CIO Unplugged 3/8/12

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

CAUTION! Teambuilding Ahead

My affection for teambuilding sparked during the journey through cubscout and webelos. Army experiences further revealed that survival depended upon team. We had to work as a unit to navigate our way through a forest or through complex situations while under fire. Eventually, I recognized the transferable benefits to the corporate world. Today, few things thrill me more than getting my team outdoors to test and build our collective capabilities.

Of course…there is an element of danger involved in these pursuits.

The Burn. My first civilian ropes course. I was a Director at Parkview Medical Center, and all leaders were required to attend this training. We had a blast pushing the boundaries. That is, until we got to the capstone element: the Power Pole. “One participant climbs to the top of a utility pole using staples. Upon reaching the top, the participant leaps from the pole and attempts to catch the trapeze bar suspended in the air.”

A 45-five foot pole towered above me. Few attempted to even reach the top, and I couldn’t blame them. I was the last to go, and peer pressure and pride kept me from bailing out. I climbed to the highest point, and I still recall the effort it took to reach above the climbing staples and hook up to the safety line. Then I stood on top of the 12-inch wide utility pole. It swayed with the wind, keeping me off balance. About 10 feet out and 2 feet lower than my line of sight, the trapeze bar beckoned. I’d never felt so scared in my life—except the time I got arrested for joyriding when I was fourteen.

My halfhearted plan was to make it look like a strong attempt for the trapeze then just fall and wait for the safety line to catch. I removed my gloves, crouched, and made the leap. Before the safety caught, I grabbed the climbing rope attached to the trapeze. Gravity sucked me down about 10 feet until the safety jerked me into a halt. I hung in pain. The skin on the insides of both hands had ripped away.

Once I was lowered, the CNO and ED Director took me straight to the hospital. More agonizing than the burn was the ED doc cleansing the wound before working on it. Even writing this makes me want to clasp my hands shut as I had done after the injury.

Lessons Learned:

• Never do anything half assed or expecting to fail
• When handling ropes, wear gloves!

Rapids. My team had accomplished the incredible. Over 18 months, as part of a start-up, they installed a new application across 23 disparate and independent minded academic departments that represented 750 physicians plus residents. To celebrate, they chose the teambuilding activity of river rafting. A month later, we entered the Class III/IV rapids of the Youghiogheny River. Although I rafted a bit in simulated beach assaults with the Army, I had zero experience with rapids. I became raft captain by default.

We hit the first Class II rapids (easy), and I fell out. My raft-mates grabbed for me, but the current was too swift. Floating downstream and getting beat up by underwater boulders I then remembered the training: float feet first and on top of the water. Easier said than done. The rafting company had a three-tier safety layer in place in the event a bozo like me fell out. Tier one failed. I was headed straight for serious Class III and IV rapids. A Tier two guide in a kayak couldn’t reach me. I started to panic, which made matters worse. In the distance, the Tier three guide stood on a large boulder in the middle of the river with a rope. She threw out the safety line, and my eyes affixed like laser beams on my last hope. She couldn’t have been more than 100 pounds, but she was all I had between life and death.

I grabbed the rope as I hit the Class IV rapids. A “keeper hydraulic” took me under. The jet-like flow ripped through every crevice of my life vest and helmet until I felt as if the water would strip away all my safety gear. The current pushed me under, and I fought for air. I saw the proverbial flash of my life. That one-hundred-pound saint on top of the boulder…to her credit, she remained steadfast and eventually pulled me into an eddy. I stood there, shaking. The Tier two kayak made its way toward me, and the sliver of courage I had left got me back in the water and reunited with my team. And yes, this entire event was caught on video thanks to the “package” we purchased from the tour group.

Lesson learned:

• Listen to and consider all safety precautions
• Don’t stick your ass out too far unless you’re willing to accept risk (that’s how I fell out of the raft)
• If you fall, muster your courage and soldier on

Slide for Life. Prior to being commissioned as an Army Officer, all cadets had to acquire a RECONDO certification. One of the activities in the course was the Slide for Life. You slide down a zip line across a lake, keeping your eye on the flagman on the far side. When the red flag raises, you extend your legs straight until your frame forms an L-shape. When the flag lowers, you let go of the zip line and drop into the water. Given the trajectory, this posture enables you to hit the water butt first and the world is good.

With great amusement, I lingered after completing this event to watch the other platoons execute. Most did fine, but every once in a while, someone decided against the L-shape and let go in an I-shape. The soldier hit boots first resulting in spectacular somersaults. In other cases, some were too scared to release at all and ended up crashing into the sandbags at the end of the zip line.

Lesson learned:

• Follow instructions
• Fear causes paralysis

After a string of traumatic experiences, I chose safer team building activities. Here’s what happened:

Curling. One of my directs was a curling fanatic, so I agreed to some ice time. What could possible go wrong? We dressed warm and headed for the Mayfield Curling Club. My CTO was tall and aggressive. We were in this to win. I shoved our stone down the ice where he was sweeping to heat up the ice and influence trajectory. He pushed too hard on the broom and his feet came out from under him. He fell face first. When we rolled him over, blood gushed from his mouth where his teeth had punctured a hole through his lower lip. Our CMIO and two nurses applied first aid. Given the severity of the cut and apparent concussion, we called an ambulance.

I could just hear my CEO. “We lost our CTO to what? Curling?” Thankfully, the man was released the next day following observation and stitches.

Lessons Learned:

• Ice is slick as hell
• Don’t make fun of curlers

The “low-key” retreat. I held an offsite retreat once with no outdoor events. One of our team accidentally slipped and fell and messed up his knee before the meeting even began. A great object lesson in teamwork followed: The CMIO did an evaluation. The combat medic rounded up some gauze and wrapped the knee. The CTO ensured the meeting room was set-up to accommodate the wounded. The non-clinicians fetched ice and painkillers. And, in the ultimate display of team and knowing nothing was broken, the injured refused to seek medical attention until after the day was done.

Lessons learned:

• Injuries can happen in any environment
• It is smart to have clinicians as your direct reports!

Despite the potential for injury, if you haven’t escaped with your team to develop relationship and strengthen the bond, then plan one today. Mmmmmm…perhaps climbing mountains should be avoided….

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

Nuance to Buy Transcend Services for $300 Million

Nuance announces Wednesday morning a definitive agreement to acquire Transcend Services, a provider of medical transcription and speech editing services, for $300 million, net, in cash. The acquisition accelerates Nuance’s expands the company’s presence in the small- to mid-size hospital market.

Janet Dillione, EVP and GM of Nuance’s Healthcare business said, “The acquisition of Transcend will expand the delivery of our innovative voice and Clinical Language Understanding solutions especially to small- and mid-size hospitals. With Transcend, we will drive change and improvement to the way these hospitals capture and leverage clinical information. The acquisition is a natural extension of Nuance’s existing healthcare business, and will strengthen our solution and services portfolio, as well as enhance our profitability.”

Transcend acquired electronic clinical documentation provider Salar in August of 2011.

News 3/7/12

Top News

Physicians using computerized patient records are more likely to order new tests, leading to higher healthcare costs. Researchers, whose findings were  published in Health Affairs, found that physicians with point-of-care access to imaging were 40 to 70% more likely to order more tests, compared to doctors relying on paper records. Researchers could not determine the reason for the trend but theorize that doctors on computerized systems order more studies because of the the ease of online entry.

Reader Comments

From WallE “Re: HIMSS musings. I think the show would have been better if the floor plan and layout was simpler. After looking at New Orleans floor plan I’m thinking it will be better.They are returning to the single hall with a large “main street” walkway down the middle of the show.” I also prefer the main street, one hall layout, although the argument could be made that there was less walking required with this year’s floor plan.

From CTO “Re: Music.  It was good to ‘see’ you at the sponsor lunch at HIMSS. Since you have the helm this week, how about some insight into your taste in music?  I always like to read about  what Mr. H is interested in.” First let me say that Mr. H and I have very different tastes in music. Mine is a bit eclectic but a short list of my all-time favorite artists include Lyle Lovett, Bonnie Raitt, Aretha Franklin, and Allison Krauss. Some of the more current groups I find fun include Chiddy Bang, Flo Rida, and Bruno Mars.

From Ralphie “Re: Burger, Babes, and Vegas. I thought you might get a chuckle out of what I heard walking back from the HIMSS conference to my hotel behind what looked like two slick make vendor-types.  One turned to the other and said that he had been propositioned by two prostitutes and one of them offered her services for $35. The other one quipped, ‘Wow, that is less than the room service cheeseburger and fries I had last night.’” Love it.

From IDXwatcher “Re: More GE layoffs.  GE Healthcare layoff confirmed March 2nd.” According to an article in the local press, fewer than 30 people (about 2%) were let go last week. GE says the cuts were necessary “to increase competitiveness.”

From Aaron Brrr “Re: Madison Dolly comment on v12 of Epic. Madison Dolly said that v12 of Epic was shown at HIMSS and coming soon. Two questions: what’s in it and when did they change policies about showing that which isn’t available?” Anyone?

From Wondering aloud “Re: Epic. Epic is having a great run like SMS did with INVISION in the 90’s, but their business model is more like MEDITECH’s. Wondering if “in the know” readers think Epic will struggle the same way MEDITECH has recently with 6.0 when Epic attempts its inevitable near term re-platforming as well?”

From HIStalk Fan “Re: Allscripts. A recent analyst report discusses a Q3 restatement involving software transaction, as well as Allscripts’ disclosure of a subpoena in connection with a grand jury investigation and recent litigation involving Medical Services Associates.” Allscripts filed a 10-K last week related to a restatement of a bulk sale and delivery of licenses through a complex structure based on a decision that future performance obligations require the deferral of revenue. The net reduction to operating income was $3.1 million and a $0.01 reduction in EPS. I asked one of HIStalk reader/analysts for his take on the restatement and his opinion was the adjustments were very minor and reflected Allscripts’ conservative approach to revenue recognition. As to the litigation, MSA alleges Allscripts negligently caused the loss of medical billing data, intentionally misrepresented certain facts regarding the computer sold to them, and breached certain aspects of their contract. My take: Allscripts and vendors of their size are regularly hit with similar lawsuits and thus it’s not a cause for alarm.

From Stringer “Re: Medical software sales guy. This guy was convicted today of 1st degree murder of his wife. Very ugly situation, first trial was a hung jury. As you can see he is ALWAYS referred to in the press as a medical software salesman but have never mentioned the company. Thought it might be a good HIStalk expose.” Jason Young was convicted of brutally murdering his pregnant wife five years ago. Young contends he is innocent. I did a bit of digging and could only find one Jason Young in Linked In that could have potentially been a match. If you know the scoop, please share.

From OldTimer “Re: Allscripts send-off. Allscripts says goodbye to 24-year veteran Vada Hayes. Luminaries in attendance included John McConnell, Eric Sellers, Alan Winchester, Steve Shepherd, Bob Bothwell, and many, many others. There were four cakes: Medic, Misys, Allscripts, and the current color scheme. That’s cakes in green, purple, orange, and lime.” Would have loved to seen the cakes, but here is a shot of the retiring Hayes, along with former Medic/Misys CEO John McConnell.

HIStalk Announcements and Requests

A few readers mentioned having difficulty getting onto the HIStalk sites today. Of course I can’t find Mr. H’s email from four years ago that explained who to contact if this ever happened. Hopefully Mr. H will check in soon and the issue will be resolved. Thanks for your patience.

Thanks to all the wonderful readers who sent encouraging e-mails about relief from post-HIMSS exhaustion and to remind me a vacation is in my near future.

Acquisitions, Funding, Business, and Stock

DocuTAP, a provider of EMR/PM solutions for urgent care providers,  secures a two-stage $12 million investment from Bluff Point Associates.

Healthcare software and service company iMedX completes its acquisition of the medical transcription assets from The Inner Office Ltd.

Sales

Iowa Health System contracts with MediRevv for accounts receivable conversion assistance as it transitions its core hospital system to Epic.

The VA selects HP Enterprise Services to continue as a prime contractor for its claims processing program, CAPRI.

Upper Peninsula Health Plan chooses the MedHOK platform for integrated care management, quality, and compliance.

CPU Medical Management Systems selects NDS’s Provider Edge product to automate payment processes and convert EOBs into ANSI standard 835 ERA.

The state of Louisiana contracts with CNSI for a 10-year, $185 million project to develop and deploy a new Medicaid claims processing system.

People

Healthcare data analytics company Qforma promotes Mark Feeney to VP of client services and Joann Flynn to senior director of business development operations and employee development.

AirStrip Technologies announces the addition of Connie McGee (KPMG) as VP of strategic accounts and the opening of a regional office in the Nashville area.

The Open Source EHR Agent (OSEHRA) names James Peake, MD (CGI Group), John Halamka, MD (Beth Israel Deaconess Medical), and Michael O’Neill (VA) to its inaugural board of directors. OSEHRA is a not-for-profit organization tasked with serving as the custodial agent of an open-source development project to upgrade the VA’s VistA EHR system.

Announcements and Implementations

ZirMed launches www.StarStopICD10.com, a site designed to gauge industry opinion and gather comments surrounding the ICD-10 implementation timeline.

The Cleveland Clinic expands its EMR to include a visual repository with diagnostic images of patient X-Rays, lab tissue samples, photographs and other images.

All 15 of the independently owned primary care clinics in the Integrity Health Network (MN) transition to EMR.

QuadraMed launches a remote hosting service for its identity management, RCM, and HIM solutions. Cabell Huntington Hospital (WV) is the first hospital to utilize the service.

McLaren-Bay Region (MI) goes live on McKesson Paragon EMR March 11th.

Intermountain Healthcare (UT) launches a 90-day pilot telehealth program, allowing patient employees to connect with providers via video chat.

Aetna announces the availability of an enhanced version of its iTriage app, which Aetna acquired in late 2011.

Government and Politics

An analysis of eight years worth of Medicare claims data reveals that Hospital Compare, Medicare’s public reporting initiative for hospitals, has had minimal impact on patient mortality. The study found the reporting of quality data led to no reductions in mortality beyond existing trends for heart attack and pneumonia and led to a modest reduction in mortality for heart failure.

Technology

RTLS provider AeroScout partners with McRoberts Security Technologies to introduce a Wi-Fi-based campus-wide infant security solution that enables hospitals to attach an RTLS tag to the infant’s umbilical cord clamp.

Other

The Galveston County HIE (TX) and the HIE of Southeast Texas join the Great Houston Healthconnect, making it the state’s largest HIE market with 133 hospitals and over 14,000 providers.

Mayo Clinic rehab nurse Andy McMonigle and three physicians say an iPad helped saved McMonigle’s life when he suffered a heart attack. The nurse, who was exercising in a Mayo Clinic fitness center for employees, felt the onset of the attack and quickly found three doctors in the center. One of the physicians pulled out his iPad and accessed McMonigle’s online medical chart and previous EKGs. Because they had immediate access to his chart, the doctors quickly identified the issue and had  McMonigle transported to the cath lab to remove a blood clot blocking his artery.

Smartphones are the most popular technology among doctors since the stethoscope, according to this study which looks at the global growth of mobile phone technology in healthcare. The use of mobile technology healthcare has the potential to reduce the cost of elderly care 25%, reach twice as many rural patients, and reduce the cost of data collection by 24%.

Speaking of smartphones, almost half of Americans now own one, making it the most widely adopted type of cellphone device.

Sponsor Updates

• Summit Medical Center (TN) shares how its OB/GYN physicians are using AirStrip Technologies to improve patient care during labor and delivery.
• MEDecision hosts a March 21st webinar on best practices and technology to enhance value-based healthcare.
• Wolters Kluwer Health and HealthStream partner to offer the Lippincott’s Professional Development Programs suite to HealthStream’s client base.
• Billian’s HealthDATA partners with RealTime Medical Data to provide Medicare payment data and analytics through RealHealth Analytics.
• Trustwave signs an agreement to purchase M86 Security to enhance its security product portfolios.
• Versus customer Dr. Brett Daniel of Pacific Medical Centers discusses his organization’s use of Versus RTLS at this week’s AMGA 2012 Annual Conference.
• Ignis Systems releases its free webinar schedule for March and April.
• Medicity client Michigan Health Connect receives second place in the Healthcare Informatics Annual IT Innovator Awards for its use of iNexx to create electronic-referral networks throughout Michigan.
• Memorial Healthcare System’s Joe DiMaggio Children’s Hospital (FL) goes live on GetWellNetworks’ IPC solution.
• LRS offers a Webinar featuring speakers from Carilion Health System and Sisters of Mercy Health System, who discuss ways to lower costs and simplify document management in Epic print environments.
• Shareable Ink customer Dr. Brian Woods, CMO of NorthStar Anesthesia discusses his experience automating with Shareable Ink’s technology.
• The Huntzinger Management Group (HMG) publishes Nathan Kaufman’s HIMSS presentation entitled, “Preparing for the Inevitable Perilous Journey from Entitlement to Accountability.”
• SRS EHR customer Pediatric Associates of Savannah (GA) chooses SRS Patient Portal for its 10 provider practice.
• Inland Empire HIE (CA) selects Orion Health’s HIE suite for its 48 participating healthcare organizations.
• GE Healthcare initiates a 90-day free evaluation period for its Global Safety Network, an online community for hospitals to collaborate on improving patient safety.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Curbside Consult by Dr. Jayne 3/6/12

The League of Extraordinary Gentlewomen

A few days ago, I had lunch with some friends. Anyone walking by might have thought it was simply a table of ladies who lunch, but it was much more than that. The reason – three of the five women at the table were, at one time or another, my boss. I’ve written before about bad bosses and bosses who don’t know what to do with CMIOs but today I wanted to talk about bosses who do it right.

I haven’t always been a CMIO – I’ve been an EHR pilot (read: guinea pig) as well as the nebulously-named Physician Champion. I’ve been a Department Chief, faculty member, and front-line physician depending on which hospital I was rounding at on a given day. I’ve also been a teacher, worked retail, and changed my own oil. The point is that many of us come to the table with a variety of experiences. A good boss will recognize the way in which experiences shape employees and draw from those experiences. They will seek to get to know their employees and what they can bring to the table besides title and credentials alone.

All three of these extraordinary bosses saw different things in me. One saw a fairly-green but passionate physician who had a vision and passion for technology. Choosing me over other ‘safe’ choices to provide clinical oversight for my first major IT project could have been a career limiting move for her (and more than once I pushed it to the limit, I’m sure.) Still, she cared enough to get to know me as a person as well as in the capacity of being her employee. Understanding what made me tick and how I reacted to change helped her advise, counsel, and mentor me and increased my value to her team.

She taught me how to dig in when the going got tough as well as how to quickly assimilate huge quantities of data into something useful for physicians to evaluate. I learned about process and methodology, how to work with consultants, and how to recover after getting one’s posterior handed to one by other physicians. She taught me how to leverage those difficult physicians and involve them in the project so that it became “our” project rather than the loudest physician’s idea of what things should be.

With different management styles, different bosses can motivate people to achieve in different ways. My second boss was able to build on what her predecessor had done – taking it to the next level with lessons in political strategy and operational tactics which have been invaluable to me as a CMIO. Although I was familiar with physician to physician politics, when hospitals and payers are involved there is an entirely different level of gamesmanship needed. She taught me to be confident in what I knew to be right as well as how to stick up for it without being obstructive.

She also taught me how to survive when being forced to do things I absolutely didn’t want to do or didn’t believe in – skills which have been critical when dealing with certain kinds of disagreeable organizational strategies that we all face. She gave me space when I needed it and didn’t micromanage, letting me find my own groove and set my own goals.

The other extraordinary gentlewoman at the table was my peer before becoming my boss, which happens to many of us at least once in our careers. We learned together how to swim in the choppy waters of health IT and having shared that experience she knew how thoroughly I would be willing and able to back her up when things got tough. She understood the way physicians make decisions and our ability to take multiple pieces of complex information and quickly arrive at a conclusion that balances patient safety, quality, and efficiency. She understood that I saw the applications we supported as patients and that I was constantly assessing their new ‘aches and pains’ and integrating new discoveries and features to try to come up with the best diagnosis and treatment plan. With that background, she was able to help others in the IT department understand that although it may have seemed like I was just throwing out an answer quickly, it was well-reasoned and also helped me learn to better explain my thought process so that people weren’t spooked.

(So help me, though, if you ever show up as a trauma patient in my Emergency Department, don’t expect me to explain what I’m doing in gory detail just so you can feel better about how quickly I arrived at a conclusion. When you’ve got a chest wound, I guarantee you want the doc to be rapidly processing the situation at the same time she’s giving orders and executing a well-thought and rehearsed plan. There’s no consensus-building when someone’s bleeding out and my reflexes are going to take over and get things done. I do promise though that I’ll explain it to you when you regain consciousness.)

Besides leadership styles and management skills, I learned another key lesson from these extraordinary women – that work/life balance is essential to avoid burn out. We worked in extremely complex situations, short on budget and resources and long on demands and expectations. They taught me how to care for myself so that I could continue caring for others (and also so that I could continue working my tail off for them, which I happily did.)

I truly wish that each of you has, at some point in your careers, one boss that you would walk through fire for. When you do, you’ll understand what I mean – someone who so totally inspires confidence and motivates you, that you’d do anything they ask. And if you’re really lucky and the stars align – you might just be lucky enough to have three.

E-mail Dr. Jayne

Monday Morning Update 3/5/12

From Observer “Epic CIOs. After seeing that two more Wisconsin CIOs that are installing or expanding Epic have lost their jobs recently, I noticed an interesting trend that I call ‘Epic – the Teflon Vendor Effect.’ Have you noticed that when an Epic clinical system install stumbles and fails, it is the CIO’s fault and when the same thing happens with a different product, it is the vendor’s fault?” I will defer to readers on this question,  but following the same logic: does Epic and not the CIO get (or deserve) all the credit when a project succeeds? And do CIOs get the credit when other products are successfully  implemented?

From Reluctant Epic User “Re: Anodyne. My large practice (over 200 providers) is considering Anodyne for BI. The word is that it can extract Epic’s data at the flip of a switch. Do you know or have you heard anything about their implementation? How much effort was required to by the Clarity SQL writers to connect Anodyne to Epic’s Clarity Database? Thanks in advance for the amazing work you, Mr. H, and the two doctors do. It really does make my job and life easier.”Thanks for the kind words. I know very little about Anodyne but I bet we have readers who are experts and willing to share their experiences.

Mr. H has left me to my own devices for the week while he is taking some R&R with Mrs. H. I must confess I am wildly jealous of Mr. H’s gallivanting across the globe, especially since my mind and body are still  experiencing a HIMSS hangover. Do a girl a favor and drop me an email this week and tell me all the secrets you would have told Mr. H. Or,  just send a note reminding me that my vacation will be coming soon. And thanks for reading.

A tornado rips the outside wall from three patient rooms at Harrisburg Medical Center (IL) and forces the evacuation of patients. The storm damaged multiple windows and tore heating and air conditioning systems from the building’s roof. Hospital administrators estimate damages in the millions.

Saint Alphonsus Health System (ID) signs an an agreement to implement MedVentive Population Manager and MedVentive Risk Manager.

The House Energy and Commerce Committee’s subcommittee on commerce, manufacturing, and trade hears testimony in favor of helping state build interoperable drug monitoring systems to reduce prescription drug misuse.

In case you didn’t get your fill of HIMSS and booth critiques, Dodge Communications sent a link to their fun post highlighting the best and worst from the exhibit floor. They name GE’s booth “Best in Show” based on its approachability and messaging. They also poke some fun at a few vendors’ lack of creativity:

Now, we know it’s tough to find relevant imagery in this business. And we see lots of free stock photography depicting smiling, multi-racial healthcare workers reveling in their use of the exhibitors’ technology. Definitely not easy. But pictures of bridges (“Bridges to meaningful use!”), stethoscopes (“We’re in healthcare!”), puzzle pieces (“Putting all the pieces together!”), and chain links (“We’re the missing link!”)  are not cool! C’mon people, be more creative! The most effective way to see if your imagery resonates is to test it with the market. It’s easy to test, and it doesn’t take long to realize that your audience doesn’t think it’s cool either.

Geisinger Health Plan reports that its use of telemonitoring technology has reduced 30-day hospital readmissions by 44%. Using interactive voice response technology from AMC Health, case managers track post-hospital discharge patients’ biometric and symptom information in real-time.

Oakwood Hospital and Medical Center (MI) prepares for its August 1st go-live of Epic’s EMR.

A PwC study finds that 61% of hospitals and physician groups have formal clinical informatics programs and most plan to add additional technical analysts and clinical informaticists over the next two years.

Cumberland Consulting Group promotes John Waters, Charles Flint, and Leah Wilson to executive consultants.

First Databank launches a corporate rebranding initiative designed to focus attention on the company’s growth and future in clinical decision support. Mr. H checked in from his vacation long enough to point out that FDB’s press release mentions their sponsorship of HIStalk, which they call an “influential industry blog.” We like that.

EHR Scope launches AIMSConsultant, a service to provide anesthesiologists and operative facilities with information on anesthesia information management systems.

The Milwaukee paper profiles the Wisconsin HIE, which currently connects 13 area hospitals. No surprise here: the HIE’s executive director notes that the organization’s biggest obstacle to growth is not technology, but money.

HFMA awards Winthrop Resources its “Peer Reviewed” designation, based on the effectiveness, quality, price, value and support of Winthrop’s offerings.

CincyTech and Cincinnati’s Children’s Hospital Medical Center form QI Healthcare, an HIT company to commercialize Children’s proprietary quality-improvement software. CindyTech and Children’s are each investing $200,000 and have named John Atkinson (WebMD, Mede America, SourceMedical)as the new entity’s CEO.

HKS Medical Information Systems changes the company’s name to OTTR, d/b/a OTTR Chronic Care Solutions. OTTR is a provider of transplant patient tracking solutions.

E-mail Inga.

News 3/2/12

Top News

The Defense Department appoints former Harris Corp. VP Barclay Butler to serve as director of the Defense Department/VA Department Interagency Program Office to manage the development of an integrated EHR for both departments.

Reader Comments

From HairClub: “Re: Shafiq Rab. The CIO at Orange Regional Medical Center is taking the VP/CIO position at Hackensack University Medical Center.” Unverified.

From Free Lunch: “Jason DeSantis. Joining Zanett’s healthcare division as executive director of business development.” Unverified. He’s division CIO at University Hospitals in Cleveland.

From Last Man Standing: “Re: GE Healthcare. Layoff today of 5% targeting services and support.” Unverified. Many of the GEHC rumors I get are somewhat true but exaggerated, so if the company provides an update (which companies usually don’t for HR-related issues) I’ll run it here.

From Printgeek: “Re: Epocrates. Laid off their entire EMR staff on Tuesday and are shutting down their EMR project. The BOD lost patience, as crazy sales expectations were set by previous CEO and CFO. They expected to sell 1,500 docs in 2011 with an uncertified system that was release in July. This exec team did a good job hiring talent, but failed to listen to their feedback on what it takes to actually sell EMR and the subsequent expectations.” I think there’s a lesson to be learned here: if selling EMRs was easy, everybody would be doing it, and HITECH has accelerated the polarization of the successful and unsuccessful vendors. If Epocrates, which has an impeccable brand recognition in healthcare and was seemingly doing all the right things, struggled to meet sales numbers for its EMRs, clearly the age of the mom-and-pop EMR is over. Actually, there’s an even more applicable lesson here: publicly traded companies may say all the right things about being dedicated to healthcare, but quarterly numbers can send them fleeing for cover almost instantly. Whatever docs just bought their EMR are now finding out what it means to be on the wrong side of their vendor’s “core business.” The one-year share price chart doesn’t inspire much confidence that a steady hand on the tiller is what’s needed – shares are down almost 60% in the past year.

From HIT Student: “Re: Connected Care Challenge. I thought some of your readers might be interested.” Janssen is offering $250K in awards for easily adopted, low cost technology solutions that can improve information sharing among hospitals, patients, caregivers, and community physicians, with the goal of improving post-hospital care and lowering the cost of unnecessary readmissions. Submissions are being accepted through March 25.

From Non-Sequitur: “Re: SNOMED. Here are examples of the proposal to require SNOMED in Stage 2/2014 Edition. In the 45 CFR Part 170 Standards Companion, see Pages 45 (cancer registry), 52 (problem list MU objective), 58 (summary care record MU objective), and 90 (lab results to public health agencies MU objective.)” Thanks. I know several readers are interested in the potential requirement to use SNOMED.

From I Was There: “Re: HIStalk sponsor lunch at HIMSS. Great location, great food, a nice mix of heavy hitters and rising stars, and great networking with lots of cards being passed and commitments for follow-up discussions. Art Glasgow’s talk was very well received, talking about how HIStalk plays a part in his daily activities as Duke University Hospital CIO, how vendors and providers should help spread the word about it, and the shifts he made going from the vendor world at Ingenix to Duke. The focus was on the three of you as people were trying to figure out who you are and checking out Inga’s shoes. I thought the event was great.” It was really cool that 100+ folks from our sponsoring companies took time away from a very busy first day of the HIMSS conference to let us say thanks to them for supporting what we do. Naturally Inga, Dr. Jayne, and I felt simultaneously ridiculous and vulnerable appearing in disguise, but we did our best. Most of our sponsors understand that we’re going to objective and fair to sponsors and non-sponsors alike and, to their credit, they support us even when what we say isn’t going to be popular back in their offices. If you were there, thank you very much.

From Judy Judy Judy: “Re: Epic consulting firm. Last week Judy F. of Epic met with executives of [consulting firm name omitted] about their violation of Epic’s non-solicitation clause. An Epic client turned them in to Epic after the firm poached a handful of the client’s employees. Epic banned the firm for a year (which was ‘negotiated’ to a shorter term) from selling to or doing business with any new Epic customers. Seems like a slap on the wrist based on recent discussions with Epic Consulting relations personnel and their stringent expectations for consulting partners. Why not take away their preferred certification program as well?” Unverified, so I’ll leave out the company name for now.

From MD Informaticist: “Re: digital pen technology – mightier than the mouse? Are they really making an impact on usability and clinical documentation? I would be interested in your opinion of the Verizon and other digital pens and clarify for us: can this technology re-energize a dormant innovative industry?” What I’ve seen of them seems pretty cool, but I’m interested in hearing from readers about who is actually using them and what results they are getting.

From Mark Schmidt: “Re: HIMSS. It’s become such a large event that the Booth Crawl brought back feelings of those early days when it was possible to spend time with just about every vendor. I learned a lot and heard the latest from Sunquest, which has not been sitting still as the industry has progressed!” Mark, CIO of SISU Medical Systems of Duluth, MN, won a Sunquest-provided iPad last week. He and I have swapped occasional e-mails going back to early 2008.

From Just a Fan: “Re: 5010. Anyone else having issues with a claims clearinghouse not being ready? Our cash on hand is taking a beating because our claims have been sitting at the clearinghouse and are only just now starting to trickle out to payers, which are requesting information required on 4010 but deleted in 5010. And the enforcement delay was good why?” We keep hearing anonymous rumblings with no specific examples. Give us details and we’ll see what we can find out.

HIStalk Announcements and Requests

This week on HIStalk Practice: Dr. Gregg pulls a double shift in an an attempt to diffuse last week’s “mournful silence” on HIStalk Practice while I was busy drinking IngaTinis and walking my high heels off at HIMSS. Dr. Gregg missed HIMSS this year, but still offers some fun HIMSS musings. A proposed rule would require physicians to return improper Medicare payments within 60 days of  notification and allow auditors to investigate 10 years of records. Most physicians believe EHR use is valuable for improving quality and managing patient care, but less convinced that EHR improves diagnosis accuracy or treatment planning. Black Book Rankings announces its ambulatory EHR vendor rankings. Athenahealth CEO Jonathan Bush likens his company to a “snippy kind of overconfident Chihuahua jumping up and trying to nip at the tails of the Dobermans.” By the way, we are conducting a reader survey on HIStalk Practice that is in addition to the HIStalk version; we’d love readers to take a moment to  have a  to provide input. Thanks for reading!

I appreciate the support of Levi, Ray & Shoup (specifically LRS Output Management) for supporting HIStalk as a Platinum Sponsor. The company’s expertise is in document solutions for hospitals, so let’s use a typical Epic shop as an example. Maybe your big Epic print jobs fail; you need centralized capability to monitor and reprint jobs without re-running them on Epic; you are maxing out out your Windows print queues or the Windows print spooler; or you’d like to save print costs by allowing users to preview reports before printing and automatically route large reports to more economical printers. With the LRS solution, you gain centralized control, you can implement load balancing, you avoid installing multiple print drivers on each workstation, and you get rid of the unreliable science fair of printing solutions (UNIX to JetDirects, multiple printer types, a mix of Epic text and ERTF documents, etc.) and you can even require users to verify their identity before printing patient documents to an unattended printer. It doesn’t matter how cool Epic is if the tangible, patient-critical label or report it creates as an end product is hanging out there in the ozone because of a cobbled-together print solution that is far less enterprise grade than the system that drives it. One hospital with four FTEs handling printing issues cut back to just one after implementing LRS Output Management, which can handle anywhere from hundreds to thousands of printers. And while Epic is a good example, the solution works with any application (Lawson, SAP, etc.) Check out their case studies from Carilion, Hopkins, UVA, etc. Thanks to Levi, Ray & Shoup for supporting HIStalk.

Liaison Healthcare Informatics is supporting HIStalk as a Platinum Sponsor. The Atlanta-based integration and data management company has over 9,000 customers all over the world, including more than 600 in healthcare. The company’s cloud-based data integration solutions provide a platform for the secure exchange of data among providers, payers, patients, and HIEs. Some of the pain points it addresses are HIPAA, HITECH, DEA Form 222, Safe Harbor qualification of encrypting PHI data at rest, electronic file transfers, and avoidance of data breaches. Its Liaison Protect solution makes sure you are securing your databases, integrating encryption, tokenization, key management, and logging. Its Liaison Exchange managed file transfer software suite allows cost-effective management of ever-increasing volumes of file transfer exchanges both inside and outside the organization. If you need to accelerate your HIE or ACO efforts, securely share patient information with other organizations, or gain control over risky and poorly monitored file transfers, give their offerings a look. Thanks to Liaison Healthcare Informatics for supporting HIStalk.

Inga mentioned the reader survey — you have one last chance to provide input that we’ll use to plan the next year of HIStalk. Thanks. It really does help us given that we work largely in a vacuum and have to pick and choose our projects since we have limited time to get things done.

For our numbers-obsessed reader(s), we had a record-breaking 125,867 visits in February, along with 196,565 page views. The e-mail blasts go out to 7,935 subscribers, while Dann’s HIStalk Fan Club has 2,268 members (OK, I admit that we’re not entirely comfortable with the idea of having fans, but it’s slightly satisfying to reflect on that fact during our frequent bouts of feelings of inadequacy and lack of accomplishment.) You can move our emotionally needy needles by (a) subscribing to the updates; (b) connecting with us on Facebook, LinkedIn, and Twitter; (c) supporting the sponsors who support us by poring over their ads, clicking those of interest, checking out their Resource Center pages, use the Consulting RFI Blaster to quickly solicit consulting help; (d) sending us news, rumors, guest articles, or anything else that would interest your fellow readers; and (e) feeling the positive thoughts Inga, Dr. Jayne, and I are beaming your way for supporting what we do in whatever form that support takes, which means a lot to the ladies and me.

A reader asked about WellStar’s ambulatory EMR project. I have the information, but agreed to sit on it for a few days. Stay tuned.

The overachievers at API Healthcare, not content to simply mail Gabe Davis (right) of Texas Health Partners his iPad prize from the recent Booth Crawl after he had to leave the HIMSS conference early, sent VP Kyle Allain (left) to his office to hand-deliver “the famous HIStalk iPad” personally. This was Gabe’s first trip to HIMSS and he had nice things to say about HIStalk and API’s support of it. His 16-year-old son will get the iPad and is apparently pretty stoked about it, and rightfully so because iPads are darned cool even if you aren’t an Apple fanboy.

On the Jobs Page: Financial Systems Consultants, Meditech CPOE Go-Live Support, Epic Certified Builders. On Healthcare IT Jobs: Senior Health Information Technology Specialist, Implementation Consultant, Project Manager CMIO Informatics, McKesson Paragon Consultants.

I’m taking a little break to escort Mrs. HIStalk to somewhere warm and sunny where laptops are as rare as bathing suit tops (OK, I’m kidding on that one) so the eminently capable Inga and Dr. Jayne will be holding down the fort as I try to fight the urge to stay off e-mail (I’m rarely successful.) I don’t know about you, but I’m really tired after all the HIMSS-related activities over the past few weeks and I want to see what it feels like to sleep more than five hours in a single night.

Acquisitions, Funding, Business, and Stock

Teledermatology provider Iagnosis raises $1 million from 11 investors.

Accretive Health releases its Q4 numbers: profit of $13.2 million ($0.13/share) compared to last year’s $5.5 million ($0.06/share.) Net services revenue grew 53% to $260.1 million.

HP Enterprise Services notifies the State of Wisconsin that it will be eliminating 157 Medicaid program jobs in Madison and Milwaukee.

Sales

DR Systems announces six new contracts for its Unity platform totaling more than $2.07 million.

Cancer Treatment Centers of America signs an agreement to deploy Unibased Systems Architecture’s ForSite 2020 application suite across all its facilities.

People

Beacon Partners appoints Christina Bertsch (EMD Serono) VP of human resources.

The National Quality Forum board of directors announces that President and CEO Janet Corrigan will resign as of June 2012.

HHS Office for Civil Rights names attorney Juliet K. Choi (American Red Cross) as chief of staff and senior advisor.

Announcements and Implementations

Four Lakeland Healthcare (MI) hospitals go live on their $50 million Epic system.

T-System licenses its clinical terminology to Prognosis HIS, allowing Prognosis to incorporate into its ChartAccess EHR more than 200,000 clinical phrases.

MED3OOO chooses Macadamian to help develop a new product that it says will expand the usability and adoption of its ambulatory systems.

Shareable Ink incorporates Pentaho Business Analytics to create a data analytics platform for healthcare.

Michigan Health Connect wins second place in an IT innovator awards contest for its electronic referrals solution app, powered by Medicity’s iNexx, that was rolled out to nearly 1,000 physicians over 28 counties. 

Government and Politics

The Advisory Board Company does a nice high-level summary of the proposed Meaningful Use Stage 2, nice for CIOs prepping peer execs for what the IT agenda will look like.

In England, two NHS trusts seek a supplier to take over their IT help desk and infrastructure in what would be the first outsourcing contract of its kind. The deal is valued at  $50 million.

I liked Doug Fridsma’s post on HHS’s blog about the Interoperability Showcase at HIMSS. He says Farzad Mostashari showed up there by surprise and challenged the participants to demonstrate impromptu interoperability with another participant with whom no relationship existed. He gave them one hour to make it happen technically, which involved overcoming challenges such as authentication certificates, vocabularies, and firewalls. The result: NextGen sent a C32 to Allscripts, EXCITA HIE and Medical Informatics Engineering exchanged a transfer of care document in ER discharge summary format, and Enable Healthcare sent a CCDA discharge summary to Verison to create a new patient chart. That’s pretty cool.

Other

Ochsner Health System (LA) announces that its neurologists recently completed their 1,000th patient consult as part of Ochsner’s  telehealth stroke treatment program.

KLAS reports that some providers are concerned with a number product gaps and weaknesses in the McKesson Paragon product and wonder if Paragon can scale to larger hospitals, especially those with more than 400 beds.

Jackson Health System (FL) announces the layoff of more than 1,000 people in an effort to save the organization $69 million.

Trinity Health’s Michigan hospitals sign an agreement with University of Michigan to explore ways the organizations can work together to coordinate care, with one of the areas of discussion being information technology. 

A physician’s assistant who sued her former employer, Mercy General Hospital (CA), for sexual harassment is awarded $167 million.

The folks at MED3OOO asked Inga and me to choose and announce a winner from the six finalists in their contest to create the best video testimonial. They offered to pay for our time, but we said it either had to be (a) free to them because they’re a sponsor, or (b) if they really wanted, they could donate whatever amount they wanted to a charity of our choice. Thanks to MED3OOO for their donation to Best Friends Animal Society, a highly rated charity whose mission is “to bring about a time when there are no more homeless pets.” And congratulations to the winner, Kyle Adkins, administrator of Golden Valley Medical Clinics of Clinton, MO (he’s in Interview 1 on the finalist page) which implemented the InteGreat browser-based EHR from MED3OOO. My favorite quote: “You don’t ever make this decision well the second time or a third time. You may make a better one if you’ve made the wrong decision, but there will be someone else making the decision.” Great job, Kyle, and for that you win an all-expense paid trip to MED3OOO’s 2012 National Healthcare Leadership and Users Conference in St. Thomas, US Virgin Islands in October.

Sponsor Updates

• World Wide Technology is sponsoring Geek Day 12 in Washington DC, April 11-12, complete with showcase labs, breakouts, and birds of a feather session divided by industry focus. The event is free and so is lunch.
• API Healthcare partners with Presagia Software to offer Presagia’s workforce absence management solutions to API clients.
• ProHealth Care (WI) goes live with iSirona’s connectivity technology to deliver patient data from anesthesia monitors into Epic EMR.
• A survey by BridgeHead Software finds that most hospitals want vendor neutrality with more control over their image data.
• Black Book names Quest Diagnostic’s Care360 EHR the best EHR for single physician practices and for e-prescribing. It was also ranked eighth on Capterra’s most popular EMRs.
• Alexander Orthopaedic Associates (FL) selects White Plume Technologies’ AccelaSMART resolution engine to bridge the gap between its Exscribe EHR and ADP’s AdvancedMD’s PM system.
• MEDSEEK and BrightWhistle partner to offer a search and social media marketing solution.
• Lawson Software enhances its Cloverleaf Secure Courier and Global Monitor for its Cloverleaf Integration Suite to increase speed and provide greater connectivity.
• New York-Presbyterian Hospital goes live with Awarepoint’s RTLS at its Columbia University Medical Center campus.
• Aventura will participate in the World Congress Inaugural eHealth Innovation Conference this month in Cambridge, MA.
• Santa Rosa Consulting advisor Matt Wimberley  discusses confidentiality, integrity, and availability in the HIPAA security rule.
• Bruce Friedman MD, emeritus professor of pathology at University of Michigan Medical School, keynotes at the Lifepoint Informatics User Conference 2012.
• Evergreen Healthcare (WA) shares how API Healthcare’s Time and Attendance and Staffing and Scheduling technology helped the organization get its productivity and costs under control.
• MedAptus launches a revenue cycle reporting and performance analytics module for its Professional solution.
• Coastal Cardiovascular Consultants (NJ) will implement the SRS EHR at two locations for its six providers.

EPtalk by Dr. Jayne

The American Journal of Preventive Medicine recently published an article about cybercycling. It shows that riding a stationary bike which hooked up to interactive videogames could increase brain function in older adults compared with a standard exercise bike. Elderly study participants who took 3D tours and raced computer generated avatars showed better memory, attention, and problem-solving abilities. Not surprisingly, some reported knee and back pain as well as “frustration with interacting with a computer.” Now we just have to wait for a vendor to allow the cybercycling data to flow through the patient’s PHR into their EHR charts.

Shades of Eliot Ness: Even without federal approval, Illinois is getting tough on Medicaid fraud. The state will start matching Medicaid patient data with the state driver’s license database to make sure only Illinois residents are receiving benefits. Applicants would also have to show additional proof of income to maintain benefits. Even without federal blessing, this seems like a reasonable idea – recently 6% of Medicaid cards were returned as undeliverable or having an out-of-state forwarding address.

It looks like there might be another way for vendors to expand their offerings. The Department of Health and Human Services recently announced plans to look as far back as 10 years when auditing Medicare overpayments. I forsee a whole new subset of vendors offering data archiving and retrieval specifically for Medicare billing. As Medicare goes, so go the rest of the payers, so it’s only a matter of time before providers are forced to maintain massive amounts of data. And we thought seven years for the IRS was bad.

For those of you who work directly with providers, it will be interesting to see how upcoming changes to the Medical College Admission Test (MCAT) affect the physician pool. The test is being updated to gauge “knowledge of the psychological, social, and biological foundations of behavior” as well as critical thinking skills. The goal is to “better prepare students to be doctors in today’s changing health care system.” It will be interesting to see if this really makes a difference in patient care, but I do hope it will also make a difference in being able to intervene with colleagues who are ripping their hair out due to the continuous onslaught of ever-changing federal and payer regulations.

USA Today reports that Hawaiians rank at the top for residents having the best overall sense of well-being. Don’t attribute it all to the sunlight and tropical breezes though – North Dakota, Minnesota, and Alaska also made the top ten. West Virginia finished last. Gallup gathered the data by calling 1,000 people daily for all but 15 days of 2011.

I’m still poring over all the Stage 2 documentation that’s coming across my desk (and phone, and e-mail, and the water cooler) and for better or worse, it seems like I’ve become comfortably numb as far as finding something noteworthy to discuss. Have a thought about your interpretation of those 455 pages of bliss? E-mail me.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

CIO Unplugged 2/29/12

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

Are You an Insider?

My siblings and I took a beating from our peers because of the Bavarian clothes our parents insisted we wear long after our arrival in USA. We were, however, embraced on the futbol pitch. The seven of us kids had the benefit of growing up on the soccer field in Germany. When we arrived here in the mid ‘70s, American soccer was in its infancy. Coaches welcomed our soccer finesse, experience, and smarts. It took time for our teammates to accept us foreigners who played with a different style, but our impact proved undeniable.

What was good for those teammates is equally good for IT.

One of my first healthcare jobs held a single yet challenging objective: “make docs happy.” In that competitive environment, physician loyalty was paramount. My role was one-third ombudsman, one-third consultant, and one-third party planner.

I loved it. I met with physicians daily to make sure their concerns and ideas were appropriately vetted with hospital administration. I dived deep into practice management and provided consulting services ranging from business development to system selection to establishing regional CME events. The most enjoyable aspect was organizing some serious parties to celebrate accomplishments and recognize the medical staff and their contributions to our healthcare system.

Despite my established healthcare background, I transitioned into the position of IT director as an outsider. I brought with me a different skill set. I viewed things differently from my tradition- oriented IT peers.

It was not easy for me or my new cohorts at first, but we helped each other. Mixing outsider perspective and experience with solid IT operations made for a dynamic environment resulting in vastly improved performance and outcomes.

As a believer in the diversity approach, I’ve purposefully sought to develop teams comprised of traditional and non-traditional workers. In a former post, “Got Clinicians?” I share the absolute necessity for ensuring appropriate clinical insights. Now I aim to encourage you to build a healthy mix of non-healthcare experienced talent into your fold.

Most would agree that healthcare, conservative by culture, is three to five years behind the technology curve. Bringing in outsiders who have worked in progressive industries such as finance or international business will help push the organization forward and help ensure currency. Not just currency, but also what is on the horizon. A couple of the chief technical officers I’ve hired have had zero healthcare experience. On both occasions, my organizations experienced a massive technological bounce.

Promoting only from within will continue to retard the growth curve as compared to other industries. It’s all about striking that healthy balance.

So, what about you and me? Even outsiders eventually become insiders. How do we stay fresh and think with the objectivity of an outsider? Spend at least 50% of your learning outside of healthcare.

Some methods to avoid becoming a healthcare IT junkie:

• Conferences. Choose wisely. Skip HIMSS every other year and go to the consumer electronics show instead. You will see things that will eventually be shown at HIMSS three years later.
• Blogs. Read posts that are on the bleeding edge.
• Magazines. Check your subscriptions. At least half should be outside of healthcare and, of course, a high percentage should be business and non-technical.
• Peers. Spend time with non-healthcare peers. I previously posted on how we compare notes regularly with companies in different verticals. Next up, Kimberly-Clark.
• Organizations. Actively participate in professional groups such as SIM where you are exposed to peers from across industries.
• Hiring. Keep yourself on your toes by hiring outsiders who are smarter than you.
• Diversity. Don’t hire your twin
• Advisory boards. Participate in those that are vertical agnostic.

Fitting in to please everyone is a worthless pursuit. Avoid that temptation. Hiring outsiders is healthy for your team. This will create more opportunity as new technologies are transferred to the team. Hiring outsiders is beneficial to your organization as you begin to deploy new tools that will enable mission fulfillment. Hiring outsiders advances healthcare. You’ll leverage technology and help reduce the cost of healthcare, elevate patient and clinician satisfaction, and ultimately improve the quality of care.

Most of us German-transplant kids had successful soccer careers in high school and beyond. We helped our coaches take our teams to the next level. Goal! And for at least a few hours each week, we were free from our lederhosen.

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

HITlaw 2/29/12

Exposure Disclosure. Liability and Accountability.

HIPAA has been around for a while. I would not say we are generally complacent about it, but I believe we have become at least comfortable with it.

Enter the HITECH Act, which puts real muscle into HIPAA. Providers should recognize the urgency of reviewing not only their current internal policies regarding protection of patient information, but also the agreements they have in place with entities that use and access patient information on their behalf. With everything that is approaching under HITECH (or here already), providers may be unsettled to find that they are exposed to more potential liability and financial consequences than originally contemplated when HIPAA first came on the scene. That said, the good news is that accountability will now be shared with those entities to which you contract services involving patient information.

Capitalized terms refer to defined terms under HIPAA and HITECH Act, and I am purposely avoiding long explanations and citations with the assumption that these terms are known already to HIStalk readership.

As a quick refresher, the HIPAA Privacy Rule (effective in 2003) and Security Rule (effective in 2005) set out the regulations applicable to health care providers (Covered Entities) and their protection and treatment of patients’ Protected Health Information (PHI). Covered Entities were required to enter into Business Associate Agreements that secured written agreement from Business Associates that they would protect PHI from unauthorized disclosure. At that time it was suggested but not required that the Covered Entity secure an indemnification from the Business Associate, protecting the Covered Entity in the event of an unauthorized disclosure of PHI due to the actions of the Business Associate (optional indemnification language was even previously included in the HHS Office of Civil Rights (OCR) sample Business Associate Agreement).

All providers should undertake a complete review of their existing Business Associate Agreements, while also reviewing their own policies regarding privacy and security of PHI. Business Associate Agreements should be amended or replaced as necessary in order to address the changes to HIPAA resulting from the HITECH Act. While reviewing the Business Associate Agreements, identify those that do not have an indemnification provision whereby the Business Associate indemnifies the Covered Entity for unauthorized disclosures of PHI caused by the Business Associate. This one factor alone is worth the entire review process. See HITlaw February 18, 2011 for a brief indemnification explanation.

HIPAA and HITECH

There is a ton of material worthy of elaboration packed into the following points, but space is limited. Being the straightforward type that I am, here goes:

• HIPAA requires that providers review and update their policies, procedures, and safeguards with regard to the privacy and security of PHI.
• HITECH mandates audits of providers to determine compliance with HIPAA (which would include determining if a provider has updated its privacy policy).
• OCR was given authority under HITECH to enforce HIPAA, is investigating data breaches, and has imposed penalties on providers in excess of $1m (two of these in 2011).
• HITECH final regulations will put the bite into HIPAA that until now has had mostly only bark, including required enforcement and mandatory penalties in certain situations.
• HITECH extends compliance regulations and penalties to Business Associates.

In addition to reviewing privacy policies, all providers should review their actual operations with regard to protection of PHI, because while a policy may look good on paper, non-adherence in daily operations will undoubtedly become evident in the event of an audit or investigation.

Liability

Here is the most important item to understand. Just because your organization contracts with a Business Associate that performs certain tasks and operations on your behalf does not mean that responsibility for any data breaches and unauthorized disclosures of PHI is automatically passed on to the Business Associate. Your organization, as the health care provider and Covered Entity, is ultimately responsible to the patient. Having an indemnification provision in the Business Associate Agreement ensures that if a breach or unauthorized disclosure of PHI occurs that is in any part the fault of the Business Associate, you will have legal recourse in order to pursue financial contribution from the Business Associate.

The potential impact on a provider organization without this protection is significant. Suppose a breach occurs and it is completely the fault of the provider’s staff. The provider organization is responsible and pays the price. Suppose however that a breach occurs and it was the fault of a Business Associate. The provider organization is still responsible and will pay the full price if it cannot shift some financial responsibility to the Business Associate under an indemnification provision.

Refer back to the bullets above. Before HITECH, everyone in this industry was fairly settled in with HIPAA and knew about the obligations to protect PHI. With the advent of HITECH, HIPAA takes on a much stronger presence. Audits will be performed, failures in compliance will be discovered, and penalties will be assessed (assuming adoption of the HITECH final regulations that amend HIPAA happens in the not-too-distant future). On a practical note, while assessment of a penalty on either the Covered Entity or Business Associate does not by any means guarantee a patient plaintiff a verdict in court, the very existence of any imposed penalties (on either the Covered Entity or its Business Associate) will certainly be introduced in legal actions by patients for unauthorized disclosure of PHI.

As for the Business Associates (vendors) in the industry, HITECH also requires that Business Associates obtain written agreement from subcontractors that they will comply with the Business Associate requirements to which your companies are subject with respect to your provider customers. All the above advice is applicable to your agreements with your subcontractors, and the indemnification from the subcontractors is essential for protection of your companies. Just re-read the above, and put “my company” in place of provider or Covered Entity, and “subcontractor” in place of Business Associate. Civil and criminal penalties, formerly applicable to Covered Entities under HIPAA, may be imposed on Business Associates for HIPAA violations under HITECH. Careful review of your company’s policies and procedures, especially with regard to administrative, physical and technical safeguards, is important. HITECH mandates Business Associate compliance with these HIPAA requirements, so if you do not have a privacy and security policy in place, this should become a top priority for the very near future.

Accountability

Clearly the HITECH Act calls for increased accountability. First, on the part of providers through audits, investigations, and penalties. Second, by extending compliance requirements (and audits, investigations, and penalties) to Business Associates. This is the real game-changer for technology companies in this industry. Prior to HITECH, the impact and exposure of any breach of a Business Associate Agreement for the Business Associate was dependent on action by the provider customer (Covered Entity). HITECH changes all that and brings accountability, responsibility, and the possibility of civil and criminal penalties right to the Business Associate.

The inclusion of Business Associates in the compliance and penalty aspects of HIPAA though the enactment of HITECH is a strong message from Washington that it is understood providers in some cases are not responsible for data breaches and unauthorized disclosure of PHI, but they alone (until HITECH) were accountable and subject to penalties in those situations. HITECH’s amendments to HIPAA permitting or requiring penalties for Business Associates for their violations is a clear statement of recognition that the penalty, if imposed, should lie where the fault occurred and not just with the Covered Entity which, through no fault of its own, was previously subject to penalty for the actions of others.

I suggest that vendors consider the accountability aspect of HITECH and realize that taking on responsibility and liability is truly becoming a cost of doing business in the industry. Providers did not impose HIPAA and HITECH on themselves. Just as Business Associate vendors should obtain protection from subcontractors for their faults and failings, they should also realize the potential impact on provider customers of any breach with regard to PHI. Fairness dictates that what you require from your subcontractors for your protection you should consider providing to your client base for their protection.

Note I am not anti-vendor, nor am I anti-HIPAA or anti-HITECH. We must all deal with HIPAA and HITECH and the associated benefits for patients, as well as the negative aspects for both Covered Entity and Business Associate offenders. What I suggest is fairness for all, with parties being responsible for their actions.

Providers

Review policies, practices, and Business Associate Agreements and update all accordingly. Note: just because HITECH extends civil and criminal penalties to Business Associates does not mean that liability and responsibility to patients for disclosure of their PHI shifts from Covered Entities to Business Associates. While penalties may be imposed, they are not for the sole purpose of compensating patients whose PHI was disclosed. Some portion of the penalties is intended for this use, but this does not mean that your patients will in any way be prevented from bringing action against your organization directly. This enforces the need for indemnification from your Business Associates.

Business Associates

Review policies and procedures (or establish them now), and obtain a written “Subcontractor Business Associate Agreement” from all subcontractors. In any action for data breach or unauthorized disclosure of PHI, attorneys for the patients will try to bring in as many entities as possible, from the provider Covered Entity to the Business Associate to the subcontractor of the Business Associate. Another practical note – just as the existence of a penalty for violation of HIPAA does not guarantee a patient plaintiff a favorable verdict in legal action, neither does the absence of penalties suggest a verdict for the defendant Business Associate (or Covered Entity). Make sure you are in compliance with HIPAA and have indemnification from your subcontractors as described above.

Although to some the information here may seem basic or obvious, I can assure you that it is not so for all readers. I have composed this posting over the past few months based on real inquiries from, and interactions with, people in different areas of responsibility and levels of leadership within the healthcare industry. Some were truly surprising.

In my various engagements, I represent providers as well as technology companies. This gives me a unique perspective, and in postings like this I try not to take sides but rather to offer advice to all. I also throw in a generous dose of fairness because that is what I believe is most important in structuring and negotiating agreements between parties.

William O’Toole is the founder of O’Toole Law Group of Duxbury, MA.

News 2/29/12

Top News

Epocrates reports Q4 numbers: revenue up 9%, EPS –$0.18 vs. $0.01. The company reduced 2012 revenue estimates and says it will seek strategic alternatives for its EHR, which includes a native iPad version, since “the effort has hindered our ability to aggressively pursue such [physician network] opportunities.” Maybe that list of EHR mistakes is of theirs.

Reader Comments

From BeenThere: “Re: WellStar. Shutting down its ambulatory rollout of [vendor name omitted].” I’m looking for confirmation and will provide more details if I get them.

From Non-Sequitur: “Re: SNOMED. My manager attended Dr. Mostashari’s session and is able to substantiate what you wrote down about SNOMED and the problem list. He captured the talk on a Flip and we just listened to that segment talking how ‘we now have a standard for this or that’ ontology. Here’s specifically what he said regarding problem lists: ‘There is now a single standard for problem lists: SNOMED.’ I concur with the other people who have commented there is no mention of a requirement for SNOMED in the currently released document. We’ll see if what is published in the Federal Register provides additional detail.“ Thanks! I was hoping I hadn’t dreamed that part so early in his talk.

From Jockey: “Re: Allscripts. Curious if you’ve heard rumors of an acquisition by some big non-healthcare guys.” Two anonymous readers have said that IBM (and possibly Oracle) might be making a move, but I have nothing substantial to back that up.

From BrazosKid: “Re: KC area eClinicalWorks user group meeting. Surprise guest was CEO Girish. Said a few words and took some questions, made time for anyone who wanted to talk to him. A very personable and approachable CEO. You should interview him.” I have, actually: in 2006, 2008, and 2009. Girish Kumar Navani is one of my favorite people to talk to: honest, logical, and insightful, not to mention fun and an excellent businessman.

From Phil: “Re: HIStalkapalooza. The flipbook with Elvis was the highlight of the memorabilia I brought back!” Those were cool. Check them out in the video if you haven’t already. I may need to make Elvis a fixture at future events since he was fun.

From Kathy Wheatley: “Re: thanks for the Booth Crawl iPad from T-System. Coincidentally, some of our facilities use T-System and love it. Paper T’s in the past, but the electronic version is very easy, fast, and reliable. Thank you T-System for sponsoring HIStalk. I get my information from HIStalk, HIStalk Practice, and HIStalk Mobile, pull out applicable info, and copy it in another e-mail for our leadership team. My boss told me not to stop sending them – he was getting a lot of good market info from them. You have a great knack of pulling together applicable and trend information to hand it to your readers with a great synopsis and links to the full articles, which I have used often. I appreciate the writings of Inga, Dr. Jayne, and Dr. Gregg as well, and I enjoy reading Ed Marx – so spot on. Thanks for being the glue that holds this together.” Thanks for those nice comments from Kathy from HCA, for which I’m sure I’m speaking for T-System as well. I also got  nice e-mail from Jason Blunk, who won his iPad from MedPlus and said he enjoyed checking out booths he would have missed otherwise.

From Sagacity: “Re: Meaningful Use Stage 2 references. Along with the bookmarked version of the NPRM, here is a bookmarked version of the ONC Standards, Implementation Specifications, and Certification Criteria. It comes with the added bonus of clickable MU Objective links, which take you back to the CMS MU objective being referenced in the CMS document. (Just be sure to save both in the same folder).” Thanks for sending the links.

From The PACS Designer: “Re: iPad 3. When the iPad 3 is released next month, you’ll find that the majority of changes will be inside, since rumored details indicate that there will be no change in the size of the screen. One new upgrade coming is better High Definition, where the number of pixels will double by using a 4×4 matrix instead of 2×2 currently in the iPad 2.”

HIStalk Announcements and Requests

If you’ve completed my once-a-year Reader Survey, thanks. If not, I’d appreciate your input.

Acquisitions, Funding, Business, and Stock

Halfpenny Technologies secures $2.25 million in VC funding co-led by Vital Financial and Emerald Stage2 Ventures. The company also announces that it has won approval as the first pilot by the Laboratory Results Interface Pilots Work Group.

T-System acquires Clinical Coding Solutions, a provider of technology for facility and professional charge capture and coding for EDs, observation, urgent care centers, and outpatient clinics.

Hello Health raises $10 million in a combination of common and preferred shares and issuance of convertible debentures through its parent company Myca Health.

Sales

CentraState Healthcare System (NJ) chooses Cognizant to develop its ICD-10 transition strategy.

Trinity Health (MI) selects Quest Diagnostics’ ChartMaxx Enterprise Content Management solution.

LifeCare Hospitals (TX) chooses Meta’s integrated HIM and CDI software suite for abstracting/coding and clinical documentation for its 27 long-term acute care facilities.

CMS awards SAIC a contract to provide enterprise remote identity proofing and multi-factor authentication credential services. The total contract value is $78 million, assuming all contract options are exercised.

HMO Simply Healthcare (FL) selects MedHOK’s care management, quality, and compliance software for quality improvement initiatives.

Sacred Heart Health Systems (FL), Piedmont Healthcare (GA), and Orlando Health (FL) sign contracts with QuadraMed for its identity management solutions.

People

KPMG appoints Richard Bakalar (Microsoft Health Solutions Group) to its Global Healthcare Center of Excellence.

CORHIO Executive Director Phyllis Albritton announces that she will step down at the end of March after four years of leading the organization.

Cape Cod Healthcare (MA) promotes Jeanne M. Fallon to VP/CIO.

CareCloud appoints John Hallock, formerly with athenahealth, as VP of corporate communications.

Siemens Healthcare names David Fisher, formerly with the Medical Imaging & Technology Alliance, as VP of healthcare policy and strategy.

Announcements and Implementations

Ochsner Health System (LA) standardizes on the Informatica platform for HIE, BI, and other IS initiatives.

Sentara Princess Anne Hospital (VA) implements EXTENSION’s clinical workflow solutions for nursing staff in its neonatal ICU.

Oakwood Healthcare Dearborn (MI) will go live with an $80 million Epic project in August.

Midwest Orthopaedis at Rush goes live with SA Ignite’s MU Assistant, which documents EHR usage in preparation for assessment.

Delaware Health Information Network announces that all of the state’s acute care hospitals and skilled nursing facilities are participating in its statewide community health record, making it the first state to have all hospitals involved.

New York eHealth Collaborative is accepting presentation proposals through March 23 for its 2012 Digital Health Conference to be held in October.

Shareable Ink announces partnerships with Greenway, NextEMR, and VoiceHIT for its handwriting recognition technology.

Government and Politics

In England, a hospital pilots an analytics service in which drug companies can use the hospital’s de-identified and aggregated data directly from its databases to perform queries and data analysis.

The VA orders worked stopped on its $103 million enterprise service bus that would connect external products to the EHR it’s developing with the Department of Defense. CIO Roger Baker also says the VA is looking for less-expensive alternatives to Microsoft Office, but has no immediate plans to switch.

CMS credits its fraud detection technology for the indictment of a Texas physician and six other people who it claims bilked the government for $375 million of unnecessary home health services. CMS says the physician certified more Medicare beneficiaries for home health service than any other US medical practice, claiming that he recruited them via door-to-door solicitations and visits to the local homeless shelter.

Other

Novant Health (NC) is hiring 150 people with clinical and computer experience as it transitions to Epic.

Weird News Andy extends this story on cosmetic leg-lengthening surgery, which he captions, “Men, grow six inches.” WNA also likes this ink on medical tattoos, including “No CPR” emblazoned on a man’s chest, although the wording WNA suggests for breast implants is not family friendly.

Nuesoft is conducting a survey on attitudes about the transition to ICD-10 and ANSI-5010.

An article in the Minneapolis paper covers the local VA’s use of a virtual ICU to cover hospital ICUs in multiple cities from a single location, which an intensivist there likens to air traffic controllers watching from afar.

Sponsor Updates

• DIVURGENT and Bon Secours Kentucky Health System publish a white paper on implementing an EMR.
• Covisint partners with Anvita Health to add Anvita’s Smart Problem List to its HIE platform.
• Comanche County Memorial Hospital (OK) will migrate from McKesson’s Horizon Clinicals to Paragon HIS.
• ZirMed introduces VeraFund Manager, an end-to-end automated patient/payer solution for healthcare providers.
• CommunityHealth IT (FL) partners with RelayHealth for its HIE.
• Allscripts and MyCareTeam launch a diabetes management system that integrates the MyCareTeam application with Allscripts Enterprise EHR.
• Beacon Partners launches Pillars Project Planner, a Web-based project management and implementation tool that provides organizations real-time access to their projects.
• Nuance introduces two clinical language understanding solutions, Dragon Medical 360 | M.D.Assist and Dragon Medical 360 | QualityAnalytics.
• eClinicalWorks announces Community Analytics, a data analytics solution for communities and ACOs that provides reporting, alerting, and messaging capabilities to manage population health.
• UC Health (OH) expands its use of Streamline Health Solutions in three of its hospitals.
• Central Alabama Health Image Exchange selects MEDecision to deliver its DICOM images and clinical information solution to seven of its hospitals.
• Healthland partners with Imprivata to resell Imprivata’s single sign-on and access management technology.
• Concentra (TX) selects Allscripts EHR to deploy in its 310 urgent care locations across the country. CVS Caremark’s MinuteClinic will transition from its proprietary EMR to AllscriptsMyWay EHR.
• HFMA grants Surgical Information Systems the “Peer Reviewed by HFMA” designation.
• LTC provider NuVista Living (FL) implements the Intelligent InSites RTLS solution as part of its Living Smart Room.
• Trenton Health Team (NJ) selects Covisint as its HIE provider.
• GetWellNetwork says it gained 25 new hospital customers and a 35% increase in live beds for its interactive patient care solution in 2011.
• Healthcare Management Systems (HMS) and Certify Data Systems partner to make Certify’s HIE solution available to HMS customers.
• Microsoft selects Health Language to map patient data within Microsoft Amalga platform.
• Practice Fusion wins top honors for customer satisfaction in the primary care division of the Black Book Ratings
• Imprivata introduces CorText, its secure texting application.
• T-System introduces care coordination technology at the Emergency Nurses Association Leadership Conference.
• PatientKeeper introduces the latest release of its medication reconciliation software.
• Brown & Toland IPA (CA) selects Humedica MinedShare as its analytics platform to assist its 1,500 physicians with Pioneer ACO requirements.
• CynergisTek partners with Iatric Systems to offer Iatric’s Security Audit Manager and Medical Records Release Manager solutions.
• Quest Diagnostics announces a 30-day EHR implementation guarantee to enable bi-directional data exchange between hospitals and ambulatory physicians using the Care360 EHR.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Readers Write 2/27/12

Why Device Connectivity Is Hot Now
By Dave Dyell

Tech-based solutions often enjoy a surge or hot period—a moment in the sun if you will. For those of us in the medical device integration (MDI) space, 2011 felt pretty sunny. For one thing, 2011 was the first year in which KLAS, an independent research organization that ranks health information technology vendors in key market segments, recognized MDI.

In an annual report titled Medical Device Integration 2012: Proven Connections, KLAS detailed the major MDI vendors and their individual strengths, as well as the overall benefit of MDI. For those of us who have worked in the MDI space for several years, recognition from KLAS represented a major milestone.

So why did KLAS add MDI to its list of relevant tech spaces in 2011? Why is the HIT spotlight on MDI now?

One reason is that MDI is a necessary component, or stepping stone, on the road toward achieving HIT initiatives such as Meaningful Use, health information exchange, ACOs, etc. In this way, the rise of MDI has been fueled to a certain extent by the passing of the HITECH Act in 2009.

But I believe that the real momentum behind MDI has another, slightly more organic explanation that is rooted in MDI’s payoff. The promises of MDI—improved clinical efficiency and quality—mirror the promises of other large, federally mandated initiatives. The difference with MDI, though, is that it is a much quicker win. The feedback loop with MDI is shorter than, say, the feedback loop with ACOs.

MDI automates the flow of data from devices directly into the hospital’s clinical information system (CIS) or electronic medical record. This automation (as opposed to handwritten transcriptions and keying) immediately improves clinician productivity as well as data accuracy and availably throughout the hospital.

The aforementioned KLAS report also notes this immediacy. When comparing the benefits of MDI to other HIT initiatives, the report states, “In a simple, more immediate way, some healthcare providers are quietly getting a bump in quality and efficiency through medical device integration systems.”

What does “bump” mean in this context? More than 65% of the study’s respondents reported that MDI saves time and provides the ability to make more informed decisions concerning patient care using the data that MDI makes available.

For the hospital trying to figure out which tech-based solutions to purchase, the KLAS report paints MDI as a solid investment with immediate and future payoffs—a synergy that those of us in this emerging industry have always stressed and will continue to. 

Dave Dyell is founder and CEO of iSirona of Panama City, FL.

Walking Through HIMSS
By Carlos Nunez, MD

Walking the aisles of the exhibit hall and participating in HIStalkapalooza at the world’s largest gathering of healthcare IT professionals and the companies that do business with them led to several interesting discoveries. 

All of the usual suspects were well represented in the exhibit hall (Epic, Cerner, GE, etc.), along with the expected collection of smaller IT vendors and specialty niche solutions (did you know that Rubbermaid makes hospital-grade computer carts?) And, of course, you found companies like IBM, Oracle, and Microsoft that also play in this space.

Coming in to the meeting, it was expected that ICD-10 would be a big topic of focus, but with the recently announced delay in the implementation requirement, that story seemed less relevant. There was also the announcement  that the Stage 2 requirements for Meaningful Use were ready to be published in the Federal Register, but likely wouldn’t be available until after HIMSS. The announcement was big news, but it came too late to have any discernible impact on the conference floor. Finally, the trend toward mobile devices and cloud-based solutions is still grabbing a great deal of attention and booth space.

The trend that was most interesting was the rise and growing prominence of companies exhibiting at HIMSS that – at first glance – may seem out of place. For example, I had a meeting with the folks from Lockheed Martin. Yes, the same Lockheed Martin that makes fighter planes and satellites also has a healthcare business and is now partnering with Johns Hopkins on a patient safety and quality initiative. One of the larger booths in the exhibit hall belonged to a collection of IT and benefits management businesses that were recently cobbled together by one of the major insurance companies. I guess it should come as no surprise that as the American healthcare system continues to grab more attention (and more dollars) than any other segment of the economy, businesses new and old would look for their place at the table.

This trend got me thinking about my own place at HIMSS, and more specifically, where CareFusion should be slotted in the spectrum of industry represented there. To the uninitiated, you might think that CareFusion belongs closer to the Rubbermaid end of the spectrum, especially if you only focus on the “things” that CareFusion makes. What do surgical instruments, infection prevention, or infusion pumps have to do with information technology? However, when you realize those “things” are key components in a portfolio of solutions, many of which are tied together by the very technology that defines HIMSS, you begin to see that CareFusion brings a unique perspective and vision to the HIT conversation.

What became vividly apparent this year at HIMSS is that Healthcare IT today, and the concept of Meaningful Use, is much more than an EMR. It is the information ecosystem that supports every patient encounter. It is the millions of clinical data points streaming from a ventilator or an infusion pump, into a server or into the cloud. It is a medication order entered in a CPOE system, tracked and secured through an automated pharmacy system, and the surveillance engine on a constant vigil for inappropriate medication dosing or signs of infection.  It is new technology designed to make devices and HIT systems talk to one another and provide critical patient data to caregivers when and where they need it, seamlessly across hospitals and systems.

Initiatives like Meaningful Use can sometimes make us forget that healthcare IT is more than just software or the systems we build to collect and store data; it’s how those systems enable us to convert data into useful information to help improve workflow, efficiency, and patient safety. As many providers begin to focus on Stage 2 Meaningful Use requirements, broader concepts like interoperability and standardization will emerge as critical objectives in achieving the desired end goal.

Or as ONC chief Farzad Mostashari, MD, asserted in his keynote speech at HIMSS, “We’re on the right track to make meaningful use of Meaningful Use.” What I saw and heard at HIMSS was a promising acknowledgement of our shared responsibility to improve healthcare. It’s a challenge that’s breaking down barriers between providers, suppliers, and companies of all industries and competencies working to make a contribution. I was proud to represent a company bringing so many meaningful solutions to the table.

Carlos Nunez MD is chief medical officer of CareFusion of San Diego, CA.

Curbside Consult with Dr. Jayne 2/27/12

Over the past several years (and especially with Meaningful Use) there has been a fairly significant shift in the attitudes of ambulatory physicians who are making the leap to electronic health records. The hospital-based physicians (and ambulatory physicians who see patients in the hospital) are a different story. They’re a captive audience who has always been subject to hospital control and who has a long-standing history of adapting to things imposed by various Big Brother entities: the Joint Commission, the hospital’s formulary team, insurance and hospital case managers, etc.

Those physicians have done pretty well adapting to electronic documentation, computerized order entry, and the like while in the hospital. Hospitals have also tended to phase their implementations over the scope of years – deploying in a modular fashion with lab, nursing documentation, CPOE, and provider documentation all done as separate initiatives. Ambulatory docs who dislike the hospital’s conversion have been able to escape back to the relative safety of private practice and cling to their paper charts.

As ambulatory physicians transition to EHR, though, they tend to deploy more rapidly – wanting to get rid of all the paper immediately, but also with a strong drive to keep the revenue stream steady. When I started deploying EHRs some time ago, we worked with early adopters who believed in the promise of electronic recordkeeping and were more willing to staff up, reduce patient load, or work longer hours to realize their goals. These physicians are now mature users who are leveraging their EHRs to achieve advanced Patient Centered Medical Home designations, increase fee schedules through demonstrable quality, and improve patient satisfaction.

On the other hand, there are now thousands of physicians who previously found the idea of the EHR distasteful and feel forced to make the transition. Whether by peer pressure, payer requirements, or the threat of government-related penalties, they’re now implementing and with a significantly different strategy than may be prudent.

More often, I hear of physicians that want to implement a system fast, cheap, and easy. The rest of us who have done this for a while know that it’s very difficult (if not impossible) to do all three. Often these late adopters refuse to follow vendor advice, consultant advice, or frankly anyone’s advice. Convincing them to cut schedules or hire staff is a challenge. Ultimately, it’s the patients who suffer.

As the healthcare market consolidates, hospitals and health systems are looking to “align” (one of my least-favorite buzzwords) with community physicians to ensure profitable referral, ancillary, surgical, and inpatient revenue streams. Many are offering subsidies and other incentives to bring these providers onto EHR systems.

Often these practices don’t actually want to align, but are feeling cornered and desperate. Some have previously turned down acquisition offers from the same hospital and see taking a subsidized EHR as a way to be somewhat protected from burdensome federal requirements while maintaining at least some degree of autonomy. Others simply can’t afford an EHR without the subsidy. A last group is providers who’d like to be acquired but for various reasons aren’t suitable candidates, but hope that alignment (and sending a steady volume of referrals which of course cannot be spoken about) will result in being ultimately asked to the dance.

These physicians often deploy on an existing system-wide EHR. Since they’re late to the game, though, they haven’t been stakeholders in any of the decision-making that’s already occurred and often have less buy-in to the idea of group goals than those users who are actually part of the group.

Another angle is that even though subsidized, these physicians are paying customers with different expectations than employed physicians and different ideas about governance. Of course, this would have been true even if these subsidized physicians were early adopters, but the differences are magnified by them being late in the EHR game and feeling pressured to demonstrate Meaningful Use as quickly as possible.

I still go out on implementations and perform physician training on a regular basis. Until recently, most of the physicians I have worked with have treated me as a respected colleague who could assist them through the difficult transition. Some have even looked at me as some kind of EHR shaman, able to smooth their journey to the other side with mystical wisdom. Of course, there have always been a few docs who were borderline (or overtly) hostile, but they were few and far between and usually we could leverage their partners or peers to moderate their behaviors.

Lately I’ve run into more and more angry physicians who are completely resistant to the idea of the EHR transition even though they’ve agreed to go paperless. Some are passive-aggressive, but others are openly abusive. This manifests in a variety of ways – disruptive behavior, inappropriate comments during training (think middle school students with a substitute teacher), or refusing to be trained at all. I find the latter group the most frustrating because then they can’t figure out why the system is so hard to use and scream the loudest about lack of support.

Looking at the data on how many physicians are actually using EHRs in practice (let alone being robust users) we’re just approaching the midpoint. If what I’m seeing in the field is any indication, it’s only going to get tougher as the last-ditch adopters come through with increasingly unrealistic expectations and correspondingly difficult implementations.

I feel bad for the vendors and for the teams who have to support these folks (mine included.) I feel bad for the physicians who don’t want to transition to EHR and the staff members that have to work with them every day. But most of all, I feel bad for the patients who entrust them with their care. Regardless of what they think about the EHR, the IT team, or the government, I hope the angry docs remember that after all, it IS all about the patient.

E-mail Dr. Jayne.

Monday Morning Update 2/27/12

Mr. Greg Wilson’s here to host the show,
Little Johnny Bush knows where the HISsies go,
We’ll have a fashion show and name the King and Queen,
You can wow the judges if you make a scene,
So let’s rock,
Everybody let’s rock,
Everybody here who loves HIStalk,
Start dancin’ to the HIStalk Rock.

Listening: Nick 13, shuffly old-school country swingabilly or something like that (I just made that up.) I’m not a country fan, but this is good, melodic, and sparsely produced. Their song In the Orchard 2011 is perfect. Live video here.

Now that HIMSS is over, it’s time for my annual reader survey. It would help me a great deal if you could spare a handful of minutes to answer the 14 questions. Just about every improvement I’ve made to HIStalk over the years has started off as a reader’s recommendation in the survey. Thanks for helping out.

Over 60% of respondents think that it was a mistake for HHS to delay its ICD-10 implementation date. New poll to your right: grade ONC’s performance with regard to Meaningful Use Stage 2.

Here’s the latest HIS-tory from Vince, covering the 1980s bedside device maker CliniCom.

A surgeon in India conducts a hip replacement procedure using an iPad to calculate and verify the position of the acetabular cup introducer, hoping to achieve a more accurate placement that can increase the useful life of the procedure by 100%.

Swisslog announces the first sale of its MedRover mobile medication dispensing cabinet.

I don’t think I’ve heard of Health IT Now!, a coalition advocating rapid adoption of patient-beneficial healthcare IT that counts among its members Aetna, Intel, Nortel, and quite a few other large corporations and member organizations. The organization issues a press release saying the proposed Meaningful Use Stage 2 doesn’t go far enough, unacceptably allows a delay in its implementation by an extra year, and doesn’t require referrals have to support electronic information exchange for two years.

This week’s Kaiser Permanente employee e-mail from Chairman and CEO George Halvorson was all about technology and mostly about HIMSS. He mentions that KP’s new smart phone app for patients got a million hits in its first month. He also mentions KP’s IT successes as announced at the HIMSS conference: 36 of the 66 EMRAM Stage 7 hospitals are Kaiser’s and KP won the organizational Davies (he says it’s like an HIT Oscar, except “bigger and shinier.”) Apparently KP’s HISsies win as the “Best Provider Use of Healthcare IT” was not sufficiently impressive to deserve a mention.

MedAssets announces Q4 numbers: revenue up 47%, EPS $0.07 vs. –$0.87. Non-GAAP EPS was $0.32 vs. $0.18. Shares were up 4% Friday on the news.

A reader passes along that if you’re interested in the Healthcare Experience Design conference in Boston March 25-27, you can save $100 on registration with promo code FRIEND. Jonathan Bush (athenahealth) and Todd Park (HHS) will be reunited as keynote speakers.

User-centered design consulting firm PointClear announces plans to open an office in the Atlanta area. The Huntsville, AL firm has 40 employees and expects to add at least 10 in Atlanta.

Odd: two prominent Montreal cardiologists are accused of taking bribes from patients in return for putting them at the front of the line for nationally funded healthcare services. A newspaper article claims that patients put $100 bills under their hospital pillows before being taken to the OR and others made off-the-books office payments of up to $10,000 in addition to what insurance would pay.

The Health IT Accelerator is launched in Cleveland, OH by BioEnterprise, founded by Cleveland Clinic, Case Western Reserve, and other local institutions. Company submissions are being accepted.

A guest article in London’s Daily Mail compares the author’s first-hand experience with Britain’s NHS and a stay at Cedars-Sinai. Conclusion: Cedars had a lot of computer gadgets (“computers on trolleys follow the nurses around like small dogs”) but waits were long, nurses were cold (“as if the price tag attached to medicine has desensitized them”) , and the costs were high. Advantage: NHS.

An employee of North Dakota’s worker compensation program says a claims supervisor violated state law when she ordered parts of a case manager’s patient notes deleted, removing information that would have supported the patient’s claim.

A Washington Post article finds that Medicare’s $77 million anti-fraud computer system, launched last summer and built by Northrop Grumman, prevented only one fraudulent payment by Christmas, saving taxpayers a grand total of $7,591. Medicare says looking at payment suspensions in a vacuum is an “unsophisticated view” of its activities and the actual benefits of the system exceed $20 million even though it can’t measure the actual recovery total. Sen. Tom Carper (D-DE) said, “I wondered, did they leave out some zeroes? … My point is there was off-the-shelf stuff they could have bought and applied … we ought to be seeing savings of $5 billion a month.”

E-mail Mr. H.

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Additional Booth Crawl Winners

HIStalk’s sponsors are the best. After I named the Booth Crawl winners, several companies got in touch and said, “We would really like to give an iPad to some of your readers. Can we do a draw of those who didn’t get all the answers right?” Congratulations to these additional iPad winners, courtesy of the sponsors who appreciate your imperfect but honest effort.

John Harte, Server and Development Manager
Self Regional Healthcare
Prize provided by The Advisory Board Company

Jason Blunk, Project Manager
Reid Hospital & Health Care Services
Prize provided by MedPlus, A Quest Diagnostics Company

Justin Graham, CMIO
NorthBay Healthcare
Prize provided by Medicomp Systems

Mark Schmidt, CIO
SISU Medical Systems
Prize provided by Sunquest

Kathy Wheatley, Clinical Solutions Director
HCA Healthcare
Prize provided by T-System

HIMSS Final Notes 2/24/12

From Mr. H

My body is totally confused after a long week, a redeye flight home, lack of exercise because of overpriced Harrah’s facilities, and not having to make yet another trip to the Venetian. And here I am working on a Friday night nonetheless, with the large Monday Morning Update to write Saturday. I hope everybody makes it back OK with all the weather disruptions going on.

Bettina Dold of Acusis captured this moment on the show floor, which she titled,” HIMSS Men at Play.” People were having a blast (no pun intended) at these Merge Healthcare arcade games every time I strolled by.

Here’s the most exciting news of the week – the original OnBase magician was back! I’m telling you in all seriousness that this is the funniest and most talented guy working in Las Vegas this week, and that includes show lounge performers. I can’t really explain how masterful he is not just doing jaw-dropping magic tricks, but working the crowd, adding humor on the fly, and moving his audience into the booth for sales attention when he is finished. I look forward to him every year. Whatever they pay him isn’t enough. I wanted to ask him about his background since he seems to know a lot about OnBase and the industry in general, but you’ll never find a time that he doesn’t have a crowd around. Way to go, magic dude! You were the highlight of the conference as usual.

I don’t know what this means since I never did figure out how to find Booth 12953 in the poorly marked and laid out Hall G, but I suspect that if companies were paying HIMSS for “hidden gem” booth space, this sign isn’t going to pacify them.

Inga, Dr. Jayne, and I have individually listed our “how to work a booth as a rep” ideas. As a public service, I’d like to put this together into a checklist for HIMSS exhibitors: don’t sit on the job, don’t talk to your co-workers, etc. This is a potentially important masterwork to help guide the youngsters trying to make a place for themselves in healthcare IT, so help me out with your ideas. You don’t need to include the “confiscate all smart phones” item since that’s a given.

Thursday Booth Notes

• Lots of folks bailed on Thursday, so it was much quieter. I still say many of the serious prospects don’t come by until then, so it’s a shame that so many of the reps were sprawling, screwing around on their phones, and conducting animated and sometimes profanity-laden conversations among themselves as passers-by tried unsuccessfully to get their attention. In on area, I counted reps on phones and iPads in seven of eight booths, then four of six in the adjacent space.
• Cumberland Consulting Group caught my eye by having their HIStalk sign out, but they had probably the best consultation area that I saw, with nice seating and a net-like drape to separate areas off without making you feel like you’re in a box.
• Practice Fusion had some cool shirts and a great pitch. Kellie told me they have 32 million patients in their system and that quite a few of their physician users have stopped by.
• I decided to challenge Suzanne in the MobileMD booth, asking her innocently tough questions like, “Why did Siemens buy your company?” and “How do you like working for them?” She gave perfect answers.
• Krina at Ingenious Med, you were very good and engaging me and giving me a good, concise explanation of mobile charge capture for rounding physicians when I pretended I didn’t know anything about it.
• Salar had a row of candy jars and was making custom bags of treats for attendees. That was fun.
• Charlie Cook, president of Orchestrate Healthcare, set a great example for the troops as he engaged me in the booth periphery, got me to pause, and then moved quickly to the bullet lists of why I should care. Although I admit that I was looking at the HIStalkapalooza-winning shoes on display over his shoulder, courtesy of winner and company CEO Megan Cook.
• It takes special talent to be a theater barker to get people to move off the pedestrian highway to sit down for a demo or presentation, but the best I heard all week was Becky from VMware. She was fresh and funny, even though this was in the waning exhibit hall hours on Thursday.
• Good idea, PC Connection – putting out a sign that attendees could print their boarding passes at your booth. Well done.
• I was entertained at Network Hardware Resale, which was giving away a remote-controlled helicopter as a prize. They gave it a test drive all the way to the high ceiling, then promptly crashed it from 40 feet up and in all its lit-up glory directly into the head of an attendee.
• T-System gave me a nice overview of what they do. I already knew, so they passed the test.
• I sat in on a presentation by Andres Jimenez, MD of ImplementHIT, who talked about using Nuance’s Dragon with Allscripts. Seems like a nice guy, a surgeon finishing a PhD in education. A quote: “It’s not about Meaningful Use with the government. It’s more about going home to have a meaningful dinner with my wife.”
• I spent much of Thursday downstairs in Hall G because I felt bad for the vendors HIMSS put down there. On the other hand, several I talked to said they had been quite busy, so hopefully attendees found their way down.
• Carstens was playing classical music in their booth. I think Dr. Jayne or Inga mentioned this, but it really was effective.
• My favorite booth person of the whole conference was Colleen at the 1Call booth in the Mobile Health exhibit. They do secure messaging for mobile devices. I felt bad for her since she was sitting in the equivalent of a hidden telephone booth, but she was just as sweet and fun as she could be, plus she explained their product effectively. If I’d had a trophy in my pocket, she would have gone home with it.
• iSirona was hopping in Hall G. They gave me a short overview of their medical device connectivity product. They also gave me a tee shirt.
• Megan at Intelligent InSites gave me a really nice overview of their RTLS solution when I pretended to not even know what that means, telling her I stopped by only to “see what the colorful diagram on the monitor is.” OK, I’m good at playing stupid, which maybe isn’t something to brag on. She moved me right into benefits and competitive advantage without breaking the flow and without blowing me off since I clearly wasn’t a prospect.
• I cold-called Holon Solutions, asking “what do you do.” They told me pretty well.
• The Apixio guy was fun in a SoCal way, drawing me in to see their EMR search solution. They also gave a free trial, which I need to try since it’s sitting in my e-mail inbox. I asked an obvious questions he couldn’t answer, though: he only demonstrated searching by patient name, which is not only impractical but dangerous, and hadn’t heard of the idea of searching by medical record number. He was still cool.
• Inga misspoke on the Blue Hair Girls. I kept wondering why I didn’t see them in the SIS booth as she wrote, the reason being that it was The SSI Group.
• I tried several times to figure out what RL Solutions does since they had a very cool, Apple-like booth on the far end of the hall, but every time I trolled, their reps were deep in conversation only with each other and refused to react to eye contact. They’ve missed their window of opportunity since I now don’t even care.
• Ruckus Wireless had a really creepy stuffed dog in the booth.
• Barco had the best beer I’ve ever seen on the show floor. Joe the bartender was professionally handing over fresh-from-the-ice bottles of great European beer like Hoegarden, Stella, and Leffe. It was superb.
• My new best bud rep is Joel from Fixmo, a Toronto mobile device security company. I was drinking my Hoegarden from Barco and we started talking beer talk, to the point that I went down and got him a Hoegarden of his own so we could emulate a bar setting as we elbow-leaned and swigged. He gave me some brands to try: Rickard, Brador, and Steam Whistle. I saw him interacting with passers-by and he is very engaging and friendly. I just didn’t feel that invisible shield between us that keeps you from really engaging with a rep.
• I was hanging out with the Medicomp folks as the exhibits closed at 6:00 Thursday evening. I’ve never stayed past closing time, so it was interesting to watch armies of workers and equipment immediately tearing down all that glitzy magic you enjoyed (or tolerated) all week. They were pulling up carpet almost before the last people exited, and by the time I left at around 6:45, the hall had mostly bare concrete floors, all the booth lighting was powered down, and exhibit people were tearing down the village they had built earlier in the week. By the time you read this, there’s probably another conference in that same space that looks like it’s been there forever.
• Here’s another recognition. I wandered in a cul de sac deep in the bowels of Hall G (or is that Hell G?) Eight small booths facing each other, with seven of them featuring reps sprawling and Facebooking. One booth stood out with a sentry-like presence in Lanette Fugit, who was fronting the Mobile Iron booth.  She was like a guard at the Tomb of the Unknown Soldier: ramrod straight, eyes unwavering, ignoring the people around her who were mostly just screwing around. She engaged me, went smoothly into a short and obviously well-rehearsed but not overly glib informational pitch, and then steered me to the two technical guys working with her as the handoff for geek talk. I verified that she’s a contract person. Her pic is below, but despite her obvious attractiveness, I wasn’t even thinking that – I was thinking she’s the one person who cares enough to be professional when she could have gotten away with less since she’s not even an employee.

Some Booth Crawl Winners

Here’s Franklin Crownover, pharmacy informatics coordinator at Tufts Medical Center and Booth Crawl contestant, accepting his iPad from Chris from Shareable Ink. Some of the contestants obviously check e-mail regularly and like iPads immensely since they showed up almost immediately to pick it up after I e-mailed them that they’d won, which I like since it indicates that they were excited about it. Facebook post here. Thanks to all those who played for visiting the booths of the sponsoring companies. Winner Dan Williams e-mailed me to say, “It is a great way to see everything and especially to meet the HIStalk sponsors.”

Another iPad winner – Jonathan Rubin MD of Froedtert Hospital-Medical College of Wisconsin. His prize came from Surgical Information Systems, which commemorated it on their Facebook. I note his enthusiasm as evidenced by the blurred thumbs-up gesture, caught mid-stream as he welcomes his new electronic family member.

Another Booth Crawl winner – Anuj Desai, director of business development for New York eHealth Collaborative. Why was the photo taken in front of the HIMSS bookstore, you might ask? Because the presenter is Guy Scalzi of Aspen Advisors (on the right), who co-authored the book IT Governance in Hospitals and Health Systems, published by HIMSS this month. You may remember Guy from his former lives as an FCG senior vice president and CIO at New York-Presbyterian.

Rick Beberman of Fulcrum Methods seems to be just as pleased to be holding our HIStalk sign as he does to be presenting a brand new iPad for the enjoyment of Jim Hetherington, HIE applications manager at Catholic Health Initiatives. I swear even the boxes Apple uses are sexy. Jim also e-mailed me a photo he took in one of the education sessions, in which a young lady was wearing a coat that was almost identical to the one work by Evan Frankel at HIStalkapalooza. I’m not running it since she might not appreciate the comparison although it’s definitely there.

Cynthia Hartmann, come on down! To Vitera Healthcare Solutions, that is, which presented Cynthia (of University of Mississippi Medical Center) with her shiny new iPad.

Apple loves AirStrip Technologies and is always putting their cool remote monitoring solutions into their commercials and on-stage announcements, so it’s only fitting that Donna Morrow, chief of client operations officer for the company, presents Anthony Schuster MD with an iPad. Tony is CMIO with the outstanding H. Lee Moffitt Cancer Center in Tampa, FL. I note with pride that his LinkedIn profile indicates that he’s a member the HIStalk Fan Club, which I swear had nothing to do with his victory.

Here’s a brilliant idea. We still have a few iPads to give away since we didn’t have enough successful Booth Crawl contestants (more info to follow on the additional winners) but ICA drew their winner from entrants in the food bank donation project. Congratulations to Lisa Lyon, clinical informatics coordinator at Cherokee Nation of Pryor, OK. They were the first tribe to earn an EHR incentive payment from the state’s Medicaid program. That’s Lisa on the right in the group shot above as they accepted the incentive payment last July. Thanks for the work you do and enjoy your iPad, courtesy of Informatics Corporation of America.

Gabe Davis, Booth Crawl winner from Texas Health Resources, e-mailed me to say that he had a ton of fun, and that “I can honestly say that I made several connections with vendors that I wouldn’t have normally spent time with. It was a great idea.” Gabe’s iPad came from API Healthcare.

From Inga

If you missed HIStalkapalooza, check out the video above from ESD. Now that I think about it, I stayed in my one little spot most of the evening and didn’t get to see all the other fun stuff going on. It makes me so happy to see so many people having a fun time! The fashions — from the shoes to the gowns to the tuxedoes — were fantastic! A year from now when Mr. H and I are pulling our hair out with our pre-HIMSS activities, I will pull up this video and remember it was all worth it. Many thanks again to ESD, our emcees, our HIStalk Elvis, and our judges for making it a magical evening.

Many kind folks have forwarded notes expressing their thanks and appreciation for both HIStalkapalooza and our sponsor luncheon. Here is a sampling:

Our team had a lovely time at the HIStalk luncheon. Thanks for recognizing your sponsors and the contributions you make to the industry.

Just wanted to thank you for the invite to last night’s event. I had a great time and got to catch up with a lot of folks I hadn’t seen in a while.

Thanks for the IngaTini(s) and the fantastic hospitality tonight.

Best party at HIMSS year after year.

Another awesome HIStalkapalooza! Jonathan Bush was as simultaneously irreverent and insightful as always. Whoa, those HISsies!

I posted a number of photos from the party on the HIStalk Facebook page, including many of the shoe fashions. I am happy to report my shoes were deemed attractive enough to capture the eye of our shoe judges.

I am hoping someone filmed the HISsies as well because Jonathan Bush was on his A game yet again. He’s funny, smart, doesn’t hold back, and is pure entertainment. And he drinks very large beers.

HIMSS says that as of Friday morning, attendance hit 37,032 attendees, surpassing HIMSS11’s 31,500 attendance figure. A total of 1,123 companies exhibited.

There is nothing hotter than a guy in a pink tuxedo with lights. That’s Trey Lauderdale of Voalte, the company known for their pink apparel.

I didn’t get too many trinkets this year: a couple of t-shirts (including an XXL one from Medicomp – whoops); a couple of hats (I really like the Trustwave one); chocolate; and a few pens. Though not swag, the Intelligent InSites people made sure I received the above poster. I love it! Intelligent Insites offers an RTLS solution that requires less walking for nurses to find equipment and therefore allowing them to switch to the hot shoes like the ones pictured. I just like gazing at the shoes.

Speaking of shoes, despite mostly wearing flats all day, my poor little feet are swollen and have blisters. I am thinking it will be a barefoot weekend.

My brain as well as my feet are exhausted, so that’s it for now. All in all, it was a great week and a great conference.

From Dr. Jayne

I thoroughly enjoyed watching Inga play Quipstar yesterday afternoon, although I must say I was quite jealous of the hardcore security detail that was outside her dressing room (complete with ear pieces!) and the paparazzi that were on hand to capture her entrance. Medicomp did it up right and even had a shoe-cam to focus on her seriously spiky stilettos.

There seemed to be a bit more buzz in the hall – brighter faces and a shift in the general tone from Tuesday’s eerie quiet. Maybe people are doing well in the casino and it’s making them more chipper. I noted huge crowds at the Nuance booth as well as at ICA,  where I dropped my entry to win cash for my local food bank. Lots of friendly folks there who just wanted to chat.

I connected with a couple of specific people to get answers to some technical questions about products that I had posed earlier in the week. It was nice to have follow-up and know that people understand this is a time for many of us to accomplish a lot of data gathering in a short period of time.

But alas, all good HIMSS must come to an end and for me today (Thursday) was the last day. I had to sprint home to prepare for a Big Meeting tomorrow with some physicians who take a dim view of being rescheduled for what they perceive to be merely another trade show. I found a forlorn little post card in my mailbox, urging me to visit the ANX booth to pick up my special “hangover kit” and experience a special photo op inspired by “Hangover.” I hope they’re inspired to follow up with their marketing team to find out why their mailing wasn’t postmarked until February 16, which made delivery prior to HIMSS nearly impossible.

I was happy that my suitcase only gained a pound and a half during this Vegas trip – probably because I took a lot of smart phone photos of interesting materials to reference, rather than picking them up. The airport was full of HIMSS survivors and I spotted several FormFast fedoras as well. I’m looking forward to New Orleans next year (better have some beignets in the booths, people!) but right now I have to cozy up with the Stage 2 proposed rule in all of its 455 pages of black and white glory.

From HIMSS 2/23/12 – Inga’s Update

It’s Thursday afternoon. I left the exhibit floor a bit early to get my bag and write a few updates before getting on my plane for home. A reader suggested my posts have not been very insightful the last couple of days (sorry) and another suggested they have been too short (sorry.) I’ve been going non-stop, taking plenty of notes, so I will attempt to reclaim my insightfulness over the next couple of days as I share details of my HIMSS experience.

I’d say the most-discussed topic this year was the announcement of the proposed Stage 2 MU rules, followed by the ICD-10 delay. Since the rules were not published until Thursday morning, few people had a handle on what was included. Dr. Mostashari’s overview Wednesday morning didn’t include many details, though apparently some of Thursday’s sessions went deeper. So the first part of the week was all about speculation of what was going to be included, followed by a few “what did you understand was included” type conversations. Of course, many folks also grumbled about the rules not being announced a few weeks ago.

On the ICD-10 front, many were speculating that ICD-10 would be delayed indefinitely and that we’d stick with ICD-9 until transitioning to ICD-11. I pity the vendors who had invested years of development work to facilitate the ICD-9 to 10 transition.

Typically at HIMSS we also hear official or unofficial news of acquisitions or mergers. If there were any such deals this year, they flew under my radar. You did see new booths and refreshed marketing spin from several of the entities that have recently changed their name or rebranded, including Optum, Vitera, and M*Modal.

Speaking of spin, I visited one of the relatively new ambulatory cloud-based EMR vendor whose small space was in the downstairs exhibit hall (or the “dungeon” as one of the downstairs vendors termed it.) I can’t say I saw enough of EMR to form an opinion, but I did smile when the young sales guy explained how the product was developed to adapt to the physician’s workflow. I recall using very similar words when I sold EMR software 10 years ago. Seems to me that if you are marketing a product running on the latest greatest technology and with a sexy interface that you should figure out a fresher pitch.

Rather than sticking with my traditionally more comfortable ambulatory-focused world, I sat through a few demonstration of inpatient products, including Cerner Millennium. The demo featured a high-level look at a new (or coming soon?) version that includes a new chart note entry screen. The most curious part of the demo was the sales guy’s comment that the chart note entry is now laid out more like Epic’s.

Several companies were promoting new products that feature natural language processing. I got a peek at QuadraMed’s computer-assisted coding module, which uses M*Modal’s NLP technology. Cool stuff.

Practice Fusion always seemed to have decent traffic and I spent a few minutes asking questions.  The company says it has 150,000 clinical users, of which 40% are physicians, and since rolling out their MU version in September, over 300 EPs have attested. They continue to tweak their ad module, which includes advanced technology to narrowly target the interests of individual physicians and their individual patients and diagnoses.

The Meditech booth was hopping each time I walked by, even though they were not in one of the major thoroughfares.

Allscripts’ booth was the size of a city block, and a busy city block at that. One of the Allscripts execs told me he walked through the downstairs exhibit hall and it brought back memories of not too many years ago when Allscripts had a similar small budget and presence.

A reader e-mailed me this comment: “I am concerned about the industry’s commitment to cleanliness because I can tell you that 70% of the male attendees don’t wash their hands in the restrooms.” I will have to take the reader’s word on that one.

I enjoyed Dr. Mostashari’s Thursday morning keynote. I will start by saying he is a dapper dresser and was wearing a dark pin striped suit, white shirt, and his signature bow tie (yellow.) He also strikes me as a regular, down-to-earth, and smart guy who believes in his organization’s mission. In his talk he highlighted the last few years of EMR adoption, the ONC’s and CMS’s role, and discussed what needs to happen next. One person I asked called Mostashari’s keynote “brilliant.” Another said the whole message could have be summarized with a simple, “Go, team, go!”  I think the content, balanced with the engaging delivery and bow tie, was not necessarily “brilliant” but solid nonetheless.

I had a chance to walk the floor with a physician and later with a CIO. I have to admit I often felt ignored by vendors when I was with them. I realize that the CIO and the doctor are the real prospects but I was a little offended when a couple of vendors barely glanced in my direction. It’s hard to be a diva.

A few booth observations:

NextGen always comes up with entertaining talent to attract a crowd and this year was no exception. NextGen had  a “spelling bee” that included some odd-ball contestants, including a goofy-looking John McEnroe. It may not have been as captivating as last year’s artists, but still fun.

Medecision had a neat ice sculpture and was offering an assortment of unique drinks, from iced coffee in the morning to cocktails in the afternoon.

athenahealth updated its booth a bit and added bamboo and grass here and there. The changes were subtle, but I liked it.

eClinicalWorks never has a huge booth, but always seems to attract a decent crowd.

At 12:30, the line for gelato at Harris’s booth was so long that I am guessing I wasn’t the only one who found it difficult to grab a quick lunch.

Was it me or was there many shades of orange? Optum, Vitera, and Elsevier, to name a few.

dbMotion’s four demo stations and center conference table were full every time I walked by.

Thank you Perceptive for the tee shirt, which appears to be a women’s cut instead of the boring unisex style.

I think my favorite booth was CareTech’s. It was not one of the huge booths and what made it unique was its use of black and white photographs to communicate its vision. So many of the booths are heavy on the bright colors and huge signs, but CareTech’s was simple and not overstated. Well done.

Dell’s booth, on the other hand, was accented in fun colors (pink, yellow, blue, green.) Tastefully done and attractive.

T-System’s booth was decked out to resemble an ER, complete with the “H” hospital sign, wheelchairs, and blood pressure cuffs. Very clever.

Optum’s new booth (orange) was very open and included a theater and conference rooms. I prefer the booths that don’t require you to pass through a front reception area and encourage attendees to walk in and check things out.

3M had a dome-like tent for their demo theater. Different and cool.

MesAssurant had a good-size booth with couches and hardly any booth staff. They had monitors that look like they might have been running PowerPoints, but the PowerPoints weren’t running. I couldn’t figure out if the lack of staff was intentional and they just wanted to offer attendees comfy couches a feel-good space with subtle marketing messages.

McKesson’s booth was of course big, but not as imposing as it has been in some previous years.

I didn’t see any creepy mimes, body contortionists, gorilla costumes, or black body suits. Maybe I missed them or maybe vendors have retired those gimmicks.

I still have not provided many comments about HIStalkapalooza, which was fantastic from the fashion, to the drinks, to the wonderfully accommodating hosts. Look for that in the next day or two. I didn’t get too much in the way of swag this year, but I have photos of a few of the best goodies.

Happy travels if you are heading home today. If you have already made it home, happy wading through your e-mail inbox. And if you were not able to be in Vegas this year, I hope that between Mr. H, Dr. Jayne, Dr. Travis, and me we have shared enough to make you feel that not everything that happens in Vegas stays there.

Booth Crawl Winners

We were overly ambitious on the Booth Crawl requirements given the exhibit hall logistics and the short timeliness. That challenge made it hard for our players to complete the contest successfully. Still, we know it was possible because 12 contestants who are employed by provider organizations got all the answers right by Wednesday evening.

Thanks to everyone who played, including those who visited the booths of the sponsors but were unable to finish in time.

We’ll have more later, including the correct answers to the questions and perhaps some photos of the winners.

Stop by the following booths today to pick your iPad.

Susan Heichert, SVP
Allina Hospitals and Clinics
MED3OOO – pick up at Medicomp, Booth # 855.

Anthony Schuster MD, CMIO
Moffitt Cancer Center
AirStrip, Booth # 870

Cynthia Hartmann, Director, IT Solutions Consultants
University of Mississippi Medical Center
Vitera Healthcare Solutions, Booth # 445

Jim Hetherington, HIE Applications Manager
Catholic Health Initiatives
Fulcrum Methods, Booth # 13247, Kiosk 6

Jonathan Rubin MD
Froedtert Hospital-Medical College of WI
Surgical Information Systems, Booth # 1339

Gabein Lee Davis, Clinical Analyst
Texas Health Partners
API Healthcare, Booth # 2617

Rita Cartwright, Sr. Business Systems Analyst
Tucson Medical Center
Access, Booth # 860

John-Paul Jones MD, CMIO
CentraHealth
MedVentive, Booth # 64661 (ACO Knowledge Center)

Anuj Desai, Director of Business Development
New York eHealth Collaborative
Aspen Advisors (they will contact you for delivery)

Dan Williams, CIS Administrator
Saint Francis Medical Center
dbMotion, Booth # 4219

Franklin Crownover, Pharmacy Informatics Coordinator
Tufts Medical Center
Shareable Ink, Booth # 7100

Aaron Spratt, Director of ARRA implementation
Saint Francis Medical Center
Awarepoint, Booth # 3412

From HIMSS 2/22/12

From Mr. H

Update: I’ve posted Inga’s recap here.

You could feel the energy suck out of the convention center as the ONC Meaningful Use Stage 2 Road Show took over the conference rooms and discussion subjects. I felt bad for anyone – vendor or provider – who came to the conference for other reasons since those were unceremoniously shoved out of the way. ONC said they tried to get the Stage 2 stuff out last week but got held up. I would have suggested waiting another week instead of cramming it into the HIMSS agenda without having anything tangible to put out, like detailed PowerPoints or the draft wording. They didn’t even have room assignments since they usurped the schedule at the last minute, so those had to be read out in the first presentation on Wednesday. It’s almost like when a vendor pre-announces a product that isn’t finished just to keep a competitor from getting attention in the mean time, except what could have been getting attention was more immediate concerns than draft legislation that won’t really kick in for a couple of years.

But I will say that the entire ONC crew came across as personable and occasionally amusing, even if Farzad didn’t attend HIStalkapalooza like he’d said he might (I’d guess he was too busy wrapping up the legislation.) Overall, I feel good about the whole process, other than the timing and the fact that I don’t like my tax money being used to buy equipment for private businesses. It sounds like Stage 2 gets closer to benefiting patients than just setting the theoretical stage as Stage 1 does.

I went to a few educational sessions today. All were unremarkable, which is pretty much par for the HIMSS course. What I blame: having to submit abstracts almost a year in advance, sessions that are really too long to stay interesting in many cases, and button-down presenters who do presentations as they learned by observation, i.e. badly (reading from PowerPoint bullet lists, over-preparing, and not making any attempt to engage attendees.) I saw some of my pet peeve behavior – attendees who grab the post-presentation microphone under the guise of asking a question, but then pontificate endlessly with obvious pride in their own wonderfulness. I honestly wish presenters wouldn’t even allow questions at the end, other than to provide me a cue to sprint for the door.

Heard from a moderator in a session today: “Please turn off your Palm Pilots.” I need clarification of whether he was being ironic or was ill-advisedly displaying a profound lack of contemporary technology knowledge.

Stand by on the Booth Crawl winners. I have the list, but I need to clarify a couple of things before we can post it.

I know I keep saying it, but ESD did a super job with HIStalkapalooza. I wanted to hug every of those green-dressed ladies for giving up their evening to keep things running smoothly, but since I couldn’t, I compromised by giving Brittanie a couple. She almost made me mist over a little because the whole event obviously meant so much to her and to ESD. Do me a favor – drop by their booth (#4616) and say thanks. You have an ulterior motive as well – they had a full professional video crew filming everything and the polished final version is running in the booth. If you were there, you may well see yourself on the video since they got a lot of crowd shots. If you weren’t there, you’ll get to see some of the stage antics. At least I feel justified on having Mrs. HIStalk assemble all those beauty queen sashes due to my lack of time since everybody had fun flaunting theirs.

Check out these fun badge ribbons from Liaison Healthcare. Ambitious attendees may strut around with their CIO or presenter badges, but I’m happier with my Meaningfully Useless one.

One of our sponsor lunch attendees wanted to commend Duke University Hospital CIO Art Glasgow for speaking there. “He was excellent. Gave a great perspective on how valuable the site is for a CIO.” Art was the classy part of the agenda. Inga, Dr. Jayne, and I just stammered around looking silly in our costumes, so it went downhill fast once Art finished up. We’re delighted that he (and our sponsors) attended. It’s kind of overwhelming for anonymous, amateurish bloggers to see a roomful of industry experts like that since we’re used to working in empty rooms with computers. We’re somewhere between smarter than we sound in person and dumber than we sound in writing.

A reader reminded me about the Pub Nights that Encore Health Resources always puts on at HIMSS (he didn’t exactly remind me since I didn’t know about it, but it’s an Ivo thing that’s fun.) “Rather than do a party one night at HIMSS, Encore Health Resources does Pub Nights every night. I’ve been Sun and Mon and each night had several hundred people there. Seems to be the place where CIOs like to congregate after hours.  Free beer and wine and funky psychedelic mugs. Lagasse Stadium – Lower Level of the Venetian. I don’t think you need an invite. I ran into Ivo and took this pic. He said it was the only title he ever deserved.”
 
Seriously, vendors – make your reps turn in their smart phones when they show up for work on the exhibit hall floor. You might as well give them a Gameboy for all the time they spend screwing around with them instead of actually trying to provide a professional impression to folks you’ve paid dearly to impress. I realize that everyone under 30 can’t survive more than two minutes without checking to make sure something earth-shattering hasn’t been posted on Facebook or that they haven’t been Twittered about, but it’s just embarrassing to see this on such a wide scale. They have living, breathing prospects right in front of them – nothing on that phone is more potentially valuable to your company enough to warrant carrying it around and I guarantee they won’t be able to keep their hands off it.

I think the strong fashion interest of Inga and Dr. Jayne is rubbing off on me. I saw an impeccably dressed guy in the exhibit hall and thought Inga and Dr. J would enjoy his photo if I could snap one surreptitiously. I couldn’t, but I ran across him later in his booth and explained why I wanted his pic. It’s Mike Mosquito, president and CEO of HealthNovation, an Atlanta-based company he founded that offers technical compliance tools and services for meeting HIPAA and NIST requirements. I wish you could see the razor-sharp creases in the pocket handkerchief that matches his tie and cufflinks, not to mention his really cool-looking Italian shoes (Delli Aldo, which are super inexpensive, so extra points for thriftiness).  On top of being an extremely sharp dresser, Mike was maybe the friendliest, most fun person I’ve met at the conference – he reads HIStalk and said we’d mentioned him before when he wore some outlandish golf attire (was that redundant?) to a tournament on a dare. It would be fun to surprise Mike with a bunch of visitors at the booth on Thursday, so if you’re inclined to participate in a timed-release flash mob, drop over to Booth #3869 and say hello to our new BFF. Hopefully he won’t disappoint by deciding to slack off with shorts and a tee shirt.

A reader asked for a picture of the $1.99 foot long hot dog I mentioned in my first conference post (kind of an odd thing to want details about, but I’m not judging.) It’s from Casino Royale, a low rent but fun casino between Harrah’s and the Venetian. I bought one this evening just to get a shot for the reader. I hadn’t eaten since breakfast and I had just finished an icy Blue Moon draft beer courtesy of the Forcare booth folks, so I couldn’t resist downing this particular snouts-and-tails tube steak even though I wasn’t planning to. It was OK given appropriate expectations and pre-lubrication with the same place’s $1 Michelobs, so that’s a $3 lunch or dinner that would appall doctors of all specialties. They have ketchup, but nobody over age 10 should be putting that on a hot dog no matter how many $1 beers they’ve downed (as I constantly remind Mrs. HIStalk when she does it.) Sriracha would have been good, though.

Inga was a celebrity player in Medicomp’s Quipstar game show held on the exhibit hall floor. She joked that to protect her anonymity and to stroke her needy ego, she would need bodyguards, a limo, and Van Halen-style M&Ms of a single color (green.) They played along, so here she is egressing her limo as heat-packing muscle protect her from the adoring throngs (other than the paparazzo who got this shot.) She didn’t win, but her charity of choice did, courtesy of a $5,000 donation from Medicomp. The funny thing is that in Las Vegas, public behavior apparently would have to be a lot more bizarre than this to warrant anyone’s attention.

Here’s a pic of Orchestrate Health CEO Megan Cook, showing off her awards (Best in KLAS, Inga Loves My Shoes) and as the company says, “showing off our love for HIStalk.” Cool!

Lady Pharmacist sent this picture of a jewel-encrusted skull at the entrance to the Palazzo. Very tasteful.

A reader didn’t like my comment that Hall G (downstairs) has some small and weird booths, thinking I was criticizing the companies there. I wasn’t – I’m criticizing HIMSS for selling space that is just not getting traffic equal to the upstairs booths (I asked the people downstairs, who had plenty of time to chat since I was one of few people strolling around there). The oddball booths I mentioned aren’t vendor booths – they have colleges down there, government agencies, member organizations, and a bunch of other stuff that is hard to figure out (not to mention vast cafeteria and Bistro HIMSS spaces.) It’s not the fault of the vendors there, and I’d certainly make the trip down this week since there are definitely vendors worth checking out (which I did today.) I think they would be glad to see you if you drop by. It’s hard to find from inside the other halls, but if you go outside the halls and then down a level in just the right place, you can get there. It’s not quite as hard as trying to figure out how to escape the main exhibit halls, which make it really hard (maybe intentionally) to find the doors out to daylight.

Random Booth Observations

• eClinical Works had our sign out. Thanks!
• The Sunquest booth had a cool spiral staircase going upstairs, and like they do every year, they had the coolest tote bags on the show floor. These are seriously cool beach bags, way above the quality of anything else I saw.
• Encore Health Resources had a fake fireplace in their booth and were looping slides with consultant bios.
• API Healthcare had our sign out and I had a nice chat with a couple of the reps there. They were on point, engaging me easily within seconds.
• Digital Prospectors had our sign out. These were some fun guys.
• A new exhibitor called Innovatient had an interesting electronic whiteboard for patient rooms that fed into a nursing station monitoring app, complete with video feeds.
• Nuance had our sign out. They announced the winner of the 2012 Mobile Clinician Voice Challenge as the iPad-based SparrowEDIS (video here.) I was one of the judges and will have more later, including an interview with the winner. The announcement also describes the other apps that were in the final group. It was a fun contest.
• Nuance e-mailed to say that it is awarding HIMSS attendees who upload Instagram photos with the hashtag #HIT12 with a $125 prize. Check it out here. I’m not sure they listed all the rules since surely not everybody gets $125, but someone will clarify I’m sure.
• FormFast was giving away cool Frank Sinatra-style fedoras. I wondered where people were getting those. Like a man’s shirt, they look strangely alluring on women.
• I had a very nice chat with the people at Companion Data Services.
• I got a demo of SOTI, a mobile device management system (monitoring, security, policy enforcement, remote control, etc.) They’re offering a 30-day free trial. Hospitals will probably need something like this if they’re going to pursue a “bring your own device” mobile policy.
• Harris had a full gelato bar in their booth. The mango flavor was excellent.
• Intelligent InSites had a booth downstairs in Hall G. They had our sign out. Thanks!
• Kony is downstairs too, running workshops on how to develop mobile device apps using their IDE. I chatted with one of their partners and she said Kony basically owns the apps development market.
• Etransmedia is in Hall G too, and with our sign out besides (thanks!) They’re partnering with Costco to sell MyWay for $499 per month, but they also do HIE stuff. I asked the guy if they were getting a lot of traffic and he said it was pretty good, but he was surprised that so many potential investors are showing up cold to see what the company’s doing. That’s an interesting observation – I guess quite a few investment types cruise the booths looking for potential investments. Another good reason to exhibit, I guess.
• The HealthUnity people had some really cool green scarves on the ladies and diamond pattern sweaters on the men.
• Allscripts had a good idea for their demo stations – a folding tent sign that said “Private demo in progress” to prevent pushy passers-by from hijacking a demo.
• John at CTG’s booth gave me a good overview of their consulting services.
• athenahealth’s theater presentation schedule had the ICD-10 sessions marked out with an explanation: “Postponed due to widespread industry failure.”

From Dr. Jayne

With all of yesterday’s activities, I didn’t get to give as full a report on the exhibit hall as I would have liked. This year’s HIMSS exhibitors are quite subdued compared to last year. I saw far fewer quirky costumes (although there were a few, which I will detail) and a general lack of buzz. Maybe it’s because ONC’s release of Meaningful Use Stage 2 somewhat upstaged everything, maybe it’s a downturn in budgets, who knows. No contortionists or booth reps throwing moon pies this year. Many booth reps were generally apathetic – I was actually ignored at a couple of booths while reps played on their iPhones.

I toured the hall yesterday with HIStalk gadabout Evan Frankel. Full credit is given to Net Optics, who lured us from our wandering with the promise of a 90-second presentation in comfortable seats. Although it went much longer than that, I enjoyed the presenter’s hand motions and breathy sarcasm every time he said the name of the product, Phantom.

Our next stop was Precyse, where Evan posed with what I assume was supposed to be an “I Love Lucy” model handing out chocolate. I’m still not sure how it tied into the theme of the booth, but at least they were reaching out to connect with the crowd.

We stopped by Apixio to look at their population management tool and there were some funny quirks to their demo, which I enjoyed. The simulated scanned patient documents included off-kilter scans with occasional speckles, hospital documents with mis-transcribed words, and even a coffee cup ring.

Quest Diagnostics had a cowboy doing lasso tricks at their Care360 booth, but he was wrapping up as we came by. We were intrigued by a man speeding by in what looked like a Wilderness Scouts outfit and wanted to trail him to his booth, but it turned out he was just hustling to the men’s room.

I liked HipLink’s cool pit crew shirts. The company does integrated paging and mass notification – in another word, outreach. You’ll notice they differentiate themselves from other booth staff because they are actually doing outreach – facing the aisle, looking to engage, and NOT staring at their phones.

As a sequel to last year’s Indiana Jones hats, this year FormFast was giving out kicky fedoras, a la the Rat Pack. Starting to wear down a bit, we had to stop by the Harris booth’s Gelato Bar and I was impressed by my new sidekick’s ability to predict what I’d order.

PACSmate had this cute cart that would look adorable in a pediatrics office.

Mr. H mentioned that he ran into me toting a blue martini, courtesy of MEDecision. I was surprised to see them serving martinis at 1 pm and although grateful for a little refreshment, quickly discovered that their secret recipe seemed to only include two ingredients: Everclear and Powerade.

After the ONC update this morning (which I must admit made me feel largely queasy) it was back to the exhibits again. Vendors seemed a bit more eager to engage, but I was kind of creeped out by one who responded to my “thanks, but not now” rejection of his pitch with an offer of free hugs. Not exactly professional, dude.

The staff at Inspire WiFi were engaging and friendly two days in a row and today were downright helpful. They’re located in Booth 5061 (look for their “pain in the gluteus” graphic) which happens to be right next to an exhibit hall map. When I stopped to locate a booth, the staffer asked if he could help me. It’s good to run across genuinely nice guys. They offer exclusive patient/guest networks for hospitals (as well as hotels and apartments) with no upfront capital expenditure, which is appealing.

Giveaway of the day: Document Storage Systems had pink flamingo pens that were eye-catching. They also support one of my favorite endeavors, Honor Flight, so stop by and check them out.

The razz of the day goes to LexisNexis, whose booth was entirely empty when I came by. I was going to ask them about their white paper on the role of organized crime in healthcare, which does bring up some interesting points.

DrFirst had their superhero manning the booth, the DrFirst Defender. He really should have worn those boots to HIStalkapalooza!

Speaking of coulda-shoulda-woulda, this gentleman needs to make sure to request an invitation to HIStalkapalooza next year.

HISsies 2012 Winners

Note: anyone could nominate candidates for all categories. The most-often nominated were placed on the ballot, with voting limited to the HIStalk e-mail subscriber list with one vote per reader. Agree or disagree, voting reflects the opinions of around 1,000 HIStalk reader-voters.

Smartest Vendor Action Taken
Google shuts down Google Health

Stupidest Vendor Action Taken
GE and Microsoft move their healthcare products to a new joint venture

Best Healthcare IT Vendor or Consulting Firm
Epic

Worst Healthcare IT Vendor or Consulting Firm
GE

Best Leader of a Healthcare IT Vendor or Consulting Firm
Judy Faulkner, Epic

Best Provider User of Healthcare IT
Kaiser Permanente

Most Promising Technology Development
Mobile health

Most Overrated Technology
Social media

Most Overused Buzzword
Cloud

When ______ Talks, People Listen
Farzad Mostashari, ONC

Most Effective Healthcare IT Provider Executive
Ed Marx, Texas Health Resources

Most Effective Medical / Clinical Informatics Professional
Paul Tang, Palo Alto Medical Foundation

Industry Figure With Whom You’d Most Like to Have a Few Beers
Jonathan Bush, athenahealth

Industry Figure In Whose Face You’d Most Like to Throw a Pie
John Hammergren, McKesson

HIStalk Healthcare IT Lifetime Achievement Award
Judy Faulkner, Epic

HIStalk Healthcare IT Industry Figure of the Year
Judy Faulkner, Epic

From HIMSS 2/22/12 Inga’s Update

From Inga

I participated in Medicomp’s Quipstar. I lost, but I am blaming my sunglasses because I couldn’t see the keyboard to find the answers. However, Medicomp did donate $5,000 to my favorite charity, so I accept the humiliation of my loss. Plus, the green M&Ms and IngaTinis in the Green Room (see above) were pretty awesome.

The SIS girls – definitely the cutest and most fun girls I met. Me: why do you have blue hair? SIS girl: why don’t you have blue hair?

That’s my feet getting a foot massage at the DrFirst’s booth. Serious heaven.

I noticed many black patented leather flats. Not too many flip flops, but if they work for you…

Standing room only in the Stage 2 Meaningful Use overflow meeting room. Cute boots for standing in.

Hot pumps on the escalator.

Today was full of sensory overload, with cute shoes, the Quipstar contest, and Stage 2 Meaningful Use news. Mr. H already provided a high level overview, so I won’t say more for now. I was seated in the overflow room and got to watch the presentation via video feed. I also attempted to attend the ONC Town Hall, but both the regular session and the overflow room were full by the time I arrived. Bummer.

Thanks to all the HIStalk sponsors who proudly displayed signs recognizing their HIStalk support, including Iatric, Billian’s, MEDSEEK, Access, GetWell Network, Trustwave, CareTech, and Cumberland. If you see one of the those signs, please tell the sponsors thanks for supporting us.

I am not a big complainer, but it seems the lines to get food and drink are crazy. My post-HIStalkapalooza body waited 15 minutes to get coffee this morning. I should have gotten a muffin because by the time I was ready to find lunch, the lines were horrendous. My friend and I opted for the wine food group for lunch because we wanted to catch up and didn’t have the 20 minutes to wait for $20 worth of bad food. Many thanks to the sponsor who took pity on me and gave me one of their leftover fruit cups.

Either I missed them or someone has finally convinced companies that if you are spending $100,000 and beyond on booth space, you can’t afford to have your staff checking their phones the whole time. I seriously saw very little of that going on today.

Friendliest booth guys today were either the FormFast folks (who gave me a hat) or JarDogs (whose sales guys were also very cute.)

Nicest change of pace: Carstens had classical music playing in their booth.

I appreciate sales folks who can give an elevator pitch in less than a minute. Especially good jobs by the staff at  Trustwave and Elsevier.

More to come…