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News 7/13/11

July 12, 2011 News 2 Comments

Top News

The Government Accountability Office reports that the federal government’s systems for analyzing Medicare and Medicaid data for possible fraud are inadequate and underuse, making it difficult to detect the $60 to $90 billion in fraudulent claims paid out each year. The GAO also notes that:

  • CMS spent $150 million on new systems that went live in 2009, yet crucial pieces are missing.
  • The current systems don’t include Medicaid data and CMS’s plans to share Medicare and Medicaid data with states and implement new software have been delayed.
  • Of the 639 analysts who are suppose to use the system, only 41 have been trained so far.

CMS’s top anti-fraud administrator was scheduled to testify for a Senate subcommittee Tuesday to discuss the findings.


Reader Comments

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From Bamma Bubba “Re: UCLA HIPAA violation settlement. Hospital snoops will never stop – it’s a people problem, not an IT problem. Could be a way to increase federal revenue, but then hospitals just pass the costs on to patient and insurers.” Yep, even though our mothers told us to mind our own beeswax, humans are generally just plain nosy. And at HIStalk we also like to make fun of people that can’t spell HIPAA.


HIStalk Announcements and Requests

Mr. H is still vacationing for a few more days. Either Mrs. H has banned him from the computer or he is in the Land of Bad Internet (I’m betting the latter) because I’ve hardly heard a peep from him in two days. Until his return, feel free to send any hot news my way. Or, if you don’t have hot news, just drop me an e-mail for the heck of it.


Sales

7-12-2011 5-15-54 PM

When Sidra Medical and Research Center (Qatar) opens in 2012, it  plans to run the Cerner Millennium platform and be the first fully digitized medical facility in the country.


People

Mediware hires Michael Anania as VP and GM of the company’s Blood Center Technologies product group. Anania’s previous employers include Roche Diagnostics and Baxter Healthcare.

7-11-2011 2-40-38 PM

MGMA names Susan Turney, MD its president and CEO, succeeding the retiring William F. Jessee, MD. Turney, who is an internist, has served as CEO of the Wisconsin Medical Society since 2004 and founded and chaired the Wisconsin Statewide HIE.

Apollo Health Street beefs up its sales force with the addition of four regional VPs: Ken Bartlett (SSI, McKesson), Dan Contilli (Healthation, SunGard), Troy McCormick (Invikktus, Emdeon) and David Richards (Dell Services, EPBS-Internedix.)

7-12-2011 4-13-40 PM

PointClear Solutions, a provider of HIT product development services, names Rodney Hamilton, MD, CMIO and managing director of its product strategy practice. Hamilton most recently was chief strategy officer for Vanguard Health Systems; he also spent time as a physician liaison with McKesson.


Announcements and Implementations

Predixion Software collaborates with the development team of Clinical Looking Glass to create a predictive model for reducing patient re-admissions. Clinical Looking Glass is a decision support tool that was developed at Montefiore Medical Center (NY).

7-12-2011 5-35-43 PM

Chelsea Community Hospital (MI) goes live next weekend on its $12 million EMR system. Chelsea is part of Trinity Health so I am assuming it’s a Cerner implementation.

7-12-2011 5-23-15 PM

The Indiana HIE reports that 70 distinct hospitals, long-term health facilities, and health systems were connected to the exchange as of the end of 2010. For the full year, IHIE delivered 3.3 billion pieces of clinical information, which is about 1.1 billion more than 2009’s totals.


Government and Politics

Arizona, Connecticut, Rhode Island, and West Virginia have now launched their Medicaid EHR incentive programs, bringing the total number of live state programs to 21. Only 14 of those states states have issued incentive checks.


Other

7-12-2011 4-55-15 PM

Cerner is sponsoring a 10-week weight-loss competition aimed at helping Kansas City residents drop a combined 100,000 pounds. The KC Slimdown Challenge is expected to involve about 20,000 people. For the calculator-challenged, that’s about five pounds a person.

Corepoint Health is the top-rated vendor in KLAS’s just-released interface engine report. Corepoint has the largest presence of any vendor in smaller healthcare facilities but very few clients in facilities over 500 beds. InterSystems was ranked a close second, though almost all InterSystems Ensemble customers are in 500+ bed facilities.


Sponsor Updates

7-12-2011 6-23-25 PM

  • Cumberland Consulting Groups promotes Erik Howell to principal. Howell has managed multiple HIT projects for Cumberland since joining the company in 2004.
  • Surgical Information Systems is hosting a July 13th webinar on how social media affects healthcare.
  • PatientKeeper’s 2011 User Group Conference is scheduled for September 18-21 in Denver.
  • Lori Prestesater, RelayHealth’s VP of strategy and business development, will be discussing ACOs and Meaningful Use as a panelist at the Institute for HIT’s summit July 26-27 in Denver.  Also at the summit: Software Testing Service CEO Jennifer Lyle, who will join a panel discussion on strategies to achieve Meaningful Use.
  • URAC awards accreditation to MEDecision’s Alineo health utilization management platform.
  • Cancer Treatment of America  selects CareTech Solutions’ Service Desk to provide 24x7x365 IT support for its national network of  centers.
  • Concerro is offering a July 23rd webcast on nursing documentation and reimbursements. Coding expert Glenn Krauss will lead the discussion.
  • Karen Knect of Encore Health Resources will overview e-Measures during a online session July 13th.
  • The Los Angeles County Department of Health will implement Wellsoft Emergency Department Information Systems at its Los Angeles County and USC Medical Center hospitals.
  • Vocera Communications names John McMullen to its board of directors. McMullen is a SVP and treasurer at HP and will serve as chairman of the audit committee.
  • GE Healthcare launches its fully integrated EMR/PM system, Centricity Practice Solution 10.
  • CynergisTek CEO Mac McMillan will be a panelist for the launch of Clearwater Compliance’s HIPAA-HITECH Blue Ribbon panel July 14th.

Contacts

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

MedQuist Holdings to Acquire M*Modal for $130 Million

July 12, 2011 News Comments Off on MedQuist Holdings to Acquire M*Modal for $130 Million

7-12-2011 6-01-04 AM

MedQuist Holdings announced the signing of a definitive agreement to acquire M*Modal and its Speech Understanding technology for total consideration of $130 million, which includes $77.2 million in cash and 4.1 million shares of common stock.

Former Misys CEO Vern Davenport was appointed chairman and CEO of the new entity. He will replace Peter Masanotti as CEO and Bob Aquilina as chairman. Aquilina will continue to serve on MedQuist’s board. and Masanotti will remain a consultant to MedQuist through the end of September.

MedQuist has already been using M*Modal’s technology for its medical transcription business. The company intends to enhance further the integration of M*Modal’s front-end speech recognition technology with MedQuist’s clinical documentation platform.

M*Modal has a current annualized revenue run rate of $24 million, about $7 million of which came from MedQuist.

Comments Off on MedQuist Holdings to Acquire M*Modal for $130 Million

Curbside Consult with Dr. Jayne 7/11/11

July 11, 2011 Dr. Jayne 4 Comments

I talked a little last week about the perils of new resident physicians starting at teaching hospitals. Not only do new residents relocate in the summer, but a lot of families do as well to take advantage of the gap between school years. Knowing I’m a physician, a new neighbor surveyed me about choosing a primary care doc for the family. Unless you have a doc next door, most people consult relatives, co-workers, neighbors, and friends for recommendations. One hot button area that doesn’t get much coverage in Health IT circles though are online rating services such as HealthGrades, RateMDs.comAngie’s List,  and others.

Remembering my experience with the Medicare Physician Compare website, I decided to find out what I look like on some of the other sites as well as what it would be like to correct errors, should I find them. I started with HealthGrades, which listed me at the correct address at least, but I had no ratings. Although that doesn’t help new patients at all if they are looking for a physician, one thing it does say is that at least I haven’t made anyone sufficiently mad enough that they logged on and gave me a thumbs-down.

Kind of surprising since I make at least one patient a day angry by refusing to prescribe antibiotics when they’re not necessary or by refusing to order unneeded imaging tests. HealthGrades does have a physician portal where providers can update their information or post a response to ratings. I searched two of my friends, just for additional sample size. One who works for a large HMO had no ratings; another who is part of a small private practice had nine. No individual patient comments were posted.

RateMDs.com had me listed at a location where I haven’t practiced in half a decade. I didn’t have any patient ratings, nor did my HMO colleague. My private practice buddy had eight ratings this time, seven of which were extremely positive and one which could not have been lower. Individual patient comments were posted, and the site also had the ability for logged in users to respond to other users’ posts.

Not being a member of Angie’s List, I couldn’t see what we look like there. They do offer the ability for “businesses” to register and see their own profiles but I’m trying to have a bit of a vacation and was tired of fighting the molasses-like hotel internet so I took a pass on registering. Regardless, I’m not sure what I think about being rated as a degreed healthcare provider in the same vein as auto mechanics and tree trimmers. Patients are not SUVs or oak trees. A website that had the potential to be inflammatory was WrongDiagnosis.com, which seemed to just be a redirect to HealthGrades information as opposed to anything sensational.

I talked to my two colleagues to see what they thought about these sites. My HMO connection didn’t think much about it at all – she said it has never really come up with any of her patients and if they have issues with her care, it goes through an internal ombudsman process, which she theorizes is responsible for how quiet her profile was, as well as other docs in her organization that she pulled up. Virtually no one she works with had any ratings either. (We were having a good time searching people we know while we chatted, kind of reminded me of going through the Freshman Annual at college trying to figure out what info we could gather on classmates in the pre-Facebook era.)

On the other hand, maybe for my small-practice colleague, patients felt they didn’t have any other feedback mechanism than the websites. She revealed that she’s had issues with a particular patient in the past, who was terminated from the practice for disruptive behavior. The patient then went on multiple rating sites posting information about my colleague which was found by the state medical board to be unsubstantiated. She and her staff spent what she believes to be hundreds of hours having all the comments from that patient removed.

Determining whether a bad outcome was the result of mistakes by the healthcare team, issues with patient compliance, underlying comorbid conditions or other factors is extremely difficult. In the case of my colleague, from the ratio of glowing reviews to poor ones, it’s pretty obvious that either something dramatically different from all the other visits happened, or that the physician and patient didn’t click. From my limited sample, it’s not clear whether the rest of us are just boring physicians that no one cares to write about, or whether this technology hasn’t really taken off with patients.

If you have an experience with physician rating sites, whether as a provider or as a patient, I’d be interested to hear about it. Until then, I’m headed back to the beach with some Inga-inspired reading material:

7-11-2011 6-39-42 AM

drjayne

E-mail Dr. Jayne.

Monday Morning Update 7/11/11

July 10, 2011 News 19 Comments

From 4merMCK: “Re: McKesson. USA Today reported that MCK’s Hammergren made $150m in 2010, a sizable increase. The gap in salary alone for MCK-IT employees is approximately 375x, and merit increases in the former HBO were 2.5%, or around $2,000. Under Hammergren’s leadership, MCK shares have risen around 20%. At the end of the day, it is shareholder value that drives CEO compensation. Whether that’s worth his increase, only shareholders can answer. Rumor in Alpharetta is that the HIT business was shopped around, but based on the asking price and a declining base, there were no offers. Now they are trying to determine what a ‘growth’ strategy would look like.” Unverified.  

From The PACS Designer: “Re: Internet2 and healthcare. Rural healthcare facilitated through the use of telemedicine solutions is a trend that is gaining more attention. One new area that can accelerate the adoption of telemedicine applications is Internet2, which offers higher speed communications tools. The FCC’s Rural Health Care Pilot Programs (RHCPPs) have been in the past a funding source for employment a rural EHR and telemedicine experiments. State-by-state license requirements for physicians has been one of the roadblocks to further expansion of the concept.”

From Mr. HIStalk: “Re: holiday woes. Funny that I’m reading this on a plane to vacation.” The referenced article includes suggestions for prepping the office in advance of taking R & R to avoid “vacation interruptus.”  Coincidentally, Mr. H just skipped town for some well-deserved time off, leaving me (Inga) as the designated second-in-command. The same article notes that 30% of workers are like Mr. H and intend to contact work while on vacation. Mr. H barely opened his first beer before checking in (and contributing to this post), but Mrs. H and I are hoping he’ll get into the chillin’ mode soon.

7-10-2011 9-13-00 AM

Technology vendors and the healthcare system are most responsible for disconnected patient information, readers say. New poll to your right, just to change it up a little: is your company’s CEO honest and honorable?

7-10-2011 12-41-30 PM

The Tennessee Comptroller of the Treasury releases an audit reporting finding that Community Health Network (CHN) lost or misused $1.26 million between 2007 and 2009. CHN is a non-profit organization that provides medical technology to rural communities, often through grants. Auditors claim the company’s former CEO, Keith Williams, improperly received more than $80,000 by paying himself unapproved bonuses, making personal purchases with CHN’s credit card, and claiming reimbursement for meal purchases that were paid for with CHN’s credit card. Former CFO Paul Monroe was found to paid over $10,000 in unauthorized pay. Auditors also say that Williams and Monroe falsified grant invoices and grant reports and misused proceeds from a state grant to purchase almost $600,000 in unauthorized software. The software vendor later hired Williams as a consultant while he was still employed at CHN.

7-10-2011 11-17-18 AM

Georgia Governor Nathan Deal will speak Monday morning from the Alpharetta headquarters of McKesson Provider Technologies, pitching the state’s campaign to lure technology jobs. It will be streamed live at 8:30 a.m Eastern.

More from Vince on minicomputers, this time focusing on the companies that wrote software for them, one of the biggest of which was started in the proverbial garage.

The VA reveals plans to allow clinicians to use  Android devices, iPhones, and iPads, in addition to the currently supported BlackBerries.

This week’s Time Capsule editorial from 2006: USB Drives Would Help Consumers Quickly Access McClinics. Its conclusion: “This system of having patients walking around with their own information ready to plug into a provider’s system seems like the best solution for now.”

7-10-2011 7-36-44 AM

Morris Hospital & Healthcare Centers (IL) names Cassie Brown manager of health information management. I like that Brown worked at Morris Hospital as a medical records file clerk while in high school school and college and before learning the ropes at a couple of other medical facilities.

Healthcare jobs grew by 13,500 in June, though the hospital sector declined 0.1%. Ambulatory healthcare added 16,500 jobs, including 5,000 in physician offices.

7-10-2011 11-51-07 AM

HIStalk Practice’s own Dr. Gregg gets a shout out in the Columbus (OH) business journal for being the state’s first doctor to get an EHR stimulus check from Ohio Medicaid.

7-10-2011 11-59-42 AM

Broadlawns Medical Center (IA) becomes the first medical center in the state to use PatientSecure’s biometric patient ID system.

7-10-2011 12-10-22 PM

British Columbia’s former deputy minister of health Ron Danderfer pleads guilty of fraud in relation to benefits he received between 2004 and 2007. Danderfer, who oversaw the creation of the province’s $222 million EHR system, admits he accepted the use of a vacation condominium and a job for his wife.

7-10-2011 1-55-38 PM

Surescripts and the authors of JAMIA-published article, “Errors associated with outpatient computerized prescribing systems,” issue a joint statement to clarify the study’s use of the term “e-prescribing.” The authors point out that their use of the term “e-prescribing” does not reflect the way the term is used today, nor does it match the federal government’s definition. The study examined what was considered e-prescribing back in in the old days (2008); that is, prescriptions generated by a computer, faxed to a pharmacy, and then printed. You’ve got to admit that “E-Prescribing Doesn’t Make The Grade” is a far more compelling headline than one that says, “The Way Things Were Done Three Years Ago Wasn’t All That Great.”

Contacts

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

Time Capsule: USB Drives Would Help Consumers Quickly Access McClinics

July 8, 2011 Time Capsule 1 Comment

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 2006.

USB Drives Would Help Consumers Quickly Access McClinics
By Mr. HIStalk

You’ve seen the flurry of recent news. Your local Wal-Mart, Target, or chain pharmacy will soon offer basic medical care through in-store clinics.

It’s a low-friction process. If you wake up with strep throat, you just head over to your local store and quickly see a nurse practitioner or physician assistant. Maybe $60 and 20 minutes later, you walk out with a prescription, having avoided the tedium of sitting in a cheap chair and stealing glances over your 2004 Newsweek to guess what’s wrong with everyone else in the room.

Most of us don’t have a firm relationship with a primary care physician, so drive-through McMedicine will suit us just fine. Just gimme the prescription, please, and let me get on with life.

Since these casual liaisons will take mere minutes, handling the dreaded “new patient” forms will be the biggest waste of time for both patient and clinic. You laboriously write everything down so they can re-enter it into their systems, even though you may never cross their door again (hopefully, each brand of clinic will at least share their EMR data nationally among themselves, like the drug chains do for prescriptions).

Here’s an alternative that I think has great possibilities. You enter everything in advance on your PC, saving it to a USB memory drive. Bring that along when you impulsively drop by the McClinic and hand it over to the receptionist. You’ve saved everyone time and reduced the chance of error. Maybe you even get to jump ahead of the guy hunched over the clipboard.

What the clinic needs is an interface to my gadget. They shouldn’t have to print and re-enter everything that I’ve already given them in electronic form. They should be able to plug in the device and press an import key in their EMR. Why not? A universal standard for exchanging basic personal health record information should be a slam dunk compared to all the other interoperability challenges ahead. You create and maintain your own information in one place — just bring it along.

Since electronic information saves the clinic time, it could encourage customers by providing free data entry software, and maybe throwing in a cheap USB key-ring drive with security features. That encourages brand loyalty, much like grocery store member cards. They could even update your device as you leave with encounter information, including instructions and information links.

This model has more opportunities to new consumer health care players like Intuit and Microsoft than the usual clipboards and copy machines. It also places consumers in control.

We’re moving toward a provider system that looks more like that of chain pharmacies, with a variety of interchangeable providers competing for customers. The big boys want to play in our sandbox — companies that value customer convenience, low cost, and competitive advantage a lot more than the current players.

Universal EMR interoperability at a national level isn’t coming anytime soon. Consumers are scared of the Internet when it comes to health care privacy. This system of having patients walking around with their own information ready to plug into a provider’s system seems like the best solution for now. If I were running a chain of these clinics, I’d jump all over it to beat my competitors.

News 7/8/11

July 7, 2011 News 6 Comments

Top News

7-7-2011 9-58-22 PM

The start of Stage 2 Meaningful Use will likely be pushed back a year, now that ONC head Farzad Mostashari, MD agrees the current timeline is too aggressive. Stage 2 requirements won’t be finalized for another year, so the growing consensus is that a January 1, 2013 start date would not give EPs, hospitals, and vendors adequate time to prepare.


Reader Comments

image From WildCat Well: “Re: Comcast. Considering offering an EMR system at no cost to physicians who subscribe to Comcast Metro Ethernet services. Physicians have their choice of six-plus EMR preferred providers.” Unverified, although readers have been suggesting that a deal of this type has been in the works for some time.

7-7-2011 9-06-43 AM

image From Man in the White Suit: “Re: Shoe Beacon. You should really be more discrete about where you live.” There’s nothing better than good yard art to express one’s obsessions.


HIStalk Announcements and Requests

7-7-2011 8-35-09 AM

image Check out the new HIStalk Resource Center. Our new reader-requested tool gives you an easy way to search for products and services in over 100 HIT-related categories. Fifty-two HIStalk sponsors have provided details of their offerings and quick links to request more information. To get there: (a) click on the link at the top of this page; (b) click the small banner below the Founder sponsor banners to your left; or (c) click the link on the Related Sites listing to your right. We will continually update the Resource Center, so check it out regularly and let us know what you think.

image Ever find yourself wondering what the heck is going on in the ambulatory HIT world? If so, make sure you are a HIStalk Practice e-mail subscriber. Here are some highlights from this week’s posts: Rob Culbert offers tips for documenting operational and functional workflows to boost customer satisfaction and cash flows. MGMA reveals the top challenges for practice managers. NextGen parent company Quality Systems brings homes three Stevies. AHRQ offers a toolkit to analyze workflow before, during, and after and HIT implementation. Thanks for stopping by.

image Listening: angry 1970s punk from Cleveland’s Dead Boys. Arguably better than the Ramones.


Sales

Aria Health (PA), Norton Healthcare (KY), and St. Luke’s Health System (ID) contract with Hyland Software for its OnBase enterprise content management software.

Aria also selects Allscripts Community Record, powered by dbMotion, to enable data sharing between the hospital’s Allscripts Sunrise, the employed physicians’ Allscripts Ambulatory EHR, and third-party EHRs used by other regional providers.

7-7-2011 8-49-31 PM

The State of New Jersey posts an RFI for the New Jersey Health Information Network, requesting “a single, complete solution” and suggestions of how it can sustain itself financially.


People

7-7-2011 10-16-35 AM

SmartBusiness profiles EnovateIT’s Fred Calero, who leads his company “by treating others as they would like to be treated.” He notes that many of EnovateIT’s employees started on the company’s assembly lines building medical carts.

NCO Group promotes Michael Albrecht to lead its Healthcare Services sales team.

7-7-2011 2-55-10 PM

UnitedHealth Group names Larry Renfro as CEO of its Optum business unit. He replaces Mike Mikan, who is leaving to run a private equity fund. Renfro was CEO of the company’s Ovations group.

7-7-2011 8-34-33 PM

Richard Noffsinger joins Aetna subsidiary ActiveHealth as president and CEO. He was previously with Anvita Health, Amicore, and Microsoft. He replaces Gregory Steinberg, who will head up clinical innovation for Aetna.

7-7-2011 9-19-45 PM

Bob Zollars, chairman and CEO of Vocera since 2007, is profiled in Smart Business of Northern California. He was previously with Wound Care Solutions, Neoforma, and Cardinal Health.


Announcements and Implementations

7-7-2011 2-08-44 PM

University Physicians Hospital (AZ) goes live with EmergisoftED.

image CareCore National announces that its TouchMED prior authorization application for physicians is available on the Cisco Cius tablet. You might expect that this announcement and product information would be available on the company’s Web site since they went to the trouble of issuing a press release, but you would be wrong.

Cerner’s uCern customer collaboration platform wins an award from Jive, the company whose technology powers it.

7-7-2011 10-02-40 PM

University Medical Center (NV) says it has $25 million to spend for system upgrades needed to qualify for HITECH money, but needs $60 million. Its county owners say they don’t plan to make up the shortfall. The hospital is negotiating with McKesson.


Government and Politics

7-7-2011 10-05-51 PM

UCLA Health System settles with HHS for $865,500 for alleged HIPAA privacy and security violations. Two celebrities accused hospital employees of peeking in their charts.

CMS says it won’t be ready to electronically receive quality outcome data for Meaningful Use in 2012 as originally planned. That means that in 2012, EPs and hospitals can report outcome data via attestation and data calculations, just like they’ve done for the 2011 payment year.

The president of the Ontario Medical Association says political party leaders should forget about the scandal-ridden and expensive eHealth Ontario and include electronic medical record programs in their platforms anyway.


Innovation and Research

A JAMA-published study finds that critical access hospitals lag other hospitals in survival rates for heart attack, heart failure, and pneumonia. The author suggests telemedicine as a possible solution.


Technology

image A Florida doctor who came up with the idea for his iMobile Health Record in 2001 is finally getting it to market. Users key in their medical history and med and get a health score in return. It will sell for 99 cents. If it’s the guy I’m thinking, though, he is loaded with credentials: orthopedic surgeon, president of the hospital medical staff, CMIO for a clinical guidelines vendor, researcher, and entrepreneur. I was prepared to make fun of the idea, but he’s got enough credibility to keep me quiet.


Other

image A fired medical data technician sues University Medical Center (NV) for failing to accommodate her claustrophobia by forcing her to work in a cubicle. She has medical documentation backing her claustrophobia claims, so the hospital settled for $150,000.

Physician-run hospitals score 25% higher in quality measures than those where the CEO is a business school type, although the study can’t explain why other than perhaps physicians are truer to the core business of health.

KLAS reports that the number of live HIEs has more than doubled since last year, with private HIEs increasing more rapidly than public HIEs. The lack of traction of public HIEs is attributed to more complicated governance and concerns over long-term funding. Among HIE vendors, Medicity, RelayHealth, and Cerner ranked highest for private HIEs.

image Weird News Andy is atwitter at this news, which he tags as “researching in 140 characters or fewer”: Hopkins researchers run two billion public tweets through software to extract those related to health, then analyze patterns related to allergies, flu, obesity, cancer, and other conditions. They believe tweets can help uncover public health information, but they recognize that users don’t get into much detail, they are usually younger and US-centric, and they probably won’t tweet about some health issues.

7-7-2011 10-08-12 PM

7-7-2011 8-44-35 PM

image A federal appeals court upholds the 2009 conviction and 10-year prison sentence of former McKesson chairman Charlie McCall. His lawyers claimed he signed public filings and auditor letters without knowing that his acquired HBO & Company (McKesson paid $14 billion for it) was inflating revenue figures by improperly recognizing software revenue, but the appeals court ruled 3-0 that he knew exactly what was going on. MCK shares dropped almost by half the day the company announced its findings and still have not regained their pre-Charlie price more than 12 years later.

image Somehow I missed this: Dennis Quaid keynoted at the 2009 HIMSS conference, talking about the heparin overdoses that nearly killed his newborn twins, but merged his Quaid Foundation with the non-profit Texas Medical Institute of Technology a year later.


Sponsor Updates

  • Kansas City Business Magazine recognizes Perceptive Software as one of the city’s top 10 companies for global growth. Selection was based on company culture, community involvement, plans for growth, and commitment to employees. The company has grown its employee count by 40% in the last year.
  • Aventura Hospital and Medical Center (FL) selects ProVation, a division of Wolters Kluwer Health, for gastroenterology and procedure documentation and coding.
  • Sunquest is hosting its 2011 User Group conference July 11-15 in Tucson. New to this year’s meeting: an executive two-day conference, a session by the College of American Pathologists,  and a discussion of the lab’s role in ACOs.
  • MD-IT is searching for a VP of sales and marketing.
  • West Virginia Regional Health Information Technology Extension Center selects Greenway Medical’s PrimeSUITE as a prequalified EHR. 
  • GetWellNetwork adds Jeff Fallon as VP of business development and national accounts.
  • Capsule  is exhibiting at the 2011 HMS Regional Training and Exposition July 12-13 in Austin, TX.
  • Holon Solutions appoints Worth Roberts to VP of sales for its eastern region.
  • OptumInsight partners with RemitDATA to offer Remit Advice Professional, a Web-based analytics service for physician offices that analyzes health plan remittance notices and provides coding and reference tools.
  • Symantec and Allscripts partner to offer an online privacy and risk assessment tool for identifying potential gaps in HIPAA and HITECH compliance.
  • Wayne Memorial Hospital (NC) selects the Access Enterprise Forms Management suite to integrate electronic patient forms with its Meditech system.
  • Webinar alert: a clinical analyst from Jefferson Regional Medical Center will share how his hospital used iSirona’s device integration solution to connect more than 40 devices to Sunrise Clinical Manager. It’s on July 20 at 1:00 PM EDT.
  • The use of the AirStrip OB smartphone monitoring system by Rowan Regional Medical Center (NC) is profiled on a Charlotte TV station, with one OB-GYN predicting that its use could become a nationwide standard of care. AirStrip Cardiology goes live at Cedars Sinai and Texas Health Resources.

EPtalk by Dr. Jayne

7-7-2011 7-45-44 PM

I received a lot of feedback about Monday’s Revolutionary-themed Curbside Consult, including some historical corrections and the hilarious photo of Colonial Kermit. HIStalk readers are the best!

Dr. Jayne,

I am an avid reader of HIStalk and am a great fan of yours. I just loved your July 4 article and I have been a Molly Pitcher fan for quite some time. So it is with trepidation that I have to say that I was also severely disappointed. The Declaration of Independence was approved by the Continental Congress on July 2, 1776 and read in public on July 4. The signing began a week or so later and was not fully completed until the end of the summer. In a letter to his wife, John Adams indicated he expected July 2 to become a national holiday as that was the meaningful date when the Continental Congress declared its independence from Great Britain. Thanks for HIStalk – we all just love it.

Terry

Duly noted. My reference used the word “adopted” to describe what the Continental Congress did on July 4. A handwritten draft was signed by John Hancock and Charles Thomson that day and was sent to be printed for distribution. As for the final product, the National Archives says that most signed on August 2, 1776. The Archives also notes that t “one of the most widely held misconceptions about the Declaration” is that everyone signed it on July 4, so I guess I’m not alone.

I’m glad to encounter another Molly Pitcher fan. I shamelessly admit that I dressed as her once for a patriotic event. Everyone thought I was Martha Washington, though. Maybe I should have put a cannonball wound in my skirt.


Dr. Jayne,

The first incidences of biological weapons as you describe in your recent Independence Day post that I have been able to find was back in the middle ages (mid-14th century) when plague victims were flung into walled cities via catapult by those who we besieging the settlement.

Weird News Andy

Andy always delivers and provided multiple links for my reading pleasure, which I will of course share. I remember this fact from World History and probably a Monty Python movie, but being in Colonial Mode must have suppressed it.

Emergency Medicine covers plague
EyeWitness to History and The Black Death
Attacking a Castle – also includes excellent coverage of fire, battering rams, and other mayhem

7-7-2011 7-55-53 PM

Several readers responded to my recipe solicitation. Here are a few submissions mixed with my personal favorites. And thanks to Janice – I took your advice,but instead of vodka/cranberry on ice with a blue umbrella (apparently my cocktail accessories are lacking),I threw in some blueberries.

Fourth of July Cocktails
Patriotic Cocktails
Twenty Red, White & Blue Cocktails
Five Red, White and Blue Cocktails (including the one pictured above)

No one seemed eager to share a potato salad recipe (what does the proportion of cocktail recipes to side dish recipes say about the average health IT reader, I wonder?) but one reader did share this link — and who doesn’t love a Web site called Killer Salad anyway?

7-7-2011 7-59-49 PM

Now, back to our regularly scheduled HIStalk feature …

It is the month of July, and the usual articles about avoiding medical mistakes and the perils of new interns starting rotations at academic medical centers (the “July Effect”) have started to show up. Prevention leads with  14 Worst Hospital Mistakes to Avoid, noting that most mistakes are medication-related.

MSN jumps right in with Don’t Get Surgery in July…, citing a 10% spike in fatalities in teaching hospitals during the month “confirmed by a new Journal of General Internal Medicine study,” but then saying the spike isn’t due to surgery anyway. It’s basically a hack of the Prevention article, so don’t bother going there. The article is actually from 2010 and the original source is available in PDF here.

Internship was bad enough when all you had to do was write your orders on paper, I can’t imagine walking in with CPOE on top of it. I’d love to interview a PGY-1 to get his/her impressions on healthcare IT but obviously can’t do it with one of my own housestaff. Anyone with friends just starting internship or are you a faculty member willing to serve up an intern? E-mail me.


Contacts

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

Readers Write 7/6/11

July 6, 2011 Readers Write 1 Comment
Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

Navigating Uncompensated Care
By Jay Mason

7-6-2011 6-39-43 PM

Despite decades of efforts around improved revenue cycle management, hospitals across the US are still struggling with levels of uncompensated care that threaten their viability and vitality. Much of that low-hanging fruit has been harvested. Hospital executives looking to further reduce uncompensated care will have to look toward solutions that enable innovation and leverage technology.

The chorus in the healthcare industry has been to treat patients with the right care, in the right setting, at the right time. If we’re serious about that mantra, there needs to be renewed focus upon the most basic yet overlooked part of the patient experience: scheduling. More specifically, that focus needs to be on scheduling connectivity, or getting patients through to the next step in the continuum of care.

Having an effective strategy around scheduling connectivity — both inside and outside of the hospital — is essential to capturing revenue and reducing the costs of uncompensated care. Simple referrals, most would agree, are not enough. Appointments can and should be made instead. It’s possible to achieve this goal realistically, through a combination of better communication, greater awareness of available physicians, and adjustments to staff workflows.

Hospitals are still relying on patients to schedule important follow-up appointments on their own. Sometimes patients will, but often they won’t. Hospitals that are looking to keep patients within their system need to confirm follow-up appointments with their physicians before patients leave their walls, or they may not get a second chance.

From a cost perspective, uncompensated care is driven largely by uninsured patients who continue to use the emergency department for walk-in care because they are not effectively connected to community-based providers, such as FQHCs (Federally Qualified Health Centers). As for inpatient care, hospitals are facing new pressures to ensure patients are getting the right follow-up care, as penalties for hospitals readmissions will become the norm.

To address these issues, hospitals need to embrace the goal of scheduling connectivity. Effective scheduling connectivity starts with ensuring that physician offices are willing to allow trusted partners to access their available appointment slots. This must be done with great sensitivity to the needs and preferences of those providers. Physician offices won’t open up their schedules for others to access if they feel as though they are losing control of their calendars. Rather, scheduling connectivity should strive to ensure that physician offices are given the tools to better manage their calendar.

Effective scheduling connectivity also means that patients obtain a confirmed appointment before they leave the hospital. In other words, submitting a request for an appointment or making a referral isn’t enough. The loop must be closed, or the risk is great the referral will never result in an actual appointment.

What do hospitals need to do in order to achieve the goal of scheduling connectivity? The solutions involve creating effective electronic links between provider schedule solutions. But technology alone is not enough. Hospitals will also need consultation to understand the unique and dynamic nuances that match needs and preferences of both the physicians and patients.

Jay Mason is CEO of MyHealthDIRECT of Brookfield, WI.


Drive Angry
By Jack James Dio

Redbox recently e-mailed me to tell me about a hot new release called Drive Angry on DVD and Blu-Ray. It’s a Nicolas Cage movie I somehow missed, but check out this summary:

An undead felon breaks out of hell to avenge his murdered daughter and rescue her kidnapped baby from a band of cult-worshipping savages. Joined by tough-as-nails Piper, the two set off on a rampage of redemption, all while being pursued by an enigmatic killer who has been sent by the Devil to retrieve Milton and deliver him back to hell.

This is one of the most ludicrous premises I’ve ever read. Naturally, I can’t wait to see this movie. I know going in it’s going to be horrible, but I can rent it for a dollar. The dollar is the deciding factor. 

But I love the fact that someone funded this idea. It pleases me that capitalism is at work.

Someone went into what I imagine are highly fancy offices of movie makers and said something to the effect of, “Hey, this one’s got Nicolas Cage as an undead felon who breaks out of hell. Of course, he’ll be pursued by an enigmatic undead killer.” And in response, a guy smoking a cigar and wearing a pinky ring and shiny black shoes yanked out his checkbook and replied, “Let’s get started! I’ve always wanted to make a flick about a rampage of redemption.” 

If someone’s going to hand over money to people with ideas — good or bad — then the people with ideas will take it. People take the money and they always will. 

This is where we are now in healthcare technology. If you’re in the mood to read a 32-page document on that, see PwC’s recent paper called The New Gold Rush.

Everybody wants in. This by definition means there will be a higher percentage of bad ideas making the rounds. More bad ideas are here, and there are more coming. Very few will pass the elusive acid test of being able to answer a simple question: do I really need this?

How long, for example, until there’s an iPhone application to let you take a picture of a funny-looking mole on your arm and tell you if it needs to be seen by a specialist? Will the fear in your heart from an erroneous “uh oh” message back from that iPhone app be worth it when you could’ve already been to the dermatologist? Or to your patient medical home, which I like to call an internist? (Incidentally, if there’s already an application for this, please don’t hold it against an undead felon like me.) 

I’m not prophetic, but a lot of bad ideas are coming soon to a facility near you.

The current healthcare IT landscape reminds me of LinkedIn and its ever-present recommendations. Everything is recommended and spoken highly of. There’s little objectivity, and few are willing to say, “Wait a minute — this product stinks.” Or, “Sorry, but this cat cannot do that job!”

Where’s the balance? Where’s someone to say plainly, “We don’t need that?”

Probably 12 years ago as part of a VC gathering, I heard the Gomez in Gomez Advisors present the company’s rankings of Internet stockbrokers, banks, mortgage lenders, and credit card issuers. I don’t remember the criteria, only that it seemed oddly biased. 

After some audience questions, it turned out that Gomez also consulted with more than a few of the companies he was ranking, which smelled funny to a room full of CTOs and CIOs. 

When he finally sat down, he looked over at a table near where I was sitting, loosened his tie, and said, “Man, tough crowd.” He didn’t like the hot seat he found himself on, but he also didn’t change anything in his approach because it made money. (Full disclosure – Gomez Advisors was bought by Compuware in 2009 and it has an array of products for Web and mobile application management, including an EHR tool.)

Who’s going to help make this tidal wave of interesting but unnecessary HIT products and services manageable? Who has time? And does anybody really care? 

After all, some things simply don’t change, like the inescapable fact that Nicolas Cage makes plenty of awful movies and will continue to do so. The difference, it seems, is in the price of admission.

News 7/6/11

July 5, 2011 News 13 Comments

Top News

7-5-2011 5-37-48 PM

image Management consulting firm Beacon Partners will announce Wednesday that it has acquired Healthcare Innovative Solutions (HIS), which offers consulting services related to clinical system implementation and workflow redesign. The ten-year-old HIS gives Beacon additional Siemens capabilities, adds to its CPOE expertise, and boosts its revenue and headcount by 15%. I did an HIT Moment With interview with HIS CEO Daniela Mahoney RN a few weeks ago. Congratulations to HIS as the latest in a long list of HIStalk sponsors to be successfully acquired.


Reader Comments

image From NAFTA Doesn’t Work: “Re: Ontario. Healthcare informatics is at an all-time low here, with contracts based on who you know. I applied for a NAFTA-defined TN-Visa for professionals after being hired for a US contracting gig. No problem if you are a US citizen coming into Canada for EMR work, but if you try to go into the US, you are in for a chop-busting. Bring your degrees, transcripts, licensure, immunization records, and first-born child. An immigration officer berated me for being an RN and computer science graduate, saying ‘Seems like an odd combination, doesn’t it? Who would hire you anyway? Why are you trying to take jobs from Americans?’ Like it’s my fault your country can’t find enough people qualified to implement clinical systems based on the $19 billion ARRA commitment. Nothing like being stuck between a rock and a hard place.” We’re not very visitor-friendly here, that’s for sure, but that’s a 9/11 thing. We have a massive Homeland Security bureaucracy, along with a close-the-borders mentality that has caused quite a drain in technology expertise. I know from limited travels out of the country how unwelcome even US citizens are made to feel at immigration after short-term travel, so I can only imagine being a non-citizen trying to relocate here. I felt more welcome and respected in Russia than Newark.

image From Mr F: “Re: The PACS Designer’s WebGL blurb. Key point left out: Microsoft won’t be implementing it in IE because they think it is inherently insecure.”

image From Dakota Dan: “Re: Henry Ford Health System SVP/CIO Arthur Gross. No longer on their Web page.” His bio page has been removed, but that’s all I could turn up since I don’t have contacts there that I recall.

7-5-2011 7-54-30 PM

image From Collard Greens: “Re: KLAS. To consolidate their ambulatory EMR categories, also looking to consolidate/drop research for other ‘non-profitable’ research segments.” I contacted Adam Gale, president of KLAS, who says you are partly right. KLAS is planning to reconfigure their ambulatory EMR categories to better map how those solutions are actually sold to the market. Something like, let’s say, small practices (1-10 docs), medium (11-50), and large (51+). Adam says the other half of your statement isn’t true, though: market need rather than profitability drives the research segments KLAS covers and they’re planning to continue rating mostly the same categories ongoing. It almost seems the opposite to me: they keep adding interesting categories.


HIStalk Announcements and Requests

image Someone asked me at work today about the Stage 1 Meaningful Use rule for hospital clinical decision support. Since I had to look it up anyway to make sure I hadn’t forgotten something, here’s the summary. You have to implement at least one real-time alert and it can’t involve drug-drug interactions or drug-allergy contraindications. It must use information from the meds list, allergy list, demographics, or lab results. The rule must address something that’s of high clinical priority to the hospital and you have to be able to track compliance with the rule. If the rule is of the “don’t enter this order under any circumstances” variety, then the numerator could be calculated as: (number of times the rule fired minus the number of orders entered anyway) divided by the number of times the rule fired. Otherwise, you would need to electronically ask the provider if they changed their intentions based on the rule’s recommendation since you can’t assess compliance or rule effectiveness otherwise, unless you’re comfortable looking at overall ordering patterns for changes (and I wouldn’t be).

7-5-2011 7-24-53 PM

Thanks to new HIStalk Platinum Sponsor McKesson Paragon HIS. If you follow the industry, you know that Paragon is pretty hot stuff, named for five straight years as Best in KLAS in the Community HIS category. It’s certified, runs on a single database, is fully integrated (including clinical and financials), has low hardware costs, is intuitive and easy to use, and runs on pure Microsoft technologies (including SQL). Clinical modules include clinical assessment, CPOE, care plans, order management, meds, and results reporting. On the financial side, there’s patient management, AP/GL/MM/FA, payroll, resource scheduling, HIM, transcription, utilization review, and release of information.  Ancillary apps include pharmacy, OR, ED, rehab, radiology, lab, mobile phlebotomy, and micro. If you are a Meditech customer or prospect, McKesson would be happy to send you a white paper describing the benefits of Paragon for your consideration. I’ll throw in an observation that even though KLAS ranks it under the Community Hospitals category, I’ve heard from users first hand that it scales well to facilities up to at least 400 or 500 beds even though you don’t need a lot of IT people to run it, so don’t let that label scare you off. Thanks to the McKesson folks involved with Paragon HIS for their support of HIStalk.


Acquisitions, Funding, Business, and Stock

image Cerner shares hit an all-time high Tuesday (at least it looks like it as I’m eyeballing the share price graph), closing at $63.00 and pushing the company’s market cap to $10.6 billion.

Chicago area- based Resurrection Health Care and Provena Health will merge their twelve hospitals.


Sales

7-5-2011 10-00-13 AM

University Hospitals Case Medical Center (OH) will deploy athenaCollector for its 1,000 providers. Its MSO is already an athenaCollector client.

7-5-2011 4-13-02 PM

Presbyterian Intercommunity Hospital (CA) signs a services contract with Zotec Partners to manage its radiology department’s revenue cycle.


People

7-5-2011 5-22-54 PM

Blount Memorial Hospital (TN) names Clay Puckett CIO and assistant administrator. He was previously senior director of IS for Carolinas HealthCare System.

7-5-2011 7-09-27 PM

image Mathematician Robert Morris dies at 78, leaving a biography that should be made into a movie. He helped develop Unix, was a master cryptographer for the National Security Agency, led a 1991 cyberattack against Iraq before the first Gulf War, developed Unix security protocols in the 1970s that are used on Apple devices today, developed software that tracked enemy submarines and astronomical bodies, and warned Congress in 1983 that computer viruses were a risk but not likely to be created by children. He was proven wrong in that last assessment five years later when his own son’s worm program spread out of control and took down 6,000 Department of Defense computers (the lad is now an MIT computer science professor).


Announcements and Implementations

7-5-2011 10-02-18 AM

Legacy Salmon Creek Medical Center (WA) will go live on its $110 million Epic EMR by the end of September.


Government and Politics

CMS issues its proposed fiscal 2012 Medicare payment rules and suggests minor increases for most facilities and a whopping 29.5% decrease for physicians. Outpatient payments would increase 1.5%, ACS’s 0.9%, and dialysis facilities 1.8%.


Technology

Radiology site AuntMinnie runs an article on biometric ID,  mentioning palm vein scanning (PatientSecure), physician mobility (Imprivata), fingerprint ID (Digital Persona), and proximity biometrics (Proxense).


Other

Here’s Vince’s latest, this time on minicomputers and complete with names you haven’t heard in quite some time, like Burroughs, DEC, and Four Phase.

image Epic ranks #1 in new HIT contracts for hospitals of greater than 200 beds. KLAS calls Epic’s track record of successful implementations “unmatched” despite lagging technology and a large price tag. Cerner was #2, with many of its new contracts involving new facilities for existing customers. The report finds hospital consolidation is increasing the interest in system integration.

image Johns Hopkins Hospital (MD) will eliminate 160 clerical positions by the end of the year as the hospitals switches to electronic medical records. The hospital will try to reassign the workers, who had been responsible for order transcription and creation and maintenance of paper charts. A reader sent a note last week saying Johns Hopkins was moving to Epic for its ambulatory clinics; Mr. H predicts the move to Epic will be system-wide.

7-5-2011 4-10-26 PM

USA Today profiles Banner Health’s (AZ) five year-old eICU network, which relies on remote critical care specialists to provide guidance to onsite providers. Banner has invested $11.3 million in equipment for the telehealth system and estimates that over the last four years, the program has helped prevent 600 deaths, reduced days in critical care by 26,000, and cut hospital stays by 100,000.

image AMA will draft model legislation for HIEs that will spell out who owns clinical information and who can view it. They seem concerned about insurance company ownership of HIE technology vendors (Aetna and UnitedHealth Group, which own directly or indirectly Medicity and Axolotl, respectively).

7-5-2011 6-43-04 PM

image Would you trust your HIPAA compliance education to this company?

image I thought of Dr. Jayne’s observations about the unhealthy lifestyle choices her patients often make when I read this article. A motorcyclist flips his Harley and dies of a head injury during an organized ride protesting mandatory helmet laws. Experts said the helmet he was illegally not wearing would have saved him. The event organizers, the state chapter of American Bikers Aimed Towards Education, announced that the rider “risked his all for freedom.”


Sponsor Updates

  • Aaron Kaufman, GM and VP of Kony Healthcare, will speak at World Health Congress (MA) July 28-29.
  • Clairvia leads the market segment in Staff/Nurse Scheduling according to KLAS 2011 Mid-Term Performance Review.
  • CareTech Solutions launches its Zero Worries campaign to promote the company’s hospital IT help desk services.

Contacts

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

Curbside Consult with Dr. Jayne 7/4/11

July 4, 2011 Dr. Jayne 4 Comments
July 4, 1776 was the day the Declaration of Independence was signed. Informally, July 4 is considered the birthday of the United States of America, although the Revolutionary War (sometimes known as the War for American Independence in the rest of the world) continued well into 1783.

7-4-2011 1-19-50 PM

I’m a bit of an American History devotee as well as a medical history nerd. Molly Pitcher (Mary Hays) is one of my favorite Revolutionary War heroes. Starting as a “camp follower” at Valley Forge, she worked her way from carrying water for thirsty troops to carrying water to cool hot cannon barrels between firings.

When her husband collapsed next to his cannon at the Battle of Monmouth, she took his place, ramming the barrel in between shots so that it could be loaded. Legend has it that enemy fire blew a hole in her skirt and she shrugged it off with the comment of, “Well, that could have been worse.” How can you not be in awe of a gal like that?

7-4-2011 1-21-56 PM

I hope you’re all flying your flags – I know I am. Despite all of the flaws, America is still a great place to practice medicine. We’ve come a long way from leeches and mercury to the age of wonder drugs. Sure, electronic health records are debatable, but let’s look at a few of the things we’re glad have (thankfully) gone into the history books as well as some interesting historical factoids. And as you’re reading, remember that many people around the world still live in conditions that haven’t changed much since Molly Pitcher swabbed her last cannon.

  • During the Revolutionary War, soldiers were more likely to die from illness than combat. This continued pretty much until World War I, when battlefield engineers found more effective ways to maim and kill.
  • There were approximately 3,500 physicians in the colonies prior to the war. Although physicians in the 1770s were highly esteemed members of society, they were taught to never question their training and the idea of testing theories (the cornerstone of today’s scientific method) was met with disdain.
  • The first medical school at the Pennsylvania Hospital opened in 1768. Otherwise, physicians were trained through apprenticeships. Fewer than 300 of the physicians that served in the Revolutionary War had degrees, and those that did were mostly trained in Europe.
  • The study of anatomy was optional.
  • Use of leeches was common, as was treating illnesses with heavy metals such as mercury. Some physicians did pursue herbalism and remedies from Indians they encountered.
  • Amputations were common as a remedy for trauma. Sterilization of equipment was unfortunately not common, leading to survival rates often less than 30%.
  • Anesthesia was limited to rum, brandy, opium, and the proverbial “bite the bullet” technique.
  • Smallpox may have been the first biological weapon, allegedly used by the British. The Continental Congress encouraged soldiers to take advantage of an early type of vaccination.
  • General Washington doctored his troops with apple cider vinegar and honey. Although it is generally accepted that Washington died of a throat infection, it is likely that the efforts of his physicians probably sped things along with a combination of bleeding, mercury tonics, and blistering.
  • The first Surgeon General of the Army, Benjamin Rush (one of five physicians who signed the Declaration of Independence) began to advocate for cleanliness as a method for preventing disease. Unfortunately, this was hard for the Revolutionary Army to accomplish.
  • Physicians, notably William Cullen from Scotland, began to question whether imbalances in “nervous tension” caused disease. Stress-induced illness, anyone?
  • On the home front, barely more than half of all infants made it to age six. Only 10 of every 100 made it to their mid-forties.
  • Surgery for appendix removal was less than two decades old.
  • Physicians had only recently recognized that citrus fruits cured scurvy.

Those who are curious can learn more about Revolutionary-era medicine by perusing Dr. William Buchan’s book Domestic Medicine.  Watch out — make sure you don’t catch The Quinsey or even worse, The Gleets.

Now that you’re more than glad that you can have your gallbladder removed laparascopically or pop in to see the nurse practitioner at the local pharmacy for a script to cure your strep throat, let’s cover one tidbit that was discussed over 200 years ago yet didn’t make it into the Constitution: Medical Freedom. Benjamin Rush advocated at the Constitutional Convention:

Unless we put Medical Freedom into the Constitution, the time will come when medicine will organize into an undercover dictatorship … to restrict the art of healing to one class of men, and deny equal privilege to others, will be to constitute the Bastille of Medical Science. All such laws are un-American and despotic and have no place in a Republic … The Constitution of this Republic should make special privilege for Medical Freedom as well as Religious Freedom.

Not exactly something most of us heard about in American History class, but just as interesting a concept today as it was in 1787. So when you’re out of things to say at the family barbecue, you can feel free to throw that one out there. I guarantee the relatives that always discuss Medicare and Social Security will have a field day with that one.

Have a great recipe for red, white, and blue cocktails or a killer potato salad? E-mail me.

E-mail Dr. Jayne.

Monday Morning Update 7/4/11

July 2, 2011 News 8 Comments
7-2-2011 6-07-40 AM

From Michigan Wolverine: “Re: Munson Healthcare downtime. At least the administrator was truthful about the ‘chaos,’ if not about the patient care.” The three-hospital Michigan system loses all connectivity to the world when a planned switch to a backup fiber optic circuit fails. Applications, paging systems, wireless devices, and their IP telephones all went down hard, requiring 4.5 hours for recovery.

From The PACS Designer: “Re: 3D Web browsing. WebGL permits 3D viewing if you use Google Chrome (coming soon to Firefox 6 ). TPD thinks healthcare may find the web 3D feature helpful in following the diagnosis of conditions, such as viewing a colonoscopy result along with healthcare treatment videos. An excellent example to view in 3D on Chrome is the WebGL Iceberg Demo.

From Peter: “Re: thoughts on Google Health. Brilliant, lucid, and real. Thanks, Mr. H :)” This comment came all the way from New Zealand, so I figured I could at least mention it (especially since I appreciate it).

7-2-2011 6-10-45 AM

From Ilya: “Re: Johns Hopkins. Going with Epic for ambulatory to start in a project called Ambulatory First, with a statement from the JHM CEO that ‘we will continue to look for systemwide opportunities for the Epic system to support our health care reform initiatives and goals.” Ilya sent over the CEO’s e-mail announcement, which also points out that Hopkins has more than a dozen patient records systems that are going away. I’m sure additional planning and approvals will be required, but the tea leaves seem to say that Epic will replace a bunch of Hopkins systems very soon, most notably Allscripts Sunrise.

From A CIO: “Re: job change. You recently mentioned my new job. Your reach across the industry is amazing. I’ve heard from people I haven’t been in contact with for years.” I really love hearing that since it’s a blast to get people reconnected just by mentioning them in some way. Maybe I should profile one reader each week with a mini-bio and a photo just to see who reaches out to them.

From McOffice: “Re: executive offices. I was in the office of McKesson CEO John Hammergren a few years ago. It was understated and functional like a working manager’s office, but the view of the Golden Gate Bridge was pretty sweet.”

From Lusitania: “Re: executive offices. McKesson executives in Westminster, CO have very modest offices. Only a few have line-of-sight to the Rocky Mountains – most just see cubicles or walls. The cubes on the west side actually have a better view. The largest offices only have room for an additional four-top conference table. Otherwise, even our lowest directors have offices that match in size and furniture quality (basic Office Depot mahogany).”

7-1-2011 7-24-04 PM

From Cam: “Re: executive offices. We’re in an old mill right on a river between two waterfalls with 20-foot ceilings, wood, and brick. We fish out the window. The CEO’s office is filled with Legos.” I love old mills on rivers, with rough brick and massive wood beams. Somehow it feels right to be working on something high tech in historical, industrial surroundings. Cam was less philosophical when I made that flowery statement in responding to his e-mail, replying with tongue in cheek that, “except our history has to do with exploiting children in a mill setting and we work for pediatricians .”

From Delbert: “Re: executive offices. Judy Faulkner’s is big, but unassuming. Prairie style with a desk area in one part and an almost living room seating area. It’s right by the entrance to one of the buildings, so visits arrive via a sidewalk that goes right by her windows. Definitely no evidence of pretense of wealth and power in her digs.”

From Antoine: “Re: executive offices. NextGen’s two executives share a single office. No parking space, no special bathroom, they swipe the same security card to get into the building. The SVP has the exact same office as her managers – no windows. Very much the NextGen vibe, modest and unassuming.”

7-1-2011 7-36-59 PM

From IntelliDoze: “Re: IntrinsiQ. After looking for several years, it finally has a buyer in ABSG (AmeriSource Bergen Specialty Group). The press release will come out Tuesday. All of the employee options are under water, but on the bright side, they will be asked to sign two-year non-competes! The only folks making money are private equity firm Accel-KKR, not a huge return, but happy to get any return after buying at the top of the market.” Unverified. IntrinsiQ makes the IntelliDose chemotherapy protocol management tool and oncology-specific data mining applications.

From Fess Up: “Re: nextEMR. Those guys are still showing the CCHIT 2011 logo on their site even after you reported that CCHIT ordered them to take it down. They simply didn’t receive that certification.” They now have both the ONC-ATCB and CCHIT logos on their site, so I guess that’s some improvement – they added the correct one, but failed to take down the incorrect one.

Happy Independence Day to my fellow Americans. Some contrarian US history: the Declaration of Independence was signed on July 4, 1776 when the 13 insurgent colonies that were at war with their own British government announced that they were illegally breaking off and starting their own country. It’s very much like when the Southern states announced their secession from the Union in the 1860s, except the British weren’t quite as brutal in using scorched earth force against civilians to keep their empire intact. It was their Vietnam, a humiliating defeat at the hand of cunning rebels that we celebrate annually with hot dog eating contests and China-sourced pyrotechnics. My flag is waving today to celebrate our country, even though its history (both old and new) is uncomfortably less virtuous than they teach in school. But in any case, happy Fourth of July, if you must call it that (and Merry Twenty-Fifth of December).

My Time Capsule editorial from five years ago this time around, squinting in the bright sun after being buried since 2006: Vendors Should Make Software That Crusty Night-Shift Nurses Can Love. I veered into an overly broad generalization about nurses and computers that will probably raise hackles all over again: “Looking over their computer shoulder is like watching your kid play tee-ball – you try to help them by sending powerful telekinetic messages (‘Press Shift-Tab … Shift-Tab’) or with surreptitious body English.”

Listening: Skins, almost new from Buffalo Tom, a Boston alt rock guitar band that has drifted in and out of obscurity since 1986, but has always been good. Great road trip music that also wins my highest and rarely awarded honor: it has gone on my gym MP3 player. 

7-2-2011 11-04-49 AM

A good Google Health epitaph from Zak Kohane at Children’s Boston: “Google is unwilling, for perfectly good business reasons, to engage in block-by-block market solutions to health-care institutions one by one and expecting patients to actually do data entry is not a scalable and workable solution.” Let me be clear in saying that Zak is brilliant (and not just because I know he reads HIStalk and would make a fine writer for it, hint hint). Check out this provocative  article in which he suggests that computers could replace doctors for a lot of the protocol-driven work doctors do, which probably elicited predictable “doctors aren’t fry-slinging teens working at McDonalds” knee-jerk reactions instead of thinking about his point – do we really need doctors to do a lot of what doctors do instead of more important stuff? (and he’s a doctor, so his opinion counts double, not to mention that the military already delivers a large amount of care, including that on the battlefield, using non-physicians who have undergone focused training):

We want our healthcare providers, and particularly our physicians, to be completely up-to-date across the exponentially growing knowledge base of medicine, from drug side effects to genomics. Yet, in this era of  “evidence-based medicine,” we also expect these same physicians to follow well-defined protocols (algorithms on paper or on in electronic medical record systems) so that each patient receives the care that panels of experts have determined to be best. Just as McDonald’s follows sophisticated but regimented systems to make and sell its French fries and shakes.

So, which is it? Is each patient encounter a potential virtuoso tour of the medical arts and biomedical applied sciences? Must each doctor be the equivalent of Todd English? Or is it enough that each patient receive an honorable, workman-like execution of the best guidelines that are available? It is becoming increasingly apparent that we cannot afford a model that claims both kinds of performance delivered by the same person with the same job description.

7-1-2011 8-25-20 PM

Welcome to new HIStalk Platinum Sponsor Covisint, part of Detroit’s Compuware. The company enables “information ecosystems” that allow all healthcare players to securely communicate and collaborate. Its ExchangeLink platform connects hospitals to other providers (physicians, post-acute, referrers) by supporting workflow-driven fax solutions, a secure inbox for online delivery, and document exchange with practice EMRs. It has all the pieces and parts built in: identify management, MPI, and record locator service, and is used by states and HIEs to share information on a large scale to improve quality and coordinate care. Covisint’s App Cloud offers third party apps for e-prescribing, lab orders and results, referrals, disease management, EMR/PHR, and others from names such as Epocrates, DocSite Registry, Ingenix CareTracker, Allscripts, Dossia, and DrFirst. The company just won a MSHUG innovation award for its work with Vermont Blueprint for Health in providing a central registry, clinical decision support, and a care team portal. Many thanks to Covisint for supporting HIStalk.

Here’s a Covisint overview video that I found on YouTube.

A Bloomberg Businessweek post by business intelligence expert Leonard Fuld reminds everybody that his war game simulation predicted that Allscripts needed to merge with another company to avoid becoming an also-ran (it’s not mentioned whether the simulation gave Allscripts the idea). Like many prognosticators, he doesn’t mention other predictions that may not have panned out, like those involving McKesson and GE Healthcare in the same scenario (or his March 2007 statement that “the all-powerful MySpace, with its 130 million-plus members, seems invincible.”) Still, he seems to know his stuff when it comes to competitive intelligence.

7-1-2011 7-10-17 PM

Texas Health Presbyterian Hospital Dallas begins RFID equipment tracking, citing studies indicating that nurses spend up to 15% of their time tracking down needed equipment. The 898-bed hospital says it’s saving $30K per month by avoiding equipment rental. The vendor is Intelligent InSites tied into a Skytron ZigBee wireless network. The hospitals plans to use more RTLS apps tied into its systems (Epic, TeleTracking, and Siemens Invision).

Tampa-based software vendor MedHOK releases 360ACO, an analytics solution for complying with proposed CMS ACO rules.

A reader sent over the JAMIA article that looked at “errors” with e-prescribing. I’d take it with a large grain of salt. The study did indeed use prescriptions from 2008, even though it’s just now being published. Since the retail pharmacies faxed over the de-identified prescriptions, they had no way to know which were truly e-prescribed vs. just printed off from a computer system. Potential ADEs included the potential of harmless issues, like rash or nausea. Most of the “errors” involved omitted or unclear information, such as how long to take the med (which was probably already discussed with the patient and assumed from the quantity prescribed). They also could not make any conclusions about particular e-prescribing or pharmacy systems and had no way to assess how practices implemented their systems or how physicians were trained to use them. To me, the only valid conclusion is that doctors could turn on more edit-checking capabilities of their e-prescribing systems to reduce inefficient clarification callbacks from pharmacies. I don’t see much patient safety impact. Unfortunately, the rags often pick up a story like this and run with it, adding misleading but sexy headlines and trying to make the conclusions seem more dramatic.

7-2-2011 6-13-54 AM

The numbers are unchanged from my 2007 survey: a scant 13% of the most healthcare IT-savvy people on the planet keep their medical information in a PHR. New poll to your right: who is most responsible for the lack of sharing of patient information?

This is strange: Walmart is donating the time of its 142 in-house lawyers to Medicaid patients of Arkansas Children’s Hospital, taking on the government agencies and schools that don’t provide those patients with the benefits to which they believe they are entitled. The company says it will be “facilitative” rather than “adversarial” to Medicaid. If you’re a taxpayer unhappy with the huge entitlement programs you’re funding through your labor, this is probably not the best news you’ve heard today.

Thanks to the companies that supported HIStalk in June by starting or renewing their sponsorship. I do nothing to solicit sponsors except to e-mail a little handout PDF that Inga and I threw together when someone asks for one, so I appreciate those that persist in overcoming our appearance of indifference to support what we do.

7-2-2011 10-06-03 AM 
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Unrelated, but kind of amusing: the hammy, preachy host of the endlessly re-run, 2008-cancelled To Catch a Predator (“Have a seat over there. What do you think would have happened if I wasn’t here and a 14-year-old girl was home alone?”) is himself caught on hidden camera as he engages in nocturnal hanky panky with a hot TV anchor 58% of his age and 100% not his wife. Unlike the sickos his show entrapped for almost-honorable reasons (not to mention ratings), he wasn’t unnecessarily pounced on by a dozen camera-hogging, Taser-wielding police officers as he tried to leave the hotel.

E-mail Mr. H.

HIStalk Interviews John Hallock, Director of Corporate Communications, athenahealth

July 1, 2011 Interviews 5 Comments

John Hallock is director of corporate communications at athenahealth of Watertown, MA.

7-1-2011 4-52-38 PM


Give me a brief description of what you do at athenahealth.

I’m director of corporate communications. I oversee all external communications to media, analysts, and any public outside of the company. 

I used to have a part in investor relations, but now we have a team that handles that in house given the vast amount of coverage we get on Wall Street. We’re up to about 25 sell-side analysts, which is an awful lot for a company our size. We’ve had to really branch that off in the last few years.

What are the good and the bad aspects of your job when you’re working with someone so eminently yet dangerously quotable and entertaining as Jonathan Bush, who is running a publicly traded company?

Todd Park was my boss initially when I started with athena as a really young, almost a kid in my mid-twenties coming out of the agency world. I had the opportunity to work with some decent-sized companies working at mid to large PR firms and their CEOs and doing thought leadership campaigns. There’s a lot of articulate CEOs and there’s a lot of visionaries.

I had never encountered anyone like Jonathan and like Todd, quite honestly. You can see that now in his role at HHS where he’s very much in the forefront there.

Jonathan is … it’s kind of the like movie Seabiscuit. It’s the faster horse in the race, but you don’t always know what it takes to get the horse in the gate. He’s very candid. He absolutely has had a vision for this company and for the industry and that sometimes flies in the face of what many – whether it’s in the policy world or in the vendor community – want to see happen. He has a very unique talent of taking mundane or even boring topics and making them relevant to a broad audience, whether it’s a CNBC or CNN kind of audience or in a mainstream newspaper. That’s a plus as a PR person.

The other side of it, he is not an executive where I write talking points or a script and he just regurgitates them, as you know. There’s always this give and take, where he’s not someone that’s going to be “handled,” but rather it’s a relationship we’ve built over many years, where he’s got a really savvy PR mind himself and understands why he might want to talk to someone or do something.

There’s always a level of integrity there. It’s never done – as you know in the things we’ve done with HIStalk – it’s never done simply for publicity’s sake. When we went to HIStalk back in ’06, it was because we felt that the blog at the time was speaking to an audience that we were having a very difficult time reaching, quite frankly. No one knew about us. We still have a problem with that in terms of reaching a key audience in physicians and providers and in large groups, and having them understand our technology.

That is where he is very unique in terms of executives. You don’t often see an executive like him, given his role in this industry, have that much of a hands-on approach to communications. That emanates throughout the entire company in terms of how we talk to our employees, how we talk to media, and how we talk to analysts on Wall Street.

Some like that and some don’t. We are very candid with our employees. Every employee is an athenahealth insider. That has been accurate ever since we went public. Every single employee, and now thousands of them, have information that other people outside the company do not have. That presents risks, but it’s inherent to how the company operates. That really trickled down from him and Todd and the other leaders way back when they founded the company.

He has maybe the strongest gift I’ve ever seen in making whoever he’s talking to at the moment feel like his best friend, his smartest acquaintance, and the most entertaining person in the world. It doesn’t matter whether it’s a reporter or a stock analyst. I assume that comes natural, but behind the scenes there must be work to get him prepped and make sure what he says is covered the way he intended.

I think it’s twofold. You’re right. Like I said earlier, he and I have created a relationship over a period of time now, but he’s a genuine person. He’s sincerely excited about healthcare technology and I’ve never seen a person get as excited about medical billing as he does. From an executive standpoint, he’s probably forgotten about medical billing than most people in the revenue cycle management space understand or have ever known.

He’s a person that enjoys speaking with people that have an interest in the same things he does. That comes across whether it was him or anyone else. That’s a genuine conversation.

That being said, he’s also somebody that — based on his upbringing, I’m sure, and his experiences probably before athena went public and having to raise money and the venture capital and all the things you have to do as entrepreneur — he’s built that ability to make connections with people right from the get-go.

That said, as the company grew and we went public, especially after 2009 with the stimulus, we were just bombarded with not just outbound media relations, but inbound. We worked so hard over so many years to build this rapport with reporters and producers, so that if and when there came a time in the industry that something like that occurred, athenahealth and Jonathan would be the de facto resource they go to for clarification. That is what happened, which is great. It’s a PR success.

Yes, there’s an awful lot of work that goes into it, too. He’s a busy guy. You want to get the most out of any meeting. That’s pretty standard in PR, but at the same time you don’t want to… there’s never a time where he’s so over-prepped. You’ve covered a lot of this. There’s a lot of executives that, if you look at their interviews, you can literally read verbatim the same message. You don’t necessarily find that with him.

What you’ll find is that we’ll try to create two or three core messages on whatever it is we’re talking about. That’s something we will consistently hit home. The rest of it is really where we can ad lib and he can have a conversation. He keeps that ability to be genuine to himself and to the person he’s talking with.

Other executives in most practices in PR and communication it’s, “Here’s our messaging platform and you do not deviate from that.” You’ve probably interviewed lots of people that do that, and it suddenly sounds kind of like the teacher on Snoopy or Charlie Brown … waa waa waa. It loses its affect. That only works so long. 

It’s the same if you’re a reporter or if you’re a producer. They do not want an executive on who isn’t going to be able to roll with the punches and have a banter and a back-and-forth, whether it be with the talent on television or a reporter face to face, especially at a very high level. If you’re talking to a New York Times reporter or a Wall Street Journal reporter, they’re well researched. They’re intelligent people in their own right, or somebody like yourself, and their BS meter is extremely high.

The best PR people I’ve encountered are folks that you weigh the risks and you say, “OK, what do we get out of doing this versus not doing it? And what are the variables I can control and what are the variables I can’t control?” Then you play that. You let that equation play out.

Maybe you’ll agree with this. Athena is an incredibly aggressive PR company. It always has been. Whether it’s the campaigns we’ve launched, like PayerView and the Physician Sentiment Index, a lot of it is transparency. A lot of it is focused on releasing data and driving advocacy programs and pushing the envelope there. Again, that comes a lot from him and wanting to elevate the dialog. We know that’s something that allows us to play up our differentiators against competition and in the industry.

You mentioned the early days of HITECH.  When that came to life, did companies launch an all-out PR war to try to get attention?

Absolutely they did. I’m proud of the fact that if you look at the coverage, we and Jonathan and the company were right there getting our fair share, if not the majority of it.

A lot of that is hard work. Right up to two years before the IPO, building those relations with reporters that, by the way, weren’t even covering healthcare technology. There might be a technology unit. Take a Steve Lohr at The New York Times, for instance. He’s an individual that covers technology companies, but was suddenly thrust into covering healthcare technology when 20, 30 billion dollars was just tossed into a relatively tiny industry. Some of the companies he covered as a beat — Microsoft, IBM, etc. — were kind of fluttering around that industry.

If you’ve already built that relationship with him that he can go to Athena and he wrote about us a few times prior to HITECH, now he understands that, all right, this is an executive, this a PR person, this is a company that I can go to if I’ve got to work on a story. They’re going to give me something that is useful and it’s not going to be fluff. It’s not going to be toeing the company line to the point where he really can’t use it for his story. It takes years to build those relationships.

In February of ’09, literally, my phone was not stopping. I couldn’t even tell you how many interviews Jonathan did on TV. Dozens and dozens, not including media interviews. That was fantastic for us, but we got huge training for that around the IPO. We had the #1 debut IPO of 2007 in the country. That was, as you know, a whirlwind of media. 

At the same time, if you look back on that period, we went public in September 2007. We had obviously a great debut and we had very large investment banks backing us, so there was a lot of buildup to that. That said, that October of 2007, with MGMA, and nobody on Wall Street knew how to define what we were. You remember — no one knew what’s the model of this Web-based, Internet-based thing and the recurring revenue and percentage of payment.

What they called us was Software as a Service. Then every vendor, six or seven of the top ambulatory vendors at MGMA that year, released “SaaS solutions.” All the PR we had done to try to differentiate ourselves, we now had a new challenge of saying, “No, no, no, SaaS is not a monthly payment model. I’s not an ASP. It’s not something that’s remotely hosted — there has to be a service delivered. It has to be a service delivered over the Internet and the vendor has to have a stake in it. That’s the Athena model.”

We have not stopped to this day pushing that. Now, it’s because at Microsoft and IBM and others, the cloud as emerged. That has actually been great for us because that is essentially what athena is—a cloud-based service. It’s a lot easier for us to come in behind the Microsofts and IBMs and much larger brands that are pushing that and more a pure play and they may not be. They may have elements of a cloud play and raise their hand and talk to media and talk to other folks.

Honestly, it helps with prospects, because when you’re dealing with larger enterprises that obviously know who Microsoft, IBM, or Dell is and may not be as familiar with an athenahealth versus traditional IT guys in healthcare like Epic or Allscripts. Now we can have a much broader conversation. That’s where PR plays that strategic role for us.

I’m often critical of press releases that are badly written and don’t have any news value. Why do companies let that happen?

If it’s a little company, if it’s a private company, they’re trying to create news so they can create news. We did that a long time ago when we didn’t have a lot to say. I think as a company matures, you have to build — and we have built — mechanisms and protocols where we say when t is and is not worth  putting a formal press release out.

Press releases are the most significant form of communication a company, especially a public one, can do. It’s a formal communication and it’s regulated. You want to be careful when firing out a piece of “news” that it’s got news in it. It’s not just, “Hey, we agree, with this passing of a policy.”

One of the reasons that companies like to put out press releases more often is search engine optimization and the ability to link in press releases. That drives inbound leads to Web sites, so there’s a whole integrated approach there. The purity of the news has got to be at the forefront and we try to keep it there.

How do blogs and social media fit into the company’s strategy and how have they changed jobs like yours?

Night and day. I was talking with a former colleague from my days at Weber Shandwick, which was the largest PR firm in the world when I was there. There was no such thing as blogs or Twitter, Facebook, or any of that good stuff. That’s what we do now … that’s pretty much what we do. You put out a press release, that thing fires, and we’ve got the Twitter going and we’ve got the blog going. We have a content team now.

I look at where we were years ago in terms of just headcount and where we are now, and how large our marketing communication and content team and investor relations team is. Our ability to communicate via social media has grown exponentially, and it has to. The days of just putting out a press release are over. If you’re not in a position to take advantage of social media and new media, then you really can’t say you’re being a fully functional PR or communication department of a company.

In the old days, the only thing bad that could happen was that you didn’t get any coverage. Now there are folks outside the traditionally advertiser-friendly publications who might actually say something negative.

Oh. yeah. Just look at your blog. If you want to talk risk and reward, you know every time Jonathan does a Q&A with you, there’s good and bad there. He’s a lightning rod, so I know there’s going to be 20, 30 comments, because everything he says flies mostly in the face of the established vendors and the consultants and the folks reading your blog, which is who we want to change and how they think. But you know there’s going to be very negative comments. Or, the fact an executive – in our case, Jonathan – may say something about regional extension centers and that gets picked up by a competitor’s blog. 

All these things happen. From a PR person’s standpoint, your job. It’s not just picking up the paper every morning now and saying, “OK, my local reporter who covers healthcare — what did he write today?” It has nothing to do with that, for the most part, and has everything to do with keeping track of the blogosphere and who’s tweeting what and what other competitors are blogging about and understanding that one comment can have a massive ripple effect good and bad.

We honestly learned quite a bit through HIStalk. I’m not just saying that because I’m giving an interview here. We had some successes on the blog and interviewing, and we had some times where I would do things differently. Prime example – Jonathan’s last interview. Maybe doing something live or a podcast where you can hear the inflection of its voice or the fact that he’s making a joke or something like that — it gets lost in normal transcription. Usually you learn these things, but you understand that once that’s out there, people say, “Boy, that executive doesn’t even make sense,” when in fact he does, and if you were listening to the conversation, he sounds funny and articulate. But once it’s out there, it’s out there.

You got connected early with this tiny little quirky athenahealth with an ultra charismatic CEO that now has grown up and gone public. Where do you take it from here and where personally go next?

If you had asked me that a year ago, I’d say, boy, biding my time and Athena’s winding down. I’ve got to go be there, maybe start a firm or look for the next kind of Athena. But I think given all that’s going on in the industry … it was funny, I think now I’ve gotten a second wind. I’d really like to see this through. 

I think Athena’s really on the precipice of making some … we really hit the ball out of the park on the revenue cycle management side. It took us a number of years to do that. I don’t think there’s many people that would argue that Athena’s not a leader in that regard. I think on the clinical side, we’re starting to see some traction.That’s exciting and we have a long way to go, but I’d like to see where that ends up and my role in that.

Looking back as a young 24, 25-year-old kid at dinner in New York City with Jonathan and Todd … they essentially fired me the night they hired me. I was working at a PR firm that they weren’t happy with. I inherited the account to manage it and I was down there on a media tour. We had this great media tour with the two of them, and we went out to dinner. Again, I was just a young guy, nervous, and Jonathan says, “Hey, listen. We really like you, but you’re fired.” Immediately I started thinking, “How am I going tell my boss?“
I had to wait a little bit of time for a non-compete. 

I was very fortunate in that regard, but I don’t think my time at Athena is done. There’s a lot of great companies coming up, though. Nancy Brown went to one, MedVentive, which is doing some exciting stuff. I think anything that’s Web-based, that’s on the cloud, depending where the ACO debate plays out. But Athena, you know, it’s rocking and rolling. It’s big now. That gives us some muscles and we can do some more things and it’s exciting.

Honestly, as a PR person, if you spend six years or so building a brand or helping to build a brand, to me, it doesn’t make sense that when it’s starting to really hit an inflection point, you jet. I think that’s the time when you start to enjoy it and say, “OK, we’ve got the ability now to do some things that maybe we couldn’t do three, four years ago and talk to some people and influence some things.” If you’re a real, true, PR practitioner, that’s what you look for.

Time Capsule: Vendors Should Make Software That Crusty Night-Shift Nurses Can Love

July 1, 2011 Time Capsule 1 Comment

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 2006.

Vendors Should Make Software That Crusty Night-Shift Nurses Can Love
By Mr. HIStalk

I wasn’t surprised by a recent study’s seemingly conflicting results. Nurses see themselves as key players in patient safety, yet admit that they often break the very rules created to keep patients safe, such as checking a patient’s identity by two methods before giving meds.

Nurses continually amaze me in two ways. They are stunningly caring and comforting to the frightened and hurting patients under their care. They are also terrible computer users.

Before I get lynched by nurse readers, allow me to present my flimsy and anecdotal evidence. I’ve known at least 500 nurses over the years in my clinical and IT roles. Almost none of them were interested in programming or were capable of fixing basic PC problems. Looking over their computer shoulder is like watching your kid play tee-ball – you try to help them by sending powerful telekinetic messages (“Press Shift-Tab … Shift-Tab”) or with surreptitious body English.

It just doesn’t come naturally. The “caring” part of the brain has some sort of limbic dominance over the “nerd center.” That’s quite unlike lab techs, pharmacists, and physicians, who love creating databases and playing around on the Internet.

It’s great news as a patient that few nerd nurses are out there comforting the dying and cheering up sick kids. It’s not so encouraging to systems vendors.

Nurses don’t think in black and white. They bend or break the rules whenever it makes sense. Their numbers and organizational structure ensure they’ll be hard to reach and harder to convince, especially when they’re being asked to change their routine. They know they’re in short supply, so you can’t scare them into compliance.

Along comes software, which is about control, reduction in variability, and elimination of individuality (management in a box, in other words). Nurses hate that stuff. For example, the No. 1 problem with bedside bar-coding systems is nurses who copy patient wristbands so they don’t have to scan the real thing before giving meds. (I don’t get it either, but I’m sure there’s a reason on the front lines.)

The primary users of our clinical systems are nurses. Nerd-designed systems don’t make sense to them, even if slightly higher nerd-center developed nurses (a.k.a. informatics nurses) advised them.

Few industries have professionals on the front line, and even fewer expect them to be competent users of a wide variety of software and technology. We roll out software with poor user design and “in your dreams” workflow. We cut training because we can’t spare the time away from patients. We use software as an enforcer of rules already being ignored, then we throw in a few new ones because that’s what software does. The end result is an application that’s underused, misused, and blamed for a reduction in quality.

Providers are unlikely to hire nurses based solely on computer skills or willingness to follow orders (software or otherwise). For that reason, software needs to be designed for the average nurse, paying attention to usability and task-based design.

Instead of the friendly audience of IT or management nurses, vendors and providers should seek counsel from the crustiest, most cynical night-shift nurse who just wants to be left alone to care for patients and then go home to lead a non-computer lifestyle. Maybe the end result would be software that even a nurse could love.

News 7/1/11

June 30, 2011 News 11 Comments

Top News

 image Third-party firms that implement vendors’ applications outperform the vendors themselves – except in the case of Epic. Deloitte earns the highest overall marks among third-party firms in KLAS’s survey. Coastal and Peer Consulting outscored GE in overall customer satisfaction by 30 or more points; ACS and Vitalize beat Allscripts by 20-plus points, and Encore and Vitalize outscored Cerner by 20-plus points. Epic outperformed them all.


Reader Comments

6-30-2011 6-29-31 PM 

image From Johnny “Hot Rocks” Garcia: “Re: making appointments online. Check out ZocDoc and take note of its investors!” ZocDoc allows searching for doctors within a ZIP code by specialty and accepted insurance. It’s pretty cool, although available only in eight metro areas so far. They have an iPhone app. Investors include The Founders Fund (run by the founders of PayPal, Napster, and Facebook), Jeff Bezos (Amazon) and the chairman and CEO of Salesforce.com. 

image From Glenergy: “Re: Allscripts. A new general counsel – Jackie Studer from GE.” Unverified.

image From Jordan: “Re: copied medical records. Kind of expensive for an electronic copy.” Texas Health Resources charges state-mandated fees for medical record duplication: $42.05 for the first 10 pages of a paper record, $64.07 if they’re on microfilm, and a flat fee of $76.20 for electronic records requested in electronic form. The state may set the price, but I would have to guess hospitals had input into the rather large numbers. That makes the paper statements of banks look like a great deal, although their free online option isn’t even offered by hospitals. Charging more for an electronic dump is odd, although if you’ve looked at a hospital chart, your $42.05 isn’t going to go far considering the stacks of paper that go far beyond 10 pages. Maybe they should just charge law firms 10 times that amount and let patients have copies of their own information at no cost. Most hospitals think they’re doing patients a big favor by letting them see what they’ve written about them.

image From Viking: “Re: GE Healthcare. A marketing director friend had their job eliminated this morning, saying there’s a sweeping org change underway.” Unverified. GEHC doesn’t respond to personnel rumors, so I didn’t even bother asking.

6-30-2011 10-20-38 PM

image From Terminator: “Re: PHRs. I wonder if their functions are gaining ground as standalone apps that people actually do use? For example, Walgreens keeps all my prescription records and I can access them from anywhere, so I have no reason to import them to a PHR. I use an online tool for diabetes logging, although it would cool if it were updated automatically from any meter I use. If I see a glucometer that allows batch uploads of data to a site like this one, I’m grabbing it! That’s all I want in a PHR except for lab data and the ability to communicate with providers, but patient portals are adding PHR-like features as well, some of which have access to data and have appointment-setting tools.” That’s the big debate – would consumers prefer an independent but minimally functional tool like Google Health or one that’s rich in function and data, but tied to a specific provider? So far, they seem to be saying B (and who can blame them, given that both are free?) Notice above that Walgreens even offers online pharmacy chat right from the public Web page, although it would be interesting to know who’s on the other end.

6-30-2011 10-22-06 PM

image From LaidOffInDallas: “Re: UT Southwestern Medical Center. Just laid off several IT employees.” UT Southwestern just announced that, due to the loss of $31 million in state funding, it has cut 350 staff positions, laying off 105 employees.

image From Former CIO: “Re: Epic art. I would suggest that Mr. Ciotti’s opinions about wasting client money are focusing on the wrong target. The vendors who are wasting money are those that spend more on marketing and less on development, thus producing products that are not integrated and do not support patient care needs. Perhaps the artwork enhances employee attitudes and they get more work done for the money. The cost of the product is a fraction of the true cost of ownership when one considers clinician time and effort. Even so, the cost of the product is still competitive.” At least Epic is sharing the investment with employees instead of hogging the goodies for its executives in a “we’re better than you” kind of way, such as companies that give the suits reserved parking spaces, private bathrooms, and offices that would hold 20 of the veal pen cubicles that the real workers toil in. I can’t vouch for Judy’s office since I haven’t seen it, but I picture it as quirky but modest. That’s a fun challenge: e-mail me with a description of the top dog’s office wherever you work – I will run them anonymously. If they have really splendid digs, make sure to snark it up some.


HIStalk Announcements and Requests

image Stuff you’ll want to check out this week on HIStalk Practice: Micky Tripathi details the difficulties associated with tracking and reporting clinical quality measures for Meaningful Use. HHS halts its mystery shopper program for measuring access to primary care. Experts suggest reasons practices are behind schedule for the HIPAA 5010 transition. Dr. Gregg struggles with HITECH guilt and living on the dole. Costco jumps into the EHR world with deals on Allscripts MyWay. AAFP launches its $90/year clinical messaging system. While you are over on HIStalk Practice, sign up for the e-mail updates like the rest of HIT’s coolest kids.

image Listening: reader-recommended Belle and Sebastian, 70s-style indie pop from Scotland. A nice sample is here, if you can overlook the fact that the preachy announcer sounds like Mike Myers playing the Scottish dad in So I Married an Axe Murderer.

image I’m thinking about refreshing the look of the site and maybe even changing the smoking doc logo in some way. I’ve been using this layout for years, and while I don’t really care all that much one way or another, I guess it’s time for an update (I think Inga is interested). If you have ideas, let me know. Most of the responses I’ve received in the past have been of the “don’t change anything” variety, so that’s the default course of action to challenge. 

image I’ll probably publish a Monday Morning Update even though it’s Independence Day (please call it that rather than the Fourth of July). You can amuse me over the weekend by connecting on LinkedIn and Facebook, signing up for e-mail updates, or just checking in to let me know that I’m not the only one with HIStalk on my mind. Have a great holiday. I’ll be taking a few days off starting next weekend, leaving the fabulous Inga and Dr. Jayne in charge.

Jobs on the sponsors-only Job Board: Director of Marketing – Hospital Segment, Director Sales Operations, Senior Enterprise Sales Executive Hospital Southeast. On Healthcare IT Jobs: CEO & President, Clinical Nurse Analyst, Epic Resolute Consultant.


Sales

6-29-2011 12-45-06 PM

Aspirus (WI) signs a clinical documentation contract for MedQuist’s DocQment EP.

6-29-2011 12-45-57 PM

University of Utah selects Authentidata Holding Corp. for its three-year telehealth project that includes health information exchange, workflow management services, and remote patient monitoring solutions.

6-29-2011 12-47-19 PM

University of Oklahoma chooses OmniMD as a preferred provider for medical transcription services.

VHA signs an agreement with Deloitte to offer RCM consulting services to its 1,350 not-for-profit community hospitals.

Ochsner Health System (LA) signs up for Philips VISICU, which will make it the first eICU program in the state when implementation is finished next year.


Announcements and Implementations

6-29-2011 1-37-06 PM

InterSystems names Gila River Health Care (AZ) the winner of its Breakthrough Applications Award for using InterSystems DeepSee BI technology with its Diabetic Analysis Management System.

Scripting automation vendor Boston Software Systems celebrates its 25th anniversary.

6-30-2011 9-21-34 PM

Medtronic announces a free smart phone app for its CareLink telemetry system for implantable cardiac devices.


Innovation and Research

image Cisco announces its Android-powered Cius tablet, due out at the end of July, with the video above featuring Palomar Pomerado Health Chief Innovation Officer Orlando Portale (starting at around the 41 minute mark). The Cius will cost $700, has no 4G connectivity, has only a few dozen apps available from Cisco’s own store, and is sure to bring up the puzzled question, “Why would I want this instead of an iPad that costs less?”


Technology

Oracle will buy storage startup Pillar Data Systems for an undisclosed price. That company’s CEO and majority shareholder: Larry Ellison, who also happens to be the CEO of Oracle. He claims he recused himself from the acquisition discussions, although he didn’t mention why a guy with an Oracle-generated net worth of $40 billion was off running another company on the side.


Other

6-30-2011 7-06-22 PM

image The developer of Nashville’s Medical Trade Center says it will not break ground until at least 60% of its space is leased. The developer anticipated this goal would have already been met, but a mere 20% of the space is under contract. Committed lessees so far include HIMSS, Steelcase, and mdi Consultants.

image  A Florida doctor who moved to a cloud-based EMR a year ago loses access to the records when his Internet connection goes down. He’s been treating patients blindly for three days so far while Comcast tries to fix his broadband. I’ll predict that ONC won’t make his experience the focus of one of its feel-good EMR stories: “If can’t access a patient’s medical records, I’m afraid in the rush of things I might miss something or not do as good a job as I normally would.” His phones are down, too.

6-30-2011 6-00-48 PM

image Note to companies seeking to become “leading” suppliers in healthcare: your message tends to be more powerful when you reference the correct vertical market in your press release (unless there’s a connection I missed between vehicle dealers and healthcare). 

image I saw a press release about a survey claiming that more than 50% of consumers would choose a hospital based on their Facebook and Twitter presence. I found that hard to believe, so I e-mailed the company to ask for the methodology. They offered to provide it if I bought the report for $1,250. I guess I’ll just remain skeptical.

image The coroner says mistakes made at Marin General Hospital (CA) helped kill an ICU patient. A doctor, a respiratory therapist, and three nurses were identified as putting the patient on a ventilator, then leaving the room without making sure it was working. It wasn’t.

image A study of electronic prescriptions finds that about 10% contain at least one error, the same percentage as paper prescriptions. I only have access to the abstract, but I notice that (a) the electronic prescriptions reviewed were form 2008 for some reason; (b) the study treated all errors equally, with the most common being omitted information (which causes no patient harm); (c) it looked at “potential adverse drug events,” which could indicate lack of decision support on the e-prescribing end, but not necessarily (for example, I don’t know if they counted potential drug interactions as “errors” if the electronic prescriber of Drug A was the same one who prescribed Drug B, which is not necessarily either prescriber’s fault).

image Weird News Andy says this man couldn’t have picked a better place to have a heart attack. He complains of chest pain during a cardiologist’s lecture on heart disease at Central Maine Medical Center, then collapses with no pulse or respiration. One of three cardiac nurses in the room jump starts him with a defibrillator, whereupon he is treated in the ED and is doing fine.

image Strange: a former managing director of bankrupt investment banking firm Lehman Brothers is busted for trying to pass photocopied prescriptions for Oxycontin and Ritalin at the local drug store. Police follow his Range Rover to his $35 million home and arrest him.

image Not healthcare related, but an indication of pervasive technology. The Pope tweets on an iPad to help launch a media portal. Yes, that Pope. You might want to friend him.


Sponsor Updates

  • T-System celebrates its 15th anniversary with a five-video series about the history of emergency medicine and of the company.
  • ADP AdvancedMD will expand its workforce by 45% this and add up to 100 new jobs in the Salt Lake City area.
  • West Penn Allegheny Health System (PA) will continue its rollout of Allscripts EHR to its employed physicians and begin offering Allscripts MyWay to its 2,000 affiliated physicians.
  • East End Health Alliance (NY) and its member hospitals choose MedVentive’s Population Manager for sharing clinical information and monitoring performance against evidence-based medicine. MedVentive also announces that former Massachusetts HHS Secretary Charlie Baker is joining its governing board.
  • MEDSEEK enters a strategic alliance with Diebold to offer an automated patient check-in, co-payment, and appointment scheduling solution utilizing Diebold’s self-service kiosk.
  • ZirMed earns its highest-ever rating in the most release KLAS rankings. In addition, 100% of its surveyed clients indicated they would buy ZirMed again.
  • Indiana University Health Centers select eClinicalWorks for two campuses.
  • Iatric Systems announces that its PtAccess, Patient Discharge Instructions, PHR Connect, Clinical Document Exchange, Visual Flowsheet, and PHI Interface solutions have received ONC-ATCB 2011/2012 Certification.
  • Capsule’s DataCaptor medical device integration software earns a KLAS score of 90.5 with three Konfidence Level check marks in the 2011 mid-term performance review.
  • Washington and Idaho Regional Extension Center (WIREC) includes e-MDs as one of the seven vendors chosen for its initial Group Purchase Program.
  • LawLogix joins Perceptive Software’s partner developer network to offer a central document repository with forensic-level audit controls using Perceptive’s ImageNow software, allowing HR departments to manage I-9 and E-Verify compliance requirements.
  • A new KLAS report on HIEs names MobileMD as the highest-rated vendor serving the private HIE market segment.

EPtalk by Dr. Jayne

Multiple news outlets (including HIStalk Practice) picked up the announcement that the Department of Health and Human Services is scrapping its “Mystery Shopper” initiative, originally aimed at determining whether physicians’ acceptance of new patients depended on type of insurance. Observant folks will notice they left the door open to bring this one back later though, stating, “we have determined that now is not the time to move forward with this research project.”

I don’t need a bunch of grant money to tell you the answer to the question of “can you get seen quicker with good insurance” is “yes.” And if we’re talking about specialist physicians, the answer is “double yes.”

I practice in a major metropolitan area with multiple health systems, numerous tertiary referral centers, and some topnotch medical schools. From experience, if you are a Medicaid patient who needs to see an orthopedic surgeon or a neurologist, there less than a handful of places that will see you at all, and even then you’re going to wait. Most likely, you’re going to wind up being seen in a residency clinic.

I’m fortunate to work for a health system that doesn’t force employed physicians to cap Medicaid patient panels — we have a mission to care for those in need. As a result, I do more than my share of Medicaid care compared to my private practice colleagues, who may cap at 150-200 Medicaid patients if they even take Medicaid at all (and many don’t). Reimbursement doesn’t cover the cost of the visit, and frankly, I don’t remember the last time my practice made a profit. If not for the mission of the health system and their generous subsidy, I’d have had to go out of business before I ever had a chance to make a go of it.

There are some patients who are working the system, but the majority of my Medicaid patients are folks that have fallen on hard times or have had other life-altering events such as an unplanned pregnancy or a severe medical issue impact their lives. Some of the most rewarding patient relationships I have are with these patients, who are genuinely appreciative of the care they get.

I practice evidence-based medicine and don’t refer unless I have to. It breaks my heart to have patients waiting six months or more to see a specialist when I know that if they had a commercial payer, I could get them an appointment within a few weeks. I’ve been forced to expand my scope of practice because specialists won’t see Medicaid patients. It’s almost like being the Little Doctor on the Prairie when in fact, I’m just a few doors down from Starbucks.

(And thank you to my “generous” specialty colleagues willing to proctor me in expanding my procedural techniques because you didn’t want to actually see the needy patients yourselves. Guess what? I don’t just do them on Medicaid patients now — I keep all the procedures in-house.)

I’d be happy to charge CMS, HHS, or anyone else willing to listen a hefty fee to tell them how to increase access for Medicaid patients. States such as Colorado are already at critical shortages of primary care physicians. Articles such as this should be required reading for the politicians deciding how to carve up the healthcare pie. Some ideas:

  • Increase the attractiveness of the primary care specialties by increasing Medicaid and Medicare payments for primary care and other cognitive (non-procedural) specialties. The relatively low primary care salaries — coupled with hefty administrative burden, constant on-call and hospital work, and rising patient expectations — are no match for the financial lure of other specialties.
  • Increase loan-repayment plans for primary care and/or offer more zero-interest loans for these disciplines. Most of my classmates came out of training with at least a quarter of a million dollars in student loans. Unless you have a vocation for primary care, a salary of $300-$400K each year looks a lot more welcoming than the $130-$140K primary care starting salary when you’re sporting a student loan payment that’s more than most mortgages.
  • Increase the availability of case managers, care coordinators, dieticians, health coaches, and social workers for Medicaid patients at no cost to the physician. Don’t tie it to some ACO-type scheme. I promise with this infrastructure, if you build it they will come. (My apologies to William Kinsella for shamelessly poaching your line.)
  • Remove administrative barriers for care of medically and/or socioeconomically needy patients, regardless of payer. In addition to the above, remove the requirement that physicians pay for translator services for patients and reimburse this through payers, public or private. I’ve paid over $450 for interpreter services for a visit that I was paid $24. And this is a patient that needed to come in every month because they were complicated – it was a minimum of $150 to get the interpreter to come. Thank goodness my health system is willing to subsidize this, because most private docs don’t have the luxury.
  • Reduce the administrative burden related to health IT initiatives. If you’re going to require something (like submission of data to an immunization registry or submission of syndromic surveillance data) ensure that the states actually have an infrastructure to receive the data. Do not send me on a pointless mission to contact department after department across multiple states trying to find someone who has any idea what I’m talking about, only to find out my state can’t accept either kind of data.
  • Make quality initiatives make sense. Micky Tripathi’s Pretzel Logic: The Quality measure Conundrum says it all. Most clinicians want to give good quality care. But when it becomes so complicated that the average physician is torn between the spirit of the incentive program and the somewhat malleable calculations to demonstrate it, there are a good chunk of docs that decide it’s just not worth it.
  • Understand that the push for healthcare IT has actually made it easier for providers to “cherry pick” the healthy patients or “lemon drop” those that are non-compliant or have poor payers. Back when we had paper charts, it was a lot of work for providers to weed those patients out. Now docs can report on them on a monthly basis with the click of a mouse and decide which patients are too difficult to manage. Probably not what was intended, is it?

So even though it’s dead for now, I’m taking bets on how long it takes the Mystery Shopper program to show itself again. Any takers? E-mail me.


Contacts

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

CIO Unplugged 6/29/11

June 29, 2011 Ed Marx 14 Comments

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

Why We Need Transformational Leadership

The labor and delivery room filled quickly with physicians and nurses. The walls turned inside out, revealing sterile equipment. The transfiguration from birthing suite to operating theatre was complete. I figured this was not a good sign.

Despite numerous inducements, my wife’s body refused to give up the gift inside. I went from active coach and participant to frightened bystander. Moved aside, I worked my way behind my wife, out of the path of clinicians and equipment, yet close enough to stroke her hair, hold her head in my hand, and whisper prayers in her ear.

While I wasn’t familiar with all the technology, I knew to keep an eye on the fetal heart monitor. Fluctuating wildly, the bottom kept falling out until the heart rate eventually registered as zero — and stayed there.

Seconds passed like minutes, minutes like hours. After cutting, vacuuming, forceps, and physical manipulation, our baby appeared. “We’ve got a floppy,” the doctor announced. He handed the bundle over to his partner, who whisked our child to a nearby table for resuscitation.

Nightmarish thoughts invaded my mind. Instead of returning home and rejoicing over a new life, would I be planning a funeral? Picking out a tiny casket? Mourning? Wondering if it would be worth trying again? While clinicians huddled around our daughter, we changed her name from Kirsten to Talitha.

Seven forever minutes later, a nurse displayed our child, swaddled in a blanket and breathing on her own. “Here’s your daughter,” she said, before they took her down the hall.

Talitha is an Aramaic word used by Jesus in the Gospel of Mark. A father chased after Jesus and pleaded for Him to heal his recently deceased daughter. Impressed by the man’s faith, Jesus went to his house. Upon seeing the lifeless body, He commanded “Talitha Kuom” (translated “young woman, arise!”). The girl awakened. Ours did also. Miracles still happen.

Talitha slept in isolation in the newborn intensive care nursery. We could look at her, but not touch. Strep B had caused the trauma, but she was also fighting pneumonia and a hole in her stomach. Physicians forecasted long-term physical and mental damage.

In our shocked state, we reviewed options with the clinical team. We signed releases, willing to assume any risk that might help Talitha survive. Our church pastors loved on us, praying for wisdom and healing. We gave thanks for the hospital and dedicated clinicians.

The biggest decision lay ahead. Should we undertake a risky “flight for life” transfer from our hometown hospital Level 3 NICU to a Level 1 NICU 90 minutes away? Adding complexity, Julie was not physically well after the trauma, and I did not want to separate her from Talitha. The receiving hospital specialists said they could consult remotely if there was an automated way to collaborate. But this was the early 90s.

I had been serving as the physician relations coordinator for this hospital. A year prior, I had been given an additional responsibility related to IT. The IT staff was struggling with physician adoption of a clinical system application module that allowed them to dial in (on a 2,400 baud modem) and have real-time access to clinical data. Because of my track record in working with physicians, I took the job of evangelizing this tool to the medical staff. We went from 5% to 90% adoption in one year.

What if?

What if we gave the consulting physicians direct access to the clinical record and they could treat my daughter from afar? Two hours later, they had access. Care coordination and collaboration began. This defining moment made my calling and career crystal clear. I knew I was to combine my leadership talents with my technical skills and apply them to healthcare information technology.

Eight long days later, Talitha was released, albeit on oxygen. The strep was treated, her pneumonia was resolved, and her stomach had healed itself. No physical impairment. Today, because of her high IQ, no one could ever know of the fight Talitha endured to be a part of our family. (Well, perhaps with the exception of her “Goth” period around age 14. LOL.)

And Julie? She, too had a miraculous recovery. The quarter-sized hole connecting her uterus and bladder (caused by a 9.5 pound baby) closed without surgical intervention.

This story is one example that illustrates the power of technology when it’s paired with leadership and harnessed to share clinical data. As we mash up transformational leadership with emerging technology, we will hear many more stories like Talitha’s that inspire us to do greater things.

This fall, we’ll celebrate our beautiful daughter’s 18th birthday. She is the reason I serve in healthcare information technology. I can’t imagine having any vocation outside of healthcare. I am a direct beneficiary, and it changed me forever.

Ed Marx is a CIO currently working for a large integrated health system. Ed encourages your interaction through this blog. Add a comment by clicking the link at the bottom of this post. You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook and you can follow him via Twitter — user name marxists.

News 6/29/11

June 28, 2011 News 23 Comments

Top News

6-28-2011 9-53-41 PM

French IT services vendor Capgemini is looking for IT services acquisitions in the US, particularly in the healthcare sector. Says the CEO, “We are a marginal player in several of the key markets. For instance, we are non-existent in healthcare in the US, which I think is a mistake. So we need acquisitions.” You may recall that Cap bought Ernst & Young Consulting in 2000, stuck their name on it (above), then sold it to Accenture five years later after losing a ton of money. I worked with E&Y quite a bit at a previous hospital employer back in their heyday and they were excellent for strategic planning, IT governance stuff, and security work. I had a couple of occasions to work with Cap and they were clueless.


Reader Comments

6-28-2011 8-31-41 PM

From Susan: “Re: Kettering Medical Center (OH). Went live on Epic May 1 on inpatient, ambulatory, and revenue cycle.” The video is here.

From CloseToEpic: “Re: Epic. Heard from a Madison, WI apartment owner that Epic has hired approximately 2,000 new employees who will be starting end of summer. Apartments filling up around Madison.” Unverified, but reasonable.

From WildcatWell: “Re: Google PHR dead. Told ya so. Give a brother some love! Your EMR/EHR insight is THE industry leader. Let’s get all your readers together – I’ll buy the first round.” WCW is a good information source, but I notice that his drink offer was made anonymously.

From Academic CIO: “Re: HIStalk’s eighth birthday. You have really created a resource that, on top of the insight, information, and perspective you deliver, has replaced the trade mags we used to read to try to get a handle on what was happening in the industry (and which were really only giving the vendor-approved view anyway).” I really appreciate those kind words – thanks. The best part about it is getting to connect with some really interesting people and to help bring a variety of opinions to the table.


HIStalk Announcements and Requests

Inga’s taking a semi-break, so I’m soloing this time around. She’ll be back shortly.

Vince Ciotti poses this (easy) question: “What vendor spends (wastes?) the most of its clients’ money on extravagant architecture and frivolous artwork?” Examples above from Vince’s collection.

Ed Marx added an update to his June 15 post with responses to reader comments.


Sales

6-28-2011 10-02-50 PM

Sentara Healthcare (VA) contracts with TeleHealth Services for its interactive patient education solution.

SSM Health Care (MO) contracts with revenue cycle solutions vendor Passport Health Communications for SaaS-based eligibility and financial screening solutions and services for its 15 hospitals.


People

6-28-2011 4-51-22 PM

Practice Fusion names Cora M. Tellez to its board. She’s the former president of Health Net and CEO of Blue Shield of California-Bay Region.

6-28-2011 8-52-23 PM

Mark Lederman, formerly VP/CIO at Interfaith Medical Center (NY), has been named VP/CIO at Chilton Hospital (NJ). We swap e-mails occasionally and he sent over the update, so congratulations to Mark.


Announcements and Implementations

6-28-2011 10-26-24 PM

UMass Memorial Health Care (MA) integrates MyCareTeam’s MCT Clinical diabetes management system with its Allscripts ambulatory EHR, enabling patients to upload their glucose readings.

6-28-2011 11-31-39 AM

Chicago mayor Rahm Emanuel announces that Allscripts will add 300 new jobs in the city by the end of 2012. The company will also host its annual user convention at McCormick Place starting next year.

UPMC implements Oracle GoldenGate with Cerner’s 724Access software to help reduce potential EMR downtime.

A Bama Buddy find: a hospital reports that a batter’s box-type outline made of duct tape outside the rooms of infected patients helps reduce infections, reminding employees about contact precautions and giving them a safe zone in which they can still interact with patients without gowning up.

6-28-2011 9-13-25 PM

Allscripts announces Allscripts RCM Services at HFMA, which it describes as a cloud-based, outsourced business office for physician practices that is charged as a percentage of monthly collections.


Government and Politics

CMS selects The Lewin Group for a project to reduce the number of hospital readmissions for Medicare beneficiaries and improve quality outcomes for patients transitioning from hospitals to other care settings. The company, which is part of OptumInsight, will receive $2.3 million for the first year of the five-year program.

California lawmakers put together a bill that would require clinicians to flag any information they change in electronic medical records. The bill originally required all changes to be identified by user and to let patients see changes to their own records, but those requirements were removed after big healthcare organizations expressed their opposition that California’s standards would then differ from federal standards.


Innovation and Research

6-28-2011 8-38-37 PM

Deborah Peel MD of Patient Privacy Rights sent a link to this story about Personal, a soon-to-be-launched site that lets consumers store information about themselves and then sell it to commercial organizations willing to pay for it. It’s 100 “gems” include such information as when your next oil change is due and what kind of food you like, which they’ll broker on your behalf for 10% of the proceeds. It has some big-time financial backers. Her interest: something like that could give consumers control of their healthcare information, which is being freely sold without their consent for purposes not necessarily in their best interests. It could be used like a PHR, where people enter information that could be made available to sell (to companies) or to providers (for free).


Technology

The Robert Wood Johnson Foundation introduces an online directory that includes performance measurements for hospitals and doctors. It links 197 reports with information on outcomes, cost of care, and whether patients received recommended tests and treatments.


Other

6-28-2011 10-07-27 PM

The LA Times picks up the story reported here awhile back, in which a premature baby was killed by sodium chloride overdose due to a data entry error into a hospital pharmacy’s IV compounder software. The article tries to link that human error to IT safety in general, but the problem really was a lack of IT: Advocate Lutheran General Hospital apparently had no interface between its pharmacy system and the compounder software, so they let unlicensed personnel (pharmacy techs) do the manual data entry, where it’s pretty easy to accidentally swap the values of the electrolytes (although properly installed software should have given a warning). I’ve seen that problem first hand (unfortunately) and developed a simple but elegant solution (fortunately). If you’re a CIO, e-mail your pharmacy director and ask how IV formulas get to Abacus or whatever IV compounding software your hospital uses and whether they have warnings set up in it.

6-28-2011 9-36-02 PM

1-800 Labwear brings out a lab coat with outside pockets specifically designed to hold an iPad (which they spell incorrectly).


Sponsor Updates

  • Kony is named the Most Innovative Company of the Year by the American Business Awards in the technology company category.
  • Hayes Management Consulting adds a Regulatory and Compliance services division that will focus on federal healthcare mandates, HIPAA billing and security policy, EDI V5010, and ICD-10. Anita Archer will lead the division.
  • Northeast Valley Health Corporation (CA) and Community Health Center Network (CA) are among 32 community health centers to select NextGen EHR solutions.
  • Vitalize Consulting Solutions earns an average score of 88.62 in its five service areas as measured by KLAS in its mid-term performance review.
  • T-System celebrates its 15-year anniversary.
  • Northern Virginia Regional Health Information Organization (NoVaRHIO) launches a pilot program with Picis that will allow ED clinicians from Inova Alexandria Hospital ED clinicians to quickly access prescription information.
  • Medicity’s Health Information Exchange Solution for hospitals receives Federal Certification for meaningful use.
  • Inland Northwest Health Services announces that the Spokane Virtual Lifetime Electronic Record (VLER) pilot is now enabling the secure exchange of electronic health information using the Nationwide Health Information Network (NwHIN) Exchange. The use of VLER improves the portability of health information to Veterans and active duty Service members in the Spokane, WA area.
  • CMS awards the Medicare Part D Transaction Facilitator contract to RelayHealth.
  • Orthopedic Institute (SD) chooses the SRS EHR  for its 38 specialty providers.
  • East Liverpool City Hospital (OH) goes live on ChartMaxx by MedPlus.
  • Thomson Reuters launches Infection Xpert, a clinical intelligence dashboard that combines real-time clinical surveillance information, patient information, and patient-specific reference content from Micromedex for reducing and managing hospital-acquired infections.
  • Nashville’s 211 Call Center health navigator program, operated by Family & Children’s Service, chooses MyHealthDIRECT to allow operators to connect callers with available area providers specific to their needs, including the ability to search available provider appointments.
  • Ness County Hospital (KS) goes live on the ChartAccess Comprehensive EHR from Prognosis Health Information Systems just four months after its selection. The hospital plans to meet Stage 1 MU requirements by the end of the year.
  • Main Line Health (PA) signs a five-year extension with MobileMD for its 4D health information exchange service, which it has used since 2007 to connect four hospitals and more than 30 practices to create a virtual complete medical record.
  • Workforce management software vendor Concerro licenses two labor analyses tools from Workforce Prescriptions to allow it to offer labor efficiency review services that cover scheduling practices, agency use, care delay causes, and policies that impact labor ability. Hospitals average $7 million in annual realized savings from labor misalignment. The company’s take on labor management is covered in its blog, with the latest topic being the complexity of managing hospital labor costs.
  • NCR is exhibiting at HFMA this week (Booth 1420), talking about self-service solutions that improve efficiency, cost, and revenue cycle.

More Thoughts on Google Health

Nobody’s really disappointed or even surprised that Google Health is dead (actually, few have even noticed, which tells you all you need to know about its problems). The only surprise is that such an unenthusiastic effort came from one-time paradigm-buster Google in the first place.

Actually, maybe the biggest surprise is that Google is shutting Google Health down in an embarrassingly public raising of the white flag. It would be one thing if they were spending a lot of R&D money on it, but there’s no evidence of that. The app is somewhere between simple and ugly, announcements of new functionality or connectivity have come along once in a blue moon, and no lofty promises were made that it would ever be anything more than it was. Given that GOOG’s market cap is $156 billion, and that pretty much nobody was using Google Health anyway, maybe they should have just abandoned it to die quietly instead of convening a very public funeral, raising ugly questions about the cause of death.

The only real traction Google Health got was among folks who wanted to see a brash, smart, and well-funded upstart barge its way into the healthcare IT vendor mix, elbowing out the companies that have been around for decades to shake them out of their maddening complacency. In that respect, Google ironically did what the non-healthcare IT vendors are sometimes blamed for doing: it laid down a smokescreen of rosy PR, under-delivered on even modest promises, ignored the advice that users and experts were giving, and then just cut and run when the going got tough, another healthcare dabbler that should have known better.

I thought Google Health would do OK, if for no reason other than the company seemed committed to hanging in there, at least initially (they threw the stereotypical launch party at HIMSS, then went silent). But the signs were there. The inexperienced folks they put in charge were replaced by even less experienced folks. Their HIMSS booth was a joke, an empty table with a few black-and-white photocopied half sheets of paper handouts. They didn’t make any acquisitions; they didn’t create any innovative technologies; they didn’t differentiate themselves publicly from HealthVault; and they made no apparent attempt to flex their muscle with the providers, EMR vendors, and insurance companies that were sitting on the key asset needed to make their product fly: data.

Sometimes visionary companies can create a market by thinking big and solving a problem consumers didn’t even know they had (MP3 players and Facebook, for example). This wasn’t one of those times. Google Health was a solution looking for a problem, much like its high-flying and equally dead stable mate Google Buzz. If nothing else, Google Health proved that Google is just as fallible as arch-rival Microsoft in thinking it understands what customers want without bothering to actually ask them.

Here’s my epitaph for Google Health, not as a PHR expert (which I’m not, since I have little interest in them) but as an average consumer/patient.

  1. Google knows just one business: pushing ads in the faces of users willing to tolerate them in return for getting free access to some reasonably useful Web tools. Without large numbers of eyeballs, Google wasn’t interested, and without those useful tools, neither were the eyeballs.
  2. The Google Health model required massive uptake to be successful by its standards, but it was designed to address the health needs of the vocal 2% rather than the indifferent 98%. Hospitals learned that lesson long ago – if you want doctors to use CPOE, you aim your technology at the average doc (busy, struggling, and administration-suspicious), not the geeked out, administration-friendly CMIO who has little in common with them other than wearing a white coat but who sometimes can dangerously convince everyone else they speak for the majority (not like Dr. Jayne, in other words, who actually practices medicine and uses the systems she supports).
  3. When it comes to healthcare, consumers are not empowered, and no amount of technology will change that. They have a tiny bit of discretion when it comes to choosing a doctor, but almost none when choosing a hospital or insurance company. Cool Web tools or not, Joe Sixpack has no leverage over the massive bureaucracies of the average academic medical center or insurer.
  4. Those massive bureaucracies suck big time at managing their own data. The last thing they want to do is (a) share their crappy and unreliable information with patients, or (b) import unvetted patient information from some other source and then have to figure out what to do with it since they are paid for piecework, not thoughtful reflection of piles of information.
  5. “Health” is a good thing that everybody wants for everyone else, but “healthcare delivery” is a cutthroat fight for the financial pie. Collaborative tools are tough sell when the folks at the table are trying to stab each other in the back without being noticed, but especially so when Google didn’t even seem interested in working with them.
  6. The average person (be careful who you picture – the masses are not healthcare- or IT-savvy) sees his or her own healthcare as someone else’s problem. They get sick, they use someone else’s money (insurance) to see a provider, they want immediate gratification from pills or surgery, they aren’t interested in information or recommendations of lifestyle changes. Few of them study the government’s dietary recommendations, interface their bathroom scale to a computer program, or participate in online support groups. They just want to be left alone, secure in the knowledge that their poor health choices can be overcome by an insurance-assigned doctor or hospital. Any suggestion that electively unhealthy folks pay more for their healthcare than electively healthy ones is met with cries of discrimination. The only way to get their attention would be to pay them to take better care of themselves, just like giving your kid $10 for each A on their report card.
  7. Only a tiny number of zealots will accurately and consistently enter their health information into an online shoe box. Not only is it work, there’s no apparent payoff since most providers don’t have the time or interest to read what those folks entered (partially because the technologies they use don’t play well with others any more than those providers themselves).
  8. Consumers use technology for three reasons: it provides them with emotional satisfaction (Facebook), it offers them convenience (Amazon, paying bills online), or it saves them money (eBay, Groupon). Google Health and most PHRs offer none of these benefits.
  9. Addressing the convenience aspect requires removing the friction of healthcare delivery system transactions. They are horribly inefficient, often because the doctors, hospitals, and insurance companies themselves are horribly inefficient (which lends credence to the argument that arming either Joe Sixpack or providers with a lot of technology doesn’t necessarily make things better, particularly when it comes to patient outcomes).
  10. Nobody really trusts big companies all that much, and people are especially suspicious of who sees their health information. Geeks might trust Google with their entire identity, but the average person probably won’t.

Now is probably a great time to retire the term Personal Health Record. It had a questionable premise to start with, but now Google has tainted it as being a plain, static Web page that’s about as fun to use as TurboTax and a whole lot less useful.

I’m an average patient and I want nothing to do with a Google-like PHR. What I want is to be able to:

  1. Make electronic appointments, including being able to search for openings at multiple locations or among competing providers. I don’t want to have get on the telephone or compose an e-mail.
  2. Request prescription refills.
  3. See my lab results as soon as they are available, with a personalized explanation of what they mean.
  4. E-mail my doctor and get a timely response.
  5. Get specifically requested information to my doctor efficiently, and know that he’ll ask for the information he needs, it will remain on file in case it’s needed again, and I’ll have a say in the decisions made from it.
  6. Get automatic reminders for EMR-triggered events (vaccinations, next physical exam due, etc.) but with the option to suppress those that aren’t helpful.
  7. Manage someone else’s health with their permission, such as a child or parent.
  8. Earn an insurance or treatment discount for following recommendations that result in measurably improved health.
  9. Solicit bids or search prices for services not covered by insurance.
  10. View any health information recorded about me with an efficient mechanism to correct any errors.

The average PHR doesn’t do most of these things. They can’t unless providers, insurance companies, and EMR vendors can be convinced to work together. Patients don’t have the sway to make that happen. Employers might, or perhaps some kind of government mandate.

Short of that, PHRs are going to struggle since, by definition, they are trying to bring competing parties together electronically without giving them an incentive to do so. That leaves PHRs as little more than a spreadsheet on which a few consumers can record their own information that nobody will look at.

Many folks who cheerlead for PHRs do so with a vested interest instead of as a consumer. So here’s the challenge to those inclined to comment on this post: instead of the usual pedantic posturing about PHRs as a technology or a business, tell me how YOU PERSONALLY use a PHR, what benefits you’ve received, and what you wish it would do. The “experts” can’t stop talking about Google Health, but none of them so far has admitted actually using it or any other PHR.


Contacts

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

Experian To Acquire Medical Present Value for $185 Million

June 28, 2011 News 4 Comments

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Ireland-based financial information and technology vendor Experian announced this morning that it will acquire Medical Present Value for $185 million in cash. The Austin, TX-based MPV offers revenue cycle services to providers that include eligibility verification, patient-friendly statements, credit scoring services, and claims software.

MPV, which has annual revenue of $45 million, will become part of Experian’s North America Credit Services division, which offers services for running small businesses. The company’s other healthcare product is SearchAmerica, a 2008 acquisition that evaluates patients for their likelihood of payment and eligibility for financial assistance programs.

Dan Johnson, president of Experian’s Healthcare Services, was quoted in the announcement as saying, “Healthcare providers in the US face growing challenges when it comes to billing and collecting payments for services. With the addition of MPV, Experian is able to provide a more comprehensive set of products and services across the healthcare payments life cycle and help clients manage multiple vendors through a single point of contact”

MPV was founded in 1998 and serves more than 75,000 providers. Its principal investors are Rho Ventures, CenterPoint Ventures, Star Ventures, and Care Capital.

Readers Write 6/27/11

June 27, 2011 Readers Write Comments Off on Readers Write 6/27/11

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

Will Meaningful Use and EMRs Help Jump the ACO Hurdle?
By Frank Poggio

6-27-2011 6-49-34 PM

The Accountable Care Organization (ACO) is the government’s latest attempt to improve quality of patient care and control the ever-escalating growth in healthcare costs. The Affordable Care Act (commonly known as the health reform law) encourages, via financial incentives and penalties, the formation of ACOs by organizing healthcare teams, technology, and knowledge around patient needs. 

As might be expected, there are many complex organizational, monetary, and other significant policy issues surrounding the ACO model of care delivery.

The ACO concept is not new to the healthcare world. In past decades, we called them PHOs (Physician Hospital Organizations) or HMOs (Health Maintenance Organizations).  Both of these in the 1980s and 1990s had only a small impact on healthcare costs. Many PHOs and some HMOs are still in existence today.

In fact, we have always had some form of ACO going as far back as 1939. For example, the Kaiser Health Plan, The Cleveland Clinic, Sharp HealthCare, Geisinger Clinic, and many others are basically ACOs. If they include an insurance component, they are more like an HMO.

The simplest definition of an ACO is a health care delivery system where the physicians and hospitals work under one corporation, have one set of synchronized patient objectives, and share in the profits  and losses from normal operations. Medicare wants doctors and hospitals to work together and accept one payment for all levels of care and accept the responsibility for coordinating the care of the patient across all modalities of care. 

Where ACOs work and why

The concept has worked at Mayo, Kaiser, and Cleveland Clinic because the attending docs are part owners of the hospital. They get paid a salary and bonus based on both the performance of their practice and the performance of the hospital and other health services.

For example, the physicians readily accept that fewer support staff will save the hospital money, which in turn could result in a year-end monetary bonus while hopefully improving patient care. That, in turn, can lead to more patient referrals and more revenues. The same is true for ordering fewer tests or procedures. Fewer tests equal less costs, and under a fixed payment system like Medicare DRGs, that means more profit.
 
But today, the independent physician makes his or her money seeing as many patients in his or her office as possible. The hospital is just a cost-neutral and convenient place for physicians to perform complex procedures. If an ACO is that simple and beneficial, why are there so few of them?

How did we get here?

Today and for the past half century, we have been in a situation where the person most responsible for “product definition” and most responsible for “bringing in the business” is not an employee of the hospital. That person is the attending physician, or sometimes called the independent practitioner.

It goes back to the establishment of the AMA and the AHA in the early 20th century. Both of these groups were focused on increasing utilization of hospital and medical services. Even at that time, just as today, medical care was relatively expensive. To drum up business, they both came up with the idea to sell a medical insurance policy.

Rather than work together, around 1940, the AMA founded Blue Shield and the AHA started Blue Cross. Each had similar, yet different objectives. Keep in mind that almost all doctors in the early part of the 20th century were independent practitioners and hospitals were places to be avoided.

In 1966, along came Medicare. If you go back and study the legislation of the day, you will find that physicians fought Medicare with a vengeance and wanted no part of the government or the institutional side of the package. Of course today, if you tried to take Medicare away, you’d have a rebellion — and not just from seniors. Medicare in 1966 solidified the doctor-hospital split via separate payment systems by creating Medicare Part A for hospital payments and Part B for physician payments.

Then in 1972, as the health insurance industry matured, the Federal Trade Commission became concerned that doctors and hospitals selling insurance was a little to cozy. The AMA had to spin off Blue Shield and AHA split with Blue Cross. Later, as the Blues saw themselves more as insurance companies than part of the medical establishment, many of the Blues merged and eventually morphed into today’s United Health, Wellpoint, etc.

To drive the hospital-physician wedge deeper, in 1993, Congress passed OBRA, which contained the infamous Stark amendment. The Stark amendment made it a crime for doctors to refer patients to a hospital in which they had a financial interest. The feds saw this as a conflict of interest that would drive up healthcare costs. 

The structure we have today — full physician independence — has been around a very long time. It has been repeatedly fortified through separate provider and piecework-based payment systems.

That raises today’s big question: who is accountable for all the care a patient receives? 
 
How can we create more ACOs?

Now, after more than a half century, the government has come to the conclusion that doctors working separately from hospitals with separate payment systems and different incentives is a counterproductive operating model. (too bad we didn’t see that coming when we initiated the Medicare-Medicaid systems.)

Under the duress of a very large federal deficit (in part, a result of healthcare costs), we are trying to reverse 70 years of misdirected legal and financial incentives. Under an ACO, the feds want both parties to work together, share the payments, and share the risks.

The ACO statute of April 2011 lists the following provider combinations as potentially eligible ACOs:

  1. ACO professionals in formal group practice arrangements.
  2. Networks of individual practices of ACO professionals.
  3. Partnerships or joint venture arrangements between hospitals and ACO professionals.
  4. Hospitals employing ACO professionals.
  5. Such other groups of providers of services and suppliers as the Secretary determines appropriate.

Combinations 2 and 3 are what I call the “virtual’”ACO. Combinations 1 and 4 are more like the PHO/HMO of the past, or the Mayo model.

As stated by CMS, ACO compliance with the requirement to reduce costs and improve care may involve a range of strategies, which they state includes the following examples:

  • A capability to use predictive modeling to anticipate likely care needs.
  • Utilization of case managers in primary care offices.
  • Having a specific transition of care program that includes clear guidance and instructions for patients, their families, and their caregivers.
  • Remote monitoring.
  • Telehealth.
  • The establishment and use of health information technology, including electronic health records and an electronic health information exchange, to enable the provision of a beneficiary’s summary of care record during transitions of care both within and outside of the ACO.

Promote the virtual ACO

As can be seen from the compliance strategies, CMS is leaning heavily on HIT and EMR to help avoid some very difficult political battles. As an interim step, they are encouraging hospitals and physician groups to use EMR systems to build and support a virtual ACO.

In this scenario, the physician and the hospital would remain corporately separate, but the patient information and the payment would be shared. This dovetails with the new federal HITECH Act that promotes EMRs and stronger coordination of care via interoperability.

CMS has defined the five levels of ACOs and has set target dates for providers to achieve one of the levels. If a provider organization achieves an ACO level during the next five years, they will get a financial bonus. If they don’t, their Medicare payments will be reduced. Sounds like MU all over again.

Initially, the AMA was indifferent towards the ACO concept. AHA gave it mild support. But after CMS issued draft regulations in April noting the bonus-penalty provisions and the shared payment component, both associations came out strongly against it.

Of course, the 800-pound gorilla is who should run the ACOs, physicians or hospital executives? If there’s to be a single payment for Medicare patient services to the ACO, how do you split that payment?

CMS is staying out of this battle and leaving it to the docs and hospitals to fight it out. To say the least, AMA probably views it as the death knell for the independent physician practice, and AHA may see it as the surrendering of institutional autonomy to physicians.

I think it will be a long arduous road getting to real ACOs. Remember, the overall objective is to reduce the costs of healthcare. According to a CMS analysis of the proposed regulation, Medicare could potentially save as much as $2 billion over the first three years, so somebody’s ox has to get gored.

But as we stumble down this long and very bumpy road, I believe in the early years, the focus will be on the virtual ACO. The CIO’s office will be right in the middle of it. If you look at the Meaningful Use criteria for CCR, CCD, and interoperability, the first hurdle is staring us in the face.

Frank Poggio is president of The Kelzon Group.

Security: An Often Overlooked Meaningful Use Requirement
By Jeff White

6-27-2011 6-42-28 PM

During the first quarter of 2011 alone, there were media reports of inappropriate access to electronic Personal Health Information (e-PHI) of four sizeable healthcare organizations. This is damaging in terms of public relations, patient confidence, possible revenue loss, and increased costs to protect patients with exposed identifying details. It seems that many organizations are overlooking or delaying the need to perform a security risk assessment.

Yet under the HITECH Act, one of the core Meaningful Use measures is the requirement to “Conduct or review a security risk analysis … and implement security updates as necessary, and correct identified security deficiencies prior to or during the EHR reporting period to meet this measure.”

This measure is, therefore, a key task healthcare providers must conduct before attesting to their ability to meet Stage 1 requirements. Additionally, the risk analysis requirement in the HIPAA Security Rule is not only an integral part of meeting Meaningful Use for HITECH, but also for being in compliance with the law.

A risk analysis is the very foundation from which to build your information security compliance program. A security risk analysis should be conducted with active participation of internal auditors, IT leadership, and IT subject matter experts.

The Office for Civil Rights (OCR), the security watchdog for the Department of Health and Human Services (HHS), suggests that a covered entity use the National Institute of Standards and Technology (NIST) risk-based approach for doing a risk analysis, which encompasses nine primary steps:

  1. System characterization to fully understand key technology components in your infrastructure.
  2. Threat identification.
  3. Vulnerability identification.
  4. Controls analysis to assess the capabilities of your existing set of controls to meet your environment’s needs
  5. Likelihood determination to assign likelihoods, considering the threat motivation and ability, the nature of the vulnerability, and current and planned controls
  6. Impact analysis to analyze that impact, considering for each system the effects of lost confidentiality, integrity, or availability, and the effect of any current or planned mitigating controls
  7. Risk determination, a combination of the impact rating and the likelihood determination
  8. Control recommendations, a roadmap for planning controls for future implementation
  9. Results documentation.

To prepare for Meaningful Use attestation, it is recommended to conduct the security risk analysis at both the technical design and system build phase when implementing a new EHR system. Additionally, it will be important to update the risk analysis further on in the MU Roadmap approximately four months prior to go-live.

As ongoing changes happen, new risk occurs. An annual risk assessment should become part of the compliance process; that is, the risk assessment can be merely updated as an addendum and not as an overbearing intrusion that competes with other organizational needs. A regular review of your risk posture is what is required to protect e-PHI. Too many new threat vectors and vulnerabilities are introduced into information environments each day. A reasoned, systematic, and consistent approach will help to achieve your organizational goals.

Spurred by the HITECH Act, the healthcare industry is embracing EHRs at an accelerating rate. This move carries with it a need for heightened responsibility since digital information can be copied, transmitted, or used so easily. As such, the risk accruing from this transition to electronic records must be well understood.

In its passage of HITECH, the US Congress took special consideration to note that security and privacy of patient records should be a paramount concern. In essence, HHS recognizes that the very success of the HITECH program rests in part on patients’ ability to trust provider information systems with sensitive information.

Jeff White is a principal with Aspen Advisors of Pittsburgh, PA.

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