health East’s president CEO Judith M. Persichilli would be EVP. The organizations anticipate reaching a definitive consolidation agreement in the spring of 2013.

Sales

Australia’s UnitingCare Health will implement Cerner at the recently-opened St. Stephen’s Hospital, which claims it will be the country’s first digital hospital.

The 60-provider Mid Dakota Clinic (ND) selects athenahealth’s EHR, practice management, and care coordination solutions.

Wenatchee Valley Medical Center (WA) chooses Merge’s iConnect Enterprise Archive.

The University of California, Irvine Medical Center, will deploy MModal Fluency Direct and MModal Catalyst integrated with Allscripts Sunrise Clinical Manager.

People

RCM and consulting services provider Cymetrix names Jeffrey Nieman (Accelion) SVP of remote operations.

Alan Fowles, managing director of Cerner Europe and overseer of the first Cerner NHS installations, resigns after 11 years with the company.

RCM provider Office Ally names Daniel Wojta (United Healthcare) director of eSolutions and business development.

Health First (FL) appoints Lori DeLone (PatientKeeper) SVP/CIO.

Mobile PHR provider Cognovant hires Andrew Lambert (Press Ganey) as EVP of business development.

Lynn Danko (Lawson Software) joins Amcom Software as CFO.

Ambulatory surgical center and rehabilitation clinic software vendor SourceMedical announces the resignation of CEO Larry McTavish and the promotion of Ralph Riccardi from EVP/COO to president and CEO. The company announced last month that PE firm ABRY Partners had made a significant investment.

Standard Register promotes John King from VP of sales to president of Standard Register Healthcare. He replaces Brad Cates, who is leaving the company to serve as CEO at another company.

Announcements and Implementations

Omnicell and Cerner will develop interoperability between their products using CareAware iBus,  Cerner’s medical device connectivity solution .

HIMSS names the 91-provider Coastal Medical (RI) the winner of its 2012 Ambulatory HIMSS Davies Award of Excellence.

Kennewick General Hospital (WA) launches McKesson Paragon CPOE.

Baptist Memorial Health Care (TN) deploys EMC VNX and Citrix virtualization technologies in advance of its Epic implementation.

University of Kentucky Healthcare implements Harris Corporation’s Business Intelligence Documentation and Coding dashboard.

MedAptus announces the availability of its ICD-10 software suite.

Government and Politics

National Coordinator Farzad Mostashari, MD says the HIT Policy committee will review whether EHRs are leading doctors to overbill Medicare. He says repeated copying and pasting of patient information is “not good medicine” and wants to determine if EHR functions that prompt doctors to inflate their bills should be made “off limits.”

An Institute of Medicine report finds that the DoD and VA’s failure to create a sequential prescription number system has hindered joint EHR development at the co-managed Captain James A. Lovell Federal Health Center (IL). Because the DoD and VA have both agreed not to charge their respective EHRs, the departments are spending $700,000 a year for pharmacists to manually input prescription data. The IOM recommends that the DoD and VA avoid establishing other combined facilities until an integrated EHR is available.

The VA launches a contest to encourage the development of an appointment scheduling system to work with VistA EHR open source applications.

ONC announces availability of Cypress, an open source certification tool for testing the availability of complete or modular EHR systems to meet Stage 2 MU requirements for clinical quality measures.

As of September, almost 50 percent of all EPs and nearly 81 percent of hospitals have registered for the MU program. CMS also reports total program-to-date payments of $7.7 billion, including $4.8 billion to hospitals and $2.6 billion to eligible providers and healthcare professionals.

Two weeks after House Republicans call for a freeze on all MU payments, four Republican senators request a meeting with HHS Secretary Sebelius to discuss the incentive program. The senators would like CMS and ONC to address four questions, including whether EHRs are increasing the volume of diagnostic tests and Medicare billings. One of those questions (above) indicates a lack of familiarity with the HITECH program, which did not require providers to buy anything at all to qualify for taxpayer-funded incentives.

Technology

eMDs launches its nMotion EHR iPad application.

Medsphere Systems contributes its MSC FileMan database management system to the OSEHRA open source community, which chose it for collaborative development work on VistA.

An article in MIT’s Technology Review says that medical devices in hospitals are regularly infected with viruses because vendors are so scared of the FDA’s requirements that they won’t allow hospitals to keep their operating system patches and antivirus software current. I’ve seen this personally: my former hospital had a nasty worm that was flinging itself with impunity from one networked system to another because our vendors wouldn’t allow us to apply any changes to their FDA-approved configuration (even including applying the latest antivirus update that was known to fix the problem). We had to take the entire imaging network and several systems offline to the extreme displeasure of our physicians, while the vendor said they might get us an answer in a few weeks. I told the network team to ignore everything they had heard and simply do what they knew needed to be done. We were worm-free within a few hours and I have no doubt patients would have suffered had we not ignored our vendor’s advice, albeit at our own risk.

Other

Former Beth Israel Deaconess Medical Center CEO Paul Levy, writing in his Not Running a Hospital blog, equates buying Epic to the Stockholm syndrome, where hostages develop affection for their captors. He concludes that Epic’s market share, driven by HITECH money, makes the company a target for Congressional retribution if a system malfunction harms patients. He also complains, “How did this firm get such a big share of such a critical market with no government review?”

The local paper covers Michigan-based HipaaCat, an image sharing and messaging app developed by a plastic surgeon.

Dan and Colin from Divurgent said Olympic bling-bearers Kerri Walsh Jennings and Misty May-Treanor were “great fun and great sports” in posing with attendees like themselves at CHIME 2012 this week. They (Kerri and Misty, that is) look a lot different with sunglasses off and clothes on.

In England, a healthcare trust that’s in such serious financial straits that it may be dissolved takes heat from the local paper for sending five managers to the Cerner Health Conference. The paper couldn’t find a source to back up its predetermined editorial outrage, so it quoted some guy who whose partner “does not wish to be named who worked as a nurse at Princess Royal Hospital.” It also seems to find a sinister connotation to KC’s power and light district, which it repeatedly places inside quotation marks as though it’s a code word for a hooker-staffed crack house. Must have been a slow news day.

Weird News Andy thinks maybe someone misspelled “birth” as “berth” in this story: a woman delivers her one-month premature baby in a Philadelphia subway car in which she is the only occupant. She calmly walks off the car and finds a police officer, who says the newborn girl “took on her personality” in exhibiting the same calm demeanor as her mother as they were taken to the hospital.

Tweets from CHIME

Heard in the hall – with healthcare consolidation there will be a lot fewer CIO positions available in healthcare. #cio #CHIME12

— Steve Huffman (@SteveHuffmanCIO) October 18, 2012

@farzad_onc shouts out to #CHIME12 for response to the republican letters on #HealthIT

— Nick van Terheyden (@drnic1) October 18, 2012

Magical thinking: National patient ID for under 65 and poof all of our patient matching problems will go away @farzad_onc #CHIME12

— Gienna Shaw (@Gienna) October 18, 2012

#CHIME12 breakout–more organizations today want CIOs with a clinical background.

— Nicole Kerkenbush (@OTSG_CMIO) October 17, 2012

Sponsor Updates

• PatientKeeper employees donate services, goods, and cash to help a Boston-area homeless family move into a furnished apartment.
• GetWellNetwork launches its Transformative Health blog with an introductory post by CEO Michael O’Neill, Jr.
• Intelligent InSites shares best practices for deploying an enterprise-wide RTLS during an October 25 Webinar.
• Infor opens its new headquarters in NYC and unveils updated branding. Also, the Institute for Transfusion Medicine (PA) upgrades its Infor Healthcare Revenue Management solution to integrate with its outpatient records and receivables solution.
• Oregon Medical Association will offer Dr. First’s RcopiaMU e-prescribing services to its members.
• Emdeon releases a white paper on payment collection best practices for small physician offices.
• Teradata will integrate QlikView in-memory data with Teradata’s Integrated Data Warehouse via the QlikView Direct Discovery  utility.
• Physicians in Costa Rica’s public health system use DynaMed’s clinical reference tools to create national breast cancer guidelines.
• Quality IT Partners sponsored last month’s 2012 Hillman Cancer Center Gala in Pittsburgh.
• Imprivata announces 10 additional sponsors of its Imprivata HealthCon 2012 User Conference next month in Boston.
• Cancer Treatment Centers of America and CareTech Solutions present a case study on the need for clinical help desks at this week’s CHIME CIO Forum.
• American Well CEO Roy Schoenberg and Allscripts CMO Douglas A. Gentile discuss the benefits of integrating American Well’s telehealth offer with EHRs offered by Allscripts.
  McKesson integrates RelayHealth’s procedure and test results functionality into its Practice Choice EMR and financial management software.
• T-System announces six winners of its T-System Client Excellence Awards.

EPtalk by Dr. Jayne

Researchers at Duke University create a 3D training application for transesophageal echocardiography for anesthesiology residents. It runs only on the iPad, leading one researcher to state that it would have greater effect if it worked on multiple platforms.

Speaking at the American Academy of Family Physicians annual meeting in Philadelphia, Farzad Mostashari encourages physicians to “turn the tables” on vendors that aren’t addressing interoperability issues. He reportedly advised users to report vendors to certification bodies. Considering the rank-and-file primary care physicians I work with every day, I’m not sure many of them are savvy enough to understand the certification requirements, let alone to become whistle-blowers. I’d rather see physicians spending their time learning to use their EHRs efficiently to deliver quality care. I invite my family physician readers who may have heard the speech in its entirety to weigh in – don’t worry, I’ll keep you anonymous.

The Breast Tissue Screening Bra from First Warning Systems has been designed to detect minute temperature changes in breast tissue that may indicate cancer via sensing the growth of new blood vessels. Temperature data is uploaded to the Internet and algorithms provide a reading to the patient. FDA approval is pending, but release in Europe is anticipated next year.

An impending change in the ranks of Medicare administrative contractors prompts concerns from providers that payments could be delayed. CMS is in the process of re-bidding contracts for claims processing, program enrollment, and other administrative functions in several regions. During a 2008 change, some payments were delayed for six to 12 months. Given the rigor with which CMS audits providers and the narrow tolerances in which we must perform to get paid, it would sure be nice if they held their contractors to the same standards. If we don’t file promptly, we don’t get paid – maybe if they don’t pay promptly, they should be fined.

I have to admit that I’ve been jealous reading about Inga’s plans to attend the MGMA meeting in San Antonio next week. I’m trying to find a way to sneak away for a day so the two of us can make a pilgrimage to the source of some of the hottest boots known to (wo)man. I had a chance to buy these beauties last year and flinched. Cross your fingers!

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Collective Action 10/17/12

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

Not an App for That

While listening to the radio recently, I heard about a new app called the Super Pac App (as far as I can tell, it is only available for Apple products, go figure.) It got me thinking about how I wish I had this ability in all areas of my life.

The app provides information relating to political ads. It is, of course, an election year, and ads are flying around in both traditional and social media. The app will tell you the following: the validity of the ad, the funding source, who it benefits, and what the ad wants you to believe. Simply stated from their website, "The Super PAC App is a simple way for you, the voter, to bring transparency to the 2012 presidential campaign."

Wouldn’t it be nice if we could apply this app to all areas of our life? What is my wife really trying to say when she casually mentions that there are still coffee grounds in the coffee maker? Why doesn’t she just say that she feels it is my responsibility to empty the coffee maker since I am the one who makes it in the morning? I would like to use this app like Siri: “Super Pac App, what does my boss mean by that statement?" That would be awesome!

Unfortunately, there are no magic apps we can download to help change the effectiveness of our communication forever. There is a reason why communication is very challenging and whole are fields dedicated to the study of it.

In our IS department, we try to tie our core values to everything, especially communications.  Our core values are honesty, transparency, unity, and integrity. Every time I walk away from a conversation (especially a group discussion), I think about the impact of that discussion and whether or not our core values were on display. Sometimes it is an intentional thought. Mostly, it is that gut feeling or instinct a lot of us rely upon. That gut instinct in this case is rooted in our core values.

As I was writing this, the red car syndrome hit me. You know how when you buy a red car, suddenly you see a lot of them on the road? The increase in red cars is not accurate, of course. Because of your focus, you are more aware of them. 

The red car syndrome has delivered a lot of communication-related articles to me, most of them spot on and with several small, important steps an individual or group can take to increase effectiveness. None of them, however, addressed authentic communication, as I like to call it. When you walk away from a conversation or a presentation, you generally know if the presenter or other person was honest and trustworthy.  

If two people in the same day delivered the same news or information to you but you knew one of them was shady and the other was honest and trustworthy, who you would go to for follow up questions or comments? Easy answer, right? That’s the point.  

Now here is a hard statement. If that is true for you, then it is true about you as well.  

Uh-oh, I’ve crossed the line, gotten into your space, stirred you to look inside. Sorry about that, but you need to know that others are looking inside every time you talk to them, regardless of the circumstance.

I am kind of glad this transitioned into a conversation about you and me, because that is where all change begins. I have worked for several organizations by now, as most post-industrial age professionals do. In most of them, I have had issues with management and decisions made. I have made a commitment however — a commitment to making myself better regardless of where I might find myself. 

The good thing about that commitment is that it works everywhere. Let’s bring that back to communication. If I think that people around me are not communicating effectively or are not very trustworthy or honest, I can either complain about the situation or dedicate myself to being trustworthy and honest and using my influence to bring positive change (that’s right, no matter where you are in an organization, you have influence.) When communicating, communicate with others the way you would like to be communicated with. The power of positive influence is strong. Sometimes slow, but always strong.

In my last post, I mentioned the frantic change in healthcare IT today. Research shows that one of the keys to successful change management is communication. If communication is key, then the last thing this industry needs is for people to walk away from conversations second guessing what has just said because they are questioning someone’s character.  

I could easily parrot other published articles here and give you five quick points to help your PowerPoint presentation. That would be fun and provide value. The harder road leads to the core of the matter and recognizes that your character, above everything else, impacts the effectiveness of your communication.

This may not make me many friends, but that is not the reward I am going for. I am striving for something greater. I am determined to effect change in an industry that is in the middle of historic transition and needs great leadership.

The higher up you go in an organization, the more circles you may be exposed to, but sometimes I find the best impact and the biggest influence usually happens around a coffee cup. You don’t need to be high up to have influence and effect positive change. You just need a coffee cup and a few minutes. Sprinkle it with honesty and trust and your message becomes clearer.

It is no different in a group setting. If you are presenting in a group, a lot of people will be "looking in." If that group even senses dishonesty or lack of integrity, the message is blown regardless of how important it is. The core of communication is not what you say — it is how you say it.  What you are saying may be critically important, but what people walk away with is always the “how.”  

Some people are master communicators, but if you do not trust them and you feel there is an angle, how effective are they, really? I would rather be bored to PowerPoint death by an honest, trustworthy person who desperately needs Toastmasters than to be wowed by someone with an angle and a personal agenda.

Keep it real. Keep seeking improvement. Commit to making yourself better regardless of circumstance and you will find yourself experiencing positive change in your communication skills and beyond. Character delivers much more than any app ever will.

Bill Rieger is chief information officer at Flagler Hospital of St. Augustine, FL.

Readers Write 10/17/12

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

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

ONC Moves on Data at Rest
By Frank Poggio

ONC recently published the draft of the new Stage 2 certification criteria for data at rest — or as they call it, End User Device Encryption Test Procedure 170.314(d)(7). With the almost weekly stories about stolen notebooks, lost thumb drives, and missing data CDs while the new HIPAA audits get underway, this new criteria are no surprise. But as understandable as the ONC goals are, the implementation of 170.314(d)(7) may give system vendors fits.

Per the published ONC test script, there are two ways for a vendor to meet this criteria:

1. If, while your Complete EHR or EHR Module is active you allow data to be moved to external devices, then your system must do it using a FIPS 140-2 (AES 256) encryption algorithm. The data on the device must stay encrypted and only be allowed to be de-encrypted by authorized personnel. Encryption must be the default setting.
2. Or, your system must prohibit any movement of PHI data to external devices.

To pass the new Device Encryption test procedure, you must have either one of the above capabilities embedded in your system.

Here are just a few possible problems you might encounter from a vendor’s perspective under Scenario 1.

If you are currently using a full system encryption tool such as BitLocker under Windows, this will not work for external devices, so you’ll have to move to other third party products such as TruCrypt or 7Zip.

If within your application you support user-generated SQL searches and tools like Crystal Reports, then the reports that the user generates will only be allowed to be copied to external devices (thumb drives, note books, tablets, etc.) if the reports are properly encrypted. The same is true for images, care notes, instructions, etc.

It can get more complicated if you have a patient portal and allow me to download my personal info to my personnel tablet. Will you encrypt the download? And then give me the key to allow me to view my information after I have signed off from your portal? Will my tablet support your encryption tool? If on the other hand you (the vendor) do not support downloads, yet I undertake that step on my own (e.g. use screen print), then per ONC the vendor is not responsible.

If all that seems too complicated to deal with, as noted earlier, you could go for Option 2 and prohibit any movement of PHI to external devices. You allow clients to see reports on screen but not move /copy them. No transfers to Excel or Crystal and no screen dumps. Already I can hear the roar of client complaints.

On a positive note, ONC does say that the vendor must supply the provider with this capability, but it is up to the provider to use it. This new criteria also state if a provider manages to accesses your application data outside your application, you are not responsible.

Finally, included in the last set of Stage 2 test criteria there was a another new one called ‘Safety Enhanced Design’ (170.314(g)(3). I’ll cover that one next time. You can see all the new Stage 2 test criteria here.

Frank L. Poggio is president of The Kelzon Group.

RTLS Offers Value Beyond Asset Tracking to Healthcare Facilities of All Sizes
By Barry Cobbley

HIMSS Analytics Vice President John Hoyt was recently interviewed regarding Real-time Locating Systems (RTLS) for an article that appeared at mhimss.org and healthcareitnews.com. The premise of the article is true enough—that RTLS offers significant ROI as well as improvements to patient safety, yet adoption among hospitals is lower than it should be.

However, other assertions simply miss the mark.

First and foremost, RTLS is discussed primarily in terms of asset tracking. It’s a common use, but forward-thinking healthcare organizations use it for so much more. Mr. Hoyt does mention “patient tracking,” but only as a way to relay completed stages of a patient’s visit to family. The article even goes so far to state that “RFID/RTLS has a lot to offer—but primarily only to hospitals—big ones, at that.”

This couldn’t be further from the truth. Large facilities like The Johns Hopkins Hospital will reap huge value from RTLS, but there’s plenty of evidence that small- and medium-size facilities benefit as well, and the value goes far beyond simple asset tracking.

What Mr. Hoyt seems to miss is that RTLS is not just about tracking. It’s about making healthcare more efficient through workflow automation. In this way, RTLS addresses a fundamental challenge that all healthcare organizations are facing: how to do more with less.

Large and small emergency departments, hospital operating rooms, outpatient clinics, ambulatory surgery centers (ASCs), long-term care facilities, and others successfully use RTLS to improve processes, giving providers more time with patients while increasing volume. They’ve reduced patient wait times and increased patient satisfaction. They’ve nearly eliminated phone calls and search times for patients, assets, and other staff members, allowing more time to focus on the patient. And in one of the most impressive use cases, they’ve automated EMRs, relieving skilled clinicians of tedious data entry.

I agree with Mr. Hoyt that the rate of RTLS adoption would certainly be higher in a healthcare landscape not focused on regulatory compliance. But the fact of the matter is that nearly one in five hospitals have already adopted this technology without a mandate. In other words, based strictly on merit. Those organizations that are truly internalizing the need to operate more efficiently are at the head of the adoption curve.

Take for example Memorial Hospital Miramar, a 178-bed facility in Florida, the first to automate Epic EMR with RTLS. Thanks to their work, RTLS was highlighted as a hot technology recently at Epic UGM. The integration automates the entry of important patient data normally typed manually into Epic (patient arrival, nurse/doc assignment, room/bed assignment, nurse/doc assessment complete, discharge time, etc.)

EMR automation is just one of several ways Memorial Miramar leverages RTLS. This community hospital is one of many who see the big picture of healthcare IT, where technology like RTLS improves efficiency and enhances patient care—far beyond finding assets.

Barry Cobbley is director of location solutions of Versus Technology of Traverse City, MI.

Strategies for Healthcare’s Successful Transition into the BYOD Era
By Brent Lang

Bring Your Own Device (BYOD) is a hot topic as companies across all industries are increasingly faced with allowing employees to use their own smartphones, tablets, and other mobile devices for work purposes. Within the healthcare industry, there continues to be a rise in the number of busy physicians, nurses, and other healthcare professionals who have consolidated their mobile devices to streamline the use for both work and personal into one. In fact, a recent survey of mobile device usage indicates that 84 percent of individuals across all industries use the same smartphone for personal and work issues.[i]

Despite this demand, security concerns have led hospitals and health systems to embrace BYOD in varying degrees. Some organizations permit employees within designated departments to use personal devices, while requiring other employees to use company devices designed specifically for unique healthcare settings. For instance, purpose-built devices or in-building wireless phones are relatively easy to manage, secure, and clean. Conversely, there can be great variation in employee personal devices and operating systems. This lack of uniformity will place an increased burden on IT departments as they seek to configure, manage, and implement both security and network changes on a plethora of devices.

Fortunately, various strategies exist to mitigate the risk caused by this rich diversity of mobile devices entering the healthcare work environment. For example, the use of Mobile Device Management (MDM) software, which can include password protection, software control, version management, remote wiping, inventory, and other security controls. MDM tools can also be used to create “enterprise partitions” in personal devices. This allows for an individual’s work-related applications and data to reside on a secured partition within the device, easily managed by the hospital or health system. Organizations may also consider storing patient information on a centralized enterprise server rather than on the individual device, or creating wireless local area networks (WLANs) specifically for personal devices to help limit network access.

Additionally, executives tasked with health IT purchasing decisions should only partner with healthcare communications vendors that make their applications “BYOD ready.” In certain circumstances, this will include encrypting all data while “at rest” and “in motion” and providing remote wipe capabilities. Vendors should also have the ability to monitor the security of their corporate data.

By and large, BYOD is having an impact on companies across all industries. Its evolution has unique meaning in healthcare, where a generation of internet savvy physicians, nurses, and other clinicians are bringing the promise of mobile technology to the bedside. To ensure the successful transition of the healthcare industry into the BYOD era, hospitals and health systems must carefully consider and adopt policy, software and infrastructure controls, and educational initiatives.

[i]Weber, M. (2012, August 14). BYOD Survey Results: Employees are not playing it safe with company data. 

Brent Lang is president and COO of Vocera Communications of San Jose, CA.

 ICD-10: Time to Act
By John Pitsikoulis

Now that the ICD-10 implementation deadline has been extended to October 1, 2014, time is ticking away as we move closer to the date. The extension was a reaction to intense pressure from the American Medical Association (AMA), hospitals, and others who reported that they need more time to implement the extensive changes. As the deadline loomed, many hospital leaders admitted that their organizations weren’t prepared for the ICD-10 transition.

Now that we have an extension, how can providers use the time wisely, especially as they are contending with other competing and conflicting priorities such as electronic health records projects, Meaningful Use deadlines, and IT system replacements that impact the abilities of organizations to stay on task with their ICD-10 activities? Now is the time for hospitals to go into overdrive and concentrate on their planning, strategic decisions and implementation activities.

Developing the ICD-10 project plan for complying with the deadline is the first step many organizations have accomplished. While there are some great resources for organizations to utilize for managing the assessment and implementation key remediation components, many organizations are relying on a “check the box” methodology for readiness and mitigating the risks associated with the conversion to ICD-10. While this is a good framework for project managing the global tasks associated with ICD-10 initiatives, this approach will not provide the organization with alternative strategic considerations or the content expertise that will complement the organization’s portfolio of strategic initiatives. The average organization’s resources are stretched so thin, they just do not have the bandwidth of personnel to manage all of the activities required to mitigate the risks.

Managing a multi-year enterprise-wide initiative is a monumental initiative that requires planning, preparation, collaboration, progress evaluations, and alternative decisions throughout the project’s life cycle. With any multi-year enterprise project, periodic evaluations of the plan, progress, and timelines are critical success factors for achieving the desired end goals. But how are you measuring the end goals?

For example; there is an industry shortage of medical record coders. The simple answer to meet the demands of the industry would be to train more coders. This might be a solution for the productivity issues associated with ICD-10, but how many CFOs would be comfortable with entry-level coders determining the organization’s reimbursement? Coding is more complex than simply assigning a code from a coding book – it takes years of education, training, and mentoring to be a seasoned coding resource. You may have met the goal of providing education and training, but do you have the confidence that after the coders, physicians, and other contributors are educated they will achieve the same level of proficiency they obtained with the ICD-9 system? Managing the clinical documentation specificity and coding quality requirements will be a continuous process that will require dedicated resources focused on clinical documentation improvement, operational process improvement, and financial analysis to ensure the organization is receiving the appropriate reimbursement under ICD-10.

How will your organization test for ICD-10? We know the testing focus for ICD-10 will be fundamentally different than 5010 testing. Even with the 5010 experience, the industry learned that validating the end result was not sufficient and a significant amount of content modification was required. ICD-10 will require changes to the IT infrastructure, which is the foundation for the organization’s business processes. More importantly, the content of the business transactions that are the core of the healthcare delivery, reimbursement, and data outcome models is being replaced with a new set of coding standards.

Standard testing for compliance with format and content will not be enough for a seamless transition. End-to-end testing with payors and trading partners will require a detailed inspection of the claims submission and adjudication transaction process, both from an internal and external methodology, to ensure that business intent and reimbursement requirements meet the anticipated results.

Testing functionality and content with payors will be a challenge that will be costly from a dollars and resources perspective. Close enough is not good enough when talking about revenue neutrality and compliance with billing guidelines. ICD-10 testing will certainly need to include end-to-end, cross-functional, bi-directional, internal and external testing activities. Additionally, ICD-10 will require coupling testing analytics with ICD-10 coding expertise to validate the results of the test transactions and expected revenue outcomes.

Hospitals must also take a hard look at their strategic approach when it comes to the ICD-10 transformation of the organization’s processes and technology. Emphasis must be placed on the tactical approach for education, clinical documentation improvement, testing, and data outcomes, etc. Organizations that focus on content and desired outcomes and not merely the steps to complete a task will achieve the benefit s of a highly trained workforce and a strategic and comprehensive ICD-10 business transition that covers every major impact area.

John Pitsikoulis is ICD-10 practice leader for CTG Health Solutions of Buffalo, NY.

Seven Things Most Important to Top Performers
By Frank Myeroff

Can you relate?

Recently, a leading HR organization conducted a survey of top performing professionals at a wide variety of organizations in order to understand what they find most important to them on their jobs. Overall top performers ranked the following seven as the most important things to them (industry or practice area did not matter):

1. Challenging and meaningful work. Top performers want to be engaged and energized by their work and organization. In addition, people generally want to feel a sense of achievement, responsibility, and to know that what they’re doing on a daily basis has some purpose behind it.
2. Compensation. Top performers want to make top dollar, and salaries that include bonuses and benefits ranked as very important. Also, regular performance reviews and salary reviews were included as part of compensation.
3. Job security. While job security is hard to come by these days, it is important for workers to avoid layoffs and declining salaries. Therefore, top performers found it important to have up-to-date skills, follow industry trends, and keep pace with their industry in order to bolster their job security.
4. Work-life balance. Top performers are looking for synergy between their personal and professional lives. The 8 a.m. to 5 p.m. schedule isn’t for everyone. They appreciate having a say over when they work and sometimes even where they work, including from home.
5. Career development. Technology innovations and fast-changing trends in any field are hard to keep up with. That’s why top performers value ongoing career development and training. It enhances their capabilities and sharpens their skills.
6. Leadership style. A manager’s leadership style is critical to a satisfactory work environment and production levels. To keep the best and brightest engaged in their jobs and performing at high levels, managers need to provide support, resources, and opportunities.
7. Advancement. A promotion is viewed as important and desirable because of the impact it has on pay, authority, responsibility, and the ability to influence broader organizational decision making. In addition, a promotion raises the status of an employee because it is a visible sign of esteem from the employer.

Frank Myeroff is managing partner and VP of business development and operations of Direct Consulting Associates of Solon, OH.

Wolters Kluwer To Acquire Health Language, Inc.

Wolters Kluwer Health announced this morning that it will acquire medical terminology content and mapping vendor Health Language, Inc.

Arvind Subramanian, president and CEO of Wollters Kluwer Health Clinical Solutions, was quoted in the announcement as saying, “Medical terminology management is quickly emerging as a core point-of-care market as hospitals, EMRs, and payers are increasingly focused on interoperability of systems to realize the advantages of healthcare information technology. Health Language has built a leadership position in meeting this important interoperability need. This acquisition allows Wolters Kluwer Health to enhance its current market leading point-of-care solutions and better position its customers to fully leverage existing and emerging healthcare quality and reimbursement initiatives. The acquisition also provides Wolters Kluwer Health with greater access to payers, key customers for various Health Language offerings.”

The Denver-based Health Language has 85 employees. Terms were not disclosed.

News 10/17/12

Top News

Massachusetts Governor Deval Patrick and other state officials celebrate the launching of the Massachusetts state HIE as the first medical record is transmitted from Massachusetts General Hospital to Baystate Medical Center. The Massachusetts HIway was funded by a $17 million federal grant. John Halamka writes about the significance, professional and personal, on his blog (his photo of the “Golden Spike” is above).

Reader Comments

From FirstHand: “Re: MModal changes. SVP of strategic business development Taras Silecky has left the company. Not sure if it is a one-off personnel change or a sign of restructuring following several acquisitions.” Unverified. MModal declined to comment, citing policies prohibiting disclosure of personnel information. His LinkedIn page says he’s still there, but those are notoriously unreliable.

From Allagash: “Re: Aprima. Aprima gave indication that they would have a direct migration from MyWay to Aprima. Not the case. Aprima says that the client needs to contact Allscripts and beg for the database, which won’t come easy since they’re trying to sell us Pro. I get the impression there’s a large fee as well.” Aprima President and CEO Michael Nissenbaum responded as follows: “Aprima offers a free software license and upgrade for MyWay customers with the purchase of an annual support and maintenance agreement. MyWay customers have a multitude of environments in which they reside, including hosted with Allscripts, hosted with independent hosting entities, as well as practices having their own servers. Aprima’s statements regarding our offer are based on the practice having access to their database and an ability to move it to a server / hosting location of their choosing. In most scenarios hosting is a service offering, and as long as the practice is in compliance with the hosting contract, they should have access to their database. Most companies do not hold the practice’s data hostage.” Specific details of Aprima’s migration offer are here.

From Scrooge: “Re: CIO cost pressures. Reports say that CIOs in all industries are having a hard time justifying the long-term operating costs for advanced systems. Hospitals are under pressure to cut staff and other costs due to Medicare cuts. Maybe a topic for a survey?” I would be interested in hearing from hospital IT executives on this issue in a bit more detail than a poll allows. Send me your thoughts and I’ll run them, anonymously if you so indicate.

From Cool School: “Re: Pulse. I received an e-mail indicating that Basil Hourani (director, president, and CEO) and Alif Hourani (executive chairman and CTO) are ‘retiring,’ leaving former CFO Jeff Burton as CEO. Lots of blah about amazing journey, innovation, vision, etc. Recall that they were bought out by Cegedim two years ago. Significance?” Unverified, but reported by several readers. The PM/EMR vendor’s web page has no news. I’ll defer to readers to comment.

From Shock & Awe: “Re: Will Showalter, VP/CIO @ Sisters of Mercy Health System in St. Louis. Left last week. Can you find out why? Everyone loved and adored him!” As mentioned below, Mercy (as the former Sisters of Mercy now calls itself) has replaced him with no explanation. I’ll update if he checks in.

From Magenta: “Re: Cerner Health Conference. The tagline was ‘because it’s personal,’ which I thought was a little ridiculous on all the signs and displays. I didn’t realize how much until I saw this sign.”

From Buffalo Tom: “Re: Health 2.0 and Stanford MedX conferences. Free recorded streams are available from a company called Learn it Live that’s trying to disrupt the learning market. The interview with Lumeris CEO Mike Long was especially inspiring – he said mercenary companies look for where to make the most money, while missionary companies want to solve big problems and hope to make money. Sign up for free, choose the ‘three CEOs’ session, and go to the 31.25 mark.” He’s fun to watch. He gives his e-mail address and invites people creating cool things to contact him because he doesn’t think the big companies are moving fast enough.  

From PC Doc: “Re: pharmacy chains encroaching on the practice of medicine. Walgreens has walk-in clinics whose mission is to sell what’s on their shelves, give vaccine injections, and now deliver meds to hospital bedsides to ‘curb readmissions!!’ I smell a coordination nightmare as patients get mammograms at the local retail pharmacies and pharmacists manage diabetes, not to mention that Walgreens is smelling profit while physicians are again asleep at the wheel.” It is interesting that just as we see EMRs taking a firm hold and interoperability taking a shaky one, now you’ve got disconnected non-EPs out there whose corporate parents may lack the interest or ability to share the medical information they’re creating. I don’t know how they’ll play in the ACO world, though – maybe they’ll just pick up the cash-paying business. Those with long memories may recall that the difference between EMRs and EHRs was that the latter were supposed to collect information from every potential point of healthcare service, but here we are years later still thrilled when docs working for the same health system can exchange information with the hospital and each other. That’s a problem with the proprietary EHR-centric model in which neither providers nor vendors have much reason to push their data out in a way that everybody can use it, and the further away you get from the traditional office practice, the less likely those providers are going to be on the grid. In other countries, patients are expected to keep their own medical records and bring them in – sounds primitive, but with all the technology investments we’re not too far beyond that here with our printout and faxes. Not to mention that at least in those countries, the patients are in control of their own information.

HIStalk Announcements and Requests

Going to MGMA next week in San Antonio? Here is our annual list of Must See Vendors. Inga will be there to pick up trinkets, make stealth observations, and post daily updates.

Welcome to new HIStalk Gold Sponsor Direct Consulting Associates and its sister organization Direct Recruiters Inc., both of Solon, OH. DCA offers IT consulting and staffing solutions (staff augmentation, temp to perm, and permanent placement), providing individuals or entire teams to help with Epic, Allscripts, Cerner, Meditech, McKesson, and other healthcare IT systems for short- or long-term contracts. DRI is an executive search firm with a healthcare IT practice that places top professionals (CXO, VP sales, sales rep, product manager, applications engineer, IT director, CMIO, etc.) The company’s site has a nice testimonial from Medicity that calls Director of Healthcare IT Mike Silverstein a “trusted resource” who doesn’t push candidates, but rather listens to understand the talent needs first and makes sure to present only the most qualified candidates. Thanks to DCA and DRI for supporting HIStalk.

Also supporting HIStalk is new Platinum Sponsor PatientPay of Durham, NC. PatientPay is an innovative, patented, Web-based service that addresses the physician practice challenge of managing patient balances. Practices can be up and running within 30 minutes of signing up online, with no IT help required to instantly integrate PatientPay into the practice management system. Patients review their balances and pay online by credit card, while the cost of managing paper is reduced by half. No upfront or monthly costs are involved, just a small, flat per-transaction fee that means they get paid only when the practice gets paid. The company’s goal is to be the most attractive patient payment solution for their ambulatory PM/RCM vendor partners. They’ve been around since 2008, and you may recall hearing a couple of months ago that David Bond (A4, Medic, Allscripts) has joined the company as EVP of sales and marketing. They’ll be at MGMA, so drop by and tell them you saw them mentioned on HIStalk. Thanks to PatientPay for supporting my work.

Speaking of my (endless) work, I’ve reluctantly reached the conclusion that I need more help to make HIStalk, HIStalk Practice, and HIStalk Mobile the best they can be while not getting fired from my hospital job. I’m interested in hiring someone, but I’m picky about capabilities: a stellar and fast writer, lots of energy, an enviable sense of humor, skill with social media, and knowledge about healthcare IT. Sometime with a full-time job probably won’t work since I need more hours. I’m looking for a self-starter who probably doesn’t need to be prompted about what to do next, but here’s a hint since it worked for Inga and Dr. Jayne: tell me why I should hire you while demonstrating the qualities I mentioned.

Acquisitions, Funding, Business, and Stock

The UK-based Wellcome Trust secures an equity stake in AirStrip Technologies.

Healthrageous, a developer of Web and mobile health apps for consumers,  raises $6.5 million in Series B financing.

Nuance discloses that it paid $230 million in cash for QuadraMed’s Quantim HIM division and another $265 million for JA Thomas and Associates, raising its 10-year acquisition total to 34 companies at a cost of $3.6 billion (Nuance’s market cap today is $7.2 billion). Maybe its best deal was paying $400 million for eScription in 2008 to get a strong healthcare foothold. Historians (hello, Vince?) may recall Nuance’s origins as a vendor of scanners under the ScanSoft and Visioneer names  — the PaperPort was all the rage in the mid-1990s.

UnitedHealth Group’s Q3 numbers: revenue up  8%, EPS $1.50 vs. $1.17, beating expectations of $1.34. Growth of its Optum division contributed to the $1.56 billion of quarterly profit, although the company warned of uncertainty about competition and the November election. Analysts say the company always sets conservative expectations, with one saying, “There’s nothing there that reform is going to hurt.”

Sales

Regional Medical Center at Memphis (TN) replaces its Cisco wireless network with Aruba.

Sigmund Software will embed OrdersAnywhere from Ignis Systems into its behavioral health EHR to manage lab orders and results.

Emergency Medicine Specialists of Orange County (CA) selects McKesson Revenue Management Solutions to provide billing and RCM for its 40-physician practice.

The Military Health System’s TRICARE Management Activity segment awards Four Points Technology a multi-year contract to facilitate an expanded rollout of RelayHealth’s Medical Home Support Package.

People

Richard Poulton (AAR Corp) joins Allscripts as CFO. An SEC filing discloses that Poulton will earn an annual salary of $450,000, a $450,000 annual bonus target, a one-time cash payment of $750,000, and stock grants worth up to $2 million. He’s also guaranteed double his salary and target bonus plus full equity vesting if terminated due to a change of control, which could be relevant if the company goes private as has been rumored.

Clinithink names Phil Davies (NHS Connecting for Health) CIO.

Mercy (MO) names Gilbert Hoffman (Maritz) VP and CIO, replacing Will Showalter.

Kathy Ebbert (Achieve CCA) joins Clearwater Compliance as EVP and COO.

Delta Health Technologies names Ben Clay (Prognosis Health Information Systems) VP of product development.

Announcements and Implementations

InterSystems Corporation and eHealth Technologies will offer offer single-click access to diagnostic quality images via the InterSystems HealthShare platform.

EXTENSION added 22 customers of its critical alerting and HIPAA-compliant texting solutions during the third quarter.

VersaSuite announces that its certified ambulatory EHR is the first to earn CCHIT’s certification for Clinical Research, with the capability to automatically determine if a patient is eligible for an open clinical trial.

UMass Memorial Health Care is working with with Informatica and MedCPU on a readmissions reduction project.

AHRQ awards the Oregon Health & Science University a $1 million grant to create smarter and better organized EHR systems.

NYeC and Partnership for New York City Fund select eight early- and growth-stage companies for its inaugural class of the NY Digital Health Accelerator. The winning companies, which were selected from 250 applicants, were each awarded up to $300,000, plus mentoring opportunities from senior-level hospital executives. The Accelerator program is expected to create 1,500 jobs over five years and attract $150 to $200 million in VC investment post-program.

North American Partners in Anesthesia partners with SIS to offer a combined AIMS and managed anesthesia services solution.

Electronic patient payment processor BillingTree announces a new partner program for solution providers interested in integrating a payment portal into their products.

Nuance Communications announces that its voice recognition technology is now integrated into Epic’s Haiku for iPhone and Canto for iPad applications.

Industry long-timers Bill Spooner, Bert Reese, and Colin Konschak are the editors of a newly published book called Accountable Care: Bridging the Health Information Technology Divide. It’s on Amazon for $89.99.

DrFirst launches Patient Advisor, a medication adherence solution designed to work with DrFirst’s Rcopia e-prescribing platform or any EMR or HIT solution.

DSS releases its Patient Search Tool Extension and Launcher to the Open Source EHR Agent via the Apache 2.0 Open Source license, enabling VistA EHR users to search for free text data within a chart.

Government and Politics

ONC names iBlueButton from Humetrix the winner of its Blue Button Mash Up Challenge to make personal health information for usable and meaningful for consumers. ONC also awards Apollo’s Pinaxis top honors in the EHR Accessibility Module Challenge for creating an Internet portal to allow patients to interact with any provider’s existing EHR system over the Web.

Other

Akron General Medical Center (OH) fires several employees for unauthorized access of computerized patient records following the fatal shooting of an ICU patient.

Epic will install six 262-foot wind turbines on its Verona campus that, along with its geothermal and solar systems, will allow it to generate 85 percent of its energy needs by 2014.

I haven’t watched Saturday Night Live for years, but this week’s skewering of the iPhone 5 and self-obsessed Americans in general was savagely funny. It’s slightly mHealth related, at least if you watch through to around the 5:00 mark for the punch line.

The Methodist Hospitals (IN) settles its 2011 lawsuit against FTI Cambio, HealthNET, and Meditech. The hospital hired Cambio to review its entire operation, part of which involved bringing in HealthNET to review its Epic implementation that had already cost $26 million. The lawsuit says HealthNet recommending dumping Epic and buying Meditech for $16 million because of lower maintenance costs. The hospital says the consultants lied in saying it would cost $25 million to finish the Epic project when in fact it would have been only $11 million. It also claims that Meditech never worked and caused a host of problems to the point that the implementation was abandoned in 2009.

The Italian hacker who turned to the Web for help with his brain cancer diagnosis has received 200,000 responses in a month from his Open Source Cure plea. The Italian government is interested in his project as an example of opening up medical records since he struggled to obtain his records and images in an easily read electronic format. He has decided to have surgery, but is talking to 40 doctors about which procedure to have, and will also follow a crowd-sourced diet in the hospital.

Sponsor Updates

• A study by Truven Health Analytics finds that hospital employees are less healthy and more likely to be hospitalized compared to the general workface, with their healthcare costs also running nine percent above average.
• Versus customer Northwest Michigan Surgery Center discusses its use of RTLS to maximize patient flow during an AHA Solutions Webinar.
• Liaison Healthcare launches its Healthcare Information as a Service solution suite.
• GetWellNetwork and Treatment Diaries partner to provide additional resources for patients during and after their hospital stay.
• ZirMed showcases its RCM solution at this month’s MedTrade, MGMA, NAHC and APTA conferences.
• Ninety percent of anesthesia providers believe that perioperative solutions increase success rates, according to a Surgical Information Systems-commissioned study.
• HIStalk sponsors earning a spot on Modern Healthcare’s Healthcare’s Hottest 2012 based on revenue growth include: ESD (1,455%), Allscripts (533%), Cumberland Consulting Group (328%), Merge Healthcare (213%), Beacon Partners (172%), and The Advisory Board Company (92%).
• MEDSEEK moves to new office space in Fitchburg, WI after almost doubling its Wisconsin operations over the last year.
• Two teams of Craneware employees spend a week Peru volunteering with medical staff at the Villa la Paz Center for Destitute and Sick Children.
• Aspen Advisors principal Guy Scalzi discusses HIT governance at this week’s CHIME Fall CIO Forum.
• Digital Prospectors Corp wins a subcontractor role as part of a $15 billion Alliant Small Business Governmentwide Acquisition Contract.
• MModal partners with the BigHand Group for next month’s BigHand Healthcare user conference on digital dictation, speech recognition, and clinical correspondence system .
• A SuccessEHS survey of MGMA registrants finds that the majority are losing revenue due to four problems: clean claims, same-day collections, preventable denials, and underpayments.
• Klinikum Weis-Grieskirchen Hospital (AU) reports saving 10-20 seconds per login session with Imprivata’s OneSign single sign-on solution.
• NextGen adds Logi Info from LogiXML as its embedded actionable analytics tools within the NextGen Dashboard product.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Curbside Consult with Dr. Jayne 10/15/12

It’s been a rough couple of weeks around the hospital with several ambulatory practice go-lives. It’s also the last time this year that Eligible Providers can start their Meaningful Use attestation periods.

We had a couple of affiliated physicians decide at the last minute that they wanted to give it a try. Since my hospital never says no, the team had to scramble to get everything in place for them to be ready to report. Everyone is so afraid of the audits that the level of documentation being produced to support attestations is simply staggering.

Whenever there’s an increased work load in my day job, I find myself spending more and more time on Twitter and other social media sites just surfing around and trying to get my brain to shut off for the night. I also end up sifting through little notes I make throughout the week reminding myself of potential content for HIStalk. Many of us should be glad that we work in IT because it somewhat insulates us from being on the front lines. Here’s tonight’s highlight reel:

• Healthcare “feel bad” story of the week: A Detroit paramedic lands in hot water after giving a blanket to an elderly fire survivor who escaped his home wearing only his underwear. This is a great parable for preventive medicine. It sounds like the powers that be would have preferred to have to treat the man for hypothermia and transport him to the hospital instead of keeping him warm in the first place.
• The supersonic skydive: I’m eager to see the data they gathered regarding human physiology in extreme conditions. I have a soft spot for space exploration and am also excited about potential new technologies to help astronauts in the event of a catastrophe.
• Healthcare “gross out” story of the week: The New England Compounding Center fiasco, which has led to hundreds of sick patients and at least 15 deaths. While I’m being audited to make sure my recommendations meet strict guidelines and that I check meaningless boxes to meet federal requirements, these guys are completely unregulated at the federal level.
• Black market silicone injections: I spend a good part of my day telling patients that their backsides are too big and they need to lose weight. Another chunk of time is spent with patients who are trying to fight me about the costs of preventive care and screening tests. And yet, there’s a subset of the population out there who is willing to give thousands of dollars in cash to charlatans selling illegal cosmetic treatments to plump up their posteriors. Some of the substances injected by perpetrators: hardware-grade silicone, mineral oil, Fix-A-Flat tire sealant, and furniture polish additives.
• Proofreading is dead: The editor of CMIO Magazine (now Clinical Innovation + Technology) pens an article about their recent CMIO Leadership Forum. Unfortunately, her headline copywriter doesn’t know the difference between a marquee and a marquis. Farzad is definitely a headliner, but now I’m excited to learn he’s also a nobleman.
• Too much standardization is just too much: I received my flu shot recently at an occupational health clinic where I received it last year. I was handed a patient demographic form (clearly printed from their billing system, because they hadn’t replaced the vendor’s logo with their own) and asked to verify the contents. My employer information was completely incorrect, so I made sure to mention it to the receptionist rather than just handing back the clipboard after I marked it up. I work for a large health system with hundreds of locations, but know for sure that we don’t have a building at the address that was listed. The explanation: they wanted to standardize their master files, so they only allow one location for any given employer name. I can buy that, but if you’re going to do so why not choose the address of the corporate headquarters at least? I hope they never have to call me at work, because I didn’t recognize the phone number either. I’m also not sure why they wanted me to waste my time updating it if they have no ability to correct it.
• D’oh, I can’t believe I missed this: I ignore a lot of e-mails I get from certain organizations, simply because my mailbox is so full it’s barely functional. As the days get shorter I can’t believe I missed that the AMA 2012 Interim Meeting is in Hawaii in a few weeks. It would have been a great opportunity for some sunshine and a tax-deductible trip to stock up on material.

Let’s hope this week is better than the last few. Thank goodness I have a vacation coming soon!

E-mail Dr. Jayne.

EHR Design Talk with Dr. Rick 10/15/12

The View of the Patient over Time

Until now, all of my posts have dealt with EHR user interface designs for a single patient encounter. In other words, they have been designs for displaying a snapshot of the patient’s health at a single point in time.

An electronic health record, however, is fundamentally a longitudinal record – a record that includes both the present and the past medical history. The record is updated as events, interventions, and health changes occur.

The electronic health record can be thought of as a cognitive tool for understanding and reasoning about these past and present health events to make the best decisions going forward. If you accept this premise, then in rethinking EHR design, even before considering usability or functionality, the most important question should be:

What user interface designs do the best job of presenting the patient’s past and present history and findings? How does a physician make sense of all the disparate information that accumulates in a patient’s chart over time?

There are two fundamentally different EHR user interface designs for presenting a patient’s story.

The design used by most EHRs places emphasis on the patient’s present state of health. In this design, each category of data (Problem List, Medications, Allergies, Procedures, and so forth) is maintained as a separate list. The lists are updated as events occur. Each event in a list has a start date associated with it – for instance, "Lipitor started 12/12/2008." Past events in the lists are indicated by stop dates or by designations such as "resolved" or "discontinued."

I might state this model formally as:

The patient’s current health information is the most important determinant of his or her future health. The patient’s current health status is best organized and understood as a set of categories that contain up-to-date lists of both present and past information. While it is essential to work with an up-to-date record of the patient’s current health problems, it is not necessary to be able to retrieve snapshots of what the record looked like in the past.

I believe, however, that both the patient and the physician think about the patient’s health very differently – as a series of inter-related events that unfold over time. It is fundamentally a story, a narrative of how things got to be the way they are. The story has the capacity to convey all the richness, complexity, and uniqueness of each patient.

A powerful way of telling and understanding the patient’s story is to present each point in time as a single screen view – a snapshot of the patient’s health at that time. The patient’s story can then be understood by stepping through the screen views in sequence, similar to turning the pages of a paper chart where each event or encounter is documented on a separate paper form which gets appended to the previous pages in chronological order (see my post on Why T-Sheets Work).

It’s also a little like turning the pages of a picture book or viewing the frames of a story board for a film – the patient’s story gradually unfolds.

I might state this model formally as:

The patient is a complex biological organism whose health changes over time. Every health event, intervention, procedure, and change in behavior potentially has an effect on all subsequent health events. The best way to comprehend the patient’s health issues is to treat the record as a narrative that unfolds over time and to present that narrative as a series of snapshots.

In the abstract, the difference between these two models may seem academic. In practice, there are profound implications for how easy or difficult it is to grasp and reason about a patient’s health issues. More on this in my next post …

Rick Weinhaus MD practices clinical ophthalmology in the Boston area. He trained at Harvard Medical School, The Massachusetts Eye and Ear Infirmary, and the Neuroscience Unit of the Schepens Eye Research Institute. He writes on how to design simple, powerful, elegant user interfaces for electronic health records (EHRs) by applying our understanding of human perception and cognition. He welcomes your comments and thoughts on this post and on EHR usability issues. E-mail Dr. Rick.

Monday Morning Update 10/15/12

From mmm: “Re: Allscripts vs. HHC. The whole $1.4 billion is set out in the board agenda. A very small portion of that is Epic software, training, and implementation itself, which came in LESS than Allscripts. Some of it is the maintenance of the software (Epic + InterSystems) over 15 (yes, 15) years. Another huge chunk must be allocated for conversion/interfacing with legacy systems and adding staff.” The September HHC board minutes explain the decision to drop QuadraMed CPR (executive turnover, minimal sales, low R&D, and insufficient functionality) with Epic. The 15-year cost analysis has Epic at $303 million vs. Allscripts at $299 million, with the complete Epic project expected to cost $1.4 billion over 15 years, including significant labor costs that include internal staff and keeping existing systems running during the transition. According to the HHC total cost of ownership analysis, it would have cost $1.278 billion just to keep 135 existing systems and implement 15 required new ones (Epic replaces 90 of those), so if HHC’s numbers are accurate, the switching cost is minimal. From the same document, the five original vendors being considered were Allscripts, Cerner, Epic, McKesson, and Siemens, with McKesson and Siemens voted out early. The minutes suggest that Epic was chosen because of a single inpatient-outpatient record, its track record as a financially strong and stable privately held company, and the percentage of its clients represented on the HIMSS EMRAM Stage 7 list.

From Limber Lob: “Re: extensibility of Epic. IT organizations need to develop software to gain competitive advantage. Academic health centers who are the first to figure out how to do this efficiently and safely with Epic will eat everyone else’s lunch.” Limber Lob is an informaticist – physician at one of those big medical centers and points out that Vonlay is offering services that include development on Cache’, Epic’s Web Services, and probably (but not stated) using Epic’s programming points to extend the applications. It’s early in the game since many of Epic’s customers are relatively new and working within the basic implementation, but it will be interesting to see whether Epic follows some of its competitors in declaring that it’s a platform upon which vendors are welcome to build value-added applications.

From The PACS Designer: “Re: network cleanup. Just as there’s spring cleanup each year at home, there needs to be a regular check and cleanup of network infrastructure wherever it may reside. With the FCC approving a new frequency spectrum for wireless patient monitoring systems, the time is right to make this the effort to improve network speeds and traffic management. The file sizes are also getting larger with each new system release from vendors, so networks can quickly be slowed during busy hours of the day. Also, if network equipment closets haven’t been check for several years, now is the time to upgrade those still working systems with the latest technology offerings for maximum possible throughput of data streams.”

From Radio Silence: “Re: IBM’s protest of the VA’s RTLS award. They probably wouldn’t have spent the entire $540 million anyway, but the options would be (a) reissue the bid, possibly after rewriting the RFP; (b) put the entire project on hold; or (c) split the pie differently so that all the parties agree not to fight the new decision. I would have bet on Option C, but with the political and budget variables they may invoke at least a modest delay.” The GAO accepted IBM’s protest of the award to HP Enterprise Services, saying that the VA’s assessment of the proposals relied on erroneous conclusions.

Thanks to Inga for covering during my vacation. She was one-for-two in her “exotic beach sipping umbrella drinks” guess as to my whereabouts. Correct about the beach, but not the umbrellas  — they tend to poke your eye when you’re trying to sip from a bottle of local Central American beer, although Mrs. HIStalk seems to like them in the wildly colored concoctions she favors. I both enjoy and detest being forced to disconnect from the real world due to poor Internet connectivity. My inbox is bulging (some of those being of the impatient “Why haven’t you responded to the e-mail I sent you yesterday?” variety) and my HIT situational awareness is a week behind, so my priority is to catch back up on both. You can help by e-mailing all those rumors, news items, and fun items that I missed last week.

Three-fourths of poll respondents believe that those four Republican Congressmen who called for an immediate end to HITECH payments were motivated by politics rather than fiscal responsibility. New poll to your right: what’s the holdup on the widespread exchange of patient information? Feel free to use the poll’s comment function to argue your position or to choose a different answer.

Listening: the final album from the recently deceased blue-collar electric bluesman Michael “Iron Man” Burks, recommended by a reader. I’m usually indifferent to blues unless I’m listening to it live in a smoky bar with cheap beer, but he had a 70s-sounding gritty vocal, some wicked growling organ, and a searing rock-style guitar reminiscent of Robin Trower or Eric Clapton. He out-Hendrixes Hey, Joe on this live video. I’m playing him hard on Spotify given my appreciation for honest, non-computer enhanced musical craftsmanship.

I was intrigued by Inga’s mention that the Nashville Medical Mart project has been killed by its developer due to lack of leasing interest, apparently not salvageable even with its partner HIMSS cheerleading and announcing grandiose plans for its involvement going back to the heady HITECH days of 2010. HIMSS planned to place its Interoperability Showcase there, run special exhibits and conventions starting with the center’s grand opening in 2013, and create a “world showcase” for “one-stop procurement market for health information technology, equipment, and software” with up to 600 vendor showrooms on site. The developer blames the sluggish economy for their failure to sign tenants, a lame excuse given that the healthcare IT economy is booming even more than back in 2010. A similar project in Cleveland that’s struggling with the same problems (construction delays, few interested tenants) can at least say it has now no competition, which is similar to being the last front-line soldier who hasn’t surrendered or retreated. All that’s left in Nashville other than cancelled lease agreements is the overpromising vaporware video above.

The other big news item that caught my eye last week was Allscripts protesting New York HHC’s selection of Epic. Usually the protesting vendor at least claims some kind of procedural error or violation of rules, but Allscripts apparently is protesting only that Epic shouldn’t have been chosen because the bid from Allscripts was lower. That’s not exactly the case, according the the board meeting minutes I quoted above (Epic’s software cost was actually less, and the 15-year analysis was performed only for Epic, so there’s no good way to make an apples-to-apples comparison unless you work for HHC, as did the people who chose Epic for presumably sound reasons). Not to mention that software isn’t such a commodity that the lowest bidder automatically wins. The positive outcome for Allscripts would be that the decision is overturned and the bidding opened back up to give them a second chance. I can see quite a few negatives in the “lose the selection, file a protest” strategy:

• Winning the protest would require implementing a complex system in a notoriously problematic client who liked your competitor’s product better, which is a nice short-term boost but a long-term nightmare.
• Going to the press with the protest invites the hospital to do the same with their rebuttal, which HHC’s president has done (he said in the New York Times that Allscripts’ cost analysis is false, HHC’s choice of Epic turned out to be wise given the financial and management problems Allscripts has had since the decision was made, and Allscripts is just trying to buy time as they “scramble to get private equity firms to take them over,” not exactly the kind of PR you want from a prospect that has evaluated your company carefully over many months.)
• If the protest is denied, the protesting company risks losing quite a bit of credibility along with the deal.
• Most importantly, future prospects may balk at inviting a vendor to the table who has previously tried to go over the heads of hospitals that chose a competitor. I’ve only ever banned one company (SMS, now Siemens) from my hospital’s premises and it was for that reason – the rep whined to the board chair that the IT department was incompetent in choosing their competitor, which at the board chair’s insistence got both the rep and the company banned permanently from setting foot on hospital property.

Imprivata has assembled a nice collection of cartoons under the Funny Bones banner. Here’s the latest one.

An interesting demonstration of PEBMAC (Problem Exists Between Monitor And Chair): a physician classifies 90% of his patients as Albanian in his new EMR. Reason: it’s the first country listed alphabetically in the EMR’s Ethnicity pull-down menu.

Health Nuts Media has raised $19,000 of its $90,000 goal to develop The Best Asthma Education App in the World … Period. You get swell prizes if you chip in as little as $5 by October 31.

In Canada, hospitals in Saskatoon and Regina go live on bed tracking software from Allscripts, which I assume is the former Premise although it’s not specifically named.

In England, poor employee training is blamed for quality problems in several areas after the recent Cerner implementation at Royal Berkshire Hospital, including increased wait time for cancer diagnostic results and reduced venous thromboembolism performance.

Henry Schein, which offers the Dentrix dental practice management system, acquires a majority interest in Vancouver-based Exan, which sells software for dental schools and dental practices.

A San Francisco business publication names Kaiser EVP/CIO Phil Fasano as a potential candidate to replace retiring Chairman and CEO George Halvorson.

Former Concerro CEO Graham Barnes is named CEO of care coordination systems vendor HealthyCircles.

The entrepreneur who launched Epocrates and Doximity advises companies developing software for physicians to focus on solutions that, in order, (a) save them time; (b) make them money; and (c) improve the quality of care.

Vince wraps up the HIS-tory of QuadraMed with a timely piece on HDS Ulticare, then Per Se Patient1, then Misys CPR, and finally QuadraMed QCPR. A timely story as it turns out: QCPR is the system that New York HHC is replacing with Epic, at least assuming that the protest by Allscripts does not change the plan.

Cerner Health Conference Tweets and Photos

The official recap is here. There were very few attendee tweets and minimal comments from HIStalk readers, so here’s what I could find that was interesting.

thanks everybody #CHC12 for your incredible kindness & passion “@tgrdd: @farzad_onc Great message @chc 2012.You touched many lives today"

— Farzad Mostashari (@Farzad_ONC) October 11, 2012

Neal Patterson: Clients aren’t implementing St John sepsis program because they’re busy with other things which won’t save lives. #CHC12

— Craig Joseph (@CraigJoseph) October 9, 2012

It is not about the technology doing something that impacts quality, cost and speed, it is how you use the technology @farzad_onc #chc12

— Joe Bush (@joebush1) October 10, 2012

It’s not what you do that matters, it’s why you do it. -Simon Sinek. That’s why it’s not about IT, it’s about improving health care. #CHC12

— Brice Jewell (@bricejewell) October 7, 2012

Sponsor Updates

• Dodge Communications offers an October 16 Webinar on leveraging social media tools in conjunction with trade shows, with panelists Brian Ahier (Mid-Columbia Medical Center), Jennifer Dennard (Billian), and Cari McLean (HIMSS).
• An HCI article covers the Top Three Tips for a Successful Go-Live.
• Streamline Health adds Netsmart CEO Michael Valentine to its board.

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

Time Capsule: Enterprise IT Projects Are Like Corvettes: Keep Hotheaded and Unskilled Drivers from Behind the Wheel

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 December 2007.

Enterprise IT Projects Are Like Corvettes: Keep Hotheaded and Unskilled Drivers from Behind the Wheel
By Mr. HIStalk

Big IT projects are a lot more fun to talk about than little ones, aren’t they? Transformational! Visionary! Strategic!

Hospital executives love those adjectives. Big projects make them look like decisive leaders and doers, bold swashbucklers in gray pinstripe who will throw well-placed caution to the wind to get an exhilarating ride to the IT stars.

That those projects nearly always fail doesn’t deter them. CPOE, ERP, and RHIO projects are launched with great fanfare and unrestrained executive enthusiasm. They almost always die an ugly, quiet, and protracted death, sad little pockets of unrealized objectives and defeated naiveté. The executives find other pressing obligations at the first smell of death, leaving the CIO and team to ride the flaming plane into the ground.

Tactical IT projects, on the other hand, nearly always succeed. You want to put in a lab system, HR suite, medication automation, PACS, or portal? They’ll work as planned, delivering pretty much exactly those reasonable benefits projected by the less-lofty suits who are usually involved. Sexy or not, most hospitals have the aptitude to make these projects work.

Unfortunately, enterprise-wide failures suck up a lot of the available capital, organizational energy, and IT resources of hospitals whose reach has exceeded their grasp. Failure is hard work.

The bigger the project, the more likely it will flop. It’s more than a linear relationship. Projects twice the size have four times the chance of failing. (Note: I just made that number up, which is shameful for an objective publication, but then again, I’m just an obnoxious guest here).

Where that failure point lies depends on an organization’s readiness. An assessment tool for warning signs might be useful. Score low enough and your project is doomed before the Rolex-wearing salesperson has headed off for the Caribbean.

Your organization should steer clear of big-vision projects and stick with the tactical stuff if:

• Organizational politics are ugly and widespread.
• Everybody in the trenches likes things the way they are and management doesn’t have the skill to convince them otherwise.
• Strategies always seem to involve copycatting the ideas of smarter or better-known organizations.
• Conditions are never stable enough for long-range planning and consistent execution.
• Stakeholders are too busy to attend project meetings.
• Everybody secretly hopes software will start enforcing all the rules that nobody follows now.
• Managers rely on intuition instead of objective tools like productivity management, process redesign, and a consistent reward system.
• Non-IT projects that cross disputed organizational territories (physicians vs. administration, pharmacists vs. nurses, finance vs. everybody else) fail every time they are attempted.
• Funding never seems to be available for post-project assessment and improvement.

Hospitals don’t see themselves in the flattering mirror held in front of them. Vendors and consultants don’t say a word. The healthcare IT industry would shrink to half its size if somebody created a tool that could unerringly conclude, “Don’t waste your money – you can’t handle this project.”

Rich parents have no business giving their 16-year-old a new Corvette, even though the salesperson is deliriously reassuring. That car is for people with years of experience and cooler heads.

If only the healthcare IT industry could figure out how to keep its overconfident and unskilled drivers from behind the wheel, maybe fewer of them would wrap themselves around trees at 100 miles per hour.