News 5/17/13

Top News

The House Appropriations Committee approves $344 million in development funds for an integrated EHR for the VA and DoD, but mandates that no funds be expended on any EHR unless it is an open architecture system that serves both agencies.

Reader Comments

From Stifler’s Mom: “Re: Marin General Hospital. Nurses warn that the new computer system is causing errors.” A dozen unionized Marin General nurses attend the healthcare district’s board meeting to ask hospital administration to put the McKesson Paragon implementation on hold, claiming orders are being entered on the wrong patients, patients have been given meds to which they are allergic, and discharges and surgical prep are taking two hours.

From Carolyn: “Re: first HIStalk Webinar with HTTS. Will the recording be made available for those of us who could not attend the live session?” The recorded Webinar, “Vendor Software Training: What Providers Should Demand” is available for anyone to view here and a PDF of the slides is here. Everyone who registered will get an e-mail with these links, along with those to the HTTS-developed forms mentioned in the presentation (the Software Vendor Training Checklist and Sample Evaluation Form.)

From Horizon Consultant: “Re: Bayhealth – Milford Memorial Hospital. Went live on Horizon Expert Orders full house with physicians this week, with few problems.”

From Acorn: “Re: Maine Medical problems. Their Epic project is over budget by some unidentified amount, but will be high 8-9 digits, more than member hospital boards signed up for. Rollouts that were expected to conclude in 2013 are on hold until Maine Medical Center is stabilized – 2015 maybe? MaineHealth’s mouthpiece said training was not an issue, but I respectfully disagree. Insufficient engagement at all levels and all phases has been at the root of problems.”

HIStalk Announcements and Requests

This week’s highlights from HIStalk Practice include: the AMA looks at how patient-physician communication is affected by the use of computers in the exam room. INTEGRIS Health (OK) contracts with athenahealth for athenacollector and other products. Doctor office visits fell in 2012 while patients’ out-of-pocket costs jumped 30 percent. Primary care providers beat specialists in generating money for hospitals. The AMA does not recommend jumping directly from ICD-9 to ICD-11.  Make the world a happier place (at least my world) and sign up for e-mail updates when you check out the HIStalk Practice news. Thanks for reading.

Nuance CMIO Nick Terheyden tweets out another fun photo as he carries the HIStalk logo on his travels, this time with HIMSS President and CEO Steve Lieber from the stage of the Arkansas HIMSS Chapter meeting. Take along a printed logo or your iPad and snap and e-mail a photo from somewhere fun and I’ll run it here. We’ve seen photos from London and Dubai previously, so it’s your turn.

I’m behind on almost everything, so be patient if you are expecting something from me. I was so exhausted Wednesday night after work that I literally fell asleep in the middle of typing HIStalk, so I’m struggling to keep up.

On the Jobs Board: Clinical Analyst, Marketing Communication Specialist. Sponsors post their jobs for free.

Welcome to new HIStalk Platinum Sponsor, HCS (Health Care Software, Inc.) of Wall, NJ. Everybody likes stable vendors who aren’t just dabbling temporarily in healthcare, and HCS has been doing provider-only healthcare IT since 1969 (!!) The company’s INTERACTANT platform, an integrated suite of clinical and financial applications (revenue cycle, financials, EMR, mobile, and analysis) is meeting and exceeding the needs of all kinds of provider organizations (inpatient, outpatient, long term acute care, behavioral, and rehab). Check out their white papers (the best title: “Meaningful Use: Why Should Ineligible Providers Still Care?”) and case studies.  Thanks to HCS for supporting HIStalk.

Acquisitions, Funding, Business, and Stock

The AMA reports a four percent decline in 2012 revenues from 2011, largely due to an 86 percent drop in advertising revenues and lower sales for printed coding books.  Membership was up over three percent, but net  operating profit fell 33 percent.

Sales

Port Huron Hospital (MI) signs a three-year contract with CareTech Solutions to use the iDoc Archive solution for storage of patient data as the hospital transitions to a new EHR.

Wilson Memorial Hospital (OH) chooses Access to integrate electronic patient signatures into Meditech and register patients electronically during downtime.

Trinitas Regional Medical Center (NJ) selects Dell’s Unified Clinical Archive solution to manage its clinical image archive.

The VA extends its contract with Authentidate for its Electronic House Call vital signs monitoring device and service and for the Interactive Voice Response System for remote patient monitoring.

People

MedeAnalytics names Andrew Hurd (Epocrates/Carefx) CEO, taking over for Mike Gallagher who will serve as executive chairman.

Jerry Baker (Halfpenny Technologies) joins HIT Application Solutions as president and CEO.

URAC appoints Kylanne Green (Inova Health System) president and CEO.

Streamline Health Solutions promotes Nicholas Meeks from VP of financial planning to SVP/CFO, taking over for the resigning Steve Murdock. Carolyn Zelnio (Aderant) also joins the company as VP/chief accounting officer.

Announcements and Implementations

HealthTech, parent company of HMS, MEDHOST, and Patient Logic, held a ribbon-cutting ceremony this past Wednesday to celebrate the opening of its new, larger headquarters in Franklin, TN. Participating were Allen Borden (assistant commissioner, Tennessee Department of Economic and Community Development); Rogers Anderson (Williamson County mayor); Ken Moore, MD (City of Franklin mayor); Matt Largen (president and CEO, Williamson County Chamber of Commerce); Bill Anderson (president and CEO, HealthTech); Steve Starkey (president, HMS); and Craig Herrod (president, MEDHOST).

Encore Health Resources launches its health analytics consulting practice, which follows the company’s preference of "Smart Skinny Data” (using information from specific sources to focus on specific analysis needed) over “Big Data.” The practice will offer analytics strategy, tools selection, implementation, performance improvement, and data governance help.

New York eHealth Collaborative issues an RFP to develop a statewide health portal, just after declaring Mana Health’s design to be the winner earlier this week.

Patient Updater releases a new version of its HIPAA-compliant messaging platform that allows hospitals to keep the families of surgery patients informed.

Government and Politics

The Senate confirms Marilyn Tavenner as CMS administrator, making her the first CMS leader to be confirmed in over nine years.

CMS will spend up to $1 billion for the second round of the Health Care Innovation Awards to promote projects that test new payment models in support of better care and lower costs.

Eleven top government officials will speak at the 2013 Health Privacy Summit, June 5-6 in Washington, DC, including Todd Park (White House), Joy Pritts (ONC), Leon Rodriguez (OCR/HHS), and David Muntz (ONC).

Innovation and Research

Massachusetts Governor Deval Patrick visits a digital health summit in Ireland to discuss collaboration between startup companies in their respective areas.

The wireless pill reminder bottle from AdhereTech wins the Healthcare Innovation World Cup.

Other

CareTech Solutions takes the top spot in a KLAS survey on IT outsourcing. Though many providers are pulling back on extensive IT outsourcing (EITO) in favor of partial IT outsourcing (PITO), EITO remains the most popular option for smaller hospitals.

The city government of Juneau, AK, which owns 57-bed Bartlett Regional Hospital, votes down an $8.5 million appropriation for a Cerner implementation the hospital has already signed for. The hospital CEO says the contract was signed before Quorum Health Resources left as facility managers and he’s not comfortable with the $1.155 million in annual maintenance costs on the $7.37 million capital purchase (15.7 percent per year). The hospital is hoping its contract has enough out clauses to convince Cerner to allow it to walk away as it seeks a less expensive system.

The deadline to submit proposals for educational content for HIMSS14 is June 3, or about 7 1/2 months before the actual conference. Interestingly, HIMSS suggests that proposed topics be “timely.” Interested speakers should consult their crystal balls before applying.

The federal government charges 89 people — including about 22 doctors, nurses, and other medical professionals in eight cities — with Medicare fraud schemes that totaled $223 million in false billings.

A New York medical practice exposes the personal information of thousands of its patients when a clerk mistakenly attaches an Excel worksheet to an e-mail being sent to 200 patients.

Weird News Andy offers a pithy headline for this story, “Time to eat cookies whilst on the rack,” but you’ll have to think to get it. British researchers find that body mass index (BMI) is a poorer predictor of life expectancy than the ratio of waist size to height. People with a ratio of 0.8, which would be 56-inch waist for a 5’10” man or woman, lived 17 years less on average, while keeping the ratio at 0.5 or less (a 35-inch waist in this example) was associated with reduced incidence of stroke, heart disease, and diabetes. The ratio works on children as young as five, the researchers say.

Sponsor Updates

• OB leaders at MedStar Franklin Square Medical Center (MD) describe PeriGen’s EHR, surveillance, and decision support system that supports healthier babies and mothers on “Today in America.”
• T-System posts a video explaining how its system benefits ED patients and clinicians.
• e-MDs will offer analytics and dashboards to its customers via an agreement with dashboardMD.
• ReadyDock adds Complete Tablet Solutions as a reseller of its tablet management products.
• This week’s 2013 Truven Health Advantage Conference in Scottsdale, AZ featured keynote addresses by Gov. Howard Dean, MD; Sen. Bill Frist, MD; and David Newman, MD.
• Prognosis Health Information Systems discusses key considerations when changing EHRs. 
• SuccessEHS hosts a CEU-approved Webinar May 29 on ICD-10 changeover planning.
• The Boise Metro Chamber of Commerce recognizes Heathwise with its Healthcare Industry Excellence Award.
• Kareo posts a Webinar on the ins and outs of Stage 2 MU.
• Verisk Health hosts a May 29 Webinar featuring Bob Kay, senior data analyst with New Hampshire’s Granite Healthcare Network, who will discuss analytics for ACOs.
• Craneware offers Webinars May 22 and May 30 on best practices for improving financial performance.
• ChartWise Medical Systems CEO Jon Elion, MD discusses ethical practices in clinical documentation improvement on May 21 during the ACDIS Conference in Nashville.
• MedAssets customer Oconee Medical Center will share how it used the company’s technology and services to improve point-of-service collections at this week’s NAHAM conference in Atlanta.
• Finalists for Impact awards from the Technology Association of Georgia Southeastern Software Association include Billian’s HealthDATA (emerging mega trend and technology solutions provider) , McKesson (technology solutions provider), and NextGen (independent software vendor).

EPtalk by Dr. Jayne

From Big G: “Re: sick or not sick. I have a story to mirror yours. There I was, a medical student rotating at a large, urban children’s hospital’s ER. I was getting my duties from the charge nurse (‘Don’t touch anything.’) Without breaking stride, looking out at the vast, screaming waiting room, surely my vision of Hell, she pointed to one kid, and said, ‘He’s next.’ 30 years on, that display of sick/not sick sticks with me. Meningitis. Thanks for sharing. We’ve all had those semi-scary moments where we’re amazed by someone’s psychic abilities. Thank goodness for seasoned warriors in the trenches.”

During a recent “listening session” with CMS officials, the AMA offered testimony on the issue of cloned documentation. Comments on usability and reconsideration of Stage 2 MU were also hot topics in the discussion.

What is it with endorsements on LinkedIn lately? In recent weeks I’ve been “endorsed” for skill sets that I don’t remotely possess. If nothing else, it’s good for some entertainment, and some of it makes me sound just the slightest bit cool.

The National Committee for Quality Assurance (NCQA) publishes the names of 112 people newly certified as Patient Centered Medical Home experts. Those certification is aimed to help providers assess the quality of those offering to assist practices through the PCMH process. I hope they were all aware that their e-mail and snail mail addresses were going to be published to the world.

Speaking of certifications, I’m interested to hear who plans to sit for the American Board of Preventive Medicine subspecialty board exam in clinical informatics. The online application for initial certification is live and late fees apply to any application submitted after June 1. The exam is already fairly pricey and the Board will offer a non-fellowship pathway for the first few years. It will be interesting to see how presence or absence of certification impacts the job market for physician informaticists. Have you registered? What did you think? E-mail me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 5/16/13

House Spending Panel Backs Joint Defense-VA Electronic Health Record

The House Appropriations Committee approves the VA’s requested 2014 budget line item of $252 million for an integrated electronic health record, then adds another $92 million, but mandates that no money be released except for an open architecture system that will serve as the sole EHR for the VA and DoD.

Physician adoption of health information technology: Implications for medical practice leaders and business partners

A Deloitte survey of US physicians finds that 75 percent believe that Meaningful Use holds promise for improved efficiency but that reduced costs resulting from the use of EHRs is inflated and that ultimately care will cost more, not less.

Wake Forest Baptist Medical Center reports gain in excess revenue

Wake Forest Baptist Medical Center reports operational income losses attributed to problems with its Epic implementation after spending $13 million directly on Epic and $8 million on implementation expenses. The hospital also reports $26 million in lost margin due to volume disruptions during initial go-live and post go-live optimization. Baptist was already scheduled to complete a staff reduction of 950 employees by June 30, but will now implement additional immediate cost-cutting measures. Moody’s has downgraded its long-term debt rating.

Expert predicts ‘meaningful use fatigue’ in 2015

Laura Kreofsky, principal at Impact Advisors and director of Sutter Health’s Meaningful Use program, discusses the need for organizations to operationalize Meaningful Use-related projects by moving them from small project teams to increasingly stretched IT departments. Due to this shift, she predicts widespread organizational "MU fatigue" by 2015.

Readers Write: Hospital Pricing Data: Another Step Down the Rabbit Hole

Another Step Down the Rabbit Hole
By Data Nerd

On Tuesday, May 7 at 9:53 p.m., the Center for Medicare and Medicaid Services released a new open dataset to shed light on hospital pricing variations. The Times and The Washington Post (among others) published lengthy online articles (presumably overnight), complete with data visualizations to assist consumers in understanding the vast differences between what hospitals charge Medicare for their services. CMS released state and national averages a week later after The Washington Post published an article aggregating the data for comparison on the state level.

On the first day of its release, the dataset was downloaded over 100,000 times, displaying the large appetite that the public has for open healthcare pricing data. What is unfortunate is that this data set is fundamentally flawed for the purpose for which it was made public.

In the age of high(er)-tech journalism, I was disappointed to read article after article that overlooked the data documentation and went straight to the numbers and visualizations that could be concocted. Even HHS’s own chief technology officer got it wrong when he referred to the data as, “The actual prices that hospitals charge Medicare for the top 100 procedures across the country.”

The data given are not the top 100 procedures. They are the top 100 DRGs, which means that in any given claim, there could have been anywhere between one and 25 procedures performed (and they do vary, wildly.)

If the goal is to compare hospital’s charge rates, you need a normalized cohort. Or in layman’s terms, you need to compare apples to apples instead of kumquats to grapefruits. People with the same DRG suffer from the same diagnosis and often share similar courses of treatment, but wouldn’t a better analysis look at patients that all had the same procedures?

A DRG is a diagnostic related group, a very broad categorization of the primary diagnosis that the hospital is treating. A claim only has one DRG, but can have anywhere between one and 25 procedure codes. The data as it is currently presented is inherently incapable of pointing to charging discrepancies because a claim could be charging for one procedure or 25.

Personally, I think the move was more of an administrative muscle flex going into the healthcare exchanges set to open in October — fueled by the threat of public perception rather than an attempt to shed (non-refracted) light on the subject. A more accurate approach would have been to isolate claims where only one procedure was performed and provide the average charge or reimbursement data for those. Unfortunately, CMS charges nearly $4,000 for the data in a format that would allow this type of analysis.

This open dataset is another unfortunate example about our exuberance for “big data” giving way to our human propensity to under-analyze and take misinformed baby steps toward a greater goal, however noble it may be. As more and more data is presented for public digestion, its dissemination must be properly documented and cited if it is to be used to drive analytical outcomes.

HIStalk Interviews Benjamin Albert, CEO, Care Team Connect

Ben Albert is founder and CEO of Care Team Connect of Evanston, IL.

Tell me about yourself and the company.

The company started officially in late 2008, but I took it on full time in early 2009. Prior to starting Care Team Connect, I worked in healthcare technology for my whole career, most recently in a services company, PatientKeeper, for the acute care setting, where we were pulling together data for hospitalists and the providers within the hospital to better coordinate and manage care within the hospital.

As a result of that and parallel to that, my grandfather had his second stroke. Seeing all the effort that was going into the inpatient setting and very little effort going into the community setting compelled me to start the company to better coordinate care in the community for high-risk patients.

Describe how care coordination should work ideally.

There’s a number of perspectives on that. In my opinion, the way care coordination should work is that patients should get a patient specific plan of care that encompasses all people who touch that patient so they’re singing off the same sheet of music. Making sure it considers psychosocial factors, patient history and patient risk, and the whole patient as the plan is assembled, so that everybody knows who is going to do what when for each patient. That will enable efficiency, lower costs, and higher quality.

What needs to happen to make the patient-specific plan of care ubiquitous, like medication reconciliation?

You need to have the right team in place in order to manage and coordinate a population’s care. While our technology will streamline it and allow you to do a tremendous amount more with the resources that you have than if you don’t have a platform like ours to power workflow and coordinate care, if you don’t have the people who are focused on it — and I mean truly focused on it, not tangentially focused on it — as soon as you determine that you need to establish a team that’s responsible for coordination, then you need to power that workflow and allow it to scale.

Where we see most of the initiatives fail is that people will make that decision, but then they won’t be able to get lift or scale around the population, because they end up managing just the highest of high-risk patients with a few part-time or full-time resources. That in itself isn’t a way to enable full, broad-scale care coordination.

You need a more systemic process around how you are going to manage the high-risk, moderate-risk, and low-risk patients. What things are you going to do specifically for each patient as they impact quality and cost? Then allow yourself to scale that through automated processes like our technology. But before you even get to technology, you need to talk about your program development and how you can scale,  which we also help our clients with.

How does your platform support that process?

The platform listens for data that would trigger action on a patient that’s being managed in a population. Truly managed, not any patient in the population. We’ll identify which patients need to be managed. We’ll reconcile actionable data, which could be a real-time admission alert from an ADT, it could be a new medication, it could be a change in a patient’s psychosocial status like a change in home setting.

Any number of these things can be a triggerable event in our system that would drive action. The system listens for that, weights it against the patient-specific information and the risk to the patient and the care program that that person sits in, i.e. what we need to do in the event this piece of data comes in for this particular patient at this risk?

It drives the specific tasks to the right people across the continuum. When I say that, I mean those right people can be a family member, a clinician, a nurse, and anybody who has a relationship to that patient. The system’s rule will tell you, OK, based on this patient, here’s where you fire this task to.

What integration is required?

The most common integrations we do are to either claims or attribution models from payers or a shared savings program or ACOs or however they have their attribution models in their claims from the payers. We’ll pull that in as the foundation for the population being managed. Then we’ll marry real-time data to that on the fly, which includes ADT, medication feeds, and visits to the physician office. Those types of pieces of data are real time, married to the attribution and patient-specific data.

It can be labs. It can be any number of data elements that will trigger action. Based on the population being managed, we build these programs and actionable events around the data that’s more pertinent to the population being cared for.

How would a typical customer connect to that data and what are they doing with the results?

I’ll walk you through a couple of customer scenarios. We work with medical homes, ACOs, health systems, and we’re starting to get into some more of the employee health types of things. In the ACO medical home scenario, we’ll take a client who is currently managing 120,000 lives across an entire state with 77 physician practices. They need to manage that care across all those lives, across all those demographics.

They take their attribution, and then they take some real-time ADT information from various places across the state, and the plan of care that’s been established for each of the patients based on their criteria. They marry that specific data, i.e. an admission for anyone in their 120,000-patient population will trigger a workflow for the care managers or care navigators supporting that population. That’s a very basic core workflow that prevents readmission, increases coordinated care, and truly establishes a workflow around it, a transitions of care workflow in particular. That’s one example.

Another example might be a pure preventable readmissions initiative with a specific client, who upon discharge, we receive just ADT information along with some other data to identify which patients are at risk of readmission. From there, we’ll drive a particular plan of care based on what type of patient it is, what type of follow-up needs to occur, and drive the tasks and the actionable plan around that in an automated fashion.

If I go back to that first scenario for a second, I failed to talk about one core piece of data that is a differentiator. The population health analytics companies who today are doing a great job of identifying gaps in care and managing the data around the population that also in case of truly managing the health of a population, that data is valuable in addition to the real-time data, in addition to the attribution to trigger the right plans of care based on the patient’s attribution, risk, gaps, and beyond.

Many companies are involved in analytics and population health management. How do you see your offering fitting and who do you consider to be your competitors?

In the population health analytics space, we look at their data as great triggerable events married to all the other things we’re doing with the population. We like to work closely with them, especially if our clients decide to go in that direction and feel the need is strong enough for their population to identify gaps and do that analytics.

We really don’t feel like we’re competitors to the analytics companies. It’s more as a partner, where we can leverage their data to truly drive workflow and action, which seems to be a pretty big gap in the market right now that we’re filling.

Is it difficult for people to understand what you’re offering and how it fits in?

It can be, until the market understands the difference between care coordination and care management and population analytics, which we’re charged with helping the market understand. There’s a huge difference. It can get gray in terms of the client’s perception of what we do versus what those solutions provide.

But as soon as a client really digs in and says, OK, how are we actually going to manage the population? Not how are we going stratify and identify the population, but how are we actually going to manage the population and all of these care coordinators we’re hiring now? How are we going to power their workflow in a way that we’re sure that they are going to follow the right patients and that we’re going to get the yield out of the initiative that we anticipated getting?

It’s the next step. People recognize that as a major need. We sit on front of it to make it all happen. But until there is that understanding of what analytics is really built around — and it’s really built around crunching the data and what we do, which is built around workflow and coordinated care — I think the market does get confused until they understand the difference.

It sounds so obvious that there should be a patient-specific plan of care. Describe how it gets created and maintained and what the end result looks like.

It is somewhat of a new concept in the way in which we approach it, but I think there had been a lot of folks after the longitudinal plan of care for a patient. They are often templated and disease based, much as disease management companies or groups like that have approached the market in the past.

What we do is much different. There are elements of disease-based plans of care, but it’s really about the patient themselves, the psychosocial data, meaning what is their mental health, what is their home status? A number of those other elements which can help dictate how to follow up and manage that patient. Essentially, how much do I need to do to support this patient as opposed to how much can they do on their own without my involvement?

Our approach takes that data, which changes over time, and marries it to the real-time data. The plan is always changing. It’s a living, breathing plan of tasks and documentation to support that patient. As data changes from a real-time perspective and there is a profile change for a patient, the plan morphs along with the patient to make sure that it’s always providing the right level of support and efficiency around that patient’s care as required.

That’s really a big difference for us. It’s by no mean a single-threaded plan of care. This is a living, breathing plan of care based on the data coming in to the system and the patient’s needs, which really hadn’t been done before, not in this way, anyways.

It seems to be getting a lot of traction in the marketplace as a result, because our clients don’t have all the resources in the world and that’s not going to change. How are you going to truly manage this population of patients and help our community members who are collaborating with you in this ACO or in this shared risk initiative to support the population in real time? That’s how we help it happen.

A typical example would be where there is a primary care provider and a hospital relationship that integrates specialists and therapies. They’re potentially with an admission or an ED visit and there might be a specialist involved and there might be therapies of some sort. The resulting plan integrates all that into a single single source of truth that everybody agrees and understands that is taking care of that patient.

Absolutely. You’ve got it. That plan is driven by the individual or group that is responsible for the population. The ACO group may create that source of truth through our platform, or the hospital. It really depends on where is the risk is. They’ll drive that plan based on the automated routines.

The new brave new world of ACOs has put together some bedfellows that may not be comfortable with each other, as in hospitals and practices. 

You can add the health plans into that mix as well, in terms of all the groups who are participating in these initiatives and how well they work together in a way that makes sense for everybody.

I suppose the answer to you is that’s initiative by initiative, community by community. In some cases, like in Battle Creek where we are working, everybody is collaborating really well. It’s actually the practices who are leading the initiative, supported by the health systems and other folks in the community organizations and the community.

In the hospital-driven initiatives, it can be very effective. For example, we’re working with a health system in the Northeast. They are powering all their skilled nursing facilities through our platform. Upon discharge, one of the skilled nursing partners will get all their detailed plans for a heart failure patient that’s being discharged to them. Not in the placement type of variety, which I know is probably the next question, but more on, what’s the plan of care for this patient?

Those people are engaging and wanting that type of information because they aren’t armed with that data in a way that makes them successful. They want that type of collaboration. They know in the future it’s all going to be shared, and if they are not lining up to collaborate well with the health system today, it’s going to be a big problem for them in the future.

Everybody thinks about physicians and hospitals when they think about care coordination or ACOs, but in this model that you’re describing, it sounds like there is an important role for a nurse.

A huge role for a nurse and family and community partner. If you fall in to the trap of this is only a physician-led or hospital-led initiative, you’re not going to change things the way that they need to be changed in order to really coordinate care.

You need to infiltrate that with a care navigator-type nurse function that supports the population and also understands what it means to truly work with community members, Meals on Wheels, various partners in the community, family members, adult caregivers. All these people who can play a role for you. 

I’ve got all this work to do for this population. I know I need to do to support the population well. I have a handful of resources to make it happen. There are community resources out there willing to do this and they just need to be armed and ready to go. If you put that process in right, you are actually solving a much bigger problem by truly supporting the community and the population as a whole.

Where do you see that company being in five years?

That’s a great question. I get it often. The way I answer that is, I’m not sure where the company will be in five years. We just keep delivering value week to week, month to month, year to year basis, and keep listening to what our clients are telling us. Making sure we understand where the market is going and keep driving and building a successful organization that has value and purpose.

We try very hard not to focus on our five-year plan, but to focus on execution, action, value, and purpose as an organization. The rest will take care of itself.

Any final thoughts?

The company is doing tremendously well. I’m sure this is consistent with what everybody says, but the company is truly doing great. We recently signed our largest client to date. I think Care Team Connect is very, very well positioned for the foreseeable future. We’re just excited to continue to read your blog and hopefully show up there more and more with good news.

Morning Headlines 5/15/13

Compuware subsidiary Covisint files for IPO to raise $100 million

Detroit-based Covisint, which provides cloud-based business platforms for a variety of industries including HIE technology for the healthcare market, files for a $100 million IPO.

Why VC’s Shortchange Healthcare IT—And How to Change It

Athenahealth’s Jonathan Bush contributes an article looking at funding trends in health IT and a perceived lack of opportunity for innovative startups in that space.

Medicare Fraud strike force charges 89 individuals for approximately $223 million in false billing

The Medicare Fraud Strike Force executes operations in eight cities that result in charges against 89 individuals, including doctors and nurses, for their alleged participation in Medicare fraud involving $220 million in false billings.

Exam Room Computing & Patient-Physician Interactions

The American Medical Association releases a study on the use of computers in the examination room and its effect on patient satisfaction. The study found that patients’ attitudes toward the computer were heavily influenced by the physicians’ attitude toward it. The more positive they perceived their doctor’s attitudes, the more likely respondents were to indicate a preference for computer use in the exam room.

McKesson Announces Nationwide Expansion of its Million Dollar EHR Software Give-Away Program, McKesson Gives Back

McKesson expands its McKesson Gives Back program nationally. The program, launched in 2011, donates McKesson Practice Choice EHR systems to small physician practices that operate in underserved and underinsured communities.

News 5/15/13

Top News

Compuware subsidiary Covisint, whose healthcare business offers an HIE platform, files for a $100 million IPO.

Reader Comments

From Olga: “Re: identifying patients by driver’s in Texas. I think it’s a bit naïve to think that one can simply attach a card swipe solution to a provider’s registration system and everything will be good to go. Card swiping is only the first step of the registration process. The data captured from the card still need to be bounced up against the provider’s EMPI so that this service can determine if this is a new registration or if that individual already exists within the patient index that matches the demographic details on the ID card. The card swipe is really only part of the solution. It doesn’t solve issues around identity theft. That can be addressed only through two-factor authentication, maybe through the use of biometric devices like fingerprint or palm vein scans. I commend Texas with a step in the right direction, but this shouldn’t be classified as, ‘Whew! Solved that problem!’” I agree – lots of people get services under false pretenses by presenting someone else’s insurance card, and the link needs to be made to the hospital’s records in the absence of a national patient identifier. The only sensible solution would be that identifier plus biometrics, but you couldn’t get elected dogcatcher having your political opponent pounce on that perfectly sensible and fraud-detecting idea as government meddling.

From Passionate Radiologist: “Re: American College of Radiology. Launches Imaging 3.0 – Beyond Image Interpretation to keep rads in the forefront of patient care.” Imagine 3.0 is described as, “It includes a set of technology tools that equip 21st-century radiologists to ensure their key role in evolving health care delivery and payment models—and quality patient care. Imaging 3.0 is a call to action to all radiologists to take a leadership role in shaping America’s future health care system.” I would be interested in the opinions of radiologists about this initiative.

From KJ!: “Re: eHealth in Canada. Interesting article about funding cuts.” The federal government says Canada Health Infoway won’t be shut down despite the surprise decision not to give it new funding in 2013. The organization has already earmarked the $900 million it has received, the last of which was in 2010. The government says it needs to cut back on spending.

From Dr. Gregg: “Re: athenahealth. Have you guys seen CodeView?” I hadn’t seen it. Athenahealth’s CodeView is a billing code lookup that shows average reimbursement per per procedure for all insurance types as pulled from the company’s network.

HIStalk Announcements and Requests

Thanks to everyone involved in today’s first-ever HIStalk Webinar. We had good attendance and a nicely done presentation by Lorre and Shauna from Health Technology Training Solutions. Thanks to our moderator Jim and the CIOs who pre-screened the run-through with me and provided feedback that the presenters then incorporated into the final version. That’s how we’ll run Webinars going forward.

Acquisitions, Funding, Business, and Stock

Printing management system vendor Levi Ray & Shoup will acquire Capella Technologies, which offers products for HP printers.

Sales

Ephraim McDowell Health (KY) expands its contract with HealthCare Anytime to include its entire patient portal suite.

Northeast Georgia Health System selects Isabel Healthcare to provide diagnosis decision support and patient engagement tools.

The Department of Defense will implement Mediware’s blood donor and transfusion software validation services in partnership with Planned Systems International.

Continuum HealthPartners (NY) selects Wellsoft’s EDIS for its four NYC-area EDs.

Griffin Hospital (CT) will implement Vree Health’s TransitionAdvantage service to help patients adhere to the hospital’s recommended post-discharge care plans and reduce preventable 30-day patient readmissions.

Texas State University selects eClinicalWorks EHR and Patient Portal and the Health & Online Wellness PHR smartphone app for its student health service.

Hartford HealthCare Corporation (CT) will implement the AccessAnyWay content management enterprise solution from Streamline Health Solutions.

Lehigh Valley Health Network (PA), White Plains Hospital (NY), and Laurens County Health Care System (SC) select the Good to Go discharge communication solution from ExperiaHealth, a subsidiary of Vocera Communications.

Bay Area Hospital (OR) will use Besler Consulting’s BVerified Screening and Verification solution to address CMS sanctions screening requirements.

Hanover Hospital (PA) choose Capsule’s DataCaptor for medical device integration with Meditech.

People

nTelagent names Lloyd Baker (Passport Health) regional VP of sales.

BizTimes Milwaukee names API Healthcare President and CEO J. P. Fingado winner of its 2013 Bravo! Entrepreneur Award.

Polycom CEO Andrew M. Miller joins Informatica’s board.

Telehealth provider Teladoc names Henry DePhillips, MD (Audax Health) CMO.

Convergent Revenue Cycle Management, Inc. appoints Greg Rassier (Rassier Consulting/Conifer Health Solutions) COO.

Intellect Resources names Dan Stoke (Allscripts) VP of client sales and service.

SeniorCare, a provider of analytics-driven prospective care solutions, appoints Joell Keim (Outcomes Health information Systems) president.

HealthMEDX hires Craig Frazier (Intuitive Medical Software/McKesson) as COO.

Matt Ebaugh (Kaiser Permanente) is named VP/CIO of Kings Daughters Health System (KY).

Announcements and Implementations

Strategic Health Intelligence of Pensacola and Atlantic Coast HIE of Miramar become the first providers to exchange patient information with the Florida HIE Patient Look-up Service developed by Harris Corporation.

NextGen Healthcare will integrate PDR Network’s drug information technology with the NextGen Ambulatory EHR platform.

St. Francis Memorial Hospital (NE) goes live on McKesson Paragon June 17.

LDM Group will provide its healthcare messaging solutions PhysicianCare and ScriptGuide to providers through DrFirst’s Rcopia e-prescribing solution and Patient Advisor patient education solution.

Community Memorial Health System (CA) begins deployment of PatientKeeper CPOE for more than 500 physicians.

Healthwise will offer National eHealth Collaborative’s Consumer eHealth Readiness Tool to its clients.

Mountain States Health Alliance reports significant improvements in glycemic control within 60 days of implementing Glytec’s inpatient glucose control platform Glucommander.

Athenahealth completes its $168.5 million purchase of the 760,000 square foot Arsenal on the Charles complex in Watertown, MA from Harvard University, in which the company’s headquarters has been located since 2005.

Government and Politics

Proposed legislation in Texas would allow licensed healthcare providers to collect or verify patient information with a swipe of a patient’s driver’s license.

Innovation and Research

An project seeking crowdfunding via Indigogo is a placebo mobile app, which is a lot more interesting and scientific than the title would suggest.

Technology

Student journalists from Virginia Commonwealth University  interview Colin Banas, MD, CMIO of VCU Medical Center (VA). He talks up the hospital’s PatientKeeper system, which they are running with Cerner.

Other

MaineHealth President and CEO Jim Donovan tells patients of its St. Andrews Hospital that the hospital’s future direction wasn’t set by the decision to replace Meditech with Epic.

New York eHealth Collaborative names the winners of its Design Challenge for the Patient Portal for New Yorkers. Mana Health took first place.

In a Techonomy guest article, Jonathan Bush of athenahealth says VC funding of healthcare IT companies is “tragic” if you exclude HITECH, with the reason being (a) healthcare is not a shopper’s market; (b) the federal government stifles innovation and instead rewards risk aversion that he calls “the scenario of maximum regret” – audit, lawsuit, and death; (c) doctors are paid for volume instead of service, quality, and competitive pricing. His solutions aren’t nearly as decisive, but he naturally likes his own company’s innovation program.

An Arizona nurse sues her former physician business partner for blocking her access to their clinic’s computer systems, which she says prevented her from treating her patients.

Weird News Andy hopes his turn signals were working. A man accidentally amputates his arm while cleaning equipment, then puts it in the car and drives nine miles to the hospital, where he parks calmly in the parking lot, walks in, places the arm on the receptionist’s desk, and asks to have it reattached.

St. Luke’s Hospital (AZ) finds a 19-year-old student passed out in a wheelchair in its ED lobby, left there by his friends after 20 shots of tequila with a 0.47 percent blood alcohol level and a Post-It note stuck to him explaining that he had been involved in a drinking contest.

Sponsor Updates

• Ping Identity CEO Andre Durand discusses how creating the right circumstances can lead to “eureka moments.”
• Informatica introduces Informatica Cloud Summer 2013, the latest release of its integration and data management software which delivers native SAP connectivity, process automation, and MDM advances.
• Caradigm signs an OEM agreement for BIO-key International’s fingerprint biometric technology for identity and access management.
• McKesson expands its McKesson Gives Back Program nationwide and will provide up to 100 selected physicians with the McKesson Practice Choice EHR/PM program.
• Impact Advisors principal Laura Kreofsky predicts that most organizations will experience Meaningful Use fatigue by 2015.
• Winthrop Resources will participate in the International MUSE 2013 event May 28-31 in National Harbor, MD.
• NTT Data will participate in the Open Data Center Alliance’s Forecast 2013 event in San Francisco June 17-18.
• MedAssets calls for exhibitors for the 2013 Technology & Innovation Forum October 1 in Orlando. Deadline for submissions is June 3.
• Bruce Eckert, national practice director for Beacon Partners, discusses habits of meaningful EHR users at the Arkansas HIMSS conference May 16.
• Vitera Healthcare Solutions sponsored this week’s MediFuture 2023 that promoted disruptive innovation in healthcare in the Tampa Bay region.
• Beacon Partners releases a white paper on the seven steps to know and do now to reach Meaningful Use Stage 2.
• Intelligent InSites offers a white paper with tips for enterprise RTLS success and hosts a May 23 Webinar on the operational aspects of an intelligent hospital. 

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 5/14/13

Report: Global health IT market to hit $56.7 billion by 2017

A recent analysis of the global health IT market forecasts an annual growth rate of seven percent driving the $40.4 billion industry as high as $56.7 billion by 2017.

Winners Announced for New York Patient Portal

The New York eHealth Collaborative’s Patient Portals for New Yorkers contest has concluded with Mana Health taking first place honors. Mana Health’s portal includes secure e-mail communication with providers, an audit trail of patient chart accesses, and a clean and intuitive layout.

Medical Association Backs Bills to Cut Red Tape

Texas lawmakers have passed a bill that will allow providers to start swiping patients driver’s licenses to collect identification information for claims processing. The change is supported by the Texas Medical Association, which has suggested in statements that automating the recording of demographic information will free up a significant amount of time for clinic staff.

Dangers found in lack of safety oversight for Medicare drug benefit

ProPublica releases an online tool that displays individual physician prescribing behaviors in easily understood graphics intended to highlight how far from "typical" a physician’s prescribing practices fall for their specialty. The underlying data comes from four years of Medicare Part D 2007-2010.

EHR Design Talk with Dr. Rick 5/13/13

The Data-Ink Ratio

In the last several posts, we’ve been considering the two major high-level user interface designs for organizing a patient’s EHR record over time – the Snapshot-in-Time Design that formed the core of much paper-based charting and the Overview-by-Category Design that has been much more widely adopted by EHR vendors.

Despite the widespread adoption of the Overview-by-Category design, it does a poor job of helping the physician understand the patient’s record as a narrative that unfolds over time. As a result, most EHRs employing the Overview-by-Category design also provide a workaround that does, in fact, provide the physician with a snapshot-in-time view – The Text-Based Workaround.

In my last post, we saw a major problem with the text-based chart notes generated by most EHRs – they have an exceedingly low data density. In addition, they often have a second problem –a low data-ink ratio.

The concept of the data-ink ratio was introduced in 1982 by Edward Tufte, a pioneer in the field of data visualization – the field of how to present abstract information graphically in formats optimized to take advantage of our high-bandwidth visual processing system.

Tufte defined the data-ink ratio as the amount of ink used to display data divided by the total amount of ink used in the graphic or display. He proposed that, within reason, good visual designs maximize the data-ink ratio, both by devoting a large share of the graphic to actual data and by pruning unnecessary and redundant non-data. Think of the data-ink ratio as the signal-to-noise ratio for graphics.

Let’s return to the same EHR-generated text-based chart note we’ve been considering and investigate how well it maximizes the data-ink ratio. The mockups shown below are a composite design based on several widely used EHRs.

In order to see the mockups and read the accompanying text, enlarge them to full screen size by clicking on the ‘full screen’ button in the lower right corner of the SlideShare frame below.

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

Curbside Consult with Dr. Jayne 5/13/13

I attended a very traditional medical school. We weren’t allowed to actually think about diseases (let alone actual patients) until the second year. Once we had nearly finished the second year coursework and had learned enough about diseases to merit his appearance, one of the more senior members of the clinical faculty would teach.

Dr. Elliott was an extremely well known internal medicine physician who had published enough papers to scare the willies out of all of us. Since we hadn’t met him before, we didn’t know what to expect from his lecture. We quickly figured out that although he looked a little bit like Santa Claus, he wasn’t bearing gifts unless that gift was a personality that was a cross between Dr. House and an extremely grumpy teddy bear.

All the syllabus said about the lecture was the title: “Sick or Not Sick.” Dr. Elliott went up to the podium and started reading a patient case study. At the end, he’d look out over the class and say, “Sick, or Not Sick?” and call on some poor unsuspecting student.

The student would give his or her answer, which was invariably wrong. We were used to reading about diseases, so we figured if the patient in question had anything that sounded like one, they were “sick.” Only after sitting through about 20 minutes of torture did he begin to tell us what he was looking for.

By definition, “sick” was a patient who needed hospital admission. “Not sick” was someone who could be cared for in the ambulatory setting. To second-year students, all of them sounded pretty sick.

Flash forward to today. Probably none of those patient would be classed as “sick” since we’re now discharging patients that are sicker than those we used to admit. Once the length of stay is reached, it’s a race to get them out of the hospital.

The simple black-and-white nature of “Sick or Not Sick” crossed my mind today as I was reading a depressing string of articles. Topics included the 80 percent C-section rate at private hospitals in Brazil; the rise of patient empowerment; the drastic increase in healthcare costs as a portion of our economy; and the rabid competition of hospitals for market share.

I have to mention that I was reading these articles in the frame of mind of someone who is extremely tired of the consumer culture in which we live and just survived an ER shift where no less than three patients threatened to report me to the state board for “denying care” when I was delivering evidence-based practice for viral illnesses. Overlay a couple of articles about how one of the richest people in the world is trying to end polio and improve sanitation around the world with a flashback of the patient who threw her bedazzled iPhone across the room because I had to unplug it to use the outlet for a medical device, and there you have it.

If we want patients to be rational thinkers about their healthcare, they need to be both intellectually and economically engaged. We need to play a black and white game of, “Do I need it to get better or is it a marketing gimmick that will drive up all of our costs?” as we look at hospital initiatives.

I’ve written before about hospitals that post their ER wait times on the Internet or services that allow pre-scheduling of ER visits. Sure, that can increase patient satisfaction. But is it actually going to make me better? Probably not. Would I pay extra out of pocket for it? Probably not. So why is the hospital spending thousands of dollars on IT systems to support it?

Same thing with “dining on demand,” which has been a nightmare at my hospital. Since I started my medical career as a Candy Striper delivering meal trays on a labor and delivery ward, I’ve seen lots of hospital meal trays over a fairly decent period of time and have even partaken of a few myself. Is allowing a patient to order their meals on a touch-screen at the bedside cool? Sure. Does it allow patients to eat when they want? Definitely. Has it improved the quality of the food in proportion to the amount of money it cost to interface the ordering system with the EHR dietary orders and the additional personnel cost needed to operate like a restaurant and make sure it’s all accurate? That’s debatable. Again, will it actually improve my clinical outcomes or is it something we just think we need? Would I rather have a lower nursing ratio or dining on demand? I know what I would choose.

We need to think carefully about cost vs. convenience and quality vs. gimmicks. More are more people are going without healthcare this year than I’ve ever seen. It’s largely due to cost. This is driving hospital revenues down at the same time that costs to lure patients with the latest robots and gadgets are going up.

It’s time to stop the madness. It’s time for all of us – patients, physicians, and administrators – to stop thinking about “me” and start thinking about “we.” Put down the smart phones and stop being self-absorbed and look at the world around you. There’s a difference between “need” and “want” and “what is good for you.” We all need to embrace that difference as quickly as possible.

Have a gimmicky system at your hospital that cost more than it was worth? Are you tired of the tail wagging the dog? E-mail me.

E-mail Dr. Jayne.

Morning Headlines 5/13/13

Cash-strapped hospital bosses employ American IT expert on a salary of £25,000 A MONTH…and even picked up his bar tab and his laundry bill

In England, Rotherham NHS Hospital is being criticized for spending $40,000 a month on consultants in hopes of salvaging a struggling $60 million Meditech implementation.

District Medical Group Partners with Medical Scribe Program to Optimize Electronic Medical Record

Phoenix, AZ-based District Medical Group hires scribes to support physician documentation in its transition to an EMR. The scribes has improved physician workflow and eliminated transcription costs.

UPMC Q3 operating income down by half

University of Pittsburgh Medical Center reports a nearly 50 percent drop in Q3 revenue compared to the same time last year. The drop-off would have been closer to two-thirds lost had UPMC not picked up a $53 million return on its 2006 investment in dbMotion, which sold to Allscripts this March for $235 million.

Tampa Stakes its Claim to Lead Healthcare into the Future

In an effort to attract jobs, Tampa is developing a city-wide program to embrace technology and best practices to reduce overall healthcare costs, generally the second highest cost for businesses after payroll. The program is being offered in lieu of the traditional tax breaks offered as an incentive by most cities.

Monday Morning Update 5/13/13

From The PACS Designer: “Re: PACS advice. TPD worked with Herman Oosterwijk at a previous employment and benefited from his knowledge of DICOM and its attributes. He just published an Aunt Minnie article on the top 10 things to consider when replacing your PACS. It’s well written and can help lead the migration to more robust PACS/RIS/Archive solutions. ”

From Leverage: “Re: MModal. For your expert to further reflect on, from S&P’s ‘Leveraged Commentary & Data,’ May 10, 2013.” I fear my excellent MBA finance grade may have been a sham given that I understood very little of the writeup, which was summarized as, “MModal is seeking roughly two years of covenant relief via a loan amendment package that launched yesterday afternoon. The deal is on a tight time frame, with responses due on Monday, sources said.” One Equity Partners, which acquired the company last year, will instead of executing an “equity cure” add $20 million in new equity.

From Quietly Working: “Re: McKesson. Has concluded that a shareholder relationship with Automation isn’t required to enable clinical and technological integration with healthcare software and pharmacy distribution providers. As such, McKesson has made the decision to divest the Automation business. Their intent to sell was announced earlier this week.” I did mention that along with the company’s decision to sell its international technology business in summarizing the earnings call last week.  

EHRs aren’t the problem when hospitals experience financial setbacks during or after their implementation, with 40 percent of respondents saying it’s more that hospitals have unrelated issues that they don’t address. New poll to your right: should Meaningful Use Stage 2 be delayed a year as recommended by CHIME?

Welcome to PerfectServe, sponsoring HIStalk, HIStalk Practice, and HIStalk Connect at the Platinum level. PerfectServe’s cloud-based, HIPAA-compliant platform helps hospitals improve efficiency and care by providing reliable and secure clinical communications (voice, online, and mobile.) It’s used by more than 30,000 physicians to communicate more easily, representing more than 10,000 practices and 60 hospitals that include Advocate Health Care, MemorialCare, Hoag, WellStar, and Orlando Health. PerfectServe connects every clinician, whether on campus or off, allowing them to use voice-powered lookup by name or service and incorporating on-call schedules and physician preferences with every transaction documented and analyzable. Patient-endangering communications breakdowns caused by complicated coverage and communications rules are eliminated, while the average customer saves 12,000 hours each year in wasted nurse time. Just announced last week was DocLink, a private and secure HIPAA-compliant texting, voice messaging, and real-time call routing system for doctor-to-doctor communication. The company offers case studies (the one I read randomly involved reducing time to treatment of stroke patients by simultaneously notifying both the neurologist and neuroendovascular specialist with escalation or backup for non-response), white papers, and studies. Thanks to PerfectServe for supporting HIStalk, HIStalk Practice, and HIStalk Connect.

Here’s a YouTube video illustrating how nurses contact physicians using PerfectServe by telephone.

UPMC made an $18 million profit on its $35 million investment in Israel-based interoperability technology vendor dbMotion when the company was sold to Allscripts for $235 million in March 2013. 

CIC Advisory names Liz McNamara, MHA (ECG Management Consultants) as business intelligence service line leader and Eric Zuhlke, RN, BSN, PMP (Abrazo Health Care) as IT strategy and planning service line leader.

Aventura will announced Monday that it has promoted VP of Sales and Marketing John Gobron to acting CEO, replacing the retiring Howard Diamond.

Eric Novack, MD, PhD (Valley Orthopaedic Consultants) joins Intelligent InSites as senior medical advisor.

Bobbie Byrne, MD, MBA, VP/CIO of Edward Hospital (IL), tells me they went live on Epic big bang at both hospitals on April 28, on time and on budget. They’ve hit CPOE numbers in the 75 percent range since go-live day, impressive given that it’s a community hospital with few in-house physicians. I interviewed her in December 2011 (she had some very interesting thoughts, having been an Eclipsys SVP and CCHIT clinical director) and I have proposed that we do an update.

MModal’s Catalyst for Quality wins the top healthcare IT innovation award from the North Carolina Health Information and Communications Alliance and Intel.

A Brandeis professor of health policy says CMS’s release of hospital charge master data for common Medicare DRGs is “useless and misleading” because nobody pays list prices for services, hospitals tune their individual charges based on payor mix and desired margin, and the public has no idea what any of this means. A Harvard public health professor says the information offers one benefit: “It helps people understand how ridiculous and complex our system has become.”

Vince Ciotti offers a tip for frequent travelers: spend the $100 for a five-year registration for TSA’s Pre-Check program. He used it for the first time at LAX last week and skipped the mile-long security lines, only needing to have his boarding pass scanned at the empty pre-check security lane, a standard X-ray with shoes and belt on instead of the full-body scan, and then a standard bag X-ray except that laptops and liquids don’t require removal. I also noticed that the program was expanded to some international flights last week.

Forbes contributor, Avada CEO Dave Chase, says Tampa, FL is throwing out the marketing and tax breaks approaches to get corporations to locate there and instead will pitch its lower healthcare costs, second only to payroll expense as a cost of running a white collar business. The city’s May 13 MediFuture 2023 event features Harvard professor author Clay Christensen talking about disruptive healthcare innovation. Chase, who is also speaking at the event, says hospitals are making the same mistakes newspaper publishers made in the 1990s in worry about competition from each other instead of from outsiders. Examples of the “shadow” healthcare system are workplace clinics, national primary care providers, retail clinics, domestic medical tourism, and Medicare Advantage programs.

District Medical Group (AZ) implements a medical scribe program at two Phoenix children’s clinics as doctors learn to use their new EMR. An orthopedic surgeon says the scribes eliminated transcription costs and improved the revenue cycle, adding that, “Scribes may have very well saved the clinic by helping with the implementation of the new EMR. Having EMSS [the scribe service] here definitely allowed the clinic to get back up to its running speed in less than the anticipated amount of time."

In the UK, debt-ridden Rotherham Hospital Trust is criticized for paying a US consultant almost $40,000 per month to try to save its struggling $60 million Meditech implementation that has caused lost appointments and financial problems.  

Allscripts (one-year share price in blue vs. the Nasdaq above) reported all-around bad quarterly numbers last week. From Thursday afternoon’s conference call:

• CEO Paul Black stated that the lawsuit against New York City Health and Hospitals Corp., filed when Glen Tullman was running the company, was dropped because, “This management team does not believe it is in the company’s long-term interest to pursue such litigation.” You may recall that the lawsuit won the attention of HIStalk readers, who proclaimed it the “Stupidest Vendor Move” of 2012 in the HISsies awards voting.
• Black predicts that rip-and-replace projects will wane.
• The company’s focus seems to be moving toward integrating disparate systems, or as Black described it, “Innovation to accelerate our leadership in ensuring multivendor interoperability through open community architecture.” That led to the acquisition of dbMotion and Jardogs (now Follow My Health) as well as the GA of Allscripts Community Care Director, which hospitals use to manage post-hospital care.
• Black said, “Sunrise Financial Manager is one factor impacting our ability to capture larger mind share within our client base.”
• The consolidation of offices was mentioned as one cost-cutting move, with the hopes of saving $50 million per year by 2014.
• Company revenue was down because of the shift to subscription-based contracts (apparently that excuse was part of the Eclipsys acquisition since that company used it every quarter for years). Allscripts reported revenue drops in both system sales and maintenance for the quarter.
• Less than 25 percent of Sunrise clients are running 6.0, with many of them planning to skip that release and jump to 6.1 instead.
• When asked how Allscripts pitches against competitors, Black mentioned revenue cycle management, hosting, total outsourcing, and population health management.

Also notable from the Allscripts earnings call is the highest and most annoying concentration of the phrase “kind of like,” this impressive demonstration of a verbal crutch firepower coming from the Morgan Stanley analyst’s question: “So can you just kind of like give us a little bit more color about kind of like your clients? Are they making kind of like long-term retention commitments? Or are clients more kind of like taking it — taking more of a wait-and-see approach and kind of like taking it kind of like one step at a time?”

ESD celebrated Mother’s Day by providing surprise Mother’s Day gifts for each of the women at Mom’s House of Toledo, which helps low-income single mothers earn an education that will allow them to break the cycle of poverty and welfare.

Vince finishes up his HIS-tory of GE Healthcare, covering its very early entry into healthcare in the 1960s, its exit in the 1970s, its re-entry in the 1990s, and what Vince says could be the company’s fall back down the healthcare IT revenue chart. He brings up an item that I may have missed: GEHC sold its Centricity Pharmacy product to Canada-based BDM IT Solutions in March 2013, which is interesting because GE bought BDM Information Systems and its RxTFC system in 2002 and renamed it Centricity Pharmacy.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Readers Write: Managing Total Medical Expense While Improving Health Outcomes

Managing Total Medical Expense While Improving Health Outcomes
By Michael Gleeson

As our healthcare system evolves and payment reform expands, providers are forced to deliver higher quality care at a lower cost to curb explosive growth in national expenditures seen in past decades. As a result of this paradigm shift, the industry is responding.

In order to accommodate the incentives and priorities set forth by the Affordable Care Act (ACA), health systems must elevate the importance of primary care. This care model is shifting, with many adopting a patient-centric “Medical Home” approach to patient management. This new model emphasizes cross-provider care coordination, risk-stratified patient management, and proactive, preventative care.

Organizations are also using data more effectively. Increased adoption of electronic health records (EHRs), has led to valuable clinical data that can be mined and analyzed to inform health plans and providers on both their patient population as well as clinician behavior. However, the problem is that it isn’t being mined correctly. By integrating claims and clinical data, building trust and acceptance by care delivery professionals, and reorganizing care teams around actionable information, health systems will start demonstrating reductions in medical costs while improving patient outcomes.

So where should you start?

The four key pillars for success outlined below focus on improving health outcomes and managing total medical expense as critical elements in achieving lasting change within the practice.

Building Trust and Sharing Data

Despite significant investment in technology and data sharing by health systems, health plans and most primary care providers still have no visibility into their patients’ activity outside the four walls. And some health systems are hesitant to share data and/or performance with their counterparts, so as a result, it’s important to do the following when integrating with the network:

• Create data governance policies. It is important to have a policy that dictates the use and exchange of shared data.
• Establish role-based security and blinded data policies. This is a good rule for those who are apprehensive to share information. Not everything needs to be shared in order to drive change.
• Data validation. Assessments to ensure that the data presented to the practice accurately reflects the activities at the point of care is critical to building trust.

Patient Attribution and Outreach

Quality improvement programs are often hindered by the challenge of accurate patient designation. If you can’t accurately identify who is responsible for a patient, you can’t improve the care rendered to them. Health plans often provide member rosters, but these can be large, burdensome to work with, and are often wrong.

It’s important to implement a system that will absorb the membership files from multiple plans, sync this data with the EHR and Practice Management data, and generate a list of members who are inaccurately attributed. The upkeep on this process, once it’s started, can be done monthly and will only take a couple of hours. With the attribution problem solved, the practice can reach out to the non-engaging patients it was responsible for and re-immerse them in primary care.

Fast, Accurate, and Actionable Data

In the whirlwind of external data feeds and complex EHR data structures, finding meaning can be a long process. Utilizing a flexible, transparent and vendor-agnostic data warehouse system allows information from multiple EHR feeds and claims files to aggregate on a nightly basis. This data is merged into a simple, patient-centered data model for reporting and analytics use. A focus on the EHR’s clinical data ensures near real-time analysis and greater relevance to the providers and care teams, resulting in more accurate and efficient patient results that can be monitored accordingly.

Transforming Clinical Care Teams

Even with access to timely and accurate data, practices can still struggle to improve outcomes because of inadequately aligned care teams. Providers are burdened with excessive documentation requirements in poorly optimized clinical systems. When a PCP is spending 10+ hours a day documenting in their EHR, they do not have the time and energy to consume the relevant information to drive proactive care management and move the needle on patient performance measures.

Arranging these roles appropriately within the care team maximizes resources and is critical to successful patient care. Medical Assistants should become the primary consumer of reports and act as a quarterback for the team, beyond their role of taking vitals. Using pre-visit planning reports, they should identify care gaps and coordinate with the RN and care manager to ensure the right actions are taken before the patient arrives. This will enhance the interaction and allows all current and potential problems to have the time to be addressed.

The inevitability of healthcare reform is forcing practices nationwide to shift how they view, plan and deliver care. While there is a renewed focus on managing quality and cost containment, this requires health systems of all sizes to master their data assets and align care team roles around the right tools and mandates.

As noted earlier, this charge is not easy. However, many organizations are currently rising to and conquering this challenge by utilizing these four pillars of success. By meticulously positioning themselves in line with this industry transformation, and keeping their goals and attention keenly on improving patient care and dissolving excessive costs, real improvements are being identified in the current health environment.

Michael Gleeson is senior vice president of product strategy for Arcadia Solutions.

Time Capsule: Dirty Geeks and They’re Done Dirt Cheap: How Wall Street’s Huddled Masses Could Reshape Healthcare IT If We Just Asked Them

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 October 2008.

Dirty Geeks and They’re Done Dirt Cheap: How Wall Street’s Huddled Masses Could Reshape Healthcare IT If We Just Asked Them
By Mr. HIStalk

Healthcare IT has always been inbred. The same folks just keep moving between provider and vendor, hospital operations and IT, and Organization A and Organization B. The name tags change, but the faces stay the same. Most of the value of the HIMSS conference is in reconnecting with all those folks who scattered like billiard balls since you saw them last.

HIT is an esoteric discipline, at least according to those who are in it. We’ve kept it that way by demanding healthcare experience for most jobs, ensuring that few strangers and their highfalutin’ new ideas enter our comfortable midst (it also helps that healthcare pays less and uses bizarre technologies that the rest of the techie world has never heard of, like MUMPS and Magic).

Nobody knows whether healthcare will dodge the economic bullet this time around. If it does, lots of non-HIT techies will be pressing their noses to our glass, seeking a chance to start earning a paycheck again. It will look like that Twilight Zone episode where the guy is holding a gun on his neighbors to keep them out of his bomb shelter.

This Mariel boatlift of geeks could be great news for healthcare. Banks and investment companies were (note the past tense) full of experts in online transaction processing, security, project management, and forecasting. What will we tell those folks when they drop by?

Traditionally, it would be a slightly more polite variant of “hit the road.” No healthcare experience means we don’t want you, no matter how skilled and experienced you are at the same kinds of technology that we’re planning to use. We’re healthcare and we’re different.

That’s a mistake. The industry could use some new, baggage-free ideas from people who have spent their lives doing what healthcare is just now learning about: running large-scale, mission-critical systems and conducting business innovatively over the Web. And right now, especially if your hospital or company is anywhere near New York, Boston, Chicago, Hartford, Charlotte, or other cities that revolved (note past tense) around the financial services industry, I bet you could hire them for about the same money you pay those same old retreads.

This could be the most exciting HIT development in decades. Many of our bread-and-butter applications are old, poorly secured, and Web-indifferent. Developing portals and RHIO connectivity is a snap compared to keep tracking of some of those bizarre investment instruments their former finance bosses just choked on.

Interested in patient payment systems, real-time adjudication, Web-based customer service, or throughput modeling? Those are the folks who could knock that out right now, already used to skipping lunch and working long hours.

Healthcare has always been jealous of banking IT people, visibly grinding their jaw when innocent outsiders make the inevitable comparisons of their cutting edge work vs. healthcare’s 1980s-era challenges still being solved. Deep down, we knew they were right. Former hospital staff turned self-taught analysts couldn’t hold a candle to the best and brightest techies who headed to Wall Street in droves and moved that industry from staid old storefronts to cutting edge electronic commerce. Hey, their stuff works – it’s not their fault that their big-dollar bosses were a lot dumber than everybody thought.

Now we get even. Pay them a lot less, squeeze them into cubicles, and make them take orders from clinicians turned semi-programmers. The tortoise won this race. We don’t care about your international arbitrage software – just write an EMR system that doctors will actually use.

Think of this as your own Wall Street bailout, with benefits.

Morning Headlines 5/10/13

Allscripts swings to first-quarter profit loss

Allscripts releases Q1 results: a $11.6 million loss on the quarter resulting in a -$0.07 EPS compares to a $5.8 million profit and $0.03  EPS for the same period last year. The stock was down 10 percent in after hours trading but is up 47 percent on the year.

Philips, Al Faisaliah Medical Systems officially open Philips Healthcare Saudi Arabia

Philips announces the opening of a joint venture with Al Faisaliah Medical System to market Philips solutions in Saudi Arabia.

HHS Releases Hospital Data on Charge Variation to Promote Transparency

HHS releases hospital charge data to promote cost transparency.

Accenture Eight-Country Survey of Doctors Shows Significant Increase in Healthcare IT Usage

A recent study highlights electronic medical records utilization trends across eight countries. The United States is leading all nations in the adoption of EHRs and nears the top of HIE adoption.

News 5/10/13

Top News

Allscripts reports Q1 results: revenue down 4.8 percent, EPS –$0.07 vs. $0.03, missing estimates on both.

Reader Comments

From IT Exec: “Re: HIStalk. Thanks for everything you do. My day wouldn’t be complete without spending a few hours on there.” Thanks. Mine either.

From PCP Doc: “Re: athenahealth. Just got back from their user conference. Jonathan Bush did not mince words on stage, just like in their earnings call, when talking about ‘companies of Epic proportions.’ Athena going to Haiti to install an EMR in a rural clinic that treats spinal injury patients was a noble touch.”

From Green Lantern: “Re: CMIO searches. I am aware of a couple of hospital systems that restarted their search rather than make an offer to an existing applicant. Does that happen often with CMIO searches vs. other C-level corporate officers? Are there enough applicants, or are hospitals being unreasonable?” Your thoughts are welcome.

HIStalk Announcements and Requests

Highlights from HIStalk Practice this week: the AMA’s board of trustees chair criticizes the federal government for mandating the use of EHRs under threat of monetary penalty while simultaneously accusing providers of cloning documentation. Frederica Krueger responds to the AMA’s complaints in a “Nightmare on EHR Street” Readers Write post. DigiChart changes its name to Artemis. American Medical News reviews the status of various lawsuits against Allscripts since the company announced plans to stop regulatory development of its MyWay product. CMS creates a timeline for aligning quality measurement and reporting for multiple initiatives. Dr. Gregg considers patient engagement and patient empowerment from both the provider and consumer points of view. Get your fix of ambulatory HIT news and sign up for the email updates while you are there. Thanks for reading.

On the Jobs Page: Open Positions in Development, Senior Manager Engineering Development, Clinical Analyst.

Acquisitions, Funding, Business, and Stock

HealthTap raises $24 million in series B funding led by Khosla Ventures.

Alere reports Q1 results: revenue up 10 percent, EPS $0.09 vs. –$0.05, beating expectations on both. The company also acknowledged that an investment firm that is a major shareholder will launch a proxy fight.

The Advisory Board Company reports Q4 results: revenue up 19.1 percent, adjusted EPS $0.33 vs. $0.31, beating analyst expectations for both.

Canada-based vertical software vendor Constellation Software acquires Quantitative Medical Systems of Emeryville, CA, which offers dialysis-specific revenue cycle and EMR software.

Sales

The Mount Sinai Medical Center signs a multi-year agreement for Cureatr, a mobile app designed by one of its residents that offers HIPAA-secure group text messaging for care coordination.

Chicago Health System ACO (Vanguard Health Systems) selects Care Team Connect’s integrated care management platform.

SSM Health Care – St. Louis (MO) selects the EDCO Health Information Solutions day forward medical record scanning services for use at its seven area facilities.

Quality Health Solutions, formed to support the virtual network of seven healthcare systems and Medical College of Wisconsin, chooses population health management and clinical integration solutions from Valence Health.

People

     
Culbert Healthcare Solutions adds Jason Faaborg (Dell), Tom Gurdak (CSC), and David Howe (Public Consulting Group) as VPs of sales.

Forbes profiles Imprivata CEO Omar Hussain in an article on leadership.

Adventist Midwest Health names Thomas Schoenig (Wyoming Medical Center) as regional CIO.

Care collaboration platform vendor CareInSync names Steve Curd president and CEO. The company also announced a follow-on investment from California HealthCare Foundation’s Health Innovation Fund.

NCPDP names First Databank’s VP of Health Policy and Industry Relations Tom Bizzaro to its board of trustees.

Mike Vandiver (SecureWorks) joins Ingenious Med as CFO.

Charlie Ditkoff (Bank of America Merrill Lynch) joins Cumberland Consulting Group’s board.

Announcements and Implementations

Royal Philips and Al Faisaliah Medical Systems open Philips Healthcare Saudi Arabia, a 50-50 joint venture to market and sell Philips solutions and services in the Kingdom of Saudi Arabia.

Geisinger Health System (PA) will give patients access to their doctors’ notes in its RWJF-funded OpenNotes program, in which 82 percent of participating patients opened up at least one EMR note.

Martin’s Point Health Care will present at the AQA meeting in Washington, DC on May 13. They use Forward Health Group’s PopulationManager at all nine sites and 70 provider panels for micro and macro reporting.

API Healthcare and TeleTracking Technologies enter into a strategic partnership to offer API’s workforce optimization solutions and TeleTracking’s workflow automation offerings.

Project MIST takes first place in an athenahealth and MIT H@cking Medicine-sponsored hack-a-thon for its glaucoma eyedrop spray canister.

Lake Tahoe Regional Hospitalists (NV) and Shasta County Hospitalists (CA) deploy MedAptus for inpatient charge capture.

Rochester General Hospital (NY) implements EDCO Health Information Solutions’ point of care batch medical record scanning solution.

Government and Politics

HHS releases data on inpatient charges that shows significant variations in pricing, such as joint replacement that ranges from $5,300 to $223,000.

Innovation and Research

Healthfundr launches its equity-based crowdfunding platform for health startups, open to accredited investors only and working with more established companies.

Technology

Epic gives VMware Horizon View “Target Platform” status for EMR delivery through a virtual clinical desktop, quoting Metro Health CIO William Lewkowski as saying the move is saving his organization $1.6 million per year.

Other

Fletcher Allen Health Care (VT) will lay off 40 staff members and outsource its transcription services to Nuance Communications, which will offer jobs to 35 affected transcriptionists.

The Leapfrog Group finds in its spring update that hospitals have made only incremental progress in addressing errors, accidents, injuries, and infections that kill or hurt patients. Sixteen hospitals received an “F” grade.

Gila Regional Medical Center (NM), struggling with uninsured patient volumes, downgrades employees, halts an expansion project, and postpones implementation of a new hospital information system.

Keynote speakers at the MUSE conference May 28-31 in Washington, DC will be Farzad Mostashari and George Will.

A Surescripts report finds that 69 percent of office-based physicians actively e-prescribed last year and nearly half of patient visits generated an electronically-delivered medication history, 31 percent more than in 2011.

Allscripts will add 350 new jobs over the next five years in Raleigh, NC as it consolidates its US engineering centers. State officials will extend up to $5.35 million in incentives if Allscripts meets investment and hiring goals and maintains its 1,266 jobs in Raleigh.

An eight-country survey of physicians finds that 93 percent of US physicians report using an EMR. E-prescribing rates were highest (65 percent) among US providers, as were rates for entering patient notes into EMRs (78 percent.) While the majority of doctors in all countries report EMR and HIE have had a positive impact on their practice, US doctors were the least likely to report that their use reduced organizational costs.

Ken Roberts, MD and Jim Granfortuna, MD sing about EHRs in “Our Song of Epic Proportions.”

Weird News Andy wonders, “What is it with Brazilians and harpoons lately?” A couple of weeks ago a Brazilian guy accidentally shot a harpoon into his own head. Now a Brazilian man cleaning his spear gun in the living room accidentally shoots off a spear that goes through the mouth of his wife, who was in the kitchen at the time. She’ll recover fully. And in another incident, a Brazilian teen fishing in the Amazon River mistakes his brother for a fish, shooting a harpoon into his face and then paddling 195 miles in a canoe to take him to the hospital.

WNA also ponders this story, in which a South Florida plastic surgeon is arrested for using waterboarding-type torture on his girlfriend for 16 hours after being angered by her Facebook post.

Sponsor Updates

• Consulting firm Virtelligence and its client Cone Health (NC) donated 400 tree seedlings via the Arbor Day Foundation to the Guilford County School System, whose students planted the trees around the Triad. The company tracked the number of pages printed during the Epic implementation and used an online program to estimate the number of trees required (361) to manufacture it.
• NTT Data moves its North American corporate headquarters to Plano, TX.
• EClinicalWorks releases agenda details for its 2013 National Users Conference October 11-14 in San Antonio.
• Holon Solutions hosts a May 15 Webinar introducing the value of building an HIE.
• Sandlot Solutions Director Rosalind Bell discusses how recent emergencies highlight the need for HIEs.
• Billian’s HealthDATA releases its Provider Portal benchmarking database, which gives hospitals and health systems data for competitive analysis.
• In a company blog post, Patientco addresses the growing patient payment problem.
• Red Herring names Awarepoint, InstaMed, and Kony Solutions finalists for its 2013 Top 100 North American Award, which honors private technology ventures.
• Aspen Advisors consultants will co-present at two sessions during next week’s Texas HIMSS Conference in San Antonio. Aspen’s Director of Clinical Informatics Mark Van Kooy, MD will participate in a panel discussion during an executive summit in San Francisco May 15-17.
• Kathy LePar, VP of strategic services for Beacon Partners, offers recommendations for healthcare organizations for creating an integrated, holistic approach to strategic enterprise initiatives.

EPtalk  by Dr. Jayne

Georgia Governor Nathan Deal signs the State Physician Shield Act, which is aimed at preventing use of Affordable Care Act provisions to establish standard of care in liability cases. Supporters want to ensure that payment guidelines aren’t used to define care standards to the exclusion of individual patient factors or other clinical standards.

CMS releases Medicare provider charge data for the top 100 most frequently billed discharges across 3,000 hospitals. The variation across some procedures is as much as tenfold.

CNBC recently ran a piece on bad habits demonstrated by younger job-seekers. There are certainly a lot of relatively young workers in IT departments, but I’ve found that regardless of age, behavior is becoming more boorish. I may not be Emily Post, but I’d like to offer some etiquette tips for the age of social media:

• Learn how to put your phone on silent. Practice this skill often.
• Texting or checking e-mail on your phone while in face-to-face meetings is just rude.
• Choosing “Darth Vader’s Theme” as your supervisor’s ringtone is not a career-advancing move, especially if you haven’t learned to put your phone on silent.
• If you’re hosting a Web-based meeting and sharing your desktop, turn your instant messenger and e-mail notifiers off. I’m tired of seeing embarrassing, unprofessional, and distracting messages come across while I’m trying to work with you.
• If you’re attending a meeting by conference call, don’t multitask unless you have the skills to pull it off. Asking, “Can you repeat that? I was on mute.” makes no sense and brands you as inattentive and illogical.
• If you join a meeting late, don’t waste the group’s time with excuses. Say “I’m sorry” then sit down and get to work.
• Lock your Facebook page down like Fort Knox unless you can keep your mouth shut. Do you really think it’s smart to advertise to your co-workers that you accepted prime hockey tickets from a vendor and thereby violated corporate policy?
• Learn how to use Scheduling Assistant, Busy Search, or whatever tools your company uses when inviting people to meetings. If an attendee is already booked and you make them “required,” have the courtesy to discuss it and obtain approval first.

Speaking of meeting etiquette, it’s been a rough week, so I was happy to see a tweet for The Ridiculous Business Jargon Dictionary. I think I’m going to try “acluistic” in a meeting I have scheduled for tomorrow and see if anyone figures it out.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 5/9/13

Athenahealth and MIT H@cking Medicine Announce Winners of Hack-a-thon

MIT and athenahealth co-hosted a hack-a-thon this past weekend and have announced a winner of among the 20 teams that competed. Top honors and $5,000 went to Project MIST, which came up with a hardware prototype that helps glaucoma patients overcome aiming difficulties and more easily administer their eye drops.

Geisinger Gives Patients Access to Doctors’ Notes

Danville, PA-based Geisinger Health System will give patients complete access to their physician notes within the health systems patient portal in an effort to increase patient engagement. The decision follows a pilot program that showed promising results.

The National Progress Report on e-prescribing and Safe-Rx Rankings: Year 2012

More than 40 percent of prescription were transmitted electronically in 2012, according to a recently released study from Surescripts.

Memorial ‘still on path’ to join MaineHealth despite Maine Med’s financial problems

Conway, NH-based Memorial Hospital’s CEO Scott McKinnon reports that MaineHealth’s recent Epic problems are not enough to derail Memorial Hospital from joining MaineHealth. In earlier interviews, McKinnon had cited working under a system-wide Epic platform as a primary reason for joining MaineHealth.

Morning Headlines 5/8/13

McKesson 4th-Quarter Net Down 50% Amid Lower Revenue, Higher Costs

McKesson reports a fourth quarter profit of $259 million, down from $521 million a year earlier. Revenue was down 3.4 percent, missing analysts’ expectations. The technology solutions sector saw revenue increase 6.2 percent over the year, with a gross annual revenue of $913 million. Stock ended flat on the day and was up 1.5 percent in after hours trading.

A Bold New Vision for Meditech

John Halamka, MD, CIO of BIDMC, reports his initial impression of plans for Meditech 6.1 which he says will be a cloud-hosted system based on standards, Web-centric and mobile-enabled, with both inpatient and outpatient capabilities, complete with analytics, a PHR, and care management tools.

The discriminatory cost of ICD-10-CM transition between clinical specialties: metrics, case study, and mitigating tools

A study published in JAMIA finds that transitioning to ICD-10 will be difficult and disproportionately costly to specialists. The study found that only 60 percent of ICD-9 codes have a direct ICD-10 equivalent, while the other 40 percent will require clarification.

UCSF Creates Center for Digital Health Innovation, Names Director to Lead It

UC San Francisco will create a Center for Digital Health Innovation to lead the institution away from "disease-based treatment approaches" and toward "individualized precision medicine." The new Center will be run by UCSF Medical Center CMIO Michael Blum, MD.

Raleigh clinic says X-rays were stolen, may have included patient information

A Raleigh, NC clinic alerts patients that X-rays were stolen and patient information may have been compromised when a sham scanning and archiving company stole the x-rays for their silver content and then disappeared.