Curbside Consult with Dr. Jayne 8/1/11

E-mail Dr. Jayne.

Monday Morning Update 8/1/11

From ACC_Champs: “Re: NCHICA’s response to Accounting of Disclosures. By getting input from all sides of the issue, they have drafted a great response.” Some of their concerns:

1. Just because few people ask for Accountings of Disclosures now doesn’t mean they won’t in the future, requiring hospitals to do a lot of unpaid work.
2. The scope needs to be better defined since not everything is stored permanently in the EMR (such EKG strips, as I read from their example).
3. The definition of “access” should be clarified, such as if someone searches for “John Smith” in an EMR and is shown a long list of John Smiths, is that considered “access” of every one of them?
4. It’s not as easy to generate an Access Report as you might think, with hospitals churning out tons of data from many systems (one hospital found that an average six-day inpatient stay generated 1,800 accesses).
5. Access logs aren’t something the typical patient would be able to understand, meaning they may expect someone to spend time explaining them.
6. Patients who don’t understand that hospitals have a lot of unseen people involved in their care are going to file unwarranted complaints to OCR.
7. Employees aren’t protected from ambulance chasers or crazy patients who could easily obtain their full names by requesting an access report.

From Quaid: “Re: Siemens. Hawaii Health Systems Corporation just signed a $28.7 million deal for Soarian.” Verified.

From Anony: “Re: Piedmont Healthcare, Atlanta. Can’t believe I haven’t seen it here yet, but they’re moving from Allscripts to Epic.” As usual, the best way to verify is to check the hospital’s job postings since the Epic implementation method requires hiring a ton of people fast, including posting all jobs instead of just reassigning current staff. Piedmont listed several inpatient Epic positions on July 12, so I’d say that’s confirmation. I should also mention that Johns Hopkins signed its Epic contract this week. Both will apparently be Allscripts Sunrise losses.

From Anonymous: “Re: Allscripts. Continuing to reduce workforce in Raleigh as jobs are offshored, with 15-20 folks gone in the last week or two.” Unverified.

From Nasty Parts: “Re: Compugroup. Heard on the street that they’re buying the Sage Healthcare business. Folks at Compugroup USA HQ openly talking about it.” Unverified.

From KnowurCMIO: “Re: Cerner and Epic. Epic has indeed started expanding overseas — they have a satellite HQ in the Netherlands and have already installed there. I suspect they will begin seeing rapid growth once the implementations stateside slow down. Spaarne Hospital was the first EpicCare client in Europe in 2007.”

From Bob: “Re: shoe hoarder. I read this and thought of Inga.” A Philadelphia mom who happens to be a big-money poker champ owns 1,200 pairs of shoes (one pair worth $4,000) stored in four closets, one of them a converted sitting room. She’s profiled in a film about shoe nuts, which concludes that such compulsion is related to seduction and sex. I’ll let Inga to clarify her own motives.

Here’s the latest HIStory from Vince, this time covering Dynamic Control.

Listening: the new CD from teen rockers Jessica Prouty Band, sent over by her mom, who has a lot of history in HIT. Their sound has matured a lot over the years I’ve followed them, putting them right up there with Evanescence, Within Temptation, and some of the other female-led metal rockers. Big sound for a four-piece, with singer Jessica handling the bass very well. This is a really polished production – you would never suspect that the members are barely old enough to drive to their gigs. Video here.

My Time Capsule editorial from 2006 this week: When CIOs Are Under Pressure, “Man of Action Syndrome” Kicks In, snipped herein: “From my limited experience, I would say that CIOs overrule the concerns of nurse informatics people nearly 100 percent of the time and IT-based physicians at least 50 percent of the time.”

Most respondents believe that HITECH’s legacy will be increased EMR adoption, although the “waste of taxpayer money” camp was right on their heels. New poll to your right, spurred because I got a HIMSS member survey recently: how would you grade your satisfaction level with HIMSS? As always, you are able and encouraged to add your comments by clicking the Comments link on the poll, visible after you’ve either voted or clicked the View Results link.

HIMSS moved its Chicago headquarters this weekend.

Sage announces Intergy v7, which includes user enhancements, certification of all 44 ONC-ATCB clinical quality measures, and 5010 support for the PM/EMR system.  

NHS Scotland contracts with Imprivata for its OneSign single sign-on and password reset solution.

A reader sent over the full text EHR articles that were just published in the July issue Journal of Oncology Practice. Here’s a brief rundown of those I found interesting.

• A US Oncology team, working with iKnowMed to standardize over 500 chemo regimen order sets, found that 10% of them needed to be eliminated, with changes required for all the rest (other than changes in title, the most common changes involved updating the cited references and changing doses and cycles). They mention that EMRs can help address drug safety issues.
• NorthShore (IL) looked at the cultural impact of moving all inpatient and outpatient oncology ordering to Epic in 2005. The main benefit was data sharing among members of the multidisciplinary team (labs, rads, referrals, appointment information) and patient communication (secure communications, online test results). Chemo ordering in Beacon was found to be more complete and safer, with the percentage of complete documentation going from 67% to 93% and pharmacy interventions also increasing. They’re at 100% e-prescribing (other than for narcotics and oral chemo), outpatient med rec is over 90%, and AR days have dropped to 30. They’re using Epic’s data for research and quality monitoring.
• A Vanderbilt group looked at improving compliance with nursing guidelines on chemo administration and documentation using their systems (WizOrder, Horizon Meds Manager, Horizon Expert Documentation, StarPanel). Pros: two-signature compliance improved, standardized MARs were easier for nurses to follow, alerts improved safety. Cons: systems could not track doses by relative day or dose number, could not document infusion stop time, stat and verbal orders required an override, and pharmacy had to adjust schedules frequently to avoid “wrong time” alerts.
• Johns Hopkins pediatric oncologists wrote up their CPOE design process and creation of Eclipsys Sunrise MLMs to check height and weight, to force inclusion of hydration orders, and to provide the capability to adjust chemo doses by percentages. They also developed a fast-track process for creating and approving new order sets.
• Memorial Sloan-Kettering described their Eclipsys CPOE chemo ordering implementation. They created 1,250 adult and 466 pediatric order sets and mandated CPOE-based ordering. They reported nearly universal use of the order sets. I didn’t see anything that documented clinical outcomes, but they did mention problems related to cumulative dose calculations and alerts.

From McKesson’s earnings call:

1. They talked a lot about acquiring Portico Systems (surprising given that McKesson is a massive company acquiring a relatively tiny company for $38 million, which would be just a few weeks’ pay for CEO John Hammergren since he took home $151 million last year) and said little about their drug business.
2. Technology Solutions  revenue was up 6%, but only because of revenue recognition timing – they expect growth to be a little better than last year’s 2%.
3. Hammergren mentioned “significant progress” in the technology business, but basically said focus is on implementation rather than sales even though the company is “continuing to strategically position the business for continued growth.”
4. He said that clinical systems are today’s opportunity, but a lot of McKesson’s customers are running 20-year-old financial systems that might be candidates for Horizon Enterprise Revenue Management.
5. He thinks that big companies (“the anchor tenant”) will be the healthcare IT winners in the payer, hospital, and physician practice markets since smaller companies won’t be able to get to those prospects cost effectively.
6. He mentioned some “consolidation in our overhead and our selling infrastructure last year.”
7. An analyst asked directly about IT customer retention in calling 2010 “a tough year” for McKesson, with Hammergren’s response being that the company had spent a lot over the last two years to make its products better and he hopes the market share changes are a trailing rather than a leading indicator, with the potential of a slight rebound in market share this year with Paragon as the leader.

My sideline analysis of the MCK call (your comments are welcome):

1. Most of the analysts’ questions involved the company’s challenges in the IT business, again surprising given its core business of drug distribution.
2. McKesson seems to be acknowledging that it’s falling behind Epic and other vendors on the clinical systems side and is placing its only hope on a pendulum swing back to financial systems and its struggling HERM.
3. The company hopes that product improvement will stop the market share slide.
4. I inferred no commitment to innovation, acquisitions, or thought leadership, just that McKesson is banking on its huge size and customer touch points to keep selling all of its products.

The local paper covers the $36 million Epic system that will be in place when Orange Regional Medical Center (NY) moves to its new hospital next week. It says that stimulus money will cover half the cost.

In Canada, Nova Scotia will implement a $27 million system for sharing patient medication information, with all pharmacies expected to be linked by 2013.

Hawaii Governor Neil Abercrombie announces that Thomas Tsang, MD will join his healthcare transformation leadership team. He is ONC’s medical director over Meaningful Use, but it’s not clear from the announcement whether he’s resigning that post.

GE Healthcare Performance Solutions acquires Medical Event Reporting System, a Web-based system that helps hospitals collect and analyze patient safety events. It was developed by Columbia university with AHRQ support. The company, also called MERS, had been a GE Healthcare JV partner since 2008. A white paper on its use by Mount Sinai Hospital (NY) is here. GE says it’s working on rollouts to 16 hospitals.

From Cerner’s earnings call:

1. The company talked up its physician practice sales, saying its improvements in the user interface and workflow positioned its products well as clients look for systems that integrate inpatient and outpatient.
2. CERN says it is different from competitors in its willingness to connect to other systems.
3. They are expecting Meaningful Use to keep driving sales for years.
4. They suggest that 50% of US hospitals will reselect their core systems in the next 5-7 years as even those customers who are happy today will find their vendors falling short with regard to interoperability and reporting.
5. The ProFit financial system is doing better.
6. CERN says they expect to take on more outsourcing contracts since they are more able to hire scarce HIT employees than hospitals.
7. Neal didn’t pop in for even his usual one-paragraph drive-by.

Shares in Omnicell touched off a 52-week-high Friday after turning in good numbers after the market close Thursday: revenue up 6.6%, EPS $0.08 vs $0.02. The one-year share price (blue) against the S&P 500 (green) is above. Market cap is $567 million.

Meditech filed its quarterly report Friday, with revenue up 25% and EPS up 33% ($0.86 vs. $0.64). The cost of acquiring the 78% of shares in ambulatory vendor LSS that it didn’t already own was given as $13.7 million in cash, with LSS’s first quarter performance being $0.8 million in net income on $5.4 million in revenue.

Strange: the former head of Alberta Health Services (Canada), who left his job in November after repeatedly telling reporters at an emergency meeting that he was too busy eating a cookie to answer their questions, gets $735K in severance. He seemed overly peeved, but made sense in pointing out that maybe the eager beaver talking heads should attend the scheduled press briefing that was being held in 30 minutes instead of chasing him down the street for their own personal on-camera moment.

E-mail Mr. H.

Time Capsule: When CIOs Are Under Pressure, “Man of Action Syndrome” Kicks In

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

I wrote this piece in June 2006.

When CIOs Are Under Pressure, “Man of Action Syndrome” Kicks In
By Mr. HIStalk

Hospitals and vendors don’t brag when their IT projects harm patients. Therefore, I’m not surprised that press releases haven’t announced several recent, disastrous examples where IT leaders overrode worried clinicians and continued with a flawed clinical system go-live to the detriment of patient care.

Being of a clinical background, I’m compelled to give this scenario a name and an acronym, even though I can’t diagnose or cure it. Man of Action Syndrome, or MAS, is the psychological need of someone in IT authority to veto those more knowledgeable clinicians who express well-founded patient safety concerns about clinical IT projects.

The name is not sexist since I’ve not yet seen a female CIO so afflicted. MAS also seems to spare CIOs with a clinical background.

Its victims are generally male, Type A, ego-driven MBAs with a history of programming or consulting. Anxious to add value by showing business savvy and decisiveness in an ill-suited environment of caring and empathy, they won’t allow budgets or dates to slip. It’s a quantitative thing.

A wise old project management saying is, “Good, fast, cheap — you can only pick two.” Unfortunately, those with MAS obsess on ‘fast’ and ‘cheap,’ knowing that it’s far easier to bury (no pun intended) qualitative project shortcomings that fall into the ‘good’ category. You can always blame users or the vendor.

I’ve been on both sides of the fence. IT people add value in formalizing system selection and planning. Those are repeatable processes where past experience may improve the chance of success. Unfortunately, that kind of management-by-control experience doesn’t work with clinical process change.

Ideally, an assembled group of clinicians would drive clinical system projects. However, it’s hard to engage them. That’s when MAS kicks in: “My neck’s on the line, so here’s what we’re going to do.”

From my limited experience, I would say that CIOs overrule the concerns of nurse informatics people nearly 100 percent of the time and IT-based physicians at least 50 percent of the time. Because those people represent a large number of their disenfranchised non-IT counterparts, the CIO has, in effect, dismissed the concerns of an entire discipline, often with reasoning such as, “They don’t see the big picture” or “They don’t know the pressure I’m under to deliver ROI and on-time implementation.”

Maybe practicing clinicians should be the ones making the go/no-go decision without IT people or other hospital management in the room. I’ve seen clinicians leave meetings shaking their heads, worn down from trying to get their message across to an IT team more comfortable hard-selling their own agenda instead of listening to what’s best for patients.

Perhaps the evolving role of the chief medical information officer will eventually balance the MBA approach. Maybe we’ll see more CIOs who have cared for patients instead of thriving in a Dilbert-esque world. Possibly the new wave of clinicians formally trained in informatics will provide credibility to concerns that the software doesn’t work, the users aren’t ready, or the communication has been poor. Non-IT hospital leadership may eventually understand that that silver bullet they paid for is just lead under the paint. Until then, if you’re a CIO with symptoms of Man of Action Syndrome, please contact your health care professional at once.

News 7/29/11

Top News

Cerner’s Q2 numbers: revenue up 15%, EPS $0.42 vs. $0.33, beating earnings expectations by a penny after excluding one-time items.

Reader Comments

From AzEMRGuy: “Re: Tucson Medical Center. Hiring for multiple Epic positions.” Above is the hospital’s recruitment video, which talks up Epic opportunities. I assume that means Allscripts Sunrise is egressing unless TMC switched systems since the last time I was there. CORRECTION: reader Zaphod Beeblebrox correctly notes that I confused University Medical Center in Tucson (a Sunrise client) with Tucson Medical Center. TMC is already an Epic customer.

From Instamatic: “Re: displaced CIS vendors. This chart from the KLAS newsletter says 2010 sales volume remained about the same as 2009. Would you assume that most of the displacements are Epic’s?” I would assume so, especially given the win/loss numbers that KLAS put out along with the graphic (almost two-thirds of sales to 200+ bed hospitals went to Epic, with Horizon customers being especially ripe for the plucking). I’ve been saying for a year or two that Epic is dominating the market of mid-size hospitals and up (say, 300+ bed community hospitals, but also academic medical centers and IDNs), putting a big-time hurt on Cerner, non-Paragon McKesson, and the former Eclipsys. Not to mention as the healthcare system inevitably consolidates under healthcare reform, more organizations will hit Epic’s sweet spot of size and scope as they look to standardize. Vendors such as GE, QuadraMed, and Siemens weren’t much of a sales factor anyway, so that would seem to leave Epic on the high end and Meditech and Paragon for everyone else as the only vendors booking significant net-new customers. That’s not considering rural and critical access hospitals, which would look at Meditech, Paragon, HMS, Prognosis, and a few others. I think you’ll see the others trying to make their numbers with hosting, upselling, and services – in other words, they’re in a mature market, which can throw off some nice profits while waiting for the inevitable downward slide to accelerate. They all have other business lines, so they’ll be fine. I’m not saying that’s good or bad, just how it looks to me.

From Mathemagician: “Re: Cerner. They can’t compete with Epic any more for hospitals of more than a couple of hundred beds, so they have three ways to drive growth: (a) sell to very small hospitals that don’t already have systems; (b) provide outsourcing services to existing customers, such as IT outsourcing and revenue cycle management; and (c) sell outside of the US where Epic doesn’t tread.” I would agree, adding also Cerner’s apparent interest (possibly Epic-motivated) in providing actual healthcare and healthcare management services rather than just IT products and services. Cerner’s biggest competitive weapon is its market cap, which provides options that the company appears to be tentatively exploring.

From rsm2800: “Re: Journal of Oncology Practice. The July issue contains 12 articles about EHRs in oncology.” Only subscribers can read the full text articles, but the titles relate to CCHIT certification; Memorial Sloan-Kettering’s chemo ordering system (which must be the amazingly cool Allscripts Sunrise work I saw at HIMSS last year); CPOE in peds oncology; standardized CPOE order sets; EMR-based checklists; use of natural language processing to extract clinical information from free text documentation; chemo medication administration systems; patient-physician e-mail; EMR effects on culture; CPOE outcomes; and the interest in sharing information by those with cancer. The topics sound excellent.

HIStalk Announcements and Requests

Have you kept up with HIStalk Practice this week? A few highlights: MGMA joins CHIME and other professional organizations in calling for HHS to withdraw its proposed HIPAA accounting of disclosure rules. DrFirst intros an e-prescribing option for controlled substances. The American Academy of Ophthalmology publishes a list of EHR requirements for ophthalmologists seeking to achieve Meaningful Use incentives. Salaries for physician practice managers remained flat in 2010.  Sign up for the e-mail updates while you are passing through and thanks for reading.

I featured Aventura in the latest Innovator Showcase this week. Just to recap the process: several dozen companies nominated themselves to be included; my expert team of investment bankers and providers chose eight of them after reviewing their application materials; and those companies will complete a video, a customer testimonial, and a telephone interview to be presented with their showcase article. Two of the eight have been featured so far. It’s quite a bit of work for the companies and for me, but readers have asked me repeatedly to give creative vendors a chance to be seen.

Keep an eye on the swinging pocket watch … you are getting sleepy … when you awaken, you will feel happy and rested. You will immediately sign up for e-mail updates to your upper right … your legs and arms are getting heavy … you will make the inevitable electronic connections offered by Facebook and LinkedIn to Inga, Dr. Jayne, and Mr. H … you can barely keep your eyes open …. you love HIStalk’s sponsors and will feel fulfilled by clicking their ads … going into a deeper sleep as you pledge to send me news, rumors, articles, or anything interesting … you’re become a little more alert … when I count three you will awaken rested and refreshed, feeling better than you’ve ever felt … one, two … and almost forgot, you’ll bark like a dog every time you hear the word “interoperability,” you’ll never embarrass yourself again by writing trite Internet phrases such as “wow, just wow” or “Best. Wine. Ever” and you’ll send love notes to Mr. H and Inga … three. Thanks to readers for reading, sponsors for … sponsing, and caregivers for caring.

Acquisitions, Funding, Business, and Stock

McKesson reports Q1 results: revenue up 9%, EPS $1.13 vs. $1.10, meeting Wall Street revenue expectations but falling short on earnings. Technology Solutions revenue was up 6% with adjusted profit of $119 million. The earnings call transcript should be out tomorrow and it usually has some interesting nuggets about the company’s software business.

Private equity firm Blackstone Group is rumored to be in discussions to acquire Emdeon for more than $3 billion. Shares jumped from less than $13 to over $16 on Thursday, closing at $15.49.

Healthcare learning and employee competency platform vendor HealthStream announces Q2 results: revenue up 26%, EPS $0.08 vs. $0.06.

NextGen parent company Quality Systems, Inc. reports Q1 results: revenue up 21%, EPS $0.65 vs. $0.42, beating estimates on both. Shares will split two for one on October 27.

CPSI’s Q2 numbers: revenue up 30%, EPS $0.72 vs. $0.39, blowing through estimates.

Revenue cycle management company Precision Revenue Strategies renames itself MediRevv.

Medicity’s performance is featured in Aetna’s earnings call Wednesday, which said its contract backlog is $200 million. Aetna made $537 million in profit on $8.3 billion in revenue for the quarter. Also stated about Medicity, which it acquired on January 3 for $500 million:

Our strategy is to grow our footprint in this space and to deliver clinical and administrative content through Medicity’s installed base of health information exchanges. For example, Medicity has developed and is beginning to distribute a suite of applications that are certified as being compliant with the federal meaningful use standards. Medicity’s application development expertise and patented distribution technologies are great examples of how the company combines content and connectivity.

At Aetna, we are excited about our role in promoting health information technology because we believe it has tremendous potential to improve the quality of health care and to make health care more affordable. We continue to build a portfolio of businesses that simultaneously generate high growth fee revenues and improve the performance of our health plan businesses.

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Sales

Texas Health Resources contracts with Streamline Health for its Epic Integration Suite.

The Tehachapi Valley Healthcare District Board of Directors (CA) approves the purchase of Healthland’s EHR. The local paper reports that the $400K five-year cost of HMS was one-fourth that of competitor McKesson.

HealthSouth selects Cerner to provide EHR for its 97 inpatient rehab facilities.

Memorial Hermann chooses CodeRyte for computer-assisted coding.

Hoag Memorial Hospital Presbyterian (CA) signs for Unibased ForSite 2020 Resource Management System for enterprise scheduling and a patient portal.

People

Former Wipro Technologies CIO Laxman K. Badiga joins Anthelio as COO.

Pat Cline, president and board member of Quality Systems, announces that he will retire this year.

Accretive Health names Joseph Bellini chief revenue officer.

Shared Health hires former WebMD founding COO Michael Heekin as CEO.

Announcements and Implementations

Misys Open Source Solutions wins the international “Best Use of Open Source Technology” award for its Misys Connect HIE solution.

The Rhode Island REC accepts ABILITY Network as an health information service provider to provide its member secure health information exchange.

Epocrates announces first phase availability of its Epocrates EHR mobile and Web-based EHR, designed for primary care practices with 10 or fewer physicians. The company will also offer a license to a native Apple iPhone app that supports remote patient look-up, schedule access, and e-prescribing capabilities.

Other

CMS’ Office of the Actuary predicts that national healthcare spending will hit $4.6 trillion by 2020, up from this year’s $2.7 trillion. The biggest increase in spending (8.3%) will occur in 2014, when many federal health reforms take effect.

The Salt Lake City paper observes the challenges of connecting physician practices and hospitals via Utah’s Clinical Health Information Exchange, with incompatible EMRs leading the list. An interesting tidbit that may have been inadvertently disclosed by a University of Utah Health Care spokesperson: they’re using Cerner on the inpatient side and Epic for outpatient, but will soon migrate to a single system. You’ll want big odds if you’re betting on Cerner to win that deal.

The Town of Freetown (MA) lays out the requirements Meditech will need to meet to develop a five-story, 186,000 square foot office building there that could bring up to 800 jobs to the area. Meditech’s costs are estimated at $80-100 million.

Tampa General Hospital (FL) files a $9.2 million claim against the estate of a deceased 29-year-old patient who had spent five years as an inpatient. Maybe they should use any proceeds to hire case managers or buy equity in a skilled nursing facility that will accept transfers.

Sponsor Updates

• Cottage Hospital (NH) achieves Medicare Stage 1 Meaningful Use through its use of the Healthcare Management Systems (HMS) EHR.
• Michigan Eye Institute chooses the SRS EHR for its eight-provider, five-location practice.
• Five providers from Aquidneck Medical Associates (RI) receive an $18,000 check for their Meaningful Use of the eClinicalWorks EHR, making them among the first in the state.
• Microsoft recognizes MEDSEEK as its 2011 US Public Sector Partner of the Year.
• Milwaukee Health Care Partnership and Wisconsin Health Information Exchange (WHIE announce a two-year extension of their contract with My Health Direct.
• St. Mary’s Regional Medical Center (OK) selects Merge Healthcare’s cardiology solution, while Sisters of Mercy (MO) adds the company’s iConnect solution.
• Mount Carmel Health Partners (OH) chooses MedVentive Population Manager to support improved patient care and clinical outcomes.
• Lexmark reports record earnings for Q2 and acknowledges the contribution of its Perceptive Software business unit.
• Health Language Inc (HLI) launches an upgrade to its Provider Friendly Terminology solution, now containing over 120,000 terms.
• T-System announces a call for entries for its Client Excellence Awards.
• Sentry Data Systems expands to a new office in Austin, TX while partnering with UT’s health IT program.
• GetWellNetwork adds two options for its interactive patient care system, a multi-function touchscreen and a lower-price, eco-friendly nettop.
• ZirMed announces successful transmission of claims and receipt of electronic remittance advices using HIPAA 5010 format.

EPtalk by Dr. Jayne

Quite a few organizations are using scribes as part of their EHR. A local hospital (which happens to be an Epic client) recently started using scribes in the emergency department, with the goal of having scribe coverage for all emergency physicians by early next year. According to a PR piece, several companies provide scribes and offer scribe training, with an estimated 200-plus hospital emergency departments starting to use scribes over the last two years.

Our group experimented with scribes several years ago when there weren’t as many formal opportunities for scribe training. We mainly wanted to use scribes in physician offices to aid EHR adoption and provide a safety net for older docs who were close to retirement and resistant to EHR implementation, but who still needed to get data into the system for patient safety and care continuity purposes.

A medical assistant or medical secretary would typically receive additional training, but it was rare for the practice to go the distance and hire someone to do the staffer’s usual work while he/she was scribing. As you can imagine, it doesn’t go well when you take a full-time employee and add another full time job to his/her plate. The program was dead before it ever left the gate.

Scribe staffing firms target pre-medical and pre-nursing students who are looking for experience in the healthcare field who are willing to work cheap. Starting salary for a scribe is $8 to $10 an hour. After preclinical training, the firm that’s staffing our local hospital includes a 100-hour “apprenticeship” with a senior scribe before new scribes are allowed to work independently.

The non-profit American College of Clinical Information Managers (ACCIM) recently emerged to hopefully help the rapidly proliferating scribe programs develop standards and monitor themselves. A visit to their website revealed an online training program and an exam leading to certification as a Clinical Information Manager, which can be taken after as little as 100 hours of work with a minimum of 100 patients documented. The exam costs $40 and an annual certification costs $20.

I like the idea that they require certified scribes to complete 20 hours of continuing education a year. Our state medical board only requires 25 hours for physicians and I think that’s pretty sad. Although the website said it would have a list of individual certified scribes, I wasn’t able to find it. Corporate members of the ACCIM include Scribe America and Emergency Medicine Scribe Systems.

As a physician, I’d love to know that all my data is being captured the way I like it while I can focus on the patient in front of me. From experience, though, I know it’s hard to have that level of teamwork and trust when you’re in a shift-work environment. I’ve done my share of emergency department work, and unless the scribes are remarkably consistent, I think it would be hard to have a different one for every shift.

The local paper profiled this change, noting that the scribes “win” by seeing jobs first-hand as they are “attached to the hip of a physician.” Do they really? I wonder what the average shelf life of a scribe is?

Depending on what they see, it might send them running in the opposite direction of actually entering the healthcare field. Most pre-med students are pretty smart cookies who will quickly figure out if they truly have a calling for days where you stand for 12 hours without a meal or a trip to the bathroom in exchange for taking on upwards of $250,000 in student loan debt.

On the other hand, it’s a great way to get experience and actually get paid. Back in the dark ages when I was an undergrad, unless your parent was a doctor and would hire you to work in the office, the only experience you could get was as a volunteer. I’d certainly rather have had the opportunity to do scribe work than to do what I did, which was to edit a medical textbook written by an extremely cranky researcher who had chosen someone without a firm grasp of the English language to do a first pass on her book before firing him. Although frustrating, I must say it prepared me for some of the technical manuals and white papers that grace the ever-growing stacks on this CMIO’s desk.

Do you have scribes at your hospital or health system? Do they make for happier EHR users? E-mail me.

Contacts

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

HIStalk Innovator Showcase – Aventura 7/27/11

Company name: Aventura
Address: 1001 17th St. Suite SL-100, Denver, CO 80004
Web address: www.aventurahq.com
Telephone: 888.484.4643
Year founded: 2008
FTEs: 25

Elevator pitch

Aventura overcomes technical hurdles that exist at the intersection of where your caregivers use your computer systems to deliver the computing experience that doctors and nurses demand.

Business and product summary

Aventura is in the business of making caregivers happy and IT look like heroes. Aventura’s revolutionary new platform fundamentally improves the usability of computing systems for doctors and nurses, leading to increased productivity. Aventura also centralizes and standardizes many aspects of the enterprise environment, saving IT significant time and headaches. Our software is licensed to hospitals through enterprise agreements, and our raving fans are the caregivers that use our solution every day.

The best way to understand Aventura is through a quick example of a user’s experience. A doctor or nurse logs on at a new terminal in a patient room using dual-factor authentication (smart cards, proximity cards or biometric). Based on who this person is, their new location, and any other pre-defined set of rules established by the hospital, Aventura begins updating this person’s existing desktop session (which has been securely locked from their last location) before displaying it.

For example, printing defaults are updated, some applications may be hidden, necessary ones pop up automatically, and some URLs (including already open ones) may be restricted or hidden. This updated desktop and all appropriate applications are then presented to this caregiver.

What is most important about this process is that it all happens in less than five seconds. Log-out is as instant as removing his card. Access is simple and secure. Usability for doctors and nurses is significantly increased because they are no longer wasting time logging in and accessing the right applications and data, and instead can focus on the job they signed up to do: provide incredible patient care.

Who is your target customer?

Today Aventura sells its services to small, medium, and large size hospitals. In the future, Aventura will be delivering its services also to physician practices.

What customer problem do you solve?

Aventura is a small company focused on solving one enormous healthcare IT problem. All the billions of dollars being spent on new IT systems and improving clinician productivity will never realize their full potential because of a “weak link” at the intersection of where doctors and nurses have to access these systems. Adoption of these new systems, including CPOE, suffers not because of the applications themselves, but because of the painful process and useless time wasted by doctors and nurses trying to access these new applications 50 to 70 times a day.

That is simply unacceptable for us, so we’re doing some pretty amazing things to fix it. Aventura has designed something totally new, an architectural framework that delivers what caregivers need in order to do their job from any location, securely, in less than five seconds every single time.

Aventura architecture (click to enlarge)

Who are your competitors?

Today, there are no other companies in the market providing the breadth and depth that Aventura delivers when it comes to delivering a dynamic computing environment. While there are a number of folks piecing together clinical desktop solutions using various virtualization and SSO solutions, these projects don’t overcome the technological barrier and the associated issues of roaming a static desktop session.

Why are you better than your competitors?

The idea for Aventura was born in a hospital. We understand that doctors and nurses want instant access to the right data and computing services from any computer at any time. However, in order to make this happen, we recognized that there are significant architectural limitations in today’s computing environments, and that the only way we were going to be able to address this problem is with an architectural solution.

Other companies have partial fixes; single sign-ons, roaming desktops, expensive one-offs, but they are all still based on a static operating system that was never designed to serve people who work on dozens of different computers in a single day.

Aventura’s new platform called Enterprise Operating Framework allows us to dynamically update clinicians’ computing sessions, and respond to their needs based on who and where they are. Access is intuitive and consistent and completely respects the way clinicians want to work. Further, Aventura is designed to provide this improved caregiver experience using whatever computing infrastructure a hospital currently has in place.

In other words, we can deliver our dynamic computing experience using any virtual desktop technology, or what is even more cool, leveraging only the existing PCs that most hospitals have in place.

Pitch video

Customer interview (infrastructure and customer support manager for a two-hospital, 300-bed system)

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

Aventura has allowed us to extend the refresh cycle of the hardware inventory and still take advantage of new software technology that requires greater processing power and memory.  The smart card solution improved the security and authentication process, which helped meet HIPAA requirements.  The ease of use and ability to move the user’s desktop from workstation to workstation has greatly improved the clinician’s workflow.

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

We have had a very positive experience with Aventura.  Their staff has been responsive to requests for enhancements and is readily available to provide technical support when needed.

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

If you would like to reduce the cost of your hardware refresh and provide a secure, standardized desktop solution for your end user.

An interview with Howard Diamond, CEO of Aventura

Hospitals seem pretty happy with single sign-on and technologies like Citrix that allow wireless users to stay connected even though their connection may drop temporarily as they move around. Why do they need your product?

I probably don’t accept your basic premise. Most of the customers that we have and most of the pilots we’ve got going are people that are probably already using an SSO and are already using virtualization like Citrix or VMware or Terminal Services. They still have significant problems in terms of caregivers getting access to the different systems and applications they use.

The average nurse logs in 50 to 70 times a day. Even with an SSO, the amount of administrative burden on them is pretty dramatic.

This would be a fairly key piece of infrastructure if your technology sits between the clinicians and their systems. How do you convince hospitals to trust that aspect to a relatively small company?

That’s a challenge, without question. The approach we take from a sales perspective is we have three phases of implementation.

Our first phase is what we call a lab pilot. If somebody is seriously interested in our technology, for $15,000, we come and show them how it would work in their specific environment to connect it to their specific infrastructure. They get to play with it for three to four weeks in a lab environment.

Once they’ve done that, they opt to go into what we call a production pilot. They try the technology in a real unit of the hospital with real caregivers interacting with real patients.

Based on those two experiences, they then make the decision to buy the software. We set up a pretty sophisticated try-and-buy in their environment.

Sounds like that’s good for the customer, but difficult for the company since hospitals have a long buying cycle anyway. Is it difficult to plan your business around a long-term pilot?

There are two different pieces to it. First of all, we charge $15,000 for the lab pilot. We charge $40,000 for the production pilot. We’re not doing it for free.

We have a hospital doing their production pilot right now. One week into the production pilot, they called us up and said, “All right, we’re convinced. We want to buy the software now.” Even though the theory is that it can lengthen the sales cycle, what is actually does is truncate it, because once they get the technology in front of the caregivers, the caregivers who are not using the technology see the caregivers who are and say, “Wait a minute, you’ve got to be kidding me. We’re not going to wait three months to get access to that. We want access to it now.”

Who is it that makes that decision and what objectives do they have when they come to you or you come to them?

Our point of entry is usually a CMIO if they exist. A lot of time we work directly with IT, but our focus is to get caregivers directly involved pretty quickly because the core of the technology really dramatically addresses things from the caregiver’s perspective. So where there isn’t a CMIO, we work with both CMOs and their like and influential doctors. We definitely get the caregivers involved very early in the process.

Has anybody done studies of the benefits?

Yes, pretty dramatic. Caldwell, which is actually just finishing up their lab pilot and moving to a production pilot, has actually already done a research study where they claim that their analysis showed that doctors would save over 40 minutes per shift and nurses would save over 80 minutes per shift using our technology.

What’s your method of pricing the solution and how do customers justify its cost?

The approach is it like a SaaS charge. Our base price is $15  per user per month.

The ROI actually is pretty easy to do. We show dramatic productivity gains on the caregiver’s side. Because of the fact that we do things like manage printing and provide them with a significant amount of self-help from a printing perspective, we actually show some pretty quick specific gains for IT, particularly in terms of reduction of calls to help desks.

I saw your Web site mentions the roving printer concept. I guess that’s a weakness in a lot of clinical systems. Is that a big draw for customers?

Yes. I’ll be honest with you — when my staff first built it into the product, I thought it was pretty boring. It was not an area that I had particular interest in. It’s turned out to be a dramatically important thing.

It turns out that pretty much every back-end system out there, particularly the EMRs, are horrible when it comes to managing the printing. The fact that we fixed that has actually become an enormous positive for us, even though as CEO, I was too stupid to understand that for a while.

You mentioned a couple of customers on your site, Denver Health and Alegent. Where are they in their implementation and how many clinicians do they have using the devices?

Thousands. Denver Health has been using the technology for a few years and they use it everywhere. The same thing is true of Alegent at their 10 hospitals. If you talk to Mike Westcott, who’s the CMIO at Alegent, he’s actually an embarrassingly great evangelist for us. Greg Veltri, who’s the CIO at Denver Health, is as well. In both cases, they’ve got literally thousands of caregivers using our technology every day.

I was curious why you sell only to healthcare. It seems like that the solution that you have would be of interest to other industries. Is healthcare just the entry point, or is there something unique about healthcare that makes this more attractive than it would be elsewhere?

You’re pretty on top of it. I’m impressed. The reality is that we work with a lot of virtualization partners. The very first thing they ask us whenever they get to know the technology is why we’re not bringing it into other industries.

This technology was born in a hospital, it was developed in a hospital, and the founder started it there. I came and took over the company a little over a year ago. We will go more horizontal in the next year and a half, but I believe that small companies fail a lot because of lack of focus.

Since the heart of the company is in healthcare, we’ll establish our beachhead in healthcare pretty strongly before we move horizontally. But there are a number of other industries that are appropriate for it, and a lot of the virtualization partners we work with want to bring it into places like manufacturing and legal right away.

What do you hope to gain from this exposure?

When we get in front of caregivers, they are blown away by the technology. It literally is something that every time we do a bake-off comparing our technology with anything else out there. Caregivers give it a dramatic grade.

The exposure is just a really important thing. It’s a very small company. We’re just starting out. The technology has just been released in its new form as we talked about some of the stuff we submitted to you. Getting exposure is just great for us.

News 7/27/11

Top News

McKesson completes its $38 million acquisition of provider management tools vendor Portico Systems, announced last month.

Reader Comments

From The PACS Designer: “Re: LogMeIn Central.  LogMeIn has announced a new cloud based service called LogMeIn Central for IT administrators to monitor network uses by iPad and iPhone users.  As the expansion of iPad usage increases in institutions, it appears to be a solution that could ease the management and demand for information access by users.”

From Epic Guy: “Re: Johns Hopkins. Announced today at Epic that they are our latest enterprise customer. Probably not a big surprise to most readers of this blog.”

HIStalk Announcements and Requests

Listening: reader-recommended Joe Bonamassa, an amazing blues/rock guitar virtuoso. Here’s live video of his cover of Yes’s Heart of the Sunrise and Starship Trooper. Pretty old school for a guy who’s only 34.

The folks at CapSite hooked me up with access to their database of actual RFPs, proposals, and hospital contracts after I wrote a little about it a few weeks back. I pulled up a few vendor products and was instantly looking at individual facility price breakout worksheets and actual PDF contract scans (I love terms and conditions, so I was engrossed, although I felt kind of dirty reading some other hospital’s contract even though the facility name was redacted). They’re offering a free 30-day trial of CapSite Lite to providers. I’m not pitching it, just saying that if you would benefit from seeing the kind of deals other hospitals are getting or interested in market reports, you could give it a look for free.

Prognosis Health Information Systems is supporting HIStalk as a Platinum Sponsor, which I appreciate. The Houston-based company offers the Web-native, standards-based, HIE-ready ChartAccess EHR for rural and community hospitals, one of the first to be certified by CCHIT way back in 2007 and again among the first with ONC-ATCB Stage 1. Its affordable, modular solutions include CPOE, clinical decision support, eMAR, pharmacy, clinical documentation, ED, lab, radiology, ADT, document management, patient scheduling, patient accounting, and even an ambulatory EHR, all running on client-free SQL Server with a choice of local or remote hosting. Its value prop involves minimal hardware cost, centralized maintenance and upgrades, automated backups, and shortened time to go-live (Ness County Hospital in Kansas was live four months after choosing ChartAccess.) They’ll even finance its purchase. Thanks to Prognosis for supporting the work we do.

Acquisitions, Funding, Business, and Stock

GE Healthcare has begun the previously announced relocation of the global headquarters of its diagnostic imaging business from Waukesha, WI to Beijing, China.

Sales

Memorial Sloan-Kettering Cancer Center chooses iSirona for medical device integration with Epic outpatient and Allscripts Sunrise inpatient.

People

Martin Tursky, one-time CIO at Aultman Hospital (OH), is named president and CEO of Memorial Hospital of Rhode Island.

Announcements and Implementations

Wentworth-Douglass Hospital (NH) goes live on Soarian’s CPOE this month and on Soarian Financials in October.

Southern Coos Hospital (OR) goes live this week on McKesson’s Paragon EHR.

CodeRyte announces an NLP-based Health System Coding that extracts information from supporting documentation to support accurate HIM coding.

Concerro releases a new video pitching its Internet-based ShiftSelect employee scheduling and shift management system. The male actor is a Bill Shatner-type scenery-chewing bad actor (maybe intentionally so — check out his hammy foot-stomping emphasis at 1:00), but his female counterpart is good.

Italy-based pharmacy technology vendor Health Robotics takes on a Spanish partner to help with US marketing after a legal squabble with former distribution partner McKesson. In a no-holds-barred announcement in March (written by too-perfectly named marketing coordinator Claudia Flaim), Health Robotics accused McKesson of having a “David/Goliath syndrome” in taking a “bullying strategy” after being “unwilling to cope with competition” and then making up “a non-existent excuse for its own failures.” I don’t know who’s right or wrong, but give the scrappy upstart points for coming out swinging, although heavy legal expenses so early in a product’s rollout can’t be good for business, especially when you’re a new Italian company trying to get a US foothold.

Government and Politics

The VA will allow iPhones and iPads on its hospital networks starting in October, with initial access provided to e-mail and VistA. It’s even considering allowing employees to choose one of those devices instead of a laptop. CIO Roger Baker says his IT department will soon roll out approved access to cloud computing applications, which got some VA users in trouble last year who were found to be keeping patient information in Google Docs.

Other

Four hundred Kaiser Permanente IT employees collectively lose 1,500 pounds in its CIO Challenge, including computer specialist Frederick Curiel.

Thumbs up to Apple. Over the weekend, my iPhone slipped out of pocket and hit the pavement, cracking the screen. I scheduled an appointment at my local Apple store with one of the Geniuses, even though I didn’t have much hope they could do anything beyond selling me a new iPhone 4.  After I flashed the designated Genius my best Inga smile and showed him the sad state of my phone, he explained that cracked screens were not covered by warranty. However, he said he would go ahead and switch out my old phone for a new one at no charge. Perfect customer service and the right thing to do, especially given Apple’s  release of the Phone 5 in just a few weeks.

Uh oh. Apparently Google is deleting the Google+ accounts of users not using their real names. Lame. If Inga HIStalk stops following you, go ahead and blame Google.

Nurses at a New Zealand hospital complain that “dumb” staff scheduling software from HealthRoster is to blame for nurse fatigue, saying it creates schedules with long runs of consecutive work days and rotating shifts that allow as little as seven hours between them.

The Chicago Tribune profiles some health-related Web startups that include HealthTap (personalized health information from a panel of experts), Simplee (healthcare expense tracking), ZocDoc (book provider appointments online), and Practice Fusion (free EMR). That’s a lot of Rounded Arial fonts and blue color schemes.

Weird News Andy can’t decide whether it’s the instrument or the “doctor” that’s not the sharpest knife in the drawer. Police find a 63-year-old man lying naked outside his house with a knife handle sticking out of his stomach, which he then removes and replaces with a lit cigarette. He had noticed a protruding hernia and decided to remove it with a butter knife. A surgeon contributed advice that is most likely unneeded by anyone other than this individual: “It is absolutely impossible for someone to fix their own hernia.”

Sponsor Updates

• Ampla Health chooses MED3OOO’s InteGreat EHR for its eleven FQHC and community health centers.
• CAP/SNOMED Terminology Solutions is selecting beta sites to participate in full Lab Interoperability Cooperative pilot.
• Gateway EDI is offering resources for HIPAA 5010 conversion preparation.
• NextGen offers an August 3 webinar on clinical data sharing, with the CMIO of Colorado Associated CHIE and the CMO of Avista Adventist Hospital presenting.
• Wellsoft welcomes new clients AnMed Health (SC), Capital Health (NJ), Southwest Mississippi Regional Medical Center (MS), Pikeville Medical Center (KY), and Thomas Jefferson University Hospitals Methodist Hospital (PA).
• RJ Infusion Services (KS) selects Perceptive Software’s ImageNow to give instant access to patient records from anywhere.
• Baptist Memorial Health Care (TN) selects RelayHealth for a 14-hospital HIE.
• Children’s Memorial Hospital (IL) selects Merge Healthcare’s iConnect to give radiologists and treating providers immediate on-site and remote access to images.
• New York eHealth Collaborative selects e-MDs as a Meaningful Use Partner.
• East Orange General Hospital (NJ) goes live with GE Centricity Enterprise.
• Practice Fusion names the Top Five Worst Electronic Medical Record Myths.
• Tampa General Hospital (FL) selects CareTech Solutions’ Service Desk to augment its existing help desk, focusing on physician support.
• University of North Carolina Hospitals, University of Washington Medical Center, University of Kansas Hospital, and University of Kentucky Hospital go live with Physician Insight Plus from Carefx, which provides dashboards that tracking, analyzing, and comparing performance on clinical and operational outcomes, safety, and utilization.

Contacts

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

Readers Write 7/25/11

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!

Walter Reed Medical Center to be Decommissioned this Week
By Orlando Portale

As part of the Base Realignment and Closure announcement on May 13, 2005, the Department of Defense proposed replacing Walter Reed Medical Center with a new Walter Reed National Military Medical Center (WRNMMC). The new center would be on the grounds of the National Naval Medical Center in Bethesda, Maryland, seven miles from its current location in Washington, DC. The proposal was part of a program to transform medical facilities into joint facilities, with staff including Army, Navy, and Air Force medical personnel.

At the same time, my own organization was in the design phase of our $1B “hospital of the future,” which is scheduled for a 2012 opening (our construction webcam is here.)

In the fall of 2007, I was asked by Congress and the Department of Defense to participate in an independent review of the design plans for the Walter Reed Replacement Project. My role was to identify potential technology and design shortcomings in the Walter Reed replacement facilities.

In May of 2008, our committee submitted a report, noting design and operational deficiencies, but nonetheless advising that the project proceed on schedule.

On Wednesday July 27, the Walter Reed Army Medical Center is closing its doors after more than a century. Hundreds of thousands have received treatment at Walter Reed, spanning World War I, World War II, Vietnam, and the Iraq and Afghanistan conflicts. The move to the new facilities is scheduled for the weekends of August 12 and August 19.

In case you have not been to the old Walter Reed Campus, there are many important pieces of history there. The original red brick hospital was named to honor Major Walter Reed, an Army physician who treated troops and American Indians on the frontier. Dr. Reed had numerous medical achievements, but his most important work involved research that proved yellow fever was spread by the mosquito. He died in 1902 at the age 51 of complications related to appendicitis.

There is a memorial chapel on campus where President Harry S Truman visited after taking office. General Pershing had his own suite on campus for many years. Vice President Richard Nixon was treated for a staph infection over a few days, and received an unexpected visitor one day, then-Senator Lyndon B. Johnson. President Calvin Coolidge’s teenage son died in the hospital from an infected blister he received while playing tennis at the White House. President Dwight Eisenhower and Generals John Pershing and Douglas MacArthur died at Walter Reed.

In 1977, a new addition to Walter Reed was dedicated. The new hospital was as tall as a 10-story building. There were 5,500 rooms covering some 28 acres of floor space. The distance around the top three floors stretched the length of six football fields.

As you can see, the new Walter Reed National Military Medical Center is a beautiful facility. My hope is that it brings comfort and healing to those who have put their lives on the line for this country for us every day.

While our report identified a number of shortcomings with the design plans for the Walter Reed replacement facilities, many of these have been addressed. In fact, recently the new hospital was granted LEED Gold certification, which was an area addressed in our report. Very few hospitals in the US have achieved this status.

More important than the design of the new facility, however, are the extraordinary and dedicated people there who care for our wounded warriors every day. Congratulations to the great team at Walter Reed for all of their hard work and continued dedication.

Orlando Portale is chief innovation officer at Palomar Pomerado Health, San Diego, CA.

Over the past year, we’ve been helping a hospital in New Orleans augment their data center operations to avoid a disaster when the next major hurricane grows out the Gulf of Mexico. Doing this work in the midst of other recent natural disasters across the Midwest and South has helped to reinforce my thoughts about the importance of detailed and actionable plans for disaster recovery and business continuity.

When catastrophic events occur, the concept of business continuity (BC) is really focused on continuity of patient care. This is the ability to continue to attend to those in immediate need and also assist patients who rely on their caregivers on a regular basis.

You would be amazed to know about the number of healthcare organizations with EMRs that have minimal disaster recovery (DR) and care continuity plans. Some hospitals do well in this regard; however, many others have inadequate DR plans that are infrequently revised or tested. Manual care processes for long-term systems outage also suffer from lack of definition or practice. When an organization without good plans faces a major disaster, they quickly learn about their planning deficiencies at the worst possible time.

St. John’s Regional Medical Center in Joplin, Missouri was damaged so badly by an EF-5 tornado on May 22, 2011 that all patients had to be evacuated to other hospitals in the area. When a catastrophic event occurs, the provision of care for patients can be easier and many adverse event risks avoided if some portion of the medical record is available. Recent procedures, conditions, medications, orders, lab results, and radiology reports are extremely helpful in care continuity.

Hospitals can prepare for many types of disasters. We have advance warning for hurricanes, tornadoes, and even floods. Of course, some of the less-frequent disasters such as earthquakes and fire are not preannounced. With knowledge of an impending disaster, the hospitals with an EMR can have a process for the IT department to take steps to assure that current pertinent patient information is available.

Simply printing information at each nurse station in the hospital for the admitted patients is not sufficient. The hard copy reports can be misplaced or damaged. Writing these reports to an encrypted file on a CD, DVD, and even a USB flash drive (a.k.a. memory stick or thumb drive) will assure that important patient data is immediately available after the disaster causing event has passed. When the risk of a disaster is high, write the reports to the disks and flash drive, and along with a laptop PC and spare laptop battery, seal them in a waterproof bag and lock them in a fireproof safe that is anchored to the floor, typically in the data center. If practical and time permitting, prepare a second flash drive with another copy of the data delivered to a key person as identified by the DR/BC plan.

These few simple steps can help you to continue delivering appropriate care for your patients and potentially even save lives in the aftermath of a major disaster.

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

Curbside Consult with Dr. Jayne 7/25/11

Last week, Inga mentioned that the results of the annual EHR User Satisfaction Survey have been published by the American Academy of Family Physicians. Unfortunately, AAFP has this content on a restricted members-only site, so I had to bribe my favorite cross-town family doc for a copy.

I don’t want the copyright police to come after my friend, so I won’t share the full article, but I’ll summarize some key thoughts here. It also gives me a chance to hone my “speech” because I’m sure I’ll have colleagues waving it in my face (just like they did the last time the survey was conducted) and wanting to talk about how “our” system did. Some key thoughts:

There were “far more” responses than previous surveys. However, I found the reasons for excluding some respondents pretty funny. They included:

• Not using an EHR
• Not naming the system they used
• Naming a practice management system rather than an HER
• Naming a “home-grown proprietary system or… something that we could not verify as an EHR”

There were 2,719 usable responses covering 205 systems. Only 30 systems had 13 or more respondents. Those that had over 100 respondents included:

• EpicCare Ambulatory – 392
• NextGen Ambulatory – 247
• eClinical Works – 244
• Centricity EMR – 209
• Allscripts Enterprise – 180
• Practice Partner – 123
• e-MDs – 120
• Allscripts Professional – 106

There was a broad distribution of practice sizes.

Detailed information on version and implemented features was not presented. Nearly half of respondents “apparently did not know their product’s version number.” My spidey senses always tingle when small practice users have issues with their EHR. I’ve worked with docs who are using versions that are up to three years outdated and are surprised at how well the “current” version works once it’s applied.

The version paradox isn’t unique to small practices, though. For example, how many different flavors of Epic are there depending on how it was implemented? One of my buddies complained that it was ridiculous that Epic doesn’t have e-prescribing. Turns out her organization hadn’t included it in the initial physician training for some unfathomable reason.

Duration of use of the system ranged from “weeks” to “20 years,” with the majority being up to three years and another chunk being in the three to 10 years category. I think time on the system might be a useful exclusion criteria for future surveys. From experience, even with the best implementation, it still takes some practices a minimum of six to eight weeks for users to settle in and for workflow to stabilize if not longer depending on the commitment of the users and the willingness (or resistance) to change.

Fourteen percent of respondents have switched systems at least once due to dissatisfaction with a previous EHR.

The authors recognize these limits, summarizing:

As we said to begin with, it’s probably best to consider the survey results as input you’d get from a large number of colleagues who volunteered informally to report on their EHR experience. That said, we believe that the results presented in this article and its online appendix can help any family medicine practice considering the purchase of an EHR system.

This is a really key point. The study was not randomized, but rather respondents self-reported. Bias could be toward either providers who have serious concerns about their system or those who are significantly satisfied. Although the numbers were much better this time around, it’s not a true cross-section of users and doesn’t account for variables that can truly make or break an end user’s experience. These include poor implementation, lack of commitment among providers and office staff, and failure to implement recommended best practices.

During the implementation of my first EHR, there was no “kickoff” to bring everyone in the practice to the same page. Nor was their a discussion of workflow changes or process redesign. The trainer showed up and started teaching the template builder without the users having any context to her lessons. Coupled with her training on a version that was different than what we had installed, it was an unqualified disaster.

On the client side, some providers feel entitled to behave badly. I’ve had providers refuse to show up for training, refuse to complete practice scenarios, and refuse to be part of the customization process, yet complain relentlessly that the EHR doesn’t meet their needs. Those of us that have been in this a while know that deploying an EHR on top of a dysfunctional practice will only make it more dysfunctional. Partners who have historically felt disadvantaged in the practice often use implementation as a time to lash out against their peers.

Users often go against what the vendor recommends. Sometimes this is justified, such as when there are defects in the software or specialty-specific or regional issues that the vendor isn’t addressing. But sometimes it’s not. I’m currently watching the equivalent of an EHR car crash as one of my closest colleagues is being forced onto a system that isn’t configured optimally. She’s part of a larger group and is a younger physician with little political power to counter the decisions being made higher up. As a user of the same system, I’m keenly aware that the choices they have made will lead to more work being placed on the physicians, less efficient charting, and potential patient safety and regulatory issues.

I’ve armed her with enough knowledge to try to steer them in the right direction, but so far she hasn’t been successful. Eventually they’ll learn, but at the price of user bitterness and potentially patient safety. I recommend that new users take advantage of all the training and information they can get their hands on, whether formal – training programs, client conferences, user symposia, webinars, and the like – or informally through Internet chat groups, informal user get-togethers, hospital colleagues, or blogs.

Many systems offer the ability to customize on a per-physician basis. Providers who are not fully educated on the risks and benefits of doing so can quickly customize themselves into a corner and out of the ability to achieve a decent workflow (not to mention loss of the ability to reach Meaningful Use). I strongly recommend users make an attempt to use the system as the vendor delivers it for at least a month before customizing (although if the system arrives with defects and bugs, often customization is needed to effectively deploy the system).

I encourage practices to consider using EHR implementation as a chance to look at all office policies and procedures, whether written or anecdotal. Automating bad workflow just allows bad workflow to happen more quickly on a greater scale. I encourage partners to think out of the box and consider whether it’s rational for each doc in the office to have his or her own process for handling phone messages and refills. Often there is one process that is more efficient that can be expanded to the entire office with a little effort, resulting ultimately in greater satisfaction for end users.

A survey such as this one can’t account for all these factors, so my advice to users (and those still shopping for an EHR or looking to replace what they have) is to take it with a grain of salt and do your research. Talk to current users and not just those references served up by the vendor sales team. Talk to your colleagues. Spend as much time hands-on with the application as you can, and carefully consider your choices during the build and implementation process.

And for those users who are dissatisfied with their systems or feel their needs aren’t being met, don’t just fillet your vendor in the next survey. Take a proactive stance. Review your contract and implementation documents and make sure you’ve taken advantage of all the training you were allowed, and if you need more, buy it. It amazes me that physicians who wouldn’t start performing a new surgical procedure if they didn’t feel fully trained are happy to jump into an EHR with only a few minutes of training.

Log defects with your vendor and keep records of any defect and enhancement submissions. Understand your support contract and how your vendor is required to respond to issues. Take advantage of any account management or client management services that your vendor offers. Even if you’ve been on a system for years, don’t be afraid to consider retraining, especially if you have to upgrade your software to qualify for Meaningful Use. It’s a great opportunity for a refresher, and CMIO types like myself can always use the Big Bad Wolf of MU to sneak in additional workflow coaching during “mandatory” training.

AAFP has conducted this survey three times before. The first had 408 responses, the next 422, and the 2009 survey had 2012 responses. It will be interesting to see what the results look like the next time it’s conducted and whether any conclusions can be drawn once Meaningful Use is in full swing.

E-mail Dr. Jayne.

Monday Morning Update 7/25/11

From Give Me a Break: “Re: press releases. Do readers find it as annoying as I do when a vendor issues a press release congratulating its customers for making a list of some kind? The average health system has over 240 apps from 70 vendors.” I do indeed find that particular practice somewhere between pointless and annoying, right up there with those announcements that “applaud” some government decision that benefits the vendor directly. That’s especially true when the award the customer has won comes from a for-profit company looking for publicity (see: Most Wired, any company’s customer awards). I’m generally hostile toward press releases that contain no discernible news, even of the self-serving variety. They’re lucky that lazy magazines and sites are so desperate for free content that they’ll foist crap like that on their readers anyway, hoping that hyperventilating headlines and cutesy writing will keep readers from noticing the waste of their time.

From DeeDee: “Re: University of Missouri Health Care. The video with their being named HIMSS EMRAM Stage 6 has some marketing polish, but interesting. Buy-in of the Tiger public/private venture seems impressive.”

From Tooter: “Re: Webmedx. You didn’t mention that HIStalk ran the Nuance acquisition rumor before the announcement was made.” True enough: I ran MT Hammer’s rumor report on June 24, while Nuance announced the acquisition on July 14.

From Lucy Gucci: “Re: Epic new hire blog posting on WSJ. I remember feeling this way about starting at Epic, too – excited to be a business traveler and still glossy-eyed over the architecture. Also, I’ve heard that Judy is talking about the June new hire class making up a certain percentage of the national job growth for that month.” A 21-year-old new grad (business administration, Asian studies) gushes with enthusiasm about being hired as an Epic project manager, ready to “improve patient care, create better processes, and in general aid hospital systems” as she “moves rapidly toward adulthood.”

Most respondents say the government shouldn’t get involved with EMR usability, although not by a large margin. New poll to your right, from a reader’s comment: what will HITECH’s legacy be?

Listening: reader-recommended Big Head Todd and the Monsters, straight-head soulful rock with thoughtful lyrics and an unchanged member lineup (and relatively unchanged musical style) for 25 years.

Unrelated, but music again: singer Amy Winehouse is found dead at 27, joining other notoriously drug-abusing rock stars to expire at that age (off the top of my head, that list includes Jim Morrison, Janis Joplin, Jimi Hendrix, Kurt Cobain, and Brian Jones).

This week’s Time Capsule editorial from 2006: Your Co-Workers Are Your Biggest IT Security Problem. A snip: “A hospital’s internal documents and policies probably aren’t all that interesting to competitors, but you might reconsider storing Social Security and credit card numbers.”

I hung on every word of Vince Ciotti’s HIStory this week since it covers Compucare, IBAX, and other faded names from yesteryear that still seem recent to HIT long-timers (the notepad cover I use every day is a Compucare one, so I’m just realizing how long I’ve had it). He got help this time around from pioneers Ed Gavin, Sheldon Dorenfest, and David Pomerance. Given the great response Vince is getting, I’m thinking he should reprise his SMS reunion of a couple of years ago, except open it up to anybody who worked in HIT in the old days (before 1980, let’s say) and do it at the HIMSS conference. Then he could really tap into some first-person memories for future installments. Vince is willing to take his show on the road for interested classes or groups (like regional chapters of HIMSS or HFMA) – just e-mail him.

Dell confirms the rumor I ran Thursday from Jamie that healthcare VP Berk Smith, brought over in its Perot acquisition, is leaving to start a healthcare-related company.

Thanks to the folks at Preceptor Consulting of Fort Myers, FL, supporting both HIStalk and HIStalk Practice at the Platinum level. Preceptor offers design, build, testing, and training support for all the top clinical systems (Epic, Cerner, McKesson, etc.). Their name comes from what they do: provide licensed clinicians (physicians and nurses) to get those systems live, which they’ve done in more than 500 healthcare facilities over the past five years. Their motto will be familiar physicians: See IT. Do IT. Teach IT. You’ve spent a lot on that shiny new clinical system, so spend a little more to engage authoritative, experienced clinician experts who will make sure it’s built right, tested as safe, and accepted by well-trained users (think of it as cost-effective CIO/CMIO job security insurance). Find out why the largest health systems get clinical implementation support and healthcare IT expertise from Preceptor Consulting. Thanks to Preceptor for supporting HIStalk and HIStalk Practice.

Here’s a really well done video about Preceptor Consulting I found on YouTube, with some of the “preceptors” talking about working on site at hospitals and some of their clients talking about their experience. “Any time you had a question or an issue, they were right there to help. I don’t think you could make the transition without the preceptors. I don’t think it could be done.”

Athenahealth sues AdvancedMD, claiming the company violated an athenahealth patent. The patent number cited suggests that the suit is related to athenahealth’s centrally maintained insurance billing rules engine.

John Halamka will resign his part-time position as CIO of Harvard Medical School, saying it needs someone full time, but is staying on at BIDMC.

A former EVP and general counsel of Children’s Hospital of Philadelphia pleads guilty to charges related to his embezzlement of $1.7 million from the hospital, accomplished by submitting and approving fake invoices. He bought himself a yacht with its own captain.

CodeRyte will make some announcements this week about a new Natural Language Processing system for computer-assisted coding in hospitals, which a few customers have already signed up for. Fun executive team facts: CEO Andy Kapit taught autistic kindergarten children. Chairman and President Richard Toren invented the EpiPen, which has saved the lives of countless allergic patients. COO Glenn Tobin and Chief Revenue Officer Don Trigg are fairly recent hires from Cerner (COO and UK GM, respectively).

GE announces Q2 numbers: revenue down 4%, EPS $0.35 vs. $0.28. GE Healthcare revenue was up 10%, with profit up 8% to $711 million.

Hospital of St. Raphael (CT) fires three employees after one of them takes cellphone pictures of the fatal gunshot wounds of a 17-year-old ED patient and sends them to other employees.

A hospital in England, which pays the travel expenses of some family members visiting patients in its mental health units, suggests that the family members use Skype instead to save money.

Eighteen former employees of insurance company Molina Healthcare file a lawsuit against their former employer, its former CIO, and outsourcer Cognizant, claiming they were discriminated against as the IT department brought in increasing numbers of Indian workers to the point it was called “little India.” They say the department celebrated Indian holidays while making employees work Thanksgiving and Christmas, promoted only employees from India, and conducted meetings in Indian languages. They charge Molina with firing 40 technical workers the day after Cognizant was approved to bring in 40 H-1B employees. The former employees also claim that Molina regularly violated HIPAA requirements when the H1-B workers would send full, unencrypted patient files to their counterparts in India.

E-mail Mr. H.

HIStalk Interviews Mark Debnam, Founder and CEO, Quality IT Partners

J. Mark Debnam is founder and CEO of Quality IT Partners, Inc. of Mt. Airy, MD.

Give me a brief overview of yourself and the company.

I founded the company in 2000. My first partner, Marty Zola — he’s our chief technology officer – joined about three months later, followed in 2001 and in 2003 by our final two partners, who are with us still today — Carol Wheeler and Donna Eversole.

We are very family-oriented company here. We’re a small company, about 20-25 folks, and we specialize in healthcare IT. We cover just about everything out there. We have seven different application practice areas. We have eight management consulting-focused areas as well. We also do a lot of work in the hospital and medical office building architecture and construction work, in addition to infrastructure.

We just this year celebrated our tenth anniversary. We did it in Hershey Park, Pennsylvania, so it was a lot of fun. We just got back from that. Every year we do that — we fly everybody and their families and to enjoy time together and get to spend that time that we rarely get together.

The company’s been around for 11 years and clearly there have been some new shingles hung out here in the last couple. Do you think the barrier to entry is too low for consulting companies and should a prospect care about the company history when they’re trying to decide who to hire as a consulting firm?

That’s a great question. I think there’s always room for great companies to get into our market space. As time goes by, there’s less and less differentiators, so it becomes highly important to develop a strong differentiation between yourself as a small company.

When I started the company, it was intensely difficult to get in and be a player without good, solid qualifications and stories and references and all that. You have to really a compelling background and a compelling story about what you’re doing and why you’re doing it. You know, that really hasn’t stopped.

There’s a reason we’ve stayed small. As a company, we have always focused on the highest quality of delivery of service. We’ve grown steadily and we’ve had a profit every year since I’ve started the company. The key here is being able to really develop a strong sense of differentiation in the marketplace so that folks can see what they’re going to get in terms of value. People are very discriminating. Our clients are telling us they want more now than they ever have. 

There’s never poor time to get in if you have a compelling story. One of those compelling stories, particularly in the consulting field, is how you interact with and how you provide the best environment for your consultants and the folks that you have on board in terms of support and things like that. It’s a tough, tough business. That’s probably the main reason why we have such a family-type environment here at Quality.

A big company would say their size is a positive differentiator just as you would say your small size is a plus. But one thing that seems to stand out on your Web site is the value-based cost structure. Describe that.

We keep our overhead cost extremely low. By doing so, we are able to keep our rates low. We’re very cost-conscious in our investments, but we don’t shortchange the key investment areas in any way, shape, or form.

We’re very strong on education and benefits and so forth within the company, but we don’t go out and acquire things that are expensive in terms of overhead costs, like extraordinary office space or elaborate anything. We keep things here in a very modest way so that our staff can reap the benefits of their hard efforts. That’s a big, big part.

Our officers of the company don’t get exorbitant salaries or anything like this. We put our people first and our customers right behind that.

I think that as far as keeping the cost down for our customers, it’s been a big, big plus for us. When you are a small company, I think there’s an expectation that we’re not going to hit you with a high cost. On the flip side of that, there has to be a reason why a customer would be compelled to pay you anything to come do work for them.

We have a tremendous performance record and we’re very blessed to have that. We have just a wonderful team of folks that have a reputation for delivering very high-quality service. We have well over 85 to 90% of return customers to the company. We’re very, very proud of that, but you have to earn that every day. I think our customers see the value for sure in what we do.

The consulting company executives that I talk to say their phone’s ringing off the hook with people wanting to buy their business or buy into their business. Are you getting those calls, and why do you think companies want to buy consulting companies?

We get serious calls. There have been a lot of them I’ve received over the years. They know a little bit about what you do and what you’ve done and they’ve heard through the grapevine, etc. I think that they see that as an opportunity to get into the market or expand their current offerings that maybe they don’t have, and be instantly profitable.

If they can retain staff, that’s a huge plus for them to not have to go through a process of having to go and hire people. The time it takes to bring all new staff and build a staff versus the time it takes to acquire a consulting company are vastly different.  You can bring on a team in an acquisition very quickly. I think that would be one of the reasons why folks like getting into that business.

I’ve always wanted to ask this question after I’ve looked at the job ads. What does it take to hire an Epic consultant these days?

You ask a good question there. It takes reputation, it takes a very compelling story; and it takes a special match — let’s be realistic about it — between what the person’s desires are and what the company’s made of.

We’ve been very fortunate. Our largest team here is Epic. We have a very broad spectrum of folks of all ages and genders. I think mostly that they seek to expand their education. We see a lot of that — folks that want to continue and expand in their certifications. For Epic, that’s a big, big thing. They need to be with a company that will support that.

The folks that come from Epic tend to not want to live that lifestyle any more. We’re very, very different in the way we do things here. We don’t kill our people. We’re very, very cautious in watching out for the welfare of our people, and we find that in other consulting firms or Epic, this is maybe not so much the case in a lot of ways. 

When folks come here, it’s not that they want to take a relaxed lifestyle. They just want a strong work-life balance. The company’s committed and convicted to that philosophy. Not burning out the people. People also want to know that they’re going to be working with other folks that are of great caliber, and that they can learn from and grow with them.

Business continuity and disaster recovery are always in the news. What are the top two or three things you see clients doing wrong or not planning for?

It’s the last thing that folks want to pay for and it’s the first thing they want to have when it happens. We, fortunately, have been blessed with working with a lot of customers, like Ohio State University. The common thread is those organizations are committed to really doing it right and doing it thoroughly and have a good plan. Others that will try to do it internally and there’s sometimes a lot of struggles with that.

A business continuity plan is often best facilitated — and I don’t mean this as a consulting plug – by someone with an outside viewpoint. Folks don’t always really understand some of the ramifications of what can happen in a disaster. We’ve done a lot of work in California related to the earthquakes. We had a hospital in Florida hit by a large hurricane right after we had finished up our business impact analysis for them. Fortunately, they had some things to fall back on. These things happen and they’re real. There are some obvious and quick benefits that can come from even a cursory business impact analysis.

A lot of what the consulting companies are asked to do is fairly routine work. Have you seen anything really cool that hospitals are doing?

There’s a number of things that folks are taking on. You publish a number of exciting things that folks are doing with different types of media and hand-held devices.

We have a couple of neat projects that we’re working on. One of which is an imagery project for a large, California-based medical center, cutting edge in real-time capture of image retrieval and large-scale storage of things like sonograms, cardiology, and all these things. There’s really, really cool stuff. We’re leading and implementing a project out there and managing multiple vendors. It involves a lot of challenges. It involves a lot of hand-holding between the vendors, which sometimes you don’t get a lot of cooperation on.

Our customer is taking quite a risk and quite a position of conviction to invest in this technology and hospital doctors are loving it. It’s one of these things where if they get that kind of attention and they get these opportunities to work with those systems, they’re going to be attracted to stay in practice there. We’re working hand-to-hand with these physicians in delivering these technologies. It’s been wonderful, but it has not been trouble-free. It is absolutely bleeding edge technology in a lot of ways and we’ve been fortunate to be amidst that and be leading a project. We’re going live on it as we speak.

Hopefully you’re not getting a call waiting that says, “Uh, it’s not working.”

[Laughs] It’s been a challenge and a labor of love, let me tell you. But it’s great to see this kind of investment.

You offer interim management services. From your experience, is the most common reason that hospitals and CIOs part ways?

I think the most significant reasons are organizational direction and changing of the business ways. Hospitals operate as businesses. There are so many wonderful CIOs out there. A lot of times, though, when you have a change in business philosophy — whether that be through infusion of the business leaders or other means — you have a difference of opinion  that comes to bear. “Well we’ve done this a certain way, it’s been done this way successfully, why should we change it?”

Well, because the business is changing. The hospital is run like a business first. If a CIO is not able to put on their business cap before they put on their technology cap, that’s a concern for that CIO, unfortunately. They could be the brightest, the most brilliant of people and yet not have the ability to make it within that organization.

Projects fail. Sometimes they aren’t the fault of the CIO or any other leadership, and sometimes they are, but when you have a big failure of a project and things just don’t go well, that’s usually not a good marker for a CIO to make it. The higher the visibility, the higher the possibility that the CIO is going to be leaving.

Do you have any final thoughts?

I want to reflect on how great our relationship with HIStalk is and how grateful we are to be part of your family. 

One  the things we’ve taken on here as a very, very important endeavor is our investment and our commitment to charitable causes. If you look at our Facebook page, you’ll see a video that we captured to reflect our works and our investment and our time with the Cleveland Clinic. We have a very successful project going on there in oncology. We’ve written many of the protocols there for the oncology group at Cleveland Clinic, so we’re very highly connected with them.

I had the honor of being at their gala last year and being part of their big show and doing part of their private gala. I had the opportunity to meet all of the celebrities there, spent some time with Brad Paisley. It was wonderful. I was very inspired by that. I’m a musician — I’ve been playing guitar for about 32 years this year. I know you like music. 

I came back and wrote a song. We copyrighted that song and as part of the company, I dedicated it to the Cleveland Clinic. We posted it to our Facebook page and then you  guys published it as well, which was delightful. We’re very interested in helping to find a cure for cancer.  

This is a big thing, among other big things. You’ll see other charitable things. It’s a big, big part of what we want to be. We all go through various challenges in our lives. We really want to bring home the things in life that matter to this company in not just business, but things that affect us all when we’re trying to do business. I just want to leave you with that thought — that the company is very committed to that.

In addition to our appreciation for everything you’ve done for us and helping us get out there and inform the folks, we’re very blessed to have the clients we have, and in having this wonderful staff of folks here on our team and that we’ve had in the history of the company.

Time Capsule: Your Co-Workers Are Your Biggest IT Security Problem

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

I wrote this piece in June 2006.

Your Co-Workers Are Your Biggest IT Security Problem
By Mr. HIStalk

I’ll bet that every hospital in the country has had sensitive information fall into unauthorized hands at least once. The VA, big banks, and universities have skilled security teams to prevent employees from exposing data, accidentally or otherwise. If those large organizations can’t control breaches, the average hospital doesn’t have a chance.

Health care organizations have spent years and hard-won dollars trying to catch up to the IT standards of other industries, where nearly all employees have enjoyed easy access to PCs, e-mail, and both wired and wireless networks. However, once the green-screen terminals went away, so did the last chance to keep confidential data secure. Data convenience is both a blessing and a curse.

CIOs and network engineers spend hours trying to out-think shadowy foreign Internet hackers when the real problem involves the co-workers they pass in the halls each day.

Employee security policies provide a false sense of security. The headlines scream that information on 26 million veterans has been breached, not that the VA had a great policy broken by a rogue employee who took data home without authorization, only to have it stolen.

Employees may drag laptops or USB drives home because their employer doesn’t have a good remote access solution to let them work from home. Perhaps backups are unreliable, leading cautious staff to create their own. Maybe software policies or budgets are so limited that common productivity tools aren’t available, making it tempting to load data onto the family PC. Whatever the reason, employees are breaking the rules.

Accidental data loss is bad enough, but one study found that 70 percent of employees have stolen electronic data from their employer, most often in the form of e-mail lists, databases, and documents. The most common reason: to help them get a new job. Three-fourths of those surveyed didn’t see anything wrong with that, especially if the employee helped create the information in the first place.

Security technology can help, but it requires tough decisions. Most hospitals don’t have the budget or organizational willpower to disable USB ports, remove CD-RW drives and floppies, buy encryption software, and install physical locks on laptops. Even if they did, web controls are inadequate to prevent using Hotmail accounts or online file storage that provides a non-hardware method of moving data to unauthorized locations. For that matter, there’s that old security hole called a “printer.”

Maybe the best security policy is to avoid storing anything that would be useful to someone else. People get paranoid about their medical information, but it has little monetary value (unless you’re a celebrity or political candidate). A hospital’s internal documents and policies probably aren’t all that interesting to competitors, but you might reconsider storing Social Security and credit card numbers.

The good news is that the recent health care-related breaches have been accidental, where well-meaning employees screwed up. For that reason, I’d put my IT security money into employee education, awareness, auditing, and protection tools for laptop users instead of obsessing over Boris and his hacking team. That’s the best hope of staying out of the headlines.

Even then, I’d develop a damage control plan for a breach. There’s a good chance it will get used.

News 7/22/11

Top News

Athenahealth will acquire Proxsys, a Birmingham, AL-based vendor of front-end revenue cycle tools that include medical necessity checking, insurance verification, pre-certification, referrals, and facility scheduling. The all-cash deal is worth up to $36 million. Athenahealth says it will use Proxsys technology in its newly announced athenaCoordinator service, which will move patient and insurance information between hospitals and their affiliated physician practices in return for a per-transaction fee. ATHN shares are up almost 10% Thursday in after-hours trading following the release of positive Q2 numbers and news of the acquisition. Share price has nearly doubled in the past year, giving the company a $1.69 billion market cap.

Reader Comments

From Scrambled CIO: “Re: software conversions. We are in the middle of a lot of system replacements and consolidation. I am amazed at the estimates and fees associated with a flat file conversion from SCC Soft Computer. Three hundred hours for a pathology conversion.” I assume you’re converting “from” rather than “to” SCC, in which case they have little incentive to give you a deal knowing you don’t have an option and your wounded former-customer indignation won’t matter anyway. It’s funny that I was describing exactly that scenario to someone at work today, where you’ve told your vendor that you’re dumping them down the road and they stop returning your calls and price everything at list-plus-larceny. It’s like an ugly divorce – if you had known how cold and vindictive your spouse could be, you’d have insisted on a pre-nup or maybe married someone else. But I don’t know the particulars in this case, so in fairness to SCC, I’ll just say “unverified” and assume there was a rationale for the price quoted.

From Crabby: “Re: ARRA’s legacy. it will not be widespread adoption of EHRs. but rather the technical standards that ONC has laid out. They will do more for our industry, patient safety, and adoption than any sexy interface or legislation could ever do. Access to complete patient data across the continuum of care will be enough of a reward for a provider to login. Once logged in, we must make it easier for him/her to click the buttons than to bark at the nurse.” No one expected ARRA to be a panacea and fix all of HIT’s flaws, but incorporating standards should reap some benefits. Yep, there is still more work to do.

From Jamie: “Re: Berk Smith. The Dell Healthcare VP/GM resigned Wednesday after 22 years at Perot Systems and Dell. He’s leaving for a startup.” Unverified. I e-mailed a Dell press contact, but haven’t heard back.

From Emily: “Re: 3M Health Information Systems. Another round of layoffs last week following another poor quarter of sales.” Unverified.

HIStalk Announcements and Requests

Highlights from HIStalk Practice this week: the ever-witty and irreverent Dr. Joel Diamond reflects on technology over the past decade. Highlights from AAFP’s 2011 EHR User Satisfaction Survey. digiChart’s new CEO suggests the company is prepping itself to be acquired some day. Patients feel disrespected by their doctors.  Canadian docs express familiar-sounding complaints about EMRs. Almost 70% of practices are looking to become a PCMH. In honor of Oscar de la Renta’s 79th birthday (or just because), feel free to sign up for the e-mail updates while you are checking out the hottest ambulatory HIT news.

I am now on Google+, though I haven’t figured out what it’s going to give me that I don’t already have with Twitter, Facebook, and LinkedIn. However, if you feel the need to be in my circle, send me an invite.

Unrelated except to music fans: an influential but seldom-acknowledged musician of the 60s and 70s died this week. Grass Roots lead singer Rob Grill was 67. I actually saw them live well past their heyday in a bar holding maybe 25 fans and chatted with them while getting a beer. They still sounded good playing I’d Wait a Million Years, Temptation Eyes, Sooner or Later, and Midnight Confessions.

On the sponsor-only job board: Senior Enterprise Hospital Sales Executive, Senior C#/.NET Developer, Configuration Architect. On Healthcare IT Jobs: Informatics Analyst, Senior Systems Engineer – Windows Server Technology, Senior Director of Applied Clinical Informatics, Vice President of Client Services.

Acquisitions, Funding, Business, and Stock

athenahealth reports Q2 revenues of $77.9 million, up 33% from 2010. Non-GAAP adjusted net income was $7.9 million ($.22/share), compared to 2011’s $4.1 million. The company beat analysts’ estimates of $.18/share and revenues of $75.08 million.

The provider of MyMedicalRecord PHR announces an agreement that gives a Chinese venture partner warrants to purchase up to four million shares of its stock. Sounds impressive until you notice the share price is $0.04, valuing the big international deal at $160,000.

Private investment firm Veronis Suhler Stevenson acquires hospital financial analytics software vendor Strata Decision Technology, which claims 800 hospital customers that include Allina, Catholic Healthcare West, and Cleveland Clinic.

Express Scripts will acquire its prescription drug benefits competitor Medco in a $29.1 billion deal. The companies, whose combined revenue is $110 billion, say they’ll be able to lower costs and improve health with their combined drug purchasing power.

Microsoft’s Q4 numbers: revenue up 8%, EPS $0.69 vs. $0.51. beating consensus earnings estimates of $0.59. Windows revenue slipped for the third straight quarter, while Office revenue was up 8%.

Sales

‘s

Parkview Health (IN) signs an agreement with Streamline Health Solutions to upgrade six of its hospitals to accessANYware v1.9.

Northrop Grumman will partner with Verizon and Wellpoint subsidiary National Government Services to develop predictive modeling technology for CMS’s National Fraud Protection Program. CMS announced last month that it had awarded Northrop Grumman the $77 million fraud detection contract.

People

Clinical integration and search technology provider Apixio names Steve Roberts its VP of sales and Jenny Field its director of product marketing. Roberts is a former VP of sales for NextGen; Field was director of ambulatory medical informatics for Salinas Valley Healthcare System.

Former Healthland president and CEO James Burgess takes over as CEO for Advanced Health Media.

HFMA president and CEO Richard L. Clarke will retire on July 31, 2012.

Jason Bray is named CIO of Oklahoma State University Medical Center. He was previously CMIO of the OSU Center for Health Sciences.

Announcements and Implementation

Summa Health System (OH) deploys BIO-key’s fingerprint biometrics for authentication with Allscripts Sunrise Clinical Manager platform.

PHR vendor Dossia announces its Health Manager health management system, which it says will improve the health behaviors of its users through personalization involving games, social dynamics, incentives, and messaging. Dossia chair Craig Barrett says it represents the next generation of PHRs.

Government and Politics

CHIME chimes in on proposed changes to HIPAA, saying the standards would be difficult for providers to meet and should be scaled back. CHIME claims the rules rely too much on technical capabilities that are not widely available and fail to acknowledge the amount of human intervention necessary to achieve compliance. Of particular concern is the proposed requirement for providers to create a consolidated report that documents all incidents of PHI access within a designated record set.

The VA and Department of Defense were charged with developing overall integration between their organizations at a Chicago demonstration project for the first Federal Health Care Center, with some EHR integration due October 1, 2010 (single sign-on for clinical staff, single patient registration, and orders portability). A GAO report says they missed the date for the first two items but those are live now, but they’re struggling with lab orders. Pharmacy order integration has been “indefinitely delayed” and five pharmacists were hired to manually verify orders between the two systems and to check for drug-drug interactions. The GAO says they’re struggling because of the same old problems that always come up: “lack of an integrated and comprehensive project plan from VA and DoD.”

Other

The Women’s Health ABU at Cerner breaks out into a dancing flash mob during lunch at Cerner headquarters. Diners included Cerner associates, about 100 new hires, and over 40 clients. All I have to say is I want to be part of a dancing flash mob one day.

Core Health is running its annual HL7 Interface Technology Survey for CIOs/CTOs, IT managers, and HL7 professionals. They did a nice job last year. Respondents are entered in a drawing for a ThinkPad tablet.

Weird News Andy is on the tail of this story, which he summarizes as, “His butt, her end as a CNA.” A nursing assistant is fired from her job at a transitional care facility and faces voyeurism charges after taking pictures of a male patient’s buttocks, which she described to a co-worker as “too funny,” and posting them on her Facebook.

WNA also fell for this story from England: a disabled man who falls out of his wheelchair in a hospital’s parking garage just 100 yards from its ED has to wait 25 minutes for paramedics to be sent from the other side of London. A bystander claims hospital nurses refused to help and said they aren’t allowed to treat patients outside their areas, although a hospital spokesperson says no such rules exist and nurses have responded to garage emergencies previously. 

Data integration software vendor Informatica and the IT division of Hospital Corporation of America are embroiled in a legal squabble over software license fees, with Informatica claiming HCA owes it $6.3 million following a license audit. HCA interprets the scope of its license differently and disputes the claim.

Cayman Islands Health Services Authority CIO Dale Sanders tells me that they’re re-competing their Cerner contract, with the core vendor tender here. If it were me, I’d plan the install for January and watch the resumes flood in from cold-haters more than willing to spend the winter there at discounted rates.

A 34-year-old Australian woman who died immediately after visiting a physician for an ear infection is found by coroners to have experienced an allergic reaction to the antibiotic Ceclor, prescribed for her by an 85-year-old “computer illiterate” doctor who did not notice her documented allergy on the screen. The doctor has since given up his license and sought psychological counseling. 

An indicted New Jersey couple who sold medical students and licensed physicians a $5,000 medical licensing exam test prep course that included stolen questions remains on the run, while their student-customers, most of them foreign medical school graduates, are being asked to defend their scores by re-test. Several have already failed and may lose their medical licenses. The National Board of Medical Examiners got suspicious when the wife took the USMLE exams several times and scored low, with a surveillance camera review showing her taking pictures of the computer monitor.

Researchers in Brazil find that tweets containing the word “dengue” correlate to local outbreaks of dengue fever, the disease that kills hundreds of people each year there, allowing authorities to identify geographic areas of outbreak and respond more quickly.

A 27-year-old hospital nurse in England is arrested after insulin was injected into IV bags in a storeroom, killing five patients.

Sponsor Updates

• Sunquest Information Systems hosted a “Build a Bike” team-building event at its user group meeting last week. Fifteen bikes were donated to local Tucson charities.
• United Regional Health Care System (TX) signs an enterprise license agreement for iSirona’s device connectivity solution.
• TELUS expands its Canadian EHR ecosystem with the connection of Optimed Software Corporation’s AccuroEMR to TELUS Health Space.
• CareTech Solutions announces that 14 of its clients were named Most Wired 2011 Hospitals. Five more were named Most Improved.
• Billian’s HealthDATA interviews Gail Donovan, EVP/COO of Continuum Health Partners about the economic challenge of providing high quality care and outcomes.
• Besler Consulting’s George Porette offers analysis on Medicare DSH and uncompensated care reimbursement in The Besler Beacon, the company’s quarterly newsletter.
• Awarepoint’s Q2 bookings beat 2010’s numbers, increasing its hospital client count to 153.
• Medicity’s Novo Grid is ranked the #1 private HIE solution by KLAS, the position it has held since the category was first reported last year.
• Porter Hospital (IN) will install the iConnect image operability solution from Merge Healthcare.
• Tulsa Spine and Specialty Hospital (OK) selects ProVation MD for physician point-of-care documentation.
• Jennifer  Lyle, CEO of Software Testing Solutions, will serve as a Meaningful Use panel presenter at the iHT2 Health IT Summit in Denver next week.
• Southwest Mississippi Regional Medical Center chooses Wellsoft’s EDIS for its two hospitals.
• Thomson Reuters and CareEvolution expand their partnership to deliver the Thomson Reuter’s HIE Advantage solution, which leverages CareEvolution’s secure interoperability solutions and Thomson Reuters’ analytics expertise.
• The 40-provider Philadelphia Hand Center contracts for the SRS EHR.

EPtalk by Dr. Jayne

I was intrigued by the item in Monday’s Sponsor Updates regarding the Surescripts White Coat of Quality program. I have to admit not being familiar with it, but was able to find its Web site. Frankly, I’m surprised to see that only four vendors were given this recognition for 2010. To quote directly (including grammatical and spelling errors) from the Surescripts website:

The criteria for earning a White Coat in 2010 was, by design, very straight forward:

1. Provide a signed commitment from company leadership affirming their organization’s commitment to quality.
2. Measure quality metrics as specified in the published industry guidelines and report those metrics each month to Surescripts.
3. Implement changes to software that address issues identified in quality reporting. Take steps to eliminate any issues measured in #2 above.
4. Raise prescriber awareness through training.

As a provider, this seems like a slam-dunk. I’m not sure why more vendors aren’t on the list, especially some of the larger ones.

I was flipping through Health Data Management while watching HIPAA training and a McKesson ad aimed at independent physicians caught my eye. It grabs the reader with “I didn’t survive my residency to be an I.T. Manager” and says solutions are “arriving fall 2011.” The ad features an older gent with some pronounced hair loss.

To me, this ad seems aimed at either (a) physicians who are the last-ditch holdouts for putting off EHR implementation, or (b) those that hoped they could retire before someone forced them to bite the bullet and go electronic. Nothing new on the Web site, so I suspect this is just marketing rather than something truly transformational. Maybe it’s a discount for AARP members.

Speaking of independent spirits, a colleague cornered me in the doctor’s lounge waving an article on usability from American Medical News, reminding me how much he reveres his paper charts.

(I still don’t quite understand what the AMA is doing with this publication. They offer it in both print and digital versions, but the same article has different publication dates. I understand the Web version is going to come out before the snail mail version, but can’t we at least use the same dates, hmmm? This was dated June 20 online and July 11 in print for those of you who are playing along with the home game.)

Anyway, the article doesn’t tell us anything we don’t already know regarding usability. Guess what? Vendors are trying to reduce click counts, de-clutter screens, and save us from alert fatigue among other not-so-small feats like being certified for Meaningful Use, transitioning to 5010 and ICD-10, and so on.

The piece mentions CCHIT’s five-star usability rating as a tool some vendors use to differentiate themselves. Wondering if this is anything like the above-mentioned White Coat of Quality, I wanted more information. (I’ve been deployed on stable systems for some time and have a low tolerance for boastful sales practices, so it’s been a while since I’ve played the system / vendor selection game looking at it through the eyes of the average user.)

The CCHIT Web site seems clunky and vendors are not in alphabetical (or any other seemingly rational) order. I never did find a list of those products that had received the five-star usability rating, although a Google search brought up lots of individual vendor listings, many of products I wasn’t familiar with. Maybe my search skills are deteriorating or maybe it was the effects of too much fruit of the vine while watching what might be the saddest web-based HIPAA training I’ve ever seen in my life as I apply for staff privileges at a new hospital. Still looking for the list – can anyone help a girl out? E-mail me.

Contacts

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

CIO Unplugged 7/20/11

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

PoléPolé (Slow Slow)

3:21 a.m.

Zero degrees and our Camelbacks turn to ice 2,000 feet below Kilimanjaro’s summit. Five days of steady marching behind us. Almost home, but struggling.

Team chatter is eerily silent. Heads hung low and lamps dim, distraught climbers from other groups turn around short. Fear and doubt slither through our minds. Can I make it to the top? Will I be the one who fails?

“Angels We Have Heard on High” pierces the silence. Sensing our internal turmoil, the guides sing a familiar melody that shatters our foreboding. The crescendo of “Gloria” generates a second wind. Spirits lifted, we proceed with renewed vigor towards the prize.

Panting with joy, we crest Stella Point at sunrise. We pause on the volcanic rim, a mere 750 feet from the peak. We will make it. All of us. After a brief round of hugs, we persevere towards the summit.

Without a word, the four founders quickly move out and up the line of march. We conquer the final stretch together. Kilimanjaro was our collective idea, our blood bond, thus important and symbolic to finish together. After more hugs, high fives, and requisite pictures at the peak, I cry, hard.

Thirty-six hours later, we shower and settle in at the Arusha Hotel bar to celebrate. Debriefing over beers, we relive the climb, tell stories, and share leadership lessons learned. I gladly share them with you:

Fortitude. Mental toughness is only honed via trial and refined by fire. No amount of mental gymnastics can prepare you like reality can. Don’t throw in the towel in tough circumstances. Put one leg in front of the other and move forward.

Training. A person rises to his level of training, not to his expectation. No exceptions. If you don’t make the time to train, you don’t make the team – period. Over the year, most climbed smaller peaks in preparation.

Gear. Reaching the top requires the right gear. No amount of training or exhortation can close the distance between success and failure when you are ill equipped. Invest in yourself and the team. A lack of gear equals climbing failure.

Vulnerability. We threw out titles before taking the first step. Administrators, presidents, physicians, and teens were now peers. Spending 24×7 with strangers requires a rapid adoption of transparency. The first day, we peed from a distance and behind some trees. Come day two, we’d grown beyond these formalities.

Encouragement. Maximum performance is nearly impossible without a pat on the back from a friend. Kind words work like salve on a wound.

Nutrition. You can fake your way and run on adrenaline for a day or two. But without sustained energy, you will collapse. Leaders must replenish themselves routinely.

Attitude. Zig Ziglar’s adage proved true: “Attitude, not aptitude, determines altitude.” No one benefits from listening to naysayers. Good leaders present good attitudes, even when they feel like vomiting.

Teamwork. Individuals caring for individuals, together. Shared hardships hasten lasting bonds.

Planning. Although the journey took only seven days, we organized over seven months. Anything worthwhile requires diligent strategic and tactical planning.

Support Team. We had an incredible support team comprised of friends and family. On the mountain, we had guides and porters.

Two lessons I’m still trying to internalize:

Climb High, Sleep Low. Reaching new heights requires giving up some ground. We spent a couple days where we gave back more elevation than we conquered. Although ‘straight up’ seemed the shortest distance, a sheer, vertical route would lead to breakdown. Every mountain has its peaks and valleys. Embrace these.

PoléPolé. To reach the highest summits, take time to acclimate at various heights and simultaneously build endurance. If you rush, the odds of success diminish exponentially. Sometimes you must go slow to go fast. Be in the moment. A leader must shrink the gap between frontrunner and laggard without losing sight of the ultimate objective or compromising passion.

We unveiled our corporate flag in front of the summit sign. This band of ruffians brought together 11 individuals and over the course of planning and execution built a team. The Kilimanjaro success rate is 60-70%, but we achieved 100%. Success demanded leadership and followership.

That rock taught us a lot. Changed us. Did someone say Everest?

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.

SAIC To Acquire Vitalize Consulting Solutions

Vitalize Consulting Solutions has signed a definitive merger agreement that will make the company an independent, wholly owned business unit of Science Applications International Corporation (SAIC), the McLean, Virginia-based government contracting firm. Terms will not be disclosed in the announcement, to be issued later this week.

Vitalize CEO Bruce Cerullo told HIStalk that SAIC pursued the acquisition to support its strong position in government healthcare IT. The Department of Veterans Affairs is considering commercial healthcare IT products, while the Coast Guard has already contracted for software from Epic Systems. Vitalize, with 600 consultants and annual revenue of over $100 million, runs one of the country’s largest independent Epic practices, Cerullo said.

”Meaningful Use will normalize, but will follow with ICD-10, HIPAA 5010, and Accountable Care Organizations. We want to play hard in that arena,” Cerullo said. “SAIC has great tools and methodologies they want to bring into the commercial world and we want to move into government.”

Cerullo said Vitalize’s leadership team and organizational structure will not change. Its headquarters will stay in Reading, MA with offices in Kennett Square, PA and Santa Ana, CA.

“We’re committed to bringing together the best of Vitalize with the best of SAIC,” Cerullo said. “We’re going to go slow. SAIC is growing at 8-10%, while we’re growing 100% year over year. They know what we’re doing is working.”

He added, “Vitalize has been part organic growth, part acquisition, and I suspect we will do more of both. We’re swapping private equity owners for a strategic owner. Our organizational structure, benefits, compensation, sales, and practice-oriented structure will remain.”

Completion of the transaction is expected in August.

News 7/20/11

Top News

The FDA releases draft guidance on the oversight of mobile medical applications. The two categories of apps that would qualify for oversight include those that serve as an accessory to an FDA-regulated device (for example, one that connects with a PACS) and those that turn a mobile platform into a mobile device (the smart phone is used as an EKG device.) In some cases, software developers would have to demonstrate that their mobile apps work comparably to their non-mobile versions.

Reader Comments

From Vince Ciotti: “Re: Epic’s 75 wins in 200+ bed hospitals. All of Epic’s clients are multi-hospital IDNs since ‘normal’ community hospitals simply can’t afford their epic fees. Judy won’t even condescend to bid to single facilities under 200 beds. If the typical multi has 5-10 hospitals, that represents about 10 wins for Epic. Still, at their incredibly high prices, this was enough to drive Epic to over $800M in revenue last year. Add in the hundreds of millions in hardware fees even bigger implementation ‘consulting’ fees they generate and Epic alone may represent our long-lost economic recovery!”

HIStalk Announcements and Requests

Thanks to Inga for capably holding down the fort while I was away. It was good to be gone and almost as good to be back. I’m behind, but that’s not unusual – the only change is that I’m determined to stop feeling guilty about it since it’s too many jobs, not sloth or lack of time management skills, that’s responsible. I’d go part time at the hospital if that was feasible.

Listening: the first new Yes album in 10 years. I’ve been a fan for much of my life and I saw them live not long ago, so I like it even as I acknowledge that prog rock isn’t everyone’s cup of tea. Reading: Life by Rolling Stone Keith Richards (excellent, either he and/or his hired gun co-author is a genius), so I may need to crank some B-side Stones.

Acquisitions, Funding, Business, and Stock

Healthcare Growth Partners releases its quarterly HIT market report, with merger and acquisition activity recovering well from low activity a couple of years ago. Here’s a quote:

Generally, sub $100 million companies have three valuation inflection points: proof-of-concept, initial scalability, and expansion scalability.  Proof-of-concept is value created when a company shows that its product can be successfully sold and deployed in a commercial setting.  This inflection point is generally of more value to venture investors than it is to acquirors, as companies at this stage tend to be too early to realize significant value through a sale.  Initial scalability occurs when an earlier stage company begins to show strong profitability at high levels of growth,  although the organization is still small and lean. Expansion scalability takes place after a company has matured to a level where it takes on real infrastructure, and the company begins to show strong profitability after building out a mature corporate organization. 

Although the size of a company at each inflection point can vary significantly based on a company’s product or services and sector, the general rule of thumb in HIT is that proof of concept occurs at revenue of less than $1 million, expansion scalability in the $5 to $10 million revenue range, and mature scalability in the $20 million revenue range.

Philips reports Q2 numbers: revenue down 2.6% and a loss of $1.9 billion, with the CEO announcing cost reductions and share buybacks. Its healthcare business fared better than the company overall, with an 8% sales increase.

Apple announces Q3 numbers: revenue up 82%, EPS $7.79 vs. $3.51, wildly beating analyst expectations of $5.82. The company sold more than 20 million iPhones and 9.25 million iPads in the quarter.

Shares in WebMD Health recovered a bit on Tuesday following Monday’s drop of more than 30%, which was triggered by the company’s announcement of lowered revenue expectations. The one-year share price graph looks merely unimpressive until you notice that the straight vertical line to the right is not the margin of the graph.

Lawson Software, whose $2 billion acquisition by Golden Gate Capital and Infor was completed last week, has begun restructuring and employee layoffs.

Australia’s federal court approves CSC’s acquisition of iSoft for $202 million after 97% of shareholder votes were cast in favor of the proposal.

A major player in HIT consulting will announce its acquisition later this week. I’m holding back specifics until the announcement comes out. It’s going to be a pretty big deal (no pun intended).

Sales

ADVANTAGE Health Solutions signs an agreement with IGIHealth for its ORBIT Clinical Exchange and portal to support ADVANTAGE’s ACO infrastructure.

Children’s Medical Center Dallas selects the Enterprise Data Warehouse business intelligence tool from Health Care DataWorks .

Final Support chooses EMR-Link from Ignis Systems to provide lab-EMR integration for its GE Centricity customers.

People

The board of Franciscan Hospital for Children (MA) fires CEO Paul J. DellaRocco, citing financial irregularities that include the inappropriate submission of expenses.

Former Allscripts COO Eileen Martinson is named CEO of Sparta Systems, a provider of quality and compliance management software.

RTLS vendor Versus promotes Susan Pouzar to VP of sales.

Practice Fusion hires Zachariah Gursky as its first VP of ad sales. He was previously with Coupons Inc.

Todd Cozzens is promoted to CEO of Accountable Care Solutions, a new business unit of Optum. He was previously with the company’s OptumInsight business, the former Ingenix that bought Picis, of which Cozzens was CEO. He mentions his new job and some thoughts on “virtual Kaisers” and their data needs in his latest blog posting.

Announcements and Implementations

The Georgia Health Information Technology REC selects Halfpenny Technologies to develop a lab hub demonstration project for the exchange of clinical data.

Banner Health (AZ) completes its pilot of MyHealthDirect and will be implementing the service across all its facilities. This news clip explains how Banner is using MyHealthDirect to book appointments at low-cost clinics and thus reduce unnecessary ER visits and wait times.

Middle Park Medical Center in Kremmling (CO) begins implementation of Healthland’s EHR and anticipates a go-live by the end of the year. The 19-bed hospital expects to qualify for up to $250,000 in EHR incentives.

Johns Hopkins Medicine begins recruiting for over 60 people to implement Epic. Positions for the initial ambulatory rollout will focus on clinical documentation, analytics and research, and scheduling and registration.

LodgeNet Interactive restructures LodgeNetHealthcare into an independent but wholly-owned subsidiary. Gary Kolbeck, who was previously GM of LodgeNet Healthcare, will serve as president.

Microsoft establishes a Web page for Google Health users interested in transferring their data to Microsoft’s HealthVault record. The site includes step-by-step instructions on how to move the data.

Government and Politics

HHS’s Office of Inspector General finds that 12 of 13 states do not plan to verify all the eligibility requirements for paying Medicaid EHR incentives to doctors and hospitals . The reason: most states lack the data necessary for complete verification because data collection requires too much effort and too many resources.

The federal government files a complaint against a Kentucky nursing home for fraud, but also alleges that five residents died from “worthless care.” Nurses were accused of failing to administer diabetes meds, diapering patients who had normal bladder function, ignoring physician orders, and not showing up at all for one 2.5 day period in which the nursing home had no RN coverage at all.

Innovation and Research

The Industrial Designers Society of America awards Silver recognition to Seattle-based Artefact for its design work on the prototype of the Seattle Children’s Patient Information System.

Use of a real-time alerting system for patient deterioration reduced LOS 9.7 to 6.9 days and increased clinician response from 29% to 78% in a UK study. The $1.5 million Patientrack system was developed by an intensivist in Tasmania, but no Australian hospitals were interested in trying it. The weak link seems to be that it requires the nurse to manually enter the vital sign values.

The VA offers a $50,000 prize to a developer who implements Internet-based technology similar to the government’s Blue Button program, which allows patients to download a summary of their health records. The competition started Monday and ends when a winner is chosen or on October 18, whichever comes first.

Other

According to the local paper, independent physicians wanting to tie into Lee Memorial Health System’s Epic EHR would have to pay $15,000-$16,000 for the software license plus $25,000 to $80,000 per practice to cover implementation fees. Annual maintenance is an additional $4,500 per provider. Depending on the size of the practice, that could be a hard sale. Independent physicians in the area control about 84% of outpatient care.

UPMC removes 29 of its 51 directors following a consultant’s recommendation for improving the board’s effectiveness. Its membership had swelled over the years as representatives were added from acquired hospitals.

Memorial Health System (CO), the hospital whose electronic patient records were breached by a city-employed nurse and part-time psychic, says it has fired 22 employees in the past three years for privacy issues. One of them was caught looking up the records of friends so she could create a birthday database.

Odd: a woman sues a Pennsylvania hospital and the county child protection agency when her newborn baby is turned over to foster care after testing positive for opium, which the mother blames on her own ingestion of poppy seed-containing salad dressing. Both organizations had been sued by another mother a few months ago for exactly the same thing, except that particular mom blamed a poppy seed bagel.

Sponsor Updates

• MEDSEEK announces its fifth consecutive year on the HCI 100 list, based on its 2010 revenue performance.
• Sentry Data Systems CMO William Kirsh DO, MPH participated as a writer and editor for a HIMSS Revenue Cycle Task Force white paper.
• Surescripts recognizes  Allscripts as one of seven vendors to achieve Gold Solution Provider Status for e-Prescribing. Surescripts also awards e-MDs its White Coat of Quality.
• AdvancedMD announces the release of its ONC ATCB-certified EHR 2011 solution that includes an enhanced patient portal, new Meaningful Use reporting tools, and utilities for submitting immunization and health surveillance data.
• API Healthcare is offering a variety of sessions on creating more effective workforce management at its annual user group meeting this week in Milwaukee.
• Orion Health’s Rhapsody Integration Engine and Rhapsody Connect earn ONC-ATCB EHR module certification .
• Providence Health & Services selects Elsevier / CPM Resource Center as its vendor of choice for evidence-based clinical content.
• Concerro releases a series of white papers collectively called the Workforce Management Wellness Series.
• Kony hires Peter Buscemi to lead the company’s global marketing efforts.

Contacts

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

HITlaw 7/18/11

Who’s On First?

Recent O’Toole Law Group engagements have raised a critical issue that’s worth passing on to HIStalk readership.

When providers contract with vendors, they expect certain products and services. This much is obvious. The issue presented here arises as a result of all the distributing, bundling, packaging and rebadging of products.

Vendor A may offer Vendor B’s product alongside its own products. In this case, Vendor A is a distributor (and usually a reseller) of Vendor B’s product. Typically this type of collaboration exists when the two products perform related tasks for the provider. Like ice and your favorite drink, each is good, but together they are great!

Vendor X may offer a product called “TurboEMR” that also has some type of label like, “powered by HISware” or something to that effect. This probably means Vendor X has HISware’s software embedded in its product, and the “powered by” refers to this fact. In this case, Vendor X is sublicensing technology developed by HISware.

In each situation, the provider gets the package deal and the functionality it is seeking, which would not be possible with only Vendor A or Vendor B in the first instance or with only Vendor X in the second.

So everyone wins, right? Hopefully, but maybe not.

When things go well and you have a great prime vendor that really steps up and fills that role, life is good. The provider gets precisely what they signed up for. They have a single point of contact for resolution of problems with any of the products involved.

But what happens when things go wrong? Are the responsibilities and procedures clearly set out? Key contract components that must be addressed fully by all vendors involved include support obligations, copyright / patent protection, indemnification, and liability provisions, to name a few.

How does the provider determine exactly what they are getting and precisely whom they are dealing with?

One simple way to determine the “who” part is to look for the warranty of ownership. Something like, “Vendor warrants that it owns the software.” Once you find that section, really analyze it. It is probably not more than a sentence or two, three tops.

If the vendor warrants that it is the developer and sole owner of the technology being licensed, then you are dealing with a single vendor and its products. This is the cleanest, most simple scenario.

(Quick sidebar here: it must be a warranty, not a representation. Warranties have certain protections and remedies that representations do not.)

If the vendor warrants that it is the owner of the technology OR that it has the right to license it, that is your red flag duct taped to a flashing light. This is not bad, but it means the product contains or is packaged with third-party software. You need to be aware of this and you must obtain certain crucial contract terms for your protection.

The best-case scenario (keeping in mind that there is another vendor involved that is not a party to your agreement, which is the reason behind this article) is a warranty from the vendor that you are contracting with that it has warranties of ownership, operation, and error correction (for example) from the other vendor. This is critical because it can then be used to back up the same warranties from your selected vendor to you.

The biggest warning flag you could ever encounter is where there is a disconnect in the protection(s) offered. If the vendor warrants that “all software is great and works fine and they will fix everything, but this warranty does not apply to a certain line item or product,” then you have a problem. What happens if there is a failure with the excluded software?

If you have no answer while reviewing contract language, just imagine the discomfort you will feel if your system is down and all indications point to the excluded product.

OK, stay with me here. All the legal stuff aside, what those in IT really want to know is what happens if there is a problem with the products.

As stated before, with a solid prime vendor you are in good shape. But what about those unfortunate situations where fingers get worn out from all the pointing?

To try and avoid heartburn later, fix the contract up front. Try this simple exercise. Remember connect the dots, those partially finished pictures in coloring books with numbered dots? Connect them in numerical order and complete the picture! Give it a try with your software agreement.

If you have more than one vendor involved, just imagine a system crash, and then try to connect the dots to all the vendors, especially the vendor behind the scenes. Do you have adequate warranty protection? Do procedures exist for escalating a software problem to the correct level at the vendor? Can you get to the vendor at all??

Make clear for each product included, or component thereof, which vendor is responsible for support, updates, fixes, etc.

Make certain that you have contract pathways to obtain that service. Assume vendor A is first point of contact. When the problem ultimately is identified as residing in Vendor B’s product, then what? It may be that the responsibility remains with Vendor A, but it also may be that Vendor A is only responsible for “Level 1 Support” and then you go to Vendor B for the difficult stuff. Ideally Vendor A stays involved and shepherds the issue through to resolution, sort of like a new car warranty. Inga’s Cadillac dealership did not build the car, but when the car breaks down, you take it back to Inga’s to get it fixed. Inga’s then takes care of the work required and is backed up by the manufacturer.

Taking the car analogy a little further, in terms of your contracted vendors, while you may know who is in the driver’s seat, you may not know who else is along for the ride. It could be an awesome two-seat Tesla roadster with two great vendors, or it could be the mud-covered SUV with a bunch of buddies all saying they work together just fine (and the driver is wearing really dark shades.) Due diligence in contracting pays off, and lack of diligence can really sting you later.

Vendors, please make it clear. You know best what is going on. Put it right out there.

After 20+ years doing this, I still remember a situation where an executive at a monster hospital chain felt something had been “snuck in.” In reality it was not, but the impression stuck hard and fast in this executive’s mind and we had to face extra scrutiny for several years to follow. Kind of like a dog that gets whacked by something at one of those birthday parties where twenty kids are running around screaming and things get zany and someone hands a whiffleball bat to the kids for the piñata. Anyway, the dog gets whacked (accidentally, of course) and never forgets the kid that did it. Don’t be the kid with the bat!

Tangential issue: get a warranty that states no other software is required, from your prime vendor or any other vendor, for operation of the software products being licensed. If other software is required but not included, require a listing in the agreement of all such products. Failure of your prime vendor to include something on this list should mean the vendor has to pony up and pay for it. That will bring all the fine details right to the top.

Finally, once you get everything above all set, make sure that all your hard work does not blow away in the wind because a vendor subcontracts work or assigns the agreement to another vendor. Include provisions prohibiting assignment or subcontracting without the customer’s agreement. That way you know what you are getting, from whom you are getting it, and that things will stay that way unless you agree otherwise.

Please take care in your interpretation of this article. I have been involved in countless good situations involving multiple vendors and very happy customers. When the provider does get a good prime vendor that truly takes on its role, you win. No question it works well in the right situations. My point is to be diligent and try to avoid bad situations by at least having good contract language on your side. The combination of a poorly performing vendor and weak or lousy contractual support will really ruin your day.

Big takeaways:

• Contract language, warranties, and obligations should be consistent as applied to all products and vendors involved, even if designated to a prime vendor. Watch for disconnects in supporting language.
• The contract should map out clearly the support chain and obligations of the vendors involved, again, even if designated to a prime vendor.
• Require listing all software required for operation of the products being licensed and obligation for the vendor to provide whatever they failed to list.
• Prohibit assignment and subcontracting by the vendors without your consent.

This article is intended to provide general advice and is not by any means exhaustive on the issues or language required and must not be taken as specific legal advice. Hopefully HIStalk readers enjoy the presentation and take away a valuable lesson or two.

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

Curbside Consult with Dr. Jayne 7/18/11

I’m finally back in my normal routine with the usual rounds of meetings, committees, working groups, conference calls, and Meaningful Use activities that make up the fun-filled CMIO lifestyle. Lots of reader response this week, and that has kept me going through it all. Every time I take vacation, I forget how much one gets punished the week after, so thanks to all of you for keeping me going. Your e-mails have been a true bright spot in an otherwise harried week.

Last week’s piece on physician rating web sites generated several comments. Most of them agreed that the sites don’t have a tremendous amount of worth compared to word of mouth or physician recommendations. Tammi sent her thoughts:

Too bad there isn’t a truly reliable source I would trust. Having been down the roads I have been down, my choice would still be to do my homework and ask around and ask the right folks. And then ask again. It is about more than the physician, too. Who supports them and what is their experience?

Entirely true. There may be a lead physician performing a procedure, or a primary care physician quarterbacking the care, but there’s a whole world of nurses, consulting providers, patient care technicians, case coordinators, therapists, and a host of others involved. Having seen it from both the physician and patient sides, it pays to do your homework.

In response to my comments on physicians and social media, Chris reminds us that it goes both ways:

A lawyer friend of mine passed this along the other day about a judge allowing Facebook posts as evidence in a personal injury case. I wonder how long until we see this same thing in a medically related case?

Based on some of the antics of my employees on Facebook, it’s apparent that people don’t care who is reading or what they are writing. And no, I’m not stalking them. Most of them actually friended me, so it’s not as if they don’t know that I might be reading. I worry for their livers and their brain cells, that’s all I’m saying.

Tremendous feedback on my quest for appropriate cocktail pairings to go with mandatory online training. I can officially confirm that Personal Protective Equipment is much more enjoyable with a drink and some nibbles. Judy encouraged me to not forget Compliance as a potential topic. My recommended pairing for either Compliance or Risk Management training:

Over the next few weeks, I’ll be working on some online modules that are required for specialty board recertification. For those, I have chosen some picks from Caduceus Cellars.  (For those music lovers who like Mr. H’s notes on what he’s listening to, you may be interested to know that Caduceus is project involving Maynard James Keenan, legendary front man for Tool and A Perfect Circle.)

Rock star HIStalkapalooza correspondent Evan Frankel mentions:

I have fallen back in favor of Portugal’s very unique and refreshing green wine ‘vinho verde’ with scholarly research. With an iced glass as its chalice, [it] really does induce people to sit outside, enjoy a sunset and get into really meaningful and enjoyable conversation about the future of healthcare in America.

Evan, do you wear your fabulous jacket when you drink it?

Matthew noted:

One cannot go wrong with Orin Swift’s excellent The Prisoner. Not only is this blend of mostly Zinfandel, Cabernet Sauvignon, and Syrah pleasing to the palate, the label itself perfectly sums up how one feels while attending mandatory training offerings.

Oh yes, I will be using this one. Perhaps some bottles as attendance prizes for Meaningful Use upgrade training? Or for myself, when I’m forced to attend said upgrade training, which although I wrote and approved, I have to attend to verify credit in the online system?

Speaking of verification of attendance, a letter to the editor in American Medical News caught my eye this week. Massachusetts surgeon Jeffrey Kaufman writes about his experience of being required to punch a time clock. Although I’ve not had to actually clock in and out, my employment agreement and pay stubs reflect an “hourly wage” for being a physician. I don’t remember the last time I worked a straight 40-hour week. When I asked about it, I was told that the personnel resource management system (aka software) can’t handle a salaried employee. I’ve been known to mentally divide my salary by actual hours worked. As a Chief Resident, I could have done better on the night shift at Taco Bell.

Last but not least, the perfect wine pairing for a discussion of Meaningful Use. I will definitely be looking for this one the next time I shop for the fruit of the vine. I’ll have to make a point to have some in house prior to the final decisions on Stage 2. Have any other cocktail suggestions? E-mail me.

E-mail Dr. Jayne.