Readers Write: The Pitfalls of Resource Labeling in EMR Projects

The Pitfalls of Resource Labeling in EMR Projects
By Tyler Smith

In enterprise-wide EMR software implementations, the labels “clinical” and “technical” are often utilized in an attempt to categorize the project’s human resources. When taken to improper extremes, these two labels can give rise to an unhealthy “us vs. them” mentality among project team members which can be highly detrimental to the project’s timeline and team member cohesion.

The us vs. them mentality can hardly be considered de facto in enterprise EMR software projects. The division of clinical and technical team members is often intentionally defined by the leadership of large scale enterprise EMR projects. The division is worked into the project’s staffing plans and subsequent role assignments. There are often defined minimum numbers of clinical and technical team members for each of the project’s teams.

The justifications for role assignments based on clinical or technical skillsets are obvious. A project needs individuals with hands-on experience in the areas where the software will be applied in order to give a necessary perspective to builders and PMs, as well as to increase the legitimacy of the final product. A project also needs individuals with sharp IT skills who can translate flowsheets and labs, along with about everything else in these HITECH days, into computerized workflows. Ownership is important on IT projects, and the labels add ease to the sometimes difficult assignment of ownership.

What I fear most about the division is not hurt feelings, although I’m not saying that hurt feelings can’t directly result from the intentional division. What I really fear is the waste of resource time the labeling can cause if it is taken to its extreme.

Although mostly absent from Washington these days, the willingness of team members to compromise and sometimes share ownership is essential in divvying up tasks between clinical and technical team members. While some project tasks can be clearly divided – and these areas are no doubt a huge reason for the pronounced division – there are often gray areas that are not so easily categorized.

Battle lines are drawn when a group is delegated the task of owning a project or heavily assisting with an assignment that they do not believe is aligned with their label’s responsibilities. I have seen technical team members who refused to complete orders build based on lacking clinical knowledge. I have seen clinical team members refuse to perform easy interface cleanup based on lacking technical skill.

While both of these team members were right to the letter of the law, the project’s thin resource allocation necessitated their somewhat misplaced assignment. When it came down to it, given a little bit of willingness to learn, each team member could have accomplished either task. Validation would have been required, but the compromise would have saved hours of argument that waste resource time and increase the project costs.

Therefore, while divisions may be necessary to create a neatly formatted organizational chart or to meet certain artificial quotas, a culture of flexibility needs to be promoted in concert. Technical people should be encouraged to Google healthcare topics a little more and clinical people should not be afraid of reading up on computer languages.

Deference to each other’s expertise remains a given, but showing respect by attempting to learn the other side’s language goes a long way. After all, team members are not made members of the project to simply live to a label. Project members exist in order to facilitate the project’s ultimate success.

Tyler Smith is a consultant with TJPS Consulting.

Time Capsule: Hello, NAHIT? Wanna Buy My Dictionary for $29 Billion?

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 May 2008.

Hello, NAHIT? Wanna Buy My Dictionary for $29 Billion?
By Mr. HIStalk

The New Oxford American Dictionary costs $48 and contains definitions of 350,000 words. What a deal! HHS just paid consultants $500,000 of taxpayer money to make up five healthcare IT definitions (being overachievers trolling for future engagements, the consultants threw in an extra one). At that rate, that $48 dictionary is actually worth just over $29 billion (shipping extra).

Furthermore, NAHIT (sorry, they apparently prefer the authoritarian-sounding “The Alliance,” according to the Web site) didn’t even get real definitions for its (your) money. Your sixth grade English teacher would be horrified to see, for instance, that the definition for electronic medical record starts out with “An electronic record …” That’s not a real definition, even if it did cost $83,000. If it were, the dictionary entry for civil war would be, “A war that is civil.”

Consultants can’t say, “Have a nice day” without gravely presenting a PowerPoint and an executive summary, so the handful of one-sentence definitions is buried in a 40-page report that no one will ever read.

Note: it is law that every healthcare IT article written by dull reporters or unimaginative academics must start with one of two opening lines, either, (a) “In 2004, President George Bush called for every American to have electronic health records by 2014” or, (b) “In its landmark 1999 report To Err is Human, the Institute of Medicine said that medical errors kill 98,000 Americans each year.” Spoiler: this one goes with (a).

The report implies that the appalling lack of consultant-produced definitions was a matter of national importance, suggesting that the pesky term Health Information Exchange threw the entire United States government into a near-standstill by causing poor EMR adoption and public indifference to healthcare IT. Its conclusion is that, despite war and economic woes, all is again right in the federal world and the HIT pipelines are flowing. The definition deficit has been eliminated.

Give the criticality of the situation, what methodology did BearingPoint use to create the definitions? Since they’re consultants, duh, they “conducted a literature review” and then asked a few people, “Say, what do you think these terms mean?” and packaged it all up with a big invoice. Ca-ching!

Here’s a polite assessment of their work: at least the definitions won’t be contentious. Nobody would read them and argue (except non-CCHIT certified EMR vendors since the report says, in essence, that their CCHIT-certified brethren are EHRs and everybody else’s are EMRs, giving a nice, parochial nod to another ONCHIT pet project). The definitions, in other words, were plainly obvious, thereby throwing the whole “why did they spend all that taxpayer money” question right out into the open.

Here’s another negative beyond $500K of irretrievably lost funds. The cash went to perennial trough-lapper BearingPoint, which some lawmakers tried to ban from government work after its $472 million debacle, the CoreFLS ERP system at the Bay Pines VA in Florida. That project nearly shut down the hospital before it was mothballed for good in August 2004, having never advanced beyond disastrous beta testing. All has been forgiven, apparently, except for those VA folks who were fired or reassigned because of it.

Optimists would say that taxpayers usually fare much worse when Washington bureaucrats meet big consulting firms, so blowing only $500,000 is actually not a bad outcome. Here’s another: if you order in the next 30 minutes, I’ll sell you that dictionary for just $1 billion. Act now and, like BearingPoint, I’ll throw in a bonus definition: boondoggle.

HIStalk Interviews Reed Liggin, CEO, RazorInsights

Reed Liggin is president and CEO of RazorInsights of Kennesaw, GA. 

Tell me about yourself and the company.

RazorInsights was formed in December of 2010. We are an enterprise hospital information system company.

We named our company from the principle of Occam’s Razor, which says the best explanation is usually the simplest one. Our tag line is “Simplified Healthcare Technology.” Our goal was to build an electronic health record initially that was easy to use, simple to learn, and something that you would purchase from the company that would be easy to do business with and simple to do business with.

We offer the solution on cloud technology. It’s software as a service. It’s a single integrated database on a multi-tenant cloud. We call our solution One simply because it’s on a single database.

As for my background, I’m a pharmacist by trade and have been in health IT since around 1997. I formed the company with two colleagues that I worked with in the past, Edward Nall and Michael McKenzie.

I don’t even remember the last time somebody wrote a new full-hospital system from scratch. Why haven’t they done that, and why is RazorInsights doing that now?

[laughs] Well, I think we’re just crazy enough to give it a try. It’s really a big challenge and a daunting task.

Our initial roadmap was the EHR Meaningful use criteria that were released in 2010 along with the pharmacy system. We felt that medication management was the core of a good clinical system. We started there, and we’ve evolved into a full enterprise HIS as a response to market conditions and the opportunity that’s been presented to us.

Do you think your product is competitive with systems like Meditech and CPSI that have been around for decades?

We do. I think I would be disingenuous to say that we have every single bell and whistle and the breadth of functionality that companies have been the space for a really long time do. But I think we do a really good job of focusing on the really critical 30 or 40 percent of things that hospitals need the most and make sure we do those really well.

Then we are on a long-term mission to, every day, expand our functionality to cover all the pieces of functionality that hospitals need out of an enterprise hospital information system. But I will say that I think we are very competitive across the board as far as feature functionality goes. The depth of our functionality in quite a few areas like CPOE and pharmacy is very strong, but obviously we still are a work in progress.

Is it difficult to convince a customer that it’s in their best interest to have a limited but deep set of features?

We have to find the right customer that shares our vision. As we started the company two years ago, we have taken a deliberate pace to not try to sell every single deal we could possibly sell. We had to be sure that our product was ready to go to the market on a large scale. 

We try to be fairly selective in choosing the right hospitals who share our vision and understand that there’s an evolution here and the end result will occur in a very short amount of time. The end result will also be that they’ll have a solution that can be achieved from going with a different company.

I assume that your primary customers are going to be smaller hospitals. Is that a limiting factor because that’s as big as an enterprise you can serve or just because they’re easiest to sell to at this point?

It’s a little of both. Certainly you want to start where there’s an opportunity. We saw an opportunity in the smaller hospitals — under 100 beds — because those hospitals typically had older technology for the most part. As we started to serve those hospitals, we have had opportunities to sell to larger hospitals, but most of the time they’re not ready to go into a situation where they’re going to have to do without certain functionality for a period of time.

You start with the opportunity that’s the biggest where you can serve the needs. We expect to evolve to be able to serve larger hospitals, but one of the things we wanted to do as a company was not try to do too much too fast. We want to be careful, because the worst thing you can do is try to outsell your capabilities, whether that’s to too many hospitals too fast or whether that’s to larger hospitals that you can’t accommodate. We want to be sure we got this right as we go along.

A lot of folks would say that part of Epic’s success is because they qualified their customers as much as their customers qualified them. Is it difficult as a small company to not pursue sales that you probably could make?

I don’t know if we’ve been as selective as Epic. We had an opportunity that was presented to us with the stimulus to get in the game, so to speak. We didn’t really get that selective, but we targeted hospitals that we knew would be a good fit for what we’re trying to do and found hospitals that had management teams or executives who shared the vision we were creating. 

The challenge for us has been, if you grow at a more deliberate pace, obviously there’s market pressures based on the window of opportunity you see that there’s always pressure to move faster, to get bigger faster, to move to bigger hospitals faster, to sign more hospitals faster. We always have that pressure to move faster because the window of opportunity won’t be there forever. We want to be sure that we capitalize on the opportunity that’s before us, but at the same time not put ourselves in a position where we can’t deliver.

My sense is the market wants competition instead of just Epic, Cerner, or Meditech and some of your competitors in the smaller hospital market. Do you feel the pressure to be something that you’d rather not be in serving those larger hospitals that don’t have a lot of choices?

I think there’s a tremendous amount of pressure from larger hospitals and medium-sized hospitals that are looking for another choice. They want us to get there faster than is probably possible. We just try to get up and get better every day. That’s our motto — every day we just try to improve upon what we’re doing and grow as fast as we can. 

That being said, we built our ONC-certified Complete Inpatient EHR from the day we started coding it to the day we were certified in about 100 days. We built a full, enterprise HIS within two years. We have some breadth of functionality still to cover in that product, but for the most part, we can service a small hospital very well. We’ve done it faster than most other companies have done it. I think that works in our favor.

What’s the secret? Nobody else has been able to figure out how to do that.

What we know needs to be done, a lot of people know. I’m a little surprised sometimes not more people have tried it. I think probably because it’s a capital-intensive effort that’s held a lot of people back.

We were just a group of people who had worked in the trenches at various health IT companies, at hospitals as healthcare workers, and really had a clear vision of exactly what we wanted the product to do and what we wanted it to be. We wanted it to be something that was easy to use, easy to learn, a modern look and feel.

We use a rich Internet application called Adobe Flex for our graphic user interface. We were looking for that new modern user experience in a system that would be easy to adapt.

On the services side, we also wanted to focus on being transparent with our customers, keeping our pricing simple. We have a bundled pricing model that’s all inclusive. You don’t get a contract with two pages of line items of different third-party software that’s included in the product. We try to be very straightforward. 

Also, we actually do the build for our clients. When we go into a hospital to do an implementation, we’re gathering information from the hospital, and then we do the build process and then bring the product back and train the client on it. 

It’s a different approach, and I think there’s other companies that have done different elements of that. I don’t know if there’s a lot of secrets there. There are a few. One is the way we develop. We have a pretty unique development process which takes a lot of industry subject matter expertise combined with some very fast coding talent to develop the product almost around the clock. We’re able to produce new code pretty quickly.

Are those technical resources employees or are they  contracted?

Some of both.

It seems like it would have taken a lot of cash for some guys who used to work for vendors to put together.

[laughs] We bootstrapped it pretty much to date. We are in the final stages of completing a private equity deal. We’ll be announcing that within the next couple of weeks. That will give us the capital to take the company to a whole other level and put our foot on the accelerator when it comes to building out this enterprise vision.

What can you share in terms of company size?

We’re still pretty small. We have 55 team members. That’s the team that services, develops the product, and everything. We have clients mostly in the Southeast, but we’ve expanded to some states west of the Mississippi and in the Midwest also.

What’s your pitch when you get in front of these small hospitals and maybe they’ve never heard of you? How do you sell them on the idea of doing business with you?

First and foremost, we’re all about being a single database, integrated product. Today we bring a single database integrated financial and clinical system to the market. By spring, we’ll be releasing our ambulatory product, which will include an electronic health record and practice management system for physician practices on that same single database.

The other thing that we’ve done, as we started to develop the system, we looked at hospital systems and how they evolved. They evolved departmentally, where there were pharmacy systems and lab systems and nursing systems and CPOE systems, etc. What we looked at was, how can we really make this a more efficient, improved approach? 

We decided to knock the walls down between the departments in the hospital. We’ve created what we call a non-modular solution. Each user has access to the system based on the privileges they have according to their role, but every user has the same access into the system and a similar look and feel and view.

We call that view of the patient record our holistic patient record. If I’m a pharmacist, in a lot of systems, I can only see what’s going on with the patient’s medications and maybe some lab results. I can’t necessarily see the surgical procedures or radiology tests they’ve had unless I go to a different module in the system. In our system, in the holistic patient record, I’m able to see all of that information and have a complete picture of what’s going on with the patient right there in one view no matter what role I have, as long as I’m supposed to have access to that information.

Are your revenue components fully developed even though your emphasis seems to be on clinicals?

We started out as an inpatient electronic health record vendor. We began building out the entire clinical suite. As we got into the market, hospitals were rapidly adopting EHRs for the stimulus opportunity.

About a year into it, hospitals started to pretty much demand that they would select a new vendor based upon them having an entire HIS. The market really changed a lot more quickly than we expected. We did expect a system replacement market to occur, where old technology would be replaced by newer cloud technology in the next few years, but the shift happened a lot more quickly than we expected. 

We either had to acquire or partner within a revenue cycle system or we had to build it. We opted to build it. There’s still work to do and we’ve got most of the pieces built. We can operate a hospital. There’s a few things we still will build out, but in a couple of instances we used partners to help supplement what we don’t have at this point.

Since you and your colleagues  worked for a variety of vendors, what mistakes do you think you’ll be able to avoid having that experience?

I think staying true to the vision as a single integrated database is important. While you may not necessarily want to build every piece of software that a hospital would ever use, you need to have a clear vision as to what’s a core component of that single integrated database solution and stay true to that.

Additionally, I think reliability is a big factor – becoming a company that is known for reliable installs, reliable support, somebody that is a partner the hospital can count on. Obviously our friends at the big ship in Wisconsin have done a great job of that.

You mentioned your VC investment that’s upcoming. A lot of companies stumble at that point because the VC wants to take it in a different direction, at a faster speed, or with different people running the show. Do you see that vision holding true with the influence of the outside money you’re going to take in?

Yes, we do. It’s an interesting process and the first time I‘ve been through this process to seek capital for a company. I spent about a year looking for the right partner. I went from Silicon Valley to New York and everywhere in between meeting with venture capital and private equity firms. Usually within the first 10 minutes, you could tell in the conversation if they understood what you were trying to do and understood your vision.

We were just absolutely committed to the fact that we were going to find a partner who understood what we were trying to do and understood our vision. We turned a few offers down and finally found what we think is the ideal partner. They share the vision, they understand exactly what we’re trying to do, they have a really in-depth knowledge of the space. We think we’ve pretty much found our dream partner.

How do you see the next five years playing out for the company and for the industry?

Wow, that’s a big question. The next five years for the company, we’ll continue to grow our market share in the small hospital space. I think we’ll evaluate whether we want to move upstream to bigger hospitals and how quickly. At some point, we’ll start to execute on moving into that space, where we think there’s potentially a lot of opportunity in addition to the small hospitals.

Additionally, we may look at some international opportunities. We’ve been investigating a few recently. If they make sense and are not outside of our core focus, we may pursue some of those. I think we’re in the beginning of a real shift for a lot of HIS system replacements to take place over the next few years. We just want to make sure that we capitalize on being a part of that opportunity.

For the industry in general, I think you’ll see obviously a lot of smaller hospitals moving to cloud or hosted solutions as that becomes a more practical way for them to manage a system without a lot of IT resources on staff.

You’ll see IDNs continue to consolidate smaller hospitals into their organizations. We’ll continue to see the trend of physician practices becoming part of hospitals and IDNs and becoming employees. It will be interesting to see what happens in our space with some of the larger ambulatory EHR vendors as hospitals acquire those physician practices. They may start to encroach on their market share by pushing hospital systems out to those physicians, so I think there’s an interesting dynamic that will come along with the consolidation. And then, finally, I think it’s still to be determined what impact ACOs will have in our industry, but there will be some impact. It’s going to be interesting to see how that plays with what’s going on in HIT.

Morning Headlines 2/8/13

Nuance Shares Stumble After Hours As Guidance Disappoints

Nuance reports a Q1 loss of $0.07 per share vs. a positive $0.03 last year, falling short on revenue and earnings estimates. The company says reduced transcription volume, spurred by increased usage of EMRs and its own Dragon Medical transcription software, is constraining its healthcare revenue.

CHIME Weighs In on Federal Health IT Safety Plan

The CIO organization calls for more consistent matching of patients to their data, expresses concerns about the time providers may need to spend filing federal patient safety information, and urges that control of the patient safety plan be moved outside of the federal government to an independent organization.

Mayor Bloomberg Announces Expansion of Electronic Health Records Result in Major Health Care Improvements

New York City Mayor Michael Bloomberg says the city’s EHR use has improved outcomes for hypertension, diabetes, and smoking-related complications. New York’s Primary Care Information Project was started in 2005 by then-Assistant Commissioner Farzad Mostashari, MD, now National Coordinator.

ECRI Institute PSO Uncovers Health Information Technology-Related Events in Deep Dive Analysis

The non-profit patient safety organization identifies five problem areas with healthcare IT: inadequate data transfer between systems, entering data on the wrong patient, making data entry mistakes, HIT system bugs, and configuration errors.

News 2/8/13

Top News

The VA and Department of Defense give up their contentious, expensive, and multi-year effort to develop a common EMR, deciding instead to keep their existing VistA and AHLTA systems and settle for a common user interface and unstated interoperability. They plan to launch a pilot in the summer of 2013 with a general rollout in 2014. The now-abandoned project, begun in 2011 with the declaration that VistA and AHLTA were outdated and lacking functionality, was supposed to have been completed in 2017. According to Secretary of Defense Leon Panetta:

We recognize that bringing together two large bureaucracies, trying to make those bureaucracies work together to form a seamless support system for all service members and veterans is not an easy challenge … It’s been inefficient for service members to have to hand-deliver records from one system to another when they get out of the military. It doesn’t make a hell of a lot of sense … Our goal had been to complete this effort by 2017 … our worry is, how long is it going to take to get to that goal? And what is going to be the price tag to get to that goal? And how many times is it going to be delayed? …  Rather than building a single integrated system from scratch, we will focus our immediate efforts on integrating VA and DoD health data as quickly as possible, by focusing on interoperability and using existing solutions. This approach is affordable, it’s achievable, and if we refocus our efforts, we believe we can achieve the key goal of a seamless system for health records between VA and DoD on a greatly accelerated schedule. We’re now directing our departments to do just that.

We have just witnessed hundreds of millions of dollars go down the drain. I’m disappointed that our nation’s two largest government agencies – one of which is the world’s foremost developer of high-tech machines and cyber-systems – could not come together on something that would have been so beneficial to those that served.

Reader Comments

From Billy East: “Re: McKesson Provider Technologies. Major re-org, with changes in leadership over Horizon Clinicals and other changes in Analytics and Relay divisions.” Unverified.

From Printgeek: “Re: McKesson. Has rolled its Physician Practice Solutions business into its RCM business along with Medisoft, Lytec, Practice Partner, Practice Choice, and now MED3OOO.” Unverified. The e-mail include the departure of an executive I won’t name at the moment, along with predictions of product sunsetting that are speculation at this point. I’ve seen no announcements, changes in the company’s Web pages, or updates to the LinkedIn profiles of those named.

From Tar Heal: “Re: UNC Health Care. Rolling out its Epic plan.” Not only did UNC avoid choosing a gimmicky name for its Epic project, they created a project logo that incorporates Epic’s identity along with their own. Go-live is planned for the spring of 2014.

From Primus: “Re: HIPAA. It’s halfway between sad and embarrassing when folks who lecture on HIPAA spell it incorrectly.” They hedged their bets by sometimes spelling it HIPPA, sometimes HIPAA.

HIStalk Announcements and Requests

My BFF Dr. Jayne and I are already working on our HIMSS party calendar. She has tasked me with securing the invites while she works on the logistics of how to attend the most events in a limited amount of time. We are partial to soirees that are open to all HIStalk readers, such as Divurgent’s summHIT Balcony Party on Sunday, March 3. If your organization is sponsoring an event that is open to all of our readers, we are happy to mention it on HIStalk and of course add ourselves to the attendee list.

A few must-read items from HIStalk Practice from the last week: CAGH launches an EFT enrollment tool that allows providers to enroll with multiple payers through a single online process. The Boston Globe profiles eClinicalWorks and its new patient engagement inititative. The percentage of medical claims filed electronically has nearly doubled between 2002 to 2011. Denial rates for established office visits range from 44 to 65 percent. HIT adoption by FQHCs is associated with significant improvements in care. Brad Boyd of Culbert Healthcare Solutions offers thoughts on practices shifting to a core vendor prior to ICD-10 implementation. Dr. Gregg wonders if Meaningful Use is getting lost in translation. I like to think of myself as a gal who doesn’t require much to keep her smiling: a hot pair of shoes, a nice glass of wine, and a few new HIStalk Practice readers every month. Make me smile. Thanks for reading.

What we like: (a) people who subscribe to our e-mail updates on HIStalk, HIStalk Practice, and HIStalk Connect; (b) connecting with readers via Facebook, LinkedIn, and Twitter; (c) seeing nice stats indicating that readers are interested in the ads of our sponsors and are clicking them for more information, as well as checking out the Resource Center and Consulting RFI Blaster; (d) getting rumors and news online, by e-mail, or on the Rumor Line telephone, with details to your right; and (e) getting support for what we do from readers, contributors, and sponsors. All of us (Inga, Dr. Jayne, Travis, Lt. Dan, Donna, and I) do this part time after work, and that wouldn’t be possible without help of a variety of types, for which we say thanks.

On the Jobs Board: Healthcare Industry Solutions Director, Software Product Development Manager, Senior Applications Engineer, Director of Marketing.

I keep getting e-mails asking for HIStalkapalooza details that I’ve already spelled out on HIStalk twice, so here’s one final notice for the skimmers: registration is still open. Sign up and then read HIStalk and watch your e-mail for details – please don’t e-mail me with questions or requests because I barely have time to sleep as it is (not to mention I would be spending time replying to people who don’t read HIStalk anyway). So far it looks like maybe 100 or so presidents and CEOs have signed up from my quick scan down the list. My favorite attendee title: “CEO Wife/Mistress” (should we hold one spot or two?)  while one (male) attendee volunteered that, “I am willing to wear high heels just to get in.” The event draws the most interesting crowd of anything at HIMSS because not only are HIStalk readers smarter, funnier, and sexier (scientific proof available on request), we get a stimulating mix of internationally known executives, CIOs, CMIOs, trench warriors, consultants, clinicians, investment bankers, sponsor people, and government officials who know their stuff and also know how to have a good time. I’m also happy to report that next year’s HIStalkapalooza in Orlando is already sponsored, as is the 2015 version in Chicago.

HIStalkapalooza sponsor Medicomp Systems will once again host its Quipstar game show in the HIMSS exhibit hall, offering fun competition, tee shirts, prizes, and cold drinks (beer and Ingatinis are mentioned, and I had the former last year). Register to play here. The grand prize is super cool: two business-class airfares to Bangkok, a 10-day stay in Medicomp’s corporate apartment, and two executive physicals at Bumrungrad International Hospital. Thai food is among my favorites and it’s shockingly cheap there, which just might be reason enough to go. Check out a disguised Inga at 0:25 in the video from last year above.

Acquisitions, Funding, Business, and Stock

Athenahealth reports Q4 results: revenue up 26 percent, EPS $0.29 vs. $0.26, beating earnings estimates by $0.01.

Analytics vendor Health Data Vision raises $2.8 million in Series A funding.

Nuance reports Q1 results: revenue up 28 percent, EPS –$0.07 vs. $0.03, falling short on revenue and earnings. Shares are down more than 15 percent in after-hours trading. On the earnings call, Chairman and CEO Paul Ricci said reduced transcription volumes due to increased EMR adoption and the company’s own Dragon Medical software will hurt the company’s healthcare growth until business picks up for its computer-aided coding and clinical documentation offerings.

Mobile health technology provider Diversinet Corp. is awarded two US and Canadian patents related to “bring your own device” security .

Sales

Vancouver-based Fraser Health contracts for dbMotion’s interoperability platform.

Mercy Health System (MO) selects MModal Fluency for Coding workflow platform for its network of 26 hospitals and clinics.

Huron Valley Physicians Association (MI) chooses e-MDs as a preferred EMR partner for its 700 members.

The OneBlood, Inc. (FL) blood center licenses Mediware’s HCLL Transfusion software.

The HealtheConnections RHIO (NY) selects Mirth’s HIE technology.

People

Rose Ann Laureto (UNC Health Care) is named CIO of ProMedica (OH).

Acusis promotes KB Anand to CEO.

Hearst Media extends the responsibilities of First Databank President Gregory Dorn, MD, MPH to deputy group head of Hearst Media, where he will oversee business-to-business services in the automotive, electronic, and finance industries along with the company’s healthcare brands MCG (the former Milliman Care Guidelines), First Databank, Zynx Health, and Map of Medicine. I interviewed him in September 2012.

Health Catalyst appoints John Haughom, MD (PeaceHealth) CMO and SVP.

AHIMA hires Deborah Green (LaVie Care) as EVP/COO and promotes Denise Froemming to EVP/CFO.

Announcements and Implementations

QuadraMed will offer Q-Matic’s self-service technology for managing patient flow through its enterprise Access Management suite.

EClinicalWorks will invest $25 million over the next year to enhance and expand its patient engagement tools in its healow business unit.

OSF HealthCare System goes live on sharing its seven-hospital Epic information with other participants in the Central Illinois HIE using ICA’s CareAlign exchange platform.

Cogdell Family Clinic (TX) implements scanning technology from EDCO Health Information Solutions to eliminate its paper-based medical records.

Truven Health Analytics launches HIE Advantage Analytics for the analysis of HIE utilization and population management.

ICSA announces a mobile app testing program to help enterprises determine if their supported apps are properly protecting sensitive data.

Government and Politics

CMS will develop a new records systems to facilitate quality reporting for long-term hospital care.

What ever happened 2 #blueButton Health assistant developed back in 2010 4 patients 2 download EHR data ? adobe.ly/TRhKNe

— Sherry Reynolds (@Cascadia) February 8, 2013

Good question. Adobe won a VA prize in 2010 for a slick Blue Button project using Adobe Air. It would be fun to revisit old announcements occasionally to see which turned out to be fluff, BS, or wishful thinking.

CHIME’s comments on ONC’s proposed patient safety plan emphasize that methods of matching patients to their data are inconsistent and a growing problem with HIEs, although it fell short of providing the obvious but politically deadly solution of a national patient identifier. CHIME also expressed concern that patient safety event data collection might take a lot of provider time and urged ONC to turn implementation of the patient safety plan to an organization that isn’t under direct government control.

ONC’s Farzad Mostashari throws down the gauntlet to the minority of EHR vendors that aren’t forthright in their pricing, that write unfair contracts, and that hold customer data hostage to prevent them from moving to another system, warning that if those vendors don’t step up, “We will go back to the regulatory process.”

Secretary of the Army John McHugh visits the National Center for Telehealth and Technology in Joint Base Lewis-McChord, WA. It offers video chat-based mental health consultations to soldiers in remote locations.

Senator Robert Menendez (D-NJ), new chair of the Senate Foreign Relations Committee, acknowledges that he tried to intervene in a billing dispute between CMS and his largest political donor, a Florida ophthalmologist who was ordered to replay $8.9 million for overbilling Medicare for an eye drug. The Senator, who also admitted to inappropriately using the doctor’s private jet, tried to convince CMS that the billing rules were confusing.

Other

A national survey finds that the most-hated job in America, as scored by those holding the position, is IT director. Sales and marketing director came in at #2, product manager at #3, senior web develop #4, technical support analyst at #8, and marketing manager rounding out the list at #10. Companies should probably be concerned if their sales and marketing executives are that miserable.

AHRQ and CMS announce a new EHR format for children’s health that includes recommendations for child-specific data elements such as vaccines, prenatal and newborn screening tests, growth data, and child abuse reporting.

A study in Health Affairs finds that care costs averaged $88 less per episode when delivered via an online clinic versus traditional settings, with strong effectiveness indicators and a 98 percent “would recommend” consumer rating.

A county commissioner and Tea Party leader in Michigan casts the lone dissenting vote in considering the health department’s request for new Medicaid billing software, explaining, “My worry is that if it’s part of (electronic health records or EHR)—which is Obamacare. I’d like to make sure our information is not being collected. You’d be selling your health care and your liberty to Big Brother. We should make darn sure this is not part of the EHR system … I feel our records would be better off kept in private hands.” 

A KLAS report finds that ED physicians believe best-of-breed ED systems offer better clinical decision support, usability, and documentation accuracy compared to enterprise ED systems. The highest-ranked best-of-breed vendors are Wellsoft, Picis, T-System, and Medhost, while Epic takes the top spot among enterprise vendors.

The ECRI Institute Patient Safety Organization looks at HIT-related safety events, identifying five problem areas:

• Inadequate data transfer between systems
• Entering data on the wrong patient
• Making data entry mistakes
• HIT system bugs
• Configuration errors

Security analysts find a vulnerability in Internet-connected devices manufactured by Honeywell that could allow hackers to take control of large-business environmental systems, some of which they identified as belonging to hospitals. Hacking the device could also provide direct access to a hospital’s network since they are often direct connected via Ethernet.

World-renowned Johns Hopkins neurosurgeon Ben Carson, MD (played by Cuba Gooding Jr. in 2009’s “Gifted Hands: The Ben Carson Story”) makes his fellow presenter President Obama squirm at the National Prayer Breakfast with his suggested alternatives to Obamacare: “We spend a lot of money on health care, twice as much per capita as anyone else in the world, and yet not very efficient. What can we do? Here’s my solution. When a person is born, give them a birth certificate, an electronic medical record, and a health savings account to which money can be contributed pre-tax from the time you’re born to the time you die.” He also said that the government is fiscally irresponsible and needs to place more emphasis on education.

Santa Clara Valley Medical Center (CA) is fined $100,000 after patient dies after going into cardiac arrest without receiving treatment for nine minutes. The patient’s monitor leads had become disconnected and the technician called for a nurse via overhead page at 1:27 a.m., but the nurse said she didn’t hear it. The hospital, thankfully, says it has developed a better way to notify nurses. Google tells me that Vocera’s headquarters building is less than two miles from the hospital in San Jose and the hospital is a Vocera customer, so that’s probably a much better solution than waking patients up with middle-of-the-night overhead pages that could be missed.

Twelve patients file suit against North Shore University Hospital (NY), claiming that medical records face sheets were stolen and their information used to file fraudulent tax returns, charge credit cards, and open cell phone accounts since 2010. The suit claims that a theft ring operated for more than a year, but patients weren’t notified.

The top 10 executives of non-profit Carolinas HealthCare System (NC) each earned more than $1 million in 2012, including $4.76 million for the CEO.

I was amused that Dr. Jayne uses the word “pop” below in referring to fizzy sugar water, which I know is a regional term since I’m fascinated by stuff like that (calling the midday meal “dinner,” referring to a rubber band as a “gumband,” declaring the side of the road to be a “berm” instead of a curb, etc.) Then I remember that there’s an Internet, meaning someone has devoted their very existence to studying the “pop” phenomenon, so that’s the graphic above. The yellow parts of the country call it “pop,” the blue say “soda,”and the purple refer to it generically as “Coke” (although my favorite is the unlisted variant I always heard from my Southern relatives, “Co-Cola.”)

Perhaps this OB-GYN shouldn’t have chastised her tardy patient on Facebook. The hospital has reprimanded her and is reviewing her posts after reports that some may have contained patient information. I would add that she should be reprimanded for starting a sentence with “so,” an appallingly lame and unnecessary verbal crutch that seems to be ubiquitous these days.

Sponsor Updates

• SuccessEHS says it has doubled in size since January 2011 with the hiring of 295 new employees.
• Surgical Information Systems demonstrates interoperability for each IHE profile at the 2013 IHE Connectathon.
• Forbes recognizes iSirona, Kareo, and Ping Identity on its list of the country’s most promising privately-held, high-growth companies.
• Levi, Ray & Shoup opens a branch office in Westchester, IL.
• Elsevier launches the MEDalternatives database, which gives users access to drug cost savings options through access to information on alternative therapies.
• Vocera donates its communication technology to MedShare (GA), a non-profit that recovers and redistributes surplus medical supplies and equipment to developing countries.
• Access hosts a February 12 Webinar profiling Norman Regional Hospital (OK) and its use of Access products to advance paperless initiatives.

EPtalk by Dr. Jayne

HIMSS alert: For those of you who may be out cavorting with vendors or clients in the Big Easy, a recent study shows that mixing alcoholic drinks with diet pop may lead to higher blood alcohol levels than using regular pop. The study was small with only 16 participants and attributes the effect to diet pop moving more quickly through the stomach.

Speaking of vendors, clients, and cocktails: CMS released the final rule on the Sunshine Act this week. Starting March 2014, pharmaceutical and medical device must report payments to providers for consulting fees, honoraria, gifts, food, entertainment, travel, and charitable contributions. There will be a 45-day review period for physicians to ensure the accuracy of any information submitted. The rule is 287 pages long and it’s already been a long day, so anyone who wants to send me highlights is welcome. Instead of stale pickup lines accompanying offers to buy me a drink, I’m sure I can look forward to, “Hey baby, what’s your NPI?”

I’ve received lots of reader comments on my recent piece regarding hospital budget cuts and administrative ridiculousness. Some of my favorites:

• “I thought it was bad when they stopped emptying our trash daily and told us all food-type trash needed to go to the kitchen and that if any varmints or bugs appear, each department would be charged for pest control.”
• “They started vacuuming during the day because it is cheaper. So you are on conference calls or any type call and along comes the high-powered vacuuming. Also lights have been dimmed, so you practically need a flashlight.”
• “My most ridiculous administrative experience occurred smack dab in the middle of the current recession. Senior management felt our product was so critical they decided to raise prices. I could only shake my head in amazement and easily forecast the impending carnage to come… and did it ever come! Our competitors had a field day as clients dropped us like a bad habit!

Keep the stories coming. I really do enjoy reading your comments and knowing that our hospital isn’t the only one that has totally lost its collective mind.

ICD-10 challenge: I had a patient present this morning with eye pain which she attributes to staying up all night reading Fifty Shades of Grey. The best part of the encounter was that my scribe had never heard of it, and watching his face as the patient tried to explain what the book was about was priceless. I guess I’m stuck with a nonspecific code for exposure to other specified factors. Any suggestions?

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 2/7/13

Remarks by Secretary Panetta and Secretary Shinseki from the Department of Veterans Affairs

A Department of Defense meeting transcript indicates that the DoD and VA will pursue interoperability and a common user interface rather than creating a single EHR to meet the President’s goal of a joint system. Secretary of Defense Leon Panetta says the VA and DoD have aligned their data elements and will start a pilot project this summer on a common VistA/AHLTA user interface for physicians. He says that project, plus the recently expanded Blue Button initiative, will meet the President’s directive faster and cheaper than creating a single EHR. The departments announced in March 2011 that they would create a common joint EHR platform, saying then that their respective systems were outdated and lacking functionality.

The Advisory Board Company Acquires 360Fresh

360Fresh products use natural language and text processing to analyze information from electronic medical records and other sources, adding real-time predictive analytics capabilities for The Advisory Board Company’s Crimson customers.

Physician Satisfaction with Best-of-Breed EDIS 59% Higher than Enterprise Systems

A new KLAS report on emergency department information systems finds that ED physicians give best-of-breed ED systems higher scores because of clinical decision support, usability, and accuracy of documentation, while enterprise systems provide advantages in interoperability, continuation of care, and communication with other hospital systems.

New Children’s Electronic Health Record Format Announced

AHRQ and CMS release a guide for EHR developers that includes a minimum set of data elements and data standards for children.

HIStalk Interviews Lorre Wisham, CEO, Health Technology Training Solutions

Lorre Wisham is president and CEO of Health Technology Training Solutions of Tucson, AZ.

Tell me about yourself and the company.

I’ve spent almost two decades in a wide variety of operations leadership roles in healthcare IT. I am a problem solver and a process person. Years in a customer-facing role taught me to look for solutions.

HTTS was the vision of my late husband, Josh Wisham, who had a long and successful career in healthcare IT. Three years ago, he did some research into the most successful HIT solutions and found that training is always a key element. He partnered with McKinnon-Mulherin, a Salt Lake City-based company that focuses on instructional design and training development. Liddy West, a long-time friend and colleague, signed on to lead sales and marketing. HTTS then started to deliver solutions to the challenges of customers — inadequate resources or skills, short deadlines, and customer demands. Those customers loved the result.

After Josh passed away last summer, I stepped in as CEO. We’ve updated our website, added a catalog of services, and sponsored the coolest blog in the industry. [laughs]

What’s have you seen, good and bad, with vendor-developed training?

There is a broad spectrum here. I think some vendors do a great job with their training and others don’t. Generally, I would say the greatest positive is that the person creating the training is a subject matter expert and knows the product inside and out.

At the same time, that very thing can also be the greatest negative. Someone who knows something so well often assumes a level of understanding that customers may not have. And in many cases, vendor training people don’t have instructional design skills or understand how adults learn best.

I’ve said it before and I will say it again. Training is typically not well planned and is often an afterthought or a rush in the eleventh hour before a new release or product has to go out. When that happens, the outcome is somewhat negative because training is just a checkbox or a line-item cost for the client and vendor.

When training is done right, it delivers positive outcomes in many areas, from adoption to satisfaction to reduced call center costs. We know that.

Give me a few examples of how you’ve worked with customers.

HTTS has delivered effective training solutions to a number of healthcare IT companies. We have done everything from evaluating training programs and resources to designing and developing of e-learning modules for a retail pharmacy company.

I think what allows us to create the right solutions is our approach. We do an assessment first to understand the current state and the needs. We can suggest where we can help the most. We want to fill the gap. We don’t want to take over and do what the existing training department is there to do. 

We mentor or supplement or we do it all. It varies so much from one company to the next. Every one of us at HTTS has been on the customer’s end of the conversation in our careers, and we work to make it as easy and impactful as possible.

How would instructional designers with expertise in training technology and adult learning principles approach new version user training differently?

It seems to me that no matter what company you are looking at, training is something that gets put off until the last minute. When product management is thinking about a roadmap for a new release, they might mention training, but it usually isn’t really an active part of the project until the product is almost ready for GA. Everyone on the vendor side is sighing with relief because they’re done and ready to move on to the next thing.

Training is often rushed and incomplete. Because the people creating the training know the content so well, they assume everyone knows as much as they know, so training can miss some of the fundamentals. Or worse, the training is organized according to the way developers designed the product rather than how customers will use it.

When instructional designers look at the product, they don’t assume anything. They aren’t subject matter experts. Instructional designers create the training for people who are seeing the product for the first time. Considering how much staff turnover and system replacements we’re seeing on the client side, the odds are pretty good that they are working with new applications and devices regularly.

Beyond that, instructional designers know how different people learn and how their work and learning environments can impact that. Think about how training needs to be different for a physician in the office versus a nurse in a busy emergency department. IDs are trained to think about those differences and to go beyond a lecture or demo. The result is training that is more engaging, more applicable, and longer lasting.

What metrics can be used to measure the effectiveness of a training program?

Interesting you should ask me that because it is something we are spending a lot of time on so we can quantify ROI. Most learning professionals are fully aware of the steps we need to take to evaluate training effectiveness, but getting the metrics can be a little tough. 

How do you measure customer adoption of software? That is a critical aspect of what we are talking about here. If a customer knows how to use the product and takes full advantage of it, how do you measure the value of that compared with another customer who doesn’t? Satisfaction, probably, but how can you be sure it can be attributed to training? 

The one obvious metric we discovered when working with an imaging company was the reduction in support calls. Luckily, they were already capturing the “How do I?” questions in their CRM. They told us those training-related calls were reduced by 35 percent after HTTS delivered the new version training. For them, that was huge. 

Not all clients are able or willing to provide benchmarks. There is risk in measuring ROI and some benefit in not knowing. It lets you keep doing things the way you’ve always done them. One of our goals is to encourage clients to capture and share benchmark data on adoption, sales, customer satisfaction, and support calls and then compare it to post-training numbers. That way, we can measure not only the effectiveness of training, but also the value that good training delivers.

Can training programs be a competitive differentiator for vendors?

Absolutely. But the trickier question is, does anyone think of it that way? I’m sure many of your readers follow the KLAS reports. Most vendors read the comments their customers wrote about their products. But who focuses on the training comments? Often the implementation manager reads them, but it is probably not his or her area of responsibility.

I can’t think of a customer I have encountered in my career who has said, “Wow, the training was amazing, and I feel so much more prepared to use your software.” Epic customers come the closest to that because Epic forces them to become certified in using and administering their system. It is brilliant. They are happier users and good references because they are able to integrate the system more naturally into their workflows.

How do you see software training evolving over the next few years and how will the company address those changes?

The biggest changes will come in delivery methods. While many in healthcare are just barely getting their minds around Web-based e-learning modules, other industries are already delivering their training on mobile devices. They are taking advantage of social networking to create learning communities where knowledge is shared in faster and more dynamic ways, right when and where the user needs it.

Our job is to help healthcare bridge the gap between where providers and vendors are today and where they can be tomorrow. We know what’s possible with today’s rapidly evolving learning methods and technologies, but we also know the unique needs of the healthcare IT environment. We are going to keep nudging vendors and providers forward so they can benefit from these changes while not losing sight of the real-world complexities they face right now.

The Advisory Board Company Acquires 360Fresh

The Advisory Board Company announced this afternoon that it has acquired clinical analytics vendor 360Fresh of Palo Alto, CA.

360Fresh offers two products. Pulse360 uses text and data mining to extract information from existing systems such as EMRs to answer clinical and quality questions. Track360 is a clinician care coordination and workflow tool that streamlines provider handoffs, provides alerts, and improves patient communications. Both systems are targeted for use by academic medical centers, independent community hospitals, and large-scale ambulatory providers.

We spoke to CEO Paul Roscoe of The Advisory Board Company’s Crimson group ahead of the announcement. He says Crimson provides its members with analytics solutions for retrospective data review, while the additional of 360Fresh’s technology will create the next generation of analytics capable of capturing real-time information for hospitalized patients, including both discrete and free-text EMR data, and then using predictive analytics to identify opportunities to improve outcomes.

”360Fresh’s technology uses data mining techniques to gain access to the data that exists and in many cases is locked up in the electronic medical record,” he told us. “It performs text analytics and NLP processing, and then adds to that very advanced mathematical and predictive modeling capability that allows you to analyze structured and unstructured clinical data – progress notes, admission records, text results, billing information – and glean from that the salient clues to a patient’s behavior and clinical trajectory to create a comprehensive view of their risk factors for certain negative outcomes.”

Roscoe says Crimson members will be able to use existing rich data sets to identify areas of opportunity, including in accountable care-type models that require the ability to manage population health and chronic diseases. He refers to the new capabilities as “dynamic clinical intelligence,” which he contrasts to clinical decision support in that instead of running fixed rules to identify possible ordering errors, predicts future events such as the likelihood of a post-surgical patient being transferred out of the ICU within eight hours.

J. Sairamesh (Ramesh), PhD, 360Fresh CEO, president, and founder, led business solutions for IBM over 14 years, working on technologies that included Early Warning Systems and Watson. Roscoe says 360Fresh is working with several large medical centers that have not yet been publicly identified. Terms of the acquisition were not disclosed.

Morning Headlines 2/6/13

Cerner Reports Fourth Quarter 2012 Results

Cerner beats estimates with earnings per share of $0.67 vs. $0.55 a year ago, with revenues up 15 percent.

DOD, VA to Speed Integration of Health Records

The Integrated Electronic Health Record, originally scheduled for a 2018 rollout, is on track for go-live by the end of 2014.

Can computers predict medical problems? VA thinks maybe.

The VA solicits bids for a pilot program that will analyze information in its VistA electronic medical record using natural language processing and machine learning to uncover patterns that can be used to improve outcomes and efficiency.

Health care venture in Leawood plans to generate 200 jobs

Startup eLuminate Health, which offers a consumer site for pricing elective surgeries and choosing providers, says its planned Kansas headquarters will create 200 jobs over the next five

News 2/6/13

Top News

Cerner announces Q4 results: revenue up 15 percent, EPS $0.67 vs. $0.55, beating estimates of $0.64. Shares rose five percent in after-hours trading Tuesday. The company’s market cap is $14.3 billion. From the earnings call:

• Q4 bookings were just over $1 billion, a record
• System sales were $252 million of the $710 million in revenue
• Thirty percent of the bookings came from non-Millennium clients
• The company says it had nearly double the number of new HIMSS EMRAM Stage 6/7 users as its closest competitor, presumably Epic
• It claims that Epic is pushing back on Meaningful Use Stages 2 and beyond because it will be challenged to meet them
• EVP Jeff Townsend said the industry needs to step up to the challenges of interoperability, including use of a patient identifier
• The company says it thinks even Epic clients that have paid a lot of money can be convinced to change systems if their reimbursement is threatened due to quality problems
• The company signed four deals worth $40 million or more, with the showcase being LA County
• Neal Patterson said the market is really a choice between two companies, presumably Cerner and Epic
• The company says 85 percent of its customer base has completed Stage 1 attestation

Reader Comments

From Mike Tomlin: “Re: Rich Goldberg. He is leaving McKesson/MED3OOO to run marketing for GE reseller Virtual OfficeWare.” Unconfirmed, but the source is good and his departure would not be surprising given McKesson’s recent acquisition of MED3OOO.

From Bean Enumerator: “Re: Brigham and Women’s CIO position. Not filled yet.” A reader reported on January 30 that Joe Schmitt was taking the job, but that was not verified. The opening remains posted.

From MedWreck: “Re: Innovation Institute. Color me skeptical.” St. Joseph Health (CA) launches for-profit The Innovation Institute that will include includes an incubator, shared services, and an investment portfolio. The primary motivator seems to be to commercialize the intellectual property of large academic medical centers. The only hospital member named is St. Joseph Health, which provided almost all the institute’s executives, including former St. Joseph Health SVP/CIO Larry Stofko, who will run the Innovation Lab. Larry let me know about the Institute’s formation last summer, at which time I mentioned it and his new job there.

From Incredulator: “Re: HIMSS e-mail blast. A customer forwarded this e-mail they received from a company pitching their HIMSS booth. Check out the last line.” It’s easy to doctor a forwarded e-mail, so I’ll assume that’s the case since surely the company whose identifiers I’ve blurred wouldn’t be stupid enough to end an otherwise button-down e-mail blast with a puzzling grand finale. Although if they did, I’ll be interested to see if they own up to it as either a horrific faux pas or an overly bold attention-getter.

HIStalk Announcements and Requests

We did a good interview with Vocera Chairman and CEO Bob Zollars on HIStalk Connect.

Welcome to new HIStalk Platinum Sponsor Cornerstone Advisors Group. The five-year-old Georgetown, CT-based professional services firm, in its own words, “provides high-value consulting, advisory, implementation, and staffing services to the healthcare delivery middle and lower market segments at a fair and reasonable price” around its core principles of partnership, integrity, commitment, and value (remember “value” because it’s coming up again). The company took the #1 spot in “Planning and Assessment” and #2 in “Vendor Selection” in the 2012 Best in KLAS awards, with its customers scoring it with a sweet 98.4 and 96.1, respectively, also giving Cornerstone stellar marks for value with a 9.0 in the all-important “Money’s Worth” score in both categories. Cornerstone’s leaders and associates are former Big Six consultants, CIOs, and physicians, and I notice that President and Founder Keith Ryan has a distinguished industry history on the front lines as VP/CIO of Stamford Health (CT) and Elmhurst Memorial Healthcare (IL) as well as having held executive positions with top consulting firms, not to mention that I notice he is an HIStalk Fan Club member, which carries a lot of weight (with me, anyway). I’ve seen the company’s revenue and FTE numbers by year and it’s a steep curve up, earning it a spot on the Inc. 5000 with 431 percent three-year growth. Some of its clients include HCA, William Backus, Chilton Memorial, and Finger Lakes. If you need help with advisory, implementation, or staffing services, consider giving Cornerstone Advisors Group a chance to earn your business. I appreciate their support.

Acquisitions, Funding, Business, and Stock

Oak Investment Partners invests $40 million in xG Health Solutions, an independently operated venture that will market intellectual property and expertise developed by Geisinger Health System, including healthcare IT optimization, consulting services, population health data analytics, and care management. We announced the news on January 11 when phony-named reader Jerry Aldini forwarded a copy of the internal announcement.

CTG acquires etrinity, a provider of IT services to the healthcare market in Belgium and the Netherlands.

Michael Dell will regain control of the fading company he founded as Dell announces plans to be taken private in a $24 billion leveraged buyout that also includes taking a loan from Microsoft. The company plans to move its focus from low-margin and low-demand PCs to enterprise services, which worked for IBM years ago as it moved away from hardware. That same strategy hasn’t done much for HP, which is now discussing breaking the company up in hopes of finding shareholder value hidden somewhere in its diverse offerings. The Dell change could be good for its healthcare consulting folks, most of whom were brought on board with its 2009 Perot acquisition that included the former JJ Wild.

Startup eLuminate Health announces plans to open its headquarters in Leawood, KS and create 200 jobs over the next five years. The company offers a network for imaging and surgical providers to provide transparent pricing, clinical quality, and customer satisfaction ratings for consumers (sounds pretty much like an Angie’s List for elective surgery). CEO Tami Hutchison came from Cerner, which you probably guessed given the company’s location and line of business.

Speech technology vendor Vestec raises $1.5 million in capital from V. Raman Kumar, founder and former CEO of MModal. The company offers a speech recognition engine and a Natural Language Understanding system, with a text-to-speech engine planned. The products seem to be small-vocabulary systems for specific voice commands for use in devices such as TVs, GPSs, and PBX-type setups, although Kumar says he’ll help the company move into healthcare.

Sales

CHRISTUS Continuing Care (TX) selects HEALTHCAREfirst’s homecare, hospice, and CPO solutions.

MDH Radiology chooses Sectra’s Breast Imaging PACS, Merge Healthcare’s CADstream, and other tools to create a national telemammography solution.

MD Anderson (TX) chooses Oracle Health Sciences applications  and Oracle technology for an organization-wide analytics initiative to develop personalized cancer treatments.

CMS awards Emdeon a contract to define the process for testing new HIPAA and ACA transaction standards.

Kentucky Medical Services Foundation and UK Healthcare sign a five-year agreement for Opportunity AnyWare, the business analytics platform from Streamline Health Solutions.

Kalispell Regional Medical Center (MT) selects EDCO Health Information Solutions for its day-forward scanning technology and services.

Middletown Community Health Center (NY) chooses EHR, PM, and EDR (dental) solutions from SuccessEHS for nine service locations and two mobile health units, announcing plans to go live within 90 days. 

Parkview Health (IN) selects ProVation Medical from Wolters Kluwer Health for gastroenterology procedure documentation and coding.

People

Kasey Fahey joins Direct Recruiters as project coordinator in its healthcare IT practice.

Announcements and Implementations

Covisint launches Covisint Healthcare, an integrated solution for analytics across multiple systems and stakeholders that includes enhanced data capture and reporting, real-time admission and discharge notifications, and patient outreach and scheduling.

Reading Hospital (PA) goes live on its $150 million Epic implementation.

Four hospitals of Bassett Healthcare Network (NY) go live with Epic.

LHP Hospital Group (TX) implements McKesson Paragon at five hospitals.

Cox Medical Center Branson (MO) completes activation of T-System’s PerformNext Care Continuity solution to facilitate patient transitions and improve communication and access to clinical data.

ZirMed launches Clinical Link, a nationwide provider-to-provider information exchange platform.

Awarepoint Corporation launches Bed and Bay Sensor for precise tracking of mobile equipment and patient and caregiver interactions in locations with tight bed spacing such as the ED and PACU.

Government and Politics

The VA solicits bids for a pilot program to test how advanced clinical reasoning and prediction systems can use its VistA patient data to improve care, efficiency, and outcomes.

Brian Ahier reports that a new federal law will be published this Friday that will require drug, device, and medical supply managers to publicly disclose gifts given to physicians or teaching hospitals. The Physician Payment Sunshine Act, part of the Affordable Care Act, charges HHS with collecting information about consulting fees, gifts, honoraria, food, entertainment, and travel from companies that are covered by any federal health program.

Innovation and Research

The Washington Post looks at the burgeoning field of geomedicine, which uses geographic information system technology to correlate environmental conditions with health risks. One example is an inhaler device from Asthmapolis that is equipped with Bluetooth to track when and where patients use their inhalers.

A Germany-based company develops an intelligent armchair that contains health-monitoring technology that constantly measures the health of its occupant, also displaying the user’s historical health measurements via a tablet PC to the TV using Bluetooth. A virtual health assistant uses the information to develop and monitor a personalizes health plan, for which the chair transforms into a rowing machine. The company plans to add mental games to encourage participation and increase alertness.

Fast Company covers the just-concluded MIT Health and Wellness Hackathon, which focuses on commercially viable products. Some of the entrants: an app that encourages HIV/AIDS patients to take their meds, a sensor-based home monitor for congestive heart failure, an endometriosis surgery app for patients, home Parkinson’s monitoring tools built into gloves and a coffee cup, a blood pressure pill bottle reminder, and a diet tracker for epileptics.

Other

I don’t see the point of “pass a test, earn some paper” certifications like the ones offered by HIMSS and some for-profit companies, but this one really puzzles me. HIMSS introduces CAHIMS, designed for “emerging professionals” with less than five years’ experience in healthcare IT. I would be doing all I could to try to hide my newbie status on my resume rather than proudly waving around a paid-for certificate that boasts of my relative inexperience.

Baltimore-based startup Parallax Enterprises, founded by a physician who is also a military pilot and an Air Force major, raises $1 million to develop a heads-up display of surgical checklists. I’m intrigued that Jeff Woolford, MD has booked 1,000 hours in the single-seat, low-level combat A-10 Thunderbolt II tank killer, which is ugly, slow, low-tech, cheap, and scary as heck for the pilot but the most reassuring sight imaginable for ground troops, at least those on the same side. I’ve seen live exhibition flights of just about every modern-era US warplane and the A-10 was the most memorable. Hats off to Dr. Woolford for his service as a Wart Hog driver over Afghanistan.

Former HealthStream executive Luther Cale offers 33 Ways to Reboot Your Life, free on Amazon through midnight Wednesday. Judging from the “Look Inside” feature, you won’t get much out of it if you don’t believe in non-traditional medical techniques like spiritual psychotherapy and healing tonics.

Unverified rumors claim that Cerner and McKesson will open up interoperability between their systems to try to compete with the Epic juggernaut, with a potential announcement planned for the HIMSS conference. I’m skeptical that two large, publicly traded competing companies would agree to such cooperation, so if you have details, please share.

Seattle-based Carena launches its CareSimple program, offering Webcam-based virtual visits with one of its 15 physicians and nurse practitioners for limited conditions for a cost of $85 or for $5 with a family membership of $35 per month.

Texas Medicaid tries to revise its “pay and chase” policies after a TV station’s investigation finds that taxpayers were charged for $705 million over three years for orthodontics. The state is holding the payments of 91 dentists suspected of fraud.

Sponsor Updates

• MedAssets pledges support to employees who serve in the National Guard and Army Reserve.
• Chris Tackaberry, co-founder and CEO of Clinithink, shares details of how Clinithink came about and the challenges along the way in an interview. 
• SimplifyMD reports that 100 percent of its customers choosing to file for MU attestation have completed the process.
• The Advisory Board Company hosts senior policy makers on Capitol Hill to discuss efforts to improve care under new Medicare value payment programs.
• Cerner will integrate Gateway EDI’s claims and remit systems with its PM solutions.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 2/5/13

Geisinger launches xG Health Solutions

Geisinger Health System (PA) forms for-profit xG Health Solutions, backed by $40 million in financing from venture capital firm Oak Investment Partners. The new company will offer healthcare IT optimization, consulting, population health data analytics, care management, and third-party administration services.

ZirMed Launches Clinical Link

ZirMed launches provider-to-provider communication for the 100,000 EMR users connected to its network.

A National Action Plan To Support Consumer Engagement Via E-Health

A HealthAffairs article by Farzad Mostashari and ONC colleagues explains ONC’s “Three As” strategy (access to electronic patient information, apps, and attitudes) to improve consumer e-health.

HIStalk Connect Interviews Bob Zollars, CEO, Vocera

Vocera CEO says being publicly traded “has made us a better company,” the end of the hospital pager is near, and “trying to fight the BYOD movement is like fighting a religious war.”

New technology helps doctors link a patient’s location to illness and treatment

Epidemiologists develop a GPS-equipped inhaler to correlate asthma flare-ups with location. “Place should be a vital sign,” says a spatial epidemiologist in a field now known as geomedicine.

The Skeptical Convert 2/4/13

If you were my patient and I mentioned to you that it wasn’t until recently that I found out that blood circulation was how you get oxygen to your body parts instead of absorbing it from your skin, what would you think of me? I think you’d politely excuse yourself and leave. Because although I specialize in gastroenterology, I as a doctor am supposed to have an understanding of how the whole body works. I’m not supposed to see it as some mysterious black box that I had to learn to deal with by rote.

When I talk to a cardiologist about a case, he may not go as far into physiologic details with me as he would with another heart specialist, but he will refer to general principles that we all learned earlier in our education and training, to orient me to at a reasonable level of understanding about what is going on and what needs to be done.

Right now though this concept doesn’t seem to apply much in the medical computing world.  By way of an example, I direct you to a study and editorial in the January 15 Annals of Internal Medicine. The original study looked at Meaningful Use measurements in practice by going back over the actual records.

The authors documented a statistically “wide measure-by-measure variation in accuracy” that “threatens the validity of electronic reporting.” I know, that’s no big surprise to any regular reader at this site–file it under “Department of Duh.”

The accompanying editorial caught my attention, though.  It was written by a distinguished general internist, trained at top institutions and a university medical faculty member. She wrote very well, and with a knowledgeable authoritative tone, about the problems with getting statistically valid data out of multiple sources, users, and formats.  

Right in a middle paragraph, after a general comment about about how variable use of the EHR by different providers increases “measurement noise”, she noted a striking personal example, and I quote: ”In my own practice, I learned that my lower rates of blood pressure control reflected the fact that I was documenting the patient’s blood pressure in free text rather than using an available structured field.” And then back to the general subject.

Wow. It seems to me that that deserved more discussion. OK, maybe she didn’t know they were tracking blood pressure in the first place. Maybe she assumed the system had the ability to capture that information from a text entry by some sort of NLP process. I’d like to know that, but I’d also like to know if she understood at that point about these things called databases underneath applications — that they store different categories of data, that they treat numeric data differently from text, and how numeric data generally needs to go into structured fields for that to happen.

Because I can tell you, from lots of personal conversations I’ve had, that whether she did understand those basic concepts or not, plenty of other medical practitioners don’t. That was worth discussing at greater length, whichever of those theories or combinations are true or false.

Why? Because if medical practitioners, as users, are going to see HIT as an alien world only approachable by rote training, they’re going to fall into potholes like this all the time, and I see it happening a lot.  There are a lot of lousy EMR designs out there, and a lot of mediocre training, but I can’t help but think that at least some of the problems with usability stem from gaps in basic user comprehension of the bigger picture.

David Brooks said it well the other day. “Change is hard because people don’t only think on the surface level. Deep down, people have mental maps of reality — embedded sets of assumptions, narratives, and terms that organize thinking.”  

That’s what happens when I’m talking to the cardiologist. Deep down, we have a common map of reality in our heads. That’s how we organize things in our minds and how we think. We’re here in the first place because that’s what we’re supposed to be able to do.

I read a lot of naysaying on this site about the computerization of medical practice, written as if it could all go away.  It’s not going to, but what we have right now isn’t working very well. Part of the solution will be for the mental maps of HIT people and physicians to match up better. The physicians do need to accept that their mental maps are going to need some revision. The IT people need to realize that we need explaining to get the training to sink in.  

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

Curbside Consult with Dr. Jayne 2/4/13

I wrote a few weeks ago about the ICD-10 planning debacle at our hospital. Our ICD-10 task force had come to a physician staff meeting to discuss the transition plan, which had been created in a silo. I asked betting folks how long they thought it would take until the application team managers were asked to redo the planning. Any of you who guessed four days wins a prize.

The announcement that the IT teams would now own the initiative occurred just before our annual IT planning conference. During most years, we lock ourselves in a room for several days of bad takeout food, worse coffee, and questionable prioritization exercises.

I usually find myself at the end feeling bewildered at some of the initiatives that are given the green light. For example, last year we approved a hideous EHR conversion project for a single practice, but placed a project for hospital charge capture on the back burner even though the charge capture project was cheaper and easier.

If anyone asks, we use a well-known proprietary decision making process to decide which projects are most valuable to the organization. We all had to go through a multi-day course to use this methodology, although at the time it felt like multiple weeks. For those of you whose organizations are into that sort of thing, I salute you as survivors. (I don’t want to get sued using their name, but if you’ve ever dealt with The Red Sweat, you know what I’m talking about.)

For the physicians on the team who are used to assimilating numerous disparate data points and coming up with a diagnosis rapidly, it was pure torture to sit creating grids, weights, and ranks for various decision points. The hospital spent a huge amount of money licensing the program and training all of us, however, so we’re stuck with it.

For each project proposal, we have to create a matrix where we then rank things to hopefully achieve an objective outcome. It’s a completely biased process, however, because most of us know how to game the different measures to up- or down-rank a project. The outcomes remind me of the worst kind of back-room dealing. At least if we agreed up front that the decisions would all be political, we could save a couple of days and a few thousand calories of bad catering.

This year, we really should have skipped it. The results were so skewed it can hardly be called a prioritization process. Every project proposal seemed to earn the highest marks except for ICD-10 and MU-2, which of course shouldn’t have been part of the process since they’d already been labeled as mandatory.

One team member was hell-bent on twisting each of her pet items to associate to a regulatory requirement. It reminded me of Animal Farm, where all animals are equal, but some are more equal than others. By the end of the planning retreat, my fingers were raw from speed-surfing the Web trying to research and contradict her continued demands that we do every single item “because it’s regulatory.”

My current boss is extremely non-confrontational, so this behavior was allowed to continue. We are now left with a list of things to do that would require a team three times our current size. So much for prioritization.

Now it’s up to the managers to get together and cut deals to see they can help each other out and what projects overlap or can share resources so we actually have a shred of hope that we will get them done. There’s certainly no extra money floating around, so we’re going to have to shuffle the pieces on the board and figure out how to deliver the impossible. It’s lining up to be a very interesting year.

Have a great story about your organizational planning strategy? Do you feel like you spend every day in a war room? E-mail me.

E-mail Dr. Jayne.

HIStalk Interviews John Howerter, SVP, Levi, Ray & Shoup

John Howerter is senior vice president of Levi, Ray & Shoup of Springfield, IL.

Give me some brief background about yourself and about the company.

I’ve been with LRS for 20 years. I have been involved mostly in the software side of the LRS business.

Before coming here, I was with IBM. I started as a technical guy and then got into sales, then back into systems engineering management and sales management. I left IBM in 1992 and wanted to stay in the central part of Illinois. I really wasn’t interested in moving around the world, so I came to work for Levi, Ray & Shoup, a privately-owned software company, in July of 1992. I saw it was a good place for me to learn some things.

The company is owned by Dick Levi. We continue to stay focused in this niche. It’s been a crazy ride for 20 years, but a lot of fun.

It doesn’t seem that people think of hardcopy printing as mission critical. Do you think that’s the case?

I’d say certainly printing is the last thing that people think about. The fundamental issues about what people think about printing now versus what they thought about it 20 years ago has not changed much. When I came to LRS 20 years ago, before accepting a job here, I asked Dick Levi — who was going to be my ultimate boss — what his biggest concern was at that time. It was that the mainframes would go away. Certainly the role of the mainframe has changed, but people’s attention to the issues surrounding print management haven’t changed at all. People never think about it.

Since I’ve been here, we continually get phone calls and talk to people who say,”I’m going to print less.” They’ll implement the system without regard for even thinking about the printing infrastructure. Then they run into problems. That’s when we get involved. 

Hard copy has never been sexy or at the front of a business process, but in many industries — and particularly in the healthcare industry — things that get printed continue to have an impact on successful and smooth operations.

In healthcare, the end result of the workflow is often a label, wristband, or report. Until you get that, you haven’t accomplished much. Do prospects understand that?

I guess it depends who you ask. [laughs] I think the people doing the work clearly understand that. Our customers have told us that vendors today and over the last 20 years have said, “We’re not going to print any more.” What? You’ve got to put labels on prescription bottles, samples, blood, and patients. People never think about printing until it stops.

It almost seems that companies trying to sell managed print services took away the impact. Paper and toner is so cheap that it was tough, at least in my hospital, to make a business case for consolidating and centralizing printing. 

Certainly people are printing more today than they used to. There are more opportunities to print. People print from Web pages. People today print all kinds of things that they probably shouldn’t be printing in their daily jobs.

We think about printing in a couple of different ways. We think about printing that is a part of the workflow of any line of business application. Then we think about printing that occurs in the Windows office environment. 

I think there’s a continued push for people to move towards managed print services. Certainly the printer vendors are all trying to add value to differentiate their commodity products in some way. Money can be saved in printing, but the things that you try to do in managing and controlling the costs of printing in an office environment are very different than the things that you need to do to control and manage the printing that occurs in a business workflow environment.

Application software printing usually involves an uneasy technical handoff to the underlying operating system, putting the customer in the middle where it’s hard to say for sure that something that was supposed to print really did at the place they expected. The end result can be a workflow nightmare. What’s the value of putting your solution between the vendor software and the operating system?

Seventy percent of our sales in North America in the last couple of years have been in the healthcare market. The reason for that is exactly on the point that you just mentioned. The value that we provide is that we are a reliable place where your output is. Output is either in our print spool or it has printed. There’s no in-between. 

We provide end-to-end visibility. If the Epic system has created the output, we have it or it’s been printed. When somebody walks through a printer and looks for their output and says, “Wow, it’s not here,” with our tools, we can tell you where it is. We can instantly re-route it to another device where you’re standing and we can manage all that. Our value add, quite simply, is we give you end-to-end visibility. Without a subsystem to ensure delivery, it gets lost in the middle, and that happens far too often.

I’ve seen first-hand where patient care was compromised because of delays caused by missing printed documents, often because the print spool service was hung up on the server or a printer was stuck in an error state that nobody knew about. Do people tell you those stories?

That’s exactly what happens. A lot of people cannot foresee that. The technical people foresee it. The people who are buying applications like Epic, Millennium, or Soarian want to believe that those problems are resolved by the application vendors. They’ve got bigger problems. That’s what we hear about constantly.

We commissioned IDC to do a study for us two years ago. Our biggest challenge is convincing people buying and implementing these large line-of-business applications that printing is going to cause enough of a problem for them that it’s worth investing in solving those problems. IDC concluded that after talking to 10 of our customers and analyzing their environments before and after our solution, there is about $51,000 per year per 100 printers managed in savings for customers who have selected our system. About half of that savings comes from improving the productivity of the people in IT who track down printing problems.

Of that half, 60 percent comes from eliminating the tasks required to track down failed print problems. That doesn’t mean the server is down. That might mean the printer is turned off. That might mean there’s no paper in the tray. That might mean the application has sent it, but for some reason, there was a network problem. The hassles and the time that people spend tracking print that didn’t show up where it was supposed to show up –that is the lion’s share of the value that we provide to people.

It’s always frustrating when tracking down printer problems that you can see documents waiting to print, but Windows doesn’t let you see their contents. You can’t tell what’s in the documents the user didn’t receive and you can’t route them to another printer.

That’s real. Here’s what happens. IT organizations deal with that. Those problems are being solved by people. They’re being solved the hard way. 

I  can talk to a CIO in a healthcare organization and say, “How much time do you spend with this?” They say, “Well, I don’t know. I don’t hear that this is a problem.” You don’t hear it because your organization has solved that problem, but they’re solving it in a very inefficient way. They’re solving it with people. 

You’re right. You can’t reroute a job out of a Windows queue. You can’t reprioritize it. You can’t reformat it. You can’t instantly say, “Oh, I see. It’s here. Let me print it on this device over here.”

It was a nice luxury on mainframes and midranges to be able to view the contents of waiting spool files, make a copy, or move them around. Windows doesn’t seem very enterprise strength in that regard.

That’s exactly what we do. As I mentioned, this company started in 1979. Our owner wrote a program to allow access to IBM’s mainframe spool called the JES Spool and route that output to a network-addressable device. We utilized the IBM JES Spool as our spool mechanism, but we took the output from an interface of that spool and allowed people to manipulate it, to translate it from IBM data string formats so it could print on an HP LaserJet, for example.

That’s our heritage. We focus on the enterprise. We are bringing that kind of reliability and manageability to distributed environments. That’s what our primary business is today – giving that kind of flexibility to manage the things in the spool and deliver them. If you don’t do that, you’re flying blind. You have no visibility from the application all the way down to the output device. It’s more complicated than it used to be because everybody does things their own way.

You seem to work a lot with Epic shops.

I talk to people a lot about whether or not they should consider investing.  We have a lot of very large and very successful Epic customers. We fulfill that value proposition for Epic customers as we do some of the others. We have worked with Epic to help us get metadata about output. For example, for every piece of output that we print, you can know the Epic user who initiated the output. We have worked with them to enable our software to get data so we can account for who printed it, where it was printed, and where it came from.

Our Epic customers fall into two categories. They’ve bought Epic, and on the front end of that implementation, recognize that they need a more robust management system for output to avoid inhibiting the workflow. Compared to an investment in Epic, an investment in our software is fairly insignificant. Many of our Epic customers start on the front end and say, “We want to do this right. We want this implementation to go well.”

There’s another category of customers who have been implementing Epic for a few years and had been struggling with the problems that you mentioned — I can’t find my output, it was supposed print and it’s not there, why is it not formatted correctly, who knows what. After a couple of years in an organization that has any scale to it, physicians and caregivers have raised the level of noise in the IT organization so that it’s a problem that needs to be dealt with.

I’m not sure that there’s anything specific about Epic that is different than the others. It’s just that people are not willing to let an Epic implementation suffer, I suppose, at least from my perspective. In lot of cases, we are dealing with enlightened IT people who want to avoid the risk of not providing a stable, hassle-free environment, so we take that pain away. A lot of people don’t realize they’re going to have it until they get into it.

Have you seen any impact from the changing HIPAA requirements and HITECH?

Certainly. We are an infrastructure vendor. We talk a lot about HIPAA. When you say HIPAA to me, it makes me immediately think of securing data and controlling where output can go and accounting for where output can go. Certainly that is in our sweet spot.

We intend to be the single output server for all output in a large organization. We can efficiently route that. That means we can officially keep track of who did what. HIPAA, Sarbanes-Oxley in other industries, and all these regulatory environments that cause people to want to know who did what so they can audit it certainly have been helpful to us.

How do you see the business changing?

We work with all the printer vendors. We are working with a lot of these folks in terms of trying to ensure that when print vendors are engaged in managed print services projects, we’re working together with them to try to create the best possible environment for the customer and allow a customer to buy our software in the way that fits their budgeting and their management systems.

We’re certainly dealing with mobile devices, where our tools allow you to manage output and see output queues, for example, from any smartphone. You can manage print queues, see what’s going on from a mobile device.

We have enabled and provided downtime reporting tools. We allow you to electronically store and view output in a very simple way, interface or output management systems. We’ve provided in Epic environments some very usable and affordable downtime reporting technologies. We’re trying to figure out how the tablets and the iPads integrate into this. We’re working very hard to support virtual desktop environments.

This is all we focus on. We’ve been successful in this niche because this niche that we’re in isn’t big enough for the big guys. The application vendors have more to worry about than just printing. Many times they think you just create a PDF file and you’re good to go. We’re focused on integrating mobile technologies. We’re focused on making sure that we can support all the devices that are there. We’ve always been on the leading edge of supporting all the devices that exist because our large customer base contains lots of different devices.

In terms of development, it has to do with creating an enterprise output management system that serves the needs of a line-of-business applications like Epic and Soarian and Millennium and anything else that’s out there, balancing that with enabling use for office printing technologies. We’re eliminating hundreds and hundreds of Windows print servers. We are enabling pull printing technologies where that makes sense. 

We’re trying to just continue to focus on this niche and all that’s there because that’s what we know. We’ve got a very loyal customer base and a reputation that allows us to compete in these kinds of opportunities.

Morning Headlines 2/4/13

HHS Secretary Sebelius Address National Health Policy Conf.

HHS Secretary Kathleen Sebelius, National Coordinator Farzad Mostashari, MD, Paul Tang, MD of Palo Alto Medical Foundation, and David Blumenthal of The Commonwealth Fund will deliver addresses at the National Health Policy Conference in Washington, DC February 4-5. Portions of the event will be broadcast live on C-SPAN2 beginning at 9:00 a.m. Eastern today.

McKesson Management Discusses Q3 2013 Results – Earnings Call Transcript

Technology Solutions revenue was flat, margins impacted by revenue recognition changes for a UK acquisition. Legacy conversion to Paragon has been better than expected, while the company states that Horizon will support future Meaningful Use stages.

MyMedicalRecords Files Patent Infringement Complaint Against Walgreens

MMR, which has threatened a flurry of lawsuits claiming infringement on patents it recently acquired, files suit against Walgreens. MMR claims that displaying a list of prescriptions to a patient infringes on its intellectual property.

Meditech Files Annual Report

The privately held company reports that revenue increased by 9.7 percent for the year, with earnings per share improving from $3.41 to $3.55.

Monday Morning Update 2/4/13

From HIStalk Fan: “Re: HITPC/HITSC testimony of Karen Van Wagner, executive director of North Texas Specialty Physicians. The Pioneer ACO shares results of its community HIE.” She talks about successful efforts to increase EMR usage (eCW, Allscripts, NextGen) and the results of the exchange (Sandlot Solutions), which was launched in 2006. She says traditional healthcare IT isn’t providing cost and quality improvements because it focuses on retrospective data, often from claims databases, and the optimal solution involves both retrospective and current clinical information. They did a discharge transitions project study that exceeded targets for PCP follow-up, having discharge summaries available for the follow-up PCP visit, and readmissions. Her specific recommendations to the government: (a) simplify consent and disclosure rules; (b) expedite adoption of IHE standards; (c) require laboratory diagnoses to delivered by LOINC standards; (d) require hospital EMRs to send a “just admitted” notice to community providers via their own EMRs; and (e) require pharmacy systems to communicate with HIEs and provide their information at no charge.

Hospitalist DZA MD left an insightful comment on my Time Capsule article about doctors getting lost in the barrage of generally useless information cluttering up EMRs. Excerpting:

Anything that is templated has exactly zero clinical information value to me. I don’t care if Osler himself dropped in “dyspnea improved,” “no diarrhea” … If I want to know the validity of that kind of thing, I will look at the narrative part of the nursing note … The only data I look at that actually represents signal is the vital signs and lab data. The rest of the discrete data is noise … The narrative and visual graphics (including graphic displays of lab and vital signs data) are for us (clinicians). The templated stuff is for the suits and insurance grifters. QED.

From The PACS Designer: “Re: Microsoft Office 365. Microsoft is making a dramatic switch by selling its enhanced Office products in the cloud. They are calling it Office + Office 365, and will be offering a monthly subscription service with pricing based on business size and features selected by the customer. It’s a big gamble on users satisfaction with cloud services which as we know can experience interruptions in service at inappropriate times of the business cycle.” The good thing about Office is that the once-touted Office killers, especially Google Apps, are vastly inferior flops. The bad thing is that home Office users aren’t likely to lock themselves into a $100 ongoing subscription for something they formerly bought or stole once, although it’s a pretty good deal if you have a bunch of PCs since the home license covers up to five (less likely now that everybody’s using iPads and phones instead of extra PCs). And, you can temporarily load and run it to a non-licensed PC. I think it can work – antivirus software moved subscription software for home users to the mainstream, not to mention that Microsoft can just jack up the price of the box version to move people toward the cloud-based offering,  which would also kill the bootleg business (possibly their primary motivation). It won’t help that Office 365 had an outage almost immediately after its launch, allowing the boxed software users to work merrily along while the leasers couldn’t even get to Outlook.

From Godzilla: “Re: [hospital name removed]. Filing suit against [vendor name removed]. Unhappy with the products, implementation, and project management.” A hospital media spokesperson replied on the record to my inquiry, “Nothing could be further from the truth. Inaccurate on all counts.”

From Unbeatable: “Re: [vendor name removed]. Laid off 31 developers and outsourced all work to India and the Ukraine. The Chicago office lost the largest number of staff.” I’ll see what I can find out.

From IndustryBnkr: “Re: OptumHealth. Rick Jelinek is leaving as CEO to pursue another opportunity outside the company, with Larry Renfro taking over.” Unverified, but his former “About Us” page has been deleted. He took the CEO job a year ago.

From HITEsq: “Re: MMR. Made good on its threats to sue someone for patent infringement in January, going after Walgreens. MMR’s theory is that displaying a list of your prescriptions infringes on its patents. I seem to remember having access on Walgreens before 2005 when the MMR patent was filed.” Patent trolls love the US system because (a) the Patent Office is overwhelmed, they don’t have the knowledge required to understand highly technical patent requests, and will approve just about anything and let the courts sort it out later; and (b) lawyers are so expensive that mounting a legal defense can bankrupt a defendant even when they are clearly right since our legal system requires the winner to pay their own legal costs. Unfortunately lawyers often morph into politicians and are predictably loathe to bite the hands (as inserted into the pockets of others) that once fed them and may again, so we are required to be collectively complacent about the status quo.

Speaking of despicable patent trolls, let us hear from our new hero, Lee Cheng, Newegg chief legal officer and extortionist squasher. 

In related patent troll news, billionaire bad boy Mark Cuban endows “The Mark Cuban Chair to Eliminate Stupid Patents” at the Electronic Frontier Foundation, which he funded because, “Dumbass patents are crushing small businesses. I have had multiple small companies I am an investor in have to fight or pay trolls for patents that were patently ridiculous.” Mentioned in the article is Acacia Research, which I’ve railed about here many times, which claims to own the process of sending medical images over the Internet.

Yale-New Haven Hospital (CT) went live with Epic on January 31. Above: Sue Fitzsimons, RN, PhD (SVP, patient services); James Staten (EVP, finance); Marna Borgstrom (CEO); Daniel Barchi (CIO, health system and medical school); Lisa Stump (VP, Epic project); Peter Herbert, MD (chief medical officer); and Richard D’Aquila (president and COO).

The stock-pickers among us like Cerner and athenahealth just about equally. New poll to your right: did you go to the HIMSS conference last year, and are you going this year?

Speaking of those stocks I listed, I decided to see how they’ve done in the past year: athenahealth (up 40 percent), Allscripts (down 45 percent), Quality Systems (down 57 percent), Cerner (up 34 percent), and Merge (down 49 percent).

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

Psychology scientists from Brigham and Women’s Hospital perform an interesting study in their research into “inattentional blindness.” Radiologists were asked to examine the CT scans of five patients and click on whichever of the 10 known nodules they could find. The final case included a gorilla image that was 50 times the size of the nodule, which 20 of the 24 radiologists did not notice even though eye-tracking instruments showed they had looked right at it. I don’t see this as necessarily bad – a lot of the work in medicine is tuning out the noise to focus on what you’re looking for. However, it does reinforce the idea that in general it’s good to get a second opinion from someone less focused on the problem at hand, and if you’re a patient or lesser expert, you still might detect the forest that the tree-obsessed people have missed. It may also touch on confirmational bias, where people tend to place higher value on information that matches what they already believe (like brains not containing gorillas).

A New York Times op-ed piece observes a “casual lack of transparency” in that drug and device companies make sure that only positive studies are published, with the trigger being Johnson & Johnson’s recalled artificial hip that was marketed despite known problems that the public wasn’t told about. It observes two attempted fixes that have failed: (a) the FDA requires new clinical trials to have summaries posted on a federal site, but an audit found that 80 percent of the trials ignored the requirement and no fines have been levied; and (b) the medical journal industry promised to publish only pre-registered studies, but an audit found that more than half of published articles involved trials that weren’t registered correctly and one-fourth covered studies that weren’t registered at all.

Good luck explaining healthcare pricing to the public. A graduate student’s gallbladder removal was billed at $60,000 by an out-of-network provider. His insurance paid what it defined as a reasonable rate: $2,000. The average commercial price is $12,292, while Medicare would have paid $958. An advocacy group stepped in and the surgeon accepted $340. The article says the Affordable Care Act does nothing to limit out-of-network fees, which are almost always a surprise to patients since buildings and white coats don’t come with “I’m in your network” labels. I’ve known people burned by in-network EDs that used out-of-network doctors or lab companies, and of course nobody volunteered that information, not that you really have a choice in the ED anyway. The comments left on the New York Times article are fascinating and often insightful. The graphic above is from a new AHIP report.

A foundation employee of Fairbanks Memorial Hospital (AK) is charged with diverting $12,000 in donations that had been collected online via PayPal.

GE Healthcare is working with the VA to develop surgical robots that can locate, sterilize, and deliver instruments.  

Meditech files its annual report. For the year, revenue was up 9.7 percent, EPS $3.55 vs. $3.41. Neil Pappalardo owns nearly 39 percent of the company, holding shares worth around $650 million. CEO Howard Messing’s shares are valued at around $18 million. Share values are probably low given that the company is not publicly traded – I just used the most recent per-share acquisition price, but if the company were to be sold or IPO’d, the value would probably be a lot higher.

Nuggets from the McKesson earnings conference call late last week:

• Technology Solutions revenue was flat
• Margins of the Technology Solutions numbers was hurt by a required revenue recognition change for the System C UK business McKesson acquired in 2012
• RelayHealth and the payor software business contributed more than half of the profits of Technology Solutions
• More legacy customers than expected have either already moved to Paragon or have committed to do so instead of moving to competitor systems
• The Paragon ED solution is close to being generally available
• Both Horizon and Paragon will support Meaningful Use Stages 2 and 3

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Readers Write: Students in the HIT Spotlight

Students in the HIT Spotlight
By Lisa Reichard RN, BSN

Inspiring! That was the word that ran through my mind when I heard that the HOSA team of Harris County High School, Hamilton, GA had won the second annual Student HIT Innovation Award at the Health IT Leadership Summit for its Type 1 diabetes mobile health app.

As a former pediatric nurse who has worked with children newly diagnosed with diabetes, I was thrilled to see an app that can aid in the education and training of newly diagnosed patients developed by 11th grade high school students. Best of all, right here in my own back yard.

In my experience, this can be an isolating disease with challenging daily management. According to the Center’s for Disease Control (CDC), Type I diabetes has spiked 23 percent among children, with a 21 percent increase in Type II diabetes also reported.

The student team from HCHS rose to the challenge and was chosen from 12 semifinalists followed by a final four selection. HIStalk Connect’s own Travis Good, MD was on the judging panel.

Left to right: Todd Bell, senior VP at Verizon; Brooke Grantham; Aleah Harris; Hank Huckaby, chancellor of the University System of Georgia; Christopher Keough; Brittney Wilkins; and Cheryl Batts, Harris County High School HOSA Advisor

I had a chance to chat with team member Christopher Keough to hear more about the experience.

How does your Type 1 Project app work and how does one download it?

Our Type 1 Project app has several links to choose from that provide general information about Type 1 diabetes, informational videos, a link to our website and Facebook page, and even a link to a carb counter. To download our app, search for “Type 1 Project” in the Google Play store, or to access it on your iPhone, visit type1project.conduitapps.com and just add to your home screen.

How will the app help kids recently diagnosed with diabetes?

We feel that kids would rather use a mobile application than receive information from a doctor or a book because most of them own some form of technology. Children and young adults can relate to how to best calculate the amount of carbs in food on the go with the link that we’ve provided through the app. They can also learn more about their condition through our website and the informational videos that we’ve provided.”

What are the plans for the product?

This mobile application started as a project for the Health IT Leadership Summit award, but we plan to keep it live for a limited time and try to make more users aware of the app through Facebook and other methods. We also plan to make ongoing improvements to the mobile application.

I also had the chance to ask Cheryl Batts, Keough’s advisor, how those of us in the health IT community can encourage students to foster future creativity in application development, and succeed in pursuing future IT careers.

“We can start in our classrooms,” she explained. “Last year, the health IT project was directed toward middle school students. Although an estimated 95 percent of students in my classes have cell phones, and this is where our mobile app can come into play, I believe many students have no idea what healthcare IT is. I know when I mention the number of job openings in Atlanta in my classroom, they all start thinking hard about it.”

“The mobile app we developed had a monetary award for our HOSA organization. HOSA, a national student organization, used to be an acronym for Health Occupations Students of America. However, it now stands for just Future Health Professionals. The chapter is for any student interested in a career in healthcare. The mission of HOSA is to enhance delivery of compassionate, quality healthcare by providing opportunities for knowledge, skill and leadership development of students. HOSA provides competitive events and leadership training at conferences that include knowledge and skill competencies through a program of motivation, awareness and recognition as part of the Health Science Education instructional program. Of course, these conferences cost money, so earning money for the organization helps reduce student expenses. The offering of scholarships is a big help to our students as well.”

Congratulations to Harris County High School on the receipt of this milestone award. Let’s all do what we can to support our local students. Who knows? We may start seeing more students demoing apps at trade shows. The future is looking bright!

Lisa Reichard, RN, BSN is director of business development of Billian’s HealthDATA of Atlanta, GA.