HIStalk Interviews Pam Pure, CEO, HealthMEDX

Pam Pure is CEO of HealthMEDX of Ozark, MO.

Let’s get the obligatory McKesson questions out of the way. What are you proudest of from the time you spent there and what regrets do you have?

I look back at McKesson with great memories. I’m very proud of our team and I’m very proud of what we accomplished. 

We took a business that was basically going nowhere in the ‘98-‘99 time frame. We built a strategic plan and brought together a series of products — clinical products, imaging products — that we could deliver as a really robust solution to our customers. Over the eight years that I was there, we built great customer relationships, built a great working organization, and put some customers on the road to full clinical implementation and physician connectivity. It was a great time, a great experience, and I look back on it with a lot of pride.

In terms of regrets, I don’t really have any. I look at that as a great chapter in my career, a chapter that I’m very proud of. I learned a lot and it was a great launching point to this next chapter, which I recently started and I’m really excited about.

What led you to leave McKesson?

It was the right time, time for a new chapter. I left the organization and began thinking I was going to take a year off and just spend some time with my family. Things went on a whirlwind from there until I ended up HealthMEDX.

As you’re watching now from the sidelines, were you surprised by the announcement about Horizon Clinicals and Horizon Enterprise Revenue Management  being de-emphasized in favor of Paragon?

I know this is going to be hard for a lot of people to believe, but I really don’t spend a lot of time watching McKesson. I’ve made a conscious decision, like when you send your kids off to school. You have to let them go. A really important transition point for me was letting McKesson go.

There’s a lot of great people there, a lot of smart people there. I rely on them to make the best decisions for the company and for the customers. I hope they will continue to do that because I think we set a precedent of putting our customers and employees first.

But you know what? I really don’t follow it. I’ve tried very hard not to have an opinion on McKesson, but just to support their continued success.

What is it about HealthMEDX and the post-acute care market in general that simultaneously got you to come there and for investors to acquire the company?

I left McKesson and I had this grand plan that I was going to take off a year and travel with my kids and do things like exercise and get fit. Shortly after I left McKesson, my mom was diagnosed with a really serious Stage 4 cancer. She had a lot of surgery and a very long rehab, which she experienced in my home. 

And you know, here I am — I think I’m like Miss Healthcare, because I think I’ve been involved in healthcare for 27 years, so I must understand it — but here I was in the middle of helping someone I love recover from something very serious. It was the most challenging thing I’ve ever done, because it was very, very difficult to figure out how to manage her care.

My mom got back to the point where she could live at home with my dad. We went on a two-week vacation, came back, and my father had a heart attack in our driveway. He had quadruple bypass surgery and then he moved into the Pure Rehab Center, at which point over the door came up Pure Rehab Center the sign. We shipped him home about eight weeks later. 

Three months later, my mother-in-law had a stroke. In this very compressed eight-month period of time, I had three people — who are very independent, very successful in their own lives, very healthy — all go through these major post-acute events at three fabulous health systems. In every case, I was so disappointed and so stunned by the lack of follow-up support.

While I was at home dealing with the emotions of taking care of parents and in-laws, I had a very introspective time. I said, what am I going to do next? I don’t want to go back and do another very large company. I would really like to help figure out how to solve this problem in the post-acute space. 

I started spending time with my parents’ friends, my in-laws’ friends in trying to understand how they were dealing with managing their home care, moving to retirement communities, moving to assistant living organizations. As I started digging into this, I found that these organizations were very disconnected. It was confusing for my parents and their friends to deal with healthcare and follow-up. There are many people involved doing the same things, many different locations, and it was totally a paper system.

I approached the private equity firm and said, “I would really like to do something in the post-acute space to figure out how we can build a technology-enabled system that could be connected back to the health system. Post-acute care is going to be very strategic moving forward, and it’s got to be more connected and it’s got to be more automated.” That’s what began my journey at looking at companies in this space.

The question I should have asked you earlier but I was hung up on the McKesson questions is to describe what HealthMEDX does.

HealthMEDX provides an integrated technology platform that manages a patient in a post-acute environment. If they’re not in the hospital and they’re not in front of a physician, we automate it – home care, hospice, skilled nursing, assisted living, rehab, retirement communities, transitional care organizations moving from the hospital back out to the home. Anything that doesn’t occur in the hospital or doesn’t occur in the physician office — we can manage the patient through that experience.

What is most different about that client base compared to physician practices and hospitals?

For the most part, post-acute providers have more long-term patient care responsibility. I visit some of our customers that are skilled nursing homes. The patient might be there for 12 years. These post-acute providers or even a rehab center – these providers are kind of like the last check to make sure the patients gets as healthy as they can be. They finish the care. 

In the hospital or in the physician office, treatment tends to be very episodic — finish off and go. In the post-acute center, it’s more focused on how do we get the patient back, how do we get this person back as good as they can be, and where is the right end place? I think there is more focus on managing the patient back as opposed to managing an episode.

That’s changing in health systems, and obviously with risk-shifting and ACOs, there is a great focus on the patient. That’s why I think these post-acute organizations are going to become more strategically important.

That market wasn’t really considered all that sexy by most people, where institutions were perceived to have both financial challenges and technology challenges. How did HealthMEDX turned out to be the biggest vendor in it?

The uniqueness of HealthMEDX comes in two areas. Most technology players in the post-acute space focus on one segment. You’ll see a lot of home care companies, you’ll see a lot of rehab companies, you’ll see a lot of skilled nursing companies. Most of those companies do one thing.

I think the difference and the magic of HealthMEDX is it’s a patient-centered system that knows it has to manage the patients. Where they are doesn’t matter in terms of how the care is automated and delivered. 

If you look at our customer base, it’s very diverse. We do these large, national, senior living retirement communities. We automate the whole community. We do post-acute transition programs, where it’s a program for 14 days to get the patients from the hospital to home. We do home care, we do hospice, we do rehab. We have a large presence in all of the different segments of the post-acute market.

A big part of our strategic thesis was that post-acute care providers are going to diversify and consolidate. Nobody just wants to be a skilled nursing home or just an assisted living these days. They want to provide rehab services or home care services. The technology needs and the requirements of these organizations are changing.

Do you think federal reimbursement changes will encourage growth or consolidation, changing the way these organizations compete with each other as well as competing with hospitals?

We’re going to see a lot more networking between post-acute providers and hospitals. More sharing of the risk. When you look at readmissions and the health system focus on reducing readmissions, there are a lot of post-acute providers that can help them get there, in terms of managing the patient once they leave and trying to keep the patient form coming back. 

A lot of the changes in the regulatory environment and in the risk-shifting environment will cause the post-acute providers and the health systems to become more tightly integrated. Some health systems will acquire more post-acute providers. I see some purchasing nursing homes, assisted living, some building retirement communities where they’ll have full management of the patient. Then I see a number that are building very progressive networks with regional post-acute providers to manage their patients once they go home.

There was a time when hospital CIOs really knew next to nothing about physician practice systems because they weren’t relevant to their organizations. Do you think that they’re going to be pushed into gaining the same expertise in long-term and home care systems?

I absolutely do. It’s very interesting to watch, because we all watched in the ‘80s and the first half of the ‘90s as the hospital markets started to automate it. It started with financial automation, then clinical automation, and then connectivity. We watched the physicians go through the exact same evolution – financials, then EMR, and then a huge focus on connectivity. That became the continuum of care.

I think we’ll see an extension in the continuum of care. I think that extension will include the people who are responsible for the care of the patient after they leave the hospital and after they leave the physician office. I think we’re going to see the exact same thing. Those post-acute care organizations have billing today. They’re now beginning the journey for an electronic clinical record. I think the journey for that electronic clinical record and health system connectivity will almost occur concurrently because of their importance in an ACO environment.

Those of us on the hospital side might assume that we’re doing cool stuff that should find its way into nursing homes and home care. Are those organizations things that hospital people could learn from?

There will be a great deal of information shared and a great deal of learning on the health system in the post-acute side as we build this collaboration and extend the continuum. 

The hospital market today is much more experienced with implementing advanced clinical systems. The lessons learned in terms of process flow and workflow automation will be essential to the success of some of these post-acute care providers and will help us figure out the right way to make handoffs … what happens when a patient is discharged, what happens when a patient shows up in the emergency room. The health system and hospital clinicians are more system savvy and can help direct those handoffs, which I think will be great.

On the post-acute side, what’s very interesting to me is that the location of the patient is really insignificant in the care of the patient. For the most part, hospital systems and physician systems have been very visit specific and episodic in the way that the data is managed. Especially with HealthMEDX, the post-acute view is much more patient centered, just naturally patient centered in the way the product was built, with the assumption that the system has to follow the patient — the patient doesn’t follow the system. Just a lot more flexibility in how the technology can be deployed and the intelligence of the product to know the right way to bill.

Some of the biggest changes in healthcare IT have been driven by government changes, like reimbursement or Meaningful Use. Do you see that happening in the market that you’re in? Will hospital software companies need to build or to buy to get into that market or be left behind?

The post-acute market has similar regulatory requirements that are getting more complicated and more intense and I believe are driving the automation of the EMR in the post-acute market, very similar to what happened in the hospital and the physician market. Subtle incentives to automate, so you can electronically transmit clinical data and electronically transmit some more complex financial information. The regulatory push is definitely there.

Many of these post-acute organizations are selling “directly to patients,” quote-unquote, in terms of the value they can provide and the quality of care. In many cases, patients are making a very definite choice of where to receive their care and the technology infrastructure is becoming more important. Patients want families, want their parents in organizations that they feel are safe, with quality systems and services. Technology is becoming part of that decision process and the shifting reimbursement and relationships with hospitals.

We’re going to look back and see the next three years as a critical time in terms of hospitals and physicians being able to follow their patients home. To do that, the post-acute technology and post-acute connectivity is going to become essential. I think the progressive post-acute organizations realize that and are moving more rapidly than we expected.

How is selling and supporting customers in your market different than it was for hospitals and physician practices?

From a selling perspective, customers are very focused on three or four things that are very important to them. There is more clarity of what they are looking for. When you look at a hospital or health system, it is a very complex sales cycle with a lot of decision makers and a lot of stakeholders at the table. The post-acute environment tends to be more focused on exactly what’s required and is not as large and long.

When you look at the company over the next five years, what are your priorities?

It’s a great question, because I just really am excited about the potential to help build the technology-enabled post-acute world. 

When I look at the next three to five years, the first thing that we can do is help these post-acute care providers build an electronic medical record that includes all of the information for the patient, whether they’re receiving home care, whether they’re receiving rehab, or whether they’ve had to move to assisted living. We can build one integrated record to manage that patient. I think Job #1 is supporting the consolidation and the diversification that’s happening in the post-acute market with an electronic clinical record. It’s really essential.

The second thing that is going to happen — and it’s going to happen quickly — is helping health systems connect and build relationships with these post-acute organizations so they have the capability to follow patients home. That will require a lot of work with health systems in terms of setting up the infrastructure and the process flow of moving a patient home or moving a patient to an assisted living or a rehab organization. Also being prepared to take the patient back when they show up in the emergency room or have to come back for services. Health system connectivity supported by industry standards — I think that’s Job #2.

Job #3, once we get that going and these post-acute providers are automated and they’re connected, there will be great learnings in terms of analytics. Where’s the most cost-effective place to send a patient? How quickly do you discharge them into transitional care? How long should transitional care last?

I’ll tell you this great story. A post-acute customer who’s trying to develop a specialty in transitional care said, you know, if a patient comes in for hip surgery and it’s scheduled, and you look at that same patient is not scheduled — they fall down and they break their hip. The patient who falls down and is unscheduled spends 10 days longer in transition care. And you know what we figured out? They need mental health services, they need emotional support. The fastest way to cut those 10 days is support for dealing with the stress of the trauma and the unplanned medical experience.

I really believe, and what I’m most excited about, is once we are able to automate the post-acute space and connect it, we’ll be able to figure out questions like, where is the most cost-effective treatment location? How do you move patients through the continuum of care in a quality, cost-effective manner? Because now you really have the continuum.

Any concluding thoughts?

I’m very excited about the business. We’re about to open an office just outside of Boulder, Colorado, so we’ll be expanding to two offices. We’re growing quickly.

For me personally, I’m just thrilled to have the opportunity to focus on a segment of healthcare that I’m extremely passionate about after dealing with some very traumatic personal experiences. I wake up in the morning believing that a company like ours can impact the way that care is delivered in the post-acute environment. 

I would also say that I’m equally focused on building a company culture where people come to work and feel as excited and passionate about what they’re doing as I do. I’m really looking forward to that.

Time Capsule: EMRs: Free May Not Be Cheap Enough for Physicians

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 March 2007.

EMRs: Free May Not Be Cheap Enough for Physicians
By Mr. HIStalk

Now that Stark restrictions have been relaxed, hospitals are rushing headlong into the ambulatory EMR business. It makes sense. Hospitals have a lot of technology expertise and private physician offices usually have none. The government wants to increase the embarrassingly small number of EMR-capable practices, so throttling back Stark is a free solution that makes almost everyone happy.

Are EMRs the peace pipe that will suddenly bring the traditionally wary partners / competitors together in a long-awaited passionate embrace? Probably not.

Community-based physicians are often scornful of hospitals, seeing them as a hotbed of meddling management, questionable quality, and carefully hidden profits. Imagine what they’ll think when they first encounter hospital IT types, those grudging emissaries of a department built around rigid conformance to rules, perpetual understaffing, and a vision for the common good that squelches the individuality and self-determination that doctors thrive on.

Hospital CIOs like service-heavy, expensive vendors that won’t get them fired. They also like standardization and vendors that offer the theoretical possibility of integrating office-based EMRs with inpatient systems and RHIOs. For those reasons, I expect most CIOs will favor EMRs from big-iron, old-line ambulatory vendors like Misys, Epic, and Allscripts.

These are the vendors that small practices studiously avoid in many cases. They dislike them for the same reasons CIOs love them.

I spoke about this with Jonathan Bush, CEO of athenahealth, at the HIMSS conference. He has an interesting perspective, although not surprising considering that his company sells simple, easy-to-use systems that increase physician income through reduced claims denials.

Bush described the EMR offerings of the big, inpatient-oriented vendors as “elephant’s ass systems.” The little two-doc practice sees the hospital IT truck back up and out comes a complex application with loads of customization options, stacks of thick manuals, and no direct support except whatever the providing hospital has decided to offer. Free or not, there’s training to attend, configuration choices to make, and conversion from existing systems to plan. Oh, goody.

Doctors aren’t that thrilled with EMRs. Most of their benefit goes to insurance companies, studies have shown. Until pay-for-performance kicks in, there’s not much incentive. Plus, docs are always paranoid that hospitals will see how much money they make.

Benefits aside, EMRs take more of the doctor’s time to use. Something that’s free but consumes an hour or two more of the doctor’s day is hardly a welcome gift. All the doctor has to sell is time, and suddenly there’s less of it available.

Bush predicts what he calls a “hairballing up” of these feature-rich EMRs. The hospital may spend the money, staff a support center, and hand-hold the implementation, but there’s still a good chance the doc will thrown up his or her hands and announce, “I’m not using this. I don’t have the time.” Then, they’ll either ditch the whole EMR idea or find an easier to use system that gives them a financial benefit.

Remember when insurance companies and hospitals gave away free PDAs with all kinds of supposedly doctor-friendly software on them? Docs lined up to get one. No one was smart enough to realize until afterward that asking for a free gadget was hardly a commitment to change practice patterns.

Perhaps hospitals have underestimated this hairball effect. They’re giving doctors systems that are mostly loved by hospitals: feature-rich, committee-designed for a large range of practice settings, and with extensive clinical capabilities that may or may not interest the physicians who are expected to use them enthusiastically.

It’s great that hospitals will help drive EMR adoption by private medical practices. Hopefully they’ll give the docs a voice in choosing systems that they’ll use before spending too much money on a monolithic system that may not fit all.

News 3/23/12

Top News

Thomson Reuters reportedly puts its healthcare data and analytics unit back on the market after shelving the process last year due to tough market conditions. Multiple bidders may be vying for the business, which is expected to fetch up to $1 billion.

Reader Comments

From Willy Loman: “Re: Imprivata. Being sued for patent infringement for its OneSign SSO.” I Googled and came up with a new suit brought by CeeColor Industries LLC claiming that Imprivata is infringing on its 1999 patent for proximity-based security using electronic sensors. Imprivata’s OneSign uses a webcam with optional facial recognition software to validate a user and lock their session when they walk away. I can find nothing about CeeColor Industries, which suggests that their primary business, if they have one beyond just owning a patent, at least isn’t extortion by litigation. Companies get sued all the time for reasons both valid and not, so I wouldn’t get too excited about this lawsuit just yet. I interviewed Imprivata CEO Omar Hussain a year ago and asked him about Secure Walk-Away and how the webcam aspect works. Above is a video that explains it.

From James: “Re: Roy the HIStalk King. We (Medicomp) had Roy’s HIStalkapalooza sash framed. He seems very happy about it ;)” Roy Soltoff from Medicomp was not only named HIStalk King, he also served as part of Inga’s security detail for her Quipstar competition. You can see Roy in action in the excellent HIStalkapalooza video that ESD put together (he wins at the 2:30 mark.) His beauty queen sash looks good up there on his wall and the color / black and white photo effect is cool (either that or Medicomp and its people are very drab.)  

From Roller Boy: “Re: Allscripts. Downgrades from Jim Cramer and JP Morgan have created the perfect storm. Night and weekend meetings with board and execs with talk of impending changes.” Unverified and unwarranted, I’d say, given that shares are down only 6% in the past month, although the Nasdaq was up 4% in that same period. Other brokers have stood by their recommendations and neither Cramer or Morgan said anything new – they just recited the obvious challenges the company faces in integrating and selling Sunrise after its $1.3 billion acquisition of Eclipsys, if indeed that’s such an important driver of their business. My interview with Phil Pead and Glen Tullman about the acquisition is here and worth a revisit since I asked some tough questions, like how their performance should be graded two years down the road (that date is coming up soon.) I also said this about Eclipsys when the deal was announced in June 2010:

Despite the arguably superior CPOE and clinical documentation capabilities of Sunrise, it has competed poorly against Epic and Cerner … Nearly 40% of ECLP revenue supposedly comes from about 20 big customers … Eclipsys most likely paid big money for its recent acquisitions, buying the former Medinotes/Bond practice EMR products, EPSi financial management, and Premise throughput management as it desperately sought to diversify away from its at-risk Sunrise user base. Those acquisitions didn’t seem to do much for the company’s performance … It’s late in the HITECH land grab to try to integrate companies and products in the hopes that enough hospitals are left that haven’t locked into their vendor partners to prepare for Meaningful Use. This would have been a much better deal a year ago.

From HITwatcher: “Re: system sales. A quiet year as everyone is hunkered down protecting their base while Epic continues to go after the huge brass rings. Will Partners really announce a choice of Epic by April 1? Dunno, but they will go that route, then on to HCA for the no pie-in-face lady.”

HIStalk Announcements and Requests

What you missed if you didn’t check out HIStalk Practice this week: Dr. Gregg’s recent cloud/hosted server debate. Joslin Diabetes Center (MA) offers national telehealth services. Practices adopting the PCMH model of care have higher staff morale but also higher physician burnout. EZ DERM incorporates Nuance’s medical speech capabilities into its iPad EHR. Practice Fusion offers free interfaces to 16 reference labs. While you are stopping by HIStalk Practice, take a moment to sign up for the e-mail updates because it will keep you smart and make make me feel loved.

My Internet (and cable TV) went out earlier this week, so I have resorted to tethering my laptop to my iPhone for Internet access. It’s not an ideal solution (the connection seems to drop at least once an hour) but it’s actually pretty handy. I’ve used the tethering option a bit in the past when I’ve bee in an area without free Wifi, but never before full time. I wouldn’t trade trade tethering for my high-speed cable, but it’s a surprisingly workable solution. Meanwhile, I keep wondering if no cable TV means no recordings of American Idol on the DVR.

On the Jobs Board: Release Manager, Consultant, Application Developer. On Healthcare IT Jobs: Director of Federal Health Business Development, Technical Project Manager, Health Information Systems Programmer/Analysts.

Inga, Dr. Jayne, and I are emotionally needy. We yearn for intimacy and fulfillment with our much-loved readers, but alas, our anonymity and geographic separation preclude such contact. Therefore, like a prisoner who proposes surreptitious visual stimulation from the other side of the telephone room glass or requests passionate mail in lieu of physical contact, may I suggest that you: (a) sign up for the e-mail updates; (b) engage in the mutually satisfying activity of liking, friending, and connecting via the appropriate online services in which we dwell; (c) send us news, rumors, or anything else that might serve as a fancy-tickler; (d) review and click some sponsor ads, marveling that otherwise button-down companies publicly support our unpolished journalistic style and sophomoric humor because their executives at times find as amusing and informative as a hyperactive, crude teen armed with neighborhood gossip; (e) check out the Resource Center for more sponsor information and the Consulting Engagement RFI Blaster to painlessly request consulting proposals; and (f) enjoy our fleeting moments together since one of these days when I’m no longer clacking the keyboard, you’ll be bereft of musical recommendations and HIMSS booth critiques. Thanks for reading, since without you all this typing would be pointless.

Acquisitions, Funding, Business, and Stock

On Assignment, a provider of temporary workers to IT and healthcare companies, will purchase IT staffing firm Apex Systems for $383 million in cash and $217 million in new stock.

Sales

Xerox’s IT division wins a 10-year, $1.6 billion contract to oversee claims processing for California’s Medicaid program.

WESTMED Medical Group (NY) chooses UnitedHealthcare and Optum to help it launch an ACO for its 220 physicians in Westchester County, NY.

People

The Huntzinger Management Group hires Nancy Chapman (ACS) as practice director of ICD-10 transition and RCM services. We also note that she is part of an exclusive group of 2,324 industry leaders who have joined the HIStalk Fan Club that long-time reader Dann started and maintains on LinkedIn.

LifePoint Hospitals (TN) appoints Karla Schnell (North Highland) as senior director of informatics and Paige Porter as senior director of pharmacy informatics.

National coordinator Farzad Mostashari will present the opening keynote address at the Summit on the Future of Health Privacy in Washington, DC on June 6-7, hosted by Patient Privacy Rights and Georgetown University. Security expert Ross Anderson PhD, FRS will also address the conference and Rep. Joe Barton (R-TX) will receive an award for his support of privacy and security protections in the HITECH act. Registration is free.

Announcements and Implementations

US Preventative Medicine announces an agreement to offer its wellness platform through Dossia’s Health Management System.

HIMSS names The Health Information Exchange Formation Guide, written by Laura Kolkman and Bob Brown, as its 2011 Book of the Year.

PerfectServe announces that its clinical communication applications are available for BlackBerry and Android smart phones.

iMDSoft’s MetaVision Suite for ICUs and ORs earns ONC-ATCB 2011/2012 certification.

Elsevier signs an agreement with ExitCare LLC to offer its patient education information via Elsevier’s Clinical Pharmacology electronic reference. Elsevier will also offer ExitCare licenses to its customers.

Air ambulance operator Mercy Jets implements iPad-based medical records, allowing its medical teams to monitor vital signs and to document care delivered during patient transport.

In England, Northumbria Healthcare NHS Foundation Trust goes live on NextGate’s Multi-Language EMPI for its clinical portal that links multiple systems.

Government and Politics

HHS launches a developers’ challenge to design Web-based applications that use Twitter to track health trends in real time, allowing officials to identify emerging health issues.

The FDA’s Janet Woodcock MD says the agency could do a better job of predicting the effectiveness and safety of new drugs if it were able to collect information from the field electronically rather than relying on voluntary drug company reporting.

The State of Maryland, along with the CRISP RHIO and the Abell Foundation, launches a competition to identify innovative ways to improve public health using clinical information available from Maryland’s HIE, either alone or tied into publicly available data sets (motor vehicle records, birth and death, boards of education, etc. or Maryland subsets of federal databases) Submissions can address either general public health issues or ideas related to the Million Hearts initiative to prevent heart attacks and strokes. Prizes are offered and submissions are due by April 16. If you don’t want to submit, you can vote – the first round of vetting and discussion will involve the public, who can participate right on the site.

Technology

Memorial Sloan-Kettering Cancer Center and IBM collaborate to combine the computational power of IBM Watson with MSKCC’s clinical knowledge and data to create an outcome and evidence-based decision support system.

Other

The Saginaw newspaper describes Covent HealthCare’s used of 14 locally trained scribes in the ED to interact with its Epic system while the physician focuses on the patient. Doctors say they save at least an hour for every 25 patients they see.

HIMSS clarifies that hotel rooms for exhibitors at HIMSS13 haven’t been released yet, so they aren’t showing up on the housing site. They says a “blog site” (obviously this one) said they’re full, which isn’t exactly true – a reader (two, actually) told me that rooms weren’t showing up and I said I don’t know anything about exhibitor housing since I’m a provider grunt, but I did see at least 10 hotels showing non-exhibitor availability. Like most everything else at the conference, high rollers (Diamond members) get first crack. It’s like college football programs that require a big upfront donation to earn the privilege of buying expensive football season tickets.

Epic is awarded a patent for a search method that provides a list of possible appointments that match require provider and resource criteria.

Federal agents seize documents and computers from the town hall of West New York, NJ, reportedly investigating possible insurance fraud by Mayor Felix Roque, a physician who runs a pain clinic. Campaign staffers of the mayor’s defeated political opponent admit that they provided information to federal authorities hoping to discredit him.

A highly regarded and long-established family clinic in Wisconsin becomes one of the first in the state to stop accepting Medicare, citing inadequate payments and increasing expenses that include $700K for a new EMR. Says the founder: “I love taking care of Medicare patients, but every time we treat them we have to dig into our wallets. What kind of business model is that?” The doctor’s wife says he says up until midnight at home some nights to finish up his EMR charts.

A former patient sues a just-closed eight-bed Ohio hospital, claiming the struggling facility refused to transfer him to a more capable hospital because it didn’t want to lose the revenue. The lawsuit claims that lack of prompt treatment of the man’s infection by Physician’s Choice Hospital resulted in gangrene that required surgeons to perform emergency surgery, which included removing skin from his penis. He said it hurt, of which I have little doubt.

Sponsor Updates

• T-System posts a new video showing its T SystemEV EDIS.
• Lifepoint Informatics announces that its March user conference was attended by over 40 clients, with a keynote address by Bruce Friedman MD on “The Continuous Search for Greater Lab Functionality: Best of Breed LIS versus Enterprise-Wide Solutions.”
• GE Healthcare will introduce Centricity Cardio Enterprise at next week’s 61st Meeting of the American College of Cardiology.
• TELUS Health Solutions announces the integration of HIPAAT’s privacy consent management services into its Assure EHR Integration Platform.
• API Healthcare sponsors the DAISY Foundation, which honors nurses through its DAISY Award for Extraordinary Nurses.
• MedAssets offers a case study of the $65.4 million it helped Texas Purchasing Coalition save from its supply chain.
• White Plume releases AccelaMOBILE, a free physician charge capture app for mobile devices.
• The Advisory Board Company launches its Innovations in Impact grant program designed to reward best practice-driven initiatives that articulate measurable, quantitative outcomes goals. The application deadline for the $20,000 per year grants is April 13.
• Houston Orthopedic & Spine Hospital achieves Stage 1 MU using the Healthcare Management Systems (HMS) EHR. 
• Gateway EDI earns full EHNAC Healthcare Network accreditation. Gateway also shares results of ICD-10 preparedness survey, which includes the finding that 56% of practices report are moving forward with ICD-10 preparation despite the enforcement delay.
• DrFirst congratulates 44 of its EHR partners who were awarded the Surescripts White Coat of Quality for 2011.
• Nuesoft posts a full transcript of its billing webinar series on third-party insurance billing.
• An article by Santa Rosa Consulting’s Matt Wimberley discusses the opportunity to improve a hospital’s financial outlook through participation in the MU program.
• Informatica highlights BCBS Michigan’s ICD-10 transition and Ochsner’s standardization on Informatica technologies for its HIE.    
• Recondo Technology partners with ZirMed to offer the ZPay credit card and check processing solution.

EPtalk by Dr. Jayne

Several readers were taken with my article on the caduceus vs. rod of Aesculapius debate. Several mentioned Nehushtan, the fiery serpent used by Moses to heal those who looked upon it.

CMS asks  providers who feel they have received an ePrescribing penalty in error to contact them. Impacted providers may have had their G codes stripped by billing clearinghouses or may have reported the wrong annual code. Problems with hardship exemptions may also be the culprit.

HHS’s Office of the Inspector General approves Ascension Health Alliance to form a group purchasing organization, allowing it to offer its contracting services to hospitals and health systems outside of Ascension. The 21-state Ascension, the largest Catholic healthcare organization in the US, says formation of the GPO “demonstrates our commitment to transform healthcare by 2020.”

A research letter in this week’s issue of JAMA discusses the prevalence of physicians using social media to post unprofessional content online. Surveying state medical boards, the authors found violations that included inappropriate patient communication, sexual misconduct, prescribing without a clinical relationship, and online misrepresentation of credentials.

IBM Research teams with an Italian cancer center on a new analytics platform that will personalize treatment based on pathology guidelines and past clinical outcomes as documented in hospital systems. The Clinical Genomics tool can also provide an aggregated view of patient care.

AMA Board of Trustees chair Robert M. Wah MD reflects on his recent trip to the HIMSS conference, calling it “a gathering of more than 40,000 of my closest friends and colleagues.” Dr. Wah has an interesting pedigree: Navy active duty, deputy national coordinator for health IT and founding staffer at ONC, chief medical officer at Computer Sciences Corp., and head of the Navy’s largest OB/GYN training program. He’s an interesting guy and I am glad someone with his experience is chairing the board. I hope the AMA will show real healthcare IT leadership to reverse the black eye it obtained by blocking ICD-10.

Speaking of ICD-10 codes, one of my Twitter followers keyed me in to this app available on iTunes. For $24.99 and it only one review, I think at this point I’ll take a pass.

Several readers responded to my mention of the allergist who closed his practice to join the Army as a lieutenant colonel. Rank is apparently based on experience and specialty. One reader told a great story about his own Army service, where he had to take away several service weapons from physicians who mishandled or misplaced them, including one major who left his Beretta in the PX while shopping. That’s a little different than losing your sunglasses or your keys.

A shout out to Children’s Hospital Los Angeles Medical Group, which is hosting its annual “Pediatrics in the Islands: Clinical Pearls” conference in Maui. It’s a great conference. but I think it’s time to include some health IT topics, hint hint. Perhaps a celebrity guest speaker?

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

An HIT Moment with … Andy Hoover

An HIT Moment with ... is a quick interview with someone we find interesting. Andy Hoover is IT director at WoundVision, an Indianapolis vendor of risk assessment software and thermal imaging tools for early pressure ulcer detection. The company recently migrated its platform from Amazon’s EC2 public cloud computing to a virtual data center.

What led you to originally choose cloud-based hosting instead of self-hosting for your application?

We are a small startup company, less than 20 employees. With limited financial resources and a small staff, there really wasn’t another option for us. We needed to be able to focus all of our attention on developing our line of products and rely on a vendor for providing a reliable hosting platform.

What did you learn about the differences among cloud computing providers?

Nearly two years ago we first looked at the big two in Amazon and Microsoft. Microsoft wouldn’t work for us because of limited capabilities with SQL Azure compared to SQL Server and the inability to install third-party software and tools on Windows Azure.

Amazon allowed us to run a little more like a traditional data center. We actually ran in the Amazon cloud for a year. But due to lack of readily available support, the learning curve of using the EC2 and S3 storage both from a development and administration standpoint, and limited monitoring and visibility options, we decided to look in another direction.

Once we decided we needed to check into other vendors, we looked at multiple vendors a little closer to home. The big thing we discovered is there are a lot of companies jumping into the cloud hosting business.

The key factors to us in selecting a new vendor ended up being the experience in the market, support options, and the physical data center itself. The provider we picked excelled in all of those areas. Bluelock has been around since 2006. Their support options and capabilities were far beyond what others could offer. There has been nothing we have asked for that they couldn’t provide or at least offer a contact for. Their data center is extremely impressive.

What special needs did you discover you needed to address because you are dealing with a healthcare application and hospital customers?

The question of "where is the data hosted?" always comes up. It became very import to be able to answer specific questions about where the data was hosted and how our data is being protected.  To be able to explain where the data center is at and exactly how it operates was very important. It helps boost our credibility when talking with clients about protecting their data.

Having readily available documents from our provider, such as a SAS70 certification or a disaster recovery plan which could be passed on to clients, is very helpful. With logging being so key in guarding medical data, we found we need to be able to gain visibility into all incoming and outgoing traffic.

What advice would you have to a startup considering EC2?

While cheaper than many other providers, EC2 will require more personnel time to build and maintain. When you have questions, you are left to figure them out for yourself via knowledge base articles or blogs. As a startup, it might make sense to pay a little more to work for a vendor that functions a more like a traditional data center, has better support options, and knows who you are as a customer.

What resources did you need to implement your current cloud solution and what’s involved with maintaining it?

We needed a highly available platform capable of running multiple Windows VMs, multiple VLANs, SQL Server, and a firewall in which we have visibility.

Now that we have been up and running at Bluelock for over a year now, not a lot of maintenance is required on our part. I use their monitoring portal to keep an eye on things such as performance, availability, and usage. We are able to ask for custom options, such as custom monitoring and alerts for metrics we care more about. Maintenance of the servers doesn’t included much on our part — monitoring, patching, and pushing new releases of our software. 

News 3/21/12

Top News

Misys, whose only remaining healthcare-related product that I recall is Misys Open Source Solutions, agrees to be acquired for $2 billion by Vista Equity Partners. Competing offers are possible despite a simultaneously announced Misys profit warning after Q3 revenue slid 12%. If the deal goes through, Misys will join a family of Vista-owned companies that includes Sunquest and Vitera.

Reader Comments

From HIMSS Benefactor: “Re: HIMSS13. Almost all the decent hotels are already booked. What happened? The W French Quarter has a few rooms left at $909 per night! Too much hassle … will have to skip this one.” I just checked the HIMSS online booking site and they’re showing 13 hotels available to attendees, starting at $155. The four-star Marriott on Canal Street is $230 per night and appears available, as is the close-by Courtyard at $180. I tried several of the travel sites to see if maybe HIMSS hadn’t locked down the whole block, but all showed no rooms available. Major concerns about infrastructure readiness abounded when HIMSS last went to New Orleans in 2007 and the experience was uneven in many hotels and restaurants. Having too few or too expensive hotels would give HIMSS a black eye it doesn’t need after massive attendance in Las Vegas. Let’s hope they just haven’t released all the rooms yet since we’re nearly a full year away. Otherwise, I’m going rent a house or two for the week, bring in sleeping bags, and run a HIMSS Hostel at exorbitant nightly rates. I don’t know where I stayed last time – I only remember that it was forgettable.

From The PACS Designer: “Re: SMArt. With the release of the iPad, TPD thought it would be the right time to mention The SMArt Platform created by the Children’s Hospital Boston and Harvard Medical School. Travis Good alerted us a year ago about it and mentioned that there is $5,000 prize challenge for the winning design. The SMArt platform is envisioned to be an app store for health, with applications geared towards both patients and providers.”

From Doreen: “Re: HIMSS. You should rent one of the tiny booths for around $5,000, use the fact that you have the greatest advertising strength on earth for healthcare IT to tell people you’ll be there, have guest booth hosts like Ed Marx and Dr. Gregg, and offer giveaways.” I had to embellish the idea, of course, by suggesting that (a) I set it up like a welcome center and offer information on HIStalk’s sponsors, or (b) I find some other company in tiny booth Siberia and tell them I’ll be their next-door neighbor and bring lots of traffic their way if they’ll pay for my space. Then I recruit volunteers to serve as my proxy to host the booth in rotation. I was excited about putting out kegs of beer until I Googled the price at the Morial Convention Center: $450 for crappy domestic brands.

HIStalk Announcements and Requests

Medicomp commemorates Inga’s participation in its Quipstar game on the HIMSS exhibit hall floor with a video. Note the Shoe Cam pictures, security entourage, the IngaTini in her hand, her green M&M snack, and the carefully placed reflector thingy that I bought her as part of her disguise. She was scared to death, but determined to earn Mobile Loaves & Fishes the $5,000 charitable donation offered by Medicomp in return for her involvement.

Welcome to new HIStalk Platinum Sponsor Jardogs. The Springfield, IL company connects patients, providers, and communities with its Jardogs FollowMyHealth Universal Health Record, an ONC-ATCB-certified cloud-based solution that aggregates information from disconnected organizations (it was recently selected by Iowa Health System, I recall). Patients become gatekeepers of their own information from anywhere in the world using a single comprehensive view instead of running around to a bunch of individual, proprietary patient portals. They can electronically complete physician-requested forms that are pre-populated with the practice’s EMR information, check in for appointments, and get real-time updates. Providers improve their patient relationships and address ARRA incentives for patient access (send reminders, provide electronic copies of results and med lists, share information per patient authorization, and connect to public health registries). The company also offers a patient kiosk that streamlines registration and data collection. Next up: home and wellness applications, such as for home physical therapy and potentially for home monitoring. Thanks to Jardogs for supporting HIStalk.

Acquisitions, Funding, Business, and Stock

RCM provider MD On-Line acquires MD Technologies, a provider of RCM products and the Medtopia Manager PM system.

Axial Exchange announces that its care transition solutions, Axial Provider and Axial Patient, are available for cloud deployment. The Raleigh, NC-based company offers care coordination and communications applications that connect first responders, hospitals, physicians, and health plans via a clinical dashboard.

In the UK, University of Lincoln and the local hospital trust develop a prototype of an orthopedic surgery training simulator that uses the Nintendo Wii to mimic the use of a surgical drill, allowing surgeons to improve their hand-eye coordination.

Sales

The non-profit United Health Organization (MI) will use video-to-handheld technology from JEMS Technology to connect patients requiring specialized medical attention with off-site physicians for consultation. Volunteer specialists who can’t leave their practices can visually examine the patient and provide treatment recommendations from their mobile devices.

DR Systems announces new contracts for its Unity CVIS with Twin Cities Community Hospital (CA), Good Shepherd Medical Center (TX), Healthcare Partners Medical Group (CA), and St. Luke’s Cornwall Hospital (NY).

The Maryland Department of Health and Mental Hygiene awards CSC a $297 million contract to replace the state’s Medicaid management information system and to provide fiscal agent services. The contract is for five years with three two-year options.

The Maricopa County (AZ) Board of Supervisors approves a $4.55 million contract to NaphCare for EMR licenses and installation services for its correctional healthcare system, which lost its accreditation in 2008 for issues that included poor recordkeeping.

People

Two weeks after agreeing to serve as CEO of Cal eConnect, Ted Kremer withdraws his acceptance and announces plans to stay on as executive director of the Rochester RHIO after learning that Cal eConnect’s funding is uncertain. Cal eConnect interim CEO Laura Landry will assume the CEO post.

Legacy Health System (OR) names John Kenagy PhD as interim SVP and CIO. He was previously with Providence Health & Services.

Healthcare analytics company Qforma appoints Valerio Aimale MD as chief of advanced products, William Howard PhD as SVP of new product development, and Delphina Perkins as director of client services.

Authentidate Holding Corp. names former Viterion Telehealthcare CEO Sunil Hazaray its chief commercial officer.

Announcements and Implementations

Cookeville Regional Medical Center (TN) implements MEDHOST’s EDIS.

Susquehanna Health Partners (PA) adopts Summit Healthcare’s Downtime Reporting System to address its business continuity and data protection needs.

Practice Fusion launches its research website to help public health agencies and physicians predict and manage outbreaks.

Objective Health, part of McKinsey & Company, announces the release of its Objective Scorecard performance dashboard and analytics solution for hospital executives.

UPenn Health System goes live on Brainware and Ascend solutions for accounts payable automation, helping it manage paper invoices and integrating with its Lawson ERP system.

The EZ DERM iPad EHR adds speech recognition using Nuance’s cloud-based technology. I accidentally strayed onto the cool new EZ DERM video above on YouTube. The company modestly calls its product “The Best EHR in the World.” I can’t vouch for that, but it might well make the best EHR videos in the world.

SAIC’s COO talks up the company’s Vitalize Consulting Solutions acquisition in Tuesday’s earnings call: “SAIC’s acquisition of Vitalize Consulting Solutions continues to support strong, double-digit growth in the commercial health IT arena.” In not-so-positive news, SAIC racked up a $161 million Q4 loss after setting aside $500 million to settle a criminal investigation involving cost overruns on a payroll system it developed for New York City.

Government and Politics

ONC releases a new version of its Connect software that incorporates updated technical standards and descriptions for the NwHIN Exchange. Connect version 3.3 supports such functions as patient discovery, document queries, and information retrieval.

Louisiana behavioral providers say that the state’s new Medicaid reimbursement software, which was supposed to make their claims submission easier, isn’t working. Providers say they can’t always enter new client information and some of what they’ve entered was lost, the progress notes function isn’t working, and nobody’s been able to bill for their services.

Other

TeleTracking posts a fun video of The Capacity Blues, a Cajun-flavored piano tune written and performed by one of its employees in honor of its upcoming New Orleans patient flow symposium.

Divya Shroff MD, HCA’s chief clinical transformation officer, writes a company blog post called Can Access to an EKG on your Phone Save a Life? in discussing the company’s collaboration with and investment in AirStrip Technologies. Her example involves door-to-balloon time for cath patients, with the potential to send EKGs directly from the ambulance to the cardiologist as both are in transit to the hospital.

I’m watching interviews filmed at HIMSS in Las Vegas by EHRtv that our pal Eric Fishman MD has been posting. Here’s one with Matthew Hawkins, CEO of Vitera, and here’s another with Shareable Ink’s Stephen Hau.

In England, hospital officials admit that they ordered the IT department to clone and snoop around the computer hard drive of a whistleblowing doctor who complained about unqualified staff and and was later fired. His boss justified the action, saying she had heard from employees that he was on the Internet a lot and wasn’t seeing enough patients.

The local newspaper interviews eClinicalWorks CEO Girish Kumar Navani.

Dr. Wes says EMRs bury doctors in data without giving them useful information:

There’s so much data that we risk doctors becoming lost in it. It is entirely possible that we are in danger of not being able to find our most important clinical signals amongst the noise and clutter of all the data. Worse: time with patients is disappearing. Our health care information gold rush has acquired teams of programmers to feverishly implement a myriad of bureaucratic information system requirements in just a few short years. To this end, these programmers have been extremely effective. But almost as incredibly, these same programmers have little perspective of what physicians do or how we interact with patients and THEIR data. As a result, doctors are not only confronted by all of this this information placed before them, but waste precious time sifting amongst the data and continue to be the fall-guy for data entry. Codes, quality measures, documentation requirements and, oh, yeah, the progress and operative notes, are all being entered by doctors. In return, our screens have become crowded intersections of buttons, flags, options, icons, colors, warning alerts and (if we’re lucky) text. Oh yeah, and a new “upgrade’s” coming next week.

Note to companies: just in case you can’t spell HIPAA correctly, at least leave it out of the press release’s big-font headline.

University of Louisiana at Lafayette is looking for healthcare geeks to participate in its free Cajun Code Fest on April 27-28. Speakers include US CTO Todd Park, Intel’s Eric Dishman, and the guy who founded Priceline.com.

A Crain’s New York study finds that the 25 highest-paid New York City hospital executives earned a combined $60 million in 2010, with New York-Presbyterian’s Herbert Pardes topping them all again at $4.3 million.

Sponsor Updates

• CapSite GM/SVP Gino Johnson will provide an overview of the HIE market at next week’s 4th Annual Health IT Insight Summit in Boston.
• Liaison Technologies will offer Preventice’s wireless monitoring technology to collect and transmit patient data via its cloud services.
• Bloomberg Businessweek profiles Digital Prospectors Corp.
• CTG Health Solutions will participate in the Allscripts Central Region Users Group meeting in Des Moines, IA on April 19.
• Trustwave completes its acquisition of M86 Security.
• Health Care DataWorks selects Health Language’s Language Engine to map disparate data into its data warehouse.
• BESLER Consulting will use the Inventu Flynet Viewer to give its hospital customers access to the Medicare Common Working File stored on 14 CMS mainframes, allowing faster and more efficient claims review.
• DIVURGENT’s David Shiple discusses the proposed MU Stage 2 emphasis on personal health records vs. low consumer interest in using them in a blog posting.
• The local paper discusses Premier Health Partners’ use of MEDSEEK’s predictive analytic tools for targeted consumer mailings.
• Merge Healthcare and AG Mednet partner to integrate AG Mednet’s image collection platform with Merge’s Clinical Imaging Management System (CIMS) to enable higher quality images and data flow directly into Merge’s CIMS and EDC solutions. 
• Capsule announces that it has surpassed the 1,000 mark for healthcare organizations using its medical device integration solution, including 200 new customers added in the last four months.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Curbside Consult with Dr. Jayne 3/19/12

I spent the better part of today taking a tree down. It might surprise some of you, but I do know my way around bow saws and chain saws as well as scalpels. Unlike the delightful specimen above, mine was extremely close to the house and required yearly maintenance. It also had some other unsavory features, and since today was a beautiful spring day with a light breeze and not too much sun, it was time to get it done.

It would have been easier if the tree were ugly or diseased, but unfortunately this particular tree was in full spring bloom. Most of the trees I’ve been involved with taking down were diseased, in wooded areas, or part of a service project where everyone understood why they needed to be removed. I’ve never had to do one right next to the house in full view of the neighbors and everyone else who passed by walking dogs or enjoying the spring weather.

Not surprisingly, people had things to say about the tree coming down, and I started to question my decision. To the casual observer, a beautiful tree was being removed. The casual observer, however, didn’t ever have to deal with the messy fruit that it dropped, staining the driveway before being tracked in to create a nasty gelatinous mess in the kitchen. He or she also wouldn’t have to deal with the birds that liked to congregate in the tree, eating the fruit and creating an additional level of mess that prevented anyone from ever parking in the driveway or walking on it during the better part of the year.

Passersby also wouldn’t know about the lovely herringbone brick walkway that was installed by the previous owner, and which the roots of the tree destroyed. They also wouldn’t realize the hazard that the now-uneven walkway caused to anyone who tried to visit in the winter – the destruction of the walkway made it impossible to clear snow or ice.

Initially the neighbors just thought this was a routine trimming, but after large limbs started coming, down it was obvious that this was more than that. I started feeling guilty. After all, it was outwardly a very good-looking tree. I had to remind myself that it was also a species that tends to split in high winds, and due to its size and proximity, if it split (as many trees of the same age in my area already have) it would likely come through the house. That certainly wasn’t anything I wanted.

As the work progressed (thanks to some strapping young men who offered to help) and I looked at all the blossoms littering the yard and the street, I choked back my guilt by remembering that had the tree remained, nearly every one of those would have turned into a piece of messy fruit. I also had to remind myself that the tree was in the way of a pending construction project on the house, which includes revising drainage to ensure that the foundation stays dry and the yard ceases to be a muddy pit.

Working on projects like this always makes me contemplative. This particular project went on for hours, giving me plenty of time to think about what I was doing as well as the parallels to my work life.

Dealing with this tree reminded me of dealing with a particularly difficult employee who ultimately had to leave the organization. From the outside, he appeared to be a solid worker. Gregarious and outgoing, co-workers found him likeable. His outgoing nature often proved to be an issue, however, when he couldn’t complete assignments due to excessive socialization. He needed frequent reminders to stay on task.

Unfortunately, early attempts to correct his behavior resulted in friction with other members of the leadership team who only saw the beautiful tree and discouraged his direct supervisor from formal corrective action. This worker frequently took credit for his colleagues’ work and directly reported these successes to those above his supervisor, putting the supervisor in an awkward spot. Maybe it’s all the time I spent studying human behavior, but aside from his direct supervisor, I felt like I was the only person seeing through his showy exterior.

As time progressed, our little tree dropped his proverbial fruit throughout the department, creating messes that others had to clean up. His roots grew into other departments, resulting in complicated entanglements with female staffers that created additional instability. We pruned and we pruned, but as much as we tried, he grew.

We began to carefully document every action taken because his twisted roots threatened to undermine his supervisor and his peers. Only when his continued presence threatened the future of several key projects could we muster the support to finally remove him.

I felt guilty throughout the process, but like today, had to remind myself of the current dysfunction as well as the potential for future damage and the ways in which he was impeding progress.

Once he was gone, I was pleasantly surprised. Other co-workers grew into the void and supported his replacement, like sheltering trees protecting a young sapling. The team regained its cohesiveness. Some members who had been in his shadow were finally recognized for their achievements.

Like dealing with my former employee, I know that taking down the tree was hard, but it was only the beginning. There’s plenty of work coming – branches to bundle, a stump to remove, French drain to install, and more. Once those things are stable, the new tree (non-fruiting of course) will arrive to be planted and nurtured, ultimately providing shade and beauty. The effort will be worth it and I’m looking forward to the future.

Have a question about arborists, making your own compost, or what’s the best way to store a face cord of wood? E-mail me.

E-mail Dr. Jayne.

Readers Write 3/19/12

Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

Sampling the Legislative Sausage
By Civics 101

Be careful reading the proposed Meaningful Use regulations. Note the “proposed” part. As a Notice of Proposed Rulemaking, it’s unwise to ignore any part of the document.

Every word in the document – even in the preamble — has survived numerous rounds of federal vetting. Every section is important, but especially so are those areas in which public comment is invited. Objectives may be added or removed, so don’t get hung up on those to the exclusion of the preamble or the overall intention.This is not a set of business requirements that is ready to be handed off to programmers to implement.

Read the NPRM as a big picture, keep an open mind, and try to understand the intention, not just the tentative objective list. And above all, don’t forget that while Stage 1 is locked in place, Stage 2 isn’t. My organization and yours need to study the NPRM carefully and comment on what we like or don’t like about what’s been placed before us. Remember all the changes that were incorporated between the Stage 1 NPRM and the final version? Every one of those came as a result of public feedback.

Using the iPad in Surgery
By Michael B. Peterson, MD

I use the iPad every day while rounding at work and connected to the encrypted hospital wireless network, finding web information for patients and showing educational videos. I use a Bluetooth keyboard and sometimes a stylus that fit into a netbook soft case when I need to do heavy typing.

We were doing a complicated vascular surgery, an axillary femoral femoral bypass. I had dissected out the blood vessels on the right groin, but the surgeon working on the left could not locate the critical arteries and branches. The patient did not have any pulses in the groins because of severe vascular disease.

I had the nurse drop the iPad into a sterile sleeve and seal it. I used it to pull up the CT scans on the table and paged to the proper level so we could compare the right to the left. Then we knew where to go. We could place the iPad right on top of the patient and visualize what we needed.

Then while my colleague and our PA completed the left side, I checked my Lotus Notes e-mail, went into the vascular econsult program and triaged some vascular consults to the appropriate clinics, and checked my inbasket in our Epic EMR to read labs and answer messages (the iPad runs Epic very well.) When I was done, we were ready for the rest of the surgery.  

The x-ray viewing is an innovative project on which we are partnering with with Thinking Systems.

We are using the latest Citrix Receiver to host our version of Epic on the iPad and other devices as well. Since the rollout of Epic Summer ’09 across the country in all Kaisers, the old web address we used for Spring ’06 access no longer works for the iPad. In addition, there are additional video requirements for Summer ’09 that our current web servers need that the Citrix receiver cannot handle. Attempting access to the Summer ’09 environment will result in a connection failure with a “USKIN” error message.

Fortunately our Kaiser web engineers were aware of this and understood the need for iPad functionality. They created special web addresses for Kaiser iPad users in Northern and Southern California, Hawaii, and Pacific Northwest. The official term is PNAgent Site. Setting it up is complicated, but the iPad works very well.  

Of course there are ergonomic challenges with a smaller screen, and accurate tapping is critical. But it is so fast and convenient — you don’t have to wander around looking for an unoccupied keyboard and computer. If I need to look up something, I just do it where I am. It has really spoiled me.

I don’t know if there is any way to demonstrate improved outcomes with the iPad. Kaiser is starting to roll it out to other medical centers with different specialties. My general feeling is that with the EMR, there is a 20% productivity hit with data entry and typing your note. It does take longer on the generic computer, but the the iPad is so much faster and it literally puts the medical record at your fingertips… or perhaps the patient’s.  

I plop the iPad down in front of the patient and point out pictures, diagrams, and a quick graphic plot of their rising creatinine. I run the lymphedema pump movie to show them how it works, or review the online video again to remind me or others how that endovascular closure device works again before I actually do it.  

I have invested the time it took to get comfortable with the iPad and arrange it the way I want. I could not do without it. I have very little specialized software on the iPad except for the VPN and the Citrix Receiver. And my medical apps, books, and games!

Michael B. Peterson MD is a surgeon with The Permanente Medical Group in Hayward, CA. His use of the iPad in the operating room was featured in the April 2012 edition of Macworld. Since Mike is an old friend of HIStalk, I asked him for more detailed information, which he provided above.

What Do You Do Regardless? Five ICD-10 Steps To Continue
By Torrey Barnhouse

The AMA lobby is strong. US government program delays are common. The two came together on February 16, 2012 when Health and Human Services Secretary Kathleen Sebelius announced a potential delay in the October 1, 2013 deadline for ICD-10 implementation.

The announcement, made just before the start of the HIMSS12 Annual Conference, left a lot of attendees scratching their heads and asking themselves, “Now what?” Most agreed a delay of one year or less gives everyone more time to prepare, train, and test. However, a delay of greater than one year spells chaos for healthcare providers and payers.

While at HIMSS, TrustHCS had the honor of sponsoring an executive roundtable on ICD-10. During the roundtable, speakers discussed five ICD-10 projects that should continue full steam ahead despite the delay. It’s a good list and worth sharing.

In general, the panel’s advice was to identify ICD-10 tasks that have collateral benefit for ICD-9 coding. These are the tasks that should be continued until such time as HHS makes another announcement regarding their plans, intentions, and deadlines.

Vendor and Payer Assessments

Continue checking with vendors and payers to see when systems will be ready for testing. Know what the ICD-10 upgrade will cost your organization, if anything. If your vendor simply can’t accommodate, start evaluating new systems to replace them. Conduct ICD-10 testing with your payers whenever and wherever possible to help reduce backlogs and denials upon go live.

Clinical Documentation Improvement

Any improvement in clinical documentation specificity and granularity will help support better, higher quality coding and reduce time wasted querying physicians. Coders can only code what is documented. This same core principle applies in ICD-10. CDI programs must be continued regardless of a delay.

Coder Biomedical Training

While educating coders in the finer nuances of ICD-10 coding can be postponed, strengthening their knowledge of the basics can’t. Many coders graduated from programs 10, 15, or 20 years ago. Medical science and our knowledge of anatomy, physiology, and disease processes has grown exponentially. Now’s the time to make sure your coders are brilliant at the basics. Anatomy and physiology training should continue to be conducted: online through a service provider or at a local community college.

Computer Assisted Coding (CAC) Technology

Coder productivity is predicted to drop by 50% during the implementation of ICD-10 and perhaps remain 10-20% below normal output for ICD-9 coding. CAC systems help offset this productivity loss by electronically “reading” the record and suggesting codes to the human coder. While CAC systems don’t replace coders, they do make them more productive and efficient. The delay provides more time for organizations to evaluate and implement this technology.

Assess and Refine Your Work Plan

Conduct a methodical step-by-step review of your initial plan. This process will identify which tasks can be pushed out and which cannot. The review will also uncover other tasks that have collateral benefit for ICD-9. For each task in your work plan, ask yourself, “Does the delay impact this task?”

Industry experts are already predicting the cost of an ICD-10 delay. Other experts are predicting lawsuits by providers to help recoup monies already spent. This expert simply suggests that you stay the course and keep working toward ICD-10 preparedness. We will all have to get there eventually. Better to be early than late on this one!

Torrey Barnhouse is CEO of TrustHCS of Springfield, MO.

Viva la CPOE!
By Daniela Mahoney

According to the HIMSS Analytics EMR Adoption Model , CPOE adoption remains steady at a rate of 13.2% for the past two quarters. And in recent months, many hospitals achieved the first stage of Meaningful Use. Congratulations to all!

However, looking at the story behind CPOE implementations reveals that adoption struggles continue —regardless of the vendor system. Many community hospitals expend great effort and many dollars meeting Meaningful Use criteria, but additional time and money is also spent avoiding a full-blown revolution within their provider community because of CPOE implementation.

Technology is really only 15-20% of a CPOE implementation. Process, acceptance, culture, and constant transformation are the parts that truly define the difference between CPOE failure and success.

At the end of the day, technology’s golden purpose is to support the infrastructure: devices, performance, remote access, integration/interoperability, streamlined single-sign-on, and ease of navigation. But even when working flawlessly, it’s still an uphill battle capturing provider adoption on that much-needed “voluntary basis.”

I can always hear the physician protests, even when left unsaid: “Why should I use it?” “What is in it for me?” “Show me the money, Jerry.”

The question remains: why? Why won’t providers embrace new CPOE technologies and take advantage of the wonderful features, such as clinical decision support or evidence-based order sets that streamline the admission process?

Truthfully, there is nothing wrong with the providers’ feelings here. They simply know what’s at stake. And the odds are not in favor of CPOE, despite the benefits we may see through our own rose-colored glasses:  “Oh, how it benefits the patient! Why don’t you providers just snap out of it and embrace CPOE for the people, or at least for the children?”

Kidding aside, what a new CPOE system takes away from providers is TIME.

… at least for a while.

Time is a provider’s most precious commodity. A new system changes the way they work and takes time away from office hours and family. Time is irreplaceable and invaluable.

But the Meaningful Use mandates say “so what” and to just do it and accept it. CPOE is a reality and must be part of every provider’s future in the hospital or in the office. With that, I sympathize. Providers may have cause to rebel.

I spent some time researching literature while preparing this article, looking at provider efficiency with CPOE. Many studies are relatively old, done in the ‘90s or early 2000s. Not to dismiss their importance, but many issues experienced then have been since resolved with today’s systems. In retrospect, they really aren’t relevant.

But one thing overlooked then and now, to me, is the most important question: what is the right value proposition to the provider?

The answer? One that fits a provider’s community and meets their conditions to accept CPOE into their domain.

With 22 years invested helping providers through CPOE adoption , I found only one simple and effective system pitch. Be truthful and realistic. That’s what works. That’s what opens door and also ears.

For example, we can’t deny that it typically takes significant time to adopt and adjust to a new system, and that efficiency improves only with consistent use. Additionally, never overpromise that CPOE is faster than handwriting an order or checking boxes on a pre-printed order set. I can tell you, that approach doesn’t work.

Once providers are engaged, gather the value proposition’s building blocks by talking and listening to them –  eliciting their concerns, needs, and requirements — and also identify opportunities for compromise.

Usually during interview sessions, similar things are voiced. And believe it or not, it’s less about Meaningful Use (understanding the “benefit” of hospital reimbursement is typically demonstrated by only a few) and more about the direction of technologies in healthcare and reporting requirements and how it affects the way they practice medicine.

For example, for some it is important to have remote access, and not just to CPOE, but to also do other tasks, such as signing their charts. And from others, I often hear how they would prefer using their own laptops or iPads, so they do not need to compete for devices.

Here are some very telling interview quotes from providers about CPOE adoption:

• “Access from outside of the hospital, home access would be great.”
• “CPOE should be a resource for us. It should not make us work harder to accommodate it.”
• “Ease to use and quicker order entry is most important.”
• “Online view of medications administered would be a great value.”
• “Reduces errors and provides clarity of medical orders. There must be a safety net if errors are made, especially with residents. Incorrect orders need to be stopped.”
• “A quick-pick list for providers would be nice.”

In the end, the right value proposition delivers the commitment of the hospital’s leadership to respond to what providers say and need. It engages all providers and can convince them to fully adopt CPOE as part of their workflow—especially with respect to efficiency in daily operations.

Providers become very reasonable and willing to compromise if engaged and their voices heard. Realistically, you cannot fulfill every need, but it is still important to listen and respond. The hospital’s leadership must be proactive and have a solid communication plan to manage expectations at different levels before, during, and after implementation. The direction of CPOE within the organization must be clearly defined, from the adoption and training to the deployment strategy. Lastly, completing a cultural evaluation the provider community provides tremendous insight into defining the value proposition which is the foundation of your CPOE success.

Let them eat cake, because we’re having crepes …

Here is a simple but delicious nutella-banana crepe recipe enjoyed by our family. Bon appetit!

Daniela Mahoney, RN BSN is vice president of Beacon Partners of Weymouth, MA.

Monday Morning Update 3/19/12

From Eric Rose MD: “Re: proposed MU rules. Like a lot of people, I get annoyed at how difficult it is to get to the actual regulatory text because the headings are embedded. I’ve extracted the actual text and marked them up with section headings. Turn on the Navigation Pane in Word and you can easily find the sections, particularly those with certification criteria or MU objectives. I created these for my own convenience, but others might find them useful. Feel free to share with the HIStalk community.” I’ve set up the certification criteria and MU objectives for downloading. Thanks to Eric, who is a clinical terminologist with Intelligent Medical Objects.

I’ve been having problems with the e-mail blast application that nobody can figure out, so I’m changing it to a hosted solution since I have no time for further investigation. The differences you’ll notice are: (a) the update notices will be HTML messages, which are a little bit nicer looking and easier to use than plain text; (b) the e-mails will look better than before when reading on mobile devices; and (c) hopefully the e-mails will go out faster and get delivered more often. I’ve learned way more than I ever wanted to know about the technical side of Exim, SMTP hosting, and server message queues and it’s not nearly as simple as just sending someone an e-mail. I’ve still got some fine tuning to do and I may need to change again if this doesn’t work as well as I’m hoping, so be patient and we’ll get through it.

Listening: Penelope Houston, one of the better female folk-rockers you’ve never heard of. She used to be singer of punk band The Avengers, but now does moody Euro-sounding 60s pop with mandolin, autoharp, some vintage Hammond B3 organ in the mix.

My Time Capsule editorial this time: US Healthcare Value is Low – Follow the Fancy Buildings, summarized by this snippet: “I’m not smart enough to figure out who the good guys and bad guys are in healthcare, so I look at just one thing: buildings. When I see stunning hospitals, vendor headquarters, insurance offices, and doctors’ houses, I figure they’re doing a little better than I’d like.”

A couple of readers chimed in on my comment about Epic implementations slipping from their aggressive, MU-driven timelines, saying they’ve heard of places having that problem. I think you’ll hear more about this. Big money at risk or not, system implementations are always harder and more complicated than they seem, and hospitals are notoriously bad at change management (although Epic leads them through it by the hand.)

This is encouraging in an “eat your own dog food” kind of way: 80% of respondents have primary care providers who use electronic medical records. My university-associated doc does and it’s made a huge difference in how my encounters work: I get accurate medication reconciliation performed at every visit with the system (even though all I take is a diuretic), he has all my history right in front of him (it’s fun to see how my weight has changed over the years, mostly because it’s gone down quite a bit), and we have avoided duplicated lab tests. The doc looks smarter, I feel like my entire health situation has been considered, and we use the on-screen information together as a teaching and planning tool. I’ll say something I would not have said a couple of years ago: I really think I’d sadly have to find another doctor if mine was stuck in the paper chart world. New poll to your right, in honor of the Mostashari vs. academic researchers flame wars: will wider EMR usage reduce the number unnecessary imaging exams? Maybe someone should just ask doctors themselves instead of trying to make inferences from sketchy data.

On the Jobs Board: Client Care Engineer, Mobility Software Engineer, Epic Inpatient Module Go-Live Support, Vice President Healthcare, Meditech CPOE Activation Support, Consultant. On Healthcare IT Jobs: NextGen Analysts and Consultants, Horizon Meds Manager Consultant, Assistant Health Services IT Director. I don’t know about your phone, but mine is ringing constantly from recruiter calls, although I do have specific expertise that’s hard to find. A lot of the calls are from folks looking for consultants.

Thanks the the following new and renewing sponsors that supported HIStalk, HIStalk Practice, and HIStalk Mobile in February (click on a logo for more information):

An article in the newsletter of the USAF’s Hurlburt Field describes the Air Force’s MiCare Portal, a RelayHealth-powered site that allows patients to send secure messages to clinicians and request refills, while the providers can send patients appointment reminders, results, referral information, and changes in clinic hours. The group practice manager says the goal is to make MiCare the preferred method of communication after in-person appointments, avoiding phone tag and missed handoffs. Other bases using MiCare: Hanscom, Langley, Nellis, Offutt, Scott, Seymour-Johnson, and Travis.

Weird News Andy offers his own flavor of March madness with this story, in which an enterprising urology group is offering a free pizza with each vasectomy performed in March. The practice says March is their busiest time as men figure they might as well recover on the couch while watching basketball games on TV. WNA finds the last line of the story, which describes the free pizza, disturbing: “It does actually come with one topping. Maybe you can put some meatballs on it.” He also adds his own joke: what did the urologist’s wife sing to her husband when he finished his residency? “Urine the money, urine the money, we’ll have a lot of what it takes to get along.” </rimshot>

Here’s Vince’s HIS-tory of CliniCom (Part 3.) Check out the resemblance of the 1980s-era CliniCare handheld nurse terminal to the iPad.

I remembered Friday at work to print off the Archives of Internal Medicine article that has generated all the simplistic rag headlines that meet their goal of being stupid-simple and sexy at the expense of accuracy in summarizing the original study (example: iPads: Increasing Doctor Efficiency, Decreasing Patient Wait Time). The actual University of Chicago study wasn’t nearly that conclusive. The university gave iPads to 115 internal medicine residents and taught them to use Epic on it, along with online publications and the internal paging system. Four months later, the residents were surveyed. Results: 90% were using the iPads for work (it’s interesting that 10% weren’t) and 75% of those were using them daily (meaning 38% of those given an iPad weren’t.) Three-quarters of those said they thought they were more efficient and 68% of them said they thought patient care delays had been avoided because of the iPad. Residents entered a few more (5%) orders before 7 a.m. rounds and within the first two hours of admission. Study weaknesses:

• A sample size of 115 residents in one academic hospital isn’t all that predictive and doesn’t cover other specialties.
• Residents work a lot differently than attending physicians and community-based docs.
• Asking residents if they thought their free iPads were useful may have encouraged them to inflate the results to avoid having to return the iPads.
• The difference in order timing was tiny and compared 2010 patterns with those of 2011, a time during which other factors surely changed.
• The team had no way to determine which orders were entered from the iPad vs. from a desktop or laptop, so there’s no proof that the “earlier” orders came from iPads at all. It was also not stated whether Epic was available on wireless devices in 2010.
• It was not stated which devices were in use in 2010 – wireless laptops or hard-wired desktops. If residents didn’t have their own individual wireless laptops in 2010, you would expect orders to be entered more quickly (no waiting for a device) and closer to post-call rounds (the device would be at hand in the conference room).
• Placing orders early doesn’t necessarily translate to better outcomes or increased patient satisfaction, although it’s still a good thing overall.
• Epic has a native iPad client that most systems don’t offer, so experience with a less-functional clinical systems client would likely be less positive.
• Still, all that aside, if you can make residents think they’re more effective (not to mention cooler) for just $500 and you even potentially avoid the cost of buying them their own laptops, why wouldn’t you?

Mission Health (NC) names Sulaiman H. Sulaiman, formerly CIO of Cleveland Clinic’s hospital in Abu Dhabi, as SVP/CIO, replacing the retiring Arlo Jennings.

Athenahealth will hire 80 people to work at its Belfast, ME office, raising its headcount by 20%.

An article in The Atlantic says innovators develop products for people who are like themselves, which is why mHealth apps influence only the already-good health of what it calls “The Social Network” (well-educated, technically savvy, and affluent whites and Asians living on both coasts) while having minimal influence on the behaviors of the more diverse and more healthcare-expensive population as a whole. As Dr. Travis has said on HIStalk Mobile, running apps are a lot more popular with runners than couch potatoes. Or as Bill Gates says, we already have healthcare technology that tells people that they need to change their habits, but unhealthy people just ignore what it’s telling them (bathroom scales.)

E-mail Mr. H.

Time Capsule: US Healthcare Value is Low – Follow the Fancy Buildings

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 March 2007.

US Healthcare Value is Low – Follow the Fancy Buildings
By Mr. HISTalk

Cerner CEO Neal Patterson made a characteristically blunt comment to a newspaper reporter at the HIMSS conference. Referring to what he quoted as the 31% of healthcare costs wasted on administrative functions, he said, “One of our goals is to eliminate insurance companies as they exist today.”

Many of us in healthcare would agree. It makes me boiling mad to drive by the palatial offices of Blue Cross Blue Shield and other companies like them. God forbid that a living, breathing patient or provider should cross their doorstep. I bet they’d call security.

On the other hand, I seem to recall that Cerner has some pretty nice digs out there in Kansas City. Neal’s sitting on about $300 million worth of Cerner stock, all of it due to the free spending of hospitals buying his product. Maybe insurance companies should state a goal of eliminating computer vendors who get rich by trading paper-pushing for mouse-clicking with little patient benefit.

Like they say about banks, casinos, and car dealers, “They didn’t build those big buildings by giving their customers good deals.”

I can’t blame insurance companies or Cerner for taking advantage of the messed-up healthcare system we’ve all allowed to be created. And in their defense, BCBS is no less hilariously “not for profit” as those big medical centers with hundreds of millions in bottom-line “excess revenue” and their own version of the $3 million a year executive. They usually have Taj Mahospitals themselves.

I’m not smart enough to figure out who the good guys and bad guys are in healthcare, so I look at just one thing: buildings. When I see stunning hospitals, vendor headquarters, insurance offices, and doctors’ houses, I figure they’re doing a little better than I’d like. Make a nice income, but don’t flaunt it.

There’s little question that we’re getting a poor return on our healthcare investment. We spend head and shoulders above the entire rest of the world on healthcare, which continues to chew up more and more of our gross domestic product, yet we have life expectancy and infant mortality that rival that of third-world countries. The costs keep climbing faster and faster.

It seems to me that hospitals, insurance companies, and IT vendors have a symbiotic relationship. You wouldn’t be selling many $8 aspirin if people had to pay up out of their own pockets. And without those, your hospital wouldn’t be buying expensive IT systems to spit out bills and document care. Everybody needs big profits to pay for those buildings.

There’s plenty of blame to go around for our poor bargain healthcare system. About all we IT types can do is to apply technology to process change. Not just buying Neal’s systems, in other words, but actually doing something useful and measurable with them to increase quality and decrease cost.

If we do that, then maybe all of those big buildings – owned by hospitals, insurance companies, and IT vendors – will become a little less opulent.

News 3/16/12

Top News

CMS pushes back the enforcement date for HIPAA 5010 transactions another three months, to June 30, 2012.

Reader Comments

From HIT Observer: “Re: City of Hope (CA). Looking to acquire some in-house talent. I believe it’s an Allscripts shop.”

From Cowabunga: “Re: UCLA. Was scheduled to go live with Epic patient accounting and registration at its hospitals and 150 clinics on July 1. Pushed the date back to March 2013 this week.” Unverified. You wonder if hospitals didn’t overcommit trying to hit Meaningful Use dates and are just beginning to realize the extent of the work required.

HIStalk Announcements and Requests

Inga is still off on a sojourn of some kind, so it’s just me (Mr. H) at the keyboard (Logitech, not Wurlitzer.)

Listening: new from Ceremony, NorCal punk rockers (think Pixies or Bad Religion.)

Welcome to new HIStalk Gold Sponsor Informatica. The global data integration company’s healthcare provider products include enterprise analytics data management, EMR data migration and archiving, the Informatica Integration Engine, and HIPAA 5010 Crosswalk. A few weeks back, I interviewed Chief Healthcare Strategist Richard Cramer, who has heavy provider-side IT experience from UMass and Penn. It was a good interview – I learned from it. Resources on the company’s site include “chalk talks” on data governance and a master data foundation solution for healthcare, a Webinar on why interface engines are obsolete, and improving care through data quality improvement. Thanks to Informatica for supporting HIStalk.

Acquisitions, Funding, Business, and Stock

Mediware will acquire the Cyto Management System chemotherapy management solution from Cobbler ICT Services BV in a $2.2 million transaction. The product, deployed only in Holland and Belgium, is used by hospitals and cancer centers to manage oncology protocols and costs, including drug preparation and administration. Mediware will continue to market the product under existing agreements and will roll it out in the UK and Ireland to complement its medication management product.

Voicebrook and Nuance announce an agreement to work together to develop speech-enabled reporting solutions for anatomic pathology laboratories. Voicebrook will integrate its VoiceOver pathology software with Dragon Medical 360.

I don’t follow stock pickers since most of their wisdom seems retrospective, but if you have a higher annoyance threshold than I do for Mad Money’s Jim Cramer, maybe you care that he’s tired of pitching Allscripts and now throws his questionable prognostication skills behind Cerner. “I’m going to eat some crow, admit the error, and tell you it’s time to put Allscripts in the sell block. If you want a healthcare IT play, the stock to own is Cerner, although I suggest you keep your powder dry on this one because it’s been red-hot and we could get a pullback.” The self-proclaimed expert claims that Allscripts has had problems integrating its “Aclipsys” platform, has a “large number of different versions of its software on the market,” and doesn’t manage expectations well.

Here’s the one-year share price comparison between Cerner (blue) and Allscripts (red). Thanks a lot, Jim – do you like the Giants or the Patriots in Super Bowl XLVI?

Reuters profiles Toronto-based NexJ Systems, which is using its IPO funding to expand its software business into healthcare with its interoperability solutions, portals, and population health management tools.

People

Kevin Fickenscher MD, formerly with CREO Strategic Solutions and Dell Healthcare, is named as president and CEO of AMIA. He replaces Ted Shortliffe MD PhD, who announced plans to step down last year.

Cleveland Clinic CIO Martin Harris MD, MBA is elected to the board of Thermo Fisher Scientific.

Intelligent InSites appoints Major General Terry L. Scherling (Ret.) to its board. She is president and CEO of global security planning solutions vendor TENICA and Associates LLC of Alexandria, VA.

Forbes profiles Grant Verstandig, the 22-year-old college dropout who formed Audax Health (social networking meets insurance benefits) and raised $16.5 million in funding from some heavy hitting backers in less than a year.

Revenue cycle and EHR services vendor Zeus Healthcare names Larry Havelis as CEO. He was previously with Quest Diagnostics and Allscripts.

Announcements and Implementations

Investor’s Business Daily writes up HealthStream-powered medical simulation mannequins and covers the company’s SaaS medical learning center, which has 2.75 million subscribers.

GE Healthcare and Intel open a laboratory in Israel to test new technologies.

Intelligent Medical Objects opens an office in Research Park on the campus of the University of Illinois.

Government and Politics

A security researcher says 84% of government web applications don’t meet security standards. One reason: instead of getting embarrassed or fired for writing bad code, government contractors get to bill extra for change orders to fix the mess they created.

New York eHealth Collaborative held a meeting Thursday to address health IT issues in the state’s Medicaid medical home initiative. A Department of Health official stated that current IT tools can’t bridge the care gaps in the managed care environment, and new applications are needed that can operate on the Statewide Health Information Network of New York.

Innovation and Research

Researchers use patient databases from drug trials and from the electronic medical records system of Stanford University Hospital to identify hundreds of previously undocumented drug-drug interactions and side effects. They developed algorithms to match similar patients to eliminate false alarms caused by gender, age, and disease status. The lead author plans to present the results to FDA as a possible way to improve drug surveillance programs.

Johns Hopkins University has 49 studies of mHealth applications underway as part of its Global mHealth Initiative. Director Alain Labrique says health-related apps should carry a disclaimer since most of them have not been validated through research. The GmI’s mission is to provide evidence-based support to technologies that have the best chance of improving global health in resource-limited settings.

Other

EHRtv posts interview videos from the HIMSS conference.

A Miami passenger cruise industry conference runs its first medical pavilion, covering medical technologies such as satellite-based telemedicine available anywhere in the world, electronic medical records for crew members and passengers, and outbreak detection and public health reporting associated with infectious disease such as norovirus.

Medical College of Georgia Hospital and Clinics announces that an unencrypted laptop stolen in a burglary earlier this year contained the medical information of 513 sickle cell patients.

 Sponsor Updates

• Speakers from Lehigh Valley Health Network will keynote TeleTracking Technologies’ free two-day symposium in New Orleans April 19-20.
• NextGen will host an April 2 webinar featuring Sherry Shults RN, BSN, CIO of South Carolina Heart Center on attestation for MU.
• Kony Solutions and Gartner offer a webinar on best practice guidelines for mobile app development.
• HealthStream offers reasons on why healthcare organizations should continue with their ICD-10 training and preparation despite implementation delays.
• API Healthcare experiences growth due to increased use of its workforce technology by healthcare staffing agencies.
• Certify will participate in IHI’s 13th Annual International Summit in DC next week.
• dbMotion and Allscripts will host an April webinar entitled “Innovative Workflow Leadership” with Rebecca Armato (Huntington Memorial Hospital), Yafa Minazad DO (Southern California Neurology Consultants), and Joel Diamond MD.
• Vocera launches its discharge solution, Patient Connect, at the AONE 45th Annual Meeting in Boston March 22-23.

EPtalk by Dr. Jayne

Healthcare IT News has opened its 2012 “Where to Work: Best Hospital IT Departments” nomination process. Categories are small (under 100 beds), medium (101-150 beds), or large (over 350 beds). If you think your shop is top, this is the time to make it known.

For another opportunity to toot your own horn, HIMSS (along with the American Society for Quality, the National Committee for Quality Assurance, and the National Patient Safety Foundation – that’s ASQ, NCQA, and NPSF for those of you playing along with the acronym soup game) announces a new call for the “Stories of Success!” program. (Yes, the exclamation point is included! Not sure why! But it is!) The blurb says:

This program showcases outstanding accomplishments in the adoption and use of health IT to fulfill national priorities recommended by the National Priorities Partnership (NPP) and The Joint Commission’s National Patient Safety Goals (NPSG). We are looking for real-world, case studies!

More acronyms and exclamation points abound, so be sure to submit your SQUIRE-inspired application form today. (I’m going to go make you look that one up yourself.)

I finally received the “HIMSS12 Overall Evaluation” e-mail today after hearing people talking about it last week. After two pages of the survey I was just aggravated and couldn’t bring myself to continue. I’m annoyed by HIMSS in general right now. The fact that some New Orleans hotels are already booking up is a mess waiting to happen. I may boycott next year and just show up for HIStalkapalooza, hot shoes, beignets, etouffee, and jazz.

NCQA keeps sending me invites to their Health Quality Awards dinner at the end of the month in Washington, DC. One of the honorees is Atul Gawande MD, who inspired me to get back into writing. Individual tickets are $350 a pop though, so I’ll pass.

I just received notice of which PQRS measure my staffing company has selected for me for 2012. Thank goodness they’re super-easy things that we do all the time anyway, so I don’t have to think about them. Just jumping through yet another hoop.

I was intrigued by the item that Inga ran the other day about the allergist who closed his practice to join the Army. Based on the statement that he was coming in as a lieutenant colonel, I assumed that he had previous military experience or was a reservist. After reading the full article though, it seems he has no military background. Anyone want to shed some light on how that works?

I did get one response to my call for medical tattoos – this one of a caduceus with an N for nursing. I like the blue, but not the delightful surrounding inflammation. Medical history tidbit of the day:  the caduceus with its dual snakes and wings was historically the symbol of commerce. Kind of funny that it’s been adopted as the symbol of medicine (especially in America) as opposed to the rod of Aesculapius, which is the original symbol of medicine (single snake, no wings.)

One of my faculty pals is a purist about this, so here’s your historical factoid of the day. In Greek mythology, the god Aesculapius was a healer, and apparently Hippocrates worshipped him. One potential theory of how the symbol originated was that it is a depiction of the stick used to remove guinea worms from the body. (note: picture in link is not for the squeamish.)

Have a question about acronyms, tropical medicine, or what is the maximum number of exclamation points that should be used in a single post? E-mail me!

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Dr. Sam 3/14/12

Mandating Physician EHR-Related Policies

It seems apparent that the problem of physician adoption of electronic health record (EHR) technologies, with which the industry has struggled for more than a decade, is finally lessening as digital technology continues its relentless infiltration into our everyday lives, and as the percentage of hospitals implementing EHR systems increases -spurred on by Meaningful Use financial incentives. Nonetheless, hospitals are still faced with residual challenges, including the creation of policies pertaining to their EHRs.

Creating policy is one thing. Medical staff compliance is something else.

So what does a hospital do when a physician or group of physicians refuses to use their EHR, attend training sessions, or comply with specific EHR-related policies?

If you have read any of my past commentaries, you must know that I am a history buff and enjoy intertwining historical episodes where they seem to apply to challenges of today.

In the case of mandating, President John Tyler comes to mind — mainly because he mandated that he would become president when it was not clear that he had the constitutional right to do so. I guess the analogy lies in creating a position of power and acting on it in a consistent fashion to establish precedent – or in his case, president.

John Tyler was William Henry Harrison’s vice president and was facing in a precarious position when Harrison died just one month into his term in 1841. There had never before been a presidential death in office and the Constitution was not of much help as to what should happen next. The wording within the Constitution is ambiguous, for it reads that, “in case of the removal of the President from office, or of his death, resignation, or inability to discharge the powers and duties of the said office, the same shall devolve on the Vice President.”

This could be interpreted to mean that the vice president’s powers remain ”the same” or that the vice president shall assume “the same” powers as the president had – in which case Tyler would become president.

Tyler was not a very popular man. After Harrison’s death, he was addressed as the “Vice President Acting as President” by his political opponents. He, however, referred to himself as President Tyler, and refused to open any mail addressed to “Acting President Tyler”.

At his first cabinet meeting, cabinet members insisted that he obtain their consensus before he acted. He informed them that he was the President, and if they didn’t like it, they could resign. Shortly thereafter, after a particularly unpopular veto by Tyler, all but two of them did exactly that. Through a long succession of political maneuvers — including virtually daring opponents to try to impeach him — he firmly established his hold on the presidential office, serving from 1841 to 1845.

Because of Tyler’s actions, the ascension to the presidency by the vice president in case of death or incapacitation of the president became standard procedure. There was still no requirement of a disabled president to hand over the reigns of government. This did not become law until the passage of the 25th Amendment to the Constitution in 1967 following the death of President John Kennedy.

Tyler just made it happen.

In the absence of likelihood that a constitutional amendment will come to the rescue of hospitals seeking to establish mandates related to their EHRs, what steps can be taken to stimulate physician recognition of hospital authority?

Step one is consistency in establishing policies – and all policies should be expressed with the entire C-level team on the same wavelength leaving no room for divide and conquer.

Realistically, it should first be accepted that most clinicians have little interest in hospital finances and are much more concerned with their own workflow issues, which are often appropriately viewed in their minds as intimately and directly related to patient safety. Herein lies the big ace up the collective sleeve of the medical staff – and the basis upon which many a shutdown has occurred or been threatened.

It’s difficult to keep an EHR up and running when the medical staff claims that it is impeding their ability to assure the safety of their patients. A medical staff will usually live with workflow impediments, although rarely silently, since most are accepting of the probability that features and functions of the system that are slowing them down can eventually be resolved through a vendor enhancement request process. But they will not live with what they view as imposed workflows that impact their ability to provide safe care — or more importantly, what they view to be safe care.

Therefore, one very important policy procedure to have in place is an effective enhancement request process. Clinicians must know that their suggestions for improvements in the EHR they are using are being heard, responded to, documented, and included in enhancement requests submitted to the vendor on a regularly scheduled basis.

The importance of policy and structure to the enhancement request policy cannot be sufficiently stressed. Nothing creates havoc more efficiently than a cacophony of complaints and suggestions from a large number of doctors directed in a steady stream at a varying number of administrative hospital executives during a complicated implementation process. This may even be further complicated by physicians who communicate directly with vendor sales representatives or even vendor executives to deliver their complaints and suggestions or demands.

The solution to this particular issue lies in an effective governance structure that establishes a clear path by which enhancement requests are evaluated by clinical peers and submitted for approval by a steering committee which is solely responsible for communicating with the vendor. Policy is spelled out to the clinicians and included with the terms to be signed by the clinician at the time they are certified for use of the EHR upon completion of required training.

Such a policy brings clarity and an understanding that a path exists to assure attention to physician issues. It reduces the risk of widespread simmering dissatisfaction, which can be toxic to any implementation process.

Educating the medical staff about Meaningful Use requirements that impact the hospital’s ability to meet these criteria is also very helpful. This understanding should reduce complaints about steps that were previously not part of their workflow, such as using history and physical examination formats that allow for the capture of specific data points, or having to include a diagnostic indicator with a study requisition if such indicators are not automatically included by the EHR in use.

But what to do when policies are not adhered to? This is the stuff that causes sleepless nights for many a C-level hospital executive.

Don’t pull a John Tyler yet!

"Mandating" policy has challenges specific to the institution’s business structure. It is much easier for a hospital that employs all of its medical staff or an academic institution to create policies which must be adhered to as a requirement for continued employment, than it is for a community-based hospital with a volunteer medical staff over which they have less control. Many hospitals have a combination of arrangements with employed physicians or groups (hospitalists, radiologists, pathologists, emergency doctors) and a volunteer staff.

Even mandating policy to employed physicians can be very difficult. It’s easy to write a policy that requires an employed doctor to follow certain procedures, but firing someone is a huge step that brands that person’s professional reputation for a lifetime. Legal consequences may ensue, and the human resources department had better have all of their ducks in line before any such move. Additionally, rural and remote hospitals may be faced with finding replacement services, which might be challenging.

The first place to start is with the hospital bylaws. Careful legal review and appropriate verbiage should be included to place the hospital on solid ground for the imposition of policy mandates and consequences of failure to comply. Included in this process is a clear outlining of credentials of individuals who fall under the category of "providers" of care using an EHR. By including these specifications in the hospital bylaws, individual policies can be created with simple reference to the bylaws without spelling out the affected caregivers impacted by each policy.

Begin the mandating process with something palatable, understandable, and reasonable to the medical staff. For example, an initial mandate that 50% of all orders must be by computerized order entry is a heavy hand applied at the onset to a staff not accustomed to being dictated to. A reaction may reasonably be expected.

However, a mandate that passwords may not be shared under any circumstances is entirely reasonable and understandable. It is a good starting point and establishes an understanding that the hospital is prepared to take a firm stance with future rules to follow. Consequences of failure to comply should be clear and uniformly followed through on without exception. For example: share your password once and you’ll receive a warning letter. Share it twice and you’re off staff.

Such a mandate is reasonable and even expected under the same arguments applied to an EHR that clinicians find cumbersome — possible patient safety and medical legal consequences.

Some creativity may be required if a hospital does not wish to impact the career of an employed, noncompliant physician who refuses to follow required procedures such as attending training sessions or using CPOE. Failure to comply could mean loss of remote access to the EHR as a consequence. Remote access can be reinstated when the physician is trained, credentialed, or has entered a predetermined percentage of orders by CPOE over a designated period of time.

Another creative approach is to deny a noncompliant employed physician from taking emergency call. One might expect such a "penalty" to be received with glee, but the physician’s department head may not be too happy with rearranging a call schedule, or worse yet, having to take call personally to cover the ”penalized” physician. It’s more than likely that the noncompliant doctor will soon receive a dictate from above.

I am always surprised by how rarely community hospitals take advantage if their most reliable ally – the community that they serve. When a community is educated about CPOE, for instance, CPOE becomes an expectation and patients may begin to select physicians who are using technology that reduces the risk of errors.

Just as John Tyler lined up his ducks in finding support to bolster his position, the community being served may become a powerful ally. One creative approach to physician compliance in a community hospital setting is to simply periodically publish a list of physicians in the community who are helping the hospital assure patient safety by using the hospital EHR. A sample heading might read: "XYZ Hospital System is pleased to acknowledge and thank the following physicians who have displayed their dedication to the safety of our patients and high quality of care to which we are dedicated by using our state-of-art electronic health record system"

Not too many community physicians will want to be missing from that list.

There may be similar value obtained by issuing an appropriately worded certificate of EHR credentialing or thanks to a community physician to hang in his waiting room. The doctor’s patients may feel added security with their doctor, and the doctor will have another set of credentials in place if he or she ever decides to explore a second career in medical informatics — in which case they can be the ones dealing with non-compliance, mandates, and creative approaches to their refractory colleagues.

Lest this commentary appears to be one-sided, I should add that I fully understand the frustrations of my physician colleagues who are themselves beleaguered by falling reimbursements, ever-increasing regulation, and medical-legal vulnerability. Frustrations abound for all parties involved.

This is where I enjoy bringing up my favorite metaphor, a lesson that I learned during my years of travel with professional musicians.

Any professional band realizes that the goal is not for the “killer” guitar player to get out front and blast away in order to leave the crowd in awe so that they leave thinking, “What a great guitar player!” Real professionals know that the goal is to make everyone else in the band look good so the crowd leaves thinking, “What a great band!”

We’re all struggling with the sheet music we have been handed. The trick will be to make great music together.

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

HIStalk Interviews Brian Phelps, CEO, Montrue Technologies

Brian Phelps MD is co-founder and CEO of Montrue Technologies of Ashland, Oregon. The company’s Sparrow EDIS for the iPad was the grand prize winner in the 2012 Mobile Clinician Voice Challenge, presented by Nuance Healthcare.

You’re an ED doc. Why did you develop Sparrow EDIS?

I’ve been in practice for 10 years. I’ve had the good luck — or bad luck, depending on your point of view — of being involved in a few software implementations. One of them failed spectacularly. I felt like I learned quite a bit about the good and bad of software in the ED. I thought about the culture of the companies that are offering software and how to make the culture better suited coming into that environment.

When the iPad came out, it was pretty obvious that that was the future for us. I assembled the team and here we are.

Is the iPad application just for presentation using other systems or is it a completely separate application?

It’s a native iOS application that communicates with the Sparrow Server that then integrates with the underlying EMR. It’s an abstraction on top of the underlying EMR, but as far as the user experience is concerned, they’re in a purely Apple environment.

Describe the product and how they’re using it.

The Sparrow Emergency Department Information System includes patient tracking, order entry, physician and nurse documentation at the bedside, discharge planning, and prescribing. They’re doing all that on the iPad at the bedside. You don’t have to interact with the PC workstations any more with our system.

Does everybody use it? Is using it mandatory?

We’re the whole product, so we come in with the devices as with the software. We’re in pilot phase now so there’s some details to be worked out, but the idea is that that we provide the whole solution, including white coats that have pockets big enough to hold it and the stylus if you want it. Doctors and nurses and registration all are using the devices. 

At HIMSS, I learned a lot and met a lot of great people. One of the themes that kept coming back was getting doctors on mobile devices and the “bring your own device” mentality, which I think is a symptom of a disease and not a cure. The disease is that consumer technology has so rapidly outpaced enterprise technology that it’s making end users crazy. They’re coming in with these personal devices and they’re demanding to connect. They’re using Citrix and whatever else they can and it’s not providing a very good user experience. 

Nobody ever asked me to bring my Dell on wheels to the hospital. Ideally the hospitals will recognize that the users have spoken and these are the tools that they think are right for the job. That’s where we come in and deliver the right tools and the right software, all locked down in a secure environment.

How do you determine the success of the product if users can still use the underlying systems directly?

They can use the underlying systems to review records and place orders in the hospital information system, but we have order sets and a workload that is specific to emergency medicine. There are no longer paper charts when we come in. If they want to use the order sets that they have created, they would be using the iPad.

What tools did it require to create the iPad application?

It’s a lot. We have a server that runs SQLite. All of the devices run our application, which is in Objective-C for iOS. Our server and our iPads come in. There’s an interface that’s required to exchange data in HL7 with the inline EMR.

We have a strategic relationship with Nuance and they’ve really helped build out our product. Their SDK was very easy to use — it literally it took a few hours to get up and running. We have a relationship with LexiComp to do medication interaction checking and allergy checking on the devices and several other strategic business relationships that flesh out the product.

So it was easy to integrate speech recognition using the Nuance tools?

It was great how astonishingly easy that was. We had planned on speech integration from the very beginning. For all their wonderful qualities of iPads, the input mechanism for narrative is one of its minor weaknesses. We always knew speech was going to come into play. In fact, we built our application around it before we even knew that it was going to be technically possible. 

We had our eye on Nuance. When they released the mobile SDK, we snapped it up. The next day, we literally had a fully speech-enabled application.

Describe how the application uses speech recognition.

The thing about speech and documentation in medicine in general is that it allows you to capture the narrative. The patient’s story is really the heart of the patient-doctor relationship. There is no way that can ever accurately be captured by pointing and clicking. I can give you several examples of where template-driven documentation of the patient’s story led to harm. 

Building in speech recognition for the history of present illness and medical decision-making is really important. But we have to balance that with structured data to meet compliance and other measures, and also because there are some areas where structured data is perfectly appropriate. Medication reconciliation, for example, or even in our case we have templates for building physical exams and reviews of systems. 

Finding that balance between the unstructured narrative and the structured data input is what the iPad is ideal for, because as you’re sitting there with a patient, you basically can tap along and review their history and enter the important information. Then as you’re going to the next patient, you can speak in the parts of the encounter that are unique to that patient, namely their story.

What advantages does the user get from using an iPad application?

The biggest advantage is using the Apple navigation paradigm. We’ve been in a design relationship with Apple for about half a year. They’ve been advising us and getting it to be simpler and faster and more intuitive. The fact that it runs natively on the device means that it is incredibly fast and easy to use. Anyone who has used an iPhone or an iPad and used any of the native Apple applications knows immediately how to use our system.

It’s hard to overstate the importance of having something that sits in your lap while you’re engaging the patient. We’ve been speaking and poking at things for a million years as humans. We’ve only been pointing and clicking for 20. When patients are scared or in pain or feeling vulnerable, it’s almost cruel to turn away from them to click away on a QWERTY keyboard.

One of the themes that kept coming back at HIMSS was patient engagement. It means different things to different people, but in my line of work, I’m trying to engage the patient who’s sitting in front of me. I don’t think that you can engage patients with technology or with the latest application. You engage them by looking them in the eye and asking good questions and listening carefully and showing compassion.

Technology has only interfered with that process. The advantage of our system is that we get out of the way and allow doctors and nurses to interact with their patients in a way that they know how to do.

During your pilot phase, what are you measuring and what kind of response are you getting back?

We’re integrating the back end and we’re not live with patient data yet, so that’s coming up. When that happens, we’ll be measuring productivity, patient and physician and nursing satisfaction, and of course compliance with Meaningful Use.

Did you form the company just for this product or you have other products?

We formed the company with the goal of bringing mobile technology to emergency medicine. We had thought about strategy of having different sub-modules, but when it comes down to it, if you’re going to be successful in emergency medicine, you have to completely replace the three-ring binder. We spent two years building out every aspect of what had been a paper interface into our system. We are currently a one-product company and that’s our emergency department information system.

You said you designed the product around speech recognition even though it wasn’t available at the time. Do you think somebody could develop a comparable product without using it?

I think it could be done, but I think that the narrative input mechanism would be challenging. One possibility would be to have Bluetooth keyboards in each room and you pop the iPad in and type away your narrative, but I don’t see that it would be as effective. The combination of tappable templates plus speech for narrative on the iPad is really a match made in heaven.

At HIMSS there were companies at different stages of doing work on the iPad. What was your general feeling about where the industry is right now with the use of iPads? Did you expose your product to anyone to get a reaction?

We had an opportunity to present at the Venture Forum as well as on stage at the Nuance booth. We got lot of great feedback.

I think it’s very exciting what Epic is doing with their iPad interface. PatientKeeper has an excellent product. Nobody is doing exactly what we’re doing. We’re pretty thrilled that these other companies are demonstrating that there is a large, important market here. Beyond that, we take all that energy we might be thinking about competition and try to drive it back into our product and make it better.

Were you surprised that you were named the winner?

[laughs] I thought there was a pretty good chance we had a shot.

How will you use your prizes?

The best thing that came out of this was a deeper relationship with Nuance, who has been wonderful and supportive throughout. Just the recognition that that has brought to us has been phenomenal.

Assuming your pilot is successful, where do you go from there?

We’re making the product back end-agnostic, so any hospital that has an EMR that is struggling with workflow in their emergency department is a potential customer. There are at least 3,500 hospitals that meet that description. We’re pretty confident that as this wave of mobile devices washes into the mainstream, there will be a significant demand. The next step for us is to continue to make the product simpler and faster and more intuitive and then to connect with paying customers.

Typically that’s hard for a small company because it’s difficult to mount up a sales force. Do you see yourself selling directly into individual hospital emergency departments or partnering up with a specific vendor to make it an add-on?

We have been working on some channel partners. One strategy for us has been to look at the relationships we have with interface vendors to assuage the interoperability concern. We are pretty excited about the relationship that we built with Apple and we see a lot of ways that they — as part of their ambition to enter the enterprise space — could really be helpful for us getting in the mainstream market.

So far, our feedback from doctors and nurses has been fantastic. We’re pretty confident that we can leverage that groundswell of enthusiasm from end users to develop a relationship with their executives. To them, we will be focusing on our profound return on investment, which comes through improved charge capture.

I’m glad you mentioned that since I assumed the pitch would strictly be clinician satisfaction.

When software deployments fail, that’s the majority of the time due to physician rejection. Clinical informatics people really do have an incentive to make sure they’re finding a product their clinicians like to use. That’s one part of it.

The other part is that we capture charges just through the process of simple tap documentation. One of the commonly missed charges is IV start and stop times. Our system triggers the appropriate documentation, which we think will improve charges by about $40 per patient. There’s a thoroughly profound return on investment for executives as well.

The big challenge is that the gatekeepers tend to be the folks who have the least direct benefits from the application. Our goal now is to try as best as we can to understand what their needs are and meet those needs while still delivering a very usable product for these doctors and nurses.

Do you have any final thoughts?

This may resonate with you and what you’ve done with HIStalk, which has been phenomenal for me to learn about the industry over the last couple of years. When you really believe in something strongly as we do and you‘re willing to work at it, if you’re on the right track, doors start to open and more opportunities present themselves. That’s where we’re at with Montrue. We’re pretty happy that we’re on the right track and we’re excited about what’s to come.

News 3/14/12

Top News

Blue Cross Blue Shield of Tennessee will pay $1.5 million to settle potential HIPAA violations, a result of the first enforcement action triggered by HITECH-mandated breach reporting. Fifty-seven unencrypted hard drives containing the PHI of over 1 million people were stolen from a BCBST-leased building that did not have access controls.

Reader Comments

From HIT Cynic: “Re: EMRs and test ordering. Finally someone says what lots of us out here are thinking.” The authors of the Health Affairs article respond to criticism of their study by Farzad Mostashari in an ONC blog post titled Recent Study: Get the Facts and a sub-headline of “Don’t Believe the Hype.” The original article suggested that EMR usage is associated with higher ordering rates of imaging tests, concluding that expected EMR-driven diagnostic savings may never materialize.

Mostashari said (a) any HITECH-related conclusions from an observational study using 2008 data are worthless, especially since it did not consider clinical decision support and information exchange; (b) EMR users didn’t order more tests, but high-volume imaging prescribers  are more likely to view those images using an EMR; (c) the study didn’t look at appropriateness of ordering, so comparing the number of imaging orders omits important factors such as practice demographics and whether the high-volume physicians have a financial stake in the imaging centers they use; and (d) EMR cost savings aren’t dependent on reducing test volume.

The authors respond: (a) physicians who viewed images electronically ordered 40-70% more of them; (b) the famous RAND study that Cerner helped pay for said billions would be saved by reducing imaging and lab test volumes; (c) even though the study data were from 2008, the same EMR vendors are selling pretty much the same products; (d) Mostashari’s explanation that high-volume prescribers probably bought electronic systems specifically to view the results was tested and rejected in their analysis; (e) the study did take into account patient demographics, severity of illness, and other factors; and (f) while observational studies can’t prove causation vs. correlation, ONC has used cherry-picked studies of similarly dubious methodology to cheerlead EMR success and plenty of other studies have found no IT-related quality improvements. The authors conclude:

Dr. Mostashari is also correct in reiterating that randomized trials are the best way to assess health IT. In fact, no randomized trial has ever been published that examines patients’ outcomes or costs associated with off-the-shelf health IT systems that dominate the U.S. market. No drug or new medical device could pass FDA review based on such thin evidence as we have on health IT. Yet his agency is disbursing $19 billion in federal funds to stimulate the adoption of this inadequately evaluated technology. Dr. Mostashari is perhaps the only person in our nation who commands the resources needed to mount a well done randomized controlled trial to fairly assess the impact of health IT, and the comparative efficacy of the various EHR options. Finally, Dr. Mostashari’s unbridled faith in technology is mirrored by his belief that ACOs are the next panacea for health costs and quality. That health policy flavor-of-the-month also remains wholly unproven.

I’m going to score this as a win for Mostashari even though the lady doth protest too much, methinks. The study was only marginally interesting and I would have serious reservations about drawing any conclusions whatsoever from it (particularly in comparing electronic image viewing to the use of full-blown EMRs,) but the authors seem to want to elevate it to a government policy argument, and now are launching a second front on ACOs for no apparent reason. Lazy journalists wrote their usual hysterical headlines with obviously limited understanding of anything in the article, which got Mostashari fired up to launch an unnecessary counterstrike in a war that he not only can’t win, but shouldn’t be fighting in the first place since it just gives the article more exposure.

My conclusion: don’t believe either side. Nobody knows if having previous images available would reduce new orders for them, especially if doctors receive benefit from unnecessary tests. Even if the conclusions of both sides are data driven, unbiased, and definitive (which I’d say is highly doubtful in both cases) they are also irrelevant. Taxpayers are already paying for EMRs and we won’t know for years whether we’ll get our money’s worth in the form of lower healthcare costs. My crystal ball says we won’t unless they’re used to prod patients to change their health risk behaviors, like convincing the 75% of the population that’s overweight to eat better and exercise more.

HIStalk Announcements and Requests

Inga is taking a semi-break, so it’s just me (Mr. H) this time around, other than for a few items she sent over. I’ll dispense with the red/blue icons for today.

Acquisitions, Funding, Business, and Stock

Jiff Inc., a developer of a HIPAA-compliant private healthcare social network and digital health apps platform, completes a $7.5 million Series A financing round led by Aeris Capital. The company also named Derek Newell (Robert Bosch Healthcare) as CEO.

Vocera expects to price its 5 million IPO shares at $12 to $14, using the proceeds to pay down debt and potentially to make acquisitions.

Greenway Medical Technologies announces its first quarterly results as a publicly traded company: revenue up 30% to $29 million, EPS –$0.01. Shares closed Tuesday at $13.75, up from February’s IPO price of $10 but down from their high of just over $15.00 on March 1.

Milwaukee-based point-of-care technology consulting company True Process Inc. acquires the PDA-based VeriScan bedside medication verification system from Hospira. Does anybody even make PDAs these days, and if so, who’s buying them?

Sales

Geisinger Health Plan chooses NaviNet’s Insurer Connect solution to give providers online access to patient benefit information.

Tyrone Hospital (PA) selects Promantra’s RCM system for billing and claims management.

St. Jude Medical Center (CA) chooses PerfectServe’s clinical communications platform.

People

MedAssets appoints Michael P. Nolte (GE Healthcare) as EVP and COO.

MEDecision promotes Ken Young from VP of finance to CFO.

Announcements and Implementations

The Wexner Medical Center at The Ohio State University goes live on its $102 million Epic system. The hospital appended “Wexner” to its name last month to honor $200 million donor Les Wexner, chairman and CEO of Limited Brands (Victoria’s Secret, Bath & Body Works.) He’s worth $3.2 billion, lives in $47 million house, and has a 315-foot yacht.

Health Language Inc. announces that its data mapping software and content support all terminology standards required by MU Stage 2.

NYU Langone Medical Center announces that 125,000 of its patients are using the PatientSecure palm vein scanning identification solution, launched nine months ago and integrated with Epic.

T-System offers integration with the iTriage Web and smart phone applications, allowing hospitals to list their ED wait times and patients to notify the ED that they’re coming in.

Patient teaching technology vendor Emmi Solutions announces that its products now work on Android and iOS smart phones and tablets.

SCI Solutions offers order entry and results reporting via mobile devices for its Order Facilitator product. The new service provides a national physician directory so that hospitals interested in improving their physician outreach and referral programs can integrate with physicians even if they don’t use the hospital-preferred EMR.

Government and Politics

OSEHRA, the open source community created by the VA in August 2011 to oversee VistA and VA-DoD EHR  integration projects, announces three new members of its inaugural board: James Peake MD (SVP of CGI Group, retired Army officer, and former VA secretary), John Halamka MD (CIO, Beth Israel Deaconess Medical Center), and Michael O’Neill (senior advisor of the VA’s innovation program.)

AHRQ is soliciting proposals for the validation of a workflow toolkit it developed to identify and avoid workflow-related problems with technology implementation in the ambulatory setting.

West Virginia’s Department of Health and Human Resources is forced to throw out bids for a Medicaid computer system and start over when HP’s proposal lists a subcontractor that employed the COO of the West Virginia Health Information Network. Philip Weikle says he had nothing to do with the bidder selection and has since left the consulting firm to become a full-time state employee. DHHR had already restarted the Medicaid system bidding last year for unstated reasons.

Innovation and Research

An article in Archives of Internal Medicine supposedly finds that medical residents using iPads felt the devices made them more efficient. I don’t trust the conclusions of reporters when reviewing research articles, so all I’ll say is that the article isn’t available to non-subscribers. I’ll try to remember to pull it up from my hospital PC to see what it says.

A JAMA article concludes that Ontario hospitals that spend the most under the universal healthcare system deliver the best patient outcomes. Patients at the top-spending hospitals had lower rates of death, readmission, and cardiac events and were more likely to be given evidence-based care. However, the authors note that lower-spending hospitals can’t just increase their spending to improve outcomes since the drivers seem to be the use of evidence-based medicine, better nurses, more specialists, and more technology. It may also be that the higher-spending institutions are teaching hospitals. As is always the case, correlation was modest and the unknown or unmeasured factors could be skewing the conclusions.

Other

Poudre Valley Health System (CO), which says its transition to Epic will decrease transcription needs, will outsource 37 transcription jobs to Nuance.

A company that reviews medical insurance claims shuts down, blaming the compliance cost of dealing with a medical data breach after a break-in at its headquarters. Impairment Resources LLC was required to report the breach to numerous federal and stage agencies and says that expense, plus threat of lawsuits by those whose data was exposed, forced the company to declare Chapter 7 bankruptcy. In snooping around, I found that the company’s chairman, Christopher Brigham MD, was a MUMPS programmer at Mass General in 1972.

The local newspaper covers the $750 million implementation of Epic at Providence Health Services. Richard Gibson MD, who runs informatics for Providence’s Oregon Region, says Epic will reduce costs through optimal physician ordering and analytics. He said, “If we’re going to survive and needlessly take money from roads, schools, lunch programs and world peace, let’s not go into diagnostic studies and treatments that don’t do any good.”

TEDMED 2012 will offer a free HD streaming live simulcast at regional locations such as hospitals, medical schools, government agencies, and corporations. It is also offering $2 million in scholarships to in-person attendees, expected to number 1,200 for the April 10-13 conference in Washington, DC. Registration is $4,950.

Several healthcare-related associations release two brochures on personal healthcare records, one for consumers and one for clinicians. They can be downloaded here. They probably should have had readability experts help out since the verbiage is a bit dense for mass consumption. They also mention Google Health, which of course has shuffled off this portal coil (OK, lame pun there by me.)

Here’s another of those overpromising, underdelivering headlines. TV doctor Sanjay Gupta provides his plan to eliminate medical errors, as gleaned from note-taking at weekly hospital M&M (morbidity and mortality) conferences. He’s conveniently included them in his just-released first fictional novel rather than publishing them in a peer-reviewed journal. I’d keep expectations correspondingly modest.

An Oregon jury orders Legacy Health System to pay a couple $2.9 million in their wrongful birth lawsuit. The hospital incorrectly told them their unborn daughter would not have Down syndrome. When she did, they filed suit, saying that if they had been told, they would have had an abortion.

Sponsor Updates

• United Regional Health Care System (TX) builds on its Allscripts portfolio with the selection of Allscripts Care Management.
• Robin Tardif of Hayes Management Consulting posts Part 1 of her series “Reduce Human Error in EHRs.”
• Sam Whitaker, CEO of Greenphire, and Zaher El-Assi, GM for Merge eClinical will present a webinar discussing payment and integration processes for healthcare facilities.
• Versus will participate in the AONE 45th Annual Meeting & Exposition this month.
• Billian’s HealthDATA offers a white paper, Providers’ Perceptions: Accountable Care Organizations.
• OrthoKansas selects SRS for its 12 providers.
• An Aspen Advisors white paper describes the company’s involvement in developing the Epic rollout plan for specialty clinics of University of Utah Health Care.
• Healthwise adds the concept of Patient Response to its patient education EMR module, which allows prescribers to order health education and tools and receive reports back of their degree of compliance.
• Sunquest Information Systems will participate in the 2012 Patient Safety Awareness Week after releasing Collection Manager 5.0, which focuses on POC patient safety.
• Xpress Technologies integrates with DrFirst to launch its end-to-end eRX solution.
• Intelligent InSites integrates WaveMark’s consumables asset tracking system with its RTLS.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Curbside Consult by Dr. Jayne 3/12/12

I’ve been wearing my faculty hat more than I’m used to lately. It’s a little sad but not surprising that increasing numbers of medical students are questioning their career choices. Although I historically precepted students in traditional medical rotations, I’ve more recently led electives in practice management and health informatics.

For those of you who aren’t in academic medicine, this week is “Match Week,” which is the time when the National Resident Matching Program (NRMP) spits out residency program offers to medical students who have spent the better part of the last year filling out applications, traveling to interviews, and generally trying to one-up each other on important clinical rotations.

The truth comes out on Friday the 16th at 1 pm ET. Across the country starting at noon, fourth-year medical students will participate in a variety of events (from formal ceremonies to all-out keggers) and receive a sealed envelope that tells them their fate.

Think of sorority / fraternity rush on steroids. These students have spent tens (if not hundreds) of thousands of dollars on tuition then several more to go through this process, where they rank residency programs and the programs in turn rank them. That hopefully results in a match that allows students to pursue their post-graduate training program of choice. Most of them will move to another city, then embark upon three to seven years of additional training (some moving again between the first and second year due to residencies that don’t have integrated internship programs) and ultimately be able to join the rest of us in the trenches.

For those students that don’t match, there used to be an aptly-named “scramble” process where lots of phone calls were conducted to try to find an open slot. This year there’s a new process called SOAP – the Supplemental Offer and Acceptance Program. Students who are eligible for SOAP received e-mails last Friday night and now will have to go through eight “offer rounds” starting on Wednesday. Hopefully the process ends with a match by Friday at 5 pm. Each round will have fewer offers available, so potential residents are encouraged to accept a first-round offer if it is satisfactory. The offers are essentially binding contracts.

The entire SOAP process hinges on brand new software that, hopefully for the students’ sake, has been well-tested. I know more about this than I probably should due to this year’s increased number of students showing up on my doorstep to discuss their options. Many of the students who have rotated with me are thinking about going the administrative or informatics routes with their careers. They tend to stay in touch since there aren’t a lot of mentors out there and other faculty members tend to try to shame those students to some degree about “wasting” their training.

A number of them have decided (against my better advice) to not even do an internship or residency. There’s a growing sentiment that it’s just not worth it and that medicine has gone into what one termed “the death spiral.” One recently said, “If I’m going to wind up not being able to control my life, at least if I go into administration or to the pharma industry, I’ll be well paid.” The downside of not doing an internship is that you can’t be fully licensed, but some industries don’t care, and schools of business and law definitely don’t mind.

Looking at this year’s graduating class, there are nearly a dozen headed to business school, law school, or straight into the workforce. The number of students choosing careers in primary care is low – family medicine is almost a curse word at my institution. We’ll have to see what Friday brings. Over the last two years, the number of students matching to family medicine programs nationwide was up, but if the nation looks anything like our current student body, we’re in trouble.

It’s also interesting to look at the demographics of specialty matching. Last year in family medicine, 94% of available slots were filled, but only 48% of those by US grads. As a physician staring down the barrel of an onslaught of aging baby boomers, seeing that US grads don’t find family medicine attractive is concerning. Not surprisingly, NRMP data shows that some specialties continue to be filled with high numbers of US grads: anesthesiology (80%), dermatology (93%), emergency medicine (79%), neurosurgery (90%), orthopedic surgery (93%), otolaryngology (95%), plastic surgery (93%), radiation oncology (94%), diagnostic radiology (80%), general surgery (81%), thoracic surgery (92%), vascular surgery (97%). I’ll let my very intelligent readers climb the ladder of inference and figure out where these specialties fall on the pay scale compared to primary care.

So here’s to The Match – one more third-party hoop for physicians to jump through in preparation for a career containing many more. But even better – here’s to a Friday afternoon that allows those of us who are not on call to start drinking at lunchtime, officially sanctioned, with the Dean picking up the tab.

Have a question about residency programs, the challenges of subinternship, or which pumps look sassiest with your interview suit? E-mail me.

E-mail Dr. Jayne.

EHR Design Talk with Dr. Rick 3/12/12

Humans Have Limited Working Memory

Consider a very common, high-level EHR design. The screenshots that follow are from a particular EHR, but many vendors use a similar design.

A row of clickable tabs at the top of the screen is used to designate the different categories of data that make up the patient visit. When a tab is clicked, the window for that category of data opens to full screen size. The tabs can be clicked in any order.

The screenshot above shows what I would see after having clicked on the History of the Present Illness (HPI) tab and having entered some data.

If I were then to click on the History (Hx) tab and enter some data, the new screen would look like the one above. The HPI data is no longer visible because the HPI window automatically closes when the Hx tab is clicked.

This EHR design is completely logical. It is also completely usable, if usability is defined as being able to easily navigate from one part of the record to another with a single click. In fact, it is a totally reasonable design if it weren’t for one problem — humans have absolutely terrible short-term (working) memory.

It used to be thought that humans could retain about seven unrelated elements in working memory, but recent work suggests that the actual number is more often in the range of four to five. In contrast, a modern computer has no problem retaining thousands of unrelated data elements in random access memory.

Given our severe limitation in working memory, this EHR design doesn’t work very well. Every time I click on a new tab, the previous window closes and that data is no longer visible. I have to carry that information in my head. Furthermore, the row of tabs itself contains no information. It just serves as a navigation tool.

In other words, this design is based on how a computer — not a human — thinks. It is a computer-centered, not a user-centered design (see my first post).

As a clinician, I need to devote my full cognitive resources to my patient’s health issues. I need to be able to retrieve information from any part of the record quickly and effortlessly. While completely logical, this very common EHR design just doesn’t do a good job of extending my working memory. From personal experience, I can tell you that using a system like this is enough to drive you crazy.

So what’s the alternative? The alternative is to design an EHR based on what humans are good at — using our visual system to make sense of the world. The data needs to be organized spatially, assigning each module to a fixed location on the screen the way that T-Sheets and other paper forms do (see my previous post). Instead of making the overview of patient data just a row of information-less tabs, display the actual data in a one- or two-screen view, allowing the clinician to see the information rather than forcing him to remember it.

Of course, every design requires compromises. If you decide to use a compact, fixed spatial layout for your high-level design, then you need to solve the twofold problem of what to display in the default view and how to display more information on demand.

In my next post, I will present an example of one widely used EHR design solution to this problem.

Next post:

The Problem with Scrolling

Rick Weinhaus MD practices clinical ophthalmology in the Boston area. He trained at Harvard Medical School, The Massachusetts Eye and Ear Infirmary, and the Neuroscience Unit of the Schepens Eye Research Institute. He writes on how to design simple, powerful, elegant user interfaces for electronic health records (EHRs) by applying our understanding of human perception and cognition. He welcomes your comments and thoughts on this post and on EHR usability issues.

Passport Health Acquires STAT Technologies

Passport Health Communications announced this morning that it has acquired STAT Technologies. The Hazlet, NJ company offers Web-based inpatient and ambulatory applications for patient scheduling, eligibility verification, charge capture, transport management, physician portal, patient self-service, and an HIE platform.

Passport CEO Scott MacKenzie was quoted as saying in the announcement, “Scheduling is a natural expansion of the Passport eCare NEXT Suite. It enables hospitals to begin revenue cycle functions at the point the order is received from a physician office, and improve coordination when there are different systems between the hospital and outside physician offices. Within a hospital organization it supports coordination of schedules, precertification, and onboarding between all departments, facilities, and silos of patient information, where disparate scheduling tools and other IT systems often exist.”

Financial details of the acquisition were not disclosed. Passport said in the announcement that it expects to acquire additional companies this year.

Monday Morning Update 3/12/12

From N2InformaticsRN: “Re: Ed Marx and Jim Murry. Did a nice job discussing mobility in healthcare on CIO Talk Radio.” That’s pretty cool – the audio sounds like a real radio station.

From @Cedars: “Re: Cedars-Sinai CPOE go-live. As a consultant going from project to project, it’s easy to forget why I began to work in healthcare, but this weekend I was reminded of it. This means everything to our industry, as past failure is redefined forever. This project has been done right in every way. I was inspired by this note from CIO Darren Dworkin. Please, please interview him.” I think I’ve asked Darren before. The CPOE implementation and quick de-implementation at Cedars-Sinai years ago gives it an honored spot in the Healthcare IT Failure Hall of Fame, right up there with BIDMC’s massive network outage, Kaiser’s waste of $500 million hiring IBM to develop IT systems that were abandoned before completion to instead passionately mate with Epic, and El Camino’s near-shutdown after implementing a patient-endangering Eclipsys medication solution. Feel free to suggest new nominees since every one of these examples provided painful but valuable lessons for not just those involved, but also for the rest of us gawking at the smoking wreckage from the safe side of the “do not cross” yellow tape. All of those organizations learned from their mistakes and came back better than ever, although iterative learning isn’t necessarily a good thing for patients.

From Sinking Ship: “Re: GE Healthcare. Cancels the 2012 Healthcare Technology Symposium due to mounting budget pressures.” The reader provided a copy of what appears to be the announcement letter from VP/CTO Mike Harsh. UPDATE: I asked GEHC what this event is since I could find no reference to it. It’s an internal-only event, so it has no customer implications.

From Bed Manager: “Re: HIMSS13. They are pre-booking hotels and relatively few rooms are available in New Orleans. Did attendees wise up and book early, or are rooms being held back for exhibitors, or does New Orleans just not have enough rooms to handle the increased size of the HIMSS conference? Both hotels of my choice are sold out and they aren’t even in the HIMSS block.”

From Epic Employee: “Re: Farzad Mostashari. Will be speaking at Epic on April 24. Pretty cool.”

From John: “Re: HIMSS conference exhibit layouts. The problem was because it was at the Sands Expo Center instead of the Las Vegas Convention Center, which has high ceilings and a long hall. I heard that the conference was supposed to be in Chicago but fell through at the last minute, leaving the Sands as the only alternative. HIMSS missed revenue since it sold out the Sands space weeks before the show, although I liked the Sands because it involved less walking and easy access to the Strip.” I don’t know if HIMSS planned to return to Chicago after what I would consider a predictably terrible first and only trip there (snowstorms even after screwing up the schedule by moving the event back, surly union workers in the hall, wildly overpriced hotels), but I thought they originally announced a permanent rotation of only Orlando, New Orleans, and Las Vegas. I don’t think that plan lasted long since they’ve been to Atlanta since then. New Orleans was OK last time, but that was right after Katrina when hotels and restaurants really didn’t have enough employees to keep things running smoothly. I’ll still hold out for San Diego as my favorite HIMSS experience and I heard they were expanding the conference center to handle the huge annual comic book convention.

From VA Doc: “Re: digital pens. The VA puts out an RFI for the technology, which has matured to the point where it makes sense to move beyond case studies.”

From MT Hammer: “Re: Clinical Documentation Industry Association. Ceasing operations, annual conference in Baltimore cancelled, financial pressures cited.” CDIA was a trade association for clinical documentation services, basically transcription. HIMSS could have possibly taken it over given a few familiar names among its dwindling list of members: Acusis, Arrendale, Diskriter, MD-IT, MedQuist, M*Modal, Nuance, and Verizon. The former Medical Transcription Industry Association (MTIA) rolled out its new name at the HIMSS conference in 2011, but a year later, both the organization and the conference are defunct.

From Sagacity: “Re: International Society for Disease Surveillance. Seeking comment on syndromic surveillance guidelines for the ambulatory and inpatient settings, targeting potential application for Meaningful Use Stage 3. The organization did the same thing for emergency and urgent care in the past, which led to MU Stage 1 specs.” Information here.

From Just a HIT Guy: “Re: WellStar. Moving off McKesson, NextGen, and GEMMS Cardiology, going to Epic. Internal memos released this week.” I’ll list this as unverified because I agreed to wait for a formal announcement as a courtesy to WellStar, but as usual, the organization’s long list of inpatient Epic job listings tell you everything you need to know anyway.

From EMR_Guru: “Re: WellStar. Announced to physicians they are scrapping NextGen and going with Epic. Wellstar has acquired a large number of physician practices over the last several years, Imagine getting bought and deploying NextGen only to be told a few months later that you have to scrap it and go with Epic.” That’s one of many risks involved in deciding to work for a hospital instead of for yourself.

From Prevailing Winds: “Re: Allscripts. You mentioned a vague acquisition rumor about Allscripts and IBM, but here’s something I’ve heard mentioned that I should say is completely unsubstantiated but potentially related. I’ve heard rumors of a potential buyout of Xerox/ACS by IBM. Allscripts remote hosting is outsourced to Xerox/ACS, so maybe the rumors refer just to that business instead of the whole company. Just rumor mill grist that may or may not mean anything.”

From Bony Moroni: “Re: HIMSS evaluation survey e-mail. It contained confusing instructions, misspellings, and a splash screen apologizing for errors in the e-mail. And we wonder why our industry is the butt of jokes by non-healthcare people. Here’s a crazy thought for an IT association in an industry known for sloppy work: test the damn e-mail merge program first. Not only was the merge done incorrectly, the ‘brief survey’ has a million questions on 11 pages, a status bar instead of an idea of what’s to come, and a pointless listing of the name and company of each recipient apparently just because they could. Obviously this is a contracted vendor, but does HIMSS really want this shoddy effort being the last thing people remember about the conference or the quality of work that HIMSS puts out?”

I’m back and rested after a week off out of the country, woefully behind, facing 500+ e-mails in my inbox, and regretting the loss of an hour due to springing forward since I’m already re-immersed into chaos even before I get back to my “real” job at the hospital. Actually I’m not that well rested since I got only four hours’ sleep Saturday night after downing my first-ever Red Bull to stay awake until  getting home at 3:00 a.m. Still, I’m happy to be back in my multiple saddles even though the horses tend to take off in different directions most of the time. Thanks to Inga for  keeping the HIStalk fires burning in my e-mail free absence. I’m sure I’ll repeat some items she’s already mentioned in trying to catch up, but that should be a one-time occurrence before things get back to normal with Tuesday’s news.

Thanks sincerely to everyone who completed my annual reader survey. It helps immensely and I’ve already made a to-do list for the next year based on the results. Obviously I almost cheated on my no-Internet vacation pledge to Mrs. HIStalk, but rationalized it to her by explaining that it took only seconds to download the results, even if I did spend several frowning and chin-stroking hours thinking about them and furiously taking notes. The preponderance of supportive comments was touching, although I probably won’t run them all here since that seems rather vain (as does re-reading them repeatedly, but at least I keep that particular vanity to myself.)

Readers grade ONC’s MU Stage 2 performance as maybe a D+. New poll to your right: does your PCP document your encounters in an electronic medical record? Mine does, even though the system he uses is about to get the boot in a hospital-mandated EHR replacement.

How did your Daylight Saving Time switchover go? Let me know if you had problems at your hospital. I’m always curious since vendors (some at my hospital, anyway) still haven’t worked out the bugs and punt by just suggesting shutting everything down for a couple of hours. Most of the problems are in the fall, when the “fall back” causes the 2:00 a.m. hour to be repeated, driving some badly designed systems crazy.

My Time Capsule editorial this week happens to be maybe my favorite one (at least until next time): Want to Anger a Nurse? Make Smug Comments about Grocery Store Barcoding. A desensitization dose: “They would buy Doritos by the bag, but would have to repackage and label individual chips and then track every chip – who bought it, who ate it, and whether they ate it in an appropriate quantity and with only complementary foods and according to dynamically calculated nutritional needs. ”

Fujifilm Medical Systems donates $25,000 to a laid-off radiology tech to save her foreclosed home, as seen on the Ellen show. 

Former HHS CTO and athenahealth co-founder Todd Park is named CTO of the United States, replacing Aneesh Chopra. Who would have put their money on the first HIT’er in the White House not being Allscripts CEO Glen Tullman?

Doug Stacy is named CIO at Labette Health (OK.) He was previously CIO at Coffeyville Regional Medical Center (KS.)

Dean Marketti, previously with BCBS, is named the first CIO of Morris Hospital & Healthcare Centers (IL.) I almost gave up trying to figure out what state the hospital is in given the common small-town newspaper website practice of not giving their location, apparently convinced that if you don’t already know, you couldn’t possibly care. Which I’ll concede is pretty much the case. 

Scott & White Healthcare names Matthew Chambers as CIO. I’m guessing he was interim while working for KPMG since his LinkedIn profile says he’s had the job since July 2011.

Holon Solutions (solutions for telepharmacy, order entry, results reporting, and the CollaborNet data sharing solution) names industry long-timer Mike McGuire as CEO. He was previously with MET-test.

Cincinnati Children’s Hospital (OH) and the local technology incubator launch QI Healthcare to commercialize the hospital’s quality improvement software that analyzes EMR data to identify improvement opportunities. I’m a bit skeptical about how easy it will be to commercialize any EMR data analysis application given the inconsistency in how each product and user stores and uses data, but hopefully they will figure out how to make that giant leap from Customer #1 to Customer #2. It took forever to find the startup’s Web page, which appears to be due to a combination of (a) lack of search engine optimization and Web content (just a leering stock art doctor on a GoDaddy parking page,) and (b) a poor choice of names that’s always going to give unrelated Google results. I continue to be amazed that new companies still choose names that won’t stand out in an Internet search.

It’s old news since I’m catching up, but First Databank mentions HIStalk (“the influential industry blog”) in the announcement of its rebranding, which I think is the first time a large, respectable organization has mentioned the name of this small, not all that respectable one in a significant announcement. I was impressed.

In the UK, Lord Carter of Coles, who heads up an NHS group to ensure fairness to its suppliers, is pressured to resign after the newspaper belatedly realizes that he’s also chairman of the UK division of McKesson (which he clearly disclosed when he took the job) and is part of an investment group that owns chunks of several healthcare companies. NHS pays him $90K per year for his two-days-per-week job, while McKesson pays him $1.25 million. Not surprisingly, nobody is suggesting that he quit the McKesson job.

Here’s Vince’s Part 2 of the CliniCom story.

The local paper covers the implementation of McKesson Paragon by McLaren-Bay Region (MI.) I think that’s actually McLaren Health Care, which makes a lot more sense.

A study at Minneapolis Heart Institute finds that surveillance software was able to retrospectively detect problems with implantable cardioverter-defibrillator devices long before the routine monitoring performed by the device manufacturers. The problem, of course, would be in collecting data in near real-time from the universe of patients in order to capitalize on the lead time.

The founder of SAP backs MolecularHealth, which offers software that matches the genomic data of individual patients to scientific evidence to suggest optimal cancer treatments. The application, which the company calls clinical decision support for oncologists, is being refined at MD Anderson.

Inga ran an anonymous reader’s rumor suggesting that GE Healthcare’s Centricity Perinatal could be on the sunset list. Not true, according to GEHC, and I’m sorry we ran that without asking the company for verification. GEHC is really fast and courteous about getting answers to my questions or rumor reports and I would have asked them for confirmation before running it. Inga doesn’t know the contact and probably figured she wouldn’t get a response.

Mrs. Dennis Quaid #3, the mother of the twins who were overdosed on heparin at Cedars-Sinai four years ago that were the subject of Dennis Quaid’s 2009 HIMSS conference keynote speech, files for divorce from the actor.

BCBS of North Carolina rolls out a mobile website that lets patients view claims, check their plan benefits, find a doctor, get a treatment estimate, and comparison shop drugs and insurance plans. The site, developed by Kony Solutions, supports Android and Apple platforms.

Philip White, historian and PR manager of electronic forms management vendor Access, appeared on Fox News last week after the release of his book about Winston Churchill’s Iron Curtain speech in Missouri in 1945. They asked him whether the lessons learned from the previous cold war still apply in situations related to Iran’s nuclear capabilities.

The local paper covers Oakwood Healthcare System’s (MI) $80 million Epic project, to be kicked off in August.

A fun Bloomberg BusinessWeek article discusses the joys of attending a conference in Las Vegas. It contains interesting mentions of the HIMSS conference, including four Craigslist “casual encounters” ads targeting HIMSS attendees like the one above.

A Kaiser Health News/Fortune article profiles Farzad Mostashari and HITECH. A quote:

Remarkably, in an era of partisan government, Mostashari’s program enjoys bipartisan support — or, at least, bipartisan tolerance. While only three Republicans voted for the stimulus bill in 2009, which provided the program’s funding, few have spoken out against it. The fact that the information technology industry is a big supporter — giants such as IBM, Microsoft, General Electric, Hewlett-Packard and a host of smaller health-care specialty technology companies — doesn’t hurt. The $27 billion will flow their way, and plenty of high-priced lobbyists are working hard to keep it flowing.

The New York Civil Liberties union criticizes the state’s privacy and security policies, saying HIEs should require patient consent to access their records and that the all-or-nothing approach to privacy means doctors see a lot of confidential information they don’t need to do their jobs.

Utah Business names Amy Rees Anderson, CEO of HIE technology vendor MediConnect Global, as its CEO of the Year.

State auditors discover that 269-bed Salinas Valley Memorial Healthcare System (CA), which earned scathing headlines last year when auditors found that its retiring CEO was paid over $5 million, did $21 million of business over a five-year-period with firms in which its executives held a financial interest.

A woman whose pending Supreme Court lawsuit argues that the federal government can’t force individuals to carry health insurance files bankruptcy after the family car repair business fails. Among the debts she’s petitioning the federal court to allow her not to pay: several thousand dollars owed to hospitals and physician practices. She had opted not to purchase health insurance.

E-mail Mr. H.