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Monday Morning Update 7/9/12

July 6, 2012 News 7 Comments

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From Gob Bluth II: “Re: Health Information Partnership for Tennessee (HIP TN). HIP RIP. Another HIE bites the dust.” Verified. Gob forwarded the e-mail that went out to stakeholders on Friday, along with a copy of the official announcement that will be released Monday. The three-year-old state network says officials decided to pursue a simpler strategy of using the DIRECT system as a HIP replacement. HIP TN chose Optum’s Elysium Exchange (the former Axolotl) in October 2010 and now it’s going to the Greek mythology version of Elysium, the afterlife of the chosen.

From Data Birth: “Re: Consumer Reports hospital safety rankings. I’ll wager the reason the data were inconsistent or missing is because hospitals don’t want this particular information to reach the eye of regulators or the public. You would think this would be available through Joint Commission inspections.” In my experience, the Joint is good for two things: (a) reacting to headlines by setting big-picture goals and ever-moving standards that never result in hospitals getting punished, and (b) clearing the hallways of carts and getting storage boxes away from the fire sprinklers, which happens only when their inspectors are on site. Hospitals in the past have been given a clean bill of health by Joint Commission, only to be threatened with shutdown immediately afterwards by inspectors from the state or CMS over egregious patient safety problems. I’m not casting implications on the Joint’s motivations since I’d much rather have them than not, but they’re making nice coin by not only selling inspections but also the tools and services that help hospitals pass them, and sometimes I think they struggle with the balance of being both a regulator and a vendor (like other similar organizations.) I think they see their role as more consultative than punitive, while sometimes the latter seems more appropriate.

From Max Payne UK: “Re: NHS and Epic. Epic doesn’t have a UK localised product and Cerner is installed in several Trusts. Reportedly, Cerner was cheaper than Epic. So how did Epic wind up being the winner? What consulting company or consultant advised the Trust on this decision?” Hospitals often choose Epic for non-financial reasons: perceived honesty, a near-perfect track record of going live on time, general polish on issues like training and documentation, and lack of Wall Street pressure that could shift their focus quarter by quarter. Not to mention that the big price tags mentioned for Epic projects are all-inclusive of even internal labor, which other vendors don’t include to the later discomfort of their customer. If you’ve seen the actual contracts (and I have), Epic isn’t always more expensive than arguably inferior alternatives. With regard to localization, they have over 5,000 employees and have learned from the mistakes made by others, so the have a leg up on the pioneers before them who crawled back with arrows in their backs. You bring up a good point – do organizations buy Epic because consultants recommend it, or do consultants even get involved with Epic decisions? And as one last thought, Epic (and Meditech) are big enough to command UK attention, but emerged unsullied by the NPfIT meltdown since they weren’t players, so that’s a plus for them. I would hope that those who made the Epic decision talked to the Cerner-using trusts first.

From Konrad: “Re: job stress. I often wonder if part of the fear of EMR and Obamacare is tracking of stressful of employers, like cancer centers. One place I worked actually did that for employees.” The former CEO of France Telecom is released on bail after being questioned by government officials about the suicide of more than 30 company employees in the two years just before he quit. He says the suicide rate was similar to that of non-employees and blames pressure brought on by the economy and the company’s minority shareholder (the French government), but did say he wishes he had paid attention to the warnings of doctors that the company’s massive layoffs and unreasonable performance targets were causing employee health issues.

From BitesTheDust: “Re: John Muir. Epic must have gotten another major McKesson account – this time John Muir in California. Looks like the CIO (Eric Saff) is already gone too as an executive firm looks for his replacement and prefers Epic experience.” They chose Epic awhile back, I think. I had run a rumor here (without naming the hospital) that Epic had originally declined to work with John Muir over some perceived conflict with its IT department and told the hospital’s board as such. I think this may happen more often that we know – the Epic train rolls right over the CIO during selection or implementation when Epic’s way isn’t warmly embraced by IT.

From HR Guy: “Re: stack ranking of employees. Epic does stack ranking as well, with about the same results, combined with the slow hire/quick fire mentality it’s been pretty deadly.” An article about Microsoft’s lack of agility and its fall from swaggering innovator to bean-counting market follower blames stack ranking, the practice that requires a fixed percentage of employees to be identified as great, adequate, or poor, with the great getting promotions and the poor getting shown the door. It concludes, based on Microsoft employee interviews, that everybody spent more time stabbing each others’ backs and sucking up to those who might review them instead of worrying about how Apple was beating them like a drum. Steve Ballmer gets a lot of the blame (honestly, what does Microsoft see in that guy that nobody else does?) but the damage was well underway when Bill Gates was still running the show. A former marketing manager concludes, “I see Microsoft as technology’s answer to Sears. In the 40s, 50s, and 60s, Sears had it nailed. It was top-notch, but now it’s just a barren wasteland. And that’s Microsoft. The company just isn’t cool any more.” Epic does apparently follow the same practice of quickly categorizing employees based on feedback from managers and co-workers who may barely even know them. I like the practice in theory, but as in most aspects of life and business, execution is everything.  

7-6-2012 7-42-46 PM

Welcome to new HIStalk Platinum sponsor Visage Imaging. The San Diego company is a global provider of enterprise and advanced visualization solutions that make slow, trickily deployed client-server and Web-based PACS approaches obsolete. No more reconstructions at the modality console while the radiologist twiddles his or her thumbs waiting on digital mammography or PET/CT — Visage 7 makes even the largest multi-slice datasets completely navigable in seconds via an intelligent thin-client viewer displaying server-rendered 2D, 3D, 4D, and advanced visualization imagery on a single desktop (in plain language, huge images don’t need to be pushed painfully and slowly from the hospital data center to the radiologist’s workstation – the server does the work and interpretation gets underway faster no matter where the radiologist is sitting.) Its platform enables enterprise viewing and interpretation and image enablement of EMRs, VNAs, HIEs, and RIS/PACS. You can use it on smart phones and even on Macs. Thanks to Visage Imaging for supporting HIStalk.

I headed over to YouTube to see if Visage Imaging had anything there, and lo and behold, here’s a brand new video on Visage 7 that includes some cool product video (though being a non-radiologist, anything with lots of movement and color seems cool to me).

Clearing out my “Listening” box for now: Phideaux, interesting “psychedelic progressive gothic rock” led by TV soap opera director Phideaux Xavier. Think Jethro Tull, Kansas, and Renaissance rolled into a more modern package with bigger production. It’s really good, especially coming from a guy who directs General Hospital as his day job. I’m playing it loud enough for Mrs. HIStalk to ask me what I’m listening to, though her tone suggests an interest that doesn’t necessarily involve my loading it to her Nano.

Inga and I are coincidentally both traveling this week (not together, just to be clear) so we may be occasionally tardy in our responses and terse in our writing as we take rare simultaneous vacations. Let me know if anything really important comes up this week that I might otherwise miss since I’m hoping to spend a few more hours than usual not working.

Thanks to the following sponsors, new and renewing, that supported HIStalk, HIStalk Mobile, and HIStalk Practice in June. Click a logo for more information as you ponder with me the illogicality of respected, successful companies backing a shoot-from-the-lip journalistic ne’er-do-well who nonetheless appreciates their support in forms that often extend beyond financial to personal. There hasn’t been a day in the nine years I’ve been writing HIStalk that I didn’t marvel at how cool it is to live my Mr. H alter ego even though it’s purely imaginary.

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7-6-2012 5-04-01 PM

PPACA pretty much splits us as taxpayers, but we apparently like it fine as healthcare IT people. New poll to your right: which group would you target first to reduce healthcare costs? Obviously it’s a simplistic question with limited answer choices, so the poll accepts comments for your further elucidation.

7-6-2012 6-21-45 PM

A Physician’s First Watch poll on the Affordable Care Act drew similar results, with 65% of respondents (presumably mostly doctors) saying they like the Supreme Court’s decision (which presumably means they like PPACA).

7-6-2012 6-27-42 PM

CapSite releases its 2012 Laboratory Information Systems study. By the numbers, the dominant vendors are Meditech, Cerner, and Sunquest, and 81% of respondents say they won’t be replacing their system within two years. I like reading CapSite’s reports because they’re formatted as PowerPoints saved as PDFs and they get right to the point with charts. I had forgotten until I read the graphic above that Allscripts offers a LIS, which I assume is the former Sysware that it acquired in 2006. I also noticed that Epic’s Beaker is moving up the LIS ladder even though it’s not quite there yet, but probably will be by the time its newly implementing customers are ready to take another look at lab systems.

For the stats-obsessed among us (not me, but maybe Inga, and surely that one person who always e-mails me to ask), June’s readership numbers were really good given the annual summer slowdown: 102,849 visits and 191,515 page views, up a bunch from last year.

Weird News Andy finds the comments left on the Physicians’ Declaration of Independence interesting.

7-8-2012 6-38-12 AM

Here’s why e-MDs CEO Michael Stearns is  no longer with the company, as explained to its customers via e-mail. Grizzled Veteran provided that rumor last week. Founder and board chair David Winn has replaced Stearns as CEO.

7-8-2012 7-01-33 AM

This might be the first time that a hospital is acquired primarily for the value of its expected Meaningful Use payout. Cookeville Regional Medical Center (TN) will hold back $700K of its $6.7 million acquisition price for Cumberland River Hospital until that hospital gets its $4 million in Meaningful Use money. CRMC’s CEO said, “Part of the viability of this acquisition is the fact the Meaningful Use dollars are tied to it. That’s why it’s vital to have those dollars. That’s why we were adamant to have a hold-back of $700,000 so that we wouldn’t close the deal and they would stop working if they have a chunk of money held out there to comply with the purchase."

Vince continues his HIS-tory this week with HMS, having connected with co-founder Tom Givens to get a first-hand account of those heady days. I suspect many of you who are enjoying Vince’s series lived the experience first-hand in some of the 1970s-80s companies he has mentioned (and those he’ll be mentioning down the road). If so, Vince could use your old pictures and papers for future installments, but most of all, your anecdotes of what it was like back in the day.

E-mail Mr. H.

HITlaw 7/6/12

July 6, 2012 News 1 Comment

Practice Fracture and EMR Rights

Physician groups are signing up for EMR technology in a rush in order to meet eligibility deadlines for reimbursement under the HITECH Act. Unfortunately one of the key considerations in the process, the license agreement, is too often seen as a “last step” on the checklist. As I have urged in previous papers and postings, this should not be the case, as many items are overlooked in the push to acquire an EMR, implement, go live, and finally attest to Meaningful Use.

One important issue that is left unaddressed in the supermajority of licenses is transfer rights in the event of a practice split.

By split I do not mean the situation where a physician leaves a practice and the practice remains intact, because in those cases the license stays with the practice. No issue there. The departing doc takes nothing away in terms of license rights.

But when a practice splits and dissolves, what happens with the EMR license? How is data divided and protected? Who is responsible to the vendor for the security and confidentiality of the EMR system?

When licensing EMR technology (or any other type), the practice should negotiate terms for the perhaps unlikely but still possible situation of the practice breakup. The first request to the vendor should be an accommodation permitting the transfer of the license to multiple successor entities in the event of a breakup. Note that this will rarely, if ever, be without additional cost to the subsets of physicians, and many vendors have minimum provider thresholds, all of which is fair. If a vendor does not market customarily below a certain provider level, there is a reason, which is in most cases ongoing cost. They have determined the minimum sustainable level at which a product can be licensed, enhanced, and supported.

That said, the key issue here is the right to split the license should the need arise. No vendor wants to lose a client, and if the vendor can accommodate a license split, they actually increase their client base and revenue stream.

Next on the priority list would be some recognition by the vendor that in the event of a non-subscription-based license split, some accommodation will be made in terms of original license fee investment. (Quick sidebar – I exclude subscription-based systems because there is no upfront, perpetual license fee – it is simply pay as you go.)

With regard to non-subscription license fees, providers should not expect a known, predetermined allowance, as there are too many factors involved. For example, a five-provider license could be split into subsets of providers in 120 different ways, if my math skills are still up to par (5 factorial, or 5 x 4 x 3 x 2 x 1). Now do the math for a 10-provider license and you will be amazed at the number of combinations. Further, if the license is more than five or seven years old, the practice has in all likelihood taken a full depreciation on the initial investment and should keep this in mind.

I suggest that the most you could reasonably request is a statement that the vendor will make an accommodation of some type with regard to license fees, perhaps on a prorated basis allowing for depreciation and subject to the vendor’s minimum provider level. Prior implementation costs and support fees are clearly not eligible, as those services were provided and paid for. However, there may be a savings to be realized if minimal implementation and training are required by the new practices due to the familiarity with the incumbent vendor’s system. There is real incentive to the vendor to move from a single customer to multiple customers, with no sales effort, minimal implementation effort, and increased revenues, both one-time and recurring. The flip side is the customer should not expect to split a single license into multiple licenses and systems with no corresponding increase in fees, especially support fees.

Although not a pleasant topic, the practice breakup is a possibility, and having a pathway for continued use of the subject technology is important. If done up front, it means one less (or smaller) headache should the breakup occur.

Another very important issue is the data in the EMR. If a practice breaks up, what happens with the data? The first issue here is to determine what happens between the physicians with regard to their respective patients’ data. Consider record retention periods and ongoing access to records by patients or former patients. These are not issues for the vendor, and the best time for the practice to address these issues is when the EMR (or other) technology is acquired.

The associated request to the vendor should be a “transition services” accommodation. This should include the willingness to export or convert data to another vendor’s system should the practice at some point move to a different technology, obviously at a cost. Next you should discuss and investigate (before signing), the ramifications of splitting data into subsets, even if to populate new systems from the same incumbent vendor, and address those as well. Find out before implementation if there are any issues to consider regarding how the EMR or associated database should be structured.

Finally, when the practice breakup occurs, what happens with the original EMR system? The customer practice has obligations to the vendor. These must be carefully considered and fully performed. From the vendor’s point of view, it does not really matter which entity (original or successor) is responsible, but that there is an accountable entity involved. This may not be necessary if the original system is split and licensed anew to subsets of the practice, with the eventual result that there is no “old system.” However, too many times I have assisted vendor clients in situations where the provider customer expects new systems to be created with credit(s) or allowance(s) given for the original system, but then also expects to keep the original system alive and well and running in order to access historical data.

It doesn’t work that way, especially if the original practice is dissolved. The vendor needs protection. Providers should recognize that if you “want it both ways” you should expect to pay full price for the new systems, which is entirely fair. I have used the example many times that you cannot purchase a new car at a price based on trading in your old car, and then decide to keep the old car with no corresponding increase in price for the new car. Note there is also the reasonable middle ground where the old system may be accessed and “wound down,” with corresponding support fees, for a limited period of time after which the system goes away and the customer certifies this to the vendor.

When practices do not work out details ahead of time as to license and data ownership rights, the vendor gets drawn into the fray. As far as the vendor is concerned, the original licensee — the practice itself — is the holder of the license and the owner (as between vendor and customer that is) of the associated data. If you find yourself in this situation as a provider customer, develop a few options that might work between practice members and then approach the vendor.

Just keep in mind that no vendor wants to be asked to decide issues that are properly between practice members. If your EMR license agreement does not contain language permitting a partial license transfer for the benefit of practice members in the event of a practice split, you can imagine what might result. Some members might want to continue using the system and consider the license “theirs”. Others might seek to block that effort. Both might go to the vendor and ask for a ruling. For the benefit of all, I will repeat once again, address these issues up front at acquisition time.

In summary, practice groups should plan ahead when signing for new technology. Negotiate license transfer rights. Expect to pay something, but know you have established a transfer pathway. Determine between practice members what happens with the practice data if the practice breaks up. Discuss this with the vendor, address conversion of data in the license, and investigate database configuration options for implementation time. Do all this at the time the technology is acquired.

Time spent addressing important license issues at the acquisition stage helps avoid future problems, whether between practice members or the practice and the vendor.

William O’Toole is the founder of O’Toole Law Group of Duxbury, MA. You may contact him at wfo@otoolelawgroup.com and follow him on Twitter @OTooleLawHIT.

Time Capsule: Software: No, You May NOT Have It Your Way

July 6, 2012 Time Capsule 2 Comments

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 August 2007.

Software: No, You May NOT Have It Your Way
By Mr. HIStalk

mrhmedium

Healthcare IT is a lot more like McDonald’s than Burger King. When it comes to software, you may NOT have it your way.

Here’s a classic example. Well-intentioned clinical software sends alerts to doctors or pharmacists that a certain drug is eliminated by the kidney. Therefore, it nags incessantly, making sure you’re amply warned to reconsider the dose you’re ordering. Sometimes the warning is too stupid to even realize that the patient’s kidneys are normal – it just fires indiscriminately any time that drug is ordered.

That’s not terrible for inexperienced residents, but it’s darned annoying for specialists who spend their entire working lives dealing with patients and drugs like this. "I’m a nephrologist and this system thinks it knows more than me? Hah."

So, one might innocently ask, why must the computer treat all users as infuriatingly equal? Would it not make sense to allow those warnings to be selectively turned off for qualified users? Or, maybe clinical systems should work like some PC applications, where there’s a "basic" mode with limited available options and an "advanced" mode that opens up all kinds of cool but dangerous capabilities once you’ve proven your capability, kind of like a learner’s permit.

Much of the software in use today was built with the mainframe paradigm, i.e. users are stupid and programmers need to spank them if they dare make a mistake. Programmers usually have a deeply held contempt for non-geeky users. If the technology existed, they’d send 110 volts through the keyboards of imperfect users in some kind of Skinner-inspired operant conditioning experiment. I’ve been a programmer and we always dreamed longingly about this ("So he enters medical record number where it says visit number, and — ZAP! Read the screen next time, loser.")

PC and Web software has, in the mean time, progressed into this century. Amazon knows who you are, makes recommendations, lets you easily find your previous orders, and offers you deals on stuff it knows you’ll like. iGoogle lets you build your own home page and use your choice of hundreds of widgets that can do everything from showing your inbox to displaying the latest headlines from The Onion. When you want to do stuff in Windows, you can choose a friendly, step-by-step wizard instead of an imposing screen full of impending, cryptic warnings.

It’s no wonder that doctors and nurses are disappointed by the multi-million dollar systems we make them use. They’ve used the cool PC stuff. Using healthcare software is like waiting in the driver’s license line: everyone is treated contemptuously equal.

Here’s how it should work. The kidney expert gets a basic warning about a certain drug’s dosing in renal failure. A button should be right there that says, "Don’t show me these kinds of messages again." Just like Word’s spell checker, in other words. The doctor is a big boy or girl and can choose for themselves what’s useful and what’s not. Just because the computer has the capability to issue warnings doesn’t mean it should. You trust users to deliver care, so trust them to ignore unhelpful information.

Technically, this is not hard. Neither is personalization that allows users to customize menus, create their own subset of commonly used items, or create an inbox of the kinds of new information they’d like to see about their patients.

It’s no wonder that clinical users just can’t warm up to a computer system as a trusted ally when it often behaves like electronic idiot savant happy to fire off ignored and unwanted information to those who resent it.

News 7/6/12

July 5, 2012 News 1 Comment

Top News

7-5-2012 8-33-40 PM

Consumer Reports
rates hospitals on safety in the August issue just published, with a surprising number of the big names omitted from the top. The safest hospital in the country, says CR, is Billings Clinic (MT) with a score of 72 on a 100-point scale. The worst is Sacred Heart Hospital of Chicago, which racked up a 16. At the bottom of their respective states: Central Florida Regional Hospital (FL), South Fulton Medical Center (GA), Wake Forest Baptist Medical Center (NC), Medical Center of Lewisville (TX), and Clinch Valley Medical Center (VA). However,they could only review 18% of US hospitals because of missing or inconsistent information (there’s another IT challenge if you’re up for one). Criteria were infections, readmissions, communication, CT scanning, complications, and mortality. You can bet that hospital marketing people are spinning the numbers even as we speak given that even the top-rated hospitals still scored low.


Reader Comments

From Grizzled Veteran: “Re: e-MDs. Word on the street is that President and CEO Michael Stearns is no longer with the company. He’s no longer listed on their management page.” Unverified, but his bio has indeed been expunged.

7-5-2012 8-35-38 PM

From Jog: “Re: Baptist Memorial Memphis. A buddy told me they’re leaving McKesson for Epic.” Unverified.


HIStalk Announcements and Requests

7-5-2012 8-37-21 PM

inga_small The latest goodies from HIStalk Practice: attorney Jessica Shenfeld discusses four questions every physician in private practice should ask themselves. Hayes Management Consulting’s Rob Drewniak provides advice for practices to improve internal security and protect against security and privacy threats. Lawmakers introduce legislation that would allow behavioral health providers to participate in the MU program. AMA recommendations for practices weighing HIE options. If you are are not a regular HIStalk Practice reader, what are you waiting for? And if you are, thanks for reading.

7-5-2012 6-34-20 PM

I replaced HIStalk Mobile’s comment function with a version that improves readability, allows logging in with Facebook credentials, supports easy subscribing to comment updates, and allows easy sharing of comments with social networking sites. It has other functions that I’ve turned off for now, but look it over on this post and let me know if you think I should install it on HIStalk as well. Try posting a comment, but just remember it’s like HIStalk in that incessant spamming from overseas has forced me to approve each comment, so you may not see yours immediately.

Listening: Black Bonzo, Swedish rockers that sometimes sound like 1970s hard-rocking but musically precise prog bands like Uriah Heep, Deep Purple, and Kansas with a bit of Anglagard mixed in. They’re sporting big Mellotron and Hammond organ sounds, always a plus in my book. And if you’re looking for something laid back and different but still proggy, try fellow Swedes Moon Safari.


Sales

Oak and Main Surgical Center (NJ) selects SourceMedical’s Vision OnDemand for EHR and billing.

Gilbert Hospital and Florence Hospital at Anthem (AZ) choose the Healthcare Management Systems EHR.


People

7-5-2012 5-59-29 PM

Mobile health development tools vendor Diversinet names Bret W. Jorgensen (MDVIP) chairman of the board to succeed Albert Wahbe, who is retiring as chairman but keeping his board seat.


Other

Doctors at Australia’s Gold Coast Health say their new clinical system is “totally inadequate and dangerous” because of log-in problems, delays in finding records, and lost information. A hospital spokesperson admits that the system is “very bare-bones” and “does some things particularly poorly,” but they don’t have the money to fix the problems. The hospital’s rollout was part of a $200 million Cerner project by Queensland Health, which was accused of fast-tracking its Cerner selection by intentionally wording its proposal to exclude other vendors. 

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Also in Australia, a Canberra Hospital executive admits that the hospital changed dozens of ED records each day to make their publicly reported ED wait time stats look better. Auditors also found that the user accounts under which the records were altered were generic and had weak passwords that had never been changed. The auditors also noted that the iSoft system has a “feature” of not recording previous values when information is changed, making audit logs nearly worthless had the hospital checked them (which they hadn’t.)

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And in yet another Australia story, the government admits that its recently launched $480 million personally controlled health record system can’t accept patient names with hyphens, requiring online registration to be taken down right after go-live. Accenture gets the black eye, not only for that, but also because the system was hacked during development because of what the government says was sloppy Accenture security practices. Other reports suggest that Accenture completed only 40% of the agreed-on work by go-live. The president of the Australian Medical Association summarized the system’s launch as “throwing a paper plane out the window at Cape Canaveral.”

A newspaper in M*Modal’s home state of Tennessee questions why the company wants to sell itself for what some analysts are calling a too-low price of $1.1 billion, saying it’s worth at least $300 million more than that and that it would be better off pursuing its growth with a financial partner rather than a new owner. Several law firms are threatening to file the usual shareholder class action lawsuits that claim the company didn’t hold out for maximal shareholder return.

In Canada, Hotel-Dieu Grace Hospital rolls out a bed control smartphone app that displays available beds, expected discharges, and the length of time ED patients have waited for a bed.

Greenville County, SC pilots software in a program to triage low-acuity 911 calls to a nurse to determine if emergency response is warranted. The chief medical officer of Greenville Hospital System says that 5% of patients use 50% of the system’s ED resources, with 61 patients accounting for 1,000 visits in one year (with one patient racking up 100) and most of them weren’t really emergencies. They cite figures saying that connecting patients to a medical home, managing their care, and helping them with transportation and prescription costs reduced the ED visits by 26% and patient days by 55%. The county says 20% of the 911 calls it gets are for non-emergency situations, but it is still required to send an ambulance at a trip cost of $280. The software they’re using isn’t named, but is used nationally in the UK.

7-5-2012 7-30-45 PM

Methodist Dallas Medical Center (TX) suspends its kidney and pancreas donor program after transplanting a donated kidney into a patient who wasn’t next in line on the recipient list. The hospital blames human error – the donor ID number wasn’t matched to the recipient.

UnitedHealthcare launches its Blue Button program, which like the original VA program will allow its 26 million insurance enrollees to view, print, and download their health information by mid-2013.

Access to medical care isn’t a problem for some: the governor of Iowa is hospitalized “out of an overabundance of caution” after choking on a carrot and vomiting it up during a ceremony.

7-5-2012 8-46-54 PM

Only in America: a New Jersey woman hit in the face by a baseball at a Little League game two years ago says the 11-year-old catcher did it intentionally when he overthrew the pitcher he was warming up in the bullpen. She’s suing him for medical costs plus pain and suffering, plus her husband has added his own damages of loss of her apparently valuable consort to raise their demand to $500K. The boy’s parents, both Little League volunteers, say they’d like to beat the charges in court, but it would cost thousands of dollars and require the young players to take the stand. The Little League national organization has refused to get involved.


Sponsor Updates

7-5-2012 8-48-30 PM

  • Sunquest Information Systems hosts its annual users group conference August 6-10 in Phoenix.
  • ZirMed earns full EHNAC HNAP certification.
  • CSI Healthcare IT spotlights its 2011 sales leader, Bryan Richardson.
  • NextGen’s parent company Quality Systems Inc. wins two Gold Stevie Awards in the 10th Annual American Business Awards.
  • CPU Medical Management Systems, a division of MED3OOO, releases Version 7.01 of its MED/FM practice management and billing software.
  • Consultant Cynthia Castro discusses the ease of the 5010 conversion process using Kareo’s software.
  • NextGate posts a fun story highlighting the travel adventures and challenges of two of its engineers implementing NextGate EMPI in Spain. 
  • Lancet joins the Informatica INFORM Channel Partner Program.
  • nVoq director Derek Plansky discusses the advantages of using speech recognition with CPOE.

EPtalk by Dr. Jayne

The AMA reports that through efforts to process health insurance claims more effectively, more than $8 billion has been put back into the US healthcare system. I’m not sure where the savings has gone. The report mentions that physicians had to spend more time on prior authorizations, adding $728 million in “unnecessary administrative costs and countless hassles.” I’m betting that much of the savings went into for-profit coffers.

No surprise: a study published last month found no association between patient satisfaction and a practice’s adoption of patient-centered medical home processes. A researcher states, “It may lead to better care for the patient, but some of these things maybe turn these places into factories.” Based on anecdotal evidence from the Medicare beneficiaries in my family, I don’t disagree. Team care results in less face time with their physicians. Even though patients get better diabetic care, they don’t perceive it as having as much value as chatting directly with their physicians (even about subjects unrelated to their care).

A bill recently passed in the Pennsylvania Senate moves the Keystone State closer to its first statewide health information exchange. Governor Tom Corbett plans to sign it, setting up the Pennsylvania eHealth Partnership Authority to oversee its development. The goal is a decentralized system to connect regional private HIEs currently under construction.

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Citrix offers a video promoting the ability for physicians to always be accessible “whether it’s in the middle of the night or on their day off.” Grammar issues aside, I’m not in favor of the idea that physicians need to be accessible 24×7. I see too many burned out docs on a daily basis. New technologies allow them to access charts from everywhere, making them reluctant to sign out to covering partners. Allowing people time to unplug and participate in self-care activities is essential to promoting healthy caregivers. I know the kind of decisions I make when I receive a phone call at 2 a.m. while I’m on vacation, and they’re generally not at the level I want to deliver where patients are concerned.

For ambulatory EHR developers: a recent study finds that more than 25% of American teens have sent nude photos of themselves electronically. The authors suggest that physicians who care for teens ask them about sexting practices. It’s time to think about adding some new questions to those well-child visit templates, I suppose.

7-5-2012 6-08-32 PM

Quote of the day: “Harassment is supposed to be sexy. You’re not even doing it right.” Thanks to one of my favorite consultants, I was recently introduced to Better Off Ted. For those of you who haven’t seen it, the plot revolves around the R&D department of a soulless conglomerate. In some ways it reminds me of our industry. Episodes are 21 minutes long, which is just the right length to take a break but not feel like you’re idly wasting time.

Thanks again to all the readers who sent birthday wishes on Facebook, Twitter, and e-mail. It was nice to receive them throughout the day and they helped mitigate any dread of being a year older. I’m pretty sure being a CMIO ages one more rapidly than other careers. However, I’m content knowing that with age comes wisdom (or at least the sense of having been there and done that, and knowing how much heartburn a new project will bring when you see it coming 50 yards away).


Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

HIStalk Interviews Ralph Fargnoli, CEO, Beacon Partners

July 4, 2012 Interviews 3 Comments

Ralph Fargnoli, Jr. is president and CEO of Beacon Partners of Weymouth, MA.

7-4-2012 7-01-48 PM

Tell me about yourself and the company.

I started my healthcare career in a health system in Rhode Island that was an early adaptor of technology. I started working at IDS up on Commonwealth Avenue in Boston in 1983. That really put me into the forefront of healthcare systems, working for Paul Egerman. I worked at IDS, which changed their name to IDX, until 1988. 

I was managing many implementations. What I saw in the management of those implementations was that they were hiring consultants. The consultants were at the time, I think, Big 8 or Big 10. I felt that I had some things to offer the other side of the table, and instead of working on the vendor side, working on the consulting side. 

I left IDX and started Beacon Partners in 1989. The goal was to provide healthcare professionals with experienced healthcare professionals who understood their business, who understood the technology and how it would impact their business. From there, Beacon has grown substantially from a small company focused mainly on IDX to 300 employees, with service lines of the major vendors including IDX, Epic, Meditech, and Siemens.

We’ve been shifting our business to be more strategic in nature over the last three years. We are focusing more on strategic planning, working with many organizations about aligning physicians, changing over legacy systems, ICD-10, security, and so forth. The business model has changed from just providing implementation and project management services into strategic areas.

Beacon Partners is a national firm. We have clients from Hawaii to Puerto Rico – actually to Ireland — and of course, in Canada. We have a Canadian practice with clients in most of the provinces except Quebec. 

The growth has been exciting. It has been fueled by technology, but also all the opportunities with regard to the regulatory and compliance issues that are either being mandated or pushed into the provider world by the federal or the state government. We’ve put together a good senior leadership team, and you’ll see announcements about new people who are joining the company. 

It’s an exciting time to be in this business. We look for another five to 10 years of growth and opportunity for everyone in the company.

 

Do your customers care about innovation and competitive advantage when they’re choosing systems vendors? Or are they just trying to make modest process changes and measure those in hopes of learning from the data what they should do next?

My perception is that customers are trying to find some type of innovation, something that will help their patients and their provision of medical services and in getting to data to help them with patient care. But it looks like to me it’s unknown whether that will be the ultimate outcome of all these major investments that are going on right now.

We see a lot of demand for vendor software, but what I also see is that it seems to be a market play. Let’s get as much software in as we can, then we’ll go back and optimize it and see what kind of data we want to get out of our system. So to me, it’s more of a technology push. 

I think we also see that in the studies that are being done, physicians are not really bought into all this technology. They feel it’s interfering, or that it’s not the right software for them to practice medicine so far. 

I think that the innovation of how to use data to enhance patient care will be over the next three to five years, versus what we see going on right now, which is basically just a technology replacement and adaption.

 

Have you seen examples where someone truly got a lot better clinically or operationally by just installing something?

I can say that in some of our clients, we have seen that they’re starting to use the data in their research or they’re trying to understand patient access and looking at opportunities for more advanced service lines for patient care. We’re starting to look at that. I also see data analysis for cost controls and understanding what their true costs are.

I think we all know about the Kaisers of the world and Mayo Clinics and Cleveland Clinics. They seem to be at the forefront. I think many organizations need to understand how they’ve turned their technology investments to a competitive advantage, because I see many of our clients still at that phase where they’re trying to get the systems installed and have some type of realization on those investments.

 

Their model is different than 99% of what goes on in hospitals and they can afford technologies that nobody else can. Can what we learn from them be plugged into the average 200-bed community hospital?

That’s going to be very difficult. Kaiser is a not-for-profit, but it’s a well-run business corporation that provides medical services. The 200-bed  community hospital is not there. They’re not business people. They’re not driving it towards running it like business. I think they’re caught up with the patient care aspect of it and the patient services, which is their mission, but they truly need to take a step back and say, “That’s our mission, but how do we do this in the best way to maximize these investments, to get realization of these costs so we can contain them for the future of our mission?”

I think many organizations look at it independently. I look at it that we have technology, we have patient care, we have our physicians. If you look at some of these organizations and the way they’re integrated in their communication of technology and how we’re going to use it, it seems to me very siloed. They’re not there yet.

 

Will reimbursement and policy changes, along with the difficulty in delivering technology, do the same as it did for the solo independent physician practice, to the point that it will no longer be practical to run a 100-bed unaffiliated community hospital?

I do think that most, if not all, of the community hospitals will eventually have to align. It’s interesting here in Massachusetts. We have a very good community hospital, South Shore Hospital, that is now aligning itself with Partners HealthCare System. It has been a strongly-willed independent, but they need access to specialty care to drive their competitive nature. They’re aligning themselves with Partners because they need the dollars for the specialty care. They also want a more competitive edge against other community hospitals that are also forming their own smaller systems. You see the physicians not only aligning, but actually becoming employed by these hospitals.

I see a trend where you’ll have a network of the smaller community hospitals, but they will try to maintain their independence like South Shore. South Shore Hospital is going maintain their independence to some degree and the physicians will become employed, but I think they all have to be at some point integrated to maximize technology investments, to maximize data exchange, and to control their costs. They all realize that with all the specialties out there now and new technologies for medicine, they all can’t afford it. They all can’t just be independent in that degree and make those investments, so they have to leverage each other at what they’re good at. I think that will evolve over the next couple of years.

 

Meaningful Use has been good for the healthcare IT business. Do you think it’s been good for providers and patients?

I’m not sure how much patients know about Meaningful Use in the sense of technology adaption. I think providers look at it with some degree of angst, especially some of our senior providers. There seem to be mandates and a lot of push, that Meaningful Use dollars to grab the incentives and avoid the penalties. From an organizational standpoint, it helps with the investment. Of course it doesn’t pay – I  would be surprised if it paid for 25% or 30% of the total cost of the investment.

Some providers are definitely excited about the adaption, but I think some of them are finding hurdles to it. Now they have to change their work flows. It’s not necessarily the way they’ve practice medicine for years. What we see out there is a lot of hesitancy, a lot of training and educational issues.

On the patient side, we see some questions about, “Why is he staring at his computer? Why is he typing and not paying attention?”

We have many of these physician rollouts going on. The word from the consultants is that patients seems to be curious about the technology and there is a learning for physicians to try to balance the patient attention versus getting the information into their system. It’s definitely going to be a learning curve for both the patient and the provider and how to interact with each other in the technology.

Until the patient sees the benefit for being at home and being able to access portions of their medical record to see their lab results — that’s happening today, but as more and more get that access, we’ll see a better response to it all around. I think even the physicians eventually will see that this is a good use of technology so they don’t have to make phone calls and push out letters and so forth.

 

A lot of the attention of the providers is being directed toward Meaningful Use and implementing the systems required to get the financial carrot. When do you see that tapering off, and then what’s the next hot issue waiting in the wings?

I think Meaningful Use will start to end probably around the 2016 timeframe, but I think the technology adaption will be around for at least five to 10 years. I look at what we see as some deficiencies in technology out there. There’s just so much to be done that the market, from a technology adaption standpoint, could go on for the next five to 10 years. Meaningful Use, because of the timeframe that the government has put in place — there’s a great push to avoid the penalties. When we get to the penalty side — like anything else that happens in healthcare and with the government — they could say, “We’re not going to penalize you. We’ll push it out for another year.” 

What also is driving our business and others like us is the changeover in ICD-10. That’s going to be a major project for many organizations. I believe that most of them are not prepared to take this on. They’re not thinking about how it impacts their downstream revenue when this happens. 

We also have security of patient information as we pass data from organization to organization through HIEs. That’s something that we see as a business driver also, because there’s a lot of questions out there. How do protect the PHI? As you probably see, we’re not very good at it yet. We seem to have PHI on laptops and USB drives. We have basic password issues. 

Business intelligence and understanding data from all these investments that we’re making is going to be a large business driver for us and others the next five years.

 

Any concluding thoughts?

We seem to be spending an awful lot of money adapting technology. Organizations that are no more than maybe five miles apart are spending $75-$100 million to adapt similar technology as a competitor down the street. At some point, some of these boards that approve these projects are going to be asking “We spent this money. Are we getting the ROI and meeting the expectations from these big investments?” Many of these boards are approving these large implementations and procurements of these systems, but not really understanding the magnitude of what it takes to get this done.

As we progress over the next couple of years, this is going to be a business driver. We see it as an opportunity, if you have the right people, to help these organizations be successful. I also believe that someone needs to take a step back and look at this and say, “Do we have the people? Where are we going to get the resources?” 

I think that they’ll be questioning whether these investments are paying off. Also, whether they can use the data they have collected to improve and enhance patient care.

Over the next three to five years, those questions will be asked. It will be interesting to see what those answers come out to be. I’d still question many of these organizations spending these dollars very independently from each other. Why not together?

News 7/4/12

July 3, 2012 News 7 Comments

Top News

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Speech recognition vendor M*Modal will be acquired by the private equity arm of JP Morgan Chase for $1.1 billion in cash, representing an 8.3% premium over Monday’s closing share price. Philips owned a 70% share of MedQuist until 2008, when it sold its shares to CBay for $200 million. The resulting MedQuist Holdings then acquired bankrupt transcription vendor Spheris in 2010, acquired M*Modal in July 2011 for $130 million, and then took that company’s name in January 2012.


Reader Comments

From HISEsq: “Re: Cerner. Sued for patent infringement by a patent troll named CeeColor, whose only claim to fame seems to be suing HIT and security companies.” CeeColor’s intellectual property, like that of other patent trolls, is vaguely described. In their case, it’s a proximity-based computer security system. I mentioned in March that the same company sued Imprivata claiming similar infringement. Googling their name turns up nothing but lawsuit filings, so one might logically assume all they have is a patent bought elsewhere and a lawyer with lots of free time available to hound companies into paying them “licensing fees.”

7-3-2012 7-25-35 PM

From Reppin’: “Re: GSK. You should run the GSK Las Vegas sales kickoff video if you can find it. That’s what’s wrong with healthcare. The big boys scream to government, ‘Get off our backs, we can regulate ourselves.’ They can’t, and a $3 billion fine is nothing to them. Executives should have been fired. They aren’t alone: Abbott, Pfizer, etc.” Drug maker GlaxoSmithKline will pay $3 billion for promoting two of its popular drugs for unapproved uses and for hiding safety information about a third drug. Its marketing tactics included sending doctors on pheasant hunting trips to Europe and paying them for speaking. GSK pushed doctors to prescribe Paxil for depression in children even though the drug was not approved by the FDA for patients under 18. GSK says it has learned its lesson, which would be remarkable given the very long list of similar problems the company has bought its way out of over years (overbilling Medicaid, charging third-world countries high prices for AIDS drugs, adulterating drugs, dodging US taxes, and hiding drug side effects.) Company profits dropped in the most recent quarter to a “disappointing” $2.1 billion, so the “huge” fine amounts to around 18 weeks’ of profit. Maybe that’s the lesson they’ve learned – settlement payouts for arguably criminal wrongdoing are just a marketing cost. If it were me, I’d go after the docs who were willing to place their patients in danger for perks – publishing their names publicly should have been a condition of the settlement. We know drug companies often lean toward scumbaggery given ample opportunity, but they didn’t take the Hippocratic Oath and represent themselves as the patient’s advocate while pimping out their prescription pads.

From Luis: “Re: GSK. Cleveland Clinic is mentioned. Did they find the drug problems with data mining out of Epic?” The original journal article was published by Steven Nissen MD, chairman of cardiovascular medicine at Cleveland Clinic and drug company critic. He did the legwork proving that Vioxx and Avandia cause problems, leading to an FDA crackdown on their use. Above is an interview in which he talks about healthcare reform and how Cleveland Clinic is different. They went live on Epic on the ambulatory side in 2000, so they may well have dug into their own data to link drugs to patient harm. Even if they didn’t, many health systems will be able to do that going forward – all they need is enough patients to make a valid sample size.

From GreenGiant: “Re: Valley Medical Center, Renton, WA. Live on Epic ambulatory on July 2.” I apparently missed the link on their main page. Its board voted in December 2010 to move from McKesson to Epic.

From HIT Guy: “Re: fat-producing foods. The Supreme Court talks about broccoli, healthcare firms punish obese workers, and Vince Ciotti talks about making certain foods expensive. Science is now saying that diets that were previously thought good for you aren’t, and the early studies were good examples of how not to do a study.” A New York Times article talks up a theory that I believe in firmly: weight isn’t as simple as calories in minus calories out, with a new study finding that it’s more about the carbs consumed than the calories. My theory is that weight problems are due to fat storage and insulin regulation (i.e., the hypoglycemic index), not just taking in more calories than are burned off. I also believe that not all exercise is created equal, and pure cardio is good but building muscle is better. You can run your butt off on the treadmill for an hour and only burn the equivalent of a candy bar, so that’s not going to work for most folks unless their body composition changes.

From James: “Re: healthcare system repair. Taiwan was a free market system like ours and became one of the best by going with a single payer, which gets the full pool of money for both healthy and sick patients, can’t cherry pick the young and healthy, negotiates prices with providers and manufacturers, and makes judgments for what to reimburse. Private payers still have a crucial role for all the stuff that the main payer doesn’t cover, like physical therapy, allied health, home care, etc.” I’m frustrated enough with the current non-system here that this alternative is sounding attractive.

From Tom: “Re: healthcare system repair. If I could change one thing, it would be to eliminate employer-based health insurance, a remnant of the World War II era. Individuals buying insurance directly from payers improves continuity of care, removes a major employer cost, incents individuals to manage their health, and reinforces the need for interoperability. It would open the floodgates on HIT innovation and use of tools such as mHealth and PHRs.” I’m becoming cynical that any solution that involves insurance is doomed. Not only because insurance companies will always find ways to make a profit from healthcare, but because healthcare insurance covers more than just catastrophic situations. Homeowner’s insurance is relatively inexpensive because you collect significant amounts only if you suffer major damage, which nobody in their right mind wants, so if we all pay a little everybody is spared from losing their home due to a tornado or fire. Imagine the cost of homeowner’s insurance if it covered every possible problem with appliances, appearance, and the lawn and business were created around collecting inflated payments for providing those services. Not only would policies be priced out of reach, services would become so expensive that you’d have to have insurance to afford them, causing prices to just keep going up to everybody’s benefit except the person needing the service. I’d like to see the concept of healthcare separated completely from the requirement of buying a third-party company’s actuarial bet that you’ll consume less of it than they charge you.

7-3-2012 8-32-16 PM

From SW: “Re: ACA. Stan Hupfeld, former president and CEO of Integris Health, wrote an excellent book summarizing the Affordable Care Act, why solutions for other countries won’t or can’t apply here, and how neither party serves us well.”

From CIO: “Re: ROI due diligence on clinical systems. My organization is spending many dozens of millions to install inpatient clinicals. We paid attention to ROI, but it was not the driving factor, and actually I am grateful for that. Proving out a hard ROI is not only a challenge, but I think it diverts attention from the real reasons an organization may want to pursue a new system. Our organization changed our IT strategy after years of integration issues from a ‘best of breed’ to ‘integrated clinical system.’ We did this prior to the guarantee of Meaningful Use funding because we felt it was the right direction for our organization and patient safety. As a part of our new system installations, we resolved a number clinical and IT data exchange issues that have improved patient safety measurably. One small example relates to interface issues with messages erroring out, requiring manual work to resolve the specific problem. On occasion this included patient allergies and other vital data. And for those of you in the industry, you know all the other examples of data exchange challenges that also impacted best of breed approaches. We could have put a price on risk / actual claims / patient harm for this and related issues, but we kept on focus on the improvements we wanted and not the dollars. And frankly with all the other challenges pressing down on hospitals, I take some pride in knowing that we have a safer environment with our new system than our prior ones. This approach may not stand up to real accounting scrutiny, but I think the real question is, ‘Are patients materially safer?’ For us, the answer is yes.” 

From Bruce Brandes: “Re: Pliny’s question about FDA regulatory oversight of mobile apps. What Pliny is describing is a clinical decision support system. FDA considers these to be at least Class 1 medical devices per their mobile medical app guidance. Where the data is processed is not important. If the input and display take place on a device, whether it’s a mobile app, web page, terminal application, hardware/software product, then the device is a medical device and subject to regulatory oversight. The determination of whether the device is considered Class 1 or 2 depends on the risk to the patient attributed to a misdiagnosis or delay in treatment. From a regulatory standpoint, class 1 and class 2 devices require the company establish and maintain the same quality management system and design and servicing controls. The only difference is Class 2 devices require premarket approval by FDA, Class 1 devices do not.” Bruce is EVP and chief strategy officer of AirStrip Technologies, which has a lot of experience working within FDA guidelines. I’ve always assumed that most of the healthcare apps out there weren’t created with the FDA in mind, but maybe I’m wrong. Feel free to chime in.


Acquisitions, Funding, Business, and Stock

7-3-2012 6-52-11 PM

HealthStream acquires Decision Critical, an Austin, TX-based provider of learning and competency management products for acute care hospitals, for $4.3 million.

7-3-2012 6-51-20 PM

Dell will purchase IT management software provider Quest Software for $2.4 billion.

Microsoft announces a $6.2 billion write-down of the $6.3 billion in cash it paid to buy online advertising company aQuantive in May 2007.


Announcements and Implementations

7-3-2012 10-22-02 PM

Catskill Regional Medical Center (NY) goes live on Epic in its two hospitals of 235 and 25 beds.

Grand Itasca Clinic and Hospital (MN) announces a partnership with Allina Health System to install Excellian, Allina’s version of Epic. Allina will provide implementation assistance and support.

The local paper highlights the T-System and NextGen implementation of White Mountain Regional Medical Center (AZ).

7-3-2012 7-44-13 PM

David Runt, CIO of Contra Costa Health Services (CA), tells me that they went live on Epic (called ccLink at their place) on July 1 enterprise-wide (hospital, clinics, and health plan.) I notice from David’s LinkedIn profile that he spent 22 years as a medical service corps officer in the US Air Force Medical Service, so I’ll throw out an Independence Day nod to David and his fellow veterans for their service.

In the UK, Cerner complains to Cambridge University Hospitals Foundation Trust that its EHR bidding process was a sham and it had already chosen Epic without regard to submitted prices. The trust says it followed the rules when it picked Epic in April.

Oracle announces its Health Sciences Network for developing and conducting clinical trials, working with Aurora Health Care and UPMC to create a cloud-based system to manage de-identified patient information from member providers. Aurora was a key player, providing its patient information in hopes of improving its work in several hundred research studies. Expected challenges include the possible unwillingness of academic medical centers to participate, the difficulty in combining information from a variety of proprietary EHR data formats, and the storage required to eventually add genomic information.

Caradigm, the Microsoft-GE Healthcare joint venture, announces that the number of active users of its identity and access management solutions (Vergence, expreSSO, and Way2Care) has increased by 50% in the past 18 months.


Government and Politics

A proposed California bill would change the Confidentiality of Medical Information Act, which allows patients to sue healthcare providers for up to $1,000 per breached medical record. AB 439 would eliminate damage awards for first offenses and in some cases for repeat offenses if the provider notifies patients whose records were exposed and takes preventive action. The bill’s sponsor is McKesson.


Innovation and Research

7-3-2012 7-51-50 PM

The for-profit technology subsidiary of Palomar Health Foundation, which operates Palomar Pomerado Health (CA), announces that AirStrip Technologies has acquired exclusive rights to its MIAA mobile EMR viewer application. I first wrote about it in February 2011 when Cisco was helping pay for its development.

DataMotion files a provisional patent for a Direct Project-based secure e-mail messaging system for patients and providers.


Other

7-3-2012 9-01-15 PM

A London Daily Mail article covers Epic Systems. It’s loaded with snark and off-topic rants, but says that not only will Epic sign a $16 million, two-trust contract, but will soon take on another two hospitals in England and most likely bag more as each trust makes their own decisions and sees the value of using Epic as a data-sharing replacement for the failed NPfIT. It describes Judy Faulkner as “a 68-year-old Harley-Davidson-riding friend of President Barack Obama” who lives in a “nice, but not palatial” house. The paper tried to pry information from someone who answered the phone at Epic and was told, “Your messages have been passed on, and if we want to get back to you, we will.” It speculates that the massive Verona campus expansion was spurred by the likelihood of Epic’s expansion in England.

Another Epic article, this one from Wisconsin, describes the company’s construction boom, with its reporters counting 12 construction cranes hovering overhead. The company expected to hire 300 more employees in June and 1,000 more for the year, bringing its total to over 6,000 (and another 750 expected next year). The Farm Campus will add another 1,000 offices, underground parking for 1,000 cars, and the 11,000-seat auditorium that looks like a UFO crashed and buried itself into cow field. The article says the new construction on the 811-acre campus is valued at around $400 million, with 1,300 construction workers on site making it the biggest construction job in the Midwest.

Orthopedic surgeon Larry Bone MD (I’m not making that up) finishes up basic training and is shipping off to Afghanistan for a three-month tour of duty as a battlefield trauma surgeon. He’s 64. The head of orthopedic surgery at the University of Buffalo wants to give back for the treatment his son received after an IED explosion in Iraq six years ago.

A JAMIA article evaluates CPOE orders that are cancelled and then immediately re-entered on a different patient, concluding that over 5,000 orders per year are being entered on the wrong patient. The proposed solution: make physicians enter the patient ID twice before allowing order entry.

In England, a 22-year-old teaching hospital cancer patient becomes delirious from dehydration and missed meds, finally dialing the equivalent of 911 to say he’s thirsty and nobody will give him water. Nurses send police away when they arrive, but the patient dies shortly afterward. His mother, who says her son was restrained, sedated, and ignored in his room the night before he died, said a nurse asked afterward, “Can I bag him up?”


Sponsor Updates

  • Bottomline Technologies offers webinars on payments and cash management.
  • RelayHealth shares details of its role in preparing for ICD-10.
  • Liaison Healthcare Informatics will provide awareness activities in support of National Health IT Week September 10-15. Liason is also sponsoring NCHICA’s quarterly roundtable meetings for CIOs and CMOs/CMIOs.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Readers Write 7/2/12

July 2, 2012 Readers Write 8 Comments

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

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


ICD-10: The ED Effect
By Robert Hitchcock, MD, FACEP

7-2-2012 7-20-38 PM

As I visit current and prospective hospital clients, they openly express uneasiness about their organizations’ finances. Market forces are squeezing margins and expectations are high that Medicare and private payers will continue cutting reimbursement rates. These challenges are only intensified by ICD-10 and Meaningful Use mandates.

In the 20-plus years I’ve worked in healthcare, I’ve seen no other initiative with the potential to impact hospitals more greatly than ICD-10. With one-half of all inpatient admissions and 45% of a hospital’s overall revenue, the emergency department in particular can help define whether or not this impact will be positive or negative. As the population ages, patient volumes will continue to multiply, and the ED will need to keep up in order to keep the hospital financially afloat.

Most hospitals are anticipating – and depending upon – their departmental or enterprise EHR vendors to provide the necessary changes that will facilitate the capture of the appropriate information needed for ICD-10 coding. Unfortunately, however, some key hospital executives fail to recognize that very different approaches can be taken when implementing ICD-10 in clinical applications.

It is imperative that these executives evaluate how a solution will achieve compliance. How will content be built and maintained? How will ICD-10 codes be generated? How will the system work to maintain productivity? The method for compliance can represent success on one end of the spectrum and failure on the other end – each with tremendous financial implications.

If the vendor does not provide and maintain standardized encoded clinical content for documentation but instead offers “fully customizable content,” the client will be required to update and maintain an extensive data set with the corresponding ICD-10 terminology and/or codes. While a money-saving approach for the vendor, it will mean significant costs to the client.

If the vendor chooses to simply use an ICD-10 clinical terminology look-up function that is not integrated with other clinical content in the application, it could limit the ability of the application to re-use previously recorded information, requiring duplicate documentation. This presents another productivity burden to the clinician.

In terms of ICD-10 code generation, some software designs will offload to the physician the burden of navigating long lists of possible code-able terms to search for the most appropriate clinical diagnoses. ICD-10 represents a vast increase in the number and specificity of codes from ICD-9. As a result, physicians may fail to complete this part of the documentation or choose less definitive diagnoses when and where it saves time. This can negatively impact reimbursement as well as reporting for regulatory compliance, risk management, conformance to clinical polices, etc. Instead, having codes that are generated automatically based on providers’ documentation will not impede clinician workflow, productivity and, ultimately, documentation quality.

To obtain accurate, discrete data for analysis and reporting, physicians must embrace the user interface design of the application. Good data analysis requires a foundation of good data collection. Like CPOE, if the clinical workflow and user interface is well designed, potential benefits are quickly realized. If designed poorly, the results can be agonizing.

The increased specificity of ICD-10 will drive more than just reimbursement, magnifying the impact of the ICD-10 implementation for better or worse. Additional granularity, if accurate, can facilitate many other processes that also have financial implications to the ED and hospital, such as risk management, regulatory reporting, quality initiatives, clinical decision support, and metrics for productivity, patient throughput, ordering of tests, and resource utilization.

As well, ICD-10 has the potential to offer easier and tighter system interoperability. A standardized coding system requires that all systems speak the same language, freeing hospitals to choose the best possible technology for the ED. Indeed, having disparate but interoperable systems in the ED and inpatient environments no longer has to present the same challenges it has in the past.

My advice to those solving for ICD-10: Look beyond the basic issue of compliance and choose technology that will truly optimize the ED. It is the front door to your hospital, the start of the patient record, and the key to your organization’s prosperity. I would hate for any hospital to have to experience the frustrations and wasted expenses associated with having to rip out a system and replace it. 

Robert Hitchcock MD, FACEP is vice president and chief medical informatics officer of T-System of Dallas, TX.


Standardized Data Just the Start in Making Data Usable at the Point of Care
By Jay Anders, MD

7-2-2012 7-30-44 PM

3M Health Systems recently announced it will open access to its Healthcare Data Dictionary, which translates standard terminologies and enables semantic interoperability between disparate systems. 3M made this move to meet contract conditions with the VA and Department of Defense, which are using the Data Dictionary to facilitate interoperability for their joint EHR.

The news is significant for several reasons. By making its Healthcare Data Dictionary free, providers and vendors have access to tools that translate a collection of clinical terms in a variety of standard terminologies such as RxNorm, ICD-9, ICD-10, LOINC, and SNOMED. A common language for clinical terms facilitates data standardization, analysis, and exchange.

When data is available in a standardized format, health information exchange is easier. The interoperability of clinical data is essential for Meaningful Use and the cornerstone for new reimbursement models that emphasize outcomes and accountability for patient health over traditional patient encounter volume.

The need for tools that decipher disparate but related clinical concepts will continue to grow exponentially in coming years. The healthcare industry relies on standard terminologies to move information between providers, and many stakeholders are calling for even more standards for files, codes, and other data.

The proliferation of standards aids data exchange, but the data is of limited value without means to disseminate the information and then to make it usable by clinicians. Clinical data mapping addresses part of this problem.

Payers and clinical researchers, for example, rely on clinical data to analyze financial and health trends. Data mining on a large scale is nearly impossible without technology that identifies common concepts, regardless of the terminology.

Similarly, Accountable Care Organizations and HIEs require tools to make sense of vast amounts of data from physicians, health systems, and other providers. Clinical data mapping enables the efficient identification and accurate interpretation of the information required for ACO and HIE analysis and reporting.

Given the amount of clinical data which is about to flood the industry, organizations must have methods in place to both exchange and store clinical data in standardized formats, and to make the clinical data usable at the point of care.

These are not the same.

In addition to 3M’s Health Data Dictionary, there are clinical data technologies and tools available from Clinical Architecture, Health Language, Inc., Intelligent Medical Objects, Medicomp Systems, and others. Regardless of which one of these is chosen to exchange and store clinical data, it is also necessary to organize and present clinical information to the clinician during the patient encounter.

For example, for a patient with five existing clinical conditions, the provider needs to be able to instantly see the clinical data relevant to renal failure, as opposed to their diabetes, hypertension, arthritis, or migraine headaches. Once the HIEs are up and running, there may be thousands of clinical data points for a single patient.

What is needed is an engine to organize and present clinical information at the point of care. This requires millions of links between data points to filter, analyze, and present data relevant for that specific patient encounter.

This is critical in enabling physicians to follow their own thought process and make sense of the flood of clinical data. Widespread standardization and sharing of clinical data between systems has the potential to enhance the quality of healthcare. The power and potential of clinical data is truly realized when data is delivered and made usable at the point of care.

Jay Anders, MD is chief medical information officer of MED3OOO of Pittsburgh, PA.


Healthcare Cure?
By Vince Ciotti

The idea is simple: keep people healthy. We do a great job of treating those who are already sick, but it is costing us far too much, whether through taxes, premiums, or deductibles and co-pays. How to keep people healthy? Discourage them from getting sick. How to do that? Make the cost of things that make them sick prohibitive. How do we do that? Pass the cost of curing sick people on to those products that cause specific, preventable illness.

One of the leading cancer killers today is lung cancer, pretty directly attributable to smoking. Best way to break the smoking cycle? Turn our capitalist free-market system loose by passing the cost of treating lung cancer directly on to those who smoke, until the price is so prohibitive they cease to buy tobacco. Thanks to PPS and DRGS, we know what treating most specific diseases cost. Let’s say last year the ≈300,000 people who died from lung cancer cost us taxpayers about $100,000 each to treat. That’s roughly $300B in taxes and premiums we all paid for their care. Now allocate that $300B across the tobacco companies based on their revenue. That’s a pretty stiff hit on any company’s bottom line, so they’d have to triple or quadruple the price of cigarettes to $20 or even $30 a pack to maintain a decent profit margin.

By letting the free market accurately reflect the healthcare cost of a given product, we consumers would be a lot wiser in buying unhealthy products, and their manufacturers would have to develop healthy alternatives or see their revenue gradually dry up. Farmers would have to plant other crops, and the many attorneys who file tobacco lawsuits would have to find other segments of society to represent.

Let’s shift to another easy target: obesity. Pass the cost of treating diabetes on to sugar manufacturers. Not a tax, but an invoice for what they are costing us in health care to treat diabetes. Like tobacco manufacturers, they would have to raise the price of their product to cover the resulting health care cost. Now, Wheat Checks and Al Bran would only cost a fraction of what sugar-laden cereals cost and more people would buy them, catching manufacturers’ attention. So on and on, with every disease that is directly attributable to a specific product or ingredient: mesothelioma and asbestos, cirrhosis and alcohol, heart attacks and cholesterol, melanoma and tanning booths. 

It would be a bitch to set up. Many politicians, their PACS, and lobbyists would fight hard every step of the way for each disease being targeted. Maybe we should pass the cost of treating heart attacks and ulcers on to them. Jobs would be created for medical experts, economists, and statisticians. Jobs would be lost for lawyers, doctors, and marketers.

In the long run, consumers would follow their wallets to those products that cost the least, once they included healthcare costs, and avoid those products that cost the most, because of high healthcare costs. That’s the beauty of capitalism’s free-market way. This is an economic problem for which we need an economic solution.

Vince Ciotti is a principal with H.I.S. Professionals LLC.

Curbside Consult with Dr. Jayne 7/2/12

July 2, 2012 Dr. Jayne 1 Comment

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It’s been four days since the Supreme Court issued its decision on the Affordable Care Act. I did get to have a little fun with it on Friday. One of the guys I work with fancies himself a Supreme Court aficionado, so I left a beribboned bunch of broccoli in a decorative vase on his desk. He totally didn’t get it, which made the day of several people.

Watching my physician colleagues react to the decision has been interesting, particularly because some are so detached from really understanding its impact. They’re well-versed, however, in knowing what the various talking heads are saying about it on TV and in other media.

In talking through it with one of my CMIO colleagues, we came up with a theory. Since we spend so much time in hospitals, most of the physicians we’re exposed to on a daily basis are hospital based. These are typically procedural specialists in higher income brackets and they tend to be more self protective and income oriented. Not surprisingly, most of them cited the upholding of the Act as the end of truth, justice, and the American way.

Reaching out to some primary care colleagues, there was a greater proportion of physicians who support the act, but I was surprised by the number of front-line family physicians who reacted with extreme negativity. Several expressed the opinion that this decision is just the beginning of ongoing legal wrangling which will distract from the real work that needs to be done in reworking the American health care system. Although the Act will allow more patients to be covered by private insurance or Medicaid, it doesn’t materially change the availability of care in the short term.

Professional organizations are predicting an increase in patients seeking care in the emergency department rather than in the ambulatory primary care setting. The forecast shortage of physicians needed to care for the influx of patients into the health care system still hovers at 60,000. Interventions such as telemedicine that could allow physicians to better care for patients in continuity (and keep them off of overcrowded office schedules) still aren’t reimbursed by major insurance payers. Subspecialty providers are rewarded for performing procedures and high-tech interventions, while primary care practices are forced to subsidize care management initiatives with the promise of potential future income that may never be realized.

The American Academy of Family Physicians praised (their word, not mine) the decision in an online posting and received numerous negative comments. These reflect the ongoing divisions in the medical community that won’t be resolved until real care transformation takes place.

I’m sure additional legal challenges will follow and states will maneuver as much as they can. Physicians will continue to be in limbo. I don’t foresee a jump in the ranks choosing primary care, nor do I see care actually becoming more affordable.

Are you a front-line physician with an opinion on the decision? E-mail me.

Print

E-mail Dr. Jayne.

Monday Morning Update 7/2/12

June 30, 2012 News 6 Comments

From Hellcare: “Re: ACA. Interesting reader responses. You have collected many devoted readers and contributors with varied backgrounds, experience levels, and opinions over the past few years. What about an open forum week, in addition to your regular articles, where we discuss, ‘What is wrong with the healthcare system and how do we repair it?’ Who knows, maybe we’ll do better than Congress! I don’t think that it even needs to be a dissection of the ACA, but maybe opinions from more than just C-level management that have to give the answers they have to give to save their jobs. If Ell Jeffe is right, then there is much to discuss and even better, more to learn.” I’m game. To keep it positive instead of everybody just complaining, tell me what you’d change and why. Also, operate under the assumption that we aren’t going to simply throw out today’s healthcare system, so your changes should be realistic. Anyone want to start us off?

From Pliny: “Re: mobile apps. The FDA says they are subject to its oversight if they process user input with a formula or algorithm, output a treatment recommendation, or perform a calculation that results in an index or score. That would cover any mobile app that connects to an ARRA-certified product, would it not?” Good question. I interpret it as meaning the logic is running from the mobile device itself, which wouldn’t be the case with most clinical system front ends that are just displaying data and capturing input, no different than a Citrix session. Anybody else want to chime in?

6-30-2012 4-58-00 PM

From The PACS Designer:”Re: Apple’s 7-inch iPad? With the launch of Google’s $199, 7-inch tablet called Nexus, can Apple be next with a 7-inch iPad? Earlier this year, such rumors were swirling about a mini iPad that would make a better fit in lab jacket pockets, so we may see it in 2013 at a price of around $300.”

6-30-2012 4-54-59 PM

From DrLyle: “Re: AMDIS meeting. About 300 attendees, mainly CMIOs and similar, about 50% more than last year. Some great discussions from both academics and applied informaticians, with topics such as problem list management, ACOs and population health, EMR usability, analytics, and role of the CMIO.” Presentations from the AMDIS 21st PCC Symposium are here. Above is a DrLyle photo from the meeting last week in California.

6-30-2012 2-20-47 PM

A surprising 91% of readers say hospitals and practices aren’t using sound financial principles when they decide to buy their clinical systems. New poll to your right: what’s your professional and personal reaction to the Supreme Court’s decision that Obamacare (as both parties now call it) will stand as law?

From the above poll results, here’s my challenge to CIOs of hospital that are spending $100 million or more on an inpatient clinical system. Readers are skeptical that your employer did its due diligence on return on investment. Explain to them why they are right or wrong (e-mail me a paragraph or two – I will leave you anonymous unless you indicate otherwise.) How did your organization justify the expense and what’s being measured to prove that the decision was a good one? Or if you made your investment and went live more than a year or two ago, how do the benefits you’re seeing (both financial and non-financial) compare to what you expected?

I haven’t followed the PPACA drama all that closely, but here are the healthcare IT ramifications I would expect judging from what I’ve heard here and there.

  • The majority of people and companies who paid little attention to PPACA under the assumption that some or all of it would be found unconstitutional will have to scramble to catch up. Few expected it to survive unscathed, so they wasted the first couple of years after it became law in March 2010 when they could have been figuring out what it means to them.
  • More people will have access to insurance, so hospitals theoretically won’t see as much self-pay and bad debt. However, they will need even more people and systems to handle all of those insurance transactions.
  • A fly in the ointment, however, is that employers may decide that the penalty for not providing insurance is cheaper than actually buying it with their significant employee subsidies, so they may just drop coverage entirely and force employees into the open market via health insurance exchanges. Employees may make the same choice, especially in PPACA’s early years, when penalties for not carrying medical insurance are minimal (just a few hundred dollars per year). Real-time eligibility checking and a plan to collect patient responsibility upfront will be required for provider survival.
  • States have made poor progress in developing health insurance exchanges, so they probably won’t be ready any time soon.
  • Medicaid rolls will swell massively under the plan, so providers will need to watch their reimbursement rates and payor mix carefully, especially since states are already teetering financially and now have another headache to deal with.
  • With 30 million newly insured citizens and a shortage of primary care providers, the pressure will be on to improve PCP efficiency (even if just to restore the time EMR usage has stolen).
  • Platforms that provide the ability to schedule PCP visits against their open schedules will be in demand to even out supply and demand based on provider and location.
  • Given the likelihood that PCPs will still be overloaded, I would expect more care to be delivered by extenders and telemedicine, which will change the expectation of the systems in use.
  • The demand for provider information will be insatiable. The same federal government and insurance companies that require endless petabytes of questionably useful information will now want even more of it once the promise of cost reductions isn’t realized. They are even more in charge of providers now than they were previously.
  • Medical device vendors can’t be happy since PPACA requires them to start paying an annual 2.3% tax on gross revenues starting in January.
  • PPACA’s impact on cost will probably be to increase it. In that regard, the biggest problem has still not been addressed since the special interests would have killed the bill otherwise – the healthcare system, regardless of who’s paying, is bloated, inefficient, and run by those special interests (including the biggest special interest of all, politicians.) 

6-30-2012 5-07-43 PM

Investor reaction to the Supreme Court’s decision: shares of hospital chains and healthcare IT vendors are mostly up, insurance company shares are down. Allscripts was up 8% on the week, while Quality Systems, McKesson, and Cerner jumped around 4%, a little better than the S&P 500. Athenahealth was up, but only by 1%. Cerner’s market cap is up to $14 billion, with Neal Patterson holding $462 million worth.

Not getting your HIStalk e-mail updates? Here are two solutions: (a) sign up for them if you haven’t already (duh), and (b) add mlsend.com to your so-called whitelist of e-mails allowed to get through your spam filter (your e-mail administrator will probably need to do this). I changed the e-mail service a few weeks back, so if you aren’t getting the e-mails all of a sudden, go with option B and tell your e-mail person that mlsend.com e-mails aren’t spam.

6-30-2012 3-44-24 PM

CapSite releases its Revenue Cycle Management study, which finds that 21% of hospitals plan to replace their RCM solution in the next to years and 53% say they will upgrade what they have. Interestingly, the larger the hospital, the more likely they are to replace or upgrade their RCM. The most-desired bolt-on solution is patient insurance eligibility verification, although 400+ bed hospitals are more interested in kiosks and the most-planned purchase of all is coding solutions. I was also interested in a relatively minor stat from the extensive report – in 400+ bed hospitals that responded, the #1 registration/ADT vendor (as a proxy to overall system penetration in my mind) was Epic, followed by Siemens, Cerner, and GE. I also liked the strategic priority question above.

The non-profit Patient-Centered Outcomes Research Institute (PCORI) is hosting the National Workshop to Advance the Use of Electronic Data in Patient-Centered Outcomes Research this week in Palo Alto, CA. Assuming it’s a bit late to plan attendance in person since they just sent me the announcement, they’ll have a live webcast (July 2-3). Speakers include folks from PCORI, Stanford, UCSD, NIH, FDA, and other big organizations. I hadn’t heard of most of the speakers, but those whose names I recognize are Doug Fridsma (ONC) and Paul Tang (PAMF).

Medical image management vendor UltraLinq offers Cardiac Accreditation Accuracy, software that allows users to track their QA documentation and statistics through integration with its exam data.

The PACS Designer is updating his list of iPhone apps, so if you’ve run across any that are interesting, post a comment to tell him about them.

CTG announces four new contracts for outsourcing, business process re-engineering, IT medical management, and HIE implementation support.

6-30-2012 6-00-33 PM

A jury returns a $15 million verdict against Springhill Memorial Hospital (AL) for a 2008 incident in which a 45-year-old non-ventilated patient died after bypass surgery due to an overdose of the anesthesia drug propofol that was administered by a nurse working her first shift in the cardiac recovery unit. The nurse was found to have no documentation of training appropriate to her assignment, had no experience in working with cardiac recovery patients or propofol, and failed to call for help when the patient lapsed into an immediate coma. Afterward, the nurse changed her documentation of the patient’s vital signs and ventilator settings, then erased the IV pump’s memory and destroyed the propofol container.

Vince’s HIS-tory this week covers HMS, tracking down co-founder John Doss for a first-person account.

Wall-mounted entertainment consoles are being removed from South Australia hospital patient rooms after at least four patients are harmed by units falling off the wall. Plans to install 3,500 of the units were cancelled.

Strange: a journal article chronicles the case of a 24-year-old software engineer from India who experienced an intense headache every time he tried to watch pornography, forcing him to change his plans. The authors didn’t figure out what caused the headaches, but they successfully treated the patient by advising him to pre-medicate himself with ibuprofen and acetaminophen.

E-mail Mr. H.

Time Capsule: Untethered Caregivers = Great Clinical Systems Opportunity

June 30, 2012 Time Capsule Comments Off on Time Capsule: Untethered Caregivers = Great Clinical Systems Opportunity

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 August 2007.

Untethered Caregivers = Great Clinical Systems Opportunity
By Mr. HIStalk

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Networking hardware vendor Cisco made a surprising announcement last week. The company’s two-year-old hospital division has become its growth leader. Sales have doubled in those two years to a cool $1 billion annually. Much of that involves wireless networking. That’s an unqualified "great" for Cisco and a qualified "good" for hospitals.

Healthcare customers were already buying a lot of Cisco gear, so carving out a separate healthcare business may not have made much difference. Still, the company must see a lot of opportunity in hospital wireless, infrastructure upgrades, and new construction. They’re smart.

Cisco will learn from a hospital-focused division. The company supposedly ran afoul of FDA regulations after making meaningless claims about a "medical grade network." It backed off a little, but is now pushing the good concept of integrating medical devices via wireless connectivity.

Hopefully Cisco won’t misstep again when injecting its products between patients and caregivers. If the company backpedals on reliability guarantees or has a patient-harming episode and hides behind legalese, word will spread fast. Cisco has a couple of hot little competitors like Meru and Aruba who would be more than happy to snatch a few of its crumbs.

Anyway, what’s most interesting about the announcement is that, clearly, most hospitals now have some flavor of wireless network. They vary in coverage, reliability, speed, use, and user acceptance, but they’re out there in force. And because of that variation, Cisco and other vendors see a gold mine in replacement the early-generation 802.11b and 802.11g systems that are limping along unimpressively.

Expectations have changed. Wireless is mission critical. Entire clinical systems strategies have been crafted around mobile caregivers wandering seamlessly around buildings while using portable computing devices.

Software vendors haven’t quite caught up. Applications are sometimes mobile user-unfriendly, requiring carefully targeted mouse clicks and keyboard entry that doesn’t work well when cradling a tiny notebook PC in your arm. Less-than-youthful caregivers may have to squint painfully to read screens that were designed for 17-inch monitors. .

The writing is on the wall, however. Wired devices will soon be as antiquated as those early-generation VCRs that had a wire-attached remote control. Wire’s last advantage is about to be eliminated as 802.11n matches or exceeds its speed.

Hospitals will save a bundle by not hard-wiring buildings. It’s painful to sit through construction meetings trying to convince architects and construction project managers that network wiring requirements are just a bit more complex and expensive than running electrical power to wall outlets. That’s a concept you can tell your grandkids about some day, like when TVs had a picture tube or when music came from a store instead of a download.

The downside, as it always is, is cost. We’re re-buying all this gear from Cisco and other vendors, ripping out what we bought just a few years ago. That’s capital that could have been used elsewhere, like virtualizing servers or improving redundancy.

If all goes well, this second round of spending probably buys the performance you expected from the first round.

Still, wireless technology developments are exciting. Hospitals need to figure out how to improve patient care given untethered caregivers who carry an impressive arsenal of technology in lightweight devices. There is cool stuff yet to be done using VoIP communication devices, new bedside patient monitoring and diagnostics, and information systems designed to help deliver care, not just document it.

Clinical systems vendors, it’s a great time to rework or build applications without the assumption that users are sitting at a desk all day. Ubiquitous wireless connectivity changes the game. If you don’t believe it, think about what went on in coffee shops before Wi-Fi.

Comments Off on Time Capsule: Untethered Caregivers = Great Clinical Systems Opportunity

News 6/29/12

June 28, 2012 News 13 Comments

Top News

6-28-2012 8-51-24 PM 6-28-2012 8-52-43 PM

A GAO report finds that the VA and DoD have made progress in their pilot project to integrate care at the James A. Lovell Federal Health Care Center (IL), but delays in implementing the IT component have resulted in additional costs. IT investments have already surpassed $122 million and some initiatives are almost two years behind schedule.


Reader Comments

6-28-2012 2-53-31 PM

From Convener: “HIStalk’s announcement on the Supreme Court ruling. Once again you beat Modern Healthcare and all the others, and with a more comprehensive article.” Since Mr. H is busy traveling for his hospital job, we decided in advance that I would sit by computer and TV, listen for the announcement, and send readers a quick update. The moment MSNBC said the healthcare law had been upheld, I looked for an online write-up. Above is a screen shot of what CNN posted, which obviously left me mighty confused (obviously several so-called journalists hit the “post” button for their pre-written stories after reading only the first sentence of the ruling.) Thankfully I decided CNN simply had it wrong before I blast the news incorrectly to the HIStalk universe. Boy, Mr. H would have never let me live that down.

6-28-2012 8-55-55 PM

From SummerFun: “HIStalk Practice Advisory Panel. I liked the write-up. Great questions and interesting answers.” In case you missed it, our first HIStalk Talk Practice Advisory Panel post was published earlier this week. The participants, who are primarily physicians and staff in ambulatory care practices, shared thoughts on their EMRs and discuss other technologies. It’s a fun read and a good mix of positive and negative impressions, just like real life.

From Blue Eyes: “Re: healthcare reform act. What do you think of the news and its effect on healthcare IT?” I think people have forgotten that Thursday’s ruling affirmed only the legality of creating the law, not to assess it as a good or bad idea. I’ve yet to hear anyone claim to have read and/or understood the 2,900 pages of legalese, including the politicians who voted for or against it, and it’s discouraging that even the Supremes voted pretty much along liberal / conservative lines (it’s either legal or it’s not, but you wouldn’t know that from the 5-4 opinion). I don’t know if anyone of us know what it means beyond lots of newly insured people showing up at the doors of hospitals and practices (at least when they can find a primary care provider to schedule them). I’d bet healthcare costs will continue to go up, healthcare IT will ramp up for another year or two until the Meaningful Use wad has been shot and providers go back to buying only what boosts their productivity or bottom line, and we’ll nonetheless start getting some highly useful big-picture data telling us where we stand from a population health perspective but leaving us to actually do something about it (like finding a way to get Americans to lose weight, exercise, and manage their expensive chronic conditions wisely and cost effectively). Here’s where the crowdsourcing thing works well: click the Comments link at the bottom of this post and tell me what you think. For those who have never commented, you don’t have to register first and you can give a phony name to stay anonymous. My general assessment when wearing my HIT tunnelvision goggles is that it’s a good thing. As a taxpayer, I’m not really sure.

From Watcher of the Skies: “Re: HCA. Going Epic. I was in training in Verona and someone from HCA in my class said so.” Unverified. HCA originally said they were doing a one-hospital Epic pilot to decide between it and upgrading Meditech, but nobody’s told me definitively which way they’re going.

From Robbie Douglas: “Re: McKesson. Close to making an acquisition of [company name removed], whose offerings include an ambulatory EHR and billing and management services.” I removed the company’s name since the rumor is unverified, but it sounds like a done deal. It’s a pretty big outfit. 

6-28-2012 9-01-53 PM

From Cool Runnings: “Re: Drex DeFord. Leaving Seattle to take CIO position at Steward Health in MA. Steward’s for-profit 80-hour work weeks have taken their toll on a few CIOs in a short period of time. The CEO likes to call his leadership on weekends and expects them to work as many hours as he does.” Drex has updated his LinkedIn profile to list the Steward CIO job, so I’ll call that rumor verified. I worked for a for-profit hospital chain once for a short time. It was run by the biggest scumbags in the industry given my first-hand observation of their indifference to patient care and total worship of the bottom line. I wouldn’t care to repeat the experience, but to each his own.


HIStalk Announcements and Requests

Here’s some highlights from the last week on HIStalk Practice, in addition to the above-mentioned post from our Practice Advisory Panel: the biggest challenges of running a group practice. Alleviant announces plans to open a new facility in Vermillion, NC. The Office of the Inspector General finds that EMRs from Allscripts, eClinicalWorks, and GE Healthcare were products most widely used by physicians to document E/M services. Humana is the top payer among US health insurers in athenahealth’s Payerview Rankings. Aaron Berdofe discusses the federated model in the second part of his series on healthcare infrastructure data models. It takes so little to make me happy: a glass of nice wine, a new pair of strappy sandals, or a few new subscribers to HIStalk Practice. Make me merry, if you can. And thanks for reading.

On the Jobs Page: Software Engineering Manager, Project Manager, Web User Interface Design Engineer, Senior Buyer – Third Party Labor.

Listening: Lush, underrated alt rockers from England who had a 10-year run that ended in the late 1990s when their drummer killed himself. The music is rich, sweeping, and sweet, but rocking in a wistful sort of way (some place them in the “shoegazer” genre, but I’m not sure about that). I don’t know how I missed them, but it’s not too late since it still sounds fresh today. You’ll like it if you enjoy Cocteau Twins.

Everybody’s talking about voting of one kind or another these days, so here’s an urge to visit the (electronic) polls. Register to vote by signing up for e-mail updates. Cast your vote for progress by liking, friending, and connecting with the HIStalk party (Inga, Dr. Jayne, Dr. Travis, and me) via the social media ballot boxes. Send us your tired, you poor, and your rumors and news. Show your appreciation of our supporters by checking out the sponsor ads to your left and trying out the searchable, categorized Resource Center and Consulting RFI Blaster. As Alice Cooper says, I’m your top prime cut of meat, I’m your choice, I wanna be elected – as HIT’s go-to site for news, scandalous rumors, and occasionally irrelevant amusement. Thanks for your vote to keep me in (my upstairs spare bedroom) office for another bunch of years – I won’t let you down. I’m Mr. HIStalk and I approved this message.


Acquisitions, Funding, Business, and Stock

Practice Fusion secures an additional $34 million in Series C funding led by Artis Venture. The company has raised $64 million since it launched in 2007.

6-28-2012 9-03-07 PM

Carena, which offers webcam-based provider visits and other products, completes $14 million in financing led by Catholic Health Initiatives.


People

6-28-2012 7-35-04 PM

The Digital Pathology Association appoints Sharp HealthCare CIO Bill Spooner to its board.

6-28-2012 7-38-58 PM 6-28-2012 7-39-34 PM

Employee scheduling software vendor Avantas announces the promotion of Christopher Fox from SVP of growth and innovation to CEO and Jackie Larson from VP of client services to SVP. Fox takes over for founding CEO Lorane Kinney, who is retiring.

6-28-2012 7-41-38 PM 6-28-2012 7-43-05 PM

athenahealth appoints Charles D. Baker (General Catalyst Partners) and Jacqueline B. Kosecoff, PhD (Moriah Partners/Warburg Pincus)to its board.


Announcements and Implementations

Hoag Memorial Hospital Presbyterian (CA) implements Unibased’s ForSite 2020 RMS resource management and patient access solution across all of its diagnostic imaging locations.

The Pennsylvania eHealth Collaborative announces a grant program that gives providers a free year of DIRECT messaging services for secure health information exchange.

RiverView Health (MN) will go live on Epic July 1.

Ochsner Health System (LA) will go live on Epic this week ad its health center locations.


Government and Politics

Five senators introduce a bill that would create a national standard for notifying affected individuals about information security breaches. The bill, the fourth attempt to create national requirements, would also move enforcement to the Federal Trade Commission and allow that agency to levy fines of up to $500,000.


Other

The Bethlehem Area School District (PA) joins The Children’s Care Alliance, which maintains an EMR database of student health data supplied by school districts and made accessible to area hospitals.

6-28-2012 8-30-08 PM

Meditech President and CEO Howard Messing provides the opening remarks for the 11th Annual Pappalardo Fellowships in Physics Symposium at MIT, which is obviously supported by Neal Pappalardo of Meditech. Both are MIT alumni and physics fanboys. It’s a good talk.

Highline Medical Center and Franciscan Health System (WA) announce plans to explore a strategic affiliation, partly driven by Highline’s interest in using Franciscan’s Epic system that will go live next year.

University of Texas MD Anderson Cancer Center (TX) notifies patients that a computer containing patient and research information was stolen from a physician’s home April 30. The hospital says it will step up efforts to encrypt its computers, making you wonder how an organization as smart and rich as MDACC needed negative press to finally move the needle on encryption. Here’s a gentle nudge for their fellow fence-sitters: if you don’t encrypt your portable devices, you are being inexcusably irresponsible and deserve the inevitable headlines, CIO firing, and class action lawsuits that are likely to result when the “pay me now or pay me later” time bomb you allowed to be planted finally goes off. Everybody knows that healthcare IT is stuck in a 1980s time warp, but are we seriously still waffling on encrypting PHI-containing devices?

Meanwhile, the Alaska Department of Health and Social Services agrees to pay HHS $1.7 million to settle possible HIPAA violations stemming from the,theft of a USB hard drive from an employee’s car. The Office of Civil Rights determined that the Alaskan agency had inadequate security and risk controls in place and now must take corrective action to safeguard electronic PHI.

6-28-2012 4-26-36 PM

Is that a parachute in your backpack or are you just glad to see your surgeon? Mexican doctors remove a 33-pound tumor from the back of a two-year-old, 26-pound boy.


Sponsor Updates

  • ICA announces that the Central Illinois HIE is live, with four up and running.
  • Kony Solutions expands support of open standards with the release of its KonyOne Platform v5.0.
  • Phoenix Children’s Hospital (AZ) chooses Access Intelligent Forms Suite to integrate data among its Allscripts HIS, electronic forms, and its MedPlus ChartMaxx content management application.
  • Kareo releases a free iPhone app for accessing physician schedules online.
  • Ingenious Med explains how its PQRS Registry is helping healthcare facilities to avoid penalties and improve revenue.
  • Medicomp Systems CEO Dave Lareau  discusses five EHR considerations for organizations preparing for ICD-10.
  • Julie Corcoran, principal consultant with Hayes Management Consulting, highlights five of the major issues facing hospital revenue cycle teams.
  • MyHealthDIRECT expands its partnership with Amerigroup to include Amerigroup’s Maryland provider partners and giving them access to MyHealthDIRECT’s online scheduling services.
  • Wolters Kluwer Health announces that Essentia Health (MN) is the 1,000th customer to deploy its ProVation Medical software.
  • BridgeHead Software releases the results of a survey finding that only 26% of worldwide HIT leaders have robust disaster recovery plans in place. 
  • Centracare Health System’s St. Cloud Hospital (MN) selects Merge PACS.
  • New York eHealth Collaborative says it’s the first REC to hit 1,000 providers qualifying for Meaningful Use money.

EPtalk by Dr. Jayne

Like Inga and Mr. H, I sometimes become annoyed when my day job cuts into my HIStalk time. Unfortunately, this is one of those weeks. I had taken some time off this week to make sure I would be able to immediately respond to the much-anticipated Supreme Court decision, but it has been sucked up by a couple of hospital projects that have gone off the rails. I’ll definitely be responding to the decision, whatever it may be, but just not tonight.

HIStalk reader and contributor Micky Tripathi writes about “The Dangers of Too Much Ambition in Health Information Exchange.” He warns of over-architected HIEs that try to be all things to all people at the expense of short-term wins with real value. It’s a great piece that I hope obtains wide readership.

CMS will begin enforcing the use of version 5010 HIPAA transactions next week. Although it doesn’t seem there are continued widespread issues, anecdotal reports include ongoing tales of claims difficulties.

Physicians are subject to as many as 20 different varieties of payer audits. The American Medical Association has archived a webinar that covers the who, what, where, when, and why of auditing. Anyone who wonders about the high cost of health care and declining levels of provider satisfaction should take a peek.

No surprise: An online article in the Journal of the American Medical Association discusses the higher per-patient operating costs found in clinics with higher medical home scores. Medical homes can reduce overall health care spending, but there is little incentive to incur the upfront burden if the savings isn’t passed to those doing the work.

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For Inga: a chocolatier says the  Massachusetts pharmaceutical gift ban is hurting its business. Their popular corporate gift: chocolate shoes.

PremierConnect debuted this week, allowing providers and healthcare systems to access data from payers, claims, lab, billing, and other sources to monitor clinical performance and perform predictive modeling. The aggregated database includes data from more than 2,600 hospitals.

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I was in Canada recently and heard quite a few public service announcements on the radio encouraging blood donors to step up and give. I haven’t heard much at home, but blood supplies in the US have reached “emergency levels,”according to the Red Cross. Summer heat and vacations typically limit donations and only 3% of people in America donate blood. If you’re looking for an air-conditioned place to spend some time over the upcoming holiday, consider taking a trip to your local blood bank. Chances are you’ll leave with a cookie and some orange juice in addition to knowing you may have just saved a life.

drjayne


Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Supreme Court Upholds Healthcare Law

June 28, 2012 News 6 Comments

The Supreme Court rules to uphold the ACA, including the individual mandate.

CIO Unplugged 6/27/12

June 27, 2012 Ed Marx 5 Comments

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

Excellence, the Road Less Travelled

Another summer working for meager wages was no longer an option for John and me. Both married with kids, we searched for a breakaway strategy where we could make decent cash to hold us over until our first big break. Under-experienced and over-educated in the utopic college town of Fort Collins, this proved a herculean task.

Nevertheless, armed with respective degrees in psychology and Spanish (teaching certificate), we came up with a vision that would forever change our lives. We started our own company. Men… who do Windows!

We visited our local janitorial supply store. With 10 minutes of in-store advice and a $100 investment in buckets, soap, and squeegees, we were bound for glory.

After analyzing our competition in the Yellow Pages, we realized we’d need a bold approach. Competing with dozens of vendors and with no time or money for static advertisement, we took an unconventional approach. We created fluorescent-colored flyers and paid teens to deliver them to targeted neighborhoods. Our phone began to ring.

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We bid each job in person and dressed in nice clothes. We parked our company car (a urine-colored Honda CVCC) down the road a few houses so as not to tarnish the high-end brand we strived for. Who would notice the 24-foot extension ladder strapped on top of an 8-foot car? We wore “uniforms.”

We priced our services higher than our competitors — a bold move. But we hoped to differentiate ourselves by stressing customer service and excellence.

Included in our bid was our happiness guarantee: “We not only clean your windows, but your screens and window sills as well. When we enter your home, we take off our shoes. We have towels under all of our tools so you never need worry about us leaving your home a mess. We will move all drapes and curtains and furniture as needed. Prior to us leaving your home, we will inspect each window with you. If you are dissatisfied with any, we will redo them until you are happy with our work.”

We closed 90% of our bids. Our window redo rate = 0.01%.

After a few weeks, we could not keep up with demand and had to stop all advertising. It became vogue in some neighborhoods to have the Men… who do Windows sign in their yard. A few customers insisted on serving us lunch on their decks overlooking a lake. Excellence creates demand.

With graduate school awaiting me and another summer break for John, we resurrected the business the following year with the same results. We grossed an average of $400 per day, with the cost of doing business a low 5%. Excellence is profitable.

John and I believe our success was attributable to the high quality we put into our craft. We encouraged one another to be our best as we honed our squeegee skills to ensure a streak-free finish. Why would people willingly pay a 50% premium for our window-washing services? Because they knew it would be done to perfection. Our customers knew we would meet expectations and not leave without their approval. Excellence elevates the performance of those around you.

We both replicated this value in our personal and professional relationships — John as a teacher and later a pastor and I in healthcare. This pursuit of excellence has blessed our families and careers. Moreover, the people and organizations we serve have benefitted. Excellence creates differentiation that separates good from great.

Ten years after Men…. who do Windows, I was invited back to Colorado State University to serve on the advisory board of the college from which I received my Master’s. During lunch, I was approached by a fellow board member who asked if I had ever cleaned windows. I revealed myself as the founder of Men. He looked me straight in the eye and earnestly exclaimed, “My windows have never been so clean!”

Imagine — 10 years later and he still recalled the service he received from our company for washing windows. Excellence is not forgotten.

Twenty years after Men, both John and I visited Ft. Collins with our families. The owners of Trios AVEDA Spa and Salon knew we were in town. They had a big social after-hours shindig taking place one evening, and yes, they asked if we could reprise Men and clean their windows so they would dazzle. We obliged. It was a great reunion, and we still had our skills. Excellence sets a pattern for future performance.

The Men experience was priceless. Alas, the time came for us to move into our chosen professions.

Rather than sell the business, we gave it away to others in similar circumstances as we had been in two years’ prior. We taught them everything we had learned, from window washing basics to customer relationship management. Even the happiness guarantee.

By the end of the first season, the business lost half its value. We mourned when Men folded midway through the following year. Excellence requires passion to attain and sustain.

A long time ago, a writer in Greece observed the games that would eventually become the Olympics. He said, “Do you not know that in a race all the runners run, but only one gets the prize? Run in such a way as to get the prize. Everyone who competes in the games goes into strict training. They do it to get a crown that will not last, but we do it to get a crown that will last forever.”

Excellence is doing everything you do with the very best you have.

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

News 6/27/12

June 26, 2012 News 4 Comments

Top News

6-26-2012 10-31-15 PM

ONC’s Director of Meaningful Use Joshua Seidman, PhD resigns to take a job as managing director of quality and performance improvement with Evolent, the ACO services provider spinoff of The Advisory Board Company and UPMC.


Acquisitions, Funding, Business, and Stock

Atlantic Health Solutions acquires fellow medical billing company DataSolv Services.


Sales

Lehigh Valley Health Network (PA) chooses MedAssets to provide RCM technology and consulting services, including MedAssets Charge and Reimbursement Integrity solutions and Collections Management product.

6-26-2012 10-53-08 PM

Bradley County Medical Center (AR – above), Ellis Hospital (NY), and Jamaica Hospital Medical Center (NY) sign contracts with QuadraMed for the ICD-10 compliant version of Quantim Coding and for QuadraMed’s 3-Learning and Education program.

6-26-2012 10-55-45 PM

The West Coast Regional Office of VHA and Penn State Milton S. Hershey Medical Center (PA – above) sign agreements with Avantas for the company’s healthcare enterprise labor management technology.

The VA awards Ray Group International a $4.9 million contract to support the Open Source EHR agent project, which allows developers to contribute software code for the VA/DoD integrated EHR.

The Texas Department of Information Resources (DIR) signs a contract with PatientOrderSets.com to use its solutions in public and DIR-eligible hospitals.

Summa Health System (OH) selects PatientKeeper Charge Capture software for its 300 physicians.

Lenco Diagnostic Laboratories, a New York reference lab, implements EMRHub from Lifepoint Informatics, which allows it to distribute lab data to an unlimited number and variety of EMRs through a single connection.


People

6-26-2012 9-23-45 PM

RCM provider Recondo Technology names Major General (Ret.) Elder Granger, MD (TRICARE) to its board.

6-26-2012 9-27-56 PM 6-26-2012 9-29-34 PM

GetWellNetwork appoints Beth Martinko (Avid Technology) SVP of client experience and Hugo Borda (NeighborBench) VP of enterprise architecture.

6-26-2012 9-30-28 PM

Medsphere Systems adds Mike Morotti (Validus Medical System) as VP of sales.

6-26-2012 9-31-26 PM

PerfectServe appoints George Pace (Verisk Health) RVP of sales.

6-26-2012 9-41-27 PM 6-26-2012 9-43-26 PM

Ernest & Young names The Advisory Board Company CEO Robert Musslewhite a winner in of a 2012 Entrepreneur of the Year award for the Greater Washington Region. Ernst & Young also names T-System CEO Sunny Sanyal a finalist for the 2012 Southwest Area North Entrepreneur of the Year.

6-26-2012 10-24-43 PM

Beacon Partners names Jon Mello (EMC) as EVP.

Greenway reseller iPractice Group names Monte Ruder (Integrated Healthcare Solutions) its VP of sales and adds three additional account executives. Last week iPractice announced that an undisclosed California company is investing $32 million in the company.


Announcements and Implementations

Kaiser Permanente and the Social Security Administration announce a pilot program to exchange electronic health information using the NHIN.

The Kentucky HIE, St. Elizabeth Healthcare, and HealthBridge announce their successful secure exchange of patient health information.

6-26-2012 10-58-25 PM

McPherson Hospital (KS) implements Meditech.

OTTR Chronic Care Solutions announces the arrival of its OTTR 6 release.

Merge releases its eClinical OS Platform for capturing any type of data from any source and over any modality.

Former BayCare Health System (FL) critical care nurses Cynthia Davis and Marcy Stoots form CIC Advisory, which offers strategic consulting services specializing in EMR-driven clinical process improvement. They were involved in BayCare implementations in executive roles.


Government and Politics

6-26-2012 11-01-45 PM

ONC releases a new version of its online Certified Health IT Product List that lists 1,700 EHRs and modules and includes several new features, including functionality to identify hybrid certified EHRs.


Other

6-26-2012 11-05-07 PM

Winter Haven Hospital (FL) says it has pushed backed the full implementation of its EHR system from last spring until October 1 in order complete physician training. Cerner, I believe.

6-26-2012 10-39-21 PM

KLAS takes a look at Epic consulting firms and ranks Impact Advisors highest in enterprise implementation leadership and advisory, Encore highest for team implementation leadership and advisory, and Nordic Consulting highest for staffing implementation and support. KLAS identified 45 firms with Epic consulting engagements and found that nearly every firm received good marks for consultants. Thanks to KLAS for allowing us to quote their report and include the graphic above.

The Wall Street Journal covers the failed EMR implementation of 25-bed Girard Medical Center (KS), which says it paid Cerner $1.2 million and still can’t quality for Meaningful Use money (we reported its lawsuit against Cerner back in January). The hospital claims that Cerner didn’t include quite a few items in its $2.9 million agreement, but also admits that it didn’t understand the contract it signed and relied on Cerner to tell its executives what it covered. According to the CIO of the IT department (which had only two employees when the hospital signed with Cerner), the additional costs were only $100,000 over the term of the five-year agreement, but the hospital decided to stop paying Cerner to get their attention over poor service. They did – Cerner e-mailed the hospital to say it was walking away. Based on the skimpy description in the article, I’m siding with Cerner – the hospital didn’t do its due diligence, bought way more system than it needed or could maintain, and then tried to play tough over a price discrepancy of less than 4% of the total contract value. Granted some vendors (Epic) wouldn’t have sold a deal like that knowing the chance of success was minimal, but it’s not Cerner’s job to advise the hospital as a neutral party. If someone deserves blame other than the hospital, it’s the federal government for financially baiting providers into buying systems they otherwise had been wisely avoiding as a bad fit.

The president of CVS Caremark’s MinuteClinic says its retail clinics support continuity of care by giving every patient a copy of their medical record, sending their physician a copy if the patient approves, and integrating with practices by either sending them electronic information or (for the large number of practices that don’t have an EMR) a nightly batch fax.

An article by early Epocrates executive Michelle Snyder observes that despite all the technology being thrown at physicians, they’re less productive now than 10 years ago. She urges the use of simple technologies that, like Epocrates, are easy to use and save individual doctors time – no more, no less. Examples: HealthFinch (lets doctors delegate prescription refills to staff); ImagingCloud (Webex-like medical image collaboration); and Doximity (LinkedIn-like physician referrals and consultation).


Sponsor Updates

  • NextGen changes the name of its Practice Solutions Division to NextGen RCM Services. 
  • Bulletin Healthcare Briefings partners with the National Association of Pediatric Nurse Practitioners to publish and electronically deliver its members-only daily electronic news briefing PNP Daily News.
  • ZirMed and DoctorSites offer a free webinar entitled, “Online Marketing and Payment Secrets That can Make – or Break – your Practice.”
  • Mowery Clinic (KS) selects NextGen’s EHR/PM and portal solutions for its 33 physicians.
  • Imprivata scores a score of 88.4 on KLAS’s 2012 mid-term performance report.
  • Emdeon announces that three of its RCM solutions have received HFMA Peer Reviewed designation.
  • Allscripts reminds developers that the deadline for its Million Hearts Clinical Decision Support Challenge is July 13. The company is offering a $50,000 prize for the best publicly available app that optimizes cardiovascular disease care through clinical decision support.
  • Passport Health adds its PatientTrack and PatientRisk modules to the Care Cycle Suite.

More news: HIStalk Practice, HIStalk Mobile.

Curbside Consult with Dr. Jayne 6/25/12

June 25, 2012 Dr. Jayne 7 Comments

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I maintain staff privileges at a hospital where I almost never admit. Even with my non-existent volume, I still have to attend training, so I wasn’t surprised a few months ago when I received the postcard saying that it was time to talk about finally going live on CPOE.

It’s kind of funny, because more than four years ago I served on the selection committee for this particular product. I remember at the time being shocked that we were even considering it because the user interface was so buggy at the hospital where we did our site visit. Meanwhile, I had moved on to greener CMIO pastures, but I still keep those privileges out of nostalgia (or maybe out of fear that one day I might have to go back into traditional practice.)

Luckily the final training blocks coincided with a couple of comp days I had already scheduled. I wrote about my recent Meaningful Use upgrade training a few months ago and I hoped that this would be a similar experience. However, I think I could use it to write a case study in how to alienate the medical staff.

Being a veteran trainer, I arrived 15 minutes early because I knew I’d have a logon / password issue since I rarely go to that facility. The training room was dark, so I poked my head into the room next door to make sure I was in the right place. The training team was sitting around and barely noticed me. In fact, they were talking about another physician – making fun of one who had arrived half an hour early because he was cutting into their break time. I pretended I didn’t hear them and asked if I was in the right place. I was told they’d be in the room shortly.

I went to the room and found a seat at a folding card table (no, I’m not kidding) with actual damp coffee on it. They finally walked in five minutes after training was supposed to start and began passing around a coffee-stained sign-in sheet for continuing medical education credit. That was a plus – I hadn’t expected to receive hours and it’s always good to have some “live” credit since I do most of my CME online. But the coffee was a turn-off.

Additionally, since the last time I rounded, the facility had gone to proximity badges. I didn’t have one, which created much hubbub, although none of the trainers could tell me who to talk to in order to get one. Surprisingly, my ancient logon and password were not expired.

After dealing with the sign-in sheet and the proximity badges (I wasn’t the only one without one – the other doc who had arrived 30 minutes early didn’t have one either) they finally decided to fire up the projector and went through a whole “how do I adjust the keystone” saga. My new Twitter BFF, @MeetingBoy, would have been proud.

Training finally started about 15 minutes late. To my chagrin, they not only accommodated late arrivals, but stopped class and rehashed everything that had been covered to that point.

I was given a cheat sheet with some patient names, one of whom was a 14-year-old male named “Samantha,” which added realism to the scenarios. The class moved at a glacial pace to allow for one of the more senior members of our class (whom I know to be at least 85 years old) to keep up. I felt so sorry for her – she is very sweet and is a fixture at the hospital, and they really should have offered her an individualized class.

About an hour and a half into the class, everyone was kicked out of the application. The trainers explained that the build team was still creating order sets and had a tendency of uploading their work several times a day “to keep the environment fresh.” I don’t know about you, but I’m pretty sure we didn’t need their recent (probably untested) build work to make it through class.

I was surprised to see that the version being deployed was the same version we looked at four years ago. I know this product didn’t make its vendor’s “go forward” list, but I’m pretty sure there’s been another release since then. I’m not sure about the rationale for taking outdated software into a live environment.

All the bugs and UI glitches that we had seen during selection were still there. Some orders were in alphabetical order when it would have made more sense to have them sorted by frequency of ordering or grouped by body system. Others were arranged by the order in which they were added to the database rather than being in alphabetical order. You could see what the “oops, forgot that one” tests were because they were at the bottoms of the lists. Seeing “do not use” abbreviations is always a treat as well. Several screens had such inconsistent use of color that it looked as if a bag of Skittles had been upended on the screen.

I was pleasingly surprised to see that the system had a button for logging bugs (really a glorified e-mail launch) and the other docs in the room got a kick out of that too. Docs were told to log anything they thought should be added and that it would be placed in the system. There was no mention of change control, governance, or peer review of the suggestions.

Laughs were had over the trainer’s warning that we shouldn’t try to use the embedded help files because the system had been customized so much that they weren’t relevant. The trainers took great pride in telling us how many hundreds of hours it took to build some screens vs. others and the hours quoted were really quite unreal.

Several common acronyms were used in the order sets, but unfortunately some elements were out of order and others were missing, making it hard to recognize the acronyms. With as many thousands of hours as were allegedly spent building, it didn’t appear that there was much clinical oversight. No surprise – the hospital in question does not have a CMIO and I’m not sure there were medical informatics experts involved in system planning and design either.

This was the fourth training session of the fourth week (only a few days prior to go live) and at least three of us noticed a major patient safety defect that had not yet been discovered. On some screens, patient demographic and vital signs data rounded up and/or down without reason. I’m not sure about you, but when a patient is documented as weighing 78 kg in the base clinical application, I don’t expect to see him rounded down to 70 kg in the CPOE module. Other areas of the system simply had garbage in the build (the ubiquitous ZZZZ added before pick list items to push them to the bottom) which always drives me crazy.

The doc seated next to me said she couldn’t believe we were forced to attend the class live. It could easily have been given as a 90-minute webinar instead. I didn’t disagree. I did receive two hours of continuing education credit for my four-hour tour, so it wasn’t a total loss.

The hospital went live on CPOE over the weekend. From what I hear, things went well, all things considered. I wish them the best, but hope the next rollout has not only better software but better training.

Have a training horror story? Does your system remind you of colorful candy? E-mail me.

Print

E-mail Dr. Jayne.

Readers Write 6/25/12

June 24, 2012 Readers Write 3 Comments
Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

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


HIE Success: Think Google, Not Government
By Orlando Portale

6-24-2012 2-55-45 PM

In March 2010, Governor Schwarzenegger named CaleConnect as the new entity that would deploy funds from the Obama economic stimulus package to build out a statewide health information exchange. As was reported recently, the effort has been transitioned to UC Davis.

Make no mistake, this was never going to be an easy task. There are lessons learned for all of us as we plan for our own public or private HIE initiatives.

Shortly after the formation of CaleConnect, I visited with members of the board, including Jonah Frohlich, the Terminator’s right-hand man on HIT. As I indicated to the CaleConnect board back in 2010, “This could turn out to be just another Keynesian economic experiment where money is spent, but nothing tangible is ever delivered.”

Prior to the meeting, I distributed a white paper (click the link to download) to the board outlining specific strategies and potential pitfalls to avoid. Here is its introductory section:

The business sustainability strategies adopted by the California eConnect (CeC) organization are likely to be the same ones employed by other technology startup companies. Success for any startup venture is largely determined by the organization’s ability to rapidly deliver compelling solutions with clear customer value propositions. These solutions must not only meet the functional requirements of the targeted customer segment, but be efficiently delivered and effectively supported. Startup companies that succeed in capturing a given market with compelling solutions are generally rewarded with increased profits and sustained customer loyalty. The path for the successful launch for CeC will be conditional on having the right organizational framework in place, sound business strategies, an understanding of current and future customer requirements, solid solution planning capabilities, financial management expertise, and superior execution. This paper will outline high-level strategies for CeC to consider with regard to achieving a sustainable and successful organization.

When I visited with the board, I stressed the following key points: 

  • Make sure you clearly define roles and responsibilities of the board of directors versus the CaleConnect executive team. The board should not attempt to micro-manage the effort, rather provide high-level oversight. Leave day-to-day decision-making to the organization’s CEO.
  • Don’t line up a burdensome schedule of periodic meetings. A solid, well-understood governance structure will avoid needless conflict later.
  • Run the organization like a Silicon Valley startup, not like a branch of state government. Set up shop in Palo Alto, not Sacramento. Think Google, not government. Embrace speed to market, agility, pivoting … everything you would do in a startup company.
  • Build out the beta version of the product ASAP. Get some early adopters to test it out ASAP. Iterate on it like crazy. Enlist the beta testers to evangelize your product.
  • You are building a product. Treat it like a startup product’s design, build, and delivery effort.
  • Your #1 priority should be on the product. Avoid the usual pitfalls of constituent outreach and conference speeches about what might be possible if California had a wired healthcare system. Don’t hype up your stuff until you can demo something.
  • When you do get it built, market the heck out of it.
  • Don’t waste your time running around the state talking about what might be possible in advance of the product release. Everyone has been pitched endless times about the potential value proposition for health information exchange.
  • Everyone will be skeptical, and rightfully so. They have heard it all before. Until you can demonstrate something real, you will have zero credibility.

Unfortunately, as the project unfolded, many of the pitfalls I had warned about were realized.

I continue to believe that a highly agile approach to HIE planning and deployment is greatly beneficial. Remember, think Google, not government.

Orlando Portale is chief innovation officer with a large healthcare organization in Southern California.


Why Windows 8 Might Be the Next Big Thing for Healthcare
By Anthony Hooper

We’ve been following Windows 8 since the developer beta was released at build/windows and it really excites us. Why? Microsoft has a ton of device driver support for Windows XP, Vista, and 7, and most of these drivers will work with Windows 8.

Clinicians want mobility in their day-to-day jobs and they want a device they can carry with them, but one that will also augment and make their day more efficient by allowing them to enter information on the go. Consuming data isn’t the only reason for a tablet any more.

Windows 8 brings a ton of medical device driver support to the table, powerful computing hardware, and a great touch-enabled interface. Finally, a mobile OS that allows health professionals to run their current Windows-based EHR and charting applications, and augment them with metro touch-enabled workflows.

With Windows 8, a clinician can have a single mobile tablet that can be carried during rounds and can be used for taking blood pressure readings without cumbersome dongles. Then, clinicians can return to their desk, switch into desktop mode, and complete many of the tasks they started in the mobile-optimized application.

Unlike iOS, Windows 8 will have a wide variety of hardware manufacturers. This means each hospital or clinic administrator can select the hardware profiles that meet their team’s needs. And it opens the possibility for biometrics hardware and HDP-enabled Bluetooth chipsets.

Anthony Hooper is development manager at Macadamian of Gatineau, Quebec.


Use the ICD-10 Deadline Delay to Maximum Advantage
By Deepak Sadagopan

Just as healthcare providers were getting serious about progressing toward the much-heralded ICD-10 era, the announcement of a potential deferral in the compliance deadline has spawned a new wave of delays and second guessing about how best to apply limited IT resources. Some organizations are freezing ICD-10 budgets and slowing down, or even halting work completely, until a new date is set. While a one-year deadline delay may be productive, it would be a mistake to assume that planning can be halted until this time next year and then resumed – primarily because most organizations are already far behind the curve in preparing for ICD-10.

Any delay or reallocating of internal resources in an environment where healthcare provider budgets are already tight can result in process inefficiencies and, ultimately, higher implementation costs. Many are concerned with how to make the extension beneficial to their organization. Providers should use the additional time to implement a more sound and strategic approach to collaborative testing with their primary trading partners – the most difficult and unpredictable segment of conducting a successful ICD-9 to ICD-10 migration. As it is, most large IT projects typically require more testing time than is usually allocated – and the current status of ICD-10 readiness demonstrates this case is no different. In fact, given that ICD-10 can have a tangible impact on revenue flows, providers should ensure that they work hard to mitigate their risk of disruption with trading partners that account for 80 percent or more of their revenue. Such systematic testing initiatives with key trading partners are essential for achieving the goal of financial neutrality.

Across the industry, we can look at the progress health plans have made to set the future for providers. This newly found year of extra time will be a critical period for internal and external testing. Collaborative testing should focus on maintaining the operational status quo. This means keeping the business neutral with respect to key performance indicators such as claims acceptance rates, support inquiries, electronic claim adjudication rates and aggregate claim reimbursement amounts. Many ICD-10 codes will result in an increase in clinical complexity and document specificity as compared to ICD-9. Through collaborative testing with health plans, both parties will be assured that migrating claims to ICD-10 will allow benefit and payment neutrality.

To test effectively, providers and their trading partners must develop scenarios that reflect use of high-risk codes, specifically claims that use codes expected to have high volumes, complexity, and high dollar values. The key is to minimize the risk to the business by focusing efforts on testing scenarios that could have the most impact.

Successful external testing requires new levels of collaboration and information sharing among providers and insurers. While it may be uncomfortable to collaborate on such testing, failure to do so may lead to big surprises in payments after the transition date, which will cause even greater discomfort for insurance companies and providers alike.

The ICD-10 transition is the most substantial effort the industry has faced. The scale of the project means that the testing required to fully ensure business readiness, as well as benefit and financial neutrality, is unprecedented. For those organizations that have the determination to keep moving forward as if the delay had never been announced, it will undoubtedly end up being a true gift on the testing front. Take advantage of the time afforded to realize a true benefit from the delay. And devote any newfound hours to ensuring that neutrality is achieved.

Deepak Sadagopan is general manager of clinical solutions and provider sector at Edifecs of Bellevue, WA.


Payback is a CPOE
By Daniela Mahoney

Right from the beginning of a project, I elicit the customer’s motivation for deciding to invest in CPOE. For meeting Meaningful Use requirements only? Or for what I like to hear, which is things such as “an organizational initiative for quality improvement,” or “to reach the highest level of patient safety goals” or even, in some cases, “cost reduction and avoidance.”

But if only about the money, we need to understand that the return on investment for a CPOE project — outside of incentive dollars — is difficult to calculate. Baseline costs of essential processes are hard to define, and often a number of benefits do not lend themselves to a quantifiable measurement process (i.e., improved communication across departments). Additionally, many organizations have difficulties measuring their medication errors and adverse drug events.

Although measurable improvement may be detected in well-defined areas, such as the use of expensive diagnostic and therapeutic procedures and compliance with core measures, CPOE should be viewed as an indispensable supportive technology and should be included in the overall quality improvement strategies of the organization.

And just how much will it cost an organization to implement CPOE?

For starters, we know CPOE is 80-85% clinical transformation, rather than tangible software, hardware, or infrastructure. Costs are more about people and processes than implementing technology. There are a few good studies published in the past few years that discuss the financial impacts of CPOE from a cost to ROI perspective.

One well-known study was initiated by the Massachusetts Technology Collaborative (MTC) and the New England Healthcare Institute (NEHI). The study was led by Dr. Bates and his team of physicians and nurses, who audited 4,200 medical charts from community hospitals in Massachusetts over a 12- to 18-month period. Once Dr. Bates’ team completed its work, PricewaterhouseCoopers did a complete financial analysis of the costs associated with each error identified and, if an error had been prevented, to whom the savings would have accrued.

Based on this study, most hospitals that have considered purchasing and implementing CPOE can expect a return on their investment within 26 months, a quick payback. The acquisition cost for a CPOE system was cited as being about $2.1 million, and hospitals could expect annual operating expenses of about $450,000 a year. After breaking even on the initial investment, hospitals with 70% use ratings for CPOE can expect a net savings of about $2.7 million per year.

Examples of cost:

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6-24-2012 3-09-26 PM

In the example above, averages are from $7,000 to as high as $17,000 per bed as a total cost of implementation. Also, I looked back at the data I have accumulated over the 20+ years to compare the costs for hospitals I’ve worked in and some of the published case studies. Looking at the cost of the implementation per bed, there does not seem to be a significant difference between the larger facilities and smaller ones.

Looking at a range of lows and highs, I am seeing costs varying from $7,550 to $12,000 per bed, depending on how costs were estimated based on the initial project assumptions. In the latter case where the cost per bed is higher, we have accounted for other items as part of the initial capital investment; things such as servers, devices, end-user support staff, and training hours for staff and the entire implementation team members.

CPOE is not an inexpensive endeavor, to say the least. But in the end, it’s cost vs. effectiveness

Organizations will spend a great deal of their initial investment regardless of whether they implement the minimum requirements to meet Meaningful Use or implement to improve quality care delivery for the entire organization. However, one thing is certain: benefits cannot be anticipated if only a handful of providers are using the system and we constantly have to come up with workarounds to bridge the gaps. There are so many benefits to CPOE and real-time clinical decision support.

So I ask the question: what is more important to your organization, cost or effectiveness? This is a critical question to understand and answer to seek because it will help you fully recognize the value of medical technology and the likelihood of adoption by your organization.

We talked about money and the “richness” of CPOE. Why not take this a step further and complement our topic with a nice summer dessert? Extra-rich strawberry ice cream. I guarantee it you will enjoy it, and it will cleanse your palate from the bitter taste this topic leaves behind.

Daniela Mahoney, RN BSN is vice president of Beacon Partners of Weymouth, MA.

Monday Morning Update 6/25/12

June 23, 2012 News 21 Comments

6-23-2012 9-17-36 AM

From DCollins: “Re: WatchChild. Rumored to be up for sale. That would be a huge signal to the world of HIT – why divest in times of growth?” Unverified, but even if it’s true, I don’t know if I would draw too many negative inferences about the healthcare IT market as a whole. The WatchChild OB monitoring system is owned by Hill-Rom, mostly known for selling expensive hospital beds and a few other marginally related product lines. WatchChild was supposed to be a natural extension of the company’s NaviCare nurse call system. HRC shares haven’t exactly shone lately, dropping from $48 in July 2011 to $30 now, so Hill-Rom may simply see the frenzy of M&A activity in healthcare IT as a good opportunity to sell some or all of its IT holdings to focus on core business. All of this is speculation since they’ve made no announcement that I’ve seen. Hill-Rom used to be known as Hillenbrand Industries, whose humorously complementary business was Batesville Casket Company. I’ve always wondered if they might put some of their nurse call technology in those caskets as an upgrade for those who fear being buried alive.

6-23-2012 2-33-29 PM

From TopExecIT: “Re: MRO. Overheard that it has acquired smaller release-of-information vendor Discovery Health Record Solutions.” Unverified.

From Grammar Neighborhood Watch: “Re: grammar mistakes. Thought you would enjoy this WSJ article called This Embarrasses You and I.” You are correct – I did enjoy the article, which calls out the “epidemic of grammar gaffes in the workplace” as the grammatically challenged get even sloppier as encouraged by Twitter and similar stream-of-consciousness outlets for narcissism (especially the younger folks, taught by questionable educational methods to ignore long-standing rules suggesting that maybe it’s a good idea to spell words correctly and compose sentences that the rest of us can easily follow, for the same reason that traffic laws encourage societal harmony.) Worse yet is that people actually get snippy if anyone points out their mistakes, as though being careful about language is a character flaw. The article suggests that companies have become sloppy in allowing poorly constructed writing to be blasted out publicly. It brings up an issue that is one of few that I would defend physically if necessary: the Oxford comma, omission of which is indefensibly illogical. I nearly always have to fix that when folks send items to run on HIStalk. The other is equally illogical and indefensible — sticking two spaces after every period. Unless you’re writing on a typewriter that supports only monospace fonts and thus requires the extra space to provide a visual break, placing two spaces after a period is just plain wrong.

From Kermit Randa: “Re: question about Epic and FDA regulation of transfusion systems. I think the question warrants a broader discussion around software as a regulated medical device. The FDA has classified numerous specific products that perform data and information transfer, storage, display, conversion, and similar management functions, such as a LIS or PACS. Last year, the FDA raised more questions than it resolved when it issued a new classification, the Medical Device Data System (MDDS) which it defines as hardware or software products that transfer, store, convert formats, and display medical device data. The FDA, in its commentary, made clear the definition of an MDDS is narrow. For example, an MDDS does not modify the data or modify the display of the data, does not by itself control the functions or parameters of any other medical device, and is not intended to be used for active patient monitoring. However, the FDA was not clear about whether or how they would classify software that falls on the outside edges of the MDDS definition and does not fall under one of the earlier classifications such as LIS or PACS. Furthermore, the FDA made clear that a health care facility may be directly responsible for compliance with the FDA regs for an MDDS, not just its software vendors. So as we all work to streamline clinical workflows and achieve meaningful use, the intersection between different types of information systems is raising issues about medical device compliance. More here, or click here to see which companies have registered as a manufacture of an MDDS (enter OUG in the product code search field.)” Thanks to Kermit, a long-time reader and COO of Surgical Information Systems, for providing that explanation. It seems that the climate for FDA regulation of some aspects of healthcare IT is heating up, so it’s worth watching carefully.

From Privacy Shrink: “Re: sharing patient data in Boston. I like the comparison between mental illness and Parkinson’s disease.” The article describes how Boston area hospitals handle sensitive parts of the medical record, such as psychiatric notes. Partners HealthCare says every doctor needs to see everything, so patients must request that certain information be placed off limits and Partners makes the final call. BIDMC allows psychiatrists to restrict access to the information they create. Neither system described any capability for patients to become involved in the decision. Privacy is a tough issue, but I’m siding with the patient – why can’t I decide who sees my information? The Partners approach comes across as smug and paternalistic, with the patient serving as a low-ranking, inherently unreliable player apt to gum up the disease mitigation factory works.

6-23-2012 2-36-35 PM

From The PACS Designer: “Re: Microsoft’s Phone 8. Along with the upcoming Microsoft Windows 8 release this fall, we’ll also get Windows Phone 8. It appears that Microsoft wants a piece of the enterprise business for phone improvements and has structured Phone 8 as an alternative to Bring Your Own Device (BYOD) to give IT total control of phone security enforcement within institutional walls.” Good luck with that. Microsoft’s consumer strategy seems to be to imitate whatever Apple is doing, adding in its usual missteps, poor design, and uninspired marketing. The result is predictable. There was a time when Microsoft was a near-religion among geeks and businesspeople who dismissed Apple as a bunch of hippies building products used mostly by students and temperamental artistes, but even those former Gates fanboys now worship at the Cupertino altar.

6-23-2012 7-14-22 AM

The feds should make doctors and hospitals jump through only evidence-based hoops, 93% of respondents said. New poll to your right: are hospitals and practices applying good financial analysis and ROI calculations to make EMR purchasing decisions? Obviously your yes/no vote makes you one of the silent majority or minority, but you can overcome the “silent” part by adding a comment by just clicking the comments link right below the survey’s voting button.

A hospital in Northern Ireland finds that a problem with its radiology information system caused radiologists to miss reading 17,000 images over several years. They’re reading the images now and have set up a patient hotline.

Nominations are open for HIMSS board and nominating committee positions. I know several folks who have used their HIMSS positions as a nice career springboard, so that might be the additional carrot you need to throw your hat in the ring if you have something to offer HIMSS beyond unbridled ambition.

HealthCor, the Allscripts shareholder that threatened a proxy fight until the company gave it three board seats, raises its ownership of the company from 6.1% to 7.3%. Share price has been flat since it fell off a cliff in late April following several negative announcements. The hugely important next quarterly report is scheduled for August.

6-23-2012 8-18-02 AM

HIM/IT services and outsourcing provider Anthelio (the artist formerly known as PHNS) names John Dragovits as president and COO. He was formerly EVP/CFO of Parkland Memorial Hospital and was a Cerner VP before that.

Nordic Consulting, a Madison-based, Epic-only consulting firm, is ranked #1 in staffing and implementation support in “Navigating the Sea of Epic Consulting,” a new KLAS report.

In England, several NHS trusts join together to seek a replacement for their RiO mental health EMR, expecting spend up to $470 million.

Vince has more to say about Dairyland and several related companies this week. You can help him out by reminding him of other companies he can riff about, especially if you were around in the early days prior to 1980 or so. I offer Continental Medical Systems, Megasource, Dynamic Healthcare Technology, Atwork, and Visteon/Avio as a few old-time names I’ve heard recently. In another angle of attack, has Vince missed any big personalities of that era, folks who kept turning up in one company after another? He would appreciate your ideas and contact information for the pioneers he could reminisce with.

Aetna and Inova Health System (VA) jointly form Innovation Health Plans, which will offer new HMO and PPO services. Inova’s healthcare services delivery will be supported by Aetna’s benefits administration and technology (presumably Medicity) that will allow physicians to track patient care.

London-based SwiftKey releases its on-screen tablet or phone keyboard for healthcare that claims to reduce text input time by 49% by predicting the next word to be typed. Price for this version wasn’t given since I suspect they’ll sell through hospitals and software vendors, but their non-healthcare product is $1.99, and priced appropriately given mixed reviews. Watching the guy thumbing his way through entering medical text in the video above made me nervous – doctors don’t pay enough attention to on-screen defaults and choices as it is, so I can envision some major medical errors caused by too-quick approval of the wrong word.

More Accretive Health fallout: the Treasury Department proposes regulations that would require charitable hospitals to keep their collection dogs on a leash, improving their effort to help patients qualify for financial assistance before garnishing their wages or dinging their credit scores.

An FDA report finds that software problems cause 24% of medical device recalls, also noting that the engineering teams that build medical devices are often woefully ignorant of best practices for developing and distributing software. It mentions FDA’s Functional Performance and Device Use Laboratory, which will allow the agency to test user interfaces and analyze device usability.

E-mail Mr. H.

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