Monday Morning Update 1/16/12

From Barry Goode: “Re: 5010. I’m glad to dish out all the dirt I know as a vendor. Big picture, it’s been a LOT easier and less troublesome than we expected. Most of our payers and intermediaries have been really good. Our clients have a 99+% clean claim rate. The clearinghouses have been far more troublesome than the payers as a rule, which is pathetic because it’s their primary business. A good clearinghouse having trouble with a particular payer should be able to EASILY resubmit claims in the 4010 format in order for the practices to be paid while issues are worked out. The deadline was moved! Although the clearinghouses are to blame for some of the trouble, the real culprits will soon be the state Medicaids. Some of them have yet to even indicate when they will be ready for testing.”

From Rumble: “Re: Partners. Heard they’re making that big decision by April 1. Why use that date? Push it out a day or two, jeez …” 

From HIPAA Hound: “Re: how doctors die. Here’s another article, a tad longish, but interesting. My wife and I are both of this mind, and we have our living wills/advance directives on file and our durable POAs ready if necessary. In my opinion, too much technology in the hands of the uninformed or emotionally involved (that’s not the right word, but I can’t seem to call the correct one to mind) is what runs US healthcare costs out of sight. My two cents.” I’m no expert, but Americans seem to be uniquely culturally incapable of accepting death. We’re so used to endless opportunity (at least until recently), unlimited science, and never-ending self-actualization that to just admit that your number is up never happens. It’s not just the elderly – every hospital I’ve worked in spends millions saving wildly premature babies weighing a pound or two. My conscience hasn’t resolve the question of whether that’s the best use of increasingly limited healthcare resources, especially when you look at some of the families and try to decide what that baby will be going home to after unbelievably expensive months in the NICU.

From The PACS Designer: “Re: iPhone’s 5th. It’s had to believe, but the iPhone just celebrated its 5th anniversary. When it was first released, virtually no one predicted it would dominate the marketplace and outdo other smart phones in popularity. Healthcare has always been a sweet spot for Apple products, so that’s why there’s always a place for almost every new Apple product introduction. The first iPhone was 1.16 cm thick and had a 3.5″ widescreen touchscreen display with multi-touch support, 8GB of RAM, Bluetooth, WiFi, and a 2 megapixel camera.” I couldn’t easily find the link, but an HIStalk poll I ran when the iPhone came out found that readers mostly thought it would have little influence on healthcare. As a vendor, how would you like to have a product that’s in such high demand that Chinese consumers are willing to attack humorless police and criticize their government when the local Apple store doesn’t open on time? Maybe financially irresponsible countries should consider slapping on iPhone tax like the cigarette tax, knowing that people are addicted. I floated a similar to proposal to a slightly interest audience (Mrs. H) while in the airport this weekend – revenue-happy airlines that are even charging passengers for boarding ahead of their assigned zone should charge the idiots that congregate around the boarding lane before their turn, blocking the path of those trying to board as called. You can sit for free, or obstruct for a fee.

I’ve whisked Mrs. HIStalk away for a rare long weekend as I attempt to temporarily recover from the onslaught of HIMSS-related HIStalk work (not to mention work at my hospital) that has been testing my mental and physical capabilities. I’ll keep this post brief rather than just bag it completely or dump it on Inga to write, pecking it out on my small HP laptop on modestly good hotel wireless. Your regularly scheduled verbosity will resume Tuesday evening. In the mean time, Mrs. H and I are tooling around in a really cool Mustang convertible (a rental – something I’ve always wanted to do), eating in good restaurants, working out, and relaxing. Then it’s back for the final assault before the conference.

I’m fascinated with Vince’s HIS-tory this week because he gives some rare and fun background on a couple of industry long-timers: Judy Faulkner and Frank Poggio. His series always reminds me that it’s about the people more than the companies.

Here’s my final thought on CMS’s Meaningful Use numbers. I’m pretty sure ONC’s point was to show what a great job it’s been doing in getting providers to use EHRs, and their information (not surprisingly) seems to support that. I’m not sure why they included vendor information, though. They should have known that everybody would try to over-analyze and massage the skimpy data to gain competitive advantage. That focus has actually caused many folks to miss the point that the adoption curve is moving sharply upward, which is ONC’s real job rather than feeding the competitive EHR market frenzy. As a provider, your mileage will undoubtedly vary no matter what someone else’s numbers show. And the next set of numbers will provide a much-needed data point: does adoption seem to be increasing, or has it peaked?

I was interested to hear that Adventist Health is putting Cerner in its ambulatory locations. I didn’t know that, at least according to one reader, they’re displacing Epic ambulatory. That’s how it should work, of course – the hospital system generally drives the choice of the outpatient system, not vice versa, although Epic has benefited greatly from customers who don’t find that to be an acceptable choice given their incumbent vendors. I was thinking that Loma Linda University Medical Center might be impacted since they announced an Epic inpatient decision not long ago, but I guess they aren’t part of Adventist Health like I thought I remembered.

Thanks to everyone who signed up for HIStalkapalooza invitations. The signups have been closed and invitations will be e-mailed out shortly to the folks we can accommodate (we had around 1,000 invitation requests, so unfortunately we can’t send everybody an invitation.) Thanks, too, to everyone who voted in the HISsies – I’ve closed that voting as well.

It

The economy is looking better to a good number of the folks responding to my most recent poll. New poll to your right: CMS released Meaningful Use numbers. How are attestations running compared to what you expected?

The New York Times writes up Epic in its business section. It’s not a particularly insightful or in-depth piece, but they did apparently interview Judy although the article has few quotes. It does include some interesting statistics: Epic has 260 customers, 35 of which signed on last year. Their software will cover 127 million patients next year. The company has 5,100 employees and will hire another 1,000 this year. Revenue for 2011 is expected to come in at $1.2 billion, up 45% from 2010. It also mentions a retired UW professor of psychiatry who was an original Epic investor and who sits on the company’s board, the first mention I’ve seen that the company has investors or a board. It would be interesting to know what she invested and what that investment is worth now, although obviously private company shares are illiquid, making valuation (and selling) tricky.

Cerner hits the 10,000 employee mark.

This week’s employee e-mail from Kaiser Chairman and CEO George Halvorson talks up walking, with nearly 30,000 of KP’s employees enrolled in its walking programs. KP has developed an EveryBody Walk! app to help people develop a walking plan and find walking routes.

Just in case you’re Googling for old HIStalk posts prior to 2007, they’re gone, at least temporarily. The blog service I used for HIStalk from 2003 until 2007 has gone belly-up, which isn’t surprising since it was really run more like a geek’s electronic bulletin board than a professional service, so WordPress killed it off easily (that threat and a couple of issues I had led me to abandon it years ago). I have an XML backup that can supposedly be imported into WordPress, so if I see benefit to putting the old stuff back online, I’ll hire someone to port it over. I feel some loss – I spent a ton of time and energy crafting those old posts.

Akron Children’s Hospital names Amy Maneker MD as CMIO to oversee its Epic implementation. She previously held a similar role with Rainbow Babies and Children’s Hospital in Cleveland.

Inga ran across this on Facebook. RelayHealth donates its $50,000 prize for winning the VA’s Blue Button for All Americans contest to the Wounded Warrior Project, which helps wounded service members.

E-mail Mr. H.

An HIT Moment with … Liz Roop

An HIT Moment with ... is a quick interview with someone we find interesting. Liz Roop is president of NPC Creative Services, LLC of Tampa, FL.

What are the biggest mistakes companies make in their public and media relations activities?

Failing to articulate how your product or service delivers on its sales promise. With PR, you have to go deeper than the sound bite. If your advertising promises that your software helps an organization achieve Meaningful Use, transition to ICD-10, or comply with core measures, you better be able to explain how. This is especially true for niche health IT products and services.

Failing to commit the necessary human resources to PR, especially at the executive level. Nothing backfires quicker than telling an editor that the CEO isn’t available on the day of a major announcement, or that the CMIO is going to miss an article deadline.

Basing PR decisions on what competitors are doing rather than what customers and prospects are saying. While it is important to understand the competitive landscape, it’s a strategic misstep to do something just because it was done by a competitor. That kind of “me too” public relations undermines a company’s credibility – and is how we wind up with so many nonsensical catch phrases and buzzwords.

Last is not listening to the experts retained to manage the company’s public relations. That’s how the other mistakes happen.

Where should a small, newish company trying to get a foothold in a competitive market with a modest budget and minimal in-house PR expertise focus its energy to get the word out?

The best approach is one that connects a company with its prospects and customers when they are in decision-making mode. I may be biased because this is where NPC specializes, but the best place to make that connection is in the trade media. Think of it this way: when was the last time you were contemplating order set software or patient satisfaction survey tools when you were reading your local newspaper?

The catch is that while it doesn’t require a lot of expensive bells and whistles, trade media relations does require a comprehensive understanding of the issues your product or service addresses and the ability to articulate how it does so. If your internal team is struggling for whatever reason to stay on top of how industry changes are affecting your customers, you need to explore an agency relationship. That’s true even if your budget is modest. Boutique PR firms are surprisingly affordable.

Old-school PR involved schmoozing a handful of glossy magazines mostly looking for ad revenue and hoping they would pick up a press release for a mention. How has that changed with the advent of blogs, Facebook, and Twitter that stream non-professionally produced information almost in real time?

It has definitely changed the role of the press release. In the past, the release was written for the media with the hope of enticing a reporter to pick up the phone, ask a few questions, then write a little something about the announcement. With the advent of social media and online newsfeeds, press releases must now be written for the customer. They must also be written to accommodate the lack of professional editorial gate-keeping in terms of how the news is abbreviated as it goes viral.

Press releases aside, the real-time nature of today’s media actually makes schmoozing more important than ever. It’s just handled differently. Substantive coverage still comes from cultivating mutually beneficial relationships with the appropriate media. However, today, those relationships are typically established electronically rather than over lunch or with the old-fashioned media tour. So while many of the rules remain the same, the methods of communication are definitely different.

We like to make fun of bad press releases. What are some classic bad ones you’ve seen? How can companies write better ones?

Oh boy, that’s a loaded question. I enjoy making fun of bad press releases as much as you, but I also know that none of us is immune from sending out the occasional stinker. Sometimes it’s a matter of being human. Sometimes it’s because we have to pick our battles. So I hesitate to cast stones in the vicinity of my glass house.

But since you asked…The release that stands out to me as truly awful was issued several years ago. I could almost get past the multiple typos and punctuation errors in the headline and the first two run-on sentences. But I couldn’t get past its claim that the firm was a key advisor to the Obama administration’s healthcare transition team. It took two more paragraphs to learn the real story. The company’s executives were members of a subcommittee that was part of an association’s workgroup that issued unsolicited recommendations to the administration for advancing health IT.

To write better press releases, companies need to avoid making outrageous claims and focus on stating the news clearly and concisely. Exhaustive detail is exhausting for the reader. So edit. Then proof. Then edit and proof again.

If a company wanted you to help them come across as brash, fun, and outrageous, what would you do?

I would advise them to proceed with caution. There’s a fine line between edgy and cartoonish. Crossing that line can do irreparable damage to a company’s credibility, especially if the customer base doesn’t respond well to brash or outrageous.

There are ways to inject fun without overpowering the informational or educational aspects of public relations. Find-A-Code’s ‘Yeah, there’s a code for that’ ICD-10 videos are a great example of doing it right. They’re funny and educational. It’s all about striking a balance.

News 1/13/12

Top News

Adventist Health expands its affiliation with Cerner, announcing plans to implement Cerner Ambulatory EHR across its 130 clinics.

Reader Comments

From Booth Babe: “Re: HIMSS and HIStalkapalooza. Have mercy on the aching feet of worn out tradeshow floor ‘workers’ who have only minutes to spare getting from work to FUN. Do you know how often during aching feet moments we think of the upcoming party and how it drives us through each additional hour until we can cut loose and have some fun?! I would never have time to deck out as some of those fashionistas did last year, though they looked fabulous and were fun to see. Maybe you should add a category for best ‘survivor’ shoes for tradeshow performance. ” Gee, the term “survivor” shoes is right up there with the “straight from the exhibit hall” style company logo shirts. That being said, I have a couple pair of great shoes similar to the ones above that are comfy enough for the trade shoe floor, yet stylish enough for a quick transition to Vegas nightlife. E-mail me if you want details on the brand.

From ThickAndThin: “Re: McKesson. To acquire European firm MACH4 Pharma Systems?” Unverified. The England-based company sells drug packaging and preparation automation for hospital pharmacies.

From DeepThrowIT: “Re: White House CTO Aneesh Chopra. Word on the street is that he will announce in the next few weeks that he will be leaving his job. No word on where he’s going next.” He’s a young guy (39) with a lot of enthusiasm and charisma, so if the rumor is true, we’ll see whether he pursues money (running a private company) or power followed by money (running for office.)

From LeftCoaster: “Re: EDI 5010. Oregon and Washington hospitals are experiencing significant issues with transmission and receipt after mandated January 1 use, but deferred enforcement until April 1. Clearinghouse vendor [vendor name omitted] is a huge problem – they are not responding to support calls and hospitals are considering switching. Both Cigna and Providence Health Plan claim they are unable to transmit payments and organizations are having major cash flow problems, particularly community hospitals. Anyone else having problems?” Unverified, so I removed the vendor’s name. Further reports are welcome.

From Nasty Parts: “Re: [vendor name omitted]. Is moving away from their legacy EHR product and all efforts will be put behind a SaaS product they bought last year. 400+ people will be RIF’d as a result in the near future.” I removed the vendor name while we try to get confirmation (which I don’t expect to be successful), but Nasty Parts has been accurate about this company in the past.

HIStalk Announcements and Requests

Highlights from HIStalk Practice this week include: Dr. Gregg explains why he is skipping the HIMSS soup line this year. Hospitals now employ 20% of physicians. CareCloud grows rapidly. A breakdown of EP attestations by EMR product. Age affects physicians’ perceptions of HIT. A little bit of ambulatory HIT news is like a ray of sunshine of a cloudy day. In other words, by signing up for e-mail updates on HIStalk Practice, you can keep the winter doldrums at bay. Thanks for reading.

Welcome to Humedica, sponsoring both HIStalk and HIStalk Practice at the Platinum level. The Boston informatics company offers SaaS-based clinical business intelligence solutions that create a real-time longitudinal patient care view, giving providers insight into their patient populations, the outcomes of the treatments and procedures, and how those factors impact quality, outcomes, and cost. For physician practices, the company’s MinedShare Ambulatory product supports clinical, operational, and financial benchmarking. Humedica partners with Anceta, the informatics subsidiary of AMGA, to allow its members to collaborate on quality improvement and to share best practices. I interviewed President and CEO Michael Weintraub last month, where he talked about the company’s top-rated performance in KLAS, its partnership with Allscripts, the $50 million in capital investment the company has received, and what’s next for the industry after EMRs. Thanks to Humedica for their support of HIStalk and HIStalk Practice.

Speaking of Humedica, the company announces a predictive analytics tool that analyzes EMR data (not claims information) to identify high-risk CHF patients and intervene before they require hospitalization. Preventable heart failure admissions cost up to $35 billion per year, with 40% of Medicare CHF patients readmitted within 90 days. MinedShare client Community Physician Network (IN) says the tool will help it perform in an Accountable Care Organization model by avoiding unnecessary admissions and providing better patient outcomes.

Reminder: you app and Web developers still have plenty of time to enter Nuance’s 2012 Mobile Clinician Voice Challenge, considering that it takes only a couple of lines of application code to speech-enable your mobile or Web app for clinicians and the deadline isn’t until February 3. Prizes and fame could be yours. Even non-programmers can get a shot at the prize kitty by tweeting about the contest.

Acquisitions, Funding, Business, and Stock

T-System acquires Practice Management Associates, a provider of coding and billing services for EDs.

TriZetto Group, which last week acquired Medical Data Express, acquires Kocsis Consulting Group.

Practice Fusion raises an additional $2 million in funding, raising its total to $38 million from Band of Angels, Felicis Ventures, and other investors.

Columbia University signs an exclusive agreement with Health Fidelity to commercialize its MedLEE text-based natural language processing technology. Fidelity offers its own NLP solution called Fidelity Platform, which uses MedLEE to extract medical data from unstructured text and generate SNOMED codes from it.

In Europe, CompuGroup Medical acquires Netherlands-based ambulatory and pharmacy systems vendor Microbais Werkmaatschappij BV. The transaction also gives CompuGroup a 51% stake in healthcare connectivity startup MediPharma Online.

Sales

Barnabas Health (NJ) adds MedeAnalytics’ Revenue Cycle Intelligence solution to compliment its existing Patient Access Intelligence solution.

El Paso Children’s Hospital (TX), which opens next month, selects RCM provider Cymetrix for business office technology and services.

The DoD awards GE Healthcare a three-year, $43 million extension of its contract for patient monitoring systems.

Illinois Neurological Institute selects JEMS Technology to provide tele-stroke evaluation.

Massachusetts Eye and Ear selects PatientKeeper Charge Capture and PatientKeeper P4P for its 250 clinicians.

Catholic Health East signs a five-year, $40 million contract to implement AUXILIO’s managed print services in its 19 hospitals.

People

Former Google Health exec Missy Krasner joins Morgenthaler Ventures as executive in residence. She was also previously senior communications director at ONC under David Brailer.

Medical appointment booking site ZocDoc adds former Senators Tom Daschle and Bill Frist to its advisory board.

Encore Health Resources promotes Thomas J. Niehaus from EVP of client services to president and COO. Dana Sellers remains as CEO. In case you missed it, Mr. H recently interviewed Joe Boyd, Encore’s chairman of the board.

Lisa Conley, formerly with McKesson, joins Sunquest Information Systems as VP of North American sales and global marketing.

Industry long-timer Kerry de Vallette joins OPTIMA Credentialing as EVP of sales and marketing.

Interactive patient care systems vendor Skylight Healthcare Systems names Scott Johnson as VP of sales. He was previously with A-Life Medical and Philips.

Announcements and Implementations

North Hawaii Community Hospital begins implementation of its HIE, which uses Wellogic’s technical platform

Intelligent Medical Objects announces the successful integration of 2012 ICD-10-CM within its newly released IMO Problem IT 2012 Regulatory 1.3 software.

Nuance Communications expands the availability of Dragon Medical to French-speaking Canadian providers with the delivery of Dragon Medical 11 French.

Yale New Haven Hospital SVP/CIO Daniel Barchi provides an update on its Epic project. Six practices of 27 physicians are live, with e-prescribing at 91% and 80% of encounters closed the same day. Physician productivity for those docs is nearly back to pre-Epic levels. Greenwich Hospital will be the first hospital to go live in April. Daniel is one of few CIOs who has implemented Epic in two large health systems (he came from Carilion) so I asked him how it was the second time. He says Epic’s greatest strength is that they fully believe and trust their own process — developing their own software, rarely partnering with other companies, and creating finely detailed training plans. The benefit for customers, he says, is that if you just follow their plan, you will have a successful go-live.

Innovation and Research

Researchers at the University of Washington develop medical robots that support the open source Robot Operating System, saying it’s time to get away from proprietary, one-off medical robots and allow universities to collaborate in sharing their applications.

Technology

Ford partners with Microsoft, Healthrageous, and BlueMetal Architects to develop “the car that cares,” which would monitor the health and wellness of drivers. Data would be collected biometrically and through voice capture, then uploaded into HealthVault.  And I thought texting while driving was distracting.

A doctor in Canada gets her smart phone PHR app certified by Canada Health Infoway, only the second app to earn that distinction. She named it Mihealth, with the “Mi” referring to her feeling that adopting digital data in Canada was Mission: Impossible.

The Qualcomm Tricorder X Prize offers $10 million to anyone who can create a Star Trek-like tricorder that can diagnose medical conditions non-invasively. The X Prize Foundation chairman helpfully adds, “We don’t have a requirement that it makes the same noise.”

Other

An AHRQ study finds that 5% of Americans account for 50% of the country’s $1.26 trillion in healthcare costs. The top 1% of spenders account for 22% of the costs.

Could there be a connection? Life expectancy is up two years since 2000 and Hostess, maker of Twinkies, DingDongs (my personal fav), and HoHos, files for bankruptcy protection. Experts blame a shift toward healthy foods.

Here’s a point/counterpoint issue to mull over. Inga and I disagree on the value of CMS’s attestation statistics. Inga thinks the percentage of each vendor’s customers that have attested is a good benchmark, so she did lots of spreadsheet work to compare vendors and to assume that varying percentages among them must be reflective of product capabilities and ease of use in meeting Meaningful Use requirements. I said the information is useless for that purpose since it’s more reflective of unmeasured customer demographics and buying criteria than anything else and that it would be wrong (not to mention statistically indefensible) to use the CMS figures to infer that vendors with a higher percentage of successfully attested users have a better product for earning Meaningful Use money. Feel free to take sides. One thing’s for sure: vendors who massage the data into slick marketing collateral won’t be footnoting their handouts with statistical disclaimers.

Weird News Andy says “the eyes have it” in referring to this story, in which researchers are working on a smart contact lens that can continuously and non-invasively monitor glucose levels, electrolytes, and cholesterol, sending the results electronically.

Former Steve Jobs mentor turned nemesis John Sculley, who served as Apple CEO for 10 years, is interviewed at the Consumer Electronics Show, where he was promoting a company he advises and invests in, Audax Health. He describes his interest:

The area I am particularly excited about now is healthcare. Healthcare has been the last major industry that hasn’t been touched by technology in terms of productivity and consumer adoption in the way so many other industries have. While I’m not bringing any technology experience to the healthcare industry, I do see some similarities between what I was asked to do when I came to Apple, which was to bring big brand consumer marketing to Apple and carry it over to the whole Silicon Valley industry – because everybody does that today – well that same opportunity exists today in healthcare. Health innnovation enabled by digital technologies to build big consumer service brands, is an incredibly interesting complex problem to work on. Audax is really the first social health company and it’s focused on consumer engagement in the healthcare space bringing in a lot of the social media technologies and experiences that have been learned from companies like Facebook and Zynga and others.

The federal government adds insurance fraud to the list of charges faced by a Louisiana doctor that also includes possession of child pornography. The doctor was medical director for a company that monitored neurophysiologic surgeries over the Internet, billing insurance companies for their time. He and the company are accused of billing for surgeries in which no Internet connection was established, padding their billed hours, and instructing non-physician employees to log on to the monitoring system and pose as physicians for billing purposes.

An Indiana health insurance plan alerts 2,700 members that their records may have been exposed on the Internet in February 2011, when a server was inadvertently opened up to the Web during an upgrade.

Sponsor Updates

• SRS helps its customer Midwest Ortho (IL) celebrate its successful MU attestation with a tasty-looking cake.
• Pete Rivera of Hayes Management Consulting  discusses building leaders and improving team effectiveness.
• Picis will participate in this month’s 2012 Military Health System Conference in Maryland.
• OnX and MEDSEEK enter into a strategic partnership that allows OnX to distribute all of MEDSEEK’s enterprise patient engagement solutions.
• MED3OOO shares details of InteGreat EHR’s improved KLAS scores.
• Minnesota’s REC recognizes e-MDs customer Christopher Wenner, MD for being one of the state’s first providers to achieve Meaningful Use.
• Gateway EDI and AAPC align to offer ICD-10 training for practices, starting with a January 24 Webinar.
• Orion Health opens its 14th international office in Paris.

EPtalk by Dr. Jayne

It may only be Thursday as I write this, but I’m really wishing it was Friday. This has been a hectic week full of clinical snafus and customer services annoyances.

The first guilty party is HIMSS, whose registration system apparently malfunctioned last month. HIMSS12 registrants were charged a zero dollar amount for their HIMSS renewals. I received an e-mail notice about the registration problem and was told that someone would call me to discuss whether or not I really wanted to renew. They did, while I was seeing patients. I didn’t want to ignore it and risk a snafu in Las Vegas.

I called the customer service number left on my voice mail and the answering staffer had no idea what I was talking about. After more than 15 minutes on the phone and two call transfers, they finally got their act together. I hope the conference itself runs much more smoothly. And to HIMSS, let me introduce you to the concept of service recovery. If you accidentally undercharge people, let it go and use it as a lesson learned. Did that many people really register on those two days that you are going to suffer without the extra $160 per person? Goodwill is invaluable.

The second guilty party was the staff at Well-Known University Medical Center whose performance at the check-in desk gave new meaning to the phrase “epic fail.” Not only did they insist that my insurance information wasn’t in the system (doubtful since it just paid a claim last week on another appointment) but they were also rude about it. As I sat in the waiting room, I was also annoyed by their ham-handed questioning of patients on race and ethnicity. I wanted to jump up and intervene with some better scripting.

If organizations can’t even handle those customer service basics, I have no idea how they’re going to achieve Meaningful Use, let alone be a meaningful participant in an ACO. Not to mention that they didn’t ask everyone about race and ethnicity. I’m not sure if they just “assumed” for the rest of us or if they decided to judge by appearance.

The final straw was a resident physician who actually was using his BlackBerry to e-mail or text during my visit. Really. Talk about smartphone distractions. He set it on the table between us and typed as he was doing the exam. I know for sure he wasn’t documenting in the EHR because the scribe was tapping away at the PC in the corner.

The resident didn’t think it was funny when I asked him if I was keeping him from something important. He did sheepishly put it in his pocket. Maybe he should have noticed the “faculty” label on my encounter bill. Oops!

Lest you think I’ve just become Angry Jayne, some good things did happen this week. Inga and I strategized on the coveted HIStalkapalooza beauty queen sashes and I have narrowed down the list of candidates who are vying for the chance to escort me to the event.

HIMSS released their list of its 2011 Best Hospital IT Departments. Texas Health Resources, whose IT shop is led by contributor Ed Marx, is listed for large hospitals.

I’m curious about Nemours/Alfred I. DuPont Hospital for Children, which is described on the “medium hospitals” list as having 237 IT staff for its 180 licensed beds. I could certainly do a lot more with 1.3 staffers per patient. I wonder what their nursing ratio is?

Life Technologies Corp. announces that its new Ion Torrent genome sequencer will be able to map an individual human genome in a single day for less than $1,000. Although technically this is HOT, sequencing of a person’s genome brings up lots of controversial ethical and legal issues, not to mention the cost of the human expertise needed to transform the genetic data into something meaningful and to then counsel patients.

The absolute highlight of my week, though, is this delightful video about computers in medicine circa 1964. Thanks to Rockstar HIStalkapalooza correspondent Evan “Velvet Jacket” Frankel for making my day. See you at HIMSS.

Contacts

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

John Gomez 1/11/12

Recently I developed a Leadership Cheat Sheet for clients and friends. The document provided guidance on how to evolve your leadership style and suggestions on avoiding common leadership mistakes. As we move into 2012 (wow,  2012 sounds so Buck Rogers, doesn’t it?) I started thinking about a cheat sheet for HIT executives that helps them evolve their strategies and hopefully avoid technological mistakes in the coming year. By no means is this cheat sheet a comprehensive end-all, be-all, but rather a high-level guide of what to consider in the coming year.

Let me start by saying that not everything in this article is going to be applicable to every organization. You may also find that some of the items in the article are not necessarily new or all that leading edge. In some ways, much of this is a return to the meat and potatoes of HIT. Yet there are some new fancy, out there, Star-Trek gizmos that most of us love to envision included for you mavericks. With that disclaimer, let’s get started.

If I were on the hospital side of the equation (not the vendor side,) I would see 2012 as year to rework foundations and drive strategies that grow revenue and/or margin. I believe these two things go hand in hand. Although it may seem obvious, I find that Meaningful Use has in some ways become a huge distractor to allowing HIT to build an organization’s margin and revenue.

In my eyes, all IT organizations — not just those in healthcare — should be indirect profit centers, able to demonstrate that their strategies are driving organizational growth and financial stability. To do this, many organizations need to consider their foundational systems and begin making bets on what to invest in during the coming year, so that over the next three years, they can demonstrate that IT is a strategic partner to the business, not just a cost center. Sounds rather basic, doesn’t it? Yet it is such as difficult thing to execute upon, and that challenge is the reason for this little cheat sheet.

OK, so first things first. You can’t really get around your continued MU efforts or ICD-10 adoption. Yes it is draining, taxing, distracting, painful, lethargic, and about as exciting and forward thinking as watching wall paper erode. Most of your resources are going to be tired up on MU/ICD-10, yet you need to really think about how you rebuild your technology foundation and drive corporate revenue growth. After all, healthcare is a business.

My first suggestion to you is to establish an “imagineering” team. This can be a small team (depending on your budget) comprised of multi-functional talent, empowered to make decisions, drive change, and most of all, execute upon their decisions. If you want further details on how-to build an imagineering team, let me know, but the key tenets are (a)small team; (b) self-learners; (b) self-starters (c) highly passionate; (d) cross-functional; (e) full-time assignment; and (e) only looking at changes that can be accomplished without the need for board or finance committee approval. The reason for that last item is that you don’t want this team to get bogged down with big, complex changes and projects. Secondly I believe you will see greater returns from smaller strategic investments than big multi-year projects.

The Cheat: Carve out some resources and create an imagineering team. Keep your MU/ICD-10 work moving forward and make progress on the little things that provide big returns.

Recently I had the opportunity to meet with some rather smart and very talented software developers. We were discussing a new product that they are trying to bring to market. The discussion quickly turned to object orientation, software as a service, cloud-based computing, etc. They were pretty shocked when I said that really doesn’t matter – it’s all just drivel. What matters, I said, is getting your product to market and solving the client’s problem, doing those things really, really well, better then anyone else. Why does that matter to you?

I believe in 2012 you need to really consider evolving your departmental systems. Why? Because there is gold hidden in those departments. Want to improve throughput? Lower costs? Drive better ROI? Deal with future challenges related to genomic and personalized medicine? Then you should evaluate your departmental solutions and start thinking about how upgrading or replacing them (yes, replacing) could yield much higher returns. Solving your client’s problems is what matters.

OB/GYN, cardiology, optometry, ED, oncology, pathology, lab, advanced surgical, and other lines of business are highly specific workflows. Although some of the EMR/EHR vendors do a good job at this, you will find that your return is much higher by going with niche vendors who have systems optimized for these areas. The landscape of offerings in these areas is changing and you may find great deals, with short implementation cycles that create huge downstream returns.

The key to improving your revenue and margin is lowering operating costs and seeing more patients (yes, a no-brainer.) Yet to make that happen, you need to consider new systems and consider looking at some of the smaller players in these spaces that are doing some truly amazing things with really new technology. This is the perfect type of project for an imagineering team.

The Cheat: Review your 2012 departmental portfolio to determine if by evolving or upgrading you can improve patient throughput and lower costs.

“You can’t get there from here,” said the farmer along the side of the road.

“Why not?” I asked.

“Because they ain’t built a road, you fool,” he snapped.

Are you building roads in 2012? In my eyes, the next three years will see a tremendous shift in technology within HIT. You can only embrace these changes by laying foundational infrastructure that allows you to not only take advantage of those shifts, but also assure that you can do so at a cost and pace that yields strong ROI.

Throughout 2012, you should come to terms with mobility, patient tracking, resource tracking, analytics, security, and data integration/exchange. I consider this your infrastructure portfolio. Just like you have a departmental portfolio, you should consider developing a portfolio of your infrastructure to better understand how you are positioned for the future. Each of these items in the portfolio should provide a set of “roadways” which allow you to digitally get to anything or anyone in your organization and system.

Key investments in RTLS, HIPAA compliance management, privacy and security management, and the other areas are critical. If you have not deployed directory services and EMPI systems, you need to get that done. Why? Because I believe that over the next three years, we will see more and more focus on the integration of devices and humans. This will drive a tremendous need for an underlying infrastructure that allows you to orchestrate an ecosystem. Evaluating and investing in your infrastructure portfolio is critical to long-term success, reducing costs and driving revenue.

The Cheat: Develop and evaluate your 2012 infrastructure portfolio. Develop key plans for at least RTLS, PRM, HIPAA compliance, and privacy and security. Focus on technologies that improve patient throughput, reduce costs, and drive long-term ROI. If you have not deployed directory services and EMPI, get on it.

Little by little, the world of retail is changing. More and more retailers are evaluating or deploying self-service systems that allow consumers to do more for themselves and get help from a sales associate only when they need or want help. Airlines are also embracing the self-service mentality for passengers and crews, providing access to tools that allow greater access to what was once complicated processes that required human intervention. Developing a “healthcare self-service” strategy in 2012, which puts more power in the hands of the patient, is a key means to drive greater throughput and gain financial upside for the healthcare organization. The self-service strategy should include patient relationship management, patient access, and other tools that allow the patient to take greater control. Although human interaction is vital to patient care, there are a variety of processes that patients can do for themselves and actually would champion to be allowed to do, if they had access to the tools.

The Cheat: Drive higher patient satisfaction, better patient throughput, and ROI through the development of a 2012 self-service strategy. Also consider how self-service can be applied to hospital employees.

“To boldly go where…” you know the rest of the line, I am sure. So what about the cool Star Trek stuff? Well, I do think that you will see subtle shifts in 2012 that have long-term implications, but I am not sure if we are going to remember 2012 as the year that changed the face of healthcare forever. That said, for those leading edge organizations out there, I do think that there are some things you can start evaluating.

Some of my things to watch are DDS (diagnostic decision support), healthcare gaming, robotic aides, and large-scale data analysis, as well as the application of social graphs to patient care and collaboration. Each of these has a backdrop of affecting patient throughput and managing costs. For instance, DDS can help drive better decision-making in shorter amounts of time, freeing up clinicians to see more patients or spend time with patients. Healthcare gaming provides the opportunity to reduce readmissions, improve wellness, and educate patients. Robotic aides will at some point help drive care, though challenges with battery life and size make this a long-term realization. Large-scale data analysis, social graphs, and related technologies are also very much in their infancy, but there is promise and opportunity for those organizations looking for leading-edge game changers.

The Cheat: Pick one or two leading edge technologies that can provide long term differentiation to your organization.

ACO, ACO, ACO. OK, so we are making some progress and little by little, it seems to be coming together. But what is coming together is still a mystery. Developing an ACO strategy is important and probably a good thing to do in 2012, but I would caution you that there are probably other items you can focus on that will drive higher returns. That said, there is some low-hanging fruit an imagineering team can go after in regards to the world of patient financials. That fruit includes asking your current patient financial vendor to outline their strategy to address patient financials over the next three years (not just ACO.) I would not suggest changing vendors unless you are either having serious issues with your current vendor or your current vendor has no strategy for the next three years. If your satisfied with your vendor strategy, then focus elsewhere and monitor the evolution of ACO and its impact to your organization. Wait for the dust to settle, learn from the mistakes of others, and take a crawl-walk-run approach. If you must change vendors or your vendor doesn’t offer a strategy, then this is a project way too big for an imagineering team.

There are a ton of more cheats I can offer and probably some things you might be surprised not to see in the article. My goal, though, isn’t to cover it all. I realize that many of you may find that much of this is already known, which is cool if you are already on it. My goal is to help you think about the little things you could be doing to move your organization forward while you and your team drive greater revenue and, hopefully, margins.

The Last Cheat: If you agree with each of the cheats in this article, you can copy them to a PowerPoint (just the cheats) and present them to your leadership team. You will have an instant outline of your key goals for 2012.

John Gomez is CEO of JGo Labs.

News 1/11/12

Top News

Federal defense contractor ManTech International acquires federal healthcare system integrator Evolvent Technologies. You may remember Evolvent from HIStalkapalooza in Atlanta a couple of years ago, which they co-sponsored with Encore Health Resources and Symantec.

Reader Comments

From Stacy London: “Re: HIStalkapalooza. I have registered and hope to make the official invite list. I haven’t been before, so I am not sure what to wear. Thought it was better to ask you than Mr. H.” Indeed. You will see everything from the dreadful “straight from the exhibit hall” company logo shirts to glitzy gowns and tuxedos (seriously.) However, if you’d like to be in the running for HIStalk King or Queen, I suggest some serious cocktail party attire, complete with great shoes and lots of bling. Because we are in Vegas, we are including two special categories: Best Elvis Impersonator and Best Left in Vegas Attire. Ideally, the winners of the Vegas categories will actually be trying to win. All winners, including those crowned in the Inga Loves My Shoe contest, will be awarded fabulous prizes from the generous Mr. H (who may not know fashion, but who knows this stuff makes me happy so he puts up with it.) Our esteemed judges are pictured above.

From Is It Just Me: “Re: HISsies survey. Of all the silly questions and odd choices, I thought listing John Hammergren as an ‘HIS industry figure’ was the biggest stretch. And shouldn’t ‘guest contributor of the year’ between Vince Ciotti, Ed Marx, Ben Rooks, and Mr. H’s Epic id merit a question?” The silly questions have been the same for years, so there’s nothing new there. Readers chose the nominees, so any quibble about the odd choices should be directed that those who submitted nominations (or more accurately, the vast majority who didn’t despite my exhortation, saving their input until it was too late.) Inga advocated for adding a “best HIStalk contributor” item, but I didn’t want to diminish the accomplishments of those who didn’t win since they’re all good. If you received an e-mail HISsies ballot link, please vote soon since I’ll probably finish it up this weekend. About 1,000 votes are in and there are some surprise leaders so far. We’ll invite some of the winners to join us at HIStalkapalooza, although they usually turn us down.

From Ed Amame’: “Re: UMMC layoffs. Some folks on the right aren’t happy about it. Hot Air, as I understand it, has a pretty big readership. Wonder what waves this will create in HIT policy discussion outside the niche?” Right-wing site Hot Air quotes my mention of University of Mississippi Medical Center layoffs that were implied to be related to its $80 million Epic cost  (a story I just picked up from a newspaper there) and turns it into another vast conspiracy of Obamacare-loving liberals. A few thoughtful comments were left (one basically just pasting in my discussion from the original mention), but many are wildly tunnel-visioned, hysterical, and hateful. It’s no wonder the government is paralyzed by partisanship and an unwillingness to compromise – the politicians are unfortunately representing their intellectually lazy and often ill-informed electorate perfectly, so thoughtful democratic process has turned into a bad reality TV show.

From Spanky: “Re: unions. Why they’re bad for healthcare.” An ambulance technician in Scotland ignores an emergency call because he’s eating lunch. The patient dies. The union last week rejected a salary increase that would have paid paramedics $150 every time an emergency causes their break to be interrupted.

HIStalk Announcements and Requests

HIStalkapalooza invitation signups will be closed Friday evening, so if you have an interest in attending but haven’t filled out the online form, now’s the time.

Acquisitions, Funding, Business, and Stock

Consumer health site WebMD gives up trying to sell itself, its CEO quits, and the company warns of “significantly lower” profits in 2012 because drug companies are moving away from buying its advertising and competition from Facebook is increasing. Shares dropped 29% on Tuesday.

Healthcare apps developer Novarus Mobile Technologies changes its name to Novarus Healthcare. The company also hires Tom Hearn, formerly SVP of ambulatory services with Novant Health (NC), as managing principal.

Shares in Scotland-based charge master software vendor Craneware drop by a third after the company warns that performance of its acquired US revenue cycle software business ClaimTrust will not meet expectations. The company also says it may sue after it lost a large ClaimTrust InSight contract that was being handled by a third party and complains that US hospitals are buying HITECH-subsidized clinical systems instead of its financial ones. 

Ascend Learning acquires Advanced Informatics, a Minneapolis-based vendor of clinical education systems.

UnitedHealth Group forms strategic partnerships with three mobile health companies: CareSpeak Communications (patient medication communication by text message – above,) Lose It! (a weight loss app,) and Fitbit (pedometer and sleep monitor app.)

Sales

Hamad Medical Corporation (HMC) and Cerner sign an agreement to digitize the public health system of Qatar, including all HMC hospitals and primary care centers.

BCBS of North Carolina and Kansas City form Topaz Shared Services and choose TriZetto Group to provide claims, enrollment, and billing services.

People

Sandata Technologies, a provider of IT solutions for the home care industry, names Tom Underwood (Alere Health) CEO.

ApeniMED (formerly MEDNET) elects Charles D. Birmingham, VP of corporate development for CareMore Medical Enterprises, to its board.

Carestream hires Barry Canipe (American Standard Brands) as CFO and promotes Jianqing Bennett to VP of global medical sales and services.

Surgical Information Systems promotes Kermit S. Randa to COO.

Streamline Health Solutions appoints Michael K. Kaplan (Altos Health Management) to its board.

Healthcare consulting firm Equation hires Howard Salmon (Premier, ReHab Care, Phase 2 Consulting) as principal.

Three Kansas hospitals that are affiliates of Sisters of Charity of Leavenworth Health System name Mike Malone as project manager for their Epic implementation. He was previously with the parent organization.  

Capella Healthcare names Magda Osburn BSN, RN as director of medical informatics. She was previously with McKesson Provider Technologies.

RCM company Medistreams hires Marcia McLure Hardy as national director of business development.

Announcements and Implementations

The local paper (which apparently does not use spell-check) highlights the EMR use of Takoma Regional Hospital (TN), which just received a $1.3 million check for its meaningful use of Cerner’s EMR. When I shared this with Mr. H, he got all nostalgic on me, reminiscing about a consulting gig he had at the hospital years ago, the nice people there, and the great grub at Stockyards Cafe.

While I was trying to figure out which EMR Takoma had in place, I found Cerner’s list of clients that have attested for Meaningful Use, which includes 136 hospitals and 238 EPs.

Omaha Imaging (NE) implements Avreo RIS/PACS.

Four Mercy Health (OH) hospitals go live on Epic’s Care Everywhere, allowing hospital staff to view the chart of any patient whose provider is also using Epic and Care Everywhere.

Zynx Health announces a software enhancement that improves integration of ZynxOrder order sets with MEDITECH CPOE.

BryanLGH Medical Center (NE) implements the Pharmacy Xpert clinical surveillance and intervention solution from Thomson Reuters.

Three Ohio hospitals implement InQuicker, software that allows patients to make ED appointments online and “skip the ER waiting room.”

Government and Politics

The latest Meaningful Use numbers, captured in December and presented at Tuesday’s HIT Policy Committee Meeting:

• 172,974 EPs and 3,077 hospitals registered for either the Medicare or Medicaid MU programs.
• Medicare paid $275 million to EPs and $1.1 billion to hospitals.
• 33,515 EPs attested, 355 unsuccessfully.
• 842 hospitals attested, all successfully.

Aaron Berdofe analyzes the November Meaningful Use attestation report using IBM’s Many Eyes tool, finding that (a) Epic has 6,330 attestations, more than triple the #2 vendor; (b) Epic’s strength is concentrated in a few states where it dominates almost totally; and (c) Complete EHR attestations outnumber Modular EHR attestations 21,765 to 1,196.  

  ONC launches its Healthy New Year Video Challenge, offering $5,000 in prizes to consumers who submit a short video explaining their health-related New Year’s resolution and how they will use technology to accomplish it.

  Newt Gingrich, speaking at Dartmouth-Hitchcock Medical Center, says bureaucracy crushes healthcare innovation and that treatment protocols based on statistics interfere with the doctor-patient relationship. Peter Merrill, DHMC IT director, grilled Gingrich on his role in government gridlock, but wasn’t impressed with Gingrich’s answer. “I thought it was an incredibly articulate and well-reasoned defense of his actions in response to my characterization of him as responsible for the current gridlock in government. It was in no way an answer to my question of how to get past the current gridlock. My personal belief is that he is one of the major people responsible.” Merrill says he’ll probably vote for Obama again unless Republicans come up with a better candidate.

Technology

First-year medical students at the NYU School of Medicine use an interactive, virtual 3D cadaver to complement the traditional anatomy instruction, exploring the digital content with projected images, 3D glasses, and iPads. A free online version is here.

Other

  US health spending grew 3.9% in 2010, which was only .01 percentage points faster than the 2009 rate and the second-slowest rate in 51 years. The slower growth is blamed on high unemployment, loss of private health insurance coverage, lower median incomes, and higher patient deductibles and co-pay. Total 2010 spending was $2.6 trillion, or $8,402 per person, of which the federal government paid a record 29% and the combination of federal, state, and local governments paid 45% of all health spending.

The Bureau of Labor Statistics reports that healthcare added 22,600 jobs in December, including 9,800 in hospitals and 11,300 in ambulatory health services. Healthcare employment grew by about 315,000 jobs for the year.

A study finds that nurses using a basic EMR reported better outcomes and were less likely to report adverse patient safety issues, frequent medication errors, and low quality of care.

Cerner, dbMotion, Epic, Medicity, and RelayHealth are the vendors winning the most private HIE deals, according to KLAS, while Axolotl, InterSystems, Medicity, and Orion Health are leading in public HIE selection. Affordability is the top consideration in vendor
selection.

  Fast Company covers mHealth. It’s not particularly conclusive or insightful (at least not compared to HIStalk Mobile,) but does mention some interesting technology work: Best Buy is researching earbuds that can monitor heart rate, J&J has invested in sleep monitoring technology, and AT&T and Qualcomm are working on mHealth projects.

Two English hospitals struggle with error-filled surgical case lists, warning employees to double-check them. The North Bristol NHS Trust blames user error. One surgeon said his case list included patients from outside his specialty.

  Weird News Andy likes this Baby Beyonce’ Lockout story. Beyonce’ and Jay-Z have their daughter (named Blue Ivy) at Lenox Hill Hospital (NY), but at least one other new parent says the hospital locked down the NICU to accommodate Beyonce’s visitors, preventing everybody else from seeing their lesser-pedigreed babies. The hospital denies reports that it was paid $1.3 million to give the celebrities an entire floor to themselves. Gossip sites claim the hospital installed bulletproof glass in the delivery area, taped over security cameras and confiscated employee cell phones to prevent pictures being taken, and kicked people out of nearby waiting rooms. The couple is supposedly worth something like $750 million.

WNA also says he’ll “take a flyer” that the da Vinci medical robot people didn’t count on their robots to be used to make paper airplanes, even in Boeing-centric Seattle.

Guess which company is looking for a senior sales manager. The candidate must cold-call, hit sales targets, negotiate contracts, create sales campaigns and models, persuade prospects, and “aggressively solicit new customers by telemarketing and formulating follow up plans.” The answer: HIMSS, which needs someone to push corporate memberships and organizational affiliate memberships.

An IT specialist with an Atlanta medical practice is sentenced to 13 months in prison for hacking into the server of his previous employer, a competing practice located in the same building. He download patient information from his former employer’s system, deleted it from their server, and then launched a direct mail campaign touting his current employer.

Sponsor Updates

• Kindred Healthcare Inc. selects MED3OOO’s RCM services and InteGreat PM for its partner physicians.
• PatientKeeper CEO Paul Brient will speak this week at the JP Morgan 30th Annual Healthcare Conference.
• Fred Pennic, a senior advisor with Aspen Advisors, suggests six ways for healthcare organizations to use business intelligence software.
• HealthEdge and Keane announce a strategic partnership to deliver a performance-based business process outsourcing service to the healthcare payor community.
• Imprivata releases a white paper on preparing for a HIPAA audit.
• RelayHealth hosts a live HFMA webinar January 11 on patient consumerism.
• Nuesoft announces its podcast series “2012 Billing Trends: What’s on the Horizon.”
• A Texas hospital selected for the OCR’s pilot HIPAA audits contracts with CynergisTek for preparatory consulting and advisory services.
• McKesson Specialty Health offers a free webinar on the selection and implementation of EMRs in oncology practices.
• eHealth Global Technologies Inc and OptumInsight will deploy a medical image exchange service for HEALTHeLINK, a New York RHIO.
• Idaho Health Data Exchange signs an agreement with Greenway Medical to provide interoperability between Greenway’s PrimeSUITE EHR and the OptumInsight-powered HIE.
• Community Health Network (IN) says consulting services and technology from MedAssets improved its cash position by $26.7 million, reduced denials by 47%, and increased patient access employee productivity by 100%.
• Aspen Advisors ranks third in Planning and Assessment in the Best in KLAS awards.

Contacts

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

Curbside Consult with Dr. Jayne 1/9/12

The New Year is ringing in slowly from a news perspective. Maybe everyone’s just a little saggy from the holidays. I did manage to find some thought-provoking tidbits for the week.

Almost 40,000 new laws have recently gone into effect, now that 2012 is here. The biggest changes involve immigration, civil rights, budget woes, abortion, and other hot-button issues. Some less-reported but no less interesting legislation:

• Georgia will require those who drive golf carts on the road to have brakes, back-up lights, and a horn.
• Illinois allows motorcyclists to run red lights if they don’t turn green (the lights, not the motorcyclists) in a reasonable amount of time.
• Nevada is requiring fire performers and their apprentices to register with the state fire marshal.
• Utah nixes happy hour.

Congressman Edward Markey has asked HHS Secretary Kathleen Sibelius to tackle the issue of alarm fatigue. Specifically, he requests that the Institute of Medicine look at the issue and recommend solutions.

The New York Times reports on a new Medicare study that claims hospital workers only recognize and report medical errors and accidents one out of seven times. Daniel R. Levinson, inspector general of the Department of Health and Human Services, also notes the following:

• More than 130,000 Medicare beneficiaries experienced at least one adverse event in a hospital during a one-month timeframe.
• Although hospitals have systems to report adverse events, staff failed to report most of the harmful incidents.
• Hospital administrators are aware of underreporting by staff.
• Hospitals fail to connect adverse events with systemic quality concerns, resulting in few changes to policies and procedures.

I’m trying something new this year. My goal is to complete all of my required Continuing Medical Education and Maintenance of Certification activities at the beginning of the year rather than waiting until December is halfway out the door. I’ve been doing pretty well so far, plowing through piles of journals and article links that people have sent.

The Journal of Hospital Infection publishes a study on the hazards of lidless toilets, especially in spreading pathogenic bacteria like Clostridium difficile, one of the nastiest hospital-acquired bugs. In my hospital, the only commodes with lids are those little space-shuttle style ones found in the ICU patient rooms. Now that I think of it, you don’t see too many staffers wearing full protective equipment when helping patients in that way. Something to think about. Kind of makes my kvetching about dirty keyboards less relevant.

PLoS Medicine publishes some interesting thoughts on a topic dear to most health care workers and an increasing number of IT workers: “Poor Diet in Shift Workers: A New Occupational Health Hazard?” It cites data (including some from the Nurses Health Study) linking shift work to type 2 diabetes in women. Potential underlying mechanisms include poor diet and exercise, poor sleep, and disruption of circadian rhythms. Knowing the differences between day-shift menus and night-shift menus in most hospital cafeterias, brown-bagging it is probably the safest option if you’re looking at interventions.

David Blumenthal penned the recent A Piece of My Mind column in the Journal of the American Medical Association. It’s titled, “A Physician Goes to Washington… and Safely Returns,” which actually encouraged me to read it, unlike most of the pieces in JAMA which sound like something to read with a glass of warm milk when you have insomnia. I was hoping for some juicy revelations or HITECH wisdom, but it’s mostly about what it’s like to spend time in government service.

I’ve finished my stack of mandatory reading for the day, so am heading to lounge with a bit of fluff – Explosive Eighteen by Janet Evanovich. I can’t believe they’re finally making a movie of her first book One for the Money – it’s due out the end of this month and I’m counting down.

E-mail Dr. Jayne.

HIStalk Interviews Andy Smith, Co-Founder and VP, Impact Advisors

Andrew Smith is co-founder and vice president of Impact Advisors of Naperville, IL.

Tell me about yourself and about the company.

Impact Advisors is a healthcare IT consulting firm. We’re dedicated to the provider space. For us, that’s medical centers, academic centers, children’s hospitals, and physician groups. We also do some work in the payer space. 

We’re focused on the technology aspects of both planning and implementation. About a third of our business is associated with planning and assessment work, things like selections, Meaningful Use assessments, long-term strategy, interim management, governance modeling, and mergers and acquisition planning. Two-thirds to three-quarters of our business is focused on implementation work. A lot of our work is around the major inpatient vendors as well as the major ambulatory vendors.

I’ve always worked for a non-profit hospital, so I’m curious. The company has been around not quite five years. How do you go about starting a business in terms of money, research, and effort? How do you know what it takes to build a sustainable business?

Great question. I wish I would have known the answer five years ago. It’s basically School of Hard Knocks. The firm was started five years ago by myself and my brother, Pete Smith. Before that, we had spent 16 and 20 years plus at another consulting organization. For a lot of reasons, it was the right time to start up on our own. 

When we started, we had very modest aspirations. We thought we would just hang our own shingle and do some work.  But very quickly, other colleagues started to call, and clients started to call looking for a different kind of solution. We started to grow and have been growing ever since for the five years.

How do you form that company? That’s a great question. We hired some very experienced people to help us. We outsourced a good bit of our function. We just sort of figured it out. 

In terms of the requirements to get started, I get calls fairly frequently from people that are looking to start an organization. What I tell them is that working for yourself is great and I highly endorse it, but you need to be prepared to learn a lot on the job, you need to be prepared to take a lot less money and maybe not get paid for quite some time, and you’ve got to be willing to take some risk. If you’re willing to do that and you’re smart and your motives are pure, it typically will work out.

Some consulting firms stay small and are happy with that, while others get huge and then hit the wall where they either need to be acquired or grow to the next level. You’re probably at least somewhat surprised that you got as big as you did over that time. How do you see that playing out and what do you look for to challenge you in the next five years?

For us, culture and quality trump growth. We have grown. Our clients have asked us to grow. They’re asking us to do more and more for them to solve more and more complex problems. But for us, we are way more interested in doing it the right way. We resist those growth opportunities where we don’t think they are directly in concert with what we’re trying to accomplish as a firm.

We want to be a world class consulting firm. We want to be the best place for our consultants to work. We want to do really high quality work for our customers. We want to partner with them. We want to take work when we think we can provide it and we want to turn it down when we think that we can’t do the best job possible.

That has been a barometer of our growth. We couldn’t grow much faster than we have. We’ve probably averaged 50 to 70% growth over the five years, but that’s absolutely secondary to doing it the right way.

We’re a culture-based firm. We hire on attributes like work ethic and content knowledge, but almost as important is attitude. We want people that are willing to support each other, that are empathetic, that are client-delivery focused and obsessed, and at the end of the day are somebody that you wouldn’t mind having dinner with. That is the very first gate you’ve got to pass.

Growth has been a very nice outcome. We like growth. Growth means you’re winning. Growth means there is more opportunity for people to move in different directions in their careers. But for us, that is absolutely secondary. We think we still got some track in front of us. We think we can still grow for the foreseeable future and continue to retain our culture.

Consulting companies aren’t always great places to work with all the travel and emphasis on billable time. You’ve won some awards and hired a Happyologist, which I’m sure I made fun of at the time. What are you doing that the other consulting and vendor firms aren’t?

At the end of the day, it really gets down to the Golden Rule. Treat others like you want to be treated. It seems so patently obvious to me. I don’t know why their firms don’t do it, but I think we’re pretty good at creating culture. 

A lot of that comes upfront by making sure we have the utmost integrity during our recruiting process, and that we don’t overpromise during the recruiting process. We’ve got a wonderful recruiter who really is a wonderful gauge of that. It starts right up front at the first meeting and is constant communication through that person’s career. That’s the first thing we do.

Second thing, as you mentioned, we hired a Happyologist. His official title is director of associate satisfaction and culture. I think we’ve done a nice job of culture building. We won some awards. We were  number three in Modern Healthcare’s best places to work this year. We were the highest-rated consultancy in the last two years. We take it very seriously. 

I think we’ve done a historically good job of creating and nurturing culture, but we wanted to hire somebody who is absolutely 24/7 obsessed with how we treat each other and a culture we’re creating as a firm. So we hired our Happyologist, Michael Nutter. He has done a fantastic job over the last year. He’s really responsible for three things.  He is in charge of communication, internal and external. He is in charge of our professional development process or career coaching. He’s also in charge of our culture. 

That’s the intangible, but we do a lot of things around that.  We have our annual retreat, which we call Impactpalooza. Sorry – I think we might have used the name before you did, but we both stole it from Lollapalooza. You know we had an associate pet supermodel contest. We do winter dinners pretty frequently. We just finished a round of holiday dinners. Michael is really in charge of making sure that we celebrate ourselves, so that we celebrate our successes. We pick people up when they fall. That has left a very tangible impression about the firm.

Most of your folks are on the road, so I guess you have to make it bigger than life to make it memorable since you don’t see them often.

It is really hard. To win an award like Best Place to Work is really hard as a consultancy. We have some things going against us. We all travel like maniacs. We’re all pretty Type A-driven people. We’re working really hard at our clients. 

It’s really a family commitment. That’s one of the things we stress when we hire. Hey, this is tough work. You’re away from home, you’re working hard, you got demanding clients, you’re solving really tough problems that they can’t solve on their own. Your family needs to be comfortable with the lifestyle and the amount of work. I’ve actually interviewed spouses that we brought in to the recruiting process just to make sure we’re all in the same page.

You beat out some pretty good competitors to win the Clinical Implementation Principal award from KLAS, especially considering that the company hasn’t been around that long. What are the secrets that companies who might have been the favorites to win aren’t doing?

We pay a lot of attention to clients. We’ve got an executive assigned to each one of our clients. Their job is to make we are paying attention to them.

We are certainly not flawless. We’ve had mistakes. But I think where we are exceptionally good is that if we make a mistake, we always overcompensate. I’ve literally flown across the country to give a client their money back on a job where we did just an average job. Quite honestly, I don’t think we are an average firm; I think we’re an exceptional firm. So I flew across the country, gave the gentleman a check, and lo and behold, a few years later, we’re back there working again. 

Being private and small has allowed us to do some pretty interesting things and to stay really obsessed with overachieving our clients’ goals. I think that’s probably the thing we do better than others.

Who would you say are your most direct competitors?

We deal with the Big Five, the traditional ones. We deal with a number of vendors in the space that have similar profiles to ours. Depending on the job, we could compete with Deloitte or Encore or Aspen. We don’t typically do a lot of staff augmentation roles, so we don’t find ourselves competing with the staff augmentation firms that much. That’s a good business model; it’s just not the model we are in right now.

What we’re really doing is trying to hire the best people. We staff them from the leadership positions on down. It has become an interesting time because our clients are asking us to expand our services and asking us to supply a bigger and bigger footprint in their implementations. We’re starting to move in that direction a little bit, but I don’t think we will ever be a staff augmentation firm. If a client calls us and says, “I need 30 trainers for three months,” we very politely decline or we refer them to some trusted partners.

Opinions seem to vary about how many providers are chasing Meaningful Use money and how many of those are likely to get it. What are you seeing?

It’s absolutely been a catalyst for people to kick off large EMR projects, which has been great. It seems like there’s a bit of a gold rush going on right now. People are really focused on the money and maybe not so focused on the goals that are inherent of achieving the money. I totally get it. There’s money out there to be garnered; you might as well make sure you get it. I am hoping that there may be some tempering of enthusiasm over the next couple of years. All of our clients are very involved in planning for, reporting, and now cashing the checks.

Hospitals seem to be pacing themselves for a sprint, forgetting that after the sprint comes the long run. Do your clients understand that they’ll need more work than just going live, looking 5-10 years down the road to change their business?

I would totally agree. I don’t think as an industry we’re asking that question. What do we do when we get there? 

What we see is the industry is moving so quickly that there is going to be a wave of optimization or a Phase Two of these implementations going forward. We’re very interested in that. We spend a lot of time focusing at what’s next after the next two years. We think that’s going to be the really hot service area. 

We’ve got some methodologies already developed around how to attack that, but quite honestly the market’s not buying that right now. Our industry is really focused on foundational systems at this point, digitizing electronic medical records. After that’s done, I think there is going to be an entire wave of work about, OK, did the data we collect have integrity, what do we do with it, how do we turn it digital information? That’s the analytics – business intelligence wave of technologies we think will be very important in the coming years.

You must be involved in quite a few system selections. What products are hospitals looking for and what factors are driving the decisions they make?

Yes, we are doing a number of selections. I would say the most traditional selection is a system that is looking for a single vendor across multiple disciplines — inpatient, ambulatory, clinical, and rev cycle. It would be great if there was a vendor out there that provided traditional ERP solutions along with those other modalities, but I don’t think we’re there as an industry yet. 

They’ve been frustrated by a best-of-breed approach and the lack of information flowing across their continuum of care. That is probably the biggest driver we are seeing right now.

In terms of the sizeable accounts, is anybody beating Epic?

Not really. They are certainly the vendor to beat in the space right now. They do have a lot of that integration story to tell. They have integrated ambulatory, inpatient, rev cycle, and clinical product, obviously. You probably saw the KLAS reports as I did. They’re winning a majority of selections in the industry right now.

What does that mean for a business like yours? Epic offers their own implementation services and Epic-certified consulting firms are competing for the limited number of certified people.

We are a certified Epic partner as well. There is an incredible demand for a good implementation partners that know that set of technologies. That has been a major growth area for us in the last two years and will probably continue to be one for the next few.

I think we have a very good relationship with Epic. We absolutely challenge them, but I think at the end of the day, what we do is help implement their products more efficiently and to a better outcome. 

I find that we typically provide a lot of leadership, subject matter expertise on their projects, but we’re not backing up the truck, either. We are a small firm. If a client comes up and says, “I would like to outsource my 200-person Epic implementation,” again, we politely decline. But if they come to us say, “Hey, we really need some trusted partners in some key positions to help us implement this more effectively,” that’s right up our alley. That’s where we’re best.

You mentioned that you don’t back down from Epic, but if getting on their bad side resulted in their not approving you as a consulting firm, that would hurt desperately. Do you think companies fear Epic in that way?

I don’t worry about that. I don’t think we really can worry about that. I think at the end of the day, if our intentions are pure and we’re trying to accomplish what’s best for our clients, all the rest is going to work out. That is Epic’s corporate philosophy as well. I find that we’re typically very synchronous in what we are trying to accomplish. It may just be the means to the end.

Having said that, we work very well within their methodology. They bring in an incredible amount of tools and skills to the implementation and I think we complement that very nicely. Our traditional person within Impact Advisors comes with probably a 10-year clinical operations background and a 10-year consulting background. We bring some real-world experience that complements very nicely their products and services, so I think it’s a nice fit. I don’t really worry about challenging them. I worry very much about being an advocate for our clients. The rest tends to work out.

What issue or actions are threatening hospital CIO job security?

Failed implementations are always at the top of the list. If you aren’t meeting the objectives you set forth and you spent tens or hundreds of millions of dollars in the pursuit of, that’s not a good thing. At the end of the day, you need to be able to prove outcomes. Our industry, I would say, has not done that great a job of clearly identifying the return on investment and then measuring it post implementation. 

I think there will come a time where the CIO is expected to say, “OK, we spent $100 million and we achieved a 120 or 200 or 300 million dollars worth of benefit.” That would be the first thing I would worry about. The second thing is no different than any business — overpromising and under-delivering. If you can’t run a tight organization and have a staff that’s focused on client delivery and outcomes, that’s never good as well.

If you look at where the industry is today and where you think it might be 5-7 years down the road, what kind of things do you see?

I think it is going to be an incredibly fun ride. I think the next five years is going to continue to be dynamic and tumultuous. I think that the firms that do best in this industry over the next five years are going to be the ones that  innovate with their clients, that hire the best, that are nimble and agile, that can move with the market. I think we’re good at that. 

It is very difficult to predict what is going to happen over the next five years, but if we stay focused on the objective of good client delivery and helping our clients achieve great clinical outcomes and help them do that as efficiently as possible, we can’t go wrong no matter what happens in the regulatory environment or legislative environment.

Any concluding thoughts?

It has been amazingly fun to grow a company over the last five years. It has been really liberating. I’m very proud of what we have achieved over the last five years. I’m really proud of the culture we have built. I’m really proud of the people we get to work with every day. 

I’m thankful for our clients. We get to work with some of the blue chip clients in our industry. We get to learn from them and help them achieve some great things. It has been a fun ride.

Monday Morning Update 1/9/12

From California Girl: “Re: CareFusion. Has done some executive trimming of late and more layoffs may be in the offing.” Unverified.

From Lucitania: “Re: Gerry McCarthy of McKesson. Confirming that he’s leaving for HealthMEDX to work with Pam Pure again. The internal announcement didn’t give his new role.”

From RS: “Re: Kathleen Sebelius. Op-ed in The Washington Post this evening.” One might quibble with her assessment that the Affordable Care Act is “putting consumers back in charge” by (a) requiring insurance companies to provide an explanation when they increase premiums by 10% or more, and (b) also requiring them to spend 80% of premiums on health care services, which of course still lets them make their big money by investing prepaid premiums until services are actually rendered, which allows them to put their signs on tall buildings and to sponsor sporting events. The problem with reducing healthcare costs is that it would require (a) patients who are conscientious about their consumption of healthcare dollars paid by someone else, which hasn’t worked well historically; and (b) politicians with non-partisan political backbone who are willing to rile big organizations that are loaded with lobbyists and campaign donations, which never happens. And in the way of counterpoint, here’s a comment left on the article:

Tired talking points. Where do I start? Funding was shifted from the Medicare program and the doctor SGR fix was intentionally omitted to make this law "bend the cost curve down", but ACA does nothing to lower costs. Savings were based on finding fraud and abuse, which could have been done in the current system. The rising costs of premiums cited by Sebelius are going to insurance companies who squirrel it away in profits hidden as loss reserves. Any increases in payments for the last 9 years to doctors and hospitals have been lower than the same inflation rate. Her state-based "competition" is dependent on states participating. The "80-20" rule doesn’t apply to AARP plans in exchange for their support. For AARP it is really a 65-30. Lastly if it is so great, why has the administration granted so many waivers to unions and large contributors?

It’s HISsies voting time. I’ve placed the most-nominated entries on the final ballot, which I’ll e-mail out Monday evening. I won’t send an e-mail reminder (since I always get a few complaints about wasting 0.5 seconds of someone’s time to read and ignore the e-mail subject line vs. the five minutes it takes to complain about it), so watch your inbox and check your spam filter if you don’t receive yours. Voting is limited to subscribers to the e-mail update as of this past Saturday morning when I had time to create the ballot e-mail list.

Vince’s HIS-tory this week goes micro – it’s all about the early days of PCs in hospitals. Quite interesting as always, and fun to read of the one example where Apple took a hospital beat-down from the old-guard IBM.

Listening: Veruca Salt, mid-90s, unpolished hard-charging chick rock. And while Mrs. HIStalk and I were having lunch today at the local hipster taqueria, I bet I was the only person there who could identify the music playing over the sound sytem – Portishead’s “Glory Box.” Mrs. H applied minimal effort in pretending to be impressed.

Around two-thirds of readers aren’t buying it when a hospital’s post-mortem on computer downtime claims that patients weren’t harmed as a result. New poll to your right: are business conditions better now than a year ago?

Welcome to HEI Consulting, a new Platinum Sponsor of HIStalk. The KCMO-based company provides expertise all over the world in everything related to Cerner Millennium on both the clinical and revenue cycle sides of the house, including assessments, selection, implementation, workflow analysis, revenue cycle, EDI, CCL scripting, Cerner Open Engine integration, data extraction, and optimization. They offer experienced analysts who have been involved with Millennium implementations worldwide, including in the UK, Middle East, Canada, and of course the US. If you need help with Meaningful use, workflow optimization, ICD-10, give them a call. Thanks to HEI Consulting for supporting HIStalk.

My Time Capsule editorial from five years ago: Happy 2007 – Now Get Back to Work! An extract: “Hospitals, too, get busy after months of letting IT projects lie fallow. No wonder ROI is hard to come by — projects come to a screeching halt because of non-IT staff refusal to get involved during (a) the November to January holiday block; (b) summer vacations; (c) school spring breaks; (d) impending JCAHO or state inspection visits; and (e) local, state, or national conferences involving anyone remotely involved in projects. No wonder implementations take forever – they’re on hiatus half the year. ”

The perennial underperforming and unimpressive Yahoo pays $26 million to secure the services of its new CEO for one year, although that’s a pay cut from that of the previous CEO, who made $47 million in one year before being fired over the telephone. I like Yahoo Finance and I use their e-mail because I like it better than Gmail, but otherwise I couldn’t tell you anything they offer and I don’t really want to know.

John Snyder MD of Mayo Health System in Eau Claire, WI is named as a Mayo MacMillan Scholar. He’ll continue his work with workflow and electronic medical records.

A new Vanderbilt study by Josh Denny MD, MS (above) and Dana Crawford PhD links DNA samples with electronic medical records to examine the genetic basis of hypothyroidism.

CMS takes a bold step to curb high levels of Medicare fraud in 11 states (FL, CA, MI, TX, NY, LA, IL, PA, OH, NC, MO) in allowing RACs to review claims before providers are paid instead of the “pay and chase” standard of pay first-ask later. Orthopedics specialists, as you might expect, aren’t thrilled at that policy, suggesting also that CMS should spend some effort cutting back on direct-to-consumer advertising for free motor scooters and sleep apnea machines, which it says only two countries (the US and New Zealand) allow.

National Coordinator Farzad Mostashari lists ONC’s accomplishments for 2011 and invites comments on the biggest health IT trends for 2012. On his list:

1. Launching Meaningful Use
2. Taking the Direct Project live
3. Releasing the National Quality Strategy to use technology to reduce hospital-acquired conditions, heart attacks, and strokes.
4. Running the Standards Summer Camp.
5. Developing software contests.
6. Issuing grants and curricula for healthcare IT education.
7. Implementing breach reporting requirements as part of HITECH.
8. Launching a consumer e-health program that includes regulations making it easy for patients to access their lab results.
9. Exceeding the enrollment goals of RECs.
10. Measuring the growth in EHR adoption.

Rural doctors in Australia, eligible for $6,000 each in telehealth grants but offered minimal assistance and incompatible software modules, are often just giving up and using Skype instead. According to the president of the rural physician’s association, “In many cases, it works much better than some of the more sophisticated things out there. There is a whole range of technologies and, in establishing video-conferencing, [doctors] are not going to go out and buy some extravaganza of a system, they are going to stick with the simple stuff. Inevitably, there will be shonky players coming into something like this. Doctors have concerns about people putting together hardware and software and calling it a video-conferencing solution.”

E-mail Mr. H.

Readers Write 1/6/12

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!

Building a Successful EMR Dress Rehearsal Program: Why it Matters
By Kathy Krypel

EMR implementations are not technology-only projects. They are care process redesign efforts enabled by technology. To that end, it is critical to engage care providers early in the planning and design process and throughout implementation and support. Dress rehearsals, in particular, let them to see how their decisions made during the build process “come to life” prior to actual go-live.

Dress rehearsals are detailed scripted care events that interweave complex processes from various members of the care team with the new EMR technology to simulate real care delivery experiences. There are different approaches to dress rehearsals, so picking the right one depends on the scope of the interactions, risk level, and process complexity. The most common ones are:

• Departmental. Scope is narrow, detail is deep. There are some significant procedures that do not happen frequently, but are so complex that organizations want to develop a dress rehearsal to make sure all roles and possible outcomes are addressed (e.g. transplants).
• Day in the Life. Scope is wide, detail is shallow. Day-in-the-life rehearsals are typically short (less than one hour) to perform and focus on workflows nurses, physicians, and other clinicians follow during their day.
• Integrated. Scope is wide, detail is deep. Integrated dress rehearsals are the most common type and usually last two to four hours. They focus on common workflows with multiple integration points.

The keys to successful dress rehearsals are preparation and participation. When the application teams, site leadership, and super users are fully engaged in both planning and execution, there’s greater buy-in up front, and there are fewer calls to the help desk after go-live.

Questions often come up during the planning phases concerning timing, issues communication, and degree of authenticity. While there’s no one right answer, the following responses to FAQs are based on our experience with successful dress rehearsals:

Timing: “Match timing with approach”

Day-in-the-life dress rehearsals can start as soon as some basic nursing and physician workflow(s) are built and ready for all to see. “Lunch and learn” sessions often offer end users a chance to see and interact with the system prior to go-live.

Integrated and department-specific dress rehearsals should be held as close to go-live as realistically possible. They are led by super users and attendees who have already been through training and practice sessions, so they are familiar with the system. This type of dress rehearsal offers end users one more chance to interact with the system before go-live and to follow their workflow through the care process.

Authenticity: “Keep it real”

Whenever possible, use the equipment and follow workflows accurately. However, make sure all of the pieces work in the dress rehearsal environment. The use of interfacing technology, when working smoothly, greatly contributes to end user confidence. When it doesn’t work, it adds to end user anxiety and impacts confidence in the technology.

Issue Resolution and Communication: “Write it down and follow up”

The dress rehearsal scribe needs to record any questions and concerns, and assign due dates for resolution. Consider using the time at the end to address issues. Often, the needed expertise is already attending/ participating, so problems can be readily resolved and changes approved.

Done at key points during the implementation project, dress rehearsals identify issues early on, so adjustments in technology and process can be made in time to retest and refine. This in turn increases the likelihood of a successful EMR implementation. Equally important, dress rehearsals engage care providers prior to system go-live, mitigating pre go-live anxiety and gaining their buy-in – all critical for achieving Meaningful Use.

Kathy Krypel is a senior associate with Aspen Advisors of Denver, CO.

VNAs and Enterprise Archiving – A Stepping Stone To Healthcare Data Management?
By Tim Kaschinske

At the same time that PACS are proliferating beyond radiology and into other disciplines (such as cardiology and orthopedics, for example), the responsibility for archiving and storing all of this DICOM data is moving away from individual departments (that have traditionally managed these environments) to a hospital’s central IT department. Healthcare CIOs have rolled up their sleeves and embraced the concept of a Vendor Neutral Archive (VNA) or Enterprise Archive as the best approach to managing this data storage challenge.

However, PACS is only one of many systems that a hospital has to manage; and healthcare data encompasses content from all manner of applications, both clinical and administrative. Consequently, a hospital’s storage systems also need to support everything from video to scanned documents to e-mail. Here are just a few of the activities and data types that need to be incorporated:

• Sleep Studies – where EEG and EKG waveforms are captured for brain and heart activity during sleep. Often this data is stored in a proprietary format.
  Endoscopy – where videos of the esophagus, stomach, or colon are captured.
• Scanned Documents – where paper documents that are scanned in and stored as PDF files.
• Laboratory Results – often transmitted using HL7 messages and stored in various formats.

To cope with these many and varied data types, hospitals need a VNA or Enterprise Archive that can deal with more than just DICOM data. In addition, to facilitate data exchange, these archives are adopting the XDS standard for cross-enterprise document sharing.

Over the next 12 months, more CIOs will adopt XDS-enabled archives as a standardized way to store, query and retrieve clinical and administrative content. In facilitating the registration, distribution ,and access across healthcare enterprises of electronic patient records, XDS enables IT to manage and share any document type. It works with DICOM (XDS-I) as well as multiple repositories indexed by a single enterprise registry.

As healthcare storage evolves, the VNA acronym will almost certainly be replaced with something that more accurately describes hospital storage systems. In reality, hospitals are looking for comprehensive healthcare data management. As such, hospitals need to adopt all the best practices typically associated with managing data across the Enterprise, such as:

• Data Protection – providing the ability to store additional copies of data to multiple locations and restore that data in the event of a disaster.
• Multi-media Support  – offering the ability to store and migrate data across different storage devices and media types, all independent of user applications.
• Data Versioning – enabling version control and management of data that can be restored in case of errors or corruption.
• Data Authentication – ensuring that data copied between sites or media types remains consistent and is not corrupted during the copy.
• Business Continuity – for the protection, preservation, and speedy restoration of systems and data during an outage.
• Data De-Duplication – providing the ability to detect multiple copies of identical data and store only one copy with multiple references.

Throughout 2012, hospital IT will be challenged to transform their PACS-centric storage into holistic healthcare data management systems. In the process, they will need to adopt a vendor neutral approach to their hardware and a data-agnostic approach to content. Just what we’ll end up calling it remains to be seen.

Tim Kaschinske is a consultant, healthcare solutions with BridgeHead Software.

2012 New Year’s Resolutions
By Vince Ciotti

Listed in order by their annual revenue, here are Vince Ciotti’s 2012 New Year’s resolutions for each of the leading HIS vendors:

1. McKesson:  Series will be sunset and Horizon announced as the go-forward product. Whoops, I’m sorry, that I meant to say Star is being sunset and Paragon is… oh, never mind!
2. Cerner: “ProFit” to be re-named “LossLeader” and targeted to hospitals whose CFOs and CIOs have a combined IQ of under 25 beds.
3. Siemens: will begin work on a new ERP suite for Invision which will allow them to automatically deduct monthly invoices from the AP system. The new system will be called Invasion.
4. GE: any hospitals that buy Centricity in 2012 will receive a free GE refrigerator for the first 30 patients registered in Centricity.
5. Epic: will sell to 100-bed and under hospitals provided they agree to send all inpatients to Verona for a two-week vacation to learn their EHRs. Epic will send one of its rookies to outpatient’s homes for training, but this will not earn them “good” maintenance rates on their EHRs.
6. Allscripts: will announce the complete integration of all of Eclipsys and Allscripts’ sales brochures, advertisements, PowerPoints, proposals and contracts. Work on disparate data bases and reports to commence in 2013.
7. Meditech: now that the Release 6 implementation line has reached 36 months from date of contract signing, orders are being taken for Release 7.
8. NextGen: announces an integrated solution combining their Opus, Sphere, and Prognosis HIS systems, to be called “Opusphernosis.”
9. QuadraMed: is renaming the integrated version of Affinity and QCPR as “Infinity,” the time it is estimated it will take to complete the project.
10. Keane: NTT wants its money back from Caritor, claiming that Optimum was not fully developed despite the many demos they observed, extensive marketing literature provided, written RFP response attached to the contract, and personal assurances they received from executives.
11. CPSI : is targeting the 500+ bed and up hospital market with a powerful new system that will run on two servers!
12. HMS: their new MedHost ED system is now being offered to hospitals without an ED at a special reduced price during the first quarter 2012.
13. Healthland: is planning a name change to Dairyland to emphasize their Midwest roots, strong service ethic, and diverse industry experience.

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

Time Capsule: Happy 2007 – Now Get Back to Work!

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.

Happy 2007 – Now Get Back to Work!
By Mr. HIStalk

Happy New Year! Considering the alternative, be glad that you were alive and well enough to eat and drink too much over the past couple of weeks. Now get back to work!

You’ll notice your local newspaper, having slyly given many of the real news staff time off for the holidays, is padding out their already-slim editions with time-insensitive material written in advance or copied off the wire services: witless phony New Year’s resolutions for local politicians, tired rosters of the biggest personalities and celebrity deaths of 2006, and pleas for donations to community causes.

I can see why. Healthcare IT news is sparse this time of year, too. No one wants to bring out new products, start implementations, hire or fire people, or make changes in the strategic plan when no one is paying attention (hmm: this would actually be a good time to announce bad news, wouldn’t it?)

If our industry was a sport, the season would begin at the HIMSS conference in late February. It sets the tone for the upcoming year, as companies save positive announcements to coincide with the annual bacchanal. Vendors who make a bad impression at HIMSS will find it difficult to recover throughout the year, with attendees critically evaluating their demonstrations, booth size, staff attire, and cheery spirit or lack thereof. No wonder that even those companies in imminent danger of collapse spend the equivalent of a small country’s gross domestic product on one glorious, go-for-broke HIMSS splash, hoping against odds to get their money’s worth in new business.

Hospitals, too, get busy after months of letting IT projects lie fallow. No wonder ROI is hard to come by — projects come to a screeching halt because of non-IT staff refusal to get involved during (a) the November to January holiday block; (b) summer vacations; (c) school spring breaks; (d) impending JCAHO or state inspection visits; and (e) local, state, or national conferences involving anyone remotely involved in projects. No wonder implementations take forever – they’re on hiatus half the year.

CIOs have plenty of work to do. All those clinical systems projects still need to be finished. Celebrate the completion of major phases with some downtime and reflection, don’t forget to keep pushing at needed process changes and system improvements, and then jump into the next round of work. Clinical systems projects are like painting the Golden Gate Bridge: they’re never finished.

Speaking of clinical systems, if you haven’t yet made a commitment to bedside barcode verification of medications, then now’s the time. Same, too, with tightening up your Pyxis access with biometric security, override vigilance, and double-checked stocking procedures. Your patient safety experts aren’t sitting in IT, so get them involved and listen to their recommendations.

Microsoft has a new operating system and Office version – yay! Users will be upgrading at home, scornfully wondering why your IT department is holding them back in the Stone Age with systems they shamefully underuse anyway. You needed that non-strategic headache, right? At least PC hardware keeps getting cheaper, right about the time Vista will neutralize the benefit by requiring more of it.

RHIOs will want your attention in 2007. Your data, too. Maybe now’s the time to catalog all the electronic data elements you have available and to develop a plan to move important paper-based ones to electronic formats.

If you haven’t already, let one of your computer geeks play around (officially) with Linux, both server and desktop. If you aren’t running it at all now, you will be soon. In fact, you might as well encourage your nerds to bring in whatever compiler, software, scripts, tools, or websites they’re fooling around with because the gap between hobby computing and work computing is narrowing. At least you’ll be able to explain to youthful users why your hospital doesn’t need an official MySpace page.

Stark relaxation means you may need to support a new class of impatient, computer-illiterate users: doctors in private practice and the inconsistent employees they hire. Keep stats to get budget dollars since those support hours have to come from somewhere. It’s a warning you don’t need: office EMRs are going to be hot for the foreseeable future, which means lots of newbies are going to need help.

Lastly, if you’re in management, please make sure to recognize and reward those who work for you. When you get too full of yourself, make a list of which essential personnel would be needed in case of system failure, natural disaster, or clinical emergency. You’re probably not on it.

I hope our industry and all of us working in it have an excellent 2007. If in doubt about a particular course of action, remember WWIWAAP (which you may pronounce WEE-WEE-WAP, since I just made it up): what would I want as a patient?

News 1/6/12

Top News

HHS introduces streamlined rules governing electronic fund transfers from health plans to doctors, which it says will cut approximately $4.5 billion in administrative costs over the next 10 years. The new rules require remittances from health plans to include tracking numbers, making it easier for doctors to match payments with bills.

Reader Comments

From NoVegas: “Re: animated ad. When reading yesterday, I noticed that there are still some animated ads up. I thought they were going away?” A handful of well-intentioned sponsors missed the deadline to switch out their banners, but have assured us their new ads are forthcoming. Meanwhile, join me in a collective “thank you” to those who were happy to comply with readers’ requests to retire the flashing ads.

From Swami: “Re: MedPlus. An RFP posted by New Mexico HIC says they’re exiting the HIE market. Are you aware of their plans?” We asked the company, which provided this response:

MedPlus, the healthcare IT subsidiary of Quest Diagnostics, has made the decision that the company will no longer enhance or further develop the product known as the FirstGateways Clinical Portal or Centergy Clinical Portal. MedPlus continues to satisfy its support and contract obligations to each customer of this product. When all such support and contract obligations expire, however, the product will be permanently sun-setted.

From Birdie Little: “Re: McKesson Provider Technologies. [executive’s name omitted], a 20-year veteran SVP of product management and marketing, is leaving, supposedly to take a small company CEO job. The Horizon fallout had influence.” Unverified, with the name omitted for that reason. Another person reported a similar rumor about the same person, but gave the new employer as HealthMEDX, which former McKesson EVP Pam Pure joined as CEO a few weeks ago.

From The PACS Designer: “Re: Apple’s 2012 launches. The rumor mill from the Far East is heating up again, with info circulating that we may see the launch of Apple’s iPad 3 with the LTE communications upgrade. Since Steve Jobs’ birthday was February 24, the launch may happen then. Later this year, we’ll see the launch of Apple’s iTV, not to be confused with the current $99 Apple TV product.” February 24 would be a lousy date since vendors will be giving away bunches of iPad 2s that very week at the HIMSS conference, just in time for them to be rendered obsolete. That happened last year, as the iPad 2 was released on March 2, a week after the conference. As an alternative, how about the above as a giveaway to Apple fanboys (most of us, I suspect): a creepily lifelike 12” Steve Jobs action figure (that’s an actual photo of the doll above). The manufacturer provides free accessories: two pairs of glasses, a chair, two apples (one with a bite taken out of it), and a backdrop that says “One More Thing.” It goes on sale next month as long as Apple’s lawyers can’t figure out how to shut down a company operating in China.

From Rumble:

“Re: Partners HealthCare. The earth shook in 1994 when MGH and Brigham and Women’s joined to form Partners. Rumor has it that they’re definitely going commercial for their clinical systems – the end of home-brewed. They spent $200M for Siemens ADT before Glaser became CEO of Siemens. Several sources, none official, are confident they’re going Epic. I feel the earth moving again.” Unverified, but I would be shocked if they decided otherwise.

From Roots Fan: “Re: Burlington, VT. Men’s Health just listed it as the #1 Best City for Men, with emphasis on the local hospital’s implementing of Epic, especially MyChart.” The real objective is to sell magazines, and junk stories based on a numbered list (often presented via a lame slideshow) to bait intellectually lazy readers. They’re the literary equivalent of fast food restaurants, providing overly processed, nutrition-devoid fat calories (“The 15 Hottest Actresses You Will Never See Naked On Film” “10 Humor Sites to Make You LOL” … notice they always start with a number to make it clear that minimal mental effort is required to skim them.) I’m not sure having MyChart available is that big of an advantage and Burlington is hardly unique in that regard, but the magazine was mightily impressed, suggesting that doctors just needs your encouragement to implement Epic so you can play with MyChart on your iPhone:

“Our major medical center recently introduced electronic medical records, which will hopefully further boost rates of preventive care,” says Dr. Vecchio. Doctors will soon be able to program preventive-care reminders into patients’ e-records so they never miss screenings. Ask your M.D. about switching to digital records, and then download the MyChart app, which lets you use your smartphone to view your medical file and any screening reminders.

From HIPAA Hound: “Re: doctor’s perspective on end-of-life care. Exactly what I’ve often thought, but never heard much like this, especially from a physician. Adherence to this treatment philosophy would surely save the country billions each year.” I’m glad you sent the link since I read and enjoyed the piece, but forgot where I’d seen it. The gist of the article is contained in a quote from it: “… Doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little.” It argues that doctors are expected to recommend care that they themselves wouldn’t want, with procedures that are not only futile, but painful or degrading. It’s restrained in barely mentions the huge cost taxpayers bear as all the stops are pulled out for Medicare patients in their final days of life, with minimal benefit to anyone.

HIStalk Announcements and Requests

  One of our creative sponsors suggested a new and fun event for HIMSS this year: the HIStalk Booth Crawl. More details will be coming soon, but it’s likely that Crawl participants will have a better chance of winning an iPad 2 than they would hitting it big in the $1 slot machines. If you are a sponsor and have not received details on the Crawl, drop me a note ASAP. Potential players, stay tuned.

  After last week’s getaway in the part of the world Mr. H called “The Land Without Broadband,” I am back in full force. If by chance you failed to peruse HIStalk Practice over the last couple of weeks, here are a few gems you missed. Who to contact to appeal 2011 PQRS or e-prescribing payments. A family practice doctor’s use of social media includes posts entitled, “Are You Smarter Than a Medical Student?” My secret indulgence and 2012 predictions and resolutions. CareCloud adds a director of clinical technologies. Don Michaels offers excellent insight into EMR attestation in 2012 (it’s going to be crazy) and ACOs (the jury is still out.) Dr. Gregg and the percolating e-patient revolution. It just takes a few minutes to be enlightened on happenings in the HIT ambulatory world, so come join the fun.

Over 500 people have signed up for HIStalkapalooza invitations in the first couple of days, so if you are contemplating attending, click here or on the graphic in the upper right column. We always get an interesting mix of executives, unsung in-the-trenches grunts, students, investment people, and semi-celebrities, and this year’s event was designed to encourage them to network (lots of conversation-friendly small spaces, for example, not to mention an open bar.) We’ll close down registration in a few days and e-mailed invitations will follow. It’s only a handful of weeks away, shockingly.

I mentioned that I’m not a fan of year-end industry predictions, given that (a) many of the pundits don’t have the credentials and experience to be making them; (b) nobody wants to look stupid in print, so they predict the obvious; and (c) their predictions are often tediously defended with shallow and unconvincing reasons they believe themselves to be right. Not true of our own Travis on HIStalk Mobile, whose 2012 predictions are specific, bold, and concisely convincing. I like his attitude: “I’ve tried to be specific with some of them, not because I necessarily have any inside information, but because I’ll look good if I’m right and people will likely have forgotten if I’m wrong.”

Listening: reader-recommend Arkells, Canadian semi-hard rockers with a blue-eyed soul sound and strong vocals (think Hall & Oates meets Kings of Leon meets Springsteen.) I’ve listened to the album a couple of times and it’s really good. Nice call by the reader. I’ll definitely be giving it several more listens.

Acquisitions, Funding, Business, and Stock

MedAssets announces that is has paid the $120.1 million deferred purchase consideration due to the former owners of the Broadlane Group as part of the acquisition completed in November.

Frontier Capital invests inHealthx, an Indianapolis-based vendor of health plan portals for patients, employees, and physicians.

Sales

Iowa e-Health selects ACS to implement and manage its HIE.

Summit Medical Group (TN) signs a three-year contract renewal with Zix Corporation for its e-mail encryption services.

The Illinois HIE awards InterSystems a $7.25 million contract to implement its HealthShare HIE technology platform.

North Shore LIJ Health System selects Wolters Kluwer Health’s ProVation Order Sets as its electronic order set solution.

Prognosis HIS announces new sales to Colorado-Fayette Medical Center (TX), Biggs-Gridley Memorial Hospital (CA), Plumas District Hospital (CA) and Shamrock General Hospital (TX).

Mammoth Hospital (CA) will deploy Allscripts RCM services and EHR at its 11 outpatient clinics.

Independence Blue Cross (PA) selects Kony Solutions’ Write Once, Run Everywhere as its mobile application platform.

Mental Health Partners (CO) chooses Stockell Healthcare Systems’ InsightCS RCIM to integrate with the MindLinc behavioral EMR.

Pacific Eye Specialists (CA) selects SRS EHR for its 10 providers.

Doctor’s Medical Center (FL) signs up for Vitera Intergy Meaningful Use Edition for its 23-physician practice.

People

Olathe Health System (KS) hires George Dix as CIO. He was previously with Cape Fear Valley Health System (NC).

Andrew Ziskind MD, previously with Accenture, joins Huron Consulting Group as a managing director in the company’s healthcare practice.

Announcements and Implementations

St. Joseph’s Medical Center (CA) implements PerfectServe’s clinical communication and information delivery system.

Continua Health Alliance and some of its member companies will exhibit personal connected solutions at the International Consumer Electronics Show (CES) in Las Vegas next week. That show outdoes HIMSS in terms of celebrity sighting potential, with Dennis Rodman, Justin Bieber, Snooki, and 50 Cent among the glitterati collecting big corporate paychecks for serving as set dressing for booths.

athenahealth announces that it proactively sought and received a favorable Advisory Opinion from HHS’s Office of Inspector General relating to athenaCoordinator, a fee-based offering that would provide order transmission and coordination services to providers. The opinion clears the way for athenahealth to offer a per-transaction pricing model that charges fees to parties that are exchanging clinical data, but steering clear of anti-kickback statutes.

Government and Politics

HHS announces two winners of its contest to create HIT applications using public data for cancer treatment and prevention. The ONC awarded $20,000 each to the developers of  Ask Dory!, submitted by Applied Informatics, and My Cancer Genome, submitted by Mia Levy PhD, MD of Vanderbilt University Medical Center.

Other

Serbia’s health minister says the introduction of an electronic health card system has turned doctors into scribes, forcing them to fill out forms instead of taking care of patients. He offers a solution: “When a doctor finishes examination, he/she enters data into computer and then takes a health card and fills it in manually. I asked them why not printing the findings and attaching them to the health card. That would speed up the process.”

University of Mississippi Medical Center lays off 115 employees and cuts 90 unfilled positions, saying it’s struggling with increased charity care and coming up with the $80 million it needs to implement Epic.

An Iowa public policy analyst discussing the pre-caucus healthcare climate there says the governor accepted $7 million in federal HIE grants while calling it a government takeover of healthcare. “The practical side of that is that many don’t want the government telling them what to do, and the only way that can happen should this continue forward is by setting up your own exchange, otherwise the feds will set up their own.”

Sponsor Updates

• Free EMR vendor Practice Fusion streamlines its e-prescribing workflow.
• Greenway Medical Technologies and NextGen will join MedAllies at the HIMSS12 Interoperability Showcase to demonstrate MedAllies’ Direct HISP patient data exchange solution.
• Computerworld includes Ugo Mattera, VP of information technology operations at McKesson Health Solutions, in its 2012 class of Premier 100 IT Leaders.
• MED3OOO announces a free webinar regarding its PQRIwizard powered by CECity.
• McKesson introduces its cloud-based supply chain solution to support supports multiple materials management information systems.
• Southern Tier HealthLink (NY) expands its use of Lawson Cloverleaf Hosted HIE.

EPtalk by Dr. Jayne

An article in the Journal of the American Board of Family Medicine discusses barriers to use of formulary information by physicians who e-prescribe. It wasn’t a huge study and the authors claimed it looked at eight practices of varying size and specialty, but a closer look finds the practice size to range from one to four physicians, which I would generally consider to be small practices. Each was using a standalone eRx program. Information was gathered both through observation and through interviews.

Some interesting points. The study included the use of a standalone EHR program, which I bet that made it easier for providers to consider a paper-based workaround. I wonder if the results would have been different if the eRx solution were part of a reasonably robust EHR or if larger practices were reviewed. The researchers had backgrounds in medical anthropology and labor relations, which is certainly an interesting combination.

Although few users were using formulary and benefit references prior to the study, there was a central theme of provider distrust of the electronic resources due to inaccurate data. Providers continued to use paper-based workarounds to find information. Three key difficulties were noted: (a) health plans aren’t required to provide a full set of formulary information; (b) some software packages “normalize” the data, creating groups such as preferred, formulary, or off-formulary which really don’t mean anything; and (c) some payer information is group-level rather than plan-level, which can mean a huge difference in insurance coverage information.

In my market, only 70% or so of the patients have valid formulary information accessible through the EHR despite our attempts to make provision of formulary information a part of our contract renewal process with payers. I agree that the coverage groupings are confusing, but they were confusing in the paper world as well. Personally, I’d like to see some realistic ideas of coverage such as “covered and dirt cheap” vs. “covered but crazy expensive” or even “don’t even think about it.” That would certainly help me be a more Meaningful User.

In addition to immunization and disease surveillance registries, some states are offering registries for Advance Directives, with Virginia being the most recent to head online. I love the idea of patients being able to document what kind of healthcare they want in the event they are no longer able to make their own decisions, and putting it online is a lot more helpful than stashing it in a file cabinet at home or in a bank lockbox. State information exchanges may eventually allow physicians access.

Unfortunate things can happen when patients lose the capacity to indicate their wishes, especially if they haven’t communicated those wishes to family members. Whether you have an online registry in your state or not I, encourage everyone to talk to your loved ones about what you might or might not want done should the situation arise. Some nurses made fun of me when I arrived for an elective procedure (as a sassy 20-something patient) with my advance directive and healthcare power of attorney documents in hand, but I wanted to make sure that in the event of something horrible, it was clear how I wanted my care to proceed.

Speaking of cheery topics, the American College of Physicians recently released its update to its Ethics Manual. The sixth edition features new guidelines that address the issue of cost effectiveness and efficiency in care delivery. Other new or expanded sections include: confidentiality and EHRs; health system catastrophes, social media and online professionalism; pay for performance and professionalism; and patient centered medical home.

Websites like Groupon that offer daily deals are increasingly prone to offer health-care related services. Patients without coverage use the discounts to receive dental care, while others may take advantages of bargains on elective or non-covered services such as Botox or laser vision surgery.

Contacts

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

Acquisitions for Mediware, Cumberland Consulting, and TriZetto

Mediware has announced its acquisition of the assets of Transtem, which sells software for managing adult stem cell collection and transplantation. Mediware President and CEO Thomas Mann said in the announcement, “This is cutting-edge healthcare that is pursuing cures for such large patient population diseases as myocardial infarction (MI), critical limb ischemia (CLI), Parkinson’s disease, diabetes, cancer and many others. Importantly, there is a growing demand for a comprehensive software solution to effectively manage the collection and preparation of the therapeutic cell solutions as well as streamline donor, patient and treatment data management.”

Cumberland Consulting Group has been acquired by members of its management team and private equity firm Tailwind Capital, with participation by investor and former HCA Chairman R. Clayton McWhorter. Tailwind Managing Director Geoffrey Raker said in a statement, “This transaction represents a tremendous opportunity for Tailwind to invest in a proven platform that provides high quality services to a dynamic industry in the midst of an IT transformation. Cumberland has a very experienced management team and is well-positioned for future growth and expansion. We look forward to supporting Cumberland as it pursues future organic initiatives and acquisitions.”

TriZetto announced this morning that is has acquired Medical Data Express, which offers Medicaid and Medicare encounter management software. TriZetto Chairman and CEO Trace Devanny said in a statement, “By acquiring MDE, TriZetto is cementing its ability to offer customers a proven, comprehensive and reliable solution that helps payer organizations meet federal and state requirements for medical encounter data processing. We are committed to continuing to enhance our suite of solutions helping Medicare and Medicaid plans leverage the efficiencies they gain for strategic advantage while maintaining compliance.” 

HIStalk Interviews Robert Musslewhite and Paul Roscoe, The Advisory Board Company

Robert W. Musslewhite is CEO of The Advisory Board Company. Paul Roscoe is CEO of Crimson.

Robert, tell me about yourself and what The Advisory Board Company does.

Robert Musslewhite: Unlike many of your interviewees, I’m not the founder of the company. I was really fortunate to find the company eight years ago after spending some time at McKinsey, and before that, being trained as a lawyer. I immediately realized what a special place this company is. First and foremost, we have an incredible team that’s very engaged and an incredible group of employees that cares a lot about improving healthcare. I think that’s really special.

In terms of what we do, we partner with senior executive teams at over 2,800 hospitals and health systems. We focus on improving clinical, financial, and operational performance. The focus is through this network to identify and service proven, demonstrable best practices, communicate these out to our members, and help them install them to drive performance improvement.

Increasingly, If you look over the past several years, not just through our traditional best practice research, which a lot of our members and member executives know us for, but also through hosted analytic software tools. Most of them have the same format of pulling critical information from hospital IT systems and translating it into key performance metrics, which we load into analytic dashboards that hospital executives and staff can use to drive and hard-wire performance improvement. Today we’re doing this across all key performance areas for the hospital, so things like value-based care, accountable care, physician management, quality, revenue cycle, clinical operation, supply chain, etc.

If you put all that together, we have a deeper and more comprehensive set of services for our members than we had traditionally. That’s a really exciting path for us.

Do you still consider yourself a consulting firm rather than a software vendor?

Robert Musslewhite: No, I think increasingly we consider ourselves a technology company. More than half of what we do is on the technology side today.

I do think the best practice research is such an important part of who we are as a company. It forces us to focus on the practices that matter — what moves the needle in performance, what doesn’t. It forces us to communicate those practices out clearly and think about how to make those practices actionable for hospital executives so they can use them.

If you think about the evolution, as we’ve developed these technology products, it’s based on the insights from the research side and on focusing on helping install best practices and help hospital executives and teams capitalize on the learning that we have on the best practices in a more targeted and tangible way.

The Crimson and Southwind acquisitions obviously expanded your offerings. What’s your vision for the company and what do you see in the future?

Robert Musslewhite: If you think about what’s going on with our hospital and health system members, they’re really at the nexus of transformative change. There’s all kinds of new pressures and imperatives that they’re facing. That’s causing them to change the things they need to do to manage successfully in this environment. It’s pushed up the change to the company.

We’re becoming deeper and more comprehensive in our abilities to partner with hospitals to help them address these challenges. If you go back eight years ago, you would have said we’re a fantastic best practice research provider in helping hospitals understand best practices. Today, we do a lot more to not just help them understand those, but to hard-wire them through technology like Crimson. We also provide services, support, and management services to help  bring those practices to bear on the ground level. That’s what Southwind helps do.

The previous model was more publishing than it was consulting in some ways, where you consolidated best practices and presented them really well. How do you transform from being the best practices aggregator to somebody who’s actually out there solving problems?

Robert Musslewhite: It’s a great question. In some ways, it’s a big change, so there are some operational implications. We have a technology development team. We have an office in India that helps with all the data management and the technology development. There’s a lot that implies about our hiring and recruiting practices and the types of expertise we need to have.

On the other hand, it’s really not a big change at all. We’re still focused on the same thing, which is to help hospitals and health systems understand and use best practices in better and better ways. The metrics and the tools are based on best practice insights. We provide benchmarks across the network of members that we have to help members understand where they fall on their performance, where to focus, and which practices they should be employing to help them improve on that dimension.

Southwind and our other services business provide support when a member needs either physician practice management support or consulting support to embed those best practices and to hard-wire them into their institutions. So from that sense, it really hasn’t been a change at all in terms of our focus in what we want to do help our members.

What are the most pressing issues for your membership and how can you help them in ways that other consulting firms can’t?

Robert Musslewhite: There are obviously a lot of pressing issues out there today. To drill it down to a few is always hard. I would say the number one issue that everyone is facing is the shift in Medicare reimbursement that everyone knows is coming. It creates cost pressure, but it is not the same type of cost pressure that hospitals saw a couple of years ago, where it was “cut, cut, cut” trying to make budget this year.

It’s much more about evolving the business models to be able to manage on a continuing basis what we call Medicare break-even, or success under Medicare margins. That involves bunch of different capability enhancements, from revenue capture to expense management on both on the clinical and on the supply side. Expanding capacity on the right places and improving case mix and top-level growth. There are a lot of different dimensions to that that are driven by the changes that you see in the market today with Medicare and increasingly on the commercial side of reimbursement.

Your work is very targeted to the CIO audience as well. We do a lot of research for hospital CIOs, and what I think is neat there and different is that we focus on the executive suite set of issues and then translate those into what matters from that set of issues and how the CIOs should be responsive there. Rather than just making research that’s targeted for the CIO, it’s in the context of what are the broader health system imperatives and why is that important to the CIO.

Paul, turning to you, give me some background about yourself and then talk about the Crimson product line.

Paul Roscoe: I started my professional life as a lowly management accountant in the British National Health Service many, many moons ago. I’ve been involved in healthcare IT in Europe and in the US for over 20 years.

Prior to the Advisory Board, I was general manager of Microsoft’s Health Solutions Group. I came into that organization alongside Rob Seliger, building the Sentillion business from its infancy and startup phase to the pre-eminent identity access management solution out there in the marketplace that was ultimately acquired by Microsoft.

It was a pretty good decision for me to come to the Advisory Board for many reasons. One, amazing people. Two, as you’re starting to get a sense from and many of our members who’ve experienced our technology first hand every day, an amazing set of technology that the Advisory Board hasn’t historically been known for. A deep sense of commitment to doing the right thing for the membership. All of those combined made it an easy decision for me to come on board and to manage the Crimson business.

When we think about Crimson, we think about it as a Platform with a capital P for aligning hospitals with physicians as they think about the challenges that they’re facing, as they’re rethinking the healthcare network and the reshaping the health system’s role in managing populations of healthcare. Clearly they spend a lot of time thinking about how they should align themselves with physicians.

We created this analytic platform that helps them in a number of different ways. Firstly, a lot of health systems are thinking about how they can secure alignment with physicians, and from that perspective, how they can understand who their most important physicians are, from both the clinical and financial perspective, to target for growth through good old physician liaison outreach or through employment. Given the referral patterns that we see in the marketplace these days, the relationship between docs who are the biggest influencers, and that those the ones that we want to like us and what kind of incentives do we want to build with them. Think of this as like network building — securing physician alignment.

Secondly, clearly you’ve heard this a lot from the people you speak to. The big challenge is how do we work with those health systems and physicians to reduce cost and advance quality? We need to within this domain demonstrate that we can only not only measure physician performance, but frankly not just measure it, but engage with physicians and provide tools that engage our physicians, not just an analyst or a VP of quality. Those are important, but a real change comes from engaging physicians in conversation, looking for the outlier both from a positive and negative perspective, and then finding ways to remediate that to bring that into a high-performing organization.

We think these two things are essential whether you’re in a fee-for-service world or whether you are in a value-based or risk-oriented world.

What we’re now starting to see our members think more about and what Crimson is starting to help them with is the shift from not only maximizing in an inpatient setting, but trying to find ways of transforming ambulatory care. Given the burden of unprofitable patients with chronic conditions, many of our members are investing in – for want of a better description – a medical perimeter around their inpatient facility. The purpose of this infrastructure is to do exactly the opposite from what we’ve done in the past couple of decades – keep those patients out of the hospital; treat them in the ambulatory setting; create the medical homes, care teams, and health coaches, all that good stuff; and invest in ambulatory EMRs and CI programs. That has a huge implication from a technology platform.

The final piece of the puzzle is once you figure out your network, you got the right physicians, you’ve reduced cost, you’ve improved quality, you got a great ambulatory environment — how are we now going to manage populations of healthcare patients? How do we provide analytical tools and competencies to help a provider act in some ways as a payer would, and give them access to technology and data that they typically haven’t had?

Those are the four challenges and the underpinnings of what Crimson has been built to provide on this platform.

You offer CPOE tools. Do you have any tips or best practices to share, or anything to say about the status of CPOE?

Paul Roscoe: From a Crimson point of view, one of the three areas that we’re focused on is how to measure the effectiveness of the order sets that are getting used in CPOE. We’ve built an interesting set of analytics that hospitals are now deploying to help them understand if the evidence that they’re using in their day-to-day clinical practice is actually driving the outcomes and efficiencies that they want it to do.  

Clearly CPOE is being well adapted. There are still opportunities for us to make sure that we are optimizing the delivery of evidence-based medicine. Being able to have analytical tool that allows you to measure that performance across a set of physicians, across a set of hospitals. I think one of the things that’s unique in some ways to Crimson is the ability to benchmark your performance, not only against your peers in your hospital, but on a wide national basis — give me all the neurosurgeons in this particular size of the cohort.

Hospitals are so excited to get a clinical system in place that they often stop at just consolidating the order sets and steering physicians to the center of the guardrails. Will they need to go back now and think about the evidence-based approach and try to not just improve efficiency, but to change practice patterns?

Paul Roscoe: We’re already seeing it. Even the most advanced CPOE deployments that I would put up there in the US have used Crimson to go back to evaluate, now that they’ve got many years of experience under their belt, their performance against those order sets. What they’ve found is that there are significant cost and quality improvements that can come from testing the validity of those order sets, making changes to them, and then reevaluating the performance of it. We’ve seen some quite startling ROI from our members within a year to a year and a half of them deploying Crimson, particularly in an environment where they’ve got sophisticated order sets.

What are some of the IT pitfalls to avoid when working on clinical integration?

Paul Roscoe: From an IT perspective, one of the biggest challenges that you find in the clinical integration environment is that the hospitals are aligning themselves with independent physicians, hence the nature of clinical integration. One of the challenges that many of those hospitals are finding is how do you get good quality data out of the independent practices? You’re aligning yourself with 50 or 60 practices. Each of those practices has different ambulatory electronic medical records, practice management systems with different degrees of interoperability with them. What we have spent a lot our development effort on is building an integration platform that allows us to take this data out of these systems in a very automated fashion.

The second challenge you will find increasingly in a clinical integration environment, how do you link across the continuum? How do you link data that is in the inpatient setting with data that you find in the ambulatory setting? We’ve also set about that problem by building what we call a UPI, Unified Person Index, sort of a mini-EMPI that is right-sized for our use. It allows us to track patients and physicians across the continuum and look at them holistically.

Robert, any concluding thoughts?

In the broad picture, it’s a really challenging time to be a hospital executive. It’s a time of great change, but also a time of great opportunity. From a company perspective, we want to be aggressive in making investments in the improvements and the product rollouts to be sure that we’re right there by our members’ sides in helping them address these challenges. It’s been really exciting to see how big a role Crimson is playing in the market today. The evolution we have planned for Crimson to continue to match what’s going on in the market is very exciting to me. 

When I think of what that means to the Advisory Board, the continued growth is exciting. The innovation it forces us to do is exciting. But at the same time, what I and almost all of our employees would say that they love most about the company is the continued focus on our mission of helping our members. People here get really excited about the prospect of improving healthcare, and to do that in close partnership with a group of executives in a time of pressure and change is tremendously exciting.

Paul?

I think it’s very exciting. It’s also exciting to see the next generation of analytics solutions that we can really impact value and care in the healthcare environment. We’re bringing to market a set of solutions that are very much focused on starting to inflect performance in a real-time environment when the patient is still in the hospital. Analytical solutions can be very valuable when looking historically, but there’s a real opportunity to inflect while the patient’s still in the hospital.

We’re coming out with a set of products that are focused on how we prioritize that information. How do we get predictions of which patients to focus on into the caregiver’s hands at the point of care in a real-time setting? That’s very exciting for me.

2012 Mobile Clinician Voice Challenge 1/4/12

The Problem

Clinicians and their mobile devices are everywhere. Doctors, nurses, and other licensed professionals are interpreting clinical information and making clinical decisions right now using smart phones and tablets, often from locations outside the four walls of the hospital, clinic, or medical practice. They need better ways to interact with these systems beyond tiny keyboards.

The Solution

Give mobile clinicians a voice by speech-enabling your applications, both Web-based and mobile, with as few as two lines of code and in as little as a couple of hours. Free them from the limitations of poking at keyboards that are too small for normal fingertips –let them document on the go using their voice.

Link.

The Challenge

The 2012 Mobile Clinician Voice Challenge offers over $25,000 in prizes for most innovative, speech-enabled healthcare application (Web-based or mobile) developed using the HIPAA-secure, cloud-based Nuance Healthcare Development Platform. The contest runs through February 3, 2012, with winners to be announced at the HIMSS conference.

The Prizes

Full Details

Information is available on the contest page. See the text ad in the right column of HIStalk as well, which will run throughout the contest.

Not a Developer?

Tweet about the contest using @NUAN_Healthcare and #2012mobilechallenge and you’ll be entered in a daily giveaway for contest tee shirts and an iPad 2.

Contest Video

Link.

An interview with Jon Dreyer, senior manager of mobile solutions marketing, Nuance Communications, Healthcare Division


Describe Nuance’s philosophy about the mobile clinician.

The “mobile clinician” is quickly becoming synonymous with the modern clinician. In fact, physician smart phone adoption, which is currently at 72%, outpaces the general U.S. adult population by more than 50%.  And by the end of 2012, mobile device adoption among healthcare professionals is expected to reach 85%.

Whether racing from exam room to exam room or working remotely, mobile access to clinical information and mobile collaboration tools are essential for caregivers. This new breed of healthcare professional is in need of better experience-enhancing technologies, such as speech recognition that is available on any device at any time, in order to be completely untethered, yet still be fully plugged in to interact with and contribute to the care delivery process.

With voice-powered applications becoming common, especially on smart phones, do you see that as becoming a standard for systems designed for clinician use?

Absolutely. Voice will continue to grow as a primary form of input into mobile devices for consumer markets as well as within healthcare. Touchscreen devices with small onscreen or physical keyboards will never catch up to the speed of data entry on a desktop environment. Speech recognition overcomes the challenges associated with touch typing and bridges the gap to provide a ubiquitous experience for all users on all devices and platforms.

Keep in mind that speech recognition software designed specifically for healthcare professionals has been in use for more than a decade. On a daily basis, hundreds of thousands of clinical users across all healthcare specialties rely on the technology to reduce turnaround times, cut costs, and improve the overall delivery of patient care.

Given the dramatic rise in mobile device adoption over the past few years, and its projected growth, it’s only natural that the speech recognition experience clinicians have come to appreciate on their desktop is something that they will expect from their mobile and web-based apps as well.

Give me some cool ideas or apps you’ve seen that would be a good choice to speech enable just in case developers out there need some inspiration.

We have more than 100 partners in our evaluation program today. Healthcare app developers are rapidly embedding secure, cloud-based, medical speech recognition in point-of-care documentation/mobile EMRs, reference and content databases, disease management, clinical trial, pharma, and specialty-specific reporting tools. The applications run on a variety of devices and operating systems that are supported by the development platform, including iOS, Android, Web Browser (Internet Explorer, Safari, Firefox, Chrome), and native desktop applications.

Examples of clinical scenarios and apps that use speech recognition powered by Nuance Healthcare include:

• Mobile EMR access. With speech recognition as part of the workflow, physicians can easily voice document findings and clinical notes without having to return to a workstation or office.
• Interactive patient-side care. Specialists using mobile applications can now visit patients post-surgery and retrieve, as well as document using their voice, all relevant information on their mobile devices.
• Trauma communication and coordination. With specialized, speech-enabled mobile apps, clinicians can capture in their own words the patient story without delay. In a trauma scenario where every minute matters, this streamlined mobile approach helps to speed communication across care teams while expediting prep time for surgery.
• Diagnostic image view and reporting. Radiologists can now access patients’ diagnostic images via their mobile device and dictate reports from anywhere and at any time. The time in which patients receive feedback and care can be significantly shortened.

Do you have any words of encouragement for those who are thinking about entering the challenge?

Healthcare app developers should join the challenge because there’s really no reason not to participate.  Not only is it free to evaluate the Nuance Healthcare cloud-based medical speech recognition technology, but it’s also easy to integrate, deploy, and maintain. It requires minimal development effort (most evaluation partners have their integrations up and running within a few hours of registering) and clinical end users will benefit greatly from having access to medical speech recognition from their mobile and web-based apps.

Contest Notes

• The contest is open to any developer who is a legal resident of the US.
• You can submit multiple entries.
• Apps do not need to be live and/or commercially available.
• Apps do not need to be written specifically for the contest – it’s OK to integrate the speech service into an existing app.

Links

• Contest page
• Press release
• Nuance Healthcare’s ‘For the Health of IT’ blog
• Twitter
• Facebook

QuadraMed Acquires NCR Healthcare Solutions

QuadraMed announced this morning that it will acquire the healthcare solutions business of NCR Corporation, whose products include a patient access kiosk, patient and physician portals, and a payment solution. Terms were not disclosed.

NCR acquired the product portfolio when it bought Maitland, FL-based Galvanon in December 2005.

QuadraMed CEO Duncan James was quoted in the announcement as saying, “This addition to QuadraMed’s portfolio is a logical extension of our existing Access and Identity Management offerings. NCR’s healthcare solutions will improve our clients’ ability to meet the increasing demand for patients to control and self-direct their healthcare experience at hospitals, clinics and physician practices.”

NCR’s healthcare workforce in Lake Mary, FL and Hyderabad, India will become QuadraMed employees on January 5, 2012.

News 1/4/12

Top News

The District of Columbia, armed with $1.06 million in ARRA money, issues an RFP for an HIE technology platform. Bids for the one-year contract are due on January 13. The District decided to support the simpler Direct Project rather than a traditional HIE last year, putting the DC RHIO, which was expecting to get the grant money, out of business.

Reader Comments

From Sunshine: “Re: new hire. Mike Mieure from Sunquest and Misys is the director of IS for Vitera Healthcare.” Confirmed via LinkedIn.

  From Tipsy: “Re: tips for meeting with reporters. Joseph Goedert has some great advice for vendors scheduling meetings with the press. My personal favorite: don’t send your marketing manager to talk to the reporter.”  Mr. H does far more interviews than I do, but I am sure that if anyone attempted to give us a lesson on HITECH basics, we’d be making fun of them later. If you handle media relations for a vendor or PR firm, do yourself a favor and give Joe’s blog post a quick read.

From AnotherDave: “Re: Dr. Jayne’s 1/2/12 post, What Gets Measured Gets Managed. To quote Nick D’Onofrio, ‘You can expect when you inspect.’” Dr. Jayne outdid herself with her post this week, which is getting tweeted and mentioned all over the place. It was informative while being fun to read. She enjoys using reader feedback for future posts, so if you have something you’d like her to write about or comment on, e-mail her.

From Pyorrhea, IL: “Re: a second Judy Faulkner article. Does this include any new information, or is it just the same thing over again?” The first article seemed merely politically biased and sloppy with facts, but the second one by the same author ventures into pure nut-job territory, claiming “a de facto alliance between Epic and the Service Employees International Union” because some of Epic’s hospital customers employ SEIU-organized labor, which is hardly shocking given that Epic’s core customer base is academic medical centers in big cities. I have one positive comment about the article: it was short.

HIStalk Announcements and Requests

  Mr. H seems to have survived without my assistance last week. No surprise, of course, but I like saying it so he’ll take a moment to reflect on how much more fun it is to have me around pinging him with e-mails all day. In my absence, I have noticed almost all our sponsors have now replaced their animated ads, giving the site an almost Zen-like peacefulness (thank you, sponsors.) Now that I am back, Mr. H and I are heads down in our HIMSS planning and are excited about a couple of new fun projects in the works. In addition to the more serious stuff, we are addressing details for the annual Inga Loves My Shoes contest, as well as the crowning of the HIStalk King and Queen for the best-dressed HIStalkapalooza party-goers. I predict an exhaustingly good time will be had by all.

It’s the New Year, so it’s time for HIStalkapalooza signups. Our amazingly gracious, creative, and fun event sponsor ESD has been working tirelessly for months in planning a memorable Las Vegas event for you. It’s at First Food & Bar in The Shoppes at the Palazzo (ESD bought the whole place out for the evening) on Tuesday, February 21 at 6:30 p.m. ESD is a consulting firm, so let’s go over the deliverables. Great food – check. An award-winning bar plus specialty drinks such as the IngaTini, the Mr. H Incognito, and the ESD Activation Sensation – check. Fun contests involving shoes and people dressing up – check. A special performance by Elvis – check. And of course, Jonathan Bush and the HISsies – check and mate. Click the graphic above, the button to your right, or here to request an invitation. If we get fewer requests than we have capacity, then beautiful – everybody who signs up will get an e-mailed invitation. If we’re overbooked (which has happened every year so far, and often quickly), we’ll invite the number of folks we can handle. HIStalkapalooza is held in honor of those involved with HIStalk, HIStalk Practice, and HIStalk Mobile in any way (reader, sponsor, contributor, etc.) and we gratefully acknowledge the support of ESD in making it possible. More to come once we get the signups finished.

Here’s some background about ESD (they didn’t ask me to talk them up, but it’s the least I can do considering they’re paying for HIStalkapalooza.) The Toledo, OH consulting firm provides expertise that includes clinical transformation, go-live support, legacy system maintenance, staff augmentation and training, system optimization, and help with ICD-10 and Meaningful Use projects. Clients often (always?) need healthcare experience and workflow expertise that’s way over the head of freshly minted vendor implementers. That’s where ESD’s expert clinical consultants can save the day, helping CIOs sleep at night by reinforcing their front lines to complete projects, generate ROI, and optimize processes. Founder and President Joe Torti started the company as a solo consultancy in 1990 and has grown it to over 400 clinical IT consultants (nurses, physicians, pharmacists, etc.) and 30 corporate employees. If you’ve been around awhile, you’ll no doubt recognize some of the management team names as I did: Joe Mason, David Tucker, and Dan Oberle, to name a few. ESD not only brings you HIStalkapalooza 2012, but is also a Platinum Sponsor of HIStalk. I greatly appreciate the ongoing support of ESD.

Acquisitions, Funding, Business, and Stock

Chicago-based solar products company SoCore Energy LLC raises $3 million in an equity offering. Among its investors is an investment fund run by Michael Ferro (Merge Healthcare). The company’s chairman and co-founder is Allscripts CEO Glen Tullman. I Googled hoping to find that Epic’s mammoth solar installation used solar panels from SoCore, but nothing came up, dashing my hopes for perfect irony.

Sales

San Jacinto Memorial Hospital (TX) selects PerfectServe’s clinical communication and information delivery platform.

The Premier Healthcare Alliance awards a group purchasing agreement to Authentidate for its Electronic House Call Kiosk and Interactive Voice Response solutions.

Stanford Medical Center (CA), HealthEast (MN), Oakwood Healthcare, and McLaren Healthcare (MI) prepare for the ICD-10 deadline by utilizing OptumInsight’s A-Life Medical computer-assisted coding.

Albany Area Primary Health Care (GA) selects eClinicalWorks EHR suite for its 14 locations.

People

MedQuist hires Michael Raymer as SVP of solutions management. He was previously general manager of Microsoft’s Health Solutions Group.

Announcements and Implementations

Tuomey Healthcare System (SC) partners with Advanced ICU Care to deliver remote tele-ICU monitoring by intensivists and critical care specialists.

Regional Health Services of Howard County (IA) launches Cerner at its 25-bed acute care hospital.

Canton-Potsdam Hospital (NY) begins installation of MEDITECH 6.0.

AirStrip Technologies earns CE Mark certification for its FDA-approved mobile patient monitoring applications, allowing them to be sold in Europe and other areas.

Intelligent InSites integrates the TempSys Fetch real-time locating technology into its RTLS system. The InSites RTLS software solution works with several sensing systems, including active and passive RFID, ultrasound, WiFi, and ZigBee.

Pike County Memorial Hospital (MO) goes live on McKesson Paragon, earning the hospital a story in the local paper.

George C. Grape Community Hospital (IA) will hold a Virtual Ribbon Cutting next week to celebrate the completion of its EHR implementation and Meaningful Use attestation. The 25-bed hospital had to deal with Missouri River flooding through the summer as it accelerated its Meaningful Use timelines as a beta site for Healthland’s Centriq small-hospital EHR.

Government and Politics

Washington’s state prescription database goes live, but previously supportive doctors and pharmacists line up against it when the US Department of Justice tells the state not to expect to get federal money for the $530K annual operating costs. State health officials ask lawmakers to remove the portion of the law that bans charging providers for its use, which would entail yearly per-provider charges of $11 to $15.

In Canada, the leader of Ontario’s democratic party calls for a hospital CEO salary cap of $418K – double the premier’s salary — after hospitals release their compensation contracts following a ruling that they are covered by freedom of information laws.

Other

The US Patent and Trademark Office issues a patent to DR Systems for technology that tracks the resolution (or other parameter) for a displayed medical image.

Indiana University Health Physicians misses its 1,200-physician year-end employment target by 350, with some of the slowdown attributed to physician delays in committing to a common EMR and approving common treatment protocols.

Joslin Diabetes Center (MA) partners with Alliance Health Networks to participate in that company’s Diabetic Connect social network.

Sponsor Updates

• Phoenix Children’s Hospital shares how deployment of the Vocera wireless communications solution has improved communication in its NICU.
• NextGate profiles Hartford Hospital (CT)and its use of  NextGate’s matching technology to identify patients in Connecticut’s HIE.
• Besler Consulting announces the general availability of BVerified Transfer DRG and BVerified IME proprietary solutions.
• Concerro adds VLOG, a video blog option, to its Concerro University client learning center.
• Intellect Resources is holding Big Break New Orleans on January 21, a one-day audition for folks who want to help Ochsner Health System implement Epic as trainers.
• Independence Blue Cross chooses Kony Solutions as its mobile application platform.

The Iowa Caucuses and the Stakes for Healthcare
By Donald Trigg

How should we feel about an anonymous force driving US policy? Does it serve our interests to have a beef-loving sovereign dictating our national conversation? Should a single player carry such outsized influence?

We are talking, of course, not about Mr. HIStalk, but the first-in-the-nation caucuses this evening (Tuesday) in Iowa. And in the less harried first days of the New Year, a moment offers itself for a primer on the quadrennial contest and a short exposition on how it might inform the health policy dialogue this fall.

Forty years ago, an obscure McGovernite orchestrated an early start date for the Iowa caucuses. Four years later, a peanut farmer named Jimmy Carter leveraged a “win” (finishing second to uncommitted) to vault to national prominence, a party nomination, and then the White House. Iowa’s outsized role in the nominating process has been set ever since.

The number of delegates at stake in Iowa toward the 1,143 needed for nomination is modest. GOP aspirants are looking, instead, for what George H.W. Bush in 1980 called the “Big Mo.” In our vernacular, Iowa is not a supplier of choice designation. It is a down select.

Indeed, since 1972, the eventual GOP nominee has finished in the top three in Iowa with only one exception. But unlike the definitively predictive South Carolina primary, Iowa does not decide the GOP nominee. It is the “winnower” of the field.

The mechanics of the caucus process are straightforward. Voters gather in roughly 800 locations, typically in a church basement or a high school gym. After electing a temporary chair and a secretary to record the proceedings, Republicans rise to speak on behalf of their preferred candidate. Then, votes are cast. The results are aggregated and a late evening winner is declared.

If the process is fairly unambiguous, the fate of the six candidates contesting Iowa is less clear-cut. Historically, the GOP has nominated by primogeniture — falling in lockstep behind the next person in line. The 2012 race has been marked from the outset by the absence of an overwhelming front-runner.

Instead, the so-called Exhibition Season has seen a series of volatile swings from candidate to candidate in an elusive search for an alternative to former Massachusetts Governor Mitt Romney. Michelle Bachman. Rick Perry. Herman Cain. Newt Gingrich. Now, we are seeing a late “Santorum Surge” that may put the former PA Senator within striking distance this evening.

It has been said that there are only three tickets out of Iowa. Romney, Paul, and Santorum appear to be clutching them, according to the final Des Moines Register poll. But with 41 percent indicating that they could still change their mind, the Register’s Kathie Obradovich rightly characterized the race as “a moving target.”

The stakes for healthcare are large. David Blumenthal wrote last month in the New England Journal of Medicine, “The 2012 election will be the most important in the history of the health care system.” For all the potential implications in 2013 and beyond, however, the topic has featured only modestly, even comically, thus far.

We had, to the chagrin of public health advocates, Herman Cain advisor Mark Block silently smoking into the camera –reminding us that a 20-something staffer, a video camera, and free time are the campaign equivalent of whiskey, car keys, and teenage boys. We had Romney’s Massachusetts bill, and its common features with the Accountable Care Act, as consistent debate fodder. And we had the criticism of Gingrich amid his Q4 rise for his paid advocacy through the Center for Health Transformation to his vocal backing of Part D in 2004. But neither deep policy substance nor deep debate has featured to date.

One reason, beyond the constraints of the modern campaign, is that the US economy looms so large. An NBC/Facebook poll of early state voters out Sunday put the economy at 59 percent as the top voter concern ,with the federal deficit at 19 percent and with healthcare a distant third at just 11 percent. There is little reason to think that mix will shift this autumn.

The impact of that framing for healthcare finance is that the “second phase” debate will be centered almost exclusively around cost and predominately within the context of the current FFS model. We are headed toward a moment akin to the 1997 Budget Act and it may come as soon as 113th Congress.

But first we will need a GOP standard-bearer. Iowa, “the purest of prairie states,” is an opening step in that drama. It is a good and decent place where Winenrenner properly wrote the politics are “clean and competitive” and, just like HIStalk, “the arena is fair and open.”

Donald Trigg is chief revenue officer for CodeRyte. He worked for then-Governor George W. Bush during the 2000 presidential cycle in Austin, TX. He has traveled to all 99 counties in Iowa, suffering chilly winds and an unsettling amount of chicken fried steak.

Contacts

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

Curbside Consult with Dr. Jayne 1/2/12

What Gets Measured Gets Managed

During the last five years, we have seen significant shifts in how healthcare is delivered and in the way in which different healthcare services are valued. Most of us have realized for quite some time that fee-for-service medicine is clinging to life. Pay-for-outcomes is going to be the order of things from here on out.

Hospitals are no longer going to be paid to ameliorate hospital-acquired conditions or to deliver care to patients who were impacted by preventable harms. Physicians are going to be judged on their patients’ lab data and biometric information rather than the number of visits they bill.

Care will be transformed regardless of how we feel about it, whether it’s by the name Accountable Care, Shared Savings, or Pay-for-Performance. It’s something we all need to get used to.

My colleagues were ringing in the New Year this morning in the time-honored tradition of complaining around the coffee pot. (Most of us were rounding a bit later than usual and I did see a couple of bloodshot eyes.) It seems that many independent physicians, particularly those in small practices, don’t know where to start. (Employed docs are generally confused too, although to a slightly lesser degree.)

I decided to introduce them to Peter Drucker, whose famous statement, “What gets measured gets managed,” should be well understood by now. But let’s just say I was more than surprised by the blank looks in front of me.

Several of the docs didn’t understand that Meaningful Use is going to get trickier as time goes on. Although there are some metrics for Stage 1, many of them are easily achievable with a minimum of work. (Apparently though not as easy as people might think – I’m still stumped by the phenomenon of people unsuccessfully attesting. If you don’t have the numbers, why would you attest? Still waiting for someone to shed light on this.)

Although we don’t have final metrics for Stage 2 and beyond, it’s virtually guaranteed that the bar will be higher and the hoops smaller. In talking with the docs in the lounge, though, many of them don’t have a clue how to approach care metrics – even those with sophisticated software. I’m seeing far too many physicians who are barely using their certified EHRs, who are confused by some of the terminology, or who are hung up on wanting flash and sizzle.

I felt like I was giving a Grand Rounds presentation because our friendly chatter turned into a lecture that I probably could have given CME credit for. Docs don’t seem to understand that you have to know what you’re looking at in order to drive change. It’s not going to drive itself. You have to figure out what you want to work on, then measure it, then work on it, then measure it and work on it some more. Lather, rinse, repeat.

It seems pretty straightforward, but maybe it’s not, so allow me to share some other “secrets” that your docs may not know.

First, don’t get hung up on the fact that your EHR vendor may or may not have a registry or dashboards. Maybe they do and it’s just called something else, or maybe they don’t. One doc I was chatting with was caught up in the fact that he didn’t have his vendor’s dashboard product live yet. He was either under the impression (or in denial – it’s debatable) that he couldn’t start managing care until he had the pretty charts to back up the data. He didn’t like it too much when I called baloney on that one.

Most certified EHRs have at least some minimally decent ability to do reporting. That’s really all you need to start. If you have discrete data, you can report on a wealth of conditions. Prostate cancer screening? Check. Blood pressures? Check. Documentation of advance directives? Check.

You don’t need pie charts to tell you how to care for patients. When your report has blanks on it because you haven’t documented an item for a particular patient – that, my friends, is an opportunity for care.

Second, don’t get baffled by the metrics. Looking at some of the NCQA or NQF or MU measures and how they’re calculated makes my head spin as much as yours does. If you’ve never tried to do quality improvement before, start with something basic.

If it’s important to you to make sure every patient over 50 has a documented cholesterol test, start there. Don’t get hung up in the numbers and managing everyone down to an LDL of 70 or figuring out complicated exclusions. Start with something manageable, such as actually testing everyone. Run reports, do outreach, give it a month or two, then run those reports again and see if you’re making a change.

Third (and this is one of those points where I’m glad I’m anonymous – my CIO is probably spitting his coffee as he reads this) you don’t even have to have an EHR to make a difference. (I think I heard a few vendor gasps out there, perhaps the hissing of the word “heresy,” but it’s true.) You can make tangible gains in patient care without even a single chart pull. If you have a practice management system (that’s a “billing system” to some of you docs) with even rudimentary reporting capabilities, you can find opportunities to deliver care.

How so, you ask? Take an all-too-common diagnosis like diabetes (250.xx in ICD-9 terms.) Run some claims reports. Run a report of patients seen in the last three years with that group of diagnoses codes on a claim (or pick a single one like 250.00 if you’re scared at what you might find) and the date of their last billable visit. Presto! Anyone who hasn’t been seen in the last six months is an opportunity for care. This, of course, assumes that you actually bill the codes you’re addressing at the visit and not just cloning the last visit’s codes, which may or may not have included the diabetes. Primary care physicians are notorious for under-documenting the work they do.

Calculate the percentage of diabetics who haven’t been seen in the last six months and you just created your first metric. (If you passed epidemiology and biostatistics, which you must have to have graduated, you can calculate this. Trust me.) Send some postcards and make some calls (HIPAA-appropriate of course) and get those patients to come to your office for an actual billable visit. Report again in two to three months and see how you did. If you need a graph to show you the results, allow me to introduce you to my friend, Microsoft Excel. But I’m betting the numbers will speak for themselves.

Finally, it’s not just enough to have the data. You have to make it visible to make it actionable. Post your goals and action plans in a visible place in the office. Post monthly outcomes numbers. Celebrate those victories. When the numbers aren’t in your favor, take some time to figure out why and how you can do things differently. Involve everyone in the office. Even if you’re only focusing on a single metric each month, you WILL make a difference in the lives of your patients.

If you don’t believe that what gets measured gets managed (especially if you’re posting it publicly for everyone and their cousins to see) think again. I used to think I was pretty decent with my exercise habits (although it truly is difficult to hit the treadmill with a martini, so I wouldn’t recommend it.) In 2010, I did about 870 miles, which wasn’t totally shabby.

However, a double-dog-dare by some of my staff led to the public posting of our activities, with technical validation courtesy of our friends Garmin and Nike+ to prohibit cheating. (I suppose I could have paid the neighbor kid to jog around with my Garmin on, but that wouldn’t have been very sporting.) We have some serious running junkies on our team, and although I wasn’t delusional about keeping up with them, I felt pretty strongly about being able to beat most of the 20-somethings that populate the cube farm we call home. (Yes, they’re young. Yes, many of them are liberal arts grads. No, we’re not an Epic shop.)

Everyone had to share his or her numbers Saturday night. I almost forgot, so I was frantically uploading with a glass of Bailey’s in hand. I finished respectably with over 1,200 miles, but there’s always 2012:

Just Measure It. Just Manage It. Just Do It.

E-mail Dr. Jayne.