News 6/10/11

Top News

ONC chooses ANSI for a three-year term as the Approved Accreditor (ONC-AA) of its Permanent Certification Program (ONC-ACB) that will replace the ONC-ATCB designation in 2012.

Reader Comments

From Cabrito: “Re: Meditech. I hear that customers upgrading to 6.0 are required to buy all hardware from Dell, pay Dell an enormous implementation fee, and pay ongoing fees to Dell for maintenance. If they choose not to do so, they have to pay Meditech to certify the hardware. This smells of the East Coast good ol’ boys club. Does 6.0 really require hardware that’s all that different from Dell or any other vendor?” I passed your inquiry along to Meditech and invited them to respond. The company’s response was, “No comment.” That made me think of the old Magic days, when you had to buy specifically programmed (and much more expensive) display terminals because it wouldn’t run on anything else. I would hope that’s not the case here.

From William Hanson MD: “Re: my book, Smart Medicine. Thanks for calling it out. I am indeed the CMIO at Penn now. I’m an avid reader of your blogs. Keep up the good work. Thanks, Bill.” I see Amazon has added “Look Inside” for the book and it’s an engaging read – Bill is a really good writer.

From the medical consumer’s standpoint, a generation of patients who grew up with Google, eBay, and Wikipedia will soon have access to comparably comprehensive, current information about medicine and its practitioners. They’ll be able to find best-performing doctors and hospitals in the same way they can now shop for best-buy electronics and credit card rates. The successful practitioner and medical systems of the future will be the ones that adapt best to the new patient, who was raised on universal information and immediate gratification.

From IT Director: “Re: HIStalk. Your site was instrumental these last few years to help me sort out the different HIS vendors and to see where the industry is now and where it is going. Our C-level has been mystified that I knew so much about the industry, largely thanks to you and Inga. HIStalk has a HUGE impact — don’t change a thing. Happy shoe wishes to Inga.” Thank you.

From Saul Revere: “Re: Paul Egerman, founder of eScription. Pretty strong language in claiming Republications are ‘incapable of simple arithmetic’ and ‘I have more money than I could possibly imagine.’ The problem is that his own math is perilously stupid — to plug the current projected deficit over the next five years by taxing those with more than $200K income, tax collections would have to triple.” The conservative site’s article makes a point that I somewhat believe: if a person or group wants everybody’s taxes raised to support some pet cause, why aren’t they voluntarily supporting that cause themselves by sending in their own extra checks to the Treasury? Still, these are liberals with huge incomes, so at least their proposal would hit their own personal bottom line. And Paul’s right: his windfalls from selling IDX to GE and eScription to Nuance have certainly given him all the money he’ll ever need and then some. He says the Bush-era tax cuts saved him over $10 million and he didn’t trickle any of it down, as was the case with most of the mega-millionaires joining him in the proposal. I don’t dislike their idea, but the problem is that politicians from both parties have pushed the country so far into the red that even the few billion dollars it would generate won’t help much, as you noted. I also see that Googling “Paul Egerman” still brings up my 2005 interview with him (one of my favorites) as #1 of 83,600 hits. I asked him about his Democratic politics back then and he gave a good answer (although in the interest of full disclosure, Paul sought me out at HIMSS years ago as Mr. H and he won me over with his friendly manner and by picking up the breakfast tab):

I grew up in a single parent home. We didn’t have a lot of money. In fact, it was before there was welfare, and I got my healthcare at a county hospital. Our family got by as a result of a lot of help from a lot of people, and I’m very fortunate that I’m to be a member of what I call the Winner’s Circle right now. It was a wonderful ride and I’m very fortunate that I’m able to do well. The reason that I have "blue state" political beliefs is that I personally know that I couldn’t have made it without the help of the government and lot of people. I think the Winner’s Circle should be expanded and other people should have that same opportunity that I had. I respect other people’s opinions and I keep politics separate from my business, but my involvement in politics is only because I’m interested in good government.

A representative from Dell e-mailed that the reader’s comment from Monday stating that Kootenai Medical Center’s Meditech system is hosted by Inland Northwest Health Services was incorrect. She says Dell is hosting that hospital on its MSite Meditech hosting solution, which has brought several hospitals live and has 40 more contracted.

From HIS Junkie: “Re: webinar. ONC is now competing with HIMSS, charging $100 for a webinar on HIT trends that other firms charge $1,000 for. I guess ONC is doing all they can to reduce the federal deficit. Maybe they should stick to fixing the mess that has been created with all the convoluted new MU regs.” The webinar is through National eHealth Collaborative. Most of their NeHC University offerings are free, but a few cost $100. If I ever leave my day job and free up some time, the first thing I’ll do is run some webinars and industry news and trends analysis. I have endless ideas, but zero time.

From Lula: “Re: AHIMA. I didn’t see that you ran the news about Alan Dowling.” I totally forgot since we had already run a solid rumor a week ago that the top AHIMA brass had quit and former CEO Rose Dunn had been brought back in some capacity. That turned out to be correct, as I expected: AHIMA CEO Alan Dowling exits after a little more than a year, along with COO Sandra Fuller. The “some capacity” for Rose Dunn is interim CEO. We heard some rumblings that the new folks had tried to implement some good ideas but stepped on toes in the process. Alan has impeccable credentials: master’s degrees in computer science and healthcare management engineering, an MIT PhD in health management and information systems, consulting experience with E&Y, and 35 years in the Air Force with a rank of colonel. Association work is probably quite a bit different than running a company, so maybe it just wasn’t a good personality fit.

HIStalk Announcements and Requests

This week on HIStalk Practice: new FAQs from CMS. The Louisiana Care Quality Forum REC designates Greenway’s PrimeSUITE EHR as a supported EHR product. Industry experts tell a Congressional committee that financial and regulatory barriers make EMR adoption difficult for small practices. IPAs could be coming back in vogue, thanks to the emerging ACO model. Take a tour of the HIStalk Practice site and make my day by  signing up for the e-mail updates.

Listening: new from Black Lips, fiercely independent, ragged Atlanta-based garage punk (think 1965 Rolling Stones with some Pixies and Dandy Warhols elements added). I wouldn’t want to be in the presence of either the band or their die-hard fans since I have a feeling both are seriously psycho, but the new CD is outstanding.

I mentioned that Mike Cemeno had been promoted from interim CIO to CIO at Waterbury Hospital (CT). That wasn’t the case: while the hospital’s newsletter introduced him with the CIO title, there was a line further down in the article noting that Mike and the executives featured with him were hired as interim management, which I missed. He and I have swapped some chatty e-mails — he hasn’t decided to apply and hasn’t been offered the job.

 Modern Healthcare is running its 100 Most Influential People in Healthcare poll. I keep hoping I’ll at least be nominated one of these days (especially given that Nancy-Ann DeParle is on the list and nobody’s heard of her since she took the supposedly high-profile White House health reform job), but until then, I found some familiar, HIStalk-friendly names that might be worth one of your five votes: Jonathan Bush (athenahealth CEO), John Halamka (CareGroup CIO), James “Kipp” Lassetter (Medicity founder), Ed Marx (Texas Health Resources SVP/CIO and HIStalk contributor), Deborah Peel MD (Patient Privacy Rights founder), Peter Pronovost (Johns Hopkins professor), Sunny Sanyal (T-System CEO), and Glen Tullman (Allscripts CEO). I’m sure I missed other friends of HIStalk in my quick skim down the list, but I’ll add them as I notice. I figure a tiny bit of Ed Marx’s influence can be attributed to his regular and well-received HIStalk posts, so Inga and I will bask in his reflected glory if he wins.

Thanks to Elsevier Clinical Decision Support for sponsoring HIStalk at the Gold level. The company is behind some well-known clinical content brands (Clinical Pharmacology, Mosby’s, OnFormulary, CPM Guidelines, and First Consult) and also offers Pinpoint Quality (clinical performance data analysis), Pinpoint Review (clinical surveillance), Clinical Measures (intervention and error documentation), Risk Navigator Clinical (predictive analytics), Risk Navigator Performance (provider care patterns for improved clinical and financial outcomes), Risk Navigator Provider (helps physicians analyze real-time patient information for care and communications), and quite a few more systems. The common thread is point-of-care technology and content that improves quality, safety, and cost-effectiveness. Thanks to Elsevier Clinical Decision Support for helping keep the HIStalk keyboards clacking.

Speaking of Elsevier, they’re accepting nominations for Mosby’s Nursing Superheroes, launched last month during Nurses Week. Four winners will be announced in October. 

On the Jobs Page: Meditech CPOE Consultant, Sales Executive – Medical Device Experience, Regional Sales Executive – NYC, Associate Regional Sales Executive. On Healthcare IT Jobs: Epic Lead Analyst, Ambulatory Clinical Analyst I, Director, Product Management, Clinical Healthcare IT Project Manager.

Acquisitions, Funding, Business, and Stock

Streamline Health reports a net loss of $281,000 ($.03/share) for the first quarter. That compares to a net loss of $1.18 million a year ago. Revenue was up 17% to $4.14 million.

A judge in Australia rules that iSoft will have to pay CSC $2 million US if the struggling company decides to sell to a different suitor. Former iSoft chairman Gary Cohen, who has said he wants to buy iSoft himself, says he is pleased with the judge’s decision.

Sales

LHP Hospital Group (TX) contracts with Conifer Health Solutions to provide patient access and business office services.

Wishard Health Services (IN) selects MedTouch to design, build, and integrate the health system’s patient portal and RelayHealth into a site. Patients can request appointments, view lab results, communicate with physicians, and access patient education content.

People

Former AHIMA CEO Linda Kloss joins the Precyse Advisory Council.

Announcements and Implementations

CliniComp completes a two-year installation of Essentris-EMR at 59 Military Health System inpatient treatment facilities worldwide.

Government and Politics

HHS and ONC introduce the Investing in Innovations (i2) Initiative to spur innovations in HIT. As part of the rollout, CMS awards Health 2.0 and the Capital Consulting Corporation $5 million to fund projects supporting innovations and to encourage HIT development using mechanisms like prizes and challenges.

The VA chooses Systems Made Simple and Technatomy Corporation to provide software development, support, and documentation for several projects of its EVEAH program (Enhance the Veteran Experience and Access to Healthcare).

Innovation and Research

Above is an interview with Orlando Portale, chief innovation and technology officer of Palomar Pomerado Health (CA), whose self-developed mobile patient information app was named one of 12 finalists in the I Awards for innovation in wireless and mobile healthcare. It’s an impressive app, judging from the screen shots above.

Technology 

WebPAX is awarded a patent for technology that allows a Web browser to display medical images stored in multiple geographic locations. The image management company holds several other patents that allow viewing diagnostic-quality images in a Web browser with full PACS capabilities. The Durham, NC company says its solution requires no client software, runs on any browser on either PCs or Macs, and is storing 180 million images online with 1,400 physician users. The technology is also used for clinical trials and physician training. I assume it was either developed for or used by Duke given the duhs.duke.edu address in the screen shot above.

Other

A report says that 76% of Fortune 50 companies are in healthcare or have health divisions. The same study predicts the health market will account for nearly nearly one-fifth of the GDP by 2019 and (optimistically) forecasts that 58% of small physician practices will roll out EHRs over the next two years. Perhaps more realistic: the mobile health market will grow from $1.4 billion in 2008 to $12.7 billion by 2014.

Weird News Andy can find no words to describe this story from England: a patient high on drugs and alcohol goes to the hospital ED for treatment. Employees decide he’s just drunk, so they leave him a corridor to sleep it off, with nurses stepping over him frequently. Ten hours later, a nurse finally checks on him and finds him dead. Security cameras captured video of employees dragging his uncovered body away like a sack of fertilizer.  

Nineteen people in western Pennsylvania are charged with high-tech oxycodone trafficking: they obtained doctor names, DEA numbers and license numbers from a Web site; created a computer prescription template; and put their own cell phone numbers on the prescription form so they could verify the prescriptions when pharmacies called.

Pfizer starts the first clinical drug study to be conducted over the Internet, with patient contact performed via Internet questionnaires, video, and Web pages instead of home visits.

Sponsor Updates

• Lehigh Valley Health Network (PA) will use T-System’s DigitalShare documentation system to support its on-scene emergency healthcare during this weekend’s 5-Hour Energy 500 event at Pocono Raceway.
• Siemens partners with Surgical Information Systems to offer the SIS Anesthesia solution to the enterprise healthcare clients of Siemens.
• Healthcare Informatics ranks MED3OOO 47th on its HCI 100 list of top HIT companies by revenue. Orion comes in at 64 and Capario earns the number 87 spot.
• Medicity is awarded a second patent on its Novo Grid technology for clinical information exchange.
• Tucson Medical Center and OptumInsight (Ingenix) announce plans to create a sustainable health community based on the ACO model.
• Central DuPage Hospital (IL) contracts with iSirona for its medical device connectivity solution.
• Sage hosts a June 28th webinar on Meaningful Use success, featuring two physicians who have already received incentive checks. Register here.
• KLAS ranks Encore Health Resources as one of the top two overall performers in the HIT advisory services segment.
• Nuesoft posts a video on FDA regulation of EHRs.

EPtalk by Dr. Jayne

Government Health IT reports that the Association of Academic Health Centers finds the HIPAA Privacy Rule’s disclosure requirements to be “excessive and burdensome” and requests an exemption for researchers.

Statistic of the week: fewer physicians filed address changes last year, possibly reflecting the impact of the economy on physician decisions to relocate or retire. American Medical News notes economic pressures and the state of the housing market as possible factors. Interestingly, plastic surgeons had the lowest move rate, approximately half that of family physicians. Although I do love medical data and working with it, sometimes working with statistics makes me crazy. It would be more interesting if they did it like baseball: left-hander Dr. Jones is 14 for 15 on successful colon biopsies with the Olympus scope, 15 for 15 with the Pentax. You could even have baseball-like trading cards for your favorite attending physicians.

Legislative Corner

Sometimes I get a little burned out on reading about healthcare legislation, specifically Medicare/Medicaid regulations, reimbursement, Meaningful Use, etc. Although it’s a key part of my job, it just gets a bit depressing. I decided to find out what other health-related activities our lawmakers are pursuing when they’re not trying to tell the IT department how to do our jobs. Here goes:

For my Southern friends, North Carolina lawmakers are debating the Youth Skin Cancer Prevention Act that would require minors to get a physician’s prescription for indoor tanning. It’s coming down to cancer prevention vs. parental rights. Since the pools are now open, what I’ve seen of the outdoor tanning habits of teenagers is extremely concerning. Makes me thankful that my “too much time at the computer” paleness will hopefully keep the wrinkles at bay.

Speaking of wrinkles, New Jersey may require a statement of medical necessity for Botox injections received by patients under age 18. Teens are seeking the injections in an attempt to prevent wrinkles. The issue “took on a new urgency” after reports of the so-called Botox Mom who injected her eight-year-old. Botox is a godsend for certain medical conditions; however, the cosmetic version is a big-time money maker. I’d like to see a requirement that anyone who wants to use Botox for wrinkle prevention has to demonstrate their commitment by slathering on SPF 50 every day (see above).

Not to be outdone by their neighbor, New York is considering a dress code aimed at reducing hospital-acquired infections. Neckties, jewelry, and watches would be banned under a “bare below the elbow” dress code. Although the evidence doesn’t seem to support their approach, I definitely worry about people who are less than great at handwashing because they are worried about getting their cuffs or watch wet. Personally, I’d like to see someone take aim at white coats — I’ve seen some nasty ones out there lately. Makes me want to keep coupons for the 99-cent dry cleaners in my pocket to hand out.

Finally, legislation with an IT twist. Florida’s new law to prevent physicians from asking about gun ownership in certain situations (HB 155) gets a new enemy: The Brady Center to Prevent Gun Violence. A lawsuit was filed this week that states the inability to ask about guns in the home prevents physicians from educating patients. IT staffers beware: even if the physician’s question is relevant to the patient’s care or safety, the law prevents the response from being entered into a database.

Contacts

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

Readers Write 6/8/11

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!

Note: today’s first article was written by the CIO of an academic medical center that will move to Epic once the necessary approvals are in place (not yet announced). I suggested drafting some thoughts about why Epic is so successful in that market, even with hospitals that had no plans to replace their existing systems. I thought the perspective of a CIO in the middle of that decision would be interesting since it’s hard for the rest of us to understand how Epic can be so consistently successful, and therefore tend to blame unspecified “Epic Kool-Aid drinking” rather than the real differences between Epic and its competitors.

Why Epic? Why So Many Decisions to Deploy Epic?
By Thoughtful CIO

As a nation of healthcare delivery systems, we seem to be selecting Epic in record numbers. I’m told that nine of every 10 decision-makers are selecting Epic.

It is astounding, but it is also rather obvious. Epic has become the market choice for many of us. And like many market swings, the causes are many.

I’ve given it some thought. I fully expect that many will disagree. This is just one person’s opinion.

In some ways (I hope you can forgive the melodramatic root cause), I think our focus on Epic and the need for tight integration and simplification of our environments might relate to the upcoming 10th anniversary of September 11. We are longing for a return to a simpler time.

It has been ten years since the “world stopped turning.” I think many of us are carefully revisiting where we have been and what we have accomplished since that September day. It might not be deliberate, but I think it is real, nonetheless.

We all refocused on the “main thing” back in 2001. It may have been different for different industries, but in healthcare, we decided we were going to make a difference. And I think we meant it.

Sadly, in spite of much hard work, and many system deployments, we are not yet achieving safe, efficient, and effective healthcare to the degree we all had hoped.

Here is some thinking out loud. 

1. In a world where healthcare decisions and information flows are growing increasingly complicated and are conflicting, our care providers are overwhelmed with complexity, burdened by too much not-always-relevant information, and are often interrupt-driven as they attempt to make decisions. It feels like chaos because it is. It’s a difficult balancing act. Many of us are longing for a simpler and safer approach to the management of information. We haven’t yet found it, and we worry that it is hurting our patients and making it more difficult to be a care provider.
2. Patient- and family-centered care is going to become even more critical in the world of individualized health and personalized medicine. This will require improved access to longitudinal patient records. It will necessarily involve and empower the patient to be an active member of the care team. It will soon be the only way to effectively and efficiently manage and allocate scarce resources. Targeted interventions and therapies will be the future of medicine, and information technology will be a critical component of the deal. But we are not yet delivering on the promise, in spite of many millions of dollars of investment.
3. To deal with this complexity, chaos, and the critical focus on the patient-centeredness, we are focused on minimizing the burden on our care providers and our patients. We want to collect data once, at the source, in the most user-friendly way possible. We want our data collection to be the by-product of care, not an added responsibility. And we want it to be easy to do. We have not yet found a way to achieve these goals in a meaningful way, at least not consistently.
4. Some current vendor-supplied solutions offer choices and options. They promise to be all things to all people. They rely heavily upon a provider-based organization to make wise decisions and “perfect decisions” in the midst of a very imperfect world. The decisions that must be made expect that there is clarity, when in fact there is not. We are not realizing increased productivity, lower costs, and more efficient care. In fact, many of our healthcare delivery systems are questioning the investments we have made and are not yet able to clearly define the benefits we had hoped to achieve.
5. Many of us have experienced implementations that over-promised and under-delivered. We trusted our vendor partners and some of them failed us. We then we failed our user partners. The systems didn’t perform well, the vendor was unable to deliver the rich functionality that was promised, the product didn’t scale, the developer didn’t listen, etc. Everyone loses, and we were parties to the losses.
6. Enter Judy Faulkner and Epic. There is no ambiguity! For more than 30 years, she has been crystal clear about her strategy and the strategy of Epic. The patient is at the center. The business of healthcare is about saving lives and managing information to support life-saving activities. No ambiguity. It’s about the basics, and she gets the basics right! From the beginning, what you see is what you get. No ambiguity.
7. Judy Faulkner and Carl Dvorak treat everyone the same. No deep discounts, no development partners. We’re all in this together. There is no ambiguity.
8. Judy and Carl have a healthy optimism about the future. They believe there are many opportunities we can leverage, but they never make a promise they can’t keep. They tell the truth. They do what they say they will do.
9. Judy doesn’t offer to solve problems she can’t solve. She is completely transparent and tells the truth, both when it is popular and when it isn’t. No pretense. She doesn’t need to be liked. She has a product that works, that scales, and is fully integrated. There is no ambiguity.
10. Judy also sells a product that works well. She provides the rules for how it must be implemented. Again, she eliminates the ambiguity. Follow the rules and everybody wins.

I’m not sure I’ve captured what I was hoping to capture. In summary, when I think of Epic, I think of a few words:

• Honesty
• Integrity
• Candor
• Trust
• Transparency
• Consistency
• Focus
• Commitment
• Patient-centered

These are words I hope folks will use to describe the work we all do in healthcare IT.

What Providers Need to Know about Patient Engagement
By Donna Scott

Given all the talk these days about patient-centeredness, is there really change afoot? Will the US healthcare system of the future really be built around the needs of patients? Or is “patient-centered” just another buzzword which won’t quite survive the complexities, the political realities, and the multi-faceted stakeholders in the great healthcare reform debate?

Well, I have been called an “optimist,” so you can probably guess my opinion on the subject. Yes, I believe that we are truly at the crossroads of change in the healthcare system in the United States. In spite of the complexities and difficulties ahead of us, the desire to implement new ways of managing healthcare in this country has never been stronger.

Regardless of what you think about the future success of Accountable Care Organizations or Patient-centered Medical Homes, there appears to be widespread agreement that US healthcare delivery needs to shift from a quantity orientation to quality of care and better outcomes. And better patient outcomes will be enabled by a much higher level of patient engagement across the healthcare industry. This shift toward quality outcomes and patient engagement represents both an opportunity and a challenge for providers.

Because of this shift, a small group of patient engagement enthusiasts and industry pundits were recently asked by The Institute of Technology Transformation to write a paper for providers about the current state of patient engagement. The objective was to offer healthcare providers a summary of the latest research that exists about patient engagement and provide some key points for their consideration as they embark on the healthcare reform journey. The Top Ten Things You Need to Know about Engaging Patients is the result of our efforts. The paper can be accessed here.

In summary: there is a lot of good patient research out there that our group has synthesized into the following key ten considerations for providers:

1. Providing Patient Education Online
2. Interactive Online Dialogue
3. Patient Segmentation
4. Role of Caregivers
5. Trust in Physicians
6. Consumer Mobility
7. Security and Privacy Concerns
8. Leveraging Inexpensive Tools
9. ROI of Patient Engagement
10. Changing Care Models

In each of these ten areas, we briefly discuss the research and the key learnings which are relevant to providers. In addition, we include four key recommendations for practical action:

• Walk the talk: set specific patient engagement objectives and measure them
• Champion your hospital’s social media strategy and assure mobility as a key component
• Pay attention to caregivers and do your homework on patient demographics
• Consider HIT solutions that already incorporate patient access and engagement capabilities

For some progressive hospital administrators, this information will simply affirm what they are already doing. For the others, we hope it will spark ideas on how to take their patient engagement strategy to the next level. Because the need for more patient engagement in the U.S. healthcare system will impact all of us, sooner or later.

Donna Scott is leader of the Patient Engagement Action Group for the Institute of Health Technology Transformation and executive director of marketing strategy for RelayHealth.

Twitter, Dogs, and Healthcare
By Ronnie James Dio

I see a lot of dogs out in public these days. They’re everywhere. People bring them to Home Depot and into Starbucks. Sometimes they’re peeking out of purses. 

I love dogs. I’d even go so far as to say I consider most dogs excellent judges of character. But I’m not wild about sharing my coffee and oatmeal at Starbucks with somebody’s dog right next to me. When I go to the grocery store, I don’t want to see a dog riding in the basket of the grocery cart. 

I went to the dentist the other day. Guess who’s hanging out by the reception desk? You got it — a big black Lab. Named Elliot, by the way, which I consider to be a decidedly un-dogly name. The look in his eyes said, “I’m begging you, call me Fetcher.”

I want some boundaries is my point. Just give me a shopping experience without dogs. 

Same goes for ubiquitous talk about social media. More specifically, Twitter. I really don’t care that Anderson Cooper of CNN on-air wants to tell me he’ll be tweeting during the broadcast. (I especially don’t like the word “tweeting,” while we’re coming clean with each other.)

Also, I don’t need software I use in my healthcare IT business to update Twitter with what I’m doing, as a contract management tool I have is dying to do for me. Just sent a contract out! Third one today!

I don’t say this thinking trade secrets could be disclosed. It’s much simpler: I’m just not that interesting.

And now that we have these two things on the table (too many dogs in public; I’m largely boring) I need to cover one more thing. I don’t find Twitter interesting or helpful for healthcare except, I’m sad to say, in a catastrophe such as an earthquake or tornado, where we actually learn things we couldn’t know otherwise. 

When tornadoes strike or a tsunami hits, Twitter can be indispensable. It can become a strikingly important tool for healthcare, if only to inform others where help is needed. When we least expect it, a hula hoop becomes a vital messaging tool.

Otherwise, it’s the dog in Starbucks, the thing I can’t escape that I actually don’t dislike, but I want to pick and choose my interaction with it. 

And just because there’s a tool that lets us share 140 characters of text with the world doesn’t mean it’s valuable. In the real world of healthcare, when things are not catastrophic, I’m arguing that Twitter is rarely helpful, and as parents can attest (via the attestation process) in the breezy “real” world teenagers move in, few have the slightest interest in Twitter. It interferes with their texting.

I have a very high professional focus on healthcare IT, so I typed in “healthcare IT” from the main Twitter screen. This popped up: 

We r letting d Tfare issue overshadow d aim of the damn lunch. It was a forum where issues of light, good healthcare / education were discussed.

Besides the fact that I find the phrase “damn lunch” funny, I have no idea what the post means, but I’ll bet a quarter it’s right at 140 characters. I’m also pretty sure there is no such thing as “light, good healthcare,” and I’m positive that you should be able to find “healthcare IT” in context when using an ever-present tool for social media.

So I put to you a simple question. Outside of emergencies or catastrophes, when does Twitter actually benefit healthcare? Who is helped, and how? 

I’m wide open to learning something here, but please answer in 140 characters or less. I’ll be back in touch after I take my dog to church, then out for a damn lunch.

News 6/8/11

Top News

Merge Healthcare acquires Ophthalmic Imaging Systems (OIS) for approximately $30.3 million in stock. OIS and its subsidiary Abraxas Medical Solutions offer EMR and PM products, as well as digital imaging systems.

Reader Comments

From The PACS Designer: “Re: Apple at WWDC. This week, Steve Jobs announced Apple’s next generation of products. The Apple iOS 5 will ship this coming fall and will support iPhone 3GS, and 4, iPad 1 and 2, and iPod touch third and fourth generation. Also of keen interest was Apple’s new LionOS operating system for iMacs, which will sell for $29.99.”

 From Roman DeBeers: “Re: Chuck Friedman. ONC’s chief scientific officer is leaving in July after four years.” Unverified. I e-mailed him to confirm, but he didn’t respond.

From Jim: “Re: speeding up HIStalk. I think you gave tips before. I’m a bean counter, so technically deficient. Any ideas? Love this resource!” Here we go: (a) I assume you are an IE user since it’s the most trouble-prone browser by far, so use the infinitely faster and better Firefox or Chrome browser instead, even if just for reading HIStalk; (b) if you can’t dump IE, upgrade it if you can since old versions (anything before IE8) are notoriously buggy and slow; (c) add the extension print to any HIStalk web address to view a bare-bones print layout that doesn’t include graphics, sidebar content, sponsor ads, etc. There are all kinds of browser options that can slow you down, which is another reason to like the non-IE ones – those browsers seem to work better without tweaking. 

From JC: “Re: Ingenix / Optum. Looks like they will be the winning bidder over GE to acquire HMS/MedHost. I hear it will become their EDIS of choice.” Unverified.

Acquisitions, Funding, Business, and Stock

Germany-based surgery software vendor Brainlab acquires Voyant Health, the Israel-headquartered vendor of the TraumaCad, OrthoWeb, and VoyantFlow specialized surgery planning tools for orthopedic surgeons. Voyant has also announced future availability of its VoyantLink cloud-based image exchange network.

CSC announces the launch of its Global Institute for Emerging Healthcare Practices with the stated mission of “monitoring worldwide trends, conducting regional and multi-country studies, and evaluating emerging operational practices and technologies that have the potential to improve performance of healthcare industries around the world.” I think all that marketing-speak is really just saying that CSC wants to be a bigger player in healthcare and having a name that includes Global Institute sounds very noble. Mr. H’s cynicism is clearly rubbing off.

Israel-based dbMotion builds up its presence in Australia as the government prepares to bid out big contracts for a new Personally Controlled E-Health Records system, which will allow all Australians to review their meds, immunizations, and lab results electronically. The program, announced a year ago, is a building block for the National Health and Hospitals Network and will cost $500 million US over two years.

Intel launches its AppUp hybrid cloud service that offers pre-packaged, subscription-priced applications to small businesses, but allowing those small businesses to store their data on their own local server. Allscripts was listed as a vendor whose applications will soon be added to the catalog.

McKesson gets sued yet again over claims that it conspired with Hearst Corp. to inflate average wholesale prices of drugs (AWP, also known as Ain’t What’s Paid since it’s a phony number of dubious value). This time, it’s Michigan doing the suing, claiming its Medicaid program overpaid pharmacy claims for eight years because of a secret McKesson-Hearst collusion to inflate AWPs via Hearst’s First DataBank drug database. McKesson has settled several related racketeering lawsuits for several hundred millions of dollars over this same issue, but an early estimate of the company’s exposure was $15 billion. Here’s my analogy: First DataBank published the equivalent of one of those baseball card price books that claim to survey card shops to find out what cards are selling for. Customers used the book for the unintended purpose of pricing their own cards (in theory, there would then be one universal price since all sellers would set the same price from the same book). States and other insurers, lacking a way to determine what drugs really cost but insistent on paying based on any kind of cost, even a totally phony one, latched onto AWP as a lazy substitute even though everybody knows that nobody pays AWP. The plaintiffs are like customers who bought baseball cards at the book price, only to find out that the book didn’t do their surveys very well, causing them to overpay for a Ken Griffey Jr. rookie card. McKesson’s role, if I’m remembering right off the top of my head, was minimal – FDB started surveying only McKesson to get the AWPs it published and McKesson says it was unaware of that fact, not to mention that there was no benefit to McKesson for inflating the prices anyway. My take: stupid buyers who overpay always blame someone else and expect to be reimbursed for their incompetence.

Sales

Health Management Associates contracts to deploy the MEDHOST ED solutions in 58 hospitals.

In Canada, CGI Group signs a seven-year, $50 million contract with University Health Network of Toronto to develop a shared diagnostic imaging repository.

People

Former national coordinator David Blumenthal is named chairman of the Commonwealth Fund Commission on a  High Performance Health System.

Former Yale-New Haven ACIO Michael Cemeno is named CIO of Waterbury Hospital (CT), removing the “interim” portion of his title.

Union Hospital (IN) promotes Kym Pfrank from VP of information systems to the newly created role of SVP and CIO.

Former WellSpan Health VP/CIO/CTO Buddy Gillespie joins infrastructure and hosting vendor Distributed Systems Services as director of healthcare solutions.

Dave Roberts, HIMSS VP of government relations and Solana Beach, CA city council member, is appointed to an HHS panel that will advise CMS and HHS on issues such as insurance outreach programs and helping consumers understand health plans.

Announcements and Implementations

Epic names Dell as its first Community Connect Certified Consulting Firm for EMR/PM services. The new designation is designed for service firms implementing Epic for affiliated physician offices and community hospitals on a shared EMR.

CAP, AHA, and Surescripts are recruiting hospital laboratories and critical access hospitals to participate in the Lab Interoperability Cooperative (LIC). It’s funded by a two-year CDC grant and aims to electronically connect hospital labs with public health agencies. It will be represented at the Healthcare IT Connect summit in Washington June 21-23.

Lee Memorial Health System (FL) goes live on its $70 million Epic system.

The use of AirStrip OB at Novant Health (NC) is profiled in an article in the Charlotte newspaper. The article also mentions AirStrip OB’s use in three Presbyterian hospitals in Charlotte, with an interesting angle: doctors are nicer to nurses when called in the middle of the night because they can immediately pull out their iPhones to look at the OB tracing in real time instead of getting impatient as the nurse describes what they’re seeing.

Government and Politics

Kentucky’s governor announces that two HIT-related companies have set up North American headquarters in Newton and will bring 20 jobs there: Arcron Systems (a Korea-based hospital information system vendor) and Meaningful Use Technologies. Despite the governor’s bragging, I think it’s actually one company with two lines of business. I couldn’t make much sense out of the Web site of the former (“With the help of our experienced professionals and years of reflecting clients’ opinions to our products, Arcron Systems strives to promote public healthcare and to facilitate understanding medical industries”) and the latter seems to be the implementation arm of the former. Arcron itself appears to be connected to the Hyundai Medis medical tourism company and the Hyundai Group conglomerate (shipping containers, securities, elevators, logistics, and other stuff, but not the carmaker, apparently).

HHS CTO Todd Park left his big athenahealth cash-out retirement in his 30s for government service because he was promised a role as “entrepreneur-in-residence.” He describes his job: “I have no budget. I have no formal team. I don’t control any government contracts. I don’t control any grants. It’s perfect, because it actually gives you the kind of freedom to maneuver, to really be a change agent.”

Innovation and Research

The Wall Street Journal covers Project RED (“Re-Engineered Discharge) that prepares inpatients for discharge and uses an animated “virtual discharge advocate” to provide instructions to patients and verify that they understand them. The program was developed at Boston University Medical Center, supported by grants from AHRQ, NIH, and NHBLI. Everything can be downloaded from its site.

Other

From last week’s e-Health conference in Toronto: the CEO of the Ontario Hospital Association makes waves by suggesting that physicians should be required by law to use EMRs and that paying physicians who don’t is an “unfair and inappropriate use of public money.” Meanwhile, the president and executive director of the Montreal Regional Health and Social Services Agency in Quebec blames poor technology for low EMR adoption rates, noting the systems are of little use to physicians or patients and that “we tried to create monsters and nobody wanted to use them.” Love those Canucks.

County-owned Singing River Health System (MS) gets approval to borrow $40 million to buy an EMR and to make unrelated improvements, although one county supervisor questioned why the two-hospital system would take out a 25-year loan for software that might last only ten years. I’m assuming its Epic since the hospital’s LinkedIn profile mentions an Epic project director.

A new book by William Hanson, MD of University of Pennsylvania School of Medicine went on sale Tuesday. Smart Medicine: How the Changing Role of Doctors Will Revolutionize Health Care discusses data mining, genomics, electronic medical records, telemedicine, and other technologies. I’m not clear on whether he’s CMIO there since it’s mentioned in some online bios, but not his own or that of Penn Medicine — those show him as professor of anesthesiology, critical care, surgery, and internal medicine.

The sheriff of Winkler County, TX (above left) goes on trial for helping a doctor (right) retaliate against two nurses who expressed anonymous concerns about the doctor’s performance to the Texas Medical Board. The nurses, who had worked at Winkler County Memorial Hospital for a total of 47 years, were fired and charged with felonies after the doctor asked his friend the sheriff to find out who sent the complaint letter about him. The medical board has placed the doctor on probation for four years; the nurses won a $750,000 settlement from the county, the hospital, and sheriff; and lawmakers passed a bill that protects nurses from retaliation when they are advocating for patients. The sheriff faces 10 years in prison if convicted of either of the two felonies with which he has been charged – misuses of official information and retaliation – plus a misdemeanor charge of official oppression. The county attorney and the hospital administrator were also charged and the doctor faces four criminal counts.

Sponsor Updates

• MEDecision will showcase is new Alineo and InFrame platforms at the 2011 Western EOC conference this week in Chicago and at AHIP June 15-17 in San Francisco.
• St. Joseph’s Health Center in Toronto selects Intelligent Forms Suite from Access for its electronic forms management system.
• Twenty-one Texas providers have received Medicaid EHR incentive checks for their meaningful use of the e-MDs EHR.
• Shareable Ink partners with Waiting Room Solutions to combine its digital pen technology with the EHR from Waiting Room Solutions.
• T-Systems will donate its T-Sheets documentation solution to the Texas Disaster Medical System, a collaboration of state and local public health agencies and providers that facilitates disaster planning and provides emergency response care.
• Jason Poteet joins Cumberland Consulting Group as director of business development.
• Cancer Treatment Centers of America selects Micromedex from Thomson Reuters for evidence-based drug, disease, toxicology, and patient education information.
• Radiology & Imaging Specialists (FL) contracts with GE for its Centricity OneView solution.
• Practice Fusion earns full ONC-ATCB certification from the Drummond Group.
• Ingenix announces that its transition to the OptumInsight name is complete.
• Wolters Kluwer Health releases a query tool to streamline the collection of quality data for the GI Quality Improvement Consortium benchmarking initiative.
• Spring Hill Primary Care (WV) contracts with Sage Healthcare Division for the Intergy Meaningful Use Edition.
• CHRISTUS Health picks MEDSEEK’s eHealth ecoSystem and ecoSmart solutions.
• UltraLinq Healthcare will donate an ultrasound machine and its UltraLinq solution to benefit Gift of Life International, an organization that coordinates surgeries for children with congenital heart defects. The donation is being made in connection with next week’s American Society of Echocardiography Scientific Sessions in Montreal.
• AnMed Health (SC) chooses Wellsoft’s EDIS to integrate with its existing McKesson suite of products.
• Nashville General Hospital will implement MyHealthDirect to connect its patients with appropriate providers.
• Danbury Orthopedic Associates (CT) chooses the SRS EHR. 
• Adena Health System (OH) chooses the eClinicalWorks EHR/PM and patient portal for its 150 employed physicians.

Contacts

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

Thomson Reuters to Sell Healthcare Business

News and information provider Thomson Reuters has announced that it will sell its healthcare business, which includes software and data products for clinicians, hospitals, and drug manufacturers. CEO Thomas Glocer said in the announcement that its healthcare business “lacks the integration with and global scale of our other units” and that proceeds from its sale will be reinvested in its core markets of financial, legal, media, and science.

Thomson Reuters is a publicly traded company with annual revenue of $13 billion and market capitalization of $31 billion. The company says the healthcare business generates $450 million in annual revenue, with a profit margin comparable to its consolidated 19.3%. Its products are used by more than 3,000 US hospitals.

Popular Thomson Reuters healthcare products include Micromedex (drug reference), CareNotes (patient education), ClinicalXpert Navigator (mobile patient information), CareDiscovery (benchmarking), CareFocus (clinical surveillance), Ascent (financial management), The 100 Top Hospitals program, and Clinical Performance Solutions (formerly Solucient and Medstat).

The company’s benchmarking database stores information from more than 750 healthcare organizations and is claimed to be the largest in the industry. Its MarketScan data warehouse contains information on more than 40 million unique patients. Thomson Reuters announced on May 25 that it had jointly developed a data and analytics solution with GE Healthcare to support population-based effectiveness and outcomes research.

The company says it expects the sale of the unit to close by the end of the year. Morgan Stanley and Allen & Co are its financial advisors.

We interviewed John Loyack, the company’s director of healthcare product management, in December.

Curbside Consult with Dr. Jayne 6/6/11

Lots of things going on this week, but one that caught my eye was decidedly low tech. The United States Department of Agriculture replaced the time-worn Food Pyramid with My Plate. Fruits and vegetables cover half the plate, with a circular dairy icon that looks a bit like a bird’s eye view of a glass of milk. Desserts don’t show up; neither do fats or oils.

I do think it’s a much more simple visual than the 2005 update to the food pyramid, which took a good idea and made it incredibly confusing and hard to teach to patients. (There have been multiple iterations of the food pyramid since its debut in 1992). The Washington Post notes that the new design “fails to direct consumers away from slathering their vegetables in butter or lard.”

What, you may ask, does this have to do with health IT? Potentially a lot. Look for targeting of obesity and other conditions that can be significantly impacted by lifestyle decisions to continue to be a major factor in healthcare reform, payment initiatives, and during the 2012 Presidential campaign. For the readers at the 20,000-foot level, that may not make a big difference.

But for the IT grunts in the trenches, look for more requests for reports in this area and for dynamic alerts and clinical decision support around these conditions. As more physician groups and health systems dip their toes into the Accountable Care Organization waters, look for “cherry picking” of desirable patients and “lemon dropping” of undesirable patients to increase. American Medical News reported last week on Florida physicians who are refusing to treat patients who weigh more than 200 pounds or whose body mass index indicates obesity.

Last month I talked a little about my support of the syndromic surveillance portion of Meaningful Use. On May 25, the Centers for Disease Control released a pre-solicitation notice that states, “there is a need for practice and technical standards that support syndromic surveillance using primary and inpatient care health data.” They are looking for someone to “identify messaging standards and information exchange architectures.”

The actual solicitation (RFP) will be posted on June 26, 2011 and will be open for thirty days. I suppose the cart went a little before the horse since providers are already going to have to test this to attest to Meaningful Use in 2011 or 2012.

Most of you are already aware that CMS has proposed additional “hardship exemptions” for providers hoping to avoid the 1% Medicare pay cut in 2012. One of these is for providers who may be in the process of adopting certified EHR technology that has delayed their implementation of e-prescribing. They recognized that these delays may have been due to the fact that the list of ONC Certified HIT Products didn’t start appearing until September 2010, whereas the eRx proposal went on public display in June 2010.

It’s always nice when the Feds admit that the right hand didn’t know what the left hand was doing, but it doesn’t give me confidence. Having trouble sleeping? You can read the proposal yourself here.

People who know me know I’m a shameless Netflix addict for a variety of reasons. Although I have several critically acclaimed films lined up for viewing, there is a part of me that likes mindless action flicks. This week’s pick was Unstoppable with Denzel Washington. Although most of the time I can see the plot on action films coming from a mile away, this one had some surprises and made a good diversion from the pile of technical reading I brought home with me this weekend. Have a movie recommendation, favorite ICD-9 code, or juicy CMIO rumor? E-mail me.

E-mail Dr. Jayne.

Monday Morning Update 6/6/11

From Cop Rock: “Re: Meditech 6.0 multi-facility. Steward Health Care was set up by Cerebrus Capital Management to run the six Caritas Christi hospitals it bought from the Archdiocese of Boston. Their Meditech 6.0 implementation will encompass all six hospitals, surely the largest implementation to date of 6.0.”

Another reader mentioned that the first multi-site 6.0 install may have been Kootenai Medical Center (ID), whose systems, he points out, are hosted by HIStalk sponsor Inland Northwest Health Services. That organization, via its Information Resource Management subsidiary, performs HIT work that includes an HIE, all kinds of Meditech services, and consulting related to ARRA, infrastructure, revenue cycle, and clinical processes. Not to mention the services they provide to physicians throughout the Northwest that include hosted GE Centricity apps, help desk, networking, desktop management, and e-mail services. Their latest newsletter is here. I figured I might as well mention them since I haven’t said too much about them lately and I keep forgetting that they’re doing cool stuff.

From Portnoy’s Complaint: “Re: Georgetown. Georgetown Memorial / Waccamaw Community Hospital is running Meditech 6.0, now live for one week at two hospital campuses about 30 miles apart. A few minor bugs remain to be ironed out, mostly with running reports from secondary report writers; also old scanned images from MT 5.0 are not viewable, but should be fixed soon. Some one-time patches run to fix problems at go-live with patients not crossing over have unfortunately resulted in those patients still appearing on rounding lists though they’ve already been discharged. No major meltdowns from physician staff during the transition. Meditech support staff were reportedly helpful and senior Meditech administration came on site to learn about the problems with implementation and they seemed genuinely interested in creating a better product. Kudos to CIO Frank Scafidi and his team for managing the transition.” Unverified.

From Mike: “Re: free PDFs from the National Academies Press. Here’s the press release. Everybody can now download their 4,000 reports for free.” Mike, who runs Meaningful Use Rule Consulting, listed some now-free HIT-related titles (the first thing I thought of was using them as texts for online courses):

• Digital Infrastructure for the Learning Health System: The Foundation for Continuous Improvement in Health and Health Care: Workshop Series Summary (2011) Institute of Medicine (IOM)
• The Future of Nursing: Leading Change, Advancing Health (2011) , Institute of Medicine (IOM)
• Innovations in Health Literacy: Workshop Summary (2011)
• Preliminary Observations on Information Technology Needs and Priorities for the Centers for Medicare and Medicaid Services: An Interim Report (2010)

From The PACS Designer: “Re: Windows 8. Microsoft has released details of their upcoming introduction of Windows 8, which is rumored to be available in the fall. The Windows Start screen will now be the method to access your most important features by using tile graphics and the touch feature everywhere instead of the icon clicking available currently for your existing applications. Additionally, it looks like Microsoft ported many of the Windows Phone 7 User Interface graphics to this new release to compete with the Apple iPhone.” My take is this: every other Windows release sucks. Think about the dog upgrades people paid good money for, like Windows 98 Second Edition, Windows ME, and Vista. Windows 7 was good, therefore history suggests being wary of Windows 8. I hope MSFT surprises me. I’m finally taking the plunge to Windows 7, replacing my two-year-old desktop PC with a model on sale at Best Buy for a price I couldn’t resist (my current one is a $349 barebones kit that I did myself, adding in the extra parts and Win XP from its predecessor). I hate to replace a relatively new PC, but I’m having odd lockups and the hassle and cost of reformatting to install Win 7 makes the replacement option attractive. I’ll keep the old one as a spare or maybe raid the good parts I added in, like the Thermaltake power supply. 

From Todd: “Re: CIO salaries. I remember seeing it on the site, but couldn’t locate it. Can you provide the link or tell me how you found the salaries? Thank you (as always) for your great site. I’m not sure why you keep your day job or how you pull off doing everything you do, but your work is sincerely appreciated wide & far by the HIT industry.” I really like my day job – not only is it interesting and challenging, I get to see what I do have a direct impact on patient care, patient safety, and clinician satisfaction and I would miss that. Plus, I work for a non-profit hospital employer I really admire, not like when I worked for the uber-sleazy for-profit hospital (that didn’t last long) or the clueless vendor (that lasted way too long). In both cases, I wanted to wear a paper bag over my head to work each day so nobody would recognize me. The CIO salary information (old) is here. You can look salaries up by finding the 990 form for a non-profit hospital – I use GuideStar or Foundation Center (sign up for a free account for the former). Search by organization name, choose the most recent 990, and then look under two sections: Part VII (highly compensated employees) or in the appendices. Sometimes the CIO isn’t listed because they aren’t on the highest paid list, or sometimes they’re listed by name and not title, or sometimes they pull a UPMC and form a separate management company to keep the public from knowing what they’re paying. Above is one from WellStar, which I randomly chose (I blurred the names because the CIO in question is an HIStalk reader, so I figure I owe him that). Sometimes you can find how much a hospital paid an IT vendor if that vendor is among their highest paid. In WellStar’s case, McKesson is #1, with $10 million in payments over one year. If a vendor’s 990 isn’t listed, they are required by law to provide you one if you ask (the same goes for HIMSS and any other non-profit).

Speaking of sticking with healthcare as a profession, two-thirds of survey respondents would. New poll to your right: is a proposed HHS rule that requires EHRs to log all access to patient records and providers to make those logs available to the patient on request a great idea that’s technically reasonable, a great idea that’s technically unreasonable, or just a bad idea?

Say hello to new HIStalk Gold Sponsor Ignis Systems of the ultra-cool city of Portland, OR. The company’s EMR-Link gives its 4,000 physician users an efficient way to enter lab orders, which is important since docs do that almost constantly. They don’t need to enter orders once in the EMR and again in the lab ordering system. In fact, they don’t need an EMR at all. EMR-Link does medical necessity and insurance checking, prints order sheets, prints ABNs if needed, and routes orders automatically to the correct lab based on insurance and location. Repeat what I just said about radiology orders, since EMR-Link also integrates radiology ordering into the EMR. Meaningful Use is all about interoperability and connectivity, while physician acceptance is about workflow — EMR-Link connects EMRs to lab and rad providers, but also connects orders and results to any HIE. Setup is in hours, not weeks, docs just work like they’ve always worked, and everybody gains efficiency and saves money. I found an excellent and surprisingly unbiased presentation from January on their site that talks about EMR expectations, ARRA, and integration. I was also amused at the fun executive bios (the CEO’s history: “Working for a 600-person company was too big; a one person company was too small. This seems just right.”) Thanks to the folks at Ignis Systems for supporting HIStalk.

My Time Capsule editorial from 2006 for this time around: Small Vendors With Good Ideas Can Carve a Niche In Healthcare. Other than a now-outdated reference to Myspace, here’s an amuse-bouche: “Build something that supports what healthcare users themselves want to do, not what someone else wants them to do. Sounds obvious, but think about CPOE, nursing documentation, and other software that forces change on users who don’t want it, often leading to fierce resistance and vendor acrimony.”

Reading the long-forgotten word Myspace makes me think of another former technology darling that’s now a head-scratching trivia question: Second Life. Remember when Cerner and all those “visionary” hospitals wasted time, money, and press releases sticking virtual worlds out there with no apparent awareness of how utterly ridiculous that was? Nobody was using the dog-slow Second Life except nerds living in their parents’ basement and pervs hoping for creepy simulated hookups. I criticized Second Life in 2007 and proclaimed it a goner a year ago: “I said in 2007 that I thought Second Life was clunky and pointless despite all the hospitals and webheads raving about how transformative it was going to be for business and consumer commerce. Maybe in a virtual world, but in the real one, Second Life parent Linden Labs is tanking. Predictably, Second Life proved to be as pointless for corporations as it was for everybody else.” I predicted the same outcome for Twitter in that post, so we’ll see if I’m as wrong about that as when I proclaimed Epic as irrelevant back in 2003.

I ran the first of several Innovator Showcase pieces this weekend. My volunteer panel of investment bankers and a provider chose a handful of companies from dozens that applied to be featured, looking at those that were small and innovative. Logical Progression was the first and I’ll follow that format for the others: company info, a quick read about what they do, a pitch video made specifically for the HIStalk Showcase, a customer interview, and an executive interview. It’s like being at a venture fair, but with the ability to research the company and product in a more leisurely fashion. I’ll follow up with Chris from Logical Progression in a few weeks to find out if anything has changed.

HIStalk turns eight years old on Wednesday. It’s hard to believe it’s been that long. I figure I work on HIStalk at least 40 hours per week, so that’s about 16,000 hours (and counting) that I won’t be getting back.

We ran a reader comment about e-prescribing vendors being pushed by practices to get them running by June 30 so they can bang out their 10 Medicare e-prescriptions to avoid a 1% Medicare penalty, while doing 25 electronic prescriptions will earn them a 1% bonus. e Interactive Universe is capitalizing on that rush, offering a system they say can be running in just a few hours, including online training. The company guarantees that the required volume can be met in less than one business day.

Shareable Ink sent over an advance copy of a press release going out next week that announces its partnership with Waiting Room Solutions. Shareable Ink’s digital pen and paper has been paired up with WRS’s ONC-ATCB certified small-practice EHR. Three customers of the package have already received Medicare incentive payments, one of them being Lawrence Gordon MD of ENT Specialty Care, who credits both companies with getting him to MU attestation so quickly (April 20) and with improving the health of his patients.

Here’s the latest HIStory from Vince Ciotti, with a personal history of the biggest name in HIT for decades, Shared Medical Systems (they were cloud before cloud was cool).

The use of AirStrip Cardiology at several Broward County, Florida hospitals is profiled by the local CBS TV station.

St. Luke’s Episcopal Hospital (TX) implements GE Healthcare’s Patient Care Capacity Management, developed at Mount Sinai in New York. From the announcement, it appears to be a combination of consulting services and the AgileTrac RFID tracking system for employees, patients, and equipment. St. Luke’s expects to save $10 million by using it.

The Institute of Medicine will hold its second health data forum this Thursday, June 9 in Bethesda, MD (it will be simulcast as well). The event will feature 50 companies that are building tools around government databases. Speakers include HHS Secretary Kathleen Sebelius, HHS CTO Todd Park, the CEO of Walgreens, the CTO of the VA, Aneesh Chopra, Tim O’Reilly, and others.

Rock Health, the cool new accelerator for Web-based and mobile health applications, chooses its inaugural class of 11 startups. Three are in stealth mode, but announced were (a) Brainbot – mental performance; (b) CellScope – home diagnosis; (c) Genomera – personal health collaboration; (d) Health in Reach – procedure marketplace; (e) Omada Health – clinical treatment social networking; (f) Pipette – patient monitoring and education; (g) Skimble – mobile fitness; and (h) WeSprout – connecting health data and community.

Florida Governor Rick Scott changes his mind about the proposed doctor shopper database he promised to kill just a few weeks ago, signing a pain clinic bill that will start it up on October 1. The bill also prohibits doctors from selling meds directly from their offices, calls for an automatic six-month suspension for doctors who overprescribe, and requires pharmacies and drug wholesalers to report suspicious drug usage. Interesting stated fact: 85% of national sales of oxycodone occur in Florida, often bought by middlemen who resell it to drug-stupored Appalachian hillbillies. Right after the bill was signed, federal authorities raided the office of an Orlando doctor who prescribed 303,000 oxycodone doses in one year, more than the entire state of California. Given the rampant Medicare fraud that Florida is also known for, perhaps the feds should just move all of their agents there in an Iraq-like surge.

Beth Israel Deaconness physician informaticist Shane Reti is conducting a New Zealand trial of the iPad 2 as a kiosk at which patients complete an allergy form and check the accuracy of the clinic’s allergy records. The information is sent to the doctor’s smart phone for review during the visit.

Citrus Valley Health Partners (CA) hires Paveljit Bindra as CMO/CMIO. He brings impressive credentials: cardiologist, Harvard undergrad and MD, Fulbright scholar at Oxford, Mass General and Penn residencies, and a Wharton MBA in both finance and healthcare management.

Bizarre: a teenager in China sells a kidney to buy an iPad 2 and an iPhone. The hospital in which the illegal surgery was performed said it wasn’t responsible since it had rented out its urology department to the businessman who arranged the transaction.

E-mail me.

Time Capsule: Small Vendors With Good Ideas Can Carve a Niche In Healthcare

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

I wrote this piece in March 2006.

Small Vendors With Good Ideas Can Carve a Niche In Healthcare
By Mr. HIStalk

A just-announced study found that Michigan’s CPOE adoption rate of about 10% is nearly double the national average. I thought about how I would read those results if I were a software vendor unfamiliar with healthcare. Would I see health care as a market ripe for new entrants? Or would I steer clear of what looks like a mature market with low potential for growth due to poor customer acceptance of the 10 or so available CPOE products?

Assuming for a moment that the market is attractive, how would I compete with the big healthcare vendors? I’d need a fast development cycle, reference sites, and leverage from existing technologies. That rules out applications like CPOE, ERP, nursing documentation, surgery, and patient billing. Those are long, ugly slogs for both the vendor and the customer.

Healthcare has a few products that enjoy high acceptance: PACS, laboratory systems, AP/GL, HR information systems, online clinical references, and wireless networking. Those require a lot of domain expertise and development, however, and those markets already have entrenched players. Pass.

As a vendor, I want to make money. Healthcare seems to be one of few industries in which vendors of expensive software still can’t turn a profit in many cases.

So what’s left? My best ally as a little guy is innovation. It’s uncommon in healthcare IT, whose longstanding culture is more mainframe than MySpace. That means I should:

• Build something that supports what healthcare users themselves want to do, not what someone else wants them to do. Sounds obvious, but think about CPOE, nursing documentation, and other software that forces change on users who don’t want it, often leading to fierce resistance and vendor acrimony.
• Create a product around off-the-shelf technologies that can be tweaked into a healthcare-specific package. By now we should have seen more healthcare applications built around office suites, voice over IP, Intranets, search engines, knowledge management, and instant messaging.
• Build something that isn’t stodgy and dead serious. Think Google or Skype instead of Invision or Star. When’s the last time you saw a “cool” healthcare application with devoted admirers?
• Sell your product shrink-wrapped, or nearly so. The last thing healthcare customers need is another cadre of consultants that cost more than what they’re installing.
• Price for volume, not the once-a-year home run. Lower prices mean shorter sales cycles and a lower level of approval authority. Market penetration means more opportunities for add-ons and upselling.
• Provide flexibility without customization or automate areas where processes are consistent. If you can build a system that even 20% of hospitals can use as-is, you’ll have more customers than you can handle.
• Target your decision-makers. Who has the influence needed to get your product in the door? In hospitals, that’s usually predictable (the nursing vice president — no; the finance vice president — yes). Can you reach them easily and explain your concept in a paragraph or two? Is the number of people affected small enough so that concerns about upheaval are minimized?

The Michigan study tells me to forget CPOE and carve myself a niche. The big vendors are locked in long, messy implementations of aging, high-ticket products, often trying to keep Wall Street and/or conglomerate parents happy rather than delighting customers with fresh thinking. Someone with good ideas and low overhead might be able to build a nice little business from the crumbs they drop.

HIStalk Innovator Showcase – Logical Progression 6/3/11

Company name: Logical Progression
Address: 125 Edinburgh Drive, Suite 210, Cary, NC 27511
Web address: www.logicalink.com
Telephone: 919.655.1970
Year founded: 2005
FTEs: 8

Elevator pitch
Logical Ink is a tablet-based documentation software solution that helps healthcare organizations improve their documentation and replace paper-based workflows with interactive, mobile, pen/touch-friendly electronic forms.

Business and product summary
Our core competency is providing healthcare organizations a patient and provider-friendly way to capture documentation in a mobile setting. We’ve been focused on the pains providers are having with the adoption of electronic medical records and the pains hospitals are having with eliminating paper in patient-centric settings such as registration and consents. Traditional approaches such as desktop and Web-based software have a miserable track record of success because of a number of factors. We address this with years of research, guidance from a number of physicians/providers in the industry, and a balance of technologies: our interactive forms platform, digital ink, handwriting/voice recognition, mobile tablet devices and sophisticated integration with existing clinical systems.

We provide a simple, monthly subscription pricing model that is based on the number of forms you submit through our document portal.

Who is your target customer?
Hospitals and medium to large clinics.

What customer problem do you solve?
We help hospitals fill the gaps in their EMR and more easily transition to electronic medical records with a provider- and patient-friendly solution. We eliminate paper forms while introducing eforms intelligence to validate at the point of care, capture clean documentation, feed the completed documents to the enterprise content management (no more manual scanning/indexing) and feed the captured discrete data to the clinical repository.

Who are your competitors?
Topaz SigPad solutions, Digital Pen solutions like Shareable Ink, Salar, Phreesia are all in our space (patient/clinical documentation and patient check-in) and doing good things. But paper and the status quo (traditional approaches to the EMR interface) are our biggest competitors.

Why are you better than your competitors?
In short, our technology, our approach (pen + tablet), and our people. We offer things you can’t do on paper, sig pads or digital pen: interactive forms with video playback, image capture and annotation, colored ink for emphasis, zoom in/out, in-place editing/erasing, drop-down lists, dynamically hidden form sections based on answers (e.g., mark pregnancy question as read-only/hidden if patient is male), dynamic form content (populate informed consent risks based on selected procedure), and popup instructions/tooltips.

Real-time validation at the point of care for missing dates, signatures, and values. We can lock down parts of a document based on security roles. We provide real-time integration with the EMR or clinical repository via HL7/ODBC to keep demographics, vitals, medications, allergies and orders current in the documentation. We’re active in CFR Part 11 compliance because of our work in clinical trials.

We are the only vendor focused on using tablets (Windows, iPad, Android) and pen-based input (along with traditional keyboard and voice). That means no paper and no wires so providers can remain bedside. We have over 30 years combined experience with enterprise eforms and mobile technologies. We’re experts in everything tablet.

Pitch video created specifically for this Showcase

Customer interview (the HIM manager for a large, prestigious academic medical center)

What problems have you solved using the Logical Ink technology and what has been the overall impact on the hospital?

As we were making the move to a fully electronic health record, we did an assessment of all of our documents within the record. We realized that we had several types of documents that our major systems could not support. The documents were in different care settings and completed by different role groups, but they all had a common denominator – they were documents that required a patient signature. Some of those documents were being scanned, but we knew that this was an interim step and were looking for something that could truly move us from a paper to an electronic record. 

We were additionally challenged with a highly decentralized environment where our clinicians have offices in several locations throughout the campus (or the state). When we we made changes to forms based on policy or regulatory requirements, it was very difficult to ensure that we had appropriate version control. Inevitably someone would still be using an old version of a form.

Finally, we wanted to make sure that documents were available when they were needed. Our environment meant that forms were sent via interoffice mail or faxed to the correct office after being completed. This inevitably led to delays in availability which led to bottlenecks in our workflow. 

The initial feedback has been quite positive from both the front end clinicians and the back office staff. The technology is easy to use and mimics paper. The output is crisp, clear, and the patients seem to love it. The decision support has been very helpful in ensuring that documents are completed before they are filed in our repository

If you were talking to a peer from another hospital, what would you say about your experience with Logical Progression?

The Logical Ink team has been great. From the start, they were constantly thinking about solutions to our concerns. We chose the procedure consent as our document to pilot. One of the key issues that we needed to resolve was how to provide our physicians with the flexibility and freedom to complete the document as they felt was appropriate while maintaining structure around document classification and content. Logical Ink worked with us to provide an innovative solution to the issue that made our physicians, our IT department, and HIS happy. They are still developing ways to innovate within our project parameters, the most recent example is embedding a video into a form to assist with patient education.

How would you complete this sentence in summarizing for them: "I would recommend that you take a look at Logical Ink under these circumstances:”

I would recommend that you take a look at Logical Ink if you need a flexible solution to complete your EHR migration which is capable of capturing patient signatures, handwriting, and integrating multimedia.

An interview with Chris Joyce, founder and president of Logical Progression

Tell me how your solution is better than digital pens.

We have really embraced a paperless forms platform that’s more interactive than the forms platform that you’d get with digital pen. We do share a lot of the natural user experience with writing your notes in the margins, capturing discrete data, just the familiarity that the physicians and the patients would have immediately when they see the interface. But obviously, when we put our forms on the tablet, we’re paperless, there are no wires attached, so that’s the immediate thing you notice.

Once you’re completing a form, we provide validation at the point of care. The forms platform will highlight required fields that have to be signed or filled out. If you try to save a form and you’ve got incomplete data, it will tell you there at the point of care, “The patient forgot to sign this,” or, “They forgot to date this” and you can correct it on the spot. You’re not having to wait until you’ve docked the pen and you’re receiving an alert after the fact. We think that’s pretty important for just cleaner documentation in general. It really doesn’t disrupt the physicians because they can quickly correct that and move on.

There are some little things like drop-down lists that can be dynamically populated from the clinical repository, pop-up tool tips for help instructions, color ink annotation on diagrams that can be pulled from a static library or even the camera on the tablet. Those are some of the major differences.

I believe overall, as you just get off of paper, the better off you are when it comes to archiving as well. Our electronic form in the source document. I’s the original source and we know when we archive that that we don’t have any extra pieces of information that have to go along with that.

I’ll ask you an investor-type question. Are any parts of your offering patented?

They are not.

You said you compete mostly with paper and traditional EMR interfaces. How hard do you think it will be to get customers to spend money on your product to replace those?

We have had some pushback historically because people expect our user experience to be baked into their EMR solution. Ultimately, that’s one of the reasons why we want greater exposure. I believe that they’re correct in a lot of ways that if you’re going to provide a mobile, physician-friendly module to your EMR, you should have an experience like Logical Ink in your product. We are, however, complimentary to that investment.

In practice, even though hospitals are investing a lot of money in electronic clinical systems, there are a lot of gaps that are left over. Not all physicians are created equally, so some will have weaker areas than others, but particularly in the areas where we’re extending the EMR to the patient in their documentation in intake and registration, in questionnaires — there are big holes there — but in the physician areas of the ED and the clinical documentation and the anesthesia record, those are just areas where the conventional approach is so frustrating and weak for the physicians that it’s a non-starter.

We get calls from ED physicians a lot that are looking at our solution because they’re very concerned about their productivity loss if they were to switch to a traditional-based system. We certainly recognize that we are providing something that a lot of the larger vendors should be providing just as general sensibilities for mobility and user-friendliness.

Do you think it will be hard to convince hospitals to trust a small company to provide and support technology that in many ways could be mission-critical?

We haven’t had that big of a problem there. Historically, IT and healthcare is risk-averse. The same could be said for clinical trials and the life sciences folks. It seems like the consumer tablet market and the Meaningful Use legislation has really reached a critical mass with that sort of forcing them to take greater chances, to get meaningful progress toward electronic records.

I think that the EMR vendors have been around long enough and their traditional approaches have been tried out. It’s not due to lack of money. I’s not due to the lack of not trying. It’s just there are some fundamental problems with their approaches and I think that there are going to be some vendors and some hospitals that will take those risks to go ahead and make progress.

What is the next level for the company and what will it take to get there?

We’ve been fortunate to have an explosion of tablets in the last year and that has obviously forced us to innovate. We were initially supporting Windows tablets only. With the introduction of the iPad and the Android devices, you’re finding that the platforms are very fragmented.

The software development platform is what I’m speaking to. We will continuously support the new, emerging devices and it will force us to also re-think some of our approaches. Traditionally we’ve been looking at a pen-based interface, whereas the new tablets don’t always come with a stylus. In some cases we’ll introduce Digital Ink to those platforms and use third-party styluses or we’ll make the forms platform more flexible for additional types of input, like touch, soft keyboard, that type of thing.

As far as business, what does it take to advance?

Our goal in participating in HIStalk and in this discussion is really to raise awareness. We want to, in the short term, get more hospitals to adopt solutions like ours just to be aware that they exist and just see the benefits of them.

I think ultimately from a business standpoint, we would like to partner with a large EMR vendor that’s ambitious and wants to address the mobility and the user-friendliness of their documentation solutions and integrate Logical Ink into that experience.

News 6/3/11

Top News

Primary care providers treating hepatitis C patients via videoconferencing achieved results identical to those of specialists at a university medical center, according to a NEJM-published study. The program was Project ECHO at the University of New Mexico Health Sciences Center. I interviewed Sanjeev Arora MD, the project’s director, in October 2009. I was impressed.

Reader Comments

From DrLover: “Re: DrFirst. Looks like DrFirst is being inundated with requests for people to enroll in eRx before the submission deadline of the end of June. What normally took them three days is up over a week. Thirty days left for providers to write 10 Medicare scripts to prevent 1% penalty, 25 scripts to get 1% bonus.” 

 From Kramer: “Re: AHIMA. Just about everyone at the top has left. What’s going on?” I haven’t heard much, although one source says there were internal conflicts after CEO Linda Kloss stepped down a year ago. Former CEO Rose Dunn has been brought back in some capacity (note: I erroneously originally assumed it was Linda Kloss who had returned, but not so). All unverified. I have to admit that the first reaction that both Inga and I had when we got your question was that HIMSS was taking over AHIMA, which isn’t the case as far as I know (but isn’t exactly a far-fetched scenario given the historically acquisitive nature of HIMSS).

From N.S. Sherlock: “Re: IBM’s Watson in healthcare. Did you see this? Very interesting.” Above is a video featuring Eliot Siegel MD, professor of diagnostic radiology and nuclear medicine at the University of Maryland School of Medicine. It’s one of two universities working with IBM’s Watson computer to identify potential healthcare applications. They say that Watson can, like a medical student, learn and then apply that knowledge through experience.

From Pogo: “Re: Healthcare Informatics top 100 vendors list. I bet you have more companies supporting HIStalk as sponsors than they do as advertisers.” Maybe. I eyeballed the list and counted at least 35 of the 100 that sponsor HIStalk, HIStalk Practice, or HIStalk Mobile (some haven’t been announced yet, but are coming soon). Thanks to my sponsors and congratulations to those who made the list. If I ever get the time to reflect, I’m sure I’ll be amazed that so many companies support some hospital guy’s part-time blog – it is truly humbling and there’s no precedent that I know of in Internet-land.

From Maia: “Re: ‘spurred’ customer. Perhaps their previous EMR vendor was Dude Ranch EMR.” An EMR vendor’s press release headline leads off with “After Being Spurred by Previous EMR.” Awkward phrasing for sure and there’s plenty more in the remainder of the release (the verb tense wanders aimlessly throughout). The practice mentioned is an OB/GYN clinic, so maybe they should have worked in an accompanying stirrups pun.

From Klara: “Re: six important letters. Something for you to make fun of.” And I shall: an unfortunate Logicalis press release touts the freshly earned CPHIMS credential of one of its managers as “like a PhD in HIT.” Like a mail-order PhD, maybe — you just have to pass a multiple choice test. No coursework, research, teaching, or real-life competence is required. The odd thing is that their employee, according to her LinkedIn profile, holds a master’s degree that’s worth a lot more than a CPHIMS certificate and they don’t even mention that fact.

From Sharky: “Re: Stage 1 MU. IDC Health Insights just put out a list of vendors who have helped customers achieve Stage 1 and Epic isn’t on it. Everyone assumes Epic has customers who have cleared the bar, but why haven’t we seen evidence of this?” I assume because Epic doesn’t do press releases. Note the highlight from the article you mentioned. It’s totally lame, even more so coming from a research company. Attestation started just over a month ago and I doubt many hospitals were ready (compared to small practices, anyway) and especially Epic shops since so many of them signed on in the past year or two. If you run Epic at your place (inpatient or outpatient) and have successfully attested, e-mail me and I’ll set the record straight. UPDATE: Sharky responder points out that the HHS Web site lists several Epic facilities that have already received checks: “Epic customers who have checks in hand include Univ of Wisconsin, Texas Health Resources, Rush in Chicago, Northshore in Chicago, Beaumont in Michigan and many EPs associated with them. Most of them for multiple hospitals. I’ve heard as much as 50% of the money went to Epic sites (that would need to be verified, but worth checking).” Ed Marx of Texas Health Resources confirms that they attested on the first day (April 18) and received their check quickly. I found the the CMS list of providers who have received checks here.

Some unverified responses to HITuser’s question about running Meditech 6.0 in a multi-facility environment: (a) two-hospital Georgetown Hospital (SC) went live a couple of weeks ago; (b) Steward Hospital (MA) is going live late this month on 6.0 and claim their Meditech people are telling them it’s never been done; (c) TheScoop says he knows of just one and it’s in Hawaii. Thanks to those who replied.

HIStalk Announcements and Requests

Listening: Green Carnation, because I’ve always liked them and I needed a shot of Norwegian prog metal.

Thanks to Lawson Healthcare of St. Paul, MN, joining our merry band of sponsors at the Platinum level. If you work in a hospital, you probably know about the company’s financial management, human capital management, customer relationship management, and supply chain management systems. Maybe you haven’t heard about their other offerings: the Cloverleaf line of data integration products, the Initiate patient and provider identity management tools, the MediSuite clinical system for Canadian customers, the recently announced Lawson Analytics for Healthcare, and the Lawson Enterprise Exchange HIE component line (clinical document exchange, clinical portal, and results delivery). Lawson’s healthcare-specific enterprise management products focus on critical hospital resources – people, supplies, and finances. A recent entry on the company’s Simplifying Healthcare blog mentions that its supply chain customer, the hard-hit St. John’s Regional Medical Center of Joplin, fully stocked its temporary hospital within 12 hours. Thanks to Lawson Healthcare for supporting HIStalk.

Your “things to do before or shortly after you die” list: (a) sign up for e-mail updates to your right, ensuring that you’ll get at least something potentially useful among all the spam; (b) cement our symbolic and symbiotic social media relationship by friending Inga, Dr. Jayne, and me on Facebook, liking HIStalk while you’re there, and connecting with us on LinkedIn; (c) send me news and WikiLeaks-like rumors; (d) treat the sponsor ads to your left with click-worthy admiration rather than jaded contempt since these companies not only see you as the powerful, influential thought leader and desirable demographic that you are, they also keep Inga in shoes; and (e) observe my offered high-five for being a loyal HISalk reader and don’t leave me hanging.

Jobs on the Job Board: Certified Epic Ambulatory Builder, Meditech Project Director, QA and Testing Specialist. On Healthcare IT Jobs: Healthcare EA Architect and Developer, Healthcare Software Product Manager, Implementation and Account Manager, ICD-10 Project Manager.

Acquisitions, Funding, Business, and Stock

The co-founder of Citrix Systems starts VirtualWorks, which sells technology that finds all versions of a file on any kind of storage system via a Universal Index. He says small hospitals are particularly affected by “data sprawl” due to virtualization, cloud computing, and use of mobile devices, but no affordable solution was available previously.

Sales

Health Sciences South Carolina signs an exclusive, sole source agreement with HalfPenny Technologies to participate in a demonstration project to share clinical lab data between members of the state’s REC.

Kingman Regional Medical Center (AZ) contracts for Craneware’s InSight Denials to manage its denied insurance claims. The product was developed by ClaimTrust, which Craneware acquired in February.

People

Quality Systems CEO Steve Plochocki is profiled in a Smart Business cover article titled How Steve Plochocki built a new operating model for Quality Systems. It’s pretty fascinating, especially if you’re interested in what was on the minds of EMR vendors as HITECH was being put together.

Patient outreach technology vendor Phytel names Patrick Flynn as CTO.

TELUS Health Solutions promotes Michael Guerriere, MD to chief medical officer, a newly created position.

Announcements and Implementations

Vital Images announces its VitreaView universal image viewer.

TELUS Health Solutions announces its partnership with Carefx to create TELUS CareShare, a set of cloud-based provider services that includes results distribution, electronic referrals, medical reconciliation, and care coordination.

Fujitsu’s annual technology symposium this week had a theme of consumerism in healthcare, featuring speakers from the VA, Stanford, Mayo, West Wireless Health Institute, Kaiser, Continua, and others. The company displayed its PalmSecure biometric solution, document scanners, electronic wait time signage, mobile monitoring, mobile phone wellness management, and Slate PC.

Government and Politics

OptumInsight (formerly Ingenix) CEO Andy Slavitt testifies to members of the Congressional Small Business Committee’s Subcommittee on Healthcare and Information Technology and presents low-cost recommendations to help small practices adopt HIT. He suggests creating standards for EHRs and HIEs, providing federal support for HIEs, providing legal protection for physicians in regard to privacy issues, extending small business loan guarantees for physicians, and continuing support of RECs.

HHS’s Office of Inspector General says it will recover $3.4 billion in the first half of the fiscal year as a result of its audits and investigations.

Four legislators introduce a bill to provide Meaningful Use EHR incentives to individual hospitals within a multi-campus system.

CMS designates June 15th and August 24th as National 5010 Testing Days, encouraging participation by all providers, clearinghouses, and vendors.

Other

 
 

 

A reader sent a report describing the work done by Mercy’s IT department when the tornado hit their St. John’s Regional Medical Center in Joplin, MO. Here’s a summary, beginning on Sunday, May 22.

• Sunday 5:41 PM – the tornado hits.
• 6:00 PM – Mercy Technology Services establishes two conference bridges, one for leadership and one for technical issues. Nobody at the hospital could be reached by telephone.
• 7:00 PM – servers were failing even though the network was up. Power had been shut off to the buildings, generators didn’t kick in, and the UPS finally died. A phone tree was set up to locate employees. Patient charts and a census were printed from Epic at the Washington data center (the hospital had just gone live with Epic three weeks before and none of that information was lost). Kronos time clock data was cross referenced to Lawson to get contact information for employees who had clocked in.
• Monday 8:00 AM – all 183 patients were accounted for and matched to their printed charts. Five patients and one hospital employee had died.
• Tuesday evening – satellite-based voice and data communications were in place at temporary treatment locations at a local auditorium and hotel. Epic was running in the auditorium. Groups from HR, finance, and other areas worked in assigned areas with IT support, including network access, printing, and applications.
• Friday – the tent hospital was in place.
• Saturday – 54 mbps radio-based connectivity was in place in the tent hospital. PCs and multi-function devices were in place on mobile carts. A network was running in the tent hospital, with three drops every four feet.

Thomson Reuters releases its third annual study identifying the top 10 US health systems based on quality of care, efficiency, and patient satisfaction. The list includes three-time winners Advocate Health Care (IL), Kettering Health Network (OH), and OhioHealth (OH).

The average clinician spends 122 hours per year trying to access various forms for EMR, according to a study sponsored by a single sign-on vendor. Without SSO, users require an average of 6.4 passwords to access clinical systems.

The MUSE conference is underway in Nashville. If you are attending and run across anything newsworthy, let me know.

Students at UC Merced are creating a telehealth program to address gestational diabetes, hoping to find sponsors to cover the cost of glucometers and software.

Mobile device management software vendor AirWatch gives Inova Health System $100,000 to fund three projects: a telestroke program, a study of how mobile technology affects inpatient physician productivity, and a pilot that will equip home health nurses with tablets. I mentioned the company in February after getting an impressive HIMSS booth pitch from a co-founder – their tools should give hospitals a lot of comfort in allowing mobile devices (including the always troublesome Apple ones) into the enterprise.

Strange: a company called Medical Justice gets doctors to put a “mutual privacy agreement” in the clipboard full of forms that patients sign, which then gives the practice ownership of any reviews the patient posts about it on sites like Yelp. The company claims it exists to give doctors a way (at $625 per year) to have fraudulent reviews taken down, but another critique suggests that the company also posts its own glowing reviews of its practice customers. The company says it’s not posting fake reviews, it’s just helping patients post their genuine reviews (the article claims all of those they post are five stars and the company won’t provide proof of their authenticity). I can’t imagine any other type of business trying to control reviews posted by its customers, not to mention that phony reviews would probably be posted by non-patients who would not have signed the form anyway.

Sponsor Updates

• Allscripts President Lee Shapiro joins the board of Medidata Solutions, a provider of development tools for clinical trials.
• AirStrip Technologies names former CliniComp president Alan W. Portela its new CEO. He replaces founder Gene Powell, who will remain as chairman of the board and a senior advisor.
• The University of Texas Medical Branch selects ProVation Order Sets as its electronic order set solution.
• ICA’s chief marketing office John Tempesco writes about cutting hospital administrative waste in a recent Business Edge post.
• St. Luke’s Hospital & Health Network (PA) chooses CareTech Solutions to provide remote 24/7/365 IT infrastructure monitoring.
• iMDsoft is reviewed in the recent KLAS anesthesia documentation report, which notes that 100% of surveyed customers said its MV-OR system is part of their long-term plans, with seamless interfacing with clinical and surgical systems being a strong factor.
• Nemours Children’s Hospital (FL) hires Orchestrate Healthcare to install Epic in its new Orlando facility.
• MED3OOO is hosting a free Webinar discussing Why ACOs Should be Physician Led that features Amit Rastogi, CEO and president of PriMed. Sign up here for the June 8th session.
• The Public Health IIM Syndromic Surveillance Interface olf Iatric Systems earns ONC-ATCB certification.
• University Health Systems (NC) wins Concerro’s 2010 Client of the Year ward for optimizing labor management through its use of Concerro technologies.
• Siemens Healthcare certifies BridgeHead Software’s BridgeHead MediStore as a medical imaging and full disaster recovery solution for Siemens SYGO uses.
• NCR Healthcare chooses EPX as its preferred payment provider, planning to integrate its payment processing functionality into NCR’s kiosk and patient portal self-service offerings.
• Awarepoint VP Chris Doran spoke at the VA-sponsored VHA Real Time Location Systems Conference this week in Atlanta, with a talk entitled “RTLS Technology Appropriateness.”

EPtalk by Dr. Jayne

Lots of buzz about cell phones this week. First, multiple media outlets, including the Wall Street Journal, covered the World Health Organization’s conclusion that cell phones potentially increase cancer risk. The agency’s International Agency for Research on Cancer reviewed existing studies looking at the effects of radio frequency fields, classifying phones as “possibly carcinogenic” and increasing the incidence of certain types of brain tumors. Other agents in the “possibly carcinogenic” realm include DDT, car exhaust, lead, and pickled vegetables. Bad news for most office types: coffee is on the same list.

Next, the Los Angeles Times reported that “cell phones used by patients and families are twice as likely to contain potentially dangerous bacteria compared with the mobile phones used by healthcare workers.” Samples collected included drug-resistant staph and other bacteria associated with hospital-acquired infections. A sassy comment on the Web site poses this question: if cell phone radiation can cause cancer, why doesn’t it kill the bacteria? I like the way he/she thinks. In the mean time, folks, wash your hands before using the phone!

More 5010 news as CMS schedules National 5010 Testing Day to be held June 15. For those of you who are close to ready for testing activities, this is your chance to work with clearinghouses, insurance plans, and Medicare contractors to make sure things go smoothly. For those of you who might be a tad behind, I found the Get Ready 5010 Web site to be helpful. Available webinars highlight action plans for both small and large practices and also cover how to work with clearinghouses and payers. The site is sponsored by the AMA, WEDI, HBMA, and AHIMA.

HHS has posted what some are calling a Wall of Shame that lists nearly 300 organizations (including payers, physicians, and hospitals) that have reported breaches of medical privacy affecting more than 5,000 patients each. I take comfort in reading that they weren’t all laptops, hard drives, or other IT-related issues — several organizations were cited for issues involving (gasp!) paper records. Check out the list – lots of prominent organizations appear and it specifies the type of breach whether it was theft, loss, unauthorized access, or hacking.

American Medical News reports that CMS is finally putting their money where their mouth is, unveiling three new Medicare ACO options to aid in the transition to this new care model. This “pioneer” ACO program would provide cash advances for organizations to set up and fund the care coordination needed for viability, assuming that the investment would be repaid through cost savings. It’s unclear what would happen if organizations gamble with the cash and don’t save any money. CMS will hold four training sessions, the first being June 20-22 in Minneapolis. A public comment period is open and you can weigh in at advpayaco@cms.gov and let them know what you think.

For those of you who are always looking for the “next thing,” keep in mind that we’re only a month away from the National Committee for Quality Assurance (NCQA) publishing their version of ACO rules. Due out in July, it will give those of us who have to digest, summarize, define, compare, and forecast some additional beach reading.

I’ll close by mentioning a piece I saw in Medical Economics. The print version was heartwarmingly titled What a rock star taught me about the practice of medicine (the online version unfortunately titles this Brief encounter with rock star influences physician’s career, an editorial.) Internist Gregory A. Hood of Lexington, KY talks about meeting Roger Daltrey of The Who and how being a physician played into his experience. It’s mostly a feel-good piece, but my favorite part is when he talks about being “an extremely fast typist” who can fly through the Ticketmaster screens while purchasing tickets. He attributes his success in scoring front row Daltrey seats to his EHR-honed typing, stating that “EHRs have redeeming features.”

That’s enough to warm my little CMIO heart (as if the heat and humidity across most of the country wasn’t enough). Do you have a story about your EHR’s redeeming features? E-mail me.

Contacts

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

Healthcare IT from the Investor’s Chair 6/2/11

Ask the Chair

 

My broker has found nothing other than the usual suspects and none of them are rated all that good. Would be interesting to have your investment banker dude weigh in on investing in a fund or a reasonable combination of individual stocks, with no promises or guarantees, of course.

I’m guessing that would be me, as both a former analyst-dude and I-banker dude. 

Here’s my view. While I used to make my living recommending stocks, I’ve come to the conclusion that buying individual stocks is nearly an impossible game to win. Why? There’s a theory known as Market Efficiency, which basically postulates that all information known about a company and its prospects is already reflected in its share price.

Now clearly the readers of this blog know more about this sector than the average stock market participant (and are probably better looking and more fun to party with), but we’re talking about the market as a whole, ranging from little old ladies’ investment clubs to the likes of Raj Rajaratnam (the Galleon hedge fund owner recently convicted of insider trading).

As readers of my debut column will recall, buy-side and sell-side analysts spend their time scouring for “market inefficiencies.” In other words, seeking out stocks that don’t fully reflect their value. They do this by attending HIMSS; reading financial statements; talking to users, consultants and company management teams; and other forms of fundamental research.

Now clearly these market inefficiencies do happen for a number of reasons. Sectors go in and out of favor, companies miss (or exceed) their Street forecasts and are over-penalized (rewarded) as a result, or you just might really believe in what a company you use or saw at HIMSS is doing and so want to bet on them. (The key word here is “bet,” so please behave accordingly.)

Now that I’m done flaming about market efficiency (there’s no zealot like a convert), here’s what I do:

• First, my personal investment strategy is based around a core and diversified portfolio of low-cost index funds. That said, sometimes I just can’t help myself. That’s what a “satellite account” is for. If you want to “play” the market (again, notice the word we use), consider allocating 10-15% for that purpose. Mine is in my IRA so I don’t have tax consequences to worry about.
• Next, do your homework. You presumably have an investment thesis beyond just wanting to own HCIT stocks (e.g., love Cerner / athenahealth / Allscripts’ product at my hospital / medical group; Jonathan Bush has a great sense of humor; I use ePocrates every day; etc.)
• Watch the stocks you’re interested in and look at their valuations relative to other sectors, each other, and their history. I’ll note that these stocks have had a great run over the past few years and, in my view, the easy money might have already been made.
• If you can, try to obtain some analyst reports. At the very least, check the company’s SEC filings.
• If you determine that there’s a good buying opportunity, for whatever reason, place your trade and hope for the best! I’ve traded these stocks for my own account a few times, with generally good, but occasionally horrid results – your mileage may vary!

If you’re bullish on the entire sector, one idea might be to divide your HCIT portfolio across a number of stocks to diversify away some of the company-specific risk. As I used to say to portfolio managers who asked me to choose between two different competitors: remember, you’re not selecting the best system for your facility / practice, you’re buying pieces of paper that trade. There’s no reason you have to pick just one.

That diversification reduces risk is something even most economists agree on (though there’s the counter-view: “no guts, no glory”). Just don’t put next month’s mortgage payment or your kid’s college tuition into these stocks — they’re volatile at best! As an aside, the best book on investing I’ve ever read is A Random Walk Down Wall Street, by Burton Malkiel.

Did you attend the Health Evolution Partners’ Leadership Summit? What was it like?

For the second year, I was invited to attend this event in Dana Point, CA. While the conference began years ago as a Versant Ventures event, Health Evolution Partners took it over a few years ago. HEP is a billion-dollar private equity fund focused on healthcare, with CalPERS as its lead investor. As readers of this blog likely recall, the fund’s chairman is David Brailer, MD, PhD, the first “Healthcare IT Czar.”

(In the interest of disclosure, I should mention that I’ve known the good doctor since he was the T.A. in a class I took at Wharton while he as earning his PhD over 20 years ago. He’s been a friend and supporter ever since.)

I view this as one of the best work-related events I attend each year. As Dr. B said in his opening remarks, he asked his staff to find the best one hundred minds in healthcare, and about 400 showed up. The event included a number of panels on topics ranging from the future of for-profit hospitals to innovations in primary care, the emerging super-consumer, personalized medicine, risk-bearing medical groups, and more.

The speakers ranged from such luminaries as Michael Dell and Todd Park (athenahealth co-founder, now CTO of HHS) to CEOs of corporations of varying sizes to policy wonks and, truthfully, ranged a bit in quality (as is ever the case). I’d give them a B+ (as high as I ever grade panel events, btw).

Beyond the panels, however, were several other aspects of the event that made it extremely worthwhile. Friday afternoon had two noteworthy components. First, was “strategy sessions,” where senior executives from companies ranging from Kaiser and Optum (fka Ingenix) to Pfizer and Oracle shared their visions and strategies in a small, boardroom-type setting. This was the first time I’d heard the Optum viewpoint and strategy actually expressed, and I walked out nodding my head in agreement with much of it (though the devil and valuations are clearly in the details).

Finally, the event concluded with a round of “speed dating,” where a number of innovative companies were given short sessions with a range of sponsors, including large vendors, health systems, and funders. In effect, HEP is trying to use this “Innovation Network” to bring the smaller (often more creative) companies together with the execs of the larger (always better capitalized) companies to find some areas of potential common interest and, hopefully, accelerate the pace of progress.

As an observer, it appeared to be an outstanding opportunity for both sides, though I do wish there’d been a way for people in neither group (such as this author) to participate.

Best of all, the quality of the attendees and the networking events were simply outstanding, really the best of its sort I attend. There was a great deal of card swapping, as well as reconnecting going on. A highlight for me was a casual introduction I made between two ST Advisors’ clients and learning that one was on the board of a hospital which was in need of the type of solution the other’s company provided! That kind of serendipity can’t be beat. I’m already looking forward to next year.

Ben Rooks is the founder of ST Advisors, a consultancy which has worked with dozens of HCIT companies and investors typically on issues around strategy, financing, and outcomes/exit planning. He enjoys food and wine, debating market efficiency, discussing healthcare, and most especially, reader comments!

HIStalk Interviews Howard Landa MD, CMIO, Alameda County Medical Center

Howard Landa MD is CMIO at Alameda County Medical Center of Oakland, CA and vice chairman at AMDIS.

 

Give me some background about yourself and about the medical center.

I got involved with informatics almost out of residency. I started putting a patient list on Lotus 1-2-3 back in the 80s. I really got involved formally in the mid 90s when I was at Loma Linda. We had a great CIO. I talked to him about how the systems didn’t work, so he put me on a committee to fix it. We had three physicians. Basically, I said, “Your system sucks” and he said, “No, your system sucks … here you go.” 

We did an evaluation and we chose Cerner. We implemented Cerner in the mid to late 90s. I left there in 2001 and started working for Kaiser in Hawaii. I’m a pediatric urologist, so I did pediatric urology for them part time and got involved with their implementation of a Kaiser’s homegrown solution at that time, which lasted a few years. It really wasn’t a great product. 

When George Halvorson became the CEO of Kaiser, which I think was in 2003, he looked around and said, “We’re a medical company. We’re not a software company. We should take care of patients and let somebody else design software.” We decided to implement Epic. 

I was one of the lead physicians implementing Kaiser’s first ambulatory attempt for Epic in 2004. That went very well and then I became CMIO in 2005. For five years, we finished up the ambulatory implementation and went live with practice management and inpatient.  

As we were finishing up, I started looking around for something else to do. Alameda reached out to me even before Meaningful Use was capitalized. They were looking for a CMIO. They looked around and said, “Well, look what Kaiser’s doing. Look what Sutter’s doing. Look at what everyone around us is doing. We don’t have anything.”

I joined them in the end of 2009 just after we went live with inpatient for Kaiser and cleaned that up. I’ve been working there for about a year and a half. I joined with a CIO who was in the active process of retiring. We got through six months of treading water, and then when Mark Zielazinski joined us as CIO, we really took off looking to what we were going to do, both inpatient and outpatient.

We decided to go with upgrading Siemens Invision — which was a system that we had and had a contract for a number of years left on it — and to implement Soarian inpatient. Siemens’ partner for the ambulatory space is NextGen, so we signed a contract in February to do the whole kit and caboodle. We are really just getting rolling with starting the workload discussions. I’m actually in Philadelphia taking the training classes.

How did you end up choosing Soarian?

We had the Invision system for all the ancillaries and order transmittal as well as financials, scheduling, and registration. About three years ago, Alameda got a grant to implement nurse documentation. The price that Siemens gave them they couldn’t afford, so they went with McKesson, who gave them a very sweet deal to put in nurse documentation with an eye towards replacing Invision or replacing all of Siemens products in the future if it went well.

We have nurse documentation live on Horizon Clinicals, which works reasonably well. We did a competition between the two. We had doctors look at it. We had a lot of the executives involved with it. Both had advantages, but we had a long relationship with Siemens, which had been stormy in the past, but had gotten much better.

From a financial position, it was the better decision. From the ambulatory side, Horizon Ambulatory was a very young product and very questionable, whereas NextGen was a fairly established ambulatory product. Even thought it was not integrated, it still had very good functionality and we went down that road. It was a very close competition, but finally we chose to stick with Siemens. I would say based on the last six months of negotiations and getting things started, I think it was the right decision.

You had an insider’s look at Epic at Kaiser being used on both inpatient and outpatient and now you’re working with Soarian plus NextGen. Do you feel that’s a comparable package?

I think that from a clinician user, physicians and nurses, I think Epic is an easier-to-use product. It’s a more integrated product. It’s a much more complicated product to build, but it’s a much easier product for the end users.

Soarian and NextGen are going to be simpler to build and maintain. They are a little clumsier. They’re a little more primitive than Epic. But I think that they still provide good functionality and I think they’re going to be easier to train and easier to use than the fancy stuff. The basic functionality, I think, is very solid in Siemens and Soarian. NextGen … I’m only just starting to get into, but so far what I’ve seen I’ve been impressed by.

You’re not giving up anything on the inpatient clinical side to go with Soarian from what you’ve seen?

As I said, I think Epic is a more mature product. It’s much more established. It’s been out there really being used in large places and small places. I think that we’re going to have some real work to make Soarian sing, but I think that the potential is there. I think it’s built on a solid foundation.

I think we’re finally seeing a lot of movement in Soarian. You know, for years there were just a couple of players out there who had it in place. Physician order entry was difficult. But the last year or two, we’re seeing a lot of people implementing Soarian. People going live with order entry. This has really been a huge way of that getting going.

Bringing on people like John Glaser and Marc Overhage is a tremendous comfort. People who really get where this needs to go. I spoke to John on several occasions about his vision, and as usual, John is dead on. I think those are great moves by Siemens in the right direction.

How do you feel about Meaningful Use and your readiness for it?

It’s part of our contract. I fully expect to meet Meaningful Use, probably just in time on the inpatient side, where we’re shooting for the beginning of 2013. It’s an aggressive implementation. We’re basically going to do all of inpatient and all of outpatient between a contract signing in February and implementation and go-lives that start early in 2012 and run through 2012 ending right at the end of the year. That’s a very aggressive take on it, but from everything I’ve seen so far, I think we can make it.

Do components like CPOE concern you?

You know, one of the things about Alameda — and probably the reason I joined — was it’s just an absolutely incredible physician staff. As I said, they were looking to put in a system a year or two before Meaningful Use was out there. That was one of the things that most attracted me. They really got it before the government said, “We’re going to incentivize it.” 

It’s an unusual situation to have a large physician group saying, “We want to do electronic documentation. We want to do electronic order entry.” It’s a residency-run hospital and several large residency programs. Residents and many of the attendings come to our office regularly with, “How come we’re so far behind? How come we’re not there already? How come we can’t do this?” 

That to me is the most exciting. I have very few people who’ll come to me and say, “I can’t believe we’re doing anything this stupid,” which you certainly hear in a lot of organizations.

I have to ask you about the hospital’s turnaround that was profiled in Fast Company. I’m really intrigued by how that’s going and how that impacts what you do. Can you describe the situation before you came and what’s been done to turn things around?

I think it really is a leadership and cultural issue. For years, it was a standard, old-fashioned county hospital. Most people’s take on it is that it takes care of the indigent. It takes care of people who don’t have any choice, so they can’t make the demands on the system. We had to just do the minimum and get along. Why push the envelope? 

Wright Lassiter came in and said, “There’s no reason it has to be this way.” The board was very enthusiastic about making Alameda County a real standout in the world of safety net institutions. He brought in Bill Manns shortly afterward as chief operating officer. Spent a couple of years really trying to get the finances arranged, get rid of old debt, really re-establish relationships.

Over about a 24- or 30-month period, he basically replaced the entire executive team. I’ve been there for a year and a half and I’m one of the more senior people. After Bill and Wright, there’s two or three people who have been around four or five years, but most of the executive team has been around for between one and two years. The chief medical officer came in two or three months before me. The CIO came in six months after me. The CFO and chief nursing officer came in the same time as Mark. The entire executive team is really brand new, picked from a large group of people who have been successful in their respective roles.

The idea that it’s a county hospital merely means it’s a county hospital. We’re looking to actively be a place that people want to come to, and at least on a quality basis and a care basis, compete with the Kaisers and Sutters and the health systems in northern California.

The quality metrics have really risen the last couple of years. Patient satisfaction is still low, as is not too surprising at a county hospital, but is increasing dramatically. The attitude of the front line staff and the executives is that this is going to be a different organization than your run-of-the-mill county hospital. They really want to be the flagship.

When you read that article, it almost sounds too good to be true. Is it really that dramatic and as much a function of leadership as it sounded?

It’s hard to say definitely since I wasn’t there, but certainly when I first came in, I saw some of the people who were in the positions before, especially the CIO. I understand how bad it was. The front line staff wanted to do the right thing, but had very little leadership and very little mentoring. The executive staff kept turning over, so nobody was ever really was able to take hold and create a culture of care quality and financial stewardship and pride.

The front end people definitely have a tremendous amount of pride in what they do, but I think the middle and upper staff in the past was really … it was just a job to them. The people providing care … it’s their community. These are their compatriots and there is a tremendous amount of pride and dedication to that community. You talk to the physicians — and I’ve worked at several county hospitals — and the usual attitude in one of, “It’s a job, I’m here, I’m taking care of people.”

This group is absolutely, incredibly dedicated to taking care of this patient population. It is such a pleasure to see and to work with. I think the leadership was the key, but I think you already had a number of good people, especially on the physician side and the front end clinicians and nurses, who really wanted to make it a showplace.

Are you getting interest from other places that want to know what you’re doing there?

Through the Safety Net Institute in California, which is the local extension center for the county hospitals, we’re meeting with the CIOs and CMIOs twice a year. We’re also actively talking about, since a number are going live with Soarian over the next year or two … we’re going to try to go down and help them with their implementations. We’re talking to Pomona Valley, we’re talking to Riverside, and Kaweah Delta. We’re taking about going down and helping them with their go lives, and they can come up and support us. Trading resources in more of a bartering system. Instead of paying outside consultants to come in for huge dollars, bring in people who really use the system who are in similar institutions. That’s the plan.

Do you think that the problems that the Medical Center had and the solutions that they’ve developed is a sequence that other hospitals are going to be going through with healthcare reform?

I think so and I hope so. It does take a leadership that is willing to take some chances and willing to really try to change culture, which as you know is far more difficult than implementing systems.

Healthcare reform … everyone talks about it and everyone says it’s coming. I’m still unclear exactly how it’s going to pan out and how we’re going to make it work. I think the system has to change if we’re going to manage to provide care to everyone in the nation, not just the indigent. The system is — I don’t want to say broken, although I think it is — but it really has to change to start paying for quality, paying for fair delivery instead of increasing the waste.

That’s one thing I learned working for Kaiser. When I was at Loma Linda, we had a large number of capitated contracts for urology. The Kaiser model of an Accountable Care Organization is where it needs to go. Alameda has about 30 or 40 percent of its patients that are county patients for which we are essentially capitated. We provide the care for a fixed amount and we need to provide ambulatory and specialty and hospitalization care for that group.

The better we take care of them, the better quality we provide, the more we do to keep them out of the hospital and keep them healthier, the better we’re going to do financially and the better they’re going to do medically. I’m a firm believer in that model. My years at Kaiser absolutely convinced me of that.

Other than the obvious applied informatics aspect of Kaiser, when you look at the analytics and information needed to compete and provide good quality outcomes, where do you think the industry is in terms of being able to use data to meet standards that someone will be setting?

I think the whole applied informatics piece is a dual approach. One is we need to be able to provide care and collect the information to take care of the patients in a structured format so we can report on it. Then the other side of it, having a structured data that we can take, review the actual data, and derive from that what is our best direction. How do we provide this care in an effective and efficient model? You need to have both pieces. 

I think we’re seeing proxies for quality now. We’re seeing a number days central lines are in place. We’re seeing a number of pressure ulcers that are avoided. We’re seeing those kind of things, which I consider proxies for quality. What we need to do eventually is come back and say, “Are we really improving the overall quality of life of people who we’re taking care of? Are we increasing lifespan? Are we improving quality of life? Are we doing it at a reasonable cost?”

Those are the kinds of things you really need the analytics to drive. We just don’t have the data at the front end. Where we’ve got these measures that are important, but they really aren’t what we’re trying to accomplish. They’re just proxies for it. The more data we have, the more structured data we can aggregate, the better we can actually ascertain what kind of bang for a buck we’re getting for the money we’re spending .

Any concluding thoughts?

I certainly thought several times before taking this position. There are significant resource challenges for a county hospital. It’s a very interesting place to work, but the people that I’m working with and the drive they have to do the right thing, in my perception, have really made it an incredible experience. I’ve been very happy there.

News 6/1/11

Top News

 

HHS issues a proposed rule requiring healthcare providers, health plans, and their business associates to maintain an access report detailing all disclosures of patient information within an EHR or accounting system. Providers must also record every EHR chart access, including details on who opened the patient chart, the date, and the time. The access report must be made available at the request of patients.

Cerner announces a two-for-one stock split, with a June 24 distribution date. Shares closed Tuesday at $120.10, valuing the company at just over $10 billion. Neal Patterson holds $512 million worth. Above is the one-year CERN share price (blue) compared to the S&P 500 (green).

Reader Comments

From All Hat No Cattle: “Re: HHS’s HIT certification. Seems like another needless scam.” ONC announces availability of six Health Information Technology Professionals examinations: (a) clinician / practitioner consultant; (b) implementation manager; (c) implementation support specialist; (d) practice workflow and information management redesign specialist; (e) technical / software support staff; and (f) trainer. ONC is offering vouchers to qualified applicants; otherwise, it’s $299 for the first exam and $199 for each additional. ONC pre-nicknamed the exams HIT PRO, which is trademarked for some reason. I’m not entirely sure what the point is – in the “Why Take the HIT Pro” explanation, they talk about a shortage of qualified HIT workers, implying that passing the test makes someone qualified. There are no educational or occupational prerequisites for taking the 125-question tests, although the target audience is the folks who have finished one of those short, ONC-funded HIT programs that community colleges offer.

From MadCow: “Re: Loma Linda University Medical Center. Pulling an EMR swap, from Cerner to Epic.” Verified. LLUMC’s board approved Epic last week, which will be rolled out through their entire system. Epic will replace Cerner for inpatient and ambulatory clinicals, GE for faculty practice management, and a homegrown registration and billing system. LLUMC will keep their Cerner lab apps because Epic’s Beaker is a few years away from having the capabilities needed for an organization of that size.

From HITuser: “Re: Meditech 6.0. Have they implement any sites running multiple facilities?” A good question, which I will open up to those HIStalk readers who surely know. I’d have to guess yes.

HIStalk Announcements and Requests

A reader asked if I could interview someone from St. John’s in Joplin about their emergency preparedness lessons learned once things settle down there. If anyone is reading from there and would be willing at some point, let me know.

Watching: Life on Mars, a quirky one-season sci fi/cop show in which the lead character is sent back in time to 1973. Harvey Keitel is excellent in it, former Cosby kid Lisa Bonet has a role, and the pop culture (hair, clothes, music, etc.) are cool. Lots of Bowie tunes. It’s the American remake, predictably inferior to the original British version, they say, so I’m hoping the original hits Netflix streaming.

Welcome to new HIStalk Platinum Sponsor Impact Advisors of Naperville, IL. The company’s service offerings include strategic advisory (IT performance assessment, strategy, system selection, contracting, ROI, HITECH readiness, governance, and facilities planning) and strategic implementation (planning, readiness, project leadership, staff augmentation, project oversight, interim management). Impact Advisors has won several awards,including Best in KLAS for Planning and Assessment for three straight years. They’ve also bagged some “Best Places to Work” recognition in case you’re looking for opportunities (I see they need implementation specialists for Epic and Cerner at the moment, as well as HIT strategy folks). Founders Andrew and Peter Smith are HIT long-timers and have boatloads of experience working with hospitals and physician groups and are on the speed dial of quite a few big-name CEOs and CIOs as their trusted advisors. Former FCG President Steve Heck is a VP there, so you can catch up with him when you contact the company. Many thanks to Impact Advisors for supporting HIStalk.

It’s a quiet week by all appearances, which is a relief since I’m trying to catch up after a few days of being semi-off. It seems like about half of the 7,359 HIStalk e-mail subscribers are kicking back an “out of the office” reply this week, so good for everybody who is getting away a bit for the unofficial beginning of summer. It’s a great time to send in your news, rumors, guest articles, or whatever goodies you have that might interest others.

Acquisitions, Funding, Business, and Stock

A London newspaper says that Sage is reviewing its healthcare business and will likely sell it, although it did not provide details or sources.

A Chicago Tribune story on excessive executive pay speculates that McKesson shareholders may push back on the compensation of CEO John Hammergren at this summer’s annual meeting. He’s California’s third-highest-paid CEO at $54.6 million for the year ended last March (the company hasn’t released his FY2011 take).

Announcements and Implementations

IBM announces the expansion of its Dallas-based Health Analytics Solution Center, including the addition of new technology and the doubling of its solution architects and technology specialists. Mobile technologies, remote patient monitoring, and analytics are some of the areas IBM says the Center is addressing.

Health information network provider Availity earns EHNAC recognition for achieving the requirements for the 5010 Readiness Assessment program.

MIM Software introduces the VueMe App for iPad, iPhone, and iTouch. The app allows patients to view diagnostic images that have been sent them from their doctors, or to share those images with a specialist.

Government and Politics

Your tax dollars at work: as of May 19th, the Medicare EHR incentive program had paid providers $75 million; the 15 state Medicaid programs paid an additional $38 million. Including HIT training programs and RECs, HHS says it has doled out a total of $1.7 billion to promote EHR adoption. ONC coordinator Farzad Mostashari also notes that EHR use among primary care physicians increased from 20% in 2009 to 30% in 2010.

ONC publishes a proposed rule that addresses how the agency can remove an approved accreditor of the permanent EHR certification program. The ruling establishes a process to deal with situations where the ONC-AA engages in misconduct or does not perform its responsibilities.

Weird News Andy notes that the Feds are cracking down on healthcare fraud by threatening to file criminal charges against corporate executives whose companies are caught in wrongdoing, even if the executive had no direct knowledge of the illegal activities. Instead of just accepting a fraud settlement from big companies who treat it as a cost of doing business, Uncle is pulling out previous precedents that it says allow it to hold executives personally responsible, noting that several Fortune 500 companies have bought their way out of Medicare fraud several times (can I get an amen?) A quote from HHS’s chief counsel for the inspector general:

To our way of thinking, the men and women in the corporate suite aren’t getting it. If writing a check for $200 million isn’t enough to have a company change its ways, then maybe we have got to have the individuals who are responsible for this held accountable. The behavior of a company starts at the top.

Maybe the government should have cracked down on this guy: a man who used patient information to charge phony narcotics prescriptions to a federal employee insurance plan gets off with a six-year sentence and a fine. He had pleaded guilty to charges of healthcare fraud, HIPAA violations, and identity theft in obtaining the drugs to sell.

In the UK, a member of Parliament says NHS should fire CSC from its $5 billion NPfIT contract since it has implemented only three hospitals in nine years. MP Richard Bacon, always a great source for quotes, says NHS CIO Christine Connelly’s assertion that it would cost more to fire CSC than to let them finish the work is “incredible,” saying if that’s true then everybody involved with Connecting for Health should be fired. Tony Collins reports on a leaked memo that says CSC is proposing to cut the number of trusts it will implement from 220 to 80, but at a rate per trust that’s double what the current contract specifies.

Other

Bizarre: 53% of surveyed teens say they would rather lose their sense of smell than their personal technology, while 47% say they want to be remembered for their social network connections.

 Sponsor Updates

• Carlos A. Labrador, MD (FL) is named as one of 15 eClinicalWorks clients to receive EHR incentive checks from CMS.
• Dell InSite One is managing over four billion diagnostic imaging objects and associated reports with its managed cloud enterprise archive.
• Fujitsu names Perceptive Software its Central Region Premier Partner of the year.
• T-System partners with Isabel Healthcare to integrate its T-SystemEV EDIS with Isabel’s diagnosis decision support content.
• Lawson Healthcare recognizes five provider organizations with its 2011 Customer of the Year Awards.
• maxIT Healthcare will provide consulting services for Meditech Magic users who are implementing the OrderEase software from Iatric Systems .
• Twenty Meditech hospitals have selected Imprivata OneSign in the last six months, bringing Imprivata’s Meditech client base to 150.
• HMS DIRECT, HMS’s remote hosting service division, expands it data center capacity to accommodate the growth of the company’s ASP business.
• Molina Healthcare picks GE Centricity Practice Solution as its primary EMR/PM platform.
• A Gateway EDI/LarsonAllen study finds that physician practices that have adopted RCM tools have higher revenues and collect more patient payments at the time of service.
• NCR is holding a June 16 Webinar called Revenue Cycle: Why Self-Service is Key, featuring Elmhurst Memorial Hospital.

Contacts

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

Curbside Consult with Dr. Jayne 5/31/11

Dr. Jayne Interviews KC Frank, EVP, Document Imaging Systems Corp.

KC Frank is executive vice president of Document Imaging Systems Corp. (DISC) of St. Louis, MO.

Give me some background about yourself and DISC.

DISC has been in business since 1958. Originally founded as a microfilm company, DISC has evolved into a document management solution provider focused on improving our client’s business processes. In 2007, DISC was acquired by The Flesh Company, a 98-year-old print solutions provider. I joined DISC as vice president in 2003 and have helped develop new solution offerings, strategic relationships in healthcare, and growth strategies. I am a long-time member of MGMA, AIIM, AIIM, ARMA, and TAWPI and recently received an AIIM Distinguished Service Award for accomplishments in the Information Management industry.

One of your marketing campaigns, which has been mentioned on HIStalk, is “No hybrid EMRs.” What do you mean by this?

A hybrid EMR is one where providers rely on both an electronic and paper chart post-EMR implementation. I have heard countless stories of physicians walking into encounter rooms with both a paper chart and a tablet PC. Managing patient care in a dual environment is both incredibly inefficient and frustrating. Without a solid strategy to eliminate the paper charts, the hybrid EMR will be a reality for physician groups as they migrate to EMR.

Many practices I talk to think they can scan their documents cheaper or better themselves. What’s your experience?

If organizations truly understood the process of conversion before starting, they would probably all outsource. About 50% of the clients we work with have tried to scan on their own first. Most organizations underestimate the time, difficulties and costs associated with converting their paper charts. It’s been proven many times over that a scanning process managed and executed by inexperienced staff results in double and sometimes triple the cost of outsourcing to an expert service provider.

It’s common sense. Businesses get better each time they execute a process. DISC has converted over a billion documents in our history. Physician groups may have never scanned a single chart when they start planning their implementation. Service providers like DISC are converting documents using technology designed for large batches of scanning, including scanners that cost in the hundreds of thousands of dollars. With better technology and processes built on experience, it’s difficult to imagine a healthcare organization that could scan cheaper and better.

How is working with outpatient medical practices different from working with a hospital, or say an academic medical center?

There are subtle differences such as project design, chart setup, document types, chart access needs, and workflows. Ultimately, with strong project management by the client and service provider, the differences are negligible.

Do you just work with local clients? What’s the farthest client or most exotic locale you’ve visited to convert charts?

We typically provide services on a regional basis. Since we are certified by both Allscripts and NextGen to provide services in the central region of the United States, the majority of our clients reside in an 18-state central region of the US. We’ve provided services as far west as California and as far east as North Carolina. Do they practice medicine in Hawaii? We’re still waiting for that call.

Thinking of some of your more difficult customers, what are some pieces of advice for practices preparing to convert from paper charts to an EHR?

First, decide on a conversion strategy. Will you outsource or attempt an in-house conversion? Will you scan all charts prior to go-live or scan by the schedule after go-live? Will you scan the entire chart or just a portion of the chart? All key strategic questions. Many times organizations lean on providers like DISC to help understand the pros and cons of each of the strategies.

Pick a strong project manager. Many times the HIM or medical records director is the right choice. Make sure the person you choose cares about the success of the project. Do not hire temp staff to manage the project.

If you choose to outsource, choose a partner that has experience with medical record conversion and the EMR you are migrating to. A service provider that doesn’t have experience with your EMR system may not be able to get the documents filed appropriately in that system.

If you plan to scan yourself, do time tests to determine how long it’ll take to scan a chart. This is critical. If an organization plans to scan by the schedule, meets with 200 patients per day, and can scan a chart in 20 minutes, it’s simple math to determine that it’ll take about 66 hours per day (8 FTEs) to keep up on that project. Don’t be caught off guard.

DISC does more than just scan old paper charts. What other solutions do practices need to manage the mountains of paper they’re used to moving? Will you go out of business when all the old charts are scanned?

If we relied solely on scanning historical charts, we would be out of business in five to seven years. Fortunately, we have developed other solutions in both document and content management to evolve with our clients. Although paper is slowly being eliminated from business processes, the volume of electronic documents and content continues to increase.

Today, we are offering solutions such as Daily Go-Forward Scanning, Revenue Cycle Document and Content Management, Accounts Payable Automation, Electronic ROI, and Business Intelligence. We also offer a variety of solutions in other vertical markets, including finance, manufacturing, education, and government. We plan on being around another 50 years.

Does it make a difference whether a scanning vendor partners with an EHR vendor?

Absolutely. Having intimate knowledge of the system the healthcare organization is implementing allows the scanning vendor to automatically load the electronic charts directly into the patient chart within the EMR. Without the auto load, healthcare organizations may be left with electronic charts stored and retrieved in a third-party system or internal network drive. This, of course, is not optimal since providers have to work within two systems to find charts instead of just the EMR.

Both Allscripts and NextGen realized the importance of this integration and put certified programs together to support their clients. DISC is a part of both of those programs.

You’re located in the Midwest, an area hit hard recently by floods and tornadoes. Any great “saves” with your clients during these disasters?

We actually did have a client this year ask us to scan hundreds of boxes of records stored in the first level of their building due to flood concerns. Unfortunately, natural disasters have a history of reducing the historical content of a business to rubble; specifically all the important documentation which resides in a paper format. Fortunately, companies like DISC can digitize that critical information so disaster recovery of those documents is as simple as reloading a backup.

Any final thoughts?

Another common strategic discussion we have with clients is whether or not they should scan the entire chart or just a portion. We have seen successful projects on both ends. Understand that the benefits many organizations expect when going to an EMR, such as eliminating chart filing labor costs and reusing paper chart storage space for revenue-generating opportunities, will not be realized until the entire chart can be removed from the chart room. This decision is typically made with one of two goals in mind – to satisfy clinical needs (partial scan) or to satisfy business needs (full scan).

E-mail Dr. Jayne.

Monday Morning Update 5/30/11

From Pericles: “Re: Allscripts outage at Allegheny General. The article refers to the company’s ‘New Jersey headquarters’ instead of Chicago. Could they have named the wrong vendor?” I assume the problem was with a hosted version of the Sunrise application, which is run from the former Eclipsys hosting center in Mountain Lakes, NJ. That operation and service was turned over to ACS/Xerox just over a month ago in a 10-year, $500 million outsourcing deal.

From Nosmo King: “Re: Nuance. As result of the Nuance partnership with 3MHiS that created CAPD (Computer-Assisted Physician Documentation), there are rumors that Nuance might buy the troubled document creation and management business of 3MHiS, formerly known as SoftMed.” Unverified.

From Mercy IT Gal: “Re: St. John’s Regional Medical Center, Joplin. It’s been a crazy week here at Mercy. A lot of time and effort is going into making sure the patients are taken care of, making sure our co-workers are OK, and securing the assets that were in the hospital. The mobile hospital is pretty wild – looks like a MASH unit (picture attached). The mobile hospital is an attempt by Mercy to show the community of Joplin that we’re not going anywhere. Mercy is committed to the Joplin community and will not abandon them in their time of need, even if it means setting up a temporary structure until we can get something new built. The frustration at work can get pretty high at times, but I can tell you that this week I’ve been pretty proud of working at Mercy. It’s amazing how people have come together looking for a way to help. Probably one of the best stories I’ve heard is from someone who volunteered to answer the hotline assigned to checking to make sure our Joplin co-workers were safe. She said she got a call from someone who had some damage, but was overall OK. She was concerned about her job and stated that she didn’t want to go to Freeman because Freeman is a for-profit hospital.  She said her heart was at Mercy and that’s where she wanted to be. I didn’t mean to turn this into a propaganda e-mail touting the virtues of Mercy, but as you can guess, this has been an emotional week and I guess it’s getting to me. Thanks again for all the hard work you do to keep us healthcare geeks informed and entertained. In case you don’t hear it often enough it really is appreciated. I hope you take some time to relax over the holiday weekend with Mrs. HIStalk.”

Update 5/29: the temporary hospital was scheduled to open Sunday afternoon in time for the President’s visit. Above are additional pictures from St. John’s – the photo album is here. The one with the printer in the lower left is what’s left of the data center.

From Sy Alice: “Re: abstract from the American Urological Association meeting. I imagine the good doctor could have phrased this better: “Good treatments are available for all patients and, depending on what the patient is willing to do, every man can get an erection if he sees a physician specializing in sexual dysfunction.” I’m not touching that with a … well, I’m just not touching that.

From The PACS Designer: “Re: CloudFoundry. CloudFoundry is the world’s first open Platform as a Service (PaaS) offering. The CloudFoundry.org Web site is a community-driven open source project that is led by VMware. With the CloudFoundry Beta, you can try for free the VMware Horizon App Manager, which is an open, user-centric management service for accessing cloud applications.”

From Lab Rat: “Re: Epic Beaker. I wouldn’t even think about implementing it until Epic gets back to work on it, especially in a larger hospital. Label printing is way more complicated to set up than with Cerner or Meditech and instruments were having troubles with the labels.” A Beaker site contact I asked agrees that it needs work.  

Photo: Patriot Guard Riders 

Monday is Memorial Day, a day to honor those men and women who have died in military service to the United States. Try to squeeze in a few minutes among picnics, car races, and the beach this long weekend to remember the fallen who earned that one day of honor the hard way (many of them barely old enough to vote). It’s perfectly fine to be anti-war and anti-military and still be supportive of those in the service – most of the fallen didn’t get to pick the cause they died for, so you can’t hold that against them. I ran one of my favorite poems on Memorial Day 2005 and a time or two since. My flag is flying and I hope yours is too – it’s the (very) least we can do.

Listening: Lez Zeppelin, an all-girl Led Zep cover band (not as weird as it sounds since Robert Plant shrieked like a girl most of the time anyway and cute girl rockers are always better). I’m not a fan of cover bands or even Led Zeppelin in general, but somehow I like their albums (yes, they’ve done two) that are note-for-note covers of the originals. I’m air guitaring to Dazed and Confused right now, wishing I was watching them live. Also: Manchester Orchestra, Atlanta-based emo-ey indie that veers into hard-rocking territory every now and then and sounds just fine.

About two-thirds of provider respondents aren’t so sure their employer has good enough security practices to keep their medical records private. New poll to your right: how loyal are you to working in healthcare?

I was going to run a poll on CHIME’s CIO credential, but I remembered that I did that two years ago. The opinion then was 91% negative (13% said it’s a vanity credential, 33% said it has no connection to competency, and 43% said it’s just another way for CHIME to make money).

Six-employee MobiuSoft of Flint, MI says they’ll hire up to 144 more folks in the next 18 months if their HIE product earns certification (that’s what I’m inferring from the newspaper article, anyway). Former Genesys PHO VP Jerry Van Horn formed the company in 2009.

Quality Systems (NextGen) announces Q4 numbers: revenue up 24%, EPS $0.64 vs. $0.45, beating analyst expectations for both.

Thanks to new HIStalk and HIStalk Practice Platinum Sponsor Gateway EDI of St. Louis, MO. The 30-year-old company’s 85,000 physician users trust its fully integrated tools and proactive service team to monitor their claims, catching and fixing issues before they cause problems for their practices. The fast-growing company’s founder was a physician who created new solutions when existing claims processing tools weren’t doing the job. Users rave about the personal support they get from the customer service department, with one happy physician customer calling them “the Nordstrom of EDI.” Providers get paid faster, big practices enjoy the customization capabilities of the Web-based software, and vendors offering Gateway EDI’s solutions with their PM software give customers an all-in-one solution. Thanks to Gateway EDI for supporting HIStalk and HIStalk Practice.

ED doc Kevin Kitka, DO of Mercy/St. Johns Regional Medical Center of Joplin, MO describes what it was like to be working in the hospital as it was severely damaged by the recent tornadoes. He’s an excellent writer:

A small child of approximately 3-4 years of age was crying; he had a large avulsion of skin to his neck and spine. The gaping wound revealed his cervical spine and upper thoracic spine bones. I could actually count his vertebrae with my fingers. This was a child, his whole life ahead of him, suffering life threatening wounds in front of me, his eyes pleading me to help him. We could not find any pediatric C collars in the darkness, and water from the shattered main pipes was once again showering down upon all of us. Fortunately, we were able to get him immobilized with towels, and start an IV with fluids and pain meds before shipping him out. We felt paralyzed and helpless ourselves.

Speaking of St. Johns, nearby hospitals accepting its evacuated patients had a heavy OB load. The hospitals credit GE Healthcare for rushing a team of employee volunteers to get fetal monitoring set up, one of them driving four hours to get to the hospital and another doing configuration from her laptop while hunkered down in her pantry because her own Dallas neighborhood was under a tornado watch.

Allscripts fires PwC as the auditor of its financial statements. I don’t really understand the reasons or the impact from the SEC filing, but maybe someone can enlighten me.

It looks like Cerner has a new logo and a tag line of “Health care is too important to stay the same.” I like the new one much better – it uses green (my favorite color, and everybody wants to use green these days) and it ditches the robotic-looking, all-caps-shouting CERNER in favor of a cute, non-threatening rounded font that everybody uses when trying to look Web 2.0.

Cerner’s just-published 2010 annual report has a chatty letter from president, chairman, and co-founder Neal Patterson with some fun quotes:

• Thirty-one years ago, had we known exactly how hard, how long and how costly it would be, we might have chosen a different industry. I am thankful today for how youth and ignorance can sometimes prevail over conventional wisdom.
• In my professional experience, vision is the thing you as a leader use to give your organization the courage and motivation to invest in new ideas years before they produce economic returns.
• We view our work over the past 30 years as analogous to building the foundations and laying the electrical grid for a great city that hasn’t been built. Reaching the place where we can actually start to build on top of that foundation is inspiring for us and our clients. Things are starting to get fun.
• In the past several years, we have made changes to our health plan, fired our third party administrator (we prefer to think of it as eliminating our first insurance company), launched an on-site new age clinic and pharmacy, incorporated biometric measurements for our population, realigned the economic incentives for associates in our health plan price tags and rolled out a data-based wellness management program that
  provides personalized health profiles for our associates.
• The Cerner of today is known for care; we expect the Cerner of five or 10 years from now will be recognized for health as much as care. As I mentioned, we can see a plausible scenario where health actually becomes the bigger portion of our growth.
• This is the start of my fourth decade at Cerner. This is the first decade that I will not finish—at least not in the role of CEO. Unfortunately, there is a direct correlation between years of experience and chronological age. Often when I share Cerner’s age (31 years), I make the offsetting remark that Paul, Cliff and I were all in our 20s when we started Cerner. In my case, I was 29. If you add thirty-something to any age, the numbers start getting large. I don’t intend to end this decade as Cerner’s 70-year-old CEO … which is frustrating because this is going to be the most exciting decade yet.
• [This is an entry on his personal to-do list, referring to his sister-in-law Linda, who died of sepsis due to lack of care coordination] Save Linda’s life. Make it systematic that preventable events that harm people are exposed to the appropriate caregivers and eliminated. This will not bring back Linda, but it may prevent the next 50-year-old schoolteacher from rural America from dying unnecessarily from the uninformed, sometimes inadequate, sloppy, delay-ridden thing we call a healthcare system.

Here’s Vince Ciotti’s latest HIStory, which points out the parallel of a 1960s government program that drove financial systems development and sales much like ARRA is doing for EMRs today.

McKesson’s lawsuit against Epic isn’t over. A federal court will rehear McKesson’s case, which claims that Epic’s MyChart infringes on a RelayHealth patent covering patient-doctor communication via the Web. The previous ruling let Epic off the hook, saying that Epic’s customers and not the company itself set up MyChart. The issue at hand is whether Epic encouraged its customers to do so, and if so, whether that constitutes patent infringement.

Rennselaer Polytechnic Institute is awarded a $1.2 million NIH grant to develop patient-specific “phantoms” that can model the organ-specific radiation exposure involved in CT scans.

The new management team at Guam Memorial Hospital finds financial irregularities that include paying $25K per year for software that generates a form that they say could easily be photocopied instead.

Interesting: Regenstrief doctors are developing software that will use EMR data to determine which warnings and side effects are relevant to individual patients, creating dynamic prescription labels.

High-powered venture capital firm Venrock adds Bob Kocher, MD as a partner, expanding to three partners who will focus on healthcare IT companies. He was previously with McKinsey, Brookings, and the Obama administration. Venrock’s previous investments include athenahealth, RelayHealth, Awarepoint, Castlight Health, Coderyte, and Vocera.

Hospital and population health applications vendor Healthways outsources its application development and technology management services to HP in a 10-year, $380 million deal.

GE Healthcare and Thomson Reuters will offer drug companies and other researchers a database that combines de-identified patient EMR data from GE with de-identified claims and prescription data from Thomson Reuters.

A study of 17 physicians in a clinic moving from an old EMR to a new and more powerful one finds that prescribing errors dropped, but mostly because use of unapproved abbreviations was reduced. The total number of other errors increased at the 12-week mark and was identical to baseline at 12 months, suggesting that EMR implementation may cause errors early on and have little effect after a year. Most of those same doctors said the alerts weren’t useful, it was too slow in handling prescriptions and refill requests, and the more sophisticated system wasn’t any safer than the old one.

England’s NHS Direct hotline launches a free mobile app that allows patients to assess symptoms, get self-care advice, and contact NHS’s telephone nurses. It’s Android-only for now, with an iPhone app coming in a few weeks.

Population and risk management software vendor MedVentive raises $1.5 million in convertible promissory notes and warrants. I interviewed Nancy Ham (president and CEO) and Nancy Brown (chief growth officer) last August. I asked some reasonably good questions about technology support for ACOs and whether providers are fixated on EMRs while ignoring potentially more important solutions.

Sponsor Updates

• The use of AirStrip OB by Lovelace Health Systems (part of Ardent Health Services, which uses it in all of its hospitals) is profiled in the New Mexico business paper.
• Billian’s HealthDATA is hosting a June 8 Webinar called Providers’ Perceptions: Mobility in Healthcare. They’re also offering a free white paper titled Social Media Strategy for Healthcare Vendors.

E-mail Mr. H.

A Reader’s Response to HIStory 5/23/11

In Mr. HIStalk’s Monday Morning Update (5/23/11), Vince Ciotti’s HIStory slide show installment focused on the former Lockheed / Technicon … / Alltel / Eclipsys companies and their health information systems. However, this installment is full of factual errors.

Ron Johnson was NOT one of the original Lockheed engineers. Ron was hired at the Technicon company (1980?) as director of marketing, and he was let go after a brief stint.

In addition, the late George Kennedy was NOT one of the original Lockheed engineers. At Technicon, compared to others, George’s role was thin and short-lived. 

Ralph Korpman, MD was involved as a pathologist for the Technicon laboratory information system and famously sold a version of it to the then-HBOC (lawsuits followed; settled out of court).

Jack Whitehead, who owned Technicon Instruments, a laboratory system company (Tarrytown NY), bought the original Lockheed system (along with many of its engineers) and named the company Technicon Medical Information Systems (TMIS), as it was called when I joined the company in 1978. TMIS was set up to take the Lockheed system and commercialize it. 

It was pretty clear who drove that vision in those early days. Unsung heroes, such as Sam Virts, Ralph Boyce, Dick Kortum, Chuck Tapella, Bob McCord, Mel Hodge, Stan Grahams, Bob Williams, Dave Brown, Carole Widener, RN, Shirley Hughes, RN, ……….. (and forgive me for leaving out so many who deserve to be included here).

Around the same time that TMIS started, Spectra 2000 Medical Information Systems was started by another group of former Lockheed engineers and initially financed by Transamerica (LA). This company was later bought by Medicus; Richard Jelineck, PhD, et al. The two competing TMIS and Spectra systems obviously were similar. What set the systems apart functionally was Spectra’s MIS provided the first colored screen text. However, Technicon’s MIS was fully installed and used in a hospital based on documented cost / benefits.

In 1975, two reports were written about the TMIS system: One was written by Battelle Columbus (OH) Laboratories – Final Report on Evaluation of the Implementation of a Medical Information System in General Community Hospital. The other was Demonstration and Evaluation of a Total Hospital Information System – El Camino Hospital, Mountain View CA.

El Camino Hospital has never employed physicians nor have physicians ever owned the hospital. ECH was and still is a community-based, district facility. The community physicians from the Sunnyvale Clinic and the smaller Mountain View Clinic were key supporters of the TMIS. Other, key, physician leaders, such as Ralph Watson, were part of smaller physician practices / groups. The fact that these community physicians were not employed and there was success in gaining wide-scale adoption of CPOE during the 1970s is an accomplishment that other companies and products required 25+ years and paid incentives to achieve.

In 1981, Jack Whitehead sold TMIS and the lab system division, Technicon Instruments, to Revlon. TMIS became Technicon Data Systems (TDS). In 1984-85ish, Revlon sold TDS back to Jack Whitehead’s son, John, who again took the company private and renamed the company TDS Healthcare Systems. Technicon Instruments was sold to a number of companies after Revlon, with its legacy now part of the medical division of Siemens. The name “Technicon” was bought by Bayer and cannot be reused.

In 1996-97, John Whitehead sold TDS Healthcare Systems to Alltel. This lasted 2-3 years before Alltel sold it to Harvey Wilson (formerly of SMS) who started Eclipsys with the idea that he would take the Brigham & Women’s home-grown HIS, put it in a “box”, and take the market by storm.  Harvey lasted awhile at Eclipsys, but his vision never even came close to fruition. 

Yes, a handful of those old Technicon, TDS, … systems still chug away.  On the other hand, Mr. Ciotti writes that he is a frustrated English major, and he can’t even use / spell the word "it’s" correctly! Thankfully he wasn’t a frustrated history major, because he really would have had no excuse for all the “HIStory” errors in this installment (and others?).

This reply was composed by the following, former TMIS / TDS / Alltel /……employees, who remain proud having been able to work with the above, early system, company, and exceptional engineers and clinician developers … and who remain alive and well working in today’s world of healthcare IT:

Jane Baseflug, RN
Connie Berg, RN
Edith Caesar (retired)
Ann Farrell, RN
Deborah (Debby) Kohn, RHIA
Elizabeth West

News 5/27/11

Top News

St. John’s Regional Medical Center (MO) may not be salvageable, according to hospital’s president Gary Pulsipher. He says St. John’s, which is part of Mercy Health System, will open a 60-bed mobile hospital by Sunday and will rebuild. The hospital went live on EHR less than a month ago, but will soon be back online to connect the mobile hospital with other Mercy sites.

Reader Comments

From Easily Amused: “Re: magazine typo. A finance newsletter described a vendor as ‘provider of elf-service and revenue cycle management applications.’ I had visions of Santa’s helpers pitching in to improve collections.” At least they aren’t involved in elf gratification.

From Meaningless User: “Re: attestation. Do you have any info regarding which hospitals have attested to MU and what their success has been? I have not yet heard any announcements or rumors of a hospital achieving MU yet.” I doubt there’s a publicly available list, but some have met the Stage 1 requirements. It would be interesting to know if any have been turned down, but that’s not the kind of news that makes vendor press releases (not to mention that hospitals probably wouldn’t apply unless they were pretty sure they qualify).

HIStalk Announcements and Requests

In case you missed it this week on HIStalk Practice: Kareo lends advice on how to handle medical billing after a zombie apocalypse. Massachusetts eHealth leads the nation in enrolling primary care physicians for its REC. AMA reports a 45% increase in profits for 2010.  Dr. Gregg reflects on egos in the industry. And my personal favorite: the fake doctor who used toothpicks to treat his patient.  None of this news appeared on HIStalk , so if you follow the practice side of technology and aren’t signed up to get HIStalk Practice e-mail blasts, then you are getting left in the dust.

I’m taking a few days off for fun family stuff and trying to spend minimal time on the laptop, so I’m a little bit disengaged at the moment as I struggle to resist the gravitational pull of work and focus on non-work. I’ll be happy to get back to endless HIStalk hours in a few days.

Acquisitions, Funding, Business, and Stock

 

Standard Register enters a definitive agreement to acquire 100% ownership interest in informed consent provider Dialog Medical. Terms of the deal were not disclosed.

Resilient Network Systems raises $5 million in Series A funding, led by Alsop Louie Partners. Resilient’s technology facilitates the electronic transfer of health records.

People

Former Healtheon/WebMD CEO Mike Long is named president and CEO of EGHC, of which he was already board chair. The company’s businesses include a health plan, the Lumeris quality management software line, and ClearPractice EMR.

Announcements and Implementations

HIMSS introduces the ICD-10 PlayBook to educate providers on the transition to ICD-10

Allegheny General Hospital (PA) resorts to paper recordkeeping Wednesday after shutting down its Allscripts EMR. The hospital says it upgraded the system over the weekend and began having slowdown problems Monday and Tuesday. The hospital voluntarily shut down the system for about 12 hours while Allscripts fixed the issues.

CHIME reports that 109 individuals have earned Certified Healthcare CIO designation since the credentialing program was launched in July 2009. I said it was a dumb idea then and I’ll stand by that opinion now. Obviously the credential hasn’t exactly gone viral if only 109 out of thousands of hospital CIOs have signed on over two years, voluntarily jumping onto the hamster wheel of spending hospital money on renewals and going to CHIME meetings to earn CE. To each his own, but I’d be embarrassed to use a non-educational  credential earned by passing a multiple choice test of job-specific knowledge (designed by asking CIOs what they do on the job, then testing them to see if they theoretically know how to do it). My theory has been that CHCIO appeals to CIOs who feel inferior to their better educated C-level peers because they never expended the minimal effort required to earn a graduate degree by any of a zillion inexpensive, flexible, geography-indifferent programs that are out there.

athenahealth releases its sixth annual PayerView Rankings and awards Aetna the top spot among major players. BCBS-RI was the best overall performer, while state Medicaid providers were the worst in terms of days in AR and denial rates. Compared to last year, payers averaged payment one day faster with 5% fewer denied claims.

RCM provider RealMed announces its integration with Epic’s billing software.

Medicomp Systems announces that its Quippe electronic documentation system SDK is available for licensing to EMR developers. The browser-based, iPad-friendly system (which Dr. Gregg, Inga, Dr. Jayne, and I all raved about after working with it at HIMSS) uses the company’s MEDCIN-powered patented prompting technology to create and present EMR information in an amazingly intuitive way that even a non-doctor like me could use immediately after a ten-minute overview.

NCO Healthcare Services earns the “Peer Reviewed by HFMA” designation for several products related to eligibility, bad debt, and and extended office services.

Government and Politics

More grumblings about the proposed ACO regulation, this time from seven US senators. The lawmakers send Secretary Sebelius a letter urging HHS to withdraw its proposed ACO rules, saying, “the proposed ACO regulation will fail to accomplish its purpose” of better quality care and lower costs. The senators claim the proposed rules do not align incentives and accountability and include requirements that are too complex and an ROI that is uncertain.

CMS clarifies financial incentives for ACOs in rural areas, saying participants would be eligible for a savings exemption. CMS says that ACOs with fewer than 10,000 assigned beneficiaries would be exempt from the 2% savings threshold required of larger ACOs.

Add BIDMC to the list of hospitals claiming to be the first to receive HITECH money, $2.57 million in its case.

Other

Emergency physicians claim the biggest challenge to cutting costs in the ED is fear of lawsuits. An American College of Emergency Physicians poll finds that 53% of ER docs say the main reason they conduct the number of tests they do is fear of being sued.

Sponsor Updates

• SCI Solutions is attending and exhibiting this week at the National Association of Healthcare Access Managers conference in San Antonio, providing their traditional “Stress Free Zone” that features massages and cocktails.
• ESD heads to MUSE later this month (booth 910) as well as the Canadian E-Health Conference (booth 203). The ESD folks also shared that their KLAS ratings are up should you be interested in taking a look.
• Oklahoma Surgicare picks Provation MD software for gastroenterology documentation and coding.
• NextGen announces that Springfield Center for Family Medicine (OH) received federal funds for demonstrating Meaningful Use under the Medicare incentive program.
• Tim Reiner, VP of revenue management for Adventist Health System, describes that organization’s use of self-service technology from NCR for patient collections in a YouTube video.
• Yavapai Regional Medical Center (AZ) contracts for several applications from Lawson Software.
• Prime Healthcare Systems, California’s largest for-profit system at 14 hospitals, expands its use of document management technology from FormFast  to improve health information, revenue cycle, and patient registration.
• Self Regional Healthcare (SC) chooses RelayHealth as its HIE partner to improve care and support the Meaningful Use efforts of its eligible providers.
• Tele-Tracking releases Patient Flow Dashboard for monitoring enterprise-wide patient flow and getting more efficient use of existing capacity.

EPtalk by Dr. Jayne

I’ve been fairly critical of the federal Meaningful Use program lately. For the record, I want to mention one piece of the program (even if it did get relegated to the Menu Set) that I’m absolutely in favor of: increasing the number of providers who report syndromic surveillance data to public health agencies.

We’ve seen huge benefits to the field of epidemiology with increasing availability of health-related data. I still like the Google Flu Trend site as an idea even if it’s only search data. And “old school” diseases aren’t going away – the number of measles cases reported across the US just hit a 15-year high. 

The ability to track, trend, and prevent killer diseases is one of the cooler things we can do with healthcare IT (and one that’s proven to work, mind you). Can you imagine the TV show Quincy ME  if Jack Klugman had population-based aggregate data to work with?

In that same vein, a throwdown to my favorite elected officials. Hey Congress, how about putting together a true “Menu Set” of information technology interventions that have been proven to be effective and incentivizing them individually so that providers aren’t faced with the “all or none” problem with Meaningful Use? Any of us who have had to fill out the awful paperwork from the county health department to report a sexually transmitted disease would be happy to interface it directly from our EHR at the click of a button.

The American Medical Association offers a new app to assist with CPT codes. Only available for Apple users at this point, it allows you to search for, track, and e-mail selected codes. The first problem I had with it is that it apparently ignores the iPad’s gyroscope – it can only be viewed in portrait mode, which is a bummer for those of us that like to prop the iPad on our desk landscape-style so we can stream Netflix while we multi-task.

Navigation to the various sets of codes was pretty easy, but there wasn’t enough information on the screen to make a decision about the right code. The user would have to select each code and read the description. It would be more helpful to have a quick blurb visible on the screen rather than having each entry on the list say “office consultation,” which isn’t very helpful. (It was particularly unhelpful in the preventive codes section, but I couldn’t get a screenshot off my iPad to show, so I clipped this from the AMA Web site.)

I didn’t receive any IT-related checklists for a potential Zombie Apocalypse, but Inga did turn up Kareo’s thoughts on handling medical billing after the fact. I hadn’t really thought about Web-based telecommuting as a strategy to prevent employees from being eaten, but it does make a lot of sense.

Rest assured that due to our decentralized, multi-state virtual office architecture, the HIStalk staff is at significantly lower risk for being decimated by zombie attack than most health IT vendors.

Although Kareo’s piece mentions they didn’t know the code for having one’s brain eaten, I can propose (courtesy of IMO’s Problem IT product): E968.7 Assault by human bite and E979.8 Victim of crime or terrorism.

The Journal of the American Medical Association reports on Navigating the Challenges of In-flight Emergencies. There are apparently minimal standards for emergency medical kits, but kits and employee training vary from carrier to carrier. Airlines also have their own reporting systems and protocols, often relying on physician passengers rather than employed medical control officers on the ground.

The article proposes standardized reporting to the National Transportation Safety Board; expert recommendations for first aid kits (and eventually evidence-based kits based on the data gathered through reporting); enhanced training for flight attendants; and enhanced ground-to-air medical support.

Having had to respond to “Is there a doctor on board” more than once, I’m in agreement. Plus, it looks like an excellent opportunity for vendors to go after another potential customer base. Anyone want to hire a sassy CMIO to write your content for airline medicine? I’d be happy to travel all summer and write code for the most common airline emergencies I encounter along the way.

Contacts

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

News 5/25/11

Top News

The market for anesthesia information systems is predicted to increase 50% by 2012 and be valued at $4 billion by 2017. Vendors battling for market share include Picis, GE Healthcare, Draeger, IMDsoft, Merge, and Philips.

Reader Comments

From Baywatch: “Re: UCSF. The CIO is leaving involuntarily. Looks like the board finally figured out that the Centricity debacle was as much of a leadership problem as a software problem. The Epic project is floundering and bleeding money, with poor direction and an incompetent staff.” We asked a UCSF press contact, who replied: “Mark R. Laret, CEO of the UCSF Medical Center, today announced that ‘Last Friday, CIO Larry Lotenero notified me that he will retire at the end of June, completing 10 years of service to UCSF.’”

From TopCrush: “Re: AAOE meeting. I’m at the American Association of Orthopaedic Executives in Orlando this week, along with a few hundred other folks and about sixty exhibitors. ACOs are definitely a concern for these guys. Orthopedic docs are scared of being left out and worried about the financial ramifications. Kind of funny but they have a VIP entrance for participants that have been coming for years or on a chapter board.  AAOE set up a fun Sports Lounge in the middle of the show floor – shuffle board and fuse ball included.” Thanks for the update from the field. I wish I had a special door I could walk through every once in awhile, just to make me feel more important.

HIStalk Announcements and Requests

Mr. H semi-left me on my own tonight, just in case you were wondering why there are fewer smoking doctor images that usual. Mrs. H deserves a date night every once in awhile and I hope he is taking her somewhere special.

People

Community Health Network (IN) appoints Ronald Strachan CIO. Strachan is the former CIO for WellStar Health System and for HealthEast Care System.

Shared Health names Hedge Burt VP of sales. Burt has served as SVP of business development with Entrada, as well as VP of provider sales for Kryptiq.

PACSGEAR names Eli Rapaich CEO. Rapaich succeeds company co-founder Brian J. Cavanaugh, who will assume the role of COO. Most recently Rapaich served as VP of sales at Philips Healthcare.

Announcements and Implementations

The DoD awards SAIC a $53 million contract to provide IT and EHR system support to the TRICARE Management Activity MHS.

Gulf Coast Medical Center (FL) will move to Epic EMR next month.

CMS notifies Jefferson Regional Medical Center (AR) that it has met Stage One Meaningful Use requirements and will receive approximately $3 million. Jefferson uses Allscripts’ Sunrise Clinical Manager EHR.

Catholic Health Initiatives selects Beryl to provide outsourced patient experience solutions, including physician referral services.

Hospital EHR vendor eCareSoft, the US subsidiary of Mexico’s largest HIT vendor, embeds task-oriented tutorials and collaborative e-learning tools into its application. Hospital users can share shortcuts and workarounds and provide feedback to the vendor’s support team right from the application.

Trinity Health (MI), Baycare Health (FL), and Jackson Health System (FL) go live on the LegacySuite solution from Legacy Data Access. LegacySuite provides data storage and Web-based solutions for retired HIT applications.

The Federal Health Architecture (FHA) awards CGI Group a one year contract for $5.7 million to support FHA’s CONNECT NHIE Gateway solution.

Swedish Medical Center (WA) picks PRISM contact management software from Aegis Health Group to automate its physician relations management process.

Jefferson County Hospital (MS) selects Custom Software Systems to provide ChartSmart EMR, document management, and lab modules.

Texas Health Resources, where Ed Marx serves as CIO, receives over $19.5 million in Medicare EHR incentive payments for the meaningful use of its Epic system. THR has invested more than $200 million on its EHR initiative.

Innovation and Research

A new study concludes there’s no consistent association between EHRs and clinical decision support in ambulatory patient visits. Researchers looked at data from 2005-2007 so perhaps newer decision support tools might paint a different picture. However, only one of 20 indicators showed superior quality with EHR visits versus non-EHR visits.

Other

The video above is from St. John’s Regional Medical Center in Joplin, MO, heavily damaged after taking a direct hit from a tornado. Its 183 patients were evacuated, but five patients and a visitor died and several employees were injured. Hospital x-rays were found 70 miles away, with the hospital asking anyone finding hospital records to hold them while they figure out a way to collect them. Missouri’s disaster medical team has set up a makeshift 30-bed hospital in a tent, staffed by 40 doctors, nurses, pharmacists, and support staff.

Health IT ranks among the top 10 most popular career path for college graduates, according to a University of CA-San Diego study. Top jobs include healthcare integration engineers, system analysts, clinical IT consultants, and technology support specialists.

Sponsor Updates

• DIVURGENT will host a CHIME College Live session June 8th entitled Accountable Care Organizations: Overview and the Role of Information Technology.
• Thomson Reuters’ Meaningful Use Quality Manager 1.0 earns ONC-ATCB modular certification from CCHIT.
• Voalte signs up to resell the Epocrates Essentials premium clinical suite with Voalte’s communications solution.
• CynergisTek CEO Mac MacMillian and Ohio Presbyterian Retirement Services CIO Joyce Miller-Evans will present at the Colorado Health Information Management Association’s Long Term Care Spring Meeting this week.
• Geisinger Health System (PA) picks Orion Health Rhapsody Integration Engine as its integration platform.
• Vocera CEO Bob Zollars is named a finalist for the Ernst & Young Entrepreneur Of The Year award for Northern California.
• The Redwood Falls City Council (MN) approves the $50,000 purchase of Provation software for the Redwood Area Hospital. The hospital will interface the software with its Meditech EMR.
• Awarepoint is awarded a patent for its wireless interaction-based tracking system.
• MED3OOO announces the general availability of InteGreat V6.4, which includes the components required to meet Meaningful Use standards.
• University Hospitals Bristol NHS Foundation Trust implements Imprivata OneSign for its 5,100 users.
• Baylor Health Care System (TX) affirms its plans to implement GE Centricity EMR across its entire HealthTexas Provider Network of more than 500 physicians.
• Prime Healthcare Services (CA) expands its rollout of FormFast document management technology to its recently acquired facility, Alvarado Hospital.
• BridgeHead Software celebrates the 10th anniversary of its partnership with MEDITECH.
• Lakeland Healthcare (MI) selects the ChartMaxx Epic integration package to integrate their physicians’ ChartMaxx EMR with the health system’s Epic program.

Contacts

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

HIStalk Interviews Jim Traficant, President, Harris Healthcare Solutions

Jim Traficant is president of Harris Healthcare Solutions, the healthcare business of Harris Corporation of Falls Church, VA.

Give me a brief background about yourself and your new job. Congratulations, by the way, on being promoted to president.

Thanks. It’s a great privilege.

I’ve been at Harris now for 10 years. I worked at a small business prior to joining Harris, so I’ve experienced both large and small companies. I’ve worked in government and commercial business. I’ve got 25 years’ experience as a technologist and as a business executive, but my passion for transforming healthcare comes as a result of being a patient.

I’ve had two liver transplants. The first one, my neighbor saved my life. We were the fifth to have the surgery, the first that weren’t related. I have had two transplants in between an episode of sepsis. 

In my experience traversing the healthcare market, I learned that people are passionate about their work in healthcare, obviously. They have lots of data, but what was missing was information.

After my second transplant, I sent a note to the Harris CEO asking to take the company into healthcare. Harris is a pretty large company. We move information with lives at stake in every market we serve, like defense and intelligence. We have two million passengers that ride on our Harris Network for the FAA. I knew if we could move information in healthcare like we did in those other markets that we could save lives, make a difference, and maybe even create a business. 

Five years ago, I didn’t know if I would ever get to work again. To be honored by working at Harris and leading us in healthcare is a privilege I could not have imagined. It’s just terrific.

Harris has mostly been known, as you said, as a government contractor. It seems like that may not necessarily be the case going forward. Will the company go after the commercial healthcare markets?

The way I like to describe it is that Harris will have a significant role to play in helping to shape the future of healthcare, and healthcare is going to have a significant role in shaping the future of Harris. It’s a really good match.

Tell me about the strategy behind the Carefx acquisition.

We were really fortunate. Early in our healthcare venture — we’d been at this for four years now — we were awarded the Nationwide Health Information Network Connect program. We were working on behalf of the Federal Health Architecture to integrate the largest creators of health information, like military health, the VA, and Indian Health Services, so they could share information securely with each other and then provide that information to the largest consumers of health information at the federal level, like National Cancer Institute, the CDC, Social Security — which spends, you know, a half billion dollars a year just trying to find health information so they can determine benefits.

We had a couple of breakthroughs in that process. One was that Social Security used to take on average 83 days to find health information to determine benefits for our citizens. When they went through the gateway that we created for the Federal Health Architecture, this program called Connect, they went from 83 days to 24 seconds getting that information. That’s the kind of transformation I think the nation’s looking for out of IT being applied in healthcare.

A second thing we learned was that over half of the care provided for our active duty and retired service members comes out of the private sector. If we were going to play a role in transforming healthcare, it wasn’t sufficient that we could just get the federal sector connected to try and create a tipping point in health information exchange. We had to connect it to the private sector. 

What Carefx brought to us was this real strength in the private sector. They were at over 800 hospitals globally, over 650 in the US. What we had done at the federal level to provide this integration and connectivity connecting the infrastructure, they did on the commercial, side but in a different context. They were able to take the information from where it was created and deliver it to the computer screen and organize it the way a clinician thinks and works according to their workflow — labs, images, med reconciliation. 

It seemed like a perfect fit. Culturally, it was a perfect fit. They’re just great talent, great people, very deep in the healthcare domain, and really able to inform this rich technology base that Harris has as we move out and try to play a role in transforming healthcare.

That acquisition was a pretty strong signal of the interest of Harris to get into the commercial space. Do you see the potential for more acquisitions, or do you think Harris will be more of a builder than a buyer?

I would say this about Harris. It’s a great company. It has answered national priorities in almost every dimension over its hundred-plus year history. Healthcare is a national priority that’s going to require bold thinking and a strong presence and Harris is one of those companies. We’ll continue to grow organically, and I would expect over time that we’ll do more acquisitions. We’re committed to playing a key role in healthcare, so all of those options are going to be in play.

Healthcare divisions of big and broad conglomerates seem to lose some of their innovative capabilities. Do you see the Harris culture being different?

We have a very rich culture. In fact, it was one of the surprising things for me when I came out of a small business into this large, now six billion dollar company.

One of the things that many don’t know about Harris is that defense and intelligence invest very dramatically in Harris to take the state of the art in a number of technical disciplines and advance it or apply it in unique ways. In combination of significant investment plus what we contribute, we do about a billion dollars of research and development a year.

What we’ve seen is there are great parallels in healthcare to the challenges that have been faced in these other markets. I’ll just give you an example. What we saw post-9/11 in the intelligence community was we had all of the data. What was missing was a situational awareness at the national level that would be able to piece together all the information that was in these isolated pockets. 

In healthcare, what we see is a very fragmented market. There’s lots of data, but it’s isolated with stovepipes. It needs to be connected. Then we need to make sense out of the information and create situational awareness for healthcare just like we do for intelligence.

The other corollary we see is when you think about what an intelligence analyst does, they sift through a variety of information sources and then apply judgment in a time-critical fashion with national security and lives at stake. We provide that information on a global scale and enable that capability. It’s exactly what physicians do. They have to piece together information on disparate sources and apply judgment in a time-critical fashion with lives at stake. 

We see this transference of technology from our core markets into healthcare as a totally logical and compelling way for us to do this. All this innovation that exists really distinguishes us from a lot of the players in healthcare.

For example, from a security standpoint, we are very unique nationally for ability to secure information and move it anywhere in the world and any device authorized to see it. In healthcare, it’s not going to be, “Can we secure information in healthcare?” It’s going to be, “Can we translate our security in a way that can be meaningful in healthcare, that they can afford it, that it can be used in a very efficient way?”

The innovation exists in Harris. I would say these other companies have innovation as well, but the passion, the national mission, the sense of purpose applies directly. One of the ways I like to communicate healthcare inside Harris and also with our potential customers is that Harris is uniquely trusted at the intersection of life and data and every market that we serve.

It’s a very natural extension for us to move into healthcare. The response we’re getting in healthcare, I think, is evidence of the fact that we really have something to offer.

Harris is used to taking on projects with a large price tag and large scale. Who do you see as your customer in healthcare?

We started at the federal level because it was familiar. We knew how to compete. There are also some real strong forces at play when you look at military health. Harris being a defense contractor — that’s a logical place for us to participate.

The Department of Veterans Affairs — how do we take care of our servicemen and women who served us so well for so long? Those entities are not only providers of care, but they are payers. We knew there would be alignment and rewarding of enterprise solutions that would deliver efficiencies that would help us provide better care at a lower cost. 

We began there and got traction almost immediately, moving our technologies from the intelligence community for imaging, for example. We created an architecture for military health. We acquired a company in the VA that allowed us to do imaging across the enterprise for the VA, and then connectivity between DoD and the VA, not only from the integration or interoperability standpoint, but also for images and photographs and scanned documents, all of those being shared and able to be associated with a health record.

We knew that to transform healthcare, we had to move into commercial sectors. We’re not looking at healthcare in the same way we would look in defense or intelligence. We recognize that the buying and the programs tend to be much smaller in size, but we believe and we’ve demonstrated we could move technologies and do it very efficiently and create compelling solutions that will be affordable and transformative in the healthcare context. 

We’re very excited about what this market has to offer. Just from a business context, it’s hard to deny that it’s four times the size of the Defense Department. I think that’s why others are pursuing it. We’re looking at more as a chance of, if we can make a difference in healthcare, focus on the transformation, then the money will take care of itself. So far that’s been the way it’s played out.

You mentioned the VA and the DoD. I’m interested in the conversations being held about whether they should buy or build or how they can agree on a single system. You have a unusual perspective and viewpoint. What are your observations?

I think we have to be careful in one sense. I think there needs to be seamless system. It can’t be that the information struggles to come back from theatre to stateside and then into the VA. And then we have to think about the continuum. It doesn’t stop there. It has to be able to be connected to the private sector as well. That’s when ONC and some of these federal initiatives become really important as we set the foundation for how healthcare will happen in the US.

The military mission is different from the VA mission. I think we need to make sure that whatever we come up with, I’m not sure one size fits all. But we have to make sure that we can fit the military mission primarily for the military, and then make sure that what we’re providing for the VA is able to provide a continuity of care that bridges both the military as well as the private sector.

I don’t know if you can do that in one off-the-shelf system. You might be able to. I don’t think anybody knows, to be honest.

The other thing that the VA is challenged with, but I give them credit, is they get to work through these very hard solutions on a very large scale in a public way. Everybody’s watching every move they make, so if there’s any flaw, it gets exposed and printed. Most enterprises don’t have that type of scrutiny. 

What the VA and the military have been able to do — quite extraordinarily when you look at enterprise healthcare in managing multi-millions of patients and doing it securely and on that scale — they really helped advance healthcare in the United States. I commend them for what they’re trying to do. I’m not sure what the solution needs to be, but they got the right minds looking at it and I’m confident they’ll come up with the right answer.

Have the taxpayers seen value from their projects?

I’d have to say yes. They have seen value. You have to remember that the VA has led in a lot of instances. Ninety percent of all doctors trained in the United States go through a VA facility in the course of their training, so there’s a benefit broadly to the US for what the VA has done that we can’t lose.

At the same time, there are new technologies and new systems that are coming into healthcare. I think the VA, very strategically, is looking, “Hey, we’ve been doing it our particular way, but that doesn’t mean it has to be the way we do it going forward.” So again, I give them credit that they’ve been self-reflective and wherever they can leverage commercial investment and solutions, I expect that they will do that more, not less, but time will tell.

Harris recently announced the joint venture with Johns Hopkins Medicine to do some work with medical imaging products. I’m curious what the scope of that project is.

Hopkins saved my life on more than one occasion. My first transplant was there. I had sepsis and they again saved my life a second time. I knew a lot of the physicians there. 

I went back to them and after I was given the privilege of starting a healthcare business. I said, “Look, you saved my life, maybe even saved my career.” We started working together. What materialized is when they looked and saw the kinds of things we could do in imaging. I’ll just give you an example. 

In the intelligence space, somebody at the edge of the network — one of our servicemen or women serving in harm’s way — makes a request of imagery of some type. We go through a discovery process and find what’s been requested and enhance it with additional information that would make it more germane to their circumstance. We deliver it anywhere in the world on any device authorized to see it in near real time. It is awesome. Harris is literally a national asset in the imaging context.

What we see is a very unique ability to translate some of those technologies to healthcare in an accelerated way and create solutions that didn’t exist previously. That’s the opportunity we see at Hopkins. They’re the most trusted name in healthcare. Harris, I’d like to argue, is the most trusted name in secure information management. When you put those two things together, it enables Hopkins to leverage the information sciences in very unique ways, in this case particularly imaging, and help fuel the transformation that the nation’s looking for. We’re very excited about what’s possible in that relationship.

When you look at what healthcare IT advances are out there or potentially coming, as a technologist and a taxpayer and a patient, what gets you excited?

A couple of things. I think that when we move from a disintegrated, fragmented, and we can argue primarily paper-based system — although there’s a lot going on to digitize it. But if we had a digital system versus a paper-based system, it would better than what we have, but a far cry from what we need.

What has to happen is it has to be a connected framework for healthcare — where instead of walking into a hospital with your life at stake and your information carried under your arm in a notebook with some CDs in your hands hoping somebody can make sense out of this and figure out how to save your life — that the information shows up when you do and it’s a complete picture of your health. And now we take the knowledge base of these tremendously skilled and dedicated clinicians and enable them to take more information and apply judgment against it in an accelerated way. We will totally transform healthcare.

If we get to a data-driven care delivery model, OMB has said we will take out one-third of the national spend. When you look at the impact nationally of healthcare, the cost of healthcare in the United States and what we get as a return that investment, we’re not getting nearly the return that we need.

The technology will not in itself transform healthcare, but it will enable that transformation. I consider it a privilege and my life’s calling to be part of that transformation, leveraging the rich technologies of Harris to make it happen.

Doctors don’t want to type into a computer all day and patients have no interest in entering their information into personal health records. Do you think there’s a challenge that we may either not have anybody willing to create data or that there won’t be enough people sitting on the back end to monitor and react to it?

I think we’re going to get better at this. We’re in the very early stages of a transformation and it’s a little bit awkward right now. 

I came out of the aerospace world previously. We used to fly satellites, for example. Like in the Apollo 13 movie, they’re staring at streams of paper that are flowing and guys are sitting down and doing math equations trying to solve hard problems. Then we went to the computer, and all we did was emulate what we were doing on paper. We did it on the computer. We would look at strings of bits and bites and try to make sense out of it.

Eventually we advanced the interface so that we could run constellations of satellites with one or two operators. We did that because we were able to distill the information from bits and bites and go from data, to information, to knowledge. 

That’s going to happen in healthcare. It won’t be that we’ll supplant the clinician or the judgment in healthcare, but we’re going to give them a stronger knowledge base from with to apply judgment and be able to deliver it in a simple, easy to assimilate way. It’ll just become part of the workflow.

I really think we’re just in an awkward phase of transition. This is going to get to a point where it will be second nature, just like it is for us on our smart phones and how we engage even socially using computer technology. It’s certainly going to transform healthcare.

What would you say are the most significant opportunities and threats to healthcare IT as an industry?

That we allow it to be digital and fragmented is the biggest threat.

Once we connect the framework for healthcare, there’s going to be innovation in healthcare in an accelerated, unprecedented way that healthcare has never experienced previously. There’s going to be an enablement of a system approach to healthcare that has never been possible previously. We’re going to see competitive models. We’re going to see efficiencies delivered.

We’re going to go through a transformation. I’m not sure how quickly it will happen. It might take us five years. I hope it happens in less than 10, but we’ll get to a place where the information flows in healthcare like it does in other industries.

The biggest risk is that we continue to behave as if digitizing is sufficient, we continue with proprietary technology, we continue in monolithic systems.

My confidence in healthcare is that it’s just part of the transition. It will be the first phase of the transition. It won’t be the endpoint. We will certainly get to a place where we’re operating in a system framework, information flowing securely and ubiquitously. It will patient-centric, data-centric — a whole network built around patients. I think that’s the biggest opportunity. It takes advantage of what America’s great at, and that’s innovation and technology.

I think we’re in a great spot to lead the world and help to transform this. I think it’s going to go from a terrific cost and drag on our national economy to fueling our national economy in ways that we have not imagined.

Do you have any concluding thoughts?

First, thank you for doing this interview. I really appreciate it.

I also would like to thank the caregivers in healthcare. They’re the unsung heroes. They’re the part of the healthcare system that’s yet to to be tapped. I think they know a lot about how we can improve it. I think this future state of technology is going to make it more efficient, better care, lower cost, and transform this economically in the United States.

The last thing I would say, and this is personal, is I’d like to thank the people that work with me at Harris Healthcare for their passion and dedication. I like to say the two best days in a person’s life are the day you’re born and the day you know why. We are fulfilling what for me is a dream. The people that are working with me are just the finest. That goes for the latest part of our family at Carefx — just great people, committed to making a difference. I’m just proud to be associated with them.