Curbside Consult with Dr. Jayne 1/30/12

Don’t Take Me Out of Context

Depending on the size of the communities they live in, CMIOs can sometimes feel isolated. Some may work in cities with multiple hospitals and health systems and have easy access to peers (and getting together over drinks is certainly fun!) but many work in towns with only one hospital. For the latter, finding and collaborating with peers can be a challenge.

I belong to a virtual community of CMIOs that contains a mix of big-city and small-town CMIOs. There are a couple of former CMIOs and a couple of young pups just starting out in informatics thrown into the mix as well. It’s been a great resource for idea sharing over the last several years and has helped me preserve my sanity on numerous occasions.

We recently got into a discussion about single sign-on options. Even those hospitals with single-database systems often have legacy systems with which clinicians need to interact. They also need to access a variety of homegrown and interfaced applications in order to care for patients and manage clinical data. Many hospitals have tackled this with single sign-on, proximity badges, or other strategies to reduce the need for clinicians to manage multiple passwords.

I’ve used several of these solutions and they are undoubtedly cool. However, they lack the ability for clinicians to rapidly access a single patient across multiple systems. Providers end up searching for the patient in multiple applications while they try to mentally create a unified view of the patient. This is less than ideal. One of the young pups in the group mentioned that he was looking at context-sharing solutions in an effort to remediate this problem. Luckily we have a few CCOW aficionados in our group. For best-of-breed shops, this can be essential to efficient access by clinicians.

For those of you who don’t know where I’m going with this, let me introduce you to CCOW. CCOW stands for Clinical Context Object Workgroup, which is an HL7 standard that allows clinical applications to share information. Through this standard, applications can participate in both user context sharing and patient context sharing.

From a practical standpoint, this means that when the clinician accesses a patient chart, all other applications that the provider is accessing synchronize to that patient. When user context is also included, it may also facilitate reduced sign-on into applications which are subsequently accessed. CCOW can go deeper than just user and patient context – encounter context can also be included.

CCOW (thanks to Health Level Seven, Inc. for the graphic) is often misunderstood by clinical and IT people alike. Although many vendors create their applications to be CCOW compliant, this does not mean that just installing two of them will “automagically” link them together. Context management is required. When the systems lack a shared master patient index or a common patient identifier, an intermediary mapping agent may also be necessary. Dedicated context management software may also need to be installed locally or on servers to help synchronize client-server and Web-based applications.

CCOW also doesn’t magically move data from one application to another. It simply allows users to access information on a single patient across disparate applications with a minimum of fuss and bother. Depending on the setup of the environment, CCOW may not work the same for users accessing from home or from non-network devices.

The use of CCOW also creates additional testing requirements during application upgrades in order to ensure that functionality remains unchanged. I know of at least one major vendor whose CCOW functionality has been negatively impacted by an upgrade, causing much consternation to the numerous hospitals live on its product.

There are multiple context managers out there, including Microsoft’s Vergence product (formerly of Sentillion) and Carefx Fusionfx. The fate of the Vergence solution is one reason that the recent Microsoft / GE Healthcare joint venture (first reported by Mr. HIStalk back in December) makes a lot of people nervous. Customers were already twitchy after Microsoft acquired Vergence from Sentillion in 2009, with reports of a decline in customer service and support.

Quite a few significant players in the hospital industry are customers, so hopefully that will be incentive enough for the as-yet-unnamed entity to resist making a mess of it. (Any idea on that name? I’ve been keeping my eye out, but haven’t seen anything, and there’s nothing on the Microsoft Health Web page yet, either.)

Most of the big vendors are CCOW compliant, but there are still some who don’t understand the value proposition to clients. Far from a gimmick or a “nice to have” feature, for organizations such as Mayo Clinic, Johns Hopkins, and many more, it’s essential. Once again, I was grateful to my CMIO coffee klatsch for a good discussion and plenty of humorous anecdotes. I’m looking forward to catching up with y’all at HIMSS12 in just a few short weeks!

Have a question about virtual networking, best-of-breed systems, or what the new Microsoft/GE entity should be called? E-mail me.

E-mail Dr. Jayne.

HIStalk Interviews Joe DeLuca, Knowledge Architect, Fulcrum Methods

Joe DeLuca is knowledge architect with Fulcrum Methods of Oakland, CA.

Give me some brief background about yourself and about the company.

I have been in the healthcare informatics and information technology industry for about 30 years. I started back in Wisconsin, primarily doing research work on effectiveness, the use of information technology to achieve what we would call the early ‘80s critical effectiveness, and better efficiency and efficacy. That started my career in wanting to help improve the healthcare through both consulting and the development of measurement tools. That culminated in the development of Fulcrum Methods.

At Fulcrum Methods, we provide methodologies, templates, and standard tools that help organizations go through the information technology planning, vendor selection, design, implementation, PMO processes – all focused on outcomes. The theme in my career has been aligning the specifics of a clinical improvement process or business improvement process with the use of technology. I feel very fortunate and privileged to have been part of this evolution over the last 30 years as it continues on.

You co-wrote the book, The CEO’s Guide to Healthcare Information Systems. What mistakes do you see hospital CEOs making with regard to IT strategy and their relationship with their CIO?

I think I would break that into a couple of components, if you’ll allow me to.

I think there’s been a tremendous shift in the awareness of the role of information technology and responsibilities of the CIO over the decades that I’ve been doing this. I think today the CEO-CIO relationship, whether it’s a direct report or not, is much more respectful than it was in the past. Progressive, if you will.

The mistakes that are made today have to do with incomplete involvement of the CIO in the strategic visioning process for the organization, and in the assessment of how information systems can progress, accelerate, and differentiate the organization. I think it’s better than it used to be, but it still requires some improvement.

For example, we have many technologies … I’ll pick on one because it was just recently noted in part of HIStalk … NCR’s healthcare kiosk was sold to QuadraMed. There was a time when the whole kiosk self-serve technology was foreign to the healthcare industry, and many regards it still is, depending on the adoption rates.  But there were some leading CIOs who came forward and said, “You know, we really need to look at this. This improves our patient convenience. It improves our satisfaction scores. It gives us better access to information, increases productivity, and so forth.”

That kind of thinking — bringing that forward — is something CIOs need to do more. That’s just a small example of that versus waiting for the CEO or the executive team to dictate more of what should be done based off of someone else’s doing it.

Because of Meaningful Use, people are making huge investments in clinical systems. Some of those decisions are being made fairly quickly and without a lot of publicly obvious analysis. Do you think those decisions are adequately involving the CIO?

I’m going to say yes to that. I think they are, because I think that the investment dollars and the potential for the stimulus dollars in inventive payments and then eventually, the Medicare disincentive payments and penalties are ironically forcing the CIO, because of that financial perspective, into a larger role with more credibility and more involvement on these decisions.

I think the patient safety initiatives that started to launch 5-7 years ago had a similar effect, though I think that bubbled off a little bit with the implementation of the systems and the increasing roles of the CMOs and CMIOs in the organization. So I would say there is adequate involvement, or an increased perspective.

I’d also say that today, with the emphasis on what’s going on at Meaningful Use, the CEOs have a better conviction, are more aware of and are focusing on the quality of the implementations that are occurring. At least in my consulting work, I see CEOs and CFOs actively sit back and go, “This is not just about getting the money. This is about doing it correctly. This is about doing it so that we permanently change our processes. In order to do that, we have to have a team of medical management, CMIOs, CIO, and other elements of the organization to achieve that.”

I’m sure some places consider the HITECH money they’re going to get as the initial return on investment. The CIO gets a pat on the back for achieving that. What pushes the next set of steps?

For the first point, in some organizations, I’ve seen the CIO and the team involved share some incentive bonuses relative to achieving Meaningful Use. Not large ones, but it’s certainly happening.

When the program was put in place and the set of Stage 1-2-3 distinctions were put onto the timeline, it was really quite an intelligent process out of Washington, DC. The emphasis on Stage 2 … some of it is just increasing the numerators on number of medication orders that are processed through the system electronically, but many of them, especially the physician requirements, the eligible professional requirements, really do focus on increasing the patient involvement, the patient interaction with care, transferring some data along the continuum of care in a consistent way that can be used and interpreted by the providers along the continuum. That clearly is the movement towards whether we want to call it accountable care or value-based compensation or pay for performance or population management – good things to do for healthcare, things that have been needed for a long time.

I think the impetus to continue will be the business value that’s now achieved from certified electronic health records as it moves towards managing a population, both for quality and for economic gain. At the end of the day, the health systems and eligible professionals are still going to look at what’s the financial benefit associated with Stage 2 and clearly Stage 3, with an emphasis on population health improvement, are the incentives to continue to move along to the end road further.

If a CIO realizes that most of their responsibilities and the expectations placed on them involve keeping systems up and running, having the help desk be responsive, and keeping cost under control, what are some strategies they can use with this opportunity that HITECH and the potential of Accountable Care Organizations have put in front of them to earn a more strategic role?

I think the first realization that CIOs have to come to grips with is that they can no longer think information technology, infrastructure, and application systems. Many have progressed beyond that. The CIO today, in order to advance and survive two, three, or five years from now, has to be thinking informatics. I use that term very precisely.

They have to be thinking about how the information that is managed through the information technology assets are actually used to achieve that business benefit for the organization, that clinical benefit for the organization. It’s really quite beyond just efficiency. Efficiency is certainly one element of it. Could I move my transactions along faster? But it’s really the informatics component. How do all of these different aggregations of data get transformed to clinical information that then improves both our care position with our population and our financial position?

The key survival element is to get very deep into this learning curve, if they’re not already there. Get in front of the questions that are being asked.  If someone today says, “I’m going to build an Accountable Care Organization. I’m going to need to have some quality improvement metrics.” Great. That’s certainly a starting point. The CIO needs to be saying, “How are we going to actually improve care? What’s the next step in those quality metrics? How does that integrate in with a patient-centered medical home? How much do I understand that, so that instead of waiting to be informed by the physician community, by payer community about this, I can actually inform my executive team about those needs two or three years from now?”

What structure and expertise does a CIO in a medium to large hospital or hospital network need that they didn’t need two or three years ago? What do they need to operationalize that change in philosophy about what IT is all about?

There are many demands on the CIO, operational as well as strategic. They need to have a strategic thinking department that may not actually reside within the IT department per se. That could be aligned very, very tightly with the strategic planning group ,with the CMO of the organization, and also since most medium or larger organizations today will have some form of a medical foundation or medical group affiliation, really aligning closely and understanding their needs and their vision going forward.

They also need to have a very strong data modeling capability within the organization. That’s not necessarily to build a custom clinical data warehouse or clinical performance reporting system, but to really be able to understand as all of a sudden, “Gee we have to plug into a patient-centered medical home that’s using remote management technology for congestive heart failure patients.” The minute we say something like that, we have a superficial vision of the clinical flow of information that moves along in order to achieve that. You need someone in the organization who can sit back and model that at a meta level, and inform all of the other elements, both within the IT department of the data characteristics, the patient transactions that need to occur along the way. It’s not really from a technical perspective, but it’s understanding of what’s behind the data and understanding what’s needed to make that data harmonious across all the different ownership patterns of the data.

I will also say that with the explosion of mobile technologies, the CIO really needs to have a good handle on mobile technologies and what that means.

Are IT departments going to be funded to do that? Are CEOs aware of these multiple priorities, everything from customer service to Meaningful Use to analytics to integrating with physicians and other partners, and giving CIOs being given the budget and the responsibility to carry those things out?

I think it’s a split vote right now. One of the concerns I have about Meaningful Use is that it’s forcing this huge investment up front in electronic health records. There may be a hangover effect similar to what happened with Y2K, where all of a sudden, “OK, you had your share. Now we will only fund and continue this progression in very select areas or in a marginal way.”

I’m actually seeing in the consulting practice about half of the organizations constraining IT growth rather than expanding IT growth. That’s resulting in extending the Meaningful Use deployment schedule. We won’t try to get all the money up front that we could, or we won’t try to get any this fiscal year, but we’ll string the investment out or two or three years and slide in right under the wire relative to the reporting attestation guidelines. I’m also seeing pulling back dollars that might otherwise be used for – I’ll call them experimental programs, but that’s not the right term – but for exploratory efforts that might be going on, like piloting that kiosk.

I think it’s going to get worse. I think as the cost pressures come in, we will see further emphasis on containing IT costs to some industry standard metrics that may be underfunding the environment.

I think we’ll also see – talking out of the other side of my mouth on this – a greater emphasis on system impact. If we can prove that it will speed things up, make things better, quicker, faster, improve patient safety, or support some form of a new reimbursement model … those will get funded differentially.

New systems always cost more than the ones they replace, and once the Meaningful Use money has been spent and forgotten, hospitals will be locked into high-cost maintenance. The hospital has a low margin and no real potential for it to get higher, but the IT budget has to grow because all of the systems that were optimistically brought. How will hospitals reconcile their original appetite for IT versus the ongoing cost to keep it?

I agree with those trends. Just as a footnote. I recently completed a total cost and ownership budget for an EHR purchase, working on a graph with percentage hardware, software, and implementation costs, and maintenance and support over time. I went back to a similar study that I did 10-15 years ago just to see what’s actually somewhat happening. As you would expect, hardware cost has gone down pretty significantly as a proportion. Software dollars were about the same as the total proportion, a little bit higher. Implementation costs and ongoing software support were almost twice what they were as the percentage of budget.  

I see that as a problem. The reaction from any organization will be, “These are fixed costs. We know we have to have the software vendor invoices paid, so we will cut end user support. We will trim down our help desk functions. Instead of using an N minus 1 release program,  we’ll go to N minus 2 or N minus 3.” I think that it’s a very real issue. There will be a constant tension in that environment.

I think the other thing that happens is the competition for resources between things like information technology and clinical services, when you have a revenue cycle and top-line revenue is flat or margin is under further pressure. Those contentions, those issues between those buckets of money, become even greater.

Give me some predictions or some unconventional thinking about what you see as the future of healthcare IT.

I think we will see, unfortunately, a major security breach that will damage the view of what we can do in information technology that will potentially hurt the long-term evolution of sharing of data amongst providers. We’re all somewhat very concerned about this. We have information in our silos. We know how to exchange it selectively. We’re now opening this up further with health information exchanges and so forth. I think that’s all very good, but I think we will have a breach that will somewhat shock us.

I think the role of the medical home will rapidly change to not only its physician-supported view, but we will have a new class of care attendants in the home environment. This could be, for example, myself taking care of a chronic asthmatic child or an insulin-dependent parent, where the technology that we will use will be much broader than what we perceive now as the PHR — Personal Health Record, and some monitoring that might be attached to it – that will really be into assisted diagnoses, some replacement of what we would consider to be normally a physician- or clinician-supported process. I see that coming fairly quickly within three to five years, especially as the health insurance exchanges come into play and we move a huge population of uninsured people into the insured population without an adequate supply of provider resources under the current physician labor model.

Last but not least, I think that the aggregation of some of the clinical information into our data warehouses and into our clinical performance reporting systems will support and provide breakthrough benefits for new disease management models. Once we really get some of this information consistently applied, we’ll be able to  overlay pattern analysis and other considerations that we don’t use today, which will help us improve population care.

Any concluding thoughts?

I would make a couple of observations. First, I appreciate the opportunity to do this. 

I have one other concern in the industry. Where’s our next generation of informatics leadership coming from? I am concerned about the CIO for now, concerned about incentives for CMIOs and CIOs to come into the industry and stay in the industry and to fight through the challenges and barriers that are out there. 

One of my closing comments would be, keep this dialogue going, keep people reading things such as HIStalk. Hopefully, that will provide the community that will support the evolution of us in the industry very different than 30 years ago.

Monday Morning Update 1/30/12

From You Know Who: “Re: RelayHealth. Jim Bodenbender out, announced abruptly on phone call. Jeff Felton, who ran the RelayHealth Pharmacy group and was a transplant from McKesson San Francisco, is taking over the entire division.” That appears to be true from the company’s management team page, on which Jeff Felton (above) is now listed as president.

From RAC Frustration: “Re: electronic RAC responses. I see that Medical Electronic Attachment (MEA) has become the latest company to be certified by CMS. I am curious how many HIStalk readers will use the esMD (electronic submission of medical documentation) for RAC and MAC responses?” MEA’s progam uses an NHIN gateway to send electronic responses to CMS’s post-payment audit requests of several flavors (RAC, MAC, CERT, PERM, and ZPIC.) I’m interested in how much transaction volume the average hospital will experience to keep CMS happy once esMD Phase 2 goes live in October and all documentation requests will be sent electronically. Comments welcome.

Surely the calendar is playing a cruel joke: it can’t be just three weeks until the HIMSS conference, can it?

My Time Capsule editorial this week from five years ago: Want Physicians to Use Systems? Standardize Screens Like You Do Back-End Databases. A free sample: “Hospitals never seem to get how illogical it is to physicians that every hospital buys a different system, but expects community-based doctors who cruise in for an hour a day to master all of them without burning up more hours of their self-employed day. They seem puzzled when doctors jeer at their zealous requests to bone up on Cerner when he or she is fuming at Eclipsys across town and McKesson at the university hospital.”

Listening: reader-recommend James, which I would characterize as jangly Britpop with strong vocals. They (it’s a band,  not a guy) remind me of the Smiths. They aren’t totally obscure, having sold 25 million albums in their 30 years. They probably would sell more if they had a more search engine friendly name, although come to think of it, that’s another similarity between them and the Smiths. 

A lot of money and effort is spent putting on the exhibit and educational tracks of HIMSS, but that’s just to provide the backdrop for the real reason people attend: to connect with folks for business and pleasure, two-thirds of respondents said. New poll to your right, as suggested by a reader: what reaction do you have when you hear that a vendor uses offshore programming resources?

Thanks to CSI Healthcare IT, supporting HIStalk as a Platinum Sponsor. The company is a leading national provider of IT and training professionals, both contract and permanent. The company’s team of 75 recruiters can often find local qualified resources, minimizing billable travel expenses to the client. Its pricing model has saved health system customers such as Sutter, Baylor, Texas Health, Clarian, and Sentara up to 60%. The company is vendor neutral, providing resources for projects involving McKesson, GE Healthcare, Allscripts, Epic, Cerner, Meditech, NextGen, and others. It can handle work ranging from providing a single resource to managing the projects of large health systems, also offering a specific package called Epic Community Connect that helps health systems provide Epic’s ambulatory systems to community practices (marketing, contracting, readiness assessments, implementation, and support.) Thanks to CSI Healthcare IT for supporting HIStalk.

Federal CTO Aneesh Chopra resigns and is expected to run for lieutenant governor of Virginia. You aren’t surprised if you read HIStalk on January 13, when my non-anonymous, well-placed informant chose the fantastic phony name of DeepThrowIT to tell us that Chopra was heading out. I think that might have been my first non-healthcare IT big scoop rumor.

I recently quoted some Epic facts provided by Chief Administration Officer Steve Dickmann in a recent talk he gave to a Madison group. The full video is here, from which I pulled a few more:

• The company started in a basement in 1979 doing UW psych department work.
• Epic went from 2.5 employees in 1979 to 30-40 employees in 1994, but then changed direction to focus on the electronic medical record.
• The product was changed from text-based to a graphical GUI in 1994, the same year when the database was scaled up for large enterprises.
• Epic Web came out in 1997; MyChart in 2000.
• The company gained competitive advantage from Y2K because it had minimal remediation to accomplish while its competitors had to redirect resources to work on that problem.
• Epic also gained competitive advantage from being in Wisconsin, which was an early adopter of large integrated delivery systems.
• Epic does not subcontract or acquire software; everything was developed in Wisconsin.
• The original motto was “Do good, have fun.” The “make money” part was added later.
• Epic focuses on large hospitals and clinics, children’s hospitals, and academic hospitals and turns away other prospects. The only exception they will make is for hospitals located in Wisconsin.
• Epic doesn’t do acquisitions because they would have to rewrite the code anyway to keep a truly integrated product.
• Competitors have 20-30% of their employees doing sales and marketing, while Epic has 1%.
• Epic’s culinary team has 70 employees and it also staffs its own horticultural team. It does not contract those functions out.
• All of Epic’s implementers fly out Monday afternoon, which ties up a good bit of the Madison airport’s capacity with 600-700 people all leaving at about the same time.
• Each customer has an assigned tech support team that knows the customer’s people and systems. The team is available 24×7.
• 91% of the HIMSS EMRAM Stage 7 hospitals use Epic.

Supporting HIStalk as a Platinum Sponsor is Versus, which offers real-time location systems for patients, staff, and equipment. Hospitals use that information to automate workflow, improve efficiency, increase patient safety, boost patient satisfaction, and increase revenue. The company provides interesting examples: (a) advancing patients to the next level of care based on events, such as completed labs or EKGs; (b) locating telemetry patients in distress wherever they are; (c) alerting the physician when patients are ready to be seen; (d) reminding staff to wash hands; and (e) alerting housekeeping to clean the room when the patient’s badge is dropped into the discharge bin. The Traverse City, MI company has been around for over 20 years, with its combined infrared/radio frequency system being endorsed by the American Hospital Association. Hospital customers have documented improvements such as cutting equipment losses from $1.5 million to $40,000 year, eliminating the need for clinic waiting rooms, reducing telephone calls by 75%, and increasing bed capacity by 25% with no construction. Interesting stats: the company has over 600 facilities using 500,000 of its components to track more than 1 million patients per year. The big announcement a few weeks back was that The Johns Hopkins Hospital chose Versus to manage staff and assets in real time for some locations after a three-year pilot of several RTLS systems, with additional deployments scheduled. Thanks to Versus for supporting HIStalk.

The Peace Corps has an RFI out for an EMR product, just in case you’d like to sell them one. They’re actually looking to have OpenEMR customized, along with Microsoft Dynamics 2011 and BizTalk for reporting.

In England, Homerton University Hospital allows its original NPfIT contract for Cerner and BT expire and signs its own seven-year extension directly with Cerner, declining to open the opportunity to other vendors because of its working relationship with the company.

The Bipartisan Policy Center releases its recommendations for using healthcare IT to improve care and reduce costs. Quite a few industry names served on the task force and provided their input. Some of its observations and recommendations:

• Even with new delivery models, the healthcare system continues to financially reward procedure and patient volume rather than better care. Recommendations: purchasers and plans should reward care that is higher quality and lower cost, incorporate those models into Medicare physician payments, expand pilots of new care models, and share lessons learned with private sector pilot projects.
• Despite a lot of HIE activity, not much patient information is actually being exchanged. Recommendations: improve the HIE business case by adding more stringent information exchange requirements to Stage 2/3 of Meaningful Use, develop long-term standards that make sense for healthcare delivery, assess the level of information exchange that is occurring, do more work related to two-way data exchange, and clarify the role of health information exchange in the several programs funded by HITECH.
• Consumer engagement with electronic tools is minimal. Recommendations: raise public awareness, help providers engage their patients to use technology, improve the usability of consumer tools and provide easy data import/export for consumer-facing applications, launch an awards program for consumer tools outcomes, share lessons learned, ramp up Meaningful Use requirements to include more consumer tools, and offer incentives to chronic disease patients to use electronic tools to manage their health.
• EHR and Meaningful use adoption is still low. Recommendations: raise awareness of incentive programs and expand RECs and similar programs, clarify Meaningful Use requirements, roll out lessons learned form federal programs to the whole industry and not just government contractors, encourage sharing of best practices, and improve EHR usability.
• Consumers are worried about privacy and security. Recommendations: require all entities that use PHI to comply with policies at least as stringent as HIPAA, clarify government guidance across agencies, development a national strategy for patient identification (a national ID was not specifically mentioned), and issue common sense security practices to providers.

I’ve previously mentioned the MIAA EHR mobile viewer app developed by a three-person Palomar Pomerado Health development team for its own use with its Cerner systems. A preview at a Toronto mobile healthcare conference generates interest, with the app going to pilot in March. The hospital hopes to commercialize it. Said a Canadian hospital IT director at the conference, “We need to look seriously at how a publicly-funded hospital in the States has been able to advance their technology like this when we seem to stumble on things like policy and rules.”

The Pennsylvania Health Department finds that nurses at St. Luke’s Hospital overdosed three patients in the past two years by incorrectly programming their PCA pumps. Hospital employees said the hospital did not require training on the devices.

An article covering successful businesses that did not use outside financing provides an example in eClinicalWorks CEO and co-founder Girish Kumar Navani, quoting him:

I don’t foresee leaving the company for at least 10 years. I would like to leave it a private company with no external investors and absolutely no thoughts whatsoever about Wall Street. I am having fun and take great pride in my freedom. There is no reason I would give that up. We are a cash flow positive company. We have recurring revenues and no debt. We have a large customer base that is growing exponentially.

Compuware says it will take its Covisint subsidiary public in its next fiscal year, which starts in April. Covisint, which has $74 million in annual revenue, offers an exchange platform that connects hospitals and practices, including services for identity management, collaboration, master patient index, and record location.

Vince’s latest HIS-tory: Part 2 of Health Micro Data Systems.

A column in The Atlantic revisits a 1995 article it published about Newt Gingrich, saying that some of his goofy, overly dramatic “we are at a crossroads” ideas (like colonizing the moon) prove that he can’t separate something that sounds cool if given little thought from pushing the government into spending huge amounts of money just to find out how cool it is or isn’t, even though the free market is better equipped to make that call. Healthcare technology was mentioned in that 1995 article:

Gingrich also thinks health care technology is cool. Serious students of this subject worry that insurance insulates patients from the cost of technology, thus yielding lots of high-cost, low-benefit use and in turn steering too much of society’s resources to the further development of such machinery. But Gingrich wants more. In 1984 he wanted more cat-scan machines, and he wanted the government to provide a $100 million incentive for the development of user-friendly dialysis machines–even though "there are already companies and researchers interested in this problem." The point here isn’t that Gingrich will now waste tons on technology. The current political climate will restrain this tendency. The point is that–in case you hadn’t noticed–there is little careful thought underpinning his enthusiasms, nothing solid beneath his unshakable self-assurance and his intense disdain for disagreement.

E-mail Mr. H.

More news: HIStalk Practice, HIStalk Mobile.

Readers Write 1/27/12

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

The Top 10 Mistakes Salespeople Make at the HIMSS Conference
By Beth Friedman

A vendor’s sales staff is one of the company’s most important assets. While marketing, PR, and events management put it all together, the sales staff determines whether or not the HIMSS conference is a success.

Is your sales team engaged, interacting with prospects, and busy with pre-scheduled appointments? Or are they sitting around the booth, eating dinner together, and looking like Las Vegas wallflowers?

Here’s a Top 10 list of sales staff mistakes at HIMSS derived from our 30+ years of combined experience. Avoid them and you’re golden. Make them and you’re history. It’s that simple!

Mistake #1: Sitting Around the Booth

Your booth is crowded with salespeople, but no prospects. This is the most common mistake at any trade show.

Prospects must be enticed to enter your booth. They won’t come into it willingly. It is the job of your sales team to get them in. Yes, that means standing at the edge of the carpet and greeting attendees. A simple “hello” and smile works wonders. Multiply your smiles and see how many you get back. Hey, these guys and gals are competitive – have a contest!

Secondly, ask attendees easy, friendly, open-ended questions as they pass by. Get them engaged in a friendly conversation to start. Before you know it, you’ll be giving a demo! For example:

• How are you enjoying the show so far?
• What did you think of the keynote this morning?
• How are you finding the educational sessions this year?
• Did you go to HIStalkapalooza?

Mistake #2: Smart Phone Syndrome

All year you’ve made cold calls, left messages, and begged for appointments. Guess what? The same folks you’ve been trying to reach for six months via phone are here at HIMSS, live and in person. Dump the cell phone and talk to everyone in real time.

Avoid e-mail or any other electronic-based interpersonal avoidance. This includes time spent in the booth, between exhibit hall and hotel, in the elevators, during lunch breaks, and at the roulette table. Attendees are everywhere. Be “on” and smile at all times.

Mistake #3: Selling Too Much

Keep the sales pitch in the booth. If you meet attendees at events, poolside, or at the casino, keep conversation fun, personable, and low pressure. People are people. Everyone likes to meet someone personally first, professionally second. Overselling is one sure way to drive people away.

Mistake #4: Having Dinner Alone

Even if your company is small, make the most of having all your customers and prospects in one place. Arrange a dinner. Invite customers for cocktails. Host a small reception, focus group, or breakfast.

Breaking bread with fellow employees only is an opportunity lost. Make sure every meal includes a customer or prospect. You’ll be glad you did!

Mistake #5: Assuming One Size Fits All

Sales staff often uses a “one size fits all” approach to HIMSS attendees. Take a moment to ask questions and better understand your audience. See what problems they are trying to solve. If your company can solve it, great! If you company can’t solve it, don’t waste their time. Refer them to a company that can, and remember that smile!

Mistake #6: Avoiding Sessions

HIMSS offers a huge educational opportunity. Hundreds of sessions are offered and your prospects are sitting in each one!

Take the time to attend sessions. Sit next to someone interesting. Introduce yourself. Attending educational sessions is the best investment sales teams can make at HIMSS. Plus, it might make you smarter.

Mistake #7: Negative Selling

Talk your company up, not others down. Negative selling never works. And it especially doesn’t work at HIMSS. Enough said.

Mistake #8: Keeping Your Company’s Presence a Secret

You’ve invested time, money, and effort into HIMSS. Why not shell out a few more bucks to let everyone know? Direct mail is back. E-mail campaigns and promotions help. Unless attendees know you’re there, you’ll get lost in the noise.

And remember to attach promotion to your HIMSS efforts, and some emotion to your promotion. Give attendees a reason to visit your booth. And have some fun!

Mistake #9: Confusing Signage

OK, this mistake is usually made by the marketing folks and not sales. But confusing signage is a nuisance to everyone. Your company has less than three seconds to tell HIMSS attendees what you do. Make those three seconds count! Keep signage brief and communicate in familiar industry terms.

Mistake #10: Not Making Appointments

Failing to make one-on-one appointments with customers and prospects at HIMSS is inexcusable. Even if your company doesn’t have access to the pre-show attendee list, just call them! See if they are going. If your direct contact is not going, chances are that someone from their organization is. Call and introduce yourself. Schedule a cup of coffee or have a drink.

Reach out and touch someone before the conference. Because once everyone is in Vegas, it is too late.

Good luck. Have fun. Make the most of HIMSS. It only happens once a year!

Beth Friedman, RHIT is president of The Friedman Marketing Group of Atlanta, GA.

EHR Systems Can Be “Genius” to Use
By Seth Henry

In proper accordance to government regulations, approximately 50% of doctors’ offices nationwide have implemented some form of electronic health record (EHR) system. However, of these, only 25% have adopted the technology to serve in a meaningful and useful way. Most managers understand the mandatory changes that are underway, and in many cases, have begun the critical transition to these systems. Even if users have implemented the proper technology, they may be unsure of how to effectively incorporate it into their daily protocol or how to operate them with maximum benefits.

Compounding the financial investments required to implement an EHR system, there is an average of 1,000 hours of data entry required within the first year of adoption. Doctors and their staff are already pressed for time and money and do not have the proper resources to accomplish this tedious but crucial task. Moreover, they need to be focused on their real job – providing quality healthcare to patients.

The good news is that EHR systems can become user-friendly with the addition of proper infrastructure. Comparable to personal technologies, EHRs originate as a generic platform, with the responsibility of the owner to engage with the product to create a usable, tailored system.

Compare your iPod to that of your friends. No two are exactly alike after you each have the opportunity to personalize and import desired features and applications. Electronic health record systems are similar. They start with standard capabilities and can be uniquely personalized and adapted to meet individual facility requirements. The EHR technology requires applications to make them accommodate the needs for users to engage with the system on a daily basis to further benefit patients.

The most formidable part of any technical change is the actual use of the product and gaining consensus amongst the staff to implement it accurately and consistently. EHR professionals are constantly looking for better ways to educate, counsel, and instruct their client facilities on the technology as together they identify the most meaningful way to apply the tailored applications.

Taking a bite out of Apple’s famously coined “Genius Bar,” functional, hands-on training and support is the cornerstone to the successful use and implementation of any new product integration. The “Genius Bar” adapts the concept found at global Apple retail stores: in-person assistance for product-related education. Technology providers are retaining onsite, dedicated experts equipped with the skills, solutions, and passion for information sharing to guide facility staff through the program until they are 100%autonomous.

A single-style teaching approach is not an acceptable resolution to ensuring total integration of these technical upgrades. Thoroughly educating users in a personalized method, void of time constraints, will enable them to be properly trained to engage with the systems. Not everyone responsible for use will learn in the same manner or adapt as quickly as others. Therefore, the “Genius Bar” solution allows hands-on training and a continuous resource for resolving practical issues encountered as they implement the systems.

When the facility staff and doctors are comfortable with using the products, they are more inclined to incorporate the processes into their daily routines. In-person, ongoing support from their “Genius Bar” representative will help facilitate a smooth transition and implementation process.

The real benefit of an EHR system lies in generating, analyzing, and, ultimately using patient information to directly improve overall patient care. Tailored applications that enhance the EHR technology allow facilities and users to employ the appropriate features and accommodate their needs without the high cost of in-house IT infrastructure and staffing.

With the value of applying customizable, intuitive features, internal office support, and the help of the “Genius Bar” staff, facilities can succeed in long-term implementation and meaningful use of electronic health records.

Seth Henry is founder and president of Arcadia Solutions of Burlington, MA.

Time Capsule: Want Physicians to Use Systems? Standardize Screens Like You Do Back-End Interfaces

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

I wrote this piece in January 2007.

Want Physicians to Use Systems? Standardize Screens Like You Do Back-End Interfaces
By Mr. HIStalk

The premise of RHIOs and physician portals is that, given the lack of industry coordination, everybody’s computer system stores data differently. It’s up to you (vendor or provider) to match their standard layout. How hard that is for you to do isn’t their problem. If vendors don’t have uniformity on the front end, at least they will on the back end.

It’s an important concept in standardization. The RHIO makes the rules. That’s a political reality, not a technical one. Not surprisingly, providers and their vendors can standardize when they have to. The problem is lack of incentive.

Not long ago, hospitals and doctors were paranoid about sharing patient information. The vital secrets of John Smith’s CBC result or mole removal notes were far too incendiary to let a competitor sneak a peek. Coldly formal hospitals weren’t about to stoop so low as to let the other guy see their data, even though it might improve care for a given patient.

That seems pretty silly looking back. For nonprofits to be arguing over information that could help patients seems incredibly provincial and self-serving (“We’re not telling you what she’s allergic to because you may steal our market share …”). The patient didn’t get to vote, but luckily, common sense prevailed anyway.

With that battle mostly won, let’s move on to doctors. They see patients in two or more hospitals in the same service area, both of which are determined to push their CPOE agenda forward because they spent a lot of money and effort on implementing that system. Doctor, we’d like to make you a data entry clerk.

Hospitals never seem to get how illogical it is to physicians that every hospital buys a different system, but expects community-based doctors who cruise in for an hour a day to master all of them without burning up more hours of their self-employed day. They seem puzzled when doctors jeer at their zealous requests to bone up on Cerner when he or she is fuming at Eclipsys across town and McKesson at the university hospital. Are those systems really different enough that everybody has to buy a different one?

Given the mediocre at best state of clinical systems and CPOE, mastering even one of them as a community-based doc is a stretch goal. Mastering two or more? It will never happen.

When I drive a car, I expect the instruments to work basically the same. If I pick up a TV remote, I don’t want to attend training or read a poorly developed manual. I don’t care how creative your engineers are, I still want the buttons on a telephone to be arranged the same.

Vendors who don’t want to follow standards won’t get my business. A car rental company that decides to creatively swap the brake and gas pedals would fail quickly. Nobody has to pass a law to prevent that; vendors aren’t that stupid. Standardizing the user interface is a market expander that benefits everyone.

In HIT, vendors claim product superiority, but systems have been commoditized to the point where they accept pretty much the same information. There are only so many ways you can order meds, labs, and rads. Still, each vendor manages to design their physician user interface with enough quirks to ensure distinction from competitor offerings. If you’ve seen one system, you’ve seen one system. There’s no such thing as best practices.

Maybe it’s time to develop the equivalent of a portal or RHIO for physician ordering, decision support, and communication. Standardize the user input just like the RHIO’s accepted data format. Why should every doc have to learn every system?

Vendors would hate that, but they weren’t fans of RHIOs either because the importance of their link in the chain was diminished. Data coming from a Cerner system is no better or worse than that coming from a Meditech or McKesson system, so nobody on the other end cares which one you use.

Knowing the HIT vendors aren’t about to support that level of standardization, perhaps some third-party scraping-and-scripting tool vendor could make Meditech look exactly like Cerner for doctors. Think that wouldn’t sell in towns where both are used by hospitals with medical staff crossover?

News 1/27/12

Top News

CPSI announces Q4 numbers: revenue down 2%, EPS $0.59 vs. $0.61, raising questions about the state of the hospital clinical systems market.

Reader Comments

From Vegas Question: “Re: HIStalkapalooza invitations. Will the e-mail come from your usual address or a new one? My spam folder is pretty large and I don’t want to miss it.” Invitations and regrets will be sent from histalkapalooza@contactESD.com this week. The walk-up plan will be described for those we couldn’t invite because of capacity. Check at the registration table at 8:00 and if we have room due to no-shows, we’ll let more folks in.

From Rick: “Re: GE Healthcare. Restructuring of its IT division continued Tuesday with an announcement that it will terminate the Centricity Advance hosted EMR/PM solution immediately. Customers will have to make arrangements to move their data out of the cloud before the system is taken offline. All development in its Hospital and Large Practice division has been halted and products placed in maintenance-only mode, including Centricity Business revenue cycle solution. The Centricity EMR product will be sunset with no Version 10 release, replaced by the Centricity Practice Solutions combined EMR/PM system.” I asked GE Healthcare for a response Tuesday evening and agreed not to run the rumor then since the spokesperson indicated that it contained inaccuracies. Here are the main points from GE Healthcare:

• The company will shut down its hosted PM/EMR solution Centricity Advance (the former MedPlexus product that GE Healthcare acquired in March 2010) on June 30, 2012.
• The decision was made because of market overlap between the Centricity Advance product and Centricity Practice Solution.
• Customers can retrieve their data in read-only form until December 31, 2012.
• Customers will be offered an upgrade to the Centricity Practice Solution PM/EMR, with data migration, training, and implementation costs covered by GE.
• The company will eliminate an unspecified number of jobs related to the announcement.
• The Centricity Business revenue cycle product is unaffected by the announcement.

From Expat Consultant: “Re: Dubai Health Authority embezzlement. These people own the company representing Epic in the current bid for DHA business.” Two men are charged with embezzling $250K from a company providing services to the DHA.

From Rebecca: “Re: HIMSS presenters. Have you thought about listing sessions that will be presented by HIStalk’s loyal followers and contributors? You have so many followers attending and it would be nice to encourage them to attend educational sessions.” I’m a sucker for doing good deeds even though I’m already overwhelmed, so if you’re speaking at a session that’s on the regular HIMSS educational track (not in the exhibitor’s theater, on the show floor, etc.) you can enter your information here and I’ll try to put out a list.

From Ileus: “Re: links to HIStalk Practice and HIStalk Mobile. I can never find them. Why not put them at the top of the page?” That’s a good idea that we’ll take one step further by placing tiny links at the bottom of each news post, starting today. That way, readers using mobile devices and RSS feeds can click them. I hadn’t thought about the ease of finding the links, to be honest.

HIStalk Announcements and Requests

Highlights from this week’s HIStalk Practice: eClinicalWorks CEO Girish Navani highlights his company’s 2011 achievements and 2012 goals. SBA loans to doctors have surged in the last 10 years. Seven states have still not initiated Medicaid EHR incentive programs.  Julie McGovern of Practice Wise discusses New Year’s resolutions, vendor relationships, and setting realistic and appropriate expectations.  The ever-irreverent Dr. Joel Diamond explains the history of ICD-10 (it’s a must read.) Actually, I think everything on HIStalk Practice is a must read, so make sure you are signed up for e-mail updates.

On the Jobs Board: Senior Product Manager of Healthcare Solutions, SCM Go-Live Support, Epic Credentialed Trainers. On Healthcare IT Jobs: Director of Technical Operations, Allscripts Application Analyst, IT Director and IT Leader.

Inga, Dr. Jayne, and I do our HIStalk work in a bubble of lonely anonymity, so we always enjoy connecting with readers, even if only by electronic means. We enjoy seeing the names of the 2,128 folks who have signed up for Dann’s LinkedIn-based HIStalk Fan Club, which is almost four years old now (hello to the new folks there from Citizens Memorial Healthcare, American College of Cardiology, McKesson, Cornerstone Advisors, Vitera Healthcare, DrFirst, Medibis, Medicity, GE Healthcare, and Lehigh University). We accept all friend/connection requests from Facebook and LinkedIn, connecting you to a pretty big web of people that might come in handy someday. We like it when you send us news and rumors, subscribe to the e-mail list, click the ads of our sponsors, and use the Resource Guide and Consulting RFI Blaster. And of course thanks for reading, and thank goodness you do since we would be wasting our time here otherwise.

I forgot to give a proper introduction and welcome to Dr. Rick, whose first EHR Design Talk has earned a great response from the Twitterverse and from reader comments. He chose where to start his series, but you get to decide where it goes from there through your interaction with him. You will no doubt appreciate his active (and sometimes almost immediate) response to your comments, indicating his keen interest in usability and your thoughts on what it means to EHR users. It takes a lot of effort to research and write posts like his, so thanks to Dr. Rick for sharing his time and expertise with us.

Acquisitions, Funding, Business, and Stock

drchrono closes a $2.8 million funding round. The company says 15,000 users have registered.

EHR and PM provider Image MD (formerly eHealth Made EASY) announces it has increased its invested capital from $15 million to $25 million over the last year.

Quality Systems, the parent company of NextGen, reports Q3 earnings: revenue up 23% to $112.8 million; net income up 20% to $21.1 million. The company’s $0.36 EPS missed analysts’ estimates by $0.02.

Sales

Masonicare (CT) selects the Summit Express Connect interface engine to provide interface integration between Masonicare’s MEDITECH HIS and ancillary systems.

People

Former Clinecta President Jeffrey A. Pfund joins JEMS Technology as COO.|

Brian Mitchell, formerly of GE Healthcare, joins ClearDATA Networks as vice president of sales.

M*Modal (MedQuist) promotes Michael Clark to EVP of global sales.

University of Chicago Medical Center promotes Sameer Badlani, MD from associate CMIO to CMIO.

Healthcare data analytics and consulting firm Sg2 appoints Eric Louie MD, MBA as chief medical officer.

Former Microsoft Health Solutions Group VP Peter Neupert joins venture capital firm Health Evolution Partners as an operating partner, joining former ONC head David Brailer MD.

Healthcare Data Solutions, a provider of healthcare databases and intelligence services, names Scott Thompson (InfoGroup) its CTO.

Drexel DeFord, VP/CIO of Seattle Children’s Hospital, will serve as 2012 chair of CHIME’s board of trustees.

Rick Schooler, VP/CIO of Orlando Health (FL) is named CHIME-HIMSS John E. Gall Jr. CIO of the Year.

Leigh Ann Myers RN joins PerfectServe as VP and chief clinical officer. She was previously with PatientSafe Solutions.

Announcements and Implementations

Virtua (NJ) goes live with the first phase of its enterprise-wide device infrastructure using Nuvon’s VEGA System to connect to its Picis perioperative solution.

Upstate University Hospital (NY) introduces Upstate MyChart, giving patients online access to their medical records. The hospital is part of SUNY Upstate Medical University, which is in the midst of $40 million Epic implementation.

API Healthcare announces that 20 hospitals have recently gone live with its workforce management solutions.

M*Modal Inc and Merge Healthcare partner to integrate M*Modal’s speech and natural language understanding technology into Merge solutions.

Siemens HSB CEO John Glaser and Texas Health Resources SVP/CIO Ed Marx are among the presenters of a January 31 webinar, Can Healthcare Providers Afford to Ignore Social Media?

MedAssets announces general availability of its Access Integrity suite for front-end RCM processes.

Greenville Hospital System University Medical Center (SC) goes live on Holon’s CPOE Medication Order Management solution at all of its facilities.

Government and Politics

ONC head Farzad Mostahari MD predicts that at least 100,000 providers will receive EHR incentive payments by the end of 2012. In a blog posting that discusses his forecast for HIT in the coming year, he says:

I see 2012 as the year in which health IT truly comes of age. While much work still needs to be done, the groundwork is firmly in place for what promises to be a breakthrough year in the adoption and widespread use of health IT in ways that improve care for individuals, improve health outcomes for populations, and increase the value we get from our health care dollars.

A just-published article in The Center for Public Integrity’s iWatch News covers the special interest advocacy activities (or political influence peddling, according to rival Mitt Romney) of Newt Gingrich’s for-profit Center for Health Transformation. It lists some examples of Gingrich pitching his clients in various government hearings for projects requiring major government expenditures, among them GE Healthcare, Siemens, Allscripts, and HealthTrio. The center’s project director is mentioned as testifying that the Department of Labor should require healthcare providers to use electronic medical records, which it implies morphed into HITECH. Gingrich also appeared at a press conference in the Senate Office Building to promote a bill requiring e-prescribing, in which at least 20 of his paying clients had a financial interest.

The government says that an upgrade to Symantec’s Veritas Storage Foundation caused the significant downtime experienced by the Military Health System’s AHLTA clinical system last week.

ONC’s Office of the Chief Privacy Officer announces a project to identify best practices for mobile device privacy and security. They will convene a public roundtable in the spring.

Other

Affiliated Computer Services (ACS) officially adopts the Xerox name, two years after its acquisition by that company.

Server problems at a clinic in Canada cause month-long issues, including the inability to access patient records and the complete shutdown of the telephone system for a day.

Healthcare Growth Partners releases its latest healthcare IT industry review, covering Q4 and reviewing 2011’s activities. It’s a very well done review of macroeconomic and healthcare IT industry factors that will affect merger and acquisition activities and share performance of publicly traded companies. I really liked the chart above that describes why some companies command high revenue multiples when acquired, while others don’t. What it’s showing is that recent acquisitions aren’t following the typical trend, with more premium-priced acquisitions than usual. I would attribute to the fifth factor listed in the rightmost section – deep-pockets outsider companies are making it rain to snap up available players so they can scratch their itch to get into healthcare quickly, even if irresponsibly. Whether they’ll stay in is another question (most don’t.)

Weird News Andy declares that bacon is the new duct tape, noting a report from Michigan doctors who stopped a four-year-old girl’s platelet-related nosebleed by shoving raw bacon up her nose. One of the doctors said he got the idea from his military days, when pork was recommended as an antihemorrhagic. WNA postulates that the story was sponsored by the ThinkGeek product above.

An Oklahoma hospital that took a $500K donation from country singer Garth Brooks to build a women’s center to be named after his mother but then used the money for other projects is ordered to give Brooks his money back plus another $500K as punitive damages. The hospital argued that the gift from Brooks was originally made anonymously and without restrictions and that he was fuzzy on details about the meeting when asked later.

Sponsor Updates

• Fulcrum Methods launches its ICD-10 assessment, remediation, and program management tools.
• T-System’s T SystemEV EDIS successfully completes the highest level of interoperability tests at IHE’s Connectathon.
• Sunrise Health System (NV) becomes the first health system in Nevada to use AirStrip CARDIOLOGY.
• MEDecision’s January 31 Webinar will feature a discussion on the use of coordination solutions and EHRs to lower costs and improve care. 
• Concerro announces the keynote speakers for its April 2012 Concerro Client Conference.
• Southeast Alabama Medical Center selects PatientKeeper Mobile CPOE to compliment its McKesson HIS.
• MedAptus announces that its Professional Intelligent Charge Capture solution was named Mobile Data Systems Category Leader in KLAS’s annual report.
• Medicity validates its interoperability capabilities at the IHE North American Connectathon 2012.

EPtalk by Dr. Jayne

The media have been all over reports about physicians distracted by their electronic devices. I laughed out loud at this headline, though: Paperwork causes unintended distractions for physicians and nurses. This quick little piece on KevinMD.com is worth the read. I think sometimes we’re so aggravated by our technology that we forget what it was like before.

As a physician, I’m annoyed by lawmakers’ attempts to control how I practice or how patients care for self-limited illnesses. The recent spike in state and municipal laws that restrict purchasing of over-the-counter cold remedies is an example. Communities typically decide (often in patchwork fashion) that these will now be available only by prescription. This drives me crazy, because although I can purchase it over the counter without a prescription, if I prescribe it for a patient it is considered a controlled substance and requires the use of my DEA number and the use of special prescription paper as it cannot be electronically prescribed (at least not now in the state where I practice.)

In turn, this causes patients to spend a co-pay to come see me, plus the insurance company to fund the rest of the cost for an office visit, all so that the patient can purchase a drug that should have cost $4.99 at the local discount store. An article I recently ran across  lets us know that not only have the meth makers outsmarted the restrictions on pseudoephedrine purchase, they’re also driving up healthcare costs in unintended ways. Users have turned to small-batch techniques (the “one pot” or “shake and bake” approach) to make their own meth rather than relying on the large batches typically produced by dealers. This has caused a spike in burn patients when the experiment literally blows up in the user’s face. An Associated Press survey reports that up to a third of burn patients were injured making meth. These patients are often uninsured and their care is more costly than that of other burn patients. The ultimate cost could be in the hundreds of millions of dollars. Definitely something to think about.

Insurers are moving into the mobile health game. Aetna, WellPoint, and UnitedHealth Group are among payers who have jumped into the fray in a big way. I enjoy following HIStalk Mobile and am supportive of things that help patients get more in tune with their health care and personal wellness. I’m a bit skeptical, though, about in-car health. I’d rather encourage people to get out of their cars instead of convincing them that time sitting in them is terribly worthwhile.|

Speaking of personal fitness: for some, obesity continues to cause issues even in death. Due to the potential for decreased learning when working with obese cadavers as well as the difficulties in preparing and storing them, some medical schools are rejecting donations based on size. Scientific donation of a body is a true gift and I am grateful to those individuals and families who choose this route. I’m sad for those who want to make this gift but are unable to do so.

One of my closest friends is gridlocked with his employer over the use of the CMIO title. He’s been doing the job for years but they refuse to recognize him. It may be just a name, but to bolster his spirits I want to share some unusual executive titles. Hang in there, and remember that in your head, you can have whatever title you want. Personally, I think I’ll choose Imperatrix. Now I just need to figure out something equally important-sounding for Inga.

I’ve been trying to get into Twitter, but it seems to be conspiring against me. Since I haven’t been wasting any time tweeting, I’ve been able to continue my pre-HIMSS shoe shopping. Although I’m not eligible for the “Inga Loves My Shoes” contest, I don’t want her to think I’m a slouch, so I’ve been texting her with my finds. So far I seem to be meeting her standards, but I’m not convinced I have the perfect pair just yet.

In response to Monday’s Curbside Consult, readers are continuing to send some great suggestions. I’m looking forward to hitting some of them soon. Please keep them coming!

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

CIO Unplugged 1/25/12

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

The Annual Review

They say people fear giving a speech more than death. I say people fear performance reviews more than speech and death combined.

Despite having had some excellent managers over the years, I can’t say that I ever had a review I enjoyed or gained much from. And frankly, I am not sure how many helpful reviews I deal out. Reviews are not a strength for most. They should be.

Admit it. You appreciate the person who lets you know the tag is sticking out on the back of your shirt. Or that you have oatmeal stuck in your braces. If I’m going on a date with my wife, I often ask my teenage daughter, “Do I look hip in this outfit?” Her enthusiastic nod—or more often, her grimace of embarrassment—tells me the truth. She helps me improve.

We want to know these details about ourselves, trivial as they may be. So why does our attitude change in the work setting? Nothing trivial there. In fact, our efforts—and non-effort—can have a serious affect on the department, if not the entire organization. My performance is never self-contained. My conduct, attitude, and effectiveness cascade through the ranks. My subordinates frequently do what I do … and what I do NOT do. Not surprisingly, their people follow their example.

Does your annual review reflect the real you? Do your assessments accurately reveal your staff?

How easy it is to cave in to temptation and give overly optimistic reviews to avoid discomfort. I’ve done it; you’ve done it. We’re all guilty. At the end of the day, I kick myself because I’ve shortchanged everyone. In fact, I’ve undermined my employee and my organization. Worse yet, if I’m not modeling appropriate and accountable reviews, my subordinates will follow my poor example. (Ouch. I feel the pain as I write.)

This post is as much of a kick-in-the-rear encouragement to me as it is to you. Since it’s that time of year again, we the leaders are going to invest the time and energy to make the review honest and meaningful. You with me?

Here are four tips:

1. Spandex. Brutally, honest friend. If you want to know where you stand with weight management, pull on a pair. Someone can tell me I’m fit, but when I see the rolls of fat hanging over the spandex … as Clapton might sing: ♫ “It don’t lie, it don’t lie, it don’t lie … Spandex!” ♫. This sort of accountability keeps me on the right path. We need Spandex feedback in our careers to ensure that our performance remains in check. Give honest feedback even when it’s uncomfortable. Your employee deserves to know the truth no matter how brutal. Nobody likes flab.
2. Satiate the hunger. Deep down, most of us long to improve. If I can give my subordinates one tangible thing to work on, most will clutch it like a pit bull clenching a bone. Imagine if your boss gave you one strength to focus on every year to help you move to the next level and you really did something with it. You might become CEO. That annual performance review might become something to look forward to.
3. Break it down. Several years ago, I switched to doing performance reviews quarterly with several of my directs. This helped make the annual review less dreadful with those who chose this format. When you’re tracking progress, evaluating, and encouraging throughout the year, there are no surprises to contend with. The annual review almost becomes a formality.
4. Abundance of counselors. If I don’t get a bone to chew or my Spandex feels loose, I move on to other senior leaders that I trust. Some of the best feedback for improvement I ever received did not come out of my manager’s review, but rather from the next office over. I encourage my directs to seek the same. The combination of both leads to spectacular outcomes.

For Christmas, I received the latest in athletic gear, compression shorts. Compression shorts are medical grade – Spandex on steroids. While I track my pulse, pressure, Vo2, weight, blood chemistry, and speed, few things let me know where I stand health-wise better than my new shorts. They offer a whole new level of accountability and transparency.

Honest feedback to stimulate improvement is what our people and organizations need the most. That and Spandex.

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

News 1/25/12

Top News

MedQuist Holdings changes its name to M*Modal, which is the business MedQuist acquired last year for $130 million in cash. CEO Vern Davenport rang the Nasdaq opening bell to commemorate the company’s rebranding and new MODL trading symbol. The company also confirms that most of its executives will work from an office to be opened in Raleigh, NC while company headquarters will remain in Franklin, TN.

Reader Comments

From Lourde: “Re: Party attire. I finally found my shoes for the party last night. Super excited that that is off my plate!! Choosing the perfect shoe – so ‘stressful.’” I feel your pain. I will admit to no one how many pairs of shoes I have bought in the last month because I keep finding what I think are the “perfect” pair. Since we are talking shoes, it’s a good time to mention that this year’s Inga Loves My Shoes contest during HIStalkapalooza will include special shoe categories. Our judges (Lindsay Miller of RelayHealth and Timur Tugberk of DrFirst) have not yet revealed the categories, but I promise to share more soon. Meanwhile, if you are seeking fame in the overall best dressed contest, keep in mind you’ll have an opportunity to be crowned HIStalk King and HIStalk Queen, as well as Best Elvis Impersonator and Best Attire Left in Vegas. Ladies and gentleman, start your shopping.

From Party Central: “Re: invite from DIVURGENT. We are hosting our Kingpin Bowling Social event Monday night during HIMSS. It’s at 8:00 pm at the Palms Casino and Resort Kingpin Suite and we’d love HIStalk readers to join us.” Sounds fun and gives me an excuse to wear my bowling shoes! Here’s the invite and RSVP information.

From Number Cruncher: “Re: Practice Fusion. Their latest press release indicates 130,000 users. Are those all doctors?” The Practice Fusion folks tell me that about 40% (about 52,000) are physicians. I asked for clarification to understand if the 52,000 physicians were all considered “active” users, but not yet received a reply. Regardless, assuming the US has 600,000 office-based physicians, the 52,000 figure would give Practice Fusion about 8.5% of the market.

From GilaMonster: “Re: Awarepoint. Has laid off 10% of its workforce.” We asked the company, with this response from Merrie Wallace, EVP of product solutions and marketing:

Awarepoint has seen a record-setting year for sales contracts and hospital implementations in 2011. Along with its steady growth last year, Awarepoint strategically acquired Patient Care Technology Systems (PCTS) in order to become the only complete RTLS solution optimizing healthcare workflow. After the acquisition, an analysis of the workforce revealed duplicate positions and a decision was made to restructure the workforce. Around 10 positions have been consolidated, though Awarepoint continues to hire strategic positions to support growth and customer support.

From RS: “Re: Catholic Healthcare West. Just changed their name to Dignity Health.” The 40-hospital CHW also drops its Catholic Church affiliation and opens up its governing board to non-Catholics, although its 25 Catholic hospitals will retain the sponsorship of local congregations. The press release mentions the $1.8 billion it is investing in electronic health records. The organization announced plans to triple its revenue, so the change allows it to acquire and partner with hospitals without running afoul of church policies.

HIStalk Announcements and Requests

Our own Travis Good MD of HIStalk Mobile will serve as a guest speaker of a January 31 Kony Solutions webinar, Mobile Strategy for Pharma – Opportunities and Challenges.

Acquisitions, Funding, Business, and Stock

The Advisory Board expects to realize a $3.5 million gain on its recent sale of its OptiLink business to Kronos. Also, Texas Governor Rick Perry announces that his state will invest $500,000 in The Advisory Board, which plans to create more than 200 jobs and invest $8.1 million to expand its Texas operations.

Sales

Rockingham Memorial Hospital (VA) selects Amcom Software’s messaging and communications solutions.

The VA contracts with Decision Simulation’s virtual patient platform for its simulated training and education program for healthcare providers and educators.

Montrose Memorial Hospital (CO) selects PatientKeeper’s application suite.

Unity Health System (NY) chooses dbMotion’s interoperability platform for its 70 locations.

CentraCare Health System (MN) picks iSirona’s device connectivity technology to deliver patient data from its ventilators into its Epic EMR.

Cooley Dickinson Physician Hospital Organization (MA) signs a contract for MedVentive Risk Manager, which it will use to manage its new Alternative Quality Contract with BCBS.

Intermountain Healthcare chooses the mobile application development platform from Kony Solutions to develop its own apps.

The State of New York chooses First Databank and Ernst & Young to survey drug average acquisition costs, a Medicaid reimbursement benchmark authorized by the legislature in 2011.

People

GE Healthcare IT appoints Michael Jackman VP and GM of its specialty solutions business. He was previously with iSoft, Carestream Health, and Kodak.

The Huntzinger Management Group names William C. Reed VP of business development. He’s the former president and CEO of AllOne Health and CIO of Geisinger Health System and Thomas Jefferson University Hospital.

Rubbermaid Medical Solutions names Cheryl D. Parker, PhD, RN-BC, FHIMSS as its chief nursing informatics officer. She was previously with Motion Computing.

Noel Williams, CIO of HCA, announces her retirement, effective at the end of May.

M*Modal names Amy Amick as COO. She was previously GM of worldwide services for Microsoft’s Health Solutions Group.

Mediware promotes VP and Controller Robert W. Watkins to CFO.

Announcements and Implementations

Kaiser Permanente announces that its 9 million patients can access their medical information on a new, free Android app, with an iPhone version to follow in a few months. It offers appointments, secure e-mail, lab results, refills, and a facility locator, all available to both patients and their families acting on their behalf.

UPMC moves all its electronic transactions with suppliers to Toreion’s EDI exchange solution.

Isabel Healthcare and BMJ Group partner to offer Best Practice, which combines Isabel’s diagnostic tools with BMJ’s clinical content. BMJ publishes the British Medical Journal and is a wholly owned subsidiary of the British Medical Association.

Cerner chooses TrustHCS to provide its clients with ICD-10 education.

Innovation and Research

Children’s Hospital Boston offers a $25,000 prize to the researcher who develops the winning best practices for communicating the information found in a patient’s genome to physicians and patients to improve outcomes. The prize carries one of the most contrived and awkward names ever – CLARITY, which they explain stands for “Children’s Leadership Award for the Reliable Interpretation and appropriate Transmission of Your genomic information.” One of the three project leaders is Isaac Kohane MD, PhD of the Children’s Hospital Informatics program. Applications are due March 12.

Technology

Tanking BlackBerry maker Research in Motion continues its unbroken streak of questionable decisions, naming one of its two low-visibility COOs (the one in charge of the RIM’s Playbook tablet, whose sales were so bad even at $99 fire sale prices that the company had to write down $485 million) to replace its two recently department co-CEOs. The new boss says he will mostly follow the path set by his predecessors, except he will hire a chief marketing officer. Shares have dropped 80% from their February 2011 price and took another 4% hit on the CEO announcement.

Apple’s Q1 numbers: revenue up 73%, EPS $13.87 vs. $6.43, crushing estimates with the its highest-ever revenue and profit. In the quarter, the company sold 37 million iPhones (up 128%), 16 million iPads (up 111%), 5.2 million Macs (up 26%), and in the only negative news, 15.4 million iPods (down 21%). The company has $98 billion of cash in the bank. Your $10,000 investment three years ago would be worth more than $50,000 today.

Other

Medical records scanning and document management company EDCO Group will increase the number of employees in its Sioux Falls, SD facility from 40 to 70, helped out with development money from the state’s workforce commission.

Weird News Andy says this isn’t weird, just cool, even though he’ll pass on a spot on the camera recovery team. Researchers in Israel take the “pill cam” intestinal camera system to the next level by developing a version that can be steered by the magnet of an MRI machine.

In a rare public appearance by an Epic executive, COO Steve Dickman provides some company facts to a local technology group:

• 2011 sales exceeded $1.2 billion, up 45% from 2010
• The company expects to add 30 large customers this year
• Construction continues on a new 11,000 seat on-campus auditorium
• 38% of US patients are covered by an Epic product
• The company hires 1,500 new employees a year from 150,000 submitted resumes
• Only five employees work in sales, while 55% do implementation and support
• The average employee age is 29
• The company says it has no interest in buying competitors or being acquired itself

The Wall Street Journal runs a point-counterpoint article on whether the US should implement a national patient identifier. Arguing for: Michael Collins MD, chancellor of the University of Massachusetts Medical School. Arguing against: Deborah Peel MD, psychiatrist and founder of Patient Privacy Rights. Reader votes are running 59% no, 41% yes.

An Ohio hospital’s transparency policy regarding medical errors blows up in its face when the chief medical officer tells the family of a deceased knee surgery patient that his death was caused by malfunctioning lab equipment, which delayed reporting of the high serum potassium level that contributed to his heart attack. Unbeknownst to the hospital, the family had smuggled a tape recorder into the meeting and used the chief medical officer’s recorded admission as evidence in its wrongful death lawsuit against the hospital.

A Florida jury finds that an HCA-owned hospital allowed an uncredentialed surgeon to perform gastric bypass surgery on a patient who suffered brain damage. They award the patient $178 million.

Stanford University researchers find that women report feeling about 20% more pain than men for unknown reasons. Previous studies found that women are more likely to tell doctors about their pain and to delay seeking treatment for it. Here is my theory: men like to be perceived as macho, especially if they happen to be under the care of a cute nurse of the opposite sex. Meanwhile, women feel more cumulative pain between the experience of childbirth and the subsequent carrying of infants, toddlers, kids, and 40-pound bags of dog food. All that, of course, while wearing four-inch heels.

Sponsor Updates

• Humedica and West Health Policy Center announce their collaboration to identify healthcare cost drivers that can be lowered through the use of technology.
• Premier Healthcare Alliance Inc announces a group purchasing agreement with UltraLinq Healthcare Solutions.
• Ingenious Med extends its mobile offerings to Android mobile devices.
• Sparrow Laboratories uses EMRHub from Lifepoint Informatics to send lab results to provider EMRs.
• MEDecision achieves full pass certification for its interoperability tests at the 2012 IHE Connectathon.
• NextGate announces its successful testing of MatchMetrix EMPI at the IHE Connectathon 2012.
• Commonwealth Orthopaedics (VA) selects SRS for its 91 providers.
• McKesson announces an ICD-10 transition service.
• Aspen Advisors publishes a case study on its ICD-10 readiness assessment for East Jefferson General Hospital (LA).
• Jon Phillips of Healthcare Growth Partners discusses his firm’s trade show strategy for HIMSS.
• CHRISTUS Health (TX) selects Compuware’s Gomez Platform to optimize the performance and availability of its EHR.
• AT&T announces communication and infrastructure tools to allow providers to use tablets and messaging more securely.
• Over 10,000 New York State healthcare providers had enrolled in either the NYC Health Department’s NYC REACH program or the NY eHealth Collaborative by the end of 2011.
• Intelligent InSites offers a January 25 Webinar on applying RTLS visibility and lean production principles to healthcare.
• MEDSEEK announces support for the ONC’s “Putting the I in HealthIT” program, which seeks to empower patients to become partners in their own health.
• DrFirst releases a Healthcare Hero video, also offering a HIMSS conference night on the town (limo, dinner, and show) as a prize to one selected person who leaves a comment on the video’s YouTube page.

Contacts

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

EHR Design Talk with Dr. Rick 1/23/12

Computer-Centered versus User-Centered Design

Within the next few years, most physicians in this country will have converted from paper-based charting to electronic health record (EHR) technology. This is an unprecedented technological change in healthcare delivery. Whether this technological transformation succeeds will in large part depend on the design of the EHR software itself.

As a physician in clinical practice, my day-to-day care of patients depends in large part on how easy or difficult it is to interact with my EHR. Like many of my colleagues, I find that while my EHR provides all the necessary functionality, using it requires too much cognitive effort. In other words, the EHR design is computer-centered instead of being user-centered.

What’s the difference between computer-centered and user-centered design? Let me give an example.

Imagine that you and your very young son have recently started playing tic-tac-toe against each other on two networked computers. Your son thinks he should be winning more games, so he proposes a change, not in the rules, but in your screen view, in order to make the odds more even.

While his screen view of the tic-tac-toe grid will remain the same, your screen view will no longer be the standard three-by-three grid, but rather will be a single row of nine boxes.

He enlists his older sister, who is great with computers, to program your new user interface. Each of you can only see your own screen.

The first three boxes in your row correspond to the three boxes in the top row in his grid, the next three boxes in your row correspond to the three boxes in the middle row of his grid, and the last three boxes in your row correspond to the three boxes in the bottom row of his grid.

So, for a particular game, your respective screen views would be as follows:

All of the sudden, you find that you’re working pretty hard just to play tic-tac-toe. You’re working hard because you can no longer ‘see’ the problem.

First you have to mentally reconstruct the normal three-by-three tic-tac-toe grid, then mentally segment your row of nine boxes into three groups of three, and then transpose each segment back onto the appropriate part of the tic-tac-toe grid that you are keeping in your head. (Alternatively, you might decide to solve the problem using a different strategy, but that would still require cognitive effort on your part.)

With a lot of effort, you’re able to stay pretty even with your son, but then your daughter introduces a second challenge — a two-second time limit for each move. At this point, your son starts winning a lot more games than you, restoring family harmony.

What is interesting about this example is that, from a logical perspective, the two screen views contain exactly the same amount of information. And, in fact, if a computer program were using an algebraic algorithm to play tic-tac-toe against you, the screen view would be immaterial.

But for humans, it is clear that the grid view works better. It works because we can literally ‘see’ the solution.

If we see a tic-tac-toe grid, we can visually superimpose horizontal, vertical, or diagonal lines at will. If we are faced with the game position below, we don’t have to compute the slope of the line passing through the two Xs or solve an equation to know whether that line would also pass through the square on the bottom right.

In other words, the human brain is an extremely powerful computer, but one that evolved to help us survive in the physical world by making sense of our spatial environment. Our brain is almost always better at solving problems visually than by using formal logical or mathematical operations.

Donald Norman, a cognitive scientist and pioneer in applying human cognition to design, has written extensively on this topic. In Things that Make Us Smart, he devotes a chapter to why certain design variants are easier for humans than others, even if the variants are formally identical. He includes one diabolical example which turns tic-tac-toe into a variant of Sudoku.

Humans enjoy solving mental games and puzzles for fun, which is why we invent things like Sudoku, but we don’t enjoy them at all when they interfere with complex tasks. Physicians need to be able to devote their full cognitive attention to patients in order to help solve their very real health puzzles.

As physicians, we need user-centered EHR designs that take advantage of our innate visual and spatial perceptual abilities and stay in the background, instead of competing with patients for our finite cognitive resources. Far too many EHR designs force us to play linear tic-tac-toe.

Next post:

Why T-Sheets Work

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

Curbside Consult with Dr. Jayne 1/23/12

I was inspired by Ed Marx’s post last month, Transformation Through the Written Word. He talks about doing book studies with his direct reports, which then expanded throughout the workplace. The thing that most fascinated me about Ed’s piece was his book list. Having been the victim of a boss who tortured his team with 17 Irrefutable Laws of Teamwork, I was surprised (and quite pleased) to find books on his list which didn’t scream “teamwork!” or “leadership!” or “business!”

I’m a voracious reader, although lately I’ve been reading some fairly insubstantial fluff in an attempt to reduce stress and achieve relaxation. One of my best friends keeps recommending things like The Mathematics of Life or The Omega Theory,  but I just can’t seem to get into the mode for deep thinking.

I liked the fact that Ed’s list is eclectic – it includes James and the Giant Peach and Disney psychology along with the classic management and leadership-themed works. One of my personal favorites is The Checklist Manifesto: How to Get Things Right  by Atul Gawande. This book should be required reading for everyone who does anything which remotely impacts patients or other living things. I’ve liked Atul Gawande since reading his first book, Complications: A Surgeon’s Notes on an Imperfect Science, years ago. It helped to make sense of the things I encountered during training and in understanding the psychological complexity of events physicians are exposed to.

Speaking of psychological complexity, I’m already tired of the run-up to the November elections. One of the hot topics is healthcare reform. I’m not convinced that any of the candidates is qualified to actually speak to the issues. The general public gets pulled into the rhetoric as well. I end up discussing healthcare politics with a patient at least a couple of times a day. I recently ran across a book that should be required reading for anyone who thinks they are educated regarding the delivery of healthcare in the United States.

I don’t want to turn into Oprah, but I’m throwing it out there as the first “Dr. Jayne’s Book Club Challenge.” Some talking points from my friend Doug Farrago (of Placebo Journal fame) really sum it up:

• Our society has warped our perception of true risk. We are taught to fear vaccinations, mold, shark attacks, airplanes, and breast implants when we really should worry about smoking, drug abuse, obesity, cars, and lack of basic hygiene.
• Somehow we have developed an expectation that our health should always be perfect.  We demand unnecessary diagnostic testing, antibiotics for our viruses, and narcotics for bruises and sprains. And due to time constraints on physicians, fear of lawsuits and the pressure to keep patients satisfied, we usually get them.
• The bottom line is that most conditions are self-limited. “Our best medicines are Tincture of Time and Elixir of Neglect.”
• There is tremendous financial pressure on physicians to keep patients happy. But unlike business, in medicine the customer isn’t always right. Sometimes a doctor needs to show tough love and deny patients the quick fix. A good physician needs to have the guts to stand up to people and tell them that their babies gets ear infections because they smoke cigarettes. That it’s time to admit they are alcoholics. That they need to suck it up and deal with discomfort because narcotics will just make everything worse. That what’s really wrong with them is that they are just too damned fat.  Unfortunately, this type of advice rarely leads to high patient satisfaction scores.

It’s available now from Amazon, although not yet in Kindle format, which I know will make some of you sad. If you’ve read it, let me know what you think. And if you know anyone in politics, feel free to leave copies on their desks.

E-mail Dr. Jayne.

Monday Morning Update 1/23/12

From KC HIT BootsOnGround: “Re: Missouri’s statewide health information network. A rumor no more … Cerner will not serve as the technical service provider. Statement attached.” Above are last April’s announcement that negotiations had commenced and Thursday’s announcement that they have ended.

From Al Faretta: “Re: Baptist Montgomery. Just wanted to let you know that our clinical system is not McKesson – it’s Cerner. Thanks for all you do – I start my morning with you!” Thanks. That eliminates McKesson’s sole entry in the Thomson Reuters Top 15 Hospitals list and boost’s Cerner’s presence there.

From Karen Thomas: “Re: Main Line Health. I wanted to clarify the systems used at Jefferson Health System, JHS. JHS is comprised of Main Line Health and Thomas Jefferson University Hospital. TJUH uses GE as their EMR. The Main Line Health System uses Siemens Soarian in four of our hospitals and Cerner in one of our hospitals. I understand that this does not change the point of the author, George, but I thought I should point out that GE is not the EMR for JHS. Also, all the Main Line Health hospitals have recently achieved HIMSS analytics Stage 6 designation.” Thanks for the clarification. Karen is VP/CIO of Main Line Health.

From PharmGuy: “Re: Prognosis Health Information Systems. The CTO, who was the brains behind the company and a co-founder, is gone.” I asked Prognosis President and CEO Ramsey Evans about Isaac Shi. He responded as follows:

Isaac is a co-founder of Prognosis and remains a significant shareholder. He has the gift to see the “big picture” and introduce innovative solutions to the marketplace. His leadership of our ChartAccess EHR has been the foundation of our rapidly growing company. As you realize, our marketplace demands a fully integrated clinical and financial solution. As a result, we’ve broadened our focus and Isaac’s responsibilities changed as our strategy has evolved. With the 2006 vision now becoming a reality and confidence in our path forward, Isaac made a decision to look at some other opportunities to expand on his vision. He remains in good standing with Prognosis and is very supportive of our company’s direction.

From Alzado: “Re: separated at birth? Being an HIT guy and a music connoisseur, I figured you would recognize the resemblance.” I do, but I’ll leave it up to readers to figure out how those categories fit this photo. Hint: two first names, both starting with J.

From Pippy: “Re: HIStalkapalooza. Have the invitations gone out yet?” Everybody who signed up will get a response by the end of the week, hopefully – either an invitation or an apology that we couldn’t invite everyone (it’s about 50-50 since we had over 1,000 requests). As much as I like hearing from readers, I respectfully request (based on experience from previous years) that folks don’t e-mail Inga or me to ask (a) what happened to their e-mail, since we can’t control your spam filters, or (b) if we can slip them an invitation even though they didn’t get one or didn’t register in the first place. I’m already overwhelmed. But here’s some good news – next year’s HIStalkapalooza in New Orleans is already somewhat underway, with a sponsor and venue secured. I’m really lucky that companies volunteer to underwrite not only the cost of putting on the event, but to manage the surprisingly complex logistics required to do it right for readers.

From The PACS Designer: “Re: Blue Button initiative. TPD was first introduced to healthcare blogging by Shahid Shah, a fellow blogger, who started HITSphere to power this whole healthcare phenomenon by highlighting HIStalk and other websites. Now, he has blogged about the VA’s Blue Button Initiative and what he sees as its key benefits. Since it is on the NHIN Watch website, you’ll have to create an account there to read his seven key positives of the project. ”

The level of HITECH payouts is about what most readers expected, although a significant minority thought it would be more. New poll to your right: what do you like best about the HIMSS conference?

My Time Capsule editorial from 2007: Crossing the Cliché Chasm: Banished HIT Words for 2007. It obviously wasn’t effective since most of 2007’s overused words are still being repeated endlessly. A snip: “Thought leaders – people smarter than you and me, at least in their own minds. Companies often present their high-ranking employees as thought leaders when they want to sell you something. Thought leaders don’t have real jobs –they just think and cling to HIMSS podia. Picture that Rodin statue wearing a suit or black turtleneck and bringing Dilbert-laced PowerPoints.”

I just noticed that with increasing readership, we’ll be close to hitting the 5 millionth HIStalk visit right around when the HIMSS conference starts. That’s since I started it, way back in June 2003. I sometimes question whether it’s worth the effort, but I still have a blast doing it every single day, as much or more than I did 8.5 years ago.

Listening: I got several outstanding recommendations from reader Cody, including one I posted here way back in 2007 that deserves a revisit: The Hives, a hard-working Swedish garage rock band that doesn’t take itself too seriously (they wear matching but ever-changing black and white costumes and use old-school corded instruments) playing real, raw rock music with a stage presence and energy that makes them probably the best live band in the world. Proof: the live versions of Tick Tick Boom or Hate to Say I Told You So, which is like a 40-years-ago Mick Jagger without the scowling. They’re playing Coachella in April and my MP3 player starting today. When it comes to music, it’s not about their look, their audience demographic, or their age – it’s about how their music makes you feel. If you can sit immobile while The Hives are playing, then we differ.

Vince’s HIS-tory this week pays tribute to Bill Corum, who passed away earlier this month. Vince will have some fun stuff upcoming – I got an e-mail from Elaine Heusing, whose enjoyed seeing a cover of the magazine her father produced, Healthcare Computing and Communications, on one of Vince’s slides. I suggested to Vince that he cover some of those publications of yesteryear and the people who put them out. Back in the day, you waited anxiously for your mail copy of the magazines (even thought most of them were 70% ads, with mostly harmless and vendor-friendly prose intended to not threaten that ratio) and even faxed copies of newsletters like H.I.S. Insider. The folks who published those magazines and newsletters were highly respected, many of them with healthcare IT experience that went above just writing about it.

Welcome to new HIStalk Platinum Sponsor First Databank. The company requires minimal introduction since its electronic drug databases power a great number of the clinical IT systems out there, but here’s a recap. The San Francisco-based FDB’s team of pharmacists, physicians, and technologists, working with its system developer customers, turn drug information into tools that reduce medication errors by empowering clinicians as they make medication-related decisions: drug information, drug selection, clinical decision support, clinical alerts, and patient education. FDB has developed the first physician-friendly CPOE drug database, the OrderView Med Knowledge Base, that gets clinicians quickly (two clicks, in many cases) to the desired medication without bogging them down with needless details related to dispensing or billing (making prescribers choose a warfarin 5 mg and a warfarin 2 mg to get the desired dose of 7 mg is lame – that’s a dispensing decision that prescribers shouldn’t have to worry about.) The company offers case studies of how developer customers have used its products: Design Clinicals (medication reconciliation), athenahealth (meet Meaningful Use requirements), DMD America (drug pricing analysis), and Personal Caregiver (consumer drug information for mobile devices). FDB, whose vision is “A World Free of Medication Errors,” has been delivering drug knowledge solutions for over 30 years and it was recently ranked #1 among drug database vendors in nearly all key indicators in the just-published KLAS report on clinical decision support. Thanks to First Databank for supporting HIStalk.

The Virgin Islands Health Department conducts an EMR and HIE town meeting with mixed results. An interventional cardiologist talks up how much he likes the EMR, but loses his computer connection while demoing it, leading another doctor in the audience to comment that lost connections are typical in her practice and that the infrastructure may not be up to the challenge. Another doc said computerization slowed them down so much that patients were waiting 2-3 hours to see a doctor and she was thinking about finding a different career purely because of the EMR.

Robert Schwab MD, chief quality officer at a couple of Texas Health hospitals, warbles The Ballad of Go-Live in recounting their Epic go-live week by week.

In England, reliably anti-NPfIT MP Richard Bacon calls for the Cerner Millennium patient scheduling system to be shut down after problems are reported by two NHS trusts. Surgeons complained that their surgery schedules listed incorrect procedures and cases that were not within their specialties. Another trust had so many problems with long call wait times and delayed appointments that they had to stop charging patients for parking.

The VA, fulfilling its data center consolidation plan, will move VistA hosting to Defense Information Systems Agency facilities operated by Verizon subsidiary Terremark Worldwide. In a related story that I missed while taking a break last weekend, the military’s AHLTA system goes down for 10 hours after an upgrade-related problem with its commercial data storage software. An unidentified source says the outage highlights the lack of Military Health System contingency plans for AHLTA, such as a failover data center.

Kronos acquires the OptiLink acuity-based staffing solution from The Advisory Board Company. Kronos will use the system to enhance its healthcare workforce management solutions, saying it will support collaborative cost management efforts between hospital finance and nursing departments.

I like this week’s e-mail from Kaiser’s George Halvorson. He’s throwing down the gauntlet on HIV treatment next week and the CMS Health Care Innovation Summit, challenging organizations to meet KP’s HIV death rate that’s less than half the national average and even 20% better than the VA. KP will also share its tools and strategies. Most interestingly, KP has eliminated HIV treatment disparities, with no outcome differences by race, with a goal of eliminating race-related differences in 16 NCQA HEDIS categories. Well done.

A belated holiday-related charity update: HEI Consulting offered a matching donation challenge to benefit Community Services League, raising $15,000 for the Jackson County, Missouri self-sufficiency organization.

Paul Beckwith, former assistant controller of clinical intelligence vendor TheraDoc (acquired by Hospira in December 2009 for $63 million,) is sentenced to 18 months in federal prison for moving $1.3 million of the company’s money to his stock trading accounts. He initially profited from trading and moved the money back monthly, but like many gamblers and speculators, started losing and got desperate to recoup his losses by betting even more. The company got almost all of its money back.

The Secretary of State of Massachusetts goes public with his spat with Meditech over a proposed construction site, saying of Founder and CEO Neil Pappalardo, “Mr. Pappalardo wants the right to do whatever he wants and not be responsible for anything — including the rights to dispose of skeletal remains if they find them.” A public hearing is scheduled for Tuesday on the construction project, which pits jobs against archaeology.

GE reports Q4 numbers: revenue down 8%, EPS $0.35 vs. $0.42. GE Healthcare reported a revenue increase of 1% to $5.16 billion, but operating income dropped by 5% to $953 million.

GE Healthcare lays off an undisclosed number of employees (“less than 50”) at its South Burlington, VT office, citing “changing market demand and technology needs” in healthcare IT.

Police in Russia investigate whether frequent power outages were responsible for the deaths of eight newborns in 10 days, all of whom were on respirators that apparently had no back-up power source.

Clinical documentation vendor MD-IT names Bard Betz as CEO, replacing former President and CEO Tom Carson. Kevin Shaughnessy is promoted to president.

A baby born 16 weeks prematurely at 9.5 ounces (considerably less than a can of soda) is discharged after a five-month stay at LA County-USC Medical Center. The hospital declined to state who is paying the estimated $500-700K cost.They’re still not sure if the baby, now at 4 pounds 11 ounces, has permanent neurological damage.

Reader James thought maybe Weird News Andy preempted him on this story, but he nailed it. A man building a shed thinks he cut himself with his nail gun, at least until he has X-rays, when doctors told him he had actually shot a nail into his brain. His response: “Did you get that out of the doctor’s joke file?” The response: “No, man, that’s in your head.” While being transported by ambulance to another hospital for surgery, he cheerfully posts his X-ray on Facebook. After surgeons successfully removed the nail and replaced a chunk of the man’s skull with titanium mesh, he said, “We need to get the Discovery Channel up here to tape this. I’m one of those medical miracles.”

E-mail Mr. H.

Time Capsule: Crossing the Cliché Chasm: Banished HIT Words for 2007

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

I wrote this piece in January 2007.

Crossing the Cliché Chasm: Banished HIT Words for 2007
By Mr. HIStalk

In its tremendous continuing service to humanity, Lake Superior State University has issued its 2007 list of words and phrases that should be banished from the English language (or American, anyway.) It exposes those overused and misused language extensions that might have been cute for about five minutes, but are just plain annoying now. Think mullet haircuts once hicks started wearing them (and, in some cases, never stopped.) Or, those oft-repeated but outdated bon mots like “Makin’ copies” or “Party on, Garth.”

Some examples from their list are “Gitmo”, “truthiness”, “we’re pregnant”, and “awesome.” I’m trying not to form my hands into a choking pattern just picturing someone using them in my presence or on TV.

As my contribution to the literature, here’s my list for healthcare IT.

Actionable – “information” wasn’t good enough, now it has to be “actionable,” a legal term turned into sales babble.

Applauds – vendors attempting to steal a free ride from someone else’s publicity have hijacked this word. If the President or anyone other than a competitor says anything that might sell more of their product, out comes the “we applaud” press release consisting of one sentence of praise, then a page full of hard-sell hype of why that news is so pleasing to them.

Chasm – blame IOM and their “Crossing the Quality Chasm” for turning a geographical term into a synonym for any tough problem. People writing articles and giving cliché-filled speeches often latch on to this overused word.

Clinical transformation – into what? Hasn’t anyone been transformed yet? Shouldn’t the transformational consultants stop invoicing? Are they just transforming your hospital’s money into theirs?

Closed loop – this is an engineering and biology term gone bad at the hands of HIT vendors. Any two systems they sell are now “closed loop,” even though customers have found many areas in which the loop is quite obviously gaping.

Collaboration – a positive term for everything involving two or more people: a meeting, a loud argument, or a knock-down catfight.

Continuum – healthcare doesn’t start or end in a hospital, which is apparently news to people who keep throwing out “continuum” like it’s a new concept.

Electronic Health Record – “clinical systems” became “electronic medical records” and then “electronic health records,” all without programming changes. You don’t have an EHR unless you are importing information from retail pharmacies, dentists, chiropractors, and home health services. Since no one does, please call vendors out when you hear them throw EHR around in an attempt to put lipstick on their pig.

Integrated – no vendor has ever called their products “disintegrated,” even when they bought them one day before from a defiant competitor. Poor definition and blatant misuse have rendered the word useless. It often displaces the correct but degrading word “interfaced.”

Partnership – a vendor selling a product to a customer. Any resemblance to a real partnership is unintentional, since any partnership base on one partner writing checks to the other would quickly dissolve.

Reimbursement – a cute euphemism for when hospitals or doctors making millions get a check, often for far more than any cost they expended and therefore a far cry from being “reimbursed.”

Robust – possibly the most clichéd of all HIT adjectives. Any application with more than one screen is “robust.” The word is never defined, just repeated as if describing a religious experience.

Solutions – slick salespeople have been calling software “solutions” for years, trying to inflate its value by making it sound more all-encompassing and thoughtful. It forces readers of their brochures and press releases to guess at what the hell they’re talking about.

Space – a sorry dot-com relic pressed into service as a synonym for “market.” Example: “we’re in the business intelligence space.” Fortunately, its use is mostly now limited to those who have it between their ears.

Streamline – every product or service claims to streamline something. It rarely happens, but the appealing image of putting a mess in order is intended to incite demand.

Suite – even tiny vendors repackage their harmless little applications into individually named products to make themselves look bigger, allowing them to claim a “suite” as the result. My eyes roll every time I hear it.

Thought leaders – people smarter than you and me, at least in their own minds. Companies often present their high-ranking employees as thought leaders when they want to sell you something. Thought leaders don’t have real jobs, they just think and cling to HIMSS podia. Picture that Rodin statue wearing a suit or black turtleneck and bringing Dilbert-laced PowerPoints.

Tipping point – usually claimed by someone who would benefit if it really is. It usually isn’t.

HIStalk Interviews Dan Paoletti, CEO, Ohio Health Information Partnership

Dan Paoletti is CEO of Ohio Health Information Partnership of Hilliard, OH.

Tell me about yourself and about OHIP.

I’ll start with the Partnership since that’s really what it’s about. The Partnership is a non-profit created about 2 1/2 half years ago by the Ohio Hospital Association, the Ohio Medical Association, the Osteopathic Association, the State of Ohio, as well as another non-profits. It was designed to apply for the federal ARRA grant dollars that had just been issued. We were awarded the state-designated entity for health information exchange in Ohio by the governor at that time and were awarded those federal dollars as well as we were awarded about $28.5 million of Regional Extension Center monies to help providers adopt electronic medical records.

My background is very simple. I was vice president with the Ohio Hospital Association. Previous to that, I worked for Johnson & Johnson. I’m kind of a data geek. I am really here just to facilitate the grassroots effort of the Partnership.

Ohio is progressive when it comes to healthcare technology, even down to Board of Pharmacy regulations that are both admired and feared. Compared to how other states or organizations have set up their HIEs and RECs, how is your structure different or better?

It’s hard to compare if we’re actually better, but I think we are different. We decided very early on that we were going to use the resources and the expertise that existed already in the communities throughout Ohio. There was no reason to layer on another complex organization on top of all that. We are really a facilitating body to gather together the resources that exist in the state, like connecting the dots and get everybody working in the same direction.

Most of the work is being done at the community level, the grassroots level. It took us a while to get started. We started off pretty slow, but right now I believe we have more doctors than anybody signed up in the country. We just passed 6,000 primary care providers that are using our Regional Extension Center services. That grassroots effort is really the key. That’s what makes the difference.

Early on, groups thought their problems were going to be technical, so they were quick to go through a rigorous process of selecting technology vendors and looking at infrastructure. What blew up in their faces was issues related to bringing competitors together at the table or privacy issues that were a lot different than they expected. When you look at your long term strategy, the question always is, “Well, what’s your business model once the grant money runs out?”

Great question. You did hit the nail on the head with that. It’s really not a technology issue, it’s a trust issue. 

It goes back to our roots. Our board consists of stakeholders from throughout Ohio that have a lot vested in this and building the trust among each community. We’re targeting not Ohio necessarily as a state, but community by community, and using the community leadership to really get people to the table. That’s the key. It’s not about the partnership. It’s not about the health information exchange, it’s about assisting and solving problems in those local communities. That’s really what’s generated the success model to date.

Privacy is a huge issue. We’ve decided with CliniSync , which is what our health information exchange is called, it’s an opt-in model. We have developed a policy that users of the program will assist and educate the patients that are going into the exchange, what that means. It’s not a law, it’s not a state-level policy, but it’s users of the CliniSync program. We’ve tried to address those very carefully. It’s taken us a long time, but we’ve gotten buy-in from most of the major players and small providers in the state. We’re ready to move forward, and we are.

You must have a good message to get that number of providers on board since they typically understand that there’s patient benefit, but it requires extra work and potentially money from them, plus having to work with competitors that they’re not especially fond of. What selling points make them want to hook up to the HIE?

The core message is it’s about the patient. This is about what’s best for the patients in Ohio and the folks that are receiving care in Ohio. The providers in the state understand that. That’s really what’s most important.

We’re not competing about data. It’s not about competing on that. It’s about competing on service and quality. All of this can have a great effect on that as well as bring efficiencies to the table. Once you sit down and look at specific issues around what the electronic medical records and what the exchange can do for that community-based model and really take it down to that level, people understand. It’s keeping the focus on the patient. That really has had a tremendous affect.

Like all statewide organizations, you’ve got some high-profile, big-ego organizations involved. You also have some that are using systems like Epic, which touts its own private HIE capabilities among Epic users. Has that been a problem when you’re working with groups like Cleveland Clinic?

It’s not a problem. It’s one of those issues that you have to really get down to the patient level and figure out what’s best for the community. I’m not sure about this statement, but I think by the end of this coming year in 2012, we’ll probably have more Epic installs than state in the country. 

It’s a unique challenge, but when you look at specific community models, not everybody in every community is using the same systems. You have to be able to communicate with home health agency. You have to be able to communicate with the skilled nursing facility and the competitor down the street. If that patient is moving in and out of all of those, there’s no way that one system solves all that problem.

What we’ve tried to do is position this product as very community-focused, a neutral third party that is a gateway. We’re not storing data. We’re not a data repository. It just allows people to communicate with each other. The focus on the patient has been the key to getting people to work together.

In your experience connecting these different clinical systems that are out there both in the practices and the hospitals, have you found that you had to blaze new ground with vendors who weren’t comfortable with either the technology or the concept of sharing information?

That’s an interesting question. I don’t think technology is quite at the point where we thought it was to allow for the free flow of information. But we’ve worked very closely with most of the vendors, especially the ones that have the bulk of the market, and for the most part they have really been great to work with. They are looking for some standardized process to make all this happen. They really do want this to happen now that this is real, because it is happening and this transformation of healthcare is real. 

It has been a challenge. We’re finding a few that are ahead of the others, but we’re using them to blaze that new ground in sharing that information with the others. Even among the vendor community, what we’ve found is they really do work well together as long as you’re not taking sides. That neutrality is key. But it is blazing new ground, without a doubt.

You had an announcement within the last couple of weeks about using the Direct system to communicate with another state, which sounded good on paper, but somebody might say, “Well, it’s not really that relevant. Most care is local.” Why was that event important?

It really did not affect any patient care. This was really a test of whether we could accomplish it.

If you look at what ONC has tried to do – and I would like to just say that this is all happening, this transformation in healthcare around electronic medical records and exchange, is really a result of this stimulus act, and it’s a result of a lot of the great work that ONC has done — Direct is something that they thought was a way to quickly allow people to exchange information. We want to help them be successful. It was really a communication between two clinics. We really didn’t have a whole lot to do with it except to help them facilitate that process. They wanted to see if it could happen, so it was really instigated by the providers themselves.

The important piece was that you had providers that were trying to exchange information across state boundaries. It wasn’t the fact that we could do it, it was their interest, and we were help in enabling that. But what is important about that is there is information that without sophisticated health information exchange in using this Direct Project, these Direct protocols, it can really help the patients.

Let me give you an example. You have a mental health patient that shows up in the ER. That sensitive type of information is very difficult to exchange in a health information exchange, especially with the laws in Ohio. We see the Direct protocols as a way to exchange some information, with the patient’s permission, explicitly to another provider that they might be going to for a follow-up care. We think there are some definite use cases that that can help. It’s an easy way for doctors to do that. Was it going to change the world? No. But it’s a start.  The exciting part is that it was between the providers. That’s what we want to emphasize.

According to the announcement, that was the first time Direct had exchanged data across state lines. I would have thought it was further along than that. Is there a technical reason that it hasn’t been done or was it just that nobody felt the need to do it?

I think it has a lot to do with everybody ramping up. The Direct protocols are fairly new. People are ramping up trying to create those protocols and create the secure e-mail systems. There’s nothing new about secure e-mail, but getting the providers provisioned with an address and making sure that everything adheres to HIPAA compliance and all of that — it’s complicated for a lot of folks to get that up on a large scale; especially with a lot of folks that received these state-designated entities. We’re getting close. We just happen to be a little bit out in front, but I think you will see a huge charge of other states and other entities doing this now. We just happen to be a little in front.

What does the big picture look like when there are HIEs springing up from two places that are a mile apart to crossing multiple states, you’ve got the Direct protocol out there for folks to use, and maybe private HIEs that vendors have set up. How will the average medical practice be interoperating?

I’d like to speak for Ohio if I could. The picture here is really community based. The reason that’s important is that the majority of care occurs inside a community. That community could be a single town, it could be a county, it could be multiple counties. But there is some geography where the bulk of care occurs. Ensuring that that information can be exchanged, whether there’s two regional health information exchanges that exist within that community or whether it’s a community without any ability to exchange. The vision that the partnership board and the grassroots stakeholders in the state that are part of OHIP see is that the partnership can be that gateway to facilitate that.

Again, it’s not about us. It’s not about our ability to store and retrieve data. It’s about our ability to allow others to communicate with each other. And for a while – I don’t know whether it will be five years, 10 years, 20 years — there’s still going to be some middleware required to allow that type of exchange to occur. I think that was the vision of ONC — to facilitate this.

In Ohio, our model is just a little bit different, but we’re pleased because we have a lot of folks that have already expressed interest and commitment to make that happen regardless of where they stand technology-wise. That’s our vision, it will be interesting to see what happens though in the next five or 10 years.

The jury seems to somewhat be out on whether Regional Extension Centers are really increasing EHR adoption and whether they’re helping technology improve outcomes and reduce costs. Do you get the sense that they’re accomplishing what they were supposed to?

Our process is a little bit different. It all starts with electronic medical record adoption. It’s hard to accomplish all that without widespread adoption, so that’s where we spent the last two years, really working with our community leaders to adopt the electronic medical records. The next stage is working with the community stakeholders to begin to exchange that information and get a solid base of exchange going so we can start to work as a community on the outcomes and improving quality.

It’s connecting the dots. It’s been a phased approach. I think it will be difficult to accomplish the vision that many people have set without that kind of phased approach. We think we can, because we are accelerating things here in this state. Adoption is the key.

There was huge interest in HITECH money early on, but it’s starting to look like some folks gave up or decided it wasn’t worth doing. Are you seeing people who thought they might be going with electronic health records who saw the wall in front of them and decided to stick to where they are?

In the beginning, there was a lot of doubt and a lot of concern. I do think we did have some people drop off. But what we did here in the state is develop that grassroots support mechanism, so the physician and the practices and the small hospitals weren’t out there by themselves. They had a support structure in place. Because of that support structure, I think you will see an incredible acceleration of Meaningful Use attestation in 2012.

Ohio, I believe, ranks third as far as Medicaid payments for Meaningful Use and we also are at the top as far as Medicare attestation. Our goal for next year is to help 10,000 providers attest to Meaningful Use, not just primary care providers, but all providers. It’s pretty lofty, but because of that support structure, we’re trying to accelerate and keep things moving forward, because without that, we’re not going to see the benefit. That’s our number one priority. The key is that support structure — they have to have somebody to fall back on.

Is there resistance to the check-off for Meaningful Use that it isn’t really directly related to patient care?

That’s a very difficult thing to answer, especially where we are right now. Is the Meaningful Use criteria going to directly affect patient care? I think it will, in the sense that as providers have to work towards meeting that, it’s going to naturally bring along more and more of the practices as far as how it’s going to affect that patient outcomes. It was a great starting point, but what people have to realize is there’s only so much at the federal level that they can make happen. It really comes down back to that community level in putting the support structure in place to help people meet Meaningful Use. 

Then make the next step to help them exchange that information, then get these projects together that will help providers learn from each other and really make the impact on patient care in the outcomes and the efficiencies — because we have to have the efficiencies as well. It will happen. It’s just coordinating all that together, which is a monumental task. 

Every transformation is hard. It’s about having that support structure in place at the grassroots level to help facilitate that. It will happen. We spent a lot of time looking at the return on investment of electronic medical records, return on the outcomes of care of electronic medical records. I think there’s enough documentation out there now to prove that yes, it does have an affect. We want to be able to prove it has a significant effect. We think in a couple of years that we’ll be able to do that.

If you look down the road, let’s say five years, how will you know that you’ve done the job you hoped to do?

I can tell you the goals we have in place. Our board and our stakeholders make sure that we’re very goal-oriented.

To document success is the number of providers that have adopted; the number of providers that have attested to Meaningful Use; the number of providers and institutions that are sharing information; and then ultimately getting the entire community — the payer community, the employer community, the patient-consumer community, as well as the provider community — to get enough data to document that we have had an impact on the outcomes and the cost of care. And getting everybody involved in that process.

Can I give the exact metrics that we’ll need to prove that? No. But we have enough momentum now that I believe in five years, at least in Ohio, we’ll be able to prove what kind of success that this whole thing has caused. We’re pretty excited about that.

Any concluding thoughts?

This is really an exciting time for Ohio. ONC has enabled us to jump on board with this and provided the funds we’ve needed to help create transformation here in the state. It’s not about our organization. It’s really about the folks out in the community doing the work. We’re here to help them, and we hope to be one of those models of success that people can point to and say, “Look, if you can do it like this, you’ll be successful.”

News 1/20/12

Top News

Minnesota’s attorney general sues revenue cycle vendor Accretive Health for losing a laptop last summer that contained patient information from two hospitals that had contracted with the company. The unencrypted laptop was stolen from an Accretive employee’s rental car. The lawsuit demands that the company inform patients in the state what information it keeps and how it uses it, saying the company “showcases its activities to Wall Street investors but hides them from Minnesota patients.”

Reader Comments

From MountainMan: “Re: Pre-HIMSS insanity. Here is a picture of the first of many to come ridiculous invitations, overnight letters, and expensive marketing crap that will be headed my way. ‘Tis the season to determine the vendors with more money in marketing than in development!”  

From WorkingGirl: “Re: Manager Systems. Love this graphic– makes me think of managers with weird heads in charge of the place. One (red) is totally defeated, head hung. The yellow head is going along to get along (the ‘whatever’ approach,) and the blue head is ‘blue sky thinking’ or ‘head in the cloud.’ I have worked for them all and more!” The logo is for Manager Consultoria em Informatica LTDA EPP, a Brazilian company recently acquired by 7 Medical Systems. The blue one actually looks like a dunce cap, which might be apropos for some managers.

From Otoscope: “Re: Epic. I hear that Epic is competing for a deal in NYC. I wonder if the puff piece in the Times about how cool their campus is and Judy Faulkner giving them a rare interview isn’t an Epic marketing push to win over some decision-makers struggling to find a reason to pay Epic’s exorbitant asking price? Maybe there’s a pattern of newspaper exposure where Epic had other high-profile deals on the table.” The article also claims that Epic steals the best programmers who would otherwise be working for Google or Facebook, which seems a bit of a stretch given Epic’s reputation for hiring new grads with no experience. I doubt many world-class programmers are torn between working with cutting edge technology for Facebook in the Silicon Valley vs. moving to chilly Wisconsin to write MUMPS just because Epic’s campus is cool (not that there’s anything wrong with that, especially if they’re doing it for the satisfaction of helping patients.) The article was a bit fawning, but it was a business feature, not a hard-hitting expose’.

From George: “Re: your question about the systems used by the Thomson Reuters Top 15 hospitals. Check this out.” It’s almost all Cerner and Meditech, with only one Epic customer in the bunch. Only a third of the Top 15 are at EMRAM Stage 6 or 7, and of those, Cerner has three customers and Meditech has two. I like to think these facts prove my oft-stated points: (a) it’s not the IT you have, but how you use it; (b) IT can make good hospitals a little bit better, but it’s not going to transform low-performing hospitals into stars; and (c) your mileage will assuredly vary, so just as buying a toupee and a flashy Corvette won’t make you as popular with young ladies as your 20-something nephew, don’t put all of your organizational eggs in the IT basket in hopes of a miracle. And to cap it off with my most annoyingly repeated tagline, plenty of incompetent carpenters own great hammers.

HIStalk Announcements and Requests

Some goodies you might have missed this week on HIStalk Practice: Greenway Medical sets the target price of shares for its upcoming IPO at $11 to $13 per share. Physicians who have an ownership interest in their practice are more likely to think their EHR implementation is difficult. Telemedicine enhances dermatology care. Upcoming Meaningful Use deadlines for eligible providers. Smaller practices may have more difficulty with the 5010 transition than their larger counterparts. Dr. Gregg explains why he isn’t satisfied with the market’s EHR options.  Thanks for reading.

We’re sponsoring something new for HIMSS conference attendees: the First Annual HIStalk Booth Crawl. We’ll be sharing more details as the conference gets closer, but here’s the big one: we will be giving away over 40 iPads generously donated by sponsors. We’ve canned the silly stamp cards, eliminated the reviled “must be present at the very end of the conference to win” restriction, and improved the chances of winning by offering dozens of cool iPads instead of one motorcycle or set of steak knives. Contestants just need to visit some booths or Web sites to be in the running for one. It will be fun, especially for the winners. It’s fun for our sponsors as well, considering that some companies have charged vendors up to $20,000 to participate in similar events and we’re charging nothing just because we like seeing readers get iPads.

Another super HIStalk-sponsored event: a shoe drive benefiting Soul4Souls, a charity dedicated to the distribution of new or gently worn shoes to people in need across the world. A couple of HIStalk sponsors will have drop off boxes in the HIMSS exhibit hall and we’ll also accept shoes at our HIStalkapalooza event (sorry, you still need an invitation.) The terrifically creative folks at Friedman Marketing Group presented the idea a few months ago and of course I fell in love with it. The curmudgeon Mr. H doubts that people will be willing to lug an extra pair of old sneakers all the way to Las Vegas to donate; however, I seek to prove him wrong. I know there are enough shoe-loving HIStalk fans that appreciate the joy of a newish pair of shoes and who would find some room in their suitcase in order to assure the world is a more joyful place. I might even wager Mr. H on this since I so sure he’s wrong.

Welcome to new HIStalk Platinum Sponsor Fulcrum Methods. The Oakland, CA company provides tools and expertise that help providers manage projects, programs, and change initiatives: work plans, guidebooks, and electronic document and worksheet templates. For hospitals or EPs interested in Meaningful Use, the company offers a structured approach and SaaS-based tools for evaluating EHR capabilities, tracking met and unmet requirements, and assessing resource needs for compliance (notable users include Lucile Packard Children’s Hospital and Maine Health, to name a couple.) It’s EP Tracker allows easy MU oversight of affiliated EPs, making sure they are ready to attest, tracking their attestation, and managing the result flow of funds. An interesting service is Pre-Attestation Compliance Services, providing a defensible, documented review that proves to potential CMS auditors that the attestation was legitimate. Other tools and services cover Program Management Office methodologies, change management, long-range planning, and vendor selection and system implementation methodologies. Good IT departments often need nothing more than proven tools, processes, and structure to boost their own proficiency and that’s what Fulcrum Methods offers. Thanks to the folks there for supporting HIStalk.

If you agree that mobile health in its various forms is important, you might want to drop by HIStalk Mobile and sign up for the e-mail updates there. Travis is really good at understanding that market and he’s not shy about saying which products he likes and which ones he doesn’t (and as a doctor and a mobile health startup guy, he’s plenty qualified to offer his opinion.) Read his latest post and I bet you’ll find at least a handful of items that are interesting and useful.

On the Jobs Board: NextGen Go-Live Support, SCM Go-Live Support, and Cerner and Epic Resources. On Healthcare IT Jobs: Implementation Consultant, Epic Willow Consultant, IT Interface Analyst, Epic Certified ASAP Builders, and Senior Applications Programmer/Analyst.

Want to support what we do and make Inga happy? Here are some ideas: (a) stick your e-mail address in the Subscribe to Updates box to your right so you get the news before everybody else, at least everybody other than the 7,800 readers who preceded you in signing up; (b) support our delusions of popularity by connecting with us on LinkedIn and Facebook; (c) while you’re on LinkedIn, sign up for the HIStalk Fan Club that Dann started long ago that now has 2,089 members – when people ask me for something, that’s the first place I look to see if they really are fans; (d) send me news, rumors, pictures, music recommendations, or anything else that might tickle my fancy; (e) peruse with ill-concealed wonderment the roster of fine companies who support HIStalk, perhaps clicking an ad or two, checking them out on the Resource Center, or using the Consulting RFI Blaster if you need consulting help; and (f) look squarely into the mirror and give a world-weary nod to the person who makes it easier for someone who’s already worked a long hospital day to come home to another five hours’ worth of HIStalk work – that would be you, thanks. 

Acquisitions, Funding, Business, and Stock

Private equity firm LLR Partners acquires Paragon Technology Group, a provider of strategy technology solutions to the public sector, including HIT. LLR appointed former Xerox and GTSI executive Scott Friedlander as president and CEO.

The healthcare merger and acquisition market generated 980 deals worth $227.4 billion last year, of which 435 involved the technology segment.

Release of information vendor HealthPort has retained Credit Suisse to find a buyer for the company, reports suggest.

UnitedHealth Group reports Q4 numbers: revenue up 7.9%, EPS $1.17 vs. $0.94, beating consensus expectations by $0.13. Its Optum unit was credited for contributing to the insurer’s $1.26 billion in quarterly profit.

Sales

Arnot Ogden Medical Center (NY) expands its relationship with Surgical Information Systems (SIS) by selecting its anesthesia module.

Nationwide Children’s Hospital (OH) renews and expands its five-year licensing agreement with Streamline Health Solutions, adding additional document management and workflow solutions.

People

HealthGrades announces that its founder and CEO Kerry R. Hicks will assume the chairmanship of the company’s board of directors. The current chairman, Roger C. Holstein, will assume the CEO role.

The Federation of American Hospitals promotes Samantha Burch from director of healthcare policy and research to VP of quality and health information technology.

CollaborateMD, a provider of PM and billing software, hires former Lockheed Martin executive Stephen Hightower as chief strategy and technology officer.

Mobile app provider Happtique names Ben Chodor CEO. He was formerly with InterCall.

Peter Longo has joined Predixion Software as global sales leader. He was previously VP of sales with Allscripts.

Netsmart Technologies hires Dennis Morrison PhD as chief clinical officer. He was previously with Centerstone Research Institute.

Announcements and Implementations

Sharon Regional Health System (PA) unveils its new $3 million, 5,000 square foot IT department that will connect to the health system’s 18 facilities.

QuadMed, which operates 22 on-site primary care clinics in 12 states for large employers, adds telemedicine to its slate of services.

Westchester Medical Center (NY) selects QuadraMed’s identity management solutions.

TELUS Health Solutions launches MyHealthReference.com, a health reference portal for Canada.

Government and Politics

The GAO reports that the National Quality Forum (NQF) failed to complete five of its eight projects promoting EHR on time. The GAO blames both NQF and HHS for “overly ambitious deadlines, given the scope and complexity of the work.”

Other

Titus Regional Medical Center (TX) fires a nurse looking at medical records she was not authorized to view. The nurse claimed she only looked at the 108 charts because she was “curious.”

The teen who made headlines last year for impersonating a doctor in a Central Florida hospital is arrested again, this time for pretending to be a police officer. The 18-year-old was driving with a sheriff’s badge, a pistol loaded with hollow-point rounds, a Taser, handcuffs, a police radio, police lights, and a dash-mounted laptop. He got caught after advising a motorist stopped at a traffic light to fasten his seatbelt, unaware that the driver was coincidentally an undercover detective.

Sponsor Updates

• Picis releases a case study profiling Winter Haven Hospital’s (FL) use of Picis ED PulseCheck to drive patient satisfaction.
• World Wide Technology Inc. ranks #50 on the Fortune 100 Best Companies to Work For list for 2012.
• Bloomberg Business profiles Digital Prospectors Corp.
• CynergisTek CEO Mac McMillan will lead several IT security discussions and workshops during next month’s HIMSS conference.
• DIVURGENT Managing Partner Colin Konschak discusses the future of healthcare and the viability of ACOs in a company blog post.
• SIS successfully demonstrates its perioperative interoperability at the IHE North American Connectathon.
• Quest Diagnostics announces a grant program to provide eligible providers with an 85% discount off the retail price of its Care 360 EHR, including fees for licensing, hosting, support, training, and implementation.
• Craig Hospital (CO) deploys Access Intelligent Forms Suite as part of its patient safety initiative.
• A Beacon Partners survey finds that most hospitals understand the value of HIEs and plan to participate in them, but the hospitals don’t have an adequate budget to participate and are concerned about HIE costs and governance issues.

EPtalk by Dr. Jayne

I’m excited to report that the pre-HIMSS advertising schmooze-fest has started. I was getting a little worried since I hadn’t seen anything yet – not even a post card. The first e-mail came from Hyland Software, which will again be at HIMSS with their OnBase Sports Bar & Grille, offering three daily happy hours. As for other exhibitors, they’re still pretty quiet. One thing is for sure though – I’m hoping that the always-delightful IngaTini will return.

The first CCHIT eNews blast of the year highlights Mr. H’s recent interview with Bobbie Byrne MD MBA, VP/CIO of Edward Hospital and a CCHIT commissioner.

American Medical News advises small practices to guard against security breaches amid concerns that basic security is taking a back seat to the focus on Meaningful Use. I’ve experienced data breaches personally: the Veteran’s Administration; my bank; and now Zappos has notified me of “illegal and unauthorized access” to my account. I’m sure they were after credit card information, but I hope they find humor in the sheer variety of shoes in my account history.

Speaking of credit card information, a recent article spotlights physician offices that require patients to provide credit card information, calling the practice “jarring.” One reader comment states:

When I sit and wait past my appointment time, I always send the doctor a bill by registered mail. I charge $100 an hour for wait time. If I have to wait a half hour, I send him a bill for $50. I have done this three times in California. Each time, they refused to pay the bill. It cost me, but I take them to small claims court. In California, no attorney can represent you — the doctor has to defend himself. They always pay the $50 or $100. They won’t take a day away from the practice to go to court. I had to find another doctor, of course. There are more doctors than attorneys. But I cured them of sucking eggs.

I hope this guy doesn’t show up in my practice. I also hope he never has an emergency medical problem or crisis that causes his physician to run late for the next patient.

E-mail of the day from the AMA: last fall, physicians had the opportunity to seek hardship exemptions and avoid penalties for failing to successfully participate in Medicare’s e-prescribing program. The Centers for Medicare & Medicaid Services (CMS) is reviewing each hardship exemption request on an individual basis and has not yet completed its analysis. Therefore, it is possible that some physicians will be subjected to a 1 percent Medicare payment penalty inappropriately until the backlog of exemption requests is reviewed. Ultimately, CMS will reprocess the claims. No mention of how long it will take or how much CMS is spending on the review.

USA Today reports that 1% of Americans are responsible for 22% of healthcare costs in 2009. Nearly half of health care spending can be attributed to just 5% of patients. The data is from the Agency for Healthcare Research and Quality, but most primary care physicians could tell you that just from gut feelings.

I was initially sad at hearing that a researcher at UConn who has published several articles on the health benefits of red wine apparently falsified his data. It’s unclear whether the data manipulations affected study outcomes. Reviewers have been combing through his research since an anonymous complaint in 2008. The list of deceptions found in the research are almost unbelievable – I’ve judged elementary science fairs with more integrity. My spirits were bolstered, however, by a recent article in the Journal of Women’s Health sharing a recent study finding that red wine has activity similar to a group of medications called aromatase inhibitors which are used to fight breast cancer. White wine drinkers take note – this is strictly an attribute of the reds.

Contacts

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

Readers Write 1/18/12

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

The EHR Bubble Will Pop—To the Victor Go the Spoils
By Evan Steele

There is no question that the EHR incentives have created a frenzy of EHR purchasing and that the trend will intensify in 2012 because this is the last year to qualify for the full $44,000. As I look at what’s happening in the market, it becomes apparent that at some point in the not-too-distant future, the EHR bubble will pop and many vendors will face financial challenges that will lead to their demise.

Despite the surge in EHR purchases in 2011 and 2012, it is important to recognize that there will be some unintended consequences of the rush to meet the government’s deadlines and requirements. Many physicians will be unhappy with their newly acquired EHR because, in their haste, they made a poor product choice. Others will face a rude awakening as they are forced to use their EHR in ways they never have before, and discover that it does not support their workflows. In the rush to market, there will also be some products that, while certified, are of inferior quality—possibly developed offshore.

Vendors will be backlogged and unable to manage the surge in new purchases in a timely manner due to insufficient staffing levels. Many will come to market short of the necessary educational resources to help physicians navigate the complexities of Meaningful Use, and physicians will find themselves victims of inadequate, rushed EHR implementations by green, wet-behind-the-ears trainers. Other vendors will be so overwhelmed that they will fail to keep to their promised implementation schedules, preventing their new clients from meeting the government’s timetable entirely.

In the years following the initial boom, many physicians will become disillusioned with the EHR Incentives Program. There will be too many requirements that will seem either burdensome or irrelevant to their practice—or both. As the increasingly stringent Stage 2 demands are weighed against the drastically decreasing dollar value of the incentives, physicians will either abandon the program or trade the EHR they originally purchased for one that supports not only the government’s needs, but also the workflow needs of their practices.

To see what will happen to many of the EHR companies, it is important to understand how they are financed. In order to raise money, companies had to show investors a story anticipating significant new client acquisition. Initial funding for EHR companies was based on “hockey stick” growth projections, fueled by the availability of government incentive money. Each individual company’s projection anticipated rapid, accelerating, and long-term growth in EHR demand.

The first thing to recognize is that these projections were overly optimistic. In fact, if you add the projections of all the EHR companies together, they would grossly overstate the total potential market. To excite investors, a typical start-up EHR company seeking funding was likely to predict that it would have 5,000 customers within five years.

With a population of approximately 600,000 physicians serving the ambulatory market — 25% of whom may never adopt an EHR due either to approaching retirement age or doubting that the penalties will ever be imposed –there is a potential market of 450,000 physicians. ONC’s Certified Health IT Product List (CHPL) website currently lists 472 vendors that offer at least one “Complete EHR” product. A conservative assumption that the top 20 vendors will together secure half of the physician market leaves the other 452 vendors competing for their share of the remaining 225,000 physicians. This represents an average of 498 physicians per vendor—not even a paltry 10% of their projections.

The circumstances described above present a textbook case of a dramatic bubble followed by a dynamic shakeout. Whether at the end of 2012 or in 2013 (when the bulk of the incentives are no longer available and physicians will have to focus on the conversion to ICD-10), the bubble will pop, and the financial fallout will be significant. Missed growth projections, government money drying up, and mounting physician dissatisfaction will leave many companies unable to find investors willing to fund their future growth. Scores of companies will face a cash crunch as revenue growth slows, or revenue declines, in the face of continued and significant expenses for implementations, support, ongoing upgrades and certification requirements, etc.

As in the dot-com era, strong companies will survive. Those that generate other sources of income from a deep set of products that offer alternative growth opportunities will be around to take advantage of the second EHR bubble that will be fueled by the looming EHR penalties, the development of ACOs, and new pay-for-performance programs, among other factors. There will be a trend toward consolidation, and financially strong companies will acquire distressed companies for pennies on the dollar, reaping the benefits of their unique technologies and/or their customer bases. To the victor go the spoils!

Evan Steele is CEO of SRSsoft of Montvale, NJ.

HIMSS Prep: Get Inside the Head of Your Customer
By Rosemarie Nelson

How much is it costing you to exhibit at HIMSS? It’s all about making a connection, developing a relationship, and delivering results. That’s why you’re exhibiting. These are my tips for vendors on the trade show floor.

First, Do Your Homework

What do you know about HIMSS? How many members? How many are attending? How many physicians are in those organizations? What else is important for you to know?

Who is walking the floor? You expect to see the C-level. The significant physician. Directors, administrators, and managers. Those from the academic world of academics. And “other.” Other means influencer. Think of the impact of the media, consultants, attorneys, accountants, and spouses. They know, work, eat, and maybe even sleep with the purchasers. Smile and greet them all.

They’re smart. Chances are they are graduate level. They are ready with questions that delve deeper than your elevator pitch. Prepare your answers.

They are boomers, more than any other generation. Are you Generation X or Y? How do you relate to the boomer’s characteristics? How does the boomer relate to you? Regardless of generation, the attendees will fall into one of the following cohorts:

• Wide-eyed wonder (first-time attendee)
• Seasoned cynic (been here, done it all)
• Social butterfly (came for HIStalkapalooza)
• Loyal customer (wants to learn even more)
• “If it’s free, it’s for me” (expert flea market goer)
• Heads-down tweeting and texting (oh, that’s you, the exhibitor!)

Like a Boy Scout, be prepared. Engage the enthusiastic, be cautious with the cynic, curb the chatty, appreciate the customer, and WALK AWAY from your smart phone while you’re in the exhibit hall.

Next, Know the Buzz

• Reimbursement will continue to decrease.
• Regulation will increase.
• Business and government focus on clinical quality will intensify.
• Payers will increasingly pay for demonstrated performance.
• Hospitals will employ larger numbers of established physicians.
• New physicians will continue to seek hospital employment over private practice opportunities.
• Increased consolidation among hospitals and physicians will result in intense competition for insured patients in local markets.
• Improved technology will facilitate — and force — change in healthcare delivery.

Then, Know the Trends

• Consumerism and patient-centered care.
• Transparency and everyone knowing how much healthcare costs and how effective it is.
• Value, represented by quality and safety in relation to cost.
• Metrics and developing gold standards. 
• Information and technology that delivers real-time data on the patient, processes, and systems.

Consumerism Trend

As the population statistics change and the baby boomers age, health care costs rise. Telemedicine, smart phones, direct-to-consumer marketing and the economic constraints on organizations’ fundraising efforts are all opportunities and threats to the traditional methods for delivering health care.

Mobile Technology Trend

Reduces need for hospital admissions and physician office visits. 40% of physicians say they could eliminate 11% to 30% of office visits through the use of mobile technology (PWC Health Research Institute, Sept. 2010). Why would providers accept technology that hurts incomes?

Insurance and Coverage Trend

Medicare spends more than 25% of its budget on patients in their last year of life. As a society, we can’t keep up with the growing needs for coverage and care: state budget constraints, federal budget pressures, and unwillingness to raise taxes. By increasing the preventive services and by monitoring key measures specific to chronic diseases, payers expect to improve health outcomes and reduce overall costs based on reduced hospitalizations and additional procedures.

ICD-10 Requirement

The costs of transition are almost as much as the costs to acquire an EHR.

And Finally, The Bottom Line

Does your solution address one of these trends? Why does what you do or provide matter to the exhibit hall walker? Each buzz signals a reduction in costs to the health care system, which means reduced income to those delivering the service. Are you signing up for a reduction in your income? No one wants to do that. How can you improve that income picture for your potential client?

“How does this solution/product help me?” is running through the mind of that exhibit hall walker. Do you know enough about them and their issues to answer that question? Challenge the conventional thinking in your sales process. If you keep doing what you’ve always done, you’ll keep getting what you’ve always gotten. Is that really what you want from your investment in HIMSS 2012? 

Rosemarie Nelson, MS is principal consultant with MGMA Health Care Consulting Group of Englewood, CO.

The Biggest Mistakes Companies Make in the War for Healthcare IT Talent
By R. Gaines Baty

“War” is officially declared and the healthcare industry is the battlefield. We speak of “The War for Talent” in healthcare – the perfect storm at the intersection of ballooning demand, limited supply, and mandated urgency, with no viable solutions but to accept mediocrity or fight for the best. 

This is not a new phenomenon, nor is it unique to the healthcare industry. Similar forces were at play in the IT industry leading up to Y2K. We in healthcare, as a result, now find ourselves in a candidate-driven “seller’s market” for executives.

No organization can excel without great leadership. Most chief executives agree that for an entity to ascend to and perform at an optimal level, it must attract and retain the best leaders possible. Some, however, don’t align their own recruiting processes with this fundamental truth.

We’ve pinpointed several of the more common and detrimental mistakes potential employers make in the pursuit of great executive talent. Of course, relevant candidate flow is crucial (and the reason good search firms are in business.) This said, the following issues can derail the pursuit of excellent potential leaders.

1. “Perfect Profile” expectations. It is advisable to first seek the perfect match. However, recruiting is not pizza delivery. When a comprehensive search is producing quality candidate flow, the market will reveal the caliber of talent and credentials available to the company. If and when the elusive “perfect person” does not appear, organizations may be best served by evaluating through a different lens. Prioritization and flexibility are required in this approach, with due credit given for transferrable skills and a recurrent track record of success. The operative question must become, “Can she do the job?” Strong performers come in different packages, and may not appear perfect at first glance. One can find something lacking with anybody, even a candidate fully capable of achieving an organization’s objectives.

2. Failure to “sell” the candidate. Excellent candidates typically have multiple suitors and are not necessarily looking for a job. Therefore, everyone in the recruiting process should reinforce consistent and inspired organizational vision, importance of the role, opportunity for success, potential for recognition and reward, and future career opportunities. Undoubtedly, effective candidate evaluation is paramount. Simultaneously, however, a consistent and compelling value proposition must also be perceived by the candidate. This should be complemented by a prompt decision and an appealing compensation offer. Candidates should be treated like prospective customers. We must bring our “A” games to the interview room.

3. Poor communication, indecision and ineffective processes. Organizations frequently drag out hiring decisions nonchalantly for months; communicate inconsistent visions; utilize inconsistent or ineffective evaluation criteria; inadequately communicate with sponsors or recruiters; conduct distracted or unprepared interviews; and generally create unimpressive or sloppy candidate experiences. This same process may be a candidate’s only window into the soul of a potential employer. In contrast, competitive suitors with crisp, clean recruiting processes will quickly eclipse others for this top performer’s services.

In summary, big game hunting for high quality leadership can reap huge rewards. However, the real stars are rare and may appear differently than we first imagined. Competition is stiff. The hunter only has one shot at the target, before it disappears.

R. Gaines Baty is president of R. Gaines Baty Associates of Dallas, TX.

News 1/18/12

Top News

Thomson Reuters names its Top 15 Health Systems that have achieved superior clinical outcomes based on quality, patient perception of care, and efficiency. If anyone knows how many are Epic, that would be interesting given all the lofty ambitions expressed by customers trying to justify their expensive projects. Or for that matter, how many are HIMSS EMRAM Stage 6/7 since HIT cheerleaders are always trying to make the connection between HIT and outcomes.

Reader Comments

From Barefoot in Vegas: “Re: Trade show shoes. AMAZING TOPIC!!!!!!! Please send me your show list.” I love people who don’t chinch on exclamation points, so I was happy to share my shoe brand tip with Barefoot. I admit I was amazed (!!!) how many people were interested in my footwear insights. It made me feel a little like Oprah.

From Social Profiteer: “Re: pimping HIT tweets. Apparently so-called news organizations, especially those owned by HIMSS, are willing to sell out their readers.“ I can’t decide which is more interesting: (a) charging vendors $10,000 for a couple of tweets,  or (b) vendors thinking that barraging a news site’s readers with unwanted Twittermercials is actually hip, progressive marketing that will benefit those companies. It seems kind of unsavory and reader-insulting for a company with “news” in its name to be doing this kind of revenue augmentation without regard to the potential damage to whatever reputation it has, but it’s really none of my business – that’s between the publication and its readers.

From Harcourt: “Re: inpatient MU attestation. Please post this graph. I believe the huge gap between Cerner, Meditech (including its contribution of HCA’s attestation), and Epic would create interesting discussion.” The graph is here. As with EP attestation numbers, I would be cautious about trying to apply client MU figures to the likelihood of a given customer earning MU money. Meditech has more live hospitals than anyone, so I’d expect its numbers to beat those of other vendors. In fact, I’m slightly surprised that it doesn’t have a wider lead over Cerner and especially Epic (Epic’s number suggests that 50% of the hospitals it has ever sold to have attested, which I would think trounces both Cerner and Meditech if you’re calculating odds). I can’t say I’m really interested in any of this information, since any vendor with even one successfully attesting client has proven that its software has the capabilities needed. Beyond that, much of the required effort belongs to the customer.

From HITEsq: “Re: Girard Medical Center (KS). Really doesn’t like Cerner – suing them for breach of contract. Among the interesting tidbits, Cerner staff apparently though that Cerner was able to get the hospital to agree to an agreement as a result of ‘concert tickets and booze’ and that the Cerner staff was only there ‘because [they] drew the short straw.’ Apparently, Girard feels like it paid $1.3M for nothing.” The 21-bed hospital says it has paid $1.3 million of the $2.9 million total without receiving “any tangible work product” and that the time and attendance system that it thought it was getting wasn’t included (they claim Cerner helpfully suggested using an Excel worksheet instead.) The hospital also claims that Cerner assigned “incompetent staff” to implement the system. That’s all fun to read, but (a) this is one side of an argument that has two; and (b) some of the claims fall between irrelevant and desperate. There’s a good lesson here for customers: don’t let your buddy-buddy salesperson talk you out of getting an expert in contract law to insert protection into the agreement that covers whatever you are (or should be) afraid of as a customer. Once it gets to the lawsuit stage, there’s a good chance that nobody will be happy with the result except the hourly-billing lawyers.

HIStalk Announcements and Requests

Listening: reader-recommended Turisas, epic pagan battle metal from Finland, like a band of Vikings hit Kerry Livgren over the head with a mace in 1975 and took over prog band Kansas, then merged it with Green Carnation and Muse. While I acknowledge that most folks won’t like it, I definitely do. 

I’m really behind after taking some time off, just in case I seem unresponsive. I don’t think that situation will change until well into the weekend since I’ll be working all of it.

Acquisitions, Funding, Business, and Stock

7 Medical Systems, a provider of on-demand digital imaging, EMR, and RCM solutions, acquires Manager Consultoria em Informatica LTDA EPP, a Brazilian company  that offers similar services to hospitals and clinics in Brazil.

Elsevier purchases QUOSA, a provider of life sciences content management and workflow productivity solutions.

VeriTeQ Acquisition Corporation completes its acquisition of PositiveID Corporation’s VeriChip implantable microchip  and Health Link PHR.

Sales

The DOD’s Military Health System awards Planned Systems International a five-year, $96 million contract to provide code maintenance services.

Putnam County Hospital (IN) announces plans to implement CPSI.

Prevost Memorial Hospital (LA) selects CMR EDIS version 3.3 for its emergency department.

Home health provider RBA Texas selects Axxess’ Agencycore home health software.

Nashville General Hospital signs a multi-year agreement with Sectra for its integrated RIS/PAC solutions.

Baylor Health Care System (TX) adopts technology from strategicplanningMD, a provider of strategic planning software for the healthcare industry.

IASIS Healthcare LLC (TN) selects NextGen Practice Management and RCM for its 19 hospitals across seven states.

Ellenville Regional Hospital (NY) selects Healthcare Management Systems (HMS) EHR and financial applications.

The Premier Healthcare Alliance awards a contract to UltraLinq Healthcare Solutions for its Web-based imaging system.

Mercy Medical Center (IA) selects MedVentive’s Population Manager and Risk Manager products to facilitate management of its accountable care contracts.

Massachusetts General Hospital chooses Voalté’s consolidated voice, alarm, and text communication system for nursing communication.

People

Aria Health (PA) appoints Brian A. Hannah MD as CMIO.

OB fetal monitoring software vendor PeriGen names former Allscripts SVP Matthew Sappern as its CEO. He replaces Donald Deieso, who retired at the end of December to join Arsenal Capital Partners.

St. Joseph’s Hospital Health Center (NY) appoints Michael A. Spurchise director of enterprise and ambulatory systems.

Chris Caramanico joins SCI Solutions as SVP of marketing and business integration. He was previously SVP of new business enterprise applications for Allscripts.

Cornerstone Advisors names Gregg Fajkus as VP and Epic practice director. He was previously with Encore Health Resources.

Pamela Lane, formerly VP of health informatics with the California Hospital Association, is appointed deputy secretary of the health information exchange at California’s HHS.

Steven Arnold MD is named chief medical officer of surgical implant management solutions vendor MediQuip.

Announcements and Implementations

Human capital management software vendor API Healthcare announces strong growth for 2011, including the best quarter in its history.

Stockell Healthcare Systems announces GA of its InsightCS Business Intelligence Suite 2.0, which expands its revenue cycle management system with executive dashboards that include days in AR, cash receipts, collector productivity, denial rates, clean claim rates, and coder productivity.

In England, six hospital trusts say they’re saving $12 million per year by operating a telestroke program based on Polycom’s RealPresence video collaboration solution.

Misys Open Source Solutions grants exclusive Swiss distribution rights for its Misys Connect XDS registry and repository to Switzerland-based enterprise content management vendor Uptime Services AG.

Other

A data entry error creates grossly inflated bills for hundreds of Bronx-Lebanon Hospital (NY) patients. The hospital blames its billing company for inserting invoice numbers in the space designated for the amount owed.

The local paper profiles Beacom Health, one of six practices that have taken advantage of subsidies from Fremont Area Medical Center to implement eClinicalWorks.

Cerner donates $10,000 to its First Hand Foundation to celebrate hitting the 10,000-employee milestone. The company has now employs 10,062 associates, including 6,575 in the Kansas City area.

I couldn’t help think of Mr. H when I read this since I know he enjoys both his music and his exercise. Between 2010 and 2011, 47 people were killed or seriously injured while walking and wearing ear buds or headphones. I predict a few lawsuits against Apple for allowing the music to play so loud. 

Weird News Andy says he’s excited at the news that a pill may replace the need to exercise, but he’d be happy with one that helps him remember where he put his car keys.

Strange: unknown criminals steal a computer and paper records from a South Carolina doctor’s office, then drill a hold in the roof, insert a garden hose, and turn it on to run all weekend.

Commissioners of Bay County, FL discuss a settlement with chiropractic office management software vendor Redpine, which relocated to the area to take advantage of $750K in incentives and then closed its doors. The company has offered to sell its software rights to repay the incentives and claims it has several prospective buyers.

Sponsor Updates

• Health Language Inc. releases a new version of its provider-friendly terminology  to include clinician friendly synonyms and more than 100,000 attributes for ICD-10-CM.
• The Health Training Network, a service of Inland Northwest Health Services, opens a new training facility to house medical classes, including a paramedic program.
• IMDsoft reports strong growth in 2011, including first-time installations in three countries and involvement with  45 critical care and anesthesia projects.
• SCI Solutions announces HITECH certification of its Schedule Maximizer V34.
• Awarepoint reports that 10 of its newly-live customers were interviewed by KLAS, with all of them reporting high satisfaction.
• McKesson customers share keys to successfully attesting for Stage 1 Meaningful Use.
• The New Zealand Trade and Enterprise names Orion Health one of nine finalists in the “Best Business Operating Internationally” category in the New Zealand International Business Awards.
• Aspen Advisors announces that in 2011 the company grew revenue 40%, expanded its leadership team, and added 23 clients.
• ICA Informatics signs a memorandum of understanding with the New York eHealth Collaborative to join its workgroup for developing connectivity standards.
• Princeton Orthopaedic Associates (NJ) selects the SRS EHR.
• Canon and Nuance Communications successfully  complete interoperability testing of Nuance’s eCopy ShareScan v5 software for converting and passing scanned documents from Canon ImageRUNNER ADVANCE MFPs into EHR applications.

Contacts

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

Curbside Consult with Dr. Jayne 1/16/12

Jayne Gets Her Tweet On

During a recent e-mail exchange, a friend of mine repeatedly chastised me for not being on Twitter. He failed to see why someone who lives in the land of blogging and social media wouldn’t want to Tweet with the rest of the world. To be honest, I’ve been more than a little scared to take the plunge. Knowing all too well what an outrageous time suck Facebook can be, I didn’t want to get into something else that had the potential to further unmask certain addictive personality traits.

Nevertheless, I took the plunge. Signing up was deceptively easy, although I’m having a hard time deciding who to follow. I don’t want to overdo it with too much information. So far, I’m following HIStalk (of course), my BFF Inga, and my very public secret crush Farzad Mostashari (and his dashing bow tie.) You can follow my shame spiral @JayneHIStalkMD .

While I’m feeling social, I decided to share some reader correspondence. It goes back a bit, as you can imagine my inbox usually looks something like the hallways of a New Orleans emergency department during Mardi Gras (which incidentally is just a month away for those of you who plan to get your party on).

From Miami, My Amy: “I was at a physician office this week and they couldn’t get the right patient into the right room. They took me back twice and reseated me in the reception and did the same thing to another person. Made me wonder whose medical record they were viewing. I find I am becoming a “difficult” patient, bristling with all the paperwork to fill out time and time again… with the same provider.” I agree, this sounds pretty annoying and it’s also a significant patient safety issue. I do hope your physician apologized though. I that was happening in my office,I would expect my staff to make me aware so that I could say something to patients.

From Bama Bubba: “Your Curbside Consult today really charged up my growing OCD. Public restrooms never have commode lids, plus they often flush with a great torrent of surging water, not the home-based gentle swirl. This flushing surely raises huge clouds of nasty water droplets perfect for deep lung deposition. I had a remembrance of the huge toilet complex at McCormick Place in Chicago and literally dozens of commodes in narrowly separated stalls, used by folks from all over the world, being flushed at the same time. Whoa! Talk about a toxic cloud of international viruses. Excuse me, I have to go wash my hands again.”

From HealthNut: “Re: shift work food options. I worked 11-7 for a stretch and our food options consisted of coffee, colas, cigarettes, and vending machine staples of sandwiches with greenish mystery meat/cheese, lukewarm canned chili or Beanee Weenee, peanut butter crackers, candy bars, and gum. The only thing that kept us from morbid obesity was bring broke all the time because we were students.” Yeah, that and the fact that we had to run arterial blood gas samples to the lab in styrofoam cups of ice chips and run to radiology to look at actual x-ray films all night long. At my hospital, our vending machines were just updated with a new item: White Castles.

From Golfing Great: “Regarding your recent post on technology as the new scapegoat. It’s not only the users who operate the systems, but also the folks who create and maintain the systems, the training they receive, their proficiency, and their ability to anticipate — or at least understand — the needs of those users (which I try to do by subscribing to HIStalk, so thank you very much!) When problems occur, there is usually more than enough blame to go around. It’s a shame the time spent deflecting isn’t devoted to planning, training, and coordination instead. It is important to keep in mind that systems are comprised of technology, people, and processes, all of which must function properly for the system to succeed. I’m not sure that any system will ever be able to address the intentional ignorance demonstrated by people in some of the scenarios you quoted, certainly technology alone cannot. I couldn’t agree more that culture is key, particularly when, even in spite of best efforts, systems are inadequate.” Thanks for that feedback. If I could convince organizations of the need to do one thing prior to and during implementation of any health IT system, it would be this: change management.

From Mr. Clean: “What is the evidence base on best way to sanitize tablets and (especially) keyboards? Inquiring minds want to know!” There’s not a ton of data on this. Personally, I use the same wipes that we use in the emergency department, which are a healthcare-grade sanitizing wipe for hard surfaces. Low-level cleaning requires keeping the surface wet for at least thirty seconds; higher-level disinfection requires keeping the surface wet for at least three minutes, which is a little harder to do with a keyboard.

Just a few days ago, the FDA cleared a self-sanitizing hospital keyboard with the bargain price of $900. The solution uses UV light to eliminate bacteria. Another reader suggested the WetKeys Washable Keyboards, which actually look pretty cool and have much more accessible pricing. It would definitely be easier to keep those wet for three minutes than a traditional keyboard. I really like the looks of their washable flexible keyboard. Too bad Santa has already come and gone — he could have rolled one up and left it in my stocking.

Have questions about ICD-10, the most common injuries seen during Mardi Gras, or whether you should order your White Castles with double pickles? E-mail me.

E-mail Dr. Jayne.