Time Capsule: Public Trading Leads to Trouble for Merge and Misys

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 July 2006.

Public Trading Leads to Trouble for Merge and Misys
By Mr. HIStalk

In this week’s Merge Healthcare saga, three top executives stepped down, the company’s previous financial reports and audits were declared unreliable, and Nasdaq de-listing appears imminent. Talk about your memorable holiday!

Merge’s nemesis was that least-exciting of corporate swashbucklers, the unseen accountant, whose pressured blessing of questionable bookkeeping practices ticked like a time bomb — buying desperate executives time to avoid the torch-waving mob of unhappy shareholders, but eventually blowing up in the faces of anyone unfortunate enough to be in the vicinity at the time.

Publicly-traded firms do everything they can, sometimes including cheating, to show a paper profit. Stock price trumps everything. The shareholder is the most important customer and they demand not just profit, but profit growth. Every quarter’s end is another spin of the Russian Roulette revolver.

Privately-held companies do the opposite. Profits mean paying taxes, so those are deferred as long as possible. Companies have little reason to juice the books unless they are borrowing money or trying to go public. Owner-operators are motivated by their long-term equity in the business, so what’s good for them is probably good for me as their customer. We’re both in for the long haul.

The Misys situation provides an interesting backdrop. The rash of activity seems to point to one outcome: Misys will likely cease to exist as a publicly-traded firm. Prospective purchasers, including the company’s current and prior management, see more value than the share price suggests, leading to talk of taking the company private. That won’t come cheap, so there’s a good chance that the healthcare division would be auctioned off to pay down some of the cost.

Neither Merge nor Misys would be in trouble if they weren’t publicly traded. The lure of shareholder cash came with an unpleasant ride on a merry-go-round that didn’t agree with them or their customers. In Misys’s case, they’re willing to pay to get off. They are disillusioned with the pot of gold that most privately-held companies secretly seek.

I’ve watched several of my vendors go public or be acquired by public companies over the years. I can’t think of a single example where my organization was better served afterward. Once the sexier siren of shareholders stole their attention, I saw a decline in support, development, and customer communication. A revolving door of soothing suits tried to explain the publicly-proclaimed synergies that somehow never seemed to benefit my organization. I went to bed with Company A for logical reasons, but then woke up startled to find an uninvited Company B beside me instead.

I don’t consider it to be good news when my vendor announces plans to go public or to be acquired. As a customer, my experience suggests that I won’t be thrilled with the result. In a perverse way, the only safe strategy might be to just go ahead and buy from the big publicly-traded vendor upfront, whose large warts are at least fully developed. In other words, for the same reasons people eat at McDonald’s – to accept plainly obvious mediocrity for fear of being disappointed otherwise.

HIStalk Interviews John Elms, President, Connexall USA

John Elms is president of Connexall USA of Boulder, CO.

Tell me about yourself and the company.

I was the CEO at SpectraLink Corporation. SpectraLink did about half of their sales in healthcare. We built wireless telephones for the workplace. During my tenure as the VP of operations before becoming CEO and then as CEO, GlobeStar Systems, the parent company of Connexall, was my business partner. They were my master distributor for Canada. I partnered with them as I did with their competitors to make a market for the middleware solution that would connect my SpectraLink phones to patient monitors, nurse call systems, and other kinds of applications in healthcare.

I sold SpectraLink in 2007 to Polycom. I went off and did some start-uppy things in China and Silicon Valley, finished that up, and came back and reconnected with David Tavares, who is the CEO of Globestar Systems, my chief investor here – or sole investor, really – at Connexall USA. 

David asked me if I would build out and operate a US company on his behalf, because while Connexall the product was installed in about 80% of the hospitals in Canada, nobody in the US really knew who we were. If there were such a thing as an 800-pound gorilla in Canada, we were it, but we were clearly flying under the radar in the United States. 

Because of my prior experience at SpectraLink and SpectraLink’s brand recognition in healthcare and the fact that David and I had known each other for about 10 years, David asked me if would start up and run this company. We did that beginning in July of 2010. We’ve been in business here in the United States as a separate entity for just over a year now.

What are the most common medical devices that hospitals need to interconnect and what benefits are they seeing from doing that?

The business really started out by connecting nurse call systems to mobile phones. That freed the nurses from having to hang around a central station or look at lights being lit above doors, and really alert them on a mobile communication device that their attention was needed in one of their patient rooms. To the hospital, it provided speed of response, better patient care, better patient satisfaction. Nurse call was really the foundation of what got us all into this business.

Patient monitoring was the next logical step, so that nurses who are mobile throughout the unit could receive information about the status of their patients, particularly when they went in to some form of distress or some sort of out-of-bounds condition. What I heard at SpectraLink was that nurses saw this as a real benefit to their quality of work life. They were not tethered to a geographical location. They could be free to do their work within the nursing unit, but receive critical information at the point in time and wherever they were that they needed it.

Some adjuncts, we get into things like pumps and vents as devices as we’ve really grown and matured the market. Healthcare applications like patient wandering and infant abduction have been integrated into this world. 

As we started to look to how to support the healthcare industry with the new emerging legislation tied to Meaningful Use and ARRA and all that sort of stuff, really now it’s about taking information from the EMR system — that electronic filing cabinet, if you will — and passing that back to clinicians. 

In certain instances, it’s now critical lab results. Lab results get posted to the electronic medical record system, and those results get delivered to the clinician by Connexall so that the clinician knows that there’s information that is critical to their patient care that’s available and ready for their processing.

Really, any kind of smart medical device, smart medical application, even building management systems. There’s a case study about Disney Cancer Center where Connexall interfaces to the building management system to create an environment that is conducive to patient care and conducive to each individual patient’s definition of what is most conducive to their patient care. The drapes are open or closed, music on or television on, temperature warm or cool … all those kinds of things are catalogued when the patient is admitted. Connexall will adjust the environmental conditions to the patient’s specifications and as they move and out of their room as detected by RFID.

How does nurse call integration work and how does it fit in with specific systems like Vocera and Voalte?

In the case of Vocera and Voalte, we are the means by which those communication devices receive the nurse call notification, whether it’s Rauland-Borg or Hill-Rom or Intego …  I think there’s about 27 different nurse call systems we connect to. When the patient actuates the nurse call button, Connexall will detect that. We’re an IT kind of application, so we sit on the network. We watch traffic going by. When we see a nurse call packet, we intercept it and we move that off to the Voalte device or the Vocera device or whatever device. 

The primary, purpose-built application remains intact. The nurse call button rings at a nursing terminal at the central station as sold and built by the nurse call vendor. We just watch the packets go by and capture those and pass them as a secondary form of alert to those mobile devices.

Really, if you think about it, we’re a large trans-coding gateway. We can take the nurse call protocol, generally TAP, process that in Connexall, and send that out in the protocol that the communication device. In our case, we would send it to the Vocera server or to SpectraLink OAI, or now native SIP integration is the up-and-coming thing.

As more and more of these devices communication-enabled, how can hospitals use that flow of information to their advantage without turning staff into monitor-watchers who get overwhelmed with data noise?

I think there’s two key attributes that allow us to do that. One is particular to us, and that is the granularity with which we, I’ll just say, intelligently wrote those alarms. We can go into our interface client, and each interface client is a plug-in, if you will. That plug-in is architected to interface to the types of information that’s delivered from each medical device. They’re all custom to the medical device, so that if it’s a Drager monitor, there’s a Drager interface client or plug-in, and if there’s a GE, it’s a GE. It’s not one-size-fits all.

With that kind of custom development, we can very specifically identify the types and severity of the various alarms. For instance, on a Drager monitor, if it’s a leads-off alarm, we can route that to a patient care tech or a CNA, whereas if it’s a V-tach or a V-fib, we can send that to the RN. If it’s an asystole, we can trigger a Code Blue.

When you say how, do you keep the clinicians from being other than automatons that are watching alarms and alerts and monitors, the way we do that is we only send the alarms that they need to deal with or that they’re most appropriate to deal with as their workflow dictates. We don’t dictate. We interrogate, we analyze, we build the workflow based on how they do their business, and then we configure the system to accommodate that.

The second element — how do you keep them from being automatons? Well, we know that alarm fatigue is one of the key problems that nurses have. The fact that every application that a healthcare facility purchases has its own alert and alarm system, Connexall can be the chief aggregator for those alarms and the chief router for those alarms. The pump’s dinging, the vent’s buzzing, the nurse call’s ringing … we can just take all that in and ask, “What do you want to hear? From what device do you want to receive it? From on what device do you want it directed?”

We really configure so that we think what we do is we free up the nurses from having to deal with seven or 10 different alerting alarming systems and really be that chief aggregator and router for them. We really try and get at that problem of alarm fatigue and make them more meaningful such that the clinician can deal with that which really needs to be dealt with and the nuisance stuff goes elsewhere.

That article from Boston said nurses often fail to notice critical alarms in the ICU because alarms were going off constantly. Is that situation fixable?

I think it is fixable. I think that the root cause problem is alarm fatigue, and to the extent that we can minimize alarm fatigue by intelligently routing only the information they need to have, I think we get to the heart of the problem.

The Boston problem, as I remember the literature, was the nurse shut off the alarming capability of a patient monitor and they encountered sentinel event. It was at Mass General, right? The fix at the facility was, “Make it so the nurse can’t turn off the alarms.”

Now that’s kind of a blunt instrument approach to solving the problem. I’d like to think that we’d use a little bit more of a nuanced method, which is, let’s make sure the nurse is only getting the critical alarms. Let’s send the nuisance alarms either to a central stations, where you’re paying a different class of person, a different caliber, a different skill set, to watch everything that goes on. The RN, whose job it is to make people well and keep people safe, is really only being interrupted by the information that he or she needs to deal with.

Connexall really does get to the heart of that problem. We really do believe that we stand apart from others who purport to do what we do. Many in this space are focused on alerts and alarms. We’ve tried to get above that and really look at ourselves as an integration platform and take  heterogeneous, disparate systems and getting a consolidated point of management visibility communication. Sitting above the fray, if you will, and not just adding to the noise level.

Because we’re this engine that sits above all those beeps and sounds and music and everybody thinks they have to be a smart device, we integrate all these things that beep and burp and make noise. When you talk about sensory overload, these people are having a tough time discerning between noises. They sound alike. The answer isn’t to make everything smarter, but to pull it together so that you can see patient from a holistic view.

That’s our goal. It’s what we do at the front end of these projects. We sit down with the people who actually give the care and talk about what they’re measuring, what they need to know, and who needs to get it. It’s not just independent beeps and buzzes. It’s a holistic view of patients, critical information, critical tasks, and critical people who need to work around that patient. We pull it all into one system.

Along those lines, the home health personal monitors have gotten pretty sophisticated, but the gripe against those is, “Who’s going to sit around and watch these streams of data coming in?”

That’s true. With the whole move towards ACOs and more people receiving home-based care, that’s a market we haven’t tackled yet. We’ve been very focused on acute care, generally 200 beds or larger kinds of facilities. But increasingly the lines are going to get blurred. 

One of our accounts is the MD Anderson Cancer Center. They told me when I was talking to them about their IT strategies that they saw themselves as unique because the line was pretty blurred between inpatient and outpatients at their facility. I think that’s going to become the norm. Admittedly we haven’t tackled it. We’re going to have to get after that one before too long and figure out how maybe Connexall can help in that market as well.

Can you verify that the information you send was received?

We absolutely can. It’s a two-way communication medium. The administration terminal will show a blue checkmark on the icon, so if we trigger an alert, the alert will go on what we call – and now we’re even into buzzwords here – an active alarm client, but we’ll have an alarm screen. The alarm screen will show the status of all active alarms, and those which had been dealt with receive a blue checkmark. 

If you’re a clinician and the nurse call system sends you a message, you can accept it, in which case it will stop alarming, but it’s going to wait for you to close that call at the bedside because we want to know that you actually went to the bedside. We’re not going to let you close it from the phone, although from the phone, you can escalate it. Usually with another patient, somebody else needs to deal with it, in which case Connexall will send it to that nurse’s buddy or designee for escalation.

In some cases with Connexall, you can trigger an event. You might send nurse calls to a central call desk. They would screen the alarm. They would see “is it pain, is it water, is it AV equipment” – I’m told 40% of nurse call has to do with “I can’t make my TV work” — and Connexall could redirect that alarm to the appropriate person. 

It really is a very flexible system that allows you to do many kinds of responses, but the basic response is, “Yep, I have it.” When you so respond, the person who generated the request or the alarm that was generated by a machine will show a blue checkmark that says, “It was received and it’s been accepted.”

This is an intelligent routing, that front-end workflow that’s so important that says, “What do you want to have happen?” There are three shifts, there are four shifts, a number of teams, code teams, who’s on who’s off that day — where do you want that message to go and what does success look like? That one team, a complete team if it’s a code, all have attended and how do you know that?

We build all of that in. It’s the wrong point of view that we only do alerts and alarms. We are this communication with collaboration platform. At the front end, we can talk about and reassign and reorganize workflow across tasks, people, departments, floors. It can be lab results coming back. It’s not just about alert and alarm management.

I just want to make sure we’re heard. I think what we’re doing is pretty unique competitively. Our value proposition is pretty unique in today’s space.

Is alarming and alerting strategic for hospitals and where do you see it going in the future?

Is it strategic in hospitals? This is an interesting question. I think I could make an argument both ways.

I think basic alerting and alarming … it’s jacks or better in this space. There’s probably a tactical kind of attribute that makes the nurses more effective. Perhaps it helps staffing and will help with some of the shortages that we find in certain of the specialties, allow them to cover more space with fewer folks.

I think where it gets strategic is as we get into Meaningful Use Phase 2 and the requirement to interconnect all these smart medical devices and healthcare information systems. As we know it — or as we used to know it in the old days — it was a tactical kind of application just making the nurse call system more effective, making the patient monitoring and information more readily available. I think that’s tactical.

With Meaningful Use Phase 2 and successors to that related to healthcare legislation, I think it moves into the strategic. I’d like to believe that we will move in that direction and maybe a little further, faster, and better than some of the folks that are still focused principally on alarms today.

I would say nurse call integration is tactical and what Connexall does is strategic. What we do is bigger than one device, one way of looking at patients … that part of why we hurt people when they come in the hospitals with wrong treatment, alarm fatigue, and a lot of other things is we don’t collaborate, we don’t talk, we don’t talk across departments, we won’t talk across teams, we don’t have a holistic view of patients. 

I think that we don’t share information very well. The goal of sharing information and reducing all of these untoward events that we don’t want to have happen and we don’t want to make the front page in the newspaper … we’ve got to show that we’re delivering better care for better outcome. If we can’t do that, we should all go home.

Technology has over-promised what it could do since the very beginning. Technology enables clinical people to deliver better care. EMRs are great at collecting data from all kinds of places, but we need to get it out. We need to get it out of the EMR, out to the people who are actually delivering the care. That is a strategic initiative. We believe that we are right in the center of getting data out to the teams of people who need it. 

Some of that are devices, some of that are tasks, some of that is workflow, staff management, efficiency tools, all kinds of other things. It’s the whole system view, not nurse call integration, which is where this industry started. That’s over. That’s one small component. It’s not what we’re about.

Today it is one application. It is important, it’s nice to have, but where we are today is around a “have to have,” which is teams of people need more complete information around patients to take better care of them. That’s where we fit — right in the middle of that whole collaboration process.

News 8/26/11

Top News

Cerner reveals plans for two stainless-steel and glass office towers for its new Kansas City, KS office complex. The exterior design of the buildings is based on a digitized image of human DNA. Construction of the 660,000-square-foot development, which will house 4,000 employees, is expected to be completed by mid-2015.

Reader Comments

From Beau Tocks: “Re: healthcare’s most influential. Not sure that is the real list of movers and shakers in healthcare, so maybe it says something that Mr. H is not on the list!! Did Judy have some airbrushing .. or go under the knife?” The 100 Most Influential list was developed based on votes from the publication’s readers. I’m sure HIStalk readers would have compiled a totally different list. BTW, Mr. H’s insights extend well beyond HIT — he, too commented that Judy’s new headshot looks a little Photoshopped.

From Dr. Nick Riviera: “Re: ExR. In a sales call yesterday, a physician said, ‘I do not want to buy an EMR. The federal government is only paying people that have an EHR. I am going to buy one of those.’” Scary, on many levels.

From EpicBlackEye: “Re: Carle Foundation Hospital. Heard their Epic consultants walked off the job before next week’s go-live.” Unverified. I e-mailed for confirmation, but didn’t get a response. I’m skeptical pending further information.

From MT Hammer: “Re: All Type medical transcription service, North Brunswick, NJ. Acquired by Medquist. Employees notified by e-mail.” Unverified, but also reported by several All Type employees on an MT discussion board.

From St. Eligius MD: “Re: half of physicians practicing with NPs and PAs. Hallelujah! The AMA must be gnashing their teeth. What wonderful news for a new dawn in medical care for the future – MDs actually working with extenders, rather than trying to keep them out of practice. The sun will have actually risen when NPs, PAs, and CNMs can actually open their own practice.”

From Alabaster: “Re: Medify. I know someone in their focus group, which was mostly clinicians with heavy healthcare advocacy experience. None of them found it intuitive, it covers few conditions, and its goals were unclear. I heard they mostly just scratched their heads.” It looked like they found some cool information and built a nice GUI around it without having a clear vision of who would use it and why. It’s like reading one of those slick HIT articles cleverly written by a reporter with no subject matter expertise, where you’re first impressed because it reads so smoothly and authoritatively, but then you realize only in hindsight that it didn’t really say anything useful.

From Porphyria: “Re: Medify. I searched for ‘autism,’ but the treatments suggested had nothing to do with the condition, suggesting several cancer drugs. Very confusing and inaccurate.”

From OhNoPerot: “Re: Dell Services. Another 200+ person layoff today, all in the legacy Perot teams. Healthcare team continues to take most of the hits as the legacy Dell leadership takes over all key roles.” Unverified.

HIStalk Announcements and Requests,

Are you current on all things ambulatory HIT? New this week on HIStalk Practice: Dr. Gregg applauds collaboration between EHR vendors and specialty societies. An EMR vendor promotes transparency with its Meaningful Use Tracking Board. Healthcare costs may rise as hospitals employ physicians. The AMA gives a thumbs-up to Bundled Payments. If you follow ambulatory HIT, make sure you remain in the know by signing up for e-mail updates on the site.

Also, have a look at HIStalk Mobile and sign up for those e-mail updates if you want, which is full of good mobile health news and analysis by Dr. Travis (example: he was the first I’ve heard mention a special deal given to drug companies by Facebook, where they’re allowed to selectively block objectionable postings to their walls).

Listening: reader-recommended Richard Ashcroft, his latest solo CD (he used to be in Verve). He’s apparently wildly full of himself and some of the reviews have been savage (mostly because it doesn’t sound like Verve), but I like it quite a bit. It’s got a nice orchestra-backed, pop-oriented hip-hop vibe, although it’s a bit repetitive and inconsistent. I probably like it better than Verve, which was known for big-sounding, trippy psychedelic lushness  — you would instantly recognize their Bittersweet Symphony, although you probably thought it was U2 when it came out in 1997. 

If you’re in need of JFK-like “ask what you can do for your HIStalk” ideas, here’s a few off the top of my head: (a) sign up for e-mail updates to your right so that you don’t miss anything and so Inga can brag on the number of folks like you who have done so (7,468, since I know you were about to ask); (b) connect with Inga, Dr. Jayne, and me on Facebook and LinkedIn, giving us a Like if you’re so inclined, and joining the HIStalk Fan Club on LinkedIn like our BFFs have done (1,792, since I know you were about to ask once again); (c) send me rumors, news, or other stuff by clicking the big green Rumor Report monstrosity to your right; (d) check out the sponsor ads to your left, which are becoming less animated day by day, and click on any that tickle your fancy; and (e) do some carefree navigating and searching of sponsor-land in the Resource Center. I get the whole passive reader concept, but a little interaction on your part goes a long way when I’m sitting here alone for very long evenings after work trying to be scintillating using the written word alone. Thanks for reading. 

On the sponsor-only Job Board: Epic Implementation Project Manager, Epic and Cerner Consultants, Regional Sales Executive. On Healthcare IT Jobs, which is back online but a little behind on new job postings: NextGen Workflow Process Consultants, Senior Pharmacy Analyst, Manager IS Clinical Applications.

Acquisitions, Funding, Business, and Stock

Trend alert: the growing number of  hospital-based physicians, along with stock market uncertainty, are fueling investments in practice management companies for hospital-based physicians.

RTLS vendor Awarepoint secures $27 million in a Series F financing round led by Kleiner Perkins Caulfield & Byers. The company will use the capital for growth and to drive adoption of its aware360Platform.

Canada-based aviation simulator company CAE acquires Sarasota, FL-based medical simulator technology vendor Medical Education Technologies Inc. (METI) for $130 million.

Sales

Ipswitch Hospital NHS Trust (UK) will deploy Microsoft’s Vergence single sign-on and context management solution to improve clinician access to systems.

People

Microsoft announces the appointment of Michael Robinson as GM of US Health & Life Sciences and Dennis Schmuland to the newly-created position of chief health strategy officer. Robinson previously served as GM, public sector for the Middle East and Africa.  Schmuland is Microsoft’s former national director of Health Plan Industry Solutions.

Voalté hires Teresa Anderson as its chief nursing officer. She was previously an independent consultant for the American Nurses Credentialing Center.

Announcements and Implementations

HIMSS names two Davies Award winners in the public health category: the Florida Department of Health, Bureau of Epidemiology for its electronic surveillance system for early notification of community-based epidemics; and the NYC Department of Health and Mental  Hygiene for its Primary Care Information project.

The Healthcare Business Solutions subsidiary of New Jersey Hospital Association partners with Artificial Medical Intelligence to offer its member hospitals the EMscribe’s Coding Assisting Coding product to facilitate the ICD-10 transition.

Medicomp announces the initial distribution of ICD-10 mappings and functionality in the new version of its MEDCIN Engine. It includes a new user interface to make it easier to use ICD-10 within EMRs, providing clinically contextual, problem-oriented views of incoming data using standard reference terminology.

QuadraMed announces a new version of its Quantim Facility Coding that will support both ICD-9 and ICD-10, allowing users to test ICD-10 transactions while coding live encounters in ICD-9.

WoundVision announces the launch of iNSIGHT, Web-based risk assessment software that supports prediction and prevention of pressure ulcers.

Crestwood Behavioral Health (CA) deploys the OpenDNS Enterprise intrusion-blocking system in its 23 locations.

Innovation and Research

Healthcare costs are lower when clinicians use an HIE to care for ED patients, thereby avoid ordering duplicate services due to lack of information, according to Humana.

Emory School of Medicine establishes a biomedical informatics department, led by Emory Healthcare CMIO Joel Saltz MD, PhD. He’s also a professor in Emory’s departments of pathology, biostatistics and informatics, and mathematic and computer science (his PhD is in computer science).

Other

GE Healthcare informs Milwaukee-area employees of its intention to cut 81 manufacturing jobs, primarily in assembly operations for GE’s diagnostic imaging business. Those affected likely include some who participated in the company’s annual Community Service Day this week by sprucing up 400 classrooms in area schools.

Kirby Partners is conducting a survey on hospital IT employee retention, with results to be presented at the CHIME CIO Fall Forum (and here first, they’ve promised, in return for my mentioning it). I looked it over and the questions are good. To take the survey, click the appropriate variant: CIO, manager/director with people management responsibilities, or staff member with no people management responsibilities. UPDATE: I changed the survey links because their setup is a bit goofy – the original links forwarded to a specific link that gave the “you already took this survey” message. Try again if you’re interested.

Despite an overall trend towards enterprise solutions, Dimensional Insight’s Diver Solution earned top markets in a KLAS report on business intelligence. Information Builders’ WebFOCUS, IBM Cognos 8 Business Intelligence, McKesson’s Horizon Business Insight, and SAP XI Data Analytics were also ranked.

The Texas prison system has saved almost $1 billion over the last 10 years by implementing a statewide EMR and leveraging telemedicine, according to a press release issued by its EMR vendor (BCA) that cites a Gartner study.

Minnesota Health Information Exchange (MN HIE) quietly shuts down, merging its operations into a Duluth-based Community Health Information Collaborative (CHIC). CHIC’s president and CEO says their work overlapped and there wasn’t enough grant money to go around. MN HIE focused on EDs, with some big-name players that included Allina, BCBS, HealthPartners, and the state’s Department of Human Services. The splashy 2007 announcement of the formation of MN HIE, in which the governor said it would be one of the largest in the country, is here.

An Indiana prosecutor will ask the Office for Civil Rights to investigate the apparently intentionally circulated medical records of a city judge (and election candidate) following his stay at IU Health Ball Memorial Hospital.

Fellow shoe enthusiasts: a friend of mine wore these beauties to a party we attended last weekend. Sadly, I was unsuccessful at stealing them. They come from Turkey, so if you happen to be traveling that way, let me know.

Sponsor Updates

• Companies earning a spot on Inc.’s Top 500/5000 include Advanced MD, Concerro, Culbert Healthcare Solutions, Cumberland Consulting Group, e-MDs, EnovateIT, Enterprise Software Development (ESD), GetWellNetwork, Greenway Medical, H/P Technologies, Hayes Management Consulting, Healthcare Innovative Solutions (now part of Beacon Partners, which also was just named to the Top 100 Best Places to Work in Healthcare list), Iatric Systems, MED3OOO, MEDSEEK, TeleTracking Technologies, Vitalize Consulting Solutions, and ZirMed.
• iSirona releases a white paper illustrating how device integration improves EMR data.
• MD-IT announces a series of webinars for channel partners and transcription associates.
• ICA Informatics releases two new white papers entitled HIE Strategies Discussed at HLNY ACHE and HIEM Expands Use of CareAlign HIE Platform.
• Practice Fusion’s Research Division releases data indicating that one out of three children are now overweight or obese.
• ZirMed partners with Waiting Room Solutions to offer an insurance eligibility and claims solutions for physician offices.
• SCI Solutions will participate in healthcare access management meetings in Maryland, North Carolina, and Arizona in September.
• MEDecision achieves NCQA HEDIS recertification.
• A Billian’s HealthDATA  blog entry discusses the benefits of data in healthcare.
• Nuance offers a webinar entitled Spotlight on Innovation: eScription V10 on September 14.
• Grays Harbor Community Hospital expands its use of Access Intelligent Forms Suite after a successful pilot.
• Aspen Advisors announces successful implementation of CPOE at Virtua (NJ).
• Samaritan Medical Center (NY) selects ProVation Order Sets.
• Frank L. Urbano, MD joins the care coordination and compliance practice of BESLER Consulting.
• Lahey Clinic (MA) selects computer-assisted coding technology from 3M Health Information System.

EPtalk by Dr. Jayne

I’m surprised it hasn’t happened before now — the marketing people have apparently found my e-mail address. Today was apparently Send Jayne a Press Release Day. Leading the pack in the “why bother” division was the American Medical Association with an absolutely banal statement about its stance on bundled payment initiatives at CMS. Blah, blah, blah. The AMA is increasingly seen as irrelevant, and if they hope to counter that sentiment, they really should step it up.

As usually I’m a bit behind in my e-mail, so I was going through it during an extremely boring Grand Rounds presentation. Direct-to-physician marketing group Physicians Interactive wanted my opinion about something. Usually I ignore those messages, but this one invited me to participate in an 8-10 minute market research study about my “use of ePrescribing and Electronic Medical Records.”

With the promise that my opinions would “assist in understanding the potential for reaching Health Care Professions through ePrescribing/EMRs” as well as “help to evaluate the value of integration of clinical reference materials at the point of ePrescribing” I decided to give it a whirl. Unfortunately, the survey was closed by the time I responded. Maybe that’s an incentive to keep up with my e-mail. I’d love to see how companies are thinking about marketing through EHRs. Just what we need – more distractions that are incorporated into our workflows for secondary gain.

In follow up on an item I mentioned earlier this month, the South Carolina man who was denied Medicaid coverage for his breast cancer treatments has been granted coverage by the state Department of Health and Human Services. Director Tony Keck states, “If the federal lawyers choose to deny those claims based on a discriminatory policy, that is their choice and our department will appeal the decision.” I’m no Constitutional lawyer, but score one for states’ rights and general human dignity.

This week is National 5010 Testing Week. Are you ready? From talking to my colleagues, it seems there are quite a few practices out there that aren’t even on compliant software yet.

Hofstra North Shore-Long Island Jewish School of Medicine began classes this month. As a brand new medical school, faculty are putting some interesting spins on how physicians are trained. One of these initiatives includes training incoming students as Emergency Medical Technicians. The goal is not only to teach students valuable skills, but to reinforce the team care concept of medicine.

The school is holding off on its traditional “white coat ceremony” (where students are presented with the white trainee’s coat and often take the Hippocratic Oath) until after the students take the New York state EMT exam. I’ll be looking forward to seeing how these students progress and how a new medical school incorporates healthcare IT in training. If you’re on faculty or involved in this program, I’d love to hear from you.

Contacts

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

Readers Write 8/24/11

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!

“Installing IT” Understates the Organizational Change that IT Can Bring
By Mike Quinto

Our organization recently underwent an $18 million turnaround in 24 months. We are very proud of this accomplishment and have no intention of stopping there. 

In a recent financial periodical, our CFO was quoted as saying, “Considerable attention has also been given to IT. In the past, top-of-the-line software products purchased for the radiology, pharmacy, lab and other areas were highly functional in their own spheres, but didn’t integrate well. Now, new integrated software is being deployed to improve communication among departments.”

Well, he said it was IT. In reality, we in IT focus on getting cross-functional teams working together to solve business challenges. IT has been the facilitator of organizational change through process redesign, not new fancy software that adds, subtracts, multiplies, or divides better. 

Software, for the most part, does not “…improve communication among departments.” Governance, change management, and cross-functional teams do. 

We implemented Lawson’s ERP suite, but the largest benefit was not gained from the new splash screen or the logo in the corner of the screen. Vendors tend to think that they have solved the same old problem with new fancy software. It is rare that there is disruptive technology that actually changes the way we do things. For the most part, software is a commodity. The real benefit is the implementation and process redesign that takes place during a system rollout.

The opportunity was the chance to focus on charge capture and develop a policy, process, and strategy around it. We could have used a spreadsheet — the technology was not a magic bullet. The focus on business strategy was.

Don’t get me wrong, we like Lawson as a vendor. However, the software had little to do with our transformation. It was the implementation process that allowed open dialogue about the way we do things, and the way we should do things. That opportunity allowed us to evaluate broken process, identify areas that there was poor or no communication, and establish governance around important operational metrics. Just getting HR and Finance in a room monthly has done wonders to find financial opportunity and redefine policies and process. 

In one case, we had two vendors blaming each other for an outrageous claims denial rate. QuadraMed and McKesson couldn’t get on the same page, and that was creating a claim that had fields transposed. This created a denial rate that was almost 100%. I don’t blame the vendors. At the end of the day, we had a department that was not communicating and working with a broken process. 

Once we “re-implemented” the software, we were able to have open, honest conversations about who needed what and how the billing office should be run. Yes, there was an interface issue; however, IT and the business office were not talking. That was the larger issue.

We put in place weekly change management meetings, assigned application owners for each operational department that has an IT counterpart, and implemented basic project management. These changes had more to do with the performance improvement than any single piece of software, hardware, or vaporware we could install.

To say we purchased IT and installed it is underestimating the organizational change that “IT” can bring.

As a CIO, I spend most of my time helping business units redefine their goals, processes, and governance. Very little of my time is spent with bits and bytes.

Mike Quinto is VP/CIO of Appalachian Regional Healthcare System, Boone, NC.

PDF Healthcare: Why PDF is the "Currency" of Health Information 
by Tom Lang, MD

Health information technology faces challenges from many different quarters and for many different reasons. It’s time for a major dose of simplicity. PDF Healthcare (in both static and dynamic modes) is this major dose of simplicity.

Here are two compelling reasons that PDF Healthcare lives up to its billing as a "secure container for the exchange of healthcare information."

PDF is easily viewed/printed from virtually any computer. With the ubiquity of PDF readers, this is a reality. This fact can be thought of as another approach to interoperability. That is, if we can simply turn healthcare information into PDF, that information is available in a human readable form. Last time I checked, humans were still taking care of patients.

Image and other unstructured data files are easily converted to PDF. Clinical medicine is a world of image files and unstructured data, and that will never change. For example, our universe is filled with EKGs, X-ray images, video clips, audio files, and text-based reports  Equally important are those medication and allergy lists that are scrawled on scraps of paper (yes, paper!) that are so important at the point of care. The fact that PDF supports image files and almost any type of file format is very important in this environment.  ​

PDF (Portable Document Format) was originally developed by Adobe Systems Incorporated, but released as an open ISO standard in 2008. This has been an important step to stimulate innovation and competition, making PDF more capable, affordable, and available for our use in health IT as well as other industries.

As an ER physician, let me give you one example of how PDF can jump over the top of interoperability problems.  

I do quite a bit of locums ER work in many settings and frequently find myself in small rural hospitals trying to communicate with specialists that I need to refer patients to over a distance. Probably the biggest slam dunk for HIT has been PACS, which even in the smallest hospitals is almost universally present.  

One weekend, working in very small rural hospital, I faced the same problem twice: I saw patients with complex fractures, and the question was, "Does this patient need surgery immediately, or is this something that can be splinted and taken care of in a day or two?” Orthopedics is not available at this small hospital, and these patients requested orthopedic care in different directions.  

I was easily able to contact the orthopods by phone, but they needed to view the films to make a decision about what needed to be done and how urgently it needed to be done. This hospital has PACS, but despite this, neither of these orthopods could view the images. In this case, which is the most common arrangement I see, the only person who had remote access to view the images was the radiologist who was contracted to officially interpret the study ("Dr X not credentialed, hospital not on this image sharing network … blah … blah … blah").  

Because the radiology tech for the day was a hacker of sorts, he had some screen capture and turn-to-PDF programs on one of the radiology monitors. In both cases, we brought the images we needed on the screen, took a screen shot, turned the file to PDF, and e-mailed to the orthopedist. Also in both cases, not only were the orthopedists delighted we could provide this to them, but we determined that both patients could be splinted and dealt with in 1-2 days rather than immediately, saving many parties much trouble.

In order to raise the level of awareness of PDF Healthcare, colleagues from the PDF Healthcare working group have arranged, for a limited time, to give away a simple little app that will help HIE in the trenches. We are doing this for the solo / small doctor office. As a special for HIStalk readers, we will give away 50 copies.

Here is a short video that outlines the functionality of this app.

For your free copy, be one of the first 50 to go to the PDF Healthcare site and scroll down to Health Information Aggregator (under the heading of Resources.)

Tom Lang is an ER physician and a member of the PDF Healthcare working group.  

This Way to a Better Patient Experience
By Jeff Kao

Everyone’s been lost at one time or another. Whether you’re far from home or just around the corner, the experience is universally the same, with plenty of stress, aggravation, and wasted time.

Thankfully, the advent of navigation systems and smart phones means most of us get lost much less frequently these days, and that’s a good thing. But what about when you’re off the grid, say trying to find a family member’s hospital room or a lab for a blood draw?

Few places are as massive and confusing as a medical campus. With countless floors, departments, and even buildings to navigate, locating the desired destination can be a daunting task. On top of these logistical challenges, patients often arrive at a medical office or hospital feeling rushed, unwell, or anxious about their visit, only compounding the situation and causing them to be late or to miss appointments altogether.

Wayfinding systems offer a viable solution and pick up where navigation systems leave off. From the moment a patient or visitor walks in the door, these self-service kiosks virtually map paths to and from multiple points in a facility, resulting in a more pleasant and personalized experience. Leading healthcare organizations like Chicago-based Northwestern Memorial Hospital have placed wayfinding kiosks near entrances and other common areas, making it easy for patients and visitors to quickly locate a specific room or department and print a customized map with step-by-step directions.

At a time when consumerism is on the rise and patients have greater flexibility in their choice of healthcare provider, such systems are fast becoming a valuable strategic asset. According to a survey conducted by The Beryl Institute, hospital executives list the patient experience as one of the top three priorities they will focus on over the next three years. Wayfinding systems directly impact the experience patients and visitors have by enhancing the level of service that’s provided and eliminating the hassle of being late or lost.

Beyond guiding patients to the correct destination, wayfinding systems can also reduce demands on staff time, both in terms of time spent giving directions and updating software. While some wayfinding systems once required users to manually re-create maps on each kiosk every time an office or department was moved, today’s dynamic, data-driven applications are extremely scalable and allow technical and non-technical staff alike to quickly recalculate routes on the fly.

When not in use for wayfinding, these systems provide an effective venue for displaying video or text-based messages and marketing medically-related services and events. Patients can also use kiosks to register for promotions or request additional information. And, once in place, wayfinding systems establish a platform for future expansion and growth, eventually allowing healthcare providers to add new self-service capabilities from the same screen.

So, what is the path to a better patient experience? The answer may be inside your own front door.

Jeff Kao is vice president and general manager of NCR Healthcare.

Specificity to the Extreme: As ICD-10 deadlines Draw Closer, Is Your Organization Ready for the Good, the Bad … and the Offbeat?
By Sean Benson

Chances are that most healthcare organizations will be able to raise the bar on current documentation practices high enough to support coding for suture of an artery under ICD-10—even though the possible codes expand from just one under ICD-9 to more than 180 under the new code set. But what if a patient walked into a lamp post (W22.02xA) or was bitten by a sea lion (W56.11xA)? What if the patient was burned by a flaming jet ski (V91.07 xA) or suffers from inadequate sleep hygiene (Z72.821)?

If your organization’s clinical documentation and coding processes can’t support that level of specificity, you need to act fast to get it up to speed. Because rest assured, no matter how weird the diagnosis, ICD-10 includes a code that accurately defines the patient’s status to a T.

The authors behind ICD-10 covered all the bases in an effort to capture the full patient picture—sometimes to the extreme and offbeat. With approximately 68,000 diagnosis codes compared to just 13,000 under ICD-9, it’s clear that documentation approaches that work fine today simply won’t cut it under ICD-10.

It will be complex enough to ensure coding staffs are adequately trained on ICD-10. Finding the resources necessary to advance clinical documentation improvement programs to meet the ICD-10 challenge is simply out of the question for many organizations. Nor are most clinicians interested in spending the amount of time required to become fully proficient on the new system, especially when it takes them away from patient care.

That is why many hospitals and healthcare facilities are looking to software vendors to help them make the transition. Software that automates the documentation and coding process can ease the transition to the expanded code set and shorten the learning curve for physicians, especially if they are faced with the ever-so-common encounter of a patient who has been struck by a bird (W61.92).

Not all coding and documentation software is created equal. The best ones will drive comprehensive documentation to capture the high level of detail required under ICD-10. The software should guide physicians through the process of documenting with enough specificity and granularity to ensure appropriate coding. Otherwise, the code that would accurately identify an embarrassing fall on the local airport’s escalator (W10.0xxA) might be missed.

Healthcare organizations will want to focus on the software’s ability to provide prompts relevant to the documentation needs of ICD-10. That is why it’s important that the evaluation be done by someone who is well-versed in ICD-10 to ensure the right questions are asked.

There are multiple initiatives competing for the attention and resources of healthcare organizations, including 5010 and Meaningful Use, in addition to ICD-10. Because it will affect every aspect of operations, the transition to ICD-10 needs to be placed at the forefront.

For many organizations, leveraging the efficiencies inherent in technological solutions to drive documentation improvement is the best strategy for meeting the ICD-10 challenge head-on.

Sean Benson is co-founder and vice president of consulting with ProVation Medical, part of Wolters Kluwer Health.

News 8/24/11

Top News

HHS announces its Bundled Payments for Care Improvement initiative, a new CMS program that allows hospitals, physicians, and other clinicians to bill their services as a single package instead of as separate items, giving them incentive to manage care better. Applicants can share in the savings over traditional fee-for-service costs, defining their episode of care as one of four models: hospital stay only, hospital stay plus post-acute care, post-acute care only, or a single all-encompassing bundled payment.

Reader Comments

From BubbasChili: “Re: healthcare reform. I have the answer – legislatively re-categorize insurance companies to non-profit status and require that profits over a given amount be distributed back to consumers. I would also push tort reform, but my first idea is the fix. Just my two cents.” Maybe that requirement should be applied to non-profit hospitals first.

From GladItsNotMe: “Re: Lehigh Valley, PA. Has started the evaluation process to replace the old Carecast system. Rumor has it being replaced by that little ol’ vendor out of Madison, WI.” I was too busy at work today to ask Harry Lukens, so I’ll leave this as unverified for now.

From PHEye: “Re: CDC’s Public Health Informatics conference in Atlanta. A speaker complained that HIStalk doesn’t cover public health.” I sometimes touch on public health topics that don’t get much attention otherwise, but those news items aren’t always that interesting to me and probably wouldn’t be to my predominantly hospital-based readers either. And while I appreciate the confidence the unidentified speaker places in a part-time blogger, full-time hospital employee to branch out into an entirely new discipline, I do need to sleep occasionally. I’d be happy to start up a fun, informative public health version of HIStalk as a public service if CDC wants to spend some of its legendary grant money to allow me to quit my day job, but otherwise I don’t have the time to take on new challenges.

From Reporting In: “Re: RelayHealth. Here’s Jim Bodenbender’s e-mail announcing that sales SVP Mike Lang has resigned to work for an EHR vendor. Jeff Gartland replaces him.” I’ll mark this as verified since RelayHealth already updated its management page with Jeff as sales SVP.

From 11YearHITVet: “Re: consulting with less travel. I’m burned out and would like a 50% or less travel schedule. Some of said go into interface work or designing Cerner PowerNotes. Ideas?” I think it depends on how you define “consulting.” Certainly you could do build work remotely, working either for someone else or yourself. Vendors do most of their work of this type offsite given ubiquitous and fast broadband (some of it remotely from Asia, in fact.) But that’s probably not the sexy, high-paying work you’re doing now as the PowerPoint-wielding, suit-wearing expert from afar. If you’re doing general management or operational consulting, it’s really a completely different line of work to do remote technical or functional application support (or to just hire on permanently with a client, for that matter). If  you are willing to make that change and have experience, there’s work out there, especially if you know the hot packages like Epic or Cerner. I’ll let readers chime in since I’ve never been a full-time consultant.

Acquisitions, Funding, Business, and Stock

MedAssets gets approval from its board to repurchase up to $25 million of its stock.

Sales

Presbyterian Healthcare Services (NM) signs a multi-year agreement with Health Care DataWorks (HCD) for its Enterprise Data Warehouse Appliance.

Geisinger Health System chooses Altosoft Insight for Pathology for real-time clinical and AP lab reporting.

Montfort Jones Memorial Hospital (MS) selects NextGen’s inpatient clinical and financial systems.

People

CHRISTUS Santa Rosa Health System (TX) hires George Gellert MD for the newly created position of regional medical informatics officer.

Joyce Hunter, CEO of government healthcare IT consulting firm Vulcan Enterprises, joins HavServe, a volunteerism service for developing countries, as CEO. She has volunteered with a number of healthcare IT organizations, including the local HIMSS chapter, HITSP, Maryland’s CRISP HIE, and Cal eConnect.

Announcements and Implementations

Jersey Shore Hospital (PA) and Fulton County Medical Center (PA) team up to implement Meditech EMR. The critical access hospitals expect to save about $300,000 each by sharing hardware at a hosted facility and scheduling training and implementation at the same time.

Anoto Group announces implementations of its digital pen and paper technology, including Shareable Ink’s implementations with Allscripts, Cerner, Epic, McKesson and Meditech. Other new partnerships directly with Anoto or its resellers include NextGen Healthcare, Intelligent Medical Objects, Waiting Room Solutions, Nightingale Informatix, and Bayscribe.

The Community Health Information Collaborative (CHIC) announces plans to consolidate its operations with Minnesota HIE, resulting in a single state-certified entity named HIE-Bridge.

Ministry Health Care (WI) will implement EHR Doctors’ Medibridge.net HIE technology to enable the exchange of patient information and provide patients with access to their health information.

The Electronic Healthcare Network Accreditation Commission (EHNAC) develops an Outsourced Services Accreditation Program for HIE technology service providers. The program will evaluate HIE vendors to verify they meet industry standards of quality for PHI; follow appropriate privacy and security regulations; and meet acceptable standards for technical performance, business processes, and resource management.

The governor of Guam announces the launch of its first HIE, mentioning that Guam Memorial Hospital will get $5 million in federal incentive money and another $21 million is available for doctors who sign up.

Government and Politics

UK health secretary Andrew Lansley calls on developers to create applications that relate to one of five healthcare themes: personalization, improved outcomes, autonomy and accountability, improving public health, and improving long-term care. NHS is running a developer’s contest, but offering no prizes or funding. Consumers are also encouraged to submit their favorite health apps (“maps and apps”) or those they’d like to see developed.

Other

Once again Mr. H was robbed of a spot on this list of the 100 Most Influential People in Healthcare. Representative Paul Ryan tops the list, followed by Vermont Governor Peter Shumlin and President Obama. Donald Berwick, Kathleen Sebelius, and Farzad Mostashardi were included in the top 10, while Judy Faulkner (with an updated head shot) earned the #44 spot.

A watchdog organization finds that only 15 of the largest 100 HIT firms participated in HIT lobbying efforts between October 1, 2010 and March 31, 2011.

The Department of Homeland Security is soliciting vendors to provide an EHR to store medical data on undocumented residents across 22 immigration detention facilities.

Memorial Hermann Healthcare System (TX) launches Houston’s first HIE. Patients must opt in, with 96% of those that have been asked so far saying yes.

Weird News Andy says he can’t top the quote in this article: “a felony case of stupidity.” A workers’ compensation billing company puts detailed medical information on 300,000 California residents on a server that it thinks is visible only to its employees. Someone Googling discovers that the entire database is wide open on the Internet. The “felony stupidity” comment was in reference to the fact that the company didn’t password-protect the information and didn’t include the “noindex” HTML meta tag that tells search engines to skip indexing that page.

A reader sent over a new JAMIA article called Factors Contributing to an Increase in Duplicate Medication Orders After CPOE Implementation. It looked at the impact of implementing Epic’s CPOE in a 400-bed hospital’s adult and cardiac ICUs (Geisinger, I believe). The number of duplicate med warnings quadrupled, which the study found was caused by (a) multiple providers entering orders at the same time; (b) lack of hand-offs; (c) design problems that caused false alarms; (d) poor data display, where providers entered a new order because they didn’t notice an existing one; and (e) poor local design of order sets that contained pre-built duplicates. Providers both pre- and post-study were neutral about the value of duplicate therapy alerts. The study also found that some potentially duplicate orders weren’t flagged, such as duplicates with differing routes of administration and serial orders where the same therapy was ordered at slightly different times. I didn’t see anything surprising here: duplicate warnings are the ‘stupidest’ of the usual medication screening types (drug, dose, allergy, interaction, drug-lab, drug-disease, etc.) and usually make up at least half of the useless warnings that providers see. There’s no really smart way to tell whether two PRN meds that both contain acetaminophen will be a problem – if the patient gets one or the other but not both, then there’s really no duplication (but that can’t be determined until administration time, not when the order is entered).  Smarter systems ignore route differences (IV vs. topical gentamicin) and maybe skip PRN duplicates and those from the same order set completely, but otherwise it’s almost impossible to separate intentional duplication vs. unintentional. Give the high percentage of provider overrides, one might postulate that duplicate warnings do more harm than good, masking significant problems of other types with their sheer volume and rarely resulting in DC’ing one of the alleged duplicates. I’m not optimistic that it’s a solvable problem – you won’t get a useful answer if you ask providers to sketch out a universal decision tree of when to trigger a duplicate alert, so you can’t expect the computer to improve a process that can’t really be designed. Turning duplicate alerts off completely might be the best strategy.

Seattle startup Medify, staffed with former employees of airfare prediction company Farecast, is creating a searchable consumer database of vetted research study information covering side effects, treatments, and symptoms with social networking connections to similar patients. I struck out on my first search when it didn’t recognize “congestive heart failure” as a medical term, but got a lot of information on “cellulitis” (which talked a lot about maggot therapy for debridement). It’s aimed at consumers, but it looks to me like clinicians would find it useful to get current thought on treatments (not to mention that consumers aren’t going to pay out of their own pockets, but the usual pharma/insurance companies might if it could improve outcomes or cost). Besides, a lot of what it returns is barely understandable even to providers, like when I clicked “clindamycin” for cellulitis and got, “A semisynthetic broad spectrum antibiotic produced by chemical modification of the parent compound lincomycin. Clindamycin dissociates peptidyl-tRNA
from the bacterial ribosome, thereby disrupting bacterial protein synthesis. (NCI04)” Not exactly a compelling Facebook post like the maggots would have been.

The Washington Post highlights an interesting conflict: Medicaid is trying to reduce overuse of EDs as free doctors’ offices to save taxpayer dollars, but much of the potential savings isn’t being realized because hospitals are aggressively marketing their EDs for routine care, hoping to pump up profitable admissions. A quote from South Carolina’s Medicaid director: “When you are advertising on billboards that your ER wait time is three minutes, you are not advertising to stroke and heart attack victims.” For-profits HCA (which runs wait time billboards) and Tenet (which runs billboards and also accepts online ED appointments) claim they haven’t seen a significant increase in Medicaid visits.

Hospitals in Wales are testing university-developed software that can reduce wait times and analyze the cost-effectiveness of medical treatments. It uses simulation and queuing theory, which the project’s director likens to a 1990s computer game called Theme Hospital that allows what-if analysis.

Here’s the kind of lawsuit lunacy that forces hospitals to hire expensive lawyers. A (barely literate) former patient claims a hospital surgeon, while removing his tonsils, implanted a GPS tracker into his armpit.

Sponsor Updates

• Shareable Ink will participate in the Innovation Booth at next week’s Allscripts user group meeting, ACE. The company also gets a mention in a Wall Street Journal article discussing Nashville’s growing  healthcare industry. 
• Holon introduces Pharmacy Workflow Manager, which allow hospitals and IDNs with multiple locations to manage and report workload and productivity.
• GE Healthcare launches Centricity Business 5.0.
• TeleTracking announces the release of RTLS TempTracking.
• CynergisTek announces the release of its Meaningful Use Security Program to assesses compliance with security regs and reduces risk in preparation for MU attestation.
• Modern Healthcare’s 2011 Top 100 Best Places to Work in Healthcare includes Aspen Advisors, Encore Health Resources, Enterprise Software Deployment (ESD), Hayes Management Consulting, Iatric Systems, Impact Advisors, maxIT Healthcare, and The Advisory Board Company. Rankings will be revealed in October.
• Sentry Data Systems will attend Health Connect Partners Hospital Pharmacy Conference next month in Phoenix.
• Orion Health is hosting a free webinar on August 31 entitled Integrating HIE into Clinical Workflow.
• e-MDs launches e-MDs Rounds for the iPhone, giving doctors access to their EHR data via their mobile device.
• Jason Colquitt, Greenway Medical’s director of research services, is elected to a two-year term on the HIMSS EHR Association’s executive committee.
• Perceptive Software hosts a job fair this week at its Shawnee, KS headquarters. The company is seeking to hire more than 60 people in R&D, sales, and professional and technical services. Also announced: the company’s ImageNow product has earned Modular HER certification for both inpatient and ambulatory.
• Informatics Corporation of America and the Health Information Exchange of Montana announce that as of June 6, 2011, three hospitals and one community health center are connected using ICA’s CareAlign HIE solution.
• ZirMed earns its sixth consecutive spot on Inc magazine’s annual ranking of the nation’s fastest-growing private companies.

Contacts

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

Curbside Consult with Dr. Jayne 8/22/11

As most of us know, it doesn’t matter how much time you spend doing e-mail. It’s impossible to stay ahead. Sometimes I e-mail myself articles that I would like to mention. Before I have a chance to get my thoughts on paper, they scroll up, up, and away as the inbox gets larger and larger.

(Speaking of, have you ever tried to change the way you work your e-mail, say from top to bottom when you’re used to working bottom to top? I recently had this experience, and for whatever reason, it was extremely difficult. Talk about assaults on muscle memory! It’s finally back the way I like it, but it was a painful experiment that although designed to yield efficiency, just made me crazy.)

As I did some e-mail cleanup during a bit of unexpected free time (thank you, cancelled conference call!) I found an e-mail that reminded me to look at a journal article: Longer Lengths of Stay and Higher Risk of Mortality among Inpatients of Physicians with More Years in Practice.  The study looks at patients hospitalized during a two year period (2002-2004, coinciding with the residency training calendar on a July-June basis) on the teaching service.

For those of you not in hospitals that have residency programs, the teaching service is staffed by interns and residents under the supervision of an attending physician. Depending on the structure of the teams, supervision of the trainees varies, but ultimately it’s the attending physician who’s on the line should something go wrong.

There is speculation that patients who are hospitalized in July do worse because of transitions in the trainee pool (I talked about this “July Effect” last month), so I was glad to see this study controlled for the variable of having residents and students involved in care. All of the patients were treated at Montefiore Medical Center in the Bronx. They also controlled for any chance that having a more lengthy physician-patient relationship would influence the outcome by restricting patients to those who had never received care from the attending physician.

The authors looked at four groups of attending physicians: those in practice 1-5, 6-10, 11-20, and >20 years. Although the number of physicians was only 59, they looked at over 6,000 patient admissions. Patient groups were similar in demographics and clinical characteristics.

The study found that physicians in practice more than 20 years had greater mean length of stay numbers and greater mortality rates (both in-hospital and 30-day) than physicians with less than five years in practice. This impacted the sickest patients greater than those with less-complex conditions.

They also found that when the teaching service was less busy, patients stayed the same amount of time regardless of physician age. However when there were more patients to care for, length of stay increased in the longer-practicing group.

The authors conclude, “Inpatient care by physicians with more years in practice is associated with higher risk of mortality. Quality-of-care interventions should be developed to maintain inpatient skills for physicians.”

Well, isn’t that special! Talk about a solution that doesn’t necessarily address root cause.

Quite a few organizations commented on the study, with some citing earlier data showing that more seasoned physicians are less likely to adhere to published guidelines. This strengthens the argument that physicians should have to recertify periodically to prove that they are staying abreast of current standards of care. 

I agree with that. My specialty requires everyone to recertify, but other specialties have allowed older physicians to be “grandfathered” into perpetual certification.

Certification aside, though, I’d like to propose two other areas that need analysis. The first is the fact that the more seasoned physicians have gone through a tremendous amount of change in medicine over the last two decades. There have been drastic changes in the non-clinical work physicians are responsible for (insurance issues, E&M coding, pay for performance, loss of autonomy, economic pressures, etc.) and one of the natural responses to change is to entrench in the past.

The second involves looking at the systems that have proliferated based on the changes above, both operational and technical. There has been a proliferation of operational platforms impacting how clinicians are forced to navigate – everything from the Disney Institute to Six Sigma. Simultaneously, there’s been tremendous pressure to move to electronic systems that range widely in their ease of use, stability, and quality.

I’d like to see similar data where they survey the physicians about their comfort level with not only hospital policies and procedures (including proliferation of care coordinators, discharge specialists, length of stay coordinators, coding coaches, etc.) impacting their care, but also on their comfort level with the systems they use and how well they use them.

Because of the presence of interns and residents, I have a sneaking suspicion that some of the more experienced attendings may not have leveraged technology and the team approach (sometimes perceived as interference) as much as they could have. Old work habits are hard to break, and when you’re used to the lower-ranking physicians doing everything and just co-signing at the end, it’s easy to miss things.

Coupled with a mistrust for technology, it’s even more complex. I suspect newer attendings for whom these systems have always been present would be more likely to be hands-on with the technology rather than passive.

Regardless of the reasons, it’s something that deserves a second look.

E-mail Dr. Jayne.

Monday Morning Update 8/22/11

From Hot Off the Press: “Re: Cal eConnect. President and CEO Carladenise Edwards PhD steps down.” HOTP forwarded her e-mail from late Friday afternoon announcing her transition to senior advisor of the HIE organization due to “personal reasons.” Cal eConnect was created when California’s HHS department, overseer of $39 million in federal HIE grant money, decided to form a new statewide oversight organization instead of supporting CalRHIO, effectively shutting that organization down in January 2010. TechLeader obtained information suggesting that earlier last week, Cal eConnect suspended its RFP for a provider directory service, with no bidder selected.

From THB: “Re: tax-exempt hospitals. A potential trend?” Three non-profit Chicago area hospitals express shock that the Illinois Department of Revenue has denied their tax-exempt status requests, ruling that they aren’t owned by charitable organizations and aren’t being used for primarily charitable purposes and therefore must pay property taxes like any other business. The state said the hospitals didn’t list uncompensated care on their requests, but did in their own records: Prentice Women’s at Northwestern (1.85% – pictured above), Edward (1.04%), and Decatur Memorial (0.96%). The state says it won’t set a minimum charity percentage, although one legislator is sponsoring a bill that would require at least 3.5% of total revenue. Just for fun, I checked the IRS forms of Edward Hospital: it made a profit of $25 million in the most recent year, paid the CEO $1.6 million, and claimed it provided $45 million in charity care.

From The PACS Designer: “Re: IBM’s 100th anniversary. Most all of us have encountered business relationships with IBM in our work careers. TPD first learned about IBM solutions in the early 1960s while getting educated to be an electronics engineer by being trained on the use of an IBM vacuum tube computer. Later in my electronics career, I worked with IBM to interface the IBM Shark information storage system to a PACS to create one of the first central archives for all hospital information including imaging files.  InformationWeek recently published a video history of IBM’s 100 years.”

Thanks to a few of my overachieving sponsors who have already swapped out their animated ads with a static replacement, well in advance of the January 1 deadline I set to allow them plenty of time. I appreciate it, as do those many readers who requested that change.

Over 60% of respondents agree with the recommendation of Congresswoman Renee Ellmers that HHS study EMR effectiveness and impact on patient safety. New poll to your right: does Epic CEO Judy Faulkner have too much influence on federal government healthcare IT decisions?

Listening (and watching): reader-recommended Live from Daryl’s House, a fascinating Internet program created by (and paid for by) the first half of Hall and Oates. I hated the 80s poofy-haired, “blue-eyed soul” dreck they did and was kind of hoping he’d been reduced to unpaid gigging at the Paducah Holiday Inn, but I now want to be Daryl Hall: inviting all kinds of big music names to jam with him in a barn-like room of his $16 million spread, drinking wine, bringing in guest chefs to cook for them, having scintillating dinner conversations, and recording the whole thing as a homebrew reality show. The audio and video quality are amazing, the guests compelling. My favorites so far have been Grace Potter and the Nocturnals and Krieger / Manzarek of The Doors, with whom Hall does just fine vocal work on my favorite Doors tune, The Crystal Ship. He’s 64, rich, and living large, just playing his music to an Internet audience. I’ll grumblingly admit that even the versions of Hall and Oates tunes he and his guests covered (like the insipid Sara Smile) sound amazing and fresh. I wish I could be that cool.

I swear that Vince Ciotti is digging deeper into company histories with every new HIStory chapter, finding veterans willing to share their previously untold stories. This time he  covers a company I don’t remember: Sentry Data. Upcoming are these vendors: AR/Mediquest, JSData, and Gerber-Alley, so if you have war stories to tell about them, Vince is your guy.

Urology EHR vendor meridianEMR files a lawsuit and gets a restraining order against competitor Intuitive Medical Software (UroChart), claiming UroChart cloned one of its servers and thereby gained illegal access to meridianEMR’s product and the protected health information stored by its clients.

The weekly employee e-mail from Kaiser honcho George Halvorson talks up their first iPhone app, KP Locator, which he says is “the next connectivity path on a journey that is turning into a superhighway of connectivity over time.” He says it’s the first of many that will be built and invites employees to send him ideas for the next round.

An article in Silicon Valley / San Jose Business Journal details how much local hospitals are spending on EMRs. Factoids: (a) 403-bed Mills-Peninsula Hospital spent $50-75 million; (b) six Daughters of Charity hospitals spent a total of $80-90 million; (c) Stanford says it’s spending 30% of its total available capital each year to implement EMRs; (d) Stanford also spent $13 million to hire a 100-member temporary go-live team for three weeks, which must be a misprint or an incomplete description since that’s over $800 per hour;  (e) O’Connor Hospital spent $2-3 million on EMR training; (f) Mills-Peninsula expects to spend 2.5% of the hospital’s entire budget each year in perpetuity for EMR maintenance.

Beth Israel Deaconess reportedly offers its CEO job to Kevin Tabb, chief medical officer at Stanford Hospitals and Clinics, who would replace the ousted Paul Levy. He’s an internist, but went into healthcare IT straight out of residency as a clinical informatics analyst for iKnowMed, a data director for MedicaLogic, president of clinical data services for GE Healthcare, and then chief quality officer / CMIO for Stanford. Sounds like he would be a geeky kindred spirit for CIO John Halamka there.

Asante Health System (OR) chooses Epic, saying “only one vendor had an integrated solution for hospitals and physician offices, and that was Epic.” They also added that Epic puts 47% of earnings back into R&D and has less than 2% of its workforce involved in sales and marketing.

Thirteen Danish hospitals announce plans to migrate their 25,000 employees from unnamed proprietary office software (care to take a guess?) to the open source LibreOffice, a fork of OpenOffice.org.

A computer professor in England enlists the help of his colleagues to create a computer game to help his four-year-old daughter, who has cystic fibrosis. She can control on-screen graphics by breathing into a PEP mask, which forces her airways open, an otherwise monotonous exercise that kids don’t enjoy. Her doctor can review her game results to determine how her lungs are doing. The group hopes to have the game tested and available to the public within a year.

Former Allscripts COO Ben Bulkley is running Fluidnet, a Massachusetts-based IV infusion control system vendor that just raised $25 million in investment capital.

HP wants out of the consumer computer business, but its systems work isn’t such a hit in Ohio either, where the Medicaid Information Technology System that went live on August 2 is inappropriately denying payments to providers, improperly kicking patients off assistance programs, and causing prescriptions to go unfilled by rejecting the Medicaid bills from pharmacies. Rep. Dennis Kucinich will meet with CMS administrator Don Berwick on Tuesday.

Regulation of EMRs by FDA
By Tim Gee

In the HIMSS top nine trends to watch in health IT, they missed a big one: the regulation of EMRs and other applications by the FDA, and potentially transforming providers into medical device manufacturers.

Between the final MDDS rule (which called out hospitals as potential regulated medical device manufacturers) and public testimony by Jeff Shuren, director of CDRH at FDA that the FDA intends to regulate at least some EMR software, healthcare IT is going to be coming to grips with FDA regulations for some time to come.

How many hospitals have written software to acquire data from medical devices? I’d guess over 100. I’ve heard estimates from sources that FDA expects to be regulating thousands of new manufacturers in the near term.

Since the final MDDS rule was published, four providers have registered with FDA as medical device manufacturers and listed their MDDS products with FDA. The providers are Partners, Gundersen Lutheran, Intermountain Health, and the Alaska Native Tribal Health Consortium.

And when FDA regulates portions of EMRs (they’ve set their sights on decision support systems first), providers who modify their EMR applications may be transformed into medical device manufacturers and become regulated, too. How many early adopter hospitals have have written their own DSS from scratch? They, too are likely to become regulated medical device manufacturers.

The MDDS rule was the shot across the bow. Expect a draft guidance document from FDA on regulating EMRs late this year. Yes, FDA will go slow, but responding will be like turning a battleship – it will take a while and require substantial effort in some cases.
In the next two or three years, I’ll bet most hospitals will be looking to hire regulatory affairs / quality assurance directors, and many hospitals may be rethinking their wholesale modification of HIT apps they purchase, not to mention foregoing rolling their own apps.

E-mail Mr. H.

Time Capsule: Consider Funding Health IT Projects Like Bill Gates Would

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 June 2006.

Consider Funding Health IT Projects Like Bill Gates Would
by Mr. HIStalk

It’s no longer news when a big, non-profit integrated delivery network pays a CEO $1 million or a CIO makes $300K for running a small department. We’ve come a long way since the days when ministering to the sick was a calling, where selfless caregivers toiled for a subsistence wage in service to mankind. And why not, since a big IDN can make hundreds of millions of dollars in profit (sorry, “surplus”) in a good year? Once nuns got replaced by MBAs, hospitals became a big business, feeling quite unlike charities to those working inside them. The only surprise in the IRS’s questioning of whether hospitals deserve tax-exempt status is that it took them so long.

VP panic ensues when the local newspaper prints executive salaries, fiscal year results, or drawings of the latest vanity construction project. Nurses may be de-motivated. Unions might be called in. A bitter janitor might key all the luxury cars in reserved spots. Beaten-down doctors may get even crankier when they find out that even bottom-feeding HR and marketing VPs out-earn them.

I thought of this when I read that Bill Gates and Warren Buffet will turn over their billions to serve those in need. I’ve worked in hospitals and IDNs for many years. Are we good stewards of charitable dollars, efficiently funneling them directly to those in need with minimal administrative overhead and waste? That’s how you evaluate a charity, and on that basis, IDNs don’t seem to compete very well. We’re no Salvation Army, with tiny salaries and a focused mission.

Still, another headline gave me an idea. Studies are proving what we all knew: RHIOs can’t survive without charity. If RHIOs provide benefits to patients, yet offer no hope of financial self-sufficiency, then maybe that’s a good and direct use of charitable dollars. Put a few million long-term dollars into some well-organized RHIOs and see what happens.

I like this because Gates’s charity is notoriously efficient. You compete with other causes under rigorous conditions on how well your project will benefit society. RHIOs would have to prove themselves worthy of funding, which would be an interesting exercise in itself given their sketchy “let’s put on a show” origins.

What other health care IT projects deserve charitable consideration? I’d vote for a center for usability research to make health care software more user-friendly and less training-intensive. I like the idea of a free clearinghouse for clinical rules, knowledge, and content to be shared by non-profit hospitals. Maybe we need a patient safety organization just for IT, watching out for problems caused by poorly-designed software and medical technology. Perhaps a non-profit medical informatics consulting organization could help hospitals with an occasional need for that expertise..

If you’re involved in hospital IT, my advice is to review your projects like the Gates Foundation would. Are they ingenious, cost-effective, highly beneficial to patients, and highly likely to succeed? If so, put your resources into those.

In the meantime, here’s my challenge to you. Come up with a list of health care IT projects that are noble causes, benefiting a large population in a way that the free market and the government haven’t. What IT-related work would be ingenious, cost-effective, highly beneficial, and highly deliverable enough to pass scrutiny from the Gates Foundation? Send them my way and maybe we’ll talk about them in a future article.

News 8/19/11

Top News

General Dynamics will acquire federal healthcare software vendor Vangent for $960 million, the company announced this week. Says the General Dynamics chairman and CEO, “Vangent is a well-regarded, fast-growing company that will add significant depth and breadth to General Dynamics’ healthcare IT organization, creating a Tier 1-level healthcare IT business unit with the scope and scale to compete in markets that are receiving high priority in current funding and entitlement-reform initiatives” The Arlington, VA-based Vangent, which has 7,500 employees, does work for HHS and the military. It developed the Army’s MC4 battlefield EMR. Kerry Weems, SVP and GM of Vangent’s Health Solutions business, joined the company in 2009 when he left his government position as head of CMS. He was also vice chairman of the American Health Information Community.

Reader Comments

 

From Watchdog: “Re: HIMSS. Pictures of its new headquarters in the financial district of Chicago. They also hired Steve Rosenfield as executive vice president / managing director of HIMSS Media, a new position and department, and seek an associate manager of social media to improve the society’s ‘positive visibility.’ All that was required is an Associate’s Degree.” Steve doesn’t appear to have a degree, but did write co-write this book documenting the late 70s history of an influential Long Island club that includes photos and an audio CD of the folks who performed there (Springsteen, Aerosmith, Rick Derringer, Stanley Clarke, etc.)

From One Of Their Hospitals: “Re: MDG Medical. The support numbers are no longer in service.” I ran this reader’s rumor last week, in which he said his hospital’s pharmacy got word from the pharmacy dispensing automation vendor that they would close their doors last Friday. I said I wouldn’t name them until I checked to see if the phones were disconnected. Sure enough, the support number and PBX option now give a fast busy. The Israel-based company opened an office in Beachwood, OH in 2001 and moved its corporate headquarters to Aurora, OH in 2010. It claims to have 150 hospital customers and was announcing expansion plans as recently as October. I can’t verify anything other than that their support numbers aren’t working and they didn’t respond to my earlier e-mail asking about the rumor.

From Wildcat Well: “Re: RECs. There have been claims that healthcare IT will be the primary sector for job creation. Does it count when a REC receives funds from ONC, the REC coordinator contracts for systems integration work with ‘local’ vendors, and the jobs are filled through the overseas facilities of those vendors? We may just be stupid enough to deserve the mess we are in.”

From Hate Manual Entry: “Re: Sage Healthcare. Rumor is they bought a SaaS-based HER from a recently bankrupted company. Any others hearing the same?” We asked Sage, which said that for competitive reasons, they don’t comment on acquisitions or technologies that may or may not be under consideration.

From Laura: “Re: Joplin. I’m sure you’ve seen that Mercy has announced plans to rebuild in Joplin. They have kept employees on the payroll since the May tornado and raised $500 million in a co-worker fund to help with expenses.” The 28-hospital Mercy (formerly called Sisters of Mercy) will spend $950 million to build a new 327-bed hospital in Joplin. They’re an Epic shop, I believe.

HIStalk Announcements and Requests

Check out the good stuff on HIStalk Practice: Don Michaels of Hayes Management Consulting and the Harvard School of Public Health weighs in on ACOs and the results of CMS’s demonstration project. Julie McGovern of Practice Wise offers recommendations for providers upgrading their software. Rob Culbert of Culbert Healthcare Solutions suggests key performance indicators to assess a practice’s financial health. CMS provides a breakdown of EMR Meaningful Use payments by specialty and provider type. The GAO advises CMS on how to improve physician quality reporting. I’m a simple gal with simple needs and I’ll be simply thrilled if you sign up for e-mail updates while visiting HIStalk Practice.

On the Job Board: Project Manager I, Epic and Cerner Consultants, Senior Enterprise Sales Executive.

Acquisitions, Funding, Business, and Stock

drchrono closes an additional $650K in seed funding and announces the release of OnPatient, a free patient check-in app for the iPad.

Deloitte acquires the assets of Intrasphere Technologies, a New Jersey drug safety and regulatory consulting company that also offers R&D informatics software for registering clinical trials.

HP announces a restructuring that includes ceasing production of tablet computers and smart phones, trying to sell its PC business, and spending $10 billion to acquire British search technology vendor Autonomy at a 64% premium to its share price. The HP Touchpad has barely been on the market for a month. The announcement probably signals the inglorious end of Palm, which HP bought last year for $1.8 billion before phasing out the brand.

Sales

The University of Chicago Medical Center will implement Omnicell’s Inventory Management Carousels with WorkflowRx software for inventory management and Omincell’s automated dispending system.

Imprivata announces that 12 Siemens customers have chosen its OneSign single sign-on.

Stamford Hospital (CT) will implement SmartRoom technology in all of its patient rooms, which provides real-time patient and RTLS information on an in-room monitor and provides touch-screen documentation capability. SmartRoom was developed by UPMC, which owns the company.  

Evergreen Healthcare (WA) chooses Cerner clinical systems.

People

 

Healthcare software vendor Net.Orange names Rob Beardall MD, MPH as EVP/Chief Medical Officer and Troy Roth as SVP of solutions strategy. They come from Health Synectics LTD and MedAssets, respectively.

Paula Guy, CEO of Georgia Partnership for TeleHealth, joins the board of the Georgia Health Information Exchange.

Announcements and Implementations

Arkansas critical care hospitals Piggot Community Hospital, DeWitt Hospital, Delta Memorial Hospital, and Chicot Memorial Medical Center select Healthland.

Nine hospital systems in Western Pennsylvania partner to create the ClincalConnect HIE. dbMotion will supply the infrastructure for the $4 million project.

The radiology department of University of Utah Health Care reports that its use of artificial intelligence resource management software from Allocade reduced overtime cost by 90% and overall FTE expenses by 10-15%.

Miami-based EMR vendor CareCloud says it has tripled headcount in the past year to 80 and will bring on another 30 employees by the end of the year.

Government and Politics

The VA issues an RFI for cloud-based collaboration tools for its entire workforce. They plan to pilot document sharing and calendar applications with 5,000 physicians, potentially replacing Outlook and Exchange, SharePoint, and Jive Software for all of their employees if the pilot is successful.

Other

I got an earful from my doctor and his office manager today about their “horrible” EMR. Since purchasing it a year and a half ago, they’ve suffered through performance issues, upgrades problems, inadequate templates, and many unexpected expenses. The Meaningful Use money, which they’ll receive this month, covers the EMR’s cost but not the $10K per year for maintenance. The doctor blames the vendor, which has been around for less than five years, for releasing an immature product. I checked their Web site and it looks like the latest and greatest. I wonder how often providers opt for bleeding edge, only to later regret not buying the tried and true option?

Here’s a video showing the Texas Health Resources group that climbed Mount Kilimanjaro (including Ed Marx) opening a medical clinic in a Tanzanian village a few weeks ago.

A drug company’s laid-off IT tech pleads guilty to extracting his revenge by wiping out most of the company’s electronic systems while he still had access as a contractor. The drug company lost e-mail, inventory systems, and payroll capabilities, crippling it for several days at an estimated cost of $800K. The tech faces 10 years in prison.

The FBI subpoenas Parkland Memorial Hospital (TX) and its IT department, seeking records related to a former Dallas County commissioner and a telecommunications system business owned by a close friend. According to the Department of Justice, the investigation involves “allegations of public corruption, tax evasion, and money laundering.” The telecommunications company got $3 million worth of consulting work from Parkland and UT Southwestern Medical Center. Another of its customers, the local toll authority, paid $47,500 for a no-bid consulting report that basically said “your equipment needs to be replaced” and included graphics lifted directly from another company’s 12-year-old product manual.

In Ireland, an interim examiner is appointed to review three hospital software vendors that have claimed insolvency, putting the electronic records of 10 million patients at risk. The companies operate under the name IMS Maxims.

French software vendor Atos Healthcare, whose software is used in England to evaluate disability claimants, investigates two employees (one of them a nurse) for their Facebook comments about those claimants, which they characterized as “down and outs” and “parasitic wankers.”

Sponsor Updates

• Intelligent Medical Objects and dbMotion will participate in the Allscripts Client Experience next week.
• MEDSEEK’s eConnect HIE technology successfully connects the WNC Data Link (NC) HIE to the VA’s VistA.
• UCare selects RelayHealth’s Payer Connectivity Services (PCS) for its 230,000+ members.
• API Healthcare will exhibit at the ASHHRA annual conference in Phoenix next month.
• Healthcare Innovative Solutions VP Daniela Mahoney, RN, will present Best Practices in CPOE Deployment Strategies, and Physician Resistance, Adoption and Value Proposition at the Kansas Hospital Association: Meaningful Use Summit, and Executing Key Plays: How Team Members Must Adapt to Succeed at SC Hospital Association the TAP Conference.
• TeleTracking Technologies is offering a free Patient Flow symposium in Raleigh, NC next month.
• Nuance Communications unveils Dragon Medical Practice Edition, which targets the needs of physicians in practices smaller than 25 providers.
• OptumInsight’s Axolotl EMR Lite, version 9.2 receives ONC-ATCB certification as a complete ambulatory EHR.
• A healthcare claims review company implements Symantec’s PGP Whole Disk Encryption to meet HIPAA requirements, claiming a one-month payback period after switching from free encryption software that was killing employee productivity.

EPtalk by Dr. Jayne

I returned home from my most recent sojourn to find the only thing I hate worse than filing my taxes or a root canal — a re-credentialing packet for my hospital privileges. Despite our health system’s large IT department and our belief that we are high tech, the credentialing process is decidedly low tech.

When I was a practicing physician, my practice manager took care of the application and applied sticky flags to areas that needed review or my signature. But now that I’ve crossed to the dark side of information technology, there’s no one in my organizational tree who has any idea how to do these, so I have the pleasure. I think next year I might just ask my former staffer if she’d be willing to do it for cash (as an independent contractor, of course — I’m not about to run afoul of the IRS.)

Under the 26-page “standard” credentialing form was an additional 22 pages of forms to be completed. They had been photocopied so many times they were practically illegible. Lurking at the bottom of the stack were several nearly identical sets of privilege forms for the different hospitals at which I am on staff, one for each facility (heaven forbid they share information from a central repository or from the master application itself.)

I find it slightly humorous that I still hold privileges for OB labor and delivery as well as operative circumcision despite having not performed either procedure in quite some time. Oh yes, and I can also pierce the earlobes of inpatients if I so choose.

In addition, they want a copy of my Curriculum Vitae and documentation of my Continuing Medical Education hours, which along with everything else has to be returned on paper and by mail. Seriously. Everything else we do in the hospital is electronic – CPOE, patient recordkeeping, even patient meal selections done on a touch-screen at the bedside. Except this.

When it comes to the concept of ensuring that physicians have accurate and up-to-date data before approving them to start or continue seeing patients at a facility, we’ve gone back to 1956. (Actually, 1956 was probably easier – you could most likely have just hung your diploma on the wall and started seeing people.)

If this would have been an online process, I’d have knocked it out right away while lounging on the sofa with some quality Netflix and recuperating from my travels. But instead, it goes on the dreaded ‘pile’ somewhere between the bill from the local lawn care guy and the student loan payment coupon, both paper-based businesses.

Turning to health IT news, legislators on the House Energy and Commerce Committee have asked the Government Accountability Office to review Federal Communications Commission efforts to ensure the safety of wireless medical devices. Their request featured discussion of the recent demo where an insulin pump was hacked and hijacked. As I was reading this piece, I envisioned a flashing “As Seen On HIStalk” seal of approval.

Finally, a reader question. It’s been a long time since we have had one and I do enjoy them (hint, hint).

Dear Dr. Jayne,

Is the new Chest-Compression-Only method of CPR taking hold, or is there some resistance to it? I still see classes offered in the older method and have to wonder… why? What do you think?

Breathless but Hearty

Dear Hearty Reader,

I think overall, more data is needed. When I completed my certifications for CPR and advanced life support (both cardiac and trauma) as well as pediatric life support a few months ago, traditional CPR was required. The American Red Cross issued a statement last year about compression-only CPR, stating:

“…Compression-Only CPR until an AED [Automated Extermal Defibrillator] is available is an acceptable alternative for those who are unwilling, unable, or not trained to perform CPR.”

I tend to agree with them. The idea of CPR is that you want to prevent brain death, and unless you’re oxygenating the blood by getting air into the lungs then circulating it with compressions, you’re not going to be as successful if oxygen levels remain low.

On the other hand, if it’s the difference between CPR not being done because a bystander isn’t sure how to do it correctly or is worried about communicable diseases or some of the more unpleasant side effects of bystander CPR, then I think compressions alone are better than nothing.

The American Heart Association offers a trademarked “Hands-Only CPR” method that’s demonstrated on their website. I like their bullet point: “Don’t be afraid. Your actions can only help.” Regardless, knowing the legal world, I offer this advice — if you’re trained in traditional CPR and have no other reason not to do it, traditional CPR should be your first choice. I’d hate to get into a “standard of care” discussion on this one.

Jayne

Have a question about LOINC codes, the Russell Viper Venom time assay, or whether snakebite extraction kits really work? E-mail me.

Contacts

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

CIO Unplugged 8/17/11

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

Connect.

One thing that differentiates top performers from peers is neither skill nor experience — it’s talent. One key talent is compassion. Top performers connect their skills with compassion. They link their hearts to their brains. Connection is the difference maker.

As a leader, how do I help make that connection for my team? How do I create an environment where we can cultivate compassion? How do I help them view their job as more than a paycheck, but as a contribution to a patient’s life?

A motivational speech might spike emotions for a day or two, but I need something with a longer half-life. I need an approach that transcends mental understanding, a connection so strong that synapses will rewire and link the brain to the heart and infect the soul. Forever.

The single most effective method I have leveraged is what I term Connections. I have employed Connections for eight years, at two different organizations. The remarkable happens when you remove the physical barriers between clinicians and those who support them.

A programmer’s heart changes when he sees the impact of his code on a patient. When a service desk agent sees the face of the physician she’d helped navigate through the electronic health record, her heart expands. Sympathy awakens in the data center engineer when he learns from a nurse that patient outcomes improve because of the technology delivered with zero downtime. And an administrative assistant understands the urgency of communication when she personally witnesses the life and death stress.

Our brains tap into our hearts. Compassion-infused work follows.

Outcomes

• The clinicians who are shadowed learn more about technology. They learn that we care and that they have this incredible support structure surrounding them. This aspect is almost as beneficial as the Connections themselves.
• Relationships develop and then are cultivated, creating a family-oriented culture.
• Respect from operational leaders increases because they see that you care enough to take such action.
• While not scientifically validated, there appears to be an overall correlation between organizational outcomes and Connections.
• As Connections form, employee engagement rises, creating and nurturing new talents.

Employee Transformation Testimonies

• “I must admit, I hated this idea but did it because I had to. I have worked here for 20 years and for the first time I realized we have patients. Of course I knew what we did as a hospital but really, this was incredibly impacting and I will never be the same.” (Programmer)
• “I am not the same today as yesterday.” (Network Engineer)
• “I volunteered to observe in the OB unit. With clinician and patient consent, I witnessed the birth of twin babies. I never realized all the behind the scenes coordination required and it opened my eyes to a whole new world.” (Admin Assistant)
• “I never saw myself as part of the patient care process until now.” (Field Support)
• “My life is changed. I always wanted to be care giver but didn’t like blood so chose a different path in technology. Now I tell people I am both.” (Application Analyst)
• “I run marathons. I was more exhausted shadowing a nurse today. I never knew.” (Project Manager)
• “In one day I witnessed the joy of healing and the pain of death. I now see how critical IT is and why we need to be the best that we can be to support the front lines.” (Business Analyst)
• “I am a nurse and did not see why I had to take part in Connections. After today, it was like I was hit by a ton of bricks! Wake up call! Thank you, thank you, thank you.” (Application Analyst)
• “The experience is another reminder that the bigger picture of our health system, being a body of entities, departments and individuals, come together for the patients to have one more beat of life.” (Data Center Operator)
• “The experience was one that I am very thankful to have participated in and I can’t wait to do it all over again next year.” (Application Manager)
• “Patient care was the core focus of every area. It was really great to see the patients and what we really work for. Connections reminds us of what is truly important and why we do what we do (Security Analyst)
• “There is a lot of new technology on the floor and it’s cool to see how all the parts fit together to make the whole. People working with people and technology involved to make health care better.” (Business Analyst)
• “This is my second Connections, and every time I get a much more vivid idea of how my contributions and duties make a difference and reaffirms the promise to our community and the people we serve.” (Data Center Operator)
• “Clinicians are the reason we all have jobs, and I thank them for all of their hard work.” (Business Applications Manager)
• “It was very educational for me to see what the nurses and physicians do and how they use technology in their environment. It’s always a good thing for people working in technology to understand the business they support. Glad I had the opportunity. (Data Center Manager)
• “I have worked at 4 different health care organizations in 3 different states and this is the first time I have seen a program like this. I am proud to work here.” (Application Analyst)
• “Given what I saw I can’t begin to imagine how stressful their work must be. We need to do everything we possibly can to make it less so.” (Vice President)

I love a great speech and giving out raises and bonuses. But evidence suggests these have fleeting influence on performance and certainly do not develop compassion. In fact, some studies indicate the enthusiasm over a raise lasts two weeks.

I speculate this is because money only engages the brain. Conversely, transforming a person’s way of thinking and view of themselves results in long-term effects and a new person. Even the hardest of hearts and the most gifted intellectual will begin to view things differently. Once they’ve Connected.

***Leave a comment and I will send you a simple 10-step process for successfully setting up your own Connections program at your organization.

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

News 8/17/11

Top News

The VA has been on-again, off-again on whether it will build or buy a replacement for its VistA system, but former deputy CIO Ed Meagher says the VA and DoD may pay companies billions to write a new open source system. He now works for CSC, one of the contractors hoping to get the VA’s business. I knew the VA recently issued a $5 million contract to create an open source community for the VistA replacement and had previously announced plans to go that route, but I haven’t heard a definitive final word, especially when a group of Epic-friendly politicians is pushing the VA to look at commercial systems. The article’s choice of experts to quote about vendor products is questionable: Allscripts has done a great job creating an open architecture platform (according to an investment firm analyst who just put a Buy rating on MDRX shares) and GE Healthcare could work well in the VA’s environment (according to a government sales guy from GE Healthcare).

Reader Comments

From Too Big for my Breaches: “Re: yet another data breach. I’m getting tired of hearing about these.” St. Francis Hospital (DE) apologizes for a doctor’s loss of a thumb drive containing information on 474 maternity patients. He lost it in the spring, but someone mailed it back to him on June and he didn’t report it until then, pushing the hospital’s 60-day deadline to report the loss. The doctor was authorized to copy the information but violated hospital policy by not encrypting the drive. He must have been researching old cases — the hospital says the in utero babies whose records he copied are now nine or 10 years old.

From Victory at Sea: “Re: UAB. I believe that most people in healthcare are honest and want to help people, but there’s a lot of money rolling around inside these organizations (vendors too) and temptation is always to be found for those who are open to it.” The FBI launches an investigation into Alabama’s only organ donation center, UAB-run Alabama Organ Center, after discovering that its director and associated director had an “improper financial relationship with a vendor.” UAB has fired the employees and parted ways with the unnamed vendor.

From TxPathDr: “Re: Jason Dufner. Anyboy else notice that he had a Greenway Medical logo on his chest for the PGA tournament in Atlanta this week? I can’t remember ever seeing an EMR company logo on a golfer before.” Greenway struck a deal a few weeks back to have him wear their logo and be available for marketing and company-sponsored events. The green logo really pops on his pink shirt.

From A CEO: “Re: our interview. Questions I get from healthcare trade rags and the financial press are vanilla – my sense is the editors / journalists are just trying to get their stories written vs. trying to arrive at insights relevant to their readership. I found your questions intellectually stimulating. Keep doing what you are doing – we appreciate it.” Thanks, both for doing the interview and for the nice words. I don’t like asking stupid questions, at least when I can help it, so I treat my interviews as a conversation. As in most conversations, not everybody is fascinated by every interview of the hundreds I’ve done – it depends on their area of interest. As for me, everybody I’ve interviewed has taught me something.

From Bruce Werner: “Re: interview with our CEO, Mark Debnam. The HIStalk interview was a big success. Our Facebook ‘likes’ jumped significantly. We are proud to be part of the HIStalk family.” Mark of Quality IT Partners and I are both progressive music nerds, so we were nearly breathless in discussing the latest tours and albums from Yes and Asia, which I omitted from the interview transcript since, puzzlingly, not everybody is a fanboy for semi-obscure bands whose heyday was a couple of generations ago.

From Chillicothe: “Re: Epic. Wondering if you saw this?” Several readers sent over a link to that story in The Examiner, a free, conservative DC-area newspaper. It’s all rehash: Judy Faulkner of Epic was appointed to the HIT Policy Committee and Epic employees have given $300K to Democrats since 2006 (doesn’t sound like much for a company of that size). Surely nobody’s shocked that donors get some reciprocal back-scratching, like being appointed, but her spot was set aside as a vendor rep, so why not her? The article takes a somewhat slanted position that Epic isn’t open to interoperability (the article’s one quoted source to back that statement – CEO Glen Tullman of Epic competitor Allscripts, who is himself a lot better connected politically than Judy will ever be). The rag finds a hidden Obama agenda — the examples he’s given of well-run hospitals (Geisinger, Kaiser, Cleveland Clinic, and Mayo) are all Epic customers. One thing I might agree with: it would indeed be a bit suspicious if Epic got the VA’s bid (which doesn’t seem to be happening, at least at this moment) but otherwise, they’re getting plenty of business without government help. And yes, the Obama administration was mighty generous with our money in bribing providers to use EMRs they weren’t spending their own money on. 

From The PACS Designer: “Re: Toodledo. Will Weider of Candid CIO blog fame recently posted about a to-do listing app called Toodledo. You can get Toodledo versions for your mobile phone, as well as an app to add it to your e-mail, on your calendar, and integrate it directly into your web browser.” I’d be interested if it does recurring events and reminders. I don’t use Outlook at home and I’m finding Google Calendar to be pretty sucky when it comes to reminders. In fact, I’m becoming slowly annoyed at most things about Gmail and Google Docs – the spare design was cute at first, but everything feels clunky and I still don’t like the “conversation” design of Gmail since I’m always deleting entire message threads by mistake.

Acquisitions, Funding, Business, and Stock

Intermedix, a provider of RCM services for emergency healthcare services, buys the assets of RCM-provider Comprehensive Medical Billing Solutions of Oklahoma City.

Axiom Systems acquires Ivertexo Internet Solutions, a provider of administrative software solutions for healthcare providers.

MedQuist Holdings announced Q2 numbers Tuesday morning: revenue flat, EPS $0.11 vs. -$0.06. Its acquisition of M*Modal gets clearance to be completed in August. MedQuist shares made the list of biggest Nasdaq losers Tuesday, down 18%. The company says it’s pushing more work offshore, but is being negatively impacted by customers sending work offshore themselves, by customers using speech recognition instead of transcription (which I’m sure is why they are buying speech recognition provider M*Modal for $130 million) , and by providers focusing on EHRs.

Vocera files SEC paperwork for its $80 million IPO.

Sales

Cooper County Memorial Hospital (MO) will spend $2.5 million for Meditech, which it selected over Cerner and Healthland. Hospital CEO Allen Waldo says, “Meditech won the contract because the hospital’s clinicians thought it was more user-friendly and had a better data recovery system.”

The VA awards ICS Nett and Beacon Enterprise Solutions Group a $3.4 million contract to provide the management and installation of an RTLS solution for tracking equipment, supplies, implants, and surgical instruments.

St. Joseph’s Medical Center (CA) selects PerfectServe’s voice, mobile, and Web-based clinical communications system.

The Australian government chooses a consortium of eight firms to participate in the infrastructure build of its $466.7 million personally controlled electronic health record (PCEHR). Winners include Accenture ($47.8 million), Oracle ($17.8 million), and Orion Health ($11 million) along with sub-contractors Telstra, Cerner, ThinkPlace, Extensia, and Ocean Informatics.

People

Lehigh Valley Health Network promotes Donald L. Levick, MD, MBA to CMIO.

Former McKesson Health Solutions CFO and VP Peter P. Csapo will join VHA as CFO.

Beebe Medical Center (DE) names Jeffrey Hawtof, MD VP of medical operations and informatics.

Kevin Groskreutz is promoted to CIO of Hospital Sisters Health System Western Wisconsin.

Bassett Healthcare (NY) names Scott Groom VP/CIO. He was previously with Cabell Huntington Hospital (WV).

Announcements and Implementations

Resurrection Health Care (IL) goes live on its system-wide Epic implementation with the activation of billing and scheduling at 20 ambulatory care clinics. The practices will add EMR over the next six to eight months;  the first of six hospitals will begin go-lives in the fall.

Zynx Health announces two enhancements to its clinical decision support technology: Workflow Management to streamline content development and Export Validation to allow Cerner CPOE users to validate order sets before exporting them.

Vital Images / Toshiba gets 510(k) clearance for its VitreaView browser-based universal patient imaging viewer, which allows EMR and HIE users to view all patient images. It was announced in June.

Government and Politics

President Obama announces new economic initiatives to spur growth and create jobs in rural areas, including loan programs to enable hospitals to purchase HIT. The administration also announces a loan repayment program for more than 1,300 small, rural hospitals to recruit new physicians. The White House estimates that the addition of one new primary care physician in a rural community generates $1.5 million in annual revenue and creates 23 jobs annually.

FDA will hold a public workshop seeking input on what types of mobile medical applications it should regulate on September 12-13 in Silver Spring, MD. This follows FDA’s July draft guidance on that topic.

Other

A proposed compost facility in Freetown, MA is stinking up Meditech’s plan to develop a new office building that could bring 800 jobs to the area. The city is looking into the issue.

CEO compensation at Boston’s nonprofit teaching hospitals is leveling off, with 2009 pay equal to or less than the previous year’s. Elaine S. Ullian, the former CEO of Boston Medical Center experienced one of the biggest declines: $1.8 million in 2009 compared to $4.8 million in 2009.

About 40% of EDs in urban areas e-prescribe compared to just 6% in rural areas.

I’m loving the site (sites, actually: this one and this one) of Atlanta anesthesiologist Michelle Au MD, author of This Won’t Hurt a Bit (And Other White Lies): My Education in Medicine and Motherhood. She’s darned funny, describing her book as: “It contains ‘pages’ and ‘words.’ I done wrote it.’” But if you’re on the fence as to whether she’s wickedly humorous, click the graphic above to enlarge. Brilliant. I think I’ll buy the book.

Vince Ciotti (and I) would approve: McKesson joins The IT History Society as a corporate member.  

Another highly paid non-profit hospital CEO: the head of a 326-bed Brooklyn hospital made $4 million in 2009 while laying off employees and closing clinics that served its predominantly Medicaid patient population. The board gave the usual “market rate” excuse.

Sponsor Updates

• Memorial Sloan-Kettering Cancer Center (TX) signs an enterprise license agreement for iSirona’s device connectivity solution.
• Canterbury District Health Board (NZ) partners with Orion Health to provide secure access to patient information.
• Capsule is exhibiting at this month’s Allscripts Client Experience 2011.
• Capario launches a new Web site, blog, and social media presence on Twitter, Facebook, and LinkedIn.
• Scott Besler of Besler Consulting will discuss New Cost Report Changes at next month’s HFMA NJ’s quarterly meeting.
• NextGen announces a webinar and live demo for its digital pen solution, NextPen.
• MedPlus will exhibit at Epic’s 2011 Users’ Group Meeting in September.
• Practice Fusion’s Research Division releases a list of most-prescribed drugs, derived from its EMR database.
• The 25-bed critical access hospital Lakewood Health System (MN) selects McKesson’s Paragon HIS.
• Billian’s HealthDATA publishes a white paper called Providers’ Perceptions: Mobility in Healthcare.
• Eisenhower Medical Center (CA) contracts with Wolters Kluwer Health for its ProVation gastroenterology procedure documentation and coding software.
• The healthcare business of Thomson Reuters introduces Payment Reform Solutions to help hospitals adopt new payment methodologies.
• Kyle Swarts joins Culbert Healthcare Solutions as a regional sales executive.
• The District of Columbia Primary Care Association subscribes to CapSite’s online service, giving its network of providers the ability to identify technology pricing and packaging options.
• Kareo hires James Mathews its first VP of business development. He has worked for Sage Healthcare, Carefx, and WebMD.
• GE Healthcare will launch Centricity Business 5.0 at next week’s Centricity Business National Users’ Conference in Boston.

Contacts

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

Quality Systems Acquires CQI Solutions

Quality Systems, Inc. announced this afternoon that it will acquire CQI Solutions, Inc. of New Braunfels, TX, which offers hospital systems for surgery management and patient scheduling. CQI will become part of the NextGen Inpatient Solutions business of Quality Systems, with its applications offered as both standalone and integrated products. 

Steve Puckett, executive vice president of Quality Systems, was quoted in the announcement as saying, “We are pleased to extend our portfolio to meet these cross-departmental needs, demonstrating our commitment to the community and rural hospital marketplace. With the additional integration of our award-winning ambulatory solutions, our inpatient and ambulatory clients are now collecting critical data across the care continuum, helping them meet requirements of quality of care initiatives and current business drivers such as Meaningful Use, where clients have already earned in excess of $5 million in incentives.”

Curbside Consult with Dr. Jayne 8/15/11

In the realm of medical devices, this is one of the coolest things I’ve seen in a long time. University of Illinois engineering professor John A. Rogers and team have designed a sensor that’s about as obtrusive as a temporary tattoo. Not only can it pick up biometric data, but when placed on the throat, it can sense differences in spoken words such as “stop” and “go,” as well as directional commands. Hot news for patients with muscular or neurological conditions, it appears in last week’s Science.

Pardon me while I embrace my inner physics geek, but the sensor adheres using the van der Waals force, which is what geckos use to climb glass. Sounds funny, but it’s a big deal for patients who are allergic to medical adhesives. Tuck that away for your next Trivia Night.

I came across too many juicy tidbits this week to hold them for EP Talk, so this week’s Curbside Consult is more newsy than usual. Some recent all-nighters and an insane volume of Meaningful-Use related work also may have caused my attention span to be so short I’m not sure I’m capable of crafting an entirely cohesive page-long feature at the moment.

And did I mention the not-so-subtle influence of Las Vegas, home of total sensory overload? (BTW, it’s chock full of Siemens people. I thought about crashing, but maybe some readers can send me reviews and commentary from the Innovations ’11 Customer Education Symposium.)

Now that some vendors have finally tweaked their systems to allow appropriate documentation, the World Health Organization declares the H1N1 “swine flu” pandemic over. It doesn’t mean that the virus has gone away, just that it no longer meets pandemic standards. As an IT person, this was a great litmus test for the ability of vendors to be nimble. Quite a few were able to load systems with the ability to document, treat, and track quickly; several were less fortunate. This isn’t the first time we’ve seen emerging diseases (remember SARS?) and certainly won’t be the last, but hopefully next time it will be easier for the end users.

The Patient Right to Know Act will bring back a controversial Illinois database housing information on physicians, including malpractice settlements and judgment information. The database and its associated Web-based tool went offline following an Illinois Supreme Court decision regarding a medical malpractice reform law. The database will contain information on over 46,000 physicians and should be online in a few months.

Speaking of state news, Kentucky and Ohio are banding together to share prescription data. KASPER, the Kentucky All Schedule Prescription Electronic Reporting system, will connect with the Ohio Automated Rx Reporting System, also known as OARRS. (Not to be confused with the band O.A.R., which if Mr. H hasn’t listened to them yet, he should check them out — their new album was released last week.) Focusing back on the topic, it sounds like a great idea, but I’m very interested in how it actually works for the doc who’s trying to figure out whether the patient is drug seeking. If anyone has details or first-hand knowledge, please share.

Athens Regional Medical Center in Georgia has seen a 15% rise in online scheduling since implementing a scannable Quick Response code in advertising materials. The code is different depending on where it is placed, allowing tracking for the most effective referral sources.

Speaking of smart phones, I’m liking Mobiledia right now. Sometimes I need a break from healthcare, and their recent piece on Chinese plans for an app to update People’s Liberation Army troops on the latest happenings was just what I needed. Watch out though – the site is fascinating but will take you Wonderland-style right down the rabbit hole. I quickly bypassed the blurb about the recent bust of counterfeit Apple stores straight to the one about the Chinese teenager who sold his kidney for an iPad 2. (I don’t think I’ve ever put three hyperlinks in the same paragraph, so you can tell how addicting it is.)

I just discovered this is the tail end (no pun intended) of the World Mermaid Convention, so I’m going to check that out. If it’s a bust, there’s the Official Star Trek convention as well. Viva Las Vegas!

E-mail Dr. Jayne.

Monday Morning Update 8/15/11

From Big Ragu: “Re: HHS CTO Todd Park. Gave a great speech at the Health 2.0 NYC meetup Friday. He was a really dynamic and engaging speaker and showed off some amazing projects from Health Data Palooza, sponsored by IOM and HHS.” He’s at the 51-minute mark of the video here.

From Wanderlust: “Re: [vendor name omitted]. Lackluster replacement for [former VP 1], internal political fights over who owns product strategy, no progress on new revenue cycle product, offices being consolidated, open platform not what was promised to partners, and a shaky start to integration as employees freak out about their long term job prospects. This employee is putting down my copy of Visual Studio and checking out Monster.com. But wait, another rumor is making the halls of the office that does create some hope. That rumor is that [former VP 1] and [former VP 2] may be returning.” All unverified. I’m doing some liberal expunging since obviously there’s no way the company can confirm or deny so I’m not comfortable just throwing it out there, but I’ll say that Wanderlust was mostly right on some items sent my way earlier this year. I just talked to [former VP 1] this week and didn’t get any feeling that a return was imminent, so I’ll attribute that last sentence to wishful thinking.

From HappyNotToBeAMcKessonite: “Re: McKesson. Loses another large system, this time in Albuquerque, to guess who? Good luck finding Epic specialists through job boards. This health system has been cheap in the past, so it’s interesting they have allocated $90 million for the project.” Unverified. The health system wasn’t named, but I assume it’s Presbyterian, which signed a much-touted $22 million Horizon and homecare deal way back in 2001, the same year McKesson bought the rights to Vanderbilt’s WizOrder and called it Horizon Expert Orders. Presbyterian has a lot of Epic jobs posted that look like inpatient, so you can draw your own conclusions.

From Melina: “Re: Siemens. Signed some new deals.” Listed in the announcement: Regional Medical Center (TN) signs up for Soarian Clinicals and Financials; Jefferson Regional Medical Center (PA) goes with Soarian Clinicals; St. Joseph’s Healthcare System (NJ) will migrate off INVISION to Soarian Clinicals and Financials; and University of South Alabama will move from INVISION Clinicals to Soarian Clinicals.

From PumpDoc: “Re: IV pump design errors. I think you have given readers the impression that my company’s Plum A+ pump was the cause of the errors and that’s not true. Can you please clarify? Ours doesn’t have the start button next to the zero and decimal point. I’m guessing someone just picked a stock pump picture to go with the story. Thanks – I am an avid reader!” Correct – I just put up a general picture of an IV pump that didn’t really have anything to do with the article, other than for someone who didn’t know what an IV pump looks like. The article didn’t implicate any particular brand of pump, so it wasn’t the Hospira pump, which as the full-sized picture above shows, has the Start button on the upper left.

From Lodi: “Re: new HIMSS certification. Seems to duplicate the HIT program.” The National Science Foundation is apparently paying HIMSS to develop an entry level certification program, Certified Specialist in Health Information & Management Systems, kind of a junior CPHIMS, which is itself kind of a junior everything (advanced degree, relevant experience, useful specific certifications like PMP or CISSP …) Would you really hire someone on the basis of a credential proving that they are “entry level?” I’ve yet to see any general certification that’s worth anything other than to ease the sometimes justifiable anguish of the resume’-insecure, but it’s their money.

From HIStalker: “Re: salaries. A $6 million hospital CEO!” A hospital CEO salary survey covering only the Midwest finds the pack led by 314-bed Children’s Mercy Hospital and Clinics (MO), which paid its CEO $6 million in the most recent year. Must be a terrible place to work if that’s what it takes to get someone to run it. Mercy Janesville paid $4.5 million, Advocate $4 million, and Northwestern $3.4 million. It’s bad enough when private industry CEOs make massive multiples of what the worker bees are paid, but absurd when talking about non-profit hospitals, all of which ironically anguish publicly over escalating healthcare costs. If public school systems or soup kitchens could bill Medicare, I suppose they’d be unnecessarily run by $2 million administrators.

Honky Cat was moved to wax poetic about HIStalk:

An Ode to HIStalk
It’s 9pm and my bourbon glass in reach;
Mouse, keyboard, email, and alas,
An alert from HIStalk breaches the still.
Curse your anonymity!
Show your face and be criticized.
Yet the rhythm of my heart accelerates.
For I know the contents will amaze and amuse;
I may learn one morsel of data,
One shard of vendor information,
That cuts deeply to the quick
And such as a participle, hangs with an airy loft.
Or, perhaps a CIO interview that portends the strategy versus the reality;
Inga and her shoes.
Could she be the muse?
What have I to lose?
There is meaningful use.

This week’s Time Capsule editorial from 2006 lauds the hard-nosed vendor negotiation style of former NPfIT head Richard Granger. A snip: “Granger holds firm and goes public when he has to, unafraid to rip recalcitrant vendors by name. I like to picture him as a Gordon Ramsay-type scrapper, happy to take someone down a notch when they need it.” Knowing now that NPfIT is pretty much ash-heaped, you might smirk that I was way off base, but I argue no: the real problem was that, despite all that aggressive negotiation and multi-billion dollar contracts, there just were not any contractors or vendors who could pull off their part of the project. They overcommitted and under-delivered, but in this case, poor performance hit them hard financially and they walked away. Granger’s threats were a bit hollow since there were only so many potential contractors out there and the pioneers were coming back with arrows in their backs.

Listening: Big Big Train, recent British progressive rock that sounds like 1970s Genesis before Phil Collins ruined it by selling out to make teen dance tracks. Think And Then There Were Three, from which “Undertow” is one of my favorite songs of all time with amazing music and lyrics. Big Big Train is right up there with them.

A slight majority of poll respondents think hospital CIOs wield undue influence over clinical system selection and implementation. New poll to your right: should HHS study the effectiveness of EMRs and their impact on medical errors as Congresswoman Ellmers has urged? Click the Comments link on the poll widget to explain your rationale if you are so inclined.

Am I the only one getting weary of announcements proclaiming that XX hospital or practice is the first in some state to get Meaningful Use money? I figure there are 50 states, you have both EPs and hospitals, and MU comes in both Medicare and Medicaid flavors, so that’s a potential crap-load of self-congratulatory vendor press releases to wade through, none of which really mean a whole lot. Far more interesting would be a list of certified EMR vendors who don’t yet have even one customer that has received a check. It wouldn’t be any more meaningful, just more fun.

Iowa Children’s Hospital develops a Facebook medication reminder system for teens, especially transplant patients. The patient clicks on which meds they’ve taken and the information is sent back to their PCP.

Some excellent posts you might want to check out: Don Michaels concludes on HIStalk Practice that providers shouldn’t move too quickly to sign ACO contracts given demonstration group’s lack of success in earning payment, while Dr. Travis dissects WellDoc’s consumer health apps on HIStalk Mobile.

The Army tests its MC4 battlefield EMR  on iPad, iPod Touch, iPhone, and Android devices, expecting approval to replace their outdated Motorola handhelds with tablets later this year. What they like: larger screen, gestures, the ability to run common apps, the ability to access the Internet, and patient lookup by their ID card.  Above is a 2008 video of MC4 running on the Symbol (acquired by Motorola in 2006).

It’s been a crazy stock market week, so I thought I’d check the current vs. month-ago prices of some HIT stocks:

Allscripts: $15.27 vs. $19.74 (down 22%)
athenahealth: $53.00 vs. $45.16 (up 17%)
Cerner:  $58.18 vs. $62.29 (down 7%)
McKesson: $79.02 vs. $83.04 (down 5%)
Nuance: $18.04 vs. $21.07 (down 14%)
Quality Systems: $79.77 vs. $89.10 (down 10%)

A conservative political group in Kansas called SOCK (Stop Obama Care in Kansas) wants the state’s Republican party chair to quit, saying that Amanda Adkins has a conflict of interest because she’s an employee of Cerner, and as such has a vested interest in both Obama Care and the government’s push of healthcare IT.

As you must know, Cerner Corporation is not taking a passive stance in hopes of remaining a key player and profit taker in the HIT industry but is very aggressively working, including to influence the government, to ensure its leading position in the HIT industry is maintained if not enhanced. The position of your employer, Cerner Corporation, is diametrically opposed to that of the State of Kansas, the current KGOP platform and the vast majority of the GOP rank and file as well as other Kansans.

SAS hires Graham Hughes MD as the first chief medical officer for its Center for Health Analytics and Insight think tank. He was previously CMIO of GE Healthcare IT.

In the UK, workforce management solutions vendor Allocate Software acquires Zircadian Holdings, a vendor of software used by hospitals to manage physicians (scheduling, locum, and evaluation).

Ridgeview Medical Center (MN) partners with Healthbox to launch a three-month mentorship for up to 10 HIT seed-stage company entrepreneurs.

One of the inventors of the IBM PC says PCs in general are extinct, just like the typewriter and vinyl records. He replaced his own PC with a tablet, but says the devices themselves are not innovative – it’s the social spaces they access where people and ideas meet.

The fascinating story of SAI and its family tree in both directions, in this week’s HIStory from Vince Ciotti (he’s the hirsute lad on Slide 9, wearing a sofa-patterned, suspender-supported plaid suit and flanked by an avocado green touch-tone telephone). He loves your feedback and input, such as suggesting which long-gone companies he should write about (my list: Atwork, Continental Medical Systems, HealthQuest, Health Data Sciences, Phamis, and TSI).

Children’s Hospital Colorado is hit with a federal equal opportunity lawsuit for rejecting a job applicant for a staff assistant position who they found to have fibromyalgia, meaning she can’t sit at a desk or work on a computer for long periods. She wants the job, back pay, compensation for emotional distress, and punitive damages.

Dan Moriarty, founder of HIStalk Gold Sponsor Stimulus Search, has joined Health Data Specialists as recruiting manager. They focus on resources for Epic, Siemens, Cerner, and Meditech.

Stanford bioinformatics researchers mine the electronic patient databases of Stanford University Hospital, Vanderbilt, and Partners HealthCare to discover a drug-drug interaction between the heavily prescribed drugs pravastatin and paroxetine. Said the study’s lead author, “We’re bioinformatics people, not clinicians. We can develop ways to mine these huge data sets for interactions that have escaped attention, but you have to start with a clinical expert to curate a set of drugs and effects so you’re looking for something that actually matters in the real world. I’d love to hear from pharmacists about the kinds of questions they would like answered with data-mining. Their drug knowledge is invaluable to this kind of program.”

West Penn Allegheny Health System (PA) will partner with Highmark, Allscripts, and Accenture to offer EMRs to private practices. A local physician says WPAHS is obviously trying to keep its beds occupied: “If a hospital comes into your office and offers to front you $250,000 for an electronic medical records system, they’re not doing it out of the goodness of their hearts.”

Florida’s multi-millionaire Governor Rick Scott is criticized for paying low rates on state-provided health insurance, which he says is appropriate since he has the same plan and cost as everybody else. State big shots (all 32,000 of them) apparently get family medical insurance for premiums of less than $400 per year. Wildly generous state and federal government employee benefits and retirement plans somehow never seem to come up in all the zeal to control the cost of entitlements.

In India, a former hospital COO is arrested for stealing the hospital’s patient data and selling it to other hospitals through a consulting company he started. The hospital got wind of what was happening and installed keylogging software that showed him e-mailing information from his personal account.

E-mail Mr. H.

Time Capsule: US Hospitals Can Learn a Lot From Richard Granger’s Approach

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 June 2006.

U.S. Hospitals Can Learn a Lot From Richard Granger’s Approach
By Mr. HIStalk

The British government’s audit report of its Connecting for Health project, released a few days ago, confirms the obvious. Richard Granger and company have put together a remarkable program for aggressively managing their software vendors.

Granger was tough from the beginning. He threatened, for example, to write his own PACS if high vendor pricing made that an attractive option. Complex contracting was wrapped up in less than a year. Vendors had to prove their ability to deliver through real-life simulations. Most importantly, contracts clearly state that no one gets paid until their stuff is working. All of this, unfortunately, is highly innovative in the back-scratching world of public sector IT.

The Achilles heel of Connecting for Health’s vendors has been the contractor-subcontractor relationship. Big consulting companies won the business, then promptly subbed out to application vendors. That was covered in the contracts, too: the bidder is liable if its subcontractors under-perform, which they largely have. Smart contracting protected the National Health Service against the failings of iSoft and IDX, hitting the consulting companies who chose them squarely in the wallet. That’s how it ought to work.

Granger holds firm and goes public when he has to, unafraid to rip recalcitrant vendors by name. I like to picture him as a Gordon Ramsay-type scrapper, happy to take someone down a notch when they need it.

Providers in the US can learn a lot from the auditor’s report. Vendors throw the ‘partnership’ buzzword around a lot to impress rubes, but it’s usually a marketing term instead of a true risk-sharing contract like Granger demands. Hospitals usually just moan about poor vendors instead of using their intelligently crafted contract to withhold payment or send them packing. The auditors lauded NHS for protecting the taxpayers’ money through smart IT management, and rightly so.

I compare it to road work, which most states do poorly. How many times do you drive by miles of orange barrels with no workers in sight, unless they’re standing around aimlessly, and even then only on weekdays from 8:00 until 4:00 when they’re not on break? Traffic is snarled around the clock for months as grass grows from piles of unmoved dirt amidst infrequent activity consisting mostly of sociable shovel-leaning. That’s how hospital IT projects and vendors sometimes work.

On the other hand, I lived in a state that ran roadwork like a private business. Contractors were given incentives to finish projects early while meeting quality standards, which unsurprisingly, they almost always did. Work could be done only at night, worker inconvenience notwithstanding. The difference to motorists was striking, the state saved money, and incompetent contractors were driven out. The only mystery is why other states aren’t smart enough to copy their success instead of having single-lane rush hour traffic cursing at orange barrels.

I admire Richard Granger. What’s wrong with being tough when so much public expectation and money is at stake? Hospital IT departments may be smaller, but they can learn a lot from Connecting for Health’s experience in managing their vendors and their projects. Of all the blowhards on the health care IT speaking circuit, he’s one of few who I’d look forward to hearing.

HIStalk Interviews Tom Stevenson DO, Chief Medical Officer, Covisint

Tom Stevenson, DO is chief medical officer of Covisint of Detroit, MI and a preceptor in the family medicine residency program of MetroHealth Hospital.

Tell me about yourself and about Covisint.

I’m a family practice doc — 17 years in rural family practice. I’ve been doing IT on the side for most of that time, including the six years now I’ve been in the industry. Lots of boards, president of different associations, that sort of thing.

The things that are interesting about it is that I’m currently using my third EMR. I’m not using our product. I still teach family practice residents one day a week, so I’m using Epic in my base hospital that I’ve been at for a long time. In addition to that, I was chair of the State of Michigan HIT Commission, so that’s how I got exposed in great detail to health information exchange and all that sort of thing.

In terms of Covisint, I wish I could pull out the elevator pitch, but the main thing is that we are a health information exchange vendor. We’re both an SaaS environment but also referred to as PaaS ,or a Platform as a Service Environment. It’s all cloud computing.

We have some of our own products that we put out for functionality for an exchange to come up on, but then we also have a number of partner vendors that we work with that have pre-integrated products that are able to be utilized by our end users as well. It’s called AppCloud. Think of it as the App Store, but with SLAs and other restrictions to them. We need to be able to integrate with them and be able to make it a package, as opposed to independent applications that you would run into with the App Store.

You’re on your third EMR. Do think that’s going to be common? What led you to have three EMRs under your belt?

A part of it was a change in locations and everything as I’ve moved around. I started about 15 years ago and actually became employed. I went from being in a small, rural practice to becoming a part of a larger hospital-employed practice so that we could afford to get an EMR in the first place. We used that one for a number of years. Unfortunately, just like many situations, we bastardized the system and never utilized it like it was supposed to be used.

The second one I was involved in was after I’d left private practice and went into the industry. I went into academic setting as well and used a different EMR in that setting. Then lastly, again I’m teaching residents now and it’s back to my old hospital and we’ve switched vendors with a new one. That’s how I ended up with three different EMRs.

But that was an interesting comment about it — is this something we’re going to be seeing in the future? Yes, I think there are some significant changes that are going to happen in the EHR environment. I think the EMR or the EHR of the past that tried to be all things to all end-users oftentimes ended up being very conflicting and difficult to use and very expensive and difficult to maintain — not always the most nimble and flexible type of system. I think there’s going to be some very significant change in terms of what the EHR of the future is going to hold.

What would you say have been the most positive and the most negative aspects of Meaningful Use so far?

The most positive is driving adoption. I’ve been saying for many years that if the industry really didn’t get their act together – and that included the physicians within the healthcare industry – and start adopting HIT that the government was going to get involved. That may be in a light way, it could be in a heavy way. It turned out to be somewhat in the middle of going towards heavy.

The problem with that is that with government incentives and everything come regulation policy, processes that are not necessarily dictated by what’s best for the environment, but what meets the government’s needs.

The biggest negative of Meaningful Use is that it’s driven it so fast that people are trying to make decisions on the fly. They’re doing it based on what they know, and what we know has been fairly limited. What people do is they resort to what’s been out there and that sort of thing.

I think where there was some innovation that was taking place in EHRs, now they’ve had to put all their energies and development into meeting Meaningful Use guidelines, which for the most part, they’re really not bad. I think what we got down to, finally, in terms of the Core Menu items for Meaningful Use, were really quite relevant. On the other side of the coin, though, is that not everybody was up to speed with them. To become compliant, a lot of energy went into that, as opposed to innovation and moving forward with EHR products.

Do you think that with Meaningful Use and reported data and outcomes that there’s at least an implicit buy-in of the idea that the government thinks it knows how to define optimal patient care?

Well, yes. This is where I’m going to get controversial a little bit. I’m not a huge believer in a lot of the quality initiatives because they’re so focused on a very specific set of diseases that again, it’s one of those things where people put a lot of energy into meeting the quality parameters for specific disease processes — which, don’t get me wrong, are extremely important, there’s no doubt about that — but it’s to the exclusion of the other ones out there.

In fact, in several discussions this week, I’ve already said, that in my view, I want to make sure that we not only become excellent at delivering the quality indicators, analytics, and reporting and tools for the physician to be able to meet those goals, but that we go far beyond that and bring in evidence-based medicine and the proper guidelines to support care across the broad spectrum of disease processes that are out there. Ever since HEDIS has been around, the practices that do well are the ones that meet those goals, and I don’t know if that’s always necessarily the best care for those patients.

It isn’t necessarily obvious that what’s good for Meaningful Use is good for the patient. Do you think Meaningful Use could actually make outcomes worse as physicians chase the goals?

I don’t think it will make it worse. And trust me, I don’t know that I have answer for how to do it better. It’s not necessarily the best physician who could look very, very good on paper because they figured out a way to meet those goals. They’ve got the right tools or they put some policies in place to be able to meet them.

I was part of a committee for our state Blues plan. I was a representative for our state organization.  Meeting with the committee was a physician profiling team. That physician profiling team was taking the data — the kinds of data that they were gathering — and making decisions on whether a doctor was good or bad. Bad doctors where at the tail, the good doctors were in the middle.

I think it’s been very clearly demonstrated that that is not the case, that oftentimes the tails represent practices that are doing something a little bit aberrant from the norm. It’s not bad aberrant, but they just have a different focus in the practice.

The bad doctors, the truly bad ones, are trying to beat the system and everything like that are very good at that. They can make things look normal, while at the same point, they’re not doing things that they should be doing.

Do bad doctors know they’re bad doctors?

No, not necessarily. You can categorize bad in a number of different ways. One is they just don’t practice good care. In other words, they don’t deliver care in a fashion that’s beneficial to their patient. I think for most of those people, they just don’t know.

Medicine is a mentoring approach. Our mentors teach us things and we tend to retain those and that’s what we do from there on out. It takes a lot for us to change those habits that we developed in our post-graduate training. So there’s some of that out there — you just don’t know.

There are plenty of bad docs out there that are trying to beat the system. In my mind, those are the ones that are crooks. Medicine is a microcosm of society. There are good people and bad people in all aspects of society, and medicine is one of those as well. So those bad ones — I think that they probably know that they’re bad and they are beating the system. Those are the people that know how to cover their tracks.

Everybody agrees that Accountable Care Organizations are going to need a lot of technology, especially data reporting. Do you think there’s a way that technology can help independent physician practices avoid giving up control to those groups that have all the technology?

If I have anything to say about it, yes. I was a long-time independent practitioner and I feel very strongly that there are many good aspects to having not all docs affiliated with large organizations. There’s definitely an art to medicine and some of that is lost when all of us have to practice the same way according to rules that are established by parent organizations.

As far as I’m concerned, there are some drivers that in the current ACO model that have pushed a lot of folks to acquire as many physician practices as possible. I hope that is not going to be a continuing trend. That’s fine if it works in your environment and you’re already part of a strong affiliated physician group — doing that physician alignment if it includes employing docs and that sort of thing, then that’s good for your environment.

I think the vast majority of locations, though, are dealing with physician alignment with independent docs who want to stay independent. I certainly know that we are working to be able to facilitate the ability of physicians to maintain their independence while still being able to meet the needs of the ACO.

You mentioned the art of medicine. Do you think anybody really believes in that any more? Everybody wants to do things that they can measure and they want to pay for things that are widgetized. Do you think the art of medicine is something you just have to do on your own time while doing all the other check boxes that someone else says you have to do?

Yes. I think that’s actually a very good way to put it. The thing is that the art of medicine is what really makes the difference out there. If you talk to patients and you do appropriate patient survey, there still is a strong emphasis on having a good relationship with their physician. The patients that tend to be happiest in a practice are ones that do have a good relationship with their docs, who they feel are taking the time to treat them well.

Now that doesn’t mean you can’t work in an environment that really meets the checks and balances of all these regulations that are put out there and still have a relationship. The doc that can do that is a skilled practitioner – that can juggle all those things at the same time. I think we’re going to see more and more as we go along that this very clinical approach to delivering care –this really regimented type of thing to make sure you’re hitting all those checks and balances — are going to continue to put barriers in the doctor-patient relationship. 

In my academic time, one of the classes I taught was doctor-patient relationship. The value of having that ability to have an appropriate relationship with your patient can mean all the difference in terms of bringing the appropriate information that you need as well as the patient feeling confident and comfortable enough to be able to actually divulge what they came in for that particular day. Quite often, what they are really there to see you for has nothing to do with what they called in and scheduled their appointment for.

Covisint’s in the interoperability business. Do you think insurance companies and the bigger healthcare systems are using interoperability to gain competitive advantage?

They certainly would like to. I think that anybody that’s in the business is going to try to leverage the environment to improve their presence and improve their marketability and where they stand. I think that there are certainly several instances of that sort of thing taking place and … I’m going to leave it at that.

When you look down the road five to 10 years, what is most encouraging and discouraging as a practicing physician about the way both technology and the industry is moving?

Some of the negatives first. I think we’re getting back to some of our early discussion. We’re seeing an increasing adoption of HIT. Unfortunately, I think people are buying up things in a reactionary mode. I’m not sure that everyone’s going to be happy with what they get.

It’s going to take a few years before this settles in and so we can re-learn how we interact with patients, how we can leverage the technology to do things I feel are very important, and that is to automate these manual processes, especially the ones that are more regulatory in nature as opposed to actually imparting appropriate clinical care. Some of the fallout of all the things that are going on right now is the slowdown in the ability to improve overall healthcare delivery, including the doctor-patient relationship.

The good side is that as HIT and HIE take place and we actually take some of these new models such as ACOs or whatever ACOs end up being, there will be some potential significant benefits. For the individual patient, the clinical decision support we’re able to provide that doc to help them to recognize gaps in care or better ways to do things has a tremendous opportunity, the catchwords “quality, safety, and efficiency” aspect. As we go along and we’re able to automate these processes and be able to take care of a lot of back-end functions without having to think about them from the physician’s standpoint, we can spend more time concentrating on our patient.

I didn’t go into HIT because of my love for it. I do really enjoy it and I want to do the best that I can with it, but the biggest reason I got involved in HIT was the regulatory impediment to my relationship with the patient became more and more notable after my first years of practice.  The amount of paperwork that was done, the amount of regulation we had to meet, the E&M coding guidelines just became bigger and bigger barriers to my ability to deliver care in the way I felt was appropriate.

The reason I’m in it is that I feel HIT gives us the greatest opportunity to meet those requirements and remove those barriers from the day-to-day basis so I can see my patients, get to know my patients, and deliver the best care possible to them.

News 8/12/11

Top News

Rep. Renee Ellmers (R-NC) asks HHS Secretary Kathleen Sebelius to study the adoption, benefits, and cost effectiveness of healthcare IT, including its impact on medical errors. She’s a nurse and her husband is a physician; she ran for Congress as a critic of government-run healthcare. She chairs the Subcommittee on Health Care and Technology. She was quoted in a March press released as saying this about PPACA waivers:

As a nurse of twenty years, wife of a surgeon and owner of a wound clinic, I am not only aware of the problems that currently exist in the American health care system, I have seen them up close as a caregiver, a patient and a small business owner in the health care industry. Unlike the remedy we were promised, ObamaCare has done nothing to improve the quality of health care in our country, and has already done significant damage to the economy. I join Chairman Graves in asking for a full explanation of the waiver process, to ensure that individuals and small businesses are treated fairly.

Reader Comments

From Data Dump: “Re: [vendor name omitted]. Loses years of patient data at an Epic facility, is technically unable to recover data from the backup.” Unverified, so I’ve omitted the name of the enterprise content management vendor. I’d be interested in hearing from the client, though.

From CagneyInMillerton: “Re: Yale. You are missing a big story on their not rolling out Epic. Big negative money angle and someone going after Harvard CIO position.” I asked CIO Daniel Barchi, who reports that (a) they are two months away from their first practice go-live; (b) they are under budget; and (c) the three hospital go-lives have been moved up, with the first going up in April 2012 and the last in June 2013. They are implementing Epic in three hospitals, the School of Medicine, the 800-physician Yale Medical Group, and several independent community physician practices. Daniel says if the Harvard rumor was about him, it’s not true.

From One of Their Hospitals: “Re: [vendor name omitted]. Based on a phone call our pharmacy received, they are closing their doors Friday.” Unverified. I asked for confirmation from the company, but got no response. This Ohio-based vendor offers medication and supply management systems, mobile carts, and software. I think the source is solid, but I’ll give the vendor a little extra time to respond (or call this weekend to see if the telephone has been disconnected).

From Ronnie James Dio: “Re: Computerworld article on HIT job growth. The author says SimplyHired has 7,200 HIT jobs posted out of 4.9 million. That sounded way too low, so I contacted SimplyHired to find out how they arrived at this number. Their answer: they just searched for the specific term ‘healthcare IT,’ which does not even remotely identify all healthcare IT positions. Downright goofy.”

HIStalk Announcements and Requests

This week on HIStalk Practice: legislation is proposed to allow PAs and NPs to qualify for Meaningful Use funds. Aprima Medical acquires an RCM company. AAFP posts its EHR survey results online. Meaningful Use incentives drive physicians to adopt EHRs. Sage Health employees volunteer at CHCs in honor of National Health Center Week. Integritas President Mary Stroupe explains why even “ineligible” providers should adopt certified EHRs. When you are catching up on your ambulatory HIT news, show some love to our loyal HIStalk Practice sponsors by clicking on their banners and learning what they are all about, Heck, they could be offering some good stuff you didn’t even realize you needed. Thanks for reading.

On the Jobs Page: Director of Public Relations, Project Manager – Healthcare Implementation, Developer I. Healthcare IT Jobs is temporarily offline while some administrative and technical work is completed to move it to a new hosting service, but it will be back soon. 

You know who’s cool? You, for reading – thanks. To take cool to the next level, consider: (a) signing up for e-mail updates; (b) socially attaching yourself to Inga, Dr. Jayne, and me on Facebook and LinkedIn (Dann’s HIStalk Fan Club has 1,751 members, so you might as well join that while you’re at it); and (c) checking out the sponsor offerings by clicking the lovely (and soon to be non-animated) ads to your left or delving deeper in the searchable, categorized Resource Center. We can’t promise to always be the most informative and entertaining site in HIT, but it’s not for lack of trying. 

Acquisitions, Funding, Business, and Stock

An Emdeon shareholder sues Emdeon and Blackstone Group, charging that Blackstone’s $3 billion buyout offer for Emdeon undervalues the company.

Nuance announces Q3 numbers: revenue up 20%, EPS $0.13 vs. –$0.01, or $0.35 vs. $0.30 excluding one-time expenses, beating analyst expectations of $0.34. Healthcare revenue was up 22%.

CSC’s Q1 numbers: revenue up 3.1%, EPS $1.17 vs. $0.91, but the earnings jump was partially due to a one-time tax benefit. The company restated guidance, but both analysts and shareholders reacted negatively. Revenue is projected to be flat even with the contribution of newly acquired iSOFT. In the earnings call, the CEO declined to speculate on the potential future of NHS’s NPfIT, a big customer of CSC and its former subcontractor, iSOFT.

Sales

The VHA awards Apelon a multi-year blanket purchase agreement for its terminology and data interoperability solutions.

The Wisconsin HIN selects ABILITY network to provide electronic messaging services for its connected stakeholders.

Flagler Hospital (FL) chooses Allscripts Sunrise Enterprise, also endorsing the Allscripts PM/EHR for its 130 affiliated physicians.

People

Genomind hires former MEDecision CEO Scott Storrer as COO.

Decision Resources Group names John Ho, MD president of its Decision Resources Consulting.

Health Language Inc (HLI) promotes April Yoder to VP of professional services.

Navigant adds eight senior consulting professionals to its healthcare practice.

Announcements and Implementations

UPMC and Nuance sign a 10-year agreement to develop EMR information capture technologies related to speech and clinical language understanding, as well as natural language-powered data repository searches. UPMC will also standardize on Nuance to provide speech and natural language processing tools for its 20 hospitals, 30 imaging centers, and 400 outpatient sites. Nuance says the co-developed solutions will be generally available by the end of the year.  

Government and Politics

Two years after to agreeing to merge their EMRs, officials from the DoD and VA admit it could take up to six more years to complete the project. VA insiders acknowledge that the process has been complicated by bureaucratic infighting, as each agency is unwilling to give up its legacy health system. The departments have now agreed to slowly upgrade both networks into a new shared system over the coming years.

Kansas Governor Sam Brownback returns a $31.5 million HHS grant, saying he had doubts the federal government would be able to maintain its promised future payments. Kansas was one of six states awarded grants to establish HIEs that other local governments could use as a model; Oklahoma also rejected funds for the project. Critics say the move was politically motivated.

Other

Hospitals tell KLAS they need more comprehensive and integrated systems for pharmacy inventory management. Providers report that the biggest functionality gaps for these systems involve formulary database integration, expiration date tracking, and reporting.

A British physician risks being “struck off the medical register” for bad behavior that includes self-prescribing medications, asking an employee to shred hospital correspondence related to an ongoing investigation, and biting a police officer.

In Australia, a software error causes the deletion of prescription records for more than 140 patients, with the conditions of 14 of them found to have worsened during that time.

Canadian researchers blame poor IV pump design for the 4.5% of medication errors that involve children receiving 10 times the intended drug dosage, often in PICU/NICU. They point out that IV pump keypads have the decimal point, zero, and confirm buttons side by side.

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Mayo Clinic opens a high-tech consumer wellness information storefront in the Mall of America, intending it to be a gateway to its services. Features include wellness evaluations, symptom checkers, “trained health experience navigators,” and unnamed products for sale. Mayo says they have no plans to replicate the project in other malls, but wants to “learn about adapting its services to other settings.”

Another part of Mayo’s mall experiment: an iPhone-powered scavenger hunt.

The team of GAUCHOS, an Open Software electronic charting application developed for volunteer clinicians (homeless shelters, the Operation Smile cleft palate repair organization, etc.) launches a Kickstarter project. They hope to raise $83,800 in crowdsourcing funds to complete the Operation Smile rollout and to develop a tablet version that does not require Internet connectivity. Like all Kickstarter projects (including a couple that I’ve donated money to), swell prizes are offered — $1,000 gets you a launch party invite and Web recognition, but just $15 earns a logo coffee mug.

A Sage Healthcare survey finds that non-EHR using physicians have different expectations than those actually using EHRs. Physicians already using an EHR say they’re happy if it tracks outcomes and reduces errors, while the holdouts say they expect the EHR to increase their revenue.

A computer-on-wheels catches fire at Uniontown Hospital (PA), requiring firefighters to air out the third floor.

Sponsor Updates

• Team GetWellNetwork and CEO Michael O’Neil will compete in the September 11 Nation’s Triathlon in Washington, DC to support the Leukemia and Lymphoma Society. The team’s fundraising page is here. They are participating in memory of Justin Thornton, who died of leukemia this year at 19. He was the son of Lt. Cmdr. Tony Thornton, CIO of National Naval Medical Center.
• Hamilton General Hospital (TX) achieves Stage 1 Meaningful Use using the EHR of Healthcare Management Systems (HMS).
• Elsevier releases a new white paper, “Two Years and Counting,” and updates its eBook, A Guide to Education and Training for ICD-10 Implementation.
• Healthcare Innovative Solutions will exhibit at Siemens Innovations 2011 on August 14-17.
• Orlando Health selects MEDSEEK ‘s 360-Degree Patient Experience to create a single patient interface to multiple EHRs.
• Louisiana Health Information Exchange (LaHIE) chooses Orion Health as its primary technology provider.
• e-MDs announces that physicians of its client, Silver Sage Center for Family Medicine, are the first priority primary care physicians in Nevada to receive Meaningful Use funds.
• Anita Archer, director of regulatory and compliance services at Hayes Management Consulting, provides some thought leadership on how ICD-10 can improve patient care and the importance of EMR documentation. Hayes also published a white paper on vendor selection.
• Staffing and consulting provider H/P Technologies will exhibit at the Epic UGM in September.

EPtalk by Dr. Jayne

As of last month, the American Academy of Family Physicians is no longer offering a paper mail-back card for its Continuing Medical Education quizzes. Participants will need to complete the quiz online. Definitely a step in the right direction as far as encouraging computer literacy at a basic level. Despite what those of us in the IT space might think, there are still quite a few docs out there who haven’t used a computer. Usually when those folks are integrated into our health system, I have the privilege of training them one-on-one. You’d think it would be exasperating, but it’s often very rewarding as you see one of these physicians start to realize the power of computers.

A 26-year old South Carolina man was denied participation in a federal assistance program for breast cancer patients because he’s a man. Approximately 1% of all new breast cancer cases each year involve men. This gentleman doesn’t have health insurance and didn’t qualify for Medicaid. The Breast and Cervical Cancer Prevention and Treatment Act is a federal law designed to help patients in this category;  unfortunately, you have to be female to qualify. South Carolina has tried to cover male patients under this provision in the past but has been denied. The Centers for Medicare and Medicaid Services state they’re working to find a solution.

Speaking of CMS, it recently launched the Hospital Compare website to go along with the Physician Compare website that we’re all so fond of. There is much more information available to look at for hospitals: process of care measures, outcomes measures, etc. Of course, hospitals have been more transparent about this information than individual physicians, so it’s not surprising.

In other South Carolina news, Greenville Hospital System is offering “speed-dating” events to try to match young adults with physicians. Realizing that health reform legislation will increase the number of young adults with insurance coverage (by allowing them to stay on parents’ policies, purchase through exchanges, or enroll in Medicaid) they’re using Facebook and more social events to draw these patients in.

Sometimes I receive e-mails I just can’t believe. Here’s what came from the American Medical Association the other day:

Find out how you can achieve meaningful use without an EHR. Learn about a unique approach to meeting federal meaningful use guidelines at less cost than an electronic health records (EHR)-based approach by viewing a webinar at noon Eastern time Wednesday from Amagine, Inc., a subsidiary of the AMA, and WellCentive. The program will feature a demonstration of WellCentive EHR-M.

Really? The marketing folks behind this blurb should be fired. The product demonstrated has EHR in its name. How does that make it not an EHR? Is it really any cheaper than the cheapest certified system out there?

A quick visit to the WellCentive website looks like it’s just another modular product. And I bet once you get done buying WellCentive EHR, WellCentive PQRS, WellCentive e-Rx, WellCentive Patient Outreach, WellCentive Registry, and WellCentive Connect (you get my point) you might as well have bought a top-shelf complete EHR.

The Department of Veterans Affairs is sponsoring a contest (complete with a $50,000 prize) to use its Blue Button download tool to develop a personal health record and place the technology on 25,000 physician websites. Over 300,000 veterans have used the Blue Button on MyHealth.va.gov to download data in the last year. The goal is to expand this functionality to the 17 million vets receiving care from non-VA providers. The contest runs through October 18 unless someone wins it sooner.

A shout-out to all of you at Community Health Centers since this is National Health Center Week. You are vital to the healthcare of so many people. I’m continually amazed by the ability of some CHCs to deliver high-quality care to a challenging population on a shoestring budget. Keep up the good work, and thank you!

Contacts

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