Curbside Consult with Dr. Jayne 8/15/11

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

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

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

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

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

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

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

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

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

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

E-mail Dr. Jayne.

Monday Morning Update 8/15/11

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

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

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

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

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

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

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

Honky Cat was moved to wax poetic about HIStalk:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

E-mail Mr. H.

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

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

I wrote this piece in June 2006.

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

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

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

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

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

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

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

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

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

HIStalk Interviews Tom Stevenson DO, Chief Medical Officer, Covisint

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

Tell me about yourself and about Covisint.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Do bad doctors know they’re bad doctors?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

News 8/12/11

Top News

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

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

Reader Comments

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

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

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

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

HIStalk Announcements and Requests

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

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

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

Acquisitions, Funding, Business, and Stock

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

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

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

Sales

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

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

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

People

Genomind hires former MEDecision CEO Scott Storrer as COO.

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

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

Navigant adds eight senior consulting professionals to its healthcare practice.

Announcements and Implementations

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

Government and Politics

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

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

Other

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

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

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

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

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

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

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

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

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

Sponsor Updates

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

EPtalk by Dr. Jayne

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

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

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

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

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

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

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

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

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

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

Contacts

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

HIStalk Interviews Steve Barlow, CIO and Co-Founder, Healthcare Quality Catalyst

Steven C. Barlow is CIO and co-founder of Healthcare Quality Catalyst of Salt Lake City, UT.

Tell me about yourself and the company.

Healthcare Quality Catalyst was established three years ago with the mission of helping organizations accelerate the process of outcomes improvement using information and measurement to support that process.

I worked at Intermountain Healthcare for about 18 years. The last 10 or so years there, I was the director of the enterprise data warehouse team. I had the great opportunity of working with some clinical visionaries who really knew how to apply proven quality improvement principles in healthcare and lead the information in evolution of analytics to support that process.

After spending that time with Intermountain Healthcare, my business partner and co-founder Tom Burton and I launched and started Healthcare Quality Catalyst to bring those same kinds of principles and products to organizations across the country.

Data-driven quality improvement solutions usually involve some combination of technology and consulting services. How is your approach different from what your competitors do?

We are more of the technology and products company, with services to support the installation and configuration of those tools. We bring a set of tools.

Let’s say an organization just deployed or has recently deployed an EMR system such as Epic and now needs a rational solution to get access analytically to those data. We have a data warehouse core starter set that we have built for EMRs like Epic that can get a client up and running on a data warehouse core in a matter of a few short months.

The services we provide involve orienting the client organization around proven guiding principles in data warehousing. Data warehousing is one of those disciplines that has a few leading schools of thought that haven’t necessarily been proven all that effective in healthcare. We bring some proven and rational incremental approaches to healthcare data warehousing in this domain.

The products are the data warehouse and then a few other tools, such as a Wiki-based metadata repository; a centralized data capture tool that allows analysts and clinicians and researchers to, in short term, capture information that may not be readily available in the EMR; and a tool called the Key Process Analysis Tool that we’ve developed which helps organizations prioritize and identify where they have the greatest opportunity for quality improvement, which typically is demonstrated through the amount of variation in a given domain. For example, why do we have an average length of stay for a hip replacement DRG with the same severity-adjusted population of x days in this facility and x + 5 in this facility? We have a tool that helps bring visibility into those opportunities for improvement.

Data warehousing seems to be something that hospitals think should be easy and inexpensive and they get scared away when they find out that it’s not necessarily either. Do you find that that’s an issue in convincing people that your solution will work for them?

Yes. We do typically see clients who are a little anxious about the size of these projects. 

Our competitors take an approach where a lot of those lengthy project timelines really are required. The products that we bring to the table really accelerate the time from project initiation to usable information in an integrated data warehouse. Now we don’t prescribe or pretend to think that we’re going to have, in a few short months, a completely robust data warehouse that includes data from every possible disparate system within the organization, but we get them a long way down the path. 

We also teach them some very tried and true pragmatic principles, both design and process principles, and get them well on their way. In a few short months, three to four months, we can have a client up and running and knowledge workers in the organization beginning to actually discover knowledge and do analytics.

Many companies have offered data warehouses and business intelligence dashboards geared toward quality and cost. Do you think hospitals have seen the results they expected from those? Why do you think that is or isn’t the case?

You know, I don’t think they have. There have been a lot of reports circulated over the last decade where across verticals — not just in healthcare –  over 50% of projects are deemed as failures. Based on our experience, I think I would highlight a few reasons we see those still failing.

One, it’s a technology project looking for a business sponsor. The “If we build it, they will come” approach will never be deemed successful by the business.

Two, I think there’s a lot confusion about, “What architecture should we use for this data warehouse?” There’s a lot of fits and starts. A couple of the predominant approaches have been proven to be very effective in industries such as finance and manufacturing and retail where the data are a bit simpler and much less complex than they are in healthcare. We prescribe to one of those approaches, as opposed to, “Let’s think pragmatically and maybe adjust one of those approaches to fit the need in healthcare.” 

The final reason I would highlight based on our experience is the motives behind building a data warehouse often are misguided. For example, we see often organizations either acquiring analytical products or deploying measurement systems for the purposes of identifying where there are outliers and reining those outliers in. It’s used in a more punitive way, as opposed to a learning way where,  “Let’s identify in this organization side by side, technologists with clinician, where we have some great things being done and let’s learn why it’s being done consistently in this area and permeate those changes across the system.” It’s punitive versus learning motivation.

With that in mind and knowing as you said an organization needs a business sponsor as well as the technology, how can you tell if a prospect is really going to be motivated to take the actions that the data are going to indicate?

That’s a great question. I think when we go into a client organization we really like to visit with both sides of that fence. We like to visit with the technical leadership as well as the operations and clinical leadership. We can quickly get a feel within the organization how motivated and engaged they will be with a business in a clinical sponsorship driving the technology and how open the technology folks will be in that kind of a relationship. It’s quite easy to tell in a few short visits.

Can you give me a few of the specific outcomes that customers have seen as a result?

We’ve seen some of our clients, as they deploy the technology very quickly, they also begin to deploy the methodology that we would prescribe. They begin to have opportunities open up to them — the provider organizations — to speak with payer organizations and say, “Hey listen, we’re working on these quality improvement initiatives and we see opportunities to share in the savings that will result from these initiatives.” There are some exciting discussions and relationships beginning to form between payers and providers where they co-fund these initiatives and begin to share in the savings.

There are also real clinical improvement measurable results that we have seen with some of our clients. As an example, one of our clients set some goals to reduce the elective induction labor before 39 weeks. We know based on research that if labor is induced before 39 weeks gestation, the risk of NICU days goes up and the average duration of labor is increased. The goals are to reduce the percentage of the time that labor is induced electively before 39 weeks gestation. One of our clients went in less than a year from a 15% elective induction rate down to a 2% elective induction rate. That’s just one example of some interesting improvement initiatives that we see happen in our clients.

You mentioned Epic. Kaiser is doing some pretty amazing things with their information from HealthConnect, which is Epic. What kind of work are you doing with Epic customers and what’s the benefit to them beyond what Epic offers out of the box?

Epic did a great platform, a great EMR system. What we can provide is really helping clients now who have deployed Epic. We’ll leverage that rich resource of information and very quickly, in a matter of a few short months, they can have those data available in a data warehouse — a very scalable, usable data warehouse platform into which they can also integrate other disparate data sources.

We have a product roadmap where we’re going to bring in some interesting visualization tools and other ancillary tools to support that process around clinical domains. As a clinical diabetes team or cardiovascular team gets together and identifies their opportunities for improvement, we’ll have the data and the visualization tools to support those efforts based on evidence-based work done inside and outside the client’s area.

The company has a pretty large and well-credentialed management team. What’s the strategy going forward?

Our strategy going forward is to increase the number of connectors, if you will, to the various EMR systems and to continue developing and enhancing our current ancillary toolset. As well as creating greater knowledge into these targeted data sets around conditions that we see after doing some interesting Pareto analysis from client to client. We patterns bubbling up the top 10 or 15 clinical conditions and we’re going to fill out and make more robust those information assets that we’ll make available to our clients around each of those conditions.

How do you see the role of data-driven quality and cost initiatives changing with healthcare reform?

There are so many pressures from all angles that impose on provider organizations from the regulatory perspective, from a payer perspective, that I see the appropriate application of measurable outcomes improvement initiatives using a rich information repository is going to be an absolute fulcrum to make all of this possible. 

I  think we’re going to see – and are seeing — more and more healthcare organizations, from both from internal and external pressure, forced into paying much more attention to data coming out of these systems that we spent so much time getting data into over the recent years.

Do you have any concluding thoughts?

Healthcare is a very dynamic industry. We feel that Healthcare Quality Catalyst is positioned very well based on our rich experience and heritage and set of products that we bring to the market. We are just very excited to help healthcare organizations benefit from our experience and our toolset to accelerate their time to improving clinical outcomes for the patients they serve. It’s a great opportunity, and we certainly feel a responsibility to do our part to help in this solution to the healthcare problems that we face in this country.

News 8/10/11

Top News

IBM and nine other vendors file protests with the VA for not being chosen to participate in its $12 billion technology program. All the protests except IBM’s have already been denied.

Reader Comments

From Observer: “Re: Flagler Hospital, St. Augustine, FL. Replacing Meditech with Allscripts Sunrise, which beat Epic and Cerner as well. It’s a 300-bed  HealthGrades Best 50 hospital.” Unverified, although I had heard that an unidentified hospital had signed on.

From Otoscope: “Re: hospitals that have successfully attested. Is there a list somewhere that includes which vendors they use?” I haven’t seen a list like that. If you have, let me know.

From Unlisted: “Re: shakeup at ONC. Arien Malec, coordinator of NHIN Direct, is returning to RelayHealth. Dr. Doug Fridsma will leave his current post and take over Dr. Chuck Friedman’s former position as Chief Scientist. All of this will leave ONC-sponsored interoperability efforts lost at sea.” Arien tells me that he announced his departure from ONC on Monday – his nine-month RelayHealth leave had turned into 18 (he was not an ONC employee). He reports that it was already announced that Doug Fridsma is covering the Office of the Chief Scientist role in addition to Office of Standards and Interoperability. I wouldn’t say that any of this necessarily qualifies as a shakeup, though. 

HIStalk Announcements and Requests

You may have read last week that I was traveling a bit, leaving Mr. H to carry an even heavier load than usual. In addition to some shoe shopping (a mere two pair), I paid a visit to eClinicalWorks and athenahealth. If you care to learn details about eCW’s nifty new headquarters, or see some pictures of Jonathan Bush’s office, you’ll find the write-ups on HIStalk Practice.

Acquisitions, Funding, Business, and Stock

Private equity firm Halyard Capital invests in RCM provider Practice Insight.

At least five law firms file class-action lawsuits against WebMD, alleging that the company misrepresented its financial position to shareholders and failed to make timely disclosures about projected drops in  advertising revenues. CEO Wayne Gattinella lowered revenue guidance for 2011 in July and the stock price fell 30%; however, company insiders sold $44.7 million in stock in the months following the issuance of WebMD’s February financial statements.

SAIC completes its acquisition of Vitalize Consulting Solutions.

Emdeon reports Q2 net income of $5.8 million, up from $4.2 million a year ago. Non-GAAP adjusted net income was $31.8 million ($0.26/share) which beat analysts’ expectations of $0.25/share. Revenues were up 16% to $282.1 million. The company announced last week that it will be taken private by a Blackstone Group fund.

Symphony Corporation, a Madison, WI-based technology provider, acquires JGI, a New Jersey human capital management consulting firm. Both companies claim a significant healthcare presence.

Sales

Stormont-Vail Healthcare (KS) selects TeleHealth to provide interactive patient education services.

Mille Lacs Health System (MN) contracts with Indigo for its Identityware SSO and access management solution.

Iowa Health System will use Medicity’s HIE technology to connect its hospitals and clinics.

People

LSU Health Shreveport promotes Marcus Hobgood to CIO.

SCI Solutions names Joel French managing partner and CEO and Jeff Anderson managing partner and chief sales officer. Founder John Holton will serve as managing partner and COO. French was most recently VP/GM Healthcare of Motion Computing; Anderson was managing director at Huron Consulting Group. SCI also announced that The Wicks Group of Companies and New Enterprise Associates have invested in the company to support its expansion efforts. 

RedBrick Health, a Minnesota vendor of technology-driven online wellness services, names Daniel Ryan as CEO.

Announcements and Implementations

Taiwan goes live on its nationwide EMR initiative in November, allowing physicians across the country access to patients’ clinical information.

Cerner says that all 18 Major League Soccer teams have implemented its HealtheAthlete health management platform. During the 2010 season, 621 players were tracked in the system and 1,500 injuries were logged.

The Christ Hospital (OH) implements a real-time interface that captures data from hemodialysis treatments and imports it into its Epic EMR.

Stillwater Medical Center (OK) integrates its the vital signs monitors in its same-day surgery unit with its Meditech HIS using Accent on Integration’s Acceleor Connect technology.

Dell and NextGen announce plans for Dell to sell and support NextGen’s ambulatory and inpatient solutions and to provide hosting services for NextGen clients. Dell also becomes the platform of choice for NextGen solutions and for NextGen’s internal use.

LA Care Health Plan (CA) will spend $1.5 million to develop and implement an eConsult system at 47 LA County safety net sites. It will handle provider communication and referral requests. A previous pilot program was claimed to reduce face-to-face specialist visits by up to 48%, depending on the specialty.

Government and Politics

New Hampshire Governor John Lynch signs legislation that establishes the state’s Health Information Organization (NH-HIO.)

HHS issues a Notice of Proposed Rulemaking regarding the use of metadata standards to support health information exchange.

In Australia, standards work for the government’s eHealth program is stopped when the non-profit Standards Australia fails to secure a new government contract.

Other

The Colorado Department of Public Health and Environment fines Heart Check America $3.2 million for a variety of violations, including performing diagnostic scans without the order of a state-licensed physician. The company was also cited for failing to monitor employee radiation exposure and not having policies and procedures to ensure safe CT scanner use. The company closed its Denver facility in May following a state inspection.

HIT jobs will grow 20% annually through 2018, according to the US Bureau of Labor Statistics. Because of particularly strong demand for CIOs and CTOs, individuals from banking, manufacturing, and other industries are now being hired into healthcare.

KLAS reports that Cerner’s Millennium PowerChart has the most hospitals live on CPOE, followed by Epic.  An average of 81% of orders are being entered via CPOE in Cerner hospitals and 83% at Epic sites. The third-ranked McKesson had 90 installations of Horizon CPOE at the end of 2010, with an average of 45% adoption, plus 11 Paragon sites with 25% average adoption. Overall industry adoption of CPOE was still less than 22%.

Doom and gloom from Down Under: The Australian Medical Association warns that the federal government’s online medical records system is “doomed to failure” because not enough people will sign up for it. Patients are required to opt in to participate; the medical association wants the government to make participation mandatory unless the patient opts out.

Strange: an health board IT technician in New Zealand is fired by the CIO for departmental theft. His loot: one blank DVD.

Weird News Andy is nuts about this premature discharge story: a man tucks his girlfriend’s pink pistol into his waistband as the couple enters a grocery store, accidentally pulling the trigger and shooting himself in his private parts. The girlfriend calls 911 and the emergency operator tells her to apply pressure, but not to look at the wound. “I did look at it and it’s pretty bad,” she admitted. The local police department turned the unfortunate incident into a teaching moment, helpfully advising locals to use holsters rather than jamming weaponry down their pants Hollywood-style.

WNA also turns up this story: a 26-year-old with breast cancer and no health insurance is denied coverage by a Medicaid program specifically created for that condition. The reason: he’s male. Above is CMS’s special coverage conditions, which exclude the several thousand men who are newly diagnosed each year.

An Ann Arbor, MI couple who owned hospital inventory software company Ariel Software are indicted for failing to pay taxes to the IRS over a 12-year period. They are accused of withholding $880,000 in employment taxes, but spending most of the money on the business instead of sending it to the IRS. The husband was also charged with failing to file personal tax return for several years.

A former VA data warehouse manager is sentenced to 11 years in prison for extracting patient information from the VA’s system and using it to file 800 fraudulent tax returns through his home tax preparation business.

Doctors in Estonia complain about the HP-developed EMR used there, saying that entering data for a single patient requires 50 mouse clicks and opening dozens to hundreds of documents one at a time.

General Cannabis announces that its WeedMaps marijuana dispensary finder took in $1.1 million in July. Its patient management system will complete beta testing shortly and offers patient self-scheduling, electronic medical records, and an appointment reminder system. According to the CEO, “Our technology is applicable beyond cannabis and we are already in development on our next medical niche.”

Members of a Florida ministry’s medical bill-sharing program join together to pay each other’s “responsible” medical bills, eliminating the administrative expense of for-profit insurance companies. The program, which the ministry insists is not insurance, pools expenses for members to share as they wish. It also offers healthy living rewards and helps its parishioners adopt healthy lifestyles. Its interactive tools include a 24×7 Twitter-like Prayer Stream for prayer requests and offers of encouragement.

The parent company of a West Virginia nursing home will appeal a jury’s $91.5 million medical negligence verdict that claimed its understaffing caused the death of an 87-year-old resident.

Sponsor Updates

• The College of American Pathologists, the CDC, the AHA, and Surescripts will present The Lab Interoperability Cooperative: Engaging and Empowering Hospital Laboratories and Public Health Agencies in Electronic Laboratory Reporting for Meaningful Use at CDC’s Public Health Informatics 2011 Conference, August 21-24.
• Besler Consulting publishes a paper on Healthcare Reform – Do You Have The Clinical Outcomes to Achieve the Financial Rewards?
• API Healthcare is exhibiting at Healthcare WFM 2011 August 19.
• Bulletin Healthcare announces an opening for Senior Medical Writer.
• EDIMS is attending the iHT2 Health IT Summit next week.
• Voalte will hire 50 employees over the next three years as it expands its Sarasota, FL offices.
• Employees of Sage Healthcare are doing volunteer work at community health centers this week as part of the company’s support of National Health Center Week.
• DIVURGENT publishes a paper entitled Meaningful Use Requirement for HIPAA Security Risk Assessment.
• MediServe is offering a Webinar, CMS 2012 Final Rule – How Will the New Rule Impact Your Facility?”
• St. Joseph’s Hospital Health Center selects CareWorks CMS from CareTech Solutions for its Web sites.
• dbMotion receives ONC-ATCB 2011/2012 certification for three use cases.
• GE Healthcare releases Centricity Advance – Mobile as an iPad application, while also announcing U.S. launch of Optima CT660.
• MEDecision Inc. announces that its 2011 URAC accredited Alineo Clinical Programs are available.
• Access announces that 10 of its customers have been named to HHN’s Most Wired Hospitals list for 2011.
• AdvancedMD receives recognition as the top EMR for OB/GYN.
• GetWellNetwork releases a new white paper, Meaningful Use of Health Information Technology: Requirements and Solutions in Patient and Family Engagement.
• A National eHealth Collaborative HIE report recognizes two Orion customers, HealthInfoNet and SMRTNET for their mature HIEs.
• The Advisory Board Company expands it Austin,TX software center following a 10-year, $372,590 incentive deal with the city. The company will create 239 jobs and invest $8.1 million in improvements to its leased space by 2017.
• Greenway Medical reports that its customers have secured more than $1 million in combined Medicaid and Medicare Meaningful Use incentive funds.

Contacts

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

Curbside Consult with Dr. Jayne 8/8/11

I had a long, lazy weekend, of which I spent a good part staying up too late catching up on the Netflix releases that have been mocking me from the top of my television. Kind of like those folks that tend to smoke only when they visit bars — when I stay up late, I have a bad habit of winding up at Taco Bell. As I sat in the drive-through lane pondering what it is that makes even the most health-conscious physician stray, I noticed a billboard for a local hospital advertising the ability to hold one’s place in line in the emergency department.

It was news to me that one of our competitor hospitals had partnered with InQuickER, whose slogan is “Skip the Waiting Room.” Essentially, for a $9.95 registration fee, patients can register for their emergency department visit and wait at home until their projected treatment times. Kind of like call-ahead seating at Red Lobster, although I assume you don’t get a cute crustacean-shaped beeper when you arrive.

As a technical person who also speaks fluent Administralian, it sounds good. It’s a relatively easy technical application – if restaurants can do it, there’s no reason it can’t be applied to other industries, including healthcare. As a physician leader, I can imagine that patients who aren’t frustrated from sitting for hours in a crowded waiting room are likely to give higher scores on patient satisfaction surveys and may be less likely to taunt the triage staff or harass caregivers.

On the other hand, as a clinician, it makes me cringe a bit. Although InQuickER admits it doesn’t actually schedule appointments but rather holds a patient’s place in line while they wait at home, it does offer a guarantee in which users who aren’t seen within 15 minutes of their projected treatment time are given their money back.

During the past decade, I’ve watched the physician/patient relationship slowly erode. There are a lot of factors impacting this both positive and negative.

Personally, I believe that educated patients are healthier patients. I believe in patient self-determination and that some physicians need to jettison the antiquated paternalistic tendencies they continue to carry. I want patients to be smart shoppers and to understand their healthcare choices. I don’t want them to necessarily do things because “the doctor told me to.”

On the other hand, I believe the overt consumerization of healthcare has some serious downfalls and minimizes the complexity and skill involved in caring for and treating patients.

Although InQuickER’s FAQ section clearly states that hospitals do use triage protocols and that its users do not receive preferential treatment, it’s easy for a patient who doesn’t read the fine print to make the logical leap that they’re going to receive special or quicker treatment. They advertise a 95% success rate for patients being seen within 15 minutes of their projected treatment time, and for physicians already under pressure to reduce cycle times and see greater numbers of patients more and more quickly, this is just going to add more stress to an already bubbling pressure cooker.

I cover the emergency department regularly and see a large proportion of patients who don’t need to be there, many with non-urgent conditions who haven’t tried any over-the-counter remedies or exercised a reasonable degree of Boy Scout-level first aid skill. In some cases, the thought of sitting in the waiting room with “all those sick people” is enough to keep them at home and out of the emergency department, and sometimes their issues spontaneously resolve without at $50 copay.

For a mere $9.99, the inconveniences of waiting are avoided, and I worry that this will bring more non-urgent cases into our already overcrowded system. On the other hand, for some cases, this could be heaven sent – for the migraine patient who has exhausted all home prescription medications and is bothered by light and sound, the ability to minimize time in the waiting room is solid gold.

As I crunched on my Volcano Taco, I surfed the hospital’s Web site. Injecting a bit of humor into the situation was this: the InQuickER site projected a 75-minute wait for me, while the hospital’s own handheld app advertised a 14-minute wait on their real-time waiting room ticker. With stats like that, of course, the odds that I’d be seen before or within 15 minutes of my projected treatment time were pretty good.

I can see both sides of this one, so for me, the jury’s still out. Nevertheless, I put the word out to colleagues at the hospital in question to ask how it’s really going, but I’d also like to hear from readers. Are any of your facilities using the system or that of a competitor? InQuickER is SaaS model — how are they to work with? How is support? Any issues? E-mail me.

E-mail Dr. Jayne.

Monday Morning Update 8/8/11

From Carlos: “Re: State of Connecticut HIE. Likely to hire Axway, a French company with headquarters in Arizona, to provide the platform. Too bad they didn’t commit to an American company.” Unverified, but it’s like car makers: tough to sort out whether you’re really buying American given that the executives, employees, subcontractors, and taxes paid are scattered around the globe and you don’t really know which country benefits the most. Axway is a publicly traded company (on the NYSE Euronext) spun off from IT services firm Sopra this past June. The CEO is French.

From Leisure Suit Larry: “Re: hospital EHR adoption. Have you seen 2010-2011 numbers? I haven’t seen anything since the 2009 AHA IT survey.” Maybe someone can help out.

From The PACS Designer: “Re: DICOM’s expansion. The stability of the DICOM Standard has been solidified with its expansion into the test and measuring field of practice. The ASTM DICONDE Committee has recognized the value of DICOM as a standard in healthcare, and adapted a version for test equipment called the E2339 Standard titled Practice for Digital Imaging and Communication in Nondestructive Evaluation. There are standards for various test methods which include Digital Radiography (DR), Computed Radiography (CR), and Computed Tomography (CT).”

From Bang Bang Shrimp: “Re: for-profit hospitals. I helped open HCA West Paces Ferry Hospital in Atlanta in 1974. We attached Addressograph charge slips to single Band-Aids at an unconscionable mark-up. We bought disposable ventilator tubing for $1.25 and charged Medicare $22.50. It took the federal government 20 years to realize they were being raped and not even receiving a kiss – thus the Dartmouth Study and prospective reimbursement.”

Thanks to the following HIStalk sponsors that started or renewed their sponsorship in July. Click a logo for more information.

HIMSS got mixed grades on last week’s poll, with 62% saying it deserves a B or C and more respondents giving it a failing grade than an A. New poll to your right: do hospital CIOs have too much influence in choosing clinical system vendor or implementation strategies?

Listening: reader-recommended (from Lake Hartwell) Heartless Bastards, a no-frills, hard-rocking Dayton bar band with a deep-voiced female singer (think Chrissie Hynde of The Pretenders meets Johnette Napolitano of Concrete Blonde) who also writes the songs and plays a mean rhythm guitar. Nothing phony or computer-enhanced here. Excellent.

The British government is expected to officially kill the 10-year, $18 billion NPfIT project next month after reviews conclude that the massive undertaking, the largest non-military IT project in history, is “beyond the capacity of the Department of Health to deliver.” Deadlines have been missed, contractors have pulled out, benefits are unclear, and reviews have concluded that project officials didn’t get enough input from physicians and other clinical users. An editorial reminds that there’s plenty of blame to pass around, including ministers for approving the use of custom systems without requiring small-scale trials, civil servants for approving questionable contracts, and vendors (notably CSC and BT) for continuing to collect taxpayer money despite not meeting their contractual obligations. The project is expected to turn into an HIE-like federated data sharing system, where local health trusts and hospital can buy whatever systems they want rather than those mandated by NHS.

Australia’s struggling, over-budget $425 million HealthSMART system is blamed for faxing hospital discharge summaries to physician practices that included clinical information for different patients. The Health Department says faxing software attached the wrong information to the fax header, acknowledging 13 incidents that had no known patient impact.

The VA awards 15 prime contracts for its technology and telecommunications program called Transformation Twenty-One Total Technology. The value of the contracts could reach $12 billion.

Kaiser Permanente’s nonprofit hospital and health plan business announces Q2 profit of $663 million, up 64% from a year ago. Revenue was $11.9 billion and membership increased to 8.8 million. An e-mail to employees sent Friday from its COO and CFO says KP will begin implementing videoconferencing technologies to link providers and also systems that can send monitoring device data directly to the patient’s EMR. I wondered about the salary of CEO George Halvorson, so I looked it up: for 2009 (the most recent year available), $6.7 million in total compensation.

My Time Capsule editorial this week from the 2006 archives: Vendors Seek to Diversify as the Hospital Systems Market Matures (this was pre-HITECH, when hospitals bought systems because they wanted them, not because the government bribed them to). A snip: “Business will sizzle in ambulatory systems, various forms of telemedicine, data analysis, payer intelligence, genomics, interoperability, consumer health, drug research, home health, and medical device connectivity.”

Brigham and Women’s Hospital announces that a doctor left an external hard drive in a cab in Mexico, potentially exposing the medical records of several hundred patients that had been downloaded to it. The doctor said the information had been deleted, but the hospital announced the loss anyway since it couldn’t verify that the information was unrecoverable.

Adventist Midwest Health names Chet Robson, DO as regional director of medical informatics, ambulatory systems.

Dr. Sam (Bierstock) and the Managed Care Blues Band, self-billed as “The World’s Most Reluctant Band,” release their latest — HITECH Blues. Sample lyrics: “I’m sitting here in prison, I’m living in a life of tears, I could be in my office, but they gave me 20 years. I never should have hacked into, the PHR of Britney Spears. I used to have to deal with, 4 different kinds of EMRs, I had one in my office, the ED, hospital, and the OR. Just ‘cause I saw that information, I’m sittin’ behind bars.”

Here’s the latest HIStory chapter from Vince Ciotti, covering Keane.

Speaking of Vince, he’s looking for stories and information about his next featured company, Charlotte-based SAI (1988 coverage above), if you want to pitch in.

European hospital pharmacy technology vendor Health Robotics is granted a motion to dismiss McKesson’s lawsuit that sought to rescind their joint distribution agreement.

ESD rebrands itself with new graphics and a tagline, “IT Consulting Rooted in Healthcare.”

Twenty-nine Penn State pre-med students are deployed at Mount Nittany Medical Center to coach physicians on its EHR transition. CMIO Stephen Tingley came up with the idea to give students the summer job. A cardiologist expressed his appreciation for the help, saying, “The system is not easy to figure out. It’s so different, like a maze. I’m dreading the day when they’re not here.”

Strange: a rural health center nurse in Pakistan, who claims a dental surgeon sexually harassed her and had her salary withheld for a full year, goes to a press club and pours gasoline on herself. Bystanders step in before she can get it lit. And stranger: a passenger on budget air carrier RyanAir goes into cardiac arrest during a flight and stops breathing, with his wife shouting for someone to bring oxygen. The flight crew, concluding that his blood pressure was the problem instead, brings him a sandwich and soda. After he revived, they came back to collect payment for the snack.

E-mail Mr. H.

Time Capsule: Vendors Seek to Diversify As the Hospital Systems Market Matures

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

I wrote this piece in June 2006.

Vendors Seek to Diversify As the Hospital Systems Market Matures
By Mr. HIStalk

Vendors of traditional hospital information systems are hedging their bets for future success, judging from recent announcements. McKesson said this week it is acquiring RelayHealth to move into consumer health care systems. A group of vendors said they would develop standards to make their home health devices interoperable. And Cerner’s announced growth areas are mostly outside of traditional hospital IT.

The message seems clear – business prospects are better elsewhere. Wall Street likes growth that big conglomerates and publicly-traded vendors can’t get from hospital-only sales, given a finite supply of prospects that are big enough to afford their wares. The recent spike in clinical systems deals may have been transitory, locking up all the laggard customers but leaving fewer for the years to come.

Perhaps we’re in the classic mature market, where the customer base is saturated, vendors are consolidating, product prices go down to reflect decreased demand, and emphasis moves from R&D to solid, user-friendly applications that are differentiated primarily on specific features (think Rubbermaid). Vendors can still make a lot of money, only instead of from product sales, profits come from selling high-margin services and maintenance to existing customers.

Under this scenario, and given high switching costs, hospitals may no longer command the undivided attention of vendors whose gaze is wandering to sexy new markets. Maybe there won’t be any successful hospital-only vendors left, except possibly for Meditech, which is ideally suited for success due to its dominant market penetration, near-universal customer retention, low cost through economies of scale, and private ownership.

Even if the hospital systems market is mature, just about every other health care IT sector isn’t. Business will sizzle in ambulatory systems, various forms of telemedicine, data analysis, payer intelligence, genomics, interoperability, consumer health, drug research, home health, and medical device connectivity. Products in the innovation and growth stages of the product life cycle require high development and sales costs. The aggregate market must be defined and created. Most companies will lose money, but winners will emerge from the turmoil to gain competitive advantage and profitability.

It will be interesting to see how the traditional players fare in these markets, where they’ll need seldom-used capabilities such as technical innovation, nimble execution, and delivery of their message to a much larger number of prospects who behave less cohesively and identifiably than hospitals. Having a good idea isn’t enough. If I were an investor, I’d buy strictly on the quality of company management, choosing vendors with visionary, focused leaders who can rise above a host of new market entrants that are likely to fail due to stumbles in execution.

The original HIT marketplace was first changed dramatically by the emergence of large, full-line hospital systems vendors that moved the industry away from small, innovative best-of-breed vendors and customer self-development. The second change was the absorption of most vendors into unfocused conglomerates or larger competitors. The third wave — obviously underway — is diversification of vendors into non-hospital health care IT.

It remains to be seen whether hospitals will be better or worse off with these changes. We struggled even when we had the undivided attention of our vendors, failing to manage change and gain ROI in an admittedly screwy and ever-changing health care non-system. We may not enjoy giving up the limelight. After many years as a hospital IT person, I’m a little jealous to see the excitement growing in those areas of health care I don’t yet know much about.

HIStalk Interviews Ken Willett, CEO, Ignis Systems

Ken Willett is president, CEO, and chief technical officer of Ignis Systems of Portland, OR.

Tell me about yourself and and the company.

I’ve been in software development ever since I got out of college in 1974. I’ve worked in a number of high-tech startups, mostly in the electronic design industry. I got into healthcare IT as I started a consulting business in about 1994. Ignis Systems was incorporated in 1999. 

One of my first major clients was MedicaLogic, now the Centricity products from GE since they bought MedicaLogic. That then led to EMR-Link, which is the current product that we have. Ignis is no longer a consulting company — it’s a product and services company. A number of people have joined — quite a few of them with GE Centricity background — but we’re now spreading out, bringing in people with expertise in other EMRs. 

The system deals with CPOE from the ambulatory side – orders and results – and in the diagnostic area: lab orders, lab results, radiology orders and results, and so forth.

Describe briefly how the orders flow within an ambulatory EMR.

The EMR is the main cockpit of the provider these days. People who are really using EMRs well want everything to be driven out of the EMR — the decisions that they’re making, documentation they’re providing, and in particular, creating orders for outside services.

In the past, what’s typically happened is labs have provided either Web-based or application-based ordering systems to providers. Providers don’t want to switch to a different application to place a lab order, a medication order, or any other kind of order. They want that out of the EMR.

We provide the ability for them to do the ordering within the EMR. The provider generally provides some minimal information. What they’re interested in is, “What tests do I want run? What’s the justifying diagnosis for this test? When does it need to happen? Is it an urgent or a regular order?” But that’s not really sufficient information for the lab. The lab needs to know a lot more status information about the patient. They need to know about insurance. They need to know what account to bill things to. 

Our application collects the information from the provider, the basics of the order. It then allows a staff person to augment that information to get it to the point where it meets all the order requirements for the lab.  That helps to guarantee that when the results come back through us, they are going to meet the needs of the provider in terms of being a high-quality diagnostic report.

Many people would have assumed this problem was solved many years ago, especially since e-prescribing has settled down to universal standards. Do you think a long-term solution is coming for orders other than what you are offering, or is this as good as it will get in linking an ambulatory practice to the outside world?

I hope it will get better. When I was first involved with MedicaLogic, e-prescribing was just as much of a black hole as lab orders and lab results are now. What happened in the intervening years was there were a few large players on the prescribing side that were the pharmacy benefit managers. Once those large players got their act together and Surescripts was involved and that technology. That made it easy to essentially move that whole industry toward one set of standards and one method for communicating these orders.

The same thing hasn’t happened on the lab side. The lab industry is much more fragmented. There are two or three big players in the US, but they only account for about 20% of the total lab volume. We’re talking about hundreds or thousands of hospital labs, and now, even more in-office labs in large physician practices. It’s very, very difficult to drive a consensus there through just market activity.

What we end up having to do is have lots of different kinds of connections to different labs. They have slightly different flavors of HL7 data for orders and results and have different communications methods. We have to make sure that our hub adapts to those differences.

I think over time, particularly with a push from the federal government for information exchange, there will be some focus on standards. There’s some standards activity going on right now both at the federal level and within the HL7 community that hopefully will get adopted more widely. I think that will reduce the number of variations we have to deal with, but I don’t think it’s going to drive it down to one common standard that everybody’s going to be using.

Who is your target audience?

We sell services to the major labs and also to hospital labs as a way for them to connect the providers and their community, or the providers that they market their lab services to. The same thing with radiology. But the main user of our system is the provider. We have to make sure that what we are doing is a great solution for the doctor as they’re providing care for the patient, even though they typically pay for a small portion of our service. Most of our service is actually paid for by the lab. So it’s not simple from a marketing and sales point of view, because we have one customer who’s making the purchase decision, but we’re going to have a different customer that we have to satisfy from the usability point of view.

Let’s say LabCorp sponsors the implementation for a particular practice. Is the connection only then to LabCorp, or once it’s in place, can it be used for other lab companies?

One of the things that we think is important is to have a single ordering solution that can connect with all labs that a particular provider is going to use. The typical case is probably two to three. Because of insurance contracts, most of the people who send orders to LabCorp also send them to Quest because some insurance carriers require that. Then they may have a hospital lab that they send things to just because it’s in their community.

We have is a single application that allows ordering from any of those. From a business point of view, we have to break that apart so that LabCorp is paying for their piece of that system, Quest is paying for their piece of that system, and then there’s a subscription piece that the provider pays that’s a recurring annual usage fee.

By definition, your practices all have a large entity as a sponsor, correct? Its not really a universal system from the physician side, but rather whatever parts the sponsor wants to subsidize?

That’s true for the larger labs, but we actually have a range of different scales that we operate at. We have a lot of customers that are relatively small practices, maybe a dozen or so providers, but they have in-house lab. They want electronic ordering and electronic results. The smaller-scale LIS systems that they may be using for their in-office lab maybe don’t have that capability. 

We can allow them to do electronic orders and results. Even though the lab system is in the same building that they’re in, they connect through us because it just works better and smooths out the workflow.

Then we have a lot of labs that are in the middle. They may be a single hospital or a multi-hospital organization that may have a single consolidated lab, or they might have a lab at every hospital. We provide the ability for them to connect to practices either within their organization or affiliated practices within their community.

And then of course there are the large reference labs where labs are their only business. We also have a number of hospitals who provide labs and radiology, and we can provide a single ordering and resulting solution that handles both types of orders.

What kind of user or transaction volume are you seeing?

We have about 5,000 providers using our solution at between 250 and 300 different sites. We’re handling between a half million and a million transactions a month through our system. We have unsolicited results in some cases, but they may quite often have an order with a matching result coming through.

What’s the selling point for Meaningful Use?

This goes back to the Meaningful Use criterion around structured lab results. Lab results traditionally, in a lot of cases, have been faxed to providers or they’ve been sent through a remote print engine. They print it on paper, and then maybe they’re rescanned. But the established EMRs that have been around for a number of years can handle HL7 lab results. They can do things like display the patient trend graphs or they can filter the population based on lab values.

We’re seeing a flood of new EMRs hitting the market and a lot of them don’t have that capability. A lot of them believe that lab results just means that you can present a lab report to the provider so that they read it. If a provider or an organization chooses structured lab results as one of the menu items in Meaningful Use, then they need to have a system that can present that structured data to them. In some cases, their EMR may not be able to do that.

One of the things that we provide on the result side is that we can maintain the structured data in our system. We can provide it a readable, high-quality printed report or viewable report to the provider, but we can also provide the trending and the structured data that they need. It’s also sometimes the case that we can provide viewable lab results to a provider who doesn’t have an EMR yet, or isn’t set up to handle structured lab result data yet. We can populate that EMR with the structured lab data once that provider’s ready.

It seems reasonable for EMR vendors to let a specialty company develop the integration piece while they focus on the inherent functionality needed for their own workflows.

We think that’s the right model. In most cases, with a few exceptions, the EMR vendors don’t really do a very good job of interoperability with outside systems. It tends to be an afterthought. It’s a whole different business. EMR vendors usually are as software development and database experts. They’re used to building essentially closed systems that are delivered and installed at the customer’s site.

Interoperability is a much broader game. You have to be an expert in data communications and security, error recovery, and all kinds of things which may be or not that applicable in the EMR that’s installed at a particular customer site. I think it makes sense for people to leave that to us. 

We’re finding that, both with the EMR vendors and also with labs, when they start to add up they’re paying to implement lab interfaces and get them working, maintain them over time, and recertify them every two years, a lot of those companies that just don’t want to be in that business.

You mentioned use of your tools by practices with no EMR. Tell me about Orders Anywhere, which you market as a starter step.

That’s great for people that aren’t on an EMR yet. There are also many EMRs which don’t have electronic ordering at all. They don’t have the ability to generate an outbound electronic order message. A lot of them are designed just to document the orders in the chart. Some of them have an ordering capability but it’s just not very good — they don’t have the ability to configure ordering preferences to what the provider needs and they can’t split orders when they need to be split into multiple requisitions. 

Orders Anywhere is a way for people to have electronic ordering, even when their EMR doesn’t provide it. It’s both for people that don’t have an EMR and people whose EMR doesn’t have good ordering capability.

Are you seeing providers who have decided that HITECH money just isn’t worth the trouble and picking and choosing just those technologies that make benefit them directly, like perhaps your electronic ordering product?

You don’t necessarily find out what the provider is intending as far as the Meaningful Use stuff. I’ve heard stories of doctors who have said, “This isn’t worth it to me right now.”

But I think what we’re seeing is that a lot of the volume growth in EMRs really is being driven by the Meaningful Use rules, so the people who’ve decided that it’s not worth it probably aren’t talking to us anyway. For somebody who has an EMR and they think EMRs are good tools to use, they’re probably going to figure out how to get their use of the EMR up to the point where they can get some Meaningful Use reimbursement.

The other thing that we’re seeing that’s sort of odd and a little scary is vendors who build their systems to the Meaningful Use requirements. They may have some technology pieces and they’re asking, “What’s the minimum we can do so that a doctor can get paid by the government?” Not what’s a good EMR or what makes sense for taking care of patients, but more, “How do we meet the letter of the Meaningful Use regulations so that if they buy our product they can get paid?“

That’s not a very far-sighted view. Those regulations are going to change over time, but that set of things that have been identified by the ONC by the Meaningful Use, they’re really pretty arbitrary. There’s a lot of other things that you really should be doing if you’re going to be a good EMR user.

You’re in a fairly niche-type technical product area. Do you see your expertise translating into other products or services beyond orders integration?

Yes. We have a couple of things in the works that I can’t really talk about them in detail, but there are a number of problems now that are of the form of having multiple back-end organizations with different standards like the labs are in our world, maybe having to have some connection on the front end to every provider, or maybe all providers in a state, or all providers in a certain geographic area.

Understanding how to put together a hub-and-spoke architecture that does the right kind of translations in moving data from one side to the other  — we’ve learned a lot about doing that with labs and radiology. We believe there are similar problems that can benefit from that.

CCHIT chose your tools to test orders integration for certification. Did that raise the company’s profile?

Well, we hope it did. We have lots of experience with lab results and what works in the real world. That was a project of mine to work together with the CCHIT technical team to put together the test suite for Meaningful Use certification for lab results.

Where does the company and the industry need to go?

One of the things that we work very hard at is being really responsive as things change. One characteristic of where we are in the market is we’re hooking up new practices and new labs all the time. We have a hosted solution, a Software as a Service model, and we need to be able to turn things on very quickly, generally within the space of a few days. We can do that pretty readily as a small company. I think it might get more difficult as our organization gets bigger.

But there’s a lot of room for small companies like ours to fill in some of the gaps between these large systems, which often take 12-18 months to incorporate new capabilities. Things are moving too fast – people can’t afford to wait that long.

Any final thoughts?

I think there will be a separation between transport companies and transport technologies and content companies and technologies, sort of like what’s happened in the television industry. Communications companies deliver data from one place to another, then you have other organizations, like Facebook or  HBO, that provide the content.

We’re very much in the content business. We want the information provided by the provider to be useful for the lab, and we want the results from the lab useful to the provider. We don’t necessarily want to be involved in the plumbing that makes all that happen. In the HIE world, some of the work that’s going on with Direct standards, the transport pieces are becoming more of a commodity. Those things will separate themselves out from those of us who focus more on the content.  

News 8/5/11

Top News

A diabetic computer security researcher proves that hackers could theoretically remotely control medical devices such as insulin pumps and glucose monitors, which don’t have enough battery power to encrypt their wireless signals. The same threat had already been demonstrated for defibrillators, but no real-world examples have surfaced.

Reader Comments

From Gary: “Re: drchrono free EMR. I can’t find anything on their site about their revenue source other than VC funding. Is it advertiser supported?” The company says they’ll get back to me on that. Their free product is limited in storage and support and doesn’t include some functions (e-prescribing and electronic billing), so I assume they hope users will move up to a paid version. I don’t know much about the product, but their website is one of the slickest ones around.

HIStalk Announcements and Requests

Listening: a new lost album from The Screaming Trees, a 1990s Seattle band with a fresh roots rock sound (even now) that mixes light grunge with dark twang and psychedelia, like minor chords REM meets Alice in Chains. They never made it big, but should have. I’m kind of loving it as I contribute my air drumming to the mix.

I made a decision last week after careful deliberation: I’m phasing out animated sponsor ads on HIStalk on January 1. Sponsors are responding positively to Inga’s e-mail describing the change, which I appreciate – I think they know intuitively that everybody will benefit from less distraction and faster page loads, which will result (ironically) in more ad views and clicks. That’s the theory, anyway.

Inga will be back to full HIStalk duties shortly. If you want to make her return even more joyful, consider: (a) signing up for e-mail updates on HIStalk and HIStalk Practice; (b) give us the electronic version of the insincere Hollywood air kiss by friending us on Facebook and connecting with us on LinkedIn; (c) send us cool stuff like rumors and secret information; (d) click some sponsor ads to check out their offerings since I turfed off the “no more animated ads” sponsor e-mail to her to send and she probably needs to regain her stature in their eyes for being the messenger; and (e) use subtle peer pressure to send new readers our way since she loves poring over the readership stats.

Acquisitions, Funding, Business, and Stock

ZocDoc, a provider of an online physician locating service, raises $50 million in Series C funding from DST Global. Other ZocDoc investors include Marc Benioff (Salesforce.com) and Jeff Bezos (Amazon).

Sales

St. Vincent’s Medical Center (CT) signs a seven-year agreement with GE Healthcare to upgrade to the SaaS version of several Streamline Health products for HIM.

Centegra Health System (IL) will implement iMDsoft’s MetaVision critical care system for all 113 of its monitored and ICU beds, integrating it with ADT, labs, CPOE, billing, scheduling, PACS, LDAP, and its GE EMR.

People

Paul Ruflin, former CEO of Eclipsys and Noteworthy Medical Systems, joins software tools vendor PreEmptive Solutions as president and COO.

Integrated Healthcare Strategies announces that William F. Jessee, MD will join the consulting firm as a SVP and senior advisor following his October 2011 retirement as MGMA’s president and CEO.

Surgical Information Systems (SIS) appoints Gary S. Long (above) to VP of North American sales and Jonathan C. Lujan to VP for Business Development & Strategic Planning.

David Kissinger, regional VP of maxIT Healthcare, is appointed to the board of directors of Southern Ohio HIMSS, also serving as its public relations committee chair.

ZirMed names former IDX/GE executive Thomas W. Butts president and CEO. He replaces Jerry Merritt, who stepped down “for personal reasons.”

Announcements and Implementations

North Colorado Medical Center goes live with CPOE as part of Banner Health’s $250 million Cerner EMR initiative.

Swedish Health Services (WA) expects the former Stevens Hospital to be live on Epic’s EMR by the fall of 2012. Swedish took over management of Stevens last year and is making $150 million in infrastructure upgrades.

Royal United Hospital Bath NHS Trust goes live on Cerner Millennium three years later than planned, caused by Fujistu’s termination as the local service provider.

RCM software provider Avisena partners with Intuit Health to make the Intuit Health portal available to Avisena practices.

NextGen confirms the earlier rumor I ran – the company is working with MEDSEEK to create a new NextGen Enterprise Patient Portal for hospitals, allowing patients to access staff, review test results, make appointments, and request prescription refills in a single view. It’s business as usual for the existing NextGen Patient Portal – this is an alternative for a different audience.

Ouachita County Medical Center (AR) chooses Healthcare Management Systems for its financial and clinical applications, including EDIS. Meanwhile, CMH Regional Health System/Clinton Memorial Hospital begins its implementation of HMS.

Oroville Hospital (CA), which uses a version of the WorldVistA EHR 2.0 that it customized, helps WorldVistA get it certified for outpatient Meaningful Use by contributing its self-developed e-prescribing module. They say it’s the first version of VistA to be certified for outpatient use. Oroville says it has spent $4 million hospital-wide on implementing the open source product, but did it all with internal IT resources.

Midland Memorial Hospital (TX) connects to the Nationwide Health Information Network and the Social Security Administration MEGAHIT project using the Medibridge.net HIE platform from EHR Doctors. It generates Continuity of Care Documents from VistA/CPRS like the Medsphere version that Midland uses.

Government and Politics

CMS reports that about 77,000 providers have registered for the Medicare and Medicaid EHR incentive program as of July. A total of 2,383 EPs have verified they met MU requirements; 137 attested unsuccessfully (though it’s unclear why.) CMS has issued almost $400 million in incentive payments.

Other

US physician practices spend nearly four times as much per physicians Ontario in dealing with health insurers and payers. Though much of the difference stems from Canada’s single payer system versus the US’s multiple payer model, the authors of the Health Affairs-published study suggest there are ways that US health insurers could reduce costs and increase efficiencies.Other

An article in an Indian business publication says that companies there will get a lot of business from ARRA and ICD-10, quoting Bronx-Lebanon CIO Ivan Durbak. The hospital says it is saving at least 50% of the cost of its EHR project by issuing its $30 million contract to a Chennai-based outsourcer.

In Canada, Ontario Telemedicine Network is expanding by adding an Internet-based videoconferencing solution that participants can access on any PC.

Emergency personnel in western North Carolina paid their respects Tuesday to Asheville Fire Department Captain Jeff Bowen, who died in a medical building fire last week after helping save an oncology clinic’s computers and electronic records.

Max Harry Weil MD, PhD, who in the 1950s developed the “shock ward” concept of today’s ICU, including crash carts, stat labs, and computer-monitored vital signs, died last week at 84.

Odd lawsuit: the family of a man killed by his chemist wife, who poisoned him with the diagnostic agent thallium, sues her drug company employer, the hospital where he died, and six doctors. The suit claims he would still be alive “if only one of the world’s biggest drug makers and an accredited medical center had just done their jobs.”

Sponsor Updates

• Regal Medical Group, a California-based IPA, announces a partnership with MyHealthDIRECT to assist its members in the care transition process.
• MEDSEEK earns a #5 ranking in the State of Alabama’s Best Companies to Work For program in the 50-249 employee category.
• Pamela Bradshaw RN, CCRN, NE-BC, CNO and VP of Nursing and Clinical Services at United Regional Health Care System (TX) credits Clairvia’s CVM Patient Acuity for higher levels of job satisfaction among staff nurses and better patient care.
• CareTech Solutions announces a partnership with Cardinal Path, a Google Analytics Certified Partner, as a value-add service for its CareWorks content management system.
• FormFast will host a free August 18 webinar entitled EMRs Need More to Support Meaningful Use.
• TeleTracking Technology is nominated for Tech Titan of the Year for 2011 by the Pittsburgh Technology Council.
• Perceptive Software expands its global OEM program.
• Nuesoft releases a video on reducing medical practice risk through strong HR policies.
• Merge Healthcare announces sales of $57M in the second quarter. The company also posts a podcast on radiologists and Meaningful Use.
• Lorie Richardson of Hayes Management Consulting discusses eight ways IT can improve training and adoption rates.
• Concerro offers a webcast entitled CXO, WOW & WOM: A Powerful Approach to Patient Experience Management Tied to the Bottom Line.

EPtalk by Dr. Jayne

Nominations are now open for the 2011 HIMSS Award and Recognition Program. Too bad Mr. H is anonymous, because he certainly meets some of the criteria for service to the industry. Nominations are open through October 14.

Weird drug news: the first FDA-approved treatment for scorpion stings has arrived. That’s good news for those of you in Arizona, which plays home to most of the poisonous scorpions in the US. I’ve spent enough time in the southwest to be freaked out by these little buggers. Although most adults don’t need treatment if stung, this is good news for children who might have a too-close encounter of the Centuroides sculpturatus kind.

Like many of you, I’m pretty tired of US politics and healthcare reform being flogged during the debt ceiling discussions. One bright spot in government though is the “Restoring Access to Medication Act” introduced as H.R. 2529 and S. 1368. This would allow patients to use their flexible spending accounts and health savings accounts to purchase over-the-counter (OTC) medications without a physician order, as they could prior to 2011.

I can attest that this issue has caused quite a bit of patient angst and increased healthcare spending as patients come in for office visits to obtain prescriptions for OTC drugs, not to mention healthcare IT spending as many practices created custom order sets and forms to be able to rapidly order a broad spectrum of OTC drugs for patients in a single click. I shuddered the first time I had one of these visits as I wrote scripts for Tums, hydrocortisone cream, and a pregnancy test. (Even worse is the fact that a pregnancy test is not an OTC drug and that a script isn’t required – but my patient had a letter from her benefit administrator demanding a script and stating that they wouldn’t honor the examples given in the FAQ section of the Internal Revenue Service website.) It’s about doing what’s right for the patient, regardless. Let’s hope Congress gets this one right.

I’ve mentioned my thoughts on sunscreen and tanning before, as well as my appreciation for a good glass of wine. A recent study from the Journal of Agricultural and Food Chemistry notes that “A compound found in grapes and grape derivatives may protect skin cells from skin-damaging ultraviolet (UV) radiation.” Maybe Inga and I can sign up for the follow-up study.

There are days when I joke about needing to wear body armor to work, but I’m usually referring to the need for protection from the slings and arrows of my colleagues. The LA Times reports on this, noting that 10% of emergency department nurses had been assaulted in the week prior to being surveyed. Most violence is from patients and family members.

I was recently at a training techniques class with a group of professional Health Informatics trainers. There were a few newbies in the group, and the topic of physicians “getting physical” during EHR training came up. Nearly all trainers reported having something thrown at or near them – from pens and paper to coffee cups, all the way up to laptops. One even reported a physician tipping over a computer-on-wheels in frustration. Seriously, people. It embarrasses me that physicians behave like this. Discipline for these kinds of infractions should be the same as that for surgeons that throw instruments in the operating suite. The fact that EHR or CPOE training is involved is no excuse.

Last, our nominee for quote of the week: This gem is from CMIO magazine and William F. Bria MD, President of the Association of Medical Directors of information Systems (AMDIS). “Another usability problem is the expectation of some physicians that the whole point of these systems is to make them more efficient and happy.” If you’re a project manager out there selling technology as a way to increase physician satisfaction, please think of another marketing bullet point. How about patient safety? That’s something we should all be able to get behind.

Contacts

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

Blackstone To Acquire Emdeon for $3 Billion

The Blackstone Group will buy Emdeon for $3 billion, with the private equity firm taking the publicly traded Emdeon private, it was announced this morning. For the past year, Emdeon earned $19.5 million in profit on $1 billion in revenue.

Nashville-based Emdeon offers revenue cycle solutions for providers, pharmacy benefits transaction processing, and claims solutions for payers.

Rumor of the acquisition was reported here on July 29.

Readers Write 8/3/11

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!

The Pressures of EHR Adoption and a Market Trend of Converged Services and Technology
By Janet Dillione

Recent mergers and acquisitions in the healthcare information technology (HIT) industry bring to light many facets of electronic health record (EHR) implementation that often go overlooked. As many in the medical industry know, implementing an EHR system so it works seamlessly with clinical workflow is more complicated than downloading and installing software with the click of a mouse. There is not an EHR switch that can simply be turned on.

Healthcare organizations that have successfully implemented EHR systems, along with those currently navigating the process, can attest to the need for a scalable system wide approach. To achieve improvements in the quality, safety and efficiency of patient care special attention should be paid to services and technologies that foster EHR adoption across the clinician population.

Recent strategic alliances in the healthcare IT space signify a movement toward a promising future of EHRs, a future with a genesis in advanced clinical documentation. A successful, long-term EHR strategy, one that will position healthcare organizations to overcome the many pressures of the healthcare industry in the years to come – Meaningful Use, ICD-10, Accountable Healthcare – begins with effective data capture. The reality is that an EHR is only as good as the information captured within it, and as the saying goes, it takes a village …

I have no doubt that the industry will continue to see more strategic partnerships. These alliances establish greater resources for the healthcare industry, leading to more streamlined workflows, greater cost savings, satisfied physicians, and improved quality of patient care. However, none of this happens overnight and healthcare organizations should see this as an evolutionary process, not one of instantaneous change. By this I mean, every provider setting has a clinical documentation workflow in place, and pursuing an approach that is diametrically opposed to the status quo can prove counterproductive to the effort.

Despite the enthusiasm for employing state of the art technologies, healthcare organizations should not feel pressured to immediately make all data capture mobile, to put all applications in the cloud tomorrow, or to force doctors to use an EHR without a safety net out of the gate. In time, the increased amount of service and technology convergence across the industry will help healthcare organizations to better address the pressure of EHR adoption, and more importantly, will help them better manage their robust collections of clinical data.

It is becoming increasingly clear that in healthcare, data is knowledge. It drives care decisions, billing and reimbursement, compliance with federal regulations, and is key to overall health system improvement. Today, there is no one solution, no one vendor, and no magic potion that can address all of these issues and capitalize on all opportunities. However, by strategically bringing together the best in technology with the best in services, healthcare organizations will be better positioned to make the transition from traditional workflows to the EHR in a thoughtful, natural way.

An impressive amount of progress has been made over the last several years, particularly in light of EHR adoption pressures. Innovation and automation is transforming the processes and outputs of clinical documentation. What once was scribbled on a notepad, created on a typewriter, or passed from caregiver to caregiver in the hallway, is captured and transferred more efficiently and effectively than ever before. Such effective clinical documentation establishes an important foundation for EHRs.

By leveraging and contributing to technology collaborations, healthcare organizations can access the best in services and technology. This means a transition from handwritten records stored in manila folders to digital information stored within EHRs captured through natural clinical workflows. Moving forward, there will be multiple ways to capture the patient story including keyboard input and speech-to-text technologies.

Once clinical information is captured, we’ll see the application of highly intelligence clinical language understanding (CLU) technologies, often referred to as natural language processing or NLP in other industries. These highly sophisticated technologies will turn our vast amounts of clinical data into knowledge to be leveraged across the healthcare ecosystem.

The convergence going on across the healthcare industry amongst healthcare IT vendors, academic centers, service-oriented businesses, and other organizations is promising, but should be scrutinized by healthcare organizations.  There are many promises amongst the recent M&As and partnership activity, but only few proven results and long-term plans.  As you work to tackle EHRs as a strategic initiative, enlist supportive guidance and build a nimble infrastructure where the EHR can become a launching pad for better use of data.

Janet Dillione is EVP/GM of the healthcare division of Nuance of Burlington, MA.

Meaningful Use and Innovation
By Ryan Parker

All human development, no matter what form it takes, must be outside the rules; otherwise we would never have anything new. – Charles Kettering.

I have recently finished up some consulting work for a startup HIT company (which for non-solicitation reasons I will refer to as Company X.) I was working with them to help develop their EMR. 

When Company X first showed me their product, I was amazed. In just over a year, they had developed an almost fully functioning EMR. Using more advanced coding language than what you would find in most legacy systems (i.e. C#, Silverlight) they came as close to mimicking the clinical workflow as I have seen with an information system.

Everything was looking up. Their product was becoming more and more complete and becoming more and more advanced. But then they ran into an issue. If anyone has worked with or been a part of a start-up, momentum is key to success, and in this company’s case, the Innovation truck slammed head first into the Meaningful Use wall.

To be completely honest, forcing Company X to get their product Meaningful Use certified did have some benefits. There were some system needs they hadn’t thought of previously. In terms of HIE and interoperability, the requirements will have a positive impact as a whole as we move to a more ‘data-sharing’ driven information system structure. However, the innovation, creating a system different from anything else, which, to keep the truck metaphor rolling, was sitting in the driver’s seat of the company, dissipated as executives and engineers dived deeper and deeper into the ONC requirements.

Weeks turned into months of working on the Meaningful Use requirements. Although Company X was making progress, the focus slowly turned from creativity and ingenuity to one of conclusion, as in, “How soon can we meet these requirements and be done with this product?”

Soon, the executives starting turning their attention to other products, focusing on solutions that fall outside of the ONC/Meaningful Use umbrella.

I have no doubts that after they complete their Meaningful Use certification in the near future, and hospitals and health systems get a good view of their product, Company X will receive accolades on their HIT advancements from the healthcare community. Personally, I will be wondering what progress could have been made without standardization. What advancements could Company X have made without the rigors and requirements forced upon EMR vendors?

Ryan Parker is implementation practice director of Preceptor Consulting Corporation of Fort Myers, FL.

HIEs: High Performers Will Be Around for the Long Term
By John Haughton

Improved patient care outcomes, lower administrative costs, fewer medication errors, improved ability to manage chronic conditions, reduced unpaid re-admissions, greater efficiency, fewer ER visits …

There is no question about the benefits that a highly effective health information exchange (HIE) brings. By highly effective, I mean a healthcare ecosystem grounded in evidence-based medicine, clinical guidelines, and performance reporting.

For providers hoping to achieve Meaningful Use (MU) or to become Accountable Care Organizations (ACOs), performance-based HIEs hold the promise of pulling together data from myriad sources — medical staff and community physicians, insurers, labs, imaging centers, behavioral health and home health providers, employers, consumers, retail pharmacies — to finally deliver truly coordinated care.

But there is also no question about the challenges facing fledgling HIEs, the primary one being a sustainable business model. It turns out that, if you build it, they won’t necessarily come. And once the grant money runs out, the organization rapidly runs out of steam.

The only way to build an HIE with enduring power to transform the health of a community is to have providers pay for it. And the only way to do that is to provide high value — quickly. This means demonstrating value from Day One by raising the bar on clinical quality for their customers, namely, patients.

In response to the MU requirement for value-based purchasing and market realities pushing margins into negative territory for about half of all hospitals, HIEs must help hospitals survive and thrive in the new patient-centric business model to garner lasting provider support.

The HIEs that have done this successfully have something in common: they pretty much all have their heads in the cloud, which is to say, they use platform-as-a-service (PaaS) cloud computing technology that offers authorized users easy, but extremely secure access to centrally stored, actionable information for an affordable price.

Here are the seven technology elements needed to play in the high-performance league:

1. Maximum functionality and flexibility. Since around three-quarters of healthcare in this country remains paper-based, technology is needed that supports hospitals and physicians regardless of their technology sophistication. This favors best-of-breed EHR modules that can meet a wide variety of needs, budgets and timetables, rather than a comprehensive, enterprise-wide approach.
2. A full range of value-added tools and services. Think of the app store on an iPhone. That type of flexibility and customization are what is wanted from HIEs, only instead of YouTube, GPS, and Fandango, apps that provide clinical decision support, performance management, quality reporting and analytics, clinician messaging, shared guideline dictionaries, and disease registries are valued.
3. On-the-fly translation. As long as stakeholders continue to speak different electronic languages — all of which are upgraded and updated almost constantly — mapping and translation services are needed for interoperability.
4. Scalability. An HIE is a dynamic entity; it needs a platform that continually accommodates more of everything: providers, users, technologies, regulations… Collaborating across town is great. Collaborating anywhere is the ultimate goal, however.
5. Ease of use. An identity federation service means providers need just one user name and password to interact with each other, health plans, regulators and patients — and just one point of access for all clinical and administrative data held by the HIE.
6. A 360-degree, real-time view. A single, comprehensive view of a patient’s status, including all information submitted by all authorized sources from five decades ago to five minutes ago, will help eliminate redundant tests and procedures.
7. Sharing of best practices. The best HIEs aren’t merely repositories. They must be able to analyze input, generate point-of-care solutions, and disseminate data that draws on documented successes.

So the future is bright for those high-performance HIEs that “bring it” — clinically speaking. HIEs and other data exchange organizations that figure just having the data will have hospitals and physicians beating a path to their door are being naïve and are putting their long-term survival at risk.

Like it or not, healthcare is a business as well as a service, and organizations need to deliver ongoing value to ensure their long-term relevance and sustainability.

John Haughton MD, MS is CMIO of Covisint of Detroit, MI.

News 8/3/11

Top News

Atlanta-based transcription vendor Transcend Services announces that it has acquired electronic clinical documentation and charge capture vendor Salar Inc. in an $11 million cash for stock transaction that closed last week. According to the announcement, Salar had $1.2 million in operating income on $4 million in revenue last year. Transcend says it will migrate its speech recognition technology to Salar-based templates for users who prefer that form of documentation, allowing it to offer customers a hybrid solution that will help them meet Meaningful use requirements. Salar, founded in 1999, will remain in Baltimore as a business unit of Transcend. They are the latest in an amazing string of HIStalk sponsors to be successfully acquired, for which we congratulate Todd Johnson and his fun band of pirates — we call them that since they attended our HIMSS reception in swashbuckling regalia a couple of years ago.

Reader Comments

From E-Reader: “Re: NextGen. Will announce later this week that it will partner with Medseek for a new enterprise patient portal for hospitals.” Unverified, but reported by several readers.

From CIO: “Re: HIS vendor quote. This is my new favorite, just received from GE: ‘While we do our best to eliminate as many crashes as possible with each release, we did not expect crashing to go away with DP7 entirely, only to be reduced.’” Unverified. I actually admire that they came clean technically. While everybody’s #1 preference would be for a vendor to fix all technical problems (and cause none), the #2 preference is for the vendor to at least disclose when a problem exists so it can be mitigated in ways that don’t make the client’s IT department look stupid.

From Amish IT Guy: “Re: EMR. Take a look at this one and see how long it takes you to realize something funny is going on. It’s an EMR for marijuana dispensaries. Do you get a medical necessity button that always says, ‘ Duuude, go for it?’” An LA TV station went undercover last to film some of this vendor’s EMR clients using the system to illegally issue marijuana cards without any physician involvement, causing the company to threaten those users with termination of their accounts so they wouldn’t “blemish the good practices of everyone else.”

From Epic Guy: “Re: overseas expansion. There’s a small office in Abu Dhabi now.”

 From CERNest Goes to Camp: “Re: Cerner’s executive cabinet. The most recent annual report showed 10 executives, with Gorup and Illig as mostly inactive honoraries. That leaves eight execs, of which three have left in the last few weeks (Wing, Herzog, and Valentine) even as the stock was doing very well. If they really do need to go after acquisitions or new business to offset the business that Epic has taken from them, the second order churn at the VP and director level may hurt the traditionally well oiled machine.”

HIStalk Announcements and Requests

Inga has been doing a bit of traveling, so her contributions this time around are mostly straight news, thus the absence of her cute little red icon to indicate opinion, snark, or insight. I expect the ratio to improve next time.

Acquisitions, Funding, Business, and Stock

Mobile healthcare communications vendor Vocera files plans for an $80 million IPO, with shares to be traded on the New York Stock Exchange. Some big securities firms are involved: JP Morgan, Piper Jaffray, Robert W. Baird, and William Blair. The company had $69 million in sales for the year just ended.

NLP provider Coderyte raises $2.5 million from nine investors, including Polaris Ventures and Solstice Capital.

MedAssets reports Q2 net revenue of $147.4 million, up 55% from last year, primarily due to its acquisition of Broadlane in November 2010. Acquisition costs attributed to a quarterly loss of $2.5 million ($0.04 per diluted share) versus $3.3 million in 2010 ($0.06 per diluted share.)

Allscripts reports Q2 numbers: revenue up 11%, EPS $0.08 vs. $0.09, meeting consensus earnings expectations excluding one-time expenses.

The Allscripts conference call transcript is already up. Nuggets:

• CEO Glen Tullman cited a June CapSite survey that found Allscripts leads all EHR vendors in mind share.
• Allscripts beat Cerner at two-hospital, 550-bed Heritage Valley Health System (PA) in a newly announced Sunrise deal.
• A South Australia deal was announced, with SA Health signing a “limited pre-production software license agreement” as the first stage in implementing an EHR across 80 hospitals and clinics. Value of around $50 million was implied.
• The company is expecting 5,000 attendees at the Allscripts Client Experience later this month, where Allscripts will demonstrate full integration of their ambulatory and inpatient EHRs.
• Allscripts may move slowly into more hosted offerings like they offer for Sunrise.
• Glen mentioned a figure of 300-400 big hospital EHR deals being done in the next 18-24 months and he expects to get" “more than our fair share” of those.

Automated Tracking Solutions files a patent infringement lawsuit against a number of healthcare RFID/RTLS vendors, including Awarepoint, TeleTracking, and RadarFind. ATS sells no competing products that I can tell – its only assets are patents (the oldest being from 2005, with one of the technical illustrations above) and its lawyer owner.

CSC completes its acquisition of Australia’s iSOFT Group.

The COO of Humana mentions EMRs in the company’s earnings call:

And then finally, in the Stars and quality area, EMR investment. You may have seen some press releases that we’ve done here recently with companies like Allscript and Athenahealth and others where we’re trying to get a lot more information in electronic medical records going forward, in line with what the government’s doing. We think there’s a real opportunity there. And finally, in the clinical area, the Care Hub, something that we talked about with all of you in the past. Our clinical messaging system and workflow system, more rules, engine and accelerating IT spend there. Mike talked about hiring more Humana Cares nurses throughout the United States, field nurses throughout the United States in areas where we anticipate growing. And then finally, we did some work here recently to in-source all of our DM programs, and we’re going to accelerate that because we’re seeing some nice results there.

Sales

UW Health Partners Watertown Regional Medical Center (WI) selects GetWellNetwork’s interactive patient care solution.

USC University Hospital and USC Norris Cancer Hospital (CA) choose MedAssets as their exclusive provider of technology-enabled business office outsource services.

People

Tele-ICU provider Advanced ICU Care names Bradley Green VP of sales.

Sandlot LLC, a Texas-based subsidiary of North Texas Specialty Physicians, names Kimberly Alise as CEO. She was previously CEO and co-founder of EHR vendor Empower Systems. 

Former Sandlot CEO Telly Shackelford is promoted to CIO of North Texas Specialty Physicians.

Alex Veletsos, formerly of Orlando Health, joins Ascension Health Services as CIO of St. Mary’s of Michigan and St. Joseph Health System.

Announcements and Implementations

In an SEC filing, Cerner discloses it paid $36.3 million for its May acquisition of Resource Systems, a provider of long-term care software.

Integrated Document Solutions partners with SourceMedical to provide document scanning and outsourced paper imaging services to SourceMedical clients transitioning to EHR.

Healthland launches Healthland Centriq, an EHR solution for rural clinicians.

Delaware Valley Hospital (NY) uses professional services from Accent on Integration and the Siemens OPENLink interface engine to integrate and share data with the Southern Tier Health Link RHIO.

Kareo announces the availability of free support to all its customers. The company also notes that internal surveys show that customer satisfaction is up 325% as a result of several recent improvements.

Clinical communications technology vendor Voalté signs its first reseller agreement. Houston-based Halco Life Safety Systems will offer its Voalté One smart phone solution to hospitals there.

Florida Hospital and Cerner will work together on a system that facilitates communication between patient care physicians and their researcher counterparts, connecting Cerner’s clinical systems with its PowerTrials and Discovere applications to automate and integrate diabetes research activities.

Phytel introduces its Hospital Readmission Management solution to automate post-discharge care processes and reduce readmission rates.

An AIDS prevention group in India is finishing its software to track HIV-positive pregnant women and their babies, necessitated by hospitals that don’t bother filing their reports.

Spain-based technology vendor Andago, which offers government and eHealth software (including Continua-compliant mobile health applications for wellness, disease management, and independent living) leases space in a University of Miami research building adjacent to Jackson Memorial Hospital for its first US office.

The Government of Jordan launches a regional health clinic that will use Cisco’s Care-at-a-Distance HealthPresence technology to link specialists from two hospitals for consultations.

Government and Politics

AMIA weighs in on the proposed HIPAA Accounting of Disclosures rule. Their concerns:

• HHS assumes that EHRs maintain user-friendly audit trails that covered entities (not to mention their business associates) can easily extract and hand directly over to the patient.
• The NPRM uses the term “designated record set” inconsistently, and hospitals have a large number of IT systems that may contributed to that set.
• Patients won’t get much benefit since the disclosure list doesn’t address their primary concern – large-scale electronic theft – and will confuse them since they are generally unaware that many people they don’t see directly are involved in their care, such as students and back-office employees.
• The rule proposes to include the full name of those accessing records without asking those caregivers for consent, which AMIA cleverly points out isn’t that much different than looking at patient records without their consent.
• Just a quick look at a patient’s record could generate dozens of entries, but still not capture all accesses, such as seeing a patient’s name on a list or running a query (like from a data warehouse) that touches a patient’s record. They also question whether medical case presentations and guest expert rounding require someone to log the “accesses” manually.
• AMIA worries that provider may simply eliminate access rather than account for it, such as denying research access to students.
• Data transmission, such as batch file extracts, don’t generally populate audit logs.
• If HHS really believes that few patients will request disclosure logs (which is how it justifies the workload involved), then maybe it’s not really worth the provider and vendor cost of making them available.
• Even complete audit logs won’t answer the specific questions that patients probably had in requesting a report, such as “Did my ex-girlfriend who works at your institution look at my record, and if so, why?”
• AMIA is “astounded” that research use must be included in access reports, even those involving an IRB, patient authorization, or a limited data set.
• HHS’s $20 million estimate of cost to providers is absurd since that’s only $30 per covered entity. Even just a wording change to a single provider’s Notice of Privacy Practices would cost thousands of dollars in legal review fees.

Other

We mentioned a couple of weeks ago that Cayman Islands Health Services Authority CIO Dale Sanders told us they would be re-competing their Cerner contract. Here’s more. The bid document says the Cerner system costs $2.7 million per year, but users find it cumbersome and are “largely unhappy with the workflow and user interface.” The hospital is seeking a less-expensive alternative that is free from the “dysfunctional influence of the US financial and economic model” for healthcare.

HHS Secretary Kathleen Sebelius gives EMRs a plug during a tour of the tornado-damaged St. John’s Regional Medicine Center in Joplin, MO. Says Sebelius:

"There’s no question that … the availability of an electronic record may have actually saved lives. They were able to immediately go into the treatment phase and not spend a lot of energy trying to reconstruct (records)."

Georgia’s second annual Health IT Leadership Summit will be held on November 8 at Atlanta’s Fox Theater. Entries for its first innovation awards are due August 24.

Pocatello Family Medicine (ID) sends potential breach letters to its patients after finding that a technician forgot to reactivate the firewall after maintenance work, leaving its EMR wide open on the Internet for several months. The practice says it doesn’t think anybody accessed the patient records, although someone did park some movies on their server.

Weird News Andy reproduces this article from India, which describes the surprise of surgeons in finding that a male patient admitted for a suspected hernia had a complete set of female reproductive organs in his abdomen. He’s recovering well from his hysterectomy.

I love this Epic ad from a 1984 MUMPS journal, as sent over by Limber Lob. Here is his explanation:

Attached is an advertisement from Epic that appeared back in 1984. I had set this ad aside so I could someday ask Judy about the comment at the bottom, which reads, "All Epic software is written in the MIIS dialect of MUMPS."

But a colleague just reminded me that it was all about speed, as Meditech’s MIIS dialect of MUMPS was very fast and ran circles around all other early MUMPS implementations, such as those from Digital Equipment Corporation (DEC) and InterSystems.
As you know, Neil Pappalardo, who founded and still owns Meditech (which still uses MIIS), was the original developer of the MUMPS programming language when he worked for cardiology researcher Octo Barnett at the Massachusetts General Hospital in the mid-1960s. As MUMPS moved slowly towards (ANSI) standardization, Neil wanted to pursue his own ideas at a faster pace, and left MGH to develop MIIS and found Meditech. Back in 1984, when minicomputers were slower than today’s slowest desktop machines, Judy used the MIIS dialect of MUMPS for Epic’s software because it was the fastest game in town But as the other (standard) MUMPS implementations got faster, the benefits of using ANSI Standard MUMPS dominated the language selection decision, and Epic switched to the ANSI/ISO Standard MUMPS that virtually everyone but Meditech uses today. This ad surprised me, as I hadn’t remembered the details, but it’s good to be reminded that system speed has been an Epic priority since the beginning.

Sponsor Updates

• Presbyterian Intercommunity Hospital (CA) selects ProVation MD software from Wolters Kluwer Health for documentation and coding of gastroenterology procedures.
• St. Luke’s Hospital & Health Network (PA) chooses Allscripts EHR and PM for their 1,600 physicians, underwriting a portion of the cost to enable the physicians to qualify for ARRA incentives.
• Heritage Valley Health System (PA) signs up for Allscripts Sunrise, which it will connect to its Allscripts Enterprise ambulatory EHR.
• NP Scharmaine Lawson-Baker (LA) uses Practice Fusion’s free, Web-based EHR and her iPad to care for senior and disabled patients via house calls.
• T-System Inc announces that it will incorporate content from PEPID into its ED information system, T-SystemEV, improving accuracy and patient care.
• Merge Healthcare announces Covenant Healthcare’s selection of iConnect Access to provide images to its physicians. Northeast Georgia Health System (NGHS) also selects iConnect for its HIE strategy, while and Mon General Hospital (WV) chooses Merge Cardio as its enterprise-wide cardiovascular information system.
• Stockell Healthcare Systems announces that ProMedica St. Luke’s Hospital (OH) is ProMedica’s tenth facility to go live with its InsightCS Revenue Cycle Information System.
• Keane, an NTT Data Company, announces that SVP Robb Rasmussen will speak at the CIO 100 Symposium on cloud computing in August.
• Thanks to NPC Creative Services, which counts quite a few HIT vendors among its strategic PR clients and keeps us in the loop with new announcements (and who is an HIStalk sponsor itself).
• Intelligent Medical Objects (IMO) is attending the Aprima and ACE user group meetings in August.
• Gateway EDI is exhibiting at MGMA Alabama, MGMA Georgia, and PriMed Mid-Atlantic in August.
• TeleTracking Technologies attributes its strong second quarter to the 14 new hospital contracts for its TransferCenter referral automation software.

Contacts

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

Curbside Consult with Dr. Jayne 8/1/11

E-mail Dr. Jayne.

Monday Morning Update 8/1/11

From ACC_Champs: “Re: NCHICA’s response to Accounting of Disclosures. By getting input from all sides of the issue, they have drafted a great response.” Some of their concerns:

1. Just because few people ask for Accountings of Disclosures now doesn’t mean they won’t in the future, requiring hospitals to do a lot of unpaid work.
2. The scope needs to be better defined since not everything is stored permanently in the EMR (such EKG strips, as I read from their example).
3. The definition of “access” should be clarified, such as if someone searches for “John Smith” in an EMR and is shown a long list of John Smiths, is that considered “access” of every one of them?
4. It’s not as easy to generate an Access Report as you might think, with hospitals churning out tons of data from many systems (one hospital found that an average six-day inpatient stay generated 1,800 accesses).
5. Access logs aren’t something the typical patient would be able to understand, meaning they may expect someone to spend time explaining them.
6. Patients who don’t understand that hospitals have a lot of unseen people involved in their care are going to file unwarranted complaints to OCR.
7. Employees aren’t protected from ambulance chasers or crazy patients who could easily obtain their full names by requesting an access report.

From Quaid: “Re: Siemens. Hawaii Health Systems Corporation just signed a $28.7 million deal for Soarian.” Verified.

From Anony: “Re: Piedmont Healthcare, Atlanta. Can’t believe I haven’t seen it here yet, but they’re moving from Allscripts to Epic.” As usual, the best way to verify is to check the hospital’s job postings since the Epic implementation method requires hiring a ton of people fast, including posting all jobs instead of just reassigning current staff. Piedmont listed several inpatient Epic positions on July 12, so I’d say that’s confirmation. I should also mention that Johns Hopkins signed its Epic contract this week. Both will apparently be Allscripts Sunrise losses.

From Anonymous: “Re: Allscripts. Continuing to reduce workforce in Raleigh as jobs are offshored, with 15-20 folks gone in the last week or two.” Unverified.

From Nasty Parts: “Re: Compugroup. Heard on the street that they’re buying the Sage Healthcare business. Folks at Compugroup USA HQ openly talking about it.” Unverified.

From KnowurCMIO: “Re: Cerner and Epic. Epic has indeed started expanding overseas — they have a satellite HQ in the Netherlands and have already installed there. I suspect they will begin seeing rapid growth once the implementations stateside slow down. Spaarne Hospital was the first EpicCare client in Europe in 2007.”

From Bob: “Re: shoe hoarder. I read this and thought of Inga.” A Philadelphia mom who happens to be a big-money poker champ owns 1,200 pairs of shoes (one pair worth $4,000) stored in four closets, one of them a converted sitting room. She’s profiled in a film about shoe nuts, which concludes that such compulsion is related to seduction and sex. I’ll let Inga to clarify her own motives.

Here’s the latest HIStory from Vince, this time covering Dynamic Control.

Listening: the new CD from teen rockers Jessica Prouty Band, sent over by her mom, who has a lot of history in HIT. Their sound has matured a lot over the years I’ve followed them, putting them right up there with Evanescence, Within Temptation, and some of the other female-led metal rockers. Big sound for a four-piece, with singer Jessica handling the bass very well. This is a really polished production – you would never suspect that the members are barely old enough to drive to their gigs. Video here.

My Time Capsule editorial from 2006 this week: When CIOs Are Under Pressure, “Man of Action Syndrome” Kicks In, snipped herein: “From my limited experience, I would say that CIOs overrule the concerns of nurse informatics people nearly 100 percent of the time and IT-based physicians at least 50 percent of the time.”

Most respondents believe that HITECH’s legacy will be increased EMR adoption, although the “waste of taxpayer money” camp was right on their heels. New poll to your right, spurred because I got a HIMSS member survey recently: how would you grade your satisfaction level with HIMSS? As always, you are able and encouraged to add your comments by clicking the Comments link on the poll, visible after you’ve either voted or clicked the View Results link.

HIMSS moved its Chicago headquarters this weekend.

Sage announces Intergy v7, which includes user enhancements, certification of all 44 ONC-ATCB clinical quality measures, and 5010 support for the PM/EMR system.  

NHS Scotland contracts with Imprivata for its OneSign single sign-on and password reset solution.

A reader sent over the full text EHR articles that were just published in the July issue Journal of Oncology Practice. Here’s a brief rundown of those I found interesting.

• A US Oncology team, working with iKnowMed to standardize over 500 chemo regimen order sets, found that 10% of them needed to be eliminated, with changes required for all the rest (other than changes in title, the most common changes involved updating the cited references and changing doses and cycles). They mention that EMRs can help address drug safety issues.
• NorthShore (IL) looked at the cultural impact of moving all inpatient and outpatient oncology ordering to Epic in 2005. The main benefit was data sharing among members of the multidisciplinary team (labs, rads, referrals, appointment information) and patient communication (secure communications, online test results). Chemo ordering in Beacon was found to be more complete and safer, with the percentage of complete documentation going from 67% to 93% and pharmacy interventions also increasing. They’re at 100% e-prescribing (other than for narcotics and oral chemo), outpatient med rec is over 90%, and AR days have dropped to 30. They’re using Epic’s data for research and quality monitoring.
• A Vanderbilt group looked at improving compliance with nursing guidelines on chemo administration and documentation using their systems (WizOrder, Horizon Meds Manager, Horizon Expert Documentation, StarPanel). Pros: two-signature compliance improved, standardized MARs were easier for nurses to follow, alerts improved safety. Cons: systems could not track doses by relative day or dose number, could not document infusion stop time, stat and verbal orders required an override, and pharmacy had to adjust schedules frequently to avoid “wrong time” alerts.
• Johns Hopkins pediatric oncologists wrote up their CPOE design process and creation of Eclipsys Sunrise MLMs to check height and weight, to force inclusion of hydration orders, and to provide the capability to adjust chemo doses by percentages. They also developed a fast-track process for creating and approving new order sets.
• Memorial Sloan-Kettering described their Eclipsys CPOE chemo ordering implementation. They created 1,250 adult and 466 pediatric order sets and mandated CPOE-based ordering. They reported nearly universal use of the order sets. I didn’t see anything that documented clinical outcomes, but they did mention problems related to cumulative dose calculations and alerts.

From McKesson’s earnings call:

1. They talked a lot about acquiring Portico Systems (surprising given that McKesson is a massive company acquiring a relatively tiny company for $38 million, which would be just a few weeks’ pay for CEO John Hammergren since he took home $151 million last year) and said little about their drug business.
2. Technology Solutions  revenue was up 6%, but only because of revenue recognition timing – they expect growth to be a little better than last year’s 2%.
3. Hammergren mentioned “significant progress” in the technology business, but basically said focus is on implementation rather than sales even though the company is “continuing to strategically position the business for continued growth.”
4. He said that clinical systems are today’s opportunity, but a lot of McKesson’s customers are running 20-year-old financial systems that might be candidates for Horizon Enterprise Revenue Management.
5. He thinks that big companies (“the anchor tenant”) will be the healthcare IT winners in the payer, hospital, and physician practice markets since smaller companies won’t be able to get to those prospects cost effectively.
6. He mentioned some “consolidation in our overhead and our selling infrastructure last year.”
7. An analyst asked directly about IT customer retention in calling 2010 “a tough year” for McKesson, with Hammergren’s response being that the company had spent a lot over the last two years to make its products better and he hopes the market share changes are a trailing rather than a leading indicator, with the potential of a slight rebound in market share this year with Paragon as the leader.

My sideline analysis of the MCK call (your comments are welcome):

1. Most of the analysts’ questions involved the company’s challenges in the IT business, again surprising given its core business of drug distribution.
2. McKesson seems to be acknowledging that it’s falling behind Epic and other vendors on the clinical systems side and is placing its only hope on a pendulum swing back to financial systems and its struggling HERM.
3. The company hopes that product improvement will stop the market share slide.
4. I inferred no commitment to innovation, acquisitions, or thought leadership, just that McKesson is banking on its huge size and customer touch points to keep selling all of its products.

The local paper covers the $36 million Epic system that will be in place when Orange Regional Medical Center (NY) moves to its new hospital next week. It says that stimulus money will cover half the cost.

In Canada, Nova Scotia will implement a $27 million system for sharing patient medication information, with all pharmacies expected to be linked by 2013.

Hawaii Governor Neil Abercrombie announces that Thomas Tsang, MD will join his healthcare transformation leadership team. He is ONC’s medical director over Meaningful Use, but it’s not clear from the announcement whether he’s resigning that post.

GE Healthcare Performance Solutions acquires Medical Event Reporting System, a Web-based system that helps hospitals collect and analyze patient safety events. It was developed by Columbia university with AHRQ support. The company, also called MERS, had been a GE Healthcare JV partner since 2008. A white paper on its use by Mount Sinai Hospital (NY) is here. GE says it’s working on rollouts to 16 hospitals.

From Cerner’s earnings call:

1. The company talked up its physician practice sales, saying its improvements in the user interface and workflow positioned its products well as clients look for systems that integrate inpatient and outpatient.
2. CERN says it is different from competitors in its willingness to connect to other systems.
3. They are expecting Meaningful Use to keep driving sales for years.
4. They suggest that 50% of US hospitals will reselect their core systems in the next 5-7 years as even those customers who are happy today will find their vendors falling short with regard to interoperability and reporting.
5. The ProFit financial system is doing better.
6. CERN says they expect to take on more outsourcing contracts since they are more able to hire scarce HIT employees than hospitals.
7. Neal didn’t pop in for even his usual one-paragraph drive-by.

Shares in Omnicell touched off a 52-week-high Friday after turning in good numbers after the market close Thursday: revenue up 6.6%, EPS $0.08 vs $0.02. The one-year share price (blue) against the S&P 500 (green) is above. Market cap is $567 million.

Meditech filed its quarterly report Friday, with revenue up 25% and EPS up 33% ($0.86 vs. $0.64). The cost of acquiring the 78% of shares in ambulatory vendor LSS that it didn’t already own was given as $13.7 million in cash, with LSS’s first quarter performance being $0.8 million in net income on $5.4 million in revenue.

Strange: the former head of Alberta Health Services (Canada), who left his job in November after repeatedly telling reporters at an emergency meeting that he was too busy eating a cookie to answer their questions, gets $735K in severance. He seemed overly peeved, but made sense in pointing out that maybe the eager beaver talking heads should attend the scheduled press briefing that was being held in 30 minutes instead of chasing him down the street for their own personal on-camera moment.

E-mail Mr. H.