HIStalk Advisory Panel: Working with Startups

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: Let’s say you are mentoring the founder of a startup that has developed a creative software application for hospitals. What advice would you give that founder about developing a working relationship with a hospital to validate and improve their product to make it marketable?

First, it is important to develop a beneficial relationship with a hospital to, ideally, test out the application in the trenches and provide feedback for improvement. There’s huge value of working with a hospital as a beta user to run the application through the day-to-day uses. It’s important to establish a relationship with the key managers and staff in the area to provide the best feedback. It’s valuable to determine the right relationship scope so that the hospital staff are motivated and willing to provide feedback, in addition to their usual daily tasks.

[from a vendor employee] The main thing is the solution needs to provide enough value for hospital that they would even want to use and collaborate with the vendor.  Assuming it’s a great concept and the founder has gained access to hospital decision-makers who are interested in the solution (I think we’ve touched base on this before on the Advisory Panel), the next step is positioning the partnership in a way that’s mutually beneficial for both organizations. 

In our early stages, we honed our solution by offering discounted “beta” prices to multiple key sites in exchange for collaborative feedback and a tolerance for a beta product in development. This really was an invaluable process for us to hone both the solution as well as the company for widespread market expansion later. These need to be win-win partnerships to really work. The beta site got a groundbreaking solution that improved their organizations and a vendor relationship that allowed them to play a significant role in its development to fit their own needs. We obviously got early clients, market traction, and an awesome cauldron for rapid improvement of the solution. One drawback is that once a site thinks it’s a beta site and a beta product with beta prices, you’ll have a much harder time moving things to non-beta mentality and normal retail pricing. It was worth it to us, however.

I’ve seen other startups invite early clients to be part of their boards or to actively participate as advisors. Many startups get offered funding by potential hospital clients – I’m torn on whether that’s a good or bad thing. We never did it. It really depends on the hospital client, the deal, and where the startup is financially. 

All vendors started somewhere. I like what Voalte did. They consulted with several CIO/CTOs in the industry. They found a local hospital that needed that product and worked with them until they got their product fully tested and implemented. Since then, they have gone on to be successful.

To create a strong working relationship with a hospital like this, the startup should expect to shoulder all associated costs unless they are offering an equity stake (and obviously, shouldering the costs by the startup is the better financial option for the startup). Subsequent to getting that relationship off the ground, the quality of support provided, and responsiveness to hospital feedback on the part of the startup will dictate the quality of the relationship they build and maintain.

We have done this a couple of times. There needs to be a symbiotic relationship. The hospital cannot just take the free or reduced cost software or services. They need to give back in terms of recognition that what is developed must be flexible enough for the marketplace and not driven strictly by the way the individual organization would like it to work. The CIO, clinical leadership, and others need to be ready to be partners through reference calls, site visits, demonstrations etc. The vendor needs to recognize that the hospital is looking for a return on their investment (of time and resources) and also recognize that the relationship needs some form of "cost recovery" be it free or reduced price software and support, site visit credits to use with other products, or other.

[from a vendor employee] GET EVERYTHING IN WRITING!!! Finding a hospital champion is already difficult, much less finding one that wants to partner. Find a facility close to your companies office that you think would be willing to work with you. Look at the background of the person you are trying to work with. Did they work for a vendor in the past or have they done consulting? Are they a consultant on the side? Are they a programmer by trade? Is the facility outsourced and your contact works for the vendor? You need to find someone that understands the entrepreneurial spirit and wants to be a part of building something from the beginning.

Be careful of your selection. Some hospitals will tell you they use mobile products, but I haven’t seen very many do it very well. Clinicians are not always as ready to commit their time as they say they are. They need to make the commitment time very definite up front.

Make an offer they can’t refuse. Most of the offers I hear are weak and not worth my time investment.

Risk-sharing. Don’t charge me an arm and a leg for a pilot. Put your system in for low or no cost if you are confident of its efficacy. The positive reference for a startup is more important than making money on the first sale.

[from a vendor employee] I would take a three-pronged approach. First, make sure my top-level executive/CEO/founder can create a connection with someone at CxO level of hospital. Their focus should not be on technology, but on business issues, pain points, what is getting in the way of the provider hitting their numbers, growing, delivering high quality care, attracting employees. Second, have developers/product management people sit shoulder to shoulder with end users inside the hospital to see the workflow with their own eyes. Roam the halls if possible, interact with employees. Third, have the sales/account manager develop a relationship so that when prospects call or visit, the salespeople have a relationship with key people inside the hospital.

One thing I appreciated about Voalte was the ability for all end users to send text messages to the company. These included use questions and, more importantly, suggestions for product improvement, which were actually implemented quickly. Their service model of putting a rep on site and roaming the halls every week has been a big hit as well. Other vendors haven’t reacted too well to these ideas when I suggested they do the same.

Work with the CIO, CMIO and Quality in combination so that you’ve got all the players you need to get started. Find a physician champion who is committed not overly “salesish.”

Find a physician champion, start small – pilot in one area, and then work on spreading it. Be prepared to answer the usual bureaucratic/legal questions about HIPAA, server info, etc. If it’s the first customer, consider making them a partner (e.g. give it for free/cheap, and give equity) rather than trying to extract a little money — will align both sides better to win long term.

it needs to be an inside job. The current buzzwords are "champion" and "executive sponsor." Someone in the organization, as opposed to someone knocking on the door, has to be so excited by your product that they push for adoption of your software solution. How to get that champion? Bribes with money or sex will probably backfire eventually; specialty society meetings (physicians) and introductions by a friend of a friend (CIO) would seem the best bet. E-mail, snail mail, cold calls probably aren’t worth the time. Professional publications would be good, but they would have to have actual scientific validity.

We are actually in the middle of that situation. The company made connections with our for-profit arm and we are an investor. We continue to work with them to help with the development. My advice would be to create a very strong value proposition and it has to be pitched to the right C-level person first. I would suggest into the CIO / CTO as the idea would have the best chance that route if it is a good idea. The first few are the hardest as many places won’t take the risk if they are first, even if it is free. But if there is real potential, I am happy to take some risk to get to something that is good.

[from a vendor employee] I’m fortunate to have been able to participate in a startup as well live in a startup mode for many years as we both developed the products, but also the market in which we serve. One of the most important lessons that I learned is that people buy from people. This, of course, can touch many aspects of how to be successful. One of the most important is clearly in how we listen to our customers, focus on developing the relationship with our customers, but don’t just blindly listen – challenge, make sure you understand why it is important then work together on how it will be delivered.

I’d also strongly contend that this relationship building isn’t just something a startup should focus on. This should be at the foundation or core values of any company that wants to be successful in delivering products, especially healthcare products. Develop relationships, listen to your customers, challenge each other with new ideas, and deliver great solutions!

In a hospital there are several constituencies and you have to go after one.  You have to sell it to the doc, the nurses, IT, or one of the other areas that would find it useful. If it is a timesaver for the physician or nursing, sell it to them and they will pull IT into it. If it is an IT sell, then you can try the senior folks if you have connections. If not, try to find at least a project manager or primary support person for the area that will benefit most from your product. The CIO is bombarded with the latest gadget sales and the latest sales brochures. If you can find a way to market it from inside the organization, you will be more likely to get CIO time.

Readers Write 12/19/12

Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

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

Epic’s “Rules of the Road”
By Frank Myeroff

Are you aware of the hiring guidelines from Epic entitled “Rules of the Road?” These rules are in place to protect Epic clients by ensuring that staff members do not negatively impact their implementation projects by leaving them.

The rules state that you are not able to recruit or hire any employee from an Epic customer until four months after the go-live, unless the individual is hired for a position that is not related to Epic. You are also not able to place or hire any individual who left employment from a customer’s Epic project before critical go-lives or rollouts are complete until one year after the individual’s last day at the customer.

The “Rules of the Road” no longer permit recruiters to acquire employees from an active install or rollout. With rollouts at hospitals continuing well into 2014, the Epic contracting staff are essentially locked in and prohibited from leaving and consulting before completion. Before these rules, recruiters were able to acquire HIT talent already working at hospitals but interested in entering the job market as an Epic consultant.

As a result, the demand will continue to grow, but the consulting pool will shrink. This increased competition for Epic consultants could increase hourly rates over 2013.

From time to time, I speak with Epic candidates who have quit their jobs in order to consult prior to knowing about the “Rules of the Road.” Unfortunately, these candidates are not eligible to consult on any Epic project for one year.

Please ask the question: is the Epic contractor I’m about to hire eligible to consult? Don’t find yourself in the situation where you’ve filled an open Epic consulting position with an ineligible candidate.

Infractions to Epic’s “Rules of the Road” will result in the loss of the consultant’s access to the Epic User-Web. Eligibility of the candidate to consult should be the first question you should ask any staffing firm submitting a candidate for consideration in order to avoid this costly situation.

To be sure that you are meeting Epic’s “Rules of the Road”, only work with firms that have a relationship with Epic and its consulting relations department. Reputable firms will work closely with that department to validate that your candidate(s) is eligible to consult.

Frank Myeroff is managing partner of Direct Consulting Associates of Solon, OH.

Multi-Tasking Metrics
By Anil Kottoor

An Accountable Care Organization (ACO) is only as successful as the sum of its fundamental parts. Failure by just one participating provider to achieve a successful outcome on any of the 33 required quality measures could ultimately stand between the ACO and its eligibility for incentives under the Medicare Fee-for-Service Shared Savings Program.

So why not make those required metrics multi-task?

Every provider involved in an ACO should be leveraging the quality metrics they must already track to monitor internal performance and identify areas in need of improvement. From improved documentation to streamline care transitions to compliant coding and billing for more appropriate reimbursement levels to better utilization of resources for efficient patient throughput and reduced overhead costs, every aspect of a provider organization can be improved with internal benchmarking.

By repurposing data already collected to comply with reporting requirements, ACOs can easily perform effective internal benchmarking across the organization to identify gaps in care or areas of exposure before they affect the organization as a whole.

In particular, the metrics collected under the care coordination/patient safety and preventive care domains can reveal clinical outliers that may necessitate education, outreach, or process improvements. For example, by tracking the average HbA1c level across its diabetic population, an ACO can identify which if any patients run consistently higher than average after a one-year period. This could trigger a closer look at how individual physicians engage their diabetic patients to determine whether the outliers are a result of the treatment plan or the patient’s non-adherence to that plan.

Tracking and monitoring utilization rates and medical costs can also be useful to identify those providers who are managing care and costs more effectively compared to their peers. This information can then be leveraged to identify best practices which can be shared to align all providers within the ACO.

Further, by monitoring claims data, ACOs can identify the frequency of returned and rejected claims or missed filing deadlines. From there, the ACO can take a closer look at individual practice workflows and processes to determine how the situation can best be remedied.

The full benefits of ACO participation will only be realized when all providers are efficiently managing care and costs within the organization. One provider or practice can impact overall ACO performance. By utilizing the real-time information necessary to comply with external benchmarks for internal benchmarking purposes, providers can ensure that they are contributing to the good of the ACO and the organization is on track to meet the quality outcomes necessary to qualify for shared savings.

The successful ACO will partner with a technology company that can present data both retrospectively and in a real-time actionable manner to improve workflow and care outcomes. By focusing efforts on real-time reporting, ACOs will be more likely to demonstrate improvements in care and quality outcomes, thereby improving the likelihood of receiving financial incentives under the Shared Savings Program.

Anil Kottoor is president and CEO of MedHOK of Tampa, Fla.

Coordinated Care and the Changing Role of Payers
By Ashish Kachru

The result of the recent presidential election did more than return President Obama to the White House. His signature policy victory, the Affordable Care Act (ACA), looks like it’s here to stay as well.

Whether or not you agree with this policy politically, the ACA will introduce substantial changes to the US healthcare system. Millions more Americans will have an opportunity to purchase health insurance. The nature of that insurance is also changing. Lifetime limits on benefits and coverage of pre-existing conditions will be lifted.

One of the most significant systemic shifts introduced by the ACA is the expansion of integrated care delivery models. With millions more Americans now eligible to receive healthcare, hospitals and primary-care practitioners simply do not have the capacity to handle this new volume of patients. For RNs and other clinicians in a variety of care settings to effectively pick up the slack, patients must be assured they will receive seamless, consistent, high-quality care.

Of course, bringing millions of new patients into the healthcare system is unsustainable without to reducing the cost of care delivery. The ACA includes a host of cost containment and quality improvement initiatives that, collectively, are helping us migrate from a reactive, quantity-driven healthcare system to one that’s driven by quality, patient satisfaction and coordination among patients, physicians, providers, and payers.

It’s hard to overstate the importance of this migration. A reactive approach to care is one in which patients present symptoms to their healthcare providers. Treatment is focused on identifying the illness as presented and mitigating its effects on the overall health of the patient. Proactive care hinges on communication initiated by healthcare providers. The focus is not on treatment but prevention – identifying potentially negative health outcomes (and their associated costs) before they occur.

In a proactive care environment, physicians, hospitals, and other healthcare providers coordinate care for a population to improve the health of individual patients. With the right data, analytics tools, and workflow technology, coordinating population care can be streamlined, cost effective, and powerful.

The Center for Medicare and Medicaid Services (CMS) has taken a lead role in our migration to a proactive care environment by initiating and funding a variety of new payment and delivery models. At the federal level, more than 150 Accountable Care Organizations (ACO) have been launched since 2011. The CMS State Innovation Models Initiative provides competitive funding opportunities for states to implement and test their own payment and delivery improvement models.

Many safety-net health plans have existing population care management platforms that already enable them to coordinate care proactively with their provider community. These systems dovetail nicely with both the ACO mission and many state-specific care coordination initiatives. Many payers, in other words, are already up to speed on leveraging data – both internally-generated claims data as well as clinical data from provider EMR systems – to identify high-risk patients and actively engage them in their health.

The next few years will be crucial to ensuring our proactive, quality-driven healthcare system becomes successful. It’s a huge shift for everyone involved. But with the right technology solutions, widespread implementation of best practices and the removal of data barriers between patients, providers, and payers, the US healthcare system can successfully delivery higher-quality care to more people at a lower cost.

Ashish Kachru is CEO of Altruista Health of Reston, VA.

The Patient’s Point of View: Patient Centered Medical Homes (PCMH)
By Joe Crandall

About 10 years ago, I was hospitalized a few times for colon cancer. Because of this experience, I pursued a professional career in healthcare.

Most recently, I have seen a care provider about 10 times for myself or my kids. You could say I am an educated consumer of healthcare. I would like to offer a patient’s perspective on the PCMH being adopted as a new care delivery model for the primary care physicians (PCP) office.

First, the PCMH has a lot to offer patients and caregivers:            

• Better access to healthcare
• Utilizing the right healthcare provider for the right problem
• Electronic medical records being shared to reduce tests and exams
• Better coordination for preventative medicine and long-term disease management

However, the PCMH has two problems:

• A marketing problem
• A change management problem

The term Patient Centered Medical Home is confusing to patients. The confusion arises because the name implies a physical location versus what is a change in the care process. For organizations implementing this solution, they should change the name to better reflect what they want to accomplish. A title suggestive of “centralized care coordination” would be better understood and adopted by all. Patients will be pleasantly surprised by the changes if they get past the poor naming convention.

The second problem the PCMH will have to overcome is resistance to change. Most organizations are slow to change because they don’t know where to start and/or they don’t know what they need to do to get certified. Luckily, the NCQA has specific guidelines on attaining designation as a PCMH along with some great tools to help with certification. Organizations are left on their own to conduct a comprehensive, unbiased, and objective assessment of their current capabilities. A good assessment will not only tell the organization where they are, but also why they are at that state of readiness.

With the starting point clearly identified and the 2011 NCQA standards as the goal, the organization can develop detailed courses of action. Even with excellent courses of action that clearly outline the steps to certification, organizations are reluctant to change. Each and every office worker needs to be educated on the PCMH model so they can articulate a clear message to each patient that visits the office. By involving and education everyone, the chances of success increase dramatically.

My PCP adopted the PCMH last year. His office appeared to run smoother. I got an appointment immediately and I waited less. Since then I have been treated, diagnosed, prescribed medications, had x-rays, and got the results all without seeing my PCP.

I didn’t feel like I received lesser treatment. I felt I received better, more focused care because the people I saw were available when I needed them and qualified for the level of care provided – all because of a centralized care model based out of my PCP’s office (not a home).

Joe Crandall is director of client engagement solutions of Greencastle Associates Consulting of Malvern, PA.

Allscripts Gets No Buyer, Cleans Executive House

Allscripts announced Wednesday evening that its board has rejected its strategic alternatives and has instead decided to “develop Allscripts’ long-term potential under the direction of our new management team.”

Glen Tullman has relinquished his role as CEO and board member, stepping down immediately. He has been replaced by Paul Black, an Allscripts board member and former Cerner COO. Allscripts President Lee Shapiro will step down immediately and will be available as a consultant to Paul Black for six months.

Dennis Chookaszian, Allscripts board chair, said, “We want to thank Glen Tullman for building Allscripts into one of the leaders in the evolving healthcare IT industry. Glen began at the Company in 1997 when it was unprofitable, turned Allscripts around and achieved record revenues and profits in 2011.  Along the way, Glen also grew the workforce to more than 7,000 employees. I also want to thank Lee Shapiro for his many important contributions to Allscripts, particularly with respect to our M&A strategy and international expansion.”

Allscripts shares were down 17 percent in after-hours trading shortly after the announcement.

UPDATE: According to an Allscripts customer e-mail forwarded by a reader, Laurie McGraw (chief client officer) and Diane Adams (EVP of culture and talent) will also be leaving the company.

Morning Headlines 12/19/12

Elliott offers to buy Compuware for $2.35B

Compuware shares closed up 17 percent after Elliot Management, which owns 8 percent of existing stock, submitted a $2.35 billion acquisition offer, which represents a 15 percent premium over Friday’s closing price.

PatientSafe Solutions raises $13.3 million

PatientSafe Solutions raises $13.3 million in equity financing toward its overall goal of $25.7 million.

California-based Health Group Selects Paragon to Fuel Growth Strategy

Rideout Health selects McKesson Paragon for its clinical and financial EHR solution.

Orion Health Mobile Will Increase Clinical Efficiency and Enhance Patient Care

Orion Health announces the release of a mobile app providing access to real-time patient information.

News 12/19/12

Top News

A Wells Fargo Securities analysis of EHR attestation data finds a surge in the number of hospitals and practices qualifying for Meaningful Use money, which it expects to continue through the February deadline. It also notes that Epic is starting to dominate in all measures, leading in the number of physicians that have attested in with a success rate of 35 percent and representing 21 percent of the total attestations. Athenahealth was also noted as performing at an above-average rate, with neutral numbers for Allscripts and slightly negative numbers for Quality Systems. I ran the cumulative percentages by vendor and found that 80 percent of attesting providers are represented by just 22 of the 391 vendors listed: Epic, Allscripts, eClinicalWorks, NextGen, GE Healthcare, McKesson, Greenway, Cerner, Practice Fusion, athenahealth, Vitera, e-MDs, Community Computer Service, Eyefinity, Amazing Charts, Compulink, BioMedix Vascular Solutions, MedPlus, Medflow, Aprima, Partners HealthCare, and MedInformatix.

Reader Comments

From The PACS Designer: “Re: X-rays using your phone. Two engineers from California Institute of Technology have developed a microchip that can produce images inside objects without using the normal radiation method. The circuits operate with existing mobile phone technology but use the terahertz operating region to produce the viewable image for the phone. Terahertz radiation can penetrate through the body without damaging the tissue it passes through.”

From Vendor Middle Manager: “Re: clinician compensation. Can you ping the vendor community on the levels of compensation (salary, bonuses, options, etc.) being paid to clinicians? It’s hard to find out because of inherent reluctance to disclose compensation and the variety of titles that don’t reflect true roles. It would be great to hear anonymous examples of physician and nurse compensation with the primary role specified (doing demos, designing user interfaces, developing content, etc.)” I’ll collect and anonymously report your responses if you would care to either e-mail me or use the anonymous Rumor Report.

From Mini Me: “Re: iPad Mini. I’m interested to know how doctors are using the iPad Mini.” Me, too. If you are a clinician using an iPad Mini or an IT person involved in its rollout for clinical use, let me know why you chose the Mini and how it’s being used.

Acquisitions, Funding, Business, and Stock

Investment firm Elliott Management offers to buy Compuware for about $2.4 billion, a 15 percent premium over last week’s closing price. Elliot, which owns 8 percent of the company, says Compuware’s “execution, profitability, and growth have meaningfully underperformed.” Above is CPWR’s five-year share price (blue) vs. the Nasdaq (red). Compuware filed for a possible IPO of its Covisint Corp. unit last week and could conduct the IPO in three to six months.

Revenue cycle software provider Recondo Technology acquires eHC Solutions, an Indianapolis-based developer of EDI solutions.

pMD releases a mobile version of its patient handoff product.

PatientSafe Solutions (formerly IntelliDot) raises $13.3 million in equity financing, about half of the amount it is seeking, raising its all-time financing total to $83 million. The company offers bedside scanning solutions for medications, specimens, and breast milk along with documentation and caregiver messaging.

Sales

Rideout Health (CA) selects McKesson’s Paragon HIS as its financial and clinical solution.

ARcare (KY/AR) selects SuccessEHS PM/EHR for its 45 community health center locations.

MemorialCare Health System (CA) will implement the KnowledgeEdge Enterprise Data Warehouse from Health Care DataWorks.

Trustees of St. John’s Medical Center (WY) decide to spend $240,000 to buy eClinicalWorks as a replacement for McKesson Practice Partner, which it has been running for five years. They say Practice Partner is not user friendly and makes it difficult to document office visits.

People

The Premier Healthcare Alliance names Gary S. Long (Surgical Information Systems) chief sales officer.

CCHIT adds Janet M. Corrigan (National Quality Forum) and Grace E. Terrell, MD (Cornerstone Health Care) to its board of trustees and promotes Executive Director Alisa Ray to CEO.

The National Quality Forum names Christine K. Cassel, MD (American Board of Internal Medicine) president and CEO effective mid-summer 2013.

James D. Morris (Western Digital) joins Harris Corporation as group president of the Integrated Network Solutions business, which includes Harris Healthcare Solutions.

The SSI Group appoints Brian Campbell SVP of sales and Tom Myers chief strategy officer. Both will maintain their roles with MedWorth, an SSI subsidiary.

Meditech promotes Carol Labadini to associate VP for development, implementation, and support of Meditech’s ambulatory solution and Hoda Sayed-Friel to EVP of strategy and marketing.

Billing company PatientFocus adds Philip Hertik (Windsor Health Group) and Lucius E. Burch, IV (Burch Investment Group) to its board of directors.

Ormed names Bill Hockstedler (Connance, Inc.) VP of sales and marketing.

Imprivata names Carina Edwards (Nuance) as SVP of its new Customer Experience Group.

Informatica names Margaret Breya (HP) chief marketing office and EVP.

Announcements and Implementations

New Horizons Health Systems (KY) goes live on Healthland Centriq EHR.

Hutchinson Clinic (KS) exchanges CCD from its Allscripts EMR to the Kansas Health Information Network using the ICA CareAlign Exchange platform.

Orion Health announces the release of Orion Health Mobile, which allows users of Orion Health HIE to view real-time patient information on their iPhones and iPads.

Ormed sells its Canadian business to a subsidiary of Constellation Software, saying it will now focus on selling it ERP, HR, and decision support products to the US healthcare market. Constellation has completed several acquisitions this month, including buying documentation and charge capture systems vendor Salar from Nuance. Constellation also owned 21 percent of Mediware, or about $40 million worth, when that company was acquired by Thoma Bravo last month.

A profile of NewYork-Presbyterian Hospital SVP/CIO Aurelia Boyer, RN, MBA describes the organization’s use of Caradigm Amalga to analyze quality measures in real time, which she says saved $1.5 million in discovering CHF treatment variations.

Medecision’s Aerial care management system earns NCQA disease management certification.  

Government and Politics

ONC recognizes Ohio for coordinating its Regional Extension Center, HIE, and Beacon Community in supporting Meaningful Use and interoperability. More than 8,200 Ohio providers have met Meaningful Use requirements, receiving $368 million in federal payments.

In England, the chair of the Public Accounts Committee says paying trusts to implement CSC’s Lorenzo system are “bribes.” An earlier report from eHealth Insider says that CSC has offered $1.6 million each to the next 10 hospitals who sign up for Lorenzo, with funds coming from the Department of Health and CSC. CSC says the report contained factual errors, while Department of Health denies the suggestion that the incentives give CSC an advantage over competitors.

Other

An article in a North Carolina newspaper illustrates why hospitals are snapping up medical practices. Simply by buying the practice, hospitals can bill up to double or more what the same physician in the same office would have been paid for performing the same service. Non-profit hospitals argue that they deserve to bill extra because of Medicare underpayment, a higher level of regulation, treatment of the uninsured, and a higher level of staffing. The article says North Carolina Attorney General Roy Cooper is considering using of antitrust laws to keep hospitals from raising healthcare costs by buying up their practice-based competitors. It cites an example of a patient’s echocardiogram, whose cost to her jumped from a $60 co-pay to a $952 bill even though the same technician performed the same test. In the Charlotte area, more than 90 percent of cardiologists are now hospital employees, spurred by a decline in their incomes of 30 to 40 percent in the past three years.

Weird News Andy says this baby was saved by scissors, but not like you’d think. UK doctors decide to save a baby born after 23 weeks of gestation (within the limit of legal abortion in almost all US states) because she weighed the minimum one pound to be considered viable. Only later did they realize that she had been weighed without removing a pair of scissors from the scales, with her actual weight being only 13 ounces. She’s been discharged after six months (after what must have been a monumental taxpayer expense) and is doing fine.

Sponsor Updates

• Several Marines pay a visit to eClinicalWorks’ Westboro, MA headquarters to collect donated toys for Toys for Tots.
• CommVault will pay $5.9 million for land in Tinton Falls, NJ to build its new headquarters.
• A Wolters Kluwer Health survey finds that 80 percent of consumers believe they would benefit from have more control of their healthcare, though only 19 percent have a PHR. Nineteen percent also say that the most important consideration when selecting a physician is the practice’s level of technology.
• Surgical Information Systems showcased its AIMS solution at this week’s PostGraduate Assembly on Anesthesiology in New York City.
• PSS World Medical will offer Wellcentive’s population health management and analytics platform to its customers.
• GetWellNetwork integrates Stanley Healthcare’s RTLS with its interactive patient care solution to identify caregivers entering patient rooms.
• Dx-Web will offer LDM Group’s PhysicianCare and ScriptGuide products to its network of EMR vendors, expanding the relationship between the companies.
• The Center for Medicare and Medicaid Innovation awards the Mayo Clinic, Philips Research North American, and the US Critical Illness and Injury Trials Group over $16 million to improve critical care in the ICU.
• Billian’s HealthDATA offers strategies for providers to reduce re-hospitalization rates in a blog post.
• AirStrip Technologies will add secure messaging to its applications using Diversinet’s mobiSecure SDK.
• RazorInsights will incorporate Health Language, Inc.’s software into its EHR system to support standard terminologies.
• Clinithink publishes the seventh installment of its seven-part blog series entitled, "Clinical NLP in Plain English."
• DrFirst is ranked by Black Book as the #1 vendor of standalone electronic prescribing systems.

Report from the Healthcare Privacy and Security Forum
December 2-3, Boston, MA
By MrVStream

If you are not serious about your patient information security and privacy issues, the Office of Civil Rights (OCR) is, and it will have both financial and legal consequences for the entity. Just check out the Case Examples and Resolution Agreements (more on OCR to follow.)

I had the very good two days attending the inaugural Security and Privacy Forum sponsored by Healthcare IT News and HIMSS in Boston last week. It was well attended with over 250 registrants and 15 corporate sponsors. It does remind me of the early days for HIMSS (I won’t tell you how many years ago that was). It was serious, interactive, and had relevant subjects.

Here are some of the highlights and noteworthy points.

• The keynote was delivered by Tim Zoph, SVP of administration of Northwestern Memorial Healthcare. He shared the greatest impact of a lack of focus on patient security and privacy is the erosion of confidence from patients and consumer towards healthcare providers, with the reported 435 breaches that affected 500 or more individuals since September 22, 2009, now totaling more than 20 million impacted individuals. Tim offered hopes and guidance to healthcare leadership that through creating a culture of security, simplifying the technology environment, using a standards-based security model, being proactive, and most importantly applying the right governance structure that is multidisciplinary, we can avoid security as one of these blind spots outlined in How the Mighty Fall by Jim Collins.
• Barbara Demster, chair of the HIMSS Patient Identity (PI) Integrity Work Group, outlined that PI Integrity has direct impacts to privacy and security in the areas of operations and finance. She offered a HIMSS white paper from the Patient Identity Integrity Toolkit. The current estimate is that records are duplicated in the eight to 12 percent range, with institutions experiencing 47 percent false negative and 51 percent false positive (more problematic). The financial impacts range from administrative, regulatory, and patient care-safety. Barbara also suggests that PI integrity processes need to include stakeholders across the organization. Barbara emphasized that commitment and explicit organizational guidelines towards data governance are imperative.
• Lisa Gallagher (senior director of privacy and security for HIMSS) and Bob Krenek (senior director of Experian Data Breach Resolution) presented the summary results of the 2012 HIMSS Security Survey, released December 12. Summary: (a) security budgets hold steady at 3 percent of the IT budget; (b) those organizations not conducting formal risk assessments will not qualify for MU incentives; (c) organizations need to establish a robust patient information secure environment in order to be able to safely share data externally; and (d) physician practices are not as advanced as other healthcare organizations in many areas of data security.
• Sharon Finney, corporate data security officer for Adventist Health System, shared that her approach in meeting the needs and prepare for an OCR audit is moving her department from internal audit functions to risk assessment, focus on the potential risk impact, quantifying the financial risk, and engaging other departments. She also urged understanding people and process and to focus on the connecting points between each steps. She said she expects MU audits to be performed on all the institutions received funding.
• Edward Ricks, VP/CIO of Beaufort Memorial Hospital suggested that to prepare for an OCR audit is to simplify the process and use outside consultants for support.
• Mobile access and BYOD in healthcare are still major issues for patient information security and privacy with no single strategy, especially in the areas of device-to-device communication of PHI and home or consumer data collection. Sample strategies: Kaiser (do not allow any BYOD), Partners (restrict to technology standards — iOS only), Children’s Hospital of Central California (provide a virtual desktop environment), and others using network security to limit information access. The general agreement is that leadership is required to create a culture of patient information security. There is plenty of work to be shared by all the functional roles, but the reality is, a low amount of resources devoted and focused on the efforts of patient information security and privacy from both the administration and the white coats.
• Jennings Aske (CISO of  Partners HealthCare) and Darren Lacey (CISO and director of IT compliance of Johns Hopkins University and Johns Hopkins Medicine) discussed the role of cloud computing. They suggested that it is necessary for the cloud supplier to sign a BAA, disclose underlying infrastructure, obtain third-party certification, and to demonstrate disclosure transparence. They did suggest that hybrid cloud services architecture is a good compromise.

Leon Rodriguez, director of the Office for Civil Rights (OCR), made these statements in an interview:

• HHS OCR enforces the HIPAA Privacy and Security Rules as well as the HITECH Breach Notification Rule.
• The final HIPAA Privacy and Security Rules are expected very soon.
• The greatest challenge is the transformation of the agency from a regulatory body to an enforcement agency, where the scope is expected to be broader in nature.
• The director position requires a balance of business needs and the need to comply with the regulations.
• OCR expects from providers a well-documented procedure and we expect the entity to follow the process. The focused is on encryption, encryption, and encryption.
• The awareness of management is still lacking, which makes it difficult for healthcare organizations to meet the regulations.
• OCR has to work to help  consumers to understand privacy violations.
• OCR is starting to move from a reactive mode to proactive audits based on risk analysis.
• OCR expects more monetary restitution in the future and to expand the agency using the proceeds of the fines. $4 million was collected in 2012, but that is expected to grow.
• OCR most likely will offer technology guidance, but will focus on the process.
• OCR is still trying to assess the level of resources necessary to complete the audit.
• Healthcare entity leadership will separate the successful implementation of a security and privacy plan from the unsuccessful ones.

Do you hear the OCR coming down the chimney to your facility? Plan to attend the Forum next year. I think you will find it worthwhile, and it may get you on the official Good List.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 12/18/12

CCHIT plans to develop and share IT framework for ACOs

CCHIT announces that it will develop and publish healthcare IT framework recommendations to support an ACO model.

Community Hospital CIS Market Share 2012: Small Hospitals, Big Changes

KLAS releases a new report on community hospital market share shows the largest growth for Epic, Cerner, CPSI and Healthland in the under-200 bed market segment.

Piedmont Healthcare and WellStar Health System Partner on Health Plan

Piedmont Healthcare and Wellstar Health System announce plans to offer a health system-based insurance plan starting in 2014. Hospital executives report a need for greater access to patient data to support a population health model of care.

New Horizons Health Systems, Inc. Moves Away from Current HIT Provider and Selects Healthland EHR Technology

New Horizon Health System, a 25-bed critical access hospital in Owenton, Kentucky selects Healthland’s Centriq EHR.

HIStalk Advisory Panel: Use of Mobile Devices

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 month’s question: What interesting uses of mobile devices are you seeing by hospital employees and physicians?

We have very limited use of mobile devices in our organization due to security-driven policies. We are hoping that once we complete a virtual desktop infrastructure install we’ll be able to be more flexible.

Jordan Hospital in Plymouth, MA has a terrific mobility approach. They had a serious noise problem on the patient floors. They decided to implement a "quiet hospital" program. They banned the use of the PA system for any reason on penalty of being fired. They bought a large number of iPhone 4s (at a great discount since the 5s have debuted).  They disabled their cellular functionality, making them usable only on a WiFi network (the hospital’s). At the beginning of each shift, the nursing staff picks up a phone from a large charging bay. He or she types in a code and that phone automatically rings to his or her personal extension during the shift. In addition, when the nurse logs in, he or she has immediate access to all of the patient EHRs (Meditech) that have been assigned to him or her for that shift. The charge nurses can assign patients individually or take a single nurse’s entire patient load and assign it to another nurse on the next shift with only a few keystrokes. Patient calls to the nursing station are automatically forwarded to the iPhone of that patient’s nurse. If the nurse doesn’t respond in 15 seconds, the call is automatically forwarded to the charge nurse. Doctors affiliated with the hospital also get iPhones, but theirs have their cellular functionality left intact, so he or she can be reached whether or not they are in the hospital. Individual extensions never change, and the on-call physicians in each specialty can be dialed or texted with a single keystroke. Jordan has not lost a single iPhone since the nurses’ units don’t work outside the four walls of the hospital. They were very surprised when they analyzed what functionality was being used by the nurses most frequently. It turned out to be texting, which was not expected since the average nurse’s age is 54. Within two weeks of implementation of the program, patient satisfaction scores went from the low 70s to the mid 90s.

We are using Clinical Expert to do some clinical surveillance relative to sepsis. These alerts are sent to response team via iTouch and iPad app.

[from a vendor employee] We’re definitely seeing increased uses of mobile devices by the people we connect with in revenue cycle, finance, and department heads. They’re relying on their mobile devices to have up-to-date information, dashboards, and reports on the overall financial status of their facility or system. These reports range from AR, productivity, and charge capture for revenue cycle. Department heads are moving toward utilizing mobile devices for up-to-date reports on physician performance and relative ranking within their department. Upper management likes to have this information "at their fingertips" during meetings or ad-hoc discussions. Properly designing these reports and dashboards for viewing and interaction on mobile devices hits the spot.

On the positive side, many hospital employees and clinicians continue to use their mobile devices as a reference tool to assure they properly understand diagnoses, medications, etc. We continue to see good use of these devices for continuing education and various other apps in that regard. One tremendous use of mobile devices done by our IT staff recently was to utilize FaceTime to allow a seriously ill patient to virtual attend their daughter’s wedding. On the dark side, hopefully everyone in the industry is aware that unsecure, unencrypted texting between staff and clinicians continues to be a risk that will not be eliminated without a secure texting solution. The lure of convenient, asynchronous communication is considerable and individuals will disregard policy and use available means to do so if we are not providing them with an appropriate and approved tool.

Nothing out of the ordinary. They are proving to be great for quick communications and coordination. Many providers are very HIPAA security aware and asking that we provide secure messaging apps. We do see responsiveness and coordination to be better than using pagers or other means for contacting individuals.

[from a vendor employee] At a recent visit to see a family member in the hospital, I noticed that all of the staff had a phone that they had clipped to their pockets. It wasn’t the size of a cell phone, but was a little smaller than cordless phone you would have at home (back when people had home phones). I asked one of the nurses what they used them for and she said, "I don’t know, but I hate it." Another nurse said that she loved it because it gave her all of the "notifications" she needed without having them broadcast over the intercom. She did say however, that it was very heavy and that it pulls on the her clothes (scrubs aren’t stiff enough to hold it). I noticed the staff checking theses phone constantly – like my teenager does when he’s texting his girlfriend.

Nothing good. Right now I’m fighting the battle of nurses using their personal cell phones to take pictures of EKG strips (PHI is blacked out) and sending them via unencrypted text to the physician. Evaluating our options right now.

Secure e-mail/calendar access. Texting between providers.

[from a vendor employee] I talk a lot about how the market niche we serve (enterprise clinical content management) has become much more than about how data is managed through its lifetime but rather now how data is accessed within a patient context. I believe the unprecedented demand for clinical data drives a greater need for data liquidity across healthcare IT applications. That said, as we continue to achieve a higher level of data liquidity, we will see clinical content accessed through many mobile devices. Heck, I’d argue that the platform becomes unimportant, data should just be available. Therefore we should be able to access the internal EMR, external EHR, even the HIE, though any device. On top of this, these devices are becoming the portal to multiple types of high definition content – be it pictures, movies, or other Internet-elivered content – why can’t clinical content be just as rich. As we move towards what I like to refer to as the High Definition EMR, I believe all clinical content will be accessed through any device, including mobile devices – especially by hospital employees and physicians.

We have rolled out Epic’s Haiku and Canto for our clinicians using iPhones/droids and iPads. The early response has been very positive. It’s read-only, but we will be adding Dragon functionality soon. We also have over 300 wireless mobile carts roaming the units using virtual desktop (VDI), thin clients, and Imprivata single sign-on with proximity access. Also a big satisfier.

Airstrip OB for fetal heart monitoring. Residents and younger attendings are using lots of apps for providing care instead of textbooks.

Communication! They are doing it now with all sorts of devices, so we are exploring a way to make it (1) integrated with the EMR (e.g. choose from a patient list), (2) more secure, but easy to use, and (3) widely adopted, but we recognize there may be more than one use case scenario (e.g. one use case might be about confirming orders, another about relaying a lab value, another about sending a photo, and another about getting a quick consult). We’ll see if one solution can solve all, or if more than one is needed.

Naturally, mobile devices on the public WiFi (as opposed to the hospital firewall) are not censored like the hospital intranet. So when you can’t get to the breast cancer walk site (because the hospital thinks it might be porn), you whip out your portable device. Same for ESPN.

While we use UpToDate Mobile and Epic’s Haiku and Canto, the cool thing we use today we developed and patients use is called WebAhead. Allows access to our urgent care locations and clinics and you can pick your appointment time on the fly… we call it WebAhead. There may be others being used by staff, but we don’t control the mobile aps nor are we pushing any right now as we are coming our Epic install.

Not seeing a lot. We are throwing new laptops and Dragon with PowerMics at our docs and for most of them that is plenty of technology at one time. We have also upgraded their desktops if they were very old. We have had a couple of request for the iPhone app for our EMR, but since interest is low key, we will add it later.

Curbside Consult with Dr. Jayne 12/17/12

ONC released the 2014 Edition Test Method for EHR Certification on Friday. In case you didn’t have anything to do over the holidays, now you can curl up in front of the fire with some cute and cuddly Test Procedures.

I have to be honest. I still struggle with Meaningful Use. I completely understand the goal. I also understand that there are a number of baby steps that must be taken in order to make data more transparent and transferrable. It’s extremely frustrating as a clinician, however, to have to codify data in ways that are seemingly meaningless.

Take the certification criteria for smoking status, for example. The Test Procedure document includes the approved SNOMED CT concepts “to assist the developers and implementers of EHR technology in the implementation of this requirement.” The concepts are:

• Current every day smoker
• Current some day smoker
• Former smoker
• Never smoker
• Smoker, current status unknown
• Unknown if ever smoked
• Heavy tobacco smoker
• Light tobacco smoker

For a minute, I’m going to take of my informatics hat and put on my average primary care provider hat. Let’s assume the only thing I know about SNOMED is that it’s some kind of coding system that sits under my EHR (if I even know that much, which I might not). Although the coding allows each of these to be uniquely identifiable, I’m not sure any of these (other than “Never smoker”) have specific levels of meaning to the majority of primary care physicians without detailed explanation.

For example, what is the definition of a heavy vs. light tobacco smoker? There are significantly different clinical risks to the former smoker depending on whether they’re a former heavy smoker vs. a former “only when I drink with friends” type of smoker.

There is a clarification that “smoking status includes any form of tobacco that is smoked, but not all tobacco use.” There are different risks to pipe smokers and cigar smokers than to cigarette smokers, but we’re not required to capture that nuance. In the old world, I could write TOB: 2ppd x 20y and 99 percent of clinicians would translate that to “cigarette smoker, two packs per day for twenty years” and could appropriately assess the patient’s risk. Now, to meet Meaningful Use, I’m going to be steered towards selections that don’t have a lot of clinical meaning.

Some vendors who had detailed and granular ways of documenting this information prior to Meaningful Use have kept their ability to gather that useful data and mapped it to the required codes. I can’t help but think that this will cause the data to lose something in translation.

Other vendors who are focused more on certification have added the new fields alongside their old ones. This forces clinicians to document the data twice – once for clinical significance and once for a federal program. Although it meets the letter of the law, it makes for unhappy users and poor design. I know of at least two products out there, however, which function in this way.

ONC works through the paradox of mapping on page 3 of the smoking status document. It gives the sample of a “pack a day” smoker that the Certified EHR maps to “current heavy smoker.” It notes that when the transition of care document is created, the additional text description and any other metadata could be included along with the SNOMED. It continues”

Note that “heavy smoker” is not the only concept that is appropriate here, and we leave the decision regarding which of the eight codes is the most accurate descriptor of clinical intent to the judgment of those implementing the form, template, or other EHR data capture interface.

I’m not sure that makes me feel much better. Unless they have dedicated clinicians working through these design specifications, it leaves us with software developers deciding how to best document clinical intent.

As the document continues, they include language from the 2011 preamble of the Health Information Technology standards document. It specifies the definitions of the various selections:

… we understand that a “current every day smoker” or “current some day smoker” is an individual who has smoked at least 100 cigarettes during his/her lifetime and still regularly smokes every day or periodically, yet consistently; a “former smoker” would be an individual who has smoked at least 100 cigarettes during his/her lifetime but does not currently smoke; and a “never smoker” would be an individual who has not smoked 100 or more cigarettes during his/her lifetime. The other two statuses (smoker, current status unknown; and unknown if ever smoked) would be available if an individual’s smoking status is ambiguous. The status “smoker, current status unknown” would apply to individuals who were known to have smoked at least 100 cigarettes in the past, but their [sic] whether they currently still smoke is unknown. The last status of “unknown if ever smoked” is self-explanatory.

I wonder how many of my primary care peers have read this language and share this definition? It’s been awhile since I was in medical school and residency, but I’m pretty current on my continuing education classes and haven’t seen this emphasized in recent articles about the risks of smoking. What’s magical about 100 cigarettes? Is there solid data that shows a difference in risk once a smoker hits that number? Maybe I need to go back to school.

Continuing on, the document clarifies the cutoff of “heavy vs. light” smoking as being more than 10 or fewer than 10 cigarettes per day, “or an equivalent (but less concretely defined) quantity of cigar or pipe smoke.” What if they smoke exactly 10 cigarettes per day? They don’t meet either definition.

I realize I’m splitting hairs here and some of you may have tuned out by now, but that’s the point. We’ve taken data that had clinical meaning and was easily understandable and turned it into data that is confusing and potentially meaningless. I’m not sure if that’s really taking us forward. The data is only as good as the staff entering it and the likelihood of physicians understanding the concepts (let alone training their staff to understand the concepts) may be low.

Compared to other parts of MU, the documentation of smoking status seems fairly straightforward. That’s not very reassuring considering a program which will continue to become more complex as we move forward. We’re not even to Stage 2 yet and I need a break. As they used to say, smoke ‘em if you got ‘em.

E-mail Dr. Jayne.

Morning Headlines 12/17/12

2014 Edition Test Method

ONC releases the 2014 Edition Test Method which outlines testing steps for EHR certification

HealthTrio Sues Aetna for Patent Infringement in Colorado

HealthTrio sues Aetna and its ActiveHealth Management and Medicity subsidiaries for violation of its patient portal patent.

New Medicare fraud detection system saves $115 mil

A new CMS report claims it has realized $115 million in savings after implementing a $77 million fraud detection system.

2 Chesco companies report combined 168 layoffs

Medecision announces that it will lay off 83 employees from its software development and technical support divisions, effective February 3.

Monday Morning Update 12/17/12

From John: “Re: ONC. What happened to its announced intention to publish an EHR safety action and surveillance plan? It was announced in November 2011 and was supposed to be finished within 12 months.” 

From California Dreamin’: “Re: MMRGlobal’s patent trolling lawsuits for patient portals. I hear ONC and the California Attorney General are interested in the company’s reason for e-mailing individual hospitals about its patents. The company seems to be going after hospitals rather than vendors for patent infringement.” The former is unverified, while the latter does seem to be the case as the company’s lawyers cast the net wide, apparently including just about every hospital as a potential patent violator.

From Former Allscripts Employee: “Re: HHC lawsuit. I know for a fact that Glen and many others at Allscripts (as well as many outside of the company) are convinced that Epic is fleecing its customers. They feel Epic’s costs – especially the undisclosed long-term costs of operation – are outrageous and are hurting healthcare. As a former employee who participated in many C-level conversations, I’m guessing that they hope to use the lawsuit to bring those costs to light through the discovery process. Moreover, Allscripts has in fact demonstrated the integration of its ambulatory and inpatient EHRs at least one live site. And I’m sure they feel HHC could benefit from connectivity to Allscripts systems currently in place at Columbia, NewYork-Presbyterian, Memorial Sloan-Kettering, North Shore Long Island, and other NYC-based health systems serving millions of local patients whose records would be helpful to HHC providers. So while I agree it’s a dumb PR move for Allscripts, it’s not necessarily a bad business decision.”

Allscripts filed the lawsuit because NYCHHC failed to even address, much less resolve, significant concerns that Allscripts’ raised in its agency-level protest concerning the propriety of HHC’s iCIS award decision. Documents produced by HHC indicate that the agency failed to follow the rules governing the competition and overlooked hundreds of millions of dollars in potential savings offered by Allscripts’ proposal. In these times, it is critical that public procurements be awarded through the conduct of fair competitions that objectively assess the merits of competing proposals and document a reasonable basis for the decision. From all available information, the HHC award to Epic is lacking in all of these respects. Allscripts’ product is currently being used by some of the most prestigious organizations in New York, we offered substantial cost savings over the life cycle of the project, and we committed to creating more than 100 new technology jobs in the City. Had proposals been evaluated properly, we believe that our offer was clearly the best value for the City. Our goal remains the same: We want transparency in the process… we want the bid process reopened so that the competing proposals can be reviewed fairly, consistently and side-by-side to ensure that the taxpayers of NYC obtain the best value Electronic Health Record solution.

Communications. Combine the following medical, cultural, and technical TLAs and FLAs  into a meaningful sentence. You may use one pronoun, one verb, two prepositional modifiers, and a gerund.  Ex: IMHO, CMIO NCQA PCMH FAQs without LOINC, HL-7, or SNOMED FYIs were DOA and SOL. SNAFU. 

PS: if you know all these, you do not need to complete the rest of the test.

1. SQL, LOS, CMS, PDQ, CDS, MSSP, MRSA, TIN, RAC
2. HTML5, CVA, TJC, CFO, FYI, CXO, EDW, HIE, AKA
3. CPOE, CTO, SOL, HIPAA, ACO, TIA, IMHO, GOMER
4. PERL, TWAIN, ACA, VTE, PHR, CAPTCHA, POS, POC

Patient management. Who will have the most useful problem list?

1. Five different hospitalists, NPs, and nurses using a combination of ICD9/10, SNOMED, and homegrown synonyms, with no one in charge
2. A 70-year-old GP using free text
3. Surgeon – two items for 84-year-old ICU patient
4. Neonatologist — 27 SNOMED items for a three-day-old
5. Patient’s PHR

Training. Which of the following techniques works least badly?

1. Day-old pizza and handouts in the lunch room
2. Department meetings at 7 a.m. on a Monday
3. E-mails from people no one has heard of
4. At-elbow support by people who just heard about  the project yesterday

Leadership. You have 15 hospitals over four states. Which model of leadership works best?

1. Central (disconnected, jet lagged, and intermittent)
2. Local (random, quirky, and adversarial)
3. Democratic (but only certain people can vote)
4. A CMIO with no direct reports, graded on “influence”

Fill in the correct phrase or words.

1. CFO is to Budget as Sphincter is to __________.
2. Twitter is to Communications as Static is to ____________.
3. Regulation is to Efficiency as Friction is to ____________.
4. ACO is to HMO as Deja vu is to ___________.

Order management. You are leading a CPOE installation and want to use the latest evidence-based guidelines. What is the right approach?

1. Call a meeting of department leads, take two years, then make them up yourself
2. Use third-party content, send to department leads, wait six months, then make them up yourself
3. Use your paper-based content and sneak in the latest content with the one guy who comes to your meetings (i.e., make them up yourself)
4. Google

Support. You are stopped in the hall and asked to design a new system that will save this physician maybe 2 –3 clicks a week, but will take your team at least two months of design, development and testing, two more months of training the entire staff, along with disrupting everyone else’s workflow. What is your response?

1. Ask them to send you an e-mail describing the effort, knowing that they are “too busy” to get around to it
2. There is no other correct answer

Software selection. You have been asked to select a new EMR for your 200-bed hospital. What  are the first steps you should take?

1. Change your bed number to 500 so Epic will talk to you
2. Watch the Cerner salespeople twitch when you ask one of them to demo the entire “standard implementation”
3. Read KLAS, develop detailed requirements, do reference visits, then cave in to the most powerful docs (that couldn’t be bothered to come to demos) because they heard that System X was hard to use
4. Go to HIMSS for wine and dine, then play spin-the-pocketbook and pray you get the “mature” implementation team promised by a sales guy you will never see again

Statistics. Which of the following principles are true?

1. Pareto principle – 20 percent of the producers will make 80 percent of the product, but they will not be paid like it
2. Death panel principle – 5 percent of the population consumes 50 percent of the costs, but you can’t do anything about it
3. Incentive principle — the other 80 percent (see Pareto) will spend more energy gaming the system than producing
4. Software development principle – 3 percent of the use cases will drive 80 percent of the timeline delays

Meetings. As CMIO, you are invited to a 2.5 hour mandatory budget meeting. What is your response?

1. Attend with iPhone and iPad charged and catch up on e-mail
2. Dial in while getting work done from your office, knowing that the CFO’s secretary will not be able to figure out the teleconference link
3. Attend, listen closely, and wait for the moment when a physician’s fiscal wisdom will be most appreciated
4. CMIOs do not get invited to budget meetings, and if they do, that is when you use the spam filter excuse.

Alerts. What is the most effective method of providing meaningful alerts to busy clinicians?

1. Goldilocks – community-based balanced approach that will still get you eaten by the bears, and the “ community” will be nowhere around
2. Overalerting — as determined by docs who just want to know when they are definitely going to kill someone
3. Underalerting — as determined by your legal representation
4. Individually tuned for relevancy, with actionable orders easily accessible within the order, highlighting only important info that you didn’t know and makes a difference in this unique patient (available in the next release)
5. Horror stories in the physician’s lounge

User interface. Which of the following is the most effective modality for communicating key clinical information?

1. A 24-inch LCD monitor with 5,347 elements in three-column view, vertical scrolling, and 23 colors
2. An iPhone with no information on the top screen, but multiple branching links which will eventually lead you to YouTube
3. An angry nurse that  you have not returned pages to for over an hour
4. An intern whose pre-med major was theatre arts

13.  Pa55Words. Which of the following is optimal policy?

1. Same password for all your applications “HckerPLsDoEmails2OK?”
2. Four factor – iris scan, voice profile, 10-character randomly generated password changed every three months, with RFID embedded chip, Comrade
3. Three strikes, you get pepper spray
4. Prefilled sticky notes attached when shipping monitors

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

HIStalk Interviews Yann Beaullan-Thong, CEO, Vindicet

Yann Beaullan-Thong is CEO and founder of Vindicet.

Give me some background about yourself and about the company.

I’m the founder and CEO of Vindicet. We started the company in 2009. Prior to that, I was the vice president of e-business at Aetna for a division called Intellihealth. It was the first public healthcare website prior to WebMD.

My intention when I started the company was to create a software company that would provide affordable, process-oriented solutions to providers. In 2009, I met Dr. John Votto, CEO at Hospital for Special Care and a thought leader for long-term acute care hospitals. I was asked to provide a system to make the referral process more efficient.

As we started to build a patient referral tool, I took the bet that bundle payments and ACOs will be here to stay and will need systems to support these new business models. We morphed our referral tool into a coordination tool to manage the patient through the continuum of care.

Who does the company compete with?

Indirectly, we can compete with a lot of other players, like Curaspan, Cerner or Allscripts. The patient management process, the referral process, the compliance process , the admission and discharge process are supported by many vendors. They are part of the problem — too many vendors supporting different processes at the facility level.

We are the only system that can support all these processes for the ACO or enterprise health system level using one platform. We are able to provide a safe transition care tool using a light Enterprise Resource Planning approach.

Describe the referral process as it exists and how you think it will look under the new models of care.

Today with a fee-for-service payment, each facility operates as an island. Referrals are no more than a discharge to home or a post-care facility. Moving forward with ACOs, the referral is becoming a central component. The financial compensation will be tied to the overall outcomes. Tracking the patient through the entire continuum of care and managing the coordination of care between the different providers will be essential to optimizing outcomes.

Let’s assume that a patient comes in for congestive heart failure and they are a Medicare patient. We know that out of 10 patients, five to six might will end up into a post-care facility. Suddenly everybody has to be very well aware of how well they’re going through the entire episode. Not just from the acute side, but when they are discharged to a long-term acute care and then moved into an inpatient rehab center and finally discharged home under the supervision of a home health agency.

Under a bundled payment model, you’re going to be responsible for that whole episode. Under this coming model, absolutely nobody is prepared to deal with this new challenge.

Initially, we designed a referral system for standalone post-care facilities. Through the years, we modified it to become a multi-facility transitional and coordination care system. Our unique approach allows us to integrate the enterprise coordination process with patient management and compliance reporting.

Do you see new companies starting to try to do what you’re already doing?

There are a lot of companies that are coming to the space, but we are about 18 months ahead. We have been approached by some large companies, very large payers who are looking into the ACO space.

I am looking to make the coordination of care more efficient between providers, including primary care physicians. I would say that the problem I’m trying to resolve is transitional care. An EMR is not solving that problem. An EMR is designed to provide care at the delivery point. It’s not designed to manage care across providers.

It’s interesting, because when I started the company about three years ago, a lot of people were asking me to build an EMR. My answer was, “There’s plenty of EMRs. The last thing you need is another one.”

Also, talking to CEOs and CFOs, I often hear, “OK, now that we have an EMR, we need to integrate with the ambulatory care services and post-care facilities.” And in the same breath, they will say, “We are running out of money with this EMR project.” Literally people are looking at each other around the room and saying, “How are we going to do this? How are we going to pay for it?”

Either you build what I call islands — EMR for post care, EMR for ambulatory care, and for acute care — and spend a ton of money to add the bridges. Or, let’s look into a system that will allow us to have one view of the patients across the continuum. That’s when I come in with my poor man’s solution.

Do you think providers believe that HIEs will provide that capability or that interoperability is the answer? Are they beginning to realize that just talking to other systems may not be enough?

Executives are starting to realize that it’s not as easy as it sounds to integrate legacy systems. HIEs don’t address the process issues. Also, I’ve noticed a trend of information overload. It is not just pulling the information, but making it relevant and usable.

The other riddles that need to be solved when we’re talking about the HIEs — besides the exchange of information — is integrated process. You’d have to integrate various processes if you’re going to go through a longitudinal-type of continuum of care. It’s not just tracking the information at each point of care with different providers. You need a seamless process on how you can move a patient from one place to the other.

Do you think providers are ready not only technologically, but as you said process-wise, to be able to function effectively in that kind of environment?

I’ll try to give you a response that is apolitical. I’m absolutely convinced in my fiber that as a country, if we don’t resolve our healthcare problem, we will go bankrupt. We’re already at 16 percent of GDP.

If you’re going to do reimbursement based on outcome, which is where the industry is going (the Kaiser model), we are going to need to collect a lot of data and use key performance indicators to increase efficiency. We are already there. 

I just built a CMS data quality tool for 17 long-term acute care hospitals where they had to report outcome within 24 hours for discharges and within four days when it comes to admissions,. They need to report outcomes to the government in order to avoid the 2 percent penalties.

Moving forward, the government is going to ask for more data. Collecting data is a very expensive business. Healthcare systems out there are struggling to implement an EMR system, and now we are asking them to track outcomes through the different providers. Most of providers have no funding left following an EMR implementation, and now we want them to fund projects to track patients across the continuum.

I guess hospitals aren’t happy when they have to come to you, then?

They’re not, but I came up with a value proposition that makes the solution affordable. A lot of clients tell me, “How do you make a living with the way you’re selling it?” I say, “Don’t worry. I’m OK.” I moved away from the licensing per bed to unlimited number of users. It’s time as an industry to think out of the box and come up with solutions that are affordable.

Will other vendors get that model of following a long-term strategy rather than just charging the absolute most they can?

I think they will have to. One of the reasons why I believe that system is going to do well is transparency. I truly believe that transparency will exist in healthcare. I come from a payer and they’re probably not the most transparent players, but they have the tools to become more transparent.

They are data-driven companies. I learned one thing. If you want to be efficient, you need to change your mindset from being non-profit to a mindset of better outcomes in order to stay in business. You need to be transparent. You need to be transparent in front of the patient. You need to be transparent with physicians. I think as an industry, it’s time we start to be transparent. If we do not become transparent, we’re going to go broke, period. It cannot stay the way it is.

I think there’s a movement out there toward change. All of us recognize that there’s need for a change, and I think the change will come from the outside. I always say when an industry has a problem, the answer is not within. Usually the guys that start to find the answer are guys that come from other industries.

Any concluding thoughts?

As an industry, in healthcare, we need to change our mindset from a non-profit mindset to what I’m calling for-profit, where we’re going to be more accountable. To be more accountable, you need to collect data. To collect data, you need to build systems that implement new processes. I envision healthcare facilities being managed like a Walmart by the minute to keep costs down.

When I go to see CFOs in hospitals, they manage their business by quarter or a year ahead. There’s a need to manage your business by the minute. To get there, we need to start to collect data. Not just clinical data, but financial data and administrative data .We need to create key performance indicators, or KPIs. If you don’t run the business according to KPIs, there’s no way in the world that you’re going to change the way you are operating.

The government is probably going to make people more accountable and switch from fee-for-service to pay-for-performance. However, we’re a long way from being efficient. I see  government mandating more and more data collection for compliance. As an industry, that’s where we’re going. Whether you’re from the left or the right doesn’t matter. Accountability is the buzzword. I think it’s going to force the entire industry to learn to do more with fewer resources.

Time Capsule: Community Physicians and Technology: Think Convenience Store Owner, Not Society-Minded Scientist

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 February 2008.

Community Physicians and Technology: Think Convenience Store Owner, Not Society-Minded Scientist
By Mr. HIStalk

I have had the magic revelation. I know now why we healthcare IT people can’t figure out the seemingly puzzling behavior of small-practice doctors when it comes to technology adoption.

Here it is. Once they hang out a shingle, they’re no longer society-minded scientists. They’re small business owners.

The next time someone talks about physician practices, replace that term with “convenience store owner.” They’re on every corner, they compete vigorously for business, they watch expenses with an eagle eye, and they pay themselves only after everybody else gets paid. And unlike convenience store owners, they have to deal with insurance companies who tell them what they’ll get paid and hammer them with a mass of ever-changing regulations.

They’re also going to look at IT a lot differently than doctors in hospitals. Or especially, than hospitals themselves. Any money they spend on IT comes out of their own pockets. Any help they need doesn’t come from the friendly IT department — they have to find someone and pay high rates for even simple tasks, like installing a PC or figuring out connectivity problems.

Technology cheerleaders get frustrated that docs don’t just buy systems and get with the program so everybody can benefit. The problem is that everybody doesn’t benefit. Doc has just made a donation to insurance companies, patients, and hospitals who all appreciate the boost in their well-being from his or her investment. That doesn’t even include the extra time required to maintain electronic documentation, which always takes longer than scribbling. Physicians have just one thing to sell: time. They protect it strenuously, as they should.

We hospital types forget that 90 percent of a general practitioner’s time and even more of his or her income comes from their small business. Seeing patients in the hospital is a cost of doing business, not the day’s focus. While the hospital folks are going to meetings and delivering care as part of a big team, Doc’s out there on the front lines taking all comers, armed only with a few minimally trained assistants and whatever’s in his or her head, trying to improve health and provide a positive customer experience in an average of six minutes per visit.

The people they deal with in hospitals have, for the most part, never run a small business. They’ve always worked for someone else. The world looks a lot different when the only employer who’ll take care of you is you.

From an economic standpoint, doctors are paid to work. If we’ve got some kind of beef about excessive use of diagnostic procedures or esoteric treatments, we need to stop paying for them. That convenience store owner will sell you cigarettes and beer that are bad for you because (a) you want them, and (b) it adds to their bottom line. There’s a word for those civic-minded C-stores that stop selling them on principal: defunct.

Doctors are pretty much stuck in the small business model. The problem is that we’re expecting them to hold hands and join the choir even though they’re struggling to keep the doors open given rampant competition, reduced payments, and a fickle market.

I’m making a point to think twice before ripping doctors for not jumping all over e-prescribing, pay for performance, or interoperability. Unless you’ve got a rock-solid argument that would convince a convenience store owner, you’re wasting your time.

KLAS Releases 2012 Best in KLAS Awards 12/14/12

Epic takes top honors for Overall Software Vendor,  Overall Software Suite Vendor, and Overall Physician Practice Vendor in the 2012 Best in KLAS Awards.

Epic sweeps eight Best in KLAS award categories and athenahealth receives the second most Best in KLAS wins. Impact Advisor was named the number one Overall Services Vendor.

Morning Headlines 12/14/12

Allscripts Sues NYC Health & Hospitals Over Contract Award

In an inexplicable strategic decision, Allscripts files suit against both NYC Health & Hospitals and Epic over HHC’s recent selection of Epic over Allscripts.

Streamline Health Reports Third Quarter Fiscal Year 2012 Financial Results

Streamline Health reports Q3 results, with 52 percent increased revenue and EPS –$0.11 vs. $0.03.

Battle Mountain General Hospital Selects Prognosis HIS Enterprise Solution for Fast Usability and Adaptability

Prognosis HIS is awarded vendor of choice by Battle Mountain General Hospital.

Bill Moran Named Chief Information Officer at The Brooklyn Hospital Center

Bill Moran is named CIO of The Brooklyn Hospital Center, leaving his position as SVP and Health Practice Principal Executive at Dell.

5th Annual HIMSS Security Survey

HIMSS surveys HIT professionals on security policies, auditing, and budgets. More than half of the survey respondents reported an increase in budget for information security.

News 12/14/12

Top News

Allscripts files suit against NYC Health & Hospitals along with Epic Systems over the $303 million contract HHC awarded to Epic in late September. The complaint says the award is “arbitrary, capricious, an abuse of discretion, and lacks a rational basis” because it claims Epic’s proposed cost is $535 million more than that of the Allscripts proposal. HHC says it will defend its decision and added, “Allscripts’ claim that it underbid Epic by more than half a billion dollars is absurd and strikes us as an ill-fated attempt to reassure investors and inflate its sagging stock price. Unfortunately, as our multi-year review has revealed, Allscripts lacks a truly integrated EMR solution and has repeatedly lost business to Epic and other vendors as a result.” MDRX shares closed Thursday at $10.80, down 2.44 percent and indeed sagging at less than half their February price.

Reader Comments

From Bain Marie: “Re: Allscripts sore loser lawsuit against New York HHC. They had to deal with Hurricane Sandy and now will spend a fortune to defend themselves against Glen’s bizarre public accusation that its prospect would pay almost anything to avoid buying its product. Would you say this is the dumbest move in HIT history?” It’s certainly in the top handful, and probably the undisputed #1 in the “desperation” category (HBOC’s frenzy to mate with McKesson was even more desperate, but Allscripts wins on style points for suing a non-profit hospital.) I won’t editorialize further since Allscripts employees, shareholders, prospects, customers, and potential acquirers (if indeed any are still interested) are probably already amply embarrassed by this latest in a string of bad company decisions that always send competitors running gleefully to the scanner to make sure prospects get copies. That’s my opinion. If you work for a hospital, especially one with Allscripts connections, I’d like to hear yours. If you work for Allscripts, I’d be even more interested.

From Nasty Parts: “Re: Mike Lovett. Promoted to replace Scott Decker at NextGen.” Unverified. His LinkedIn profile shows a new job of SVP/QSI Division Leader – Ambulatory Division.

From  Kaiser Surgeon: “Re: video by KP ambulatory surgery staff at Fremont Ambulatory Surgery Department. They are well known for high-volume cataract surgery on our Kaiser patients. They do seem to have an esprit de corps.” I’m always a sucker for hospital music videos like this one.

From Former Stanley Tool: “Re: Healthcare Informatics Associates. Stanley Healthcare Solutions is shutting it down.” Unverified, but searching LinkedIn finds at least one former employee who is freshly entering the job market.

HIStalk Announcements and Requests

If you have been busy holiday shopping and missed reading HIStalk Practice this week, here are some highlights. Two-thirds of EPs will apply or have applied for MU incentives. ONC says that more office-based physicians are using EHRs that have higher-level functionality to meet MU objectives. ED use declines when patients have access to after-hours service from their primary care provider. HHS offers tools to protect PHI on mobile devices. Physicians spend more time on health content-specific websites than any other health sites, though more are also visiting EHR portals. Epocrates releases a native app for iPads and iPad minis. Dr. Gregg pronounces the consumer the heir to throne of healthcare. I made the “nice” list again this year, but the only gift I need is a few more e-mail sign-ups on HIStalk Practice. Thanks for reading. (P.S. If you are a shoe distributor, own a wine shop, or are a male admirer who likes to give expensive jewelry, please disregard the “only gift I need” statement.)

Welcome to new HIStalk Platinum sponsor RazorInsights. I’m guessing the Kennesaw, GA-based company found HIStalk because I’ve run several non-anonymous hospital reader comments about the company’s ONE Enterprise HIS for rural, critical access, and community hospitals. It offers a single-database, certified, cloud-based hospital EHR. Every one of the company’s live hospital clients have earned Meaningful Use payments. Customers enjoy one database, one simple user interface, and capabilities that include a master patient registry, patient encounter management, nursing documentation, CPOE, and physician offline orders. It’s available in multiple editions that include clinicals only, clinicals plus financials, clinicals plus ambulatory, and the Enterprise Edition including all of those. Customers can go live in as little as 90 days, enjoying cost-effective training services and around-the-clock support. People always bemoan the lack of new companies and new, scratch-built technologies in the inpatient EHR business, so here’s one for you. The company’s management has plenty of industry experience, including folks with pharmacy and nursing degrees along with vendor experience. To learn more, sign up for a live product webinar on their site or check them out at the HIMSS conference in a few weeks. Thanks to RazorInsights for supporting HIStalk.

I always head over to YouTube when introducing a new company just to see what’s out there, so here’s an introductory video from RazorInsights. You’ll get a hint about the company’s name early in the video, although you might have to Google the reference like I did.

It’s an odd time of year to be swamped at the hospital and at HIStalk, but that’s the case. I work on HIStalk until at least 10 every night and I’m back in the same chair by 5 the next morning before I head out to work. I try to respond to requests quickly, but it often doesn’t happen, and re-sending the e-mail or expressing indignation doesn’t change my time constraints one bit. I usually catch up over the weekend, though.

Acquisitions, Funding, Business, and Stock

Cerner will repurchase up to $170 million of its common stock.

Global Record Systems acquires the eCastEMR platform and service business from eCast Corporation.

Streamline Health Solutions reports Q3 results: revenue up 51 percent, EPS –$0.11 vs. $0.03.

LocalMed, a patient self-scheduling software company that won $3,500 in seed capital from the LSU Student Incubator, will establish its headquarters in Baton Rouge, LA and plans to hire 52 employees by 2016.

Sales

Sales Battle Mountain General Hospital (NV) selects ChartAccess EHR and FinancialAccess from Prognosis HIS .

HealthInfoNet, the HIE for Maine, signs a three-year agreement with Arcadia Solutions for its Analytics and Quality Data Warehouse platform for clinical data warehousing. Aracadia will also test the linkage of the HIE’s clinical data with claims data from the state’s All-Payer Claims Database.

People

The Brooklyn Hospital Center (NY) names Bill Moran (Dell) SVP and CIO.

Lisa Rawlins (Broward Health) joins SRG Technology as director of health care.

Norman Joseph Woodland, who co-invented the bar code as a graduate student in 1951, has died at 91.

Announcements and Implementations

Joslin Diabetes Center (MA) will use de-identified clinical data from Humedica for education and research activities.

Government and Politics

ONC launches a mobile device security initiative that provides white papers and articles to help providers understand how to protect patient information on mobile devices. The site is a product of HHS’s March 2012 Mobile Device Roundtable along with tips and information contributed during its 30-day comment period. Included is a video titled Worried About Using a Mobile Health Device for Work? Here’s What to Do!
 

Technology

AT&T unveils a prototype of Asthma Triggers, a wireless sensor that sends air quality data to mobile devices.

Other

The Leapfrog Group, criticized by hospitals to which it assigned below-average patient safety grades last month, announces a partnership with Johns Hopkins Medicine to fine-tune its scoring methodology, also vowing that, “the Hospital Safety Score is here to stay.”

More than half of HIT professionals report a budget increase for information security, according to a HIMSS survey. Other key findings:

• Most hospitals are conducting risk analyses, with 71 percent performing an analysis at least annually
• One in five respondents say their organization experienced a security breach in the last year
• More than half the organizations spend three percent or less of their IT budget on securing patient data
• Two-thirds report that their organization conducted an audit of their IT security plan.

Paper medical records belonging to a recently raided and closed unlicensed pain management clinic in Florida are found in the dumpster of a nearby Dollar Store. Also found in the trash: used syringes and uncashed checks made out to a contracted pain doctor who was apparently being paid $1,500 per day to crank out oxycodone prescriptions.

Tampa General Hospital’s bond ratings agency calls out the hospital’s “compressed profitability” as being due to Epic implementation costs, lower inpatient utilization, and state Medicaid cuts.

Weird News Andy continues his armchair medical reviews with this article, in which Children’s Hospital of Philadelphia injects a disabled form of HIV into a six-year-old whose leukemia was expected to kill her within two days, hoping to stimulate her immune system enough to allow her to receive a bone marrow transplant. Six months after the infusion, the T-cells are still working and she’s in remission.

Sponsor Updates

• Mercy Regional Health Center (KS) expands its use of the Access Intelligent Forms Suite into its human resources department.
• Vitera Healthcare announces the general release of Live Chat, which provides customers with immediate online access to Vitera customer support.
• Surgical Information Systems enhances its perioperative information systems to provide interoperability with Siemens Soarian Clinicals.
• Agilum Healthcare Intelligence publishes a white paper that includes strategies to help small and mid-sized hospitals overcome common obstacles to obtaining useful business intelligence.
• Levi, Ray & Shoup sponsors this week’s Next Generation Healthcare Summit in San Antonio.
• Emdeon discusses the benefits of utilizing check reader devices at the point of service in a newsletter article.
• Adirondack Radiology Associates (NY) shares how it has increased coder productivity and reduced denials since implementing the Optum Computer-Assisted Coding solution. 
• API Healthcare’s Deborah Moore shares thoughts on the use of HIT to increase quality of care and patient satisfaction in a blog post.
• Informatica offers predictions on where technology is heading in 2013.
• Fourteen CareTech Solutions customers win a total of 20 eHealthcare Leadership Awards for their CareTech-designed websites.
• RSource, a provider of receivables management recovery solutions, and Streamline Health Solutions will cross-market each other’s services within their client bases.
• Winthrop Resources Corporation will offer equipment financing and advice to customers of MPC, an IT asset lifecycle management company.
• The British Columbia Ministry of Health selects McKesson as the vendor of choice for its radiologist peer review initiative.
• First Databank and JAC Pharmacy sponsor the Improving Patient Safety award at the NHS Isle of Wight Awards 2012.
• NextGen Healthcare will offer Aviacode’s cloud-delivered medical coding services to its customers.

Morning Headlines 12/13/12

Mediware Buys MediServe to Continue Expansion

Mediware Information Systems announces the acquisition of MediServe, a Chandler, Arizona-based provider of electronic documentation solutions for inpatient and acute care rehabilitation.

Pennsylvania Patient Safety Authority Studies Electronic Health Records’ (EHR) Safety

Pennsylvania’s Patient Safety Authority reviews 3,099 EHR-related events and determines that 89 percent resulted in no harm, 10 percent resulted in an unsafe condition but did not result in harm, and fifteen individual events resulted in actual patient harm.

Maine tops states for provider rate of EHRs, meaningful use

National Health IT coordinator Farzad Mostashari, MD, commends Maine, Kentucky and Ohio for having the most accelerated adoption of EHR rates in the nation during ONC’s annual meeting.

Cerner Announces Share Repurchase Program

Cerner approves a buyback of $170 million of its common stock, representing 1.2 percent of the company’s outstanding shares, as it closes out a year in which its stock is up more than 29 percent.

HIStalk Interviews Winjie Tang Miao, President, Texas Health Harris Methodist Hospital Alliance

Winjie Tang Miao is president of Texas Health Harris Methodist Hospital Alliance of Fort Worth, TX.

Tell me about yourself and the hospital.

I’ve been in healthcare for about 12 years now, all with Texas Health Resources. I guess it’s rare nowadays to be with an organization that long. THR is a faith-based, not-for-profit healthcare system in the Dallas-Fort Worth area. We have about 25 hospitals, a large physician group, and other healthcare services.

In my 12 years, I’ve been really privileged to work in three of our facilities, but most recently at Texas Health Harris Methodist Hospital Alliance, a brand new hospital that just opened in September.

When you look at the organization’s overall positioning and strategy, how important is IT?

I think it’s essential. Our stakeholders are demanding more of us, “us” being healthcare and the healthcare industry as a whole. We need technology to help us met their expectations of us, and honestly, our own expectations of ourselves.

Do you see the technology becoming more visible to patients or becoming more of a competitive differentiator?

Yes, I think it’s definitely already more visible to patients. For example, in our facility, we have technology now where you can look at your medical record in real time while you’re lying in your bed. You know what the physician has ordered for you in the morning and the afternoon. 

The education that’s been ordered for you now gets automatically pushed out. If I’m a congestive heart failure patient and I require some smoking cessation education, for example, technology enables us to make sure that patient gets that education and that they receive the education as documented in real time. All of that is direct technology that the patient sees.

I think there’s a lot of technology, though, that is really there to enhance the human capacity that patients may not necessarily see. Those are some of the things that I’m most excited about. How do we make the environment more user friendly for our caregivers, our physicians, our nurses, and all the staff that are at the facility? Because as we know, as the baby boomers retire, the workforce is going to shrink. We really need that technology to help bridge that gap.

In terms of being a competitive edge, I think there are certain parts that are going to be non-negotiable. I think an EMR is going to be non-negotiable. You’re going to have to have it, so I don’t think that’s a competitive edge. But I think having some other technologies — like proactive tools that will help improve management of chronic conditions and those type of things — would be a competitive edge.

What is the most innovative of the technologies that you’re using or planning to use?

What I would say is innovative is not necessarily the technology in itself. We do have a patient information device. We do have RTLS throughout our facility. But it’s not the technology that is innovative for me.

I think what is innovative in this particular facility is how we’re integrating all those technologies together. How does Vocera talk to RTLS and to nurse call? How does that mean that, OK, now that I have I have a patient discharged, I can just take their RTLS locator tag, dump it in a box, and because it’s in that box, it automatically sends a note to TeleTracking to say, “Now it’s time to clean this room.” The housekeeper on Vocera automatically gets notified because through RTLS, we know that that’s the housekeeper on that floor. A process that normally would take either multiple phone calls or multiple clicks on a computer is now automated in real time.

As a new facility, you’ve probably had conversations with vendors about what technology you’re going to use and how you’re going to use it. Is that different from what the other Texas Health Resources hospitals use?

I think the extent that we’re integrating all the technology is more than what other Texas Health facilities have. That required many vendors to come into the room and have a conversation that they’ve actually never had. Vendors who had never met each other, even though we’ve had their systems in some of our hospitals for years, because it was very siloed. We bought the nurse call system or we bought the Vocera system or we bought Epic or whoever it was. We bought these systems, we implemented them vertically, and then we integrated them horizontally. 

There were a lot of vendor meetings that we had. In fact, as we were choosing what systems to go with, one of the most essential criteria that we made the decision on which vendors to go with was either past history and experience that they could demonstrate a
successful collaboration and integration or a willingness that they showed to be able to do that.

Is the IT support centralized, do you have some IT people locally in the hospital, or some of both?

All of our IT is centralized at the system office. From the system office, there are certain members of our IT team that are deployed locally.

What expectations do you have of the IT department and the folks leading it?

I have the same expectation that I have of any leader in the organization, which is one of collaboration, transparency, communication, and all those good things.

In terms of specific IT leaders, though, I’ve had the opportunity to work with a variety of IT leaders in my career. I think that what separates the good IT leaders from the exceptional IT leaders are the ones who are able to balance that creativity and desire to be on that leading edge and try new things with an understanding of hospital operations. Having that knowledge, having the common sense, and really sometimes the humility to say, “You know what? That’s a great technology. I’d love to put it in, but it really doesn’t make sense for us, and here’s why.”

In terms of the risk involved with being innovative, is there conclusion about how much IT innovation is the right amount?

I really think it’s based on the culture of the organization that you’re in. Implementing new technologies and being innovative is really about change management. If you have a culture that is used to change, open to change, wants that change, is able to function still and maintain high performance while going through change, then that organization, I think, can tolerate more innovation.

In an organization where perhaps you don’t have as talented of leaders, both from the IT and the operational side, to manage that change through, then it doesn’t matter if it’s even the smallest of innovations, managing that is going to be difficult. You’re not setting yourself up for success. I think being able to gauge the level of tolerance in an organization is important, but for those who have that capacity, then I think go for it.

Between the operational leadership and the IT department, who should look for something innovative and who should lead that change if and when it happens?

I hate to give “it depends” answers, but I think it depends. [laughs] When I look at how we created this facility and all the technology that we’re integrating, some of the best ideas came from the IT side and some of the ideas came from the hospital operation side. It’s really a blending of the two.

I think ultimately deciding whether or not to pull the trigger on a specific technology requires everybody at the table. Then once that decision is made, clear delineation of roles and responsibilities for that particular technology, because again, all technologies aren’t created the same, either. 

You may have something like telephones. We made a decision to go with a particular platform. While that’s really read better from the IT side, it’s not as invasive from a clinical standpoint, Obviously we all need telephones, but it doesn’t require a whole lot of clinical expertise to do telephones. We just need to make sure they’re programmed correctly so the clinicians use them properly. But you take something like Vocera or nurse call or AirStrip OB, which is much more clinical, I think the ratio changes. 

I think having a “one process fits all” solution is unwise. I’ve seen that happen sometimes. I think that’s where the roadblocks come in and some organizations have run into trouble. But to really look specifically at the innovation, and for this particular innovation, what are the roles and responsibilities going to be? A strong PM does that and can manage that through the organization for a successful implementation.

In large health systems, the smaller facilities or the bigger ones or the ones that are furthest away sometimes feel they’re not getting the right amount of IT attention. What’s the IT secret to making sure that you’re engaged and feeling like you’re well served as part of an organization that has several people who want those same things?

It’s funny you ask me that question. I mentioned that I’ve been with Texas Health for 12 years. I’ve been at one of our largest facilities — it’s 850 beds. In fact, that’s where I started my career. Then I went to literally the smallest facility in our system, which had 36 beds.

What I’ve always said is I think the key to success from an IT standpoint is understanding that smaller facilities don’t have less needs, they just have different needs. I say that from a management standpoint, too.

I remember being in a larger facility early in my career. I’d  look at the smaller facilities go, “Gosh, they have it so easy. They only manage this and it’s a small patient population. Of course they’re outcomes are great, because they only have 18 patients to manage compared to the 800 that we’re managing here.”

And I remember when I first got to the smaller hospitals, I’d look at the larger hospitals and think, “Gosh they have it so easy. They have all these layers of support and people that just do education. Whereas at the smaller facilities a lot of times, the managers take on additional roles and wear multiple hats because you can’t have a million FTEs taking care of 36 patients.”

When I had those two experiences, I remember one day sitting back and going, “It’s not that one job is easier or harder than the other,” which is the perception when you’re in those facilities. They’re just very different jobs. I think from an IT standpoint, it’s the same thing. The needs aren’t less, they’re just different. The good IT leaders can go in and understand what those needs are and deliver on those.

I would think it’s unusual for someone with a degree in biomedical engineering to be in a leadership role. Do you think that gives you more affinity with the IT operation or are you an outlier among your peers who went through a more traditional undergraduate program?

I would say that I’m definitely an outlier amongst my peers. I’m not familiar with any of my peers who have an engineering degree.

I think that having an engineering degree and understanding systems and processes and being trained in that gives me less angst in terms of dipping my toe in the technology waters, because I have a little better understanding of how things work. Clearly I’m not a computer programmer — the last time I programmed was in C++ , so that’s definitely not something you want me doing [laughs], but at least the philosophy behind that and how it works. I think the mystique is maybe less and so the apprehension is less.

You went through a construction project, which forces you to be as innovative as you can knowing that you’ll be stuck in that footprint for a while. What are some of the innovations in the new facility that would not have been common in older facilities?

I think that if you look at older facilities and facilities that were planned 20-30 years ago, most healthcare was provided in a hospital or in a doctor’s office. You sought healthcare because you were sick.

Today, your healthcare happens in a variety of environments — from your home thanks to telehealth, to the doctor’s office, to even your local drugstore. Walmart now has minute clinics or different things like that. Or you go to a surgery center or a freestanding lab. There’s a lot more venues now to deliver healthcare.

We understand that we need to optimize well-being in order to really control healthcare costs, not just take care of people when they’re sick, which is what we were focused on doing 20-30 years ago. For us, designing a new facility was trying to design a system where care is rendered where it makes the most sense. Going back to that engineering background that I have, how do you optimize the system, both from a cost and a convenience perspective? 

In our facility, for example, we don’t have a large outpatient imaging area because a hospital isn’t the most cost-effective place to the get that service. In our facility, we have a separate ambulatory surgery center that’s wholly owned as part of the hospital. We did that for two reasons. One, patients don’t want to pay a high hospital deductible in order to have some-day surgery. They want to pay whatever it is on their plan, $250 co-pay and have their surgery and go home. But a lot of times, we’re still doing those outpatient surgeries in a hospital.

Secondly, I can build that surgery center space at significantly less cost than I can build hospital space. I’m not going to get into the details of why that is, but that’s just how it is. If we know that we can deliver that care in a more efficient setting, we’re going to do that.

And of course, technology has played a big part in building design as well. The most obvious example is the first hospital I worked in had a medical records department the size of a football field. At our facility, we have a fully deployed EMR, so we didn’t build medical records storage at all. We get to use that space for other things. Those are just a few examples.

In that planning of what the future looks like, both healthcare in general and your organization and your facility specifically, what are the most pressing opportunities and threats looking five to ten years down the road?

I think the biggest opportunities are being creative and developing those new processes and systems to address things like coordinated care across the continuum. As we move towards managing the health of populations and ACOs, what does that look like? Do we build that? Do we partner with somebody who’s already an expert in that? Do we acquire that? How does that all work together? 

Getting to create something new in an industry is fun and exciting and a great opportunity for a lot of innovation and growth. I think the challenge to that, though, is that our current reimbursement system is still build on that per-click system. We take care of you when you’re sick, and when you come to my hospital and you need your appendix taken out, I get paid for that appendix to be taken out.

What we need to be careful of is that as we transform our organization and as we optimize health and well-being, that the timing is appropriate and sustainable for the organization. 

The final wildcard which I’m sure everybody is aware of and throws out there is, we still do not understand the full impact of the Affordable Care Act. All that is still being developed and rolled out. How do we implement the exchanges and what are the rules for exchanges? All that good stuff is still coming, so I think that’s still a big wildcard.

What would surprise people most about what it’s like running a hospital?

I will tell you, what surprises most people that I talk to outside of the healthcare industry is that either (a) we do not employ our physicians, or (b) a physician does not necessarily run a hospital. People really think, “Oh, physicians don’t work for you in the hospital?” That’s really the thing that surprises people the most.

What do you like best and least about your job?

I think what I like best is that at the end of the day it’s very fulfilling and challenging work. It’s an exciting time to be in healthcare. There’s a lot of change going on. What we’re doing hopefully at the end of the day improves the lives of the people in the community you serve. Having that fulfilling, big-picture goal drives me and sustains me.

In terms of what I like least, I think that just like anybody else, the parts I like least are the parts that aren’t necessarily value-added to meeting the goals of the organization and making necessarily our stakeholders’ lives better. Things that perhaps required from a regulatory standpoint, or certain things that we do that we have to do for governmental reasons.