Time Capsule: Services-Heavy Vendors: The High-Flying Offense Turned Boring Ground Game

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 June 2007.

Services-Heavy Vendors: The High-Flying Offense Turned Boring Ground Game
By Mr. HIStalk

Enterprise software vendors go through three lifecycle stages:

• Stage 1 – We’re going to develop and sell the greatest software application in our market.
• Stage 2 – The software market is fickle and cutthroat now that new entrants are in play. We’ll keep our product competitive but, in the meantime, we’ll ramp up a highly profitable services business like all those consulting companies that are pulling down easy money.
• Stage 3 – Our legacy software applications are getting killed by Stage 1 competitors, so we’ll just milk the services side and maybe someday develop some new applications if that cash cow ever dries up and the market forces us into it.

If you’re a vendor, what stage is your company in? If you’re a provider, where are your vendors?

It’s important, because in all but Stage 1, there’s not much innovation going on. Once the services money starts rolling in, no one wants to risk it by investing in innovation. The big money is made in Stage 3, where the capital investment is paid off and the gravy train is rolling in.

It’s like the Super Bowl. A team often gets there by fearlessly airing the ball out and running reckless blitzes, beating all comers. Once they’re in the big game, they suddenly drag out a conservative ground game and prevent defense that causes spectators to nod off in their $1,000 seats. Often, they lose.

You see that a lot with publicly traded companies that are scared to death of one bad quarter. Instead of playing to win, they’re playing not to lose.

Conservative customers keep encouraging them. They give Stage 3 companies preference, using the same criteria that a grandmotherly investor looks for: solid financials, a long list of customers (even if they’re largely indifferent ones), and well-groomed executives who talk about vision but mostly worry about financial ratios and earnings reports.

In other words, customers claim to want innovation, but when it comes to their own IT capital, they invest in those companies least likely to innovate. Vendors say they want innovation, too, but they usually just take the easy way out and buy the Stage 1 upstart and smother them with their stifling culture.

A Stage 1 company might offer the best chance of creating a truly brilliant product, but getting a critical mass of customers is hard. The company could run out of capital, lose its visionaries, sell out to a big competitor, or otherwise stumble and never realize its potential. If there’s a 60 percent chance of that vs. a 100 percent chance of a boring but serviceable Stage 3 product, most hospitals will take Door Number 2.

According to KLAS surveys and watercooler discussions, few hospitals really like those multi- million dollar systems they keep buying. Certainly the results they obtain from implementing them are largely unimpressive.

That isn’t surprising if you buy the idea that vendors are all striving for Stage 3, having long outgrown their starry-eyed beginnings. Recurring revenue is the Holy Grail. Software only needs to be good enough to keep the service revenue coming. The one-shot capital bump from licensing is small potatoes in comparison.

The market won’t change unless threatening new companies enter at Stage 1. A constantly replenishing supply of them is needed because they, too, want to hit the Stage 3 Promised Land.

You’ll know if we ever get enough Stage 1 vendors nipping at Stage 3 heels. The Stage 3 powerhouses will suddenly get mad enough to start airing the ball out again. That ought to wake up the bored fans.

HIStalk Interviews Jim Hewitt, CEO, Jardogs

Jim Hewitt is CEO of Jardogs and CIO of Springfield Clinic, both of Springfield, IL.

Give me some background about yourself and the company.

I started in healthcare IT back in 1989 with a startup company named Enterprise Systems out of Bannockburn, Illinois. They were focused on hospital-based systems. Their CEO at the time had this vision that PCs and networks were going to be the future, so we needed to migrate everything off of the mainframe into this client-server environment. I started as a developer there and have been focused on healthcare IT pretty well my entire career.

I did a short stint in the financial space for the Options Clearing Corporation, which was a very unique opportunity to do some work for them. But really, my heartstrings were back in healthcare. I left the OCC and joined Allscripts just as they were starting. I spent about six and a half years with Allscripts as their CIO.

I left there for family reasons and moved to Central Illinois. I got a call from one of the Allscripts’ customers, Springfield Clinic, to ask me to come help them implement their EMR. I decided to do a short-term stint with them to help them do their EMR implementation, which was very successful throughout all of their locations.

At that point in time, I was getting the itch to get back into the vendor side of the world. I decided to start a new company, which was Jardogs. I started that a little bit over three years ago. The clinic had come back and asked me to stay on with them as their CIO and have the clinic incubate Jardogs for us. That brings us to current state. I’m still CIO of Springfield Clinic and I’m also CEO of Jardogs.

Jardogs was founded on my vision that as you look at healthcare as a whole, healthcare IT really started in automation of those back-end systems within the hospital. Over the years, we’ve evolved to be ambulatory focused, where the dawn of the EMRs have come about. As I was looking at that trend as well as where we are nationally in a healthcare state, I truly believed that the next big thing and focus was around patient engagement.

That was the basic premise of starting Jardogs three years ago — to look at the evolution of how to engage the patient as part of this whole healthcare system and how we can add value both to the patient as well as those connected organizations.

Tell me about the name. I don’t think I’ve ever heard where it came from.

It’s a closely-kept secret. It is an acronym, but the mystique is much better than what the actual name means.

We went through a very long and tedious process. It’s almost impossible to find a unique name that isn’t already taken from a domain name standpoint, so we had run a contest three years ago. We asked a bunch of people to submit different names and ideas and then we brought that to our board. Jardogs won without anyone knowing what it actually meant. It won because it stuck out in everyone’s mind. After the name was selected, that’s where the logo and the branding and that fun component of the company came into play.

It’s hard for me to get a grasp of exactly what you do. Is it population health? Is it interoperability? Can you characterize all the things that are out there circling around in your ecosystem and where you fit?

It’s a great question. Honestly, we have hard time putting ourselves into a specific niche because we are a very unique offering into the industry.

The primary system is our FollowMyHealth, which we call a Universal Health Record, which is different from a patient portal or a personal health record. It’s a combination of a multitude of different systems. At its core is that it is a national personal health record, but it has all the attributes of a connected patient portal.

When I was sitting back and looking at personal health records and that concept, it’s very important to our nation that we have central repositories for patients to manage their healthcare. But the downside is if you look at HealthVault, or Google Health at the time, those products did not really add any value to the patient. They were very difficult to manage because they weren’t connected to their healthcare providers. You had to go in and manually update all of your information. I go see the doctor, then I have to go home and remember to key in all that information. 

That’s what’s so great about what they call a tethered patient portal. The patient portal is directly connected to the organization or your provider. The downside with that is it’s not national, and it doesn’t share information with everybody else.

The concept was to come up with a national or local community-based portal where all of your information could be aggregated and managed by that patient. To do that was very complex, because it was really building parts of an HIE, building a tethered patient portal with all the integration into a multitude of different EMR vendors, as well as creating a national infrastructure to share that data like a personal health record. It’s a culmination of all of those things together which creates the Universal Heath Record.

That would be different from something like Epic’s MyChart in that you’re not vendor specific. Is it otherwise similar?

That’s exactly right. Epic is trying to do some things with trying to share that record outside of their organization, but they haven’t built the framework to translate all of their data into a common nomenclature and then allow that to easily flow with patient consent to all other healthcare organizations.

There are some differences. The reason that Epic is at that national level is because they are widespread throughout the United States. We do have customers that are on Epic that actually use the FollowMyHealth system to aggregate data and provide that inside their own entity.

Who buys your product and how do they roll it out?

Our customers are clinics and hospitals throughout the US. The providers or those hospitals will buy a license. They get a customized website. They have all the attributes of a tethered portal — their own branding, their own information — but then that entire system is connected into the national FollowMyHealth infrastructure across the board. It’s free to the patient.

If a hospital has its own practices or affiliated practices, they can connect those electronic medical record systems, whatever they are, to integrate with the product?

There are really two different scenarios. The first scenario is that I’m a large IDN, and I have multiple EMR systems within inside my organization. The main problem that they’re trying to solve in that case is how to provide a single portal across their entire entity. How do I aggregate the data inside my own organization and then provide that through a single portal to my patient population?

In that case, our infrastructure allows us to very easily pull that all together and then drive that into a single portal for the patient. On the flip side, when the patient tries to communicate back to that entity, we can then route that information and integrate it into the appropriate hospital system or EMR on the back side. It provides that one fluid portal to this large complex entity.

In another case, you may have a community in a large city where you have multiple hospitals, clinics, multi-specialty groups, and single-specialty groups that all have different portals, but have come to the realization that patients want to manage their health information in a single location. That’s where we’re seeing multiple entities go into those communities and say, “We need a community-based solution. We’re going to all have separate portals and separate entry points, but we’re going to have one central repository for the patient to manage all that data.” There are multiple storefronts on that single repository.

You’re not just showing the patients stuff from different systems — you’re reposing data and doing something with it in addition to presenting it to them.

That’s correct. We have national master patient index, and one of our key components is translation services. When a patient connects to an individual organization and that organization releases the information to the patient or makes that connection, we translate all that data into a single nomenclature and put it up into that patient’s personal health record or repository. When they connect to another organization, we do the same thing, and we translate it into a common nomenclature and bring that in to the repository. The patient has a single view of their data across those multiple systems.

If they want to share back into those individual organizations, the aggregated sum of the data then comes back down. It can be discretely brought into those EMRs for verification by the healthcare provider.

Will there be capabilities on the provider side to do public health or surveillance or anything like that with the data that didn’t necessarily come from their own system?

Sure. We bring it back in to their systems, so then they have the capability if their systems support it. The first phase for us is building that national infrastructure and connecting patients with the physicians. For me, that was Phase I.

But if you look at trying to solve the overall healthcare issues that we have today, we know that we have to engage the patient. We know that we have to be proactive within our healthcare. Once we have this conduit in place, how can we leverage that to actually engage the patient and become proactive? That’s where population management, monitoring compliance, home health and wellness components layer on top of that to provide that true engagement at home.

The three product lines that we’re working on right now that sit on top of that infrastructure are exactly those. We have a population management component, we have a monitoring and compliance component, and then we have a home health and wellness component. Each one can live individually, but the entire suite together is what rounds out our whole patient engagement solution.

HITECH grant money is funding development of HIEs. How does your offering fit into the situation where somebody is already getting HIE money? What are they not doing that they could do if they had your product?

I’m on the board of Lincoln Land HIE here in Central Illinois, so I understand the HIE. I know what they’re trying to do. The way that I break it up is that current HIEs today are more focused on B2B transactions. You’re going to have data moving from organization to organization without the patient being involved.

That’s great. I love the concept of standardized interfacing for orders, results, documents across a large area, even potentially across multiple states. That’s much better for healthcare. The struggle is, how do you use those systems to engage the patient? They do provide value to the physician side, but I don’t see that patient engagement component.

What some of the HIEs are gearing up to do is to try to create a central repository and then do population management on that central repository, but organizations are really struggling with data ownership and competitive issues. If there’s five primary care physician groups all using that same repository trying to do population management, is the patient going to get five notices on some health maintenance reminder from five different people? That’s where the struggle is from an HIE perspective. 

Where we’re a little different is that the data is managed by the patient and released by the patient. The patient decides, “I want this organization to be my primary care manager of that information,” and that’s where it’s going to flow and be managed.

So they’re not specifying data element by data element, saying, “This is OK to release. This isn’t.”

Right. There’s two different levels of release we’re building. The first level is based on request.  The healthcare organization, based on an appointment reminder, will request information. What is being built with these new solutions is that the patient can set up a real-time flow of information back to an individual organization. That’s where that organization is going to get a lot more value, because all that information can flow real time to them.

Other than seeing their own data and controlling who else can see it, what patient engagement tools are possible?

From the Universal Health Record standpoint, all of the standard stuff that you get from a tethered portal. You can pay your bill online, prescription renewals, lab results, health maintenance reminders, online consults, either direct scheduling in or requesting a schedule appointment. I’m sure I’m probably missing something, but all of those basic features that you get from a tethered portal.

Other features you get are forms, but also sharing that information across different organizations. We also have a mobility suite for them, so if they are travelling, they can either fax or e-mail their health information directly from their phone. If I’m in Florida and my kid gets sick or I’m sick, I can provide that information directly to them if they’re not a FollowMyHealth user already. We have proxy support, so I can manage my parents’ health information if they give me access. There’s a lot of features I’m just managing and reviewing my information.

The other big thing that we see within our customer base is that most of them are doing a full release of information. They’re releasing all chart notes and scanned documents. You’re really getting a full release of information as opposed to just problems, allergies, meds, immunizations, and results. Our system is delivering a lot more tangible information to the patient.

A physician can set up a monitoring and compliance program and order that through the EMR system. That will monitor and notify care teams if a patient isn’t being compliant or if a data range became out of range. We can be very proactive in saying that we want you to either go through the patient portal and enter this information, or we want you to take one of these connected devices at home and we want you to take your blood pressure every day or whenever it may be. If you fall out of compliance, the system will automatically notify care team, nurse, physician … however you want that to be configured. Because of that connectivity, we have the ability to do some pretty cool things.

The trend everywhere, but especially on the interoperability side, is to open up the platform and let other folks build apps to sit on top of it and add value.

We’ve already done that. We provide a software development kit. Organizations, either our customers or non-customers, can come in and build applets that snap directly into the FollowMyHealth infrastructure. We provide that for free. There’s no fees for that. We believe in complete open systems and allow the consumer to choose. We are very, very open. We also have a very open standard on all of our interfacing into different systems. We’re trying to be as easy as possible to use.

People have shied away from the term “personal health record” since Google Health left a stench over it. What did you learn from the failure of Google Health?

There were really two issues. One was concern about privacy of data. Number Two was adding value to the end users. The Google Health mindset was to have the consumer or the patient come in, create an account on their own, and then manage it. If their organization someday decided to be a Google Health user, you might get some data to flow.

We’re taking a completely different approach. We are engaging the healthcare organization upfront, having them engage the patients to connect, and then providing real value in that connection. They get their data immediately. They have the ability to request appointments. They can get prescriptions refilled or renewed. They can go through that entire process and have real data right there upfront.

I’m really concerned about HealthVault as well. They take the same approach of, “Let’s have consumers come to us, create that record, and then hopefully connect someday.”

Any concluding thoughts?

We have to figure out ways to engage the patient. Not only sick patients, but healthy patients as well. We need to move to a model where the patient is engaged, the patient cares about their health, and they are being compliant. The focus need to be on how we can do that effectively. How can we create engaging tools that will allow our patient populations to help us manage their health?

That’s the true way we’re going to get cost out of healthcare. Whatever system it may be, we need to figure that out and make sure that we are engaging those populations.

Allscripts Caves to Proxy Fight, Nominates HealthCor’s Board Candidates

Allscripts announced this morning that it will nominate a three-member board slate to settle a lawsuit and proxy fight brought by key shareholder HealthCor Partners. HealthCor previously called publicly for the replacement of Allscripts CEO Glen Tullman, sued the company over its plan to nominate its own candidates to replace four board members who quit in April in a management dispute, and had obtained an expedited review of its arguments in a hearing that was scheduled for June 14, the day before the Allscripts shareholder meeting.

The director nominees are:

• Stuart Bascomb, founder of Express Scripts and chairman and CEO of QualSight, which offers managed care refractive surgery
• David Stevens, former chairman and CEO of specialty pharmacy vendor Accredo Health Group
• Randy Thurman, founder of Viasys Healthcare and former CEO of Corning Life Sciences and Rhone-Poulenc Pharmaceuticals

Tullman said in the announcement, “We welcome the addition of Stuart, David, and Randy and believe they will bring new perspectives and additional industry experience to our board. Taken together with the recent additions of Paul Black and Robert Cindrich, the Company will have added five, high-quality, independent directors in just the past few weeks. We believe this is a positive outcome for Allscripts and its stockholders and we look forward to working collaboratively as we continue to implement our strategic initiatives and make the important and necessary investments to deliver a connected community of health for our clients and build value for all of our stockholders.”

HealthCor co-founder Arthur Cohen said, “We are pleased to have reached this amicable resolution with Allscripts, which we believe will serve the best interests of all stockholders. We continue to believe that Allscripts has great products, strong capabilities and a unique installed base of customers. Furthermore, we are confident that Stuart, David, and Randy will make strong additions to the Board, and will work hard to represent all stockholders and assist the Company in seizing the tremendous market opportunity before it.”

News 6/1/12

Top News

A study finds that physician practices using EMRs did no better (in fact, did a bit worse) in delivering diabetes care. It wasn’t a very large study, it was narrowly focused, it didn’t take into account such important variables as insurance or patient demographics, quality of EMR use wasn’t considered (the survey just asked whether the practice “owned” an EMR), and it used old data (the baseline assessment was from 2004 and the follow-up was in 2006.) I don’t take it to mean much, to be honest, but I’m sure it will be widely (mis)quoted with headlines that don’t reflect the data. The full text article is here.

Reader Comments

From Master of Tweets: “Re: Aneesh Chopra tweet chat sponsored by HIMSS and the magazine they publish. He mentioned HIStalk, but their magazine removed that from their transcript.” Above is the former US CTO’s answer when asked what he reads to stay current on health IT trends, That tweet does indeed not appear in the magazine’s transcript (which means it’s not really a transcript since they edited stuff out.) My favorite question he was asked: "Many ‘experts’ in health IT have never used let alone implemented an EHR – how do we get stories of success out?" I’ve learned to tolerate the writing and tweeting of HIT-naïve reporters, academics, etc. when they stick to repackaging the news, but I don’t recognize their credentials to be armchair quarterbacking to CIOs, doctors, government folks, or vendors. You need street cred like Inga when she threw down by fearlessly by asking Farzad Mostashari, “When was the last time you used an EHR?” with both her question and his answer (after his initial shock) raising their respective levels of professional credibility.

From Maxwell Smarts MD: “Re: Cerner. Their silence is deafening giving their central role in the HealthSMART program, now declared a total failure.” The Victoria, Australia government finally puts HealthSMART out of its misery due to the ubiquitous dynamic duo of cost overruns and implementation delays. I’ve been reporting regularly on HealthSMART, launched in 2006 with an estimated cost of $318 million, but now dead after blowing through $557 million with only 40% of the sites live several years after the expected completion date. Millennium was the key component and Cerner struggled to localize it according to critics there, but the government apparently also contributed its expected share of incompetence. Maybe there’s a shining example out there somewhere of government bureaucrats and politicians hunkering down in the mud with big contractors and Wall Street-driven vendors to deliver a successful IT project on time and on budget, but I can’t think of even one.

From Killjoy: “Re: Harris Corporation. Looks like they are purging many of the CareFx positions after their acquisition last year. I heard 40 or so were let go Wednesday.” Unverified.

From Secretive: “Re: Accretive Health. Its SVP apologizes while being grilled by Sen. Al Franken’s committee.” It was a conditional apology – the SVP says that while some patients may have been offended, the company operated within legal and industry guidelines, also pointing out that it fired the employee whose widely quoted e-mail called patients “deadbeats” and “stupid.” More interesting to me was that according to Minnesota Attorney General Lori Swanson, Accretive customer North Memorial Medical Center turned patient information over to Accretive without having a business associate agreement in place, but created one later and back-dated it. That hospital’s data was exposed when a laptop was stolen from an Accretive employee’s car.

From @Cascadia: “Re: NHS. They are shutting down the PHR, but they are clearly emphasizing patient portals according to their just-released Department of Health strategy.” They are indeed. The PHR, in addition to being a big-time flop, wasn’t really necessary to give patients access to their own information. The story of vendor-offered PHRs is pretty much like that of mullets, Zamfir’s pan flute, and the Big Mouth Billy Bass – they’re an unpleasant memory of an unfortunately popular fad that nobody admits to having embraced.

HIStalk Announcements and Requests

On HIStalk Mobile, Dr. Travis posits a great question: why aren’t we hospitals involving inpatients and their families in their care by giving them their own meds lists? They could not only learn by following along with their copy of the MAR, but would also undoubtedly catch a bunch of medication errors. You would think that despite potential embarrassment, hospitals would appreciate being given a chance to avoid making a medication mistake. Why wait until right before discharge to suddenly start dumping information on the patient for take-home use?

HIStalk stats for May: 116,203 visits (the second-busiest month ever, barely behind the HIMSS month of February 2012) and 219,070 page views (beating the all-time record from last month by 20%). Year over year, visits are up 42% and page views are up 98%. Very nice for a month that’s usually the beginning of the summer doldrums. I don’t really follow the numbers, but some readers e-mail me if I don’t mention them. I work the same whether it’s a bunch of readers or not many. Which reminds me as I’m writing this: HIStalk turns nine years old on Sunday, meaning I can’t even remember what it was like having only one full-time job.

I don’t have any reports from the MUSE meeting. Yours is welcome.

On the Jobs Board: Service Delivery Manager, Cerner and Epic Resources. On Healthcare IT Jobs: Programmer Analyst II, Cerner Go-Live Project Manager, Network Engineer II.

It doesn’t take much to make Inga, Dr. Jayne, and me happy. Just your reading HIStalk pretty much does it. If you’re an overachiever, you can (a) sign up for the spam-proof e-mail updates; (b) check out the searchable, browsable sponsor Resource Center; (c) use the Consulting RFI Blaster to painlessly get proposals for your consulting needs; (d) connect with us on LinkedIn, Facebook, Twitter, and all those trendy sites since we approve all requests to join our fairly large network; (e) support our sponsors by perusing their ads and clicking on those that tickle your fancy; and (f) keep the news, rumors, photos, etc. coming since we are not omniscient – we get a lot of help from readers. Of which you are by definition one, and we appreciate that.

Acquisitions, Funding, Business, and Stock

MED3OOO announces its acquisition of St. Louis-based KASS-MSO, an 80-employee provider of medical practice services.

RTLS vendor Versus Technology announces Q2 results: revenue up 89%, net income $198,000 vs. –$405,000.

SAIC reports Q1 numbers: revenue up 4%, EPS $0.35 vs. $0.36. The company said its Vitalize Consulting Solutions acquisition increased revenue, but its Military Health System revenue was down.

Sales

Greater Houston Healthconnect (TX) selects Medicity’s HIE solutions to connect more than 130 hospitals and 14,000 physicians.

Catholic Health East purchases NetSafe business continuance and downtime protection software for its 15 hospitals.

Covenant Health (TN) selects InfoSystems to provide data center virtualization and optimization infrastructure.

NextGate and CSC announce plans to integrate the NextGate Multi-Language Enterprise MPI with several iSOFT applications.

Caverna Memorial Hospital (KY) selects clinical and financial solutions from Healthcare Management Systems.

People

Robin Settle, former leader of PricewaterhouseCoopers’ HIT leadership team, joins Kurt Salmon’s HIT practice.

CORHIO announces that its policy director Liza Fox-Wylie has been selected to become Colorado’s State HIT director.

RCM provider Medical Business Resources appoints Thomas D. Sidebottom (Oracle) its CTO.

N-of-One, a provider of personalized diagnostic and treatment strategies for oncology patients, names Christine Cournoyer , former president and COO of Picis, as CEO.

Vitera Healthcare Solutions appoints Steven Holmquist (MedPlus/Cerner/HBOC) VP of sales.

Apollo Health Street brings on three sales professionals with healthcare IT experience: Andrew Finck, Greg Williams, and Anil Kumar.

Announcements and Implementations

Maine’s HIE announces the pilot of the nation’s first statewide medical imaging archive, which will include data from 56 radiology imaging centers, require about 200TB of storage, and be hosted by Dell.

UPMC deploys AeroScout’s Healthcare Visibility Solutions to automate temperature monitoring at its St. Margaret Hospital and will roll out temperature monitoring and asset tracking across most of its US hospitals.

DPR, a provider of imaging informatics for the radiology industry, will embed M*Modal Fluency Direct technology into its CaseReader structured reporting software solution.

St. Michael’s Hospital in Toronto implements Amcom Software’s Mobile Connect solution to send encrypted messages to staff on their iPhone, iPad, and BlackBerry devices.

Madison Memorial Hospital (ID) goes live on PatientKeeper CPOE and Medication Reconciliation.

Gateway EDI announces that it has signed its 100,000th client and expanded its client base by 19% over the last year.

Government and Politics

Last chance: nominations are due June 11 for open slots on the HIT Policy and Standards Committees.

Other

An article called That CT Scan Costs How Much? in the new Consumer Reports covers wide variation in healthcare charges, even for patients who are careful to use in-network providers. The price of an in-network colonoscopy in one city ranged from $840 at a freestanding practice to $4,481 in a big academic medical center. In another example, a woman with new Cigna insurance was treated in the ED for back pain and the hospital told her she owned $6,500 of the $14,600 bill that included a $9,000 CT scan. The hospital told her they’d take $3,000 cash if she paid immediately, which she did, only to find afterward that other Cigna providers offered CT scans for $318. Other stories: a woman with high-deductible insurance couldn’t find any lab that could tell her what her two routine tests would cost; a patient went to an out-of-network neurosurgeon for a risky procedure and was charged $592,000 by the surgeon vs. the $112,000 the insurance company would pay as usual and customary; and a woman who carefully chose an in-network surgeon still got stuck with a $10,000 bill from the hospital’s out-of-network anesthesiologist.

Feather River Hospital (CA) will shut down its 12-employee medical transcription department and outsource the work, saying the government’s push for EMR usage will reduce its need for transcription services. Said one of the transcriptionists, “I think they are going to find that they still need us. I don’t think computers are going to cut it.” That’s what stenographers said.

The 3,700-physician Hill Physicians Medical Group (CA) posts its financial results publicly: $481 million in revenue and $11.6 million in profit, even after spending $7 million last year on an EMR. The full report mentions specific applications they use: RelayHealth, Ascender, and NextGen.

A specimen control clerk at Mount Sinai Hospital (FL) is arrested on identity theft charges after police found credit cards and hospital computer printouts that were later traced back to her.

National Coordinator Farzad Mostashari will deliver the opening keynote for the 2nd International Summit on the Future of Health Privacy, held in Washington DC June 6-7. Registration is free to either attend in person or to view via streaming Webcast. The agenda is here.

An Abu Dhabi publication profiles Cerner nurse executive Deirdre Stewart and the state of healthcare IT in the Middle East. It says UAE spending on healthcare IT will rise from $3.1 billion to $4.7 billion this year, with quality (“the latest technology from reputed companies”) rather than price driving product selection.

The government of South Australia provides $186 million to fund three health IT projects: a patient administration system, a pathology information system, and a medical image storage system.

Weird News Andy predicts that June 21 will be a long day for patients in the UK. Unionized doctors there vote to go on strike for a day for the first time since 1975. The docs are mad about government plans to push back their retirement age from 60 to 62 and to make them contribute more towards their pensions. In the example given, a doctor making $185K today could retire at 60 with an annual pension of $74K, with one Member of Parliament (who’s also a doctor) saying, “The public will simply not understand why doctors have called for strike action over pensions that private sector workers and many other frontline NHS workers can only dream of.”

A money-losing hospital in Canada that installed a Tim Horton’s coffee shop expecting to make the same $300K annual profit that similar outlets rake in instead finds itself losing $260K per year. The CEO of the health authority explains: “We charge you a buck-ninety-four for that large coffee, but we insist that the staff who are pouring the coffee are Eastern Health staff, and they get paid $28 an hour.” The health authority says it will turn the location over to a private operator that isn’t saddled with its generous compensation practices.

Sponsor Updates

• Memorial Medical Center of West Michigan selects Wolters Kluwer Health’s ProVation Order Sets as its electronic order sets solution.
• Frost & Sullivan awards Imprivata its 2012 North American Customer Value Enhancement Award for accelerating EMR adoption with its single sign-on solution.
• Hayes Management Consulting announces that its MDaudit software provides an E&M bell curve reporting module to help organizations identify providers who are consistently coding higher than their peers.
• A local newspaper interviews Kareo sales director Jason McDonald, who shares how his experience as a Marine has transferred to his civilian career.
• The Advisory Board Company posts a case study that details how St. Joseph’s Hospital (TX) launched a four-hospital clinical integration network in just six months.
• Premier Bone & Joint Centers (WY) selects SRS EHR for its 12 locations and 10 physicians.
• CTG Health Solutions hosts a Webinar on healthcare security issues.
• Health and Social Care Northern Ireland selects Orion Health to provide a clinical portal-based Electronic Care Record.
• Sentara Healthcare discusses how Capsule Tech’s DataCaptor solution helped it connect more than 1,800 medical devices from over 1,000 patient beds. 
• Healthmark Regional Medical Center (FL), Millford Memorial Hospital (UT), Beaver Valley Hospital (UT), and Kit Carson Memorial Hospital (CO) select Prognosis HIS Enterprise Clinical and Financial systems.

EPtalk by Dr. Jayne

NCQA offers a seminar on Improving Organizational Performance to be held July 11 in Washington, DC. Speakers will discuss overcoming obstacles and barriers as well as implementing effective quality interventions. ONC will be providing faculty support as well. The fee is a bit steep, though – $795 unless you register prior to June 13 for the early bird discount.

George Washington University’s Hirsh Health Law and Policy Program has launched Health Information & the Law as a guide to federal and state laws on the access, use, release, and publication of health information. Information is grouped by topic and an analysis section also features articles and issues briefs by GW authors.

A colleague from residency recently introduced me to Quackwatch, which describes itself as “your guide to quackery, health fraud, and intelligent decisions,” which got my attention. Although some of the articles are older, there were many interesting reads. The kinds of scams described never go out of style, unfortunately.

If you build it they will come. Or not. A recent report shows that less than a third of eligible physicians reported quality data to CMS for 2010. Although 125,000 physicians received a bonus, 50,000 attempted and failed. Physicians who don’t report in 2013 will be assessed a noncompliance penalty starting in 2015, although it’s relatively small at 1.5%. I don’t blame paper-based physicians who have small Medicare panels for concluding that reporting may be more trouble than it is worth. On the other side, for most providers with reasonable EHR technology, you’re just throwing away money if you’re not reporting.

CMS will host a National Provider call on June 7 for Eligible Professionals to learn about registration and attestation for the Medicare/Medicaid incentive programs. There are quite a few providers out there who still have only minimal knowledge of the programs. Since this is the last year that providers can start and still earn the full incentive, it’s a good starting point for providers who need to catch up. If you’re a provider who didn’t report, why not? Do you plan to report in 2013?

A thoughtful reader sent an article to Mr. H “for Inga and Dr. Jayne on their never-ending quest.” It was a review of Rachelle Bergstein’s book, Women From the Ankle Down: The Story of Shoes and How They Define Us. It’s been added to my Amazon wish list (ahem, to certain men in my life who may be shopping for a soon-to-be arriving birthday) and I’ll be sure to read it prior to the next HIStalkapalooza so I can provide more informed commentary on the shoe competition. In the mean time, I learned a great factoid from the review: Salvatore Ferragamo invented the cork-soled wedge after taking human anatomy classes at USC. Who would have guessed?

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

CIO Unplugged 5/30/12

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

Memorial Day: What is Your Legacy?

April 2007. While in Washington DC on business, I spent some time sightseeing with fellow/former Army officers. One gentleman was the recently retired commanding officer of the 3D US Infantry Regiment (Old Guard) charged with guarding Arlington Cemetery, including the Tomb of the Unknown Soldier.

He gave us the most unexpected honor. He prearranged for a couple of us to lay the flowered wreath at the Tomb during the evening changing of the guard.

I still get the chills as I reminisce that moment: escorted between sober, armed soldiers; laying a measly garland of flowers before a solemn tomb; silently saying “thank you” for the millionth time to men of sacrifice with no identity, lost but never forgotten. The sight of our flag coupled with the singing of our national anthem generally brings tears to my eyes, so this honor was as good as it gets.

A sacrifice… never forgotten. Despite language, religious, and geographical differences, humanity shares a universal desire: to make life meaningful. Whether it means having an impact on a family, a village, or a nation, we all want our lives to count for something.

The Memorial Day Service my wife and I attended this weekend reminded me of the brevity and sanctity of life. Every song sung, every speech read, and each poem recited proved life was meant to be lived with relevance and significance. Am I living in such a way that beneficiaries will take time to reflect on my contributions?

For some, contribution means laying down life in battle to defend freedoms. For another, service and sacrifice will have a different flavor. Whatever we are called to do, let us impact people positively and serve the forthcoming generations.

I began to personalize these thoughts in terms of my career. “There’s no limit to the amount of good you can do if you don’t care who gets the credit.” I don’t know who said that, but it’s a truism that helps me keep a healthy perspective. The world isn’t about me, but it does either gain or suffer based on my involvement, how much I give and take.

My new philosophy goes like this:

Let my employer be a better place for teaching, healing, and discovering as a result of my leadership. Let the decisions I preside over have lasting beneficial effect. May I treat others in such a way that their children and their children’s children will benefit. May I always keep the long term in mind to avoid compromise and complacency. Let me leave my employer a better place than when I arrived. May those who I serve have accomplished more than otherwise possible, furthering their careers and thus their impact. May clinical and business outcomes have been positively impacted and lives improved.

Though no one else might see it, my epitaph will read, “My service in healthcare mattered.” In the end, even if no one remembers our names, maybe they’ll still place a metaphoric wreath at a tomb in honor of all of us who served to make healthcare better.

What about you? What legacy will you leave behind?

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

News 5/30/12

Top News

In the UK, NHS says it will shut down its HealthSpace personal health record by March 2013. The Department of Health director says the system attracted few users, which he says is because, “It is too difficult to make an account. It is too difficult to log on. It is just too difficult.” A 2010 report commissioned by the government said it was failing for the reasons that government-run software projects usually fail: poor project oversight, lack of ability to define standard datasets, poorly defined consent practices, and contractors looking out for their own interests. I found this comment fascinating and relevant to other clinical IT system deployments:

The fortunes of the SCR and HealthSpace programmes appeared to turn partly on the philosophical question “Where is the wisdom we have lost in knowledge?”. Many though not all senior stakeholders in CFH, the professions and the IT industry viewed knowledge as stable and discrete data items which could be extracted from their context, placed on the SCR and transmitted to new people and contexts while retaining meaning. An alternative perspective holds that much knowledge is tied to particular people, organisations, experiences and practices and is difficult if not impossible to extract from its context or the people who know it.

Reader Comments

From Period Piece: “Re: hospital pricing article. Cash is king.” The LA Times covers the seldom-discussed topic of hospitals offering lower prices to cash-paying patients. Its lead example is a hairdresser who pays $700 per month for medical insurance and who was charged $6,707 for a CT scan, of which her share after insurance was $2,336, but had she just written the hospital a check, she would have paid only $1,054. Another hospital lists the same test at $4,423, the Blue Cross Blue Shield negotiated price is $2,400, and the cash price is $250. Says the patient, “I was really upset that I got charged so much and Blue Shield allowed that. You expect them to work harder for you and negotiate a better deal … it kills me that I’m paying that much in premiums and it’s better to pay cash out of my own pocket.” In yet another example, a doctor ordering blood work for his patient found that the hospital charges $782, the insurance company billed the patient for $415, but the patient’s cash price would have been $95. Like everything related to hospital charges, there’s even a catch to paying cash: you have to lie upfront in saying that you don’t have insurance since hospitals won’t give the cash discount otherwise since they don’t allow price cherry-picking, although they may offer a cash discount on the insurance company’s negotiated price. The hospital’s Robin Hood-like explanation: insured patients have to pay more to cover the underpayment of Medicare and charity care. The hairdresser is suing Blue Shield and seeking class action status, but the insurance company says it doesn’t guarantee that providers won’t undercut its negotiated prices for cash-paying patients (in other words, they’re making a fortune on administrative skim and premium-raising and thus have no incentive to worry about what their customers are paying providers.) Here’s the thing about medical insurance: both patients and providers would be better off without it other than for its coverage of catastrophic events, which of course is what it was supposed to be in the first place until it morphed into the borderline socialist “health insurance” that used to pay for everything, but now pays less and less even as medical costs increase and patient rebel at the idea of being responsible for their own healthcare expenses.

From Pico D’Gallo: “Re: Duke. Their cost for implementing Epic was announced at $700 million over seven  years, surely a record.” Verified, at least the $700 million part — I found a link here.

HIStalk Announcements and Requests

Based on the success of the HIStalk Advisory Panel, we want to add a separate HIStalk Practice Advisory Panel for practicing physicians and others working in the ambulatory space. Every month or so we’ll e-mail 3-4 questions pertaining to product issues or needs, cool technology that you might be using in your practice, and other issues affecting physician offices. If you have a few minutes every so often to participate, please drop me an e-mail. Many thanks!

Thanks to HealthCare Anytime, joining HIStalk as a Platinum Sponsor. The San Diego-based company offers a cloud-based patient self-service portal (online bill pay, recurring payments, once-time payments by telephone, appointments, pre-registration, secure messaging, refills, and PHR) that gets providers paid faster and makes their operation more efficient. Of course, patients like it too – who wouldn’t, compared to playing time-wasting telephone tag and jotting down indecipherable notes about balances and appointments? The portal helps providers meet two key Meaningful Use Stage 2 requirements: allowing patients to view/download their information and actually exchanging secure messages with at least 10% of them. The company has been around since 2000 and is run by Steve Click (founder and former CEO of Dairyland, now Healthland) and Brady Click (CEO of Intelligent Health Systems and founder of HealthCare Anytime.) The company is at MUSE in Orlando this week if you’d care to drop by Booth 207 to say hello. Tell them you saw them mentioned on HIStalk – sponsors love that tangible manifestation of their support. Thanks to HealthCare Anytime for supporting HIStalk.

I trolled YouTube to see if there were any videos about HealthCare Anytime and, what do you know, here’s a just-posted two-minute overview of their patient portal. I’m usually not that lucky, mostly because not all companies have caught on to the marketing value of posting videos on YouTube or Vimeo.

I can’t believe I’m saying this, but I’m getting kind of excited about Windows 8. I’m hoping it’s an easy and cheap upgrade, but the “cheap” part is negotiable with me – I don’t mind paying for an OS that’s more stable and functional (but I wouldn’t use Internet Explorer even if you paid me.) History has shown a predictable “every other Windows release sucks” pattern going back to Windows for Workgroups, so I’ll believe Microsoft has regained its long-lost relevancy and reputation for innovation if they can break that pattern. If not, Steve Ballmer needs to be fired immediately and I may go with a Mac since the Win 8 team appears to have stolen liberally from the Mac OS anyway. I’m interested in the announcements from WWDC (Apple’s developer conference, probably the most-watched conference in the world) in a couple of weeks, the first without Steve Jobs.

Acquisitions, Funding, Business, and Stock

In the UK, McKesson hires a lobbying company to help it earn IT business following the demise of the government’s NPfIT project. McKesson, which wasn’t a successful bidder in that project, can now sell directly to individual hospital trusts.

Sales

The National Institutes of Health awards Evolvent Technologies a 10-year contract to provide IT services and solutions for the NIH IT Acquisition and Assessment Center. The contract’s ceiling value is $20 billion.

Australia’s Austin Health and the Center for Ambulatory Surgery (NY) select ProVation by Wolters Kluwer Health for GI coding and documentation.

In the UK, Surrey and Sussex Healthcare NHS Trust votes to not only stick with the NPfIT-provider Cerner Millennium, but to extend its contract and add on the RadNet radiology information system. The trust is also seeking a PACS.

David Miller, vice chancellor and CIO of University of Arkansas for Medical Sciences, tells me that the organization has approved an $87 million Epic implementation. They expect to save $10 million per year in clinical improvements and $2 million in reduced software maintenance costs. Upgrading existing systems to meet Meaningful Use requirements would have cost $24-30 million.

LongView International Technology solutions wins a $300 million Military Health System contract to develop proof-of-concept applications that may have something to do with the joint DoD-VA EMR (the announcement doesn’t really say). The company also recently won part of another $20 billion contract. The five-year-old company was started by a retired Navy officer with an MS in hospital administration who had been assigned to the Secretary of Defense to manage a $20 billion appropriation (hopefully not the same one his company won.)

People

Imprivata names Mark Clark (Hitachi Data Systems) as VP of international sales, based in London.

Andrew Terry is named VP of software engineering at electrophysiology lab software vendor Perminova. He was previously with Sotera Wireless.

Announcements and Implementations

Krames StayWell makes its library of discharge instructions available to Meditech customers.

The HealthBridge HIE (OH) announces the go-live of its ED Admit Alert System, which lets physicians know when their patient visits the ED or is admitted.

MediServe announces that its MediLink for Outpatients solution will support recent changes to therapy caps for hospital-based outpatient therapy services.

The White House invites Iatric Systems to participate in the June 4 Patient Access Summit, where it will be one of 25 invited participants. Facilitating the event will be US CTO Todd Park, National Coordinator Farzad Mostashari, and VA CTO Peter Levin.

Image sharing network vendor lifeIMAGE anounces release of programming APIs that will allow software developers to enable image sharing directly from their applications. The announcement cites an unnamed academic medical center’s use of the API to send images from access management systems to Epic and to allow its employees to populate WebMD’s PHR with their images. I interviewed President and CEO Hamid Tabatabaie awhile back and learned a lot about the state of image sharing.

Government and Politics

Former US CIO Vivek Kundra, now with Salesforce.com, takes a shot at the IT establishment, which he says is stifling innovation. “There are these evil CIOs that everyone hates because they’re the ones that tell you ‘you can’t bring technology to your workplace.’ They represent the greatest threat not just to innovation, but also to citizens getting the services they want.”

Under fire: the Affordable Care Act’s 2.3% excise tax on the gross sales of medical devices, set to kick in next year but facing increasing Congressional resistance. At least if you believe the WSJ article, which seems to be partisan in the Republican direction (read the article comments for fun).

Innovation and Research

The CareFusion Foundation awards a $329K grant to the Healthcare Technology Safety Institute to study smart IV pump errors. Brigham and Women’s will coordinate the efforts of 10 hospitals in observing smart pump use to find problems, then identify possible solutions. The institute is part of the biomed-intensive, non-profit Association for the Advancement of Medical Instrumentation, which has worked with FDA on issues related to IV pump safety.

Technology

Epic authorizes implementations of its EHR on Intel x86 servers running open-source Linux, virtualized to VMware. Previously Epic ran exclusively on AIX and UNIX servers. This should make Epic a bit less expensive and perhaps more attractive to smaller facilities, though hardware is a minor part of the Epic implementation budget. Awhile back we ran a rumor that Epic was looking at the open source equivalent to Cache, so this might be a signal that they are looking for less proprietary and less expensive ways to run their systems.

Cisco kills off its Cius tablet for businesses less than two years after it was launched, born back when the original iPad wasn’t all that robust and businesses were expected to buy enterprise-grade tablets instead of succumbing to pressure from their employees to be allowed to  bring in their own far cooler tablets. It’s bad enough to be trying to move non-Apple tablets, but you are toast if yours is more expensive besides (the Cius was $700).

Other

South Shore Hospital (MA) will pay $750,000 to settle charges related to a 2010 data breach that compromised the personal data of 800,000 people. The hospital contracted with Archive Data Solutions to erase and resell 473 data tapes, but failed to encrypt the data and didn’t tell the vendor that the tapes contained PHI. The vendor shipped the tapes to a subcontractor to do the work and two of the three boxes were lost.

A UK doctor accused of killing two elderly patients by ordering tenfold overdoses of morphine is acquitted of manslaughter. He admitted that he made a mistake in prescribing the drugs while he was reading e-mail and checking online cricket scores.

Also in the UK, a hospital launches an urgent investigation after a patient complains that an exam light wasn’t working when the doctor was trying to stop her post-delivery bleeding, leading him to order the nurse to hold up his iPhone so he could work from its light. Says the patient, “Then the doctor and nurse had a bit of an altercation when the light went off, as she didn’t know how to do the finger swish thing to keep turning it on, and he… felt she wasn’t listening to his instructions.”

Weird News Andy says this took guts, but he urges police to add practicing surgery without a license to the charges. Police responding to the home of a New Jersey man who was threatening to harm himself with a 12-inch kitchen knife find him barricaded in his room, and when they kick the door down, the man stabs himself repeatedly in the abdomen and throws skin and parts of his intestines at the officers. The man, who has a history of psychiatric problems, is hospitalized in critical condition.

Sponsor Updates

• AT&T Health sponsors a June 5 Webinar discussing the creation of an enterprise image management strategy in the cloud. 
• Bloomberg Businessweek profiles Digital Prospectors Corp.
• Capsule will showcase its device integration solution a this week’s International MUSE 2012 Conference.
• Newfoundland and Labrador Centre for Health Information selects Orion Health to provide framework for its providence-wide interoperable EHR.
• SCI opens registration for its Client Innovation Summit 2012, to be held October 21-24 at Chateau Élan in Braselton, GA.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Curbside Consult with Dr. Jayne 5/28/12

Just when you thought it was safe to go back to the office, Big Pharma is at it again. I’ve never been a fan of direct-to-consumer advertising. I’d rather spend the few minutes I have with each patient in careful discussion of health promotion and disease prevention rather than discussing those “ask your doctor if Brand X is right for you” drug ads. My primary care patients learned over time that I’m a big fan of generics. If I recommend a drug, we’ll have a pro/con discussion of all the alternatives, not just the ones with great TV commercials.

Takeda Pharmaceuticals dropped this little number in my inbox – an app called Tummy Trends that allows patients to track their bowel symptoms, chart and graph them, and e-mail reports. The e-mail encourages me to let my patients know “that tracking symptoms can be convenient and discreet.”

I tried to get more information on the app, but found that the top five sites that my search engine served up were actually outlets for maternity clothing. Kudos to the marketing team for their excellent research of the name. Additionally, I’m not sure how many adults really refer to their digestive system as their tummy. I did finally track it down and ultimately downloaded it to my iPad to check it out.

I was disappointed. It wasn’t optimized for iPad, running in the tiny iPhone-shaped window instead. Data collection was minimal. I’d expect that if a pharmaceutical company was going to slap their name on it, they’d give it lots of bells and whistles.

I decided to see what other apps were out there for the same patient group  and found Bowel Mover Lite. It not only seemed to have more features, but even more important in my book, was pharma-free and the kicky logo was an added bonus. Really – don’t patronize patients with names like Tummy Trends (which is a little too close to the tummy time we recommend for infants anyway.) Bowel Mover displayed nicely on the iPad and also introduced me to Habits Pro and a couple of other apps. One was quite interesting – not appropriate for mentioning in mixed company, but check out Track & Share Apps, LLC and you might find it.

I haven’t had too many patients bring in smart phone diaries other than calorie trackers and exercise apps. When you’re in the primary care trenches, however, every day is a new adventure. I’ll keep you posted if I see anything sassy, humorous, or awesome. If you see one that fits any of those categories, e-mail me.

E-mail Dr. Jayne.

HIStalk Advisory Panel: Wrap-Up 5/28/12

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

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

I previously ran the panel’s recommendations to Allscripts and a list of the innovative companies they’re working with. These are their remaining comments.

General Comments

”The coming wave of BI use that will be required for any healthcare organization to be profitable, especially if they get involved in ACO or population health management. There was such a void of these companies at HIMSS it was shocking.”

”CMS and AHIMA are pushing ICD-10, a 30-year-old coding system. Like forcing us all to buy Betamaxes.”

”We have an internal debate ongoing within our parent organization whether EHRs will become a commodity purchase in the next few years. The implication is that you would be able to buy the EHR in pieces from best-of-breed vendors and then meld them together. I would be interested in what HIStalk readers, and of course yourself, feel about this prediction. Big organizations with lots of R&D dollars haven’t been able to pull it off even with just to products to integrate. I don’t think we have the standards to pull this off for at least a decade.”

”I think the platforms being developed by Allscripts and Greenway are an important harbinger of where the industry is going — the idea of the EMR as a platform and companies building apps to sit on top of them to help fill gaps and expand functionality. Other companies talk about it, but are not ready technically. Epic says they won’t do it, but I think they all eventually will.”

Cerner

”We are getting excellent results with Cerner PowerChart on both the ambulatory and acute sides. The newer mPage technology has let us develop specific apps within PowerChart that address Meaningful Use and quality goals while also improving physician experience and adoption with the EMR. Examples include a physician-designed ED CPOE template (that only an ED doc could love) and an app for admission med rec that better ties in nursing, physician, and pharmacy workflow (for example, the physician hands off therapeutic substitution task to the pharmacy). Cerner’s tools let us optimize workflow.”

Entrada

“Entrada is an interesting little dictation and transcription service that is partnering to bring voice to data services along. They are making some noise in the ortho markets.”

”Epic is good and not great. The install methodology is good, but they rely too much on their UserWeb to send customers for information. They also do a poor job of preparing CIOs for what life will be like after the install. We don’t have time to figure out which classes we should attend so we can get an idea of how the suite works and what it takes to support it. I have asked repeatedly for guidance and am still waiting.”

GE Healthcare

”What’s up with the GE Healthcare product suite? I haven’t heard much. I fear that their ambulatory PM/billing system formerly known as IDX has seen better days. They have been historically strong products.”

”I haven’t heard much lately about what GE is doing with their ‘new product’ or how the new joint venture is going with Microsoft.”

Hyland Software

”Hyland is doing a great job for us. On time, on budget. Can’t ask for more than that.”

InterSystems

”We’re vendor shopping and you get to see many products and talk to a lot of sales reps. InterSystems gave us their sales pitch, but didn’t even pitch us their correct product. We had met with them at HIMSS and clearly they didn’t take any of that conversation into account.”

McKesson

”It was painful that McKesson announced in December that they are going to sunset Horizon Clinicals. Having stopped developing their emergency and ambulatory solutions (HEC and HAC) puts lots of things into question. We don’t use HAC, but we do have HEC in all our facilities. Moving to Paragon – really?!?!? They have been unable to execute over the last five years on what they said they would deliver on. Who would believe they could do it with this neophyte product?” 

“It might be interesting to ask of those healthcare organizations using Horizon Clinicals as their primary EHR solution how many are currently considering moving on from McKesson and not waiting on transitioning to Paragon.This question would also be interesting for those organizations utilizing Meditech 5.6 and whether they are going to move to Meditech 6.x or will be selecting another vendor.”

Oberd

”Oberd is an outcomes research company targeting ortho.”

Prognosis

”We’re opening a new hospital. An interesting EHR vendor they liked is Prognosis of Houston, TX. I haven’t seen the product, but the selection team has raved about it.”

SYSTOC

”We installed SYSTOC (now part of PureSafety), the market leader in occupational medicine. It was a very expensive mistake that destroyed productivity. They told us they supported voice recognition several years ago, and are now promising that it will come out in the fall. They have promised improvements with every upgrade and the system just deteriorates more with every release.”

Vocera

”I have worked a lot with Vocera. Great company, very focused, recent IPO is doing well. Smart guys running it. It’s a good product that works and happy customers.”

Monday Morning Update 5/28/12

Memorial Day is not just a three-day weekend — it’s the one day set aside each year to honor those who have died in military service. Go to the beach, picnic, or have a cookout, but please take a moment to honor the memory of those who gave up all of those things to die thousands miles from home while serving their country (and are dying still today.) Most of us will never experience or even understand their sacrifice, but the least we can do is take a few minutes from our year-round comfortable existence to honor it.

E-mail Mr. H.

Time Capsule: Surprise! Below-Average Doctors Use EMRs, Too

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 June 2007.

Surprise! Below-Average Doctors Use EMRs, Too
By Mr. HIStalk

A just-published journal article seems to rip the use of electronic medical records in physician practices. Its conclusion: paper-based doctors hit diabetes quality standards more often than their EMR-wielding colleagues.

From that, you might logically conclude that EMRs don’t provide the outcomes benefits claimed by their vendors. And that, my friends, is why a little bit of information can do a lot of damage.

Observational studies often leave questions unanswered. A researcher observes that Factor A and Factor B co-exist. In a journalistic leap of faith, the conclusion (stated or not) is that one of those must cause the other.

I wish it worked that way. I’d find myself a young, intellectually impotent young lady as a companion. Why? Because you see those women on the arms of rich old guys. Ergo, eye candy makes poor men wealthy. See the fallacy?

Back to the EMR article. I assume the following:

• Caring, competent physicians will find a way to practice good, evidence-based medicine no matter what gadgets they do or don’t have at their disposal.
• Uncaring dolts won’t really get much better just because they have promising toys.
• Those doctors who will get the biggest benefit from information technology are in neither group, that undecided 60 percent who can be pushed either way.

What the article doesn’t tell us is how individual physicians changed after implementing EMRs. Isn’t that what we really want to know? If EMRs improved individual physicians, the rest wouldn’t matter.

Which leads me to these conclusions:

• EMRs can make it easier for physicians in the first category to do the right thing more conveniently. Compliance may go up a shade, as may efficiency.
• EMRs may make less-competent physicians more or less efficient without necessarily improving their adherence to clinical standards.
• Those docs in the middle might be steered and swayed by the path of least resistance to improve their practice, given both EMR technology and the motivation to change (that’s another whole discussion.)

The EMR payback comes from those doctors in the last category. Such systems won’t change the votes of party loyalists, but they can sway the masses of the undecideds.

It’s also not just what you have, but how you use it. Doctor A effectively uses a crappy EMR. Doctor B has the really hot, expensive application, but doesn’t use most of it. Doctor A’s bad EMR may greatly enhance good practice, while Doctor B’s great one may offer no improvement.

Personally, I don’t care whether my doctor uses electronic medical records, pen and paper, or a stone tablet and chisel. His tools are his business. I judge him on my personal outcomes. I expect him to invest in whatever it takes to deliver those outcomes, no different expectations than I would have for a mechanic, masseuse, or chef.

The article will likely cause interesting debate (if for no other reason, it’s a slow news time.) Still, it shouldn’t be a surprise that EMR-wielding doctors don’t necessarily deliver better care.

In fact, it’s actually surprising that anyone finds the study’s conclusions to be inflammatory. Apparently we’ve been sufficiently brainwashed to believe that brushes make the artist. We ought to know better by now.

News 5/25/12

Top News

The FCC votes 5-0 to approve allow wireless patient monitoring systems such as those being developed by GE Healthcare and Philips to share a frequency spectrum that was previously used exclusively for aircraft testing. Hospitals using the new systems will be able to monitor patients anywhere in their buildings without connecting them to hard-wired instruments and limiting them to specific areas such as ICUs. In-home patient monitoring via Medical Body Area Network devices will also be supported, so that body-worn sensors can communicate wirelessly with an in-home station that will send data to a hospital or other provider.

Reader Comments

From Raydonia: “Re: downtime of Transcend Systems/Nuance on 5/21. They are paying full-time transcriptionists the princely sum of $60 for the day of downtime. As of this writing Tuesday, we are down again. It’s a big deal. At-home workers don’t have the rights that on-site workers have. Any questions and you’re told, ‘Be glad you have a job.’” Unverified. I’m probably the last person you’d want to have soothing you since I’m not usually too sympathetic to career-related gripes. If you don’t like the job and have better prospects, you should take the better job. If you don’t have better prospects, then I agree with the company – the market is telling you something and you should be glad you’re working since lots of people aren’t. In this economy, knowledge workers and those with skills that are in high demand but limited supply are going to be treated very well, but the rest will be have to reset their expectations since the threat of automation or offshoring is always there (hello, HP layoffs). I don’t mean to be a downer, but our parents and schools are feeding us the “dream big and do whatever makes you happy and you’ll be rich and famous” story that doesn’t usually match reality unless you’re freakishly smart, cunning, connected, hard working, or lucky. I think that’s one reason the unemployment rate isn’t going down much – people are holding out for yesterday’s comfortable, high-paying jobs that are gone for good for many of them. In your case, I concur that being paid a “salary” based on piecework seems odd, but if that’s the work arrangement you signed up for, then I guess being paid just the base amount for days you can’t work is consistent, even though it sucks when it’s not your fault that there’s no work to do (kind of like minimum wage restaurant servers who would starve without tips). Hopefully they’ve got their systems back to normal since I’m sure your hospital customers are as anxious as you are to reconnect. 

From Pop Top: “Re: HL7. They are encouraging vendors to put the ‘Care Connected by HL7’ logo on their splash screens. Do you think any vendors will do this?” I don’t know why they would. Users are the ones who see the splash screen and they don’t care about HL7. Other than giving HL7 free advertising, I don’t see the benefit. And not to be overly critical since I’m probably the worst at aesthetic design (as readers who are always complaining about the HIStalk format can attest), but the logo looks kind of cheesy to me – harsh and badly proportioned wth an unpleasant 3D chiseled effect. Not to mention that the HL7 part of it, even though it’s their regular logo, is hard on the eyes. White on black looks like a DOS screen.

From Annie: “Re: Cerner. Consulting SVP David Sides resigned last week.” Unverified. His bio is still up and his LinkedIn profile says he’s still there.

HIStalk Announcements and Requests

Some nuggets you might have missed this week from HIStalk Practice: former Medic and A4 CEO John McConnell shares insights on HIT startups, Meaningful Use, Allscripts, and more. Dr. Gregg discusses the data-drenched world of HIT and the need for tools to keep things simple. A glitch leads to the rejection of 450,000 Humana claims sent through the Availity clearinghouse. Is the direct primary care model just a new name for concierge medicine? My take on banning smart phone pics in doctors’ offices (hint: good luck with enforcement.) A physician seeks opinions on drchrono. ONC promotes device integration for ophthalmologists. What do these news bits, interview, and opinion pieces have in common? None can be found on HIStalk, meaning you best pop over to HIStalk Practice to ensure you remain in the know. While there, click on a sponsor ad or three and educate yourself on some cool offerings. And don’t forget to sign up for the e-mail updates. As always, thanks for reading.  

Listening: brand new from Slash, excellent guitar-heavy rip-it-up rock that’s loaded with licks reminiscent of the best of the 1970s and early 1980s: Deep Purple, AC/DC, Whitesnake, and of course Guns N’ Roses. Nobody’s making straight-ahead hard rock these days, especially the kind that sounds like a real band instead of one guy and a laptop. It doesn’t exactly break new ground, but it’s going to be killer at summer gigs like Rocklahoma this weekend. And I can’t help cheering for Black Sabbath, together on stage again (minus drummer Bill Ward over money issues) after a seven-year hiatus and Tony Iommi’s lymphoma, opening their Birmingham, UK show last week with 1971’s amazing Into the Void.

Dr. Rick is back from the NIST-ONC EMR usability meeting. I asked if anybody recognized him since I work in an anonymous vacuum and always wonder what that’s like. He said a few folks did, including Farzad Mostashari. Rick will be providing a meeting recap after he gets caught up on his ophthalmology work.

On Healthcare IT Jobs: Application Analyst II, Assistant Director IT-Medicine, Hospital Software Analyst II, System Architect, Cerner Testing Project Manager.

Welcome to new HIStalk Platinum Sponsor Clinithink. Healthcare solution vendors use the company’s cloud-based CLiX natural language processing engine to turn free text medical notes into fully coded structured data (ICD-9, ICD-10, SNOMED CT) that payers, providers, and analytics companies can use to improve quality, increase revenue, and meet reporting and regulatory requirements. Structured data entry via check boxes and drop-downs makes like easier for the computer, but the richness of the patient encounter is often locked away in the detailed narrative of those providing the care. CLiX converts that data to information for everything from capturing Meaningful Use measurements to providing doctors with smart search capability for research that understands “bronchial hyperreactivity” as being related to “asthma.” Thanks to Clinithink for supporting HIStalk.

Here’s an overview I found of Clinithink’s CLiX on YouTube. It shows the user’s narrative popping up SNOMED CT codes.

Acquisitions, Funding, Business, and Stock

Kony Solutions closes on a $15 million third round of funding, led by Insight Venture Partners.

Healthcare payment network InstaMed secures $14 million in new capital.

Shares of Scotland-based charge master systems vendor Craneware drop by 15% after analysts speculate that its US customers might be chasing Meaningful Use money rather than buying its financial software, at least until next year. The company indicated in January that the situation was exactly that, but predicted a quick reversal of the trend. Other analysts agree with that earlier assessment, saying demand is already recovering.

Compuware reports Q4 numbers: revenue up 21%, EPS $0.12 vs. $0.16. Its Covisint subsidiary, which offers HIE and cloud-based services for healthcare, had annual revenue of $74 million, up 34%.

Nashville Medical Trade Center signs its biggest tenant so far, the RFID in Healthcare Consortium trade group. It will use part of its 80,000 square feet for The Intelligent Hospital, the hospital replica you saw in the downstairs exhibit hall at HIMSS in Las Vegas earlier this year (it was doing big business each time I checked). HIMSS will have 25,000 square feet in the building, which has 1.5 million square feet.

University of Maryland spins off Analytical Informatics, Inc., which will offer radiology dashboards and eventually expand into BI and quality tools that cross systems. 

Philips shares drop after its CEO warns that the European debt crisis may hurt imaging sales there.

Sales

Kosair Children’s Hospital (KY) selects Amcom Software’s clinical alerting middleware and smart phone communication solutions, planning to integrate it with their GE Healthcare Telligence nurse call system, GetWellNetwork interactive patient care system, and Cisco wireless IP phones and smart phones.

Omnicell closes on its previously announced acquisition of MTS Medication Technologies, a provider of medication adherence packaging systems.

Tri-State Gastroenterology Associates (KY) selects eMerge | ENDOTM for procedure documentation and workflow for its endoscopy center.

Lakeland Healthcare Group (IL) selects Merge Healthcare’s complete radiology cloud solution.

Indiana Orthopaedic Hospital selects the anesthesia information management system from Surgical Information Systems.

People

Former WellPoint VP Ryan Miller joins Availity as SVP of strategy and corporate development.

Todd Helmink (Allscripts) has joined The LDM Group as VP of strategic partnerships.

Greater Houston Healthconnect, a regional health information network, names Philip Beckett PhD (Baylor College of Medicine, RosettaMed) as CTO.

Announcements and Implementations

The US Olympic Committee announces that GE’s continued sponsorship will include the use of Centricity to manage the care of the 700 athletes participating in the London 2012 Olympic Games.

Iatric Systems and Order Optimizer announce the availability of an evidenced-based order set platform for Meditech Magic using Iatric Systems’ OrderEase solution.

MED3OOO announces the general availability of InteGreat EHR V6.5, which includes Quippe technology from Medicomp Systems.

RelayHealth and Greenway Medical complete a development agreement to exchange data between hospitals and ambulatory clinics.

Healthwise wins a Center for Plain Language award for its course on coronary artery disease. The non-profit company’s course combines easily understood content that is personalized by user type (recent coronary event, someone whose symptoms have subsided, etc.) Healthwise has previously won similar awards for its arthritis and low back pain materials.

Government and Politics

Representatives Michael Burgess MD (R-TX) and Gene Green (D-TX) introduce legislation that would require states to require hospitals to disclose information on charges for certain inpatient and outpatient services and to require insurance companies to provide enrollees a statement of estimated out-of-pocket costs for healthcare services.

US CTO Todd Park, writing on The White House Blog, announces the Presidential Innovation Fellows program. He’s looking for 15 innovators to spend 6-12 months in DC starting in July to work on one of five projects:

• Open Data Initiatives (entrepreneurial use of government data for societal benefit, including but not limited to healthcare)
• Blue Button for America (consumer downloading of their own health information)
• MyGov (access to government information)
• RFP-EZ (development of a platform to make it easier for the government to buy technology from startups)
• The 20% Campaign (move US aid payments from cash to electronic payments)

Innovation and Research

Three students at a Ugandan university win a prize for their smart phone-powered fetal monitoring system, which analyzes fetal sounds and produces a plain-English description that midwives and birth attendants can understand. The device costs at least 80% less than an ultrasound machine.

A study finds that OptumRX’s text message prescription reminder program improved medication adherence, with 85% of patients taking their at-home oral meds correctly vs. 77% without the reminders.

Technology

Cerner is looking pretty smart for buying up 65,000 IP addresses from bankrupt Borders for $12 each. The IPv6 kickoff is in a couple of weeks, but the transition is expected to take up to 10 years, meaning Cerner hedged its bets in being able to run in dual stack mode with the additional old addresses.

Other

The main Delaware newspaper covers the Delaware Health Information Network, which it says has enrolled 92% of the state’s providers. The front page story’s key figure is Christiana Care Health System CIO and DHIN Chair Randy Gaboriault, who had a recent positive experience with the value of shared medical information during a heart attack scare. He says his mother was not as fortunate – she died a couple of months ago after being treated by an unconnected hospital that did not have her history available, which he is convinced led to her unfortunate outcome.

Fairview Health Services (MN) fires CEO Mark Eustis, presumably after being embarrassed by never-ending press caused by the heavy-handed patient debt collection tactics allegedly employed by Accretive Health, which he brought in. Of course he also could have been fired had Fairview lost a ton of money by not collecting aggressively enough, so there’s that fine line thing.

As already reported here thanks to a tip from reader Gran Cru, Partners HealthCare (MA) takes a $110 million write-down on its soon-to-be dumped Siemens financial system, dropping its Q2 net income to $5 million vs. last year’s $71 million. As also reported here, bringing in Epic will cost another $600-700 million.

A scrub nurse at a Washington urology practice sues Robert Weissman MD, claiming that he threw an intra-operative tantrum that included cursing at her, throwing instruments, and finally intentionally stabbing her in the finger with a needle that he had just withdrawn from a patient’s scrotum.

Weird News Andy finds this story to be weird and wonderful. A Baltimore area high school freshman develops a 3-cent paper sensor that can detect cancer by indicating high levels of a particular protein, making it cheap enough to use in routine screening. Over 200 researchers he asked to help him test his invention turned him down, but now he’s working with a Johns Hopkins researcher, he has won $75,000 in the Intel International Science Fair (above), he has patented his device, and a San Diego biotech firm has offered to help him perform the FDA-required clinical trials.

WNA also likes this spooky security camera video from the ED of St. John’s Mercy Hospital in Joplin, MO as it was being hit by a tornado a year ago.

Dr. Jayne wants to play Weird News Andy in finding this obituary of a “crazy woman” characterized by her family as “De Facto empress of the hell she lived in.” I almost ran out of fingers trying to tally her former / present, living/dead husbands, not to mention her “friends at the Lakeside Trailer Park.” The family also noted that among the folks who will miss her most are Anheuser-Busch, Philip Morris, and the Ohio State Lottery. Her loved ones concluded with some sound advice: “Everyone dies, but not everyone lives. Mom lived. She lived hard, but she lived full. So, ‘Don’t cry because it’s over….. Smile because it happened!’ Light your smoke and raise your glass and remember the last thing she said to you that made you laugh so hard you thought you were going to wet yourself; but this time don’t hold back. Because she never did. “

I was startled to see this pop up on my LinkedIn page.

The executor of the estate of a 102-year-old heiress says everybody robbed her blind before she died, convincing her to give them extravagant gifts. Her daytime nurse got $31 million, the night nurse was given $1.1 million, her two doctors got $3.1 million, and Beth Israel Medical Center got a $6 million Manet painting for allowing her to live in the hospital for years even though she was healthy. Her attorney says she gave the gifts because she was generous (and he got only $60,000).

Sponsor Updates

• Practice Fusion announces the availability of customizable endocrinology templates.
• Cooper Green Mercy Hospital (AL) goes live on Stockell’s InsightCS Revenue Cycle Inofrmation Management system, including patient access and patient accounting.
• TELUS Health Solutions and Orange partner to develop remote monitoring solutions for chronic disease patients.
• Allscripts releases a white paper by CMOs Doug Gentile MD and Toby Samos MD that explores insights from ACO pioneers.
• Lifepoint Informatics is sponsoring G2 Intelligence’s Laboratory Outreach Conference June 6-8 in Las Vegas.
• The Advisory Board Company’s Crimson team will lead two breakout sessions at the 3rd Annual Health Datapalooza June 5-6 in Washington, DC.
• CareTech Solutions announces that its clients Barnes-Jewish Hospital (MO), Touro Infirmary (LA), and Wheaton Franciscan Healthcare (WI) have won 2012 Aster Awards for their websites.

Dr. Sam 5/23/12

On the Other Side of the Quality Chasm

The acceleration of the movement toward electronic health record (EHR) implementation and adoption begun by the Institute of Medicine reports of the late 1990s and fueled by the American Reinvestment and Recovery Act of 2009 has propelled us away from the paper environment at a rate that would undoubtedly not have been present in their absence. It is now possible to conceive of a time when the majority of our healthcare institutions and professionals function entirely in an electronic environment.

Now that the other side of the quality chasm is in sight, it is worthwhile to consider what it may be like when we land there, and prepare for a vastly different environment.

A significant body of evidence has been building over the last decade reflecting medical errors that may occur because of electronic medical records. Examples include default acceptance of all orders in an order set when some may not be applicable to a specific patient, or an inaccurate weight entered manually for a newborn but used to automatically calculate medication doses. Any implementation should include attention to proactively averting such errors by responsible quality control processes.

The practice of medicine in real time and enhanced capabilities for granular auditing bring the considerable exposure to medical liability to the forefront. Standards of expectation should be established for reasonable response times to alerts, e-mails and data generated and delivered in real time. Clear policies, consistent with state law, should be established to define exactly what compromises a legal electronic medical record, what information must be produced in the event of litigation, and consideration of consistency in patient care considerations in implementing new features and functions. (Is a different level of care being delivered to a subsection of patients within a hospital if a new feature or function goes live on one service and not another?)

It will be very long time before most hospitals and practices cease to work in a part paper, part electronic environment, but the common goal is to eliminate as much paper as possible. It is therefore highly probable, if not certain, that a generation of clinicians will eventually evolve who have never worked on paper.

It is also certain that hospitals and practices will experience both planned and unplanned system down time. Downtime policies specify circumstances where documentation and order entry must revert to paper, but do not generally address the possibility that clinicians may not know how to work on paper. As part of disaster planning and down time policy determination, policies should be in place for clinicians to be trained at regular intervals in the use of order forms, progress notes, history and physical notes, medical administration forms, etc. that may be called to use in a disaster environment or system down time. After a few years using fully implemented EHRs, they may simply not know how to use paper.

Similarly, ward clerks, pharmacists, lab technicians, and other support personnel must know how to carry out their responsibilities on paper, and must periodically be retrained.

Paradoxically, we may have to be certifying people to work on paper in the future.

Several years ago, I began to consider the vulnerability of our massively growing medical databases. Even though security measures, redundancy, and backup processes are in place, much of the firewall technology is "off the shelf," which simply means to me that someone sitting in a distant country can find a way through it. Most hospital security and background checks on IT personnel consist of credit reports and other forms of superficial investigation, but are rarely in-depth security evaluations.

In spite of painful mass casualty attacks and natural disasters that we have experienced (the Oklahoma bombing, September 11, Hurricane Katrina), our emergency rooms remain woefully unprepared to handle a massive number of injured people or able to sustain care for a large population of injured individuals for anything other than a very short time. If one considers the potential chaos that could ensue from a combined mass casualty episode combined with an intentional attack on the same regions’ medical databases, the importance of this consideration becomes obvious. Organizations such as HITRUST are bringing the importance of protecting our databases to light. As we move further toward the universal use of EHRs, hospitals and database specialists will need to devote more time, energy and money to protecting our healthcare databases.

I have recently been an active participant in the debate over physician-patient communication by e-mail. The greater issue goes far beyond this particular debate. While the mechanics of physician-patient interactions may be brought into the 21st century by reduction to the 1s and 0s of the binary world, the art of medicine cannot be.

If one has ever engaged in online dating, cyber political debate, or an e-mail argument, they will appreciate that much is lost in the absence of face-to-face interaction. Things are said that would never be said when an immediate reaction can be anticipated with someone who is physically present in real time and not in an untouchable, invisible virtual space. In an electronic environment, as much attention needs to be paid to taking care of the emotions and reactions of patients as is paid to the convenience of the communication vehicle in use. This lesson must not be lost for the upcoming generation of texting / Facebooking / Twittering clinicians. Those of us with grey hair have a teaching responsibility in this arena

Let’s not cross a quality chasm and create an empathy chasm.

Samuel R. Bierstock, MD, BSEE is the founder and president of Champions in Healthcare, LLC, a strategic consulting firm specializing in clinical information system implementation and healthcare IT business strategies.

HIStalk Advisory Panel: Innovative Companies 5/23/12

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

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

For this report, I asked panel members what small and/or innovative companies they’ve worked with recently that readers should check out.

AirStrip Technologies. “We are implementing our second solution, Cardiology, and they are doing a great job of meeting our expectations.”

Anypresence. “They have developed a platform so that organizations can create mobile apps.”

AutomateMD. “They call themselves an EMR company with an interesting suite of products, which I like to call more peripheral additions to an EMR solution. The company is looking for investors and claims to have some big-name partners. Marketing rollout for Northern California is supposed to start June 2. The company offers PM/EMR, e-prescribing, EDI, claims, medical transcription, scheduling, billing, document imaging and management, and collections.  They have offices in California and the Philippines.”

Aventura. “You’ve profiled them. We have implemented their clinician access solution.”

CenterX. “Not working with them, but stumbled on an interesting company which is creating competition for Surescripts. This is good, as they are acting like a monopoly – high prices, low innovation. The CEO is an ex-Epic guy.”

Design Clinicals. “They have a standalone medication reconciliation product, MedsTracker, that works very well. I believe they also have a CPOE product for smaller hospitals.”

EGIS Systems. “We’ve used them for HIPAA assessments and vulnerability monitoring. So far, I think we get a lot of value for the cost. They’ve negotiated some great deals to resale other security products (e.g., vulnerability monitoring, e-mail encryption, etc.) for greatly reduced prices. Could be a great offering for small to mid-size organizations. “

Emmi Solutions. “Tracks delivery and consumption of targeted information.“

Ingenious Med. Excellent results for inpatient physician charge capture. Cerner is not quite there yet. Good tool and easily adopted by physicians, replacing either spreadsheets and manual tracking or an older tool that hasn’t kept up with mobile technology.”

Interfaceware. “Its product, Iguana, has a shorter learning curve than HL7 integration and testing. The small, bootstrapped firm is out of Toronto and has an impressive client list of hospitals and vendors. Eliot Muir is founder and CEO.”

Voalte and InterMedHx. “Awesome. Customer service is over the top and products deliver.”

MobileMD. “We’ve been talking with multiple HIE vendors and have great experience with MobileMD. They were recently acquired by Siemens, but still act like the small company they started as. Hopefully they keep it up!”

Nordic Consulting. “We’ve been very pleased with them and their consultants we have engaged.”

Strategic Healthcare Programs. “A solution of choice for real-time decision support and data analytics in the subacute segment. SHP has a dominant position and its partners page reads like a directory of subacute software vendors. Barbara Rosenblum, founder and CEO, is a great lady.”

Tableau. “Fantastic visualization software. Allows presentation of complicated information in a ‘simplified’ graphical format.”

Voalte and InterMedHx. “Awesome. Customer service is over the top and products deliver. “

White Stone Group. “On the rev cycle side. Very cool product and technology that helps hospitals and md offices deal with the nasty payors who don’t want to pay on time or want to create ‘stories as to why they can’t pay. Product is called Trace.”

News 5/23/12

Top News

HealthCor, which owns 5% of Allscripts, launches a proxy fight for control of the company by suing Allscripts over its nomination process for board members. HealthCor says the resignation of three of the company’s nine directors last month, all of whom had ties to Eclipsys before Allscripts acquired that company, left the Eclipsys product lines unprotected “from the continuing failures of execution of [Glen] Tullman,” whose ouster it had previously demanded. HealthCor wants the June 15 Allscripts annual meeting postponed to give it time to nominate its own candidates for the three open board seats, saying Allscripts should not have put forth its own slate of prospective new board members without giving shareholders the same opportunity. HealthCor is also criticizing Tullman’s $7.2 million compensation in 2011, saying he makes more than the CEOs of competitors whose stock is going up instead of down.

Reader Comments

From BoltUpright: “Re: Shantanu Paul. Interesting that he left Allscripts to head up product development at Vitera. He was a major player in the overall integration strategy at Allscripts. Not sure if his departure is motivated by a desire to jump ship because they weren’t listening to him, or if he’s being pushed out as a scapegoat for the integration problems they are having.” Vitera announced Paul’s appointment as SVP of product development here.

From White Lightning: “Re: Dan Michelson, chief marketing officer of Allscripts. Leaving the company.” Unverified, but a purported internal company e-mail sent my way says he’s leaving to become CEO of a private software company after 12 years with Allscripts. He won’t be replaced, according to the e-mail.

From Reverse Transcriptionase: “Re: Transcend. The servers of the former Transcend Systems transcription company that Nuance acquired have been down for days.” E-mails forwarded to me refer to a major system issue that was caused by failed storage devices. The last e-mail I saw, from Monday, said that they were still down and were typing and faxing stat reports, preop H&P, and radiology reports. I tried the Transcend Services Web site on Monday evening and it was down, but it’s working now, so I assume the problem has been resolved. Anybody can have systems fail and I give them credit for communicating thoroughly, although I’d be interested to hear what customers did in the interim.

From Casual Hospital Administrator: “Re: famous highly wired hospital. Patients appear to have been harmed.” The family of a former post-bypass ICU patient of UPMC Shadyside (PA) sues the hospital, claiming the 68-year-old man was somehow not attached to monitors when he died. Documents apparently verify that the patient was not being monitored for a 16-minute period, saying only that “mistakes were made.”

From Don Diego: “Re: HIStalk Advisory Panel. I’m an avid reader and also impressed with the insight, but the post on what Allscripts should do to fix things is absolutely amazing. Way to go, HIStalk.” I appreciate the involvement of the 79 panel members (now 94) who have volunteered to offer their opinions on topics I’ll e-mail them every few weeks. Most of them are CIOs, CMIOs, and practicing doctors, with a few vendor executives added to the mix. They can provide their honest thoughts knowing that even though I won’t identify them in any way, they’re still not potentially untrustworthy anonymous commenters (like Allscripts competitors, for example) since I know who they are. I’ll take suggestions on what I should ask them in the next round of crowdsourcing. In the mean time, I’ll be listing a few companies they mentioned in response to my question about any cool, small companies they’re working with – stay tuned later in the week.

From CDiff: “Re: Chicago CEO pay. The Chicago Tribune set up a Web page so you can do your own sleuthing on any aspect of compensation. Allscripts and Accretive did not bubble up, the the Trib’s lead story was about Debra Cafaro of healthcare real estate investment trust Ventas, who made $18.5 million. As you know, we have no method to compensate you for all you do; you remain the very definition of priceless.” Healthcare well represented on the list: drug maker Abbott ($24 million), supplies vendor Baxter ($14 million), supplies vendor Hospira ($12 million), and drug store operator Walgreen ($12 million) on the first page alone. Glen is on the list at $7.2 million and Mary Tolan of Accretive lags the well-enriched executive pack at $1.6 million.

From Carriage Bolt: “Re: Cerner single revenue cycle product. I’ve heard Adventist Health West is helping them develop a clinic and physician revenue cycle module.” Unverified.

HIStalk Announcements and Requests

Here’s a tip for companies who go to the trouble to issue press releases about their new hires. Include a link to a hi-res photo and insist that the person create a LinkedIn profile that includes a head shot (and not a thumbnail-sized one – a professionally made full-size headshot since LinkedIn automatically creates the thumbnail). You would be surprised at how many press releases I get about folks who have no apparent photographic presence on the Web, or who use a blurry, small, or amateurish snapshot as their LinkedIn photo. I’m less likely to run those announcements. Another gripe is PR companies that e-mail me a press release that hasn’t been posted anywhere else (including the company’s own site), so I don’t have anything to link to. Or, that send Word documents instead of pasting the text into the body of the e-mail or attaching a PDF – I practice safe text, meaning I’m not opening your Word doc unless I know where it’s been.

Acquisitions, Funding, Business, and Stock

Apple’s iPad in Business page features HCA’s use of AirStrip, Epocrates, PatientKeeper, Heart Pro, and other apps I didn’t recognize.

Here are iPad screen shots of Nova’s $17.99 Heart Pro, developed with Stanford University School of Medicine as a patient teaching tool. Very cool.

Sales

Iowa Primary Care Association selects Ignis Systems to integrate lab orders and results for 15 community health centers running Centricity EMR.

San Jacinto Methodist Hospital (TX) chooses PerfectServe for clinical communications.

People

Former Optum/Axolotl VP Anand Shroff joins Health Fidelity, Inc. as chief technology and product officer.

Nate Ungerott joins Health Care DataWorks as VP of sales. He was previously with Accuvant.

Investor Sue Siegel is named CEO of GE’s healthyimagination, which is spending billions on healthcare innovation and bringing healthcare IT to rural and underserved areas. She replaces Mike Barber, who has moved to VP/GM of molecular imaging at GE Healthcare.

Teresa Jamison is named VP of customer operations of SciQuest. She was previously with Allscripts.

Announcements and Implementations

Oregon’s statewide HIE implements Harris Corporation’s CareAccord platform and Direct Secure Messaging system.

Anthem Healthcare Intelligence, a provider of healthcare BI solutions and services,  rebrands as Agilum Healthcare Intelligence.

The 319-bed Cooper Green Mercy Hospital (AL) implements Medsphere’s OpenVista EHR and Stockell Healthcare’s Insight CS financial and accounting solution, replacing Meditech. The hospital says it will receive considerably more HITECH money than its five-year costs.

CBORD will offer Horizon Software International’s point-of-sale system that allows cafeterias to handle meal plans, payroll deduction, and gift cards to provide “the best total return on investment for healthcare food service operations.” Pretty cool, but I wish hospitals cared enough about their cafeterias to stop outsourcing them to companies like Aramark or Sodexo, who are given free rein to coldly enforce margin-preserving policies that would drive a real restaurant out of business within days: pre-portioned freezer-to-grease prisoner food from Sysco (the potato peeler has left the building), wildly overpriced drinks with no free refills, and weighing plates so that a modest portion of waterlogged spaghetti with canned sauce ends up costing $8. Nobody cooks, everybody scowls defiantly (especially the cashiers), and they all clear out by mid-evening, leaving the captive audience of off-hours employees and visitors with only the vending machines as a shining example of wellness. The best, cheapest, and most nutritional food that’s anywhere close is usually the hot dog cart out front or the caterers who bring in real food for the executive meetings.

Government and Politics

The VA refines its VistA strategy at the Open Source Think Tank, planning to spend up to $5 billion to tap the open source community and the private sector to advance VistA. Among its significant challenges is the Military Health System, which likes the fat cat contractor approach that turned its own AHLTA EMR into a $10 billion flop. The generals claim they’re leading the military-industrial complex charge, trying hard to win some EMR hearts and minds. In the mean time, the VA and DoD announce that they won’t roll out their integrated EHR until 2017. The excellent NextGov got a copy of the presentation outlining the problems. The only sure thing is that it will be late, over budget, and politicized.

Innovation and Research

A Brigham and Women’s study finds that doctors who dictate their notes instead of using templates or typing free text have lower quality of care, as evidenced by standard quality measures. The authors postulate that doctors who use a keyboard instead of a microphone pay more attention to on-screen discrete data elements and clinical decision support messages.

Technology

Bloomberg profiles Jintronix, a company I’ve mentioned that’s building technology around Microsoft Kinect that helps home rehab patients do their exercises correctly.

Mentioned in the above article is potential Kinect competitor Leap, a $70 iPod-size Minority Report-type pre-order USB peripheral that the company says will be 200 times more accurate than “a game system that roughly maps your hand movements,” able to distinguish individual fingers and track movements down to 1/100th of a millimeter. Assuming it’s not bogus, which seems to be a topic of discussion.

Other

In the UK, NHS announces an initiative to provide patients with online access to their medical records by 2015.

Bond ratings firm Fitch Ratings surveys its client hospitals about capital spending and finds that they consider IT investments to be the most important, ranking much higher than capital spending to increase capacity and align with physicians. The company was surprised to find that hospitals don’t expect the Patient Protection and Affordable Care Act to have significant influence on their capital spending plans regardless of the Supreme Court’s ruling.

Boston Children’s Hospital announces that an employee at a conference in Buenos Aires, Argentina lost an unencrypted laptop containing information on over 2,000 patients as an e-mail attachment. Somehow until trying to track this down I didn’t realize that Boston Children’s Hospital is one facility of Children’s Hospital Boston (if I’m correctly deciphering the seemingly contradictory logos and names on their site).

One of those lame problem-solver type news crews investigates a woman’s 10-hour ED wait, quoting the ED doc’s two mitigating issues: a new EMR system (Cerner from Trinity Health, I believe) and the need to treat sicker patients first.

HIStalk reader Alexander Scarlat MD’s book, Electronic Health Record: A Systems Analysis of the Medications Domain, is now available on Amazon. This is not one of those easy-to-skim books that seem to get published without any real purpose – it is hardcore into the medication domain (prescribing, drug concepts, dispensing, MAR, user interface, etc.) Alex was kind enough to send me an autographed copy since I reviewed a pre-press chapter and provided a quote for the back cover:

… encompasses high-value, high-volume therapeutic transactions of indescribable complexity that touch nearly every licensed professional in a hospital, enrobing drug ordering, dispensing, and administration in sophisticated layers of clinical decision support, caregiver work lists, and back-end charging and continuum of care functions. I am pleased that the topic merits its own formal review and analysis in Dr. Scarlat’s book. I found the user interface chapter immediately useful – in fact, I’m hoping the vendors of my own hospital’s systems take its recommendations to heart.

Weird News Andy is all up in our grill with , which he subtitles, “A Brush with Death.” Doctors investigating a man’s suspected appendicitis instead find that his intestine is pierced by a nail-like object later identified to be a bristle from his metal grill cleaning brush, which had become embedded in the steak he ate.

Sponsor Updates

• Greenway Medical and NextGen will participate in a patient data exchange demonstration during the ONC’s 2012 Direct Demonstration Showcase in Washington, DC May 31.
• Healthcare Informatics releases its annual list of top 100 vendors based on revenues from HIT products and services. HIStalk sponsors earning a spot of the list include: 3M Health Information Systems, API Healthcare, Allscripts, Beacon Partners, Capario, CareTech Solutions, Cumberland Consulting Group, eClinicalWorks, GE Healthcare, Greenway Medical, Health Data Specialists, HealthStream, Iatric Systems, Impact Advisors, Lawson Software, maxIT Healthcare, MED3OOO, MEDSEEK, McKesson, MedAssets, Merge Healthcare, NTT Data (formerly Keane), NextGen, Nuance, Optum, Orion Health, Passport Health Communications, SCI Solutions, Sunquest Information Systems, Surgical Information Systems, T-System, TELUS Health Solutions, TeleTracking Technologies, The Advisory Board Company, Vitera Healthcare Solutions, Vocera Communications, and ZirMed.
• ICA and AlliedHIE launch a national health information exchange to identify technology and communications issues within healthcare organizations.
• Michael O’Neil, founder and CEO of GetWellNetwork, gave a patient engagement presentation at Cleveland Clinic’s Patient Experience Summit on Tuesday.
• Hayes Management Consulting reports that eight of the top ten US hospitals listed on US News and World Report’s Honor Roll use MDaudit.
• The hospital authority for Memorial Hospital and Manor (GA) approves a consulting engagement with Vitalize Consulting for the implementation and training of hospital’s eMAR/BMV project.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Curbside Consult with Dr. Jayne 5/21/12

Mr. H posted the results of a recent poll asking whether it’s OK to ask emergency department patients to pay before treating them for non-emergent problems. The vast majority of HIStalk readers responding thought it would be OK.

Since I’ve spent the better part of the last week working the ED, I have to say I agree. Normally I don’t work this many shifts, but the combined stresses of recent changes in our nursing ratios that resulted in some “blue flu” among the nursing staff seems to have inspired an unusual number of call-ins among the medical staff as well. (Either that, or my partners just want to get a jump on their summer vacations.)

Most of my shifts were on the lower acuity side of the ED, which suits me just fine. The full-time docs can handle all the gunshots, “fit for confinement” exams, strokes, heart attacks, and major trauma, thank you very much. I’m perfectly happy to handle fractures, asthma exacerbations, lacerations, and minor trauma. This week, however, we had a boom in patients who simply should not have been in the ED.

This was a bit of a bummer from an electronic documentation standpoint. Our recent upgrade brought us the ability to have condition-specific defaults, and I had spent a fair amount of time building out my personal templates for the conditions I typically see. I did not, however, spend any time building templates for problems that might be best handled at home with a wet paper towel and a nap. The highlight reel:

• A teenager with an insect bite. His mother wrote a note giving permission for a neighbor to bring him in. He noticed the bite in the morning before school when it wasn’t bothering him at all, but mom decided at 10 p.m. that she wanted to know what kind of insect it was that bit him. Unfortunately, I am not an entomologist.
• A high school senior with mild sunburn who wanted to know what she could put on it to make it go away before graduation (which was the next day.)
• An adult male with a 0.5 cm lump on his arm that had been there for six months. That prompted him to arrive at 1 a.m. “just to get checked out,” although he couldn’t say why he was coming in NOW.

I’m pretty sure that if someone in the waiting room would have told them it would be a minimum of a two and a half hour wait and a $200 charge, these three musketeers (and the dozens like them) would probably have chosen to go home. I wish we could have a seasoned registered nurse stationed in the waiting room, administering simple first aid and counseling patients to follow up with a primary physician or a walk-in clinic in a day or two rather than using scarce ED resources. While I was dealing with them, we had an elderly woman with a complex fracture of her upper arm, several patients with lacerations, and a chap with a knee the size of a grapefruit that needed my attention.

Unfortunately, fallout from the Emergency Medical Treatment and Active Labor Act (EMTALA) makes it difficult for us to employ creative strategies to reserve the ED for appropriate use. Becoming law in 1986 as part of the COBRA legislation, EMTALA seemed like a good idea at the time. Although EMTALA was intended to ensure that patients presenting with emergent conditions were not turned away for inability to pay or other discriminatory reasons, the unintended consequence is a generalized fear of saying “no” to anyone who walks in the door.

The Code specifically defines an “emergency medical condition.” More than half of my patients this week failed to meet that standard, yet they had full visits anyway. We had to document each visit in detail, including a full review of systems, counseling on advance directives, nutritional screening, and more. (We also had to arrange transportation home for the mom who brought her daughter by ambulance for a splinter, but that’s another story entirely.)

I wasn’t in practice prior to 1986 so I can’t say what it was like, but I can’t imagine it was as chaotic and soul-sucking as it is now. I was, however, in the trenches when E&M Coding appeared on the scene, and I experienced first-hand the ridiculous make-work that ensued.

Looking at the track record for federal meddling in health care, it’s hard for me to think that the changes occurring as a result of Meaningful Use will turn out well in the long run. I may have Certified EHR Technology and full command of the Meaningful Use program. I can cite all the measures verbatim even after a couple of glasses of wine. I have more timely access to old charts (which are now actually legible) and better drug interaction checking, but other than that, the benefits still seem elusive.

How do you think we’ll feel in 25 years when we look back at Meaningful Use? E-mail me.

E-mail Dr. Jayne.

Readers Write 5/21/12

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!

The Art of Medicine: Unlocking the Power of Patient Data
By Nick van Terheyden, MD

We are awash with information and choices in every aspect of our lives, from the selection of our morning coffee to the choice of painkiller in our local pharmacy. Worth noting, Starbucks currently offers 30 variations of espresso beverages, and each comes in three sizes with four types of milk. That’s 360 choices — enough to potentially make you want to not get out of bed in the morning.

This problem is magnified in medicine with a deluge of new information, studies, treatments, and the explosion of genome understanding and its impact on patient care. Based on current estimates, medical information is doubling at least every five years. Cyril Chanter encapsulated today’s medical information challenges best when he said, “Medicine used to be simple, ineffective, and relatively safe. Now it is complex, effective, and potentially dangerous.”

There is general agreement in the medical profession that the delivery of quality medical care is no longer possible based on recall and applying what individuals can remember at the point of care. In fact, according to the Kaiser Permanente Institute for Health Policy, “Current medical practice relies heavily on the unaided mind to recall a great amount of detailed knowledge – a process which, to the detriment of all stakeholders, has repeatedly been shown unreliable.”

The digitization of medical records, accompanied by the requirement imposed on the care team to capture discrete data, is setting the healthcare system up for failure. We’re promoting the incomplete capture of the patient note. Discrete data is much like a black-and-white drawing — it contains some of the data, but much of the critical information and nuances are missing. In order to ensure the complete capture of the patient note, discrete data and the clinical narrative must coexist.

The key transport mechanism for medical intelligence is the clinical narrative, which provides the detail that is essential for the execution of intelligent, high-quality medical care. From there, language understanding offers a legend for these pieces of information – the narrative and discrete data – which allows us to view the complete work of art, also known as the patient note.

We are a long way down the path to enabling clinicians to capture complete patient information using the latest advances in voice recognition, which converts spoken word into text. Still, it is with language understanding that we unlock the true meaning of this information, offering a “Rosetta Stone” to tap into the insights of this information and allowing us to connect the dots in our expanding picture of patient care in a digital world.

It is this unlocked data that will link the subtle details of the patient record to vast mountains of medical intelligence; allowing for a guided, evidence-based approach to medicine alongside integrated decision support. This in turn will offer care takers a more complete picture from which they can guide individual care, while enabling possibilities surrounding large health population analysis and insight.

As we unlock the capabilities of clinical data in healthcare, we open the door to new discoveries, associations, and yet-unimagined treatments that will directly affect the care of those we love and look after now and into the future.

Nick van Terheyden MD is chief medical information officer of Nuance of Burlington, MA.

I once heard it said that successful device connectivity in a hospital is like implementing a universal remote on your TV. The consolidation of controls allows for easier training of new users, fewer steps to execute a command, and less room for error. But in today’s age of accountable care and new care delivery models, the health systems that are still operating in the “universal remote” mindset will be left behind as the industry progresses.

It’s great that my DVD player can talk to my TV. But what about when I want to watch the same movie on my laptop in the other room? And while this entertainment glitch is a little frustrating, it’s actually criminal when we think of a similar scenario in the healthcare world. We don’t need to just connect one point solution to another. We need to be able to effectively care for patients, regardless of where they are within the hospital; what systems the hospital has in place; or how many physicians, nurses or other staff are involved in the patient’s care. The sooner hospitals begin to think beyond individual technologies and develop an overarching strategy to connect people and processes, the faster we’ll start to see a real change in patient care.

Historically, hospitals and health systems have approached medical device connectivity tactically, focusing on how to connect a nurse call device to a smart phone, a monitoring device to an iPad, or data from a smart bed to an EMR. Often purchased by IT departments as middleware, a range of IT solutions have been viewed as a solution to one or two key problems, and have typically been implemented one department or one facility at a time.

Because many of these technology investments were made to solve only singular, point-in-time problems, providers still struggle to deliver care that focuses on the patient across the entire care continuum. They need to get smart about implementing solutions that cater to the unique workflow of their personnel – not their hardware – if they want to drive efficiency and improved patient care.

It’s not really the provider’s fault, though. The vast majority of vendors have played into this universal remote mindset by building point solutions that connect a small subset of devices or departmental systems to one another, rather than focusing on the entire system. Providers need solutions that both cater to a department’s unique workflow and enable collaboration from one department to the next, making it possible to efficiently serve patients as they move between these diverse care settings. They need to come to the table with customizable solutions, and with services that help hospitals implement these solutions as part of a broader workflow strategy. It’s not enough to drop off a box and wish them well. Providers need partners to help them learn and improve for years to come.

We need a new movement in healthcare, one that takes a system-wide view to clinical workflow design and leverages clinical technology solutions to both connect devices and foster collaboration across the entire system. This includes everyone from patients to clinical teams to ancillary groups (biomedical engineering, dietary, environmental services, IT, and pharmacy). Clinical workflow is about more than hardware and software. It’s about the clinicians who use these solutions and need them to promote — not hinder – high-quality patient care. Vendors need to offer their customers something better than stale point solutions. 

As an industry, we need to map to the bigger picture, driving teamwork and collaboration among every individual and across the entire care continuum in order to drive dramatic performance improvements for healthcare organizations.

Mary Baum is chief healthcare officer of Connexall USA of Boulder, CO.

The Long Road Ahead: Choose your Traveling Companions Wisely
By Chad Morrill

When hospitals choose a healthcare IT provider, they too often just focus on the same questions many of us consider when buying a car: “How fast does it go?” and “How much does it cost?” But for a successful project, these are just two of the many factors to consider. Another key decision point should be a vendor’s suitability as a long-term partner.

We’re not just talking the equivalent of a 100,000-mile power train warranty, whereby the vendor will fix your system if it breaks, though of course responsive support is important. But beyond that, you’ll be better off working with a company that not only understands its products and services, but also your processes, your staff, and your goals, and will do its best to unite these elements to give you maximum performance and value.

The first thing to consider before getting on the road is your hospital’s needs, both now and for the next few years. What are the pain points you’re trying to overcome, what new compliance mandate are you struggling to satisfy, or which facet of your EMR/EHR project are you finding most troublesome? This then defines the focus of your solution search, which will in turn narrow your list of prospective vendors.

Next, ask for references from facilities like yours and see how they’re solving the very issues you want to solve. Then ask them what else they’ve been able to do with the product. A hospital sometimes picks a solution because it fits neatly into whatever box they’re trying to fill, but yet leaves the full potential of that solution untapped. One of the reasons is that an IT team is typically tasked with solving a very narrow problem, and once they’ve done it, they must move on to putting out the next fire lit by clinicians or the CIO. They then go out and look for other vendors to meet the very needs that could be met by the product they’re already using – a waste of time, effort, and money for everyone involved.

Executives tend to chase the next “shiny object” or respond to the newest tech trend, and this leads to the misconception that something ‘new and improved’ is required. Just like we all want the next iPhone or iPad, many hospital users hanker after the latest IT toys on the market, following the hype rather than putting in the effort to explore the full capability of the applications already deployed.

Despite the need for hospital project managers to be proactive in working with vendors to get the most from their systems, the burden cannot fall solely on the facility. A responsible vendor that cares about its customers and the staff and patients they serve should dedicate time and resources to helping hospitals get the most out of its solutions. A regular onsite “checkup” with both a customer advocate and a member of the vendor’s executive team can provide the hospital with a view of what its products can do now, and what the roadmap is for upcoming functionality. The vendor can explain and even demonstrate how other customers are using its offerings in new ways, and can then help the IT staff put this knowledge into action. Executive buy-in is also crucial on the hospital side, as the CIO and IT director will be key in both understanding the full potential of vendors’ products and services, and then in driving widespread user education and adoption.

The challenge to such leaders: push your IT analysts/project managers to explore each product’s entire feature set and get involved in engaging your vendors to see what else you could or should be doing. Yes, it requires accountability and an upfront time investment. But it will yield the benefits of doing more with existing tools, moving further toward achieving your facility’s goals, and, most importantly, of improving care and service to your patients. Time to start your engine!

Chad Morrill is an account manager at Access of Sulphur Springs, TX.

HIStalk Advisory Panel: Allscripts 5/21/12

The 79-member HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news development and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

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

For this report, I asked panel members what advice they would provide to Allscripts after the company’s recent earnings disappointment and board shakeup. Their responses have been edited for brevity and to ensure their anonymity. Your comments are welcome.

Vision and Strategy

• The anti-takeover defense made them look weak in my eyes. They need to communicate their go-forward strategy with large clients as soon as possible. People here are worried that our vendor is going out of business.
• Phil Pead was all about the stock price and less about the product, integration, and ease of use. Allscripts tried to tell the integrated story with several different legacy flavors of PM/EMR – too many products, too many moving parts. The Eclipsys purchase was 2-3 years too late since Epic and Cerner have already beaten them and Epic is the only one with a real story of true integration. On the low end, they are most likely getting hurt bad by eClinicalWorks, athenahealth, Greenway, and similar companies. My advice: sell Eclipsys and use the money to pick a lane with one or two flavors of product and just kill it in that space. They cannot be all things to all people.
• They need to re-examine their market and whether this Eclipsys thing is really going to work. Seems like Glen did not learn anything from McKesson and GE.
• Post-acquisition is difficult and companies sometimes make all the parties feel good by including all the legacy resources – people and products – in the path forward. That leads to lack of vision, resource mismanagement, and excessive costs. I think Allscripts got caught in that vortex. They need to clarify what they want to be, then clean up the operation despite painful changes and bruised egos. A change at the top may be necessary to keep the institutional shareholders and analysts at bay while they right the ship.
• Put a plan in front of your most important customers and enlist them to create a public statement of support. Customers trump boards of directors every day.
• Come clean to everyone with what the problem is. Replace the corporate audit firm. Either replace the management team or give them a 12-month notice to clean up their own mess and then get out, assuming there is a belief they can clean it up. Appoint an external firm to work with the board to identify the issues and to decide which board members should stay. Make sure key intellectual capital employees are willing to stay and reinforce your need for their services.
• Allscripts is a finalist in our inpatient EHR selection. The recent news has raised concerns about the company’s viability. Show the market you can recover and succeed since partnering with Allscripts at this point represents significant risk. The failure to integrate Eclipsys products is a key issue since companies like GE and McKesson promised it after an acquisition and failed miserably, leaving customers in a lurch.
• A trick of publicly traded companies is to reveal all your bad news at once, let the market kill you, then build back up. I assume this is the case and future revenues will come with a clean slate. I think they will have some good upcoming quarters.
• They have had a pretty successful ambulatory product offering. They need to leverage that business model to tackle new accounts. With the internal politics hopefully behind them, they can concentrate on integration. They have a good product – I hope they understand that. It’s their execution that’s hurting them.
• Senior management, led by the CEO, need to be transparent if they’re going to put this turmoil behind them. They need to communicate clearly, thoughtfully, and comprehensively what the plan is, with no BS and PR. Humbly admit past mistakes, acknowledge vulnerabilities, reiterate its strengths and lay out the plan to recover. Spend 30-60 days to do a thorough, honest self-assessment – including consideration of the complaints of its critics – and play out best- and worst-case scenarios. If past decisions (i.e. integration) are criticized, those can’t be changed, but they should be acknowledged and addressed. The market is still large and I don’t believe it’s too late for Allscripts to get its share. It may not achieve a #1 or #2 market position, but it can still emerge as one of the winners. It has good products, a sizable customer base, and many talented employees. The message should be positive and encouraging, but above all, credible. In the absence of an ability or willingness to do this, Allscripts should fire Glen Tullman and hire a CEO with the determination and commitment to turn the company around, like fresh leadership did at IBM with Lou Gerstner.

Sales

• The sales team needs better access to technical resources. When they do a dog and pony show for our executives, our technical team is always invited and the sales team can’t answer their questions. I want to be sold, but they can’t bring it.
• Closing deals is the way to show viability. We’ve evaluated their products for our clinics and they didn’t stack up well. One group we’re associated with uses Allscripts and they have not been happy with the product for some time, but I don’t see them moving away from it.

Products

• They need to focus on clean integration of products they are selling as integrated. The last few times we purchased ‘integrated’ solutions from Allscripts, we had to take over the integration because we were getting nowhere with the company.
• Articulate the vision of the combine Allscripts-Eclipsys platform and provide a well thought out plan on how they will get there.
• They may want to take the approach McKesson used for Horizon Clinicals – sunset Eclipsys and focus on ambulatory. They carved out a nice space in the ambulatory area and the R&D dollars going into Eclipsys integration could have been used to further the ambulatory product line. Ambulatory clients are confused. This plays right into the hands of Epic.
• Allscripts needs to stop talking about an integrated record as though they can compete with Epic. They need to find a way to leapfrog Epic. Take what Sunrise customers are developing using Objects Plus/Helios (some of which knocks the socks off Epic) and incorporate it into the product.
• We were a long-time Misys client who left after Allscripts dropped the ball. They couldn’t deliver on support. They decimated their personal relationships by replacing dedicated professionals by a different nameless person every time we made a support call. Their salespeople couldn’t even present a proposal for community integration without innumerable failures in the demo. The ‘free upgrade’ from Misys EMR to Allscripts Professional turned into a morass of fees for training that would have cost more than  buying a competitor’s product. Not surprisingly, small practices in our area have turned to eClinicalWorks and Greenway and never looked back. Simply merging individual products repeatedly without true integration and delivering on promises is not sufficient for success.

Services

• The India-based support we were getting from Eclipsys and then Allscripts was horrible, but they have really taken the bull by the horns and cleaned it up. Recent responses to our problems were clean and focused and I have been pleasantly surprised.
• Outsourcing support to India was a bad idea. Docs like me call and we get people who don’t know the product. The same is true of their patient portal – it is a Babel Tower.
• We have seen deteriorating support and turnover amongst the sales/support team that crosses product lines. Physicians are losing confidence in the product.
• We’re a large Allscripts Professional client and it’s been frustrating to watch them struggle to grow and try to compete with Cerner and Epic. Their overall support and quality has suffered, especially with new releases.
• Please care about me and provide support. I know life isn’t the best for you right now, but I still have to work and I need you to fix the support structure. Keep current customers from being so put out with you and fewer of use will become someone else’s customer.
• Hire more qualified staff. They are hiring high school graduates for implementation consultant positions and giving them only basic training before sending them out to clients at $205 per hour.