News 5/31/13

Top News

A letter to the editor in The New York Times by National Coordinator Farzad Mostashari says public policy is making the healthcare system smarter, citing the recently announced figures that half of practicing physicians and 80 percent of hospitals are using EHRs.

HIStalk Announcements and Requests

Some HIStalk Practice highlights from the last week or so: WNA makes a rare HIStalk Practice appearance to comment on a physician who has quit taking insurance. Physician satisfaction with their EHR vendors has declined over the last year. Almost one-third of physicians buying EHRs today are replacing legacy EHRs. Physicians fear that declining reimbursements, rising costs, and ACA-related requirements will threaten practice profitability. Athenahealth recognizes Midland Orthopaedics with its athenaVision award. Most nurse practitioners believe a practice led by an NP should be certified as a PCMH, but most physicians disagree. Dr. Gregg posts a letter to Allscripts. Thanks for reading.

We’ve had some interesting posts on HIStalk Connect lately, so you might want to sign up for e-mail updates if you follow mHealth, innovative technology, and startups. Lt. Dan also does a Friday weekly news recap there that provides a great summary. Some recent articles:

Tim Cook Discusses Wearables, Acquisitions, and Executive Changes at D11 Conference
The Third Screen Revolution in Healthcare Is Before Us
How Consumers Enter the System
EHRs Propagate “Best” Practices
Healthcare Q&A
VentureHealth Launches Equity Backed Crowd Funding Site
Texting for Health Revisited

Acquisitions, Funding, Business, and Stock

Shareable Ink raises an additional $3 million, bringing its total funding in the last three years to over $14 million.

Sales

Bon Secours Health System Center for Clinical Excellence and Innovation selects Quantros to advise on performance improvements to advance ED quality and safety.

Southpoint Surgery Center (FL) selects Wolters Kluwer Health’s ProVation MD and ProVation MultiCaregiver.

The Pennsylvania eHealth Partnership Authority signs a five-year agreement with Truven Health Analytics for its HIE solution.

Clyo Internal Medicine (OH) selects simplifyMD as its EHR provider.

The University of Miami and the University of Miami Health System will deploy Hyland Software’s OnBase enterprise content management solution across 60 academic departments, 30 outpatient facilities, and three hospitals.

John C. Lincoln Health Network (AZ) selects Besler Consulting to assist in the identification of Medicare Transfer DRG underpayments.

People

AirStrip names OptumInsight CEO Bill Miller to its board.

Verisk Health EVP Brian Smith joins the advisory board for telemedicine provider SnapMD.

Explorys appoints Cleveland Clinic CFO Steve Glass to its board.

Announcements and Implementations

Advocate Physician Partners (IL), a care management collaboration with Advocate Health Care, implements its 500th independent physician on SynAPPs, Advocate’s cloud-based version of eClinicalWorks EHR.

Practice Fusion announces preferred billing partnerships with ADP AdvancedMD, CollaborateMD, and NueMD.

The Idaho Health Data Exchange and St. Luke’s Health System launch Image Exchange viewing capabilities by eHealth Technologies.

Malcom Randall VA Medical Center (FL) installs Welch Allyn’s Connex Electronics Vitals Documentation System.

Edward Hospital & Health Services (IL) deploys Levi, Ray & Shoup’s VPSX print management and document delivery system its Epic system.

PDR Network will distribute drug company patient support coupons from OPTIMIZERx via EHRs.

SCI Solutions releases Order Facilitator v10, which includes mobile ordering, expanded messaging, and enhanced capabilities for lab order requisitioning, collection, and labeling.

Nuance publicly confirms for the first time that its speech recognition technology powers Apple’s Siri, with CEO Paul Ricci stating at a conference, “We are the fundamental provider of voice recognition for Apple.”

In England,NHS chooses BJSS and Valtech as finalists to develop an electronic referrals service to replace Cerner’s system.

The MUSE conference is underway this week in National Harbor, MD, wrapping up Friday. The photo above of Farzad Mostashari delivering the keynote was posted to Twitter by Dan McQueen.

CureMD will demonstrate a new chemotherapy administration module of its oncology EHR that it says took five years to develop next week at the American Society of Clinical Oncologists conference in Chicago.

Government and Politics

CMS advises practices on the role of clearinghouses in the ICD-10 transition, noting that, “While clearinghouses can help, they cannot provide the same level of support for the ICD-10 transition as they did for the Version 5010 upgrade.”

The HHS Office of Inspector General finds that healthcare provider information maintained in the National Plan and Provider Enumeration System (NPPES) and Provider Enrollment, Chain and Ownership System (PECOS) was often inaccurate, occasionally incomplete, and generally inconsistent between the two databases. In NPPES, 48 percent of records contained inaccurate data; 58 percent of PECOS records contained inaccuracies. 

HHS launches the “Information is Powerful Medicine” campaign that targets HIV/AIDS sufferers.

A group of Senate Republicans calls for an independent investigation of HHS Secretary Kathleen Sebelius, claiming that her fundraising efforts for Enroll America, a non-profit that promotes the Affordable Care Act, is inappropriate and possibly illegal in appearing to solicit donations from industries she is responsible for regulating.

Other

The Health Information Trust Alliance, which promotes data security among healthcare providers, experiences a cyber attack of a non-critical, standalone public Web server. HITRUST a test database with fictitious data was compromised.

Bon Secours Hampton Roads Health System notifies 5,000 patients of a potential EHR security breach after discovering that two clinicians had accessed patients’ medical records “in a manner that was inconsistent with their job functions and hospital procedures.” The hospital has terminated the pair and is offering affected patients free credit monitoring services.

In England, Royal Berkshire Hospital says its problem-plagued Cerner Millennium EPR forced it to write down $23 million. According to the hospital’s CEO, “Unfortunately, implementing the EPR system has at times been a difficult process and we acknowledge that we did not fully appreciate the challenges and resources required in a number of areas.”

Australian researchers review the use of CSC and Cerner CPOE systems in a small-scale study that suggests systems with more drop-down menus may increase error risk.

EMR reminders driven by a connection to New York City’s vaccine registry increased children’s flu vaccine rates by 9 percent, and when physicians chose not to order the vaccine, they documented the reason 98 percent of the time. The results were presented at a pediatrics conference earlier this month.

Despite performance challenges with Meditech 6.0, 95 percent of the company’s customers surveyed by KLAS say Meditech is part of their long-term plans, citing affordability and usability.

A New York Times article says Beth Israel Medical Center (NY) allowed an elderly heiress worth $300 million to occupy one of its rooms for the last 20 years of her life, but launched “an all-out fundraising campaign” in having executives hang around her room to hit her up for donations and drop hints about making a will. The CEO’s mother even watched a Smurfs video with her hoping to get on her good side.  

Weird News Andy titles this story Step 1: Insert Pencil. A German man complaining of headaches and a runny nose is found to have a four-inch pencil embedded in his head, lodged there 15 years previously in a childhood accident.

Sponsor Updates

• SIIM and Brad Levin of Visage Imaging have developed a three-minute survey for IT imaging leaders to bring visibility to imaging challenges before next week’s SIIM13 conference in Dallas.
• Dorland Health names Vocera subsidiary ExperiaHealth the winner of its Case in Point Platinum Award for Discharge Planning Program for its use at Cullman Regional Medical Center (AL).
• RazorInsights exhibits its ONE Enterprise EHR at next week’s Alabama-Georgia Rural Health Clinic Conference in Opelika, AL.
• SuccessEHS client ARCare (KY/AR) achieves Stage 6 on the HIMSS Analytics EMR Adoption Model.
• Imprivata announces that it has the highest market share of any SSO solution among US Meditech EHR hospitals (36 percent) and that the number of hospitals using Imprivata OneSign has increased about 57 percent in the last year.
• e-MDs posts a Webinar that includes advice for physician practices on health information exchange and Stage 2 MU.
• Impact Advisors principal Laura Kreofsky and senior advisor Jason Fortin discuss why achieving Stage 2 MU could be challenging.
• Awarepoint is named a Red Herring Top 100 North America Tech Startup.

ICA achieves EHNAC Accreditation as a Direct Trusted Agent. Other vendors recognized include Cerner, Max.MD, and Surescripts. All four were accredited for Registration Authority, Certificate Authority, and Health Information Service Provider criteria.

The HIMSS14 Call for Proposals ends next week. It’s hard to submit timely topics nearly a year in advance, but if you’re like those of us in the nonprofit trenches, it may be the only way to have a trip to HIMSS approved. You wouldn’t want to miss an opportunity to attend HIStalkapalooza, would you?

Speaking of educational opportunities, CMS offers a National Provider Call on June 5 to help providers get started with PQRS and the Value-Based Payment Modifier programs. CMS experts will also be available after the presentation to answer questions.

The University of Illinois at Chicago creates an ICD-9 to ICD-10 website. Maybe I have a warped sense of fun, but I enjoyed fiddling with it, and the results make for some frightening diagrams to spice up ICD-10 presentations.

A friend of mine e-mailed this blog by Reid Blackwelder MD, president-elect of the American Academy of Family Physicians. He tells the tale of a neighbor who fell and was taken to the ER where he was possibly misdiagnosed and discharged, then had to return for more extensive testing and a final diagnosis. Along the way, key clinical signs (like his inability to walk) were missed. Treating the numbers (test/lab/film) rather than the patient has become epidemic in the US. Is it defensive medicine, time pressure, the influence of Big Data, or simple lack of caring? I don’t know the answer, but we have to figure out a way to do better.

The article came at the same time that I was having a heated e-mail exchange with an IT colleague about whether we should push our vendor to incorporate genomics content in the EHR. I find it difficult to think that the average physician is going to be able to understand and act on genomic data when our healthcare delivery system so stressed that stories like Dr. Blackwelder’s exist. Of course that’s assuming we figure out a way to pay for gene sequencing and the subsequent treatments suggested by the data, which was the source of the original heated exchange.

Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 5/30/13

Why Some Doctors Don’t Lean On EHR

A new study published in the Journal of American Medical Informatics Association concludes that EHR adoption has less to do with how tech savvy a doctor is and has more to do with how much uncertainty — an accepted and universal attribute of medical practice — a doctor is comfortable with.

Repeated EHR Alerts Desensitize Clinicians

A case review published in the journal Pediatrics suggests that unimportant CPOE alerts negatively impact patient outcomes, possibly because they cause clinicians to miss important warnings.

Software That’s Hard on Hospital Readmissions

A local North Texas station reports on population health systems being implemented to reduce readmission rates at Texas Health Resources.

With Money at Risk, Hospitals Push Staff to Wash Hands

The New York Times covers efforts being employed by hospitals to increase hand hygiene compliance, including a number of technology advancements that include RFID tracking of physicians coupled with video surveillance and ID badge-enabled soap dispensers that track whether soap has been dispensed and alert the clinician as they approach the bedside if it hasn’t. An unannounced 16-week video monitoring trial at North Shore University Hospital revealed hand hygiene rates at less than 10 percent. Once clinicians were made aware of the video system and were sent weekly e-mails with their performance, the numbers jumped to 88 percent.

HIStalk Interviews Frank Naeymi-Rad, Chairman and CEO, Intelligent Medical Objects

Frank Naeymi-Rad, PhD is chairman and CEO of Intelligent Medical Objects of Northbrook, IL.

Tell me about yourself and the company.

I received my computer science doctorate degree from Illinois Institute of Technology. My dissertation research work was in developing medical dictionaries that support electronic medical records, decision support, and information retrieval used at the point of care.

I got introduced to medical terminology when I was teaching classes to medical students, where I was directing academic, research, and administrative information services at the Chicago Medical School. These classes included use of computers for directed history and physical documentation, informatics workup, and concepts in medical artificial intelligence as senior electives.

During the senior elective setting, I wanted students to build knowledge for different decision support applications. The major task and challenge that we had developing knowledge for the decision support was standard terminology. Each system had its own dictionary. The systems we used were MEDAS, Dxplain, QMR, Knowledge Coupler, and Iliad. The medical students had to build knowledge for pattern recognition as well as rule-based decision support and application.

The knowledge created by students for a given diagnosis was then compared to knowledge within these expert systems for the same topic. The key learning objective was that everyone learned how the computers were used to make decisions and the results could be manipulated to reflect the new discoveries.

During that process, the most important aspect that came out was when we compared students’ patterns to other expert systems. It became clear that what was missing was standard medical terminology. This became the topic of my dissertation. It was really the concept of capturing and preserving the truth, what the source of truth about a given decision was and how the decision was made by the computer.

It was then necessary to reverse engineer the patterns back to the original form to explain why it led to the need to build a dictionary that students used to codify the rule. This allowed us to compare the pattern across multiple domains using the same foundation dictionaries. This led to my dissertation topic, which was a feature dictionary for clinical systems and electronic medical records.

The ultimate test was how the students’ knowledge would perform when interfaced to real patient data. Into the late 1980s and early 1990s, there were no coded electronic records. This led to the development of a history and physical documentation program on the Apple PowerBook for medical students. This program was expanded as a tool for second-year students as part of a supplement for the introduction to the clinical medicine class.

This program allowed students to develop comprehensive documentation for the history and physical exam. While the objective was to a develop a patient electronic record that could be used to test the student decision support pattern, instead it led to the creation of an electronic medical record which was used a the Cook County ER. IMO was created to help commercialize the product that was sold to Glaxo Wellcome, which at that time was called HealthMatic.

Later on, HealthMatic was sold to a company called A4 Sytems, and then A4 Systems sold its assets to Allscripts. The EMR that we developed at the medical school, with the help from many of the same IMO team developers working with me at the medical school, helped commercialize it. The current generation is called Allscripts Professional.

You can understand how the team who is working at IMO right now are key players in the industry. This is the same team from the medical school as well as the same team that developed the early clinical documentation for HealthMatic and medical content work for Glaxo Wellcome.

Describe how IMO’s product and the terminology works with EHRs.

Our flagship product is interface terminology. Our primary objective is to capture and preserve the clinical intent and then map that clinical intent — the truth — to their corresponding regulatory requirement. Interface terminology manages and maps between clinicians’ terms and the required regulatory code terminology like ICD-10 and Meaningful Use codes as well as reference terminology like SNOMED CT.

The way we have succeeded is that we have removed the overhead of making a clinician to be a coder. They can say what they want to say. We manage the code and mapping and help our EHR partners to capture and preserve the truth.

Who is your most significant competitor?

The competitors that I see are people who do not really understand the challenge of terminology and the importance of preserving the clinical intent. Fortunately and unfortunately for us, I think the knowledge base within the marketplace is growing. We need a dynamic model to respond to these changes as soon as possible.

We are very happy that we are able to help our partners meet regulatory standards. Adaption of standards is a very daunting task for many of our vendor partners. There has been a lot of movement in our space because most of the new regulatory standards require several new coding subsets.

We expect large and innovative competitors coming into the terminology space. What they are missing is the understanding of the electronic medical record and how terminology should be used within the electronic medical record. Having the EHR knowledge expertise gives a true edge to IMO’s team as the market moves from fee-for-service to fee-for-performance.

There are many competitors within the terminology space. We have competitors who are managing the coding for reimbursement and now have to also do clinical. We have competitors who sell you tools in order for you to manage the complex mapping for the coding within the clinical setting.

Terminology management is hard and tedious work. We have a unique group of knowledge workers and physicians because they are good at it and love doing it. Adding to that our technology team, with the understanding of the electronic medical record and how terminology is used within the electronic medical record, creates a major barrier for others to match the quality of our service delivery.

What parts of HITECH have caused both vendors and providers to seek you out as a company?

It’s compliance to the Meaningful Use requirement and making sure that they are able to manage the changes associated with Meaningful Use requirements. When you look at our portfolio of clients, they initially used us to enhance clinical searching and finding codes for reimbursement. I believe Meaningful Use is creating a unique challenge for them because it is moving the market from fee-for-service to fee-for-performance and that aspect of care creates a unique attribute and need of understanding the use of terminology within the state of care. Our interface terminology service is to make sure that the truth about clinical data is stored as expressed by the clinical team.

For example, when you’re on the same term within the assessment, it may have a different ICD-9 code versus that same term in the history section. Being able to have a concept-based architecture that manages this complexity allows for correct mapping to ICD-9 as well as to ICD-10 complex billing post-coordination, but also maps to SNOMED CT and other required Meaningful Use terminology subsets.

We take that complexity out. We manage that complexity within our tool set and then we deliver those to our client base, allowing their clinical user community intent to be preserved so we can also code for care.

A recent study found that IMO’s interface terminology can identify population health issues when paired with EHR data. What are the implications of what that study found?

The early studies that I did historically looked at finding the clinical truth. You really want to make sure that what clinicians are saying is preserved in their words and that the data being collected is following guidance dictated by the clinical team. The data collection service needs to provide terms that reflect the clinician intent in its original form.

We as a company have been very fortunate to be trusted by and permitted to serve one important population of our society, and that’s the clinician. We believe clinicians are under massive pressure to do their job through primitive electronic documentation services that do not speak their language.

I worked at the medical school for 12 years and I observed students going through all of the different stages of medical training. I understand and appreciate the difficulties physicians have to go through in their medical training. The knowledge base learned as part of their training is their most important tool to make them master problem solvers. Capturing and preserving their clinical intent is always the best card we have in understanding exactly what is wrong with the patient and even when a physician is making a wrong assumption.

Our interface terminology allows the truth to be preserved and not distorted by coding optimization templates or services. Preserving the physician intent is responsible for the success of this study, identifying 99 percent plus patients correctly in this publication. By empowering the clinical team and using IMO interface terminology, we are going to have a near perfect understanding of our patients at risk.

What’s your perception of the state of readiness for ICD-10 transition and what impact this is going to have on providers?

The impact for our vendor partners is going to be nominal because we knew going from 14,000 ICD-9 codes to 90,000 ICD-10 codes will be a massive transformation for many EHR vendors. But for our clients, it’s different because we started distributing ICD-10 mapping last year and we have been working with them to deliver their point of service solution.

As part of our support for ICD-10 CM, PCS, and MU 2, we are expanding our terminology foundations by 3,000-plus concepts and as many as 30,000 interface terms per month. What that really means is that our clients are able to manage all these lexical variants long before the regulatory deadlines for ICD-10 and MU2.

ICD-10 is just a different mapping for you and you allow customers to create or maintain their own in addition to what you supply, correct?

Correct. We don’t allow them to manage their own mapping outside of our mapping because we really believe in this crowd-based or wiki-based model. It creates transparency that our clients have the correct standard mapping. Our mapping obviously grows and changes faster because of this transparent model and medical knowledge changes. We have developed sophisticated tools and workflow to manage all the mapping ourselves. 

Normally when people go to IMO we move them to what we call a migration process to make sure that everybody standardizes their local dictionaries to the same datasets. If there is an error in our mapping or if there is an inconsistency, we can always correct it quickly in the next release. But if we allow local mapping, it really can violate some of the principles that we have. We don’t prevent them from having local variation and mapping. They can have their own lexicons if they want to, but we don’t take responsibility for those maps and will not distribute to other sites.

If they have like a certain phrase that they use locally, they can build it into the equivalent of a dictionary so that even if it’s not commonly used they can still understand?

They could still understand, but they should normally be asking to send it to us. If it matches our editorial policies, we distribute to everybody else. Everybody else would use that as well.

But I think it is important for them to be cognizant of the bigger picture because we really believe that this is the grand opportunity to really make standards like SNOMED and ICD-10 to truly work, because if we map correctly to them, at least these standard coding systems and these regulatory coding systems become more valuable for our future. Obviously they will be changing as well. If people start mapping their own local terms, there’s no way to be able to validate or review that and then challenge it.

That would be unusual, right?

That’s unfortunately not true. There is always going to be new concepts requested. We have term request workflow to incorporate new valid terms in our next release within six weeks and to have everything made available to our community. There are going to be some domains that most likely our clients would need to have their own local terminology, but terminology as it relates to clinicians’ decisions, like the problem list, the past medical history, assessment, and plan, which are foundations for clinical team decision making and requires billing codes that need to be codified correctly.

Has ICD-10 changed your business substantially so that people are seeking you out for a painless solution?

I don’t believe that ICD-10 alone is the issue. The reason our product has been sought out is EHR adoption and usability by clinicians. I really do believe that clinicians are commanders-in-chief when it comes down to fighting diseases and planning treatments. Clinicians are the key stakeholders as we transform from fee-for-service to fee-for-performance. They must be in control.

What our vendors do is use IMO as a source of truth for tracking clinician commands and orders, preserving the patient problem list and differential diagnosis using their dictation into the electronic medical record. ICD-10 is just a byproduct that the EHR vendors needed to comply to. You could say the usability is how the value of IMO is realized when complying with ICD-10, SNOMED CT, and within a few years ICD-11 are byproducts.

What research and development is the company working on?

We have been done with ICD-10 for quite a while. Our biggest research and development is invested in tools to manage our growth that we are facing right now. We are becoming the foundation technology innovation platform for many of our EHR partners. What that really means is that we have worked very, very hard to make sure to marry technology with terminology.

We have a cloud-based solution we call our portal service that allows the physicians to search the way they want to search. We can then rank order the search results in context of the domain that they’re searching for. This new technology allows us to do what we call just-in-time vocabulary releases. We have 60 releases a year total and for diagnostic and procedures 10 releases each. Using the portal eliminates many of the overheads associated with local dictionary normalization.

But these 60 releases a year historically without our technology would be impossible to adopt with import/export technologies. In most cases it takes maybe some times two or three months for people to deploy updates or in many cases people only deploy the regulatory requirements rather than updating on a monthly basis. By having this portal technology available, allowing the marriage of technology and terminology, we are able to make these datasets available at the point of service for our clients almost instantaneously after delivery of our service.

This has really increased our product usage. We have over 350,000 physician users and over 2,500 hospitals using our product. Many of our vendors are moving to our portal as their terminology innovation platform. One comment that we get from our clients is that they know when IMO is not there. That’s by far the biggest compliment that we could get.

What does the physician see differently if they’re using a system that uses IMO versus one that doesn’t?

They can find what they’re looking for and the description that they want to assign to the patient’s problem in the right lexical context and within the top three to five term list results.

Is that time-saving for them?

Absolutely. We are seeing up to three minutes for complex visits and as much as 30 seconds per common visit. The most valuable is a more granular problem list and orders in their clinical speak. We have not measured the IMO factor in follow-up time saving. We hope to work with our partners and perform independent research on the effects of having IMO in time and quality.

Where do you see the company going in the next five years?

Where we are going is to empower our vendor partners to deliver the best EHR solutions in the marketplace. We believe that our technology and removing this complexity associated with its managing terminology makes our partners stronger. They can do more innovations for clinician documentation. That is the most important thing to us.

We believe we want to participate in the success of the care delivery organizations in our country. I believe that as clinicians become empowered in the clinical setting and take over the responsibility of delivery of care using IMO-enabled EHRs, they and care delivery organizations will see a reward based on the quality of care they’re delivering. We would be a key part of this transformation for our vendor partners, their clients, and users.

As we allow our vendor partners to innovate, many of IMO’s portfolio terminology-enabled assets that we have been developing in the last 20 years will become more valuable at the front line and will allow our partners to build a positive distance between their offerings and others not using IMO. We hope to grow with our vendor partners to eventually make the US destination healthcare through new innovations in medical terminology-enabled technology. This is the way it should be.

Do you have any final thoughts?

Thank you for your time and opportunity to present IMO to your audience. We are honored with the finding of the independent study result showing that when using IMO interface terminology, nearly perfect agreement is achieved with greater than 99 percent in a peer-reviewed CDC publication. This article was truly energizing for me and the IMO team working in this space of dictionaries and terminology innovation to capture clinicians’ intent. It seems that finally after all these years we can actually see the fruit of our work, and that is really a good feeling.

Advisory Panel: Handling Information Overload

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

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

This question this time, as requested by a reader: How do you manage information overload about new devices, new software, and new services?

"Make the users producers." A good way to keep up with all the new stuff is to engage end users in affinity groups to bring forward their recommendations within a context of a strategic plan. Personally, I keep abreast of new stuff through conferences, reading, talking with physicians and clinical staff, and occasionally meeting with vendors.

It is a zero sum game and always something-else has to give. Like not going to the gym as much or sacrificing some extra time with the family to go to an extra meeting in the effort to stay in the know how. Or reading “Medical Economics” instead of a fiction novel hoping that it will pay off someday by making a smart decision or help  someone else making a smart one for an organization. Or reading your blog instead of watching a show on TV because your blog is so much more fun.

If I’m not talking or listening, I’m reading constantly, 16 hours a day. HIStalk is a very important source of news — very important. I also watch the Advisory Board, Chilmark, and Circle Square. Twitter is a great source of news because of its brevity with links to more detail.

The amount of information we get is absolutely insane! We have taken a formal stand on this. We split different areas up and made them the responsibility of individuals. For instance, one person reads up on new devices, another person reads up on new software, another on new services. Everyone knows who is responsible for which area and forwards pertinent information to them. Once a month, we do an update with each person reporting on what they feel is important. This way, we are all not drowning in e-mails, snail mail, webinars, and conferences. We even split up at HIMSS and AHIMA to explore our own area of update responsibility.  It works for us and no one is overwhelmed with trying to sort through it all.

I try to first see what the demand is from our end users – what are they asking for and for what purpose is the technology needed for? After that I  generally look at KLAS reports to see opportunities to identify best of  breed and go from there.

I make sure to keep my popular blogs to a mall number and read them when time permits. That  is mainly on the weekend or while eating breakfast.  ;)  Boy Genius Report and others on device/mobile. HIStalk on the HIT front, of course! 

We have an Enterprise Architect. Among other things, his job is to stay ahead of new technology and evaluate what might work for our organization and just as important what technology to stay away from. He has a budget to acquire new technology and test it with small pilots (usually using the IS department.) Anytime I get an interesting e-mail (which is rare) regarding new technology, I send it to him for evaluation. I always tell him he has the best job in the organization since he gets to play with new toys.

We let the information enter our consciousness, but only do deep dives if we have a need for a solution or a product replacement or if someone tries to buy something and they need our opinion. It is a never ending task and the first step to not losing your mind over it is to admit it is a never ending task!

(sigh) I don’t have a good answer for this issue. The best I have been able to come up with is regular networking with peers. I tend to target the items that will meet the needs of my current business problems when conducting research. Networking gives me the opportunity to hear about solutions that others have used for problems I have not yet experienced.

Just try to keep from drowning. It is nearly impossible.

You can’t read everything and we focus so much of our time on making sure what we read, communicate, and do is based on quality data. The healthcare space is changing very fast we have to keep up.

We don’t face this issue as frequently as you might expect  However, we rely on our staff to relay back to leadership the market trends – which we in turn take great effort to communicate back to the balance of the client facing staff.

Personally, I will always try something and if it makes my life easier quickly (e.g. within the day), I will stick with it. If it does not, I will move on. At the group level, we are careful to introduce new technologies and do lots of vetting and prototyping to make sure that when we roll it out we have a clear reason to do so and there is a clear ROI to the users.

I listen to everybody and look at anything that any colleague tells me is worth a look — that’s a look, not usually a meeting. Search Twitter, G+ and Google generally for any discussion about that tech.

I am sorry; what did you say? I was too busy checking my iPhone and didn’t hear you. 🙂

Morning Headlines 5/29/13

Accent on Integration

At MUSE on Wednesday, Iatric Systems will announce the acquisition of the business assets of Accent on Integration. AOI’s products and services, including the Accelero Connect integration platform, will continue to be marketed by Iatric.

Cerner Announces 2-For-1 Stock Split

Cerner has approved a 2-for-1 stock split effective June 17, a strategy employed to reduce a company’s stock price, as CERN shares approaches $100.

Harper Government Invests in eHealth Innovation

The Canadian government announces that it will encourage the creation of local eHealth initiatives by issuing grants to 16 research projects focused on developing technologies that enable patients to self-manage their conditions via eheath applications.

Direct: Implementation Guidelines to Assure Security and Interoperability: May 2013

ONC releases updated guidelines for Direct HIE implementations that will facilitate a MU Stage 2-compliant exchange of information between organizations.

News 5/29/13

Top News

Iatric Systems will announce Wednesday that it has acquired the business assets of Accent on Integration. Iatric will continue to market the Accelero Connect integration platform, as well as AOI’s consulting and professional services. AOI President and CEO Mark C. Andiel will transition to Iatric as SVP of professional services and VP/CTO Jeff McGreath will serve as VP of patient care device integration.

Reader Comments

From Irene: “Re: Twitter. Did you see this?” MedCity News names 10 healthcare IT professionals to follow on Twitter. It’s actually nine since one of those listed is not a healthcare IT professional, but the rest of us are working CIOs, CMIOs, and clinical informatics professionals. HIStalk is described nicely as, “the pseudonym for a man who describes himself as ‘an informatics guy’ and is also the name of his long-running news and opinion blog on all things healthcare IT. It strikes a nice balance between health IT vendor news and perspectives from hospitals as well as industry trends.” I don’t really do a lot on Twitter since I don’t have much time, but I do appreciate the 5,600 people who follow me.

Acquisitions, Funding, Business, and Stock

Cerner announces a 2-for-1 stock split for shareholders of record as of June 17, 2013. Had you invested $10,000 in CERN shares at the beginning of 2000, they would be worth $191,000 today.

Sales

Bon Secours Health System (MD) renews its contract with MedAssets for revenue cycle technology and consulting services.

John Muir Health (CA) selects ZirMed’s RCM, clinical communications, and analytics tools.

People

Cumberland Consulting Group hires Taylor Ramsey (Surgical Information Systems) as director of business development.

Paul Uhrig, chief administrative and legal officer and chief privacy office of Surescripts, is named to the board of DirectTrust.

Explorys appoints Objective Health CEO Russell Richmond, MD to its board.

Valence Health names Scott J. Cullen, MD (Kaufman Hall) executive director of consulting services.

Leland Babitch, DO (University Pediatricians, Wayne State University School of Medicine) is named senior medical director of Clinovations.

Children’s Hospital and Clinics of Minnesota promotes Dave Overman from COO to president/COO. He joined the organization as CIO in 2005 and led its EMR implementation (Cerner, I believe.)

Announcements and Implementations

Alego Health becomes the first organization to join the HIMSS Innovation Center as Founding Collaborator, which requires a $100,000 “investment.”

ADP AdvancedMD launches MyICD-10, a Website to help practices prepare for the ICD-10 transition.

The Georgia Health Information Exchange changes its name to the Georgia Health Information Network to more accurately reflect its mission of creating network of existing health information networks.

Medhost begins marketing the Vanderbilt-developed perioperative management system its parent company bought with its acquisition of Acuitec, calling it Advanced Perioperative Information Management System.

Government and Politics

The ONC releases updated guidelines for Direct HIE implementations to enable the easy and secure exchange of patient health information under Stage 2 MU.

Canada’s Minister of Health announces that the government will fund 16 new eHealth projects with $100,000 grants, choosing potential innovations that empower patients, create a new generation of decision support tools, and monitor population health. Among the funded projects, all of which are led by an academically affiliated principal investigator: diabetes self-management, depression screening, self-management of cardiovascular disease risk factors, diabetes interventions, anticoagulation therapy management, mental health screening of pregnant women, depression telemetry, a rheumatoid arthritis decision aid, pediatric weight management, ICU discharge planning, and collaborative care for adolescent cancer.

Innovation and Research

Australian researchers find that using an electronic medication management system did not take time away from providers who were providing direct care.

Startups can apply for a one-minute showcase introduction and networking with a Madison, WI-area audience at Start Me Up in Madison on June 10.

Technology

The US Patent Office issues two patents to Greenway Medical Technologies that cover the receipt and transmission of data from multiple EHRs for the purpose of certifications, accreditations, and monetary incentives and for the tracking clinical events.

Other

Sonoma Valley Hospital (CA) notifies 1,350 patients that their information was mistakenly uploaded to the hospital’s public website, making it accessible to Google searches.

A blog post by anesthesiologist Shirie Leng, MD laments the impending end of informal “curbside consults” between physicians due to malpractice concerns. “Lawyers have taken an intrinsic part of human decision-making and interaction and made it, well, dangerous … The minute your doctor thinks better of asking an expert informally what he thinks about my condition or if he thinks you need a formal consultation, the quality of your healthcare goes down.”

Weird News Andy is interested in research that concludes that “sitting is the new smoking” given that he has the equivalent of a three-packs-per-day sitting habit. Researchers say “the chair is out to kill us” in finding that one hour of seated TV-watching cuts lifespan by 22 minutes, while smoking one cigarette shaves off only 11 minutes. Bars must be the most dangerous place on the planet given that patrons are sitting, drinking, smoking (although usually outside) and eating lethal foods like wings and nachos.

Police arrest a man driving 80 miles per hour and using emergency lights and a siren after he initially tells them he’s rushing a friend to the hospital. He finally admits to  playing a police siren app from his Android phone through his car’s speakers.

Sponsor Updates

• Orion Health will incorporate its Rhapsody Integration Engine into Novari’s Access to Care solution, which integrates physician offices with hospital IT systems for online appointment scheduling and automated reporting of wait times.
• Impact Advisors principal Laura Kreofsky discusses the use of social media to drive patient engagement.
• Beacon Partners is conducting a survey on ACO experience.

Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 5/28/13

DOD, VA to Clear Claims Backlog

DoD responds to accusations that its EHR decision is hindering efforts to reduce the veterans’ disability claims backlog by outlining a cross-department plan of attack. It includes providing VA Benefits personnel direct login access to DoD’s EMR and improving the format of DoD treatment records so that they are more portable.

Quebec implementing $1.6 billion electronic health record system

Quebec announces that it will move ahead with a proposed province-wide transition to EHRs. The announcement follows a successful two-year pilot program.

National critic of health care information technology says Marin General should heed nurses’ advice 

EHR critic Scot Silverstein, MD interviews with the Martin Independent Journal about the potential dangers of EHRs following recent patient safety-related protests from a nurses union at Martin General Hospital after the hospital implemented a CPOE system.

Advisory Panel: Hard-to-Fill Positions

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

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

This question this time: What positions have been challenging to fill and what creative techniques have you used to fill them?

Many positions are hard to fill.  Some good people have moved into consulting. There is an absence of candidates with desirable skills and experience or expectations applying for some of our positions such as EHR analyst and project managers. At times we have hired strong end users and trained them as one source of talent. 

Medical assistants, receptionists, nurses, all the forgotten heroes down in the trenches without whom a medical office cannot function. They are harder and harder to find as we expect them to: be nice to patients so we do not ruin our Press Ganey scores, learn and operate new billing and EMR systems on the fly, multitask, cross train, be loyal, be health IT and coding experts, show up for work and help see ever more patients, all for almost minimum wages of $9 to $10 an hour at times. All while an EMR vendor, IT consultant, medical device seller, and reseller makes triple the amount of money and not that anybody would miss them if they do not show up for work. ACO stands for " awesome consulting opportunities" and while I am happy that the healthcare reform provided ample employment opportunities to these armies of consultants, the real value in healthcare still gets delivered by those other people… They are grossly underpaid and under-appreciated.

Clinical Analysts for configuring Cerner and Data Analysts. We hired a coder from medical records with a background in computer science to fill the Cerner Analyst position. It’s working out very well, especially since we are reducing our coding staff because of simplification of our reimbursement rules under bundled payments. To fill the Data Analyst positions, I dipped into the finance industry and paired them with a healthcare domain mentor on the data analysis team.

We’ve had challenges filling most of our IT analyst positions. This includes those focused on application development, support, etc. and networking and infrastructure. We’ve started to do some recruiting at college career fairs and looked at a broader market to reach out to.

We have had some degree of difficulty finding programmers and developers that know Delphi and understand healthcare. We will hang on tight to the ones we have because of this. It seems that if someone knows Delphi, they have no idea what an EMR is our how an interface works.

The most challenging this month have been those that actually can understand an implementation plan – not necessarily even having done many as much as someone understanding workflow between the various clinician groups. Individuals are now seeming to get siloed into various career skills and  this could get dangerous as we move forward into unchartered ground.

Where I sit on the tech side, programmer/developer positions. These are the people on your development and interface team that can actual program something from scratch.  Not, oh I know Sharepoint, or I can "read" Visual Basic, C#.  I mean, here is a business process that is junk, go develop a solution based on a platform and programming language. We never have enough of those people and they are so good, the ones you do have get sucked into building templates/screens for your CPOE or outpatient EMR. To fill those positions… man. That’s a tough one because in our organization HR will not work with us on these hard structured pay bands. They treat everyone like a nurse or a millworker. They also have an equation for how much a person should be paid and it’s based more on
age/seniority that experience. When I hired an oracle DBA out of another industry, he wasn’t making that much, but he was older. The equation said I should pay him over $20k more than what he wanted to jump into our org! That kind of stuff is frustrating. So, I would say have an HR department that will work with you on recruiting talent via well-structured pay packages. Also, remove any of those pesky gaps in insurance coverage for when a person starts. Our HR department would make everyone wait 90 days before their medical coverage started. That means all of your new hires have to purchase COBRA for 90 days and that’s almost $700 per month in some cases. 

Anything Epic is a real challenge. We’ve taken the Epic approach to recruiting. Rather than trying to find people with Epic certification or using high-priced consultants, we started a "grow our own" program. We’ve contact local colleges and were able to get access to seniors in engineering, science, and math with GPA of 3.5 and above. They are bright, motivated, and cost about half of a seasoned Epic resource (including certification). They also receive a retention bonus if they stay for a specified time. This program helps with the "brain drain" of the local economy and adds more Epic resources into the national mix. We also don’t have to worry about running afoul with Epic’s non-compete with the existing talent pool. A second program is with a local consulting company that wanted to develop an Epic practice. In return for sponsoring some of their consultants, we received a 50 percent discount on the certified resource and a right to hire after six months. The consulting company paid for all certification training. Lastly, we recruited and hired a CMIO last year. Since everyone has their own definition of CMIO (including the candidates), it took about a year before we found the right fit. As a CIO, I think the best approach is to use the recruitment process as a succession planning process for your job.

None have been a challenge. We have actually reduced our staff by 15 percent since January for cost restructuring purposes.

Database administrators have been the hardest to fill as there are no training programs available locally and very few people have an interest in it. This isn’t very creative, but we found a vendor that specializes in remote database administration at a very reasonable price (a lot cheaper than having an employee). Their team is primarily offshore, but the management is stateside. We have a hard time with project management for the same reasons as above. Again, not a creative solution, but  we are training all of our analysts in basic project management skills and working on standardizing project management for our organization.

Developers and HL-7 experts. Lots of folks with average skills, but few with an inquisitive mind and in-depth skills. Hard to find technical pros with a "healthcare mindset."

Finding the really good Epic consultants to work on projects is the biggest problem. There are so many substandard folks that the expectations have been lowered. We are finding that education is the best medicine to our customers to help them understand to wait for the right person or to set their expectations to a level that they will understand what they are getting. Furthermore the staffing companies who feel they can provide all the staff for the project are doing an injustice to their customers and further damaging the space at this difficult time.

We are a software sales organization. Our greatest challenge is finding good sales people dedicated to thoughtfully selling our solutions. We’ve found that hiring friends of current employees is the best way to find good, competent people.

I think having a good EMR analyst / trainer / optimizer is always a key position. We have had success by looking from within.  The typical person will be a recent college grad who has worked at the front desk in one of our offices for at least 6-12 months. This gives them an understanding of healthcare, as well as the experience of our group culture, while also giving us an understanding of their skillset. They need to have the type of smarts that means they can figure things out when we don’t have the right answer, and they need to have they type of personality which can get along with busy doctors. They enjoy having the ability to extend their career skills and most stay several years. 

Telecommunications manager who is more than a functionary; who understands the urgency for improving clinician-to-clinician communication. Asked our various telecomm vendors who were the best folks fitting that description in the region and hired one who was under-valued where they were then working.

EMR analyst jobs have been the hardest to fill. Our best success in filling these roles has been recruiting internally within our hospitals and medical group and investing in training and experiences to transform them into new IT roles.

Curbside Consult with Dr. Jayne 5/27/13

The Greatest Generation

I enjoy volunteering. One of the most meaningful things I’ve done is placing flags on the graves of veterans. My family has a tradition of military service going back to the Civil War. Although placing flags at the National Cemetery gets a lot of recognition, there are smaller projects that may not hit the national news or even the front page of the local paper. I was invited recently to join one of those projects and I have to say it was a great experience.

What makes this event different is that it is significantly smaller and allows youth to interact with veterans directly. The morning starts with the veterans providing breakfast to nearly 300 youth volunteers who experience first-hand the concept of servant leadership. There’s nothing quite like sharing bagels with a WWII veteran and watching young people realize that war isn’t something from their history books or Wikipedia. After breakfast and a brief religious service, the young people (many who aren’t from the same faith tradition as those they’re serving) fan out across nearly a dozen religious cemeteries.

Over the last several years, volunteers (some as old as 97) have combed through cemetery records and identified veterans’ graves, adding a flag holder with a medallion next to each grave marker. In deference to the sacrifice of the veterans, volunteers approach the graves with some ceremony. The flag is placed and saluted and a brief statement of thanks is recited which includes the name of the veteran being recognized. It’s more than just adding the flags, it’s taking the time to speak directly to the person whose service allowed us the freedom we enjoy.

The majority of the veterans we honored were from WWII – often called The Greatest Generation. As we spoke the names it was hard not to wonder who they really were – whether they had children, what they liked to do in their free time, and how they came to rest in these small suburban cemeteries. This generation served their country not for fame or recognition, but because it was the right thing to do. Those who made it home from the war spent the rest of their lives continuing to do the right thing – raising families, taking care of their elders, and supporting their community.

They didn’t have the Internet, smart phones, or billions of dollars of technology at hand. The biggest technology revolution for many of them was getting telephone service that didn’t involve a party line,  and maybe a black and white television. Their solutions for many problems revolved around hard work, sacrifice, and sheer determination. I was grateful to spend the morning communing with them and watching the spirit of service be passed to the next generation.

The peaceful morning was in sharp contrast to the rest of my day, which was spent in a busy urban emergency department. Except for a handful of octogenarians, most of my patients were under age 50. Many of them presented with problems at least partly related to our dependence on labor-saving devices and the quest for convenience – obesity, computer-induced repetitive motion injury, diabetes, high blood pressure.

More than half presented strictly because they wanted the technology of the hospital to convince them they were OK. These patients ranged from the woman who refused to allow a co-worker to remove a bee stinger “because she didn’t have any medical training” to a teenager who refused to believe her two negative home pregnancy tests, demanding a blood test to convince her boyfriend she was indeed pregnant. Nearly every one of them had an iPhone and several were surfing the Internet during the interview or exam, despite requests to stop. A couple of patients argued with me about their treatment, citing Internet information they found while in the waiting room.

Several demanded CT or MRI scans for simple sports-injuries despite having no ability to pay for such a test even if it was indicated, which it wasn’t. Guess what? If you run down a steep hill wearing flip flops, you will fall and sprain your ankle. The Ottawa Ankle Rules say you don’t even need an x-ray, let alone a scan. You need an Ace wrap, some ice, and a pair of real shoes.

It was one of the rougher shifts I’ve worked. I’m sure the contrast between people who want technology to solve all their problems effortlessly and those who were willing to give their lives simply for the concept of a world free of tyranny had something to do with it. I’ve been in informatics for nearly a decade and have seen the wonders that big data can do. I’m excited by the promise of personalized medicine and genomics, but I understand that it all comes at a price. Looking at global economics, it is likely more than any of us can afford. We’re mortgaging our future while we overlook the basic lessons of the past.

Technology isn’t the solution – it’s merely a tool. We have to learn how to use it wisely and at the same time how to temper our addiction to it. I challenge every reader to consider spending a day off the grid. If you can’t spare a day, consider an hour. Go volunteer. Go do something simply to show caring to someone else. Or just go lay on the grass and see that there is a world beyond the screens and clicks. And while you’re at it, say thank you to those who gave all.

E-mail Dr. Jayne.

Morning Headlines 5/27/13

More than Half of Doctors Now Use Electronic Health Records Thanks to Administration Policies

The White House blog posts a self-congratulating piece as EHR adoption hits the 50 percent mark among eligible providers.

Obamacare’s Other Surprise

Thomas Friedman of The New York Times publishes an editorial in which he points to a rapid increase in health IT startups as an unforeseen positive consequence of HITECH and ACA.

Allscripts names 2 new directors to board

Allscripts adds former Epic CFO Anita Pramoda and former Brocade Communications CEO Michael Klayko to its board of directors.

Greenway Earns Two U.S. Patents for Care-Coordination Technology

Greenway earns patents for a server configuration that aggregates data from multiple EHR systems and auto-completes accreditation or certification forms and another related to tracking clinical events across multiple EHR systems.

Monday Morning Update 5/27/13

From HIPAA Faxing: “Re: HIPAA rules. Our esteemed EMR vendor wants $20,000 to connect each lab. The lab wants $19,990 to connect their side (funny how they charge the same). That’s $40,000 per lab connection and we use 17 labs and can’t afford that, so we use a fax server. What are the HIPAA rules around faxing? What do we need to do?” Experts, here’s your chance to contribute.

From Delta Don: “Re: Philips iSite. I’ve never seen anything like the disaster of the iSite 3.6 to Intellispace 4.4 upgrade. System and functional instability have pushed the go-live date back three times. It’s now six months late with new issues every day, but Philips personnel are enjoying their extra-long Memorial Day weekend. With vendor-neutral archives making migration among PACS vendors more feasible, you’d think there would be more effort. I won’t even start on the product name when we still have users calling it Stentor.”

Respondents weren’t overly impressed by the value to the public of the Medicare pricing information released by CMS. New poll to your right, as suggested by a reader: should Meaningful Use be ended after Stage 3 or continued? You’ll get a link to add your comments after voting, so you might as well expound on your position.

Photo: Pete Marovich/EPA

Monday is Memorial Day, set aside to honor those one million US Armed Forces members who died while serving. Their sacrifice allows you the luxury to decline to fly the flag, visit a military cemetery, or think about those who made the ultimate sacrifice on your behalf. That’s not to say it wouldn’t be nice to do it voluntarily. 

I impulsively bought Mrs. HIStalk a Google Nexus 7 tablet when I went to the office supply store to get several packs of the index cards I like to write on since she’s computer-averse and always gets my hand-me-down laptops. My initial assessment of the $199 device is that it’s very nice, in some ways better (sharper display) and some not as good (fewer apps) as the iPad mini, but at just 60 percent of the mini’s price, it’s a much better deal. Don’t buy it yet, though – an upgrade is imminent that will add greatly enhanced video.

From the Cerner shareholder/analyst call:

• Neal Patterson was not only on the call, which is rare, but he actually chaired it and reminisced a bit with good humor about the company’s origins. Fellow founder Cliff Illig was on, which I don’t recall ever happening.
• The company says the number of physicians using its ambulatory products doubled to 45,000 in the past two years.
• EVP Zane Burke says Cerner’s competitors are no longer other EMR vendors, but rather companies involved in insurance and big data.
• Responding to an shareholder’s question about Epic, Neal Patterson said, “They like to say they don’t have shareholders. I’d like to point out to the reality that they do actually have shareholders, it’s basically almost a single individual. And they also point out the fact that in this country, you can’t pass on an ongoing operation … our plans are to take away their advantages and make our strengths stronger and make their strengths weaker on a relative basis … we’re the most innovative company in this industry, we have always been.”

Jamie Stockton with Wells Fargo Securities sliced and diced CMS’s hospital EHR attestation database to find that 7 percent of hospitals that qualified for Year 1 incentives didn’t attest with the same vendor in Year 2. The interpretation was that the Year 2 incentives, which required participation for a full year, were too difficult for some hospitals to meet. The worst-performing vendor was McKesson, which saw its attestations drop off from 10.5 in Year 1 to 6.5 in Year 2, a 38 percent washout rate of an awfully low starting number.

Allscripts adds two board members that include former Epic CFO Anita Pramoda, who left Epic in 2012 and founded senior PHR vendor TangramCare.

Allscripts files a lawsuit against its landlord, Chicago’s Merchandise Mart, claiming its lease was violated by allowing excessive noise in renovating five floors just below the Allscripts offices for new (and largest) tenant Google. Allscripts is demanding that the Merchandise Mart stop using nail guns and pneumatic hammers during business hours.

Ed Marx posted an update to his most recent CIO Unplugged about a salesperson who hijacked Ed’s presentation with an overwrought sales pitch disguised as a post-presentation question. I’ll side with Ed. As much as salespeople have been educated (or brainwashed) to believe that their particular hammer is appropriate for any nail, I don’t think it’s acceptable to harass a speaker and audience just because they perceive that nobody’s returning their cold calls. Whatever happened to respecting the prospect enough to let them decide what products and services they want to consider and how they would like to evaluate them?

A New York Times piece by Tom Friedman says that Obamacare, the HITECH program, and HHS’s release of its databases has created a healthcare Silicone Valley that may improve care and lower costs because of the availability of information. Friedman spoke to a family doctor who thought she was giving appropriate colorectal cancer screening recommendations until her EHR showed only 43 percent of her patients had actually received the screening. Adding EHR alerts raised the number to 90 percent, leading to early cancer detection in three patients, which was obviously good for the patients but also for healthcare spending since early-stage treatment costs less. White House CTO Todd Park bragged on entrepreneurs who developed apps around HHS’s databases and kicked off a health data industry. Friedman met with Eviti, Teladoc, Humedica, and Lumeris.

The White House Blog brags on EHR adoption, crediting the President who spent the money rather than the taxpayers who provided it.

Two people with no transportation experience are named finalists for the position of interim director of the Capital Area Transit System (LA.) One of them is Bob Mirabito, former CIO of Baton Rouge Radiology Group, who says his position was eliminated last year and he needs a job.

The Canadian government revokes the passport of a Quebec doctor who is of defrauding US Medicare of $375 million by submitting phony claims for homeless patients when he was practicing in Texas.

Weird News Andy says he has printing on the brain after reading that 3D printing allows replacing 75 percent of a person’s missing skull.

Vince continues with the very interesting HIS-tory of Allscripts.

Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.

Readers Write: A Five- Step Approach for Collaborative ICD-10 Testing

A Five-Step Approach for Collaborative ICD-10 Testing
By Deepak Sadagopan

With the October 1, 2014 ICD-10 deadline rapidly approaching, payers and providers should be knee deep in their transition and testing efforts. According to CMS, there will be no more delays.

For many, especially healthcare provider organizations, ICD-10 is straining resources across all operational departments, including revenue cycle, coding/HIM, and IT. Providers are actively seeking ways to contain the cost of compliance and minimize revenue disruption post-transition. Many are mitigating ICD-10 risks by analyzing historical data and prioritizing high-risk areas based on impacted specialty or department.

As providers evaluate high-impact scenarios, they need to take a more strategic approach by allocating scarce, skilled resources to the evaluation of high-impact cases, natively coding those carefully selected scenarios, and then collaboratively testing these scenarios with their trading partners.

This last step is vital to avoiding revenue cycle disruption after the transition. While collaborative testing may require more testing time, the resulting ICD-10 readiness will give providers the ability to foresee potential coding problems and possibly avoid a negative impact on revenue flow.

Most importantly, with the rapid evolution of value-based reimbursement programs that would include direct trading transactions between providers and payers, collaborative ICD-10 testing will build confidence and pave the way for more intense collaboration that involve higher financial stakes for both parties.

But there’s a problem. Nearly two-thirds of respondents to a survey conducted at the February 2013 Healthcare Mandate Summit indicated they have used, or are planning to use, the additional year to conduct testing. However, two-thirds of respondents also said they do not have a specific strategy in place for collaborative testing. By not testing together, providers are missing out on a significant opportunity to share coding knowledge and outcomes with their trading partners.

Collaborative testing is a key component to overall mandate adherence and can be managed with a simple five-step approach. This approach enables providers to assess their readiness and achieve a less disruptive transition to ICD-10.

1. Establish a baseline. Providers and their trading partners should evaluate at least 12-18 months of key performance indicators such as claims acceptance rates, electronic claim adjudication rates, and aggregate claim reimbursement amounts for high-impact medical services.
2. Identify key partners. Healthcare providers should identify and connect with trading partners that want to achieve ICD-10 compliance with as little financial risk as possible. This approach brings both perspectives to the table to establish a balanced testing plan.
3. Develop test scenarios. Both parties work together to establish testing goals and mutually beneficial testing scenarios. The choice of test scenarios should involve a mix of cases likely to increase or decrease reimbursement compared to historical claims data.
4. Run tests. Both parties set up their test systems and infrastructure to test identified scenarios and run them through their processes. Providers should natively code scenarios in ICD-10 and send claims to the payers. The payers natively process the claims in ICD-10 through the complete life cycle and return the reimbursement advice to the provider.
5. Assess results. Providers and payers compare results with the baseline to identify discrepancies. Providers can use the results to assess impacts to internal coding productivity, DNFB days and revenue disruptions that may occur post-transition.

With 85 percent of healthcare costs hanging in the balance, it is imperative that problems are solved before the 2014 deadline. Providers and their insurance plan partners hold the key to each other’s success, and by coming together early, everyone can better ensure business readiness and financial neutrality.

Deepak Sadagopan is general manager of Clinical Solutions & Provider Segment at Edifecs.

Time Capsule: Camping Out for a Cerner Black Friday Door-Buster Special: Mr. HIStalk’s Plan to Stimulate the HIT Economy By Encouraging Unrestrained Holiday Season Greed

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 November 2008.

Camping Out for a Cerner Black Friday Door-Buster Special: Mr. HIStalk’s Plan to Stimulate the HIT Economy By Encouraging Unrestrained Holiday Season Greed
By Mr. HIStalk

Capitalists and fans of pointless and unsatisfying consumerism, rejoice! Even in a tanking economy, America’s newest national holiday, Black Friday, brought out the greedy and sometimes violent masses last week, just like the good old (pre-recession) days.

I’m guessing that most of us in the industry weren’t standing in front of our local Wal-Mart on Thanksgiving evening, anxiously awaiting its 5:00 a.m. opening (picture a Soviet bread line made up of looters on a camping trip). No amount of civil irresponsibility is too much to score precious Caitlin a “Baby Alive Learns to Potty” doll.

Caitlin: “Mom, did Santa bring this?”

Role Model Mom: “No, Princess, I beat a woman in a wheelchair senseless and ripped it from her bleeding hands right in front of her kids at the checkouts to save $20 that day after we gave thanks for God’s bounteous riches. Now go away while I watch Desperate Housewives.”

All of that publicly displayed greed has stimulated my latest brainstorm: HIT Black Friday.

I’m picturing a Friday morning line of rental cars filled with hospital IT people sitting in Epic’s frosty driveway, hoping to score a 20 percent break on software license fees (if they’re one of the first five hospitals to sign a contract and if Judy likes them). Turkey-tryptophan groggy CIOs rushing Cerner’s HQ to score a pre-sunrise BOGO deal on Millennium applications. RSNA attendees taking indirect Chicago flights to first get rolled-back pricing on a clinical transformation door-buster special ($200 an hour a twenty-something consultant) from one of the big consulting firms.

Like those consultants, I’m projecting big benefits. Big PR all around. Low vendor costs. Desperate competition since nobody’s selling anything anyway. The chance to upsell (“Say, know what’d go great with that LIS? A matching CPOE application and an extended warranty at 20 percent annual maintenance. Want it wrapped?”)

Print publications would love the revenue from full-page ad inserts. Muckraking blogs like mine would leap at the chance to leak the Black Friday deals. The HIMSS opening session could feature videos of big-name CIOs out-sprinting each other in Friday’s pre-dawn hours at the HIMSS bookstore to get discounts on the latest Marion Ball bestseller or chic HIMSS hoodies for all the homeys in the HIT ‘hood. Nothing creates demand better than the illusion of widespread demand.

In fact, instead of having its virtual conference during the shopping season, HIMSS should stage a Midyear Conference in December that eliminates all the usual boring parts (educational sessions) and focuses entirely on a big-budget, sprawling spectacle of Vegas-like exhibits, self-important attendees jostling to fill their vendor trick-or-treat bags, and the Marrakesh Bazaar-like scent of aroused technology capitalists getting their HIT hunt on during the industry’s annual bacchanalia of commerce (OK, smartass, it is NOT the same as the annual conference – I said December).

Now don’t get all high-horsey on me. HIT is about moving iron. Closing the deal. Getting, not using. To paraphrase that Brillat-Savarin quote shown at the beginning of Iron Chef America, “Tell me what you buy, and I will tell you what you are.”

Like Black Friday, during all the hustle and bustle of enjoying family and reflecting on one’s good fortune and place in the universe, let’s take a moment to remember what’s really important: buying a lot of soon-to-be junk like an ancient Egyptian boy king loading up his tomb with Blu-Ray players and GPSs since an afterlife without them would just plain suck.

So set your alarm for next November 27 at 3:00 a.m. for the first HIT Black Friday. Like the leader of the free world said, it’s your patriotic duty to get out there and go shopping.

Morning Headlines 5/24/13

Quality Systems, Inc. Reports Fiscal 2013 Fourth Quarter and Year-End Results

Quality Systems reports Q4 and year-end results. Net revenue was down 44 percent from 2012 to 2013, with a net loss of $4.1 million in Q4.

Intermountain Healthcare Launches Nation’s First System to Measure and Report Cumulative Medical Radiation Exposure

Intermountain Healthcare will leverage functionality within its EMR to track lifetime cumulative radiation exposure for patients.

Network execs squabble over issue of exchange connectivity

Executives from competing Kansas HIEs are struggling to cooperate with a state mandate that they integrate their networks. State legislatures had to step in this week to prevent the companies from charging each other access fees to comply with the mandate.

The Obama Crony In Charge Of Your Medical Records

Conservative blogger and frequent “Fox and Friends” guest Michelle Malkin profiles the rise of Judy Faulkner, portraying her as a political insider and big Obama campaign donor who secured herself an appointment as the only vendor representative on the federal Health IT Policy Committee.

News 5/24/13

Top News

Secretary of Defense Chuck Hagel tells the DoD that he supports the use of commercial software to replace the department’s AHLTA EHR rather than switching to the VA’s VistA platform as he previously hinted was his preference. The DoD says it has identified 20 commercial software vendors capable of meeting its EHR needs. You’d have to bet on Epic given that it’s outselling everybody in big hospitals, they were allegedly the DoD frontrunner in 2010, and the Wisconsin Congressional delegation was squeezing the federal government to choose Epic awhile back (and not to mention that there are nowhere near 20 serious players to choose from.) On the other hand, DoD loves throwing billions at the fat cat contractors and Epic might not want to work through them.

Reader Comments

From Lil Wayne: “Re: Practice Fusion. Does anyone buy into their claim of having 30 percent of the primary care market? Seems beyond ludicrous.” I’m always curious about their methodology for counting actual users vs. someone who signs up with minimal usage. I would also be interested in seeing audited user statistics. Practice Fusion isn’t in the top five vendors by Meaningful Use attestation as I recall, in the low single digit percentages of all attesting providers.

From Stephanie: “Re: certification. If I already have a certified completed EHR and use another vendor’s patient portal within the HIE, does my patient portal also need to be certified? I’m just placing patient documents out in the portal for patients to view.” I know Frank Poggio will answer if nobody else does.

From Sleepless Fax Server Administrator: “Re: HITECH modifications to HIPAA. Will add risk to faxing or mailing results. There is a 100 percent chance of a violation when a provider changes practices since no healthcare IT system can determine the right address or fax number based on the date the patient was seen – they always use the current information. Even if you solved that problem, how would any system know if the patient followed the provider to the new practice? Also, critical radiology results are required by regulation to be faxed within 24 hours.”

From Major Tom: “Re: conference. Thought you would enjoy this e-mail.” A promoter pitches their conference as offering “peer-to-beer” knowledge exchange, creating mental images of sullen, bar-perched attendees mumbling into their mugs.

From Non-Sequitur: “Re: RAC recoveries hit $1.37 billion. Forwarding a synopsis from Wolters Kluwer. You are still the brightest spot in many of my mornings!” Thanks, milady, that’s sweet of you to say. The article says RACs collected $1.371 billion in Medicare overpayments and returned $65.4 million in underpayments in the first six months of FY2013 (obviously like with the IRS, your odds of an unexpected refund aren’t so good when the RACs come knocking). The current major issue is documentation for cardiovascular procedures.

HIStalk Announcements and Requests

Listening: Superchunk, possibly the best and most prolific indie band in history. I’ve played all 15 of their albums on Spotify and it’s a stunning body of influential work spanning almost 25 years. A new album will be out in August and a tour follows.

Acquisitions, Funding, Business, and Stock

Online medical consult provider ConsultingMD secures $10 million in funding from Venrock.

Quality Systems reports Q4 results: revenue up 2 percent, EPS –$0.07 vs. $0.25, missing on both.

From the Quality Systems earnings call:

• Poor performance in the company’s Hospital Solutions Division (a $4.2 million loss on $4.5 million revenue) will require investments in development, implementation,and support.
• Steve Puckett will be moved from Hospital Solutions to CTO and COO/EVP Daniel J. Morefield will take over Hospital Solutions.
• In a “what were they doing before?” moment, the company said it has “aligned our marketing team with our overall revenue objectives and shift and focus to increasing product demand and lead creation,”
• To an analyst’s question about implementation margins of zero percent, the CFO’s response was, “There’s a number of factors, but I think hospital certainly is. I think we’ve already been talking about the — some of the challenges that we’ve been — that we’ve had there and that certainly impacted the profitability on that particular revenue category. I think — so it gets a little hard to generalize. On the ambulatory side, we’ve got — but I’ll let you — you ought to know, though, that certainly it’s not something — we are paying attention to it and we do intend to drive higher margin there in that space. We have — we are in some — having some transition in the ambulatory world … the full expectation is, for us, it’s going — going forward is to drive a higher level of profitability on that revenue category.”
• The company declined to give dates for a SaaS product, saying it will focus on the current product.
• The company expects a move back to larger EMR vendors as the small ones fail trying to keep up with Meaningful Use and ICD-10.
• They expect more government programs to follow the DoD’s apparent lead in moving to commercial software, with vendors scrambling to get their GSA status.

Sales

East Lansing Orthopedic Association (MI) selects SRS EHR.

Conway Medical Center (SC) chooses StrataJazz from Strata Decision Technology for decision support, budgeting, and capital planning.

People

The New Jersey chapter of Entrepreneurs’ Organization and the Star-Ledger/NJ.com name SRS CEO Evan Steele the winner of the Garden State Entrepreneur Excellence Award in the $10M+ category.

TeleTracking Technologies hires Nanne Finis (Joint Commission Resources) as VP of consulting services.

Yousuf Ahmad, who will take over as CEO of Mercy Hospital (OH), is profiled in the local business paper because of an earlier position as CIO of Mercy Health Partners. Interestingly, he attended University of London on a cricket scholarship, graduated at 19, and is ranked among the world’s 400 best Scrabble players.

Announcements and Implementations

Cerner’s PowerChart Touch mobile solution earns a bronze award for Best Clinical Health Care Experience at the 2013 International User Experience Awards.

All of Maine’s 38 acute-care hospitals and 376 ambulatory provider sites have agreed to participate in the state’s HIE, operated by HealthInfoNet.

Holy Family Memorial Health Network (WI), Johnson Memorial Hospital (IN), and United General Hospital (WA) implement Hyland Software’s OnBase enterprise content management platform integrated with their Meditech systems.

Government and Politics

Idaho State University will pay $400,000 to settle alleged HIPAA violations stemming from a breach of unsecured data on 17,500 patients from an ISU family medicine clinic. The university notified HHS of the breach upon realizing that a disabled firewall had left patient data unsecured for at least 10 months.

HHS reports that 55 percent of all EPs and and 80 percent of eligible hospitals and critical access hospitals have been paid MU incentives through the end of April. HHS had established a goal for 50 percent of EPs and 80 percent of hospitals to have EHRs by the end of 2013.

North Carolina’s state auditor finds that the state’s DHHS hasn’t overseen the implementation of its new $484 million Medicaid claims system properly, making it likely it will not be ready by the scheduled go-live in 40 days. CSC developed the system, which was written in COBOL by programmers from India copying code the company developed for a similar system in New York, and previous audits found poor documentation and unauthorized changes. DHHS allowed CSC to develop the acceptance criteria for its own project. The system was supposed to go live in August 2011 at a cost of $265 million. The state had already cancelled a 2003 contract with ACS saying their system wasn’t working before hiring CSC. Residents of other states are on the hook since the federal government is covering  90 percent of the development costs and at least 50 percent of the ongoing operational costs. Nothing good has ever come from combining state and federal governments, taxpayer money, contractors, and ambitious computer system plans.

Innovation and Research

Intermountain Healthcare announces a system that will track cumulative radiation exposure from higher-dose imaging exams and report it via the EMR.

Other

The County of Monroe Industrial Development Agency (NY) approves $369,359 in tax exemptions for eHealth Technologies, which is building a $4 million, 36,000 square-foot facility and is planning to add 60 jobs over the next three years.

Via Christi Health (KS) blames lower than anticipated revenues for its decision to lay off up to 400 staff members — about four percent of its workforce — across the state by the end of June.

Conservative columnist Michelle Malkin, known for writing screamingly partisan books such as Culture of Corruption: Obama and His Team of Tax Cheats, Crooks, and Cronies sets her sights for the second time on Epic’s Judy Faulkner in an article titled “The Obama crony in charge of your medical records.” She also weighs in that HITECH is “government malpractice at work;” calls out Epic and not its competitors for having “enhanced power to consolidate and control Americans’ private health information” (missing the point that only Cerner runs a profitable business unit that sells de-identified data from the hospital systems it hosts); and accuses the President of choosing Faulkner as the vendor representative on the HIT Policy Committee because of partisan politics (“the foxes are guarding the Obamacare henhouse.”) It’s a safe bet due to partisanship on both ends of the political spectrum that anyone who follows her faithfully believes every word, and anyone who doesn’t wouldn’t believe even one.

In Detroit, Henry Ford and Beaumont call off their merger plans, with the unstated sticking points apparently being cultural differences, disagreements over keeping both academic medical centers, and the unwillingness of Beaumont’s independent physicians to work with Henry Ford’s management.  

All you need to know about the inevitable demise of most HIEs once the government grant trough has been lapped dry is contained in this story. The squabbling CEOs of two Kansas HIEs  force the state’s lame duck HIE regulatory body to pass a resolution preventing them from trying to charge each other connection fees. KHIN and LACIE are required to connect their networks by July, but KHIN demanded that LACIE pay it a fee. The date has been moved back to December, and meanwhile the regulatory board – KHIE – will turn over its responsibilities to the state’s Department of Health and Environment on July 1 in a cost-cutting move. The dialog from the May 9 meeting:

[KHIN CEO] "If we give that data to another (network) they will have a competitive advantage, if we give it to them for free. We know that LACIE knows this — they’ve been out talking to providers all across the state of Kansas saying ‘If you join LACIE you can join at a lower fee, and you’ll get all of KHIN’s data for free.”

[LACIE CEO] That’s untrue, Laura. That’s absolutely untrue and we’ve told you it’s untrue. I’m sorry, Mr. Chair but that is an absolute lie.”

A University of Florida study finds that ED employees spend 12 minutes per hour on Facebook, and strangely enough their usage increases with ED patient volume and severity. On the other hand, it was a one-hospital study covering a 15-day period in late 2009 covering mostly the time between Christmas and New Year’s, so the method isn’t convincing.

A Pennsylvania judge orders the hiring of a forensic examiner to review the Facebook page of a woman who claims she slipped and fell due to a puddle of liquid on the floor of Lancaster Regional Medical Center. The woman claims she suffered serious injuries and can’t afford the surgery; the hospital found Facebook pictures and videos from up to 17 days after the accident after showing her frolicking in the snow.

Sponsor Updates

• Greenway Medical announces the availability of its PrimeMOBILE mobile access solution for Windows 8.
• Biilian’s HealthDATA posts a list of the 10 hospitals claiming the most in outpatient charges, according to expense report data published by CMS.
• Liaison Healthcare launches Healthcare Terminology Manager and Healthcare Terminology Translation to facilitate the management of diverse controlled medical vocabularies for simplified data exchange.
• Park Place International will market Interbit Data’s disaster recovery and business continuance software solutions to its customers implementing Meditech.
• Levi, Ray & Shoup introduces MFPsecure, a line of hardware and software aimed at the pull printing and secure document delivery markets.
• Ping Identity announces details of the workshops at its Cloud Identity Summit 2013, which takes place July 8-12 in Napa, CA.
• The Boston Globe names Keane, Inc., now part of NTT Data, to its Globe 100 Hall of Fame in recognition of the company’s 25 years as a top-performing company in Massachusetts.
• Visage Imaging releases Visage Ease version 1.3.0, which gives authorized healthcare providers mobile access to imaging results on iOS devices.
• Care Team Connect hosts a July 10 Webinar on readmission prevention.
• EClinicalWorks CEO Girish Kumar Navani discusses the company’s latest projects and offers his perspective on where healthcare is headed and IT’s role in healthcare transformation.  
• Greenway Medical customer Texas Orthopedics shares how its use of PrimeMOBILE has improved patient care and increased efficiency, productivity, and profitability.
• INHS highlights the SHMC Pediatric Oncology clinic and its use of online status boards to cut patient wait times.
• Encore Health Resources posts a YouTube video featuring CEO Dana Sellers participating in a discussion on EHRs and analytics.
• Emdeon CEO George Lazenby shares his secrets to innovation and growth.

EPtalk by Dr. Jayne

From Anotherdrgregg: “Re: your recent piece on gimmicks. Preparing for our EMR, we looked at all our diets, some 30 in all, including the oddly named ‘anti-atherogenic diet.’ We reduced the number of diets to four, not including bariatric diets. The reasoning was that if you could hold it down, you were probably going to be discharged home. Administration nodded sagely, then went ahead with diet on demand complete with special breakfasts and a chef in a toque. Now they want to know why utilization is not high.” Any reader who can use the word “toque” gets my vote. He went on to list other frivolous hospital expenditures: flat screen TVs, real oak moldings on the doors, and carpets so thick that you can’t roll a gurney on them. He closed with this thought: “The finest hospital I ever worked at had painted cinderblock walls. it was a forward operating base.”

Hard to believe it’s almost June. In CMS terms, that means barely more than a month before Eligible Hospitals in the first year of Meaningful Use run out of time to begin the reporting period for Fiscal Year 2013. If you don’t start your reporting period by July 3, you’re out of luck as the federal fiscal year ends September 30.

Reuters Health reports that many health Web sites are too complicated and full of jargon, leading to confusion for patients. Instead of the fourth to sixth grade reading level recommended by the American Medical Association and the Department of Health and Human Services, the average reading level of online materials studied ranged from high school to college. Reviewers also found information that was oversimplified to the point of inaccuracy and large numbers of clichés at some specialty sites.

Scientists have often debated whether white coats and neckties spread germs. Unfortunately for fashionistas like Inga, handbags are now under scrutiny. Twenty percent of handbags studied had levels of bacteria high enough to cross-contaminate other surfaces. I wonder if the findings would also apply to brief cases or laptop bags?

Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 5/23/13

Doctors and hospitals’ use of health IT more than doubles since 2012

HHS Secretary Kathleen Sebelius reports that HHS has exceeded its goal of transitioning 50 percent of eligible providers and 80 percent of eligible hospitals onto EHRs by the end of 2013.

Hagel says DoD to adopt commercial EHR 

Defense Secretary Chuck Hagel testified last month before a House Appropriations Committee to report that DoD had fallen behind on its plans to implement an integrated EHR with the VA; that much of the allocated money for the project had been spent with little to show for it; and that when the decision to launch a vendor search for a commercial EHR was made, he "didn’t think we knew what the hell we were doing." At the conclusion of that hearing, Hagel promised that he would halt the commercial vendor search and report back within 30 days with DoD’s new plan for delivering an integrated DoD/VA EHR. This Wednesday, bending to internal DoD pressure, Hagel reversed course on nearly all that he had said before the House Committee, reporting in a memo that DoD would resume its commercial EHR vendor selection rather than develop an integrated solution with the VA or adopting VA’s VistA.

All Maine hospitals sign on to electronic health records exchange

All of Maine’s acute-care hospitals have agreed to participate in HealthInfoNet, Maine’s statewide query-based HIE. Thirty-four of Maine’s hospitals are already connected to the network, and the last four are scheduled to go live by the end of the year. HealthInfoNet is also connected to 376 ambulatory practice sites.

Practice Fusion Continues To Reach Beyond Digital Health Records, Adds Free Expense Tracking To New Booking Engine

Free Web-based EHR vendor Practice Fusion launches a patient-facing site that allows patients to compare doctors and book appointments. After the appointment, patients can review their spending history across the entire history of their medical visits.

Readers Write: Pagers Cost Hospitals Billions Each Year

Pagers Cost Hospitals Billions Each Year
By Larry Ponemon, PhD

Earlier this month, the Ponemon Institute released a study titled “The Economic & Productivity Impact of IT Security on Healthcare” that aims to quantify the impact that the use of pagers and other outdated communication technologies has on healthcare. The research reveals that communication in healthcare lags behind other industries, in large part because of the perceived security and compliance risks associated with the use of smartphones and other modern technologies.

As a result, outmoded communication systems waste clinicians’ time, limit patient interaction, lengthen discharge times, and lead to significant industry-wide economic loss.

The healthcare industry is facing some challenges in trying to balance the convenience benefit of new technologies with the need to keep patient health information protected at all times. While the implementation of electronic medical records and other new technologies is designed to improve efficiency and enhance patient care, it also has the potential to introduce risk, so IT departments must ensure that these new systems meet security and regulatory compliance requirements to keep private information protected.

As organizations struggle to strike this balance, the use of pagers and other outdated communications technologies continues as the status quo, in large part because of the perceived security and compliance risks associated with the use of smartphones and other modern technologies.

To quantify the impact this has and try to understand the scope, we surveyed 577 doctors, nurses, hospital administrators, IT practitioners, and other healthcare professionals. Overwhelmingly, respondents agreed that the deficient communications tools currently in use decrease productivity and limit the time doctors have to spend with patients. They also recognized the value of implementing smartphones, text messaging, and other modern forms of communications, but cited restrictive security policies as a primary reason why these technologies are not in use.

This study revealed that the use of pagers and other outdated communication technologies decreases clinician productivity and increases patient discharge times, collectively costing U.S. hospitals more than $8.3 billion annually.

According to our findings, clinicians waste an average of about 46 minutes each day due to the use of outmoded communication technologies. The primary reasons cited are the inefficiency of pagers, the lack of Wi-Fi availability, the inadequacy of e-mail, and the inability to use text messaging. On average, we estimate that this waste of clinicians’ time costs each U.S. hospital more than $900,000 per year. Based on the number of registered hospitals in the US, this translates to an industry-wide loss of more than $5.1 billion annually.

We also found that similar deficiencies in communications lengthen patient discharge time, which currently averages about 101 minutes. The majority of respondents said about half of this time could be eliminated if modern communication technologies were allowed. Specifically, 65 percent of survey respondents believe that secure text messaging can cut discharge time by about 50 minutes. Again, based on the number of registered hospitals in the U.S., we estimate that this ‘idle time’ during the discharge process costs more than $3.1 billion in lost revenue per year across the healthcare industry.

One of the primary reasons why smartphones and other newer technologies have not yet been adopted on a broad scale is the perceived security and compliance risks this would create. As a matter of both best practices and complying with HIPAA regulations, healthcare IT administrators are charged with keeping clinical systems and private health information protected at all times. As with other industries, we see that the reduction of risk often comes at the sacrifice of the convenience and productivity benefits of newer technologies.

For example, native SMS text messaging is not encrypted and therefore cannot be used to transmit private health information. Many hospitals have a policy forbidding the use of texting despite the fact that research like ours clearly demonstrates the value it would have on both clinical workflows and patient care. In fact, the majority of respondents to our survey said HIPAA compliance requirements can be a barrier to providing effective patient care. Specifically, HIPAA reduces time available for patient care, makes access to electronic patient information difficult, and restricts the use of electronic communications.

There is clearly a tension between giving caregivers access to the best possible technology to do their job effectively and ensuring that security and compliance requirements are met. Unfortunately we see that the pendulum seems to swing in favor of the latter, and while it is absolutely necessary to ensure security and patient privacy, clinician productivity and patient care suffer as a result.

One of the takeaways from our research is that healthcare professionals—both clinicians as well as IT staff—seem to understand these challenges and the benefits of deploying more modern communication technologies. For example, 74 percent of survey respondents said secure text messaging either has replaced pagers or will replace pagers within the next two years at their organization.

This is encouraging, and we think research like this will help the healthcare industry realize that the cost of implementing new, modern communication tools will be just a fraction of the economic and productivity costs of continuing to rely on pagers and other outdated technologies.

Larry Ponemon, PhD is chairman and founder of Ponemon Institute of North Traverse City, MI.