Curbside Consult with Dr. Jayne 10/3/11

Last month I mentioned that the AMA had recently released its 2010-2011 Health Care Trends Report. The report’s “Science and Technology in Medicine” section includes items summarized from other sources, including MGMA data. Surprisingly, MGMA noted that independent practices were “more likely to have fully implemented and optimized EHR systems than hospital-owned practices.”

They noted that nearly 20% of EHR-owning independent practices felt they had optimized use of their systems, while another 50% had completed implementation and were moving to the next stage. In contrast, one-third of owned practices were still in the beginning stages of EHR adoption.

As far as quantifying how many physicians are using the system, only 43% of hospital-owned practices reported that all physicians used the system, where 72% of independent groups claimed that all of their physicians used the system.

I’ve spent a significant portion of my career toiling in the CMIO trenches, including oversight of ambulatory EHR implementation. Although this was largely in hospital-owned practices with employed physicians, I’ve had experience with private practices under hospital-subsidized arrangements as well as truly independent physicians. I’ve definitely noticed a difference in how the two groups do with EHR adoption and have a couple of thoughts on why they’re different.

My first theory involves the idea of free will. In a typical independent practice, the physicians have to come to at least some kind of consensus prior to purchase of an EHR. They’ve often been active participants in the selection process and in determining how a system will be implemented. Physicians may be active in system setup and customization of workflow and template screens.

In contrast, hospital-owned physicians are generally told which EHR they’re going to implement, as well as when and how. There are typically limits on how much autonomy physicians have with workflow, and customization at the provider level is taboo. It may be the system’s way or the highway. It’s always easier to get people to do what you’re asking when they think it’s their idea or when some reward is involved. It’s awfully easy to rebel when someone is trying to force change.

Speaking of reward, my second theory involves having the proverbial skin in the game. Because employed physicians typically have contracts which include the EHR and implementation as part of their employment agreements, they’re not paying much (if anything) out of pocket for the transition. Often employed groups are committed to keeping their physicians’ compensation stable as an EHR is implemented. Those physicians aren’t really incented to rapidly adopt or to change behaviors.

My colleagues who have had to pay their own IT bills (many of whom can also tell you exactly how much they paid for their EHR systems, down to the penny) have a different view of things. Trainers report that independent physicians are less likely to skip training sessions and tend to be more engaged. I’m sure those value-conscious providers know how much they’re paying for training hours and also how much they’ll be hurt if they can’t return to full productivity as quickly as they’d like.

My final theory revolves around the glacial speed of decision-making within hospital-owned practices. Physicians have given up a degree of autonomy (often for good reason – they’re lured by the promise of practicing medicine without having the pressure of dealing with staff, OSHA, CLIA, credentialing, vendors, and other distractions). Decisions are made among multiple levels of mangers, regional administrators, and hospital presidents.

There are often meetings to discuss the meeting before the meeting, not to mention the obligatory meeting after the meeting. Committees (and subcommittees, action groups, and departmental fiefdoms) have to sign on prior to things actually being decided. The ability to move forward with EHR adoption in a nimble fashion is seriously compromised. Each time the cycle repeats, adoption declines.

For those of you in the ambulatory arena, what’s your theory? E-mail me.

E-mail Dr. Jayne.

HIStalk Interviews Deborah Peel MD, Founder, Patient Privacy Rights

Deborah Peel MD is founder of Patient Privacy Rights.

Give me some brief background about yourself and about Patient Privacy Rights.

I never expected to be leading this organization or ever even thought about that. In my younger days, I practiced full time as a psychiatrist and Freudian analyst for a very long time, until it became clear that things were happening in DC that would make effective mental healthcare impossible. Namely, that there were lots of different ideas being floated; for example, the Clinton healthcare initiative. There was a part of it that was going to require everyone’s data from every physician encounter be recorded in federal database.

Fast-forward to the HIPAA privacy rule. That’s what really convinced me of the need for a voice for consumers, because there really wasn’t any. What I’m talking about there is, of course, the change in 2002 that happened under everyone’s radar except for – and this is the is the laugh line – when the 3,000 Freudian psychoanalysts in the nation noticed that consent was eliminated.

In 2004, I started Patient Privacy Rights because there was no effective representation for the expectations and rights that the majority of Americans have for how the healthcare system is going to work. Namely, that people don’t get to see their information without consent. Since founding PPR in 2004, we’ve still been the national leading watchdog on the issues of patient control over information and even internationally. Our power has come because when we came to DC, the other people that were working on privacy, human rights, and civil rights recognized that because of my unique position as a physician and deep understanding of how data flows, that I knew what I was talking about. 

We very quickly got a pretty amazing bipartisan coalition of over 50 organizations. That enabled us to put these issues and problems on the map.

We had some incredible successes in HITECH. Virtually all of the new consumer protections came from our group, including the ban on the sale of PHI, the accounting of disclosures, segmentation, the new requirement that if you pay out of pocket for treatment you should be able to block the flow of that data to health plans and health insurers. We were the ones that worked with Congressman Ed Markey on getting encryption, required stronger security protections, and worked with Senator Snow to get meaningful breach notice into the rules.

All of this work lead to the first-ever summit on the future of health privacy this past summer in DC. The videos and the entire meeting can be seen or streamed online.

If somebody said you had to choose between accepting healthcare IT as it is today or going back to purely paper-based systems, which would you choose?

We’ve never been in favor of going back to paper. Our position has always been there is tremendous technology for privacy and we can have far better control of our information if we implement smart, privacy-enhancing technologies and architectures.

We’ve never been in favor of going backwards, although I do have say, we now know about WikiLeaks and now because of the strong breach notice requirements, it’s appalling how abysmal the security is of electronic records. Actually, it’s looking a lot like paper records are far easier to keep from getting into the wrong hands because there’s only one of them and they’re locked up in a medical records department most of the time.

We wouldn’t make that choice. What we’ve always tried to do is promote systems that give everybody – except the data thieves and data miners – what they want.

I don’t detect any citizen groundswell about the state of healthcare privacy, just organizations doing an occasional biased survey that concludes that the public is extremely concerned or implies that they would be concerned if only they were informed. Is advocacy needed when there have been no events to get the public up in arms?

The public has two minds about this. All the polling shows that they are extremely sensitive about who controls their records and they believe that they should have the control. On one hand, that’s what they believe.

On the other hand, the polls also show they’re extremely concerned about breaches. Large majorities recognize that all these things are going to get broken into. There’s knowledge in some ways and fears about electronic systems. But the key thing is industry and the government have really not recognized how many people are, in Alan Westin’s words, “Health privacy intense.” He’s the guru of polling in health privacy.

At our summit, he presented 20 years of data. The slides are up there for anyone who wants to see. When the polling comes to views about privacy and control of information in the healthcare sector, his findings have been consistent over 20 years — 35 to 40% of the public is privacy-intensive about health information. About other information, it’s 25%. This is a really significant minority.

Even though the public is not yet marching on Washington with pitchforks — and obviously I’m saying that in a joking way — the issues about privacy are simply going to continue to grow. What the industry has really ignored — and I particularly know about because of the patients that I’ve treated for 37 years — is that people will act in ways that endanger their health in order to keep information private. Millions and millions of people. These are not good outcomes. The public knows that electronic systems are far less safe and secure than paper systems.

This is something that has to be faced. There will be people who will choose not to see doctors, who will omit information, who will ask doctors to change diagnoses, who will refuse to get tests, and so on. These are figures from the 2005 California HealthCare famous study that one in eight people does something to try to protect their privacy.

Even earlier figures from HHS in 2000 are troubling. They found that 600,000 Americans a year refuse to get early diagnosis and treatment for cancer because they know the information won’t stay private. Two  million a year — or at least that year –refuse to get early treatment and diagnosis for serious mental illnesses for the same reasons. They know that the information won’t stay private. The same is true with millions of people that refuse to seek treatment for sexually transmitted diseases.

These are not good things. If you look at the military, the Rand Corporation did a survey – I think the book was called Wounded Warriors — that the lack privacy in the military is one of the important reasons that people won’t get treated. There’s 150,000 Iraqi war vets with post-traumatic stress disorder and we have the highest rate of suicide in the military in 30 years. Actually, just this year, we turned the corner that more members of the military killed themselves than were killed by an enemy.

You’ve really, really got to take seriously the fact that people that desperately need help for illnesses and diseases that are very treatable are refusing to get them because the consequences of the information not staying private are too threatening. It’s about two things, mainly – jobs and reputation.

The survey measures their perception, but does their perception reflect reality?

What I’m talking about is the reality — the actual numbers of people who act. My point really is, yes, the polling is off the charts on what the public feels, but the data is in. It’s not just about feelings. It’s about actions people take to protect themselves and their families from job discrimination, reputational damage, insurance discrimination, and the rest.

But it still was self-reported, right?

Well, yes.  These were figures from HHS surveys and from a California Healthcare survey.

As a psychiatrist, your privacy concerns are mostly related to discrimination with regard to employment issues or insurance. Going back to the public’s perception, are there enough occurrences where that’s actually happened that could not have happened with paper medical records?

This issue of discrimination and health information leaking out of the health system is not new because we have health IT. Literally, I learned about this when I hung out my shingle in 1977. The first week I was in practice, a couple of people came in and said, “If I pay you cash, will you keep my records private?”

I was blown away by that. I’d never heard of that in medical school or residency. Nobody talked about that, but these were people who had suffered harm. Again, jobs and reputation. So I said, “Well, sure.”

It’s a very significant issue. Many mental health professionals actually give patients Miranda warnings. If you use a third-party payer, anything you say and do can and will be used against you. Many health professionals will work with people to try to find a fee that they can afford so that they don’t have to have their futures or their children’s futures wrecked.

If patients were allowed to control who can see their medical information, would you be comfortable as a physician making treatment decisions based only on what they want you to see?

As a practical matter, patients still can and do control a lot of what we see and know. I trust what I hear from patients at least on a par, if not more, than what I find in medical records. The history is everything. People are going to withhold information or even lie about it if they don’t trust you. You have to earn patient trust. You get the best information when patients know that you’re really going to protect them and keep their information out of the hands of countless, endless third parties.

I think this is something that physicians and other health professionals – some, anyway – are not going to see coming. As everyone gets their electronic health record – and hospitals are going to get blamed for this too, not just physicians and the practitioners – when they begin to realize how far-flung their data is … that was another thing that came up at the Health Privacy Summit. There’s not even any kind of a data map that can show people all of the places their data goes. It doesn’t even exist. The data gets so far afield. When people see this, they’re going to blame the doctors and the hospitals. That’s not a good thing.

Decisions are made outside the practitioner’s control about who gets that data. At least some EMR vendors believe they own the patient data and can sell it even though that fact may not be clearly stated to patients.

We’ve been pretty actively pointing out that kind of thing. I’m not a lawyer, obviously, but doctors really don’t have a right to sell patient data. That’s one of the reasons we got a ban on the sale of health information into the stimulus bill. Obviously it hasn’t stopped the particular business model of so many electronic health record companies so far, but that was one of the reasons that our coalition worked to ban the sale of PHI without consent.

But as you see, what’s in the federal law and what turns up in regulations is not always the same. That’s a serious problem. I think those contracts will eventually be found to be illegal, just like many health insurers. You probably know about this. You used to get doctors to sign contracts with them with gag clauses, where they weren’t supposed to tell their patients about certain kinds of treatment alternatives. Of course those turned out to be illegal, but that didn’t stop the insurance industry from using them widely for a very long time.

People read about their financial information and Google searches being available to third parties. Do you think they are getting desensitized to the idea that privacy is something they should expect?

No. I think they’re getting more and more rabid about it. You’ve seen lots of pushback, not just in this country, but even more so in Europe, where they have much tougher data privacy and security protection. Google got bit on Buzz. Facebook ended up getting a lot of blowback from their users who believe that they have control over their information. A lot of the controls on Facebook and Google imply that.

I often talk about how people say young people don’t care about privacy. Wrong. I’ve got two teenagers. What’s the premise of Facebook? Some people are my friends and can see things, and others are not.  If you want to think about it this way, it’s an early consent tool. You’re in, you’re out. That’s the new premise of Google Plus, that new circle of friends thing. You have different people that get to know different things about you.

But people really do want control over who sees and uses their information. They feel this very strongly. VCs and other people have begun calling us up and asking what we think about things, because they realize there really are going to be markets for products and systems where people know that they can trust what happens with their information and it doesn’t go anywhere they don’t want it to go.

If you’re one of the good guys in the privacy and confidentiality debate in healthcare, who are some bad guys?

It’s not so easy. It’s not just good and bad.

First of all, there’s a vast number of people who are simply not informed, or they’re well-intentioned and they just don’t know what’s going on. There’s a lot of them. A lot of things happen for that reason.

I also think a lot of the reason we’re stuck with these data-leaking systems is because initially, a lot of the administrative kind of software was imported from other businesses. If you think about this, other businesses don’t have to respect individual privacy in the way that they healthcare system does.

In fact, the difference about healthcare from all other commercial areas — where as you say, we can’t seem to control our data at all – the strongest rights we have to control information are in healthcare. They come from the legacy of Hippocrates. The requirement to get consent is in every ethical code for health professionals from time immemorial. We have extremely strong rights to health privacy despite HIPAA.

One of the slides that I always show is a direct quote from the HIPAA regs that talk about HIPAA is intended to be a floor, and in no way to preempt best practices or stronger privacy protections in state law and medical ethics. Well, what happened to that? HIPAA was never intended to wipe out or preempt state law or anything else.

We’re seeing some movement some beginnings of more movement in ONC to begin to try to put in place the kind of technologies that are a matter of law, like the need to segment mental health and addiction information and certain other kinds of sensitive information — genetic, STDs and so forth. They’re finally starting to spend a little tiny bit of the $29 billion on the things that matter the most to the public.

Publicly visible, high-profile advocates tend to polarize people who either see them as selfless crusaders or shameless limelight seekers chasing personal gain. How do you see your image in healthcare and who agrees and who doesn’t agree with what you do?

In the beginning, I was cast as a very polarizing figure. Everyone saw me as trying to interrupt the $29 billion dollar gravy train, although it didn’t exist until recently. I had some active reporters essentially trying to attack me as a Luddite and stuff. These were people that didn’t even read or listen to what I was saying. It was polarizing in the beginning, but many people really are of good intent.

I think there is a much more mature understanding of the importance of privacy now, as evidenced by the list of top government officials that participated in the first summit on health privacy and the industry people that participated. We had a past chairman of HIMSS,. We had Lisa Gallagher, HIMSS privacy and security officer.  Wes Rishel from Gartner was on the panel. We had top people from this nation, from outside of this nation. We had top government people, top industry people, and advocates and privacy experts in academics who were all taking the question seriously — can we build a system with privacy that’s effective and that works and is reasonable? Can it be done?

There were no catfights on the panels or anything, because everyone there believed this is really an important issue that needs to be addressed. I would say that summit is evidence of me being perceived as – I think at this point – less a polarizing figure than a convener for the people that really want to move this whole effort forward in an effective, responsible, thoughtful way that does not leave the public out and that incorporates what the public expects and what they have longstanding rights to.

Any concluding thoughts?

For me, what’s been really difficult has been the fact that even though the administration — both this one and the previous one — wanted to be inclusive and wanted to have public input, the kinds of financial commitment and staff commitment it takes to actually participate in these government private efforts does not allow the kind of input that’s needed from privacy advocates and experts and academics.

Just speaking for myself and getting back to your point about seeking the limelight for some kind of gain, I have to tell you that I’ve never taken a salary for this. In fact, my family and friends have sacrificed lots of money, lots of time, lots of their own personal efforts to me and to Patient Privacy Rights to enable this to happen. In terms of gain, for me, it’s an honor to work for the public, the people of this nation, for privacy. But in terms of any kind of financial gain, it’s certainly been exactly the opposite.

We are hoping to build on the momentum that started at the summit. We’re going to be putting together several work groups and we’re going to make this an annual event. Patient Privacy Rights is also going to create a new privacy brain trust with leaders in this country and internationally to weigh in on what we can to help move things forward in a constructive way. This nation needs a big counterweight to the many interests that want data without consent, including for-profit research entities, the government, those that sell data, and business analytics kinds of tools with patient data.

This nation and the world needs a group of experts who can provide the kind of credible information on those policy and technology to counter a lot of the one-sided infomercials that come from industry. There’s a real need to hear all sides, so people are coming together under the umbrella of the summit to be able to work together and to have an even more powerful voice than just Patient Privacy Rights and me. It’s a wonderful thing because it isn’t just me who cares about this.

Sunquest Acquires PowerPath Pathology System

Sunquest Information Systems has acquired the PowerPath anatomic pathology information system from Sweden-based Elekta AB for $33 million USD, it was announced this morning in Europe.

Sunquest President and CEO Richard Atkin said of the acquisition, “Sunquest’s commitment to Anatomic Pathology and serving the pathologist has created a natural fit for PowerPath within the Sunquest solution suite. Together, we will have an increased critical mass and expertise to meet the needs of the pathologist in this important and growing market. I am excited to welcome the PowerPath customers into the Sunquest family.”

Elekta, which markets oncology solutions, acquired PowerPath along with IMPAC Medical Systems in 2005. The product was previously sold by IMPATH and Tamtron.

Elekta President and CEO Tomas Puusepp said, “PowerPath is clearly a leading brand in its sector with an impressive customer list of prestigious institutions. However, the synergies between PowerPath and Elekta have been limited and we expect that PowerPath will have good prospects with Sunquest, given their more complementary business"”

PowerPath is supported by 44 US-based employees. Elekta reports that it generates annual revenue of $12 million and is used by more than 450 facilities worldwide that offer surgical pathology, dermatopathology, cytology, and autopsy services.

Monday Morning Update 10/3/11

From Urban Legend: “Re: MediServe. Has acquired rehab scheduling and practice management vendor SpectraSoft.” Verified. MediServe, which offers rehab and respiratory therapy applications, has acquired SpectraSoft, an Arizona-based vendor of systems that include hospital and practice patient scheduling, physical therapy, appointment reminders, and billing.

From The PACS Designer: “Re: iPhone 5 launch. It’s official — Apple will hold its launch for the iPhone 5 on October 4. With this introduction, we’ll be seeing CEO Tim Cook give the presentation instead of Steve Jobs. It will be interesting to see how someone other than Steve does with the new feature presentation for the expected crowd.” Purportedly leaked photos are coming about, above which is one. Most interesting to me will be (a) how Tim Cook does, and (b) how long the fanboy lines are. I expect high demand, reinforcing the obvious – the country’s economic suffering is not universally shared as many folks stand in unemployment and food bank lines, while others clamor in similarly long lines to plunk down cash to replace their perfectly workable cell phones with cooler ones.

From Fed Up: “Re: anonymous comments. I’m disappointed that you gave a company my IP address. I now fear for my job.” I don’t divulge anything I receive to anyone, so it wasn’t me, but the comment you left may have contained enough specifics for the company to take an educated guess on its own. If any organization was pressuring me hard to give them information that wouldn’t be appropriate, the first thing I’d do is post the full details of their request on HIStalk and let the readers decide who’s being unreasonable (that’s a lot of bad PR if the company is out of line.) I will, however, always offer companies the space to rebut comments that are incorrect, and unlike newspapers who bury such comments, I’ll put them right in HIStalk if they keep it concise. Seems fair to me.

From IV Drip: “Re: Health 2.0. The on-stage production is well run by the company employed to do that and incorporates live demos and unscripted comments. The non-stage component is what most people complain about – there is a significant lack of organization in vendor relations and logistics. There’s also the point of reference for vendors – it’s not a bland, measured, vendor-subsidized event with a huge exhibit space where content is determined a year in advance. Attendees love drinking from a fire hose of innovation over a packed two days instead of being exhausted after four days of cattle drive-like trudging around mega-halls and a Las Vegas-like show floor. It’s about networking and meeting new people. They could do a better job with logistics, but if it turns into a vendor brown-nosing type show like HIMSS, I and many other won’t be there.” It’s always a tough trade-off – everybody wants a conference that’s information-driven, off the wall, and fun (and largely paid for by vendors), but with good logistics, decent food, and a comfortable setting. Like most parties, the host’s job is to invite the right people, make sure they are relaxed and happy, and stay out of the way. That’s why I like low-key HIMSS chapter events and user group meetings, but never liked TEPR and was indifferent to last year’s mHealth Summit (bad logistics and not all that fun overall.) I will say that with my ultra-limited event organizing experience (a handful of HIStalkapaloozas, with vendor-provided event planners doing most of the work) you don’t have to sell your soul to vendors to get them to participate. Those involved in my events have been almost insistent that their participation be downplayed even though it was costing them a bundle. I always suggest a little vendor fair area for the sponsor or maybe some giveaways or a short company pitch from the stage, but they’ve always declined. However, I guess when you’re charging as much as HIMSS for exhibiting and putting competitors elbow to elbow in Gladiator Hall, expectations are raised.

New HIS-tory from Vince Ciotti, covering AR/Mediquest. If you’ve been in HIT long enough to remember that company and if you’re going to HIMSS in Las Vegas, put your contact information here to get on Vince’s e-mail list for the get-together he’s arranging there for the pre-1980 HIT’ers.

Listening: new from all-girl Dum Dum Girls, kind of a jangly, upbeat, lo-fi version of The Pretenders with some GoGo’s and spaced out Mazzy Star thrown in.

My Time Capsule editorial from 2006 for this week: For Employees in Uncarpeted Areas, Hide Technology Complexity Like McDonald’s Does, in which I said, “Medical errors, including technology-induced ones, have gotten so bad that some hospitals are actually advising patients to bring along a friend to protect them from staff mistakes. I can’t imagine any other business throwing in the towel and admitting defeat to customers. I’d have just two words for a restaurant waiter who suggests that I watch the cook to make sure he doesn’t poison me: ‘Check, please.’”

Time for me to vent (sorry) about trite words and phrases that spread like the plague from the Internet to the parroting mouths and keyboards of the easily impressionable: “not so much,” “meh,” “totally,” “epic fail,” “it’s all good,“ “just sayin’” and anything in the form of “Best. ____. Ever.” I postulate that these are the same vocabulary-challenged people who pleased themselves to no end in the 90s by cleverly inserting random outbursts of “Not” and “Party on, Garth” at every conversational opportunity and are hopefully embarrassed about it to this day. The Internet, like TV before it, can make you smarter or stupider, depending on how you use it (and a survey of the offerings suggests that the smart money is betting on the latter.)

The majority of respondents think Vista Equity Partners got a good deal in acquiring Sage Healthcare, or at least that’s how I interpret it. New poll to your right, suggested by a reader: do you know and/or follow your employer’s policies regarding device encryption and handling of confidential information like PHI?

University of Texas System chooses CodeRyte for enterprise-wide computer-assisted inpatient and outpatient coding. They will also use the company’s DataScout data mining technology.

Welcome to new HIStalk Platinum Sponsor HealthStream. The Nashville-based company offers innovative learning solutions that enable the training and business objectives of healthcare organizations: patient safety, workforce development, regulatory training, and technology education. HealthStream’s customers include 50% of US hospitals. Its Authoring Center is an open platform that allows content creators to develop and distribute learning modules using the tool of their choice – PowerPoint and PDFs, for example. Competency Center is a competency and performance management solution that hospitals use to create customized performance appraisals and competency assessments. The SaaS-based Learning Center is a learning platform and courseware library that supports 2.4 million active healthcare workers, with 70,000 course completions and 100,000 student log-ins every day from healthcare users. Also offered is a turnkey nurse CE library. Hospitals call HealthStream when they need to improve patient safety, implement quality programs, develop nurse effectiveness, improve compliance, and ensure that clinicians are trained to use new technology and medical devices. Thanks to HealthStream for supporting HIStalk.

Amcom Software’s Messenger middleware earns FDA 510(k) clearance as a Class II medical device. It connects patient monitoring systems to smart phones and pagers, allowing rules-based alert messages to be sent to clinicians.

A Reuters article says that HIT stocks are priced high because of HITECH-spurred revenue growth, but are susceptible for a big fall if Congress gets serious about reining in the red ink and cuts some of the HITECH billions. Specifically named as trading at at a high multiple: Cerner. It’s a pretty shallow article that recites the obvious and, puzzlingly, claims at the end that open source is a big threat to vendors.

Practice Fusion CEO Ryan Howard is profiled in the San Francisco newspaper. He says the company was out of cash and had only 2,000 users at the end of 2008, but has since raised $36 million in financing and signed up 120,000 users tracking 20 million patients in its free EMR. He mentions some company goals: use its customer data for healthcare predictive modeling and create a birth-to-death patient record for patients. The above video, Cracking the Entrepreneur Code, is new and covers some of the same ground about the scrappy startup – he says the company was basically out of business until he got an insurance company check for injuries he received in an auto accident, which he used to make payroll instead of for getting himself fixed up. “When we got funded, I was four years behind on my taxes and needed two root canals. The lesson here: before you go too far down this road, ask yourself what you’re willing to give to pursue your dream.” The first 17 minutes of the video where he’s talking should be mandatory viewing for anyone involved in a startup. It’s fascinating to hear about how in the early days (himself plus three engineers) he did a zero-budget homebrew press campaign to get on the radar of investors.

Greenway Medical Technologies expects to add 400 new jobs and will undertake a $12 million expansion at its corporate headquarters in Carrollton, GA, according to state officials. The company filed for a $100 million IPO a few weeks ago.

MED3OOO (I can never figure out how to spell the name – sometimes they use zeroes like MED3000 and sometimes Os like MED3OOO) puts out a cool video showing their InteGreat EHR running on an iPad with Medicomp’s Quippe. They unfortunately didn’t post the video anywhere that allows me to embed it here, so you’ll have to click the link, but I promise it’s worth it if you want to see an entirely new way for doctors to document. Quippe is undeniably cool and the InteGreat demo is well done. It even contains a bonus in the last five seconds: an Inga quote. I asked if it’s really her on the video since it kind of looks like her in a shadowy way, but she swears it isn’t.

Chester River Hospital Center (MD) was scheduled to go live on Meditech Saturday, replacing QuadraMed Affinity.

Mark Rosenbloom MD, the founder and CEO of electronic clinical reference vendor PEPID, starts an age management practice in Illinois, offering a $995 per month program of lab tests, vitamins, and training sessions.

Two small Long Island weekly newspapers are baffled when all available copies are quickly bought up from vending machines and newsstands, with at least two teams of people grabbing all available copies at or above the cover price. Based on the overlapping stories in both papers, the newspaper strongly suspects friends of a local doctor who was charged with Medicare fraud were trying to keep the story quiet. Jesse Stoff MD was arrested for giving kickbacks to patients after billing Medicare for unnecessary services. He billed Medicare more than $800,000 in one month, tipping the feds off to run a sting operation in which an undercover agent was paid $300 for five visits. The money was delivered in a “kickback room” with a Soviet-style poster warning patients not to talk about the scheme.

The Washington state chapter of the American College of Emergency Physicians sues the state over a new rule that limits Medicaid recipients to three ED visits per year for non-emergency conditions. They have a vested interest since ED docs often bill patients directly for their services. The state’s Medicaid medical director says he had to trim $35 million from his ED budget somehow and only about 3% of Medicaid ED patients are frequent flyers who will be affected, not to mention that up to half of the frequent ED visitors go there seeking drugs. The top Medicaid user in previous audits was a 27-year-old woman who visited EDs 172 times in one year (every other day) complaining of headaches.

E-mail Mr. H.

Time Capsule: For Employees in Uncarpeted Areas, Hide Technology Complexity Like McDonald’s Does

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 September 2006

For Employees in Uncarpeted Areas, Hide Technology Complexity Like McDonald’s Does
By Mr. HIStalk

A recent state survey found that El Camino Hospital’s medication error rate nearly tripled after implementation of a supposedly safer, closed-loop type of information technology for medication orders. El Camino, widely recognized as a hospital technology pioneer going back to the 1970s, suffered an embarrassing setback as onsite investigators found actively occurring medication errors that were unknown to the hospital.

Major implementations like CPOE expose serious flaws in an organization’s ability to manage change, to communicate, and to educate — those soft skills often scorned by take-charge caregivers and logical IT types. If El Camino can have problems like these, so can just about any other hospital.

Medical errors, including technology-induced ones, have gotten so bad that some hospitals are actually advising patients to bring along a friend to protect them from staff mistakes. I can’t imagine any other business throwing in the towel and admitting defeat to customers. I’d have just two words for a restaurant waiter who suggests I watch the cook to make sure he doesn’t poison me: “Check, please.“

Walk the uncarpeted areas of the hospital on night shift, where clinicians get dumped because they’re new, working multiple jobs, or desperate to earn shift differential. The variation in practice is shocking to anyone who assumes that policies are consistently followed or that nurse executives speak knowledgably for those folks who toil in the appropriately named “graveyard shift,” where some of the most horrific mistakes are made by tired, under-supported clinicians left to their own devices by the A-team nine-to-fivers. Sometimes they don’t even get computer training because no one wants to come in at 3 in the morning.

Software and medical equipment isn’t designed with these people in mind. Our mental picture of a user is an intelligent, thoughtful person who sits in a quiet room and carefully reads all the screens, labels, and warnings we put in front of them. This paradigm works well in those hospital departments where knowledge management is the key responsibility: laboratory, radiology, and pharmacy, for example. Their employees embrace technology and use it willingly to boost productivity in performing repetitive tasks. The IT track record in those departments is outstanding.

Nurses and doctors don’t work in that world, however, so our efforts and computerizing their work has been spotty. They didn’t go into their professions because they love computers. Much of their work isn’t even all that logical, no easier to computerize than that of a teacher, artist, or mechanic. Rightly or wrongly, how they do things varies by individual or by area, making it highly unlikely that non-personalizable off-the-rack software, as a rigid enforcer of business rules, will ever be fully accepted by those who don’t follow the rules anyway.

For vendors, maybe simpler is better, hiding the complexity like a McDonald’s cash register, where pushing a button with a hamburger picture on it rings up a hamburger. For hospital leaders involved in IT, maybe it’s time to venture out “where the sun don’t shine” – the night shift, uncarpeted underworld of patient care where all of our IT horsepower often fails to protect our patients.

News 9/30/11

Top News

VA CIO Roger Baker says his organization will allow smart phones and tablets on its network starting Monday, with the first batch of 1,000 users swapping out their laptops or BlackBerries for devices running an unnamed OS (Apple). He also says he’d like the VA to develop an enterprise-wide apps store, with some of those apps coming from its recently announced open source EHR project.

Reader Comments

From Matt Holt: “Re: unsubstantiated. C’mon Inga, be nice, or at least reasonable. Keanu’s comment that Health 2.0 was super disorganized? I hear everything from my team — including the three people who didn’t like my write-up of their bios — and I never heard about an argument breaking out about an ad. No one wrote mentioned the fact that we’re the only health conference with more than 120 LIVE demos, that we had two big time health plan CEOs talking directly about technology, that we put the ONC head on stage with seven patients, or that we had 1500 people come – more than 50% up on 2011? Guess next time I’ll have to ask the 20-30 people telling me that Health 2.0 is the best conference they go to that they should e-mail you instead.” Thanks, Matt, for filling in the missing details, although we just ran what an attendee (and sponsor, apparently) sent us. Maybe I am just bummed I couldn’t have been there myself to experience it. Next year.

From High-Heeled: “Re: Error messages. In my role of helping physicians survive and thrive with EHR adoption, some are generally frustrated by the error messages their applications throw up. This is a new error message one of our doctors sent to me and told me it didn’t bother her at all!” Please tell your physician that wine makes me more tolerant as well.

From Lou Reed: “Re: just good enough. Farzad Mostashari is urging the HIT Standards Committee to put out standards that are ‘good enough’ to get started on HIE. In my HIT experience, any link that is ‘just good enough’ handles the core data, but any data outside the norm (such as exceptions, outliers, etc.) gets trashed. Just look at what craziness the open text segments in HL7 cause. Providers will be spending thousands of man-hours trying to sort out this out as they trip over the myriad of exceptions that come up in health care cases. Although I am a firm believer in not letting the perfect be the enemy of the good, there are times when that approach does not fit. This is one. Would he take his child on a plane that is ‘just good enough’?”

From Sorbino: “Re: EHR. Check this KLAS report. Ever heard of PCC – Physician’s Computer Company?” I’ve heard of them, but I was never quite sure what they did (some kind of reseller, I figured). The PCC EHR, which is pediatrics specific, puts up monster KLAS scores. They’re pretty new on the report, though, and there’s often a honeymoon period before the scores start to slip as the company grows, expectations are raised, and an increasing number of users are surveyed. Still, it’s an impressive accomplishment. There’s something to be said for focusing on a particular market segment and excelling in it.

From Just Tennille: “Re: SRS user group meeting. I always feel that I’m among friends there and came home energized. “ I can see where the “energized” part came from – check out the Red Bull and coffee bean chocolates bar. All that’s missing is caffeine IV bags. The SRS developers, lined up for intros and appearing uncomfortable in their seldom-worn and/or borrowed suits, look like they would love to change into nerdwear, ravage the caffeine stash, and sling some code. That’s what you want in a developer, which is why the glad-handing and photogenic sales guys become physically uncomfortable in their presence. I’ve never had an energy drink, but I’ve noticed recently how expensive they are in bars and stores, probably making them even more profitable to their manufacturers than wine or liquor since they don’t have to pay high federal alcohol taxes (Red Bull’s founder is worth $3 billion). I bet they were a hit at the user group meeting.

From Meaningful User: “Re: NY Times on the UK’s HIT fiasco. Blumie toots a different horn now that he’s back using these poorly usable systems.” It’s a fun read, calling NPfIT “a slow-motion train wreck” and asking three experts on whether a similar disaster could befall HITECH, which costs even more than the hugely expensive NPfIT boondoggle. Former National Coordinator #1 David Brailer says the UK ran NPfIT as a giant procurement program, running all over clinicians in the process. Richard Alvarez of Canada Health Infoway says both the US and Canada are taking a different path than Britain in setting standards and outcomes, but not doing the actual implementation. Former National Coordinator #3 David Blumenthal echoed Brailer in saying it has to be a collaborative effort with clinician involvement. You docs who aren’t sold on even subsidized EMRs may have more power than you imagine, or at least Brailer thinks so: “The experience in Britain is a warning to us. The thing that brought them to their knees was the confrontation with doctors.”

From CDMer: “Re: stolen tapes. Another day, another breach.” SAIC says computer backup tapes were stolen from the car of one of its employees on September 14, potentially exposing the detailed health information of 4.9 million military beneficiaries who received care, lab tests, or prescriptions in San Antonio area facilities such as Brooke Army Medical Center.

From Dolphins Fan: “Re: loss of Minnesota PHI. When something like this happens, everyone always points out that it was against company policy. Every healthcare company on the face of the earth has a PHI policy and most have an encryption policy. Unfortunately, for many companies the goal is to put a policy in place to make people happy, but then they fail to enforce it. Execution of a policy, versus simply having a policy, is where you really see how important PHI protection is to a company.”

HIStalk Announcements and Requests

In case you have been too busy following season-ending baseball drama, tracking the latest presidential polls, or watching Dancing with the Stars, here are a few highlights from HIStalk Practice over the last week: Dr. Gregg mulls over Abe Lincoln and HIT innovation. Electronic medical reminders improve care in elderly patients. Younger docs are not necessarily better at EHR than their older peers. MED3OOO serves up education, networking, and fun at its annual user conference. eClinicalWorks sells swag for charity at their national user conference this weekend in Phoenix.  If you have not been a HIStalk Practice regular in the past, I have good news: we are still accepting new subscribers. Thanks for reading.

Welcome to Executive Search Recruiting, supporting HIStalk as a Platinum Sponsor. The Cornelius, NC-based ESR is a boutique search firm (no, they don’t find boutiques, they recruit executives and sales talent) that works with providers, payers, vendors, and consulting forms to bring on partners, principals, directors, sales executives, and consultants, to name a few of the positions they can help with. They’ve worked with companies ranging from startups to Fortune 500 companies, so there’s a 100% chance that they’ve helped an organization similarly sized to yours, offering customized fee structures that include flat fee per hire, retained searches, contract work, and an interesting (low) hourly fee share for billable consultants. The company’s employees average 15 years’ of healthcare experience in executive search, so they know where to find the really good people (hire a bad one on your own and the value proposition becomes clearer.) On the other side of the jobs table, if you’re a high performer looking for an opportunity, check out their current openings and get in touch with Don Calhoun. Thanks to Executive Search Recruiting for supporting HIStalk.

Everybody likes big and/or round numbers, so here are some for HIStalk. E-mail subscribers: 7,546. Likes on Facebook: 1,595. Mr. H connections on LinkedIn: 920. Dann’s Fan Club members on LinkedIn: 1,857. Number of unique readers: 21,350. Number of visits since 2003: 4.56 million. You will make the small round number (zero) of HIStalk full-time employees happy by increasing those numbers where you can. Thanks.

On the Jobs Board: Implementation Project Manager, Epic and Cerner Resources, Director – Product Demonstration Specialists. On Healthcare IT Jobs: HL7 Interface Analyst, Director, Clinical Applications, IT Technical / Product Support Specialist, Epic Consultant Manager.

If you were toiling away in HIT prior to 1980 and want to reconnect with old pals at HIMSS, sign up so Vince can e-mail you details about a little get-together at the HIMSS conference. One reader is hoping for Neil Pappalardo or Octo Barnett from Meditech to attend, but even if they don’t, quite a few interesting folks have already said they’re planning to be there.

Acquisitions, Funding, Business, and Stock

Greenway Medical announces that it is acquiring certain technology assets of CySolutions, a provider of clinical management and EHR solutions for FQHCs and community health centers. Greenway did not disclose the purchase price or the exact technologies it’s buying, but does indicate that CySolutions CEO Bill Young and other development staff members will join the company.

Prognosis Health Information Systems completes its acquisition of Creative Healthcare Systems, a provider of financial management and patient accounting systems.

Sales

Jeff Davis Hospital (GA), a 25-bed Critical Access Hospital, selects Healthland’s Centriq EHR.

Meadowlands Hospital and Medical Center (NJ) chooses PatientPoint’s patient engagement platform for care coordination and revenue cycle management.

Allegiance Health (MI) signs a three-year contract with TrustHCS for its ICD-10 education services and DNFB Assurance program.

Atlantic General Hospital (MD) contracts for Sunrise Clinical Manager from Allscripts. The hospital already uses Allscripts on the ambulatory side.

Blue Cross Blue Shield of North Carolina will spend $15 million to subsidize the implementation of the Allscripts MyWay EHR for 750 North Carolina physicians, with 85% of the cost covered for eligible independent practices and 100% for free clinics, including training and support. BCBSNC will work with the NC Area Health Education Centers to help practices achieve Patient Centered Medical Home status and will also help providers connect to the North Carolina HIE. Allscripts will contribute an additional $8 million to the project.

St. Francis Hospital (CT) executes a three-year agreement with MED3OOO to provide RCM services for its 200 employed physicians.

People

Ryan A. Secan, MD, the former medical director of hospitalist programs at Lowell General Hospital Medical Group and Anna Jaques Hospital, joins MedAptus as chief medical officer.

T-System promotes Erin Estes from director of implementation services to VP and GM of performance solutions.

Announcements and Implementations

Cerner announces the Cerner Reference Lab Network, which requires one standard connection to communicate with all reference labs on the network.

Community Medical Centers (CA) goes live this week on Epic.

CareTech Solutions earns HDI Support Center Certification for its Service Desk IT help desk offering, which it says is the only hospital-specific help desk in the country. The company also just invested $1.5 million to reconfigure and remodel the operation. The press release casually mentions that it’s an “on-shore medical help desk,” meaning that when you call, you’re talking to someone in Troy, Michigan, United States of America.

Scottish charge master vendor Craneware announces financial tools designed for Critical Access Hospitals.

Government and Politics

HHS launches the Comprehensive Primary Care initiative, which will pay primary care practices $20 per beneficiary per month for providing better-coordinated care for Medicare patients. The program calls for participation from private and state insurance providers, requires providers to meet certain quality measures, and will eventually include a shared savings component for participants.

iSoft will provide its Enterprise Management hospital information system to create the Brunei Healthcare Information System, a government project with a goal of creating a single electronic record for every patient in Brunei.

Fujitsu prepares to sue the UK Department of Health for $1.1 billion, saying it’s owed that amount after pulling out of NPfIT in 2008.

Innovation and Research

A hospital in England explains its green IT efforts, which include moving to virtualized servers, replacing desktops with thin client devices, and implementing the NightWatchman power management solution that powers down idle PCs in non-critical areas.

Other

An Atlanta medical practice’s IT specialist pleads guilty in federal court to intentionally accessing the protected computer of a competing perinatal medical practice. Using his home computer, Eric McNeal accessed the system of a former employer, downloaded patient data, then deleted all the patient information from the practice’s computer. He used the patient data to run a direct mail marketing campaign to benefit his new employer. He faces up to five years in prison and a fine of up to $250,000.

Weird News Andy elects not to steal second base in declaring, “I’m not touching this one.” A woman undergoing a swap-out of her breast implants wakes up after surgery to find herself with symmastia, also known as  “uniboob.” She said, “It looked like I had one big breast instead of two,” but the uniboob has since been successfully re-cleaved by another surgeon and the inevitable lawsuit has been settled.

National eHealth Collaborative seeks nominations for its board.

Consumers in Australia complain about the pharmacy association’s plan to push a particular manufacturer’s nutritional supplements when patients pick up their prescriptions. The association’s computer system will remind the pharmacist to tell the patient that the supplements can help mitigate side effects of the prescribed drug. The association’s president is particularly proud of the computer reminders, calling them a “world first for IT-enabled, software-promoted pharmacy sector messages to facilitate targeted recommendations to patients.” The manufacturer’s CEO raised the most ire when she characterized the sales program as a “Coke and fries” upselling opportunity that will boost pharmacy profits. The president of the Australian Medical Association was unimpressed: “I think the evidence for Coke and fries is about the same as the evidence for these products.”

A Denver-area agency ICU nurse is charged with identity theft and theft of medical records after Centura Health discovers he had accessed patient records inappropriately. The complaint against him says he used patient information to sign up for credit cards. His nursing license from another state had already been suspended in connection with a prescription fraud investigation.

A St. Louis-based physician and geriatrician urges the US to emulate the healthcare system of France (#1 in the world vs. the US at #37) and its smart card system. which is really just a microchip ID card that contains no medical information and is required for every citizen over 16 years of age:

The most magnificent component of the French medical system is the "Carte Vitale." This looks like a credit card and is given to the physician by the patient. It is inserted into a computer allowing the physician to review the patient’s basic medical history and is also used for billing the patients visit to the government. The patient thus controls his or her own health records, maintaining privacy.

A family practice physician in Canada, talking to a reporter about the loss of a PHI-containing memory stick from a local hospital, says patients of his own practice are not at risk. “My system is hard copy — paper, and it’s worked for me and many doctors in the city who still use it. It’s awfully hard to lose an entire filing cabinet.”

Thomas Manning, the retiring head of Commonwealth Medicine (a consulting division of the University of Massachusetts Medical School,) will become the state’s highest paid retiree with an annual pension of $347,000 when he retires next year. The organization is under investigation for receiving no-bid Medicaid contracts from the state that cost $138 million per year, but says that’s not related to Manning’s retirement.

Sponsor Updates

• Imprivata reports that the healthcare sector is the leading adopter of desktop virtualization technology, according to a recent cross-industry survey of 477 IT decision makers.
• Wolters Kluwer Health announces that Children’s Healthcare of Atlanta (GA) has selected its ProVation MD software for its GI departments.
• Surgical Information Systems (SIS) becomes an Industry Supporter of the American Society of Anesthesiologists (ASA).
• TeleTracking Technologies announces a free webinar series addressing patient throughput, overcrowding, RTLS asset management, performance improvement, and inter-hospital transfers.
• The executive director of medical operations for Pocono Raceway (PA) discusses how emergency responders are using technology from T-System and Shareable Ink.
• MobileMD introduces its 4DX Connected Health Record, an EHR application for small and family physicians that should be ONC-ATCB 2012 certified in Q4.
• Capsule announces record growth, including the addition of over 90 facilities over the last six months.
• iMDSoft adds Metropolitan Medical Services as a reseller of its MetaVision Suite.
• Billian Publishing launches HITR.com, a HIT benchmarking and social networking community for providers and vendors. The free tool includes customer satisfaction scores for nearly 40 IT systems and 300 vendors.
• CapSite releases a study of the RIS market and finds that 22% of hospitals have plans to buy a new RIS. Sixty-one percent of installed RIS systems are at least five years old.
• HIT consulting firm Care Communications collaborates with Elsevier/MC Strategies to incorporate Elsevier’s ICD-10 transition tools into its ICD-10 readiness and implementation offerings.
• Frost & Sullivan awards Awarepoint its RFID and RTLS Healthcare Competitive Strategy Leadership award.
• For the twelfth consecutive year, CMS extends its use of McKesson’s InterQual Criteria for decision management.

EPtalk by Dr. Jayne

Web sites like Groupon offer discounts on a variety of products and services. A recent article notes that such discounts may be illegal where health care services are concerned. Because part of a patient’s payment is kept by the site, it could be interpreted as violating anti-kickback laws. The American Medical Association hasn’t taken a stand, but two medical boards in Oregon (dental and chiropractic) have banned the practice.

The National Labor Relations Board affirms the right of a physician to terminate an employee for bad-mouthing the practice via social media. However, if multiple employees are collectively complaining regarding legitimate issues, employees may be protected. Timing, audience, and composition are key determinants of whether the speech is protected or not. Better dust off those policies and procedures and make sure social media use is addressed at your practice or hospital.

US District Judge Marcia Cooke has blocked enforcement of a Florida law that restricts physician questions about patient ownership of firearms. For those of you customizing EHR content and intake forms to remove these questions, you’re off the hook.

Accenture is chosen to head efforts to build a national Personal Health Record system in Australia. Orion Health and Oracle are also on the team. The system will include both patient and provider portals.

I maintain admitting privileges at a community hospital that is just now preparing to implement CPOE. I received a hilarious memo from them this week which contained so much worthless consultant-speak that I could have won a round of “Buzzword Bingo” without missing a beat. My favorite part was the discussion of a “cross-functional team dedicated to surveying spaces throughout the facility for process utilization.” I think this is fancy-talk for, “We have to figure out where we’re going to stick all these blasted workstations.” Broom closets, beware!

Sixteen organizations (including vendors, consultants, and advocacy groups) come together to form the Accountable Care Community of Practice. In their own words: “The overriding goal of the CoP is to help enable rapid, effective and efficient adoption and use of Health Information Technology (HIT) by providers implementing new care models in support of accountable care.” In addition to Webinars, they will hold regional forums in Minneapolis, Boston, New York, San Francisco, Seattle, and Austin.

PEPID announces the delivery of the National Drug Code (NDC) database to health IT systems. I’m not a fan of using NDC information for drugs, as it introduces a certain “clutter factor” depending on how vendors utilize it. Although highly specific, NDC codes for a given dose of a particular drug differ based on what kind of packaging holds the drug. As a front-line clinician, I personally don’t care if the pharmacy has 500-tablet stock bottles or 100-capsule stock bottles or which manufacturer it comes from. And don’t forget that generic drugs can have dozens of different NDC codes for the same medication.

I thought of Inga when I came across this business mentioned on a friend’s Facebook page. If it was in my home town, they would definitely get my business. It would also be an excellent name for a woman-owned software consulting firm. Now why didn’t I think of that? I could have probably expensed a number of sassy shoes as a business / advertising expense.

Contacts

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

News 9/28/11

Top News

Two Minnesota hospitals start notifying 16,000 patients that their medical information was contained on a laptop that was stolen. The hospitals blame subcontractor Accretive Health, whose employee left the laptop in a locked car outside a restaurant. The company did not give a reason that its employee had PHI on a personal laptop that was, contrary to company policy, not encrypted.

Reader Comments

From Keanu “Re: Health 2.0 conference. It might be bigger this year, but so far it’s super disorganized (and has been during the lead-up.) I’ve spoken to multiple vendors and sponsors they’ve managed to upset (including us.) I just witnessed a big argument about an ad gone wrong. Signage is lacking and has misspellings. We’ll see how the actual show goes.” Keanu sent a follow-up email, saying the first full day of the show was “semi-organized anarchy,” though better than the initial setup day.

From Jackie Dan “Re: Health 2.0. It’s sort of an interesting meeting and a cross between a mini-HIMSS and a VC startup competition. Everyone is trying to prove they’ve got the next ‘disruptive business model.’ A couple of interesting trends here though, like the whole Dr Chrono/Practice Fusion freemium thing. An insider at Practice Fusion told me that their paying customers are pretty much negligible compared to their purported 100k+ users, although, he still seemed ‘confident’ that they would survive/make money on ad revenue.” I have my own theories on the freebie EMRs and suspect Practice Fusion’s Research Center makes a nice impact to the bottom line.

From Doctor Who “Re: HIStalk resilience. FYI, you guys have significant sway these days. My profile in the Health 2.0 program makes direct reference to a post I made after HIMSS. HIStalk seems to have staying power. BTW, in addition to tons of people vying for money, the Health 2.0 conference is inspiring with some really cool and smart ideas out there. And the reception even included an open bar with Inga-like drinks (coco-tinis, nikita margaritas.)” Glad for the vote of confidence on HIStalk, as I kind of like this gig. HIStalk is over eight years old, so it’s been around for awhile. Bummed I missed the drinks. Next year, Matt.

From Fred Norris: “Re: HIMSS webinar. Got this in e-mail today. Doesn’t HIMSS charge hospitals a bunch to be members so they can benefit from their neutral, unbiased education services? Are they offering equal time to GE, Cerner, Epic, etc.? How can HIMSS claim to run a vendor-neutral annual conference (you have to swear that to be a presenter) and then run this marketing seminar? I’m sure they’re charging Siemens a fortune, so will they lower our annual dues proportionately, or are they just in it for the money like all vendors?” I raised a fuss when HIMSS started shilling its infomercials, but nobody seemed to share my indignation (or maybe they were just not surprised enough to care given the ever-blurring line between HIMSS and other vendors). Like a TV station during election season, HIMSS will indeed offer equal time to all other vendors – at an equal price. I do resent HIMSS passing sales pitches off as education, but that horse left the barn long ago and all you can do is try not to step in the part that’s left.

From NeverEnuf: “Re: Jackson. I thought you’d like this article on executive pay not being sufficient!” The new CEO of financially desperate Jackson Health System (FL), himself a former banker and city manager, gets some heat from the local paper by hiring two $500K executives who also have no hospital administration experience, one an accountant and the other a former IBMer. The CEO says the whole management team is paid well below market rates, which is definitely the case since he himself makes “only” $590K for trying to turn around the ultra screwed up Miami public hospital. That sounds plenty fair for a county official, but you know how hospitals are.

From Viggo: “Re: Thanks for looking over our Web page. I appreciate the favor.” I get quite a few requests for one thing or another: making an introduction, giving an opinion about a potential employer, offering thoughts on a vendor or product. I politely turn quite a few (maybe most) of those down since I don’t have much free time and it gets overwhelming at times (not to mention that much of the time, I’m just as clueless as the requestor and don’t want to just throw something out there implying otherwise.) My decision tree looks like this: (a) is the requestor a friend of HIStalk in some way – a sponsor, a guest article submitter, an interview subject? (b) if not, have I exchanged e-mails with them previously? (I save all my outbound e-mails, so I can tell); (c) is the requestor at least superficially supportive of HIStalk, like by being in the HIStalk Fan Club on LinkedIn or a friend in Facebook? I’ll do whatever I can to support people who support me, but I get more requests than I can handle as an after-work hobbyist (for example, I’m still writing after a crappy and long day at work that was followed by four hours of HIStalk work; my pager is going off; I won’t get to bed for another hour; and six hours later, I’ll the cycle start over again. If you’re waiting on e-mail from me, that’s why.)

From DDLT-AAGL: “Re: Epic. Having Epic installed at all necessarily gives you full access to the server-side code (which is not much use without Epic’s internal-only set of tools for navigating it.) Client (Hyperspace) code is effectively a black box to customers except where APIs are specifically created for custom forms, etc. Numerous server-side programming points allow predefined access at various code entry points — usually this is limited to simple code such as customized text output for a field, etc. But you can do a lot in theory. They draw an absolute line at customers editing any Epic-released code. Pure custom code is (reluctantly) tolerated (as it cannot be prevented by virtue of how Cache works) but discouraged and unsupported.”

Acquisitions, Funding, Business, and Stock

PatientKeeper lands $1.5 million of a planned $3 million debt financing round from a group of nine backers.

CareCloud, a provider of cloud-based PM, EHR, and RCM solutions for physicians, raises $20 million in Series A funding, led by Intel Capital and Norwest Venture Partners.

Greenway Medical Technologies amends its $100 million IPO, noting that it intends to list its shares on the New York Stock Exchange using the symbol “GWAY.”

Telehealth provider Tunstall Healthcare Group will acquire American Medical Alert Corp, a provider of  remote health monitoring and communication services, for $82.3 million.

Sales

HHS awards SAIC a contract to provide full life-cycle operations, maintenance, and enhancement services for its HRSA Data Warehouse. The maximum contract value is $15 million over five years.

The Health Information Network of Arizona (HINAz) partners with  Axoloti Corp (OptumInsight) to create a statewide HIE.

The state of Alaska hires Cognosante to conduct evaluation, technical assistance, and consulting services for the state’s HIE system.

Health Partners of Philadelphia selects MyHealthDIRECT’s Web-based scheduling solution.

Select Data chooses Emdeon’s RCM solutions for its home health customers.

Allegiance Health (MI) chooses TrustHCS to provide ICD-10 training and coding services.

The VA awards HP Enterprise Services a $10.4 million contract to provide a WiFi based RTLS to the VA hospital in Ann Arbor, MI.

People

Kony Solutions appoints Sriram Ramanathan (IBM) as chief technology officer.

Announcements and Implementations

Three Illinois-based health systems and two physician clinics join forces to establish the Lincoln Land HIE, which will utilize Medicity’s exchange technology.

Onslow Memorial Hospital (NC) will activate the second phase of its Meditech implementation next month with the go-live of clinical documentation by  non-physician users. Physician online documentation will start in April 2012.

The hospital authority for Memorial Hospital (GA) approves the $747,125 purchase of an integrated PM/EHR system for physician practices.

Floyd Valley Hospital (IA) begins its $500,000 EMR conversion to Meditech’s Client/Server release.

The American Hospital Association extends its third consecutive, three-year exclusive endorsement of Hyland Software’s OnBase solution as the ECM solution of choice.

Transcend Services releases a front-end speech technology and transcription platform that incorporates template-based documentation tools from its newly acquired Salar division.

MidSouth eHealth Alliance goes live on ICA’s CareAlign 1.0 HIE platform at 16 facilities.

3M Health Information Systems announces the release of its 3M 360 Encompass System, which unites coding, documentation improvement, and performance monitoring by providing auto-suggested codes and real-time clinical documentation improvement prompts.

NoMoreClipboard.com announces cc:me, a new addition to its personal health record service that allows patients to send and receive medical information electronically via the Continuity of Care Document format. They’re most famous for concocting (along with Medical Informatics Engineering) the Extormity fake EMR vendor. A quote from that brilliant spoof:

Generating a return on an investment first requires an investment. The heftier the investment, the more substantial the return could potentially be if there is, in fact, a measurable return. The Extormity EMR Software Suite is built on a proprietary software model renowned for its complexity. This proprietary platform and all of its components must be procured and implemented as a complete package we call the Extormity Bundle (which describes both our comprehensive package and its associated cost) … Planning for this additional infrastructure can be provided by the Extormity Strategic Consulting unit, with implementation provided by the Extormity Solutions and Services Business Unit. These Extormity business units operate in silos, ensuring that you receive and pay for duplicated services.

In Australia, Garner defends a report it prepared for Queensland Health in which health officials requested (and obtained) changes that critics say favored the selection of Cerner for a $180 million statewide EMR project. Gartner highlighted the fact that it considered Cerner the only vendor of a “Generation Three” product (on a five-generation scale, which QH’s ehealth program director wrote is equivalent to “a HIMMS scale of 5”) that is up and running in Australia. Both parties said the change was intended only to call out information already contained in the report, which provided Cerner with no advantage. It doesn’t seem the slightest bit fishy to me, but I’m not looking at it through political goggles like some of the torch-wavers down there.

Government and Politics

In the UK, ministers are considering offering US-based NPfIT contractor CSC another chance (and more money) to get iSoft’s Lorenzo up and running even though individual hospital trusts aren’t all that interesting in trying to implement Lorenzo and NPfIT is being shut down. The newspaper article called CSC “one of the worst-performing IT contractors” for being paid billions of pounds for trying, generally unsuccessfully, to implement Lorenzo, which helped seal NPfIT’s fate. 

Technology

Health 2.0 and Walgreens name Team mHealthCoach the winner of the Walgreens Health GuideChallenge and award mHealthCoach a $25,000 cash prize. mHealthCoach developed a tablet-based application that that displays data retrieved from multiple health and social media sources.

An open source advocate whose medical condition required an implantable defibrillator wants vendors of similar devices to make the source code of their proprietary software available for third party inspection, citing occasional medical device recalls. She admits that even as a programmer she wouldn’t have a clue what she was looking at or wouldn’t have any option other than getting the device or not, but adds, “I don’t want to rely on Medtronics for something as essential as my heart.”

Other

More frequent physician-patient encounters may lead to quicker control of Type 2 diabetes measurements and improve outcomes, according to a study that reviewed the EMR of almost 30,000 patients.

I knew my Starbucks made me happy: an Archives in Internal Medicine report finds that depression risk in women decreases as caffeinated coffee consumption increases.

Most health organizations are underprepared to protect patient privacy and secure data, with over half of health organizations reporting at least one privacy and security issue over the past two years. The most frequently reported violations came from internal sources improperly using PHI.

An interesting Slate article says the highest-paid doctors are the most likely to lose their cushy gigs to automation. Examples cited: technology allows faster reads of Pap smears and mammograms; technology can eliminate the need to get a second radiologist to check a mammogram; and surgical robots help surgeons work faster and allow them to work remotely. A fun quote:

By definition, specialists focus on narrow slices of medicine. They spend their days worrying over a single region of the body, and the most specialized doctors will dedicate themselves to just one or two types of procedures. Robots, too, are great specialists. They excel at doing one thing repeatedly, and when they focus, they can achieve near perfection. At some point—and probably faster than we expect—they won’t need any human supervision at all. There’s a message here for people far beyond medicine: If you do a single thing—and especially if there’s a lot of money in that single thing—you should put a Welcome, Robots! doormat outside your office. They’re coming for you.

Here’s Vince’s latest, Part II on IHC. Have I said I love reading these? You can add to the historical archive by e-mailing Vince.

Marty Gettman, a director at McKesson Provider Technologies in Atlanta working on the CareBridge Services Team, died September 15. He was 49. Condolences can be left here.

A 23-year-old traveling nurse covering for striking and locked-out RNs at Alta Bates Summit Medical Center (CA) kills a cancer patient by accidentally running nutritional supplement through an IV line instead of a stomach tube. Another contract nurse says the 500 replacement RNs were “thrown in” amidst “complete chaos” with only a brief orientation, not that orientation is needed to avoid making a colossal mistake like this by overriding all the safety precautions (like tubing that doesn’t fit the wrong kind of port).  

Sponsor Updates

• Merge Healthcare will incorporate Fovia Medical’s High Definition Volume Rendering (HDVR) across its entire PACS platform. Also announced by the company: speakers at its October 4-7 user group meeting in Chicago include Mayor Rahm Emanuel and HHS CTO Todd Park.
• T-System Inc. honors Ashtabula County Medical Center (OH), Mason General Hospital (WA), Montrose Memorial Hospital (CO), Osceola Regional Medical Center (FL), and PeaceHealth St. Joseph Medical Center (WA) with National Awards for Emergency Department Excellence.
• Iatric Systems’ Patient Discharge Instructions earns Surescripts certification.
• Business Day with Terry Bradshaw will feature The Huntzinger Management Group on the Fox Business Network on October 1.
• Ron Jones, an OptumInsight SVP, encourages CFOs to make the ICD-10 transition a priority in a guest blog post. The company also announces that 30 hospitals will implement its coding solution.
• dbMotion’s Elizabeth S. Willett discusses whether providers should develop an internal connectivity platform or join an externally driven HIE.
• Brad Hawkins, MEDSEEK’s VP of clinical experience, will participate  in this week’s North Carolina Healthcare Information & Communications Alliance Conference and Exhibition.
• Physicians with Kiddie West Pediatric Center (OH) secure stimulus funds using MED3OOO’s InteGreat EHR.
• PatientKeeper presents its Customer Innovation Award for 2011 to Clinical Practice Management Plan (NY) for its extensive and innovative use of PatientKeeper Charge Capture.
• Vocera names William Zerella (Force10 Networks) as CFO and Linda Esperance (MarketTools) as the company’s first VP of human resources.
• Orthopaedic Associates of Wausau (WI) will replace its existing EMR with SRS.
• Memorial Hospital & Health System (IN) subscribes to the CapSite Hospital Purchasing Database.
• McKesson Specialty Health introduces its Innovative Practice Services to help oncology practices improve their financial health through the use of business, technology, and clinical tools.

Contacts

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

Curbside Consult with Dr. Jayne 9/26/11

Last week I talked about the recent government proposal to allow patients direct access to their laboratory results. A certain Mild-Mannered Reporter responded to my call for information from the laboratory vendor side and his remarks are worth sharing:

As an IT manager in a commercial lab that services a state where test results may not be released directly to the patient without specific instructions from the ordering provider, we are just now beginning to think about how we will deal with this new requirement. Our entire Laboratory Information System (LIS) is designed to be provider / client oriented, so modifying our lab result delivery processes will not be a trivial effort.

As I read through the rules as written, a number of concerns pop into my head and refuse to leave:

• Many of our lab results are not patient-centric. As there is no universal patient ID and each of our ordering providers may identify a patient differently, we may have a difficult time locating all of Mary Smith’s results.
• How far back do we need to go? There are CAP retention requirements that we abide by, but not everything is kept online forever.
• We have no idea of what the demand will be. A hundred per day or two per month?
• How will we be required to deliver the results? Your comment about utilizing an electronic portal makes sense, but the current wording seems to indicate that it is up to the patient to define how he/she wishes it to be delivered:

Processing a request for a test report, either manually or electronically, would require completion of the following steps: (1) Receipt of the request from the patient; (2) authentication of the identification of the patient; (3) retrieval of test reports; (4) verification of how and where the patient wants the test report to be delivered and provision of the report by mail, fax, e-mail or other electronic means; and (5) documentation of test report issuance.” [Federal Register: September 14, 2011 (Volume 76, Number 178)] page 56722

Interesting in this wording that encryption is not mentioned when specifying e-mail. Looks like more opportunities for labs and others to accidentally violate HIPAA/HITECH by accidentally disclosing to the wrong party.

I suspect that he lion’s share of the costs will be creating new delivery systems, researching the results, and authenticating the patient. None of these costs can be passed on to the patient — only postage and media costs.

We have always run our business to serve the patients, our physician clients, and our insurance payors. It is a delicate balance to keep everyone happy, but if our clients want us to somehow manage a delay result release and the patients demand immediate access, we may be in the proverbial rock and a hard place predicament.

Now I know that there are a number of states that already require that patients have access to their lab results, so I know that this is all doable, but we need to do a lot of planning to meet this new requirement. For now, I think that we will wait for the final rule before making any major changes.

I should also add that for me, this is not really an issue. My primary care doc publishes the important lab values with his comments on a patient portal for me to see. It works just fine because we have a deal – I don’t try to practice medicine and he doesn’t come down to the lab and tell me how to run my shop.

I’ve always been a fan of The Simpsons, and hopefully some of you are familiar with Lisa’s mentor, jazz musician Bleeding Gums Murphy. (I’m a bit disturbed, though, that when I did a Bing search for ‘image bleeding gums murphy’ it also brought up a photo of former Surgeon General C. Everett Koop.)

Hopefully each one of us has had at least one person in his or her life to fulfill that mentor role. I was lucky enough to have my own Bleeding Gums Murphy for more than two decades. He passed away this weekend, and this is the first time I’ve experienced the relatively new cultural phenomenon of grieving via Facebook. A lot of people think of Facebook as a frivolous time-waster (sometimes I don’t disagree) and many cursed it mightily this week for changing too quickly for our liking. But there’s no doubt that social media have the power to bring people together.

We don’t always have the luxury of having our mentors physically close to us, but it’s been heartening over the last few days to know that when my BlackBerry dings there’s a really good chance it’s going to be someone posting a memory to his Wall. Another friend who studied with him said it best: “I will celebrate his life in memory and mourn only those who never met him.”

In the words of Carole King:

When the Jazzman’s testifyin’ a faithless man believes
He can sing you into paradise or bring you to your knees
It’s a gospel kind of feelin’, a touch of Georgia slide
A song of pure revival and a style that’s sanctified.

E-mail Dr. Jayne.

Monday Morning Update 9/26/11

From My Little Pony: “Re: Epic. They’re recruiting programmers from Hong Kong.” The job posting says Epic is looking for Hong Kong software developers, with paid relocation to Verona. Epic will have a recruiting team in Hong Kong in November. I found the list of solutions the noobs might be working on interesting: genomics and proteomics, telemedicine, creating software that adapts to the individual user, developing next-generation user interfaces, and adding gesture recognition. Epic always resists the idea of outsiders setting usability standards that vendors would be required to follow, but it sounds as though the company has something potentially big in the works. Another version of the same ad is aimed at developers from Singapore.

From Gluteus Max: “Re: Epic being perceived as ACO ready. Epic is good at storing and presenting data, but it’s not good at doing useful things with it. If the ‘Epic Octopus’ business model theory is correct, that’s very much by design. Analytics and data sharing are two of the most important features ACOs will need, so it’s difficult to believe Epic is ‘close to ACO-ready.’” Unverified.

From Verona Notes: “Re: Epic. Now has 266 customers, up from 224 last year and 190 two years ago. Future vision shows Epic is listening to usability criticism, such as software that understands the physician-patient conversation and readies documentation and orders. Unsurprising stock tip: IBM servers dominate competition in internal Epic tests. Amazing logistics for so many people, but starting late=disrespect.” Unverified. There’s that usability thing cropping up again.

From Bea Fragilis: “Re: Epic. To what extent are Epic-certified people allowed to make changes to local hospital code? My sense is that those changes must be minor, documented, and controlled from Verona.” I’ve heard that Epic will let responsible customers change source code and will even provide them with programming standards and documentation to help, although they don’t encourage everybody to start hacking around. I’m interested in that answer as well, not to mention how the customer gets access to the source code (or the extent to which application behavior can be controlled through external hooks).

From MT Hammer: “Re: front-end speech recognition. A new study finds that it results in 800% more errors in patient reports compared to transcribed dictation.” The study, published in the American Journal of Roentgenology, finds that 23% of reports created with front-end speech recognition (i.e., you dictate into a microphone and your words immediately appear on the computer screen) contained at least one major error vs. only 4% of those created from standard dictation and human transcription. Overall, the error rate with speech recognition was eight times higher than with human transcription. Interestingly, speaker accents didn’t make much difference, but imaging modality was a predictor of error rates. I don’t have access to the full text of the article, so I would be interested in radiologist’s analysis (such as the significance of issues defined as errors, why the radiologist didn’t catch the mistakes on the screen when using speech recognition, etc.) Also keep in mind that this compared only two transcription options, with the third being back-end speech recognition like that of the former eScription (now Nuance), which I believe has much higher accuracy since it can consider context and history rather than just pronunciation (similar to what transcriptionists do).

From The PACS Designer: “Re: Windows 8 tour. Microsoft has revealed aspects of its new Windows 8 platform for developers to peruse. Windows 8 will be tightly integrated with a new Internet Explorer 10 using a next generation internet platform called HTML5.”  The problem with pre-iPhone cell phones is that they worked like tiny, underpowered PCs with crappy keyboards. I’m not sure we need the opposite problem – PCs that work like huge iPhones – especially since touch screens are extremely rare in PC-land and the point is lost anyway since you’re either sitting in front of a desktop keyboard or a laptop. My understanding is that Win 8 will have two user interfaces, one for mobile use and one for desktop. MSFT had better make sure not to screw up the latter in trying to pander to those who yearn for an iPhone clone as their primary device.

From King Coal: “Re: HIStalkapalooza. Which night? Looking forward to it with bated breath.” Don’t count on it just yet. The potential sponsor had some venue contracting issues and won’t have enough space  to handle the historically large turnout (and waitlist.) I may end up cancelling it for Las Vegas, leaving you to read your HISsies winners online instead of seeing Jonathan Bush’s one-man show crafted around them (and that I really will miss).

My Time Capsule this week from 2006: The VA Outperforms Private Hospitals in IT Vision and Resolve. An aliquot: “Like a tailor-made suit, VistA was developed to meet the VA’s needs, not those of a vendor’s ‘average’ hospital customer. Just as hospitals talked themselves into buying instead of building (helped along by vendors and risk-averse CIOs,) the industry’s darling turns out to be a homebrew job.”

Reporters and TV stations have gone crazy with their lazy, press release-sourced coverage of the prospect of turning healthcare encounters over to the Jeopardy-winning IBM Watson (most common lame headline: “The computer will see you now”) but readers here weren’t equally impressed with its announced use by WellPoint, with most saying IBM and WellPoint will get the benefit instead of patients and providers. New poll to your right: now that Sage Software has announced plans to sell its healthcare division to Vista Equity Partners, who will benefit most from that transaction?

I’ve enjoyed Vince’s HIStory series immensely, to the point that I suggested that the pre-1980 industry pioneers get together at the HIMSS conference to reminisce (and knowing some of those folks, perhaps tipple a tad). Shelly Dorenfest, Bob Pagnotta, John DiPierro, and David Pomerance are a few of those who have said they’ll be there. If you know them, you should be there, too. Drop your e-mail info on this form and Vince will be in touch. Think of it as a 30+ year class reunion of the College of HIT Hard Knocks.

This week’s e-mail from Kaiser boss George Halvorson talks up the company’s newly won Davies Award win, also mentioning that Kaiser hospitals make up 35 of the 60 HIMSS EMRAM Stage 7 hospitals and that the remaining KP hospitals are all Stage 6. And despite early reports of HealthConnect availability problems, he says KP has won six awards from the Uptime Institute, the only healthcare organization to ever win (although as a counterpoint, that’s data center uptime, and plenty of ways exist to knock users off systems even though the server is chugging along). He also mentions some employee-recommended technology projects that have been funded by KP’s internal innovation fund: an automatic glycemic calculator, a hospital capacity prediction tool, and an SMS appointment reminder system.

Weird News Andy finds this story about hospital drug shortages and the resultant third-party profiteering scary. I’ll elaborate from experience to scare him more. Even if you ignore the possibility of obtaining counterfeit or impure drugs when forced to buy from secondary channels, the patient safety risks with drug shortages are considerable. Product packaging and sometimes concentrations differ from what nurses and doctors are used to, greatly increasing the chance of wrong drug / wrong dose errors. Sometimes the backup drug is therapeutically similar but chemically inequivalent, meaning doctors are forced to use a drug that wasn’t their first choice and one they may not be all that familiar with, making it more likely that something will go wrong. Shortages come and go all the time, so information systems can’t be kept current to steer prescribers to the one currently being used, sometimes requiring IT workarounds that neuter electronic protections such as dose and allergy checking. Those drugs may have similar active ingredients that are still different enough to trigger unexpected drug allergies and drug-drug interactions. My analogy is always this: suppose you’re about to have open heart surgery, but the drugs your surgeon always uses are on shortage, meaning the surgeon will have to compromise with a less-desirable drug that they’ve rarely or never used. You’d be mad at someone for letting that situation occur. The problem here is that everyone involved claims to be innocent and powerless.

On WNA’s slightly lighter side (it involves death, so it’s still not all that light), he captions this story as “Spinal Tap’s drummer?” Coroners in Ireland review the death of a man whose body was found burned in his sitting room, with no damage to the floor on which it rested, no evidence of foul play, and no signs of the source of the flame.  They conclude that he died of spontaneous combustion. A retired pathology professor ruled out divine intervention, saying, “I think if the heavens were striking in cases of spontaneous combustion, then there would be a lot more cases.”

A good article covers the high cost of children’s hospitals, with the Nemours Children’s Hospital (opening next year) in Orlando leading it off. The 95-bed hospital, being built in a city that already has two large and notable children’s hospitals, will cost $400 million ($4.2 million per bed) and was approved by the state only after the well-funded Nemours called in some political favors. Mentioned about high-profile children’s hospitals in general: lack of financial transparency, fast-rising costs accompanied by big executive paychecks and impressive construction projects, big financial war chests, and only tiny amounts of charity care provided. I can say from experience that those multi-million dollar children’s hospital CEOs have the ultimate weapon to keep the donor and political largesse flowing – feel-good happy ending stories of miraculous medical work accompanied by fuzzy-focus, intentionally heart-tugging pictures of adorable babies and toddlers. Your hospital will lose every time if your particular medical miracles involve less Hollywood-like episodic interventions on behalf of elderly patients, the chronically and incurably ill, psychiatric patients, and that particularly colorful stratum of society that shows up in the ED full of street drugs, hostile microbes, and intentionally inflicted wounds.

Don Berwick says CMS administrator is the best job he’s ever had, but he’ll lose it on December 31 unless the Senate confirms him by then. No confirmation hearings have been scheduled.

The New York Times covers telepsychiatry, where patients receive counseling sessions via Skype or specialized Web apps like Breakthrough.com. Says a psychologist, “In three years, this will take off like a rocket. Everyone will have real-time audiovisual availability. There will be a group of true believers who will think that being in a room with a client is special and you can’t replicate that by remote involvement. But a lot of people, especially younger clinicians, will feel there is no basis for thinking this.”

An OB-GYN subpoenas Bellevue Medical Center (NY), demanding a list of every person who accessed the Internet from the hospital on a particular day in 1999. The doctor is trying to find the person who posted defamatory comments about her on a physician review site, claiming she has reason to believe it came from a particular NYU doctor. The hospital says it keeps access logs for only 30 days, but the doctor’s legal team found a computer forensics expert who claims he knows a sophisticated (and undoubtedly expensive) way to bring back 12-year-old records.

E-mail Mr. H.

HIStalk Interviews Michael O’Neil, CEO, GetWellNetwork

Michael O’Neil, Jr. is founder and CEO of GetWellNetwork of Bethesda, MD.

Tell me about the company and about yourself.

GetWellNetwork is a company I started about 10 years ago after a personal cancer experience. We are really focused on one thing — helping hospitals engage their patients and families more effectively in their care. We truly believe that if we do that effectively, the outcomes will improve. This is a company focused on patient engagement. We’ve been doing it for a very long time.

Do you think patients want to be engaged or are they surprised that hospitals would treat them differently beyond just offering a TV in their room?

It really has been evolving pretty significantly over the time that we’ve been doing that. I think the tidal wave of information access for just general consumers — be it for a car you buy or a grocery store you shop in or the healthcare you receive — is so powerful now. To say it’s getting easy would be an overstatement, of course, but we are encouraged every day by how much patients are digging into the information that we provide and want to be involved in their care.

Most of the industry started as modest entertainment providers for antiquated hospital TV systems. How did you come up with the idea of taking the basic on-demand movies and Internet access product and turning it into a two-way communications and education medium?

We let the data dictate our direction. We did have that same core on-demand functionality early on in the company. We were watching the data come across. To be honest with you, the utilization was very low. Your question about do patients really want to be involved … early on, they really weren’t accessing the kind of information that we felt was important to them.

At that point, we were not integrated into the EMR and core systems. We didn’t proactively pull patients in — we let them come in themselves. We really began to change the game five years ago and created a workflow engine called Patient Pathways that lets us take triggers from existing systems and processes and invite the patient into the care process. It has changed radically the impact that we’re seeing.

From the hospital standpoint, the patient is a captive audience for education delivered directly to their rooms. Are hospitals finding that to be effective?

Yes, they are. All of the folks who read HIStalk and are part of this community are pretty bent on the fact that these hospital partners of ours are ferociously measuring whether or not any solution or process they try to implement is changing some of the measures of their care. For us, the measures that we look at are probably fairly natural ones. Does the patient’s perception of the care improve if they’re more involved? What do their HCAP scores look like? You know, pre and post-implementation of this kind of solution.

What do the quality metrics look like? The patients fall less because they’re more informed and involved and educated about the fact they’re at risk for fall. We are measuring data ferociously with our hospitals because they demand it and because we’re genuinely interested in whether or not this thing has efficacy. It’s been a really powerful last two or three years.

Are you seeing impact from healthcare hot topics like Meaningful Use, Accountable Care Organizations, and healthcare reform?

It has been such a powerful catalyst for our whole little industry segment. About a year and a half ago, KLAS picked up patient interactive as a segment, then Gartner picked it up. I would love for us to take credit for that, but we don’t.

We were yelling as loud as we could that patient engagement is a core strategy for performance improvement years ago. We found some incredible hospital provider leaders to take this thing on with a lot of risk. Over the last two years with all these things, Meaningful Use and value-based purchasing and accountable care, patient engagement has become front and center, something they have to do. It has been a great catalyst for us for sure.

Going back to the entertainment category, home TVs have turned into devices that handle everything from broadcast programming to video on-demand and Internet streaming. Is there a large penetration of systems like yours in hospitals, and for those hospitals that don’t have them, are patients disappointed at what’s available to them from their hospital bed for their five-day average stay compared to what they have at home?

Yes. What you just said is coming. The expectations of the consumer, the kind of technology and information access and empowerment in whatever they happen to be going through in a hospital course … there is increased demand to have the kind of access in any environment that consumers have at home or at work or at school. That is certainly is one thing that’s going on. Secondly, the technology to do the kind of things that we do. People expect it now. It’s certainly been a different ramp than it has been in the past.

Hospitals have finally started to take patient satisfaction more seriously. Are you seeing that drive your business?

They are. I applaud these hospital leaders. They’ve been pushing a rock up a very steep hill with wind blowing at their face for a long time. Transforming the patient experience that has been on people’s plates for a decade, but hasn’t always resulted in measured success.

Too often, this notion of patient-centered care was on a poster in a lobby, but there weren’t really solutions to hard wire the patient’s activation into the heart of the care process. That’s really what we’re after.

When we first started the company, the marketing folks at the hospital and the CEO would buy the solution and then throw it into the unit and hope that it would stick. Today, it’s completely different. It is the chief clinical officer, a CMO or a CNE alongside their technology counterpart the CIO, who are saying, “We’ve been charged to do performance improvement. We know patient engagement is an element of that. Let’s go find a solution to help do this in the organization.” It’s really changed 180 degrees for us.

Hospitals I’ve worked at looked at solutions like yours, but always decided they were a tactical “nice to have” that never bubbled to the top. Are hospitals finding that outcomes and the potential for process improvement make your product more strategic?

What you just said is exactly how we lived in this company for about four or five years. To see this kind of thing is to like it. It’s very visual. It’s very high-touch. It’s very patient friendly. We always joke in this company that we’ve never had a bad meeting. 

The fact is, we might have a great meeting and people like the stuff, but to your point, it would be number 12 on a list of 20 things to go invest time in and resources and money in. Too often, we would lose to no decision.

To your question directly, over the last 24-36 months, we are taking all the inbound requests for, “We have budgeted for a patient engagement solution. We look forward to having you come share the work you’re doing”  We lead every single time with, “You’re at 25, not three hospitals that are actually seeing a success. You won’t hear perfect, but you’ll hear that we’re moving the needle on these specific things we go attack.” That’s how we walk through it now.

The bad thing about your success is that you probably have more competitors than you had four or five years ago. What’s your message to tell prospects that your system is better than that of your competitors?

We are attracting competitors. We actually welcome that in one major respect. When we first started the company, we were competing with some of the traditional kinds of hospital TV companies. You asked the question earlier about that kind of functionality, and frankly, we really don’t care who the hospital buys their TVs from. It’s really not about that.

Today, more and more, we’re seeing competition from some of the large EMR companies who have seen this segment begin to grow and are coming at it as an appendage to the EHR and EMR. We’re more focused on how we compare and contrast ourselves with that approach. We feel pretty strongly that patient engagement is more important than just being an add-on to an EMR.

With the 10 years of data and experience and technology we have, we feel pretty confident walking into an environment and saying, “I know you’re going single source for lots of different solutions. When it comes to engaging your patients and families effectively in their care and working in partnership with your nurses, we think we’re doing the very best work in the world in that particular thing.”

Do you consider GetWellNetwork to be content provider or a technology provider?

We’re a technology provider. Most of our platform is based off this proprietary workflow engine. We have 273 live interfaces today across the country. We interface with bedside barcode systems and with RTLS systems and with EMRs and with the café cart in the lobby and the gift shops. We use all these other systems to trigger different events for that patient to engage and activate in. That’s really the technology that we have.

When it comes to content, we’re working with over 25 different content partners. We’ve aggregated tons of content, so that based on what we want the patient to engage in, we just need to make sure that we have the right content that we can put in front of them at the right time based on what the workflows are. It’s really more a technology company than it is a content company.

With the opportunities for education and hospital promotion and third-party ads, I would expect some natural interest in owning that content platform. Do you ever see that there would be a more exclusive partnership or an acquisition, either you acquiring or being acquired to actually control the content channel?

About three years, ago we spent a lot of time in R&D and decided to go attack a certain segment. We thought we could speed adoption by attacking a specific segment in a differentiated way. We did this in pediatrics.

One component of our four-component strategy was to exclusively partner with an organization to produce exclusive content for what we call GetWellTown. We partnered exclusively with KidsHealth, part of Nemours Foundation. They have subsequently produced a library of over 250 pediatric education titles for GetWellNetwork exclusively. It’s been a phenomenal partnership for them as well as for us.

I envision those kinds of things happening for us in different segments, to partner exclusively and/or acquire it if the right opportunity comes along.

GetWell@Home offers information via the Web, cable TV, and smart phones. There’s a lot of opportunity for non-hospital based chronic disease management. Do you think that’s a mechanism by which you’ll be able to get patients interested in managing their own health outside the hospital walls?

We do. I’ll tell you, it’s probably the most exciting thing going on here  on the development side right now.

We develop major new products in a task force model. Usually six or seven of our hospital partners are involved for about 18 months. Russ Branzell and the whole crew from Poudre Valley was heavily involved in our @Home task force. 

We recently launched with them at Medical Center of the Rockies and Poudre Valley Hospital. Our first patients haven been enrolled in GetWell@Home. They’ve done a powerful job in integrating the patient’s involvement, both from an acute standpoint at discharge and then following them home. Really inviting the patient to stay involved in the Poudre Valley Health System’s management of their care.

We never picture patients going to GetWellNetwork.com for their care. We are providing a platforms for those providers who have a trusting relationship to help patients navigate and keep them engaged throughout their journey. It’s been an incredible start this summer. We think this is going to be the most important thing the company’s done in the last five years.

In broadcast or cable TV, it costs a lot to run a specialized channel, but with satellite dishes, it costs very little. Do you see a point where the cost for a “channel” would be so low that you could add a channel specific to a diagnosis or a treatment, so that a diabetic patient could see The Diabetic Channel on GetWell@Home?

We’ve been thinking even more about that. We think not just about a specific channel on a certain diagnosis, but a specific channel for a specific patient.

We’re working a project right now. I can’t give you all the information, but you’ll be the first to know on HIStalk when you actually can announce it. We’re looking at not only using the Web, but also using cable TV delivery to be able to dynamically create personal video-on-demand TV channels for a patient to be able to track their health and to be involved. It will come in their living rooms even when they’re not on a computer.

We think the opportunity is so powerful to attack one of the biggest issues everyone knows, which is that transitions are just not handled very effectively for the patient or family. It’s no one’s fault. It’s just complicated, and we’re not doing a great job at that. We think we have an opportunity to engage people in a very unique way.

Do you think you’ll ever see the point where physicians can leave personal video messages for a patient or use your backbone as telemedicine virtual session platform?

The technology is available today to do that. The way it’s been started early on has been almost from the satisfaction standpoint right now, whereby we can make it very easy for a physician to have one more touch, if you will, with their patients or families. From a perception standpoint, the coordination of care is so, so powerful.

We definitely will move towards doing some more telehealth stuff down the line. We found right now that physicians, for the most part, aren’t yet ready to take that on. Technology won’t be the hurdle there. It really will be organizational readiness. I think it’s coming.

Where do you see the company’s future?

In two major directions. We spent the first eight years working inside the four walls of a hospital and inside the patient’s four- or five-day acute care stay. We see this as a true platform for patient engagement throughout their journey. We’re in the midst of building this platform that can really help providers in the accountable care model elevate the patient activation component of their strategy and really own the fact they can navigate people through them. 

In five years, we will be we will be working as much outside the walls of the building as we do inside.

The other thing that I think we’ll do pretty significantly is we have been asked about 12 or 15 times in the last year to consider doing some work internationally. We’ve held off on doing that just to make sure that we are fulfilling the promises that we’ve made here domestically. We seem to be getting a great handle around that now, so I think also in five years, we’ll be doing stuff around the globe, which we’re really excited about as well.

Any final thoughts?

What you guys do rocks. We read it all the time.  We can’t thank you for all the time and energy you spend doing what you do.

Time Capsule: The VA Outperforms Private Hospitals in IT Vision and Resolve

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 September 2006.

The VA Outperforms Private Hospitals in IT Vision and Resolve
By Mr. HIStalk

If you work in a non-government hospital, here’s what your patients are reading in this week’s Time magazine: Veterans Affairs (VA) hospitals are better than yours in satisfaction, quality, and technology. Their costs are going down while yours are skyrocketing. Elderly males treated in the VA system have a 40% less risk of death. You can only hope your ED patients don’t run out screaming to enlist in the military.

The article credits the VA’s advanced and fully-deployed information technologies, but commercial software vendors can’t gloat or take credit. The VA built the VistA system itself. It isn’t slick or technically impressive, but it works.

Like a tailor-made suit, VistA was developed to meet the VA’s needs, not those of a vendor’s “average” hospital customer. Just as hospitals talked themselves into buying instead of building (helped along by vendors and risk-averse CIOs,) the industry’s darling turns out to be a homebrew job.

The article pointed out the obvious: every hospital should match the VA in enterprise-wide longitudinal patient records and bedside bar-coding. Beyond that, though, is the implicit message that technology is a change enabler that requires significant process redesign to accomplish anything meaningful. Everybody hates to hear that because it moves the argument from “expensive” to “impossible in our culture.”

The VA didn’t go out and say, “Hey, let’s replace a couple of old systems with these we saw at HIMSS.” It didn’t hire a superstar CIO loaded with prejudices (positive or negative) formed by time spent elsewhere. It didn’t pander to making the “Most Wired” list. Earlier versions of VistA had been around for years before the VA mandated its full utilization. It took a strong, non-IT leader to drive home the mission to 200,000 employees. Information systems were involved, but it wasn’t an IT department project — not by a long sight.

Patients don’t care what tools you use. They care only about results. If your hospital is a good one, you’re probably already delivering fine care using whatever systems you have.

The bad news is for not-so-great hospitals — your IT checkbook can’t bail you out. Bad chefs don’t get better just by spending more on knives. Obvious, yes, but we seem to keep re-learning those lessons with big IT purchases that turn out to be a giant leap –sideways.

Technology’s failure to deliver isn’t usually a vendor or CIO problem, although it’s easy to make them targets. Once the software is up and running, it’s an organizational challenge, one often unfortunately dumped into the wrong laps. You can buy software as good or better than the VA’s, but your mileage will definitely vary.

Let’s give the VA its due. Against improbable odds, it managed to turn an underperforming government agency into an industry-beater, using a little bit of technology and a lot of vision and resolve. Miraculously, the VA did it while making both its patients and government bureaucrats happy. The VA has definitely raised the now-public bar for the rest of us.

News 9/23/11

Top News

The British government says it will “urgently dismantle” the failed $18 billion NPfIT project in favor of locally controlled initiatives after a series of gloomy reports from government auditors, with the final report released Thursday concluding, “There can be no confidence that the programme has delivered or can be delivered as originally conceived.” NHS will keep only the parts that work (e-mail, the appointment system, PACS, and the communications infrastructure). They also admit that the cost of getting out of various big-dollar contracts will probably exceed the cost of just paying out the rest of the money specified in the vendor contracts. The co-director of a patient advocacy group summarizes, “Thank goodness politicians have decided to stop money being poured into a huge bottomless pit. Now we must pray that they don’t sanction pouring it into endless incompatible regional pits.”

Reader Comments

From Steve Stifler: “Re: Epic UGM. Judy’s dreams of world domination are beginning to seem credible. Carl Dvorak was very clear that he doesn’t want videos of the meeting showing up in HIStalk and nobody wants Judy mad at them.” That’s Judy in costume above. Several readers sent over photos and links to unlisted YouTube videos from the meeting. I’ll be nice to Carl and Judy and not run them here, especially since they wouldn’t be all that interesting to anyone without an Epic connection anyway.

From Graying CIO: “Re: Epic UGM. This image says more to me than any other about the power and scope of Epic. Buses for the user group meeting attendees snake into the distance next to a two-acre hole in the ground that will be a future 10,000+ seat auditorium, replacing the 6,000-seat one that is too small. Others were struck by the image as well – I saw at least five people whip out their phones and take the same picture. The interesting thing about the executive overview (two hours of insight opened by Judy Faulkner and closed by Carl Dvorak about Epic, the healthcare IT environment, and Epic product development) is that it was positive and Epic is clearly on a growth tear, but that ICD-10 and Meaningful Use have drawn all of the focus and attention for the past few years and will continue to do so. Epic is responding well, but Carl was very clear that these topics have interfered with innovation both within Epic and by its customers.”

From CommunityHIZ: “Re: HP firing its CEO. I think this whole HP thing is a ruse orchestrated by Hammergren. This is kind of like Alabama thanking God for Mississippi every night before bed. With HP in shambles, nobody will focus their attention on Hammergren’s self-created mess at McKesson. (For those who don’t know, Hammergren serves on HP’s board).” More below, including my slightly critical evaluation of HP’s board (“the most inept board in America”) when they hired the guy not even a year ago.

From NoNeedHere: “Re: Accretive Health lawsuit. Juicy details in the legal documents.” A summary from the proceedings: revenue cycle management vendor Accretive Health hired an SVP over revenue cycle operations at four hospitals even though he had basically zero revenue cycle experience. He was fired and sued the company claiming sexually and racially discriminatory conduct by a mid-level supervisor, while the company said his work was substandard and hospitals were complaining about him. The district court found for the company and the US Court of Appeals affirmed the judgment in favor of Accretive on Wednesday. I’m blurring the names, although they’re in the public record if you really care.

From Larry Leisure: “Re: Sage. Unloads healthcare division. What a mess over there. I’m running for athena as fast as I can.” Thanks to Larry for e-mailing me about the announcement this morning just a couple of minutes after it came out. He probably knows that I like scooping everybody, which I believe I did in getting out a quick news blast since I happened to be at my desk at the hospital at the time. I actually think the news is good for the healthcare group. Let’s be honest, Misys and Sage shared more than their British heritage, financial software focus, and US EMR company ownership – they were never really all that interested in the US healthcare market other than for its potential to boost their predictable but unsexy profits. You’ve got to be kidding me that Sage’s CEO is blaming HITECH and healthcare reform for messing up its PM/EMR cash cow, especially when the unit booked a not-too-shabby 13.5% profit margin in the latest financial report (maybe the healthcare management team could do OK if it weren’t for the transoceanic shackles.) I can only interpret his statement to mean that once customers got a taxpayer-funded incentive to increase their EMR investment, they took the opportunity to look elsewhere. If I were a Sage Healthcare employee or customer, I’d be clinking the champagne flutes that the Brits are turning tail and letting the historically successful Vista Equity Partners take over the franchise, even though it’s likely they’ll be doing some painful but necessary cost-cutting (you can do the math: they’re paying about 1.4 times revenue or 10x annual profit, so a margin boost is needed to justify the price.) Your thoughts (anonymous if you like) are welcome since I’m just a cheap-seater here. What’s good about this deal, what’s bad, and what should Vista do?

From THB: “Re: McKesson vs. Epic. Are we back in court again for this? The issues the parties were asked to brief are: If separate entities each perform separate steps of a method claim, under what circumstances, if any, would either entity or any third party be liable for inducing infringement or for contributory infringement? See Fromson v. Advance Offset Plate, Inc., 720 F.2d 1565 (Fed. Cir. 1983).” This is the case in which McKesson sued Epic for infringing on its patent involving Web-based doctor-patient communication, such as for appointment and refill requests. The district court tossed that case out in April 2011, saying that McKesson couldn’t prove that Epic or any other single party performed all the steps in the claimed infringement by Epic’s MyChart.

HIStalk Announcements and Requests

The latest good stuff from HIStalk Practice: athenahealth and meridianEMR update their Meaningful Use dashboards. Mitochon Systems blasts fellow free EHR vendor Practice Fusion for its “over-reaching claims.” A whopping 90% of physicians say they use at least one social media site for personal use. Julie McGovern shares insights on software upgrades, compassion, and expectations.  Speaking of expectations, I expect you to sign up for HIStalk Practice e-mail updates when you take a peek at these stories. And thanks for reading.

Inga’s away schmoozing around at some conference, so the little red squares will be in scarce supply today. She will be back by the time you read this.

Listening: Opeth, genre-bending progressive metal from Sweden. Not for everybody, but I like it.

We like readers signing up for our e-mail blasts, connecting with us on Facebook and LinkedIn, sending us rumors, and supporting our sponsors. Since you are smart, we will trust you to take that subtle hint.

On Healthcare IT Jobs: Epic Applications Systems Analyst – Ambulatory, Data Warehouse Architect, Business Intelligence Developer, Epic Beacon Consultant.

Welcome to new HIStalk Platinum Sponsor MedAssets of Alpharetta, GA. The company provides solutions for revenue cycle (patient access, charging coding, UM, billing, A/R management, etc.); supply chain management (contracting, sourcing, inventory management, distribution, A/P); resource management (decision support, performance analytics, process improvement, workforce solutions), and consulting services. Their elevator pitch is easy to understand – they will sustainably improve provider operating margins by 1.5% to 5%. Case studies on their site include Fletcher Allen Healthcare ($12 million in benefit from contract management improvements and  data-supported contract renegotiations), Cooper University Hospital (reduced A/R days from 60 to 37 and added $43 million to the bottom line), and Westchester Medical Center (identified $8.9 million in supply chain savings by using analytics to examine costs right down to the individual screws used in orthopedics). Note and appreciate their non-animated ad. Thanks to MedAssets for supporting the constantly clacking keyboards of HIStalk.

Acquisitions, Funding, Business, and Stock

The bumbling HP board fires its equally bumbling CEO Leo Apotheker after 11 ugly months on the job, hiring former eBay CEO Meg Whitman to replace him. Apotheker, the third fired HP CEO in six years, gets a $25 million parting gift to go away. SAP canned him after only seven months before HP inexplicably brought him in on a golden throne, so he raked in dozens or maybe hundreds of millions in his total two-company CEO tenure total of 18 months. I said this when HP hired him in October 2010:

Speaking of SAP, HP and “The Most Inept Board in America” choose the former CEO of SAP to be HP’s next CEO. SAP fired the Germany-born Leo Apotheker after a disastrous seven months as CEO, although some say he was the scapegoat for a terrible company strategy that predated him. HP is paying him like he’s a star: $1.2 million in salary, incentives of 200-500% of that with $2.4 million guaranteed, $72 million in options, a $4 million signing bonus, and $4.6 million in moving expenses (that’s a lot of U-Hauls). I’ll go with the summary of Oracle CEO Larry Ellison: “I’m speechless. HP had several good internal candidates … but instead they pick a guy who was recently fired because he did such a bad job of running SAP.” Their pre-Hurd CEO pick was an ultra-expensive termination, too: HP’s value dropped in half after Carly Fiorina orchestrated the company’s merger with Compaq. She was let go in an ugly fight about the time the company admitted that it spied on the personal phone records of journalists and its own board members trying to find out who was leaking information about its strategy.

Sales

Ellenville Regional Hospital (NY) selects Craneware’s Chargemaster Toolkit-CAH solution to atuomate its charge master management process.

The University of Texas MD Anderson Cancer Center chooses MedQuist’s Speech Understanding and Natural Language Understanding platform from M*Modal for its ClinicStation EMR and RadStation radiology systems.

Swedish Medical Center (WA) signs for Microsoft Amalga for coordinating care and managing populations.

Announcements and Implementations

Biggs-Gridley Memorial Hospital (CA) will go live on the Prognosis ChartAccess EHR in January.

The Gorge Health Connect (OR) HIE creates a video that shows how it’s using the government’s Direct Project (via Medicity) to connect providers in a pilot project.

Vodafone signs a deal with NantWorks to develop mobile healthcare services. That’s the new name for the technology companies owned by Patrick Soon-Shiong, the physician and drug company founder whose $7 billion net worth earns him the #39 spot on the Forbes list of richest Americans.

Innovation and Research

A study published in Health Affairs finds that the Meaningful Use Stage 1 hospital CPOE threshold of 30% of orders probably won’t have much impact on heart-related Medicare deaths, but the proposed 60% Stage 2 threshold should be enough to move the outcomes needle.

David Bates will lead a team of researchers from Brigham and Women’s Hospital in using supercomputer-powered analysis of the hospital’s EMR data to look for complex correlations among patient characteristics, genetics, drug interactions, and outcomes of heart failure patients. They hope to create computer models that can help choose effective heart failure interventions.

Other

Beacon Partners’ ACO Readiness Study finds that only 15% of healthcare organization respondents are “very familiar” with ACOs and 61% say they are “somewhat familiar.”

Speaking of ACOs, providers view Cerner and Epic as the vendors that are most ACO ready. 

St. Rose Hospital (CA) is cutting 10% of its workforce due to problems that include “complications involving a new McKesson computer system that went live in late June, the recession’s impact on the hospital’s fragile bottom line, and managed care contracting snafus, including a two-week period in July when ‘we were not able to get bills out,’ [CEO] Mahoney said.”

Former National Coordinator David Blumenthal, now back at Harvard, talks up EMRs at a Boston event. He talked about his own long-ago personal experience with EMRs, although I’m never clear what kind of practice he had or whose EMR he used. Some of the docs in audience apparently made negative comments about time required to use the EMR. One said, “The computer is really like that third person in the room, and a 2-year-old at that. It’s hard to manage” Blumenthal urged patience, saying, “The current crop of products is not the crop we will have in five years. However, we will be just as unhappy with the crop we have in five years because our imaginations will soar ahead of reality.”

University Medical Center (NV) lost $70 million last year, but the CEO says he thinks next year’s move to electronic medical records will save money in the form of reduced labor costs and errors.

Sponsor Updates

• Indiana University Health Bloomington and Paoli Hospital go live on McKesson’s Horizon Patient Folder electronic document management system.
• Greenway Medical Technologies announces that its PrimeSuite EHR client, Alpine Urology, is the first practice to connect to CORHIO’s HIE. 
• The Pittsburgh Technology Council awards TeleTracking Technologies its Tech Titan MVP award.
• TeleTracking’s user conference will be held next month in San Diego.
• MEDSEEK announces GA release of Quick Response Codes to facilitate the patient marketing programs of hospitals. 
• Anesthesia Business Consultants and iMDSoft announce their partnership to offer a complete AIMS and anesthesia billing solution.
• Joan Coner of maxIT Healthcare is recognized in Strathmore’s Who’s Who Worldwide Edition for her 20+ years of contributions and achievements in healthcare consulting.
• Orion Health announces receipt of ONC-ATCB 2011/2012 certification of its Clinical Portal V7.0.
• Covisint releases a new whitepaper entitled Performance-Based Care for Accountable Care Organizations.
• MediServe clarifies newly announced changes to Medicare Part C Advantage plans.
• GE Healthcare will introduce an HIE in Australia. 
• The Rothman Institute  (PA/NJ) selects the SRS EHR for its 100-provider, 14-location practice.
• Michigan Health Information Network Shared Services engages OptumInsight for its HIE platform.
• Central Penn Business Journal names MEDecision to its list of 100 Best Places to Work for the third straight year.
• MD-IT announces the addition of Quality Transcription Services to its Medical Transcription Service Organization Associate program.

EPtalk by Dr. Jayne

Lots of folks are talking about the recent Department of Health and Human Services plan that would allow patients direct access to their laboratory test results. The proposed rule involves three HHS agencies: CMS, CDC, and the Office for Civil Rights.

Changes to the Clinical Laboratory Improvement Amendments (CLIA) are required to allow this. Patients would be able to receive copies of their lab reports on request. When faced with patients receiving lab results directly (as opposed to receiving them from their physician or another health professional), many physicians react negatively.

The consumerization of healthcare has had profound impacts on how care is delivered. Patients are better able to participate as a member of the healthcare team, which is good. However, the potential impacts of releasing lab (or any other diagnostic testing) data directly to patients should not be overlooked.

These are not uncharted waters. Many health systems already release data directly to patients, often after a delay of a day or two to allow the ordering physician to review the results and contact the patient. Others release results only after the ordering provider has signed off, again presumably to allow a conversation with the patient where needed.

Physicians worry that direct release of lab data to patients (particularly without annotation) will generate a flurry of phone calls. Before I used an EHR, I would mail each patient a copy of their lab results with my notes / comments / care plan written directly on the results. It was efficient and made for clear documentation in the chart. The occasional “abnormal” result of no significant consequence was simply marked “OK,” and 99% of patients did well with this approach. Of course, there was always the occasional patient who would call wondering if their low chloride level (one point below cutoff) was a health concern, despite the “OK.”

Radiology reports are a little trickier. Narrative reports are sometimes less clear and informative, particularly if you deal with (as I have lately) a radiology group that refuses to definitively address what they see and instead dictates a jumble of “might be” and “can’t rule out,” punctuated by the always-present “clinical correlation needed.”

My health system releases both lab and radiology reports to the patient through a secure portal, but only after a time delay. Depending on the nature of the test, the delay is shorter or longer. For example, blood tests such as cholesterol levels are released after a day or two, but CT and MRI scans are held for seven days. This gives us time to contact patients about their situation before they see the results.

Since we’ve been doing this, I’ve had several patients who had significant concerns about what they’ve seen on their reports. Many patients, even after they’ve heard from the team about their results or changes to the care plan, head straight to Google to find out what all those big words mean. What they see sometimes leads to panic and fear.

When patients in this situation call, my recommendation is to add them on to the schedule same-day or as soon as possible. Unfortunately, talking about it on the phone lacks the face-to-face reassurance that patients often need. If they come in, I can pull up the films and we can review them together along with any Internet articles they’ve been reading. The visit is reimbursable and provides an additional opportunity for health counseling or disease management education.

It will be interesting to see how lab vendors decide to handle this. Most will probably go with online patient portals, I’d guess. Depending on how often your insurance carrier or provider changes lab vendors, this could lead to multiple places where patients have to access their data over time, assuming they decide to provide the information in an ongoing fashion vs. a one-time release.

Do you work for a laboratory provider? How is your organization planning to address this? E-mail me.

Contacts

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

Sage Healthcare Sold to Vista Equity Partners

Sage Group PLC will sell its Sage Software Healthcare unit to private equity firm Vista Equity Partners for $320 million in cash, the British company announced this morning. The sale is expected to be completed in November.

Sage CEO Guy Berruyer said in a statement, “The sale of Sage Healthcare allows management in the North American region to focus on the considerable opportunities that exist within our core U.S. customer base.”

He was also quoted as saying, “When we bought this business, we could not have predicted that the Obama administration would change the market in the way it did. This business was contracting and it had moved away from our core strategy. Our North American business has been performing less well overall. Selling the healthcare business will allow our US team to concentrate on our business priorities again.”

Sage said it will take a loss of up to $108 million on the sale of the former Emdeon Practice Services, which it acquired for $565 million in August 2006. In the most recent six-month reporting period, the healthcare division earned profits of $15 million on revenue of $111 million.

Readers Write 9/21/11

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!

EMR Usability and the Struggle to Improve Physician Adoption
By Todd Johnson

Now that Meaningful Use money is up for grabs, almost every US hospital is somewhere down the pathway to deploying at least a Stage 1-certified EMR. Once installed, the tab on many of these systems can run as high as nine figures. For that kind of coin, every user in every department should see their daily workflow improve dramatically. Yet industry-wide physician adoption of hospital EMR systems continues to fall short of expectations.

For many users, the source of frustration is the clinical documentation system they’re asked to use. In theory, these tools are designed to make physicians’ lives easier. But too many documentation systems compromise the usability of the EMR for its most important users.

Not surprisingly, physicians resist changing the way they work to use tools that don’t solve their daily challenges. They stick with familiar workflows – even cumbersome tools such as pen and paper – to capture the details of patient encounters. And they leave it to the hospital to figure out how to extract the data they need.

The net result: physicians end up engaging with the EMR as minimally as possible. Without timely and comprehensive involvement from a significant percentage of physicians, an EMR system cannot help hospitals achieve their clinical, financial and operational improvement goals.

Determining the “usability” of an EMR is less subjective than it sounds. Here’s how usability is defined in the HIMSS Guide to EHR Usability:

• Usability is the effectiveness, efficiency, and satisfaction with which specific users can achieve a specific set of tasks in a particular environment.
• Efficiency is generally the speed with which users can complete their tasks. Which tasks and clinic processes must be most efficient for success? Can you establish targets for acceptable completion times of these tasks?
• Effectiveness is the accuracy and completeness with which users can complete tasks. This includes how easy it is for the system to cause users to make errors. User errors can lead to inaccurate or incomplete patient records, can alter clinical decision-making, and can compromise patient safety.
• User satisfaction is usually the first concept people think of in relation to “usability.” Satisfaction in the context of usability refers to the subjective satisfaction a user may have with a process or outcome.

Each of these components is measurable. Even user satisfaction, while highly subjective, can be measured through user queries. Yet even with an objective framework of EMR usability, physicians continue to suffer through documentation tools that often fail to meet any of these criteria.

Clinical documentation has become a victim of its own exploding popularity. Thanks to Meaningful Use and other technology-driven initiatives, the value of the data found in clinical notes has skyrocketed. Hospitals now have more incentive than ever to deploy systems that capture, aggregate and transfer data as efficiently as possible.

As the point of entry for a majority of patient information found in the EMR, electronic physician documentation has the added burden of converting notes into usable data. But too often, HIS solutions attempt to solve this problem by delivering electronic documentation that migrates all users to a single, inflexible workflow. Rather than accommodate multiple data entry methods and adapt to user preferences, physicians must instead learn to navigate drop-down menus, check boxes, and other pre-defined selections to complete their documentation.

A one-size-fits-all approach to documentation is shortsighted for two reasons. First, “narrative” shouldn’t be a dirty word in the electronic documentation workflow. A comprehensive patient record is much easier to achieve through a blend of structured and unstructured data input. Certain types of notes, such as H&Ps, benefit from the physician’s ability to capture all details of the patient encounter in his or her own words. Elements with repetitive values, such as lab results and vitals, benefit from structured input – even better if these values automatically carry forward daily.

Second and more important, we can’t lose sight of the fact that we’re asking physicians to alter a very important – and very personal – part of their jobs by asking them to use new clinical documentation solutions. Workflow flexibility is crucial to achieving user satisfaction. Narrative-based capture methods such as dictation remain popular because they’re easy to use. Forcing users to modify their behavior and abandon familiar workflows – to “document to the system” – is a recipe for continued lackluster physician engagement with the EMR.

Ultimately, a truly user-friendly advanced electronic clinical documentation system should empower users to document however they’re comfortable without compromising speed, accuracy, data availability, and overall productivity. The specialized technology solutions are in place to make that possible.

Modern speech recognition and transcription systems can convert dictated narrative to structured data. Universal interoperability standards such as HL7 Clinical Document Architecture (CDA) enable that data to integrate seamlessly into the EMR, regardless of which best-of-breed physician documentation solution you’re using.

The only way to know we’re achieving the right balance of structure and narrative is to let the end users guide the design of the finished product. By achieving high rates of physician adoption, hospital CIOs and other stakeholders can finally focus attention on other priorities.

Todd Johnson is president and co-founder of Salar of Baltimore, MD.

Is ONCHIT About to Chase the Clouds Away?
By Frank Poggio

My sincere apologies to Chuck Mangione. For our younger readers, Chuck is a great French horn jazz musician from the 70s. His signature song was Chase the Clouds Away. Now back to ONCHIT.

Cloud computing is the latest systems deployment panacea. In the recent past, it was referred to as SaaS (Software as a Service), and before that, remote hosting. The word ‘cloud’ clearly has a better visual impact. Cloud computing runs all your data and applications at a remote facility, giving the user many advantages such as built-in redundancy, reduced capital investment, effortless backups, better integration with many other Web services, and faster and simpler delivery of updates and fixes.

One of the core elements of the ONCHIT certification process and the Meaningful Use attestation requirements is that a provider must run certified software. The certification must tie back to a vendor’s specific version and build. Directives from two of the current ATCBs state:

CCHIT: If you modify or update your CCHIT Certified product in a manner that carries a significant risk of affecting compliance, you must follow this procedure. Before marketing the modified or updated product as CCHIT Certified, you must apply for re-testing of the product to verify continued compliance with all published criteria and Test Scripts.

Drummond: If changes are made to the Drummond Certified EHR product, you must submit to Drummond Group an attestation indicating the changes that were made, the reasons for those changes, and a statement from your development team as to whether these changes do or do not affect your previous certification and other such information and supporting documentation that would be necessary to properly assess the potential effects the new version would have on previously certified capabilities.

If you sell and install a certified full EHR or EHR module, you must at minimum notify the ATCB with each new version or build so that your previous certification gets inherited to your new update or release, preferably before you send it out to your client base.

Turnkey system vendors (do they really fly above the Cloud?) would send out two or three updates during the year, with perhaps one being a major release. If there was an emergency fix needed for a specific client, they might send that out separately. Clearly the update notice to the ATCB should happen before you would send the fix out, but in an emergency situation if the impact was to only one or a few clients, you could send it out just to them and notify and re-certify later.

The same would be true for any special enhancements. Say a new customer requires a specific enhancement as part of a new install contract. For the period your client is running the enhanced software, that version or build would not be deemed certified. This means they could not use your package to attest to MU. But it’s only one client, and if you are a best-of-breed or niche vendor, it may not matter to that client since they might be able to cover the MU criteria with other vendor-certified products. A good example is with the ONCHIT demographic criteria. This requirement could be covered by several EHR modules.

Lastly and most importantly, the assumption is that your updates or fixes do not impact any certification criteria. At this time, how ‘no significant impact’ is defined and determined is left to our imagination, but starting next year it will be a question that must be tackled by the ONCHIT AA surveillance auditors.

Meanwhile, back in the Cloud, it gets little more complicated. As noted before, one of the real advantages of the SaaS approach is that the user never has to load updates. They are handled centrally. One load and all clients are running the new code. Back to our example where a new client contracts for a special enhancement or a fix is needed — you code them, load them, and go. Everybody has access to the new enhancement and everybody is now running a non-certified system. Ouch!

The simple solution, of course, is to make your new customer wait for a full version release, or in the case of a fix, require a workaround until you get re-certified. Either way, ONCHIT has succeeded in turning the clock back to those Neanderthal days of legacy and turnkey system releases.

Cloud vendors who are ONCHIT certified will really need to rethink that load-and-go approach.

Frank L. Poggio is president of The Kelzon Group.

Interoperability? But of Course!
By Cheryl Whitaker, MD

An HIStalk reader, Rusty Weiss, recently wrote about interoperability (Is Healthcare Interoperability Possible With a Conflicted Federal Committee?, 9/14/11.)

I am not writing to comment on the appointment of Epic’s Judy Faulkner to the Health Information Technology Policy Committee. I am writing to endorse the concept of interoperability. 

In his article, Weiss states, “Democrats, Republicans, and industry experts alike recognize the importance of interoperability.”

Amen. It’s logical that we move to a model in which health information systems talk with each other. I concur that by “tapping into ‘big data,’ there will be opportunity to learn more from existing information – and to make healthcare more effective and less expensive.”

Weiss also states, “By allowing patients to carry their health information across provider lines as easily as we want them to carry their health insurance across state lines, we will empower patients. In fact, one of the stated goals written into the Recovery Act was the development of ‘software that improves interoperability and connectivity among health information systems.”

Weiss goes on to quote Otech president Herman Oosterwijk,  who says, “The entire industry is 15 years behind in interoperability compared with PACS systems.”

PACS solutions were early in the landscape of healthcare’s adoption of electronic information exchange. However, let’s be clear. Diagnostic imaging is far from superior in the context of interoperability. Visit a doctor’s office and you’re likely to see a patient carrying his or her own images burned onto a CD. Ride in a ambulance with a trauma transfer and you’re likely to see a CD strapped to the patient or the stretcher. 

When it comes to exchange of diagnostic images, the inefficiencies are horrific. The room for error is frightening.

Weiss quotes Andrew Needleman, president of Claricode Inc., who says, “Due to the amount and complexity of data being transmitted between systems, even systems that attempt to be interoperable run into issues when they send data to other systems. For healthcare data, even the demographic data to determine if you are talking about the same patient is complex.” 

Consider the realities of diagnostic imaging: 

• Healthcare organizations generate nearly 600 million diagnostic imaging procedures annually.
• Based on a study of data from 1995 to 2007, the number of visits in which a CT scan was performed increased six-fold, from 2.7 million to 16.2 million, representing an annual growth rate of 16%.
• One CT scan exposes a patient to the same amount of radiation as 100 chest x-rays.
• $100 billion of annual healthcare costs are related to diagnostic imaging tests – but an estimated 35% ($35 billion) represents unnecessary costs for US patients and insurance providers.

PACS solutions facilitate electronic image management. But these are proprietary, closed systems that do not allow providers to easily share information between departments and entities, and also across "ologies." Exchanging images outside of a "system" is difficult if the two facilities have different PACS vendors.

To solve this challenge, some entities have added solutions to morph imaging studies so they can be viewed on a receiving system. Until recently, this has required the implementation of specialized hardware and software and costs that were not sustainable.

We continue to see patients carrying their images around on CDs. Yet according to a January 2011 article in the Journal of the American College of Radiology, Johns Hopkins researchers found that approximately 60% of respondents said most images provided by patients on digital media were unreadable or not importable.

With today’s movement toward ACOs and medical homes, new approaches are needed. An enterprise imaging strategy must focus on providing access to any type of image, anywhere, any time, by anyone – provider, referring physician, radiologist, patient, etc. – across the continuum of care. This vision goes beyond PACS to make image sharing truly interoperable and accessible in real time on any device, without having to load and support additional software and without complicated and unnecessary movement of data. Image-enabling the EHR is also critical.

Three components are required for the move to a truly interoperable imaging environment: a standardized vendor-neutral archive (VNA), an intelligent digital image communication in medicine (DICOM) gateway, and a universal viewer that can be accessed via an embedded link or a standalone portal that enables viewing of images on any browser-based electronic device.

This technology exists. An organization can readily start with just one of the components, then build toward a more robust enterprise solution. There is no wrong door for entry.

Today’s most progressive organizations are embracing enterprise imaging, saving time and money, reducing unnecessary radiation exposure, and improving quality of care.

Healthcare data is voluminous and complex. Regulatory demands seem daunting.  Other industries, however, have adapted to a multitude of “data pressures.” Banking, for example, has been successful with leveraging federated data models to enable cross-organizational transactions via ATMs. 

The time is now for healthcare to create exchanges that allow EMRs, HIEs, and PHRs to access content and results from any location without moving data. We should empower patients, providers, and payers to manage the total healthcare experience from computers, mobile devices, and new types of access points, including kiosks.

Cheryl Whitaker, MD is chief medical officer of Merge Healthcare of Chicago, IL.

News 9/21/11

Top News

Aetna, Humana, Kaiser Permanente, and UnitedHealthcare will pool five billion medical claims records in a data mining initiative to identify trends in cost, utilization, and intensity of care. Beginning in 2012, the not-for-profit Health Care Cost Institute will combine 11 years’ worth of records from the carriers, publish scorecards, and support analysis of aggregate trends to qualified researchers.

Reader Comments

From Wilbur: “Re: Aventura. Did you already get this? You interviewed Howard Diamond for the HIStalk Innovator Showcase. Really neat company, people, and technology.” Denver-based Aventura HQ, which offers a clinician front end for EMRs and other systems, raises $13 million in its first round of institutional vendor funding. I profiled the company in late July. Wilbur isn’t a shill, by the way – he sent this non-anonymously and he has no vested interest in the company (nor do I.)

From Elane Twofer: “Re: UPMC electronic medical records alteration. I’m puzzled why that is central to peer review. Mr. HIStalk, please provide some advice and your wonderful wisdom.” The trial begins in Pittsburgh of a lawsuit brought by a deceased patient’s family against UPMC Presbyterian (PA). The family claims that doctors caring for a 62-year-old inpatient failed to note in his electronic medical record that he would be difficult to intubate. He experienced respiratory distress, exacerbated by a nurse who inappropriately gave him a tranquilizer to calm him down, and doctors could not establish an airway. He died. The family’s attorney says UPMC’s EMR transaction records show that its head of quality assurance tried to add a red-letter “Dif Intub” warning to his EMR three days after he died. The hospital says the entry was for peer review purposes rather than to favorably falsify the records. I know this reader and I believe the hope is that I’ll expound against EMRs from this example, but I’ll take the opposite approach. I’ve been on various hospital committees (death, tissue and transfusion, etc.) and I’ve seen first hand paper charts that were falsified after the fact by doctors and nurses to cover their butts after making mistakes that harmed patients. It wasn’t hard to suspect they did it (the handwriting was clearly different, the change was present only on the original order and not the copy, etc.) but hard to prove. If the family is correct, UPMC’s own electronic records will provide the inarguable evidence. Score: EMR 1, paper 0. I’d like it even better if standards were in place that would physically protect all electronic documentation transactions from database-level changes, journaling every entry, change, and deletion as a permanent record that even IT uber geeks could not destroy.

From Ludmila: “Re: NJ chapter of the American Academy of Pediatrics. Apparently there’s about to be a blowup over its PCORE (Pediatric Council on Research and Education) section accepting money related to referring practices for HITECH, which it isn’t allowed to do as a 501(c)(3) corporation.” Unverified. I e-mailed the organization and received no response.

From Sepulchre: “Re: Meaningful Use. Frequent reader, first time I’m posting a question. No one has been able to answer this. In getting your ‘certified’ system and achieving MU, what happens if the user decides to change vendors? During that kind of transition, you would expect your reporting on objectives could be impacted and you might not meet them for the year. Do you incur penalties from Medicare during that time? Seems like a great setup for vendors. Once you use them and achieve MU, you must keep using them to avoid penalties.” Hopefully my really expert readers will weigh in.

From Reluctant Epic User: “Re: McKesson ad. Do you think they’re struggling in the large hospital market because their marketing department thinks people are still running Pocket PCs?” I like the irony of the “Better Technology” headline right beside some old and not-so-good technology, but their problems are more related to Horizon than what it runs on.

From Space Ghost: “Re: newsletter. Writing headlines must be a tough job.” The mistake is especially notable since it came from Government Health IT, whose parent company has HIMSS (or HIMMS, if you prefer) as a majority owner. The correct spelling is obviously the first word of the article, so someone went out of their way to screw it up.

Acquisitions, Funding, Business, and Stock

Practice Fusion announces that it has received over $6 million in additional funding from several new investors, including Western Technology Investment (an early Facebook investor) and Scott Banister (Idealab, IronPort.)

EMR vendor SuccessEHS acquires the MediaDent practice management, electronic dental record, and dental imaging solution from MMD Systems. SuccessEHS will offer the integrated solution to Community Health Centers, including the 190 that are already its customers. 

Transcription vendor MedQuist raises guidance and announces a $25 million stock repurchase program following its recent acquisitions of M*Modal, All Type Medical Transcription Services, and JLG Medical Transcription Services.

India-based technology vendor Wipro says it’s looking to acquire US-based health and life sciences companies, especially those with analytics and mobility products and companies involved in revenue cycle management. Wipro also says it will benefit from ICD-10 conversions as US work is offshored to India and the Philippines.

The Advisory Board Company launches its new logo and Web site, which emphasize its research work plus newer offerings that focus on technology applications and healthcare support. An interesting history of its logo over the years says it started as a drawing of the townhouse owned by the founder’s mother (the company’s first headquarters, in 1979), followed by the Jefferson Memorial-related logo that was used for 20+years, then finally the new version that’s based on a revolving bookstand designed by Thomas Jefferson to allow him to check multiple references at once, a prototype of the database (which also happens to look like the letter A.)

I keep forgetting that The Advisory Board Company is publicly traded, so here’s how shares have done over the past couple of years compared to the S&P 500 (green) and Nasdaq (red). An ABCO share bought for around $25 two years ago would be worth over $60 today.

People

Meditech announces that family physician Steven Jones, MD will join the company to act as lead its EHR development efforts. He has served on the company’s Physician Advisory Committee.

MedAssets reports in an SEC filing that Neil Hunn, president of revenue cycle technology, is leaving the company to pursue “other career opportunities.” He joined the company in 2001, was promoted to RCT president in January 2011, and leaves with $570,000 in separation pay. Meanwhile, Greg Strobel (above) moves from president of the revenue cycle services business to president of the MedAssets RCM segment.

Bayhealth Medical Center (DE) names Lynn Gold as senior director of information services and telecommunications. She was previously with GE Healthcare.

Announcements and Implementations

Mobility is here to stay. It’s tactical in a sense because it is a device that allows people to do their work differently. Physicians and other clinicians are falling back into workflows that are natural to the work they are doing. They were forced out of that workflow with the advent of technology 25 years ago when they would have to go somewhere to log on to a PC. They had almost forgotten that they used to do rounds at the bedside. Now it’s conceivable and practical for them to be able to do that. The patients feel a higher level of engagement because of the tools.

Ophthalmologists at a UK hospital work on OpenEyes, an open source ophthalmology EMR.

Government and Politics

HHS’s Text4Health Task Force issues recommendations to HHS regarding text messaging and mHealth apps: a) develop and host evidence-based health text message libraries and make them available to the general public; 2) develop further evidence on the effectiveness of health text messaging programs; and, 3) explore partnerships to create, implement, and disseminate health text messaging and mHealth programs. 

In Australia, Queensland Health is negotiating with Cerner for a $249 million (US) hospital clinical systems contract, with the opposing political party claiming that health officials changed an independent report to give Cerner an edge and that the technical information Cerner provided was inaccurate.

Senior executives and physicians from Ireland are visiting the VA this week to learn more about its VistA system.

A newspaper article says patients are somewhere between surprised and offended at being asked for their ethnicity and race during physician visits, newly required by the Affordable Care Act. An ophthalmologist says many patients cross out the “race” question and one patient answered “the Boston Marathon.”

Innovation and Research

Researchers in Spain are working on a “garment-based patient biomonitoring platform,” or smart shirt, that will monitor vital signs and patient location.

AHRQ offers guidelines for future and current EHR users on avoiding unintended consequences. Credit to Joe Conn of Modern Healthcare, whose article about this came up in an unrelated Google search I was doing.

Texas Heart Institute releases a free iPhone and Android app to train medical students in auscultation (listening to the heart). It was developed by James Wilson MD, director of cardiology education.

Technology

I ran across this interesting (and free) tool. Chatter is like a private, secure, and hosted Facebook, a social network for businesses that allows co-workers to push out updates, share files, and solve problems. Signup for the hosted app requires only a company e-mail address, and the network is private to users within that domain. Clients are available for iPhone, iPad, BlackBerry, Android, and the desktop. It’s owned by Salesforce.com.

An article on MIT’s Technology Review profiles speech recognition software in healthcare, specifically Nuance’s Clinical Language Understanding.

Other

Posted on Twitter:  a picture of the opening session at Epic’s user group meeting. The poster notes, “This is a big auditorium!” Epic is expecting 11,500 attendees, including 6,500 customers, for the four-day event in Verona. Another tweet from a Stanford University physician: “35-45% US pop covered by Epic EMR, 2% of world pop covered, $92 billion in claims in 2010!”

Here are more Epic UGM photos from a reader. Thanks for sending them over. Above is the lunch tent built for the conference. They’re offering horse carriage rides and bikes for exploring the back trails. The theme is “Once Upon a Time” and attendees were invited to attend Tuesday’s opening session in musical costume as Judy was to do (I’m thinking Ziggy Stardust drag or Insane Clown Posse makeup). Your updates and photos are encouraged.

The American Nurses Association signs on as partner in Care About Your Care, a healthcare wellness awareness initiative supported by the Robert Wood Johnson Foundation, AHRQ, and ONC.

In what are believed to be the harshest prison sentences ever for Medicare fraud, a federal judge orders 50-year and 35-year sentences to American Therapeutic co-owners Lawrence Duran and Marianella Valera. The company billed Medicare for over $205 million in claims over eight years for mental health services that were either not required or never provided to patients. They were ordered to pay $87.5 million in restitution.

The Honolulu Police Department tries to figure out how to bring criminal charges against one of its officers for posting a hospital bed photo of a suspect on Facebook. The patient had been badly burned while trying to steal copper wire, giving the officer creative inspiration for the Facebook caption, “See when you like steal copper.”

Sponsor Updates

• A 12-member GetWellNetwork triathlon team led by CEO and Founder Michael O’Neil raised $36,000 for The Leukemia & Lymphoma Society in The Nation’s Triathlon in Washington, DC on September 11, 2011. The team’s donations led all national participants as it honored the memory of Justin Thorton, who died of leukemia at 19 earlier this year.
• 3M partners with Clinical Architecture to offer 3M Healthcare Data Architecture, a terminology-mapping interoperability and data standardization solution.
• Iatric Systems adds a clinical quality measure component to its Meaningful Use Manager product and earns expanded ONC-ATCB certification.
• CynergisTek and Diebold will partner to showcase their “Smart Hospital” security model at The Healthcare Facilities Symposium and Expo September 20-22.
• Alan W. Portela, CEO of AirStrip Technologies Inc. will participate as a panelist at the AdvaMed 2011 MedTech Conference September 26-28.
• API Healthcare partners with Role-Based Practice Solutions to track, manage, and develop professional role competencies.
• Colette Weston of ADP AdvancedMD provides a 5010 transactions update based on progress by AdvancedMD and partner RelayHealth.
• CaroMont Health (NC) selects RelayHealth to facilitate HIE among the hospital, employed physicians, and affiliated physicians.
• Healthwise SVP Molly Mettler will moderate a panel discussing shared decision-making at the World Congress Leadership Summit September 22-23.
• Highline Medical Center (WA) selects Wolters Kluwer Health’s ProVation Order Sets for its healthcare campuses and 20 clinics.
• Prognosis HIS clients Parkview Hospital (TX), Stonewall Memorial Hospital (TX), and Throckmorton County Memorial Hospital (TX) qualify for MU incentive funds using the ChartAcess EHR.
• Monongahela Valley Hospital signs a multi-year agreement to use Thomson Reuters Micromedex solutions for evidence-based clinical reference information.
• EHR Scope reports that its free online service EMRConsultant.com has made over 5,000 referrals so far in 2011.
• NYU Langone Medical Center establishes the Joan H. Tisch Center for Women’s Health, which will incorporate Epic’s EMR technology and palm scanning identification from PatientSecure.
• Allscripts is named a finalist for the Chicago Innovation awards.

Contacts

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

HIStalk Interviews John Gomez, CEO, JGo Labs

John Gomez is CEO of JGo Labs.

We haven’t talked for some time. Let’s start out with the obvious question. Why did you leave Allscripts?

There isn’t really a deep dark reason I left. There really isn’t a juicy back story. After almost eight years, I didn’t feel I could make the impact I wanted to continue to make and my career was pretty much at a standstill. I realized that I was becoming stagnant and I am not the type of person who likes to be stagnant. As much as it pained me, I decided that it was time for me to leave and pursue other opportunities.

During my time at Allscripts and Eclipsys, I had a tremendous opportunity to learn and stretch my abilities. I built an international business that started as four people and was break-even from Day One. Today, that business unit is tracking to be valued at over $100 million. I got to oversee and run our business development groups, product marketing, product support, and services organizations. I was able to work with some really bright and passionate product development people who I am truly proud of. I also got a chance to introduce some awesome concepts and innovations to healthcare information technology.

I do miss the people, the clients, and the products, but I am ready to try something different from an intellectual standpoint.

Name some of the innovations.

We released the first App Store in HIT, allowing third parties to access to our products through APIs. We provided copies of database schema to clients, thereby allowing them to access their data without having to confront industry standard obstacles. We also pushed hard to have a well-understood object level API. We centralized security and auditing. We did a lot of work on mobility. We redrafted our UI to be far easier to use and more powerful. Lastly, we introduced personalized workbenches and physician mobility products.

This was a lot of work, but we added substantial value to the companies’ respective product lines and enhanced capabilities for our respective customers.

Do you think the merger of Allscripts and Eclipsys was a good idea?

Yes. Both companies had offsetting strengths and weaknesses. Allscripts was strong in ambulatory and weak in acute. Eclipsys was the opposite. From a philosophical perspective, it did and does make total sense. The companies’ products gaps overlapped well and I know that there is tremendous work being done to continue fusing their respective offerings.

Any lessons learned from the merger or your time at Allscripts/Eclipsys?

So many I have actually thought about writing a book about it, kind of like a guide for executive leaders.

The biggest lesson is be product led. It is all about the product at the end of the day. If you build great products without compromise, client satisfaction, employee morale, and loyalty as well as the profits will follow. If you just focus on the financials and making the numbers, you’re not going to really deliver over the long term.

Steve Jobs, Jack Welch, Lee Iacocca, and Steve Denning all preached and proved that lesson, yet today way too many companies sell out to Wall Street and try to make a quarter happen rather than really standing strong and leading with their products and all the supporting infrastructure required to make that happen.

Think of it this way. If two companies met on the field of battle, all they would have is their products and their service and support teams. The victor would be the one with the strongest products, services, and support. All the other trappings are just that – trappings. Great products are the backbone of a great company.

What you would tell your replacement?

I don’t know the man, but from what I hear he is a good guy and has strong experience. My advice would be rather generic to anyone taking a role for an enterprise software company, not just my replacement at Allscripts.

First and foremost, learn the industry and lead. For him or anyone who wants to build great products in this industry — or any industry for that matter — I would tell them to learn the industry and challenges of the clients. Get on the ground and actively design your products. Don’t just delegate — lead the design and be part of the birthing experience.

Product managers are a good source of information, but ultimately the leaders of a company should be deciding on exactly how the product will function, wow, and thrill the clients. If you can’t log in, use, or install your products, move on to a new company and line of work. So my humble piece of advice: learn the industry and truly learn the products inside out.

Any other advice for Allscripts?

OK, I will add this, given my continued love of the entire Allscripts team. Stop telling people about your past and your car collection. No one cares and it just alienates you. Take the time to create a new chapter of shared experiences. You’re better off just asking others what they think and save the personal stories for a year from now when you have earned their trust and respect.

That said, I think my replacement, from what I know, is a great choice. He has overall been really well received and embraced. At the end of the day, people need to accept him as he is and for who he and give him a chance.

Allscripts filings indicated that you would be consulting for the company. What are you working on with them?

I think there is some confusion out there in regards to my relationship with Allscripts. The truth is that since my departure on May 31, I haven’t had any input into Allscripts products, strategy, or direction. There was some thought of me doing consulting for them, but we couldn’t come to terms.

Last time we talked, I quoted a reader who had called you "the Steve Jobs of HIT.” Now you and Steve have both resigned from the companies that defined much of your career to date.

I am truly no Steve Jobs and I doubt I could ever fill his shoes, or sandals as the case might be. I appreciate the compliment and understand the analogy, but honestly, I just love building great products. I truly believe that if you do great things, great things follow you. Love your teams, love your clients, and love your products. The rest will follow. The moment you realize you can’t love those around you and what you’re doing, it’s time to figure out a new path.

I would suspect that Steve has done most of what he has done out of love. That love translated to great products that changed lives and created fanatical followings and ultimately tons of margin and revenue. If there is any similarity between Jobs and me, it is that we are truly passionate about building great products people love to use and buy.

What are you up to now? A reader says he hears you and Jay Deady are returning to Allscripts.

I am not in talks of any kind with Allscripts to return. As far as Jay goes, he isn’t either, to the best of my knowledge. Jay and I do talk, and from what I can tell, he is loving life and leading an awesome company doing some rather great things for healthcare related to patient and resource tracking, called Awarepoint.

I started a small company called JGo Labs. Our mission is to build great leading edge products for HIT as well as in other industries. Our products focus on home healthcare. Specifically, gaming to start, predictive informatics and diagnostic decision support, and robotic aides. We also are taking all we know about building great products and working with some terrific companies in security and HIPAA compliance, mobility for healthcare, and some really interesting growth areas.

Given my passion for Apple, we are also working with a couple of hospitals on how to help them become more like Apple in terms of how they design their facilities, patient experiences, and workflows.

Any hints who you’re working with?

Sure, but I have to be a little cloak and dagger as we are bound by non-disclosure. Basically we have a series of companies reaching out to JGo Labs and asking us to help them build some really compelling products for HIT. By “build,” I mean design, strategize, evolve, and drive their ideas forward. We are very much like an IDEO or Dyson in regard to this, acting as a research lab and product design group for these companies.

At the moment, we are working on a very sleek and innovate HIPAA Compliance Appliance for one company, two very cool mobility platforms, a voice product, an AI-based documentation system, as well as some products related to workflow and process engineering. We are also in talks with the US Army regarding some advanced research that goes well beyond the current state of HIT offerings.

What about your own products? You’re a development guy.

JGo Labs is divided into two divisions. The Confab Group is doing consulting to other technology companies, their boards, and hospitals. The other division is The Manufactory, which we view as an old-world artisan studio where we craft our own products.

We are working on a very cool Xbox game for home healthcare using the Kinect technology from Microsoft. We are also working on developing technologies which bring concepts from outside healthcare to healthcare. Much of what we do is ask “what if.” For instance, “What if you could apply cross-sell and up-sell algorithms to helping clinicians?” or, “What if you could predict outcomes of a decision based on similar biological attributes and observations?”

It is very far-reaching and speculative in terms of our own products. But without risk, there is no reward.

I have no interest in continuing to work on EMR/EHR technologies as that is a crowded space with little growth. I really love the idea of working on those technologies that change the game on how we deliver healthcare. The stuff we are working on has huge potential returns and we are looking at it holistically in terms of assuring any product we release is a great experience for our clients.

We are actively working on these items today, but also trying to secure funding to accelerate their market entry. We won’t disclose our release dates, but we are trying to be as aggressive as possible. We would be happy to give you a sneak peek in the coming weeks.

What does Apple have to do with hospitals?

We started asking, “What would a hospital be if Apple designed the hospital and everything in it?” We are working with a couple of hospitals who are trying to improve their operations, margins, and patient/clinician experiences and trying to apply an Apple-esque approach.

For instance, collaboration is something that just doesn’t happen enough in hospitals. Not that it doesn’t take place, but it is cumbersome and disruptive. We are looking at a technology from a company called Blurts to see how micro-voice tags can be used to help drive better collaboration.

We are also looking at how people flow and interact with the healthcare experience and taking a lot of ideas from how Apple design’s their retail stores to route patient traffic, greet people, and interact with them and move them through the institution faster, thereby providing better returns for the hospital and overall higher quality outcomes across multiple metrics.

Your name came up with some kind of hacker convention. What was that about?

Defcon is one of the largest, if not largest, gathering of hackers in the world. I was asked to present on how to hack healthcare systems. I ended up presenting on how to hack not only your basic networks, but how you could change a diagnosis in an MRI or CT scanner or how you could literally kill a patient by hacking a medical device or rules engine. It isn’t that hard to do, and in this world of cyber-terrorism, I think that this is a serious exposure for hospitals.

Privacy regulations are not enough when you can literally alter data used by clinicians to make life or death decisions. If you compromise healthcare and shake people’s confidence in a doctor’s ability to safely treat patients, then follow that with a biological attack, even a small one, a terrorist would have one seriously successful attack.

What’s the value in telling hackers how to hack?

We aren’t showing anyone the specifics or teaching people how to do what we outline, just alerting people that it is possible. My hope and goal is to work with the Department of Homeland Security to help get ahead of this problem and help healthcare organizations address this issue. It is one of the reasons we are working with people like Corey Tobin, head of the Healthcare Solutions Group at Trustwave, on a really compelling compliance and security offering specific to healthcare that is ground breaking.

You implied that the EMR/EHR market is stagnant. Is everybody who assumes it’s the hottest thing going wrong?

It is a hot market, but that doesn’t make it a growth space. Growth is about developing products that create 20%-30% growth for a company year over year. Fundamentally, the EMR or EHR market isn’t going to yield that return or won’t long term. Eventually will be rather flat, or companies will need to expand to overseas markets, which most are not positioned to attack.

Let’s face it, we aren’t building a ton of new hospitals every year where you can go schlep your products or suddenly seeing tens of thousands of doctors every year looking for a new system. Given those factors, at least here in the US, and the fact that you have a hugely dominant vendor like Epic, well it isn’t really the place where you are going to see a lot of growth. There will be some growth and companies in these sectors will probably post some good numbers, but it isn’t going to be dramatic. You will see a bunch of services money from maintenance agreements, but I doubt anyone is announcing they are going after 1,000 new hospitals that just came into play.

What are your predictions for the healthcare IT market?

Analytics is going to be huge, but I don’t see any vendor today who really gets it. By “get it,” I mean that they are making it easy to integrate, don’t require millions of services hours, and that the system is intuitive and built on a platform that has the ability to meet future demands while providing just-in-time information.

Mobility is obviously hot. Regardless of what the old-timers think, it is going to be the future. Mobility apps will be hot, but are people willing to pay for them or are they part of the core offering from a vendor? I would heed vendors to figure that out. I see tremendous upside for niche vendors and would also see great opportunity for acquisitions of mobility vendors.

I think infrastructure will be hot. I mentioned security already, but also things like mobile device management and provisioning, medical device integration, disaster recovery, long-term storage and smart retrieval, and home healthcare and robotics.

Why home healthcare and robotics?

First, every human is a potential customer, so my bet is if you want to see awesome returns, you target home healthcare. Very few people are today, and those that are rarely get it. Secondly, it is a cool market that has a lot of need. I don’t think the PHR is the ticket to this market. I would focus on gaming and robotics. One is a mid-term deliverable and the other long-term. Both offer huge upsides to patients and clinicians, especially if integrated with mobility.

Somebody e-mailed me this week that you’re working on healthcare gaming, which surprised me.

I’ll explain briefly, because I am a little worried about having my idea stolen, especially by innovation-starved companies.

Overall, the concept is that you provide a means for people to have fun while getting treated. Take the negativity out of the experience. Make it convenient and clinically relevant.

I really want to talk more about this because it is so exciting and we are doing some great things, but I really can’t give more details.

At the mHealth Summit last year, Bill Gates said home health robotics was his prediction of the biggest growth area.

I really think that there is a tremendous upside for robotics in healthcare and we have not even scratched the surface. We are in talks with a company out of France that has designed a three-foot-tall, really cute robot. Cute is critical here, as we see the robot helping elders and special needs children at first, so the social attachment is really important.

The model is really compelling and the challenge is reducing manufacturing costs while expanding battery life. But I have no doubt that robotic aides and adjuncts will be commonplace in the long term, as there is no real daunting technology hurdle.

If you don’t like EHR as a hot sector, you probably hate revenue cycle.

People are going to upgrade their financial systems and evolve them, but I don’t think you are going to see a mass exodus to a bunch of new offerings. I think Athena is the Epic of financial systems and they will continue to see growth and grab market share. I think others will eventually level out, but I don’t think that suddenly someone will come out of the blue and own the market.

The reality is that people are trying to minimize churn and and not add to it with a huge rip-and-replace of their financial systems, putting the lifeblood of their organizations at stake without a seriously compelling reason.

Google bet wrong on PHRs.

The PHR is critical and offers tremendous benefits, but I think that the PHR as we know it is sad. A Web page that requires you to go somewhere and do something is silly in this day and age. Google’s idea wasn’t bad, it was just the wrong approach.

In today’s world, a PHR should be part of a mobile experience. You should be gather just-in-time information when the event occurs. If you feel dizzy, rate the dizziness now. You’re in pain, rate the pain now.

My point is that until there is a compelling PHR that is part of the patient’s experience at the time the experience occurs, the PHR as we know it has had its day and really isn’t the right model.

Maybe you should build one, not that the pioneers have had much encouraging success.

I would, actually. It could be fun. I see it as a space that needs to be totally rethought. Like I said, Google’s idea wasn’t bad, they just didn’t know what they were doing and were probably constrained by the need to tie it into the mother ship.

There is huge potential here, but you need to get off the Web and into the patients’ pocket. You also need to give the patient real value. Not having to repeat your meds to a doctor isn’t real value. If people think it is, they don’t understand value from a patient’s perspective.

What’s silly about the industry?

Complexity and lack of eating the low-hanging fruit.

We make things too damn complex. We spend too much time trying to please the clients and thereby make everything for everyone. As an industry, vendors need to learn what clients need, guide them to what is going to give the best return, and stop promising the world just to make the numbers. Be honest, deliver a great end-to-end experience, and loyalty and happiness will follow.

By lack of eating the low-hanging fruit, I mean that we as industry just don’t do the little and simple things that could provide huge upside. Look, I can send an appointment request from my iCal calendar app on my phone to someone across the world using Outlook. They get it and bam, it’s on their schedule. They accept, decline, or modify it, and I am updated seconds later. I know of no vendor who provides this out of the box. It is like 20-30 lines of code and it would be huge if, when you schedule your doctor’s appointment, it appears in your calendar.

Here is another one that is easy. Why can’t I integrate Facebook with my PHR? Why can’t a doctor send updates to his patient on Facebook via an EHR? Not PHI related, but general tips to his patient base, like, “Check your immunizations as we head into cold and flu season” or “I will be on vacation through end of month, for an emergency, contact…”

Why don’t most financial systems support PayPal for deductibles or online payment? There are just so many things that are commonplace across the world, yet in healthcare they just don’t exist.

Everybody says that, but nothing ever changes. Why?

Most executive leadership are sales guys who don’t understand products or product design or the state of technology. Same goes for product managers and designers. Most people I meet just don’t connect the dots, and it really isn’t that hard to do or that expensive.

Hell, to integrate Facebook, you need like 30 lines of code. I am sure people will freak at all this and say, “It’s much harder.” My advice is if you need to call someone in engineering to figure out if what I am saying is right, you shouldn’t be running a company. If your engineering is telling you it is massively hard, you’ve got big issues. It’s time healthcare started asking “what if?”

The inverse of that is “the shiny object” problem, where someone in a company sees a cool technical something or other and decides “man, that would be cool.” That is a big issue. Cool for the sake of cool is never a good idea. For instance, integration of instant messaging with a product seems like a good idea, but it’s not a great idea. The focus should be on integrating voice and video for collaboration anytime, anywhere, but somewhere along the line, someone in a company who sits at their desk all day thinks, “Why wouldn’t a doctor want instant messaging in their app? This would be so cool!” That is just stupid. It shows that the company doesn’t really understand the world of the clinician. IM might work for a billing clerk or office worker tied to their desk in a hospital, but not a clinician.

The point is, someone sees this shiny object, which is a cool technology for the most part, but has no real application to healthcare. Again, if an executive in a company — the CEO, COO, CFO — can’t distinguish between low-hanging fruit and shiny objects, they shouldn’t be running those companies. Investors should be very cautious, as should clients and prospects.

How should prospects or investors evaluate a vendor?

Everyone is an investor. I don’t care if you are a client, prospect, employee, or Wall Street investor. You are all investing. Start by really asking, “How is my money going to be used and how it is being applied by this company to get me a maximum return over the long term?” That means asking some not-so-obvious questions. How do you really decide on what goes into a product or not? Listening to our clients is not the right answer, and probably just a sales guy trying to make a sale.

How much training does your services team and support teams get per year on new products? If it isn’t 20-25% of their time, you are not dealing with a world-class company, just a company trying to make numbers. No way anyone is going to be really well skilled at implementing complicated HIT systems and not get a ton of training every year. I suggest you run for the hills or buckle in for a bumpy ride.

Show me the easy button. Take me through all the things that are going to make my life easy as a user of your products, a champion of your products, and investor in your products. Show me your roadmap and how you have made your deliverables in the past. Past does reflect the future, and you should ask how they deal with quality, make their dates, and keep their promises.

Ask to tour and speak to the development teams and support centers. Are they cool, excited, and work in really awesome environments? If not, well, sad people build sad products. Who is my dedicated account management team? If you are spending a ton of money with someone, you should be getting personal service. Heck, you get a cool concierge when you stay at a hotel for a weekend — you should get the same thing when your tossing several hundred thousand or millions to an HIT vendor and signing a multi-year contract at the very least, without paying a premium.

If you ever want to know how good a company is doing, check out the people working in accounts receivable. If they are totally stressed, working long hours, and ready to snap, it is a clear sign of unhappy clients. When you have to fight to get your money, there is always a reason.

Tell the vendor you want to be treated as an investor, not a damn partner. You really aren’t partners in all this — you as the client are an investor. You want the same accountability, diligence, openness, and hand-holding that public companies afford their investors. A company should never ever lose sight of the fact that their clients and prospects are not their partners — they are the lifeblood of their company and therefore should be treated like royalty.

I could go on and on, providing an insider’s view of selecting a HIT vendor. If people want, they can reach out to me and I would be happy to send them a list of questions and answers to look for and what that potentially could mean to them. No, I am not looking to charge them for it.

Curbside Consult with Dr. Jayne 9/19/11

E-mail Dr. Jayne.