HIStalk Interviews Kobi Margolin, Founder and CEO, Clinigence

Jacob “Kobi” Margolin is founder and CEO of Clinigence of Atlanta, GA.

Tell me about yourself and about the company.

I’m the CEO and founder Clinigence, my third venture in healthcare IT. I am semi-Americanized, an Israeli originally. In the mid-1990s after seven years in an intelligence branch of the Israeli Defense Forces with a group of colleagues that I met in the military, we started Algotec, a medical imaging company. With Algotec, I came to Atlanta in 1999 to start US operations. 

We sold the company to Kodak in 2004. I then joined a startup at Georgia Tech that focused on the Software-as-a-Service (SaaS) model in medical imaging.

At my first company, Algotec, we were pioneers of bridging web technologies into the PACS market. These were days when medical imaging went through the electronic revolution. Our technology was all about distributing clinical images across the enterprise and beyond. My second company, Nurostar Solutions, capitalized on this electronic revolution and the SaaS model to facilitate new business models for imaging services. In those days, teleradiology was exploding and we became the leading technology platform for these services.

In 2008, I started on a path that led me to Clinigence today. 2008 was an election year. In the days leading to that election, I looked at what was going on in the market and thought that there might be new opportunities opening up around electronic medical records. I had followed the EMR market since my first HIMSS in 1997 in San Diego. The market was advancing, as one of the analysts put it, at glacial speed. Then in 2008 or 2009, suddenly an explosion of funds was allocated for this market. I started thinking about what was coming next. Let’s assume that the market is already on electronic medical records. What impact is that going to have?

That led me to the concept of clinical business intelligence, which in essence is, how do we make sense of the data in electronic medical records from both the clinical and business or financial standpoint for the benefit of healthcare providers, for the benefit of medical practices and their patients? This is when we started Clinigence.

Officially started in 2010, we had our first beta in February 2011 and our first commercial installation in October 2011. Today we are in over 70 medical practices with about 400,000 patients on the platform, with two EMR companies as channel partners. We just signed our second partner a few weeks ago and our first ACO customer just a few days ago.

How do you position yourself in the market and who do you compete most closely with?

In the clinical analytics industry, we are unique in that we are entirely provider centric. We jumped into clinical analytics with the vision that everything is going to be inside clinical operations and everything is going to be electronic. We have created a technology foundation that uses electronic medical record data as its primary source.

If you look at clinical analytics, that is a multi-billion dollar industry. Pretty much all of that industry has focused on healthcare payers or health plans. The technologies are based on administrative or claims data. There are specific benefits ,we believe, in the use of EMR data as your primary source. The number one differentiator for us is in the use of EMR data, which allows us to do three things.

Number one, our reports are real time. We create a real-time feedback loop that takes the data from the provider system and goes back to the providers and helps them change the way they deliver care to their patients in more proactive ways.

Number two, our reports are very rich in outcomes. We all know that the ultimate goal of everything we’re doing in health reform today and healthcare transformation is patient outcomes. Yet a lot of the reports you look at today in the market don’t give you any outcomes in them, because the data that’s used to generate them is data for billing purposes that doesn’t include clinical outcomes.

Number three, because we focus on the system that comes from the healthcare provider organization itself, we give providers the ability to break the report all the way down to individual patients and individual clinical data elements. The reports are not anonymous for them. The reports are something that they can trust, something they can work with. With that, we have the power to change the behavior of providers and affect behavior change in their patients, which improves outcomes.

If a physician is receiving reports from your system, what kind of improvements might they suggest?

The reports from our system drive a process, the process of improvement. It’s like peeling layers of an onion. We focus today almost exclusively on primary care. When we go to a primary care practice, we first have the physicians look at how they document clinical encounters today. 

Oftentimes the outer layer of the onion is helping the practice or the individual physicians with their documentation practices — making sure that they’re documenting everything that needs to be documented. We often find that physicians say, “Oh, we do these things,” but when you look down at their report, it doesn’t show it. It turns out that they’re doing things, but they’re not always documenting them or not documenting them correctly.

Then the second layer is we help the practices compare their performance, the compliance of their staff, with medical guidelines, recommended care, and sometimes their own protocols within the organization or the practice. You go into a practice and you ask the doctors, “Do you follow these protocols?”

For example, in family medicine, diabetes is chronic disease number one. The recommended guidelines, recommended care protocols for diabetes are pretty well established. We know the things we need to do. You go in and ask the physicians and they always say, “Of course we follow medical guidelines. Of course we do all the things that we’re supposed to.”

Then you start breaking the data down to reports across the organization, across the staff within the practice. Almost inevitably you find that there are variations in care, differences among providers and their compliance with these protocols which lead to gaps in individual patient care. We help them find these variations in process compliance, close these gaps, and improve their compliance with those medical guidelines and protocols.

The deepest layer of the onion, which only a few of the practices we’re working with are at that level — certainly in the ACO market we think that there’s going to be more of that — is about going into the effectiveness of your protocols within the practice in driving outcomes and that goes both to patient outcomes and eventually to business or financial outcomes for the practice. In this context, we give the customer the power, essentially, to do things like comparative effectiveness, look at various protocols that they use and see which ones are driving the outcomes or the results that they want.

The ACO concept is new enough that I’m not sure anybody really understands how they’re going to operate. Does anybody know how to use the data that you’re providing to manage risk, specifically within an ACO model? Or is it just overall quality and that’s what ACO should encourage?

I think that the ACO market is indeed still a baby. OK, it’s a newborn. Everybody is at the beginning of a journey. Even some of the organizations that have been doing this for the longest, like the pioneer ACOs, are still in very early stages.

We are focusing in the ACO market on finding organizations that we think have the best shot of going through this journey and being successful in going through this journey. We come to them and offer them a partnership in the journey, where we become somewhat of a navigation system for them with the kind of reports I mentioned earlier. Then really all that our technology can do — empower them with those navigation tools to find the roads that lead to the holy grail of accountable care, to find the roads to the triple aim of health reform.

As I’ve said, we’ve just closed our first ACO customer, so it’s going to be presumptuous of me to say, “Yes, the answers are already there.” But with the three things that I mentioned earlier, specifically, primary care driven and physician-led ACOs have unique potential of identifying, figuring out the ways to get to that holy grail. We think that our technology is a critical piece that can help them and then accelerate them in their path towards that holy grail.

Describe the patient-centered medical home model and the data capabilities physicians need to operate under that.

In primary care, we are doing much more work on medical homes than ACOs because ACOs are still few and far between. There is great interest in the patient-centered medical home model.

The patient-centered medical home model in itself is only a care delivery model. It does not come with a payment model attached to it, but there are certain markets where payers actually offer incentives to those practices that go to the patient-centered medical home model.

To become a patient-centered medical home, there are specific areas that the practice needs to address. NCQA offers a certification process that has become the de facto standard in certification as a medical home. They don’t necessarily force you to have an electronic medical record, so you can potentially become a patient centered medical home even without one. But what we would say is, as you look at your goals in the patient-centered medical home — specifically goals around continuous quality improvement, goals around population health management — using electronic medical records becomes necessary, a prerequisite to your ability to engage seriously in those kinds of efforts. 

We typically come in with our technology after the practice implements or adopts electronic medical record technology and help them take the data in their electronic medical record and translate that into a clear path towards quality improvement.

Is it hard to get physicians to follow your recommendations?

Most physicians are independent. They don’t like to be told what to do. Before I started Clinigence, I looked at clinical decision support and decided not to jump into it, basically because I didn’t want to be in a position to tell physicians what to do. Instead, I selected clinical business intelligence. It was more around telling physicians how well they’re doing and how well their patients are doing. 

One of the unique aspects of what we’ve built is that we created a “declarative classification engine,” which in essence means that the physicians can ask the system whatever question they want about their operations, about their patients, about their quality. We give them flexibility to go around the medical guidelines that come from the outside sources, build their own protocols, and then look at compliance and look at their performance relative to the protocols that they have set up for themselves.

You have to be somewhat careful when you do that. If you’re looking for success under a specific pay-for-performance program, then you have to abide by whatever the payer or some outside authority has set for you, and it is not uncommon for us to have variations or flavors of the same guideline. One that measures performance for the outside reporting purpose, and then a second one or even a number of them that give the practice the ability to create their own flavor of protocols. 

Then it’s no longer somebody telling you – Big Brother telling you — what to do. You have the power to determine what to do. I think the ACO model — and to some degree, also the patient-centered medical home as a step towards the ACO model – puts the physicians within those ACOs in the driver’s seat. Nobody is telling them where to go or what road to try in order to drive the success of the ACO.

There are 33 quality metrics for an ACO that are defined by Medicare. We say, “Is this sufficient?” Clearly these metrics are necessary; you have to report on those to Medicare. But are these sufficient? Will these guarantee your success? 

It is clear to everybody in the ACO market that the answer is no. These may provide a starting point, but nothing more than that. You have to carve your own way to achieve the outcomes. We know what outcomes are desired, but as far as how to get there, much is still unknown. There’s great need for innovation in fact in the market to figure it out.

A number of Israel-based medical technology companies have come in to the U.S. market, a disproportionate number based on what you might expect. Why are companies from Israel so successful in succeeding here?

My personal story may be a bit of a reflection of the success story of Israeli medical technology. Israel has become a Silicon Valley, an incubator of technology. Israel has more technology companies on Nasdaq, I think, than all of Europe combined. A lot of it is around the medical field.

Why has Israel has become that? I can speak from my own personal experience. There’s a book called Start-up Nation that was written by Dan Senor that looked more generally at this same question. His thesis in the book is that the military in Israel is the real incubator, the real catalyst for innovation.

I can say from my experience it really was like that. In my first company, Algotec, we started fresh out of the military. We were a group of engineers in the military. We knew very little about healthcare, certainly not healthcare in the US.

What we knew — and what the military instilled in us — was the desire to do something, to innovate, to create something. Beyond the desire, also the confidence to think that at the early age and early in our careers as we were back then, that we could do something like that. We could go and make a difference like that. 

There’s a lot of that going on in the medical field. I joke around that every Jewish mother wants her kid to be a doctor. Certainly there’s a lot of that here in the States. When I was growing up, somehow I was never really attracted to that. I was more on the exact scientific side. For my undergrad, I chose math and physics. In grad school, medical physics for me was a way to bridge the gap, to fulfill at least a portion of the wishes of my mother.

Any concluding thoughts?

You asked me about the process that we go with practices and I said it’s like peeling layers of an onion. Today, mostly with our clients we focus with them on some of the outer layers. We help them comply with pay-for-performance or create a patient-centered medical home. 

But where I think all of this gets really exciting and interesting is when you start getting to the deeper layers. We took great efforts to build a platform that’s very flexible. The unique piece I mentioned earlier in this context was the declarative classification engine. We also built what we believe is the first commercial clinical data repository that’s based on semantic technologies. Now this may sound to some folks like technology mumbo jumbo, but what’s important here is the ability to get data — any type of data — and make sense of it, so the system can understand the data even if it has never seen data like that before.

We think that over time, as our healthcare system goes through this journey of figuring out how to deliver more effective and efficient care, we can with technologies like that drive or create a bridge in between medical practice and medical science or medical research. Imagine that all of medical research — pharmaceuticals that go to the market or new devices that go through clinical trials — where they test the devices on hundreds or thousands of patients. We are building a system that can collect data from many millions of patients. Already today we are collecting data on hundreds of thousands of patients every day in medical practices.

Imagine what kind of insights we can get out of the data that we’re collecting, and then how this can then accelerate medical knowledge. Not just in the context of the holy grail of accountable care – helping deliver care that’s more efficient and effective – but really advancing medical science, identifying new things, new treatment protocols that otherwise we would never know about or would take us generations potentially to find.

Morning Headlines 11/28/12

KLAS Report Shines Light on Global PACS Marketplace

The newest KLAS report looks at the global PACS marketplace from a high level, as well as vendor-specific perspective.

Medsphere Systems Marks 10 Years of Better Patient Care Through Affordable Healthcare Technology

Medsphere celebrates 10 years of implementing OpenVista, which it says has successfully allowed 70 percent of its eligible customers to attest for Stage 1 Meaningful Use.

Cleveland Medical Mart Signs on Cleveland Clinic, GE Healthcare as Tenants

The highly publicized Cleveland Medical Mart has signed Cleveland Clinic and GE Healthcare as tenants in the newly constructed $465 million facility.

Healthrageous and Partners Healthcare Continue Partnership to Support Company’s Growth

Healthrageous, a 2010 spinoff of Partners HealthCare, returns to the founding organization for $700,000 in Series B funding.

News 11/28/12

Top News

OIG includes “integrity and security of health information systems and data” as one of the top management challenges faced by HHS for 2013.

Reader Comments


From Image Is Everything: “Re: RSNA. As a vendor, some of us had to go to Chicago the Monday before Thanksgiving and work through the weekend. The trick was to take your spouse, since the Magnificent Mile had beautiful displays, shopping, tourists from around the world, and lots of nice people. The problem was Thanksgiving dinner – think the Chinese restaurant in ‘A Christmas Story.’” I accompanied Mrs. HIStalk to a Chicago conference a few weeks ago, the first time I’d been there since the wintry HIMSS conference of 2009. We had a pretty good time this trip – stayed at the Hyatt on the river, ate at semi-touristy places (XOCO, the Walnut Room, South Water Kitchen, and the Metropolitan Club in Willis Tower), bought Frango Mints, and tried to stay warm since the temperature dropped from the mid-70s the first day to the 40s the rest of the week, ruling out the architecture boat tour. I wouldn’t say Chicago is my favorite city (I think Seattle and San Diego probably top my list), but I at least liked it better than when snow and fellow HIMSS attendees were swirling around me.

From The PACS Designer: “Re: 3D printing. TPD has posted about 3D software solutions in the past, and now you’ll become aware of a retail 3D printer called MakerBot. This company reminds TPD of when Xerox was first to introduce a new way of high quality printing decades ago. MakerBot just opened the first 3D Photo Booth in NYC, its home base, and I’m sure when the photos are viewed, word will spread across the country quickly. Healthcare could benefit by employing this 3D solution to view images of the anatomy, especially the heart, by practitioners and patients undergoing treatment.” 

From Keystone: “Re: EMR. I’m involved with five practices being implemented and all are complaining that their efficiency is going backwards because of extra keyboarding. Do you think this is due to added documentation that they should have been doing all along, poor system design, or both? These are mostly primary care physicians and they are definitely seeing fewer patients per session. Also, do you know of bolt-on products to support dictation or other simpler input tools?” Readers, I’m sure Keystone would welcome your comments, which you can add at the end of this post.

From Cloud Dancer: “Re: PACS. Your blog is incredible! Was wondering about your coverage of cloud imaging solutions like Merge as well as other trends in PACS going cloud.” One thing I excel at is recognizing my innumerable limitations, among them being paucity of in-depth knowledge about imaging and lack of time to learn since I’m a full-time hospital employee. I could use an expert contributor if anyone is interested in taking HIStalk a bit deeper into that area. The other areas that people seem to want more coverage about include HIT-impacting federal policy activity, patient-centered technologies, and startups and other innovation. You might think it would be easy to find and engage experts to contribute to HIStalk, but it’s not – they’re either too busy or not all that interested in writing regularly since it’s harder than it looks.

HIStalk Announcements and Requests

I am back from my Thanksgiving break, which included a bit of holiday shopping. I was remarkably restrained in my purchasing, though I did note quite a few items for my letter to Santa. Topping the list: Christmas tree ornaments for the shoe lover.

Thanks for the nice comments folks have sent about the redesign of HIStalk Connect (the artist formerly known as HIStalk Mobile). Next up: a revamp of HIStalk Practice and HIStalk, which will have a different look that’s more appropriate to longer posts. I haven’t changed the appearance of the sites since 2007, so hopefully nobody will be too jarred by the change (me included).

Just in case you have any doubts about the financial literacy of the average American, check out the lines of people waiting to buy tickets for the $500 million Powerball lottery. These are the folks who couldn’t be bothered to play when the prize was only a couple of hundred million. Does that make sense? Do you suppose a lot of statisticians are plunking down their cash given the impossible odds of getting it back? Maybe the feds should run a lottery to help pay down the smothering national debt – it’s like a tax that nobody complains about.

Welcome to new HIStalk Platinum Sponsor Innovative Healthcare Solutions. The 12-year-old Punta Gorda, FL-based company offers clinical and revenue cycle implementation services, with a focus on Epic and McKesson (ambulatory and inpatient EMR, STAR, Pathways, and Horizon, including upgrades and optimization.) They’ve been a Best in KLAS winner for the past two years in the Clinical Implementation – Supportive Work category. They also do assessment, optimization, testing, and strategic planning. Their approach is proven and cost effective, with the recognition that healthcare organizations are required to focus on both financial and clinical excellence for success. The principals have lot of industry experience – Robin Bayne was at McKesson for many years and Pat Stewart has been in healthcare for more than 30 years. Thanks to Innovative Healthcare Solutions for supporting HIStalk.

Acquisitions, Funding, Business, and Stock

Healthrageous announces that Partners HealthCare participated in its recent $6.5 million round of Series B financing.

Hello Health, which offers an EHR platform that’s paid for by patients ($5 per month, according to its site) instead of doctors, secures $11.5 million in financing.

VisionMine launches a service and Web portal that will match small startups with big companies trying to solve specific technology problems. The company will grade startups for the review of the large companies and will coordinate introductions when there’s mutual interest.

Merge Healthcare files a lawsuit against orthopedics PACS vendor Medstrat, claiming the company’s false claims and unfair business practice have cost Merge tens of millions of dollars in revenue. The suit claims that Medstrat sent e-mails and advertisements to Merge customers implying that the company’s announced plan to seek strategic alternatives was an indication of instability, tagging one e-mail with the phrase, “Why go through more pain? Converting is simple.” MRGE shares closed Tuesday at $3.31, down more than 50 percent since February.

Sales

Valley Medical Group (MA) contracts with eRAD for its PACS and speech recognition solution.

Intermountain Healthcare (UT) signs an $11.7 million, multi-year contract for Siemens Image Sharing and Archiving.

Adventist Health System will expand its use of Cerner’s P2Sentinel solution for auditing clinician access to patient data.

Virtua (NJ) implements the Vergence and proVision identity and access management solutions from Caradigm.

People

Cadence Health (IL) names Dan Kinsella (Optum Insight) CIO and EVP, replacing the recently retired Dave Printz.

Orion Health names Tracey Sharma (Baxter) sales director, Sergei Maxunov (Bell Canada) senior solutions consultant, and Health Linkletter (EMIS) project manager of its Canadian eHealth team.

Announcements and Implementations

HIMSS honors the family practice of Jeremy Bradley, MD (KY) as a winner of the 2012 Ambulatory HIMSS Davis Award of Excellence.

Cerner and telecommunications information company Global Capacity partner to deploy Cerner Skybox Connect, a high availability private network for the healthcare industry.

Children’s of Alabama implements Accelarad’s medical image sharing network to enhance care coordination with referring facilities.

Jefferson Radiology (CT) deploys Repair, a remote MPI management service from Just Associates.

NextGen Healthcare and Microsoft launch NextGen MedicineCabinet, a free app for the Windows 8 platform for the management of personal medication records.

Nuance Healthcare announces Assure for Powerscribe 360 | Reporting, which uses clinical language understanding to QA radiology reports before they’re signed.

Medsphere marks its tenth anniversary by noting that more than 70 percent of its OpenVista customers have achieved Meaningful Use Stage 1 so far.

Wellcentive announces that its Advance Outcomes Manager population health management and analytics solution has earned NCQA certification.

GetWellNetwork and Sharp HealthCare (CA) develop and launch what they say is the first in-room collaborative patient whiteboard. It identifies care team members, tracks visits and family questions, provides a daily schedule and plan, and allows patients to communicate with their family members.

University of West Georgia in Carrollton, GA, whose graduates make up a third of Greenway’s employees, names its new sports stadium building “Athletic Operations Building, sponsored by Greenway, Inc.” and adds the company’s logo to the building.

Cerner lists all of its customers that have successfully attested for Meaningful Use Stage 1.

Chicago-based Valence Health, which offers population management and reimbursement risk management tools and services to providers, announces that its 2012 revenue will increase by 75 percent to over $30 million compared to 2011. The announcement mentions new hires Eric Mollman (Staywell Health Management) as CFO, Kevin Weinstein (ZirMed) as chief marketing officer, and Prasanna Dhungel as VP of product development.

The Panama City, FL paper writes up the expansion of local business iSirona,which also announces that Mercy Medical Center (IA) has contracted for its medical device integration in the OR.

Government and Politics

CMS awards a 10-year, $15 billion contract to eight vendors to compete to build various aspects of a virtual data center for the agency’s IT infrastructure, including claims processing and hosting services for a national data warehouse application.

CMS picks the Kansas City Improvement Consortium, the Health Improvement Collaborative of Greater Cincinnati, and the Oregon Health Care Quality Corporation to be the first organizations to participate in a Medicare claims sharing initiative to assess provider performance.

November 30 is the last day for eligible hospitals and critical access hospitals to register and attest for an EHR incentive payment in fiscal year 2012.

Tennessee’s Medicaid program requests $9 million to replace its obsolete IT system with the VA’s VistA.

Other

The Madison, WI paper looks at the growth of Epic and its impact on the region. Epic left Madison several years ago for Verona, which has seen huge jumps in property values, but Madison has also benefited by increased demand for rental property and more employment opportunities. Madison city officials say Epic visitors are driving revenue to the hospitality industry, resulting in a 30 percent increase in city room tax receipts from 2010 to 2012.

A new KLAS report concludes that the top global radiology PACS vendors vendors are those offering meaningful and timely upgrades with expanded usability. Infinitt and Intelerad rated highly as innovators, along with DR Systems, McKesson, Novarad, and Sectra.

A Weird News Andy literature review notes that two new studies conclude that “flu vaccine is a heart vaccine” since people in the study who got a flu shot experienced 50 percent fewer cardiac events and 40 percent lower heart-related mortality. I’d need to review the original research to feel good about that conclusion, about which I’m skeptical otherwise.  

Also from WNA: in the UK, ministers are warned that a plan to implement “virtual clinics” powered by Skype will save billions of pounds immediately, but could leave less technology-savvy patients behind. The Health Minister expects video visits to reduce unnecessary hospital stays, saying that a third of patients can be managed without a face-to-face appointment, leaving more capacity for those who need to be seen in person.

WNA also notes this nugget: the Cincinnati-based TriHealth health system fires the 150 of its 10,800 employees who did not get a mandatory and free flu shot.

I’ve mentioned Italian brain cancer patient (and artist, engineer, and TED fellow, as it turns out) Salvatore Iaconesi several times for his “My Open Source Cure” appeal for treating his condition, much of which involves the struggle to share his records electronically with experts around the world who volunteered to help. CNN ran his story on its main page Tuesday morning. You should watch his newly published TEDx talk above on the challenges created by the medical establishment and his views on wellness and cures (the human being, not the “patient”). I don’t agree with everything he says, but he will definitely make you think, especially if you’ve been a patient with a serious condition. He is exchanging information with 15,000 people and 60 doctors and reviewing 50,000 strategies sent to him with the help of 200 volunteers.

MMRGlobal is awarded a fifth EMR-related patent, proudly proclaiming that despite having supposedly harassed companies into signing $30 million worth of license agreements for its newly-issued patents, the company is not a patent troll since the patented technology is part of products it sells itself. Or tries to, anyway – according to this month’s quarterly filings, the company’s total quarterly revenue was $346,000 with a net loss of $1.5 million, with current liabilities exceeding current assets by $8 million and only $42,000 cash in the bank as it seeks additional financing from its founder and anybody else willing to loan it money. OTC-listed shares are at $0.0147, valuing the whole enterprise at $7 million and obviously reflecting serious market doubt about the company’s banking the $30 million it claims to be owed for its newly created intellectual property portfolio.

Cleveland Medical Mart announces that it has signed Cleveland Clinic and GE Healthcare as tenants. HIMSS, which had signed on with a similar project in Nashville that went bust, has toured the facility, which is three-quarters complete and scheduled for a September 2013 opening.

The local paper in Edmonton, Alberta gets its hands on the expense records of the former CIO of the Capital Health region, whose boss there was found to have been reimbursed $350,000 for questionable expenses that included opera tickets and a butler. Donna Strating, who like her boss was billing $2,700 per day as a consultant, was reimbursed for large restaurant tabs, movie tickets, and snacks.

Sponsor Updates

• Employees of Digital Prospectors supply 30 Thanksgiving meals to the New Hampshire non-profit Families in Transition.
• MModal releases software updates to its Fluency for Imaging Reporting technology platform to support report creation and clinical documentation workflow.
• Merge Healthcare makes its iConnect Enterprise Clinical platform available through EMC Select.
• The GPO Yankee Alliance offers its healthcare members connectivity solutions from Lifepoint Informatics.
• Frost & Sullivan honors Acuo Technologies with its 2012 Market Share Leadership Award in Imaging Informatics.
• Visage Imaging announces a new video about its enterprise imaging platform, Visage 7 – Speed is Everything, at RSNA.
• Frost & Sullivan awards TeraRecon its 2012 New Product Innovation Award in Medical Imaging Informatics.
• Telus Health executives Francois Cote and Brendan Bryne are quoted in a newspaper article on the digital transformation in healthcare.
• The Web Marketing Association awards Imprivata its 2012 WebAward for Outstanding Achievement in Web Development in the Best B2B Website category.
• The Detroit Free Press recognizes CareTech Solutions with its fourth consecutive Top Workplace award in the large company category.
• Frost & Sullivan awards Humedica the 2012 North American Health Data Analytics Customer Value Enhancement award.
• BridgeHead Software releases a white paper outlining strategies for addressing concerns about image availability.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Morning Headlines 11/27/12

Merge to Connect to Surescripts Network for Clinical Interoperability to Deliver Imaging Results Directly to Physician EHR Systems

Merge and Surescripts have reached an agreement that will connect the networks to allow hospitals and imaging centers to send reports and images to practice EMRs through the Surescripts network.

OIG lists EHR incentives abuse, security among top HHS challenges

OIG releases its 2012 Top Management and Performance Challenges Report, citing Integrity and Security of Health Information Systems and Data among its top 10 continuing issues for the new year.

Hello Health Raises $11.5M from First Generation Capital, Inc. and Others to Meet Market Demands for Free Revenue Generating EHR Platform

EHR and patient portal vendor Hello Health announces an $11.5 million investment from First Generation Capital that it will use to bolster its freeware EHR platform to create a revenue positive EHR for private practice physicians.

MMRGlobal Receives Fifth Patent Expanding Rights to Control of Online Medical Record

Patent troll MMRGlobal Receives a fifth patent involving patient portals and personal health records.

Syndromic surveillance for health information system failures: a feasibility study

A recent JAMIA study suggests syndromic surveillence methods may be used to monitor health information technology systems to detect system failures earlier.

Healthcare IT from the Investor’s Chair 11/26/12

A reader recently asked me about the mechanics of insider trading – out of pure curiosity, I hope, with no criminal intent! When do companies “know” what their quarterly numbers will be? How do they maintain them in secret? What prevents in-the-know employees (not to mention any NDA’d companies doing diligence) from taking advantage of what they know?

At the risk of providing a how-to guide to insider trading, today’s post answers these questions and gives some pointers on what’s permissible to ordinary knowledgeable people.

First, let’s consider Google’s recent leak of a draft third quarter earnings report as an example. That was a classic “oops” moment, when someone at its financial printing company pushed the wrong button and the data were filed with the SEC (and hence the wire services) before they should have been. Typically this information is “embargoed” properly (just like with PR firms and news outlets), so a mistake like this doesn’t happen. But let’s talk about the key issue here.

Don Berwick, former head of CMS, made a remark in a totally different context, but highly relevant to insider trading (and much more) at the Health Evolution Partners Leadership Summit this year:

“When values are strong, rules aren’t necessary; when values are weak, rules are ineffective”.

The rules in this case refer to insider trading.

SEC rules clearly prohibit “beneficial insiders” (such as corporate officers) from buying or selling stock based on “material non-public information”, of which clearly an earnings release would be a textbook example. It also requires others, such as a printer, investment banker, or PR agency employee to be considered “insiders,” thus owing a fiduciary duty of confidentiality.

In a case of a PE investor doing diligence on a target company, before even disclosing the name of the target, the banker typically requests the investor to sign a NDA (non-disclosure agreement) specifically stating that they would be a beneficial insider and bound to certain rules. In the case of corporate employees below the officer level, information is kept on a strictly need-to-know basis and public companies typically have codes of conduct and even blackout periods during which time the company’s stock can’t be traded.

That said, insider trading is a fact of the equity markets and simply can’t be completely prevented. In my experience, information often leaks. I’ve seen stocks move up or down in anticipation of good or bad news too many times to believe it’s a coincidence or simply an example of market efficiency. The SEC is focusing more on this phenomenon, and with the help of Big Data, is getting ever better at locating suspicious trades and catching more perpetrators.

The recent high profile case of Rajat Gupta – the former leader of McKinsey (of all firms) who sat on multiple boards and was convicted of passing secrets to the Galleon Partners hedge fund — is a case in point. The Gupta case involved wiretaps and a lengthy investigation, though. What about everyday cases? They, too, can be detected in the data. 

For example, if you’ve never shorted a stock (sold it, anticipating it will go down) and then suddenly do so for an unusually large amount of money, and then by great coincidence, it then does go down, you might get a call from the SEC. Because options allow even greater leverage (you can buy or sell options for many more shares for the same amount, because they have expiration dates), options activity is scrutinized even more heavily. The SEC has made some fairly impressive busts, even tracing Eastern European shill buyers to Goldman Sachs junior bankers.

In spite of the SEC’s increasingly sophisticated watchdog activities, we don’t know what we don’t know. In a recent conversation I had with a former US Assistant Attorney General who focused on white collar crime, she estimated that less than 1 percent of insider trading is actually caught.

Even so, it’s a bad idea and I recommend against it. If the unethical nature of insider trading doesn’t stop you, consider that the penalties are harsh and the publicity career-destroying. Further, it’s not the victimless crime some see it to be. Information asymmetry to this extent is patently unfair, and further, it erodes the public’s faith in the capital markets that drive our economy.

A better (and entirely legal) way to trade on semi-proprietary knowledge is one which I expect most readers of HIStalk can easily do. If you think, “Wow, this EMR strategy is terrible. There’s no way it can be sustained,” or, “Wow, this is the best product I’ve seen in my career,” and you do some research on the stock and see it’s expensive or cheap relative to its peers and historical trading range, maybe it makes sense to buy or short the company.

If you do it, though, spend only amounts you can afford to lose. This is high risk, and sometimes an investment thesis takes longer to play out than you expect.

A cautionary note to the physician readers of this blog. If you’re participating in a clinical trial and have knowledge about the compound and its manufacturer, trading on that knowledge is another no-no, as the even more recent case of SAC Capital trading on a clinical trial result showed (or will show once the indictments are finalized).

This was a great question. My thanks to the reader to who asked it! If you’re curious about another investment, Wall Street, or investment banking-related topic, please let me know and I’ll use it as a future blog topic.

As we recover from Thanksgiving, I wish everyone a great holiday season. Near-term events that are investor-relevant include the RSNA conference this week, the ever-popular JP Morgan Healthcare Conference, and the bet-worthy question of who’s going to buy Allscripts and what they will pay.

Ben Rooks spent a decade as an equity analyst and six long years as an investment banker. In 2009 he formed ST Advisors to work with companies on issues that don’t solely involve transactions. He has been a beneficial insider countless times (but never traded inappropriately) and appreciates e-mail.

Curbside Consult with Dr. Jayne 11/26/12

Last week Mr. H took a break from compiling the news, which meant that I took a break as well. Baking is one of my hobbies, so I used the free time to turn out a couple of “oldie but goodie” recipes. I’ve been making one of them since I was in junior high school but hadn’t done it in a couple of years and it was a nice treat. I find working in the kitchen to be therapeutic. The steady rhythm of knife work and the stress-relieving properties of making pastry are good reminders of getting back to the basics.

I’ve been doing more traveling lately than usual, so the downtime this week was much appreciated. The perfect storm of my specialty society meeting, a tech conference, and MGMA hit entirely too close together. Although tiring, the upshot of hitting three meetings in two months was being able to see (actually in person!) a lot of people that I typically only interact with in the virtual world. In this age of emerging communications tools, I think that the concept of friendship has evolved as well.

Although I have plenty of local friends, some of my best friends are those that I may only see once or twice a year. It’s easy to stay close when you’re only a few keystrokes and a mouse click away. The things you previously had to wait to hear in the annual Christmas letter are now presented real time via Facebook. When you meet in person, it’s almost like no time has passed since your last get-together and that is a wonderful thing.

I find that I’m closer to work friends because we interact through social media. Although I don’t like my News Feed clogged with pictures of what people ate for lunch or which beer they’re drinking tonight, I enjoy seeing what colleagues are up to when they’re not at work and seeing their children grow up. I’m thankful to be able to keep in touch with people who have moved on to new challenges or to other parts of the country.

Our HIStalk readers provided some extra special Thanksgiving moments by reaching out to say how much they appreciate our team. Sometimes it still seems a little unreal that we do this every week – IT workers by day, bloggers by night. It’s good to hear that you think we’re making a difference.

My favorite e-mail of the week was one asking me for a favorite Christmas punch recipe, and I’m excited to be thought of as the Martha Stewart of the health IT world. Let’s face it, I’ll never keep up with Inga as the fashionista, so I’ll settle for being the happy homemaker.

Since Thanksgiving seems to be the official start of the holiday office party season, I offer up Dr. Jayne’s Holiday Recipe Guide. Having spent most of my career in non-profit healthcare, I’m used to partying in the potluck style. Since HIStalk is your virtual water cooler for IT news and gossip, we’re happy to be part of your office potluck as well. Choosing something from the list below will allow you to avoid another year of shame after being labeled as “that guy who brought the case of White Castle Hamburgers.”

Appetizers

Hot buffalo chicken dip

Best made in a small crock pot on your desk since I’ve never worked in an office that has an oven.

Super-lazy cheese and crackers (perfect for purchasing on the way to work)

Unwrap a block of Neufchatel cheese (might be labeled as “light cream cheese”) and place on a rimmed serving dish. Pour Bronco Bob’s Roasted Raspberry Chipotle Sauce liberally over the cream cheese and around the dish. Serve with Wheat Thins or similar crackers.

Main Dishes

White Chicken Chili

Cranberry Cocktail Meatballs

(thanks to Mr. Z. – and I totally appreciate the notes on how you actually make them vs. what the recipe says)

2 pounds lean ground beef

1 cup cornflake crumbs

1/3 cup finely chopped parsley

2 eggs, lightly beaten

¼ teaspoon pepper

garlic powder to taste

1/3 cup catsup

2 tablespoons thinly sliced green onions and soy sauce

Thoroughly mix all ingredients. Roll into balls (about 1 to 1 ½ inches). Bake on cookie sheet at 500 degrees. It says five minutes, I think I do about seven. They are great as is for spaghetti.

Sauce

1 can whole cranberry sauce

1 12 oz bottle tomato based chili sauce

1 tablespoon each brown sugar and lemon juice

Warm in pot, drop in meatballs. I make my meatballs ahead of time and nuke them on medium to bring to room temp and drop in.

Desserts

Libby’s Pumpkin Roll 

It’s a little tricky to make without it cracking, but it looks (and tastes) like a million bucks. And yes, a seventh grader can make it.

Insanely Good Chocolate Cake

It goes by a variety of names and with subtle variations.

Bake a dark chocolate cake in a 9×13 pan according to package directions. Before it cools, poke holes all over the cake (using a serving fork or a bamboo skewer) and pour on a 14 oz can of sweetened condensed milk, then pour on an 8 oz jar of caramel topping. Refrigerate overnight. Immediately before serving, cover with whipped topping and sprinkle with crushed Heath bars.

Drinks

Christmas Punch

Martha Stewart Style and not for the office party, unless your office lets you have vodka.

Christmas Punch

Cooks.com style.

Sherbet Punch

Good for when you have to throw an office baby shower, too.

Place ½ gallon of sherbet in a punch bowl – I like raspberry personally. Slowly pour over 1 liter ginger ale and ½ liter of Fresca or Sun Drop. You can change the colors by changing the sherbet, but know that rainbow sherbet turns an unappealing color if you try to use it.

If you have favorite office party recipes, be sure to share. I’m always looking for something new and delicious. See you around the water cooler and in the buffet line.

E-mail Dr. Jayne.

Morning Headlines 11/26/12

RSNA 2012 Begins

The 98th Annual Meeting of the Radiological Society of North America  begins this weekend under a unifying “Patients First” theme.

GP blames computer for man’s death from ulcer

A UK physician blames the poor usability of his practice EMR as the root cause of a patients death after he failed to prescribe the patient a medication to treat a stomach ulcer.

Welsh First Minister Opens Clinithink’s Development Centre

First Minister of Wales Rt. Hon Carwyn Jones opens Clinithink, a Healthcare IT R&D firm based in Bridgend, Wales.

Matching DNA With Medical Records To Crack Disease And Aging

A recently published research project is matching DNA sequencing data with information from Kaiser Permanente EHR data to identify at risk patients before chronic diseases develop.

Monday Morning Update 11/26/12

From Non Sequitur: “Re: UNC. I told you I would submit the official Epic announcement when it was released. Since you have already mentioned this, it’s not really newsworthy.” Au contraire – it’s nice to get official verification, which apparently came from UNC Health Care System (NC) on November 19 with its Epic announcement. Cerner and Siemens were the also-rans. Assembly of the implementation team will start early in 2013, with 80-120 folks tapped to begin the rollout of Epic to UNC Hospitals, Rex Healthcare, Chatham Hospital, the UNC Physicians Network, and UNC Physicians & Associates.

From Max Headroom: “Re: CES Unveiled. The consumer electronics show had a lot of Fitbit-type companies, but the coolest and most Thanksgiving relevant was the HAPIfork from a Hong Kong company. The USB-connected fork tracks how many bites you eat over what time, with the premise that eating more slowly has more positive effects on metabolism. It even has a reminder to eat more slowly, so people can get alert fatigue from eating.” That sounds somewhere between creepy and  pretty smart, at least if you believe that eating slower means eating less and if you don’t eat a lot of fork-free sandwiches or soup. The fork records everything without being USB connected, then uploads to an online dashboard and to Facebook if you want (I guess that would be social net-forking). 

Welcome to new HIStalk Platinum Sponsor Acuo Technologies of Bloomington, MN. The company offers Universal Clinical Platform (a vendor-neutral archive) and clinical data migration solutions that let customers liberate their clinical content from departmental silos (including enterprise medical images). The result: putting patient information where it’s needed, with customers executing their own clinical strategies instead of meekly following those dictated by their technology vendors. It often makes sense to pursue a selective best-of-breed strategy for wound care, pathology, and neurosurgery, and Acuo’s technologies allow making data from those systems liquid while ensuring vendor independence and multi-site support. The benefits include lower TCO, built-in business continuity and recoverability, better network utilization, implementation of IHE-profile standards and vendor neutrality, and the ability to monitor system health via a single dashboard. Not to mention that the client owns both the data and the archive. The DoD chose Universal Clinical Platform a few weeks back to consolidate images from 62 Army and Navy PACS sites located around the world – UCP works with every major radiology and cardiology PACS. The company just released a white paper that describes how three of its hospital customers weathered Hurricane Sandy, along with an overview of the business continuity possibilities offered by UCP. If you’re at RSNA this week, drop by booth #7146 and tell the Acuo folks that you saw them mentioned in HIStalk. Thanks to Acuo Technologies for supporting my work.

From my usual YouTube cruise, here’s a video featuring customers talking about their Acuo implementation.

HIMSS and vendor user group conferences are those national meetings most commonly attended by poll respondents, with the other events lagging far behind them. New poll to your right, following up on a Dr. Jayne question: is transcription a commodity service that’s differentiated mostly on price? Feel free to click the poll’s Comments link after you’ve voted to editorialize your position.

I’ve been revamping HIStalk Mobile over the last several days. The site has a new look and a gradually changing name – HIStalk Connect. Travis is posting from the physician and entrepreneur perspective while Lt. Dan is handling the daily news posts. If your interests include startups, cool technologies, consumer health IT, and telehealth, you might consider becoming a regular contributor, a guest author, an interview subject, or a news tipster. I’ll have some new sponsors to announce shortly.

The First Minister of Wales opens Clinithink’s research and development center in Bridgend, emphasizing the government’s commitment to stimulate economic growth by supporting technology companies. That’s Rt. Hon. Carwyn Jones SM on the left, Clinithink CEO Chris Tackaberry on the right (he wrote a Readers Write article a week ago). The company offers the CLiX clinical language indexing engine for ICD and SNOMED that turns medical notes into coded data.

I create an eclectic music playlist every week in the hopes that folks who’ve been stuck in a musical rut going back to their college days (or since computers took over most musically related chores) will find something fresh to listen to. The one for this week includes a mix of genres and vintages: Soundgarden, Auf Der Maur, Zip Tang, Morrissey, Lana del Rey, and some cool surf tunes. Some of the tracks were recommended by readers. Let me know if anything speaks to you.

I was thinking about HP’s accusation that its recent acquisition target Autonomy had fraudulently misstated earnings, forcing it to write down $9 billion as announced last week. I’m beginning to be skeptical that Autonomy was the lone gunman. HP has been a train wreck in every conceivable way, so it seems suspicious that the company chose the day of a bad quarterly report to trot out excuses from an acquisition that closed a year ago. Peering deeper into the numbers, HP says the magnitude of the alleged accounting fraud was a few hundred million dollars, which caused it to pay $5 billion too much. That would seem to imply that the other $4 billion that was written down was because HP vastly overpaid (which was why companies better than HP had already passed on the deal). All of this happened before Meg Whitman took over as CEO (she was hired September 22, 2011), but the (literal) bottom line is that the company peed away $9 billion, with the only question being which aspect of HP’s due diligence stupidity (valuation or forensics) was at fault. It would appear that HP’s bragging rights for hiring (and most puzzlingly, retaining) the least-competent board of directors in the country remains unthreatened.

An NIH-funded project to match DNA samples from 100,000 volunteer Kaiser Permanente patients with their electronic medical record information is creating a “playground of incredibly rich data” that is already turning up medical discoveries. Researchers have discovered genetic variations that seem to influence the effectiveness of statin drugs. They’ve also found something that sounds like a like a palm reader’s life line – a specific genetic component whose physical length seems to correlate with lifespan.

Accretive Health writes $4,000 checks to 90 Minnesota patients who complained that the company harassed them with abusive medical collection practices.

A UK doctor blames the death of one of his patients on the practice’s EMR, saying he failed to notice that the patient had stopped taking proton pump inhibitors and died of a stomach ulcer as a result. The doctor says of the since-replaced system, “In a highly-charged meeting with a patient, when you’re discussing very important matters, I failed to notice the absence of a D on the computer screen. The systems fail to flag up under-use in an adequate way. It’s a hazardous system.”

Also in the UK, a patient dies after an erroneously programmed IV syringe pump delivers a 24-hour narcotic dose over just 12 hours. The nurse who set the pump admits that she isn’t sure that she understood the pump instructions another nurse gave her.

UC Davis Children’s Hospital (CA) tries its hand at crowdfunding, seeking donations for the purchase of specific items that range from $30 toys to a $12 million NICU wing. A “medical computer suite” costs $2,210 just in case you’re up for providing a stocking stuffer.

Decision support tools from Dallas-based cardiology software vendor Emerge Clinical Decision Solutions are chosen by the HeartPlace cardiology practice for use in 31 clinics and 25 hospitals. Software algorithms review patient symptoms and histories, with the company claiming that identification of some cardiac conditions is increased by 300 percent.

I noticed a drug study authored by a pharmacist from Cerner Research. That reminded me that Cerner mines and sells the patient information stored by its hosted EMR clients.

I’m annually amazed that RSNA convinces 60,000 people to leave their families Thanksgiving weekend to head off to chilly Chicago. If you are there, enjoy the conference.

The Milwaukee business paper takes a field trip to Children’s Hospital of Wisconsin to check out its $129 million Epic implementation. At 263 beds, that’s a truly Epic cost of almost half a million dollars per bed.

As more Americans get fatter, so does their mental picture of what ideal weight should be. Sixty percent of people think their weight is about right despite CDC statistics showing that 69 percent of Americans are overweight. I theorize that foreign travel will suffer as junk food eating and expandable pants wearing Americans realize that they stand out like lumbering giants when immersed into a culture of svelte locals in Asia, Scandinavia, and almost everywhere else. I blame vanity sizing, where clothing manufactures make everything several sizes bigger than the label says so customers can pretend their mirrors are defective. Not appropriate post-Thanksgiving talk, I know.

Strange: an air conditioning technician files a $1 million negligence suit against Kingwood Medical Center (TX) after stinging bees cause him to plunge through the hospital’s skylight.

The re-domesticated Vince picks up where he left off with the HIS-tory of CPSI, founded by Denny and Kenny (one of them really was a rocket scientist). Vince thrives on memory-refreshing reader e-mails, so if you have interesting nuggets or current contacts from the sepia-toned HIT of yesteryear, he would enjoy hearing from you.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Morning Headlines 11/21/12

Nuance Communications Posts Q4 Profit

Nuance releases Q4 results, reporting that revenue was up 28 percent with adjusted EPS $0.51 vs. $0.42, beating expectations of $0.48.

CareCloud Appoints Ralph Catalano as Vice President of Operations

CareCloud announces that Ralph Catalano, former athenahealth VP of client development, has joined the company as VP of operations.

Association of Online Patient Access to Clinicians and Medical Records With Use of Clinical Services

A recent JAMA study tracking clinical services consumption before and after implementation of a patient portal concludes that patient access to medical records correlates to an increased use of clinical services.

Aurora Health Care Selects Humedica MinedShare to Support Accountable Care Organization (ACO) Efforts, Joins Anceta to Collaborate with Other Leading Medical Groups

Aurora Health Care partners with Humedica to provide population risk analysis, improve coding accuracy, and develop ambulatory physician scorecards.

News 11/21/12

Top News

Nuance reports Q4 results: revenue up 28 percent, adjusted EPS $0.51 vs. $0.42, beating expectations of $0.48. In the earnings call, Chairman and CEO Paul Ricci said the company’s healthcare business will generate more than $1 billion in 2013, making the company one of the largest HIT vendors. He also said that the recent Quantim and JATA acquisitions will contribute $90-100 million in annual revenue.

Reader Comments

From Samantha Taggart: “Re: giving thanks. I am very grateful and thankful to all of you for doing what you’ve done for this (our/my/your) industry. Healthcare is a precious thing and I can’t imagine what HIT would be like today if you all hadn’t somehow provided the transparency and insight into what’s really going on in this industry. We ALL thank you so very much. Enjoy your holidays and feel very good about what you do.” On behalf of Mr. H, Dr. Jayne, Dr. Travis, Dr. Gregg, Donna, and Lt. Dan, a big thank you for the kind words. I will save this note for those days I find myself thinking I can’t possibly read one more thing about healthcare and technology. I am thankful that I lucked into the greatest job ever in HIT, that I work with such fun and smart people, and that people continue to read and support HIStalk week after week. Best wishes to all for a great holiday. I’m off for the rest of the week off to spend time with family and friends, eat too much food, watch some football, and perhaps buy a couple of pairs of new shoes.

From MDRX Scrooged: “Re: Allscripts. Everyone is expecting huge cost cutting if Allscripts is sold to a private equity firm, but what may not be expected is that the cost cutting will start in the next couple of weeks. Between 70 and 130 employees will be let go, mostly from services and engineering. Happy holidays to us!” Unverified. I’ve received a few rumors on where the possible acquisition stands, pretty much split between: (a) talks are at an impasse because the PE people won’t pay above $15 per share and the board won’t accept that offer with shares trading at $12.35, and (b) a deal has already been finalized but not yet announced. In other words, I don’t know any more than you do.

From Force Majeure: “Re: Allscripts. A practice that requested termination of its MyWay agreement was turned down even though its contract says Allscripts will comply with any CMS requirements to meet MU and any other standards, with the explanation that the practice was offered a free upgrade to Professional. What about costs for infrastructure, equipment, and possible lost productivity? The contract didn’t say they company will meet the requirements by making the customer switch products. They’re going to be flooded with these requests.” Unverified, but FM provided a copy of the purported e-mail above, where the company takes the position that moving a customer to a completely different product than the one they bought is contractually acceptable since it’s a free switch to a more expensive product. I think I’d probably side with the company legally, although as a customer I’d still be ticked that I have to spend money and energy because of the company’s business decision. Obviously your options as a customer are limited if you recently signed up for the five-year lease – you’re going Professional unless you’re willing to lose a lot of money (either by not collecting Meaningful Use money or in paying off your lease while buying a competitor’s product). I assume the leases work like they do for a consumer transaction – a third-party financing company buys the contract at a discount and handles the payment collection, meaning it’s not up to Allscripts to let customers out of their lease agreements. Leasing terms might make an interesting topic for Bill O’Toole in a future HITlaw column given this example.

From Nasty Parts: “Re: [company name omitted]. They were apparently shocked to see former employees working for competitors at MGMA and offered a bounty to current employees to identify them so they can be send cease and desist letters.” Unverified. I’m sure someone must have proof if this claim is accurate, so I’ll fill in the blank if someone will provide that proof.

HIStalk Announcements and Requests

I will most likely not do news this Friday unless I get bored since I doubt anyone would read anyway. Enjoy your holiday. I’ll be back at the keyboard Saturday as usual putting together the Monday Morning Update.

Acquisitions, Funding, Business, and Stock

Medical education firm Pri-Med, a division of Diversified Business Communications, acquires EHR provider Amazing Charts.

Shades of McKesson-HBOC: shares of the perpetually bumbling HP drop 12 percent Tuesday after the company announces that it will take an $8.8 billion write-down on its 2011 acquisition of British software vendor Autonomy. HP says Autonomy had cooked its pre-acquisition books by counting low-margin hardware sales as software income and claiming that resellers were customers. Details have been shared with US and British regulators to pursue criminal and civil charges. If HP is right, nice work by Deloitte, to whom it paid big money for pre-acquisition due diligence. The previously fired CEO of Autonomy denies everything, defers to Deloitte’s audits, and says HP destroyed the company’s value by raising prices and lowering sales commissions, adding that, “The difficulty was that the company [HP] needed a strategy, and I still couldn’t tell you what that is.” HP’s now-irrelevant Q4 numbers: revenue down 5 percent, adjusted EPS $1.16 vs. $1.17 but more dramatically –$3.49 vs. $0.12 including the write-down. The ugly five-year chart above plots HP shares (blue) against the Nasdaq index, indicating that you’d probably have been better off burning dollar bills to keep warm. Oracle was smarter: they passed when Autonomy made a “please buy us” pitch – see the hilarious Another Whopper from Autonomy CEO Mike Lynch post from September 2011 on Oracle’s site, placed there after Lynch denied trying to convince Oracle to buy his company. The always-feisty Oracle, in response to his denials, posted the PowerPoint slides Lynch used in the meeting, which seemed to jog his memory of the conversation.

Sales

The National Football League signs a 10-year contract worth $7-$10 million with eClinicalWorks to implement an EHR that can help the league research and treat player head injuries.

DoD awards Acuo Technologies a nine-year, $40 million contract for its vendor neutral archive solution.

Huntington Memorial Hospital (CA) selects the Merge PACS iConnect Enterprise Clinical Platform for its hospital inpatient EHR and its Huntington Health eConnect HIE.

Sharp HealthCare selects 3M’s 360 Encompass System for medical records coding, clinical documentation improvement, and performance monitoring across its four hospitals and affiliated medical groups.

Aurora Health Care (IL, WI) will deploy Humedica’s MinedShare analytics platform to support its ACO initiatives, improve coding accuracy, and develop ambulatory physician scorecards.

People

CareCloud hires Ralph Catalano (athenahealth) as VP of operations.

Health monitoring company Medivo appoints David B. Nash, MD (Jefferson School of Population Health) to its medical advisory board.

Announcements and Implementations

White Plume Technologies releases its AccelaMOBILEmobile charge capture product app.

McKesson will give $1 million in free Practice Choice EMR licenses to 100 small-practice physicians who practice in primary care, internal medicine, gynecology, or pediatrics and who have a history of providing unreimbursed care to low-income patients.

MedCentral Health System (OH) expands its system-wide use of the Surgical Information Systems solution to include anesthesia automation, perioperative analytics, patient tracking, and integrated tissue tracking.

NextGen Healthcare releases its 8 Series EHR content, which includes a new user interface, standardized framework for templates, and streamlined navigation.

Children’s Hospital Association goes live a contract with Baltimore-based mdlogix to provide an informatics platform that will support its Hospital Survey of Patient Safety tool.

Government and Politics

The GAO finds that CMS is behind schedule on the implementation of its Fraud Prevention System for analyzing Medicare claims data for fraudulent behavior.

CMS releases Meaningful Use Stage 2 spec sheets for EPs and hospitals.

The Tampa paper covers the power struggle between dueling startup HIEs, the state-run one and a local, for-profit HIE that has the Hillsborough Medical Association as a member. The article suggests that the organizations are fighting for the potential profits involved with selling HIE-collected de-identified patient data. The local HIE says the state HIE is not seeking physician input, noting that the average hospital doesn’t see most of the patient population and also generates only 10 percent of patient health records.

Innovation and Research

The Consulate General of Canada in Philadelphia will launch a healthcare IT accelerator in early 2013, hoping to increase growth opportunities for Canada-based companies as similar efforts have done for companies in Israel. The 4th Annual Canada-US eHealth Innovation Summit will be held November 28 in Philadelphia, featuring presentations from Canadian companies Caristix, EDO Mobile Health, Evinance, Input Health, HandyMetrics Corporation, Mensante Corporation, Memotext, NexJ Systems, Nightingale Informatix Corporation, Orpyx Medical Technologies, TelASK Technologies, and VitalSignals Enterprises.

A JAMA-published study finds that patients using a patient portal had a higher number of office visits and telephone encounters than non-users. The study, which reviewed the use of MyHealthManager by patients of Kaiser Permanente Colorado, concludes that just putting up a portal doesn’t reduce demand for clinical services, and in fact may have the opposite effect.

Technology

ADP-AdvancedMD introduces a charge capture app for EHR for use on the iPad and iPad mini.

Nurses at Phoenix Children’s Hospital create the Journey Board discharge teaching app, funded by a $5,000 donation from former hospital patients. It’s available free for Android and iOS.

Massachusetts General Hospital Emergency Medicine Network launches EDMaps.org, a national ED locator for travelers, and a new version of its EMNet findER app.

Other

Key findings from the eHealth Initiative’s 2012 Report on HIE:

• Support for ACOs and PCMHs is on the rise
• Federal funding still supports many HIEs, raising concerns about their long-term viability
• HIEs worry about competition from other HIEs and from HIT vendors offering exchange capabilities
• Other challenges for HIEs include privacy, technical barriers, and addressing government policy and mandates
• Support for Direct is growing, particularly to facilitate transitions of care and the exchange of lab results.

The National eHealth Collaborative publishes a five-tier framework of strengthening patient engagement strategies that includes steps entitled Inform Me, Engage Me, Empower Me, Partner With Me, and  Support My Community.

An Imprivata roundtable on the healthcare impact of technology and mobility featured Boston-area healthcare IT executives, with their discussion summarized in the eight-minute video excerpt above.

Weird News Andy says “This doc was da bomb.” A 60-year-old doctor and Occupy Wall Street protester who was fired by his hospital employer in 2007 for suspected stalking of a nurse is arrested when police find assault rifles and large quantities of bomb-making chemicals in his basement.

Sponsor Updates

• MedAssets CEO John Bardis wins a Community Leadership Award for driving and supporting the volunteer activities of his employees.
• Greer Contreras, T-System’s VP of revenue cycle coding, discusses revenue integrity and the need for organizations to have a holistic view of their revenue cycle processes in a guest article.
• Compressus integrates MModal’s speech understanding solution into its MEDxConnect suite.
• Vitera Healthcare introduces Hands-On Lab for virtual product training.
• Shareable Ink is spotlighted for assisting The Center for Orthopedics (OH) capture MU data.
• Zirmed releases a white paper on the use of technology to manage rising levels of patient responsibility.
• PeriGen posts its November and December Webinar schedule.
• David Caldwell, EVP of Certify Data Systems, discusses opportunities offered by HIEs that can enhance revenue and improve patient care in a guest article.
• Besler Consulting’s CTO Joe Hoffman reviews challenges in complying with the CMS exclusion list during a November 28 Webinar.
• Dell ships its PowerVault DL2300 appliance with CommVault Simpana 9 software for enterprise-wide data protection.
• SCI Solutions recognizes Mountain States Health Alliance (TN) with its Most Innovative Use award for best adoption and implementation of its self-scheduling tool.
• Levi, Ray & Shoup releases an enhanced version of its Enterprise Output Management software that includes mobile access and support for Windows 8.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Morning Headlines 11/20/12

NextGen Healthcare Launches New 8 Series Electronic Health Record (EHR) Content

NextGen releases its newest platform, dubbed 8 Series, which promises a faster and easier clinical user experience.

Medical education provider Pri-Med buys Amazing Charts, an electronic health records firm

Pri-Med, a Boston-based medical education firm, buys EHR vendor Amazing charts for an undisclosed sum.

National Football League Selects eClinicalWorks

The NFL has announced it will implement a league-wide eClinicalWorks EHR to better manage player injuries.

The Patient Engagement Framework

The National eHealth Collaborative publishes a five-tier framework for strengthening patient engagement strategies.

McKesson Announces $1 Million Software Give-Away to Help Benevolent Physicians Bring Better Health to Patients Across America

McKesson will donate more than $1 million in free EHR licenses to physicians providing charity care to the needy.

Curbside Consult with Dr. Jayne 11/19/12

Penny Wise and Pound Foolish

Working for a large health system, I’m no stranger to procurement policies whose complexity rivals the best Rube Goldberg machines. This has been made worse by consolidation among hospitals and their various service lines when administrators demand a tightly-controlled list of preferred vendors.

On its face, a preferred vendor list sounds like a good idea – make sure vendors are well-vetted, reputable, and have the all-important Business Associate Agreement squarely in place. It can also be helpful to ensure vendors reps play by the rules and behave themselves in the hospital. Vendors on the preferred list may also have a better grasp of the needs of large health organizations and can ensure contractual pricing is delivered to all parties that should receive it, whether they are part of the mother ship or merely affiliates.

This makes sense when dealing with items that are truly commodities – linens, transcription service, uniforms, furniture, medical supplies, and technology hardware. It makes less sense when dealing with emerging interoperability needs, especially when third-party interventions are needed to improve workflow or make clinicians’ lives better.

A little over a year ago, my group (which is owned by the hospital) decided to shutter the moderate complexity lab that we had hosted in our office for years. Although convenient for patients, it was a declining source of revenue and an increasing source of aggravation due to unreliable equipment and staff. When the hospital offered to place a draw station in our practice (complete with staff that we didn’t have to pay for) it was an easy decision to shutter the lab.

What we didn’t anticipate were workflow issues caused by the lab interface the hospital provided. When we owned our lab, results were printed out and scanned. We reviewed these in our EHR work basket and acted on pages of labs with a single message to staff.

Once we went live with the hospital lab interface, result flowed real-time into our work basket. This sounded like a good idea, but as primary care physicians ,this was inefficient and annoying. Rather than having all labs back together, they returned piecemeal, which meant we might have to touch a patient’s chart three or four times trying to figure out if all the labs were back and ready for us to act.

I explained this to one of my CMIO pals, who immediately recommended some middleware that he had used to solve the same problem. Even better, the solution was cheap in IT terms (barely the cost of an off-the-shelf interface project) and readily available.

The hospital agreed to pursue the solution for us since competing local labs already had a solution in place and would have been happy to have our business. We were initially enthusiastic, but work quickly ground to a halt since the vendor was not on the hospital’s preferred vendor list.

Instead of pushing to have them on the list, we have had to watch the hospital slog through its vendor identification, request for proposal, and endless review process. Ultimately they chose a vendor from the preferred list who said they could build the same type of solution, but unfortunately had not built this particular flavor before. Having my colleague’s experience to draw from, I wanted to make sure we addressed several key areas of functionality in the contract. This caused the contract to be “nonstandard,” which is apparently a euphemism for “something which will never be signed in your lifetime.”

We were in negotiations with the vendor for nearly four months. The slowness was mostly on our side, which was easy to figure out based on the many painful conference calls I attended. Once the contract was in place, the vendor began building the solution and we had to beta test it for them in their environment. Then we had to deploy it to our full-blown test environment, followed by more configuration and a couple of enhancements. After several more months, we’re finally ready to take it live.

Our physicians and staff have aged in dog years during this process. Staff has created a new process to try to reconcile what has returned with what was ordered so that providers don’t try to address a patient’s results before they’re all back. When we added up how much money this has cost (both in lost productivity and in incentives/bribery to keep the process working), we could have purchased the upstart vendor’s solution five or six times over.

For those of you who have recently joined the ranks of employed physicians or are contemplating a hospital’s purchase offer, get ready. You get to share the joys of the ubiquitous preferred vendor list.

E-mail Dr. Jayne.

Readers Write 11/19/12

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.

Paying Attention to How NLP Can Impact Healthcare
By Chris Tackaberry, MB, ChB

Unstructured clinical narrative is increasingly being seen as the primary source of sharable, reusable, and continually accessible knowledge, essential in helping providers make informed decisions, reduce costs, and ultimately improve patient care. While form-driven EHRs readily leverage and share captured structured data, the richest patient information remains locked inside EHR databases as unstructured notes.

Natural Language Processing (NLP) technology is becoming increasingly recognized in healthcare as a powerful tool to unlock this vital clinical data and turn it into analyzable, actionable information. While many have heard of NLP, there is significant confusion about what it actually means for healthcare.

In short, NLP means recovering computable data from free text. Even though most of the world’s knowledge is documented in some form of written narrative, we increasingly rely heavily on computers to analyze the world around us, and computers work better with well-defined, structured data rather than unstructured text.

Google has clearly proven that simple text search allows us access to vast amounts of information, but it still requires humans to determine meaning in the results. NLP is the science and art of teaching computers to understand the meaning in written text in order to extract data from narrative for reporting, analysis, etc.

NLP, typically embedded within other solutions, can help deliver significant benefit to providers and their patients by:

• Improved reporting and monitoring. Many administrative tasks in healthcare depend on structured data, including the submission of billing codes that describe diagnoses and procedures to insurance companies. The identification of billable concepts in clinical narrative is probably the most common application of clinical NLP because it is the most direct path to delivering financial benefits.
• Improving utilization of clinician time, resulting in more efficient care delivery. Doctors and nurses are accustomed to carefully documenting the condition and care of each patient in clinical notes. Without computable data, however, hospital operations, physician reimbursement, and patient care are all compromised. By pulling data directly from notes with NLP, even in real time at the point of care, we can save clinician time and frustration while identifying more data and detail to support clinical decision making, efficient care delivery, better public monitoring, and more.
• Improved physician understanding of patients. NLP provides the level of clinical detail necessary to provide quicker access and review of patient histories. Revealing key information in existing notes that would be invaluable for more timely, better-informed clinical decisions.
• Better research and monitoring. Existing studies have looked for correlations between patient genes or proteins and characteristics identified in the patient’s medical record. Conducting similar studies with the greater volumes of so-called phenotypic data, which can be pulled from patient records using NLP, will reveal far more about what makes our species tick – or sick.
• More efficient clinical workflow. There is an intrinsic inefficiency in EHRs because so much of the information must be documented repeatedly. As a result, there has been significant physician pushback against EHRs, despite their acknowledged advantages.
• Embedded NLP tools can facilitate EHR redesign for more efficient and intuitive documentation of patient information in a manner already natural to the traditional physician workflow.

Done well, there are countless ways NLP can be leveraged in healthcare to deliver benefit by improving efficiency, driving outcome-based performance, promoting access, facilitating research, and supporting population-based healthcare delivery models.

The application of NLP technology to healthcare will transform what we know about disease, wellness, and healthcare performance, enabling major improvement in efficiency and outcome. At the heart of this data-driven transformation is clinical narrative, a powerful and valuable asset. We need to recognize that.

Chris Tackaberry, MB, ChB is CEO of Clinithink of London, England.

Defining a Complete Patient Engagement Solution
By Jordan Dolin

A few years ago it was somewhat rare for a technology vendor to pitch the benefits of patient engagement. Today it seems that everyone is claiming to be a “leader in patient engagement technology.” This has led to a good deal of confusion in the marketplace. 

Patient engagement can deliver significant financial and clinical results, but to actually achieve these benefits, organizations need to select a "complete" solution.  A complete solution is one that addresses the needs of all constituents. It engages patients on their terms and also contains the content, technology, and regulatory considerations sought by providers to support care in every setting across the continuum. 

Simply stated, a solution that satisfies these eight critical elements has the ability to improve clinical and financial outcomes.

1. Understands how to synthesize and deliver actionable information to patients. An effective solution must impart information to a patient in a manner that will actually change behaviors and improve outcomes. Addressing a spectrum of learning styles, literacy levels, and cultural relevance requires a tremendous amount of expertise across multiple communication methodologies.
2. Facilitates engagement along settings across the continuum of care. A complete solution must support the needs of the patient and the provider in care settings across the continuum as well as the transitions between them. This includes addressing clinical, operational, and regulatory needs of providers in addition to supporting new models of care such as ACOs and PCMH.
3. Engages patients at their convenience. Historically, healthcare technology solutions have always targeted the convenience for the provider, not the patient. Patients must have the ability to receive information when they want, where they want, and on the devices they already own.
4. Seamlessly integrates into IT systems and workflow. Organizations are no longer willing to accept disruptions to their infrastructure or existing processes. To be successful, solutions must be complementary and additive, not disruptive or distracting.
5. Results measured down to the individual patient. The single unifying goal that now pervades healthcare is accountability. A solution must contain tools that allow providers to measure their impact from multiple perspectives. The ability to confirm that a patient received and reviewed information prescribed by their clinician is a fundamental measure needed to quantify impact.
6. Measures and delivers an economic return. Healthcare organizations are accountable for outcomes and their partners should be as well. Clients should expect hard dollar ROI studies and vendors should impartially fund and conduct them.
7. Backed by an organization with the requisite knowledge and experience. Investing in an engagement solution to support key business objectives is a critical decision. The vendor selected should have the appropriate experience and staff to support the success of their clients and their clients’ employees and patients.
8. Effectively supports the near-term and long-term objectives of the organization. The partner selected must understand the challenges of health systems and have a track record of delivering solutions that effectively address them. In addition, it should be clear that investments are being made in new solutions and innovations that will continue to address the needs of an ever-changing market.

Jordan Dolin is co-founder and vice chairman of Emmi Solutions of Chicago, IL. This article contains an abbreviated list due to space limitations; the complete list is available by download. 

Physician Compensation: The Accountable Care Challenge
By John C. Roy

As healthcare systems and physician groups across the country grapple with definitions and implications of “accountable health care” and “value-driven contracting,” physician compensation based on a fee-for-service model is irrational. Pioneering institutions have already incorporated quality and outcomes into their compensation plans. Similarly, payment for health care services is shifting into fee-for-value models.

As these models evolve, compensation plans must reward physicians for meaningful quality improvement and patient outcomes. Key questions emerge. How can clinical and other data help providers enhance value in the most strategic ways? What measurement strategies, and which data, can be used to reward provider teams that contribute the highest value?

In a fee-for-value world, physicians and hospitals will have to focus on quality, outcomes, and cost (or efficiency) requiring a true culture of quality improvement. Physician engagement is critical in shaping that culture. Physicians will have to assess and agree upon outcome measures and practice standards and change practice based upon valid, practice-specific data.

Today, many health systems struggle with the absence of such data. Essential data supporting such a transformation is often stored in disparate clinical and financial databases, including multiple electronic medical record systems and homegrown software solutions.

One universally challenging example is accurately attributing patients to individual physicians. Accurate attribution is central to reporting outcomes, but all too often proves extremely difficult. If physicians don’t trust that the data accurately reflect their practice, they cannot invest adequate time and energy in improving quality of care.

On the other hand, when physicians trust data that truly does reflect their practice, the data spur meaningful conversations around quality and outcomes. They see improvements in real time. The ability to correctly assimilate, align, and attribute patient data to individual physicians is a fundamental issue today and a cornerstone of reimbursement and compensation tomorrow.

As payment for health care shifts from “caring for sick” to “maintaining health,” providers will need extremely effective, efficient care management strategies for chronic disease patients. They will rely on patient data that is strategically aggregated to identify interventions around priority patient populations. They will direct sophisticated, well-coordinated management plans to help insure appropriate patient management, appropriate testing, control complications, and improve direct attention to that patient. They will have the ability to report improvements in quality, demonstrating the value of their work over time. All of these efforts deliver significant value that needs to be monitored and rewarded when achieved.

In a fee-for-value world, the provider groups who use population-level data to create and implement successful strategies for effectively managing their chronic disease patients will command higher compensation, regardless of their RVUs. Successful systems and groups will design physician compensation models around elements that matter most in a new, risk-based health care environment. To do this, patient data needs to be more physician-centric, with improving population health as the primary goal.

John Roy is vice president of Forward Health Group of Madison, WI.

Six Facts You Should Know About Stage 2 Meaningful Use and Data Interoperability
By Ali Rana, MBA, MCITP, CISSP

In the world of care delivery, having access to the right information at the right time can be a matter of life or death. Anyone who has been a patient or cared for one understands that the transfer of medical information – whether current or historical – among providers is not readily happening today.

The Stage 2 Meaningful Use requirements, which begin as early as fiscal year 2014, call on eligible providers and hospitals to increase the interoperability of clinical data and adopt standardized data formats to ensure disparate EHR systems are capable of information sharing.

The following are six high-level areas of the Stage 2 rules to consider during your preparations. These areas underscore how clinical data interoperability will change and impact IT infrastructure:

1. Interoperability of clinical data is no longer optional. Hospitals are required to connect with disparate EHR systems and send clinical information electronically for at least 10 percent of its discharges.
2. Vendor software certified for 2014 clinical data interoperability criteria will produce and consume a consolidated CDA (C-CDA) document (one specification). The C-CDA document must contain medications, allergies, and problem list elements as well as many other clinical data elements. The majority of the clinical data elements in the C-CDA have single, well-defined coding system requirements. For example, the SNOMED CT July 2012 release for a problem list. Thus, all vendors will speak the same language.
3. Transmission specifications to other systems for Stage 2 include only “e-mail” (SMTP) and cross-domain sharing format (XDS). These do not require costly and complex HL7 interfaces and instead just configuration to make connections for data flow.
4. Vendor software certified for 2014 clinical data reconciliation criteria will be able to import and reconcile home medications, allergies, and problem list elements as discrete, codified data. The ability to reconcile discrete, codified data in conjunction with the C-CDA and transmission standards nearly eliminates vendor and technical obstacles to clinical data sharing. The coding standards also eliminate some of the complexities. Vendors will likely have to map the data into their systems to support drug-to-drug and drug-to-allergy checking.
5. Hospitals must have ongoing submission of reportable labs, syndromic surveillance, and immunization information unless there is no entity present that can accept and exchange this data. This bi-directional information sharing is largely at the local level, meaning the abilities on hand to perform this function in a production state will vary. The requirement of these three submission measures is a significant change from Stage1, which only required one data sharing test and failure of that was an acceptable option.
6. Patients must have electronic access to their records within 36 hours of discharge. Eligible entities must provide a patient portal that enables the patient to view, download, and transmit information. This Stage 2 criteria now mandate providers to encourage patients to make behavioral changes accessing their own data. The information that feeds these patient portals must be available within 36 hours of discharge. Therefore, key workflow modifications ensuring appropriate timing are a top priority.

Ali Rana, MBA, MCITP, CISSP is manager of implementation and integration services and client services for T-System, Inc. of Dallas, TX.

Morning Headlines 11/19/12

Healthcare Information Technology: Trends and Transformations

Greenway releases results of an expansive survey of the HIT marketplace, including within its findings that 50 percent of surveyed hospitals say they have no ACO plans.

US firms drawing a line on after-hours email

The Advisory Board Company is featured in an article about its corporate e-mail policy which prohibits employees from checking company e-mail after business hours.

Health Information Technology; HIT Policy Committee: Request for Comment Regarding the Stage 3 Definition of Meaningful Use of Electronic Health Records (EHRs)

ONC initiates a 45-day Request for Comment period for Stage 3 Meaningful Use rules, starting this week and ending on January 14.

Quest Diagnostics’ CEO Hosts Investor Day

Quest Diagnostics, parent company of ChartMaxx and Care360EHR, announces that it will re-evaluate its EHR business strategy in an effort to focus on its core business, diagnostic information services.

Epic Systems Corporation, Applicant v.McKesson Technologies, Inc.

Epic receives a 30-day extension for a Supreme Court appeal request it is preparing in response to the recent “induced infringement” case it lost in the Federal Court of Appeals.

Monday Morning Update 11/19/12

From Documented: “Re: Cerner Content360. Does this represent somewhat of a minor strategic shift for Cerner, or is just a re-branded aggregation of existing document imaging solutions (such as Cerner ProVision Document Imaging)? When I worked at Cerner (a few years ago), it was practically a cultural taboo to suggest the need for document imaging (especially clinically, as in meds ordering) because it stood in philosophical contradiction to CPOE and its closed-loop meds process. Anyway, I was just curious if any Cerner clients or other wise luminaries among the HIStalk audience knew much about it.”

From The PACS Designer: “Re: healthcare and Windows 8. In a past HIStalk post I covered Microsoft’s Healthcare in Silverlight software. Now, with the release of Windows 8, we get to see Microsoft Flexible Workstyle for Health utilizing Sharepoint for rounding and other data viewing. Partners HealthCare has an interesting case study demo that could generate an 80 percent reduction in desktop image management efforts.”

From HITEsq: “Re: Epic. Appears ready to file for review of the McKesson case. They filed an extension for their writ (i.e., the document where they asked the Supreme Court to take the case). Nothing is a sure thing, but my guess is this has a really good shot at being accepted. The Federal Circuit was really fractured and went in an unexpected direction. The Supreme Court is good at addressing these things.” This is the years-long legal battle over whether MyChart violates a McKesson patient portal patent. The appeals court’s decision in September troubled some legal experts who are uncomfortable with its interpretation that companies (Epic in this case) can be held accountable for “inducing infringement” even when the infringement itself hasn’t been proven.

From MT Hammer: “Re: MModal. Word on the street is that they have acquired transcription provider MxSecure. No official announcement.”

From Shhh: “Re: Epic. They must have finally chosen a new CFO – the job listing is gone from all the career sites.” I was slightly aware that Anita Pramoda was the company’s CFO, but I see from her LinkedIn profile that she moved on this year as a co-founder of California-based TangramCare (I guess she didn’t have to sit out a year). I can find next to nothing about that company except that it’s some sort of technology-enabled homecare provider. From a LA Craigslist job posting, she’s taken some Epic principles out West: the “do good” motto, the hiring of “brilliant people,” and the need for candidates to state their GPA in their application. The “who are we?” section says, “Healthcare today is conducted like a horribly inaccurate Markov chain. That is, each piece of healthcare is siloed from one another, at all times with incomplete information. None of pieces the mesh well, the left hand doesn’t know what the right hand is doing/has done. This results in inefficiency, inaccuracy and unbearable patient experiences. We wake up every morning working to solve this problem, make healthcare more affordable, and save lives.” Jim Sweeney, founder of Caremark, Bridge Medical, and CardioNet, is involved and talks about the company in the video above. He has an interesting point: hospitals were created to make it convenient for physicians to see patients, but being aggregated with other sick people isn’t so great for the patients.

Half of my survey respondents are indifferent to CHIME, while the remainder are equally split in seeing the organization as positive or negative. New poll to your right: which annual conferences do you routinely attend? Check all that apply and feel free to leave a comment.

Here’s new Spotify playlist of some odds and ends that might give you some new music ideas. On it: Toad the Wet Sprocket, Broken Bells, Veruca Salt, Neon Trees, and quite a few more. If you like country music, computer-generated dance tunes, classical, or jazz, you’re out of luck since I don’t listen to those.

Speaking of music, a reader sent a link to the early 1980s company promotion album You Respond to Everyone But Me: Songs for the EMT, which seems to be the only album dedicated to EMS. Stream some of the very well done country/bluegrass tunes and see if you agree with me that it’s way better than you would expect. I’m desk-drumming to #11 – EMS Express.

ONC publishes the Request for Comments for Meaningful Use Stage 3. The comment period will open this week on Regulations.gov and will end on January 14.

The Advisory Board Company’s e-mail policies are featured in an article about companies that encourage (or mandate) employees to stop checking e-mails after hours. CEO Robert Musslewhite, saying that “e-mail has gone too far and that is now impeding productivity,” also issued guidelines that include summarizing the topic in the subject line, limiting the number of recipients, and considering the use of instant messaging instead. The company imposed an e-mail moratorium over Labor Day weekend.

Lucile Packard Children’s Hospital (CA) provides iPads loaded with kid-friendly apps in all nine of its pediatric ED rooms. The unit’s director says that “one iPad is worth 10 milligrams of morphine.” Parents can also check e-mail and FaceTime with hospital specialists, guest services employees, and interpreters.

The Columbus, OH newspaper writes about Ohio hospitals that use EHR information to tailor their marketing campaigns to specific patient populations. At least one system (OhioHealth) admits that it screens out lower-income patients in mailings encouraging patients to schedule health maintenance visits.

CVPH Medical Center (NY) lays off 17 employees after losing $400,000 in September, but says the cuts would have been a lot more severe had it not banked $3.2 million in Meaningful Use money that was counted as revenue. 

A series of Greenway surveys finds that:

• 76 percent of practices either aren’t sure about participating in an ACO or have decided they won’t participate, while 50 percent of hospitals say they have no ACO plans
• 16 percent of practices will stop taking Medicare and Medicaid patients if payments are reduced
• 39 percent of hospital CIOs say technology has improved the efficiency of their organizations
• 45 percent of patients say they would change doctors if they’re kept waiting too long
• Seven percent of patients say technology gets in the way of their interaction with their doctor vs. the 56 percent that believe it helps the physician improve their care
• Patients view paper and electronic-based systems as equally safe and secure
• More than half of consumer respondents believe it’s the government’s job to improve the healthcare system, with hospitals and physicians a distant second and third place respectively

From the Investor Day transcript from the CEO of Quest Diagnostics, parent of MedPlus (ChartMaxx, Care360 EHR):

…We are redirecting our EHR Information Systems business. We believe that business needs to be focused on helping Diagnostic Information Services. We believe there is an opportunity for that business to complement enterprise EMR strategies that companies like Cerner and Epic and that McKesson have, and we need to participate in helping them with them and be with them when they present their strategy to integrated delivery networks in hospital systems. And therefore, we’re focusing the plan in the business around that segment in the marketplace and having a proactive program to work with the enterprise EMR companies going forward.

The $5.99 BabyDoze smartphone app plays Doppler-recorded mother’s womb sounds that the company says are 98 percent effective in calming crying babies. Its author recorded his wife’s uterine sounds in 1985 with the help of hospital staff, selling the original version as an audio tape.

A study finds that goofing off at work every now and then may improve work performance. Top-performing subjects in a four-hour simulation session of piloting military drones were found to have been distracted 30 percent of the time by their smartphones, having a snack, or reading something nearby.

Vince and Mrs. Vince have been re-honeymooning in Europe, so he compares how technology has changed in the 40 intervening years. He has returned and his regularly scheduled HIT programming will do likewise next week.

Sponsor Updates

• Jardogs recently attended the University of Iowa’s Engineering Career Fair. That’s recruiter Nicole Baer meeting with a student above. The company offers FollowMyHealth patient access solutions that include the Universal Health Record and patient kiosk.
• Intelligent Medical Objects releases its IMO Terminology Browser for Android smartphones.
• We missed a sponsor who made the Inc 5000 in our list last week. Toledo-based ESD, which you may remember as the force behind HIStalkapalooza in Las Vegas earlier this year, was recognized for its three-year revenue growth of 172 percent.
• Award-winning IT staffing firm Digital Prospectors is raising funds for Hurricane Sandy victims. The company will match donations and chip in $5 for each Facebook share and $1 for each Facebook like.
• An article by Emily Ruffing of Lifepoint Informatics describes ways that laboratory information systems can be integrated with EMRs.
• Nordic Consulting, the KLAS-ranked #1 Epic service provider and the largest Epic-only consulting practice in the country, publishes a guide for Epic-certified consultants interested in joining the Madison, WI-based company.
• SayIt Clinical Notepad from nVoq,  a cloud-based iPad speech-to-text app that allows users to capture quick patient notes on the go for later addition to the EMR, is available on iTunes.
• Liaison Technologies, the Atlanta-based cloud integration and data management leader, is recognized by the Deloitte Technology Fast 500 as one of the fastest growing companies in North America.
• Bottomline Technologies recently held its Healthcare Customer Insights Exchange in Sausalito, CA with its experts and customers providing insight about mobile technologies, process automation, payment solutions, and advanced forms management. The company offers a case study of Alamance Regional Medical Center’s move to a Logical Ink-powered tablet-based patient registration solution.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

HITlaw 11/16/12

Exit Shmexit

When healthcare provider entities merge, whether physician practices or hospitals, there is usually a misalignment of technology. It is not typical that the merging entities operate the same vendor systems, which means that ultimately one vendor is out and the other gains a new (merged) customer.

Here is a real-world example recently brought to my attention. Physician Practice A merges with (larger) Physician Practice B, which basically means Practice B bought out Practice A. The two practices use different EMR products and Practice B dictates that its current EMR technology will remain the standard. Practice A will have to transfer its operations to the other vendor’s EMR technology. Not surprising and not a big deal, many are thinking as they read this, because practices convert to different systems all the time.

However, the vendor being replaced at Practice A is not playing nicely and refuses to provide the EMR data in a format that satisfies the technical requirements for conversion. Setting aside the fact that Practice A will have serious record retention issues, they will be unable to access historical patient records (unless they continue to pay for support or subscription to keep the old system, a very unnecessary cost) and will have to start from scratch in the new system. Really?

One would think that bad PR would be enough to persuade the ousted vendor to provide the practice data ready for conversion, but we have seen enough strange stories about sore losers recently to unfortunately have to consider this possibility and behavior.

About the title of this posting – Exit Shmexit? Every software contract should have a section devoted to data rights and extraction at termination. Frequently labeled in conversation as “Exit Procedure” or “Exit Strategy,” this type of language is absolutely essential. I take the tone I do because it is clear that unfortunately many practices, and to a lesser extent, some hospitals, do not take the time to carefully review and negotiate the terms and conditions under which they are investing in technology.

Evident in my HITlaw postings is the emphasis on the critical need to review and negotiate your software agreements. “Exit Shmexit” is my personal rebuke to those that consider vendor license agreements as merely “paperwork” and hurriedly review and sign what is put in front of them. Inclusion of a few sentences in Practice A’s EMR license would have prevented the present angst and difficulty for that entity.

Although not as pertinent to hospitals due to the size and expense of the technology investment (and corresponding recognition and cooperation by vendors), I am made increasingly aware of instances where physician practices are courted, quoted, and commanded. The first two everyone knows. Commanded refers to the attitude of some vendors at the contract stage. Sign here. We don’t negotiate.

Editorial comments now aside, here is the help.

To repeat, every software contract should have a section devoted to data rights and extraction at termination.

Critical inclusions that should be in the software license:

• As between vendor and customer, all data entered into the software database is the property of the customer. This is my nod to the notion that medical records are truly the property of the patient, but that is a topic for another day. The point here is that the customer owns all the data, not the vendor, and the vendor must recognize this.
• Transition must be accommodated. Upon termination of the software contract for whatever reason, all data must be immediately made available to the customer. This is to be provided without question in industry standard format and at no additional cost. This is part of the price of doing business and I have no problem advising my healthcare technology company clients that this must be done.
• The vendor must also agree to provide the data, for an additional cost if necessary, in whatever format is required by the replacement vendor, with a reasonableness factor included regarding technical feasibility.

Dust off your existing EMR license agreement or review the proposed agreements in front of you for that new EMR, PACS system, or HIS as the case may be. No exit procedure? For existing relationships, think about this before you sign with the new vendor. Go back to the existing vendor and address the issue. Far better to do so when there is still a working relationship than after you have told the vendor they will be replaced. For prospective business relationships, get agreement from the vendor as described above (as well as many other important considerations).

Going back to my editorial comments, any customer presented with a contract and the statement that “we do not negotiate” should politely show the salesperson the door. There will be another one from another vendor ready and willing to discuss your needs and listen to your contractual concerns.

This is not to say that vendors must negotiate all terms and conditions as requested by the customer prospect. Vendors are completely within their right to protect their business and intellectual property, limit their liability, and keep sacred the things most important to them. However, to place a contract in front of a prospect with the message “take it or leave it” is not good for business. Unless of course the agreement is written so fairly that it considers not only the company’s interests but also the interests of its customers in equal measures. That would be very rare.

Repeated many times in my HITlaw postings is the advice that contract review, at least for major terms and conditions, is a critical part of the vendor selection process. Do not select a vendor and then look at the contract. When you have the search down to a select few vendors, review the contracts in front of you. Look for the smoldering sections that need attention. Recognize the absence of sections of vital importance for your protection during and after the business relationship.

In the example above, the absence of a “data rights at termination” section should be immediately brought to the vendor’s attention. If the vendor provides language suitable for your protection, keep them in the game. If they refuse where others cooperate, take them off the list.

Please see my quick tips for an EMR Contract, as well as my paper Selection and Negotiation of EMR Contracts for Providers. Hopefully my general insight and advice will help avoid problem situations such as the one involving unfortunate Practice A.

Previous HITlaw postings were fairly infrequent and arose only when I found a seriously weighty topic. Look forward to more frequent postings on important issues in shorter format. E-mail me with questions and suggestions for future HITlaw writings, whether provider side or vendor side.

William O’Toole is the founder of O’Toole Law Group of Duxbury, MA. You may contact him at wfo@otoolelawgroup.com and follow him on Twitter @OTooleLawHIT.

Time Capsule: Fiction Writers, Get Ready: The “Most Wired” Bandwagon is Leaving the Station

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 February 2008.

Fiction Writers, Get Ready: The “Most Wired” Bandwagon is Leaving the Station
By Mr. HIStalk

It’s “Most Wired” time again and I’m excited! Just like those folks who find themselves overdue for a teeth cleaning or an annual prostate exam.

Actually, it’s worse. Hygienists and rubber gloved doctors work quickly. Those magazines, companies, and consultants with a vested interest in the Most Wired nonsense yammer incessantly about it for months, wasting free magazine space on how insightful it is, how much the results correlate directly to everything that’s good in the world, and how inferior you should feel if your hospital isn’t participating (and winning, preferably, since this is America and everything is competitive).

I once worked in a fairly sophisticated IDN’s IT shop. Lo and behold, right there on the newly announced Most Wired list was one of our tiny hospitals, a 100-bed rural facility with zero IT staff, remotely hosted green screen apps, and no IT budget.

We never found out who completed the application, but it was an impressive work of fiction. For example, it claimed a really high CPOE utilization, which was especially amazing because they didn’t even have a CPOE application (maybe they thought it stood for Clipboard Physician Order Entry). Same with nursing documentation – they were purely paper-based, but claimed to be electronic. Those reading the hallowed roster of winners probably thought that our little hospital was an enviably progressive IT hotbed.

People often make interpretational errors on the Most Wired survey form (often to their advantage, I know you’ll be shocked to hear) and sometimes lie outright. I’ve read down the list of winners some years and laughed out loud at their audacity. All it takes is some competitive pressure and a CIO or CEO who’s looking for bragging rights and suddenly the submitted numbers are as opportunistically flexible as a vendor completing a prospect’s RFP. If in doubt, just say you’re doing it and feign misunderstanding if caught.

Most Wired wouldn’t be so bad if only CIOs read it, bragging about their big W like a pimply teenaged boy excitedly describing his prowess in a purely fictitious romantic liaison. What’s the harm? It’s this: non-IT executives may actually think it’s a useful yardstick. The magazine loads up with impressive graphs and makes enormous logical leaps to connect IT spending with quality, cost, and the salvation of mankind. The gloss increases the danger that someone might take it seriously and leap vigorously onto the ill-advised bandwagon as a result.

I asked one of my employees to complete our Most Wired application one year. He was struggling with its ambiguity and the knowledge that many applicants were most likely fictionalizing to some unknown degree. Finally, he summarized: “How I answer depends on how badly you want to win.” We had won in the past and he knew the pressure was on for a repeat.

Just about everyone pushing Most Wired makes money on IT sales, implementations, or advertising. They have a vested interested in shaming people into buying and implementing, even when it’s a bad idea. The message is clear: winners buy IT while Luddite losers cower in the corner.

You can’t stop your peers from entering and maybe even winning Most Wired. You should, however, let your executives know what categories it measures, what you’re doing in those areas, and how your IT efforts support organizational goals in ways that go far beyond a simple survey.

If enough people do what they should be doing instead of what the survey pushes, maybe the foolishness will stop. It would be nice if organizations focused on their own strategic IT needs instead of worrying about how they rank on a vendor-sponsored survey that encourages one-size-fits-all conspicuous consumption.