Morning Headlines 1/2/13

2012 in Review

John Halamka, MD discusses the major healthcare IT-related events of 2012.

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

CMS wants to hear from hospitals and health IT vendors about streamlining the reporting process for the Hospital Inpatient Quality Reporting Program.

Pain Clinic of Northwest Florida, Inc. files a lawsuit against Allscripts

After pulling the plug on MyWay, Allscripts is sued by Pain Clinic of Northwest Florida, which claims that Allscipts misled the clinic about the quality and functionality of MyWay.

News 1/2/13

From Sal the Stockbroker: “Re: HIStalk. For seven of your 10 years I worked for a healthcare IT company and followed you religiously, even though you trashed our marketing a few times (we deserved it!) I still follow three years after I left IT. While dispensing news, opinion, rumors, and research, you all seemed almost like family. I will still follow, if nothing else but to see the latest Spotify playlist or WNA’s weekly clincher. Thanks to all of you, including Mrs. HIStalk for putting up with your insane work hours, loud music, and blogging obsession.” Thanks for the encouragement – it helps during those long, lonely evenings. Mrs. H probably knows my music only from the bass and drum beats since my room (office? study? den? All sound pretentious) is above the kitchen, although she works in that room only a fraction of the time I’m in mine — she’s often asleep in bed by the time I’m finished. I’ve started using headphones, though, since the sound is cleaner.

Happy 2013. It’s not even 9:00 a.m. Eastern time on New Year’s Day as I’m writing this and the web stats show that 30 people are reading HIStalk online right now. I figured everybody would be sleeping in, so it’s either early-rising go-getters or hard-partying folks who haven’t yet called it a night who are reading Ed Marx’s piece on creating a family plan.

My New Year’s Day plans including watching the Rose Parade with Mrs. HIStalk, the only televised parade I’m willing to watch with her since I have zero tolerance for dull scripted banter, endless product placements, anything related to Disney, and lip-synching, bottom-feeding pseudo-celebrities pitching lame TV shows that are, not coincidentally, airing on the same TV network that’s running the parade. (I repeatedly recite those observations while we’re watching the Thanksgiving and Christmas parades until we’re mutually relieved that I wander off to Netflix or the iPad.) The comes bowl games, which interest me for around 30 minutes until I go do something else, and then we always eat hot dogs as a New Year’s tradition since we were so poor when we were first married that we couldn’t afford anything else to eat on the folding card table and chairs that served as dining room furniture, which was fine because we didn’t have a dining room either. Then it’s back to work tomorrow and the inevitable HIMSS conference ramp-up that awaits through March once I get home each day.

Final December stats for the one reader who asks: 116,659 visits and 224,820 page views, up considerably from December 2011’s numbers.

HIStalkapalooza details and sign-ups will be up on January 19 or thereabouts.

Pain Clinic of Northwest Florida, Inc. files a lawsuit against Allscripts for pulling the MyWay rug out from under the practice, also seeking to have their complaint certified as a class action lawsuit. The wording of the complaint reads like someone dashed off an angry e-mail and their attorney just pasted it into a Word lawsuit template. It says MyWay was “buggy,” that Allscripts had little ability to bring it up to HITECH standards since they acquired rather than developed the source code, and the company made “fraudulent” statements insisting that the integration of MyWay was going great until the company “admitted defeat” in October 2012. It also claims that Allscripts told MyWay users they would be charged “thousands of dollars in fees” to get access to their own databases if they chose to walk away and that in some cases users were upgraded “without that user’s consent or knowledge” (how is that possible?)  It’s easy to understand why the practice is upset – they bought MyWay four months before it was put on life support.

Welcome to new HIStalk Platinum Sponsor EDCO Health Information Solutions of Frontenac, MO. The company has been helping healthcare organizations and HIM departments manage their patient information for over 50 years. Its Solarity software creates a complete electronic patient record, indexing and reviewing documents in a single step using proprietary document recognition algorithms instead of bar codes to index documents faster and more accurately. The result is a streamlined HIM process, improved return on investment on EHR systems via increased efficiency and physician adoption, and reduced A/R days due to faster chart turnaround time. The IT people like the integration, while the finance department likes paying as an operating rather than a capital expense. The company also offers the SaaS-based Solcom electronic document management system that allows hospitals to eliminate paper, enjoy seamless viewing of scanned records, and build custom workflows to maximize efficiency, all of which contribute to proactive revenue cycle management, point-of-service information capture, use of remote coders, and a fully electronic chart. Check out the case studies from Allegiance Health, Health First, Ottawa Hospital, and others. Thanks to EDCO Health Information Solutions for supporting my work.

I found this video on EDCO Solarity. It’s a nice 70-second overview.

It’s a new year, so it’s time for the HISsies Awards to start up. What were the smartest and stupidest vendor actions of 2012? Which companies are the best and worst? What buzzwords are you sick of? If you had a pie, in which industry figure’s face would you like to throw it? And in the more serious categories, who’s your choice for Industry Figure of the Year and the Lifetime Achievement Award? It all starts with the nominations, from which the final ballot will be created. The nominations form is open and your civic duty calls.

This is a chance for you to spare me the frequent and frustrating after-the-fact dialog in which someone claims that I’m clueless or biased because their pet choice wasn’t included on the HISsies ballot. I patiently explain that had they and their like-minded peers spent 30 seconds filling out the nomination form instead of complaining, their preference might well have been on the ballot. It’s simple Civics 101 – the most-nominated choices go on the ballot. Don’t assume someone else will do your work for you in nominating your preference. Nominate now or forever hold your peace. 

I’ll create the final ballot in a week or so. It goes only to readers who have subscribed to the e-mail updates, which prevents the admittedly fun ballot box-stuffing that happened during the first few years of the HISsies. Back then I was just happy that companies wanted a good-category win (“best vendor” or “best CEO”) enough to strong-arm their employees to vote for them.

Last year’s HISsies results are here if you need a refresher. I’ve done the Lifetime Achievement Award for two years and no repeat winners are allowed, so nominate someone other than John Glaser and Judy Faulkner.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

CIO Unplugged 1/1/13

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

What Do I Stand For?

But I still wake up . . .
Oh Lord, I’m still not sure, what I stand for
What do I stand for? Oh what do I stand for?
Most nights, I don’t know any more.

I like the tune Some Nights by the indie alternative group fun. You can argue the meaning of the song, but the hook, “What do I stand for?” resonates with millions, including me.

The issue people struggle with most is discovering purpose in life. This is one topic I’m frequently invited to speak on and the one concern for which people often ask my help. In light of this, I’m revisiting a blog from a few years ago that I hope you’ll find practical.

I have no secret formula nor warrant that what worked for me and my family will work for you. Making life easy and eliminating challenge is not my goal. Living out purpose involves inherent trials. What I offer are principles and a process that will facilitate your journey into discovery and could possibly transform your life on different levels. I’ve shared these ideas for many years in different cultures and have witnessed dramatic change.

Let’s set the record straight: resolutions don’t work.

The first thing I ask those who ask for help is, “What’s your plan?” Such as, what is your mission, vision, values, objectives, etc. I’ve never received an articulate first-time response. But when I ask people about their organization’s plan, they’re quick to answer.

The dichotomy is evident. Why would you take the time to memorize and labor to achieve the plans of your organization but not do the same for yourself or your family? The good news: you already possess the tools and experience to close this gap. But it takes time, energy, and determination.

I finished grad school in 1989 with business planning concepts drilled in my brain. My company embraced these concepts, and I knew our execs jetted off to resorts to spend considerable time planning. Market performance confirmed a strong correlation.

For me, the disconnect came in hearing of their struggles on the personal side of the ledger. One particular Fortune article reinforced my thought process: “Why Grade ‘A’ Execs get an ‘F’ as Parents.” Having just started a family and career, I was searching for ways to have success in both.

Could I increase the odds of personal success by adopting business theory?

Our First Family Retreat

The Marx family’s strategic planning adventure began modestly. Short, inexpensive trips away from home reduced distraction and stimulated creativity. These trips morphed into more elaborate excursions, but the focus always remained on strategic planning.

Our first retreat in nearby Estes Park cost us about $100. We worked on a one-page plan that became known as the “Marx Family Constitution.” Originally written in 1990, it has withstood the test of time.

Since incorporating this process, we’ve all experienced dramatic increases in the quality of our careers and relationships. Our oldest, now age 25, had coached his college peers in these concepts. Not long ago, my wife heard our youngest, age 19, encourage her boyfriend to discover his life purpose and come up with a plan to live it out. Julie and I recently celebrated our 27th wedding anniversary and are still twitterpated.

I don’t have the space to share the numerous examples, but I can share the one that had the most impact. My son, age eight at the time, took a ruler and pointed to the values section of our Marx Family Constitution that hung prominently in our family room. “Dad,” he said, “was that honoring mom when you yelled?” Seven months prior, when deciding which six values needed improvement, he had contributed the word “honor.” He called me on it. Accountability!

We aim to live out what Rick Warren calls The Purpose Driven Life. Decisions on how to spend our time, energy, and resources are guided by past retreats. I could go back through 20 years of documentation and show you at least one significant event that happened each year in my career, marriage, and family. Could you?

Keeping it Fresh

Take annual retreats to focus on your plan. Get out of Dodge and spend time in a setting where beauty can inspire. A place free of distraction. As leader, your job is to facilitate.

WARNING: never force your ideas down the family’s throat. Instead, invite them to dream and evaluate. Kids especially need to think for themselves. Review your plan and encourage transparent dialogue about performance. Record the highlights of the previous year. What are the gaps and how do you close them? Include significant others and engage your kids. Teach them. Envision them — but NEVER do it FOR them. Commission them. Then watch them rock not only your world, but also the world around them.

Disney makes for great vacations. Planning retreats make for enabling identity and significance.

Take Action

Forget resolutions. They don’t work. No organization runs with resolutions. Market share would drop, and eventually you’d go bankrupt.

Schedule your first retreat and prepare to write, because earth-moving ideas existing ONLY in your head haven’t the magic to propel you forward. Write them out. Teach them. Actualize them. You only live once.

There’s nothing worse than going through planning exercises merely to have the plan collect dust. Create a living vision. When someone asks you a career or life question or you face a major decision, your purpose will keep you standing.

What do you stand for?

***If interested in creating a plan for your career, life, etc., leave a comment. I will send you a copy of my one-page strategic plans (personal, career, family). I will include a retreat guide designed to stimulate thoughts and ideas around your mission, vision, values and objectives as you put your plan together.

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

Morning Headlines 12/30/12

Higgins Calls for Expanded Use of Electronic Medical Record

Congressman Brian Higgins (D), of New York’s 27th congressional district, speaks on the floor of the House of Representatives highlighting the need for increased adoption of EHRs and HIEs and the benefit they each played in the wake of Hurricane Sandy.

Higher-Complexity ED Billing Codes — Sicker Patients, More Intensive Practice, or Improper Payments?

The New England Journal of Medicine publishes an article in response to the OIG and HHS investigation of EHR-induced fraud, suggesting that a change in the role EDs play in medical care, as well as a change in average ED patient demographics could just as easily account for the increase in higher reimbursement claims.

Greenway Medical CEO: ‘You have to practice going public before you go public’

Tee Green, CEO of Greenway, gives advice to business leaders considering an IPO.

Form 8-K for ALLSCRIPTS HEALTHCARE SOLUTIONS, INC.

Diane Adams, EVP of culture and talent at Allscripts, departs taking 12 months’ severance, her target bonus, a year of health benefits, accelerated vesting, and a retention bonus.

Monday Morning Update 12/31/12

From Thankful: “Re: 10 years of HIStalk. I’m not sure I’d be as competent as I am now, as an HIT professional, without the 10 years of contributions from you and your team. I’m not one for trying to make people remember me; I’d rather do what makes sense at the moment. But in all honesty the HIStalk contributors are all getting nice words for your tombstones!” Thanks. It’s hard to believe I wrote the first HIStalk in 2003 and haven’t stopped. I doubt my tombstone gazers and obituary readers will care about HIStalk, so its eventual absence there probably means I need to find a more lasting and non-anonymous legacy.

From The PACS Designer: “Re: TPD’s List of iPhone Apps. Working on an update, so let me know of apps that readers might like.” The fitness apps I’m using at the moment are Half Marathon with Jeff Galloway (I’m training for spring 13.1, with my longest single run being this past weekend’s rather chilly 11 miles), and from the same developer, XFit Push Ups.

Two-thirds of poll respondents say Allscripts can’t successfully compete with Epic and Cerner. New poll to your right: are you confident that your doctors and hospitals can keep your medical information secure and private?

I’ve created a new Spotify playlist with what I’m listening to at the moment: The Shins, Sam Phillips, Everything But The Girl, Bob Mould, The Jayhawks, and quite a few more artists old and new. I firmly believe that you’re headed down the slippery slope to codgerly irrelevance if you just keep mindlessly listening to the same old songs or the musical equivalent of a minivan (unchallenging jazz, computer-assisted dance music, or soundtracks), so I’m always trying new stuff.

Greenway CEO Tee Green gives advice to entrepreneurs contemplating eventually taking their company public:

• Think long term.
• Structure your board and run its meetings like a public company would.
• Bring in a CFO and general counsel with IPO experience and start quarterly reporting as practice.
• Build relations with investment bankers and choose outside counsel they have worked with previously.
• Choose reliable auditing and accounting partners.

Petroleum industry BI vendor Drilling Info Inc. names former QuadraMed CFO Dave Piazza as its CFO.

Allscripts files its SEC 8-K form for the departure of Diane Adams, EVP of culture and talent. She gets 12 months’ severance, her target bonus, a year of health benefits, accelerated vesting, and a retention bonus. She does even better if the company changes hands in 2013 – she’ll get two years’ salary and bonus.

Gibson General Hospital (IN) notifies 29,000 patients of the theft of an employee’s unencrypted laptop from their home, presumably an IT support person since the hospital stated that the employee’s job “requires around-the-clock access to the hospital’s electronic medical records system.”

Kentucky’s Cabinet for Health and Family Services is notifying over 1,000 Medicaid recipients that their information was exposed when an employee of Carewise Health, a subcontractor for the state’s Medicaid computer system HP Enterprise Services, fell for a telephone scam and gave an unknown hacker access to the employee’s laptop.

Congressman Brian Higgins (D-NY) uses the House floor to urge increased adoption of electronic medical records. Translation: keep the EMR-related dollars flowing to his district, with the specific bacon he brought home helpfully listed in the press release to impress the folks back home.

Brian Ahier posted this presentation from HHS CIO Frank Baitman that lists the department’s challenges for 2013.

Vince sends this HIS-tory of Quality Systems / NextGen, getting into the spirit of the company’s dental origins by throwing down a challenge to find all the tooth-related references he included (I counted five).

Happy New Year to everyone. History suggests that I’m going to be super busy from now until after the HIMSS conference, so if you need anything from me, now’s the time.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Time Capsule: In a Capitalist Society, Somebody Will Always Sell a Fat Man a Speedo or an Unprepared Hospital a Clinical System

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

I wrote this piece in March 2008.

In a Capitalist Society, Somebody Will Always Sell a Fat Man a Speedo or an Unprepared Hospital a Clinical System
By Mr. HIStalk

One great thing about capitalist America is that people will sell you anything you can afford, even if you’re likely to do something stupid with it. Klutzes can get chainsaws. Fat guys can buy Speedos. Elected officials can hire prostitutes.

And hospitals with minimal chance of success can buy clinical information systems.

Any IT system can be misused. It’s the clinical ones that usually create the most awe-inspiring mushroom clouds, however. They come with irrationally high hopes, require the unwavering participation of stressed clinical users, and push the competency limits of both vendors and hospital IT shops.

The hospital loses millions. The vendor loses reputation points. Patients lose the chance for better or less-expensive outcomes. Money talks, however, so the customer signs on the line which is dotted, gets one last handshake from the salespeople they’ll never see again, and eventually realizes the magnitude of what’s required to get value from their big-ticket purchase. Gulp.

Would-be clinical systems customers are like that crazy 16-year-old driver down the street, except no learner’s permit or exam is required, just cash. Hospitals perform endless vendor due diligence, but those vendors don’t return the favor by saying, "Our analysis tells us that you’re going to be an unsuccessful customer who will bad-mouth us for your own shortcomings, so we’ll pass."

Let’s stretch reality by pretending that vendors might actually turn down prospects that are sure to fail. What kind of questions should they ask?

• Can you provide a list of at least three big, successful change management projects you’ve done in the last five years?
• Do you monitor and publish IT metrics, including those that measure user satisfaction?
• Are your physicians compliant with rules involving the drug formulary and chart completion?
• How standardized are your order sets?
• How standardized are your forms and how do you manage them?
• Can you document participation and results of your clinical committees?
• When was the last time your executives communicated a big vision that inspired cultural change?
• How dissatisfied are your users with current manual and paper processes?
• Are you so desperate to keep nurses and other short-supply employees that you let them break all but the most serious rules?
• Are you willing to take a productivity hit while users are being trained?
• Where will this project fall on the "most important organizational project" pecking order?
• How often are operational VPs involved in big change projects?
• Who does or doesn’t agree that this solution is the best answer to the problem we’ve identified?
• Have you set aside money for ongoing support?
• How mature is your project management function?
• Do you maintain an IT strategic plan that aligns with the organization’s overall strategic plan?
• Have you identified who gains and who loses power and prestige with this change?

Smart consultants could develop an easy hospital self-assessment tool that would predict with 90 percent accuracy whether a hospital’s implementation of a given system is likely to be successful. Vendors won’t develop it, though, because it would discourage prospects. Hospitals won’t either, because if they were smart enough to ask that question, they would be smart enough to already know the answer.

The current environment is simple to comprehend. Vendors sell products, customers use them to deliver results. Unfortunately, we’re seeing lots of the former, but far less of the latter. Everybody blames vendors, but let’s be honest – a guy who buys an extra-large Speedo should know better.

Morning Headlines 12/28/12

New system for patient records in place at Carthage hospital

Mercy McCune-Brooks hospital, a 52-bed critical access hospital in Missouri, goes live on Epic.

$1 million grant to health group aimed at improving continuity of care throughout South Jersey

NJSHINE receives a $1 million grant to connect seven southern New Jersey hospitals in a health information exchange network.

CFO Outlook for 2013 Grim

Hospital CFOs report financially uncertain times as they look toward 2013. With pressure coming from government mandates and insurance denial management systems, CFOs express concern over the year to come.

AwarePoint Lands $4,000,000 New Financing Round

RTLS technology vendor AwarePoint nets $4 million in a new financing round from an undisclosed investor.

News 12/28/12

Top News

A year-long investigation by The Washington Post finds that healthcare is among the sectors most vulnerable to hackers because it lags other industries in fixing known security holes, quoting one expert who said, “If our financial industry regarded security the way the healthcare sector does, I would stuff my cash in a mattress under my bed.” A physician user of OpenEMR, which was called out in the article for its security vulnerabilities, left this comment:

I maintain OpenEMR under Linux at my wife’s medical clinic. Behind two firewalls, not accessible over the public internet. We considered WorldVista, but that is written in MUMPS, and requires Windows clients (not on our network). WorldVista is more suited to megapractices like the VA system it was written for. OpenEMR has many problems, but being open source, the problems are being found and fixed rapidly. Software developers are encouraged to join the effort to improve it. Other alternatives include hugely expensive systems like Epic (which infests most local hospitals) and various Web-based services moving information over the public Internet (dangerous!) That is how Epic works – and anyone with two login/passwords to a megahospital system can get access to hundreds of thousands of patient records. Scary, yes – but if more barriers are added, time is lost and PATIENTS WILL DIE.

HIStalk Announcements and Requests

I don’t need an Official Red Ryder Carbine-Action, 200-Shot Range Model Air Rifle, but I could use some gifts that carry no danger of shooting my eye out: (a) sign up for spam-free e-mail updates, basking in the knowledge that doing to will make you eligible to vote in the upcoming HISsies awards; (b) support HIStalk’s sponsors by reviewing and possibly clicking their ads (now on your right), checking out their listings in the Resource Center, and using the couldn’t-be-easier Consulting RFI form to painlessly solicit consulting proposals; (c) connect our respective social ganglia on Facebook, Twitter, and LinkedIn; and (d) slip us news and rumors via the methods listed under the “Report News and Rumors” box to your right, which includes a new option: call my Rumor Line at 801.HIT.NEWS and leave a message, which thanks to Google Voice will be transcribed and e-mailed to me along with the original recording.

It’s almost New Year’s, so I’m setting my priorities for 2013. I’m looking for HIStalk-related projects or activities that would be more personally satisfying and society-benefiting than just making money, which doesn’t interest me all that much (obviously, since I work for a non-profit hospital). Thoughts?

Acquisitions, Funding, Business, and Stock

Awarepoint secures $4 million in new financing from an undisclosed investor.

McKesson says its $2.1 billion purchase of PSS World will be finalized in the first quarter.

People

The Oregon Community Health Information Network (OCHIN) names Scott Fields, MD (OHSU – above) CMO, Jonathan Merrell (Cherokee Nation Health Services) VP of performance improvement, Tim Burdick, MD (Fletcher Allen Health Care) CMIO, and D’Angela Merrell (US Public Health Service) clinical improvement professional.

Announcements and Implementations

HIEs Healthcare Access San Antonio and Integrated Care Collaboration begin sharing patient information.

Mercy McCune-Brooks Hospital (MO) goes live on Epic.

Texas Health Harris Methodist Hospital Alliance (TX), which opened as a new 50-bed hospital in September, earns HIMSS Analytics EMRAM Stage 7 recognition. I interviewed Winjie Tan Miao, the hospital’s president, two weeks ago.

The NJSHINE (NJ) HIE gets a $1 million grant from the New Jersey Department of Health to connect seven hospitals.

Other

Consumer Reports rates the performance of 19 Wisconsin medical groups based on quality measurements for cancer screening, care of people age 60 and older, and treatment of patients with heart disease. ThedaCare Physicians and Marshfield Clinic earned the top spots.

The LSU hospital system notifies 416 patients that their information, including checking account numbers, has been stolen. A former billing department employee and six other people have been charged with identity theft after creating and passing counterfeit checks and ID cards from scanned check images stored in LSU’s computers.

Pittsburgh systems UPMC and West Penn Allegheny fight to acquire each other’s affiliated physician practices, leaving patients unaware of the change and sometimes forcing physicians to practice outside of Allegheny County beginning immediately without notifying their patients to satisfy non-compete clauses. The medical records stay with the practice, leaving the patient to figure out their options

University of Michigan Health System notifies 4,000 patients that their information may have been exposed in the theft of an unsecured PHI-containing electronic device from the car of an Omnicell employee.

Efforts by the Metropolitan Chicago Healthcare Council to create Chicago-area HIE may fail as just 18 of 30 targeted health providers agree to join. Money is a sticking point, with some hospitals being asked to pay six-figure annual fees to participate. Health systems are also concerned with the uncertain value of the exchange, especially at a time many are investing heavily in their own IT systems.

A third of providers say they have experienced varying levels of payment delays during the HIPAA 5010 transition, with clearinghouses causing 52 percent of those delays, according to a KLAS report.

Hospital CFOs look ahead to 2013 with concern, worried about:

• The resources required to justify admissions
• Possible payment and cash flow problems due to Medicare changes
• Funding quality initiatives to support value-based payment systems
• The high cost, questionable return, and change involved with technology implementation
• Hiring more doctors
• Trying to scale physician compensation to what the practice actually produces
• Engaging physicians who practice only an outpatient setting
• Managing growth by acquisition
• Improving clinical documentation for patient safety and quality
• ICD-10

A maternity hospital in a Nairobi, Kenya slum admits that it holds mothers of newborns as prisoners until they pay their hospital bills. The hospital is accused by one woman of having guards beat mothers who try to leave without paying. According to the hospital’s director, “We hold you and squeeze you until we get what we can get. We must be self-sufficient. The hospital must get money to pay electricity, to pay water. We must pay our doctors and our workers. They stay there until they pay. They must pay. If you don’t pay, the hospital will collapse.” The charge for a normal birth is $35, while a C-section runs $70 and the daily room charge is $5. A first-person report (from which the above photo came) is here.

Sponsor Updates

• Vonlay offers tips on how to quickly recycle an IIS application pool in a blog pos.
• PeriGen hosts a Webcast on improving financial results in obstetrics January 16 and 30.
• Shareable Ink’s President Stephen Hau discusses mHealth applications and how they can liberate physicians and data in a guest article.
• Dennis Weissman, founder of Washington G-2 Reports, will deliver the keynote at the Lifepoint Informatics user conference Orlando March 21.
• Liaison Technologies offers a white paper discussing the use of cloud-based data integration to overcome interoperability challenges in health systems. 
• API Healthcare executives participate in a giving back campaign.
• Business NH Magazine names Digital Prospectors Corp a top small company to work for in New Hampshire.
• Dave Caldwell of Certify Data Systems shares insights on the barriers and issues that need to be addressed in order for the healthcare industry to achieve widespread interoperability.
• Besler Consulting will participate in next month’s HFMA MA/RI Annual Revenue Cycle Conference in Foxborough, MA and the Region 11 Annual Healthcare Symposium in Las Vegas.
• Thomson Reuters includes 3M, AT&T, and Fujifilm on its list of the World’s Top 100 Most Innovative Organizations for 2012.
• Saint Luke’s Health System (MO) shares how Philips Healthcare Consulting helped the organization build an eHealth strategy of regional outreach and physician-to-physician relationships to drive growth.
• ZirMed releases its 2013 PQRS Suggested Measures and Monitoring tool.

EPtalk by Dr. Jayne

The use of Health Information Exchanges is one of my pet topics, particularly issues around governance. I’m happy to see ONC hosting one of their Town Hall meetings on the topic. It will be held on January 17, so there’s still plenty of time to sign up.

It’s always fun to get together with family over the winter holidays. This year’s hot topic among the Medicare set was the concept of Accountable Care Organizations. They wanted to know my opinion. Unfortunately, I had to give the answer of, “It depends.” Even though there are core principles for ACOs, there seem to be many different flavors out there.

Patients need to realize that a key driver of ACOs is slowing the growth of healthcare spending. Quality and meeting patient needs are also goals. For patients involved in ACOs that have a long history of managing quality and cost initiatives, there may not be much of a difference in care because referral relationships and practice patterns are already established. However, for health systems that have not been functioning in shared care models, there may be trouble ahead. There will be a significant learning curve for participating physicians and their care teams.

The subtleties of the ACO patient assignment regulations can cause situations where providers are ensnared by a single ACO. Patients also need to find out whether they will be able to continue to see all the providers from whom they receive care or whether they will have to change to specialists within the ACO. I also think it’s funny that when seniors are talking about ACOs and their benefits, they refer to the Affordable Care Act. When they’re talking about the negatives, they refer to Obamacare. They’re one and the same, folks.

With the holiday, it was a snow news week. Hopefully as people are trickling back into their offices things will pick up. In the mean time, please give your friends at HIStalk the best gift of all – send your rumors, newsy tidbits, and other reports our way.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 12/27/12

HIPAA 5010 Transition: Thirty Percent of Providers Report Payment Delays

KLAS releases a market analysis of claims management and clearinghouse vendor performance through the HIPAA 5010 transition, during which thirty percent of providers reported significant payment delays. Navicure is named Best in KLAS.

OIG Advisory Opinion

OIG has published an advisory opinion clarifying that the federal anti-kickback statute is not violated if a hospital gives a practice free access to an EHR interface for orders and results.

Drchrono: Onpatient to replace Google Health January 1

As Google Health prepares to eliminate access to patient health records on January 1, freeware EMR vendor drchrono releases a PHR alternative that will accept data transfers from still-active Google Health accounts.

Healthcare sector vulnerable to hackers, researchers say

The Washington Post claims  healthcare is among the most vulnerable industries in the country to hackers, though far fewer attacks are carried out as compared to attacks on financial, corporate, and military networks.

HIStalk Advisory Panel: Vendors at the HIMSS Conference

The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a hospital or practice, you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

This question: Vendors are finalizing their preparations for the HIMSS conference. What are some things they should and shouldn’t do to get decision-makers into their booths and then present their company and products effectively?

Pricing is a touchy topic and I understand the sales logic that you don’t want to share the dollars too soon. However, I may need to understand ballpark pricing to even know if it’s worth my time to talk with you. We’ve all been talking about reimbursement cuts.  Those cuts directly impact how much we can spend for essential and cool tools. If I go to pricing early in the conversation, I’m probably trying to determine if it’s worth my time and your time to continue the discussion. At a recent conference, we encountered a vendor with a unique solution to challenge we were facing. However, my enthusiasm to continue discussions was notably less after multiple conversations that led to a summary of, "It’s really hard to give you an idea of how much it will cost" and "My price will be less than whatever you currently pay." Instead of being on the top of my follow-up pile, this vendor is a much lower priority, in part because I don’t know if my work will all be for naught because the price is more than we consider reasonable.

Coffee works. I don’t care what you say, at every trade show and conference I attend, the longest line is always where the espresso machine is. Cisco usually has a magic show — that makes me leery. Have ample seating available — people are tired of walking around all day. I think that pre-conference mail-outs have minimal success. When I know I am going to a show, I tend to pay more attention to e-mail, but not any more attention to traditional mail.

They should avoid e-mail spam, phone call spam, and otherwise being overly aggressive prior to the conference. I personally tend to avoid those who pre-annoy me like the plague. Likewise, avoid post-conference harassment. The key is to be accessible without nagging or arm twisting. There is no such thing as successful nagging or successful arm twisting – attendees might passively pay attention or pay lip service in response to such tactics, but they have zero chance of landing a "sale" or cementing a meaningful relationship.

Having and being generous with high quality giveaways never hurts. Often these may be collected by attendees to distribute to team members who cannot attend, so it’s almost like viral marketing in terms of who ends up with these and who sees them. Having edible or drinkable enticements to visit a booth is also not a bad idea, but don’t be cheap or stingy with the stuff (it is far better to have nothing than to appear cheap or to be stingy with this type of thing). Throw nice meal meetings and parties – breakfast, lunch, dinner, snack, after dinner, whatever (be creative). The quality with these events is of paramount importance, though. Going cheap on such an event delivers an obvious and lasting message of how important the attendees are to the vendor and reflect also on what an attendee can expect from the vendor’s customer service and support. Also, realize you are competing against places, restaurants, etc. the attendee might want to experience in the host city. Don’t make them feel like they wasted an opportunity to enjoy something else by giving you their time. A memorable positive experience will always create a favorable impression and build some relationship capital. Put yourself on HIStalk’s Bingo or "recommended" list – people pay attention even if they don’t overtly participate.

Don’t monopolize my time with long meetings. I go to HIMSS to get a "broad brush" on available products and technologies for later investigation. Instead, give me the "elevator speech" (what can you tell me while I’m trapped in the elevator with you) answer my questions, and plan to follow up with me later.

Have a crisp, compelling elevator pitch that all of your salespeople know. Tell us why we should invest our time to see you. Make it simple, clear, and easy to understand.

Quite frankly, HIMSS is so large that my senses are on overload when I hit the vendor booth area. They see CIO on your badge and you become raw meat. I have two official titles. One year I tried to have HIMSS put non-CIO title on badge. They refused. I schedule meetings with vendors weeks in advance so as to use my time more efficiently. I also try to visit the major vendors we have contracts with. Lastly, there is a vendor booth that is an actual bar. It’s a must stop.

Focus on the power of three and stories. Everybody in the booth needs to have a library of stories that show the impact of their solutions. Have the customers in the booth if possible. Secondly, everyone in the booth needs to know the three reasons to spend five minutes in the booth, the three reasons why their product has an impact, the three reasons why they are better than competitor, the three reasons customers buy from them.

I cynically assume that whatever I see on the floor is vapor-ware and do not use it in the decision making process. I am able to get 3-6 months of meetings with my current vendors into 1-2 days, which is a great time saver.

Skip the expensive direct mail pieces – most wind up in the trash.  I can’t think of any vendor who has done anything memorable… I suppose that tells a lot of the story.

Don’t send me postcards with the same old prose ("Find out why we are the best / fastest / cheapest / lightest / prettiest… at booth #4321). Do send me something that is tailored to my role (e.g. physician, nurse, pharmacist, IT professional, executive) and tell me how what you do can make life easier for my role or bring real value to my organization (e.g. how does it decrease cost or increase revenue while maintaining or increasing quality.) And of course let me know if you are an HIStalk sponsor, and about any cool giveaways!

The only thing that has worked with me in the past is a special invitation from someone who had researched me and my position and offered a good proposition and a quiet audience. Made me feel special and above the clamoring crowds. Didn’t use the product, but they were in the running.

Send info that is not gimmicky ahead of time. I rarely just pop into a booth, but I will if it looks like something we are interested in. Last year, I was looking for Humedica and had a booth number. When I got there, it was Allscripts and I did not see anything for Humedica. Colocation for a vendor can be a big mistake. I felt like a dolt going all the way around the booth looking for anything with the company name and even asked a booth zombie, but they had no clue. As it turned out, they were there, but not everyone knew it at the booth. Odd and not to be repeated, I hope. On the other hand, I went to the SAS booth, and what made it a great visit is that I had access to all of the right people right away. I was to the point of what I wanted to learn and so were they. Not sales-y at all.

Vendor should bring decision makers to HIMSS. Feedback I am consistently hearing from CIOs and other organizational decision makers is that HIMSS is turning into too much of a sales pitch. Customers don’t feel like they can have meaningful conversations with the vendors. Make sure those people are there. The sales personnel are important to build relationships, heck many of them can have these meaningful conversations, but make sure that you have the right resources available to engage in these conversations, along with the correct non-threatening environment to encourage such conversation. For goodness sake, don’t hire professional talent to deliver a scripted pitch – have the thought leaders in the organization that understand the topic give the presentations and engage their audience in a conversation. It should be two way — listen, challenge, exchange ideas.

Collective Action 12/26/12

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

Leader the Follow (Part 1)

I will never forget how I earned my shellback certificate. Only a few people know what that is. If you have one, you probably remember the experience like I do. It is unforgettable.

I served six years in the US Navy after high school. While in the Navy, most sailors are assigned duty to serve on a ship and go out to sea. A large percentage of deployments end up crossing the equator, and with that crossing comes a very honored tradition and ceremony where a lowly pollywog transforms into an honored shellback.

During this ceremony, the pollywogs (those who have never crossed the equator) are “abused” by the shellbacks (those who have already crossed the equator) through a series of events and scenarios before entering the royal court of King Neptune. There was no real abuse, but there were fire hoses, pushups, haircuts, and lots of crawling around on a very rough deck with your clothes on inside out.

The scenario I remember the most — and where I want to set the stage for this article — was where we crawled through chutes of rotting garbage. This was a great picture of leadership and following. Three people were going through the chute, a leader and two followers. The leader was the only one who could see the exit, but he could not get there unless the followers were “hooked” to him by grabbing onto the bell bottoms of the dungaree jeans we wore on the ship. 

Often there was vomiting. Certainly there was hesitation, doubt, and extreme overload to the smelling senses. It was challenging, but with the help of everyone involved, we made it through and eventually got to rub our faces in the greasy belly of King Neptune and claim our shellback card.

The leader can see the end. They can see where the group is going. But most of the time, the leader cannot get there by themselves. The follower is the key. Instead of focusing on the leader’s responsibility to create an environment where followers can thrive, I want to focus on the follower and try to answer some key questions:

• What makes a good follower?
• Who is a follower?
• Who will a follower follow?

Certainly there are more followers in this world than there are leaders. If not, there would be no advancement in anything, much less technology. You know the saying — too many chiefs and not enough Indians.

If the follower is such a key to success, why is it that there are far fewer books written about followers compared to those written about leaders? Followers are mentioned in the leadership books, but from the perspective of leadership. Maybe many in the workforce are not satisfied with being a follower and do not want to acknowledge their responsibility in being a good follower. Let’s explore these questions and see what we can discover about good followers that really make them leaders.

What Makes A Good Follower?

There is a great YouTube video that speaks to the significance of the follower. In this video, it is the first few followers that are the most important. 

The video helps answer the question of who a good follower is. A good follower is one who is willing to take a risk. The leader may be way off base and be going down a road that leads to failure. A follower assumes risk in whatever endeavor they are on. Much like an entrepreneur, with the increase in risk comes a potential increase in reward.

Lower risk, lower reward. If you have a job with a large hospital system, you are a follower in a relatively low-risk situation. But monetarily speaking, your reward is capped. One of the things I love most about healthcare is that most of us are in this industry because of our compassion for others who may be sick. In this case the emotional reward is great.

A good follower also has vision. Good followers ensure they are able to see what they are marching towards. Two IT people are viewing server log files. One is upset because they feel like they should be much farther in their career than just browsing log files. The other is diligent and disciplined in their review, understanding that if they can find something at this level, they may be able to prevent an unplanned system outage and interruption to critical information flow to clinicians.

Which follower would you rather work with? Obvious, isn’t it. The follower with vision and understanding will ultimately help the company produce quality products and services.

Finally, a good follower is loyal. This is not to say that a good follower may not change jobs. Loyalty runs much deeper than who your employer or boss is. A good follower is loyal to the path they are on in life. They try to align themselves with employers who have a similar vision and who can best help them achieve their personal goals. A leader is not the only one who understands the idea of “co-missioning.”

Covey covered this in his book The 8th Habit. He discusses this idea of aligning your personal mission with the mission of the organization. To me, this is one of the biggest resourcing challenges in healthcare IT, specifically regarding the technical roles. If an individual is passionate about server technology and is fascinated with managing a storage area network, they will be loyal to that versus loyalty to that is specific to healthcare. Technical aptitude is needed in almost every business sector, making it more difficult to keep good technical people in healthcare.

Good followers are loyal to their passion. Good leaders recognize this and work with good followers to best align their work to their passion. This fosters loyalty — and as a result, longevity — in the workplace.

Who Is A Follower?

The short answer to this is “everyone.” I recognize that I am a leader at work. As the CIO, I lead a group of people as we march down the road of improving healthcare delivery through information technology. However, my title is CIO and not CEO, so I need to be a good follower to advance the agenda of the organization.

The CEO is a great leader, but he too is a follower, as he reports to the chairman of the board of directors. The chairman is a follower in a sense as well, because he represents the community we serve. At the end of the day and in every industry, there are the people — community, customers, consumers, and families.

Without losing my focus on followers, I want to make a quick leadership point here. It is critical for a leader to be more that just be a good follower. They need to be a great follower. The eyes of the team are watching. As the leader goes, so goes the team. This is not an opinion, it is a principle.

If leaders are followers — and indeed they are — then they need to set the bar on how to follow. They need to take good risks and show others how to do that. They need to have vision and be able to communicate that vision and help others to see. Finally, they need to be loyal and display loyalty in a way that makes other followers want to follow.

Who Will A Follower Follow?

This leads us to the final question. Who will a follower follow?

I will start by speaking for myself here. I will not follow someone I cannot trust. Trust is such a huge issue for me, probably because I have both broken trust and had my trust broken and have seen the resulting relational devastation first hand. A leader can have a great vision with low risk in an environment that seems to foster loyalty, innovation, and creativity, but unless I trust them, I will not join them.

That is part of why changing jobs is so risky. You never really know what you are going to get until you spend time in that role, and by that time, it is normally too late. I’ll be honest — one of the reasons I have taken to writing is to put myself out there so potential employers and employees can get an idea of who I am and what is important to me. This starts to build trust even before we meet.  Naturally there will still be skepticism, but the relationship can start off with a foundation — albeit a small one — to build trust.

Behind trust, there are many qualities a leader must have for me to follow them in a great way. They must have integrity, must be honest, must have a level of transparency, and must foster unity.

What is more important to me, however, is not who I will follow, but who you would follow. I would like to make this article interactive. I would like to hear from you and find out who you would be willing to follow. What type of person would you follow into battle? Please respond via e-mail, LinkedIn, or Twitter and let me know. I will include this in the next post of Collective Action on HIStalk. Include your name if you like, but I would ask you at a bare minimum to include your role so we can have context around your response.

If a good follower knows how to calculate risk and has vision and loyalty, why are they only considered followers and not leaders? Why is there stigma with being called a follower, a.k.a. a member of the team? I will elaborate on this in the next segment once I get your answers to what kind of leader would you follow.

But I believe what keeps a follower a follower and not a leader ties back to their sense of identity. If you see yourself as just a follower, then whether or not you have the qualities of a leader, you will never lead. If you can see yourself as a leader, then whether or not you have fully developed the qualities of a leader, you still can lead and learn along the way.

Of course there are some who do not have an accurate picture of themselves.  That is when a mentor or someone close can help them point out their strengths and weaknesses.  More to come on this in the next segment, but your sense of identity it is a crucial concept that deserves specific attention because of the significant impact it has on every individual. Even if you remain a follower for the remainder of your career, you can lead strongly by consistently displaying the characteristics associated with being a good follower.

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

Curbside Consult with Dr. Jayne 12/24/12

‘Twas the night before Christmas, and all through the ward
The patients were resting with some sleeping hard.
The IVs were hung on their pumps with good care|
And staff hoped the next shift change soon would be there.

The Stroke Team was nestled all snug in their beds,
While visions of t-PA danced in their heads.
One nurse wore a kerchief, but none wore a cap
I’m pretty sure my intern just took a nap.

When out on the helipad – whoa what a clatter,
We sprang from the NOC to see what was the matter.
Away to the lift we all flew towards the crash,
The double-doors opened and we saw a flash.

The moon in the sky and the landing lights’ glow
Made quite a nice picture for patients below.
When what to my wondering eyes should appear,
But a shiny red chopper touched down on its gear.

Out jumped the pilot, so lively and quick
We knew from his bow tie he wasn’t St. Nick.
More rapid than audit requests came his voice:
Compliance is simply our goal and your choice.

There’s quality metrics and data galore
Patient empowerment isn’t a chore!
From rural America to NYC
A Meaningful User is the way to be.

As dust clouds before the big chopper blades fly
He took all our worries and bid them goodbye:
You’ve attested Stage 1 and now to Stage 2,
With lots of requirements for all to do.

And then quick and nimble he jumped to the deck
I saw there were Mardi Gras beads ‘round his neck.
I just went to NOLA, he said with a grin
In March we will all get to visit again.

We’ll share lots of stories and maybe a drink,
And Epic’s booth artwork will make us all think.
Will wonder ‘bout Allscripts and where it has gone
And which cool new startups might just get it on.

As he spoke his eyes twinkled! His bowtie looked merry!
He said to have no fear, Stage 3 is not scary!
He gave us a big smile drawn up like a bow,
And told us he’d brought gifts – now didn’t we know.

Shoes! Nothing better for Inga and Jayne
And for Mr. H in a whimsical vein
A shiny new wearable reflector thingy
Matches the new site – a little bit blingy!

This O-N-C elf was so happy and jolly
I laughed when I thought of EPs and our folly
Of thinking the money was easy to claim
And later the prepayment audits we’d blame.

The pilot he winked and went straight to his work
And threw us some guidelines, then turned with a jerk.
And laying his finger aside of his nose,
He climbed in the front seat, and up up he rose.

Away went the chopper and I gave a whistle:
They aren’t only guidelines but almost a missal.
Team HIStalk exclaimed, as he flew out of sight:
Happy Christmas to all, and to all a good night!

(With apologies to Clement Clarke Moore)

E-mail Dr. Jayne.

Monday Morning Update 12/24/12

From The PACS Designer: “Re: 802.11ac wireless. As we approach 2013, our wireless technology infrastructure will bring a key change that will excite users. The 802.11ac wireless specification is an upgrade to the new communications band called the 5 Gigahertz frequency spectrum. The currently crowded 2.4 Gigahertz frequency spectrum in 802.11n will still be usable as most of the new 5 Gigahertz routers being designed are backward compatible. The 802.11n routers installed everywhere today can remain in place, and the new 802.11ac routers can be placed at key points in the network to improve the overall speed of communications. The 5 Gigahertz spectrum is new and unused with a 1 Gigabit per second speed upgraded from 450 Megabit per second in 802.11n. This faster network technology will bend nicely with 1 Gigahertz Ethernet switches in use today.” The article brings up an interesting fact: the maximum theoretical 802.11ac speed is 3.5 Gbps, meaning that your 4G LTE smartphone could eat up your monthly bandwidth allocation in about two seconds.

Don’t be startled – you’re in the right place. I’ve given HIStalk a much-needed update. Even its formerly smoking doctor celebrity endorser has received a makeover, surrendering his reader-polarizing pipe while refusing (like a doctor clinging to paper charts) to abandon his favorite reflector headband thingy. I wanted to make the site easier to read, with the design itself being less of a distraction. We will all need a week or so to get used to it, I predict, at which time I may run a screenshot of the old design just to illustrate how much cleaner the new one is.

Speaking of the reformed smoker doc, thanks to the folks at Dodge Communications for designing the new logo. I asked CEO Brad Dodge if he could recommend someone for logo design and he volunteered to have the company create one, with SVP Brian Parrish taking the lead. I really appreciate that, and I think Brian did a really nice job in creatively accommodating my requests: (a) retain the doc figure and reflector; (b) use a typewriter-like font as a nod to reporting (c) keep it simple; and (d) come up with variants that work for HIStalk Practice and HIStalk Connect.

Allscripts is further damaging its beaten-down public image by suing NYCHHC for choosing Epic, at least according to 57 percent of poll respondents. New poll to your right, another Allscripts-related one since they’re making all the pre-Christmas headlines:  can Sunrise successfully compete with Epic and Cerner, giving its reps something to wear other than a lapel pin featuring a white flag?

ONC posted its Patient Safety Action and Surveillance Plan for public comment late Friday afternoon. This is the report that address IOM’s November 2011 recommendations. The proposed requirements challenge vendors to regulate themselves in more structured ways as providers are encouraged to report the patient safety problems they observe. Some highlights:

• Add certification criteria requiring EHR vendors to include in their products the capability for users to submit EHR-related safety problems using AHRQ’s Common Formats, which includes a new category of “Device with Health IT.”
• Develop a code of conduct for EHR vendors that will hold them accountable for problems and require them to report their IT-related safety events through a Patient Safety Organization.
• Require vendors to maintain records of complaints for review by certification bodies.
• Train CMS surveyors to identify IT-related safety problems.
• ONC will monitor events submitted to FDA’s MAUDE medical device problem database.
• Use ONC’s standards and certification criteria to enhance patient safety, including incorporation of human factors and user-centered design.
• Potentially add NIST-developed usability testing tool results as a certification requirement.
• IOM’s recommendation for an investigative body such as the National Transportation Safety Board is acknowledged without a specific commitment, but CMS plans to advise state and accreditation surveyors on health IT-related adverse events and HHS may issue public notices for EHR-related safety problems.
• Establish an ONC Safety Program to coordinate activities and analyze data.

Aprima announces that the first customer of its Aprima Rescue Plan has successfully moved from Allscripts MyWay and gone live on Aprima’s EHR. The announcement says that Crystal Community ENT (FL) had used MyWay for less than two months when it received notice from Allscripts that the product would not be enhanced to meet Meaningful Use and ICD-10 requirements.

SPi Healthcare names Louis Grujanac, DO (Accretive Health) as VP of HIM solutions.

Melissa Cruz, CFO of Progress Software and former CFO of Picis, announces her retirement.

RTLS vendor Versus Technology announces Q4 results: revenue up 77 percent, net income of $3,121,000 vs. $704,000.

In Singapore, Changi General Hospital develops an iPad-based “patient care communicator” that allows intubated patients to communicate with caregivers.

RelayHealth acquires Ahi Software, whose AHIQA patient access system is rated #1 in KLAS. It offers applications for registration, wait time tracking, eligibility, demographics verification, and patient responsibility estimation.

Park Place International recently participated in Meditech’s Adopt-a-Family program, which delivered food, gifts, and supplies to 53 families.

Weird News Andy is off on a sunny vacation, so I’m happy to step in. The Social Security Administration formally reprimands an employee for excessive workplace flatulence, saying he hasn’t supported his claim of an unspecified medical condition.

Vendor Clinician Compensation

I received the following responses from Vendor Middle Manager’s request relating to what vendors pay their clinical people. Some of those below were reported first hand, while others came from readers asking around. I appreciate the responses.

• Epic subject matter experts developing clinical content: $150 per hour.
• Informatics-certified RN: $70K.
• RN consultant: $90-$120K with bonuses raising the potential to $110-160K. Stock options same as other employees receive.
• EHR clinicians: $130-180K for work that’s 50 percent consulting and 50 percent design.
• Demo team physicians and nurses: $150-180K with half of the 20 percent bonus tied to sales success.
• RN doing demos: $85K base with compensation structure than puts them over $125K on the low end.
• Vendor CMO/CNO: $300K salary plus bonus of up to 40 percent.
• Master’s degreed RNs in product management or consulting: $150-185K base with 20 percent bonus.

People celebrate a variety of holidays this time of year. Like most readers, I’m a Christmas and New Year’s guy, but I sincerely hope that whatever holidays, customs, and practices you and your family are observing bring you love and satisfaction. Business and IT stuff is important, but let’s face it, it’s not exactly inspiring material for your tombstone. I appreciate the people who are involved with HIStalk, my hobby of 10 years. That includes everyone who reads, e-mails, writes one-time or recurring guest posts, sponsors, and otherwise provides the many kinds of support that I need to keep it going when I’m questioning exactly why I’m spending most of my free time on the computer. On my side of the monitor are the people I trust with my most valuable asset – my reputation. That would be Inga, Dr. Jayne, Dr. Travis, Dr. Gregg, Lt. Dan, and Donna, all of whom work week in and week out to bring you the information you need. I’m so busy between my hospital job and my HIStalk job that I don’t always express appreciation to everybody involved in this thrilling and totally illogical 10-year run, but they don’t mean a bit less to me just because I don’t say so often enough. Enjoy your holidays, whatever they may be.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Time Capsule: Everybody Hates Their IT Department: Where Alignment, Control, and Honesty Collide

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

I wrote this piece in March 2008.

Everybody Hates Their IT Department: Where Alignment, Control, and Honesty Collide
By Mr. HIStalk

I was talking to a colleague at HIMSS about IT departments. “Our users hate us,” he lamented. “We’re nice people trying to do the right thing, but they hate us. You wouldn’t believe some of the jokes and nasty comments we hear.”

The easy answer is that nobody likes being told they can’t do something. That’s a core competency of many IT departments: telling users they can’t install software on PCs, can’t buy systems without IT approval, and can’t blow the entire organization’s IT budget buying big-screen monitors and stylish laptops. Doing their job as laid out by leadership, in other words, as unpopular as that may be.

Implementation projects, however, probably encourage even more unlikable behavior. The marching orders are to get the system live, on time, and on budget. If that means steamrolling user objections for the good of the order, even valid ones, so be it.

In that respect, the interests of the IT department and its vendor are aligned. So, it’s not surprising that users regard them both with the same distrust and sometimes disgust, writing them off as fast-talking flimflammers trying to put something over on the people who have to live with their systems long after they’ve moved on to the next project.

IT is just another vendor. Vendors are unresponsive, clueless, and untrustworthy, users reason. Ergo, we hate them all. They get no credit for trying to do the right thing in moving the big-picture dial.

IT lives in the world of conference rooms, PowerPoints, and big teams. Clinicians thrive on making quick solo decisions with whatever information is available, changing the plan after seeing the result. It’s an honest world, though, and when IT people try to hard-sell the benefits of going live, changing processes, and accepting software inadequacies, the “us vs. them” atmosphere sets in quickly.

Clinicians are also quick to spot even well-intentioned dishonesty or heavy-handed enlightenment campaigns since they deal with human frailties all day long. When project people conspire offline to minimize or even hide major software problems, enlist secret allies to manipulate group thinking, or strategize with leadership to marginalize whiners, finely-tuned clinician noses immediately catch the unmistakable whiff of manure.

Sometimes those noses pick up the scent of condescension as well. IT folks fancy themselves as process experts and unbiased observer, which they very well may be. Users can’t make decisions, aren’t consistent in processes, and don’t understand the big picture, the logic goes. Using that knowledge to influence behavioral change, however, requires an incredible amount of finesse and ongoing respect. Those qualities don’t always run deep in IT-land.

It’s nearly impossible, in other words, for IT to be the much-loved middleman for policies made at the top but despised at the bottom: technology control, process change, and application imperatives. The IT department is often smack in the middle of clashes between what executive management wants and what the rank-and-file is willing to do with the resources they have.

It may be oversimplification to say that every IT department that’s doing its job will be scorned by users. In hospitals, however, the current state of leadership and IT alignment nearly assures it.

Morning Headlines 12/21/12

Allscripts Fires Long-Time CEO

After failing to secure a buyer, Allscripts fires CEO Glen Tullman, President Lee Shapiro, Chief Client Officer Laurie McGraw and EVP Diane Adams. Paul Black, former Cerner COO, will step in as CEO to redefine the company’s long-term direction.

Meadowlands Hospital Medical Center ACO Selects eClinicalWorks CCMR

eClinicalWorks announces that New Jersey’s Meadowlands Hospital Medical Center will implement eClinicalWorks Care Coordination Medical Record.

SAIC Awarded $17 Million Contract by United States Coast Guard

SAIC, the parent company of maxIT Healthcare and Vitalize, is selected to maintain Epic across all US Coast Guard facilities.

Microsoft Wants to Kinect with Pentagon

The DoD is considering working with Microsoft’s Kinect gaming accessory to provide remote physical therapy to rehabilitating wounded soldiers.

News 12/21/12

Top News

Allscripts shares closed Thursday at $9.14, down over 14 percent since Wednesday’s after-hours announcement that it would not pursue being acquired and instead will replace its executives and forge ahead. The company’s market cap is $1.6 billion. If you had invested $10,000 each in Allscripts and Cerner shares on January 1, 2000, you’d have $1,983 and $157,874, respectively. If you’d made the same investment five years ago, you would be holding $4,560 and $27,982. Obviously the company is hoping that Paul Black had enough influence in Cerner’s success to be able to replicate it at Allscripts. They’re bragging publicly on his background and Cerner’s success, which is odd given that Cerner is perhaps its most direct competitor.

Reader Comments

From HITEsq: “Re: another patent troll. A Puerto Rico-based company, Ingeniador, is going after GE Healthcare and McKesson for violating a 2006 patent whose claims are as ridiculous as its title – ‘Publishing System for Intranet.’”” I did some digging and found that the “company” is a former Hewlett-Packard software engineer named Marcos Polanco, who developed a database management system for his employer and then sued them for royalties. Since then, he has sued everybody and their brother, including Microsoft, HP, Oracle, Lexmark, and SAP. He apparently bought the patent he’s waving around from an oil services company. He’s big on Puerto Rican enterprise, entrepreneurship, serving as COO of glucometer vendor iCare Medical, and filing ludicrous lawsuits.

From Top Chef: “Re: Paul Black. I knew him from his Cerner days. Good guy, very smart and affable. Guess he’s ready to jump into it again!” Glen and his loyalists had to be fired, of course, when the PE tire kickers passed on Allscripts, leaving the company desperate to change something (anything) to put the stench of a disastrous year behind it — missing Wall Street expectations; firing the Eclipsys supporters on its board and barely keeping Glen; caving in to a proxy fight by reluctantly adding three HealthCor-nominated board members; watching its share price drop nearly 40 percent in a single day; having word of its private equity courtship leaked publicly; choosing the worst possible time to announce the halt in MyWay development; and having its customers name it as the worst vendor in the country with their KLAS product ratings. Not to mention the final embarrassment of having the potential acquirers walk away from the smoking wreckage. Paul Black has his work cut out for him. I would like to see his first order of business be to drop the company’s ridiculous lawsuit against NYCHHC and provide an update on the Sunrise integration status, which was supposed to have gone to beta in June per Glen. I’m not convinced Sunrise is viable given lack of sales and what must be high R&D costs and a declining user base, so they need a strategy that doesn’t involve going toe-to-toe with Epic and also to re-introduce Sunrise Financial Manager, which got lost in all the juicy company turmoil. The PE guys would have trimmed the product line and headcount (7,000 employees seems like a lot), so with Glen out of the picture, those options are surely on the table. Unfortunately, they’ll have to make those decisions under Wall Street’s microscope and that’s hard. Here’s where you get the chance to play Monday morning quarterback like me: leave a comment with the 2-3 things that Paul Black needs to do first to get Allscripts on track.

HIStalk Announcements and Requests

I got my first Christmas present in the mail yesterday from a couple of my favorite gal pals: a daily shoe calendar for 2013. Each day looks better than the next!

Mr. H also gave me an early Christmas present with the refresh of the HIStalk Practice site, complete with a new logo (thank you, Dodge Communications) and a sleeker format. Take a peek and let us know what you think. This week’s HIStalk Practice highlights include a don’t miss year-in-review post by Joel Diamond, which I promise is the funniest read of the season. SRS’s EHR takes the top spot in a survey of ambulatory care specialists. The big winners and losers in KLAS’s Physician Practice Solutions categories. KLAS is criticized for favoring big vendors that subsidize KLAS operations. CareCloud names John J. Walsh CTO. Thanks for reading.

On the Jobs Board: Chief Information Officer, Cerner Experienced Providers.

If the world ends today or if I decide that nobody will be reading on Christmas Eve, there won’t be a Monday Morning Update. I’m betting I’ll be right here over the weekend, though.

Acquisitions, Funding, Business, and Stock

Allscripts held a short investor conference call Thursday morning to go over the changes. You can listen to the recording here. My notes:

• The company still won’t say whether it received any acquisition offers, only that it decided to continue as the current entity.
• The CFO is aggressively looking at cost controls and productivity plans.
• Black: “We’re not going to waste any time going to work.”
• ICD-10 functionality is complete and Meaningful Use 2 is well underway.
• “Disruptive, open technology,” common user experience, and single patient workflow.
• “There will be no substitute for results” and “we need to move quickly.”
• Question: who will lead the product refresh effort? Answer: Cliff Meltzer, who will continue as EVP of solutions development.
• Question: since the company stopped giving guidance, how’s the quarter going? Answer: we’ll benefit from the clarity around the company’s direction. The lack of clarity this year was a misstep.
• Question: was the board’s decision to stay independent unanimous? Answer: the board doesn’t comment on their deliberations. There were no dissents on Glen stepping down.
• Question: is customer attrition running in line historically? Answer: I don’t have the number, but retention is steady in all facets of the business.
• Question: Glen said earlier this year that the company brought on 400 employees to work on integration. Was it money well spent and are customers happy with functionality? Answer: Not all of our clients are happy and we won’t rest until 100 percent are. I won’t be happy until we don’t need a sales force because they’re beating down our doors and our fax machines are burning up with orders. R&D spend will continue at the current level.
• Question: what’s the order of strategic initiatives? Answer: solidify the client base; review expenses; step up revenue, engineering, and operations to keep surprises to a minimum.
• Question: was there a precipitating event that led to the changes? Answer: just the completion of the strategic review.
• Question: what areas other than product innovation and R&D will be emphasized? Answer: increase emphasis on application hosting, add managed services for the large ambulatory clients, review why home health and patient flow solutions don’t seem to produce as well as the market would suggest is possible.
• Question: how will the executive suite shape up? Answer: I expect to bring folks in, but review talent and promote from within if possible. I will bring in people I’m comfortable with working with and those I’ve worked with in the past.
• Question: what’s the lowest-hanging fruit? Answer: the large number of doctors using the systems regularly are the mother lode and the company will build around that core.

Terms of Paul Black’s deal to take over Allscripts include a three-year contract for $1 million per year in salary and a $1.5 million annual bonus target with the 2013 payout guaranteed; a $1.25 million signing bonus; $3 million in shares vesting over three years; $3 million in incentive-based shares; $2.5 million in service-based restricted shares vesting over four years; and $2.5 million in a performance-based equity award. If he quits or is fired, he gets two years’ of severance including his bonus target (total of $5 million) and an extra year of vesting. Glen Tullman and Lee Shapiro get a parting gift that includes a year’s salary, their target bonuses, and acceleration of vesting. If the company sells itself within a year, they’ll get two years’ salary plus their target bonus.

Sales

HealthEast’s (MN) board of directors approves the $135 million purchase of Epic, which will replace seven platforms.

The US Navy and Army award Dell, BRIT Systems, and Acuo Technologies a $45 million contract to create a Unified Clinical Archive for PACS to be used by 49 medical facilities.

Meadowlands Hospital Medical Center (NJ) and Urban Health Plan (NY) choose eClinicalWorks Care Coordination Medical Record and EHR solutions to advance their ACO initiatives.

Colorado Springs Health Partners will implement the Professional Charge Capture solution from MedAptus for inpatient professional services coding and billing.

Hometown Health (NV) will deploy MedHOK’s care management, quality, and compliance platform.

SAIC wins a one-year, $17 million contract to support the Coast Guard’s Integrated Health Information System, which is the name of its implementation of Epic.

People

Harris Corp. names Vishal Agrawal, MD (McKinsey and Co.) president of Harris Healthcare Solutions.

Bob Hajek (Humanscale) joins Divurgent as a VP of client services.

PatientSafe Solutions names Frank Pecaitis (GE Healthcare) SVP of sales and Bruce Eklund (AHM) SVP of operations, also promoting Joseph Condurso from president/COO to president/CEO.

Tom Bang (A-Life Medical, Cardinal Health) is named CEO of post-acute care systems vendor BlueStep Systems. Former CEO Roy Rasband will move to the CTO role.

Announcements and Implementations

The 500-member American College of Medical Coding Specialists votes to join AHIMA.

The Texas Organization of Rural & Community Hospitals announces the Phase 1 go-live of its TORCH HIE at Wilbarger General Hospital (TX). It uses the CollaborNet interoperability solution from Holon Solutions.

Government and Politics

HHS’s Office of Inspect General advises hospitals that they are not violating anti-kickback statutes when they provide community physician practices a free interface to support exchanging orders and results.

Charles Boustany, Jr. MD (R-LA), chair of House Subcommittee on Oversight, sends a letter to HHS Secretary Kathleen Sebelius asking her to provide the department’s policies on archiving electronic messaging. Whistleblowers have alleged that HHS’s political appointees are intentionally using instant messaging to avoid leaving a discoverable record of their communication with department employees.

The government’s Space and Naval Warfare Systems Center, charged with developing a Department of Defense database for tracking medical examinations for officer candidates, is found to be $7 million over budget and may never deliver a working system. Administration of the contract, which was issued an Alaska firm under a government requirement that Alaska native companies receive preferential treatment, has been taken over by the General Services administration.

Innovation and Research

Yet another healthcare IT accelerator fans to life, this time in Miami. Project Lift Miami will offer 10 to 15 startups seed funding, office space, and mentoring in a 100-day program.

Microsoft is working with the military to offer Kinect-powered home physical therapy treatments to injured soldiers and veterans using the ReMotion 360 software from InfoStrat. Microsoft is also working on a Kinect-based based system for conducting online group therapy sessions for patients with post-traumatic stress disorder.

Technology

The Wilmington, DE VA hospital rolls out a visitor way-finding kiosk system that features a talking avatar named Val, which stands for “Veterans Affairs locator.” The system, which also allows visitors to pre-plan their visit online, was developed by LogicJunction.

A public radio station profiles Syracuse-based startup Simple Admit, which allows patients to complete their forms online before their provider visit.

Griffin Technology offers the AirStrap Med, a $90 sling case that makes it easier to use an iPad during rounds.

Other

The entire care team jointly authors a daily note for each patient using a novel application inspired by Wikipedia editing and Facebook communication. Data is captured using disease-specific templates to ensure appropriate quality indicators are recorded. At the end of each day, the primary physician responsible for the patient’s care signs the note on behalf of the care team and the note is locked. Gone are the "chart wars", redundant statements, and miscommunication among team members. As the note is signed, key concepts described in the note are codified in SNOMED-CT. The SNOMED-CT concepts are reduced to a selection of suggested ICD-10 billing codes. A rules engine reports back to the clinician where additional detail is needed to justify each ICD-10 code  i.e. a fracture must have the specifics of right/left, distal/proximal, open/closed, simple/comminuted. You can imagine that the moving parts I’ve described are modular components provided by different companies via cloud hosted web services (similar to the decision support service provider idea).

Medical device manufacturers are blaming the Affordable Care Act’s 2.3 percent tax on their products for industry layoffs, but economists say companies were already bloated in a slow market and would have had to cut jobs anyway. The manufacturers‘ trade group is trying to have repeal of the tax included in fiscal cliff negotiations, but the President says he’s not a fan of that idea.

Pediatric patients at Geisinger Medical Center (PA) receive iPad-based visits from Santa Claus in the hospital’s “Santa Cam” program.

Weird News Andy summarizes this story as “Good news, bad news.” A 27-year-old cystic fibrosis patient receives a long-awaited lung transplant, but then dies of lung cancer 16 months later. The lungs she received were from a donor who smoked heavily, which is apparently the case in 40 percent of lung transplants. The hospital trust has apologized for not disclosing that fact in their explanation of the risks involved, saying that patients almost always want whatever lungs they can get.

Sponsor Updates

• Sunquest hosted a December 7 fundraiser to provide foster children with Christmas gifts. The cookout, Hostess Twinkie raffle, and company donation raised over $7,000 for Aviva Children’s Services.

• CTG Health Solutions launched its Holiday Military Appreciation Campaign for military family members of its employees, sending gift packages both to those serving and to their families. The company also continued its tradition of taking the money that would have been spent on customer greeting cards and instead donating it to Operation Homefront, which provides support to military families.

• Cornerstone Advisors establishes Cornerstone CAres, a charitable giving program funded by employee contributions and matching company donations. Its first project was to help employees of long-time client Chilton Hospital (NJ), which was severely impacted by Hurricane Sandy. Receiving the donation was Chilton VP/CIO Mark Lederman (above).
• SIS employees raised over $12,000 to purchase gifts and supplies in support of Embracing Arms home for girls, The Empty Stocking Fund, the Secret Santa Ministry, and Toys for Tots.
• Liaison Technologies shares its 2013 forecast for cloud adoption, business integration, and managed services.
• Levi, Ray and Shoup offers a white paper on enhanced document printing and viewing in the healthcare industry.
• A White Plume blog post called “Healthcare’s Wake-Up Call for 2013-2014” warns of the urgency needed to prepare for PQRS, MU2, ICD-10, and HIX.
• Fulcrum Methods provides details of how it helped NorthBay Healthcare successfully attest for Meaningful Use.
• Raymond Fabius, MD, chief medical officer of Truven Health Analytics, warns employers that moving to  an exchange-only health benefits model based on cost alone.
• Business NH Magazine names Bottomline Technologies a “Best Company to Work For” for the fifth consecutive year.
• Northwest Michigan Surgery Center shares how its implementation of Versus Advantages IR/RFIF RTLS has helped it perform as one of the nation’s top ambulatory surgery centers.
• Medseek will incorporate the Healthwise Patient Engagement solution into its health content offerings.
• InteliChart and RelayHealth develop a health information exchange platform that integrates with InteliChart’s suite of connectivity solutions and provides bi-directional exchange between the ambulatory and hospital settings.
• Humedica and Pfizer announce a multi-year strategic alliance to use Humedica’s de-identified healthcare data to improve drug effectiveness.
• EMRConsultant offers a free survey for practices interested in improving efficiency and reducing expenses.
• Modern Healthcare names MedAssets as the largest revenue cycle company.

EPtalk by Dr. Jayne

CCHIT will develop an IT framework for Accountable Care Organizations, hoping to identify the infrastructure needed. An advisory panel is being formed to develop the framework, which will ultimately lead to additional CCHIT certification programs.

ONC seeks applications for two new consumer-focused HIT FACA Workgroups: the HIT Policy Committee’s Consumer Empowerment Workgroup and the HIT Standards Committee’s Consumer Technology Workgroup. Applications are due by January 14, 2013.

As if this week’s predicted apocalypse isn’t enough, a recent article cites ICD-10 as causing shock, awe, and fear. Seriously, people, we’ve known it’s been coming for years, and warning of “apocalyptic-type scenarios” is a little much. Remember Y2K? A staffer at UnitedHealth Group is quoted as saying that use of both ICD-9 and ICD-10 together will cause “mass hysteria.” Guess what? Using both will be reality for many of us, because not all payers are switching over. There’s no requirement for non-covered entities or those using paper claims to change.

I received a fair amount of feedback on my recent discussion of the Meaningful Use smoking status measure.

From Under the Mistletoe: “Dr. Jayne, you are not a hair splitter at all, and I think these descriptors are absurd. This is the calculation we always use: pack years. Certainly closer to quantifiable, not perfect, but I am really disappointed in what you described from SNOMED. How disappointed was I? Well, I could say ‘extremely,’ or would you prefer on a 1 to 10 scale with 10 as the worst possible – a 10?”

Mr. H hinted to one correspondent that I may have been “cranky” when I wrote that piece, which I guess is true. Like a reported 77 percent of physicians, I’m at least somewhat pessimistic about the future of medicine and exhibit a higher degree of pessimism after a day of seeing patients. When you’re dealing with parents who can’t figure out how to pay for a $4 antibiotic for their child (and who bring her to the ER because they don’t have Tylenol at home), some of the things we do in the informatics office seem pretty ludicrous.

HIMSS created a word cloud showing the educational offerings for the upcoming HIMSS13 meeting in New Orleans. In response, I offer up my own.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 12/20/12

Allscripts names new CEO as strategic review ends

The Allscripts board ends its review of strategic alternatives and dismisses CEO and board member Glen Tullman and President Lee Shapiro, naming Allscripts board member and former Cerner COO Paul Black as president and CEO. According to customer communication received by HIStalk, other executive team members will be leaving the company as well. Shares were trading down 17 percent after hours following the announcement.

The December HIT Standards Committee Meeting

The Health Information Technology Standards Committee meets to discuss timelines associated to publication of clinical scenarios for EHR certification testing and plans for adding security criteria to the modular EHR certification requirements.

HealthEast approves $135M electronic records system

St. Paul, Minnesota-based HealthEast announced plans to spent $135 million implementing Epic across its three-facility network over the next five years. HealthEast will finance the purchase as their 2011 earnings were only $29 million.

Survey suggests public is ready to engage

Wolters Kluwer Health releases a study of 1,000 US consumers, concluding that only 19 percent of the public uses a PHR, but that 85 percent of women and 74 percent of men believe that the “consumerization” of healthcare is a positive.

InteliChart Completes Development Agreement with RelayHealth Expanding Cost-Effective Health System Data Exchange

InteliChart comes to terms on a development partnership with RelayHealth to provide a patient-centric health information exchange aimed at cash-strapped private practices looking for an affordable alternative to ponying up for expensive vendor HIE interfaces.