Monday Morning Update 10/15/12

From mmm: “Re: Allscripts vs. HHC. The whole $1.4 billion is set out in the board agenda. A very small portion of that is Epic software, training, and implementation itself, which came in LESS than Allscripts. Some of it is the maintenance of the software (Epic + InterSystems) over 15 (yes, 15) years. Another huge chunk must be allocated for conversion/interfacing with legacy systems and adding staff.” The September HHC board minutes explain the decision to drop QuadraMed CPR (executive turnover, minimal sales, low R&D, and insufficient functionality) with Epic. The 15-year cost analysis has Epic at $303 million vs. Allscripts at $299 million, with the complete Epic project expected to cost $1.4 billion over 15 years, including significant labor costs that include internal staff and keeping existing systems running during the transition. According to the HHC total cost of ownership analysis, it would have cost $1.278 billion just to keep 135 existing systems and implement 15 required new ones (Epic replaces 90 of those), so if HHC’s numbers are accurate, the switching cost is minimal. From the same document, the five original vendors being considered were Allscripts, Cerner, Epic, McKesson, and Siemens, with McKesson and Siemens voted out early. The minutes suggest that Epic was chosen because of a single inpatient-outpatient record, its track record as a financially strong and stable privately held company, and the percentage of its clients represented on the HIMSS EMRAM Stage 7 list.

From Limber Lob: “Re: extensibility of Epic. IT organizations need to develop software to gain competitive advantage. Academic health centers who are the first to figure out how to do this efficiently and safely with Epic will eat everyone else’s lunch.” Limber Lob is an informaticist – physician at one of those big medical centers and points out that Vonlay is offering services that include development on Cache’, Epic’s Web Services, and probably (but not stated) using Epic’s programming points to extend the applications. It’s early in the game since many of Epic’s customers are relatively new and working within the basic implementation, but it will be interesting to see whether Epic follows some of its competitors in declaring that it’s a platform upon which vendors are welcome to build value-added applications.

From The PACS Designer: “Re: network cleanup. Just as there’s spring cleanup each year at home, there needs to be a regular check and cleanup of network infrastructure wherever it may reside. With the FCC approving a new frequency spectrum for wireless patient monitoring systems, the time is right to make this the effort to improve network speeds and traffic management. The file sizes are also getting larger with each new system release from vendors, so networks can quickly be slowed during busy hours of the day. Also, if network equipment closets haven’t been check for several years, now is the time to upgrade those still working systems with the latest technology offerings for maximum possible throughput of data streams.”

From Radio Silence: “Re: IBM’s protest of the VA’s RTLS award. They probably wouldn’t have spent the entire $540 million anyway, but the options would be (a) reissue the bid, possibly after rewriting the RFP; (b) put the entire project on hold; or (c) split the pie differently so that all the parties agree not to fight the new decision. I would have bet on Option C, but with the political and budget variables they may invoke at least a modest delay.” The GAO accepted IBM’s protest of the award to HP Enterprise Services, saying that the VA’s assessment of the proposals relied on erroneous conclusions.

Thanks to Inga for covering during my vacation. She was one-for-two in her “exotic beach sipping umbrella drinks” guess as to my whereabouts. Correct about the beach, but not the umbrellas  — they tend to poke your eye when you’re trying to sip from a bottle of local Central American beer, although Mrs. HIStalk seems to like them in the wildly colored concoctions she favors. I both enjoy and detest being forced to disconnect from the real world due to poor Internet connectivity. My inbox is bulging (some of those being of the impatient “Why haven’t you responded to the e-mail I sent you yesterday?” variety) and my HIT situational awareness is a week behind, so my priority is to catch back up on both. You can help by e-mailing all those rumors, news items, and fun items that I missed last week.

Three-fourths of poll respondents believe that those four Republican Congressmen who called for an immediate end to HITECH payments were motivated by politics rather than fiscal responsibility. New poll to your right: what’s the holdup on the widespread exchange of patient information? Feel free to use the poll’s comment function to argue your position or to choose a different answer.

Listening: the final album from the recently deceased blue-collar electric bluesman Michael “Iron Man” Burks, recommended by a reader. I’m usually indifferent to blues unless I’m listening to it live in a smoky bar with cheap beer, but he had a 70s-sounding gritty vocal, some wicked growling organ, and a searing rock-style guitar reminiscent of Robin Trower or Eric Clapton. He out-Hendrixes Hey, Joe on this live video. I’m playing him hard on Spotify given my appreciation for honest, non-computer enhanced musical craftsmanship.

I was intrigued by Inga’s mention that the Nashville Medical Mart project has been killed by its developer due to lack of leasing interest, apparently not salvageable even with its partner HIMSS cheerleading and announcing grandiose plans for its involvement going back to the heady HITECH days of 2010. HIMSS planned to place its Interoperability Showcase there, run special exhibits and conventions starting with the center’s grand opening in 2013, and create a “world showcase” for “one-stop procurement market for health information technology, equipment, and software” with up to 600 vendor showrooms on site. The developer blames the sluggish economy for their failure to sign tenants, a lame excuse given that the healthcare IT economy is booming even more than back in 2010. A similar project in Cleveland that’s struggling with the same problems (construction delays, few interested tenants) can at least say it has now no competition, which is similar to being the last front-line soldier who hasn’t surrendered or retreated. All that’s left in Nashville other than cancelled lease agreements is the overpromising vaporware video above.

The other big news item that caught my eye last week was Allscripts protesting New York HHC’s selection of Epic. Usually the protesting vendor at least claims some kind of procedural error or violation of rules, but Allscripts apparently is protesting only that Epic shouldn’t have been chosen because the bid from Allscripts was lower. That’s not exactly the case, according the the board meeting minutes I quoted above (Epic’s software cost was actually less, and the 15-year analysis was performed only for Epic, so there’s no good way to make an apples-to-apples comparison unless you work for HHC, as did the people who chose Epic for presumably sound reasons). Not to mention that software isn’t such a commodity that the lowest bidder automatically wins. The positive outcome for Allscripts would be that the decision is overturned and the bidding opened back up to give them a second chance. I can see quite a few negatives in the “lose the selection, file a protest” strategy:

• Winning the protest would require implementing a complex system in a notoriously problematic client who liked your competitor’s product better, which is a nice short-term boost but a long-term nightmare.
• Going to the press with the protest invites the hospital to do the same with their rebuttal, which HHC’s president has done (he said in the New York Times that Allscripts’ cost analysis is false, HHC’s choice of Epic turned out to be wise given the financial and management problems Allscripts has had since the decision was made, and Allscripts is just trying to buy time as they “scramble to get private equity firms to take them over,” not exactly the kind of PR you want from a prospect that has evaluated your company carefully over many months.)
• If the protest is denied, the protesting company risks losing quite a bit of credibility along with the deal.
• Most importantly, future prospects may balk at inviting a vendor to the table who has previously tried to go over the heads of hospitals that chose a competitor. I’ve only ever banned one company (SMS, now Siemens) from my hospital’s premises and it was for that reason – the rep whined to the board chair that the IT department was incompetent in choosing their competitor, which at the board chair’s insistence got both the rep and the company banned permanently from setting foot on hospital property.

Imprivata has assembled a nice collection of cartoons under the Funny Bones banner. Here’s the latest one.

An interesting demonstration of PEBMAC (Problem Exists Between Monitor And Chair): a physician classifies 90% of his patients as Albanian in his new EMR. Reason: it’s the first country listed alphabetically in the EMR’s Ethnicity pull-down menu.

Health Nuts Media has raised $19,000 of its $90,000 goal to develop The Best Asthma Education App in the World … Period. You get swell prizes if you chip in as little as $5 by October 31.

In Canada, hospitals in Saskatoon and Regina go live on bed tracking software from Allscripts, which I assume is the former Premise although it’s not specifically named.

In England, poor employee training is blamed for quality problems in several areas after the recent Cerner implementation at Royal Berkshire Hospital, including increased wait time for cancer diagnostic results and reduced venous thromboembolism performance.

Henry Schein, which offers the Dentrix dental practice management system, acquires a majority interest in Vancouver-based Exan, which sells software for dental schools and dental practices.

A San Francisco business publication names Kaiser EVP/CIO Phil Fasano as a potential candidate to replace retiring Chairman and CEO George Halvorson.

Former Concerro CEO Graham Barnes is named CEO of care coordination systems vendor HealthyCircles.

The entrepreneur who launched Epocrates and Doximity advises companies developing software for physicians to focus on solutions that, in order, (a) save them time; (b) make them money; and (c) improve the quality of care.

Vince wraps up the HIS-tory of QuadraMed with a timely piece on HDS Ulticare, then Per Se Patient1, then Misys CPR, and finally QuadraMed QCPR. A timely story as it turns out: QCPR is the system that New York HHC is replacing with Epic, at least assuming that the protest by Allscripts does not change the plan.

Cerner Health Conference Tweets and Photos

The official recap is here. There were very few attendee tweets and minimal comments from HIStalk readers, so here’s what I could find that was interesting.

thanks everybody #CHC12 for your incredible kindness & passion “@tgrdd: @farzad_onc Great message @chc 2012.You touched many lives today"

— Farzad Mostashari (@Farzad_ONC) October 11, 2012

Neal Patterson: Clients aren’t implementing St John sepsis program because they’re busy with other things which won’t save lives. #CHC12

— Craig Joseph (@CraigJoseph) October 9, 2012

It is not about the technology doing something that impacts quality, cost and speed, it is how you use the technology @farzad_onc #chc12

— Joe Bush (@joebush1) October 10, 2012

It’s not what you do that matters, it’s why you do it. -Simon Sinek. That’s why it’s not about IT, it’s about improving health care. #CHC12

— Brice Jewell (@bricejewell) October 7, 2012

Sponsor Updates

• Dodge Communications offers an October 16 Webinar on leveraging social media tools in conjunction with trade shows, with panelists Brian Ahier (Mid-Columbia Medical Center), Jennifer Dennard (Billian), and Cari McLean (HIMSS).
• An HCI article covers the Top Three Tips for a Successful Go-Live.
• Streamline Health adds Netsmart CEO Michael Valentine to its board.

Thanks to the following sponsors, new and renewing, that have recently supported HIStalk, HIStalk Practice, and HIStalk Mobile. Click a logo for more information.

Time Capsule: Enterprise IT Projects Are Like Corvettes: Keep Hotheaded and Unskilled Drivers from Behind the Wheel

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 December 2007.

Enterprise IT Projects Are Like Corvettes: Keep Hotheaded and Unskilled Drivers from Behind the Wheel
By Mr. HIStalk

Big IT projects are a lot more fun to talk about than little ones, aren’t they? Transformational! Visionary! Strategic!

Hospital executives love those adjectives. Big projects make them look like decisive leaders and doers, bold swashbucklers in gray pinstripe who will throw well-placed caution to the wind to get an exhilarating ride to the IT stars.

That those projects nearly always fail doesn’t deter them. CPOE, ERP, and RHIO projects are launched with great fanfare and unrestrained executive enthusiasm. They almost always die an ugly, quiet, and protracted death, sad little pockets of unrealized objectives and defeated naiveté. The executives find other pressing obligations at the first smell of death, leaving the CIO and team to ride the flaming plane into the ground.

Tactical IT projects, on the other hand, nearly always succeed. You want to put in a lab system, HR suite, medication automation, PACS, or portal? They’ll work as planned, delivering pretty much exactly those reasonable benefits projected by the less-lofty suits who are usually involved. Sexy or not, most hospitals have the aptitude to make these projects work.

Unfortunately, enterprise-wide failures suck up a lot of the available capital, organizational energy, and IT resources of hospitals whose reach has exceeded their grasp. Failure is hard work.

The bigger the project, the more likely it will flop. It’s more than a linear relationship. Projects twice the size have four times the chance of failing. (Note: I just made that number up, which is shameful for an objective publication, but then again, I’m just an obnoxious guest here).

Where that failure point lies depends on an organization’s readiness. An assessment tool for warning signs might be useful. Score low enough and your project is doomed before the Rolex-wearing salesperson has headed off for the Caribbean.

Your organization should steer clear of big-vision projects and stick with the tactical stuff if:

• Organizational politics are ugly and widespread.
• Everybody in the trenches likes things the way they are and management doesn’t have the skill to convince them otherwise.
• Strategies always seem to involve copycatting the ideas of smarter or better-known organizations.
• Conditions are never stable enough for long-range planning and consistent execution.
• Stakeholders are too busy to attend project meetings.
• Everybody secretly hopes software will start enforcing all the rules that nobody follows now.
• Managers rely on intuition instead of objective tools like productivity management, process redesign, and a consistent reward system.
• Non-IT projects that cross disputed organizational territories (physicians vs. administration, pharmacists vs. nurses, finance vs. everybody else) fail every time they are attempted.
• Funding never seems to be available for post-project assessment and improvement.

Hospitals don’t see themselves in the flattering mirror held in front of them. Vendors and consultants don’t say a word. The healthcare IT industry would shrink to half its size if somebody created a tool that could unerringly conclude, “Don’t waste your money – you can’t handle this project.”

Rich parents have no business giving their 16-year-old a new Corvette, even though the salesperson is deliriously reassuring. That car is for people with years of experience and cooler heads.

If only the healthcare IT industry could figure out how to keep its overconfident and unskilled drivers from behind the wheel, maybe fewer of them would wrap themselves around trees at 100 miles per hour.

10/12/12

Top News

Allscripts files a protest against New York City’s hospital system after losing a $303 million contract to Epic. Allscripts claims that its solution would be $700 million cheaper over 15 years than the $1.4 billion total cost to implement Epic. The president of the Health and Hospitals Corporation, which runs the city’s 11 public hospitals, said Allscripts’ coast analysis was false and unrealistic and the selection of Epic came after four years of consideration and analysis of nine different vendors.

Reader Comments

From Straight Arrow: “Re: Allscripts NYC protest. Allscripts comes across as a sore loser, and trying to invoke ‘teachers and doctors’ smacks of desperation. Instead of asking the health system why they chose Epic (they mention Allscripts’ history of management and financial problems) they should have left well enough alone. Nobody ever wins these challenges and cooler PR heads should have prevailed; now the market smells Allscripts’ fear.”

From HitTheRoad: “Re: Allscripts missteps. In the New York Times article, Glen Tullman is quoted as saying Epic’s ‘language is more expensive to maintain.’ That is perhaps the least-informed comment ever uttered by a vendor CEO. That comment, their bizarre bid, the MyWay announcement, and the baiting of a former prospect in a public debate that they are bound to lose in an embarrassing fashion could easily mark the beginning of the end of Allscripts.”

From MDRX Knows: “Rumor: Re: MyWay Rescue Program and Allscripts Buyout. Good for Aprima to step in and try to capitalize on a poor move by Allscripts to shut down MyWay. Converting MyWay clients to Professional is laughable. Professional is embroiled in enough trouble of its own without taking on more clients, including a lack of product functionality and overall application inefficiency. Perhaps if the buyout is successful, Glen and company can take the opportunity to clean the Professional house and actually make it the product they claim it to be, not the one they are currently selling.”

From Nasty Parts: “Costco. Word on street is that Costco is going to file a lawsuit against Allscripts over the whole MyWay fiasco. Costco is sitting on a good number of licenses that are not moving, especially with the recent news.” eTransmedia, the Allscripts reseller that owns the Costco relationship, declined to comment.

From Tracker: “Re: VA RTLS The previously announced VA RTLS award of ‘up to’ $540M to HP Enterprise Services has been vacated based IBM’s successful appeal. The entire project on hold until they decide to either re-issue after rewriting the RFP; re-examine the previously submitted responses with a possible different outcome award based on that reexamination (read – work it out so more of the pie is split and the parties agree not to fight the new decision); or, put the entire project on hold. Given the political and budget variables now present I predict there will be a modest delay for now.” Last week the GAO issued the decision stating that “the VA had made several prejudicial errors in its evaluation of the offerors’ proposals. Those errors led to a source selection decision that GAO found was unreasonable since it relied on the erroneous evaluation conclusions to support the award decision.”

From CDiff: “Re: Advice. Asking you and the readers for help in avoiding a slippery slope. Could buying a shoe ornament be considered contributing to a shoe fetish and therefore to be avoided or one of those things that we just wink at and go ahead in the spirit of gift giving with best wishes?” How could gifting a loved one with something as amazing as these shoe ornaments be wrong? Not to mention the cost is a fraction of the cost of a new pair of Christian Louboutins (size 8, in case anyone is doing some early Christmas shopping.)

HIStalk Announcements and Requests

Many thanks to all the readers who sent notes or Facebook posts wishing me a happy birthday. All the greetings were lovely, but I particularly liked the sentiment expressed here:

May you have the ability to happily wear your shoes high, proud and with padded insoles where necessary!

The best gift will be Mr. H’s return, since this job is not nearly as fun without him. Though not necessarily birthday related, I will note that several readers asked for that perfect margarita recipe. Alas, I am still waiting for the cabana boy applications.

This week on HIStalk Practice: athenahealth integrates Entrada voice services into its EHR. Women’s preventative healthcare improves when providers use EHRs. Doximity grows to 100,000 verified members. Miami Children’s Hospital selects CareCloud for RCM. BetterDoctor launches its doctor-connect app nationwide. If you are still looking to give me the perfect birthday, let me make it easy on you: take a moment to sign up for the HIStalk Practice email updates and click on a few of the sponsors’ ads to learn more about their offerings. Thanks for reading.

Acquisitions, Funding, Business, and Stock

TELUS Health acquires KinLogix, a cloud-based EMR provider headquartered in Quebec.

HealthTech Holdings acquires perioperative solutions provider Acuitec. HealthTech will integrate Acuitec’s VPIMS solution into the HMS EMR.

Investment bank Berkery Noyes reports a year-to-date 19 percent increase in healthcare and pharma IT M&A activity compared to 2011.

Sales

The Norwegian Directorate of Health awards Accenture a five-year contract to build and implement Norway’s EHR system.

OhioHealth contracts with Health Care DataWorks, Inc. for its KnowledgeEdge Enterprise Data Warehouse.

Partners HealthCare (MA) extends its contract for MedeAnalytics’ Revenue Cycle Intelligence solution for an additional three years.

Day Kimball Healthcare (CT) will implement SCI Solutions’ Schedule Maximizer and Order Facilitator for it employed and affiliated physicians.

University Physician Associates of New Jersey signs a five-year contract renewal with MedAptus for its Professional Charge Capture software.

People

Tenet Healthcare names Paul T. Browne (Trinity Health) CIO, succeeding the retiring Stephen F. Brown.

Announcements and Implementations

Country Villa Health Services (CA) will be the first organization to implement the AHRQ On-Time Avoidable Nursing Home Transfer Module from HealthMEDX.

Mt. Ascutney Hospital and Health Center (VT) implements Cerner Millennium EMR under the management of The Huntzinger Management Group.

Continuum Health Partners deploys Caradigm eHealth solutions, including the eHealth Community Desktop clinical portal and the eHealth Information Exchange.

The EHR/HIE Interoperability Workgroup, the NYeC, and Healtheway establish a testing program to certify EHRs and other HIT for the reliable transfer of data within and across organizations and state boundaries.  CCHIT will perform the testing.

Government and Politics

Kinergy Health’s MyKinergy wins the Patient Engagement Blue Button Challenge, sponsored by the ONC and The Advisory Board Company, and is awarded the $25,000 grand prize. Other finalists winning $5,000 each include Humetrix, TrialX, Jardogs, and mHealthCoach.

About 284,000 Medicare patients who are potential victims of identity theft are facing difficulties getting healthcare benefits because the government won’t issue new IDs. Medicare officials claim it’s too expensive and too many agencies are involved to reissue the cards.

Innovation and Research

Medicare’s policy to block hospital reimbursements for certain preventable, hospital-acquired infections has not significantly changed the rates of two types of infection.

Technology

Cerner will embed Nuance’s cloud-based medical voice recognition technology into its mobile EHR products including PowerChart Touch. Cerner is also integrating Nuance’s PowerScribe 360 radiology reporting product with Cerner’s RadNet RIS.

Other

The development company overseeing the conversion of the Nashville Convention Center to a medical mart suspends the project, saying that the “leases signed to date do not yet enable the project to be financially feasible.”

Meditech purchases a 26-acre office and conference center in Foxboro, MA for $19.8 million. The site, which will undergo renovations over the next year, will eventually employ 500 workers.

Sponsor Updates

• Impact Advisors releases its 2014 ONC EHR Standards and Certification Criteria primer.
• EBSCO Publishing announces the availability of the Health Economic Evaluation Database, which provides comparative analysis of of medicines for health economists.
• HIStalk sponsors earning a spot on the 2012 Best Places to Work in Healthcare list include: Aspen Advisors, Divurgent, Encore Health Resources, ESD, Hayes Management Consulting, Iatric Systems, Impact Advisors, Imprivata, Intellect Resources, Intelligent InSites, maxIT Healthcare, Santa Rosa Consulting, and The Advisory Board.
• Surgical Information Systems releases its SIS Surgery Dashboard, which displays real-time current case statuses on mobile devices.
• Elsevier recognizes four “Superheroes of Nursing” at this week’s ANCC Magnet Conference.
• University Physician Associates of New Jersey renews its charge capture contract with MedAptus.
• EBSCO Publishing releases its Applied Science & Technology Source resource to facilitate the research needs applied sciences and computing users.
• CommVault announces the integration of its Simpana 9 data and information management platform with Microsoft’s Cloud OS, including Windows Server 2012, Hyper-V, and Windows Azure.
• MedHOK is named a finalist for the Tampa Bay Technology Forum Emerging Technology Company of the Year Award.
• TeleTracking Technologies offers a three-part Webinar on reducing hospital costs through automated asset management.

EPtalk by Dr. Jayne

Another acronym bites the dust: ONC announces that the Nationwide Health Information Network (NwHIN) Exchange is now eHealth Exchange. Nonprofit Healtheway assumes operational support.

Now that 2012 is almost over, CMS has announced distribution of ePrescribing program incentives and PQRS payments from 2011. Accompanying feedback reports, manuals for interpreting the data, and guides for understanding incentive payments are available on CMS’s Quality Net portal. Don’t spend all that money in one place, folks.

An apple a day: Inga shared this article that suggests doctors practice healthy behaviors more often than other workers in the US. I’m glad they didn’t report on doctors who have become administrators or IT staffers. I was definitely healthier when I was running around a practice as opposed to sitting in endless meetings. I think I’m going to have to start adding “stand and stretch” to my time-boxed agendas if I want to avoid getting a blood clot from immobility.

Speaking of health, I went for my physical today so I can scuba dive again. As I sat in the waiting room, my phone buzzed and it was an email from the receptionist inviting me to enroll in the practice’s patient portal and fill out my introductory health questionnaire. It’s always fun to see these things actually work in a practice. Now we’ll just have to see how long it takes before my clinical summary is available.

Jeers to Anthem BlueCross BlueShield who continues to recycle tired old jokes about physician handwriting. If they want something fresh and modern to pick on, let’s try poor typing skills.

I wasn’t able to attend Health 2.0 although I enjoyed reading the reflections by Dr. Travis on HIStalk Mobile. I was glad to hear that Extormity made a with their strategic plan to acquire every application developer in attendance.

Today is my BFF’s birthday, so if you haven’t done so already please take a moment to send Inga your congratulations. I hope her day is full of sassy shoes and adoring fans.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

News 10/10/12

Top News

Bloomberg reports that Allscripts has received first-round bids for a leveraged buyout from PE firms Blackstone Group LP and Carlyle Group LP and expects additional offers within three to four weeks. Allscripts closed Tuesday at $13.57 per share.

Reader Comments

From Master Yoda: “Re: Cerner Health Conference. I doubt you will be able to make it to the conference, but if any of your readers are going, I’ll be the one in the guayabera with the hair that says ‘he really isn’t trying to impress anyone.’ I hope to see Farzad speak and I wonder how long it will take before I hear someone say ‘Epic’?” Cerner provides its own Day One Recap here.

From Innovator: “Re: Cerner conference. The vibe here is cautiously optimistic. Cerner has put a significant emphasis on mobility. PowerChart Touch (Cerner iPad app) and Cerner Careaware Connect (nurse iPhone app). Both are very impressive and the immediate reaction from the customer base seems very positive. However, you can sense a bit of hesitation, as if customers are cautious about getting too excited about new technology because they have been burned in the past.”

From Motown Nurse: “Re: HCA and Beaumont. A couple of my CRNA colleagues who work for Beaumont state that they were informed that HCA has purchased their health system. I had not read this as confirmed anywhere yet though I may have missed it.” The local Detroit business news mentioned a rumored sale last month but I could not find confirmation. Meanwhile Beaumont’s Physician Organization and United Physicians announce plans to combine operations by the end of the year.

From Future Perfect: “Re: Cerner. Have you heard about Cerner trying to sell a single patient accounting system for both hospitals and physician offices? Usually Cerner sells ProFit for hospital billing and Powerchart for physician billing but now they are trying to sell ProFit for both and compete head-to-head with Epic’s combined billing solution. Does it really work and is it tested?” Do any readers have an answer?

From Retired Barkeep: “Inspiration by drink. I have a great single-serving margarita recipe for you.” Thanks for the recipe, which I am happy to share with interested readers. I am pretty sure I will need at least a double by the time Mr. H return at week’s end. Retired Barkeep was unable to offer cabana boy services to accompany the beverage(s) so I will continue to accept applications.

From Amarba: “Stan Opstad. Stan was the product SVP at Healthland but is no longer there.” Healthland confirmed that the company’s product management and development operations were consolidated under SVP Michael Karaman in 2011 and that Opstad left the company in August.

HIStalk Announcements and Requests

Mr. H has yet to check in with me, other than to report a typo, so I suspect he is in total relaxation mode. Feel free to send me your burning HIT news until he returns this weekend.

Acquisitions, Funding, Business, and Stock

Orion Health’s managing director and majority owner says the company is “strongly considering” going public.

Health Tech Hatch, a crowd-funding site, launches to provide early funding and mentoring to HIT innovators that are developing new companies and products.

Volate secures $6 million in new funding from an unnamed HIT leader and a major healthcare system. The company plans to triple its staff to almost 150 over the next 18 months.

Sales

Massachusetts Eye and Ear Infirmary selects MedeAnalytics’ Clinical Performance Intelligence and Revenue Cycle Intelligence solutions to analyze physician utilization and quality metrics. MedeAnalytics also secures a five-year contract extension with West Tennessee Healthcare for its Compliance and Revenue Integrity and Revenue Cycle Intelligence solutions.

People

MediRevv appoints Patrick Tierney (above – University of Iowa Hospital and Clinics) managing director of consulting services and Matthew Reat and Diana Moore (CSC) senior consultants.

Medecision names Jerry Baker (Halfpenny Technologies) SVP and GM of its value-based healthcare solutions business for care delivery systems.

Consulting services firm SISU Medical Solutions names Scott Lee (Lee Advisory Services, KPMG) CEO.

RegisterPatient, which just raised $4.1 million in series A funding, hires Jana Skewes (Shared Health) as CEO.

CHIME elects Pamela Arora (Children’s Medical Center Dallas), Charles Christian (Good Samaritan Hospital), and George McCullock (Vanderbilt University Medical Center) to its board of trustees.

Announcements and Implementations

Awarepoint announces 226% deployment growth, including new activations at Kaiser Permanente, Yale New Haven Health System (CT), Monongahela Valley Hospital (PA) and Vidant Medical Center (NC).

The town of New Canaan, CT pilots a teleheath program that provides 10 seniors iwith Pad or Acer tablets to communicate with nurses two to three times per week. The participants, who range in age from 70 to 85, will also be provided medical equipment to monitor and report vital signs.

Hillcrest Medical Center (OK) goes live on Forerun’s FlexChart physician documentation in its ED.

AT&T and IBM will begin selling private cloud computing services next year over a mutually owned network.

Southern Tier HealthLink (NY) joins the New York eHealth Collaborative’s Health Information Network.

Allscripts announces its Open App Challenge, which offers $750,000 in rewards for developers that create and integrate applications that build upon Allscripts Open EHR platform.

Aprima reminds MyWay customers that the software is based on Aprima’s PRM 2008 version and offers a no-charge license migration, as long as practices sign up for maintenance and support. Aprima also says that MyWay resellers can join Aprima’s reseller network and offer their customers an upgrade option.

Innovation and Research

Physicians using EHR scored significantly higher on quality of care for four screening measures for diabetes, breast cancer, chlamydia, and colorectal cancer, according to a study published in the Journal of General Internal Medicine.

Technology

Imprivata releases Cortext, a free HIPAA-compliant text messaging solution for iPhones and Android devices and Web-based chat solution for nurses without smartphone access.

Anesthesia Business Consultants and iMDsoft launch cloud-based myAnesthesia for the iPad.

Other

Providers need to work together to accelerate interoperability and electronic information sharing across care settings, according to a report from the Bipartisan Policy Center. The Center also recommends a national strategy to improve accuracy of patient matching; an extension of Stark Law exceptions and Anti-Kickback Statute for safe harbors for HIT donations; and improved clarity of federal privacy and security laws.

Doctors are generally healthier than other US workers according Gallup-Healthways report. A physical health index that considers such factors as obesity, colds, the flu, headaches, and sick days gives doctors a score of 86, nurses 80, and other employed adults 81.

The New York Times takes a look at the use of telemedicine on Nantucket Island, MA as a means to increase access to specialists and decrease costs. Nantucket Cottage Hospital’s CEO estimates that the island’s use of tele-dermatology is saving $29,000 per year and provides patients’ access to dermatologists six times a month instead of just four times a year.

Sponsor Updates

• Three hundred Encore Health Resources’ employees build and deliver fifty wheelchairs to Houston-area veterans and the disabled during the company’s annual retreat.
• Aspen Advisors’ Fran Turisco and Dan Coate deliver a presentation on patient monitoring technologies and accountable care at next week’s NY eHealth Collaborative Digital Health Conference.
• NTT DATA will integrate Dart Chart Systems’ proactive analytics tools into its NetSolutions POC software.
• A local Eden Prairie (MN) publication profiles Virtelligence, which was recently named as one of the country’s fastest-growing companies.
• Wellcentive’s VP of product strategy Mason Beard discusses six pillars of population health management.
• Mike Reppart, (Hendrick Medical Center TX), and Kelley Blair (Craneware) will speak at the 2012 AAHAM ANI Conference on RCM strategies and performance improvements.
• IDC Health Insights recognizes Harris Corporation as a leader in the packaged HIE segment.
• Beacon Partners offers two Webinars in October on risk management.
• Infor releases its Workforce Management 6.0 solution and announces a private beta availability of its iPaaS stack on the IBM SmartCloud platform.
• EBSCO Publishing and Elsevier will provide access to Elsevier’s Scopus database from within EBSCO’s Discovery Service.
• Imprivata customer Dr Harald Eder joins a panel discussion on improving patient care with cloud-based desktops during VMworld 2012. Imprivata also announces the finalists for its inaugural Healthcare Innovation Awards.
• Visage Imaging will participate at the second annual Imaging Informatics Summit this week in Washington, DC.
• McKesson announces general availability of its Reimbursement Manager to assist with bundled payments and fee-for-service reimbursement models.
• Surgical Information Systems offers integration with abeo’s MedSuite billing software.

Clarification from Allscripts

We asked Allscripts to answer a few additional questions about their MyWay to Professional Suite upgrade option. We appreciate their providing us with these responses.

Could you clarify “free upgrade?” Is that a free license, a free conversion, or both?

This upgrade includes software, implementation and training. It will start in January 2013 and end in September 2013. The implementation will be facilitated by enhanced tools that make data conversion and interface activation seamless. This, coupled with tailored simulation learning and a hands-on weekend learning event, will prepare clients to take advantage of their newly upgraded software.

Does the maintenance fee change for MyWay clients once they’re on Pro?

The maintenance fees will remain the same as what is defined in a MyWay client’s current agreement.

And when you say “converged platform,” how is it different than the current Pro product?

We are launching a converged platform and the first step is to move our MyWay clients to this platform. They will experience many enhancements including mobility with Wand, our native iPad mobility solution, additional content including more specialties, and real time point of care/clinical decision support. In addition, the converged platform will be able to process ICD-10 codes and is planned to be certified for Meaningful Use Stage 2.

More news: HIStalk Practice, HIStalk Mobile.

Curbside Consult with Dr. Jayne 10/9/12

Despite recent calls by some members of Congress to halt Meaningful Use incentive payments, providers are still gearing up to attest. The last 90-day reporting period for 2012 just began and it’s interesting to see people who haven’t yet been able to meet the requirements try to gear up and get it done.

I ran across an article that’s really timely. Basically it poses the question: Who gets the money? Whether providers are employed by large integrated delivery systems or whether they are partners in small practices, it’s often not clear how incentive payments should (let alone will) be allocated.

This doesn’t apply to just MU payments, but nearly any kind of pay for performance bonus, quality bonus, or capitation payment. Often physicians seem to be too busy actually caring for patients to spend the kind of up-front thought needed to solve these questions before they become practice-shattering issues.

The article presents a cautionary tale about a solo physician who employed a nurse practitioner in her office. After spending more than $50,000 to implement an EHR, the employee received the MU check and walked away with the cash, leaving the practice holding the bag. There’s probably more to the story, but it raises important questions about the intent of MU incentives and how they are paid.

The employed physicians working for our large health system have language in their contracts that basically state any incentives received for work done as an employee belong to the health system. In the event that they are paid to the physician personally, they are to be signed over to the health system who also has the right to pursue legal remedies to obtain the funds. The language is clear that it only applies to work done within the course of employment. It also requires providers to complete any assignment paperwork within 30 days of receipt or penalties apply (the same language applies to credentialing paperwork, conflict of interest documentation, employee code of conduct updates, etc.) It’s very “take it or leave it” and that’s part of what being in an employed situation is about.

The key here is that these stipulations are made clear during the hiring process – no surprises. Should the health system decide to be benevolent and actually share quality bonuses with physicians, it’s completely up to the leadership. Although it’s maddening as a provider because we’re doing the work, it’s understandable because none of us personally put up the $45,000 it cost to deploy our EHR system. The one time they did pass funding through to the physicians, I ended up with a whopping $40 bonus. I think at the time it covered about a week’s worth of interest on my student loan payment.

Even in small practices with physician partners, I’ve seen resentment between those who embrace EHR and enter the majority of the data and those who coast on the coat tails of their colleagues. There need to be minimum standards for data entry if payments are to be divided equally. This is not a lot different than the decisions that need to be made when partners who have capitation agreements cross-cover patients or when one partner takes more call or works less than another.

Bottom line: regardless of which side of the table you may be on, this needs to be addressed contractually before it becomes an issue. If you’re an employer and your providers haven’t brought it up yet, don’t assume they won’t be bitter when they figure out in the future that they should have. Be the bigger person and start the dialogue now. And if you’re an employee, be ready to discuss what kind of a split you think is fair and why you feel that way. Interesting discussions will certainly ensue and it may not be easy to avoid hurt feelings or bitterness on either side. Personally, after living through my last contract negotiation, I might just be inclined to arm wrestle for it.

How does your organization allocate incentive payments?

E-mail Dr. Jayne.

Monday Morning Update 10/8/12

Allscripts announces free upgrade to improve practice solutions ow.ly/efPow #EHR #HealthIT

— Allscripts (@Allscripts) October 5, 2012

From Factory Girl: “Re: Allscripts. My company is an Allscripts partner and last week they told us they were not planning to make any official announcement about the decision to move customers off the MyWay platform. Yet I see that the day after HIStalk mentioned it, they posted details on their WebSite.” Allscripts also filed an 8-K so they probably figured everyone would know even if they didn’t read HIStalk. Allscripts is taking a $10-$13 million write-down on MyWay so that business apparently won’t be sold as once rumored.

athenahealth CEO Jonathan Bush says his company is considering a move to a larger location or an expansion of its Watertown, MA headquarters from 330,000 to one million square feet.

The local paper profiles Nashville-based Shareable Ink, which has grown from two customers at the beginning of 2011 to almost 100 hospitals and clinics today. CEO Stephen Hau says he expects the company to grow from 40 employees to 80 within the next six months.

The 100+ physician Colorado Springs Health Partners chooses Humedica’s MinedShare clinical intelligence platform.

The use of EHRs isn’t increasing Medicare fraud, say 78 percent of poll respondents. New poll to your right: what is the primary motivation of the House members who are urging cessation of HITECH payments?

Listening: new from reader-recommended The Vaccines, an English indie band that sometimes sounds like the Ramones, but is a good (better) listen even when they don’t. I’m also wistfully listening to YouTube recordings of The Howard Stern Show from the early 1990s when it was actually good (Howard, Robin, Fred, Jackie, and Billy, and especially the Jackie Puppet).

Streamline Health Solutions promotes Matthew S. Seefeld from chief strategist of revenue cycle to SVP of solutions strategy.

Providers rank CareFusion, Omnicell, and McKesson the top providers of anesthesia cabinets based on functionality, implementation, and training, according to KLAS. Half of users that have implemented anesthesia cabinet systems say the main benefit of OR-specific cabinets is having an organized and controlled medication inventory.

Surgical Information Systems integrates its perioperative IT solution with OpenTempo’s surgical and anesthesia workforce scheduling tool.

The T-System folks forwarded this card, which they developed in advance of this week’s ACEP Scientific Assembly in Denver.

The former HIM manager of a small Nevada hospital files a wrongful termination lawsuit against her former employer, claiming she was fired for questioning what she says was ED upcoding.

Just a reminder that Mr. H is taking some R&R this week. If you send him an e-mail and he fails to respond, hopefully that means he is busy reclining on an exotic beach sipping umbrella drinks. Actually I don’t think he is an umbrella drink/exotic beach kind of guy, but since that’s my idea of the perfect vacation, that’s what I am envisioning for him. While he is out of pocket this week, feel free to drop me a note, should you have any burning HIT news to share, want to offer encouragement, or have any umbrella drink recipes worth consideration.

Thankfully Weird News Andy never takes a break and sends over this story about one Florida county’s attempt to have patients waive their privacy rights. The Sarasota County sheriff’s office is encouraging pain physicians to have their patients sign a form authorizing the release of PHI to law enforcement, should a physician believes a criminal violation has occurred. The local paper reports that the medical community is is concerned the move violates “HIPPA law.”

Vince provided a HIS-tory this week after all, continuing his QuadraMed history with a fascinating look at Health Data Sciences, which was the hottest vendor going a couple of decades ago. My favorite trivia: founder Ralph Korpman MD was a computer genius who started medical school at 15.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

HIStalk Interviews Dale Sanders, SVP, Healthcare Quality Catalyst

Dale Sanders is SVP of Healthcare Quality Catalyst of Salt Lake City, UT. He is also senior technology advisor for the national health system of the Cayman Islands and a senior research analyst for The Advisory Board Company.

Tell me about yourself and the company.

I’ve been in IT since 1983. I’ve got bachelor’s in chemistry and biology. The Air Force sent me back to their version of an information systems engineering master’s program. So the first half of my career, 15 years, was in the military and national intelligence and then manufacturing. Then I got into healthcare about 15 years ago and I’ve been there ever since. It’s been a great transition.

At our core, Catalyst is a company that specializes in data warehousing analytics for healthcare. We are commercializing through Catalyst not only the technology, but the cultural alignment and exploitation of data. All of us that are involved have had the background in that operationally. This is the opportunity for us to make it more available in the industry.

I’m fascinated from your background that you were a nuclear launch officer on Looking Glass, the plane that stayed airborne to launch retaliation in the event of a nuclear strike. Did you ever almost lean on the wrong button and start World War III by accident?

[Laughs] No, never quite that. There’s a lot of checks and balances. But that was an awesome job. I mean, considering how young I was and the responsibility that the Air Force places upon you, it was phenomenal.

Here’s a weird little twist. I was actually working on a nuclear decision support aid for the Joint Chiefs of Staff when I stumbled upon healthcare. I was reading about the use of computers in healthcare, and the idea was that I was going to apply what healthcare was doing to nuclear decision making. But as it turned out, I came away from those studies and I went, “Wow, if that’s the best that healthcare can do with computers, there’s a lot of opportunity ahead.”

Thank goodness you didn’t take what healthcare does and apply it to nuclear strike decisions.

[Laughs] The parallels are very direct. It’s all about false positives and false negatives and diagnosis and the appropriate response. Not over-treating, not under-treating. It’s amazing, the parallels.

The next most fascinating thing about your background is that you went to the Caymans. I’ve been there and mostly remember that the water’s really nice and the biggest industry is bunches of post offices boxes that are the only physical presence of offshore banks. How did you end up there? You’re still working there, right?

I’m still consulting there. I plotted out this high-level strategy in my career. I wanted to work for an integrated delivery system and I wanted to work for an academic medical center. 

Then I saw what was happening in the US, and I thought I’d love to get out and work for a national healthcare system. I was actually headed to Canada, but out of the blue, this opportunity in the Caymans came along. I literally turned around within a matter of just a couple of weeks of heading to Canada and went there to work in this more laboratory-sized setting on a national healthcare level. It was the best experience of my life.

One of the nice things about my life is every job that I’ve had is better than the last one. The Caymans is exactly that. It was fascinating. What was really fascinating, talking about the financial arena, is that they pull off a national healthcare system without a national income tax system. They basically operate on what amounts to a national sales tax. There’s no income tax. It’s just fascinating from an economic perspective how they fund healthcare as well as the entire government without a national income tax.

I would assume – maybe incorrectly – that they’re not big technology users.

It’s a tiny little country, only 60,000 people, and talk about isolated from skilled labor. They implemented Cerner about nine years ago. It was not a good implementation. That’s one of the values that I brought down as we turned that around.

But they’re actually very, very capable. Technically, very capable. They were in a bad state of affairs when I took over, but they supported me very well and we turned it around.

Now we’re doing things down there that the US system isn’t even doing. We just implemented a real-time claims adjudication system that adjudicates your claim right at the point of care. The physician signs off on your encounter, and by the time you get to the checkout desk, your claim is submitted and returned, and if there’s any self-pay portion, you manage it right there.

Everybody dreams about a healthcare system where automation adds value to the patient instead of getting administrivia done. It must be frustrating to be back in the middle of this mess we call the US healthcare system.

I’ve had to learn to temper my impatience working in the US system, that’s for sure. But I’m actually very encouraged. I think we finally reached the tipping point. My theory is that whatever happens with federal legislation, the employers aren’t going to tolerate what they’ve tolerated for so many years. 

I think we’re at the tipping point now. I think we’re about to enter a very fun period in healthcare in the US.

Suddenly everybody wants to know what you know about data warehouses and business intelligence. A lot of organizations tried stuff before that flopped, often not because of the technology, but because they didn’t have the leadership or culture to act on what business intelligence was telling them. How would you assess the current state for data warehouse and business intelligence and what are hospitals doing now?

Well, it’s kind of funny. I was reflecting … you know, I love your “Time Capsule” reflections, so I was doing that myself. Then I found a paper that I wrote – it was 10 years ago to the month – for HIMSS. It was entitled, “Standing on the Brink of a Revolution: Healthcare Analytics,” I think was the title of it. It was basically the summary of my experience at Intermountain and what we were doing.

I was convinced at that time that data warehousing and analytics were going to take off in the industry. Of course, that was 10 years ago and it hasn’t moved very far, but I think we all see now that analytics is absolutely fundamental to the future. We’ve been in the EMR deployment phase, which is about collecting data. We’ve been in the HIE phase, which is about sharing data. Now we’re finally getting into this age of analytics and exploiting all that data.

It’s really fun to be a part of that and I’m really grateful to be involved with it again. In particular, I’m grateful for Catalyst. I started the Healthcare Data Warehousing Association in 2001 with the idea that we would stimulate best practices and greater adoption of analytics in healthcare. HDWA has done OK, but not great. I think there’s something like 300 member organizations, but it’s not as good as it could be. For me, the involvement in Catalyst is now an opportunity to make best practices available in the market in a commercially sustainable way. It’s a lot of fun.

We’ve been seeing all these debates about whether there is value in the deployment of EMRs and if you drive healthcare costs up or down. I really believe, having watched this now for 15 years, that the return of investment from an EMR comes from the deployment of the data warehouse. For about one-tenth the investment of an EMR, you can implement a data warehouse. I can show all sorts of data that proves the return on investment from a good data warehouse is 1,000 to 1,500 percent in two to three years. You can’t show that with an EMR, but there’s plenty of studies that show tangible measurable ROI from the data warehouse.

Some people would argue, me probably being one, that the real value of an EMR is really at the very front end and the very back end. On the front end, you’ve got decision support that may influence decisions, and on the back end, you’ve got analytics that may influence decisions more broadly and get into population management. Everything in between is a utility. Are people beginning to realize that the EMR isn’t the end of the project, it’s the beginning of the next project?

That’s a great point. I think that’s exactly where the market is right now, and we’re seeing that in kind of the market timing in Catalyst. It’s a little bit like the Wild West — their pulse rate is still pretty high from deploying EMRs. Now suddenly everyone’s saying, “You know what, you’re not done yet.” It’s really about analytics, and the EMR is really a means towards to the end state, which is analytics. People are a little confused by it right now. It’s a little bit of Wild West going on, but it will calm down in the next six to 12 months, I think.

I’m sure a lot of the calls you get are from the average Cerner or Epic shop wondering what you can do for them.

The EMR vendors are – and we would expect them to be this way – very EMR-centric. If you look at Cerner’s and Epic’s offerings, it’s really been around the aggregation of data that they collect, which is all well and good. But if you look at the ecosystem of data that you have to analyze in healthcare, it’s way beyond the data that’s collected in the EMR. 

Even if you have a full-blown suite like we did in the Caymans — or as is more commonly deployed now with Epic customers — there’s data outside of the boundaries of Epic and outside the boundaries of Cerner that you have to have in order to understand the full continuum of care, and especially to manage the risk of care and capitated payments. 

You have to have claims data, outside pharmacy data, mortality data, and you may want benchmarking data from other organizations. You want to mix that all together into an enterprise data warehouse. And that’s the challenge that Cerner and Epic have never really addressed very well. 

Epic is coming out with a new product. It’s a little more extensible. Cerner has been toying with that for a while as well, but they’re a little bit late to this. That’s OK, because the reality is, we leverage what they do. For instance, if you have PowerInsight, if you have Clarity or Cogito, the new Epic product, we will attach to that and leverage that in our data warehouse solution. We’ll pull data out of those EMR-centric designs and pull that into a more extensible design in Catalyst.

The guy who will be running the proposed Vermont statewide ACO said what he wants most is data, because if they’re approved as the statewide Medicare provider, they will get to see Medicare claims data for individual patients – how often they seek hospitalization and for what purpose, more of a population health view. Would you be able to manage government data like that if you could get it?

Yes, absolutely. I can’t say that I’ve ever had the opportunity to pull in Medicare or Medicaid data back into a data warehouse, but we certainly have a strategy for utilizing the data that goes through an HIE. It adds a lot of value to the content of the data warehouse.

I might also mention that some folks are looking at HIEs as being the primary source of data for their enterprise data warehouse. But again, it doesn’t provide the complement of data that you need. In particular, you can’t do what we focus on. You can’t do waste analysis with an HIE data stream, for example. It just doesn’t provide the fidelity or the granularity of data that you need, and there’s no costing data in that data stream. 

A big part of what we do in Catalyst is to knock out all of those relatively simple but non-differentiating reports — internal reporting and external reporting to Joint Commission and Meaningful Use and that kind of thing — that everybody has to abide by. There’s no differentiation there, so we try to make that as easy and as quick as possible to deploy. 

Then we focus on what we call the upper layers of the analytic adoption model. That’s where we get into waste elimination. We philosophically believe that the emphasis on accountable care and the physicians who are taking great responsibility for a patient’s outcome is a pretty tough accountability to swallow. Depending on which study you look at, 40 to 70 percent of the healthcare costs are lifestyle related. We don’t really know how in the near future a CEO for a healthcare system is going to take accountability for those lifestyle changes that are required to drive healthcare cost down. 

But the one thing that is within the complete control of the CEO is waste management within the boundaries of his or her own organization. What we try to do is get people up the analytic adoption model as fast as possible into those areas that allow them to quickly identify waste. It’s not unusual for us to find 25 to 30 percent opportunity waste and that can be returned right back to the bottom line of your organization.

The challenge, I would think, is trying to get the attention of prospects where every vendor of every system that can export to Excel claims they have an analytics suite. What’s the message you have to send to get people’s attention that just having a bunch of raw data isn’t really business intelligence or analytics?

We see that going on right now. In fact, when I talk to fellow CIOs about this, a lot of them are deer-in-the-headlights right now because there’s so many different options in the market. 

We’re hoping that that calms down a bit. We hope that as people become familiar with us and they see our track record and they see the history of what we’ve done in our clients — and not only with our commercial clients, but our background as operational data warehouse developers in places like Intermountain and Northwestern — that they’ll see the value that we offer. But, yeah, it’s the Wild West out there right now, that’s for sure, and the options are overwhelming to most CIOs.

Suppose somebody came to you and said, “Give me your best success story so far.” What’s the best outcome someone got from using your products and services?

About $10 million savings in readmissions is probably the big one, within a year and a half. We have numerous success stories in the $4 to $5 million range of tangible, measurable return on investment and savings. Those stories are gaining momentum all the time. It’s very fulfilling.

What effort and resources are required to implement your product?

The combination of a culture that’s willing to exploit the data along with the technology of analytics. Those are the two fundamental pieces you need no matter what your organization or what vendor you’re looking at. You have to have the culture that’s willing to exploit the data, and you have to have robust and extensible technology.

We’re a little different from a lot of vendors in that we try to commoditize the technology and get that implemented as fast as we can. At one of our largest clients, we were able to implement the core analytics solution for them in seven weeks. Our whole goal is to make the technology as commoditized as possible and then move into that cultural exploitation of data just as quickly as we can.

Time to value is a big deal for us. We keep trying to compress that all the time. The message that I share with my fellow CIOs is that if there’s ever a vendor that tells you you have to engage in a multi-year data warehousing project, you need to look somewhere else. You need to measure these data warehousing projects and their deployment and their time to value in weeks and months now. The old 18- to 24-month time to value for a data warehouse is just not acceptable any more. We’re pushing that down. We’re trying to compress that more and more and more.

One other comment on that is that as soon as we deploy the raw technology, the raw data warehouse, one of the things that we bundle on top of that is a waste analysis right away. It gives organizations this compass about where their greatest waste opportunities reside. We’re big believers in the Pareto principle. What we typically find is that most organizations have huge opportunities for waste elimination by just focusing on 10 to 20 care processes and disease states.

It’s very fun to watch that happen. We run this analysis that we call it a key process analysis. We present that to the leadership team, and it just leaps right out at them where they should focus first. Not only have we sped up the adoption and technology, but we’re speeding up the cultural exploitation of the data, too, by giving them this compass.

How does a CIO keep or increase their organizational value as the healthcare reimbursement model changes?

Maybe five or six years ago, I wrote an article for HIMSS, “The Role of the CIO in Healthcare Economic Reform.” I was reading that the other day and  there’s a lot that you can do. It ranges from keeping a lean organization internally to IT, rather than always asking for more money, try and compress your budget while still delivering greater value. Simple things, like working with physicians so that medication preferences are listed in generic format first. There’s all sorts of economic benefits to that.

I’m a little bit biased here, but I think as a CIO, the most satisfying part of my job has always been around the analytics that I help endear to the organization. A lot of times, I run into CIOs that don’t have a strong background in data, in data modeling or data management or data analysis. If everyone who feels they need to would spend some time beefing up their skills in that regard, the CIO can be the champion for the data warehouse.

People remember me at Intermountain and at Northwestern, not for all the other things that I did there, but for the data warehouses that I played a part in. Knock on wood, I’m very grateful for that, but it’s the data warehouse and the analytics that has been most kind to my career. It’s a great time to be a CIO if you can lead the organization down that path.

Do you have any concluding thoughts?

We are soon to announce a couple of major partnerships that will address this $750 billion a year waste issue that Don Berwick and company identified in the JAMA article. These two partnerships in particular are going to enable and make available this Catalyst solution on a much broader basis than we’d be able to do on just our own without the partnerships. I’m very excited about that.

Going back to who should lead these, I would encourage the CIOs to step forward and take a big leadership role in these projects. Typically what happens is that the CIO will lead the implementation and lead the selection, then over time, the day-to-day management of the data warehouse tends to migrate elsewhere — towards the chief medical officer, the chief quality officer. I’m a big advocate of the CIO, because so much of the initial implementation is technically driven. I would just encourage CIOs to get out there and really dig into this.

Wearing my other hat for just a minute, The Advisory Board just presented at their national conference in Chicago a really good slide deck on what we should be thinking about in the CIO space around business intelligence. If you can, get your hands on that slide deck and maybe schedule some time with The Advisory Board to go over it. I think it will be a good roadmap for most organizations, and it’s a great tutorial if you don’t have a background in analytics.

Time Capsule: E-prescribing is Simple, Except That Most Physicians Don’t Use EMRs

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 December 2007.

E-prescribing is Simple, Except That Most Physicians Don’t Use EMRs
By Mr. HIStalk

The push for electronic prescribing by physicians is accelerating. Mike Leavitt of HHS thinks doctors should get a bonus for doing it (actually, a chance to earn their money back from a planned reimbursement cut). Intel Chairman Craig Barrett, in his role as a member of the American Health Information Community, recently told CMS to use its purchasing power to lay down the law to its doctor vendors. He’s often a simplistic blowhard, but he’s probably right that the customer gets to make rules that suit them.

E-prescribing is theoretically efficient, easy, and secure. Why, then, is the industry still 95 percent based on wadded up, illegible, and easily altered paper prescriptions that are free of any context that could reduce errors, improve formulary compliance, and save time for patients?

I can think of several reasons.

E-prescribing, like almost all aspects of healthcare automation, doesn’t benefit the doctors who have to change their work patterns to use it.

Patients don’t benefit directly, so they don’t really care enough to push their doctors. With paper, they can (as many patients do) not get the prescription filled, save up money to pay for it, or try to order a cheaper supply from Canada or overseas. Paper gives them that control.

Existing e-prescribing systems are generally unsophisticated and lot less functional than you might expect (like not being able to handle pharmacy verification that the prescriptions were accepted and/or filled).

DEA and state regulations vary on what kinds of prescriptions can be issued electronically.

The chicken-and-egg dilemma. Pharmacies aren’t excited about processing prescriptions electronically because physicians aren’t sending them. Physicians don’t send them because, in many cases, the pharmacy is still stuck in yesterday’s world of telephone and fax.

Efficient electronic prescribing requires an electronic medical records system in the doctor’s practice, which is still a tiny minority of them.

That last item is the big one, of course. E-prescribing should be a by-product of documenting a patient visit. It’s just not reasonable to expect a physician to leave the treatment room, fiddle with a standalone e-prescribing system, and re-key duplicate information.

Scrawling out a paper prescription takes a fraction of that time. The act of writing it gives the doctor time to look away from the patient, collect his or her thoughts, and make notes on the ever-present paper chart. The ritual of handing it over offers a chance to counsel the patient and to add finality to the visit. It’s a rule: you put your pants back on while he or she is writing, you take the prescriptions with one hand and shake with the other, and then you beat it so the doc can make their patient quota for the day.

Everybody rolls their eyes at how backward healthcare is, but we’re not alone. It’s very likely that your visit to an attorney, accountant, or mechanic is computer-free, except for your final bill. In fact, here’s a challenge: name any professional other than a physician who is expected to peck clerical work into a computer while consulting with their customer.

That’s why the only answer is to reward doctors (or punish them less, under Leavitt’s proposal) for e-prescribing. If we truly believe that the benefit is significant (do we?) then somebody needs to cover its cost and maybe help out with EMR expenses too. Without either a carrot or a stick, neither electronic prescriptions nor EMRs will ever gain critical mass.

News 10/5/12

Top News

From DrLyle: “Re: House committee call to suspend HITECH payments. I’m at this meeting. Farzad is keeping his cool. He says it’s just pre-election rumblings and nothing can change without major legislative work.” Several House Republicans call on HHS Secretary Kathleen Sebelius (copying CMS Administrator Marilyn Tavenner and National Coordinator Farzad Mostashari) in an October 4 letter to immediately suspend HITECH payments because the Meaningful Use bar is set too low, resulting in a program that “squanders taxpayer dollars and does little, if anything, to improve outcomes for Medicare.” It claims that $10 billion has been wasted. It also references increasing payments due to higher levels of provider coding, as well as Stage 2 rules that don’t emphasize interoperability enough, leading to “our health care system trapped in information silos, much like it was before the incentive payments.” The letter also directly challenges the HHS/ONC count of HITECH provider participants, saying that HHS is “trying to pad participation rates.”

Signers of the House letter were Rep. Dave Camp (R-MI, Chairman, Committee on Ways and Means), Rep. Fred Upton (R-MI, Chairman, Committee on Energy and Commerce), Rep. Wally Herger (R-CA, Chairman, Committee on Ways and Means, Subcommittee on Health), and Rep. Joe Pitts (R-PA, Chairman, Committee on Energy and Commerce, Subcommittee on Health). One might presume given the timing and the fact that all four signatories are Republican that there’s a political motive, although that doesn’t change the fact that you either do or don’t agree with their assessment of HITECH. If their arguments are sincere, perhaps they should have made them earlier. Also, note that their objections aren’t to the value of EHRs but rather to the value of taxpayers in subsidizing them, so reciting a list of why EMRs are inherently good is not an appropriate rebuttal, nor would a list of accomplished users like Kaiser who got free money for using something they’d already bought without taxpayer bribes.

From BadgerMom: “Re: Valley Medical Center, Renton, WA. Goes live with Epic inpatient.” Congratulations to them. Thanks for the picture.

From Horshack’s Laugh: “Re: Caradigm. The company was simply a consolidation of two non-performing assets so that GE and MSFT could get them off their respective books and write off their significant losses ($1 billion over seven years for Qualibria alone) and allow Immelt and Ballmer to save face.” Unverified. I asked that question in my interview with CEO Michael Simpson.

From THB: “Re: Epic’s succession plan. What about HIStalk’s succession plan? You have built a great open source forum, but at some point you will be the old curmudgeon (and I mean that in the nicest sense!) Believe me, Judy reads this site, as does Glen T. and the rest of them. You share what you can and keep close to the vest what you cannot (that is a fine display of TRUST).” HIStalk is to me a hobby rather than a business, and given that I do it part time (as do my far-flung co-conspirators Inga, Dr. Jayne, Dr. Travis, etc.) I don’t have a specific plan for it to continue without me, nor am I vain enough to think that the healthcare IT world will stop spinning on its axis when I stop typing. Sometimes I feel guilty that Mrs. HIStalk would get no financial benefit from my years of labor if I flamed out tomorrow, but I don’t have a solution. It’s an inherently and intentionally amateurish operation.

From Jeeves: “Re: Patrick Soon-Shiong. His announcement was a big deal. I want to point out that at the end of last year when all the pundits were doing their predictions, Travis of HIStalk Mobile was the only one that I’m aware of that said this would be the year that Patrick’s stuff becomes real.” Travis is looking good with his predictions for the year so far: (a) smart phones everywhere; (b) more research and pilots on mHealth; (c) AirStrip as the biggest mover in mHealth; (d) price transparency gets a foothold; and several others. Travis has a lot of experience (MD, startup, NGO, etc.) and you’re missing out on his insight if you haven’t signed up for e-mail alerts when he posts something new. Soon-Shiong’s announcement this week that his NantWorks group of companies has developed a package of supercomputing, high-speed networking, and mobile access that will let doctors instantly individualize cancer treatment based on the patient’s genome. I listened to the live webcast for a few minutes while I was at work and heard him taking the usual shots against outdated, MUMPS-based systems that don’t talk to each other, although I’m not sure what that has to do with his project, which in itself sounds fascinating depending on who’s paying for it and who’s making money from it. BPC has posted the full video of the all-day event, although I haven’t had time to watch it. There’s bonus footage of an extremely cool Farzad bow tie in his segment at around the 180-minute mark.

Reader Comments

From Pick Six: “Re: Allscripts. Replacing MyWay with Pro.” An internal Allscripts e-mail says that it will standardize its small physician market offering on Allscripts Professional Product Suite, with free migration of MyWay users starting in January. The company also announced that its VAR network will be reduced from 40 to four resellers and that Pro Suite pricing will be standardized (it’s not clear from the wording whether MyWay users will get a free license or just a free migration once they’ve paid for Pro). Also not mentioned is what happens to MyWay, although the most common rumor we’ve heard is that it will be sold rather than mothballed (which makes more sense than Allscripts taking a write-off of some of its Misys acquisition costs). Allscripts is trying to consolidate platforms because of the development effort required for ICD-10, Meaningful Use Stage 2, and accountable care. The risks are that users of MyWay, rumored to be the most popular product Allscripts sells, could look elsewhere given the decision the company has forced on them. One potential winner is Aprima, which under its former name iMedica built the original version of MyWay that Misys licensed in 2007, followed by ugly disputes between the companies (see my July 2008 interview with Michael Nissenbaum). Since then, Aprima has rewritten the PM app and upgraded their version of both EHR and PM, so the gloves will come off if Aprima decides to offer an easy conversion from MyWay to their similar product, potentially also signing on some of the former Allscripts VARs who will be left scrambling. Also affected will be Etransmedia, an Allscripts partner that sells MyWay for $499 per month through Costco.

HIStalk Announcements and Requests

I noticed that one of my new Twitter followers is a “healthcare visionary,” leading me to ponder how one earns that designation. Self-assigned? Or is it an advanced accreditation available through HIMSS for those over-achieving members who feel the need for additional titles? I’m going with self-assigned, so from here on out I will refer to myself as Inga HIStalk, HV. Maybe I will get Mr. H to make some ribbons for HIMSS so fellow healthcare visionaries can promote themselves. By the way, feel free to follow me and my HIStalk buddies on Twitter, connect with us on LinkedIn, and be our virtual BFFs on Facebook.

This week’s highlights from HIStalk Practice: a rumor and a response from e-MDs. CareCloud gives Florida International University informatics students access to its EHR. Practice owners struggle over how to allocate incentive payments for employed providers.The Ohio AFP pilots a project to transform practices to the PCMH model, train medical students, and recruit physicians to practice in the state. Julie McGovern of Practice Wise offers tips for physicians to train for their EHR training – and don’t miss the comment from MarathonMan. You know what makes me happy: that two-second signup for HIStalk Practice e-mail updates. Thanks for reading. 

  Am I the luckiest gal in HIT or what? That’s Dr. Mostashari and Dr. Lyle Berkowitz holding up an IInga sign at today’s CMIO Leadership Forum. (Eat your heart out, BFF Dr. Jayne.)

Welcome to new HIStalk Platinum Sponsor VMware, which offers dependable, always-on frontline clinical systems access. Connect to your mobile clinical desktop from anywhere, view medical images, use any digital device securely with no clumsy security steps, and save time with a clinical desktop that follows you everywhere with fast logins to patient care systems. VMware offers cost-saving, secure, and IT-friendly solutions for virtualization, non-stop point-of-care desktops, trusted cloud security and compliance, and zero-downtime continuity and recovery. Thanks to VMware for supporting HIStalk.

From my obligatory YouTube cruise, I found the above VMware video wrap-up of HIMSS12. I like that they pictured and thanked their employees who staffed the booth.

Thanks to Philips Healthcare, supporting HIStalk as a Platinum Sponsor. The company’s solutions address interoperability (IntelliBridge Enterprise and Bedside to connect Philips products with others); clinical decision support (sepsis monitoring, vital signs and alert trending, EKG analysis, cardiac decision support); mobility (OB TraceVue for iPad-powered fetal information, HeartStartMRx ECG to smartphone, and IntelliSpace Event Management); and telehealth (eICU, IntelliSpace PACS, and Home Telehealth Solutions). I interviewed CMIO Joe Frassica, MD in August, who not only explained the company’s offerings well, but also got promoted to CMIO/CTO/VP right after the interview ran, according to his LinkedIn profile. Thanks to Philips Healthcare for supporting my work.

Here’s a brand new Philips Healthcare video that seems appropriate for Breast Cancer Awareness Month.

As a change of pace, I’ll refrain this week from urging you to sign up for e-mail updates and Like us and all that. Instead, I will suggest just one course of action: tell your colleagues you get news and opinions from HIStalk. I’ve received many e-mails from new readers and new sponsors who admitted that they hadn’t heard of HIStalk until people whose opinion they valued kept telling them they should read it. I appreciate that a lot.

I’ll be taking a little break next week, although I’m sure I won’t be able to resist the laptop’s siren song. My hiatus is minuscule compared to that of Vince Ciotti, who’s enviably taking his bride of 40 years to Europe for the whole month of October to re-live their honeymoon (and unlike me, he’s vowing to stay off the laptop). That means HIS-tory will return in November, and I can honestly say I will miss it since I enjoy every one of them.

Acquisitions, Funding, Business, and Stock

Homecare Homebase closes $75 million in senior securing financing from CIT Group.

Peak Health Solutions acquires the assets of consulting firm Health Data Essentials.

Sales

Managed care health plan Kern Health Systems selects McKesson’s VITAL Care Management programs to provide members with care management and educational materials.

Scottsdale Healthcare and Scottsdale Physician Organization will implement Harris Corporation’s Clinical Integration Solution to connect its hospitals, physicians, labs, and other providers.

Booz Allen Hamilton Holding announces 35 new federal and private healthcare contracts totaling more than $112 million in August and September.

People

Patient flow software provider Central Logic names Steve Erickson (SageCreek Partners) CFO.

Stephen Lawrence (Southern Illinois Healthcare Foundation) joins the Lincoln Land HIE as executive director.

Kaiser Permanente Chairman and CEO George Halvorson announces his retirement effective December 2013.

Announcements and Implementations

Inova (VA) becomes the first organization to participate in the ConnectVirginia HIE.

The New England Healthcare Exchange Network (NEHEN) selects the Massachusetts eHealth Collaborative to take over its executive management, business development, and operations management.

Mediware Information Systems earns updated 510(k) clearance from the FDA for its core blood management software products.

Penn State Milton S. Hershey Medical Center implements an interconnected CareFusion and Cerner solution that centralizes clinical information between the Pyxis MedStation 4000 system and Cerner Millennium EHR using Cerner’s CareAware iBus integrated device connectivity architecture.

Horm Memorial Hospital (IA) and Faulkton County Memorial Hospital (SC) beta-test Healthland’s Centriq Clinic, an ambulatory care solution for rural physicians.

Iowa Specialty Hospitals, The Gabrielson Clinic, and Orthopedic Specialists go live on EMR Oct. 8. The hospitals and clinics are all part of University of Iowa Healthcare, so that’s probably Epic.

CliniComp commits to meeting ONC Stage 2 MU certification with its Essentris EMR.

AHIMA calls for improved EHR patient documentation standards and principles at its conference this week.

Government and Politics

The Medicare Fraud Strike Force charges 91 individuals — including doctors, nurses, and other medical professionals — for falsely billing the government $492 million, including more than $230 million in home health fraud, $100 million in mental health fraud, and $49 million in ambulance transport fraud. Half the people, not surprisingly, operated out of Miami.

Technology

Qualcomm Foundation awards Scripps Health a three-year, $3.75 million grant to develop wireless medical devices, including biosensors that are inserted into the blood stream for disease detection; a mobile app that captures medical data from biosensors and transmits it to patients’ smart phones; and a handheld device to detect genetic variations that may prevent particular medications from working correctly.

Other

St. Francis Health Center’s (KS) will lay off eight patient accounting employees as a result of the hospital’s November 1 transition to Epic.

A Wall Street Journal article called “Hospital Horrors” covers a newly published book on hospital transparency written by a Hopkins surgeon. He says state medical boards do a poor job of policing doctors, hospitals are pushed by lower reimbursement to increase volumes to unsafe levels, and bad treatments pay better than good ones in many cases. He quotes a recent Hopkins survey of employees of 60 high-quality hospitals, where more than half of the respondents said they would not feel comfortable receiving care in the unit in which they work. I’ve said that many times: those of us working in the healthcare system are a lot more scared of it than laypeople when we become patients.

Friday is the premiere of “Escape Fire: The Fight to Rescue American Healthcare.” Variety gave it a pretty good review from its Sundance screening in January, but said it should have included more about how lobbying keeps the healthcare industry safe from political action.

Weird News Andy says he might believe the woman who blames lupus-triggered delusions for causing her to strip naked and chant religious phrases outside a high school, but that doesn’t explain why she was joined by her two adult daughters and teenage son. The adults got probation after pleading guilty to indecent exposure.

A Utah man is convicted of disorderly conduct and charged a $140 fine after paying a disputed $25 doctor bill in pennies. Apparently the practice did not appreciate having 2,500 pennies dumped onto the receptionist’s desk. Personally, I think his approach was creative, and I bet quite liberating.

Just in time for Breast Cancer Awareness month: a “smart” bra that uses sensors and predictive analytics for early breast cancer detection. Don’t look for it at Victoria’s Secret or anywhere else any time soon: the company does not expect to launch the product in the US until 2014.

Men with shaved heads are perceived to be more masculine, dominant, and in some case have greater leadership potential than those with longer or thinning hair. Thank you, University of Pennsylvania’s Wharton School for confirming what I have known for quite some time.

Bizarre: a man sues a stripper who was performing at his bachelor party, claiming she slid down the stripper pole and landed so hard on his abdomen that she ruptured his bladder.

Sponsor Updates

• CMS names SuccessEHS a 2013 EHR Direct Qualified Vendor.
• CareTech Solutions offers discounted pricing for its BoardNet portal to members of the AHA Center for Healthcare Governance.
• The CliniSync REC (OH) profiles Premier Physician Center and its use of e-MDs.
• API Healthcare celebrates customer service week by honoring its client-facing support staff.
• The Journal of the Medical Library Association ranks DynaMed in the top ten among online clinical resources.
• NextGate joins the partner network of HIT consulting firm Exsede.
• Shareable Ink introduces its Meaningful Use program for anesthesiologists.
• QlikView hosts an October 11 webinar featuring Nationwide Children’s Hospital (OH) and its use of QlikView for data discovery.
• MedHOK announces that its technology platform positions participants in the Comprehensive Primary Care initiative to share in savings and improve patient care.
• T-System showcases its RevCycle+ physician coding and billing solution at next week’s ACEP Scientific Assembly in Denver.
• iSirona sponsors a Code-A-Thon programming challenge at Florida State University’s department of computer science.
• Datapharm Australia Pty selects Merge Healthcare’s eClinical OS solution for enterprise-wide electronic data capture.

EPtalk by Dr. Jayne

I’m mourning the loss of a colleague today – one of my favorite partners is leaving our group. Patients adore him and I’d trust him to care for my loved ones. The reason: he’s fed up with insurance, bureaucracy, and paperwork and is launching a cash-only practice.

He will be sorely missed, but he’s not the only one. Increasing numbers of physicians are dropping participation in insurance plans. It doesn’t do much good to have patients insured when few will accept low-paying insurance plans (see: Medicaid). A New York Times piece this week shares some additional stories. More interesting than the feature itself are the reader comments.

Sponsored by ONC, the Blue Button Video Challenge runs through November 13. This is your chance to create an “engaging and entertaining” two-minute video to advocate use of the Blue Button to access health information online. Judging criteria include submissions being “fun, edgy, and memorable.” First prize is $3,000 to help motivate you creative types.

In the medical staff lounge this week, there has been a fair amount of discussion around the Annals of Internal Medicine article covering patient access to physician notes. The authors concluded that patients felt the practice was beneficial and that providers experienced “no more than a modest effect on their work lives.”

So many of my colleagues think the sky will fall if their patients have access to visit documentation. Not a week goes by that one of my peers doesn’t corner me about making parts of the patient plan documentation “hidden” or “non-patient-facing.” Although they profess concern that patients can’t handle the truth or that phone calls to explain the notes will be a burden, I really think they’re afraid that patients will discover their poor written communication skills.

Reading the notes of some of my peers is exhausting even when they’re dictated, so one can’t always blame the EHR. I wonder if some of them know how pompous they sound or that they simply ramble with no concept of sentence structure? In order to make sure our patients (and sometimes our colleagues) understand us, we need to be communicating clearly and often at an elementary-school reading level.

Even if your organization doesn’t have an open notes policy, I strongly encourage providers to start documenting as if patients will read the notes. Chances are they’ll be reading them in a few years whether you like it or not. Better to prepare now.

For those that are worried that patients can’t handle the truth (aka, “She’s not going to like it if I say she’s obese”) it’s time to be direct with patients. Tiptoeing around the edge of major national health problems like obesity, diabetes, hypertension, and coronary artery disease because we’re worried about hurting a patient’s feelings isn’t good for the patient or for society. I’m not saying we need to be unfeeling or unkind, but sometimes we need to just call it what it is and work to help patients address their health needs.

Being able to communicate well is a learned skill and needs to be taught in medical school and reinforced in residency and continuing professional activities. Last time I checked, online translator software doesn’t offer “Doctor” as a language choice (although I did find a pirate translator), so it’s time for healthcare providers to get with the program.

What do you think about patient-facing documentation? Do you use it in your practice? E-mail me.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

HIStalk Interviews Michael Simpson, CEO, Caradigm

Michael Simpson is CEO of Caradigm of Redmond, WA.

Tell me about yourself and the company.

I’ve been with Caradigm for 90 days like everyone else, starting June 1. Prior to that, I was with GE Healthcare, where I spent a year and a half working on the Qualibria joint development project with Intermountain Healthcare.

Prior to that, I was based in London, England working for McKesson Corporation as the chief technology and strategy officer for the international operations team. Before that, I spent almost four years with McKesson U.S. and ran their clinical operations for the Horizon product line. Prior to that, I was in high tech — Unisys, Philips, and Novell. Half of my life was spent in high tech, the other half in healthcare.

Tell me how Caradigm is structured and how many employees it has.

From a structure point of view, Microsoft had their HSG group and the GE team had the eHealth and the Qualibria teams. Coming across from the Microsoft side were about 200 or 250 Microsoft employees from the Health Solutions Group that worked on Amalga and the identity and access management team. That’s the former Sentillion group that I’m sure you remember. From the GE side was a group of about 250 folks who came in from the Intermountain-Mayo Clinic relationship with Qualibria. The rest of the team came from eHealth, which is the HIE product line.

We’ve got about 525 FTEs at Caradigm today, roughly around 750 people strong.

The original announcement said that Qualibria would be part of Caradigm, but the only Web reference I can find still has it under the GE Healthcare banner. It is part of Caradigm, right?

Yes, the intellectual property for that has come across. Qualibria as a brand is being decommissioned. All of the intellectual property on how you attach knowledge to data is going to be rolled into the Caradigm Amalga platform.

If you think about Amalga, it was really good at pulling a bunch of data together, but it didn’t have a lot of components on how to attach knowledge to that data. One of the reasons we did this joint venture was to be able to take all the connectivity that Amalga brings, the storage of the data, and the analytics and be able to attach the knowledge that we have learned between Mayo Clinic-Intermountain Healthcare to it.

Amalga was  the hottest thing going, but I haven’t heard much about it since the announcement even though there’s a ton of interest in data analysis and visualization. What’s the status of Amalga and where is it going?

Amalga v2 is still a shipping and selling product. We’re getting ready to announce – I’ll give you the scoop — Amalga Cloud. One of the complaints that a lot of people had about Amalga was that it was very heavy and difficult to install. The first wave of customers who had Amalga learned a great deal, and we learned a great deal from those customers.

What we learned is we really need to simplify the Amalga approach and where it’s headed, so we’re doing that first. By this fall, we’ll announce the Amalga Cloud services. The next year, of course, we will have a new version of Amalga that comes out.

Amalga is still key to our product line. It is very strong in what we’re doing moving forward. So, no changes from a strategy point of view relative to Amalga.

What are the benefits people are seeing from it and how do you expect that to change as the healthcare system changes?

Amalga’s value proposition is absolutely phenomenal from a connectivity point of view. For the last five years, everybody has been spending a ton of money on doing digitization of data in a dozen different silos. Now we need something to bring all that data together so we can now learn from that data and act on it in real time.

What Amalga brings to the table for a healthcare system or payer is that they can now directly attach to their EMR — whether that’s Epic, Cerner, McKesson, etc. — as well as their HIE and many of these other departmentals, put all this information together, and then start doing true analytics and change the way patients are being cared for in real time.

Is it an odd pairing that the former Sentillion access management products are paired up with Amalga, or does that makes sense in a way that I haven’t quite figured out?

Actually, it’s critical to our strategy. If you think about a physician and nurse workflow, having to bring in additional workflows — whether they’re in Epic or they’re in Horizon or they’re in Cerner — you want to develop applications that look at trends of information and add that information either back to the EMR or through some other tool. What the Vergence product line allows us to do is guarantee context. We can now share information inside the workflow of the existing physician and nurse without having them change applications.

Today, there’s dozens of great applications out there in the market that bring additional information — whether that’s TheraDoc, Humedica, all those types of applications — but it’s difficult to integrate those into workflow. If we look at where we want to go with Amalga, which provides this open platform for folks to write additional applications on, you want to go and integrate that into workflow without having to be concerned about context and logging in and all those pieces. Vergence ties all that together.

When the JV was formed, the reaction was either that a lot of innovation would occur or that both companies had just put products they didn’t really want into the new entity. What can Caradigm do that Microsoft and GE couldn’t do on their own?

At the end of the day, the things that both GE and Microsoft have been working on … it’s hard when you try to bridge the IT silos within healthcare to create new ways for organizations to look at the insights and create new workflows. It’s a new muscle that all the healthcare organizations are trying to do.

Caradigm had the benefit of looking at what GE was doing, what Microsoft was doing, and bring all those learnings together and advance that in a way that both companies as individuals couldn’t necessarily do on their own.

One thing I think we’ve all learned in healthcare over the last 10-15 years is there’s not a single vendor who can do it themselves. You need to have that open platform and allow others into your system so that you can get the benefit and the knowledge from many different people, whether that’s IT professionals, whether that’s content delivery folks, etc. You need one place for them to do that. As a new entity, from a Caradigm point of view, we are that open platform to digest and move forward.

Your background is with McKesson and GE Healthcare, two companies that lost market position in key areas, either because they didn’t invest and innovate or because they’re limited as publicly traded companies. What new opportunities will Caradigm have in operating outside of the giant corporate umbrella?

A joint venture structure gives Caradigm the ability to innovate and be a lot more nimble than you could within the corporate structures of large companies. Microsoft and GE are phenomenal organizations and they are great shareholders of Caradigm. Their ability to drive and deliver cash flow, fund the venture, and then to help us utilize their channels where we need to helps us be more effective as we move forward.

What are expectations of the corporate parents?

The expectation at the end of the day is how Caradigm can be a catalyst to deliver ACO solutions to the market, and I’ll use ACO in a global sense. It really is about integrated healthcare moving forward. Our parents are looking for Caradigm to be able to deliver on the function of connectivity, to deliver the function of learning into the healthcare environment so it can drive more innovation in the market.

I assume another goal was profitability. Will you need to take specific actions to get the products where they need to be?

The good news about having two great shareholders is that you can sit down and put a realistic plan together. Within a large company, you are required to make money in a certain period of time. As we created the joint venture, we sat down with both Microsoft and GE and said, first year you’ve got to organize the company. You’ve got all the joint venture pain to get through. You’ve got marketing to do. Then you can innovate and drive solutions. Year Three is when you really start to see the uptake from a market point of view.

The bottom line here is the two shareholders look at this as a growth play for both Microsoft and GE. They’re investing in the company to make sure that it hits its profitability goals in Year Four.

Are new products being built or new R&D being undertaken?

Absolutely. First, we continue to invest extremely heavily in Amalga as a platform. As well as in the eHealth space — this is in our health information exchange assets — and the identity and access management solutions within Vergence.

We’re also now working on a series of applications with our partners. If you look at the readmissions module, the ability for any hospital to understand algorithmically which patients are going to get readmitted based on things that we can see within Amalga.

There’s a whole series of applications that we will be announcing around the HIMSS timeframe which we will drive in the areas of transition of care, readmission, and other components around the integrated accountable care network.

These products are all being built internally?

Some are being built internally and some are being built with partners. Part of the mantra within Caradigm is that we provide the platform and the ecosystem. It’s not that Caradigm has to create all applications. Our goal is to create the environment so that we can have many different partners. It’s about bringing choice back into the healthcare environment.

If you think about it, 15 years ago, any hospital could go to a best-of-breed and then you had to worry about connectivity. In the last decade, you had to have one integrated solution. When it came to buying the best departmental for perinatal or the best departmental for theater management, you didn’t really have a choice.

Our goal with Caradigm is to bring this open ecosystem and platform to bear. Then you can decide on any partner you want to bring in.

A few companies have taken that message to heart. How do you see the idea of partnerships and opening up systems to third-party components changing the market in the next five or ten years?

The good news of what the HITECH Act and CMS have been doing is they’ve been driving additional IHE profiles, etc. All the governments around the world see the need to have an open healthcare environment. Most organizations and countries are requiring more and more openness to the common platforms. It makes it a lot easier for folks like Caradigm and others to be able to reach in and aggregate that data to provide different learnings.

If you think about the core EMR, in order to really deliver on the ACO message that we’re all trying to do over the next several years, it’s not just about the EMR. You need the EMR, but you also need a business analytics engine. You also need a lot of content brought in. You also need connectivity with HIEs. It’s a lot of different solutions.

What Caradigm delivers to market is an integrated solution. We can connect to any type of HIE or EMR. It is that umbrella application that allows us to glue all those together. They can start to focus not on the technology, but what’s important, to improve the quality of healthcare and then to reduce the cost and delivery. How are you going to manage those cohorts of patients and start to drive cohort design and focus in on the care rather than the technology?

The hospital EMR market has consolidated down to a handful of dominant vendors. Do you see opportunity if the EMR turns out to be a commodity, with much of the value being added on the back end?

Absolutely. I’m going to be politically correct here with you. The market has consolidated. There really are two, maybe three choices for any hospital to make as far their core EMR.

If you look at some our best customers, like Providence Healthcare System … they are a phenomenal Epic shop. They turned on Epic last year. What they’re now delivering with Amalga are early warning systems and care enhancements that allow them to go above and beyond what they’ve digitized within the EMR.

The EMRs are phenomenal at digitizing of data, and we absolutely respect and want those to continue. What we’re really good at is taking all that digitized data and allowing it to flow through the entire continuum of care — data brought in from the ambulatory side, the inpatient side, etc. — and then providing these early warning systems that add value to the EMR. Our goal is, how can we add value to the EMR and how can we add value to the HIE so we can improve healthcare?

I assume you spend a lot of your time meeting with customers and prospects. What are they telling you that they need or want, and what are they telling you that they would appreciate Caradigm’s involvement with?

The good news — and I’d say this is probably the most exciting thing about being with Caradigm — is what they want is what we have, from a message point of view. They want connectivity. They want to be able to connect all their different systems together. They want to be able to have one central place for all that knowledge. They want to tie learnings to that knowledge, and they want to give that information back to their clinicians.

What we can offer from a health information exchange to our core data asset, etc. is really what they’re looking for. The piece that they’re looking for the most is, how can we do it simply? When you think about all of the work that is on the plate of the IT department of the hospital, they’re looking for simple solutions. This is why we’ve come out with Amalga Cloud. They need the ability to actually send their data to the cloud to do the analytics so they don’t have to worry about the day-to-day operation of the technology. They want the outputs.

What we’re definitely seeing from a trend point of view is that hospitals, payers, physicians, etc. are all looking for the output. Historically, the conversation was all about the technology. Now what they’re looking for is, how can you help me design cohorts of patients? How can you help me put advanced early warning systems in place? How can you help me manage my ICUs better? It’s about the outcome versus the technology, which is a great conversation.

Lots of innovative stuff is going on, but hospitals are risk averse and often ignore smaller companies and focus on core systems. They’re not interested in talking about something new. Will the Caradigm name and corporate connections give you an opportunity to get in front of people with innovative solutions, possibly ones that you would acquire, and make that purchase more palatable?

No question. And again, that’s one of the great things about being a joint venture. We are Caradigm, which is a Microsoft and GE Healthcare company. We have the full support of both parents. You can look at all the folks who signed up for Amalga, the folks who signed up for GE eHealth … they signed up with very large healthcare companies due to  the expertise they could bring to the table and what else they could bring to the portfolio.

At the end of the day, if we’re driving toward a solution and we need help with Microsoft SQL, they’re only three blocks away. If we need help pulling data out of GE EMRs or CT, we’ve got the entire backing of GE Healthcare to help us do that work. So the answer is yes, I think we definitely can be a lot more nimble, but at the same time, can we provide a steady hand or a known factor from the customer point of view.

You probably have a lot of upselling opportunities, but you have a fairly limited number of products to sell. Do you see acquisitions in the future?

You know, you never turn down the opportunity. There’s a lot of market consolidation that’s going to be coming over the future. Again, my job at Caradigm is to provide this open platform. Whether it’s via acquisition or whether we provide platform services to many of these other niche players, I think time will tell.

At the end of the day, if you think about all the great companies out there, many of them have had to spend tens of millions of dollars developing a platform to gather and aggregate data. Then they add their value on top of that with their niche, whether it’s phenomenal business analytics, clinical analytics, decision support, etc. But they’ve spent all that money on a platform, and maintaining that platform is very expensive.

As we talk to different partners in the market, it’s not necessarily about acquisition, but how we can provide this platform so we all don’t have to keep spending money on developing a platform, which means we can offer services to our customers — the providers and the payers — at a much faster rate.

What are your top goals for the company over the next five years?

Five years from now, do we want to be profitable? Of course. Our shareholders definitely would like us to be profitable. But at the end of the day, what our shareholders are expecting is that we as Caradigm are a catalyst that helps control cost by improving the quality of the healthcare systems around the world.

The world will learn a lot over the course of the next four or five years as we drive toward an integrated and accountable care environment. We want to provide the tools to help bring that accountable care world to fruition.

Do you have any concluding thoughts?

It’s back to your question of GE, a great company, and Microsoft, a great company, and why Caradigm is different. We’re different because we can truly provide a tool set and a series of solutions that can help organizations deliver on the accountable care message. Our goal is to ensure that hospitals have the solutions that will help them manage the risk that they’re all going to have to take as we move forward.

I think globally we know that healthcare cannot continue to spend the way it’s spending today. Solutions are absolutely required to help manage cohorts of patients, manage populations, and manage the environment a lot differently than they have before. No one company on this planet can do it all. Our goal as Caradigm is to help provide this platform and open up all of this data so that the hospitals and the payers can help advance the care of patients.

It is about healthcare at the end of the day. We do drive toward profitability like any company does, but it’s really about how we can be that catalyst to help define where healthcare is going over the course of the next four or five years.

CIO Unplugged 10/3/12

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

Brand, or be Branded!

1997. Reverberating rave music generated a hip vibe. Cameras flashed as the crowd studied the student models.

Attending my first fashion show, I sat at the end of the runway—as one of the judges. The dean of my alma mater had appointed me to the board of the fashion school (long story). I and my fellow judges —all of whom were in the business of fashion models and designers—were responsible for appraising the graduate student champions of design.

Despite my initial excitement over the opportunity to act as a fashion critic, I quickly realized my business skills didn’t match my responsibility. And if you have seen my tie collection, you would understand. I felt as out of place as a punk rocker at a symphony.

But I gained one valuable lesson through that experience. The beauty of a model or her or his clothing design didn’t captivate me. The confidence with which the model walked did. They defined their brand despite the fabric or color.

Whether or not you embrace it, the cold, hard truth is that you are judged daily. Minus your own purposeful brand, your board, executive team, peers, subordinates, and business associates will do the branding for you.

In fact, you already have a brand and you don’t even know it. The work has been done for you. Rather than accept a label that may or may not be accurate, take responsibility and define and project your brand.

Borrowing a truism from my friends in marketing, brand or be branded.

First, do some intensive soul searching and decide on the brand you want. Examine your life. Ensure that your chosen brand is aligned with your core competencies and your personal vision. I posted on this subject several years ago in Taking Control of your Destiny.

Once you’ve defined your brand, here are a few ideas to create and manage it:

Network

Continually expand the breadth and depth of your professional and personal network. Proactively reaching out to others saves you from isolation and becoming irrelevant.

• LinkedIn
• Twitter
• Facebook

Publish

Editors are interested in genuine stories from real leaders. Send queries and don’t give up when initially rejected.

• Magazines
• Online services
• Blogging

Present

Get over your fears. Presenting forces you to nail your subject matter and confront doubts.

• Professional societies
• Neighborhood associations
• Your organization
• Church, Synagogue, etc.

Get Involved

Jump into the community. Let leaders know you’re interested in adding value.

• Professional societies
• Special interest groups

Volunteer

Find regular opportunities, and your network will expand.

• Internal to your organization
• External to your organization

Routinely Self-Review

Build in times to review progress and make adjustments. Ask for feedback.

• Update your brand
• Develop a career strategic plan
• Ask your mentor

Self-Educate

Take the initiative to self-educate. Learn from inside and outside of IT and healthcare.

• Blogosphere
• Marketing resources
• Conferences

Add to the Existing Body of Knowledge

Comment on what others have to say (you don’t always have to be the author).

• Post to blogs
• Contribute whenever the opportunity presents

No action will spoil your brand more than damaged credibility. While I’m all about a personal hallmark, it must be built upon a solid foundation of execution and excellence. These are not sequential tasks. Proactively improve performance and brand simultaneously.

Critics will say your brand is created and reinforced by your actions. This holds some truth, but it would be foolhardy not to be deliberate. Please! Take a look at politics for a second as we head into the presidential election. According to this study in The Journal of Personality and Social Psychology, when evaluating others, people prefer the potential of an individual over their past accomplishments. I maintain that this propensity for potential is stimulated by an effective brand.

Keep your brand in perspective, and let it humble you. The value of a stellar brand should reach far beyond you, and its primary benefits should accrue to the people and the organization served. If not, then it’s all about you. Possessing a personal brand, which should never come from arrogance or false humility, is key to success. For without it, you are allowing others to determine your brand and possibly your future.

You’re on the runway — lights flashing, cameras clicking. You may not always be able to select the specific clothes, but you must maintain poise and grace.

Make no mistake: the crowd is analyzing your every step. Brand yourself and accentuate it with confidence.

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

Healthcare IT from the Investor’s Chair 10/3/12

Whither Venture Financing? Or, Where Have All the Cowboys Gone?

I was delighted when Mr. H mentioned he’d gotten some feedback from readers that they would enjoy more columns from the Investor’s Chair. I really enjoy writing them, and even more, I enjoy the responses they generate.

Readers might recall my post two years ago that discussed several ways to capitalize a new venture. I’d like to use today’s post to discuss some of the root challenges in one of those options: venture financing.

While raising capital isn’t what I do at ST Advisors (though we do occasionally advise on aspects of it), from time to time I speak with entrepreneurs who need investors for their business. They tell me that raising venture dollars, especially for companies in earlier stages of development, has become increasingly difficult over the past few years. I attribute this to three major factors:

Funds have gotten larger … There are two main reasons for this fund size growth. Pensions and endowments have grown, so they have been looking to deploy larger amounts of capital. And, VCs are typically paid using a formula known as “2 and 20.” What that means is that 2 percent of the amount of the fund is used for a management fee, i.e., office space, support, travel, reporting, salaries (of both partners and associates), etc. The “20” refers to the carried interest, meaning the venture team gets 20 percent of the fund’s profits.

As a matter of historical curiosity, I recently learned (but have not been able to substantiate) that this virtually sacrosanct ratio was selected by one of the first venture funds and replicated the percentage of a clipper ship’s profits the captain and crew received. Of course, they were risking their lives…

At any rate, the 20 percent carried interest gets divided among the general partners and other fund employees as each fund sees fit. Simple math suggests 2/20 on a $500 million or $1 billion fund is much more appealing than 2/20 on a $100 million fund.

Whichever reason, it’s as much work for a venture fund to write a large check as a smaller one, and both the $2 million and the $10 million investment require similar time and effort for due diligence, negotiation, governance, management, and oversight. It’s only logical that investors are seeking to write bigger checks, as those will have a bigger impact on their funds’ (and their own) financial performance.

… but returns have been lacking … Further challenging the traditional venture investor is the fact that venture funds as an overall asset class, or type of investment (as opposed to real estate, public stocks and bonds, private equity) have underperformed the other asset classes over the past decade. A good overview of returns relative to public markets can be found in this excellent article. Some say that only $0.25 of every invested dollar has been returned. Even if you’re the best VC in the pack, raising money for a new fund in light of this performance has to be a challenge.

I’d postulate two primary reasons other than the most recent recession. First is the law of supply and demand. When venture was hot, too many funds were started and, in 1999, raising a fund was just too easy. With too many dollars chasing too few quality companies, too many bad (or even marginal) companies got funded at valuations that were simply unrealistic as investors were seeking to put money to work in a timely fashion. The chickens ultimately came home to roost, and so there’s been a shake up.

Second, cashing out has become orders of magnitude more difficult, even for investments in high quality companies. When I started my career as a research analyst in the mid-90s, $35 million IPOs were common. Today, as public equity funds (pensions and mutual funds) have gotten larger, a deal under $200 million is challenging to accomplish. Just as above, it’s harder to move the needle on a larger fund. It takes as much work to oversee a small position in a microcap company where you can only invest 0.01 percent of your holdings, as a more liquid stock where you can make a 5 or even 10 percent bet in your fund.

Not only is the stock market demanding larger IPOs, it’s also harder even for companies whose valuations can support an IPO to be public as a result of the Sarbanes–Oxley Act of 2002. Hastily passed as part of the backlash associated with Enron (overdue, but too long after the horses had left the barn, IMO), it contained needed laws and regulations for public companies. But it also undeniably increased the costs, risks, and difficulties of being public as well. An unintended consequence was that it further slowed the IPO market, especially for smaller, typically venture-backed companies.

Virtually by definition, fewer liquidity options will impact returns. Previously, smaller companies could contemplate an IPO for liquidity. Now M&A is often more attainable, and the buyers realize that. The more recently passed JOBS Act of 2012 may make IPOs easier, but I doubt it will prove to be a good thing for the investing public. See noted investor Dogbert for a common view of retail IPO investors (or simply check Facebook’s aftermarket performance).

…and so, there are fewer venture funds. The typical investors in venture funds — entities like pensions and endowments — typically follow a guideline on their asset allocation. They invest set percentages of their portfolio into different types of investments such as public equities (US and foreign), real estate, private equity, venture, etc. With the US stock market’s lackluster performance of late, the denominator has dropped. The total amount they’d seek to invest in venture, even if it performed well, has decreased. Given the poor asset class performance (and a certain degree of herd mentality), these investors have been piling into private equity rather than venture, further exacerbating the trend.

Furthermore, as readers of this blog know all too well, healthcare is complex and difficult to work in. Rooks’ First Rule of Healthcare Investing therefore states, “If you want buyers who make rapid and rational decisions, you shouldn’t target physicians or hospitals.” This means healthcare-focused venture has been hit particularly hard. The broader technology funds which seem to prefer to roll the dice on the next Instagram or gaming app are managing to raise billion-dollar funds despite the challenges of asset allocation, while some of the best venture-stage healthcare investors I know are struggling to raise their next fund, even though they have backed companies that are household names to the readers of this blog (and include current and former HIStalk sponsors.)

So, we have fewer venture investors out there, and they both need and want to want to write larger checks. What are they seeking? That’s likely another post, but in my mind, the top criteria tend to be:

• Scale. Investors seek to maximize returns while minimizing risks. For many, that means they want to back a business that has already shown a lower adoption risk. In other words, does the business have a sales track record, and will the product or service sell? The proxy for this seems to be at least $5 million in revenues. One-time revenues such as licenses are often acceptable, but recurring (i.e., subscription) is obviously preferable. Investors love SaaS for a reason.
• Barriers. What is proprietary about the offering? Can it be easily replicated by competitors with time and capital?
• Market. What is the size of the addressable market? I find most of these statistics are pulled from thin air, but at least some attempt to quantify should be made, and please avoid what my entrepreneurship professor called The China Syndrome: “There’s a billion people in China, if they each buy one …” When a sector approaches 20 percent of the US GDP, this is an easy road to go down, but without an earnest attempt at quantifying the market for the specific product, it will lead to, “Interesting story, love the idea, call me back when …”
• Team. “Bet the jockey, not the horse” is a truism that proves out repeatedly. Investors would typically prefer to back a failed entrepreneur than someone who’s never been one. Track record is why I believe Humedica has raised over $60 million and Castlight raised $100 million in one recent round alone. Whether they will prove to be good investments can’t be known, but the fact that Michael Weintraub and Giovanni Collella both ran successful businesses with good exits (Pharmetrics and Relay Health, respectively) is as good a predictor as one can find.

Filling the so-called “venture gap,” groups such as super angels have arisen, typically offering not only checkbooks, but also expertise and relationships similar to what VCs can provide. Exploring this topic will be a post for another day.

In the mean time, please keep those questions and notes coming. While I’m rarely shy about sharing an opinion or sounding off, my biggest challenge is what readers would find interesting. I’ve spent most of my career as an analyst or banker, so what I take for granted (albeit sometimes painfully gained knowledge), might be unfamiliar to readers whose daily lives are more focused on patient care or with a vendor. If there’s a relevant topic you’d like to read about, please let me know!

I’ll be attending Health 2.0 here in my new hometown in a few weeks, which I’m sure will provide the grist for another post. If you’d like to connect there, let me know.

Ben Rooks spent a decade as an equity analyst and six long years as an investment banker. In 2009 he formed ST Advisors to work with companies on issues that don’t solely involve transactions. He loves e-mail.

News 10/3/12

Top News

Patients say they are better equipped to help manage their own medical conditions when physicians give them access to their visit notes, according to the year-long OpenNotes study published in Annals of Internal Medicine. Ninety-nine percent of patients at the three participating hospitals who responded to the survey said they wanted the project to continue. None of the participating physicians elected to end their participation at the study’s conclusion — they were less enthusiastic about the patient benefits, but found that allowing patients to review their notes didn’t require any additional time or effort on their part. Responses to the potential benefits in the graphic above are indicated by circles (patients) and squares (physicians).

Reader Comments

From Jedi Knight: “Re: EHR adoption numbers. Has anyone pointed out that ONC and CDC are tracking very different numbers? They are showing 58 and 39 percent, respectively.”

From Start and Stop Again: “Re: Nuance. How do you think 3M feels with Nuance acquiring QuadraMed’s Quantim and JATA, who clearly compete with 3M? This has to signal the end of Nuance’s Computer-Assisted Physician Documentation announced last February in a partnership with 3M. Does Nuance think it can stitch the pieces of two dusty companies into Frankenstein?” Unverified.

From Familiar with the Transaction: “Re: McKesson acquiring MED3OOO. It’s a good fit. MCK gets the InteGreat EHR, which has a lot of functionality including a data warehouse and integration with Medicomp’s Quippe. They get instant market share in specialty revenue cycle management such as lab, emergency, and ambulance billing. They get a new market in full management of multispecialty groups, and ACO market opportunity from someone further down the path than they were. Not to mention that they take out a competitor and pick up a decent client base.”

From What, Me Worry?: “Re: West Penn Allegheny downtime. Patient care was not affected – we rely on meaningfully used paper.” West Penn’s servers went down Tuesday morning after a power surge, forcing the hospital to use paper backups. Some systems were up eight hours later and others were expected to come online overnight. It’s not much of an EHR pitch when a hospital claims that being without the computer didn’t really make any difference in patient care. That’s probably more of a PR observation rather than a medical one, though.

From THB: “Re: Allscripts. Are the reports that the company is putting itself up for sale accurate? After your hard day at work, here I am asking you to validate more information, i.e. do more work.” Bloomberg News claimed Friday that Allscripts talked to several private equity firms before engaging Citigroup to explore its options, but neither company would confirm. Shares have risen 11 percent since then, which might be meaningless since (a) the original rumor may have been planted by someone anxious to sell their shares, which is always possible; (b) the rumor may be incorrect; or (c) the rumor may be correct, but may not result in any decisive action. Reasons that going private makes sense: (a) the company’s shares tanked and haven’t recovered after an ugly day in April in which the company fired its board chair, saw three other board members quit in protest, announced the departure of its CFO, and reported lower earnings and guidance; (b) the company conceded to demands by a large shareholder to add its three candidates to the Allscripts board, and those new directors may be influencing the discussion of strategic alternatives; (c) the critical Q3 earnings numbers will be announced in November, and if they aren’t looking so good, this would be the time to plan an escape route from the bloodbath that’s likely to follow; and (d) the stock has fared so poorly in a generally good market that any major strategic changes might be better conducted outside of Wall Street’s baleful glare. My answer, then, is that I have no idea if the rumor is true, but I suspect that it is, and even that wouldn’t mean much until Allscripts decides what it wants to do.

HIStalk Announcements and Requests

My new iPhone 5 arrived last Friday and I am happy to report I have successfully made the migration. It’s definitely faster, the camera is better, it’s lighter, and I like the bigger screen. The battery life, however, does not seem any better than the iPhone 4 and actually seems worse, if that is possible. Maybe the battery life is longer in standby mode, but not when you are using all the cool new features. I also checked out the new maps utility and was amused that my “hospitals” search presented me with an option for “The Shoe Hospital” and for an animal hospital, but no traditional hospitals. It did find more choices when I searched “hospital” (singular), however. An “emergency room”  search found a few urgent care centers, but missed the three closest me and didn’t find any ERs attached to a hospital. Good luck with that issue, Mr. Cook.

Acquisitions, Funding, Business, and Stock

Tenet Healthcare subsidiary Conifer Health Solutions will acquire InforMed Health Care Solutions, an information management and services company.

Ontario-based Kallo, Inc. enters into a $2 million stock purchase agreement with Kodiak Capital Group. The company offers EMR, PACS, and medical device connectivity solutions.

Nuance acquires JA Thomas and Associates, which offers clinical documentation improvement programs. Obviously Nuance is interested in clinical documentation and the ICD-10 transition given the September 27 announcement that it had acquired QuadraMed’s HIM solutions (coding, compliance, computer-assisted coding, abstracting, record and document management, workflow, and clinical documentation integrity) and its acquisition earlier this year of Transcend, which offered transcription and clinical documentation (including the documentation and charge capture solutions of Salar, which Transcend acquired last summer).

HIMSS acquires CapSite, which offers a vendor database that includes actual pricing and contract information as well as research services that HIMSS will fold into HIMSS Analytics. It will be interesting to see how HIMSS balances the confidentiality desires of its vendor members against CapSite’s detailed and vendor-specific pricing and contracting information. My speculation is that it will go away, replaced by aggregated non-identifiable vendor information. And as I tweeted when the news was announced, that means that HIMSS is now an inadvertent HIStalk sponsor, which Inga pounced on with great glee.

In one of the oddest healthcare transactions in recent memory, The Washington Post Co. buys a majority stake in a hospice and home health service, obviously desperate for further non-media diversification as its Kaplan education cash cow dries up after the government reins in for-profit colleges.

Healthcare billionaire Patrick Soon-Shiong announces a deal between his NantHealth company and Blue Shield of California, which will work with St. John’s Health Center in Santa Monica, CA to roll out healthcare breakthroughs and personalized medicine. He will present the news to a Bipartisan Policy Center conference in Washington, DC on Wednesday, starting with an invitation-only 8:00 a.m. small-group breakfast session and then a larger session later in the morning. He’ll be joined in the session covering the use of supercomputer-powered genomic medicine by Senator Bill Frist; J. Michael McGinnis of the IOM; the president of Blue Shield of California; the top medical executives from AT&T, Verizon, and Caremark; and several academics.

Sales

The board of New York City Health and Hospitals Corporation approves execution of a ten-year, $303 million contract to implement Epic throughout the entire corporation. I believe the incumbent was QuadraMed Affinity, although it’s been a long time since I’ve thought about HHC. Cerner and Allscripts were the losing bidders and Allscripts has formally protested the award to Epic, which I would assume means HHC passed on the lower bid by Allscripts, which isn’t at all unusual when prospects get Epic fever. I assume the only difference from the usual hospital decision is that HHC is a government entity, so there’s someone to complain to. UPDATE: readers tell me the product HHC is running is QuadraMed CPR, the former HDS Ulticare / Per Se Patient1 / Misys CPR that they bought from HDS in the early 1990s and used in all inpatient, outpatient, and ancillary areas. It won them a Davies Award in 2006.

Baton Rouge General Medical Center (LA) chooses RelayHealth for its enterprise HIE.

The 77-physician Optimal Radiology selects McKesson Revenue Management Solutions for billing, reporting, and collections.

Faxton St. Luke’s Healthcare (NY) adds the Surgical Information System anesthesia information management system to its Allscripts Sunrise Surgery perioperative system.

The US Coast Guard awards Lockheed Martin a $2.3 million contract to develop a mobile interface to its Epic-powered EHR.

People

Device integration provider Nuvon appoints Christopher Gatti (Living Strategies) CEO and Stephen Spencer (Advantis Medical) VP of sales and marketing. Cathleen Asch will transition from CEO to EVP of strategic initiatives and remain on Nuvon’s board.

Jo Ann Rooney (DoD – above) and Robert Mills (ACS/Xerox) join Huron Consulting Group’s healthcare practice as managing directors.

The Military Health System names David Bowen (FAA) CIO.

University of Buffalo School of Medicine names Peter Winkelstein, MD as executive director of the school’s Institute for Healthcare Informatics. He is also CMIO of UB/MD.

Impact Advisors hires C. Lydon Neumann (Accenture) as VP.

Health Care DataWorks names founder Jyoti Kamal, PhD as president. She was previously deputy CIO and director for the information warehouse at The Ohio State University Wexner Medical Center.

Aspirus names Todd Richardson (Deaconess Health System) as CIO.

Jonathan Grau (AMIA) joins National Quality Forum as senior director of stakeholder collaboration.

Florence Chang is promoted to EVP of MultiCare Health System (WA). She was previously SVP of clinical support services and CIO.

Announcements and Implementations

WakeMed Health & Hospitals (NC) implements the Philips eICU remote critical care monitoring technology.

AHIMA awards the University of Wisconsin Hospital and Clinics the Grace Award for demonstrating effective and innovative approaches in using health information to deliver high quality healthcare.

Healthland will integrate Health Language’s terminology platform to support ICD-10 readiness and terminology standardization.

UnitedHealthcare commits $20 million to help 11 critical access hospitals in California improve their technology, including the addition of EHRs.

Partners HealthCare pledges to award Massachusetts community health centers $90 million over the next 15 years to upgrade technology and make other infrastructure improvements.

CORHIO announces that all six northern Colorado hospitals are connected to the HIE.

UPMC, Oracle, IBM, Informatica, and dbMotion will create a $100 million data warehouse that combines clinical, financial, administrative, and genomic information for analytics and predictive modeling applications.

Orion Health awards Cognosante a contract to provide integration and identity management for the first stage of the Massachusetts Statewide HIE program.

MModal makes available its Catalyst for Quality solution for clinical documentation.

North Carolina Healthcare Information & Communications Alliance offers a Vendor Management Policy Template that addresses HITECH requirements for business associate agreements. It’s free to NCHICA members, $50 otherwise.

A study published in the Journal of Clinical Epidemiology finds that DynaMed is ranked highest of 10 online clinical resources based on timeliness, breadth of coverage, and quality of supporting evidence.

CTG signs an Epic implementation contract with an unnamed five-hospital IDN.

The city of Billings, MT goes live with an ONC-funded and Dossia-powered pilot project to give its employees the ability to view and manage their electronic health information.

Dolbey announces the VoiceBox recording system that tags physician dictation so that the completed transcription can be inserted into the correct location of the EMR.

Verizon announces a cloud and data center infrastructure for storing and sharing PHI. Unlike non-healthcare cloud providers, Verizon will sign a business associate agreement that meets HIPAA requirements.

VersaSuite announces that its 8.0 product has earned pre-market CCHIT ED certification. VersaSuite is certified for both inpatient and ambulatory use, a distinction it says only two companies have achieved.

Government and Politics

Medicare initiates two ACA-legislated programs that target quality of care and readmission rates in hospitals. The Hospital Value-Based Purchasing Program allows the government to pay hospitals bonuses if they meet high performance standards on certain quality measures, while the Hospital Readmissions Reduction Program enables Medicare to reduce reimbursements up to one percent for hospitals with high readmission rates.

ONC announces a goal of helping 1,000 critical access hospitals achieve Meaningful Use by the end of 2014.

ONC releases a consumer-focused video on the benefits of electronic medical records, with cameos by Todd Park, Don Berwick, Farzad Mostashari, David Blumenthal, and others.

Innovation and Research

Kaiser Permanente researchers find that the use of an EHR improved drug therapy and follow-up monitoring of Type 2 diabetics, as well as improved the patients’ glycemic and lipid control.

Health Nuts Media launches a crowdfunding campaign, hoping to raise $90,000 to develop an asthma education app for children. Rewards are offered for various donation levels, with a $50 contribution earning a copy of the app, a “Wall of Fame” credit, coloring pages, a poster, recognition in the app, and a tote bag.

Technology

CalHealth prepares to launch MD Mouse, a device that measures pressure information when a finger is slid inside a cuff that folds out from the middle section of the mouse.

Other

The Census Bureau says adults under age 65 made an average of 3.9 visits to physicians in 2010, down from 4.8 visits in 2001. Possible explanations: more uninsured, fewer physicians, higher patient costs, innovation that allows providers to accomplish more in a single visits, and more meds available without a prescription.

Cerner expects over 10,000 attendees from 21 countries at its 27th annual Cerner Health Conference next week in Kansas City.

An Irish pediatric surgeon is found guilty of poor professional performance after a 2010 error in which the wrong mouth surgery was performed on a baby. The doctor correctly ordered an upper lingual frenulectomy in his patient notes, but an administrator entering the procedure into the hospital’s computer system said the only option it gave him was “tongue-tie.” He chose that option, it printed on the OR list, and the surgeons performed that operation. They chairman of the inquiry committee said he was satisfied with the decision even though the committee had concerns about the OR scheduling and coding systems.

Weird News Andy is amused that a study finds that tickling rats after inducing a stroke appears to prevent paralysis and sensory deficits, possibly by forcing a rerouting of blood through unblocked veins. Playing music seems to work equally well, leading to the “it may not help, but it can’t hurt” recommendation that when someone is suspected of having a stroke, squeeze their hand and talk to them. WNA is also amused at the prospect of giving the rats warfarin as a stroke treatment, which usually is dosed in much larger quantities in the form of rat poison.

WNA cheers this story with a hearty “Hear, hear.” Doctors at Johns Hopkins successfully create a new ear for a woman who lost the original to cancer. They grew the new ear under the skin of her arm until it was ready to be attached.

Strange: a veteran sues the VA for $10 million, claiming that a nurse packed his groin with ice for 19 hours following his genital surgery, causing frostbite that required reconstructive surgery.

Sponsor Updates

• Elsevier launches its nationwide ClinicalKey Experience Tour, an all-day outdoor event at hospitals and academic centers to promote its ClinicalKey clinical reference tool.
• Iatric Systems offers an October 11 webcast on Meaningful Use Stage 2 featuring Beth Israel Deaconess Medical Center CIO John Halamka, MD.
• Michigan Orthopaedic Institute (MI) selects the SRS EHR for its 17 providers.
• Intelligent InSites announces members of its Healthcare Advisory Board.
• Collom and Carney Clinic Association (TX) selects MModal Fluency Direct to voice-enable its EHR.
• Cynergis Tek CEO Mac McMillan achieves the Fellow of HIMSS designation in recognition of his advancement of privacy and security within healthcare.
• Balsam Healthcare Corporation (Saudi Arabia) licenses First Databank’s Middle East Drug Knowledge solution for integration with the OASIS HMIS system. FDB also releases new customizable alert categories within its FCB AlertSpace alert management system.
• Delta Health Technologies selects ZirMed as a preferred business partner to provide RCM solutions to homecare providers.
• McKesson hosts its 25th Health Solutions Conference next week in Orlando.
• Gregg Mohrmann and Mark Van Kooy, MD of Aspen Advisors will lead sessions at this week’s New Jersey HIMSS/Delaware Valley HIMSS joint annual conference.

A Report from athenahealth’s “More Disruption Please: The CEO Retreat”
By Jonathan Baran, Co-Founder and CEO, Healthfinch

Athenahealth’s recent "More Disruption Please" event brought together 50 CEOs of health IT companies and their investors to the Point Lookout Resort in Maine (a resort that athenahealth bought for $7.7M… a steal!). Each CEO was given their own private log cabin to stay in (or to sleep off late nights with Jonathan Bush). The purpose of the meeting was for athenahealth and these newer, innovative HIT companies to get to know and learn from each other.

Any time you get to spend time with Jonathan Bush, you never know what to expect. He did not disappoint, as he began at eight in the morning by impersonating Ali G, telling everyone how athenahealth gets "ka-ching and da bling for doing the right thing!" A couple of more presentations followed, including one by Marty Anderson, who asked how innovation can come from the top-down when "the healthcare industry is a giant cartel."

Then the fun began as 30 CEOs gave two-minute pitches, with five finalists promised a ten-minute presentation to 2,500 of athenahealth’s users. We (Healthfinch) were selected as one of the five finalists, along with iTriage, Entrada, Epion, and Wellframe. In a smart market research move, athenahealth then asked their customers to vote on which company’s product they would most like to see integrated with athenahealth. Ultimately, our scrappy startup from Madison, Wisconsin took second place to Aetna’s iTriage.

Jonathan Bush’s final display of how to "keep it real even when you’re CEO of a publicly traded company" began when he gave us a lesson on how to build a successful business model. Jonathan, like every other EMR CEO, drew inspiration from the “Saturday Night Live” skit, "D— in a Box." He gave us all the following instructions:

1. Get a box (find a pile of work that users hate and suck at).
2. Cut a hole in the box (figure out how to break into the market).
3. Put your junk in the box (bring your secret sauce to the market).

I couldn’t say it any better myself.

Athenahealth also discussed more of their plans for their entire "More Disruption Please" program, the smartest move being their recognition that the biggest challenge in bringing innovation to market (and thus allowing small companies to flourish) is in the distribution channel. That’s why athenahealth is promising to bring the top innovations to their customers by rapidly scaling interesting products and innovations to their entire user base.

Time will tell if athenahealth can live up to its grand plans to become the information backbone of the health system, but their program (and their conference) seem to indicate they are on the right track.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Curbside Consult with Dr. Jayne 10/1/12

It’s the first Monday in October, which means the United States Supreme Court is back in session. No, those aren’t our justices dressed up as Santa Claus. That’s actually a photo of the Justices of the Supreme Court of Canada. I found it much more eye-catching than the photo of our Court, where poor Ruth Bader Ginsburg looks like she’s off in the time-out chair.

Just when the Court thought it was done dealing with healthcare and the right to refuse government intervention, it agreed to hear three cases this session that deal with those issues at least on some level:

• Delia v. E.M.A. handles the concept of whether states can recover money spent to deliver care for poor or disabled Medicaid beneficiaries when it is found that they have received funds from another source.
• Levin v. United States addresses whether military medical personnel can be immune from alleged “battery” while providing medical care to a civilian.
• Missouri v. McNeely will look at whether law enforcement officers have the right to obtain blood samples from allegedly drunk drivers regardless of consent.

Except for the Medicaid issue, these cases don’t seem terribly earthshaking for the masses. There’s an underlying concern in some camps, however, that the Court is somewhat fractured after the Affordable Care Act drama of the last term. The Atlantic reports that Chief Justice John Roberts alienated his conservative colleagues when he saved the Act.

I trust that the Justices are adults and would be above any middle school-style backstabbing to make up for perceived (or real) slights in the previous term. They’re human, however, so there’s still the potential for some drama. I’m personally looking forward to some entertaining transcripts. Last year provided some rare treats, and I don’t think broccoli has received that much national press since George H.W. Bush refused to eat it.

Although the court has only accepted a few cases so far, more will be reviewed for inclusion this term. We could potentially be looking at decisions on same-sex marriage, the Voting Rights act, or election law. With a Presidential election looming, let’s hope we don’t have to hear any cases about hanging chads or other election day fallout.

Another major case on the docket, Fisher v. University of Texas at Austin, looks at affirmative action in university admissions. Depending on which way that one goes, it could lead to shakeups in medical school admissions that could have a profound impact on the diversity of the future health care delivery workforce.

Regardless of your political orientation, the Court always seems to bring something to the table for everyone to be happy about. We don’t get that very much from our other branches of government, so here’s to another term.

Have a favorite Justice? Want to suggest some kickier shoes for those that sit in the front row for the official portrait? E-mail me.

E-mail Dr. Jayne.

Collective Action 10/1/12

The views and opinions expressed are those of the author personally and are not necessarily representative of current or former employers.

Collective Action. What does that mean, and why would Mr. H and team allow this to emerge on such a highly regarded and respected industry blog?

I will attempt to answer that question with a definition, a story, and a vision. To put this in context, you will need to know a little bit about me.  

My name is Bill Rieger. I work at Flagler Hospital in St. Augustine, FL, serving as the chief information officer for our community hospital.  Like all of you, I have many life experiences. Some of them were tragic, riding on the edge of self-destruction and death (let’s just say that the 80s were rough, but the last 21 years were much better). Some were hilarious, some were somber, and some were absolutely revolutionary and life altering.  

I have come to believe that all of those experiences were necessary to help me find my destiny.  I am not going to go off here on a deeply philosophical tangent, but I do believe we are all searching for something. Some of us — if not most — are waiting for something big to happen before we take that step we know we could or should take.  My destiny — my calling, if you will — is to encourage you not to wait, but instead to take that leap, that step of faith.

Wikipedia defines collective action as, “Any action aiming to improve the group’s conditions (such as status or power), which is enacted by a representative of the group.” I like the idea of aiming to improve healthcare. I strongly believe that healthcare will best be changed by those who have dedicated their life to this field and are willing to listen to every and all ideas to facilitate growth and improvement.  

The ideas this industry needs will not predominantly come from government, or even hospital executive leadership. I believe the greatest untapped resource for creative ideas will come from the ground floor. Yes, we the people.

The first time I realized this was when I was a golf cart attendant.  Golf is one of my passions. I am fairly decent, usually shooting somewhere in the mid 80s. I was putting carts away one evening as we were preparing to close up for the day. I saw this very Dilbert- looking man working on a rat’s nest of a wiring distribution frame. As I was patiently waiting for him to finish, my type A took over and we struck up a conversation. I asked him if he was a contractor, and he told me that he was not, he was the IT manager there at the resort. I shared my experience with working on wiring frames in the Navy. No sooner had I got that out of my mouth when he asked me to be his assistant. 

In shock, we both started to ask questions. I told him that I was in school trying to get my degree in computer science and that I could not work full time. He told me that was fine. I asked how much it paid. He asked me how much I made. I told him $5.50 per hour plus tips. He told me $12.00 per hour. SOLD! $12.00 per hour — that is crazy money, I thought. I AM RICH! I was living in a trailer. I had a old truck, an old motorcycle, and a snake. This 100+ percent increase in pay would allow me to move up to the big time and fix my floorboards.

I cannot tell you how many times I reflect on that story. There are so many lessons there, but it really epitomizes what I am trying to do with this column. Whether you are putting carts away, moving patients around, writing code, selling products and services to hospitals or ambulatory facilities, presenting to the board, or implementing and optimizing an EMR, you have value. This industry needs the value you have. That Dilbert guy — my now long-time friend Ted — thought I had value when I did not see it. I want to encourage ideas, leadership, creativity, and discipline. But most of all, I want to encourage you to take some action.  

My vision for this is to think big. Think big with regards to what you can accomplish. Think big because we have big problems to solve. Think big in case you succeed!  

I do not believe that all people are inherently good. I do believe, however, that all people are capable of accomplishing more than they think. My goal is to make these articles challenging, humorous, relative, entertaining, impactful, and most of all, encouraging. I welcome all feedback, even and especially a contradictory viewpoint — they are usually enlightening. Please share your steps, even small ones, as you progress with confidence to bring an industry through a new level of maturity.

Why would Mr. H and team want this on their blog? The spirit of HIStalk, according to the “About” section of the website, is informing people about industry news and trends. Mr. H must believe that encouraging HIT professionals to achieve great things in their respective professions is good for the industry and a trend that bears supporting.

Bill Rieger is chief information officer at Flagler Hospital of St. Augustine, FL.

HIMSS Acquires CapSite

HIMSS announced this morning that it has acquired CapSite, which publishes the CapSite healthcare technology database that includes vendor pricing and contracting information, including 5,000 actual vendor proposals and contracts representing 1,600 vendors.

HIMSS will incorporate CapSite’s offerings into its HIMSS Analytics services, which has not included pricing information. HIMSS says it will also add voice of the customer consulting services through customized research, including analysis of vendor market position that includes product gaps.

According to HIMSS President and CEO Steve Lieber, “The investment in CapSite follows our overall strategy for HIMSS Analytics to provide the best market intelligence on the hardware, software, and services selected by chief information officers and other users of information technology. We will maintain the CapSite office in Burlington, VT with CapSite employees joining the HIMSS roster as part of the HIMSS Analytics team.”

McKesson to Acquire MED3OOO

McKesson announced this morning that it will acquire MED3OOO, which offers physician practice administration services, revenue cycle management, and software. The Pittsburgh-based company employs 2,800, has 10,000 physician users, and has stated annual revenue of $200 million.

McKesson will incorporate MED3OOO’s products and services into its McKesson Revenue Management Solutions business. The announcement quotes its general manager, SVP Pat Leonard, as saying, “McKesson and MED3OOO share a commitment to help customers navigate growing healthcare complexity and achieve their full potential. We are excited about the opportunity to combine best practices and superior technologies to help providers and other customers improve their operations and achieve better business health as part of our Better Health 2020 strategy.”

We mentioned the acquisition several times over the past few weeks in HIStalk, although without specifically naming MED3OOO since McKesson is a publicly traded company. Our November 2011 interview with MED3OOO Chairman and CEO Pat Hampson provides more detailed information about the company.