News 1/25/12

Top News

MedQuist Holdings changes its name to M*Modal, which is the business MedQuist acquired last year for $130 million in cash. CEO Vern Davenport rang the Nasdaq opening bell to commemorate the company’s rebranding and new MODL trading symbol. The company also confirms that most of its executives will work from an office to be opened in Raleigh, NC while company headquarters will remain in Franklin, TN.

Reader Comments

From Lourde: “Re: Party attire. I finally found my shoes for the party last night. Super excited that that is off my plate!! Choosing the perfect shoe – so ‘stressful.’” I feel your pain. I will admit to no one how many pairs of shoes I have bought in the last month because I keep finding what I think are the “perfect” pair. Since we are talking shoes, it’s a good time to mention that this year’s Inga Loves My Shoes contest during HIStalkapalooza will include special shoe categories. Our judges (Lindsay Miller of RelayHealth and Timur Tugberk of DrFirst) have not yet revealed the categories, but I promise to share more soon. Meanwhile, if you are seeking fame in the overall best dressed contest, keep in mind you’ll have an opportunity to be crowned HIStalk King and HIStalk Queen, as well as Best Elvis Impersonator and Best Attire Left in Vegas. Ladies and gentleman, start your shopping.

From Party Central: “Re: invite from DIVURGENT. We are hosting our Kingpin Bowling Social event Monday night during HIMSS. It’s at 8:00 pm at the Palms Casino and Resort Kingpin Suite and we’d love HIStalk readers to join us.” Sounds fun and gives me an excuse to wear my bowling shoes! Here’s the invite and RSVP information.

From Number Cruncher: “Re: Practice Fusion. Their latest press release indicates 130,000 users. Are those all doctors?” The Practice Fusion folks tell me that about 40% (about 52,000) are physicians. I asked for clarification to understand if the 52,000 physicians were all considered “active” users, but not yet received a reply. Regardless, assuming the US has 600,000 office-based physicians, the 52,000 figure would give Practice Fusion about 8.5% of the market.

From GilaMonster: “Re: Awarepoint. Has laid off 10% of its workforce.” We asked the company, with this response from Merrie Wallace, EVP of product solutions and marketing:

Awarepoint has seen a record-setting year for sales contracts and hospital implementations in 2011. Along with its steady growth last year, Awarepoint strategically acquired Patient Care Technology Systems (PCTS) in order to become the only complete RTLS solution optimizing healthcare workflow. After the acquisition, an analysis of the workforce revealed duplicate positions and a decision was made to restructure the workforce. Around 10 positions have been consolidated, though Awarepoint continues to hire strategic positions to support growth and customer support.

From RS: “Re: Catholic Healthcare West. Just changed their name to Dignity Health.” The 40-hospital CHW also drops its Catholic Church affiliation and opens up its governing board to non-Catholics, although its 25 Catholic hospitals will retain the sponsorship of local congregations. The press release mentions the $1.8 billion it is investing in electronic health records. The organization announced plans to triple its revenue, so the change allows it to acquire and partner with hospitals without running afoul of church policies.

HIStalk Announcements and Requests

Our own Travis Good MD of HIStalk Mobile will serve as a guest speaker of a January 31 Kony Solutions webinar, Mobile Strategy for Pharma – Opportunities and Challenges.

Acquisitions, Funding, Business, and Stock

The Advisory Board expects to realize a $3.5 million gain on its recent sale of its OptiLink business to Kronos. Also, Texas Governor Rick Perry announces that his state will invest $500,000 in The Advisory Board, which plans to create more than 200 jobs and invest $8.1 million to expand its Texas operations.

Sales

Rockingham Memorial Hospital (VA) selects Amcom Software’s messaging and communications solutions.

The VA contracts with Decision Simulation’s virtual patient platform for its simulated training and education program for healthcare providers and educators.

Montrose Memorial Hospital (CO) selects PatientKeeper’s application suite.

Unity Health System (NY) chooses dbMotion’s interoperability platform for its 70 locations.

CentraCare Health System (MN) picks iSirona’s device connectivity technology to deliver patient data from its ventilators into its Epic EMR.

Cooley Dickinson Physician Hospital Organization (MA) signs a contract for MedVentive Risk Manager, which it will use to manage its new Alternative Quality Contract with BCBS.

Intermountain Healthcare chooses the mobile application development platform from Kony Solutions to develop its own apps.

The State of New York chooses First Databank and Ernst & Young to survey drug average acquisition costs, a Medicaid reimbursement benchmark authorized by the legislature in 2011.

People

GE Healthcare IT appoints Michael Jackman VP and GM of its specialty solutions business. He was previously with iSoft, Carestream Health, and Kodak.

The Huntzinger Management Group names William C. Reed VP of business development. He’s the former president and CEO of AllOne Health and CIO of Geisinger Health System and Thomas Jefferson University Hospital.

Rubbermaid Medical Solutions names Cheryl D. Parker, PhD, RN-BC, FHIMSS as its chief nursing informatics officer. She was previously with Motion Computing.

Noel Williams, CIO of HCA, announces her retirement, effective at the end of May.

M*Modal names Amy Amick as COO. She was previously GM of worldwide services for Microsoft’s Health Solutions Group.

Mediware promotes VP and Controller Robert W. Watkins to CFO.

Announcements and Implementations

Kaiser Permanente announces that its 9 million patients can access their medical information on a new, free Android app, with an iPhone version to follow in a few months. It offers appointments, secure e-mail, lab results, refills, and a facility locator, all available to both patients and their families acting on their behalf.

UPMC moves all its electronic transactions with suppliers to Toreion’s EDI exchange solution.

Isabel Healthcare and BMJ Group partner to offer Best Practice, which combines Isabel’s diagnostic tools with BMJ’s clinical content. BMJ publishes the British Medical Journal and is a wholly owned subsidiary of the British Medical Association.

Cerner chooses TrustHCS to provide its clients with ICD-10 education.

Innovation and Research

Children’s Hospital Boston offers a $25,000 prize to the researcher who develops the winning best practices for communicating the information found in a patient’s genome to physicians and patients to improve outcomes. The prize carries one of the most contrived and awkward names ever – CLARITY, which they explain stands for “Children’s Leadership Award for the Reliable Interpretation and appropriate Transmission of Your genomic information.” One of the three project leaders is Isaac Kohane MD, PhD of the Children’s Hospital Informatics program. Applications are due March 12.

Technology

Tanking BlackBerry maker Research in Motion continues its unbroken streak of questionable decisions, naming one of its two low-visibility COOs (the one in charge of the RIM’s Playbook tablet, whose sales were so bad even at $99 fire sale prices that the company had to write down $485 million) to replace its two recently department co-CEOs. The new boss says he will mostly follow the path set by his predecessors, except he will hire a chief marketing officer. Shares have dropped 80% from their February 2011 price and took another 4% hit on the CEO announcement.

Apple’s Q1 numbers: revenue up 73%, EPS $13.87 vs. $6.43, crushing estimates with the its highest-ever revenue and profit. In the quarter, the company sold 37 million iPhones (up 128%), 16 million iPads (up 111%), 5.2 million Macs (up 26%), and in the only negative news, 15.4 million iPods (down 21%). The company has $98 billion of cash in the bank. Your $10,000 investment three years ago would be worth more than $50,000 today.

Other

Medical records scanning and document management company EDCO Group will increase the number of employees in its Sioux Falls, SD facility from 40 to 70, helped out with development money from the state’s workforce commission.

Weird News Andy says this isn’t weird, just cool, even though he’ll pass on a spot on the camera recovery team. Researchers in Israel take the “pill cam” intestinal camera system to the next level by developing a version that can be steered by the magnet of an MRI machine.

In a rare public appearance by an Epic executive, COO Steve Dickman provides some company facts to a local technology group:

• 2011 sales exceeded $1.2 billion, up 45% from 2010
• The company expects to add 30 large customers this year
• Construction continues on a new 11,000 seat on-campus auditorium
• 38% of US patients are covered by an Epic product
• The company hires 1,500 new employees a year from 150,000 submitted resumes
• Only five employees work in sales, while 55% do implementation and support
• The average employee age is 29
• The company says it has no interest in buying competitors or being acquired itself

The Wall Street Journal runs a point-counterpoint article on whether the US should implement a national patient identifier. Arguing for: Michael Collins MD, chancellor of the University of Massachusetts Medical School. Arguing against: Deborah Peel MD, psychiatrist and founder of Patient Privacy Rights. Reader votes are running 59% no, 41% yes.

An Ohio hospital’s transparency policy regarding medical errors blows up in its face when the chief medical officer tells the family of a deceased knee surgery patient that his death was caused by malfunctioning lab equipment, which delayed reporting of the high serum potassium level that contributed to his heart attack. Unbeknownst to the hospital, the family had smuggled a tape recorder into the meeting and used the chief medical officer’s recorded admission as evidence in its wrongful death lawsuit against the hospital.

A Florida jury finds that an HCA-owned hospital allowed an uncredentialed surgeon to perform gastric bypass surgery on a patient who suffered brain damage. They award the patient $178 million.

Stanford University researchers find that women report feeling about 20% more pain than men for unknown reasons. Previous studies found that women are more likely to tell doctors about their pain and to delay seeking treatment for it. Here is my theory: men like to be perceived as macho, especially if they happen to be under the care of a cute nurse of the opposite sex. Meanwhile, women feel more cumulative pain between the experience of childbirth and the subsequent carrying of infants, toddlers, kids, and 40-pound bags of dog food. All that, of course, while wearing four-inch heels.

Sponsor Updates

• Humedica and West Health Policy Center announce their collaboration to identify healthcare cost drivers that can be lowered through the use of technology.
• Premier Healthcare Alliance Inc announces a group purchasing agreement with UltraLinq Healthcare Solutions.
• Ingenious Med extends its mobile offerings to Android mobile devices.
• Sparrow Laboratories uses EMRHub from Lifepoint Informatics to send lab results to provider EMRs.
• MEDecision achieves full pass certification for its interoperability tests at the 2012 IHE Connectathon.
• NextGate announces its successful testing of MatchMetrix EMPI at the IHE Connectathon 2012.
• Commonwealth Orthopaedics (VA) selects SRS for its 91 providers.
• McKesson announces an ICD-10 transition service.
• Aspen Advisors publishes a case study on its ICD-10 readiness assessment for East Jefferson General Hospital (LA).
• Jon Phillips of Healthcare Growth Partners discusses his firm’s trade show strategy for HIMSS.
• CHRISTUS Health (TX) selects Compuware’s Gomez Platform to optimize the performance and availability of its EHR.
• AT&T announces communication and infrastructure tools to allow providers to use tablets and messaging more securely.
• Over 10,000 New York State healthcare providers had enrolled in either the NYC Health Department’s NYC REACH program or the NY eHealth Collaborative by the end of 2011.
• Intelligent InSites offers a January 25 Webinar on applying RTLS visibility and lean production principles to healthcare.
• MEDSEEK announces support for the ONC’s “Putting the I in HealthIT” program, which seeks to empower patients to become partners in their own health.
• DrFirst releases a Healthcare Hero video, also offering a HIMSS conference night on the town (limo, dinner, and show) as a prize to one selected person who leaves a comment on the video’s YouTube page.

Contacts

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

EHR Design Talk with Dr. Rick 1/23/12

Computer-Centered versus User-Centered Design

Within the next few years, most physicians in this country will have converted from paper-based charting to electronic health record (EHR) technology. This is an unprecedented technological change in healthcare delivery. Whether this technological transformation succeeds will in large part depend on the design of the EHR software itself.

As a physician in clinical practice, my day-to-day care of patients depends in large part on how easy or difficult it is to interact with my EHR. Like many of my colleagues, I find that while my EHR provides all the necessary functionality, using it requires too much cognitive effort. In other words, the EHR design is computer-centered instead of being user-centered.

What’s the difference between computer-centered and user-centered design? Let me give an example.

Imagine that you and your very young son have recently started playing tic-tac-toe against each other on two networked computers. Your son thinks he should be winning more games, so he proposes a change, not in the rules, but in your screen view, in order to make the odds more even.

While his screen view of the tic-tac-toe grid will remain the same, your screen view will no longer be the standard three-by-three grid, but rather will be a single row of nine boxes.

He enlists his older sister, who is great with computers, to program your new user interface. Each of you can only see your own screen.

The first three boxes in your row correspond to the three boxes in the top row in his grid, the next three boxes in your row correspond to the three boxes in the middle row of his grid, and the last three boxes in your row correspond to the three boxes in the bottom row of his grid.

So, for a particular game, your respective screen views would be as follows:

All of the sudden, you find that you’re working pretty hard just to play tic-tac-toe. You’re working hard because you can no longer ‘see’ the problem.

First you have to mentally reconstruct the normal three-by-three tic-tac-toe grid, then mentally segment your row of nine boxes into three groups of three, and then transpose each segment back onto the appropriate part of the tic-tac-toe grid that you are keeping in your head. (Alternatively, you might decide to solve the problem using a different strategy, but that would still require cognitive effort on your part.)

With a lot of effort, you’re able to stay pretty even with your son, but then your daughter introduces a second challenge — a two-second time limit for each move. At this point, your son starts winning a lot more games than you, restoring family harmony.

What is interesting about this example is that, from a logical perspective, the two screen views contain exactly the same amount of information. And, in fact, if a computer program were using an algebraic algorithm to play tic-tac-toe against you, the screen view would be immaterial.

But for humans, it is clear that the grid view works better. It works because we can literally ‘see’ the solution.

If we see a tic-tac-toe grid, we can visually superimpose horizontal, vertical, or diagonal lines at will. If we are faced with the game position below, we don’t have to compute the slope of the line passing through the two Xs or solve an equation to know whether that line would also pass through the square on the bottom right.

In other words, the human brain is an extremely powerful computer, but one that evolved to help us survive in the physical world by making sense of our spatial environment. Our brain is almost always better at solving problems visually than by using formal logical or mathematical operations.

Donald Norman, a cognitive scientist and pioneer in applying human cognition to design, has written extensively on this topic. In Things that Make Us Smart, he devotes a chapter to why certain design variants are easier for humans than others, even if the variants are formally identical. He includes one diabolical example which turns tic-tac-toe into a variant of Sudoku.

Humans enjoy solving mental games and puzzles for fun, which is why we invent things like Sudoku, but we don’t enjoy them at all when they interfere with complex tasks. Physicians need to be able to devote their full cognitive attention to patients in order to help solve their very real health puzzles.

As physicians, we need user-centered EHR designs that take advantage of our innate visual and spatial perceptual abilities and stay in the background, instead of competing with patients for our finite cognitive resources. Far too many EHR designs force us to play linear tic-tac-toe.

Next post:

Why T-Sheets Work

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.

Curbside Consult with Dr. Jayne 1/23/12

I was inspired by Ed Marx’s post last month, Transformation Through the Written Word. He talks about doing book studies with his direct reports, which then expanded throughout the workplace. The thing that most fascinated me about Ed’s piece was his book list. Having been the victim of a boss who tortured his team with 17 Irrefutable Laws of Teamwork, I was surprised (and quite pleased) to find books on his list which didn’t scream “teamwork!” or “leadership!” or “business!”

I’m a voracious reader, although lately I’ve been reading some fairly insubstantial fluff in an attempt to reduce stress and achieve relaxation. One of my best friends keeps recommending things like The Mathematics of Life or The Omega Theory,  but I just can’t seem to get into the mode for deep thinking.

I liked the fact that Ed’s list is eclectic – it includes James and the Giant Peach and Disney psychology along with the classic management and leadership-themed works. One of my personal favorites is The Checklist Manifesto: How to Get Things Right  by Atul Gawande. This book should be required reading for everyone who does anything which remotely impacts patients or other living things. I’ve liked Atul Gawande since reading his first book, Complications: A Surgeon’s Notes on an Imperfect Science, years ago. It helped to make sense of the things I encountered during training and in understanding the psychological complexity of events physicians are exposed to.

Speaking of psychological complexity, I’m already tired of the run-up to the November elections. One of the hot topics is healthcare reform. I’m not convinced that any of the candidates is qualified to actually speak to the issues. The general public gets pulled into the rhetoric as well. I end up discussing healthcare politics with a patient at least a couple of times a day. I recently ran across a book that should be required reading for anyone who thinks they are educated regarding the delivery of healthcare in the United States.

I don’t want to turn into Oprah, but I’m throwing it out there as the first “Dr. Jayne’s Book Club Challenge.” Some talking points from my friend Doug Farrago (of Placebo Journal fame) really sum it up:

• Our society has warped our perception of true risk. We are taught to fear vaccinations, mold, shark attacks, airplanes, and breast implants when we really should worry about smoking, drug abuse, obesity, cars, and lack of basic hygiene.
• Somehow we have developed an expectation that our health should always be perfect.  We demand unnecessary diagnostic testing, antibiotics for our viruses, and narcotics for bruises and sprains. And due to time constraints on physicians, fear of lawsuits and the pressure to keep patients satisfied, we usually get them.
• The bottom line is that most conditions are self-limited. “Our best medicines are Tincture of Time and Elixir of Neglect.”
• There is tremendous financial pressure on physicians to keep patients happy. But unlike business, in medicine the customer isn’t always right. Sometimes a doctor needs to show tough love and deny patients the quick fix. A good physician needs to have the guts to stand up to people and tell them that their babies gets ear infections because they smoke cigarettes. That it’s time to admit they are alcoholics. That they need to suck it up and deal with discomfort because narcotics will just make everything worse. That what’s really wrong with them is that they are just too damned fat.  Unfortunately, this type of advice rarely leads to high patient satisfaction scores.

It’s available now from Amazon, although not yet in Kindle format, which I know will make some of you sad. If you’ve read it, let me know what you think. And if you know anyone in politics, feel free to leave copies on their desks.

E-mail Dr. Jayne.

Monday Morning Update 1/23/12

From KC HIT BootsOnGround: “Re: Missouri’s statewide health information network. A rumor no more … Cerner will not serve as the technical service provider. Statement attached.” Above are last April’s announcement that negotiations had commenced and Thursday’s announcement that they have ended.

From Al Faretta: “Re: Baptist Montgomery. Just wanted to let you know that our clinical system is not McKesson – it’s Cerner. Thanks for all you do – I start my morning with you!” Thanks. That eliminates McKesson’s sole entry in the Thomson Reuters Top 15 Hospitals list and boost’s Cerner’s presence there.

From Karen Thomas: “Re: Main Line Health. I wanted to clarify the systems used at Jefferson Health System, JHS. JHS is comprised of Main Line Health and Thomas Jefferson University Hospital. TJUH uses GE as their EMR. The Main Line Health System uses Siemens Soarian in four of our hospitals and Cerner in one of our hospitals. I understand that this does not change the point of the author, George, but I thought I should point out that GE is not the EMR for JHS. Also, all the Main Line Health hospitals have recently achieved HIMSS analytics Stage 6 designation.” Thanks for the clarification. Karen is VP/CIO of Main Line Health.

From PharmGuy: “Re: Prognosis Health Information Systems. The CTO, who was the brains behind the company and a co-founder, is gone.” I asked Prognosis President and CEO Ramsey Evans about Isaac Shi. He responded as follows:

Isaac is a co-founder of Prognosis and remains a significant shareholder. He has the gift to see the “big picture” and introduce innovative solutions to the marketplace. His leadership of our ChartAccess EHR has been the foundation of our rapidly growing company. As you realize, our marketplace demands a fully integrated clinical and financial solution. As a result, we’ve broadened our focus and Isaac’s responsibilities changed as our strategy has evolved. With the 2006 vision now becoming a reality and confidence in our path forward, Isaac made a decision to look at some other opportunities to expand on his vision. He remains in good standing with Prognosis and is very supportive of our company’s direction.

From Alzado: “Re: separated at birth? Being an HIT guy and a music connoisseur, I figured you would recognize the resemblance.” I do, but I’ll leave it up to readers to figure out how those categories fit this photo. Hint: two first names, both starting with J.

From Pippy: “Re: HIStalkapalooza. Have the invitations gone out yet?” Everybody who signed up will get a response by the end of the week, hopefully – either an invitation or an apology that we couldn’t invite everyone (it’s about 50-50 since we had over 1,000 requests). As much as I like hearing from readers, I respectfully request (based on experience from previous years) that folks don’t e-mail Inga or me to ask (a) what happened to their e-mail, since we can’t control your spam filters, or (b) if we can slip them an invitation even though they didn’t get one or didn’t register in the first place. I’m already overwhelmed. But here’s some good news – next year’s HIStalkapalooza in New Orleans is already somewhat underway, with a sponsor and venue secured. I’m really lucky that companies volunteer to underwrite not only the cost of putting on the event, but to manage the surprisingly complex logistics required to do it right for readers.

From The PACS Designer: “Re: Blue Button initiative. TPD was first introduced to healthcare blogging by Shahid Shah, a fellow blogger, who started HITSphere to power this whole healthcare phenomenon by highlighting HIStalk and other websites. Now, he has blogged about the VA’s Blue Button Initiative and what he sees as its key benefits. Since it is on the NHIN Watch website, you’ll have to create an account there to read his seven key positives of the project. ”

The level of HITECH payouts is about what most readers expected, although a significant minority thought it would be more. New poll to your right: what do you like best about the HIMSS conference?

My Time Capsule editorial from 2007: Crossing the Cliché Chasm: Banished HIT Words for 2007. It obviously wasn’t effective since most of 2007’s overused words are still being repeated endlessly. A snip: “Thought leaders – people smarter than you and me, at least in their own minds. Companies often present their high-ranking employees as thought leaders when they want to sell you something. Thought leaders don’t have real jobs –they just think and cling to HIMSS podia. Picture that Rodin statue wearing a suit or black turtleneck and bringing Dilbert-laced PowerPoints.”

I just noticed that with increasing readership, we’ll be close to hitting the 5 millionth HIStalk visit right around when the HIMSS conference starts. That’s since I started it, way back in June 2003. I sometimes question whether it’s worth the effort, but I still have a blast doing it every single day, as much or more than I did 8.5 years ago.

Listening: I got several outstanding recommendations from reader Cody, including one I posted here way back in 2007 that deserves a revisit: The Hives, a hard-working Swedish garage rock band that doesn’t take itself too seriously (they wear matching but ever-changing black and white costumes and use old-school corded instruments) playing real, raw rock music with a stage presence and energy that makes them probably the best live band in the world. Proof: the live versions of Tick Tick Boom or Hate to Say I Told You So, which is like a 40-years-ago Mick Jagger without the scowling. They’re playing Coachella in April and my MP3 player starting today. When it comes to music, it’s not about their look, their audience demographic, or their age – it’s about how their music makes you feel. If you can sit immobile while The Hives are playing, then we differ.

Vince’s HIS-tory this week pays tribute to Bill Corum, who passed away earlier this month. Vince will have some fun stuff upcoming – I got an e-mail from Elaine Heusing, whose enjoyed seeing a cover of the magazine her father produced, Healthcare Computing and Communications, on one of Vince’s slides. I suggested to Vince that he cover some of those publications of yesteryear and the people who put them out. Back in the day, you waited anxiously for your mail copy of the magazines (even thought most of them were 70% ads, with mostly harmless and vendor-friendly prose intended to not threaten that ratio) and even faxed copies of newsletters like H.I.S. Insider. The folks who published those magazines and newsletters were highly respected, many of them with healthcare IT experience that went above just writing about it.

Welcome to new HIStalk Platinum Sponsor First Databank. The company requires minimal introduction since its electronic drug databases power a great number of the clinical IT systems out there, but here’s a recap. The San Francisco-based FDB’s team of pharmacists, physicians, and technologists, working with its system developer customers, turn drug information into tools that reduce medication errors by empowering clinicians as they make medication-related decisions: drug information, drug selection, clinical decision support, clinical alerts, and patient education. FDB has developed the first physician-friendly CPOE drug database, the OrderView Med Knowledge Base, that gets clinicians quickly (two clicks, in many cases) to the desired medication without bogging them down with needless details related to dispensing or billing (making prescribers choose a warfarin 5 mg and a warfarin 2 mg to get the desired dose of 7 mg is lame – that’s a dispensing decision that prescribers shouldn’t have to worry about.) The company offers case studies of how developer customers have used its products: Design Clinicals (medication reconciliation), athenahealth (meet Meaningful Use requirements), DMD America (drug pricing analysis), and Personal Caregiver (consumer drug information for mobile devices). FDB, whose vision is “A World Free of Medication Errors,” has been delivering drug knowledge solutions for over 30 years and it was recently ranked #1 among drug database vendors in nearly all key indicators in the just-published KLAS report on clinical decision support. Thanks to First Databank for supporting HIStalk.

The Virgin Islands Health Department conducts an EMR and HIE town meeting with mixed results. An interventional cardiologist talks up how much he likes the EMR, but loses his computer connection while demoing it, leading another doctor in the audience to comment that lost connections are typical in her practice and that the infrastructure may not be up to the challenge. Another doc said computerization slowed them down so much that patients were waiting 2-3 hours to see a doctor and she was thinking about finding a different career purely because of the EMR.

Robert Schwab MD, chief quality officer at a couple of Texas Health hospitals, warbles The Ballad of Go-Live in recounting their Epic go-live week by week.

In England, reliably anti-NPfIT MP Richard Bacon calls for the Cerner Millennium patient scheduling system to be shut down after problems are reported by two NHS trusts. Surgeons complained that their surgery schedules listed incorrect procedures and cases that were not within their specialties. Another trust had so many problems with long call wait times and delayed appointments that they had to stop charging patients for parking.

The VA, fulfilling its data center consolidation plan, will move VistA hosting to Defense Information Systems Agency facilities operated by Verizon subsidiary Terremark Worldwide. In a related story that I missed while taking a break last weekend, the military’s AHLTA system goes down for 10 hours after an upgrade-related problem with its commercial data storage software. An unidentified source says the outage highlights the lack of Military Health System contingency plans for AHLTA, such as a failover data center.

Kronos acquires the OptiLink acuity-based staffing solution from The Advisory Board Company. Kronos will use the system to enhance its healthcare workforce management solutions, saying it will support collaborative cost management efforts between hospital finance and nursing departments.

I like this week’s e-mail from Kaiser’s George Halvorson. He’s throwing down the gauntlet on HIV treatment next week and the CMS Health Care Innovation Summit, challenging organizations to meet KP’s HIV death rate that’s less than half the national average and even 20% better than the VA. KP will also share its tools and strategies. Most interestingly, KP has eliminated HIV treatment disparities, with no outcome differences by race, with a goal of eliminating race-related differences in 16 NCQA HEDIS categories. Well done.

A belated holiday-related charity update: HEI Consulting offered a matching donation challenge to benefit Community Services League, raising $15,000 for the Jackson County, Missouri self-sufficiency organization.

Paul Beckwith, former assistant controller of clinical intelligence vendor TheraDoc (acquired by Hospira in December 2009 for $63 million,) is sentenced to 18 months in federal prison for moving $1.3 million of the company’s money to his stock trading accounts. He initially profited from trading and moved the money back monthly, but like many gamblers and speculators, started losing and got desperate to recoup his losses by betting even more. The company got almost all of its money back.

The Secretary of State of Massachusetts goes public with his spat with Meditech over a proposed construction site, saying of Founder and CEO Neil Pappalardo, “Mr. Pappalardo wants the right to do whatever he wants and not be responsible for anything — including the rights to dispose of skeletal remains if they find them.” A public hearing is scheduled for Tuesday on the construction project, which pits jobs against archaeology.

GE reports Q4 numbers: revenue down 8%, EPS $0.35 vs. $0.42. GE Healthcare reported a revenue increase of 1% to $5.16 billion, but operating income dropped by 5% to $953 million.

GE Healthcare lays off an undisclosed number of employees (“less than 50”) at its South Burlington, VT office, citing “changing market demand and technology needs” in healthcare IT.

Police in Russia investigate whether frequent power outages were responsible for the deaths of eight newborns in 10 days, all of whom were on respirators that apparently had no back-up power source.

Clinical documentation vendor MD-IT names Bard Betz as CEO, replacing former President and CEO Tom Carson. Kevin Shaughnessy is promoted to president.

A baby born 16 weeks prematurely at 9.5 ounces (considerably less than a can of soda) is discharged after a five-month stay at LA County-USC Medical Center. The hospital declined to state who is paying the estimated $500-700K cost.They’re still not sure if the baby, now at 4 pounds 11 ounces, has permanent neurological damage.

Reader James thought maybe Weird News Andy preempted him on this story, but he nailed it. A man building a shed thinks he cut himself with his nail gun, at least until he has X-rays, when doctors told him he had actually shot a nail into his brain. His response: “Did you get that out of the doctor’s joke file?” The response: “No, man, that’s in your head.” While being transported by ambulance to another hospital for surgery, he cheerfully posts his X-ray on Facebook. After surgeons successfully removed the nail and replaced a chunk of the man’s skull with titanium mesh, he said, “We need to get the Discovery Channel up here to tape this. I’m one of those medical miracles.”

E-mail Mr. H.

Time Capsule: Crossing the Cliché Chasm: Banished HIT Words for 2007

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

I wrote this piece in January 2007.

Crossing the Cliché Chasm: Banished HIT Words for 2007
By Mr. HIStalk

In its tremendous continuing service to humanity, Lake Superior State University has issued its 2007 list of words and phrases that should be banished from the English language (or American, anyway.) It exposes those overused and misused language extensions that might have been cute for about five minutes, but are just plain annoying now. Think mullet haircuts once hicks started wearing them (and, in some cases, never stopped.) Or, those oft-repeated but outdated bon mots like “Makin’ copies” or “Party on, Garth.”

Some examples from their list are “Gitmo”, “truthiness”, “we’re pregnant”, and “awesome.” I’m trying not to form my hands into a choking pattern just picturing someone using them in my presence or on TV.

As my contribution to the literature, here’s my list for healthcare IT.

Actionable – “information” wasn’t good enough, now it has to be “actionable,” a legal term turned into sales babble.

Applauds – vendors attempting to steal a free ride from someone else’s publicity have hijacked this word. If the President or anyone other than a competitor says anything that might sell more of their product, out comes the “we applaud” press release consisting of one sentence of praise, then a page full of hard-sell hype of why that news is so pleasing to them.

Chasm – blame IOM and their “Crossing the Quality Chasm” for turning a geographical term into a synonym for any tough problem. People writing articles and giving cliché-filled speeches often latch on to this overused word.

Clinical transformation – into what? Hasn’t anyone been transformed yet? Shouldn’t the transformational consultants stop invoicing? Are they just transforming your hospital’s money into theirs?

Closed loop – this is an engineering and biology term gone bad at the hands of HIT vendors. Any two systems they sell are now “closed loop,” even though customers have found many areas in which the loop is quite obviously gaping.

Collaboration – a positive term for everything involving two or more people: a meeting, a loud argument, or a knock-down catfight.

Continuum – healthcare doesn’t start or end in a hospital, which is apparently news to people who keep throwing out “continuum” like it’s a new concept.

Electronic Health Record – “clinical systems” became “electronic medical records” and then “electronic health records,” all without programming changes. You don’t have an EHR unless you are importing information from retail pharmacies, dentists, chiropractors, and home health services. Since no one does, please call vendors out when you hear them throw EHR around in an attempt to put lipstick on their pig.

Integrated – no vendor has ever called their products “disintegrated,” even when they bought them one day before from a defiant competitor. Poor definition and blatant misuse have rendered the word useless. It often displaces the correct but degrading word “interfaced.”

Partnership – a vendor selling a product to a customer. Any resemblance to a real partnership is unintentional, since any partnership base on one partner writing checks to the other would quickly dissolve.

Reimbursement – a cute euphemism for when hospitals or doctors making millions get a check, often for far more than any cost they expended and therefore a far cry from being “reimbursed.”

Robust – possibly the most clichéd of all HIT adjectives. Any application with more than one screen is “robust.” The word is never defined, just repeated as if describing a religious experience.

Solutions – slick salespeople have been calling software “solutions” for years, trying to inflate its value by making it sound more all-encompassing and thoughtful. It forces readers of their brochures and press releases to guess at what the hell they’re talking about.

Space – a sorry dot-com relic pressed into service as a synonym for “market.” Example: “we’re in the business intelligence space.” Fortunately, its use is mostly now limited to those who have it between their ears.

Streamline – every product or service claims to streamline something. It rarely happens, but the appealing image of putting a mess in order is intended to incite demand.

Suite – even tiny vendors repackage their harmless little applications into individually named products to make themselves look bigger, allowing them to claim a “suite” as the result. My eyes roll every time I hear it.

Thought leaders – people smarter than you and me, at least in their own minds. Companies often present their high-ranking employees as thought leaders when they want to sell you something. Thought leaders don’t have real jobs, they just think and cling to HIMSS podia. Picture that Rodin statue wearing a suit or black turtleneck and bringing Dilbert-laced PowerPoints.

Tipping point – usually claimed by someone who would benefit if it really is. It usually isn’t.

HIStalk Interviews Dan Paoletti, CEO, Ohio Health Information Partnership

Dan Paoletti is CEO of Ohio Health Information Partnership of Hilliard, OH.

Tell me about yourself and about OHIP.

I’ll start with the Partnership since that’s really what it’s about. The Partnership is a non-profit created about 2 1/2 half years ago by the Ohio Hospital Association, the Ohio Medical Association, the Osteopathic Association, the State of Ohio, as well as another non-profits. It was designed to apply for the federal ARRA grant dollars that had just been issued. We were awarded the state-designated entity for health information exchange in Ohio by the governor at that time and were awarded those federal dollars as well as we were awarded about $28.5 million of Regional Extension Center monies to help providers adopt electronic medical records.

My background is very simple. I was vice president with the Ohio Hospital Association. Previous to that, I worked for Johnson & Johnson. I’m kind of a data geek. I am really here just to facilitate the grassroots effort of the Partnership.

Ohio is progressive when it comes to healthcare technology, even down to Board of Pharmacy regulations that are both admired and feared. Compared to how other states or organizations have set up their HIEs and RECs, how is your structure different or better?

It’s hard to compare if we’re actually better, but I think we are different. We decided very early on that we were going to use the resources and the expertise that existed already in the communities throughout Ohio. There was no reason to layer on another complex organization on top of all that. We are really a facilitating body to gather together the resources that exist in the state, like connecting the dots and get everybody working in the same direction.

Most of the work is being done at the community level, the grassroots level. It took us a while to get started. We started off pretty slow, but right now I believe we have more doctors than anybody signed up in the country. We just passed 6,000 primary care providers that are using our Regional Extension Center services. That grassroots effort is really the key. That’s what makes the difference.

Early on, groups thought their problems were going to be technical, so they were quick to go through a rigorous process of selecting technology vendors and looking at infrastructure. What blew up in their faces was issues related to bringing competitors together at the table or privacy issues that were a lot different than they expected. When you look at your long term strategy, the question always is, “Well, what’s your business model once the grant money runs out?”

Great question. You did hit the nail on the head with that. It’s really not a technology issue, it’s a trust issue. 

It goes back to our roots. Our board consists of stakeholders from throughout Ohio that have a lot vested in this and building the trust among each community. We’re targeting not Ohio necessarily as a state, but community by community, and using the community leadership to really get people to the table. That’s the key. It’s not about the partnership. It’s not about the health information exchange, it’s about assisting and solving problems in those local communities. That’s really what’s generated the success model to date.

Privacy is a huge issue. We’ve decided with CliniSync , which is what our health information exchange is called, it’s an opt-in model. We have developed a policy that users of the program will assist and educate the patients that are going into the exchange, what that means. It’s not a law, it’s not a state-level policy, but it’s users of the CliniSync program. We’ve tried to address those very carefully. It’s taken us a long time, but we’ve gotten buy-in from most of the major players and small providers in the state. We’re ready to move forward, and we are.

You must have a good message to get that number of providers on board since they typically understand that there’s patient benefit, but it requires extra work and potentially money from them, plus having to work with competitors that they’re not especially fond of. What selling points make them want to hook up to the HIE?

The core message is it’s about the patient. This is about what’s best for the patients in Ohio and the folks that are receiving care in Ohio. The providers in the state understand that. That’s really what’s most important.

We’re not competing about data. It’s not about competing on that. It’s about competing on service and quality. All of this can have a great effect on that as well as bring efficiencies to the table. Once you sit down and look at specific issues around what the electronic medical records and what the exchange can do for that community-based model and really take it down to that level, people understand. It’s keeping the focus on the patient. That really has had a tremendous affect.

Like all statewide organizations, you’ve got some high-profile, big-ego organizations involved. You also have some that are using systems like Epic, which touts its own private HIE capabilities among Epic users. Has that been a problem when you’re working with groups like Cleveland Clinic?

It’s not a problem. It’s one of those issues that you have to really get down to the patient level and figure out what’s best for the community. I’m not sure about this statement, but I think by the end of this coming year in 2012, we’ll probably have more Epic installs than state in the country. 

It’s a unique challenge, but when you look at specific community models, not everybody in every community is using the same systems. You have to be able to communicate with home health agency. You have to be able to communicate with the skilled nursing facility and the competitor down the street. If that patient is moving in and out of all of those, there’s no way that one system solves all that problem.

What we’ve tried to do is position this product as very community-focused, a neutral third party that is a gateway. We’re not storing data. We’re not a data repository. It just allows people to communicate with each other. The focus on the patient has been the key to getting people to work together.

In your experience connecting these different clinical systems that are out there both in the practices and the hospitals, have you found that you had to blaze new ground with vendors who weren’t comfortable with either the technology or the concept of sharing information?

That’s an interesting question. I don’t think technology is quite at the point where we thought it was to allow for the free flow of information. But we’ve worked very closely with most of the vendors, especially the ones that have the bulk of the market, and for the most part they have really been great to work with. They are looking for some standardized process to make all this happen. They really do want this to happen now that this is real, because it is happening and this transformation of healthcare is real. 

It has been a challenge. We’re finding a few that are ahead of the others, but we’re using them to blaze that new ground in sharing that information with the others. Even among the vendor community, what we’ve found is they really do work well together as long as you’re not taking sides. That neutrality is key. But it is blazing new ground, without a doubt.

You had an announcement within the last couple of weeks about using the Direct system to communicate with another state, which sounded good on paper, but somebody might say, “Well, it’s not really that relevant. Most care is local.” Why was that event important?

It really did not affect any patient care. This was really a test of whether we could accomplish it.

If you look at what ONC has tried to do – and I would like to just say that this is all happening, this transformation in healthcare around electronic medical records and exchange, is really a result of this stimulus act, and it’s a result of a lot of the great work that ONC has done — Direct is something that they thought was a way to quickly allow people to exchange information. We want to help them be successful. It was really a communication between two clinics. We really didn’t have a whole lot to do with it except to help them facilitate that process. They wanted to see if it could happen, so it was really instigated by the providers themselves.

The important piece was that you had providers that were trying to exchange information across state boundaries. It wasn’t the fact that we could do it, it was their interest, and we were help in enabling that. But what is important about that is there is information that without sophisticated health information exchange in using this Direct Project, these Direct protocols, it can really help the patients.

Let me give you an example. You have a mental health patient that shows up in the ER. That sensitive type of information is very difficult to exchange in a health information exchange, especially with the laws in Ohio. We see the Direct protocols as a way to exchange some information, with the patient’s permission, explicitly to another provider that they might be going to for a follow-up care. We think there are some definite use cases that that can help. It’s an easy way for doctors to do that. Was it going to change the world? No. But it’s a start.  The exciting part is that it was between the providers. That’s what we want to emphasize.

According to the announcement, that was the first time Direct had exchanged data across state lines. I would have thought it was further along than that. Is there a technical reason that it hasn’t been done or was it just that nobody felt the need to do it?

I think it has a lot to do with everybody ramping up. The Direct protocols are fairly new. People are ramping up trying to create those protocols and create the secure e-mail systems. There’s nothing new about secure e-mail, but getting the providers provisioned with an address and making sure that everything adheres to HIPAA compliance and all of that — it’s complicated for a lot of folks to get that up on a large scale; especially with a lot of folks that received these state-designated entities. We’re getting close. We just happen to be a little bit out in front, but I think you will see a huge charge of other states and other entities doing this now. We just happen to be a little in front.

What does the big picture look like when there are HIEs springing up from two places that are a mile apart to crossing multiple states, you’ve got the Direct protocol out there for folks to use, and maybe private HIEs that vendors have set up. How will the average medical practice be interoperating?

I’d like to speak for Ohio if I could. The picture here is really community based. The reason that’s important is that the majority of care occurs inside a community. That community could be a single town, it could be a county, it could be multiple counties. But there is some geography where the bulk of care occurs. Ensuring that that information can be exchanged, whether there’s two regional health information exchanges that exist within that community or whether it’s a community without any ability to exchange. The vision that the partnership board and the grassroots stakeholders in the state that are part of OHIP see is that the partnership can be that gateway to facilitate that.

Again, it’s not about us. It’s not about our ability to store and retrieve data. It’s about our ability to allow others to communicate with each other. And for a while – I don’t know whether it will be five years, 10 years, 20 years — there’s still going to be some middleware required to allow that type of exchange to occur. I think that was the vision of ONC — to facilitate this.

In Ohio, our model is just a little bit different, but we’re pleased because we have a lot of folks that have already expressed interest and commitment to make that happen regardless of where they stand technology-wise. That’s our vision, it will be interesting to see what happens though in the next five or 10 years.

The jury seems to somewhat be out on whether Regional Extension Centers are really increasing EHR adoption and whether they’re helping technology improve outcomes and reduce costs. Do you get the sense that they’re accomplishing what they were supposed to?

Our process is a little bit different. It all starts with electronic medical record adoption. It’s hard to accomplish all that without widespread adoption, so that’s where we spent the last two years, really working with our community leaders to adopt the electronic medical records. The next stage is working with the community stakeholders to begin to exchange that information and get a solid base of exchange going so we can start to work as a community on the outcomes and improving quality.

It’s connecting the dots. It’s been a phased approach. I think it will be difficult to accomplish the vision that many people have set without that kind of phased approach. We think we can, because we are accelerating things here in this state. Adoption is the key.

There was huge interest in HITECH money early on, but it’s starting to look like some folks gave up or decided it wasn’t worth doing. Are you seeing people who thought they might be going with electronic health records who saw the wall in front of them and decided to stick to where they are?

In the beginning, there was a lot of doubt and a lot of concern. I do think we did have some people drop off. But what we did here in the state is develop that grassroots support mechanism, so the physician and the practices and the small hospitals weren’t out there by themselves. They had a support structure in place. Because of that support structure, I think you will see an incredible acceleration of Meaningful Use attestation in 2012.

Ohio, I believe, ranks third as far as Medicaid payments for Meaningful Use and we also are at the top as far as Medicare attestation. Our goal for next year is to help 10,000 providers attest to Meaningful Use, not just primary care providers, but all providers. It’s pretty lofty, but because of that support structure, we’re trying to accelerate and keep things moving forward, because without that, we’re not going to see the benefit. That’s our number one priority. The key is that support structure — they have to have somebody to fall back on.

Is there resistance to the check-off for Meaningful Use that it isn’t really directly related to patient care?

That’s a very difficult thing to answer, especially where we are right now. Is the Meaningful Use criteria going to directly affect patient care? I think it will, in the sense that as providers have to work towards meeting that, it’s going to naturally bring along more and more of the practices as far as how it’s going to affect that patient outcomes. It was a great starting point, but what people have to realize is there’s only so much at the federal level that they can make happen. It really comes down back to that community level in putting the support structure in place to help people meet Meaningful Use. 

Then make the next step to help them exchange that information, then get these projects together that will help providers learn from each other and really make the impact on patient care in the outcomes and the efficiencies — because we have to have the efficiencies as well. It will happen. It’s just coordinating all that together, which is a monumental task. 

Every transformation is hard. It’s about having that support structure in place at the grassroots level to help facilitate that. It will happen. We spent a lot of time looking at the return on investment of electronic medical records, return on the outcomes of care of electronic medical records. I think there’s enough documentation out there now to prove that yes, it does have an affect. We want to be able to prove it has a significant effect. We think in a couple of years that we’ll be able to do that.

If you look down the road, let’s say five years, how will you know that you’ve done the job you hoped to do?

I can tell you the goals we have in place. Our board and our stakeholders make sure that we’re very goal-oriented.

To document success is the number of providers that have adopted; the number of providers that have attested to Meaningful Use; the number of providers and institutions that are sharing information; and then ultimately getting the entire community — the payer community, the employer community, the patient-consumer community, as well as the provider community — to get enough data to document that we have had an impact on the outcomes and the cost of care. And getting everybody involved in that process.

Can I give the exact metrics that we’ll need to prove that? No. But we have enough momentum now that I believe in five years, at least in Ohio, we’ll be able to prove what kind of success that this whole thing has caused. We’re pretty excited about that.

Any concluding thoughts?

This is really an exciting time for Ohio. ONC has enabled us to jump on board with this and provided the funds we’ve needed to help create transformation here in the state. It’s not about our organization. It’s really about the folks out in the community doing the work. We’re here to help them, and we hope to be one of those models of success that people can point to and say, “Look, if you can do it like this, you’ll be successful.”

News 1/20/12

Top News

Minnesota’s attorney general sues revenue cycle vendor Accretive Health for losing a laptop last summer that contained patient information from two hospitals that had contracted with the company. The unencrypted laptop was stolen from an Accretive employee’s rental car. The lawsuit demands that the company inform patients in the state what information it keeps and how it uses it, saying the company “showcases its activities to Wall Street investors but hides them from Minnesota patients.”

Reader Comments

From MountainMan: “Re: Pre-HIMSS insanity. Here is a picture of the first of many to come ridiculous invitations, overnight letters, and expensive marketing crap that will be headed my way. ‘Tis the season to determine the vendors with more money in marketing than in development!”  

From WorkingGirl: “Re: Manager Systems. Love this graphic– makes me think of managers with weird heads in charge of the place. One (red) is totally defeated, head hung. The yellow head is going along to get along (the ‘whatever’ approach,) and the blue head is ‘blue sky thinking’ or ‘head in the cloud.’ I have worked for them all and more!” The logo is for Manager Consultoria em Informatica LTDA EPP, a Brazilian company recently acquired by 7 Medical Systems. The blue one actually looks like a dunce cap, which might be apropos for some managers.

From Otoscope: “Re: Epic. I hear that Epic is competing for a deal in NYC. I wonder if the puff piece in the Times about how cool their campus is and Judy Faulkner giving them a rare interview isn’t an Epic marketing push to win over some decision-makers struggling to find a reason to pay Epic’s exorbitant asking price? Maybe there’s a pattern of newspaper exposure where Epic had other high-profile deals on the table.” The article also claims that Epic steals the best programmers who would otherwise be working for Google or Facebook, which seems a bit of a stretch given Epic’s reputation for hiring new grads with no experience. I doubt many world-class programmers are torn between working with cutting edge technology for Facebook in the Silicon Valley vs. moving to chilly Wisconsin to write MUMPS just because Epic’s campus is cool (not that there’s anything wrong with that, especially if they’re doing it for the satisfaction of helping patients.) The article was a bit fawning, but it was a business feature, not a hard-hitting expose’.

From George: “Re: your question about the systems used by the Thomson Reuters Top 15 hospitals. Check this out.” It’s almost all Cerner and Meditech, with only one Epic customer in the bunch. Only a third of the Top 15 are at EMRAM Stage 6 or 7, and of those, Cerner has three customers and Meditech has two. I like to think these facts prove my oft-stated points: (a) it’s not the IT you have, but how you use it; (b) IT can make good hospitals a little bit better, but it’s not going to transform low-performing hospitals into stars; and (c) your mileage will assuredly vary, so just as buying a toupee and a flashy Corvette won’t make you as popular with young ladies as your 20-something nephew, don’t put all of your organizational eggs in the IT basket in hopes of a miracle. And to cap it off with my most annoyingly repeated tagline, plenty of incompetent carpenters own great hammers.

HIStalk Announcements and Requests

Some goodies you might have missed this week on HIStalk Practice: Greenway Medical sets the target price of shares for its upcoming IPO at $11 to $13 per share. Physicians who have an ownership interest in their practice are more likely to think their EHR implementation is difficult. Telemedicine enhances dermatology care. Upcoming Meaningful Use deadlines for eligible providers. Smaller practices may have more difficulty with the 5010 transition than their larger counterparts. Dr. Gregg explains why he isn’t satisfied with the market’s EHR options.  Thanks for reading.

We’re sponsoring something new for HIMSS conference attendees: the First Annual HIStalk Booth Crawl. We’ll be sharing more details as the conference gets closer, but here’s the big one: we will be giving away over 40 iPads generously donated by sponsors. We’ve canned the silly stamp cards, eliminated the reviled “must be present at the very end of the conference to win” restriction, and improved the chances of winning by offering dozens of cool iPads instead of one motorcycle or set of steak knives. Contestants just need to visit some booths or Web sites to be in the running for one. It will be fun, especially for the winners. It’s fun for our sponsors as well, considering that some companies have charged vendors up to $20,000 to participate in similar events and we’re charging nothing just because we like seeing readers get iPads.

Another super HIStalk-sponsored event: a shoe drive benefiting Soul4Souls, a charity dedicated to the distribution of new or gently worn shoes to people in need across the world. A couple of HIStalk sponsors will have drop off boxes in the HIMSS exhibit hall and we’ll also accept shoes at our HIStalkapalooza event (sorry, you still need an invitation.) The terrifically creative folks at Friedman Marketing Group presented the idea a few months ago and of course I fell in love with it. The curmudgeon Mr. H doubts that people will be willing to lug an extra pair of old sneakers all the way to Las Vegas to donate; however, I seek to prove him wrong. I know there are enough shoe-loving HIStalk fans that appreciate the joy of a newish pair of shoes and who would find some room in their suitcase in order to assure the world is a more joyful place. I might even wager Mr. H on this since I so sure he’s wrong.

Welcome to new HIStalk Platinum Sponsor Fulcrum Methods. The Oakland, CA company provides tools and expertise that help providers manage projects, programs, and change initiatives: work plans, guidebooks, and electronic document and worksheet templates. For hospitals or EPs interested in Meaningful Use, the company offers a structured approach and SaaS-based tools for evaluating EHR capabilities, tracking met and unmet requirements, and assessing resource needs for compliance (notable users include Lucile Packard Children’s Hospital and Maine Health, to name a couple.) It’s EP Tracker allows easy MU oversight of affiliated EPs, making sure they are ready to attest, tracking their attestation, and managing the result flow of funds. An interesting service is Pre-Attestation Compliance Services, providing a defensible, documented review that proves to potential CMS auditors that the attestation was legitimate. Other tools and services cover Program Management Office methodologies, change management, long-range planning, and vendor selection and system implementation methodologies. Good IT departments often need nothing more than proven tools, processes, and structure to boost their own proficiency and that’s what Fulcrum Methods offers. Thanks to the folks there for supporting HIStalk.

If you agree that mobile health in its various forms is important, you might want to drop by HIStalk Mobile and sign up for the e-mail updates there. Travis is really good at understanding that market and he’s not shy about saying which products he likes and which ones he doesn’t (and as a doctor and a mobile health startup guy, he’s plenty qualified to offer his opinion.) Read his latest post and I bet you’ll find at least a handful of items that are interesting and useful.

On the Jobs Board: NextGen Go-Live Support, SCM Go-Live Support, and Cerner and Epic Resources. On Healthcare IT Jobs: Implementation Consultant, Epic Willow Consultant, IT Interface Analyst, Epic Certified ASAP Builders, and Senior Applications Programmer/Analyst.

Want to support what we do and make Inga happy? Here are some ideas: (a) stick your e-mail address in the Subscribe to Updates box to your right so you get the news before everybody else, at least everybody other than the 7,800 readers who preceded you in signing up; (b) support our delusions of popularity by connecting with us on LinkedIn and Facebook; (c) while you’re on LinkedIn, sign up for the HIStalk Fan Club that Dann started long ago that now has 2,089 members – when people ask me for something, that’s the first place I look to see if they really are fans; (d) send me news, rumors, pictures, music recommendations, or anything else that might tickle my fancy; (e) peruse with ill-concealed wonderment the roster of fine companies who support HIStalk, perhaps clicking an ad or two, checking them out on the Resource Center, or using the Consulting RFI Blaster if you need consulting help; and (f) look squarely into the mirror and give a world-weary nod to the person who makes it easier for someone who’s already worked a long hospital day to come home to another five hours’ worth of HIStalk work – that would be you, thanks. 

Acquisitions, Funding, Business, and Stock

Private equity firm LLR Partners acquires Paragon Technology Group, a provider of strategy technology solutions to the public sector, including HIT. LLR appointed former Xerox and GTSI executive Scott Friedlander as president and CEO.

The healthcare merger and acquisition market generated 980 deals worth $227.4 billion last year, of which 435 involved the technology segment.

Release of information vendor HealthPort has retained Credit Suisse to find a buyer for the company, reports suggest.

UnitedHealth Group reports Q4 numbers: revenue up 7.9%, EPS $1.17 vs. $0.94, beating consensus expectations by $0.13. Its Optum unit was credited for contributing to the insurer’s $1.26 billion in quarterly profit.

Sales

Arnot Ogden Medical Center (NY) expands its relationship with Surgical Information Systems (SIS) by selecting its anesthesia module.

Nationwide Children’s Hospital (OH) renews and expands its five-year licensing agreement with Streamline Health Solutions, adding additional document management and workflow solutions.

People

HealthGrades announces that its founder and CEO Kerry R. Hicks will assume the chairmanship of the company’s board of directors. The current chairman, Roger C. Holstein, will assume the CEO role.

The Federation of American Hospitals promotes Samantha Burch from director of healthcare policy and research to VP of quality and health information technology.

CollaborateMD, a provider of PM and billing software, hires former Lockheed Martin executive Stephen Hightower as chief strategy and technology officer.

Mobile app provider Happtique names Ben Chodor CEO. He was formerly with InterCall.

Peter Longo has joined Predixion Software as global sales leader. He was previously VP of sales with Allscripts.

Netsmart Technologies hires Dennis Morrison PhD as chief clinical officer. He was previously with Centerstone Research Institute.

Announcements and Implementations

Sharon Regional Health System (PA) unveils its new $3 million, 5,000 square foot IT department that will connect to the health system’s 18 facilities.

QuadMed, which operates 22 on-site primary care clinics in 12 states for large employers, adds telemedicine to its slate of services.

Westchester Medical Center (NY) selects QuadraMed’s identity management solutions.

TELUS Health Solutions launches MyHealthReference.com, a health reference portal for Canada.

Government and Politics

The GAO reports that the National Quality Forum (NQF) failed to complete five of its eight projects promoting EHR on time. The GAO blames both NQF and HHS for “overly ambitious deadlines, given the scope and complexity of the work.”

Other

Titus Regional Medical Center (TX) fires a nurse looking at medical records she was not authorized to view. The nurse claimed she only looked at the 108 charts because she was “curious.”

The teen who made headlines last year for impersonating a doctor in a Central Florida hospital is arrested again, this time for pretending to be a police officer. The 18-year-old was driving with a sheriff’s badge, a pistol loaded with hollow-point rounds, a Taser, handcuffs, a police radio, police lights, and a dash-mounted laptop. He got caught after advising a motorist stopped at a traffic light to fasten his seatbelt, unaware that the driver was coincidentally an undercover detective.

Sponsor Updates

• Picis releases a case study profiling Winter Haven Hospital’s (FL) use of Picis ED PulseCheck to drive patient satisfaction.
• World Wide Technology Inc. ranks #50 on the Fortune 100 Best Companies to Work For list for 2012.
• Bloomberg Business profiles Digital Prospectors Corp.
• CynergisTek CEO Mac McMillan will lead several IT security discussions and workshops during next month’s HIMSS conference.
• DIVURGENT Managing Partner Colin Konschak discusses the future of healthcare and the viability of ACOs in a company blog post.
• SIS successfully demonstrates its perioperative interoperability at the IHE North American Connectathon.
• Quest Diagnostics announces a grant program to provide eligible providers with an 85% discount off the retail price of its Care 360 EHR, including fees for licensing, hosting, support, training, and implementation.
• Craig Hospital (CO) deploys Access Intelligent Forms Suite as part of its patient safety initiative.
• A Beacon Partners survey finds that most hospitals understand the value of HIEs and plan to participate in them, but the hospitals don’t have an adequate budget to participate and are concerned about HIE costs and governance issues.

EPtalk by Dr. Jayne

I’m excited to report that the pre-HIMSS advertising schmooze-fest has started. I was getting a little worried since I hadn’t seen anything yet – not even a post card. The first e-mail came from Hyland Software, which will again be at HIMSS with their OnBase Sports Bar & Grille, offering three daily happy hours. As for other exhibitors, they’re still pretty quiet. One thing is for sure though – I’m hoping that the always-delightful IngaTini will return.

The first CCHIT eNews blast of the year highlights Mr. H’s recent interview with Bobbie Byrne MD MBA, VP/CIO of Edward Hospital and a CCHIT commissioner.

American Medical News advises small practices to guard against security breaches amid concerns that basic security is taking a back seat to the focus on Meaningful Use. I’ve experienced data breaches personally: the Veteran’s Administration; my bank; and now Zappos has notified me of “illegal and unauthorized access” to my account. I’m sure they were after credit card information, but I hope they find humor in the sheer variety of shoes in my account history.

Speaking of credit card information, a recent article spotlights physician offices that require patients to provide credit card information, calling the practice “jarring.” One reader comment states:

When I sit and wait past my appointment time, I always send the doctor a bill by registered mail. I charge $100 an hour for wait time. If I have to wait a half hour, I send him a bill for $50. I have done this three times in California. Each time, they refused to pay the bill. It cost me, but I take them to small claims court. In California, no attorney can represent you — the doctor has to defend himself. They always pay the $50 or $100. They won’t take a day away from the practice to go to court. I had to find another doctor, of course. There are more doctors than attorneys. But I cured them of sucking eggs.

I hope this guy doesn’t show up in my practice. I also hope he never has an emergency medical problem or crisis that causes his physician to run late for the next patient.

E-mail of the day from the AMA: last fall, physicians had the opportunity to seek hardship exemptions and avoid penalties for failing to successfully participate in Medicare’s e-prescribing program. The Centers for Medicare & Medicaid Services (CMS) is reviewing each hardship exemption request on an individual basis and has not yet completed its analysis. Therefore, it is possible that some physicians will be subjected to a 1 percent Medicare payment penalty inappropriately until the backlog of exemption requests is reviewed. Ultimately, CMS will reprocess the claims. No mention of how long it will take or how much CMS is spending on the review.

USA Today reports that 1% of Americans are responsible for 22% of healthcare costs in 2009. Nearly half of health care spending can be attributed to just 5% of patients. The data is from the Agency for Healthcare Research and Quality, but most primary care physicians could tell you that just from gut feelings.

I was initially sad at hearing that a researcher at UConn who has published several articles on the health benefits of red wine apparently falsified his data. It’s unclear whether the data manipulations affected study outcomes. Reviewers have been combing through his research since an anonymous complaint in 2008. The list of deceptions found in the research are almost unbelievable – I’ve judged elementary science fairs with more integrity. My spirits were bolstered, however, by a recent article in the Journal of Women’s Health sharing a recent study finding that red wine has activity similar to a group of medications called aromatase inhibitors which are used to fight breast cancer. White wine drinkers take note – this is strictly an attribute of the reds.

Contacts

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

Readers Write 1/18/12

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

The EHR Bubble Will Pop—To the Victor Go the Spoils
By Evan Steele

There is no question that the EHR incentives have created a frenzy of EHR purchasing and that the trend will intensify in 2012 because this is the last year to qualify for the full $44,000. As I look at what’s happening in the market, it becomes apparent that at some point in the not-too-distant future, the EHR bubble will pop and many vendors will face financial challenges that will lead to their demise.

Despite the surge in EHR purchases in 2011 and 2012, it is important to recognize that there will be some unintended consequences of the rush to meet the government’s deadlines and requirements. Many physicians will be unhappy with their newly acquired EHR because, in their haste, they made a poor product choice. Others will face a rude awakening as they are forced to use their EHR in ways they never have before, and discover that it does not support their workflows. In the rush to market, there will also be some products that, while certified, are of inferior quality—possibly developed offshore.

Vendors will be backlogged and unable to manage the surge in new purchases in a timely manner due to insufficient staffing levels. Many will come to market short of the necessary educational resources to help physicians navigate the complexities of Meaningful Use, and physicians will find themselves victims of inadequate, rushed EHR implementations by green, wet-behind-the-ears trainers. Other vendors will be so overwhelmed that they will fail to keep to their promised implementation schedules, preventing their new clients from meeting the government’s timetable entirely.

In the years following the initial boom, many physicians will become disillusioned with the EHR Incentives Program. There will be too many requirements that will seem either burdensome or irrelevant to their practice—or both. As the increasingly stringent Stage 2 demands are weighed against the drastically decreasing dollar value of the incentives, physicians will either abandon the program or trade the EHR they originally purchased for one that supports not only the government’s needs, but also the workflow needs of their practices.

To see what will happen to many of the EHR companies, it is important to understand how they are financed. In order to raise money, companies had to show investors a story anticipating significant new client acquisition. Initial funding for EHR companies was based on “hockey stick” growth projections, fueled by the availability of government incentive money. Each individual company’s projection anticipated rapid, accelerating, and long-term growth in EHR demand.

The first thing to recognize is that these projections were overly optimistic. In fact, if you add the projections of all the EHR companies together, they would grossly overstate the total potential market. To excite investors, a typical start-up EHR company seeking funding was likely to predict that it would have 5,000 customers within five years.

With a population of approximately 600,000 physicians serving the ambulatory market — 25% of whom may never adopt an EHR due either to approaching retirement age or doubting that the penalties will ever be imposed –there is a potential market of 450,000 physicians. ONC’s Certified Health IT Product List (CHPL) website currently lists 472 vendors that offer at least one “Complete EHR” product. A conservative assumption that the top 20 vendors will together secure half of the physician market leaves the other 452 vendors competing for their share of the remaining 225,000 physicians. This represents an average of 498 physicians per vendor—not even a paltry 10% of their projections.

The circumstances described above present a textbook case of a dramatic bubble followed by a dynamic shakeout. Whether at the end of 2012 or in 2013 (when the bulk of the incentives are no longer available and physicians will have to focus on the conversion to ICD-10), the bubble will pop, and the financial fallout will be significant. Missed growth projections, government money drying up, and mounting physician dissatisfaction will leave many companies unable to find investors willing to fund their future growth. Scores of companies will face a cash crunch as revenue growth slows, or revenue declines, in the face of continued and significant expenses for implementations, support, ongoing upgrades and certification requirements, etc.

As in the dot-com era, strong companies will survive. Those that generate other sources of income from a deep set of products that offer alternative growth opportunities will be around to take advantage of the second EHR bubble that will be fueled by the looming EHR penalties, the development of ACOs, and new pay-for-performance programs, among other factors. There will be a trend toward consolidation, and financially strong companies will acquire distressed companies for pennies on the dollar, reaping the benefits of their unique technologies and/or their customer bases. To the victor go the spoils!

Evan Steele is CEO of SRSsoft of Montvale, NJ.

HIMSS Prep: Get Inside the Head of Your Customer
By Rosemarie Nelson

How much is it costing you to exhibit at HIMSS? It’s all about making a connection, developing a relationship, and delivering results. That’s why you’re exhibiting. These are my tips for vendors on the trade show floor.

First, Do Your Homework

What do you know about HIMSS? How many members? How many are attending? How many physicians are in those organizations? What else is important for you to know?

Who is walking the floor? You expect to see the C-level. The significant physician. Directors, administrators, and managers. Those from the academic world of academics. And “other.” Other means influencer. Think of the impact of the media, consultants, attorneys, accountants, and spouses. They know, work, eat, and maybe even sleep with the purchasers. Smile and greet them all.

They’re smart. Chances are they are graduate level. They are ready with questions that delve deeper than your elevator pitch. Prepare your answers.

They are boomers, more than any other generation. Are you Generation X or Y? How do you relate to the boomer’s characteristics? How does the boomer relate to you? Regardless of generation, the attendees will fall into one of the following cohorts:

• Wide-eyed wonder (first-time attendee)
• Seasoned cynic (been here, done it all)
• Social butterfly (came for HIStalkapalooza)
• Loyal customer (wants to learn even more)
• “If it’s free, it’s for me” (expert flea market goer)
• Heads-down tweeting and texting (oh, that’s you, the exhibitor!)

Like a Boy Scout, be prepared. Engage the enthusiastic, be cautious with the cynic, curb the chatty, appreciate the customer, and WALK AWAY from your smart phone while you’re in the exhibit hall.

Next, Know the Buzz

• Reimbursement will continue to decrease.
• Regulation will increase.
• Business and government focus on clinical quality will intensify.
• Payers will increasingly pay for demonstrated performance.
• Hospitals will employ larger numbers of established physicians.
• New physicians will continue to seek hospital employment over private practice opportunities.
• Increased consolidation among hospitals and physicians will result in intense competition for insured patients in local markets.
• Improved technology will facilitate — and force — change in healthcare delivery.

Then, Know the Trends

• Consumerism and patient-centered care.
• Transparency and everyone knowing how much healthcare costs and how effective it is.
• Value, represented by quality and safety in relation to cost.
• Metrics and developing gold standards. 
• Information and technology that delivers real-time data on the patient, processes, and systems.

Consumerism Trend

As the population statistics change and the baby boomers age, health care costs rise. Telemedicine, smart phones, direct-to-consumer marketing and the economic constraints on organizations’ fundraising efforts are all opportunities and threats to the traditional methods for delivering health care.

Mobile Technology Trend

Reduces need for hospital admissions and physician office visits. 40% of physicians say they could eliminate 11% to 30% of office visits through the use of mobile technology (PWC Health Research Institute, Sept. 2010). Why would providers accept technology that hurts incomes?

Insurance and Coverage Trend

Medicare spends more than 25% of its budget on patients in their last year of life. As a society, we can’t keep up with the growing needs for coverage and care: state budget constraints, federal budget pressures, and unwillingness to raise taxes. By increasing the preventive services and by monitoring key measures specific to chronic diseases, payers expect to improve health outcomes and reduce overall costs based on reduced hospitalizations and additional procedures.

ICD-10 Requirement

The costs of transition are almost as much as the costs to acquire an EHR.

And Finally, The Bottom Line

Does your solution address one of these trends? Why does what you do or provide matter to the exhibit hall walker? Each buzz signals a reduction in costs to the health care system, which means reduced income to those delivering the service. Are you signing up for a reduction in your income? No one wants to do that. How can you improve that income picture for your potential client?

“How does this solution/product help me?” is running through the mind of that exhibit hall walker. Do you know enough about them and their issues to answer that question? Challenge the conventional thinking in your sales process. If you keep doing what you’ve always done, you’ll keep getting what you’ve always gotten. Is that really what you want from your investment in HIMSS 2012? 

Rosemarie Nelson, MS is principal consultant with MGMA Health Care Consulting Group of Englewood, CO.

The Biggest Mistakes Companies Make in the War for Healthcare IT Talent
By R. Gaines Baty

“War” is officially declared and the healthcare industry is the battlefield. We speak of “The War for Talent” in healthcare – the perfect storm at the intersection of ballooning demand, limited supply, and mandated urgency, with no viable solutions but to accept mediocrity or fight for the best. 

This is not a new phenomenon, nor is it unique to the healthcare industry. Similar forces were at play in the IT industry leading up to Y2K. We in healthcare, as a result, now find ourselves in a candidate-driven “seller’s market” for executives.

No organization can excel without great leadership. Most chief executives agree that for an entity to ascend to and perform at an optimal level, it must attract and retain the best leaders possible. Some, however, don’t align their own recruiting processes with this fundamental truth.

We’ve pinpointed several of the more common and detrimental mistakes potential employers make in the pursuit of great executive talent. Of course, relevant candidate flow is crucial (and the reason good search firms are in business.) This said, the following issues can derail the pursuit of excellent potential leaders.

1. “Perfect Profile” expectations. It is advisable to first seek the perfect match. However, recruiting is not pizza delivery. When a comprehensive search is producing quality candidate flow, the market will reveal the caliber of talent and credentials available to the company. If and when the elusive “perfect person” does not appear, organizations may be best served by evaluating through a different lens. Prioritization and flexibility are required in this approach, with due credit given for transferrable skills and a recurrent track record of success. The operative question must become, “Can she do the job?” Strong performers come in different packages, and may not appear perfect at first glance. One can find something lacking with anybody, even a candidate fully capable of achieving an organization’s objectives.

2. Failure to “sell” the candidate. Excellent candidates typically have multiple suitors and are not necessarily looking for a job. Therefore, everyone in the recruiting process should reinforce consistent and inspired organizational vision, importance of the role, opportunity for success, potential for recognition and reward, and future career opportunities. Undoubtedly, effective candidate evaluation is paramount. Simultaneously, however, a consistent and compelling value proposition must also be perceived by the candidate. This should be complemented by a prompt decision and an appealing compensation offer. Candidates should be treated like prospective customers. We must bring our “A” games to the interview room.

3. Poor communication, indecision and ineffective processes. Organizations frequently drag out hiring decisions nonchalantly for months; communicate inconsistent visions; utilize inconsistent or ineffective evaluation criteria; inadequately communicate with sponsors or recruiters; conduct distracted or unprepared interviews; and generally create unimpressive or sloppy candidate experiences. This same process may be a candidate’s only window into the soul of a potential employer. In contrast, competitive suitors with crisp, clean recruiting processes will quickly eclipse others for this top performer’s services.

In summary, big game hunting for high quality leadership can reap huge rewards. However, the real stars are rare and may appear differently than we first imagined. Competition is stiff. The hunter only has one shot at the target, before it disappears.

R. Gaines Baty is president of R. Gaines Baty Associates of Dallas, TX.

News 1/18/12

Top News

Thomson Reuters names its Top 15 Health Systems that have achieved superior clinical outcomes based on quality, patient perception of care, and efficiency. If anyone knows how many are Epic, that would be interesting given all the lofty ambitions expressed by customers trying to justify their expensive projects. Or for that matter, how many are HIMSS EMRAM Stage 6/7 since HIT cheerleaders are always trying to make the connection between HIT and outcomes.

Reader Comments

From Barefoot in Vegas: “Re: Trade show shoes. AMAZING TOPIC!!!!!!! Please send me your show list.” I love people who don’t chinch on exclamation points, so I was happy to share my shoe brand tip with Barefoot. I admit I was amazed (!!!) how many people were interested in my footwear insights. It made me feel a little like Oprah.

From Social Profiteer: “Re: pimping HIT tweets. Apparently so-called news organizations, especially those owned by HIMSS, are willing to sell out their readers.“ I can’t decide which is more interesting: (a) charging vendors $10,000 for a couple of tweets,  or (b) vendors thinking that barraging a news site’s readers with unwanted Twittermercials is actually hip, progressive marketing that will benefit those companies. It seems kind of unsavory and reader-insulting for a company with “news” in its name to be doing this kind of revenue augmentation without regard to the potential damage to whatever reputation it has, but it’s really none of my business – that’s between the publication and its readers.

From Harcourt: “Re: inpatient MU attestation. Please post this graph. I believe the huge gap between Cerner, Meditech (including its contribution of HCA’s attestation), and Epic would create interesting discussion.” The graph is here. As with EP attestation numbers, I would be cautious about trying to apply client MU figures to the likelihood of a given customer earning MU money. Meditech has more live hospitals than anyone, so I’d expect its numbers to beat those of other vendors. In fact, I’m slightly surprised that it doesn’t have a wider lead over Cerner and especially Epic (Epic’s number suggests that 50% of the hospitals it has ever sold to have attested, which I would think trounces both Cerner and Meditech if you’re calculating odds). I can’t say I’m really interested in any of this information, since any vendor with even one successfully attesting client has proven that its software has the capabilities needed. Beyond that, much of the required effort belongs to the customer.

From HITEsq: “Re: Girard Medical Center (KS). Really doesn’t like Cerner – suing them for breach of contract. Among the interesting tidbits, Cerner staff apparently though that Cerner was able to get the hospital to agree to an agreement as a result of ‘concert tickets and booze’ and that the Cerner staff was only there ‘because [they] drew the short straw.’ Apparently, Girard feels like it paid $1.3M for nothing.” The 21-bed hospital says it has paid $1.3 million of the $2.9 million total without receiving “any tangible work product” and that the time and attendance system that it thought it was getting wasn’t included (they claim Cerner helpfully suggested using an Excel worksheet instead.) The hospital also claims that Cerner assigned “incompetent staff” to implement the system. That’s all fun to read, but (a) this is one side of an argument that has two; and (b) some of the claims fall between irrelevant and desperate. There’s a good lesson here for customers: don’t let your buddy-buddy salesperson talk you out of getting an expert in contract law to insert protection into the agreement that covers whatever you are (or should be) afraid of as a customer. Once it gets to the lawsuit stage, there’s a good chance that nobody will be happy with the result except the hourly-billing lawyers.

HIStalk Announcements and Requests

Listening: reader-recommended Turisas, epic pagan battle metal from Finland, like a band of Vikings hit Kerry Livgren over the head with a mace in 1975 and took over prog band Kansas, then merged it with Green Carnation and Muse. While I acknowledge that most folks won’t like it, I definitely do. 

I’m really behind after taking some time off, just in case I seem unresponsive. I don’t think that situation will change until well into the weekend since I’ll be working all of it.

Acquisitions, Funding, Business, and Stock

7 Medical Systems, a provider of on-demand digital imaging, EMR, and RCM solutions, acquires Manager Consultoria em Informatica LTDA EPP, a Brazilian company  that offers similar services to hospitals and clinics in Brazil.

Elsevier purchases QUOSA, a provider of life sciences content management and workflow productivity solutions.

VeriTeQ Acquisition Corporation completes its acquisition of PositiveID Corporation’s VeriChip implantable microchip  and Health Link PHR.

Sales

The DOD’s Military Health System awards Planned Systems International a five-year, $96 million contract to provide code maintenance services.

Putnam County Hospital (IN) announces plans to implement CPSI.

Prevost Memorial Hospital (LA) selects CMR EDIS version 3.3 for its emergency department.

Home health provider RBA Texas selects Axxess’ Agencycore home health software.

Nashville General Hospital signs a multi-year agreement with Sectra for its integrated RIS/PAC solutions.

Baylor Health Care System (TX) adopts technology from strategicplanningMD, a provider of strategic planning software for the healthcare industry.

IASIS Healthcare LLC (TN) selects NextGen Practice Management and RCM for its 19 hospitals across seven states.

Ellenville Regional Hospital (NY) selects Healthcare Management Systems (HMS) EHR and financial applications.

The Premier Healthcare Alliance awards a contract to UltraLinq Healthcare Solutions for its Web-based imaging system.

Mercy Medical Center (IA) selects MedVentive’s Population Manager and Risk Manager products to facilitate management of its accountable care contracts.

Massachusetts General Hospital chooses Voalté’s consolidated voice, alarm, and text communication system for nursing communication.

People

Aria Health (PA) appoints Brian A. Hannah MD as CMIO.

OB fetal monitoring software vendor PeriGen names former Allscripts SVP Matthew Sappern as its CEO. He replaces Donald Deieso, who retired at the end of December to join Arsenal Capital Partners.

St. Joseph’s Hospital Health Center (NY) appoints Michael A. Spurchise director of enterprise and ambulatory systems.

Chris Caramanico joins SCI Solutions as SVP of marketing and business integration. He was previously SVP of new business enterprise applications for Allscripts.

Cornerstone Advisors names Gregg Fajkus as VP and Epic practice director. He was previously with Encore Health Resources.

Pamela Lane, formerly VP of health informatics with the California Hospital Association, is appointed deputy secretary of the health information exchange at California’s HHS.

Steven Arnold MD is named chief medical officer of surgical implant management solutions vendor MediQuip.

Announcements and Implementations

Human capital management software vendor API Healthcare announces strong growth for 2011, including the best quarter in its history.

Stockell Healthcare Systems announces GA of its InsightCS Business Intelligence Suite 2.0, which expands its revenue cycle management system with executive dashboards that include days in AR, cash receipts, collector productivity, denial rates, clean claim rates, and coder productivity.

In England, six hospital trusts say they’re saving $12 million per year by operating a telestroke program based on Polycom’s RealPresence video collaboration solution.

Misys Open Source Solutions grants exclusive Swiss distribution rights for its Misys Connect XDS registry and repository to Switzerland-based enterprise content management vendor Uptime Services AG.

Other

A data entry error creates grossly inflated bills for hundreds of Bronx-Lebanon Hospital (NY) patients. The hospital blames its billing company for inserting invoice numbers in the space designated for the amount owed.

The local paper profiles Beacom Health, one of six practices that have taken advantage of subsidies from Fremont Area Medical Center to implement eClinicalWorks.

Cerner donates $10,000 to its First Hand Foundation to celebrate hitting the 10,000-employee milestone. The company has now employs 10,062 associates, including 6,575 in the Kansas City area.

I couldn’t help think of Mr. H when I read this since I know he enjoys both his music and his exercise. Between 2010 and 2011, 47 people were killed or seriously injured while walking and wearing ear buds or headphones. I predict a few lawsuits against Apple for allowing the music to play so loud. 

Weird News Andy says he’s excited at the news that a pill may replace the need to exercise, but he’d be happy with one that helps him remember where he put his car keys.

Strange: unknown criminals steal a computer and paper records from a South Carolina doctor’s office, then drill a hold in the roof, insert a garden hose, and turn it on to run all weekend.

Commissioners of Bay County, FL discuss a settlement with chiropractic office management software vendor Redpine, which relocated to the area to take advantage of $750K in incentives and then closed its doors. The company has offered to sell its software rights to repay the incentives and claims it has several prospective buyers.

Sponsor Updates

• Health Language Inc. releases a new version of its provider-friendly terminology  to include clinician friendly synonyms and more than 100,000 attributes for ICD-10-CM.
• The Health Training Network, a service of Inland Northwest Health Services, opens a new training facility to house medical classes, including a paramedic program.
• IMDsoft reports strong growth in 2011, including first-time installations in three countries and involvement with  45 critical care and anesthesia projects.
• SCI Solutions announces HITECH certification of its Schedule Maximizer V34.
• Awarepoint reports that 10 of its newly-live customers were interviewed by KLAS, with all of them reporting high satisfaction.
• McKesson customers share keys to successfully attesting for Stage 1 Meaningful Use.
• The New Zealand Trade and Enterprise names Orion Health one of nine finalists in the “Best Business Operating Internationally” category in the New Zealand International Business Awards.
• Aspen Advisors announces that in 2011 the company grew revenue 40%, expanded its leadership team, and added 23 clients.
• ICA Informatics signs a memorandum of understanding with the New York eHealth Collaborative to join its workgroup for developing connectivity standards.
• Princeton Orthopaedic Associates (NJ) selects the SRS EHR.
• Canon and Nuance Communications successfully  complete interoperability testing of Nuance’s eCopy ShareScan v5 software for converting and passing scanned documents from Canon ImageRUNNER ADVANCE MFPs into EHR applications.

Contacts

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

Curbside Consult with Dr. Jayne 1/16/12

Jayne Gets Her Tweet On

During a recent e-mail exchange, a friend of mine repeatedly chastised me for not being on Twitter. He failed to see why someone who lives in the land of blogging and social media wouldn’t want to Tweet with the rest of the world. To be honest, I’ve been more than a little scared to take the plunge. Knowing all too well what an outrageous time suck Facebook can be, I didn’t want to get into something else that had the potential to further unmask certain addictive personality traits.

Nevertheless, I took the plunge. Signing up was deceptively easy, although I’m having a hard time deciding who to follow. I don’t want to overdo it with too much information. So far, I’m following HIStalk (of course), my BFF Inga, and my very public secret crush Farzad Mostashari (and his dashing bow tie.) You can follow my shame spiral @JayneHIStalkMD .

While I’m feeling social, I decided to share some reader correspondence. It goes back a bit, as you can imagine my inbox usually looks something like the hallways of a New Orleans emergency department during Mardi Gras (which incidentally is just a month away for those of you who plan to get your party on).

From Miami, My Amy: “I was at a physician office this week and they couldn’t get the right patient into the right room. They took me back twice and reseated me in the reception and did the same thing to another person. Made me wonder whose medical record they were viewing. I find I am becoming a “difficult” patient, bristling with all the paperwork to fill out time and time again… with the same provider.” I agree, this sounds pretty annoying and it’s also a significant patient safety issue. I do hope your physician apologized though. I that was happening in my office,I would expect my staff to make me aware so that I could say something to patients.

From Bama Bubba: “Your Curbside Consult today really charged up my growing OCD. Public restrooms never have commode lids, plus they often flush with a great torrent of surging water, not the home-based gentle swirl. This flushing surely raises huge clouds of nasty water droplets perfect for deep lung deposition. I had a remembrance of the huge toilet complex at McCormick Place in Chicago and literally dozens of commodes in narrowly separated stalls, used by folks from all over the world, being flushed at the same time. Whoa! Talk about a toxic cloud of international viruses. Excuse me, I have to go wash my hands again.”

From HealthNut: “Re: shift work food options. I worked 11-7 for a stretch and our food options consisted of coffee, colas, cigarettes, and vending machine staples of sandwiches with greenish mystery meat/cheese, lukewarm canned chili or Beanee Weenee, peanut butter crackers, candy bars, and gum. The only thing that kept us from morbid obesity was bring broke all the time because we were students.” Yeah, that and the fact that we had to run arterial blood gas samples to the lab in styrofoam cups of ice chips and run to radiology to look at actual x-ray films all night long. At my hospital, our vending machines were just updated with a new item: White Castles.

From Golfing Great: “Regarding your recent post on technology as the new scapegoat. It’s not only the users who operate the systems, but also the folks who create and maintain the systems, the training they receive, their proficiency, and their ability to anticipate — or at least understand — the needs of those users (which I try to do by subscribing to HIStalk, so thank you very much!) When problems occur, there is usually more than enough blame to go around. It’s a shame the time spent deflecting isn’t devoted to planning, training, and coordination instead. It is important to keep in mind that systems are comprised of technology, people, and processes, all of which must function properly for the system to succeed. I’m not sure that any system will ever be able to address the intentional ignorance demonstrated by people in some of the scenarios you quoted, certainly technology alone cannot. I couldn’t agree more that culture is key, particularly when, even in spite of best efforts, systems are inadequate.” Thanks for that feedback. If I could convince organizations of the need to do one thing prior to and during implementation of any health IT system, it would be this: change management.

From Mr. Clean: “What is the evidence base on best way to sanitize tablets and (especially) keyboards? Inquiring minds want to know!” There’s not a ton of data on this. Personally, I use the same wipes that we use in the emergency department, which are a healthcare-grade sanitizing wipe for hard surfaces. Low-level cleaning requires keeping the surface wet for at least thirty seconds; higher-level disinfection requires keeping the surface wet for at least three minutes, which is a little harder to do with a keyboard.

Just a few days ago, the FDA cleared a self-sanitizing hospital keyboard with the bargain price of $900. The solution uses UV light to eliminate bacteria. Another reader suggested the WetKeys Washable Keyboards, which actually look pretty cool and have much more accessible pricing. It would definitely be easier to keep those wet for three minutes than a traditional keyboard. I really like the looks of their washable flexible keyboard. Too bad Santa has already come and gone — he could have rolled one up and left it in my stocking.

Have questions about ICD-10, the most common injuries seen during Mardi Gras, or whether you should order your White Castles with double pickles? E-mail me.

E-mail Dr. Jayne.

Monday Morning Update 1/16/12

From Barry Goode: “Re: 5010. I’m glad to dish out all the dirt I know as a vendor. Big picture, it’s been a LOT easier and less troublesome than we expected. Most of our payers and intermediaries have been really good. Our clients have a 99+% clean claim rate. The clearinghouses have been far more troublesome than the payers as a rule, which is pathetic because it’s their primary business. A good clearinghouse having trouble with a particular payer should be able to EASILY resubmit claims in the 4010 format in order for the practices to be paid while issues are worked out. The deadline was moved! Although the clearinghouses are to blame for some of the trouble, the real culprits will soon be the state Medicaids. Some of them have yet to even indicate when they will be ready for testing.”

From Rumble: “Re: Partners. Heard they’re making that big decision by April 1. Why use that date? Push it out a day or two, jeez …” 

From HIPAA Hound: “Re: how doctors die. Here’s another article, a tad longish, but interesting. My wife and I are both of this mind, and we have our living wills/advance directives on file and our durable POAs ready if necessary. In my opinion, too much technology in the hands of the uninformed or emotionally involved (that’s not the right word, but I can’t seem to call the correct one to mind) is what runs US healthcare costs out of sight. My two cents.” I’m no expert, but Americans seem to be uniquely culturally incapable of accepting death. We’re so used to endless opportunity (at least until recently), unlimited science, and never-ending self-actualization that to just admit that your number is up never happens. It’s not just the elderly – every hospital I’ve worked in spends millions saving wildly premature babies weighing a pound or two. My conscience hasn’t resolve the question of whether that’s the best use of increasingly limited healthcare resources, especially when you look at some of the families and try to decide what that baby will be going home to after unbelievably expensive months in the NICU.

From The PACS Designer: “Re: iPhone’s 5th. It’s had to believe, but the iPhone just celebrated its 5th anniversary. When it was first released, virtually no one predicted it would dominate the marketplace and outdo other smart phones in popularity. Healthcare has always been a sweet spot for Apple products, so that’s why there’s always a place for almost every new Apple product introduction. The first iPhone was 1.16 cm thick and had a 3.5″ widescreen touchscreen display with multi-touch support, 8GB of RAM, Bluetooth, WiFi, and a 2 megapixel camera.” I couldn’t easily find the link, but an HIStalk poll I ran when the iPhone came out found that readers mostly thought it would have little influence on healthcare. As a vendor, how would you like to have a product that’s in such high demand that Chinese consumers are willing to attack humorless police and criticize their government when the local Apple store doesn’t open on time? Maybe financially irresponsible countries should consider slapping on iPhone tax like the cigarette tax, knowing that people are addicted. I floated a similar to proposal to a slightly interest audience (Mrs. H) while in the airport this weekend – revenue-happy airlines that are even charging passengers for boarding ahead of their assigned zone should charge the idiots that congregate around the boarding lane before their turn, blocking the path of those trying to board as called. You can sit for free, or obstruct for a fee.

I’ve whisked Mrs. HIStalk away for a rare long weekend as I attempt to temporarily recover from the onslaught of HIMSS-related HIStalk work (not to mention work at my hospital) that has been testing my mental and physical capabilities. I’ll keep this post brief rather than just bag it completely or dump it on Inga to write, pecking it out on my small HP laptop on modestly good hotel wireless. Your regularly scheduled verbosity will resume Tuesday evening. In the mean time, Mrs. H and I are tooling around in a really cool Mustang convertible (a rental – something I’ve always wanted to do), eating in good restaurants, working out, and relaxing. Then it’s back for the final assault before the conference.

I’m fascinated with Vince’s HIS-tory this week because he gives some rare and fun background on a couple of industry long-timers: Judy Faulkner and Frank Poggio. His series always reminds me that it’s about the people more than the companies.

Here’s my final thought on CMS’s Meaningful Use numbers. I’m pretty sure ONC’s point was to show what a great job it’s been doing in getting providers to use EHRs, and their information (not surprisingly) seems to support that. I’m not sure why they included vendor information, though. They should have known that everybody would try to over-analyze and massage the skimpy data to gain competitive advantage. That focus has actually caused many folks to miss the point that the adoption curve is moving sharply upward, which is ONC’s real job rather than feeding the competitive EHR market frenzy. As a provider, your mileage will undoubtedly vary no matter what someone else’s numbers show. And the next set of numbers will provide a much-needed data point: does adoption seem to be increasing, or has it peaked?

I was interested to hear that Adventist Health is putting Cerner in its ambulatory locations. I didn’t know that, at least according to one reader, they’re displacing Epic ambulatory. That’s how it should work, of course – the hospital system generally drives the choice of the outpatient system, not vice versa, although Epic has benefited greatly from customers who don’t find that to be an acceptable choice given their incumbent vendors. I was thinking that Loma Linda University Medical Center might be impacted since they announced an Epic inpatient decision not long ago, but I guess they aren’t part of Adventist Health like I thought I remembered.

Thanks to everyone who signed up for HIStalkapalooza invitations. The signups have been closed and invitations will be e-mailed out shortly to the folks we can accommodate (we had around 1,000 invitation requests, so unfortunately we can’t send everybody an invitation.) Thanks, too, to everyone who voted in the HISsies – I’ve closed that voting as well.

It

The economy is looking better to a good number of the folks responding to my most recent poll. New poll to your right: CMS released Meaningful Use numbers. How are attestations running compared to what you expected?

The New York Times writes up Epic in its business section. It’s not a particularly insightful or in-depth piece, but they did apparently interview Judy although the article has few quotes. It does include some interesting statistics: Epic has 260 customers, 35 of which signed on last year. Their software will cover 127 million patients next year. The company has 5,100 employees and will hire another 1,000 this year. Revenue for 2011 is expected to come in at $1.2 billion, up 45% from 2010. It also mentions a retired UW professor of psychiatry who was an original Epic investor and who sits on the company’s board, the first mention I’ve seen that the company has investors or a board. It would be interesting to know what she invested and what that investment is worth now, although obviously private company shares are illiquid, making valuation (and selling) tricky.

Cerner hits the 10,000 employee mark.

This week’s employee e-mail from Kaiser Chairman and CEO George Halvorson talks up walking, with nearly 30,000 of KP’s employees enrolled in its walking programs. KP has developed an EveryBody Walk! app to help people develop a walking plan and find walking routes.

Just in case you’re Googling for old HIStalk posts prior to 2007, they’re gone, at least temporarily. The blog service I used for HIStalk from 2003 until 2007 has gone belly-up, which isn’t surprising since it was really run more like a geek’s electronic bulletin board than a professional service, so WordPress killed it off easily (that threat and a couple of issues I had led me to abandon it years ago). I have an XML backup that can supposedly be imported into WordPress, so if I see benefit to putting the old stuff back online, I’ll hire someone to port it over. I feel some loss – I spent a ton of time and energy crafting those old posts.

Akron Children’s Hospital names Amy Maneker MD as CMIO to oversee its Epic implementation. She previously held a similar role with Rainbow Babies and Children’s Hospital in Cleveland.

Inga ran across this on Facebook. RelayHealth donates its $50,000 prize for winning the VA’s Blue Button for All Americans contest to the Wounded Warrior Project, which helps wounded service members.

E-mail Mr. H.

An HIT Moment with … Liz Roop

An HIT Moment with ... is a quick interview with someone we find interesting. Liz Roop is president of NPC Creative Services, LLC of Tampa, FL.

What are the biggest mistakes companies make in their public and media relations activities?

Failing to articulate how your product or service delivers on its sales promise. With PR, you have to go deeper than the sound bite. If your advertising promises that your software helps an organization achieve Meaningful Use, transition to ICD-10, or comply with core measures, you better be able to explain how. This is especially true for niche health IT products and services.

Failing to commit the necessary human resources to PR, especially at the executive level. Nothing backfires quicker than telling an editor that the CEO isn’t available on the day of a major announcement, or that the CMIO is going to miss an article deadline.

Basing PR decisions on what competitors are doing rather than what customers and prospects are saying. While it is important to understand the competitive landscape, it’s a strategic misstep to do something just because it was done by a competitor. That kind of “me too” public relations undermines a company’s credibility – and is how we wind up with so many nonsensical catch phrases and buzzwords.

Last is not listening to the experts retained to manage the company’s public relations. That’s how the other mistakes happen.

Where should a small, newish company trying to get a foothold in a competitive market with a modest budget and minimal in-house PR expertise focus its energy to get the word out?

The best approach is one that connects a company with its prospects and customers when they are in decision-making mode. I may be biased because this is where NPC specializes, but the best place to make that connection is in the trade media. Think of it this way: when was the last time you were contemplating order set software or patient satisfaction survey tools when you were reading your local newspaper?

The catch is that while it doesn’t require a lot of expensive bells and whistles, trade media relations does require a comprehensive understanding of the issues your product or service addresses and the ability to articulate how it does so. If your internal team is struggling for whatever reason to stay on top of how industry changes are affecting your customers, you need to explore an agency relationship. That’s true even if your budget is modest. Boutique PR firms are surprisingly affordable.

Old-school PR involved schmoozing a handful of glossy magazines mostly looking for ad revenue and hoping they would pick up a press release for a mention. How has that changed with the advent of blogs, Facebook, and Twitter that stream non-professionally produced information almost in real time?

It has definitely changed the role of the press release. In the past, the release was written for the media with the hope of enticing a reporter to pick up the phone, ask a few questions, then write a little something about the announcement. With the advent of social media and online newsfeeds, press releases must now be written for the customer. They must also be written to accommodate the lack of professional editorial gate-keeping in terms of how the news is abbreviated as it goes viral.

Press releases aside, the real-time nature of today’s media actually makes schmoozing more important than ever. It’s just handled differently. Substantive coverage still comes from cultivating mutually beneficial relationships with the appropriate media. However, today, those relationships are typically established electronically rather than over lunch or with the old-fashioned media tour. So while many of the rules remain the same, the methods of communication are definitely different.

We like to make fun of bad press releases. What are some classic bad ones you’ve seen? How can companies write better ones?

Oh boy, that’s a loaded question. I enjoy making fun of bad press releases as much as you, but I also know that none of us is immune from sending out the occasional stinker. Sometimes it’s a matter of being human. Sometimes it’s because we have to pick our battles. So I hesitate to cast stones in the vicinity of my glass house.

But since you asked…The release that stands out to me as truly awful was issued several years ago. I could almost get past the multiple typos and punctuation errors in the headline and the first two run-on sentences. But I couldn’t get past its claim that the firm was a key advisor to the Obama administration’s healthcare transition team. It took two more paragraphs to learn the real story. The company’s executives were members of a subcommittee that was part of an association’s workgroup that issued unsolicited recommendations to the administration for advancing health IT.

To write better press releases, companies need to avoid making outrageous claims and focus on stating the news clearly and concisely. Exhaustive detail is exhausting for the reader. So edit. Then proof. Then edit and proof again.

If a company wanted you to help them come across as brash, fun, and outrageous, what would you do?

I would advise them to proceed with caution. There’s a fine line between edgy and cartoonish. Crossing that line can do irreparable damage to a company’s credibility, especially if the customer base doesn’t respond well to brash or outrageous.

There are ways to inject fun without overpowering the informational or educational aspects of public relations. Find-A-Code’s ‘Yeah, there’s a code for that’ ICD-10 videos are a great example of doing it right. They’re funny and educational. It’s all about striking a balance.

News 1/13/12

Top News

Adventist Health expands its affiliation with Cerner, announcing plans to implement Cerner Ambulatory EHR across its 130 clinics.

Reader Comments

From Booth Babe: “Re: HIMSS and HIStalkapalooza. Have mercy on the aching feet of worn out tradeshow floor ‘workers’ who have only minutes to spare getting from work to FUN. Do you know how often during aching feet moments we think of the upcoming party and how it drives us through each additional hour until we can cut loose and have some fun?! I would never have time to deck out as some of those fashionistas did last year, though they looked fabulous and were fun to see. Maybe you should add a category for best ‘survivor’ shoes for tradeshow performance. ” Gee, the term “survivor” shoes is right up there with the “straight from the exhibit hall” style company logo shirts. That being said, I have a couple pair of great shoes similar to the ones above that are comfy enough for the trade shoe floor, yet stylish enough for a quick transition to Vegas nightlife. E-mail me if you want details on the brand.

From ThickAndThin: “Re: McKesson. To acquire European firm MACH4 Pharma Systems?” Unverified. The England-based company sells drug packaging and preparation automation for hospital pharmacies.

From DeepThrowIT: “Re: White House CTO Aneesh Chopra. Word on the street is that he will announce in the next few weeks that he will be leaving his job. No word on where he’s going next.” He’s a young guy (39) with a lot of enthusiasm and charisma, so if the rumor is true, we’ll see whether he pursues money (running a private company) or power followed by money (running for office.)

From LeftCoaster: “Re: EDI 5010. Oregon and Washington hospitals are experiencing significant issues with transmission and receipt after mandated January 1 use, but deferred enforcement until April 1. Clearinghouse vendor [vendor name omitted] is a huge problem – they are not responding to support calls and hospitals are considering switching. Both Cigna and Providence Health Plan claim they are unable to transmit payments and organizations are having major cash flow problems, particularly community hospitals. Anyone else having problems?” Unverified, so I removed the vendor’s name. Further reports are welcome.

From Nasty Parts: “Re: [vendor name omitted]. Is moving away from their legacy EHR product and all efforts will be put behind a SaaS product they bought last year. 400+ people will be RIF’d as a result in the near future.” I removed the vendor name while we try to get confirmation (which I don’t expect to be successful), but Nasty Parts has been accurate about this company in the past.

HIStalk Announcements and Requests

Highlights from HIStalk Practice this week include: Dr. Gregg explains why he is skipping the HIMSS soup line this year. Hospitals now employ 20% of physicians. CareCloud grows rapidly. A breakdown of EP attestations by EMR product. Age affects physicians’ perceptions of HIT. A little bit of ambulatory HIT news is like a ray of sunshine of a cloudy day. In other words, by signing up for e-mail updates on HIStalk Practice, you can keep the winter doldrums at bay. Thanks for reading.

Welcome to Humedica, sponsoring both HIStalk and HIStalk Practice at the Platinum level. The Boston informatics company offers SaaS-based clinical business intelligence solutions that create a real-time longitudinal patient care view, giving providers insight into their patient populations, the outcomes of the treatments and procedures, and how those factors impact quality, outcomes, and cost. For physician practices, the company’s MinedShare Ambulatory product supports clinical, operational, and financial benchmarking. Humedica partners with Anceta, the informatics subsidiary of AMGA, to allow its members to collaborate on quality improvement and to share best practices. I interviewed President and CEO Michael Weintraub last month, where he talked about the company’s top-rated performance in KLAS, its partnership with Allscripts, the $50 million in capital investment the company has received, and what’s next for the industry after EMRs. Thanks to Humedica for their support of HIStalk and HIStalk Practice.

Speaking of Humedica, the company announces a predictive analytics tool that analyzes EMR data (not claims information) to identify high-risk CHF patients and intervene before they require hospitalization. Preventable heart failure admissions cost up to $35 billion per year, with 40% of Medicare CHF patients readmitted within 90 days. MinedShare client Community Physician Network (IN) says the tool will help it perform in an Accountable Care Organization model by avoiding unnecessary admissions and providing better patient outcomes.

Reminder: you app and Web developers still have plenty of time to enter Nuance’s 2012 Mobile Clinician Voice Challenge, considering that it takes only a couple of lines of application code to speech-enable your mobile or Web app for clinicians and the deadline isn’t until February 3. Prizes and fame could be yours. Even non-programmers can get a shot at the prize kitty by tweeting about the contest.

Acquisitions, Funding, Business, and Stock

T-System acquires Practice Management Associates, a provider of coding and billing services for EDs.

TriZetto Group, which last week acquired Medical Data Express, acquires Kocsis Consulting Group.

Practice Fusion raises an additional $2 million in funding, raising its total to $38 million from Band of Angels, Felicis Ventures, and other investors.

Columbia University signs an exclusive agreement with Health Fidelity to commercialize its MedLEE text-based natural language processing technology. Fidelity offers its own NLP solution called Fidelity Platform, which uses MedLEE to extract medical data from unstructured text and generate SNOMED codes from it.

In Europe, CompuGroup Medical acquires Netherlands-based ambulatory and pharmacy systems vendor Microbais Werkmaatschappij BV. The transaction also gives CompuGroup a 51% stake in healthcare connectivity startup MediPharma Online.

Sales

Barnabas Health (NJ) adds MedeAnalytics’ Revenue Cycle Intelligence solution to compliment its existing Patient Access Intelligence solution.

El Paso Children’s Hospital (TX), which opens next month, selects RCM provider Cymetrix for business office technology and services.

The DoD awards GE Healthcare a three-year, $43 million extension of its contract for patient monitoring systems.

Illinois Neurological Institute selects JEMS Technology to provide tele-stroke evaluation.

Massachusetts Eye and Ear selects PatientKeeper Charge Capture and PatientKeeper P4P for its 250 clinicians.

Catholic Health East signs a five-year, $40 million contract to implement AUXILIO’s managed print services in its 19 hospitals.

People

Former Google Health exec Missy Krasner joins Morgenthaler Ventures as executive in residence. She was also previously senior communications director at ONC under David Brailer.

Medical appointment booking site ZocDoc adds former Senators Tom Daschle and Bill Frist to its advisory board.

Encore Health Resources promotes Thomas J. Niehaus from EVP of client services to president and COO. Dana Sellers remains as CEO. In case you missed it, Mr. H recently interviewed Joe Boyd, Encore’s chairman of the board.

Lisa Conley, formerly with McKesson, joins Sunquest Information Systems as VP of North American sales and global marketing.

Industry long-timer Kerry de Vallette joins OPTIMA Credentialing as EVP of sales and marketing.

Interactive patient care systems vendor Skylight Healthcare Systems names Scott Johnson as VP of sales. He was previously with A-Life Medical and Philips.

Announcements and Implementations

North Hawaii Community Hospital begins implementation of its HIE, which uses Wellogic’s technical platform

Intelligent Medical Objects announces the successful integration of 2012 ICD-10-CM within its newly released IMO Problem IT 2012 Regulatory 1.3 software.

Nuance Communications expands the availability of Dragon Medical to French-speaking Canadian providers with the delivery of Dragon Medical 11 French.

Yale New Haven Hospital SVP/CIO Daniel Barchi provides an update on its Epic project. Six practices of 27 physicians are live, with e-prescribing at 91% and 80% of encounters closed the same day. Physician productivity for those docs is nearly back to pre-Epic levels. Greenwich Hospital will be the first hospital to go live in April. Daniel is one of few CIOs who has implemented Epic in two large health systems (he came from Carilion) so I asked him how it was the second time. He says Epic’s greatest strength is that they fully believe and trust their own process — developing their own software, rarely partnering with other companies, and creating finely detailed training plans. The benefit for customers, he says, is that if you just follow their plan, you will have a successful go-live.

Innovation and Research

Researchers at the University of Washington develop medical robots that support the open source Robot Operating System, saying it’s time to get away from proprietary, one-off medical robots and allow universities to collaborate in sharing their applications.

Technology

Ford partners with Microsoft, Healthrageous, and BlueMetal Architects to develop “the car that cares,” which would monitor the health and wellness of drivers. Data would be collected biometrically and through voice capture, then uploaded into HealthVault.  And I thought texting while driving was distracting.

A doctor in Canada gets her smart phone PHR app certified by Canada Health Infoway, only the second app to earn that distinction. She named it Mihealth, with the “Mi” referring to her feeling that adopting digital data in Canada was Mission: Impossible.

The Qualcomm Tricorder X Prize offers $10 million to anyone who can create a Star Trek-like tricorder that can diagnose medical conditions non-invasively. The X Prize Foundation chairman helpfully adds, “We don’t have a requirement that it makes the same noise.”

Other

An AHRQ study finds that 5% of Americans account for 50% of the country’s $1.26 trillion in healthcare costs. The top 1% of spenders account for 22% of the costs.

Could there be a connection? Life expectancy is up two years since 2000 and Hostess, maker of Twinkies, DingDongs (my personal fav), and HoHos, files for bankruptcy protection. Experts blame a shift toward healthy foods.

Here’s a point/counterpoint issue to mull over. Inga and I disagree on the value of CMS’s attestation statistics. Inga thinks the percentage of each vendor’s customers that have attested is a good benchmark, so she did lots of spreadsheet work to compare vendors and to assume that varying percentages among them must be reflective of product capabilities and ease of use in meeting Meaningful Use requirements. I said the information is useless for that purpose since it’s more reflective of unmeasured customer demographics and buying criteria than anything else and that it would be wrong (not to mention statistically indefensible) to use the CMS figures to infer that vendors with a higher percentage of successfully attested users have a better product for earning Meaningful Use money. Feel free to take sides. One thing’s for sure: vendors who massage the data into slick marketing collateral won’t be footnoting their handouts with statistical disclaimers.

Weird News Andy says “the eyes have it” in referring to this story, in which researchers are working on a smart contact lens that can continuously and non-invasively monitor glucose levels, electrolytes, and cholesterol, sending the results electronically.

Former Steve Jobs mentor turned nemesis John Sculley, who served as Apple CEO for 10 years, is interviewed at the Consumer Electronics Show, where he was promoting a company he advises and invests in, Audax Health. He describes his interest:

The area I am particularly excited about now is healthcare. Healthcare has been the last major industry that hasn’t been touched by technology in terms of productivity and consumer adoption in the way so many other industries have. While I’m not bringing any technology experience to the healthcare industry, I do see some similarities between what I was asked to do when I came to Apple, which was to bring big brand consumer marketing to Apple and carry it over to the whole Silicon Valley industry – because everybody does that today – well that same opportunity exists today in healthcare. Health innnovation enabled by digital technologies to build big consumer service brands, is an incredibly interesting complex problem to work on. Audax is really the first social health company and it’s focused on consumer engagement in the healthcare space bringing in a lot of the social media technologies and experiences that have been learned from companies like Facebook and Zynga and others.

The federal government adds insurance fraud to the list of charges faced by a Louisiana doctor that also includes possession of child pornography. The doctor was medical director for a company that monitored neurophysiologic surgeries over the Internet, billing insurance companies for their time. He and the company are accused of billing for surgeries in which no Internet connection was established, padding their billed hours, and instructing non-physician employees to log on to the monitoring system and pose as physicians for billing purposes.

An Indiana health insurance plan alerts 2,700 members that their records may have been exposed on the Internet in February 2011, when a server was inadvertently opened up to the Web during an upgrade.

Sponsor Updates

• SRS helps its customer Midwest Ortho (IL) celebrate its successful MU attestation with a tasty-looking cake.
• Pete Rivera of Hayes Management Consulting  discusses building leaders and improving team effectiveness.
• Picis will participate in this month’s 2012 Military Health System Conference in Maryland.
• OnX and MEDSEEK enter into a strategic partnership that allows OnX to distribute all of MEDSEEK’s enterprise patient engagement solutions.
• MED3OOO shares details of InteGreat EHR’s improved KLAS scores.
• Minnesota’s REC recognizes e-MDs customer Christopher Wenner, MD for being one of the state’s first providers to achieve Meaningful Use.
• Gateway EDI and AAPC align to offer ICD-10 training for practices, starting with a January 24 Webinar.
• Orion Health opens its 14th international office in Paris.

EPtalk by Dr. Jayne

It may only be Thursday as I write this, but I’m really wishing it was Friday. This has been a hectic week full of clinical snafus and customer services annoyances.

The first guilty party is HIMSS, whose registration system apparently malfunctioned last month. HIMSS12 registrants were charged a zero dollar amount for their HIMSS renewals. I received an e-mail notice about the registration problem and was told that someone would call me to discuss whether or not I really wanted to renew. They did, while I was seeing patients. I didn’t want to ignore it and risk a snafu in Las Vegas.

I called the customer service number left on my voice mail and the answering staffer had no idea what I was talking about. After more than 15 minutes on the phone and two call transfers, they finally got their act together. I hope the conference itself runs much more smoothly. And to HIMSS, let me introduce you to the concept of service recovery. If you accidentally undercharge people, let it go and use it as a lesson learned. Did that many people really register on those two days that you are going to suffer without the extra $160 per person? Goodwill is invaluable.

The second guilty party was the staff at Well-Known University Medical Center whose performance at the check-in desk gave new meaning to the phrase “epic fail.” Not only did they insist that my insurance information wasn’t in the system (doubtful since it just paid a claim last week on another appointment) but they were also rude about it. As I sat in the waiting room, I was also annoyed by their ham-handed questioning of patients on race and ethnicity. I wanted to jump up and intervene with some better scripting.

If organizations can’t even handle those customer service basics, I have no idea how they’re going to achieve Meaningful Use, let alone be a meaningful participant in an ACO. Not to mention that they didn’t ask everyone about race and ethnicity. I’m not sure if they just “assumed” for the rest of us or if they decided to judge by appearance.

The final straw was a resident physician who actually was using his BlackBerry to e-mail or text during my visit. Really. Talk about smartphone distractions. He set it on the table between us and typed as he was doing the exam. I know for sure he wasn’t documenting in the EHR because the scribe was tapping away at the PC in the corner.

The resident didn’t think it was funny when I asked him if I was keeping him from something important. He did sheepishly put it in his pocket. Maybe he should have noticed the “faculty” label on my encounter bill. Oops!

Lest you think I’ve just become Angry Jayne, some good things did happen this week. Inga and I strategized on the coveted HIStalkapalooza beauty queen sashes and I have narrowed down the list of candidates who are vying for the chance to escort me to the event.

HIMSS released their list of its 2011 Best Hospital IT Departments. Texas Health Resources, whose IT shop is led by contributor Ed Marx, is listed for large hospitals.

I’m curious about Nemours/Alfred I. DuPont Hospital for Children, which is described on the “medium hospitals” list as having 237 IT staff for its 180 licensed beds. I could certainly do a lot more with 1.3 staffers per patient. I wonder what their nursing ratio is?

Life Technologies Corp. announces that its new Ion Torrent genome sequencer will be able to map an individual human genome in a single day for less than $1,000. Although technically this is HOT, sequencing of a person’s genome brings up lots of controversial ethical and legal issues, not to mention the cost of the human expertise needed to transform the genetic data into something meaningful and to then counsel patients.

The absolute highlight of my week, though, is this delightful video about computers in medicine circa 1964. Thanks to Rockstar HIStalkapalooza correspondent Evan “Velvet Jacket” Frankel for making my day. See you at HIMSS.

Contacts

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

John Gomez 1/11/12

Recently I developed a Leadership Cheat Sheet for clients and friends. The document provided guidance on how to evolve your leadership style and suggestions on avoiding common leadership mistakes. As we move into 2012 (wow,  2012 sounds so Buck Rogers, doesn’t it?) I started thinking about a cheat sheet for HIT executives that helps them evolve their strategies and hopefully avoid technological mistakes in the coming year. By no means is this cheat sheet a comprehensive end-all, be-all, but rather a high-level guide of what to consider in the coming year.

Let me start by saying that not everything in this article is going to be applicable to every organization. You may also find that some of the items in the article are not necessarily new or all that leading edge. In some ways, much of this is a return to the meat and potatoes of HIT. Yet there are some new fancy, out there, Star-Trek gizmos that most of us love to envision included for you mavericks. With that disclaimer, let’s get started.

If I were on the hospital side of the equation (not the vendor side,) I would see 2012 as year to rework foundations and drive strategies that grow revenue and/or margin. I believe these two things go hand in hand. Although it may seem obvious, I find that Meaningful Use has in some ways become a huge distractor to allowing HIT to build an organization’s margin and revenue.

In my eyes, all IT organizations — not just those in healthcare — should be indirect profit centers, able to demonstrate that their strategies are driving organizational growth and financial stability. To do this, many organizations need to consider their foundational systems and begin making bets on what to invest in during the coming year, so that over the next three years, they can demonstrate that IT is a strategic partner to the business, not just a cost center. Sounds rather basic, doesn’t it? Yet it is such as difficult thing to execute upon, and that challenge is the reason for this little cheat sheet.

OK, so first things first. You can’t really get around your continued MU efforts or ICD-10 adoption. Yes it is draining, taxing, distracting, painful, lethargic, and about as exciting and forward thinking as watching wall paper erode. Most of your resources are going to be tired up on MU/ICD-10, yet you need to really think about how you rebuild your technology foundation and drive corporate revenue growth. After all, healthcare is a business.

My first suggestion to you is to establish an “imagineering” team. This can be a small team (depending on your budget) comprised of multi-functional talent, empowered to make decisions, drive change, and most of all, execute upon their decisions. If you want further details on how-to build an imagineering team, let me know, but the key tenets are (a)small team; (b) self-learners; (b) self-starters (c) highly passionate; (d) cross-functional; (e) full-time assignment; and (e) only looking at changes that can be accomplished without the need for board or finance committee approval. The reason for that last item is that you don’t want this team to get bogged down with big, complex changes and projects. Secondly I believe you will see greater returns from smaller strategic investments than big multi-year projects.

The Cheat: Carve out some resources and create an imagineering team. Keep your MU/ICD-10 work moving forward and make progress on the little things that provide big returns.

Recently I had the opportunity to meet with some rather smart and very talented software developers. We were discussing a new product that they are trying to bring to market. The discussion quickly turned to object orientation, software as a service, cloud-based computing, etc. They were pretty shocked when I said that really doesn’t matter – it’s all just drivel. What matters, I said, is getting your product to market and solving the client’s problem, doing those things really, really well, better then anyone else. Why does that matter to you?

I believe in 2012 you need to really consider evolving your departmental systems. Why? Because there is gold hidden in those departments. Want to improve throughput? Lower costs? Drive better ROI? Deal with future challenges related to genomic and personalized medicine? Then you should evaluate your departmental solutions and start thinking about how upgrading or replacing them (yes, replacing) could yield much higher returns. Solving your client’s problems is what matters.

OB/GYN, cardiology, optometry, ED, oncology, pathology, lab, advanced surgical, and other lines of business are highly specific workflows. Although some of the EMR/EHR vendors do a good job at this, you will find that your return is much higher by going with niche vendors who have systems optimized for these areas. The landscape of offerings in these areas is changing and you may find great deals, with short implementation cycles that create huge downstream returns.

The key to improving your revenue and margin is lowering operating costs and seeing more patients (yes, a no-brainer.) Yet to make that happen, you need to consider new systems and consider looking at some of the smaller players in these spaces that are doing some truly amazing things with really new technology. This is the perfect type of project for an imagineering team.

The Cheat: Review your 2012 departmental portfolio to determine if by evolving or upgrading you can improve patient throughput and lower costs.

“You can’t get there from here,” said the farmer along the side of the road.

“Why not?” I asked.

“Because they ain’t built a road, you fool,” he snapped.

Are you building roads in 2012? In my eyes, the next three years will see a tremendous shift in technology within HIT. You can only embrace these changes by laying foundational infrastructure that allows you to not only take advantage of those shifts, but also assure that you can do so at a cost and pace that yields strong ROI.

Throughout 2012, you should come to terms with mobility, patient tracking, resource tracking, analytics, security, and data integration/exchange. I consider this your infrastructure portfolio. Just like you have a departmental portfolio, you should consider developing a portfolio of your infrastructure to better understand how you are positioned for the future. Each of these items in the portfolio should provide a set of “roadways” which allow you to digitally get to anything or anyone in your organization and system.

Key investments in RTLS, HIPAA compliance management, privacy and security management, and the other areas are critical. If you have not deployed directory services and EMPI systems, you need to get that done. Why? Because I believe that over the next three years, we will see more and more focus on the integration of devices and humans. This will drive a tremendous need for an underlying infrastructure that allows you to orchestrate an ecosystem. Evaluating and investing in your infrastructure portfolio is critical to long-term success, reducing costs and driving revenue.

The Cheat: Develop and evaluate your 2012 infrastructure portfolio. Develop key plans for at least RTLS, PRM, HIPAA compliance, and privacy and security. Focus on technologies that improve patient throughput, reduce costs, and drive long-term ROI. If you have not deployed directory services and EMPI, get on it.

Little by little, the world of retail is changing. More and more retailers are evaluating or deploying self-service systems that allow consumers to do more for themselves and get help from a sales associate only when they need or want help. Airlines are also embracing the self-service mentality for passengers and crews, providing access to tools that allow greater access to what was once complicated processes that required human intervention. Developing a “healthcare self-service” strategy in 2012, which puts more power in the hands of the patient, is a key means to drive greater throughput and gain financial upside for the healthcare organization. The self-service strategy should include patient relationship management, patient access, and other tools that allow the patient to take greater control. Although human interaction is vital to patient care, there are a variety of processes that patients can do for themselves and actually would champion to be allowed to do, if they had access to the tools.

The Cheat: Drive higher patient satisfaction, better patient throughput, and ROI through the development of a 2012 self-service strategy. Also consider how self-service can be applied to hospital employees.

“To boldly go where…” you know the rest of the line, I am sure. So what about the cool Star Trek stuff? Well, I do think that you will see subtle shifts in 2012 that have long-term implications, but I am not sure if we are going to remember 2012 as the year that changed the face of healthcare forever. That said, for those leading edge organizations out there, I do think that there are some things you can start evaluating.

Some of my things to watch are DDS (diagnostic decision support), healthcare gaming, robotic aides, and large-scale data analysis, as well as the application of social graphs to patient care and collaboration. Each of these has a backdrop of affecting patient throughput and managing costs. For instance, DDS can help drive better decision-making in shorter amounts of time, freeing up clinicians to see more patients or spend time with patients. Healthcare gaming provides the opportunity to reduce readmissions, improve wellness, and educate patients. Robotic aides will at some point help drive care, though challenges with battery life and size make this a long-term realization. Large-scale data analysis, social graphs, and related technologies are also very much in their infancy, but there is promise and opportunity for those organizations looking for leading-edge game changers.

The Cheat: Pick one or two leading edge technologies that can provide long term differentiation to your organization.

ACO, ACO, ACO. OK, so we are making some progress and little by little, it seems to be coming together. But what is coming together is still a mystery. Developing an ACO strategy is important and probably a good thing to do in 2012, but I would caution you that there are probably other items you can focus on that will drive higher returns. That said, there is some low-hanging fruit an imagineering team can go after in regards to the world of patient financials. That fruit includes asking your current patient financial vendor to outline their strategy to address patient financials over the next three years (not just ACO.) I would not suggest changing vendors unless you are either having serious issues with your current vendor or your current vendor has no strategy for the next three years. If your satisfied with your vendor strategy, then focus elsewhere and monitor the evolution of ACO and its impact to your organization. Wait for the dust to settle, learn from the mistakes of others, and take a crawl-walk-run approach. If you must change vendors or your vendor doesn’t offer a strategy, then this is a project way too big for an imagineering team.

There are a ton of more cheats I can offer and probably some things you might be surprised not to see in the article. My goal, though, isn’t to cover it all. I realize that many of you may find that much of this is already known, which is cool if you are already on it. My goal is to help you think about the little things you could be doing to move your organization forward while you and your team drive greater revenue and, hopefully, margins.

The Last Cheat: If you agree with each of the cheats in this article, you can copy them to a PowerPoint (just the cheats) and present them to your leadership team. You will have an instant outline of your key goals for 2012.

John Gomez is CEO of JGo Labs.

News 1/11/12

Top News

Federal defense contractor ManTech International acquires federal healthcare system integrator Evolvent Technologies. You may remember Evolvent from HIStalkapalooza in Atlanta a couple of years ago, which they co-sponsored with Encore Health Resources and Symantec.

Reader Comments

From Stacy London: “Re: HIStalkapalooza. I have registered and hope to make the official invite list. I haven’t been before, so I am not sure what to wear. Thought it was better to ask you than Mr. H.” Indeed. You will see everything from the dreadful “straight from the exhibit hall” company logo shirts to glitzy gowns and tuxedos (seriously.) However, if you’d like to be in the running for HIStalk King or Queen, I suggest some serious cocktail party attire, complete with great shoes and lots of bling. Because we are in Vegas, we are including two special categories: Best Elvis Impersonator and Best Left in Vegas Attire. Ideally, the winners of the Vegas categories will actually be trying to win. All winners, including those crowned in the Inga Loves My Shoe contest, will be awarded fabulous prizes from the generous Mr. H (who may not know fashion, but who knows this stuff makes me happy so he puts up with it.) Our esteemed judges are pictured above.

From Is It Just Me: “Re: HISsies survey. Of all the silly questions and odd choices, I thought listing John Hammergren as an ‘HIS industry figure’ was the biggest stretch. And shouldn’t ‘guest contributor of the year’ between Vince Ciotti, Ed Marx, Ben Rooks, and Mr. H’s Epic id merit a question?” The silly questions have been the same for years, so there’s nothing new there. Readers chose the nominees, so any quibble about the odd choices should be directed that those who submitted nominations (or more accurately, the vast majority who didn’t despite my exhortation, saving their input until it was too late.) Inga advocated for adding a “best HIStalk contributor” item, but I didn’t want to diminish the accomplishments of those who didn’t win since they’re all good. If you received an e-mail HISsies ballot link, please vote soon since I’ll probably finish it up this weekend. About 1,000 votes are in and there are some surprise leaders so far. We’ll invite some of the winners to join us at HIStalkapalooza, although they usually turn us down.

From Ed Amame’: “Re: UMMC layoffs. Some folks on the right aren’t happy about it. Hot Air, as I understand it, has a pretty big readership. Wonder what waves this will create in HIT policy discussion outside the niche?” Right-wing site Hot Air quotes my mention of University of Mississippi Medical Center layoffs that were implied to be related to its $80 million Epic cost  (a story I just picked up from a newspaper there) and turns it into another vast conspiracy of Obamacare-loving liberals. A few thoughtful comments were left (one basically just pasting in my discussion from the original mention), but many are wildly tunnel-visioned, hysterical, and hateful. It’s no wonder the government is paralyzed by partisanship and an unwillingness to compromise – the politicians are unfortunately representing their intellectually lazy and often ill-informed electorate perfectly, so thoughtful democratic process has turned into a bad reality TV show.

From Spanky: “Re: unions. Why they’re bad for healthcare.” An ambulance technician in Scotland ignores an emergency call because he’s eating lunch. The patient dies. The union last week rejected a salary increase that would have paid paramedics $150 every time an emergency causes their break to be interrupted.

HIStalk Announcements and Requests

HIStalkapalooza invitation signups will be closed Friday evening, so if you have an interest in attending but haven’t filled out the online form, now’s the time.

Acquisitions, Funding, Business, and Stock

Consumer health site WebMD gives up trying to sell itself, its CEO quits, and the company warns of “significantly lower” profits in 2012 because drug companies are moving away from buying its advertising and competition from Facebook is increasing. Shares dropped 29% on Tuesday.

Healthcare apps developer Novarus Mobile Technologies changes its name to Novarus Healthcare. The company also hires Tom Hearn, formerly SVP of ambulatory services with Novant Health (NC), as managing principal.

Shares in Scotland-based charge master software vendor Craneware drop by a third after the company warns that performance of its acquired US revenue cycle software business ClaimTrust will not meet expectations. The company also says it may sue after it lost a large ClaimTrust InSight contract that was being handled by a third party and complains that US hospitals are buying HITECH-subsidized clinical systems instead of its financial ones. 

Ascend Learning acquires Advanced Informatics, a Minneapolis-based vendor of clinical education systems.

UnitedHealth Group forms strategic partnerships with three mobile health companies: CareSpeak Communications (patient medication communication by text message – above,) Lose It! (a weight loss app,) and Fitbit (pedometer and sleep monitor app.)

Sales

Hamad Medical Corporation (HMC) and Cerner sign an agreement to digitize the public health system of Qatar, including all HMC hospitals and primary care centers.

BCBS of North Carolina and Kansas City form Topaz Shared Services and choose TriZetto Group to provide claims, enrollment, and billing services.

People

Sandata Technologies, a provider of IT solutions for the home care industry, names Tom Underwood (Alere Health) CEO.

ApeniMED (formerly MEDNET) elects Charles D. Birmingham, VP of corporate development for CareMore Medical Enterprises, to its board.

Carestream hires Barry Canipe (American Standard Brands) as CFO and promotes Jianqing Bennett to VP of global medical sales and services.

Surgical Information Systems promotes Kermit S. Randa to COO.

Streamline Health Solutions appoints Michael K. Kaplan (Altos Health Management) to its board.

Healthcare consulting firm Equation hires Howard Salmon (Premier, ReHab Care, Phase 2 Consulting) as principal.

Three Kansas hospitals that are affiliates of Sisters of Charity of Leavenworth Health System name Mike Malone as project manager for their Epic implementation. He was previously with the parent organization.  

Capella Healthcare names Magda Osburn BSN, RN as director of medical informatics. She was previously with McKesson Provider Technologies.

RCM company Medistreams hires Marcia McLure Hardy as national director of business development.

Announcements and Implementations

The local paper (which apparently does not use spell-check) highlights the EMR use of Takoma Regional Hospital (TN), which just received a $1.3 million check for its meaningful use of Cerner’s EMR. When I shared this with Mr. H, he got all nostalgic on me, reminiscing about a consulting gig he had at the hospital years ago, the nice people there, and the great grub at Stockyards Cafe.

While I was trying to figure out which EMR Takoma had in place, I found Cerner’s list of clients that have attested for Meaningful Use, which includes 136 hospitals and 238 EPs.

Omaha Imaging (NE) implements Avreo RIS/PACS.

Four Mercy Health (OH) hospitals go live on Epic’s Care Everywhere, allowing hospital staff to view the chart of any patient whose provider is also using Epic and Care Everywhere.

Zynx Health announces a software enhancement that improves integration of ZynxOrder order sets with MEDITECH CPOE.

BryanLGH Medical Center (NE) implements the Pharmacy Xpert clinical surveillance and intervention solution from Thomson Reuters.

Three Ohio hospitals implement InQuicker, software that allows patients to make ED appointments online and “skip the ER waiting room.”

Government and Politics

The latest Meaningful Use numbers, captured in December and presented at Tuesday’s HIT Policy Committee Meeting:

• 172,974 EPs and 3,077 hospitals registered for either the Medicare or Medicaid MU programs.
• Medicare paid $275 million to EPs and $1.1 billion to hospitals.
• 33,515 EPs attested, 355 unsuccessfully.
• 842 hospitals attested, all successfully.

Aaron Berdofe analyzes the November Meaningful Use attestation report using IBM’s Many Eyes tool, finding that (a) Epic has 6,330 attestations, more than triple the #2 vendor; (b) Epic’s strength is concentrated in a few states where it dominates almost totally; and (c) Complete EHR attestations outnumber Modular EHR attestations 21,765 to 1,196.  

  ONC launches its Healthy New Year Video Challenge, offering $5,000 in prizes to consumers who submit a short video explaining their health-related New Year’s resolution and how they will use technology to accomplish it.

  Newt Gingrich, speaking at Dartmouth-Hitchcock Medical Center, says bureaucracy crushes healthcare innovation and that treatment protocols based on statistics interfere with the doctor-patient relationship. Peter Merrill, DHMC IT director, grilled Gingrich on his role in government gridlock, but wasn’t impressed with Gingrich’s answer. “I thought it was an incredibly articulate and well-reasoned defense of his actions in response to my characterization of him as responsible for the current gridlock in government. It was in no way an answer to my question of how to get past the current gridlock. My personal belief is that he is one of the major people responsible.” Merrill says he’ll probably vote for Obama again unless Republicans come up with a better candidate.

Technology

First-year medical students at the NYU School of Medicine use an interactive, virtual 3D cadaver to complement the traditional anatomy instruction, exploring the digital content with projected images, 3D glasses, and iPads. A free online version is here.

Other

  US health spending grew 3.9% in 2010, which was only .01 percentage points faster than the 2009 rate and the second-slowest rate in 51 years. The slower growth is blamed on high unemployment, loss of private health insurance coverage, lower median incomes, and higher patient deductibles and co-pay. Total 2010 spending was $2.6 trillion, or $8,402 per person, of which the federal government paid a record 29% and the combination of federal, state, and local governments paid 45% of all health spending.

The Bureau of Labor Statistics reports that healthcare added 22,600 jobs in December, including 9,800 in hospitals and 11,300 in ambulatory health services. Healthcare employment grew by about 315,000 jobs for the year.

A study finds that nurses using a basic EMR reported better outcomes and were less likely to report adverse patient safety issues, frequent medication errors, and low quality of care.

Cerner, dbMotion, Epic, Medicity, and RelayHealth are the vendors winning the most private HIE deals, according to KLAS, while Axolotl, InterSystems, Medicity, and Orion Health are leading in public HIE selection. Affordability is the top consideration in vendor
selection.

  Fast Company covers mHealth. It’s not particularly conclusive or insightful (at least not compared to HIStalk Mobile,) but does mention some interesting technology work: Best Buy is researching earbuds that can monitor heart rate, J&J has invested in sleep monitoring technology, and AT&T and Qualcomm are working on mHealth projects.

Two English hospitals struggle with error-filled surgical case lists, warning employees to double-check them. The North Bristol NHS Trust blames user error. One surgeon said his case list included patients from outside his specialty.

  Weird News Andy likes this Baby Beyonce’ Lockout story. Beyonce’ and Jay-Z have their daughter (named Blue Ivy) at Lenox Hill Hospital (NY), but at least one other new parent says the hospital locked down the NICU to accommodate Beyonce’s visitors, preventing everybody else from seeing their lesser-pedigreed babies. The hospital denies reports that it was paid $1.3 million to give the celebrities an entire floor to themselves. Gossip sites claim the hospital installed bulletproof glass in the delivery area, taped over security cameras and confiscated employee cell phones to prevent pictures being taken, and kicked people out of nearby waiting rooms. The couple is supposedly worth something like $750 million.

WNA also says he’ll “take a flyer” that the da Vinci medical robot people didn’t count on their robots to be used to make paper airplanes, even in Boeing-centric Seattle.

Guess which company is looking for a senior sales manager. The candidate must cold-call, hit sales targets, negotiate contracts, create sales campaigns and models, persuade prospects, and “aggressively solicit new customers by telemarketing and formulating follow up plans.” The answer: HIMSS, which needs someone to push corporate memberships and organizational affiliate memberships.

An IT specialist with an Atlanta medical practice is sentenced to 13 months in prison for hacking into the server of his previous employer, a competing practice located in the same building. He download patient information from his former employer’s system, deleted it from their server, and then launched a direct mail campaign touting his current employer.

Sponsor Updates

• Kindred Healthcare Inc. selects MED3OOO’s RCM services and InteGreat PM for its partner physicians.
• PatientKeeper CEO Paul Brient will speak this week at the JP Morgan 30th Annual Healthcare Conference.
• Fred Pennic, a senior advisor with Aspen Advisors, suggests six ways for healthcare organizations to use business intelligence software.
• HealthEdge and Keane announce a strategic partnership to deliver a performance-based business process outsourcing service to the healthcare payor community.
• Imprivata releases a white paper on preparing for a HIPAA audit.
• RelayHealth hosts a live HFMA webinar January 11 on patient consumerism.
• Nuesoft announces its podcast series “2012 Billing Trends: What’s on the Horizon.”
• A Texas hospital selected for the OCR’s pilot HIPAA audits contracts with CynergisTek for preparatory consulting and advisory services.
• McKesson Specialty Health offers a free webinar on the selection and implementation of EMRs in oncology practices.
• eHealth Global Technologies Inc and OptumInsight will deploy a medical image exchange service for HEALTHeLINK, a New York RHIO.
• Idaho Health Data Exchange signs an agreement with Greenway Medical to provide interoperability between Greenway’s PrimeSUITE EHR and the OptumInsight-powered HIE.
• Community Health Network (IN) says consulting services and technology from MedAssets improved its cash position by $26.7 million, reduced denials by 47%, and increased patient access employee productivity by 100%.
• Aspen Advisors ranks third in Planning and Assessment in the Best in KLAS awards.

Contacts

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

Curbside Consult with Dr. Jayne 1/9/12

The New Year is ringing in slowly from a news perspective. Maybe everyone’s just a little saggy from the holidays. I did manage to find some thought-provoking tidbits for the week.

Almost 40,000 new laws have recently gone into effect, now that 2012 is here. The biggest changes involve immigration, civil rights, budget woes, abortion, and other hot-button issues. Some less-reported but no less interesting legislation:

• Georgia will require those who drive golf carts on the road to have brakes, back-up lights, and a horn.
• Illinois allows motorcyclists to run red lights if they don’t turn green (the lights, not the motorcyclists) in a reasonable amount of time.
• Nevada is requiring fire performers and their apprentices to register with the state fire marshal.
• Utah nixes happy hour.

Congressman Edward Markey has asked HHS Secretary Kathleen Sibelius to tackle the issue of alarm fatigue. Specifically, he requests that the Institute of Medicine look at the issue and recommend solutions.

The New York Times reports on a new Medicare study that claims hospital workers only recognize and report medical errors and accidents one out of seven times. Daniel R. Levinson, inspector general of the Department of Health and Human Services, also notes the following:

• More than 130,000 Medicare beneficiaries experienced at least one adverse event in a hospital during a one-month timeframe.
• Although hospitals have systems to report adverse events, staff failed to report most of the harmful incidents.
• Hospital administrators are aware of underreporting by staff.
• Hospitals fail to connect adverse events with systemic quality concerns, resulting in few changes to policies and procedures.

I’m trying something new this year. My goal is to complete all of my required Continuing Medical Education and Maintenance of Certification activities at the beginning of the year rather than waiting until December is halfway out the door. I’ve been doing pretty well so far, plowing through piles of journals and article links that people have sent.

The Journal of Hospital Infection publishes a study on the hazards of lidless toilets, especially in spreading pathogenic bacteria like Clostridium difficile, one of the nastiest hospital-acquired bugs. In my hospital, the only commodes with lids are those little space-shuttle style ones found in the ICU patient rooms. Now that I think of it, you don’t see too many staffers wearing full protective equipment when helping patients in that way. Something to think about. Kind of makes my kvetching about dirty keyboards less relevant.

PLoS Medicine publishes some interesting thoughts on a topic dear to most health care workers and an increasing number of IT workers: “Poor Diet in Shift Workers: A New Occupational Health Hazard?” It cites data (including some from the Nurses Health Study) linking shift work to type 2 diabetes in women. Potential underlying mechanisms include poor diet and exercise, poor sleep, and disruption of circadian rhythms. Knowing the differences between day-shift menus and night-shift menus in most hospital cafeterias, brown-bagging it is probably the safest option if you’re looking at interventions.

David Blumenthal penned the recent A Piece of My Mind column in the Journal of the American Medical Association. It’s titled, “A Physician Goes to Washington… and Safely Returns,” which actually encouraged me to read it, unlike most of the pieces in JAMA which sound like something to read with a glass of warm milk when you have insomnia. I was hoping for some juicy revelations or HITECH wisdom, but it’s mostly about what it’s like to spend time in government service.

I’ve finished my stack of mandatory reading for the day, so am heading to lounge with a bit of fluff – Explosive Eighteen by Janet Evanovich. I can’t believe they’re finally making a movie of her first book One for the Money – it’s due out the end of this month and I’m counting down.

E-mail Dr. Jayne.

HIStalk Interviews Andy Smith, Co-Founder and VP, Impact Advisors

Andrew Smith is co-founder and vice president of Impact Advisors of Naperville, IL.

Tell me about yourself and about the company.

Impact Advisors is a healthcare IT consulting firm. We’re dedicated to the provider space. For us, that’s medical centers, academic centers, children’s hospitals, and physician groups. We also do some work in the payer space. 

We’re focused on the technology aspects of both planning and implementation. About a third of our business is associated with planning and assessment work, things like selections, Meaningful Use assessments, long-term strategy, interim management, governance modeling, and mergers and acquisition planning. Two-thirds to three-quarters of our business is focused on implementation work. A lot of our work is around the major inpatient vendors as well as the major ambulatory vendors.

I’ve always worked for a non-profit hospital, so I’m curious. The company has been around not quite five years. How do you go about starting a business in terms of money, research, and effort? How do you know what it takes to build a sustainable business?

Great question. I wish I would have known the answer five years ago. It’s basically School of Hard Knocks. The firm was started five years ago by myself and my brother, Pete Smith. Before that, we had spent 16 and 20 years plus at another consulting organization. For a lot of reasons, it was the right time to start up on our own. 

When we started, we had very modest aspirations. We thought we would just hang our own shingle and do some work.  But very quickly, other colleagues started to call, and clients started to call looking for a different kind of solution. We started to grow and have been growing ever since for the five years.

How do you form that company? That’s a great question. We hired some very experienced people to help us. We outsourced a good bit of our function. We just sort of figured it out. 

In terms of the requirements to get started, I get calls fairly frequently from people that are looking to start an organization. What I tell them is that working for yourself is great and I highly endorse it, but you need to be prepared to learn a lot on the job, you need to be prepared to take a lot less money and maybe not get paid for quite some time, and you’ve got to be willing to take some risk. If you’re willing to do that and you’re smart and your motives are pure, it typically will work out.

Some consulting firms stay small and are happy with that, while others get huge and then hit the wall where they either need to be acquired or grow to the next level. You’re probably at least somewhat surprised that you got as big as you did over that time. How do you see that playing out and what do you look for to challenge you in the next five years?

For us, culture and quality trump growth. We have grown. Our clients have asked us to grow. They’re asking us to do more and more for them to solve more and more complex problems. But for us, we are way more interested in doing it the right way. We resist those growth opportunities where we don’t think they are directly in concert with what we’re trying to accomplish as a firm.

We want to be a world class consulting firm. We want to be the best place for our consultants to work. We want to do really high quality work for our customers. We want to partner with them. We want to take work when we think we can provide it and we want to turn it down when we think that we can’t do the best job possible.

That has been a barometer of our growth. We couldn’t grow much faster than we have. We’ve probably averaged 50 to 70% growth over the five years, but that’s absolutely secondary to doing it the right way.

We’re a culture-based firm. We hire on attributes like work ethic and content knowledge, but almost as important is attitude. We want people that are willing to support each other, that are empathetic, that are client-delivery focused and obsessed, and at the end of the day are somebody that you wouldn’t mind having dinner with. That is the very first gate you’ve got to pass.

Growth has been a very nice outcome. We like growth. Growth means you’re winning. Growth means there is more opportunity for people to move in different directions in their careers. But for us, that is absolutely secondary. We think we still got some track in front of us. We think we can still grow for the foreseeable future and continue to retain our culture.

Consulting companies aren’t always great places to work with all the travel and emphasis on billable time. You’ve won some awards and hired a Happyologist, which I’m sure I made fun of at the time. What are you doing that the other consulting and vendor firms aren’t?

At the end of the day, it really gets down to the Golden Rule. Treat others like you want to be treated. It seems so patently obvious to me. I don’t know why their firms don’t do it, but I think we’re pretty good at creating culture. 

A lot of that comes upfront by making sure we have the utmost integrity during our recruiting process, and that we don’t overpromise during the recruiting process. We’ve got a wonderful recruiter who really is a wonderful gauge of that. It starts right up front at the first meeting and is constant communication through that person’s career. That’s the first thing we do.

Second thing, as you mentioned, we hired a Happyologist. His official title is director of associate satisfaction and culture. I think we’ve done a nice job of culture building. We won some awards. We were  number three in Modern Healthcare’s best places to work this year. We were the highest-rated consultancy in the last two years. We take it very seriously. 

I think we’ve done a historically good job of creating and nurturing culture, but we wanted to hire somebody who is absolutely 24/7 obsessed with how we treat each other and a culture we’re creating as a firm. So we hired our Happyologist, Michael Nutter. He has done a fantastic job over the last year. He’s really responsible for three things.  He is in charge of communication, internal and external. He is in charge of our professional development process or career coaching. He’s also in charge of our culture. 

That’s the intangible, but we do a lot of things around that.  We have our annual retreat, which we call Impactpalooza. Sorry – I think we might have used the name before you did, but we both stole it from Lollapalooza. You know we had an associate pet supermodel contest. We do winter dinners pretty frequently. We just finished a round of holiday dinners. Michael is really in charge of making sure that we celebrate ourselves, so that we celebrate our successes. We pick people up when they fall. That has left a very tangible impression about the firm.

Most of your folks are on the road, so I guess you have to make it bigger than life to make it memorable since you don’t see them often.

It is really hard. To win an award like Best Place to Work is really hard as a consultancy. We have some things going against us. We all travel like maniacs. We’re all pretty Type A-driven people. We’re working really hard at our clients. 

It’s really a family commitment. That’s one of the things we stress when we hire. Hey, this is tough work. You’re away from home, you’re working hard, you got demanding clients, you’re solving really tough problems that they can’t solve on their own. Your family needs to be comfortable with the lifestyle and the amount of work. I’ve actually interviewed spouses that we brought in to the recruiting process just to make sure we’re all in the same page.

You beat out some pretty good competitors to win the Clinical Implementation Principal award from KLAS, especially considering that the company hasn’t been around that long. What are the secrets that companies who might have been the favorites to win aren’t doing?

We pay a lot of attention to clients. We’ve got an executive assigned to each one of our clients. Their job is to make we are paying attention to them.

We are certainly not flawless. We’ve had mistakes. But I think where we are exceptionally good is that if we make a mistake, we always overcompensate. I’ve literally flown across the country to give a client their money back on a job where we did just an average job. Quite honestly, I don’t think we are an average firm; I think we’re an exceptional firm. So I flew across the country, gave the gentleman a check, and lo and behold, a few years later, we’re back there working again. 

Being private and small has allowed us to do some pretty interesting things and to stay really obsessed with overachieving our clients’ goals. I think that’s probably the thing we do better than others.

Who would you say are your most direct competitors?

We deal with the Big Five, the traditional ones. We deal with a number of vendors in the space that have similar profiles to ours. Depending on the job, we could compete with Deloitte or Encore or Aspen. We don’t typically do a lot of staff augmentation roles, so we don’t find ourselves competing with the staff augmentation firms that much. That’s a good business model; it’s just not the model we are in right now.

What we’re really doing is trying to hire the best people. We staff them from the leadership positions on down. It has become an interesting time because our clients are asking us to expand our services and asking us to supply a bigger and bigger footprint in their implementations. We’re starting to move in that direction a little bit, but I don’t think we will ever be a staff augmentation firm. If a client calls us and says, “I need 30 trainers for three months,” we very politely decline or we refer them to some trusted partners.

Opinions seem to vary about how many providers are chasing Meaningful Use money and how many of those are likely to get it. What are you seeing?

It’s absolutely been a catalyst for people to kick off large EMR projects, which has been great. It seems like there’s a bit of a gold rush going on right now. People are really focused on the money and maybe not so focused on the goals that are inherent of achieving the money. I totally get it. There’s money out there to be garnered; you might as well make sure you get it. I am hoping that there may be some tempering of enthusiasm over the next couple of years. All of our clients are very involved in planning for, reporting, and now cashing the checks.

Hospitals seem to be pacing themselves for a sprint, forgetting that after the sprint comes the long run. Do your clients understand that they’ll need more work than just going live, looking 5-10 years down the road to change their business?

I would totally agree. I don’t think as an industry we’re asking that question. What do we do when we get there? 

What we see is the industry is moving so quickly that there is going to be a wave of optimization or a Phase Two of these implementations going forward. We’re very interested in that. We spend a lot of time focusing at what’s next after the next two years. We think that’s going to be the really hot service area. 

We’ve got some methodologies already developed around how to attack that, but quite honestly the market’s not buying that right now. Our industry is really focused on foundational systems at this point, digitizing electronic medical records. After that’s done, I think there is going to be an entire wave of work about, OK, did the data we collect have integrity, what do we do with it, how do we turn it digital information? That’s the analytics – business intelligence wave of technologies we think will be very important in the coming years.

You must be involved in quite a few system selections. What products are hospitals looking for and what factors are driving the decisions they make?

Yes, we are doing a number of selections. I would say the most traditional selection is a system that is looking for a single vendor across multiple disciplines — inpatient, ambulatory, clinical, and rev cycle. It would be great if there was a vendor out there that provided traditional ERP solutions along with those other modalities, but I don’t think we’re there as an industry yet. 

They’ve been frustrated by a best-of-breed approach and the lack of information flowing across their continuum of care. That is probably the biggest driver we are seeing right now.

In terms of the sizeable accounts, is anybody beating Epic?

Not really. They are certainly the vendor to beat in the space right now. They do have a lot of that integration story to tell. They have integrated ambulatory, inpatient, rev cycle, and clinical product, obviously. You probably saw the KLAS reports as I did. They’re winning a majority of selections in the industry right now.

What does that mean for a business like yours? Epic offers their own implementation services and Epic-certified consulting firms are competing for the limited number of certified people.

We are a certified Epic partner as well. There is an incredible demand for a good implementation partners that know that set of technologies. That has been a major growth area for us in the last two years and will probably continue to be one for the next few.

I think we have a very good relationship with Epic. We absolutely challenge them, but I think at the end of the day, what we do is help implement their products more efficiently and to a better outcome. 

I find that we typically provide a lot of leadership, subject matter expertise on their projects, but we’re not backing up the truck, either. We are a small firm. If a client comes up and says, “I would like to outsource my 200-person Epic implementation,” again, we politely decline. But if they come to us say, “Hey, we really need some trusted partners in some key positions to help us implement this more effectively,” that’s right up our alley. That’s where we’re best.

You mentioned that you don’t back down from Epic, but if getting on their bad side resulted in their not approving you as a consulting firm, that would hurt desperately. Do you think companies fear Epic in that way?

I don’t worry about that. I don’t think we really can worry about that. I think at the end of the day, if our intentions are pure and we’re trying to accomplish what’s best for our clients, all the rest is going to work out. That is Epic’s corporate philosophy as well. I find that we’re typically very synchronous in what we are trying to accomplish. It may just be the means to the end.

Having said that, we work very well within their methodology. They bring in an incredible amount of tools and skills to the implementation and I think we complement that very nicely. Our traditional person within Impact Advisors comes with probably a 10-year clinical operations background and a 10-year consulting background. We bring some real-world experience that complements very nicely their products and services, so I think it’s a nice fit. I don’t really worry about challenging them. I worry very much about being an advocate for our clients. The rest tends to work out.

What issue or actions are threatening hospital CIO job security?

Failed implementations are always at the top of the list. If you aren’t meeting the objectives you set forth and you spent tens or hundreds of millions of dollars in the pursuit of, that’s not a good thing. At the end of the day, you need to be able to prove outcomes. Our industry, I would say, has not done that great a job of clearly identifying the return on investment and then measuring it post implementation. 

I think there will come a time where the CIO is expected to say, “OK, we spent $100 million and we achieved a 120 or 200 or 300 million dollars worth of benefit.” That would be the first thing I would worry about. The second thing is no different than any business — overpromising and under-delivering. If you can’t run a tight organization and have a staff that’s focused on client delivery and outcomes, that’s never good as well.

If you look at where the industry is today and where you think it might be 5-7 years down the road, what kind of things do you see?

I think it is going to be an incredibly fun ride. I think the next five years is going to continue to be dynamic and tumultuous. I think that the firms that do best in this industry over the next five years are going to be the ones that  innovate with their clients, that hire the best, that are nimble and agile, that can move with the market. I think we’re good at that. 

It is very difficult to predict what is going to happen over the next five years, but if we stay focused on the objective of good client delivery and helping our clients achieve great clinical outcomes and help them do that as efficiently as possible, we can’t go wrong no matter what happens in the regulatory environment or legislative environment.

Any concluding thoughts?

It has been amazingly fun to grow a company over the last five years. It has been really liberating. I’m very proud of what we have achieved over the last five years. I’m really proud of the culture we have built. I’m really proud of the people we get to work with every day. 

I’m thankful for our clients. We get to work with some of the blue chip clients in our industry. We get to learn from them and help them achieve some great things. It has been a fun ride.