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An HIT Moment with … Patricia Stewart, Principal, Innovative Healthcare Solutions

November 30, 2012 Interviews Comments Off on An HIT Moment with … Patricia Stewart, Principal, Innovative Healthcare Solutions

An HIT Moment with ... is a quick interview with someone we find interesting. Pat Stewart is a principal with Innovative Healthcare Solutions of Punta Gorda, FL.

11-30-2012 4-03-08 PM

What kinds of projects are clients looking for help to complete these days?

Many clients are struggling simply to meet such basic IT objectives as maintaining and increasing IT services to support the organization’s business and clinical strategic goals, optimizing investments in IT so the organization receives maximum value for their investments, and mitigating risks to business processes and patient care associated with IT. All while pushing to meet Meaningful Use requirements, dealing with the impact of healthcare reform, and understanding the developments in the purchaser and payer arena. These are broad initiatives and there is pressure to move forward in all of them concurrently.

Organizations are being bombarded with a host of industry changes — accountable care and medical home models, Meaningful Use and health information exchanges, ICD-10, and the call for business intelligence. Now more than ever, healthcare organizations need solid IT strategies. Typically, however, there are limited IT resources to support these strategies. This has created many opportunities for our consulting services.

The majority of our engagements fall into three main categories. Engagements to help clients implement one or more of McKesson’s Horizon suite of products with the goal of reaching MU. Engagements to help clients implement a new system, such as Epic or Paragon. Engagements to help clients transition and support their legacy McKesson applications while they convert to a new vendor, such as Epic or Paragon. We are also seeing more requests for assistance in system and workflow optimization and analytics projects.

What are some innovative implementation ideas you’ve used or seen?

It’s still not common to manage a project from start to finish according to an overall business strategy. Or for IT groups to collaborate with stakeholders to understand their needs and challenges. These practices create innovation and success.

One of our clients created co-management arrangements with each physician service line that included quality of care, patient satisfaction, value analysis studies, and EMR adoption. They established strong teams with lean experts to develop implementation approaches for issues that affect physicians directly, such as CPOE, bedside barcoding, and medication reconciliation. The teams design the implementation approach, success factors, and metric-driven financial rewards for physicians.

Clients have created dedicated teams for testing and identifying build and process issues. They have pulled operations people into a workflow and process team to identify gaps between current and future state, to make decisions about process changes, and to provide go-live support. Some clients have cut back on classroom training and instead allocated those resources for "at the elbow" user support during go-live, which also makes financial sense since these resources can be cheaper than the cost of implementation specialists. 

The company has been around for several years. During that time, the Epic business has taken a big swing up and lots of people have formed small consulting companies to take advantage of the demand. How do you see that market and your competition changing in the next few years?

Our management team has been working in the HIT environment for many years and we have never seen the kind of market growth we’re seeing now. This demand has led to a rush of people entering the consulting profession, and — as you mentioned — a lot of new consulting companies. While we’ve seen more people choosing to become consultants, we haven’t seen a corresponding increase in the experience and skill levels these individuals bring to the table.

Unfortunately, financial opportunities instead of missions, goals, and aptitude are leading people to the market. We think it is inevitable that the market will slow down, and when it does, there will be consulting companies that drop out of the market. Few are built for long-term survival.

We credit our success to a corporate mission, culture, and identity based on simple core values: do the right thing for our clients, do the right thing for our consultants, and never forget there is a patient at the end of what we do. 

What are the best jobs in healthcare IT right now, and which ones would you advise industry newcomers to prepare for?

System and process optimization. Implementations over the last few years have occurred under stressful conditions with short timelines and limited resources. System implementations have not aligned with an organizational strategy. For organizations to be successful, they must understand how their systems impact business operations. Organizations must answer the questions: what value are we getting from the systems and how are they supporting our strategic goals? What processes must change to maximize our investments and achieve our goals?

One way facilities can meet system optimization resource needs is by creating transitional programs that take strong clinical experts and train them in application support roles. With shrinking inpatient census and greater focus on clinical quality and readmission initiatives, organizations can put clinical experts with IT aptitude on a path to IT knowledge. Facilities can grow bench strength from within. It is a long-term strategy and requires investment, but we believe it’s better than searching for talent – expensive talent – that isn’t part of the organization’s culture.

Jobs that leverage data to manage patient populations and outcomes. These jobs require an understanding of the system design so the right information is captured. Their roles and responsibilities will include using predictive analytics to proactively manage outcomes and maintain reimbursement.

What subtle industry trends are you seeing now that will become important down the road?

Systems and IT resources must support initiatives that allow healthcare to transition into community settings. We must focus on managing population health and creating effective support systems to transition patients into community care settings

The emergence of the Chief Clinical Information Officer. The melding of CMIO and CNIO for a less siloed approach.

Increased ability to adopt and manage change. With the implementation of so many complex systems, healthcare organizations and providers now have a wealth of data. With it comes a greater responsibility to respond quickly to conditions that affect patient outcomes, positively or negatively. To meet that responsibility, healthcare organizations and providers must be more nimble than ever. They must adapt efficiently and effectively to changing conditions. Having years or even months to implement changes and gain adoption will not be an option.

Comments Off on An HIT Moment with … Patricia Stewart, Principal, Innovative Healthcare Solutions

Morning Headlines 11/30/12

November 30, 2012 Headlines 1 Comment

Medicare Is Faulted on Shift to Electronic Records

A review by the Office of the Inspector General finds that Medicare is not adequately overseeing the Meaningful Use program, leaving it vulnerable to paying incentives to Eligible Providers and hospitals that have inaccurately claimed their compliance.

After All the Time and Money is Invested, Will e-Health Ever Deliver on its Promise?

A Toronto newspaper reviews Canada’s ambitious and expensive e-health program that still leaves it behind much of the industrial world, with 80 percent of physician practices still using paper charts.

MIT Media Spin-Out Ginger.io raises $6.5 Million Series A Round

The startup, which summarizes its smartphone-based population management tool as a “check engine” light for humans, raises its investment total to $8.2 million in a round led by Khosla Ventures.

Guidance Regarding Methods for De-identification of Protected Health Information in Accordance with the Health Insurance Portability and Accountability Act (HIPAA ) Privacy Rule

HHS issues a guide describing acceptable method for de-identifying patient information to comply with HIPAA’s privacy rule.

Hospitals Get New Grades on Safety

Leapfrog Group issues its second set of hospital grades on patient safety, with a significant number of hospitals moving two letter grades up or down due to new data and an adjusted methodology. One of the 25 hospitals that earned an F is Ronald Reagan UCLA Medical Center, while Cleveland Clinic’s grade slipped from a C to a D.

News 11/30/12

November 29, 2012 News 7 Comments

Top News

11-29-2012 8-05-24 PM

The Office of the Inspector General finds that CMS has not implemented adequate safeguards to verify the accuracy self-reported EP and hospital data for the MU program. It also says that the audits CMS plans to conduct after the fact may not work, either. OIG recommends that CMS randomly select providers to provide supporting documentation for pre-payment; issue guidance detailing the types of documentation that providers should maintain to support compliance; and require certified EHRs to produce reports verifying the achievement of MU measures. Medicare hasn’t audited any of the $3.6 billion it’s paid out so far. Acting CMS administrator Marilyn Tavenner doesn’t like the idea of pre-payment review, saying it could “significantly delay payments to providers” and “impose an increased upfront burden on providers.”


Reader Comments

inga_small From Uncorked: “Re: MyWay switch. I’ve learned the upgrade that Allscripts is offering  its customers from MyWay to Pro does not include a detailed conversion of financial data, meaning users have to work the old balances in MyWay. Sounds painful.” The details on the MyWay to Pro upgrade are on the client-only section of the Allscripts Web site, so I can’t verify. However, since detailed conversion of financial data between disparate systems can be quite complicated and time consuming, maybe the balance forward option is actually the lesser of two pains.

11-29-2012 7-45-21 PM

From NoNamesPls: “Re: MD Anderson. To release an EMR RFP in January.” Unverified.

From Lucille Carmichael: “Re: Nuance. Planning to spin off Salar, which it acquired with its Transcend acquisition, possibly as early as Friday.” Unverified.


HIStalk Announcements and Requests

inga_small If your week has been anything like mine, you are still recovering from all your thankfulness last week. In case you missed any HIStalk Practice news, here are some highlights. ONC says the percentage of physicians e-prescribing on the Surescripts network through an EHR has jumped from seven percent in 2008 to 48 percent as of June 2012. Almost 10 percent of US residents now receive their healthcare through an ACO. The highest-rated EMRs in an AAFP-member survey are Praxis, Medent, Healthconnect, Amazing Charts, and SOAPware. Pediatricians lag other specialties in EHR adoption. Practice Wise’s Julie McGovern offers key points for selecting an EMR vendor. Dr. Gregg muses about corporate chaos and HIT. Thanks for reading.

On the Jobs Board: Marketing Programs Manager, Meditech Clinical Trainer, National Sales Director, Ambulatory Implementation and Deployment Managers — athenaclinicals.


Acquisitions, Funding, Business, and Stock

The mobile interactive health advice platform HealthTap acquires the health business of Avvo, including its directory and network of providers.

11-29-2012 9-32-47 PM

Ginger.io, which analyzes sensor and patient-entered smartphone data to for the equivalent of a “check engine light” for patient populations, raises $6.5 million. The investor is Khosla Ventures, whose founding partner Vinod Khosla famously predicted several weeks ago that machines will replace 80 percent of doctors (some of his other investments include iPhone attachments for heart monitoring and diagnosing ear infections). Ginger.io is based on research conducted at the MIT Media Lab. The company acquired another startup, Pipette, earlier this year for its technology that claims to reduce hospital readmissions by reviewing patient-reported outcomes. Travis reported the acquisition on HIStalk Connect back in March, where he concluded,

Ginger is a company we are going to hear a lot more about in the coming years. They have a clear focus on learning about patient behavior and proactively trying to address potentially costly events. The main question will be how much money can Ginger make quickly from pharma research or how much money can it raise to sustain itself until the healthcare industry is ready to pay for services like this. Either way, this acquisition is good for mobile health startups and Rock Health.


Sales

Stormont-Vale Healthcare (KS) selects Hyland Software’s OnBase enterprise content management solution for integration with its Epic ambulatory EMR.

Yale-New Haven Hospital contracts with Mediware for its Transtem software for tracking the use of stem cell products in providing patient care.

OnFocus Healthcare adds 75 hospital clients of its OnFocus | epm software during the company’s fourth quarter.

11-29-2012 7-47-52 PM

Pomona Valley Hospital Medical Center (CA) selects Dell and Siemens Healthcare to provide diagnostic image archiving and sharing services.

BJC Healthcare (MO) expands its use of the Surgical Information Systems perioperative information system to Saint Louise Children’s Hospital and Barnes-Jewish West County Hospital.

11-29-2012 7-50-45 PM

Santa Clara Valley Health and Hospital (CA) awards CSI Healthcare a contract to support its Epic initiatives.

Beaufort Memorial Hospital selects the Medseek Empowered solution to expand its patient engagement initiatives.

St. Joseph Health System (TX) chooses GroupOne Health Source for EHR medical billing services.

Ophthalmic Consultants of Boston (MA) deploys MedAptus for professional charge capture in its office and ambulatory surgical center locations.


People

11-29-2012 1-30-21 PM

SPI Healthcare appoints Ken Christensen (Health PCP) SVP of operations.

11-29-2012 2-34-35 PM

CareTech Solutions names Robert M. Johnson (Palace Sports & Entertainment) CFO.

11-29-2012 6-29-52 PM

Joseph Kvedar, MD, director of the Center for Connected Health of Partners HealthCare,  signs on as a principal with Wellocracy, but will continue in his role at CCH. The new company will focus on personal activity trackers and motivation tools that integrate healthy activities into busy lifestyles, initially producing books. He’ll be joined by a self-help author, a personal trainer turned physician, and a media relations expert.

11-29-2012 6-45-31 PM

Bill Bria, MD (Shriners Hospital for Children) is named chief medical officer of business intelligence software vendor Dataskill.

11-29-2012 9-47-40 PM

Peter Henderson (PatientKeeper) joins social networking-based employee wellness vendor ShapeUp as COO.


Announcements and Implementations

Washington DC Mayor Vincent Gray announces the go-live of Direct Secure Messaging in the district using Orion Health’s technology platform.

RelayHealth announces that it will provide an open, vendor- and payer-neutral platform for patient identity management, patient consent management, and other technology services to enable a longitudinal patient record. The technology will allow providers to embed a cross-entity MPI into their native systems and enable patient identification across multiple systems.

11-29-2012 7-51-45 PM

Jennie Stuart Medical Center (KY) goes live on Ingenious Med’s Impower charge capture solution.

The Kansas HIN and ICA share patient data with the CDC’s Biosense public health tracking system.


Government and Politics

An opinion piece in The Wall Street Journal written by former US Senator George LeMiuex (R-FL) says the government is doing little to stop the estimated $100 billion per year that Medicare loses to waste, fraud, and abuse. He had proposed a credit card-like fraud prevention system that would stop questionable claims before they’re paid, but that’s the $77 million system developed by Northrop Grumman and Verizon that had stopped less than $8,000 in questionable payments in its first eight months. He concludes that the problem is “bureaucrats hiding in their own ineptitude.”

11-29-2012 3-09-34 PM 

CMS has paid more than 150,000 EPs and 3,238 hospitals $8.4 billion in MU incentives through the end of October.

CMS extends the Medicare MU attestation deadline for New York and New Jersey hospitals affected by Hurricane Sandy. Eligible hospitals must submit to CMS and extension application to extend the attestation deadline from November 30, 2012 to the spring of 2013.

11-29-2012 6-48-13 PM

HHS issues a guide for de-identifying patient data to meet HIPAA privacy rule requirements.


Technology

11-29-2012 8-44-55 PM

British troops in Afghanistan are using a portable 3D camera to assess battlefield injuries and send images around the world for second opinions.

Surgical Theater LLC sells its first 3D imaging surgical rehearsal platform. It generates statistical models from an individual patient’s scanned images, providing life-like feedback using flight simulator technology that allows the surgeon to practice the procedure hands on. The first customer is University Hospitals Case Medical Center (OH), which isn’t surprising since its co-originator is the chair of the hospital’s neurosurgery department and the product bears his name. FDA approval is pending. The co-founders are former members of the Israeli Air Force, with my reason for calling out that fact becoming more clear as you read further down the page.


Other

The California Department of Public Health fines Prime Healthcare Services $95,000 after determining that Shasta Medical Center violated patient confidentiality when it shared a woman’s medical information with journalists and sent an e-mail about her treatment to several hundred hospital employees. The disclosures were made when the hospital was seeking to respond to a news story featuring the woman and the hospital’s alleged overbilling of Medicare.

11-29-2012 1-56-22 PM

Philips moves from last place to first place in KLAS’s review of the MRI market.

11-29-2012 2-58-34 PM

A survey finds that promoting EHRs and mobile health are a low priority for voters compared to other healthcare issues. When asked where federal healthcare spending should be cut, 50 percent of voters said payments to providers should be reduced, while 42 percent said the government should spend less on healthcare IT.

11-29-2012 8-18-21 PM

Leapfrog Group’s second round of hospital safety ratings show significant swings in the months since the original report after it changes its methodology and uses newer data, with 103 hospitals moving from a C to and A, two changing from A to D, and an overall 8 percent moving at least two grades. Ronald Reagan UCLA Medical Center earned an F grade along with 24 other hospitals, while Cleveland Clinic took home a D. Predictably, the high-profile hospitals with the bad grades denounced the methodology when stung by local press coverage of their embarrassing results, claiming they’ve improved vastly in the 1-3 years since the information was collected.

The Bureau of Labor Statistics predicts that IT positions in healthcare and social assistance will account for about 28 percent of all new jobs by 2020.

A New Zealand sleep expert blames mobile devices for a 50 percent jump in sleeping pill consumption by young people, saying, “People go to bed with their iPhones and iPads and expect to be able to then go straight to sleep, but realistically, you can’t do that. You really need to put these devices down about an hour before you go to bed.”

11-29-2012 7-52-48 PM

I was interested in the answer Kobi Margolin gave to my interview question about why Israel produces so many healthcare IT companies that sell products to the US. He suggested reading Start-Up Nation, which describes the business climate there. I plan to do so, but from the Amazon reader comments, some of the reasons that the country is so successful despite being constantly at war, surrounded by enemies, and devoid of natural resources are: (a) mandatory military service that encourages innovation and forges early social networks; (b) Jewish tradition; (c) open immigration that encourages brilliant innovators to come there; (d) a tradition of young people traveling all over the world due to the small size of the country; (e) government policies and culture that supports entrepreneurism and the questioning of authority; (f) a flat hierarchical society; (g) acceptance of failure in the quest for success; (h) early maturity and lack of belief that people shouldn’t start businesses without a lot of experience, emphasizing instead agile, problem-solving generalists; (i) mashing up technology with other disciplines in fresh ways; and (j) great universities. In other words, pretty much exactly opposite what we have in the US except for the great universities part. If you’ve read the book, feel free to chime in.

An article in The Wall Street Journal raises the question of the ownership of data created by implanted medical devices like defibrillators. It’s your body, but only the device manufacturer (and possibly your doctor, if you see one regularly) can see what it’s emitting. A Medtronic spokesperson says, “Our customers are physicians and hospitals” and says demand is low and patients couldn’t make sense of their data anyway, but then admits that the company is thinking about selling its patient data to health systems and insurance companies. Another senior Medtronic executive calls the information it collects “the currency of the future.” The company has created a data unit specifically charged with creating a business around selling patient data, working the loophole that only providers are covered by the 17-year-old HIPAA regulations, not device manufacturers. One patient paid $2,000 to take a technician’s class for reading the reports, but still has to pay his cardiologist for a visit to get the data.

Remedy Health Media launches a service that will send electronic newsletters to patients with specific conditions under the name of their doctor, who pays the company for use of its patient data management system. The company says health reform gave them the opportunity, while advertising drug companies give them their profit. It’s a double-opt in service due to comply with spam laws, meaning patients need to sign up and then click a link on a welcome e-mail indicating their interest to receive further e-mails. Some of the company’s brands include HealthCentral, The Body, RemedyMD, and My Refill.

Attendees of an auction at a bankrupt and closed Pennsylvania hospital claim to have seen unattended medical and employee records and computers up for bid that were displaying patient information. The bankruptcy trustee claims the medical records were in roped-off areas and the computers had been wiped clean, but a bidder says that’s not the case.

An excellent article in the Toronto newspaper questions whether e-health will ever deliver a return on investment in Canada. It calls out the massive spending on eHealth infrastructure, implying that it’s a desperate shot at addressing the question, “Could the elderly bankrupt Canada?” but points out that for all the investment, Canada is still well behind most of the industrial world, with 80 percent of its physicians still using “a fax machine running full blast against a ceiling-high backdrop of manila files.” It says that Canada’s efforts are looking a lot like those of the UK, where ambitious and expensive programs tanked with little to show for it other than billions of taxpayer pounds transferred to consultants and contractors. A former deputy health minister had an interesting thought: instead of buying EHRs for everybody, which he says will cost more than the healthcare services they consume, he suggests providing them only for seniors and people with chronic disease since 1 percent of Ontario patients have been found to consume 50 percent of hospital and nursing home costs.

Weird News Andy wonders if this is where we’re headed. In England, sick babies are being put on “death pathways,” with the rather lurid newspaper article quoting one doctor who admitted that he took part in “starving and dehydrating ten babies to death in the neonatal unit of one hospital alone.” A hospital nurse calls it “euthanasia by the back door.” An investigation will determine whether hospitals earned bonuses for hitting death pathway targets.


Sponsor Updates

11-29-2012 9-57-58 PM

  • Nuance gives the $73 (at Walmart) Philips Digital Voice Tracer dictation recorder its highest rating for recording and voice recognition accuracy with Dragon Naturally Speaking.
  • 3M announces details of its 2013 Client Experience Summit, set for April 2-4 in Tysons Corner, VA.
  • Liaison Healthcare announces that four out of five global pharmaceutical companies use its integration and data management services.
  • The Orlando paper spotlights Kony Solutions and its “cutting edge” app development.
  • Levi, Ray & Shoup publishes a case study highlighting the benefits that Memorial Hermann Healthcare (TX) realized simplifying output management.
  • SuccessEHS integrates the Midmark IQvitals device with its EHR.
  • BridgeHead Software releases a white paper highlighting the crucial concerns of image availability.
  • Besler Consulting offers a free comprehensive summary of the Hospital Outpatient Prospective Payment System final rule.
  • API Healthcare offers five tips for payroll success in hospital mergers and acquisitions.
  • Informatica introduces a global messaging routing capability for the Informatica Ultra Messaging environment.
  • The Tampa Bay Technology Forum honors MedHOK with the 2012 Emerging Technology Company of the Year Award.
  • Ingenious Med releases software upgrades for its Web and mobile solutions that include a Virtual Superbill to improve charge capture.
  • Health Language Inc. releases new terminology mapping to support providers and EHR vendors meeting Stage 2 MU requirements for SNOMED-encoded problem lists.
  • iSirona releases Software Makes Sense, a five-part video series detailing the specific configurations and their advantages used by iSirona’s hospital customers to sync medical devices and EHRs

EPtalk by Dr. Jayne

Friday is the last day for HIMSS 2013 Interoperability Showcase submissions. Demonstrations must include health information exchange between at least three healthcare organizations.

Friday is also the last day for Eligible Hospitals and Critical Access Hospitals to register and attest for incentive payments in fiscal year 2012. CMS has a tutorial on YouTube which, strangely, enough seems to have been filmed in front of a green screen that wasn’t replaced by graphics, rendering it nauseatingly distracting.

Finally, a data breach that doesn’t involve a lost laptop or stolen hard drive. A resident physician terminated from the University of Arkansas for Medical Sciences kept patient lists and notes after being terminated in 2010. The resident began to produce the records during a lawsuit against the residency program, leading to a court order to prevent further release.

Discussions at RSNA reveal mixed opinions about releasing radiology results directly to patients. I think many providers would prefer to release only annotated results to patients – those results to which the ordering physician has added comments that explain the clinical significance of the radiologist’s interpretation. There are a lot of vague terms used by some radiologists (clinical correlation recommended, questionable presence of something, etc.) and that leads to fear of patients misunderstanding, which leads to fear of being transparent with results. If health systems are going to release without annotation, maybe they should require radiologists to document results at the 5th grade reading level: “Your chest x-ray looks like the chest x-ray of every other person who lives in your part of the country. I don’t see anything that doesn’t belong there.”

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For those whose providers have embraced transparency and are offering patient portals and other engagement platforms, the Family Caregivers Video Challenge offers a chance to tell how health information technology or eHealth tools have helped manage a loved one’s care. Video submissions are due by December 10 and prizes worth $8,350 are at stake.

My hospital has been lucky that this hasn’t happened to us (yet). A NYU staffer inadvertently sends an e-mail that allows a student to accidentally “Reply All” to nearly 40,000 of his classmates. Thousands of students jump on the bandwagon, creating what some termed the “replyallcalpyse.” It’s only a matter of time before it happens here.

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Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Morning Headlines 11/29/12

November 29, 2012 Headlines Comments Off on Morning Headlines 11/29/12

Report finds ACOs serving more patients than expected

A recent report suggests that 45 percent of the population now lives in an area covered by at least one ACO.

State Variation in E-Prescribing Trends in the United States

E-prescribing rates show significant increase as more than half of MDs nationwide have adopted e-prescribing.

NextGen Healthcare Forges Partnership with Aviacod

NextGen partners with Aviacod, a medical coding service, to provide cloud-based coding to NextGen customers.

AMDIS President Bria named Dataskill CMO

The Association of Medical Directors of Information Systems president William Bria, MD is named chief medical officer of Dataskill, a San-Diego based integration engine.

Comments Off on Morning Headlines 11/29/12

CIO Unplugged 11/28/12

November 28, 2012 Ed Marx 6 Comments

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

Chasing Mercury … Leading with Excellence

Each year, I participate in a couple of dozen races. Everything from 5K runs to complex endeavors like Ironman, Spartan Beast or Escape from Alcatraz. I train like I race; I work like I live—purposeful, intending to win.

I don’t like losing. Although I enter races knowing my podium chances are slim, I still race to win. I push as hard as I can.

What hurts more than losing is missing the podium by one athlete. Fourth-place finishes kill me. I can recall every race where I lost because I gave up the will to win or I compromised my performance.

Heading into this year’s Thanksgiving Day half-marathon, I wasn’t about to take another fourth-place slot. As we assembled at the starting line, I saw a man with the wings of Mercury tattooed on his ankles. I figured if I followed on his heels, I’d have a chance for the podium. I chased Mercury for much of the race.

During athletic events, my body talks. Loudly. A fast heartbeat. Strenuous breaths. Muscles strain. Then my mind takes over and makes up appealing excuses. If I heeded my body’s instinctive impulses, I’d stop. I’d hop on the couch, turn on Netflix, and throw down a beer.

Of course, I don’t stop. Instead I start to justify the very behavior I loathe. I slow down or walk. Worse, I become delusional in believing that the lead I built early in the race gives me the right to go on cruise control. Why push harder if I’m already ahead? Does it really matter as long as I finish? Nobody else is working hard, and they are doing just fine. Who would know?

This same digressive situation manifests in the workplace.

Come on, we all wonder how those leaders we consider inept got into their positions in the first place. The Peter Principle explains some, but not all. So what happened to the others? You gotta figure they performed with excellence at one time, but then something changed. Did the energy and passion drain? Perhaps they lost focus. How did the clarity that once existed vanish?

Somewhere along the trail, rationalization turned intolerable excuses into tolerable performance. Many leaders finish the race, but few do so with excellence. I fear embracing the fourth-place mindset in my work.

At Mile 5, with Mercury in sight, I felt strong. But my body was already trash-talking me. I ignored the impulses and stayed focused. At the turnaround point, I could tell I was in the top six, but I had the chase group on my heels.

I thought about those fourth-place finishes and what it would take to stay in the lead pack—a resolve to win. I shunned the mind games and pushed towards the finish. In the last two miles, a few passed me, but I still saw Mercury. I set a personal record for the half-marathon and finished first in my age group.

True leaders don’t give into complacency or entitlement, no matter their age, status, or tenure. Yesterday’s performance made you the CIO, but it won’t make you a podium finisher without an unrelenting resolve to win. Leaders push for the gold, bringing out the best in themselves and in others.

Chase Mercury.

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.

HIStalk Interviews Kobi Margolin, Founder and CEO, Clinigence

November 28, 2012 Interviews Comments Off on HIStalk Interviews Kobi Margolin, Founder and CEO, Clinigence

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

11-28-2012 4-02-40 PM

Tell me about yourself and about the company.

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

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

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

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

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

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

 

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

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

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

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

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

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

 

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

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

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

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

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

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

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

 

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

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

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

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

 

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

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

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

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

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

 

Is it hard to get physicians to follow your recommendations?

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

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

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

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

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

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

 

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

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

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

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

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

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

 

Any concluding thoughts?

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

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

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

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

Comments Off on HIStalk Interviews Kobi Margolin, Founder and CEO, Clinigence

Morning Headlines 11/28/12

November 27, 2012 Headlines Comments Off on Morning Headlines 11/28/12

KLAS Report Shines Light on Global PACS Marketplace

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

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

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

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

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

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

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

Comments Off on Morning Headlines 11/28/12

News 11/28/12

November 27, 2012 News 16 Comments

Top News

11-27-2012 1-34-54 PM

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


Reader Comments

11-27-2012 9-01-37 PM
From Image Is Everything: “Re: RSNA. As a vendor, some of us had to go to Chicago the Monday before Thanksgiving and work through the weekend. The trick was to take your spouse, since the Magnificent Mile had beautiful displays, shopping, tourists from around the world, and lots of nice people. The problem was Thanksgiving dinner – think the Chinese restaurant in ‘A Christmas Story.’” I accompanied Mrs. HIStalk to a Chicago conference a few weeks ago, the first time I’d been there since the wintry HIMSS conference of 2009. We had a pretty good time this trip – stayed at the Hyatt on the river, ate at semi-touristy places (XOCO, the Walnut Room, South Water Kitchen, and the Metropolitan Club in Willis Tower), bought Frango Mints, and tried to stay warm since the temperature dropped from the mid-70s the first day to the 40s the rest of the week, ruling out the architecture boat tour. I wouldn’t say Chicago is my favorite city (I think Seattle and San Diego probably top my list), but I at least liked it better than when snow and fellow HIMSS attendees were swirling around me.

11-27-2012 7-00-21 PM

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

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

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


HIStalk Announcements and Requests

11-27-2012 8-50-43 AM

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

11-27-2012 9-04-09 PM

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

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

11-27-2012 5-55-07 PM image

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


Acquisitions, Funding, Business, and Stock

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

11-27-2012 9-08-13 PM

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

11-27-2012 6-25-21 PM

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

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


Sales

11-27-2012 9-02-58 AM

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

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

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

11-27-2012 9-11-52 PM

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


People

11-27-2012 9-50-11 AM

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

11-27-2012 1-24-59 PM  11-27-2012 1-23-57 PM  11-27-2012 1-23-05 PM

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


Announcements and Implementations

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

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

11-27-2012 9-59-23 AM

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

11-27-2012 10-04-07 AM

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

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

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

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

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

11-27-2012 6-35-21 PM

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

11-27-2012 6-54-44 PM

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

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

11-27-2012 7-55-29 PM

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

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


Government and Politics

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

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

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

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


Other

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

11-27-2012 4-15-16 PM

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

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

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

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

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

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

11-27-2012 8-16-43 PM

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

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


Sponsor Updates

11-27-2012 12-55-37 PM

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

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Morning Headlines 11/27/12

November 26, 2012 Headlines 1 Comment

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

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

OIG lists EHR incentives abuse, security among top HHS challenges

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

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

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

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

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

Syndromic surveillance for health information system failures: a feasibility study

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

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

November 26, 2012 News 2 Comments

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

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

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

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

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

The rules in this case refer to insider trading.

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

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

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

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

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

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

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

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

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

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

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

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

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

Curbside Consult with Dr. Jayne 11/26/12

November 26, 2012 Dr. Jayne 5 Comments

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

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

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

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

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

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

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

Appetizers

Hot buffalo chicken dip

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

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

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

Main Dishes

White Chicken Chili

Cranberry Cocktail Meatballs

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

2 pounds lean ground beef

1 cup cornflake crumbs

1/3 cup finely chopped parsley

2 eggs, lightly beaten

¼ teaspoon pepper

garlic powder to taste

1/3 cup catsup

2 tablespoons thinly sliced green onions and soy sauce

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

Sauce

1 can whole cranberry sauce

1 12 oz bottle tomato based chili sauce

1 tablespoon each brown sugar and lemon juice

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

Desserts

Libby’s Pumpkin Roll 

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

Insanely Good Chocolate Cake

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

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

Drinks

Christmas Punch

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

Christmas Punch

Cooks.com style.

Sherbet Punch

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

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

 

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

Print

E-mail Dr. Jayne.

Morning Headlines 11/26/12

November 25, 2012 Headlines Comments Off on Morning Headlines 11/26/12

RSNA 2012 Begins

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

GP blames computer for man’s death from ulcer

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

Welsh First Minister Opens Clinithink’s Development Centre

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

Matching DNA With Medical Records To Crack Disease And Aging

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

Comments Off on Morning Headlines 11/26/12

Monday Morning Update 11/26/12

November 24, 2012 News 6 Comments

11-23-2012 9-15-15 PM

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

11-23-2012 9-38-53 PM

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

11-23-2012 8-29-06 PM

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

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

11-23-2012 8-46-54 PM

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

11-23-2012 8-54-12 PM

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

11-23-2012 8-58-33 PM

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

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

11-23-2012 10-36-47 PM

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

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

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

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

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

11-23-2012 10-22-34 PM

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

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

11-24-2012 7-05-09 AM

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

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

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

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

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

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


Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Morning Headlines 11/21/12

November 20, 2012 Headlines Comments Off on Morning Headlines 11/21/12

Nuance Communications Posts Q4 Profit

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

CareCloud Appoints Ralph Catalano as Vice President of Operations

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

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

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

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

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

Comments Off on Morning Headlines 11/21/12

News 11/21/12

November 20, 2012 News 9 Comments

Top News

11-20-2012 8-06-30 PM

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


Reader Comments

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

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

11-20-2012 6-47-24 PM

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

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


HIStalk Announcements and Requests

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


Acquisitions, Funding, Business, and Stock

11-20-2012 5-33-03 PM

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

11-20-2012 6-12-45 PM

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


Sales

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

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

11-20-2012 11-13-02 AM

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

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

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


People

11-19-2012 7-23-45 AM

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

11-20-2012 8-56-21 AM

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


Announcements and Implementations

11-20-2012 11-14-34 AM

White Plume Technologies releases its AccelaMOBILEmobile charge capture product app.

11-20-2012 11-15-40 AM

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

11-20-2012 5-43-37 PM

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

11-20-2012 5-52-53 PM

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

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


Government and Politics

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

11-20-2012 6-44-34 PM

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

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


Innovation and Research

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

11-20-2012 8-11-44 PM

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


Technology

11-20-2012 5-45-23 PM

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

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

11-20-2012 7-54-25 PM

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


Other

11-20-2012 11-52-23 AM

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

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

11-20-2012 5-49-42 PM

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

 

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

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


Sponsor Updates

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

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Morning Headlines 11/20/12

November 19, 2012 Headlines Comments Off on Morning Headlines 11/20/12

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

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

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

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

National Football League Selects eClinicalWorks

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

The Patient Engagement Framework

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

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

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

Comments Off on Morning Headlines 11/20/12

Curbside Consult with Dr. Jayne 11/19/12

November 19, 2012 Dr. Jayne 3 Comments

clip_image002

Penny Wise and Pound Foolish

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

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

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

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

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

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

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

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

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

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

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

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

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E-mail Dr. Jayne.

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