News 5/11/11

Top News

Q2 numbers for Nuance: revenue up 17%, EPS $0.01 vs. -$0.05. Revenue was up 13% in healthcare, its largest segment. The company announced that it will acquire document management and print management solutions vendor Equitrac for $157 million in cash. NUAN shares hit a 15-year high Monday on rumors of a potentially expanded relationship with Apple.

Reader Comments 

From MEDITECHer: “Re: Howard Messing. Wins the town’s annual award.” Meditech’s president and CEO wins the annual community service award from Town of Westwood, MA, where he has lived for 21 years and for which he has served on several committees and provided technology expertise. Meditech long-timers are definitely give-back types.

From ArkieHorn: “Re: JPS Health Network. The CIO resigns only a few months after taking on the full-time role from his interim role. The tax-supported hospital in Fort Worth selected Epic to make MU in 2009. Rumor has it they contracted with Accenture for a CIO to manage the Epic project … also being implemented by Accenture. The fox is in the house.” Unverified.

From Anonymister: “Re: Alameda County Medical Center, Oakland, CA. A nice article on turning around a failing public hospital.” Fast Company profiles ACMC CEO Wright Lassiter III and calls him a “medical wonder” in turning around the “shockingly mismanaged” inner city hospital (as its tenth CEO in 11 years), which is mostly remembered for a patient beating one of its doctors to death and “nurses who followed doctors’ orders only when they felt like it.” Lassiter brought in a new management team, cut costs, fired underperformers, and got union concessions (and signed up for Soarian, as we just mentioned). I like that he holds an MHA instead of the more common and less healthcare-specific MBA. His stated goal:

I want to make this place as good or better than the private hospitals. I believe ACMC has to be a real third choice in this community, a place where an elected official or a corporate executive would come for care. It’s not just the quality of medical service; it’s the helpfulness. Are people looking you in the eye and saying, “What can we do for you?”  — anticipating your needs, instead of saying, ‘’Just go in the corner and wait. We have too many people to deal with today.”

From Coolio: “Re: physician practices. There is strength in numbers. It is hard for an independent physician to leverage size while negotiating reimbursement contracts (and even larger organizations often do not use their decision support applications well in determining whether a contract makes sense). Independent physicians are just at a disadvantage when dealing with payors. Plus, is it really worth being on call every night or every third night? And not being able to spread back office costs among more providers? That is a question for physician to face. (And it’s the primary care doc who usually loses out.) For years and years, hospitals have focused on physician outreach and links/alliances (for referral business). Software apps are one of those links. Why would a physician want the headache of implementing an EHR with clinical content tailored to her practice when she could share the cost of it?”

From The PACS Designer: “Re: using iPhone for dictation. Another iPhone app that looks interesting is one that provides dictation capabilities. Not sure how accurate it can be, but with the development of an iPhone dictation platform by Integrated Document Solutions called Voice2Dox, it’s probably worth a try in clinical applications.”

 HIStalk Announcements and Requests

I thought it odd that Reuters cited “particularly weak” Medical Manager sales in its review of Sage Healthcare’s recent performance. I didn’t think Medical Manager would have that much influence considering that Sage’s go-forward product is Intergy, but I figured Reuters must know something I don’t. Turns out they don’t — my Sage executive contact tells me that Medical Manager hasn’t been actively sold for quite some time, even though Sage continues to support and enhance it. I’m not sure what Reuters was thinking.

Listening: Shinedown, Leave a Whisper. Solid, radio-friendly hard rock from Jacksonville, FL.

Acquisitions, Funding, Business, and Stock

Elsevier acquires Fisterra. com, a Spain-based clinical reference solution.

Microsoft will acquire free phone calls software vendor Skype for $8.5 billion, its largest acquisition ever. My reaction: (a) they’re paying way too much for a company that has always managed to lose money even with high penetration and big revenue, maybe just because they didn’t want Google to end up with it; (b) most Skype users don’t pay anything, and have plenty of free alternatives to prevent MSFT from simply charging for its use, so the best use of it will be as an add-in to other MSFT offerings; (c) it’s kind of bittersweet to remember when Microsoft was the brash innovator instead of the cash-rich, reactionary follower (remember when they wanted to pay eye-popping dollars to buy the hoarily irrelevant Yahoo, which has dropped something like two-thirds in value since then?); and (d) as an occasional Skype user (I use it for doing interviews) and I hope they don’t mess it up.

I’m suddenly getting e-mails from some pay-membership site aimed at healthcare CIOs, but apparently written by folks with limited understanding of healthcare IT and English as a first language. Here’s a sample: “Wolters Kluwer’s Buys Lexicomp: An Acquisition of Importance to The Realm of Meaningful Use. Wolters Kluwer Health (WKH) acquired Lexicomp. What is the big deal? Why is this any different than say Allscripts and Eclipsys?” It misspells both company names in the headline, mangles punctuation in several creative ways, and throws in some truly puzzling choices of wording (you don’t often see “What is the big deal?” in an article aimed at executives – that odd wording made me immediately think of SNL’s wild and crazy guys, “After all, there is no other pair of Czech brothers who cruise and swing so successfully in tight slacks!”). The graphics are randomly chosen stock photos (like a Meaningful Use analysis featuring the Jefferson Memorial). The site takes great pains to provide no information about who owns it, where it’s located, or what the annual subscription costs (even on the signup form where you’re committing).

Sales

Muenster Memorial Hospital (TX) picks Custom Software Systems’ ChartSmart Electronic Medical Record for its critical access facility.

St. Joseph’s Hospital Health Center (NY) contracts with MedQuist for clinical documentation outsourcing services.

Advocate Trinity Hospital (IL) will use PerfectServe’s clinical communication system.

Dallas Medical Center (TX) chooses HMS’s EHR and remote hosting services from its HMS Direct subsidiary.

People

Netsmart Technologies names former Cerner EVP/COO Michael Valentine as CEO. He replaces the retiring James Conway.

iSirona appoints Polly Mulford, formerly of AHA, as VP of account management.

Cape Regional Medical Center (NJ) appoints Dianna Derignan, MD to the role of CMIO.

Precyse names Chris Powell to the newly created position of president. He was previously with GE Healthcare and IDX.

Former Hillcrest Medical Center (OK) CEO Steve Dobbs joins the board of advisors for PSCI, a provider of analytics and decision support tools.

Billing service provider MedData names Frank B. Murphy to is board. He is president and CEO of Perimeter Health Advisors and was formerly president and CEO of HealthPort Technologies.

I see from my LinkedIn updates that HIStalk friend Mark Andersen, former CIO at Yale New Haven who I think is doing consulting work now, is interim chief technology and health information office at University of Virginia Health System.

Announcements and Implementations

PwC earns top ranking in a new KLAS report on extended business office service firms, followed by Firstsource (MedAssist) and Deloitte Consulting. Providers said the most important factor in selecting and keeping a vendor is, not surprisingly, its ability to keep receivables low and cash collection high.

CSC announces that it has brought all prisons in England live on the SystmOne clinical software.

Other

A Florida woman diving for coupons in a recycling bin finds a variety of paper records from an oral surgeon’s office that contain medical histories and Social Security Numbers. The doctor could be penalized even though the documents were placed in the recycling bin in error. Quote from a patient: “Thank God for the coupon lady. Without her, anybody could have gotten their hands on this."

A hospital volunteer sues Longmont United Hospital (CO) after being hit by a food cart during her shift, causing a fall and a compression fracture. She wants more than $100,00 to cover medical expenses and “loss of enjoyment of life.” I personally have felt compelled to sue various folks (a couple of ex-boyfriends come to mind) for loss of enjoyment of life, but never took action.

Sponsor Updates

• Culbert Healthcare Solutions hires Jeff Wasserman to lead the company’s strategy and executive services team. He was previously with The Bard Group.
• Southeast Eye (GA) selects NextGen EPM PM and EHR for its eight-location practice. TSI Healthcare will provide implementation services.
• Surgical Information Systems (SIS) recognizes four clients with its 2011 SIS Perioperative Leadership awards for significant advancements in operational, financial, and clinical initiatives. The company also announces that Huntsville Memorial Hospital (TX) has selected the SIS system to interface with its current Meditech HIS.
• The Ohio Health Information Partnership selects Medicity to create the technology infrastructure for its CliniSync HIE.
• e-MDs is named a Tier 1 EHR vendor by the Kansas Foundation for Medical Care, the REC for the state of Kansas.
• Allscripts makes a strategic investment in clinical analytics company Humedica. The companies will collaborate to market Allscripts Clinical Analytics Powered by Humedica, a new module which Allscripts will integrate into its acute and ambulatory EHRs.
• MED3OOO wins 2011 top honors in customer experience and satisfaction among all EMR systems focusing on multispecialty clinics. Other top performers include NextGen Healthcare, Allscripts, Dr. First/Rcopia, Sage, Epic Systems, LSS Data, and Greenway Medical.
• Childs Medical Clinic (AL) successfully attests as Greenway Medical’s first client to receive payment for Meaningful Use.

Contacts

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

Readers Write 5/9/11

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

Nurse Buy-In Essential to ACO Success
By Lisa Reichard, RN, BSN

Though the healthcare technology landscape has changed greatly over the last 10 years, what the clinical nurse cares about most has not: delivering the best care possible to the patient. As National Nurses Week celebrates the caregivers that most would agree form the backbone of healthcare, it is interesting — as an RN who now works on the vendor side of things — to watch the leadership role of nurses evolve, especially in light of the policies behind accountable care. The ACO model will directly affect a nurse’s role at the bedside, or, as mobile technologies may have it, over the phone, via text, or by Skype.

The pending ACO model will be physician driven, true, but it must also include nurses and other providers to improve the quality of healthcare services and reduce costs. Regardless of whether an organization pilots an ACO, gets ready for the Medicare Shared Savings Program, or even chooses to wait and see how ACOs develop, the main cornerstones of ACOs — assumption of clinical risk, improvements in quality care measures, and decreasing costs — will be required of all organizations as the healthcare industry moves through reform. Therefore, nurses will be required to enhance their overall accountability and embrace the role of patient advocates in the ACO model, especially with regard to management of patients’ chronic conditions.

As CMS statistics show, 75-80% of healthcare costs are related to chronic conditions. The impact of the clinical nurse on continuity of care, from emergency room to clinic or physician office to home care, will be crucial to accountable care’s success. So how will this need for greater accountability work its way into a nurse’s already pressure-filled shift? How can administrators, doctors, payers, and even vendors get a nurse to buy in to an ACO?

Vendors tend to emphasize new technology and cost containment surrounding ACO policy as the biggest pieces of the pie when going into a clinical setting. It is important to understand, however, that at first glance, the clinical nurse may be inclined to view ACOs as roadblocks to patient care since they are used to the “treat the illness and hope that patients will comply at home” model now in place. This is where vendors and policy makers can point out and emphasize the benefits of the ACO model – improved patient outcomes and higher quality patient care, which, after all, are what nurses value most.

The time is ripe for nurses to take the lead in defining the way ACOs will deliver. Opportunities abound, including:

• Identifying patients at risk for 30-day and multiple readmissions;
• Assisting in developing clinical criteria and benchmarks around “The Right Care At The Right Time,” which is central to ACOs;
• Increasing the usage and compliance with regards to home monitoring devices;
• Ensuring timely care coordination between hospital and community-based providers;
• Involving nurses as change agents to improve quality indicator scores;
• Taking an active role in delivery models that focus on ongoing care coordination and resultant evaluations of clinical and financial effectiveness;
• Developing nurse peer groups and support around new technologies like EMRs and PHRs; and
• Helping with the development of quality measures not currently being tracked by CMS. These could include measures for the treatment of cancer, arthritis, osteoporosis, or chronic pain. It will be challenging to create outcome measures that capture all key attributes of successful treatments.

Vendors can assist in this process by walking in the nurses’ shoes, understanding their world and what is at the heart of their work — helping patients to get well and stay well. Coming from this angle of understanding and cooperation, friends will be made, and yes, care will even become accountable.

Lisa Reichard, RN, BSN is director of business development at Billian’s HealthDATA.

Meaningful Use: A Case for Choosing Cloud-Based Technology
By Russ Keene

On Monday, April 18, a moment that was once among the most hyped in recent health IT memory passed almost unnoticed. That day, the Department of Health and Human Services opened the process for physicians to attest to demonstrating Meaningful Use of an EHR system so they could qualify to receive Medicare incentive payments.

Of the estimated 95,000 physicians now using an EHR system, just 150 stepped forward to attest to achieving Phase 1 Meaningful Use measures.

What gives?

As Douglas Foreman, DO, one of those 150 physicians learned, demonstrating Meaningful Use isn’t difficult. In fact, he exceeded the requirements, and did so within the first 90-day eligibility period.

Foreman’s (and his staff’s) commitment to his patients and to meeting the Core and Menu Set requirements cannot be discounted. But a decision he made in 1997 to use a cloud-based practice management and EHR system gave him a head start.

The term cloud computing is a recent entry to the IT lexicon, but the technology has been around for a while. Cloud-based health IT systems don’t require client-server hardware or for physicians to install special software on each computer. They deliver advanced health IT capabilities through a simple Web browser. System maintenance and upgrades are included in a monthly subscription rate, and delivered seamlessly.

Foreman’s example offers a clear case for physicians to consider cloud-based technologies for their health IT systems and to rid themselves of the archaic client server-based systems which are difficult to upgrade and costly to support.

Foreman received his Meaningful Use upgrade one weekend in May 2010, along with thousands of other doctors. Within days, he said he could see how well-designed technology contributes to his ability to improve patient care while also making it easier to demonstrate Meaningful Use.

However, as Foreman told Physicians Practice, the EHR vendor needs to support physicians’ efforts to demonstrate Meaningful Use. “Your vendor should have a support team. They need to be familiar with the process and support you,” he said.

He’s right. Health IT providers owe it to their clients to help them be successful at demonstrating Meaningful Use, to make using health IT simple and affordable, and to ensure the technology really delivers when it comes to supporting better patient care.

Dr. Foreman was successful because of his commitment to make technology work for his practice and because of the technology that he chose. As a result, he will receive his first payments soon. Meanwhile, tens of thousands of other EHR users are still waiting for their health IT vendor to get around to upgrading the systems in their offices. As those companies know, scaling to meet that demand is exceptionally difficult.

Physicians shopping for an EHR system should ask a couple of questions. If it’s this difficult for the old technology companies to enable their current clients to meet Phase 1 Meaningful Use requirements, how will they fare in preparing even more users for Phases 2 and 3? And, can they realistically support ICD-10 and future regulatory changes that require updates to their software?

Meaningful Use is just one stop on a long ride of technology advancement. As such, the case for “the cloud” is clear.

• Minimum upfront investment, lower total cost of ownership, and rapid ROI
• Cumulative value and simple interoperability with a wealth of systems and health industry partners
• Adaptability to future demands, from ICD-10 to new Meaningful Use rules to additional performance and quality measurement capabilities

It’s time to focus on the needs of the end user. The cloud offers the easiest, fastest, and most economical means for many physicians to implement and use an EHR system.

Russ Keene is vice president of Ingenix CareTracker.

The Power to Fail
By RJ Dio

As good as the fine novel Spooner is by Pete Dexter, it’s Dexter’s bio on the back jacket that pleases me more. Dexter wrote the bio himself and it states:

Pete Dexter began his working life with a US Post office in New Orleans, Louisiana. He wasn’t very good at mail and quit, then caught on as a newspaper reporter in Florida, which he was not very good at, got married, and was not very good at that. In Philadelphia he became a newspaper columnist, which he was pretty good at, and got divorced, which you would have to say he was good at because it only cost $300. Dexter remarried, won the National Book Award, and built a house in the desert so remote that there is no postal service. He’s out there six months a year, pecking away at the typewriter, living proof of the adage “What goes around comes around” –that is, you quit the post office, pal, and the post office quits you.

What can we learn from this (besides using a sense of humor when we can)? Courage. Not many people admit their mistakes, and few of us would be candid in our assessments of ourselves or our efforts. 

It takes courage, for example, to admit an HIT project was a disaster, and to candidly discuss how it went wrong, lessons learned, and what can be done to avoid this again. The typical post-mortem that all thoughtful projects (even unsuccessful ones) should use at their conclusion. 

Where’s the story on the eight-year Cerner rollout that wasn’t intentionally slotted for eight years, for example? The lowdown on why a vendor would explain poor business intelligence reporting by suggesting the hospital spend close to another million dollars to add CPUs in a database server so the reports will run faster? The honest facts on a clinical workflow software solution that’s a glorified Intranet?

As the woman in the Wendy’s commercial in the 1980s demanded, “Where’s the beef?”

We live in a world where everyone has a raving recommendation on LinkedIn — or maybe 30 — and most of us have written them, too. Meanwhile, we could use a few people to step up courageously with constructive feedback on HIT efforts that lost their way, without permanently judging (or misjudging) those who didn’t succeed.  Some great leaders (but not enough) readily say to others, “Let me share some of my mistakes with you so you don’t have to make them, too.”

After all, failure serves a purpose in life, and business, and sometimes it makes us far better than we ever could have been otherwise. It just takes time to know. “A lot of good things in my life came from half my mistakes,” says the songwriter Radney Foster, and I’m right on board with him, (even if I did use too many parentheses in this piece).

Curbside Consult with Dr. Jayne 5/9/11

My large healthcare system, like many, is in the business of doing everything possible to make friends with independent physician practices. The average primary care physician drives several million dollars in ancillary revenues each year, so we can’t afford not to.

Our system offers discounted access to our EHR product for affiliated physicians. Although we have quite a few takers, many are still skeptical. After all, they’re independent for a reason. If they really wanted to buddy up, they would have been purchased long ago.

In a continuing effort to woo these last few holdouts, I was tasked with checking out some of the resources available to independent physicians seeking an EHR or practice management systems. Since Inga mentioned the new MGMA/AMA effort to create an online directory of practice management systems that are compliant with the 5010 standard, I decided to check it out.

I must have spent too much time with adolescent relatives over Mother’s Day, because my response to the directory is “lame, lame, lame.”

The directory lists only 20 vendors. Some of them aren’t even software companies – one lists its product as “Consulting and Implementation of several PM/EMR”s” [typo on parentheses left in on purpose.] As an AMA and MGMA member, I was embarrassed by this document. Version numbers included “n/a” and “current”, which I found hysterical.

Really? If this data would have been gathered by my intern, I would have sent him back to his cube in shame. They have a link on the page that if you don’t see your vendor, you should e-mail and they will ask the vendor to participate. Does neither the AMA nor the MGMA have the ability to identify the top 100 vendors and survey them to create a useful guide?

Now mind you, none of the vendors I use are on the current directory, so I can’t verify the accuracy of the listings. But in checking out a couple of the individual detailed profiles, I learned the following:

• Cerner PowerWorks PM has 250 customers and doesn’t support Microsoft .NET, does not use a “modern and widely supported relational database for the underlying data structure,” and the database is not ODBC compliant. Kind of a surprise.
• Ingenix CareTracker has one box checked that the “modern and widely supported relational database” is standard. Another is checked that says “does not provide.”
• MCA Systems CodeHERO product was about to get a “best product name” prize until I noticed it “does not provide” the following: appointment scheduling, resource scheduling, claims generation on the CMS 1500 or UB 04, or ability to maintain payer lists including fee schedules. How exactly is this a practice management system?
• Allscripts, GE, eClinical Works, NextGen, Sage, McKesson, and Athena are all missing in action on this list.

If I were a vendor not listed, I’d e-mail them at busdevelop@mgma.com and tell them to get with the program. If I were a listed vendor, I’d certainly double check my data and find out who in my organization submitted it, if it’s not accurate.

So what’s the point of all this? First, I always like to let Inga know I’m reading her material. HIStalk girlfriends have to stick together, you know? Second, whether I work for a monolithic organization or not, I’m still a small-practice physician by training and I care what happens to my friends in the trenches. Third, large organizations like MGMA and AMA who want to actually help said physicians in the trenches need to do better.

Do you have a better source of info for physicians who are shopping for a new PM system or want to verify that theirs will handle 5010? I still have to impress a hospital president with a fancy PowerPoint presentation. E-mail me.

E-mail Dr. Jayne.

Monday Morning Update 5/9/11

 
From Ralph Hinckley: “Re: [vendor name omitted] acquisition. Announcement coming very soon on a core HIS vendor acquisition.” Just for fun, above is a tiny bit of the logo of the company supposedly being acquired (left) and that of the acquirer (right).

From CMIO: “Re: Apple iPad 2 commercial. The medical app shown is almost certainly Great Connection, a Swedish company partnering with Qualcomm.” The company’s site says a hospital can deliver and receive medical images with nothing more than an Internet connection to its cloud server that takes five minutes to connect to an ultrasound machine, allowing them to be sent (encrypted and authenticated) to a smart phone or e-mail. It also says that a US entity was founded in San Diego and took over the Swedish entity in the spring of 2010. It also notes that the product is available in a white label version to mobile operators that want to resell healthcare images and related services to consumers.

From Lucite: “Re: Nuance. As a stockholder in both companies, this would be exciting!” Some rumors suggest that Apple will buy Nuance, while others say an expanded partnership is more likely, with the impetus for either being Apple’s interest in including speech recognition technology in the upcoming release of iOS 5. Nuance has a market cap of $6 billion, with its five-year share performance shown above (Nuance in blue, the S&P 500 in green). Those who timed their NUAN purchase just right by buying on the December 2008 dip would have tripled their money in just over two years, and surely will do even better if either rumor is correct.

From Epic Alum: “Re: Epic non-competes. Legal and enforceable or not, Epic has no-hire agreements with clients that they don’t tell you about in the exit interview. Those seem seem to prevent you from working with Epic clients through third parties, including those that aren’t Epic partners (but you might have better luck than I did). Even if you got a job or contract, Epic will instruct its employees to ignore your phone calls, e-mails, and questions at meetings, which would make your job all but impossible. I’d be concerned about retaliation from Epic when it comes to getting and maintaining certification later, although I don’t know for sure that they blackball anyone. As for what you should do now, every else (a) goes to grad school; (b) does non-Epic programming work if they’re a programmer; (c) does non-Epic healthcare consulting; or (d) works outside of healthcare. There will be plenty of work next spring. Advice to prospective employees, most of which are in their first real post-college job with no money saved: when you leave, you will be pretty much locked out of the one industry you have real experience working in.”

From InovaDoc: “Re: Epic at Inova. I wish that IT departments could be more transparent about their decisions. What will happen to those physicians that spent $30K on GE to integrate with the hospital? De-install, then re-install, foregoing their investment?”

A quick poll … please answer if you would be so kind. Thanks. Just trying to get a read on who’s out there.

Listening: Electric Wizard, Dopethrone. I’m the least-likely demographic for this Sabbath-y sludge / doom /stoner music, but I still think it sounds pretty cool. Also: Blackmore’s Night, renaissance faire rock by the former Deep Purple guitarist and the angelic Candice Night. And Watching: Saxondale, a well-made Britcom about a trying-to-stay-cool 1970s rock roadie turned pest control operator who mumbles his wry, psuedo-intellectual monologues like Johnny Depp’s Jack Sparrow.

I think I may have messed up one of the e-mail blasts Friday night, so apologies if you got something confusing. I put in nine hours at the hospital, ran six miles on the trail, and did another seven hours of HIStalk work after I got home, eating only some peanut butter crackers in the 12 hours from lunch until bedtime. I think the combo of hypoglycemia, slight dehydration, and way too much work made me a little woozy.

My Time Capsule editorial from March 2006 covers open source in healthcare, which I prefaced by promising little: “Since my open source knowledge is right up there with most CIOs and health care executives (I have next to none, in other words), I figured my populist opinions might be as useful as the next guy’s (also next to none).”

An article in last week’s San Francisco Business Times confirms that Alameda County Medical Center (CA) is going with Soarian (clinicals and revenue cycle) and NextGen, with CIO Mark Zielazinski giving the price tag as $75 million, including infrastructure upgrades. The hospital expects to receive $18 million in HITECH money.

Community Health Network (IN) names Ron Strachan as CIO, replacing the retired Ed Koschka. He was formerly SVP/CIO at WellStar.

Valerie Fritz joins the RTLS division of TeleTracking as VP of marketing. She was previously with Awarepoint.

NaviNet promotes Michael Ross MD to chief medical officer and David Kates to SVP of product management and clinical strategy. Both came to the company via its Prematics acquisition in December 2010.

I mentioned that Camden-Clark Hospital (WV) has signed up for Allscripts Sunrise Enterprise and Enterprise Performance Management. Also announced as new Sunrise Enteprise customers: Hannibal Regional Healthcare (MO) and Lakeway Regional Medical Center (TX).

It’s a fairly even split of which company’s stock looks good to readers. New poll to your right: when will vendors see the peak of HITECH-generated business?

Kaiser’s Q1 numbers: $12 billion in revenue, $921 million in profit, up 9% and 30%, respectively. Membership rose by 208,000 to 8.8 million. Considering healthcare costs, I can’t decide whether this news is good or bad, although I’m leaning toward the former since Kaiser is just about the only provider out there showing success in controlling costs without reducing quality.

Two Allina hospitals fire 32 employees, 28 of them from Unity Hospital, for snooping in the electronic records of 11 teen partygoers who overdosed on a synthetic drug. That surely is a record number of privacy-related terminations. Allina says it knew the patients were high profile, so it did an EMR access review afterward and discovered the digital intruders.

Q4 numbers for The Advisory Board Company: revenue up 22%, EPS $0.30 vs. $0.32. Two new programs were announced: Crimson Care Registry, which prompts physicians based on clinical care guidelines, and Clinical Denials Prevention Program, a best practices approach to pre-certification.

Quest Software acquires virtual desktop scanning and imaging technology vendor RemoteScan. RemoteScan has a pretty big healthcare presence in providing a scanning solution for providers running EMRs on Citrix or Terminal Server.

Froedtert Health (WI) cancels its HIM outsourcing contract with Pyramid Healthcare Solutions, offering jobs to all but three of 118 contractors. Pyramid was acquired a year ago by an India-based conglomerate.

Britain’s Department of Health will reduce CSC’s scope of work involved on the NPfIT project, specifically cutting back on work related to the Lorenzo system. CSC is in the process of acquiring Lorenzo vendor iSoft.

An interesting fact in a story about union nurses at Tufts signing a new contract: the average salary of a full-time nurse there is $115K.

Omnicare Clinical Research, a contract research organization, will use the clinical trials and clinical trials imaging solutions of Merge Healthcare in a large-scale clinical trial.

Hopefully, gentlemen, you did not forget either your mother or your wife on Mother’s Day. The entirely logical but ill-advised insistence that that, “Hey, you aren’t MY mother” will greatly increase the chances of experiencing a lonely night in the dark visually tracing said soulmate’s vertebral column.

E-mail Mr. H.

An HIT Moment with … Brad Swenson

An HIT Moment with ... is a quick interview with someone we find interesting. Brad Swenson is VP and national healthcare leader for Winthrop Resources Corporation of Minnetonka, MN.

 

When you look at the financial environment that most hospitals operate in, which includes low margins and slipping bond ratings, what could they be doing better from a capital standpoint?

It’s really about the right tool for the right job. I’ve seen a segment of healthcare with a bit of one size fits all mentality – hospitals putting most everything on long-term revenue bonds, regardless of the estimated life or use.

I think especially today, with the uncertainties in the economy — capital markets, healthcare reform, future stages of Meaningful Use — cash preservation is an important part of any strategy. Many hospitals have strained days cash on hand and put themselves in jeopardy of tripping bond or bank covenants.

Finally, let’s not forget one of the most important benefits of technology — enhanced efficiencies. Whether we are talking about healthcare providers or other non-healthcare segments, technology can help us more efficiently deliver care. Adoption of these new technologies cannot be put on the back burner. Healthcare must embrace technologies to more effectively deliver care, as well as improve patient safety and clinical outcomes.

In an age of cloud computing, decreasing hardware costs, and shorter refresh cycles, should hospitals consider buying and maintaining technology as a utility rather than as ongoing individual capital purchases?

Every hospital and project is going to be different. It really depends on how the forces of change’may impact the life of each individual asset.

For example, point-of-care devices in the hospital. I’ve seen a strong majority of hospitals change directions on the types of devices based on clinician preferences, software vendor requirements, network infrastructure challenges, and patient room real estate. Other technologies we are seeing that have a high propensity to change are traditional IT technologies and many clinical or lab technologies that are impacted by the ripple effect.  The higher the propensity for change, the more a utility model such as rent, lease or hosting makes sense. These tools provide a great way to create additional agility within a hospital’s overall technology strategy.

A utility model offers some attractive benefits:

• Predictability and consistency of payments — no large capital infusions to catch budgets or the board by surprise. 
• Lowering maintenance fees on older equipment.
• The most modern equipment to be on the ground and in use by your staff.
• The benefit of technology comes from its use, not from owning it.
• Technology is a unique asset class that depreciates rapidly and obsolesces quickly, not a type of asset that lends itself to investment / ownership. These types of assets should be leased or rented.
• Predictable end-of-life technology disposition strategy. 

What potential accounting benefits lead hospitals them to engage your services?

I’ve never met an IT leader who enjoys going back to the CFO to request dollars for unbudgeted or unplanned items, even if it was caused by unexpected change. Healthcare CFOs are challenged in making ends meet on very thin margins.

They also need to avoid penalties associated with violating bond covenants. To date, many hospitals leverage off balance sheet financing to reclassify the costs as an operating expense since liabilities do not have to be reported because no debt or equity is created. This does not negatively affect their bond covenants. 

The key difference is that with an operating lease, the asset stays on the lessor’s balance sheet. The lessee only reports the expense associated with the use of the asset (i.e., the rental payments), not the cost of the asset itself. Another benefit from this type of accounting treatment is creating liquidity while avoiding leverage, thereby improving debt to equity ratios. New proposed accounting changes may negate off balance sheet classification, but for now, it remains a strong benefit. 

The accounting benefits are only one of many advantages of utilizing a true leasing strategy. Others include the ability to:

• Lower the financial and technological risk associated with owning assets that rapidly change and are consumed.
• Utilize cash and capital for strategic and organic growth and purchases of long-term assets.
• Maintain or increase competitive advantage.
• Increase patient safety, quality of care, and efficiencies in delivering care.
• Simplify the acquisition, deployment, and management of technology assets.

HITECH incentives are accelerating purchase cycles, but require significant upfront capital investment in hardware and software long before the federal checks will arrive. What programs do you offer to help them meet the federal deadlines while avoiding the capital crunch?

I refer to it as the Financial Road to Meaningful Use.  By now, most facilities have an estimate for what their MU incentive will be and when they will receive it.  By mirroring this incentive estimate to a lease payment stream for applicable EHR components, a very nice, customized financial strategy can be created. 

Many so-called leasing companies are mere brokers who are constricted in any sort of customized financial strategy such as the one just described. This is further complicated when a change event appears in the healthcare provider organization and their agility is negated — think home mortgages. 

Ultimately, the common wisdom of “use the right tool for the right job” applies. Hospital CFOs have multiple financial tools to utilize. Most simply, long-term assets should employ financial tools that give up flexibility for low-cost, long-term commitments. Technologies that a provider organization has identified as susceptible to change should utilize shorter-term, more flexible financial strategies.

The consumer housing market changed after the financial crisis, causing many people to question the traditional wisdom of buying vs. renting an asset whose value won’t necessarily increase. Are there lessons learned for the technology market?

I think one needs to consider the overall dynamics of the current environment, which is highlighted by the fact that things are changing more quickly and the outlook is shorter and more fluid. The lesson for me is twofold. In the past, one just assumed that buying was the end-all, but I believe you always run the numbers, especially in today’s environment. And secondly, there should be some value placed on flexibility. Even though it is subjective, it should be represented in the numbers.

Time Capsule: Open Source Won’t Break Commercial Vendors’ Hold on Market, Unless…

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

I wrote this piece in March 2006.

Open Source Won’t Break Commercial Vendors’ Hold on Market, Unless…
By Mr. HIStalk

The California HealthCare Foundation released a report by Forrester Research last week titled Open Source Software: A Primer for Health Care Leaders. Its conclusion begins, “conditions are fertile for open source solutions to take root in health care.”

Since my open source knowledge is right up there with most CIOs and health care executives (I have next to none, in other words), I figured my populist opinions might be as useful as the next guy’s (also next to none).

I’d love to see open source take off. Physician offices, small- to mid-sized hospitals, and long term care facilities need software that’s inexpensive, easy to use, and functional. Open source promises support from talented spare bedroom programmers striving for recognition among their community instead of cash. (I don’t get that concept, but apparently it works sometimes).

The reality is, however, that open source in health care has been limited to just a few industry-agnostic, super-techie utilities that aren’t seen by end users: Apache, some Linux, a smattering of PHP and MySQL for Web pages, maybe Firefox or Netscape browsers, and a tiny sprinkling of non-Microsoft Office deployments. Maybe you’ve seen more, but I haven’t.

You’ve read a lot about the VA’s VistA, but it doesn’t fit the classic definition. It most definitely cost Uncle Sam big bucks, even if the government did later place it in the public domain. Will a thriving community improve it and support it, even starting with a finished and tested app? Maybe.

CIOs gripe loudest about Microsoft, so surely they’re jumping on free operating systems, office suites, and e-mail packages, right? Not that I’ve seen. What’s the incentive for a CIO to replace an expensive software application with a free download, an act that could end up being a career-ending move when the merry band of scattered volunteers with cool nicknames doesn’t respond to an urgent plea for help on the support forum?

Open source software ought to be cheaper because it’s free of licensing fees. However, you still have to pay those high costs for implementers, travel, hardware, middleware, and so on. If your $5 million vendor project becomes a $3 million open source project, is the savings worth the risk? For many organizations and particularly for many CIOs, I’m not so sure.

Traditional software vendors could neutralize whatever market pressure that open source brings. They could lower or eliminate licensing fees, make source code available to local developers, use more open standards and tools, and give customers a MySQL option instead of Oracle or SQL Server, all serving to bring new customers on board and work the economy of scale largely missing in our industry.

On the other hand, customers aren’t demanding that. They’re happily buying what vendors are selling, voting for the incumbent. They want people on site with them, attentive project managers, 24×7 support, and free lunches. Aggressive salesmanship and turnkey service beats geeky downloads every time.

The only chance open source has to crack the major health care application areas is if someone creates a vendor-like organization to provide support and enhancements. Customers won’t do it for themselves. Suppose a few dozen or a hundred small hospitals, a bunch of physician practices, or a trade group chipped in a few dollars each to create a shop for the further enhancement and support of an open source app? Or, if those user organizations closed ranks and gave competing vendors a take-it-or-leave-it offer for a one-time license for source code for the entire group and then hooked up with an offshore company… naaah, that’s just crazy talk.

News 5/6/11

Top News

Q1 numbers for Allscripts: revenue up 82% , EPS $0.06 vs. $0.12, but beating expectations by $0.01 excluding non-recurring items. The company announces a $200 million share buy-back.

Alembic Foundation announces the availability of Aurion 4.0, its first release of the open source HIE software based upon CONNECT from the Federal Health Architecture.

Reader Comments

From RC: “Re: Inova Health System. They’ve announced that they will be going with Epic. They were previously with IDX since before the GE acquisition.” Unverified since I couldn’t find any mention on the Web, but I believe it for two reasons: (a) an official-looking press release was included, and (b) I had little doubt after interviewing CIO Geoff Brown a few weeks ago, even though he didn’t come right out and say anything. Actually, I did just now find a tiny mention in an undated message from the peds chair at Inova Fairfax: “The Joint Commission (TJC) now requires all inpatient chart entries to be dated, timed and signed, with either a provider code or legible name present. This is evolutionary. The Electronic Medical Record will automatically contain this, and many of its other benefits will be transformative in nature. Inova is now going with the EPIC system.”

From Fixer Upper: “Re: Judy Faulkner. Is she selling her house? This must be it – it’s the same architecture and artwork as the Verona campus.” I see the resemblance, but from what little I could find by sleuthing, the $3.9 million, 8,000 square foot home on 173 acres (top) in Oregon, WI is being sold by an owner that isn’t Judy. The same sleuthing suggests that the house in the bottom picture, worth about 10% of the the Epic-looking one, is hers, which would strike me as being more in character. But that’s just casual Internet detective work. Maybe someone who works there knows, not that it’s all that important anyway.
From Maven: “Re: not news, not rumor … just venting. As an HIT industry insider, I get so discouraged when I am a patient. I just registered for a minor procedure at a major teaching hospital that’s a beacon for HIT adoption. I was handed a two-inch, three-ring binder and was told by the clerk to take it with me when my name was called. Only nurses entered information into the computer, while the MDs and CRNAs did their documentation in the binder. I saw no evidence of innovation over what I implemented in 2002. I bet their EMR is mostly a document imaging system. I’ve seen progress behind the scenes at most hospitals, but bedside technology lags far behind.” I’ve worked in big places and IT is usually advanced in some areas, but a disaster of paper and poorly interfaced, outdated legacy systems in most. I’ll stick with my assessment that the big hospitals buy gazillion-dollar systems overseen by huge IT shops and highly compensated magazine-cover CIOs, but it’s often the tiniest ones that deliver the most impressive results from the systems they can afford. The main reasons: (a) fewer prima donna doctors and executives; (b) a more focused environment, both culturally and geographically; (c) better connection to their local community and patients; (d) more urgency to make IT projects succeed since they don’t have the bloated budgets to take a mulligan and buy them all over again a few years later when fads change. All of that offsets the lack of cash and the preponderance of community-based physicians whose EMR participation can’t be mandated.

From Jen: “Re: ex-Epic employees. I’m within the ‘exile period"’ of a year and am curious about my realistic job options. Recruiters lose interest when I explain I can’t staff for a few more months. Any tips on where I should put my considerable skills to use? Perhaps readers who have been in a similar position can offer advice.” Comments welcome. I’ve heard of employers taking on Epic-certified folks even with their mandatory time out, figuring they can let them do general project work until they are allowed to leave the penalty box. It depends on their project timeline and how desperate they are to land experienced people. It may be that recruiters just don’t want to be bothered with explaining your situation even though potential employers might be OK with it. But I’ll shut up and let those who have lived it first-hand chime in.

From California Dreaming: “Re: Alameda County Medical Center. Deep into a Soarian install, I hear.” I found the above in its 2010 annual report.

HIStalk Announcements and Requests

This week on HIStalk Practice: Micky Tripathi shares insights on Meaningful Use Stage 1’s Nasty Little Surprises in his Pretzel Logic column, about which a reader posted, “Adding Micky Tripathi to the HIStalk crew is further evidence of why HIStalk is one of the most worthwhile reads on the Web.” Emdeon acquires EquiClaim for $41 million in cash. St. Jude Medical integrates its Merlin.net Patient Care Network with GE’s Centricity EMR and Scottcare’s Oneview CRM. AMA introduces online tutorials to help physicians select and implement HIT systems. Only about 21% of eligible providers participated in the 2009 PQRS program and only 12% earned bonuses. If you are thinking to yourself that you don’t recall reading any of these stories on HIStalk, you are correct! Sign up for HIStalk Practice updates so you don’t miss a thing.

Jobs on the Sponsor Job Board: Segment Marketing Manager, Product Specialist – Physician, Software/Implementation Engineer. On Healthcare IT Jobs: Senior Systems Analyst – Financial Systems, Director, IT Business Services, Epic Reporting Specialist, Metadata Administrator.

Acquisitions, Funding, Business, and Stock

Start-up eMerge Healthcare receives $650K in investment commitments, including $250,000 from the Ohio state-supported venture development group CincyTech. The company was founded by a group of Cincinnati gastroenterologists who developed intra-operative voice command software to document surgical procedures.

British software vendor Sage reports improving numbers for the six-month period ending in March, although its healthcare business fell 5%, with especially weak sales of its Medical Manager PM/EMR. The CEO declined to comment on rumors that the company is planning to sell Sage Healthcare, expressing a belief that stimulus money will eventually boost demand for Intergy.

Sales

St. Joseph Healthcare (CA) will use Emerge.MD’s OnePlace virtual clinic to support its telehealth pilot project and to expand services into other remote care services.

Downey Regional Medical Center (CA) signs a multi-year agreement with MedAssets to manage its patient financial services, including billing and collections for self-pay and third-party insurance accounts.

Conifer Health Solutions secures a multi-year contract to provide revenue cycle services to Memorial University Medical Center (GA).

Camden-Clark Medical Center (WV) signs for Allscripts Sunrise Enterprise and Enterprise Performance Management for recently acquired St. Joseph’s Hospital, replacing Meditech. Its Camden-Clark Hospital is already using those products.

Salem Hospital (OR) is mentioned as an Epic customer, with a rumored price of $48 million and an expected HITECH payout of $14 million over five years. It’s hard to determine exactly what was being announced, but I think they were Epic before, at least on the ambulatory side, and they did just go live with MyChart.

People

Harris Corporation promotes Jim Traficant from VP and GM to president of Harris Healthcare Solutions. An interesting quote from CEO Howard L. Lance: “Jim’s personal healthcare experience as a two-time liver transplant survivor drives his passion for transforming healthcare and informs his ability to understand the complex needs of patient and provider."

Skylight Healthcare Systems, a provider of interactive patient care systems, appoints Carla Hilts, previously with McKesson, as chief clinical officer.

MedSynergies adds Aaron Garinger and Amy Hartt from Baylor and Wellspring+Stockamp, respectively, as managing directors of its consulting services group.

MEDecision promotes Carole Hodsdon to EVP/COO, reporting to CEO Deborah M. Gage. She was previously EVP/CTO.

Kent Rowe, a former GE Healthcare VP/GM and IDX sales VP, joins Culbert Healthcare Solutions as VP of information technology services.

Announcements and Implementations

CIO Shafiq Rab ceremoniously flips a switch symbolizing the EHR go-live of Orange Regional Medical Center (OH) EHR. It’s moving its two hospitals to Epic as part of a $30 million HIT initiative.

The Varian ARIA oncology EMR receives ONC-ATCB certification as a complete EHR.

In New York, North Shore-LIJ and Montefiore announce a strategic alliance to share best practices, with Montefiore citing one of its own strengths as IT systems that support care management.

Government and Politics

The HIT Policy Committee suggests delaying Stage 2 Meaningful Use one year until 2014. Providers and vendors have told the panel, ONC, and CMS that they need the extra year to develop and implement the new technology since the final Stage 2 rule is not expected to be released until mid-2012. An added benefit of the date push-back: more providers might participate in the Stage 1 qualification process since they would have an additional year to qualify.

Innovation and Research

Interesting healthcare technologies are mentioned in an Indian newspaper: (a) a hospital’s smart card that can be used as a debit card and to store patient information in its 4 KB chip; (b) a Web service that allows finding blood donors by sending an SMS text message, with the same service also posting a message on Facebook and asking users to tweet it; (c) a smart phone-based personal case management system in which teams of experts monitor diabetics, send text reminders and advice, and intervene as needed; and (d) an online results service (Web, e-mail, SMS) offered by a chain of diagnostic centers.

UPMC and Alcatel-Lucent will jointly develop a telemedicine platform, extending their agreement that goes back to 2006. The “virtual exam room” will reach the commercial market in early 2013. UPMC will consolidate its telemedicine offerings, which are used in 16 service lines and 19 facilities.

Technology

The new iPad 2 TV commercial features medical imaging as one of its key uses. I’d guess it’s AirStrip’s app that is shown since Apple features them in nearly every promo, but I don’t know for sure.

Other

Twenty-four percent of hospitals will invest invest in new transcription services, according to a new CapSite study. The report also finds that 61% of study participants currently take or plan to take a hybrid approach to capturing physician documentation to meet MU requirements and 53% would consider their current transcription vendor for data extraction and analysis needs.

KLAS’s latest report looks at the challenges and benefits of an anesthesia information management system (AIMS) and the most talked-about AIMS vendors. The vendors with the largest market share are Cerner, Draeger, GE, Philips and Picis. Similar to findings with other modalities, hospitals tend to prefer enterprise integration over best-of-breed.

Vince Ciotti says you should watch his HIStory Part 7 (above) if you want to know the connection between IBM, men’s hair, and miniskirts.

Weird News Andy can’t decide if a proposed New York law intended to reduce infections is “typical bureaucratic overreaching or actually a good idea.” It would prohibit doctors from wearing ties on the job.

Kaiser Permanente finds that its use of health IT has allowed it to avoid using 1,044 tons of paper for medical charts annually; to eliminate 92,000 tons of carbon dioxide emissions by replacing face-to-face visits with virtual visits; to avoid 7,000 tons of carbon dioxide emissions by filling prescriptions online; and to reduce the use of toxic chemicals by 3.3 tons through the use of digital imaging. Kaiser also claims that despite the increased energy use and waste associated with PCs, its use of HIT has had a net positive effect on the environment.

The ratio of the length of a man’s ring finger to that of his index finger is linked to facial attractiveness, according to researchers in Switzerland (who must have extra time on their, um, hands). Apparently, the longer the ring finger, the hotter the guy. It all has something to do fetal testosterone. I can’t wait to test the theory next time I am at a cocktail party.

Sponsor Updates

• Catholic Health Initiative’s use of the Clairvia Care Value Management solution is presented as a case study in the latest issue of HFMA’s Leadership report. A quote from CHI’s SVP/CNO: “Instead of just sitting there with a list of nurses and a list of patients and trying to figure out how to match them, this system will make assignments that are not only best for the patient, but better for the nursing staff, too.”
• Maury Regional Medical Center (TN) selects ProVation Order Sets as its electronic order set solution.
• CynergisTek will showcase its on-demand and managed security solutions alongside partner Diebold at next week’s 2011 Amerinet Member Conference in Orlando.
• Medicity expresses support for the ONC’s Direct Project specifications.
• Voalté is hosting a one-hour Webinar on May 19 entitled 3 Steps to Get Your Smart Phone Strategy Rolling. Sarasota Memorial Hospital’s CIO Denis Baker is the featured presenter.
• Mobile Anesthesiologists (IL) implements the Shareable Ink Anesthesia Suite for capturing clinical data and streamlining billing.
• Lakeway Regional Medical Center (TX) selects Allscripts’ Sunrise Enterprise suite, including EHR and CPOE.
• Olmsted Medical Center (MN) chooses the Access Intelligent Forms Suite to generate on-demand, pre-filled patient forms from its McKesson Series 2000 system.

EPtalk by Dr. Jayne

I recently attended a conference where I presented to community-based physicians on Meaningful Use. Now that we’re a good chunk of the way through 2011, it still surprises me that some physicians don’t seem to know much about it. Specialty and advocacy groups have done a good job of trying to educate the general physician population and CMS is also running journal ads, so even those folks who read print journals should have a rough idea what’s coming.

On the other hand, they could be like my colleague who insists on getting the print versions of all his journals even though he never reads them. His office is straight out of an episode of Hoarders. When we first went to tablet PCs for our EHR, he complained about the accuracy of the stylus. Turns out he had the tablet balanced on a giant unstable mound of mail on his desk, causing the tablet to wobble every time he tapped the screen. I jokingly moved the cardiac arrest crash cart next to his office because I’m sure I’m going to find him one day trapped under twenty-odd years of JAMA.

Back to Meaningful Use. I was not only surprised by these physicians’ lack of understanding of MU, but their lack of understanding of the operations of their practices in general. They were a mix of employed and independent physicians, all of them at a minimum on electronic practice management systems and about half of them on an EHR already. Several didn’t have any idea whether they’d even qualify for either of the incentive programs, with no idea of the size of their Medicaid or Medicare panels.

One of the challenges of technology is not just the implementation and adoption, but also optimization. I used existing software systems as an example in a breakout session. We talked about what several referred to as “billing systems” and how the practices use them. One physician sheepishly admitted that he had used pegboard billing until sometime in 2002, but had finally embraced the 1990s after payers forced his hand.

There was an overall lack of understanding of the role of a true practice management system as opposed to just a billing system. These physicians were not using on-board reporting, panel management, disease registry, or revenue-enhancing features of systems that had been in place for years.

If the practice is only using a small percentage of their capabilities, how in the world are they going to be able to implement, adopt, and maximize patient outcomes with an EHR? I guess that’s why consultants do so well. There are plenty of groups poised to drag these folks (kicking and screaming or not) into the Brave New World of healthcare IT.

I sent the group home with some basic homework to discuss with their practice management teams:

• How big is your panel of active patients?
• How big are your Medicare and Medicaid panels?
• What are your top five payers, and are there any problematic trends?
• What percentage of your patients are self-pay, and has it shifted in the last year?
• What is your first-pass “clean claim” rate?
• How many of your active patients have diabetes, coronary artery disease, hypertension, obesity, or another one of the Top 10 chronic diseases based on ICD-9 codes assigned at the time of billing?

Hopefully this homework will spur some important discussions and will set the groundwork for them to determine if Meaningful Use is worth the time and effort in their specific situations. With or without an EHR, these data points provide important information on the health of a practice. Physicians should be conversant about these metrics.

Understanding the “clinical” data already available in their practice management systems can position them to dip their toes into disease registries, quality reporting, and a wealth of other incentive programs that can be put in place with or without Meaningful Use, some even with (gasp!) paper charts. And better understanding of existing technology might just put a few more dollars in their pockets.

Contacts

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

CIO Unplugged 5/4/11

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

Taking a one-post break from my short series, “The CIOs Best Friends,” BFFs who are critical in ensuring CIO effectiveness. Next time we cover the Vendor Account Executive – CIO relationship.

Where Dreams and Fear must Collide*

What is your biggest dream? What’s been in your heart but never attempted?

Fear keeps most people from pursuing their dreams, or even speaking about them. Three years ago, I completed my first Ironman. A physical feat for sure, but also lessons for work and play.

Ironman accelerated my personal and professional growth and to this day serves as a vivid reminder that one can accomplish great things where dreams and fear are allowed to collide. I never thought I could be an Ironman until life events dictated otherwise. My manager actually envisioned me and encouraged me to pursue despite my fears.

These videos explain the story for those interested.

If you’ve followed me for any length of time, you know I view each of life’s parts as one continuous journey. I integrate all aspects of living in order to maximize time and opportunities. Crossover is key to accelerated and sustained growth.

Here is what I learned and how it applies to our careers.

• Training. Many CIOs believe no further training is necessary once they’ve reached the top. To the contrary, requirements increase with elevation. Continually equip yourself or you’ll be passed along the way.
• Embrace change. During Ironman, a racer encounters unforeseen circumstances. Strong winds. High tides. Flat tires. No one is exempt from trials. Do you accept change and make the most of it, or do you spend energy fighting elements you cannot control? Adapt to curveballs thrown your way, and then thrive.
• Guts. It’s not merely the most fit who finish Ironman. It’s also those who want it badly. Crave it. I surpassed colleagues in my career who were brighter than I because they lacked fortitude, desire, and focus to push through challenges. Painful things will happen that tempt you to quit, so harness the power of passion, for passion creates guts and drives success.
• Bust boundaries. A 5K run was a long distance. Running a marathon struck me with fear. Today, however, 10K is a warm-up. Ironman busted boundaries I believed invincible. As CIO, we must continuously bust boundaries lest our organizations become complacent and visions dim. Test boundaries, then break through and grow to the next level.
• Planning. No one wakes up and decides to do Ironman that morning. It takes advanced planning and years of transformation to see grand dreams achieved. Plan similarly for your career and your organization. Proper preparation preludes proficient performance. No greater euphoria will seize you than crossing the finish line – a plan fully executed and realized.
• Rest and refueling. There is a science to Ironman, which includes rest and refueling. Continuous activity leads to burnout. Take time for nourishment and you sustain your energy. Constant action is not synonymous with effective action. Build in time for rest and refueling.
• Followership. Be sure the person you are following has the vision and stamina to keep you on the right track. Great leaders help you overcome fear. “Followership” is a critical talent for reaching dreams.
• Two are better than one. By riding in a pack, you gain 40 percent efficiencies over riding alone. Teams accomplish more. Pushing and pulling together, a team outperforms the loner. Surround yourself with positive people dedicated to your success. They will get you through the loneliness and pain of challenging times.
• First break all the rules. Sometimes you’ve got to shake things up and not do the same things over and over, especially if they’re not working. Focus on strengths not weaknesses. I made the choice to strengthen my strong bike over my weak swim, and it paid off.
• Bigger picture. As a leader, do you have a significant purpose? Put people first. Seek to serve. Dedicate your efforts to others. My Ironman was inspired by and dedicated to cancer victim Ellen. She kept me in the race. In health care, the Ellens are the ultimate endurance athletes running a race that nobody should ever have to run. We are there for them.

Epilogue

An update for those who watched the videos. Ellen traded her earthly rags for a robe of righteousness on July 26, 2009. I will never forget the energy she gave me during my training and our time together at the finish line. She helped me overcome fear and reach my dream. My bike still bears her name.

Pam is in complete remission.

You can’t tell by his energy and attitude, but “Ironman” Sam is still fighting. I hope to accompany Sam on his first triathlon this September. He will be 8 years old. I will help him overcome fear and fulfill a dream.

*Where Dreams and Fear must Collide. “Let me Fall”, Cirque du Soleil, Quidam

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

News 5/4/11

Top News

McKesson’s Q4 numbers: revenue up 8.6%, EPS $1.62 vs. $1.26, beating earnings expectations by $0.02. Technology solutions sales were up 7%, but the Horizon Enterprise Revenue Management write-down in Q2 hurt the numbers, as did “continued investment in the Horizon product line.” CEO John Hammergren said in the earnings call:

Overall, our Technology Solutions financial results did not meet our expectations as our Horizon product line profitability fell below our anticipated level. It’s important to recognize that this financial performance is not an indication of problems or product functionality … I think that our view is that we’re quite pleased with the progress of the organization, and you know we’ve made many changes in our leadership team there. And frankly, if you go into the organization, we’ve made great progress in our development organizations and our implementation team. So I think we’re doing, frankly, a great job of getting after the issues that we would have faced two or three years ago that are now rapidly behind us. I think from a go-forward perspective, the clinical products are going to be a little less profitable than we had expected primarily because of the work required to make sure that our customers got them installed, got them installed quickly and are getting to Meaningful Use.

Reader Comments

 

From Ms. Blackwell: “Re: golf course fashion. I thought you would appreciate a few pix from yesterday’s GAHIMSS annual golf tournament. The Billian’s HealthDATA team took first place, with a little help from a last-minute recruit from GNAX. Attached are some pix snapped of two guys who were definite standouts in the fashion category, including Mike Mosquito, president and CEO of HealthNovation.” I agree with Ms. Blackwell. There are few things I appreciate more than guys who know how to show some flair at business events.

From David StockMan: “Re: Cerner ‘underperform’ rating from Oppenheimer. That particular analyst has been very negative on HCIT stocks since ARRA was passed. He likes to garner attention by being a contrarian, but conveniently changes employers from time to time and re-initiates coverage with a fresh start.” Unverified.

From Sun Myung Sun: “Re: Cerner. I enjoy this blog like something crazy. We’re a Cerner outpatient site looking into getting kiosks for patient check-in, but the insanely high quote from Cerner made that DOA. Do you know of any places that have implement kiosks with Cerner and like them?” Your non-commercial comments are welcome if you have experience to share with SMS. 

From Wikileaks: “Re: nextEMR. They are displaying the CCHIT 2011 logo on their site even though they only achieved ONC-ATCB certification, not comprehension. That’s a clear violation of CCHIT’s trademark and is confusing to providers.” I forwarded your comment to CCHIT and they say you are correct – nextEMR is using the wrong seal and CCHIT has told them it has to come down immediately. They should be using the one on the left, but are using the one on the right.

HIStalk Announcements and Requests

Welcome to new HIStalk Gold Sponsor AirStrip Technologies of San Antonio, TX. The company gets a ton of buzz for its cool mobile device apps, which give clinicians real-time access to waveforms, alarms, and patient data from patient monitors and other devices. Its FDA-approved systems include AirStrip OB (maternal/fetal waveforms, annotations, meds, progress notes, etc.); AirStrip CARDIOLOGY (12- and 15-lead waveforms), and AirStrip PATIENT MONITORING (waveforms for cardiac, SPO2, ventilator, arterial lines, plus vital signs, meds, labs results, and other EMR data). Hospitals are finding that plain old remote access pleases some users, but not physicians in high-acuity specialties who want easier and more convenient access to data they need to manage critical patients from anywhere. Benefits include tighter physician alignment and higher satisfaction, quality gains, increased efficiency, and reduced risk. Not to mention that its products always show up in Apple’s commercials and you know docs like cool stuff. I interviewed co-founder Cameron Powell MD just over a year ago. Thanks to AirStrip Technologies for supporting HIStalk.

Here’s a live, Steve Jobs-type AirStrip demo I found on YouTube, which I note earned Cameron Powell spontaneous applause (which seemed to embarrass him a little) when the waveform screen came up on the iPhone.

TPD updated his list of iPhone apps, which I moved to a new page. You can find it here.

Acquisitions, Funding, Business, and Stock

Merge Healthcare posts Q1 numbers: revenue $52.7 million, up from last year’s $20 million. EPS -$0.04, unchanged.

Texas-based EDIS vendor MedHost will move its headquarters to a a larger facility after increasing headcount from 90 to over 130 in the past six months.

Q3 numbers from Mediware: earnings of $1.4 million ($0.17/share) compared to $891,000 ($0.11/share) last year. Revenues were $13.8 million, up from last year’s $12.8 million.
 
Meditech hired 618 people in the last year, a 20% increase in employees. The company is planning a new 180,000 square-foot facility on a 135-acre tract in Falls River, MA. A former city councilman estimates that the land cost $80-$100 million.

MEDSEEK acquires Third Wave Research Group, a predictive analytics company specializing in healthcare applications.

Precyse Solutions changes its name to just Precyse, along with a new logo and Web address (precyse.com). The company says the new identity is “designed to more accurately reflect the breakthrough technologies and comprehensive and holistic blend of services that are sparking true innovations in the flow of health information throughout the hospital environment, significantly improving the flow of revenue, work and patient data.” As Bard liked to say, “What’s in a name, that which we call a rose.”

Consulting firm Arcadia Solutions will acquire Concordant, which also provides consulting services.

Sales

eHealthObjects chooses Elsevier/Gold Standard’s Alchemy as its drug database for eHealthObject’s ThinkHIE, ThinkEHR, and ThinkCDM products.

Otto Kaiser Memorial Hospital (TX) picks ChartAccess EHR from Prognosis Health Information Systems. The 25-bed hospital will begin implementation this month.

The 44-bed Tippah County Hospital (MS) purchases Healthland’s EHR.

People

PNC appoints Marlowe Dazley as SVP and senior managing director to lead the company’s new revenue cycle advisory group. He was previously with Premier Consulting Solutions.

HIT consulting firm WPC Services appoints Rebecca Jones (InterComponentWare) VP of sales, Patrick McGrath (MedSolutions) director of technology services, and Larry Watkins (Qaledix) director of business services.

Streamline Health Solutions hires Gabriel Waters (Carefx) as VP of business development.

Former Partners HealthCare CEO James Mongan MD died Tuesday of cancer. He was 69.

Announcements and Implementations

The HealtheConnections HIE in New York says it has connected its first five facilities. Fifteen other community hospitals across Central and Northern New York will eventually join Community General, Crouse, St. Joseph’s and Upstate University hospitals, as well as the Laboratory Alliance of Central New York.

Logansport Memorial Hospital and Woodlawn Hospital (IN) join the Indiana Health Information Exchange.

Singapore goes live on the first phase of its $144 million national EHR system, which will provide a central repository for clinical data collected from different hospitals. Accenture, Oracle, and Orion Health are providing  technology.

The folks at Shareable Ink tell us that Gartner has named them one of five cool vendors in healthcare for 2011. Click on the link if you like, but have $20K ready if you want to actually read what’s behind the teaser page. Congratulations also to another HIStalk sponsor, AirStrip Technologies, for making the list, along with AxSys Technology, DisastersNet, and Health Care DataWorks.

Omnicell announces its G4 platform, which will integrate 11 of its medication and supply automation products onto a single database. New products include a biometrics-capable console with a built-in medication label printer, a redesigned anesthesia workstation, a new controlled substances system, and a system (video above) for delivering meds from the dispensing cabinet to the bedside. The company also announced Q1 numbers: revenue up 5.5%, EPS $0.02 vs. $0.03.

Government and Politics

CMS issues a simplified final rule for credentialing and privileging physicians who provide telemedicine services. Hospitals and critical access facilities can use credentialing and privileging information from the hospital that’s providing telemedicine services instead of making their own privileging decisions for the consulting physicians.

NIST is holding a workshop on EHR usability on Tuesday, June 7 at its Gaithersburg, MD campus. I don’t quite understand the registration page since it says registration closed 6/1/11 (a few weeks from now – maybe it was supposed to say “closes”), there’s no pricing information to allow completing the “amount due” field, and it misspells “usability,” but I’m sure you can work it out with them if you want to attend (it’s not a very usable registration page for a workshop on usability, but that’s just me nitpicking). I didn’t recognize the names of many speakers since most are from NIST, but I did see Charles Friedman from ONC, Arien Malec from Direct, and DrLyle on the list.

The two physician founders of a South Florida software company unleash lobbyists and contribute $3 million in one year to state political groups, hoping to kill a bill that would stop doctors from dispensing medications directly to workers compensation patients at markups that far exceed what pharmacies can charge. Automated Healthcare Solutions sells software to support direct physician dispensing to those patients. A state senator drafted a veto-proof bill to kill the practice, but was told by the senate president’s office not to bring it up for a vote. “I’m just doing what I was told,” the senator says, dashing the few remaining hopes that politicians do the right thing and not what someone with money or power tells them.

Technology

HL7 publishes a standard that will allow insurance companies to transfer a patient’s personal health record information among themselves. They call it P2PPPHR – plan to plan personal health record.

Apple acquires a paging system patent that one expert believes will be used for in-hospital iPhone and iPad communication without using cellular networks, reducing power consumption and potential interference in the same way that RIM pagers work. Why does the expert think it’s intended for hospital use? Because they’re the only ones using digital antiques like pagers and fax machines.

Other

HP commits to spending $25 million over the next 10 years to support the expansion of Lucile Packard Children’s Hospital (CA).

The Office for Civil Rights says more than 10 million patients have been affected by 260 data breaches since September 2009.

A special thank you to the reader who saw this desk plate and sent a photo my way. It brightened my day immeasurably.

Weird News Andy, invigorated after his hiatus, provides his penetrating commentary for this story as, “It might be a little deep.” The cause of the bad cough of the former president of South Korea is found to be an acupuncture needle stuck in his lung. WNA also chimes in on an article observing that it’s going to get a lot harder to see a doctor given that Medicare is paying them less while giving more patients insurance, concluding, “When you lower payments without lowering costs, you get less supply. It’s been that way forever even if you don’t understand Econ 101. The most telling part is the average wait times going from 33 to 55 days in the home of Romneycare.”

I can never figure out why supposedly smart companies (especially ones with cool names themselves) give their products names that can’t be pronounced or remembered, seemingly choosing names intended to make everybody in a conference room full of marketing types happy to get a little piece of the final, unmemorable, Frankenstein-like compromise. Case in point: the new mobile results application of Halfpenny Technologies: ITF-GoDoc MobileOE. It looks like someone’s cat was stretching itself on the keyboard. Know a lot of buzzworthy nine-syllable brands, do you?

Sponsor Updates

• Hayes Management Consulting promotes Robert Drewniak to Director of Strategic & Advisory Services.
• The Anesthesia Quality Institute designates Surgical Information Systems as a preferred vendor.
• Karl Graham of CareTech Solutions co-presented with Brett Norgaard of Kinetic Data at the Technology Services World 2011 Silicon Valley conference this week. Their case study was The Intersection of IT Outsourcing and Healthcare: How CareTech Solutions Achieved Top 20 Best in KLAS Awards Distinction.
• Center for Diagnostic Imaging adopts Merge Healthcare’s RIS v.7.0 to meet Meaningful Use certification requirements.
• 3M introduces its Mobile Physician Solution that integrates coding technology to provide advice to physicians as they enter charges.
• Diversified Clinical Services, a provider of wound care management services, to will use Allscripts EHR and PM products as part of its i-heal 2.0 clinical productivity solution.
• Cumberland Consulting Group promotes Memory Baker to executive consultant.
• Nuesoft posts a video called Reworking Workflow to Maximize Revenue.

Contacts

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

Curbside Consult with Dr. Jayne 5/2/11

This has been a bit of a crazy week for me, with entirely too many hours at the hospital. I had a pounding headache after a particularly chaotic shift. After taking the proverbial two aspirin and trying to unwind with some quality Internet surfing, I came across a blurb about the noise levels in hospitals. Could this be the culprit?

Digging deeper into the Chicago Tribune, the article cited “alarm fatigue,” a significant safety issue for hospitals. If you haven’t experienced this personally and you live in the IT or medical device worlds, you’ve probably heard clinicians complaining about what the article describes as “incessantly beeping devices.” I definitely met this face to face while rounding on the cardiac floor, where every patient has a heart monitor.

The Trib mentions the Food and Drug Administration’s responsibility for regulating medical devices, and the scope of its reach is broad. Ever wonder what all they regulate? It’s much more than X-ray machines and prosthetic knees. A list of the various regulated devices is here. I had no idea they regulated some of the things they apparently regulate. Maybe I can use some of them for trivia at my next cocktail party.

Based on their extensive reach, I’m actually pretty surprised they haven’t yet gotten into the electronic health records arena. Many people are calling for FDA regulation. The Tribune article brings up some important points, however. FDA, in its regulation of devices, hasn’t been able to find the “sweet spot” between specifying the appropriate alarms to adequately support clinical care while reducing the fatigue caused by overly sensitive parameters.

The piece cites a noise researcher from McMaster University as saying, “People don’t pay attention to alarms; they exist as much for legal liability reasons as much as for actually doing anything for patients.” If we have this situation with devices that have been regulated for years, what does that say about the ability of the FDA to improve the performance of electronic documentation systems?

As cited in the article, ERCI Institute has a top ten list of technology hazards. For 2011, alarm-related adverse events is number two, right between radiation overdose (!) and cross-contamination from flexible endoscopes (yuck). Data loss and “other health IT complications” is number five. This is a pretty serious list: surgical fires and misconnected intravenous lines also made the cut.

The Chicago Tribune isn’t the only major outlet to report on this issue. The Boston Globe ran a piece in February. Their investigation revealed 942 alarms per day on a 15-bed unit at Johns Hopkins Hospital — a rate of one critical alarm every 90 seconds. In studies, up to 85% of alarms have been shown to be false alarms. The FDA is apparently stretched thin already, failing to follow up on case reviews with manufacturers in some cases.

Organizations other than the FDA have gotten into the alarm fray. Joint Commission made alarm recommendations part of its National Patient Safety Goals in 2004, but dropped them in 2005. Some safety experts have lobbied to block hospital staff from turning off critical alarms, a move that was rejected by an industry working group due to caregiver objections and the need to “permit the clinical staff to solve the problem in peace and quiet.”

As a clinician, I experience alarm fatigue every day. Cardiac monitors start beeping when patients turn or cough. IV machines beep when infusions are completed (even if the next infusion isn’t due to start for another 23 hours). My hospital’s EHR warns me that the diabetes drug I’m about to prescribe should be used with caution because it might lower blood sugar. Kind of sad, since that’s the main reason I’m prescribing diabetes medications in the first place — to lower blood sugar levels!

I’d love to see some standards put in place. Standards created by rational clinicians based on data and science, not based on the risk of lawsuits or on anecdotal experiences. The FDA doesn’t seem to have a track record in this area and they don’t seem to have the horsepower to take on regulation of another industry. As a physician, if they had additional funding, I’d like to see them tackle the dietary supplement industry first. How many patients are harmed by taking entirely unregulated substances marketed by greedy manufacturers who can say whatever they want because their product is classified as a food rather than as a drug?

Other federal agencies charged with regulating or advising in these areas haven’t fared much better. The United States Preventive Services Task Force is charged with recommending preventive health care services based on evidence-driven criteria. However, their recommendations have been blasted (and undermined) by various disease-centric organizations and professional groups and even the payment policies of CMS. It’s hard to explain to a patient why a test isn’t justified based on mountains of clinical evidence when they can counter with, “Then why does Medicare cover it?”

Let’s say we’re going to tackle alarm fatigue. Who can do it, how should they do it, and where are we going to get the money to pay for it? I’m interested to hear your ideas.

E-mail Dr. Jayne.

Monday Morning Update 5/2/11

From Kelli: “Re: Epic Beaker lab system. Epic isn’t much help in installing this application. Neither the technical or application side is a font of knowledge. I know it’s not a seasoned app, but I would still expect the company that coded it to have more knowledge about it.”

From Madeleine: “Re: immunization registry EMR interface. After multiple communications with [vendor], they decided that if the test submission of the Immunization Interface to the I-CARE registry fails, they will still charge us the full price of the interface. I asked for a refund if it fails and they declined to do so. The cost to our practice with be $6,000 for the interface and $900 for interface support, unfortunate since our three-provider practice already invested heavily in hardware to be able to upgrade to the vendor’s MU version. Even if all three providers are awarded MU in 2011, we will have paid more into the system to obtain MU than we will get back from the EHR Incentive payment.” We forwarded the comment to the vendor, giving them a chance to explain or maybe change their minds even though we (and possibly they) don’t know who you are. In the mean time, I’ll leave their name to give them time to respond. Hopefully you didn’t implement for the money alone because it won’t be the pot of gold you might have thought (as you are now finding out).

Nearly 3/4 of respondents to my last poll don’t think Meaningful Use will improve patient outcomes and patient safety. New poll to your right: given Oppenheimer’s initiation of coverage of certain healthcare IT stocks, which company’s shares would you buy today for long-term appreciation?

Meanwhile, the newly issued “underperform” rating that Oppenheimer gave Cerner didn’t dampen investor enthusiasm after the company posted strong quarterly numbers after Thursday’s market close. Shares closed Friday at $120.18 after touching on a new all-time high of over $124 in mid-morning. Cerner’s market cap is just over $10 billion, pushing the value of Neal Patterson’s holdings to beyond the half-billion dollar mark.

The Boston Business Journal reports that athenahealth’s SEC filings indicate that CEO Jonathan Bush earned $4 million in total compensation in 2010 and made another $4.4 million from exercising stock options. ATHN shares are at $46.21, double their July price and valuing the company at $1.6 billion.

From Meditech’s just-filed SEC quarterly reports: revenue up 20%, EPS $0.77 vs. $0.60. Product revenue made up $15.6 million of its $20.2 million increase in revenue. Meditech paid $13.7 million to acquire the remaining of shares of ambulatory EMR vendor LSS in February, with its total cost to buy the company just over $17 million.

This week’s Time Capsule editorial, revived from the slumber it has enjoyed since I wrote it in 2006: Just Back from HIMSS? Finish Implementing Yesterday’s Fads First. A sample: “Newly-minted experts fill HIMSS meeting rooms with audiences of the mildly curious, the crassly opportunistic, and consultants desperate for a fresh horse to ride.”

Weird News Andy is back after a break, entitling this find as “Here I sit, broken-hearted” and in Rohrshach test fashion, observing that the photos look like Jelly Bellies to him. Scientists genetically engineer E. coli bacteria to release specifically colored pigments in the presence of various maladies, turning bowel movements into a color-coded diagnostic tool.

Helen Devos Children’s Hospital (MI) creates My Baby View, which allows parents of newborns (who have an average length of stay of 27 days) to view their babies remotely. Parents ask for live video by calling the nurse, who positions the camera and e-mails back instructions for logging in to a secure Web site to view the video stream. The system was funded by a $25,000 grant from Ronald McDonald House Charities of Outstate Michigan.

Welcome to new HIStalk Platinum Sponsor dbMotion of Pittsburgh, PA. The company’s service oriented architecture (SOA)-based interoperability and HIE solution gives caregivers a real-time view of integrated patient information from disparate clinical systems and multiple facilities, providing the benefit of integrated patient records without system replacement. Providers get better information to make decisions and less time searching for important information, reducing unnecessary procedures and poor integration between acute and primary care settings. Its Semantic Framework enables information exchange across diverse systems. It also supports clinical effectiveness through population management, turning mountains of information into meaningful information for use by clinicians, for health surveillance, and to enable disease management. Thanks to dbMotion for supporting HIStalk.

India’s newest export: American babies, carried there by Indian women willing to become birth surrogates for cash in an arrangement called “rent-a-womb.” India’s minimal regulation and low prices encourage doctors to manage the high-profit process and for women to carry the babies of foreign strangers in return for several thousand dollars. A couple from Canada complain that the Indian doctor jacked up the price right before their baby’s due date, saying the original proposal was the “base price,” then billed them for the hospital stay at triple the usual price without paying the hospital its share. The couple paid the hospital directly, but the doctor’s staff prevented them from getting an exit visa to leave the country. It ended costing about the same as it would have in the US.

Driscoll Children’s Health Plan (TX) chooses Sandlot for its HIE, connecting it with Driscoll Children’s Hospital.

Mary Anne Leach, VP/CIO of The Children’s Hospital (CO), is named by the Denver Business Journal as its CIO of the Year for non-profits.

Sad: the Seattle Children’s Hospital critical care nurse and 27-year hospital employee who killed a baby with an overdose of calcium chloride last year after making a calculation error hangs herself.

Michael Dell speaks at the Health Evolution Partners Leadership Summit, saying the “insights gleaned from working with healthcare organizations around the world” have convinced him that higher-quality care is correlated to higher-quality information. He encouraged healthcare leaders to unlock healthcare information (buy Dell EMR solutions), empower caregivers (buy Dell mobile devices), improve business processes (buy Dell revenue cycle services), and use information for innovation (buy Dell medical archiving solutions).

API Healthcare and Kronos have explained why they cancelled merger plans, but the Department of Justice offers an explanation of its own, saying Kronos would have controlled 70% of the time and attendance market in healthcare and that “the abandonment of this transaction means that consumers will continue to receive the same benefits of competition, including greater innovation and lower prices, they’re now receiving.” That would make a great quote for API’s marketing collateral if you ask me.

More on the $4 million lump sum retirement package (plus $150K per year for life) given to the president and CEO of Salinas Valley Memorial Healthcare System (CA), which has one 269-bed hospital. The payouts were apparently structured into seven different plans to skirt IRS rules, with the board president justifying the amount by saying the payouts were OK’ed by an outside executive compensation firm and that the hospital has to pay big bucks to compete with for-profit companies. The union president says the district should be ashamed since the hospital is cutting 25% of its workforce and that the consulting firm who recommended the layoffs was paid $10 million in the last year to “do the job (the executives) should be doing.”

Strange: EMTs are called to the home of Doctor #1 to transport Doctor #2, who the inebriated partygoers thought was having a heart attack. During the ride, Doctor #2 unfastens his seat belt and starts hitting the EMT’s female co-worker. Doctor #1, riding shotgun, swore at the EMT and told him he would have his EMT license revoked. At the hospital, Doctor #2 unfastens his seat belt again, so the EMT holds him down to prevent the cot from overturning, inspiring Doctor #1 to rush over and punch the EMT in the jaw. Doctor #1 later pleads guilty to battery; the EMT files suit against him and wants his medical license revoked.

E-mail Mr. H.

Time Capsule: Just Back From HIMSS? Finish Implementing Yesterday’s Fads First

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 2006.

Just Back From HIMSS? Finish Implementing Yesterday’s Fads First
By Mr. HIStalk

Every HIMSS annual conference is the “Year of the Something.” CPOE, PDAs, networks, wireless, or CHINs. Newly-minted experts fill HIMSS meeting rooms with audiences of the mildly curious, the crassly opportunistic, and consultants desperate for a fresh horse to ride.

Sometimes the Something booms, although often only after several years. Sometimes it disappears without a whimper. Neither outcome dampens the enthusiasm of HIMSS, consultants, and vendors to push a new, carefully-orchestrated Something each year, likely because fewer people would attend conferences, hire consultants, and buy new products otherwise. Maybe they learned that from the car makers.

This is the Year of the RHIO. I’m not against that, but it would be nice if organizations finished implementing yesterday’s fads first, like CPOE and electronic medical records. Those are still a hopeful dream for the vast majority of hospitals. And, we know they can deliver value today.

At least some of the RHIO hype appears to be genuine (unlike the Year of the PDA, which everyone knew was a joke). It seems that technologies developed by Connecting for Health and IHE will allow RHIOs to interconnect, at least according to groups chewing through government grant money. The enthusiasm is palpable, although those with functional memories will recall that technology problems weren’t what ended the Year of the CHIN in the first place.

Eventually, RHIOs will provide patient benefit (at least three to five years from now, I expect). In the mean time, they could become CPOE redux: encouraging premature interest in immature products by unprepared organizations, consuming resources and organizational energies that could have been spent on more worthwhile projects.

Most hospitals still haven’t implemented bedside bar coding, smart IV pumps, electronic MARs, and clinical decision support, all comparatively inexpensive slam dunks compared to CPOE. But, we convinced ourselves to lead with CPOE through some bizarre logic. We’re still trying to get physicians to use it years later, passing up some great patient safety opportunities along the way.

In any case, RHIOs are about to morph from a science fair project run by grant-fueled big contractors to the mainstream. Uncle Sam is sending just one receiver downfield, and it’s RHIOs. Whether you are ready doesn’t matter. That virtually no doctors have EMRs that can contribute or use clinical data doesn’t matter. That hospital clinical systems still capture only a small percentage of electronic data doesn’t matter. What does matter is that RHIOs are hot and hospital executives will be encouraged to hop on the bandwagon.

I think many RHIOs will go right down the toilet through lack of a sustainable financing model, poor governance, or a general lack of interest in cooperating with barely tolerated competitors. Those that are successful will at least spur demand for better clinical systems in all settings. That’s good. According to several HIMSS speakers this week, we’re turning our backs on those systems just as they are becoming good enough to use.

Let’s celebrate the shockingly fast progress that’s been made on RHIOs. Clearly lots of good work has been done. But, remember that your first obligation is to ensure good outcomes for patients under your facility’s care right now. We need to finish implementing all those now-gauche technologies that didn’t make the HIMSS hot list this year.

HIStalk Interviews Aaron Kaufman, VP, Kony Solutions

Aaron Kaufman is vice president, healthcare and life sciences solutions, of Kony Solutions of Orlando, FL. 

Give me some brief background about yourself and about Kony Solutions.

I’m GM and vice president of the healthcare division of Kony Solutions. I come from 15 years of healthcare expertise in health information technology. I was previously the chief technology officer for Cardinal Health’s specialty division. Prior to that, I was the vice president of Infomax Development, which is like the CTO over at US Oncology. Before that, I was running a fund tranche as well as some activities in healthcare information technology activities for Patrick Soon-Shiong out in Los Angeles. He started a company called Abraxis Bioscience and I helped out with that and a couple of other initiatives that he had going.

Kony Healthcare is about six months old. Kony as a company was started in 2007 by a gentleman by the name of Raj Koneru. He saw an opportunity, a mixed bag of issues in mobile in general. He eventually realized there was some continuing expansion and divergence in the mobile space. As mobile platforms keep arising, new operating systems keep getting deployed. Companies go into this maintenance spin that gets them into a point where they’re not releasing new features or functionalities, but having to keep up with their application and not focusing on the features and functionalities that their applications should be focused on. 

He eventually identified this problem and solved it with this concept of a mobile platform solution. The Kony platform is several things. It’s a studio, it’s a server. We have some vertical apps in the healthcare market space and several of the other spaces too, but really that studio and server are there to help you develop apps that are truly future-proof for changes in healthcare, whether a new device comes out, a new operating system comes out, or a change to an operating system happens.

I’m interested in the Write Once, Run Everywhere approach. Companies trying to get mobile apps out quickly focus mostly on the iPhone and iPad and ignore significant devices like the BlackBerry and Android. Is that the wrong approach and if so, how do you help them avoid it?

All the companies that we talk to are trying to get an application out the door. They see it’s going to take developers and a specific code base to get an application out the door, whether it’s doing Objective C, C++, or doing Java development for Android. That’s all fine and dandy, but you only hit about 50% of the marketplace at max with those two platforms. If you want to hit the consumers, the broad base of consumers, you’ve got to get to more platforms, like BlackBerry, Symbian and Windows Phone 7. Those kind of devices are covered on our platform. 

But it’s not just getting the app out to market, it’s maintaining it as well. Not only are you doing yourself an injustice by releasing under a small group of platforms for your opportunity in the marketplace, but actually creating a maintenance nightmare and a cost nightmare for having a team of five to ten people per app, per platform in place just to get an app out the door and maintain it. Again, like I said earlier, in order to maintain this app, you’re going to be focusing mostly on the changes in mobile and not your app’s features and functionalities for your business needs as time evolves.

Are you finding that companies, especially in healthcare, are saying, “Hey, you can get to our Web page on a mobile device, so we’re good to go?”

I think the companies that we’re talking to and the ones we generate interest from organically or internally or approached us have all seen the need to have a native application, mostly because of the user experience. The users are looking in an app store before they typically go out and search the Web to find whether or not a site is mobile enabled. If they find a mobile-enabled site, they’re realizing the functionality doesn’t really fit the size and screen of smart phone capabilities and they want to fully leverage their smart phone capabilities with its GPS, accelerometer, camera … there’s all sorts of nice features that you can leverage through the native experience.

With HTML 5 coming out and the specs being really loose, there’s still an unclear roadmap on how HTML 5 will be able to affect the broad base of all the smart phones that are out there. Everybody calls for different standards, like what happened with in general with mobile in the back and HTML 4 coming out in the past. It’s an evolution that is to come eventually, but we still feel like there’s always going to be some divergence in least common denominator with the HTML 5 spec that the browsers are going to implement. I still feel native applications are the way to go.

Obviously our platform does all native applications as well as mobile web as well as SMS, Facebook, Twitter integration, etc. But again, our healthcare clients and our customers that are coming to us are really, truly interested in native applications first and then secondarily being able to use the same application and Write Once, Run Everywhere concept to deploy their mobile application.

Describe Kony Mobile Healthcare and who’s using it and what they’re using it for.

In the healthcare space, because we’re about six months into it, our healthcare customers are finding us as a competitive advantage, so I’m unable to share our client list. We’re basically in 45 top global 500 company brands that are out there. We’re working with some of the largest payer and provider organizations in the healthcare in general and some very, very large HIT companies that have long tail and short tail.

Since you can’t name specific healthcare customers, who is your target audience and what are the possibilities of using Kony Mobile Healthcare?

I think the keys are the three Ps: the payers, the health plans; pharmaceutical companies; and the providers themselves through the HIT vendors. We’re not going to go after each individual provider. We’re going to try to capture those guys through the HIT vendors. That’s our key focus.

We’re really multi-sector, multi-domain in healthcare. Several verticals inside of healthcare, obviously. We’re also focusing on the distribution logistics companies as well. There’s really nothing in healthcare that we’re leaving out that’s consumer facing as well as provider facing.

How would a vendor use your solution?

They would leverage our platform, our IDE and server, to develop an application that can exhibit the true mobile use cases for their application in the best fashion possible. Obviously we do a lot of human factor engineering to our healthcare expertise here to help them guide and mold and shape their application to fit the mobile environment.

We actually have a third offering outside of the studio and server, which are our vertical apps. By vertical app, I mean applications that are specific solution accelerators for the healthcare segment. For example, you have a starter application, a solution accelerator application, for the payer space that has the key features like find a doc, locate a pharmacy, being able to do a prescription refill, senior benefits, senior co-pay, senior deductibles, stuff like that.

From your experience in other industries, what opportunities do you see in healthcare to leverage mobile device technology and your tools?

There’s a lot of buzz around location-specific services, where you physically are at the time of care being needed — an urgent care center needs to be found, being able to use your GPS to find out where you are and which care center is closest, what the wait time might be, and possibly even how far away or the hours of operation. Then also helping with disease management, the concept around where you are, all the workflow and situational-based concepts that that exist, whether it’s retail like your at the Walmart or some retail store trying to but a product and you use RedLaser to take a picture so  you can see if you’re actually getting a good deal.

We hope to see that kind of use case also in healthcare, and leverage mobile application shopping and shopping carts that we’ve done for the airlines, as well as for working with the retail companies that we’re working with. Maybe you’re wanting to buy durable medical equipment while in your payer app, your health plan, and you want to see what you’re benefits are and associated with your payments on actually purchasing something through the store. 

It’s almost like a mash-up  concept. There’s a lot of that going on as well in the other spaces. We can mash up some healthcare functionality that’s not just specifically related to your benefit, but maybe actually helps you procure, whether it’s a durable medical device or a pharmacy prescription benefit, etc.

Walgreens seems to be the healthcare poster child, with a suite of mobile products that really changed the dynamic of how retail pharmacy works. Is anyone coming to you and using them as an example they want to emulate?

Some of our PBMs are asking us for features like that. Being able to take a picture of UPC code and implementing that into your PHR, saying “I’m taking this over-the-counter medicine,” being able to do stuff like that. Also taking a picture of your current prescription through a brick and mortar and possibly converting that to a mail order drug because it will see cost benefit savings that way.

Are hospitals being aggressive in their use of mobile technology, or are they happy with offering ED wait times and facility directions? Will some push the envelope to interact with consumers and physicians?

We’re definitely getting buzz around the larger healthcare provider systems out there, like the ones that have 700-plus beds. Some of the smaller guys are pinging us through their HIT vendors, so some of the HIT vendors are getting notices from their smaller hospital systems and are getting up to us what they heard about Kony is doing in the healthcare space and how they might interested in acquiring some of the technology use cases and accelerators that we have. But for the most part, the large providers are the ones creating demand, which is I guess what’s really been driving HIT for the longest time.

As someone who’s seen the mobile evolution in other industries, where do you see this ending up in a few years in healthcare?

I see all the features that are being used in the other industries hopefully being used in healthcare. Key ones, like social media. Being able to be a part of some discussion groups that are characterized around your disease type, where apps are not just miniature apps that solve a specific need, where apps are more portal-like, like the Facebooks of the world, where you can do multiple functions. Things that are out there in other industries, such as being able to a product and what store that product’s at and what the cheapest way is to get that. That’s some of the stuff that we hope to see in healthcare.

The biggest concept for me that I see really playing out is how the ones with all the cash — which is the payers, the health plans, the pharma companies — are going to leverage mobile. We see the pharma creating media brand apps today to educate patients around the drugs that they’re taking or drugs that they could be taking. We see payers helping their members find a physician, maybe lowering some of their healthcare costs by recommending pharmacy benefits management or disease management.

All these things put together can create pretty interesting concepts in the way a lot of the technologies are coming together with service-oriented architecture and open APIs. If HIT truly delivers its value and starts to open up the ability to place orders in to EMRs remotely and with proper audit logs and all the laws and security mechanisms in place, there could be a pretty interesting app being created. Many of our companies who we’re working with can all work together to create an app that’s the best for the patient, whether it’s managing their current health or their current diet, knowing what they bought at the grocery store, linking in the customer loyalty cards into their healthcare and knowing what their diets look like, and just overall management. As the ACOs continue to evolve, there’s some interesting disease management, population management use cases that could come out from mobile leveraging, social leveraging the entity around a patient, not just specific things that a patient would deal with when they’re sick.

Have you seen in other industries where where the concepts of mobile, such as the app store and better usability, have pushed back into mainstream IT and changed the expectations for how applications should look and work?

Absolutely. That demand in the marketplace, like consumerism, is hitting even the providers, who are expecting certain things to happen on their iPads when they’re at a hospital. Being able to refill a prescription, being able to communicate with their patients, e-mail, all that integrated secure messaging. It’s really interesting to see some of the requests that are coming from the providers as well as the consumers are expecting functionality around their medical viewpoints and the whole device, and that pressure is going to continue to come as consumers get more and more averse to using some of these other industry apps.

Any concluding thoughts?

Our Write Once, Run Everywhere platform in the healthcare space really helps healthcare organizations, whether you’re a plan, whether you’re a provider, whether you’re an HIT company, whether you’re a distribution and logistics company, to leverage the costs. If you’re going to go out and develop an app, we’re an enterprise app development solution for mobile. We don’t just create the app, we actually service the app. We have lots of back-end analytics, etc.

There’s lots of things to look at when you’re trying to pick a platform or even develop a mobile application. The enterprise approach is typically a company approach. We’re not two guys in a garage trying to build an app. We are building enterprise class apps that you can manage, monitor, see how you’re usually using the app, has analytics behind it, you can understand what changes you might need to make to the app.

We’re able to build seven of the operating systems out there. You have Apple, you got Android, you got Blackberry, you got Windows Phone 7, Symbian, etc. We also have eight form factors on the mobile device. Every smart browser renders things differently. We render on those 6,500 different devices for mobile Web and that’s coming from one code base. We also have SMS-MMS services that will offer two-way applications, so if a patient doesn’t have a full-featured phone, they could request information through SMS, through a short code or through a phone number, that returns back data to them. We also have integration with social media, Facebook, and Twitter. We also have Windows presentation framework which allows us to do Windows Kiosk applications from the same code base. And then we focus obviously on all the tablets.

Where no one comes close to competing with us is that within 30 days of release of a new operating system version to the developer community, we will have all those features with deprecations, etc. all covered under our platform. Ninety days after a brand new device comes to market, for example a Playbook, we’re also able to get that under wraps and our Write Once, Run Everywhere platform. You’re able to easily use your app and deploy your app into that app store. When Windows Phone 7 came out, we were one of the first, if not the first, to launch our enterprise apps that we developed for our customers into the Windows Phone 7 app store.

News 4/29/11

Top News

Wolters Kluwer Health will acquire Lexicomp, a provider of drug information and clinical content for pharmacists and clinicians.

Toshiba will buy medical imaging software company Vital Images for $273 million. Toshiba Medical Systems is the largest customoer of Vital Images. Toshiba America Medical Systems also announces that Donald L. Fowler, a former VP of Siemens Medical’s MR business unit, will be the division’s GM and SVP.

Cerner’s Q1 results: revenue of $491.7 million, up 14% from a year ago. Profit was $64.6 million or $0.75/share compared to last year’s $0.59/share. Cerner also says it signed a record $524.9 million in new bookings, a 30% jump over last year.

Reader Comments

From Sam Adams: “Re: GE and tax protests. Did you see the pictures of people protesting outside the GE/IDX building last week on tax day?” Thanks to Sam for sending the link. GE Healthcare’s Burlington, VT facility was the chosen site for protestors rallying against the US corporate tax code, which they believe unduly benefits large corporations. Earlier this month, The New York Times reported that GE paid zero federal taxes on $14.2 billion in profit.

From Epicwatcher: “Re: Epic. I’ve heard from three sources that Epic might go for an IPO. It would be a good time to go to market, but I doubt Judy would go for it.” Unverified, but agreed on both arguments. It would be a great time but it probably won’t happen.

From Keep em Honest: “Re: Cerner. Interesting coincidence that Cerner COO Mike Valentine resigned within 48 hours of the first Siemens customer attesting for MU. HIT sleuths will recall that Valentine’s signature was on a letter penned to rival Siemens customers back in 2009 that claimed Siemens would not be able to get their customers to MU in time. As it happened last week, Siemens was the first of the major HIT vendors to have a customer attest.”

From JD: “Re: cloud backups. Your readers might be interested to learn about GNAX, a company in Atlanta that provides data center and cloud hosting services. Its customers include a number of hospitals in the Atlanta area. I toured their facility a few months ago and was very impressed by the many backups they had for their backups in case of things like power outages, floods, etc. (though I readily admit I am still learning when it comes to the cloud).” I found the video above on YouTube, which is fun as well as educational because there’s a great keg party going on right behind the speaker in the HIMSS11 exhibit hall. I should mention that I know JD and this isn’t shilling – she’s in an unrelated healthcare business.

HIStalk Announcements and Requests

This week on HIStalk Practice: Dr. Gregg contemplates dancing stars and easy EMRs. Rob Culbert debuts his Consultant’s Corner column with suggestions for the successful development of medical groups. CaroMont Health partners with athenahealth. Greenway Medical helps out the Boys & Girls Clubs. Triangle Capital Corp. bets big on house-calls. A urology group asks a judge to evict a hostile doctor. While you are visiting, join 1,063 of HIT’s coolest kids and sign up for the e-mail updates. You know you wanna.

Thanks to new HIStalk Gold Sponsor JEMS Technology of Orion, MI. This is cool stuff: a physician can perform a HIPAA compliant JEMS Consult via smart phone or tablet. Examples: consulting on a patient who’s on the surgery table, conducting a stroke evaluation from any location, getting or giving a second opinion, and safely evaluating prisoners without entering facility. The on-site person chooses the camera feed, the remote consultant presses the JEMS icon on their smart phone and enters their password, and the consultant is instantly participating in a live JEMS Consult from wherever they are, including the ability to carry on a conversation with those on the other end over the video stream. Benefits include making surgeons happier, decreasing OR time with on-the-spot consultations, and potentially reducing lawsuit risk. AT&T chose JEMS as its partner for handheld video streaming in healthcare. Thanks to JEMS Technology for supporting HIStalk.

Preaching to the PR people, continued: everyday is an adjective, not a phrase. You might wear everyday shoes, but you wear those shoes every day, not everyday. That was in a press release I got today and I was appalled. On the other hand, I was happy just to receive it since Yahoo Mail was down all afternoon and is still acting flaky even though the mail’s going through. Maybe this cloud thing is overrated.

On the other hand, I was beaming at the simple fix to my slow wireless Netflix streaming to the TV via my Roku box: powerline network adapters. I was skeptical, but they worked right out of the box: plug an adapter into a wall jack and connect it by network cable to your router, plug the other in the wall jack next to the TV and run the network cable from there to the Roku. Two minutes and $85 later, no more wireless bottlenecks – it’s like I had Cat 5 wiring right to the TV.

Listening: new from Augustana, straight-ahead Springsteen-type rock.

Jobs on the sponsors-only job board: Director, Revenue Cycle Solutions – Virtual Office, Product Specialist – Physician, Inside Sales Executive/Telesales, Systems Engineer. On Healthcare IT Jobs: Business Development Manager, eGate Integration Analyst, Epic Clinical Applicataions Specialist.

Your honey-do list: (a) sign up for e-mail updates to your upper right; (b) visually inspect HIStalk Practice and HIStalk Mobile as my quality assurance specialist to make sure Inga and Dr. Travis are doing a good job; (c) Friend, Like, or Connect everything HIStalk-y on Facebook and LinkedIn to help Inga, Dr. Jayne, and me feel like immensely popular celebrities, which offers some illusory consolation as we contemplate our reality of toiling in solitude like monks copying scripture on papyrus; (d) avail yourself of the Rumor Report function to send me whatever you know that is scandalous, insightful, or funny; (e) intently observe the impressive lineup of sponsor ads to your left, paying them homage with an occasional click in recognition of their sometimes misplaced confidence that sponsoring HIStalk means their days of worrying about being the subject of negative news or snotty commentary are over. And thank you for riding shotgun in the HIStalk weenie wagon by reading what we write since it would be pointless otherwise.

Acquisitions, Funding, Business, and Stock

A federal jury finds that a former Mayo Clinic researcher misappropriated trade secrets and violated his employment contract when he left Mayo for a job at Mount Sinai Medical Center. However, the jury ordered Mayo to pay Dr. Peter Elkin $143,222 in royalties for record-keeping software that was eventually sold by the company, LingoLogix, to Cerner for $5.7 million. Elkin and Mayo have been battling the issue since 2008. Mayo says Elkin tried to undermine the commercialization of the software. We profiled the technology (pre-Cerner) back in 2008. A Mayo representative sent over their summary of the verdict, saying the amount awarded to Elkin was money they had already planned to pay as his share even before the lawsuit was filed. The non-profit Mayo requires all funds that result from commercialization of its intellectual property be returned to it.

Telehealth provider iMetrikus changes its name to Numera. The company says its new brand “reflects the company’s focus on developing high-quality, low-cost methods of collecting objective patient health and biometric data and integrating this into popular electronic medical records, care management, and personal health records .” I don’t get how a name change “reflects” any of that, but then again I majored in economics and not marketing. The company also appoints Tim Smokoff CEO “to spearhead the newly branded company.” Smokoff is the former GM of Microsoft’s World Wide Health Industry Solutions Group.

athenahealth reports Q1 earnings of $69.9 million, a 28% increase over last year. Net income was $3.3 million, or $0.09/share, versus 2010’s $0.01/share.

Oppenheimer, which just started coverage on Cerner with an “underperform” rating, initiates coverage of Allscripts with an “outperform,” setting a $25.00 price target. Shares closed Thursday at $20.61, giving the company a market cap of $3.9 billion. Above is a one-year share price chart showing Allscripts (blue), Cerner (green), and the S&P 500 (red).

Sales

McLeod Health (SC) picks MedeAnalytics’ Patient Access Intelligence product for front-end patient collections and insurance verification.

The VA awards telehealth system provider Robert Bosch Healthcare a new contract for its Health Buddy System.

Reference lab PAML (WA) selects 4medica for clinical pathology lab ordering and results reporting.

Three HCA hospitals in South Florida sign up for AirStrip Cardiology to allow physicians to read ECGs on their smart phones.

People

IGI Health hires Lee Barrett as president and CEO. Founder Arthur Kapoor will assume the role of chairman. Barrett has previously served as executive director of EHNAC CEO of Claredi.

Streamline Health Solutions appoints Stephen H. Murdock as CFO.

Harry Greenspun, MD joins the Deloitte Center for Health Solutions to focus on health sciences and government clients, leaving his position as EVP and CMO at Dell Healthcare Services. He came to Dell as part of its Perot Systems acquisition.

Former Misys Healthcare CEO Vern Davenport is named to the advisory board of public health consulting firm SciMetrika.

PenRad Technologies hires Dan Bickford as EVP of sales and business development. He was co-founder and EVP of Confirma, now Merge Healthcare.

University of Wisconsin-Madison gives Judy Faulkner and four other alumni its Entrepreneurial Achievement Award.

John Glaser of Siemens is mentioned as being on the board of KEW Group, a Boston-area startup that is buying and partnering with community cancer centers that will use its personalized medicine and clinical IT platform. According to the company’s site, he is a founder.

Garrick Palmer, formerly of Oracle, IBM, and Cerner, joins Fujitsu to lead healthcare sales of its biometric solutions, such as the PalmSecure palm vein scanner.

Announcements and Implementations

AHA gives its exclusive (paid) endorsement to nVoq’s SayIt in the category of healthcare voice recognition. I have to say that I’ve never heard of it. I didn’t know that Nuance even had competitors that it hasn’t already acquired.

Sharp HealthCare uses Oracle’s SOA Suite and Weblogic to create its patient portal.

Government and Politics

HHS is considering a “mystery shopper” program to assess primary care physicians on their willingness to accept new patients and to provide them with services in a timely manner. The Office of the Assistant Secretary for Planning and Evaluation will contact 465 PCPs and simulate requests for appointments for both privately and publically insured patients. I have just two words to summarize my opinion: budget crisis.

CMS announces that it will offer conference calls next week to provide information about the Meaningful Use attestation process. They are scheduled for Tuesday for hospitals and Thursday for EPs. Signups close the day before the session.

The LA Times brings to light public pensions, including those of healthcare executives. The president and CEO of a public hospital district received a $3 million lump sum retirement payout when he turned 65, worked two more years at $688K per year, will get another $900K when he retires for a second time this week, and will get a pension of $150K per year for life. “I think I’ve earned it,” he says.

Other

Road warriors take note: Columbia University researchers find that extensive travelers are 260% more likely than light travelers to rate their health as fair to poor. Extensive travelers are also 92% more likely to be obese and have higher cholesterol and blood pressure.

Thieves steal $100,000 worth of copper from the Cerner campus and cause “a substantial amount of property damage.” The copper was in a building under renovation.

An internal audit at University of Iowa Hospital and Clinics finds “flaws” involving its $61 million Epic system, including inconsistent use and information being incorrectly entered or not at all. One pediatrician had not switched to Epic for prescriptions and was using an outdated system that lacked audit controls. Significant lag times were noted in three departments and 32 bills were missed in November as physicians were not entering charges in a timely fashion. One regent noted that “younger staff are more comfortable with the new technology but older staff have a harder time adapting.” So is it flawed software or flawed workflow?

Imaging the World wins a $100,000 grant from the Bill & Melinda Gates Foundation for its low-cost rural ultrasound project for areas of high maternal and neonatal mortality. The founders are Kristen DeStigter, MD (Fletcher Allen Health Care associate professor and vice chair of radiology) and Brian Garra MD (chief of imaging systems and research at the Washington DC VA and associate director in the imaging division of the FDA).

Employees of the Allscripts office in Raleigh, NC used Thursday’s “Take Your Daughters and Sons to Work Day” to prepare kits of personal items for victims of the April 16 tornadoes, which will be distributed by the Salvation Army.

Pompare Technologies files suit against Hospira, Cerner, and Epic, claiming those companies infringed on its patent for controlling an IV infusion pump. Pompare doesn’t come up in a Google search. Its patent was granted Tuesday and it set the lawyers loose on Wednesday, seeking to recover damages “but in no event less than a reasonable royalty.”

A couple’s lawsuit against a hospital in which the woman claimed she suffered marital problems and traumatic anxiety after a physician’s assistant stole the narcotic from her epidural pump is thrown out by a skeptical jury. The woman claims her motivation was purely to improve hospital safety, saying she wanted to make sure “this was something that wasn’t hid in the closet.” The jury foreman found her intentions less noble, saying “Every time we got to a particular count, it was like Swiss cheese. I almost felt bad for their attorney.”

Sponsor Updates

• Grant Memorial Healthcare (WV), a 45-bed facility, selects HMS’s clinical and financial applications.
• Iatric Systems receives ONC-ATCB certification from CCHIT for its Public Health Immunization Interface solutions.
• Wake Endoscopy Center (NC) will implement ProVation MD software for gastroenterology procedure documentation and coding and ProVation EHR and patient charting.
• Brazosport Regional Health System (TX) picks the e-Forms Repository downtime registration solution from Access.
• RelayHealth announces the general availability of ProSMART, an on-demand pharmacy claims adjudication reporting product for payers. Pharmacy benefits manager Restat is deploying the solution.
• Sunquest Information Systems is honored for its development of a CRM system that integrates sales and support functions.
• Heartland Regional Medical Center (MO) implements Voalte’s iPhone communication solution. The company also gets a story in its hometown Sarasota, FL paper for the pilot program, mentioning that nurses there can use their Voalte-powered iPhone to access the hospital’s GE call system, Philips Emergin alarms, Cisco wireless, and Siemens telephone system. It also notes that the company will hire developers to port its application to Android smart phones.
• Childs Medical Clinic of Samson, AL becomes the first Greenway Medical Technologies PrimeSUITE 2011 customer to attest and receive payment notice for Stage 1 Meaningful Use incentives.
• Billian’s HealthDATA adds contact information for more than 10,000 long-term care executives to its online market intelligence portal, which now includes more than 3,000 data points covering more than 40,000 US healthcare facilities.
• The Vancouver Clinic (WA) goes live on Epic ambulatory, with implementation assistance from the Epic practice of Culbert Healthcare Solutions.

EPtalk by Dr. Jayne

Dear Dr. Jayne,

Do you plan to attest for Meaningful Use in 2011 or 2012?

Dave the Healthcare Bean Counter

Dear Dave,

Are you a plant from my day job? Seriously, I get this question all the time. And the answer is, “most likely 2012.” We’re going to play the game under the Medicare rules, so we can’t ask for a check just for having purchased a system.

Like many other organizations across the US, we will have to upgrade to our vendor’s certified product before we can attest. Even though we’re able to do 90% of what Meaningful Use intends us to do, without the certified version, we may not be documenting in the precisely specified field that’s used for the certified version.

I alluded to this last week when I talked about tobacco use documentation. Do I ask every patient about their tobacco use and counsel those who use tobacco that they need to quit? Do I have a reportable discrete field in which to document? Absolutely. Am I documenting using one of the six required data points? Not so much, until I upgrade.

Additionally, after the upgrade, we’ll want to allow time for our providers to transition to the new fields (and some of the slick new workflow that comes with the upgraded version, independent of Meaningful Use) as well as to benchmark where our physicians stand.

I work for a large health system, which (news flash!) had priorities established long before MU was a blip on the horizon. We have a multi-year strategic plan that we’re trying to execute, with important outcomes like reducing length of stay, preventing medical errors, and providing care to the underserved and indigent. We’re targeting diabetes and obesity. We’re delivering thousands of babies and providing preventive care.

Needless to say, our IT department is fairly busy supporting all those initiatives. Although a fair amount of resources has been shifted to achieving MU, we don’t get to stop working on those priorities just because someone is handing out cash.

I’m grateful that our organization has gone with this approach. I think there are enough rational folks here who understand that MU is a bit of a shell game and will most certainly cost providers more than the payments they receive. But they’re also savvy enough to know that we don’t want to miss out on any of the money. Although we had plans to do the technology anyway, it’s definitely nice to have our friend Uncle Sam pick up part of the tab.

There was a recent discussion in the doctor’s lounge that revolved around whether Congress would repeal the provisions of health care reform and whether there would be any money available. Several independent physicians were discussing their plans to attest as soon as possible, just in case the funding dries up. Others lobbied for not even bothering, fearing or hoping that the program will disappear.

They asked my opinion, and it was this. If you plan to attest this year, keep going. Make plans to run interim reports to see how you’re doing and where you stand on the metrics, and implement programs and processes to get your numbers up if needed. Don’t let the fact that you can do it in either year delay you from your plans.

If you planned to attest in 2012, keep chugging away as well. If you meet your metrics early, you can always go ahead and submit and be ahead of the game.

Dr. Jayne

Contacts

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

Readers Write 4/27/11

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

There is Nothing Normal about the “New Normal”
By Tom Carson

I recently had a conversation with a physician friend of mine. He shared the experience of their hospital system’s EMR implementation for their ambulatory practices, which is, so far, an 18-month project and counting.

This project has resulted in a 12% decrease in physician-generated revenue, 75% of which is attributable to reduced physician productivity. Fewer patient visits, in other words. When I asked what they intended to do about what sounded like a serious problem, he told me, “Nothing. Our administrators are calling this the ‘New Normal’ for production.”

If this had been the first time I heard this explanation, my jaw would have dropped. I mean, really, whoever heard of implementing technology to decrease the productivity of the most expensive resource in the healthcare delivery chain?

As it is, the “New Normal” mantra is being repeated often. Vendors of these products (and their customers) must be hoping it catches on as truth, preserving the reputations of both.

Here is my problem with reduced productivity as a “New Normal.” Management doesn’t really believe it. If they did, hospital administrators in these provider organizations would be reassuring all the physicians involved that to make up for their productivity losses, they would all be given 12% raises and their visit quotas would be reduced accordingly.

No longer would doctors be spending 2-4 hours each day off the clock to catch up on documentation responsibilities made more burdensome by their new system requirements. Instead, the dark side of the “New Normal” is the implied expectation that doctors will suck it up and find a way to return to former levels of productivity, regardless of personal cost. That is simply not sustainable.

Every business leader I know understands the correlation between happy employees and satisfied customers. An unhappy work environment creates stress in all parts of our lives. it is destructively unsustainable for both individuals and the companies that employ them. When doctors are free to practice medicine on their terms, the organizations that employ them can attract better doctors. The result is satisfied patients and better outcomes. This is a positive feedback loop that is sustainable.

I don’t know when this breakdown of honest communication and respect occurred, but it would be in the best interests of patients, physicians, and provider management to fix it. Here are my ideas. 

Management, you do not have to settle for a “New Normal” that reduces your economic performance and crushes the enthusiasm of your staff. Ask yourself if you would have made the system purchase under the terms you did if the vendor had explained up front that you should factor in a 12% revenue reduction. If the answer is no, then do your fellow administrators and the industry at large a huge service and start raising Cain. Eventually, your vendor, or his replacement, will honestly address the problems.

I have never seen a documented case in which average physician productivity in an ambulatory setting did not decline following implementation of an EMR system. There are ways to recover productivity outside of the vendor’s design, including the use of virtual scribes, physical scribes, and speech recognition for some physicians. These won’t be free, but they will cost much less than what good physicians cost.

Physicians, you owe it to yourselves to not fall into the trap of believing that you can overcome long-term limitations through the short-term measure of working more hours. You owe it to your management group to provide fact-based feedback on the realities of what is going on at the patient encounter level.

I am not anti-EMR. Far from it. My company has been committed to moving physicians to electronic records for 11 years. However, we have always believed that the transition will work best when working with and for the physicians — not around them.

Tom Carson is president and CEO of MD-IT of Boulder, CO.

Build IT Right
By Guy Scalzi

According to Modern Healthcare’s 32nd annual Construction and Design Survey published March 14, the healthcare construction industry continues to show signs of rebounding. There’s pent-up demand from years of capital freezes that will soon explode, so it’s more important than ever to get the information services right the first time when designing and building any new facility.

Timing is Everything. IT professionals need to be involved as soon as possible in the planning or design specification stage and stay actively plugged in throughout the project.

IT – A Critical Element of Design. IT must be involved before the design specification is generated to define what applications and technology will be used in the space. It’s important that as soon as required work space is estimated, the space needs of the hardware to support the activities are included and the plans reflect those needs. This is the time to get it right, so the workflow will be enhanced by the space, not compromised.

The overall project budget should incorporate IT requirements. Many times, the square footage needs to be reduced or the planned services have to be scaled back to fit within the amount of available dollars. Don’t try to retrofit old IT equipment into the space to save on budget because this technology is often at the end of its life cycle or not powerful enough to run the current software.

Best Practices and Next Practices. The new space should make optimal use of the next release of major software applications and functionality. iPhones and iPads are already being incorporated into new releases of HIS software. This means fewer requirements for viewing data on workstations, but a heightened need for docking stations and additional places to enter data. New space will most likely take advantage of RFID tags and generally richer user interfaces requiring powerful hardware.

Not a Night and Weekend Job. Depending on project size, there needs to be one or more IT staff dedicated from design to opening. Questions will arise on a daily basis, and bad decisions are made when there’s a lack of knowledgeable IT input.

New Sandbox for Strategic IT Direction. This is an opportunity to pilot new processes, systems, and technology. There’s no reason to move workflow, applications, or hardware that are only marginally acceptable, or failing. While beta testing of applications should be avoided, technology that’s proven elsewhere but still new to your organization can be piloted.

Test, Test, and Test Again. A few weeks before the opening, fully staff for two or three days with test patients cycling through the systems, at about half of what’s expected at peak volume. Data can be entered in a test database, so it’s easy to review but won’t interfere with production. Necessary changes can be implemented quickly and be ready for the next test session.

Blanket with Support. On opening day, have as many IT people and vendor staff as possible on site during all hours of operation. While the staff is in a learning mode, they’ll be receptive to new ideas and skills. A lot of progress can be made quickly.

By applying these and other industry best practices, IT can be strong partners in ensuring healthcare facilities meet the needs of patients and practitioners alike.

Guy Scalzi is a principal with Aspen Advisors of Pittsburgh, PA.

Summary of the ONC EHR Usability Meeting 4/21/11
By Vicente Fernandez

”A computer makes it possible to do, in half an hour, tasks which were completely unnecessary to do before.” Larry Wolf, Health IT strategist, Kindred Healthcare (original author unknown)

”Cumbersome system design is the biggest threat to the ARRA investment.” Kamal (Bill) Hashmat, CEO, CureMD

“Every industry believes it’s ‘special’ and doesn’t want to deal with the issue of standards. Variability of design and display of common and necessary information is not creativity, it’s chaos.” Ben Shneiderman, PhD, University of Maryland, CureMD

Synopsis

Most of the discussion seemed to pivot around the pleas from the provider community to standardize usability measures by either making them a part of certification, creating a Consumer Reports-like system of reporting and comparing EHRs and/or mandating a common user interface.

There was also a call for EHRs to be held to accessibility standards, to support system-wide interoperability for the wholesale migration of data from one product to another, and to be more transparent with their internal usability and accessibility guidelines.

Probably the most intriguing testimonies were from Ben Shneiderman from the University of Maryland, Stanley Wainapel MD of Montefiore Medical Center, Eva Powell from the National Partnership for Women and Families, Mary Kate Foley of AthenaHealth, Carl Dvorak from Epic, and Doug Solomon of IDEO.

Cerner was also represented by David McCallie, who contributed this interesting insight: “The tools [EHRs] are designed for the volume of documentation instead of the value of the information.”

Executive Summary

Although the conference title specifically stated EHR (Electronic Health Record) Usability, the presentations and discussions were applicable to all types of electronic and Web applications across all healthcare environments. The resulting work and recommendations from the Health IT Policy Committee will have far-reaching effects, and are likely to impact all forms of future human-computer interaction in healthcare settings.

The EHR Usability Conference presented fresh and insightful perspectives from five separate panels: Care Provider, Patient/Consumer, Vendor/Technology Developer, Measurement and Improvement, and  Options Around Usability.

The most important items addressed were:

• The current state of usability in healthcare applications
• Accessibility standards in healthcare applications
• How usability affects the well-being and lives of patients/consumers
• How usability should be included in health technology certification
• The roles of vendors, providers and organizations in developing usability standards and guidelines
• The role of the Federal Government in producing and enforcing usability standards and guidelines
• The roles of vendors, providers and patients in ensuring that delivered products are usable

Dominant opinions and recommendations from providers, consumers, developers and experts included the following.

Current usability in healthcare applications is atrocious

• Difficult to navigate.
• Time consuming.
• Frustrating.
• Cluttered and disorganized.
• Unsearchable.
• Leads to fatigue and ultimately burnout.
• Does not adequately support disabled community.
• Does not adequately support clinical workflows.
• Critical information is dispersed & buried.

Recommendations to vendors

• Develop streamlined methods of entering, retrieving and displaying complex data sets.
• Display data from disparate sources in fewer, simpler views.
• Create navigation pathways that match the workflow and thought flow of clinical work.
• Design and build applications within accessibility guidelines and enable integration with accessibility hardware and software.
• Support patient-centered information flow.
• Provide a mechanism or process for the customer to submit feedback for rapid changes and fixes.
• Allow for customizable views of varied information from multiple sources.
• Modularize and increase interoperability of product offerings.
• Publicize internal usability guidelines and standards.
• Work closely with the clinical community to develop best practices and appropriate workflows.
• Limit or change the use of structured data capture for specific workflows.
• Incorporate usability personnel and best practices in product development.
• Design and build products to support effective partnerships between providers across care settings, and between patients and providers.
• Design and build products to support a patient-centered healthcare system.
• Work with regulators to develop standards and tests to measure usability.

Recommendations to HIT professional associations and certification agencies

• Develop usability standards and metrics.
• Work with regulators to develop standards and tests to measure usability.
• Publicly report usability comparisons across healthcare applications.
• Create reporting mechanisms for the healthcare community to voice their opinions and relate their experiences with healthcare applications.
• Develop methods of measuring and relating usability to “effectiveness.”
• Educate and provide guidance to vendors on a user-centered design process.
• Educate providers on what to look for in a user-centered design vendor.

Recommendations to provider institutions

• Allocate the appropriate personnel and resources for effective application implementation.
• People, systems, processes, and hardware.
• “Vote with your wallets” – create the demand and pay for products with high usability standards.

Recommendations to government agencies/regulators

• Work with providers and vendors to develop standards and testing as a part of certification.
• Require public reporting of comparative vendor performance of usability.
• Foster an innovative vendor environment by requiring interoperability at the enterprise level to allow the wholesale migration of an organization’s data from one vendor to another and requiring interoperability at the modular level so that providers can select the best combination of applications that will work together seamlessly.
• Require healthcare applications to meet accessibility guidelines.
• Mandate consistency in the presentation of standard data types.
• Mandate a common user interface.
• Promote the wealth of usability science and resources already available.
• Allocate resources to get feedback on usability from providers.
• Develop simple, best practice guidelines for providers to follow in selecting, customizing and implementing healthcare applications.
• Garner best practice workflows for safety.
• Develop usability quality measures that coincide with the specific practices.
• Increase transparency and discussions around usability efforts.

Vicente Fernandez is “just a dude trying to make a difference in healthcare with my skills as an interaction designer.”

API Healthcare Terminates Kronos Merger

Workforce management technology vendor API Healthcare announced this afternoon that it will terminate its previously announced merger with Kronos. API will exercise a right contained in the January merger agreement that allows either party to terminate if regulatory approvals were not obtained by mid-May. The Department of Justice had made a second request under antitrust laws.

API President and CEO J.P. Fingado stated in the announcement, “This process has been challenging, but it has also reaffirmed that our vision for healthcare-specific workforce management is solid. During the HSR review process, we heard the strong reaction of our healthcare provider clients from across the country as they spoke out with passionate support of our solutions, services and strategy.”

Fingado contacted HIStalk about the announcement, saying, “This may sound odd, but it is the right thing for our clients and employees, and that is what API Healthcare has always been about. I am very happy moving forward and very excited about our opportunities. We released ‘Synergy’ just before this all happened and now we can work even harder to roll that out to our existing and new clients. The support from our clients during this process has been amazing.”

Ezra Perlman of Francisco Partners care was quoted in the announcement as saying, “When we acquired API Healthcare two years ago, we saw the opportunity for long-term growth of a great healthcare-specific workforce management technology company. While the merger offer from Kronos certainly validated API Healthcare’s strong value proposition, Francisco Partners is looking forward to continuing to provide strong support to the API Healthcare management team and associates as they continue on their aggressive growth path as an independent company.”

News 4/27/11

Top News

  The VA and DoD agree to “buy” rather than “build” a joint EHR in an apparent change in direction from their last announced plans. They will round out missing departmental modules by looking first at any available internally developed systems and will develop their own applications only as a last resort.

Reader Comments

From Professor Paul MD: “Re: Amazon cloud downtime. For those who didn’t know, their northern Virginia data center that hosts EC2 and RDS services went down hard for 24 hours last week and didn’t recover all volumes until late Sunday. A small company that apparently does ECG monitoring repeatedly begged for help on Amazon’s public online forum, bringing up good points on what to consider when hosting health apps on the cloud. I like the Halamka shout-out, too.” Someone immediately questioned why they would be running a mission-critical life-or-death system on the cloud, to which the original poster answered, “Well, it is supposed to be reliable.” One of several uncharitable responses was:

If you were smart, you would have a disaster recovery plan for just this kind of thing. Judging from your lack of said preparations, you lot figured the cloud never goes down, and got greedy by not wanting to spend money on hot standby machines on a different infrastructure. Good going. Hope none of your cardiac patients croak because you’re going to get sued into next week…

That news item does encourage good discussion. If your organization runs cloud-based apps, please share what actions you’ve taken, both contractually and technically, to prevent and mitigate outages. What happens if your Internet connectivity dies (killed in most cases by the proverbial cable-shearing backhoe excavating for some minor project outside your facility using erroneous city-produced utilities maps?) What is required to maintain a hot swap site? How often do you test? Send me what you can and I’ll share it here.

From Olivia: “Re: McKesson. Gio Colella and Pam Pure might have a different opinion about how big winning that patent lawsuit against Epic would have been. That was just a place to start. Think Kaiser. Then think about all the other vendors with similar solutions. That sure would have helped to justify the purchase of the original RelayHealth company, which happened not long before the lawsuit was filed. Another intriguing story for cocktails and dinner sometime.” Is that an invitation? 

From Puts and Gets: “Re: Cerner. More changes in the plastic hair lineup. The stock has had an artificial ride up since investors don’t have a decent, large-scale pure play in health IT, so they get the default money. They are going down the other side of that first roller coaster hill later this year.” I’ll steer clear of this debate and mark it Unverified.

 From NotAnEpicShill: “Re: Epic. Another Epic employee here. What Lucy Gucci describes may be true for some Epic employees, but there are plenty of us whose jaws drop when we see things like that on the Web. I myself work about 45 hours a week (50-55 a few times a year during a crunch) and have a pretty good balance of life to work.The same holds true for many, many people with whom I work. I just wanted to get it out there that though certainly not everything at Epic is sunshine and roses, the rumors of our misery are greatly, greatly exaggerated.”

 From Madrigal: “Re: Neil Pappalarado. Just announced at the Meditech shareholder’s meeting that he had a minor stroke last week. He’s still in the hospital, but is expected to make a full recovery.”

From Human Factors: “Re: ONC usability meeting. The general consensus was that EHRs are difficult to navigate, time-consuming, frustrating, cluttered and disorganized, and unsearchable. They lead to fatigue and ultimately burnout, do not adequately support disabled users, do not adequately support clinical workflows, and they disperse and bury critical information. Most of the discussion was around provider pleas to either make usability standards part of certification or mandate a common user interface. There was also a call for EHRs to be held to accessibility guidelines, to support easy data migration from one to another, and for vendors to be more transparent about their internal usability guidelines. A Cerner spokesperson contributed this interesting insight: ‘The tools [EHRs] are designed for the volume of documentation instead of the value of the information.’”

 From Private Pyle: “Re: ONC usability fireworks last Thursday. You have to listen to the recording and read through the testimonies on ONC’s site. The docs told vendors their systems sucked, then consumers told them they were disconnected electronically and don’t have the information they need to be an engaged member of the care team, the vendors whined about new requirements and said that certifying usability would kill innovation, and the usability experts tore up the crappy vendor systems. A heated exchange ensued. The vendors tried to use the analogy of cars and that it makes no sense to put parts from three different makers together, but the committee trashed that, saying monolithic platforms have such a high barrier to change that customers are at the mercy of the vendor. I truly believe the monolithic vendors will not disrupt themselves and we will see some serious challenges that will provide capabilities and price points that will destroy the current market.” I wrote a few thoughts at the end of this post about the meeting. Usability measurement and any new federal involvement in it is obviously a big topic that gets a lot of folks stirred up. Comments from all viewpoints welcome.

HIStalk Announcements and Requests

Readers occasionally tell me they’re having trouble reading HIStalk because of errors or slow load times. The culprit in 100% of those cases so far has been long-obsolete versions of Internet Explorer. IE is a far inferior browser to begin with (feel free to check page load times on any media-rich site if you don’t believe me), but it’s really trouble-prone in old versions. Here are some suggestions.

1. If you must use IE, upgrade if possible to the latest version your operating system will support – Version 9 if you have Vista or Windows 7, or Version 8 if you’re on XP.
2. If your computer isn’t in IT lock-down mode, download Firefox or Chrome, at least to read HIStalk. You can still leave IE on your PC for any purposes for which it’s required.
3. HIStalk is supported by the sponsors whose ads you see on the left, which means we all benefit when you read the site normally. If you can’t load the page, however, add /print to the link you get in the e-mail update to view a text-only version (so instead of this link, use this one instead, for example). Or, read via RSS reader (I use Google). You’ll miss a lot of other stuff, too, though – polls, links to the latest comments, upcoming events, etc.

I had to re-send an e-mail update that failed on the server for some reason, so if you got the same e-mail on both Friday and Tuesday, I promise I’m not intentionally spamming you. There was no way to pick up where it left off or to even tell how far down the list of 7,311 subscribers it got, so I started it over.

Acquisitions, Funding, Business, and Stock

Halfpenny Technologies says 13 new clients have signed up for its integration technology framework for delivering interfaces among hospitals, labs, and EMRs.

Huron Consulting announces its Q1 financials: revenue up 11.9% to $143 million and diluted EPS from continuing operations up 46.2% to $.19/share.

Keystrokes Transcription Service acquires competitor MTS of Texas, including its TxMTI online transcription school.

Oppenheimer initiates coverage of Cerner with an “underperform” rating, saying the company is “showing signs of age” with flat software sales even as HITECH brings buyers to the market, lower margins as services replace software sales, and a price-to-earnings multiple more appropriate for a software high flyer than a low-excitement services business. They also didn’t like the fact that the departure of COO Mike Valentine was announced on April 22 when the stock market was closed, saying “the timing of his departure is curious” unless he turns up almost immediately as CEO of a good-sized company (and if anyone knows where he’s going, let me know). 

EncounterPRO chooses Intuit Health’s patient portal to offer its 300 pediatric practice EMR customers.

Consulting firm Computer Task Group (CTG) reports Q1 numbers: revenue up 22%, EPS $0.17 vs. $0.11. Healthcare revenue was up 30%, mostly from big EMR projects.

Sales

The Metropolitan Chicago Healthcare Council announces plans to develop the MetroChicago HIE using Microsoft’s Amalga and technologies from CSC and HealthUnity Corp. Seventy percent of the hospitals in Chicago are participating, with the notable exception of NorthShore University HealthSystem.

The Missouri Health Connection picks Cerner to build a statewide HIE, although they’re still negotiating the price.

The Missoula, MT paper reports that St. Patrick Hospital, part of Providence Health System, is moving to Epic. Cross-town competitor Community Medical Center is implementing NextGen for outpatient and will add Cerner inpatient next year.

Dundy County Hospital (NE) purchases Healthland’s EHR for its 14-bed critical access facility, anticipating a Q3 2011 go-live.

Salina Regional Health Center (KS) will implement Summit Healthcare Downtime Reporting System as part of its disaster recovery strategy.

People

Ben Foster rejoins Huron Consulting as managing director of  its healthcare practice and will work with providers to improve their revenue cycle.

MetroSouth Medical Center (IL) names Steven H. Rube, MD as medical director of the hospital’s seven community health centers and CMIO for the hospital. He’s the former CMO and EVP of EmpowER Systems.

UC Health (OH) appoints Anil Jain, MD as the organization’s first CMIO and SVP. He was a senior executive and physician at Cleveland Clinic.

eHealth Initiative founding CEO Janet Marchibroda is named chair of the Bipartisan Policy Center’s Health IT Initiative. She has also worked as chief healthcare officer of IBM and was COO for the National Committee for Quality Assurance. BPC, a non-profit think tank, launched its health project in January, led by former senators Tom Daschle and Bill Frist and former governors Mike Rounds and Ted Strickland.

Robert Barber, 64, director of financial services at Carolinas HealthCare System (NC), was shot and killed last Friday morning by an unknown assailant in an apparent robbery attempt while walking outside a coffee shop near his home in Charlotte, NC. He was a retired Air Force Reserves colonel, held a doctorate in health administration from the Medical University of South Carolina, and was a part-time instructor for several universities. He had held several executive positions in his 19 years with CHS, including stints as CFO and CEO in affiliated hospitals, and was a former president of the North Carolina chapter of HFMA.

Government and Politics 

Norton Healthcare (KY) agrees will pay the federal government $782,842 to settle allegations of Medicare overbilling. Federal prosecutors contend that Norton submitted charges for evaluation and management services that were never performed.

Dartmouth-Hitchcock Medical Center (NH) will pay over $2.2 million to state and federal agencies for improper Medicare, Medicaid, and Tricare billing. The payment includes over $344,000 to a former Dartmouth-Hitchcock physician who blew the whistle on the improper billing, which allegedly included charges for services delivered by unsupervised residents.

The American Telemedicine Association (ATA) calls for CMS to remove restrictions on telemedicine for ACOs. Recommendations include more medical videoconferencing access in metropolitan areas, home-based videoconferencing, and delivery of therapy services via telehealth.

Other

Performance scores for the four top interventional lab providers tighten to within five points of each other, according to KLAS’s latest report. KLAS notes that GE,  Philips, Siemens, and Toshiba have slowed down the delivery of market-changing developments. In addition, healthcare reform and reimbursement pressures have resulted in increased provider innovation and the move toward multi-use labs.

A former employee of Carthage Area Hospital (NY) says its systems vendor CPSI was “thrown under a bus” when the hospital blamed the company for its billing problems. She says the problems started before CPSI was implemented, the hospital declined to send employees to Alabama for training because of the expense, and they replaced the business office manager who had received training right after they went live. 

  In case you have been living under a rock (or perhaps you’re just a normal guy) there’s a big wedding coming up Friday morning. I can’t decide if I will watch it live or set the DVR. Maybe both so I can relive the moment a few times. I did buy a special hat for the occasion, since I hear hats are an essential fashion accessory for royal weddings. And of course, some new shoes. Maybe Mr. H can come up with a Union Jack theme for next year’s HIStalkapalooza so I’ll have a chance to wear these beauties again.

Sponsor Updates

• Sunquest’s Physician Portal 5.1 earns modular  ONC-ACTB certification from CCHIT.
• Mark N. Bair, MD, R.Ph and Jordan L. Schlain, MD join Ingenix’s independent advisory board. Bair is and ED physician and CEO for Emergency Medical Services, Inc. in Utah. Schlain practices internal medicine and is medical director and founder of Current Health Medical Group (CA). 
• Culbert Healthcare Solutions completes the implementation of Epic’s ambulatory suite of products at the 200-provider Vancouver Clinic (WA). The project took less than 12 months to implement from kickoff to go-live.
• TeleTracking Technologies releases its Patient Flow Dashboard, powered by TeleTracking XT application, which monitors the real-time status of enterprise-wide flow operations.
• Capario names Stephen Garcia as CFO.
• Orthopaedic Surgery Associates (MI) selects SRS EHR and CareTracker PM for its 13 providers.
• Vocera Communications announces that its first quarter revenues grew 56% compared to 2010. Vocera also added its largest client to date, a Department of Defense hospital.
• The iDoc document imaging and management solution from CareTech Solutions earns certification as an EHR module.
• Aspen Advisors is highlighted by Consulting magazine as one of “Seven to Watch” consulting firms. The magazine cited the company’s doubling of headcount and revenue since 2009 and the fact that 40% of its employees have at least 20 years of healthcare experience.

Thoughts on ONC’s Certification / Adoption Workgroup’s April 21, 2011 Meeting on Usability

I haven’t had time to listen to the audio, but I got a few interesting nuggets from skimming the meeting materials:

1. What folks are calling “usability” is really more “suitability to task,” not just counting clicks and seeing if on-screen terminology is consistent, but measuring how long it takes to do common tasks. In other words, ugly screens don’t matter too much as long as experienced users can get their work done quickly and accurately.
2. Because of that, vendors are worried about new “usability” requirements that may go well beyond usability, not to mention the need to have a consistent, unbiased way to measure usability in whatever way it is defined.
3. To compare usability among products requires definition of a perfect EMR, which puts the government in the position of designing systems.
4. Vendors claim they have all kinds of formally trained usability experts who have design authority over applications, but customers don’t seem to think the final product reflects that fact.
5. Users working with the same application rarely agree on the number and significance of usability problems.
6. Any measurement of usability needs to take place in a real-life work setting, not in a lab.
7. Some safeguards built into EMRs would be considered negatives by usability experts, such as the requirement for providers to review existing patient data, avoiding the dangers of “auto-complete” functions, and inclusion of the government-required signoffs and notifications that users resent and don’t find useful.
8. According to one practitioner, systems don’t work as well as paper in her practice. Examples: ordering a routine mammogram electronically takes 10 minutes, entering a family history on paper takes 24 seconds on paper and two minutes in the EHR, systems don’t highlight important information from the electronic clutter they create, and EHR information (such as with scanned documents) may be “in the record” but not easily accessible.
9. A provider urged the government to require vendors to design systems around a common schema to allow easy switching from one product to another, and also to require them to follow an app store model that supports picking and choosing from among competing functions.
10. Several presenters said the government itself makes usability worse by requiring entry of generally worthless information, such as IV end times.
11. Jacob Reider MD of Allscripts admitted that as a frustrated EHR user in 2004, he wrote a blog post blasting Allscripts for designing a system that took 40 seconds to enter a patient’s blood pressure. He said “the president of the company that had developed the EHR I was using to request that I delete the post, as it was costing the company sales.” He went to work for the company 18 months later (he must have either impressed them with his insight or inspired them to put him on the payroll to keep him quiet).

And some interesting comment snips from ONC’s usability committee blog:

• If the Federal government wants to really accomplish they goals they list, every medical entity needs to be on the same system so it is seamless and information can be shared. Usability experts need to be brought in ASAP before the entire project fails. This should have been done before the project was ever launched!
• Developers tend to follow what they know, retreading what’s been done before and packaging it with sharp marketing.
• I truly don’t understand the arguments against standardization, when data exist to support it. Standardization has saved countless lives with respect to mission-critical systems, and EHRs are decidedly mission-critical systems. In fact, standards often originate as a response to accidents and disasters that occurred because of a lack of standardization. To say that having standards regarding font sizes, color contrast, and a host of other usability-related variables clearly related to human performance “stifles innovation” is a weak argument.
• The current failure to act responsibly on this and other safety-related issues in health IT is an important ethical question that needs badly to be publicly discussed. It is wonderful that ONC has raised the issue, but unfortunately, it is several years too late, as care delivery organizations are currently too busy installing what’s available today in order to get the stimulus money to really attend to usability; and vendors are too busy managing these new installations to invest in the sort of thoroughgoing redesign that is needed.
• I am horrified when I look at the design of HIT which violates standard, well-known usability principles. When I tried to publish a paper on a particular EMR design that was particularly horrifying, the lawyers stepped in and said we were not allowed to publish any screen shots (which would show the issues) as this **violated the contract with the vendor**. In discussions with them, the vendor argued that their design was user-centered because it was successfully transitioned from the company’s prior use of the software as a restaurant management system!
• I hate my wonderful EMR. It has decreased my efficiency, decreased my face time per patient, not eliminated errors and resulted in significant employee dissatisfaction. In addition, it is not information-ful: when I read outside records on a complex patient and have to wade through page after page of meaningless review of systems, immunization histories, pharmacy records, vital signs, etc., etc. and never find what the patient was really feeling or what the reasons for the referral are, I have just wasted another 10 minutes that I could have spent with the patient – finding out relevant stuff! However, all important components of billing and compliance have been duly fulfilled (excuse my misapprehension that this was supposed to have something to do with patient care).

Contacts

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