News 12/12/12

Top News

WebMD Health Corp. will eliminate 250 jobs, or about 14 percent of the company’s workforce, in an attempt to reduce operating expenses by about $45 million. The company has suffered declining ad and sponsorship revenues and its stock price has fallen 63 percent since the start of 2012.

Reader Comments

From Former MCK’er: “Re: Dave Souerwine, president of McKesson Provider Technologies. Gone and ‘pursuing other opportunities,’ according to an e-mail sent to employees Monday.” Several readers forwarded the internal e-mail from McKesson Technology Solutions EVP/Group President Pat Blake, to whom Dave’s former management team now reports. I confirmed Dave’s departure with a McKesson spokesperson: “After an intense period of execution and putting McKesson Provider Technologies on a positive strategic course, Dave decided to leave to reassess where he wants to spend the remaining time of his career. Dave played a key role in our Better Health 2020 strategy working with other presidents across our Technology Solutions businesses, and those efforts will continue as we focus on helping our customers prepare for the complexities of health reform.”

From Unbarred: “Re: Epic’s lawsuit against a consulting firm. It’s an intellectual property lawsuit in which Epic claims tortuous interference, breach of contract, trade secret misappropriation, and other related transgressions. They say the defendants inappropriately logged into the customer area of Epic’s website to access an ambulatory training video. Epic wants all of its material returned and removed from any website on which it was loaded, along with punitive and actual damages.”

From The PACS Designer: “Re: IT convergence. With all of the mobile devices and desktop workstations accessing data of all types in daily activities, it becomes more important for IT management to control the platform running everything viewed by users. Microsoft realizes the need and is addressing the challenge by incorporating Windows 7 and 8 in their .NET Framework software. As more vendors migrate to Windows 7 and/or 8, the pressure will build to move towards Microsoft’s .NET Framework solution to enhance IT convergence.”

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum sponsor Ormed of Austin, TX. The employee-owned company’s product line includes financial management  (AP/GL, asset management); decision support (EIS, cost accounting, budgeting, dashboards); supply chain management; human capital (scheduling, HR, payroll, employee self-service); e-commerce transaction services; and accounts receivable. Ormed MIS decision support for healthcare includes Cyberquery information access, which delivers vital business intelligence information to authorized employees as graphs, reports, or spreadsheets. The fully integrated Ormed MIS software and Ormed X2 B2B portal help create efficiency, cost savings, and controls across the entire organization. The company has been working since 1989 to provide hospitals and other healthcare organizations with tools for timely and informed decision-making, cost-effective growth, and improved service and satisfaction levels, with over 5,700 software applications in use in the US and Canada (see the interactive user map, which lists its customers). Thanks to Ormed for supporting HIStalk.

Acquisitions, Funding, Business, and Stock

Sutherland Global Services will pay $184 million for the business process outsourcing unit of the India-based Apollo Hospitals Enterprise, which provides IT support services to more than 150 US healthcare organizations.

A Nuance Communications investor day presentation predicts a paradigm shift that will favor the company’s speech recognition and natural language processing products, observing that nearly every mobile device includes capabilities covered by a Nuance offering. Key product lines include the Dragon family, OEM versions of its speech recognition products increasingly being incorporated directly in computer hardware, voice-enabled televisions, and cloud-based speech recognition. Nuance’s healthcare division reports strong growth, aided by the HITECH act and relationships with EMR vendors such as Cerner and Epic.

Rothman Healthcare, which developed the Rothman Index for analyzing data points to identify hospitalized patients whose condition is worsening, renames itself PeraHealth and hires Stephanie Alexander (MedAssets) as CEO.

Kansas City-based Health Outcomes Sciences will relocate to Overland Park and expand from 13 to 37 employees in the next five years. The company, which is seeking incentives from Kansas state government for the move, offers the ePRISM clinical predictive modeling tool for improving outcomes. CEO Jim Wilson was previously president of Craneware and has worked for Cerner and Oacis.

The parent company of LifeCare Holdings, which operates 27 long-term acute care hospitals in 10 states, declares Chapter 11 bankruptcy to allow the company to be acquired by a group of its lenders.

LSU announces plans to form public-private partnerships for the operation of three of its hospitals, hoping the $12 million it will receive in advance lease payments will help it avoid the previously announced layoffs of hundreds of employees. The state announced similar privatization agreements for two additional hospitals in Houma and Lafayette as it dismantles its charity hospital system.

Sales

Duke University Health System (NC) will implement TeraMedica’s Evercore Smartstore and Univision modules for medical image management.

The University of Kentucky contracts with CSI Healthcare IT for project management and support services for current and future software applications.

Providence Health Care (BC) selects MModal Fluency for Transcription as the speech platform for all Lower Mainland Health Authorities hospitals and facilities.

North Oaks Health System (LA) selects iSirona’s device connectivity solution to integrate with Epic.

Cumberland Center for Healthcare Innovation (TN), a 29-practice ACO, will use clinical data analytics technology from Clinigence.

Sanford Health (ND) chooses Click Portal from Huron Consulting Group to manage HHS-mandated conflict of interest disclosure rules.

Sentara Healthcare (V) chooses Accalarad’s medical imaging solutions for its imaging centers and hospitals in Hampton Roads.

People

Clearwater Compliance hires Ashley Bampfield (Bampfield Communications) as director of marketing.

Cone Health (NC) promotes Steve Horsley to VP/CIO, replacing the retiring John Jenkins.

Ross Martin, MD, MHA (Deloitte Consulting) is named VP of corporate relations and business development of AMIA.

Jay Colfer (Prognosis Health Information Systems) joins Surgical Information Systems as sales EVP.

Phil Pead (Allscripts) is named president and CEO of application development tools vendor Progress Software. He was serving as executive chairman and interim CEO.

I interviewed Joseph Kvedar, MD of the Partners Center for Connected Health about his involvement with Wellocracy on HIStalk Connect.

Peter Cyffka (O’Melveny & Myers, House of Blues) is named CFO of Epic Systems.

The National eHealth Collaborative elects six officers including Janet Corrigan (National Quality Forum), Tom Fritz (Inland Northwest Health Services), Paul Uhrig (Surescripts), Bill Spooner (Sharp HealthCare), Michael Barr, MD (American College of Physicians), and Leslie Kelly Hall (Healthwise).

Announcements and Implementations

MaineHealth and Maine Medical Center go live on their $150 million Epic system, with which the organization hopes to qualify for $50 million in EHR incentives.

HIMSS names Mount Sinai Medical Center (NY) as the winner of the enterprise Davies Award. HIStalk sponsor Culbert Healthcare assisted Mount Sinai with the application process, including developing quality improvements measures and a return on investment model.

Bassett Medical Center (NY) goes live on Epic.

Community Health Solutions of America deploys Cognizant’s ClaimSphere HEDIS for compliance measurement and reporting.

Meridian Health (NJ) upgrades to ICA’s CareAlign Exchange platform, which includes Direct messaging, CCD repository, a patient identity manager and registry, HISP capabilities, and global opt-out for patients.

Oroville Hospital (CA), the first hospital to self-deploy the VA’s VistA, releases a self-developed, open source e-prescribing module under the name eRx VistA, which meets Stage 2 MU requirements.

University of Utah Health Care offers online access to its database of 40,000 patient satisfaction surveys, including comments about its 1,200 physicians.

Emmi Solutions announces EmmiPrevent, a population health management application that initiates interactive calls to patients to encourage then to take preventative action.

Government and Politics

National Coordinator Farzad Mostashari becomes a Blue Button user on behalf of his parents, finding that the straight download of claims data is hard to interpret even for a physician like himself. However, he finds that the iBlueButton app, which recently won an ONC programming challenge, does a nice job of reformatting the information into a usable list of problems, diagnoses, encounters, and treatments. In a suspiciously dramatic story, he reports that he downloaded the data Thanksgiving day, his father developed an emergent medical condition on Black Friday, and he was able to immediately share his freshly downloaded data with a specialist.

Innovation and Research

It happens every year right after the mHealth Summit concludes: an mHealth expert and advocate expresses frustration that the few clinical studies involving mHealth technologies usually fail to show any conclusive benefit, with most of the positive accounts coming from purely anecdotal reports. Or as NIH Director Francis Collins, MD, PhD said succinctly, "The plural of ‘anecdotes’ is not ‘data.’"

CardioMEMS, an Atlanta-based company that is developing wireless body monitors, wins the Intel Innovation Award.

An article in The Atlantic profiles a non-profit South Dakota "patient-less hospital" that provides long-distance critical care to rural hospitals in six states. Avera Health Network uses two-way video consulting to provide what it calls "hands in pockets doctoring," covering 60 percent of the ICU beds in South Dakota. They’re expanding to cover nursing homes and prison infirmaries. While the program reduces the cost of sending patients to major hospitals, it says its main benefit is to limit the decline of small, rural communities.

UCLA gastroenterologists test a program in which patients with inflammatory bowel disease are given free iPads to enter their information for remote monitoring by nurses. The software also provides education, a job coach function, mental health coaching, and even traffic reports for patient trips to the office. The UCLA Center for Inflammatory Bowel Diseases originally announced the program in September.

Technology

FDA is developing guidelines for how drug companies can promote their products using social media, but in the mean time, the manufacturers are finding new and unregulated ways to market their wares in potentially deceptive ways. Way back in 2010, the agency sent warning letter to Novartis for using a Facebook widget to market a leukemia drug by placing ads on the news feeds and profile pages of individual Facebook users.

Other

Epic seeks to buy an additional 38 acres of land from a zoned subdivision southeast of its existing 811-acre property. The company presented conceptual plans to Verona, WI city officials that include proposals for a fourth and fifth campus. Some residents expressed concern that Epic’s never-ending construction projects are encroaching on nearby homes and creating noise and traffic throughout the area, but others expressed support for Epic’s plan to reserve part of the land for a park and said the company at least makes a better neighbor than closely spaced apartment buildings.

A KLAS report covering business intelligence finds that the most significant impact of BI solutions involves knowledge dissemination and end-user adoption.

India launches its first cloud-enabled eHealth Center for delivering primary care in remote regions. It provides remote medical consultations and sends SMS-based patient reminders.

Russian hackers hijack and encrypt the electronic patient files of a clinic in Australia, demanding $4,200 to restore the information. Experts say the clinic doesn’t have much choice but to pay up in this latest episode of so-called ransomware, but warn that paid-off hackers often hit the same victims again to demand more cash.

Greek hospitals are struggling in the country’s economic crisis, facing supply shortages and budgets cut by half. A neurologist says pay cuts have left him making $1,600 per month for a 100-hour workweek, while patients can’t get medication because the government can’t pay its pharmacy bills. Greek healthcare, critics say, is like the rest of the country’s economy in suffering from corruption and mismanagement.

Weird News Andy likes this “pacemaker for brains” story in which Johns Hopkins researchers implant a stimulation device in the brain of an Alzheimer’s patient in the hopes it will stop cognitive decline. Also from the infectious weirdness that is Andy: five Cedars-Sinai heart valve transplant patients contract staph infections when the gloves of their surgeon develop tiny tears, allowing bacteria from the wound on his hand to infect them. The hospital says the surgeon is no longer performing operations there.

Sponsor Updates

• Besler Consulting President Brian Sherin addresses the company’s growth over its 25 years in business in a newsletter article.
• Emdeon reviews the top priorities of its channel partners.
• William Bithoney, MD of Truven Health Analytics and Jeffrey Softcheck of Silver Cross Hospital address the future of healthcare and improving care quality and outcomes at this week’s IHI conference in Orlando.
• StartUp Beat profiles PatientPay and its billing and collections technology.
• NextGen launches its 8 Series EHR content, which includes embedded MU criteria and an optimized seven-tabbed clinical workflow.
• The Orange County Register names Kareo a “Top Workplace in Orange County.”
• Prognosis will integrate its EHR platform with DrFirst’s e-prescribing solution.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 12/11/12

ACOs, already surging, poised for even more growth

The American Medical Association publishes a snapshot on ACO growth which it says shows significant traction leading into 2013, based on the more than 500 organizational applications submitted to CMS this year requesting ACO recognition.

Bipartisan Policy Center Calls for Greater Use of Electronic Tools to Engage Patients and Drive Improvements in the Cost and Quality of Health Care

ONC’s Farzad Mostashari, MD and former US Senate Majority Leader Tom Daschle host a technology discussion in conjunction with the release of a BPC report calling for greater use of mHealth technology to streamline care and reduce healthcare costs.

Epic Systems close to owning more land in Verona

Epic is in the process of adding 40 acres and 8-10 office buildings to its “Intergalactic Headquarters.”

Central Tennessee ACO adopting clinical analytics software

The Cumberland Center for Healthcare Innovation, a central Tennessee ACO, will implement Clinigence clinical analytics software to help meet Medicaid Shared Savings Program goals.

Bassett Medical Center Implementing Inpatient EMR

Bassett Medical Center goes live on Epic Inpatient after ambulatory clinics completed their Epic implementation this summer.

E-Mail Incident Involves Some Patient Information

Carolina HealthCare System notifies 5,600 patients of a data breach after a hacker was discovered to have accessed  a physician’s e-mail account over a six-month span.

Readers Write 12/10/12

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!

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

Baseball Traditionalists: Whose “Use” was More Meaningful?
By Robert D. Lafsky, MD

Isn’t it fascinating to follow the daily progress of a battle that pits traditionalists against digitally-armed insurgents? On the one side are deeply-entrenched practitioners of an ancient art dependent on subjective judgment calls that, in their view, can only be described in descriptive natural language. On the other side are advocates of a granular hard data approach that, although tedious and opaque to the untrained, reveals insight into previously unseen trends and realities.  

Ain’t baseball something?  

You do have to admit, if you’ve read the sports pages lately, that the battles in the sport eerily reflect arguments that run through the pages and comment sections of this blog. I cite as the crowning example the brouhaha over the naming of Miguel Cabrera as this year’s National League Most Valuable Player.

The traditionalists have a powerful argument for Cabrera. For one thing, his Detroit Tigers won their division and went to the World Series, while second place Mike Trout’s LA Angels finished third in their division. And Cabrera was the first Triple Crown winner (highest batting average, most homers, and runs batted in) in 45 years. He had a knack for hitting when it really counted, and he selflessly agreed to move to third base from first when the Tigers acquired the powerful but slow Prince Fielder. The traditionalists say it’s obvious he’s the MVP.

But the “Moneyball” guys have their points about Trout. Using highly sophisticated and detailed data, they determined using a measure called “wins over replacement,” — using not only batting statistics, but defensive and even individual ballpark factors to compare Trout to an average replacement player — he accounted for 10.7 additional wins for the Angels over 6.9 Tiger wins for Cabrera. And that, to them, is what matters. All that other stuff is dismissed by these “Sabermetricians” as mere “narrative.”

But the traditionalists could ask, I suppose, the following cogent question:  whose “use” during the season was more “meaningful”? 

That’s an obvious parallel  to current trends in medical computing, right? Well, let’s not forget an obvious point. Baseball has always been a thing entirely made up by humans. Before these high-end statistics were developed, it had a clear-cut set of rules and a clear-cut goal–scoring the most runs in the most games.  

Medicine’s rules, on the other hand, are essentially defined by nature, and after more than 40 years in the field, I still wonder what the goals of practice really are. Fewer deaths, of course, but that’s really hard to count. And we know that people focus on a lot of other things that don’t affect critical outcomes like death and disability.

So, no — it’s way more complicated.  And advocates of evidence-based practice make valid points. We won’t settle any arguments here. But I know that obtaining and analyzing data is hard.  

Which is why we need baseball.  Go ahead and break for home, Bryce Harper. When that happens, we don’t need no stinkin’ statistics.

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

The EHR Conversion Staffing Dilemma: Cost vs. Go-Live Disaster
By Don Sonck

With the window to initiate participation in the Medicare EHR Incentive Program expiring in 2014, the next two calendar years are certain to be chaotic within the EHR arena. With an ever-increasing number of hospitals and physician groups already scheduled to implement an EHR and still others in the final selection stage, internal and external resources necessary to staff these critical and expensive projects are already at a premium.

Particularly on the acute support side of these projects, professional consultants (internal and external) who possess clinical experience and know firsthand the inner workings of a hospital or ambulatory environment should be utilized. Ratios of one acute EHR professional for every four to five core clinical staff members is optimal. Any ratio greater typically results in frustration and morale decline, extended end user adoption, residual training, and of course, increased expense.

Far too often I’ve encountered healthcare systems of all sizes (as well as physician practices) that underestimate the importance of clinical support staff. During EHR post-mortem discussions, leadership rues the fact they overlooked or underappreciated the skill and expertise that clinical resources bring to the table, particularly during the critical 4-6 weeks just prior and subsequent to go-live. Too often, the main focus and budget allocation is on the EHR build and associated infrastructure costs. IT consultants are justifiably a majority slice of the overall project budget pie, but these same resources are ill prepared for and lack the “soft” skills to prosper as super users with core clinical staff during that chaotic go-live window.

My advice? Do not rely solely on overtime utilization of existing staff, the float pool, or seasonal staff. Make sure you pay for the ala mode on top of that budget pie in the form of nurses, therapists, and physicians who are seasoned in both go-live experience and the particular EHR vendor software to which you are migrating. When blended with existing core staff, these clinicians can assist in both patient care and technical guidance on the electronic charting process, easing your clinical team’s anxiety, reducing overtime, minimizing the need for additional EMR training consultants, and accelerating the adoption and knowledge of the EHR software.

When considering the employment of third-party clinical support staff, avoid the pitfall of waiting until the eleventh hour to pull the trigger. Human resources and nurse recruiting teams have enough on their plate without the added burden of answering these questions for themselves:

• How will nurses and physicians learn the system and treat their patients at the same time?
• What scheduling challenges will we experience due to the temporary decrease in productivity?
• Who will handle my core employees’ technology aversion?
• Will overtime compensate for coverage during classroom training time?
• What will be our electronic charting standards be day one, week two, and month one?
• Who will be taking care of orientation, credentialing, and my other duties during implementation?
• What will my patients experience be during go-live?

Be an early adopter of the clinical staffing question, at least six months prior to go-live. Your CFO, CIO, and CNO will all thank you.

Don Sonck is director of EMR staffing solutions of AMN Healthcare of San Diego, CA.

Questions for ONC and the Obama Administration
By John Gomez

The Meaningful Use program requires technology to be adopted and utilized by healthcare providers and payers throughout the United States. The funding for these programs is coming from federal tax dollars  All that is well and good. In the long term, we will hopefully see a good return on these investments through standardized care, lowered administrative overhead, and a reduction in medical errors that affect patients.

The technology that is designed, developed, tested, and deployed to support Meaningful Use requires literally thousands and thousands of engineers, consultants, product and program managers, not to mention all the system administrators, network managers, and others. It is perplexing to me though, that in these times of economic hardships, many healthcare software vendors and secondary software service providers offshore these positions. 

For instance, companies like Allscripts have huge staffs in India and smaller presence in Canada. Some companies are offshoring to Israel, China, and Europe. Given that we as taxpayers are funding the Meaningful Use program, shouldn’t there be a provision requiring that those companies benefiting from these programs only utilize US-based resources? 

There is potentially a silly argument that could be made that if were to require these companies to use US resources, they would need to charge more for their products and services and that would ultimately cause a deeper burden to the taxpayer. That is an accurate knee-jerk response based on lack of information and research.

We could keep these jobs here in the United States and not increase the cost of operations for these companies if these companies fill these positions in areas of the United States that are hardest hit by the current state of our economy. The level of talent, required training, and other factors would be similar if not better then that which is encountered outside our borders.

I realize that this is not a simple problem. Wall Street and private equity firms are more interested in margin improvement then really considering the long-term benefit to our country. But in my eyes, I think that creating jobs here is a priority. 

We should do what we can to get more Americans working, even if it impacts the margins of healthcare software companies or slightly raises the cost of software or services. When you have a program as big as Meaningful Use, the benefit should be well beyond that of its primary objective.

John Gomez is CEO of JGo Labs of Asbury Park, NJ.

Stage 2: You Ain’t Finished ‘till the Paperwork is Done
By Frank Poggio

Many years ago I saw a cute little cartoon that pictured a three-year-old climbing off a commode. Standing next to him was his mother, instructing him that he wasn’t finished until his paperwork was done. Well now, the characters in that cute cartoon can be replaced by a vendor and the ONC, respectively.

Two new Stage 2 test scripts for certification will require vendors to supply documentation previously not needed under Stage 1. They are:

1. Safety Enhanced Design – 170.314(g)(3), and
2. Quality Management System – 170.314(g)(4)

Safety Enhanced Design (SED). In early drafts of Stage 2, this criterion was referred to as User-Centered Design. The primary impetus for SED came from the November 2011 IOM report (Health IT and Patient Safety: Building Safer Systems for Better Care) that lamented the lack of built-in safety elements in many clinical software products.

An excerpt from the ONC test script describing SED follows:

This test evaluates the capability for a Complete EHR or EHR Module to apply user-centered design for each EHR technology capability submitted for testing and specified in the following certification criteria:

§ 170.314(a)(1) Computerized provider order entry

§ 170.314(a)(2) Drug-drug, drug-allergy interaction checks

§ 170.314(a)(6) Medication list

§ 170.314(a)(7) Medication allergy list

§ 170.314(a)(8) Clinical decision support

§ 170.314(a)(16) Inpatient only – electronic medication administration record

§ 170.314(b)(3) Electronic prescribing

§ 170.314(b)(4) Clinical information reconciliation

The Tester shall verify that for each EHR technology capability submitted for testing and specified in the above-listed certification criteria, the Vendor has chosen a user-centered design (UCD) process that is either:

A) UCD industry standard (e.g.; ISO 9241-11, ISO 9241-210, ISO 13407, ISO 16982, and ISO/IEC 62366); and submitted the name, description, and citation or,

B) Not considered an industry standard (i.e. may be based upon one or more industry standard processes); and submitted the named the process(es) and provided an outline and description of the process(es)

The Tester shall examine each Vendor-provided report to ensure the existence and adequacy of the test report(s) submitted by the manufacturer. The Tester shall verify that the report(s) conform to the information specified in NISTIR 7742 Customized Common Industry Format Template for Electronic Health Record Usability Testing.

Full EHR vendors must address this new requirement, while EHR Module vendors can skip it if your certification request does not include any of the above criteria. On the other hand, if your EHR Module includes even one of the above, you then must address the SED for that criteria.

The second new criterion questions the use of a Quality Management System 170.314(g)(4). The ONC-published test script states the following:

For each capability that an EHR technology includes and for which that capability’s certification is sought, the use of a Quality Management System (QMS) in the development, testing, implementation and maintenance of that capability must be identified.

– The Vendor identifies the QMS used or indicates that no QMS was used in the development, testing, implementation and maintenance of each capability being certified

– The Tester verifies that for each capability for which certification is sought, the Vendor has

1. Identified an industry-standard QMS by name (for example, ISO 9001, IEC 62304, ISO 13485, ISO 9001, and 21 CFR, Part 820…)
2. Identified a modified or “home-grown” QMS and an outline and short description of the QMS, which could include identifying any industry-standard QMS upon which it was based and modifications to that standard
3. Indicated that no QMS was used for applicable capabilities for which certification is requested

Clearly ONC is interested in learning more about what QA tools vendor use (if any) for each of the submitted Stage 2 criteria. Under Stage 2, per step 3 above, you do not have to have a formal (or any) QA process available. No QMS is an acceptable answer. But, you can easily guess what will happen in Stage 3. Words to the wise: if today you do not incorporate in your systems development a formal and documented QA process, better get one soon.

Last year in a previous HIStalk post I referred to the FDA coming to EMR systems through the back door. SED is a big step in. I fully expect the criteria covered to expand in Stage 3, and expect the depth and extent of the documentation submission to expand as the test agencies (ACB) gain more experience in 2013.

Lastly, if your staff is not familiar with the ISO and IEC standards, better do some homework. I suspect that the best of breed /specialty and new HIT startup firms would have a more difficult time in addressing SED than the large legacy firms. Documentation and QA are typically not their strongest suits.

All the new Stage 2 criteria and test scripts can be found here.

Frank Poggio is president of The Kelzon Group.

The Jury is No Longer Out
By Nicholas Easter

Very recently, I was a summoned to District Court for my civic responsibility of jury duty. Unlike many Americans, I relish the opportunity to sit for a jury trial, as it affords me the great opportunity to assist in the beautiful process of democracy. Unfortunately, the attorneys did not choose me this time around. But there is always next week, when I will be summoned to return.

Due to my freedom from this specific trial, I can comment on some of the particulars, but the important message from this trial comes from the other panelists as the voir dire was conducted.

In short, the case was/is an inmate at a federal detention facility (prison) attempting to sue members of the healthcare team at the facility for negligence in treating his life-threatening illness. A mix of guards, nurses, PAs, and a doctor being sued by an inmate for violation of the 8th Amendment to the US Constitution, since it is a constitutional question, was remanded to Federal District Court.

Eighteen lucky people were selected to move from the pews to the comfy seats in the jury panel. Each was interviewed by the judge and asked a series of questions to whittle the number down to 10 jurors.

Among the questions was a seemingly innocuous one: “What is your opinion on the healthcare provided to inmates?” Each of the 18 responded that they believed it was a right for each and every prisoner to receive fair and adequate medical attention. Of the panelists, there were teachers, engineers, consultants, unemployed persons, and the director of a local emergency room’s nursing team. I repeat, every single one thought it was the duty of the Federal Department of Corrections to provide ample and adequate healthcare to its inmates.

I believe it is time to formally reaffirm that a majority of this country believes that access to quality healthcare is a right afforded to each and every citizen, even felons. It is this basic comment on the structure of our society that gives a full and formal mandate to our leaders in Washington DC to complete the process of unifying the delivery of healthcare in America to make it accessible and affordable for all Americans.

If 18 randomly selected Americans above the age of 18 without any prior convictions for felonies can confirm that this basic right is required for criminals, then it ought to signal that it is high time to continue to find ways to make this an affordable reality for the remainder of Americans.

Social scientists agree that the “Social Strain Theory” is accurate. The greatest impetus to criminal behavior is poverty. America’s healthcare system can easily push even the most well-heeled patients into poverty. Hopefully the healthcare system of tomorrow will recognize the sharpness of its sword as it begins to eradicate a lot of ills that befall our society.

Curbside Consult with Dr. Jayne 12/10/12

It was cold and rainy, so I decided to file my state license renewal this weekend. When I was in a community practice, the office manager used to take care of that (as well as credentialing, liability insurance renewals, and just about everything else). Now that I’m in informatics, I’m on my own. The administrative assistant I share with four other people barely has time to open the mail and manage our calendars, let alone handle something like licensure renewals.

My state requires a certain amount of Continuing Medical Education (CME). Although I meet that requirement without issue each year just through routine activities and journal articles, it’s only half of the amount required by my specialty society. I was grateful for the reminder to catch up on my hours. Coincidentally, CMS continues to send e-mail bulletins about ICD being “closer than it seems” and one sent this week stated they had CME available.

(Apparently they partnered with Medscape Education back in September, but I must have missed the original announcement.)

I decided to check out the ICD-10 CME. There are two modules and an article offered. The modules are targeted towards small to medium practices and large practices, respectively, and are specifically for physicians. The article is more general for all health care providers. Since I work in Big Healthcare, I made a cup of tea (Earl Grey – hot) and settled in for the large practice video.

The video is narrated by Daniel Duvall, MD MBA of the Hospital and Ambulatory Policy Group at CMS. I liked that it didn’t claim that ICD-10 was going to improve care or make our lives easier. It was clear about stating that there would be “much more specificity in information sharing” and that the key point of relevance for physicians was that it is necessary for claims submission and those who delay may not be reimbursed.

I’d have liked the CME better if it had been self-paced. It wouldn’t allow me to fast forward and one couldn’t forward the slides at his or her own pace. I can generally read faster than I can listen to someone read slides to me, and find that I learn more reading things on my own rather than being lectured to. There was some choppy editing that was a little annoying, so by six minutes into it I was pretty much “done” but couldn’t blast through it.

Luckily it did allow me to skip to the test (which I aced – it only had three questions) and the subsequent course evaluation. I was disappointed that the evaluation wasn’t specific to this kind of educational activity. It asked me if I planned to modify treatment plans, change screening or preventive practices, incorporate different diagnostic strategies into patient evaluations, or use alternative communication methodologies with patients and families. It’s always nice to have questions that are actually relevant to the course just taken.

For a physician who doesn’t know much about ICD-10, the course provides a reasonably good base. For anyone who is deep into an ICD-10 playbook, it’s not worth the time unless one is killing time or needs CME hours. I realized when I got to the end of the course that I probably should have verified how I was logged in to Medscape. At least it will make a nice addition to the certificates on the wall of my home office.

E-mail Dr. Jayne.

Morning Headlines 12/10/12

Health IT training center opens

The Jewish Healthcare Foundation, the Pittsburgh Regional Health Initiative, and Health Careers Futures form the Pittsburgh-based Quality Information Technology (QIT) training center, with the goal of training health professionals on emerging technologies that will add emphasis on coordinating care and measuring the quality of care.

For ER doctors, an extra hand on the keyboard

Rochester General Hospital’s use of scribes in the ED, which realized an annual $600,000 savings last year and is credited with allowing ED staff to treat 30 percent more patients per shift, is profiled in a local paper.

Third-party revenue cycle expertise reduces healthcare costs, tightens processes

Strong growth in the revenue cycle management segment is being attributed to meaningful use, ICD-10 plans, and reduced payments.

Panetta says DoD, VA to ‘meet or beat’ iEHR rollout goals

DoD announces a revised plan that will expedite the completion of the iEHR rollout, culminating in a 2017 go-live.

Monday Morning Update 12/10/12

From HITEsq: “Re: Epic. It appears they aren’t happy with some consultant, suing two individuals and three similar sounding entities (KS Information Technologies). They were granted a motion to seal the complaint to protect sensitive information. Maybe someone knows more.”

The government should get more proof that providers have met Meaningful Use requirements before sending them a check, according to 72 percent of poll respondents. New poll to your right: should FDA create an Office of Wireless Health as proposed by Rep. Michael Honda (D-CA)? I’ve generously included a “don’t know/don’t care” option for those anxious to participate despite indifference to the topic.

My latest Spotify playlist includes the usual mix of music I like, including Villagers, This Providence, Gov’t Mule, Faith No More, and going back decades, Mountain, Throwing Muses, and even the virtually unknown 60s Detroit band Frijid Pink. I spend a fair amount of time choosing what I think is worth listening to and then play the list several times to make sure it makes sense, not that I’m in need of extra work. Give it a listen if you’re stuck in a musical rut.

I never look at (and in fact am annoyed by) infographics, those trendy, huge, multi-font pictures that fool short attention span Internet skimmers into thinking they understand a complex topic, often created by someone who hopes their agenda will be accepted as truth instead of opinion because it’s easier to stare at dumbed-down pictures instead of using your brain to read something more challenging and informative. If you don’t feel that way, cruise over to ONC’s EHR infographic for consumers. At least theirs is footnoted.

The secretaries of Veterans Affairs and Defense say they will present a plan in January to speed up the VA-DoD EHR integration. The planned go-live date of 2017 may be moved up. 

Manitoba’s eChart HIE  will allow users to hide their information even though they can’t opt out of the service. It will contain prescription information, immunization histories, demographics, and lab results.

The Jewish Healthcare Foundation, the Pittsburgh Regional Health Initiative, and Health Careers Futures form the Pittsburgh-based QIT training center, funded by the foundation and the County tourism office. It will offer training to healthcare executives and workers on emerging technology. ONC Deputy Director Jason Kunzman is former CFO of the foundation. Also announced was the QIT Health Innovators Fellowship program for graduate students in the health professions, who will submit IT solutions for judging in a 10-week program.

Healthcare provider CIOs on the 2013 Computerworld Premier 100 IT Leaders list:

• Horace Blackman, Department of Veterans Affairs
• George Brenckle, UMass Memorial Health Care
• Thomas Bres, Sparrow Health System
• Sonya Christian, West Georgia Health
• Chad Eckes, Cancer Treatment Centers of America
• Randall Gaboriault, Christiana Care Health System
• Theresa Meadows, Cook Children’s Health Care System
• Mark Moroses, Continuum Health Partners Inc.
• Stephanie Reel, Johns Hopkins Health System
• Kathleen Scheirman, Kaiser Permanente
• Thomas Smith, NorthShore University HealthSystem

A new KLAS report on revenue cycle performance finds that Meaningful Use, reduced payments, and ICD-10 fears are forcing providers to examine their revenue cycles more closely for efficiency and effectiveness, with many of them engaging outside assistance.

RSNA attendance was down 9 percent this year, with possible reasons being lack of technology breakthroughs and a new policy that required guest attendees to pay.

A technical school in the Philippines creates a telenurse training program, preparing nurses to offer their patient consultation services via smart phones. ClickMedix, an online health company is participating, offering the nurses access to its smart phone application, doctors, and medical library in return for a percentage of their billings. Experts say it’s time to create business models for nurses to become online health consultants. I tracked down ClickMedix, which turns out to be a US-based company (Rockville, MD) formed by faculty and students of MIT and Carnegie Mellon to address global healthcare challenges. The company’s mHealth platform offers modules for delivery of medical services, patient management, administration, and healthcare services purchasing.

Ergonomics researchers warn that the increased use of EMRs and other keyboard-based technologies for long periods of time raises the risk that providers will sustain repetitive stress injuries as happened when offices computerized in the 1980s. A small study found that more than a third of doctors reported RSI-related pain in their neck, shoulders, back, or wrists. In what could be an indirect measure of the uptake of EMRs, another small provider study found that more than 90 percent use a computer, averaging more than five hours a day.

An article in the Rochester paper describes the use of contracted scribes in the ED of Rochester General Hospital, which says its 60 ED scribes cost $1 million annually but save the health system $1.6 million per year. According to the associate ED chief, “When you come to see the doctor, you want to see the doctor. You want eye contact. You don’t want us standing at a computer screen. I care for people. I’ve never been trained to be a good typist or a data entry specialist.”

An Atlanta nephrologist serving as the medical director of a clinic owned by dialysis provider DaVita files a whistleblower lawsuit against the company under the False Claims Act after noticing that its computer systems showed large amounts of wasted drugs. His suit claims DaVita overcharged Medicare for up to $800 million over eight years by intentionally using oversized vials of medication and discarding the remainder, billing Medicare for unavoidable waste. The doctor was noticed by his fellow whistleblower, a nurse who says the company was pushing employees to increase their drug revenue. The company says CMS approved all of its practices.

Scheurer Hospital (MI) renovates its patient rooms to include technology improvements, placing a computer in each room to allow nurses to document at the bedside. They also added a new patient call system that alerts nurses on cell phones.

The former executive director of Syringa General Hospital Foundation (ID) is sentenced to six months in prison and is ordered to pay $115,000 in restitution after pleading guilty to using the hospital’s computer system to transfer money to her personal accounts.

Aetna will pay $120 million to settle lawsuits claiming that it used databases from UnitedHealth Group’s former Ingenix unit to intentionally underpay insurance claims for members using out-of-network medical services. UnitedHealth paid $350 million in 2009 to settle a similar lawsuit in New York, at which time Aetna also settled by agreeing to stop using the Ingenix database and paying $20 million to help create an independently developed replacement for it.

Weird News Andy says he now knows how your mom always knew what you were thinking. Researchers find that a mother’s brain often hosts living cells from her children born decades earlier. WNA also digests new medical research as being an explanation for crazy cat ladies: a common cat parasite is found to have the ability to enter the human brain and to possibly cause behavioral changes.

More on CPSI in this week’s HIS-tory from Vince, putting it into current perspective by reviewing the MU success of its customers and how its practices parallel those of Meditech and Epic. Next up is NextGen’s inpatient division, so connect with Vince if you can help him out with background information.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Time Capsule: Sun Was Right: The Promise of Healthcare Applications Requires a Grid, Not a Data Center Full of Servers

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.

Sun Was Right: The Promise of Healthcare Applications Requires a Grid, Not a Data Center Full of Servers
By Mr. HIStalk

Sun Microsystems has been saying for years that “the network is the computer.” I hooted when I first heard that because it seemed so transparently self-serving, but I actually think the company was right all along. Sometime, maybe sooner than later, your data center won’t need servers. In fact, you probably won’t need a data center or IT staff at all (so in an ironic twist, you can use that space to store paper medical records).

I came to this conclusion after realizing that those Sun thin client blowhards were right, too. All the software that’s important or cool these days runs over the Web, not on a desktop PC. I’ve traded Office bloatware and piggish e-mail clients for free, stripped down versions that run on the ubiquitous information grid known as the Internet. Tastes great, less filling. I can get my job done, derive and create greater value, and let somebody else worry about what’s under the hood.

In other words, I don’t need a loaded PC any more than I need a gas generator, a TV antenna, or an outhouse. The grid is better, cheaper, and more reliable to meet those needs. All I need is a connected appliance. But more importantly, the network adds tremendous value. You contribute a little by joining, but you get a lot in return (well, hopefully not in the outhouse part of my labored analogy, but you know what I mean).

That’s how physician billing vendor athenahealth works. It applies the collective knowledge of thousands of customers to instantly update reimbursement rules for all the practices on its grid. Doctors’ offices don’t need a roomful of souped-up computers or an expert on arcane billing practices. They just need a connection to the grid.

Back in the hospital, we’re still using the same old (literally) applications, monolithic piles of esoteric and proprietary hardware that require skilled care and feeding, connected by a fragile spider web of interfaces and middleware that often causes problems with response time, downtime, and botched upgrades. Even when they’re up and running, those systems have plenty of functionality but zero intelligence, obediently regurgitating stored data in a format that’s little different than how it was entered.

The Holy Grail is to pull data back out in a way that lets hospitals learn something actionable, like which antibiotics work best or which lab values correlate with genomic profiles. Few hospitals have the capability to even get that kind of information from their own locally stored data. Fewer still can tap into the collective knowledge of their fellow IDN members. And nearly none can focus the accumulated intelligence of hundreds of peers when making important clinical and business decisions.

New technologies such as Software as a Service will allow hospitals to move to the next level of collaboration – actually pooling their collective expertise with that of their fellow grid users. The applications themselves could be expertly managed by experts and paid for as a service instead of buying racks of servers and installing patches.

Organizations centralized IT in the first place to gain leverage, reduce costs, and reduce risk. Hosted applications are the next step up the food (and value) chain. Capital requirements should be less, space and people requirements minimized, and they’d get the best IT talent money can buy, not just the best that’s willing to move to International Falls, Minnesota.

Hospitals are uniquely positioned to share knowledge compared to nearly every other industry. Most of them are non-profits, those more than 50 miles a way aren’t competitors, and few disagree that healthcare costs are sucking the wind out of our economic sails. For that reason, it will soon make good sense to shut down the endlessly duplicated silos of locally maintained hospital IT and get on the grid instead.

HIStalk Interviews Don Menendez, President, White Plume Technologies

Don Menendez is president of White Plume Technologies of Birmingham, AL.

Tell me about yourself and the company.

I began my career with IBM. I’ve been in software for a long time. I got into healthcare in the late 1980s. I joined a company that had a billing operation, a Unix-based PM system, and an RCM element. The real interesting thing was that we had a shared resource, a large IBM mainframe that we were selling time on. Clients didn’t incur technological or cost risk — they paid on a monthly basis. We didn’t even know it, but we had an ASP before we knew what it was.

That’s how I got to the healthcare side of it. We sold that company to a publicly-held company and then I was looking for a problem to solve. I believe software should solve real problems in a simple way.

I looked at  two things. There were two big gaps in the workflow in the physician offices that I saw. One was, back in 1999, clearly the EMR gap. I felt from a timing perspective and the amount of disruption that it would cause for physicians the timing didn’t make sense at all.

There was another one that was kind of interesting. It was what we ultimately got into. It was the automating of the front end of a revenue cycle management process.

It had been the same for quarter of a century. I’d always known that the first time you automate a manual repetitive, complex, confusing process, that’s when you get to ring the bell financially for your costumers, as opposed to what version 10.1 does for him. That was what this area was. A lot had been done on the back end, but very little on the front end. We felt that if we could push the process use technologies and know-how at the front end without negatively impacting the doctor, we had a real winning solution for him.

Why would practices that already have a PM/EMR system need your products?

It’s really interesting because probably in the last 18 months, the great majority of our new clients are exactly that – people who have an EMR already installed and a PM system. 

I think what happens is this. We approach a number of these practices when they’re in an EMR evaluation stage. Many of them feel like they’re going to be able to achieve the results that are provided by the kind of solutions that we provide once the EMR is implemented. What a  lot of them seemed to find out was that for any number of reasons, they’re all different. The EMR solution is working well, but they’re not satisfied with the results they were able to get as it related to the automated charge capture and coding process.

Sometimes these physicians find the charge capture process too time-consuming and they won’t do it, or it just doesn’t work for them. Other times it doesn’t match the workflow within the practice of how to do what we call post-encounter coding, taking that encounter and adding all the additional things to it necessary for it to get paid correctly. It’s not all done by the physician, and so there are some real workflow issues.

Other times, what ends up happening is they come to us because they’ve figured out that to solve this problem, they’ve had to hire additional administrative people just to do additional work to get the charges in correctly now because they’re starting with physicians than a different manner they started before.

While they took a step forward in the clinical process, it seems like they either made no progress on the RCM side, or worse yet, they took a step backwards. It’s been really interesting that most of our new business is coming from those folks. I would not have predicted that, to be honest, three or four or five years ago, but that’s really what happened.

Do you think it’s a surprise to physicians that when they finally get a PM or an EMR system, much of the benefit accrues to someone else?

My personal opinion is it’s all across the board. For some of them, they predicted that forever. They were very skeptical in the beginning and it was borne out. For others, they were skeptical and it’s borne out differently. They’ve really gotten some value out of it.

In our particular area, the niche that we serve, and what we’re trying to accomplish — quite frankly, the functionality that we provide is an afterthought for both the physician practice and the vendors that are trying to sell the EMR product. Automated charge capture and coding is an afterthought. Many times is an afterthought in the design process, during the sales process, and during the implementation process.

For what we do, they really haven’t thought much about it during the evaluation and implementation process. But when they get down to the point where they’ve rationalized all that technology and are starting to move forward, we find the administrative people say, “We’ve taken a step backwards” or “We made no progress on this at all, and we didn’t realize that there were something out there that could solve some of these problems.”

Describe how your system works differently from the PM and EMR.

Our whole approach was that you can’t slow the physician down for an administrative task or process. It just didn’t make sense. It was counterintuitive to do that. Everything that we’ve done has been designed around that. The part of the process that starts with the physician needs to help them with their productivity, or certainly not slow them down.

This is an odd thing. It sounds counterintuitive, but when we started this business 13 years ago, the great majority of physicians out there — I’ll bet 90 to 95 percent of physicians — were marking encounters on a paper encounter form. They would spend somewhere between three to 10 seconds with that form. That would be enough information to start the process so they can get reimbursed with that encounter. That’s a pretty high standard against which to take an electronic system and try to make that work. 

We’ve focused on the charge capture device, whatever that is, to be productive for the physicians. We’re agnostic towards that. We don’t care. We’ve always had a real open attitude. The best way to get a charge into the system is whichever way is the best for the individual doctor. It could be an iPad. It could be another tablet device. It could be an iPhone, an Android, or other mobile devices. It could be EMRs, keyboards, and lab systems. It could be paper. Regardless of the tool used to capture that data, it should complement and leverage the process and the workflow of the practice. That’s what’s important.

Like most software companies, we learn on the back of our customers. We’ve been doing this same very focused process for 13 years. They’ve taught us a bunch about how it works. It’s not slowing the physician down.  It’s not pushing administrative tasks to the physician. It’s leveraging productivity and accuracy on the front end of the process as opposed to the back end of the process where most of that’s been.

How does it integrate with the PM/EMR?

We originally integrated with PM systems because EMR adaption was so minimal that it just wasn’t an issue for most of our clients. We probably have upwards of 30+ different interfaces that have been in place for quite some time now. Over the last three or four or five years, we have been doing many more EMR interfaces, so that once the doctor is finished with the patient encounter from an EMR basis, they will send us the important bits of data that we need for the charge encounter.We’ll run it through our automated workflow and coding system and then electronically send it to the PM system as if it had been keyed in by the PM system itself.

Obviously, there’s a real benefit there when you got an environment where there’s one PM system and a different vendor for the EMR system. We provide a nice middleware bridge for them just to pass the data, but when we pass it, we clean it up.

I notice you just brought AccelaMOBILE for mobile capture of physician hospital charges. Explain how physicians bill for the hospital services they provide.

It’s really interesting. In the ambulatory setting when they’re in clinic, the administrative personnel will put all sorts of procedures and processes in place around the physician to make sure they get the information they need to get an encounter paid. But when those physicians go out to the hospital, they’re on their own. 

It’s almost like the Wild West out there. It’s every way possible you could think about it. Some are doing along 3×5 card. Some of them get a rounding list printed off from their PM system and they jot those things down. I’ve seen physicians jot it down on their scrubs. They run into a colleague in the hall and they do a consult that nobody knows about and they forget do it. They go to the football game or the music recital right from the hospital and they lose their charges.

One of the big problems with mobile charge capture is just getting decent good data back to the billing staff so they can clean it up. That’s the real allure of mobile charge capture and the concept of AccelaMOBILE. It’s always been about getting the form factor and a technology used by the physicians. 

We looked at doing this 10 or 12 years ago, but the technology just wasn’t there. But now, with physicians being 10 years younger than they were, they’re accustomed to the form factors of smartphones and iPads and those kinds of things. We can now at least solve that first part of the problem — we can get the data back to their billing office in a legible manner that’s complete about what they were doing in the hospital. That’s what the real excitement of the mobile product is.

The second piece is that once you get the data in, it does need to be cleaned up and appropriately done so that you get paid for it. The mobile product is the front end for remote charge entry by the physician. That is complimented by our back-end suites of products that do the workflow and the coding on it.

For some companies, it’s a whole different ballgame to develop their first mobile application and do it right. What did you learned in bringing out AccelaMOBILE and seeing how physicians are using it?

I’ll sound like a broken record, but we’re dealing with high-knowledge professionals that are extremely busy. They were trained to see one, do one, and teach one. That’s the way we try to do the user interface. It has to be simple, it has to be quick, it has to have very few clicks, it has to provide them shortcuts necessary so that they can get into the technology and get out of it very quickly. That’s a continually improving process, and frankly, our physicians are the ones that teach us the most about that. But the simpler the better for them.

How hard is it to make a business case for a practice that may have stretched themselves to buy another new system and now you’re offering them a different one still?

A big issue for everybody is the bandwidth of the practice. Intellectual bandwidth, time to do another project, certainly finance is a commitment, that kind of thing. That is a big issue for us in the marketplace at this juncture, but we try to do things to minimize that. Our whole approach is focused on minimizing that.

We believe that if you’re seriously looking to improve your automated charge capture and coding process on the front end, you can take a look at what’s out there in the marketplace. You can evaluate the systems. You can evaluate what’s available and how it’ll work, probably within a week or two if you could devote a little bit of time to it. 

For us, implementations are typically three days. We’re in and we’re out. It’s a pretty quick process, so it’s pretty light as it relates to the staff itself, but the bigger issue is just the idea that you’d even think about looking at something there.

On your website, it says that HITECH has skewed the EMR market and the vendor accountability to customers with what was described as a checkbook and a gun. How do you see the EMR/PM market evolving over the next several years?

I’m bullish about that, for two reasons, primarily. We believe that once Meaningful Use settles down a bit, the same market forces that have been in place for years will be refocused on, and that’s downward pressure in reimbursement — we don’t see that changing – and increasing complexity and cost associated with physicians figuring out how to get that reimbursement. We expect the focus to shift back to operational efficiency in the ambulatory setting.

I may be wrong about this, but it seems as if none of the current incentive programs are really incenting operating efficiency for the practice. What they’re about is about driving data. Once that moves a bit, I think we’ll play really well, and that as they start to turn towards maximizing efficiency again.

The other piece, the wild card that everybody’s talking about and knows about, is ICD-10. It’s a huge, huge threat to physician productivity and to revenue cycle performance. That’s not about driving data — although for the government it is about driving data — but to practices just trying to see their patients and do what they need to do, it’s a huge threat to both those areas. That’s where we focus. We hope that it doesn’t get pushed out. It’s a distraction. We understand the importance long term about it, but we think it’s an unfortunate distraction.

We think that once all that quiets down a bit, it will return to some of the basic issues. Frankly, they’re going to be harder. The economics are going to be different in an acute setting than it is the ambulatory. The hospitals are buying up all these practices. As they move out of that acquisitive mode and they start to try to rationalize their acquisitions, I think there’s going to be more focus on maximizing operational efficiencies. They’re going to look for help in the ambulatory setting with revenue cycle systems and that kind of thing without having staffs.

Any concluding thoughts?

I’m grateful for the great team we have here. I started this because I thought that business is a part of the fabric of life. You can do both. You can have a great team, you can compete effectively, you can be profitable, but you can have a place where people can live balanced work lives. I’ve been fortunate that the folks that decided to work here really care about our customers and find ways to solve problems. I’m grateful for that. 

I’m grateful for that and I’m grateful for our customers. We have learned so much from them about the challenges that they face and how to make our product a better result of that. Software companies learn on the backs of their customers. I’ve been in the software business since I got out of college and they never get credit for teaching us, but they do teach us. I’m grateful for that.

This is a great time to be in the business. I don’t know what’s going to happen, but as long as physicians wake in the morning, see patients, and hope to get paid for what they do, they’re going to need to get encounter data to the payer and we seem to know how to do that pretty well. There are lots of different ways of making that happen, so we think that means that there’s going to be an opportunity for us. Even as a small player, we’re bullish on what the next three to five years might look like for us.

Morning Headlines 12/7/12

Athenahealth to buy Watertown complex for $169M

Athenahealth completes a deal with Harvard University to buy a 760,000 square foot Watertown, MA campus for $168.5 million.

Ninety-Four Percent of Hospitals Surveyed Suffered Data Breaches; Estimated Cost to Healthcare Industry Averages $7 Billion

Survey results from the Ponemon Institute reveal that 94 percent of hospitals experience data breaches in the last 12 months, with 45 percent reporting more than five breaches over the past two years.

T-Systems Wins Major IT Outsourcing Agreement in US Health Industry

T-Systems expands its presence in HIT as it closes a “pay-as-you-go” IT outsourcing for Presbyterian Healthcare Services.

Reuters – Thoma Bravo, Francisco, THL Final Suitors for Merge

Thoma Bravo LLC, Francisco Partners and Thomas H. Lee Partners have submitted revised takeover offers to Merge Healthcare.

SAIC Announces Financial Results for Third Quarter of Fiscal Year 2013

SAIC announces Q3 results: revenue up 3 percent, EPS $0.33, missing on expectations of $0.35. The company reported that it had signed over $100 million in consulting contracts through its Vitalize and MaxIT acquisitions.

News 12/7/12

Top News

Reuters reports that PE firms Thoma Bravo LLC, Thomas H. Lee Partners LP, and Francisco Partners have submitted revised takeover offers for Merge Healthcare and are awaiting a decision from the company.

Reader Comments

From Nasty Parts: “Re: MedeAnalytics. Oracle backed out of a deal to buy the company, so they’re re-orging and putting a number of folks on the street.” Unverified.

From Spamalot: “Re: funny vendor spam. The ridiculous image and hilariously misspelled text caught my eye before I could hit the delete key.” Could it be that the company has decided to offend as many of the senses as possible, with your delayed “delete” validating their cunning premise of turning your head like a gruesome car wreck? Surely it was not a native English speaker who composed the pitch for business “coninuity” and referred to network security as a “new sexy term.” The company’s two addresses appear to be mail drops, and the Facebook link in the spam goes to a marketing person’s personal page that features family photos and cutesy kitty porn. I’ll hazard a guess that their incoming lines won’t be overwhelmed by clamoring prospects.

HIStalk Announcements and Requests

In case you have missed any HIStalk Practice posts in the last week, here are some highlights. Most physicians who e-prescribe believe it reduces prescription fraud and facilitates decision-making. Vermont’s eight FQHCs go live on five different EMRs. OIG finds that physicians who protest the denial of Medicare claims win their cases 61 percent of the time. Spring Medical Systems will offer its EHR clients an analytics solution from Clinigence. The AMA argues that pre-payment MU audits would be too burdensome for physicians. None of this news can be found on HIStalk, so if you are interested in the ambulatory HIT world, make sure to sign up for the HIStalk Practice e-mail updates. Thanks for reading.

On the Jobs Board: Director of Reimbursement, Cerner Activation Consultant, Director of Marketing, Marketing Programs Manager.

I’m not really interested in two front teeth for Christmas since I don’t have a spot for them, but I could use some holly jolly reader gifts that cost nothing: (a) take 10 seconds max to sign up for spam-free e-mail updates from HIStalk, HIStalk Practice, and HIStalk Connect; (b) sleuth us out on Facebook, LinkedIn, Twitter and make the electronic connection; (c) support the companies that pay the bills by checking out their ads to your left, reviewing their offerings in the Resource Center, and sending out an effortless request for consulting information via the RFI Blaster; and (d) graduate from spectator to player by sending me news, rumors, and guest posts. I note that Dann’s HIStalk Fan Club on LinkedIn now has 2,881 members, all of whom get extra attention when requesting something because I’m reassured that they aren’t ashamed of reading HIStalk. A reminder: we’ve got the top headlines each weekday morning on HIStalk, courtesy of the newest crew member, Lt. Dan. You won’t get an e-mail blast to remind you since I figured that would be really annoying, so just head over to the main page and you’ll see what’s new before you head out for work (like I do).

Acquisitions, Funding, Business, and Stock

Toronto-based Constellation Software purchases 100 percent of the fully diluted shares of Salar from Transcend Services, a division of Nuance. Transcend purchased physician documentation and charge capture systems vendor Salar in July of 2011 for $11 million, followed by Nuance’s acquisition of Transcend for $300 million in March 2012. We ran an accurate reader rumor report of the then-unannounced sale on November 30.

EMR vendor Modernizing Medicine raises $12 million in Series B financing to expand into the orthopedic and ENT markets.

SAIC announces Q3 results: revenue up 3 percent, EPS $0.33 vs. –$0.28, missing on expectations of $0.35. The company said it signed over $100 million in contracts from its recent acquisitions, maxIT Healthcare and Vitalize Consulting Solutions. SAIC also announced that it will cut 700 jobs in advance of possible fiscal cliff federal spending cuts that would decrease defense spending. Shares that were at $20 in early 2010 closed Thursday at $11.26, valuing the company at just under $4 billion.

Sales

Presbyterian Healthcare Services (NM) signs a multi-year agreement with IT service provider T-Systems to manage the health system’s data center operations.

Martin’s Point Health Care (ME/NH) selects athenahealth to provide EHR, billing, PM, and care coordination services for its 90 providers.

Catholic Health Initiatives will partner with Encore Health Resources to create a suite of electronic healthcare intelligence solutions focused on quality, performance, and risk analytics.

Indiana University Health selects Healthcare Quality Catalyst’s data warehouse platform for reporting and analytics.

Mercy Medical Center (IA) will implement iSirona’s device connectivity software to automate the flow of patient data from more than 150 devices into Epic.

Abington Health System (PA) selects the Surgical Information Systems perioperative IT solution for its two hospitals.

WellSpan Health (PA) subscribes to the CapSite Database to improve its purchasing processes.

Maury Regional Health System (TN) selects Medseek’s patient portal solution.

Ophthalmic Consultants (MA) adopts the Professional Charge Capture solution from MedAptus.

People

Interoperability software provider Compressus names Joe Lavelle (Results First Consulting) as COO.

Clinithink hires Fiona Lodge, PhD (Microsoft) as director of technical operations and Nathan Skorick (Altos Solutions) as business development executive.

Huntzinger Management Group VP William Reed (above) joins the company’s board of directors, along with Richard Sorensen (US Health Holdings.)

Emdeon adds former Allscripts Chairman Philip Pead and former Harris Corp. CEO Howard Lance to its board.

Hospitalist Fred Chan, MD is named to the newly created position of CMIO for GBMC HealthCare System (MD).

Jardogs names Ken Mikesh (MyHealthDIRECT, above) as SVP of strategy and business development and Brenda Stewart (Merge Healthcare) as SVP of marketing.

Homer Warner, a cardiologist and medical informatics pioneer, died November 30. He started developing clinical software at University of Utah and Intermountain Healthcare in the mid-1950s and wrote Intermountain’s ground-breaking and still-used HELP system in the 1970s, one of the first electronic medical records and clinical decision support systems. He was chair of University of Utah’s Department of Medical Informatics, the first such program offered by a medical school. Intermountain opened the Homer Warner Center for Informatics Research at Intermountain Medical Center in 2011. He remained active, vital, and humorous until his death at age 90, as evidenced by this video interview conducted a few weeks ago.

Announcements and Implementations

Vitera closes its hardware support business unit through a partnership with DecisionOne, which will hire Vitera’s field technicians. Vitera notes that it has added more than 270 employees this year and anticipates filling another 200 positions.

The University of Texas at Austin launches the country’s first HIE laboratory, which is funded by ICA, Orion Health, eClinicalWorks, and e-MDs.

DrFirst announces Akario, a free secure clinical messaging system.

GE Healthcare launches its Centricity Business 5.1 RCM solution.

Allscripts releases Sunrise Financial Manager, a revenue cycle solution designed for accountable and value-based care payment models.

The HIEs of West Virginia and Alabama, both customers of Truven Health Analytics, earn federal recognition for reaching milestones for full query-based and directed information exchange.

MModal opens a medical transcription center in Mysore (India), where the company plans to create 100 jobs over the next two years.

Cisco Systems is providing video calls with Santa to patients at 31 children’s hospitals (including Children’s of Alabama in a photo from Tuesday, above) via its Santa Connection Program, which runs through December 21 .

Government and Politics

The IRS releases a final rule subjecting the sale of medical devices to a 2.3 percent tax beginning in 2013, which is expected raise $29 billion in tax revenue through 2022.

Innovation and Research

Independence Blue Cross, Penn Medicine, and DreamIt Ventures create Philadelphia-based DreamIt Health, yet another digital healthcare accelerator. It offers $50,000, a four-month boot camp, office space, mentoring, and a demo day. It gets 8 percent of the equity in return.

Other

Athenahealth will buy the 29-acre, 11-building, 760,000 square foot Arsenal on the Charles complex in Watertown, MA from Harvard University for $169 million. The company was already leasing 330,000 of space in the complex for its headquarters.

A CapSite survey finds that one-third of US hospitals have adopted a vendor-neutral archive, while another 19 percent plan to do so.

Kaiser Permanente will open a new IT center in the Denver, Colorado area and will hire 500 IT employees by 2015.

A survey finds that 94 percent of healthcare organizations suffered at least one data breach in the last year. Other findings: (a) 69 percent don’t secure PHI-containing medical devices such as insulin pumps, and (b) almost all of them use cloud-based solutions and allow employees to use their own medical devices even though half of the organizations question the security of those technologies.

The CDC reports that 40 percent of office-based physicians now use an EHR with a basic level of functions, up from 34 percent a year ago.

At a dermatologist appointment this week, I noticed signs on the window urging patience, as the one-doc practice had just changed EMR systems. I asked the doctor and got an earful in return. He had already attested for Meaningful Use Stage 1, but was convinced by a salesperson to trash his EMR and move to GE Centricity. He said it’s the worst business decision he has ever made, not because Centricity is bad, but because he spent a lot of money, he’s being hit constantly with additional upgrade and maintenance fees, and to top it all off, he now realizes that he has no chance of collecting Stage 2 money because the bar is set too high for his practice. Not to mention that as a specialist, the EMR is not providing much patient value. He says he’s hoping to hold on for the 2-3 years it will take to get his practice back on its feet again, as the EMR is now his single largest expense. I can only describe his behavior as ashamed, followed by relieved as he realized from our discussion that he’s not the only one struggling to pay for something that he probably should never have bought in the first place. Needless to say, he’s not exactly thrilled with the HITECH program. It’s an eye-opener to realize that these little practices are cash-strapped businesses run by folks who may be excellent clinicians, but who are also marginal, accidental businesspeople just trying to keep the doors open and their employees paid. Derms are usually well paid and minimally stressed thanks to acne and Botox, so I can only imagine what it’s like for a primary care practice.

In Canada, Vancouver Coastal Health fires a long-time clerical employee for looking up the electronic records of five local media personalities out of curiosity.

Hello, Doc, Internet porn is free: a female employee of a doctor’s practice notices a red light glowing behind supplies in the restroom. She finds a video camera pointed at the toilet. The doctor finds his career potentially in that same toilet, as police executing a search warrant find the camera-controlling software on his computer. Maybe he should claim that the restroom doubles as a telemedicine station.

A privacy “weakest link” example. MC and Mel, a couple of morning zoo-type deejays from Australia sporting the worst fake British accents in history, call up the London hospital treating the Duchess of Cambridge for morning sickness, doing hilariously unskilled and giggling impersonations of Queen Elizabeth II, Prince Charles, and barking Corgi dogs. They get through to a nurse who provides a full update on the former Kate Middleton’s condition, learning that Kate “hasn’t had any retching with me.” The hospital is evaluating its privacy practices. UPDATE: in a not-so-funny ending to the story, the nurse who took the prank call has apparently committed suicide.

Sponsor Updates

• Billian sponsored the December 4 Health IT Leadership Summit at the Fox Theater in Atlanta, which attracted 600 attendees. Above are Ellen McDermott (University of West Georgia), Jennifer Dennard (Billian Inc.), David Hartnett (Metro Atlanta Chamber of Commerce), and Cynthia Porter (Porter Research).
• AT&T adds a remote interactive patient monitoring solution from Ericsson to its ForHealth remote patient monitoring platform.
• Mercy Regional Hospital (KS) implements a paperless employee time off request process using Access Evolution.
• Healthcare Clinical Informatics offers ten tips for realizing the value of EHR.
• Shareable Ink will exhibit at next month’s ASA Conference on Practice Management in Las Vegas.
• Beacon Partners and its employees donate over $9,500 in support of the Red Cross’s Hurricane Sandy relief efforts.
• ChartWise Medical Systems will integrate TruCode’s grouper, pricer, and editing Web Services into its ChartWise:CDI software.
• Imprivata publishes a white paper highlighting best practices for realizing care team collaboration and productivity benefits using HIPAA-compliant texting.
• CPU Medical Management Systems, a MED3OOO company, partners with RISARC Consulting to provide CPU customers an option for secure electronic document exchange.

EPtalk by Dr. Jayne

ONC holds its annual meeting on Wednesday, December 12 in Washington, DC and also accessible by webcast. It will include sessions on HIE and interoperability, patient engagement, and of course Meaningful Use.

A study in the December issue of Pediatrics lists five key features needed for pediatric EHRs: well visit tracking, support of growth chart analysis, immunization tracking, immunization forecasting, and weight-based drug dosing. Although the article notes that “it’s nearly impossible to find an EHR that meets those standards,” I guess I’m lucky because my system supports all of these. One of my friends is looking to replace her system and I’m attending a demo with her over the holidays. We’ll have to see how that vendor stacks up.

Over on HIStalk practice, Inga mentioned a survey on e-prescribing. Although I’m optimistic about its potential, I’m skeptical about the ability of pharmacies to keep up. Case in point: e-prescribing of controlled substances. Although the DEA finally approved this and several vendors piloted it in a handful of states, there is still a lack of awareness. I happened to stop by the pharmacy at a local supermarket chain and ask if they’re ready to receive such scripts (because I’m more than ready to start transmitting them) and received a stern lecture from the pharmacist about how he’s been told it’s illegal to do so.

Weird news story of the week: A New Orleans ambulance crew finds their vehicle immobilized with a parking boot, applied while they were on the scene with a patient.

I previously mentioned Scanadu, the startup that hopes to make a Star Trek-style medical scanner a reality. The company unveiled its SCOUT product, which is headed to the FDA for approval as a home diagnostic device. If it really delivers what it says – five vital sign results in 10 seconds with 99 percent accuracy – I think they’re missing a major market. For physician practices where rooming patients quickly is essential, this would be a killer app.

One of my favorite Tweeps is @MeetingBoy. Since I shared my holiday party recipes, I’ll share his piece on Eight Reasons Why I’m Skipping the Office Christmas Party.  I’ve never been to a real-life office Christmas party – we don’t have those in non-profit land. The closest we have is the holiday potluck. I’d love to live vicariously through HIStalk readers and of course promise to keep you anonymous. Bonus points for anyone who has received a corporate logo holiday gift worse than what I received one year: jumper cables.

Flu season has arrived early. If you haven’t received the vaccine, there’s still time. Whether you’re vaccinated or not, please keep covering those coughs, stay home when you’re sick, and keep washing those hands. And in case you wondered, paper towels spread fewer germs than drying your hands with a blower.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Morning Headlines 12/6/12

ONC, CMS revise EHR Stage 2 rules

ONC and CMS revise several stage 2 rules, publishing an interim final rule with a 60-day comment period.

Allscripts Releases Sunrise Revenue Cycle Management Solution

Allscripts announces a newly developed revenue cycle management solution designed to track costs across the enterprise and support value based care models.

Truven Health Analytics HIE Advantage Customers Receive National Recognition for Achieving Health Information Exchange Milestones

West Virginia and Alabama, both running HIE infrastructures put in place by Truven Health Analytics, receive federal recognition for reaching full query based, and directional information exchange.

Vitera Healthcare Solutions Partners with DecisionOne Corporation to Deliver Superior Hardware Services and Support to EHR/PM Customer Base

Vitera closes its hardware support business unit through a partnership with DecisionOne. All affected Vitera employees will be absorbed by DecisionOne, which will take over support functions for Vitera starting in 2013.

Readers Write 12/5/12

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!

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

Hey Healthcare, ‘I Dare You to Do Better’
By Nick van Terheyden, MD

I was reading “Dream Big, Start Small: NYU Startups Disrupt Big Industries” when a quote from Mana Health caught my attention: “We want to make the job as easy as possible for doctors … We want to be Apple in [the] health industry.”

This quote got me thinking about the role of simplicity in healthcare. Part of what makes Apple unique is its simple approach to consumer technology. While bells and whistles are buried beneath the surface, what the user experiences is the ability to pick up a piece of Apple technology and interact with it without reading a verbose manual or watching a “How-To” YouTube video.

Clearly, a team has already taken the time to anticipate how people will use this technology, what questions they might have, where they might get hung up, and what’s really going to “wow” consumers and keep them engaged. There’s something mystical and awe-inspiring about this type of simplicity, particularly if you compare it to what clinicians have to do in order to get up to speed on the most basic healthcare technologies.

Maybe it’s because The Official Star Trek Convention was recently held in San Francisco, or the fact that I just recently heard that a nine-minute teaser for the latest Star Trek movie, “Star Trek Into Darkness” will be available in 3D IMAX theaters on December 14, but in addition to “simplicity,” I’ve also been thinking a great deal about how advancements in technology can help the healthcare industry “boldly go where no one has gone before.” And more importantly, to get “there” without asking clinicians to fight Klingons.

Over the past year, there has been an array of studies and stories pointing to frustrations associated with electronic health records and Meaningful Use. This is compounded by additional pressures putting the heat on the healthcare industry — a looming physician shortage, an aging population with increased care demands, and changes in the reimbursement model.

Still, for every problem, there’s a solution. What keeps me up at night, though, is the fact that all too often we try to slap a new coat of paint on a problem in an effort to mask the issue as quickly and efficiently as we can. More often than not, we approach problems — especially in healthcare — with a fast and furious desire to make things right in the moment instead of aiming to make things right for the long term.

The fast fix in healthcare is often not the real solution to the problem. Take the transition to ICD-10, for example. At first, some healthcare providers wanted to keep doctors as far from the transition as possible. And at first glance, I can understand why. No one wants to take the focus off of the patient. Still, the transition to ICD-10 can’t be simplified without having doctors on board as part of this massive personnel and technological overhaul.

See, the problem with simplicity is that to get to that type of Apple approach in healthcare, you have to take into consideration the myriad of players that will be affected. You have to take the time to test and tweak, test and tweak in an iterative process that while challenging and time intensive, will ultimately be rewarding. In other words, to get to “simple,” you have to trudge through the difficult for quite some time.

As we head into the holiday season and take a look back at the accomplishments and failures from the past year, let’s agree to remain focused on integrating a new sense of simplicity into the complexity of all things healthcare in 2013 – whether it’s technology, health insurance, or patient communication. One particular “Star Trek” quote mapping back to the simplicity theme that seems like a fitting request for all healthcare players in the coming year is this: I dare you to do better.

Nick van Terheyden, MD is chief medical information officer at Nuance of Burlington, MA

Humble Suggestions from an Allscripts Pro Client to Ease Transition Pain for MyWay Clients
By Cathy Boyle, RN, BSN

By now, I’m sure everyone who uses Allscripts MyWay is aware that the company is transitioning customers to the Professional Suite. You’re probably overwhelmed sorting through options as you decide whether to upgrade to the new product or to jump ship and start over with another EHR company. 

Starting over with another company may be painful, but it’s also somewhat vindicating. On the other hand, agreeing to upgrade to the Professional product may be the easier road because you’re exhausted and don’t want to start over with someone new. 

Let me offer a little perspective …

Three years ago, our practice learned Misys was merging with Allscripts and we would need to move to the Allscripts product. No choice.

We were miffed, to say the least, and jumped ship to a competing product. Within three months, we realized it was a serious mistake. We ate a little crow and made the decision to return to Allscripts. 

We implemented the Allscripts Pro EHR/PM system and came to the conclusion that even though not all of our experiences with Allscripts have been perfect, it was the right choice. Like it or not, Allscripts is the leader in the EHR world for a reason. They haven’t always gotten it right. Unfortunately, no one does. 

I will not pretend to understand how any of you feel as a MyWay client. The only thing I can offer is my perspective from moving to another product and realizing the grass is not always greener on the other side. 

My suggestions are threefold:

1. If you haven’t already, sign up for Allscripts Client Connect and check out the resources available for people upgrading to the Pro EHR and for those considering other options. You’ll find links to webinars, product demos. and lots of other info. Can’t hurt, right?
2. Go to the Pro ARUG (Allscripts Regional User Group) page for your state and start asking questions of Pro users in your area. They’ll answer you honestly. They are not paid by Allscripts and have real-life, in-the-trenches perspectives on the Pro product.
3. Find out who in your local community has the Pro product and go take a look at it. See it for yourself firsthand as you make the best decision for your practice.  

Then, if you don’t like what you see and hear, feel free to explore other options.

I wish you the best in this world of healthcare changes – I really do!  But if you come to realize, as we did, that the Pro solution is right, I would personally like to welcome you to the Pro family! We will help you, support you, cry with you, teach you, bang our heads (at times) with you, and celebrate the victories that come with finding a system and a family of users from which you can benefit. It’s not always easy going, but you will be heard and you will not be alone.

I am not paid by Allscripts and do not reap any personal benefit from writing this post. Just concerned with what is happening to fellow clinicians in the Allscripts community. Feel free to contact me directly if you have questions. I will not mince words and am happy to help in any way I can. 

Cathy Boyle, RN, BSN  is clinical director at Heiskell King Burns & Tallman Surgical Associates, Inc. of Morgantown, WV.

OCR’s Guidance for De-Identifying Health Data
By Deborah Peel, MD

The federal Office of Civil Rights (OCR), charged with protecting the privacy of nation’s health data, has released guidance for “de-identifying” health data. Government agencies and corporations want to de-identify, release, and sell health data for many uses. There are no penalties for not following the guidance.

Releasing large data bases with the de-identified health data of thousands or millions of people could enable breakthrough research to improve health, lower costs, and improve quality of care — if de-identification actually protected our privacy so no one knows it’s our personal data. But it doesn’t. 

The guidance allows easy re-identification of health data. Publicly available databases of other personal information can be quickly compared electronically with de-identified health data bases to reattach names, creating valuable, identifiable health data sets.

The de-identification methods OCR has proposed are:

• The HIPAA Safe Harbor method. If 18 specific identifiers are removed (such as name, address, and age), data can be released without patient consent. Still, 0.04 percent of the data can still be re-identified.
• Certification by a statistical expert that the re-identification risk is small allows release of databases without patient consent. There are no requirements to being called an expert. There is no definition of small risk.

Inadequate de-identification of health data makes it a big target for re-identification. Health data is so valuable because it can be used for job and credit discrimination and for targeted product marketing of drugs and expensive treatment. The collection and sale of intimately detailed profiles of every person in the US is a major model for online businesses.

The OCR guidance ignores computer science, which has demonstrated that de-identification methods can’t prevent re-identification. No single method or approach can work because more and more personally identifiable information is becoming publicly available, making it easier and easier to re-identify health data. See Myths and Fallacies of Personally Identifiable Information by Narayanan and Shmatikov, June 2010. Key quotes from the article:

• “Powerful re-identification algorithms demonstrate not just a flaw in a specific anonymization technique(s), but the fundamental inadequacy of the entire privacy protection paradigm based on ‘de-identifying’ the data.”
• “Any information that distinguishes one person from another can be used for re-identifying data.”
• “Privacy protection has to be built and reasoned about on a case-by-case basis.”  

OCR should have recommended what Shmatikov and Narayanan proposed: case-by-case “adversarial testing” in which a de-identified health database is compared to multiple publicly available databases to determine which data fields must be removed to prevent re-identification. See PPR’s paper on adversarial testing.

Simplest, cheapest, and best of all would be to use the stimulus billions to build electronic systems so patients can electronically consent to data use for research and other uses they approve of. Complex, expensive contracts and difficult workarounds (like adversarial testing) are needed to protect patient privacy because institutions — not patients — control who can use health data. This is not what the public expects and prevents us from exercising our individual rights to decide who can see and use personal health information.

Deborah C. Peel, MD is founder and chair of Patient Privacy Rights Foundation of Austin, TX.

Evolution in your Data Center
By Axel Wirth

The change of a biological organism through a combination of mutation and natural selection over a number of generations was first articulated as the Theory of Evolution by Charles Darwin. In short (and with my apologies to the great scientist), if a change occurs and the next generation is more successful, it will have a higher probability of passing on its characteristics to future generations.

Survival of the fittest, survival of the smartest, or plainly a strategy to adapt to a changing environment. Whichever way you look at it, it has enabled the human race to populate the earth from our origins in Africa to the icy north.

But evolution works in both directions. Think, for example, of the problems caused by antibiotic-resistant infections like MRSA. We can also apply a similar thought model outside of biology. Let’s have a look at the scary and complex world of computer viruses and malware.

A recent example. In mid-2009, W32.Changeup, a polymorphic worm written in Visual Basic, was first discovered, but was not really anything special. It wasn’t harmless, but in general, it was classified as a medium damage, medium distribution, and easy to contain worm.

But then evolution came to play (granted, this was not evolution by mutation, but evolution by design). As of recently, we have seen over 1,000 variants of W32.Changeup, some of which much more aggressive and successful than the original. Some variants recently showed an increase in activity of over 3,000 percent in a single week.

What is even more concerning is that based on some of the characteristics of this worm, it is especially dangerous for the typical healthcare infrastructure. We have already seen several hospitals hit hard over the past weeks.

Why now and not back in 2009? Just like MRSA, W32.Changeup evolved and became more resistant and dangerous.

There are a number of malware threats which, due to the way there are designed, are affecting healthcare IT more than others. Downadup, also known as Conficker, was one of them. It looks like Changeup is joining the club. Here is why:

• It spreads through removable drives. Devices and subnets which are perceived to be protected through isolation and may not have sufficient malware protection and resilience are at risk.
• It infects old and new versions of Windows on workstation and server platforms. Certain devices on hospital networks with older or unpatched operating systems (e.g. medical devices, dedicated workstations, and servers) may be especially vulnerable.
• It uses multiple propagation methods through removable drives and shared network drives. Once a system is compromised, Changeup’s main purpose is to download various additional malware. Among it is a Downloader Trojan, which in turn will download even more malware.
• Changeup is polymorphic in nature. As it copies itself to other devices, it maintains its function, but changes it look. This makes it difficult to detect with traditional signature-based antivirus software. Modern anti-malware software provides more functionality than signature-based protection, but proper configuration of your endpoint protection combined with a layered security approach are required to detect and protect against a sophisticated worm like Changeup.
• Changeup copies itself to removable and mapped drives by taking advantage of the AutoRun feature in Windows, which should therefore be prevented for all users and devices, including network shares.

This brings us back to the initial point made about evolution. We now have diseases which are resistant to a single antibiotic and require a complex, multi-pronged approach. Similarly, with computer malware like Changeup, a single approach (e.g. relying on signature-based antivirus alone) is not sufficient any more. At a time where we are seeing well over 10 new viruses and variants being created per second, we need to take a strategic “defense in depth” approach.

Of course, traditional and signature-based antivirus is still part of that picture, but it needs to be complemented by system and network intrusion detection, peripheral security (firewalls), system configuration and controls, security event monitoring, and URL filtering to prevent connection to known C&C (command and control) URLs.

Axel Wirth is national healthcare architect for Symantec Corp. of Mountain View, CA.

Collective Action 12/5/12

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

Engagement

I failed, and I mean big time. Like “I was surprised I kept my job” type failure. Fortunately there were circumstances around me that moved the attention off the failure, but it still happened.  

I was 31. It was my first director-level job. I was, in many ways, woefully unprepared. I walked into this IT director position at a 100-bed behavioral health hospital at a time where they were selecting a vendor for their EMR project.

Even before I officially started there, I had to fly out to sit through vendor demos. My second day on the job I was in a meeting with the CFO, CEO, controller, CMO, and a hired consultant and was asked which system I thought we should go with. I didn’t even know where the restrooms were and had hardly logged on to my computer. It was a real “drink from the fire hose” experience.  

We eventually made a decision and started to progress through the project. I leaned on the consultant a lot, as I was learning healthcare terminology and at the same time trying to implement an EMR. It was crazy.  

Ultimately, the project failed. We never got it off the ground. Right about the time it failed, the company was bought by another company and the focus shifted away.

As I reflect on that project, I realize that the biggest piece that was missing was what I now refer to as engagement. We set up meetings and the CMO would not show up. The nursing director was too busy to help document workflows and processes. None of the physicians or nurses ever thought it would really happen — they were all seemingly waiting for it to fail. The CEO was a verbal champion for it, but could not quite get the CMO and nursing leaders to engage appropriately.  

I learned a tremendous amount from that failure. I carry many of those lessons with me today.  

The greatest lesson I learned is the power of engagement. In this example, it was lack of clinical leadership engagement that was the primary reason for failure. That project and experiences since that project have collectively heightened my sensitivity to and awareness of engagement. I now understand that engagement encompasses much more than I originally thought.

I want to provide a few examples of how we at Flagler Hospital are trying to engage with leadership, staff, and physicians.

The first example relates specifically to the IS team. Within my first six months of employment here, I floated the idea of what we now call the Clinical Experience program to the newly formed IS leadership team. The idea is rooted in the fact that we are not here for IT purposes — we are all here to support and improve patient care. How can you sit in a cube and make decisions that impact patient care without understanding what it means to provide patient care?

We implemented a program with the assistance of clinical leadership where every member of the IS team is required to spend eight hours per quarter on a clinical unit or combination of units. This time is documented and included in the employee’s quarterly performance review.

Some people have responded very well to this and have become even more engaged in what they are doing. Some just go through the motions and don’t see the value. They may not see the value, but that does not mean there is no value. The real impact came in one of our team meetings when we reviewed a network incident that took the ED down hard. Everyone there had a clear understanding of what that meant because they had all spent time in the ED, at least briefly, witnessing its dependence on IT services.

The next example of engagement is at the organizational level. We are in the middle of an EMR implementation at our hospital, but of course we have not always been in the middle. There was a beginning! The beginning for us was January 2011, and it was launched with an organization-wide event planned mostly by the marketing team (who else should be planning these things?)

They did a great job of putting a theme together that tied our corporate theme of iCARE (Compassionate, Always listening, Responsive, and Empowered) with the project. This ended up with the project name of iCAREiConnect.

Before the event took place, the marketing department went around with a video camera to each department in the hospital and recorded departmental dance routines to Stereo MC’s song “Connected.” The video they put together kicked off the event.

There were Xbox iConnect stations as well as other game stations around the room. Our vendor, Allscripts, was there performing product demos and handing out marketing items. Overall, it was a very successful event that got the whole organization, including physicians, engaged. If you watch the video, you will see that we are all in. That level of engagement and buy-in has been evident throughout this implementation and is something that we rely on daily to progress forward.

The final example is also project related. We are mostly completed with the build of our Allscripts environment and are looking forward to testing and training phases of the project. As you can imagine, stress levels are high and people are getting worn down. We wanted to ceremoniously mark the completion of build and shift of focus to testing and training, so we decided to have a “Project Reboot” event. The theme of the event would be Finish Strong, based on the book Finish Strong by Dan Green.  

Again, marketing planned and coordinated the event. It included a photo shoot, video shoot, a few speakers, and a formal ceremony. The whole IS department was present, as well as clinical leadership and SMEs, vendor partners, and hospital administration. The CEO spoke, the CMIO spoke, and because Dan Green could not make it to talk about the principles associated with Finish Strong, I took his place and wrapped up the speaker portion of the event.  

The final portion involved two significant ceremonies. The first one was the book. We purchased copies of Finish Strong for everyone present. For four weeks prior to the event, I worked with nursing leadership (engaging nursing leadership) to get each book signed by a patient. When we distributed them at the event, we talked about how a patient signed each book and how we told the patients what we were up to (engaging the community.) People were really touched by this — it suddenly got personal.  

We ended the event by handing out Finish Strong bracelets to everyone and asked them all to wear them at all times until we go live with the new system. We’ve done bracelet checks periodically since the event and most are still wearing them. I sent a book and bracelet to the CEO of Allscripts and asked Glen to wear it, as he is as much a part of this process as we are.

There are so many more examples of engagement. Our CMIO is doing a fantastic job engaging the physicians with the PIT Crew. We are going through every single order set in the hospital and will have consolidated, evidence-based order sets when we go live.

This kind of stuff doesn’t just happen. It must be intentional. It must be authentic. You have to actually believe that without engagement from everyone, you will fail. You can believe it or not, but that does not make it any less true.  

As I wrap this up, I want to encourage you to see where you are engaging others in the organization. Ask other leaders if they feel involved in what you are doing. We have not done this perfectly and are receiving feedback about where we are lacking. We listen to that feedback and try to engage others in different ways. This is not an IT project. It is a clinical transformation that requires the engagement of all areas of the hospital.

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

An HIT Moment with … Marc Andiel, CEO, Accent on Integration

An HIT Moment with ... is a quick interview with someone we find interesting. Marc C. Andiel is co-founder, president, and CEO of Accent on Integration of Murphy, TX.

What integration-related parts of Meaningful Use Stage 2 will the average hospital struggle to meet?

With Meaningful Use Stage 2, hospitals and providers are under more pressure than ever to demonstrate the use of CPOE, record and chart vital signs changes, and effectively leverage clinical decision support. In this environment, it’s imperative that healthcare organizations make the automatic acquisition of device data a reality. It saves significant time, streamlines documentation processes, facilitates valid and accurate orders, ensures clinicians have the most recent and relevant patient data, and reduces errors.

In fact, we’re seeing that clinicians are outright demanding this automation. But because patient care device interfacing requires considerable time, effort, and resources, many providers simply cannot support the effort.

One significant struggle is that in most hospitals, medical devices have historically been completely separated from the information technology group. They may reside on proprietary networks, as well as closed, non-interoperable deployments. Breaking medical device data out of these silos is imperative to meeting the integration-related Meaningful Use Stage 2 core measures.

Manufacturers began addressing this problem by providing modality-specific solutions. This model worked at first, but it resulted in many one-off projects that didn’t benefit the organization as a whole. But with the onset of Meaningful Use, providers made it a priority to take a more enterprise approach. We’re seeing that more than ever, provider organizations are refusing vendor-specific integration offerings and instead demanding enterprise-wide, vendor-neutral solutions like our Accelero Connect integration platform to interconnect a multitude of disparate technology systems.

Organizations will continue to struggle with integration projects unless they deploy solutions that are architected to facilitate the convergence of medical device technology and information technology. Additionally, caregivers, IT, biomedical / clinical engineering, and vendors must come together and take a patient-centric approach to fully unite people, processes and technology.

How many hospitals have integrated their medical devices with their clinical IT systems and what lessons have they learned in doing so?

From our experience, basic level vital signs device integration with clinical IT systems is the exception, not the rule. Far more hospitals have this on their roadmap than the number of facilities that have already completed basic vital signs integration.

It’s important to note that there is a huge gap when it comes to full medical device integration with clinical IT systems like monitors, smart pumps, ventilators, glucometers, and smart beds. Hospitals that have integrated medical and patient care devices with their clinical systems are finding that many devices beyond monitors will send clinical parameters that are not supported by their clinical systems. 

Because basic vital signs integration for monitors — bedside, continuous feed, low acuity — is still uncommon for most hospitals, the real challenge that lies ahead is connecting more complex devices that will require clinical support of several more parameters.

Quite a few companies offer medical device integration products and services. How is Accent on Integration different?

Our software-only solution has zero requirements to be at the point of care. Another difference is that we don’t see ourselves as simply a product company. We will always function as both a services and a product company because we believe this will result in the most benefit for our customers. This is extremely important to us because the services component of our business allows us to be very in tune with what device manufacturers are doing now and with their product roadmaps.

It also means that we stay well informed of the current capabilities of consuming systems — like EHR, BI/CDS, EDIS, etc. — and most important, we remain in touch with clinical workflow and everyday clinician realities and challenges. To us, without an intimate knowledge of the devices, the IT systems, and the end-users’ needs, it is highly unlikely that a product alone can meet its envisioned purpose.

In addition, we routinely work for the big healthcare IT and medical device vendors to integrate their systems. We feel that the breadth of our knowledge of the different systems available in the market today and how they work is unsurpassed by any competitor. Lastly, we have extensive experience working for and with provider organizations, clinical IT vendors, RHIOs, HIEs, and technology companies.

Your leadership team all worked for Baylor. What made you decide to start a company and what’s good and bad about working for yourselves?

Jeff McGeath and I started AOI in 2006 with a simple vision that there has to be an easier way for healthcare organizations to connect their disparate systems. We reflected on our expertise and recognized that although we were very proficient in the IT system integration space, the future of healthcare relied on connecting disparate devices that housed an incredible amount of clinically critical information. Additionally, it was becoming more and more necessary for providers to be able to exchange information outside of the walls of their organization.

There was so much change and flux at the time that we weren’t completely certain the industry would go in the direction we predicted. As with most startups, things didn’t come together overnight. However, eventually we were providing services for device manufacturers as well as for one of the first HIE vendors.

Eventually it became clear that our early predictions and focus areas were growing into very important healthcare verticals. We are proud to have been a key player in steering the path of integration for the last six-plus years. Because we forged early roots in this space, today we are able to say that AOI can provide services from the device to the connected community and everything in between. We can offer expert services to providers, hospitals, and vendors alike.

While we always knew we wanted to be both a services and products company, we absolutely wanted to make sure there was a need. A benefit of working without outside influences like investors and private equity is that you have complete control of the focus of the company. You can be much more nimble. Certainly there is the early, day-to-day struggle of bootstrapping the organization. However, seven years later, we are much better for it and have been able to take the needed time to evaluate the market.

As we built our organization’s capabilities and grew our services offerings, we were able to keep a keen eye on where there were market gaps we were interested in. We were able to easily work toward filling those gaps.

One of the hard parts about working for ourselves has been building our team so that we can provide the level of professional capabilities we offer today. Finding exceptional people is hard and very time-consuming work. In our previous jobs, we were fortunate to work with great individuals who were already in place, but when we started Accent on Integration, we had to start from scratch and build a team of professionals that we knew would contribute to the company’s success.

Everyone has a core group of people that they have worked with in the past that, if given the chance, they would want them by their side again. You pointed out that our leadership team all has previous ties, and Jeff and I would have it no other way. We did everything we could to bring those folks on board, and it is a continuous process to add to our team of all-stars. Our employees are our greatest asset.

What new integration needs do you see developing for hospitals in the future?

Full waveform integration is definitely a hot topic with hospitals today. Every customer we meet with has questions about the best way to get waveform data out of their ancillary systems and into the hospital EHR in a format that can be viewed natively. Today, this is sometimes accomplished by attaching documents or scanning strip images. But what we’re seeing is that hospitals are pushing the EMR vendors toward native support of this rich data.

The market has matured to the point that basic HL7 interchange is not really a challenge for hospitals and vendors using a variety of tools. Richer content — such as waveforms and CCDA — and the orchestration of multi-step technical workflows to support clinical workflows are the integration needs we see the industry heading toward. The standards organizations like HL7 and IHE are already a few years into that stage of integration readiness, with one example being IHE’s Waveform Content Management (WCM) profile.

We also expect to see EHRs supporting a richer set of parameters from devices so a greater amount of device data can be integrated. As more data is available in real-time, alerting will continue to mature, which will greatly improve patient care and safety and has the potential to significantly improve overall operations.

In addition, we see HIEs and ACOs having community-based offerings that leverage device data not only from the hospital, but also from any location including the home.

Lastly, the interface engine market appears to be experiencing some redistribution, and there will be provider organizations that will need people skilled in both product X and product Y to do a good migration of interfaces.

Morning Headlines 12/5/12

Nuance Communications Acquires Accentus

Nuance acquires medical transcription, document imaging and remote coding vendor Accentus of Ottowa, CA for an undisclosed sum.

Children’s Hospital Central California Selects Athenahealth To Help Achieve Higher-Quality, Comprehensive Patient Care

Children’s Hospital of Central California will implement Athenahealth’s cloud-based EHR across its 127-provider system.

VA Taps GetWellNetwork To Provide Patient Engagement Platform to Transform Care for Veterans

The VA choses GetWellNetwork to implement enhanced patient education and patient communication tools across 21 VA medical centers.

Imprivata Cortext Sets Pace as the Fastest Growing HIPAA Compliant Text Messaging Solution with More Than 250 Healthcare Organizations Enrolled within 60 Days of General Availability

Imprivata signs 250 organizations up for its HIPAA-compliant text messaging system, which ranges in price from free to $5 per user/month.

News 12/5/12

Top News

The Atlanta newspaper covers the case of an internist whose stolen identity was used to apply for a National Provider Identification number, then used to incorporate a fictitious Buckhead medical clinic using a UPS Store mail box as an address with “Olga Teplukhina” named as the clinic’s CEO. The paper then did its own investigation, finding 131 CMS-registered medical providers that used an Atlanta UPS Store as their practice location, resulting in OIG looking into at least two dozen of them. One UPS Store-based company was found to have billed Medicare for $1.2 million in fraudulent injections, but is still in business because companies that are barred from billing Medicare can still bill private insurance. Despite the fact that the newspaper created the list of 131 practices using minimal effort and desktop software, CMS says it doesn’t have the technology to recognize private mailboxes since they carry a regular street address. The article says CMS pays claims that it really should deny under existing regulations because it worries that legitimate provider mistakes would unduly delay payments. One doctor complained to CMS that his name was being used to bill Medicare fraudulently, but two years later, the phony provider still has an active NPI that uses the doctor’s name.

Reader Comments

From Diminutive Avian: “Re: Epic. Most people don’t know that Epic has one final implementation check. Judy has to personally give the go-ahead. If she doesn’t like what she sees, she tells the customer she’s pulling out and gives them their money back. That’s another reason why the company has only successful implementations. Unlike publicly traded vendors, Epic is more than willing to walk away if the client is botching the install and ignoring Epic’s recommendations.” I’ve been told that at least two big academic medical centers are in precisely this predicament as we speak. From what I’ve heard, Judy gives the client two choices: (a) agree to let Epic send in a SWAT team to take over the project, or (b) find themselves another vendor.

From BubbaLove: “Re: Duke University. Heard they’re being sued by Deloitte for breach of contract due to mismanagement of the Epic implementation.” Unverified. Perhaps HITEsq or another attorney reader can scour the legal databases and report back. UPDATE: two well-placed sources and one even better second-hand source contacted me to say there’s no truth to this rumor. I’ve also had no volunteers tell me they’ve turned up any legal documents. I’m concluding that the reader’s report report, which they admitted was second hand, is inaccurate –the Duke and Deloitte working relationship hasn’t changed as the project continues.

From Current Epic Employee: “Re: Epic’s employee ages. In the November staff meeting it was announced that Epic’s #2 Carl Dvorak has worked for Epic for 25 years. He showed a slide saying that 42 percent of the current employees weren’t born then — i.e. are under 25 — and 78 percent are under 31.” People get nervous at the idea of fresh graduates telling major medical centers how to run their business, but it seems to work and it’s brilliant on Epic’s part. You take new graduates whose career prospects are negligible, plant them in Wisconsin where there aren’t many other jobs, and pay them more than they would make otherwise but less than everybody else pays their more senior HIT people. You train them in skills with minimal value elsewhere, like MUMPS programming, and give them job perks that make them feel like they’re working for Google. The young folks don’t complain much, they don’t bring in all the bad habits they learned working for less successful vendors, and by following the formula they almost always get the job done. That makes Epic almost infinitely scalable unless Midwestern universities stop graduating liberal arts majors with high GPAs. Nobody seems to mind except the experienced people who Epic won’t hire.

From UKnowMe: “Re: IBM. Seems like several high-ranking healthcare people are getting very connected on LinkedIn lately. A sign of change to come?” I don’t know, but I think your observation has business merit for LinkedIn. They could sell the names of companies that have a large percentage of current employees updating their profiles (preparing to bail) or companies newly added to a lot of profiles (on a hiring binge).

From HC IT Advisor: “Re: AeroScout, recently acquired by Stanley Black and Decker. Has issued a cease and desist order to Centrak and will be filing a patent infringement suit. Apparently Centrak is using the patented CCA capability in their new WiFi tags.” Unverified. Calling HITEsq again, either that or I need to sign up for one of the lawsuit databases like PACER so I can look these up myself.

Acquisitions, Funding, Business, and Stock

Health analytics and research company Decision Resources Group acquires the UK-based Abacus, a health economics consulting firm.

Talent management software provider HealthcareSource acquires NetLearning, which makes learning management software for the healthcare industry.

Nuance acquires Accentus, an Ontario-based transcription, documenting imaging, and remote coding technology vendor.

An article in the San Antonio newspaper questions whether Gene Powell, chairman of the University of Texas Board of Regents and co-founder of AirStrip Technologies, should have disclosed that Vanguard Health Systems, which the board chose to launch a new $350 million children’s hospital in San Antonio, had a pending business deal with AirStrip at the time. Powell did not vote on the issue, did not recommend Vanguard, and was not legally required to make any disclosure since he owns no Vanguard stock and is not a Vanguard employee, so perhaps it was a slow news day.

The former Big Five accounting firm Arthur Andersen, driven out of business in 2002 for its role as Enron’s auditor, is ordered to pay an additional and final $9.5 million for its similar auditing involvement in the 1999 merger of McKesson and HBOC. Andersen agreed to pay $73 million to settle McKesson HBOC-related class action claims in 2006, with the possibility of contingent payment claims.

Sales

Children’s Hospital of Central California will implement athenaClinicals, athenaCollector, and athenaCommunicator across its 127-provider system.

Marietta Memorial Hospital (OH) extends its IT services contract with CareTech Solutions for an additional three years.

Twenty-one VA medical centers will implement GetWellNetwork’s interactive patient care solution, including the new Interactive Patient Whiteboard.

Memorial Health System (IL) purchases the Omni-Patient enterprise master data application and the WebFOCUS BI platform from Information Builders.

MemorialCare Health System (CA) renews and expands its relationship with MedAssets to include GPO services for supplies and purchased services and MedAssets Capital and Construction solutions.

Huntsman Cancer Institute at the University of Utah selects Wolters Kluwer Health’s ProVation MultiCaregiver EHR.

Contract resource organization NCGS selects Merge’s eClinical OS and clinical trial management solution.

Consulting firm AmpliPHY will provide Wellcentive’s data analytics platform to primary care practices.

Managed care company Amerigroup Corporation chooses McKesson Clear Coverage for point-of-care utilization management, coverage determination, and network compliance.

Michigan Health Information Network Shared Services signs with HIPAAT International for technology that allows patients to control the sharing of their PHI and allow them to view an audit log of who has viewed it.

People

Qualis Health hires David Chamberlain (Cardiac Science and Criticare Systems) as CIO.

Saint Francis Hospital and Medical Center (CT) names Sudeep Bansal, MD as the organization’s first CMIO. 

Todd Johnson, former president and CEO of Salar and SVP of Transcend Services/Nuance after Salar’s acquisition, is named CEO of HealthLoop.

Michael Waldrum, whose roles at the UAB Health System included a five-year stint as CIO through 2004, is named CEO of University of Arizona Health Network.

Charlie Baxter, AVP of Iatric Systems and former Army captain, died Friday at 48. The guest book is here.

Announcements and Implementations

Allscripts EHR customer Primary Physician Partners (CO) becomes the first practice to connects to the CORHIO.

The Indiana HIE says that more than 750 physicians and 174 practice sites have agreed to publicly post their clinical quality measure scores on the Quality Health First Program’s public reporting website.

Imprivata announces that more than 250 healthcare organizations enrolled in its Cortext HIPAA-compliant, pager-replacing text messaging solution its first 60 days of release. Pricing ranges from free (unlimited users, unlimited messaging, unlimited photo messages, standard support, 30 days’ archiving) to $5 per user per month (upgraded support and archiving).

Elsevier integrates its ExitCare library of discharge instructions and patient education with Meditech’s EHR.

ICSA Labs and IHE USA unveil a certification program to test and certify the security and interoperability of HIT, with three tiers of certification: conformance to IHE profiles, demonstrated interoperability among disparate systems, and validated implementations of deployed certified technologies. Participants in January’s 2013 NA Connectathon in Chicago can register for testing at the event.

Montrue Technologies releases a free version of its Sparrow EDIS iPad-based emergency department information system. I interviewed Co-Founder and CEO Brian Phelps, MD earlier this year.

Government and Politics

Recovery auditors collected $2.2 billion in overpayments in fiscal year 2012 and gave providers $109 million in underpayments. Net 2012 corrections were $2.4 billion, compared to 2011’s $939 million.

Congressman Mike Honda (D-CA) introduces the Healthcare Innovation and Marketplace Technologies Act to foster more healthcare innovation through the development of marketplace incentives, challenge grants, and increased workforce retraining. The bill would also establish an Office of Wireless Health at the FDA.

Innovation and Research

A Microsoft Research documentary shows the organization’s work in using technology to fight tuberculosis in India, including development of a biometric monitoring system to make sure patients keep their healthcare appointments and systems that trigger an SMS message to a manager when a patient misses scheduled medication doses. Treatment is effective and straightforward, but requires more than 40 clinic visits in six months. Non-compliance causes TB spread, drug resistance, and nearly 1,000 deaths per day in India.

UCLA engineering school researchers create BigFoot, a software package that allows people with chronic foot problems to track their conditions using a PC and flatbed scanner.

Other

Streamline Health, which acquired Atlanta-based Interpoint Partners a year ago, will move its corporate headquarters from Cincinnati to Atlanta. The company will continue to operate the Cincinnati and New York City offices.

Cerner analyst Staci Klinginsmith is crowned Miss Kansas USA.

University of Virginia Medical Center warns patients that a mobile device used by on-call IV pharmacists in its home health agency is missing and contains patient information, including diagnoses, medications, and Social Security numbers used as health insurance ID numbers.

HIMSS, responding to OIG’s recommendation that the bar for Meaningful Use payments should be raised via pre-payment reviews, improved EHR MU reporting, and improved EHR reporting certification, supports CMS developing guidelines that will help providers prepare and retain audit-related documentation. In other words, like CMS, HIMSS isn’t a fan of pre-payment reviews.

I’ve spent a considerable amount of money and energy on programming workarounds required to make HIStalk work on the incredibly buggy and standards-breaking Internet Explorer, but I’ve noticed its gradual improvement. I’m encouraged that Microsoft gets the lack of browser love it receives and can even poke fun at itself with a fun “it sucks less” video (above) and a new site, www.browseryoulovetohate.com. I’m checking it out in Firefox, of course, since I’m not that forgiving of IE’s past transgressions, but I may download the IE10 beta just to see what all the fuss is about.

A new JAMA article finds that the average dentist now out-earns the average physician, with pharmacists not too far behind.

Lyle Berkowitz, MD (Northwestern University) and Chris McCarthy, MPH, MBA (Kaiser Permanente Innovation Consultancy) are editors of the newly published Innovation with Information Technologies in Healthcare. DrLyle says it tells the stories of 20 organizations who are HIT innovators in improving care quality and value, with details that he describes as “a big cookbook of recipes on how to innovate with HIT” divided into sections covering electronic medical records, telehealth, and advanced technology. I took a quick skim over a couple of the sample chapters he sent over and it’s meaty, without the usual fluff that makes some HIT books seem like a handful of good ideas and thoughts that were shamelessly padded to justify an author credit and a higher selling price. The book is $74.14 on Amazon and you can use the Look Inside! option to try before you buy.

A Colorado Public Radio article covers EMR adoption, showcasing a five-physician practice that expected its new EMR to increase patient capacity by 25% and get its bills out more quickly. That turned out to be wishful thinking on the salesperson’s part. They never got back up to more than 80 percent of their pre-EMR workload, they found that their Medicare patient volume was too low to qualify for incentive payments, one doctor quit over frustration with the EMR, and the remaining four partners were on the hook for the $200,000 they had borrowed to buy it. The end result: they had to sell their practice.

Use of mobile technology to view patient information and to access non-protected health information is on the rise, according to a HIMSS mobile technology survey. Key uses include collection of data at the bedside, bar code reading, monitoring data from medical devices, and capturing visual representation of patient data. Funding and security concerns are the top barriers to mobile technology adoption.

Athenahealth’s Jonathan Bush channels Dr. Mostashari on Fox Business wearing a holiday-red bowtie and pitching healthcare technology.

A local paper shares the story of a clerical supervisor in a British Columbia hospital who was conducting training on the Vocera communication system when the device issued a Code Orange, warning of an impending flood. Clinical staff moved patients to safety just before a wall collapsed in a flood of water, while the supervisor scrambled to save paper charts and the hospital’s stockpile of 75 Vocera badges.

Weird News Andy is really fired up about use of the Liverpool Care Pathway for palliative care in the UK. An audit of records from 178 NHS hospitals finds that nearly half of the dying patients who had life-saving treatment (drugs, fluids, food) withdrawn via the protocol weren’t told that fact, 22 percent had no documented evidence that their care and comfort was maintained, and a third of the families didn’t receive literature explaining the process. A proposal is on the table to require consulting with the patient or family before initiating the pathway, which leads to patient death in an average of 29 hours.

WNA could contribute only a “sheesh” to this article, which finds that Dallas mothers and daughters are bonding over cosmetic surgery procedures, often motivated by reality TV shows that make that practice seem normal.

A former Microsoft manager takes advantage of newly legalized marijuana in Washington by opening a “premium marijuana” retail business, expressing his desire to position his brand of weed like fine brandy or cigars to high-income baby boomers. He says, “Think of us as the Neiman Marcus of marijuana … the buzz is in the air.” He says he came up with the plan while high and will name the business after his marijuana-farming great-grandfather.

In Brazil, an apparently computer-savvy thief robs an ATM by replacing its USB security camera with a Plug and Play keyboard and a USB stick, then restarts the machine and keys commands to withdraw all its cash. He was caught. The article mentions the recent discovery of several ATMs at Inova Fairfax Hospital (VA) that were rigged with “ATM skimmers” that fit over the card slot, capturing the card’s number and in some cases using video recording to capture the user’s PIN.

Sponsor Updates

• Aspen Advisors hosted 62 associates at its annual retreat in Fort Lauderdale, which included a run fun that raised $1,000 for the University of Miami Health System.
• Besler Consulting representatives will present at upcoming New Jersey and Metropolitan Philadelphia HFMA seminars.
• Santa Rosa Consulting announces E2E Activation Support, a service line that will provide elbow-to-elbow EMR go-live support.
• The Black Book Rankings names DrFirst the top vendor for e-prescribing and recognizes Emdeon for outstanding developments in clinical exchange solutions. Other HIStalk sponsors earning honors include Allscripts, e-MDs, Vitera, Aprima, SRS, Quest MedPlus Care 360, and McKesson.
• A local paper profiles eClinicalWorks CEO Girish Kumar Navani and the success of his company.
• AT&T names its top five healthcare trends for 2013, which emphasize growth in mobile apps and telehealth.
• Sacred Heart Health Systems (FL/AL) shares how Iatric Systems’ Security Audit Manager has aided privacy compliance by capturing audit log data from its Siemens, McKesson, and Picis systems. 
• Three Informatica customers win Ventana Research Leadership Awards, including HMS Holdings (IT Leadership Award for Analytics and Overall IT Leader); Moffitt Cancer Center (Business Technology Award for Big Data); and  Ochsner Health System (IT Leadership Award for Information Management.) Informatica’s PowerCenter Big Data Edition also won the Ventana Research Technology Innovation Award.
• Mark Van Kooy, Myra Aubuchon, and Dawn Mitchell of Aspen Advisors present a December 5 Webinar on addressing EMR value with a hospital board.
• 3M Health Information Systems offers a Webcast featuring 3M CMIO Sandeep Wadhwa’s presentation on improving ACO efficiency and outcomes.
• Cumberland Consulting promotes Charles Taylor to principal and Jose Gonzalez to executive consultant.
• The Advisory Board Company’s Southwind program recognizes Dignity Health (CA), Adirondack Region Medical Home Pilot (NY), and Lancaster General Health (PA) for successful physician partnerships.
• Covisint releases a white paper that outlines the evolution, growth, and future of HIEs.
• Beacon Partners employees assemble 108 care packages for troops during the company’s annual meeting.
• Wellcentive’s VP of Product Strategy Mason Beard discusses interface strategies for population health management in a blog post. 

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 12/4/12

AMA calls pre-pay meaningful use audits a ‘burden’ on docs

AMA and CMS raise concerns with an OIG recommendation to implement pre-pay audits as part of the Meaningful Use payment program.

University of Missouri Health Care touts success in implementing electronic medical records

A local newspaper reports that that the Ellis Fischel Cancer Center, Missouri Orthopedic Institute, Missouri Psychiatric Center, Women’s and Children’s Hospital and University Hospital have all achieved HIMSS Stage 7.

Efficacy of a Clinical Decision-Support System in an HIV Practice: A Randomized Trial

A newly published study ties improved patient outcomes to increased sophistication and design of clinical decision alerts.

For Second Opinion, Consult a Computer

The New York Times covers the Watson in Healthcare project, an IBM initiative aimed at increasing the clinical potential of computers, by highlighting some of medicine’s most brilliant diagnosticians.