News 10/3/12

Top News

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

Reader Comments

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

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

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

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

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

HIStalk Announcements and Requests

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

Acquisitions, Funding, Business, and Stock

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

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

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

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

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

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

Sales

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

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

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

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

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

People

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

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

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

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

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

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

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

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

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

Announcements and Implementations

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Government and Politics

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

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

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

Innovation and Research

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

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

Technology

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

Other

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

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

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

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

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

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

Sponsor Updates

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

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

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

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

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

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

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

I couldn’t say it any better myself.

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

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

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Curbside Consult with Dr. Jayne 10/1/12

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

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

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

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

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

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

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

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

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

E-mail Dr. Jayne.

Collective Action 10/1/12

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

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

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

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

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

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

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

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

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

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

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

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

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

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

HIMSS Acquires CapSite

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

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

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

McKesson to Acquire MED3OOO

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

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

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

Monday Morning Update 10/1/12

From DanburyWhaler: “Re: Western Connecticut Health Network. The manager we thought was being groomed to take over as CIO is gone after three months. They are laying off people left and right. The major construction budget is way over.” The hospital recently laid off 28 employees, citing economic conditions, state taxes, and general healthcare trends. The $150 million expansion is pictured above.

From Boomer: “Re: Patrick Soon-Shiong. The billionaire’s healthcare coming out event is this Wednesday, when he will announce the results of an oncology-focused application of his supercomputer / high-speed fiber / middleware / mobile platform that he has been building for years. He claims that 8,000 oncologists using his decision support tools lowered the patients receiving the wrong treatment from 32% to 0%.” He’s presenting at the Bipartisan Policy Center’s October 3 conference in Washington DC, Accelerating Electronic Information Sharing to Improve Health Care.

From At Northwestern: “Re: Epic. No commitment from Northwestern Memorial Hospital to move to Epic.” Like the original rumor saying they were making that move, this one is unverified.

From Bean Multiplier: “Re: Allscripts. I hear from a good source that the company would be willing to take a private equity deal for $15 per share.” Unverified. Shares closed Friday at $12.42, up 14% on rumors that the company is exploring a possible sale to private equity. Shares were last above $15 on April 26, the day before the company fired Chairman Phil Pead, after which three of the company’s board members quit in protest. Even now the P/E ratio is at 40, about the same as Cerner’s. I assume the P/E ratio takes into account the $200 million of repurchased shares, which would have raised earnings per share by reducing the share count rather than reflecting increased profits. Bloomberg did not cite the source of the “possible sale” rumors, which could either be an informed, unbiased source or a pump-and-dumper trying to unload some shares on the market’s reaction to the non-news.

From The PACS Designer: “Re: RIS/PACS integration. There’s been some fresh looks at how a RIS fits into the flow of information between radiology presents, and the submission for and completion of a radiology study. Since most configurations between the RIS and PACS are customized at each institution, it leaves many opportunities for a future RIS/PACS upgrade to be a more robust information source. This upgrade should provide two-way information flow so everyone can plan their activities each day more efficiently. One way to achieve the better information flow goal is to insist that the new system of a combined RIS/PACS come from the same vendor.”

From Miraculous Miler: “Re: John Landis of Cerner. Rumor is that he’s gone.” Cerner’s media relations department confirms that John Landis, SVP of ClientWorks, has left the company.  

From MumpsInToronto: “Re: University Health Network, Toronto. Going to RFP. They are running QuadraMed now, which is MUMPS based. From the volume of data that will need to be converted, you can bet they will be looking at Epic.” Unverified.

McKesson announced Better Health 2020 and an investment of $1 billion in R&D in last December. Three-quarters of poll respondents said the company’s healthcare IT position is worse now than then. New poll to your right: has the use of EHRs increased Medicare fraud?

Welcome to new HIStalk Gold Sponsor Agilum Healthcare Intelligence of Franklin, TN, which describes its offerings as “Business intelligence in a box.” Modules include Service Line Costing and Profitability (margins by service line and payer, case mix trends, length of stay and volume trends, DRG mix, margin by physician, etc.); Revenue Cycle Performance (dashboards, A/R performance indicators, ageing reports, net revenue modeling, and denials by reason); Operational Performance (executive view with KPI line item indicators, facilities operations and department dashboards, daily volume dashboards and forecast, and operating ratios); and Productivity Manager (departmental dashboard, pay period reports, daily reports, overtime ratio reports, and skill mix reports). One of the most technologically astute hospitals in the world, Bumrungrad International Hospital in Thailand, recently signed up for Agilum’s business intelligence solutions to improve its operational, managerial, and financial decision making. Thanks to Agilum Healthcare Intelligence for supporting HIStalk.

I headed over to YouTube to see what I could find on Agilum Healthcare Intelligence. Above is an overview.

I had heard reports that HCA signed a big contract with Epic to replace its Meditech system, but two HCA sources told me off the record that it’s still just one HCA site piloting Epic so far. HCA is still rolling out Meditech CPOE.

Epic consulting firm Nordic Consulting announces that it has raised growth capital from SV Life Sciences, Health Enterprise Partners, and HLM Venture Partners. All three backers focus on healthcare, with the one catching my eye being SV Life Science since Bruce Cerullo is a venture partner there in addition to being the CEO of Vitalize Consulting Solutions that was sold to SAIC a year ago.

CapSite releases its 2012 Ambulatory EHR & PM Study. It finds that 40 percent of organizations are still in the market for an ambulatory EHR, with most of them planning to buy within the next two years. The practice management market offers less opportunity, with only 27 percent of responding organizations indicating their interest in buying or upgrading and just 21 percent saying they would replace their current practice management system to move to an integrated PM/EHR.

Pearson and Cerner announce RealEHRPrep, an EHR learning tool for nursing students.

The UK’s Department of Health admits that the failure of its NPfIT project means it no longer owns rights to the software developed for it by CSC using billions of dollars of public funds. The original contract called for software ownership as one of four terms that were to protect the government’s interests if the project failed, which it did, but either the contract was incorrectly drafted or the government negotiated the rights away in trying to avoid a CSC termination lawsuit. The Department of Health and vendors involved (CSC and BT) are ignoring information requests, according to the ComputerWeekly.com article.

Also in the UK, and external review finds that the rate of clinical errors increased after NHS turned over operation of its pathology laboratories to the multinational corporation Serco. The report by a non-profit watchdog also found that the money-losing JV required hospitals to chip in cash to keep it afloat, and even then the company will pull out of certain markets. Computer problems caused some of the patient-related problems: a patient received the wrong blood type after the software failed to issue a warning, an incorrect creatinine clearance calculation was highlighted as a near miss, and the company’s blood analyzers were shut down for four days after becoming infected with a computer virus.

And also in the UK, a report commissioned by Imperial College Healthcare Trust concludes that 3,000 of its cancer patients have not been seen promptly because the hospital uses 17 different computer systems, some of them requiring manual data entry. The trust says they’re looking for a single system, but the report warns them of the risks involved.

A Wall Street Journal article listing the top 50 startups says that healthcare has fallen out of VC favor based on its somewhat subjective criteria, with last year’s top-ranked Castlight Health dropping off the list entirely.

The VA was expected to award a contract for mobile device management software by Sunday, September 30, the end of its fiscal year.

Weird News Andy likes this story, in which police used fingerprints to locate the former owner of a human finger that was found inside a fish caught from an Idaho lake. When the sheriff called a wakeboarder who had lost four fingers in a towline accident in June, he immediately responded, “Let me guess – they found my fingers in a fish.” The sheriff offered to return the well-preserved digits, but the man declined, saying, “Uh, I’m good.”

Another WNA find: pathology researchers at Georgetown Lombardi Comprehensive Cancer Center (DC) develop a method of testing the susceptibility of a patient’s specific cancer cells to various chemotherapy drugs, much like the routine culture and sensitivity tests that help doctors choose an appropriate antibiotic for a given infection.

Here’s Vince’s HIS-tory on QuadraMed, Part 3, which purely coincidentally provides a history of the Quantim product line that the company just announced that it’s selling to Nuance.

Sponsor Updates

• Vitera Healthcare’s VIBE user group meeting was held September 12-14 at Disney’s Grand Floridian Resort & Spa in Lake Buena Vista, FL.
• Optum announces an ICD-10 education program for hospitals.

E-mail Mr. H.

Time Capsule: If Nurse Shortages Require a 50 Percent Labor Reduction, What Technology Will You Install (or De-Install)?

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

I wrote this piece in December 2007.

If Nurse Shortages Require a 50 Percent Labor Reduction, What Technology Will You Install (or De-Install)?
By Mr. HIStalk

The recent CDW Healthcare nurse survey about IT is both fascinating and sobering. Nurses are too busy with patient care to get application training or participate in IT projects. They continue to believe that IT can improve their jobs, even though current systems involve frustrating duplication. They also think that applications bought on their behalf are ineffective and unreliable.

“Nursing systems” really aren’t that at all. They are really “systems to get nursing to do stuff that someone else wants.” Electronic charting, medication administration, order entry, bedside barcoding, and patient assessment: none of these save nurse time. They may have an impact on quality (slight or otherwise) and they may create an impressive-looking electronic record for other people to read. What they don’t do is make it easier for nurses to finish their work by shift’s end.

Here’s an exercise to ponder. The hospital CEO comes to you and says, “Mr. or Ms. CIO, our RN shortage is serious this time. There’s no solution in sight. We have no choice but to use just half the nursing hours we have available today. You heard me right — I said half. Quality cannot suffer. You have an unlimited budget to implement whatever technology you can find that will deliver that result. Do that and you’ll get a nice bonus — I’ll let you keep your job.”

Let’s say you receive that ultimatum. Would you recommend clinical documentation systems or bedside barcoding as a way to survive on 50 percent fewer nursing hours? I’m pretty sure you wouldn’t. So what would you recommend?

You’d first need to find out how nurses spend their time. That’s a simple observation study, easily done by data-driven IT types, engineers, or quality experts.

Then, you’d push tasks that add minimal value down the food chain to cheaper and more readily available employees. That assumes you have those, of course. Many hospitals inexplicably got rid of LPNs and nurse aides years ago, using expensive and hard-to-find RNs to pass meal trays and give baths. Didn’t all those hospital suits learn anything about labor management in their MBA programs?

Then, you’d automate where you could to improve efficiency. Buy more PCs and Pyxis machines so nurses don’t wait in line. Provide portable communications devices. Have all drugs and supplies delivered to an in-room cabinet for each patient. Let someone else reconcile narcotics counts and give report. Integrate nurse call systems with other communications.

Maybe you’d even de-install some of those applications that quietly eat up nurse time because of poor design. Watch the kid at McDonald’s ring up your hamburger. Now imagine what the screen would look like if your current clinical systems vendor designed it. Real estate sales would skyrocket because every McDonald’s would need another mile of drive-through lane to hold the angrily waiting customers.

Maybe the RN shortage isn’t that severe at your place (so far, anyway). Still, you should make sure that IT systems aren’t contributing to it. When installing new systems, practice “first do no harm”: will they require more nurse time? Any answer other than “no” is unacceptable. And if you’re convinced that technology saves time, this is a great opportunity to prove it.

HIStalk Interviews Alan Portela, CEO, AirStrip Technologies

Alan Portela is CEO of AirStrip Technologies of San Antonio, TX.

Tell me about yourself and the company.

I’m the CEO at AirStrip Technologies. I have about 20 years of experience in healthcare information technology. I came from the EMR side in the past. I have been on the board of AirStrip for about two years and have been the CEO for a little short of two years, since January 2011.

When I came to AirStrip, the core business was mobilizing medical devices — specifically in obstetrics — on the inpatient side. We were accessing fetal surveillance on mobile devices with 510(k) class II FDA clearance. We were the only company doing this with FDA clearance. We remain today the only company doing this with FDA clearance.

Since then, the company moved into mobilizing other medical devices in the inpatient care setting and adding applications for ambulatory care as well. We introduced a cardiology product, which is now deployed in about 60 medical centers. We also introduced a patient monitoring component for mobile devices. All of our medical device connectivity products are cleared with the same classification by the FDA.

Next, we’re moving into the home health space with a partnership we formed with Qualcomm Life to be able to take management of chronic diseases outside of the hospital walls into a patient / population-centric approach.

I interviewed Cameron Powell – the president, co-founder, and chief medical officer — in early 2010. He said that contrary to what people might think, AirStrip is not just a vendor of mobile waveform display applications, but instead is a mobile solution that can expose any data. How will that influence the direction of the company?

I’d like to talk a little bit about the industry trends, how we fit in, and how we evolved as a company to where we are today.

When I started at AirStrip, the comment I received from the members of the team is that AirStrip was viewed at that time — two years ago — as a nice-to-have tool. Mobility overall was viewed as the first technology that healthcare organizations were going to deploy as soon as they were finished with the implementation of their electronic medical records and electronic health records systems to comply with Meaningful Use requirements, at the time Stage 2 and moving to other stages in the future.

My comment coming from the EMR world to my team was, “Well, good luck, because it’s going to take a long time until the process of EMR and EHR deployment is ready. There’s always a new tool that is coming up and a new product that is coming out.” That was the market trend.

I stated to the team that there are a number of initiatives and challenges that we need to look at in the industry. One is the shortage of caregivers. We have known since the Leapfrog Report that there is a shortage of caregivers. Now as we’re going into an outcomes-based reimbursement model and a patient-centric care approach, everything is centered more around the specialists and the top chronic diseases – a cardiologist for heart disease, endocrinologist for diabetes, neurologist for stroke.

What we need to do is leverage mobile technology to bring the data to the specialists and the primary care physicians wherever they are, rather than bringing them to the data. Mobile technology has to become a mission-critical tool to be able to bring the clinically relevant data to those caregivers at the right time, so that they can make the right decisions.

We started looking at mobility throughout the continuum around chronic diseases. When we shifted our messaging to a patient-centric approach, we started experiencing significant growth. In 2011, we grew about 300% over 2010. We started signing contracts, developing partnerships with large healthcare organizations like HCA, Dignity, Vanguard, et cetera that clearly saw the importance of using mobile technology not only to attract patients to their facilities, but also to attract physicians to their systems by offering the right tools and improving their quality of life.

As we looked at this whole thing, we said if we are mobilizing one of the most important clinical data sources — medical devices — throughout the continuum, we need to make sure that we look at the other clinical data sources that are going to make the physician’s life much better. Immediately we looked at EMRs and EHRs. About three months ago, we acquired the intellectual property of a product that was developed at a healthcare organization by physicians on a very similar platform with a very similar approach as what we have done with medical devices. We acquired the IP for a mobile EMR extender.

This is where the other trend comes in. As you see more organizations creating ACOs to manage population health, you’re starting to see that a number of providers are expanding outside themselves by buying more hospitals or acquiring surgery centers, urgent care centers, imaging centers and the like. They’re adding to their systems. Mostly likely they are going to have multiple EMR vendors, even though primarily they were using one particular EMR or EHR vendor.

The moment you do that, it’s the same thing that we experienced on the medical device side. You’re going to have multiple vendors in different units. You need to have a seamless way of mobilizing all those devices into one view.

What we realized was that by buying the IP for this mobile EMR extender, we now needed to do the same thing we did with mobilizing medical devices — mobilize all EMRs and EHRs into one single view, being able to move data across the continuum and having physicians look at one view of their world, improving their workflow.

Of course, there are other things that we have to include. Later on, we’re going to look at imaging and at third-party components that we can apply on top of our platform. Then we will look into videoconferencing to be able to offer the complete solution.

I always talk about that announcement from Steve Jobs when he introduced the iPhone. He said, “It’s not a Web browser. It’s not a phone. It’s not an iPod. It’s everything in one.” That became a revolutionary announcement. What we are basically telling the industry now is, it’s not a medical device, it’s not an EMR/EHR, it’s not an imaging system. It’s all in one, fully integrated on a mobile device, bringing the data to the physicians in one view wherever they are. We create that whole concept of the virtual physician in a way we have all been trying to do for a long time.

The key is to be able to now support data standardization throughout the care continuum, looking at things like CCD — continuity of care documentation — as a standard, and also looking at how we can move HL7 data to create a true healthcare information exchange and take advantage of things that the government has made available to us. This includes NHIN Direct or NHIN Connect for routing, data warehousing and also for an enterprise master person index.

Today the company has evolved beyond medical device mobility. Now we’re mobilizing EMRs/EHRs in a seamless way for physicians. We are now working with the existing standards the same way we’ve been working with the FDA requirements. We’re looking at the standards for data standardization, nomenclature and healthcare information exchange to be able to support the care continuum.

I think that AirStrip now offers is equivalent to what Steve Jobs announced for the iPhone. I think that AirStrip is the next generation of healthcare transformation — being able to put everything into one view for caregivers.

The company is fairly new to have gotten this far with remote monitoring solutions and FDA approval. Are you concerned about what it will take to go after those goals you mentioned?

We all have to recognize that the transformation is necessary and we need to stick to the things that we know, that will be able to make a difference. Transformation will take place thanks to our mobile platform.

I always make the comparison of operating systems on your devices. On your PC, you have Microsoft, or on any Apple device, you have the O/S, the operating system. The true value that you bring to improve workflow in any industry comes from the ability to apply technologies or applications on top of those operating systems. For us, we have the same situation, but we not only have good applications in the mobile space, but we have a very solid platform that we view as becoming that platform or operating system in healthcare that is going to allow for us to bring not only our modules, but other third-party components on top of our platform to be able to solve the problems that we are discussing.

From a development standpoint, what we’re going to do is stick to our core. Today, our core is mobilizing medical devices, EMRs and EHRs. When it comes to imaging and videoconferencing, all we’re going to do is look at third-party packages, plug them into our platform, and then use standards to be able to support single sign-on, content management, and as I spoke about earlier, healthcare information exchange to move the data around.

The key for us, and we’re doing, is to pick those healthcare organizations that are the visionaries and partner with them to be able to move in baby steps toward implementing this huge transformation — but do it in a way that we start region by region — medical devices, EMRs, EHRs and then bring the tools to those regions to be able to replicate that model in other geographies. What we’re doing is carefully picking those healthcare organizations that have the right vision and have the right clinical level of expertise and the right intentions to improve outcomes while reducing cost. Then, working with them, we take things to the next level.

When I’m talking about the vision, I’m really explaining a vision that we’re planning to achieve in the next 12 months. Although the technology is ready today, the bigger challenge is continuity of care. It’s allowing all those systems that the hospitals have to be able to comply with the standards that already exist.

How big is the company today in terms of revenue and headcount and how large it will need to get in the near term?

As a privately held company, we don’t share our revenue figures, but I can tell you that when I came in about two years ago, we were probably about 20 people. We have over 100 already. We have offices in San Diego, Nashville, Chicago, and our headquarters is in San Antonio — that’s where the company started.

As I mentioned to you when I talked about the growth of last year, we added a lot of presence with some key customers. We introduced our cardiology solution officially about 10 months ago and we already have anywhere between 57 to 60 hospitals installed. We already have contracts with another 200 to go live over the next 12 months.

We definitely see a significant growth in the company, but where we are putting most of the emphasis is on what we call clinical / business transformation. We clearly identified that technology is just an enabler of transformation. Transformation happens as a result of aligning people and process as drivers, with technology as an enabler. We created a whole new team where we brought physicians from the top consulting firms to work with us to be able to partner with our customers –you’re going to see some announcements in this area coming out in the next few weeks – to partner with customers to deliver the value proposition.

I believe that technology moving forward is not going to be acquired unless the technology pays for itself, clearly proves out the value proposition on a daily basis and is aligned with the requirements for ACO and Meaningful Use. That’s also why one of the acquisitions we made about two weeks ago was a Meaningful Use tracker to be bundled with our EMR enhancer. We believe that the EMR enhancer on mobile devices is going to increase decision, adoption and utilization and that automatically creates the compliance with Meaningful Use, being able to go to Level 1 and Level 2 much faster.

You have an extensive background in selling systems to the federal government. Do you see that in AirStrip’s future?

Yes. As you know, I was part of the team that installed 60 medical centers at the Department of Defense and 30 at the VA. That is close to my heart. My biggest passion before coming to AirStrip was to help those wounded warriors. Today’s environments are more dramatic. You look today at shortening stent time, event-to-balloon time, for a patient that has a full blockage of the arteries. You look at the wounded warriors, you have to immediately react to patients that are injured in the battlefield and take them through several layers of care until you bring the right outcomes to those kids.

My goal is take this to the federal government and be able to learn from what they have done in areas like security. The federal government is doing security at a level that no one else is doing yet in the private sector. We’re going through that process as we speak because we want to bring that lesson to the private sector – security from the federal government. We also want to bring the experience that we have in the private sector to all the things that we’re doing in the military space. So, yes, it’s definitely an area that we’re planning for.

Do you anticipate further acquisitions or going public at some point?

At this point we are backed by Sequoia. We just closed our third funding round with the Wellcome Trust group, who are very close partners with Sequoia. Now we have a strong 18 to 24 month plan to be that game-changer in healthcare.

That’s our immediate goal. How can we make the transformation to the point that everybody will look back two years from now and say, “AirStrip recognized the importance of virtualizing the caregivers and supporting the patient / population-centric model.” Everybody will remember the types of discussions that we’re having, how we were able to do that by collaborating with large progressive health systems as partners but also large EMR/EHR vendors and medical device companies. We are talking to all of them. We are looking at all of those as partners in full collaboration.

The idea of IPO is not something that we are concentrating on right now. We are enjoying this incredible growth. Acquisitions of other products that will be synergistic to our vision … we are always open to that.

Any final thoughts?

The key moving forward is coming up with the right technological approach and partnering with the right people and the right processes to be able to transform healthcare. But when we talk about people, we have to recognize that that we are talking about the provider, the payers, the vendor community, the systems integrators, all working together and collaborating to be able to sustain the transformation.

We know that transformation is coming. The sense of urgency has been established. This is where you’re going to see more collaboration between all the sectors, more than you have ever seen before. The ones that do not collaborate are the ones that are going to be left out.

News 9/28/12

Top News

The American Hospital association agrees in a letter to HHS Secretary Kathleen Sebelius and the Attorney General Eric Holder that EMR-assisted cloning and upcoding should not be tolerated, but retorts that CMS has ignored its repeated recommendations to expand E/M (evaluation and management) codes to create a national standard for hospital ED and clinic services. My opinion: the election-sensitive, administration-friendly HHS’ers got blindsided by a Center for Public Integrity article that insinuated but didn’t prove that a shift to higher complexity codes means that EDs and physician practices are gaming the system to the tune of $11 billion, so given too little time between now and the November 6 election to actually do something useful (like identify and prosecute someone who’s actually guilty), HHS just went public with meaningless finger-wagging to make it appear that they’re on top of the situation. HHS keeps bragging on how great their fraud detection systems are (which they should be, given the hundreds of millions paid to fat cat contractors to develop them), yet they apparently trust journalists more than their own armies of bureaucrats to tell them they have a problem. The reimbursement system is even worse than the tax laws in being a confusing hodgepodge of rules that nobody, even CMS, really understands or can interpret consistently. Some providers are undoubtedly committing fraud and the 99% honest ones would love to see them shut down and punished. However, as with tax loopholes, there’s nothing illegal or immoral about taking the maximum benefit that the law allows. There’s a reason that crime syndicates are moving from drug dealing to Medicare fraud: payment is quick and rarely questioned, the money is great, and the risk of actually going to jail is almost zero.

Reader Comments

From High Roller: “Re: QuadraMed. Quantum is just the first QuadraMed domino to fall. Franciscan Partners isn’t interested in holding on to the rest of the company forever, so it won’t be long before the other pieces are sold off. QuadraMed has a large enough client base, so they could milk their revenue stream for awhile. More likely, Franciscan will look to sell what’s left to someone like Allscripts who’d be interested in having a larger client base to sell into.”

HIStalk Announcements and Requests

Highlights from the last week on HIStalk Practice: patients want more online access to their health records but most doctors don’t offer the option. Lack of staff impacts EHR adoption, especially in smaller practices. Tips for using an EHR as a marketing tool and to increase patient satisfaction. Parents are more likely to fill children’s e-prescribed prescriptions than paper ones. Physicians are working fewer hours and seeing fewer patients than they were four years ago. I am looking for some MGMA picks. Thanks for reading.

Welcome to new HIStalk Platinum Sponsor Emdat, which offers hybrid clinical documentation and transcription solutions that improve the productivity and satisfaction of EHR-using physicians. Instead of pointing and clicking, physicians continue to use the most efficient method of documenting patient encounters – dictation. Emdat’s DaRT system automatically tags sections of transcription content (chief complaint, medical history, etc.) and then seamlessly auto-populates discrete information directly into the EHR just as though the physician entered it directly using structured documentation. Its Emdat Mobile solution not only allows physicians to document encounters on the go, but provides a more patient-friendly way to document during an encounter. Loyola University Health System uses it with Epic and says the setup was simple, reducing transcription turnaround time by 50% and allowed doctors to continue dictation, which they say is faster and better for patient care. Thanks to Emdat for supporting HIStalk.

Mr. H took off a little early to treat Mrs. H to some fun, so today’s post is a bit shorter than usual.  He’ll be back to serve up a full course of the Monday Morning Update over the weekend.

Acquisitions, Funding, Business, and Stock

As reported earlier today, Nuance will acquire QuadraMed’s Quantim product line. You have to wonder if Nuance didn’t rush the announcement a bit following our Wednesday mention of the deal on Twitter and HIStalk: early Thursday morning Nuance posted these (now corrected) announcements referring to “QuadaMed” and “Quantrim.”

The Kentucky Economic Development Finance Authority approves a $150,000 grant for Health Catalyst, a business accelerator for companies creating health-related software, including life-sciences and HIT companies. Health Catalyst will nurture five startups a year by providing work space, mentoring, and seed funding.

Sales

Evergreen Health (WA) selects MEDSEEK’s ecoSmart Patient Precisioning solution for predictive analytics.

Adventist Health selects MedeAnalytics’ Patient Access Intelligence solution for point-of-service cash collection across its 16 hospitals.

People

Mark Burgess (Cerner) joins Allscripts as director of solutions management.

Fletcher Allen Health Care (VT) hires Adam P. Buckley, MD (Beth Israel Medical Center) to be the organization’s first CMIO.

Announcements and Implementations

Wake Forest Baptist Health (NC) goes live on Epic.

Wellcentive announces Advance Risk Manager, a predictive risk modeling system for population health management that allows providers to focus on patients with specific risk profiles.

The three largest health systems in St. Louis join the Missouri Health Connection HIE.

Government and Politics

Rep. Mike Honda (D-CA) will introduce a bill to set up an Office of Mobile Health at the FDA to provide recommendations on mobile health issues. The legislation also calls for the creation of a support program at the HHS to advise app developers on privacy regulations and for a low-interest loan program for physician offices to purchase new technology.

Technology

The West Health Institute is developing Sense4Baby, a wireless and portable fetal monitor for high-risk pregnancies in remote clinics. The system, which is being piloted in Mexico, sends the captured data over a cellular network to the patient’s physician.

Other

The Seattle Times covers Caradigm, the Microsoft-GE joint venture whose headquarters opened this week in Bellevue,WA. Positive comments from Providence about Amalga are included, along with less enthusiastic ones from Swedish CMIO Tom Wood, who says he’s not sure how they can add a layer on top of EMRs without a lot of cooperation.

UMass Memorial Health Care (MA) will eliminate 140 positions, some of them in IT, in seeking $80 million in cost reductions.

John Reynolds, the former CEO of Hospital for Special Surgery (NY), is arrested for racketeering, charged with soliciting kickbacks from prospective vendors and extorting $300,000 from a hospital employee in return for arranging an annual bonus.

Weird News Andy wonders how this is possible. A women who is “internally decapitated” when her skull is torn from her spine in a car accident not only survives, but is basically back to normal.

Here’s a new video from St. Jude Children’s Research Hospital, featuring patients, employees, and celebrities singing “Hey, Jude” to highlight National Childhood Cancer Awareness Month. Some of those featured are Jennifer Aniston, Betty White, Robin Williams, and Michael Jordan.

Two-thirds of CHIME members report staff shortages and are in most need of more specialists to implement and support clinical applications.

A study published in the Journal of the American Medical Informatics Association concludes that CPOE was the main challenge among hospitals failing to achieve MU in the program’s first year.

Sponsor Updates

• TELUS Health brings its TELUSHealth.com portal live to showcase its solutions that link Canadian patients to their providers.
• Elsevier unveils its EduCode Clinical Documentation Improvement eLearning curriculum for ICD-10 at next week’s AHIMA meeting.
• New York eHealth Collaborative spotlights five health IT champions at the NYeC gala October 15.
• Muhannad Samaan, MD of Aultman Inpatient Medicine discusses how Ingenious Med’s charge capture software improved patient hand-off and communications.
• Software Magazine ranks Macadamian #435 on its Software 500 list, which is based on revenues of the world’s largest software and services suppliers.
• Sandlot Solutions releases a report on using data and analytics to improve healthcare delivery.
• Skylight Healthcare Systems integrates its Service Recovery process with Vocera’s communication devices.
• Optum launches its Optum ICD-10 Core Education program.
• TI combines its DM8148 system on-a-chip with Imprivata OneSign to provide out-of-the-box strong user authentication into any software application.
• McKesson expands its Intelligent Coding portfolio to include observation services.
• First Databank executives Keith Fisher, MS and Patrick Lupinetti, JD  will present educational sessions at next month’s AMCP 2012 Educational Conference.
• Vitera Healthcare Solutions reports record attendance at this month’s VIBE conference in Orlando.
• 3M Health Information Systems adds 18 physician education modules to its Web-based curriculum to address ICD-10 readiness.

EPtalk by Dr. Jayne

Don’t forget — October 3 is the last day for Eligible Professionals to begin their 90-day reporting period for the Medicare EHR Incentive Program, aka Meaningful Use. One of my buddies in the consulting business has been sharing e-mails he is receiving from providers. Today’s special: “I would like to be Meaningful Use but do not know to begin. I need the money. Please send tips for me to start?” I guess that’s someone’s idea of a consulting RFP.

An American Medical News article lists common EHR blunders. I’ve seen all of these in various forms across practices from small to large. Topping the list: lack of infrastructure, lack of workflow assessment, lack of training, lack of buy-in, failure to communicate with patients about delays during the transition, and failure to appropriately integrate the computer into the patient-physician relationship.

News flash: Nearly one-third of US medical school students who initially planned to enter primary care ended up switching to a more lucrative specialty. Surveys of students in New York show that “medical students who anticipated high levels of debt upon graduation and placed a premium on high income were more likely to enter a high-paying medical specialty.” Really.

In similar news, the US medical schools that still don’t have Family Medicine departments are starting to get with the program. Some of these schools are big name and I know all too well what it’s like to attend one. Now we just need to get all medical schools to incorporate informatics into their programs. Let’s teach budding doctors (and nurses, and everyone else) how to leverage technology to better care for patients rather than fighting it or trying to undermine it. Although the new generation seems tech savvy, I see too many students trying to short-cut their documentation.

Mashable lists “10 Office Technologies on Their Way Out.” The list of items they predict will vanish in the next five years includes obvious items like fax machines, tape recorders, and the Rolodex. I’m not sure about desktop computers, cubicles, and standard working hours. There are a lot of entrenched management types out there who will resist. Although I won’t miss formal business attire, which includes pantyhose (#7), I’d like to lobby to keep fashionable shoes part of the equation. If I see one more pair of flip-flops in the office, I just might scream.

The Greater Atlanta area is a hotbed of health IT vendors, so I hope that none of you were recipients of the free kittens given away in the parking lot of the McDonough Walmart. Apparently they were rabid.

As Mr. H mentioned earlier this week, HIMSS registration is open and the room supplies are dwindling. I’m glad he gave me a reminder. I booked tonight, yet wasn’t able to get my preferred hotel or even my preferred dates. I’m leaving a day early, but that’s probably OK since I have to take vacation to attend this year. My hospital no longer has a conference budget or paid professional development days, so I’m not complaining about spending one less night in an overpriced hotel. Plus, I was able to snag a super-cheap plane ticket so I can afford some hot new shoes for Histalkapalooza.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Nuance To Acquire QuadraMed’s Quantim HIM Line

Nuance Communications announced this morning that it will acquire QuadraMed’s Quantim product line for health information management. Quantim includes applications for coding, compliance, computer-assisted coding, abstracting, clinical documentation integrity, record and document management, and workflow.

HIStalk reported Nuance as the buyer Wednesday on Twitter and on HIStalk following the filing of Federal Trade Commission documents. The announcement was reportedly originally scheduled for October 1, the first day of the AHIMA conference.

Readers Write 9/26/12

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

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

Weaknesses Revealed:  Secrets Exposed by Data Integrity Summary Reports
By Beth Haenke Just

The data integrity summary report is one of the most powerful – yet underutilized – tools hospitals have at their disposal for maintaining the integrity of the data within their MPI. Digging deeper into the statistics provided in these reports reveals far more than the volume of overlaid or duplicate records within the system. It can also reveal areas of weaknesses that, left unchecked, could threaten the long-term integrity of the MPI, limit its usefulness in achieving quality and safety goals and Meaningful Use, and hamper participation in ACOs and HIEs.

In addition to pinpointing the root cause of data integrity issues, summary reports can identify specific areas upon which hospitals should focus corrective efforts. These may include improved education and training, policy clarification, enhanced communication, and other steps that result in fewer duplicates and overlays for a more accurate MPI and improved data integrity.

Regular reviews of summary reports can also reveal patterns of errors. For example, too many null or empty fields in certain records can signal problems with registration processes. Drilling down deeper, data integrity statistics can be used to track errors with greater specificity, such as identification of incorrect patients, transposed Social Security numbers, or non-compliance with naming conventions. Data integrity reports can even provide detailed insight into the specific types of errors that are happening most frequently within individual departments or facilities and even enterprise-wide.

Once patterns are identified, individual cases can be closely examined to pinpoint where additional training or policy refreshers might be required. Coupling the data integrity summary report with advanced analytics tools allows hospitals to determine precisely where errors are entering the system and the specific types of mistakes being made. This, in turn, allows education programs to be customized to strengthen specific areas of weakness.

For example, if the summary report reveals an unusually large number of registration errors being made within a short period of time, a hospital can drill down into the data to determine the department where the mistakes are originating, as well as who is making them, why, and how. Often the culprit is an individual who is unfamiliar with the registration process and who is attempting to save time by creating new records for every patient versus first searching the MPI for existing ones. Additional training and education will significantly reduce, and in some cases eliminate, these types of registration errors.

The integrity of patient identity data is critical to achieving care quality and safety goals and plays an integral role in the success of HIEs and ACOs. By taking advantage of the wealth of information found within summary reports, hospitals and health systems can ensure the long-term integrity of their data.

Beth Haenke Just, MBA, RHIA, FAHIMA is CEO and president of Just Associates of Centennial, CO.

Round Peg in a Square Hole: Behavioral Health and EMRs
By Kathy Krypel

Implementing an EMR for behavioral health is like putting a round peg in a square hole. Yes, you read that right: a round peg in a square hole (the opposite of the traditional analogy). The EMR (round peg) can fit, but unless certain steps are taken, it won’t fill the behavioral health (square hole) need entirely. Those steps that need to be taken include:collecting the appropriate data and offering the behavioral specific tools and care plans for optimal diagnosis and care delivery.

Why does it matter? Since many large hospital systems offer behavioral health services as part of their continuum of care, it is important to fill in the gaps and variances around the EMR. The following are just a few examples of why it is important to offer behavioral care services that are supported by a robust EMR:

• One in eight (or nearly 12 million) ER visits in the US are due to mental health and/or substance use problems in adults.¹ This is the most costly venue for care delivery.
• Major depression is considered equivalent, in terms of its burden on society, to blindness or paraplegia. Schizophrenia is equivalent to quadriplegia.²

What are these behavioral healthcare EMR gaps and variances?

1. Providers. Most behavioral health providers are not MDs. In fact, primary care physicians spend limited time with patients and are often hesitant to diagnose and treat behavioral concerns. Most behavioral health providers are clinicians with Masters or Doctorate degrees who have been licensed by their state(s) to diagnose and treat behavioral health disorders.
2. The diagnostic process and tools. Behavioral health disorders are the only serious, chronic illnesses that are diagnosed based solely on self report. The tools used to assess the behavioral health patient’s mental status and substance abuse patterns are very different than the traditional medical diagnostic tools of imaging and lab work. Behavioral health diagnostic tools are most often elaborate question and answer tools that are can be both clinician-administered and self-administered. Behavioral health clinicians use tools such as the Beck Depression Inventory (BDI), Generalized Anxiety Disorder scale (GAD 7), and the Diagnostic and Statistical Manual (DSM IV). These tools need to be incorporated into the data capture and workflow built into an EMR. Additionally, behavioral health providers are required to develop elaborate treatment plans with the patient’s participation. Non-behaviorally focused EMRs typically don’t have tools built in for this and must be built (or ignored). If ignored, the EMR becomes nothing more than a word processor.
3. Customization will always be required. While there are multiple behavioral health specific EMR vendors in the marketplace and enterprise-wide EMRs that can be configured to cover behavioral health, customization will be required to meet multiple state-specific mandates, practitioner specialty requirements, and federal privacy rules that apply to behavioral health.

Although there are challenges, successes are growing. The following recommendations help to ensure a positive implementation outcome:

• Create a small but specific implementation team that aligns with your behavioral health leadership during the build and test period, so all build and testing work is completed in a collaborative manner.
• Build using the most commonly used diagnoses and their DSM IV criteria into the EMR to make it easy for providers and therapists to use drop-down lists to create the diagnostic picture of the patient.
• Build using ASAM criteria, so chemical dependency staffs can more easily complete treatment planning.
• Design within the “tighter than HIPAA” federal constraints that govern confidentiality of patient information for patients receiving chemical dependency treatment (i.e., CFR 42).
• Involve trainers and testers in the workflow discussions.

In order to avoid putting a round peg in a square hole, it’s essential to understand the variances in the behavioral health setting and address them in workflow, data capture, information exchange, provider engagement, and administrative requirements and incorporate them into the EMR project plan, design, and implementation.

Sources:

1. Mental Disorders and/or Substance Abuse Related to One of Every Eight Emergency Department Cases. AHRQ News and Numbers, July 8, 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/nn/nn070810.htm

2. Disability Adjusted Life Year, DALY, Daly 2004

Kathy Krypel is master advisor at Aspen Advisors of Pittsburgh, PA.

Data Virtualization Best Practices Accelerate Time to Value
By Richard Cramer

Data virtualization offers a value proposition that quickly excites business leaders and technologists alike. Business executives are enthusiastic because data virtualization enables IT departments to more quickly respond to new requirements – often in days or weeks rather than months or quarters. Information technologists are similarly excited about being able to get more done, more quickly, and deliver higher value to their business customers.

However, unless we’re careful, this same enthusiasm can lead to organizations trying to use data visualization where it’s not appropriate and results in a classic “square peg in a round hole” situation. It is important to keep in mind that while data virtualization is an important part of the data management tool kit, it is not the right tool for every purpose, and doesn’t eliminate the need for a traditional data warehouse.

Successful deployments of data virtualization share some common characteristics. First is that data virtualization is most successful when it complements a mature data management infrastructure, development standards, and implementation processes. Best practice in these organizations is to use data virtualization as a part of an overall data management life-cycle where data mapping logic that had been built in the virtual solution is seamlessly reused in the physicalized data integration solution.

Second, there are specific use cases where data virtualization is most appropriate. Best practice is to vet candidate uses of data virtualization against these use cases. Just because data virtualization can be used does not mean it should be used.

This is particularly true in the early stages of adopting data virtualization technology, since missteps in using data virtualization for inappropriate use cases in the first project or two can give the technology a black eye that is hard to overcome later.

Good use cases for data virtualization share the following characteristics: (a) data needs are of a short duration; (b) business requirements are unclear or evolving; and (c) situations where quickly prototyping a view of integrated data is required.

Situations where data virtualization is not a good fit include: (a) complex join logic is required; (b) high performance query response is a driving requirement; or (c) source system availability is unreliable or unpredictable.

In this context of best practices, it is exciting to see the healthcare industry providing many opportunities where data virtualization can be a key enabler of organizations looking to maximize their return on data. There are a large number of healthcare organizations with traditional enterprise data warehouse solutions in place, and that can most benefit from the addition of data virtualization to their architecture.

There are also many examples of use cases that are appropriate for data virtualization and can quickly deliver high value. For example, data virtualization can be used to accelerate drug research by providing scientists with integrated views of internal and external information to aid in the drug discovery process. The unpredictable nature of discovery can be enabled by virtualized data integration solutions—quickly combining lesser-known external data with well-known internal data speeds up the decision-making process and ultimately reduces the time to bring new drugs to market.

For healthcare providers, the ability to respond to ambiguous and frequently changing data requirements in a rapidly changing regulatory and business environment is a must. The rapid prototyping enabled by data virtualization can be invaluable in meeting fleeting reporting and data needs today that may be gone or completely different tomorrow. 

Richard Cramer is chief healthcare strategist of Informatica Corporation of Redwood City, CA.

Coordinating Physician and Nursing Care
By David Lareau

Historically, physician and nursing systems and workflow have often been parallel, but independent of each other. Physicians and nurses must be able to share information to provide coordination of care.

For example, physicians must comply with standards such as ICD-10, ICD-9, SNOMED CT, RxNorm, LOINC, DSM-IV, and CPT, while nurses employ terminology like NANDA, NIC, NOC, ICNP, PNDS, and CCC. With so many different standards in place, creating an integrated picture of patient care can be difficult at best.

Fortunately, all of these standards have already been mapped to link physician and nursing information. The capability now exists to integrate physician and nursing documentation and care capabilities as well as provide links between a patient’s clinical diagnoses and nursing care.

To create this functionality, all existing nursing standards were evaluated to identify the best candidate for use at the point of care in computerized systems. The Clinical Care Classification (CCC) system was selected and 182 CCC Nursing Diagnoses were linked to the more than 55,000 clinical diagnoses. Linking the CCC and clinical diagnoses makes it possible for all members of the care team to generate a list of nursing diagnoses based on the physician’s clinical diagnoses for that patient.

In addition, CCC Nursing Diagnoses are linked to CCC Nursing Interventions and to more than 1,760 specific nursing actions. Also, a starter set of customizable documentation protocols has been developed for each of the nursing actions.

One of the most significant aspects of this work is that the same concepts in the nursing protocols are linked to the physician content where appropriate. Coordination of care has arrived.

David Lareau is chief executive officer of Medicomp Systems of Chantilly, VA.

HIStalk Interviews Paul Taylor MD, CMIO and Co-Founder, Wellcentive

Paul Taylor, MD is CMIO and co-founder of Wellcentive of Roswell, GA.

Tell me about yourself and the company.

I’m an internal medicine physician. I practice clinic-based internal medicine about half time. I see patients five days a week. I also chair the clinical integration committee for our PHO. Our committee oversees all the different quality work.

We’re part of the Trinity Health System. We’re in the process of forming a tiered network and just signed up as an ACO. That along with the experience as a practicing physician and chief medical information officer for Wellcentive … it’s been such a lot of fun to put those three different things together.

Wellcentive is a population health management company. We provide population health management solutions that help physicians and their organization across the entire spectrum of population health management, including point of care, care gap analysis, outcomes reporting, automated patient outreach, predictive modeling, risk assessment, care management, and care coordination.

We’re taking a broad view of what population health management means and providing tools developed by a physician for physicians and their organizations. We also focus on aggregating and normalizing data from a variety of sources to make the solution as useful as possible.

The concept of providers being responsible for population health management got thrown into their laps without much warning. Do you get the sense that they are ready to take that on?

I would say most of them are not ready. This is a whole new set of tasks and responsibilities that physicians are being called upon to execute, and lot of the time, don’t really understand. They also have a hard time changing. Most physicians are set in their ways. For us to practice medicine in a different way than we’ve done for potentially decades is a tall order.

The conversation around improving outcomes, cutting costs, and to a certain extent the payment reform of accountable care is going much faster than most physicians can keep up with.

Providers are always suspicious of payers and insurance companies, and those payers have been aggressively investing in analytics and population health management technologies for a long time. Do you think that providers are at a disadvantage against companies that have made analytics a core competency?

I would say that they are. There are some gun-shy physicians as well when it comes to technology. I don’t think that electronic medical records have been as well received by physicians as they could have been. Some physicians are frustrated by the interruption to their workflow.  

Using a population health management solution is really different than an EMR that would be just one more thing. Some physicians are reluctant to dip their toes in that water. Payment reform is going to push them hard in that direction, though.

There weren’t many incentives for physicians to implement technology, but now they’re going to need the information from systems that contain their data. Will this need for analytics drive technology adoption, specifically of electronic medical records?

The need for the data and for the reporting — but also the need for the ability to proactively make improvements in your clinical outcomes and financial outcomes for your patients — is really going to drive that technology adoption. It’s not enough to be looking backwards. 

Analytics are knowing where you’ve been, but it’s having the tools, processes, and programs in place in your office to look forward, know where you want to go, and put the programs in place to get there. That’s where we are and should be going.

EMRs can be helpful in some regard to that end. The amount of actionable data that you need to have good insight and to how you’re doing — that predictive, forward-looking analytics to know where your patient may be over the next year — that type of technology is a lot different than a traditional EMR ,though.

Let’s say you’re a health system with a large hospital, a couple of smaller ones, and perhaps some owned and affiliated practices that use several different EMRs and exchange information through an HIE. What technology pieces are you missing that you’ll need under this new paradigm?

One of the important components is an interfacing platform that can aggregate and normalize data from EMR systems, practice management systems, e-prescribing solutions, local and national labs, health information exchanges, payers, and a variety of other different data sources. That’s a core competency and a core need. 

Data analytics is important to be able to do flexible outcomes reporting, so that you can tailor the reporting that you do for your organization to your specific organizational goals and metrics. Having some sort of outreach tools where you can communicate with patients and help close the gaps in care is important. For organizations that are working with risk-based contracting, risk assessment tools and predictive modeling to give them a good idea of their financial risk and patient panel so that they can properly negotiate with payers and employers.

The one big concept that’s important to understand is that if you look at an accountable care organization, they have to take into consideration the whole landscape in their communities. They have to tie all of that together with their different EMR systems, different practice management systems, different e-prescribing tools, and so on. They need a tool that can do that to help with their different business and clinical objectives, too.

EMRs are driving an unintended consequence in causing small practices and hospitals to align with bigger and more technology-astute providers, such as practices either selling out to hospitals or turning their IT management over to them. Will the need to manage populations provide another push for small organizations to align with larger ones?

I do think so. The likelihood is that the development of accountable care organizations and tiered networks with their more community-based reporting requirements are going to drive alignment of physicians with healthcare systems and their specific overarching umbrella technologies in ways that are probably a little different than with EMRs.

EMRs dictate workflow in physician offices to a certain extent. Because of that, there’s a lot of personal preference for which physicians like this EMR system, or which like another. Having an EMR that a health system offers can be helpful, but it also can be polarizing. Whereas if you have a population health management solution that‘s just a core business function for your accountable care organization, all the physicians are going to be engaged with it, using it, and have their outcomes reported through it. I do think that’s a phenomenon we’re going to see again.

After all the time and money that hospitals and practices have spent implementing EMRs, do you think they will be able to implement these new tools?

I do. We work with physician groups and organizations that have EMRs and some who don’t. The value a population health management solution brings is significant, even for those offices that have an EMR system.

The way that the systems are used in an EMR office is different than the way it is in a paper-based office. In a paper-based office, it does tend to be more point-of-care, hands-on use — looking at clinical decision support tools and doing medication reconciliation directly in the tool as opposed to through an interface with an EMR. With an electronic medical record, we tend to rely a little more on electronic communication between the population health management tool and the EMR, so there is not a duplication of the workflow and effort.

If I’m the typical hospital or practice with an EMR, what’s the bang for the buck in looking for additional technologies to move toward with managing populations?

You are going to need a population health management tool — one that can help you with the reporting, one that can help collect actionable data from a variety of different sources in your community to help make the reporting that you get out of it meaningful to help make the identification of high-risk patients accurate.

For example, if you’re implementing a case management program, having a strong population health management toolset that’s highly integrated with the pertinent data sources within your community is really probably the next step.

Do you see an overlap between what EMR vendors offer and the more specialized tools you provide, and is it hard to convince providers that they need those tools?

It’s beyond just simple functionality. You can have a rules engine that does analytics, but if the data that you’re running the analytics on isn’t accurate, it’s not up to date, it’s not complete, then the reporting that you’re going to get out of it is not going to be very meaningful. The physicians aren’t going to trust it. They’re not going to pay attention to it. They won’t get engaged.

EMR vendors generally are not focusing on integration and interfacing of actionable data across a community. That’s an easy argument, and a very valid argument to make.

Some of the toolsets that you find in a solution that’s geared towards population health management are beyond what most EMR vendors do. For example, predictive modeling and risk assessment, using vetted algorithms to help identify patients that are high risk of poor outcomes, using different types of tools that way so that you can enroll them in case management programs, or help you in your conversations with payers through case mix adjustment, that sort of thing. Those technologies are a little beyond EMRs.

Being able to track the cost and utilization of healthcare across a population of patients is something that’s really valuable information for physicians, especially ACO-type organizations. That’s also something that you really don’t see in EMRs.

We generally don’t think of a population health management solution as being in competition with an EMR. We see them as different types of workflow, parallel technology tracks with some overlap in the uses of the systems. But the goal of the population health management solution is primarily improving the clinical outcomes for a whole population, and also improving the cost of the healthcare delivered to them at the same time.

I see population health management solutions shining in community-wide implementations, which is a distinct and parallel technology track with respect to EMR implementations. Population health management and EMR solutions are complementary, and I don’t see them as being in competition with each other. Their clinical and business purposes are very different.

If I’m a patient now being covered by your tools through my provider organization, what changes in my care will I see?

You might find that you get some automated outreach to you, maybe on a quarterly basis. You get a phone call telling you all the different things that you’re due for, like a diabetic foot exam, mammogram, colonoscopy, that type of thing. The information that’s given to you on that phone call is more likely to be accurate.

You will also probably find that your physician is little more engaged with population health, in that they might be more likely to have care management work that’s being done in their office, a care team that’s involved with helping with your care. You may find that there are other people inside the office who, at a visit or between visits, are using the solution to help improve your care. That’s something that patients generally notice.

As hospitals acquire or align with medical practices, what information do they need to manage that relationship?

Without the appropriate toolset, it’s difficult for health systems or physician organizations to have a good feel for the quality of care that their physicians are providing. If they want to have more insight into that, they need the core set of data — the patient demographic information, accurate information about what’s the patient’s medical history is, what their diagnosis is, what medication they take, what sort of procedures or tests have been performed, and what immunizations have been given and what should not be given.

It’s also important in today’s environment to have an understanding of which payer those patients have. Also, to be able to use a benchmarking tool to help see how an individual physicians stacks up against his or her peers within the office, their specialty, or within their region. A lot of times we see health systems or physician organizations proactively working with those physicians whose performance rates are not as good, trying to help bring them along. Which is, of course, good for everybody.

What changes would you expect the average hospital or physician practice to see in the next five years in terms of the things we’ve talked about, and what should be their priorities in doing something now to be ready?

We’re going to see a lot more collaboration. We’re going to see much tighter relationships between hospitals and the physicians around quality, cost, and outcomes. We’re going to see the business structures of those relationships change significantly, and I would imagine fairly quickly, over that time frame, such that there’s less, “Well, that’s the hospital and this is my clinic here,” more of a feeling like, “We’re all on the same team trying to work together to take care of patients.” 

I believe that the financial incentives are going to be rewarding a community of physicians to help improve those outcomes. The only way you can really do that is by care collaboration through communication, through being proactive, looking forward, and doing things that require a care team to accomplish, like case management, care management programs, that sort of thing. I think we’re going to see a lot of changes over the next five years.

Any concluding thoughts?

Wearing my physician hat, I look at all the technology in this conversation around solutions, data, and interfacing. In my mind, the technology is just enabling. It won’t get the job done for you, but it’s going to help you get there if you choose to put the effort in.

I’m a firm believer that this kind of quality improvement work needs to be led by physicians and managed by physicians. Patients don’t want to be taken care of by some stranger at the case management program. They want their doctor to take care of them.

I also think that it’s important for physicians to roll up their sleeves in their offices and change the way that they’re doing things, so that they utilize the staff that they have in different ways to help drive outcomes and put together an office-based clinical quality improvement program centered around trying to take care of all patients, not just the ones who were in the office that day.

I see all that technology helping to enable, that but it’s just critical that the physicians are leading the charge.

News 9/26/12

Top News

HHS Secretary Kathleen Sebelius and US Attorney General Eric Holder warn AHA and other hospital organizations that the government will take appropriate steps to pursue healthcare providers who misuse EHRs to defraud Medicare, specifically calling out upcoding and cloning of medical records.

Reader Comments

From Wicked Fun: “Re: HIStalkapalooza planning. I just moved from the vendor side to a provider organization. As much as I am loving my brand new job, I miss the ‘fray’ of the world of HIT. The first comment from one of my MD friends  was, ‘What if you don’t go to HIMSS? We always go to the HIStalk party together!’’” The lesson here for the HIStalkapalooza faithful is to add our annual event as a mandatory condition of employment in your contract negotiations. If you like planning ahead, the 2013 version of HIStalkapalooza is scheduled for Monday, March 4, with registration opening sometime in January.

From Plinker: “Re: Northwestern in Chicago. Going Epic.” I don’t recall if I’ve mentioned that previously.

From Squint Eastwood: “Re: Vermont. Not a rumor, but interesting.” Fletcher Allen Health Care and Dartmouth-Hitchcock Medical Center submit an ACO plan that would create the for-profit OneCare Vermont LLC, which would include 13 of the state’s 14 hospitals (Porter Medical Center passed), 58 medical practices, two FQHCs, and other organizations. If approved in October, OneCare would be up and running by January 1, serving most of the state’s 105,000 Medicare beneficiaries. Fletcher Allen SVP Todd Moore, who will be CEO of OneCare if it’s approved, says access to data was a driver. “This is really an access to information revolution as much as it is anything else for us. This gives us access to the full claims set for the first time to Medicare beneficiaries that we treat … to understand how they seek care, how often they go to (the doctor) — whether it be at Fletcher Allen or at Northwestern Medical Center or in Florida.”

From Adam: “Re: Tampa General Hospital. Saw they’re going with RelayHealth for HIE. Aren’t they an Epic shop?” They are indeed.

From HereWeGo: “Re: MCK acquisition of MedVentive. The fat, spoiled kitty found a new toy to bat around and destroy until the next shiny object captures its attention.” Usually the fat cat in a given deal is the seller, so at least some of MCK’s cash trickled down to the MedVentive owners. I should clarify that the rumored MCK acquisition that I mentioned last week isn’t MedVentive, so another announcement could be coming if the rumor turns out to be accurate.

From Bobby D: “Re: MCK acquisition of MedVentive. This is the second company that Nancy Brown has been involved with that McKesson bought, the first being Abaton.com. She has two to go to catch Mike Myers of CliniCom history, who has sold them four companies.” Mike’s at QuadraMed now, I’m told, so he could bag “one for the thumb” if MCK happens to buy QuadraMed’s Quantim line, if indeed the rumor is true that it’s about to be sold (and even if it is, MCK hasn’t been mentioned as a player.) UPDATE: per Federal Trade Commission filings, Nuance will be the acquirer of Quantim.

From Moak: “Re: upcoding. How did you miss this one?” I get at least one e-mail per day (including this one) with a link to a big news story that I’ve already covered, so skimmers are missing out. Still, I appreciate the notice just in case I really did miss something, and Moak brings up an interesting point: the feds gave Faxton St. Luke’s Healthcare (NY) as an example of an ED whose higher levels of treatment jumped 43 percent in 2009, the same year it implemented EHRs. He says the hospital only has 22 days’ cash on hand and therefore is not stealing from anyone. I wouldn’t necessary make that assumption since poverty usually encourages rather than discourages criminality, but I think his point is that the hospital was struggling financially and may have simply cracked down on sloppy billing practices. One might assume that the feds would do some audits before slamming the entire healthcare provider universe with unproven fraud innuendo, but given its poor track record in uncovering even widespread fraud (see: South Florida), maybe the only arrow in its quiver is to bluff. If they have found even one case of EHR-abetted fraud and wanted to deliver an effective message, they should have had a photo op with someone in handcuffs.

HIStalk Announcements and Requests

A big thanks to all the readers who sent me notes bragging that they had already gotten their iPhone 5s after little or no wait at their local Apple store. My phone will arrive from China on Thursday. I loved the lightweight feel of a friend’s iPhone and had fun taking a few panoramic photos. My friend claims it is much faster than the iPhone 4, but she is not yet convinced the battery life is dramatically improved.

Welcome to new HIStalk Platinum Sponsor VersaSuite. The Austin, TX company offers an integrated system for medical enterprises (hospitals, clinics, surgery centers) that includes a hospital information system (including CPOE and eMAR), inventory management, RIS/PACS, laboratory information system, pharmacy management system, accounting, and HR. It’s all built on a single Windows-based stack running on a single database, standardizing the user experience across inpatient, outpatient, and ED. The company says it holds the largest number of CCHIT certifications of any single product, including CCHIT’s enterprise certification, giving healthcare systems one product that is MU certified for both EPs and hospitals. VersaSuite’s EHR includes specialty-specific templates for 24 disciplines, keyboard-free data entry, dashboards, tablet support, and a four-click assessment/plan for outpatients that takes only 5-10 seconds vs. up to two minutes in competing EHRs. The company is a member of IHE and its products support interoperability standards such as HL7 and DICOM and are compliant with HIPAA 5010 and ICD-10. Thanks to VersaSuite for supporting HIStalk.  

I booked my HIMSS room this week and suggest you don’t wait too long. I got my first choice, but the supply for close-in rooms is dwindling. HIMSS usually opens up more hotels later, but they’re usually a long shuttle bus ride to BFE.

Acquisitions, Funding, Business, and Stock

Cancer support site Navigating Cancer raises $2.3 million to hire developers and integrate its patient portal into EMR applications.

McKesson announces that it will acquire MedVentive, which offers population and risk management tools.

Sales

Wentworth-Douglass Hospital (NH) selects the Siemens perioperative management system by SIS.

The Upper Peninsula HIE (MI) will implement ICA’s CareAlign CareExchange platform.

Tampa General Hospital (FL) selects RelayHealth Enterprise HIE for CCD data exchange.

Johns Hopkins Hospital and Health System (MD) selects 3M’s 360 Encompass System for automated coding and clinical documentation.

Health plan service provider Magnacare (NY) will offer online appointment scheduling services from DocASAP, a startup competitor to ZocDoc.

Methodist Dallas Medical Center (TX) selects ProVation Order Sets from Wolters Kluwer Health.

Amcon’s Australian division announces the launch of its Messenger clinical alerting middleware at the 848-bed St. Vincent’s Hospital Melbourne.

People

M*Modal hires Mike Etue (OptumInsight, Allscripts) as EVP of sales, replacing Michael Clark.

Former PatientKeeper VP Michael Bertrand joins home health software provider HealthWyse as VP of development.

RemitDATA appoints John Stanton (Beacon Partners, above) as VP of consulting and Phillip McClure (MedeAnalytics) as VP of sales.

Beacon Partners promotes Christopher Kondrat from principal to VP of professional services.

Phillip Madden (Cerner) is named director of client sales at Orion Health.

Yuma Regional Medical Center names Robert Budman, MD (Catholic Healthcare East) as CMIO.

Besler Consulting appoints Edward J. Niewiadomski, MD (Southern Ocean Medical Center) as senior medical advisor.

Quality Systems, Inc. appoints Daniel J. Morefield (LEADS360) as EVP/COO.

Announcements and Implementations

Munson Healthcare (MI) implements VPLEX Metro virtual storage from EMC and private cloud technology from EMC and VMware.

SCIOinspire Corp. changes its name to SCIO Health Analytics.

Prognosis adds a configurable template engine and a physician rounding tool to its ChartNotes EHR.

In the UK, CSC admits that it will sunset the former iSOFT physician systems, including Synergy, Premiere, and Ganymede, that are used by about six percent of England’s practices. It denied the rumor of the impending retirement until Monday’s announcement.

PerfectServe adds a patient-centered rounding feature to its communications system, allowing clinicians to contact the appropriate physician for each patient.

Cleveland Clinic is implementing software from its new spinoff iVHR, which will present information from its Epic system to doctors in a visual form. The software will create maps patient locations with indicators of patient condition that link to all the background data from Epic, displaying it visually to help doctors see the big picture.

Government and Politics

The FCC’s mHealth Task Force recommends that wireless health and e-Care technologies be incorporated as best practices for medical care by 2017. Example technologies are remote monitoring devices, apps, body sensors, implanted microstimulation devices, medical device data systems, provider apps for remote image viewing, patient portals, clinical decision support tools, and a broadband-enabled HIT infrastructure. Some of its specific recommendations to the FCC include: (a) fill the open position for an FCC healthcare director; (b) provide education and outreach; (c) work more closely with ONC and CMS, specifically helping ONC with secure health messaging and communications standards; and (d) open up more of the communications spectrum for mobile broadband.

UC Davis Health System signs a 16-month, $17.5 million agreement to take over the state’s struggling HIE, formerly run by Cal eConnect. The project has been renamed the California Health eQuality Program (CHeQ) and will be led by Ken Kizer, MD MPH of UC Davis, who was previously CEO of the VA healthcare system, Medsphere, and the National Quality Forum. The project is halfway through its four-year, $39 million grant. They claim they are confident they’ll seamlessly move to a post-grant revenue model when the federal breast runs dry in 2014, which will make them one of almost none if they actually pull it off.

NPR posts the audio and transcript from Tuesday’s “The Diane Rehm Show,” featuring Farzad Mostashari and others on “The Pluses and Minuses of Electronic Medical Records” (but not Diane Rehm, who was on vacation, and not Farzad for the second half because he had to leave). The substitute host led an inordinate amount of the discussion toward upcoding, which made it a lot less interesting. What Farzad said: (a) maybe the EHR just captured the charges correctly; (b) the current system pays doctors more for recording what they actually do, so why wouldn’t they?; (c) EHR or not, fraud is illegal, and in fact the audit trails of EHRs can make it easier to detect. A former healthcare CIO and practice manager named Jim called in to say that his docs always intentionally downcoded with paper records because they were afraid insurance companies would challenge their recordkeeping, but were more confident that electronic records made it safe to bill accurately.

Other

OIG finds that Essentia Health (MN) overbilled Medicare by $865,000, or $3.18 for every $1.00 it was owed. Essentia blames its billing system, which it says it has replaced.

Avado CEO Dave Chase opines in a Forbes article that New York is “the epicenter of healthcare’s reinvention.” He cites as examples health accelerators, Medicaid HMOs, WebMD, the New York eHealth Collaborative, the state HIE, IBM, and Farzad Mostashari.

Weird News Andy finds an article from the physician author of Bad Pharma stating what everybody knows: drug companies selectively publish studies that make their drugs look good, using tricks such as small-numbers studies and statistical tricks that exaggerate questionable benefits. Less-flattering studies get shelved. Industry-funded drug trials were positive 85 percent of the time, while only 50 percent of government-funded studies were. Industry-sponsored studies of statin drugs were 20 times more likely to favor the test drugs. From the book’s description, “We like to imagine that doctors are familiar with the research literature surrounding a drug, when in reality much of the research is hidden from them by drug companies. We like to imagine that doctors are impartially educated, when in reality much of their education is funded by industry. We like to imagine that regulators let only effective drugs onto the market, when in reality they approve hopeless drugs, with data on side effects casually withheld from doctors and patients.”

Another WNA find, which he labels “workaholic”: the New York Post digs through public records to find city-employed psychiatrists who make multiples of their base salaries by claiming extensive overtime for ED coverage. One psychiatrist boosted his $173K base pay to $481K by claiming he worked 80 hours per week. The same doctor made $689K in 2009 by turning in 3,820 hours of overtime, including one non-stop stretch of 96 hours. The physicians are also allowed to operate private practices.

Here’s the latest cartoon from Imprivata.

Sponsor Updates

• eClinicalWorks releases the agenda for its October 25-28 National Users Conference.
• DrFirst creates an infographic called “Key Dates You Need to Know to Maximize Meaningful Use Incentive Payments.”
• Lifepoint Informatics announces its Gold Level sponsorship of the G2 Lab Institute Conference in Alexandria, VA October 10-12.
• MED3OOO VP Steven Stout discusses the risk and rewards of contracting for global risk in an October 3 Webinar.
• McKesson hosts a September 27 Webinar on strategies for driving reimbursement.
• A survey by commissioned by simplifyMD finds that EMR vendors often convince practices to replace their practice management system when implementing their EMR, but practices often experienced problems with cash flow and employee productivity as a result.
• MedVentive offers demos of its Population Manager and Risk Manager products during next week’s AMGA Institute for Quality Leadership Annual Meeting.
• Benefis Health System (MT) realizes a $4.9 million increase in appropriate hospital charges, a $3.5 million increase in reimbursement, and a $2.3 million reduction in uncompensated care within four months of implementing the first phase of its RCM initiative with MedAssets.
• MedAptus releases its Mobile Schedule application for Apple iOS.
• An Imprivata-sponsored survey finds that 72 percent of hospital IT decision makers believe pagers will be replaced by secure text messaging within three years.
• iSirona releases a white paper on device integration.
• Wellsoft will participate in the 2012 ACEP Scientific Assembly next month in Denver.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Curbside Consult with Dr. Jayne 9/24/12

As a primary care physician, I think the concept of health information exchange is exciting. I’m tired of seeing patients who forget to bring their medication lists. Don’t get me started on those who really have no idea about their health history. I’d love to be able to exchange with other practices in my community, but for now I have to settle with downloading their medication list from Surescripts and digging through hospital charts and scanned records.

Several groups are trying to get private exchanges going in my area. Our state is woefully behind in the exchange game, so it’s not surprising that people are stepping up to fill the gap. The technology is there, the desire is there, but unfortunately the governance is not there. Small, medium, and large-ish independent groups are in active discussion about sharing information, but are woefully undereducated about data ownership, participation agreements, and patient consent.

A colleague of mine was involved in one of these exchanges several years ago. It ultimately folded due to lack of agreement among the four participating practices. There were no arrangements for determining “source of truth” for patient information and the database quickly became corrupt and ultimately unusable. It was a shame, because initial participation yielded outcomes that were published in peer-reviewed journals and looked truly promising.

I was excited earlier this summer when ONC issued a Request for Information on Governance of the Nationwide Health Information Network. The RFI asked for input on how to make patients and providers confident about information exchange. As someone who has had to counsel patients on why they should share their data, the idea of a national standard was enticing. I’ve also had to hold the hands of providers as well – making them understand that having “somebody else’s stuff” in their charts is not necessarily a bad thing.

The other shoe dropped earlier this month when ONC announced that it will not “continue with the formal rulemaking process at this time, and instead implement an approach that provides a means for defining and implementing nationwide trusted exchange with higher agility, and lower likelihood of regret.”

I sympathize with all the statements that Farzad Mostashari made on his blog – that there are voluntary governance bodies, that regulation may slow trusted exchange, etc. ONC hopes to “identify and shine the light on good practices” and “provide a framework of enduring principles to guide emerging governance models.” I’m afraid, though, that for some nascent exchanges, it will be too little, too late.

Who is going to shine the light on the private exchange that is sharing patient data without their consent? The providers think it’s just fine because “the patients signed the HIPAA form,” not understanding that HIPAA consents typically cover treatment, payment, and operations. A standard form may not cover the fact that all the patient’s data just got populated into a private HIE which has no provisions for filtering sensitive information or tracking patient authorization. It may not have restrictions on who can access the data or who monitors data consumption. The providers can’t even articulate whether they’re practicing in an opt-in or an opt-out state.

Some of you may think this is a fable, but it’s the reality of a practice where I was a patient last week. After figuring out what was going on, I should have billed the practice for the free consulting I gave them explaining that in their state they simply can’t just choose to populate patient data to a health information exchange without consent.

I hate over-regulation as much as anyone, but the private HIEs that are popping up are starting to feel a little too “wild, wild west.” Voluntary bodies aren’t going to help them if they’re not even aware the voluntary bodies exist.

What do you think about private health information exchanges? E-mail me.

E-mail Dr. Jayne.

HIStalk Advisory Panel: Increasing Physician Involvement

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 month’s question: What successful actions have you taken to improve the involvement and satisfaction of physicians with IT projects and services?

• We ask physicians what kind of IT solutions they believe would be beneficial to our service, quality, and affordability objectives. Physicians help us evaluate proposed solutions. Project teams are partly staffed by physicians, and in some roles, we pay them for their subject matter expertise. CIO meets directly with CMIO to ensure alignment on priorities and clarity regarding improvement opportunities.
• We strive to find ways to use HIT to make it easy for our physicians to do the right thing. We obsess over how many clicks each action takes, and whether someone else on the team should be doing it instead of the doctor. We are not perfect, but we’ve stumbled into a few things based on these principles which are unique ways to use our EMR, but which result in improved efficiency and quality.
• We formed a physician group called the PIT (Physician Information Technology) group that meets every other week. We do this so frequently because we are in the middle of a large EMR project. We run all decisions impacting docs through this group, from order sets to clinical notes design. Another thing we have done is launched a physician portal that has a blog manned by our CMIO and CIO, but I will have to tell you it does not get much traffic.
• The single most important tool for physician engagement has been shoe leather (OK, shoe rubber?) Getting out and making face-to-face contact with them in the hospital and in the clinics. Asking what works and what we can do better. Optimizing the EMR is an ongoing task and the first step is to convince them that we’re committed to it. Also, recognizing that one size does not fit all, whether it is the interface or the device or the software tools, has been critically important. Be flexible wherever possible about the tools we provide.
• I think this follows the classical thought process today: First, have a physician in a key leadership area seen as the owner of the project. I like to have a VPMA or Medical Director leading the charge depending on the scope of the project. (IMO, depending on this roles relationships with physicians and the physician model of the organization, this may or may not have any impact on the project.) Another key is having the right type of person in a Physician/IT role (CMIO, Med Dir of Informatics, etc.) Someone that can earn the trust and respect of the other Docs, translate clinical needs between IT and business workflow, and "prep the battlefield" for major decisions by meeting with groups or individuals off-line. Having key physician champions attend discussions with other clinical areas is a must. This is where workflows overlapping various areas (physicians and nursing, for example) come to a head. For ongoing support, maintenance, and optimization, having IT topics on MEC, division meetings, physician steering/champion groups, etc is a key strategy. And as a last resort, free meals are always appreciated. 
• We’ve taken a new approach to engaging physicians with our EMR via an online collaboration / community. Our "MyEMR" secure intranet site is unique and now has almost 500 physician members. Physician IT champions moderate discussion forums, answer questions for their peers. Education ‘tips and tricks’ videos. Design drafts are posted for review on new content and development items. New information (e.g., Stage 2 Meaningful Use information) also posted for review and education. Project status documents posted so that all can see progress on important efforts. This site was conceived by our physicians and now co-managed with them.
• Defining specific roles for physicians and using physicians to recruit other physicians has been a successful approach that I have used. Whether it is software implementation work or ICD-10 implementation or anything in between, physicians need to have clarify on the expectations and time commitments that they will be signing up for.
• We created a steering committee for them that reports to the medical staff executive committee. The only person from the hospital who is there routinely is the IT director (no CIO here). It is their chance to blow off steam about issues, and they do. If they gripe to the hospital administration about IT, they’re told that they have a channel for those complaints, and they are asked to use it. Once they recognized that we do listen and that within the strictures of the software and legalities, we’ll accommodate them if we know there are problems, they started using the committee. Now, it is more about moving forward than about fighting the battles of the last 20 years.
• With any change, you need executive leadership support (administration and physician), evidence-based metrics, peer-to-peer pressure, and a system’s level continuous process improvement culture that is combined with a comprehensive, multi-pronged communication plan that reaches all levels of your organization. You have to include physicians (champions and high-volume user representatives) at the table from the very beginning and recognize that they are key stakeholders, and not just barriers to IT implementation. Physicians, like us all, are slow to adopt new, disruptive technologies. Active involvement and an active communication plan are critical to getting them involved.  If they feel like they are part of the solution, then it will work. The solutions themselves also have to be designed for the user (the physician). They need to here "what is in it for them." Perhaps it is a reduction in time, errors, callbacks, etc. The more specific the better.
• We created a CITAC (Clinical Informatics Technology Advisory Council) made up of physicians representing most of the sections of the hospital(s) and we take them all of the new things we look at, get their input, get advice as to how to communicate with the entire medical staff, or to introduce new systems or technologies, etc. They also bring us suggestions from their respective sections on order sets, CPOE screens, prompts, core measure attributes to build in, etc. It’s really been helpful. In addition to the docs, we also include some nursing staff, my IT clinical informatics staff, and our vendor representative. We air some dirty laundry, and deal with some turf issues, some of which can be awkward but the end result is pretty positive. In addition to this, we have made trips to each of the major provider clinics to meet with those physicians to discuss issues and desires related to CPOE screens, prompts, processes, etc. But, one of the biggest things that I feel contributes to better adoption of new technologies, is that we use a lot of hospitalists in our organization, and once we get them to use technology and make some changes based on their feedback, we’re finding the other physicians are more prone to try it (since they see the hospitalists using it).
• We’ve worked very hard to partner with and develop Physician Champions. Physicians in this role are more in tune with current projects and services, and enjoy being involved in the decision making process. For many of our physician champions, we have regularly scheduled meetings with them and their Practice Administrators to prioritize projects and discuss options, which is beneficial for all of us. We are expecting to roll out a full Physician Governance program this next year.
• Physician IT committee, physician champion for certain projects, specific physician IT ‘helpline’ to facilitate quick resolution of their issues.
• The key to physician satisfaction and engagement in health IT efforts is definitely having them involved. It is not enough for them to just be invited to receive information about the project. They need a seat at the decision making table and a voice that is heard and listened to. The level of their involvement in decision making and governance can vary depending on the project/program at hand, but having as many thought and action leaders from the medical staff in active roles in the project/program as feasible pays dividends with the entire medical staff. The opposite situation (zero physician involvement) yields highly negative results in terms of medical staff satisfaction, engagement, and adoption. However, it is also absolutely vital to choose wisely those physicians that are selected for involvement. We naturally want to involve those who have "connectedness" with their peers and thus high influence, but we also must select for traits such as "collaborativeness", ability to understand and explain the "vision" and rationale of what we are doing to peers, and flexibility (as plans necessarily change while in progress more often than not).
• Most success has been to not just involve the docs, but have them lead initiatives. For example, we have three MDs that have had tasks and expanding roles in our Epic project. In addition, when you can have the docs be decision makers in projects, and those docs have the respect of most of the medical staff, per se, then things seem to go better. Having docs sit on a committee and updating them or asking for opinion is clearly not enough. They have to be like the pig at a breakfast of bacon, sausage, and eggs. Not like the chicken. 
• When we went through the process of choosing an EMR we intentionally set up a steering committee made up largely of our physicians. We had representatives from all of our clinic types and almost one from each clinic. These docs were an integral part of the process. Once our selection process was down to three, we did demonstrations of several days with each vendor and asked all of our clinicians docs and staff to sit in. We required a survey upon exiting even if it was just a check mark on a few basic questions. After demos, site visits, and analysis was completed, the only folks who voted were the physicians. We have tweaked the system we purchased to make it as useful to the docs as we can. When we have a live date planned, we make sure the physician has someone within hearing distance to answer all questions and concerns. It is all about the support.
• This is a long story, but something for which we are proud.  Many years ago (1993, in fact) we created a Clinical Systems Advisory Committee. It came to be because there was significant dissatisfaction among members of the user agreement. It started as a very small group of physicians who would meet with us weekly, then ultimately bi-weekly, to discuss our work. We provided dinner and (cheap) wine. We would always meeting in the evening; we would always make it a comfortable, and somewhat informal meeting. Over the years, it grew, and grew, and grew. And now, we meet monthly. The room is full with doctors, nurses and IT professionals. There are often more than 50 people in the room. Sometimes there are 75 or 80 people in the room. It is open to anyone who wishes to attend, although there is a membership list. Lots of great folks participate, and we all genuinely look forward to the meeting. It’s a social event as well as a work event. Lots of time to network and catch up. The meeting typically lasts for about two hours, but many folks stick around late into the evening. We serve great dessert. We have learned so much, made important decisions, and used the output as a way to advise our executive team. It has been a real joy. Additionally, now that we have embraced Epic as our enterprise-wide solution, we have added a Physician Council and a Nursing Council. In this case, we have ensured that we have a representative from every department or division. It is equally effective, equally active, much more focused and a bit more formal.
• Use of "Tech Rounds" at one of our hospitals, conducted by the local CMIO; done monthly and showing latest technology applications, use of system, etc.
• We have a mature CPOE implementation and a lot of community docs and contracted hospitalists (in many disciplines). It has been challenging to maintain physician involvement and enthusiasm for continuous improvement of order sets, decision support, etc. On the satisfaction front, hiring a CMIO (me) has been very helpful, and having a crew of dedicated physician educators / support specialists has been essential. Most of our physicians don’t bother with the IT Help Desk any more.
• Lots of one on one discussion; open conversations with physicians in various meeting formats, informal lunches, working  to provide prebuilt documentation screens by specialty, demonstrating the improvements in outcomes using computer associated protocols agreed to by provider groups.
• As part of our Epic implementation, we formed a Physician Advisory Group chaired by our CMIO consisting of physicians representing every discipline across our health system. This group has been key to driving significantly increased engagement by physicians in the requirements, design, implementation, testing, training, go-live, and ongoing improvement of our new EMR. The core advisory group has been meeting weekly for a year and has been very successful. We also invite other physicians, outside the core group, to participate in requirements and design sessions when needed, which extends our reach further into the community. These, and other supporting, actions have been effective in improving involvement and satisfaction of our physicians with IT projects and services. 

McKesson To Acquire MedVentive

McKesson announced this morning that it will acquire MedVentive, which offers population and risk management solutions. Terms were not disclosed.

MedVentive, based in Waltham, MA, was founded in 2005 by Jonathan Niloff, MD. Its solutions include MedVentive Risk Manager and MedVentive Population Manager. McKesson will add its offerings to its McKesson Enterprise Intelligence suite.

Time Capsule: Sutter’s $150 Million Turned $500 Million Clinical Systems Project: Where Seldom was Heard a Discouraging Word, Apparently

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 2007.

Sutter’s $150 Million Turned $500 Million Clinical Systems Project: Where Seldom was Heard a Discouraging Word, Apparently
By Mr. HIStalk

Sutter Health didn’t seem embarrassed when the local newspaper recently reported that its 26-hospital Epic clinical systems project will end up costing around $500 million. In fact, Sutter’s COO even hinted that the tab could run higher, saying that EMR projects rarely meet budget and timeline projections. He didn’t sound concerned.

Or, maybe it was gallows humor. Sutter’s original project budget was $150 million. Being off by over 230 percent is scandalous, at least when someone other than Uncle Sam is involved. Luckily, Sutter can afford a gaffe of a few hundred million.

Wildly faulty project budgets and timelines are not uncommon. Project complexity goes up much faster than being simply linearly related to bed size or headcount. It’s closer to geometric: doubling the bed size quadruples the effort (and therefore the cost). It’s anti-economy of scale. Little hospitals have it easy, other than they’re broke.

That’s no excuse for a bad estimate. Complex projects demand sophisticated planning and risk mitigation. Socking a lot of cash in a contingency fund is poor substitute for planning well in the first place.

The main reason for underestimation may be more psychological than numeric. Project costs are often underestimated and riddled with unlikely assumptions because that’s what people want to hear. This is similar to groupthink, in which members of a group are so reluctant to disrupt group harmony that they avoid viewpoints that are contradictory or critical.

Those executives who collectively decide to plunk down hundreds of millions of dollars for software may not be all that enthusiastic about the idea individually and off the record. Everybody else seems to like the idea, so it’s easiest to avoid arguing with peers by just going along as a passive rubber-stamper, especially if the boss clearly favors doing it.

After all, everybody else is hot to get going, too. Consultants urge action, especially when they smell an opportunity to get new engagements. Affected departments love anything new and fun, at least initially, so their appointed representatives can’t wait to get started. Journals, HIMSS conferences, and vendor salespeople encourage action because the industry (and therefore their place in it) depends on churn.

The CIO, being nurtured in an IT advocacy mindset, often naively believes that IT fixes problems, even when available solutions are dysfunctional and collective experiences suggest otherwise. If the other VPs are willing to do it, the reasoning goes, why not get a chance to shine, beef up the resume a little, and move up on the staff-and-budget yardstick they measure each other against?

Many of these big-ticket projects will never even come close to being worth what they cost. Does anybody go back to the people who made the “go/no go” decision and either ask for an explanation or fire them for bad judgment? Not usually. The project’s once-broad circle shrinks to a grim core of IT people stuck with the unenviable task of trying to reconcile unreasonable expectations with the ugly product limitations and internal processes at hand. What started out as a noble collective mission becomes a never-ending IT ground war that no one wants to talk about.

It goes without saying that IT people shouldn’t be initiating or leading projects other than those involving IT infrastructure. What may need to be said, however, is that the process and choice of people involved in making huge IT project decisions may be flawed as well. Seldom is heard a discouraging word when project-friendly allies sit around a conference room table breathing each other’s air.

If hospitals really wanted to make an informed decision, they’d bring in patient advocates, safety experts, physicians, risk managers, finance experts, and process engineers. That’s pointless if the pre-ordained executive answer to the “should we do this” question is already “yes.”