News 8/22/12

Top News

MModal becomes a wholly-owned subsidiary of Legend Parent Inc., an affiliate of JP Morgan’s One Equity Partners, following the completion of Legend’s tender offer for all of MModal’s outstanding shares.

Reader Comments

From PCP Doc: “Re: specialists. In my community, 40-50% of specialists are practicing primary care because there are too many of them. It makes coordination of care more difficult. One patient sees a cardiologist for blood pressure and another who had breast cancer two years ago sees an oncologist, radiation oncologist, surgeon, OB-GYN along with her primary care doc just to get a breast exam, mammogram, and CBC. Specialists have said they’ll do primary care if the pay goes up, but they’re a bit rusty at it.” I suppose that’s the downside of luring the procedure docs back into primary care – many of them have never done it and more than a few are probably going to be lousy at it because of personality type or lack of interest. Can you imagine retooling a cardiac surgeon into a pediatrician?

From Leopold: “Re: hospital software lineage. I’m looking for the link posted earlier this year showing vendor consolidation.” Constantine Davides of JMP Securities created the HIT family tree for HIStalk readers (parenteral alert: it’s full of HIT incest that spans decades.) I think he’s sorry he opened this particular can of worms since it was pain to create and then update with reader-suggested additions.

From Scott: “Re: Tableau data visualization free trial. Altosoft also offers a free download, but with no registration required. Clients include Cleveland Clinic, Geisinger, Memorial Sloan-Kettering, Yale, etc. We have pre-built dashboards for AP, CP, radiology, leadership, charge nurse, etc.” Scott’s from Altosoft.

From Oh the Humanity: “Re: PlatinumMD. I heard they’re calling practices with a ‘courtesy call’ from the ‘Stimulus Recovery Department’ and asking to have the doctor call them back about ‘the doctor’s reimbursement checks that come from CMS.’ I can only imagine how they respond once they find out that the company is a MU consultant and not the government calling to reclaim their stimulus dollars.” Unverified, but their site does have a page called Stimulus Center.

From Nicole: “Re: hospitals forced to share records. Two New York hospitals were told by the state that their certificate of need requests for construction would be approved only if they join a RHIO.” Nicole sent the article over, which is available by registration only on the Crain’s site. The Department of Health’s Public Health and Health Planning Council told Hospital for Special Surgery and Memorial Sloan-Kettering that their construction projects (valued at $859,000 and $339 million, respectively) would be approved only if they agreed to join a RHIO, observing that they are the only two hospitals in New York County that haven’t already done so. Council member Jeffrey Kraut said, “The time has come to make all CON applications join,” and when another member said their reasons might be financial, Kraut shot back, “You mean Sloan-Kettering is too poor?”

HIStalk Announcements and Requests

Listening: Pentagram, after watching a documentary on Netflix about their singer’s 44-year drug addiction and the band’s recent comeback attempt after years of self-inflicted lack of commercial success and endless membership changes. I’ve played this magnificent song, recorded during a 1976 basement practice session on a cheap reel-to-reel recorder, least 100 times in the last three days because it sends chills up my spine (it really kicks in at 1:50). Pentagram is like a mix of 70s heavy metal bands from my vinyl collection that you’ve probably never heard of, like Captain Beyond, Sir Lord Baltimore, and UFO. I may get a Pentagram tee shirt as my tribute to non-conformist failure in the presence of ample talent.

Acquisitions, Funding, Business, and Stock

The Outsource Group, an RCM provider for hospitals, acquires XAM/MAX, a provider of self-pay collection and insurance follow-up services.

Behavioral software vendor Netsmart Technologies, whose CEO is former Cerner COO Mike Valentine, acquires Behavioral Pathway Systems, which sells behavioral provider benchmarking services.

Sales

Arkansas Heart Hospital signs a 10-year, $10 million agreement with Siemens to implement Soarian clinicals, financials, pharmacy, and med administration check. Siemens Financial Services division financed $4.8 million of the purchase.

Jordan Hospital (MA) selects Mediware’s Insight Performance Management software for monitoring enterprise performance programs.

Trinitas Regional Medical Center (NJ) chooses Hyland Software’s OnBase enterprise content management to integrate with its Allscripts Sunrise EMR.

University of Iowa Hospitals and Clinics chooses Voalte’s iPhone-based communications system for use throughout its facilities.

People

Home health software provider Procura appoints Rebecca MacKinnon VP of US sales. She was the founder of BeyondNow Technologies, which was acquired by Cerner in 2003.

PracticeMax, a provider of practice management services, announces the retirement of Rick White as president and the promotion of Patrick Lukacs (above) from VP of software services to VP of operations.

Press Ganey Associates names David Costello, PhD (SCIOinspire) chief analytics officer.

Consumer health engagement firm Silverlink Communications names Adam A. Hameed (Emdeon) chief revenue officer and Paul G. Fitzgerald (ITA Software) CFO.

Natalie Sensabaugh (Picis/OptumInsight) joins PerfectServe as a clinical advisor.

Elsevier/MEDai names Peter Edelstein, MD (Adventist Health System) as chief medical officer and Gerald Osband, MD (Trizetto Group) as director of product strategy.

UNC Health Care System (NC) promotes Donald Spencer, MD to VP/CMIO.

Announcements and Implementations

HealthBridge and the Greater Dayton Area HIN announce the launch of secure, electronic transmission of immunization data from two primary care practices to the Ohio Department of Health.

Arnot Health (NY) joins the Rochester RHIO.

Healthcare Quality Catalyst says its data warehouse solutions sales increased by 1,100% in the first half of 2012 vs. 2011.

Microsoft announces release of an iPhone app for its HealthVault personal health record, which also includes a list of compatible apps such as iTriage and CareCoach.

Government and Politics

The Department of Defense and the VA eliminate an RFP requirement that proposed pharmacy systems for their combined EHR use First DataBank’s drug database.

HHS awards $48.8 million in grants to bolster epidemiology, laboratory, and health information systems in state health departments to help states fight the spread of infectious diseases.

ONC’s Consumer eHealth Program announces a contest for a mobile app that mashes up an individual’s Blue Button personal health data with open public health data to promote better personal health and lower costs. The top entry wins $45,000.

In England, the Department of Health and the trade department will encourage hospitals to open clinics abroad under the NHS brand to bring in additional revenue. They want to model their services after Mayo and Hopkins in providing services in India and China under the direction of Healthcare UK, an oversight board that has already been created.

Innovation and Research

In the UK, Birmingham Children’s Hospital is testing car-monitoring software that was developed for McLaren’s Formula 1 racing team. Input from 130 sensors provide 750 million data points during a race (fuel use, temperature, and tire wear) and the hospital is using it to monitor the vital signs of its pediatric patients. Says a PICU doctor, “Formula 1 engineers do lots of real-time monitoring during races and look at performance and modeling to see when they should change tires and have pit stops. They’re predicting, essentially, which we don’t tend to do in healthcare. Although we can see what is happening at the bedside, we can’t see trends over time.”

Sotera Wireless receives 510(k) clearance for its ViSi Mobile wireless vital signs monitoring system, whose body-worn sensors use hospital WiFi to allow monitoring to continue as the patient is ambulating or being transported. The company says the device’s output can be sent to an EMR.

Other

Hospital leaders rank WellPoint the worst health plan in the country, with BlueCross finishing last based on payment rates.

A former Florida Hospital Celebration ED employee is arrested following accusations that he sold the information of 700,000 auto accident patients to chiropractors and attorneys.

Sunquest held its annual executive summit on August 6 as the kickoff of its user group meeting, with presenters that included CIOs Dave Pecoraro of Exempla Healthcare and Allana Cummings of Northeast Georgia Health System along with Steve Lieber, CEO of HIMSS.

An article in The New York Times describes the secretive use of e-score, a “digital ranking of American society” that’s calculated as people cruise the Web. The CEO of eBureau says his product can predict whether a given person is likely to be a good or bad prospect in less than a second, scoring 20 million people a month and selling the names to interested companies. A spinoff uses similar information to decide which online ads to display. Clients send lists of sales leads they’ve bought, then eBureau extrapolates and adds details from other databases to generate up to 50,000 variables per person, which it then grades against similar factors for existing customers. Sounds harmless enough until they start selling scores to insurance companies or employers.

MD Anderson (TX) notifies 2,200 patients that their information was compromised when a trainee lost an unencrypted thumb drive on the employee shuttle bus. The feel-good part of the notice says they’re working at device encryption and have purchased encrypted thumb drives, probably hoping that nobody will remember that an unencrypted laptop was stolen in April that contained information on another 30,000 patients.

The State of California sues a plastic surgeon (who also apparently graduated from law school) for using strong-armed collection tactics on ED patients whose insurance doesn’t cover the full amount of her bill. She has sued more than 50 patients, taken out liens on their homes, and damaged their credit ratings, the state says. Her attorney admits that she is “very persistent” in her collections effort, but says she’s entitled to be paid. Other attorneys say so called “balance billing” isn’t common the ED because the patient doesn’t really have a choice about who to see, plus California law specifically requires doctors to settle their payment disputes with the insurance company and not the patient. Her lawyer has an answer for that, too: the patients were stable in the ED, so these weren’t emergency situations.

And administrative director at Maine Medical Center sues his employer, claiming they fired him for speaking out against the tradition of taking sports medicine residents attending an out-of-state conference to strip clubs. He says the hospital retaliated by moving his office to the attic of an old building that has bats. The hospital says he wasn’t very professional in raising his concerns, piping up at a department leadership meeting and addressing a physician in attendance, “So, what do you want to tell us about the lap dances at your conferences?”

Strange: a hospital in Israel recognizes clowns as members of the healthcare team, with up to 20% of surgeries featuring pre-op clowns to reduce tension and thus the amount of anesthesia required. A study found that in vitro fertilization success rates increased from 20% to 36% if the patient received a pre-procedure visit from a clown dressed as a bumbling chef. An American doctor says it probably won’t work here since a lot of us find clowns annoying.

Sponsor Updates

• Billian sponsored last week’s Lekotek of Georgia Run 4 Kids that benefits special needs children, with its team receiving a bronze medal for participation in the four-mile run.
• Virginia Physicians selects eClinicalWorks EHR for its 58 providers across eight locations.
• Visage Imaging announces GA of an upgrade of its Visage 7 Enterprise Imaging Platform with enhancements that include lesion tracking, drag-and-drop support, single-click attachment of non-DICOM images, and integration with Nuance PowerScribe 360.
• Capario launches an integrated patient pay solution in partnership with TransFirst that facilitates the collection of patient payments, including co-pays, deductibles, and balances after insurance has paid.
• CommVault announces the integration of Nimble Store CS-Series with CommVault Simpana snapshot management software as part of the IntelliSnap – Connect Program.
• Kony Solutions acquires Sky Technologies of Melbourne Australia to expand its global enterprise mobility market.
• Prognosis Health Information Systems sponsors a Webcast featuring National Rural Health Resource Center CIO Joe Wivoda discussing EHR for rural health leaders.
• The Nashville Area Chamber of Commerce names Cumberland Consulting Group, Emdeon, HealthStream, and Shareable Ink among the finalists for its second annual NEXT Awards.
• dbMotion and Allscripts host a webinar on preparing for accountable care.
• Anesthesia Business Consultants partners with Surgical Information Systems to integrate data captured in SIS’s AIMS with ABC’s anesthesia billing tools.
• Inc. names the following HIStalk sponsors to its list of 5000 Fastest Growing companies:  Beacon Partners, Culbert Healthcare Solutions, eClinicalWorks, Enovate, ESD, etransmedia Technology, GetWellNetwork, Greenway Medical, Hayes Management Consulting, Healthcare Growth Partners, Iatric Systems, Impact Advisors, Ingenious Med, Intellect Resources, iSirona, Kareo, maxIT Healthcare, MED3OOO, MEDSEEK, Virtelligence, and Vocera.
• A Wolters Kluwer Health Survey finds that a third of Americans have experienced a medical mistake, with two-thirds of them  firsthand or from a third party. The majority of respondents expect new technologies to reduce errors.
• CPU Medical Management, a division of MED3OOO, announces a vendor partnership with eBridge to offer a combined PM and document imaging solution.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

HIStalk Interviews Darren Dworkin, CIO, Cedars-Sinai Medical Center

Darren Dworkin is senior vice president for enterprise information systems and chief information officer of Cedars-Sinai Medical Center of Los Angeles, CA.

Give me a brief overview about yourself and about the health system.

I’m the chief information officer at Cedars-Sinai Health. I’ve been here for almost seven years. Before that, I was the chief technology officer at Boston University Medical Center.

The health system itself is made up primarily of our large hospital. We’re a single-hospital facility located in Los Angeles, California. Like most large organizations, we’ve diversified through physician groups and other stuff that made us more of a health system.
We’ve been spending most of our time over the last four or five years setting and implementing our clinical IT strategy.

What’s different about working in a hospital that some people call “The Celebrity Hospital” or “The ER of the Stars,” where you got a lot of movie star patients and their supporters?

We don’t really think of it that way on a day-to-day basis. The reality is that we have a small percentage of famous clientele that use our organization, but for the most part, we try to define ourselves through the quality of care that we deliver and the programs that we offer.

That being said, I think there is no question that being here in Los Angeles, we end up having a little bit more scrutiny or an eye on us that sometimes weaves itself into our planning and even some of our communications. When it comes to implementing clinical IT, we try to make sure we do things well, but I think between our past CPOE failure and the media market it can sometimes feel a little like a fishbowl.

The one case where the Hollywood connection definitely worked against the hospital was the heparin incident with the Quaid babies. That must have triggered quite a bit of internal review. What was the IT involvement in those discussions about patient safety?

For obvious reasons, that is a hard question to fully answer, but I think that’s where Cedars has been good to not to look at errors specifically through one department, but really approach them as a system review. There’s no question that highlighted a system failure

The incident had us look at lots of different components that were part of the chain of events. But back then very few of them were directly IT related since we were busy implementing and most was not live yet.

Not to brag, but today we believe we stand in the top 5% with our use of barcoded med technology at the bedside. We scan in the high 90s on a fairly regular basis. But your readers are well informed about the complexities of the real workflows in a busy hospital, so while having bedside barcoding is great, it far from solves every problem.

The hospital has come a long way since back in 2003 when the decision was made to shut down the CPOE system after physicians protested. What do you think were the lessons learned that helped you get where you are today?

The decisions to implement and ultimately build the CPOE system are complex. They’re complex now and they were complex then. That story really starts in 1998 or 1999, as the Medical Center began looking for the right system for itself. I think back then, looking at the choices of what was available and the complexity of the organization, I think Cedars made a good decision to try to self develop.

Obviously, it didn’t end well. That story is well documented, maybe even over documented. But a lot of good lessons were taken from that failure that have since helped us, we could probably write a whole book.

It’s cliché now to talk to the idea that you have to involve clinical teams and make sure you do the right things from a training and engagement perspective, as today I think everyone understands that. Back then, these projects were seen much more as IT-centric things. 

As much as we knew we had to keep everyone engaged this time around, it was still hard to keep applying it. Especially the discipline to really focus on training — which by the way if someone insisted on me giving them only one piece of advice for a successful CPOE project, I would say besides the idea that there is not just one thing, focus on training.

The second area is the idea of a pilot and what you really want it to mean. The first time around, we used pilots as a substitute for a phase with the intention and plan to carry on to the next step regardless of the outcome. This last time around, we left real time to get input and to modify our approach.

We installed in seven phases. Epic tells us that is a record for a single site. While I would not recommend it, as we had too many, it allowed us time to tweak our approach. By the time we rolled out CPOE big bang in the hospital as the last phase, we did pretty darned well. We hit over 90% utilization — using real math — our first weekend ,and have stayed that high five months later. Remember, this is with very large private medical staff.

The last stuff is around how hard it is for organizations like hospitals to build and sustain large development teams to design and implement good clinical software. At the end of the day, a big problem of the original CPOE system was it was not great software. This drove us to select a vendor-based system as a core requirement. We chose Epic and are very happy with it.

Speaking of that, if a peer asked you what it was like to go through the selection, implementation, and now the support of Epic and to manage an IT organization throughout that process, what would you say?

For every organization, it’s different. A lot of it is where you’ve been that will shape how you decide you move forward. For us, obviously, given our history as a failed implementation, we spent a lot of focus on selection.

Selection for us was purposely run for a fairly long period, probably longer than other hospitals. It was a way of building initial engagement across the medical center in terms of helping people understand what the right type of system was for us.

The story I like to share is that shortly after selection, the good news was that it was unclear whether nurses had picked the system or the physicians had picked the system. Both constituencies thought they had played the pivotal role. I think it’s an example of having known where we started, we spent a lot of time focused on making sure that selection was done just right. We made sure we involved everybody that needed to be involved in participating in what ultimately became large-scale enterprise workflow design sessions.

People always want to know about what Epic’s secret sauce is in getting their customers live in a predictable fashion without too many surprises. How are they different from other vendors?

There are a couple of things that are unique with Epic. It’s strong software that delivers what it says it’s going to deliver. It has a strong user interface which clinicians relate to so when they’re demoing the system, they can more easily imagine how they’re going to use the system.

But most important — and I think to Epic’s credit — their secret sauce is that they rolled in an implementation methodology into the product itself. Very few people will implement Epic in a way that doesn’t use some portion of Epic’s methodology. I think that they really appreciated and understood well that it’s not just about the software. It’s how you put it in and how you ready your organization to begin to accept it.

How are you engaging with physicians now vs. before?

It’s hard for me to answer directly because I wasn’t there then, but I’m certainly part of it now. What we’ve done is more than just say we’re going to involve clinicians, which as you know sometimes involves showing it to physicians and nurses in the eleventh hour. They were part of the work teams. They were part of the teams that helped validate design. We had physicians as part of testing. We had physicians as part of the design sessions.

What we did effectively was bring together all the different members of the hospital into the same room, so that as things were worked on between the different constituents, they didn’t change so that people couldn’t recognize them as they went through a committee.

As much as possible, we brought all the people to the same place at the same time. In some ways, that resulted in 200-plus people being involved in a hotel ballroom going through something. But in the end, while at the time felt rather tedious, it paid off in terms of making sure that things were well integrated together.

Of course our challenge now, with a little bit of irony, is that as we continue to optimize the system. The number of people that want to come back into the room to really address system changes because the system is so integrated is enormous.

How did that get you on your journey to Meaningful Use and where do you see that playing out?

I’d characterize Meaningful Use more as a side trip for us rather than the journey. What I mean by that is that Meaningful Use was and still is a very important catalyst in driving IT adoption around the country, but for Cedars, our plan was well in motion and our strategy — and frankly, the tactics underneath that — were well understood prior to meaningful use being created. While we certainly knew that Meaningful Use was an important piece of the equation, we didn’t retool tactics to accommodate Meaningful Use. We knew that the end points would ultimately lead to the same destination.

When you’re looking at projects, especially when you talk about multi-year ones, you really have to make sure you demonstrate a discipline and a commitment to make sure you get to your goal as originally designed no matter how tempting the side trips may be.

You mentioned changing conditions. There’s a lot going in state and federal government. How do you see the developments that are happening changing the long-term strategy and thus the IT strategy of Cedars?

Some stuff is having a big influence. Some stuff is still yet to be defined.

Maybe speaking to the popularity of the product that we chose, it’s an integrated system that brings together ambulatory and inpatient as well as financials. As organizations ready to look at what it will take with accountable care, there’s no question that all those pieces of the puzzle need to come together. The better organizations are positioned in terms of seeing that information across the continuum merged with financials, the better equipped they will be. To that respect, not a lot has changed. I think that will continue to position ourselves to leverage our investment.

With regards to what’s ahead, there’s no question that as the demand moves higher upstream and organizations are transitioned from a fee-for-service world to accountable care, where you begin to blend in more population health management tools, we’re going to need to make sure that IT is at that center point to be able to provide it. The way we’re seeing it take shape, our agenda going forward is very much focused on the tools that will help us manage risk as we begin to take on risk in the new world and whatever form of contracting or arrangement that takes. As well as just become smarter and better at using the data that we have in a way maybe a little bit outside of that transactional lens that for a lot of years — probably going back four or five years ago — people really thought of as the objective or the goal.

Said maybe a slightly different way, I think that four or five years ago, it might have been a little bit easier to craft a goal around some of these projects — EMR projects — because you’d measure them in terms of physician orders written electronically or nurse documentation. The goals are moving well beyond that and the focus will be on the outcomes of the data that you’ve now collected.

That’s a criticism of Epic, that they were late to the database party and use a lot of gimmicks to move the data from their non-relational database to a usable form. What technology will you need to take advantage of your data?

I’m not sure I so much agree with the context of the question. We’ve not been struck by a challenge to get our information. I think our challenges have been more in terms of how we want to begin to use that information.

The reality is that perhaps for some smaller organizations, it’s true that out of the box tools or the automagical buttons might not exist in sufficient quantity to produce the data. But At the end of the day for us, the name of the game is trying to understand what we want to do with the wealth of the information we have.

To be perfectly candid, it’s relatively new to us. We went live on March 2 with CPOE , so we’re still learning which data we should begin to mine first and what we want to build.

I’ll give you a small example. For a very long time, we held back on a lot of decision support, largely because our focus was around engagement, usability, and adoption. While we knew that decision support is certainly an important tool of any EMR, we wanted to make sure we were very conservative in what we applied to maximize the usability. Now that we’ve lifted that veil since we’re successfully live, it’s been an interesting journey for us to figure out how to decide what decision support gets thrown into the system and how to ultimately prioritize that. In the end, as we better learn to manage the data that we’re collecting, I think that’s where all the work will be.

To go back to your question though, I think I would add that we do see, at least for ourselves, always a place to externally keep all of this information since it’s as critical as the EMR is for us. Our teams, have a long history of managing a clinical data repository. We will continue strategically to imagine ourselves as holding that data at a higher level than the transaction or application layer.

There’s a debate over whether implementing Epic means you’re being innovative or in fact being anti-innovation. What do you think innovation means in a hospital or health system environment and how do you practice it?

Our philosophy with Epic is that Epic does a lot of things great. Frankly, Epic provides us the innovation out of the box, which I think is maybe the theme of some of the accusations out there. But we embraced that as an opportunity in that, “Great, if somebody else has that covered, we’ll work on the next thing.”

We think of one of our roles in innovation as filling the white space between functional modules or between applications. But we try not to take too much pride of ownership in the innovation as when we see a commercial vendor — either an existing one or a newly emerging one — meeting the need, we are happy to yield the space back and look for the next opportunity.

Our challenge lately has been that healthcare IT continues to be such a hot sector that younger companies that we often look to partner with aren’t surviving long enough in their core ideas. The popularity of the sector has brought in a lot of new money with sales and growth expectations that are hard to deliver with providers. Everybody wants to expand quickly into other areas to make numbers. Nobody wants to stay and innovate in their box long enough to deliver complete end-to-end workflows. 

As we work with some of the smaller companies that start with a really good idea and fill a need, they quickly can represent to us a collection of functions intertwined with companies with intersecting business plans and colliding products. It makes you think about how private companies with strong backing can probably stay focused for longer and might be better positioned to grow an end-to-end workflow company.

How do you see the market playing out over the next 5-10 years?

I think parts of the market — as others have predicted and I will tag along — will continue to consolidate and some parts of the market will likely dwindle away. The EMR market just feels ripe for more consolidation. The niche clinical product market that’s out there — my guess is we’ll start to see that continue to dwindle away as enterprise clinical systems take over.

I still have lots of faith in the capital markets and innovation. I think that as new problems emerge, there’ll be new companies that will come up and help hospitals and health systems solve them. I have little doubt that we will continue to see data intelligence as a big focus for the next few years.

The tricky part is going to be how some of the bigger organizations like Cedars and obviously many, many others continue to learn to manage the integration challenge. Especially as health system appear to be acquiring. While we think internally that we moved away from best-of-breed, we have not moved away from deep investments in our integration technologies. Because we know that ultimately there’s always going to be a role for putting small pieces together to serve the whole. I believe this will be a big area in the next few years as well.

Does it worry you that an awful lot of hospitals have chosen Epic and that its large application set means you’re putting a lot of eggs in their basket?

I think at times there are some things we worry about, but overall I wouldn’t say that it’s a worry. I think that healthcare is still new in the consolidation business. While Epic is big, it’s not uncommon in other industries to start to see dominant players like that.

In a lot of ways, I think there are some positives with it. California is just beginning to see the potential of leveraging Epic for information exchange. Other states have been able to leapfrog some other efforts by joining together already. I also think there has been some great group think and group input that we’ve benefitted from in terms of more rapid maturity of the applications because there’s such a wide and diverse customer base.

In the end, it always gets measured in terms of what organization’s specific needs are. For us, we’re comfortable– and in fact, frankly pleased — to see a large, healthy vendor behind what is obviously a fairly large and significant investment for us. We’ve not been afraid to innovate or seek small partners if we were looking to do something that was out of their sphere.

Any concluding thoughts?

Yes, two.

The first is on people. It may sound weird, but it’s still amazing to me how much people play a big part in everything that we’re trying to accomplish. I know that there’s a lot of focus often on the software vendors and the products, but I’d tell you the same thing that we talk about internally. The largest reason for delay or the largest inhibitor to moving forward with a new project — besides funding — is most often the ability to find the right people to work on the project with the right skill sets. We spend a lot of time encouraging and growing our own teams, knowing that ultimately that’s the secret to our ability to deliver. We are recruiting and so is almost every fellow CIO I meet. We need to find a collective way to start to solve our people shortage.

And second, thank you for interviewing me. You have a great product with a rather shocking reach.

Curbside Consult with Dr. Jayne 8/20/12

Mr. HIStalk, Inga, and I don’t get to see each other in person very often – usually just at HIMSS or in the odd instance our paths cross while traveling. It’s always a nice surprise though when one of them publishes on a topic that parallels something I’m doing at my day job. It happened this week when Mr. H ran one of his Time Capsule pieces on hospitals aligning with private practice physicians.

Not unlike other hospitals and health systems across the US, my employer is no stranger to the relaxed Stark anti-kickback rule. They’re using the EHR exception to offer a variety of subsidized EHR products to community physicians. One tenet of the exception is that the software being provided must be interoperable.

It would have been nice if the hospital simply offered the same EHR that the employed physician group uses so that we could all begin exchanging data immediately. This would potentially have had an immediate impact on reducing duplicative testing, ensuring referrals arrived with appropriate clinical data attached, and strengthening referral patterns. Throw in a couple of laboratory interfaces and it would have been a winner.

Instead, the hospital chose to do what Mr. H suggested and let the recipient practices choose their own EHRs. Trying to connect different platforms via point to point interfaces can be tricky, so the hospital decided to throw a health information exchange into the mix as well, promising quick connectivity. Community physicians chose four different EHR systems which vary dramatically in quality, comprehensiveness, and production of discrete data.

A wise CIO would have allowed third parties to implement these physicians on their systems of choice. Ever eager to curry favor with the various regional administrators and informal power-brokers, our CIO chose to form a “tiger team” to implement and support all four products as well as the yet-to-be-deployed HIE.

Several years have passed, and as you can imagine, the project has been somewhat of a mess. I’m glad I haven’t been involved and can’t believe they’ve staffed it with only three people. Frankly, I don’t know how those poor souls cope. I only have to deal with two EHRs (one ambulatory, one inpatient) and that can be a challenge in keeping up with different releases and features.

Even in ideal circumstances, I can’t imagine trying to learn, implement, and support multiple ambulatory EHRs. This team is not working under anything remotely close to ideal circumstances. They’ve had to cut corners just to stay afloat and haven’t fully implemented the features of even one of the systems.

Like those mentioned by Mr. H, the physicians taking part in this subsidy program are largely unreasonable and haven’t been terribly cooperative with practice reengineering or making sure office staff members are held accountable for learning the systems and using them correctly. They complain bitterly about how much money they’re spending (even though they’re footing between 15% and 30% of the total EHR bill) and how little they’re getting for it. Enter Dr. Jayne, who has been placed on temporary duty assignment to “find out why those doctors are so unhappy and fix it.”

I’m pretty sure the CIO thinks I have some kind of magic wand that I can just wave and make this whole thing go away. After visiting with a handful of providers, however, it’s going to be a lot more complicated. I’m pretty sure it’s going to involve the practice management and healthcare IT equivalents of a backhoe, a steam roller, and seven sticks of dynamite.

I’m not confident we’re going to improve things unless the providers learn to check their egos at the door and the practice managers start running the practices like businesses. The hospital administrators leading this project need to learn to hold the practices accountable. Even if all of these pieces fall into place, I still give it no more than a 50% chance of success.

Without a change to the regulations, the Stark exception is set to expire at the end of December 2013. The hospital administrators and the CIO are confident that the provisions will be extended. HIMSS has lobbied that the EHR exception be made permanent. Although I don’t see the government announcing any extension until at least 2013, I know of three people eagerly waiting for this project to die a timely (if not early) death. Depending on how long this “temporary” assignment lasts, I’m going to be counting down the days alongside them.

Have an EHR exception horror story? Have a fantastic tale of success? E-mail me.

E-mail Dr. Jayne.

Monday Morning Update 8/20/12

From The PACS Designer: “Re: data visualization. The concept is booming outside of healthcare. One of the beneficiaries is Tableau Software. They have free trial software for anyone in the healthcare field to try if they want to get an idea of what can be accomplished with it.” I’ve played around with it a couple of times over the years courtesy of their free trial offer. Both times I thought it was pretty cool initially, but I quickly ran out of stuff to try and lost interest. I probably would have kept working with it had there been specific, short examples or pre-loaded demonstrations of why it’s better than Excel 2010’s pivot tables or Analysis ToolPak, which can do quite a bit and don’t cost $999 for the personal version. Tableau gets a lot of love out there, so I assume it works well once you figure out what you’re doing and starting throwing more complex data at it.

From EHRbitrator: “Re: EHRevent. The EHR event reporting system has been showing an ‘under construction’ message. What’s going on with it?” I asked Ed Fotsch MD, CEO of PDR Network, the company that donates the resources to run EHRevent (PDR hosts the service, but it’s managed by the non-profit iHealth Alliance). Ed says that since EHRevent was launched, the Institute of Medicine report called for a national approach to health IT safety, which would have required EHRevent to expand dramatically. PDR Network and the iHealth Alliance decided to suspend the service pending a decision by the federal government on IOM’s recommendation. I interviewed Ed about EHRevent and other topics in November 2010.

Nearly two-thirds of poll respondents say that Meditech’s market position has worsened in the past year. New poll to your right: Allscripts is emphasizing its “open systems” message. By your definition, would you characterize the systems it sells as open? Once you’ve voted, show your work by clicking the Comments link on the poll and explain what your definition of “open” actually is.

Inga and I read tons of press releases and often roll our eyes at how badly done they are (which usually means the alleged news won’t see the light of day on HIStalk or probably anywhere else). Instead of just making fun of the PR atrocities, we’ve put together a list of 25 tips for doing them right. We’ll be sending it out to our sponsors, who no doubt will rise to the top of the press release heap after heeding unconventional advice from hack pseudo-journalists like ourselves.

Listening: The Bamboos, big-band soul from Australia (“funk from the deep southern hemisphere”). That’s when I can tear myself away from the purely angelic First Aid Kit, which is harder after I found this video that I’ve watched in amazement about 20 times. I’m listening to it solo in the house as I write this Saturday morning, having taken Mrs. HIStalk to the local farmer’s market for some summer tomatoes, a vegan barbeque hand pie that I ate right there in the parking lot, and a blueberry-cardamom goat cheese cake for later. She’s off for the facial and massage that I arranged and I’ll meet her for lunch (barbeque may or may not be involved), followed by my usual exercise routine, more work, and one of the Sierra Nevada Summerfest Lagers that I tried a couple of weeks ago and bought today. Maybe it gets better than that in your world, but not in mine, except maybe when college football starts in a couple of weeks.

Quality Systems Inc. held its shareholder meeting Thursday, but says the results of the board member election won’t be available until this week. In other words, we don’t know yet whether dissident shareholder Ahmed Hussein was able to wrest control of the company via his proxy campaign (although rumor has it that he lost and demanded an independent recount, which is why it’s taking so long, but that’s unverified). Hussein’s previous attempts failed, but that was before QSII shares took a beating and he added former QSI President Pat Cline to his slate of director nominees. Shares have rebounded to $19 after touching off the $16 range three weeks ago, which would be fantastic news had they not been in the mid-40s when the ugly slide started in April.

Stan Nelson, founder and chairman of Scottsdale Institute and former CEO of some major Midwestern health systems, died earlier this month at 85. The guestbook is here.

Dick Schopp, a 50-year healthcare IT veteran, died August 16 at 75. He had worked for McAuto and HIS, Inc. and also founded Healthcare Computing Strategies. He was a principal with HIS Professionals, LLC. He is survived by his wife Pat, five children, 27 grandchildren, and seven great-grandchildren. Vince Ciotti let me know and says he’ll have a salute to Dick in his next HIS-tory.

The VA awards a $4.5 million, one-year contract with four optional years to Ray Group International to restructure the MUMPS code of one module of VistA as well as its application layer, making it more modular. That’s the same company that got a $4.9 million contract in June to develop the VA’s OSEHRA project to make VistA an open source, community supported application. I’m impressed with CEO Ronald Ray: a Marine and Green Beret battalion commander for 21 years, three tours in Vietnam as a platoon leader, recipient of the Medal of Honor, a White House Fellow, and assistant VA secretary. He did something in Ia Drang Valley in 1966 that I thought only happened in movies: as he was getting his legs shot up by machine gun fire, he flung his body onto a live grenade to protect his comrades.

An article by two Yale economists says women would be better off financially to become physician assistants instead of doctors. Reason: women in medicine work fewer hours than their male counterparts, so their correspondingly reduced earnings don’t readily cover the high cost of medical school. If you didn’t buy the “an increased supply of doctors creates its own demand and therefore increases healthcare costs” argument, you might suggest that healthcare reform dictate a faster and cheaper pathway to becoming a primary care physician. You know the financial dynamics in play, however: universities love healthcare professions programs because they can charge huge tuition (knowing that students can get loans easier with expectations of eventual high incomes) and every healthcare profession is fiercely protective of its own, doing all it can (like any other business) to raise the barrier to entry to keep cheap newcomers out. On the other hand, it’s sad to see how many students take up one of those valuable spots and then either never practice medicine or gravitate to one of the high-paying specialties that does little to improve population health.

Several companies named as best to work for by Consulting magazine offer healthcare IT services. I don’t know all of them, but those I know as primarily serving healthcare are Impact Advisors, Aspen Advisors, and Cumberland Consulting.

West Virginia University Hospitals-East goes live on Epic.

ED management company Emergency Physicians Medical Group will implement a digital dashboard from Emergency Medicine Business Intelligence for its 44 hospital customers to improve ED turnaround time. Scott Richards, one of the two principals of EMBI, used to be an IT director at UAB Health System.

Consumer health expense management software vendor Patientco gets $3.75 million in funding. It offers patient-friendly bills, multiple bill payment methods, and secure patient-to-provider messaging for asking questions about a bill. They register using a secure code printed on their statement. 

Fidelity National Information Services sells its healthcare payments and claims business to a private equity firm for $335 million.

A University of Florida study finds that patients with three or more chronic conditions are only half as likely to receive treatment for depression if their doctor uses electronic medical records. The researchers speculate it’s because EMRs reduce the time doctors spend with patients or perhaps the EMR directs their attention to purely physical issues.

I’m always fascinated that this happens all the time in India when relatives suspect hospitals or doctors of substandard care of their loved one. Family members go on a rampage after the death of a hospitalized teenager, destroying hospital computers, breaking windows, and attacking police officers. Eighteen family members were detained and eight police officers were injured, two of them requiring hospitalization.

A former VA hospital employee who won a $1 million lottery prize in January of last year buys a scratch-off ticket, but gives it to a beggar in the convenience store. It turns out to be a winner worth $260K. She protests to the lottery commission, saying the man pressured her and she intended to give him money instead, but surveillance camera footage and interviews show she gave him the ticket voluntarily. Despite the million dollars she won, the woman claims she’s broke because of medical bills and her unpaid leave from the VA. She’s writing a book about her life.

Strange: a nurse performs her own fecal transplant to cure her chronic diarrhea, using her husband’s feces, a blender, and a turkey baster. She told the reporter that she kept the blender, so I’d suggest passing if she offers you a Margarita.

Vince’s HIS-tory this time is about INFOSTAT. If you’re watching on NBC, mute your TV now for a spoiler: “They were acquired by Keane in 1995.”

Sponsor Updates

• Assisting Lee Memorial Hospital (FL) its its just-mentioned Epic go-live was HCI (Healthcare Clinical Informatics).
• Elumin Healthcare Solutions has expanded its LinkedIn page to keep its consulting customers and associates up to date on the company’s activities.
• Visage Imaging offers an online white paper (no registration required) called It’s Your Image: Top 15 Reasons to Consider an Enterprise Imaging Viewer.

E-mail Mr. H.

Time Capsule: Smoking the CIO-Doctor Peace Pipe: Let Practices Choose Their Own PM/EMR Gift

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 October 2007.

Smoking the CIO-Doctor Peace Pipe: Let Practices Choose Their Own PM/EMR Gift
By Mr. HIStalk

Hospitals suddenly want to align themselves with private practice physicians. They don’t want to buy their practices in that fashionable and fabulously unsuccessful trend of a few years back, but they recognize the need to at least keep the war cold.

Much of the desired hand-holding is, by definition, electronic. RHIOs, referrals, integration of office systems with hospital systems — all require expertise beyond what doctors have available. It’s junior league IT in the doc’s office, hospitals figure — a cakewalk for the crackerjack IT team they’ve assembled.

What sometimes knocks the idea off the tracks is someone holding the CIO title who doesn’t really buy into the concept of enterprise computing, which includes connecting outside the organization.

CIOs are, by and large, reasonable and polite people. However, many of them know nothing about physician practices. They have their hands full already, falling further and woefully behind under a tsunami of unfunded IT demand from inside the hospital walls.

CIOs are trained to keep hospital department heads happy, and rightly so. Not doing so is a career-limiting strategy. Throwing a bunch of whiny and uncooperative doctors into the mix isn’t likely to increase the level of unrestrained joy among the technophiles.

Doctors have unreasonable demands, at least as observed from hospital IT departments. They abhor standards in any form, medical or technical. They don’t work in a polite business culture, so they are alarmingly prone to say exactly what they think, with an extra helping of sarcasm and contempt laid on top of what may well be a shaky intellectual platform. Anything that costs them money is an abhorrent attempt to pick their pockets, starve their children, and insult their intelligence.

Hospital executive leaders understand that doctors distrust hospitals and everyone who works in them. The feeling is generally mutual. However, the market is limited for doctors without hospital privileges and hospitals without admitting doctors, so cooler heads prevail and technology peace pipes must be smoked. That means turfing the whole thing off to the CIO to make it happen.

Some CIOs are as stubborn in their unwavering paradigms as their doctor counterparts. IT systems must be purchased from big, reputable vendors with publicly scrutinizable financials. Extra points are awarded if the company also sells hospital systems, runs on familiar hardware, is used by similarly unimaginative hospitals, is priced high enough to avoid suspicion, and has a cadre of glad-handing suited minions to soothe concerns that the product might be anything but the best.

That’s how CIOs buy hospital systems. Since the goal is getting access to doctor data and tying them to the hospital by giving them free systems, the CIO gets to pick the gift themselves since they have to support it afterward.

Physicians don’t use EMRs all that much, but consider this: utilization hasn’t improved much since hospitals got involved. Whatever they’re buying for doctors isn’t inflecting that magic tipping point. Free isn’t cheap enough if it’s something you don’t want (think “free kittens”).

Most physician practices are small. They want systems that are simple and that save them time (time is all they have to sell, after all). They aren’t about to use the CIO-friendly systems that hospitals want to provide them at no cost if those systems don’t fit their small business. If it takes more of their time, the “no cost” part of the pitch isn’t convincing.

The track record of CIOs in choosing systems that doctors will use in their offices isn’t any better than that of choosing systems they’ll use in the hospital. Lesson learned: let the doctors pick the systems you insist on giving them for free.

News 8/17/12

Top News

Streamline Health Solutions acquires New York-based HIM systems vendor Meta Health Technology for $15 million in a mostly cash deal. Streamline Health also announces new financing that will reduce its capital costs and a $12 million equity investment by Great Point Partners, LLC and Noro-Mosely Partners.

Reader Comments

From Grizzled Veteran: “Re: Quality Systems proxy fighter Ahmed Hussein. He sent a letter to fellow shareholders saying that NextGen VP Jerry Shultz has resigned after 15 years as sales VP, claiming that Shultz quit because the company is splitting the sales team while the market is demanding an integrated inpatient and ambulatory solution. Hussein says he’s been warning all along that critical employees could start leaving.” Unverified. Jerry Shultz still listed as SVP on the company’s site.

From exMDRX: “Re: ACE conference in Chicago. Apparently there’s some confusion this week. What is this EMR tool, and does it take 120 or 220v?” I was hoping that John Madden would take a wrong turn from his RV and join Glen on the podium with a turkey leg and Telestrator in his hands.

From Chrissy: “Re: pMD. We are big fans of HIStalk! We are a mobile charge capture company and work with doctors to streamline their practices. We released our new website today – wanted to let you know!” I would ordinarily delete a message like this without a second thought since companies are always bugging me for free PR (with said trashing being more likely if the requester isn’t one of the 2,668 members of the HIStalk Fan Club on LinkedIn, which Chrissy isn’t), but I figured I’d take a look at the new site before pressing Delete. It’s funny and brilliantly designed. The creative agency had the cool paper-cut illustrations made in Lucca, Italy, which against all odds has now been mentioned twice in one HIStalk post (see Lucca Consulting Group, coming up in a couple of inches).

HIStalk Announcements and Requests

Happy Elvis Week, everybody! If you have been too busy celebrating to stay current on HIStalk Practice, here is what you missed. PairOfAces points out that Chicago’s McCormick Center was headquarters to both the Allscripts ACE meeting and the ACE Hardware convention this week. Medical schools may not provide students adequate training on EHR usage. Several eClinicalWorks customers discuss the perks and problems of EHRs. Aaron Berdofe maps out MU attestations and looks for meaningful correlations (there are some.) When you check out these stories, please don’t be cruel; love me tender(ly) and sign up for the e-mail updates. Thanks for reading.

Welcome to new HIStalk Platinum Sponsor Lucca Consulting Group. Listen up if your organization is implementing Epic: Lucca is 100% dedicated to providing Epic implementation & training support, and can provide certified and credentialed consultants for those hard-to-find Epic skill sets, or if you’d rather, they’ll send you an entire project team. Maybe you’re worried about a big bang Epic go-live and wondering how in the world you’re going to get enough credentialed trainers or instructional designers to get over the hump. As the “go-to firm” for Epic training, Lucca can help there, too. Cedars-Sinai says “Lucca had the most qualified trainers of the competing consulting firms”, while UMass calls them "agile and accommodating." Need to backfill legacy apps so your team can move to your Epic project? Lucca can provide skilled expertise for Siemens, McKesson, Eclipsys/Allscripts, and others, working remotely to keep expenses down or on site under your direction if you prefer. They hire the best and the brightest, offering flexible employment options for those interested in a rewarding career with a company that supports them. Don’t call up asking for someone named Lucca, though — the company couldn’t get excited about yet another generic or clever healthcare IT name, so they went with Lucca, the picturesque Italian city (in Tuscany, actually) that founder Gina Craig had recently visited prior to starting Lucca in 2008 (check out this article and you’ll see why it’s memorable, but you’ll end up hungry). Thanks to Lucca Consulting Group for supporting HIStalk.

Response from e-MDs

In agreeing to publish Wednesday’s letter from Michael Stearns, MD related to his termination from e-MDs, I had said that in the interest of fairness, I would also run the company’s response if they provided one. They did, which I’ve added both to the original article and below:

e-MDs, Inc. removed all the material and information that comprised the web posting “The Truth About Michael Q. Stearns” that had been posted in March of 2010, and this removal occurred immediately following the action taken on July 2, 2012 by e-MDs that completely terminated its affiliation with Michael Q. Stearns. Both e-MDs, Inc., and Dr. David Winn, each formally retract that entire prior posting statement and want to be very clear that statement should not be relied upon as the current position of e-MDs, Inc. or of Dr. David Winn.

Acquisitions, Funding, Business, and Stock

Allscripts and Microsoft collaborate to create a healthcare open platform ecosystem through the Application Developer Program.

Sales

Long Island Radiology Associates (NY) and Horizon Imaging (AL) adopt Merge Healthcare subscription-based solutions.

Samaritan Health Services (OR) selects iSirona’s device connectivity solution to deliver patient data to Epic.

USC Care Medical Group (CA) chooses MediRevv’s Day One Self Pay Management services for self-pay cash collections.

Nonprofit health system Group Health, which offers health insurance and medical care in Washington and Idaho, chooses RTLS software from Intelligent InSites.

People

Origin Healthcare Solutions hires Steve Brewer (Merge Healthcare – above) as chief sales and marketing officer and Christine Campbell (Medical Present Value) as chief client offer.

Consulting firm North Highland names Richardo Martinez, MD (The Schumacher Group) its first chief medical officer.

Hill Meade (MEDecision, Siemens Healthcare) joins personalized medicine test maker Genomind as SVP of IT.

Announcements and Implementations

The local paper profiles the $70 million Epic implementation at Lee Memorial Health System (FL), which went live at four facilities earlier this month. Only one independent practice has contracted with the hospital to set up Epic in their office, and cost is a likely a barrier: affiliated practices pay $16,000 for licensing, $4,500 per year per provider for maintenance, and $25,000 to $80,000 for implementation.

McKesson announces the release of Cardiology 13.0.

Informatica introduces PowerCenter Integration Pack for dbMotion, which enables customers to draw clinical data from the dbMotion solution.

Saskatchewan eHealth (Canada) implements Orion Health’s Clinical Portal.

Allscripts announces plans to integrate American Well’s telehealth platform into its EHR. University of South Florida Health says it will use it to serve huge retirement community The Villages, which the press release describes as being “near Tampa, Florida,” which at 82 miles away and in the middle of nowhere other than being not too far off I-75 south of Ocala, could at least have been listed as near Orlando (58 miles).

Other

Parkland Memorial Hospital (TX) reports that its staffing has reached “crisis mode” with almost 16% (more than 1,300) unfilled positions. Most are in clinical areas, including 400 in nursing. The hospital is investing $250,000 on an enhanced recruiting plan that includes wading through a backlog of 29,000 job applications. With that many applications to process, maybe the first new hires should be in HR.

Ten St. Louis-area women sue their plastic surgeon after finding their before-and-after breast augmentation surgery pictures by Googling their names. Even though the pictures were not labeled with the patients’ names, the names were attached to the image files. Not that I have any reason to believe I would have any before-and-after pics on the Web, but reading this story made me feel compelled to Google my image. Curiously, a search of Inga HIStalk brings up a picture of John Glaser. Draw your own conclusions.

A Wall Street Journal article on new medical devices shows an artificial foot being tested that allows the user to adjust the ankle microprocessor via smart phone.

Here’s the latest cartoon from Imprivata.

The number of University of California employees making over $1 million per year has quadrupled to 22 in the past five years, with most of them being either coaches or doctors.

Weird News Andy declares that there’s no beating around the bush on this issue. Family physician Emily Gibson MD urges a truce in the “war against pubic hair” (her term for bikini waxing), warning that shaving causes susceptibility to infection and abrasion.

Strange: nurses who have been on indefinite strike over a minimum wage against their hospital in India have their demands met after three of them climb on the roof and threaten to jump. The nurses made $36 per month, but the new minimum salary will jump (no pun intended) to $137 per month.

Sponsor Updates

• Presbyterian Intercommunity Hospital (CA) connects Surgical Information System’s anesthesia information management system to its Allscripts Sunrise Surgery solution, powered by SIS.
• The Interboro RHIO (NY) and NYC Health and Hospitals Corporation join the Statewide Information Network of New York run by NY eHealth Collaborative.
• Imprivata records 45% year-over-year growth for the first half of 2012 and the addition of 105 healthcare clients.
• Galway Clinic (IR) selects Access Universal Document Portal to transfer paper documents into its Meditech scanning and archiving module.
• Centra Health (VA) participates in an Emdeon-sponsored Webinar discussing its use of Emdeon’s eligibility and enrollment services.
• The Huntzinger Management Group joins a panel discussion on MU attestation during the IHT2 Summit in September.

Report from the Allscripts Client Experience – Day Two and Three
By Bill Rieger, CIO, Flagler Hospital

The conference has been very good. It has been a very busy couple of days. From my perspective, Allscripts has pulled off a very successful event. 

One of the only issues I have experienced relates to the sessions. I went to one today where no one showed up to present. I heard others that went that way, so there is definitely room for improvement. 

At Wednesday’s kickoff keynote, both the mayor of Chicago and Glen Tullman spoke (the mayor for 10 minutes, Glen for an hour or so.) Again, Glen focused on the open nature of Allscripts. His message was to both Allscripts clients and partners — we made it open so you can innovate.  

Thursday morning’s keynote was Dr. Daniel Kraft. He spoke about the future of healthcare in many ways — technology, cost, genomic study, data, etc. It was an overstimulating presentation. He gave you so much in the first 15 minutes that could keep you researching for days, so much to think about that it was almost distracting for the rest of his presentation. A brilliant guy with a lot of great ideas, some of which are available today (EKG on iPhone, Eye Netra, Qualcom Tricorder etc.)

I spent most of my time in the Hub, where the booths are. Similar to HIMSS, but much smaller and more focused. I spoke to some great partners like MModal, Nuance, and SIS.  

By far, the highlight of the trip for me was a discussion and demo from The Breakaway Group (a Xerox company). Many of you may have read the book Beyond Implementation written by this group. It is a great read that challenges "go-live" focus and redirects focus to adoption through proper simulation-based training.  

Before I spoke with them, I had a meeting with Steve LeLand and another great partner, iMethods, an awesome organization helping us with staffing and culture development. During the meeting, Steve talked about the new Allscripts partnership with The Breakaway Group and their focus and commitment to adoption. That fit very well with our focus on culture and its impact on successful implementation.

Another awesome part of the event was a photographer who had people write on their body with a marker, mostly on arms, and took a picture. There were some very creative ideas and people had a lot of fun with it. Tonight they have reserved Navy Pier in Chicago for a blowout party. They had a killer party at HIMSS in Orlando at the Hard Rock, so I am heading into this with high expectation! 

My take on this whole event is that Allscripts is positioned for success. They struggle with the same challenges that all of these HIS vendors do, getting the right people on board when HIT staffing right now is very fluid. If their leadership stays in place and they maintain focus on their direction, they will do well. This conference has increased my confidence in Allscripts as an organization and a partner for our community.

EPtalk by Dr. Jayne

Researched published in the September issue of Pediatrics looks at whether systematically developed clinical decision support provides usability benefit or whether it decreases cognitive workload. Seven pediatric surgeons (residents, fellows, and attending) used either an ad hoc order set or a systematically developed one for managing postoperative appendicitis patients. After a washout period, each was tested on the other order set. Authors concluded that well-designed order sets reduce cognitive workload and order variation, although they didn’t improve speed, reduce mouse clicks, or reduce free text entry.

One of the things that annoys me in practice is the IRS rule that Flexible Spending Account funds are “use it or lose it.” This means that patients are calling the office throughout December trying to find reimbursable ways to spend their money. Rules like this just promote a consumer culture and lead people to buy things they may not need rather than forfeit. The Treasury Department is seeking comments on whether this rule should be modified or eliminated. Comments can be submitted through Friday. I tend to think that promoting savings for unanticipated future needs is a good thing and allowing a rollover would be beneficial.

HIStalk contributor Ed Marx tweeted about the stress-inducing nature of open office floor plans. Having worked in an office environment that not only was open but had mere half-walls between the cubicles, I agree with the statements about high noise, lack of privacy, and distractions. What surprises me with many of the groups I work with, however, is the lack of office protocols targeted at creating a better workplace. I recently visited an IT cube farm where many of the employees were either using speakerphones or listening to music (or in one situation, both). A simple intervention like requiring workers to use telephone headsets or listen to music with earphones would have made a huge difference. I’m thinking about printing copies and leaving them anonymously on a few management desks.

This is the 35th anniversary of the death of Elvis Presley. He was 42. The annual Elvis Week celebration of his life and work is expected to draw 75,000 people.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Readers Write 8/15/12

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

Note: the views and opinions expressed are those of the authors personally and are not necessarily representative of their current or former employers.

A Letter from Michael Stearns, MD

As many of you know, I was until recently the president and CEO of e-MDs, Inc. an ambulatory EHR vendor. I joined e-MDs in 2006 as their CMO and was promoted to president and then president and CEO in 2007 and 2008. Through 2011, my tenure at e-MDs was marked by significant increases in revenue.

On July 2, 2012, I was abruptly removed from my position with e-MDs for reasons undisclosed, other than a vague inference to company policy violations. e-MDs has refused several requests to disclose the details of these alleged infractions or the names of those involved, making it impossible to respond or to provide essential information that would allow me to clear my name. 

Unfortunately, e-MDs took the unusual step of publishing a press release that contained information based on false allegations that have not been subject to basic tenets of due process. The rationale for taking such action is difficult to discern. Regardless, I will be relentless in my pursuit of the facts. I remain confident that information will eventually emerge that will exonerate me completely. 

Due to a very unfortunate situation that occurred while I was a Navy medical officer roughly two decades ago, I have learned to be particularly sensitive to my conduct in the workplace. In summary, I found myself caught up in the fallout from the Tailhook scandal of 1991 that resulted in hundreds of naval officers having their careers damaged or destroyed, as detailed in this Duke Law Journal article.

Staffing shortages in the Navy resulted in a lack of available female chaperones, and female patients made a number of complaints. One of my patients, a female seeking disability for unexplained loss of genito-rectal sensation, bladder dysfunction, and lower extremity weakness, complained that my examinations had been overly detailed on two separate occasions. An investigation of my conduct with female patients over a four-year period led to two other complaints emerging, but the overwhelming majority of patients reported that I was “one of the most caring and thorough physicians they had ever known.” 

During the investigation, a number of facts emerged that shed doubt on the validity of the claims made by these individuals. Given the post-Tailhook atmosphere, there was a great deal of pressure on the commanding officer not to demonstrate leniency in any matter of this nature. I was given the option of either fighting the allegations in court or submitting my resignation in lieu of charges. However, under a subsequent threat of media attention, they reneged on the resignation offer and filed indecent assault changes.

My military counsel, after a cursory fact-finding effort, informed me that given the hysterical climate created by Tailhook — regardless of my guilt or innocence — I would be found guilty and could spend up to 15 years in prison. I was told my only realistic option was to accept a time-sensitive plea offer that reduced the charges to the misdemeanor equivalents of simple assault and battery. In return, I would also be found formally not guilty of the indecent assault charges, including any reference to inappropriate sexual touching. I was also informed by my attorney that the plea bargain would not result in a loss of my medical license, based on direct communication she had with the Maryland Board of Physician Quality Assurance (MBPQA).

A MBPQA review body recommended that my license be suspended for six months and the suspension stayed. However, after a protracted and acrimonious process, the MBPQA removed my license to practice medicine for a minimum of one year. Perhaps most disappointing to me, especially in light of the fallout from the Tailhook scandal, was that, despite my pleadings, the MBPQA did not perform an independent investigation that would have revealed a number of exculpatory findings of fact. Making matters worse, the published MBPQA order contains false information that has never been corrected. I was found formally not guilty of indecent assault and all language to that effect was removed from the guilty pleas. Despite this, the MBPQA order states that my guilty pleas arose from inappropriate sexual touching, something for which I was actually found innocent.  

My former employer, to their credit, conducted their own independent investigation in 2010 to address the facts surrounding the MBPQA orders. e-MDs went so far as to speak with a physician who served alongside me in the Navy and who corroborated the information I provided to them. They concluded that the process had been unfair and biased and published their findings on their website for over a year. HIStalk republished their findings in this article. 

Due to the age of information and easy availability of this erroneous MBPQA order, a number of individuals have drawn incorrect conclusions regarding the facts and actual findings of law based on the MBPQA orders. I appreciate HIStalk giving me the opportunity to address this in a public forum and I am hopeful that the MBPQA successor, the Maryland Medical Board, will correct the errors in these documents.

While always conducting myself in a respectful way, I have learned to be cautious and somewhat guarded in my professional interactions over the 18 years that have passed since this situation arose. Thus, I was stunned to hear of the vague allegations brought forth by e-MDs. 

During my leadership, e-MDs was increasingly seen as a company willing to contribute substantially to core informatics efforts driving advances in healthcare and clinical research. In addition to running a company that saw a roughly 15-20% annual increase in revenue during my tenure, I represented e-MDs on multiple boards and played a direct role in informatics, policy, standards, interoperability, genomics, coding, patient safety, patient privacy, compliance, and educational efforts related to HIT initiatives; gave over 100 educations presentations; provided five testimonies to various work groups of the ONC; and was invited to a private White House town hall meeting on HIT in June of this year.

It is disheartening to believe that a company to which I dedicated more than five years to would publish something so vague as to invite innuendo and speculation. The unusual step e-MDs took in publishing conclusions based on a hastily conducted and inexplicably incomplete fact-finding process was highly unfortunate and damaging to my reputation. Knowing that inaction in the face of defamation can cause long-term damage, I have no other choice than to provide corrections through public forums while I work diligently to clear my name.

Michael Stearns, MD.

Response from e-MDs

e-MDs, Inc. removed all the material and information that comprised the web posting “The Truth About Michael Q. Stearns” that had been posted in March of 2010, and this removal occurred immediately following the action taken on July 2, 2012 by e-MDs that completely terminated its affiliation with Michael Q. Stearns.

Both e-MDs, Inc., and Dr. David Winn, each formally retract that entire prior posting statement and want to be very clear that statement should not be relied upon as the current position of e-MDs, Inc. or of Dr. David Winn.

HIStalk Advisory Panel: IT and Patient Outcomes 8/15/12

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

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

This month’s question: Why has healthcare IT not uniformly improved patient outcomes?

Vendors and Products Don’t Align with Clinical Needs

• Doctors don’t see technology as an ally in helping them take care of patients. Please see the article recently published on Medscape. The default mode of healthcare practice in the US is to practice defensive medicine (defense against lawsuits). Examples like those given in the article above don’t raise a healthcare provider’s confidence in technology. Notice how the article specifically gives the example of vendor contracts that say if something goes wrong using our technology, it’s not our fault.
• We have focused on a computer fixing a workflow problem while at the same time becoming more dependent on computers to tell staff what to do.
• With few exceptions, the vendor community supports our efforts to enhance and embellish the product with each deployment. In some cases, neither the vendor nor the client has an incentive to collaborate with other vendors, or other clients, to ensure that every deployment of IT is better than the previous one. This is getting better, but we still have much to do in this regard.
• Some outcomes take a long time to improve, longer than the HC IT has been in use. Some HC IT focuses too much on documentation without a balanced approach to deriving outcomes information let alone being integrated into the care process sufficiently to affect outcomes.
• The answer is in part within the question: IT implementation has not really been uniform across the care spectrum. As most realize, systems are often if not usually built from a developer / programmer standpoint, reaching out to address a problem rather than starting with a problem (or "job to be done") and working back to develop the necessary system to perform that job. This has lead to numerous issues of usability, human-computer interface problems. More importantly, and more fundamentally, many systems simply aren’t designed to improve patient outcomes. They’re built from the start to support billing, financial management, documentation, etc. As a corollary to the above, rarely is the clinical environment placed at the center of the system. This is evident in the approach vendors generally take with deals: focus on administrative and IT needs (decision-makers) with lesser attention devoted towards those who both use and see the actual patient effects.
• The Jurassic Park line, “Just because we could does not mean we should"says it all. Not every EMR or HIT app needs to be adopted or will prove to be of value. Not all of them are created equal. In many instances, it has been the technology that drove the cost with very little benefit.
• Clinical decision support that follows the rights (right clinician, right intervention, right time, right level of alert logic, right ease of use ) is almost non-existent, except for the simplest medication alerts. Apologies to Jerry Osheroff, I don’t think he gets this quite right. Until the biggest EHR players improve their CDS functionality, and there are good guidelines for turning structured knowledge into CDS, I don’t think we will get very far. We will, but I am waiting for the ability to use a general purpose programming language on data in the EHR to create new levels of CDS that are actionable. Further, I bet not much of this happens locally until the EHR players are forced to have some "skin in the game", some liability for the CDS that is already baked into their model install. It is just silly that each of 5,000 hospital CDS committees have to decide whether an aspirin after an MI is a good thing, or whether you ought to check a cholesterol every couple of years on a statin.
• There are many factors that contribute to uniformly improving patient outcomes. But one issue that is still a work in progress is developing and deploying a system to provide the right information to the right people in the right place at the right time. Integrating data on previous care that a patient receives from their primary care physician during regular clinic appointments, with emergency encounters, possible inpatient episodes, care provided at an ambulatory care organization, etc. pose a unique challenge to collect all of these disparate encounters and the data generated. While EHR systems bring together some of these important data elements, there are still gaps (for example — data on an emergency room visit while a patient is out-of-state on vacation). Additionally, even if data is integrated together, all of these indicators and data points need to be filtered and targeted to improve upon a specific outcome (e.g. reducing the likelihood of myocardial infarction readmission). Recommendations on improving outcome and supporting information need to be concisely delivered to the proper places when care is provided, to the physician when a patient presents at the emergency room with chest pain to the care coordinator prior to discharge.
• While there has been considerable time spent integrating healthcare IT into related systems of care, there needs to be a more systematic approach, time and resources spent integrating into the process of care – specifically clinician workflow so the tools are optimized.

Usability/Integration Issues

• I think Dr. Rick’s excellent articles have shed light on the usability issues of EHRs. He mentioned some data on how short-lived human working memory is. EHRs can take 5-10 seconds to respond to every mouse click.  These long delay times make it difficult to keep a coherent stream of thought going when documenting, especially when providers get interrupted (appropriately) by office staff who need something or the other. In the end, what gets produced are long canned narratives about generic patients. When the note is read a few days later by the provider or someone else, they see a generic note that tells them little about the patient. Our EHR would take 45 seconds to a minute to open a chart in the mornings. By the late afternoon, it was five minutes to open a chart. That’s typically caused by memory leaks. We (a medical clinic) had to call a technology firm that says its been in business for 20 years to tell them they had memory leaks! Now all charts take about 45 seconds to open.
• The main problem is usability, which involves both design and implementation. Many HIT systems are simply not designed well. They are often trying to "replicate the current way of doing things" with the idea that this will improve adoption. However, it turns out that computers are lousy at being paper, and so can never match up. However, computers are really good at being computers, and so the best HIT software takes advantage of the unique properties (e.g. complex data analysis, data visualization) and enables a better experience. Additionally, good design should start with observing the real needs of the end user (not just listening to what a user thinks they need), and most importantly should involve an iterative process which acknowledges that the programmer and physician should work closely for months to fine tune a system. However, the second problem may be even more worrisome. The same EMR system can be implemented in so many ways that the results can range dramatically. A recent editorial talked about how EMRs cost a lot, and slow down doctors, and introduce new errors, and are thus not ready for prime time. But the fact is that while this is a reasonable conclusion based on many experiences, it is a short-sighted view of the potential of what can happen when a good EMR is implemented well. I think the best use of an EMR is to allow for automation and delegation of various parts of the workflow to empower a team to do more care and to do it consistently – thus resulting in both higher quality outcomes as well as less work for physicians.
• Technology in and of itself is useless and even detrimental unless built and used correctly. In order to have a positive patient outcome, in my mind, a technology theoretically should be easy to use, be actually useful (for the user or the patient), and have minimal negative impact (on workflow or patient care). A breakdown of any single one can result in a subpar result. Patient outcomes may not have improved universally because current healthcare initiatives don’t necessarily encourage focus on all items. Also things like “usability” can be oftentimes extremely difficult to create.
• The hodgepodge of company acquisitions that has created a market where products have never been integrated. One of the reasons Allscripts is collapsing is because of an inability to integrate Eclipsys products. I find it hard to believe that companies that size, with the resources they have, can’t integrate two products. Clinicians have to sign onto several products multiple times a day to get information they need. It is guaranteed that in such a system there will be conflicting data in different databases increasing the risk of patient harm. Maybe this makes systems like Epic better, but that also stifles innovation. EHRs aren’t going to improve with markets dominated by companies like Epic as is being demonstrated everyday right now.
• Too many disparate systems that don’t talk to one another. Even with HL7 messages, there is still a lot of variance. All it takes is sending something in the wrong HL7 field to cause a problem.

It’s the User, Not Just the Technology

• A dependency on the skill and performance of the user related to the IT solution in question. The use of the word "uniformly" makes me consider that every user will create a different outcome. As an example, an electronic health record relies on inputs from various sources in order to aggregate the patient history and then present a user with information to make decisions. The term "decision support" is bandied about with great import these days but as the term implies the tool is there to simply support the clinician’s capability to make a decision. Almost all technology is just that, a support system to assist the clinician or user. The same can be said of a technology such as the Da Vinci Robotic Surgical System. In the hands of a great surgeon, the outcomes can be outstanding. In the hands of a first year surgical resident, the outcomes probably will not be the same.
• That is like asking why the carpenter’s apprentice who was recently trained on how to use a hammer, router, etc. (insert your specialized tool or technique of choice) hasn’t improved his/her ability to create beautifully crafted cabinets or furniture. It takes time to become competent, proficient, and then the master of skills with the usage of newly introduced and evolving tools. This describes skills improvement for the individual. To obtain uniformly improved skills and thereby products / outcomes, it takes even more time to build an organization or industry of skill masters. Our digital society that expects instant gratification and results has forgotten that it takes time and commitment to master skills and provide high quality products and services. This obviously is an oversimplification, but I think an appropriate analogy to the usage of a healthcare IT to improve outcomes.
• While this question is understandable given all of the federal government’s promises and expectations of what HIT will do to improve patient outcomes, the question reveals a lack of understanding of what IT in general can and cannot do. Healthcare IT (and in fact any IT investment) on its own can do nothing; it is only when used in conjunction with improved workflow and processes that patient outcomes can be improved. That is what we should be measuring. There is a reason why IT is called an “enabler”, and a “complementary” technology (like electricity). On its own, IT (like electricity!) has no value, and therefore won’t (can’t) improve anything. It has to be used in conjunction with changes in workflows and processes in order to improve outcomes.
• The effective deployment of technology has a number of requirements, of which the actual technology may be the smallest piece of the puzzle. At the end of the day, improved patient outcomes are a combination of provider decisions and judgment, patient compliance, adequate monitoring of efficacy of treatments and the use of technology to support all of those. The last item on that list is dependent upon the provider learning and adopting the technology to its full (not necessarily fullest) capabilities. Any one of these factors has the potential to derail the process, so if we don’t look at the process holistically, we shouldn’t expect uniform improvement.
• Lack of leadership on the provider side and lack of appreciation and understanding of HIT on the hospital executive side (one executive in charge of 11 hospitals did not know who Todd Park is).
• Ultimately it is not HIT by itself that will change outcomes, but what people do with it and how providers use it. Even HIT left unchecked can be harmful. I made more mistakes with electronic prescribing than I ever made on paper. I do not believe that we should stay on paper at all, but until we are all connected out there on the Medical Internet and the information flows freely, we will not reap the benefits of technology. One article in the Economist called "When the carpet calls the doctor" failed to explain how a device attached to the carpet that sends a signal to the doctor when the patient is about to fall is going to prevent that fall. Is the doctor or nurse supposed to get in the car or fly to the rescue? How about the apps that would monitor the patient’s weight or glucose — what will one do if the patient will not use it? Who is going to sit in a tower 24/7 to monitor all this and who pays for it? Not much is being said about that. As excited as I am about HIT, I do realize that our bigger-than-life expectations may not be materialized — not soon enough, anyway. Hope this helps, as it is written in between rounds at three hospitals, two of which are still on paper.
• Because IT alone won’t accomplish anything.  If you take a bad process and simply duplicate it with IT solutions, you still have a bad process.
• I would be mildly surprised if it had. In my view, outcomes will improve with decreased variability (with the most likely shapes of the outcome curve you can prove this mathematically) and clinical decision support. Theoretically, EHRs reduce variability with templates and order sets, but I have seen few real world examples of templates standardizing care, except in very limited areas, like DVT prophy. Clinicians still go off and do their own thing after the initial orders are in, and the templated H+P is done.

Variations in Implementation

• Probably the top reasons would include: variability in the technology itself, variability with the implementation, and variability of the adoption/use of the technology by the end users. All of those areas of variability exist at every hospital (even those within larger health systems who attempt to "standardize" their efforts). It should surprise no one, then, that "Healthcare IT" does not have uniform results. A poor implementation of even a very good technology solution will not have the same results as a good implementation. Similarly, poor adoption will not yield results from the effort to implement the technology (or may yield negative results directly due to the hybrid environment created by poor adoption where some are using and others not using the technology). Additionally, any negative outcome will be blamed on the new technology being implemented even if something else is actually to blame. However, I would posit that a good implementation with good adoption and engaged end-users with even a mediocre technology solution has the potential of generating positive results for patients.
• There is nothing uniform about the way we deploy healthcare IT solutions. We are often inwardly focused and insular as we define, design, and deploy the solutions that we must implement. We are often working very hard to leverage the technology we have acquired so that we can make the best use of scarce resources. We seldom take the time to measure our own local progress. We surely struggle to make time to share lessons learned with others. Our local efforts often limit the extent of our reach, while also limiting our ability to measure what impact we may have had.
• Just because your facility has implemented an EMR system, regardless of how mature the model is, it doesn’t mean the facility is using that technology to improve outcomes. Case in point: our facility is in the last stages of an EMR implementation. We are incorporating what our clinical team believes is industry best practices and evidenced based care i.e. Elsevier and Zynx, and we are going to reduce the variation in care that not only drives cost up but produces varying outcomes. We went on a site visit to a hospital who has already implemented this system but are using terrible practices. That is not the fist place we went where we saw this. It takes real leadership to stand up and say we are going to do it a specific way that uses evidenced based/best practice care. The IT systems can readily support an organization who is trying to do this with real time clinical behavior reporting. This will start to drive outcomes.
• Healthcare IT has not been uniformly distributed. The inequity among hospitals will be even deeper. Hospitals that are EMRAM level 6 or 7 and hospitals in rural areas that could benefit the most from health IT but cannot afford it.
• Lack of consistent adoption. Lack of understanding on how some technology can impact outcomes. Lack of discipline in organizations to use what they have. Poor BI use that would help isolate areas of improvement.

Lack of IT Support

• The CIO/IT Director doesn’t always get it. If we don’t understand the business of our organization, there is no way that we will provide the tools necessary to analyze / improve our business. A good example is that of business intelligence. My organization doesn’t think it is necessary or quite frankly, even understands what it is. I know that we have to have better analysis, and that in order to do that, I have to provide the appropriate tools. If I wait till the organization gets behind BI, it won’t happen for another 2-3 years and then it will be too late. I’ve searched out a solution that makes sense in our environment and began the implementation 12 months ago. The next step is to push it out to the organization and educate the management team on its value.

Meaningful Use has Distracted Clinicians and Vendors

• The emphasis on Meaningful Use metrics over the past years has led to a significant percentage of adopters to be focused almost exclusively on meeting those criteria that would allow for bonus attainment. These tools have the possibility to bring focus to a singular patient’s health issues and treating that patient as a unique individual with unique needs. This can be done efficiently and effectively when the clinician is able to utilize the tool as they see fit. Instead the clinicians become distracted by unnecessary hurdles mandated by someone sitting on Capitol Hill. The emphasis on evidence-based medicine and population health also distracts somewhat from the unique physician / patient experience by moving the focus up a layer or two from the primary interaction. Eric Topol has written a great deal about this.

The Healthcare Business Model Stands in the Way

• Our supply driven healthcare system and culture that needs to change. For-profit HIT, hospitals, and so on that has made us pursue the highly profitable but not always the most cost effective or valuable course of action.The only one whom I saw commenting on that was Peter Orszag, who said that it will be difficult to reconcile years of marketing in healthcare and direct-to-consumer advertising with customer satisfaction and reducing costs. We want to retire on 401(k) plans that invest heavily on healthcare companies and we want them to be profitable, but squirm when it comes to paying for it and attempting to cut cost. We cannot have it both ways.

Benefits Will Be Realized Only when Quality can be Measured

• Most providers / clinical entities are still trying to get past the data entry hurdles. Not yet at a point where most are focused on measuring quality. No defined quality standards that most agree on. Multiple groups with multiple standards, and these are not aligned with EMR companies.
• There is nothing stable about the environment into which we are implementing systems. The regulatory climate, the scientific environment, and the relentless pursuit of discovery creates a dynamic setting into which we are deploying systems. Collectively, this often prevents us  from thoughtfully, comprehensively, and accurately measuring the impact of our implementations. So to some degree, we don’t really know if we are making a difference. We don’t always measure the things that matter, and sometimes we aren’t certain of the aggregate benefit of our collective actions.
• Healthcare IT has not uniformly improved patient outcomes because we have few clinicians with sufficient vision and understanding of the potential that can, in turn, influence the change. The CIO/Clinical IT employees cannot produce the level of influence needed and it will take a lot longer to move from a world of data collection to a world of data analysis. In addition, we still take too much of an individualistic approach to patient treatment. Evidence-based medicine has not been accepted in any of the organizations with which I’ve been affiliated.
• There have not been enough in-roads in the establishment of systems where data has been uniformly stored and then shared. Taking those outcomes and running them through statistical engines is the holy grail to improve outcomes. It takes time to build the foundation to support this future endeavor.
• Patient outcomes have not been well defined and continue to elude us. A patient who does well after open heart surgery may do so because he has a supportive family as opposed to one who lives alone. HIT cannot alter that; it can only help measure it.
• Our litigation-crazy society has made it almost impossible to share and be transparent about mistakes and medical errors,HIT induced or not.
• I do not believe we learned any lessons yet. Someone should interview those hospitals that spent in the $100 million range IT budgets or the ones that made mistakes so we can all be enlightened.
• The most obvious answer is that healthcare IT has been used in different ways, and to different degrees, from one provider to another and from one department to another. Now that healthcare IT is becoming more broadly adopted, and as advanced analytics are developed to empower caregivers more, patient outcomes are expected to improve. Any discussion of outcomes should recognize its limitations. For example, some medical conditions lend themselves to objective measurements of improvement, while others don’t. Despite the extreme complexity of healthcare, there’s a natural desire to measure the end result, the output of the process, in objective and simple terms. Did the patient get better? If so, how much? Did the patient population get healthier? If so, how much? But not every patient with the same diagnosis(es) will get better in the same way. Can an objective measurement adequately convey the difference? Some patients won’t get better at all. For a terminal patient released to hospice, for example, shouldn’t we instead be asking whether the patient and loved ones feel they were treated with respect, dignity, and compassion? For them, that is an outcome. Acute care hospitals should follow the lead of the subacute sector, which focuses heavily on such measurements. For non-terminal cases – those that indeed may be expected to get better – were they and their loved ones kept informed throughout the stay, or did they feel frustrated by a disjointed, piecemeal system of specialists, which mostly kept them in the dark? Were they informed and guided through decisions? These considerations should be incorporated into any meaningful discussion of "outcomes."

News 8/15/12

Top News

SAIC completes its acquisition of maxIT Healthcare, making SAIC’s Health Solutions Business Unit the nation’s largest commercial consulting practice in EHR implementation and optimization.

Reader Comments

From Neal Patterson’s Evil Twin: “Re: new research group survey of hospital CIOs. It compares the cost of a major EHR upgrade to the original contract price: Epic (40-49%), Cerner (30-35%), Allscripts / Eclipsys (20-22%), and McKesson Paragon (10-13%). Epic had the lowest cost for minor upgrades at 1%. Amazingly, the CIOs surveyed seem to have been caught off guard – they didn’t develop an adequate total cost of ownership model.” Unverified, since the company producing the report requires registering to get a copy of it and I refuse to do that on principle. I agree that Epic, often bought recently at the height of organizational optimism and as a knee-jerk reaction to previous experience with unresponsive vendors, is going to be a big budget problem for a lot of hospitals that will never realize the ROI. I don’t know of any examples where IT on its own has ever changed the trajectory of an organization – it usually just accelerates it slightly. If your organization has always sucked at management, planning, and delivering quality care efficiently, it’s probably not lack of Epic that caused that situation nor implementation of Epic that will fix it for you. Like all non-profits, hospitals change only to threats to their existence.

From Don: “Re: E.J. Noble Hospital hiring a CFO to improve their financial software. They are CPSI even though the CFO’s relevant experience was with Meditech.” Trying to confirm which system a given hospital is using is almost impossible. I always Google and try to find a couple of items that seem to confirm and none that contradict (announcements, posted jobs, physician newsletters, etc.) but I always say it “appears” they’re using the system since you never know what’s changed. In the case of E.J. Noble, I turned up one Meditech user list that included them (perhaps that site incorrectly assumed that they are the same facility as Noble Hospital, a Meditech hospital in Massachusetts) and, most convincingly, E.J. Noble Hospital’s employment application specifically asks whether the applicant has Meditech experience, which is not a common question for non-Meditech sites. I assume the reader is correct, but I can’t prove that, either.

From Dell Encore: “Re: Encore Health Resources. In serious negotiations to be acquired by Dell.” I asked EHR CEO Dana Sellers, who says she hadn’t heard the rumor and says the company isn’t for sale. I believe her since she’s always been a straight shooter, but I should mention that when I ask CEOs about acquisition rumors, I get one of three possible outcomes: (a) they don’t respond, which leads me to assume the rumor is true and I’ll run it as an unverified; (b) they tell me the rumor isn’t true, although in at least two cases CEOs who I would consider to be friends of HIStalk flatly denied a reader’s rumor that turned out to be deadly accurate all along shortly thereafter, which I don’t really consider to be uncool since they can’t have me blasting it everywhere right in the middle of their negotiations; or (c) the CEO tells me off the record that the rumor is true, but implores me to hold off mentioning it until the announcement, which I usually do (sometimes they offer me an exclusive story or interview in return). Occasionally I get briefed even before anything is announced, allowing me in several cases to conduct an interview and have it ready to blast out the second the news hits the wire. The best ever was when a CEO arranged to call my house one evening to tell me that the company was going to be acquired for huge money by a publicly traded company, which was fun because, (a) he treated me like a real journalist, trusting me not to do something stupid like leak the news or trade the stock of the company that was involved, and (b) it was priceless when Mrs. HIStalk asked me who I was talking to and I casually mentioned that a CEO just wanted to chat with me about selling his company for a few hundred mil the next day. For at least 30 seconds, I felt like more of a big shot than just some hospital guy and spare bedroom blogger, but then I had to get back to work.

From Horshack’s Laugh: “Re: predictive analytics solutions. Lots of vendors and providers are talking about the need for them without offering a standard definition of what they are or aren’t. Have you looked into who might be the reportedly top 5-10 vendors? Thanks much … love your stuff.” My stuff loves you right back. I’ll defer to readers on the question since I know better than to opine in the presence of experts.

From Dr. Nancy: “Re: article in The Atlantic. It’s old, but worth reading if you haven’t seen it. You are the best.” The perspective of the 2007 article by Shannon Brownlee (Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer) is interesting and timely: do we have too many rather than too few doctors? It says that the usual arguments that aging Baby Boomers will increase demand just as aging doctors retire, causing a decline in patient outcomes, just might be wrong, quoting a physician researcher who said, “If we sent 30% of the doctors in this country to Africa, we might raise the level of health on both continents.” The article observes that docs congregate where business is good (bigger population, more insured patients) and generate their own demand by ordering more stuff for patients, but outcomes aren’t any better in those doctor-rich areas like Manhattan and Los Angeles. Doctor-patient ratios at academic medical centers are 2-3 times higher at UCLA and NYU than Mayo and Duke with no better results, it says, possibly because all those docs need to justify their existence, like by ordering unnecessary tests and not communicating with the hordes of competing specialists roaming the halls.

Acquisitions, Funding, Business, and Stock

Emdeon posts a loss of $35.4 million for Q2 compared to a net income of $9.2 million a year ago, attributing the red ink to the costs of its acquisition last year by Blackstone. Revenue was up 4.4% to $294.5 million.

HIM consulting firm TrustHCS acquires Legacy Coding LLC, a clinical coding and auditing form.

Health accelerator Healthbox starts its three-month Cambridge, MA program today, with 10 companies getting office space, mentoring, and $50K in seed capital in return for a 7% stake. I got distracted (and annoyed) by the write-up of Bon ‘App, which says its nutritional app has “simplistic language.” As Inigo Montoya says, “You keep using that word. I do not think it means what you think it means” (either that or its app is one to avoid).

Sales

Texas Health Resources selects Medicity’s HIE solutions to power information exchange among its facilities and physicians.

Winkler County Memorial Hospital (TX) will implement financial solutions from Prognosis HIS.

The George Washington University and the National Institute of Child Health and Human Development will use PeriGen’s PeriCALM Patterns alerting system for maternal in a research project involving the use of intrapartum fetal heart rate monitoring to predict neonatal outcomes.

People

Former Siemens Healthcare President and CEO Eric R. Reinhardt joins the board of Varian Medical Systems.

Seattle Children’s Hospital promotes Wes Wright from VP/CTO to SVP/CIO.

Beacon Partners promotes Kimberly Post from controller to CFO.

Announcements and Implementations

Harris Corporation will expand Florida’s HIE secure messaging service to 11,000 physician offices that use Care360 solutions from Quest Diagnostics.

Regional Medical Center at Memphis completes implementation of the Siemens perioperative management solution by SIS, which will interoperate with Soarian.

The Kansas HIN and ICA announce that Via Christi Health Systems and HCA Wesley have successfully transferred data into the KHIN production environment.

MEDSEEK will incorporate GetWellNetwork’s GetWell@Home into its patient portal.

University of Michigan Health system goes live this week on Epic’s MyChart patient portal. The article in the Ann Arbor paper also mentions that hospital executives attribute part of its fiscal year loss, announced in June, to the cost of implementing Epic.

Health Care DataWorks announces Value-based Purchasing, which tracks the 20 CMS VBP quality outcomes measures that affect hospital payments starting in October.

Government and Politics

Innovate Primary Senior Care (IL), Treasure Coast Healthcare (FL), and Virginia Commonwealth University Health System and the Medical College of Virginia Hospitals and Physicians (VA) join 16 independent practices in CMS’s Independence at Home Demonstration.

You might think the VA is paperless given the high marks its VistA system receives. Not so, as a VA OIG inspector knows after writing up its Winston-Salem, NC office for piling 37,000 claims folders on top of file cabinets, to the point that the sixth floor office’s floor was sagging and in danger of collapsing. The VA cleaned up the area and will spend $400K for a filing system to be located in the basement.

Innovation and Research

A group of 14 organizations in 10 European countries begins trials of the DebugIT antibiotic decision support system they developed, which applies statistical methods to their collective susceptibility information to recommend optimal antibiotic therapy to clinicians.

Other

The Kansas HIE board postpones voting on the proposal to dissolve the organization and instead forms a committee to analyze the proposal and return with a recommendation for the board’s September 12 meeting.

Greg Reed, CEO of the embattled eHealth Ontario, declines his $81,250 performance bonus for the second year in a row. The Ontario government is facing a $15 billion deficit and wants all public sector workers to take a two-year wage freeze.

The Surgeons of Lake County (IL) announces that an unauthorized user hacked into its computer system, encrypted the server, and demanded money in exchange for the password to regain access the EMR and corporate e-mail files. The practice refused to pay the ransom and instead turned off the server and contacted law enforcement. It’s unclear whether the practice had a backup, but the server remains unplugged. The practice believes the intent of the authorized access was to extort money rather than obtain patient information.

Ed Marx has an article called “CEOs, CIOs must look to IT for success” in Modern Healthcare (registration required).  

The Siemens folks at their user meeting sent this photo of John Glaser with Cal Ripken, Jr., who looks disturbingly like Uncle Fester in this shot.

Speaking of Baltimore, HL7 is holding its annual meeting there September 9-14. A reader invites you to attend a session on standards-based approaches for PACS-EHR integration, which will focus on DICOM and IHE workflow profiles. That session is September 13 from 11:00 a.m. to 3:30 p.m. at the Hyatt Regency Baltimore at the Inner Harbor. I would almost make the trip just as an excuse to revisit one of my all-time favorite restaurants, the brilliant Woodberry Kitchen.

Weird News Andy captions this article as “Say What?” but stop reading now if you’re one of those people that worries about bugs crawling on (or in) you while you sleep (or whether China has a HIPAA policy). Doctors at a hospital in China, examining a woman complaining about itching in her head, find and remove a spider that had burrowed into her ear five days earlier, easily discernible in the creepy photo above.

Speaking of HIPAA, the firefighter’s unions in Las Vegas, trying to convince insolvent cities to stop considering outsourcing non-emergency calls to private ambulance services, may have inadvertently violated HIPAA privacy laws by posting a list of private ambulance calls that took longer than their 12-minute contractual maximum. The list contained home addresses and reason for the call, which included such items as suicide attempts and drug overdoses. The image above blurs those reasons, but the one on Latefor911.com didn’t.

A New York Times article covers the huge profits being made by HCA and the mind-boggling money that private equity firms like KKR and Bain are making in orchestrating its complex financial transactions. How HCA does it: aggressive billing of private insurance, creative use of the coding system, turning non-emergent patients away from its EDs, and cutting clinical staff. On the other hand, the company at least pays taxes, unlike its non-taxpaying counterparts sometimes use those same tactics to boost their bottom lines. All of this was inevitable when the decision was made, going back to the early days of Medicare and Hill-Burton if not earlier, that hospitals should be run as businesses rather than as charities or religious outreaches. The new rules said you had to make money but weren’t specific about the limits of how you could do that beyond your organizational conscience.

Union representatives in Contra Costa County, CA say correctional system nurses filed 142 complaints about its new $45 million Epic system in July, claiming that they are Epic’s detention facility guinea pig. A nurse says super-users told management about the problems and warned that the two-hour training sessions weren’t adequate since the training system wasn’t fully set up. “What nurses want is for the Epic program to go away until it’s fixed,” she says.

A cardiac perfusionist sues Mount Sinai Hospital (NY) and her former boss for creating a hostile work environment, claiming everybody knew that he regularly watched porn on his smartphone while working cases in the OR.

Sponsor Updates

• Forbes includes Greenway Medical Technologies as one of its five favorite growth stocks.
• Like Kareo on Facebook by August 17 for a chance to win a Kindle.
• St. Joseph Health (CA,TX, NM) adds additional revenue cycle technology solutions from MedAssets.
• Simonmed Imaging will deploy Merge’s radiology and interoperability solutions across its 50+ sites.
• A Vitera Healthcare Solutions study finds that 91% of doctors want a mobile EHR solution, yet only 6% connect to an EHR through a mobile device.
• Allscripts says it will debut new mobility functions and integration between acute and ambulatory settings at this week’s ACE 2012 in Chicago. Wednesday’s opening address is available on the website.

Report from the Allscripts Client Experience – Day One
By Bill Rieger, CIO, Flagler Hospital

Today was a pre-conference workshop day. As CIO, I attended the executive session, which started off with Glen talking about transformation and change in a session titled, "It’s not about IT."  

He talked about the open approach Allscripts has, both from a philosophy and a technical perspective. He talked about Allscripts’ CLEAR values: Client experience (client always first); Leadership (inspire, innovate, grow);  Extraordinary people (learn, grow); Aspire (think different, think big); and Results (say, do).  

Kevin Larson from ONC spoke next and really didn’t enlighten us with any more information than we already had about MU and ONC initiatives. He brought up the concept of semantic interoperability (I saw a bunch of folks looking it up on their phones, me included!) and it became a buzzword that I heard multiple times throughout the day.

There was a panel discussion where LIJ, Brown and Toland, and Jefferson Medical college talked about accountable care and the iterations each organization has engaged in. Maureen Kahn, CEO of Blessing Hospital in Quincy, IL told a great community story and how the successful implementation of ADX 1.5 has impacted their organization.

Finally before lunch, Cliff Meltzer, VP of development at Allscripts, talked about what has been delivered since last year’s ACE conference: automated testing features, a client advisory group, and an early adopter program. He talked about the performance improvement with MSSQL2012 and how in 6.0 the whole environment can be virtualized. One of the things I liked that he talked about was end user performance monitoring.  I believe that the hourglass is the enemy of adoption, so I was glad to hear that they were focusing on that a bit.  

After lunch there were breakout / roundtable sessions that I found to be very valuable. I attended two of them. One discussed linking outcomes to income and heard several stories about using data to improve physician behavior leading to additional revenue. The other one was related to HIE, and dbMotion was there. There were some roundtable discussions that showed me that we are all not on the same page when it comes to simply defining what HIE is and what are the problems they are suppose to solve. Interesting, but frustrating.  

Finally, Thomas Atchison spoke. It was very entertaining, and I walked away with two thoughts. One is that in the absence of information, the void is always filled with negativity. The other is that words lie, behaviors never lie. Two things for me to chew on there. Looking forward to tomorrow when the regular conference begins.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Curbside Consult with Dr. Jayne 8/13/12

When I originally applied to be a HIStalk sidekick, Mr. H and I discussed what I could potentially bring to the table. One of his ideas was for me to review and comment on articles from the physician point of view. I’ve done that from time to time, but this is the first time I’ve decided to completely dissect an article with the intent of defending physicians from bad information.

There is so much going on in healthcare today that it’s nearly impossible to keep up. According to the conversations in the physician’s lounge, many physicians (especially those in primary care) rely on a variety of blogs, newsletters, and trade journals to try to keep up. Who wants to read 800+ pages of Meaningful Use legislation and thousands of pages of commentary? Who wants to read the Supreme Court transcripts related to the Affordable Care Act? (OK, y’all know I did read it all, and I know some of you did too, but that’s beside the point.)

One of my favorite quickie journals for trying to keep up is Medical Economics. The July 25 edition had a couple of articles which I found mildly aggravating, as they grossly oversimplified the analysis needed to determine if a physician should enter into the business of running a moderate complexity laboratory as a means of increasing revenue. However, the article on the potential influx of millions of patients to our already dysfunctional health care system left me grinding my teeth. Physicians who aren’t well versed in the gory details of the legislation, the regulatory environment, and how health systems run are likely to take this kind of writing as fact rather than as the quasi-opinion piece it is.

You’re welcome to read for yourself, but I’m putting on my “Mythbusters” hard hat and safety goggles to start debunking.

Myth #1: Having health insurance is going to make people run to the doctor and undergo lots of tests and procedures. I don’t disagree that there are quite a lot of people who would certainly take advantage of new coverage, many of them with existing health needs. However, I know a great number of people who have really good health insurance (many are my co-workers, neighbors, and friends) who simply don’t go to the doctor. Even with fully-covered preventive visits (no co-pay) they don’t see a need to go. Some patients are afraid of physicians and others are instead afraid of the federal government tapping their personal and health information. Others prefer to spend their time and resources on unproven alternative treatments and distrust the medical establishment. I imagine the percentage of people falling into these categories may be quite similar among currently insured and yet-to-be-insured individuals.

Myth #2: We can’t grow the physician workforce. The article states: “The AAMC notes US medical schools have complied with requests to boost class sizes by 30% time [sic] over the past 6 years, but the overall supply of US physicians cannot expand unless Congress increases the number of federally funded residency training positions, a number that has been frozen since 1997. The AAMC is working hard to revisit this freeze… staying where we are will leave US medical school graduates without a training position.” Not exactly true (and questionable editing, but I digress). According to 2012 National Resident Matching Program data, nearly 5% of family medicine positions were unfilled. A large number of federally-funded residency positions were filled by foreign medical graduates – in family medicine, only 48% of the positions were filled with graduating seniors from US medical schools.

Saying there are no positions for US grads simply isn’t accurate. The problem is that the positions are in specialties where US grads don’t want to work, such as family medicine. Low pay, grueling hours, and constant insurance and regulatory hassles do nothing to draw prospective physicians. Imagine the marketing campaign: Do you want to drive a ten-year-old Honda Accord? Love those Dockers you wore during your medicine sub-internship? Want to be 50 years old and take extra shifts in the ER to send the kids you never see to college? Primary care is for you!

There are a number of other ways to increase the number of physicians in the work force. I’d like to know how many of those new medical school slots are being used by MD/JD, MD/PhD, MD/MBA, and other combined program students with no intention of ever practicing. My medical school alone has historically graduated up to 10% of students who never intend to pursue clinical care. Additionally, why in the world do we require qualified physicians who have been educated in other countries to pursue a residency in the US? I’ve worked with a number of highly competent physicians who were practicing physicians in other countries who have been forced to either repeat training or change specialties to practice in the US. Years ago, my family knew a highly skilled physician who had defected from the Soviet Navy and was working as a home health aide because he couldn’t obtain a training slot. If we really have a shortage, this doesn’t make sense.

Myth #3: It’s easy to add capacity to the system. I was truly angry after reading the article’s “8 ways to see more patients” sidebar. The author interviewed Michael D. Brown of Health Care Economics in Fishers, Indiana. “Brown believes that physicians can easily move from seeing six patients per hour to 10 by socializing less. Many physicians spend the first 80% of a visit chatting.” First of all, having spent more than a decade in the primary care trenches, even seeing six patients an hour and trying to deliver comprehensive, compassionate, quality care is a challenge. Add to that the need to deal with complex regulations, insurance snafus, and time-sucking EHRs and it’s enough to overwhelm even the hardiest of souls. Ten patients an hour in primary care? Patients have revolted at the notion of the six-minute HMO visit and unless they’re bionic or extraterrestrial, I really do not see the majority of the PCP workforce being able to achieve this.

I haven’t spent 80% of a visit chatting since I was in medical school. I frequently have to redirect patients to stay on topic to just get through the updates on their diabetes, heart disease, and obesity. They want to tell me about their children and grandchildren and their vacations, but that’s just not a reality any more. The old-time family doctor I hoped to be is an extinct species. I have to ask patients to pick their top three issues to talk about just to stay on time. Patients always come in with more concerns than they told the scheduler, and that’s my only way to survive. It’s certainly not what I signed up for, but it’s the nature of the beast, and I run a reasonably high patient volume with a highly interoperable EHR and a strong staff. However, if I run late, my patient satisfaction scores drop. Since that’s what partially drives my compensation (and keeps the parade of regional practice administrators off my back), it’s what I do to stay afloat.

Brown goes on to say, “You can’t spend 8 of the 10 minutes you have allotted for a patient on unrelated matters and stay on schedule.” That’s funny, because in the previous paragraph he only allowed us six minutes per patient. Brown also goes on to say physicians who can’t handle 10 patients per hour should add two more appointment slots to each day. “At $75 each, times 10 per week, doing so can increase earnings an additional $37,500 per year with no added overhead.” I’m not sure what kind of practice management consultant forgets that seeing patients involves staff (especially if you’re going to leverage medical assistants and mid-level providers as he also recommends) which certainly involves overhead. If you’re already optimized, you can’t just cram more slots on the schedule without adding staff capacity or more time to the day unless you cut corners.

I’d keep going with the Mythbusting, but it’s late and I’m on teaching rounds this month. I have to be at the hospital at the crack of dawn, and due to work hour restrictions, most of my residents and students will have had more sleep than I will. It’s always challenging to be on service, but there’s no better way to shape the future physician workforce.

Have a medical or health care IT myth you’d like busted? E-mail me.

E-mail Dr. Jayne.

EHR Design Talk with Dr. Rick 8/13/12

Fitts’ Law and the Small Distant Target

“. . . the importance of having a fast, highly interactive interface cannot be emphasized enough. If a navigation technique is slow, then the cognitive costs can be much greater than just the amount of time lost, because an entire train of thought can become disrupted by the loss of contents of both visual and non-visual working memories." — Colin Ware, Information Visualization: Perception for Design

Paul Fitts was the pioneering human factors engineer whose work in the 1940s and 50s is largely responsible for the aircraft cockpit designs used today. His life’s work was focused on designing tools that support human movement, perception, and cognition.

In 1954, he published a mathematical formula based on his experimental data that does an extremely good job of predicting how long it takes to move a pointer (such as a finger or pencil tip) to a target, depending on the target’s size and its distance from the starting point.

Fitts’ Law has turned out to be remarkably robust, applicable to most tasks that rely on eye-hand coordination to make rapid aimed movements. Although digital computers as we know them did not exist when Fitts published his formula, since then his law has been used to evaluate and compare a wide range of computer input devices as well as competing graphical user interface (GUI) designs. In fact, research based on Fitts’ Law by Stuart Card and colleagues at the Palo Alto Research Center (PARC) in the 1970s was a major factor in Xerox’s decision to develop the mouse as its preferred input device.

As you would expect, Fitts found that it takes longer to move a pointer to a smaller target or a more distant one. The interesting thing is that the relationship is not linear.

If a target is small, a small increase in its size results in a large reduction in the amount of time needed to reach it with the pointer. Similarly, if a target is already close to the pointer, a small further decrease in its distance results in a large reduction in the amount of time required to reach it.

Conversely, if a target is already reasonably large or distant, a small increase in its size or small decrease in its distance has much less effect.

What is Fitts’ Law telling us? Why isn’t the relationship linear? Are the two tasks fundamentally the same or are they different, requiring different visual, motor, and cognitive strategies?

Perhaps the best way to get a feel for this aspect of Fitts’ Law is to try it yourself. If you have two minutes to spare, click on the link below for an online demo. You will see two vertical bars, one blue and one green. The green one is the target. Your goal is to use your cursor to move to and click on the green bar, accurately and rapidly, each time it changes position.

As you go through the demo, imagine that the bars represent navigation tabs or buttons in an EHR program. In other words, imagine that your real goal is to view EHR data displayed on several screens—clicking on the green target is just the means to navigate to those screens.

You will see some text displaying a decreasing count: hits remaining — XX. Keep track of this hit count while moving to and clicking on the green target. This task will have to stand in for the more challenging one of remembering what was on your last EHR screen (see my post on limited working memory).

When you finish, you can ignore the next screen, which displays your mean time, some graphs, and a button to advance to a second version of the demo.

Here’s the link to the online demonstration of Fitts’ Law.

What did you find?

You probably found that if the green target was sufficiently wide and close to the cursor, you could hit it in a single "ballistic" movement. In other words, with a ballistic movement, once your visual system processes your starting position and the target location, other parts of your brain calculate the trajectory and send a single burst of motor signals to your hand and wrist. The movement itself is carried out in a single step without the need for iterative recalibration or subsequent motor signals.

Your brain used the same strategy as the one used for ballistic missiles. The missile is simply aimed and launched, with no in-flight corrective signals from the control center.

Conversely, you probably found that if the green target was narrow and far from the cursor, you couldn’t use a ballistic strategy. After initiating the movement, most likely you had to switch your gaze to the cursor, calibrate its new screen location in relation to the target, calculate a modified trajectory, send an updated set of motor signals to your hand, and so forth in iterative loops, until reaching the target.

These two strategies are fundamentally different. Not only does the ballistic movement take less time, it requires much less cognitive effort. In fact, if the target is large and close enough to your cursor, you can make a ballistic hand movement using your peripheral visual field while keeping your gaze and attention on the screen content.

These differences between ballistic movements and those requiring iterative feedback may explain the non-linear nature of Fitts’ Law.

As I discussed in a previous post, the rapid "saccadic" eye movements we use to redirect our gaze are the benchmark against which all other navigation techniques should be measured. Not surprisingly, these saccadic eye movements, lasting about a tenth of a second, are ballistic. Once the brain has made the decision to redirect gaze, it calculates a trajectory and sends a burst of neural signals causing our eye muscles to turn the eyes to the new target and simultaneously preparing our visual processing system to expect input from that new location.

It makes sense that saccadic eye movements are ballistic. We want to turn our eyes to the new fixation point as quickly and effortlessly as possible. In fact, we take in no visual information whatsoever during the saccade itself. We only acquire visual information between saccades, when our gaze is fixed on an item of interest.

From an evolutionary standpoint, it would appear that saccadic eye movement, being more rapid and efficient than iterative strategies, was selected as our primary means of navigating visual space. If we want our digital input devices and interactive designs to approach the efficiency of saccadic eye movement, we should create user interfaces that facilitate ballistic strategies.

Returning to the vendor’s design presented in my last post, the "maximize" buttons, shown below outlined with red circles, are both tiny and distant:

There is no way we can move the cursor from one maximize button to another (except for the adjacent ones) using a ballistic strategy, whereas the design below, using a separate navigation map, supports such a strategy:

Of course, all design choices require trade-offs. The second design requires a major compromise. By requiring a separate navigation map, it adds another level of complexity to the user interface.

It’s not usually the case that one high-level design is good and another isn’t. Most high-level designs have their advantages. But if you are going to stick with the vendor’s design, at least use the entire area of the title bars as the targets. If you are going to use a separate navigation map, make the panes large and close enough for a ballistic strategy to work.

To be clear, the problem is not the extra second or so that it takes to acquire a small, distant target. It’s that poor designs cause the user to break concentration and use working memory for non-medical tasks. An unnecessarily difficult navigation operation can disrupt the train of thought needed to apply good medical judgment to an individual patient.

Quite simply, when designing EHR interfaces, many choices are not a question of preference or aesthetics. We are hard wired so that certain tasks are simply easier than others. Our EHR design choices need to be informed by an understanding of these human factors.

Next post:

A Single-Screen Design

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. E-mail Dr. Rick.

Monday Morning Update 8/13/12

From The PACS Designer: “Re: big data mining. One of the challenges facing healthcare is how to collect, manage, and view data that can improve outcomes. Some interest is brewing in the open source community to help with the challenge. An open source solution drawing this interest is Hortonworks with Apache Hadoop 1.0. While it’s still relatively new, the chances of HortonWorks being production ready in the next year or two are high, and it could show up in healthcare settings in several years.” The post also quoted EMC’s CTO, who listed some healthcare big data opportunities: (a) always-on end user query capability for all data sources; (b) data collection from real-time medical instrumentation; (c) in-memory capabilities for fast decision-making in the ED; and (d) real-time health scoring as is done in ICUs. Above is a nicely done overview of the Hortonworks Data Platform that should get tech geeks salivating.

From A Curious Reader: “Re: Meditech’s KLAS numbers. The 16 customer losses in 2011 are from the C/S platform, while the 14 are from Magic. The C/S losses are a mix of v.5.x and v.6. KLAS issued an trend alert in July reporting that 35% of over 50 hospital respondents said they wouldn’t buy v.6 again because of product immaturity and usability issues. Of the non-IT respondents, more than half said they wouldn’t buy it again. According to a CIO quoted, ‘Some of the applications have been developed in the new v.6 language and some applications are in the old NPR language. Because of that, the new v.6 platform requires a million connections, and from a management and monitoring standpoint, the transfer of data is very complicated.’” Just to address the counterpoints: (a) Meditech has a ton of hospital customers, so their percentage loss is probably tiny; (b) Magic is ancient and upgrading is almost like a re-install, so it’s not surprising that those clients would explore and sometimes choose alternatives; (c) Meditech hospitals tend to be small and thus more likely to be acquired and subjected to a forced system replacement, assuming those are counted by KLAS as “losses” (which would likewise give Epic an inflated count of wins.) The customer comments about v.6 are indeed troubling, however.

Listening: First Aid Kit, a pair of amazing sisters from Sweden who covered a Fleet Foxes tune with their camcorder running in a Swedish forest when they were 17 and 14, making them a modest YouTube sensation. That was five years ago and they’re still putting out mature, bittersweet harmonies that could be pegged somewhere between indie pop and American country-folk. They use talent, not studio tricks – check out this rather stunning video that was shot as they sing and play memorably while walking down a public street in Paris right before their show, with cars and people milling around them. They’re doing several US dates in September and October.

Two-thirds of us would be disappointed if we went straight from a routine doctor’s appointment to the hospital, which would have no record of our just-concluded ambulatory visit. New poll to your right: how has Meditech’s market position changed in the past year?

As I was creating the poll, I struggle as I always do with whether I should write Meditech (my usual) or MEDITECH (like everybody else does). It struck me that I should check the “AP Stylebook” (the Bible of news writing) that’s two feet from my chair, which says all-capital company names aren’t used unless the letters are individually pronounced. It’s OK for IBM or GE, but not Nasdaq or Meditech. That leaves me puzzled about HIMSS (Himss?) since it’s always sounded out. I also learned that characters are not used in a company name (so it’s MModal, not M*Modal), periods go outside parentheses unless what’s inside is a full sentence (so it’s outside this set), and the first word of a sentence is always capitalized no matter what (so it’s Athenahealth, not athenahealth, if it’s the first word of the sentence).

Speaking of MModal, the company agrees to release the projections its financial advisors used to determine that JP Morgan’s $1.1. billion buyout offer was fair. The disclosure is one of the terms in a settlement agreement the company reached with shareholders who felt the offer price was too low, representing just an 8.3% premium over current market share price and 18% less than a competing bid from Nuance that MModal’s directors rejected. Meanwhile, the company reports Q2 results: revenue up 7%, adjusted EPS $0.21 vs. $0.31, missing expectations on both but maybe backing up the board’s arguments that the buyout price is fair.

Bond ratings company Fitch warns bond investors that HITECH payments can hide the “otherwise anemic revenue growth” of hospitals given that it’s a one-shot payment that doesn’t even cover the IT costs required to earn it in many cases. They also say that the need to implement IT is helping drive hospital consolidation.

Presidential candidate Mitt Romney names Rep. Paul Ryan (R-WI) as his running mate. Ryan’s healthcare IT connections: (a) he wants to overhaul Medicare and Medicaid, saying the country can’t afford the cost; (b)  he was #1 on the “100 Most Influential People in Healthcare” for 2011; (c) he co-sponsored a bill in 2008 that would have established independent health record trusts that would allow consumers to manage their own health records, force EMR vendors to link to those trusts, and split the proceeds from de-identified data sales between the patient and the trust to fund the operation; and (d) he and four other Wisconsin politicians tried to influence the VA and DoD to buy systems from home-state vendor Epic instead of writing their own. My favorite trivia items about him: he was voted prom king and “Biggest Brown-Noser” as a high school senior and he worked a college summer job at Oscar Mayer and was allowed to drive the Wienermobile once (both irrelevant factoids courtesy of warring Wikipedia edits by fans and foes).

Allscripts chooses Symedical Server from Clinical Architecture to address clinical terminology requirements for its entire product line.

E.J. Noble Hospital (NY) hires a new CFO mostly for his IT experience, saying an unnamed system it installed in 2010 works OK for patient care, but isn’t user-friendly for the finance people. That system would be Meditech, according to noted healthcare IT expert Mr. Google. UPDATE: they aren’t Meditech, even though their job application asks about Meditech experience. Folks are suggesting they are using CPSI.

St. Luke’s Hospital (NC) goes live on McKesson Paragon after what it said was a 3,000-man-hour, $2.5 million project.

General Dynamics is awarded a five-year, $20.6 million contract to connect the Indian Health Service’s EMR system (an offshoot of the VA’s VistA called RPMS) to the Nationwide Health Information Network.

Former Awarepoint CEO Jason Howe is named president and CEO of Vaporstream, which offers a secure digital messaging channel for executive communication that prevents legal discovery.

Personal health records systems haven’t done much of anything, but that doesn’t keep everybody and his brother from cranking out low-rent versions sold cheap on the Internet or burned onto flash drives. Here’s a new $35 one from from “a local Mom” that runs on your PC and requires printing out your manually entered information in advance. The local mom even made a TV commercial. I couldn’t find a screen shot or example of the printed report anywhere. At least the local mom identifies herself as “Owner/Founder” on the site, unlike most spare bedroom part-time moguls who grandly label themselves as CEO like that’s going to fool someone into thinking they’re running multinational conglomerate.

This story about over-capacity Yale-New Haven Hospital buying the money-losing Hospital of Saint Raphael, also in New Haven, CT, illustrates how political the hospital business is. The YNHH people had to brief city aldermen whose constituents have been pestering them about their fear of losing their jobs or benefits. YNHH said only one group would definitely lose their jobs: the estimated 60 people on HSR’s payroll that Yale had previously fired, raising the ire of one alderwoman who said, “Just because Yale fired them they can’t work? You’re not willing to give them a second chance?” YNHH was also questioned about whether it would dismantle the Teamsters union at HSR; it said it wouldn’t. Maybe it’s no mystery why HSR needs a bailout given that it hires previously fired employees, has to deal with the Teamsters, and pays so much that employees are afraid of a gravy train derailment after being taken over by a university, a group collectively known (as are hospitals) for overpaying masses of marginally competent people who will never be fired or demoted for anything short of a felony committed on company time. Hospitals are like NASA: the science is sometimes questionable, the lack of value is inarguable, but nobody can touch them because they create a lot of jobs and political allies.

Bizarre: a new mom who agreed to appear in an instructional video for breastfeeding is horrified when Googling her own name to find a slew of porn links and explicit YouTube videos. The video company said it’s not their fault that somebody spliced the breastfeeding scenes into a porn video featuring graphic footage of someone who resembles the woman performing acts much less innocent than breastfeeding, but they don’t deny that the video displays the woman’s full name on the screen. She’s suing, of course.

Weird News Andy finds the story of this former law student inspiring (“Tough as Nails,” he labels it). Experts can’t figure out her skin disease, in which fingernails are growing out of hair follicles all over her body. She was referred to Johns Hopkins, where she’s racked up $500,000 in medical bills that her insurance won’t pay because it’s an out-of-state provider. She takes 25 medicines, of which insurance pays for five.

Vince responded to a reader’s request to have all of his HIS-tory episodes available in one place. All 50+ of them have been loaded to his company’s site, where I intended to take a quick look but got wrapped up in reviewing them all over again. This week’s edition is an introduction to the series, why he’s doing it, some folks he fondly remembers, and a plea for material for future episodes from those who lived the HIS-tory he writes about.

Sponsor Updates

• Certify Data Systems, which offers the HealthDock intelligent interoperability appliance, is named as a "Major Player” in HIE technology.
• A White Plume blog post observes that physicians seem to prefer to code E/M visits manually even though most EHRs can do it automatically.
• A HealthCare Anytime fact sheet describes its patient portal, which offers online bill pay, appointment requests, refills, messaging, and a PHR.
• Henry Elliott & Company’s hot position openings include Cache’ developers, MUMPS programmers, and several other technical jobs.
• Eastern Health goes live with the disease screening solution of NexJ Systems, which offers next-generation customer relationship management systems for healthcare.
• Besler Consulting provides an overview of CMS’s Hospital Readmission Reduction Program.
• Southern Oregon Orthopedics (OR) chooses SRS after de-installing its legacy EHR product that it says had tedious drop-downs, wasn’t meeting transcription needs, and wasn’t getting them to Meaningful use.
• Shareable Ink customer Sheridan Healthcare (FL) describes its use of the company’s “digital pen and paper” system.
• Current opportunities at Executive Search Recruiting include consulting VP, IS director, consulting partner, and certified consultants for Meditech and Epic.
• API Healthcare offers a free August 14 Webinar called “Will You Ever Love Your Patient Classification System? Embracing PCS with Evidence and Persistence.”
• Health Data Specialists, which offers consulting services for Cerner, Epic, Meditech, and Siemens, will exhibit at Siemens Innovations this week in Baltimore.
• TrustHCS, which offers coding, compliance, and ICD-10 solutions, will speak about ICD-10 readiness at the AHIMA convention October 1-3 in Chicago.
• OTTR Chronic Care Solutions will host its user conference September 17-19 in Omaha. The $485 registration fee includes 2 1/2 days of discussions, Q&A sessions, networking, lunch, and a half day of small group workshop training.

E-mail Mr. H.

Time Capsule: I’ll Have What He’s Having – Why Hospital Software Selection Is More Lemming than Deming

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 October 2007.

I’ll Have What He’s Having – Why Hospital Software Selection Is More Lemming than Deming
By Mr. HIStalk

It’s a wonder that any hospital IT systems are on the market today. Somebody had to actually start using those systems without the benefit of endless hand-wringing with peer hospitals. How do you like it? Would you buy it again? How’s it ranked? How is the response time, support time, and implementation time? Can we come see it at your place?

Hospitals gripe about lack of vendor innovation, but salespeople can’t wedge a foot in the CIO’s door unless at least 20 hospitals have been live on the system for five years. Half of those customers need to be within 20 percent of the prospect’s bed capacity and one of them should be in the prospect’s state or an adjacent one (geographic disparity must be ruled out). It’s like the collective migration of lemmings – everybody just blindly follows someone else who seems to have a clue.

Hospitals can be like indecisive restaurant patrons who point at someone else’s plate and tell the waiter, “I’ll have what he’s having”. If you develop a cure for cancer, you still may not be able to find a brave first hospital customer. I’m told that this rampant me-tooism is stronger in healthcare than in any other industry and I don’t doubt it a bit. That’s why healthcare IT is both wonderful and aggravating.

Here are some thoughts on why we play follow the leader:

• Hospital executives always (and sometimes rightfully) feel less competent than their private business counterparts. Therefore, they’re not about to lose one of few local jobs they’re qualified for just because some vendor has a risky product that could provide big benefits. If you can’t get promoted, at least don’t get fired.
• CIOs are too busy or indifferent to figure out for themselves whether a product is appropriate for their setting. The easiest course of action is to let someone else do the legwork, i.e. buy only those things that someone else bought or that a hopelessly broadly composed committee voted for. There’s mediocrity in numbers.
• Hospitals are not good at writing contracts that align incentives and hold vendors accountable, so they spend the effort instead buying the lowest risk products, which are usually those with the least potential to pay off big.
• Nobody wants to build software, even though many (most?) applications on the market started out as a custom development project for one or more hospitals. It’s easier to buy stuff that probably won’t work than it is to get exactly what you want, especially if you don’t really know what you want anyway.
• The urge to buy something often outweighs urge to do something. Grinding out years of hard process redesign is much less satisfying than throwing a software Hail Mary, one of few chances the IT department has to be decisive.

So, to clarify: hospitals want and expect massive improvement driven by sophisticated software, as long as it doesn’t require messy organizational change, risk, unproven technologies, or executive engagement. If you follow quality guru W. Edwards Deming, you’ll identify one way or another with his statement: “The timid and the fainthearted, and the people that expect quick results, are doomed to disappointment.”

While a conservative position is understandable given how busy everyone is, it does assure that averages aren’t skewed upward by risk-takers who improbably succeed wildly after a gamble on brilliant but unproven information systems.

Einstein defined insanity as “the belief that one can get different results by doing the same thing.” Add “… as every other unsuccessful hospital” to the end of his statement and you will have described hospitals seeking the software silver bullet – more lemming than Deming.

News 8/10/12

Top News

Allscripts reports Q2 results: revenue up 4%, EPS $0.04 vs. $0.08 (adjusted: $0.16 vs. $0.22), falling short of analyst estimates on earnings. The company raised earnings expectations for 2012 and says it will borrow money to buy back its own stock, sending shares up 18% on Thursday. Puzzling given the current lackluster results right there in black and white, but perhaps this was a relief rally since no new bombs went off like last quarter and pessimism was already built into the share price. Some highlights from the conference call:

• Two new Sunrise clients signed on in the quarter, one of them in the UK.
• The company says it continues to “make progress enhancing the performance and integration of our portfolio."
• Sunrise Financial Manager is entering early adopter phase and is scheduled for general availability in Q4.
• The company admits that upgrades have been spotty as some clients "experienced challenges."
• Allscripts expects 4,000 attendees to attend the Allscripts Client Experience in Chicago next week.
• The company says it expects to win more hospital business in the next year since unnamed competitors have "started to step away."
• Glenn Tullman admits that some prospects were holding back in case more corporate surprises surfaced or the company turned in a disastrous quarter, but says "the selling environment is going to come back."
• MyWay sales were announced as flat, with more of its users moving to Professional.
• Allscripts Professional will have an iPad version released at ACE.
• Glen Tullman describes Sunrise as "affordable, easy to install, and open."
• Glen Tullman: "The open message is starting to resonate … paying these astronomical amounts to installed a closed system doesn’t make sense for the future … they simply can’t afford it anyway … healthcare is going to get squeezed … we’re in talking to a lot of customers, including some customers who are saying, hey, we have this big system that’s from a well-known brand and we can’t afford it anymore, so how can you help us take down our cost.."
• More Glen Tullman: "And relative to population — health and population management, Humedica is our partner there. As full disclosure, we have an ownership stake in Humedica, that they’re known as industry leader in the space and we’re strengthening both our marketing and sales efforts, but we are also strengthening the integration between the products."
• On the relationship with clinical research organization Quintiles: "But as we talked about creating a partnership to improve research, that benefits the clients, it benefits the patients and it benefits pharma "

Reader Comments

The mere selling or providing of software to a covered entity does not give rise to a business associate relationship if the vendor does not have access to the protected health information of the covered entity. If the vendor does need access to the protected health information of the covered entity in order to provide its service, the vendor would be a business associate of the covered entity. For example, a software company that hosts the software containing patient information on its own server or accesses patient information when troubleshooting the software function, is a business associate of a covered entity. In these examples, a covered entity would be required to enter into a business associate agreement before allowing the software company access to protected health information.

From Digital Bean Counter: “Re: personnel updates. Michael Streetman has joined WellStar as VP of IT. His LinkedIn profile does not yet show the update. I am fairly certain Michael is Jeff Buda’s replacement (Jeff left for Floyd Medical Center, as you reported).” Unverified.

From Love is a Drug: “Re: HIMSS. Continues to demonstrate a complete lack of leveraging basic online business and IT practices. First it was the horrible, long post-conference survey, and now this week it tested a listserv in production, filling by inbox with a dozen garbage messages. They’re not moderating the comments on their mHIMSS site, allowing search engine manipulators to post spam. The industry is lost if this is our leader.” I see they’ve added CAPTCHA spam protection to their commenting function and have removed the garbage comments that were posted earlier.

From Chester the Investor: “Re: technologies. Speech recognition came out of nowhere after many years of dormancy to suddenly be the hottest thing in the sector, as just about all the players were acquired over a short period. Is there a similar technology that will follow that trajectory?” Real-time location systems.

From Pilsner Paul: “Re: surveys. How can vendors influence surveys conducted by reputable survey firms? You say they do, but I don’t see how.” The best way of all is the method drug companies have been using for years to get positive research articles published: commission a bunch of them, then toss all the ones whose findings don’t match your marketing plan. Nobody knows that the one good research paper represents 50 that failed to prove anything positive and therefore never saw the light of day (note to self: why doesn’t FDA require all research to be registered with them in advance as with hospital IRBs so we see all the results, not just the favorable ones that get published?)

From Hurry & Wait LLC: “Re: Meaningful Use. I’m hearing that OMB now has the final rules from ONC/CMS. However, it may take until the fall of 2012 (think turkey and stuffing) for the final rules to be published. With that comes the requirement that the MU2 attestation period will be 90 days in Year 1.”

HIStalk Announcements and Requests

If work, vacation, or Olympics TV viewing got in the way of reading HIStalk Practice this week, here are some highlights: a UC Medical School physician says EMRs are expensive, take time to implement, and decrease office efficiency. CareCloud adds a VP of product management. AAFP supports new measures to reduce prescription drug abuse. Better economic conditions and new insurance plans that support preventative care services helped drive clinician visit volume up 5% in Q2. The ever irreverent Joel Diamond considers the meaning of “ACO.” Kyle Swarts of Culbert Healthcare Solutions tackles business intelligence and the need to create a body of knowledge. My fragile self-esteem gets a boost each time a new subscriber takes the required two seconds to sign up for e-mail updates, so thanks for taking the time to boost my mental health. Thanks for reading.

Thanks to the folks at Vitera Healthcare, sponsoring both HIStalk and HIStalk Practice at the Platinum level. I figured we’d made them mad since they previously sponsored awhile back, but apparently their was some mixup that they’ve fixed by rejoining the fold of happy sponsors. They’re talking about the newly released Vitera Intergy v8.00 if you’d like to click on over to reassure them that they made the right decision. Thanks to Vitera.

This is the point where I cheerfully warn anyone who doesn’t already know (noobs) that I’m always behind, so set your expectations appropriately for me to respond to e-mails. Picture your own full-time job, then another 4-5 hours of heads-down focus when you get home, plus all weekend — that’s pretty much my life right there. My “sent” folder has 25,000 e-mails, so that gives you an idea of how long it takes to work my way through my inbox, which usually has hundred of e-mails crying for attention. I try to catch up over the weekend, so wait until Monday at least before resending, which just makes the situation worse. After nine years of writing HIStalk, I’m cured of the shame of not always being able to keep all the plates spinning in the air at once, so now I just say that’s the way it is.

I know how to keep women happy and dewy-eyed satisfied, at least if the ladies in question are Inga and Dr. Jayne, who will reward your skilled electronic touch (male or female) with a rapt, smoldering gaze of longing and maybe even a more intimate connection if you play your cards right. Here’s the move: (a) sign up for spam-proof e-mail updates; (b) arrange to have your paths cross by surreptitiously seeking them out on the usual social not-working sites (Facebook, LinkedIn, Twitter) and connecting with them; (c) influence them through their friends by reviewing those shimmering sponsor ads to your left and possibly perusing the surprisingly robust Resource Center that has cool, searchable sponsor information and maybe even some videos and stuff; (d) stand out in their crowd of smitten admirers by sending news, rumors, guest articles, and anything else that demonstrates your wit, wisdom, and charisma since everybody likes someone who can make them laugh or feel special; and (e) feel free to tell everyone you know about your shared experience — the ladies have enough reader love to go around. We appreciate your attention in whatever form it takes and we reciprocate whenever we can.

Acquisitions, Funding, Business, and Stock

Shares of Accretive Health fell more than 14% Wednesday after the company reported earnings that missed expectations and lowered its revenue forecast. Shares are down 41% since April 24, the day the Minnesota attorney general accused the company of using overly aggressive hospital collection tactics. The company tried to put some positive spin on the glum report by announcing that it has signed a five-year contract extension worth up to $1.7 billion with its largest customer, which to the slight detriment of the big news, happens to be partial owner Ascension Health.

Meditech files its 10-Q for the most recent quarter. Revenue was up 9%, net income increased by about the same percentage.

People

University Hospitals (OH) names John Foley (West Penn Allegheny Health System) as CIO.

NaviNet appoints Frank Ingari as CEO, succeeding Bradley J. Waugh. He was previously CEO of Essence Healthcare, a sister company of Lumeris Corporation, which acquired NaviNet earlier this year.

Cloud computing vendor ClearDATA Networks hires Ralph Reyes (an early partner in KLAS) and Jonathan Russell (HMS) as sales VPs.

CareCloud names Edwin Miller (Cardinal Health) as VP of product management.

Old news, but I missed the announcement if there was one: Jacque Dailey, formerly CIO of UPMC’s Children’s Hospital of Pittsburgh, is now CIO at Highmark.

Announcements and Implementations

Regional Medical Center at Memphis (TN) completes its six-month implementation of perioperative and anesthesiology systems from Surgical Information Systems.

The local paper in Cranston, RI profiles the use of GetWellNetwork by an 11-year-old boy whose rare skin disease requires frequent hospitalizations and surgeries. His condition precludes the use of his hands, so he has learned to use Facebook, control on-screen entertainment functions, and peruse medical education content by using his feet on the touch screen (he says he got a ton of Facebook Likes when he explained how he was posting.) If you watched the video I posted a couple of weeks back from the GetWellNetwork user conference in Orlando, you saw him (Antonio Torres) speaking to the group.

Grand Itasca Clinic & Hospital (MN) goes live next week on Epic (or EPIC, as they apparently can’t resist shout it out proudly), provided by Allina.

The Phoenix business paper covers the work of Dignity Health and the Arizona State Physicians Association to create an accountable care organization with Vanguard Health Systems, which will allow independent physicians access to an HIE powered by Siemens MobileMD.

Government and Politics

CMS releases details on the Medicare EHR Incentive Program 2012 Reporting Pilot for eligible hospitals and CAHs.

Other

The Geisinger-led Keystone Beacon Community (PA) will use Caradigm’s data-sharing technology to allow skilled nursing facilities to contribute their patient data to the HIE, even if the facilities do not have an EHR. The Caradigm “MDS to CCD Transformer” converts the minimum data sets (MDS) used by nursing homes into Continuity of Care Documents.

Columbus Regional Hospital (IN) blames its new EHR for temporarily doubling its average ED wait time to nearly five hours. Two months after the go-live, the average wait is still more than three hours, worse than before. The system vendor isn’t mentioned, but they were a Meditech site at one time.

A federal judge approves a whistleblower lawsuit against Florida Hospital Orlando and several other Adventist Health System hospitals in Central Florida. A former billing employee says the hospitals overbilled the federal government tens of millions of dollars in false or padded medical claims. The attorney for the plaintiffs says damages could exceed $100 million, barely containing his excitement over his mentally tabulated percentage.

CapSite’s 2012 US Medical Device Integration study finds that nearly two-thirds of 400+ bed hospitals recently bought such technology, with many of them implementing it right now. Cerner and Capsule were the most common vendors, with Capsule easily leading the pack in the 400+ bed range. iSirona is getting an equal number of looks from those considering vendors. The primary reasons for implementing medical device integration was to improve outcomes and efficiency. Of those big hospitals that haven’t bought yet, an amazing 82% say they’re planning to, most of them within two years.

A new KLAS report on hospital clinical system finds that when it comes to new wins, it’s pretty much all Epic with a bit of Cerner thrown in and everybody else eating their dust. There’s not even a clear-cut third-place winner for reasons spelled out in frank detail (remember, these are customers talking, not self-proclaimed experts.) Epic sold 54 hospitals of 200+ beds in 2011 and lost none. Biggest losers were GE Healthcare, McKesson Horizon, and Meditech (who lost more current product users than legacy product users.) Thanks to the folks at KLAS for allowing us to excerpt their report. Definitely worth a read if only to hear the customer-provided counterpoint to what some glass-half-full vendor CEOs are saying.

A federal monitoring team hits Parkland Hospital (TX) with scathing criticism about poor management and a quality culture that allowed patient-harming errors (and deaths) to occur. One bright spot: the report said Parkland was doing a pretty good job in enhancing its clinical systems (in other words, Epic is the best thing happening there, according to the report.)

A Reuters article frets that Obamacare will make it easier to identify and deport illegal aliens who seek medical care since they’ll be the only people left without an insurance card.

The teenager accused of impersonating a PA at Osceola Regional Medical Center (FL) and performing CPR on one patient, blames hospital personnel for giving him the wrong ID card. He says it was the hospital’s “stupid” mistake and that whoever made the error should be fired “because apparently they are too ignorant to have that position.”

Strange: in England, an NHS hospital ED doctor who took a six-month paid sick leave for stress and then worked at other hospitals goes on trial for defrauding her primary employer of almost $50,000. She was turned in by her former boss (also her married former lover) after boasting of her “megabucks” and “stupid amount of dosh” on Twitter, catching the attention of the former boss’s wife. The doctor said she worked the extra shifts to keep her clinical skills current.

Sponsor Updates

• Medicomp Systems announces its MEDCIN U conference October 14-16 in Reston, VA.
• dbMotion and Allscripts host a free webinar September 18 on preparing for accountable care within the workflow.
• Imprivata announces details of its HealthCon 2012 user conference November 6-8 in Boston.
• Alere Health and AT&T partner to deliver DiabetesManager,  a mobile health solution powered by WellDoc for type 2 diabetes management.
• Jay Savaiano of CommVault authors an article on big data in healthcare.

EPtalk by Dr. Jayne

It’s not just for pharmaceutical companies any more. ONC uses direct-to-consumer marketing to explain “how widespread adoption of electronic health records and other health information technology is giving our health care system a 21st century upgrade.” The animated video from ONC’s new Office of Consumer eHealth aims to “spark conversation” between patients and providers about leveraging technology. The opening slide shows various caregivers, including ‘my doctor’ and ‘my gynecologist.’ (last time I checked, gynecologists were doctors, too.) Some of the other graphics are downright goofy: a stereotyped female nurse in old-school whites and a cap and a hipster pharmacist who needs a shave.

All the health IT in the world can’t fix the fundamental problems: many people eat too much, don’t exercise enough, and indulge in habits with negative consequences. A Centers for Disease Control report published Tuesday corroborates this. The study was designed to assess the prevalence of walking, which was defined as “at least one bout of 10 minutes or more in the preceding 7 days” which is really quite minimal. Not surprisingly, one out of three US adults reports no aerobic exercise during leisure time and less than half report levels of activity meeting current guidelines.

In trying to convince patients of the importance of exercise as “medicine,” I started recommending the Presidential Active Lifestyle Award challenge program. Anyone age six or older can sign up for the six-week program and jump start their exercise plans. As an added bonus, those of us who weren’t proficient at the flexed arm hang or the shuttle run in middle school have another chance to earn a cool patch with the Presidential seal. The downside: the website is a little glitchy and they don’t have a mobile app. Perhaps the folks at ONC could help out.

I came across this publication in the AHIMA library: Ensuring Data Integrity in Health Information Exchange. It offers a good, high-level overview for anyone starting involvement with HIE. They address governance up front, which is unfortunately something quite a few HIEs fail to do effectively. This should be required reading for all tech people working on HIE projects so that they understand the big picture.

Thanks to Twitter to alerting me to this piece by Atul Gawande talking about how restaurant chains control quality, cost, and innovation. He wonders if health care can learn from the Cheesecake Factory. I found the discussion of “guest forecasting” and restaurant analytics fascinating and agree with Gawande’s premise. We need to be using aggressive analytics throughout healthcare and enable highly functional teams throughout the patient care space. He also talks about his mother’s knee replacement experience, which is timely for those of us with parents in the Medicare set.

Have an idea how long you have to spend on the treadmill to neutralize a piece of cheesecake? E-mail me.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Readers Write 8/8/12

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

Note: the views and opinions expressed are those of the authors personally and are not necessarily representative of their current or former employers.

RTLS: A No Brainer to Enhance Top-Line Revenue and Drive Clinical and Financial Improvements
By Deborah Tuke Bahlman RN

Real-time location systems (RTLS) are underutilized in the health care domain. I consider myself and my organization fortunate to have access to this technology and can’t imagine what life would be like without it.

Just a little over a decade ago, our periop staff, surgeons, and anesthesia teams spent considerable time using the phone to determine the patient’s physical location and stage of care. Communicating this information by phone is inefficient and a waste of precious patient care time, resulting in numerous phone calls, potential delays to surgery, and an environment not conducive to healing and quiet.

At our two large flagship facilities in Oregon, we have more than 75 operating rooms. We have been able to accommodate growth by eliminating inefficiencies — like multiple phone calls — and can now find equipment quickly at the click of a mouse.

To accomplish this, we installed a real-time tracking system. We spent 18 months analyzing workflow and working with the vendor to design the application. We piloted the system in 2002, starting with asset tracking and then expanding it to track patients. This gave us the ability to locate people and equipment in real time and improve workflow, communication, patient throughput, and care delivery efficiency. The ability to instantly locate needed equipment also had a positive impact on the bottom line by reducing unnecessary purchases and rentals.

The benefits have been impressive. There are three key ways a hospital can optimize clinical performance, workflow, revenue, operations, and patient safety with RTLS:

1. Tracking. Being able to quickly identify and track any tagged equipment, staff, or patients anywhere within a facility equates to on-time procedures and efficient use of nurses’ valuable time. It helps staff easily locate assets, maintain an accurate inventory, and adhere to regulatory requirements. RNs typically spend about one hour per shift looking for missing equipment, additional staff, or the actual patient. This unnecessary time contributes to delays in 30% of all scheduled surgeries.
2. Rentals. The average US hospital owns or rents at least twice as many mobile medical devices (pumps, vents, wheelchairs, etc.) than it actually needs. RTLS provides visibility into inventory which enables facilities to better match supply with occupancy and acuity needs, which can eliminate excess inventory and result in significant cost savings.
3. Preventive maintenance. RTLS improves the timeliness of preventive maintenance by providing data that helps hospitals identify process inefficiencies in equipment management including cleaning and sterilization. Up to 25% of mobile assets are not properly cleaned between patients, resulting in hospital-acquired infections that can adversely affect a hospital’s bottom line now that insurers have stopped coverage for those conditions.

It is astounding that only 10% of hospitals have implemented RTLS, which can quickly boost top-line revenue. With health systems wrestling with declining reimbursement rates and increased regulatory mandates and quality improvement initiatives, the pressure to improve operational efficiency and care has never been greater.

For Providence St. Vincent Medical Center and Providence Portland Medical Center, RTLS has been a true asset. We plan to further maximize our RTLS investment by integrating it with our new EMR. The integration will streamline access to lab results, medication lists, and other critical data, positioning us to meet the challenges of the rapidly changing health system.

Deborah Tuke Bahlman RN is system manager of surgery information systems at Providence Health & Services of Renton, WA.

Carrying the Torch
By Guy Scalzi

As part of the Olympic coverage, I’ve learned more about the significance of the Olympic Flame and the journey it takes through the host country before the last torchbearer lights the cauldron at the opening ceremony in the Olympic Stadium, marking the official start of the Games.

As you know, the Olympic Flame stands for peace, unity, and friendship. As part of the London 2012 Games, 8,000 inspirational torchbearers carried the Olympic Flame through more than 1,000 cities, towns, and villages in the UK over a 70-day journey delivering that message: peace, unity, and friendship.

The stories of the torchbearers are inspiring, and the images of the 70-day relay journey are truly breathtaking. I encourage you to read their stories watch some of the relay footage.

You and I both know that it took many more than the 8,000 torchbearers to make this accomplishment possible. Day in and day out, all of us in the HIT field support our torchbearers – the nurses, physicians, and other clinicians at the bedside delivering care. And yes, our flame represents patients and their care quality and outcomes. We all play a part in carrying the torch, and it’s essential to keep our eye on the flame — the patient. The more the human element is kept at the forefront by all of us, the better healthcare will get.

I was invited to the Yale Medical School graduation in 2010 and heard Don Berwick MD speak to the class. He emphasized that the person-to-person, clinician-patient relationship and interactions are possibly the most important part of care giving. Two points he shared struck me:

• “All that matters is the person. The individual. The patient. The poet. The lover. The adventurer. The frightened soul. The wandering mind. The learned mind. The Husband. The Wife. The Son. The Daughter …”
• “Those that suffer need you to be something more than a doctor; they need you to be a healer. And to become a healer, you must do something even more difficult than putting your white coat on. You must take your white coat off. You must recover, embrace and treasure the memory of your shared, frail humanity …”

We in the IT realm don’t interact with patients for the most part, but we do interact a lot with the clinicians who treat the patients. If we listen to them, respect them and their work, and relate on a human level, I think this will translate to a better use of technology and perhaps have a ripple effect.  

As I shared earlier, the more the human element is kept at the forefront by all of us, the better healthcare will get.

Guy Scalzi is a principal with Aspen Advisors.

Four Tips for Addressing Healthcare IT Implementation Costs
By Walter Reid

A recent KPMG poll confirms that hospitals continue to struggle with managing implementation costs of healthcare IT systems, including electronic health records (EHRs). However, hospitals would do well to take a broader look at their entire IT agenda and make a long-term commitment to maximizing value from those investments.  Below are a few ways to better address the healthcare IT implementation challenge. 

1. Get more from the core. It’s been estimated that most providers only use about 50% to 80% of their IT system’s core clinical and revenue cycle features, and many routinely under-invest in learning about new releases. By re-evaluating your core system capabilities, you can analyze whether or not you are fully leveraging existing resources. Such steps will go a long way toward making the most of the technology you already have.
2. Promote from within. If you work with your HR team to develop your own internal “champions of change,” you can drive adoption of clinical informatics and reduce the expense of costly external consultants. That’s not all, as internal champions also can help you further generate – and sustain — system uptake to achieve long-term value. In addition, ensure your systems are readily accessible with easy-to-use applications, based on a familiar industry standard such as Microsoft Windows, as that can further encourage ongoing use of IT.
3. Keep it simple. Select an HIS with fully integrated applications and a single-database design. This will help your organization streamline current solutions, retire dormant third-party applications, and consolidate IT providers. Doing so provides opportunities to reduce acquisition costs, system complexity, and maintenance by requiring less hardware and fewer servers. In addition, systems with a faster deployment period and a lower total cost of ownership help ensure that hospitals achieve cost savings over both the short and long term.
4. Collaborate. Hospitals should expect greater flexibility and collaboration from those entrusted to develop, deliver, and deploy their critical HIS technology. Move beyond just demanding discounts and suggest collaborative win-win solutions that work for both you and your vendor. This includes offering flexible delivery options, new implementation alternatives, and more efficient and effective methods of system training, including using Skype or other web-based methods.

Ultimately, reducing healthcare IT implementation costs starts with IT vendors themselves. Those that demonstrate a willingness to truly partner with you and provide simple, flexible, cost-effective options are best positioned to help you achieve better business and better care.

Walter Reid is vice president of product strategy and marketing with McKesson.

Consumer Reports Points to Opportunity to Improve Patient Communications
By Tim Kelly

I used it before I purchased my last car, digital camera, and just a month ago when I purchased virus protection software. The “it,” of course, is Consumer Reports (CR) magazine. If you are nodding in understanding, you and I are like eight million other Americans who reference that publication to evaluate automobile tires and scrutinize models of the latest electronic gadgets.

It is thus intriguing that CR has, for the first time, introduced hospital ratings in its August issue. Until now, there were few well-known resources to compare one hospital to another. Arguably, both The Leapfrog Group’s Hospital Safety Score program and Health & Human Services’ Hospital Compare website are readily available to prospective patients. However, neither is “mainstream” and familiar to the readers of CNET, Yelp and TripAdvisor.

Consumer Reports readers will immediately recognize the standardized format with which hospitals are ranked. Safety scores are presented as horizontal bars with a numerical value, while the other key rating categories contain familiar red and black blobs. Both metrics are characteristic of CR ratings for hundreds of products and services.

Unlike the cleaning performance of a laundry detergent, the quality of care offered by a hospital is extremely difficult to summarize with only a number and a few shaded circles. Critics will argue that the historical data employed for the CR rankings is by default out of date when presented, imprecise, and limited in scope, failing to provide a complete picture of the organization. Ironically, those same concerns apply to the just-released U.S. News & World Report rankings of Best Hospitals. Yet for 23 years, hospitals have proudly cited their top U.S. News rankings on their organizations’ websites and in their press releases.

Clearly, the difference between the U.S. News approach and the Consumer Reports approach is that as an independent, non-profit organization, the publishers of CR do not hesitate to be critical – even to the extent of identifying the “Bottom 10 Hospitals” in their rankings. CR is also quite comfortable copiously assigning black blobs – its “worst” rating. Nowhere are the black blobs more abundant within the hospital ratings than in the “Communication” category. The CR article reports that not a single hospital earned its top score for communications.

This glaring weakness will have many in the HIT community scratching their heads. Conceivably, patient communications can be improved with proportionally less effort than might be required for other categories, such as rates of hospital-acquired infections or readmissions. A three-year study of 394,000 Kaiser Permanente members, published in the July issue of The American Journal of Managed Care, found that use of Kaiser’s online personal health record tools made patients 2.6 times more likely to remain members of Kaiser. The Kaiser experience demonstrates how technology can easily be deployed to assist patients with better understanding their procedures, how to prepare for surgery, what to do when discharged, and how to take new medications.

Consumer Reports has introduced a new ratings system, one that provides easy-to-understand comparison data on 1,159 hospitals. The ratings are from a recognized, trusted source, and they are presented in a familiar, digestible format. The impact, if any, of CR ratings on consumers’ choice of hospitals is unknown. The opportunity to redouble efforts to deploy HIT initiatives to improve patient communications should be clear to all of us.

Tim Kelly is vice president of Dialog Medical.

News 8/8/12

Top News

The board of the Kansas HIE, having found few takers for its fee-based services, meets this week to decide whether to dissolve itself and turn its operation over to the state, hoping to reduce its $400,000 in annual operating costs. Taxpayers would be on the hook to cover the remaining half of its costs. Former Kansas Governor Kathleen Sebelius, now HHS secretary, convened the commission that recommended creating KHIE by executive order in 2010, which makes it questionable as to whether the group has the legal authority to simply disband itself. KHIE funded its operations with a $9 million federal grant and has $5.5 million left.

Reader Comments

From InTheKnow: “Re: Alere. Just closed a deal to acquire DiagnosisOne.” Verified, but not announced as far as I can tell. Alere (the former Inverness Medical Innovations, which acquired interoperability vendor Wellogic last year ) offers diagnostic and health management  technologies and programs, while DiagnosisOne sells tools for order sets, decision support, analytics, and public health surveillance. DiagnosisOne is backed by Edison Ventures, which is how I verified the rumor after digging around forever – the acquisition was buried on one of the pop-up pages on their site.

From Justa CIO: “Re: Indiana University Health. Announced that Bill McConnell, Jr. started this week as CIO, replacing Chris Van Pelt, who has left the organization.” Verified. Bill has updated his LinkedIn profile showing that he started this month. He was previously CEO of FlowCo, which makes a stent-related medical device.

From Jeremy: “Re: 3D printed medicine. How would people feel about their EHRs printing the medicine ad hoc?” A research paper speculates that a 3D printer could be loaded with pre-filled, drug-containing vessels, allowing medications to be “printed” on demand.

From Rick Starkey: “Re: JAMA article. Very entertaining.” Indeed it is. John Lennon’s Elbow, by Robert H. Hirschtick MD from Northwestern University’s Feinberg School of Medicine, is funny as it criticizes EMR documentation with Beatles references (I won’t give away its conclusion, which yielded the title.) A snip:

I once asked an intern why his successively longer daily progress notes retained old or irrelevant test results. His response was revealing: “This way, my final progress note is also the discharge summary.” This Twelve Days of Christmas approach—building a final supernote by successive daily addition—yields a discharge summary that is long, thorough, and unreadable. Unreadability is a problem only if readability is a goal. But these notes are not constructed to be read. They are constructed to warehouse data. All the key information is contained within but as hard to find as a radial pulse beneath multiple color-coded wristbands.

From Consultant: “Re: Providence Health Systems. They are slowing down their Epic implementation, one of the largest in the US to learn from initial go-lives.” Unverified. The $750 million implementation was announced in 2010 and the first go-live was originally planned for 2012, with a 30-month completion timetable.

HIStalk Announcements and Requests

My top Olympics’ observation of the day: water polo players rock. Twenty-eight minutes of treading water and swimming and throwing a ball? The athleticism of it has almost inspired me to jump off the couch and go for a run. And speaking of runners, how about Felix Sanchez, the 35-year-old from the Dominican Republic who won the men’s 400m hurdles? Way to beat the youngsters. And speaking of youngsters, I am adding Uruguayan footballer Edinson Roberto Cavani Gómez to my Hot Olympian list.

Acquisitions, Funding, Business, and Stock

HCA reports Q2 results: revenue up 12% to $8.1 billion, EPS $0.85 vs. $0.43. The company reaffirms 2012 guidance, including estimated EHR incentive income of $325-$350 million and EHR expenses of $90-$115 million. The company also announced that it was notified this week that the Justice Department wants to see records from its heart procedures at certain hospitals. A New York Times report suggested that they performed unnecessary procedures to boost revenue in preparation for HCA’s 2011 IPO.

Mediware  will acquire the assets of Strategic Healthcare Group, an Indianapolis-based provider of blood management consulting.

Nuance announces Q3 numbers: revenue up 31%, EPS $0.25 vs. $0.13.

Staffing company Cross Country Healthcare swings to a Q2 loss due to a delay in an unnamed large EMR project for which it provides staffing.

It’s not healthcare related, but it’s a cautionary tale about letting computers do too much thinking (or maybe to do more testing before a rollout.) Stock trading firm Knight Capital, which single-handedly caused wild swings in stock market share prices last week when its newly installed high-speed trading software sent incorrect orders to brokerage houses over a 45-minute period, nearly goes out of business when the SEC holds it accountable for the $440 million in erroneous trades its software caused, four times the company’s profits last year.

Sales

Orlando Health (FL) selects onFocus epm software for enterprise performance management.

Muenster Memorial Hospital (TX), United Hospital District (MN), and Rothman Specialty Hospital (PA) sign with Park Place International for its OpSus|Live cloud-based hosting solution utilizing Meditech-certified servers and storage.

Poudre Valley Hospital (CO) selects ProVation Medical Software for gastroenterology procedure documentation and coding in its GI labs.

Windsor Health Plan will deploy MedHOK’s care, quality, and compliance platform that includes NCQA certified software for HEDIS, pay for performance, and disease management performance measures..

Anderson Hospital (IL) selects M*Modal Fluency Direct for use with Meditech in the hospital and NextGen in its physician offices.

Allied Services (PA) signs a contract to implement Cerner Millennium. It offers rehab, vocational, home care, and residential services.

Announcements and Implementations

South Lyon Medical Center (CA) goes live on CPSI’s EHR.

Powell Valley Healthcare (WY) goes live on NextGen’s Inpatient EHR.

Orion Health is named a reseller and services provider for Caradigm’s Amalga platform and Vergence SSO software in the Asia Pacific region.

McKesson announces McKesson Cardiology Inventory and McKesson Surgical Manager Point-of-Use Integration Module which allows a clinician’s single barcode scan to document, charge, and reorder items.

Chicago Mayor Rahm Emanuel proclaims October 30 – November 7 to be Informatics Week (plus a couple of days, apparently), a “city-wide celebration” of biomedical and health informatics that will precede the AMIA meeting there.

The VA begins its RTLS implementation at seven VA VISN 11 medical centers in Indiana, Illinois, and Michigan. HP is managing the project, which involves several brands of sensors providing real-time information to its Intelligent InSites RTLS software to track equipment and supplies, monitor temperatures, and trigger workflows. The $543 million project will eventually cover 152 medical centers.

Hospitals in Franciscan Alliance Northern Indiana Region go live on Epic, right on time from their project plan.

Zynx Health announces Version 3.0 of its AuthorSpace clinical decision support authoring tool.

Katalus announces an EHR Total Cost of Ownership model that will be offered as a cloud-based solution.

Government and Politics

The Substance Abuse and Mental Health Services Administration awards $4 million in grants to six organizations for HIT tools to expand access to substance abuse treatment in underserved areas.

Innovation and Research

Researchers from NorthShore University HealthSystem (IL) find that the increased use of EHRs by hospitals and health systems could help physicians make more exact, real-time decisions when prescribing antibiotics.

Technology

Health engagement management provider Eliza Corporation receives a notice of allowance from the patent office for its Complex Acoustic Resonance Speech Analysis System, which provides conversational, high-performance speech recognition.

Other

Hospital officials at Olympic Medical Center (WA) tell commissioners that their ongoing transition from Meditech to Epic will cost about $6 million, with ERP software from Infor/Lawson running an additional $1 million.  

A blog post from John Glaser of Siemens Healthcare compares his selection to throw out the first pitch at a baseball game to the impending accountability of healthcare IT to improve care (in neither case would you want to pull a Baba Booey in front of a crowd.)

HHS records show that the medical records of 21 million patients have been exposed by breaches since September 2009, with six organizations reporting incidents that affected more than a million people. Leading the pack is the federal government itself, whose Department of Defense / TRICARE (specifically, federal contractor SAIC) lost backup tapes during shipping in September 2011 that contained information on 4.9 million individuals.

ONC’s Office of Consumer eHealth puts out a video pitching EHRs to consumers.  

If you’re an Epic competitor, there’s not much good news in the KLAS Mid-Term Performance Review from June that a reader just sent my way. Unless you sell anesthesia information systems, anyway.

A pharmacy technician at University of Miami who “seemed to live beyond his means” in paying $56,000 in cash for a BMW is suspected of stealing $14 million in drugs from the cancer center pharmacy over a three-year period. The university’s CFO admits that the pharmacy had no inventory controls at all in place. The technician was caught pocketing drugs on surveillance cameras, but his lawyer says that while he did steal some drugs, it could have been anyone who nabbed the $14 million worth since anybody could just grab what they wanted. He was caught when the pharmacy buyer noticed discrepancies in the quantities on hand of the drug Neulasta, which she then inventoried manually since the new inventory software “was not the most trustworthy.”

Seattle Children’s Hospital, trying to cheer up a 16-year-old cancer patient who has been hospitalized in isolation for months and missing her cat Merry, crowdsources through Facebook to collect 3,000 cat photos to project in a “virtual feline cocoon” they built for her. Her response: “You guys remind me that there is so much good in the world, and its just makes me feel so much better, and connected. I can’t tell you how it feels sometimes, feeling disconnected and cut off from the world, and then with something like cat pictures bringing me back.”

Sponsor Updates

• GetWellNetwork launches a video on the future of patient engagement using interactive patient care solutions.
• Billian’s HealthDATA recognizes five hospitals to watch on Twitter.
• e-MDs hosts a webinar featuring Jen Brull MD, FAAP and her practice’s use of social media to build community and engagement with patients.
• GE Healthcare releases details of its Centricity Perinatal National Users Group conference in October.
• OTTR Chronic Care Solutions will participate in next week’s NATCO Conference in DC.
• Forrester Research names Covisint a cloud identity and access management leader in its Enterprise Cloud Identity and Access Management report.
• A Surgical Information Systems survey indicates that drivers for implementing perioperative IT include facilitating improvements in OR efficiency, the quality of patient care, and reduction of documentation errors. 
• Howard County Medical Center (NE) selects BridgeHead Software’s healthcare data management solution as its backup and archival system.
• Cumberland Consulting Group promotes Mark Riley to principal.
• T-System hosts a free webinar on proper documentation of E&M services to optimize reimbursement.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Curbside Consult with Dr. Jayne 8/6/12

One of the things my organization has always struggled with is the concept of professional development. Of course we require the physicians, nurses, and other licensed professionals to attain the required hours of continuing education in their respective fields. For all the other disciplines where it is not mandatory, we tend to do a relatively poor job.

Case in point: physicians and nurses who transition from clinical practice to administrative positions are no longer granted continuing education time or funding. Although we’re required to keep licensure, it’s up to us to do it on our own.

Those of us in the IT realm have come up with creative ways to earn our hours, such as attending sessions at our vendors’ user group meetings that have been granted continuing medical or nursing accreditation. Others teach medical students and residents or simply complete online continuing ed classes. While that meets the letter of the law, I’m not sure it does much for us as far as professional development.

Being a CMIO, CMO, or medical informaticist requires skills we weren’t born with. It is important to keep up with the constantly changing environment in which we work. It’s critical that people operating in those roles be allowed time and funding to attend formal programs to enhance their knowledge of healthcare IT, software, change management, conflict resolution, process improvement, and the many other disciplines that make the difference between successful projects and failures.

Considering this, it was a rare treat when I had the opportunity recently to attend formal training with our vendor. My last “official” training on our primary system was at least five years ago, and I must say that at that time I had no idea what I was getting myself into. It isn’t as if I’ve had no training since then, but the training that I’ve been able to attend has been very focused – around specialties that are being deployed, planned upgrades, and of course Meaningful Use. There hasn’t been much of an opportunity to really look at the EHR product as a whole and how it’s implemented in our hospital.

As I sat in the training center surrounded by soon-to-be new users, I enjoyed seeing their eager faces and lack of cynicism. It was fun to be the grizzled veteran in the bunch. We went through the applications from the ground up and what I learned was surprising.

Although we are among some of the most robust users on the company’s client list, there is still so much that we’re not using. I quickly learned of a handful of features that could make our providers’ lives easier and also some that would ease the burdens of configuration maintenance. It was also good to network with medical leaders of organizations who are late adopters. They have a very different view of things than those of us who are used to being on the cutting edge, and our after-class conversations were full of great ideas.

It really caused me to think about how we missed finding these items over the past several years. I’ve decided it was because the team was thinking like the IT equivalent of physician subspecialists rather than as primary care specialists. To put it in clinical terms: while we were focused on the musculoskeletal function of the wrist, we missed hearing about the latest and greatest strategies for health promotion and disease prevention. When faced with new features, we may not have understood how we could benefit from them, so we passed them by and never came back to them (usually because our team is running 90 miles an hour with dozens of competing priorities, so I completely understand how it happens.)

I’m encouraging our leadership to plan to fund opportunities for various team members to attend formal training sessions at least every few years so that we don’t find ourselves missing out on features or workflows that could have been beneficial. At the same time, I’m hoping that the experience will give concrete proof to the hospital’s administrators as to why it is important to facilitate learning opportunities for its medical leaders.

Have a great idea about professional development? E-mail me.

E-mail Dr. Jayne.