Monday Morning Update 3/25/13

From Someone: “Re: Allscripts. Looks like they dropped their lawsuit against HHS and Epic. No one has broken the story yet – I’d like to hear more details.” Our Allscripts press contact provided this statement about the legal action, which had earned Allscripts the “Stupidest Vendor Move” in the 2013 HISsies:

Allscripts Healthcare Solutions, Inc., has discontinued its legal action against the New York City Health and Hospitals Corporation regarding the award of the Integrated Clinical Information System contract and looks forward to having the opportunity to work with HHC on other matters in the future. The NYC Health and Hospitals Corporation is pleased that Allscripts has withdrawn the lawsuit.

From McLayoffs: “Re: McKesson. Big layoffs coming 3/28, so big that corporate communications is driving the talking points.” Unverified.

From The PACS Designer: “Re: GSMA Mobile Awards 2013. A mobile app that just won the Judge’s Choice – 2013 Best Overall Mobile App from the GSM Association is Waze. The app helps the commuting effort each day through sharing real-time traffic and road info, saving everyone time and gas money on their daily commute. Also of note is that HIStalk sponsor AT&T won in the category of Smartphone Application Challenge with its app called Application Resource Optimizer (ARO).”

From TickedOffBassets: “Re: Basset EMR icons for suicide risk from Dr. Jayne. As the proud owner of two very happy, albeit sad-looking Basset hounds, I have to stand in protest to associating their images with suicidal risk. When my two wake up from their fifth nap of the day,  they will be planning their official protest before their sixth nap of the day.” Mrs. HIStalk’s brother has a pair of Bassets, which means that when we visit, each of us has 80 pounds of licking, squirming, moaning dog draped across our legs. I wouldn’t say they are particularly fun, but they are affectionate, and neither seems to be a candidate for self destruction given the amount of energy that would be required.

Around 40 percent of poll respondents gained a better perception of Allscripts since Paul Black took over three months ago. New poll to your right: have you ever contacted your primary care provider via e-mail or secure private message?

Welcome to new HIStalk Platinum Sponsor Patientco. The Atlanta-based company’s solutions make it easy for patients to manage and pay their healthcare bills online just like they do for consumer products and services. They access their easy-to-read statements using their personal SecureHealthCode that is printed on every statement and choose from several payment options via PatientWallet – online, telephone, interactive voice response, or mail. They can track all of their healthcare expenses in one place and question the provider about their bill using secure messaging. Providers enjoy submission of bills electronically or on paper, faster payments, iCash credit card processing, daily funds deposit, automated assignment of payment plans to patients who need them, and reduced time required for manual processing. Thanks to Patientco for supporting HIStalk.

Listening: The Letter Black, Flyleaf-style sexy hard rock is actually a Christian band fronted by a husband and wife from Uniontown, PA.

Nathan Lenyszyn joins Billian’s HealthDATA as director of new business development.

Aprima says it has converted nearly 200 former MyWay customers to its EHR in the six months since Allscripts announced that it would not be enhancing MyWay to meet MU and ICD-10 requirements. Aprima CEO Michael Nissenbaum says he expects the company to gain up to 1,500 provider users, nearly half of those who had implemented the Allscripts product.

An ONC brief on healthcare IT in long term post acute care emphasizes partnering with companies that offer ATCB and CCHIT LTPAC-certified EMR solutions. According to CCHIT’s site, there are four of those: HealthMEDX, AOD Software, Optimus EMR, and American Data.

Allscripts shares are up 50 percent vs. a relatively flat Nasdaq in the three months since the company replaced Glen Tullman with Paul Black.

The UK’s largest NHS Trust will deploy Microsoft’s Windows to Go on USB sticks rather than buying laptops for remote employees. Employees plug in the encrypted USB stick to start a secure Windows 8 desktop session from any compatible device. Local data storage is on the stick.

Healthcare payment exchange platform vendor PaySpan relocates its headquarters from Jacksonville, FL to Atlanta, GA.

A nurse supervisor at a New York jail resigns after an investigation of jail employees viewing the hospital electronic medical records of corrections officers and their families. The jail’s system provides access to the systems of Samaritan Hospital in Troy, NY. The nurse’s attorney says she didn’t perform the searches herself, but inadvertently allowed others to do so by taping her password to her desk.

A former medical resident at University of Michigan Hospital is sentenced to at least three years in federal prison for possession of child pornography, discovered when he left his USB drive plugged in to a hospital computer. The hospital didn’t report the incident to police until six months later.

Doctors in Ontario, Canada complain about their move to electronic medical records, citing response time problems and system lockups as 1,000 users who were added to their Nightingale Informatix EMR over the past year overwhelmed the system. 

A British Columbia doctor complains about lack of interoperability among the province’s network that connects the disparate and often outdated systems managed by individual local health authorities. A previous auditor’s review found that implementation of the $252 million system was poorly managed.

The board of Olympic Medical Center (WA) approves spending $850,000 to bring in three dozen traveler nurses to cover staff training on its Epic system, scheduled to go live in both the hospital and clinics on May 4. The hospital budgeted $1.8 million for the conversion to Epic, which is used by its affiliate Swedish Medical Center, and expects to earn $7.6 million in Meaningful Use payments.

Weird News Andy says, “I got your back.” A Canadian man is stabbed five times in a fight and is sewed up in the ED with no X-rays taken. Three years later as he scratches an itchy spot on his back, his finger catches the tip of an embedded three-inch knife blade.

Vince’s HIS-tory installments always hold my rapt attention and this is one of his best – some background you probably didn’t know about the pioneers who started Meditech.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

The Skeptical Convert 3/22/13

Weed’s Problem

After a week’s worth of somewhat manic narratives from HIMSS, recent HIStalk posts have taken a darker turn toward the adverse effects of the computerization of American medical care. Travis Good’s depressing story about his wife spending 2-3 hours a night catching up on data entry fits nicely with Ruth Bowen’s excellent piece on how her personal medical record has been chopped up and pureed by multiple competing and non-cooperating EMRs (this piece was so good, in fact, it really belongs on The New York Times op-ed page). 

I read HIStalk to get some measure of insight into a process that, like it or not, is transforming medical care. But the sense of fragmentation and chaos is demoralizing to many clinicians who do have some sense of — or at least a healthy degree of respect for — high-level degrees organization. And I mean more than just organization of our “workflows”–I mean organization of our thinking itself. We need a big thought leader, someone like Larry Weed.

Yes, those were heady days back in the 70s. Although it’s not true that there was never any serious thought given to the medical record before Weed (I recommend Eugenia Siegler’s excellent piece in Annals of Internal Medicine, unfortunately paywalled, on the stepwise and incremental developments in this area starting in the 19th century.)

Weed brought an evangelist’s zeal to his presentation of a comprehensive vision for using the medical record to transform the process of diagnosis as well as the management of treatment. It’s a shame we don’t have him around any more–he sure would have a lot to say about how things have been going lately. 

What’s that? He is still around? And he has a book out?  Funny, I haven’t seen much about it in the medical journals or the lay press. Reading this site you might get the impression he was long gone.  

But a title like Medicine in Denial seems designed to get some attention. Maybe the fact that the book has no publisher’s imprint and was copyrighted under the Creative Commons explains why we haven’t seen much attention paid.

But it, like its author, is a piece of work. You can call it a polemic, but Jeremiad gets more to of course referencing the angry language in the Book Of Jeremiah — and if that brings to mind Samuel Jackson in “Pulp Fiction” reciting those verses while pointing his Star Model B at you, well, might not be too far off.  

In fact after reading the book, my sense is that Weed would be happy to see a lot of people doing very well in the HIT field selling pencils at the corner. But don’t worry, he’d also be glad to put a lot of overeducated cognitive specialists like me right there with you competing for sidewalk space. 

But is the book any good, and does he really have any answers that work in 2013? It’s going to take more than one of these short-format pieces to get into that. This will take a bit of time, and I have a day and-sometimes-night job, it seems. But stay tuned — more will be forthcoming.  

Robert D. Lafsky, MD is a gastroenterologist and internist in Lansdowne, VA.

Time Capsule: Why IT-Led Change Projects are a Bad Idea: We Aren’t Charming Enough to Convince or Scary Enough to Threaten

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 2008.

Why IT-Led Change Projects are a Bad Idea: We Aren’t Charming Enough to Convince or Scary Enough to Threaten
By Mr. HIStalk

I was e-mailing a colleague the other day and spouted off an off-the-cuff remark that I kind of like in retrospect (that’s not just vanity talking because sometimes I say something really stupid and I realize it right away.) It was this:

“Executives buy IT because they want to crack the whip but aren’t willing to, so they use IT to force conformance without confrontation.”

I’ve been the poor IT guy who became the lightning rod for some executive’s grand plan for change. The IT project was where the rubber met the road, so we became the bearer of bad news for the masses: “You have to change your ways — your boss told me to tell you.”

(Please excuse those arrows sticking out of my back. We IT messengers get a lot of those, so they don’t really bother us all that much.)

For that and other reasons, I don’t even like the idea of calling anything an “IT project” unless it involves user-invisible infrastructure. “Buying IT” really means “demanding change,” so the expected result isn’t a “go-live” — it’s a “be-different.” Only a little of that involves computer stuff.

Anointing IT people as change agents is like enlisting the CFO to redesign care (i.e., asking for trouble). Computer-loving pessimistic perfectionists don’t make good charismatic visionaries who can get people to fall in line behind a radical change like a Pied Piper. Three seconds after the wary masses start complaining and rolling their eyes, we’re commiserating with them and casting conspiratorial glances as we say quietly, “I don’t think it will work either, but that’s what I was told to do.” That’s realistic, but not so inspirational (it’s not surprising that CIOs rarely seek political office).

The IT department doesn’t carry a lot of weight. We’re always overloaded with somebody’s great ideas from last year that still aren’t finished. We zeroes-and-ones types have minimal user credibility (insert obligatory user help desk scorn here). Most importantly, we carry no explicit or implicit authority outside of our own little domain, so we can’t impose our will on mutineers. We aren’t charming enough to convince or scary enough to threaten.

I think of IT as a subspecialty of change, right up there with communications, metrics, and process design. There’s no shame in doing any of those subspecialties well without actually running the show, even when the most visible part of a project is a computer.

This is so obvious that I’m hesitant to risk my shaky reputation by even saying it out loud, but here we go. Projects with user visibility are change projects, not IT projects. Change projects should have real objectives, not just IT objectives. Attaining real objectives requires the leadership of people who have influence and skin in the game, not IT people whose expertise involves the tools. Ergo, IT should always be supporting cast, not limelight-hogging stars.

When it comes to big change projects that happen to involve the computer, the worst idea in the world is letting the IT department run the show. It’s no accident that big projects at Kaiser and Allina were run by project teams that were completely separate from IT and staffed by people with operational expertise and credibility instead of IT managers and technicians. They recognized that their project wasn’t CPOE, it was changing the behavior of clinicians. Not coincidentally, those projects succeeded where IT-led ones elsewhere went down in flames.

Morning Headlines 3/22/13

athenahealth Partners with iTriage to Link Patients with Nearby Providers

athenahealth has partnered with iTriage in an agreement that will refer iTriage users to local doctors that use athenahealth’s EHR.

Mostashari tells Congress: Interoperability is coming

On the third day of Congressional hearings, National Coordinator for Health IT Farzad Mostashari testified before the House Energy and Commerce Committee promising that over the next two years, interoperability and mHealth will take dramatic steps forward.

Healthcare software firm Benefitfocus eyes IPO –sources

Benefitfocus, a software company that empowers employees to manage their benefits, is s working with Goldman Sachs, Deutsche Bank, and Jefferies Group Inc. as it prepares to file an IPO. Sources say the filing could come as soon as next month.

Virginia Hospital Center Names Dr. Russell McWey Chief Information Officer

Arlington-based Virginia Hospital Center announces the promotion of Russell McWey, MD, to CIO. Dr. McWey was previously serving as the chief of medical imaging and was CMIO prior to that.

News 3/22/13

Top News

Athenahealth announces a partnership with mHealth app vendor iTriage to connect the app’s consumer users with providers in athenahealth’s network.

Reader Comments

From HITcontractor: “Re: ProMedica Health. Halts install of McKesson Horizon Emergency care in its facilities, reverts to its previous vendor Picis due to failed adoption and hesitation by providers.” Unverified.  

From Interested: “Re: Northwest Community Hospital in Arlington Heights, IL. Chatter is they’re going up on Epic, although the chatter doesn’t include which consulting firm has been awarded the contract.” Unverified.

From FormerMCKIC: “Re: McKesson. Ending contracts with all non-essential Horizon Clinicals contractors including IC and project managers, CPM. Their contracts will end 3/31/13.” Unverified, but reported by multiple readers.

From Proudly Pink: “Re: Voalte pink pants. What’s with people hatin’ on our pink pants? Here’s our response to the pink pants bashing.”  Dodge Communications awarded Voalte the winners of the Most Unfortunate Booth Attire award in its annual list of the HIMSS exhibit hall’s best and worst. Apparently the Voalte crowd love their pink pants, which employees must earn the right to wear.

From Boutros Ghali: “Re:  HIMMS. It’s just embarrassing.” Indeed it is. This e-mail blast from a healthcare marketing company VP is filled with misspellings, punctuation errors, and odd wording. I can’t imagine recipients rushing to turn their brand identity over to this company. I’ll be charitable in omitting the individual and company names, but I’ll hold on to this e-mail in case they annoy me in the future.

HIStalk Announcements

Some highlights from HIStalk Practice this week include: Practice Wise CEO Julie McGovern offers some thoughts on electronic file management and protecting PHI. CMS says that between five and 10 percent of EPs attesting for MU will be selected for prepayment audits. Hospitals continue to consider practice acquisitions. Physicians with e-prescribing tools are more likely to prescribe less expensive drugs. Thanks for reading!

On the Jobs Page: VP of Sales and Channel Development, Healthcare Technology Project Manager, C-Level Healthcare Technology Sales Executive.

Here are the last of the HIStalkapalooza photos from Medicomp.

Seth Halvorson accepting the HIStalk Lifetime Achievement Award on behalf of his father, George C. Halvorson of Kaiser Permanente.

CIO Unplugged Ed Marx and friends.

Team Orion.

Team Vitera.

Bowling tournament winners.

Jonathan Bush of athenahealth and James Aita of Medicomp.

Medicomp calls this the “Where is Mr. H?” picture.

Medicomp CEO Dave Lareau (in the “I Could be Mr. H” sash) and friends.

Acquisitions, Funding, Business, and Stock

EHR data search technology startup QPID raises $4 million in its initial financing round from investors Matrix Partners, Partners Innovation Fund, Massachusetts General Physicians Organization, and Cardinal Partners.

South Carolina-based Benefitfocus, which offers employee self-service benefits enrollment systems, plans to file an IPO later this year.

Sales

New York-Presbyterian Hospital selects the PatientTouch point-of-care mobile platform from PatientSafe Solutions.

India-based outsourcer Wipro wins a $200 million infrastructure maintenance outsourcing contract from Catholic Health Initiatives.

People

Sara Teppema (Society of Actuaries) joins Valence Health as director of actuarial services.

Virginia Hospital Center appoints Russell McWey, MD, the hospital’s chief of medical imaging, to VP/CIO.

Peter Henderson (PatientKeeper) is named COO of social wellness platform ShapeUp.

Steve Everest (Prognosis HIS) is named CIO of Oklahoma Surgical Hospital (OK).

Announcements and Implementations

Overlake Medical Center (WA) migrates various HIS systems to Epic with integration assistance from Summit Healthcare.

Baptist Health Richmond (KY) says that the Accelero Connect integration platform from Accent on Integration has allowed the hospital to integrate its Philips IntelliVue patient monitors and Meditech HIS, resulting in streamlined clinician workflow and a reduced risk of documentation errors.

Lehigh Valley Health Network (PA) goes live with iMDsoft’s MetaVision in its PICU.

McKesson launches two free mobile apps for the iPad and iPhone. Lytec Mobile is for use with the Lytec 2013 practice management system, while Medisoft Mobile is available for Medisoft V18.

Meditech certifies NetApp FAS storage for its systems.

PatientKeeper adds infusion billing workflow co-developed with Partners HealthCare to its charge capture solution.

Xerox announces a cloud-based Mobile Device Management service.

Government and Politics

Representatives Sam Graves (R-MO) and Adam Schiff (D-CA) reintroduce the Medicare Audit Improvement Act, which would limit the number of document requests during Medicare audits to two percent of a hospital’s claims, with a maximum of 500 per 45 days.

I wouldn’t want his job. National Coordinator Farzad Mostashari, facing Congressional hearings on mHealth, is asked by Congressman Michael Burgess, MD (R-TX), “Hospital systems in the same city that have the same operating system aren’t talking to each other. You’re the head, why don’t you fix that? Why don’t you just make that happen?”

Technology

The US Patent Office issues EarlySense a patent for the respiratory trend analysis component of its patient safety monitoring system.

Other

The cash-strapped city of Pittsburgh files suit against the $10 billion in revenue UPMC, demanding payment of six years of payroll taxes and elimination of UPMC’s tax-exempt status. The mayor says UPMC donates less than 2 percent of its revenue to charity care, pays several executives annual salaries of more than $1 million, and has closed hospitals in poor areas while opening them in more affluent ones, all while avoiding $20 million in annual tax payments that it would otherwise owe the city.

The Institute for Health Technology Transformation outlines strategies for health organizations that are implementing big data solutions, including ways to use data to improve patient care and the types of data that can be analyzed for healthcare purposes.

Improved medical device interoperability could save the healthcare industry $30 billion a year and improve patient care and safety, according to analysis presented to a House subcommittee by West Health Institute.

In the UK, Leeds Hospital halts its $2.5 million speech recognition and digital dictation rollout due to “performance problems” that one official says was “very much affecting patient care and safety and putting patients at risk.”

Also in the UK, two NHS trusts, one of them a Cerner Millennium user, issue a tender worth up to $53 million for a shared inpatient EHR system.

Patient Privacy Rights Founder Deborah Peel, MD calls a new CVS employee policy that charges employees who decline obesity checks $50 per month “incredibly coercive and invasive.” CVS covers the cost of an assessment of height, weight, body fat, blood pressure, and serum glucose and lipid levels, but also reserves the right to send the results to a health management firm even though CVS management won’t have access to the results directly. Peel says a lack of chain of custody requirements means that CVS could review the information and use it to make personnel decisions.

A Russian gynecologist and former City of Moscow chief obstetrician who declares, “I am a doctor first” becomes a billionaire after shares in his Cyprus-based women and children’s healthcare services company rise more than 40 percent in five months. His company, which offers the only alternative to state-run maternity hospitals,  charges $10,000 per delivery, more than the annual salary of the average Russian.

Eye yi yi. A Texas woman uses her fingers to dig the eyeball out of another woman’s eye socket. The two were fighting when one of the women grabbed the other’s eye and “dug her fingers up there.” The victim was taken to the hospital and the eyeball was re-inserted. The gouger, who suffered a couple of broken fingernails, was arrested and charged with aggravated assault.

Sponsor Updates

• Health Catalyst Chairman David Burton, MD discusses how value-based purchasing is driving demand for data warehousing solutions.
• The Institute of Customer Service names Bottomline Technologies the winner of its Customer Service Leadership award. 
• CareTech Solutions donates $550 to The American Red Cross, Habitat for Humanity, and The American Cancer Society as part of its HIMSS booth activity.
• CSI Healthcare IT spotlights Jan Turner, VP of professional services.
• Aprima releases a case study on the practice of Lauranne Harris, MD, which converted from Allscripts MyWay to Aprima in four days.
• Harris VP of Government Health Solutions Don Mestas discusses the federal procurement process and how his company supports the government with its healthcare offerings.
• iSirona names UC Irvine Health (CA) the winner of its 2012 Innovator of the Year Award for leveraging connectivity technology to improve hospital processes and patient care.
• Surgical Information Systems CEO Ed Daihl recaps the HIMSS conference and discusses how intelligent integration can drive financial results.
• Michael Nutter, director of firm culture and associate satisfaction for Impact Advisors, offers advice on how to tell if employees are really happy.

EPtalk by Dr. Jayne

Glassdoor names its highest-rated CEOs, quite a few of them running companies many of us interact with regularly.

The AMA sounds the alert on a “demoralized health care work force” citing a “toxic blend” of forces including verbal abuse, physical assault, and a drive to provide more care in less time with fewer resources.

From Iconic Reader: “Re: icons. Our ED recently deployed visual indicators for suicide risk based on our screening questions. Is it me, or is that a sad-appearing basset hound? It reminds me of something I’ve seen in my kids’ Webkinz account.” Personally I find those icons a little bit disturbing, but I’m sure coming up with an icon that’s politically correct was a challenge.

CMS launches a new eHealth website. Hot topics on the site’s blog include Administrative Simplification, Privacy and Security, and Aligning Quality Measurement at CMS.

Millions of Americans admit to reading or sending texts while driving in percentages higher than those found in European countries. Cell phone use while driving was also significantly higher in the US. As someone who has almost met her maker several times recently due to distracted drivers, I implore you to hang up and drive.

Physicians with e-prescribing systems have a greater awareness of prescription costs, according to a recent survey. This led to drug choices with lower costs or better insurance coverage among the endocrinologists and primary care physicians who participated.

From History Fan: “Re: shoes. I was on spring break in Chicago and saw these shoes on display. Of course, I thought immediately of Jayne and Inga! Be grateful you don’t have bound feet.” I definitely enjoyed the pictures. My personal favorite is the classic red pump.

From Heavyweight: “Re: wheelchairs. With all the attention on high-tech doctor’s offices, it’s remarkable that some are missing some low-tech solutions.” The Boston Globe reports on practices that turned away wheelchair-using patients due to lack of powered exam tables or other strategies to transfer and position patients.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 3/21/13

Transforming Health Care Through Big Data

The Institute for Health Technology Transformation publishes a report outlining strategies for health organizations planning to implement big data solutions. Among the major hurdles organizations will need to overcome are data fragmentation — the warehousing of data in disparate proprietary systems — and data usability issues resulting from key clinical information being captured in an unstructured form.

QPID Inc. Raises More than Original Target of $3 Million in Early Finance Round; Cardinal Partners Investment Pushes Total to $4M

Recently launched health startup QPID raises $4 million in early fund raising, beating its goal of $3 million. QPID launched on St. Valentine’s day with aspirations of delivering an intelligent EHR search feature.

The Value of Medical Device Interoperability

Improved medical device interoperability could result in up to $30 billion in annual healthcare savings, according to a report released by West Health Institute. Joseph Smith, MD, chief medical and science officer, testified before the House Committee on Energy and Commerce about the findings during week-long hearings on innovation in health IT.

On Capitol Hill: FDA urged to clarify oversight of medical apps

Industry leaders from the mobile health market testified before Congress addressing the delayed publication of a final FDA regulatory policy over mobile health apps. The panel resoundingly concurred that the FDA should finalize plans quickly because the uncertainty is stifling innovation and funding.

Readers Write: The Chasm Between the Vision and Reality of Big Data

The Chasm Between the Vision and Reality of Big Data
By Ed Park

I attended the Bloomberg “Big Data” Conference in DC on Thursday, March 14. It was awesome. Folks from big business, big government, and beyond attended. Everyone was talking about the perils and opportunities of data – big data. As one executive creatively stated, “Data is the new oil, and what we want is the gold.”

I was lucky enough to take part in the healthcare panel. In short, my point of view is that healthcare desperately needs to attack and improve its many inefficiencies — much like how Walmart and FedEx have done — before it can successfully leverage big data to drive clinical enhancements. If we can’t get the simple stuff right— ensuring we follow up on lab orders, getting through Meaningful Use, etc. – we have no hope of getting to all of the great things we know are possible.

Athenahealth has brought insight and analysis to the way insurance claims are processed to ensure that the creation of claims and billing in general is streamlined. While this concept might seem simple, it has a powerful trickle effect. If physician practices can get claims and billing in order, they gain valuable time and resources to focus on care.

I tried to talk about the power of data in a tangible way by approaching the conversation from a “first things first” perspective. I tried my best to detail how data can be used to support primary care physicians’ workflow by selectively involving mid-level practitioners and administrators to take on tasks that doctors shouldn’t be doing. This in turn allows doctors to be fully present with patients.

To the dream-filled audience who perhaps thought the time for robot-driven care delivery was near, my goal was to keep it real by saying there is “no greater distance than the chasm between the promise of big data and where we are today.” The applications that healthcare needs to focus on first when it comes to big data are practical things: being more efficient, making administrative process fail-proof, identifying patient populations that are the most sick and most expensive, understanding what’s working and what’s not in the provider workflow, understanding the way patients act (or don’t act) based on a doctor’s order.

With this focus (to be more efficient), in time we’ll be better able to open the doors for healthcare to tackle data-driven clinical intelligence and improvement.

The future of big data in healthcare is bright. There are grand opportunities for patients and the industry at large as vendors, government, and health systems begin to embrace the idea of and build an infrastructure to support broad-based data liquidity. It is from this data openness that patients and providers will be empowered to take control of information to direct the health-related decisions they make.

It was mentioned at the conference that big data is not new, but what is new is “big, fat, messy, distributed data.” The challenge and opportunity is to bring together data to drive change based on evidence, with confidence.

Ed Park is chief operating officer of athenahealth of Watertown, MA.

Readers Write: Improving Patient Outcomes with Real-Time Decision Support and Analytics in the “Connected Home”

Improving Patient Outcomes with Real-Time Decision Support and Analytics in the “Connected Home”
By Fauzia Khan, MD, FCAP

Over the past decade, technology innovations have continually pushed the boundaries in the healthcare industry. Patient information in the hospital and ambulatory settings is now easily accessible through EHR/PHR systems and sophisticated Health Information Exchanges (HIE). With the addition of clinical decision support (CDS) and real-time analytics, clinicians are empowered to develop the best treatment plans for each patient, using intelligent and actionable information to improve care quality while reducing costs.

The mandate to embrace these technology innovations has been driven by federal government regulations, as well as disruption of the fee-for-service model. Although we have just barely embraced this model in the clinical world, what if these technology platforms could also be effectively used in the home setting?

With clinical decision support, patients could take a more active role in their own care. If the last decade was focused on inpatient, outpatient, and ambulatory data integration and interoperability, the next several years should focus on creating the “Connected Home.”

Data at the point of care in the home should be actionable, comprehensive, and increasingly accessible to patients, physicians, and payers. Whether that data is delivered through an HIE, EHR, or a smart device, patient data needs to be accurately captured and widely available, which will allow for the best healthcare decisions to be made. In time, once we move treatment closer to the individual, this will close crucial gaps, provide greater visibility, and accelerate decisions that lead to better outcomes.

All over the world, people want to be involved in their own care while remaining in their homes. Patients can receive attentive care in a comfortable environment, which ultimately improves their quality of life. If successful, home management will result in fewer urgent medical interactions and a reduction in hospital visits. In a recent Wall Street Journal story, the article demonstrated how the hospital-at-home concept is helping to take care of sick patients in the comfort of their homes.

With mobile technologies, ubiquitous Internet, and smart devices, the boundaries between home, hospital, and ambulatory and long-term care facilities will blur. Today, once data is captured through EHR, HIE, PHR etc., the next step is to make that information actionable.

With patient-specific and real-time information accessible at the point of care (the definition of which will also change), physicians could better manage common chronic conditions and patient populations. In addition to clinical decision support (CDS), another necessary layer to develop would be around analytics. CDS would empower clinicians to make more informed, evidence-based decisions, while real-time analytics would allow clinicians to view and analyze at-risk populations from both a preventative and interventional perspective. Analyzing patient populations and outcomes provides vital information for physicians that can significantly impact patients by triggering earlier interventions, reducing avoidable errors, and improving overall health outcomes.

A fully realized “Connected Home” is still in development, but it is certainly within reach. As we strive for more integrated technologies across hospitals and lab systems, we need to also spend our resources on developing a home network that can provide evidence-based data and real-time alerts to providers, patients, physicians, and even network managers. Once this integration takes place, the healthcare industry can focus its attention where it belongs—on better managing patients and populations.

Fauzia Khan, MD, FCAP is chief medical officer and co-founder of Alere Analytics.

Readers Write: Vendors – Welcome to the World of HIPAA

Vendors – Welcome to the World of HIPAA
By Frank Poggio

For the last decade or so, vendors were on the fringes of the HIPAA regulations. Just sign a somewhat innocuous BA agreement and let the provider worry about the details of compliance.

As of January of this year, the Office for Civil Rights (OCR) formally “invited” vendors into the HIPAA labyrinth of rules and regulations. In the new 500-page HIPAA Omnibus Final Rule, Covered Entities (providers) are required to send out new Business Associate agreements to their suppliers and vendors. You should get yours soon, and as an IT supplier, you will see several new requirements.

The biggest one is that system vendors that touch Protected Health Information (PHI) in any way must agree to commit to achieving full compliance with HIPAA rules by September 23, 2013. Touching means  coming in contact with — whether you create, capture, edit, change, store, pass on, reformat, convert, etc. a single piece of PHI even for even one patient. The HIPAA rules do not differentiate between full EHR systems, EHR modules, application type, middleware, report tools, conversion, or archive tools, etc. Basically, if your system touches it, you own it.

As an extreme example, say your software does only parking lot management for a hospital. If you somehow capture any personal ID data, your firm will have to meet HIPAA compliance.

A more realistic example is the typical analytics tool that takes detailed information, aggregates it, and generates only summary, management, or trend reports. Your analytical system (such as grabbing a UB bill file and calculating averages) may never report out or allow access to any specific patient PHI, but since you received the data on a case-by-case basis even though you may have stripped out the PHI before you stored the records, your firm and software must meet HIPAA compliance.

The Final Rule is clear that if you touch PHI, even if you don’t look at it, you must comply. There are no exemptions for encrypted data, servers in locked cabinets, or remote cloud systems.

As a vendor, what must you do to be HIPAA compliant? Your firm must supply documentation of:

1. Policies addressing HIPAA privacy and security issues
2. Privacy and security procedures
3. Workforce HIPAA training
4. HIPAA-compliant workflows
5. Compliance for an audit or data breach investigation
6. HIPAA compliance of any subcontractors you use

Your clients may require an independent audit of the above at your expense as a requirement for you to continue as their vendor. If you do not provide it, their legal counsel may advise them to replace your system with that of a competitor. Remember, the above must be in place before September 23, 2013. Lastly, if you or your provider client has a data breach and OCR finds you lacking in compliance, you could be fined $1.5million per breach.

As I noted in a past HIStalk Readers Write piece, ONC in Stage 2 “exempted” EHR Module vendors from testing on the privacy and security criteria (if the vendor so chose), but they did state that the vendor must still be HIPAA compliant. Which means, implement the ONC privacy and security criteria.

Welcome to the wonderful world of HIPAA.

Frank Poggio is president of The Kelzon Group.

Morning Headlines 3/20/13

Boulder Community Hospital computer system crash frustrates patients

Boulder Community Hospital’s Meditech system has been down since last Tuesday and is not expected to return to a fully operational state until this Friday. No official word on what caused the outage or what is delaying the return to service. All users across the facility are on paper.

Health System Implements new Electronic Medical Records on March 18th

111-bed Beloit Memorial Hospital goes live on Cerner this week.

Lifespan Takes Major Step to Transform Health Care Delivery

Five-hospital system Lifespan, Rhode Island’s largest health care system, selects Epic to bring all of its facilities onto a single system. Implementation will start this spring, conclude in 2015, and cost $90 million.

KLAS Diagnoses EMR Usability Concerns

KLAS releases a report on acute EMR usability, measuring specific Meaningful Use related functions such as CPOE, problem list, and physician documentation. No vendor excelled, but Cerner and Epic fared best.

News 3/20/13

Top News

Cerner acquires Labotix Automation Inc., which offers specimen handling and transport systems for clinical labs.

EHR Incentive Payments are Taxable Income

Physicians should have received an IRS Form 1099 from the Centers for Medicare & Medicaid Services for the incentive payments. The forms had to be postmarked by Jan. 31 and were mailed to  addresses on file with Medicare. If you did not receive your Form 1099, you may request a duplicate copy by calling (888) 734-6433, which will take you through a series of prompts (1-1-1-1-2). You will be asked for your National Provider Identifier.   Physicians in the Medicaid EHR incentive program should have received a Form 1099 from their state Medicaid office.  The Internal Revenue Service issued guidance on the EHR incentive payments that may help in tax preparation, especially if payments were assigned to your group or hospital. 

From Don: “Re: San Diego. Here’s hoping we can bring HIMSS back to San Diego where it belongs! Once the pompous mayor here concedes defeat of his push to renegotiate the hotel room tax, construction can begin. Maybe see you all back in The Gaslamp District in 2016 or 2017. Bring your finest shoe-wear and cut some rug at the grand ball room at The Hotel del Coronado.” San Diego gets the green light for a $520 million expansion of its convention center, which will take about three years. Now it’s up to HIMSS. San Diego, Seattle, and San Francisco are my favorite cities of those I’ve visited because they are on the water, have interesting terrain, enjoy mostly pleasant weather, and are walkable.

HIStalk Announcements and Requests

It’s last call to fill out my quick reader survey. I do it just once a year right after the HIMSS conference. Pretty much every change you’ve seen over my 10 years (hopefully more good than bad) came from survey comments. Inga gets nervous this time of year because after I’ve digested the hundreds of responses, I make our to-do list.

Acquisitions, Funding, Business, and Stock

Sutherland Global Services completes its acquisition of Apollo Health Street, the technology subsidiary of India-based hospital operator Apollo Hospitals Group.

Emdeon reports Q4 revenues of $300.7 million, up six percent from a year ago, and a net loss of $10 million vs. $70 million.

Tenet subsidiary Conifer Health Solutions, which offers revenue cycle solutions, breaks ground on its new headquarters construction in Frisco, TX. The company acquired Dell’s revenue cycle business in November 2012, increasing the annual patient revenue it manages to $21 billion.

Sales

Maricopa Integrated Health System (AZ) selects HP Data Protector and HP StoreOnce for data protection and disaster recovery.

Providence Health & Service will deploy Health Catalyst’s data warehouse and analytic accelerators across its 32-hospital system.

Canopy Partners (NC) chooses the MModal Catalyst for Radiology platform for reporting and analytics.

People

PatientSafe Solutions names Tim Needham (Rubbermaid Health) VP of its western region.

Long-term care provider CenterLight Health System (NY) hires William C. Pelzar (Health Dialog) as its first CIO.

Anita Samarth, Clinovations president and co-founder, is named by the Washington Business Journals as one of the top 25 Minority Business Leaders of 2013.

Announcements and Implementations

Delaware HIN and Kansas HIN validate interoperability by exchange of patient records via Direct messaging using solutions from the Allied HIE Company and ICA’s Direct Messaging and Exchange products.

Beth Israel Deaconess Medical Center (MA) deploys CommVault Simpana for data backup and security.

Beloit Health System (WI) goes live this week on Cerner.

Clinithink releases an online version of CliX, its natural language processing engine.

Lifespan (RI) announces its plans to redesign its delivery model that includes implementing Epic at a cost of $90 million.

AHIMA calls for nominations for its Grace Award that recognizes outstanding achievement in health information management. Evaluation criteria include how organizations contribute to a patient-centered model of care, advance the use of electronic health records, and integrate HIM throughout the workplace.

Government and Politics

ONC launches Web pages to support its goal of having 1,000 critical access and rural hospitals achieve MU by the end of 2014.

Technology

Healthcare IT research funded by AHRQ has helped Partners in Health and the Regenstrief Institute develop an open EMR that supports healthcare initiatives in developing countries.

Seven Tennessee school systems receive $3 million in HRSA grants to implement telemedicine programs so that school nurses can connect with doctors to diagnose student problems, but the Franklin County school board delays its approval to start the program, citing liability concerns.

Other

Boulder Community Hospital (CO) reports that its Meditech system has been down since last week and is not expected to be operational until the end of this week. Officials say the hospital has “detailed plans” for going back to manual operations. The outage has caused delays in scheduling non-critical diagnostic tests and distributing routine test results, but essential services are still being provided. The hospital offered no explanation of the problem. An anonymous physician said the backup response is “not an organized plan,” while a patient told the local newspaper, “If they can’t keep their computer system running, how can we trust them to perform surgery?”

A KLAS report finds that no acute care EMR vendor excels at usability, though Epic and Cerner are best poised to support deep clinical usage. Providers assume the bulk of responsibility for making EMRs usable and 86 percent say that configuring their EMR solution required moderate to extensive effort. Stage 2 MU, with its increased requirements for physician documentation, medication reconciliation, and problem lists, will magnify current EMR challenges.

EMR vendor Lawrence Melrose Medical Record, Inc. notifies the New Hampshire Attorney General’s office of a data breach that has potentially compromised the PHI of two state residents.

A small study of healthcare professionals finds that 75 percent of organizations are 25 percent or less complete with the ICD-10 transition process. Coding education and implementation are the biggest conversion gaps. Almost half the respondents express some concern about being ready in time to meet the October 1, 2014 deadline.

Weird News Andy finds this “more than an inkling.” Electronic sensors printed directly on the skin, aka “electronic tattoos,” can monitor health signs such as temperature and hydration status. One potential medical use would be to stream surgical wound information wirelessly to providers.

Strange: a nurse from India working in an Australian hospital just a month after finishing nursing school is fired and banned from practice after giving a 79-year-old patient the contents of a bottle marked as containing heart pills that actually held liquid detergent the patient had been using to clean his dentures. The nurse, who argued that he followed four of five medication administration rules, was ordered by the nursing board to take an English competency test, which he failed in six attempts.

Sponsor Updates

• Glenn Focht, MD of Boston Children’s Hospital spoke at a private reception during the AMGA conference in Orlando hosted by Ingenious Med.
• An EDCO Health Information Solutions Webinar profiles two McKesson Patient Folder facilities that enhanced their scanning processes using EDCO technology.
• Industrial Alliance Insurance and Financial Services signs an agreement with TELUS Health to allow certain healthcare providers to use TELUS Health’s eClaims Web portal service.
• ThedaCare (WI) selects Wolters Kluwer ProVation MD Cardiology for its catheterization labs at Appleton Medical Center and Theda Clark Medical Center.
• Ping Identity opens registration for its Cloud Identity Summit 2013 July 8-12 in Napa, CA.
• Emdeon releases details on its upcoming Webinars.
• Prognosis offers a four-part series on strategies for MU success.
• Hayes Management Consulting commemorates its 20th anniversary with an updated website.
• Nuesoft hosts a March 27 Webinar on best practices for medical billing.
• Jason Fortin, a senior advisor with Impact Advisors, discusses the need for smaller practices to select an EHR vendor that is capable of achieving Stage 2 MU certification.
• The Tampa Bay Business Journal names MedHOK the winner of its 2013 BizTech Innovation of the Year Award.
• Surgical Information Systems CTO Eric Nilsson offers a primer on how to set up a clinical quality reporting program.  
• Merge Healthcare announces that more than 650 orthopedic surgeons at over 50 practices already have or are in the process of implementing Merge OrthoPACS.
• ChartWise:CDI posts its 2013 conference schedule.
• SiliconMesa partners with DrFirst to provide Rcopia e-prescribing functionality to customers running the SiliconMesa EHR and PM system.
• Craneware announces its support of the Alzheimer’s Association and Alzheimer Scotland as part of its 2013 Craneware Cares corporate responsibility program.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 3/19/13

Cerner Has Acquired Labotix Automation Inc.

Cerner announces the acquisition of Labotix Automation Inc., a lab automation solutions vendor for the clinical labs. Financial details of the deal were not disclosed.

EHR vendor to report HIPAA breach

Lawrence Melrose Medical Electronic Record Inc., in Melrose, Mass. will notify the Office for Civil Rights of a data breach after an employee improperly accessed patients’ electronic medical records.

AHCJ unveils hospitalinspections.org

The Association of Health Care Journalists today launches a website to provide a free, searchable database of federal inspection reports for hospitals around the nation following the digital release of the reports by CMS. The Joint Commission has been petitioned to follow suit, but has so far rejected requests for this information, saying disclosure would compromise its efforts to improve hospital quality.

athenahealth Delivers 96 Percent Meaningful Use Attestation Rate Among Participating Providers

athenahealth announces that 96 percent of the company’s participating providers successfully attested for 2012 Medicare Meaningful Use Stage 1, Year 1, more than double the industry average.

Curbside Consult with Dr. Jayne 3/18/13

I got a laugh yesterday when visiting the Southwest Airlines website. In honor of St. Patrick’s Day, they revamped it with a green color scheme and leprechaun-friendly prose. They’re one of my favorite airlines, not only because they are consistently on time and predictable, but also because of their corporate culture.

Culture has been in the news recently with Yahoo’s recent change in its work-from-home policy and the resulting backlash. In many ways I agree with Yahoo CEO Marissa Mayer that having employees in the office is important. As someone who has worked both in a cube farm and remotely, there are challenges to not being in physical proximity to co-workers. There is a loss of ability to read non-verbal communications and it’s hard to build workplace trust with co-workers you’ve never seen or met. My biggest issue with many people working from home is the risk of multitasking – it’s all too tempting to multitask in ways that you would never do in the office proper. I did really enjoy working remotely, however, and was a lot more productive than I was in the office because I could focus and work on complex problems without interruption. I can see both sides of the argument.

A recent piece on the corporate culture at Google illustrated their efforts to keep employees happy when coming to the office. Themed conference rooms, “design your own desk” offices, and free meals join subsidized massage therapy at the office as perks. (I’m not too sure about the claim of free weekly eyebrow shaping, but to each his or her own.) The idea at Google is to make it a place that people want to come to rather than forcing workers to the office each day. The comments on the Google piece were pretty fun to read as well and several gave me a pretty good chuckle.

Comparing a place like Google to the average healthcare IT workplace is like comparing apples to oranges. Unless you’re at a progressive vendor with a lot of money and a culture of innovation, you’re probably making do with what you have and with few perks. Being in the non-profit hospital space, I can definitely attest to making do with very little. My current office is an abandoned conference room, which was taken out of service because the conference table didn’t really fit and also because the ventilation is sketchy at best. Being in a cube at the time, I snapped it up simply to have a door and a place where I could go to have private conversations about disciplining physicians or to just sit in silence for five minutes to get my head together before a day full of meetings. I had to go to the hospital’s “dead furniture room” to pick out a desk that is decidedly from the Reagan administration.

Our ambulatory division is housed in the former billing office and has very few conference rooms, which makes it difficult to have meetings. Even though we’re sometimes crammed in and bumping elbows, we have a rule that if you’re in the building, you’re expected to attend in person. We have a group of extremely cohesive managers and I can’t help but think that our meeting culture helps keep that team strong.

In contrast, our inpatient division is housed in a brand new building that was designed with functional layout in mind. Although the cubes are short and the floor plan is open, there are scores of meeting rooms (from small two- or three-person huddle spaces to massive training suites) which allow for both privacy and collaboration. Despite this, the office culture still doesn’t encourage workers who are physically in the building to attend meetings in person. Sometimes no rooms are booked for meetings, which leads to annoying conference call behaviors and rampant multitasking, not to mention entirely too many “can you repeat that” type statements. There’s also nothing worse than being on a call with the person in the cube next to you when you hear their voice through the air and then hear it on the phone seconds later due to the conference line delay. People are so busy on instant messenger and doing multiple projects that they can’t focus.

Having worked in a variety of environments, I know that getting people in a room together would be beneficial. Alas, it’s not my division, however, so all I can offer is my suggestions and my support to the leadership should they decide to make people start showing up. If they’re not going to make them come to meetings, they might as well let them work remotely and cut the office overhead.

Regardless of division, our employer no longer provides coffee or any other amenities in the office. We’ve turned into people who hoard spare forks and ketchup packets just in case we forget to bring them from home. There aren’t even cups to offer water to visitors, and don’t get me started on the “Coffee Club” vs. “Keurig On Desk” cliques. We’re not on the hospital campus, so there’s no cafeteria and we’re at least 15 minutes from the nearest restaurant, so brown-bagging is a must. I sent the Google article to a couple of colleagues and the responses were generally of the head-shaking variety.

Whether you’re a vendor or an end-user, how’s your workplace culture? Leave a comment and let us know.

E-mail Dr. Jayne.

Morning Headlines 3/18/13

House Republicans Question FDA on Mobile Medical Software: Taxes

FDA representatives will appear on Capitol Hill this week to answer for a delay in publishing a regulatory policy for mobile health apps. Additionally, House members want to know if the FDA plans to regulate smartphones as medical devices as has recently been speculated since they would be running FDA regulated health apps.

HIMSS13 with Dodge Communications: Our team picks the best and worst in the exhibit hall

Dodge Communications publishes its best and worst of HIMSS13. Voalte takes worst dressed, Cerner takes best in show. Alere, Caradigm, Greenway, Onyx, McKesson, SCI, and InterSystems also get mentions.

Class Calls IRS Rude, Crude and Abusive

A class action lawsuit filed against the IRS accuses agents of unlawfully seizing more than 60 million medical records from a HIPAA-covered entity in southern California following a raid in March 2011. The suit seeks $25,000 per violation. Agents are also accused of unlawfully seizing and searching employee cell phones without regard to privacy rights, ordering pizza and soda, and using the facility’s multimedia system to watch the NCAA tournament.

Making "Meaningful Use" of HHS Data

Social Health Insights publishes a visualization of Meaningful Use attestation data in what it calls its first of many data mash-ups to come.

Monday Morning Update 3/18/13

From E2M: “Re: enterprise to mobile. To make CPOE, portal, or other EHR component mobile, you either build it from scratch or build a new set of apps on top of the existing infrastructure. Capriza allows anyone without any programming skill to transfer an existing Web-based enterprise app to mobile in minutes.” Maybe someone will give it a try and report back. It seems pretty cool – you create what looks like a screen scrape type mobile front end to an existing web app by just dragging and adjusting.

From Spinnaker: “Re: Epic. I heard a rumor at HIMSS that they’ve signed some international deals, two more hospitals in the UK and one in Australia. Heard anything?” I haven’t heard anything recently, but someone can probably confirm. Usually someone attending an Epic class in Verona can verify that the new customers had people there.

From Pointy Ears: “Re: another athenahealth executive headed to CareCloud? Tom Cady, VP of professional services, has left.” Unverified, but reported by a couple of readers.

It’s time for my annual reader survey. I use it to plan the next year of HIStalk, so it would help me a lot if you could answer 10 questions.  

Thanks to the following sponsors, new and renewing, that recently supported HIStalk, HIStalk Practice, and HIStalk Connect. Click a logo for more information.

Fewer than one in five poll respondents think CommonWell was formed with the primary purpose of benefiting patients. New poll to your right: how has your perception of Allscripts changed since Paul Black took over?

Welcome to new HIStalk Platinum sponsor Quantros. The company offers SaaS-based healthcare quality and safety performance improvement systems with over 2,000 healthcare facilities as customers (Kaiser, NYU Langone, Ochsner, Scott & White, Exempla, etc.)Products include SRM safety and risk management (safety events, feedback, disruptive events, claims, MEDMARX ADE date repository, PSO submission); IRIS Executive (enterprise-wide patient safety system); ACE (continuous compliance readiness); and RRM regulatory reporting (Meaningful Use reporting, core measures, CM reporting). Quantros helps providers improve quality and safety by empowering all levels with actionable intelligence to improve outcomes and reduce risk. Thanks to Quantros for supporting HIStalk.

Here’s a new Quantros video featuring CEO Keith Hagen honoring National Patient Safety Week, which ironically was overshadowed by the overlapping HIMSS conference.

Suzanne Bledsoe and Wes Scruggs purchase oncology IT consulting firm Aptium Oncology from AstraZeneca PLC.

Here’s a nice shot of Dr. Gregg playing Quipstar at the Medicomp booth at the HIMSS conference.

Dodge Communications posts its much-awaited snarky review of the HIMSS exhibit hall and surrounding areas (like why so many of you were buying sushi from that sketchy kiosk out in the hall).

I like the Meaningful Use attestation reports created by Wells Fargo Securities. Jamie Stockton, who is in Wells Fargo’s HIT equity research group and creates the report,  e-mailed to say he’ll add any interested provider or vendor to his distribution list if you send him an e-mail.

Speaking of attestation data, Social Health Insights, which did the MappyHealth Twitter health term trend monitoring system,  did a visualization of Medicare hospitals that have attested to Meaningful Use that also includes their HCAHPS scores. Make sure to scroll down since a lot of information about individual hospitals has been mashed up.

A House committee will ask the FDA in hearings this week about any plans it has to regulate  or tax mobile health apps.

Microsoft lists software products supporting Windows 8 that were shown at the HIMSS conference.

Epocrates shareholder Goldman Sachs sells its remaining stake in the company for $32.5 million following its acquisition by athenahealth. Goldman bought $40 million worth of shares in 2007 and sold them for a total of $36.5 million after its plan to create an institutional investor research firm failed.

Weird News Andy has a solution for this problem: move to Australia. A Serbian woman sees images upside down due to a rare brain condition.

Vince’s HIS-tory this week begins the tale of Meditech. He would appreciate your nuggets and ephemera if you lived the company’s history.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Readers Write: Not Safer!

Not Safer!
By Ruth Bowen, MBA, CPHQ, CPHIMS

I’m an HIT professional in Philadelphia who lives in an area that supports multiple competing health networks. I am old enough to have a robust problem history and to have records that span multiple networks.

Having worked in this industry for 30 years, I am definitely a believer in the potential of EMR systems. But frankly, I am less safe.

All of my outpatient providers went from paper to a digital record. There wasn’t an opportunity for a conversion. Each of these practice systems took a different approach in terms of what data would initially populate the EMR. There are no standards here, only guidelines. There can be significant expense in terms of abstracting data from a paper record. Much of the data available in my paper records has just disappeared.

In one case, the paper record was simply scanned. I arrived for a visit with no problem list and no medication history and was treated as a new patient. The practice was dependent on my memory of events over 10+ years. In other cases, there was a subset of data, but in each case, most of the history was unavailable. The paper chart may have been scanned, but physicians do not page through images of paper record, so I consider the information unusable.

None of these EMR implementations has an interface from the laboratory system I use. In most cases, a subset of available laboratory results is transcribed into the electronic record. Although the physician also has a copy of the current paper lab results at the time of visit, the history of results in the EMR is incomplete and likely has transcription errors.

One of my physicians used to manually maintain a paper flowsheet for a subset of results significant to his specialty. That history is gone. His system doesn’t support the view he formerly had and there is no historical data that could populate a flowsheet or graph even if the capability was available.

The result is an increased personal safety risk related to multiple EMRs that are incomplete, each with a different subset of data. As it turns out, my responsibility in terms of patient engagement is record reconciliation at the time of visit, a reconciliation that is totally dependent on my memory. Not, I think, what ONC intended.

Ruth Bowen, MBA, CPHQ, CPHIMS is an independent HIT professional in Chesterbrook, PA.

Time Capsule: Conduct a Survey, Game the Results: If the Results are Important, Somebody’s Cheating

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 2008.

Conduct a Survey, Game the Results: If the Results are Important, Somebody’s Cheating
By Mr. HIStalk

My doctor is part of a big medical center’s group practice. I noticed a big poster on the wall last week. It explains to patients in great detail how to fill out a patient satisfaction survey. It is helpful, especially if you want to give the office a perfect score (that’s the only option shown).

It’s about as heavy-handed as those car dealers whose signs urge, “See the manager if we didn’t earn all fives on your satisfaction survey.” Sometimes they even offer a free oil change if you agree to give them a perfect score. Strange: it’s their own survey, but they’re still encouraging customers to lie about being satisfied. Why bother to conduct a survey if you’re going to tamper with the results, especially if you’re only fooling yourself?

Places I’ve worked did employee satisfaction or communication surveys. Sounds great in the HR office, but in the trenches, executives were begging and threatening to get good marks.

All that led me to think about seemingly objective healthcare IT information sources that really aren’t. If the results are important, you can bet someone is cheating.

I went on a site visit for clinical systems awhile back. I knew the hospital was threatening to kick the vendor out and sue them, but everybody seemed manically happy. For good reason, it turned out: at least one of them was a vendor’s employee wearing a hospital badge. I also accidentally discovered that the hospital CEO had sent a threatening letter to the key contact, warning him not to say anything negative that would make the vendor mad (I saw it on his desk).

I’ve stopped reading free industry magazines. My IT world is a lot uglier, less conclusive, and more frustrating than the one they claim to live in. The stories are about as hard-hitting as a vendor’s press release. If you can’t find even one negative in a case study article, you’re reading propaganda.

I believe KLAS rankings in general, but I’ve heard that vendors work hard to get their best customers interviewed.

I’ve known some Most Wired survey respondents who either exaggerated or lied outright, depending on how charitable you might be at the moment. Looks good on the resume, you know, and the CEO will finally notice the IT department.

Most recently, I was excited that some healthcare-related organizations made Computerworld’s list of best places to work. Alas, employees from one of them e-mailed me to say that their employer had strong-armed employees to turn in happy surveys (think of the irony: those in the trenches were threatened to act happy or else).

My conclusion is this: caveat emptor. Nobody has an incentive to warn prospects about questionable vendors, products, or employers. Folks who wouldn’t lie to friends might exaggerate to strangers.

There’s an informal collusion among vendors, trade magazines, and member organizations to keep prospects buying by putting on a phony happy face. That’s their job. Yours is to seek the truth. And if the publisher of this newsletter sends you a reader survey, I’ll give you a free oil change if you say I’m the best thing about it.