News 3/16/12

Top News

CMS pushes back the enforcement date for HIPAA 5010 transactions another three months, to June 30, 2012.

Reader Comments

From HIT Observer: “Re: City of Hope (CA). Looking to acquire some in-house talent. I believe it’s an Allscripts shop.”

From Cowabunga: “Re: UCLA. Was scheduled to go live with Epic patient accounting and registration at its hospitals and 150 clinics on July 1. Pushed the date back to March 2013 this week.” Unverified. You wonder if hospitals didn’t overcommit trying to hit Meaningful Use dates and are just beginning to realize the extent of the work required.

HIStalk Announcements and Requests

Inga is still off on a sojourn of some kind, so it’s just me (Mr. H) at the keyboard (Logitech, not Wurlitzer.)

Listening: new from Ceremony, NorCal punk rockers (think Pixies or Bad Religion.)

Welcome to new HIStalk Gold Sponsor Informatica. The global data integration company’s healthcare provider products include enterprise analytics data management, EMR data migration and archiving, the Informatica Integration Engine, and HIPAA 5010 Crosswalk. A few weeks back, I interviewed Chief Healthcare Strategist Richard Cramer, who has heavy provider-side IT experience from UMass and Penn. It was a good interview – I learned from it. Resources on the company’s site include “chalk talks” on data governance and a master data foundation solution for healthcare, a Webinar on why interface engines are obsolete, and improving care through data quality improvement. Thanks to Informatica for supporting HIStalk.

Acquisitions, Funding, Business, and Stock

Mediware will acquire the Cyto Management System chemotherapy management solution from Cobbler ICT Services BV in a $2.2 million transaction. The product, deployed only in Holland and Belgium, is used by hospitals and cancer centers to manage oncology protocols and costs, including drug preparation and administration. Mediware will continue to market the product under existing agreements and will roll it out in the UK and Ireland to complement its medication management product.

Voicebrook and Nuance announce an agreement to work together to develop speech-enabled reporting solutions for anatomic pathology laboratories. Voicebrook will integrate its VoiceOver pathology software with Dragon Medical 360.

I don’t follow stock pickers since most of their wisdom seems retrospective, but if you have a higher annoyance threshold than I do for Mad Money’s Jim Cramer, maybe you care that he’s tired of pitching Allscripts and now throws his questionable prognostication skills behind Cerner. “I’m going to eat some crow, admit the error, and tell you it’s time to put Allscripts in the sell block. If you want a healthcare IT play, the stock to own is Cerner, although I suggest you keep your powder dry on this one because it’s been red-hot and we could get a pullback.” The self-proclaimed expert claims that Allscripts has had problems integrating its “Aclipsys” platform, has a “large number of different versions of its software on the market,” and doesn’t manage expectations well.

Here’s the one-year share price comparison between Cerner (blue) and Allscripts (red). Thanks a lot, Jim – do you like the Giants or the Patriots in Super Bowl XLVI?

Reuters profiles Toronto-based NexJ Systems, which is using its IPO funding to expand its software business into healthcare with its interoperability solutions, portals, and population health management tools.

People

Kevin Fickenscher MD, formerly with CREO Strategic Solutions and Dell Healthcare, is named as president and CEO of AMIA. He replaces Ted Shortliffe MD PhD, who announced plans to step down last year.

Cleveland Clinic CIO Martin Harris MD, MBA is elected to the board of Thermo Fisher Scientific.

Intelligent InSites appoints Major General Terry L. Scherling (Ret.) to its board. She is president and CEO of global security planning solutions vendor TENICA and Associates LLC of Alexandria, VA.

Forbes profiles Grant Verstandig, the 22-year-old college dropout who formed Audax Health (social networking meets insurance benefits) and raised $16.5 million in funding from some heavy hitting backers in less than a year.

Revenue cycle and EHR services vendor Zeus Healthcare names Larry Havelis as CEO. He was previously with Quest Diagnostics and Allscripts.

Announcements and Implementations

Investor’s Business Daily writes up HealthStream-powered medical simulation mannequins and covers the company’s SaaS medical learning center, which has 2.75 million subscribers.

GE Healthcare and Intel open a laboratory in Israel to test new technologies.

Intelligent Medical Objects opens an office in Research Park on the campus of the University of Illinois.

Government and Politics

A security researcher says 84% of government web applications don’t meet security standards. One reason: instead of getting embarrassed or fired for writing bad code, government contractors get to bill extra for change orders to fix the mess they created.

New York eHealth Collaborative held a meeting Thursday to address health IT issues in the state’s Medicaid medical home initiative. A Department of Health official stated that current IT tools can’t bridge the care gaps in the managed care environment, and new applications are needed that can operate on the Statewide Health Information Network of New York.

Innovation and Research

Researchers use patient databases from drug trials and from the electronic medical records system of Stanford University Hospital to identify hundreds of previously undocumented drug-drug interactions and side effects. They developed algorithms to match similar patients to eliminate false alarms caused by gender, age, and disease status. The lead author plans to present the results to FDA as a possible way to improve drug surveillance programs.

Johns Hopkins University has 49 studies of mHealth applications underway as part of its Global mHealth Initiative. Director Alain Labrique says health-related apps should carry a disclaimer since most of them have not been validated through research. The GmI’s mission is to provide evidence-based support to technologies that have the best chance of improving global health in resource-limited settings.

Other

EHRtv posts interview videos from the HIMSS conference.

A Miami passenger cruise industry conference runs its first medical pavilion, covering medical technologies such as satellite-based telemedicine available anywhere in the world, electronic medical records for crew members and passengers, and outbreak detection and public health reporting associated with infectious disease such as norovirus.

Medical College of Georgia Hospital and Clinics announces that an unencrypted laptop stolen in a burglary earlier this year contained the medical information of 513 sickle cell patients.

 Sponsor Updates

• Speakers from Lehigh Valley Health Network will keynote TeleTracking Technologies’ free two-day symposium in New Orleans April 19-20.
• NextGen will host an April 2 webinar featuring Sherry Shults RN, BSN, CIO of South Carolina Heart Center on attestation for MU.
• Kony Solutions and Gartner offer a webinar on best practice guidelines for mobile app development.
• HealthStream offers reasons on why healthcare organizations should continue with their ICD-10 training and preparation despite implementation delays.
• API Healthcare experiences growth due to increased use of its workforce technology by healthcare staffing agencies.
• Certify will participate in IHI’s 13th Annual International Summit in DC next week.
• dbMotion and Allscripts will host an April webinar entitled “Innovative Workflow Leadership” with Rebecca Armato (Huntington Memorial Hospital), Yafa Minazad DO (Southern California Neurology Consultants), and Joel Diamond MD.
• Vocera launches its discharge solution, Patient Connect, at the AONE 45th Annual Meeting in Boston March 22-23.

EPtalk by Dr. Jayne

Healthcare IT News has opened its 2012 “Where to Work: Best Hospital IT Departments” nomination process. Categories are small (under 100 beds), medium (101-150 beds), or large (over 350 beds). If you think your shop is top, this is the time to make it known.

For another opportunity to toot your own horn, HIMSS (along with the American Society for Quality, the National Committee for Quality Assurance, and the National Patient Safety Foundation – that’s ASQ, NCQA, and NPSF for those of you playing along with the acronym soup game) announces a new call for the “Stories of Success!” program. (Yes, the exclamation point is included! Not sure why! But it is!) The blurb says:

This program showcases outstanding accomplishments in the adoption and use of health IT to fulfill national priorities recommended by the National Priorities Partnership (NPP) and The Joint Commission’s National Patient Safety Goals (NPSG). We are looking for real-world, case studies!

More acronyms and exclamation points abound, so be sure to submit your SQUIRE-inspired application form today. (I’m going to go make you look that one up yourself.)

I finally received the “HIMSS12 Overall Evaluation” e-mail today after hearing people talking about it last week. After two pages of the survey I was just aggravated and couldn’t bring myself to continue. I’m annoyed by HIMSS in general right now. The fact that some New Orleans hotels are already booking up is a mess waiting to happen. I may boycott next year and just show up for HIStalkapalooza, hot shoes, beignets, etouffee, and jazz.

NCQA keeps sending me invites to their Health Quality Awards dinner at the end of the month in Washington, DC. One of the honorees is Atul Gawande MD, who inspired me to get back into writing. Individual tickets are $350 a pop though, so I’ll pass.

I just received notice of which PQRS measure my staffing company has selected for me for 2012. Thank goodness they’re super-easy things that we do all the time anyway, so I don’t have to think about them. Just jumping through yet another hoop.

I was intrigued by the item that Inga ran the other day about the allergist who closed his practice to join the Army. Based on the statement that he was coming in as a lieutenant colonel, I assumed that he had previous military experience or was a reservist. After reading the full article though, it seems he has no military background. Anyone want to shed some light on how that works?

I did get one response to my call for medical tattoos – this one of a caduceus with an N for nursing. I like the blue, but not the delightful surrounding inflammation. Medical history tidbit of the day:  the caduceus with its dual snakes and wings was historically the symbol of commerce. Kind of funny that it’s been adopted as the symbol of medicine (especially in America) as opposed to the rod of Aesculapius, which is the original symbol of medicine (single snake, no wings.)

One of my faculty pals is a purist about this, so here’s your historical factoid of the day. In Greek mythology, the god Aesculapius was a healer, and apparently Hippocrates worshipped him. One potential theory of how the symbol originated was that it is a depiction of the stick used to remove guinea worms from the body. (note: picture in link is not for the squeamish.)

Have a question about acronyms, tropical medicine, or what is the maximum number of exclamation points that should be used in a single post? E-mail me!

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Dr. Sam 3/14/12

Mandating Physician EHR-Related Policies

It seems apparent that the problem of physician adoption of electronic health record (EHR) technologies, with which the industry has struggled for more than a decade, is finally lessening as digital technology continues its relentless infiltration into our everyday lives, and as the percentage of hospitals implementing EHR systems increases -spurred on by Meaningful Use financial incentives. Nonetheless, hospitals are still faced with residual challenges, including the creation of policies pertaining to their EHRs.

Creating policy is one thing. Medical staff compliance is something else.

So what does a hospital do when a physician or group of physicians refuses to use their EHR, attend training sessions, or comply with specific EHR-related policies?

If you have read any of my past commentaries, you must know that I am a history buff and enjoy intertwining historical episodes where they seem to apply to challenges of today.

In the case of mandating, President John Tyler comes to mind — mainly because he mandated that he would become president when it was not clear that he had the constitutional right to do so. I guess the analogy lies in creating a position of power and acting on it in a consistent fashion to establish precedent – or in his case, president.

John Tyler was William Henry Harrison’s vice president and was facing in a precarious position when Harrison died just one month into his term in 1841. There had never before been a presidential death in office and the Constitution was not of much help as to what should happen next. The wording within the Constitution is ambiguous, for it reads that, “in case of the removal of the President from office, or of his death, resignation, or inability to discharge the powers and duties of the said office, the same shall devolve on the Vice President.”

This could be interpreted to mean that the vice president’s powers remain ”the same” or that the vice president shall assume “the same” powers as the president had – in which case Tyler would become president.

Tyler was not a very popular man. After Harrison’s death, he was addressed as the “Vice President Acting as President” by his political opponents. He, however, referred to himself as President Tyler, and refused to open any mail addressed to “Acting President Tyler”.

At his first cabinet meeting, cabinet members insisted that he obtain their consensus before he acted. He informed them that he was the President, and if they didn’t like it, they could resign. Shortly thereafter, after a particularly unpopular veto by Tyler, all but two of them did exactly that. Through a long succession of political maneuvers — including virtually daring opponents to try to impeach him — he firmly established his hold on the presidential office, serving from 1841 to 1845.

Because of Tyler’s actions, the ascension to the presidency by the vice president in case of death or incapacitation of the president became standard procedure. There was still no requirement of a disabled president to hand over the reigns of government. This did not become law until the passage of the 25th Amendment to the Constitution in 1967 following the death of President John Kennedy.

Tyler just made it happen.

In the absence of likelihood that a constitutional amendment will come to the rescue of hospitals seeking to establish mandates related to their EHRs, what steps can be taken to stimulate physician recognition of hospital authority?

Step one is consistency in establishing policies – and all policies should be expressed with the entire C-level team on the same wavelength leaving no room for divide and conquer.

Realistically, it should first be accepted that most clinicians have little interest in hospital finances and are much more concerned with their own workflow issues, which are often appropriately viewed in their minds as intimately and directly related to patient safety. Herein lies the big ace up the collective sleeve of the medical staff – and the basis upon which many a shutdown has occurred or been threatened.

It’s difficult to keep an EHR up and running when the medical staff claims that it is impeding their ability to assure the safety of their patients. A medical staff will usually live with workflow impediments, although rarely silently, since most are accepting of the probability that features and functions of the system that are slowing them down can eventually be resolved through a vendor enhancement request process. But they will not live with what they view as imposed workflows that impact their ability to provide safe care — or more importantly, what they view to be safe care.

Therefore, one very important policy procedure to have in place is an effective enhancement request process. Clinicians must know that their suggestions for improvements in the EHR they are using are being heard, responded to, documented, and included in enhancement requests submitted to the vendor on a regularly scheduled basis.

The importance of policy and structure to the enhancement request policy cannot be sufficiently stressed. Nothing creates havoc more efficiently than a cacophony of complaints and suggestions from a large number of doctors directed in a steady stream at a varying number of administrative hospital executives during a complicated implementation process. This may even be further complicated by physicians who communicate directly with vendor sales representatives or even vendor executives to deliver their complaints and suggestions or demands.

The solution to this particular issue lies in an effective governance structure that establishes a clear path by which enhancement requests are evaluated by clinical peers and submitted for approval by a steering committee which is solely responsible for communicating with the vendor. Policy is spelled out to the clinicians and included with the terms to be signed by the clinician at the time they are certified for use of the EHR upon completion of required training.

Such a policy brings clarity and an understanding that a path exists to assure attention to physician issues. It reduces the risk of widespread simmering dissatisfaction, which can be toxic to any implementation process.

Educating the medical staff about Meaningful Use requirements that impact the hospital’s ability to meet these criteria is also very helpful. This understanding should reduce complaints about steps that were previously not part of their workflow, such as using history and physical examination formats that allow for the capture of specific data points, or having to include a diagnostic indicator with a study requisition if such indicators are not automatically included by the EHR in use.

But what to do when policies are not adhered to? This is the stuff that causes sleepless nights for many a C-level hospital executive.

Don’t pull a John Tyler yet!

"Mandating" policy has challenges specific to the institution’s business structure. It is much easier for a hospital that employs all of its medical staff or an academic institution to create policies which must be adhered to as a requirement for continued employment, than it is for a community-based hospital with a volunteer medical staff over which they have less control. Many hospitals have a combination of arrangements with employed physicians or groups (hospitalists, radiologists, pathologists, emergency doctors) and a volunteer staff.

Even mandating policy to employed physicians can be very difficult. It’s easy to write a policy that requires an employed doctor to follow certain procedures, but firing someone is a huge step that brands that person’s professional reputation for a lifetime. Legal consequences may ensue, and the human resources department had better have all of their ducks in line before any such move. Additionally, rural and remote hospitals may be faced with finding replacement services, which might be challenging.

The first place to start is with the hospital bylaws. Careful legal review and appropriate verbiage should be included to place the hospital on solid ground for the imposition of policy mandates and consequences of failure to comply. Included in this process is a clear outlining of credentials of individuals who fall under the category of "providers" of care using an EHR. By including these specifications in the hospital bylaws, individual policies can be created with simple reference to the bylaws without spelling out the affected caregivers impacted by each policy.

Begin the mandating process with something palatable, understandable, and reasonable to the medical staff. For example, an initial mandate that 50% of all orders must be by computerized order entry is a heavy hand applied at the onset to a staff not accustomed to being dictated to. A reaction may reasonably be expected.

However, a mandate that passwords may not be shared under any circumstances is entirely reasonable and understandable. It is a good starting point and establishes an understanding that the hospital is prepared to take a firm stance with future rules to follow. Consequences of failure to comply should be clear and uniformly followed through on without exception. For example: share your password once and you’ll receive a warning letter. Share it twice and you’re off staff.

Such a mandate is reasonable and even expected under the same arguments applied to an EHR that clinicians find cumbersome — possible patient safety and medical legal consequences.

Some creativity may be required if a hospital does not wish to impact the career of an employed, noncompliant physician who refuses to follow required procedures such as attending training sessions or using CPOE. Failure to comply could mean loss of remote access to the EHR as a consequence. Remote access can be reinstated when the physician is trained, credentialed, or has entered a predetermined percentage of orders by CPOE over a designated period of time.

Another creative approach is to deny a noncompliant employed physician from taking emergency call. One might expect such a "penalty" to be received with glee, but the physician’s department head may not be too happy with rearranging a call schedule, or worse yet, having to take call personally to cover the ”penalized” physician. It’s more than likely that the noncompliant doctor will soon receive a dictate from above.

I am always surprised by how rarely community hospitals take advantage if their most reliable ally – the community that they serve. When a community is educated about CPOE, for instance, CPOE becomes an expectation and patients may begin to select physicians who are using technology that reduces the risk of errors.

Just as John Tyler lined up his ducks in finding support to bolster his position, the community being served may become a powerful ally. One creative approach to physician compliance in a community hospital setting is to simply periodically publish a list of physicians in the community who are helping the hospital assure patient safety by using the hospital EHR. A sample heading might read: "XYZ Hospital System is pleased to acknowledge and thank the following physicians who have displayed their dedication to the safety of our patients and high quality of care to which we are dedicated by using our state-of-art electronic health record system"

Not too many community physicians will want to be missing from that list.

There may be similar value obtained by issuing an appropriately worded certificate of EHR credentialing or thanks to a community physician to hang in his waiting room. The doctor’s patients may feel added security with their doctor, and the doctor will have another set of credentials in place if he or she ever decides to explore a second career in medical informatics — in which case they can be the ones dealing with non-compliance, mandates, and creative approaches to their refractory colleagues.

Lest this commentary appears to be one-sided, I should add that I fully understand the frustrations of my physician colleagues who are themselves beleaguered by falling reimbursements, ever-increasing regulation, and medical-legal vulnerability. Frustrations abound for all parties involved.

This is where I enjoy bringing up my favorite metaphor, a lesson that I learned during my years of travel with professional musicians.

Any professional band realizes that the goal is not for the “killer” guitar player to get out front and blast away in order to leave the crowd in awe so that they leave thinking, “What a great guitar player!” Real professionals know that the goal is to make everyone else in the band look good so the crowd leaves thinking, “What a great band!”

We’re all struggling with the sheet music we have been handed. The trick will be to make great music together.

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

HIStalk Interviews Brian Phelps, CEO, Montrue Technologies

Brian Phelps MD is co-founder and CEO of Montrue Technologies of Ashland, Oregon. The company’s Sparrow EDIS for the iPad was the grand prize winner in the 2012 Mobile Clinician Voice Challenge, presented by Nuance Healthcare.

You’re an ED doc. Why did you develop Sparrow EDIS?

I’ve been in practice for 10 years. I’ve had the good luck — or bad luck, depending on your point of view — of being involved in a few software implementations. One of them failed spectacularly. I felt like I learned quite a bit about the good and bad of software in the ED. I thought about the culture of the companies that are offering software and how to make the culture better suited coming into that environment.

When the iPad came out, it was pretty obvious that that was the future for us. I assembled the team and here we are.

Is the iPad application just for presentation using other systems or is it a completely separate application?

It’s a native iOS application that communicates with the Sparrow Server that then integrates with the underlying EMR. It’s an abstraction on top of the underlying EMR, but as far as the user experience is concerned, they’re in a purely Apple environment.

Describe the product and how they’re using it.

The Sparrow Emergency Department Information System includes patient tracking, order entry, physician and nurse documentation at the bedside, discharge planning, and prescribing. They’re doing all that on the iPad at the bedside. You don’t have to interact with the PC workstations any more with our system.

Does everybody use it? Is using it mandatory?

We’re the whole product, so we come in with the devices as with the software. We’re in pilot phase now so there’s some details to be worked out, but the idea is that that we provide the whole solution, including white coats that have pockets big enough to hold it and the stylus if you want it. Doctors and nurses and registration all are using the devices. 

At HIMSS, I learned a lot and met a lot of great people. One of the themes that kept coming back was getting doctors on mobile devices and the “bring your own device” mentality, which I think is a symptom of a disease and not a cure. The disease is that consumer technology has so rapidly outpaced enterprise technology that it’s making end users crazy. They’re coming in with these personal devices and they’re demanding to connect. They’re using Citrix and whatever else they can and it’s not providing a very good user experience. 

Nobody ever asked me to bring my Dell on wheels to the hospital. Ideally the hospitals will recognize that the users have spoken and these are the tools that they think are right for the job. That’s where we come in and deliver the right tools and the right software, all locked down in a secure environment.

How do you determine the success of the product if users can still use the underlying systems directly?

They can use the underlying systems to review records and place orders in the hospital information system, but we have order sets and a workload that is specific to emergency medicine. There are no longer paper charts when we come in. If they want to use the order sets that they have created, they would be using the iPad.

What tools did it require to create the iPad application?

It’s a lot. We have a server that runs SQLite. All of the devices run our application, which is in Objective-C for iOS. Our server and our iPads come in. There’s an interface that’s required to exchange data in HL7 with the inline EMR.

We have a strategic relationship with Nuance and they’ve really helped build out our product. Their SDK was very easy to use — it literally it took a few hours to get up and running. We have a relationship with LexiComp to do medication interaction checking and allergy checking on the devices and several other strategic business relationships that flesh out the product.

So it was easy to integrate speech recognition using the Nuance tools?

It was great how astonishingly easy that was. We had planned on speech integration from the very beginning. For all their wonderful qualities of iPads, the input mechanism for narrative is one of its minor weaknesses. We always knew speech was going to come into play. In fact, we built our application around it before we even knew that it was going to be technically possible. 

We had our eye on Nuance. When they released the mobile SDK, we snapped it up. The next day, we literally had a fully speech-enabled application.

Describe how the application uses speech recognition.

The thing about speech and documentation in medicine in general is that it allows you to capture the narrative. The patient’s story is really the heart of the patient-doctor relationship. There is no way that can ever accurately be captured by pointing and clicking. I can give you several examples of where template-driven documentation of the patient’s story led to harm. 

Building in speech recognition for the history of present illness and medical decision-making is really important. But we have to balance that with structured data to meet compliance and other measures, and also because there are some areas where structured data is perfectly appropriate. Medication reconciliation, for example, or even in our case we have templates for building physical exams and reviews of systems. 

Finding that balance between the unstructured narrative and the structured data input is what the iPad is ideal for, because as you’re sitting there with a patient, you basically can tap along and review their history and enter the important information. Then as you’re going to the next patient, you can speak in the parts of the encounter that are unique to that patient, namely their story.

What advantages does the user get from using an iPad application?

The biggest advantage is using the Apple navigation paradigm. We’ve been in a design relationship with Apple for about half a year. They’ve been advising us and getting it to be simpler and faster and more intuitive. The fact that it runs natively on the device means that it is incredibly fast and easy to use. Anyone who has used an iPhone or an iPad and used any of the native Apple applications knows immediately how to use our system.

It’s hard to overstate the importance of having something that sits in your lap while you’re engaging the patient. We’ve been speaking and poking at things for a million years as humans. We’ve only been pointing and clicking for 20. When patients are scared or in pain or feeling vulnerable, it’s almost cruel to turn away from them to click away on a QWERTY keyboard.

One of the themes that kept coming back at HIMSS was patient engagement. It means different things to different people, but in my line of work, I’m trying to engage the patient who’s sitting in front of me. I don’t think that you can engage patients with technology or with the latest application. You engage them by looking them in the eye and asking good questions and listening carefully and showing compassion.

Technology has only interfered with that process. The advantage of our system is that we get out of the way and allow doctors and nurses to interact with their patients in a way that they know how to do.

During your pilot phase, what are you measuring and what kind of response are you getting back?

We’re integrating the back end and we’re not live with patient data yet, so that’s coming up. When that happens, we’ll be measuring productivity, patient and physician and nursing satisfaction, and of course compliance with Meaningful Use.

Did you form the company just for this product or you have other products?

We formed the company with the goal of bringing mobile technology to emergency medicine. We had thought about strategy of having different sub-modules, but when it comes down to it, if you’re going to be successful in emergency medicine, you have to completely replace the three-ring binder. We spent two years building out every aspect of what had been a paper interface into our system. We are currently a one-product company and that’s our emergency department information system.

You said you designed the product around speech recognition even though it wasn’t available at the time. Do you think somebody could develop a comparable product without using it?

I think it could be done, but I think that the narrative input mechanism would be challenging. One possibility would be to have Bluetooth keyboards in each room and you pop the iPad in and type away your narrative, but I don’t see that it would be as effective. The combination of tappable templates plus speech for narrative on the iPad is really a match made in heaven.

At HIMSS there were companies at different stages of doing work on the iPad. What was your general feeling about where the industry is right now with the use of iPads? Did you expose your product to anyone to get a reaction?

We had an opportunity to present at the Venture Forum as well as on stage at the Nuance booth. We got lot of great feedback.

I think it’s very exciting what Epic is doing with their iPad interface. PatientKeeper has an excellent product. Nobody is doing exactly what we’re doing. We’re pretty thrilled that these other companies are demonstrating that there is a large, important market here. Beyond that, we take all that energy we might be thinking about competition and try to drive it back into our product and make it better.

Were you surprised that you were named the winner?

[laughs] I thought there was a pretty good chance we had a shot.

How will you use your prizes?

The best thing that came out of this was a deeper relationship with Nuance, who has been wonderful and supportive throughout. Just the recognition that that has brought to us has been phenomenal.

Assuming your pilot is successful, where do you go from there?

We’re making the product back end-agnostic, so any hospital that has an EMR that is struggling with workflow in their emergency department is a potential customer. There are at least 3,500 hospitals that meet that description. We’re pretty confident that as this wave of mobile devices washes into the mainstream, there will be a significant demand. The next step for us is to continue to make the product simpler and faster and more intuitive and then to connect with paying customers.

Typically that’s hard for a small company because it’s difficult to mount up a sales force. Do you see yourself selling directly into individual hospital emergency departments or partnering up with a specific vendor to make it an add-on?

We have been working on some channel partners. One strategy for us has been to look at the relationships we have with interface vendors to assuage the interoperability concern. We are pretty excited about the relationship that we built with Apple and we see a lot of ways that they — as part of their ambition to enter the enterprise space — could really be helpful for us getting in the mainstream market.

So far, our feedback from doctors and nurses has been fantastic. We’re pretty confident that we can leverage that groundswell of enthusiasm from end users to develop a relationship with their executives. To them, we will be focusing on our profound return on investment, which comes through improved charge capture.

I’m glad you mentioned that since I assumed the pitch would strictly be clinician satisfaction.

When software deployments fail, that’s the majority of the time due to physician rejection. Clinical informatics people really do have an incentive to make sure they’re finding a product their clinicians like to use. That’s one part of it.

The other part is that we capture charges just through the process of simple tap documentation. One of the commonly missed charges is IV start and stop times. Our system triggers the appropriate documentation, which we think will improve charges by about $40 per patient. There’s a thoroughly profound return on investment for executives as well.

The big challenge is that the gatekeepers tend to be the folks who have the least direct benefits from the application. Our goal now is to try as best as we can to understand what their needs are and meet those needs while still delivering a very usable product for these doctors and nurses.

Do you have any final thoughts?

This may resonate with you and what you’ve done with HIStalk, which has been phenomenal for me to learn about the industry over the last couple of years. When you really believe in something strongly as we do and you‘re willing to work at it, if you’re on the right track, doors start to open and more opportunities present themselves. That’s where we’re at with Montrue. We’re pretty happy that we’re on the right track and we’re excited about what’s to come.

News 3/14/12

Top News

Blue Cross Blue Shield of Tennessee will pay $1.5 million to settle potential HIPAA violations, a result of the first enforcement action triggered by HITECH-mandated breach reporting. Fifty-seven unencrypted hard drives containing the PHI of over 1 million people were stolen from a BCBST-leased building that did not have access controls.

Reader Comments

From HIT Cynic: “Re: EMRs and test ordering. Finally someone says what lots of us out here are thinking.” The authors of the Health Affairs article respond to criticism of their study by Farzad Mostashari in an ONC blog post titled Recent Study: Get the Facts and a sub-headline of “Don’t Believe the Hype.” The original article suggested that EMR usage is associated with higher ordering rates of imaging tests, concluding that expected EMR-driven diagnostic savings may never materialize.

Mostashari said (a) any HITECH-related conclusions from an observational study using 2008 data are worthless, especially since it did not consider clinical decision support and information exchange; (b) EMR users didn’t order more tests, but high-volume imaging prescribers  are more likely to view those images using an EMR; (c) the study didn’t look at appropriateness of ordering, so comparing the number of imaging orders omits important factors such as practice demographics and whether the high-volume physicians have a financial stake in the imaging centers they use; and (d) EMR cost savings aren’t dependent on reducing test volume.

The authors respond: (a) physicians who viewed images electronically ordered 40-70% more of them; (b) the famous RAND study that Cerner helped pay for said billions would be saved by reducing imaging and lab test volumes; (c) even though the study data were from 2008, the same EMR vendors are selling pretty much the same products; (d) Mostashari’s explanation that high-volume prescribers probably bought electronic systems specifically to view the results was tested and rejected in their analysis; (e) the study did take into account patient demographics, severity of illness, and other factors; and (f) while observational studies can’t prove causation vs. correlation, ONC has used cherry-picked studies of similarly dubious methodology to cheerlead EMR success and plenty of other studies have found no IT-related quality improvements. The authors conclude:

Dr. Mostashari is also correct in reiterating that randomized trials are the best way to assess health IT. In fact, no randomized trial has ever been published that examines patients’ outcomes or costs associated with off-the-shelf health IT systems that dominate the U.S. market. No drug or new medical device could pass FDA review based on such thin evidence as we have on health IT. Yet his agency is disbursing $19 billion in federal funds to stimulate the adoption of this inadequately evaluated technology. Dr. Mostashari is perhaps the only person in our nation who commands the resources needed to mount a well done randomized controlled trial to fairly assess the impact of health IT, and the comparative efficacy of the various EHR options. Finally, Dr. Mostashari’s unbridled faith in technology is mirrored by his belief that ACOs are the next panacea for health costs and quality. That health policy flavor-of-the-month also remains wholly unproven.

I’m going to score this as a win for Mostashari even though the lady doth protest too much, methinks. The study was only marginally interesting and I would have serious reservations about drawing any conclusions whatsoever from it (particularly in comparing electronic image viewing to the use of full-blown EMRs,) but the authors seem to want to elevate it to a government policy argument, and now are launching a second front on ACOs for no apparent reason. Lazy journalists wrote their usual hysterical headlines with obviously limited understanding of anything in the article, which got Mostashari fired up to launch an unnecessary counterstrike in a war that he not only can’t win, but shouldn’t be fighting in the first place since it just gives the article more exposure.

My conclusion: don’t believe either side. Nobody knows if having previous images available would reduce new orders for them, especially if doctors receive benefit from unnecessary tests. Even if the conclusions of both sides are data driven, unbiased, and definitive (which I’d say is highly doubtful in both cases) they are also irrelevant. Taxpayers are already paying for EMRs and we won’t know for years whether we’ll get our money’s worth in the form of lower healthcare costs. My crystal ball says we won’t unless they’re used to prod patients to change their health risk behaviors, like convincing the 75% of the population that’s overweight to eat better and exercise more.

HIStalk Announcements and Requests

Inga is taking a semi-break, so it’s just me (Mr. H) this time around, other than for a few items she sent over. I’ll dispense with the red/blue icons for today.

Acquisitions, Funding, Business, and Stock

Jiff Inc., a developer of a HIPAA-compliant private healthcare social network and digital health apps platform, completes a $7.5 million Series A financing round led by Aeris Capital. The company also named Derek Newell (Robert Bosch Healthcare) as CEO.

Vocera expects to price its 5 million IPO shares at $12 to $14, using the proceeds to pay down debt and potentially to make acquisitions.

Greenway Medical Technologies announces its first quarterly results as a publicly traded company: revenue up 30% to $29 million, EPS –$0.01. Shares closed Tuesday at $13.75, up from February’s IPO price of $10 but down from their high of just over $15.00 on March 1.

Milwaukee-based point-of-care technology consulting company True Process Inc. acquires the PDA-based VeriScan bedside medication verification system from Hospira. Does anybody even make PDAs these days, and if so, who’s buying them?

Sales

Geisinger Health Plan chooses NaviNet’s Insurer Connect solution to give providers online access to patient benefit information.

Tyrone Hospital (PA) selects Promantra’s RCM system for billing and claims management.

St. Jude Medical Center (CA) chooses PerfectServe’s clinical communications platform.

People

MedAssets appoints Michael P. Nolte (GE Healthcare) as EVP and COO.

MEDecision promotes Ken Young from VP of finance to CFO.

Announcements and Implementations

The Wexner Medical Center at The Ohio State University goes live on its $102 million Epic system. The hospital appended “Wexner” to its name last month to honor $200 million donor Les Wexner, chairman and CEO of Limited Brands (Victoria’s Secret, Bath & Body Works.) He’s worth $3.2 billion, lives in $47 million house, and has a 315-foot yacht.

Health Language Inc. announces that its data mapping software and content support all terminology standards required by MU Stage 2.

NYU Langone Medical Center announces that 125,000 of its patients are using the PatientSecure palm vein scanning identification solution, launched nine months ago and integrated with Epic.

T-System offers integration with the iTriage Web and smart phone applications, allowing hospitals to list their ED wait times and patients to notify the ED that they’re coming in.

Patient teaching technology vendor Emmi Solutions announces that its products now work on Android and iOS smart phones and tablets.

SCI Solutions offers order entry and results reporting via mobile devices for its Order Facilitator product. The new service provides a national physician directory so that hospitals interested in improving their physician outreach and referral programs can integrate with physicians even if they don’t use the hospital-preferred EMR.

Government and Politics

OSEHRA, the open source community created by the VA in August 2011 to oversee VistA and VA-DoD EHR  integration projects, announces three new members of its inaugural board: James Peake MD (SVP of CGI Group, retired Army officer, and former VA secretary), John Halamka MD (CIO, Beth Israel Deaconess Medical Center), and Michael O’Neill (senior advisor of the VA’s innovation program.)

AHRQ is soliciting proposals for the validation of a workflow toolkit it developed to identify and avoid workflow-related problems with technology implementation in the ambulatory setting.

West Virginia’s Department of Health and Human Resources is forced to throw out bids for a Medicaid computer system and start over when HP’s proposal lists a subcontractor that employed the COO of the West Virginia Health Information Network. Philip Weikle says he had nothing to do with the bidder selection and has since left the consulting firm to become a full-time state employee. DHHR had already restarted the Medicaid system bidding last year for unstated reasons.

Innovation and Research

An article in Archives of Internal Medicine supposedly finds that medical residents using iPads felt the devices made them more efficient. I don’t trust the conclusions of reporters when reviewing research articles, so all I’ll say is that the article isn’t available to non-subscribers. I’ll try to remember to pull it up from my hospital PC to see what it says.

A JAMA article concludes that Ontario hospitals that spend the most under the universal healthcare system deliver the best patient outcomes. Patients at the top-spending hospitals had lower rates of death, readmission, and cardiac events and were more likely to be given evidence-based care. However, the authors note that lower-spending hospitals can’t just increase their spending to improve outcomes since the drivers seem to be the use of evidence-based medicine, better nurses, more specialists, and more technology. It may also be that the higher-spending institutions are teaching hospitals. As is always the case, correlation was modest and the unknown or unmeasured factors could be skewing the conclusions.

Other

Poudre Valley Health System (CO), which says its transition to Epic will decrease transcription needs, will outsource 37 transcription jobs to Nuance.

A company that reviews medical insurance claims shuts down, blaming the compliance cost of dealing with a medical data breach after a break-in at its headquarters. Impairment Resources LLC was required to report the breach to numerous federal and stage agencies and says that expense, plus threat of lawsuits by those whose data was exposed, forced the company to declare Chapter 7 bankruptcy. In snooping around, I found that the company’s chairman, Christopher Brigham MD, was a MUMPS programmer at Mass General in 1972.

The local newspaper covers the $750 million implementation of Epic at Providence Health Services. Richard Gibson MD, who runs informatics for Providence’s Oregon Region, says Epic will reduce costs through optimal physician ordering and analytics. He said, “If we’re going to survive and needlessly take money from roads, schools, lunch programs and world peace, let’s not go into diagnostic studies and treatments that don’t do any good.”

TEDMED 2012 will offer a free HD streaming live simulcast at regional locations such as hospitals, medical schools, government agencies, and corporations. It is also offering $2 million in scholarships to in-person attendees, expected to number 1,200 for the April 10-13 conference in Washington, DC. Registration is $4,950.

Several healthcare-related associations release two brochures on personal healthcare records, one for consumers and one for clinicians. They can be downloaded here. They probably should have had readability experts help out since the verbiage is a bit dense for mass consumption. They also mention Google Health, which of course has shuffled off this portal coil (OK, lame pun there by me.)

Here’s another of those overpromising, underdelivering headlines. TV doctor Sanjay Gupta provides his plan to eliminate medical errors, as gleaned from note-taking at weekly hospital M&M (morbidity and mortality) conferences. He’s conveniently included them in his just-released first fictional novel rather than publishing them in a peer-reviewed journal. I’d keep expectations correspondingly modest.

An Oregon jury orders Legacy Health System to pay a couple $2.9 million in their wrongful birth lawsuit. The hospital incorrectly told them their unborn daughter would not have Down syndrome. When she did, they filed suit, saying that if they had been told, they would have had an abortion.

Sponsor Updates

• United Regional Health Care System (TX) builds on its Allscripts portfolio with the selection of Allscripts Care Management.
• Robin Tardif of Hayes Management Consulting posts Part 1 of her series “Reduce Human Error in EHRs.”
• Sam Whitaker, CEO of Greenphire, and Zaher El-Assi, GM for Merge eClinical will present a webinar discussing payment and integration processes for healthcare facilities.
• Versus will participate in the AONE 45th Annual Meeting & Exposition this month.
• Billian’s HealthDATA offers a white paper, Providers’ Perceptions: Accountable Care Organizations.
• OrthoKansas selects SRS for its 12 providers.
• An Aspen Advisors white paper describes the company’s involvement in developing the Epic rollout plan for specialty clinics of University of Utah Health Care.
• Healthwise adds the concept of Patient Response to its patient education EMR module, which allows prescribers to order health education and tools and receive reports back of their degree of compliance.
• Sunquest Information Systems will participate in the 2012 Patient Safety Awareness Week after releasing Collection Manager 5.0, which focuses on POC patient safety.
• Xpress Technologies integrates with DrFirst to launch its end-to-end eRX solution.
• Intelligent InSites integrates WaveMark’s consumables asset tracking system with its RTLS.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Curbside Consult by Dr. Jayne 3/12/12

I’ve been wearing my faculty hat more than I’m used to lately. It’s a little sad but not surprising that increasing numbers of medical students are questioning their career choices. Although I historically precepted students in traditional medical rotations, I’ve more recently led electives in practice management and health informatics.

For those of you who aren’t in academic medicine, this week is “Match Week,” which is the time when the National Resident Matching Program (NRMP) spits out residency program offers to medical students who have spent the better part of the last year filling out applications, traveling to interviews, and generally trying to one-up each other on important clinical rotations.

The truth comes out on Friday the 16th at 1 pm ET. Across the country starting at noon, fourth-year medical students will participate in a variety of events (from formal ceremonies to all-out keggers) and receive a sealed envelope that tells them their fate.

Think of sorority / fraternity rush on steroids. These students have spent tens (if not hundreds) of thousands of dollars on tuition then several more to go through this process, where they rank residency programs and the programs in turn rank them. That hopefully results in a match that allows students to pursue their post-graduate training program of choice. Most of them will move to another city, then embark upon three to seven years of additional training (some moving again between the first and second year due to residencies that don’t have integrated internship programs) and ultimately be able to join the rest of us in the trenches.

For those students that don’t match, there used to be an aptly-named “scramble” process where lots of phone calls were conducted to try to find an open slot. This year there’s a new process called SOAP – the Supplemental Offer and Acceptance Program. Students who are eligible for SOAP received e-mails last Friday night and now will have to go through eight “offer rounds” starting on Wednesday. Hopefully the process ends with a match by Friday at 5 pm. Each round will have fewer offers available, so potential residents are encouraged to accept a first-round offer if it is satisfactory. The offers are essentially binding contracts.

The entire SOAP process hinges on brand new software that, hopefully for the students’ sake, has been well-tested. I know more about this than I probably should due to this year’s increased number of students showing up on my doorstep to discuss their options. Many of the students who have rotated with me are thinking about going the administrative or informatics routes with their careers. They tend to stay in touch since there aren’t a lot of mentors out there and other faculty members tend to try to shame those students to some degree about “wasting” their training.

A number of them have decided (against my better advice) to not even do an internship or residency. There’s a growing sentiment that it’s just not worth it and that medicine has gone into what one termed “the death spiral.” One recently said, “If I’m going to wind up not being able to control my life, at least if I go into administration or to the pharma industry, I’ll be well paid.” The downside of not doing an internship is that you can’t be fully licensed, but some industries don’t care, and schools of business and law definitely don’t mind.

Looking at this year’s graduating class, there are nearly a dozen headed to business school, law school, or straight into the workforce. The number of students choosing careers in primary care is low – family medicine is almost a curse word at my institution. We’ll have to see what Friday brings. Over the last two years, the number of students matching to family medicine programs nationwide was up, but if the nation looks anything like our current student body, we’re in trouble.

It’s also interesting to look at the demographics of specialty matching. Last year in family medicine, 94% of available slots were filled, but only 48% of those by US grads. As a physician staring down the barrel of an onslaught of aging baby boomers, seeing that US grads don’t find family medicine attractive is concerning. Not surprisingly, NRMP data shows that some specialties continue to be filled with high numbers of US grads: anesthesiology (80%), dermatology (93%), emergency medicine (79%), neurosurgery (90%), orthopedic surgery (93%), otolaryngology (95%), plastic surgery (93%), radiation oncology (94%), diagnostic radiology (80%), general surgery (81%), thoracic surgery (92%), vascular surgery (97%). I’ll let my very intelligent readers climb the ladder of inference and figure out where these specialties fall on the pay scale compared to primary care.

So here’s to The Match – one more third-party hoop for physicians to jump through in preparation for a career containing many more. But even better – here’s to a Friday afternoon that allows those of us who are not on call to start drinking at lunchtime, officially sanctioned, with the Dean picking up the tab.

Have a question about residency programs, the challenges of subinternship, or which pumps look sassiest with your interview suit? E-mail me.

E-mail Dr. Jayne.

EHR Design Talk with Dr. Rick 3/12/12

Humans Have Limited Working Memory

Consider a very common, high-level EHR design. The screenshots that follow are from a particular EHR, but many vendors use a similar design.

A row of clickable tabs at the top of the screen is used to designate the different categories of data that make up the patient visit. When a tab is clicked, the window for that category of data opens to full screen size. The tabs can be clicked in any order.

The screenshot above shows what I would see after having clicked on the History of the Present Illness (HPI) tab and having entered some data.

If I were then to click on the History (Hx) tab and enter some data, the new screen would look like the one above. The HPI data is no longer visible because the HPI window automatically closes when the Hx tab is clicked.

This EHR design is completely logical. It is also completely usable, if usability is defined as being able to easily navigate from one part of the record to another with a single click. In fact, it is a totally reasonable design if it weren’t for one problem — humans have absolutely terrible short-term (working) memory.

It used to be thought that humans could retain about seven unrelated elements in working memory, but recent work suggests that the actual number is more often in the range of four to five. In contrast, a modern computer has no problem retaining thousands of unrelated data elements in random access memory.

Given our severe limitation in working memory, this EHR design doesn’t work very well. Every time I click on a new tab, the previous window closes and that data is no longer visible. I have to carry that information in my head. Furthermore, the row of tabs itself contains no information. It just serves as a navigation tool.

In other words, this design is based on how a computer — not a human — thinks. It is a computer-centered, not a user-centered design (see my first post).

As a clinician, I need to devote my full cognitive resources to my patient’s health issues. I need to be able to retrieve information from any part of the record quickly and effortlessly. While completely logical, this very common EHR design just doesn’t do a good job of extending my working memory. From personal experience, I can tell you that using a system like this is enough to drive you crazy.

So what’s the alternative? The alternative is to design an EHR based on what humans are good at — using our visual system to make sense of the world. The data needs to be organized spatially, assigning each module to a fixed location on the screen the way that T-Sheets and other paper forms do (see my previous post). Instead of making the overview of patient data just a row of information-less tabs, display the actual data in a one- or two-screen view, allowing the clinician to see the information rather than forcing him to remember it.

Of course, every design requires compromises. If you decide to use a compact, fixed spatial layout for your high-level design, then you need to solve the twofold problem of what to display in the default view and how to display more information on demand.

In my next post, I will present an example of one widely used EHR design solution to this problem.

Next post:

The Problem with Scrolling

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

Passport Health Acquires STAT Technologies

Passport Health Communications announced this morning that it has acquired STAT Technologies. The Hazlet, NJ company offers Web-based inpatient and ambulatory applications for patient scheduling, eligibility verification, charge capture, transport management, physician portal, patient self-service, and an HIE platform.

Passport CEO Scott MacKenzie was quoted as saying in the announcement, “Scheduling is a natural expansion of the Passport eCare NEXT Suite. It enables hospitals to begin revenue cycle functions at the point the order is received from a physician office, and improve coordination when there are different systems between the hospital and outside physician offices. Within a hospital organization it supports coordination of schedules, precertification, and onboarding between all departments, facilities, and silos of patient information, where disparate scheduling tools and other IT systems often exist.”

Financial details of the acquisition were not disclosed. Passport said in the announcement that it expects to acquire additional companies this year.

Monday Morning Update 3/12/12

From N2InformaticsRN: “Re: Ed Marx and Jim Murry. Did a nice job discussing mobility in healthcare on CIO Talk Radio.” That’s pretty cool – the audio sounds like a real radio station.

From @Cedars: “Re: Cedars-Sinai CPOE go-live. As a consultant going from project to project, it’s easy to forget why I began to work in healthcare, but this weekend I was reminded of it. This means everything to our industry, as past failure is redefined forever. This project has been done right in every way. I was inspired by this note from CIO Darren Dworkin. Please, please interview him.” I think I’ve asked Darren before. The CPOE implementation and quick de-implementation at Cedars-Sinai years ago gives it an honored spot in the Healthcare IT Failure Hall of Fame, right up there with BIDMC’s massive network outage, Kaiser’s waste of $500 million hiring IBM to develop IT systems that were abandoned before completion to instead passionately mate with Epic, and El Camino’s near-shutdown after implementing a patient-endangering Eclipsys medication solution. Feel free to suggest new nominees since every one of these examples provided painful but valuable lessons for not just those involved, but also for the rest of us gawking at the smoking wreckage from the safe side of the “do not cross” yellow tape. All of those organizations learned from their mistakes and came back better than ever, although iterative learning isn’t necessarily a good thing for patients.

From Sinking Ship: “Re: GE Healthcare. Cancels the 2012 Healthcare Technology Symposium due to mounting budget pressures.” The reader provided a copy of what appears to be the announcement letter from VP/CTO Mike Harsh. UPDATE: I asked GEHC what this event is since I could find no reference to it. It’s an internal-only event, so it has no customer implications.

From Bed Manager: “Re: HIMSS13. They are pre-booking hotels and relatively few rooms are available in New Orleans. Did attendees wise up and book early, or are rooms being held back for exhibitors, or does New Orleans just not have enough rooms to handle the increased size of the HIMSS conference? Both hotels of my choice are sold out and they aren’t even in the HIMSS block.”

From Epic Employee: “Re: Farzad Mostashari. Will be speaking at Epic on April 24. Pretty cool.”

From John: “Re: HIMSS conference exhibit layouts. The problem was because it was at the Sands Expo Center instead of the Las Vegas Convention Center, which has high ceilings and a long hall. I heard that the conference was supposed to be in Chicago but fell through at the last minute, leaving the Sands as the only alternative. HIMSS missed revenue since it sold out the Sands space weeks before the show, although I liked the Sands because it involved less walking and easy access to the Strip.” I don’t know if HIMSS planned to return to Chicago after what I would consider a predictably terrible first and only trip there (snowstorms even after screwing up the schedule by moving the event back, surly union workers in the hall, wildly overpriced hotels), but I thought they originally announced a permanent rotation of only Orlando, New Orleans, and Las Vegas. I don’t think that plan lasted long since they’ve been to Atlanta since then. New Orleans was OK last time, but that was right after Katrina when hotels and restaurants really didn’t have enough employees to keep things running smoothly. I’ll still hold out for San Diego as my favorite HIMSS experience and I heard they were expanding the conference center to handle the huge annual comic book convention.

From VA Doc: “Re: digital pens. The VA puts out an RFI for the technology, which has matured to the point where it makes sense to move beyond case studies.”

From MT Hammer: “Re: Clinical Documentation Industry Association. Ceasing operations, annual conference in Baltimore cancelled, financial pressures cited.” CDIA was a trade association for clinical documentation services, basically transcription. HIMSS could have possibly taken it over given a few familiar names among its dwindling list of members: Acusis, Arrendale, Diskriter, MD-IT, MedQuist, M*Modal, Nuance, and Verizon. The former Medical Transcription Industry Association (MTIA) rolled out its new name at the HIMSS conference in 2011, but a year later, both the organization and the conference are defunct.

From Sagacity: “Re: International Society for Disease Surveillance. Seeking comment on syndromic surveillance guidelines for the ambulatory and inpatient settings, targeting potential application for Meaningful Use Stage 3. The organization did the same thing for emergency and urgent care in the past, which led to MU Stage 1 specs.” Information here.

From Just a HIT Guy: “Re: WellStar. Moving off McKesson, NextGen, and GEMMS Cardiology, going to Epic. Internal memos released this week.” I’ll list this as unverified because I agreed to wait for a formal announcement as a courtesy to WellStar, but as usual, the organization’s long list of inpatient Epic job listings tell you everything you need to know anyway.

From EMR_Guru: “Re: WellStar. Announced to physicians they are scrapping NextGen and going with Epic. Wellstar has acquired a large number of physician practices over the last several years, Imagine getting bought and deploying NextGen only to be told a few months later that you have to scrap it and go with Epic.” That’s one of many risks involved in deciding to work for a hospital instead of for yourself.

From Prevailing Winds: “Re: Allscripts. You mentioned a vague acquisition rumor about Allscripts and IBM, but here’s something I’ve heard mentioned that I should say is completely unsubstantiated but potentially related. I’ve heard rumors of a potential buyout of Xerox/ACS by IBM. Allscripts remote hosting is outsourced to Xerox/ACS, so maybe the rumors refer just to that business instead of the whole company. Just rumor mill grist that may or may not mean anything.”

From Bony Moroni: “Re: HIMSS evaluation survey e-mail. It contained confusing instructions, misspellings, and a splash screen apologizing for errors in the e-mail. And we wonder why our industry is the butt of jokes by non-healthcare people. Here’s a crazy thought for an IT association in an industry known for sloppy work: test the damn e-mail merge program first. Not only was the merge done incorrectly, the ‘brief survey’ has a million questions on 11 pages, a status bar instead of an idea of what’s to come, and a pointless listing of the name and company of each recipient apparently just because they could. Obviously this is a contracted vendor, but does HIMSS really want this shoddy effort being the last thing people remember about the conference or the quality of work that HIMSS puts out?”

I’m back and rested after a week off out of the country, woefully behind, facing 500+ e-mails in my inbox, and regretting the loss of an hour due to springing forward since I’m already re-immersed into chaos even before I get back to my “real” job at the hospital. Actually I’m not that well rested since I got only four hours’ sleep Saturday night after downing my first-ever Red Bull to stay awake until  getting home at 3:00 a.m. Still, I’m happy to be back in my multiple saddles even though the horses tend to take off in different directions most of the time. Thanks to Inga for  keeping the HIStalk fires burning in my e-mail free absence. I’m sure I’ll repeat some items she’s already mentioned in trying to catch up, but that should be a one-time occurrence before things get back to normal with Tuesday’s news.

Thanks sincerely to everyone who completed my annual reader survey. It helps immensely and I’ve already made a to-do list for the next year based on the results. Obviously I almost cheated on my no-Internet vacation pledge to Mrs. HIStalk, but rationalized it to her by explaining that it took only seconds to download the results, even if I did spend several frowning and chin-stroking hours thinking about them and furiously taking notes. The preponderance of supportive comments was touching, although I probably won’t run them all here since that seems rather vain (as does re-reading them repeatedly, but at least I keep that particular vanity to myself.)

Readers grade ONC’s MU Stage 2 performance as maybe a D+. New poll to your right: does your PCP document your encounters in an electronic medical record? Mine does, even though the system he uses is about to get the boot in a hospital-mandated EHR replacement.

How did your Daylight Saving Time switchover go? Let me know if you had problems at your hospital. I’m always curious since vendors (some at my hospital, anyway) still haven’t worked out the bugs and punt by just suggesting shutting everything down for a couple of hours. Most of the problems are in the fall, when the “fall back” causes the 2:00 a.m. hour to be repeated, driving some badly designed systems crazy.

My Time Capsule editorial this week happens to be maybe my favorite one (at least until next time): Want to Anger a Nurse? Make Smug Comments about Grocery Store Barcoding. A desensitization dose: “They would buy Doritos by the bag, but would have to repackage and label individual chips and then track every chip – who bought it, who ate it, and whether they ate it in an appropriate quantity and with only complementary foods and according to dynamically calculated nutritional needs. ”

Fujifilm Medical Systems donates $25,000 to a laid-off radiology tech to save her foreclosed home, as seen on the Ellen show. 

Former HHS CTO and athenahealth co-founder Todd Park is named CTO of the United States, replacing Aneesh Chopra. Who would have put their money on the first HIT’er in the White House not being Allscripts CEO Glen Tullman?

Doug Stacy is named CIO at Labette Health (OK.) He was previously CIO at Coffeyville Regional Medical Center (KS.)

Dean Marketti, previously with BCBS, is named the first CIO of Morris Hospital & Healthcare Centers (IL.) I almost gave up trying to figure out what state the hospital is in given the common small-town newspaper website practice of not giving their location, apparently convinced that if you don’t already know, you couldn’t possibly care. Which I’ll concede is pretty much the case. 

Scott & White Healthcare names Matthew Chambers as CIO. I’m guessing he was interim while working for KPMG since his LinkedIn profile says he’s had the job since July 2011.

Holon Solutions (solutions for telepharmacy, order entry, results reporting, and the CollaborNet data sharing solution) names industry long-timer Mike McGuire as CEO. He was previously with MET-test.

Cincinnati Children’s Hospital (OH) and the local technology incubator launch QI Healthcare to commercialize the hospital’s quality improvement software that analyzes EMR data to identify improvement opportunities. I’m a bit skeptical about how easy it will be to commercialize any EMR data analysis application given the inconsistency in how each product and user stores and uses data, but hopefully they will figure out how to make that giant leap from Customer #1 to Customer #2. It took forever to find the startup’s Web page, which appears to be due to a combination of (a) lack of search engine optimization and Web content (just a leering stock art doctor on a GoDaddy parking page,) and (b) a poor choice of names that’s always going to give unrelated Google results. I continue to be amazed that new companies still choose names that won’t stand out in an Internet search.

It’s old news since I’m catching up, but First Databank mentions HIStalk (“the influential industry blog”) in the announcement of its rebranding, which I think is the first time a large, respectable organization has mentioned the name of this small, not all that respectable one in a significant announcement. I was impressed.

In the UK, Lord Carter of Coles, who heads up an NHS group to ensure fairness to its suppliers, is pressured to resign after the newspaper belatedly realizes that he’s also chairman of the UK division of McKesson (which he clearly disclosed when he took the job) and is part of an investment group that owns chunks of several healthcare companies. NHS pays him $90K per year for his two-days-per-week job, while McKesson pays him $1.25 million. Not surprisingly, nobody is suggesting that he quit the McKesson job.

Here’s Vince’s Part 2 of the CliniCom story.

The local paper covers the implementation of McKesson Paragon by McLaren-Bay Region (MI.) I think that’s actually McLaren Health Care, which makes a lot more sense.

A study at Minneapolis Heart Institute finds that surveillance software was able to retrospectively detect problems with implantable cardioverter-defibrillator devices long before the routine monitoring performed by the device manufacturers. The problem, of course, would be in collecting data in near real-time from the universe of patients in order to capitalize on the lead time.

The founder of SAP backs MolecularHealth, which offers software that matches the genomic data of individual patients to scientific evidence to suggest optimal cancer treatments. The application, which the company calls clinical decision support for oncologists, is being refined at MD Anderson.

Inga ran an anonymous reader’s rumor suggesting that GE Healthcare’s Centricity Perinatal could be on the sunset list. Not true, according to GEHC, and I’m sorry we ran that without asking the company for verification. GEHC is really fast and courteous about getting answers to my questions or rumor reports and I would have asked them for confirmation before running it. Inga doesn’t know the contact and probably figured she wouldn’t get a response.

Mrs. Dennis Quaid #3, the mother of the twins who were overdosed on heparin at Cedars-Sinai four years ago that were the subject of Dennis Quaid’s 2009 HIMSS conference keynote speech, files for divorce from the actor.

BCBS of North Carolina rolls out a mobile website that lets patients view claims, check their plan benefits, find a doctor, get a treatment estimate, and comparison shop drugs and insurance plans. The site, developed by Kony Solutions, supports Android and Apple platforms.

Philip White, historian and PR manager of electronic forms management vendor Access, appeared on Fox News last week after the release of his book about Winston Churchill’s Iron Curtain speech in Missouri in 1945. They asked him whether the lessons learned from the previous cold war still apply in situations related to Iran’s nuclear capabilities.

The local paper covers Oakwood Healthcare System’s (MI) $80 million Epic project, to be kicked off in August.

A fun Bloomberg BusinessWeek article discusses the joys of attending a conference in Las Vegas. It contains interesting mentions of the HIMSS conference, including four Craigslist “casual encounters” ads targeting HIMSS attendees like the one above.

A Kaiser Health News/Fortune article profiles Farzad Mostashari and HITECH. A quote:

Remarkably, in an era of partisan government, Mostashari’s program enjoys bipartisan support — or, at least, bipartisan tolerance. While only three Republicans voted for the stimulus bill in 2009, which provided the program’s funding, few have spoken out against it. The fact that the information technology industry is a big supporter — giants such as IBM, Microsoft, General Electric, Hewlett-Packard and a host of smaller health-care specialty technology companies — doesn’t hurt. The $27 billion will flow their way, and plenty of high-priced lobbyists are working hard to keep it flowing.

The New York Civil Liberties union criticizes the state’s privacy and security policies, saying HIEs should require patient consent to access their records and that the all-or-nothing approach to privacy means doctors see a lot of confidential information they don’t need to do their jobs.

Utah Business names Amy Rees Anderson, CEO of HIE technology vendor MediConnect Global, as its CEO of the Year.

State auditors discover that 269-bed Salinas Valley Memorial Healthcare System (CA), which earned scathing headlines last year when auditors found that its retiring CEO was paid over $5 million, did $21 million of business over a five-year-period with firms in which its executives held a financial interest.

A woman whose pending Supreme Court lawsuit argues that the federal government can’t force individuals to carry health insurance files bankruptcy after the family car repair business fails. Among the debts she’s petitioning the federal court to allow her not to pay: several thousand dollars owed to hospitals and physician practices. She had opted not to purchase health insurance.

E-mail Mr. H.

Time Capsule: Want To Anger a Nurse? Make Smug Comments about Grocery Store Barcoding

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

I wrote this piece in February 2007.

Want To Anger a Nurse? Make Smug Comments about Grocery Store Barcoding
By Mr. HIStalk

One reason we hospital IT types aren’t taken seriously is the “grocery story” analogy. You know, when some well-meaning government official, non-healthcare CEO, or your next-door neighbor smugly proclaims, “There’s more automation in the grocery story checkout line than in most hospitals.” Ha, ha, what an insightful observation – first time we’ve heard that one.

Randy Spratt, McKesson’s CIO, recently trotted out the old warhorse in an interview with Fortune. I’m sure his intention was benign (i.e., “buy more of our barcoding stuff to enlarge my executive bonus”) but perhaps his lab systems background makes him insensitive to how steamed nurses get when someone trivializes the barcode verification process on their end. If it were easy, everyone would be doing it.

(Hint to Randy: those same nurses are often involved in barcode system selections, with one of their possible choices being your employer’s product. Better stroke them a little next time.)

Ann Farrell, BSN, RN and Sheryl Taylor, BSN, RN sent me a list of why the grocery store analogy is not only inappropriate, but offensive to nurses. Their list was detailed, persuasive, passionate, and soon to be published, so naturally I decided to go more for the ironic and humorous by creating my own imitative list. Until their higher purposed tome sees daylight, this will be your amuse-buche.

If grocery stores were like hospitals:

• They would buy Doritos by the bag, but would have to repackage and label individual chips and then track every chip – who bought it, who ate it, and whether they ate it in an appropriate quantity and with only complementary foods and according to dynamically calculated nutritional needs.
• They would have to set up an internal barcoding factory since grocery makers would refuse to barcode their products until all stores collectively agree to pay extra.
• Each clerk would serve 15 checkout lanes simultaneously.
• Every customer would enter the store at precisely 9:00 a.m., 1:00 p.m. and 6:00 p.m. and clerks would have to check all of them out within 15 minutes.
• It would be the clerk’s job to prevent customers from buying both Doritos and potato chips since they serve the same purpose.
• Barcode scanners would be poorly designed by programmers, grocery store managers, and former clerks who haven’t worked in a store in 10 years. Clerk training would require two days and a 500-page manual.
• Stores would not be self-service. Instead, clerks would take the customer’s list, try to decipher their illegible handwriting, and run around the store to assemble several such orders for different customers at the same time. Each item would have to be documented twice: one when pulling it from the shelf and again when giving it to the customer. Customers would be encouraged to change their lists constantly. Most stores would not have the capability update the clerk’s list electronically, so the clerk would have to scratch off and write in items on the same ratty sheet of paper.
• Somber-looking inspectors could show up unannounced demanding to see a list of customers who bought hot dogs in the last year or the complete grocery purchases of a specific person named John Smith, but only the right John Smith.
• Clerk supervisors, exasperated over loss of productivity, would suggest keeping paper copies of commonly used barcodes to save time over scanning the real thing, flagrantly bypassing the whole purpose of buying the system in the first place.
• Instead of wheeling their cart to the checkouts, customers would ring the little “I need help” button wherever they happen to be, requiring the clerk to lug the cash register to their location to scan their item.
• The loyalty card of every customer would have to be scanned before selling them anything, even if they ruined its barcode by taking it into the shower.
• Soda would be sold like paint – the clerk would have to mix and label whatever flavor the customer wants using stock ingredients.
• Once barcodes were scanned, instead of being recorded electronically, the information would print a duplicate paper receipt to be filed forever.
• Clerks ringing up the wrong price could kill the customer, would be barred from future clerk jobs, and could be jailed.
• When working alone in a 24-hour store after everyone else has gone home, the clerk would cut meat, mop the floors, make pastries, unload the truck, show compassion, attend to family needs, and humor abusive superiors who take credit for accomplishments that mostly occurred while they were offsite making ten times what the clerk is paid.

News 3/9/12

Top News

National Coordinator for HIT Farzad Mostashari, MD takes issue with the recently published report that found doctors with online access to patients’ charts ordered more tests. Mostashari disputes the study, which raised questions as to whether or not EHRs cut costs. Mostashari’s contends that the study was based on 2008 data and before the start of the Meaningful Use program and thus does not address certified EHRs’ capabilities for data exchange and clinical data support.

Reader Comments

From EFMHead “Re: OB data management. Rumor has it that GE Centricity Perinatal is to be discontinued and that CPSI is auctioning off its OBIX product. Thoughts? If true, this signals an odd and sudden exodus of two major players from the OB data management market space.” Unverified. UPDATE: per GE Healthcare, the Centricity Perinatal rumor is not true.

From CW “Cake. Here’s a picture of the cakes that were prepared for Vada’s retirement. She was also presented with a quilt that reflected all the company names and colors over the last 24 years.” The cakes were prepared in honor of the retiring Vada Hayes, a longtime Allscripts/Misys/Medic support supervisor.

HIStalk Announcements and Requests

Highlights from HIStalk Practice this week include: a handy two-page summary of Stage 2 for EPs, prepared by two e-MD physician users. US physicians charge two to three times more than their French and German peers and achieve similar outcomes. MGMA urges Secretary Sebelius to consider adding due diligence to the ICD-10 timeline and limit required adoption to hospitals. A survey finds that 30% of physicians have implemented an EHR that meets MU criteria, 14% will in the next three years, and 17% have no plans to do so. Check out the rest of the goodies on HIStalk Practice and be sure to sign up for the email updates. Thanks for reading.

HIStalkapalooza’s  own singing Elvis is seeking  music video contributions for “Gimme My Damn Data,” as debuted at HIStalkapalooza last month. Dr. Ross D. Martin, MD encourages anyone wishing to promote access to their electronic health information to submit a video clip by March 26th. Check out the video clip – fun stuff.

Mr. H will be back in front of his computer this weekend, following his week-long get-away with Mrs. H. Of course I’m ready for him to be back at the helm, especially since he is the one most likely to feign amusement by my witty e-mails. He did a pretty good job staying off the Internet this vacation, meaning his inbox is likely overflowing; no doubt he’ll immediately be back to his workaholic ways.

Acquisitions, Funding, Business, and Stock

Medivo, a provider of decision support and analytics software, acquires WellApps, a developer of mobile disease management applications for chronically ill patients.

Sales

The 150 physician Holston Medical Group (TN) selects Humedica MinedShare as its clinical intelligence solution to be used in a joint venture with over non-Holston 1,300 physicians.

WellStar Health System (GA) selects PerfectServe’s clinical communication platform.

University Health System (TX) expands its Allscripts portfolio with the selection of Allscripts Community Record, powered by dbMotion, to share data across its 24 locations.

Watson Clinic (FL) selects MedAptus’ Professional Intelligent Charge Capture for its 294 multi-specialty providers.

Oakwood ACO (MI) contracts with Wellcentive to provide its the Wellcentive Advance healthcare intelligence solution suite for Oakwood ACO physicians.

Fairview Health Services (MN) chooses Amcom Software’s communication solutions, including smartphone-ready encrypted messaging and nurse call alerting on mobile devices.

Brattleboro Memorial Hospital (VT) selects Unibased’s ForSite2020 solution for enterprise scheduling.

CSC signs a nonbinding letter of intent with the NHS to move forward with additional implementations of the Lorenzo patient records system, beyond the 10 that have already been rolled out.

People

The Cal eConnect board of directors appoints Ted Kremer as president and CEO. Most recently Kremer served as executive director of the Rochester Health Information Organization.

Former Nuance Communications executive John Shagoury joins Eliza Corp. as president. Shagoury replaces company co-founder Alexandra Drane, who takes over as chairwoman and chief visionary officer of the patient engagement company. Shagoury is the former president of Nuance’s healthcare division.

Physicians Interactive, a provider of mobile and Web-based clinical resources, names Gautam Gulati, MD (Digitas Health) as CMO and SVP of product management and Joe Caso (King Pharmaceuticals, Pfizer) as EVP of new business development.

Announcements and Implementations

Datawatch Corporation partners with HIT consulting firm Jacobus Consulting, enabling Jacobus to incorporate Datawatch’s Monarch Report Analytics platform into its client offerings.

Bayscribe partners with Health Fidelity to integrate Fidelity’s NLP platform into BayScribe’s clinical documentation solutions.

Government and Politics

The Stage 2 proposed rules for Meaningful Use were officially published in the Federal Register Wednesday, marking the start the 60 day commentary period. CMS is accepting feedback through May 7th.

Other

Solo and small practices are now outpacing larger practices in EHR adoption, with single-doctor office adoption growing from 31% to 37% for the second half of 2011. Overall EHR adoption rates remain higher as the number of physicians practicing at each site rises.

Moody’s Investor Service predicts even more consolidation among hospitals over the next few years as institutions look for ways to enhance efficiencies, improve competitiveness, and drive higher payments from insurers.

Forbes profiles Epic founder and CEO Judy Faulkner, whom it dubs “healthcare’s low-key billionaire.” The magazine estimates her net worth at more than $1.5 billion, making her the only woman to reach the rank of billionaire by founding her own technology company.

Weird News Andy checks in with a few goodies, including a story of a three-year-old who ingested 37 Buckyball magnets. The magnets snapped together in the child’s intestine, tearing holes in the intestine and stomach. WNA says, “No MRIs, please.”

WNA wonders how much the living received in overpayments, after an audit finds that Washington, DC paid nearly $700,000 in Medicaid payments for dead people, including one nearly nine years after the patient’s death.

And in an overachieving moment, WNA adds the story of a Texas dialysis nurse, accused of injecting bleach into the dialysis tubing of patients, killing five.

Sponsor Updates

• API reports it added 38 contracts with new and existing clients between Q4 2011 and Q1 2012 to date.
• BCBS North Carolina launches a mobile version of its member web portal that is based on Kony Solutions’ mobile technology
• States and regional HIE’s drive demand for technology from Medicity, Axoloti, and Orion.
• Gwinnett Medical Center (GA) launches MedGift, an online gift registry powered by RelayHealth.
• Pathology Service Associates, a division of MED3OOO, prepares to move into a new, $5.5 million 32,000 square foot headquarters in Florence, SC.
• Health 2.0’s Matthew Holt chats with Kareo CEO Dan Rodrigues about the current state of the one to four physician market.
• iSirona releases DeviceConX 4.0, its latest version of connectivity software.
• Hayes Management Consultant’s Anita Archer, CPC, provides recommendations for preparing for ICD-10.
• Vitalize Consulting Solutions ranks third in the 2011 Best in KLAS Awards for software and services. Apparently KLAS inadvertently left VCS off the original report published in December.
• The Advisory Board reports that nearly 50% of hospital CIOs will hire consultants to help achieve MU.

EPtalk by Dr. Jayne

Nuance announced plans to drop $300 million in cash to acquire Atlanta-based medical transcription and speech editing vendor Transcend Services. The move is aimed at expanding Nuance’s customer base in the small- to mid-size hospital market. We’ll have to see if employees still embrace the “It’s better here” motto after the dust settles.

In other acquisition news, CareFusion will PHACTS LLC. CareFusion hopes that by adding PHACTS to its existing Pyxis products, pharmacies can better manage inventory, manage drug shortages, and of course improve the bottom line.

IBM has named nine members of the Watson Advisory Board to “focus on medical industry trends, clinical imperatives, regulatory considerations, privacy concerns, and patient and clinician expectations around the Watson technology and how it can be incorporated into clinician workflows.” Seven of the nine are physicians, including family doc Douglas Henley MD who is CEO of the American Academy of Family Physicians. I learned at HIMSS that family docs can be a lot of fun so I’m excited to see him on the Board.

ONC is seeking public comment on how health care providers and health systems user mobile devices to access, store, and transmit health information. Laptops, PDAs, smartphones, and tablet computers were specifically called out but storage devices were excluded. Comments are being accepted through Friday, March 30^th.

CMS will be releasing new online billing statements intended to help seniors find bogus charges. The “consumer-friendly format” goes live Saturday on Medicare’s secure web site. Features include larger type and explanations of medical services in plain language. Revised paper statements are coming next year. I cruised the site looking for samples but couldn’t find any, so I’ll use my next best research source: grandma. I definitely want to see one before patients bring them to me to discuss. Apparently the site also allows beneficiaries to check claims status and use an online appeals form. It also includes the Blue Button.

HIMSS released its online photo gallery in case you want to purchase photos of your favorite ONC, CMS, and HIT crushes. Although it’s not from the official HIMSS site, I’ve been told this pic depicts the response of a certain someone when informed that he missed the chance to dance with the ladies of HIStalk at HIStalkapalooza.

No, that’s not a sample of the tattoos that Inga and I had done while we were in Las Vegas – but one of my favorite readers did send an article about the growing phenomenon of medical tattoos. It’s low tech but does make a point for patients with health conditions or who want to make sure first responders understand an individual’s wishes for resuscitation. The tattoo chosen by the reader in question: “afraid of needles.”

Have a question about voice recognition, clinical decision support, or just want to share what you’d choose as your medical tattoo? Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

CIO Unplugged 3/8/12

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

CAUTION! Teambuilding Ahead

My affection for teambuilding sparked during the journey through cubscout and webelos. Army experiences further revealed that survival depended upon team. We had to work as a unit to navigate our way through a forest or through complex situations while under fire. Eventually, I recognized the transferable benefits to the corporate world. Today, few things thrill me more than getting my team outdoors to test and build our collective capabilities.

Of course…there is an element of danger involved in these pursuits.

The Burn. My first civilian ropes course. I was a Director at Parkview Medical Center, and all leaders were required to attend this training. We had a blast pushing the boundaries. That is, until we got to the capstone element: the Power Pole. “One participant climbs to the top of a utility pole using staples. Upon reaching the top, the participant leaps from the pole and attempts to catch the trapeze bar suspended in the air.”

A 45-five foot pole towered above me. Few attempted to even reach the top, and I couldn’t blame them. I was the last to go, and peer pressure and pride kept me from bailing out. I climbed to the highest point, and I still recall the effort it took to reach above the climbing staples and hook up to the safety line. Then I stood on top of the 12-inch wide utility pole. It swayed with the wind, keeping me off balance. About 10 feet out and 2 feet lower than my line of sight, the trapeze bar beckoned. I’d never felt so scared in my life—except the time I got arrested for joyriding when I was fourteen.

My halfhearted plan was to make it look like a strong attempt for the trapeze then just fall and wait for the safety line to catch. I removed my gloves, crouched, and made the leap. Before the safety caught, I grabbed the climbing rope attached to the trapeze. Gravity sucked me down about 10 feet until the safety jerked me into a halt. I hung in pain. The skin on the insides of both hands had ripped away.

Once I was lowered, the CNO and ED Director took me straight to the hospital. More agonizing than the burn was the ED doc cleansing the wound before working on it. Even writing this makes me want to clasp my hands shut as I had done after the injury.

Lessons Learned:

• Never do anything half assed or expecting to fail
• When handling ropes, wear gloves!

Rapids. My team had accomplished the incredible. Over 18 months, as part of a start-up, they installed a new application across 23 disparate and independent minded academic departments that represented 750 physicians plus residents. To celebrate, they chose the teambuilding activity of river rafting. A month later, we entered the Class III/IV rapids of the Youghiogheny River. Although I rafted a bit in simulated beach assaults with the Army, I had zero experience with rapids. I became raft captain by default.

We hit the first Class II rapids (easy), and I fell out. My raft-mates grabbed for me, but the current was too swift. Floating downstream and getting beat up by underwater boulders I then remembered the training: float feet first and on top of the water. Easier said than done. The rafting company had a three-tier safety layer in place in the event a bozo like me fell out. Tier one failed. I was headed straight for serious Class III and IV rapids. A Tier two guide in a kayak couldn’t reach me. I started to panic, which made matters worse. In the distance, the Tier three guide stood on a large boulder in the middle of the river with a rope. She threw out the safety line, and my eyes affixed like laser beams on my last hope. She couldn’t have been more than 100 pounds, but she was all I had between life and death.

I grabbed the rope as I hit the Class IV rapids. A “keeper hydraulic” took me under. The jet-like flow ripped through every crevice of my life vest and helmet until I felt as if the water would strip away all my safety gear. The current pushed me under, and I fought for air. I saw the proverbial flash of my life. That one-hundred-pound saint on top of the boulder…to her credit, she remained steadfast and eventually pulled me into an eddy. I stood there, shaking. The Tier two kayak made its way toward me, and the sliver of courage I had left got me back in the water and reunited with my team. And yes, this entire event was caught on video thanks to the “package” we purchased from the tour group.

Lesson learned:

• Listen to and consider all safety precautions
• Don’t stick your ass out too far unless you’re willing to accept risk (that’s how I fell out of the raft)
• If you fall, muster your courage and soldier on

Slide for Life. Prior to being commissioned as an Army Officer, all cadets had to acquire a RECONDO certification. One of the activities in the course was the Slide for Life. You slide down a zip line across a lake, keeping your eye on the flagman on the far side. When the red flag raises, you extend your legs straight until your frame forms an L-shape. When the flag lowers, you let go of the zip line and drop into the water. Given the trajectory, this posture enables you to hit the water butt first and the world is good.

With great amusement, I lingered after completing this event to watch the other platoons execute. Most did fine, but every once in a while, someone decided against the L-shape and let go in an I-shape. The soldier hit boots first resulting in spectacular somersaults. In other cases, some were too scared to release at all and ended up crashing into the sandbags at the end of the zip line.

Lesson learned:

• Follow instructions
• Fear causes paralysis

After a string of traumatic experiences, I chose safer team building activities. Here’s what happened:

Curling. One of my directs was a curling fanatic, so I agreed to some ice time. What could possible go wrong? We dressed warm and headed for the Mayfield Curling Club. My CTO was tall and aggressive. We were in this to win. I shoved our stone down the ice where he was sweeping to heat up the ice and influence trajectory. He pushed too hard on the broom and his feet came out from under him. He fell face first. When we rolled him over, blood gushed from his mouth where his teeth had punctured a hole through his lower lip. Our CMIO and two nurses applied first aid. Given the severity of the cut and apparent concussion, we called an ambulance.

I could just hear my CEO. “We lost our CTO to what? Curling?” Thankfully, the man was released the next day following observation and stitches.

Lessons Learned:

• Ice is slick as hell
• Don’t make fun of curlers

The “low-key” retreat. I held an offsite retreat once with no outdoor events. One of our team accidentally slipped and fell and messed up his knee before the meeting even began. A great object lesson in teamwork followed: The CMIO did an evaluation. The combat medic rounded up some gauze and wrapped the knee. The CTO ensured the meeting room was set-up to accommodate the wounded. The non-clinicians fetched ice and painkillers. And, in the ultimate display of team and knowing nothing was broken, the injured refused to seek medical attention until after the day was done.

Lessons learned:

• Injuries can happen in any environment
• It is smart to have clinicians as your direct reports!

Despite the potential for injury, if you haven’t escaped with your team to develop relationship and strengthen the bond, then plan one today. Mmmmmm…perhaps climbing mountains should be avoided….

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 andFacebook and you can follow him via Twitter — user name marxists.

Nuance to Buy Transcend Services for $300 Million

Nuance announces Wednesday morning a definitive agreement to acquire Transcend Services, a provider of medical transcription and speech editing services, for $300 million, net, in cash. The acquisition accelerates Nuance’s expands the company’s presence in the small- to mid-size hospital market.

Janet Dillione, EVP and GM of Nuance’s Healthcare business said, “The acquisition of Transcend will expand the delivery of our innovative voice and Clinical Language Understanding solutions especially to small- and mid-size hospitals. With Transcend, we will drive change and improvement to the way these hospitals capture and leverage clinical information. The acquisition is a natural extension of Nuance’s existing healthcare business, and will strengthen our solution and services portfolio, as well as enhance our profitability.”

Transcend acquired electronic clinical documentation provider Salar in August of 2011.

News 3/7/12

Top News

Physicians using computerized patient records are more likely to order new tests, leading to higher healthcare costs. Researchers, whose findings were  published in Health Affairs, found that physicians with point-of-care access to imaging were 40 to 70% more likely to order more tests, compared to doctors relying on paper records. Researchers could not determine the reason for the trend but theorize that doctors on computerized systems order more studies because of the the ease of online entry.

Reader Comments

From WallE “Re: HIMSS musings. I think the show would have been better if the floor plan and layout was simpler. After looking at New Orleans floor plan I’m thinking it will be better.They are returning to the single hall with a large “main street” walkway down the middle of the show.” I also prefer the main street, one hall layout, although the argument could be made that there was less walking required with this year’s floor plan.

From CTO “Re: Music.  It was good to ‘see’ you at the sponsor lunch at HIMSS. Since you have the helm this week, how about some insight into your taste in music?  I always like to read about  what Mr. H is interested in.” First let me say that Mr. H and I have very different tastes in music. Mine is a bit eclectic but a short list of my all-time favorite artists include Lyle Lovett, Bonnie Raitt, Aretha Franklin, and Allison Krauss. Some of the more current groups I find fun include Chiddy Bang, Flo Rida, and Bruno Mars.

From Ralphie “Re: Burger, Babes, and Vegas. I thought you might get a chuckle out of what I heard walking back from the HIMSS conference to my hotel behind what looked like two slick make vendor-types.  One turned to the other and said that he had been propositioned by two prostitutes and one of them offered her services for $35. The other one quipped, ‘Wow, that is less than the room service cheeseburger and fries I had last night.’” Love it.

From IDXwatcher “Re: More GE layoffs.  GE Healthcare layoff confirmed March 2nd.” According to an article in the local press, fewer than 30 people (about 2%) were let go last week. GE says the cuts were necessary “to increase competitiveness.”

From Aaron Brrr “Re: Madison Dolly comment on v12 of Epic. Madison Dolly said that v12 of Epic was shown at HIMSS and coming soon. Two questions: what’s in it and when did they change policies about showing that which isn’t available?” Anyone?

From Wondering aloud “Re: Epic. Epic is having a great run like SMS did with INVISION in the 90’s, but their business model is more like MEDITECH’s. Wondering if “in the know” readers think Epic will struggle the same way MEDITECH has recently with 6.0 when Epic attempts its inevitable near term re-platforming as well?”

From HIStalk Fan “Re: Allscripts. A recent analyst report discusses a Q3 restatement involving software transaction, as well as Allscripts’ disclosure of a subpoena in connection with a grand jury investigation and recent litigation involving Medical Services Associates.” Allscripts filed a 10-K last week related to a restatement of a bulk sale and delivery of licenses through a complex structure based on a decision that future performance obligations require the deferral of revenue. The net reduction to operating income was $3.1 million and a $0.01 reduction in EPS. I asked one of HIStalk reader/analysts for his take on the restatement and his opinion was the adjustments were very minor and reflected Allscripts’ conservative approach to revenue recognition. As to the litigation, MSA alleges Allscripts negligently caused the loss of medical billing data, intentionally misrepresented certain facts regarding the computer sold to them, and breached certain aspects of their contract. My take: Allscripts and vendors of their size are regularly hit with similar lawsuits and thus it’s not a cause for alarm.

From Stringer “Re: Medical software sales guy. This guy was convicted today of 1st degree murder of his wife. Very ugly situation, first trial was a hung jury. As you can see he is ALWAYS referred to in the press as a medical software salesman but have never mentioned the company. Thought it might be a good HIStalk expose.” Jason Young was convicted of brutally murdering his pregnant wife five years ago. Young contends he is innocent. I did a bit of digging and could only find one Jason Young in Linked In that could have potentially been a match. If you know the scoop, please share.

From OldTimer “Re: Allscripts send-off. Allscripts says goodbye to 24-year veteran Vada Hayes. Luminaries in attendance included John McConnell, Eric Sellers, Alan Winchester, Steve Shepherd, Bob Bothwell, and many, many others. There were four cakes: Medic, Misys, Allscripts, and the current color scheme. That’s cakes in green, purple, orange, and lime.” Would have loved to seen the cakes, but here is a shot of the retiring Hayes, along with former Medic/Misys CEO John McConnell.

HIStalk Announcements and Requests

A few readers mentioned having difficulty getting onto the HIStalk sites today. Of course I can’t find Mr. H’s email from four years ago that explained who to contact if this ever happened. Hopefully Mr. H will check in soon and the issue will be resolved. Thanks for your patience.

Thanks to all the wonderful readers who sent encouraging e-mails about relief from post-HIMSS exhaustion and to remind me a vacation is in my near future.

Acquisitions, Funding, Business, and Stock

DocuTAP, a provider of EMR/PM solutions for urgent care providers,  secures a two-stage $12 million investment from Bluff Point Associates.

Healthcare software and service company iMedX completes its acquisition of the medical transcription assets from The Inner Office Ltd.

Sales

Iowa Health System contracts with MediRevv for accounts receivable conversion assistance as it transitions its core hospital system to Epic.

The VA selects HP Enterprise Services to continue as a prime contractor for its claims processing program, CAPRI.

Upper Peninsula Health Plan chooses the MedHOK platform for integrated care management, quality, and compliance.

CPU Medical Management Systems selects NDS’s Provider Edge product to automate payment processes and convert EOBs into ANSI standard 835 ERA.

The state of Louisiana contracts with CNSI for a 10-year, $185 million project to develop and deploy a new Medicaid claims processing system.

People

Healthcare data analytics company Qforma promotes Mark Feeney to VP of client services and Joann Flynn to senior director of business development operations and employee development.

AirStrip Technologies announces the addition of Connie McGee (KPMG) as VP of strategic accounts and the opening of a regional office in the Nashville area.

The Open Source EHR Agent (OSEHRA) names James Peake, MD (CGI Group), John Halamka, MD (Beth Israel Deaconess Medical), and Michael O’Neill (VA) to its inaugural board of directors. OSEHRA is a not-for-profit organization tasked with serving as the custodial agent of an open-source development project to upgrade the VA’s VistA EHR system.

Announcements and Implementations

ZirMed launches www.StarStopICD10.com, a site designed to gauge industry opinion and gather comments surrounding the ICD-10 implementation timeline.

The Cleveland Clinic expands its EMR to include a visual repository with diagnostic images of patient X-Rays, lab tissue samples, photographs and other images.

All 15 of the independently owned primary care clinics in the Integrity Health Network (MN) transition to EMR.

QuadraMed launches a remote hosting service for its identity management, RCM, and HIM solutions. Cabell Huntington Hospital (WV) is the first hospital to utilize the service.

McLaren-Bay Region (MI) goes live on McKesson Paragon EMR March 11th.

Intermountain Healthcare (UT) launches a 90-day pilot telehealth program, allowing patient employees to connect with providers via video chat.

Aetna announces the availability of an enhanced version of its iTriage app, which Aetna acquired in late 2011.

Government and Politics

An analysis of eight years worth of Medicare claims data reveals that Hospital Compare, Medicare’s public reporting initiative for hospitals, has had minimal impact on patient mortality. The study found the reporting of quality data led to no reductions in mortality beyond existing trends for heart attack and pneumonia and led to a modest reduction in mortality for heart failure.

Technology

RTLS provider AeroScout partners with McRoberts Security Technologies to introduce a Wi-Fi-based campus-wide infant security solution that enables hospitals to attach an RTLS tag to the infant’s umbilical cord clamp.

Other

The Galveston County HIE (TX) and the HIE of Southeast Texas join the Great Houston Healthconnect, making it the state’s largest HIE market with 133 hospitals and over 14,000 providers.

Mayo Clinic rehab nurse Andy McMonigle and three physicians say an iPad helped saved McMonigle’s life when he suffered a heart attack. The nurse, who was exercising in a Mayo Clinic fitness center for employees, felt the onset of the attack and quickly found three doctors in the center. One of the physicians pulled out his iPad and accessed McMonigle’s online medical chart and previous EKGs. Because they had immediate access to his chart, the doctors quickly identified the issue and had  McMonigle transported to the cath lab to remove a blood clot blocking his artery.

Smartphones are the most popular technology among doctors since the stethoscope, according to this study which looks at the global growth of mobile phone technology in healthcare. The use of mobile technology healthcare has the potential to reduce the cost of elderly care 25%, reach twice as many rural patients, and reduce the cost of data collection by 24%.

Speaking of smartphones, almost half of Americans now own one, making it the most widely adopted type of cellphone device.

Sponsor Updates

• Summit Medical Center (TN) shares how its OB/GYN physicians are using AirStrip Technologies to improve patient care during labor and delivery.
• MEDecision hosts a March 21st webinar on best practices and technology to enhance value-based healthcare.
• Wolters Kluwer Health and HealthStream partner to offer the Lippincott’s Professional Development Programs suite to HealthStream’s client base.
• Billian’s HealthDATA partners with RealTime Medical Data to provide Medicare payment data and analytics through RealHealth Analytics.
• Trustwave signs an agreement to purchase M86 Security to enhance its security product portfolios.
• Versus customer Dr. Brett Daniel of Pacific Medical Centers discusses his organization’s use of Versus RTLS at this week’s AMGA 2012 Annual Conference.
• Ignis Systems releases its free webinar schedule for March and April.
• Medicity client Michigan Health Connect receives second place in the Healthcare Informatics Annual IT Innovator Awards for its use of iNexx to create electronic-referral networks throughout Michigan.
• Memorial Healthcare System’s Joe DiMaggio Children’s Hospital (FL) goes live on GetWellNetworks’ IPC solution.
• LRS offers a Webinar featuring speakers from Carilion Health System and Sisters of Mercy Health System, who discuss ways to lower costs and simplify document management in Epic print environments.
• Shareable Ink customer Dr. Brian Woods, CMO of NorthStar Anesthesia discusses his experience automating with Shareable Ink’s technology.
• The Huntzinger Management Group (HMG) publishes Nathan Kaufman’s HIMSS presentation entitled, “Preparing for the Inevitable Perilous Journey from Entitlement to Accountability.”
• SRS EHR customer Pediatric Associates of Savannah (GA) chooses SRS Patient Portal for its 10 provider practice.
• Inland Empire HIE (CA) selects Orion Health’s HIE suite for its 48 participating healthcare organizations.
• GE Healthcare initiates a 90-day free evaluation period for its Global Safety Network, an online community for hospitals to collaborate on improving patient safety.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Curbside Consult by Dr. Jayne 3/6/12

The League of Extraordinary Gentlewomen

A few days ago, I had lunch with some friends. Anyone walking by might have thought it was simply a table of ladies who lunch, but it was much more than that. The reason – three of the five women at the table were, at one time or another, my boss. I’ve written before about bad bosses and bosses who don’t know what to do with CMIOs but today I wanted to talk about bosses who do it right.

I haven’t always been a CMIO – I’ve been an EHR pilot (read: guinea pig) as well as the nebulously-named Physician Champion. I’ve been a Department Chief, faculty member, and front-line physician depending on which hospital I was rounding at on a given day. I’ve also been a teacher, worked retail, and changed my own oil. The point is that many of us come to the table with a variety of experiences. A good boss will recognize the way in which experiences shape employees and draw from those experiences. They will seek to get to know their employees and what they can bring to the table besides title and credentials alone.

All three of these extraordinary bosses saw different things in me. One saw a fairly-green but passionate physician who had a vision and passion for technology. Choosing me over other ‘safe’ choices to provide clinical oversight for my first major IT project could have been a career limiting move for her (and more than once I pushed it to the limit, I’m sure.) Still, she cared enough to get to know me as a person as well as in the capacity of being her employee. Understanding what made me tick and how I reacted to change helped her advise, counsel, and mentor me and increased my value to her team.

She taught me how to dig in when the going got tough as well as how to quickly assimilate huge quantities of data into something useful for physicians to evaluate. I learned about process and methodology, how to work with consultants, and how to recover after getting one’s posterior handed to one by other physicians. She taught me how to leverage those difficult physicians and involve them in the project so that it became “our” project rather than the loudest physician’s idea of what things should be.

With different management styles, different bosses can motivate people to achieve in different ways. My second boss was able to build on what her predecessor had done – taking it to the next level with lessons in political strategy and operational tactics which have been invaluable to me as a CMIO. Although I was familiar with physician to physician politics, when hospitals and payers are involved there is an entirely different level of gamesmanship needed. She taught me to be confident in what I knew to be right as well as how to stick up for it without being obstructive.

She also taught me how to survive when being forced to do things I absolutely didn’t want to do or didn’t believe in – skills which have been critical when dealing with certain kinds of disagreeable organizational strategies that we all face. She gave me space when I needed it and didn’t micromanage, letting me find my own groove and set my own goals.

The other extraordinary gentlewoman at the table was my peer before becoming my boss, which happens to many of us at least once in our careers. We learned together how to swim in the choppy waters of health IT and having shared that experience she knew how thoroughly I would be willing and able to back her up when things got tough. She understood the way physicians make decisions and our ability to take multiple pieces of complex information and quickly arrive at a conclusion that balances patient safety, quality, and efficiency. She understood that I saw the applications we supported as patients and that I was constantly assessing their new ‘aches and pains’ and integrating new discoveries and features to try to come up with the best diagnosis and treatment plan. With that background, she was able to help others in the IT department understand that although it may have seemed like I was just throwing out an answer quickly, it was well-reasoned and also helped me learn to better explain my thought process so that people weren’t spooked.

(So help me, though, if you ever show up as a trauma patient in my Emergency Department, don’t expect me to explain what I’m doing in gory detail just so you can feel better about how quickly I arrived at a conclusion. When you’ve got a chest wound, I guarantee you want the doc to be rapidly processing the situation at the same time she’s giving orders and executing a well-thought and rehearsed plan. There’s no consensus-building when someone’s bleeding out and my reflexes are going to take over and get things done. I do promise though that I’ll explain it to you when you regain consciousness.)

Besides leadership styles and management skills, I learned another key lesson from these extraordinary women – that work/life balance is essential to avoid burn out. We worked in extremely complex situations, short on budget and resources and long on demands and expectations. They taught me how to care for myself so that I could continue caring for others (and also so that I could continue working my tail off for them, which I happily did.)

I truly wish that each of you has, at some point in your careers, one boss that you would walk through fire for. When you do, you’ll understand what I mean – someone who so totally inspires confidence and motivates you, that you’d do anything they ask. And if you’re really lucky and the stars align – you might just be lucky enough to have three.

E-mail Dr. Jayne

Monday Morning Update 3/5/12

From Observer “Epic CIOs. After seeing that two more Wisconsin CIOs that are installing or expanding Epic have lost their jobs recently, I noticed an interesting trend that I call ‘Epic – the Teflon Vendor Effect.’ Have you noticed that when an Epic clinical system install stumbles and fails, it is the CIO’s fault and when the same thing happens with a different product, it is the vendor’s fault?” I will defer to readers on this question,  but following the same logic: does Epic and not the CIO get (or deserve) all the credit when a project succeeds? And do CIOs get the credit when other products are successfully  implemented?

From Reluctant Epic User “Re: Anodyne. My large practice (over 200 providers) is considering Anodyne for BI. The word is that it can extract Epic’s data at the flip of a switch. Do you know or have you heard anything about their implementation? How much effort was required to by the Clarity SQL writers to connect Anodyne to Epic’s Clarity Database? Thanks in advance for the amazing work you, Mr. H, and the two doctors do. It really does make my job and life easier.”Thanks for the kind words. I know very little about Anodyne but I bet we have readers who are experts and willing to share their experiences.

Mr. H has left me to my own devices for the week while he is taking some R&R with Mrs. H. I must confess I am wildly jealous of Mr. H’s gallivanting across the globe, especially since my mind and body are still  experiencing a HIMSS hangover. Do a girl a favor and drop me an email this week and tell me all the secrets you would have told Mr. H. Or,  just send a note reminding me that my vacation will be coming soon. And thanks for reading.

A tornado rips the outside wall from three patient rooms at Harrisburg Medical Center (IL) and forces the evacuation of patients. The storm damaged multiple windows and tore heating and air conditioning systems from the building’s roof. Hospital administrators estimate damages in the millions.

Saint Alphonsus Health System (ID) signs an an agreement to implement MedVentive Population Manager and MedVentive Risk Manager.

The House Energy and Commerce Committee’s subcommittee on commerce, manufacturing, and trade hears testimony in favor of helping state build interoperable drug monitoring systems to reduce prescription drug misuse.

In case you didn’t get your fill of HIMSS and booth critiques, Dodge Communications sent a link to their fun post highlighting the best and worst from the exhibit floor. They name GE’s booth “Best in Show” based on its approachability and messaging. They also poke some fun at a few vendors’ lack of creativity:

Now, we know it’s tough to find relevant imagery in this business. And we see lots of free stock photography depicting smiling, multi-racial healthcare workers reveling in their use of the exhibitors’ technology. Definitely not easy. But pictures of bridges (“Bridges to meaningful use!”), stethoscopes (“We’re in healthcare!”), puzzle pieces (“Putting all the pieces together!”), and chain links (“We’re the missing link!”)  are not cool! C’mon people, be more creative! The most effective way to see if your imagery resonates is to test it with the market. It’s easy to test, and it doesn’t take long to realize that your audience doesn’t think it’s cool either.

Geisinger Health Plan reports that its use of telemonitoring technology has reduced 30-day hospital readmissions by 44%. Using interactive voice response technology from AMC Health, case managers track post-hospital discharge patients’ biometric and symptom information in real-time.

Oakwood Hospital and Medical Center (MI) prepares for its August 1st go-live of Epic’s EMR.

A PwC study finds that 61% of hospitals and physician groups have formal clinical informatics programs and most plan to add additional technical analysts and clinical informaticists over the next two years.

Cumberland Consulting Group promotes John Waters, Charles Flint, and Leah Wilson to executive consultants.

First Databank launches a corporate rebranding initiative designed to focus attention on the company’s growth and future in clinical decision support. Mr. H checked in from his vacation long enough to point out that FDB’s press release mentions their sponsorship of HIStalk, which they call an “influential industry blog.” We like that.

EHR Scope launches AIMSConsultant, a service to provide anesthesiologists and operative facilities with information on anesthesia information management systems.

The Milwaukee paper profiles the Wisconsin HIE, which currently connects 13 area hospitals. No surprise here: the HIE’s executive director notes that the organization’s biggest obstacle to growth is not technology, but money.

HFMA awards Winthrop Resources its “Peer Reviewed” designation, based on the effectiveness, quality, price, value and support of Winthrop’s offerings.

CincyTech and Cincinnati’s Children’s Hospital Medical Center form QI Healthcare, an HIT company to commercialize Children’s proprietary quality-improvement software. CindyTech and Children’s are each investing $200,000 and have named John Atkinson (WebMD, Mede America, SourceMedical)as the new entity’s CEO.

HKS Medical Information Systems changes the company’s name to OTTR, d/b/a OTTR Chronic Care Solutions. OTTR is a provider of transplant patient tracking solutions.

E-mail Inga.

News 3/2/12

Top News

The Defense Department appoints former Harris Corp. VP Barclay Butler to serve as director of the Defense Department/VA Department Interagency Program Office to manage the development of an integrated EHR for both departments.

Reader Comments

From HairClub: “Re: Shafiq Rab. The CIO at Orange Regional Medical Center is taking the VP/CIO position at Hackensack University Medical Center.” Unverified.

From Free Lunch: “Jason DeSantis. Joining Zanett’s healthcare division as executive director of business development.” Unverified. He’s division CIO at University Hospitals in Cleveland.

From Last Man Standing: “Re: GE Healthcare. Layoff today of 5% targeting services and support.” Unverified. Many of the GEHC rumors I get are somewhat true but exaggerated, so if the company provides an update (which companies usually don’t for HR-related issues) I’ll run it here.

From Printgeek: “Re: Epocrates. Laid off their entire EMR staff on Tuesday and are shutting down their EMR project. The BOD lost patience, as crazy sales expectations were set by previous CEO and CFO. They expected to sell 1,500 docs in 2011 with an uncertified system that was release in July. This exec team did a good job hiring talent, but failed to listen to their feedback on what it takes to actually sell EMR and the subsequent expectations.” I think there’s a lesson to be learned here: if selling EMRs was easy, everybody would be doing it, and HITECH has accelerated the polarization of the successful and unsuccessful vendors. If Epocrates, which has an impeccable brand recognition in healthcare and was seemingly doing all the right things, struggled to meet sales numbers for its EMRs, clearly the age of the mom-and-pop EMR is over. Actually, there’s an even more applicable lesson here: publicly traded companies may say all the right things about being dedicated to healthcare, but quarterly numbers can send them fleeing for cover almost instantly. Whatever docs just bought their EMR are now finding out what it means to be on the wrong side of their vendor’s “core business.” The one-year share price chart doesn’t inspire much confidence that a steady hand on the tiller is what’s needed – shares are down almost 60% in the past year.

From HIT Student: “Re: Connected Care Challenge. I thought some of your readers might be interested.” Janssen is offering $250K in awards for easily adopted, low cost technology solutions that can improve information sharing among hospitals, patients, caregivers, and community physicians, with the goal of improving post-hospital care and lowering the cost of unnecessary readmissions. Submissions are being accepted through March 25.

From Non-Sequitur: “Re: SNOMED. Here are examples of the proposal to require SNOMED in Stage 2/2014 Edition. In the 45 CFR Part 170 Standards Companion, see Pages 45 (cancer registry), 52 (problem list MU objective), 58 (summary care record MU objective), and 90 (lab results to public health agencies MU objective.)” Thanks. I know several readers are interested in the potential requirement to use SNOMED.

From I Was There: “Re: HIStalk sponsor lunch at HIMSS. Great location, great food, a nice mix of heavy hitters and rising stars, and great networking with lots of cards being passed and commitments for follow-up discussions. Art Glasgow’s talk was very well received, talking about how HIStalk plays a part in his daily activities as Duke University Hospital CIO, how vendors and providers should help spread the word about it, and the shifts he made going from the vendor world at Ingenix to Duke. The focus was on the three of you as people were trying to figure out who you are and checking out Inga’s shoes. I thought the event was great.” It was really cool that 100+ folks from our sponsoring companies took time away from a very busy first day of the HIMSS conference to let us say thanks to them for supporting what we do. Naturally Inga, Dr. Jayne, and I felt simultaneously ridiculous and vulnerable appearing in disguise, but we did our best. Most of our sponsors understand that we’re going to objective and fair to sponsors and non-sponsors alike and, to their credit, they support us even when what we say isn’t going to be popular back in their offices. If you were there, thank you very much.

From Judy Judy Judy: “Re: Epic consulting firm. Last week Judy F. of Epic met with executives of [consulting firm name omitted] about their violation of Epic’s non-solicitation clause. An Epic client turned them in to Epic after the firm poached a handful of the client’s employees. Epic banned the firm for a year (which was ‘negotiated’ to a shorter term) from selling to or doing business with any new Epic customers. Seems like a slap on the wrist based on recent discussions with Epic Consulting relations personnel and their stringent expectations for consulting partners. Why not take away their preferred certification program as well?” Unverified, so I’ll leave out the company name for now.

From MD Informaticist: “Re: digital pen technology – mightier than the mouse? Are they really making an impact on usability and clinical documentation? I would be interested in your opinion of the Verizon and other digital pens and clarify for us: can this technology re-energize a dormant innovative industry?” What I’ve seen of them seems pretty cool, but I’m interested in hearing from readers about who is actually using them and what results they are getting.

From Mark Schmidt: “Re: HIMSS. It’s become such a large event that the Booth Crawl brought back feelings of those early days when it was possible to spend time with just about every vendor. I learned a lot and heard the latest from Sunquest, which has not been sitting still as the industry has progressed!” Mark, CIO of SISU Medical Systems of Duluth, MN, won a Sunquest-provided iPad last week. He and I have swapped occasional e-mails going back to early 2008.

From Just a Fan: “Re: 5010. Anyone else having issues with a claims clearinghouse not being ready? Our cash on hand is taking a beating because our claims have been sitting at the clearinghouse and are only just now starting to trickle out to payers, which are requesting information required on 4010 but deleted in 5010. And the enforcement delay was good why?” We keep hearing anonymous rumblings with no specific examples. Give us details and we’ll see what we can find out.

HIStalk Announcements and Requests

This week on HIStalk Practice: Dr. Gregg pulls a double shift in an an attempt to diffuse last week’s “mournful silence” on HIStalk Practice while I was busy drinking IngaTinis and walking my high heels off at HIMSS. Dr. Gregg missed HIMSS this year, but still offers some fun HIMSS musings. A proposed rule would require physicians to return improper Medicare payments within 60 days of  notification and allow auditors to investigate 10 years of records. Most physicians believe EHR use is valuable for improving quality and managing patient care, but less convinced that EHR improves diagnosis accuracy or treatment planning. Black Book Rankings announces its ambulatory EHR vendor rankings. Athenahealth CEO Jonathan Bush likens his company to a “snippy kind of overconfident Chihuahua jumping up and trying to nip at the tails of the Dobermans.” By the way, we are conducting a reader survey on HIStalk Practice that is in addition to the HIStalk version; we’d love readers to take a moment to  have a  to provide input. Thanks for reading!

I appreciate the support of Levi, Ray & Shoup (specifically LRS Output Management) for supporting HIStalk as a Platinum Sponsor. The company’s expertise is in document solutions for hospitals, so let’s use a typical Epic shop as an example. Maybe your big Epic print jobs fail; you need centralized capability to monitor and reprint jobs without re-running them on Epic; you are maxing out out your Windows print queues or the Windows print spooler; or you’d like to save print costs by allowing users to preview reports before printing and automatically route large reports to more economical printers. With the LRS solution, you gain centralized control, you can implement load balancing, you avoid installing multiple print drivers on each workstation, and you get rid of the unreliable science fair of printing solutions (UNIX to JetDirects, multiple printer types, a mix of Epic text and ERTF documents, etc.) and you can even require users to verify their identity before printing patient documents to an unattended printer. It doesn’t matter how cool Epic is if the tangible, patient-critical label or report it creates as an end product is hanging out there in the ozone because of a cobbled-together print solution that is far less enterprise grade than the system that drives it. One hospital with four FTEs handling printing issues cut back to just one after implementing LRS Output Management, which can handle anywhere from hundreds to thousands of printers. And while Epic is a good example, the solution works with any application (Lawson, SAP, etc.) Check out their case studies from Carilion, Hopkins, UVA, etc. Thanks to Levi, Ray & Shoup for supporting HIStalk.

Liaison Healthcare Informatics is supporting HIStalk as a Platinum Sponsor. The Atlanta-based integration and data management company has over 9,000 customers all over the world, including more than 600 in healthcare. The company’s cloud-based data integration solutions provide a platform for the secure exchange of data among providers, payers, patients, and HIEs. Some of the pain points it addresses are HIPAA, HITECH, DEA Form 222, Safe Harbor qualification of encrypting PHI data at rest, electronic file transfers, and avoidance of data breaches. Its Liaison Protect solution makes sure you are securing your databases, integrating encryption, tokenization, key management, and logging. Its Liaison Exchange managed file transfer software suite allows cost-effective management of ever-increasing volumes of file transfer exchanges both inside and outside the organization. If you need to accelerate your HIE or ACO efforts, securely share patient information with other organizations, or gain control over risky and poorly monitored file transfers, give their offerings a look. Thanks to Liaison Healthcare Informatics for supporting HIStalk.

Inga mentioned the reader survey — you have one last chance to provide input that we’ll use to plan the next year of HIStalk. Thanks. It really does help us given that we work largely in a vacuum and have to pick and choose our projects since we have limited time to get things done.

For our numbers-obsessed reader(s), we had a record-breaking 125,867 visits in February, along with 196,565 page views. The e-mail blasts go out to 7,935 subscribers, while Dann’s HIStalk Fan Club has 2,268 members (OK, I admit that we’re not entirely comfortable with the idea of having fans, but it’s slightly satisfying to reflect on that fact during our frequent bouts of feelings of inadequacy and lack of accomplishment.) You can move our emotionally needy needles by (a) subscribing to the updates; (b) connecting with us on Facebook, LinkedIn, and Twitter; (c) supporting the sponsors who support us by poring over their ads, clicking those of interest, checking out their Resource Center pages, use the Consulting RFI Blaster to quickly solicit consulting help; (d) sending us news, rumors, guest articles, or anything else that would interest your fellow readers; and (e) feeling the positive thoughts Inga, Dr. Jayne, and I are beaming your way for supporting what we do in whatever form that support takes, which means a lot to the ladies and me.

A reader asked about WellStar’s ambulatory EMR project. I have the information, but agreed to sit on it for a few days. Stay tuned.

The overachievers at API Healthcare, not content to simply mail Gabe Davis (right) of Texas Health Partners his iPad prize from the recent Booth Crawl after he had to leave the HIMSS conference early, sent VP Kyle Allain (left) to his office to hand-deliver “the famous HIStalk iPad” personally. This was Gabe’s first trip to HIMSS and he had nice things to say about HIStalk and API’s support of it. His 16-year-old son will get the iPad and is apparently pretty stoked about it, and rightfully so because iPads are darned cool even if you aren’t an Apple fanboy.

On the Jobs Page: Financial Systems Consultants, Meditech CPOE Go-Live Support, Epic Certified Builders. On Healthcare IT Jobs: Senior Health Information Technology Specialist, Implementation Consultant, Project Manager CMIO Informatics, McKesson Paragon Consultants.

I’m taking a little break to escort Mrs. HIStalk to somewhere warm and sunny where laptops are as rare as bathing suit tops (OK, I’m kidding on that one) so the eminently capable Inga and Dr. Jayne will be holding down the fort as I try to fight the urge to stay off e-mail (I’m rarely successful.) I don’t know about you, but I’m really tired after all the HIMSS-related activities over the past few weeks and I want to see what it feels like to sleep more than five hours in a single night.

Acquisitions, Funding, Business, and Stock

Teledermatology provider Iagnosis raises $1 million from 11 investors.

Accretive Health releases its Q4 numbers: profit of $13.2 million ($0.13/share) compared to last year’s $5.5 million ($0.06/share.) Net services revenue grew 53% to $260.1 million.

HP Enterprise Services notifies the State of Wisconsin that it will be eliminating 157 Medicaid program jobs in Madison and Milwaukee.

Sales

DR Systems announces six new contracts for its Unity platform totaling more than $2.07 million.

Cancer Treatment Centers of America signs an agreement to deploy Unibased Systems Architecture’s ForSite 2020 application suite across all its facilities.

People

Beacon Partners appoints Christina Bertsch (EMD Serono) VP of human resources.

The National Quality Forum board of directors announces that President and CEO Janet Corrigan will resign as of June 2012.

HHS Office for Civil Rights names attorney Juliet K. Choi (American Red Cross) as chief of staff and senior advisor.

Announcements and Implementations

Four Lakeland Healthcare (MI) hospitals go live on their $50 million Epic system.

T-System licenses its clinical terminology to Prognosis HIS, allowing Prognosis to incorporate into its ChartAccess EHR more than 200,000 clinical phrases.

MED3OOO chooses Macadamian to help develop a new product that it says will expand the usability and adoption of its ambulatory systems.

Shareable Ink incorporates Pentaho Business Analytics to create a data analytics platform for healthcare.

Michigan Health Connect wins second place in an IT innovator awards contest for its electronic referrals solution app, powered by Medicity’s iNexx, that was rolled out to nearly 1,000 physicians over 28 counties. 

Government and Politics

The Advisory Board Company does a nice high-level summary of the proposed Meaningful Use Stage 2, nice for CIOs prepping peer execs for what the IT agenda will look like.

In England, two NHS trusts seek a supplier to take over their IT help desk and infrastructure in what would be the first outsourcing contract of its kind. The deal is valued at  $50 million.

I liked Doug Fridsma’s post on HHS’s blog about the Interoperability Showcase at HIMSS. He says Farzad Mostashari showed up there by surprise and challenged the participants to demonstrate impromptu interoperability with another participant with whom no relationship existed. He gave them one hour to make it happen technically, which involved overcoming challenges such as authentication certificates, vocabularies, and firewalls. The result: NextGen sent a C32 to Allscripts, EXCITA HIE and Medical Informatics Engineering exchanged a transfer of care document in ER discharge summary format, and Enable Healthcare sent a CCDA discharge summary to Verison to create a new patient chart. That’s pretty cool.

Other

Ochsner Health System (LA) announces that its neurologists recently completed their 1,000th patient consult as part of Ochsner’s  telehealth stroke treatment program.

KLAS reports that some providers are concerned with a number product gaps and weaknesses in the McKesson Paragon product and wonder if Paragon can scale to larger hospitals, especially those with more than 400 beds.

Jackson Health System (FL) announces the layoff of more than 1,000 people in an effort to save the organization $69 million.

Trinity Health’s Michigan hospitals sign an agreement with University of Michigan to explore ways the organizations can work together to coordinate care, with one of the areas of discussion being information technology. 

A physician’s assistant who sued her former employer, Mercy General Hospital (CA), for sexual harassment is awarded $167 million.

The folks at MED3OOO asked Inga and me to choose and announce a winner from the six finalists in their contest to create the best video testimonial. They offered to pay for our time, but we said it either had to be (a) free to them because they’re a sponsor, or (b) if they really wanted, they could donate whatever amount they wanted to a charity of our choice. Thanks to MED3OOO for their donation to Best Friends Animal Society, a highly rated charity whose mission is “to bring about a time when there are no more homeless pets.” And congratulations to the winner, Kyle Adkins, administrator of Golden Valley Medical Clinics of Clinton, MO (he’s in Interview 1 on the finalist page) which implemented the InteGreat browser-based EHR from MED3OOO. My favorite quote: “You don’t ever make this decision well the second time or a third time. You may make a better one if you’ve made the wrong decision, but there will be someone else making the decision.” Great job, Kyle, and for that you win an all-expense paid trip to MED3OOO’s 2012 National Healthcare Leadership and Users Conference in St. Thomas, US Virgin Islands in October.

Sponsor Updates

• World Wide Technology is sponsoring Geek Day 12 in Washington DC, April 11-12, complete with showcase labs, breakouts, and birds of a feather session divided by industry focus. The event is free and so is lunch.
• API Healthcare partners with Presagia Software to offer Presagia’s workforce absence management solutions to API clients.
• ProHealth Care (WI) goes live with iSirona’s connectivity technology to deliver patient data from anesthesia monitors into Epic EMR.
• A survey by BridgeHead Software finds that most hospitals want vendor neutrality with more control over their image data.
• Black Book names Quest Diagnostic’s Care360 EHR the best EHR for single physician practices and for e-prescribing. It was also ranked eighth on Capterra’s most popular EMRs.
• Alexander Orthopaedic Associates (FL) selects White Plume Technologies’ AccelaSMART resolution engine to bridge the gap between its Exscribe EHR and ADP’s AdvancedMD’s PM system.
• MEDSEEK and BrightWhistle partner to offer a search and social media marketing solution.
• Lawson Software enhances its Cloverleaf Secure Courier and Global Monitor for its Cloverleaf Integration Suite to increase speed and provide greater connectivity.
• New York-Presbyterian Hospital goes live with Awarepoint’s RTLS at its Columbia University Medical Center campus.
• Aventura will participate in the World Congress Inaugural eHealth Innovation Conference this month in Cambridge, MA.
• Santa Rosa Consulting advisor Matt Wimberley  discusses confidentiality, integrity, and availability in the HIPAA security rule.
• Bruce Friedman MD, emeritus professor of pathology at University of Michigan Medical School, keynotes at the Lifepoint Informatics User Conference 2012.
• Evergreen Healthcare (WA) shares how API Healthcare’s Time and Attendance and Staffing and Scheduling technology helped the organization get its productivity and costs under control.
• MedAptus launches a revenue cycle reporting and performance analytics module for its Professional solution.
• Coastal Cardiovascular Consultants (NJ) will implement the SRS EHR at two locations for its six providers.

EPtalk by Dr. Jayne

The American Journal of Preventive Medicine recently published an article about cybercycling. It shows that riding a stationary bike which hooked up to interactive videogames could increase brain function in older adults compared with a standard exercise bike. Elderly study participants who took 3D tours and raced computer generated avatars showed better memory, attention, and problem-solving abilities. Not surprisingly, some reported knee and back pain as well as “frustration with interacting with a computer.” Now we just have to wait for a vendor to allow the cybercycling data to flow through the patient’s PHR into their EHR charts.

Shades of Eliot Ness: Even without federal approval, Illinois is getting tough on Medicaid fraud. The state will start matching Medicaid patient data with the state driver’s license database to make sure only Illinois residents are receiving benefits. Applicants would also have to show additional proof of income to maintain benefits. Even without federal blessing, this seems like a reasonable idea – recently 6% of Medicaid cards were returned as undeliverable or having an out-of-state forwarding address.

It looks like there might be another way for vendors to expand their offerings. The Department of Health and Human Services recently announced plans to look as far back as 10 years when auditing Medicare overpayments. I forsee a whole new subset of vendors offering data archiving and retrieval specifically for Medicare billing. As Medicare goes, so go the rest of the payers, so it’s only a matter of time before providers are forced to maintain massive amounts of data. And we thought seven years for the IRS was bad.

For those of you who work directly with providers, it will be interesting to see how upcoming changes to the Medical College Admission Test (MCAT) affect the physician pool. The test is being updated to gauge “knowledge of the psychological, social, and biological foundations of behavior” as well as critical thinking skills. The goal is to “better prepare students to be doctors in today’s changing health care system.” It will be interesting to see if this really makes a difference in patient care, but I do hope it will also make a difference in being able to intervene with colleagues who are ripping their hair out due to the continuous onslaught of ever-changing federal and payer regulations.

USA Today reports that Hawaiians rank at the top for residents having the best overall sense of well-being. Don’t attribute it all to the sunlight and tropical breezes though – North Dakota, Minnesota, and Alaska also made the top ten. West Virginia finished last. Gallup gathered the data by calling 1,000 people daily for all but 15 days of 2011.

I’m still poring over all the Stage 2 documentation that’s coming across my desk (and phone, and e-mail, and the water cooler) and for better or worse, it seems like I’ve become comfortably numb as far as finding something noteworthy to discuss. Have a thought about your interpretation of those 455 pages of bliss? E-mail me.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

CIO Unplugged 2/29/12

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

Are You an Insider?

My siblings and I took a beating from our peers because of the Bavarian clothes our parents insisted we wear long after our arrival in USA. We were, however, embraced on the futbol pitch. The seven of us kids had the benefit of growing up on the soccer field in Germany. When we arrived here in the mid ‘70s, American soccer was in its infancy. Coaches welcomed our soccer finesse, experience, and smarts. It took time for our teammates to accept us foreigners who played with a different style, but our impact proved undeniable.

What was good for those teammates is equally good for IT.

One of my first healthcare jobs held a single yet challenging objective: “make docs happy.” In that competitive environment, physician loyalty was paramount. My role was one-third ombudsman, one-third consultant, and one-third party planner.

I loved it. I met with physicians daily to make sure their concerns and ideas were appropriately vetted with hospital administration. I dived deep into practice management and provided consulting services ranging from business development to system selection to establishing regional CME events. The most enjoyable aspect was organizing some serious parties to celebrate accomplishments and recognize the medical staff and their contributions to our healthcare system.

Despite my established healthcare background, I transitioned into the position of IT director as an outsider. I brought with me a different skill set. I viewed things differently from my tradition- oriented IT peers.

It was not easy for me or my new cohorts at first, but we helped each other. Mixing outsider perspective and experience with solid IT operations made for a dynamic environment resulting in vastly improved performance and outcomes.

As a believer in the diversity approach, I’ve purposefully sought to develop teams comprised of traditional and non-traditional workers. In a former post, “Got Clinicians?” I share the absolute necessity for ensuring appropriate clinical insights. Now I aim to encourage you to build a healthy mix of non-healthcare experienced talent into your fold.

Most would agree that healthcare, conservative by culture, is three to five years behind the technology curve. Bringing in outsiders who have worked in progressive industries such as finance or international business will help push the organization forward and help ensure currency. Not just currency, but also what is on the horizon. A couple of the chief technical officers I’ve hired have had zero healthcare experience. On both occasions, my organizations experienced a massive technological bounce.

Promoting only from within will continue to retard the growth curve as compared to other industries. It’s all about striking that healthy balance.

So, what about you and me? Even outsiders eventually become insiders. How do we stay fresh and think with the objectivity of an outsider? Spend at least 50% of your learning outside of healthcare.

Some methods to avoid becoming a healthcare IT junkie:

• Conferences. Choose wisely. Skip HIMSS every other year and go to the consumer electronics show instead. You will see things that will eventually be shown at HIMSS three years later.
• Blogs. Read posts that are on the bleeding edge.
• Magazines. Check your subscriptions. At least half should be outside of healthcare and, of course, a high percentage should be business and non-technical.
• Peers. Spend time with non-healthcare peers. I previously posted on how we compare notes regularly with companies in different verticals. Next up, Kimberly-Clark.
• Organizations. Actively participate in professional groups such as SIM where you are exposed to peers from across industries.
• Hiring. Keep yourself on your toes by hiring outsiders who are smarter than you.
• Diversity. Don’t hire your twin
• Advisory boards. Participate in those that are vertical agnostic.

Fitting in to please everyone is a worthless pursuit. Avoid that temptation. Hiring outsiders is healthy for your team. This will create more opportunity as new technologies are transferred to the team. Hiring outsiders is beneficial to your organization as you begin to deploy new tools that will enable mission fulfillment. Hiring outsiders advances healthcare. You’ll leverage technology and help reduce the cost of healthcare, elevate patient and clinician satisfaction, and ultimately improve the quality of care.

Most of us German-transplant kids had successful soccer careers in high school and beyond. We helped our coaches take our teams to the next level. Goal! And for at least a few hours each week, we were free from our lederhosen.

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.