Monday Morning Update 1/28/13

From Optumized: “Re: Optum’s acquisition of Humedica. Confirmed by Lazard Capital Markets.” I appreciate that the update from Steven Halper, managing director of equity research, credited HIStalk as the original source (as I, in turn, should thank Embers and another couple of readers who tipped me off). A Boston Business Journal article says the acquisition is valued by an insider in the hundreds of million dollars. I interviewed Humedica President and CEO Michael Weintraub a year ago. I notice that the Boston paper is getting credit for breaking the news with its Friday afternoon article even though I ran and confirmed it Tuesday evening with the help of readers.

From False Positive: “Re: Farzad’s rebuttal that talks about ‘cynical critics.’ Who are they? How does he know that they don’t like paper?” The cynical critics, at least those constantly seeking attention, are easy to spot because they sing only one loud and sustained note. When I read an emotional, overwrought restaurant review on Yelp, I always click that person’s profile to see if they have a mix of positive and negative reviews and ignore them if not. Likewise, I twit filter the monotonic EMR whiners and cheerleaders alike, placing a lot more value on the 80 percent who don’t flaunt their blinders publicly. Farzad was right about the RAND study – they said their original projections about EMR savings were wrong because EMR adoption was less than expected and payment incentives are still screwed up. The job of EMRs is to support reform, not to create it. He’s also right that those cynical critics haven’t written smug and pedantic articles extolling the virtues of paper medical records, so they’re leaving us to breathlessly anticipate their suggested alternative. And if they’re intentionally avoiding EMR-using doctors and hospitals for their own care, they aren’t blowing that horn either. What they should be criticizing is the healthcare system that created the current batch of EMRs that conform precisely to its ridiculousness.

From The PACS Designer: “Re: TPD’s List. The recent update of TPD’s List of iPhone Apps that added a HIStalk Sponsors section has created new interest amongst them to recognize their iPhone apps. Vitera informed us about an app (above) that provides healthcare providers access to their Intergy EHR solution enabling anytime, anywhere access to schedules, tasks, patient records, and e-prescribing. Humetrix alerted us to several iBlueButton apps they developed with HHS. These new apps will be added to the next TPD’s List update.”

From Ear-Ground Continuum: “Re: MEDecision. Huge downsizing – they let 83 people go last month with another round this week and next.” Unverified. Recent comments on Glassdoor are certainly interesting. UPDATE: Verified by a reader’s link.

From Nasty Parts: “Re: Greenway reseller iPractice Group. Closed its doors today. Sources say cash flow problems despite strong sales, so the board pulled the plug.” Unverified. I e-mailed the company but haven’t heard back.

Speaking of the RAND study, more readers think it was naïve rather than biased (and yes, RAND should be capitalized, at least if you buy the idea that it’s OK to make up acronyms solely to create a conveniently pronounceable word, in this case Research ANd Development.) Anyway, new poll to your right: if you had to buy a vendor’s stock, which of the five listed would you choose?

Several readers (me included) expressed an interest in hearing more from Robert D. Lafsky, MD, whose guest articles always contain an impressive mix of medical knowledge, wry cynicism, and grammatical excellence (he always e-mails me when he finds my mistakes, and the threat of incurring his gentle wrath caused me to double-check the spelling of RAND). He has agreed to elevation to regular contributor under the nameplate The Skeptical Convert, with his first installment running this weekend.

Here’s a new Spotify playlist of what I’m listening to: new Aaron Neville, The Cardigans, 4 Non Blondes, Alabama Shakes, Imperial Teen, and a few more.

Athenahealth files notice with the State of Alabama that it will lay off 36 employees at its Birmingham office on March 6. The company has not announced what types of workers are affected, although Birmingham was the location of Proxsys, the care coordination systems vendor athenahealth acquired in 2011 to boost its athenaCoordinator product.

Compuware turns down the $2.3 billion buyout offer of Elliott Management Corp and says it will instead spin off Covisint as originally planned.

Weird News Andy says this is better than die-alysis. A kidney patient in China who can’t afford dialysis treatments has lived for 13 years so far by dialyzing himself three times each week using a machine he built from kitchen tools and old medical equipment. He recently declined the Chinese government’s offer of free dialysis that was extended after his story was picked up worldwide, saying the hospitals are too far away and too crowded. He’s not worried that two of his friends died after trying a similar setup.

WNA also likes the RP-VITA iPad-controlled medical robot that just received FDA approval.

Farzad Mostashari can bask in the knowledge that he’s a big enough name to be featured in a CAP News parody (it’s like The Onion, but not as well done). I think they probably chose him randomly for the article Toilet Sizes Expand to Meet Needs of Obese Nation, quoting him in describing a new HHS standard called “Ass Cheek/Toilet Seat Ratio.”

Gartner says Big Data has reached the Trough of Disillusionment stage of its ingenious Hype Cycle, of which I’ve been a long-time fan. If the author is correct – and I would say she is – the previously Big Data-fawning press will start running negative articles, which is OK since once that negativity has been purged, it’s on to the Trough of Enlightenment, where organizations whose interest is more than fad-chasing start delivering results. A Wall Street Journal blog post on the Gartner item quotes Aurelia Boyer, CIO of New York Presbyterian Hospital, who says they’re using Hadoop with natural language processing to analyze millions of patient records to find, for example, how many of them have mentioned a gunshot wound.

A study looks at why patients may think doctors who use clinical decision support are less capable. Apparently patients worry more about doctors using non-human tools rather than having a doctor who seeks external advice.

New Hanover Regional Medical Center (NC) goes to paper downtime procedures for seven hours Thursday when its Epic system goes offline due to an AT&T regional outage.

An online publication HITECH article elicited interesting comments. Granted some of them veer into death panel nut job territory, but they’re still fun to read and some are insightful.

• “EMRs encourage doctors and nurses to cheat and lie. EMRs have made medical records inaccurate and unreliable. When I read medical records nowadays, I often can’t tell what the hell happened.”
• “In an EMR, every URI is an average URI.”
• On the use of surgical case templates: “… worked out with the hospital risk management department to describe what should happen, and entered in the EMR with one click of a mouse. What actually happened? No one can tell.”
• “The response calling this idiocy a step in the right direction apparently fails to get the point, which is that EMRs make crappy doctors look like decent ones by giving them the same well-written notes as the good ones.”
• “It seems to me that this isn’t exactly the unintended consequences of EMR; it’s the unintended consequences of the government incentivizing bad EMR by incentivizing the wrong things:  the ACA encourages rapid adoption of immature or awkward technologies without clear benefits; medicare, medicaid, ACA, and the employer-provided health insurance tax exemption incentivize egregious billing practices. EMR and provider companies respond to the incentives; the problem isn’t the software per se, but the incentives. There’s no inherent reason why an EMR system should require more data entry on the part of doctors, or why the data entry should take longer than updating a paper chart. Systems could be designed that work better and provide consumer benefits, but they aren’t appearing because the system incentives really aren’t designed to serve the customer.
• A physician on not customizing template-created notes: “I like to think most of us are pretty honest, and this doesn’t feel like a lie, more like the best that can be done with the time available and the limits of the EMR. I don’t know if I am only humoring myself about the honesty. I do know the job can’t be done except by the copy and paste method.”
• “This article misses a key point. If they’re fine falsifying electronic records, why wouldn’t they be comfortable falsifying written records? Moreover, electronic records are easier to falsify, but they’re also easier to catch.”
• “I think physician associations need to reemphasize that documentation by exception is not appropriate for physicians, perhaps even take it a step farther and officially declare it outside the standard of practice. The great potential benefit of EMR’s (along with the requirement that they be able to produce data in a standard format) is that medical charting will stop being primarily about stories and start being primarily about data. This will not only make treatment of patients more scientific, it will energize evidence-based medicine. Right now, about half of medical treatment is done despite no evidence of efficacy. Of course, if the data is unreliable, we have GIGO. So the use of charting by exception leading to bad data is a huge problem.”
• “EMR’s are the vehicle for corporate and government direction of medical care. I predict that within 5 years, it will be illegal to provide medical care to a patient unless it is through an Electronic Medical Record … this idea will be advanced as important to preventing waste, fraud and abuse.”
• “Simply put, doing a thing, and documenting the doing of a thing, are two separate, and not particularity related skills (I would figure that journalists would understand this better than anyone), and it is unlikely that a person who is good at the former is also good at the latter, and when we ask him to do both, this is what we get. Cheer up, we could get the people who do amazingly good documentation to do the surgery. I suspect that would be much worse.”

I’m scooping Weird News Andy on this story: a drunken Englishman is hospitalized after the paramedics he called found his frigid sexual partner dismembered in a snowy field. The partner was a snowman; the man’s injury involved frostbite of his manhood, which nearly required amputation.

It’s NextGen Part 3 from Vince this week as he covers Opus Healthcare Solutions.

Sponsor Updates

• SimplifyMD is running cartoons and videos looking at the humorous side of medical practice at “Easy Street Family Practice.”
• Nuance announces that the electronic medical records systems used by hospitals and clinics in the United Arab Emirates will be voice-enabled using Dragon Medical.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Time Capsule: The Idealistic HR Rep Is Wrong: IT Success Means Treating Your Stars Better Than Everyone Else

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

I wrote this piece in May 2008.

The Idealistic HR Rep Is Wrong: IT Success Means Treating Your Stars Better Than Everyone Else
By Mr. HIStalk

Healthcare IT is an industry of experts. Folks with highly specific skills are the hardest to find and keep.

You know them. They’ve developed battle-hardened expertise in the quirks of a particular vendor’s product, often as technical experts (aka programmers, system analysts, or application specialists). You, some other hospital, or a vendor raised them from sapling to stout oak. Unfortunately, others covet and sometimes steal them. Losing one can kill your project or your reputation with users quickly.

Job #1 for an executive is to keep these stars. Here’s the biggest secret for doing that: don’t treat everyone equally. The idealistic, chipper HR rep is dead wrong. You keep your stars by identifying them and treating them better than everyone else, proudly and loudly.

(My motto is this: keep the top 10 percent of employees deliriously happy, the middle 80 percent comfortable, and the bottom 10 percent miserable).

Stars are like attractive women – they know it. That means having options, one of which is leaving for greener pastures. Insecure managers who try to beat down excellence by applying by-the-book principles of democratic, feel-good management in which everyone is treated alike will be left with plodding conformists. The geniuses will be long gone. Unfortunately, one genius can outperform a handful or more of plodders, especially when you’re talking about programmers, DBAs, and the like.

Most of those stars don’t want to be managers, so the promotion carrot doesn’t work. They aren’t starving, so throwing money at them won’t buy their loyalty. The best strategy is to identify that top 10 percent, then break the rules for them (who doesn’t feel special when someone breaks rules for them?)

Make them attend only that 10 percent of meetings that are important. Managers have long detuned their outrage threshold and will happily sit through time-wasting sessions where no conclusions are reached and no assignments made, but technical folks would rather be accomplishing something.

Give them whatever technical toys they need and then some. Your best analysts should have a huge monitor, a mobile device of their choosing, and whatever software they think will look cool on the shelf. These may or may not improve productivity, but they serve as a badge of honor visible to all that they’re special (that motivates others to seek stardom, too). Compare the cost to that required to find and train a replacement – it’s nothing.

Feed them. Surprise pizza or an off-campus lunch is cheap.

Put your best people in the best workspaces. Windows motivate. So do fancy chairs. Working from home on occasion is a real perk. Airless, institutional cubicles that scream interchangeable galley slave aren’t for stars. Brad Pitt doesn’t share a dressing room with the extras.

Send a note of thanks to their significant other after a long stretch of heads-down work.

Let them wear whatever they want as long as they’re not meeting with outsiders. People do their best work when they’re comfortable. Only managers wore ties as toddlers.

Respect stars, even if you can’t do the same for everyone else. Everyone, right up to the big boss, should know their background, hobbies, family members, and favorite vacation spots.

Send them off to training. It’s a badge of honor for an employer to invest in training-related travel. If the training budget is limited, spend it on the stars instead of dividing it equally.

Let them screw around on the clock with technologies you may never use. Hospital stuff is sometimes outdated, so exposure to cutting edge technologies is a motivator.

Allow them to interact with users and executives and users if they want. It’s insulting to have a middle manager boss steal the limelight when things are going great, but hide behind a closed door the rest of the time (I know because I’ve done it).

Make it clear to managers that their primary focus is to keep their stars happy and productive, which often means butting out and not trying to artificially add value. Not all managers are stars, either.

If an assignment is too trivial to make it sound crucial even by stretching the truth, give it to someone else, not a star. And if it’s critical but probably impossible, give it to a star and tell them so, feigning surprise when it gets done in a blinding flash of genius.

All of this sounds simple, but have you formally identified your stars and intentionally treated them better than the non-stars? If not, you’d better do it before someone else does.

Collective Action 1/25/13

The views and opinions expressed are those of the author personally and are not necessarily representative of current or former employers.

Leader the Follow (Part 2) — Identity

Let’s see … where were we? Oh yes, talking about being a follower and the significance of that role. This is a follow up to the last Collective Action post on HIStalk.

Last time I asked for input from readers about what kind of leader you would follow. I received several responses and I will include some of them at the end of this article. Thank you to all who provided feedback — it was insightful and entertaining. 

The key to studying followers is similar to the key to studying leaders. It is not about characteristics of a leader or follower. To me, the key is identity. How you see yourself determines your effectiveness. 

I agree we need to talk about Meaningful Use, business intelligence, ACOs, and what the next great innovation in healthcare will be. But none of those things can happen without  a focus on both leaders and followers and teams they lead.

As I was researching this topic of identity, I came across an interesting term: “metaperceptions.”  This is not how you are perceived, but rather how you perceive others perceive you. The difference is slight, but profound. 

I have a great example of this from a recent presentation I gave. I was speaking to a crowd of about 100 people here at our hospital at a recent event. It was an EMR project-related event that we themed “Finish Strong,” where I and others presented concepts from Dan Green’s book Finish Strong. 

I consider myself a good communicator. I believe I have a gift that allows me to write and present well. As I was presenting, someone in the audience dozed off. I thought right then that her perception of me was that I was a lousy presenter. Instead of continuing as I should have, I got thrown off. I thought they had lost interest and I started rushing through the rest of the presentation, not giving some of the more impactful parts ample time. 

Afterwards, I spoke to her and asked her how she liked the event and presentation. She said that she loved it, but had a new baby and was very tired. She made some comments about what was said and how it impacted her. I was blown away. My metaperception was wrong, but that didn’t matter, it impacted my effectiveness.

The root of our identity is only partially based on what others think. It is mostly based on how we view and think about ourselves. Here are some interesting statistics regarding how we think about ourselves. 

According to Daniel Amen, MD, a renowned psychiatrist and brain imaging specialist, we have about 60,000 thoughts per day — one every second while we are awake. Ninety-five percent of those thoughts are the same ones we had yesterday (a broken record!) For the average person, 80 percent of those thoughts are negative. 

That is incredible. Every day, the average person working in your department or your hospital or living in your home has 45,000 negative thoughts. Whether you are a leader or a follower, whether or not you care about what others say about you, you can do enough damage to yourself to keep yourself from fulfilling your destiny.

How do we combat this? How do we help those around us combat this? If you don’t think this is true about yourself, then you are probably not average, but you know someone who is. While it may not directly impact you, it impacts you in some way.

Let me offer something to you that is a bit unorthodox, but that has literally changed my life. I got this from the late Zig Ziglar, who says that how you see yourself is everything. A part of his program, called Self Talk, includes a laundry list of positive attributes: honest, intelligent, organized, responsible, committed, teachable etc. He offers several paragraphs with affirmations and instructs everyone he works with to say this list of affirmations in the mirror, morning and night, for at least 30 days. 

When I first heard this, I thought it was ridiculous, much like what you are likely thinking now. When I tried it, I thought it was stupid and embarrassing. I would not tell my wife. I locked the bathroom door and went through it as fast as possible. 

A peculiar thing happened after a couple of weeks. First of all, I finally told my wife, but I also started to become less embarrassed. I started to see that I really was some of these things, and some of them all the time. Other characteristics were just seeds and needed watering. 

At the end of 30 days, although I did not count, I literally sensed the number of daily negative thoughts decreasing, being replaced with thoughts that were empowering. Dare I say, I started to believe that I was just scratching the surface of what I thought I could accomplish in life. There is a lot more to that story, but it is for another post.

Besides how we talk to ourselves, there are additional factors in our life that impact those 60,000 thoughts. In Darren Hardy’s book The Compound Effect, he dedicates a chapter to influences. He says that everyone is affected by three kinds of influences: input (what you feed your mind), associations (the people with whom you spend time), and environment (your surroundings). These external forces are very powerful and dramatically affect how we think and feel about ourselves, our choices, behaviors, and our habits. In this book, he offers suggestions on how you can govern these forces so they can support and not derail your journey towards success.

To help deal with this on a corporate level, we have been walking our team through a couple of things to help positively reinforce who they are and where they are going.

The first was we helped everyone on our team develop a brand statement for themselves and complete a professional bio. This exercise forced them to take a look inside and actually write down what they have accomplished and really who they are as a person and a professional. 

The second thing we did was have everyone complete Clifton’s Strengthsfinder assessment. The result of the assessment was a list of your top five strengths, which most everyone, including myself, has posted on their door or cubicle wall. 

We review these things in team meetings. We try to use them to better align teams. Although we have a long way to go to really perfect this, the attempt alone at trying to deal with this has had a positive effect in the department.

Follower or leader, both are important roles, and while healthcare goes through rapid transformation, we need the best and brightest operating in their gifts with full confidence. If you struggle with this or know someone who does, you can be a resource in their life, and in turn, in this industry. The answer to how to improve healthcare will come from the people within healthcare, and we need these people thinking they can affect change. 

While this topic may not seem relevant, I believe it is at the root of advancement. Whether leader or follower, even this little bit of knowledge about your identity and how you see yourself can help you and help you help others. This is your destiny!   

Responses

The first response came from a popular HIT blogger who reached out via Twitter (@SmyrnaGirl) and said, “I would follow a leader who wouldn’t be afraid to impart wisdom and one day let me lead in their place.” 

Not all followers share this sentiment. An anonymous person shared the following. “When my personal convictions are strong and clear, others may agree and choose to follow, but they do so on their own. On the other hand, if my convictions happen to align with those of others before me, then I may seem to be a follower, but in reality I am going my own way. Either way is fine with me. I will never follow or lead just because someone thinks I should, and I have no inherent desire to fill either role.” After a few more comments, he went on to answer the question directly. “For me, I would have to first decide if it was my battle. If so, then I’d follow the plans and directions of the one who seemed most aligned to my own thinking.”  

A practice administrator in Jacksonville, FL had this to say. “This organization thus  far has given me almost free reign on how and where I am taking our primary care network, with the expectation that I do it within cultural norms and corporate guidelines. After 10 months, I am happy to report that this is a comfortable position for me.” 

A quality management informatics analyst sent an e-mail saying, “One of the best leaders I had was a supervisor who openly said that he ‘had my back.’ When business events happened that threatened to undermine my authority or the scope of my work, he would respond by protecting me and promoting my interest in the situation. As a result, I felt a lot of loyalty and trust toward him and tried even more to meet his expectations.”  

The final comment came from a chief operating officer of an HIT vendor. He provided some great comments about leadership and following in general. We had an e-mail dialogue that really gave me some great insight into leadership. He said, “Inspirational leadership is great, but good execution combined with it is rare. Find a CEO or president who is a visionary and the matching CEO or COO who has the power of execution to make it happen. Typically, the inspirational people are not good at actual execution, but they need to let go to have others execute.” It sounds like he would be willing to follow someone who in addition to being able to recognize their strengths,they can recognize their weakness and bring someone in who can help bridge the gap.

Bill Rieger is chief information officer at Flagler Hospital of St. Augustine, FL.

The Skeptical Convert 1/25/13

APSO Fact and Fiction

I sit on an Epic implementation advisory committee for my hospital’s multi-hospital organization. From time to time, we are asked to make policy recommendations. One issue brought to our attention concerned the formatting of medical assessment notes, especially the part where the practitioner actually gets around to stating his or her actual opinion about what’s going on and what to do next. 

The issue had to do with whether that information would be placed at its usual seat of honor at the end of the report, or whether it should be placed up at the top. The shorthand for the formatting issue would be “SOAP vs. APSO”, where the four letters stand for “subjective, objective, assessment, plan.”  

In medical school, we are taught the traditional “history and physical” reporting format when evaluating a new patient or problem. The patient’s own story comes first– information considered “subjective” (yes, you can argue that the subjectivity is as much in the head of the practitioner as the patient, but a digression here). What followed traditionally was a detailed physical examination.  

In the mid-20th century, Lawrence Weed, MD coined the SOAP terminology, incorporating the reality that lab tests and imaging had become major factors in the medical workup. “Objective” became his bucket term for doctor- and system-generated information beyond the patient’s history.  

But whether you call the next section “impression”, “assessment” or “differential diagnosis”, the question it attempts to answer is the whole point of the exercise. What, doctor, is your opinion about what is going on here? What do you think is wrong, and if not that, what else might it be? The plan for what to do, of course, should follow logically from that.

The argument of APSO proponents is that they don’t really want to change this, but that EMR reports have become bloated by lots of templated and imported information. Someone reviewing them just wants to get to the conclusions and recommendations of the attending or consultant. So, put that at the top. Their position is that no matter how you format the information, the workflow and “thoughtflow” (a nickel to Dr. Bierstock) stay the same.

Is that true? I have trouble believing it. In fact, deep down I really dislike the APSO format, and I didn’t like it before any computerized reporting was developed. 

Many practitioners, especially medical subspecialists, dictate their consult notes that way. They’ll say they work in their heads down from the subjective / objective, but when they dictate, they do start with the conclusions. When I read down the page of an APSO consult, I often see gaps in basic structure and/or clinical information that may have been included if the author had stayed in order. From my own experience, dictating in traditional order, I do in fact sometimes revise my opinion or add additional diagnostic options by the time I get to the end.

But really, I can’t get that worked up about it (that’s why I dumped my original title:  “Let’s send APSO to Lhasa”). The reason is that APSO notes at least have some sort of thought-through assessment in them. Frankly I read a lot of notes that dutifully go through the motions of a history and physical, but then the conclusion — often compressed into some ghastly mutant section called the “Assessment/Plan” — blandly restates the available findings and problems and goes straight to the tests and consults that will be requested. If you have nothing to say, you might as well spit it out at the beginning. Saves time for me, anyway.

Will Epic straighten these problems out or exacerbate them? I’m out of space now, but Epic go-live is in two months. Stay tuned.  

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

An HIT Moment with … Chuck Demaree, Access

An HIT Moment with ... is a quick interview with someone we find interesting. Chuck Demaree is CTO of Access of Sulphur Springs, TX.

What’s the continuing role of electronic forms as hospitals move to EHRs and other systems?

First, we have to establish a basic understanding about forms. A form is merely a structured tool to collect and organize data. Whether it is paper or electronic, its purpose remains the same.

Electronic forms can be placed in two categories. Online forms are primarily used for data acquisition. Managed output forms re-structure and automate the distribution of data in either a printed or electronic format. 

Hospitals need both types of forms going forward. The online, outward-facing forms collect data from sources that may not be connected to their hospital network, such as patient homes, clinics, and physician offices. Managed output forms organize data from the many disparate systems used in a hospital into a normalized format prior to routing forms into a document repository, or ECM/EDM system, as part of the EHR. This also becomes important if a Legal Health Record (LHR) ever needs to be produced for litigation purposes. 

What are some examples of workflow, productivity, and information needs that for most hospitals can be met only via the use of electronic forms?

Most health information and EHR systems — including those from Siemens, Meditech, Epic, McKesson, and Cerner – utilize some sort of workflow, but there is almost always another process or workflow that takes places even before the HIS or EHR is used. Today, that workflow is still a manual process that is either verbal or written. It is difficult to build a system that can address all the varied processes that exist. Electronic forms allow a hospital to address each process uniquely by designing a form or set of forms and custom workflow to address that process. 

Some examples are patient scheduling or pre-registration from home, feeding a registration or scheduling system. Automating acquisition of data from systems such as endoscopy, EKG, and perinatal and normalizing the structure of the data and routing and indexing the documents into the document repository. Adding electronic signatures and barcodes to existing forms and systems that do not currently provide that capability, such as discharge instructions or patient teaching documents. Business and back office functions, such as human capital management, purchasing processes, and accounting output such as checks or direct deposit notices.

If a hospital has already purchased an EHR, what would they do with your systems that would benefit patients?

Some EHRs have very nice patient portals to access the patient’s medical information, but not all patients are technically inclined or have access to the Internet. Some patients still prefer a physical document, and sometimes that is the only method for transferring data from one hospital’s EHR to another.

Our systems can provide outward-facing secure data acquisition across the Internet for patients and practitioners who are not on the hospital’s network. They can also easily control the format of data before it is printed or aggregated into an EHR. Controlling and normalizing the format of data makes it easier to read and find the information needed. This helps expedite care and reduce mistakes.

What is the role of electronic forms during system downtime and disaster recovery?

This goes back to the purpose of the form as a tool. During a downtime or business continuity episode, well-designed forms make it easier to continue to move patients through the clinical process and still capture data in a structured and familiar format. If these forms are barcoded with the form ID and the patient ID, then automatic indexing of this data into the document repository becomes much more efficient and less prone to error or misfiling.

Do hospitals intentionally use electronic forms as an alternative to entering data manually into a cumbersome online system?

I think there are a limited number of choices for hospitals to fine tune a system to make it easier for their staff and patients. We have many customers that use our output management products to automatically capture disparate medical device and clinical system data and redistribute it into an EHR or document repository. We have others who have chosen to not purchase employee or patient self-service systems and instead use our online forms solutions to create their own user-friendly front end for data acquisition.

Morning Headlines 1/24/13

Quality Systems, Inc. Reports Fiscal 2013 Third Quarter Results

Quality Systems, Inc, known to most as the parent company of NextGen, reports Q3 earnings, with revenue up two percent and EPS $0.26 vs. $0.36, missing analyst estimates for both.

Huron Consulting Group Bolsters Huron Healthcare with Strategy and Supply Chain Experts

Huron Consulting Group announces that Jim Agnew (Navigant Consulting) and Jeffrey McLaren (VHA) have joined the company as managing directors in its Huron Healthcare practice.

Vermont becomes first in nation to implement accountable care organization

Officials from Fletcher Allen and Dartmouth Hitchcock Medical Center announce the creation of the nation’s first statewide accountable care organization (ACO), called OneCare Vermont.

GE Healthcare Announces Centricity Practice Solution 11

GE Healthcare announces the release of the next Centricity Practice version, which provides enhancements to help facilitate ICD-10 transitions.

SB 1275 Medical data in an electronic or digital format; limitations on use, storage, sharing, & processing

Republican Senator Stephen H. Martin introduces a bill to the Virginia State Senate which mandates that providers cannot be penalized for refusing to implement an EHR, analytics cannot be performed across multiple patients to manage population health, and organizations are not permitted to participate the Nationwide Health Information Network.

News 1/25/13

Top News

Quality Systems (NextGen) reports Q3 results: revenue up two percent, EPS $0.26 vs. $0.36, missing analyst estimates on both. The company reported a 29 percent drop in system sales revenue as operating expenses rose six percent. The earnings call transcript is here. The results were announced before Thursday’s market open, with shares closing down only 0.16 percent by the market’s close.

Reader Comments

From Kojak: “Re: Intuit Health changes. Medfusion founder Steve Malik is retiring in June and Sanjiv Waghmare is taking over as Intuit Health’s new GM.” The e-mail announcement was attached. Malik (above) was named president of the Intuit Health Group when Intuit purchased Cary, NC-based portal vendor Medfusion for $91 million in 2010. Waghmare is a VP of product marketing.

From WHIMSSical: “Re: booth demo stations. PowerPoint or video? Should vendors use PPT since nobody can hear the video?” I say video and/or a live demo backed by a credible and engaging demonstrator, but perhaps also a fast-paced and highly graphical looping PowerPoint on a big projection screen as a billboard to grab attention as attendees streak by. Readers, what would get your attention?

From Doc Tari: “Re: Allina. Did know if you heard Allina having a bit of restructure. CMIO Shrift left to Cleveland and now CIO over all the IS areas.” 

From Carrie Prejean: “Re: HIStalkapalooza. What exactly does one wear to HIStalkapalooza this year? Bowling shoes? I want to come prepared because I am determined to win the ‘Inga Loves My Shoes’ contest!” When I first heard that this year’s bash was going to be in a (very cool) bowling alley, I was also perplexed on the proper attire. We are fine-tuning things, but suffice it to say that just about anything will go. We will once again have a red carpet, so arriving in stiletto heels and sequins will be totally acceptable. Alternatively, if you own a vintage bowling shirt, this could be the time to pull it out of the back of the closet. The shoe contest will include categories for those partial to high fashion as well as those who choose to adorn more functional bowling shoes. We will also be crowning a HIStalk King and Queen based on their total fashion package. Winners will be awarded amazing prizes, so don’t show up in your “straight off the exhibit floor” attire, especially if the look includes a company logo’d tee shirt.

From RFP: “Re: MD Anderson. Posts an EHR RFP.” The RFP strongly suggests that prospective bidders attend the pre-proposal conference on Wednesday, January 30 just in case you want to thrown your electronic hat into the ring.

From Slim: “Re: Optum. I read your update confirming that Humedica was bought by Optum. Wouldn’t it have to be announced since Optum is part of UnitedHealth Group, which is publicly traded?” I’m not an expert, but I believe SEC disclosure requirements cover only “material events,” meaning companies must file an 8-K form only if a merger, loss of a key customer, or policy change could reasonably be expected to impact share price in the company’s subjective judgment. UnitedHealth Group’s market cap of $58 billion and annual revenue of $111 billion would make all but a huge acquisition non-material.

From Bill O’Plenty: “Re: SB 1275. Crazy law introduced in Virginia.” Virginia State Senate Bill 1275, introduced January 14, would prohibit any organization that stores electronic medical information from (a) participating in the Nationwide Health Information Network; (b) performing analytics on multiple patient records for diagnosis, treatment, or population health management; and (c) processing medical data within Virginia if most of the patients represented live out of state. It also mandates that providers cannot be penalized for refusing to implement EHRs, that patient consent for electronically storing their information is valid only for healthcare coverage purposes, and that the state is prohibited from starting or operating an HIE. I e-mailed the office of the bill’s sponsor, Republican Senator Stephen H. Martin, to ask what he’s trying to accomplish with the bill, but I haven’t heard back. Senator Martin is running for lieutenant governor, which could ironically pit him against Democrat Aneesh Chopra, former White House CTO and advocate for all the items that the bill would prohibit, so perhaps he’s just trying to pick a fight.

From Wearing Dad’s Suit: “Re: Epic’s non-compete. Does it cover this?” Applicants for the head football coaching job posted on the University of Wisconsin’s HR website include a Walgreens pharmacist whose only relevant experience was as a season ticket holder, a Fedex driver who said he’d take $60K to lead the Badgers, and a financial analyst with Epic whose college athletics experience consists of having been a practice player for Tulane’s basketball team. I give our young Epic friend credit for trying even though he lost the $2 million job to a more experienced candidate who responded to the online posting, Utah State Coach Gary Andersen.

HIStalk Announcements and Requests

The latest highlights from HIStalk Practice include: Epocrates says its app has helped clinicians avoid more than 27 million adverse drug events. Farzad Mostashari, MD highlights some of the ONC’s 2012 achievements. Pharmaceutical companies and other businesses embrace advertising opportunities within cloud-based EMRs. E-visits may be as effective as in-person office visits for uncomplicated ailments. Dr. Gregg describes a day in the office in the Year 2063 (quite fun.) You know the drill: catch up on all the latest ambulatory HIT news, click on a few sponsor ads to find a goodie or two that might improve your life, and sign up for the e-mail updates. Thanks for reading.

On the Jobs Board: Cerner Experienced Providers, Product Marketing Manager, Healthcare Strategy Communications Specialist, Project Specialist.

Acquisitions, Funding, Business, and Stock

Healthcare social networking site iMedicor acquires iPenMD, which offers a digital pen solution to capture clinical data. iPenMD apparently bought the intellectual property of nextEMR this past July per a reader’s rumor report.

Merck Global Health provides $6 million in growth capital to eHealth Technologies, a provider of continuity of care solutions.

Praesidian Capital invests second lien debt capital in eTransmedia Technology to replace debt and fund growth.

Revenue cycle systems vendor Recondo Technology receives a $20 million growth investment from private equity firm Bregal Sagemount.

Healthcare Growth Partners releases its 2012 HIT Market and M&A review that summarizes capital markets, M&A, and capital raising activity for the healthcare IT and services sector.

Sales

Tampa General Hospital (FL) selects Merge’s CTMS for Investigators solution for enterprise management of clinical trials.

People

Huron Consulting Group adds Jim Agnew (Navigant Consulting) and Jeffrey McLaren (VHA, Inc.) as managing directors in its Huron Healthcare practice.

HIMSS promotes Thomas M. Leary to VP of government relations, taking the place of Dave Roberts, who was elected to the San Diego Board of Supervisors.

Iatric Systems promotes Frank Fortner from SVP of software solutions to  president.

The Northeast Business Group on Health honors Truven Health Analytics president and CEO Mike Boswood at its 18th Annual Tribute to Leadership.

Clinical data integration provider Apixio hires Jonathan Murray (Aetna) as chief business development officer.

Intellect Resources announces triple-digit growth in 2012 and announces several promotions and hires, including the promotion of Eileen Dick to VP of technology and Cindy Orr to VP of go-live services.

Robert Rowley, MD (Practice Fusion) is named medical advisor for personal health care vendor LifeNexus.

Announcements and Implementations

CareCloud and HealthTronics partner to combine CareCloud’s PM product with HealthTronics’ UroChart EHR and meridianEMR urology-specific EHR platforms.

Fletcher Allen and Dartmouth Hitchcock Medical Center (above) announce the creation of OneCareVermont, the nation’s first statewide ACO that includes 13 hospitals and hundreds of primary care physicians. We announced their plans in September.

Three Ontario hospitals go live on PatientKeeper Physician Portal, Mobile Clinical Results, and NoteWriter, including Alexandra Marine & General Hospital and two hospitals in the Huron Perth Alliance.

The RFID in Healthcare Consortium and Intelligent Hospital.org recognize six organizations for their advanced use of healthcare technology solutions.

GE Healthcare introduces Centricity Practice Solution 11.

Other

Winthrop Resources is conducting a survey on cloud solutions and bring-your-own-device practices. If you’d like to take about 10 minutes to help them out, the survey is here.

HIMSS finds yet another way to offer preferential treatment for its higher-ranking provider members whose purchasing influence makes its vendor members salivate. Healthcare Transformation Project offers “exclusive access” to services, meaning of course that someone has to be excluded (like the rest of us dues-paying members). For example, invitation-only HTPers get “up-front VIP seating at the HIMSS13 Keynote Address by President Bill Clinton” (I was going to insert a cigar joke, but decorum prevailed). The Transformers who are willing to spend $295 of their employer’s money to attend its annual forum at the HIMSS conference get to hear a bizarrely HIT-unrelated group of political speakers – former Florida Governor Jeb Bush, Democratic political strategist Donna Brazile, and former Nixon speechwriter Pat Buchanan. HIMSS says that “participants will make commitments that will translate goals into meaningful and measurable results in their own organization or community,” so we can all look forward to seeing how those work out for patients. Meanwhile, HIMSS offers vendors a bunch of expensive ways to get in or near those decision-making faces, with $50K buying you a podium speaking slot and free tickets for prospects who would be impressed by Pat Buchanan.

Cerner and Sporting KC take heat for failing to keep their promise to build a $35 million youth soccer complex in return for the $200 million in taxpayer-funded incentives they received to build their professional soccer stadium and Cerner office buildings. The youth fields were supposed to in use by now, but work hasn’t started.

Spain’s leading newspaper says it was duped when it ran a fake photo of Venezuelan President Hugo Chavez in his hospital bed, which the paper was told had been taken illicitly by a hospital nurse. The image, widely panned as unconvincing, turned out to be a screen shot of a YouTube surgery video from 2008 featuring an acromegaly patient being intubated.  

The local TV station covers the use by Georgetown University Hospital (DC) of the iPad-based patient data collection system from Tonic Health that replaces paper forms in the doctor’s office. The story says other Tonic users include Mayo, UCLA, the VA, and Kaiser. The company says the product integrates with EHRs via HL7 or can send a CCD record. It offers a free version with limited functionality. Founder and investment information is here.

As tweeted by @Cascadia: a Virginia medical practice charges patients for using its patient portal, billing $125 per year for Gold access to make appointments and refill requests, while the $250 per year Platinum plan adds three electronic visits. That’s the opposite of every other industry, where free online services encourage customers to do it themselves without tying up an expensive employee. This is like banks offering free teller service but charging for ATM access, or maybe McDonalds adding a drive-through surcharge.

A Texas judge orders the deposition of two partners of a CPA firm accused by a medical practice of failing to secure the accounting system it installed in the practice, which the practice says allowed an employee of the practice to embezzle $1 million over five years.

Weird News Andy says this man wears his nose on his sleeve, also wondering if he will pick his nose in public. British scientists are using a man’s own cells to grow a new nose to replace the one he lost to cancer. They have two noses underway (“just in case someone drops one,” the researcher said) and the patient will chose one of them to be implanted under the skin of his arm until it’s ready to transplant.

I had a feeling where WNA’s story was going when I saw his best-ever headline, “Nothing like having a cold one after work,” but I still nearly choked on my soda when I saw the story, in which a male hospital nurse is arrested on suspicion of having sex with the body of a deceased patient.

Sponsor Updates

• Nuesoft Technologies CEO Massoud Alibakhsh discusses data security and Nuesoft’s technology platform in the video above.
• Awarepoint celebrates its tenth anniversary and recaps key successes.
• GetWellNetwork Founder and CEO Michael O’Neil delivered Thursday’s keynote address on interactive patient care technologies at the IPC Symposium at Hasbro Children’s Hospital (RI).

EPtalk by Dr. Jayne

Your tax dollars at work. On Tuesday, the US Supreme Court rejected an attempt to reopen Medicare claims that are more than two decades old. The hospitals assert that CMS miscalculated payments between 1987 and 1994 that were intended to compensate their treating large numbers of low-income patients. Based on the fact that it took my local academic medical center over a year to settle the bill for a routine eye care visit, it doesn’t surprise me that it takes years for hospitals to figure out they’re missing money.

Attention vendors: Mayo Clinic releases a new list of the top reasons for visiting US health care providers. Maybe you should use this as a starting point for your primary care office visit templates rather than some of the bizarre things I sometimes see on your screens. Granted the data is from Olmsted County, MN, but it looks surprisingly similar to my clinic roster this week except for the absence of “flu” and “freaking out that spouse has the flu.”

I received my first HIMSS-related mailing today. It was so underwhelming I can’t even remember who it was from. When I went to dig it out of my recycling bin, I couldn’t find it – which means it was nondescript as well. Great job, marketing team!

A wise man once told me to always spend a small amount of time “looking for your next gig” because things are constantly shifting in the world of medicine. For those of you who think the same way, ONC is looking for a policy advisor “who knows meaningful use policy backwards and forwards.” I was curious, so I checked out the link and got the best laugh of the day. The low end of the salary range is $123,758. Leave it to the federal government to specify it down to a bizarre dollar amount.

I had lunch with four of the smartest women in the world today. Three have been my boss in the past while the fourth who taught me everything I know about billing. Here’s a shout out for leaders who not only know their fields but “get it” as far as motivating employees to excellence. Thanks for keeping me grounded and reminding me that although I currently work in chaos, I can always count on your listening ears. And your unbiased opinions when I text you pictures of shoes I’m thinking of buying. And your assistance with crafting the “Typhoon Jayne” cocktail for HIStalkapalooza. Salud!

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 1/24/13

All the Tools in the Toolbox: How ONC Delivered Value In 2012

Farzad Mostashari, MD responds to a Boston Globe article that characterizes the ONC as “an office whose primary role has been cheerleader” by publicly outlining how the ONC delivered value in 2012.

Prison Time for Health Data Theft

An emergency department registration clerk from a Florida hospital was sentenced to 12 months in federal prison for inappropriately accessing 760,000 electronic health records and then selling contact information of about 12,000 motor vehicle accident patients to a co-conspirator, who used the data to solicit legal and chiropractic business.

Medicare Program; Request for Information on Hospital and Vendor Readiness for Electronic Health Records Hospital Inpatient Quality Data Reporting; Extension of Comment Period

CMS has extended the deadline for public comments on EHR inpatient quality data reporting until February 1.

Association Between Quality Improvement for Care Transitions in Communities and Rehospitalizations Among Medicare Beneficiaries

A JAMA study quantifies the result of implementing evidence-based post-discharge interventions and concludes that while hospital readmissions dropped six percent, so did hospital admissions, resulting in an unchanged percentage of readmissions among overall admissions.

Readers Write: Dueling Myths: Interoperability and Bending the Cost Curve 1/23/13

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!

The views and opinions expressed are those of the authors personally and are not necessarily representative of their current or former employers.

Dueling Myths: Interoperability and Bending the Cost Curve
By David Lareau

We’ve been hearing for so long about how interoperability is going to do wonderful things that we may have lost sight of the fact that it isn’t actually real yet.

Just look at the sharing of patient clinical information between systems. HHS has just come out with a press release in which they highlight that the penalty per incident for HIPAA violations can be as high as $1.5M. Healthcare executives are being told, “Make your system interoperable, but if you make a mistake, you’ll pay.” Is it any wonder vendors have put clinical data in silos with massive protections around it?

Maybe a bit of reality is getting through. At least they removed the requirement to process incoming clinical quality measure data from MU stage 2, although that seems like a moot point since no one is sending it out except to the government.

But even with these mixed messages in our industry, there is hope. Within the next year or so, new companies will enter the market with systems that are being designed from the ground up to share and distribute clinical information using some of the same methods as social networks. One of the key factors in getting to market quickly for these new entrants is that they don’t have to build upon 15 or more years of “already poured concrete.”

A front-page article in the Washington Post this week said that healthcare is driving job growth in the Washington, DC, area. Read a bit further and you get to these tidbits:

• “Northern Virginia’s Inova Health System added about 1,000 positions in 2012”
• “The growth at Inova last year was largely a result of a major initiative to overhaul its medical records program”

OK, I love it that people are gearing up to update their systems and that jobs are being created, but someone please tell me how that helps us bend the cost curve down? I’m not hearing much about clinician productivity increasing, and I seem to remember from Econ 101 that there is an inverse relationship between cost and productivity. Productivity goes down, cost goes up, and vice versa.

Meanwhile, we hear rumors about Meaningful Use Stage 4 when we’re trying to read the crystal ball about Stage 3 and gear up for ICD-10-CM. I must tell you, I don’t know about the cost curve bending down any time soon, but I sure can tell you that my anxiety curve is going up.

David Lareau is chief executive officer of Medicomp Systems of Chantilly, VA.

Readers Write: Mandating Physician Data Entry 1/23/13

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!

The views and opinions expressed are those of the authors personally and are not necessarily representative of their current or former employers.

Mandating Physician Data Entry

We constantly hear about how EMRs slow physicians down in clinic. I’m on the IT side, and while I agree that every EMR needs to work on usability, it seems that part of the problem is physicians have to use the computer in cases when they would hardly touch paper.

Example: the physician used to just dictate his note and tell his nurses about any tests he was ordering. The note goes to a transcriptionist, and later comes back and is filed to the paper chart. The nurses grab whatever paper forms were needed for the tests, which the MD signs so it can be faxed over.

An analogous workflow in the EMR would be: physician dictates his note (not using Dragon, still using a transcriptionist) and the note is interfaced back into the EMR to be signed. The nurses queue up the orders and the MD signs them (or the nurse just places the order and they’re sent to the MD for signing later). This is all technically possible in Epic and I imagine in other EMRs too.

This workflow seems ideal and maintains the original division of labor. Or you could even hire a scribe to write the note and queue up the orders instead of relying on transcription interfaces and forcing nurses to deal with order entry. But it seems that hospital leadership has an assumption that physicians’ hands need to be on the computer constantly. Is there a reason for this, besides health systems not wanting to pay for the extra staff?

In an ideal world I can see mandating that physicians enter data to ensure accuracy, but maybe that’s a goal for later when EMR usability improves.

The author has chosen to remain anonymous.

Readers Write: Vendor Lessons Learned 1/23/13

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!

The views and opinions expressed are those of the authors personally and are not necessarily representative of their current or former employers.

Vendor Lessons Learned

After 10+ years working for a few HIT vendors, here are a few lessons learned:

1. Stop trying to sell half-baked products: new products, upgrades, and old products remarketed. Litmus test: if you wouldn’t sell it to your mom or best friend, it ain’t ready. No amount of sales talent will overcome poor quality.
2. Hiring a strategy firm for a lengthy assignment is a red flag that shows a lack of confidence in the direction of the company. Litmus test: validating information or evaluating a new market is one thing, hiring someone to tell you how to run your business is another.
3. Buying a business at a premium and then inflating prices to customers and prospects to cover the cost of the acquisition is not wise. Litmus test: if your pricing strategy is based on creating value for you rather than your customer, you have it backwards.
4. The best sales talent in the world can’t fix bad products, bad service, and bad strategy. Those problems need to be first addressed at the top before anyone is going to sell anything of value over time. Litmus test: silver bullets don’t work despite the temptation to believe they do.
5. Stop establishing sales quotas that have no basis in reality. Spreadsheets don’t sell deals and prospects don’t care about your budgets, business plans, or quotas. Did you hear Nick Saban talk about winning? He doesn’t focus on results, he focuses on the keys that create the results. Litmus test: if you are not clear on exactly how you expect to generate the leads required to hit your sales targets and/or your plan is solely contingent upon your reps figuring this out you have a problem. Hope is not a strategy.
6. Companies that achieve consistent growth follow basic principles. At the core, they have passionate leaders who have a cause, are committed to being the best, and are dedicated to truly helping their customers (internal and external) win. This is much easier said than done. Litmus test: you know when you have something special. You cannot really explain it, but you have Mojo – Energy, Confidence, and Focus.

The author has chosen to remain anonymous.

CIO Unplugged 1/23/13

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

The Long View

I proposed to Julie on February 1, 1984. I was 19. I’m not sure I really knew what love meant, but I sure enjoyed being around her. I loved listening to her practice piano for recitals as I stole second glances.

Despite our young age, everyone was pretty stoked about our engagement except her parents. Looking back 27 years later, with my own daughter that age, I can’t really blame them.

Julie defined their marriage. She was the apple of their eyes. They wanted to delay giving her away for as long as they could. When they did, they hoped for a doctor or lawyer. At least those were the types they had over to dinner so Julie could meet them on weekends home from college.

I recall pulling into their driveway one Friday. My Chevy Vega with the duct-taped hood cowered next to their lacquered Mercedes. Wearing baggy sweats and tennis shoes with holes, I was the definition of poor. While I grunted away in the Army Reserve as a private, her dad stood tall as a retired WWII naval officer.

They were against the marriage from the get-go and withheld their support. Then came the final meeting, one last chance to talk us youngsters out of a commitment that had failed them both previously. They hired an investigator who reported everything about me from teenage indiscretions to bank withdrawals to employment history. There was nothing new to Julie. 

Out of exasperation came the final plea came. They offered me a handsome amount of money to walk away.

I had no hesitation. I’d already counted the cost. Despite the fast and easy reward, I took the long view. I’d never had that kind of cash, but I knew money wouldn’t make me happy. I immediately said no. They walked away.

We face many temptations in our careers. Most are not so stark, but others manifest themselves in many forms. We all know of colleagues who took bribes from vendors to influence purchasing decisions. Eventually they got caught and lost their careers and reputations. The short-term gain never pays long-term dividends.

Reviewing hundreds of resumes over the years taught me to spot trends where applicants constantly jumped from job to job, each time trying to bank a modest increase. Although a person might receive payola by making so many moves in a short period, they likely won’t land the big one. Who would hire someone whose trend suggests he or she might leave in a year? At some point, all the jumping catches up to you, especially at the highest levels. Think tortoise and the hare.

I do believe there are times you must go to grow. Other times you need to grind through challenges so your character can form and your leadership can blossom. I see too many people run at the first sight of trouble.

Boy, I’ve been tempted myself. I recall one year a while back showing up at a new employer where it was clear I was way in over my head. Way over. Everyone was nice and it was a stellar advancement opportunity, but my insecurities got the best of me. After a few months, I humbled myself and called my former employer, asking to return.

The COO, who had previously served as my mentor, said no. He explained that I needed to stick it out, learn, ask for help, adjust, and succeed. As much as he wanted me back, he knew if I went in reverse, I would never reach my ultimate goal of CIO. I followed his counsel, and today I am living my career dream. Had I taken the short view, I would likely still be working in the same position today.

My in-laws ultimately had a change of heart and helped us with the wedding expenses. I appreciated the fact they wanted to protect their daughter from making such a huge commitment at a young age, not yet even a junior in college. I would’ve handled it differently, but again, I understood the motivation.

We got married and worked our butts off to get through school and start our family. Today we are richly blessed, having taken the long view.

Whenever challenges hits me, I’m tempted by the short view. But one look at my family and my career reinforces the lesson. The long view pays off.

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

Morning Headlines 1/23/13

Missouri, Kansas and Nebraska Connect via Direct Secured Messaging

The Nebraska Health Information Initiative, Kansas Health Information Network, and Missouri Health Connection announce that they are now connected and able to exchange Direct secure messages across state lines.

Naperville’s Edward Hospital to merge with Elmhurst Memorial

Edward Hospital & Health Services of Naperville, IL and Elmhurst Memorial Healthcare announce plans to merge, forming a three-hospital health system with revenues of more than $1 billion.

Providers Get Help From Clinical Decision Support Evidence Vendors but Still Face Obstacles

KLAS evaluates clinical decision support strategies and roadblocks for providers and concludes that third-party order sets, care plans, and drug dictionaries lead the pack in CDS plans but notes that a lack of integration with EHRs is hindering the utilization of these tools.

King Saud University Signs a Strategic Agreement With Cerner for Two Major Hospitals in Saudi Arabia

King Saud University signs with Cerner to implement EHRs for two academic facilities in Saudi Arabia.

News 1/23/13

Top News

The Nebraska Health Information Initiative, Kansas HIN, and Missouri Health Connection connect their exchanges to share Direct secure messages across state lines.

Reader Comments

From Embers: “Re: Humedica. Being bought by Optum, I’ve heard. I wonder what will become of the Allscripts deal that frankly brought Humedica some business, but also had them running in circles (true for anyone dealing with Allscripts in the past few years)? Also, the new Optum research center in Cambridge is gathering steam and they are putting together a nice team to be a healthcare think tank. Hope you had a nice few days off – my imagination puts you on the podium with Obama and not sipping drinks by the pool.” A couple of readers told me they’ve heard that clinical data vendor Humedica has been acquired, one of them specifically saying it happened last week with no public announcement planned. Wednesday morning update: I’ve confirmed via a reader that the company has been sold to Optum. I’m happy to say that my mini-vacation consisted of the latter and not the former, as I took Mrs. HIStalk out of the country for some magnificent and rare downtime sprawling under 80-degree blue skies, swaying palms, and very small paper umbrellas that didn’t protect our white-to-red skin but did make our tropical drinks look even more fetching. I’m paying for the break today after getting home in the early morning, heading off to work just five hours later, and now sitting here with no break or bedtime in sight after 17 hours of non-stop catching up.

From EHR Watchdog: “Re: MedLink. See attached. Unfortunately customers can’t reach the company as its top two executives are being investigated by the SEC. The company’s EHR is certified and customers are no doubt trying to figure out what to do. One physician has a contractual requirement that records for his 6,000 patients will be available digitally, but he’s having to go through them one by one to either print or save to an external device as he shops for another EHR after spending thousands of dollars on MedLink.” The reader attached the SEC’s October 2012 complaint against Medlink and its two executives, Ray Vuono and Jameson Rose. It claims the company filed a Form 10-K audit report bearing the name of an auditing firm that had in fact not audited the company’s books, with that same SEC form bearing the electronic signature of one of the company’s directors who had not reviewed the form or authorized that his signature be attached. Lastly, the SEC claims an investor asked to have his check returned, but the company deposited it instead. In the SEC’s words, MedLink “purports to be a healthcare information technology company” and Vuono is “a recidivist securities law violator.” I know what that word means because Raising Arizona is one of my all-time favorite movies.

From Iconic Reader: “Re: Allscripts. The smoking doc, at least the reflector part of his attire, is apparently the model for the isolation icon in an Allscripts product!” I give them the nod for going old school, with a doc sporting a reflector thingy and a nurse wearing a starched white cap with a red cross on it.

From Pinky Toe: “Re: vendor shakeup. The vendor is Allscripts. Major reorg in the development group, which includes product management and testing, in which 200+ remote employees are being required to move to Raleigh, Chicago, or Burlington VT or face termination. This move not initiated by Paul Black, but he has sanctioned. This is a RIF, but instead of calling it a RIF, management is calling it a consolidation of resources to ‘centers of excellence.’” More convincing (but also unverified) were reader declarations that the vendor referenced in a reader’s earlier comment about employee layoffs is in fact NextGen, but I don’t have confirmation on anything since companies rarely announce or confirm personnel actions.

From Ben Dover: “Re: NextGen. Cutting personal days for employees, sent out the week of January 16 but backdated to January 1, which means employees who took personal days for the holiday will be back-charged for vacation.” Unverified, but the source is non-anonymous and has a copy of the internal communication. The backdating, which adds a bit of sting to the slap in the collective employee face, seems indicative of either an impulsive management decision or inability to get the corporate act together.

From THB: “Re: Edward Hospital & Health Services. Merging with Elmhurst Memorial Healthcare to create a $1 billion system that would be among the largest in the Chicago area. Edward is going through an Epic implementation.” Verified in a Tuesday announcement. I interviewed Edward VP/CIO Bobbie Byrne a year ago. Edward seems to be the dominant would-be partner, so I expect the Epic implementation will continue and Elmhurst will drop Meditech.  

From Idol Observer: “Re: Greenway’s announcement of meeting ONC 2014 criteria as an EHR Module. According to the announcement, they only met two criteria, a safety-enhanced system and a quality management system. The first requires the vendor to simply name their testing methodology for the features already required by the 2011 feature – no programming is required. The second is to just identify the quality management system being used, with no programming required there either. In other words, it’s just meaningless PR that will get physicians even more confused.” I get lost in all the certification minutiae, so I’ll defer to Frank Poggio.

From Rand Reader: “Re: the recent Rand report. It said EMRs remain costly without good outcomes because doctors haven’t re-engineered their workflows to accommodate electronic systems. Why would they want to do that when the change could be averse to safe care? Just an idea for your next poll.” My opinion is that many doctors will never accept EMRs because to do so would implicitly accept the idea of process standardization and repeatable processes everywhere, and doctors are trained to be confident in their individual abilities and wary of any process that doesn’t involve their own brains and hands. Patients are usually on the side of doctors since everybody likes to think they’re getting extra-special treatment and not being managed by a corporate algorithm. I don’t know that either side has proved its point convincingly.

From Just Wonderin: “Re: ONC’s HIT Safety and Surveillance Plan of December 21. The ‘public comments’ solicited by HHS are not so public after all since they are not being presented for the public to see. Is it because HHS and ONC don’t want the public to see the comments offered by the Cerner and Epic ilk?” It appears that comments can be submitted only via e-mail.

HIStalkapalooza 2013, Sponsored by Medicomp

HIStalkpalooza will be Monday, March 4, 2013 at Rock ‘n’ Bowl, New Orleans, LA. Medicomp CEO Dave Lareau, one of the coolest guys I know, wanted to bring you some real New Orleans flavor for Medicomp’s return as HIStalkapalooza sponsor. He’s ably assisted by the ultra-professional crew who engineered the 2011 event: Patrice at bzzz productions, Shannon and Cindy from Thomas Wright Partners, Anthony from Istrico Productions, and of course the Medicomp stars like Roy and James that you saw on the stage and at the Quipstar event on the HIMSS show floor.

Medicomp sponsored the 2011 event at BB King’s in Orlando (video is here, although I doubt anyone has forgotten that bash). They said then they wanted to return this year, so naturally I’m super happy to have them back and expecting them to rise to the challenge of a superb 2012 HIStalkapalooza in Las Vegas courtesy of ESD (I still play their video every now and then because it’s so cool).

Rock ‘n Bowl is equal parts bowling alley, dance hall, live music venue, and old-school Cajun-Zydeco shrine, which sounds kind of low-brow until you notice that it has earned a 4.5 average review on both Yelp and Tripadvisor. Beats the heck out of a cookie cutter hotel ballroom or a Disney-like fake Cajun place. It’s a big place even though the layout makes it hard to tell in pictures. Some details:

• Buses will take HIStalkapaloozans from the convention center to Rock ‘n’ Bowl and back to the key hotels.
• You’ll be offered the chance to once again execute your perfect red-carpet strut while having an Ingatini thrust into your parched palm and being surrounded by industry glitterati.
• You will have the option to sip (or guzzle) the aforementioned Ingatinis and Typhoon Janes, not to mention just a lot of drinks in general. The ladies are providing guidance on how they want their namesake potions prepared (I’ll bet there’s a lot of alcohol involved), so details on those will come later.
• You’ll be entertained by Brian Jack and the Zydeco Gamblers, with instructors leading you in Zydeco dance lessons if you so choose.
• You’ll be fed you authentically and well with red beans and rice, jambalaya, crawfish etouffee, and retro bowling alley food like pizza, wings, and fried seafood. No tray-passed mini-quiches or two-per-person drink tickets here, folks.
• Inga will be overseeing our usual shoe and attire contests, best bowling shirt judging, and some other categories I’m not privy to but that I expect will result me spending excessive money on beauty queen sashes and prizes. She can chime in later on the particulars.
• The inestimable Jonathan Bush will once again preside over the not-to-be-missed HISsies awards at 7:30, the role he created at the first HIStalkapalooza in 2008 and has held since. I have it on good authority that the people you chose for all of the important and serious awards (Industry Figure of the Year, Lifetime Achievement Award, etc.) will be there, which would be quite an assemblage of industry talent.
• There will be a fun bowling tournament, but since I haven’t bowled since college (translation: I’ve never bowled sober nor seen any reason to) I’ll let Medicomp explain how that will work later. I know some of Medicomp’s partner companies will be hosting individual lanes, so I’m sure we’ll have some fun folks there.
• You will have networking opportunities like crazy given the remarkable number of CEOs, VPs, investment bankers, press, and lower-ranking but generally amiable grunts like me who’ll be hanging around and lowering their guard to conduct frank and possibly slightly slurred conversations. Deals will be made, jobs will be offered, and a variety of propositions will be extended and considered. A good time will be had by all.

The registration page is now open. Since demand always exceeds supply, registration puts your name on the “I want to come” list. If we have enough capacity, everybody on the list will get an invitation in mid-February. If not, then I’ll have to channel my velvet rope bouncer technique in choosing who gets an invitation (providers and long-time HIStalk supporters get picked first, then I just try to make it interesting by employer and role). Every HIStalk reader is important to me, so I sure hope we can squeeze everybody in since it’s your night.

Acquisitions, Funding, Business, and Stock

Kareo raises $20.5 million in series F funding led by Stripes Group.

Shares in Scotland-based revenue software vendor Craneware jump after the company said it expects half-year revenue to increase by seven percent.

Compuware reports Q3 results: revenue up two percent, EPS $0.12 vs. $0.10. The company says its Covisint HIE business grew 30 percent. The board says it will make a decision shortly about an unsolicited takeover offer of $11 per share, equal to the current share price.

Sales

King Saud University in Saudi Arabia contracts with Cerner to provide Millennium to two of its hospitals.

Lowell General Physician Hospital Organization (MA) selects HDS, athenahealth’s healthcare data management service for population-based cost and quality data analysis and reporting.

The New Mexico Health Information Collaborative will implement Orion Health’s HIE platform for its statewide exchange.

Henry Mayo Newhall Memorial Hospital (CA) selects Accent on Integration’s Accelero Connect platform to integrate its Philips IntelliVue patient monitors with its Meditech HIS and EDM solution.

Hong Kong and Tsuen Wan Adventist Hospitals select First Databank’s International Drug Knowledge.

El Camino Hospital (CA) chooses data warehouse and analytics solutions from Health Care DataWorks.

People

Mobile health provider Glooko hires Rick Altinger (Intuit Health) as CEO and Dean Lucas (Epocrates) as VP of product development. Glooko, which Dr. Travis included in a recent review of tools for diabetics, just received FDA 510(k) clearance for its mobile logbook device.

Amplion Clinical Communications names Tom Stephenson (Health Management Systems) president and COO.

Wendy Penfield (RealMed) joins Intellect Resources as VP of consulting services.

The Carroll County Chamber of Commerce (GA) names Greenway Medical founder W. Thomas Green as its 2012 Entrepreneur of the Year.

Rich Boehler, MD (MedeAnalytics) is named president and CEO of St. Joseph Healthcare (NH).

Announcements and Implementations

HIMSS awards 10 scholarships to students enrolled in HIT and management system degree programs.

Kansas City area hospitals form the Cerner-hosted Lewis and Clark Information Exchange (LACIE), originally created by Heartland Health.

Wheeling Hospital (WV) deploys PeriGen’s PeriCALM Plus in its obstetrical department.

UNC Health Care’s Rex Hospital (NC) implements Merge Hemo to automate cath lab processes into its EHR.

UPMC Beacon Hospital (Ireland) implements BridgeHead Software’s integrated backup solution for Meditech.

Neighborhood Health Plan and Partners HealthCare (MA) will provide $4.25 million in grants to 49 community health centers to expand HIT systems, train on Meaningful Use and medical coding, and train and build capacity for performance improvement.

HealthSparq launches its consumer health shopping platform (patient reviews, cost estimator, provider search, and social media forum) to health insurers.

The Government of Cantabria, Spain will deploy the initial phase of a European-wide e-health service from Texas-based Prodea Systems.

Other

Brian Ahier and a couple of privacy experts will discuss the new HIPAA rules in a Google Hangout streaming video session on Wedneday, January 23 (which is “today” for most readers) at 2:00 p.m. Eastern.

KLAS looks at clinical decision support tools and finds that more providers are turning to third-party order set and care plan vendors. Key findings:

• Almost half of providers using third-party products previously tried to build a solution from scratch.
• Among providers using third-party order sets, half use for reference content only because of an inability to move built pieces into the EMR.
• Most providers would like more ability to customize medication alerts.

Sponsor Updates

• SRS reports a 94 percent increase in revenues from 2011 to 2012 and the addition of 56 new employees.  
• AT&T Healthcare’s Christine Furjanic will speak at the Western Physicians’ Alliance (NV) January 29 seminar on accountable care.
• Orchestrate Healthcare expands and relocates its corporate headquarters to Carbondale, CO.
• Greenway Medical Technologies, Inc., announces that Greenway PrimeSUITE 2014 (17.0) is compliant with the ONC 2014 Edition criteria and has earned certification as an EHR Module.
• Shareable Ink reports 300 percent year-over-year growth and a twofold increase in employees since January 2012.
• PatientPay CEO Thomas Furr offers advice on managing practice A/Rs and cash flow in a guest articl.
• API Healthcare announces a 60 percent increase in year-over-year sales bookings and record bookings in the fourth quarter of 2012.
• T-System will offer the PayRight Health Solutions patient collection system with its RevCycle+ solution.
• CynergisTek and managed security service provider Solutionary partner to offer outsourced security monitoring.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Curbside Consult with Dr. Jayne 1/21/13

I often make fun of the American Medical Association and some of its initiatives. Despite being a life member (with a lovely crystal paperweight to prove it), I find some of their initiatives extremely whiny and self-serving.

Last week Mr. H mentioned their recent letter to ONC urging review of Meaningful Use Stage 1 and Stage 2 prior to committing to Stage 3. Given some of the murmuring about a potential Stage 4, I’m supportive of this request. The AMA shares key concerns and recommendations from physicians.

First, the requirement for achieving 100 percent on all measures is problematic. Failure to meet one measure by one percent invalidates the physician’s entire effort and opens the door to penalties. I agree, and if Eligible Providers are going to be held to this type of standard, I’d like it to also be applied to federal disability processors, Medicare claims reps, and the people at the Department of Motor Vehicles. I’d also like it applied to my personal insurance carrier. For the four medical claims I had last year, three had processing errors leading to demands that I pay amounts I didn’t actually owe.

In addition to trying to achieve MU perfection, providers are trying to gain Patient-Centered Medical Home recognition, become part of Accountable Care Organizations, submit data for PQRS, and maintain board certification. There are also payer-centric and employer-centric quality initiatives. They all have different rules. I can barely keep up with the CMS FAQs let alone all the other information out there and I have a team to assist. I can’t fathom what it’s like to be a solo physician on this hamster wheel.

Second, one size doesn’t fit all. All specialties are required to meet the same core measures with few exceptions. The document goes on to state that the program is too primary-care focused and asks that specialists be allowed to opt out of any measure that has “little relevance to the physician’s routine scope of practice.” Knowing that my group’s orthopedic surgeons tried to opt out of vital signs (stating that blood pressure wasn’t relevant to their scope of practice), I urge caution here. Personally I think anyone who prescribes medications should be concerned about blood pressures, but quite a few of my colleagues disagree.

Third, the program needs independent evaluation to allow improvement. I agree here as well. Often MU seems like one giant experiment without an Institutional Review Board looking out for the safety of the participants. We’re being used as guinea pigs and the potential outcomes could be disastrous. I’m watching colleagues become increasingly burned out and motivated to leave the profession, which is completely counterproductive.

The AMA asks for an evaluation between each stage prior to finalizing the requirements for the next stages. I completely agree here. The timeline is too tight and is forcing vendors to abandon true usability enhancements and code changes that support clinical care. Development time and effort is instead focused on making sure their system meets the certification requirements regardless of whether those requirements improve patient care or the user experience. In many ways, it feels like Meaningful Use is stifling innovation.

Fourth, usability needs to be addressed and made part of the certification process. I hope that important issues such as alert fatigue receive attention to better support patient safety and clinical quality. Further down in the usability section, the AMA buries a request that ONC should consider requiring vendors of certified EHRs to commit to supporting subsequent MU stages. They also request protection from “excessive vendor charges” for physicians who switch systems. I’ve never seen a conversion project that didn’t generate excessive charges, so this is a great discussion point.

Fifth, IT infrastructure barriers should be resolved to allow improved data sharing. Working in a major metropolitan market, I experience this every day. The patient who showed up in my emergency department in labor had records at another health system that doesn’t communicate with ours. The suspected drug-seeker next to her admits to filling prescriptions at seven different pharmacies, which means she probably uses far more than that. There was no way to see what she was actually on to determine whether she’d have a risk of drug interaction with my proposed treatment.

The document is 20 pages long and you’ll have to jump to Page 10 to see the additional recommendations, which include streamlining regulatory requirements, aligning MU with other regulatory programs, and allowing three years between states to allow adequate time for rulemaking, product development, and implementation.

Considering the amount of change management that needs to go into any successful workflow redesign project, this may be one of the most important suggestions. Practices are not just coping with technology change but a complete overhaul of how they care for patients. Providers need to learn how to be more transparent with patients and how to better coach patients into a true partnership with their care teams. They need to train staff to operate in a new paradigm. They need to figure out how to juggle the constant demands that having electronic records place on them. They need to combat the burnout that comes with those demands and learn how to regain some kind of work-life balance. And if they fail at an initial stage, providers need time to figure out what went wrong and put measures in place to be successful at their next attempts.

I sincerely hope that ONC is receptive and that Meaningful Use doesn’t continue like the runaway train it seems to be. Have you read the AMA letter, and if so, what do you think? E-mail me.

E-mail Dr. Jayne.

Morning Headlines 1/22/13

Rex Hospital Selects Merge Hemo to Image-Enable Enterprise EHR

Rex Hospital, a member of UNC Health Care, has implemented Best in KLAS cardiology solution Merge Hemo to automate their cath lab and integrate data with their Epic EHR.

Physician EHRs emerge as hot advertising venue for drugs

Cloud-based EHRs are increasingly working with drug manufacturers to deliver point-of-care advertisements embedded within the EHR.

49 community health centers win grants to boost HIT infrastructure

Neighborhood Health Plan and Partners HealthCare award $4.25 million in grants divided among the 49 members of the Massachusetts League of Community Health Centers. The grants will help fund the implementation of practice management systems and provide meaningful use training.

Shareable Ink Achieves Substantial Growth and Expands Team

Shareable Ink, a cloud-based clinical documentation vendor, announces that during 2012 it grew 300 percent and doubled its workforce.

Morning Headlines 1/21/13

athenahealth and MedOasis to Provide Comprehensive, High-Value Anesthesia Billing Solution for Hospital Departments and Independent Practices

athenahealth and MedOasis will partner to provide an anesthesia-specific billing solution that combines athenahealth’s claims processing solution with MedOasis’ anesthesia coding, charge-entry, contract management, and compliance capabilities.

UCSF Medical Center throws a great outside curve ball, keeps EMR rollout under wraps

The local paper profiles University of California San Francisco’s $160 million Epic implementation, which quietly reached its completion one year overdue and $100 million over budget. In May of 2011, then CIO Larry Lotenero was shown the door after implementation costs ballooned to three times expectations.

Identifying Personal Genomes by Surname Inference

A group of fifty men who anonymously donated DNA to genome research have been positively identified by scientists who were able to identify the patient, their address, and their relatives by taking the little demographic information maintained on the donors, and supplementing that with the wealth of information extracted from the donors genome.

Allscripts to Announce Fourth Quarter and Full Year 2012 Financial Results on February 19

Allscripts announces that it will report year-end financials during a February 19 investor call.