News 9/2/11

Top News

CMS issues its final rule on changes to the e-prescribing incentive program and includes multiple hardship exemption categories for EPs. EPs have until November 1, 2011 to request a hardship exemption for the 2012 eRX payment adjustment.

Reader Comments

From CDH: “Re: Epic trainers. More disgruntled ones, this time at Central DuPage Hospital. Of 27 hired, eight have left. They were told they would be certified, but in reality were only credentialed. The principal trainers have purely HR backgrounds without any go-lives under their belt. Training plans are being revised daily as they have not yet stopped the back-end build for the November 6 go-live.” Unverified.

From Arch Moore: “Re: WVHIN and Thomson Reuters. You reported that deal back on January 24, more than seven months before they announced the contract. I heard contract negotiations hit a big snag in June when Thomson Reuters announced to the world (and Wall Street) that they were thinking of getting rid of their healthcare business. Rumor is it was a surprise to everyone. WVHIN must have been impressed with CareEvolution since the deal went through.” Thanks for reminding me. I was thinking I’d said something about this from a reader’s rumor report back in the winter.

HIStalk Announcements and Requests

Wondering what you may have missed this week because you still haven’t signed up to get HIStalk Practice? Wonder no more: EHRA tells CMS that requiring providers to submit patient-level data for CQMs is too big a burden. I annotate toenails using Healthfusion’s MediDraw. athenahealth launches a PCMH accelerator program.  Retail medical clinics are flourishing.  If it’s fall, then it must be time for user group meetings.

On HIStalk Mobile, Dr. Travis covers all the news about apps, home health technology, and mobile health, but also summarizes what it takes to succeed in developing successful apps for consumer health.

On the Jobs Board: McKesson Consultants, Epic Implementation Project Manager, SCC/SMM Consultants. On Healthcare IT Jobs: Epic Physician Trainer, Clinical Nurse Analyst, NextGen Trainers / Consultants.

Allow me to compress my usual Thursday spiel into one-word imperatives, just for the sake of brevity: (a) subscribe; (b) Friend; (c) report; (d) click; and (e) thanks. Did you get all that?

Listening: Ghost on the Canvas, a moving last studio album from Glen Campbell, diagnosed with Alzheimer’s this year. I was never much of a fan, but maybe I should have been given this album’s outstanding songwriting, vocals, and guitar work. To my ears, the 75-year-old, who has sold 45 million records in his 50 years in music, has never sounded better or benefitted so much from fresh-sounding production and contributions from folks like Jakob Dylan and Billy Corgan. It’s everything you’d expect from someone looking back at a life well lived: reflective and poignant, but optimistic (A Better Place says it all). Glen never got much attention from the music industry because he straddled genres (country? pop?) and was goofy on TV and movies, but somebody must be blackballing him if this album doesn’t reap a truckload of awards even without the sympathy vote.

Happy Labor Day, celebrating the rapidly diminishing ranks of us who aren’t out of work or happily drawing government entitlements while practicing leisure. You fashion purists will no doubt be placing your white clothing and seersucker suits into storage next week as summer unofficially ends. For me, it’s college football, perhaps some well-crafted barbeque, and a beer or two unless Mrs. H unveils plans of her own. I will most likely post Monday Morning Update this weekend since that’s what I do, even though fewer folks will read it (time to slip in something really scandalous!) Enjoy the holiday.

Acquisitions, Funding, Business, and Stock

Despite reporting “disappointing” Q2 results Wednesday, SAIC CEO Walt Havenstein speaks positively about the company’s recent acquisition of Vitalize Consulting Solutions:

The addition of Vitalize will expand SAIC’s health solutions portfolio in both commercial and federal markets to help customers better address electronic health records implementation. The combination of Vitalize’s expertise and integrating commercial off-the-shelf software for electronic health records and systems with SAIC’s information integration data analytics, and cyber security capabilities creates a powerful combination in the marketplace.

SAIC’s Q2 numbers: revenue of $2.6 billion (a 6% y/y drop), EPS of $0.32. Analysts expected $2.77 billion and $0.35. Shares fell 13.5% on Thursday, making it the top loser on the NYSE and hitting an all-time low, after the company said reduced government spending is hurting its top line.

Ingram Micro announces a Healthcare Partner Network of healthcare VARs and managed service providers.

Shares in NextGen parent Quality Systems hit a 52-week high Wednesday before slipping a little on Thursday. Market cap is $2.66 billion. Big holders Sheldon Razin and Ahmed Hussein own $459 million and $423 million worth, respectively.

IV equipment maker B. Braun Medical sues CareFusion for patent infringement, claiming CareFusion’s Alaris smart IV pumps violate its patents that include wireless communication with hospital clinical information systems.

Sales

Twelve Community Health Centers in Puerto Rico choose SuccessEHS EHR/PM for their 190 providers and 26 sites.

People

AHIMA names Lisa Spellman as its representative to lead the health informatics committee for the international standards organization ISO/TC215. She was previously with HIMSS and Allscripts.

Steven Liu MD, founder and chairman of Ingenious Med, is named Physician Entrepreneur of the Year by Modern Physician.

Announcements and Implementations

The Buchanan County Health Center (IA) goes live on its first phase of Meditech.

The Greater Dayton Area Hospital Association and HealthBridge announce the go-live of the Greater Dayton Area Health Information Network, which connects four hospitals and over 200 physicians.

The fishing city of Navotas in the Philippines rolls out EMR at nine health centers and one “lying-in” clinic. Midwives will be equipped with 22 BlackBerry smartphones, allowing them to collect patient data as they make house visits.

Physicians connected to Brooklyn HIE can access patient records via from their ClinicalWorks EHR.

Optum enters a strategic relationship with Monarch HealthCare (CA) to manage the clinical operations of its 2,300 independent physicians.

athenahealth launches athenaCoordinator to facilitate care delivery among hospitals, practices, and other caregivers.

Government and Politics

A scathing and well-written reader editorial about “inane” Maryland Medicaid isn’t too keen on accountable care organizations:

Mr. Ransom seems to think that doctors, including the rural ones, will flock to the idea of reward for cost savings and better care management. The people who are enamored with these payment models are mostly lawyers, journalists, politicians, medicolegal pundits, bureaucrats and software companies, especially the last that endlessly inundate the medical profession with ideas that neither materialize in enhanced care for patients nor in increased income for doctors. Instead these ideas have resulted in jobs and increased income for government auditors, care deniers and people who connect doctors to the care deniers, paper pushers and bean counters; folks who will never set eyes on a patient in their lifetime.

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Innovation and Research

A doctor from Wichita State University (KS) develops an iPhone concussion symptom detection app for high school football teams. Concussion Manager, which costs $25 per player, tests before-and-after balance, memory, and reaction time on the sidelines, allowing coaches to take the player out if warranted.

Other

Insiders are responsible for the majority of PHI breaches, with 35% involving employees snooping on their co-workers and 27% the records of friends or relatives. Loss or theft of physical records or equipment account for an additional 45% of breaches.

Fred Trotter reviews the VA’s recently announced VistA Custodial Agent, concluding that, “it doesn’t suck (much).”

Weird News Andy finds the Yale School of Medicine announcement of a paper-free curriculum a little weird (there’s that word again), balancing the $100K annual savings against the $600K upfront iPad cost, inevitable repair bills, and the likelihood of buying Apple’s hot new model every couple of years as being similar to “federal government thinking.” He likes the idea, but finds predicted print savings to be an unconvincing way to justify the cost.

Weird News Guy sent over this link: if you insist on removing animals from their natural habitat and locking them up thousands of miles from home so humans can stare at them, at least give them iPads like the Milwaukee County Zoo has done for orangutans. They play with apps on the donated iPads and will soon have Skype, which will allow them to videoconference with their inmate counterparts elsewhere. That’s obviously a testament to the iPad’s ease of use. Wonder how they’d fare with an EMR? 

Former Carthage Area Hospital (NY) CIO Skip Edie says he was interviewing an out-of-work CIO for an IT position when the hospital’s CEO called the candidate in Edie’s office to tell him he should interview for Edie’s job. Edie says he saw the writing on the wall and turned in his four-week notice, only to be marched off the property. Two days later, Edie’s wife, a patient accounting manager for the hospital, gave her four-week notice and was also escorted out within 10 minutes, she claims. The CEO says both left on their own and would not comment further.

Strange: the Christmas Eve death of a radiologist from Jackson Memorial Hospital (FL) is ruled an accident by the sheriff’s office, which determined that the woman’s necklace became entangled in the shiatsu massager she was using in her bedroom, strangling her. Her husband, also a doctor, says he found her unconscious. The FDA is advising owners to not only throw the specific massager (above) away, but to break it into pieces and put the parts in different batches of trash.

Great news if you are good looking: more attractive people earn an average of $250,000 more during their careers than those who are less good-looking. Not only do the best-looking third of the population earn 5% more money than the average or ugly, they also get better deals on loans. And if you are a pretty woman, you are more likely to marry a higher-earning man. I’m now wondering if Mr. H would give me a raise if I invest in some “cosmetic upgrades.”

Sponsor Updates

• Merge Healthcare’s OrthoEMR v4.0 receives ONC-ATCB certification.
• Hayes Management Consulting reports that Ohio State University Physicians’ use of MDaudit has helped the practice reduce regulatory risk.
• Lancaster General Hospital (PA) selects Wolters Kluwer Health’s ProVation MD software.
• Healthwise will participate in next week’s The Forum 11  Annual Meeting of Care Continuum Alliance in San Francisco.
• NextGen is offering a webinar September 12 to demonstrate its Inpatient Clinicals.
• API Healthcare is exhibiting at the this month’s ASHHRA Annual Conference in Phoenix and the Healthcare Staffing Summit in Philadelphia.
• Vocera smart phones and badge communicators can now receive alerts and notifications from Extension, Inc.
• Greenway Medical announces that PrimeMOBILE now available on iPad as a native app.
• Healthcare Innovative Solutions will participate in this month’s Kansas Hospital Association’s Meaningful Use Summit in Topeka and the South Carolina Hospital Association / South Carolina Medical Association TAP Conference in Hilton Head.
• The Orthopaedic Institute of Central Jersey and Orthopaedic Spine Institute select SRS EHR for their combined 19 providers.
• 3M Health Information Systems partners with Krames StayWell to encode Krames StayWell’s patient education library using the 3M Healthcare Data Dictionary.
• Imprivata and Teradici announce updates to Teradici PCoIP firmware and Imprivata OneSign software that will provide integration and interoperability of PC-over-IP (PCoIP) zero client devices with authentication management and single sign-on software.
• Medicare awards Faith Community Hospital (TX) incentive funds following its successful Meaningful Use attestation using to Prognosis EHR.
• Aspen Advisors publishes two new case studies: Fairview Leverages Seasoned Project Managers to Ensure Successful EMR Rollouts and University Hospitals Prepares for Meaningful Use Attestation. 
• The Fullerton Radiology Medical Group (CA) picks McKesson’s Revenue Management Solutions for its 10-physician practice.
• The Advisory Board and Mercy Clinics announce their inaugural Health Coach Training course in Des Moines, IA in October and November.
• ZirMed partners with training solutions provider Contexo Media to launch ZirMed University, an online portal that provides training on the ZirMed solution as well as courses for continuing education credits.

EPtalk by Dr. Jayne

Earlier this year, the American Medical Association launched a contest to identify an innovative new application for handheld use. The top ten finalists have been announced and voting is open through an AMA website. You do, however, have to be a member to vote. Finalists are in two categories (Physician and Resident/Medical Student) and include applications for tracking hospitalized patients, surgical equipment preferences, and resident duty hours. Personally, my favorite is “What’s Not Covered,” which helps determine what organisms might escape a patient’s current antibiotic regimen.

Speaking of apps, HHS, through the Office of the Assistant Secretary for Preparedness and Response (ASPR) has issued a challenge for a Facebook application to connect friends who agree to check on each other during emergencies and communicate to the community via social media. “Additional accolades” are promised to entries with a “fun or game-like atmosphere for the user.” Maybe some smart developer can cross Angry Birds with a zombie apocalypse theme. Even smarter Facebookers will be sure to friend Inga, Mr. H, and yours truly.

I mentioned last week that Hofstra North Shore-Long Island Jewish School of Medicine is training their incoming medical students as emergency medical technicians. According to a reader, it’s not as new or revolutionary as it sounds – this was done in 1980 at The Medical College of Pennsylvania:

Bradley K, Anwar RA, Davidson SJ, Mariano J. A time efficient EMT-A course for first year medical students. Ann Emerg Med. 1982 Sep;11(9):478-81. PubMed PMID: 7114594.

Another reader alerted me to news about the Kentucky All Schedule Prescription Electronic Reporting system, or KASPER, which I mentioned as recently announcing it would interface with a similar system in Ohio. Kentucky House Speaker Greg Stumbo is seeking information regarding the system’s use (or lack thereof) by the Kentucky Board of Medical Licensure. Stumbo wants to know why the Board isn’t using data on prescribing habits across various geographic areas to investigate suspect physicians.

The article notes that only 30% of Kentucky physicians are using the system. Let’s see: I’d wager that 0% of suspect (or even slightly shady) physicians would use the system, so I’m not sure how more scrutiny of the data would really be a benefit. It goes on to mention that Public Citizen ranks the state as having the twelfth strictest board for disciplinary actions per 1,000 physicians, having been third and second in previous measurement periods.

September is Women in Medicine Month. I’m thankful for the women who came before and paved the way for the rest of us. I’ve been privileged to have some outstanding women as mentors. We’ve come a long way since Elizabeth Blackwell became the first woman to graduate from a US medical school in 1849. There’s still a bit of inequality out there, however: even with record numbers of women in medicine, my medical class was the first one in our institution’s history where women outnumbered men. We felt this acutely when 60+ women were crammed into a gross anatomy locker room designed to hold 20 women. The men’s locker room had 40 empty lockers. Go figure.

Duplicate Drug Checking
A Reader’s Response

I’m one of those readers who works for a vendor of a clinical drug database, though not the one referenced in the article. For the sake of transparency, I’m in product management at First Databank (FDB).

I agree that duplicate therapy is one of the more challenging domains of medication decision support. In the article under discussion, there was a scenario in which two different physicians wrote aspirin orders five minutes apart for a patient who had undergone a cardiac stent procedure. The authors agreed with the duplicate therapy alert that was fired (though they brought to light that the doctor missed it because it was buried amongst nuisance alerts, which I’ll touch on below).

However, in another context, two orders for the same drug will not warrant a duplicate alert (for instance, when a patient gets a one-time dose in the ED and then the order is continued on the floor). Venue matters. And that’s just one context among a number of different contexts that need to be considered, such as change in level of care, timing of the order, same or multiple clinicians placing the order, etc. Most of these factors are outside the purview of the drug knowledge base.

But I am not passing the buck. It is critical for the drug knowledge base to keep evolving to providing decision support that considers additional context.

One approach is to have the duplicate therapy knowledge driven off of pre-configured orders rather than the drug products. This requires that structured orders be employed by the vendor system, but can more easily identify orders that are intentionally given together, such as a bolus with a continuous infusion, or an order for which the nurse decides on the route (also referenced in the article). One of your sponsors, an MD, uses our structured orders, along with their own logic, and asserts that duplicate therapy does not have to overwhelm. 

Of course, as many have pointed out, dialing back the sensitivity in the content is another obvious component. We have done a lot of work on this over the last year. When I entered some of the key examples in the article into our test system, I found that we matched the authors’ recommendations.

We hit on the previously mentioned example of two aspirin orders, but not on the other alerts which the authors felt were spurious and caused the doc not to notice the true duplicate. Similarly, we satisfied the recommendation to generate a hit for an order for metoprolol IV on top of metoprolol PO.

Mr. H.’s insight that attributing severity for duplicates so that a site can turn off the less severe ones “en masse,” as is done with drug-drug interactions, also needs to be tackled. We do support our users with a solution that enables them to easily customize—turn off, or selectively turn on—alerts even without that attribute. 

We recognize that the volume of alerts is still too high for duplicate therapy as well as other domains and are investing heavily in addressing alert fatigue.

Contacts

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

HIStalk Interviews Joel French, CEO, SCI Solutions

Joel French is managing partner and CEO of SCI Solutions of Campbell, CA.

Tell me about yourself and why you joined SCI.

I’m an economist by training. I was an immature college kid. I went to school to play sports and chase girls and ended up learning about price and elasticity of demand a long time ago. I figured even a guy like me could do OK in healthcare. That was a long time ago.

I started in the physician business, back with a physician practice management company in the ‘80s. Learned that business a little bit and learned the health plan side and learned a little bit about finance. 

Jeff Anderson has been my partner in this effort. Now, along with John Holton, we’re leading SCI Solutions, along with NEA and The Wicks Group. We saw a couple of things here that we believed were unique. One is that there’s this collision point happening right now, where the line of demarcation between the financial and the clinical is blurring, and we think it’ll soon be eradicated. Reimbursement is very much an issue of clinical appropriateness, and both reimbursement and clinical appropriateness have become a matter of compliance.

The unique role that SCI has is we capture and digitize a transaction at its very point of origin in the ambulatory setting. Years ago, you might recall that The Advisory Board did a study finding that 80% of the controllable costs in healthcare hinged on physician behavior. Do you refer, do you admit, are you going to do a surgery, and so forth. We believe there’s a growing opportunity to infuse that referral transaction, or that ordering or scheduling transaction, with clinical intelligence; deeper, broader medical necessity reviews; smarter eligibility; and ways of looking at what’s the best way to take care a patient that may have a chronic condition or a comorbid condition, and what patients are eligible for, perhaps an episodic hip replacement program that might be in effect in that community. That was of high interest to us.

We were looking for a strong culture. We were looking for a business that had scale and deep, wide client footprint. SCI clearly does, with 450-some hospitals and something like 30,000 physicians. We were looking for a Software as a Service business model, so that from a vantage point of a client implementing, the capability was fast, it was capital-efficient, and it wasn’t a burden on them because they’re burdened with everything else right now. I could go on, but that’ll give you a snapshot.

The company now has a broader senior team and new investment. What are you going to do with your new capabilities?

The main thing is we’re going to help our clients navigate the transition that’s sitting right in front of them like a storm right now, particularly reimbursement reform. I was with nine clients last week in California, and without exception, all of them are worried about the legislative and regulatory burdens, both those that are in place and those that are coming around the corner.

For the average hospital, as you know, 40% of their net revenue is Medicare-dependent, and they lose eight cents on the dollar. And maybe something like 15% is Medicaid-dependent, and they lose 12 cents on the dollar. I was with a few clients last week where their Medicare exposure was 70 and 75%, respectively, so they’re very worried about this.

The company has had a 97% client retention rate that it’s managed over the years. It’s done a really good job. I think our big focus is helping our clients unlock the value of the existing infrastructure that they’ve implemented, the SCI infrastructure, to bring some working capital and liquidity to their business. Because if you think about it, most of these guys are somewhere on the horizon of laying down tens if not hundreds of millions in funds to automate manual processes, or to replace departmental systems with enterprise architecture systems.

That may be the right thing to do. For a lot of them, it is. I think that some of them are beginning to be worried that there may be an absence of measurable, risk-adjusted return on that capital, but what they know is they’re going to get depreciation on their P&L. They know they’re going to be guaranteed software maintenance expense that’s higher, and a bunch of IT FTEs running around. Potentially, if they use debt, some interest on that debt. 

At a time where you’re hiring physicians and your labor expense of net revenue has gone up and your reimbursement is going down, it doesn’t look very pretty on the horizon. Helping them unlock some working capital in their business and helping them be smart about how do they connect with patients in the community and non-employed physicians in the community — it’s a focus area for us and that’s been what the company has been known for.

Folks say the pendulum always swings back, and even though the emphasis is on clinical systems, it will come back to financial systems. Do you think that the timing is right to get in front of people that are locked into a project plan and have spent a lot of money to get a system, but knowing that at some point, especially with healthcare reform, they’ll have to look at their financial side?

No margin, no mission. I think the CFO job right now is arguably among the most important of any in a health system. I can’t imagine people that are – I guess I can, because I’ve met some — that aren’t thinking about what’s going to happen in the near future. Many of the leading prognosticators have talked about an acceleration of hospital bankruptcies. Folks that are going to have to seek merger partners on terms that aren’t commercially favorable to them because they haven’t gotten their cost at a level where they can break even on the patient mix with Medicare and Medicaid.

Somebody implementing a clinical system should be doing so for all the right reasons. You know, the surest path to long-term low cost is quality, like W. Edwards Deming said. I think he’s right, but there’s going to be a huge pivot away from simply automating stuff to generating business yield. I don’t see that right now. I see a bunch of organizations ramming in systems, ostensibly for incremental Meaningful Use reimbursement. Some of them are doing it really well. We’re going to find out.

As far as the plan to use the investment that you have, is it to build more product or to get the word out on the product that’s already available?

I think it’s to make sure that the current clients are realizing the full measure of value that they can. Our products in some respects are not like Microsoft Excel, where a typical client utilizes less than 50% of the capability. There’s an important question: how do we make sure that people are getting the value that they’ve already implemented?

Secondly, it’s to address those workflow adjacencies or business adjacencies that are literally right next to where our products are implemented, so that the physician referring a case or ordering a case can derive more benefit without us trying to take them very far afield from what they know and love about SCI.

I think the other thing is we’ve already built what you might think of as a pipeline of possible acquisition candidates that meet the fairly rigorous set of criteria in four quadrants that we look for. We’re well downstream with a handful of these now. We may or may not do anything there. It just depends on the timing and the terms and what’s best for the clients and the business and whoever our combination partner might be. But that non-organically growing business may be an option to us. We certainly have the access to capital. We also have the leadership team to grow a much larger business.

The two hottest areas that might have an impact on what you want to do would seem to be revenue cycle management and consulting services. Do those fit in to the kinds of things you’d contemplate as an acquisition?

No.There’s plenty of really good consulting firms in the market today and I’m not sure the market needs another one. I don’t see us trying to aggregate a bunch of billable FTEs. 

The focus is really helping our clients to better orchestrate patient care transitions and access. You know, if you have 16 million more Medicaid enrollees coming into the system, somebody’s got to figure out, where do you treat these people and how do you treat these people? They’ve just been going to the emergency department for primary care in the past. How do you intelligently apportion the ability to educate and care for somebody across a community?

The second is helping these clients align and link their reimbursement with clinical appropriateness and regulatory compliance. That’s the business we’re in, and that’s what we’re focused on.

It’s an unrelated question more about your history, but from your background from Motion Computing, do you think the iPad made their job tougher?

I’d learned a lot at Motion from my colleagues there and from the clients. I guess in a way it did, but the iPad has catalyzed, it seems, a big market shift. Gartner Research said the tablet category was a million units worldwide way back in ’03, ’04. I don’t recall the data offhand, but I think Apple may do – gee, you might have the numbers handy – 70 million iPads? I mean, it’s a big number, whatever it is. It’s catalyzed this shift from clamshell-type laptops to devices that can be used while walking and standing, which was Motion’s vision all along.

The question for Motion is, can they continue to succeed in the professional industries where the companies that like healthcare, where you have a toxic 24/7 environment with biologicals everywhere — blood, urine, the stuff that gives rise to nosocomial infections — and having devices that are sealed, durable, cleanable that can run the mainstream applications. I think it’ll be interesting, because what I’ve seen about the iPad is that it appeals to the docs that can buy it for 600 bucks. If they can get their apps to run on it, maybe that’s good enough for them. Time will tell.

Also from your background, I’m curious, if you were advising an aspiring entrepreneur who wanted to do some sort of a startup in a healthcare IT, either a products or services firm, what areas would you say look most attractive right now for a fairly quick payback?

I’m not sure anything’s easy. I don’t have any silver bullet answers, I’m sorry, I wish I did. I think that I would just say find a basket of clients that you trust and go listen to them, and see if there are some endemic unresolved business problems that the current set of suppliers couldn’t or haven’t remedied that you could carve out some advantage and protect that advantage over time.

But I don’t know. In terms of the business prospects areas or technology areas, I don’t have any easy answers for an aspiring entrepreneur. It’s all difficult. Some guys just get lucky or strike it right.

You mentioned that there are plenty of good consulting companies out there. You have a background in that as well. Are you surprised that big companies keep buying healthcare IT consulting firms?

No. Let the cycle continue.

Is that always going to be the case, with the big fish swallowing the smaller ones and then spawning more small ones?

Well, I don’t know if I could use the word always and I wouldn’t use the word never. Back in the day when there was just Superior Consultant Holdings and also First Consulting as the boutique domain experts in the market, everybody else was either Accenture and E&Y and so forth. We were the mid-market. If there was a publicly traded scale player that wanted to buy en masse a small little company with 100 people, it wasn’t significant to their earnings. They couldn’t put enough resources to work to make the business meaningful.

I think that’s what we’re seeing here, where entrepreneurs build up expertise, they deliver some modicum of scale – maybe they’re at 100 million or 200-300 million — and they become attractive to a larger organization that needs to do a scale buy and needs earnings. I think what happened when Superior was sold, First Consulting Group was sold, and Healthlink was sold to IBM.

It created a market gap, where entrepreneurs could take a company of 15 people, 30 people and bring it up into the several hundred people range so that they were now that new mid-market. I think we’re seeing that. Parker Hinshaw has done that at maxIT. The guys at Vitalize have done that. There’s other firms growing as well, as you know. You know this market really well.

Give me some predictions about either healthcare IT or healthcare in general that would span five to 10 years, things you’re thinking that would be surprising to the average person who doesn’t pay as much as attention as I’m sure you must.

I’m not a popular guy for saying this a lot, but, I’m a truth-teller. I think that there will be a growing number of hospital executives that are removed from their roles as officers because they either didn’t astutely apportion scarce resource or they couldn’t manage the financial enterprise successfully. The organization is either looking for new leadership or they’re looking for somebody to blame, one of the two. I think that will be true of CEOs, CFOs, CIOs, and a number of others.

People don’t like to hear that, but I don’t know how you go spend $70 million and don’t have an answer for what you got for that. I’m not sure how that’s OK with an organization running a 1% operating margin, triple-B bond rating, an 8% to 11% allowance for bad debt, and a ton of interest payments in an era where reimbursement reform is getting very ugly. But that is one point of view I happen to have. The guys that are on some of the boards that I’m on are asking questions today that they wouldn’t have asked 10 years ago.

If we look down the road 10 years, based on your crystal ball, how do you think the IT market will look different from how it looks today?

I don’t have a crystal ball and I wish I could think 10 years out. I’ll try, but there are some really smart guys that paid to do that and do it well. 

I think it’s fair to say that the data will be increasingly digital. We’ve seen that already. If you look at the HIMSS Analytics EMR Adoption Model – and I watch it every quarter – the pace of movement just in the last 18 months alone, it’s been very significant. The Meaningful Use catalyst has been effective, it seems. With digital data, you can do a lot more with it. 

I sit in a room with leaders and I ask, “Well, how many of you are profitable on your Medicare business?” No hands go up. “What about Medicaid? What percentage of your net revenue does that represent?” Fifty-five to 70%. “OK, so really, what you’re telling me is your commercial insurers are your source of profit. Is that true?” Yes, it’s true. “So they are your most significant trading partners, right?” Yes. “OK, so how many of you as executives have formed positive working relationships with your counterparts?” Blank stares.

I think the health plans are a wild card in this market. We see markets like Pennsylvania, where you see health plans and providers coming together. Humana just did that again. I think there may be employers that are contracting directly with providers. There may be providers and health plans that come together. We may not see significant distinction. I know there’s very few providers that have the balance sheet and the sophistication to manage risk at scale, but maybe they’ll learn.

Specialty inpatient capacity, such as fancy new buildings and lines of service, that healthcare systems have spent millions to build will be rationed or jettisoned over time, as reimbursement incentives recalibrate patient access and orchestration decisions in favor of lower acuity and cost of care settings, including the home.

Any concluding thoughts?

Thank you for what you do. Thank you for being an independent voice and having the immediacy of your publication. I appreciate that and I know a lot of others do, too.

Guys like me — and there’s lots of people like me — we have unfinished business in this market. These problems are worth solving. They are. Every year I age. As an athlete my entire life, my body doesn’t do what it used to do. My muscle memory is good, my mind can tell it what to do, but it doesn’t, so I need a good healthcare system and so do my kids. These problems we’re working on matter greatly.

I have never been more excited about this industry. I learn every day. After 23, 24 years of beating my head against this wall, I’m learning every day, and I’m so passionate about what we’re doing. I love working with like-minded people that are smarter than me, that I trust, and we can just get after one little problem at a time. That’s what we’re doing at SCI. That’s what John Holton is doing, and Jeff’s doing, and I’m doing, and the rest of the team’s doing.  We’re just being very narrowly focused  on those areas where we think we have a unique set of competitive advantages and we’re just trying to help those clients. That’s what I think we’ll be doing a year from now and two years from now if I get to live that long.

News 8/31/11

Top News

Prognosis Health Information Systems, Inc. signs a definitive agreement to acquire Creative Healthcare Systems, developers of the financial management and patient accounting system MedGenix. Prognosis will integrate MedGenix with its ChartAccess EHR. Creative Health CEO Steve Everest will stay on board to lead revenue management operations.

Reader Comments

From A Vendor: “Re: Billians Health Data and HIMSS Analytics. Do vendor readers have an opinion of the superiority of one over the other as a source of hospital data? We’re interested both in the database and the networking potential of the organization.” Comments are welcome.

From Antoine: “Re: duplicate med alerts. I’m not sure I agree with your comments. A duplicate check is just a med-med check where the two meds are the same. Whatever deficiencies exist in duplicate checks should exist in med-med checks. The abstract of the article said the number of exact duplicates was high, which I assume is an error, unlike conditions where other factors are different.” The biggest different between duplicates and drug-drug interactions is that the latter are graded by severity at the database level, so they can be turned off en masse and unselectively to suppress noise. Those allowed to display are then almost always clinically significant. The former are triggered by partially or wholly identical drug codes in two or more active orders, but further refinement requires looking at order-specific information such as route of administration, overlapping times, and frequency, and if that isn’t done well, those warnings are rarely clinically useful. In the article, some of the duplicate warnings were appropriate, caused by issues in CPOE such as multiple providers not looking at each other’s orders and entering an exact duplicate. Even exact duplicates may or may not be significant: if one order ends tomorrow and the other starts the next day, the system needs to decide whether that deserves a warning. I have readers who work for vendors of the clinical databases that make these “alert or not” decisions, so I welcome their review of the article. But I’ll stand by my conclusion: duplicate warnings are fairly close to useless, at least as measured by the ultimate yardstick – how many times does the clinician ignore the warning and enter the order anyway?

From ADALMA: “Re: Allscripts. I’m an employee and had two flights cancelled because of the weather. My manager called to say family comes first and not to do anything to jeopardize my family or my safety.” Another reader sent over a company e-mail that, while mentioning safety a couple of times, didn’t explicitly say to take care of family first. I attribute that to the fact that it came from a marketing person, so naturally her focus is on the conference rather than general managerial advice. I’m sure interpretations of what’s between the lines of any e-mail vary based on the reader’s disposition, but it seemed fine to me and I wouldn’t be insulted if I worked there – the company seemed appropriately concerned for the well-being of its employees. I was more interested that the reader told me that company attendees share hotel rooms at the conference, so naturally I had to ask how that works – do you get to choose a bunkmate, and what if one of you snores, is hygienically challenged, or is unusually modest? Answer: you either choose a roomie or have one assigned, or you buy out their half of the room with your own money. Forced room-sharing to save the company money always seems a little bit creepy to me, but I can see why it’s financially attractive when you’re sending hundreds of people to one event (but I still wouldn’t like it). Feel free to send me your first-person stories about that arrangement since I’m sure lots of companies do the same.

From Big Fight Brewing: “Re: 3M. ICD-10 is pushing hospitals to computer-assisted coding. 3M is telling clients that their encoder (used by 4,000 hospitals) will not interface with any NLP or CAC solution other than their own. Big clients are not happy.” Unverified.

From Gilbert O’Sullivan: “Re: UNC Health. Announced to its IT employees Friday that Rose Ann Laureto will be the new CIO. Seems to be a good hire.” She is (or was, if the rumor is true) CIO at University of Illinois Medical Center at Chicago. JP Kichak was UNC CIO until recently and still is on his LinkedIn profile, so that’s all I know.

From TRL: “Re: Cedars-Sinai. Live on Stork and a new fetal monitoring system. I’m a consultant and leadership at Cedars-Sinai might be the best in the country. They demand near perfection, but those of us with high demand skills respect being asked to perform at our best. Far too many places are just happy to follow with some strange comfort that just buying Epic is enough. Make no mistake, Epic is good software, but implementation leadership is EVERYTHING when it comes to success.” Unverified.

Acquisitions, Funding, Business, and Stock

Scotland-based charge master vendor Craneware announces financial results for its 2011 fiscal year: pre-tax profit grew from 2010’s $7.26 million to $8.65 million; revenues increased 34% from $28.4 million to $38.1 million.

Blackstone Group seeks a $1.2 billion loan to fund its $3 billion buyout of Emdeon.

India-based business process outsourcer Ajuba Solutions says US healthcare reform has boosted its business, encouraging the company to spend $5 million on technology and $5 million on a new building. It will hire 700 new employees.

Sales

West Virginia Health Information Network selects Thomson Reuters HIE Advantage for its technology backbone.

Ardent Health Services (TN) expands its use of Surgical Information Systems solutions to include anesthesia documentation.

Reston Radiology Consultants (VA), Washington Radiology Associates (VA), Shady Grove Radiological Consultants (MD), and Advanced Diagnostic Radiology (MD) select Merge Healthcare’s RIS.

PriMed (CT) expands its relationship with MED3OOO by selecting InteGreat EHR for its 28 locations and 75 providers.

People

Brad Levin is named North American GM for Visage Imaging. He was previously with GE Healthcare.

Impact Advisors hires Michael Nutter as its director of firm culture and associate satisfaction, a position it also calls “happyologist.” He was previously with Florida Hospital.

Huron Consulting Group names Michael Cadwell and Andrew Schramm as managing directors in its healthcare practice. They’re from Ingenix Consulting and Tefen Management Consulting, respectively.

Lisa Crymes joins Bottomline Technology as director of healthcare products and strategy. She was previously with Emdeon.

Announcements and Implementations

eHealth Global Technologies deploys Axolotl Image Exchange to provide diagnostic image exchange services for hospitals participating in HealtheConnections RHIO of Central New York.

The American National Standards Institute (ANSI) launches the  Permanent Certification Program for HIT that will accredit organizations that certify EHRs. The permanent program will replace the current temporary certification program in 2012. ANSI is accepting applications through October 7.

Allscripts reports that over 4,700 attendees are taking part in this week’s ACE meeting in Nashville.

Florida providers can now use secure email though the Florida HIE Direct Secure Messaging (DSM) service. The secure messaging service is the first milestone in the HIE’s $19 million initiative, which uses technology from Harris Corporation.

Addington Hospital says it will be the first in South Africa to implement Meditech 6.0.

Travis recently mention on HIStalk Mobile something that I hadn’t heard – Facebook allows drug companies (and only drug companies) to disable or edit comments left on their wall. Facebook announced on August 15 that it will no longer give drug companies that option except on pages created for specific drugs. Several drug companies have deleted their pages, while others allow comments if they adhere to stated policy. The reason for Facebook’s original special handling of drug company pages makes sense – if someone’s public comment suggests they’ve experienced an adverse drug event, the company might have to file a report with the FDA, at least in the absence of FDA policy that says otherwise.

Government and Politics

US CTO Aneesh Chopra will deliver a keynote speech at the Consumer Electronics Association’s Industry Forum in San Diego next month. The press releases mentions the announcement of “a major, new digital health and fitness program.”

Innovation and Research

Researchers at Tel Aviv University create a Facebook game that will help them understand how infections spread. PiggyDemic allows Facebook users to infect their friends, which the researchers say is how viruses really spread rather than being distributed equally across populations.

Technology

Yale’s medical school will no longer provide printed course materials, instead giving students iPads and putting all the study materials on them. They expect to save up to $100K in annual printing cost plus the labor involved. “It really makes the curriculum imminently updateable,” the assistant dean was quoted as saying, although hopefully in his mind — unlike that of the reporter — he spelled it “eminently.” Students get an iPad, apps to manage the reading material and recorded lectures, and a gift card to buy a keyboard. Harvard Medical School isn’t quite there yet, letting students buy whatever mobile device they want and giving them the choice of paper or electronic course content.

Physical therapists at Banner Good Samaritan Hospital (AZ) are using video games to put rehab patients through painful exercises. Patients like Wii Bowling, but the hospital is experimenting with Microsoft’s Xbox Kinect since it covers the whole body.

SeeMyRadiology.com releases a free iPhone/iPad remote viewing tool for its medical image exchange.

Other

Vince keeps digging deeper with his company HIStories, aided by readers who send him memory-jogging historical tidbits, so Gerber Alley turned into a two-parter, with Part I above. If you have Gerber Alley info to share (especially any photos of Urban Gerber, who died in 1984) it’s not too late to contribute to next week’s Part II. I love reading these, especially when I recognize someone’s name or picture. I’m thinking about starting an Healthcare IT Hall of Fame with a panel of voters to choose from the nominees. Wouldn’t it be cool to see them inducted at HIMSS or something? Everybody’s suddenly nostalgic about the history of Apple and Steve Jobs (justifiably), so why not our own industry, which goes back even further? Not to mention the “doomed to repeat history” thing.

In Taiwan, HIV-infected organs are mistakenly transplanted into five patients after a hospital staffer misunderstands “non-reactive” instead of “reactive” when the donor’s HIV test results are called in and not double checked.

Indianapolis Colts quarterback Peyton Manning delivers this great line to reporters after being peppered with a few too many questions about his May neck surgery and ongoing recovery:

“I don’t know what HIPAA stands for, but I believe in it and I practice it.”

Apple gives new CEO Tim Cook over $380 million worth of shares, awarded if he remains an employee for ten years.

El Camino Hospital (CA) hires celebrity nurse practitioner Nurse Barb, who seems to already be a hospital employee although it’s not exactly clear, to develop a televised health series and to increase its social media presence.

Weird News Andy was so moved by this story that he titles it, “Sheer brilliance of doctors” with only a tiny trace of his usual dry humor. An 86-year-old Arizona man drops his pruning shears while gardening. The sharp end sticks in the ground and the man slips and falls while picking them up, jamming the protruding handle through his eye socket and into his neck, pressing directly against his carotid artery. Surgeons at University Medical Center remove the shears and repair the damage with wire mesh, saving his eye and leaving him fully recovered other than some minor double vision. There’s plenty to dislike about the US healthcare system, but if you’ve got a lawn tool jammed into your skull, be glad you’re here.

Hurricane Irene Updates

Forty-three patients from Johnson Memorial Medical Center in Stafford Springs, CT were transferred to other facilities when the hospital lost power from two separate power feeds Sunday morning. The hospital had switched to a backup generator, but it failed.

Staten Island University Hospital was one of several hospitals evacuated in advance of Irene. CIO Kathy Kania reports that the hospital sustained only minor damage, including water in “peripheral” portions of the IT department. All IT systems were restored to full operations between 1:30 p.m. and 9:30 p.m. Sunday.

In the mid-Hudson Valley region of New York, flooding and damaged roads are creating the biggest problems for hospitals. Bridges approaching St. Anthony Community Hospital are washed out, leaving the hospital on an island. Several parking lots at Bon Secours Community Hospital are under water and flooding on local roads is making it difficult for employees to get to work. Meanwhile, St. Luke’s Cornwall Hospital is fully functional, though relying on a backup generator.

Dorchester General Hospital (MD) was evacuated Sunday morning and 30 patients were transferred after wind and rain damaged the roof. By 2:00 a.m. Sunday, the floor was covered in four inches of water and water was pouring from the ceiling. The laboratory sustained the most damage, though the ED, operating rooms, central supply, some patient rooms, and the chemo unit were affected.

SCI Solutions offered its customers free appointment voice reminder calls before the storm hit, working with partner TeleVox. Patients with scheduled appointments got a telephone message of the hospital’s choosing, with one hospital’s chosen message being “Hurricane Irene may disrupt power at the facility your appointment is scheduled. Please contact the facility before you leave home to ensure your appointment is still possible and/or call Central Scheduling for information. Please continue listening for your appointment details.”

Sponsor Updates

• maxIT Healthcare presents the Beads of Courage Beads in Space tour, which is traveling to 10 US cities in honor of September’s Childhood Cancer Awareness Month.
• Consulting Magazine includes Impact Advisors and North Highland on its list of 2011 Best Firms to Work For.
• Billian’s HealthDATA introduces HITR.com, a social networking tool for benchmarking hospital IT satisfaction, at an August 31 webinar.
• ESD rolls out its new branding and Web site at Allscripts ACE. Also at ACE: Awarepoint showcases its Patient Tracking Board solution and Allscripts unveils its Mobile EHR apps for iPad .
• GE Healthcare hosts a September 7 webinar entitled EMR & Quality Management.
• Central Maine Medical Center (CMMC) ranks among the nation’s 25 Most Wired and Most Improved following its partnership with The Huntzinger Management Group.
• Faith Community Hospital (TX) gets its Meaningful Use check using Prognosis ChartAccess. The 41-bed hospital signed a contract in October, started implementation in January, went live in March, and attested on June 5.
• PatientKeeper announces that its user group conference will be held in Denver September 18-20.
• Frost and Sullivan awards Merge Healthcare its 2011 Customer Value Enhancement of the Year Award for Medical Analytics.
• Imprivata announces that several organizations are have adopted its No Click Access solution for VMware.
• TeleTracking Technologies releases a white paper that lists the top 10 reasons that RTLS location accuracy in healthcare matters.

Contacts

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

Curbside Consult with Dr. Jayne 8/29/11

Hurricane Irene is this week’s big news, and I can’t help but think if Inga was on the East Coast this is what she would be wearing. All kidding aside, I’m glad to see friends and colleagues start checking in on Facebook and other social outlets to let people know they are OK.

Unfortunately, it’s not over yet. Air travel will likely be a mess most of this week.  Several friends can’t get flights until at least Thursday.

Once the winds are gone, flooding is the next problem. For those of you in affected areas, I hope your disaster recovery and business continuity plans are working without a hitch. For those of you who haven’t shared in the bounty of natural disasters we’ve seen in the US this year, it’s a good opportunity to review those plans and consider a drill.

Numerous East Coast hospitals evacuated patients. Others canceled elective procedures to reduce census numbers and make room to receive evacuees and potential casualties. Some suspended visiting hours or made arrangements for staff to stay in the facility after their shifts were over to prevent them from having to go out into dangerous conditions (not to mention that it might be handy to keep them in-house should relief staffers not make it in).

One colleague reported using her electronic medical record’s patient portal site to push messages to pregnant patients, instructing them what to do if they should go into labor during the storm. Another mentioned a communication from the Department of Defense’s TRICARE program saying that patients in affected areas may be eligible for a waiver of the Primary Care Manager referral requirement as well as emergency “refill too soon” procedures to ensure patients have needed medications.

Providers who personally experienced the impact of Hurricane Katrina in 2005 shared their experiences and recommendations over the last several years and it appears that many organizations took these to heart. I’m not seeing too many reports of hospitals that were severely affected, and I hope most if not all continue to remain unscathed throughout any flooding. It’s not looking good in Montpelier, VT where officials are considering flooding the capital to save a dam.

I’ve personally experienced some significant flooding and am a veteran of sandbagging. I’m always disturbed by the photos of people outside in the storms or defying evacuation orders. I hope folks in New Paltz, NY return to their senses. Due to the large number of people gathered to watch flooding, officials had to ban alcohol sales and order people off the streets.

If you’re among those impacted by Irene, the thoughts and prayers of the HIStalk team are with you. Stay safe.

E-mail Dr. Jayne.

HITlaw 8/29/11

William O’Toole is the founder of O’Toole Law Group of Duxbury, MA.

Monday Morning Update 8/29/11

With much of the Northeast exposed to potential disruptions from Hurricane Irene, I’ve created a page for reports from the field. Leave a comment on that post or send your updates and I’ll keep the page current. Many folks will read this Saturday evening or Sunday, so I’m interested to hear what’s going on. Above is video of Coney Island Hospital being evacuated.

From NoHelp: “Re: Dell Services. Has laid off over 20 folks in their Meditech Solutions Group, with more to come across the legacy Perot Systems Healthcare. With Berk Smith departing, Meditech is not letting up on the C/S 6.0, which is killing MSG. Without competition, they are not able to break away from Meditech and say no to them on deals. Dell is getting less and less interested in that business because it costs a great deal to run, with a very high exec in Round Rock telling me the ROI isn’t there. They will be evaluating whether to keep it running in January.” Unverified.

From Ima Peon: “Re: Allscripts. Just sent a message telling employees to come early to ACE or drive in case your flight is cancelled. Nowhere does it say to think about your own family to ensure their safety during the most serious hurricane to hit the East Coast in years.” The conference starts Monday in Nashville. Hopefully the message sender didn’t feel the need to state the obvious – secure your family first and then take whatever transportation is available (at whatever extra company expense is required) to get to ACE on time if at all possible. In the mean time, I’m watching The Weather Channel with fascination – I’m pretty sure those hyper-excited reporters talking live from one eroding beach or another are being overly dramatic. Mrs. H just noticed that one looked fine until he saw that the camera was on him, then suddenly did a hugely exaggerated “the wind nearly blew me away” stumbling move as he recited the cliché phrase, “conditions are deteriorating.” On the beachhead was TWC veteran Mike Seidel, who provided the funniest TV moments ever during Hurricane Andrew in 1992 when he tried painfully to address the non-English speaking Miami audience in the most deadpan, white bread, C-student Spanish imaginable. I’m pretty sure he would die of starvation in a tacqueria (which is where I had some stupendous carne asada tacos for lunch, in fact). I think most of his South Florida viewers were laughing too hard to evacuate.

From The PACS Designer: “Re: Steve Jobs. His outlook is grim in this photo, taken Friday. TPD is praying for him and will miss his elegant product introductions once he is no longer with us. Here’s a slide show on his best moments.” I’m not running the photo (which I suspect is fake for various reasons that I’ll explain if that turns out to be the case) since I’d rather not remember him the way he looks in it. I’ve worked with a few pancreatic cancer patients and their outcomes were all about the same – 6-12 months of a fairly normal pain-free existence with no change in appearance, then a very fast, somewhat merciful slide to the inevitable conclusion. His diagnosis was made in 2004, so he has already exceeded my best guess. Nobody who knows him seems to like him much, but they all respect him. An authorized biography is due out early in 2012, which may be too late for him to see, but I’ll buy it.

From Mavrikg41: “Re: Epic. [hospital name omitted] was rejected by Epic in the evaluation process because Epic thought [CIO name omitted] was ‘going to get in the way of the success of the implementation.’ They called that out in the report to the hospital’s executives as to why Epic would not be a good fit at [hospital name omitted].” Unverified. I’ve left out the California hospital’s name, but it’s a vendor low blow to call out an hospital executive by name to his or her peers as an excuse for turning down their dozens of millions of dollars. Unless Epic is trying to get the CIO fired, why not just politely decline the business without naming names? It does seem that Epic’s model is occasionally somewhat anti-IT, with a fair number of CIOs leaving somewhere between selection and go-live. Once the Epic train gets rolling in a given hospital, you don’t want to get in front of it since frontline executives seem happy let Epic 20-somethings tell them how to run their business (especially the IT part) instead of listening to their own vastly more experienced people. One might therefore postulate that Epic is often chosen in an environment where both the existing IT systems and the people who maintain them are held in some degree of contempt, rightly or not.

From King Biscuit: “Re: HIStalk. It’s very slow to load at times.” It’s nearly always the problematic Internet Explorer that’s at fault, usually long-obsolete versions like IE6 or IE7, but that doesn’t stop some readers from sending me nastygrams like the server is slow or that all readers are having the problem (neither is true). I’m even more frustrated since the buggy, bloated IE was causing some users to not be able to pull up HIStalk at all a few months back, with the only solution being to program around it in a way that slowed the site down for everyone. I tested from work Friday with IE7, Chrome, Firefox, and Opera (all except IE were fresh installs with caches cleared). IE took at least five times as long as all the others to display the main HIStalk page, often getting ridiculously hung up and throwing out errors when displaying components such as Vince’s HIStory slides, YouTube videos, and sponsor ads. It did better once the page had been cached: IE7 took 18 seconds to display the page, while the others were all basically instantaneous (that was again the front page that holds five posts – the e-mail link is to a single post, which comes up faster). I just tried it with a cache-cleared Chrome on a plain old broadband connection and I was reading the post exactly five seconds after pasting in the URL. Solutions:

1. Upgrade IE if you can. IE9 is current and IE10 is in beta.
2. Download any other browser and use it instead, even if only to read HIStalk.
3. Read the barebones version of HIStalk by appending /print/ to the URL that comes in the e-mail blast. To compare for yourself, try this page and then this one. You’ll miss some stuff, but the page will display quickly.
4. Read by RSS reader or on a mobile device, which again won’t display everything, but it will come up quickly.

I used to only dislike IE, but the frustration it causes HIStalk readers has made me hate it passionately as easily the worst browser available, with extra points for puzzling ubiquity. It’s good for one thing: after a fresh Windows install, use it to immediately navigate to Firefox.com to download a reliable, standards-based browser.

Listening: reader-recommended Pylon, an Athens, GA jangle-punk band started in the late 1970s and basically defunct after the death of their guitarist in 2009. Both REM and the B52s said  Pylon was the best rock band to come out of Athens, including themselves, although Pylon didn’t come close to their commercial success. Fun factoid: the female singer, known for her snarling vocals and dervish-like dance moves, is actually a shy, soft-spoken Southern belle who’s now a staff nurse at Athens Regional Hospital, which as the reader observes, would probably shock and maybe frighten her patients if they were to see Pylon’s old concert videos.

My last poll elicited a lot of votes but not a clear conclusion – 55% of respondents say Epic CEO Judy Faulkner doesn’t have excessive federal influence, meaning not many fewer than that think she does. New poll to your right: should Congress cut back on HITECH money as it tries to reduce the national debt? The poll accepts comments, so leave yours to argue your position.

My Time Capsule editorial from Independence Day weekend, 2006: Public Trading Leads to Trouble for Merge and Misys. The obligatory teaser: “Merge’s nemesis was that least-exciting of corporate swashbucklers, the unseen accountant, whose pressured blessing of questionable bookkeeping practices ticked like a time bomb — buying desperate executives time to avoid the torch-waving mob of unhappy shareholders, but eventually blowing up in the faces of anyone unfortunate enough to be in the vicinity at the time.”

Intelligent Medical Objects announces the availability of a free standalone version of its IMO Problem and Procedure terminology products for the iPhone and iPad, giving users a portable medical code reference library.

HIMSS is whining that as the debt-happy Congress tries to make even a token effort to cut out-of-control expenses, they might touch its precious HITECH money, thereby forcing providers to actually buy their own business tools instead of charging them to every taxpayer without their consent. Thus the new poll I’m running.

More on the rumor that Epic implementers at Carle Foundation Hospital (IL) walked off the job just days before its go-live. What actually happened is that five of its eight outsourced trainers left. It had nothing to do with Epic, but rather the company to which Carle had outsourced training (I won’t name the company since I’m hearing only the hospital’s side of the story). The original reader’s rumor said their gripe related to not being paid, presumably by their own company, but I haven’t verified that.

Healthcare learning technology vendor HealthStream announces management changes: Kevin O’Hara, SVP and general counsel, has resigned effective September 16 to take a CEO position with an unnamed early state perioperative analytics vendor. He has been replaced by Michael M. Collier. SVP Eddie Pearson (above) has been promoted to SVP/COO.

Mike Sweeney, president of maxIT Healthcare, tells me that the company has made both the INC 500/5000 lists and Best Places to Work. He says they’re up to 850 employees and are adding 25-30 more each month. I’d say they’re either at or near the top of the independent healthcare consulting food chain now that many of their competitors have been acquired. I’m sure Mike’s getting lots of tire-kicking calls.

Scottish hospital revenue system vendor Craneware expects ARRA to give it a big US boost, with big numbers expected for Tuesday’s report. The CEO expects headcount to double to 440 in the next three years.

Baxter International will acquire Baxa Corp. for $380 million. It offers IV-related pharmacy systems often supported by hospital IT departments: the DoseEdge workflow manager, Abacus compounding software, and IntelliFill automated compounder.

Former HP CEO Mark Hurd, recruited to Oracle a year ago, made $78 million from his new employer in that 12-month period. That plus HP’s recent public floundering probably makes dealing with Larry Ellison tolerable.

UPMC announces fiscal year numbers: $9 billion in operating revenue, $406 million in profit, and $3.6 billion in investments.

E-mail Mr. H.

Hurricane Irene Reports from the Field

If your hospital or other work location is being affected by Hurricane Irene, send me updates and photos. You can leave a comment on this article, e-mail me whatever you have, or use the Rumor Report form (which can also accept attached photos).

Time Capsule: Public Trading Leads to Trouble for Merge and Misys

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 July 2006.

Public Trading Leads to Trouble for Merge and Misys
By Mr. HIStalk

In this week’s Merge Healthcare saga, three top executives stepped down, the company’s previous financial reports and audits were declared unreliable, and Nasdaq de-listing appears imminent. Talk about your memorable holiday!

Merge’s nemesis was that least-exciting of corporate swashbucklers, the unseen accountant, whose pressured blessing of questionable bookkeeping practices ticked like a time bomb — buying desperate executives time to avoid the torch-waving mob of unhappy shareholders, but eventually blowing up in the faces of anyone unfortunate enough to be in the vicinity at the time.

Publicly-traded firms do everything they can, sometimes including cheating, to show a paper profit. Stock price trumps everything. The shareholder is the most important customer and they demand not just profit, but profit growth. Every quarter’s end is another spin of the Russian Roulette revolver.

Privately-held companies do the opposite. Profits mean paying taxes, so those are deferred as long as possible. Companies have little reason to juice the books unless they are borrowing money or trying to go public. Owner-operators are motivated by their long-term equity in the business, so what’s good for them is probably good for me as their customer. We’re both in for the long haul.

The Misys situation provides an interesting backdrop. The rash of activity seems to point to one outcome: Misys will likely cease to exist as a publicly-traded firm. Prospective purchasers, including the company’s current and prior management, see more value than the share price suggests, leading to talk of taking the company private. That won’t come cheap, so there’s a good chance that the healthcare division would be auctioned off to pay down some of the cost.

Neither Merge nor Misys would be in trouble if they weren’t publicly traded. The lure of shareholder cash came with an unpleasant ride on a merry-go-round that didn’t agree with them or their customers. In Misys’s case, they’re willing to pay to get off. They are disillusioned with the pot of gold that most privately-held companies secretly seek.

I’ve watched several of my vendors go public or be acquired by public companies over the years. I can’t think of a single example where my organization was better served afterward. Once the sexier siren of shareholders stole their attention, I saw a decline in support, development, and customer communication. A revolving door of soothing suits tried to explain the publicly-proclaimed synergies that somehow never seemed to benefit my organization. I went to bed with Company A for logical reasons, but then woke up startled to find an uninvited Company B beside me instead.

I don’t consider it to be good news when my vendor announces plans to go public or to be acquired. As a customer, my experience suggests that I won’t be thrilled with the result. In a perverse way, the only safe strategy might be to just go ahead and buy from the big publicly-traded vendor upfront, whose large warts are at least fully developed. In other words, for the same reasons people eat at McDonald’s – to accept plainly obvious mediocrity for fear of being disappointed otherwise.

HIStalk Interviews John Elms, President, Connexall USA

John Elms is president of Connexall USA of Boulder, CO.

Tell me about yourself and the company.

I was the CEO at SpectraLink Corporation. SpectraLink did about half of their sales in healthcare. We built wireless telephones for the workplace. During my tenure as the VP of operations before becoming CEO and then as CEO, GlobeStar Systems, the parent company of Connexall, was my business partner. They were my master distributor for Canada. I partnered with them as I did with their competitors to make a market for the middleware solution that would connect my SpectraLink phones to patient monitors, nurse call systems, and other kinds of applications in healthcare.

I sold SpectraLink in 2007 to Polycom. I went off and did some start-uppy things in China and Silicon Valley, finished that up, and came back and reconnected with David Tavares, who is the CEO of Globestar Systems, my chief investor here – or sole investor, really – at Connexall USA. 

David asked me if I would build out and operate a US company on his behalf, because while Connexall the product was installed in about 80% of the hospitals in Canada, nobody in the US really knew who we were. If there were such a thing as an 800-pound gorilla in Canada, we were it, but we were clearly flying under the radar in the United States. 

Because of my prior experience at SpectraLink and SpectraLink’s brand recognition in healthcare and the fact that David and I had known each other for about 10 years, David asked me if would start up and run this company. We did that beginning in July of 2010. We’ve been in business here in the United States as a separate entity for just over a year now.

What are the most common medical devices that hospitals need to interconnect and what benefits are they seeing from doing that?

The business really started out by connecting nurse call systems to mobile phones. That freed the nurses from having to hang around a central station or look at lights being lit above doors, and really alert them on a mobile communication device that their attention was needed in one of their patient rooms. To the hospital, it provided speed of response, better patient care, better patient satisfaction. Nurse call was really the foundation of what got us all into this business.

Patient monitoring was the next logical step, so that nurses who are mobile throughout the unit could receive information about the status of their patients, particularly when they went in to some form of distress or some sort of out-of-bounds condition. What I heard at SpectraLink was that nurses saw this as a real benefit to their quality of work life. They were not tethered to a geographical location. They could be free to do their work within the nursing unit, but receive critical information at the point in time and wherever they were that they needed it.

Some adjuncts, we get into things like pumps and vents as devices as we’ve really grown and matured the market. Healthcare applications like patient wandering and infant abduction have been integrated into this world. 

As we started to look to how to support the healthcare industry with the new emerging legislation tied to Meaningful Use and ARRA and all that sort of stuff, really now it’s about taking information from the EMR system — that electronic filing cabinet, if you will — and passing that back to clinicians. 

In certain instances, it’s now critical lab results. Lab results get posted to the electronic medical record system, and those results get delivered to the clinician by Connexall so that the clinician knows that there’s information that is critical to their patient care that’s available and ready for their processing.

Really, any kind of smart medical device, smart medical application, even building management systems. There’s a case study about Disney Cancer Center where Connexall interfaces to the building management system to create an environment that is conducive to patient care and conducive to each individual patient’s definition of what is most conducive to their patient care. The drapes are open or closed, music on or television on, temperature warm or cool … all those kinds of things are catalogued when the patient is admitted. Connexall will adjust the environmental conditions to the patient’s specifications and as they move and out of their room as detected by RFID.

How does nurse call integration work and how does it fit in with specific systems like Vocera and Voalte?

In the case of Vocera and Voalte, we are the means by which those communication devices receive the nurse call notification, whether it’s Rauland-Borg or Hill-Rom or Intego …  I think there’s about 27 different nurse call systems we connect to. When the patient actuates the nurse call button, Connexall will detect that. We’re an IT kind of application, so we sit on the network. We watch traffic going by. When we see a nurse call packet, we intercept it and we move that off to the Voalte device or the Vocera device or whatever device. 

The primary, purpose-built application remains intact. The nurse call button rings at a nursing terminal at the central station as sold and built by the nurse call vendor. We just watch the packets go by and capture those and pass them as a secondary form of alert to those mobile devices.

Really, if you think about it, we’re a large trans-coding gateway. We can take the nurse call protocol, generally TAP, process that in Connexall, and send that out in the protocol that the communication device. In our case, we would send it to the Vocera server or to SpectraLink OAI, or now native SIP integration is the up-and-coming thing.

As more and more of these devices communication-enabled, how can hospitals use that flow of information to their advantage without turning staff into monitor-watchers who get overwhelmed with data noise?

I think there’s two key attributes that allow us to do that. One is particular to us, and that is the granularity with which we, I’ll just say, intelligently wrote those alarms. We can go into our interface client, and each interface client is a plug-in, if you will. That plug-in is architected to interface to the types of information that’s delivered from each medical device. They’re all custom to the medical device, so that if it’s a Drager monitor, there’s a Drager interface client or plug-in, and if there’s a GE, it’s a GE. It’s not one-size-fits all.

With that kind of custom development, we can very specifically identify the types and severity of the various alarms. For instance, on a Drager monitor, if it’s a leads-off alarm, we can route that to a patient care tech or a CNA, whereas if it’s a V-tach or a V-fib, we can send that to the RN. If it’s an asystole, we can trigger a Code Blue.

When you say how, do you keep the clinicians from being other than automatons that are watching alarms and alerts and monitors, the way we do that is we only send the alarms that they need to deal with or that they’re most appropriate to deal with as their workflow dictates. We don’t dictate. We interrogate, we analyze, we build the workflow based on how they do their business, and then we configure the system to accommodate that.

The second element — how do you keep them from being automatons? Well, we know that alarm fatigue is one of the key problems that nurses have. The fact that every application that a healthcare facility purchases has its own alert and alarm system, Connexall can be the chief aggregator for those alarms and the chief router for those alarms. The pump’s dinging, the vent’s buzzing, the nurse call’s ringing … we can just take all that in and ask, “What do you want to hear? From what device do you want to receive it? From on what device do you want it directed?”

We really configure so that we think what we do is we free up the nurses from having to deal with seven or 10 different alerting alarming systems and really be that chief aggregator and router for them. We really try and get at that problem of alarm fatigue and make them more meaningful such that the clinician can deal with that which really needs to be dealt with and the nuisance stuff goes elsewhere.

That article from Boston said nurses often fail to notice critical alarms in the ICU because alarms were going off constantly. Is that situation fixable?

I think it is fixable. I think that the root cause problem is alarm fatigue, and to the extent that we can minimize alarm fatigue by intelligently routing only the information they need to have, I think we get to the heart of the problem.

The Boston problem, as I remember the literature, was the nurse shut off the alarming capability of a patient monitor and they encountered sentinel event. It was at Mass General, right? The fix at the facility was, “Make it so the nurse can’t turn off the alarms.”

Now that’s kind of a blunt instrument approach to solving the problem. I’d like to think that we’d use a little bit more of a nuanced method, which is, let’s make sure the nurse is only getting the critical alarms. Let’s send the nuisance alarms either to a central stations, where you’re paying a different class of person, a different caliber, a different skill set, to watch everything that goes on. The RN, whose job it is to make people well and keep people safe, is really only being interrupted by the information that he or she needs to deal with.

Connexall really does get to the heart of that problem. We really do believe that we stand apart from others who purport to do what we do. Many in this space are focused on alerts and alarms. We’ve tried to get above that and really look at ourselves as an integration platform and take  heterogeneous, disparate systems and getting a consolidated point of management visibility communication. Sitting above the fray, if you will, and not just adding to the noise level.

Because we’re this engine that sits above all those beeps and sounds and music and everybody thinks they have to be a smart device, we integrate all these things that beep and burp and make noise. When you talk about sensory overload, these people are having a tough time discerning between noises. They sound alike. The answer isn’t to make everything smarter, but to pull it together so that you can see patient from a holistic view.

That’s our goal. It’s what we do at the front end of these projects. We sit down with the people who actually give the care and talk about what they’re measuring, what they need to know, and who needs to get it. It’s not just independent beeps and buzzes. It’s a holistic view of patients, critical information, critical tasks, and critical people who need to work around that patient. We pull it all into one system.

Along those lines, the home health personal monitors have gotten pretty sophisticated, but the gripe against those is, “Who’s going to sit around and watch these streams of data coming in?”

That’s true. With the whole move towards ACOs and more people receiving home-based care, that’s a market we haven’t tackled yet. We’ve been very focused on acute care, generally 200 beds or larger kinds of facilities. But increasingly the lines are going to get blurred. 

One of our accounts is the MD Anderson Cancer Center. They told me when I was talking to them about their IT strategies that they saw themselves as unique because the line was pretty blurred between inpatient and outpatients at their facility. I think that’s going to become the norm. Admittedly we haven’t tackled it. We’re going to have to get after that one before too long and figure out how maybe Connexall can help in that market as well.

Can you verify that the information you send was received?

We absolutely can. It’s a two-way communication medium. The administration terminal will show a blue checkmark on the icon, so if we trigger an alert, the alert will go on what we call – and now we’re even into buzzwords here – an active alarm client, but we’ll have an alarm screen. The alarm screen will show the status of all active alarms, and those which had been dealt with receive a blue checkmark. 

If you’re a clinician and the nurse call system sends you a message, you can accept it, in which case it will stop alarming, but it’s going to wait for you to close that call at the bedside because we want to know that you actually went to the bedside. We’re not going to let you close it from the phone, although from the phone, you can escalate it. Usually with another patient, somebody else needs to deal with it, in which case Connexall will send it to that nurse’s buddy or designee for escalation.

In some cases with Connexall, you can trigger an event. You might send nurse calls to a central call desk. They would screen the alarm. They would see “is it pain, is it water, is it AV equipment” – I’m told 40% of nurse call has to do with “I can’t make my TV work” — and Connexall could redirect that alarm to the appropriate person. 

It really is a very flexible system that allows you to do many kinds of responses, but the basic response is, “Yep, I have it.” When you so respond, the person who generated the request or the alarm that was generated by a machine will show a blue checkmark that says, “It was received and it’s been accepted.”

This is an intelligent routing, that front-end workflow that’s so important that says, “What do you want to have happen?” There are three shifts, there are four shifts, a number of teams, code teams, who’s on who’s off that day — where do you want that message to go and what does success look like? That one team, a complete team if it’s a code, all have attended and how do you know that?

We build all of that in. It’s the wrong point of view that we only do alerts and alarms. We are this communication with collaboration platform. At the front end, we can talk about and reassign and reorganize workflow across tasks, people, departments, floors. It can be lab results coming back. It’s not just about alert and alarm management.

I just want to make sure we’re heard. I think what we’re doing is pretty unique competitively. Our value proposition is pretty unique in today’s space.

Is alarming and alerting strategic for hospitals and where do you see it going in the future?

Is it strategic in hospitals? This is an interesting question. I think I could make an argument both ways.

I think basic alerting and alarming … it’s jacks or better in this space. There’s probably a tactical kind of attribute that makes the nurses more effective. Perhaps it helps staffing and will help with some of the shortages that we find in certain of the specialties, allow them to cover more space with fewer folks.

I think where it gets strategic is as we get into Meaningful Use Phase 2 and the requirement to interconnect all these smart medical devices and healthcare information systems. As we know it — or as we used to know it in the old days — it was a tactical kind of application just making the nurse call system more effective, making the patient monitoring and information more readily available. I think that’s tactical.

With Meaningful Use Phase 2 and successors to that related to healthcare legislation, I think it moves into the strategic. I’d like to believe that we will move in that direction and maybe a little further, faster, and better than some of the folks that are still focused principally on alarms today.

I would say nurse call integration is tactical and what Connexall does is strategic. What we do is bigger than one device, one way of looking at patients … that part of why we hurt people when they come in the hospitals with wrong treatment, alarm fatigue, and a lot of other things is we don’t collaborate, we don’t talk, we don’t talk across departments, we won’t talk across teams, we don’t have a holistic view of patients. 

I think that we don’t share information very well. The goal of sharing information and reducing all of these untoward events that we don’t want to have happen and we don’t want to make the front page in the newspaper … we’ve got to show that we’re delivering better care for better outcome. If we can’t do that, we should all go home.

Technology has over-promised what it could do since the very beginning. Technology enables clinical people to deliver better care. EMRs are great at collecting data from all kinds of places, but we need to get it out. We need to get it out of the EMR, out to the people who are actually delivering the care. That is a strategic initiative. We believe that we are right in the center of getting data out to the teams of people who need it. 

Some of that are devices, some of that are tasks, some of that is workflow, staff management, efficiency tools, all kinds of other things. It’s the whole system view, not nurse call integration, which is where this industry started. That’s over. That’s one small component. It’s not what we’re about.

Today it is one application. It is important, it’s nice to have, but where we are today is around a “have to have,” which is teams of people need more complete information around patients to take better care of them. That’s where we fit — right in the middle of that whole collaboration process.

News 8/26/11

Top News

Cerner reveals plans for two stainless-steel and glass office towers for its new Kansas City, KS office complex. The exterior design of the buildings is based on a digitized image of human DNA. Construction of the 660,000-square-foot development, which will house 4,000 employees, is expected to be completed by mid-2015.

Reader Comments

From Beau Tocks: “Re: healthcare’s most influential. Not sure that is the real list of movers and shakers in healthcare, so maybe it says something that Mr. H is not on the list!! Did Judy have some airbrushing .. or go under the knife?” The 100 Most Influential list was developed based on votes from the publication’s readers. I’m sure HIStalk readers would have compiled a totally different list. BTW, Mr. H’s insights extend well beyond HIT — he, too commented that Judy’s new headshot looks a little Photoshopped.

From Dr. Nick Riviera: “Re: ExR. In a sales call yesterday, a physician said, ‘I do not want to buy an EMR. The federal government is only paying people that have an EHR. I am going to buy one of those.’” Scary, on many levels.

From EpicBlackEye: “Re: Carle Foundation Hospital. Heard their Epic consultants walked off the job before next week’s go-live.” Unverified. I e-mailed for confirmation, but didn’t get a response. I’m skeptical pending further information.

From MT Hammer: “Re: All Type medical transcription service, North Brunswick, NJ. Acquired by Medquist. Employees notified by e-mail.” Unverified, but also reported by several All Type employees on an MT discussion board.

From St. Eligius MD: “Re: half of physicians practicing with NPs and PAs. Hallelujah! The AMA must be gnashing their teeth. What wonderful news for a new dawn in medical care for the future – MDs actually working with extenders, rather than trying to keep them out of practice. The sun will have actually risen when NPs, PAs, and CNMs can actually open their own practice.”

From Alabaster: “Re: Medify. I know someone in their focus group, which was mostly clinicians with heavy healthcare advocacy experience. None of them found it intuitive, it covers few conditions, and its goals were unclear. I heard they mostly just scratched their heads.” It looked like they found some cool information and built a nice GUI around it without having a clear vision of who would use it and why. It’s like reading one of those slick HIT articles cleverly written by a reporter with no subject matter expertise, where you’re first impressed because it reads so smoothly and authoritatively, but then you realize only in hindsight that it didn’t really say anything useful.

From Porphyria: “Re: Medify. I searched for ‘autism,’ but the treatments suggested had nothing to do with the condition, suggesting several cancer drugs. Very confusing and inaccurate.”

From OhNoPerot: “Re: Dell Services. Another 200+ person layoff today, all in the legacy Perot teams. Healthcare team continues to take most of the hits as the legacy Dell leadership takes over all key roles.” Unverified.

HIStalk Announcements and Requests,

Are you current on all things ambulatory HIT? New this week on HIStalk Practice: Dr. Gregg applauds collaboration between EHR vendors and specialty societies. An EMR vendor promotes transparency with its Meaningful Use Tracking Board. Healthcare costs may rise as hospitals employ physicians. The AMA gives a thumbs-up to Bundled Payments. If you follow ambulatory HIT, make sure you remain in the know by signing up for e-mail updates on the site.

Also, have a look at HIStalk Mobile and sign up for those e-mail updates if you want, which is full of good mobile health news and analysis by Dr. Travis (example: he was the first I’ve heard mention a special deal given to drug companies by Facebook, where they’re allowed to selectively block objectionable postings to their walls).

Listening: reader-recommended Richard Ashcroft, his latest solo CD (he used to be in Verve). He’s apparently wildly full of himself and some of the reviews have been savage (mostly because it doesn’t sound like Verve), but I like it quite a bit. It’s got a nice orchestra-backed, pop-oriented hip-hop vibe, although it’s a bit repetitive and inconsistent. I probably like it better than Verve, which was known for big-sounding, trippy psychedelic lushness  — you would instantly recognize their Bittersweet Symphony, although you probably thought it was U2 when it came out in 1997. 

If you’re in need of JFK-like “ask what you can do for your HIStalk” ideas, here’s a few off the top of my head: (a) sign up for e-mail updates to your right so that you don’t miss anything and so Inga can brag on the number of folks like you who have done so (7,468, since I know you were about to ask); (b) connect with Inga, Dr. Jayne, and me on Facebook and LinkedIn, giving us a Like if you’re so inclined, and joining the HIStalk Fan Club on LinkedIn like our BFFs have done (1,792, since I know you were about to ask once again); (c) send me rumors, news, or other stuff by clicking the big green Rumor Report monstrosity to your right; (d) check out the sponsor ads to your left, which are becoming less animated day by day, and click on any that tickle your fancy; and (e) do some carefree navigating and searching of sponsor-land in the Resource Center. I get the whole passive reader concept, but a little interaction on your part goes a long way when I’m sitting here alone for very long evenings after work trying to be scintillating using the written word alone. Thanks for reading. 

On the sponsor-only Job Board: Epic Implementation Project Manager, Epic and Cerner Consultants, Regional Sales Executive. On Healthcare IT Jobs, which is back online but a little behind on new job postings: NextGen Workflow Process Consultants, Senior Pharmacy Analyst, Manager IS Clinical Applications.

Acquisitions, Funding, Business, and Stock

Trend alert: the growing number of  hospital-based physicians, along with stock market uncertainty, are fueling investments in practice management companies for hospital-based physicians.

RTLS vendor Awarepoint secures $27 million in a Series F financing round led by Kleiner Perkins Caulfield & Byers. The company will use the capital for growth and to drive adoption of its aware360Platform.

Canada-based aviation simulator company CAE acquires Sarasota, FL-based medical simulator technology vendor Medical Education Technologies Inc. (METI) for $130 million.

Sales

Ipswitch Hospital NHS Trust (UK) will deploy Microsoft’s Vergence single sign-on and context management solution to improve clinician access to systems.

People

Microsoft announces the appointment of Michael Robinson as GM of US Health & Life Sciences and Dennis Schmuland to the newly-created position of chief health strategy officer. Robinson previously served as GM, public sector for the Middle East and Africa.  Schmuland is Microsoft’s former national director of Health Plan Industry Solutions.

Voalté hires Teresa Anderson as its chief nursing officer. She was previously an independent consultant for the American Nurses Credentialing Center.

Announcements and Implementations

HIMSS names two Davies Award winners in the public health category: the Florida Department of Health, Bureau of Epidemiology for its electronic surveillance system for early notification of community-based epidemics; and the NYC Department of Health and Mental  Hygiene for its Primary Care Information project.

The Healthcare Business Solutions subsidiary of New Jersey Hospital Association partners with Artificial Medical Intelligence to offer its member hospitals the EMscribe’s Coding Assisting Coding product to facilitate the ICD-10 transition.

Medicomp announces the initial distribution of ICD-10 mappings and functionality in the new version of its MEDCIN Engine. It includes a new user interface to make it easier to use ICD-10 within EMRs, providing clinically contextual, problem-oriented views of incoming data using standard reference terminology.

QuadraMed announces a new version of its Quantim Facility Coding that will support both ICD-9 and ICD-10, allowing users to test ICD-10 transactions while coding live encounters in ICD-9.

WoundVision announces the launch of iNSIGHT, Web-based risk assessment software that supports prediction and prevention of pressure ulcers.

Crestwood Behavioral Health (CA) deploys the OpenDNS Enterprise intrusion-blocking system in its 23 locations.

Innovation and Research

Healthcare costs are lower when clinicians use an HIE to care for ED patients, thereby avoid ordering duplicate services due to lack of information, according to Humana.

Emory School of Medicine establishes a biomedical informatics department, led by Emory Healthcare CMIO Joel Saltz MD, PhD. He’s also a professor in Emory’s departments of pathology, biostatistics and informatics, and mathematic and computer science (his PhD is in computer science).

Other

GE Healthcare informs Milwaukee-area employees of its intention to cut 81 manufacturing jobs, primarily in assembly operations for GE’s diagnostic imaging business. Those affected likely include some who participated in the company’s annual Community Service Day this week by sprucing up 400 classrooms in area schools.

Kirby Partners is conducting a survey on hospital IT employee retention, with results to be presented at the CHIME CIO Fall Forum (and here first, they’ve promised, in return for my mentioning it). I looked it over and the questions are good. To take the survey, click the appropriate variant: CIO, manager/director with people management responsibilities, or staff member with no people management responsibilities. UPDATE: I changed the survey links because their setup is a bit goofy – the original links forwarded to a specific link that gave the “you already took this survey” message. Try again if you’re interested.

Despite an overall trend towards enterprise solutions, Dimensional Insight’s Diver Solution earned top markets in a KLAS report on business intelligence. Information Builders’ WebFOCUS, IBM Cognos 8 Business Intelligence, McKesson’s Horizon Business Insight, and SAP XI Data Analytics were also ranked.

The Texas prison system has saved almost $1 billion over the last 10 years by implementing a statewide EMR and leveraging telemedicine, according to a press release issued by its EMR vendor (BCA) that cites a Gartner study.

Minnesota Health Information Exchange (MN HIE) quietly shuts down, merging its operations into a Duluth-based Community Health Information Collaborative (CHIC). CHIC’s president and CEO says their work overlapped and there wasn’t enough grant money to go around. MN HIE focused on EDs, with some big-name players that included Allina, BCBS, HealthPartners, and the state’s Department of Human Services. The splashy 2007 announcement of the formation of MN HIE, in which the governor said it would be one of the largest in the country, is here.

An Indiana prosecutor will ask the Office for Civil Rights to investigate the apparently intentionally circulated medical records of a city judge (and election candidate) following his stay at IU Health Ball Memorial Hospital.

Fellow shoe enthusiasts: a friend of mine wore these beauties to a party we attended last weekend. Sadly, I was unsuccessful at stealing them. They come from Turkey, so if you happen to be traveling that way, let me know.

Sponsor Updates

• Companies earning a spot on Inc.’s Top 500/5000 include Advanced MD, Concerro, Culbert Healthcare Solutions, Cumberland Consulting Group, e-MDs, EnovateIT, Enterprise Software Development (ESD), GetWellNetwork, Greenway Medical, H/P Technologies, Hayes Management Consulting, Healthcare Innovative Solutions (now part of Beacon Partners, which also was just named to the Top 100 Best Places to Work in Healthcare list), Iatric Systems, MED3OOO, MEDSEEK, TeleTracking Technologies, Vitalize Consulting Solutions, and ZirMed.
• iSirona releases a white paper illustrating how device integration improves EMR data.
• MD-IT announces a series of webinars for channel partners and transcription associates.
• ICA Informatics releases two new white papers entitled HIE Strategies Discussed at HLNY ACHE and HIEM Expands Use of CareAlign HIE Platform.
• Practice Fusion’s Research Division releases data indicating that one out of three children are now overweight or obese.
• ZirMed partners with Waiting Room Solutions to offer an insurance eligibility and claims solutions for physician offices.
• SCI Solutions will participate in healthcare access management meetings in Maryland, North Carolina, and Arizona in September.
• MEDecision achieves NCQA HEDIS recertification.
• A Billian’s HealthDATA  blog entry discusses the benefits of data in healthcare.
• Nuance offers a webinar entitled Spotlight on Innovation: eScription V10 on September 14.
• Grays Harbor Community Hospital expands its use of Access Intelligent Forms Suite after a successful pilot.
• Aspen Advisors announces successful implementation of CPOE at Virtua (NJ).
• Samaritan Medical Center (NY) selects ProVation Order Sets.
• Frank L. Urbano, MD joins the care coordination and compliance practice of BESLER Consulting.
• Lahey Clinic (MA) selects computer-assisted coding technology from 3M Health Information System.

EPtalk by Dr. Jayne

I’m surprised it hasn’t happened before now — the marketing people have apparently found my e-mail address. Today was apparently Send Jayne a Press Release Day. Leading the pack in the “why bother” division was the American Medical Association with an absolutely banal statement about its stance on bundled payment initiatives at CMS. Blah, blah, blah. The AMA is increasingly seen as irrelevant, and if they hope to counter that sentiment, they really should step it up.

As usually I’m a bit behind in my e-mail, so I was going through it during an extremely boring Grand Rounds presentation. Direct-to-physician marketing group Physicians Interactive wanted my opinion about something. Usually I ignore those messages, but this one invited me to participate in an 8-10 minute market research study about my “use of ePrescribing and Electronic Medical Records.”

With the promise that my opinions would “assist in understanding the potential for reaching Health Care Professions through ePrescribing/EMRs” as well as “help to evaluate the value of integration of clinical reference materials at the point of ePrescribing” I decided to give it a whirl. Unfortunately, the survey was closed by the time I responded. Maybe that’s an incentive to keep up with my e-mail. I’d love to see how companies are thinking about marketing through EHRs. Just what we need – more distractions that are incorporated into our workflows for secondary gain.

In follow up on an item I mentioned earlier this month, the South Carolina man who was denied Medicaid coverage for his breast cancer treatments has been granted coverage by the state Department of Health and Human Services. Director Tony Keck states, “If the federal lawyers choose to deny those claims based on a discriminatory policy, that is their choice and our department will appeal the decision.” I’m no Constitutional lawyer, but score one for states’ rights and general human dignity.

This week is National 5010 Testing Week. Are you ready? From talking to my colleagues, it seems there are quite a few practices out there that aren’t even on compliant software yet.

Hofstra North Shore-Long Island Jewish School of Medicine began classes this month. As a brand new medical school, faculty are putting some interesting spins on how physicians are trained. One of these initiatives includes training incoming students as Emergency Medical Technicians. The goal is not only to teach students valuable skills, but to reinforce the team care concept of medicine.

The school is holding off on its traditional “white coat ceremony” (where students are presented with the white trainee’s coat and often take the Hippocratic Oath) until after the students take the New York state EMT exam. I’ll be looking forward to seeing how these students progress and how a new medical school incorporates healthcare IT in training. If you’re on faculty or involved in this program, I’d love to hear from you.

Contacts

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

Readers Write 8/24/11

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!

“Installing IT” Understates the Organizational Change that IT Can Bring
By Mike Quinto

Our organization recently underwent an $18 million turnaround in 24 months. We are very proud of this accomplishment and have no intention of stopping there. 

In a recent financial periodical, our CFO was quoted as saying, “Considerable attention has also been given to IT. In the past, top-of-the-line software products purchased for the radiology, pharmacy, lab and other areas were highly functional in their own spheres, but didn’t integrate well. Now, new integrated software is being deployed to improve communication among departments.”

Well, he said it was IT. In reality, we in IT focus on getting cross-functional teams working together to solve business challenges. IT has been the facilitator of organizational change through process redesign, not new fancy software that adds, subtracts, multiplies, or divides better. 

Software, for the most part, does not “…improve communication among departments.” Governance, change management, and cross-functional teams do. 

We implemented Lawson’s ERP suite, but the largest benefit was not gained from the new splash screen or the logo in the corner of the screen. Vendors tend to think that they have solved the same old problem with new fancy software. It is rare that there is disruptive technology that actually changes the way we do things. For the most part, software is a commodity. The real benefit is the implementation and process redesign that takes place during a system rollout.

The opportunity was the chance to focus on charge capture and develop a policy, process, and strategy around it. We could have used a spreadsheet — the technology was not a magic bullet. The focus on business strategy was.

Don’t get me wrong, we like Lawson as a vendor. However, the software had little to do with our transformation. It was the implementation process that allowed open dialogue about the way we do things, and the way we should do things. That opportunity allowed us to evaluate broken process, identify areas that there was poor or no communication, and establish governance around important operational metrics. Just getting HR and Finance in a room monthly has done wonders to find financial opportunity and redefine policies and process. 

In one case, we had two vendors blaming each other for an outrageous claims denial rate. QuadraMed and McKesson couldn’t get on the same page, and that was creating a claim that had fields transposed. This created a denial rate that was almost 100%. I don’t blame the vendors. At the end of the day, we had a department that was not communicating and working with a broken process. 

Once we “re-implemented” the software, we were able to have open, honest conversations about who needed what and how the billing office should be run. Yes, there was an interface issue; however, IT and the business office were not talking. That was the larger issue.

We put in place weekly change management meetings, assigned application owners for each operational department that has an IT counterpart, and implemented basic project management. These changes had more to do with the performance improvement than any single piece of software, hardware, or vaporware we could install.

To say we purchased IT and installed it is underestimating the organizational change that “IT” can bring.

As a CIO, I spend most of my time helping business units redefine their goals, processes, and governance. Very little of my time is spent with bits and bytes.

Mike Quinto is VP/CIO of Appalachian Regional Healthcare System, Boone, NC.

PDF Healthcare: Why PDF is the "Currency" of Health Information 
by Tom Lang, MD

Health information technology faces challenges from many different quarters and for many different reasons. It’s time for a major dose of simplicity. PDF Healthcare (in both static and dynamic modes) is this major dose of simplicity.

Here are two compelling reasons that PDF Healthcare lives up to its billing as a "secure container for the exchange of healthcare information."

PDF is easily viewed/printed from virtually any computer. With the ubiquity of PDF readers, this is a reality. This fact can be thought of as another approach to interoperability. That is, if we can simply turn healthcare information into PDF, that information is available in a human readable form. Last time I checked, humans were still taking care of patients.

Image and other unstructured data files are easily converted to PDF. Clinical medicine is a world of image files and unstructured data, and that will never change. For example, our universe is filled with EKGs, X-ray images, video clips, audio files, and text-based reports  Equally important are those medication and allergy lists that are scrawled on scraps of paper (yes, paper!) that are so important at the point of care. The fact that PDF supports image files and almost any type of file format is very important in this environment.  ​

PDF (Portable Document Format) was originally developed by Adobe Systems Incorporated, but released as an open ISO standard in 2008. This has been an important step to stimulate innovation and competition, making PDF more capable, affordable, and available for our use in health IT as well as other industries.

As an ER physician, let me give you one example of how PDF can jump over the top of interoperability problems.  

I do quite a bit of locums ER work in many settings and frequently find myself in small rural hospitals trying to communicate with specialists that I need to refer patients to over a distance. Probably the biggest slam dunk for HIT has been PACS, which even in the smallest hospitals is almost universally present.  

One weekend, working in very small rural hospital, I faced the same problem twice: I saw patients with complex fractures, and the question was, "Does this patient need surgery immediately, or is this something that can be splinted and taken care of in a day or two?” Orthopedics is not available at this small hospital, and these patients requested orthopedic care in different directions.  

I was easily able to contact the orthopods by phone, but they needed to view the films to make a decision about what needed to be done and how urgently it needed to be done. This hospital has PACS, but despite this, neither of these orthopods could view the images. In this case, which is the most common arrangement I see, the only person who had remote access to view the images was the radiologist who was contracted to officially interpret the study ("Dr X not credentialed, hospital not on this image sharing network … blah … blah … blah").  

Because the radiology tech for the day was a hacker of sorts, he had some screen capture and turn-to-PDF programs on one of the radiology monitors. In both cases, we brought the images we needed on the screen, took a screen shot, turned the file to PDF, and e-mailed to the orthopedist. Also in both cases, not only were the orthopedists delighted we could provide this to them, but we determined that both patients could be splinted and dealt with in 1-2 days rather than immediately, saving many parties much trouble.

In order to raise the level of awareness of PDF Healthcare, colleagues from the PDF Healthcare working group have arranged, for a limited time, to give away a simple little app that will help HIE in the trenches. We are doing this for the solo / small doctor office. As a special for HIStalk readers, we will give away 50 copies.

Here is a short video that outlines the functionality of this app.

For your free copy, be one of the first 50 to go to the PDF Healthcare site and scroll down to Health Information Aggregator (under the heading of Resources.)

Tom Lang is an ER physician and a member of the PDF Healthcare working group.  

This Way to a Better Patient Experience
By Jeff Kao

Everyone’s been lost at one time or another. Whether you’re far from home or just around the corner, the experience is universally the same, with plenty of stress, aggravation, and wasted time.

Thankfully, the advent of navigation systems and smart phones means most of us get lost much less frequently these days, and that’s a good thing. But what about when you’re off the grid, say trying to find a family member’s hospital room or a lab for a blood draw?

Few places are as massive and confusing as a medical campus. With countless floors, departments, and even buildings to navigate, locating the desired destination can be a daunting task. On top of these logistical challenges, patients often arrive at a medical office or hospital feeling rushed, unwell, or anxious about their visit, only compounding the situation and causing them to be late or to miss appointments altogether.

Wayfinding systems offer a viable solution and pick up where navigation systems leave off. From the moment a patient or visitor walks in the door, these self-service kiosks virtually map paths to and from multiple points in a facility, resulting in a more pleasant and personalized experience. Leading healthcare organizations like Chicago-based Northwestern Memorial Hospital have placed wayfinding kiosks near entrances and other common areas, making it easy for patients and visitors to quickly locate a specific room or department and print a customized map with step-by-step directions.

At a time when consumerism is on the rise and patients have greater flexibility in their choice of healthcare provider, such systems are fast becoming a valuable strategic asset. According to a survey conducted by The Beryl Institute, hospital executives list the patient experience as one of the top three priorities they will focus on over the next three years. Wayfinding systems directly impact the experience patients and visitors have by enhancing the level of service that’s provided and eliminating the hassle of being late or lost.

Beyond guiding patients to the correct destination, wayfinding systems can also reduce demands on staff time, both in terms of time spent giving directions and updating software. While some wayfinding systems once required users to manually re-create maps on each kiosk every time an office or department was moved, today’s dynamic, data-driven applications are extremely scalable and allow technical and non-technical staff alike to quickly recalculate routes on the fly.

When not in use for wayfinding, these systems provide an effective venue for displaying video or text-based messages and marketing medically-related services and events. Patients can also use kiosks to register for promotions or request additional information. And, once in place, wayfinding systems establish a platform for future expansion and growth, eventually allowing healthcare providers to add new self-service capabilities from the same screen.

So, what is the path to a better patient experience? The answer may be inside your own front door.

Jeff Kao is vice president and general manager of NCR Healthcare.

Specificity to the Extreme: As ICD-10 deadlines Draw Closer, Is Your Organization Ready for the Good, the Bad … and the Offbeat?
By Sean Benson

Chances are that most healthcare organizations will be able to raise the bar on current documentation practices high enough to support coding for suture of an artery under ICD-10—even though the possible codes expand from just one under ICD-9 to more than 180 under the new code set. But what if a patient walked into a lamp post (W22.02xA) or was bitten by a sea lion (W56.11xA)? What if the patient was burned by a flaming jet ski (V91.07 xA) or suffers from inadequate sleep hygiene (Z72.821)?

If your organization’s clinical documentation and coding processes can’t support that level of specificity, you need to act fast to get it up to speed. Because rest assured, no matter how weird the diagnosis, ICD-10 includes a code that accurately defines the patient’s status to a T.

The authors behind ICD-10 covered all the bases in an effort to capture the full patient picture—sometimes to the extreme and offbeat. With approximately 68,000 diagnosis codes compared to just 13,000 under ICD-9, it’s clear that documentation approaches that work fine today simply won’t cut it under ICD-10.

It will be complex enough to ensure coding staffs are adequately trained on ICD-10. Finding the resources necessary to advance clinical documentation improvement programs to meet the ICD-10 challenge is simply out of the question for many organizations. Nor are most clinicians interested in spending the amount of time required to become fully proficient on the new system, especially when it takes them away from patient care.

That is why many hospitals and healthcare facilities are looking to software vendors to help them make the transition. Software that automates the documentation and coding process can ease the transition to the expanded code set and shorten the learning curve for physicians, especially if they are faced with the ever-so-common encounter of a patient who has been struck by a bird (W61.92).

Not all coding and documentation software is created equal. The best ones will drive comprehensive documentation to capture the high level of detail required under ICD-10. The software should guide physicians through the process of documenting with enough specificity and granularity to ensure appropriate coding. Otherwise, the code that would accurately identify an embarrassing fall on the local airport’s escalator (W10.0xxA) might be missed.

Healthcare organizations will want to focus on the software’s ability to provide prompts relevant to the documentation needs of ICD-10. That is why it’s important that the evaluation be done by someone who is well-versed in ICD-10 to ensure the right questions are asked.

There are multiple initiatives competing for the attention and resources of healthcare organizations, including 5010 and Meaningful Use, in addition to ICD-10. Because it will affect every aspect of operations, the transition to ICD-10 needs to be placed at the forefront.

For many organizations, leveraging the efficiencies inherent in technological solutions to drive documentation improvement is the best strategy for meeting the ICD-10 challenge head-on.

Sean Benson is co-founder and vice president of consulting with ProVation Medical, part of Wolters Kluwer Health.

News 8/24/11

Top News

HHS announces its Bundled Payments for Care Improvement initiative, a new CMS program that allows hospitals, physicians, and other clinicians to bill their services as a single package instead of as separate items, giving them incentive to manage care better. Applicants can share in the savings over traditional fee-for-service costs, defining their episode of care as one of four models: hospital stay only, hospital stay plus post-acute care, post-acute care only, or a single all-encompassing bundled payment.

Reader Comments

From BubbasChili: “Re: healthcare reform. I have the answer – legislatively re-categorize insurance companies to non-profit status and require that profits over a given amount be distributed back to consumers. I would also push tort reform, but my first idea is the fix. Just my two cents.” Maybe that requirement should be applied to non-profit hospitals first.

From GladItsNotMe: “Re: Lehigh Valley, PA. Has started the evaluation process to replace the old Carecast system. Rumor has it being replaced by that little ol’ vendor out of Madison, WI.” I was too busy at work today to ask Harry Lukens, so I’ll leave this as unverified for now.

From PHEye: “Re: CDC’s Public Health Informatics conference in Atlanta. A speaker complained that HIStalk doesn’t cover public health.” I sometimes touch on public health topics that don’t get much attention otherwise, but those news items aren’t always that interesting to me and probably wouldn’t be to my predominantly hospital-based readers either. And while I appreciate the confidence the unidentified speaker places in a part-time blogger, full-time hospital employee to branch out into an entirely new discipline, I do need to sleep occasionally. I’d be happy to start up a fun, informative public health version of HIStalk as a public service if CDC wants to spend some of its legendary grant money to allow me to quit my day job, but otherwise I don’t have the time to take on new challenges.

From Reporting In: “Re: RelayHealth. Here’s Jim Bodenbender’s e-mail announcing that sales SVP Mike Lang has resigned to work for an EHR vendor. Jeff Gartland replaces him.” I’ll mark this as verified since RelayHealth already updated its management page with Jeff as sales SVP.

From 11YearHITVet: “Re: consulting with less travel. I’m burned out and would like a 50% or less travel schedule. Some of said go into interface work or designing Cerner PowerNotes. Ideas?” I think it depends on how you define “consulting.” Certainly you could do build work remotely, working either for someone else or yourself. Vendors do most of their work of this type offsite given ubiquitous and fast broadband (some of it remotely from Asia, in fact.) But that’s probably not the sexy, high-paying work you’re doing now as the PowerPoint-wielding, suit-wearing expert from afar. If you’re doing general management or operational consulting, it’s really a completely different line of work to do remote technical or functional application support (or to just hire on permanently with a client, for that matter). If  you are willing to make that change and have experience, there’s work out there, especially if you know the hot packages like Epic or Cerner. I’ll let readers chime in since I’ve never been a full-time consultant.

Acquisitions, Funding, Business, and Stock

MedAssets gets approval from its board to repurchase up to $25 million of its stock.

Sales

Presbyterian Healthcare Services (NM) signs a multi-year agreement with Health Care DataWorks (HCD) for its Enterprise Data Warehouse Appliance.

Geisinger Health System chooses Altosoft Insight for Pathology for real-time clinical and AP lab reporting.

Montfort Jones Memorial Hospital (MS) selects NextGen’s inpatient clinical and financial systems.

People

CHRISTUS Santa Rosa Health System (TX) hires George Gellert MD for the newly created position of regional medical informatics officer.

Joyce Hunter, CEO of government healthcare IT consulting firm Vulcan Enterprises, joins HavServe, a volunteerism service for developing countries, as CEO. She has volunteered with a number of healthcare IT organizations, including the local HIMSS chapter, HITSP, Maryland’s CRISP HIE, and Cal eConnect.

Announcements and Implementations

Jersey Shore Hospital (PA) and Fulton County Medical Center (PA) team up to implement Meditech EMR. The critical access hospitals expect to save about $300,000 each by sharing hardware at a hosted facility and scheduling training and implementation at the same time.

Anoto Group announces implementations of its digital pen and paper technology, including Shareable Ink’s implementations with Allscripts, Cerner, Epic, McKesson and Meditech. Other new partnerships directly with Anoto or its resellers include NextGen Healthcare, Intelligent Medical Objects, Waiting Room Solutions, Nightingale Informatix, and Bayscribe.

The Community Health Information Collaborative (CHIC) announces plans to consolidate its operations with Minnesota HIE, resulting in a single state-certified entity named HIE-Bridge.

Ministry Health Care (WI) will implement EHR Doctors’ Medibridge.net HIE technology to enable the exchange of patient information and provide patients with access to their health information.

The Electronic Healthcare Network Accreditation Commission (EHNAC) develops an Outsourced Services Accreditation Program for HIE technology service providers. The program will evaluate HIE vendors to verify they meet industry standards of quality for PHI; follow appropriate privacy and security regulations; and meet acceptable standards for technical performance, business processes, and resource management.

The governor of Guam announces the launch of its first HIE, mentioning that Guam Memorial Hospital will get $5 million in federal incentive money and another $21 million is available for doctors who sign up.

Government and Politics

UK health secretary Andrew Lansley calls on developers to create applications that relate to one of five healthcare themes: personalization, improved outcomes, autonomy and accountability, improving public health, and improving long-term care. NHS is running a developer’s contest, but offering no prizes or funding. Consumers are also encouraged to submit their favorite health apps (“maps and apps”) or those they’d like to see developed.

Other

Once again Mr. H was robbed of a spot on this list of the 100 Most Influential People in Healthcare. Representative Paul Ryan tops the list, followed by Vermont Governor Peter Shumlin and President Obama. Donald Berwick, Kathleen Sebelius, and Farzad Mostashardi were included in the top 10, while Judy Faulkner (with an updated head shot) earned the #44 spot.

A watchdog organization finds that only 15 of the largest 100 HIT firms participated in HIT lobbying efforts between October 1, 2010 and March 31, 2011.

The Department of Homeland Security is soliciting vendors to provide an EHR to store medical data on undocumented residents across 22 immigration detention facilities.

Memorial Hermann Healthcare System (TX) launches Houston’s first HIE. Patients must opt in, with 96% of those that have been asked so far saying yes.

Weird News Andy says he can’t top the quote in this article: “a felony case of stupidity.” A workers’ compensation billing company puts detailed medical information on 300,000 California residents on a server that it thinks is visible only to its employees. Someone Googling discovers that the entire database is wide open on the Internet. The “felony stupidity” comment was in reference to the fact that the company didn’t password-protect the information and didn’t include the “noindex” HTML meta tag that tells search engines to skip indexing that page.

A reader sent over a new JAMIA article called Factors Contributing to an Increase in Duplicate Medication Orders After CPOE Implementation. It looked at the impact of implementing Epic’s CPOE in a 400-bed hospital’s adult and cardiac ICUs (Geisinger, I believe). The number of duplicate med warnings quadrupled, which the study found was caused by (a) multiple providers entering orders at the same time; (b) lack of hand-offs; (c) design problems that caused false alarms; (d) poor data display, where providers entered a new order because they didn’t notice an existing one; and (e) poor local design of order sets that contained pre-built duplicates. Providers both pre- and post-study were neutral about the value of duplicate therapy alerts. The study also found that some potentially duplicate orders weren’t flagged, such as duplicates with differing routes of administration and serial orders where the same therapy was ordered at slightly different times. I didn’t see anything surprising here: duplicate warnings are the ‘stupidest’ of the usual medication screening types (drug, dose, allergy, interaction, drug-lab, drug-disease, etc.) and usually make up at least half of the useless warnings that providers see. There’s no really smart way to tell whether two PRN meds that both contain acetaminophen will be a problem – if the patient gets one or the other but not both, then there’s really no duplication (but that can’t be determined until administration time, not when the order is entered).  Smarter systems ignore route differences (IV vs. topical gentamicin) and maybe skip PRN duplicates and those from the same order set completely, but otherwise it’s almost impossible to separate intentional duplication vs. unintentional. Give the high percentage of provider overrides, one might postulate that duplicate warnings do more harm than good, masking significant problems of other types with their sheer volume and rarely resulting in DC’ing one of the alleged duplicates. I’m not optimistic that it’s a solvable problem – you won’t get a useful answer if you ask providers to sketch out a universal decision tree of when to trigger a duplicate alert, so you can’t expect the computer to improve a process that can’t really be designed. Turning duplicate alerts off completely might be the best strategy.

Seattle startup Medify, staffed with former employees of airfare prediction company Farecast, is creating a searchable consumer database of vetted research study information covering side effects, treatments, and symptoms with social networking connections to similar patients. I struck out on my first search when it didn’t recognize “congestive heart failure” as a medical term, but got a lot of information on “cellulitis” (which talked a lot about maggot therapy for debridement). It’s aimed at consumers, but it looks to me like clinicians would find it useful to get current thought on treatments (not to mention that consumers aren’t going to pay out of their own pockets, but the usual pharma/insurance companies might if it could improve outcomes or cost). Besides, a lot of what it returns is barely understandable even to providers, like when I clicked “clindamycin” for cellulitis and got, “A semisynthetic broad spectrum antibiotic produced by chemical modification of the parent compound lincomycin. Clindamycin dissociates peptidyl-tRNA
from the bacterial ribosome, thereby disrupting bacterial protein synthesis. (NCI04)” Not exactly a compelling Facebook post like the maggots would have been.

The Washington Post highlights an interesting conflict: Medicaid is trying to reduce overuse of EDs as free doctors’ offices to save taxpayer dollars, but much of the potential savings isn’t being realized because hospitals are aggressively marketing their EDs for routine care, hoping to pump up profitable admissions. A quote from South Carolina’s Medicaid director: “When you are advertising on billboards that your ER wait time is three minutes, you are not advertising to stroke and heart attack victims.” For-profits HCA (which runs wait time billboards) and Tenet (which runs billboards and also accepts online ED appointments) claim they haven’t seen a significant increase in Medicaid visits.

Hospitals in Wales are testing university-developed software that can reduce wait times and analyze the cost-effectiveness of medical treatments. It uses simulation and queuing theory, which the project’s director likens to a 1990s computer game called Theme Hospital that allows what-if analysis.

Here’s the kind of lawsuit lunacy that forces hospitals to hire expensive lawyers. A (barely literate) former patient claims a hospital surgeon, while removing his tonsils, implanted a GPS tracker into his armpit.

Sponsor Updates

• Shareable Ink will participate in the Innovation Booth at next week’s Allscripts user group meeting, ACE. The company also gets a mention in a Wall Street Journal article discussing Nashville’s growing  healthcare industry. 
• Holon introduces Pharmacy Workflow Manager, which allow hospitals and IDNs with multiple locations to manage and report workload and productivity.
• GE Healthcare launches Centricity Business 5.0.
• TeleTracking announces the release of RTLS TempTracking.
• CynergisTek announces the release of its Meaningful Use Security Program to assesses compliance with security regs and reduces risk in preparation for MU attestation.
• Modern Healthcare’s 2011 Top 100 Best Places to Work in Healthcare includes Aspen Advisors, Encore Health Resources, Enterprise Software Deployment (ESD), Hayes Management Consulting, Iatric Systems, Impact Advisors, maxIT Healthcare, and The Advisory Board Company. Rankings will be revealed in October.
• Sentry Data Systems will attend Health Connect Partners Hospital Pharmacy Conference next month in Phoenix.
• Orion Health is hosting a free webinar on August 31 entitled Integrating HIE into Clinical Workflow.
• e-MDs launches e-MDs Rounds for the iPhone, giving doctors access to their EHR data via their mobile device.
• Jason Colquitt, Greenway Medical’s director of research services, is elected to a two-year term on the HIMSS EHR Association’s executive committee.
• Perceptive Software hosts a job fair this week at its Shawnee, KS headquarters. The company is seeking to hire more than 60 people in R&D, sales, and professional and technical services. Also announced: the company’s ImageNow product has earned Modular HER certification for both inpatient and ambulatory.
• Informatics Corporation of America and the Health Information Exchange of Montana announce that as of June 6, 2011, three hospitals and one community health center are connected using ICA’s CareAlign HIE solution.
• ZirMed earns its sixth consecutive spot on Inc magazine’s annual ranking of the nation’s fastest-growing private companies.

Contacts

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

Curbside Consult with Dr. Jayne 8/22/11

As most of us know, it doesn’t matter how much time you spend doing e-mail. It’s impossible to stay ahead. Sometimes I e-mail myself articles that I would like to mention. Before I have a chance to get my thoughts on paper, they scroll up, up, and away as the inbox gets larger and larger.

(Speaking of, have you ever tried to change the way you work your e-mail, say from top to bottom when you’re used to working bottom to top? I recently had this experience, and for whatever reason, it was extremely difficult. Talk about assaults on muscle memory! It’s finally back the way I like it, but it was a painful experiment that although designed to yield efficiency, just made me crazy.)

As I did some e-mail cleanup during a bit of unexpected free time (thank you, cancelled conference call!) I found an e-mail that reminded me to look at a journal article: Longer Lengths of Stay and Higher Risk of Mortality among Inpatients of Physicians with More Years in Practice.  The study looks at patients hospitalized during a two year period (2002-2004, coinciding with the residency training calendar on a July-June basis) on the teaching service.

For those of you not in hospitals that have residency programs, the teaching service is staffed by interns and residents under the supervision of an attending physician. Depending on the structure of the teams, supervision of the trainees varies, but ultimately it’s the attending physician who’s on the line should something go wrong.

There is speculation that patients who are hospitalized in July do worse because of transitions in the trainee pool (I talked about this “July Effect” last month), so I was glad to see this study controlled for the variable of having residents and students involved in care. All of the patients were treated at Montefiore Medical Center in the Bronx. They also controlled for any chance that having a more lengthy physician-patient relationship would influence the outcome by restricting patients to those who had never received care from the attending physician.

The authors looked at four groups of attending physicians: those in practice 1-5, 6-10, 11-20, and >20 years. Although the number of physicians was only 59, they looked at over 6,000 patient admissions. Patient groups were similar in demographics and clinical characteristics.

The study found that physicians in practice more than 20 years had greater mean length of stay numbers and greater mortality rates (both in-hospital and 30-day) than physicians with less than five years in practice. This impacted the sickest patients greater than those with less-complex conditions.

They also found that when the teaching service was less busy, patients stayed the same amount of time regardless of physician age. However when there were more patients to care for, length of stay increased in the longer-practicing group.

The authors conclude, “Inpatient care by physicians with more years in practice is associated with higher risk of mortality. Quality-of-care interventions should be developed to maintain inpatient skills for physicians.”

Well, isn’t that special! Talk about a solution that doesn’t necessarily address root cause.

Quite a few organizations commented on the study, with some citing earlier data showing that more seasoned physicians are less likely to adhere to published guidelines. This strengthens the argument that physicians should have to recertify periodically to prove that they are staying abreast of current standards of care. 

I agree with that. My specialty requires everyone to recertify, but other specialties have allowed older physicians to be “grandfathered” into perpetual certification.

Certification aside, though, I’d like to propose two other areas that need analysis. The first is the fact that the more seasoned physicians have gone through a tremendous amount of change in medicine over the last two decades. There have been drastic changes in the non-clinical work physicians are responsible for (insurance issues, E&M coding, pay for performance, loss of autonomy, economic pressures, etc.) and one of the natural responses to change is to entrench in the past.

The second involves looking at the systems that have proliferated based on the changes above, both operational and technical. There has been a proliferation of operational platforms impacting how clinicians are forced to navigate – everything from the Disney Institute to Six Sigma. Simultaneously, there’s been tremendous pressure to move to electronic systems that range widely in their ease of use, stability, and quality.

I’d like to see similar data where they survey the physicians about their comfort level with not only hospital policies and procedures (including proliferation of care coordinators, discharge specialists, length of stay coordinators, coding coaches, etc.) impacting their care, but also on their comfort level with the systems they use and how well they use them.

Because of the presence of interns and residents, I have a sneaking suspicion that some of the more experienced attendings may not have leveraged technology and the team approach (sometimes perceived as interference) as much as they could have. Old work habits are hard to break, and when you’re used to the lower-ranking physicians doing everything and just co-signing at the end, it’s easy to miss things.

Coupled with a mistrust for technology, it’s even more complex. I suspect newer attendings for whom these systems have always been present would be more likely to be hands-on with the technology rather than passive.

Regardless of the reasons, it’s something that deserves a second look.

E-mail Dr. Jayne.

Monday Morning Update 8/22/11

From Hot Off the Press: “Re: Cal eConnect. President and CEO Carladenise Edwards PhD steps down.” HOTP forwarded her e-mail from late Friday afternoon announcing her transition to senior advisor of the HIE organization due to “personal reasons.” Cal eConnect was created when California’s HHS department, overseer of $39 million in federal HIE grant money, decided to form a new statewide oversight organization instead of supporting CalRHIO, effectively shutting that organization down in January 2010. TechLeader obtained information suggesting that earlier last week, Cal eConnect suspended its RFP for a provider directory service, with no bidder selected.

From THB: “Re: tax-exempt hospitals. A potential trend?” Three non-profit Chicago area hospitals express shock that the Illinois Department of Revenue has denied their tax-exempt status requests, ruling that they aren’t owned by charitable organizations and aren’t being used for primarily charitable purposes and therefore must pay property taxes like any other business. The state said the hospitals didn’t list uncompensated care on their requests, but did in their own records: Prentice Women’s at Northwestern (1.85% – pictured above), Edward (1.04%), and Decatur Memorial (0.96%). The state says it won’t set a minimum charity percentage, although one legislator is sponsoring a bill that would require at least 3.5% of total revenue. Just for fun, I checked the IRS forms of Edward Hospital: it made a profit of $25 million in the most recent year, paid the CEO $1.6 million, and claimed it provided $45 million in charity care.

From The PACS Designer: “Re: IBM’s 100th anniversary. Most all of us have encountered business relationships with IBM in our work careers. TPD first learned about IBM solutions in the early 1960s while getting educated to be an electronics engineer by being trained on the use of an IBM vacuum tube computer. Later in my electronics career, I worked with IBM to interface the IBM Shark information storage system to a PACS to create one of the first central archives for all hospital information including imaging files.  InformationWeek recently published a video history of IBM’s 100 years.”

Thanks to a few of my overachieving sponsors who have already swapped out their animated ads with a static replacement, well in advance of the January 1 deadline I set to allow them plenty of time. I appreciate it, as do those many readers who requested that change.

Over 60% of respondents agree with the recommendation of Congresswoman Renee Ellmers that HHS study EMR effectiveness and impact on patient safety. New poll to your right: does Epic CEO Judy Faulkner have too much influence on federal government healthcare IT decisions?

Listening (and watching): reader-recommended Live from Daryl’s House, a fascinating Internet program created by (and paid for by) the first half of Hall and Oates. I hated the 80s poofy-haired, “blue-eyed soul” dreck they did and was kind of hoping he’d been reduced to unpaid gigging at the Paducah Holiday Inn, but I now want to be Daryl Hall: inviting all kinds of big music names to jam with him in a barn-like room of his $16 million spread, drinking wine, bringing in guest chefs to cook for them, having scintillating dinner conversations, and recording the whole thing as a homebrew reality show. The audio and video quality are amazing, the guests compelling. My favorites so far have been Grace Potter and the Nocturnals and Krieger / Manzarek of The Doors, with whom Hall does just fine vocal work on my favorite Doors tune, The Crystal Ship. He’s 64, rich, and living large, just playing his music to an Internet audience. I’ll grumblingly admit that even the versions of Hall and Oates tunes he and his guests covered (like the insipid Sara Smile) sound amazing and fresh. I wish I could be that cool.

I swear that Vince Ciotti is digging deeper into company histories with every new HIStory chapter, finding veterans willing to share their previously untold stories. This time he  covers a company I don’t remember: Sentry Data. Upcoming are these vendors: AR/Mediquest, JSData, and Gerber-Alley, so if you have war stories to tell about them, Vince is your guy.

Urology EHR vendor meridianEMR files a lawsuit and gets a restraining order against competitor Intuitive Medical Software (UroChart), claiming UroChart cloned one of its servers and thereby gained illegal access to meridianEMR’s product and the protected health information stored by its clients.

The weekly employee e-mail from Kaiser honcho George Halvorson talks up their first iPhone app, KP Locator, which he says is “the next connectivity path on a journey that is turning into a superhighway of connectivity over time.” He says it’s the first of many that will be built and invites employees to send him ideas for the next round.

An article in Silicon Valley / San Jose Business Journal details how much local hospitals are spending on EMRs. Factoids: (a) 403-bed Mills-Peninsula Hospital spent $50-75 million; (b) six Daughters of Charity hospitals spent a total of $80-90 million; (c) Stanford says it’s spending 30% of its total available capital each year to implement EMRs; (d) Stanford also spent $13 million to hire a 100-member temporary go-live team for three weeks, which must be a misprint or an incomplete description since that’s over $800 per hour;  (e) O’Connor Hospital spent $2-3 million on EMR training; (f) Mills-Peninsula expects to spend 2.5% of the hospital’s entire budget each year in perpetuity for EMR maintenance.

Beth Israel Deaconess reportedly offers its CEO job to Kevin Tabb, chief medical officer at Stanford Hospitals and Clinics, who would replace the ousted Paul Levy. He’s an internist, but went into healthcare IT straight out of residency as a clinical informatics analyst for iKnowMed, a data director for MedicaLogic, president of clinical data services for GE Healthcare, and then chief quality officer / CMIO for Stanford. Sounds like he would be a geeky kindred spirit for CIO John Halamka there.

Asante Health System (OR) chooses Epic, saying “only one vendor had an integrated solution for hospitals and physician offices, and that was Epic.” They also added that Epic puts 47% of earnings back into R&D and has less than 2% of its workforce involved in sales and marketing.

Thirteen Danish hospitals announce plans to migrate their 25,000 employees from unnamed proprietary office software (care to take a guess?) to the open source LibreOffice, a fork of OpenOffice.org.

A computer professor in England enlists the help of his colleagues to create a computer game to help his four-year-old daughter, who has cystic fibrosis. She can control on-screen graphics by breathing into a PEP mask, which forces her airways open, an otherwise monotonous exercise that kids don’t enjoy. Her doctor can review her game results to determine how her lungs are doing. The group hopes to have the game tested and available to the public within a year.

Former Allscripts COO Ben Bulkley is running Fluidnet, a Massachusetts-based IV infusion control system vendor that just raised $25 million in investment capital.

HP wants out of the consumer computer business, but its systems work isn’t such a hit in Ohio either, where the Medicaid Information Technology System that went live on August 2 is inappropriately denying payments to providers, improperly kicking patients off assistance programs, and causing prescriptions to go unfilled by rejecting the Medicaid bills from pharmacies. Rep. Dennis Kucinich will meet with CMS administrator Don Berwick on Tuesday.

Regulation of EMRs by FDA
By Tim Gee

In the HIMSS top nine trends to watch in health IT, they missed a big one: the regulation of EMRs and other applications by the FDA, and potentially transforming providers into medical device manufacturers.

Between the final MDDS rule (which called out hospitals as potential regulated medical device manufacturers) and public testimony by Jeff Shuren, director of CDRH at FDA that the FDA intends to regulate at least some EMR software, healthcare IT is going to be coming to grips with FDA regulations for some time to come.

How many hospitals have written software to acquire data from medical devices? I’d guess over 100. I’ve heard estimates from sources that FDA expects to be regulating thousands of new manufacturers in the near term.

Since the final MDDS rule was published, four providers have registered with FDA as medical device manufacturers and listed their MDDS products with FDA. The providers are Partners, Gundersen Lutheran, Intermountain Health, and the Alaska Native Tribal Health Consortium.

And when FDA regulates portions of EMRs (they’ve set their sights on decision support systems first), providers who modify their EMR applications may be transformed into medical device manufacturers and become regulated, too. How many early adopter hospitals have have written their own DSS from scratch? They, too are likely to become regulated medical device manufacturers.

The MDDS rule was the shot across the bow. Expect a draft guidance document from FDA on regulating EMRs late this year. Yes, FDA will go slow, but responding will be like turning a battleship – it will take a while and require substantial effort in some cases.
In the next two or three years, I’ll bet most hospitals will be looking to hire regulatory affairs / quality assurance directors, and many hospitals may be rethinking their wholesale modification of HIT apps they purchase, not to mention foregoing rolling their own apps.

E-mail Mr. H.

Time Capsule: Consider Funding Health IT Projects Like Bill Gates Would

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

I wrote this piece in June 2006.

Consider Funding Health IT Projects Like Bill Gates Would
by Mr. HIStalk

It’s no longer news when a big, non-profit integrated delivery network pays a CEO $1 million or a CIO makes $300K for running a small department. We’ve come a long way since the days when ministering to the sick was a calling, where selfless caregivers toiled for a subsistence wage in service to mankind. And why not, since a big IDN can make hundreds of millions of dollars in profit (sorry, “surplus”) in a good year? Once nuns got replaced by MBAs, hospitals became a big business, feeling quite unlike charities to those working inside them. The only surprise in the IRS’s questioning of whether hospitals deserve tax-exempt status is that it took them so long.

VP panic ensues when the local newspaper prints executive salaries, fiscal year results, or drawings of the latest vanity construction project. Nurses may be de-motivated. Unions might be called in. A bitter janitor might key all the luxury cars in reserved spots. Beaten-down doctors may get even crankier when they find out that even bottom-feeding HR and marketing VPs out-earn them.

I thought of this when I read that Bill Gates and Warren Buffet will turn over their billions to serve those in need. I’ve worked in hospitals and IDNs for many years. Are we good stewards of charitable dollars, efficiently funneling them directly to those in need with minimal administrative overhead and waste? That’s how you evaluate a charity, and on that basis, IDNs don’t seem to compete very well. We’re no Salvation Army, with tiny salaries and a focused mission.

Still, another headline gave me an idea. Studies are proving what we all knew: RHIOs can’t survive without charity. If RHIOs provide benefits to patients, yet offer no hope of financial self-sufficiency, then maybe that’s a good and direct use of charitable dollars. Put a few million long-term dollars into some well-organized RHIOs and see what happens.

I like this because Gates’s charity is notoriously efficient. You compete with other causes under rigorous conditions on how well your project will benefit society. RHIOs would have to prove themselves worthy of funding, which would be an interesting exercise in itself given their sketchy “let’s put on a show” origins.

What other health care IT projects deserve charitable consideration? I’d vote for a center for usability research to make health care software more user-friendly and less training-intensive. I like the idea of a free clearinghouse for clinical rules, knowledge, and content to be shared by non-profit hospitals. Maybe we need a patient safety organization just for IT, watching out for problems caused by poorly-designed software and medical technology. Perhaps a non-profit medical informatics consulting organization could help hospitals with an occasional need for that expertise..

If you’re involved in hospital IT, my advice is to review your projects like the Gates Foundation would. Are they ingenious, cost-effective, highly beneficial to patients, and highly likely to succeed? If so, put your resources into those.

In the meantime, here’s my challenge to you. Come up with a list of health care IT projects that are noble causes, benefiting a large population in a way that the free market and the government haven’t. What IT-related work would be ingenious, cost-effective, highly beneficial, and highly deliverable enough to pass scrutiny from the Gates Foundation? Send them my way and maybe we’ll talk about them in a future article.

News 8/19/11

Top News

General Dynamics will acquire federal healthcare software vendor Vangent for $960 million, the company announced this week. Says the General Dynamics chairman and CEO, “Vangent is a well-regarded, fast-growing company that will add significant depth and breadth to General Dynamics’ healthcare IT organization, creating a Tier 1-level healthcare IT business unit with the scope and scale to compete in markets that are receiving high priority in current funding and entitlement-reform initiatives” The Arlington, VA-based Vangent, which has 7,500 employees, does work for HHS and the military. It developed the Army’s MC4 battlefield EMR. Kerry Weems, SVP and GM of Vangent’s Health Solutions business, joined the company in 2009 when he left his government position as head of CMS. He was also vice chairman of the American Health Information Community.

Reader Comments

 

From Watchdog: “Re: HIMSS. Pictures of its new headquarters in the financial district of Chicago. They also hired Steve Rosenfield as executive vice president / managing director of HIMSS Media, a new position and department, and seek an associate manager of social media to improve the society’s ‘positive visibility.’ All that was required is an Associate’s Degree.” Steve doesn’t appear to have a degree, but did write co-write this book documenting the late 70s history of an influential Long Island club that includes photos and an audio CD of the folks who performed there (Springsteen, Aerosmith, Rick Derringer, Stanley Clarke, etc.)

From One Of Their Hospitals: “Re: MDG Medical. The support numbers are no longer in service.” I ran this reader’s rumor last week, in which he said his hospital’s pharmacy got word from the pharmacy dispensing automation vendor that they would close their doors last Friday. I said I wouldn’t name them until I checked to see if the phones were disconnected. Sure enough, the support number and PBX option now give a fast busy. The Israel-based company opened an office in Beachwood, OH in 2001 and moved its corporate headquarters to Aurora, OH in 2010. It claims to have 150 hospital customers and was announcing expansion plans as recently as October. I can’t verify anything other than that their support numbers aren’t working and they didn’t respond to my earlier e-mail asking about the rumor.

From Wildcat Well: “Re: RECs. There have been claims that healthcare IT will be the primary sector for job creation. Does it count when a REC receives funds from ONC, the REC coordinator contracts for systems integration work with ‘local’ vendors, and the jobs are filled through the overseas facilities of those vendors? We may just be stupid enough to deserve the mess we are in.”

From Hate Manual Entry: “Re: Sage Healthcare. Rumor is they bought a SaaS-based HER from a recently bankrupted company. Any others hearing the same?” We asked Sage, which said that for competitive reasons, they don’t comment on acquisitions or technologies that may or may not be under consideration.

From Laura: “Re: Joplin. I’m sure you’ve seen that Mercy has announced plans to rebuild in Joplin. They have kept employees on the payroll since the May tornado and raised $500 million in a co-worker fund to help with expenses.” The 28-hospital Mercy (formerly called Sisters of Mercy) will spend $950 million to build a new 327-bed hospital in Joplin. They’re an Epic shop, I believe.

HIStalk Announcements and Requests

Check out the good stuff on HIStalk Practice: Don Michaels of Hayes Management Consulting and the Harvard School of Public Health weighs in on ACOs and the results of CMS’s demonstration project. Julie McGovern of Practice Wise offers recommendations for providers upgrading their software. Rob Culbert of Culbert Healthcare Solutions suggests key performance indicators to assess a practice’s financial health. CMS provides a breakdown of EMR Meaningful Use payments by specialty and provider type. The GAO advises CMS on how to improve physician quality reporting. I’m a simple gal with simple needs and I’ll be simply thrilled if you sign up for e-mail updates while visiting HIStalk Practice.

On the Job Board: Project Manager I, Epic and Cerner Consultants, Senior Enterprise Sales Executive.

Acquisitions, Funding, Business, and Stock

drchrono closes an additional $650K in seed funding and announces the release of OnPatient, a free patient check-in app for the iPad.

Deloitte acquires the assets of Intrasphere Technologies, a New Jersey drug safety and regulatory consulting company that also offers R&D informatics software for registering clinical trials.

HP announces a restructuring that includes ceasing production of tablet computers and smart phones, trying to sell its PC business, and spending $10 billion to acquire British search technology vendor Autonomy at a 64% premium to its share price. The HP Touchpad has barely been on the market for a month. The announcement probably signals the inglorious end of Palm, which HP bought last year for $1.8 billion before phasing out the brand.

Sales

The University of Chicago Medical Center will implement Omnicell’s Inventory Management Carousels with WorkflowRx software for inventory management and Omincell’s automated dispending system.

Imprivata announces that 12 Siemens customers have chosen its OneSign single sign-on.

Stamford Hospital (CT) will implement SmartRoom technology in all of its patient rooms, which provides real-time patient and RTLS information on an in-room monitor and provides touch-screen documentation capability. SmartRoom was developed by UPMC, which owns the company.  

Evergreen Healthcare (WA) chooses Cerner clinical systems.

People

 

Healthcare software vendor Net.Orange names Rob Beardall MD, MPH as EVP/Chief Medical Officer and Troy Roth as SVP of solutions strategy. They come from Health Synectics LTD and MedAssets, respectively.

Paula Guy, CEO of Georgia Partnership for TeleHealth, joins the board of the Georgia Health Information Exchange.

Announcements and Implementations

Arkansas critical care hospitals Piggot Community Hospital, DeWitt Hospital, Delta Memorial Hospital, and Chicot Memorial Medical Center select Healthland.

Nine hospital systems in Western Pennsylvania partner to create the ClincalConnect HIE. dbMotion will supply the infrastructure for the $4 million project.

The radiology department of University of Utah Health Care reports that its use of artificial intelligence resource management software from Allocade reduced overtime cost by 90% and overall FTE expenses by 10-15%.

Miami-based EMR vendor CareCloud says it has tripled headcount in the past year to 80 and will bring on another 30 employees by the end of the year.

Government and Politics

The VA issues an RFI for cloud-based collaboration tools for its entire workforce. They plan to pilot document sharing and calendar applications with 5,000 physicians, potentially replacing Outlook and Exchange, SharePoint, and Jive Software for all of their employees if the pilot is successful.

Other

I got an earful from my doctor and his office manager today about their “horrible” EMR. Since purchasing it a year and a half ago, they’ve suffered through performance issues, upgrades problems, inadequate templates, and many unexpected expenses. The Meaningful Use money, which they’ll receive this month, covers the EMR’s cost but not the $10K per year for maintenance. The doctor blames the vendor, which has been around for less than five years, for releasing an immature product. I checked their Web site and it looks like the latest and greatest. I wonder how often providers opt for bleeding edge, only to later regret not buying the tried and true option?

Here’s a video showing the Texas Health Resources group that climbed Mount Kilimanjaro (including Ed Marx) opening a medical clinic in a Tanzanian village a few weeks ago.

A drug company’s laid-off IT tech pleads guilty to extracting his revenge by wiping out most of the company’s electronic systems while he still had access as a contractor. The drug company lost e-mail, inventory systems, and payroll capabilities, crippling it for several days at an estimated cost of $800K. The tech faces 10 years in prison.

The FBI subpoenas Parkland Memorial Hospital (TX) and its IT department, seeking records related to a former Dallas County commissioner and a telecommunications system business owned by a close friend. According to the Department of Justice, the investigation involves “allegations of public corruption, tax evasion, and money laundering.” The telecommunications company got $3 million worth of consulting work from Parkland and UT Southwestern Medical Center. Another of its customers, the local toll authority, paid $47,500 for a no-bid consulting report that basically said “your equipment needs to be replaced” and included graphics lifted directly from another company’s 12-year-old product manual.

In Ireland, an interim examiner is appointed to review three hospital software vendors that have claimed insolvency, putting the electronic records of 10 million patients at risk. The companies operate under the name IMS Maxims.

French software vendor Atos Healthcare, whose software is used in England to evaluate disability claimants, investigates two employees (one of them a nurse) for their Facebook comments about those claimants, which they characterized as “down and outs” and “parasitic wankers.”

Sponsor Updates

• Intelligent Medical Objects and dbMotion will participate in the Allscripts Client Experience next week.
• MEDSEEK’s eConnect HIE technology successfully connects the WNC Data Link (NC) HIE to the VA’s VistA.
• UCare selects RelayHealth’s Payer Connectivity Services (PCS) for its 230,000+ members.
• API Healthcare will exhibit at the ASHHRA annual conference in Phoenix next month.
• Healthcare Innovative Solutions VP Daniela Mahoney, RN, will present Best Practices in CPOE Deployment Strategies, and Physician Resistance, Adoption and Value Proposition at the Kansas Hospital Association: Meaningful Use Summit, and Executing Key Plays: How Team Members Must Adapt to Succeed at SC Hospital Association the TAP Conference.
• TeleTracking Technologies is offering a free Patient Flow symposium in Raleigh, NC next month.
• Nuance Communications unveils Dragon Medical Practice Edition, which targets the needs of physicians in practices smaller than 25 providers.
• OptumInsight’s Axolotl EMR Lite, version 9.2 receives ONC-ATCB certification as a complete ambulatory EHR.
• A healthcare claims review company implements Symantec’s PGP Whole Disk Encryption to meet HIPAA requirements, claiming a one-month payback period after switching from free encryption software that was killing employee productivity.

EPtalk by Dr. Jayne

I returned home from my most recent sojourn to find the only thing I hate worse than filing my taxes or a root canal — a re-credentialing packet for my hospital privileges. Despite our health system’s large IT department and our belief that we are high tech, the credentialing process is decidedly low tech.

When I was a practicing physician, my practice manager took care of the application and applied sticky flags to areas that needed review or my signature. But now that I’ve crossed to the dark side of information technology, there’s no one in my organizational tree who has any idea how to do these, so I have the pleasure. I think next year I might just ask my former staffer if she’d be willing to do it for cash (as an independent contractor, of course — I’m not about to run afoul of the IRS.)

Under the 26-page “standard” credentialing form was an additional 22 pages of forms to be completed. They had been photocopied so many times they were practically illegible. Lurking at the bottom of the stack were several nearly identical sets of privilege forms for the different hospitals at which I am on staff, one for each facility (heaven forbid they share information from a central repository or from the master application itself.)

I find it slightly humorous that I still hold privileges for OB labor and delivery as well as operative circumcision despite having not performed either procedure in quite some time. Oh yes, and I can also pierce the earlobes of inpatients if I so choose.

In addition, they want a copy of my Curriculum Vitae and documentation of my Continuing Medical Education hours, which along with everything else has to be returned on paper and by mail. Seriously. Everything else we do in the hospital is electronic – CPOE, patient recordkeeping, even patient meal selections done on a touch-screen at the bedside. Except this.

When it comes to the concept of ensuring that physicians have accurate and up-to-date data before approving them to start or continue seeing patients at a facility, we’ve gone back to 1956. (Actually, 1956 was probably easier – you could most likely have just hung your diploma on the wall and started seeing people.)

If this would have been an online process, I’d have knocked it out right away while lounging on the sofa with some quality Netflix and recuperating from my travels. But instead, it goes on the dreaded ‘pile’ somewhere between the bill from the local lawn care guy and the student loan payment coupon, both paper-based businesses.

Turning to health IT news, legislators on the House Energy and Commerce Committee have asked the Government Accountability Office to review Federal Communications Commission efforts to ensure the safety of wireless medical devices. Their request featured discussion of the recent demo where an insulin pump was hacked and hijacked. As I was reading this piece, I envisioned a flashing “As Seen On HIStalk” seal of approval.

Finally, a reader question. It’s been a long time since we have had one and I do enjoy them (hint, hint).

Dear Dr. Jayne,

Is the new Chest-Compression-Only method of CPR taking hold, or is there some resistance to it? I still see classes offered in the older method and have to wonder… why? What do you think?

Breathless but Hearty

Dear Hearty Reader,

I think overall, more data is needed. When I completed my certifications for CPR and advanced life support (both cardiac and trauma) as well as pediatric life support a few months ago, traditional CPR was required. The American Red Cross issued a statement last year about compression-only CPR, stating:

“…Compression-Only CPR until an AED [Automated Extermal Defibrillator] is available is an acceptable alternative for those who are unwilling, unable, or not trained to perform CPR.”

I tend to agree with them. The idea of CPR is that you want to prevent brain death, and unless you’re oxygenating the blood by getting air into the lungs then circulating it with compressions, you’re not going to be as successful if oxygen levels remain low.

On the other hand, if it’s the difference between CPR not being done because a bystander isn’t sure how to do it correctly or is worried about communicable diseases or some of the more unpleasant side effects of bystander CPR, then I think compressions alone are better than nothing.

The American Heart Association offers a trademarked “Hands-Only CPR” method that’s demonstrated on their website. I like their bullet point: “Don’t be afraid. Your actions can only help.” Regardless, knowing the legal world, I offer this advice — if you’re trained in traditional CPR and have no other reason not to do it, traditional CPR should be your first choice. I’d hate to get into a “standard of care” discussion on this one.

Jayne

Have a question about LOINC codes, the Russell Viper Venom time assay, or whether snakebite extraction kits really work? E-mail me.

Contacts

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

CIO Unplugged 8/17/11

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

Connect.

One thing that differentiates top performers from peers is neither skill nor experience — it’s talent. One key talent is compassion. Top performers connect their skills with compassion. They link their hearts to their brains. Connection is the difference maker.

As a leader, how do I help make that connection for my team? How do I create an environment where we can cultivate compassion? How do I help them view their job as more than a paycheck, but as a contribution to a patient’s life?

A motivational speech might spike emotions for a day or two, but I need something with a longer half-life. I need an approach that transcends mental understanding, a connection so strong that synapses will rewire and link the brain to the heart and infect the soul. Forever.

The single most effective method I have leveraged is what I term Connections. I have employed Connections for eight years, at two different organizations. The remarkable happens when you remove the physical barriers between clinicians and those who support them.

A programmer’s heart changes when he sees the impact of his code on a patient. When a service desk agent sees the face of the physician she’d helped navigate through the electronic health record, her heart expands. Sympathy awakens in the data center engineer when he learns from a nurse that patient outcomes improve because of the technology delivered with zero downtime. And an administrative assistant understands the urgency of communication when she personally witnesses the life and death stress.

Our brains tap into our hearts. Compassion-infused work follows.

Outcomes

• The clinicians who are shadowed learn more about technology. They learn that we care and that they have this incredible support structure surrounding them. This aspect is almost as beneficial as the Connections themselves.
• Relationships develop and then are cultivated, creating a family-oriented culture.
• Respect from operational leaders increases because they see that you care enough to take such action.
• While not scientifically validated, there appears to be an overall correlation between organizational outcomes and Connections.
• As Connections form, employee engagement rises, creating and nurturing new talents.

Employee Transformation Testimonies

• “I must admit, I hated this idea but did it because I had to. I have worked here for 20 years and for the first time I realized we have patients. Of course I knew what we did as a hospital but really, this was incredibly impacting and I will never be the same.” (Programmer)
• “I am not the same today as yesterday.” (Network Engineer)
• “I volunteered to observe in the OB unit. With clinician and patient consent, I witnessed the birth of twin babies. I never realized all the behind the scenes coordination required and it opened my eyes to a whole new world.” (Admin Assistant)
• “I never saw myself as part of the patient care process until now.” (Field Support)
• “My life is changed. I always wanted to be care giver but didn’t like blood so chose a different path in technology. Now I tell people I am both.” (Application Analyst)
• “I run marathons. I was more exhausted shadowing a nurse today. I never knew.” (Project Manager)
• “In one day I witnessed the joy of healing and the pain of death. I now see how critical IT is and why we need to be the best that we can be to support the front lines.” (Business Analyst)
• “I am a nurse and did not see why I had to take part in Connections. After today, it was like I was hit by a ton of bricks! Wake up call! Thank you, thank you, thank you.” (Application Analyst)
• “The experience is another reminder that the bigger picture of our health system, being a body of entities, departments and individuals, come together for the patients to have one more beat of life.” (Data Center Operator)
• “The experience was one that I am very thankful to have participated in and I can’t wait to do it all over again next year.” (Application Manager)
• “Patient care was the core focus of every area. It was really great to see the patients and what we really work for. Connections reminds us of what is truly important and why we do what we do (Security Analyst)
• “There is a lot of new technology on the floor and it’s cool to see how all the parts fit together to make the whole. People working with people and technology involved to make health care better.” (Business Analyst)
• “This is my second Connections, and every time I get a much more vivid idea of how my contributions and duties make a difference and reaffirms the promise to our community and the people we serve.” (Data Center Operator)
• “Clinicians are the reason we all have jobs, and I thank them for all of their hard work.” (Business Applications Manager)
• “It was very educational for me to see what the nurses and physicians do and how they use technology in their environment. It’s always a good thing for people working in technology to understand the business they support. Glad I had the opportunity. (Data Center Manager)
• “I have worked at 4 different health care organizations in 3 different states and this is the first time I have seen a program like this. I am proud to work here.” (Application Analyst)
• “Given what I saw I can’t begin to imagine how stressful their work must be. We need to do everything we possibly can to make it less so.” (Vice President)

I love a great speech and giving out raises and bonuses. But evidence suggests these have fleeting influence on performance and certainly do not develop compassion. In fact, some studies indicate the enthusiasm over a raise lasts two weeks.

I speculate this is because money only engages the brain. Conversely, transforming a person’s way of thinking and view of themselves results in long-term effects and a new person. Even the hardest of hearts and the most gifted intellectual will begin to view things differently. Once they’ve Connected.

***Leave a comment and I will send you a simple 10-step process for successfully setting up your own Connections program at your organization.

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