News 5/4/12

Top News

The US Congress asks Accretive Health CEO Mary Tolan to provide the company’s hospital customer list, employee policies, and past complaints, citing its concerns about violations of HIPAA, EMTALA, and the Fair Debt Collection Practices Act. Above is a snip from the letter. AH shares dropped 3% Thursday and another 2% in extended trading, having given up 58% in the past four weeks.

Reader Comments

From Calorie Counter:  “Re: Cinnabon and nurses. Cinnabon is giving nurses free rolls (730 calories, 24 grams of fat) in honor National Nurses Week. Maybe hospitals should ban Cinnabon consumption.” Yeah, well, I wish hospitals good luck with enforcing that. Here’s another brilliant marketing idea: maybe CVS should consider honoring nurses by giving them a free pack of cigarettes.

From HIPAA Police: “Re: passwords. A nurse in IMCU was complaining to me about having to remember too many passwords. She then showed me the back of the badge to illustrate just how bad it is and let me take this photo.” In case you can’t make it out, her badge notes the passwords for several different systems, including Pyxis, pharmacy, and e-mail. I am sure that HIPAA Police does not work at the only hospital that can’t afford an SSO solution, so how do others manage multiple passwords? Bigger badges?

From Sweet Tea: “Re: size of the healthcare IT market. One commercial company’s estimate is $40 billion per year, close to your estimate of three times Vince’s $12 billion revenue number for the largest companies.”

From Stock Analyst: “Re: size of the healthcare IT market. Our company thinks it’s around $32 billion in size, of which $9 billion is hospitals.” Thanks for that information.

From J-Lo: “Re: Stage 2 comments. I seem to recall that with the Stage 1 NPRM, you could see the comments everybody else submitted. Is that not the case with Stage 2?”

From Nasty Parts: “Re: Allscripts. If things to continue to go bad for Glen Tullman, he can always focus on his other company. How many people know that Glenn is the CEO of another company?” At least 20,000+, assuming HIStalk’s readers paid attention when I mentioned it a couple of times in the past. People are always sending me stuff that I’ve already run, though, so maybe they’re trained by newspapers to assume that small stories aren’t important and are skimming HIStalk posts just a bit too fast. Here, I could describe World War III in one paragraph while using twice that space to rave about some weird band I like.

From Moe: “Re: Trinity Health. The group of hospitals in Columbus, OH (Mt. Carmel) brings 10,000 users live on Cerner big bang , including revenue cycle, clinicals, lab, and more.” Nice. If you have any pictures, send them over. Who doesn’t love command center pics?

HIStalk Announcements and Requests

This week’s highlights from HIStalk Practice: electronic medication reminders may improve adherence in the short term, but long term effectiveness remains unclear. More than 40% of all primary care providers are enrolled in RECs, including 50,000 in practices with fewer than 10 physicians. CareCloud CEO Albert Santalo wins Miami’s Technology Entrepenueur of the Year award. Dr. Gregg muses on odds and ends, inluding a shift in HIT discussions beyond Meaningful Use and the end of service for a few clinical informatics professionals. If you’re not a regular HIStalk Practice reader, what are you waiting for? And if you are one of the thousands of readers stopping by each month, many thanks!

A few folks always seem to be getting Inga and me confused, sending her information intended for me. Just to clarify: we don’t tag straight news items with who wrote them – we both do. If Inga adds her opinion, answers a question directly, or otherwise writes something in a way that might not be clear who’s talking, I put the little red icon in front of that item (as above). Otherwise, it’s me (Mr. H) you’re reading. I was tagging my items with a blue icon, but that was a bunch of unnecessary blue icons given that it’s just the two of us (other than Dr. Jayne, who has her own clearly marked section).

A pet peeve: confusing one-word adjectives with two-word nouns and adverbs. Example: Walmart may have everyday low prices, but you will see them in the story every day (not everyday.) You may have a backyard swimming pool, but it’s not in your backyard.

Acquisitions, Funding, Business, and Stock

MedAssets reports Q1 numbers: revenue up 15%, EPS $0.00 vs. -$0.28, with the company pointing to costs involved in its Broadlane acquisition in November 2010, but still beating estimates on both revenue and earnings. Non-GAAP earnings were $0.24 vs. $0.17.

The Advisory Board Company announces a 2-for-1 stock split following the release of its Q4 numbers: revenue up 33%, EPS $0.46 vs. $0.30.

Amcom Software acquires the IMCO-STAT CTRM product from IMCO Technologies that will allow traceable delivery of critical lab test results to the ordering physician by paging, PCs, tablets, and smart phones.

Facebook’s upcoming IPO will raise about $11 billion based on Thursday’s announced price range, valuing the former dorm room project at up to $100 billion.

Two law firms file class action lawsuits against Allscripts, charging the company and its officers with intentionally hiding failed integration efforts, missing its revenue and earnings guidance, and misrepresenting its post-merger prospects after it acquired Eclipsys. All routine and rarely meaningful, of course, guaranteed to happen when any company’s stock drops unexpectedly.

Sales

HHS contracts with Archimedes, Inc. to develop a modeling and simulation software platform for clinical scenarios, health interventions, and disease conditions.

Samaritan Regional Health System (OH) enters into a multi-year contract with CareTech Solutions for comprehensive IT services.

Radiology Associates of Fox Valley (WI) selects McKesson Revenue Management Solutions for its 33-physician practice.

Shands HealthCare will use the Rothman Index to monitor patient status and to conduct research at its Gainesville and Jacksonville campuses. I interviewed co-founder Michael Rothman 18 months ago for insight into how the software works.

People

Medecision names Katherine Schneider MD (AtlantiCare) as chief medical officer.

Former Eclipsys CFO Bob Colletti joins academic credentials exchange vendor Parchment as CFO.

MIT Sloan CIO Symposium chooses four finalists for its CIO innovation award based on four criteria: trusted advisor, business leader, strong communicator, and proven manager. Among the finalists is Catherine Bruno, VP/CIO of Eastern Maine Healthcare. Healthcare CIOs on the speaker list for the May 22 event include James Noga (Partners HealthCare), Chuck Podesta (Fletcher Allen Health Care), and Sue Schade (Brigham and Women’s Hospital.)

DuPage Medical Group (IL) names Krishna Ramachandran as chief information and transformation officer, where he will lead the 330-physician group’s Value Driven Health Care initiative. I note that he’s a member of the HIStalk Fan Club on LinkedIn, so special congratulations to him (it’s fun to read down the list of 2,408 members – since most folks have photos, it’s like an HIT yearbook.)

Announcements and Implementations

Mercy Health System (PA)  activates its Meditech EHR across its four hospitals and 44 physician offices.

Phoebe Putney Memorial Hospital (GA) goes live on McKesson CPOE on May 15.

Newark-Wayne Hospital (NY) goes live on Epic as part of Rochester General Health System’s $65 million EHR initiative.

JPS Healthcare (TX) will go live on its $110 million Epic system this Saturday, the seventh Metroplex-based health system to do so.

Practice Fusion launches an API that allows any laboratory to connect directly to its EMR and send lab results using standard HL7 data files.

Gartner names Kony Solutions a Visionary in its report on mobile application development platforms. The company also announces that it supports the BlackBerry 10 platform.

CE Broker announces the EverCheck paperless system for automatically verifying professional licenses for credentialing, including sending alerts about licensure status changes and maintaining an archive of all licensure changes for Joint Commission review. The price is $0.45 per employee per month.

Vassar Brothers Medical Center (NY) credits technology it had just installed with saving the life of a firefighter who had a heart attack during a fire. His EKG, taken immediately in the ambulance, was sent to cardiologists at the hospital, allowing them to hit a door-to-balloon time of 18 minutes, a third of the standard. The technology they use is AirStrip Cardiology (remote EKG viewing), GE Healthcare’s MUSE Cardiology (EKG storage), and Physio-Control’s LIFENET (EKG sharing between emergency medical services and hospitals).

The Johns Hopkins Hospital opens its new Sheikh Zayed Tower and The Charlotte R. Bloomberg Children’s Center using the Versus Advantages RTLS to support asset tracking, fleet management, nurse call automation, and food cart tracking. New York Mayor Mike Bloomberg donated $120 million of the $1.1 billion construction cost of the two towers.

MediServe announces a Web-based solution for private practice therapy providers. The Attigo system includes billing, documentation, scheduling, and practice management.

Government and Politics

During this week’s HIT Policy Committee meeting, members discussed whether licensed professionals and scribes should be allowed to enter data into EHRs on behalf of physicians under the Stage 2 MU program. The proposed rule would require physicians to use their own user IDs when accessing the system, also holding them responsible for approving information entered on their behalf by anyone else. Several committee members raised concerns that the doctor won’t benefit from clinical decision support otherwise since most systems provide their guidance during order entry.

Also from the HIT Policy Committee meeting: CMS reports that more than $5 billion in Medicare and Medicaid MU incentive payments have been made to 93,650 EPs and hospitals through the end of April.

Representative Renee Ellmers (R-NC), chair of a House subcommittee on health technology (also a nurse and the wife of a surgeon), asks CMS to exempt from MU requirements those physicians in small practices and those close to retirement.

Other

The US again outspends other industrialized countries on healthcare with mixed results. At $8,000 per person, well above the next-highest Norway and Switzerland at $5,000, survival rates for breast and colorectal cancer were the highest, but death rates for asthma and diabetes-related amputations were also the highest. The report blames US costs on expensive drugs, medical services, and technology such as MRIs and CT scans, with a high obesity rate also adding to the total.

In Canada, the Hospital Employees’ Union publicly criticizes the outsourcing of 130 hospital medical transcriptionist jobs, saying the result will be less secure, of lower quality, and increasingly expensive. The hospital executive in charge of HIM says they’re already outsourcing half their transcription to the same group without problems, no information is stored on transcriptionist PCs, and per-minute rates are the same as they were in 2006 and will save $3 million of the $14 million annual transcription budget. Part of the appeal was the chance to move to a system that has better speech recognition capabilities.

Also in Canada, Nova Scotia’s Department of Health and Wellness and Canada Health Infoway announce an expansion of their peer support program for users of the Nightingale ambulatory EMR.

McKesson Automation’s building in Cranberry Township, PA was evacuated Tuesday evening after a female employee reported hearing a bomb. Police gave the OK to return when they concluded that the woman was hallucinating after experiencing an adverse reaction to an unnamed medication.

Bloomberg BusinessWeek profiles eClinical Works CEO Girish Kumar Navani and the company’s involvement with health projects in New York City. The company’s annual revenue was reported as $250 million.

Sunday night’s finale of The Amazing Race pits Epic employee Rachel Brown and her husband, Major Dave Brown, against three other couples. The winners will get $1 million.

In Ireland, three NUI Maynooth students win the Irish finals of the Microsoft’s Imagine cup for developing docTek, which allows patients with chronic illnesses to record symptoms for online review by their doctors. They will compete in the global finals this July in Sydney, Australia.

A UK doctor is investigated after sending an 18-day-old baby home with what was later determined to be myocarditis, which killed the baby the next day. The parents say that during the examination, the doctor looked up the baby’s meds on the computer and suggested giving him Tylenol, but he never left his chair to actually look at his patient.

Sponsor Updates

• Benefis Health System (MT) signs an agreement with MedAssets to use its Spend and Clinical Resource Management Solutions and initiate use of MedAssets GPO and other cost containment services.
• Angleton Danbury Medical Center (TX) creates a paperless registration system for its Meditech system using forms software from Access.
• DrFirst announces that 6,000 pharmacies can now accept electronically transmitted prescriptions for controlled substances using EPCS Gold.
• GetWellNetwork recognizes ten hospitals for Excellence in Interactive Patient Care during its GetConnected 2012 conference.
• The Advisory Board honors Virginia Hospital Center (VA), Alegent Health (NE), and Monmouth Medical Center (NJ) with 2012 Crimson Physician Partnership Awards for improving the quality of care they provide while documenting more than $13.2 million in aggregate savings.
• MEDecision introduces its new brand and highlights the evolving healthcare market during this week’s 2012 Client Forum.
• A Detroit business publication profiles the growth and focus of JEMS Technology, which has seen one-year growth of 100% for its encrypted remote video solutions for healthcare.
• Culbert Healthcare Solutions promotes Tina Sarantos to manager of consulting services for the company’s GE and Allscripts practices.

EPtalk by Dr. Jayne

CMS keeps sending me e-mails about ICD-10. For whatever reason, I thought this header was really funny given the recent delay. I’m personally worried that the 60-day comment period for the Stage 2 Meaningful Use NPRM is almost over and I haven’t gotten my personal comments finished yet. You can submit yours via the MU specific comments page. Although my organization has submitted its own official comments, I’m encouraging every physician, provider, and patient I know to comment as well.

CMS also issues a final rule on the use of the National Provider Identifier (NPI) on Medicaid and Medicare enrollment and claims documents. I can’t imagine that anyone out there practicing doesn’t have an NPI after all this time, but if you don’t, you have 60 days until the rule takes effect.

A Circulation article documents improvements in blood pressure control among US veterans. Over 10 years of data from the VA Health Data Repository was analyzed. Authors credit performance measurements in the EHR as contributing to the improvements.

Medical Economics advises providers how to respond to negative reviews on physician rating sites. Common complaints from a patient group profiled in the article include long wait times, lack of communication about delays, not being informed about test results, and failure to return phone calls promptly. Among the tips:

• Don’t respond to negative reviews. Ask the site to remove unfair information.
• As your patients to review you since most give positive reviews.
• Conduct your own surveys to let patients feel heard.
• Start a blog or practice website to help control your online presence

For women physicians tethered to their practices via smart phone, JoeyBra provides a solution that lets you avoid those pesky purses, totes, and satchels. Right now, it’s only available in leopard print. Personally I think an iPhone is a little bulky to be storing in my bra, but to each his (or her) own. Even with the leopard print, I don’t see Inga lining up to purchase one either.

Remembering an Industry Leader and Friend
By Daniel S. Herman

John Cornelius Wade, former CIO at Saint Luke’s in Kansas City, former chair of the HIMSS Board of Directors, colleague, and a close friend of mine, passed away on Saturday.

He was ill for the past several months. I spoke with his wife Cheri Thursday evening, and to John on his birthday a couple of weeks ago. He was in great spirits and was talking shop.

I first met John in Chicago in 1987 when we served on the First Illinois HFMA chapter IS Committee when I was with KPMG/Peat Marwick and he was CIO at Northwestern Memorial.  We were reacquainted by a colleague at FCG in the spring of 1993 shortly after he took the CIO position at Saint Luke’s.

John was a loyal person who was tenacious in everything he pursued. He would drive from Kansas City to Boston all night to see family. He did home repair himself, refusing to call a handyman despite his wife’s objections (until he fell off a ladder and dislocated his shoulder).

His loyalty was expressed in many ways across business and personal situations. He was an authoritarian leader when it came to running the IS shop, and was often opinionated when interacting with his customers throughout the health system.

In 1993, John took over a data processing (DP) shop from an interim management team from Andersen Consulting. He was swift to make leadership changes inside the IS organization, also changing how the department served its customers. He redefined the IT strategy; enhanced governance, project prioritization and executive ownership of technology-enabled IT initiatives; and established service level metrics by which he measured and demonstrated accountability. Saint Luke’s went on to become one of the first healthcare organizations to win the coveted Malcolm Baldrige Quality Award and the Missouri Quality Award almost 10 years ago.

When John retired from Saint Luke’s in 2008, the health system’s IT group was (and still is) considered one of the most effective and well-run healthcare provider IT functions in the country. It has been recognized for its outstanding IT governance structure.

John accomplished much in his 71 years and touched many people. I’ve learned a lot from him personally and professionally during our 25-year friendship. His memory will be in my heart for eternity.

Information about John, including photos and information about funeral and memorial services, is available here. Please take a moment to read the many memories and tributes from his friends and industry colleagues and add your own.

Daniel S. Herman is founder and managing principal of Aspen Advisors.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

CIO Unplugged 5/2/12

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

Get Off of My Cloud!

1960s entertainment nailed the future. Star Trek tricorders are here. Lapel communicators are ubiquitous. And who can forget the Rolling Stones singing about the Cloud?

Most agree that mobility and agility are the future. The cloud is the infrastructure which enables them. The cloud is the delivery of computing as a service, not a product — akin to a utility. The cloud enables technology to propel the speed of business.

Friends recently returned from a trip abroad. The advanced wireless infrastructures found in third-world countries both astounded and pleased them. By unintentionally leapfrogging the technological revolution, these regions had bypassed the incremental advancements of the last 30 years and gone straight from laggard to leader. Societies that have not had a telephony infrastructure, for example, are suddenly delivering the highest per capita cellular subscribers.

Leapfrog advancement. Can we do it in healthcare IT? Maybe a better question to ask is: do we need to?

YES! Mobility, enabled by the cloud, is the path to the future.

Healthcare organizations viewed as laggards now have the potential to leapfrog peers. The cloud will empower them to bypass heavy capital investment and kludgy hardware and render single-organization data centers obsolete. You can shrink implementation timelines from months to weeks. Focus your institution on implementation and optimization rather than worry over floor space or cooling requirements.

If we don’t transform our organizations by routing capital away from brick and mortar to cloud-based mobile applications and services, the third world will pass us up.

As legacy hardware and software contracts expire, look for cloud alternatives. Basic requirements for any new application should include cloud capabilities. If the vendor has no cloud offering, be concerned. Ask deep questions. You don’t want the clock turn to 2015 and you still have data centers bursting at the seams with legacy applications residing on heavy iron.

The cloud has been around for several years in one form or another. Non-healthcare industries have embraced the cloud successfully. Some worry about security, yet the number of incidents are no different in the cloud versus in-house. Breaches occur in both. Security is not the barrier.

As a leader, show courage. Move your organization forward. Become relevant by leveraging mobility. Embrace the cloud!

Hey you, get onto my cloud!

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.

News 5/2/12

Top News

Castlight Health raises $100 million in Series D funding, raising its total to $181 million. The San Francisco company offers online tools to help consumers choose providers, evaluate cost and quality, and understand their healthcare benefits. Above is a TV news report about the company.

Reader Comments

From Reckless Speculator CIO: “Re: Allscripts. Glen will appoint someone from HealthCor to the board to placate them and save his Teflon self. I think he said after the Misys merger, ‘Given the choice to control the boardroom or executive suite, always choose the executive suite.’” I tweeted Monday that big Allscripts shareholder HealthCor Management is urging the company’s board to replace Glen Tullman as CEO or put the company up for sale, saying his 13-year record of underperformance is not acceptable, particularly with the HITECH tailwind and high returns to shareholders of the company’s competitors (Cerner and athenahealth were named). They point out the company’s strengths, such as Sunrise and EPSi.

From Customer CIO: “Re: Allscripts. Stock prices don’t mean much to us as a customer, but I would like to know what the company disagreement was about. Perhaps over resources for its clinical products vs. a new inpatient revenue cycle product.”

From EMRwatcher: “Re: Allscripts. Glen wants to engineer a buyout of the company. He’ll probably get fired first, but that will make it easier for him to spend time getting the cash together.”

From MDRX Files: “Re: Allscripts. They should be well positioned for the shift of focus to the ambulatory world with clinical integration and accountable care. Epic is benefitting from their solid vision and impeccable execution, but the door is open for Allscripts to raise the bar as the only company designed to deliver on the future. Everybody else has inpatient baggage that will slow them down. I hope Allscripts takes advantage of the stock plunge to go for it. The software side of the industry needs fresh thinking. Some companies will become commoditized as data an information prevail as strategic and they’re so entrenched in their transaction processing history that they can’t fathom any other world. Epic has the advantage of not being publicly traded and not required to deliver quarterly numbers, but maybe an Allscripts shakeup was what was needed to invigorate them to take a bolder view of the future.”  

From Global Travelin Babe: “Re: Allscripts CEO debacle. I have no idea if it has any merit, but I heard they’re going after a few brand name, reputable CEOs to get their mojo back. Two names mentioned were Ivo Nelson from Healthlink and John Glaser of Siemens.” That sounded pretty off the wall, but I asked both Ivo and John since I like to get answers when I can. They say, not surprisingly, that they have not been approached and wouldn’t be interested.

From Kermit: “Re: healthcare IT from a doctor’s point of view. This is a monthly show for the Mass Medical Society, produced at a local cable access station where I volunteer. Given my links to health IT, I suggested this topic.”

From Vince Ciotti: “Re: Susan’s inquiry about the size of the healthcare IT market. The top 13 vendors had $12 billion in revenue in 2011, so I’d guess the total market is at least twice that with all the niche players and consulting firms.” Above are Vince’s numbers.

From Dragon Man: “Re: Mike Mardini. The founder and CEO of Commissure, the radiology speech recognition company acquired by Nuance in 2007, is leaving. He was also the founder and CEO of Talk Technology, acquired by Agfa in 2001.” Unverified. No change in his LinkedIn profile so far.

From HIPPA Hound: “Re: Raleigh newspaper’s series on hospital profits and low levels of charity care. Not new since it was reported last week, but it has struck a few nerves.” Politicians (including the ever-present Sen. Chuck Grassley, who will no doubt write a scathing letter of inquiry that yields nothing) get worked up about about the ongoing series, which I’m sure is exactly what the newspaper planned. Every newspaper follows the same formula when trying to goose dying circulation: (a) write a huge and endlessly publicized series on some hot button topic, with or without solid facts and objectivity; (b) refer to their own series in some high-and-mighty editorials; (c) prod everyday people enough times about the topic du jour until they get enough outraged quotes to yield let another article; and (d) pester people in power about their articles until somebody finally at least pretends to share their outrage and makes vague promises about coming down hard on the villains. That’s about as good as it’s going to get from the dead tree folks whose readers avoid making eye contact with the politics and world news sections as they make a beeline for the sports page and comics.

From Kaiser Roll: “Re: Kaiser Permanente’s innovation award winners. Here’s the list.” Some of the technology winners:

• Knowledge Builder, which provides a way to import clinical algorithms into a rules engine to identify appropriate treatment conditions that are likely to occur, such as kidney stones
• OpQ, an operational dashboard that extracts information from the data warehouse and Epic Chronicles database every 10 minutes to allow outpatient managers to oversee staff assignments and patient flow.
• Specimen Transfer and Tracking (STAT), a chain of custody tracking system for specimens that would replace paper logs.
• Ambulance on the Information Superhighway, an inter-facility transportation clinical documentation tool.
• Nurse Advice Chat, an online chat function for the nurse advice center.
• Matching Clinical-Facility Data, tools to integrate various information sources to determine whether the physical environment, such as patient room characteristics, affect patient outcomes.
• Hospital Capacity Grid, a one-screen view of activity and capacity across a 21-hospital region.
• BirdDog, which sends lab results to the mobile devices of ED clinicians.
  

HIStalk Announcements and Requests

Welcome to new HIStalk Gold Sponsor nVoq. The privately held Boulder, CO company offers the SayIt speech recognition solution, exclusively endorsed by the AHA with vocabulary support for over 35 medical specialties. The SaaS-based SayIt is being rolled out in both ambulatory and inpatient healthcare settings, where users gain productivity within minutes as they dictate SOAP notes and other text directly into their EMR with no integration required, even using voice commands to navigate through their templates and operate other applications. SayIt is delivered as a low-cost Internet subscription, so users can use it at work, at home, or on the road. The company is interested in expanding its service delivery network and welcomes inquiries to VP/GM Debbi Gillotti. Thanks to nVoq for supporting HIStalk.

Here’s a video I found of Microsoft’s Bill Crounse MD talking about nVoq.

Acquisitions, Funding, Business, and Stock

Allscripts expands its stock repurchase program to $400 million from the $200 million that was approved a year ago.

Kansas City, MO startup Cognovant raises $500K in a seed round to launch its first product, the PocketHealth personal health record. The basic version will be a free App Store download, with paid upgrades available for versions that handle more complex needs and allow use by multiple family members. The founders are Joe Ketcherside MD and Stan Pestotnik RPh,  who were executives at TheraDoc before it was acquired by Hospira.

McKesson announces Q4 results: revenue up 10%, EPS $2.09 vs. $1.62, beating expectations on both. Technology Solutions revenue was down 2% and profit was down 20%. John Hammergren said in the conference call that several Horizon Clinicals customers have committed to moving to Paragon and conversions have begun. He also said that while EMRs are important, customer success will be driven more by performance management, analytics, care coordination, and payor capabilities, and that RelayHealth is well positioned for the MU Stage 2 emphasis on connectivity.

Sales

Perry County General Hospital (MS) selects RazorInsights’ ONE-Electronic Health Record for its 22-bed critical access hospital.

Southwest Medical Center (KS) contracts for Summit Healthcare’s Provider Exchange for integration with physician offices.

West Tennessee Bone & Joint Clinic selects SRS EHR for its 11 providers.

Fletcher Allen Health Care (VT) will use the CapSite hospital purchasing database, which gives subscribers access to research studies and thousands of real-life contracts, proposals, and RFP responses covering healthcare IT, imaging equipment, professional services, and medical devices from 1,400 vendors.

Somerset Medical Center (NJ) signs a renewal agreement for secure e-mail services from Zix.

Perinatal Quality Collaborative of North Carolina will implement a wireless clinical support system from San Diego-based startup Cognitive Medical Systems.

People

The Allscripts board of directors elects Dennis Chookaszian as its chair. He was previously chairman and CEO of retirement advice site mPower and had retired in 1999 as chairman and CEO of insurance company CNA. He’s been on the board since September 2010.

New Jersey Hospital Association’s Healthcare Business Solutions affiliate appoints Michael Guerriero (MedAssets, Eclipsys) VP of business development.

Telemedicine provider Virtual Radiologic names former US Oncology COO George Morgan as CEO. He replaces Rob Kill.

Vocera Communications subsidiary ExperiaHealth names Elizabeth Boehm (Forrester Research – above) director of patient experience collaborative and Christine Henningsgaard (Accretive Health) national practice leader.

Elsevier promotes Hajo Oltmanns to president of its CPM Resource Center.

Deaths

Joanne Wood, SVP of client services of Meditech and president and COO of LSS Data Systems, died Sunday, April 29. She was 58.

John Wade, former VP/CIO of Saint Luke’s Health System and former HIMSS board chair, passed away Saturday, April 28. He was 71.

Rick Brown, founder of the UCLA Center for Health Policy Research, died April 20 at 70.

Announcements and Implementations

Bon Secours Mary Immaculate Hospital (VA) goes live on Epic as part of Bon Secours Health System’s $200 million EHR initiative.

Lifepoint Informatics introduces CPOE Connect, a plug-in solution that allows vendors and commercial labs to offer seamless lab order entry using existing EHRs.

Preceptor Consulting, which offers go-live support and clinical training for EHR implementations, is supporting the implementation of the Cerner IView charting flowsheet at all campuses of Emory Healthcare.

In Canada, The Collingwood General & Marine Hospital goes live with PatientOrderSets.com.

Government and Politics

The American Hospital Association tells CMS that most hospitals will not be able to meet proposed Stage 2 Meaningful Use requirements, warning that, “many of the proposals put regulatory requirements ahead of actual experience with these technologies – an approach that will likely have unintended consequences."

Meanwhile, CHIME urges the government to give providers more time to prepare for Stage 2. Among its specific recommendations: a 90-day EHR report period for the first payment year in Stage 2.

The General Accountability Office (GAO) recommends that CMS verify provider requirements band collect more information before paying out EHR incentives.

Technology

MedAptus selects problem search technology from Intelligent Medical Objects for its Professional Charge Capture solution, which will allow clinicians quick access to diagnoses when completing charge documentation using ICD-10.

Wyse Technology integrates Imprivata OnSign into its thin and zero clients, offering No Click Access for Citrix and VMware View that supports roaming between locations with badge validation.

Valued Relationships Inc. signs with AT&T to provide remote patient monitoring services for VRI’s nurse-staffed telemonitoring center. The service will capture information from wireless health devices in the home, such as scales and blood pressure cuffs, and issues triage alerts to the monitoring center when appropriate.

More information on the technologies used by Max Healthcare, the first two hospitals in India to earn Stage 6 EMRAM recognition from HIMSS. They include WorldVistA EHR (a free offshoot of the VA’s VistA), the open source Mirth integration engine, and a homegrown hospital information system. Dell Services manages its IT operations, including the EHR implementation, running all IT infrastructure into a private multi-protocol label switching cloud hosted at a remote data center.

In the UK, Blackpool Teaching Hospitals NHS Foundation Trust rolls out 900 Samsung Galaxy Tab tablets to clinicians in a deal with Vodafone.

A Massachusetts psychologist creates  what she says is the first evidence-based treatment app for obsessive compulsive disorder. Live OCD Free costs $79.99.

Other

KLAS reports that half of providers anticipate buying or replacing a business intelligence solution in the next three years. In alphabetical order, the top five most considered BI vendors are IBM, McKesson, Oracle, QlikTech, and SAP.

A Weird News Andy wannabe sends this story about man with a toothache who made a poor choice of dentists: the girlfriend he had just dumped. She sedated him and removed all 32 of his teeth, saying she had tried to remain professional, but couldn’t help thinking “What a b—–d” as he was unconscious before her. Most of us gals have had that feeling once or twice.

The real Weird News Andy wonders who will update EHR med lists if the FDA allows drugs for hypertension, diabetes, infections, migraines, asthma, and allergies to be sold without a prescription, possibly justifying that practice by requiring pharmacist counseling.

Here’s a fun SNL parody video that T-System created as an opening to its user group meeting. It has a lot of details that are worth a rewind, for instance at the 1:30 mark, where development VP Bill Hall is stereotypically sucking down what appears to be a Red Bull.

In the UK, North Bristol NHS Trust admits to a huge budget overrun in its second try at a successful Cerner rollout after problems with the first. Most of the extra money was spent on additional support people.

The Dr. Oz Show partners with Temple University Health System and Practice Fusion to run a May 19 “15-Minute Physical” event in Philadelphia, where 1,000 people will be screened and the resulting analytics report presented to the city by the end of the day.

Facebook urges its users to post their organ donor status. Self-proclaimed pundits crow that Facebook is naïve in thinking that sticking a “donate” label on your profile provides legal consent, but they’re missing the point: the idea is to use social networking to encourage people to sign up with state registries. Your Facebook profile will outlive you, so your organs might as well follow its lead.

Sponsor Updates

• Cumberland Consulting Group promotes Saman Pourkermani to executive consultant.
• Merge Healthcare releases its Merge Honeycomb Archive archiving application.
• Beacon Partners is named by Boston Business Journal as one of the region’s fastest-growing companies.
• Baptist Health System (AL), INOVA Health System (VA), and Park Nicollet Health Services (MN) select  LRS software for secure document delivery from their Epic footprints.
• T-System outlines its pending response to the proposed MU Stage 2 rule to ensure it addresses the needs of EDs.
• Olmsted Medical Center (MN) extends its partnership with MED3OOO through 2017.
• Teletracking hosts a free networking lunch May 11 in Baltimore featuring Kevin Capatch, director of supply chain technology and process engineering for Geisinger Health System.
• Intelligent InSites joins the Cisco Developer Network in the wireless / mobility category.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Curbside Consult with Dr. Jayne 4/30/12

I wrote a couple of weeks ago about the pending EHR upgrade at one of the emergency departments I cover on a part-time basis. The witching hour for go-live has come and gone – or at least I think it has, or might have, but who really knows because I have received no communication whatsoever from the project leadership or from my department chair.

For those of you who may have missed my previous post, here’s the scenario. I moonlight in the emergency department at a hospital that is unaffiliated with my primary employer. They have been preparing to upgrade the ED information system for the better part of a year, with several previously scheduled upgrades being canceled at the last minute. I’ve been eagerly waiting upgrade of the system, which was less than optimal from a provider perspective. Since I’m just a contractor, I have no say in the design, implementation, or support of this product, so it’s a unique opportunity to see a system from the same perspective that my own physicians see the system I manage. I know I’m hyper-critical since I do this for a living, but some of the things that occurred were pretty unbelievable.

In the Pro column, the hospital provided plenty of notice on the training sessions. We were e-mailed approximately six weeks before and asked to schedule a slot. Opportunities were offered at two locations over a three-day period, with plenty of seats available to cover the number of providers in our department. The downside of that approach would be that if a physician was on vacation that week, he or she would not have a training opportunity. Advice for the future: split your sessions over two different calendar weeks to better accommodate vacations.

The first Con was readily apparent when I couldn’t find the training room and there was no signage – another easy fix for next time. After 15 minutes of wandering, I eventually made my way to an obscure IT office on the top floor of a physician office building. They had 20 computers set up. Since I was still early, I settled in and started checking e-mail. Apparently only some of them were actually usable for training, so when the instructor arrived (late), I was forced to move and go through the whole painful log-in cycle again.

Another Con (is this only two, or are we at three with having to move workstations?) was that the copy of the production database used to create the training database was so old that none of the users’ previous three passwords would work. Unfortunately, this led to the instructor having to use his personal log-in for all five of us, resulting in many fun adventures as we documented all over each other since we were on the same log-in.

A considerable Pro was that our instructor was clearly a grizzled vet of the IT wars. He handled all of the issues with a sense of humor, which although warped, was truly appreciated and made a difficult situation tolerable. He started his preamble with an apology; as we were the second training session of the day, he already knew that the deck was stacked against him. Our training sessions were scheduled to be four hours, and apparently the IT staff had asked our department secretary to send out a notice that the scope of the upgrade had changed dramatically and training would only be an hour long. Needless to say, none of the physicians received this message (Con) and apparently he got an earful from the 8 a.m. session. The preemptive apology definitely helped mitigate the ire of my group.

Upon making it through the log-in screen (now boldly decorated with the “Meaningful Use Certified!” enthusiasm of the vendor) the first change we noted was that our beloved grey inbox was now shaded a delightful salmon color. I’m not sure exactly why a vendor would want to do that, but salmon isn’t exactly a crowd pleaser, and I found it more distracting than the relatively vanilla grey tone we had previously.

In the Pro column, the IT staff had built test patients for each provider to train with. As a Con, however, none was built for me, “because you’re just part time – but don’t worry, since we’re only giving you part of what you need, I don’t mind if I only get part of your attention.” This instructor was really on his game – deflecting the negative vibes and making us laugh. He also gave us fair warning that the morning class identified some elements of the system that were less than stable. Maybe it was good that training only took one of the projected four hours, because that gave him time to call the mother ship to request that they stop tinkering with the system while training was in progress.

One of the major upgrades to the system was the addition of templated patient visits, a big Pro in my book because of the ease of documentation. No one wants a beautiful flowing narrative in the ED – they want what we call the bullet: “This is a 43-year-old Caucasian male with a gunshot wound.” We do not want to know that this is a 43-year-old male of Germano-Irish descent who was walking along Elm Street two blocks south of Chestnut, minding his own business on a bright and sunny day, when two guys game out of nowhere and he heard a “pop.” I found the templates extremely intuitive and the system very responsive. In hindsight, however, after writing my recent piece on ICD-10, maybe I will need to know what street he was on and what the atmospheric conditions were at the time of the injury, as well as whether he heard a “pop” or a “bang” etc. For now, however, I’ll leave those questions for the police report.

The other docs in my class didn’t like the templates much, but I think that’s largely due to the fact that they’re full-time docs who don’t have any other vendor experience for reference and who have been allowed to use voice recognition in lieu of the painful “visit builder” native to the application. (As part-timers, we are not allowed to use voice recognition due to licensing costs. Go figure.)

I was pleased to see that the patient education module had been completely overhauled (big Pro) and replaced with a third-party component that allowed creation of physician-specific macros as well as those available for sharing across the department.

Unfortunately, the biggest Con is that the much-hated prescribing system received no updates at all. When I mentioned this disappointment and how I loathe not being able to prescribe exactly what I want, one of the other docs in the class was happy to demonstrate some “undocumented functionality” in the system that allowed me to do exactly what I wanted despite the constraints. Although it’s not officially sanctioned (the instructor actually covered his ears and said “la-la-la” while we were doing this) I’m ecstatic and can’t wait to try it out.

One Pro/Con was the lack of training material given to us. Good because a lot of people don’t read it anyway (can you say Sanskrit?) and it kills fewer trees, but bad for those of us that might actually want to look at it. Apparently they didn’t print anything, because even the morning of class, they were debating the scope of the upgrade. Promising to e-mail it made sense (although I have yet to receive it.)

I mentioned a few weeks ago that I was concerned that the support staff wasn’t aware of the upgrade. Apparently this is because other than the salmon-colored inbox, all of the changes were on the provider side. Assuring us that the team would e-mail us with instructions on downtime and the final preparations for the upgrade, he sent us on our way. The instructions never arrived, but I’m putting that blame on the department secretary rather than holding it against the IT team.

Totaling the score, that’s six Pro and seven Con, a mixed bag by any standard. I hope the upgrade went well (if it went at all) but I really don’t know since there’s been no communication. I’m scheduled to work later this week, so I’ll find out then.

Have any outstanding upgrade tips to share with the HIStalk community? E-mail me.

E-mail Dr. Jayne.

HIStalk Interviews Abdul Shaikh, Program Director, National Cancer Institute

Abdul R. Shaikh PhD, MHSc is program director and behavioral scientist, Health Communication and Informatics Research Branch, with National Cancer Institute of Bethesda, MD. He is involved with the federal government’s Informatics for Consumer Health site.

Give me a brief overview about yourself and about Informatics for Consumer Health.

I’m based within the Division of Cancer Control and Population Sciences. This is one of five divisions at NCI. Our focus is primarily on looking at preventative measures for cancer as well as controlling cancer once someone is diagnosed with it, and then throughout the cancer continuum to survivorship and palliative care as well.

I work in a really diverse division here, but we have folks who have training similar to mine. I’m a behavioral scientist, but we also have scientists who are biostatisticians, who are clinical epidemiologists, who are former MDs who are now here doing research. It’s a really broad range of public and allied health sciences. Our common mission is to prevent and control cancer.

Drilling further down from the division level to the program and branch level – which is where I am based – I’m in the health communication and informatics research branch. Our primary mission here is to look at the processes and effects of communicating information related to cancer and other diseases. That involves different modalities, including interpersonal, mass media, print communication, and also of course technology and new informatics platforms.

Where I come into the picture is I really combine a passion for behavioral science and communication science with a real affinity for technology. I’ve always been a bit of a computer geek. I’ve found that in this branch I’ve been able to marry those two passions quite nicely.

What I’ve been leading here in the program in the division are few efforts. One of them is this broad notion of cyber infrastructure for population health. In the last year, I co-edited a special issue in the American Journal of Preventive Medicine, which has a number of great articles written by readers in the field looking at various issues around why we really need to start working hand in hand with folks who understand technology, who understand clinical health, consumer health, and research. It’s really to address tough challenges, such as cancer prevention and control.

Another area where I’ve been leading our efforts in the division is in this emerging area of open innovation. It comes out of the White House’s Open Government directive for increasing transparency and participation and collaboration. Out of the open government directive came the Health Data Initiative, which is when HHS and the Institute of Medicine launched this national initiative to help consumers and communities get more value out of the wealth of data that we have. Again, dealing with this big data problem.

What the reauthorization of the America COMPETES Act did in 2009 was to give us the authority in the federal government to run these challenge competitions, to try to harness innovative ideas in ways that we haven’t before. I think NASA has been one of the frontrunners on the federal end in utilizing these challenge mechanisms before America COMPETES.

This led to was two innovation challenges. I led a team of folks here and in partnership with a number of groups in academia and with the Office of the National Coordinator to put out this public call to the innovators to work with our data that’s available to develop cancer prevention and control applications.

We let the problems stay very broad, but I’m really proud to say that the winners have been successful in terms of addressing the challenge of creating applications that can help consumers advance their health and cancer control. An example would be an application that came out of Vanderbilt by Dr. Mia Levy and her team. They developed this online Web portal that provides clinicians with personalized genetic treatment information for cancers. As you might know, this is a very hot area of research. It’s very labor intensive for a clinician, let alone a researcher to stay on top of what are the best genetically influenced treatments. By creating this portal, Dr. Levy has tried to use technology to address the challenge of these types of treatments and disseminating them.

I just learned last week that Dr. Levy’s team won GE’s recent cancer data challenge. They got a $100,000 from GE and they’re getting support to further develop this application maybe to integrate it into existing EHR platforms to provide decision support. That validated for us the notion of these innovation challenges as one way to get more innovative ideas out into practice.

The open data projects are relevant to us providers, who have all of this data locked away in our individual EHR systems. Kaiser and Geisinger come to mind as doing interesting things with that information. How do you see those rich sets of clinical data that span years tying in with the broader public health efforts from the government’s side?

That’s a great question. That’s something that I think about a lot and folks here that I work with in HHS think about a lot.

From our perspective, because our mission at NCI is so much focused on advancing the research agenda for cancer prevention and control, we have been funding a lot of innovative science around using new technologies for decision support, for clinicians, for consumers, as well as for conveying complex data and information. Really a lot of things that could be relevant right now for health impact. The problem, as you recognized, is that whole bench-to-bedside or bench-to-trench gap that we’ve seen over multiple decades.

One way that we’re trying to address that — and to use this new zeitgeist that has embodied by notions of opening up data, transparency, and innovation — is that I’ve been working on developing a new small business innovation research grant. This is the mechanism that we have across the federal government. Essentially, the goal of this funding mechanism is to commercialize science. What it does for us is that it’s a vehicle to get these new innovations like Dr. Levy’s team and others have created, give them money. It could be up to $1.15 million for a Phase II SBIR in two or three years.

What they need to do is further develop their technology or application and then they need to evaluate it, because we want to know, “OK, this is a great idea, they’re using evidence, but does it actually work? Does it help patients? Does it clinicians? Does it lead to better outcomes?”

That’s what that money provides them. It also provides them with the support to then commercialize that application and reach out to larger entities. That’s what we’re working on now in terms of tying these innovation challenges to a more meaty resource mechanism to give funding to innovators to translate to science. The key here is we’re really trying to say, “How can we translate our science for impact in multiple settings — clinics, communities, consumers, and so on?”

Most of the money spent on healthcare technology is episodic systems that try to make providers more efficient. Nobody’s made a business case for public health. Hospitals and physician offices aren’t too interested in patients once they’ve gone out their doors until they come back again, except possibly some of the ACOs that are forming. How do you develop an awareness and an appreciation for public health informatics when there’s no money to be made in it?

That’s another thing that I think folks with my training and background think about. I trained in the school of public health. That’s where I did my doctorate and my master’s. I think that what’s really interesting to see now with the recent legislation such as the HITECH Act and Affordable Care is that we’re realigning incentives for payment of medical services that are tied to population health outcomes. Capitated outcomes is another way to put it.

An example would be looking at how reimbursement for prescribing medicines through electronic means is one way to start moving the needle and get clinicians to think about using technology for broader outcomes. If you look at the recently released Meaningful Use indicators, the Office of the National Coordinator for Health IT is really trying to push the needle on incentivizing systems and clinicians to look at broader outcomes for public health. I think that’s the goal with that whole initiative.

On our end at NCI, we do have research that shows that if you do focus on outcomes that are related to prevention, to smoking cessation, to improving nutrition and physical activity, these do lead to not just better health outcomes, but also to cost savings. We have that data and we have that research.

The Informatics for Consumer Health initiative was one way that we saw in NCI of getting together with important stakeholders in government. We launched this back in 2009. We had a summit with partners at CDC, NLM, ONC, NIST, NSF and AHRQ, as well as a number of stakeholders across the commercial, the health system, education, research, and advocacy sectors. The whole point of this was, “Let’s get together to talk about how we can help consumers get mastery over their own health through technology.” Part of that is what happens in clinical settings. That was back in 2009, but it’s been nice to know that there have been a number of outcomes coming out of that summit.

One is this Web portal — which is just focused on providing funding opportunities, the latest publications and research, opportunities for cross-sector collaboration, as well as informative blogs on topics related to consumer health and health informatics — to address that translation science question that we’re always thinking about. The journal that I mentioned, the special issue of the American Journal of Preventive Medicine that came out last year, was another way and another offshoot of that summit as a way to focus on these challenges.

Is part of the challenge that most of the actions that could save healthcare dollars and improve outcomes involve prevention rather than treatment? Do you think the data and apps the government has can get consumers engaged enough to take that self-responsibility to improve their own health?

I’m constantly amazed by the ingenuity and the innovation that comes out of folks that we don’t normally interact with. By “we,” I mean the normal constituents for NIH are the scientific community – academia, the cancer scientists – that are doing a heck of a job addressing cancer research and then the agenda for cancer prevention and control in our case.

But I think what these innovation mechanisms do is they’ve allowed us … we’ve seen this now running two challenges with a really small resource footprint. Our first challenge didn’t have any monetary prize. Our second challenge gave out prizes of $10,000 to $20,000 What we’ve found is that it allows for innovators out there to work with health data to address tough challenges like cancer prevention and control.

I think that what we need to do here at NIH is figure out how can we support these seeded innovation efforts with more substantial resources to then evaluate these innovations. A recent study at GW here looked at the smoking cessation apps on the iPhone. It found that almost all of them aren’t using the evidence-based guidelines that can help people quit smoking. If we can get more of these application developers to use the knowledge we already have in the development of their apps, that will lead, hopefully, to greater potential for change, for greater improvements in health-related behaviors which will lead to better public health outcomes.

My audience is primarily involved with acute care IT and care delivery. How would you like to see them get more involved in what you do?

There’s a large summit that’s going to be held here in June. It’s a follow up to the Health Data Initiative events of last year and the year before. I believe if you Google Health Data Initiative and HHS, you should find that information about it. This is a summit that is convening leaders in government, leaders in IT, and in healthcare to talk about these issues of how we can harness data, how we can use and harness innovative ideas to then advance the needle on public health and on real tough health issues. I think that’s one way where your readership can really start looking at, “OK, what is going on with innovation, with data in health and IT, and how can we get involved?” Because we’ve seen, for instance, with the Blue Button initiative, that there’s a potential for it to be a way to open up some data and allow patients to then share that data and pass it on to innovators to use to potentially improve their health.

I think these are baby steps, but they’re all going in the right direction, which is, let’s see what we can do by harnessing innovation and technology and data, because we are in a very data-intensive environment right now in health.

We’re collaborating in various capacities with federal partners including ONC, AHRQ, and NIST to address challenges such as patient engagement, communication, and care coordination for cancer patients and providers. As you recognize, the restructuring of our health services environment from the evolution of health IT and policy initiatives is creating new decisional architectures for cancer treatment and care planning that have the important implications for patient-centered communication and decision support – key aspects of our division’s research priorities.

For instance, there are many research questions on how health IT such as EHRs, PHRs, and mobile devices can be leveraged to engage, activate, and help patients and the care team communicate and coordinate care – from diagnosis, through treatment, and end of treatment transitions into survivorship / palliative care.  In addition, building on a recent NCI monograph on patient-centered communication, how can health IT be used to provide patients with ongoing support for the core functions of patient-centered communication: facilitating information exchange, making informed decisions, facilitating emotional coping, enabling self-management including navigation and coordination, managing uncertainty, and fostering ongoing healing relationships between patients / families and clinical teams.

Research questions such as these build on the key themes of translational science and use-inspired research that in my mind are necessary when thinking about the transformative potential of health IT for cancer and other diseases.

Monday Morning Update 4/30/12

From Bignurse: “Re: [vendor name omitted.] An absolute disaster in our state. No customer support is available. Lawsuits are being prepared. Meanwhile, patient care is at risk from systems that are crashing. I feel badly for laid-off employees, but every more alarming is customers facing the specter of systems going down forever. They need help!” I’ve left off the vendor’s name to offer a suggestion. Hopefully someone has complained formally to the vendor from at least one of those sites. Send me a copy of that document and I’ll run it here with any company response. That’s not only more fair to the company, but more useful to readers who really don’t know what’s going on.

From Susan: “Re: overall size of the healthcare IT market. Any estimates of total money spent annually by hospitals or clinics?” Maybe someone knows the answer to this question, which sounds like something Epic would ask on its famous employment test.

HITECH’s impact on patient outcomes has been modest, respondents seem to be saying. New poll to your right: if you had $100K to invest in the stock of one healthcare IT vendor, which would you choose?

Listening: the fresh and very well produced first album of Electric Guest, some LA kids cranking out a delightfully catchy mix of pop, soul, and electronic dance music that would be great for driving as long as you can control your in-seat gyrating better than I can. The low bass notes of the opening song are so strong out of my PC’s subwoofer that my Diet Coke with Lime can is vibrating across my desk like the quarterback in a 1970s electric football game. I’ve played the CD three times in a row, which is unusual for me.

Vince’s HIS-tory this time around covers the history of an innovative but trouble-prone input device that required creating an intentionally poor user interface to hide its design flaws: the typewriter.

The Minneapolis-St. Paul newspaper finds that two executives of Fairview Health Services, which is taking heat for allowing Accretive Health to strong-arm its patients into paying for ED and other medical services upfront, have connections to the company. The son of Fairview’s CEO is an Accretive employee, while the son of its physician group CEO is also an Accretive employee and helped it implement aggressive collection policies. In addition, the physician group CEO was found to be a shareholder in Accretive. The fallout from Tuesday’s national press about the tactics was dramatic: by Friday, Fairview had severed all relationships with Accretive. In addition, Fairview’s board held an emergency meeting from which its CEO was excluded, but he apparently emerged with the organization’s support. The biggest question is whether it was legal for Fairview to give Accretive full access to its patient records for collection purposes. Nearly overlooked in all the debate is that Ascension Health was Accretive’s original customer and owns a sizeable chunk of the company. Accretive’s market cap after its 61% share price drop (!!) over the past month is $919 million, with Ascension Health’s equity worth $72 million.

Nuance closes on its acquisition of medical transcription vendor Transcend Services.

The local business journal covers the recent Epic go-live at 206-bed Greenwich Hospital (CT), part of Yale New Haven Health System. The hospital spent $25 million ($121K per bed), according to the article, which gives the entire system’s cost as $250 million.

Yale New Haven is also mentioned as using the SAMI system from local startup MyCare, LLC, a product described as having capabilities for EMR searching, alerting, a rules engine, and analytics.

Harvard Business School healthcare expert Regina Herzlinger says accountable care organizations and patient-centered medical homes will go down in flames just like the 1990s capitated HMOs that preceded them, with the key problems being (a) inefficient EMRs, (b) awkward team culture, and (c) challenges in developing public health insurance exchanges. Instead, she advocates a focused factory model, where instead of providers taking on whatever problems cross their doorstep, they focus on particular health conditions, such as diabetes. She’s written such books as Market Driven Health Care and Who Killed Health Care? She blames today’s healthcare mess on hospitals consolidating to eliminate competition, bureaucratic insurance companies with wildly overpaid CEOs, and federal government meddling.

Weird News Andy’s joke: How do you make a Phillips screwdriver? Mix vodka with milk of magnesia (cue rim shot). That’s to celebrate this story, in which a Kentucky woman is suing her dentist, claiming she needed abdominal surgery to remove a screwdriver he dropped down her throat while repairing her dentures.

E-mail Mr. H.

Allscripts

From Stock Boy: “Re: Allscripts. This was a when, not an if. HCIT rollups never work. The coup could have gone either way – one vote and it could have been Tullman’s blood running through the Merchandise Mart. Investors are also afraid that another shoe will drop, like whether Lee Shapiro survives or even wants to. Clients have been angry – I’ve heard that Tullman is personally banned from several high-profile Eclipsys sites. The timing of Davis’s resignation could not be worse, and naming his new firm would have eliminated one piece of missing information. Investors hate uncertainty, so the stock is likely dead money for six months. They will be doing a ‘sum of parts’ valuation. Maybe a private equity leveraged buyout would work, but it would be tough. Allscripts is in third or fourth place, but it’s still a big market, and if I invested in this sector, I’d be a buyer of MDRX. Glen is a talented CEO and can sell water to a drowning man. He’s one of the most aggressive and competitive, but within an ethical framework, I’d be disinclined to bet against him.”

From MDRX Mole Army Private: “Re: Allscripts. HIStalk access is being blocked at the Raleigh office. Good thing I have a smart phone!” Unverified and pointless in any case since I’m pretty sure employees have a variety of ways to access an unfiltered Internet on their own.

Allscripts shares closed at $10.30 on Friday, down 36% on 20 times normal trading volume as Nasdaq’s second-biggest percentage loser for the day. Market cap dropped over a billion dollars, and Glen Tullman’s wallet was $5 million lighter at dinner than it was at breakfast. Not to mention that Glen’s frequent verbal sparring partner Jonathan Bush’s athenahealth now has a bigger market cap than Allscripts ($2.61 billion vs. $1.96 billion).

My reaction to Friday’s events:

• During the investor conference call, Glen’s performance hit extremes of negativity and optimism at a time when he desperately needed to inspire confidence as the last man standing. He went into graphic, pathological detail about all of the company’s significant problems. When asked tough questions by the analysts on the earnings call, however, he trotted out unconvincing cheery optimism that those problems would be quick to solve. That’s when he actually answered what was asked instead of reciting unrelated positive factoids about Agile development methodology. If I were grading his performance, I’d go with a C minus (with demerits to whoever should have been coaching him better, not just during the call, but in overall transparency given that last quarter’s conference call was rosy.) It just seemed to lack conviction, glossed over the apparent gravity of the situation, and seemed to be scripted into trying to convince everybody that these issues all came up in one quarter and would require just one quarter to fix.
• I was surprised that MDRX shares didn’t regain some of their losses by end of day Friday, especially since Nasdaq closed up for the day. Stocks often regain huge opening losses after the bad news is digested, the company’s fundamentals are re-examined, and overreaction seems likely in hindsight. in this case, the initial negative reaction stood for the most part and the dead cat didn’t bounce much.
• The biggest problem Allscripts now has isn’t the sales organization or the loss of board members, but rather the now-public record of executive upheaval and share meltdown. Hospital CIOs look first at the KLAS ratings and client roster when evaluating a vendor, but hospital CFOs go straight to the stock pages, and what they’ll find there may cause them to unholster their veto stamp. I’ve been in the room several times when that exact event occurred with other companies.
• Allscripts is raising consulting prices, pushing harder for customers to buy more of those services, and being more aggressive in cross-selling. Sometimes those tactics provide a bottom line boost, sometimes they just annoy prospects into inflating the company’s “nickel and dime” KLAS scores or even push them to choose another vendor.
• If you were a hospital swimming against the populist tide and considering Sunrise instead of Millennium or Epic, you might question whether the dismissal of all of the former Eclipsys board members and the disagreement over the company’s direction was a signal that Sunrise isn’t the company’s focus. I didn’t get that impression at all from the conference call since Sunrise was most of the conversation, but some might make that inference (and you can bet competing salespeople will be making sure their mutual prospects consider it.)
• The company has good opportunity to make its board stronger with some non-Eclipsys people. The former board members of Eclipsys were hardly a model of success, mostly known for approving questionable and ultimately failed acquisitions and finally finding a willing buyer for the company after years of shopping it around with no takers. Maybe they wanted to stick with the old Eclipsys ways, or perhaps Allscripts felt misled by what it found after it bought the company.
• Glen has said repeatedly that integration between the company’s ambulatory and inpatient EMRs would be basically a slam dunk that would send Epic fleeing for cover. Now the word is that, according to the customers who were supposed to benefit from that integration, Allscripts failed. That seems to indicate that nobody was actually talking to those customers (a massive mistake when you’ve got North Shore-LIJ to keep happy no matter what it takes.) Meanwhile, the Epic train keeps rolling over everything in its path, and all of this news just gives it a little bit more steam that it doesn’t need.
• Glen may think that losing John Gomez wasn’t a big deal, but it seems that most of the challenges Glen listed were related to development – high costs, poor delivery, and an apparently stripped down Sunrise integration plan that clearly fell short of expectations. Glen is a big-picture salesman, so every time he talks we hear about how smoothly the integration will happen, how easy it will be to juggle a barnyard full of EMRs and keep them all current with regulatory changes, and how well Sunrise can compete with Epic because Epic is 30 years old and not an “open” system like Sunrise (one might suspect that his definition of that term is anything but technical.) It’s going to take more than a company full of Glens to make that happen, no matter how you reorganize the sales force.
• The company had outsourced some of its technology work, sending some programming to India and turning over hosting management to third parties. Given that it apparently didn’t develop good integration specs for Sunrise, what does that leave as its core competency?
• The drop in share price sets the clock back three years, before HITECH and the Eclipsys acquisition. In fact, share price is less today than at the company’s 1999 IPO ($10.30 vs. $16.00).
• It will be interesting to see if the vultures swoop in to buy now-cheap shares to the point they can force the company to put itself up for sale, hoping to make a quick buck on the flip. That would be the worst possible outcome for everybody except the money-lenders.
• The same day that Allscripts was trying (and mostly failing) to ease concerns about its debacle, Cerner put up huge numbers and Epic was announced as having beaten both companies in a pivotal two-trust selection process in the UK. Not only did Allscripts lose absolute ground, it lost even more relative ground against its most significant inpatient competition that many feel was already insurmountable.
• No matter what explanations are provided, the casual observer might conclude that Glen staged a coup that cost the company four board members and its CFO at the worst possible time. Those boardroom discussions must have been particularly acrimonious given that the parties involved, all of whom hold Allscripts stock, were willing to torch the share price and possibly damage the company irreparably by going public with their spat.
• Was Jim Cramer a genius for urging investors to get out of Allscripts and into Cerner a month ago, or a fool for shamelessly pitching it and fawning over Glen Tullman for the four years prior to that? Had you bought and sold when he suggested, you would have made around 30% over 3.5 years, whereas buying Cerner upfront instead would have more than tripled your money over the same period.
• The biggest unknown: could a different CEO or ownership improve the situation? Eclipsys wasn’t selling much of anything before the acquisition; there’s little hope that Sunrise can do anything more than catch the occasional crumb dropped by Epic or Cerner; the company doesn’t have very much non-US business; it offers too many legacy EMRs that will require significant ongoing investment and face ever-stiffer competition on price; the market is rapidly changing as providers chase the ACO and population management dream (rightly or wrongly; and the HITECH tailwinds have died down considerably.
• As a counterpoint, Allscripts remains a large and profitable company; company fundamentals will make it attractive again once the embarrassment wears off and things settle down; its practices are apparently entirely honest and ethical; Glen Tullman proved himself a stock market and finance master in wresting control from the clueless overlords at Misys; he gets to pick his own loyal board members to replace the dearly departed and apparently less-loyal members; and the industry sector may be changing but it’s not going to go away. Long-timers will remember at least a couple of times that Cerner shares tanked on similar news, only to come roaring back.
• Expectations are now lowered and the gloves can come off. All the bad news is out there and already priced into the stock’s current (low) value, so now’s the time to make all the tough decisions that nobody wants to make when a company is riding high. Write down all the bad investments, retire badly aging products, fire the underperformers, show some competitive fire and frankness instead of Teflon Barbie-like reassurances that the sky isn’t falling when it clearly is, and decide exactly what it is that Allscripts wants to be when it grows up other than a collection of mismatched businesses that got thrown together primarily because they were struggling individually.

Here’s the five-year share performance of Allscripts (blue), the Nasdaq (green), and Cerner (red). A $10,000 investment in May 2007 would be worth $28,700 today (Cerner), $11,980 (Nasdaq index), and $4,350 (Allscripts).

I interviewed Glen Tullman and Phil Pead about the Allscripts-Eclipsys merger the day before it was announced, asking them to give me the criteria to judge their performance two years afterward (September 2012). Here’s what Phil Pead said:

From a shareholder perspective, I would like to see you grow the top line and prove your earnings per share leverage over that period. If I was a client, I would grade you by the integration between the product solutions to make this a great experience for their hospital and ambulatory environments so that the two came together. If you were looking at it from the employees, I would want to say that the next few years will be some of the most exciting with all the new opportunities they have to plan.

If you’re an Allscripts customer, tell me what all this news means to you. Please use your real name and employer with the confidence that I will absolutely not allow you to be identified in any way, but I need to be sure I’m getting legitimate information and not an Allscripts competitor trying to pile on (it happens). I’ve heard from investors and employees, but the real unknown is what Allscripts customers think about what’s happening.

Time Capsule: CEO Compensation 101: Why Neal Patterson’s Pay is Shocking

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 April 2007.

CEO Compensation 101: Why Neal Patterson’s Pay is Shocking
By Mr. HIStalk

We learned last week that Cerner paid Neal Patterson $4.2 million in 2006, most of it in stock. That’s a shocking amount, one that deserves the immediate scrutiny of the company’s board, its shareholders, and its customers.

Why so little?

Corporations often wildly overpay CEOs. What does overpay mean? When the shareholders are losing their shirts and the fat cat running the show still gets a big payday.

Example: Ford continues its near-death experience at the hands of Asian manufacturers with better and cheaper products, losing a mind-boggling $12.7 billion last year, but they managed to scrape up $28 million for their new CEO. That’s for just four months on the job. He’d better have brought a magic wand that can make Toyota disappear to be worth that.

Or Home Depot. While the stock was dropping 10% over the past six years, their CEO took home $124 million, plus many dozen millions more in stock options. Are those orange aprons so hideous that no one with more wealth-building talent will wear one?

At least Exxon, whose retiring chairman got a $400 million parting gift as he tried to keep a straight face about oil supply and demand, made $36 billion in profit last year. Providing $3 a gallon gas for those Fords is much more lucrative than building the cars it goes in. I hate buying expensive gas, but as long as Exxon can keep me and everybody else doing it, they’re justifiably earning big bucks.

A year ago, CERN stock was at $39.65. It’s now at $55.09. That’s an eye-popping 39% increase. The Dow was up about 14% during that time.

Pay for performance works when it comes to running companies. You want the person in charge to have big-time skin in the game. Their job is to make shareholders money. If they do that, pay them well. If not, find someone who can.

It’s like being a coach. You can be an inspirational leader, a civic beacon, and a role model, but for the money you’re being paid and the number of qualified people who could take your job tomorrow, you’d better win. Americans like winners.

Everybody has their own opinion of Cerner and its products, but it doesn’t matter what you or I think. CEOs of publicly traded companies have one audience to please – investors. Rightly or wrongly, CEOs live and die by the quarterly numbers. The most important product Cerner sells isn’t Millennium, it’s shares of stock. That’s where the real money is made.

Cerner is selling $1.4 billion a year and has a market cap of $4.35 billion. That’s pretty good for a company with cutthroat competitors and customers who (theoretically) don’t have a lot to spend.

Patterson runs the company his way, just like he did from the beginning when they were a no-name little lab vendor. That was 28 years ago. Not many current CEOs started the company, built it up, went public, and stayed at the helm.

The best possible alignment between CEOs and shareholders is to compensate them in stock. Not by giving them a bunch of free shares for taking the CEO job, but to pay them in stock instead of cash. They make money when everyone else does, the ultimate "eating your own dog food."

That’s why you shouldn’t feel too sorry for Neal. He’s sitting on $317 million worth of stock. I don’t own CERN shares, but for those happy shareholders who do, I say: bravo to him.

HIStalk Innovator Showcase – Health Nuts Media

Company Name: Health Nuts Media
Address: 949 Concha St., Altadena, CA 91003
Web Address: www.healthnutsmedia.com
Telephone: 818.802.5222
Year Founded: 2010
FTEs: 6

Elevator Pitch

Health Nuts Media is attacking one of the primary causes of skyrocketing healthcare costs, poor health literacy, with a complete platform of easy-to-use assessment tools and a full suite of consumer-friendly educational resources, including animation, games and apps.

Business and Product Summary

Low health literacy costs the U.S. health system up to $236B annually and leads to higher health care utilization, problems understanding instructions and taking medications, inappropriate self medication, and reduced life expectancy. Costs are four times higher for individuals with low health literacy than for those with proficient health literacy. Only 12% of Americans have proficient health literacy, and that number has not changed over the last 40 years. 

Health Nuts Media will dramatically improve the health literacy of Americans by providing easy-to-use online assessment tools and a suite of consumer-friendly educational resources. These include easy-to-understand animated videos for both adults and kids in multiple languages. We deliver technology in a software-as-a-service model with a wide range of customization options from hospital rooms to medical homes improving healthcare literacy one patient at a time. Our clients are managed care organizations, hospitals, doctors, schools, government agencies, accountable care organizations, disease management companies, insurers, and consumers. 

Target Customer

Managed care organizations, hospitals, physicians, health educators, schools.

Customer Problem Solved

Low health literacy leads to dramatically higher costs and poorer outcomes. Health Nuts Media increases health literacy through consumer-friendly assessment tools and easy-to-understand educational resources.

Competitors

KidsHealth, Krames Staywell, Milner-Fenwick.

Advantages Over Competitors

Health Nuts Media produces health education content that is more engaging and more interactive than other offerings in the marketplace. Our Emmy Award-winning production team delivers highly engaging, branded experiences that create true market differentiation for our clients.

Fast Facts

• Complete suite of health literacy assessment and education tools with a unique combination of quality health education, premium animation, and enjoyable storytelling
• Emmy Award-winning production team
• Kids Education Advisory Panel (KEAP) enhances our child-friendly focus
• Diverse medical expert review panel – doctors, nurses, health educators, homeschooling parents
• Customization and made-to-order content creation services available

Pitch Video

Customer Interview (a physician who runs a pediatric medical content site)

What Health Nuts products and services do you use and what difference have they made?

As a content provider for primary care practices for the past 10 years, I’ve seen a lot of medical content come my way. The animated information from Health Nuts Media is fresh, engaging, creative, and effective. We have chosen to add it to our library of medical content to distribute to many of the websites that we host and service.

How would you describe your experience in working with Health Nuts?

Tim Jones of Health Nuts Media is passionate about bringing the message of Good Health to all children. I admire his vision. He will teach many children about the importance of caring for their own bodies.

How would you complete this sentence: "I would recommend talking to Health Nuts as a potential customer if you are …"

A children’s hospital, a pediatrician or family physician, or an advocate for kids.

An Interview with Tim Jones, CEO, Health Nuts Media

Medical people seem to be challenged to provide patient education that’s both understandable and engaging. What problem does that cause and how do you turn that into a compelling return on investment for your product?

Some of the studies that we’ve seen show that low health literacy costs up to $236 billion every year, if we’re just talking about dollars and cents. Our basic thesis is people don’t want to be sick, they don’t not want to follow their doctor’s instructions or not take the medication they’re told to take. There’s just a basic misunderstanding, where individuals will overestimate their ability to understand and healthcare professionals and clinicians will overestimate what people did understand by saying, “Well, they didn’t ask any questions, so I assume they understood everything.” Therein lies this big black hole of information.

What we’re trying to do is bridge that gap and make non-written forms of communication available so that those with health literacy or innumeracy problems can understand what it is that they’re supposed to do.

Do you think the expectations have changed with online video services like YouTube and video-friendly devices like the iPad?

Absolutely. One of our advisors, Dr. Pion, is an OB-GYN doc who just turned 80 years old last summer. I don’t think any of these things are necessarily like, “Oh my gosh, we never thought of this in the ’60s or the ‘70s.” We’re just at this point in time where it’s actually possible with our technology now that even 10 years ago really didn’t exist. There was not real way to reach the masses the way that we have the ability to do today.

You have a standard library of resources. What are some of your more popular titles or topics?

Diabetes is by far the most popular. Asthma has also been very popular with us –  we know there are nine million kids in the U.S. with asthma that are dealing with it. But we also do a lot of things like gastroenteritis and vaccinations and broken bones. A lot of the topics that we deal with are common with pediatrics.

You do custom work. What kind of things have people asked for?

We’ve done breast cancer. We just finished a series on clinical research in both English and Spanish. Some of our clients like our library, but they have their own corporate mascot or brand identity, so we’ve taken their characters and wrapped them around our content as well.

When you draw the box around what you do versus what you might want to do down the road, where do you see things going? Right now you focus primarily on pediatrics. Do you see a different focus or moving into games or anything like that?

Absolutely. Every age demographic here and all around the world responds to this. Gaming is so important to our long-term objectives. We realize that it’s very popular format. It’s a great way to get information out to people without pounding them over the head with, “This is education.” We know that it works.

There’s lots of research that shows that gaming and gamification can work and deliver better clinical outcomes. That’s definitely part of the path. We see storytelling and gaming fitting together very well.

How do you make a business case that your videos are not only good for patient outcomes, but are something that customers should invest in?

We know that someone with low health literacy will end up costing something like four times more than those with proficient health literacy. Take away all the outcomes and the lower life expectancy, but if you’re just looking at a business case to say those folks that don’t understand what it is that you need to have them understand, those folks that don’t understand how to take their medication properly, how to follow your instruction will cost you four times more than those who do understand.

When you look at it in those terms and understand that that is a cost of hundreds of billions of dollars to the healthcare system every year, it’s fairly easy to make a business case to those healthcare organizations that mare managing large populations of patients, especially under a capitated basis where there’s a fixed fee or accountable care organization. It makes a pretty simple bottom line case for return on investment.

Prior to that when providers were paid for episodes and not outcomes, the only business model would have been to get drug or insurance companies to pay for your videos. The change to managing health must give you more organizations to sell to.

It does, right. We believe at the end of the day that individuals are very concerned. Nobody wants to be sick. Ideally education happens at the hospital, at the doctor’s office, at the clinic, but we also realize that when a parent has a child that’s sick and they want that information, more often than not they’re going to the Internet. They’re trying to find good resources.

For instance, we know in research that for every day a child has an asthma attack and has to miss a day of school, that will cost those parents an average of $172 per day. We know that in the average poorly controlled case of asthma, they will miss somewhere between 12 and 18 days of school per year. The real cost, not even the medication cost, not even the long-term cost on academic achievement in lifelong earnings, but just that simple mom or dad has to miss a day of work to take care of that child, it makes a pretty compelling case even at a consumer level that good information is worthwhile and will end up saving them money and help them to be more healthy.

What do you hope to gain from the exposure?

I really think we’ve got a great idea. We’ve got a great company. We’re fairly new and not a lot of people know about us yet. We also say that we like to collaborate. We like to be part of larger systems. My sense is there are so many people out there who are working in the technology space and the HIT space that really don’t know about us and they think of ways that we fit into their systems that we haven’t even thought of yet.

To me, that’s what becomes very exciting. We know where we’ve started and where we’re going and where we’re headed. We don’t ultimately know where we’ll end up. I think some of this exposure could start conversations, could start relationships that take us to places that we haven’t even yet imagined.

Allscripts Shares Open Down 42%, Epic Wins UK Deals

Allscripts shares opened Friday morning down 42% after yesterday’s financial and organizational announcements. My notes on the news and yesterday afternoon’s conference call are here.

In news from the UK, Cambridge University Hospitals and Papsworth Hospital NHS Foundation Trusts name Epic and HP as their preferred EHR vendor and are expected to sign a 10-year contract in June. Cerner and Allscripts were on the short list.

News 4/27/12

Top News

Allscripts turns in its Q1 report: revenue up 9%, EPS $0.03 vs. $0.07. Bookings were down 8% and the company has revised its full-year earnings forecast to $0.74-$0.80 per share vs. previous guidance of $1.06-$1.10. CEO Glen Tullman’s reasons for the numbers: lower sales, unfavorable sales mix, high development costs, Sunrise sales delays as cautious prospects wait for the promised integration, and a reorganization of the sales force. Also announced:

• CFO Bill Davis has resigned effective May 18
• Phil Pead has been fired as chairman of the board
• Directors Catherine Burzik, Eugene Fife, and Edward Kangas, all of whom had ties to Eclipsys and who were apparently loyal to Pead, have resigned in protest over the company’s direction and leadership

Shares are dropping precipitously in extended trading following the announcement after Thursday’s market close, down 45% as I write this. That would wipe out nearly $1.5 billion of shareholder value if the price holds when the market opens Friday morning. The transcript of the earnings call should be interesting when it’s posted shortly. If you work in Allscripts sales and haven’t found your job to be challenging enough, this should do it. My question: how will flagship customer North Shore-LIJ react to the news?

Update: the conference call transcript hasn’t been posted yet, but audio is posted here. Notes I took, including my reactions:

• Glen’s list of what went wrong includes just about everything.
• He talks quite a bit about Sunrise successes, but doesn’t say too much about the ambulatory products.
• Bill Davis is leaving to take a non-healthcare job. He was on the call and presented the financial results. He says he isn’t leaving because of anything to do with Allscripts.
• Bill said neither the inpatient or ambulatory businesses performed up to expectations.
• How many of the clients who are waiting on the much-touted integration to occur will just give up and buy something else, especially after reading about this latest company turmoil?
• Stay away from courthouses today – they will be crowded with lawyers filing class action investor lawsuits today, I expect, since that always happens when share prices drop on unexpected company news.
• “Unfavorable revenue mix” – does that mean that the only thing selling is MyWay?
• They mention high non-capitalizable development costs – does that mean bug fixes rather than planned enhancements and integration projects?
• They mention the high cost of attending HIMSS, which isn’t surprising if you saw their monstrous booth village in the exhibit hall.
• The company will spend $190 million this year to improve software integration and user experience. Glen says prospects are withholding their decisions until some of these projects are finished.
• The integration between Sunrise and the ambulatory products met the technical specs, but clients weren’t impressed. The beta of the re-do attempt will start in 50 days.
• Sunrise 6.0 will add high availability and Sunrise Financial Manager will include ACO capability and ICD-10 support.
• Glen said there’s work to be done on the client experience, and 400 employees have been hired to support that effort.
• The company is investing in its hosting capability and adding a new data center in the next 90 days.
• Getting rid of Phil Pead will cost $2 million (or at least as I interpreted).
• Glen said he’d never in his career had a quarter as tough as this one.

The Q&A ran on for more then 45 minutes and was predictably ugly.

• The first question was basically, “Why weren’t you fired instead of the board?” Glen’s answer: it was a bad quarter, but boards take a longer-term view. The follow-up: our numbers don’t match anything you’ve said, so why should we believe you? Glen’s answer: we’re making progress even though our Sunrise integration flopped.
• Question: who’s the chairman now and how do you give confidence to investors given that a third of your board just quit saying they had no confidence in you? Glen’s answer: the board will name a chairman soon and will add new members. Clients evaluate companies on their products, not their board members. We’ve changed our development methodology from Waterfall to Agile.
• Question: why aren’t the surviving board members on the call and will they have a vote of confidence? Glen’s answer: they’ve voted their confidence by remaining on the board.
• Question: I’ve never seen that much board turnover due to bad bookings. What really caused the turnover? Glen’s answer: merged companies often have a different vision about the direction of the combined entities and you can look at who quit to figure out the issue (all the Eclipsys people, in other words).
• Question: you implied at HIMSS that integration wasn’t all that important, but now you’re saying that prospects are not buying because your integration effort wasn’t good enough. Glen’s answer: it matters to a segment and customers waiting for 1.0 found it disappointing. Some problems due to sales execution, some customers waiting on the 1.5 version of the integration, some due to accounting changes.
• Question: how do you get clients to stick with you when the window isn’t all that wide? Glen’s answer: we have 350 new clients this quarter and three Sunrise signings. Some waited and that’s what impacted sales. First time that our close rate dropped. The new sales team is the best we’ve had.
• Question: all the Eclipsys people have left the board, but you said earlier that all the growth was centered around the Eclipsys products. What’s the difference in direction? Answer: we still have many Eclipsys employees and good products. There’s no change in strategy.
• Question: have you been approached to be acquired and maybe the board members left because you turned it down? Glen’s answer: no.
• Question: who will certify the first quarter’s 10Q? Answer: Bill Davis.
• Question: you said customer attrition is low. Is that current or predicted? The data looks like you’re having problems in the market. Glen’s answer: no big bump in attrition. We’re the beneficiary of our competitors having attrition problems, but everybody is struggling to compete with Epic (as I interpret it, anyway).
• Question: your stock’s going to be hammered and your credibility is shot, so why should Allscripts remain a public company? Glen’s answer: I wouldn’t speculate on that. The stock has fluctuated between $89 and $1 over the years and we just keep pushing forward.
• Question: where was the underperformance in the acute care area? Bill Davis’s answer: some Sunrise deals didn’t materialize and EPSi analytics fell surprisingly short given prior performance.
• Question: what’s the sales force stability? Glen’s answer: very good. We have some open territories. We lost only one significant salesperson and they became a CEO of another company, which indicates the quality of people we have.
• Question: where is Bill going? Bill’s answer: that will become public knowledge in a couple of weeks, but it’s a private company not in healthcare IT.
• Question: the numbers look like sales numbers on the Allscripts side are going down. Is the problem Allscripts or Eclipsys or both? Bill’s answer: it’s both.
• Question: how can you turn this around? Glen’s answer: we’ve released software timelines and there’s a vibrant market. We have the right sales structure and product deliverables, so I don’t think we’re talking about a lengthy process. We’re betting on this for the next 10 years.
• Question: will there be any other management changes? Glen’s answer: no.
• Question: a year ago at HIMSS you said that you didn’t need a single database and that service oriented architecture would do. Has that changed? Glen’s answer: yes. Epic (he didn’t actually name them) talks a lot about single database, but their customers use EPSi and other products and with genomics and other advances, you’ll always need more than one database. 93% of healthcare organizations can’t afford to rip and replace with Epic (he named them this time) and our open platform makes more sense. Some people have Enterprise and Sunrise — that’s a limited but important universe and our 1.0 release was technically acceptable but customers said it wasn’t exactly what they wanted, while 1.5 will offer that.

Glen mentioned on the call that the company has opportunities in England, but it was announced Friday morning that both Cambridge University and Papsworth have chosen Epic over Allscripts and Cerner.

Reader Comments

From Shaken The Tree: “Re: Allscripts. Time will tell, but news is MDRX is in big trouble — big financial losses, CFO resigning, COB resigning, and no one is sure what or why the CEO is safe. If this rumor pans out, it will really just be an Epic vs. Cerner market. Then again, isn’t it already?” I’ve been getting regular and entirely credible rumor reports about the company’s problems over several weeks that turned out to be almost eerily accurate, but I either didn’t run them or did so without naming the company since I’m not comfortable putting out rumors on publicly traded companies (I picture me as Charlie Sheen’s Bud Fox being hauled off bawling in handcuffs, a la Wall Street.) This anonymous Rumor Report came in at noon Wednesday, which would have given me almost two full trading days to short-sell MDRX shares had I been so inclined. I’m poorer for my inaction, but at least I’ll sleep soundly.

From Nasty Parts: “Re: Allscripts. There was a Tuesday evening board meeting where they attempted to fire Glen Tullman. He survived on a 5-4 vote. As a result, Phil Pead (above) will be leaving the board.” I don’t think TV stock picker Jim Cramer necessarily saw this coming, but he flipped his recommendation at a great time.

From Lumpy Rutherford: “Re: Allscripts. Rumor we heard was that the board tried to fire Tullman but he held on. Dissenting board members, including the chairman, resigned on the spot. Bill Davis (above) was the sacrificial lamb and was let go also.” The wheels have fallen off at least temporarily, but Glen is still driving after winning the Allscripts vs. Eclipsys arm-wrestling match with Phil Pead (shades of the “tank over the cliff” scene from Indiana Jones and the Last Crusade). So much for Glen’s insistence about the ease of integrating Eclipsys and Allscripts products just because they both run on Microsoft technology – prospects apparently aren’t buying it (literally). I like Sunrise, but Eclipsys was a disaster, with recurring self-inflicted wounds from management gaffes and overpaying for acquisitions in a desperate and failed attempt to be a player. I don’t see any way that Allscripts will ever get back the $1.2 billion it paid for the company, which everybody knew was vulnerable to losing its few big Sunrise clients to Epic and Cerner due to lack of an integrated ambulatory solution and a narrow product line. I take no pleasure in this news – we need more strong competitors in the inpatient clinical systems market and headlines like this usually send the risk-averse CFOs of hospital prospects fleeing to the HIT billionaires.

From Dismayed ExECLP: “Re: Allscripts. So all Eclipsys board members are out, Glen’s new CFO Bill Davis leaves, numbers are terrible for last quarter and the year looking forward, and Glen survives? He is destroying shareholder value, client relationships, and what had been a highly motivated workforce on both the Allscripts and Eclipsys teams pre-merger. This is worse than what Pam did at McKesson.” Certainly Allscripts suffers more from their HIT-related challenges since they don’t have a hugely profitable cash cow of drug sales to fall back on. Maybe Allscripts should rehire Newt for the EHR Stimulus Tour Part II: he’s tanned, rested, and ready.

HIStalk Announcements and Requests

Highlights from this week’s HIStalk Practice include: a federal agency fails to update its list of medically underserved communities, leading Medicare to overpay physicians millions of dollars in bonuses. More physicians could and would participate in the MU program if their EHRs provided the required functionality. Physician compensation fell in 2011. Medicare and Medicaid paid EPs $1.4 billion in MU incentives through the end of March. A Louisiana woman steals over $700,000 from her plastic surgeon employer. You know the drill: visit HIStalk Practice; sign up for the e-mail updates; bask in the knowledge that you are smarter than the guy in the next cubicle or corner office.

I am amused and touched that so many readers have sent e-mails asking if I am OK given my recent mentions of doctor office visits. Thanks for the concerns and be assured I have nothing life-threatening. I have an injury that is annoying and that has created a particularly nasty side effect: it’s hindering my ability to take full advantage of all my fashionable shoes. 

A reader suggests this as a gift for Inga: a custom bobblehead that turns photos into a 3D image of a person’s head. Cute and apropos, although maybe not $200 worth.

My Time Capsule editorial last week challenged anybody to prove that healthcare IT improves outcomes and costs. TeleTracking responded on their blog with what they say is proof. I’ll defer to your assessment – were they successful?

On the Jobs Board: Director Project Management, Implementation Project Manager, Epic Certified Builders, Senior Business Development Executive. On Healthcare IT Jobs: Cerner Orders iVew Consultant, Healthcare Services Systems Analyst III, PACS Application Coordinator II.

I always feel like a failure when I see people around me lost in an iPhone Zone while ignoring everyone around them, happily absorbed with their make-believe Internet friends in their self-imposed Cone of Silence. Was I not adequately scintillating to draw their limited attention away from the electronic lure that is infinitely more time-wasting than the “vast wasteland” of 1960s TV? Have I failed to meet their need for human interaction, forcing them to flee for the comfort of the electronic equivalent of a blow-up doll? And yet I seek such illusory validation myself, measured by the number of people who (a) sign up for my e-mail updates;  (b) Friend/Like/Connect frenetically with Inga, Dr. Jayne, and me, secure in the knowledge that we reciprocate unconditionally; (c) peruse and uncontrollably click those gloriously non-animated ads to your left because my sponsors offer such an interesting variety of valuable products and services that you really can’t stop yourself; (d) send me rumors, news, and other goodies that I can use here to appear smarter and hipper, at least to people who don’t actually know me; and (e) use the Resource Center and Consulting RFI Blaster since you would be indirectly helping the less fortunate (the grateful offshore programmers to whom I paid a pittance to develop those). You may have noticed that I’m using Twitter slightly more to prove that I’m just as pedantic as the tweet-happy crowd, so you may get some early glimpses of HIStalk stuff there if I’m in the mood. Lastly, I would ordinarily say that having a 2,400-member HIStalk Fan Club on LinkedIn is the ultimate manifestation of narcissism, but unlike some of my fellow HIT netizens, I didn’t start my own fan club, so I’m just a guest there as you could be, courtesy of Dann. That is all, other than the obvious: it means a lot to me that you read what I write.

Acquisitions, Funding, Business, and Stock

Cerner announces Q1 results: revenue up 30%, EPS $0.51 vs. $0.37, beating consensus estimates on both. The company raised guidance to yearly earnings of $2.25-$2.32 on revenue of $2.6 billion.

Athenahealth announces Q1 numbers: revenue up 38%, EPS $0.07 vs. $0.09 (unchanged in non-GAAP reporting, beating expectations).

CPSI’s Q1 numbers: revenue up 10.2%, EPS $0.51 vs. $0.49.

Quality Systems, the parent company of NextGen, acquires Matrix Management Solutions, a NextGen reseller that provides RCM, implementation, and support services. Quality Systems says the acquisition will “enable NextGen Practice Solutions to expand its footprint among private and hospital-based physicians and groups by leveraging Matrix’s RCM expertise.”

Emdeon completes the repricing of its existing senior secured credit facilities and borrows $80 million of additional term loans for general corporate purposes, including potential acquisitions.

McKesson will pay $190 million to settle yet another lawsuit over its average wholesale price debacle of a few years ago. I don’t have the numbers in front of me, but I would guess they’ve paid out nearly $2 billion over that mess.

Sales

Siemens Healthcare signs a global radiation oncology partnership agreement with Varian Medical Systems, displacing Varian incumbent GE Healthcare. Siemens also announces four Soarian revenue cycle sales: MD Anderson (TX – a 10-year agreement for Soarian financials); North-Shore LIJ (NY – a six-year extension for Soarian financials and adding Soarian physician revenue management and scheduling to the faculty practice plan); Shepherd Center (GA – a five-year extension to migrate to Soarian clinicals and financials); and Baton Rouge Medical Center (LA – a 10-year extension to install Soarian Enterprise Revenue Cycle).

Iowa Health System expands its relationship with MediRevv to include use of its Revenue Integrity Service.

The VA awards Harris Corporation an $80 million, eight-month contract to support the VA’s migration to 5010.

People

MEDecision names Ellen Donahue-Dalton EVP/chief marketing officer. She was previously with GTECH Corporation.

HealthTrio promotes Dominic Wallen to president and COO.

Announcements and Implementations

Beacon communities Quality Health Network (CO) and HealthBridge (OH) announce an agreement that allows QHN to access HealthBridge’s data analytics and BI tools.

Montgomery County Memorial Hospital (IA) goes live on NTT DATA’s EDIS solution. The hospital is a user of the company’s Optimum solutions.

Orthopaedic & Spine Center (VA) expands its use of White Plume solutions with the addition of AccelaMOBILE, White Plume’s mobile charge capture app.

OTTR Chronic Care Solutions announces OTRRbmt, a pediatric bone marrow stem cell transplant patient management system.

The New York eHealth Collaborative, the NYC Investment Fund, and the NYS Department of Health launch the New York Digital Health Accelerator, a program to promote HIT initiatives in New York state. It will offer up to $300,000 and mentoring to 12 early- and growth-stage companies that are developing technology solutions for care coordination, patient engagement, analytics, and message alerts, primarily products that could benefit the state’s Medicaid program redesign. The initial investment of $4.2 million is expected to create up to 1,500 jobs over five years and to attract up to $200 million in venture capital investment to graduating companies. Mentoring will be provided by 18 provider organizations, including New York-Presbyterian Hospital, North Shore-LIJ Health System, NYU Langone Medical Center, Maimonides Medical Center, and Community Healthcare Network.

Moffitt Cancer Center (FL) goes live with a clinical trials recruitment and personalized medicine application, built on Oracle tools, that it says will allow it to more closely connect patient care information and research results to improve clinical decision support tools.

Max Healthcare becomes the first hospital in India to reach HIMSS Analytics EMRAM Stage 6.

Government and Politics

CMS awards CPA firm Figliozzi and Co. a three-year, $3 million contract to audit payments and compliance with the EHR incentive program.

VA CIO Roger Baker says the first VA-DoD integrated EHR sites will go live two years ahead of schedule in 2014. He also announced that the VA is testing an iPad EHR app in a 1,000-clinician pilot. 

Pentagon researchers are exploring the use of computer-based simulated therapists to conduct therapy sessions with service members, with the system using motion sensing and a webcam to detect signs of post-traumatic stress disorder. The video above is of a similar DoD project that was intended for service members to use in their homes, but without the symptom detection hardware. Thanks to Guy for the link.

Technology

The US Patent and Trademark Office issues a patent to DR Systems for technology related to automated selection and forwarding of medical data to secondary locations, such as EMRs.

Other

Weird News Andy ponders whether anyone’s up for a third-hand kidney. Surgeons at Northwestern Memorial Hospital (IL) transplant the same kidney twice in two weeks in two different patients when the first recipient’s existing disease renders it useless to him. The donor was the first patient’s sister, who was disappointed that her kidney didn’t help her brother but happy that at least someone benefited from it. And being on a transplant roll, WNA also finds this story bizarre: the father and grandmother of a two-year-old boy are arrested for kidnapping him as his family sits by the phone waiting for the call saying the boy – #1 on the heart transplant list – needs to be rushed to the hospital to receive a donor heart.

One more gem from WNA. The Utah Department of Health, alerting 273,000 people of a Medicaid data breach that exposed their Social Security numbers by sending an unsigned letter advising them to call a hotline number, gets complaints about the first question scam-wary people are asked when they call: what’s your Social Security number?

Cincinnati Children’s Hospital (OH) announces an $180 million addition that will bring its total research space to 1.4 million square feet, which will make it the largest pediatric research facility in the country.

Pennsylvania’s State Health Department finds that two patients at St. Luke’s Hospital were dangerously overdosed on IV meds because nurses incorrectly programmed their IV pumps at 10 times the ordered rate. At least it wasn’t erroneously programmed PCA pumps this time, which the state said was the cause of three patient overdoses at the same hospital a few months ago.

Sponsor Updates

• Cisco honors World Wide Technology with six awards at its annual partner summit. 
• MEDSEEK recognizes five customers with eHealth Excellence Awards at its 2012 eHealth Client Congress. 
• Boston Business Journal names eClinicalWorks to its Pacesetters Powerhouse Elite in recognition of its 148% growth over four years.
• TripleTree names Awarepoint and Optum as finalists for its 2012 TripleTree iAwards for Wireless Health.
• CynergisTek will feature its HIPAA Audit Readiness Solution Portfolio at this weekend’s 16th Annual HCCA Compliance Institute in Vegas.
• Billian’s HealthDATA adds home health agencies and nursing home financials to its market coverage for subscribers.
• Aventura partners with Choice Solutions to provide one-click access to patient data.
• Gartner names MedVentive as a 2012 “Cool Vendor in Healthcare Providers” for providing innovative and potentially transformative solutions for healthcare delivery organizations.
• EBSCO Publishing adds continuing education modules for PT/OT/ST to its Rehabilitation Reference Center that’s used by rehabilitation clinicians at the point of care.
• Capsule posts the next video in its Connected Consultant series intended to educate clinicians and IT people about medical device integration, this one on hardware.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Readers Write 4/25/12

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

CDS by the Numbers: Three Useful Frameworks for Developing Clinical Decision Support Applications
By Lincoln Farnum

Clinical decision support, or CDS, is many things to many people. Ask any 10 healthcare providers what clinical decision support is and you’ll very likely get 10 (or maybe 20) different answers, all good ones. The answers are also likely to be tinged with some degree of frustration and mistrust.

CDS as a discipline stems from the original promise of computers developing artificial intelligence — actually practicing medicine, making diagnoses, and managing patient care. Obviously these early expectations have not yet been fully realized. Today, our understanding places computers in medicine into more supportive roles.

In practice today, one commonly seen CDS application is related to medication ordering — alerting for allergies; duplicate orders and therapeutic overlaps; and drug-drug and drug-food interactions. These applications have no doubt saved human lives and resources, but often do so at a high cost to prescribers in the form of confusing messages and alert fatigue from poorly designed or executed rules.

Also, ethical concerns can affect users’ experiences with CDS. Concerns that technology-driven decision making will affect the doctor-patient relationship or that it might fail to take into account the patient’s values, or produce a cumulative de-skilling effect on physician training have all been commonly cited. There are also frequent liability concerns relating to prescribers accepting erroneous advice from a computer. It’s the fallout from these common but very reasonable apprehensions that we as consultants must try to manage on a daily basis.

Designing effective CDS is as much art as science, and it’s a quite a bit of both. Detractors of clinical decision support enthusiastically point to the occasional bad examples, but are quite often not even aware of the good ones. They seldom see “good” CDS — in part because it’s so hard to do, but also because good CDS is often invisible. CDS applications are, at their best, an unseen hand gently guiding patient care and clinical decision making.

There exist today three common frameworks for designing effective CDS: the Three Pillars of Effective Clinical Decision Support, the Five Rights of CDS, and the Ten Commandments of CDS.

Let’s begin with discussing the Three Pillars.

The Three Pillars

Osherhoff, et al, in “A Roadmap for National Action on Clinical Decision Support,” uses an image of three pillars supporting effective CDS. They are represented in the image below:

Pillar 1: Best Knowledge Available When Needed

• Represent clinical knowledge and CDS interventions in standardized formats (both human and machine-interpretable) so that a variety of knowledge developers can produce this information in a way that knowledge users can readily understand, assess, and apply it.
• Collect, organize, and distribute clinical knowledge and CDS interventions in one or more services from which users can readily find the specific material they need and incorporate it into their own information systems and processes.

Pillar 2: High Adoption and Effective Use

• Address policy / legal / financial barriers and create additional support and enablers for widespread CDS adoption and deployment.
• Improve clinical adoption and usage of CDS interventions by helping clinical knowledge and information system producers and implementers design CDS systems that are easy to deploy and use, and by identifying and disseminating best practices for CDS deployment.

Pillar 3: Continuous Improvement of Knowledge and CDS Methods

• Assess and refine the national experience with CDS by systematically capturing, organizing, and examining existing deployments. Share lessons learned and use them to continually enhance implementation best practices.
• Advance care-guiding knowledge by fully leveraging the data available in interoperable EHRs to enhance clinical knowledge and improve health management.

The Five Rights

The Agency for Healthcare Research and Quality (AHRQ) has published a CDS Toolkit in which safe and effective medication management is supported by the use of CDS, though these concepts can easily be extrapolated to health care in general. The Five Rights of Effective CDS — not to be confused with the Five Rights of Medication Administration — proposes that we can achieve CDS-supported improvements in desired healthcare outcomes if we communicate:

1. The right information. Evidence-based, suitable to guide action, pertinent to the circumstance.
2. To the right person. Considering all members of the care team, including clinicians, patients, and their caretakers.
3. In the right CDS intervention format. Such as an alert, order set, or reference information to answer a clinical question.
4. Through the right channel. For example, a clinical information system (CIS) such as an electronic medical record (EMR), personal health record (PHR), or a more general channel such as the Internet or a mobile device.
5. At the right time in workflow. For example, at time of decision, action, or need.

The Ten Commandments

Finally, David Bates, et al in JAMIA published “Ten Commandments for Effective Clinical Decision Support: Making the Practice of Evidence-based Medicine a Reality,” in which he modestly proposes the following ten commandments for CDS:

1. Speed is everything. Even if the decision support is wonderful, if it takes too long to appear, it will be useless.
2. Anticipate information needs and deliver in real time. CDS must be presented at the moment the user needs it.
3. Fit into the users’ workflow. Users won’t go looking for CDS — it needs to be in their workflow.
4. Little things can make a big difference. Small changes in delivery can have an oversized effect in outcomes.
5. Recognize that physicians will strongly resist stopping. Don’t bring clinicians to a dead end when making suggestions.
6. Changing direction is easier than stopping. Propose alternatives when advising against something.
7. Simple interventions work best. Complex and multi-paged guidelines will not be readily accepted.
8. Ask for additional information only when you really need it. Try to obtain all necessary information passively. Ask for additional information only if it is absolutely required.
9. Monitor impact, get feedback, and respond. Verify that interventions are producing the desired outcomes and communicate with your customer base.
10. Manage and maintain your knowledge-based systems. Suggestions based on outdated information are dangerous and worse than no suggestions at all.

Obviously, this is a very high level overview of these frameworks. The below links will provide more information and context. The simple take-home lesson is that effective CDS isn’t easy and even good CDS isn’t always accepted or performs as its developers intend. The development and deployment of clinical decision support should be undertaken with an understanding of the challenges and recommendations for best practices, and with the strong cooperation of and input from the user community.

A Roadmap for National Action on Clinical Decision Support, Jerome A. Osheroff, MD, et al.

AHRQ, Approaching Clinical Decision Support in Medication Management

Ten Commandments for Effective Clinical Decision Support: Making the Practice of Evidence-based Medicine a Reality, David W. Bates, MD, MSc, et al.

Lincoln Farnum MMI, RRT-NPS, CPHIMS is a senior consultant with Vitalize Consulting Solutions, an SAIC Company and a graduate teaching assistant in the Master of Science in Medical Informatics program at Northwestern University.

I’m a Believer in Diagnostic Decision Support
By Scott W. Tongen, MD

When I read a vendor’s brochure about diagnostic decision support software that mirrors how medical students and physicians in training are taught to diagnose patients, I had an epiphany. My peers and I today are not diagnosing patients the way we were instructed in medical school and residency. As a result, we — and our patients — pay a heavy price.

As students and residents, we were asked to provide a list of all possible diagnoses based on patient’s symptoms, medical tests, accumulated medical knowledge, and other information. Next, we would use the data at our disposal to eliminate diagnoses that did not fit until we were left with one diagnosis.

However, advances in imaging software and electronic health records, revenue pressures, and crushing time demands had led us to stop using that “differential diagnosis” methodology on a daily basis, leading to misdiagnoses or missed diagnoses.

None of us likes to admit our mistakes and fallibilities when we’ve misdiagnosed or missed a diagnosis, but it happens: 40,000 to 80,000 patients die annually due to misdiagnosis, according to a 2009 study published in the Journal of the American Medical Association.

I believe a major reason for an inaccurate or incomplete misdiagnosis is due largely in part to the increased use of powerful EHR systems. Those systems are deemed so efficient now that they lull highly skilled and trained professionals into a false sense of security. Too many physicians rely on electronic alerts and images to help them solve the mystery of a patient’s illness, forgetting that technology can be a poor or terrific tool, depending on whether it is used correctly.

Also, doctors and hospitals do not realize that EHRs are not sold “out of the box” with diagnostic decision support that generate potential diagnoses and flag high-risk “Don’t Miss” diagnoses when patient’s symptoms and vital signs are entered into the application. When clinicians do not know what they do not know or are not thinking about a possible diagnosis, they certainly will miss it.

Another reason for misdiagnoses and missed diagnoses is physicians’ busy schedules, as continual reimbursement cuts are forcing them to squeeze in more patients. This, combined with other demands competing for their time, make it impossible for doctors to remember all pertinent details that could potentially explain a patient’s problem, much less keep up with the massive explosion of peer-reviewed studies and medical discoveries published in numerous medical journals.

All those thoughts flashed across my mind as I read the brochure, which ultimately led to my convincing administrators to fund and offer the tool to our physicians. Diagnostic decision support software can help doctors address those problems while minimizing misdiagnoses that harm or kill patients.

For that reason, every physician and hospital in the country should implement diagnostic decision support software that highlights and enables them to access relevant information about potential diagnoses. They will find the tool extremely valuable, particularly when diagnosing difficult as well as rare cases. A useful objective review of these tools was published recently, “Differential Diagnosis Generators: an Evaluation of Currently Available Computer Programs” by William Bond, MD, MS et al from the Lehigh Valley Health Network.

To be clear, I am not proclaiming diagnostic software needs to emulate a physician’s thinking. What I am advocating is that doctors should use it to bring up diagnoses they otherwise would not have considered or remembered. The tool will more than pay for itself if it prevents a single fatality or serious misdiagnosis. More importantly, it will enhance quality and safety of care.

At the time this article was written, Scott W. Tongen, MD was medical director of clinical documentation, compliance, and quality at United Hospital, part of Allina Hospitals & Clinics in Minneapolis. He has since joined Vitalize Consulting Solutions, an SAIC Company as medical director.

News 4/25/12

Top News

Cerner breaks ground on its $160 million Kansas City, KS campus, which will eventually house 4,000 employees. The first tower is projected to open mid-year 2013 and will serve 1,000 employees, including about 800 new hires.

Reader Comments

From THB: “Re: Accretive Health. Wanted to hire me with this exact thing under the guise of implementing an ACO-type process (do you want us to put the kidney stones back in?)” The State of Minnesota goes after Accretive Health for its actions on behalf of its hospital customers, including placing its employees in the ED to demand payment before services are rendered and for using information in hospital charts to try to collect overdue bills. I’m uncomfortable with the tone of the entire article, which seems to suggest that (a) hospitals should be passive in their efforts to convince patients to pay for services rendered, asking them nicely and infrequently if they wouldn’t mind setting their debts at some point if it’s not too much trouble; (b) it’s unethical to ask ED patients to make payments for previous visits before seeing them again, when in fact many of those patients show up for non-emergent conditions anyway and treat it more like a physician office visit; and (c) hospitals are being shady when they allow Accretive employees to work in its departments, even though full hospital departments like dietary and housekeeping are outsourced all the time.

Why isn’t the state upset about a national healthcare system based on ridiculously inflated charges that are favorably discounted to big insurance companies but not to patients without insurance, or with patients who incur healthcare services with no intention to pay for them even when they are financially able to do so? Hospitals and Accretive are doing exactly what you would expect given the goofy rules of the game – hospitals are often huge and hugely profitable non-profits (intentional oxymoron) with multi-million dollar executives who are wired to maximize the bottom line. The system was changed years ago to eliminate the charity and tax-supported models and instead requires hospitals to be run like a business. The shades of gray about which services are mandatory, who can and can’t afford to pay, and how aggressive the bill collectors are allowed to be just detracts from the central issue – hospitals are doing nothing illegal, just selectively distasteful to those who think healthcare isn’t a business when it clearly and intentionally is, rightly or wrongly.

From Banishing Bob: “Re: North Carolina hospitals. Subject of a scathing investigative series by the Raleigh newspaper.” The five part-series, called “Prognosis: Profits — Hospitals Prosper at Patient’s Expense” is an extension of the argument above – behavior that’s unsavory, but legal and, according to the hospitals named, necessary. North Carolina’s non-profit hospitals – which pay no income, property, or sales taxes — are banking annual profits of up to $500 million, erecting massively expensive Taj Mahospitals, paying their executives handsomely (25 in the state make over $1 million), strong-arming patients who can’t or won’t pay their bills, and sitting on multi-billion dollar reserves in a couple of cases. All in the name of sustainability and giving the locals the care they deserve, the executives say. Most of the 25 non-profit hospital executives in the million dollar club work for Novant or Carolinas HealthCare. Carolinas HealthCare paid its CEO $4.2 million, the COO $2.5 million, the CFO $1.8 million, and has EVPs making nearly $2 million. Novant’s chief clinical, medical, and administrative officers each made over $1.5 million and its general counsel was paid $1.2 million. On the IT side, Novant paid its CMIO $801K and its CIO $770K. I don’t know about Carolinas HealthCare since their federal 990 form isn’t readily available for whatever reason (I assume because they’d rather it not be). Excessive? You decide.

From Oblate Spheroid: “Re: Bill O’Connor. Gone from Zynx. What’s going on there?” Unverified. Bill’s LinkedIn profile says he’s still there. He is (or was, depending) the SVP of marketing, joining the company nine months ago.

From Beeper King: “Re: beepers. Because there is no guarantee of message delivery with cellular communications, pagers will be with us for a long time to come. How often have you received a cellular text message a day late? The cellular community will need to be pressured to make this change. However, given the small portion of their market that healthcare segment makes up, this probably isn’t likely to happen soon.” The beeper discussion is fascinating. Somehow every other industry makes do without beepers for their critical, real-time communications. The only time I felt secure in knowing whether my message was received (and opened) was in the old days of the two-way RIM pager, precursor to the BlackBerry. Even now, there’s no perfect system – secure, cheap, usable in all geographic areas, and with verifiable delivery.

From Suggestion Box: “Re: interviews. You should interview health system CEOs about IT-related topics such as Meaningful Use and ACOs.” I really like that idea. If anyone can hook me up, I’m happy to do it. I’ve tried George Halvorson of Kaiser a couple of times with no luck, but just about any big-hospital CEO would be fun.

From The PACS Designer: “Re: cloud collaboration. An application that has been adopted for collaboration by over 120,000 businesses is Box. Box offers secure, scalable content-sharing that both users and IT love. The app pioneers a new level of content management security, with role-based access controls, 99.9% uptime guarantee, and data encryption using 256-bit SSL." A one-user, 5 GB personal account is free, although so is the long-delayed, just-announced Google Drive.

From Frank Poggio: “Re: Medicare payments. CMS proposes a payment update for acute-care hospitals that it projects will increase operating payments by about 0.9% in 2013. Well, let’s see — that would mean if you did not meet Stage 1 MU, that would be a penalty of 0.3%. In a 250-bed facility, that would be maybe a $100k loss. Is it worth slamming in an EMR? I doubt it. Oh, by the way the docs got 0%, so one-third of zero equals zero penalty.”

From Daniel Barchi: “Re: Yale New Haven Health System. Greenwich Hospital went live big bang on Epic for all financial and clinical applications this past Saturday. Greenwich is the first of the three hospitals to go-live and it joins 36 physician practices from Yale Medical Group, Northeast Medical Group, and private community physicians who have been live on Epic since October. I could not be more proud of our local Epic team and the staff and leadership of Greenwich Hospital. We have also been really well supported by a talented team from Epic. I have been through many go-lives and the preparation and hard work of all of these teams made this about as smooth as a hospital go-live can go. The attached picture shows Greenwich Hospital President and CEO Frank Corvino throwing the switch at a go-live ceremony the first day.” Thanks for the report. Daniel is CIO of the Yale health system and the medical school.

HIStalk Announcements and Requests

Welcome to new HIStalk and HIStalk Practice Platinum Sponsor simplifyMD. The Atlanta-based company offers The Digital Chart Room, which includes medical-grade document management, auto-indexing of scanned documents, a template generator, the Productivity Pilot task organizer, and a personal health record. It eliminates the limitations of paper-based charts (one-person access, lost files, high labor costs), avoids the risks of EMR implementation (physician workflow interruption, expense, lack of ROI), and allows practices to increase their volume to offset higher costs and reduced payment. The company’s talking points are fast and friendly customer support, affordability, easy implementation, and elimination of customer exposure to technical obsolescence. Customers choose between a fully hosted cloud-based solution or a local cloud (a local server that allows uninterrupted operation if Internet access is lost, but with access from anywhere). It’s one monthly price ($395) for everything and the customer can just stop using it with no additional charges if they find that it doesn’t pay for itself. Check out their ROI calculator here. Thanks to simplifyMD for supporting HIStalk and HIStalk Practice.

Acquisitions, Funding, Business, and Stock

Streamline Health reports Q4 results: revenue $4.5 million vs. $4.9 million, EPS $0.00 vs. -$0.19.

Standard Register announces Q1 revenue of $157.6 million, which includes $57 million from its iMedConsent (dba Dialog Medical) division and other HIT solutions. The company notes that sales of clinical documents and administrative forms fell 12% from the previous year due to customers implementing EMRs.

Healthways acquires Ascentia Health Care Solutions, a provider of population health management technology to support physician-directed population health initiatives.

HealthStream announces Q1 numbers: revenue up 28%, EPS $0.05 vs. $0.07, beating revenue estimates but missing consensus earnings estimates of $0.06. Shares made Nasdaq’s biggest percentage losers list for the day, down 10%.

Apple beats all Q2 expectations with revenue up 59% and EPS $12.30 vs. $6.40. The company sold 35 million iPhones that accounted for 58% of its revenue. It sold 11.8 million iPads, more than double the year-ago number even though the newest model was available for only the last month of the quarter. Mac sales were up 7% to four million, while iPod sold 15% less than the year-ago figure.

Sales

DR Systems announces seven new PACS contracts totaling more than $3.7 million.

The 90-physician Allied Pediatrics (NY) selects Isabel Healthcare’s diagnosis decision support technology, which will be integrated with Allied’s GE Centricity EMR.

The VA extends its contract with Authentidate for home telehealth devices and services for at least one more year with three one-year extension options. 

Indian River Medical Center (FL) selects RelayHealth to provide HIE and PRN technologies.

The Saskatchewan Surgical Initiative announces that it will expand the implementation of Surgical Information System technologies into new hospitals.

Duke University Health System will implement iSirona’s device connectivity solution.

Cuyuna Regional Medical Center (MN) chooses PatientKeeper’s clinical applications to create a virtual EMR from the hospital’s Meditech inpatient and Allscripts outpatient systems.

People

Poudre Valley Medical Group CEO Russell Branzell joins GetWellNetwork’s board of directors. He was formerly CIO of Poudre Valley Health Systems and the president and CEO of that organization’s for-profit IT company.

Communications consulting firm WCG hires Rob Cronin, the former head of corporate communications for SureScripts, as practice leader of healthcare technology and transformation.

AMIA President and CEO Kevin Fickenscher MD is named chairman of the newly created healthcare advisory board of Intelligent InSites.

Lt. Col. Danny J. Morton (on the right above) is named as the Army’s MC4 battlefield EMR product manager, replacing Lt. Col. William E. Geesey in a ceremony at Fort Detrick, MD.

Announcements and Implementations

Open source provider Medsphere Systems joins the Open Source Electronic Health Record Agent community, which focuses on establishing a code repository for the VA’s VistA EHR.

Mount Sinai Medical Center (NY) implements Perminova EP to manage the scheduling, workflow, documentation, and billing processes for cardiac electrophysiology procedures.

Phreesia adds an electronic version of the M-CHAT autism screening tool for toddlers to its patient check-in system.

The Health Information Trust Alliance (HITRUST) establishes the Cybersecurity Incident Response and Coordination Center to provide alerts and information-sharing related to healthcare cybersecurity threats.

EHR Doctors announces that its CCD Generator is being used by Ministry Health Care to create an ONC-ATCB certified Continuity of Care Document from its multiple EHR systems.

TigerText announces a new version of its secure text messaging application, with University of Louisville as its first higher education customer.

In Canada, doctors at Ottawa’s Queensway Carleton Hospital say they like what they’re seeing in the pilot project for a discharge information system developed by TELUS Health. PCPs automatically get electronic copies of the records of their patients who are seen in the hospital’s ED, replacing the paper records that took two weeks to deliver.

Other

I don’t watch much TV (American Idol excluded) but I was glad to see that Epic employee Rachel Brown is still a contender in The Amazing Race. Rachel and her Army helicopter husband Dave are one of four remaining couples in the running to win a $1 million grand prize. If the Browns win, I am sure that Judy will be happy to offer investment advice.

A KLAS report says almost half of inpatient providers plan to purchase a computer-assisted coding solution within the next two years, according to KLAS, mostly because of ICD-10. The most recognized vendors are 3M, OptumInsight, and Dolbey.

Epic beats IBM in the StarCraft II Championship, earning $5,000 for its charity of choice, Doctors Without Borders. The motto of the 12-0 team, captained by JDUB, is “Need Medical Attention?”

A New Zealand doctor is reprimanded for failing to tell a patient about an abnormal blood test result. The doctor said he hit the wrong key on the keyboard, but a public health commission said he should have used other software to remind him about the result.

Sponsor Updates

• GetWellNetwork customer Celebration Health and its CEO, Monica Reed MD, will host all 350+ attendees on its campus to kick off GetWellNetwork’s user group meeting in Orlando next week.
• CynergisTek partners with the law firm of Davis Wright Tremaine to create the HIPAA Audit Readiness and Response Solution Portfolio for OCR audit compliance.
• NextGate announces the release of MatchMetrix v8 and NextGate Registries for Healthcare for accurate identity matching and health information exchange.
• Cuyuna Regional Medical Center (MN) selects PatientKeeper technology to aggregate data from the MEDITECH system used by the hospital and the  ambulatory care offices’ Allscripts system.
• Meritas Health Corporation (MO) selects eClinicalWorks EMR for its 72 employed physicians.
• Lakeside Orthopedics (NE) chooses the SRS EHR for its five physicians.
• eClinicalWorks opens a Chicago office to provide a central US presence. The city will host eCW’s user group meeting April 28-29.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

EHR Design Talk with Dr. Rick 4/23/12

Overview with Details on Demand — A Versatile Design

Let’s return to the EHR design problem we were considering in my last post. You’re a member of an EHR development team working on a new high-level EHR user interface design that displays an overview of an entire patient encounter in a single screen view. Your current user interface requires clinicians to navigate to multiple screens.

In the new design, each category of patient data (Problem List, Medications, Exam, etc.) is assigned to a relatively small pane on a single screen. Your problem is how use these small panes to display each category of data in a way that still makes sense to clinicians.

Your team discovers that a design based on small panes with horizontal and vertical scrollbars doesn’t work. Now it’s back to the drawing board.

Instead of trying to design in the abstract, it becomes clear that you need to start by looking at actual patient data and finding out how clinicians use it. You again start with the redesign of the medication pane.

Your current EHR design requires clinicians to navigate to a separate screen to see a patient’s full medication data. Such a screen is shown below for a particular patient who is taking nine medications. I have broken it into two parts so that it’s readable in this blog format.

If you want to provide an overview for your users, how would you proceed? What information is most important? What information is only occasionally needed?

Here is where you need input from your clinician users — in technical jargon, your subject matter or domain experts. You observe and talk to clinicians using your product.

Some of them want to see just the names of the medications in the summary view, while others want to see the medication name, the dose, and the instructions. Most clinicians agree that the start date, the notes, and the prescribing physician data are less important, but that they should still be readily available on demand.

So, with this input, what information would you display in a summary view? How would you display more information on demand?

Clearly, there is no single design solution to this problem. Any design will require lots of trade-offs and compromises. One possible solution is show below:

In this summary view, only the names of the medications are listed. By hovering with the mouse cursor in the header row, the clinician gets an expanded view, displaying the dose and instructions, as below:

When the cursor is moved off of the header row, the pane contracts to its original size.

Alternatively, by keeping the mouse cursor within the header row, moving it to the right and again hovering (or by a similar gesture), the clinician could get the view below displaying the complete medication data:

Note that this view has the same information content as the full screen view shown at the beginning of this post. Again, when the cursor is moved off the header row, the pane contracts to its original size.

There will be times when the clinician needs to keep an expanded view open while working with a different part of the screen. This could be accomplished by clicking with the mouse instead of hovering.

There will also be times when the clinician wants to retrieve information for just one data element or data field in a pane. The same convention of hovering with the mouse to get a temporary view or clicking to keep that view open until closed could be used:

Again, by using a mouse hover or click, further details can be viewed without expanding the entire pane:

And so forth:

These expanding pane and pop-up designs are of course familiar to users in other contexts, but many widely used EHRs, even newer and cloud-based ones, don’t support them or don’t support them consistently.

All too often, the EHR interfaces that clinicians use on a day-to-day basis are based either on small panes with scrollbars or require navigation to multiple different screens. Such designs overload working memory, leaving little for patient care issues.

Unfortunately, guidelines for EHR usability can only address these kinds of high-level design choices in general terms. Furthermore, usability testing protocols do not provide a mechanism for comparing one design pattern to another. Hence EHRs that rely on small panes with scrollbars or require navigation to multiple different screens can still get good usability ratings.

While the overview with details on demand design pattern is versatile and powerful, a major potential problem comes with it — when a pane or data field expands, it obscures information in adjacent panes. I look forward to addressing this issue in my next post.

Next Post:

Pane Management

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

Curbside Consult with Dr. Jayne 4/23/12

Even before our friends at the federal level decided to delay implementation of ICD-10, I had been reading quite a bit about the different strategies health systems are planning to employ in support of the transition. With the delay, most vendors are continuing full speed ahead so that they can be sure to be ready for an eventual implementation. Although some advocate waiting for ICD-11, many feel it’s a foregone conclusion that ICD-10 will happen.

Most articles I’ve read have been about preparing your practice, ensuring coders are trained, and ensuring software is updated. There hasn’t been much talk out there about how to actually train physicians (who will continue to ultimately be responsible for the diagnosis and coding as they have always been) on the new system. For those of you who not playing along at home, the change from ICD-9 to ICD-10 gives providers approximately 138,000 additional ways to miscode a diagnosis.

I don’t think many people realize that providers are going to have to change the way they interview patients in order to obtain all the information needed to accurately assign a code. A recent article in Medical Economics points out some specific examples:

• ICD-9 has a single code for a closed femur fracture. ICD-10 has 36 and it’s difficult to see how physicians or payers will really benefit from that level of granularity.
• Histories will have to include information which isn’t relevant to most physicians, such as the part of the home in which an accident occurred.
• When that information isn’t collected at the point of care, staff will either have to call patients to gather the details or risk lower reimbursements from perceived lower acuity when non-specific codes are used. Additionally, the article reminds us that in many practices there is high staff turnover, meaning that staff that are incurring training costs now may be working elsewhere in the future.

Some of the articles out there are oversimplified cheerleading. As much as I liked the article about why waiting is an option, another Medical Economics piece just made me aggravated. The nauseatingly titled “ICD-10: You can do it with these pointers”  offered such highly useful tips as these:

• Overall, the types of medicine that will be most affected by ICD-10 include cardiology, cardiothoracic surgery, emergency medicine, general internal medicine, neurology, obstetrics, oncology/hematology, orthopedics, psychiatry, and vascular surgery.
• Of the disease processes typically encountered by internists, the ones that are most affected under ICD-10 are cardiovascular disorders, cerebral infarctions, diabetes, gout, musculoskeletal conditions, neoplasms, respiratory disorders, and underdosing.

I don’t know about you, but those little “pointers” don’t make me think I can do anything but contemplate how long I have before I can actually retire. I think many of us are pinning our hopes on software and technology vendors – hoping that notes can be parsed and prompts constructed to ensure all necessary information is gathered during the patient encounter.

Often, however, the patient doesn’t even know the information required. For example, was the myocardial infarction inferolateral or basal-lateral? Did it involve ST segment elevation? In order to ensure coding accuracy, it seems like there will be much time spent in hunting old records lest we risk being “dinged” for poor coding.

Just to make things more interesting, I noted that the infographic provided in the “it’s OK to delay” article has an error in it:

My other handy-dandy coding reference at ICD10Data.com lists the codes a bit differently:

I’m sure it was easy for some non-medical proofreader to confuse “subsequent” with “sequelae,” but whenever coding is at play, the devil really IS in the details.

I want to invite each of you to share your favorite ICD-10 codes. I’ll run the funniest in upcoming posts. Until then, I leave you with a challenge:

Say I was at the Pike Place Fish Market and I was struck in the left shoulder by a mackerel. How would I code that? And would it make a difference whether it was a mackerel or a shark? What if the mackerel wasn’t flying through the air, but was being swung at the time? Does it really matter? E-mail me.

E-mail Dr. Jayne.

Thomson Reuters Will Sell Healthcare Unit to Veritas Capital

Thomson Reuters announced this morning that it has entered into an agreement to sell its healthcare unit to Veritas Capital for $1.25 billion in cash. The company offers analytics services, clinical decision support, an HIE solution, and the Micromedex drug information reference.

Robert McKeon, chairman of Veritas Capital, was quoted as saying, “The Healthcare business of Thomson Reuters is the preeminent healthcare analytics company in the industry today. The acquisition will provide us with a unique and exciting opportunity to add a truly outstanding business and world-class management team to our portfolio and we look forward to building upon our experience in the healthcare analytics market. We look forward to welcoming the business and its talented employees, including its talented management team led by Mike Boswood, into the Veritas family.”

Monday Morning Update 4/23/12

From Radar Love: “Re: Todd Cozzens. Leaving Optum after the company’s Picis acquisition in 2010 and his role change to running its Accountable Care Solutions business.” Verified. Todd confirms that he’s moving to Sequoia Capital this week, although he will continue to service in an advisory role with Optum. Sequoia is a legendary Silicon Valley VC investor that was Apple’s first backer and a player in household names like Oracle, Google, LinkedIn, and YouTube. I checked the company’s site and they have healthcare IT investments as well, most of which are in fact HIStalk sponsors even though I hadn’t previously noticed the connection (AirStrip, Healthcare Quality Catalyst, and ZirMed). At Sequoia, Todd will work with some of its portfolio companies as a board member and mentor, as well as a deal scout. Todd and I have penciled in time for a chat once he’s gotten his feet wet there since I’m interested in their view of the healthcare IT world. Trivia I learned from checking Wikipedia: the company estimates that 19% of Nasdaq’s value is made up of companies Sequoia funded. Todd’s HIStalk history is almost as long as mine – he was my second interview way back in 2005 (everybody was turning me down back then as a waste of time and Todd had to pull rank on his marketing people, who were appalled at the idea) and as one of HIStalk’s first sponsors.

From Recovering Physician: “Re: Lynn Vogel, MD Anderson Cancer Center. He has left. No word on whether he has accepted a new CIO role.” I received this over the weekend and wasn’t able to check with Lynn, but his LinkedIn profile sees to indicate that his employment at MDA ended this month. I’m sure I’ll have an update, possibly by Monday. UPDATE: Lynn confirms that he has stepped down, but isn’t quite ready to announce what he’s doing next.

Respondents were almost evenly split on the subject of hospitals choosing not to hire people who smoke or who are overweight. New poll to your right: how has HITECH affected patient outcomes?

Listening: reader-recommended Of Monsters and Men, super-catchy and creative alt-folk (think Mumford & Sons) from some cheery young folks from Iceland. Lead singer Nanna Bryndís Hilmarsdóttir sounds a bit like Dolores O’Riordan of The Cranberries, right down to the enchanting lilt in her accent when she sings. They’re so cute and fun that not only do you want to give them a group hug and carry them around in a handbag like a Shih Tzu, they may end up being Iceland’s ABBA. Their small US tour starts in May, and if they only sound half as good as they did recorded all-acoustic live in their living room, they’re going to kill.

An item that’s been on my to-do list forever is to enlist volunteers for what I’m grandly calling the HIStalk Advisory Board. What that means: I will e-mail you every 1-2 months with just 3-4 questions about what’s going on in your world – interesting product issues or needs, rumors heard, important issues I’m not writing about, etc. You do a quick reply and let me know what’s up, which will help me keep focus on what’s important to readers. I will not spam you, identify you in any way, or otherwise bug you. If you work for a hospital, clinic, or physician practice and can spare a couple of minutes every few weeks to help me out, plop your information here and accept my thanks. I may sweeten the pot with random prize drawings or something like that if it works out.

Welcome to new HIStalk Platinum Sponsor OTTR Chronic Care Solutions. I just ran my interview with CEO Lou Halperin, in which you may notice that I was fascinated with the company’s focus on transplant centers since I know next to nothing about transplants (I also learned that the company pronounces its name as “otter,” so there you go.) OTTR is the dominant player in supporting the clinical and administrative software needs of solid organ transplant centers, which as Lou points out are really like ACOs in that they’re paid a flat fee for their services, they follow patients indefinitely, and they need to assemble clinical information from a variety of providers and care venues to make clinical decisions. With new investment and leadership (not to mention a name change for the former HKS Medical Information Systems), OTTR is widening its sphere of influence into logical adjacent sectors such as bone marrow transplant and ventricular assist devices. The company has over 70 customers, manages 300,000 patients, supports 250 interfaces, and offers 24×7 technical support. They just announced that Porter Adventist is implementing its system in a cloud environment integrated with CORHIO, with employees using iPads to track patients, manage donor calls, make rounds, and to complete the forms that CMS requires. Thanks to OTTR Chronic Care Solutions for supporting what I do here.

Vitalize is celebrating its tenth year with a Disneyworld event. Founders Mary Pat Fralick (left) and Danny Arnold (right), along with Employee #3 Wendy Kadner (middle), were surprised with a cool-looking cake. The mouse ears brought back bad memories of my work trips involving MCO, the worst airport in the world for business travelers. Inbound planes were always crammed full of obnoxious kids jacked up on sugar and Mickey Mouse adrenaline, bouncing off the cabin walls with minimal supervision from their vacation-dreamy parents, any of whom might at any given moment be wearing those ears to demonstrate their temporary free-spirited insouciance. Outbound, they clogged up MCO security lines with inexpert procedure (what, we have to take our shoes off and put our carry-on bags through the metal detector?) and an abundance of backpacks and souvenir crap, but at least were quiet, newly morose at the prospect of leaving their corporately crafted fantasy land and heading back to reality.  

Weird News Andy finds it ironic that pathologist blames the death of a New Zealand woman on her two-gallon-per-day Coca Cola habit despite the company’s historical use of ad slogans that suggest Coke makes you healthy and happy (“Coke adds life, “Life tastes good,” “The Coke side of life,” and “Life begins here.”)

Boston Children’s Hospital releases its iPhone/Android app, which include wayfinding, a physician directory, appointment setting, and a patient portal with access to the patient’s medical records. 

Liverpool Heart and Chest Hospital chooses Allscripts Sunrise, the company’s first sale to a UK trust. Two other trusts choose this week from finalists Allscripts, Cerner, and Epic. The company hasn’t confirmed, no doubt saving the news for its May 7 earnings announcement.

A project manager of South Carolina’s HHS is arrested for downloading the personal information of 228,000 Medicaid recipients. He won’t say what he planned to do with the information, which involves a fourth of the state’s Medicaid population. He got caught only because of his poor work performance reviews. The incident has become a political football as the Republican Party was quick to point out that he is (or was in the past – accounts vary) a member of the Democratic Party’s county executive committee. Screen captures of the Democratic Party’s site show that his name was quick removed after his arrest. All of that is irrelevant unless he was planning to use the information for campaign purposes.

University of Arkansas for Medical Sciences announces that the information of 7,000 patients was improperly handled when a physician e-mailed a worksheet of patients to an non-employee analyst for billing purposes.

I’m both encouraged and puzzled that the embarrassing alpha pagers we use in healthcare are such a hot topic all of a sudden. Coincidentally, I watched one of the great “Beeper King” episodes of 30 Rock last night, where Dennis tries to convince Jack that technology is cyclical and beepers will eventually stage a comeback over cell phones (best lines, both from Jack: “Gosh, I hope you got a picture of that with a camera on your beeper.” and “I’m expecting a call from 1983.”) John from EMR and HIPAA sent info on docBeat, a new iPhone app in beta that provides two telephone numbers on one device, voice to text, secure text messaging (including future dating for non-urgent messages), and a directory service. I’m sure there are other products as well, and I’ll defer to Travis of HIStalk Mobile, who is checking them out. The main problem I see is poor cell coverage inside hospitals, where somehow crappy technical dinosaurs like pagers seem to work more reliably (or at least more predictably). The issue of user-to-user critical messaging is becoming important, not only because pagers are dying, but because so is BlackBerry and its BBM capability.

GE Healthcare announces Q1 numbers: revenue up 5%, net income up 10% to $585 million. Overall, GE reported revenue that was down 8% and EPS of $0.34 vs. $0.33 excluding one-time costs.

Microsoft’s Q4 numbers: revenue up 6%, EPS $0.60 vs. $0.61. Windows revenue was up a little despite flat or declining PC sales, as were sales to businesses, but Windows Phone didn’t do much and MSFT’s videogame-related sales dropped 16%.

Vince has a fascinating personal story to tell about his days at MedTake in this week’s HIS-tory. Like he says in it, it’s vendor insider stuff that should be interesting to providers they’re trying to sell to.

I’m trying to decide if the weekly review I’ve done the last couple of Mondays is worth the couple of hours it takes me to write it. I’m not feeling ambitious at the moment, so I’m going to take a break from it. I have a lot of great ideas if I ever quit my hospital job, but in the mean time, I’m finding it really hard to keep all of life’s plates spinning.

E-mail Mr. H.

Time Capsule: Is Healthcare IT Really "The Right Thing to Do?" Prove it.

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 April 2007.

Is Healthcare IT Really "The Right Thing to Do?" Prove it.
By Mr. HIStalk

I like to shock people by telling them that a hospital is basically a clean hotel with lots more staff, lots worse service, and a nightly rate that no one in their right minds would voluntarily pay for an uncomfortable bed, incessant noise, and bad food.

Going with the hotel analogy, if you owned a mid-priced hotel in a highly competitive market, what would motivate you to make an IT investment?

• It would perform some function that increases customer loyalty or occupancy rates, thereby increasing profits
• It would reduce costs and allow more aggressive pricing, thereby increasing profits
• It would improve quality in a perceptible way that would support higher room charges, thereby increasing profits

See the common theme?

None of these motivations work for hospitals. We’re already full, even those hospitals with poor performance and low satisfaction scores. Patients don’t really care if we automate or not, even though we keep trying to convince them how wonderful it is. IT rarely reduces costs for a given organization and hasn’t put the brakes on healthcare spending.

Worst of all, despite stacks of arguments trying to prove that technology investments improve patient outcomes, evidence is skimpy at best.

That leaves two reasons to invest the many millions today’s IT solutions often cost. Either (a) it’s a cost of being in business, or (b) it’s the right thing to do.

"Cost of being in business" is the lazy answer that IT vendors love. Walmart eats companies for lunch that hide behind what they think are fixed costs that Walmart can eliminate. A few good Rollback Specials and Mr. "Cost of Being in Business" isn’t for much longer. Luckily (for everyone but patients and payors, anyway), hospitals collectively have few original ideas, so the competitive threat is minimal.

Walmart invests legendarily in IT, but they’re not throwing money at the same off-the-rack systems that every other department store uses (like hospitals do.) Without the motivation of competitive advantage and eventual increased profits, why bother? Spend the money on nicer bathrooms or friendlier cashiers instead. The payback is more certain.

"It’s the right thing to do" is noble-sounding, but easily riddled with holes. You can’t prove it’s the right thing to do, can you? If even one hospital that didn’t spend $40 million on a clinical system has better outcomes than yours that did, then obviously it isn’t just about IT.

Most hospitals wouldn’t touch an expensive new drug without reams of studies proving its safety, efficacy, and cost-benefit ratio. Those same hospitals, however, continue to buy IT on faith alone, using either the "cost of being in business" or "right thing to do" rationale. If IT were a drug, we’d ban the chippy blonde sales rep from our hospital.

All of this would be irrelevant if patients found IT valuable. My doctor doesn’t use an EMR, but I’m not about to switch to a different one. My dentist doesn’t use computers except for scheduling and billing, but I’m sticking with him. When I need a new provider, I have zero interest in whether they use computers or not.

In other words, I’ll give lip service to laypeople about the wonderfulness of healthcare IT, but my feet vote differently. I’m the Chrysler sales guy who parks his Toyota around back and hopes the prospect doesn’t notice.

Maybe today’s IT systems really do improve outcomes or cost. If so, then I challenge vendors to prove it and customers to demand that proof before buying their wares. Otherwise, spend the money on staff, training, and equipment instead because we know those improve quality and efficiency.