Monday Morning Update 12/19/11

From EpicNews: “Re: HCA. Any rumors about HCA signing with Epic?” I’ve mentioned here several times that HCA is putting up an Epic pilot as they choose between that option and upgrading Meditech. I haven’t heard anything more than that, although a couple of less well-placed rumors seem to think Epic is the likely choice (I’m guessing that’s due to Epic’s track record rather than any real insider knowledge.)

From CIO Lookin’: “Re: company that has a contracts database. One of your sponsors offers a database of vendor contracts with full details about pricing and terms. I don’t remember the company’s name. Can you help?” It’s CapSite. Very useful. It’s cool looking at the actual scan of the contracts but also having all the numbers broken out into a worksheet for easier review.

Aetna reveals at an investor conference Thursday that it acquired mobile app developer Healthagen “about a month and a half ago.” Aetna says it will add cost estimation functions for patients to its iTriage app. Aetna’s chairman, president, and CEO also told investors that the company will make the software development kit for the Medicity iNexx platform available free so that anyone can write apps for it.

Micky Tripathi’s breach article on HIStalk Practice has raised the interest of The New York Times, which will apparently be running a story about his experience in Monday’s business section.

My Time Capsule editorial from 2006 for this week: Embrace FDA Oversight If You Want Clinical — not Clerical — Systems.  A snippet:

It’s like Lucy working on that candy assembly line – reams of often irrelevant information are unceremoniously dumped faster and faster into the laps of physicians and nurses, who are expected to manually figure out what’s useful and then “process” it, often by entering even more on-screen information. Eventually, the administrivia buries someone who ought to be making patient care decisions instead of romancing a keyboard.

TPD has updated his list of iPhone apps.

A reminder for McKesson folks whose jobs will be eliminated in February: check the comments left on the past few posts since I invited companies who might have jobs for you to leave their contact information.

Another newspaper picks up on Newt Gingrich’s dichotomy on stimulus money, which he called a “pork-laden bill” that should be stopped even as he cheered the $19 billion it contained to pay providers to use EHRs sold by clients of his consulting firm, Center for Health Transformation. It mentions his participation in 2009’s EHR Stimulus Tour, where his company helped its clients Microsoft and Allscripts encourage providers to use federal incentives to buy their products. Gingrich also pressed his former House colleagues to block efforts to dismantle Stage Children’s Health Insurance Program while being paid by drug companies and insurers that would have lost profits, as well as urging them to support the expansion of Medicare’s prescription drug benefit, which benefited his center’s $200K per year founding member, drug maker Novo Nordisk. Novo listed their payment as a lobbying expense, although Gingrich says that’s not the case.

In related news, the former CEO and VP of the Center for Health Transformation and Gingrich Group join Leavitt Partners to create Health Intelligence Partners, a membership organization that will offer advice to healthcare executives. The founder and chairman of Leavitt Partners is Mike Leavitt, former HHS secretary and Utah governor. The president and CEO is his former HHS chief of staff and the managing director is Leavitt’s former HHS senior executive advisor.

Some readers are getting their HIStalk e-mail blasts long after I’ve sent them out. It’s a worsening problem, primarily affecting users of free e-mail services (Hotmail, Google, Yahoo) since those are apparently ramping up their inspection of incoming e-mails for spam. Those services are also slowing down my sending speed since my server has to wait on theirs and they have throttled back their connection rates. My web host has taken a couple of steps to hopefully reduce the scrutiny and therefore increase the delivery speed, but it’s somewhat out of my hands.

Here’s my latest pet peeve (I know you were anxiously awaiting it): publications that refer to doctorate holders as “Dr. John Smith.” It’s perfectly legitimate (but damned obnoxious) to introduce yourself socially as Dr. John Smith, but that form should not be used in a publication of any kind since it provides no clue to exactly what kind of doctorate is held (MD, non-research based EdD, mail order fake PhD, etc.) Honorary doctorate holders should never be addressed either as (a) Doctor, or (b) listing their unearned PhD. If you see a professional advertising their white-coated services as Dr. John Smith instead of stating their actual degree (it’s usually chiropractors who do that) or using bookended vanity titles on both ends of their names (such as Dr. John Smith, MD) run fast and far since at least in my experience, these folks are often seriously incompetent, insecure, ill-informed, or all of the above.

Welcome to new HIStalk Gold Sponsor Macadamian, a global firm headquartered in Quebec that provides user interface design and software innovation services for clients that include HP, Cisco, and Adobe. They help product management executives turn ideas into market-ready products, including working with mobile apps. The company offers design services, usability consulting and testing, and user services (focus groups, task analysis, and field research). Healthcare IT vendors they’ve worked with include Sage (updated Intergy’s encounter note function), Cardinal Health (designed a touch-screen interface for a bedside patient information system), and Elsevier (developed a fresh user interface for the online Mosby’s Nursing Consult). The company offers a one-day EHR Usability Workshop to help vendors understand the implications of NIST’s usability draft and to develop a usability plan. Thanks to Macadamian for supporting HIStalk.

I’m getting an increasing number of requests from companies and organizations that want to get me involved in their projects in some way (conferences, education, contests, etc.) I almost always turn those down, and just to save future time all around, here are my standards, which I don’t think I’ve explicitly stated until now:

1. I have almost no time between work and HIStalk and I have no employees, so I will always turn down anything that would require much of my time.
2. I won’t do anything to compromise my ethics (endorse products, further a hidden agenda, or write anything that I don’t believe.)
3. The only item I offer is sponsorships. I don’t rent my e-mail list, run paid article placements, or shill my services for speaking or consulting (easy since I don’t do those things anyway).
4. I don’t entrust HIStalk’s reputation to anyone else, so I don’t get involved with activities unless I’m offered control over them (HIStalkpalooza being a good example.)
5. I’m not very motivated by money, so it’s easier to raise my interest for projects that will benefit HIStalk’s readers or that involve undeniably good deeds, education, industry enlightenment, or something offbeat and fun.

Only 22% of respondents reacted positively to Mckesson’s Better Health 2020 product realignment plan. New poll to your right: it’s the same as this one, only regarding Microsoft and GE forming a new HIT company.

Here are some products from HIStalk sponsors that topped out their respective category in the Best in KLAS report that just came out:

• 3M Codefinder (medical records coding)
• 3M APCfinder (medical records other)
• Allscripts Sunrise EPSi Decision Support (decision support – business)
• API Healthcare Time and Attendance (time and attendance)
• CareTech Solutions (IT outsourcing – extensive)
• Cerner CoPathPlus (anatomic pathology)
• Cerner Millennium PharmNet (pharmacy – community)
• Cerner (application hosting CIS/ERP/HIS)
• Clairvia (staff/nurse scheduling)
• Cumberland Consulting Group (planning and assessment)
• eClinicalWorks Electronic Health eXchange (private HIE)
• GE Healthcare Centricity Perioperative Anesthesia (anesthesia)
• GetWellNetwork PatientLife System (interactive patient system)
• Greenway Medical PrimeSuite Practice (practice management 1-10 physicians)
• Greenway Medical PrimeSuite Practice (practice management 11-75 physicians)
• Hayes Management Consulting (staff augmentation)
• Iatric Systems MobiLab (specimen collection barcoding)
• Impact Advisors (clinical implementation principal)
• iSirona DeviceConX (medical device integration system)
• McKesson Paragon (community HIS)
• McKesson Paragon Clinicals (acute care EMR – community)
• McKesson Paragon Financials (patient accounting and patient management – community)
• MedAptus Professional Intelligent Charge Capture (mobile data systems)
• MedAssets Contract Manager (revenue cycle – contract management)
• MedPlus ChartMaxx (document management and imaging)
• Merge Healthcare Hemo (cardiology hemodynamics)
• Nuance eScription (speech recognition)
• Nuance EXText (dictation and transcription)
• Orchestrate Healthcare (technical services)
• Passport BatchSource (patient access – eligibility checking)
• RelayHealth ePREMIS (revenue cycle – claims management)
• TeleTracking Capacity Management Suite (patient flow)
• Wolters Kluwer ProVatation MD (clinical procedure documentation)
• ZirMed (claims and clearinghouse services)

Ignis Systems releases EMR-Link ResultsAnywhere, which works with the company’s lab outreach solution to create patient-friendly lab results. It meets the new guidelines under which patients can access their own lab reports. Video here.

Weird News Andy says he has a nose for news with this article: Louisiana’s state health department warns consumers about the use of neti pots, a pitcher-like container (aka “nose bidet”) used to flush the sinuses with salty water to relieve nasal congestion. Two people have died from amoeba infection of the brain after apparently using tap water instead of the manufacturer-recommended distilled water. WNA also finds this Grinch-like story: a UK hospital cancels more than 80 surgeries, some of them involving cancer patients who had waited for months to get on the schedule, after the broad daylight theft of the copper cabling from the hospital’s backup electrical generator.

An interesting item came up at athenahealth’s stock analyst day this past Thursday. The company is trying to turn its athenaCoordinator product (from its acquisition of Proxsys in July 2011)  into a private HIE so that practices in a given geographic area can manage referrals through it, something that was hinted at in this request from an unnamed (but easily identified) vendor for an HHS ruling that was rendered on December 7. Athena would charge fees for use of its network, with a somewhat complex set of rules deciding which practice (referring or receiving) gets the bill. Athenahealth would reduce the monthly subscription cost of athenaClinicals, using the new referral transaction fees to offset its reduced revenue.

Meanwhile, it was a wild ride for ATHN shares this week, with guidance below expectations sending shares down 15%, but conflicting investment opinion pushing it partly back up (Leerink Swann and Oppenheimer upgraded, Piper Jaffray cut its price target, Morgan Stanley stuck with its Underweight rating.)  

Rep. Tom Price (R-GA), an orthopedic surgeon, says paper medical records are insane and practices should be using technology to communicate and to give patients access to their own records. He’s not a fan of HITECH, though:

Instead, what does the federal government do and think it’s getting high tech? It is defining every little thing, every box that the physician or nurse has to check every time you see a patient, in order to get an extra 1.5% of reimbursement from the government. Or, not getting dinged for an extra 1.5 or 2%. These are the Meaningful Use things.  Washington always has these great lines, right, these wonderful Meaningful Use standards. They’re neither meaningful nor useful and they’re so ridiculous that they actually incentivize pathologists to have to ask on every single patient that they care for how old they are, how many allergies they have, what medications they’re on, when was the last time they saw their primary care physician, on and on and on, including of a slide of a patient … the pathologist never actually sees that patient … or a corpse for an autopsy. This is no lie. The federal government wants the pathologist to determine whether or not a corpse has any allergies. How you feeling today, right? This is nonsense.

So what do you do with technology to make it so it actually works for healthcare? I think the proper role of government in the area of technology in healthcare is to say, OK, this is the platform we will use. This is the highway upon which we will ride. Everybody needs to have a system that allows it to speak to another system within these parameters. And not dictate what the docs are doing on a day-to-day basis for a given patient, because it doesn’t make any sense. It’s a waste of time. They can never, ever put in place the right standards for a bureaucrat to determine whether or not the doctor’s doing the right thing.

An MSNBC article says aides of former Massachusetts Governor Mitt Romney arranged to buy the hard drives of their office computers for $65 as his term ended, thus eliminating the only record of official e-mails and details about his health insurance mandate since they had also had the servers replaced. Romney says the hard drives might have contained personal information, such as medical records and job applications, but reporters noted that government officials could use that excuse to keep every paper record from the public eye by just writing their Social Security number on the bottom of every page.

Here’s the latest HIS-tory from Vince, which contains the answer to this trivia question: what hospital programmer started a one-person consulting practice that eventually grew into a company of over 1,400 employees?

Zach Mortensen of CareFusion picks up on Barry’s comment on HIStalk about a possible change in Epic’s sales strategy, speculating that Epic may be willing to sign ambulatory-only contracts because they’ve hit capacity, run out of new customers, or fear low-cost ambulatory competitors. I’m not convinced Epic is changing strategy at all just because a couple of unnamed consultants speculated as such (Epic has always sold ambulatory-only deals), but if they are, I’d infer the opposite. Epic has not hit the predicted wall on scalability, customers keep giving its products industry-leading KLAS scores, nobody is de-installing or grumbling about value, and prospects keep signing up in droves despite high project costs. Each time Epic sells an ambulatory-only deal, it (a) deprives a competitor of a new sale, and (b) plants a flag that has a decent percentage chance of yielding an easy inpatient sale down the road. If anything, I suspect Epic is gaining confidence given the near absence of significant competition and is willing to ramp up sales, which by definition means they will be selling to smaller hospitals and practices. The company’s favorite statistics involve not the number of hospital customers it has, but rather the percentage of physicians and patients using its systems. I think they want that number to keep rising for reasons beyond financial, and any change in strategy can be attributed to unchallenged dominance rather than newfound desperation.

Analysts speculate that Research in Motion (BlackBerry) may be on its last legs, with bad earnings, grim forecasts, delayed new products, and a continue share price slide (down 77% year to date).

Allina Hospitals & Clinics is involved in an unusual but minor patient privacy breach. It sends an e-mail blast to 250,000 patients promoting Epic’s MyChart, but eight of those e-mails bounce back as undeliverable. Its mail software then tries to re-send the message to those eight recipients, but mistakenly blasts it back out to the 250,000 original recipients, only this time including the name, employer, and e-mail address of the eight patients (whited out above).

A California patient opens up her medical records to an investigative reporting agency to show how medical upcoding happened at Shasta Regional Medical Center (CA), which claimed that almost 20% of its patients suffered from the mostly third-world nutritional disease kwashiorkor. A DRG coding firm analyzed the records, which mentioned nothing about nutritional issues, and found that the correct payment was $4,708. Adding the kwashiorkor diagnosis raised the payment for the same stay to $11,463. Irrelevant but interesting: the patient’s daughter reviewed her mother’s bill and noticed charges that included $273 for a cloth sling and $22 for a 4×4 gauze.

Texas Health Resources is holding a Nursing Informatics Boot Camp April 28-29 in Arlington, TX to prepare nurses to take the ANCC certification exam.

The Alaska State Medical Association is providing DocBookMD to all physicians in the state to allow them to share information, including referrals, using mobile devices.

A jazz singer unhappy with her new nose job creates a Web site criticizing the work and credentials of her plastic surgeon, files complaints with the state medical board, and posts negative reviews on several Web sites. The doctor says his practice went from $4.5 million to two patients a week. He files a defamation lawsuit against the patient and is awarded $12 million. That’s a lot of jazz.

Every year about this time (when we remember it, anyway) we like to get in the Christmas spirit by asking our sponsors what holiday and charitable activities they’re involved with, preferably with photos since the usual half-hearted hospital door decorating contest just doesn’t stir up much Christmas spirit.  Here are a few.

DIVURGENT sponsored a Winter Wonderland event at Children’s Medical Center at Legacy (TX) last week for children hospitalized there. Every child got a teddy bear, shown being delivered above.

Hayes Management Consulting donated $1,000 worth of toys to Toys for Tots and sent an equal amount of money to the Susan G. Komen Foundation.

Surgical Information Systems held its Coins for Kids fundraiser contest, where each of its departments decorated a piggy bank to collect money (the above entry from sales and marketing was branded as Miss Barbie-Q). It has raised $6,000 so far for The Giving Tree, EduNations, and the Westlake Estate Home for Girls. Employees also donated time and supplies to stuff 50 stockings for the troops and collecting DVDs for Children’s Hospital of Atlanta. Employees also held coat and winter weather drives and continued their support for Cool Girls, Inc.

maxIT sponsored the Beads of Courage Beads in Space Tour to honor Childhood Cancer Awareness Month. It’s a non-profit that works with children experiencing serious illnesses to use beads to tell the story of challenges they have overcome during their treatment, such as spending a night in the hospital or undergoing chemotherapy treatments. The organization took its program on the road, stopping at 10 hospitals to show a display of beads that few on the space shuttle, with one design from each being incorporated into a real bead and the top ten to be featured in a book.

Software Testing Solutions donated $10,000 to Heifer International, a non-profit that focuses on long-term sustainability and self-reliance by purchasing llamas, sheep, goats, chickens, and honeybees and providing agricultural education for poverty-stricken communities around the world.

The business development team of World Wide Technology volunteered at Kingdom House, a neighborhood community center in downtown St. Louis, where they repaired tables and chairs, cleaned the food pantry, and reorganized the thrift store.

Aspen Advisors held a fun walk/run at its annual all-associate retreat in Fort Lauderdale, FL and raised $1,500 for Broward Health.

Quality IT Partners supported Habitat for Humanity, the American Heart Association, Special Olympics, the Scott Hamilton CARES Initiative, the American Cancer Society, the American Association for the Study of Liver Diseases, and local schools and food banks.

Sunquest held its annual fundraising barbeque this month, this time supporting Tucson-based Aviva Children’s Services, which provides support services to children under the care of Child Protective Services after experiencing abuse, neglect, or poverty. Employees received lunch in return for their donations of toys, gift cards, and money, raising $3,500 for Aviva’s Christmas giving program.

Cynergis Tek supported OPERATION Hug-A-Hero and its Holiday Hugs program. It provides children with dolls that contain an image of their deployed service member parent or other relative, providing a tangible, comforting connection with their loved one.

E-mail Mr. H.

HIStalk Interviews Dave Lareau, COO, Medicomp Systems

David Lareau is chief operating officer of Medicomp Systems of Chantilly, VA.

Tell me about yourself and the company.

I was in Baltimore in the late 1980s and had my own practice management reselling company. One of my customers in 1990 came to me and said, “Dave, we’re real happy with your services, your billing system — we want to start looking at EMRs.” I said, “What’s that?” He said, “We think they’re going to be the thing of the future. Would you help us look at them?” 

We set up a process where once a month they would come into my office and I’d bring in a vendor. After a few months, they said, “Nope. All this makes us data entry clerks. It’s all template-based. We hate it, can’t use it. Thanks. Here’s what we need you to find.”

A couple of years later, maybe ’92, I happened to see Peter Goltra and his team at Medicomp and I was intrigued. I thought, “This sounds like what those guys were talking about. Let’s bring them in.” They looked at it and said, “That’s exactly the way this stuff needs to work, but it’s just ugly as hell.” It was a Unix-based system, the old green screens and stuff dropping down. They said, “If you put a decent user interface on that and integrate it with a billing system, that would really be something.”

I talked Peter into letting my little company do that. I eventually came home to my wife one day and said, “Honey, I just found what I want to do with the rest of life. Can we move to Virginia? I really want to work with this company. I love what they’re doing. I think it’s the thing of the future.” I figured at that point, yeah, 10 years from now everybody will have an EMR. You know how it was in 1992. 

I joined Medicomp. I found that they provide clinical content for documentation and patient care that thinks and works the way a physician does. It’s just simply that. We’ve been doing that ever since, with changes along the way in response to the markets, technology, etc.

You said you had to find Medicomp. I always got the feeling that both the company and Peter Goltra aren’t as widely recognized as they ought to be. Is that low-key approach intentional?

The low-key approach is somewhat intentional. We provide a really critical component to about 10 to 12 different vendors in the space. That’s growing all the time.

We leave it them to do a couple of things. Differentiate themselves from each other. And, we want to make it clear to the marketplace that if you want an EMR that uses our content, you need to go to our customers, not to us. 

We’re very low-key at industry events. We really only concentrate on going to industry events like HIMSS and MGMA, where we’re there primarily to support our customers, who are EMR vendors, and educate their potential customers about the benefits of an EMR that uses MEDCIN.

The other way we stay in the background is when a new vendor decides to license our technology and put it into their product, we leave it to them to time the announcement to let their installed base know. As you know, once somebody announces a change in direction, even if it’s a good thing – which we think implementing our MEDCIN engine and Quippe is — it still tends to freeze what is then perceived as a legacy product, and these people need to maintain that revenue stream.

For readers who don’t know, describe the MEDCIN engine and how it’s used.

MEDCIN at its core is a clinical knowledge base that has about 280,000 clinical concepts in it. For the most part, they are pre-coordinated. The purpose of the engine is to present the relevant information to the physician at the point of care given a specific clinical scenario. 

For example, there are 293 concepts in MEDCIN whose relevance is scored for a patient with asthma. In that case, adding more concepts to MEDCIN doesn’t do anybody good. We can focus on the relevant items given almost any clinical situation, which is what makes it valuable for a providers treating a specific patient for a specific problem or a set of problems at a specific point in time.

What’s nice is is that it thinks and works like a clinician, and then all those concepts are mapped to ICD-9, ICD-10, SNOMED, CPT, LOINC, RxNorm, and all the 44 Meaningful Use criteria. All the nonsense — from the doc’s point of view — is taken care of in the background. The engine presents to the physician the things that they would care about for a patient with that condition.

We came up with that in 33 years of working with physicians saying, “OK, here’s the presentation. What would you want to be in your note? What will you want to look at? What kind of lab results would you want? What are potential orders? What would you do for the review of systems? What history? What physical?” It presents the things that real docs who are treating patients every day tell us they would want. We’re not trying to tell them what to do – we’re presenting to them what they said they would do.

Describe where your content comes from.

We have at any point about 20 to 30 active clinical consultants. We tried in the mid-80s having medical MDs on staff and nurses on staff to do that, but we found that when we brought guest experts in — consultants to help us build the data engine — all they did was argue with each other over, “You were trained here, you were trained there. I wouldn’t do it that way, I wouldn’t do it that way.”

We ended up saying, OK, we’re going to be clinical knowledge management engineers. Let’s engineer an editing system, where we can bring these people in and we have editing facilities. Now with the Web, you don’t have to do it locally, but when we did, we had an editing facility in Martha’s Vineyard, we had one in New York, whatever’s convenient. We’d typically bring somebody in for two or three days at a time. Some of these guys come in regularly, some come in every six months, some once a year for a week or so.

We sit with them and say, you’re seeing a patient with asthma. What would you normally expect to have to think about or address? They’ll say wheezing, difficulty breathing, is the wheezing episodic. What do I see in the lungs? Auscultation. Family history. Do they have exposure to dust mites? What’s the spirometry? What’s the O2 sat? Do they have any other conditions, maybe nasal polyps?

We say, is they’re anything else that might help you differentiate asthma from something else that we should put in the asthma – we call them indices – in the asthma index that you’d need for rule-out? So there’s things in there that have both a positive and a negative correlation. 

We put those in, and then we’ll go back and say, now for each one of those things, wheezing … somebody comes in wheezing, it doesn’t mean they have asthma. Means they might, but what else might it be? Let’s built out the index for those things.

You do this in an iterative process over years. We’ve ended up with about 293 items in the asthma index, one of which is wheezing, which has 260-some links of its own to diagnoses other than asthma. You can attack it from either point. This is iterative. Then we’ll have pulmonologist come in and say, we just did this recent work with somebody who was a specialist in asthma. How does this intersect with other things that you see? Does it raise the risk factors for pneumonias? 

It’s iterative. It’s one of the reasons why it’s so hard to replicate this with a template system, because we’ve been at it so long. Everybody says you can’t take nine women and have a baby in a month. That’s sort of what we’re dealing with here.

Does the MEDCIN engine have competition other than templates and text-based literature look-ups?

In terms of what we do and the way we do it, no. But in terms of competition, there’s tremendous competition all throughout the marketplace for our approach and any other approach. We define competition as anything that causes somebody to say, “Hey, your stuff looks great, but I don’t really need it.”

You can fake some of this activity for a single-problem patient with loads of templates, but eventually it doesn’t scale up when you start to have multi-problem patients whose conditions progress over time with clinical sequelae, complications, comorbidities, etc. Nobody really does or is close to doing what we do, but as long as people think that there are reasonable alternatives … sure, we have competition, and now you’re hearing about Watson’s going to do this and Zynx has protocols and Wolters Kluwer is getting into the market. 

One of the things that we do that those folks don’t do is we actually have the concepts for documentation linked to E&M, linked to all the other stuff designed for use at the point of care. It’s not a knowledge resource — it’s a documentation and patient care resource. In that regard, there’s really nobody else that I know of that does what we do.

Explain the advantages of Quippe and why physicians like using it.

When we first started designing this stuff, we were a little bit limited by the current technology at that time, by the state-of-the-art of user interfaces, and that kind of stuff. We made the decision in 1997 to make the knowledge engine its own component without a UI. When some of the browser-based technologies and some of the performance stuff for cloud type services came along in 2002 to 2005, that enabled us to think about a completely new way to deliver two things to the user at the point of care: deliver the content and give them control over the presentation of it.

What we’ve managed to do with Quippe is take 25 years — from 1978 to about 2003 — of clinical content development and what would now be looked on as rather primitive user interface options, and bring a bunch of docs in here and say, “We can deliver any of this content anywhere you want in millisecond time. What is it you really want, and what control over it do you want at the point of care in a user interface?

We had docs come in here over a period of about two years, probably 10 different sessions, and just say “Give me what I want to know when I need to know it. Give it to me in a format that I can control, that can learn from me as I go along, adapt to my needs, and not fix me into a template, but actually push the information to me that I want to see for any condition I treat without me having to go and find it or ask for it.”

Quippe is a note-like user interface that has all this data behind it ready to serve whatever action the clinician takes and give it to them on almost any device. Right now tablets are the hot new thing, but it doesn’t have to be that way.

How is it different selling to vendors rather than end-users? You had a significant presence at HIMSS, including sponsoring HIStalkapalooza. You have to develop interest by the user, but through their vendors.

There’s two ways to do it, and we have to do a little bit of both. Going with MEDCIN and Quippe as your platform is a major strategic and management decision. You have to get the interest of probably the busiest people at HIMSS, who are the CIOs, the CEOs, the clinical people of the vendors who are there to do business with their potential customers. They’re not there to talk to me. We have to get their attention and we have to prove to them that we can provide value. 

One of the reasons we do the iPad giveaways at HIMSS that we just did at MGMA is to show these vendors that we can provide to them something that I can train their customers to use in 20 minutes on a busy show floor. They look at that and say, “Wow. That means I can scale up. I can get implementations up. The docs seem to love it. Tell me more about Medicomp and MEDCIN.”

It’s a two-pronged strategy. We’ve got to appeal to the end user, but we’ve got to also get the attention of the busiest people at HIMSS and MGMA.

I knew nothing about documenting an encounter or using an iPad, but it really was just that easy to use Quippe. What response did you get and are getting at conventions where you just sit people down cold in front of it and say, “Here you go?”

They can’t believe it. It looks so easy they think we’re faking it, which is why we have to put it in their hands. 

I don’t know anybody else that puts software with the complexity underneath it and power in a user’s hand on the show floor at HIMSS and just says, “Have at it.” That’s a very powerful message and one we’ll continue to use over the next couple of years. 

That all comes from those docs coming in here. Every time I had an idea for the user interface or somebody here did, the docs said, “No, no, no. Just give me what I want and get out of my way because I already know how to treat patients. I already know what a note looks like. I know how to document. Just give me the information I want and a format I’m used to looking at it.”

That’s really all that we do. There’s a tremendous layer of technology underneath that, but MEDCIN is like the wizard behind the curtain of Quippe, except there’s really something there, not just some guy pulling strings. The only way to prove that is to put it in somebody’s hands and let them do it.

Like the iPad it runs on, that’s an Apple-like strategy to replace complexity with elegance, but let the user do what they need to do efficiently.

Exactly. One of those light bulb moments for me was I went out to visit the end user of one of our customers about five or six years ago. She was not happy with how much the user interface that we had in the old VB6 days slowed her down. She was vocal about it, but she made some really good points. She gave me a lab coat and said, “You’re an intern for the day. You’re following me around. Let’s go see two patients.”

We went into see one. Lights were on, computer, etc. She did what she did using the software of one of our vendors, who will go unnamed. She went to document and do all this and do all that. At the end of that and said, “Did you see how excruciating that was? Let’s go in to the next patient.”

She pulled up the shades so that light came in. She unplugged the computer and pulled out a pad. Saw the patient, did what she did, gave the patient a prescription, walked out, and she said, “I already knew how to do everything. Without your technology, it took me 11 minutes. With your technology, it took 15. Don’t slow me down. Get out of my way.”

I came back to the guys and I said, “We’ve got to kill the idea of fixed templates. We got to kill the idea of checkboxes on forms. We got to come up with a different model for this. What do physicians know? They know medicine, they know what they’re thinking, and they know they have to produce a note. Let’s marry all that together.”

As it turns out, our engine was almost perfect to serve up that sort of solution. We brought the docs in here and said, “Help us do this.” They just kept saying simplify, simplify, simplify. That’s how we did it. That’s what makes it possible for us to teach people to document on an iPad on the show floor in 20 minutes.

That gets into the area of EHR usability, which is, along with ICD-10 and Meaningful Use, is a hot topic. What is Medicomp doing to address those?

A couple of things. Back in 1997, when the National Committee on Vital and Health Statistics decided to set up a standards committee, we were very involved in that. One of the big decisions they made in maybe 1999 or 2000 was ,”We’re going to set reference terminology standards for the exchange of information between systems. We’re not going to dictate user interface terminologies. We think those have to adapt to users and it’s not going to be the same for everybody ,so let’s establish standards.”

In July of 2003, they said that LOINC, RxNorm, and SNOMED were going to be some of the voluntary standards for this. We immediately said everything we do from now on is geared at making sure we maintain that layer of usability and map to all these standards in the background. We probably added 30% to our staff, we added consultants, and we just started cranking out those mappings, just doing them reiteratively over and over again.

When we saw that ICD-10 was going to happen eventually, we prepared for it. We’re now implementing that. We did the same thing for E&M, which is another kind set of coding mappings back in 1999, 2000. We continue to do all that mapping in the background.

We adopted Virginia Saba’s clinical care classification system for nursing and built a nursing engine and documentation index that integrates with the physician index that we’ve been talking about, so that nurses and allied health can both treat the patient based on the same information in the note, but their documentation overlaps in some cases, but is very different in other cases. That’s what’s getting us now into the enterprise market more deeply.

So you think you’ll have an inpatient clinical documentation system for nurses?

We do have it. I expect that we will make … as I said, we let other vendors make the announcements. I’m virtually certain we’ll make an announcement of a major vendor in the next six months and possibly two by the end of next year. They don’t announce until they’re almost ready to deploy. I think it’s going to stun people.

These are vendors that are committing to retool their product to have your version of the MEDCIN engine as the front end?

Yes. We found an interesting thing. We did a project in Asia about three years ago. I went to Asia and I demo of Quippe in English and they said, “Forget about that. Let’s see it in Mandarin, in simplified Chinese. When will you have that done?” We hadn’t even started and that wasn’t my intention. What would be acceptable? They said, “If you can document 95% of what you do in Chinese, that’ll be fine.”

We pulled the MEDCIN index out for the top 500 diagnoses, all the index records for those, plus 200 other areas of our clinical hierarchy that weren’t represented in the 500. We merged them all together and it came 10,104 of our 285,000 items. We got translations for those done in less than three months for positive and negative. I went back and did a demo — 98% of everything came out in Chinese.

That was pretty cool, but when we started dealing with the enterprise vendors and they said, “You know Dave, we’ve got existing content that covers most of what anybody does” – this is two different vendors independently – and I said. “How many others do you have?” They said just over 10,000.

How weird is that? It pretty much told us that even in a large population, 10,000 to 15,000 of our elements constitute 97 to 98% of total data occurrences, but the struggle that the continue to have to add items, they continue having to map them. The more items you add without some intelligent way of presenting them, the more templates you have to build and maintain over time. 

The big vendors, for the most part, are coming to the conclusion that they do not want to be in the clinical content business. There’s a couple of big exceptions, one located in the Midwestern state south of Chicago.

You’ve been good at predicting the future and being ready for it. Where do you go from here looking down the road a few years?

We have to be ready for a couple of things. Whether anybody likes it or not, if you’re a clinical provider and you’re treating a patient, you have to be prepared to deal with what we think of internally as the coming data tsunami. Once these HIEs are in place and once these standards are in place and people are required to send this as LOINC or RxNorm or SNOMED or ICD-10, and I’m treating a patient and they’re under my supervision now – maybe I’m their caretaker under an ACO model — I’m responsible for that data coming in. I’ve got to be able to make some sense of it.

I might have a patient with the classic big three in America — hypertension, obesity, and diabetes — plus two other things. Maybe today I just want to deal with this.  I’ve got to find the relevant information in there, because I’m probably going to be held responsible for it, and I’m probably going to be held responsible for whatever I do and making sure that patient, once I treat them, if I admit them to a hospital or I discharge them from ambulatory care; if we got to outcomes-based reimbursement, I’ve got to take that data in, treat them, and keep them from coming back.

All of our tools are built to enable that. That’s one of the reasons we got into integrating the nursing care. If somebody gets discharged or somebody comes in even to an ambulatory practice with an open wound, I’m going to be responsible if they show up with an infection coming back. I’ve got to teach them hand hygiene, I’ve got to teach them wound care, I’ve got to teach them signs of infection. I’ve got to do all that. That’s why we built that stuff and then integrated it, because whether it happens or not – and I think it will, I think it’ll take longer than people think – we’ve got to be ready for that data tsunami that’s coming.

We also have to be ready to make it possible to scale up – and I’m including implementation and training and updates of software – quickly as medical knowledge changes and get it deployed out to the places where care happens, which is why we started building our cloud-based model about six years ago. Whether or not ACOs push integrated care, information is going to increasingly be … you’re going to need to be able to integrate it quickly, absorb it, find what you want, treat the patient successfully, and manage them on an ongoing basis.

We’re building all of our tools as if we have to do that. We also know from our experience, now with about 100,000 people using MEDCIN everyday, that training consists of, “You’re new here. Let me show you how I use this.” They get about 20 minutes of training, it’s done, and they’re on they’re own. That thing had better push the information they need to them. It better be intuitive. It better be easy to use, maintain, train, deploy.

That’s what we’re focused on. It’s a lot, but it’s really one problem. Giving them the information they want when they want it so they can do what they need to do and not require massive support to do that.

Any concluding thoughts?

We think there are going two be major challenges. How do enterprises handle data and account for their outcomes? How do you get the tools to do the individual clinicians on the front lines to do their job, which is patient care, and take care of all of that other stuff in the background? That’s what we’re trying to do.

Time Capsule: Embrace FDA Oversight If You Want Clinical – not Clerical – Systems

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 December 2006.

Embrace FDA Oversight If You Want Clinical — not Clerical — Systems
By Mr. HIStalk

Most hospital information systems are old. Faded pictures of the original system architects feature bushy-haired guys wearing plaid pants, wide ties, and leisure suits. Given their unfortunate fashion sense, it’s not surprising that their precognition of today’s healthcare environment didn’t include having physicians and other clinicians use their creations directly. The goals of information technology were simple: capture charges, batch-bill the heck out of Medicare and Medicaid, and maybe provide a simple order entry function just good enough to support those first two items.

Today’s so-called “clinical” systems mostly sit atop that antique and unsuitable foundation, outdated not because of old programming languages and hardware platforms, but because their original design mindset is now hopelessly obsolete. Clinical applications are really just green-screen type data entry forms that happen to accept clinical information. It’s the mainframe mentality at its worst – the all-knowing system that requires regular data feedings from subservient users who, despite their occupational disposition, are relegated to being keypunchers.

Eventually, some company will actually design a new inpatient clinical system from the ground up. We can fervently hope that when they do, they’ll start with a blank slate and not simply port outdated, monolithic thinking to a newer technology platform. With that innovation, though, will come the crossing of a huge chasm: that no-man’s land between “information systems” and FDA-approved medical devices.

Clinicians gripe that systems are user-unfriendly, do little to help them perform their jobs, and add minimal value to personal productivity or patient outcomes. They’re just accounting systems whose widgets are clinical. One reason: HIT vendors are terrified of FDA regulation. It’s easier to make sure systems are too dumb to require it than risk exposing sometimes bad software practices to government oversight.

Clinicians are overwhelmed by too much raw data whose presentation can’t be individualized, i.e. they insult bone marrow docs with low platelet warnings (if they have alerting capability at all, that is.) That picture that’s worth 1,000 words can’t be included because 1980s-era programmers didn’t see cheap multimedia and storage coming. Failure to rescue can’t be detected in crashing patients. Systems deliver data like an obedient mailroom clerk, adding equally unimpressive value. The average automobile, riding on even older design, has better data aggregation and presentation capabilities, replacing data lists with idiot lights, navigation capability, and easy-to-comprehend gauges.

It’s like Lucy working on that candy assembly line – reams of often irrelevant information are unceremoniously dumped faster and faster into the laps of physicians and nurses, who are expected to manually figure out what’s useful and then “process” it, often by entering even more on-screen information. Eventually, the administrivia buries someone who ought to be making patient care decisions instead of romancing a keyboard.

IT vendors have good reason to fear the FDA, which won’t be happy to hear about buggy code, poor testing practices, slow updates for known defects that have clinical implications, and head-scratching user interfaces that merited no more than an afterthought. Maybe that level of scrutiny would slow development and increase costs, but accepting possibly dangerous software as long as it’s fast to develop and cheap (both debatable) doesn’t seem like much of a bargain.

A smart clinical systems vendor would include FDA approval into their long-term plans and build killer applications around it, thereby scooping their competition by years. Redesign the first-generation systems, step boldly into the FDA-regulated space before the device vendors instead invade the IT space, and build systems that improve patient care, not just turn paper forms into on-screen forms.

Today’s software was designed around old constraints and its design shows it. Someone should get clinicians together (no programmers allowed) to design the systems of tomorrow, software whose effect on patient care is less interruptive and more assistive. Doing that right will require FDA approval. For that reason, the industry should welcome it.

News 12/16/11

Top News

KLAS publishes its 2011 Best in KLAS Awards for software and professional services. A few highlights:

• Epic is named the top overall software vendor and takes the #1 spot in seven categories, including acute care EMR and ambulatory EMR over 75 providers. Epic’s winning margins in these categories were significant. In acute care, Epic earned 90.3% satisfaction score compared to second place Cerner PowerChart at 78.5%. In the ambulatory EMR75+ provider segment, Epic scored 89.8% compared to eClinicalWorks’ 76.1%.
• If you compete against Epic on inpatient core clinicals and ancillaries, you’ve got your work cut out for you. Epic tops every application category except lab, including EMR (orders, results, documentation), pharmacy, radiology, and surgery, not to mention that Epic also is #1 in patient accounting and patient management. And, all of those products run on a single database and are fully integrated. It’s not shocking, then, that vendors are trying to beat Epic on price since that’s about the only competitive point that’s up for grabs.
• McKesson Paragon beat Cerner PowerChart by 10 percentage points in the community acute care EMR segment. Interestingly, Paragon was not ranked in the acute care segment because that’s not Paragon’s primary market (according to KLAS.) Paragon’s scores in the acute care segment would have been good enough for a fourth-place ranking, beating out Horizon and others.
• It’s pretty impressive to have 100% of your users (those participating in the survey, anyway) say they would buy your product again. Among those achieving that distinction: Epic (multiple categories), SCI Solutions (enterprise scheduling), Sunquest (community laboratory), Allscripts (patient accounting/patient management), Nuance (speech recognition), iMDsoft (anesthesia), GetWellNetwork (interactive patient systems), athenahealth and SRSsoft (ambulatory EMR), athenahealth and OptumInsight (practice management), and ZirMed (clearinghouse services.) Interestingly (to us, anyway), all but two of these companies are HIStalk sponsors.
• maxIT was ranked the top overall services firm, edging Hayes Management Consulting by 0.2 points.

Reader Comments

From DtwlnLax: “Re: iPhone users. Check this out – 25 GB of free cloud storage for iPhone users.” Sign up for Microsoft SkyDrive and its yours.

From Non Sequitur: “Re: holiday greetings! HIStalk provides a great service and somehow ties us all together into one common community in some way that I don’t entirely understand, but it works. You should enjoy knowing how common an occurrence it is around this setting (and in my former life as a vendor) to walk in on a conversation where someone is saying, ‘Did you read such and such in HIStalk this morning?’ or counters an argument in a meeting with, “There was an article on HIStalk recently where they addressed this, and the gist of it was…’ I really appreciate the news, the good articles, the inside story, and of course the delicious pithy comments! An e-mail from HIStalk or HIStalk Practice is like getting a little gift from my Secret Santa. Your industry insight amazes me and those of us in the trenches really, truly appreciate the effort and commitment! Happy Holidays to Mr. HIStalk, the long-suffering Mrs. H, and to the Intrepid Inga! My hero!” That was maybe the best e-mail anybody has ever sent us. Inga wanted me to run it unedited, but I argued that it was indeed great, but it seemed distastefully self-promoting to run it publicly instead of just basking in it privately. We compromised: I edited it to the version above to reduce the volume of the shameless tooting of our own horn (from 11 to 10, at least). Non Sequitur, who works for the hospital of one of the finest public universities in the country, made our day, needless to say. She’s sweet.

From All Hat No Cattle!: “Re: Partners Healthcare. Sent an internal memo stating they have decided to buy a new EHR for their facilities. Wanna bet whether it will be Epic or Siemens?” Glaser connection or not, Siemens wouldn’t seem to be a great choice given Soarian’s limited (non-existent?) track record with facilities their size and complexity, although they’ll surely get lots of promises of extra-special hand-holding that might sway their opinion from the obvious choice.

From Patti: “Re: ACO training in four hours. Check out this Craigslist ad for the Prognosis ACO. The ACO sales rep would get four hours of education on ACOs and ‘the sales pitch’ and would then be ready to recruit physicians to sign up, pushing their EHR as well. Reps get the equivalent of $30K per year plus $500 per enrolled doc, but their contract ends in March.” The big spiff for reps is that the company provides business cards. The Craigslist ad is here. There’s not much listed about who is behind the hard-selling ACO, but domain registrations seem to point to an Illinois oncologist.

From Larry: “Re: McKesson. They wanted to get rid of Paragon years ago, but worried about the viability of old products like Series and HealthQuest with ICD-10 coming and let Jim Pesce talk them into Paragon as a clinical solution. About the same time, Michael Simpson, now running the GE-Microsoft thing, swore he could get HERM done if they let him take it offshore like he had with his previous employers (check out Unisys and Novell to see how well that worked out.) Paragon was to be the hedge bet, to be killed off if Simpson was successful. Obviously he wasn’t.”

From Wet Willy: “Re: the new company of former Allscripts CTO John Gomez. I hear they are working on a search and analytics platform for healthcare, a hybrid of Google and Amalga done right with a huge emphasis on usability for outcomes-focused analytics. I also heard they are introducing an Allscripts-to-Epic migration tool and service that will allow a hospital to migrate Sunrise facilities, printer locations, patient records, medical history, formulary and other data and map it to Epic’s schema with 80% accuracy.” I asked John. His answer for #1: “It is true, we are working on that.” For #2: “We really can’t comment.” Above are his company’s guiding principles.

HIStalk Announcements and Requests

This week on HIStalk Practice: athenahealth’s Jonathan Bush calls for greater transparency and accountability in the Meaningful Use program. The White House says the government has recovered more than $2.9 billion in healthcare fraud this year. HHS issues an advisory opinion that concludes a vendor would not be violating anti-kickback statutes if it facilitated payments between providers for the exchange of EHR data in a patient referral situation. The Chicago and Maine RECs say they’ve met their enrollment targets. If you can’t send me a pair of Christian Louboutins for Christmas (size 8), then the next best thing would be to faithfully read HIStalk Practice and sign up for e-mail updates.

A reader from a large hospital system in Shanghai, China is looking for a vendor to provide an outpatient PM/EMR/dental system that can then be expanded to the inpatient hospital. I don’t know of any US-based vendors that offer these capabilities with support for customers in China, but if yours can, I can forward your contact information. I was just happy to brag to Inga that one of our readers needed our help, and oh by the way, she’s in China.

Say hello to new HIStalk Platinum Sponsor Ingenious Med of Atlanta, GA, whose company name is one of my favorites. The physician-founded company has been around for more than 10 years, offering workflow-intelligent physician solutions for charge and data capture, coding and documentation, quality, reporting, and inter-staff communication. “Physician-friendly” means “mobile” these days, and Ingenious Med just this week won its third consecutive Mobile Star Award. The company has 9,000 users in 800 facilities that include Emory Healthcare, WakeMed, Kaiser Permanente, Texas Health Resources, Sentara, Geisinger, BJC, and a bunch of other high-profile providers. So why would a hospital be interested in solutions like these? Simple: hospitals spend tons of money subsidizing the P&L of their docs, eating the loss with the hopes of offsetting it via increased hospital business, while the company’s tools soften the blow by increasing collections by $30-40K per doc per year just by capturing information accurately (they’ll put it in writing, and show you their 97% customer renewal rate). Hospitals also like reduced exposure to RAC audits and insight into whether individual physicians seem to be over- or under-coding based on industry standards. Thanks to Ingenious Med for supporting HIStalk.

On Healthcare IT Jobs: McKesson STAR Analyst/Consultant, Cerner PathNet Consultant, EMR Application Specialist.

Acquisitions, Funding, Business, and Stock

athenahealth reaffirms its existing guidance for fiscal 2011, predicting earnings of $0.78 to 0.85 per share and revenue of $320-$325 million. Analysts had predicted $0.86 per share. The company also projected 2012 revenue of $410-430 million, in line with expectations, but non-GAAP net income of $0.85 to $0.97 per share vs. the Street’s anticipated $1.16 per share. The share price slipped over 15% Thursday to $49.04.

Spectrum Equity Investors and Trident Capital  take a majority position in HealthMEDX, LLC, a provider of long term and post-acute care technology. Former McKesson Technology Solutions President Pam Pure joins the company as CEO. Former Visicu SVP/CFO Vince Estrada was also named EVP of business development and CFO.

People

Orion Health appoints Andrew Ferrier, former CEO of Fonterra, to its board of directors.

CHIME elects Melinda Costin (VP, Baylor Health Care) and Randy McCleese (VP/CIO, St. Claire Regional Medical Center) as board trustees.

Diversinet Corp. names Hon Pak, MD as interim CEO, succeeding the retiring Albert Wahbe. Pak recently retired as CIO of the US Army Medical Department and had served as president of the American Telemedicine Association.

The New England chapter of HIMSS names Daniel J. Nigrin MD, MS as Clinician of the Year. He’s SVP/CIO and a pediatric endocrinologist at Children’s Hospital in Boston, not to mention a faithful HIStalk reader.

National eHealth Collaborative announces new officers: Kevin Hutchinson (My-Villages), Holt Anderson (NCHICA), Tom Fritz (Inland Northwest Health Services), Paul Uhrig (Surescripts), and Janet Corrigan (National Quality Forum).

Announcements and Implementations

Catholic Healthcare West’s north state division will deploy MobileMD to connect its hospitals to physician offices, clinics, and other hospitals.

St. Rita’s Medical Center (OH) goes live on Ohio’s statewide HIE with the transmission of clinical data to Greenway EHR customer Health Partners for Western Ohio.

Emerus Emergency Hospital (TX) goes live on the InsightCS revenue cycle solution of Stockell Healthcare Systems at six Texas locations.

Birmingham VA Medical Center (AL) implements GetWellNetwork’s interactive patient care solution in its tertiary care facility.

Government and Politics

A healthcare blog post in The Hill observes that Republican presidential front-runner Newt Gingrich isn’t talking about electronic medical records like he used to, possibly because conservative voters weren’t thrilled with his support for spending taxpayer money on technology for private businesses (some of which were his consulting firm’s customers.)

CMS will announce the first Medicare accountable care organizations on Monday, rumor has it.

North Carolina legislators criticize the state’s Department of Health and Human Services for allowing cost overruns for building a new Medicaid claims system. The final tally for the state’s $265 million contract with CSC is now pegged at $495 million. It will also take 22 months longer to complete the system and will cost $91 million more to keep the old system running in the mean time. One state representative called the project a “money pit” and added that if it were a private sector project, heads would have rolled, but when the agency’s IT head was asked to give herself a grade, she said she deserves an A. CSC originally got the bid when a 2004 contract with ACS was cancelled, costing the state $10 million to settle the resulting ACS lawsuit. When the CSC contract was signed in 2009, the current DHHS secretary was a lobbyist for CSC.

In the UK, vocal NPfIT critic MP Richard Bacon says BT and CSC are charging NHS trusts triple the market price for Cerner Millennium and iSoft Lorenzo.

Innovation and Research

Mount Sinai Medical Center (NY) will start a pilot project in January that will link the genomic sequence of patients to their electronic medical records, allowing physicians to incorporate the patient’s genetic characteristics when choosing drugs and dosages.

The safety institute of Johns Hopkins Medicine, led by Peter Pronovost MD, PhD, will collaborate with Lockheed Martin to create a new generation of hospital ICU. An example given of its potential work is a patient alarm prioritization system. According to Pronovost, “A hospital ICU contains 50 to 100 pieces of electronic equipment that may not communicate to one another nor work together effectively. When an airline needs a new plane, they don’t individually select the controls systems, seats and other components, and then try to build it themselves.”

Technology

Fujifilm Medical Systems announces the availability of Synapse Financials, a billing solution that integrates with Fujifilm’s Synapse RIS platform.

Axial’s Care Transition Suite wins first place in the "Ensuring Safe Transitions from Hospital to Home" initiative, sponsored by Health 2.0 and HHS’s Partnership for Patients Initiative.

Other

Wes Wright, CTO of Seattle Children’s Hospital (WA) says its deployment of 2,600 Wyse zero client devices for Citrix will save $400,000 per year in power consumption.

MoneyWatch reports the top-compensated US CEOs for 2010, with McKesson’s John Hammergren in the #1 spot with $145 million (5,370 times the median US income.) Two other healthcare CEOs made the Top 10: Joel Gemunder of Omnicare ($98 million) and Ronald Williams of Aetna ($58 million.) Another site says Hammergren’s payday will get a lot bigger if McKesson changes ownership at some point — his contract calls for him to be paid $469 million.

Making sure to place this item for maximal ironic effect, soon-to-be-displaced McKesson employees can check the comments left on my earlier post, where some vendors who are looking for Horizon or other talent have posted their contact information (I entered a few myself from information e-mailed to me).

An interesting article in The New York Times ponders whether clinicians are becoming distracted by their growing arsenal of smart phones, tablets, and other gadgetry. It cites a research article that asked technicians who monitor heart bypass machines during surgery whether they used their electronic devices right in the OR, with 55% saying they had talked on their cell phone and 50% admitting they had texted. Funny: a Stanford doctor and author calls the attention-demanding screens “the iPatient,” and says the iPatient is getting wonderful care. In a sobering example, a patient was left partly paralyzed after surgery, with evidence presented in the ensuing malpractice lawsuit documenting that the neurosurgeon had made at least 10 personal calls from a wireless headset during the surgery.

A Boston Globe article covering a visit by the head of HHS’s HIPAA enforcement organization, Office for Civil Rights (which it mislabels as Office of Civil Rights), cites Micky Tripathi’s breach article on HIStalk Practice. It’s also being reprinted in a Canadian information security journal after they requested his permission and he graciously deferred to us.

Sponsor Updates

• Jeffrey DiLisi MD, associate VP of medical affairs at Virginia Hospital Center (VA), will discuss motivating physicians to improve documentation during The Advisory Board Company’s December 16 web conference.
• MD-IT releases a case study on the ability of neurologist Gordon M. White, MD (TX) to maintain productivity while qualifying for the EMR incentive program.
• Nuance joins 11 other organizations as a strategic partner with the Center for Connected Medicine.
• Billian’s HealthDATA announces an alliance with  HealthLink Dimensions to add hospital-affiliated physician data to Billian’s existing offerings.
• Nuance releases findings of a managing paper records in a medical practice.
• Ignis Systems releases its EMR-Link Maintenance Training webinar schedule.
• Greater Glasgow and Clyde Health Board (EU) announces that over 15,500 active patients have adopted its Orion Health clinical portal.
• Practice Fusion shares its top seven healthcare IT predictions for 2012.
• The Micromedex mobile drug information app from Thomson Reuters earns a spot on the WIRED App Guide to 400 Essential Apps.
• Covisint works with Intermountain Healthcare (UT) to earn nearly $1 million in PQRS incentives.

EPtalk by Dr. Jayne

Medicare announces that starting in January, recovery audit contractors (the dreaded RAC auditors) will offer a new service to amuse and delight physicians: prepayment reviews. The audits will be piloted in states with a relatively high percentage of fraudulent and inaccurate submissions, as well as states with a high percentage of short hospital stays. Another demonstration project will require prepayment review for motorized wheelchairs and scooters, with a goal of requiring prior authorization within the next year.

It is unclear why Medicare chose to use the RACs to do this instead of the Medicare Administrative Contractors that actually process the claims. I do like the idea of looking at the process for payments covering powered mobility devices. A couple of vendors are entirely too pushy and work very hard to convince patients that every Medicare beneficiary deserves a scooter “at absolutely no out of pocket cost” because they’re not cheap and all of us are paying for them.

CMS plans to offer up to $1 billion in grants for healthcare innovations. The Health Care Innovation Challenge program targets public-private partnerships, multi-payer groups, and groups caring for patients with complex health care needs. Administered by the Center for Medicare and Medicaid Innovation (CMMI – ooh, a new acronym!), the grants stem from $10 billion in funding from recent health reform legislation. Proposed projects have to be rapidly deployable (less than six months) and able to be replicated, expanded, and sustained. I’m interested to hear from anyone who is considering an application. Letters of intent are due Monday and applications are due January 27, so if you want to wait until after the deadline so no one steals your ideas, I understand. The minimum award is $1 million, so get those keyboards moving.

Based on the content so far, I might as well make this the “all CMS, all the time” column this week. The House of Representatives passes a bill this week to postpone the scheduled 27% pay cut for Medicare physicians that is only a few days away. However, it is not expected that the Senate will follow, and even if they do, President Obama is expected to veto it.

HIMSS will open the process to solicit volunteers for its 2013-14 committees on January 2. Individual members and corporate members who are not already in HIMSS leadership positions are eligible as long as they have maintained membership for the past 12 consecutive months. Watch the Committees home page for more information.

We talked about flu vaccines recently, but right now there’s an outbreak of pertussis (whooping cough) in Chicago and surrounding counties. Vaccines are effective and are now recommended for adults as well as for children.

I mentioned last week that I had something big planned. Since our last get-together was at HIMSS11, I thought it was time that I paid my BFF Inga a visit. Although I frantically searched the racks at Nordstrom looking for something appropriate to wear, I suspected my efforts would be fruitless because I could never keep up with Inga. Seeing her walk through the door having paired these with jeans for a casual dinner, I knew I was right.

So what do the sassy ladies of HIStalk discuss over drinks? The enigma that is Mr. H, recent events at McKesson, who has the best date for HIStalkapalooza, and potential beauty queen sashes. We also discussed our no-longer-secret project. As Inga mentioned, you’ll want to make sure you include a pair of new or gently used shoes for our charity event when you make your packing list. (Sorry, no stiletto dash for those of you who suspected that’s what we were up to. I don’t want to be called upon to treat any orthopedic injuries while I’m enjoying the evening.)

It was nice to actually get together since we typically connect via e-mail and the occasional text message. I usually have at least one good physician war story for Inga, and this time she topped me with the writeup of a new book: Stuck Up! You’ll have to read for yourself what it’s about. Let me just say that it’s wackier than anything even Weird News Andy would send.

Contacts

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

Readers Write 12/14/11

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!

Time for Health Plans, Providers, and Patients to Team Up
By S. Michael Ross, MD, MHA

Current healthcare spending is unsustainable and driving us over a cliff. Despite having some of the most expensive healthcare in the world, the United States consistently underperforms on most care quality metrics. Take, for example, a 2010 report published by The Commonwealth Fund comparing healthcare in the U.S. with healthcare in Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom. The upshot: Our system ranks low on quality, access, efficiency, and equity.

A major driver is that incentives are misaligned between health plans and providers. It can all be blamed on economics. Health plans typically sell insurance to employers based on the lowest price, while providers typically try to negotiate the highest possible fee schedules.

Whether we stand in the shoes of providers or health plans, I’m convinced that our goals must be the same: improve the quality and outcomes of healthcare and reduce costs. To achieve these shared goals, there needs to be alignment of payment to providers. Collaboration is one of the best ways to reach this end result. To foster a successful partnership, health plans and providers must get past this traditional adversarial relationship and facilitate a dialogue about delivering value.

It’s no secret that fragmented care is one reason our healthcare costs are so high and that patient safety is at increased risk. More than half of Medicare beneficiaries have five or more chronic conditions such as diabetes, arthritis, hypertension, and kidney disease, so they’re routinely receiving care from multiple physicians. Failure to coordinate that care often results in patients not getting needed care, receiving redundant care, or suffering an increased risk of medical error.

A major emerging trend to address care fragmentation is the patient-centered medical home (PCMH). PCMH is designed to introduce accountability for ensuring coordinated care across the healthcare continuum. Early adopters of this model report superior clinical outcomes, more satisfied patients, and lower total cost of care. Health plans are quickly moving to PCMH. Likewise, providers are showing high levels of interest; a recent Medical Group Management Association (MGMA) survey shows that 20 percent of provider respondents already are affiliated with a PCM and 70 percent more are receptive to the idea—especially when health plans offer financial incentives to participate.

To make PCMH successful, it’s imperative that we break down the traditional information silos. We can begin to contain double-digit premium increases and align costs with quality of care only when primary care physicians, specialists, hospitals, health plans, and patients all have access to each other’s data. Aggregating, analyzing, reconciling, and intelligently distributing that information will be critical to support optimally coordinated care in the PCMH paradigm.

Workflow integration also will be a key to success. To prevent mass confusion at the provider level, the myriad data sources must be presented in a consistent and uniform manner to be utilized most effectively. Large-scale multi-payer platforms integrated into practice workflows already exist and can be leveraged to support rapid deployment of PCMH. On a related note, data to support coordinated care must be accessible across all form factors (like portals, smart phones, and tablets) in accordance with user preferences.

When we combine the administrative and financial data collected by health plans with the clinical data collected by providers, we have the power to establish continuity, promote positive outcomes, and support value-based reimbursement. From there, we naturally will reduce costs and improve patient satisfaction.

Clearly, if we want to move forward with quality care, we must enable a much richer data exchange between providers and health plans. We have in our midst the opportunity to rapidly achieve superior clinical outcomes and better health of populations—and to bend the cost curve. The time to do it is now. This is our last best chance.

S. Michael Ross, MD, MHA is chief medical officer of NaviNet of Boston, MA.

Ivo Told Me Not To Do It
By Dana Sellers

I’ve known Encore’s founder, Ivo Nelson, since the 1980s. I’ve found out over the years that he’s almost always right. In fact, I thought he was outright wrong once, but it turned out I was mistaken. So when Ivo tells me to do something, I generally listen. But every once in a while, like a horse with the bit in its teeth, I just have to go my own way out of pure stubbornness.

The other day I told Ivo I wanted to write an article about how fantasy football is like modern day healthcare. Without even a second to think about it, he told me not to do it. Normally, I’d follow his advice, but somehow I haven’t been able to get the idea out of my head. So, against Ivo’s better judgment, here goes…

In the old days of football, I really only cared about my team. I’d watch that one game, and then I’d turn off the TV. I knew who my players were, and they didn’t really change week to week. The rules were simple, and the scoring was clearly understood.

Then my sons needed one more person to complete their college fantasy league and they voted me in. Yes, me — Mom. And all of a sudden, the world of football changed. No longer was football something that was contained within the boundaries of a single game. It suddenly became something that was far more about strategy outside the walls—about finding and aligning with the very best. I had to plan, prepare and strategize. I found myself watching football in a whole new way.

Data was key. In fact, I found that I needed real-time data — on performance, on injuries, on projections. Lots and lots of data. I signed up for Sunday Ticket and StatTracker. I used all the filters and views on Yahoo! to make game day decisions, trades, and plan my next move. I downloaded all the fantasy apps for iPhone. I needed data all the time, wherever I was.

I also found that the scoring rules had become a lot more complicated and were a moving target. I’m in two leagues now, and what works in one doesn’t necessarily work in the other. The same touchdown that could help me win in one league could put me out of competition in my other league. I’ll watch a game hoping that my Cowboys will win, but that one particular player will do all the scoring because any other result will cost me precious fantasy points.

Here comes the hard part that Ivo thought I couldn’t pull off. So how is this like today’s healthcare?

I think there are a lot of similarities. In healthcare today, it’s not enough to think within our walls and turn off the TV any more. We have to be watching what’s going on across the industry, strategizing and planning and thinking about how to align with the best and brightest to accomplish what has to be done.

And data is key. We’re all going to need lots and lots of data—about performance, about quality, about projections. We’re going to need to be able to slice and dice it and look at the data in whole new ways. We’ll want it accessible for the end-user/stakeholder so that when we need it, we can get to it, wherever and whenever we want it. Our stakeholders aren’t going to want to submit a query and wait for a stale report to come back. They’re going to want the data NOW, just like they have for their fantasy football team. Why should they settle for less in their real-world job?

Finally, scoring is the hardest part. In fantasy football, if you lose, only your pride is hurt. (Personally, my teams aren’t doing so well right now, but I’m going to make some changes and see what happens next week.) But in healthcare, the score can mean survival as a healthcare organization. And we don’t just live in two leagues, we have two different scoring systems emerging right now—fee-for-service and pay-for-performance. If you optimize for one, you can hurt yourself in the other if you’re not careful. Get really good at reducing readmissions and you may see your revenue drop. Survival today means managing a shifting reimbursement world, understanding how government and payer “scoring” is changing in an almost real-time way, and being able to change and adapt in a nimble manner.

In the past, you only needed to take care of yourself and pay attention to your own hospital and your own local NFL team. Simpler times. Then along came reform, consumerism, and fantasy football. Now you have to take a more global, whole league view. Watch national trends, watch the future of government intervention, reimbursement trends, offensive and defensive schemes, and manage a diverse roster. ACOs, ICD-10, MU, VBP, and comparative effectiveness … 32 QBs, 120 or so RBs and WRs.

There is so much information to absorb and so much going on month to month in healthcare and week to week in FFL. Take your eye off of any of it and you can get crushed. Miss a nuance in a new regulation or payer contract or that a team made a scheme or roster change and you can be devastated. So stay alert, and keep your eye on the ball….

Oh, and by the way, Ivo—my “Fightin’ Frogs” are gonna crush your “Guiness Stouts” on Sunday.

Dana Sellers is president and CEO of Encore Health Resources of Houston, TX.

Answering the Question: How to Achieve ROI for Healthcare BI
By Jim B-Reay

As hospitals make significant investments in EMRs — along with related updates to hospital billing, materials management, costing, and quality systems — they typically find that the promised analytics and reporting are not adequate. To tie together data from these disparate systems and even to optimize access to data within an integrated system, a Business Intelligence (BI) strategy is needed.

A typical BI strategy encompasses data governance; data staging and warehousing; tools for query, reporting, and dashboards; and a staffing model to build the initial framework and expand the architecture to serve the changing needs of the business.

For many organizations, this additional investment is hard to justify considering the outlays already made in their core systems. While working on one strategy recently, I was asked, “If we make this investment, how can we measure the direct return on investment (ROI)? What is the actual ROI of an investment in BI?”

To help the client answer these questions, I reached out to a dozen organizations, all of which have BI programs of some degree of maturity, and asked the very same questions. The responses I got were different and enlightening. I found that successful sites had a common theme: BI value is based on the use of the system to analyze data from various clinical and administrative systems and the willingness of the organization to act upon the findings to make changes that ultimately improve productivity and efficiency.

While these organizations varied in size, EMR maturity, and technology, I found commonalities in their responses.

A Cost of Doing Business

Many of the respondents stated that there wasn’t a planned ROI. They saw the investment in BI as a cost of doing business and considered BI as a necessary investment for which the value would be proven using the results from the analytics. Thus they did not establish clear financial goals beforehand. Instead, they identified gaps in their data environment that a BI strategy would address and chartered projects to suit.

Empower the Analysts (Plus a Little Insurance)

A smaller group of the participating organizations had a slightly clearer idea of what they’re trying to achieve with their BI investment: empowering their data and business analysts. In these cases, the organizations have fairly seasoned analysts who are clamoring for better tools to continue their roles as data analyzers.

This approach drives to more standardization of data and allows for replication of the current mysterious data manipulations of these trusted analysts. In addition, replacing the desktop database with an IT-maintained warehouse and a heavily macro-filled spreadsheet with a set of summary tables and dashboards provides a measure of insurance that the knowledge and analytics would be securely in place should the analyst decide to move on or could be used by others within the organization.

Targeted and Tactical

A core group of respondents challenged the premise of BI ROI by saying that BI has NO value to the organization in and of itself unless the project is matched to strategic initiatives. Their BI projects, interestingly enough, were often much smaller than the “insurance” or “build it and they will come” initiatives.

In all of these cases, there was a level of BI infrastructure required to make this all work, but the level of direct investment required was, in most cases, far less than a full soup-to-nuts data warehousing initiative. The ROI realized was the result of targeted, limited scope initiatives with only just enough infrastructure to deliver these results.

Although there were a few cases where it appeared that investments were being made to get BI in the door without truly understanding the solution on offer, those that had embarked on their BI strategies with a solid set of requirements and strong governance will be well served by their investment. There are complex questions that these organizations simply would not be able to answer without the data aggregation and query toolsets that an investment in BI brings.

But direct calculation of a return on investment can be difficult. For the “build it and they will come” group, they have made it clear they’re willing to let the ROI be determined through later projects. What the third group of respondents showed was that if you’re looking for ROI, you need a clear definition of scope and the organizational ability to respond to findings. It is possible to get an amazing ROI from a project with one smart analyst, some extract files, and an Access database. But it’s up to the organization to take that information and act on it, and it’s up to IT to build a support structure to ensure that that information continues to be available.

To design and implement a Business Intelligence initiative that delivers a positive ROI, start out with a limited scope and strong organizational support for acting on the findings. Select a single study area, get clinical support, and assign the most experienced analysts (second model) with support for data extracts as needed. Once you have proven value to the organization, look for ways to expand. Work to productionize the extracts and move the database off of the analyst’s desktop, so the value you get from that first study area is preserved and re-useable. Work on back-loading additional data as needed to expand the study area.

Find a second and third related organizational problem that could be piggybacked on the dataset you’re using and find an organizational sponsor who will take the action needed based on the BI data findings. If possible, expand the existing structures to contain the data needed for the new studies, but don’t create a tortured data model. Don’t be afraid to create another targeted data mart as needed.

In parallel with this first initiative, start building strong BI governance in the organization. Ensure that analysts across the organization are meeting regularly to discuss and document data standards and that wheel-reinvention is minimized. This can be a matrixed group rather than a formal reporting organization, but participation needs to be mandatory. The lead for this analyst group should be invited to executive-level steering meetings to listen for areas of frustration and concern with data and be able to both represent the work that is being done and bring the concerns back to the analyst team for action.

Through targeted initiatives, experienced analysts, and strong governance, BI projects will have a tangible ROI.

Jim B-Reay is a principal with Aspen Advisors of Pittsburgh, PA. 

News 12/14/11

Top News

Continuous vital signs monitoring vendor Sotera Wireless receives investment funds and a commercial agreement from Cerner as part of its just-completed $12.2 million Series D financing round.

Reader Comments

From Insider: “ONC appointment. The ONC names Baylor Health Care System CIO David Muntz as principal deputy.” Insider forwarded us an e-mail from Farzad Mostashari announcing Muntz’s new role, which includes the handling of ONC’s day-to-day operations, staff management, and the overseeing of four offices within the ONC (Programs and Policy; Operations; Economic Analysis, Evaluation, and Modeling; and Chief Scientist.) He’s presumably taking a admirably large pay cut from the $680K Baylor reported paying him in its most recent federal filings.

From Jarritos: “Re: HIStalk. I got hooked a year ago after my VP suggested I read it. I work for a McKesson Horizon shop and read your items first thing last Friday morning and let my manager know. The CIO sent an update later saying we would be getting more information and you guys would be running an interview later that afternoon. I think it’s extremely impressive that in your spare time you’ve managed to get this kind of clout. I’m not aware of another interview anywhere else and I appreciate the information.” Thanks. It was a lost Friday evening as I rushed home from the hospital to do the interview, transcribe it, and post it. I knew readers were looking for answers and McKesson had contacted me to help get them out via the interview, so I didn’t want to dawdle. HIStalk received 13,718 visits from Friday through Monday, which is maybe 40% higher than the week before, so I assume the interview was the draw. I don’t really care about clout (if there’s such thing as anonymous clout), but having quite a few readers does give me some leverage to obtain information on their behalf. I appreciate McKesson and Dave Souerwine for reaching out.

With regard to the interviews, Mrs. HIStalk has gotten to the point that when I tell her I have to delay dinner to chat with a high-profile executive, she just rolls her eyes a little and buries herself in the newspaper as I head off upstairs with freshly dashed self-importance. Somehow I think I live a bit lower on the totem pole than the folks I interview, though, given that I took Mrs. H out Friday evening after I’d finished with Dave to the sit-down restaurant we frequent most often (Mexican) and spent considerably less than $20 for two entrees, a couple of margaritas, and a shared dessert. You can have Ruth’s Chris or expensive sushi places –  I love sitting under an inflated Corona palm tree, watching soccer on the TV, slathering the El Yucateco habanero hot sauce onto my favorite carnitas, and admiring the shy cuteness and solid work ethic of the non-English speaking waitresses. 

From Ukelele: “Re: McKesson. The corporate web site still has done nothing to update itself with all the ‘news,’ Paragon’s page still reflects a ‘community hospital’ solution, and the HERM page still sits out there advertised as the be-all, end-all revenue management system. Another sign, perhaps, of the corporation’s complete lack of interest or confidence in this business? I was surprised so few readers commented on the interview, but perhaps that’s a sign that there’s few who care any more. It will be interesting to see how the board of InSight reacts to the news.”

From DCHealth: “Re: EMRs. How many providers have adopted other than Kaiser and those docs getting help from the RECs? Has growth really increased after HITECH? Seems about the same to me.” The adoption numbers are going up slowly, but I’m interested to see what happens to the trend as HITECH realities hit. Will adoption keep climbing to 100% because EMRs are the new standard, or will they go back down the slope as providers give up and accept a little less money in order to keep their productivity?

From Disappointed Techie: “RE: FDA recall.” Draeger Medical issues a Class I recall of its Infinity M540 system used to monitor vital signs, manage patient alarms, review diagnostic images, and access patient records. A bug in its drug calculation programming can cause it to suggest a tenfold overdose, with a conclusion that, “This product may cause serious adverse health consequences, including death.” The only good news is that the only customer was Rush University Medical Center (IL) and they used it for only three months.

From Barry: “Re: Epic. A market research report suggests that Epic is backing off its push for inpatient installations and going with an ambulatory-only sales approach to plant the seed for future inpatient sales.” That was reported by two consultants quoted in the report, with an additional consultant saying that Epic is getting some pushback from customers who question whether they’re getting their money’s worth. Leave a comment with your thoughts.

From Yolanda: “Re: commercial hospital IT databases used by HIT vendors. There are two, both expensive and swimming in self-reported hospital information, but so poorly designed that it’s a wonder customers don’t demand a refund. They are as unintuitive as EMR interfaces, both of them supported by product managers who will provide training and do user searches themselves for those who can’t figure it out. They are shockingly poor at how they deliver otherwise good information. A Seattle organization called DiscoverOrg has researchers who personally call IT organizations to understand their structure and contact information, but they cover only about 1,000 US hospitals.”

From Post Toasty: “Re: hosted EHRs. A company with tools that map practice EHR data to create a limited data research set is running into problems with certain vendors. The company has signed business associate and data use agreements with its physician practices, but some vendors won’t allow the practices to access their own EHR data. My take: check your contract, but only an ultra-lame vendor (i.e. most of them) would get in the way.” If you have examples of a contract or company communication that prohibits a practice from getting at its own data, send it over so we can collectively appreciate it.

From 143: “Re: Epic. Considering a full ban of cell phone use by employees who are driving while on the clock.” Unverified, but even making the practice illegal doesn’t seem to make much of a difference where idiots do everything from shaving to eating a plate of spaghetti while rocketing down the highway with minimal attentiveness. Banning would provide only one benefit that I can see given the difficulty in enforcement: if an Epic employee rear-ends someone while yakking on their cell phone, the company might avoid legal liability by whipping out the policy.

HIStalk Announcements and Requests

Dr. Jayne and I had a chance to share a cocktail recently. The conversation covered a wide variety of topics, including of course HIT, Mr. H, and shoes. I can’t share our insights on Mr. H, but I can say that we are hoping to sponsor a shoe-related charity event during HIMSS. If all works out as planned, you’ll want to leave room in your suitcase to bring a pair of gently used shoes to Vegas. Stay tuned.

Acquisitions, Funding, Business, and Stock

Telemonitoring IT provider MedAdherence secures a $150,000 pre-seed financing commitment from Connecticut Innovations, a quasi-public Connecticut state authority responsible for technology-based economic development.

Valant Medical Solutions, a Seattle-based startup that offers a web-based EMR for psychiatrists, raises $940K, increasing its total to almost $2 million. The company has 23 employees and 800 provider users.

Quality Systems announces that it has acquired EDI vendor ViaTrack, reported here on November 28.

Sales

Tidewell Hospice (FL) selects Allscripts Homecare and EPSi financial management solutions for its 8,000+ patients.

SA Health, the public health system of South Australia, will deploy Allscripts Sunrise Enterprise.

People

Brigham and Women’s Hospital (MA) CIO Sue Schade wins CIO of the Year honors from the New England chapter of HIMSS.

Announcements and Implementations

Dossia announces that six Fortune 500 employers have implemented its Dossia Health Management System.

Brookhaven Memorial Hospital Medical Center (NY) completes its integration of Micromedex CareNotes into its Siemens Soarian Clinicals platform.

St. Francis Hospital and Health Services in Maryville (MO) will go live on Epic on March 31, 2012.

Medicity launches its first iNexx payer app, Aetna Connect, for managing provider communications with Aetna.

HHS and Emdeon announce an initiative to donate EHR software and services to physicians in small practices in underserved communities in New Jersey. 

Eight New Jersey hospitals will go live on the Health-e-cITi-NJ HIE later this month, one of four HIEs in the state that received federal funding.

A private company, HIE Networks, announces the creation of the statewide Florida Health Data Network, with endorsements from the Florida Hospital Association and Florida Medical Association. The company was created after the involvement of its founders in developing the Big Bend RHIO.

An Ohio newspaper covers what local hospitals are spending on their clinical systems and/or how much HITECH money they hope to reap as a result. Summa spent $33 million and its Akron City and St. Thomas hospitals received $5.1 million in incentives. Akron General is spending $16.8 million and hoping to get $13-14 million. Aultman Hospital expects to receive $900,000.

Innovation and Research

Early results from a three-year, 6,200 patient study finds that telehealth monitoring reduced mortality rates 45%. The NHS-sponsored demonstration project also found that telehealth interventions reduced ER visits, admissions, and patient days.

A Florida doctor develops an iPad app that can program implanted cardiac devices, such as pacemakers and defibrillators, remotely and in real time, eliminating the need to have a manufacturer’s representative and a programmer on site.

Technology

CPSI announces that the CPSI System has migrated to a new system platform featuring a Linux operating system, an open source SQL-compliant database, Java, and a cross-platform user interface. The company also introduces a new logo that “is a reflection of both the continual advancement in system technology reflective of the CPSI EMR system and the Company’s broadened identity as a leading services provider to rural and community hospitals.” All that from a little logo.

Analysts speculate that the next generation of Apple’s iPad will reach the market sometime between February and April, raising the likelihood that for the second year in a row, you could win one at HIMSS that’s obsolete almost before you get home with it.

Kony Solutions launches KonyOne, a mobile platform developer solution that can create native and mobile web applications for all seven smart phone operating systems, tablets, kiosks, and desktops from a single application definition.

Other

Open Health Tools partners with Georgia Institute of Technology on an initiative to accelerate the use of HIT to benefit benefits and providers. Former National Coordinator Robert Kolodner MD, chief informatics officer at Open Health Tools, will serve as senior strategic advisor.

BCBS of Rhode Island reports that in a three-year pilot program, the use of EHRs reduced health costs 17-33% and improved quality outcomes.

Revenue cycle vendor SPi Healthcare expands its Greensboro, NC facility and says it will create 75 new jobs in the region over the next two years.

The Ohio Health Information Partnership announces that Ohio is the first state in the nation to send and receive health information across state lines using the Direct system. Physicians in Lima, OH and Biloxi, MS  shared the data across CliniSync, Ohio’s statewide HIE. Not to be picky, but why does Ohio get bragging rights for being first and not Mississippi?

John Bardis, chairman, president, and CEO of MedAssets and founder of Hire Heroes USA, writes an editorial urging his fellow CEOS to develop hiring programs for veterans returning from Afghanistan and Iraq:

As a private sector CEO, I come from and owe my opportunities to two generations of Americans who served proudly; one as a naturalized citizen. They sacrificed greatly for the freedoms that we enjoy – as have so many service members – leaving me with the enduring belief that our veterans deserve to return home to fewer challenges than the ones they faced on the battlefield. As CEOs and corporate executives, it’s our responsibility to do all we can to support those brave men and women when they return home by helping them transition into jobs where they can support themselves and their families, enjoying this country’s freedoms like the rest of us.

Eight former executives of Siemens are charged by the US government with conspiring to bribe Argentine officials with $100 million to secure a $1 billion national identity card program that was later scrapped. One of those charged was a former member of the central executive committee of Munich-based Siemens AG, marking the first time a board member of a Fortune Global 50 company has been charged under the Foreign Corrupt Practices Act. The SEC also filed a civil case against seven of the defendants. Siemens previously paid $1.6 billion to resolve earlier bribery charges. 

McKesson’s WARN act filing for its Horizon-related layoffs of 174 Alpharetta-based employees says the effective date for 158 employees is Friday, February 10, 2012. Jobs affected: software architect, business systems analyst, clinical healthcare content analyst, database administrator, project manager, QA analyst, software engineer, systems manager, and technical writer. I will temporarily waive my ban against leaving comments containing company information for those in a position to hire some of these folks, preferably located in the Atlanta area. Leave a comment with what kind of jobs you have and how they can get in touch.

A Boston Globe report finds that ventilator warning alarms have been responsible for 119 deaths nationally in both hospitals and patient homes since 2005, with patients dying because alarms were not functioning, unheard, or ignored.

Patients and friends of an Ohio doctor who still sees patients and makes house calls at age 100 celebrate his birthday in his “computer-free” office.

A CNN report covers the use by a California hospital of NICVIEW, a password-protected webcam system that lets parents see their NICU babies in real-time streaming from any desktop or mobile device.

The CEO of Mercy Health System of Janesville, WI defends his most recent annual compensation of $3.6 million, well off the $14.4 million the system paid him in 2002. “My salary isn’t going to affect your healthcare cost,” he told reporters.

Sponsor Updates

• The Orthopaedic Group (AL) selects the SRS EHR for its 36 providers.
• Ingenious Med wins its third straight Mobile Star Award in the healthcare category for outstanding mobile services and applications.
• Wolters Kluwer Health announces that its UpToDate Mobile for iPhone clinical knowledge system is a finalist for the Software & Industry Information Association’s 2012 CODiE Awards for excellence in the software and digital content industries.
• For the third consecutive year, MEDecision is named as one of the 100 Best Places to Work in Pennsylvania.
• Passport Health Communications selects MagneSafe Security Architecture and MagnePrint to enhance its eCashiering patient processing solution.
• e-MDs announces that two providers with Southwest Family Physicians are among the first to attest for Meaningful Use in Nebraska.
• ICA Informatics announces plans to participate in the Direct Project’s December 2011 Virtual Connect-A-Thon. The company also  releases a white paper discussing how technology can enable transitions of care.
• Navix and UltraLinq Healthcare Solutions partner to offer UtraLinq’s exam management solutions to clients using Navix lab services.
• Derby NHS Foundation Trust (UK) selects the Carefx solution suite as its patient portal solution.
• MedAssets assists the Texas Purchasing Coalition in generating $54 million in sustainable supply spend costs.
• Aspen Advisors releases a case study covering the Cardiovascular Information System readiness assessment it performed for Children’s Hospital of Philadelphia.

Contacts

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

Curbside Consult with Dr. Jayne 12/12/11

This is always a busy time of year, so I’m a little late reporting on something that could have a profound impact on health care. Last month, the United States Supreme Court agreed to hear challenges to the 2010 Patient Protection and Affordable Care Act (PPACA).

The briefing schedule was just released last week. It looks like briefs are due throughout January, February, and March. We can anticipate oral arguments before the Court shortly thereafter.

Although there is no way to predict when the Court will hand down any given decision, all cases argued during a particular term are decided prior to the summer recess, so we should have a decision by the end of June. The timing of this is interesting because it means there will be a decision right around the time the 2012 presidential campaign heads into its final months.

In announcing its review of the case, the Court is consolidating two pending lawsuits. Both seek to overturn the Act, with the primary question being whether the law is constitutional – in particular, the mandate for individuals to obtain health coverage.

Specifically, an appeal from the United States Court of Appeals for the Eleventh Circuit in Atlanta is aimed at reversing the decision that a three-judge panel made to strike down the mandate. The panel felt that Congress did not have the authority to do this despite their constitutional power to regulate commerce and levy taxes. This particular appeal dealt only with the mandate, however, and left the rest of the Act intact.

The other appeal attempts to overturn a decision in the Eleventh Circuit that ruled against Florida and other states on a challenge to the law’s expansion of Medicaid. The states also argued that Congress exceeded its reach by expanding Medicaid eligibility and coverage thresholds that states must adopt. Under the Act, states must meet new conditions or lose all federal Medicaid funds.

There are several different actions the Court could choose: upholding the law, striking down only that provision, striking down other elements, or striking down the entire law. In a bit of a twist, they are also considering another issue coming out of the Fourth Circuit (Virginia) which could delay a final ruling until 2015 when penalties take effect and the ability of individuals to challenge the individual mandate becomes timely.

There are a total of 26 states challenging the law. Given the polarization the law has caused, this is sure to be one of the more electrifying cases heard this year. In anticipation of the significance of the issue, the Court scheduled more than five hours of oral arguments instead of the usual one-hour argument. They will hear two hours of argument on the issue of overstepping constitutional authority, an hour and a half on whether the mandate can be separated from the rest of the act, an hour on the Medicaid issue, and an hour on the issue of whether it is premature to decide the case.

Regardless of the outcome, it will be interesting to see how the presidential candidates react, not to mention how those battling on both sides of the aisle of Congress will react. For those of you who have a hankering for primary source material, briefs and orders are posted on the Docket page of the Supreme Court website.

Have a question on the branches of government, touring Washington DC, or where Associate Justice Ruth Bader Ginsburg gets her kicky jabots? E-mail me.

E-mail Dr. Jayne.

HIStalk Interviews Michael Weintraub, President and CEO, Humedica

Michael Weintraub is president and CEO of Humedica of Boston, MA.

Tell me about yourself and the company.

Humedica is a business that, in addition to incubation phase and the launch of the business, has been around for roughly five and a half years. We formally launched the business in 2008.

Our vision is around population health business intelligence solutions. The founders of the company, the members of the team, and I have been working within and around health informatics, health analytics for anywhere from 20 to 30 years. I’ve been in this space for about 30 years and have always been passionate around the need to get our arms around health information to drive value and change in the industry. That’s what this company is all about.

Our focus is in moving from electronic data to liquid access to information and doing that across the continuum of care longitudinally. Our view is that there are a lot of solutions out there that are brought to the industry, but there was a need for an organization that’s focused passionately and exclusively focused on bringing together all the disparate clinical financial and operational data across the continuum of care. That includes hospital information, and importantly, ambulatory clinic data in multi-specialty medical groups. Pulling that information together in a centralized business intelligence analytic way that allows a chief medical officer, VP of quality, CMIO ,and others in the organization to get their arms around the population that they treat across the continuum of care. That’s what we’ve been aiming to do since the beginning. That’s our focus, our vision and our mission. So far, so good.

Your timing must have been fortuitous. Not too many folks were interested in population health management back in 2008.

I’ve always said that it’s 51% luck at a minimum. You know the old saying about, “It’s heavily perspiration and a bit of inspiration.”

I’ve been working with claims-based information for quite some time and saw what the opportunity was with that data, as well as the limitations and the future need. I’ve always said with a smile on my face that when we started this company, Obama was a senator. If you watch the trends out there, we had a hunch of what was coming together.

Earlier in my career, I spent 10 to 15 years working with clinical data in the provider setting before EMRs. I was involved in companies that were successful when it was about chart abstraction and at grabbing that information using medical record coders and doing analytics on abstracted information. For me, it was the coming together of a distinct need around clinical information earlier in my career and then seeing the movement in technology and the availability of information as we moved from chart-based data to then, “What can you do with electronic data on the claims side?” to then coming full circle to, “What if that data actually was electronic?”

When we started the business, EMR penetration was somewhere in the high single digits. We saw what was happening in the industry with some of the leading EMRs starting to really accelerate. We were watching the technology and regulatory movement and thinking about the opportunity. If you think about what’s happened in the industry, health reform has really driven technology and EMR penetration based on the incentives and the ultimately the disincentives if you don’t have an EMR. Health reform has been a driver to technology adoption.

On top of that, from a regulation and finance perspective, i.e. healthcare reimbursement, there’s a real focus on operational efficiency and clinical effectiveness as key drivers,  more so than ever. Based on regulations and finance as a key driver and technology, we saw this coming.

The healthcare industry is really looking more and more like it needs to manufacture value at an operational level. The financial system, risk-taking, and reimbursement are all moving more and more into an alignment that – and perhaps I’m an eternal optimist of an entrepreneur — but I really believe that there’s an efficiency and effectiveness requirement as it relates to outcomes and the need to truly measure quality and cost. That starts from moving the needle to looking at data to truly transforming that data into information and ultimately into insight to drive action.

My 30 years in healthcare have all been focused on building – once upon a time we called it decision support tools, now we call it business intelligence tools – building analytics that leverage the transactional data that moves through the pipe and taking it to the next level. I think the DNA of an informatics and analytics company is very distinct, and that’s been our focus. We leveraged what we saw happening at the technology level and a regulatory and financial system level.  

We can all discuss and debate how long that will take to change and what the slope of that curve will be, but I’m optimistic more than I’ve ever been that the drivers are in place to force the focus. I think that the macroeconomics are such that sustainability is on people’s minds, more than ever before as the national spend on the healthcare industry … 20% of GNP is not out of the question anymore. The question becomes, what is sustainable? Are we getting to a true tipping point that creates the motivation for change?

Hopefully the regulatory drive and the changing economics create the focus. I’m sure it will take longer than we all want and I’m sure there will be a lot of bumps in the road, but for me, I felt that the opportunity was there to build Humedica into the kind of company that I felt could drive the value. The need is there.

The company was initially called HIT, Health Insight Technologies. When Obama and others started using that term more and more, we realized that that name would not survive, hence the focus on human medical, or Humedica, to understand to the patient experience in the healthcare delivery system across a continuum of care and be able to study it at the population health level.

A lot of companies offer business intelligence tools, including some big ones. Who are your main competitors and how are your solutions different?

I say this as a member of the healthcare industry, not criticizing it from the outside-in, that I believe that there’s a significant level of sorting out and confusion occurring now. The focus up until now and continuing for the next several years will be EMRs. Do I have the right one? Should I switch to a different one? Do I have one? Do I need one? How do I get one? There’s a huge focus on EMRs.

Certainly the next phase after EMRs is, “What do I do with the data?” There’s a big difference between transacting with the data at the point of care versus doing the analytics that we do. The industry right now is in a period of sorting out. There’s a bunch of major buckets of firms out there that all touch and talk about analytics.

What’s interesting is clinical analytics and business intelligence was a concept that was not anywhere near as strategic as it is today. The good news about health reform is it has made this strategic. The bad news about it is it’s made it so strategic that there’s a sorting out occurring that’s causing the provider industry to sort out what it does about this.

If you look at the buckets of firms that all touch this, there are EMRs, and more and more of the EMRs are saying, “Don’t worry, we’ll get to this.” We believe that there’s a distinct difference between a specific EMR, whether it’s touching some of the data or more of the data in a provider, but many providers have multiple EMRs, whether it’s within the inpatient setting or inpatient versus outpatient. Cutting across and pulling it all together is a very different value proposition.

But there are EMRs that are all suggesting, “We’ll get into this over time.” I believe that they have their hands full right now. It’s like Y2K for the EMRs. There’s so much activity. I don’t believe the providers can wait for that to be developed, nor do I believe that software firms — as opposed to analytics and informatics firms — have that as a distinct competency. There are claims-based firms out there that do analytics with claims, and many of them are now repositioning as population health, ACO, etc. but there’s a distinct difference in looking at this information for population health with claims versus clinical data.

There are firms out there that are systems integrators and data warehousing firms like Oracle, IBM, Accenture. They end up oftentimes being more our partners than our competitors for a variety of reasons. There are regulatory reporting tools that touch on population health, but they’re more focused on regulatory reporting. There are application-specific firms that provide clinical data that are very narrow and specific in application. There are health and information exchanges and vendors as well that are pulling all the data into a common pipe as opposed to doing the analytics. We are starting to partner more and more with many of the firms in each of the categories. There are business process outsourcing firms that are now building clinical process redesign competencies, again partnering with us more so than competing.

We were the first to purely focus on clinical analytics. I believe we have years of lead time from a development perspective and from a competitive advantage in that regard. Competition is good. It creates a focus on best-of-breed and advances the capability on behalf of the industry. But there is no single firm out there that is distinct with and purely focused the way we are, but there’s certainly a buzz where every major firm and lots of boutique specialty firms are all positioning and or repositioning as population health and ACOs. I’ve seen many of the firms eventually complementing with us, collaborating with us right now more so than competing.

Allscripts is now a Humedica partner. What competitive advantage led Allscripts to that decision?

It’s a tremendous and terrific partnership. It was driven by the leadership and boards of the respective companies. Many Allscripts customers have multiple EMRs, and Glen Tullman, CEO and Lee Shapiro, the president, and I have a very common vision on the need to move towards an analytics and informatics foundation. Allscripts has branded Humedica within their business as they go to market as, “Clinical analytics powered by Humedica.”

When they saw our offering, they saw best-in-breed capability that they felt would create value for their customers and our mutual customers. What we saw was an opportunity given the accelerated movement of the industry in focusing on this. They’ve got an inside and outside sales force combined of 600 people and growing. What we saw was an opportunity to go to market faster, better, more effectively and more efficiently.

We’ve been working on that partnership for several quarters. I believe you’ll see the fruits of that over the next one to two quarters in a very significant manner as we start growing some mutual customers together based on our products and their sales channel. It’s been phenomenally successful thus far.

What are clients doing with your real-time capabilities?

There’s one product on the market and there’s one product in development. In the inpatient setting, the product is being used for clinical surveillance. In the hospital setting from a CMS perspective, regulation is such that 30-day readmissions and preventable readmissions complications will not be reimbursed. From a clinical surveillance perspective, tools are up and running in a hospital setting and key therapeutic areas.

The product in development has the capability to provide real-time surveillance in a clinic or ambulatory setting focused on proactive patient management in chronic ambulatory areas, stratifying risk and focusing on a Patient-Centered Medical Home, which more and more of our multi-specialty medical groups and clinics are focused on.

Your recent financing around raised your total a pretty big number, over $50 million. How have you invested that money?

The first round of capital was used in the formative stages of the company’s development, the first three-plus years to devise, develop, and deploy what we believe is a world class product portfolio for the provider market and to get validation from our customers in that regard. We believe that’s a huge competitive advantage and a sustainable barrier vis-a-vis the competition.

As we’ve gotten that validation, a few months ago in KLAS’s market research 300-page report, we received the highest rating of any business intelligence firm, with a rating of 91.8. A new category was created, essentially a clinically powered category where a solution has clinical capability, based on their discussions with our customers. All our customers in that report said they would buy again.

The first round of capital was really focused on building the most innovative capability possible. The second round of financing is focused on commercialization in a very significant manner. We currently have customers in roughly 20 states, but our ambition is significant. We want to bring this offering to the market at large. That meant a sales force, field organization,  customer organization, managing our channel partners, which includes Allscripts as well as the American Medical Group Association. That round of capital was meant to exploit the capability and partner with a provider market in a broader way to accelerate bringing this to market and managing a growing client base.

You came from Leerink Swann. What experience did you gain there that will help you build Humedica?

Leerink Swann is an investor in the company and provided the organizational platform that we were able to incubate this business. I was there for a short period of time, only about a year and a half. The majority of my career has been focused specifically on entrepreneurial activities such as this one. Leerink clearly has an exclusive healthcare focus and they’ve provided tremendous value as an investor and a board member as well, but it provided the platform where we were able to incubate this business, pull together a team, and spend about a year to a year and a half prototyping and thinking hard about how to bring these solutions to the market.

Where do you want the company to be in 5-10 years?

We’re at an important point. We have a partnership with Allscripts, which is a leading EMR. We also have a phenomenal long-term partnership with the American Medical Group Association, which has members in almost every state in the country and its membership treats one on three Americans. What we would like to be is the de facto leader in bringing health informatics insight at a population health level to the provider industry as they get their arms around their organizations managing cost, quality, and risk and compete.

The pressure on these providers is significant. They’re making significant investment in technology and now they’re ready to harness, we believe for the first time, all of this information to study and enhance and improve their operation as they bring world class care to their customer, the patient. That’s our vision.

We’re very, very excited about what’s happening in the industry. The activity level is at an all-time high. We think 2012 is going to be a mainstream year, where clinical informatics and business intelligence become a significant initiative for more and more providers in the US.

Monday Morning Update 12/12/11

From Dr. Boogie: “Re: Gwinnett Medical Center (GA). Goes on total patient diversion due to a computer virus. Physician portals impacted, hospital systems shut down. News media says no patients were impacted. Using old fashioned paper until systems can be resurrected.” Verified. They’re using paper and runners, with campuses in Lawrenceville and Duluth still on trauma diversion this weekend after the virus was discovered Wednesday, meaning ambulances are being sent elsewhere. They hope to have the problem fixed by Monday. For the nerds among us, they were hit with SillyFDC, a worm that spreads on removable or mapped drives that have Autorun turned on. It supposedly spreads without doing harm, but having seen similar worms take down hospitals myself, I’d bet it generated so much TCP/IP traffic that the network bogged down, requiring field support techs to touch every PC with network nodes isolated to prevent the virus from propagating right back from another unfixed PC. One thing you learn: antivirus software on individual PCs can tell you if they are infected, but they don’t tell you at a network level which PCs are spreading it, so you end up looking for network traffic patterns and isolating devices one at a time. Thus, A/V tools are of limited benefit, especially if users just ignore their messages like they usually do.

From CC: “Re: Validus handheld e-prescribing tool. Has been acquired, but they won’t say by whom. An employee told me and said it was hoped the news would not appear in HIStalk, but loyalty to HIStalk got the better of me.” I assume that’s Validus Medical Systems, quietly acquired by Imprivata in July 2011. They offered a mobile order entry app for hospital physicians that Imprivata either isn’t marketing or hasn’t repackaged yet since I see no mention on Imprivata’s site. We can take joint responsibility for disappointing the folks who hoped not to see the news here.

From Petaler Dan: “Re: Quebec’s medical error registry. Here’s news on how hospital mortality rates have fallen, although it doesn’t cover Quebec. And here’s Montreal coverage on the report and how mortality rates have decreased significantly — scroll toward the end for quotes on surgical checklist implementation, which is reassuring.”

From McKesson Horizon Client CIO: “Re: McKesson. To employees affected by this latest turn of events, you worked very hard over the last several years and your dedication to the customer base did not go unnoticed. You are collateral damage from mismanagement and lack of a principled leadership. For the patients you helped me and my team serve, thank you and best of luck.”

From Uggams: “Re: GE and Microsoft. This is a Microsoft healthcare surrender flag. Somehow they convinced GE to help them bury the bodies. Michael Simpson’s only relevant experience was running Horizon Clinicals for McKesson, ironically mercy-killed the same day he was announced as CEO of the new GE-Microsoft home for dying products. Sentillion had solid, well accepted products, but was especially aggrieved by the meddling of its Microsoft masters, and now they are cast aside with products and vague ideas that nobody cares about.” That’s the biggest disappointment to me. Microsoft had insinuated that Sentillion’s products would find mainstream Microsoft use. Now it’s relegated to the group that includes some GE-Intermountain screwing around that never seems to provide any real, marketable products (are those Intermountain-led Carecast enhancements just about done?) and some GE products that, to be honest, I’ve barely heard of. I don’t think anybody really believes that Microsoft is growing its healthcare business rather than retreating from it, so that leaves GE’s track record as a nimble innovator to make something happen. But I’m going to stop being cynical and give them six months to show some progress, with my hopes that they really can do it. We need some new stuff to talk about since Epic and Meaningful Use are getting repetitive.

From Ex-Tele: “Re: TeleTracking. Anthony Sanzo, former CEO of AHERF, has stepped down as CEO of TeleTracking.” Verified by a company spokesperson. A search is underway for his replacement. The interim CEO is Michael Zamagias (above), board chair of the company.

From Booth Monkey: “Re: Meditech exhibiting at HIMSS. Something must have happened to get them back in. As a silver corporate HIMSS sponsor with mega-sponsor points, those of us who worked our way to the top of the exhibit booth selection process would start over by dropping out, so look for them back on the corner wall by the bathrooms. So it is with those who dare to thumb their nose at HIMSS, as it was in the beginning, is now, and forever shall be, HIMSS without end.”

Listening: I was in the mood for some slow-dance kind of doo-wop, one of my favorite musical forms even though it was popular only before my time and most of the original performers are dead now. Among my favorites: The Passions, Earl Lewis & The Channels, The Schoolboys, The Skyliners, The Excellents, and The Shields. I always plan to listen to just one song and end up playing them all afternoon. It’s a triumphant and truly American form of vocalizing, drawing from gospel and rhythm and blues and performed by untrained, uneducated, largely forgotten blue-collar part-timers crossing every ethnic and racial line who were working for nothing because record companies were robbing them blind (for many of the records, the performers are anonymous because nobody at the studio cared enough to even write down their names.) I defy you to listen to The Closer You Are, Just to Be With You, or  My True Story without joining in with your own background harmonies.

Thanks to the following sponsors (new and renewing) that supported HIStalk, HIStalk Practice, and HIStalk Mobile in November. Click a logo for more information.

We can learn two two facts from my last poll:  (a) around half of respondents went to the most recent HIMSS conference, and (b) about the same percentage will attend the next one. Not exactly earth-shattering news. New poll to your right: what do you think about McKesson’s Better Health 2020 plan as described by MPT President Dave Souerwine in my Friday interview? The great thing about having a lot of well-informed readers is that companies can get immediate and broad feedback that’s not available anywhere other than HIStalk, so here’s your chance to provide it (and feel free to leave comments on either the interview or the poll if you’d care to elaborate).

I don’t want to get into the placement business for displaced McKessonites who are among the announced 174 employees who may lose their jobs, but another company has already e-mailed me looking for high-level marketing people from there. E-mail me.

Speaking of HIMSS, HIStalkapalooza is on: Tuesday, February 21 at FIRST Food & Bar at The Palazzo in Las Vegas. I’ll have more later, including opening up of the invitation list sometime after New Year’s. Our soon-to-be-named sponsor is doing a great job with the planning and has bought the place out. We’re going for a fun but networking-friendly vibe. The stage show will include our King and Queen contests with Lindsay and Greg again; people running around in beauty queen sashes for no apparent reason; some kind of contest or charity fundraiser that Inga and Dr. Jayne are cooking up to which I’m not really privy (I suspect shoe-related activities, which is great for the guys since the ladies come dressed to kill); and of course the HISsies awards. Put it on your calendar and watch for the announcement in a few weeks.

My Time Capsule editorial this week from five years ago: Sounds Like Somebody’s Industry Has a Case of the Mondays. “Nobody seems to be innovating anything. Everybody claims big R&D spending, but the products are starting to all look alike, kind of a no-nonsense 1980s Soviet Union version of software by committee. Or it could be their customers, blaming everyone except themselves for poor ROI.”

Here’s a scoop from our official friends at Cerner: the company (like Meditech) will be exhibiting at the upcoming HIMSS conference after sitting out for a few years. I’ll be talking more with them soon to get the story. They said customers wanted to see them there, which doesn’t surprise me.

Quest’s Care360 EHR is named the top standalone e-prescribing platform by Black Book Rankings. Above is a demo of its iPad version, just because I happened to see it on YouTube and it’s new.

Some of my favorite “why doesn’t every vendor offer this” tools are plain old Google-like EMR search tools that physicians can use to get quick answers from electronic medical records. Mass General goes one step further with QPID, a semantically driven variant that can perform searches by concept and not just keyword.

Here’s an example of why you don’t want your company to go public: analysts warn Scottish CDM software vendor Craneware that if it doesn’t want to see its stock price drop, it needs to announce a big sale in the next three weeks. So is the message to give whatever ridiculous discount is required to convince a hesitant prospect to sign on the line which is dotted? Is that end-of-period timing so important that signing a money-losing contract quickly is still a good idea?

Here’s Vince’s latest HIS-tory, this time on boutique consulting firms. Dorenfest, Kennedy, Johnson, Weil, Levine … fascinating stuff. He names some 1985-era individual consultants and admits to never having heard of any of them – have you? It puts your own legacy and mortality in perspective when looking at names from just 25 years ago and wondering how their lives turned out, where they are today, and how their work fits against the backdrop of history.

Weird News Andy urges Hollywood to pay particular attention to this article since both smoking and breast enhancements are common there, fearing that the result during a strong wind could be “a nip in the air.” A plastic surgeon warns breast augmentation surgery patients to avoid smoking afterward since nicotine and carbon dioxide can disrupt blood flow and can “cause her nipples to turn black and fall off.” WNA also likes this story, even though he worries that patients might be admitted as brunettes and discharged as blondes: a new and promising method of room disinfection involves pumping ozone and hydrogen peroxide into a room to sterilize everything in it.

Inga asked our sponsors to share any charitable works, celebrations, or other notable holiday-related events going on at their places. Here’s one to get us started: BridgeHead Software and its 25 US employees donated $1,000 to Youth Villages Holiday Heroes, which matches the wish lists of disadvantaged children with sponsors who provide them. Kudos to them.

Employees of chiropractor PM/EMR vendor Redpine Healthcare Technology of Panama City, FL ask county commissioners to help them get overdue paychecks. The company’s CEO says he’s trying to find an investor, but employees were last seen packing up their cubes and nobody’s answering the phones. The county says it’s going after the $350K it gave the company to relocate there, which came with a guarantee the company would add at least 150 jobs over three years. The county has a lien on the software.

Struggling New River Behavioral HealthCare (NC), behind on payments to the guy who wrote some Meaningful Use enhancements for its eNotes mental health records system, faces loss of access to all of its records if it can’t pay up quickly.

Here’s one of the dumber articles that attempts to explain the Microsoft-GE JV. The article itself is obviously a typical no-value-added rewriting of the press release to make it sound like authoritative reporting, but how about that headline?

E-mail Mr. H.

Time Capsule: Sounds Like Somebody’s Industry Has a Case of the Mondays

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 December 2006.

Sounds Like Somebody’s Industry Has a Case of the Mondays
By Mr. HIStalk

Is it just me, or is the industry in the doldrums? The news is boring, optimism is in short supply, and both provider and vendor people seem to be uncharacteristically cranky and burned out.

What happened? Just a few months ago, we were on what looked like an unstoppable, exhilarating ride. Everybody was talking about healthcare IT and momentum seemed to be building toward something cool. Now we’re just trudging joylessly along.

Maybe everybody is just hunkering down to get the jobs done that were promised back then, moving us into the less-sexy execution phase from all the high-profile jabbering. That’s good, at least for awhile.

No, I think I’ll blame RHIOs for the industry’s malaise. Like a furnace in winter, it takes a lot of energy to keep that RHIO hot air flowing. Even though most of us don’t have anything to do with RHIOs, it seems like our collective focus has swarmed around them like mosquitoes to a bug zapper.

Or maybe it’s ambulatory EMRs. It is apparently the 11th commandment that ambulatory EMRs are to be “hot” and “inevitable,” except for the vast majority of physicians who still refuse to use them. Once again, we ground troops who are locked in long, desperate inpatient CPOE and clinical systems wars that were started before this latest round of new ideas were conceived have been forgotten, but we’re still holding our own deep behind enemy lines.

Speaking of which, maybe the big hospital applications vendors are bringing us down. Nobody seems to be innovating anything. Everybody claims big R&D spending, but the products are starting to all look alike, kind of a no-nonsense 1980s Soviet Union version of software by committee. Or it could be their customers, blaming everyone except themselves for poor ROI. Nobody’s shaking anybody up.

Maybe it’s the government. Brailer’s gone and no one wants his job, Hillary’s threatening to run for President, and the politicians who promised big IT spending took their (our) money elsewhere.

Company mergers and acquisitions … that’s the problem! Instead of highly strategic, widely cheered absorptions of great little companies by bigger and better ones that energize employees and shareholders, it’s mostly one boring and struggling company being acquired by another, with misplaced expectations of synergy.

Maybe it’s poor management or lack of real strategic planning that’s forcing a “work harder and like it” mindset, just as a new generation of workers makes it clear they won’t be motivated by fear or the desire to help a few company insiders line their pockets.

Whatever it is, I’d like to see it fixed. Not enough people are having fun in healthcare IT. They’re taking themselves too seriously, stifling their own creativity and everyone else’s, and breeding a risk-averse culture that’s exactly what we don’t need just as the world realizes we’re 20 years behind. We’ve got a bunch of self-important stiffs in suits and no one wearing lampshades on their heads, more like General Motors than Google.

If you’re a person or a company with fresh ideas, a sense of humor, endless creativity and resourcefulness, and a passion for patient care, we need you desperately. Bring on your innovation, new ways of looking at old problems, and a passion for doing something other than propping up the company’s stock price.

Like the line from the movie Office Space, I think somebody’s having a case of the Mondays. Lately in healthcare IT, it’s been lasting seven days a week. Still, as it always does, this too will pass.

HIStalk Interviews Dave Souerwine, President, McKesson Provider Technologies

David A. Souerwine is president of McKesson Provider Technologies.

Tell me about the impact of the just-announced Better Health 2020 program on McKesson’s IT investments and portfolio.

I know you’re pretty conversant in this space, obviously, so I’ll tell you some things you probably know. If I was asked that question by a less-informed person, I think I’d give it some broader perspective.

There’s a huge amount of focus that a lot of people give to HIS/CIS, or what a lot of people call core hospital systems. A lot of what we announced in MPT was around products in those two areas. But more broadly, what McKesson has been attempting to do over a long period of time is to create an entire technology portfolio that’s second to nobody in the industry. We’re now very focused on trying to develop products and services that will best meet healthcare reform and all the various regulatory requirements that are hitting not only our hospital customers, but because of the blurring of settings of care, also for physicians, for long-term care, for home care.

We have a large payer business. We have a large connectivity business, both in clinicals and financials. We have a connectivity business in pharmacy, which a lot of people know, but a lot don’t. We handle about 90% of all the pharmacy transactions in the country on a daily basis, so it’s a huge volume business.

The announcements that you’re now familiar with and that some of your readers started to comment on yesterday wrapped underneath a broad McKesson Technology Solutions banner that we’re calling Better Health 2020. You can interpret the 2020 as either a decade from now, where we’re trying to help customers in a very uncertain environment navigate to the best financial and clinical endpoints they can, or you could also interpret as good vision, 20/20. We think we’ve got a good sense of where the market’s leading and progressing and what we need to do to help our customers get there.

The broad agenda, Better Health as a corporate communications platform, refers to better business, better care, and better connectivity. Those are the three broad planks. I’m sure you’ve undoubtedly seen either our employee letter or our customer letter, which are pretty similar. Underneath that, we went on in those letters to describe four areas that we believe are critical success factors.

The first one is the ability to improve patient safety and deliver better clinical and financial outcomes through fully integrated core clinical and revenue cycle IT systems with a highly competitive total cost of ownership.

The second one is a reduction cost of operations, which includes pharmacy automation, supply chain analytics, and performance management.

Third is better care coordination through connectivity across the healthcare ecosystem of diverse stakeholders and IT systems.

The fourth is the ability to manage increasing complexity and risk, bundled payments, and structural relationships, because our view is there’s a lot of experimentation that’s currently going on in payment solutions, but the risk is definitely shifting towards the provider and potentially hospitals. Our customers are going to have to survive on Medicare levels of reimbursement. There’s a shortage of personnel. They’re going to have to take costs out continually. We have to have a lot of assets helping them manage through that complexity and risk.

On Better Health 2020, the other major part of that announcement was a commitment that we have across our technology businesses. It’s not an investment in Paragon or Horizon or any particular application. It’s a commitment across all of our technology assets to invest a billion dollars in research and development over the next two years, which is a really big commitment in this area.

We are sunsetting no products. We have several products outside our core clinical suite. At one time, we had renamed a lot of our imaging products under the Horizon banner. We have several that now reside in a performance management business and in our analytics capability that are called Horizon. Over the next few months, which we already had underway before these decisions were made, we’re renaming them under the McKesson brand name, just so that there’s not confusion in the marketplace related to Horizon core clinicals.

The changes that we made in strategy were just around that core clinical suite, which we put into hospitals. It’s about 30 different products that we sell under that Horizon brand name. Those are the ones where we’re making a strategic shift away from Horizon to Paragon, but nothing is being sunsetted.

In fact, I’ve gotten several questions, including from my own employees, about the relative investment. We’re continuing next year to put more into the Horizon clinical suite than we are into Paragon. There’s still a big amount of money that’s being spent beyond Horizon. We want to leave our customers with options. If they want to stay on Horizon, they certainly can. If they want to switch to Paragon now, they can. If they want to wait and assess how that roadmap develops over the next 30-36 months, they can. That product will be around for a long time. We’ve made no firm decisions on end dates or sunsetting in any way, shape, or form.

You mentioned a reduction in total costs for customers. I got the impression that there might be some bundling of McKesson offerings under an umbrella that will collectively reduce costs.

I’m not sure what that reference is to. We would tell you that we believe with certainty that the total cost of ownership for Paragon as a hospital HIS will be less than Horizon and will be less than Cerner and will be less than Epic. There’s nothing that’s changed internally in terms of corporate structure or movement of products between or amongst divisions that would create any kind of bundling. The customer still has the ability to choose solutions that are right for either gaps in their current portfolio, or if they want more capability from one vendor, we would portray that we have the broadest selection. You can get connectivity, population management, risk management, care coordination, analytics, and your HIS from one place, which is McKesson Technology Solutions.

The billion dollars in R&D that you said was collective across all the platforms. How much more is that than you’re spending now?

The reason we positioned it that way is there’s a huge commitment that the corporation is making. It’s larger than what’s been spent in the past, but I want to draw the distinction that it’s not an incremental billion, it’s just larger than it’s been in the past. It encompasses McKesson Provider Technologies, RelayHealth, and our health solutions payer and physician business. It’s all the technology components.

That said, the majority of that expense will be in MPT. MPT includes six business units. The Paragon business unit. Health Systems Enterprise Solutions, which encompasses the legacy as well as Horizon Revenue Cycle and also the Horizon Clinicals business. It’s our enterprise imaging business, which is out of Vancouver. It’s pharmacy automation, which is out of Pittsburgh. It’s Health Systems Performance and Analytics, which is a separate business unit that we stood up at the end of last year to help customers get a cost efficiency and reduction. And then we have a managed services business, which includes hardware, outsourcing, and remote hosting that cuts across all of those offerings for MPT. It’s not a homogenous thing, it’s actually six business units that we put under the Provider Technologies banner.

Is the billion dollars double what it’s been, or something less? I’m trying to get a feel for the magnitude of increase.

It’s not double. It is an increase.

Sorry, I interrupted you there.

Within MPT, I would tell you that the five key messages that came out of the change from yesterday are the commitment in R&D underneath the Better Health 2020 banner . Within MPT, we’re planning to converge our revenue cycle core clinical solutions around Paragon’s Microsoft platform. We’ll significantly increase the investment in that platform. We’re finding it increasingly difficult and not in the best service of our customer needs to continue to develop two very complete clinical and revenue cycle systems. They’re on two very different platforms.

All the Horizon stuff is on Java and Oracle, so it has a higher total cost of ownership. The evolution of that product was around very fully functionally rich products in an environment where a lot of hospitals were making decisions on a best-of-breed basis. We’re finding today almost all customers are making combined decisions to get to an integrated clinical and revenue cycle platform. The decision was largely around how do we get more focus on our investment to reach product endpoints that will serve the needs of the customer better.

You know through a lot of the comments on your own blog that we have struggled with the Horizon upgrades and some of the product commitments over the past five years that we’ve made to the marketplace. We just believe we’re going to get to a fully integrated, lower total cost of ownership, fully functional solution for customers that’s completely competitive in the market with the Paragon solution as the basis rather than continue to invest in two completely functional HIS/CIS.

There’s been some question around when we say converge, are you really putting the platforms together? No. The convergence is really around taking the best capabilities from Paragon and the best capabilities from Horizon and creating one integrated system with a lower total cost of ownership than what we have today.

The third key message from yesterday was that based on that decision, we have stopped development on Horizon Enterprise Revenue Management, which was a separate R&D project that’s about seven years old, maybe eight. It’s been going on for a while. That was just based on we believe with the capabilities Paragon has today, plus some fairly minor enhancements, that we can get a capability that’s integrated with a lower total cost of ownership in a shorter period of time than we’d have gotten customers there under the Horizon architecture. We haven’t shifted away from next-generation revenue cycle, we’ve just shifted to putting it on Microsoft architecture. Most of the products under Technology Solutions, about 70% of capability today, is also on Microsoft architecture, so we’re just trying to get synergies and better integration points across all of our solution set and that will become a higher percentage in the future.

The fourth thing that we’re trying to make very clear, particularly to our Horizon customers, is that we remain fully committed to the Horizon base. There’s a huge amount of work to be done there, including getting those customers to be ICD-10 compliant and then getting them through the various stages of Meaningful Use, which we are continued to be committed to do. We’re not sunsetting anything. We will actually spend a huge amount of resource developing those capabilities and getting our customer base upgraded over the next three or four years.

The fifth message is that we’re more confident than ever that we’re in a position to get our customers through Meaningful Use and will better position them than we believe anyone else in in the market, in terms of capabilities from one company, to get our customers through Stage 3. We believe that with our R&D focus now shifting to what’s next, that we’ll be able to continue to invest and improve deployability and support for them today and much enhanced capabilities in the future.

The CIOs that I talk to say time and again when I ask them, “Why are you buying Epic?” — and cost doesn’t seem important to them — it’s because it’s the only vendor with a single patient record that not only crosses ambulatory and the inpatient sides of the house, but also has top-ranked modules on both sides. Can Paragon deliver that?

We believe so. There’s a detailed roadmap. Paragon today is probably a lot more capable than people realize. It’s been best in KLAS for the last five years. We suspect it will win shortly for the sixth year in a row. It has a really high customer acceptance and rating. It scales up, so they also have larger customers today.

We went through a lot of work over the last year to make sure that we had line of sight so that features and functions and just general capability, including technology, that was going to be necessary to be able to claim that this was competitive with Cerner and Epic’s capabilities in this space. We think we will get there. By the time anybody starting today would be able to convert to Paragon, even if they made an immediate decision, the emergency room and ambulatory features of Paragon will be completed. It’s very capable today.

If a customer wants imaging capability or automation capability or analytic capability or health information exchange capability, we can attach McKesson solutions directly to Paragon to do that. They have a very high attachment rate of our other solutions, and those will continue to be more integrated into Paragon as time progresses .

Is anything actually being created from scratch? It sounds like there’s some porting of functionality from Horizon to Paragon and adding some modules. The criticism of McKesson is that they never build anything, they just keep tweaking the same old stuff except for the example of HERM, which was a pretty expensive failure, at least other than the intellectual material from it that you can port to different technologies. Are you building brand new, from-scratch products?

Two different answers to that question. One is that a lot of the individual application modules inside of Horizon Clinicals were variations in products that had been purchased and put into the Horizon Clinicals suite. I think that’s where the perception comes from that we don’t build anything from scratch. Some of that stuff was built, but a lot of it was purchased and put into that suite.

The development of the current version of Paragon started 11 years ago and all those applications were natively created. That stuff was built. There’s been nothing that’s been purchased. It’s been built in a way so that it’s on one database. It is fully integrated. It’s what I’m sure you over and over have heard Horizon customers asking for — how do we get to true integration and how do we get lower total cost of ownership and how do we get to an easier upgrade path?

Our customers can download whatever upgrades they need from a capability that we have internally called Download Central. They put it into their test environment, they test it until they’re satisfied with it, it moves into production. It’s not an invasive process. It doesn’t require a lot of support people to be on site. You know the experience on the Horizon side is quite different from that.

I wanted to point to you too that when I was flying back from Colorado, I saw a comment, I don’t know if it was from you or one of your readers, but the HERM decision was not around the failure of that product. We actually believe we could have gotten to a successful solution, but with the capabilities and rev cycle that we already have inside of Paragon, we didn’t see a reason to continue to rewrite the Horizon version of that product.

For the people that were affected by that decision, there is a redeployment process inside the company that started with the announcement yesterday and goes through next week. There’s openings in many different parts of our technology businesses and we believe that we’ll be able to redeploy many of those people into other areas of the company.

Just like always happens, when jobs are open and an employee wants to move from Charlotte to Alpharetta or vice versa, or they want to relocate from Colorado to Alpharetta or vice versa, there’s a relocation policy that does that if they apply for an open position. We would consider them. The downsizing happened because of the strategic decision to just focus on the one platform, but that does not mean that the people that have good capabilities that want to stay with the company will be displaced.

Do you have a feeling for the specifics of how many people will be RIFed out and how the total headcount will change?

There was a public filing, which we’re required to make, that talked about how 174 people were displaced on that team. That’s how many were actioned that first day.

We have more than that many openings in our technology businesses. It’s going to be a matter of their level of interest, if they decide to stay, whether they’ve got requisite skills to fit into those areas. We have onsite hiring managers form the businesses with openings to talk to those people starting next Tuesday. We believe that we’ll be able to redeploy many of them.

From a timing perspective, it’s somewhat late in the Meaningful Use game and Epic pretty much owns the high-end market and seems to be quickly moving down the scale to the smaller bed ranges that most people thought they would never bother with. When do you think the results of these changes, both the product changes and the packaging changes to get them in front of additional prospects, how long will that take and what will the competitive landscape look like?

The technology roadmap that we’ve created is a 30-month development. The Paragon product has gotten progressively better continually over time, so a lot of the customers that made decisions made them at a time when we didn’t even have HEO or we didn’t have an order entry system for physicians. They bought it, it came out on time, it’s gone in, the adoption rate of the physicians is very high. Same thing with a lot of the other modules. The emergency room integrated module will be GA’ed around the end of our fiscal year, which is March-April of 2012. Ambulatory is about a year and a half out.

Logically, by the time customers could make decisions, either new customers or decisions to switch, when they got onto the full suite of products through the implementation cycle, those modules would be completed and ready. There’s a really solid track record of developing and delivering on that platform.

In terms of how the market’s going to evolve, I think most of the clinical decisions have been made. I certainly wouldn’t take anything away from Epic. We know what their success rate has been and they’re well respected in the market. We would also tell you, though, that we believe our analytics capabilities, especially as we head into Meaningful Use 3 — and we don’t know if there will be stages beyond that — our capability for health information exchange, our health management, population management, are some of the aspects that we think are going to be central to both later stages of Meaningful Use and health reform are capabilities that McKesson has that our competitors do not.

It’s a balance. There’s lots of Epic customers today that have our analytics. There’s lots of Epic customers that put in Epic and have Horizon Lab, because it’s a really robust system. They don’t offer imaging, so if you want radiology or cardiology, we’re going to be your best bet in this space. It’s a mixed bag. They clearly understood the dynamic of ambulatory and physician side of the market ahead of what other people did and did a really good job in capitalizing on that, no doubt about it.

You mentioned that lot of customers have already chosen their dance partner and spent a lot of money to be in an early stage stage of implementation. A strong selling point that you’re emphasizing is total cost of ownership, and people have questioned whether these hospitals can really afford Epic and Cerner long term. Do you think that to be successful you’ll need to take customers back from them based on price?

I think total cost of ownership is going to become an increasing issue as we go forward. You’ve got a lot of factors coming into play at the same time. We’ve got a really crappy macroeconomic environment, which in my view, whether you believe there’s going to be a double-dip recession or whether that’s already occurred, I don’t think anybody is optimistic about a strong recovery anytime soon. There will continue to be a lot of pressure on capital availability and deployment. You’ve got a shortage of personnel. You’ve got all of these health reform changes and regulatory changes coming at these hospitals. It will be difficult for them to navigate.

The modeling, the data collection that we’ve done shows that an ongoing clinical decision rate will continue in the market, if you look at all 5,000 hospitals, at around 3.5 – 4%.  It will continue to be 150 to 200 decisions a year in clinicals. Financials are likely to accelerate once people get beyond Meaningful Use 3 and ICD-10. A lot of customers are continuing to use whatever financial systems or revenue cycle systems they have in place because they’re focused on clinical, but there will be a point coming soon where they’ll be making a different financials decision, a lot of times in convergence with whoever they’ve decided on for clinicals.

What goals do you have for MPT in the next five years?

It’s really goals for MTS. I wouldn’t answer for MPT. I think the big shift, a lot of which has been driven by the market, is five years ago or maybe even three years ago, if you were talking to one of my predecessors in MPT, they would have told you that MPT is a hospital software company. I don’t think anybody can be segment specific. The blurring of the settings of care, all of the vendors are going to have to be a lot more aware of what the patient and clinician experience is wherever it is that either the clinician is delivering care or the patient is receiving it.

There’s going to be some mixed models. Who would have thought that Walmart would be getting into direct care? Who would have thought that payors would be purchasing physician practices? I think there’s going to be that experimentation over time and some form of consolidation. Our goal across the technology businesses is to deliver the most capabilities that we can to support what all these customers are going to need as health reform evolves.

I couldn’t for a minute tell you that McKesson or I have the answers. We don’t have a better Ouija board than anybody. We’re just trying to stay as close as we can to the trend. Accountable care is another great example. Whether or not accountable care organizations in the legal entity sense actually end up developing or not, customers are going to need the capability of accountable care just to meet health reform. We believe we’ve got most of that capability that they’re going to need today and it’s just going to get stronger in the future.

News 12/9/11

Top News

Microsoft and GE announce the formation of a joint venture company that will take over most of the people and assets of the Microsoft Health Solutions Group along with specific GE Healthcare products. See the HIStalk story from early Thursday, which includes insights from interviews with the key executives involved.

Reader Comments

From Curious Reader: “Re: Black Book Rankings. I am confused about Black Book’s results. Do they break out their ratings by hospital size? CPSI usually sells to community hospitals, not the same ones Epic sells to. I don’t know how those are comparable. How is Black Book even defining and EMR? Picis is a surgery and anesthesia vendor — they don’t really have an EMR system.” This report includes multiple categories including under 100-bed hospitals, community hospitals, large hospitals, health systems, and EDs. Per Black Book’s website, the rankings are based on survey results that cover 18 performance areas. To make the Top 20 list, vendors must have at least 10 unique clients participate. Results for these ratings were based on 12,075 validated responses. There is no mention on how an EMR is defined, though it may be included in the full report. In you need to further satisfy your curiosity, you can purchase a report for $3,250, but note it will only include details on a single category and not all the inpatient EHR categories.

From EMR Wannabe: “Re: GE and Microsoft. From trying to work with it, I know that Amalga UIS is an overly complicated hairball. I wasn’t sure about Qualibria, although last year when I asked a GE team how the knowledge project with Intermountain Health was going, they just broke into laughter and said, ‘depends who you ask.’ I said, ‘Well, I’m asking you,’ to which they took the Fifth (amendment, not bottle). Now with this announcement, we can see that Microsoft and GE decided to combine, and then bury, their respective dead or dying.” Amalga seems cool, but I don’t hear much from its customers once they’ve signed contracts, so NewCo should work to get the word out. I hope the companies really are planning to do something innovative like the announcement says. However, those with long memories will find it hard to forget (or forgive) historical examples of big, unfocused vendors who brashly stormed the HIT gates and then slunk off quietly shortly thereafter, unceremoniously dumping the charred remains of once-proud companies they had burned through and hoping the smell of utter failure would wash out of their Teflon-coated corporate suits. Recall when Baxter and IBM formed IBAX and quickly sold it off to HBOC, relieved to put distance between themselves and the albatross they had spawned from their passionate but short-lived union by creating a new company and not really caring whether it succeeded or failed.

From SmallMe: “RE: Microsoft HSG. Major RIF and re-org in advance of the HSG/GE joint venture announcement.” According to our Microsoft contact that I asked to confirm, “Like all companies, Microsoft evaluates our business priorities regularly. As we evolve HSG’s strategy, we’re concentrating more on building a compelling platform and have eliminated a small number of positions to align with current priorities.”  

From EthicsInHealthcareBusiness: “Re: RSNA. I’m surprised there isn’t more stringent hiring vetting by big vendors. Take the example of [vendor VP name omitted], who while at [vendor name omitted] was named in a federal lawsuit (CIVIL NO. 2004-116) accusing him of fraudulent pricing in dealings with government purchasing agents. The lawsuit was dismissed on a technicality, but it drove a parallel criminal investigation by the Defense Department and the US attorney’s office in Philadelphia. Why would a company risk this potential liability?” I omitted the specifics since, as you said, the lawsuit was dismissed and his innocence must be presumed. If he’s found guilty by the Feds, I’ll name names. His previous employer was known both globally and historically for shameful bribery. I blurred their name only a little above, but enough to say I didn’t unfairly name the company specifically.

From Erik: “Re: McKesson. Halting all development of Horizon Clinicals 10.3 and deployment of Horizon Enterprise Revenue Manager.” Unverified. I got several e-mails from MCK employees Thursday morning that a company call was in progress (our readers are so loyal I’m surprised they didn’t conference us in.) Inga asked what was up and I told her if I had to guess, I would say MCK is either killing off Horizon or moving its revenue cycle efforts from HERM to Paragon since both had been rumored previously. I’ll be crowing to her endlessly if both guesses are correct, although I must credit readers who reported those possibilities to me in the first place starting many months ago. I’ll know more Friday, as McKesson Provider Technologies President Dave Souerwine asked to brief me. Unfortunately it will be late in the afternoon since I have to get home after work from the hospital to do it (darned day job!), but I’ll recap in the Monday Morning Update if not before.

From MCKWorker: “Re: McKesson. All HERM staff essentially laid off. New direction for development, to combine with Paragon. HERM employees will have 60 days to interview for positions with that new strategy.” Unverified. It’s funny that Inga pinged a couple of her MCK sources and they told her company bigwigs had warned them that HIStalk would be probing for information. They were correct. Inga and I were flattered, even though the compliment was almost certainly unintentional. Apparently they weren’t too worried about anyone but us being on top of the breaking news and caring enough to dig beyond any official announcement.

 From Must Remain Anonymous: “Re: McKesson. It has finally happened! The call came today that McKesson will cease development of its Horizon product. All support will stop in seven years. Product development will now focus on the Paragon application instead. To be announced to their physician advisory council tomorrow morning. It is about time that McKesson drops the dead weight.” Unverified, until Friday anyway. If true, that would be truly remarkable given that Paragon has been close to being killed off several times, as Vince has explained in his HIS-tory lessons. Horizon has ample problems, but to think of Paragon as MPT’s flagship product is a mind-bender. If true, kudos to that little engine that could for hanging in there, excelling over and over, and giving the company an overachieving understudy for when its star couldn’t make curtain call.

And lest we forget among the corporate announcements from the several companies mentioned here, there are people behind these decisions, grunts like you and me who leave their families every day to do the best job they can, competently even though their expertise is related to products no longer in favor, who are torn with worry about their future livelihoods that are being manipulated invisibly by factors entirely beyond their control as corporate drones judge them unfairly on what they do today rather than their ability to contribute in a different way tomorrow (I hate that about corporate BS more than anything). Right now, they’re putting on a game face to try to make a nice Christmas or Hanukkah for their kids and families without seeming too preoccupied by work stuff that shouldn’t be intruding on their celebrations and religious observations, but at night when the lights go out, they are sleepless in contemplating what could change for them and those who depend on them. Join me in beaming some positive thoughts their way because I’m guessing they could use them right about now. I’ve been there and it sucks, but it eventually gets better.

From Kurt: “Re: McKesson. I’m hearing they announced that they are spending $1 billion in healthcare IT. Is this correct? If so, this is more than most other vendors combined.” I’ll let you know soon. That sounds like an awfully large number even for a company of McKesson’s size, but I’m not ruling anything out. If they asked me for advice (not likely), I’d say they should show some leadership (meaning spend money) in building innovative solutions that will make their HIT presence respectable (i.e., high KLAS scores and a growing customer base), unlike their fellow conglomerate vendors that seem to be happy milking the wrinkled, desiccated udders of their thinning herds of malnourished and badly aging cash cows. In McKesson’s defense, they did make a huge investment (and later write-down, unfortunately) in developing HERM, so give them some credit for taking action, even if the result wasn’t what they had hoped. Corporate management has changed since then (and probably for that reason), so perhaps the environment is more conducive to nimble innovation now. I’d have to see that to believe it since it’s a rarity in a huge, publicly traded company.

From Leotardo: “Re: Epic in the UK. Old news?” Two big-name English hospital trusts name their short list of potential post-NPfIT EMR vendors: Cerner, Epic, and Allscripts. The report says that “Epic is known to have invested heavily in the Cambridge procurement.” The Brits had better price out flights from London to Madison before finalizing a budget since they would be creating a massive carbon footprint for the endless mandatory training visits. Britain was one of few places where Cerner could pursue business knowing that Epic wouldn’t be sitting across the table, so news of an Epic win would not be celebrated in KCMO. And if Epic loses, that would be even bigger news since they usually don’t.

From Wildcat Well: “Re: Costco selling Allscripts MyWay. Isn’t that an insult to every EHR sales rep out there? What exactly will Allscripts sales reps do now? The EMR adoption bubble is developing a very short shelf life.”

From JB: “Re: Epic. I think this job would be humorous to highlight.” Epic hires only fresh-from-college greenhorns, so if you are experienced in healthcare IT, informatics, consulting, or process re-engineering, this is your one chance to get your foot in the Star Trek-themed door. I wonder how many Epic dishwashers have passed the company’s notorious MUMPS programming test?

From Poutine: “Re: Quebec’s medical error registry. Finally done after being promised in 2002, but not getting provider data.” Provider error reporting is mandatory, but a third of them submitted incomplete information, while nine hospitals claimed “technical difficulties” that prevented them from filing even one report.

From Skeptic: “Re: Micky Tripathi’s breach article. Part of me says. ‘Well done for a conscientious job.’ It’s not as if the folks involved had much of a choice in how to respond if they wanted to be law-abiding and careful stewards of the cards handed them by our system. The rest of me says. ‘This is insane.’ A street thief  steals a laptop and there is ‘an infinitesimally small chance’ the information would be accessed and/or abused. We spend $300K direct dollars and another large chunk of internal time — not to mention hours spent on the government regulatory side — addressing it, after which the thug still has the laptop and the exposure is still infinitesimally small. How much will we spend when the risk is real? And the lesson learned is that we all need to behave even more carefully and institute even more policies. This is great news for security companies, government agencies, and regulators. It’s horrible news for patients. Every dollar we spend on this kind of craziness is a dollar not available for patient care. At present, we’ve managed to construct a ridiculously expensive system relative to actual care delivered. This is an index case of how we’ve done it. (a) lesson one: no amount of anything is going to prevent this sort of thing. That’s not an excuse to be careless, but we need to use some common sense when applying blame. This blame falls on the thief. Period. (b) lesson two: the most sensitive data the healthcare system owns is financial. Identity theft is worth cash; PHI is close to worthless despite the paranoia surrounding it. We need to find ways to universally encrypt ADT/financial information and to not bind it so tightly to PHI. (c) lesson three: if we want to deliver better healthcare, there are better places to spend our patients’ money.”

HIStalk Announcements and Requests

Thanks to Micky Tripathi’s outstanding contribution on his organization’s patient data security breach, traffic on HIStalk Practice has been especially heavy this week. We’ve posted a number of other great items over the last week including Brad Boyd’s discussion on the need for clinically integrated organizations. Other news bits of note: CMS releases a well done MU toolkit for providers. Physicians are fairly unaware of ACOs and don’t know if they should join one. Only 4% of all eligible providers have been paid incentives for meaningful EMR use. Physician wait times are shortest in Wisconsin and longest in Mississippi. Requests: (a) read HIStalk Practice regularly because it thrills me to know that my father is not the only one tuning in; (b) next time you need to purchase something HIT-related, consider the offerings of our sponsors; and (c) sign up for HIStalk Practice e-mail updates because I love knowing that I am not the only one with an overflowing inbox. Thanks for reading.

On the Jobs Board: Manager of Professional Services, Senior Trainer, Senior Software Engineer. On Healthcare IT Jobs: NextGen Workflow Process Consultants, EMR Application Specialist, Technical Services Manager.

Inga, Dr. Jayne, and I take risks writing HIStalk. We could get fired from our real jobs if unhappy companies figure out who we are and complain to our bosses about something we’ve said about them. We could lose sponsors for reporting news objectively and stating our opinions honestly (GE, Microsoft, and McKesson are all HIStalk sponsors, for a current example, but we still have to say what we think or else we’d be just another rag that uncritically spews vendor-friendly non-news). We could lose long- or short-term significant others because we sit in front of computers way too much, or risk letting life pass us by as we fixate on the relatively tiny topic of healthcare IT after spending already-long days at work (tonight’s HIStalk took me 5.5 hours, so my total non-work time in the past 24 hours, including sleep, was about six hours.) If you want to provide some reward to offset that risk, (a) sign up for e-mail updates for HIStalk, HIStalk Practice, and HIStalk Mobile; (b) connect with us on Facebook and LinkedIn; (c) support our sponsors, especially those we have to occasionally say negative things about, by clicking their ads, checking them out in the searchable, indexed Resource Center, and sending them consulting RFIs; (d) send us rumors, news we might have missed, and updates on what’s going on where you work; and (e) help us find the good news of IT helping patients, IT people doing commendable work, and IT companies innovating and making a difference. Thanks for being part of what we do, which means you’re actually part of who we are.

Acquisitions, Funding, Business, and Stock

A day after we (and thus you) were tipped off by HIStalk reader Elroy, Streamline Health Solutions announces that it has signed a definitive asset purchase agreement to acquire Interpoint Partners for $5 million. We like to think they had to fast-track the announcement because of Elroy’s rumor report.

Humana acquires healthcare analytics company Anvita Health.

Sales

The federal government awards McKesson Provider Technologies its DIN PACS III contract, allowing it to sell PACS and related sub-systems to all branches of the US armed forces and civilian defense department agency facilities. The two-year contract has a potential value of $30 million.

Morehead Memorial Hospital (NC) selects Unidesk for desktop provisioning and application delivery for its VMware-based Virtual Desktop Infrastructure.

Meridian Health (NJ) to ICA’s CareAlign 3.0 for its 95 locations.

Group Health Cooperative of South Central Wisconsin and Group Health Cooperative of Eau Claire (WI) select McKesson Analytics Advisor.

Tidewell Hospice (FL) chooses Allscripts Homecare and EPSi financial management.

China-based diagnostic testing vendor Kindstar Globagene Technology chooses PathCentral’s anatomic pathology system for its 2,000 hospital customers in China.

Personal health record vendor MMRGlobal, which runs the MyMedicalRecords.com site, says Surgery Center Management has offered $30 million to license its patents for the PHR, patient video site, and document management system for providers.

CSC says it expects its NPfIT contract will be extended by an extra year through 2017, despite the company’s past problems delivering implementations on schedule that contributed to the cancellation of the $19 billion project. CSC expects to earn up to $3 billion for the 12-month extension. The former CIO said CSC would probably sue if its contract was cancelled, concluding that it might be cheaper just to pay them.

People

Medical documentation software provider Emdat hires Michael Grayson (Eclipsys, Sentillion, IDX) as VP of strategic partnerships.

HIMSS adds four members to its board of directors: Dana Alexander, RN, MSN, MBA, FHIMSS (GE Healthcare); Brian R. Jacobs, MD, MS, FHIMSS (Children’s National Medical Center, DC); Kenneth R. Ong, MD, MPH, FACP, FIDSA, FHIMSS (New York Hospital Queens); and Fred D. Rachman, MD, FHIMSS (Alliance of Chicago Community Health Services.)

Encore Health Resources expands its client services leadership team with the hiring of Greg Bluth, Ken Frantz, Jason Griffin, and Jim Kearns.

MED3OOO’s board of directors promotes Carl Smollinger from executive VP of ACO and employer services to COO.

Announcements and Implementations

NYU Langone Medical Center implements IOD’s release of information solution.

Wolters Kluwer Health releases its expanded IPhone app, UpToDate MobileComplete.

University Behavioral HealthCare (NJ) goes live on Stockell Healthcare Systems’ InsightCS Revenue Cycle Information Management platform.

DrFirst partners with Atlas Medical to offer physicians the ability to place lab/rad orders and review results via DrFirst’s Rcopia e-prescribing solution.

Government and Politics

Medicare and Medicaid have paid 2,868 hospitals and 21,425 EPs approximately $1.8 million for the Meaningful Use of EHRs through the end of November.

Dr. Jayne mentions below, but here’s a list of all Medicare EPs who have received HITECH money through September 30.

The State Department and the US Coast Guard sign an interagency agreement to share Epic’s EHR and access to VLER, the EHR used by the US Armed Forces EHR for its current and retired members.

Other

VA employee unions raise concerns that a plan to add RTLS technology will lead to staff monitoring. The VA is issuing a $550 million draft request for proposals for RTLS to interface with cleaning and sterilization equipment. The department claims it has no official plans to tag and track employees. One union representative views any plans to use RTLS to track employees as “the beginning of Big Brother” and “and invasion of privacy.”

Meditech announces it will return to the HIMSS conference this year as an exhibitor. In looking at the HIMSS conference site, it does not appear that Cerner will be following Meditech’s lead in coming back.

Programmers world-wide celebrated last weekend with Random Hacks of Kindness, where self-proclaimed hackers developed programs for humanitarian purposes. Among them were an emergency response system for the Samoan Islands, a real-time disease tracking system, and an app that can scan a photo of water-borne bacteria to determine if it’s safe to drink.

The FBI subpoenas several businesses in its investigation into the financial dealings of Wayne County, MI. Among the companies whose contracts are being reviewed is Strategic Business Partners, a Detroit IT company that has billed the county for $22 million over several years, some of that for developing EMR software for the county jail.

A hospital in Canada being sued for malpractice by a patient who suffered a stroke during surgery tries to convince a judge to give it access to the patient’s Facebook and Twitter accounts, her computer, and her iPhone. The hospital’s argument was that since the patient claims her health and enjoyment of life had been harmed, they should be able to look for evidence to the contrary. The judge said no, calling it “ a classic fishing expedition without the appropriate bait.”

Sponsor Updates

• The Advisory Board Company’s Crimson business unit wins the Best Booth award at the IHI forum in Orlando, with recognition of its employees for their knowledge and demonstration skills.
• GE Healthcare releases a white paper that highlights the use of Centricity Practice Solution to achieve Meaningful Use requirements.
• Healthwise launches Healthwise Spanish Knowledgebase, which includes evidence-based health information.
• Symantec Health and DrFirst will present at April’s EPCS Leadership Symposium.
• Blanton Godfrey, co-founder of the Institute for Healthcare Improvement, keynotes at TeleTracking Technologies’ 2011 Client Conference and predicts that better workflow choices will determine winners and losers after health reform.
• DIVURGENT releases a white paper on the selection of the right IT infrastructure for ACOs.
• The Irish Health Service Executive announces that four of its 35 hospitals are live on McKesson’s Horizon Medical Imaging PACS, with the remainder coming up within 20 months.
• T-System’s CMIO Robert Hitchcock MD and CFO Steve Armond CFO discuss how to use IT to make an emergency department profitable.
• Lawson Software introduces Infor10 Lawson S3, which includes integration between Lawson technology and products and applications from its newly acquired company Infor.
• e-MDs customer James F. Holsinger, MD, PC wins the 2011 HIMSS Ambulatory Davies Award of Excellence for the quality of patient care through practice’s Meaningful Use of EHR.
• MedVentive was selected to participate in last month’s Mid-West BluePrint Health IT Innovation Exchange Summit.
• Intelligent InSites posts congratulations to President and CEO Doug Burgum, who is also chairman of the board of the SuccessFactors, just acquired by SAP for $3.4 billion. He was also an early investor and leader of Great Plains Software, which Microsoft acquired for $1.1 billion in 2001.

Contacts

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

Microsoft, GE Form Healthcare Joint Venture

Microsoft and GE Healthcare announced this morning that the companies will form a joint venture, creating a new company that will offer software tools for managing population health to improve outcomes and cost.

Microsoft will move its Health Solutions Group employees and assets to the new company, effectively ending its direct involvement in provider healthcare technology. Corporate Vice President Peter Neupert announced his retirement from Microsoft.

The new company, which has yet to be named, will be launched in the first half of 2012. Microsoft will contribute its Amalga health intelligence platform, the Vergence context management and single sign-on solution, and the expreSSO enterprise single sign-on product to the joint venture. Those products had been acquired from MedStar Health (Azyxxi) in 2006 and Sentillion (Vergence, expreSSO) in 2009.

Microsoft HSG’s hospital systems product line that was acquired from Thailand-based Global Care Solutions in 2007 had already been retired, but was sold to Orion Health in October 2011.

GE Healthcare will provide its eHealth HIE and the Qualibria clinical knowledge application that it is developing with Intermountain Healthcare. 

In an interview with HIStalk, Neupert said the bulk of HSG employees will be transferred to the new company, joining those GE Healthcare employees who are assigned to the eHealth and Qualibria projects for an initial headcount of 700. The company’s headquarters will be in Redmond, WA.

Microsoft’s HealthVault will not be part of the joint venture, Neupert told us, explaining that HealthVault needs to remain “independent and consumer-facing.”

The announcement states that the new company will deliver “a distinctive, open platform that will give healthcare providers and independent software vendors the ability to develop a new generation of clinical applications.”

Neupert explained that Microsoft Amalga will be the base layer of the new offering, bringing in data from other systems and adding metadata. GE Healthcare Qualibria will provide advanced data descriptors such as clinical vocabulary and context (such as where a patient’s blood pressure was taken and whether the patient was sitting or lying down at the time.) External applications can then retrieve data, data meaning, and workflow context from the new system. “Provider and payor will become intermixed,” Neupert said. “Our customers already do cohort management. How do we get really good at making cohort groups discoverable and manageable in an interesting way?”

Neupert said the platform will have open APIs for developer access. Amalga’s services can manage healthcare-specific requirements such as access controls and auditability, allowing third-party developers to build solutions around large enterprise databases.  “In a patient-centric world, you want the data to be separate from the app,” he told HIStalk. “You want competition to be based on user interface and functionality, not a vendor’s ability to lock up the data. Customers want choice.”

The announcement indicates that the new company will market its products globally. Neupert said that there’s always a difference between ambulatory and inpatient care and that all governments want to tie in home care. He expects the new products to assist in those efforts, acknowledging that countries will evolve differently.

Michael J. Simpson, general manager of GE Healthcare’s Healthcare Knowledge & Connectivity Solutions practice, has been named CEO of the new company. He joined GE Healthcare in 2010 after a few months as SVP of product strategy for QuadraMed. Before that, he spent 5 1/2 years as general manager and chief technology officer of McKesson’s Horizon Clinicals business unit.

Simpson told HIStalk that he plans to enable customers to be amazed, opening up the user experience to caregivers and bringing the cultures of software development and customer relationship management to the patient. “Connectivity across inpatient and outpatient will require new platforms,” he said.

CIO Unplugged 12/7/11

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

Transformation Through the Written Word

My nephew Jordan, at the time a high schooler, was thinking about careers. Spring Break of 2009 found him shadowing “Uncle Ed,” exploring healthcare. He awoke with me each morning for 5 a.m. workouts and remained engaged until we returned home for 6 p.m. family dinners. Free time was spent developing content for an innovation workshop he would help me lead for one of our hospital leadership teams.

We nailed the workshop. The hospital president was so impressed with Jordan’s facilitation techniques that he offered him a job upon college graduation. We left that Friday session exhausted but high, ready for a Starbucks reward! Immersed all week in healthcare and spending time with physicians and leaders, his career decision crystalized. After graduating as class valedictorian, Jordan began an eight-year journey as a University of Colorado Medical School BA/BS-MD student, one of only ten chosen in the nation.

An elite runner, Jordan serves me humble pie each time we connect. We met up a couple months ago and put in a few hard miles. A college freshman, he asked me for my views on Gawandi’s The Checklist Manifesto and how it has influenced our culture. A month later he asked me about Johansson’s The Medici Effect; What Elephants and Epidemics Can Teach Us about Innovation.

We met up recently in Denver, and, during this run, he wanted to know my views on Johnson’s Fire in the Mind; Science, Faith, and the Search for Order. “Uncle Ed, where does science end and religion begin?” He loses me on the hill. Is this my nineteen-year-old nephew?

The more I learn about his medical school program and curriculum, the more impressed I am. They have something special going down at UC School of Medicine with their focus on stimulating personal and professional growth through book studies. Every other week, these future physicians tackle another book and debate.

Book and debate reinforced my IT department’s approach. I was not a reader in my youth, but as my hunger grew for leadership, I began devouring the written page. A causal correlation emerged. The more I learned, the more effective I became.

I asked my direct reports to read with me, and I observed the same causality. If these book studies were helpful for my teams, then what about my entire organization? Twelve years and counting, my desire to be a continuous learner has not abated. I have seen the transformative impact on my organizations. Hearing about Jordan’s medical school inspired me to continue pressing forward.

Many people stopped learning the day they graduated. Having book studies in the work place carries numerous benefits. Studies remove excuses and make learning convenient. The studies bring a cross-section of individuals together who might not otherwise meet each other. Cohorts ensure accountability, and nobody shows up to class unprepared. Relationships form. Engagement deepens. Leadership is honed. New ideas stimulate innovation. Sometimes we invite our strategic partners. Learning happens. People grow.

How to develop a program in your workplace:

• Charge a modest fee for the class. Return the fee for 80% attendance. Unreturned fees are donated to United Way.
• Lead the first set of classes yourself so you can model the process. Then delegate teaching to your direct reports. Expand to line staff as you find alignment between a person’s passion, ability to teach, and the general need for the topic.
• Classes early in the day have the most traction.
• Books with associated workbooks work especially well.
• Meet weekly and run each class 6-8 sessions for one hour.
• Offer a variety of classes quarterly.

Here is a sample listing of the books we have leveraged through the years. While we have our reliable classics, we always scan for new books. And yes, we have gone digital:

• 17 Irrefutable Laws of Teamwork
• 21 Indispensible Qualities of a Leader
• 21 Irrefutable Laws of Leadership
• 360 Degree Leadership
• 5 Dysfunctions of a Team
• A Long Obedience in the Same Direction: Discipleship in an Instant Society
• A Message to Garcia
• Accounting for Non-Accountants
• Application Stuff for Non Apps
• Axiom
• Blown to Bits
• Built to Last
• Business Etiquette for Dummies
• Checklist Manifesto
• Churchill on Leadership
• Clever: Leading Your Smartest, Most Creative People
• Competing on Analytics: The New Science of Winning
• Computer Factoids
• CPHIMS Prep Guide
• Creative Whack Pack Deck-Book Set, Success Edition
• Cyber Warfare
• Death By Meeting
• Developing the Leader Within You
• Disintegration
• Drucker on Leadership
• Emotional Intelligence
• Finance for Dummies
• Financial Peace
• First, Break all the Rules
• Fish
• Getting to Plan B: Breaking Through to a Better Business Model
• Good to Great
• Gung Ho!
• Hardwiring Excellence
• Heart of Change
• Here Comes Everybody
• High Five
• Higher Standard of Leadership
• Hospital Management
• Hospitals: What They Are and How They Work
• How to Give a Damn Good Speech
• How to Listen to God
• Human Sigma
• If Disney Ran Your Hospital
• Innovators Dilemma
• Innovators RX
• Inside the Magic Kingdom
• IT Risk
• It’s Your Ship
• Jack; Straight from the Gut
• James and the Giant Peach
• Judgment: How Winning Leaders Make Great Calls
• Kick in the Seat of the Pants: Using Your Explorer, Artist, Judge, & Warrior to Be More Creative
• Lead with Luv
• Leadership (Giuliani)
• Leadership Lessons Learned
• Leadership Secrets of Attila the Hun
• Lincoln on Leadership
• Making Teleworking Work: Leading People and Levering Technology for High Impact Results
• Medici Effect: What Elephants and Epidemics Can Teach Us about Innovation
• Now Discover Your Strengths
• Orbiting the Giant Hairball
• Outliers
• Overcoming the 5 Dysfunctions of a Team
• Please Understand Me (Myers-Briggs)
• Raving Fans
• Redefining Global Strategy
• Safe Patients, Smart Hospitals,
• Same Kind of Different as Me
• Servant Leadership
• Social Intelligence
• Strengths Finder 2.0
• Sustained Innovation
• Technical Stuff for Non Techies
• The Art of War
• The Big Switch: Rewiring the World, from Edison to Google
• The Black Swan
• The Element: How Finding Your Passion Changes Everything
• The Fifth Discipline
• The Five Temptations of a CEO
• The Four Obsessions of an Extraordinary Executive
• The Fred Factor
• The Future Arrived Yesterday
• The Future of Management
• The Innovator’s Prescription (Innovator’s RX)
• The Leadership Challenge
• The No Asshole Rule
• The Power of Pull
• The Purpose Driven Life
• The Shallows: What the Internet is Doing to Our Brains
• The World is Flat
• Thinking for a Change
• Today Matters
• True North:  Discover Your Authentic Leadership
• What Difference Do It Make Stories of Hope and Healing
• What Got You Here Wont Get You There
• What Were They Thinking
• Where Good Ideas Come Innovation
• Who Moved my Cheese
• Wikinomics
• Wild at Heart

Our next family reunion is in Seattle during the summer. If I want to keep up with Jordan, I’d better keep reading!

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 12/7/11

Top News

Costco announces its entry into the PM/EHR software and services business through its partners, Etransmedia Technology, Inc. and Allscripts, moving from a test phase to full launch after experiencing high demand. Costco will offer the Allscripts MyWay PM/EHR along with hosting maintenance, support, training, implementation services, and unlimited claims processing for $499 per month. The company will have a booth at HIMSS.

Reader Comments

From Unibroue: “Re: Kaiser MU-payment mishap. The doctor who did not receive her MU incentive because Kaiser mistakenly claimed it is now making progress towards collecting her money. After a couple of attempts, she connected with the right person at Kaiser, they have corrected the registration issue, and the doctor should now be able to have her payment processed correctly.” Many thanks to our great readers who offered advice and contact names to help this doctor straighten things out.

From Fancy Schneider: “Re: HIStalk’s reputation. I was recently in a meeting at a hospital and HIStalk came up. Someone commented that it was the only place where they could get real information in an industry that is swamped with vaporware.”

From Bob Coli, MD: "Micky Tripathi’s First-Hand Experience with Patient Data Security Breach. This is the best overview of a PHI security incident that I have seen to date. Every word is valuable to consumers, healthcare professionals, and everyone else in America striving to achieve maximally secure and efficient data portability and fully interoperable HIE.” Other readers concur with Dr. Coli, with some urging that Micky’s post be “mandatory” reading and naming it HIStalk’s “Post of the Year.” Even Mr. H, who is parsimonious with his praise, called Micky’s piece “outstanding” and suggested that if there were Academy Awards for blog posts, that this one would be a shoo-in. The cost of the breach (above) should get your attention, after which you can read the article here.

From Dave Miller: “Re: University of Arkansas for Medical Sciences. Some news for HIStalk. Our RFP scoring committee has recommended Epic. We still have to nail down funding and get the contract done, but the die is cast.” Dave, who is vice chancellor and CIO at UAMS (cool license plate) says they will replace Eclipsys Sunrise and Medipac on the inpatient side and Logician and Signature for ambulatory, plus a bunch of miscellaneous systems. Dave’s an old friend of HIStalk who has kept in touch since his days at University of Chicago Medical Center.

From Benzyl: “Re: PQRS. Do you see the number of submitting practices increasing or decreasing this year? What about hospitals? It seems that submissions slowed down after the incentive was reduced from 2% to 1% this year, or maybe other programs are getting the attention of practices.” Readers, chime in with your comment if you like.

From Long-Time Reader: “Re: HIT spending. I was wondering if you know what percentage of total healthcare spending HIT represents? Awesome site!” I’ll again go to readers who might a data source since I don’t know that I’ve seen an HIT-specific number that’s more precise than the typical “technology” that covers medical equipment.

From Gladys Kravitz: “Re: Cape Coral Hospital (FL). I was told by someone who works there that their Epic go-live didn’t go well, taking two hospitals down for several days. The person said administration was responsible since they didn’t go for the ‘deluxe’ Epic package from Epic and tried to manage the implementation on their own.” Unverified.

From Dadudadu: “Re: HIStalk. I hate to draw the comparison, but your statement about doing what you love and the money will follow sounds a lot like the philosophy of Epic. That intangible sense of purpose, unadulterated by the naked self-interest introduced by the pursuit of money or power or fame is, of course, what makes this website so great. And results, paradoxically, in more Money, Power, and Fame than you want. Be honest, what pays more at this point: HIStalk or your day job? Regardless, kudos to you for finding what you love, and doing it well so we all can benefit from it. Thanks.” One thing I should have added to my statement is that you almost have to work for yourself to either (a) do what you really love in the way you want to do it, and (b) reap money, power, and fame, since by definition, corporate employers fully expect to arbitrage the difference in what you’re worth vs. what they pay you, laying claim the great majority of that difference by rebating tiny raises and bonuses to encourage your occupational inertia for their continued benefit. I admire Epic for at least appearing to have something other than their corporate bottom line front and foremost, although it’s rare that good-sized companies can create and maintain a “we just want to do good work” philosophy, especially after the founders step aside (no different than when humbly wealthy self-made parents leave their fortunes to bratty, entitled children.) It’s probably empowering to have a lot of money, but I’m just as empowered by not needing much of it. If I ever quit my day job, which I admit contemplating on occasion, my questionably achievable goal would be to work for myself instead of someone else for a change.

From Elroy: “Re: Streamline Health. Acquiring Interpoint Partners, to be announced next week.” Unverified. Streamline does document management, while the Atlanta-based Interpoint Partners offers business intelligence and analytics. Streamhealth’s President and CEO Robert Watson, who took the job in February 2011, was previously a director of Interpoint. That adds credibility to the rumor.

From The PACS Designer: “Re: NPfIT Roundable. The UK’s NPfIT has had its ups and downs, but they are still looking to the future and have assembled a group to talk about it.”

From LanMan: “Re: Cerner. Buying IP blocks from now-defunct Borders? What for? And I heard this from a Brit publication?” Actually you could have heard it here since I mentioned it on December 2. At $786K, it was supposedly the second largest transfer of IPv4 addresses after Microsoft bought $7.5 million worth from also-defunct Nortel. IP addresses are about to become harder to obtain and more expensive with the advent of IPv6, which is replacing the current IPv4 as it runs out of available addresses. Cerner could be buying the addresses for resale, but I would speculate that it’s just ensuring that it will have enough for its own use for the foreseeable future, or perhaps to avoid expensive network infrastructure upgrades that IPv6 addresses will require.

From Lyssa Neel: “Re: native EMR apps for the iPad. Our app, VitalHub Chart, sits on top of Cerner PowerChart and makes data available to clinicians in a native iOS interface. Please take a look and let me know what you think.” Lyssa, whom I notice sports an impressive PhD in computer science from MIT, is CTO for VitalHub. Their product was developed at Mount Sinai Hospital in Toronto. Cerner users, what do you think?

From Early Girl: “Re: Microsoft Health Solutions Group. Some kind of announcement involving GE Healthcare will be made this week, either GEHC acquiring HealthVault and/or other MSFT products or some kind of marketing agreement.” Unverified.

HIStalk Announcements and Requests

Travis Good is on the ground at the mHealth Summit, so you can check out his reports on HIStalk Mobile. He says attendance is an impressive 3,500.

Acquisitions, Funding, Business, and Stock

Healthcare quality improvement firm Avatar International acquires HR Solutions, a human capital management consulting firm that specializes in clinical engagement.

Streamline Health posts a Q3 profit of $296,000, up 212% from a year ago. Revenue fell 4% to $4.3 million.

Health Tap raises $11.5 million in Series A funding, raising its total to $14 million. It provides an online community where anyone can ask questions to US-based physicians at no charge. The company says that 6,000 physicians are participating so far, attracted by the “gamification” of earning reputation points for answering questions or agreeing with answers provided by other doctors. Big-name investors in the 12-employee company include Eric Schmidt (Google) and Ester Dyson.

SAIC reports Q3 numbers: revenue flat, EPS –$0.27 vs. $0.46, but exceeding analyst earnings expectations by a penny after excluding one-time items. The company said it paid $190 million in cash to acquire Vitalize Consulting Solutions in July 2011.

Sales

QuadraMed RCM client Memorial Hospital of Sweetwater County (WY) chooses QuadraMed’s Computerized Patient Record and Quantim Electronic Document Management.

The San Diego Beacon Community selects Santech’s SanText SMS platform to send text messages to parents for appointment reminders and to inform them of their children’s immunization needs.

Lehigh Valley Health Network (PA) selects Orion Health’s HIE for its 50+ hospitals, clinics and health centers.

Association of Ontario Health Centres signs a 10-year contract with Canada-based EMR vendor Nightingale Informatix, which says it will earn $9 million in revenue in the first three years.

Mary Crouch joins Orchestrate Healthcare as its Meditech Practice Manager. She was previously with Laughlin Memorial Hospital (TN).

Tad Jacobs, DO, CMIO of Avera Medical Group (SD), is promoted to chief medical officer.

TriZetto names Pierre Samec, formerly of Expedia, as EVP/CTO.

Announcements and Implementations

The Greater Houston HIE announces the formation of its collaborative HIE network, which includes representation from over 60 hospitals across 14 counties.

St. Francis Hospital & Health Services (MO) announces plans to launch its Epic EHR on March 31, 2012.

Aintree University Hospital NHS Foundation Trust implements CCube Solutions’ electronic document management system, powered by Kodak production scanners and Kodak Capture Pro Network Edition imaging software.

gloStream will integrate clinical decision support from DiagnosisOne into its EMR.

Trustwave announces MyIdentity, a cloud-based two-factor authentication solution that supports five mechanisms (digital certificates, one-time SMS message passcodes, voice call-back, pushed login alert to mobile, and a mobile app that generates a one-time password.)

Caristix launches Cloak, which strips patient-identifiable messages from HL7 data for creating sample messages or clinically valid data for testing. The company, which was featured in HIStalk Innovator Showcase in November, offers a seven-day free trial.

Innovation and Research

Microsoft Research is applying spam-fighting techniques to the analysis of HIV cells, finding similarities in how viruses mutate as they attack the immune system and spammers who fine-tune their payloads to bypass spam filters.

mHealth Alliance announces its Top 11 in 2001 Innovators Challenge. Winning apps include pregnancy surveillance, voice-powered information retrieval, diagnostic tools for telemedicine, counterfeit drug detection, patient teaching, physician collaboration, patient communication, baby tracking, and care reminders. Above is a demo of an smart phone-based EMR developed by Martin Were MD, MS of Regenstrief Institute for HIV treatment and control in Kenya.

IRobot, the company behind the Roomba vacuum cleaner, applies for a patent for AVA, a five-foot-tall robot with a “head agonistic design” that can accommodate tablets or smart phones.

Other

The board chair for Maryland eCare says that mortality rates have fallen 30% across hospitals that have implemented its telehealth systems that supplement ICU coverage at rural hospitals.

CPSI pays $9.5 million for its new Mobile, AL corporate headquarters, which includes 16.5 acres and 135,500 square feet of office and warehouse space. The company had been leasing 13 buildings in the same office park.

EHRrtv publishes its MGMA interview with the always entertaining (and interestingly-attired) Jonathan Bush of athenahealth. He’s like no other CEO out there.

Aetna and ProHealth Physicians (CT) say that their four year Provider Collaboration program has resulted in 37% fewer inpatient hospital days on a risk-adjusted basis and 35% few hospital readmissions.

CPSI, Cerner, GE Healthcare, and Picis earn top client satisfaction scores in Black Book’s ranking of inpatient EHR vendors, obviously reaching vastly different conclusions than KLAS.

The Leapfrog Group includes 65 hospitals (including 18 Kaiser facilities) on its list of Top Hospitals, based on the delivery of quality care.

An article in Wired magazine called Apple’s Secret Plan to Steal Your Doctor’s Heart is not particularly focused or convincing, but a fun read. I couldn’t figure out its conclusion other than (a) doctors like using an iPad because it saves them time; (b) hospitals seem to be warming up to them; and (c) Steve Jobs had a small interest in healthcare after trying unsuccessfully to develop a Pixar CT imaging system. Like many articles these days, it seems  highly analytical and fresh until you think about precisely what you learned and realize that it wasn’t much.

Sponsor Updates

• Elsevier introduces Procedures Consult App for iPad, iPhone, and iPod Touch.
• Adler Hey Children’s Hospital and Liverpool Women’s Hospital (UK) select Perceptive Software’s ImageNow electronic document management system.
• Wolters Kluwer Health announces its acquisition of Medknow PVT Ltd, expanding its open access publishing business.
• Capital Health (NJ) goes live on Wellsoft EDIS in its four emergency departments.
• dbMotion announces the 2012 schedule for its Insights into HIE seminar series.
• Michael O’Neil, founder and CEO of GetWellNework, moderates a discussion on mHealth and the role of patient education and monitoring medical compliance at this week’s mHealth Summit.
• Qualcomm Life Inc. and AirStrip Technologies collaborate to offer mobile monitoring to home health providers and patients.
• Capario launches a streamlined payer enrollment process.
• Teradici combines Imprivata OneSign Virtual Desktop Access with its PCoIP Firmware release 3.5.0 to offer virtual desktop access via access cards and ID badges.
• A Practice Fusion press release discusses five top trends and surprises in HIT for 2011.
• In a December 12 Webinar, South Jersey Health System CIO Thomas Pacek  will share how MobileMD is helping his organization’s physician network to grow and coordinate patient care.
• Nebraska Health Information Initiative announces that physicians are now sharing patient immunization information with NESIIS through the HIE’s Axoloti-powered platform from OptumInsight.
• San Diego Business Journal profiles Awarepoint and its four new RTLS patents.
• Vibra Healthcare (PA) selects PatientKeeper Physician Portal and Mobile Clinical Results for its long term acute care hospitals nationwide.
• Forst & Sullivan awards AT&T its Competitive Strategy Leadership Award for its approach to mHealth.

Contacts

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

Curbside Consult with Dr. Jayne 12/5/11

For those of you who are my Facebook friends, you may have noticed that I’m at the National Finals Rodeo this week. (And if you’re not my friend on Facebook… well, you know what you need to do to keep up with all my travels and adventures.) Despite my love of all things technology, I really am a cowgirl at heart.

For those of you who are not rodeo fans, NFR is in Las Vegas. I’m amazed at how the city transforms itself for different constituencies. The casinos of the headquarters hotels are filled with the sounds of country music. Shopping areas are featuring cowboy boots in the window instead of rhinestone stilettos (although there are plenty of rhinestones on the boots.) The cocktail waitresses at one bar I’ve been to several times in the past have given up their leather bustiers and miniskirts in favor of tight jeans and white cotton shirts. If there’s any place on earth that’s a triumph of marketing, it’s Las Vegas.

So what does this have to do with healthcare and technology? A couple of things.

First, let’s talk about marketing. We always think about vendors when we think of marketing. Nearly every vendor’s ad campaigns these days prominently feature the twin terrors of Meaningful Use and Accountable Care. If those aren’t mentioned, then it’s revenue cycle or other financial aspects of health care.

I think we forget about the sheer amount of hospital marketing that goes on, however. Just like the casinos marketing to the cowboys (many of whom have wallets the size of their belt buckles – and trust me, Jayne and her crew have been checking out some jeans pockets on this trip) the hospitals, surgery centers, and physicians are heavily marketing towards whatever demographic they feel has the fattest wallets or deepest pockets.

Driving around most cities, you see plenty of healthcare-related billboards. One hospital I passed recently boasts a Heart Hospital. What does that mean? Do they do more heart cases than anyone else? Are their outcomes better than others? Or do they just want the perception of being specialized to try to garner business when their volumes are the same as the hospital across town?

Everyone is tweeting their emergency department wait times. I’d like to see them tweeting their nurse-to-patient ratios or their infection rates instead. That would really create some interesting discussion in the community about which facility is the best.

Physicians and other providers aren’t much different. Going after high-paying patients is an art form. Medical buildings (and some physician offices, too) are installing complimentary coffee kiosks to go with their waiting room check-in kiosks. Ancillary services including cosmetic and convenience offerings are proliferating faster than Medicare Wellness exams. Availability of after-hours physician access at premium prices is becoming more commonplace. Concierge-type practice models such as MD VIP are going mainstream. My travel companion noticed a special advertising section in the Southwest Airlines Spirit magazine this month that featured not only concierge medicine, but other specialty and alternative practices.

Hospitals and physicians have their own internal marketing campaigns as well. It may be as simple as signs in a primary care office reminding diabetic patients to take off their shoes prior to seeing the physician or as complex as a multi-hospital multimedia hand washing campaign (complete with Big Brother surveillance, as we’ve seen recently) or promoting desired behaviors such as vaccine compliance through viral videos.

The medical establishment is increasingly marketing technology to patients. Not only emergency wait times, but also patient portals, secure messaging with providers, lab results online, bill pay, and a host of other services. Many of these offerings not only add value to patients and families, but also have the potential to significantly increase the bottom line for healthcare organizations. Payers are in the game as well as employers, with many offering health promotion and disease prevention as well as online enrollment, updating, and claims management features.

Many agree there are health benefits to increased patient education and empowerment. But the jury is still out on some of these marketing efforts. I’m interested to hear what HIStalk readers think about marketing – on the vendor, client, and patient sides. Have an opinion? I promise to read your comments just as soon as I’m finished watching the action. Tonight is “Tough Enough to Wear Pink Night.” I’ll let you guess what color my boots are.

E-mail Dr. Jayne.

Readers Write 12/5/11

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!

Note: this special edition of Readers Write features a special contribution from Sam Bierstock, for which the length limits were waived.

A 19th Century Perspective on Physician Adoption
By Sam Bierstock, MD

I first recognized that there was a pattern to the challenges of physician adoption of information technology in 2001. At that time, I convened a meeting of CMOs and clinical IT champions for hospital clinical information systems of all sizes, and quickly learned that they were all facing similar challenges. Basic human nature does not differ much, even in organizations that feel they are unique.

When I wrote about the importance of supporting what I called “Thoughtflow” as opposed to “workflow,” I was surprised by the widespread endorsement of the concept by clinicians, but disappointed by the sluggishness of vendor design processes to truly support the way clinicians think and work in an age of real-time data availability. I’ve been around long enough to start to see that begin to change, although I am not sure that this is because of vendor enlightenment or simply a generational turnover. The Israelites had to wander in the desert for 40 years to wait for a new generation of people to enter the Promised Land. Perhaps adoption is improving because of generational turnover as much as from demonstrable value.

A historical perspective dealing with the way healthcare was practiced during the second half of the 19th century, considering the patient safety issues of the day and the political climate, is intriguing. It says much about human nature, resistance to change – and the physician adoption champion of all champions, Joseph Lister.

In the 82 years between 1841 and 1923, six United States presidents died in office – four in the space of 40 years, five in 60 years. William Henry Harrison died of pneumonia and pleurisy in 1841. Zachary Taylor died of acute gastroenteritis in 1850 (with subsequent conspiracy theories suggesting that he was poisoned.) Abraham Lincoln was assassinated in 1864. James Garfield died after being shot by Charles Guiteau during his fourth month of service as president in 1881. William McKinley was assassinated by Leon Frank Czolgosz in 1901. William Harding died in office in 1920 of a “heart attack.”

We’ve had 10 presidents during the last 50 years. Comparing the timeframes, this rate of loss would be equivalent to us losing Kennedy, Nixon, Carter, Clinton, George Bush, Sr., and Obama while they were in office. Of the six presidents that died between 1841 and 1923, three had their fate tied to assassin’s bullets. Those occurred over the span of just 37 years (Lincoln 1864, Garfield 1881, and McKinley 1901.) One can only imagine the impact on the national psyche of these serial attacks on the lives of our presidents. One man in particular must have suffered a heavy emotional toll, for Robert Todd Lincoln bears the unique distinction of being the only person ever to be present at three presidential assassinations.

Regardless of the precipitating event, in many cases, the direct cause of death of these presidents was due to medical care that ranged from abysmal to totally incompetent.

In the later half of the 19th century, hospitals were not viewed as a place to go to recover from an illness or to have surgery. Hospitals were where you went to die. Surgeries were performed at home or similar environment. Illnesses such as influenza, mumps, diphtheria, or pneumonia – and especially infected wounds – were death sentences. In the absence of antibiotics, for instance, the vast majority of Civil War wounds resulted in death from infection.

Doctors’ standard operating garb were black smocks that they rarely washed or changed – if ever. A blood-encrusted smock was something of a status symbol and an indication of experience, and therefore presumed expertise. Surgical instruments were carried about in bacteria-laden, velvet-lined cases, and were not cleaned between operations beyond a quick wipe with a much-used handkerchief. If an instrument was dropped during a case, it was picked up off the filthy floor and used to continue the procedure (boots and shoes were not routinely cleaned off before entering the operating room). At Jefferson University in Philadelphia, the same table was used to dissect cadavers as was used to perform operations on live patients.

Things were so bad that the leading cause of death for hospitalized patients was termed “hospitalism.” Some thought that hospitalism was the result of toxic ether that surrounded hospitals.

In the 1880s, there were approximately 60 medical schools in the country – none certified by any organization – and students often had only one year of training. Until Lister came along — and for many years after he began to promote his theories about microbes causing infections — the idea of invisible organisms that could cause infection was laughable and readily dismissed by the vast majority of physicians.

Talk about a physician adoption challenge and patient safety!

In a political context, the state of presidential medical care went far beyond patient safety and had a direct impact on national policy and survival. This was a time when vice presidents were not hand-picked by the presidential candidates. They were selected by their party at their respective conventions, often by virtue of having the second largest number of nominating votes. As a result, the vice president and president were often of widely differing political views if not polar opposites, and often didn’t like each other very much.

James Garfield hardly ever spoke to his vice president, Chester Arthur. Garfield was vehemently opposed to the patronage system that infested national politics and Arthur was a product of it (although to his credit, he underwent a significant change in attitude once he assumed office.) Grover Cleveland and his second vice president, Adlai Stevenson, Sr., differed markedly on the key issue of the day, the gold standard versus the silver standard in our monetary system – an issue that had dire implications during a period of severe economic crisis. Woodrow Wilson and his vice president Thomas Marshall did not see or talk to each other while Wilson was incapacitated by a massive stroke until the day that Wilson left office.

None of these presidents relinquished power while ill or unable to perform their duties. Not until 1967, when the 25th Amendment to the Constitution was enacted after the death of John Kennedy, was the country assured that the vice president would assume presidential powers in the event that the president became unable to exercise his duties.

The death of a president during these times, therefore, had enormous impact on the direction of the country. Physicians caring for ill presidents were under enormous pressure to be sure that they could save their patients.

To avert public panic, presidents often went to great lengths to hide their human frailties and illnesses from the press. Unlike today, they were generally successful at doing so. Unknown to the populace, Abraham Lincoln became extremely ill with influenza for one month shortly after delivering the Gettysburg Address and lingered near death. Garfield did not die until two months after being shot, and aside from being subjected to the most barbaric care of any president, was reported to be in good condition and recovering steadily in bulletins issued to a nervous public several times a day. Chester Arthur suffered from “Bright’s Disease” (chronic nephritis) which he persistently denied publicly, but which took his life within two years of his leaving office.

Grover Cleveland underwent a secret operation to remove a presumed squamous cell carcinoma on his palate shortly after beginning his second term. (He is the only president to be elected twice in non-contiguous terms). In order to maintain secrecy, the procedure was performed on a friend’s yacht by a team of doctors who removed about a third of his palate, four teeth, and a portion of his upper jaw. He simply disappeared from public view during this time. He even kept his surgery secret from his vice president. When Adlai Stevenson wanted to know where the president was, Cleveland sent him on a length trip to the West Coast to keep him in the dark and to avoid the possibility that Stevenson would muster support for his position on the silver standard. In 1967, pathologists were finally allowed to examine the tissue removed from Cleveland’s mouth, which turned out to be a verrucous carcinoma – tumors that do not metastasize, but which can cause death local extensive local invasion.

Nor did the public know that Woodrow Wilson was rendered non-functional by a severe stroke toward the end of his presidency. In fact, few people knew that he had suffered several strokes prior to being elected for his first term. For the remainder of his last term in office, virtually all presidential decisions were made by his wife Edith – who, as a result, is often referred to as our first female president.

Warren Harding’s doctor, Dr. Charles Sawyer, was undoubtedly the most incompetent of presidential doctors. Appointed as the president’s private physician because of a long personal relationship, Sawyer had only one year of medical school training. Sawyer liked to prescribe medication based upon the color of the pill – once prescribing a dose of soda water with two pink pills for the president. Even though Harding was hypertensive and had significant orthopnea, exhaustion, and shortness of breath, Sawyer failed to recognize the clear symptoms of congestive heart failure, which he dismissed as “a touch of food poisoning.” Harding died in the Palace Hotel in San Francisco in 1923 at age 57 after a grueling trip to Alaska.

The most egregious care administered to a president by far was that applied to James Garfield – a man who would have undoubtedly been destined to greatness, but having served only 200 days in office, has been delegated to historical footnote status. Garfield was popular, exceedingly capable, honest, and brilliant. A man of natural congeniality, he withstood the most unimaginable procedures without complaint and generally in silence.

Garfield was shot by Charles Guiteau in the Baltimore and Potomac Railroad Station in Washington, DC on July 2, 1881 (now the site of the West Building of the National Gallery of Art.) He did not die until September 19 of the same year. During the assassination attempt, he was hit by two bullets, the first grazing one arm and the second entering his back. As he lay vomiting on the filthy station floor, his doctor inserted an unwashed finger into the back wound in an effort to locate the bullet. This was repeated multiple times by a series of doctors (16 physicians gathered), after which the wound was repeatedly probed with unsterile instruments. At one point, a probe became lodged between fragments of Garfield’s eleventh rib and removed only with great effort and resultant pain to the president. Dr. D.W. Bliss then used his finger to widen the wound so he could probe further. Over the next two months, Garfield was subjected to repeated probing of the wound with unsterile fingers and instruments, non-aseptic incisions to drain abscesses, and other invasive procedures in an effort to locate the bullet, which was, in fact, located harmlessly in fatty tissue behind the pancreas. Eventually, the original three-inch deep wound was converted to a twenty-inch long contaminated, purulent gash stretching from the president’s ribs to his groin.

Garfield’s original wound was entirely survivable even in the 1880s, and he would almost certainly have survived it had his doctors not repeatedly introduced sources of infection which ultimately resulted in his having systemic abscesses and resultant septicemia. Thousands of civil war veterans lived long lives with bullets embedded in their bodies. Garfield ultimately died of a ruptured splenic artery.

It is an interesting sidelight that a Herculean effort was made by Alexander Graham Bell to perfect his newly invented metal detector in time to save President Garfield. He worked tirelessly on the device day and night and devoted endless hours to this cause. X-rays had not yet been invented and it was deemed essential to locate the position of the bullet for possible removal. Bell was finally permitted to try his device on the president, and did so on two occasions. Garfield himself was apprehensive of the new device and was fearful of being electrocuted. Bliss, allowed Bell only to examine one side of Garfield’s body, being convinced that that was where the bullet was lodged (in fact, it lay on the opposite side.) To his great dismay, Bell detected a constant series of signals indicating metal over a diffuse area and could not understand why. He later learned that Garfield was lying on a brand new type of mattress – a coil mattress filled with metal springs.

And then there was the matter of facial hair.

In the second half of the 19th century, it was considered the norm for presidents to have facial hair, something unimaginable in our current image-conscious times.

Although John Quincy Adams and Martin Van Buren had extensive sideburns, presidents were clean shaven until Abraham Lincoln grew a beard when an 11-year-old girl suggested that he do so. For the next 52 years, facial hair became the trend, so much so that it became unimaginable for a president to be clean shaven. Beards were thought to prevent pulmonary problems and throat disease. The last president to serve with facial hair was Taft (who left office in 1913.) His successor Woodrow Wilson had a white beard during his illness and just prior to leaving office.

Beards and facial hair were almost an expectation of the day. One can only wonder about the magnitude of iatrogenic disease caused by the introduction of infectious agents by uncovered beards on physicians wearing blood-encrusted smocks and using filthy instruments during these times.

Enter Joseph Lister.

Lister spent much of the 1870s and 1880s trying to convince the world that germs existed and were the cause of wound infection. He was received with derision and frequent outright hostility. One medical journal editorial stated that, “We are as likely to be as ridiculed in the next century for our blind belief in the power of unseen germs as our forefathers were for their faith in the influence of spirits.” Doctors could simply not accept that microbes might be lurking in the air and on their hands.

In many cases, doctors might be persuaded to try antiseptic techniques by boiling their instruments prior to surgery, and at the same time be completely unaware of the need to maintain asepsis. If a previously sterilized instrument fell to the floor, it would be picked up and wiped off with an unsterile cloth and used to continue the operation. If infection resulted, the doctor would then dismiss Lister’s ideas.

Lister lectured and promoted his theories tirelessly, pointing to his own remarkable success in reducing post-operative infection. Gradually he began to gain a following, when doctors such as W.W. Keen began to use aseptic techniques in Philadelphia’s St. Mary’s Hospital after hearing Lister speak. The infection and mortality rates plummeted almost immediately, and other hospitals rapidly followed suit. Antiseptic techniques became the norm within a decade.

Lister died in 1912, having lived to see universal adoption of his aseptic techniques. He did not live to see the introduction of a household product bearing the unauthorized use of his name just two years later– Listerine mouthwash.

This historical perspective says much about human nature and resistance to change. Lister was committed to his cause, but encountered a 19th century version of the physician adoption challenges of the first decade of the 21st century. The possibility that a universal conversion to digitalized medicine will have the same impact on saving lives that aseptic techniques had seems unlikely, but it is clear that breaking through the boundaries of embedded practices has never been easy in our industry. Current day champions have a big set of shoes to fill.

Samuel R. Bierstock, MD, BSEE is the founder and president of Champions in Healthcare, LLC, a strategic consulting firm specializing in clinical information system implementation and healthcare IT business strategies.