From HIMSS 2/21/12

From Mr. H

You know you had good day when you thought it was about 10 at night, and you check your watch and find that it’s well after 1:00. I’ve never stayed until the end of HIStalkapalooza in years past and yet this time, I found new old friends that I just didn’t want to leave. I’ll probably forget all kinds of stuff since it’s late, but I’ll try to put some thoughts down.

Inga, Dr. Jayne, and I had our HIStalk sponsor lunch today, with a brief in-costume appearance. Our sponsors are magnificent, taking time from their very busy first day of HIMSS to spend time with us. Thanks to Dr. Travis of HIStalk Mobile for managing the event; Duke Hospital CIO Art Glasgow for speaking to our guests;  Tom Visotsky for helping out; and Micky Tripathi for dropping by as one of our favorite people. We appreciate the support of our sponsors and hope the event conveyed that fact to the folks who make all this possible.

HIStalkapalooza was just perfect. ESD did everything right and had a great group of ambassadors on site to welcome our guests. Ross Martin MD did an amazing opening number dressed as Elvis with lyrics customized for HIStalk –  Ross comes through for us every time and he was excellent in every way, from his rhinestone-studded Elvis costume to his great singing and dance moves. We had an Elvis impersonator, something I wasn’t sure I’d like, but he was definitely working the crowd and doing some great Elvis work up there. It was fun having e-Patient Dave there as the subject of one of Ross’s songs, and the duet featuring Ross and Elvis was really good.

The contests were great fun. I’ll let Inga fill in the details later, but the show was skillfully handled by the polished Greg Wilson of Salar and the beautiful Jennifer Lyle of Software Testing Solutions. Our new BFF Timur Tugberk helped out with the activities along with our judges (photos and details to follow). And of course, Jonathan Bush was endlessly entertaining with the HISsies awards – he’s been doing it for us for years and this was his best performance in my mind. I don’t think any description could do it justice.

The IngaTinis were seriously too good – those First bartenders concocted a mixture that was a little sweeter than I like, but prone to disappearing in seconds leaving an empty glass and an inner voice saying, “Don’t have another … these things are liquid crack.” I had two other folks try them and they just moaned their approval.

I didn’t have much to eat, but the prime rib was outstanding, the beer was cold, and the service from the First crew was really good even when it got slightly rowdy.

Thanks to everyone who came, with special recognition to the ladies who were wearing some amazing outfits and shoes and definitely working it. And thanks to ESD, especially Brittanie Begeman, who put unbelievable effort over many months into making this evening special for those present.

Here’s Inga’s footwear in a pic taken by me in the limo going to the sponsor lunch. She repeatedly emphasized that she had painted her toenails to match her jaunty scarf, while Dr. Jayne and I tried to seem moved by that knowledge.

The Palazzo shops area, near First.

One of the lovely ladies of ESD welcoming our guests.

Prime rib, nut brown ale, and a view overlooking the Strip and the Treasure Island fireworks and pirate show. Nice.

Dueling Elvi, with Ross Martin on the left. They were both good.

Jennifer and Timur with some of our contestants.

Judges on the left, Greg Wilson on the right, contestants in the middle.

The incomparable JB doing the HISsies.

The ESD folks taking a much-deserved bow.

Epic won a lot of the “good” HISsies awards. Thanks to Judy Faulkner for dropping by.

I’m sure we’ll have more, but it’s now 2:00 in the morning and I’m tired, so here’s a quick rundown of the exhibit hall.

• I was exhausted trying to swing by all the booths, only to find that there’s a downstairs. Seriously. So-called Hall G (the only place your free food coupon was good for) is downstairs off the main level, filled with mostly small or oddball booths and other non-exhibit items. I’m thinking that anyone who bought a big space down there got a bad deal.
• Iatric Systems had the coolest crowd draw – a trick pool guy with a full-sized table.
• Omnicell had cappucino.
• Versus had the perfect sized, done in a really nice green.
• The HipLink folks were wearing cool racing shirts.
• Several booths had every rep screwing around with their smart phones and never looking up even when someone stopped right in front of them (Vital was one I noticed only three minutes after the doors opened.) I’d confiscate their gadgetry if it were me.
• DrFirst was doing their superhero photos and caricatures.
• Covisint had bean bag chairs in their theater.
• Enovate had the same effect on me as in every other year – their cool ergonomic computer carts and arms compelled me to caress their wares.
• I’ll award two companies my “best booth performance of the day.” Optum had a huge space and had one rep whose name I should have got come out to masterfully strike up a conversation. One of the best demos ever was by Bonny of Aventura, who showed me their quick clinician logon/logoff. I highly recommend taking a look – it’s really cool, fast, and easy.
• Medicity’s booth was packed.  Nice.
• AT&T had a charging station for personal devices and was demonstrating their Managed Telehealth system that can be leased with a monthly fee.
• Cisco’s theater was packed.
• T-System was set up like an ED, with employees in scrubs.
• Passport Health had their booth crawl sign out.
• Quest /Care360 had their booth crawl sign out and a guy doing lasso tricks.
• Emdeon had cool purple shirts and a nice green color scheme.
• Allscripts had the biggest booth and sign that I’ve ever seen.
• Siemens had a mammoth booth as well.
• Epic had the usual fireplace, wacky sculptures, and throngs of people.
• GE Healthcare had a stations set up for Caradigm.
• NextGen had a nice open booth with real grass growing.
• Lawson had a cool coffee bar.
• Microsoft’s booth was packed.
• MEDecision had cool blue martinis and an sculpture. I saw Dr. Jayne later and she had visited it, of course.
• Merge had a honeycomb design that was fun.
• Vitalz had a full-sized race car.
• Medicomp was running their Quipstar game, which was amazing considering they programmed the game system themselves and had really cool player stations. We were early fans of Quippe last year and if you haven’t seen it, check it out on an iPad.
• I overheard good things about Intelligent Medical Objects from a customer who said they are rock solid in getting their ICD-9 releases out early and in being prepared for ICD-10 well ahead of time, which of course penalizes them with the delay.
• Alert, the Portugal-based vendor that seems to exhibit every year with few customers to show for it, had a graphic saying they had 2,926 sites live in Portugal, over 8,000 in Brazil, and 24 in the US.
• MyMedicalRecords was pouring champagne.
• Airwatch had a candy and apple display that was quite attractive. It’s nice to see healthy food in the hall.
• NTT DATA had a cool booth and a coffee bar.
• Tibro had a bicycle challenge, where you can ride a stationary bike.
• The State of Georgia had a booth and was giving away Georgia peanuts, sharing space with Georgia Tech and Greenway.
• Check out Modernsolid of Taiwan – cool carts.
• Salar had a very cool booth and lots of candies.
• Firehost was giving away decks of cards.
• JEMS Technology was demonstrating their mobile video solution in the Enovate booth. 
• SCC Soft Computing had a jet ski.
• Agfa Healthcare had the coolest coffee machine ever.
• Identity Finder told me about their product that uses patterns to locate PHI on publicly accessible servers.
• The guys from Perceptive Software showed me their iPhone that Steve Wozniak autographed in his recent visit there.
• The Advisory Board booth had some folks I know on hand.
• Billian’s had our sign out and was offering extra badge holders.
• PilotFish had a nice crowd for their interface engine despite a terrible location. They were giving away colorful fish stuffed animals.
• OnBase had the sports bar, but I was crushed to see that their outstanding magician has been replaced.
• Beacon Partners had our sign out and is conducting an ICD-10 survey.
• Dr. Nick was doing a demo in the Nuance booth.
• Epic touted its Lucy thumb drive PHR.
• McKesson had the usual dark blue/orange booth and, surprisingly, had about the same number of attendees talking to the Horizon people as with those from Paragon.
• SIS had our sign out.
• Access had our signs out. They promise they’re going to figure out a way to bring their Texas barbeque to New Orleans next year since I’ve been bugging them to do that for three years now (they have a competition barbeque team.)
• Cerner and Meditech were in Siberia after losing HIMSS points for dropping out for a few years
• Most brilliant marketing idea: Laserfiche offered chair massages, but had monitors mounted beneath the face cushion so you could watch a video while getting massaged. The massage was amazing. This is my #1 tip to check out, which Dr. Jayne didn’t need since when I told her about it, she said she’d already had one.

From Inga

I’m meeting my BFF Dr. Jayne for a pre-HIStalkapalooza cocktail, so I don’t have much time to do more than highlight the last day in pictures.

Dr. Jayne and Mr. H let me take their picture with HIIMSS President Steve Lieber (he’s the one in the middle.)

Elvis was alive and kicking last night at the opening session.

The only missing from this dancing Elvis was a pole.

This gentleman was calling home to tell his kids about the amazing giant dice decorations.

Opening keynote this morning was Twitter founder Biz Stone. But, not until 35 minutes of music, dancing and a rather dry welcome from a HIMSS board member (I missed her name.) Stone was smart and funny. I only Tweeted a couple times during his talk.

I was one of the ones crushing my way to the front of the line to get in the exhibit hall the moment the doors opened.

Merge brought another car.

I think she was a professional booth babe but wow – really tall and in really high heeled shoes.

I will be playing Quipstar at Medicomp’s booth tomorrow at 4:00 pm.  Come see me.

Bloggers meet-up. Dr. Travis is participating in one of these sessions at some point but Mr. H, Dr. Jayne, and I weren’t asked to participate.

Orchestrate was just one of the HIStalk sponsors promoting the HIStalk Booth Crawl with a sign. Thank you!

Hall G is downstairs and easy to miss but that is where you will find the Interoperability Showcase and a number of other special booths. The ceilings are definitely lower than in the upstairs hall and it feels a bit dungeon-like.  However, there were still plenty of people.

The longest line: Cafe Presse, where the caffeine-addicted stood in line for 15 minutes to get their fix.

HIStalkapalooza time!

From Dr. Jayne

HIMSS opening day – we wait for it each year, and it dawns pretty much the same as any other day, except this year it’s a day later. I was pleased to see the turnout at the opening reception Monday night – it seemed like a lot more people than last year and most of them were having a good time. Mr. H and Inga and I had a nice visit – after all, we only see each other once a year, so there’s a lot of catching up to do. I did feel a bit conspicuous standing there with the three of us just hanging out, but that’s the magic of being anonymous.

HIMSS always seems like a whirlwind, and it’s no different this year. What’s been different this year (so far) is meeting actual family physicians out in the wild – yes, they do exist at HIMSS. And I’m happy to report they were pretty fun, even introducing me to some kicky Belgian ale. You do have to love a beverage that has pink elephants on the label (and that was also served in accompanying pink elephant glasses.) Don’t get me wrong, they also ordered milk and Cookies, revealing their Midwestern roots.

What do informaticians do when they get together? Make fun of ICD-10. In honor of my collision with Judy Faulkner on Monday, one whipped out his homegrown iPhone app and coded my visit: W51: Striking against or bumped into by another person – unintentional. It was actually a pretty cool app, with twirling dials (think slot machine) that allows you to shake your phone and select codes a la Urbanspoon’s mobile app. Based on the wackiness of ICD-10, I may be better off using the app than actually trying to select codes rationally.

Your HIStalk crew got together again (this time, craftily disguised in our white coats) today for the HIStalk vendor. appreciation lunch. Since almost anything goes in Las Vegas, we didn’t get many odd looks as we swept into Fashion Show Mall. It’s great to see everyone together and we do really appreciate the support that makes it possible for us to do our HIStalk thing.

Tonight was HIStalkapalooza of course and a good time was had by all with Jonathan Bush delivering a stellar performance and many hot shoes to be seen. One winner was asked in the hotel elevator if she was Miss America, what with the beauty queen sash and all. A little disappointed that I did not see my secret crush Farzad, although several other Dr. Jayne crushes were in the house, including Evan in his polka-dot jacket.

More to come tomorrow after I get my beauty rest. These Louboutins are killing me.

From HIMSS 2/20/12

We’ll have posts tonight from me (Mr. H) and Dr. Jayne. Inga always sends hers late because she’s out socializing, so expect her recap sometime Tuesday. Our big events Tuesday are the sponsor lunch and HIStalkapalooza, so I’m sure we will have stuff to share.

We’ll be covering fewer routine vendor announcements for the next few days since we don’t really have time to chase them down. If we miss one that really is big news, let us know. Otherwise, I may do a summary this weekend after the conference is over.

Mr. H

From Jimbo: “Re: LAS taxi line. It was a 45-minute wait Monday afternoon.” It was a wait for me Sunday night as well. They have a lot of taxis, but they still can’t handle the passenger load. Not to mention that you can easily see your hotel from the airport, but you’ll spend around $20 to get there by the time the cabs add on the mandatory charge for picking you up at the airport and the $3.30 for the first 1/13th mile.

From I Know Nothing: “Re: Amagine. AMA spins it off to AT&T.” According to the draft announcement apparently set for a Tuesday release, AMA and AT&T will put the Amagine community portal on AT&T’s Healthcare Community Online, with AT&T owning the result.

From @Cascadia: “Re: HCA. Noticed that HCA is recruiting for an EHR director and it includes both Epic and Meditech.”  

From Rebecca: “Re: ICD-10. In response to your reader’s comments regarding ICD-10,  I also took away that the delay may only pertain to certain segments of the healthcare community, based on the following from HHS. The statement said that HHS would ‘initiate a process to postpone the date by which certain health care entities have to comply with [ICD-10].’ As HHS and CMS have yet to provide further clarification, I would recommend that the hospital and provider community stay the course in preparation of ICD-10.  (On a side note, shame on the government for making such a vague, open-ended and potentially financially-impactful statement without concrete direction to the healthcare community, seemingly just to kowtow to the AMA.)”

Here’s a shot I took this morning of the Venetian – Palazzo – convention center complex. HIMSS hung large banners out, but of equally massive size are those pitching David Spade and Blue Man Group.

Here’s a shot taken from the Venetian looking out to Las Vegas Boulevard. Inside, it’s a fake canal under a fake sky, women with fake breasts, and men with fake tans. Finally the exhibit hall isn’t the only place where things aren’t as they seem.

I took this picture for Inga in the Palazzo shops. I figure this guy’s a genius if he can get women to pay $1,200 for $10 worth of material turned into red-soled shoes. I admit that as a non-profit hospital guy, I felt creepy being surrounded by all this excess. We’re supposed to be following a selfless calling of taking care of patients, or at least that’s what they used to say before the government became such a big payer and made it attractive for big corporations to use healthcare as a profit center.

The exhibit hall will look perfect on Tuesday, but here’s how it looked Monday morning.

I hung out with Inga and Dr. Jayne at the opening reception. While it wasn’t anything to get excited about (bad beer choices, passable but cute Elvis impersonators, mostly a staging area to execute dinner plans) it wasn’t as bad as those in Chicago and Orlando, which were held in rooms that resembled airplane hangars without the charm. The band was better this year, which isn’t saying much given the usual bad lamestream cover bands HIMSS hires to get the straight-laced IT types gyrating slightly to the tired oldies. HIMSS ditched the drink ticket concept – it was open bar, so that’s a plus. We didn’t try any food so I can’t vouch for it, but I didn’t see or smell anything that called to me.

Remember that under this year’s odd Las Vegas HIMSS calendar, Monday this year was Sunday from years past – pre-conference workshops and the opening reception. The mainstream part of the conference starts Tuesday with the keynote speaker (Biz Stone, founder of Twitter, who doesn’t seem all that interesting on the surface.) Since Inga, Dr. Jayne, and I didn’t sign up for any of the extra-cost workshops Monday, we have nothing to report from those.

I confess that I usually get a little bit discouraged at the conferences since I’m reminded that we’re just tooling around anonymously and not accomplishing a whole lot compared to the folks actually moving and shaking. We may feel slightly good about what we do the other 51 weeks of the year, but this week, we’re bit players and sideliners. Still, we’ll do what we can.

The funniest moment: Inga and Dr. Jayne were talking about Epic’s Judy Faulkner on the way to the opening reception when Dr. Jayne ran into someone and swapped the usual apologies. Inga had to tell her it was Judy she had just collided with. What they were discussing is that Inga had seen Judy outside a session room and I said I was surprised she wasn’t surrounded by hangers-on. Last conference, Judy couldn’t hit the coffee urn or restroom without people from vendors you’ve never heard of trying to sweet-talk her into dealing with them. She was more polite than she could have been.

It looks as though the particulars about Meaningful Use Stage 2 will be released in the ONC meetings scheduled for Wednesday morning. That is damned annoying: you know they’ve been finished for some time, so holding them back just to crow about them at HIMSS is unfortunate. Why couldn’t ONC have released them last week to give people time to study the proposed rules so they could discuss them intelligently this week? ONC is going to hijack all of the topics and issues being discussed at the conference by people who have spent a lot of time and money to be here and turn it into a test of who can make an Excel worksheet the fastest. That’s a shame. It’s not like the government doesn’t already hog more than its share of the healthcare IT spotlight.

Someone brought up a very good point to me about why it’s so weird about having HIMSS in Las Vegas. In every other city, HIMSS takes the place over. You see the same comforting faces that you see every year. In Las Vegas, we’re still outnumbered by the regular tourists, many of whom are bizarre, annoying, and indifferent to the conference as is typical in Las Vegas. Part of the conference draw is that attendees get to feel very special, insular, and collegial. I’m not sure we’re getting that here. On the other hand, the skirts are shorter than you can possibly imagine.

I finally figured out what I really dislike about Las Vegas. It’s the restaurants. I keep hearing locals bragging on the great restaurants here, but they are the antithesis of great restaurants. The are upscale mall food courts owned by faceless corporations, run by faceless corporate chefs determined to orchestrate the cookie cutter experience to the maximum wallet-extracting extent possible and to kill off any independent restaurants  that might cook from the heart rather than the pocketbook. The big-name chefs set foot on the premises only long enough for a quick photo op and to load up their pockets with culinary hush money to pretend that they’re really involved and proud of the end result (surely you didn’t think Bobby Flay or Wolfgang Puck would lower themselves to actually cook in restaurants bearing their names.) The food is the kind of stuff that unsophisticated bus-tripping Midwesterners crave and brag about to those left at home – mammoth and overpriced hamburgers, expensive hunks of steak with little more creativity applied than to put them on the fire, and dumbed-down ethnic food that isn’t too challenging for the casino crowd. There is minimal farm-to-table or local cuisine because, after all, we’re smack dab in the middle of a desert where the only key food source is what comes in from more hospitable climes via the airport. If there are great Las Vegas restaurants – and I’m thinking there aren’t — I’d wager that they aren’t found in Strip hotels. Las Vegas may have slightly better chains than Cheesecake Factory and Applebee’s, but they are still soulless corporate outposts that resemble a real, creative, chef-owned restaurant only superficially.

Speaking of restaurants, HIMSS included a $10 certificate for food Tuesday, good in the exhibit hall. A nice gesture, even if $10 doesn’t get you much from union-run food service concession stands.

The Madison, WI couple competing in The Amazing Race, the female half of which works for Epic, placed first in Sunday night’s episode.

Dr. Jayne

As I was on my way to the airport to catch my flight to HIMSS, I made one last pass by the mailbox to see if there were any cool marketing materials and I’m glad I did. The first one was a kicky orange band-aid cutout (I probably should call it an adhesive bandage so the trademark police don’t come calling) from Aventura. Even better was the tagline when I flipped it over:

Needless to say, it made my day and I was grateful for a good chuckle.

I’m glad I found the other mailing from ICA because it offers a chance to win $2,000 for your local community food bank. I’ll definitely be stopping by for that contest, right after I drop off my shoes at one of the Soles4Soles collection points at ESD (booth 4616), HealthPort (252), DrFirst (5456), or Gnax Health (2875).

I spent most of the flight out planning my activities for the next few days – I’m still trying to sort out the best way to fit in all the sessions I want to catch with all the exhibitors I want to see. Plus, I need to make sure to leave some time to try to catch up with my bow tie-clad crush, Farzad Mostashari. I’m grateful for HIStalk’s Guide to HIMSS12 which gave me a starting place from which to plot my escapades.

Like many of you, my favorite part of HIMSS is networking. I’m looking forward to attending a couple of vendor events and some physician gatherings as well as catching up with old friends. I’ll be stalking the exhibit hall with a couple of my CMIO buddies and will be reporting on their reactions throughout the week. One of them is a first timer, so I can’t wait to see what he thinks.

Networking is particularly fun when you’re an anonymous semi-celebrity. I recently shared a drink with my trusty sidekick Bianca Biller and another long-time colleague who was lamenting how hard it is to keep up with all the industry gossip. The conversation turned to HIStalk, of course, and it was all I could do to not giggle. I’ll be non-competitively participating in the HIStalk Booth Crawl  so I’m sure I’ll have to suppress more than one giggle over the next few days. Good luck to all our readers competing for the chance to win one of 55 iPads. And remember – if you can’t find the answer, make up something funny to keep Mr. H entertained as he stays up ‘till the wee hours of the night handling your entries.

We’ll be on e-mail, Facebook, and Twitter this week and looking forward to hearing from our readers. Got a picture of the best giveaways, coolest booths, or craziest outfits? E-mail me.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

From HIMSS 02/19/12

Mr. H

I got into Las Vegas late, so I don’t have much to add to Inga’s writeup below, except:

• The engineer who designed the airport baggage carousels here must have hated people and/or their luggage. The conveyor shoots the bags forcefully up at an angle, ensuring that they tumble out of control as they careen over other bags and sometimes off the carousel entirely. The belt was littered with luggage parts that had been stripped off by the force.
• Thanks to the McKesson Horizon sales guy who elbowed me out of the way at the carousel, then slung his bag carelessly and darned near took my kneecap off it without so much as a “sorry.” Good luck moving Horizon, jerk.
• There’s a casino between Harrah’s and the Venetian that has $1 Michelob. It’s not my favorite beer, or at least hasn’t been until now. They have $1.99 foot-long hot dogs if you are in need of unmentionable animal parts formed into torpedoes of nutritional death.
• Las Vegas is my least favorite city in the world, full of loud drunks, long hotel check-in lines, and sensory overload. It’s like Orlando except with obnoxious adults instead of obnoxious kids.
• It’s 1:30 in the morning as I write this (4:30 for bodies on Eastern time) and the band is still playing loud outside in somewhat cool weather. I think I actually like that.

Inga

Welcome to Las Vegas and HIMSS12. Today is Sunday and exhibitors are moving in, but the masses have yet to descend on sin city. However, I arrived Saturday afternoon, just in time to attend World Wide Technology’s big bash.

I don’t know the official attendance for the party, but I understand the WWT folks were expecting 600. Based on the line to get into the party, I would guess they had far more than that. WWT provides system integration services primary to the federal government, but also has a rapidly expanding commercial health segment. As soon as I entered the main party area, I observed WWT’s prominently displayed displayed banner promoting their support of HIStalk – very cool, indeed. Thank you to WWT’s Mike Francis, who I happened to meet at the bar, for giving me a thorough overview of the company.  The crowd seemed to be having a great time eating great sushi and of course, drinking plenty of adult beverages. I was exhausted and didn’t stay too long, but I am sure the party went on into the wee hours.

I’ve never had the chance to see any big trade show behind the scenes during setup, so when a friend offered a loaner badge, I jumped at the chance. Basically the exhibit floor was chaos, with fork lifts, crates, boxes, and workers scrambling to construct massive booths. Knowing that by Tuesday afternoon the floor will be pristine makes the setup all the more an amazing sight to see.

I found the giant shoes at the Cosmopolitan. OMG this one was beautiful and I need one as yard art.

I also happened on First, the site of Tuesday night’s HIStalkapalooza. Giddy thinking of how much fun that evening will be.

Vegas offers a great opportunity to see all sorts of, um, fashion. Though I have seen lots of hot outfits, I’ve observed plenty that have left me asking, “what were they thinking?” I assume this laptop-toting gentleman in the Apixio shirt was a HIMSS attendee. I thought it was highly unfortunate that he failed to remove the jean size sticker off his right leg.

Gorgeous weather today, if not a little bit cool and windy. More meaty updates tomorrow.

E-mail Inga.

Monday Morning Update 2/20/12

From Deborah Kohn: “Re: ICD-10. I’m one of those scheduled to speak on ICD-10 at HIMSS! However, my topic is more about understanding the plethora of HIT tools that can used not only for the next round of compliance dates, but even if ICD-10 gets bumped off the US landscape. So I don’t bore the audience with OS upgrade analogies, I was going to promenade in and flaunt my cute shoes. Now I have to think about how to inspire a session room of one or two souls since Mr. HIStalk predicts it will be seriously empty.” I’ll try to help out by pitching the cute shoes, which always gets the attention of a loyal core of readers.

Listening: new from Heartless Bastards, female-led bluesy roots rock from Austin, TX that can sound like everything from The Pretenders to a restrained, better voiced, and sultrier Janis Joplin. It’s basically all about Erika Wennestrom, who sings, plays, and writes with aplomb. I mentioned them in August, but I feel justified in doing it again since I’ll predict that the new album will make them stars. They actually play real music. I’m with Dave Grohl – learn to play an instrument, sing from the heart, and forget the computers.

Inga, Dr. Jayne, and I will be posting daily from HIMSS, so this is my attempt to clear out my inbox before then. Expect lengthy posts, lots of pictures, and quite a few reader comments for most of next week as we try to grasp and convey the enormity that is the HIMSS conference. If you want to help, we can use more eyes and ears since we can’t be everywhere at once.

My timely Time Capsule editorial this week from five years ago: Despite Your Resolutions, I Know What You’ll Be Doing at HIMSS. Example: “Thrust your chest out proudly, knowing that booth people will pretend to be impressed with your title, your employer, and your town, even though they are silently sniggering at all three and looking over your shoulder for a better prospect or an incognito competitor who might hire them.”

We rolled over the 5 millionth HIStalk visitor Friday morning at 6:54 a.m. Eastern time, which Inga and I both happened to see live by pure coincidence. A reader on an iPad from Boise, ID put us over the hump. There were almost 100 readers on at that odd time of day, from places like New York City; Atlanta; Washington DC; England; Ottawa; Pittsburgh; Madison; and Kirchheim, Germany. Thanks for contributing to that number, which I still can’t quite comprehend given that my view HIStalk is just an ever-hungry blank screen in my computer / exercise room.

GE recognizes the inconvenience to these small practices that relied upon Advance, which is why GE guarantees a competitive price of $650 per provider per month for the first two years of the agreement. True, after that period, pricing is set at the discretion of the VARs but we’ve spoken with them all and have consensus that MJOG’s cited $1500 is remarkably high and well above what the going rate would settle at.

Former US CTO Aneesh Chopra rejoins his previous employer, The Advisory Board Company, as senior advisor for healthcare technology strategy. He will consult with member hospitals and contribute to the company’s strategic initiatives.

HCA will expand its use of technology from AirStrip and has taken a financial position in the company. Most HCA hospitals have been using AirStrip OB since 2007 and the hospital company will broaden its rollout of AirStrip CARDIOLOGY.

1. Automatically set up a Conference Personalizer membership-type site for every registered attendee, where you can log on with your conference confirmation number.
2. Allow vendors to target their announcements and invitations to be sent to the individual member’s site. Like e-mail, the attendee can simply delete them to make them go away.
3. Provide the capability for events to be accepted and turned into a printable / downloadable conference calendar, also RSVP’ing automatically to the sponsor of the events.
4. Allow attendees to connect with each other to whatever degree they choose in a LinkedIn-type closed message model.

Sponsor Updates

• First Databank will announce Monday the release a new alert management solution, FDB AlertSpace, that addresses alert fatigue. It allows users to customize CPOE alerts, the great majority of which are overridden during order entry, and to share common alert settings with other facilities. They will be demonstrating it at the HIMSS conference.
• Healthcare Clinical Informatics is offering a free Webinar, Making Molehills out of Mountains: EMR Optimization and Clinical Adoption, on Wednesday, March 7.

Las Vegas weather: very pleasant and sunny all week after a slightly cooler Sunday and Monday, with highs in the 60s to low 70s, lows in the mid 40s. If you are headed out, safe travels. If not, we’ll tell you what’s happening there.

E-mail Mr. H.

Time Capsule: Despite Your Resolutions, I Know What You’ll Be Doing at HIMSS

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 February 2007.

Despite Your Resolutions, I Know What You’ll Be Doing at HIMSS
By Mr. HIStalk

Punxsutawney Phil aside, you know spring is at hand when it’s time for HIMSS (already?) For those of us who go, it seems like the entire healthcare IT industry is there, most of them angrily checking their watches in the Starbuck’s line or barking self-important cell phone commands to their holding-down-the-fort underlings back home.

If you’re not going, don’t feel bad. It’s a great time to get work done without being interrupted, much like the dead week between Christmas and New Year’s. Or, if your boss will be there and you’re so inclined, to screw off with little fear of detection.

Everyone heads for HIMSS with a firm agenda, pledging this year to get serious work done instead of wasting time like at the previous ten conferences. Demos will be dutifully studied, job-related networking will be pursued, and vendor relationships will be cultivated for the benefit of the employer picking up the tab. You’re here to work. Or, so the rationalizing goes.

All those worthy goals evaporate once the first heady breath of conference air is inhaled deeply, that energizing tang of carpet cleaner, coffee, collateral, and cologne that puts you in conference mode. Like a recovering alcoholic vowing to take just one sip of beer, you’re off the wagon. Before you know it, your agenda looks more like this:

• Plan shopping, golf, or spa time from the tourist literature left in your hotel room.
• Find someone before or during the opening reception who might give you a drink ticket they don’t need.
• Walk the halls trolling for people you know, encouraging a hearty greeting and keen interest about what you’ve been up to, then silently cursing the arrogant jerks when they pass by with a vacant stare.
• Look soulfully into the eyes of vendor booth people and speak profoundly and positively about whatever they’re selling, hoping they’ll dig deep under the counter to furtively slip you an invitation to a really cool party that’s not open to the masses.
• Expect profuse chumminess from booth people who pretend to remember you and harbor no ill will from that time you cut their product from the shortlist.
• Decide just how much honesty everyone else applies when completing their CE forms, figuring that walking outside an auditorium door and catching a couple of words should be worth the full CE credit.
• Blame the speaker’s boring delivery when you decide to bag their talk 15 minutes in, climbing fearlessly over the entire row of knees, in front of the projector, and against the tide of incomers and door-standers, figuring no one knows you anyway.
• Check the agenda and decide to sleep in, leave the afternoon sessions early, and maybe sit out in the sun at lunch.
• Thrust your chest out proudly, knowing that booth people will pretend to be impressed with your title, your employer, and your town, even though they are silently sniggering at all three and looking over your shoulder for a better prospect or an incognito competitor who might hire them.
• Cruise the perimeter of the larger booths, trying to catch the eye of someone who looks like a doctor, executive, or hot rep, steering a wide berth around low-ranking losers who earned a HIMSS trip for some geeky company accomplishment like programming.
• Gather lots of vendor material for take-home study, then chuck it all in your room’s trash can before you leave for the airport.
• Having already planned to skip the Thursday sessions since everyone else does, call the airline on Wednesday afternoon to see if you can get out earlier.
• Wear your Mardi Gras beads home, bring your kids crappy booth junk, and impress the spouse with fake doubloons and a box of Café Du Monde beignet mix purchased at the airport.

Have a safe trip to New Orleans.

Dr. Sam 2/17/12

Confusion and Clarifications on Practicing Medicine in "Real Time"

It has often been said, and oft written ( by people like me) that we have entered the age of the practice of medicine in "real time." In fact, I think I may have coined the term "Real Time Medicine" about 10 years ago. At least I registered a domain name using the term about six or seven years ago, which must mean something.

The term seemed to me at the time to mean some super form of "now." Not the "now" of today, or this morning, or in the next ten minutes, but rather the instant of simultaneity – when data appeared at its point of generation  and simultaneously arrived at whatever device I use to receive it.

Being inherently paranoid with respect to all matters even remotely in the domain of influence of anyone who belongs to a state or national bar association (and having experienced more than one brush with the legal system,) I immediately began to ponder the medical legal consequences of medical decision-making in the super-now. Just how quickly was I supposed to advise Mrs. Epstein that she should alter her insulin dose when I just saw that she had a markedly elevated fasting blood glucose level?

A reasonable response would seem to include such factors as the likelihood of anything happening to Mrs. Epstein between the time I learned of her hyperglycemia and when I was able to call her, the severity of importance of my current activities (such as being in
the middle of conducting a cardiac resuscitation,) and my ability to actually reach her.

A malpractice attorney however, may be more likely to view the parameters of reasonability around a perceived degree of danger to Mrs. Epstein with each passing moment, my clear irresponsibility in delaying contacting her for any reason (certainly I could have yelled out for someone to have my office call Mrs. Epstein  as I was injecting intracardiac epinephrine,) and the potential impact of my irresponsibility on the attorney’s ability to pay off the condo in Park City.*

Ergo: Einstein was right. Time is relative. QED.

"How relative?" you may ask.

This is another subject that keeps me up at night.

Since I may have coined a term involving, by implication, the super-now, I should at least know what "now" is. Considering that today’s speediest transistors can switch faster than one thousandth of a billionth of a second, that the second has been physically divided by laser strobe technology into increments of 250 billionths of a billionth of a second, and that one meter is now measured as the distance light travels in a vacuum in  1/299,792,458th of a second, I have no idea at all of what "now" actually means. Whatever "now" is,  it’s already gone.

If we ever have peco-lawyers, we are all in a lot of trouble.

If I am ever sued on an issue of how long I took to respond to a digital message, my plan is to call in a theoretical physicist, like Paul Davies from Arizona State University, or philosopher Craig Callender from the University of California-San Diego, and others who are capable of articulating a very strong argument that time does not exist at all – an argument which is particularly appealing since it would mean that a lot of lawyers would owe a lot of people a lot of money in refunds.

To add to my personal confusion on these matters, we are getting our information in something called cyberspace. This is apparently someplace in which we all spend time without ever actually being in it. I think it’s someplace where time has no past or future. This may explain why many teenagers emerge from it effectively brain dead.

I can’t  help but wonder what the eminent diagnosticians of the past would think of the practice of medicine in cyberspace. I remember studying the writings of Sir Zachary Cope who, it seemed to me, would have been able to determine more about an acute abdomen from across the room than I could at the bedside. I remember actually tapping on someone’s chest to try to gauge the level of any fluid that might be present in the chest cavity. Today, I would remotely place an electronic order for a chest X-ray and receive an answer from New Delhi. So much for the laying on of hands.

I have been giving myself credit for coming up with the term "Real Time Medicine" for close to a decade, but honesty dictates that I cannot claim in good conscious to understand what I meant – or even claim to understand what I though I was describing. Even if someone else came up with the term at the same instant I did, it would apparently  depend upon how far apart we were physically at the time and the speed at which we were each moving relative to each other to know who had the original thought. If anyone reading this thinks they came up with the concept before me, please contact me and we’ll go to an astrophysicist together to get it worked out.

* (Possible moment of cynicism suggesting a need to apologize – but my heart would just not be in it)

Samuel R. Bierstock, MD, BSEE is the founder and president of Champions in Healthcare, LLC, a strategic consulting firm specializing in clinical information system implementation and healthcare IT business strategies.

HIStalk Interviews William Seay, CEO, Lifepoint Informatics

William Seay is founder and CEO of Lifepoint Informatics of Glen Rock, NJ.

Give me some background about yourself and about the company.

I started in the lab business in 1988 working for Clinical Diagnostic Services, which is a laboratory in the New York City area. First I was involved in operations. It was a small lab at the time, so I’ve done accessioning, order entry, driven courier cars, and prepared for CAP inspections. I’m not a med tech, but I’ve done nearly everything in the lab short of performing a lab test.

In the early ‘90s, I transitioned into sales. I’ve sold in Manhattan on the Upper East Side and the area of New York Hospital, where I was competing against NHL, Roche, Smith Kline, and Corning at the time in a highly competitive market. By the mid ‘90s, we had seen at CDS labs the success of C.C. Link from Quest and we saw that they were developing a Web product. 

The laboratory decided to undertake a pilot program. We started Labtest.com — which is a DBA now of Lifepoint Informatics — with the intent of building a portal for order entry and result reporting that would compete against the large national labs in the New York City marketplace.

Back then, those big labs started dropping printers and fax machines into physician offices right in the back yards of hospitals where those physicians practiced. Was it as dramatic as it seemed when people started realizing that these large, focused companies were willing to invest in technology to go after reference lab business?

Yes, it was dramatic. At one point before we started LabTest the company,  we were trying to productize and commercialize tele-printers. Those were very popular at the time. The fax machine era was pretty short-lived because of the Stark rules –the fax machine is a dual-purpose device. But at the time, the nationals were very strategic in their use of technology to retain clients and to gain new business, so it was dramatic.

Our product was crafted after a product called LabConnect from an LIS vendor that CBS was dealing with, which was in turn crafted after C.C. Link. We had the workflow down and we knew what doctors wanted from the ground up at Labtest.com / Lifepoint. We had our functionality and features and functions mapped out because we saw what was successful with the thick client systems.

What are the downsides of just letting the corporate reference labs plug in their technology?

I think the downside for the smaller regional labs is that it’s expensive to compete. I think technology certainly does solidify and in some ways lock in the business. In some areas, especially in Manhattan — and I have seen this in other metro areas — the physicians don’t want another piece of equipment. If they have one or two tele-printers, it’s tough to put in a third.

When you look around at your competition now, is it still primarily the internally developed systems from the national reference labs?

We’re seeing some of that. I think the trend going forward is for those homegrown systems to wane over the next five or six years. We see that as a business opportunity.

Obviously we have other connectivity vendors that we compete with that have very similar business models to ours, but the fact of that matter is Quest really drives the demand nationally for products like ours, because what our customers are looking for is a way to compete and level the playing field, particularly with Quest these days.

What challenges are hospitals facing with connectivity and outreach programs?

They move a little slower because of their non-profit status and mission. They have a longer sales cycle. I think they don’t have the profit-driven mindset and the aggressive commercial nature that the commercial labs have. It’s always amazing to hear stories about how a hospital lab has said, “Dr. Smith has been waiting for an EMR interface for nine months.” If you heard something that at a commercial lab, that would never fly.

I see EMR companies and other people in the health IT field underestimating the complexity of lab order entry, asking order entry questions, the ABN printing, and the medical necessity checking. At Lifepoint, we have solutions that can plug in and connectors that can easily adapt to multiple EMRs, either from a single sign-on or through web services.

Hospitals want to get into the reference lab business, but it’s driven by by scale. The more business you have, the more you can automate, so that the national labs supposedly have their tests down to a cost of pennies or less per test. Can hospitals compete with that volume and the polished corporate performance?

One of the reasons that the outreach lab market has been so successful is that they’re not only are they in it to increase their revenues, but they have untapped capacity. Normally they’re testing during the day. With the average business, they’re turning around specimens in the evening. In that respect, they’re filling up their capacity and utilizing their instruments at a higher rate.

Is there a patient benefit either way?

I think there is a clear benefit for doctors and patients if you think about a patient-centric view of laboratory testing. A hospital outreach lab will have the inpatient work as well as the outpatient work together in our Web portal product. That’s something that’s really tough if not impossible for the larger national labs to replicate or compete with. For patient care, I think it’s a benefit.

Do community-based physicians want a portal or do they want results sent directly into their EMR of choice?

I think they want a balanced approach and they want multiple delivery options. Auto-printing, which is the replacement for tele-printing, is where there’s a workstation that has a small footprint piece of software that drives a network printer. That’s very popular. The portal is still popular and so is the EMR interface. I’d say it’s all three, typically, when you ask a doctor, “Would you like auto-printing or EMR or the portal?” They come back and they say, “Well, fine — I’ll take all of them.”

I think the portal will continue to be necessary going forward because it gives the labs a way to control their brand and their functionality, which they lose out on if the results are streamed into an EMR.

Do to have to deal technologically with the issue of physicians not receiving or not reacting to critical lab results?

From early on, we had pretty robust auditing capabilities, particularly because of HIPAA, On a patient level and on the accession level, we can drill down at when the result was viewed, by whom, and if it was printed. Down to that level. I think that helps mitigate some of the risks that the labs may be up against.

How does your product play with the emphasis on health information exchange?

We like to think that our InfoHub product, which to use Medicity’s old words, is similar to a data stage. We can help the labs and the hospitals connect up to the HIE or out to a RHIO if they need that assistance. Our portal itself is very much like a local HIE or a private local HIE. It’s being used that way by few of our clients. We see ourselves as complimentary to the larger HIEs nationwide.

When you look at what information providers want to exchange, how much of that is laboratory based?

There’s the 70-70-70 rule that says 70% of the patient’s chart is made of laboratory data, 70% of treatment decisions are based on lab, and 70% of diagnoses are based on lab. Yet it represents only a little under 3% of total healthcare spending nationwide. It’s quite a value. 

It’s growing it quite a clip, too. The laboratory market today is $62 billion. It’s expected to grow to $100 billion by 2018 at a 6.5% growth rate.

Hospitals are focused on reducing duplicate radiology procedures. What’s the level of interest in reducing duplicate lab tests, or is that a problem given that lab tests are relatively cheap and often repeated anyway?

One of the goals of healthcare reform in general is to eliminate some of the duplicate testing. When our portal is used and there’s a local HIE, we can accomplish that. It’s good that you bring up radiology, because our portal and our EMR interfacing capability can support other ancillaries besides lab, such as radiology, transcription, discharge summaries, and anatomic pathology.

With the emphasis on accountable care where you may have to eat the cost of extra tests, is there interest in a practice knowing that the hospital already did the test or vice versa?

Yes. Years ago, we learned that we shouldn’t lead with that feature — that our portal and our capabilities can help reduce redundant testing. The labs had their own reasons for wanting to do that years ago. I think primarily around liability.

Now I think the momentum is towards reducing duplicate tasks. I’m pretty sure everybody’s on board. I think the financial people at the hospitals have put this into their five-year plan — that they may lose out on some of the revenue that would have been generated by these duplicate tasks.

What trends do you see related to lab tests and lab results in the direction that healthcare is going?

I think it’s going to be tremendously important. In the past, lab was primarily a tool to diagnose. Now it is central to not only diagnose, but to monitor and to screen. This monitoring and screening is preventive healthcare and it’s where the industry is going.

We talked about 70% of the patient chart being made up of laboratory data. That’s going to be the data that’s looked at when we’re looking to manage chronic conditions and when we’re looking at population-based preventative care. We are largely going to be looking at lab data. I think it’s going to continue to play an important role going forward.

Any concluding thoughts?

I think there are some people in health IT that have a misunderstanding of how dominant Quest and LabCorp are. In fact, together they represent less than 9% of the laboratory test market by test volume. They only comprise 26% of the independent laboratory market volume.

What we’re passionate about here at Lifepoint is enabling hospital-based outreach labs and smaller commercial regional labs to level the playing field and compete against the larger national labs with IT and connectivity solutions.

News 2/17/12

Top News

HHS announces that the October 1, 2013 compliance date for provider use of ICD-10 diagnosis codes will be pushed back to an unspecified date.

Reader Comments

From Imelda: “Re: Soles4Souls. Your shoe drive inspired me to clean out my closet. I promise to bring at least three pairs to donate. Where do I need to take them?” Awesome! You can bring your donation of any style of gently used shoes to the exhibit floor and drop them off at ESD (booth 4616), HealthPort (252), DrFirst (5456), or Gnax Health (2875). We’ll also have a drop-off box at HIStalkapalooza for those who received an invitation for it.

From Fred Gailey: “Re: your interview. I enjoyed the interview with you in the Dodge Communications blog. You were so articulate. You and the HIStalk gang are the most famous anonymous people I know.” Thanks. I like that Fred feels he knows me.

From Tom: “Re: ICD-10 delay. I thought you might get a chuckle from this web page announcing the delay today.” Bowing to AMA pressure and exhibiting typical federal government indecisiveness (and possibly keeping a close eye on the re-electability of HHS Secretary Kathleen Sebelius’s boss in the White House) HHS decides yet again to delay ICD-10 like it did HIPAA and just about every other piece of legislation that big-donor provider groups might squawk about, using patients as their human shield of excuses. It wasn’t even due to kick in until almost 20 months from now, meaning it will probably be ICD-12 or 13 if and when the feds ever pull the trigger. We don’t want to rush into ICD-10, though – it’s only been out for 20 years. ICD-10 is cumbersome, but it won’t get less so with a delay, so if it sucks, let’s just say we’re never going to do it and move on to something else. As is often the case with federal programs these days, the responsible people (those who prepared for the change instead of ignoring it) get the shaft.

From RJ: “Re: ICD-10 delay. It should be noted that HHS posted an announcement last evening with an emphasis on its commitment to the rulemaking process. They reissued the release this morning, but removed all references to the rulemaking process. Here are the versions.” I put the two versions sent over by RJ into Word and kicked out the changes. HHS removed everything referencing rulemaking and took Sebelius’s name out of the headline. Interesting.

From Bob: “Re: Booth Crawl. I can’t make it to HIMSS this year. Can I participate virtually by reviewing the vendor web sites and submitting an entry form online?” Inga and I didn’t write many rules since we made the whole thing up in about 15 minutes, so checking the rather slim rulebook finds no requirement that you actually visit the booths – you only have to answer the questions. I would be surprised if the participating companies chose questions with answers that can be easily found online, but I also admit that I haven’t actually looked. Since you do not need to be present to win, we would have no way to check anyway, so good luck!

From Dave: “Re: shoes. Saw these, thought of Inga.” Now you’ve got Shirley Temple’s At the Codfish Ball stuck in my head: “Come along and follow me, to the bottom of the sea …”

From Mark: “Re: NIST. Isn’t this a few years late?” The National Institute of Standards and Technology asks EHR vendors to provide their products to help it develop usability standards, a process it estimates will take a year to complete. Vendors can sign up through March 15. My first thought was that it would not be in a vendor’s best interest to participate, but I reconsidered … it’s probably not a bad idea to connect with the NIST folks (and ONC indirectly) and make sure they understand your particular point of view.

From Curmudgeon: “Re: ICD-10 spleen-venting. What timing. Clarification best come before the flock gathers in Las Vegas or confusion will reign. The review process better not be a Meaningful Use-esque five-act drama. CIOs know this will happen and progress must continue, but now there’s a reason for organization management to pull the old ‘well wait and see’ attitude, shorting funding, staff and time. Dr. Madara’s ‘find another method!’ has to be the mindblower of the century. I hear he wants to appear at HIMSS, but is uncertain if his horse and buggy will be there in time. There are quality reasons, information reasons and better care reasons to do ICD-10. The excuse that the rest of the world doing it is shouldn’t be the reason for the US to do it. The reason should be that the rest of the world found it smart to do it! Unless we know something they don’t. Safe travel to all going to the Strip and thanks to all who stay behind keeping the home chips and bytes burning.”

From History Buffy: “Re: previous HIMSS conferences. I ran across this 2007 document by the HIMSS Legacy Workgroup (never heard of them) that attempted to document the history of HIMSS. It has the location, number of attendees, exhibitors, etc. for all the conferences.” Pretty cool. The first conference was in 1962 in Baltimore, when the precursor of HIMSS (Hospital Management Systems Society) had all of 53 members. Conference attendance didn’t crack 10,000 until San Antonio in 1995, when HIMSS had 5,534 members.

HIStalk Announcements and Requests

Got HIStalk Practice? If not, here is what you missed over the last week: HIT adoption by US physicians is higher than in other advanced nations. CMS launches a Web page dedicated to clinical quality measures. HHS introduces a $9.1 million loan repayment program to encourage medical students to practice primary care in underserved areas. AAFP’s TransforMED publishes a toolkit for PCMH implementations. Culbert Healthcare’s Brad Boyd offers advice for extending IT to community practices. Readership on HIStalk Practice continues to climb – thank you, readers. For you non-readers, that means your colleagues and competitors are staying one step ahead of you, so you had best get on the HIStalk Practice bandwagon.

The fun folks at World Wide Technology are hosting a party in Las Vegas Saturday night and that’s where you’ll find me. They are so proud of their HIStalk sponsorship that they created a special banner to display at the event. How cool is that? Party pics to follow.

Charles Babbage posted a comment this week regarding my Dodge Communications interview, which included my confession that I was often star-struck by big-name CIOs and vendor CEOs. From Charles’ original comment:

This Inga quote illustrates how we have moved the focus of HIT from benefiting patients to selling products and glorifying salesmen and their leaders. The people Inga calls the ‘Rock Stars’ of HIT should be the CMIOs and clinicians who make the systems work to help patients and improve healthcare.

Charles added that he adores me, so my delicate ego was not too terribly crushed. In a follow-up e-mail exchange, Charles added:

Thanks also for understanding that the comment is NOT directed at you, but at the unfortunate values that HIMSS perpetuates by idolizing people who sell software that has balkanized health IT services, requires four or more years to implement, achieves usability standards of the early-to-mid 1990s, connects only to itself, and too often obscures information rather than presenting it in ways that help clinicians. And it does not help either clinicians or patient safety that the software too often takes 15 clicks to find information that should be contiguous on the same screen. Now, that does not make the vendors evil, and most do want to help healthcare if they can make money by selling their goods — and there ain’t nothing wrong with that. BTW, after today’s post, I got a slew of invites to meetings, breakfasts, etc. for only $89 each.

The DrFirst folks are offering another way for HIStalk readers to win an iPad. Stop by their booth (#5456) on Tuesday, mention their HIStalk contest, and get your picture taken with their HIT super hero Doctor Defender while doing something funny, creative, or otherwise noteworthy. The winning picture will be displayed and announced at HIStalkapalooza Tuesday night.

Welcome to new HIStalk Platinum Sponsor Healthcare Clinical Informatics (HCI.) The Jacksonville, FL company provides EMR implementation talent, helping healthcare organizations with all phases of the implementation lifecycle, making sure that workflow is integrated and ROI is delivered. The company is growing like gangbusters, having hired 70 employees in 2011 and on track to bring on another 150 this year. HCI also supports the growing UK healthcare IT market from its offices in South Wales, partnering with a number of NHS Trusts. Its clients include Adventist Health System, Parkland, and Tenet. They can help whether you need consulting help or permanent placements. I always like to check out the executive roster and I found a couple of highly experienced folks I know: CIO Sean O’Rourke (he used to be CIO at UPMC) and VP of Optimization and Clinical Adoption Marcy Stoots (she ran Baycare’s implementation.) The HCI folks are excited about being connected with HIStalk and I appreciate their support. Thanks to Healthcare Clinical Informatics.

Acquisitions, Funding, Business, and Stock

HIMSS buys the mHealth Summit conference and exhibition after helping produce it this past December. The conference was formerly run by the Foundation for the National Institutes of Health. HIMSS also hires the conference director, Richard Scarfo, as a VP of vendor events. This year’s event will be held December 3-5 in Washington DC.

athenahealth announces Q4 numbers: revenue up 33%, EPS $0.15 vs. $0.21. Excluding special items, the company’s earnings of $0.26 exceed analysts’ expectations of $0.24, sending shares up 3% early in after-hours trading Thursday.

Merge Healthcare announces Q4 numbers: revenue up 39%, adjusted EPS of $0.19 vs. $0.10, beating estimates of $0.13. Revenue fell short of expectations.

Allscripts announces Q4 numbers: revenue up 15%, adjusted EPS $0.25 vs. –$0.03, meeting estimates. Shares are down 6% in early Thursday after-hours trading as its full-year profit forecast fell short of expectations. The company also announces an expansion of its operations in India, with more than 300 positions to be filled there by the end of the year.

Sales

Family HealthCare Center (ND) contracts with Intelligent InSites to provide RTLS solutions for tracking, managing, and displaying the real-time location and status of patients, staff, and equipment.

PeaceHealth’s Sacred Heart Medical Center at Riverbend (OR) expands its utilization of the Versus Technology RTLS platform.

Health Management Associates signs an exclusive three-year technology agreement for McKesson’s pharmacy automation suite.

People

Medical scribe services vendor ProScribe hires Suzy Wier Thorby as SVP of corporate development. The former ED nurse co-founded T-System along with two physicians in 1996.

First Choice Professionals names Carol Selvey as VP of strategy and business development. She was previously with Iatric Systems.

Announcements and Implementations

Johns Hopkins Health System becomes the 100th organization to integrate Hyland Software’s OnBase ECM with Epic’s EMR. On an unrelated note, I wonder if OnBase is sticking with their sports bar-themed booth again this year or going for something new?

GetWellNetwork announces the availability of its interactive patient care solution for the iPad.

Aventura introduces the ability to auto-populate patient records on the screen as providers move from room to room.

Awarepoint’s RTLS solution is rolled out by The Royal Wolverhampton Hospitals NHS Trust in the UK in what the company says is the largest implementation of its kind in the world.

The Premier healthcare alliance will use data mapping from Clinical Architecture to standardize and normalize performance measurement across its 2,500 hospitals.

Government and Politics

CDC announces a new national system for tracking the use of antibiotics in hospitals, allowing hospitals to compare themselves with others. CDC says there’s not much work for hospitals as long as their pharmacy system supports the AU (Antimicrobial Use) Initiative. I finally tracked down a list of that software here and the only major inpatient pharmacy system on it is Epic’s.

Technology

A group convened by the West Wireless Health Institute to advocate cheaper, better wireless network infrastructure in hospitals completes its first milestone in creating a medical-grade wireless open framework. The architecture, which the group says can be incorporated in the same manner as electricity and plumbing, has been rolled out in several hospitals, including El Camino Hospital (CA) and Children’s Hospital Los Angeles (CA).

Former Sun Microsystems CEO Jonathan Schwartz, annoyed after his surgery to find that providers expected him to carry his own diagnostic images on CD, launches CareZone, a private space for families to store reference and contact information and to communicate via a Facebook-type application. The first year is free for signups before March 17, then it’s $180 per year.

Other

If you are traveling to HIMSS this week, you will likely rely heavily on your smart phone to stay connected, either to family and co-workers back home or perhaps to schedule an important post-exhibitor floor “meeting” at one of the many Venetian bars. As you keep a firm hand on your phone, it could be a good time to ask yourself if you suffer from nomophobia, the fear of being out of mobile phone contact. This study suggests that two-thirds of adults suffer from the condition, and though it is generally worse for women and younger adults, one-third of all adults over the age of 55 are also afflicted.

Epic employee Rachel Brown and her husband Dave are competing this week in The Amazing Race TV show. He’s a military science instructor recently back from deployment in Iraq, where he was an intelligence officer and a Black Hawk helicopter pilot.

Queen of the Valley Medical Center (CA) is the latest of several hospitals forced to admit that its patient records were freely available to any search engine-savvy Internet user due to incorrect server security settings.

There’s a rumor that Meaningful Use Stage 2 requirements may be issued Friday, just in time for high-fiving and hastily convened strategy discussions at HIMSS.

And speaking of HIMSS, imagine the disappointment of all those companies who built much of their exhibit hall presence around pitching ICD-10 services and products, only to have HHS rain on their parade by putting ICD-10 in limbo. Or maybe worst of all is if you’re scheduled to speak on ICD-10 at HIMSS, with the usual urgency of how providers need to take it seriously and move quickly starting yesterday to comply with the 2013 date (like that $89 breakfast I was fussing about.) Those session rooms are going to be seriously empty.

Weird News Andy opines that “ya gets what ya pays for” in this Las Vegas story. We’ve mentioned before the Heart Attack Grill in Las Vegas, whose motto is “Taste Worth Dying For” as nurse-uniformed waitresses (above) serve mammoth burgers with calorie counts up to 8,000 (free if you weigh over 350 pounds, and every customer must wear a hospital gown). A patron has a heart attack while eating a modest 6,000 calorie version, wheeled out sweating and shaking by ambulance workers as giggling tourists snap photos. The restaurant’s  menu is a hoot, offering lard-cooked fries, no-filter cigarettes, pure cream milkshakes with optional vodka, and for those who “like it in the can,” 24-ounce cans of PBR and Miller. Book your HIMSS executive dinners now since after this news (I immediately suspected publicity stunt, but the hospital verified) the place is probably packed.

Sponsor Updates

• Health Language announces a proof of concept collaboration project with Clinithink Ltd, a NLP specialist organization.
• Tanner Health System (GA), South County Hospital Healthcare System (RI), and Cottage Health System (CA) select Greenway’s PrimeSUITE EHR.
• Ministry Health Care (MN) teams with Thomas Reuters to develop a Meaningful Use quality manager solution.
• Ingenious Med introduces Imagine, a custom business intelligence and data analysis solution.
• ICA launches ICAetc, a free and open forum for software vendors to test the interoperability of their programs.
• ICA augments its ICA CareAlign solution with Emdeon Clinician for lab order and results distribution and electronic prescribing.
• MEDSEEK says that more than 100 hospitals selected its strategic patient engagement software suite in 2011.
• Wolters Kluwer Health introduces Facts & Comparisons eAnswers Mobile, allowing smart phone users find answers to drug information questions.
• DuPage Medical Group (IL) adds Merge Healthcare’s iConnect Access and Merge Eye Care suite to create an enterprise-wide imaging platform for its 330 physicians.
• Humana signs an agreement with NextGen to participate in its Medical Home EHR Rewards Program, which provides financial assistance to physicians purchasing EMRs.
• Ridgeview Medical Center selects Allscripts EHR/PM and the Allscripts Community Record powered by dbMotion.
• Vocera Communications introduces Vocera Connect for Cisco wireless IP phones and smart phones.
• T-System announces its plans for the HIMSS conference, including its participation in the HIStalk Booth Crawl.

EPtalk by Dr. Jayne

Mr. H mentioned last week that he doesn’t pay much attention to pre-HIMSS marketing mailings. I, on the other hand, am a sucker for advertising. Those of you not registered for HIMSS may or may not be receiving some of these – apparently advertisers are using both this year’s mailing list as well as last year’s.

Having changed both mailing and e-mail addresses during the last 12 months, I’m receiving all sorts of marketing materials in all four locations. The funny thing, though, is there’s no overlap. I’m not receiving the same e-mails at both addresses or the same snail mail either. I don’t know if HIMSS makes exhibitors pay for attendee mailing lists, but I’m guessing that either some are too cheap to get the updated list or too slacker-ish to update their mailing software.

For those of you not attending, I hope this brings a little bit of HIMSS to your doorstep so you don’t feel quite so left out. As you can guess, most of the next week’s posts will be about the big show. With that in mind, I bring you Dr. Jayne’s Marketing Hall of Fame / Hall of Shame. I’ll tell you what ads (of the literally eight-inch tall stack) caught my eye and which burned my retinas.

I liked Allied Telesis and their “Untold Stories of the EMR” headline with its steely-eyed surgeon and episode titles like “The Constipated Network,” “My Network is on Life Support,” and “Blame it on the Machine.” I’d give you a link to their site, but – oh yeah – they didn’t include a web address on the postcard. Seems like a pretty big oversight for a technology player advocating virtualized data storage in the cloud. And no, I’m not going to Google it for you.

Jeers to HealthPort and their bizarre comic book hero, AudaPro. With his bald pate and little glasses, he reminds me a bit of Benjamin Franklin on the cover picture. The internal picture, however, can only be described as highly creepy. What’s with the yellow trunks? Although someone certainly thinks a limited edition HealthPort comic book will entice visitors to the booth, I’d have gone with the IngaTinis.

Wolters Kluwer Health is apparently giving away a Rolex. Caught my eye, but I’d be more excited if they were giving away a pair of size 8 ½ Manolos. I doubt it’s this cool girly one I found on the website anyway. Probably some gigantic man-watch.

InteliChart sent a poker chip that can be exchanged for a Venetian casino chip (potentially worth up to $1,000,) so I might have to check that out.

Catching my eye (but in a bad way) was Healthcare Informatics Associates, who mailed a stiff plastic marketing piece that can’t be recycled. Good try with the playing card and poker chip theme, but your colors (white with light yellow outline on baby blue) made the text hard to read. I’m totally puzzled by the instruction to “peel away outer area” as I’m not sure why I’d want to turn an annoying plastic rectangle into an annoying jaggedly shaped piece of plastic.

Winning the “what am I thinking” category is Capsule with the vaguest wording ever: “See how our workflow focused solution features a patient-centered design that works with existing technologies and infrastructures and delivers a flexible and scalable solution that fits the way the nurse works.” Maybe I lost it somewhere in the run-on sentence, but from that text, I have no idea what they do or whether they’re selling hardware or software.

The most unusual piece I received was from TEKsystems, who sent this “pieceless puzzle” that was a nice spot of fun after spending the entire day completing staff performance evaluations. It’s a mouse pad cut with a seemingly unending incision, turning it into a puzzle with only one piece. It probably would have come together more quickly if I wasn’t trying to assemble it while watching a hilarious episode of Top Gear on Netflix where I couldn’t stop laughing as they inadvertently lit an RV on fire.

The last ad that caught my eye wasn’t even a HIMSS mailing but a one-page piece in the February issue of Health Data Management. NextGate carries the day with their headline, “When you exchange healthcare information, don’t gamble” and their excellent selection of sample patient names.

I hope to see all of you at HIMSS. For the rest of you keeping the home fires burning, thank you for all that you do to keep the systems up and the users happy. There’s always New Orleans in 2013.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Sebelius Announces ICD-10 Implementation Delay

HHS Secretary Kathleen Sebelius has announced that the October 1, 2013 date for covered entities to implement the ICD-10 disease classification system will be pushed back to an unspecified date.

She was quoted in the HHS news release as saying,

ICD-10 codes are important to many positive improvements in our health care system. We have heard from many in the provider community who have concerns about the administrative burdens they face in the years ahead.  We are committing to work through the rulemaking process, with the provider community, to reexamine the pace at which HHS and the nation implement these important improvements to our health care system.

ICD-10 was adopted by the World Health Organization in 1992 and is used by every industrialized nation other than the United States for morbidity reporting, limiting the ability of the US to use and contribute to global health studies and surveillance. The rule setting the October 1, 2013 implementation data was originally published in January 2009.

HHS says a new compliance date will be announced in future rules.

Update: HHS has pulled the announcement page down.

Update 2: HHS changed the date of the announcement to today’s date, which gave the page a new link here. We thought it was odd that an apparently new major announcement had yesterday’s date and wasn’t appearing on HHS’s home page. They have fixed that.

Readers Write 2/15/12

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

iPad Fatigue: Choose Your Mobile Strategy Wisely
By Chris Joyce

I get the attraction of the iPad … your own personal device that’s sexy and lean, as opposed to the standard-issue, Windows XP desktop locked down by your hospital’s IT group or the clunky computer on wheels. The simple UI and the glossy new apps let you shed the pain of those legacy systems and, most important, you get mobility.

Given the glacial pace of innovation in healthcare, who can fault people for wanting to use these beautiful devices? We are all trying to create a sea change in healthcare IT, much like the iPhone did for telecommunications. But I’m going to say something that’s wildly unpopular: the iPad is not well suited for healthcare in its current state.

I’ve been working in tablet-based mobility for seven years (yes, there were tablets before the iPad). We’ve studied clinician data collection workflow in registration, the ED, home health, cardiology, radiology, orthopedics, and clinical trials. Trust that my opinions are carefully thought out from experience.

I will concede that the Windows-based tablet manufacturers deserved to be smacked around by Apple for their lack of vision and slow progress. Years ago, I, along with my customer (one of the largest health systems in California that had been using tablets in cardiology for years) sat down with the folks at Intel and Motion Computing to tell them that the C5 was too complicated and expensive. I shared what we needed in the ideal tablet: a bright, 12” screen with stylus support that’s ideal for documents, 8-10 hours of battery life, no external ports or other gadgets, and a sub-$1,000 price tag. Our request fell on deaf ears as they paraded out the next incremental chip set improvement in their roadmap.

When the iPad hit the market, we thought we’d finally gotten our ideal tablet. The price was right, the screen was bright, the battery life was unbelievable, it ran coolly and didn’t burn your arms, it booted in seconds, and the 1.5 pound. form factor (half the current tablets) was simple and elegant. Finally, we had the perfect complement to our mobile forms software. This wasn’t just a Windows laptop with the keyboard chopped off – it was an appliance, a tablet.

But it also has some major shortcomings that our customers are now discovering:

10” display
This is subtle because I like the more portable size, but those standard consents, ABNs and Medicare forms you’ve used for years don’t fit on a 10” display without disrupting the layout. Your app has to be “touch-aware” or you’ll interact with the screen when you rest your hand to sign or add a note. Our customers are counting clicks and don’t like the iPad because they have to scroll to use the forms that once fit on their 12” Windows tablets.

No stylus
This makes capturing signatures, annotations on diagrams, and unstructured notes impossible unless you buy a third-party stylus like Pogo. But that’s like writing with a crayon and there is no place to dock your pen. Are your patients going to be comfortable signing an informed consent with their fingers?

No handwriting recognition
The soft keyboard isn’t practical for a lot of data entry because you are still holding the tablet with one hand and pecking out everything with the other. And bouncing back and forth between numeric and alpha characters drives users absolutely mad. Handwriting recognition has its place in documentation, just like voice dictation, and it can be as fast as paper. There is nothing fast about the iPad’s soft keyboard when at the bedside.

Proprietary operating system and deployment isn’t enterprise-friendly
Obviously Apple wasn’t concerned with compatibility with “legacy” apps like Meditech or MS4, but in healthcare, that eliminates about 90% of current systems. Most hospitals have compromised for “runs on iPad” versus “optimized for iPad” using Citrix or a Web interface.

That leaves the end user with an underwhelming experience. Citrix apps don’t get the intimate integration with the display, touch, or the camera for image annotation. Not many vendors were prepared to rewrite their clinical systems in iOS or HTML5. The HTML5 standard hasn’t been published yet and isn’t consistently supported by all browsers (although it is the future). I know of several major healthcare systems that are still standardized on Internet Explorer 7, so I don’t anticipate adoption of HTML5 to be as high in healthcare as Apple would like you to believe. Again, we (healthcare) are not that nimble.

Lack of rugged form factor
Eventually your iPad will come into contact with fluids or the floor and you’ll realize it’s a consumer-grade device. These devices are often in a hostile environment, very unlike the environment in most iPad commercials.

The hype of hardware
One of our best mobile forms customers is a major health system in the Northeast. They gave each clinician an iPad, only to discover that they took them home to watch Netflix versus using them on their rounds. Hardware alone isn’t the answer. You also need software that’s mobile aware.

When you’re developing your mobile strategy, keep this in mind. The iPad is a beautiful device with multiple applications (just not healthcare data collection). It isn’t going to transform your hospital systems’ user experience. But don’t compromise – there are other options to consider. Look for vendors that can fill the gaps in your EMR with mobility solutions optimized for the right tablet for your environment (iPad, Android and/or Windows) and that upgrade your user experience/productivity.

Chris Joyce is director of healthcare solutions engineering for Bottomline Technologies of Portsmouth, NH.

If you have achieved Stage 1 Meaningful Use requirements or are planning to attest in the future, you are likely aware of the required core measure for implementing and tracking at least one clinical decision support (CDS) rule. The goal of this measure — along with maintaining active problem and medication lists and recording vitals and smoking status — is to improve the quality, safety, and efficiency of patient care.

So what exactly is CDS and why is it important? 

In simple terms, CDS gives physicians the clinical information they need for decision-making tasks. For example, during a patient exam, CDS tools can provide prompting to help a doctor determine a diagnosis or select an appropriate treatment plan. Alternatively, a provider may use CDS technology to improve documentation or identify billing codes or determine the most relevant data to forward to a specialist.

CDS technologies are particularly powerful when the engine is mapped to a wide variety of medical concepts and diverse reference and billing terminologies, such as LOINC, RxNorm, SNOMET CT, ICD, and CPT. CDS tools are more robust the wider the engine’s mapping. Strong CDS engines have the ability to identify and interpret patient information from multiple sources, whether the data comes in the form of lab and test results, previous therapies, or patient histories.

It’s important to keep in mind that CDS tools don’t make the actual clinical decisions for a physician, but support a physician’s own decision-making by sifting through existing data and presenting the most relevant information. As more clinical information becomes available online from EHRs and health information exchanges (HIEs), providers will rely more heavily on CDS technologies to identify the most pertinent information for a given situation.

Many commercial EHRs and HIEs have embedded CDS tools to help providers wade through vast amounts of clinical data. CDS technologies work behind the scenes to identify the most clinically relevant information within a practice’s EMR or from a connected reference lab or from HIE records. Search engines consider additional relevant details amongst on thousands of clinical scenarios and then interpret the cumulative data. Physicians are then presented with pertinent information at the point of care and offered details to aid with diagnosis and treatment plans, as well as critical data needed for compliance and reimbursement.

Though Stage 2 Meaningful Use is not finalized, look for the ONC to add additional CDS objectives in the core measures.

Dave Lareau is chief operating officer of Medicomp Systems of Chantilly, VA.

Super-Sized Productivity Gains from Computer-Assisted Coding?
By Akhila Skiftenes

The required migration from the ICD-9 to ICD-10 has significantly increased the demand for computer-assisted coding (CAC), moving beyond its early beginnings in outpatient specialty areas. The potential benefits from using this technology to make the transition to ICD-10 can be very compelling –improved coding productivity, accuracy, consistency, transparency, and compliance.

Yet CAC products require a substantial investment, and implementing one does not a guarantee that these benefits will be realized. Therefore, it is essential for an organization to complete a thorough analysis before investing in a CAC product.

Exceptional productivity gains have been reported by vendors. However, these are based on a number of assumptions and the specific circumstances for the organizations using the system. The following are key considerations when estimating CAC benefits for your organization.

First, estimates are often based on outpatient implementation data. As more and more hospitals move toward using a CAC in their inpatient areas as well, these productivity estimates need to be adjusted accordingly. Inpatient stays are longer and have more variability, making accurate CAC translations much more complex. Vendor products have made great strides toward accurate inpatient coding, but it takes more computing power and more time, so productivity gains will be lower.

Second, CAC works best when the documentation inputs are standardized. There are four standard formats for documentation: consultation note, history and physical, operative note, and diagnostic imaging report. The more variability in documentation formats for your organization, the longer the CAC process will take and the lower the translation accuracy.

Standard medical terminology used by the electronic medical record system also impacts the effectiveness of CAC. Many EMR systems use ICD-9 verbiage rather than SNOMED-CT for physician documentation. In these situations, the CAC application will translate to a lower level of accuracy since SNOMED-CT has a more modern standard for medical terminology and greater levels of specificity.

Finally, there is a general belief built into benefits estimate that optimizing the CAC process is ongoing. Once CAC is implemented, it is vital for the Health Information Management (HIM) department to audit the output and identify any issues with the software’s documentation interpretation. A critical success factor is the working relationship between HIM and IT, with resources assigned on both sides for continued optimization.

When making a decision about CAC implementation and ongoing support, organizations need to incorporate all of these assumptions into the estimate of how much productivity can truly be realized.

Akhila Skiftenes is an associate consultant with Aspen Advisors of Denver, CO.

Virtual Patient Simulation: Strengthening Medical Decisions, Strengthening Outcomes
By James B. McGee, MD

Provide better patient care with fewer resources. Essentially, that is what healthcare reform is asking us all to do. Most providers agree that the only way to maintain the quality of patient care and decrease overall cost is to reduce errors, prevent duplicate or unnecessary tests, and discover more effective yet less expensive approaches to care.

As I see it, that is the simple reality we all have to work within. The real question is: what does it mean from a practical standpoint?

It means that the modern delivery of medical care is far more structured, more measured, and more reported on than I—or anyone—ever could have imagined. Even the most recently educated providers now have to learn new skills and processes in order to respond to federal and third-party payer demands. An entire generation of practicing physicians and physician extenders is being asked to change practice habits, yet still engage in complex decision making.

It is a tall order. However, virtual patients (VPs) offer a way to provide examples and feedback that can help train providers to work within the new constraints. Think about it: clinical decision making is a skill. Like any other skill, it needs to be practiced, refined, and updated regularly. Simulation in general offers a safe environment to assess specific skills and receive personalized, dynamic feedback. VPs can simulate a wide range of clinical decision-making scenarios without requiring dedicated space and time the way physical simulators do.

Simulators such as mannequins are a familiar way to practice clinical skills. VPs are a relatively new development best described as interactive web-based simulations used to develop, enhance and assess clinical decision-making for all types of learners (physicians, physician extenders, nurses, students, etc.). Branched narrative style VPs, in particular, do this by presenting a patient’s story and background information. They then challenge learners with multiple decision paths and show the impact of their decisions—without the risk of actually treating patients, of course.

Training with these realistic computer-based cases strikes a practical blend of simulation with the convenience of web-based delivery and centralized reporting. Think of them as “cognitive” task trainers.

Hospitals have long recognized that providers who pursue learning on a regular basis tend to have better patient outcomes at a lower cost of care. Educational programs like VPs provide a mechanism to make good clinicians better and—perhaps best of all—help novices improve the cognitive skills that lead to expertise.

One good example that I am aware of is Warwick Medical School in the UK, which created VPs to train new doctors to handle life-threatening acute medical emergencies. The doctors can practice over and over again. Through the VPs, they receive immediate, personalized feedback while responding to a rapidly evolving, life-threatening clinical challenge. This type of deliberate practice simply cannot be replicated in real life. In an actual emergency the doctors who practiced decision-making skills are more likely to perform successfully.

Given healthcare’s focus on accountability and other reform efforts, it is important to not lose sight of ways providers and nurses can improve the care and the safety of their patients. VPs provide a safe and objective way to identify variations in practice and decision-making; remediate using real-life examples; reassess until competency is demonstrated; and continually reinforce best practices.

In any given community hospital, providers with a wide range of prior knowledge, skills, and attitudes practice under one roof. Patients expect and deserve the highest level of expertise from all of their caregivers. Payers also expect a certain level of performance and have begun to reward superior performers.

Simulation provides an efficient way to assess clinician performance and provide feedback, whether in the form of clinical guidelines, performance metrics or formal educational programs. By strengthening medical decision making, virtual patients offer one way to reach everyone’s ultimate goal—better patient outcomes.

James B. McGee, MD is the scientific advisory board chairman and co-founder of Decision Simulation LLC, co-chair of the Virtual Patient Working Group at MedBiquitous, and assistant dean for medical education technology at the University of Pittsburgh School of Medicine. Additionally, he is an associate professor of medicine in the division of gastroenterology, hepatology, and nutrition and a practicing gastroenterologist.

HIStalk Interviews John Glaser, CEO Health Services Business, Siemens Healthcare

John Glaser is CEO of the Health Services Business of Siemens Healthcare.

You’ve been at Siemens for 18 months. How many of those days did you regret leaving Partners?

[Laughs] Actually, none. I was ready for a change. I am enjoying what I am doing and learning a lot still.

I feel like we’re making good progress here. We have work to do and areas we need to perform better, but this has been a real hoot and very interesting and rewarding in lots of ways. I miss my Partners colleagues dearly and will always have a part of my heart and soul in that organization, but I have been really pleased with the time that I’ve spent with Siemens.

What surprised you about what you thought the job was going to be like versus what it turned out to be like?

An example is that you can read about raising a kid, and then you can raise a kid. You can walk into a new situation with an intellectual understanding, and then there’s a feel to it that it is the part that you get used to. So in a way, there was nothing surprising.

What has been interesting is getting your head around a global market. What do you do in China, and what do you do in France and Spain and places like that? What has been interesting is to really appreciate the range of customers and hence the range of hospitals that are out there in the US – big, little academic, non-academic, tightly integrated, loosely integrated — and understanding how those differences are really quite important in what they’re trying to do.

There is getting adjusted to and becoming proficient at the Siemens way of doing budgets and HR and getting used to new methods, etc. There is nothing really surprising. What has been part of the challenge and enjoyment is getting the feel of it and getting the mastery of things that you understood at a book learning level, and now you understand at a practitioner level.

Do you think the CIOs out there in your travels view you as one of their own, or are you now just another vendor suit?

I think they view me as one of their own. They’re sophisticated folks. I’ll go into a setting and it’s old home week, recalling time you a spend at CHIME or HIMSS, things like that. 

But on the other hand, they have a job to do for their organization and have much to fulfill. While we’re good friends and colleagues, the conversation will turn to more vendor-like conversation, either new things to be done or issues to be addressed. I see both hats, and I probably wear both hats, too in the course of the conversation. I think there will always be that tie, friendship, colleagues that goes way back in the CIO profession. I think I still have a pretty darned good understanding of what their life is like, and that will probably never disappear either.

Word is your previous employer is going to be doing a system selection of some kind soon. Do you have any status of what’s going on with that?

They are doing a system selection, and we’re part of the selection process. It’s is probably not all that useful for me to go into more detail on that, other than they are doing one and we are part of it.

When we talked last, Soarian was being groomed as the rising star of Siemens. Now out of the blue, Paragon has been given that crown at McKesson. It’s an interesting parallel. How would you compare the progress of those two products over the last several years?

Both are, to your point, viewed with good reason as rising stars. I think that frankly the Paragon challenge is a significant one of going up into the larger organizations, and it’s not just a scaling issue. It’s a “feature function that addresses complexity” issue. There are certain things you can live with manually or with modest functionality in the smaller organization that just become intolerable at larger organizations. They have a challenge going up the scale.

Soarian started at the high end and has been going into the smaller and smaller hospitals.  We now have customers who have 25 beds, small organizations like that. It’s easier to move that way because you can host it and drop the cost, you can do more canned content so there’s less that they have to worry about in terms of designing order sets and things like that. I think both are stars for a good reason, with different challenges.

Can you give me an idea of how many sites are live on Soarian and how it’s doing overall?

I can get you those numbers just to make sure I get them right. I know that in December, we signed our hundredth Soarian revenue cycle contract and we have about 300 contracts.

Note: Siemens followed up with exact figures: 316 US Soarian facilities are under contract for at least clinicals or revenue management; 120 facilities are live on clinicals; 51 are live on financials.

Other than the numbers, how you would gauge the progress of Soarian?

I’m pleased. The order volume is up, and up in a very nice way. We see more and more folks coming up, more and more folks achieving Meaningful Use, etc. They’re putting it in play and getting real yield out of it.

As the product grows and encounters a variety of situations, we find areas where we need to bolster the feature function and make it stronger. That’s a part of learning. The only way that can happen is when you put it in lots of different settings and see what works and what doesn’t. We’re learning a lot, and that cycles into more feature function and a variety of things along those lines.

As you know, we have to round out ambulatory on the Soarian platform. We’ll be showing parts of that at HIMSS and engaging contracts later this fiscal year. In addition to learning and growing the core clinical and revenue cycle stuff, we’re rounding out the portfolio with ambulatory, obviously the MobileMD acquisition of last summer, further work on BI and analytics, and then engaging patients.

As we enter into this broad new era of a more accountability for care, there are things we have to grow, in addition to new modules so to speak, but also a change at the core of what you do in the revenue cycle and what you do even in the inpatient side.

So anyway, lots of progress, lots of learning along the way, with still some work to be done as we help folks get ready for what I think will be rather sizeable, dramatic, and very significant changes in the decade ahead.

Even more than when we talked last time. Epic is just killing in the market, primarily because of its ambulatory integration. Then you’ve got Allscripts, Cerner, and Meditech trying to catch up and meet that challenge. How would say Siemens stacks up against those companies, which I assume are your four biggest competitors?

We routinely do well against those guys, some more so than others. For us to win the number of wins that we want and the percent that we want,  we’ve got to get the ambulatory part in there.

All of them have different strengths. All of them have different weaknesses.  For different things, you emphasize in different situations. I’m pleased with our competitiveness, although I think it could be stronger and will become stronger when we add a bunch of stuff to the core center of products and services that we have.

When you look at those companies, Epic obviously is again strong on the ambulatory integration. Allscripts has probably the strongest CPOE component. Cerner has a broad offering and is a fairly stable publicly traded company and that may offer advantages. Meditech has a big customer base and something for the smaller hospitals that is a little bit simpler, a little bit cheaper. When you look at those companies and figure out how you’re going to play against them to win, what do you see as their weaknesses?

If you go through them, there is Epic’s technology challenge. It’s older technology, and that will increasingly be a challenge for them. That doesn’t mean that it doesn’t work, because obviously it does. But it will increasingly be difficult to get talents to work on that, because it’s true that if you’re coming out of college and you’re 22, it’s not clear that’s where you want to spend your technical profession. Increasingly, the R&D innovation will be in technology other than the core that sits at Epic. That is a challenge that won’t happen overnight, but will progressively happen to them.

I think at some point they will have a challenging transition when Judy retires or whatever. That’s always difficult for a company that is run by its founder and has been for quite a time. But who knows when will that happen? I think for the time being, it is largely the technology and at times the implementation rigidity, which can be effective, but for some folks like the customers we have, it’s just not what they had in mind.

Cerner we compete with, and we’ll be more effective with ambulatory. It is often a feature function tradeoff. It is often the workflow engine, which is a distinctive factor in making us very effective. We actually do really well against Cerner these days in competitive situations.

I think the McKesson customer base is trying to figure out what in the world is happening and where it’s going. Obviously a bunch of people are rattled by the Horizon decision and are beginning to look around. The problem with Horizon obviously is the conglomerate of acquisitions — which makes integration really hard, maybe even impossible — along with the ability to navigate through this.

I think when you go to Meditech, it was a terrific company, Massachusetts roots, homeboy and all that stuff, but it is late to the game on some of the physician-oriented systems. It has got a hill to climb in terms of the physician and nursing community being really enamored with what they can do. They have similar challenges with older technology that Epic faces.

They have different challenges across the board, They’re all still doing well and are worthy competitors. Depending on the situation, some customers are worried about some of those challenges, some are not. Some in those situations are receptive to our strengths and some are not. You size up both who are you competing against, but also what the customer has in mind, what they’d like to achieve, what they worry about, and what they value and what they don’t in determining how to position yourself.

It’s interesting that you mentioned both Epic and Meditech as using old technology like MUMPS and Cache’, invented at your old employer’s place and used by you there. But it’s also interesting that they have such a large scale that they bring in people with no background and train them on the programming equivalent of dead Latin languages. Is that unique to healthcare, where you can take technologies that nobody else has heard of and just keep training your own next generation of programmers?

I don’t know enough about other industries to know how unique it is or isn’t. I do think that it is a challenge. If you say, I’m going to be fundamentally an IT company and reliant on an IT core for my product, and yes, sometimes services, but at the end of the day, I’m delivering technology. To be in a position where the technology you’re using is multiple decades old … and that doesn’t mean you can’t bring people and then train them and maybe you don’t need that many so essentially that’s not a big of a challenge. That’s hard.

That’s hard in the years ahead to really capture the gifted technologist, to capture the synergy and the innovation that surrounds and constantly moves the technology if you go forward there. So again, it may not be all that peculiar to healthcare. It may be quite peculiar to healthcare. Regardless of whether it’s unique or non-unique, I’d be careful. It certainly was with Partners when I was there, where despite the fact that we were a big IntersSystems user and a lot of the core Partners systems are based on that.

You have a couple of old products yourself in INVISION and MS4. Are you finding that those clients are interested in moving to Soarian, or are you losing clients, or are they just in a holding pattern?

All of the above. You see people who are moving and have moved. You see people who are on a holding pattern and they might be, “I’d like to get a little further along because I’ve done a lot of customizations to my INVISION and so I want Soarian to be equivalent to that.” We see some who are waiting, because they want to get through the Meaningful Use payment period and look at the cusp between the payments and the penalties and make their move at that point. Some decide to leave us, just as we find people who don’t have our systems come to us. People will use this juncture as the time to make various decisions about what they’re going to do or not do.

Regarding the MS4 folks, we have folks on MS4 who will be on MS4 a decade from now. It’s the right thing them for them. We will continue to support that. We also have some folks in MS4 who are saying, “I’d like to move in to the Soarian realm” and it’s the right time for them, and so we see movement along those lines, too. We’ve been in conversations with both MS4 and INVISION clients and said, “Let’s talk about what you’d like to do and where you’d like to go” and we’ll see some folks who are on both products for the foreseeable future and folks who decide to move more along to Soarian.

Anyway, it can be they stay for different reasons. One, because they like it, one because they want to use their Meaningful Use check, one for product maturity. They move for a different reasons — to capitalize on Soarian feature function, etc.. You and I could be talking a decade from now and we’ll still see MS4 customers and still see INVISION customers and we’ll still take good care of them, although I think a number of them will have moved on to Soarian by that time.

Siemens doesn’t make all that many acquisitions. What’s the plan for MobileMD?

I think you’ve got to have an HIE if you’re going to be in the enterprise business, because at the end of the day, most of the health systems that will form to deliver accountable care will have learned a lesson from the big IDN splurge about 15 years ago, in which they paid a lot of money and wound up with something that was just not as agile or efficient that they would have liked it to be. I think a lot of these relations will be contractual. You and I can decide to form an ACO for diabetes care, and rather than one buying the other, we contract with each other to do this side of the other, and you have one vendor and I have another.

We’ll see a lot of heterogeneity out there, because it will be the most efficient and most flexible way to put some of these accountable care arrangements together. Given that view of the world, I’d say that will be the dominant way. Less common will be the pure acquisition of hospital and physician practices. You got to have an HIE to deal with that. Even if you decide, “I’m going to hire a bunch of doctors and buy a couple of hospitals,” there’s care outside that boundary. The HIE becomes a critical part of linking across heterogeneous sites.

The other thing that I’m pretty sure will happen is that given that, there will be an electronic health record that is built on top of the HIE. My term is an interstitial EHR. If we’ve got five providers who are working together to deliver care to some population with different kinds of systems, then there will be a need for something that sits between them that provides not only views of patients, but also does the disease registry, a lot of analytics, a lot of the customer relationship management. We’ll see a set of apps that are built on top of the HIE to become the EHR that sits between. That’s part of what we’re beginning to put together.

How do you see that open, cloud-based platform where people can develop and put value-added apps out there? Is that a whole new industry?

There’s a new industry at two levels. There will be — and whether it’s Medicity or Amalga — where there’s this thing that sits between and becomes a platform for other stuff. Some people will decide that the platform is what they’re, selling like a Microsoft. Related to that is this notion that you want to have your platform be very service oriented. Whatever sort of custom apps they want to put on top of this thing to deal with unique needs — that becomes a pretty straightforward and safe thing to do. They can do that without screwing up the whole rest of the platform.

That will encourage a lot of innovation, and it will be innovation by providers who decide they’ll use some of their staff to do that. It will be innovation by people who are in the business of providing this new kind of application. In a way, it’s analogous to the iPhone and iPad, which are fundamentally ecosystems that people write apps to and leverage that ecosystem. I think we’ll see that. We have some examples of that and some of the people we compete with have examples of that, where you create an environment that allows and encourages people to do new and innovative things that leverage that core.

Allscripts and Cerner had that early on. I don’t know that Meditech has anything, and Epic kind of does if they trust you as a customer and share their secrets for using it wisely. Do you you see it as a requirement for vendors to open it up instead of sitting on their old technology and locking the door?

I think so. I think it’s because people will increasingly expect to be able to go off and to do that. I think it’s prudent to do that as a vendor, because no matter who you are, you’ve got a development pipeline and funnel and it’s not possible to do all the things your customers want. 

You’ve got to give them a way to get to it, and in a way that leverages their investment in you rather than causing them to wonder why they bothered investing in you. I think it will become an expectation. Obviously some hospitals would say, “I don’t really want to do that. I don’t have the staff or the inclination,” but there’s enough that will.

What’s impressive to me – I remember seeing it often at Partners – is that you can have a really small number of people, the kind of work that a grad student could do or a fellow could do. Man, it was impressive what they could bang out and code in a month. It’s not as if you need this big IT staff to go out and do a lot of this activity here. 

I think it will become quite common. The whole industry is moving — not just healthcare, but broadly the IT industry — in this direction. People will learn from iPhone- iPad type of stuff to see that in fact there are parallels in some way, shape, or form. That’s a long way of saying that I think it will become a requirement and an expectation that you can do that stuff.

How has it been watching your Meaningful Use baby grow up?

Neat in a way, because to see that a series of things you talked about in the conference room in DC and in policy committees is all over the place. Any place I ever go to, there’s a conversation on Meaningful Use and how to achieve it. It has clearly had an impact, which is probably not the most insightful observation to make.

I think it’s also one of the things where you learn that fundamentally you’ve set the bar pretty high, and there were some things that were learned along the way, that if you had to, you’d go back and tune a little bit. But it clearly is moving an industry and it clearly, I think, will have an effect on improving care.

What’s not clear to me yet is if you look at the number of Meaningful Use checks cut and the amount of those, you could say geez, it’s not quite where Congress or HHS thought it would be. But I also think it’s premature to know whether it is really on track or not. We’ll know a year from now. The fact that you could get your money in 2012 versus 2011 and some people waited for a period of time. I think a lot of the people who have gotten it today were people who were close to it, and so crossing the finish line was work although it was within striking distance, whereas others had a bit more ground to cover.

So we’ll see. We’ll see, I think, about a year from now. I think it’s too early to tell whether it’s a success in the number of hospitals and physicians that moved to it. But overall, it was neat. It was work. It clearly accelerated the industry. I think it will clearly help those who deliver care using these tools be better at delivering care.

When we talked a year or so ago, I asked you to tell me how I would be able to tell if you’re doing a good job two years down the road, so this is your midterm. You said you’ll have done the job as you intended if customers are telling you that your products contribute to your success and see them as essential. How would you grade yourself and the company?

I think we’re a B heading towards an A. Obviously I’ve made a lot of trips. First year, I visited 46 customers, so I was out a lot doing that. Clearly there are some cases where that is exactly what’s happening in a multi-faceted way. There are other cases where we need to give them additional help for that to occur, whether it’s training or implementation or a feature function. 

It’s not a clean sweep. Some are superb. Some need additional along the way. That’s helped me to understand where we need to put emphasis on products and where we need to put emphasis on services. But back to one of your earlier questions, we’re getting better all the time. I suspect that if we chat this time next year, I’m hoping that I’m giving you an A to an A-minus in that regard.

That was my last question, so I’ll leave it to you for any concluding thoughts, startling predictions, amusing observations, or whatever else you have. This is your time to shine.

I think we’re in for an amazing decade with an amazing amount of change. I think it’s going to be really hard. You probably hear it and you know this already.

Organizations going through ICD-10, and Meaningful Use — let alone the organizational challenges and strategies — that won’t go away. That’s just going to be part of our fabric for the next multiple years. It will be a challenging decade.

I hope that the country is better off when this is all done, that care is better, safer, more efficient, and all that kind of stuff. I do think it’s going to collectively take all of our effort and hard work to make that occur. We’re getting into the early stages of a time that will alter in material ways the structure, fabric, and practice of healthcare in this country. It’ll be cool to be in the middle of it, but it also puts a certain amount of responsibility on all of us to do it right and to do it well.

News 2/15/12

Top News

Acting CMS Administrator Marilyn Tavenner tells an AMA audience that she is committed to re-examining the pace at which ICD-10 is implemented in order to give providers more time to make the transition. She says her office will make a formal announcement about regulation changes within the next few days.

Reader Comments

From Don Pablo: “Re: data breaches. I saw where you are not relaying the stolen laptop breaches since they have become commonplace. I used to work in financial services and watched for reports of breaches. This was my favorite site to check a couple of times a week. I bring it to your attention as not every breach is easily found.”Great site to check out, unless you are obsessively worried about your personal data getting into the wrong hands, because lots of organizations seem to be losing our data.

From WellHeeled: “HIStalkapalooza. I just want to be sure it is as black tie and glamorous as last year (so I pack the appropriate Red Carpet attire)…is that the case?” There may not be a red carpet this year, but readers have assured me they are packing their sequins, high heels, and more than one black tie. SmyrnaGirl, for example, tweeted that she is bringing her A game with these hot shoes.

From Lucky Jackson: “Best dressed at HIStalkapalooza. Tell me what I have to do to win one of Mr. H’s big prizes.” In the fashion categories, we have HIStalk King (best-dressed man), HIStalk Queen (best-dressed woman), Best Elvis Impersonator (based solely on attire, so choose your favorite young or old Elvis outfit and don’t worry about the singing), and Best Left-in-Vegas Attire (think showgirl or over-the-top glitz; Mr. H is hoping for a lot of showgirls.) If you want to be in the running for the fashion or the shoe contests, arrive early because our judges will be selecting finalists between 6:30 and 7:30 pm.

From Former CIO: “Re: booth crawl. I hope the sponsors will have the answers readily available in the booths. With 50+ answers to get in around 11 hours of booth time, there won’t be much time for sales pitches.” We’ve asked the sponsors to have their booth crew prepared with the answers. I expect some will just post the answer on their wall. As a refresher to the detailed instructions: (a) download the form here and print it off, (b) get your answers from the booths and Web pages listed; (c) post them to the online entry form by Wednesday evening at 7:00, and (d) watch HIStalk Wednesday evening to see if you won. At minimum, you get good exercise and flaunt a confident, purposeful stride as you move from one booth to the next on a Apple-seeking mission instead of just meandering around following the scent of some vendor’s freshly baked cookies. With luck (and the odds should be decent), you’ll pack home one of 55 iPads. And as I mentioned last time, I’m the one grading the entries, and if you miss a question or two, I’ll most likely be lenient because I really want you to have an iPad. I was indifferent to the device when I won mine at HIMSS last year, but it has totally replaced my iPod Touch for around-the-house stuff: checking the weather, looking at e-mail, doing a quick order on Amazon, and reading Kindle books.

From Elaine: “Re: HIMSS. Any word on a McKesson event? It would be fun to let loose a bit after hours.” I’ll be honest in saying that I don’t even open any of the HIMSS-related mail I get (sorry, companies who pay big bucks to send it) so I don’t know anything about their event. The only ones that have risen above the noise for me were from companies that contacted me directly: a cool-sounding Cerner event at the Bellagio (called me at work), a great-sounding Iatric Systems lunch (e-mailed), and and SCI Solutions get-together (sent to my Mr. HIStalk e-mail). I’ll make this offer: for companies throwing an event that’s open to anyone (and that includes vendor people, just to be clear) let me know and I’ll mention it here, as long as you’re OK with the possibility that gregarious HIStalk readers will overwhelm you with interest, which we have to re-learn every year with HIStalkapalooza. Everybody ought to have a party invitation or two, don’t you think?

From MJOG: “Re: GE Centricity Advance. Discontinued with no warning and very little time to transition. They are offering Centricity CPS, but at $1,500 it is too pricey for the small practices that used Advance. Even their own VARs can’t guarantee a transition within GE’s timeframe. Practices that went live with Advance in January 2012 have to pay in full for implementation of dead software. GE is really out of touch.” I think what you are seeing is what lots of people predicted: when EMR certification turned out to be too easy to achieve and everybody earned it, that left it up to the market to weed out those products and companies that have a less than a fully competitive position in the face of disruptive companies that are happy to sell hosted, easily implemented systems for a few hundred dollars per month. The MU carrot is forcing practices to choose their dance partners nearly simultaneously, so the consolidation writing is on the wall as the rich get richer. It’s painful for existing customers, but is both desirable and inevitable over the longer term. Maybe we should have a mandatory Y2K every 10 years to thin the herd.

From All Hat No Cattle: “Re: electronic problem lists. What do you think of this idea?” Reported in a JAMIA article, Brigham and Women’s sets up EHR alerts to prompt the physician to review the problem list if patient data in the EHR suggests that any of 17 specific conditions (asthma, hypertension, diabetes, etc.) might be present but undocumented. The alerts were accepted 41% of the time, more problems were documented, and interventions and quality improvement work could presumably be more specifically targeted. I like the idea only because it has the potential (although modest, I expect) to improve the care of individual patients, unlike the similar adverse drug event triggers that have always seemed to me to be a complete waste of time except as a learning tool that nobody ever seems to learn from. On the other hand, pestering docs with alerts that are not helpful almost 60% of the time indicates a need for algorithm refinement. That’s where these projects end a lot of the time – the available information just isn’t good enough to improve the hit rate.

HIStalk Announcements and Requests

Thanks to Streamline Health, supporting HIStalk as a Platinum Sponsor. The Cincinnati, OH-based company offers the AccessAnyWare document management system, which supports hybrid document-electronic hospitals (which is the vast majority) by organizing their information to streamline processes and improve patient care. Its OpportunityAnyWare business analytics solution aggregates information from disparate systems so that users can perform data mining and collaboration using dashboards that can include an unlimited number of key performance indicators, metrics, and alerts. Its Patient Access solutions integrate document workflow related to referrals, pre-op documentation, and financial forms to eliminate delays and process barriers, accelerating the billing process and increasing employee productivity. They even have a solution (CharityWare) to manage the need-based financial assistance screening process. Before and after stats for several clients are here. The executive team has a ton of healthcare experience and the company’s chairman of the board is our old HIStalk friend Jon Phillips of Healthcare Growth Partners, who I interview once a year or so because his healthcare IT business predictions are uncanny (and it’s about time to do that again.) Thanks to Streamline Health for helping us do what we do.

I realized today that I have listed the exotic recipe for the IngaTinis to be served at next week’s event, but forgot to mention the other custom-created specialty cocktails that will be served (the bartenders at First are seriously legendary craftspeople of the alcoholic arts.) The Mr. H Incognito is a rum punch with ingredients that are, like its namesake, best left undisclosed. For you root beer fans – and you know who you are – the ESD Activation Sensation is a mixture of IBC root beer with whipped cream vodka (who knew?) with a brandied cherry garnish. And while I’m on the topic, I should repeat that we are ecstatic to host those lucky folks who received an invitation, but we regretfully cannot accommodate anyone who didn’t (guests, co-workers, hastily propositioned showgirls, etc.) You are welcome to swing by at 8:00 p.m. to see if no-shows have freed up space, but otherwise we’re packed to the rafters.

Thanks and welcome to HealthMEDX as a new HIStalk Platinum Sponsor. The Ozark, MO company offers an integrated clinical and financial system that covers all post-acute care settings: long-term care, home health, hospital, rehab, and Continuing Care Retirement Communities (if you’re a hospital person and think this doesn’t pertain to your organization, it definitely does – the comfortable lines between acute care hospitals and all these other important venues of care are getting blurrier by the minute.) When ACO-type arrangements put you on the hook to coordinate care with these other providers, solutions from HealthMEDX ensure that best practices are followed to meet regulatory requirements, reduce cost, reduce errors, and (pay attention here) reduce those hospital readmissions that come right out of your pocket. Every one of HHS’s favorite programs requires unheard-of levels of data-sharing and coordination to give patients coordinated care at the most cost-effective location. HealthMEDX has solutions running in more than 3,000 facilities and has earned CCHIT certification for Home Health and SNF in addition to ONC-ATCB modular certification for both hospitals and EPs. And lastly, if you’re thinking, “I know I’ve heard of HealthMEDX somewhere,” it’s the company that former McKesson Technology Solutions President Pam Pure joined as CEO right before Christmas. Thanks to HealthMEDX for supporting HIStalk.

Inga is interviewed by the folks from Dodge Communications, in which she downplays her role in HIStalk and makes me seem way more interesting and virtuous than I really am. Feeling uncharacteristically affectionate after reading it because she was so sweet in her comments, I wanted to have Valentine’s Day flowers delivered to her, but the florist reacted with a combination of a contemptuous laugh and and annoyed snort when I called up Tuesday morning and cheerfully asked if they could deliver that same day (I may offer her and Dr. Jayne a spa day at HIMSS instead.) Anyway, here’s a quote, which I can verify as accurate because I’ve hung out with her at HIMSS:

I have met quite a few people in HIT over the years and I love the opportunity to catch up with former co-workers and meet new people. I’m always on the look-out for HIT rock stars and always get excited when I see a big-name CIO or certain vendor CEOs. It’s totally a nerdy reaction and I have to remind myself to act cool and not like a 14-year-old who catches a glimpse of Justin Bieber. I also enjoy the exhibits. It’s fun to see what the buzz is and what new things vendors are promoting. I like seeing which vendors are over-the-top in terms of their marketing efforts and enjoy chatting with the smaller vendors assigned to small booths on the outer edges of the show floor. It’s a circus but I wouldn’t miss it.

Acquisitions, Funding, Business, and Stock

Imprivata announces that it added 160 healthcare customers in 2011 and increased its healthcare revenue by 103%.

Lexmark’s Perceptive Software unit posts an operating loss of $4 million for 2011, although Q4 revenue grew 41% from a year ago to $31 million. Lexmark CEO Paul Rooke says the company acquired Perceptive for growth and is pleased with the numbers.

Lumeris, Highmark, Horizon BCBS NJ, and Independence BC sign an agreement to acquire NaviNet, which offers a real-time communication network for physicians, hospitals, and health insurers.

Medicity will announce Wednesday that 2011 was its busiest year ever, with 43 contracts signed (22 by new customers, 21 by existing customers expanding their use.)

GE Healthcare and Microsoft announce the name of their new joint venture as Caradigm, also announcing company executives and a board of directors comprised of company insiders. We cited a Geekwire article on February 3 speculating that Caradigm would be the name. The companies confirm that they’re working with the CenCal Regional Health Authority in Santa Barbara, CA to obtain permission to use the Caradigm name, which that organization trademarked years ago (their website still comes up at caradigm.com.) GE and Microsoft admit that they invested a lot more due diligence in choosing the Caradigm name than did CenCal RHA, which picked it in an employee “pick a name for our new company” contest 2002. The employee who came up with it got $50 and a pizza party.

A New York Times piece says that Essence Healthcare, financially backed by legendary Silicon Valley investor John Doerr, is finally bearing fruit. Two of its holdings are ClearPractice (EMRs) and Lumeris (analytic software.) Lumeris was just announced as one of the purchasers of healthcare communication network provider NaviNet, where Lumeris software will help physicians answer administrative questions sent via NaviNet.

Meditech kills its contested $65 million project to build an office complex in Freetown, MA, moving on to other location possibilities after a protracted archaeological fight with the state’s historical commission. Freetown gets to keep an empty lot that may or may not contain Native American remains, while somewhere else gets 800 high tech jobs.

Sales

Humility of Mary Health Partners (OH) signs an agreement with Care Logistics to implement the Care Logistics Hospital Operating System at three of its hospitals.

RegionalCare Hospital Partners (OH) selects MediClick’s supply chain and accounts payable solutions.

Community Health Alliance (VA) partners with MEDfx to create a statewide HIE.

Hawaii selects Medicity to provide the infrastructure for its statewide HIE.

Children’s Hospital and Medical Center (NE) selects iSirona’s device connectivity solution in conjunction with the launch of its Epic EMR.

People

Diversinet Corp. appoints interim CEO Hon Pak, MD as CEO.

NexJ Systems appoints Eric Gombrich as SVP and GM of its Health Sciences Group.

Elsevier promotes Jay Katzen to managing director of its Clinical Decision Support group within Elsevier Health Sciences.

Randy Drawas joins M*Modal as chief marketing officer.

PerfectServe names Optum Accountable Care Solutions CEO Todd Cozzens to its board.

William G. Bithoney, MD joins the healthcare business of Thomson Reuters as the national provider business medical leader. He was previously interim president, CEO, COO, and CMO at Sisters of Providence Health System (MA).

Healthcare consulting firm WPC names Ray Guzman (Microsoft) as SVP of sales and business development and Brad Hutson as  chief security officer.

Fletcher Allen Health Care (VT) hires Healther Roszkowski as chief information security officer.

MedHOK appoints David Butterworth (Emdeon) as SVP of business development.

Glenn Yarbrough joins the Health Information Partnership for Tennessee as director. He was previously with Ardent Health Services and was the CTO of the State of Tennessee.

Announcements and Implementations

Saratoga Hospital (NY) deploys DigitalPersona Pro and U.are.U Fingerprint Readers for identity authentication.

Norma Tirado, VP of HR and HIT for Lakeland Healthcare (MI), discusses her organization’s implementation of Epic, which goes live this month.

HIMSS and the nonprofit trade association Open Health Tools announce a collaboration to promote the use of open source tools in healthcare.

Optum launches a cloud-based healthcare environment and Optum Care Suite, a set of applications that provide detailed health intelligence on patient, system, and population health. We interviewed Optum SVP Ted Hoy about the announcements this week.

VistA provider DSS launches a mental health kiosk for behavioral health hospitals.

Government and Politics

Federal authorities say they recovered $4.1 billion in healthcare fraud judgments last year, up about 50% from 2009.

President Obama’s fiscal year 2013 budget proposal includes $66 million for ONC, an 8% increase over FY2012. That includes $12 million for standards and interoperability work for data exchange, $7.8 million to support EHR adoption, and $5 million for health privacy and security efforts. The proposed budget also includes a 5% cut for the Office for Civil Rights.

The VA wants a 7% increase in its FY 2013 IT budget, looking for $3.37 billion. It wants $169 million to continue development of a shared EMR with the Department of Defense, $53 million to develop a Virtual Lifetime Electronic Record, and $1.45 billion for hardware maintenance. The VA seems to be less optimistic that it seemed previously about turning over its VistA data centers to DoD, saying that unless DoD carves out specific space within its data centers to allow VA personnel to run its own systems, they will pursue setting up interim data centers. Nice digging by the folks at Nextgov.

In Canada, the illegally accessed medical records of a high-ranking member of the country’s Veterans Review and Appeal Board are used in a smear campaign by fellow agency members who disagreed with his review decisions. Up to 40 officials accessed the files of the decorated veteran in order to use his service-related disabilities to discredit him.

Technology

The US Patent and Trademark Office awards DR Systems a patent related to methods of matching medical images according to user-defined matching rules.

Other

KLAS examines medical device integration systems, focusing on Capsule’s DataCaptor, Cerner’s iBus, and iSirona’s DeviceConX.

CapSite’s 2012 US Smart Infusion Pump Study finds that 34% of hospitals are in the market for new infusion pumps.

The Tulsa newspaper profiles a BCBS Oklahoma project in which physicians at University of Oklahoma in Tulsa who offer a patient-centered medical home can review the medical claims data of covered patients to get a better picture of their health status.

A Bloomberg article says that TV cable carriers are building up their broadband revenue from hospitals and practices, offsetting declining residential cable subscriber counts by charging medical users higher prices for using their networks. Cox says telecommunications companies such as AT&T and Verizon have 80% of the healthcare business, which it estimates at $460 million in the areas it serves. Comcast says healthcare represents a big chunk of the business services market that it estimates is worth $10-15 billion per year. Cable companies can offer lower prices through bundling, but they are less competitive in the areas of data security and wireless communications. AT&T says its healthcare revenue is $5 billion per year.

In the UK, an orthopedic surgeon criticizes thieves who steal live communications cable, which in repeated incidents has taken hospital systems offline, caused surgeries to be postponed, and forced hospitals to deal with downtime of telephone systems and PACS.

Rice Memorial Hospital (MN), preparing for a computer system conversion, offers patients a 25% amnesty discount to pay old bills so the hospital can shut down its retired billing system earlier.

This isn’t really healthcare related, but it’s too funny not to mention. A Marshall University student files suit against a fraternity and one of its members after a party at the fraternity house, in which the allegedly intoxicated fraternity brother tried to shoot a bottle rocket out of his rear. The plaintiff says the bottle rocket exploded in the brother’s rectum, which according to the suit, “startled the plaintiff and caused him to jump back” and fall off the deck, with the resulting injuries costing him playing time with the baseball team.

Sponsor Updates

• WellPoint (CO) selects Health Language Inc’s LEAP I-10 to transition to full ICD-10 compliance.
• SRS releases an enhanced version of its certified EHR.
• Heritage Valley Health System (PA) enhances its mobile iPad app using the dbMotion platform.
• Fletcher Allen Health Care (VT) will deploy MEDSEEK’s patient portal and optimization services.
• Wellsoft launches its redesigned website.
• Orion customer Inland Empire HIE launches its pilot running six hospitals, seven practices and a health plan.
• CareTech Solutions releases an interactive brochure explaining the capabilities of a hospital-specific help desk.
• A Vitera Healthcare survey finds that 25% of practices are not aware of the required transition to ICD-10, though larger organizations appear more aware and have a greater sense of urgency.
• Beacon Partners’ Ben Tobin provides tips for managing revenue cycle and cash flows in the midst of health reform.
• The Advisory Board Company announces a webinar highlighting its Crimson Critical Advantage platform.
• Trustwave partners with John Gomez’s JGo Labs to enhance and evolve Trustwave’s healthcare product line.
• Tri-River Family Health Center discusses its use of RelayHealth to  communicate and reduce non-emergency phone calls.
• Caremore (CA) purchases PatientKeeper’s Charge Capture software.
• UMass Memorial (MA) standardizes on Informatica’s data integration platform for integrated views of patients, providers, and encounters.
• Intelligent InSites announces that its RTLS solution supports ThingMagic Astra passive RFID readers.
• Emdeon joins the Interoperability Showcase at HIMSS.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

An HIT Moment with … Ted Hoy

An HIT Moment with ... is a quick interview with someone we find interesting. Ted Hoy is senior vice president and general manager of cloud business platforms at Optum. The company just announced the rollout of its secure, cloud-based environment and its Optum Care Suite application suite that include care plans, care coordination, quality, and population health.

Describe the cloud-based platform Optum is launching and how you see it being used.

As you know, there are many cloud platforms out there. Some are general purpose, with limited ability to support health care applications. Others serve a single set of constituents. Optum is introducing the first open, comprehensive, cloud-based environment built from the ground up specifically for healthcare and for the all the participants within the health system.

Our clients have asked for a solution that makes it easy to integrate all the various information resources and tools they need to drive faster decisions, better outcomes, and lower costs. Moreover, they’ve asked for an environment that supports their work and the work they do alongside others in the health system. All integrated, fully secure, and easily accessible in one place. 

The other thing we learned from our clients is that innovation can happen all over the health system, but those with creative ideas lack the tools and resources to bring them to life. We designed our cloud platform to unlock that potential for innovation and be equally accessible to individual innovators and large, sophisticated organizations

The Optum health care cloud platform brings all these things — including secure voice, video, and chat capabilities — together to help users manage their work and time more efficiently, to spur innovation across the health system, and to dramatically reduce health IT costs and complexity.

What are some examples of how providers might use the cloud-based platform to improve patient outcomes?

When care providers collaborate on patient care, the patient wins. We designed the Optum health care cloud to make collaboration among physicians and their patients easy. But what is truly groundbreaking is the ability of the Optum cloud to combine information from thousands of sources, run analytics against them, and deliver health intelligence to those who need it to make better, more effective decisions quickly.

Data from EMRs, genetics databases, and even local weather information, among other sources, can be harnessed to support a more responsive health system. For example, health administrators can anticipate spikes in ER visits due to worsening conditions for those with asthma and take preventive measures with their patients.

Optum has over 20 years of expertise delivering this type of analytics through user-friendly applications. Through the Optum health care cloud, we will dramatically accelerate the ability of users to access and apply this health intelligence to their most pressing decisions, from patient care to population health management.

Software developers will be able to turn ideas into applications. How easy will it be that to do, and what’s in it for the developer?

To quote one of the great technology innovators of our time Bill Joy, “The only way to get close to state of the art is to give the people doing innovative things the means to do it.” Unlocking innovation throughout the health system is a core tenant for the Optum health care cloud. It delivers tools and capabilities essential to creating health care applications – an open SDK, analytics tools, security protocols, and more. It also features a waiting marketplace that makes it simpler and less expensive for innovators to deliver their applications to clients.

For example, you can develop an app for the health care cloud with HIPAA compliance and interoperability with other apps baked right in, along with compatibility and connectivity to major health IT systems and networks. These capabilities stand to accelerate innovation while lowering costs.

How can physicians use the new Optum Care Suite? How will be it licensed and where will its data come from?

Physicians will be able to use Optum Care Suite applications through the Optum healthcare cloud, which they can access them from any Internet-connected device. This cloud will bring together data from a wide range of sources, including databases run by Optum, from third parties, and from clients. 

We foresee offering Optum Care Suite applications on a subscription basis and through enterprise licensing agreements. One of the exciting opportunities made possible by the cloud is the ability for app developers to create different models for selling their applications. As such, we anticipate a variety of licensing arrangements to be available. 

How is Optum’s cloud similar to or different from Medicity’s iNexx platform, and what industry trends does the availability of these platforms reflect?

You raise an important question about what industry trends these platforms reflect. From our cloud to the iNexx platform and the pending Caradigm venture from GE and Microsoft, it’s clear that the health system is craving simplicity and demanding widespread interoperability. We believe there is room for a variety of healthcare cloud environments. Some are taking a limited approach, using the HIE as hub from which to extend applications to small provider groups.

Optum’s approach is comprehensive and our healthcare cloud and its applications and networks are compatible with a range of platforms. We know the most important feature is the ability to support better patient care decisions and to help health professionals transition to new healthcare delivery and payment models. This is going to require open, platform-neutral technology that is responsive to the needs of those who use it, regardless of the health IT they’re currently using.

Our strategy is to unlock the potential of newly digitized information and analytics and to support rapid, widespread innovation. That’s why we’ve built the health system’s first comprehensive health care cloud, one with unparalleled scale and scope, and one seeded with a powerful collection of applications that simplify the health system for those who live, work, and depend on it every day.

Curbside Consult with Dr. Jayne 2/13/12

Care and Feeding of the CMIO

I frequently receive calls, e-mails, and LinkedIn messages from recruiters looking to fill CMIO positions. This might be a good thing – a sign that hospitals and health systems are figuring out that they really do need a CMIO after all and are looking to fill newly-created positions. A wise man once told me that it’s a good idea to spend 10% of your time looking for your next job, so I do read or listen to everything that comes my way. Who knows? Someone could be offering a CMIO position in a tropical location with excellent benefits and an assistant to deliver a slushy adult beverage every day at 5pm.

Unfortunately judging from many of the position postings I see, not all of them are new positions. In fact, some of them have been vacant for a long time and the postings have remained unchanged despite being unfilled. Some employers are just not understanding what CMIOs are looking for as far as scope of work, compensation, and job satisfaction. Let me give you a few examples.

Ability to continue practicing medicine. This is important for a variety of reasons. Credibility is often linked to actually using the systems that we’re advocating for our colleagues. Being an actual user of the system is important in understanding the reality and magnitude of issues raised by physicians. I’ve been able to shoot down the “it takes 17 clicks to do this” rhetoric spouted by some of my colleagues because I’m a user – and I know for a fact it’s a gross exaggeration or an example of a provider not following the best practice workflow.

Additionally, requiring a current active medical license of applicants can also screen out physicians with drug problems, failure to pay child support, failure to pay taxes, criminal records, and other undesirable employee attributes. I recommend that potential employers offer this as an option rather than a requirement, though. Keep in mind there are a lot of good candidates out there who don’t have licenses – many never thought they’d practice again and let their licenses lapse – so don’t use it as an absolute yes/no test. On the other hand, watch out for resumes that show people were in practice until recently and or have unexplained gaps in their work histories.

Travel and after-hours commitments, meetings, etc. One recent job description I saw stated that the job involved 50-75% travel – mostly regional, but some national. Considering that most employers are looking for people that have not only a medical degree but also either an advanced degree (MBA, MHA, etc.) or an informatics certificate, plus three to five years clinical experience and three to five years CMIO or medical director experience, this could be a problem. You’re talking about a potential applicant pool that will be in their late 30s to mid-40s age-wise at a minimum. These are going to generally be people who have families, often with small children, and your position may not be very attractive to them.

Continuing education and meetings. This should be part of the offer. It’s extremely helpful to be able to have not only the time (either on the clock or as dedicated continuing education time) but the budgetary resources to travel to a couple of meetings a year. Although we’re all increasingly good communicators in the virtual world, there is still value in face-to-face interaction with colleagues and peers, especially if your organization is in a town where there are only a handful of CMIO types. An offer I recently considered had not only less vacation than my current package, but I was explicitly told that as an IT employee (rather than a physician employee) I was not entitled to continuing education days or funding because “only the physicians get that.” I decided right away that they didn’t “get” what a CMIO was all about, and that was the end of my looking there.

Administrative support. With everything your CMIO is going to be tackling along the lines of Accountable Care, Meaningful Use, and the acronym soup that is our lives, he or she is going to need some help. Even if it’s just a shared administrative assistant, it can be a huge benefit to not have to spend time each day juggling calendars and handling daily office “stuff.” At a minimum, I’d expect some of the same things I’d expect from a good practice manager – opening / sorting / prioritizing mail and phone messages; ensuring regulatory compliance (completing license renewals and credentialing if those are required for practice); coordinating support resources, and handling other ad hoc requests. I would never consider a position without some kind of administrative support. The ability to tackle spreadsheets, flow chart software, project management software, and the ubiquitous slide shows is almost mandatory as well.

Benefits and salary. If you’re committed to finding an experienced CMIO who can hit the ground running, you’d better be willing to pay for it. Someone with ten years’ experience is not going to settle for an entry-level physician wage. The same group I mentioned above was offering a salary that was barely commensurate with the guaranteed salary they were paying new physician grads who were joining practices. When asked for the rationale, this was the answer: the CMIO doesn’t see as many patients or generate as much revenue. Again another indicator of an organization who doesn’t “get” the CMIO role. We may not be seeing 95% of the MGMA statistics for patient volume, but what we do can allow your physicians to reach that level in a much more efficient fashion as well as to assist in increasing the quality of care provided. Government and payer requirements are increasingly complex, and if you expect your CMIO to be able to bob and weave along with the myriad of changes, you better be willing to pay for it.

Culture and autonomy. CMIOs may report to a variety of people – CIO, CEO, or someone else entirely. Some organizations have complicated dual-reporting structures. Yet others have a clear chain of command but a parallel network of “informal” governance that makes it difficult to get things done. The best way to alienate a new (or potential) CMIO is for them to feel they’re in a place without clear direction or support for their initiatives. Making them obtain approval for every little thing is another good way to disenfranchise your CMIO. For those organizations that refuse to use the CMIO title, making your director of medical informatics (or whatever you want to call it) feel like a second-class member of the leadership team because they don’t have the title is another good way to encourage your CMIO to leave.

I worked for a group like that for a while. It was unpleasant, and each day I felt like I had just played 20 rounds of Whac-A-Mole. Because there was no real organizational culture, there was little room for strategy and great need for firefighting skills. Everything was a crisis that had to be dealt with and the leadership was constantly in transition. It seemed like I had five different bosses at any given time and everything was a priority. Initially I thought it was just me trying to adjust (I was a Padawan Learner then rather than the Jedi I am today) but it turned out it was a vacuum in leadership and culture.

If you have a handle on these things, you’ll probably do pretty well trying to hire your first CMIO. If you’re an organization where that role is well established, it might be worth taking a little time to see how your CMIO thinks you measure up in these areas. The CMIO is still a relatively new addition to the corporate team and it’s certainly OK for the position to change and evolve over time.

I’m pretty happy in my current role. But if you do happen to be located in a tropical or otherwise fabulous place and can provide the aforementioned fuzzy drinks, e-mail me.

E-mail Dr. Jayne.

HIStalk Interviews Marc Willard, CEO, Certify Data Systems

Marc Willard is founder and CEO of Certify Data Systems of San Jose, CA.

Let’s start off with a brief description of yourself and the company.

I’m from England. I’ve been here for 12+ years. I’m one of those serial entrepreneurs. I’ve been in technology for most of my career. 

Certify was founded by myself in 2004. We had a vision, very early back then, of connecting physicians with hospitals or health systems. We’ve been doing that ever since. We’re in the enterprise health information exchange market.

Who would you consider to be your main competitors?

It’s changing rapidly. I would say for sure we would see Medicity. Sometimes IT units within health systems developing their own products, but that’s not really very common any more. Maybe a company like a MobileMD as well.

The market is in two segments now — state or public HIEs and enterprise. In enterprise, there aren’t too many companies at the moment. There’s a lot in the state-based, though.

Describe how you see the market shaking out and the difference between the enterprise ones and the public ones.

The public ones are normally driven by public funds or grants. They tend to try and encompass a whole state or a whole county. Their goal is to try to create a common medical record. The challenge with the public ones is that they’re driven unfortunately by politics. I think in the past we’ve seen CHINs and RHIOS all try to do a similar sort of thing.

The enterprise market is something that I’d say in the last two or three years has become very interesting. It’s probably is the fastest-growing segment now. That is where a health system is trying to enhance its relationships and exchange data with its physician community. They protect and increase their revenues for all members involved. It’s a much more sustainable business model because it doesn’t rely on  grant funding. It tends to have a much stronger ROI.

The public organizations had a challenge getting providers to sign up. Are enterprise ones more successful, and what reasons are causing providers to either sign up or decline to?

It definitely has more success. Unfortunately, it’s politics. When you try and bring everyone together in a public HIE, everyone has a different agenda. England is the best example of how a free HIE just doesn’t work.

The reason the enterprise does work is that healthcare is local. Most of the time we’re within 20 miles or 15 miles of our healthcare systems. It’s very rare that we’re even 50 miles away. Physicians feel very compelled to help in their community. It just makes a lot of sense to receive information electronically from the hospitals who they refer with. They do not feel there’s any hidden agenda. 

I think today with Meaningful Use coming on board, that’s helped as well. With some of the things going in healthcare reform, in medical home, I think the emphasis is shifting where the physicians feel a lot more comfortable.

Your model also may have helped with that since you have the federated model, where you’re not insisting that all the demographics be pulled into a third-party system that practices can’t control, instead placing the HealthDock server inside the practice’s firewall. Are customers aware of that as an advantage and are any of your competitors following that lead?

We call it a network approach, and you’re exactly right. By not asking all the providers to centralize their patient information — they feel threatened by that — but the ability for them to control it within their environment and not only share and offer up the information they want. Some offer everything. Some, if they are split between two health systems, a little bit. It’s definitely appeased their issues. 

We are at the moment about the only vendor around that’s got this true hybrid edge server model that will go down to a one- or a two-doctor office. I mean, 75% of the physicians today are less than five docs in a practice, and unless you can bring those primary care guys in, the small practices, you don’t really have a true health information exchange. You’re not really looking up the complete medical records.

Yes, absolutely it’s definitely helped. I spent between ’04 and ‘07 90% of my time in very small physician offices. We had focused user group meetings where we’d understand their requirements, their concerns. This is the way Certify has been designed — to meet that challenge. It definitely helps an awful lot.

Do you think centralized data made it attractive for other companies to buy up most of your competitors?

Yes, I do. There’s nothing wrong with a centralized model. I just think we all just need to understand the kind of dynamics that happen within an HIE. 

For example, even with us we’re a hybrid, we will bring information into the middle if you want to run analytics on it. And yes, definitely I think there are many companies today looking at companies like mine and Medicity and Axolotl that see the value of having access to that data.

The key is to make sure that the owners of that data are happy to share it. With the ACO structures being formed and now the medical home plans, a lot of the information is able to be shared. There are many, many companies out there that see value in it.

I saw some examples of things that hospitals might choose to pull in from those connected EMRs of the practices that they’re affiliated with. What are hospitals doing with that analytic capability?

Quality measures are a great example. We have a very nice health system that’s built an ACO and really believes it’s the better kind of environment. They’re pulling information in for quality measures.

Analytics to me is broken down into two segments. One is a rules-based engine — quality measures — and then the other is population management, which is more predictive analytics. I would say the rules-based stuff today, especially in rev cycle management, is pretty popular out there.

But as health systems connect more and more and more physicians in the community and really start to see that the data from the inspection of care … when I walk into my primary care office with a cough and they can have access to that information, predictive analytics become something that is very, very real and doable. I expect in the next couple of years that will be a really nice product line for Certify in the marketplace.

How does that work when you have a hospital attached practices using a bunch of different EMRs? What’s the technology involved in trying to pull all that data from all these different systems into a single database for analytics that takes into account differences in the way their data is used, stored, and defined?

That’s a big question. You’ve got two types of feeds at the moment. You’ve got an HL7 feed, and now you’ve got some of the popular XML feeds, like the Continuity of Care Document.

We spent eight years working with EMR vendors and finding ways of allowing for easy connections and trying not to make every single connection from every single health system a custom integration. That is the kind of power what our product does. Once you can achieve those connections, then we can pull out patient summaries, scheduling information, ADT, admit /discharge / transfer information, patient summaries. 

Once we have that information on our platform, we can then dice and slice it, and in some cases maybe we’ll ship an XML file to an analytics engine, and in other cases maybe we’ll ship a couple of Continuity of Care Documents to a central repository that the health system has. Once you’re in there and connected it, it’s actually fairly easy for us to manage and pull up data.

Of course, then as you start to run analytics, you’ll get into things like a vocabulary server to make sure that a blood lab test doesn’t have five different ontologies. You need to go do mapping, and that gets a little bit trickier.

Is there any potential for a standard from ONC or NIST that will eliminate the need to dig into the data to understand everything about it before you can actually have systems talk to each other?

If everyone just jumped onto LOINC and SNOMED and ICD-10, then life would be real simple, but we know it’s not that way. I think maybe 10 years down the road possibly, but at the moment not really. You’re always going to need to have some sort of vocabulary server in there. But the IP is out there. We’ve got access to great technology to do that. It’s all very solvable.

The government licensed SNOMED for everybody.

Yes, you’re right. The problem is not everybody uses SNOMED.

So that wasn’t enough encouragement? Or do EMR vendors have no incentive to use it?

It’s not really the EMR solution at the edge. It’s the human interaction. 

The lab is the easiest example. Quest or LabCorp back in the day would use different terminologies for the same thing. Then the health system would say, LOINC is the standard, and we would have to map for LOINC. The technology already exists. It’s just getting humans to adopt it and to agree to it.

I guess we’re kind of back to the age-old problem of asking people to do more work or spend more money for someone else’s benefit.

Absolutely. Absolutely. Today I would say that most of the health systems would just like to connect with their physicians. Just for the things that you and I are talking about, I see that some health systems could be three to five years out.

But the majority of health systems today would just like to connect with their physicians. They would just like to push out a clinical summary. Just like to be able to do a query for a patient record if the patient unfortunately is in the ER. All of the analytics and everything else for them is probably two or three years down the road.

But we IT companies have to prepare for the future. The market today is in a different place than maybe we’ll see at HIMSS, but I think it’s going to get there pretty quickly. It’s going to change pretty quickly.

Do you think ONC is putting the carrot out there through the Meaningful Use requirements?

I do. I think they’ve softened it, which is good. They’ve realized it’s a carrot and a stick. I think the carrot was too small and the stick was too big, so they’ve changed it a little bit now.

A number of our health systems are doing it for Meaningful Use, but most of them are doing it because it’s the right thing to do — increase quality of care. I think the energy around forming ACOs — I think that created more enthusiasm to pull HIEs together than even Meaningful Use.

That was one of the problems with Meaningful Use. It wasn’t a huge incentive, but it got everybody’s attention and they missed the whole Affordable Care Act, where maybe they should have been putting some energy into looking at ACOs instead of chasing what wasn’t much money comparatively.

You’re right. It’s what — a $40,000 reimbursement to a physician? But if they have no EMR, they’ve got to build an EMR. 

The healthcare reform stuff – the ACOs and medical homes — that one is very interesting. You create an organization where everybody can win. If we can all focus on wellness and not illness, then suddenly we’ll win. That’s a really clean example for the physicians, for the payers, the hospitals to all get on board. 

That to me is probably one of the most exciting things that’s happening. I really hope that it stays true and it stays on its course and more and more health systems create ACOs and there’s a good balance between the payer and the health system and ultimately we’re going to solve it.

Companies like Certify will end up empowering that network. Just be the veins underneath, where the information is flowing clean, and also cherry picking information off all these quality measures and so forth. But to me, that’s the exciting times over the next couple of years I’m going to personally watch.

I don’t think I asked you the question when I asked you about the company. How many customers do you have and what are they doing with your products?

Today we have, I believe, just over 70 health systems that have taken our products on board. All of them are health systems. They’re using it for exchanging clinical data in their communities. Some of them are using it to build out ACOs. But everybody’s marching down the same path. We’ve seen tremendous growth in the last two years. I mean, it’s just been phenomenal.

You have a relationship with Cerner that I don’t really understand. How does that work?

Every small company either needs to raise a fair amount of capital or they need to find a very good strategic partner or do both. We decided back in ’09 that wouldn’t it be great if we could sign up a strategic partner that could just introduce us to a large client base? We met with Cerner and our visions were aligned, and now Cerner has a relationship with Certify where they sell our products and services into their client base.

It’s been a great relationship. It still is a very good relationship. Certify now has a direct sales force and marketing team that will actually go out and sell to the rest of the world, which is the Epic, Meditech, McKesson, that kind of stuff. Most people think that we’re a Cerner company and we’re not. We just decided — and I think it was very clever for us to do it — to use Cerner as a channel to get it out to the market.

Do you have a way to share data other than just in one direction, so if you have a bunch of practices and hospital or two all connected, can any of them update things like allergies and insurance information and share that?

They definitely could. But the way our platform is designed is health systems can connect to health systems, physicians to physicians. You can have a healthcare community all aggregating up. They can all share information around. It depends on how transparent they want to be.

We have some scenarios where the health system wants the ADT data in from the practice to populate their own systems. Other health systems won’t,  and vice versa. We have controls. We have consent and data controls everywhere, but basically it’s, “OK, how comfortable are you with sharing information?” and setting the product to the conditions that you feel comfortable with. But ultimately, they could share everything with anybody. Obviously all according to HIPAA and it’s all encrypted — I don’t know want to make it like it’s a Yahoo Mail program.

We have the apparently declining RHIO model, the enterprise HIE, and some providers connecting to each other via their EMR vendor’s closed network. How do you see that playing out for the patient’s benefit in five years?

As I mentioned at the very beginning, healthcare is definitely local. I think it would be absolutely awesome for a patient to travel within their county or its state and have peace of mind that if something happened, duplicate tests won’t be performed, they’ve got basic information about who they are and what’s happened to them. I think personally if we get there in the next five years, then we’ve already created something very powerful.

It’s ultimately all about patient care and trying to reduce the cost around it. With healthcare being incredibly expensive, I think the faster we can there, then ultimately the better it’s going to be.

To do that, we also have to make sure that all of us vendors play well together. I’m a big advocate of that. We can’t create these silos. We all have to work well together. I think things like these IHE standards are very important. I think ONC’s driving stuff is very important. But I also think the healthcare vendors need to make sure they perform their part as well.

Any concluding thoughts?

We’ve spent a number of years flying underneath the radar screens and decided last year that we’re not going to do that any more. I think what you guys do is very exciting as well, giving a lot of people a voice. I appreciate your taking the time to get to know us.

Monday Morning Update 2/13/12

From Nasty Parts: “Re: Vitera. I hear the total headcount was 337. Word is that they’re dumping Intergy and putting all their efforts behind the MedAppz SaaS product they bought. People who have seen it were unimpressed.” CEO Matt Hawkins covers that ground in the interview I just did with him.

From Vitera Product Vixen: “Re: Vitera. I heard the number was closer to 75, and based on the people I know that were selected, they definitely got it right. Time to cut out the people who weren’t pulling their weight and recognize those of us that have been doing great work. CEO held an all-hands meeting in the afternoon, and gave us a preview of what’s to come – $25 million investment in R&D and new internal systems, new product launches, an iPad app, a Tampa center of excellence, etc. I’m psyched!”

From Carumba: “Re: Epic. I hear their sales folks are telling people that they are live in Abu Dhabi and the Netherlands to sound globally successful. Here’s the Cleveland Clinic hospital in which they are ‘live.’”

From Chayote: “Re: Scott & White. I’m hearing from both inside and outside that they may be merging with Baylor.”

From The PACS Designer: “Re: Hadoop. There’s a new search technique developed by the Apache Software Foundation called Hadoop that may draw some interest from healthcare institutions. While it is currently only being used as a web search tool, the possibility of using it as a tool for searching unstructured patient data files and their related image files presents a golden opportunity to get consolidated information in front of caregivers.  InformationWeek has a more detailed description of Hadoop for those interested in this new concept.“ I actually had Hadoop on my interview question list for Richard Cramer of Informatica, but ran out of time to ask him. They offer Hadoop connectivity and I was going to ask how that might be used in healthcare.

From Nick Barkley: “Re: sponsorship. Our company has been acquired, to be announced February 20. Having a sponsorship with your site has been enormously helpful in initially getting our name out there and gaining (and maintaining) credibility. HIStalk put us on the map and helped make this happen.” Nice, thanks. I don’t know that companies sponsor HIStalk with the hopes of being acquired, but I know it happens pretty often (Inga keeps a list.) That Monday of HIMSS week (the “sort of” first day of the HIMSS conference — it’s actually like the Sunday of previous conferences since the opening sessions are Tuesday) is going to be press release heavy, judging from the announcements I know about and the multiples of those that I don’t. As a vendor public service, I’ll repeat the unsolicited advice I dispense every year: if your announcement doesn’t affect your HIMSS participation, save it until 1-2 weeks after the conference. Unless yours is a big acquisition or new product announcement, it will get lost in the madhouse during the conference, but will run nearly unopposed afterward because your competitors will have shot their PR wad trying to build conference excitement.

My Time Capsule editorial from 2007 for this week: Why You Should Root for Cerner, Even if you Hate Them, where I say, “I want Neal Patterson to keep right on being Neal Patterson, a pig farmer turned Wall Street darling SOB who bootstrapped Cerner out of nothingness and runs it however he damned well pleases, the antithesis of button-down interchangeable bankers-turned-CEOs who manage companies they don’t own as dispassionately as a mutual fund.”

Listening: new Van Halen, which sounds darned good for guys in their late 50s who spent most of the decades since their last big splash fighting with each other and rehabbing. Check out their tour, but I’d be cautious about buying tickets for anything after the Boston show since tours seem to bring out the squabbling between the Van Halen brothers and whoever their lead singer is at the moment (Roth, Hagar, Cherone, lather, rinse, repeat) and the whole thing could go down in flames (think The Eagles without the concert-dollar greed that makes them pretend to get along.) Eddie may not still be gazing romantically over Jenny Craig meals at the still-adorable Valerie Bertinelli, but he plays seriously smoking guitar (live dress rehearsal video here.)

Here’s Vince’s latest HIS-tory, with some fun history of the first bedside terminal, the PNUT.

We should hit the 5 millionth visitor to HIStalk somewhere around Friday of this week. I can’t give a prize since I don’t have any way to know who that reader is, but it will still be fun to watch the counter roll over. That’s a lot of visits even after almost nine years, especially since early on I was thrilled to see a few hundred in a month.

Welcome to new HIStalk Platinum Sponsor Certify. The San Jose, CA company says it’s the leading and fastest-growing enterprise HIE vendor (71 health systems, 258 hospitals) because it has solved the “last mile” problem for health systems that need to connect to the EMRs of community-based medical practices quickly to deliver immediate value. Setup is a snap: (a) Certify ships the practice a HealthDock edge server; (b) Certify’s Physician Services team walks the practice manager through the 30-minute setup by phone; (c) HealthDock connects to the health system’s Gateway server; (d) the interface is activated and tested; and (e) the practice is up and running with results distribution, order processing, and patient summaries. Physicians get value, hospitals meet Meaningful Use requirements, and the the Certify community eMPI is builds a master patient index in the background for more sophisticated data sharing and analytics projects down the road. For the technologists, Certify supports IHE standards PIX, PDQ, and XDS queries, with HealthDock service as an XDS.b repository and registry, with an end-to-end audit trail, alerts and messaging, failsafe encrypted delivery, and community analytics reporting cubes. One SVP/CIO is quoted on their site as saying, “This is the easiest IT implementation I have ever done,” while hospitals also like the minimal support requirements (less than 0.5 FTE) and all-inclusive fees. They’ll be in Booth #5934 at HIMSS. Thanks to Certify for supporting HIStalk.

Inga has put together our HIMSS Guide, which contains information about what our sponsors are doing their (booth and/or contact information, what they do, etc.) I put a PDF version here. You can help us out by supporting our supporters, as it were, by dropping by their booths and saying you read about them on HIStalk, even if only to say hello and see if they have any cool free stuff.

For you provider-employed folks (hospital, medical practice, etc.) attending the HIMSS conference, let me explain this Booth Crawl thing we’ve been talking about, because it will give you an excellent chance of bringing home a shiny new iPad (your family will be much more impressed than if you return with the usual assortment of note pads and stress balls.) We made the whole thing up at the last minute with the idea of putting iPads in the hands of readers, so forgive any lack of polish on the idea or its execution. Here’s what you do:

1. Download the player form, print it off, and take it along to the conference.
2. Visit the booths and Web pages listed by Wednesday evening, February 22, to get the answers to the questions on the form (the exhibits are open Tuesday from 1:00 to 6:00 and Wednesday from 9:30 until 1:00, then 2:30 until 6:00).
3. Transfer your answers to the online form by Wednesday evening at 7:00 Las Vegas time.
4. Later Wednesday evening, while everybody else is out having a good time, I’ll be holed up in my hotel room doing a manual draw of the winners, making sure you got the answers correct (OK, I may cut you some slack if you miss a couple of questions because I’m just that kind of guy and because I’ll be woozy from working like a dog and eating bad room service food so I can do the drawing and entry-checking, which I’m not looking forward to, but do your best.)
5. I’ll post the names of the winners on HIStalk Wednesday evening and include the name of the sponsor that has your iPad. You swing by during exhibit hall hours Thursday (9:30 to 1:00, 2:30 to 6:00) to caress the iPad’s supple curves and inhale its bewitching scent for the first time, then take it away to its new home for your happy life together. Unlike those lame paper-based contests, you don’t have to be present to win (what’s that all about, anyway?) – the sponsor will ship the iPad to you if you can’t make it Thursday.

Being an objective sort, I asked myself why you should play in our Booth Crawl:

1. Because we look kind of stupid to the companies sponsoring it if nobody plays. We’re not charging them, but it would still be encouraging to them as sponsors of HIStalk to see some folks drop by so they don’t think I’m just making up readership numbers.
2. Because we have 55 iPads to give away, which is good odds for players, maybe the best at the entire conference.
3. Because you’re going to visit booths anyway, so you might as well visit those of the Booth Crawl sponsors and make a fun game out of it that you might win.
4. Because some of the Booth Crawl sponsors are doing other unsanctioned fun stuff for players that you’ll like and that we pretend not to know about.

Baptist Health System (AL) names Chris Davis MD as CMIO to lead its Epic implementation. He was previously with Sisters of Mercy Health System.

A good point to note from my most recent poll: don’t blame your EHR vendor for the clutter of worthless information contained in their product. You can get rid of it at any time, provided you stop dealing with the federal government, insurance companies, and litigious patients. New poll to your right, inspired by NervousIT’s question to me last week: when a big hospital takes over the IT operation of a small one, what’s the impact on the IT influence on patient outcomes?

An article in the local business journal says Cerner brought on 1,700 new employees in 2011 and will hire almost that many in 2012. That must be keeping the parking lots full and the pizza delivery guy busy.

I keep getting cheery HIMSS breakfast invitation e-mails from one of the other sites. I feel kind of honored thinking I’m on some kind of exclusive list until I click the registration link for details, then click again for the registration page, then scroll down to the very, very bottom in small print where I see that I’m to be charged $89 for my presence. Above is what I would get (one or the other, not both) after traipsing to the hotel by 7:00 a.m. and listening to a panel discussion, which is a format that I don’t like at all. I also don’t like being “invited” to something that I have to pay for. 

I’ve mostly stopped running “lost laptop” breach articles since they are common and no longer all that interesting, but here’s an exception: a laptop containing information on 500 patients is stolen from the car of nurse who works for Lakeview Medical Center (WI). Why is that newsworthy? Because the laptop’s hard drive was encrypted. Nice going, 40-bed Lakeview Medical Center.

E-mail Mr. H.

HIStalk Interviews Matthew Hawkins, CEO, Vitera Healthcare Solutions

Matthew Hawkins is CEO of Vitera Healthcare Solutions of Tampa, FL.

Give me some background about yourself and about Vitera Healthcare Solutions.

I’m a technology enthusiast and a big believer that technology can and should enable better practice, both from a business perspective and a clinical perspective. I think that’s one of the reasons I’m very excited to be at Vitera Healthcare Solutions.

As you know, Vitera’s roots are in practice management, with the Medical Manager business and some other practice management solutions. That’s a part of our DNA. Being good at practice management and helping doctors get reimbursed for the services that they’re performing and helping them manage effective practices is part of our DNA. That’s something I’m a big believer in.

One of the reasons I’m also excited about being in Vitera is I believe that software companies are really people-oriented businesses. That’s definitely true here. That’s one of the things that made me gravitate toward working within a software type organization. They’re people businesses. The soul of the business is in helping inspire people to develop and deliver great technology and provide excellent service. I think ultimately the products and services that we offer become an extension of who we are.

I’m excited about being here and excited about what we’re going to be able to accomplish as an organization with the good people that we have at Vitera.

What was the interest by Vista Equity Partners when they acquired the company in this past fall?

Vista Equity Partners acquired the business in November 2011. They’re very excited to be the owners of this business. They were thrilled to win the bid.

They see this as a long-term opportunity to create value for our clients by helping employ best practices that Vista Equity Partners has tested and had proven in a number of different businesses that they owned. They’re very familiar with healthcare, but also more broadly across other enterprise software businesses in other industries. I’ve worked with Vista for nearly five years. I know them to be very good investment partners, willing to make investments in the business and willing to do what it takes to help create value. I look forward to working with them here in this business.

People are always suspicious when private equity firms buy companies that they’re just going to slash and burn their way to flipping the company at the first chance. Have there been any headcount reductions or any other cost-cutting measures, and what’s the long-term strategy of where the company needs to go?

We’re very focused on building a great business, insofar as changing the profile of our company, and we are making investments. Vista Equity Partners isn’t a traditional private equity firm from a cost-cutting perspective. For example, this year we will invest more than $25 million to accelerate our innovation efforts in R&D. We’re investing in new systems, a CRM system so that we have a lot better capabilities and to give that to our staff to improve our customer service and support, and then we’re also investing in skill training for our staff.

All of these are really with one goal in mind — to improve the client experience that people have with Vitera Healthcare Solutions and just to improve every aspect of our service, whether it’s training and delivery or the way we support service requests. It’s definitely investing in the products and extending those to several exciting new areas.

It’s important that we let people know that I’m very focused with our team, and we’re building a fine team. We’ve brought in several people that have healthcare industry experience to help us lead our teams. We also have a good core group of employees here. We are working to change the profile of the company. As I mentioned, we’re making investments. We’ll invest more than $25 million this year while continuing to invest in several products, including the Intergy product suite — practice management and EHR –Medical Manager, and Medware.

We’ll soon launch a full, multi-tenant based cloud solution for practice management and EHR, which we’re thrilled about. We’re investing in a mobile solution that will enable doctors and practitioners to practice healthcare any time, anywhere, and we’re thrilled about that. We’re investing in better analytical solutions so that practices can have insight into how they’re practicing, both from a business perspective as well as in an increasingly important category of clinical perspective.

While we do those things, we are positioning our resources. We’re looking to concentrate some of our resources in Tampa, Florida. We’ll be hiring several people here, upwards of 100 to 200 people here centrally in Tampa, Florida in client service, in training, in development, and in product management, among other areas. We’re also looking to enhance and grow our account coverage model in the field, so throughout the United States, we anticipate growing our sales force by upwards of 40 to 50% so that we can meet the needs of the clients that we serve locally. 

It’s a balance of positioning the company, changing the profile of the company, and seeking to optimize the way that we utilize our resources, all focused on helping us deliver great technology and great service to the client practices that we serve.

You mentioned the cloud-based solution, of which I’d heard rumors. Supposedly it came from an acquisition. Can you elaborate on where that product came from and how it will be rolled out?

This occurred before I came to the business and before Vista Equity Partners acquired the business, but there was an acquisition of some cloud technology, I think a year and a half ago or two years ago. We have, since the acquisition in November, worked aggressively to take that product from where it was and enhance it and improve it dramatically.

We are in the process achieving Meaningful Use Certification as well Surescripts certification for the product. We will begin a pilot test among several client practices that are interested in the product, having seen it briefly. We anticipate being able to bring that product to market later this spring. 

We’re thrilled about the early feedback that we’ve received on it. We definitely want to deliver a high quality, cloud-based solution for practice management and electronic health records that is interoperable and works very effectively with other products on the market as well.

It seems like with the changing demographics of position practices, where a lot of them are being acquired by hospital or managed by hospitals, that everybody wants either a cheap, good-looking system that’s easy to use in a small practice so they want some giant enterprise system that hospitals like that can tie in to the hospital systems. Where do your systems fit in with what customers are looking for?

I think it’s important to think about our system as being true to the ambulatory market and the office-based practitioners across several specialties. We feel like we have a very full suite, the Intergy product in particular, with practice management and EHR. Several client practices that are large — some hospital systems, multi-doctor multi-specialty systems as well — use the Intergy Suite as well as our Medical Manager products.

We are also working to optimize our products to work with the smaller practice sizes, the one- to two-doc practices. We’ll do that both with an Intergy On-Demand, a hosted solution, and soon we’ll do that with a pure cloud-based solution. We feel like our products can address both ends of the market effectively. We’ll continue to invest to ensure that our products are able to offer great coverage to the larger practice sizes — the multi-specialty, multi-doc practice sizes — as well as the smaller one- to two-doc practices.

But I think the important thing to underscore is we never want to lose our core focus, and that is on creating a great experience for the office-based practitioner and the ambulatory market. Really understanding the workflows, the way that practices operate in that  smaller practice or mid-sized practice level, and addressing their needs effectively.

When you took over what was Sage Healthcare, what did you see as the strengths and the weaknesses of the company’s offerings or the company in general?

A real strength of Vitera Healthcare, which was formally named Sage, is the large group of loyal client practices that use the technology, more than 80,000 physicians and 11,000 practices. That’s a strength that we absolutely are focused on. We’ll continue to be focused on earning their loyalty.

I think we have a great competitive set of products. The latest version of Medical Manager is 5010-compliant and ICD-10 ready, and we’re thrilled about that. We’ve got a great pathway forward with Medical Manager. Other great competitive products that are part of this business — the Intergy Suite product, Meaningful Use certified, 5010 compliant. We have some other products that every practice should have in our practice analytics product and a practice portal solution that we offer.

I think the third area that is a strength to our business is knowledgeable, very dedicated, good employees, many of whom have years of valuable experience in healthcare technology.

Those are many of the strengths of the business. Areas where I think we can improve are getting back out in front of our client base and talking about our product vision and sharing with clients who are about to make a technology purchase decision the fact that we are investing aggressively in innovation and in R&D and that we have a clear product message and clear product vision.

I think another area to focus on for us is improving the way we serve the practices that we work with. Coming into the business, I saw service improvement as a real opportunity for us. We have great people. We can do a great job taking care of the practices that we work with, and we are committed to doing that.

When the sale was announced in September, Sage’s CEO implied that the policies of the Obama administration had reduced the attractiveness of the EMR market. I think he said something about Sage Healthcare’s US business was contracting, which seems like a bizarre statement to make. What was he talking about?

I must say I disagree with that perspective. I think this is a very attractive market base. I think the market validates that with the number of vendors focused on this market or the number of stock market type transactions that we’re seeing that are focused on healthcare technology in general. Certainly just with the amount of dollars that are being invested, either by government entities or by private practices themselves, to get themselves to be able to use state-of-the-art technology.

I feel like that it’s just a tremendous market for us to be in right now. We are positioning Vitera Healthcare Solutions to take full advantage of that by getting our clients great products that enable them to take advantage of all the government incentives. We had nearly 900 clients already that have taken advantage of some Meaningful Use incentives, which at $18,000 average incentive, is $15-$16 million in reimbursement that our clients have already procured. We’re thrilled about that. I think that speaks to the attractiveness of this market from a vendor perspective like ours.

I feel like there is tremendous opportunity for continued efficiency gain to be had in healthcare, and in the way healthcare is practiced, and in the way that it’s becoming increasingly patient centric and what patients are expecting from a healthcare experience, what providers are expecting from a technology experience. I think being a vendor in this space, it’s just a phenomenal time to be here, because we can bring all those technology best practices to bear for both providers and patients alike.

As a vendor, do you see Meaningful Use as a long-term strategy or a short-term distraction?

I think Meaningful Use is good for the industry because it’s helping all us be aware that there’s an effective way to use technology to practice medicine. With that being said, obviously there’s an investment focus or a reimbursement focus over the next couple of years. The government is rewarding practices that are investing in Meaningful Use-enabled technology. Our technology is certainly Meaningful Use enabled, so it’s not a distraction at all to us. We like that.

I think longer term, the focus on being Meaningful Use-enabled and certified is just going to lead to better healthcare, from a business perspective as well as from a clinical perspective. It’s going to position practices and practitioners, and ultimately patients, to benefit from the efficiency gains that are able to be had, from affordable care even along to accountable, proactive care to patients. I see it as a good thing.

If you look at the current ambulatory EMR market and where Vitera plays in it, what do you see is important and what do you as happening in the next several years?

I think that speaks very well to our product vision. I’ll talk about some things that I see as just being tremendously important to us.

I think the technology themes that we’re incorporating into this product vision speak to the trends that will be in effect the next several years, including helping practices profitably practice healthcare. Included in that would be our theme around practice profitability, revenue cycle optimization, and being true to the office-based practitioner core, enabling them to practice effective and profitable healthcare.

Next, I think a big trend is in patient engagement. We see the word patient-centric referred to quite a bit. I think maybe that’s speaking to the consumer as in driven by patients and the expectations that all of us have as consumers of information included in our healthcare experience and wanting to know and to be aware of and be included in the decisions being made for opportunities to learn more about the healthcare that we’re receiving. Patient engagement, I think, is a very important trend that we’re focused on and that we’ll continue to focus on.

I think the use of data as a trend .. we would call that as practice insight … and really using analytical information to help improve the clinical care of patients and to help drive to better outcomes for patients. I think that positions both providers and patients to benefit strongly from that. Not just clinical care, but having dashboards and good reporting tools from a practice perspective give practices insight into how better business productivity as well.

Just the last couple of thoughts on trends and themes and why and where I think we’re positioning Vitera Healthcare in this very dynamic market. Connectivity. I think there’s a real important trend toward the need to be interoperable and flexible between our systems and others and making sure that we support IHE and that we are able to enable practices to select our technology, but then position them to know that our technology can be connected to others and integrated and interoperable in a way that makes sense for practitioners. I think that’s an important trend that we’ll be focused on.

I mentioned any time, anywhere access mobile solutions. We’ll launch a true native Intergy iPad solution later this summer, and we’re thrilled about that. That trend is going do nothing but continue, and we’ll be focused as a business on future iPhone and Android access solutions, just mobile solutions in general.

Then I think the foundational element of just being a good software company will continue as trends. Things like having software that is easy to use, having technology solutions that are easy to understand, easy to use, easy to be trained on. I think that will differentiate us as we go forward.

Cloud computing. I mentioned our cloud computing offering as a trend and a way to position us within this space. Having a trusted partner that is there focused on regulatory compliance and security and stability, so that when practices select one of our products, they know that we’re thinking and anticipating regulatory compliance items and being very mindful of stability and security and performance along the way. 

I see that as how we position ourselves as we go forward as a company in the future. I’m very excited to be a part of that.

Any final thoughts?

I’m thrilled to be here at Vitera Healthcare Solutions. I look forward to working with you and others in the industry to advance the cause of healthcare technology. I feel like we can play a really important role in making good things happen for practices and patients and the entire community.