Monday Morning Update 11/19/12

From Documented: “Re: Cerner Content360. Does this represent somewhat of a minor strategic shift for Cerner, or is just a re-branded aggregation of existing document imaging solutions (such as Cerner ProVision Document Imaging)? When I worked at Cerner (a few years ago), it was practically a cultural taboo to suggest the need for document imaging (especially clinically, as in meds ordering) because it stood in philosophical contradiction to CPOE and its closed-loop meds process. Anyway, I was just curious if any Cerner clients or other wise luminaries among the HIStalk audience knew much about it.”

From The PACS Designer: “Re: healthcare and Windows 8. In a past HIStalk post I covered Microsoft’s Healthcare in Silverlight software. Now, with the release of Windows 8, we get to see Microsoft Flexible Workstyle for Health utilizing Sharepoint for rounding and other data viewing. Partners HealthCare has an interesting case study demo that could generate an 80 percent reduction in desktop image management efforts.”

From HITEsq: “Re: Epic. Appears ready to file for review of the McKesson case. They filed an extension for their writ (i.e., the document where they asked the Supreme Court to take the case). Nothing is a sure thing, but my guess is this has a really good shot at being accepted. The Federal Circuit was really fractured and went in an unexpected direction. The Supreme Court is good at addressing these things.” This is the years-long legal battle over whether MyChart violates a McKesson patient portal patent. The appeals court’s decision in September troubled some legal experts who are uncomfortable with its interpretation that companies (Epic in this case) can be held accountable for “inducing infringement” even when the infringement itself hasn’t been proven.

From MT Hammer: “Re: MModal. Word on the street is that they have acquired transcription provider MxSecure. No official announcement.”

From Shhh: “Re: Epic. They must have finally chosen a new CFO – the job listing is gone from all the career sites.” I was slightly aware that Anita Pramoda was the company’s CFO, but I see from her LinkedIn profile that she moved on this year as a co-founder of California-based TangramCare (I guess she didn’t have to sit out a year). I can find next to nothing about that company except that it’s some sort of technology-enabled homecare provider. From a LA Craigslist job posting, she’s taken some Epic principles out West: the “do good” motto, the hiring of “brilliant people,” and the need for candidates to state their GPA in their application. The “who are we?” section says, “Healthcare today is conducted like a horribly inaccurate Markov chain. That is, each piece of healthcare is siloed from one another, at all times with incomplete information. None of pieces the mesh well, the left hand doesn’t know what the right hand is doing/has done. This results in inefficiency, inaccuracy and unbearable patient experiences. We wake up every morning working to solve this problem, make healthcare more affordable, and save lives.” Jim Sweeney, founder of Caremark, Bridge Medical, and CardioNet, is involved and talks about the company in the video above. He has an interesting point: hospitals were created to make it convenient for physicians to see patients, but being aggregated with other sick people isn’t so great for the patients.

Half of my survey respondents are indifferent to CHIME, while the remainder are equally split in seeing the organization as positive or negative. New poll to your right: which annual conferences do you routinely attend? Check all that apply and feel free to leave a comment.

Here’s new Spotify playlist of some odds and ends that might give you some new music ideas. On it: Toad the Wet Sprocket, Broken Bells, Veruca Salt, Neon Trees, and quite a few more. If you like country music, computer-generated dance tunes, classical, or jazz, you’re out of luck since I don’t listen to those.

Speaking of music, a reader sent a link to the early 1980s company promotion album You Respond to Everyone But Me: Songs for the EMT, which seems to be the only album dedicated to EMS. Stream some of the very well done country/bluegrass tunes and see if you agree with me that it’s way better than you would expect. I’m desk-drumming to #11 – EMS Express.

ONC publishes the Request for Comments for Meaningful Use Stage 3. The comment period will open this week on Regulations.gov and will end on January 14.

The Advisory Board Company’s e-mail policies are featured in an article about companies that encourage (or mandate) employees to stop checking e-mails after hours. CEO Robert Musslewhite, saying that “e-mail has gone too far and that is now impeding productivity,” also issued guidelines that include summarizing the topic in the subject line, limiting the number of recipients, and considering the use of instant messaging instead. The company imposed an e-mail moratorium over Labor Day weekend.

Lucile Packard Children’s Hospital (CA) provides iPads loaded with kid-friendly apps in all nine of its pediatric ED rooms. The unit’s director says that “one iPad is worth 10 milligrams of morphine.” Parents can also check e-mail and FaceTime with hospital specialists, guest services employees, and interpreters.

The Columbus, OH newspaper writes about Ohio hospitals that use EHR information to tailor their marketing campaigns to specific patient populations. At least one system (OhioHealth) admits that it screens out lower-income patients in mailings encouraging patients to schedule health maintenance visits.

CVPH Medical Center (NY) lays off 17 employees after losing $400,000 in September, but says the cuts would have been a lot more severe had it not banked $3.2 million in Meaningful Use money that was counted as revenue. 

A series of Greenway surveys finds that:

• 76 percent of practices either aren’t sure about participating in an ACO or have decided they won’t participate, while 50 percent of hospitals say they have no ACO plans
• 16 percent of practices will stop taking Medicare and Medicaid patients if payments are reduced
• 39 percent of hospital CIOs say technology has improved the efficiency of their organizations
• 45 percent of patients say they would change doctors if they’re kept waiting too long
• Seven percent of patients say technology gets in the way of their interaction with their doctor vs. the 56 percent that believe it helps the physician improve their care
• Patients view paper and electronic-based systems as equally safe and secure
• More than half of consumer respondents believe it’s the government’s job to improve the healthcare system, with hospitals and physicians a distant second and third place respectively

From the Investor Day transcript from the CEO of Quest Diagnostics, parent of MedPlus (ChartMaxx, Care360 EHR):

…We are redirecting our EHR Information Systems business. We believe that business needs to be focused on helping Diagnostic Information Services. We believe there is an opportunity for that business to complement enterprise EMR strategies that companies like Cerner and Epic and that McKesson have, and we need to participate in helping them with them and be with them when they present their strategy to integrated delivery networks in hospital systems. And therefore, we’re focusing the plan in the business around that segment in the marketplace and having a proactive program to work with the enterprise EMR companies going forward.

The $5.99 BabyDoze smartphone app plays Doppler-recorded mother’s womb sounds that the company says are 98 percent effective in calming crying babies. Its author recorded his wife’s uterine sounds in 1985 with the help of hospital staff, selling the original version as an audio tape.

A study finds that goofing off at work every now and then may improve work performance. Top-performing subjects in a four-hour simulation session of piloting military drones were found to have been distracted 30 percent of the time by their smartphones, having a snack, or reading something nearby.

Vince and Mrs. Vince have been re-honeymooning in Europe, so he compares how technology has changed in the 40 intervening years. He has returned and his regularly scheduled HIT programming will do likewise next week.

Sponsor Updates

• Jardogs recently attended the University of Iowa’s Engineering Career Fair. That’s recruiter Nicole Baer meeting with a student above. The company offers FollowMyHealth patient access solutions that include the Universal Health Record and patient kiosk.
• Intelligent Medical Objects releases its IMO Terminology Browser for Android smartphones.
• We missed a sponsor who made the Inc 5000 in our list last week. Toledo-based ESD, which you may remember as the force behind HIStalkapalooza in Las Vegas earlier this year, was recognized for its three-year revenue growth of 172 percent.
• Award-winning IT staffing firm Digital Prospectors is raising funds for Hurricane Sandy victims. The company will match donations and chip in $5 for each Facebook share and $1 for each Facebook like.
• An article by Emily Ruffing of Lifepoint Informatics describes ways that laboratory information systems can be integrated with EMRs.
• Nordic Consulting, the KLAS-ranked #1 Epic service provider and the largest Epic-only consulting practice in the country, publishes a guide for Epic-certified consultants interested in joining the Madison, WI-based company.
• SayIt Clinical Notepad from nVoq,  a cloud-based iPad speech-to-text app that allows users to capture quick patient notes on the go for later addition to the EMR, is available on iTunes.
• Liaison Technologies, the Atlanta-based cloud integration and data management leader, is recognized by the Deloitte Technology Fast 500 as one of the fastest growing companies in North America.
• Bottomline Technologies recently held its Healthcare Customer Insights Exchange in Sausalito, CA with its experts and customers providing insight about mobile technologies, process automation, payment solutions, and advanced forms management. The company offers a case study of Alamance Regional Medical Center’s move to a Logical Ink-powered tablet-based patient registration solution.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

HITlaw 11/16/12

Exit Shmexit

When healthcare provider entities merge, whether physician practices or hospitals, there is usually a misalignment of technology. It is not typical that the merging entities operate the same vendor systems, which means that ultimately one vendor is out and the other gains a new (merged) customer.

Here is a real-world example recently brought to my attention. Physician Practice A merges with (larger) Physician Practice B, which basically means Practice B bought out Practice A. The two practices use different EMR products and Practice B dictates that its current EMR technology will remain the standard. Practice A will have to transfer its operations to the other vendor’s EMR technology. Not surprising and not a big deal, many are thinking as they read this, because practices convert to different systems all the time.

However, the vendor being replaced at Practice A is not playing nicely and refuses to provide the EMR data in a format that satisfies the technical requirements for conversion. Setting aside the fact that Practice A will have serious record retention issues, they will be unable to access historical patient records (unless they continue to pay for support or subscription to keep the old system, a very unnecessary cost) and will have to start from scratch in the new system. Really?

One would think that bad PR would be enough to persuade the ousted vendor to provide the practice data ready for conversion, but we have seen enough strange stories about sore losers recently to unfortunately have to consider this possibility and behavior.

About the title of this posting – Exit Shmexit? Every software contract should have a section devoted to data rights and extraction at termination. Frequently labeled in conversation as “Exit Procedure” or “Exit Strategy,” this type of language is absolutely essential. I take the tone I do because it is clear that unfortunately many practices, and to a lesser extent, some hospitals, do not take the time to carefully review and negotiate the terms and conditions under which they are investing in technology.

Evident in my HITlaw postings is the emphasis on the critical need to review and negotiate your software agreements. “Exit Shmexit” is my personal rebuke to those that consider vendor license agreements as merely “paperwork” and hurriedly review and sign what is put in front of them. Inclusion of a few sentences in Practice A’s EMR license would have prevented the present angst and difficulty for that entity.

Although not as pertinent to hospitals due to the size and expense of the technology investment (and corresponding recognition and cooperation by vendors), I am made increasingly aware of instances where physician practices are courted, quoted, and commanded. The first two everyone knows. Commanded refers to the attitude of some vendors at the contract stage. Sign here. We don’t negotiate.

Editorial comments now aside, here is the help.

To repeat, every software contract should have a section devoted to data rights and extraction at termination.

Critical inclusions that should be in the software license:

• As between vendor and customer, all data entered into the software database is the property of the customer. This is my nod to the notion that medical records are truly the property of the patient, but that is a topic for another day. The point here is that the customer owns all the data, not the vendor, and the vendor must recognize this.
• Transition must be accommodated. Upon termination of the software contract for whatever reason, all data must be immediately made available to the customer. This is to be provided without question in industry standard format and at no additional cost. This is part of the price of doing business and I have no problem advising my healthcare technology company clients that this must be done.
• The vendor must also agree to provide the data, for an additional cost if necessary, in whatever format is required by the replacement vendor, with a reasonableness factor included regarding technical feasibility.

Dust off your existing EMR license agreement or review the proposed agreements in front of you for that new EMR, PACS system, or HIS as the case may be. No exit procedure? For existing relationships, think about this before you sign with the new vendor. Go back to the existing vendor and address the issue. Far better to do so when there is still a working relationship than after you have told the vendor they will be replaced. For prospective business relationships, get agreement from the vendor as described above (as well as many other important considerations).

Going back to my editorial comments, any customer presented with a contract and the statement that “we do not negotiate” should politely show the salesperson the door. There will be another one from another vendor ready and willing to discuss your needs and listen to your contractual concerns.

This is not to say that vendors must negotiate all terms and conditions as requested by the customer prospect. Vendors are completely within their right to protect their business and intellectual property, limit their liability, and keep sacred the things most important to them. However, to place a contract in front of a prospect with the message “take it or leave it” is not good for business. Unless of course the agreement is written so fairly that it considers not only the company’s interests but also the interests of its customers in equal measures. That would be very rare.

Repeated many times in my HITlaw postings is the advice that contract review, at least for major terms and conditions, is a critical part of the vendor selection process. Do not select a vendor and then look at the contract. When you have the search down to a select few vendors, review the contracts in front of you. Look for the smoldering sections that need attention. Recognize the absence of sections of vital importance for your protection during and after the business relationship.

In the example above, the absence of a “data rights at termination” section should be immediately brought to the vendor’s attention. If the vendor provides language suitable for your protection, keep them in the game. If they refuse where others cooperate, take them off the list.

Please see my quick tips for an EMR Contract, as well as my paper Selection and Negotiation of EMR Contracts for Providers. Hopefully my general insight and advice will help avoid problem situations such as the one involving unfortunate Practice A.

Previous HITlaw postings were fairly infrequent and arose only when I found a seriously weighty topic. Look forward to more frequent postings on important issues in shorter format. E-mail me with questions and suggestions for future HITlaw writings, whether provider side or vendor side.

William O’Toole is the founder of O’Toole Law Group of Duxbury, MA. You may contact him at wfo@otoolelawgroup.com and follow him on Twitter @OTooleLawHIT.

Time Capsule: Fiction Writers, Get Ready: The “Most Wired” Bandwagon is Leaving the Station

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

I wrote this piece in February 2008.

Fiction Writers, Get Ready: The “Most Wired” Bandwagon is Leaving the Station
By Mr. HIStalk

It’s “Most Wired” time again and I’m excited! Just like those folks who find themselves overdue for a teeth cleaning or an annual prostate exam.

Actually, it’s worse. Hygienists and rubber gloved doctors work quickly. Those magazines, companies, and consultants with a vested interest in the Most Wired nonsense yammer incessantly about it for months, wasting free magazine space on how insightful it is, how much the results correlate directly to everything that’s good in the world, and how inferior you should feel if your hospital isn’t participating (and winning, preferably, since this is America and everything is competitive).

I once worked in a fairly sophisticated IDN’s IT shop. Lo and behold, right there on the newly announced Most Wired list was one of our tiny hospitals, a 100-bed rural facility with zero IT staff, remotely hosted green screen apps, and no IT budget.

We never found out who completed the application, but it was an impressive work of fiction. For example, it claimed a really high CPOE utilization, which was especially amazing because they didn’t even have a CPOE application (maybe they thought it stood for Clipboard Physician Order Entry). Same with nursing documentation – they were purely paper-based, but claimed to be electronic. Those reading the hallowed roster of winners probably thought that our little hospital was an enviably progressive IT hotbed.

People often make interpretational errors on the Most Wired survey form (often to their advantage, I know you’ll be shocked to hear) and sometimes lie outright. I’ve read down the list of winners some years and laughed out loud at their audacity. All it takes is some competitive pressure and a CIO or CEO who’s looking for bragging rights and suddenly the submitted numbers are as opportunistically flexible as a vendor completing a prospect’s RFP. If in doubt, just say you’re doing it and feign misunderstanding if caught.

Most Wired wouldn’t be so bad if only CIOs read it, bragging about their big W like a pimply teenaged boy excitedly describing his prowess in a purely fictitious romantic liaison. What’s the harm? It’s this: non-IT executives may actually think it’s a useful yardstick. The magazine loads up with impressive graphs and makes enormous logical leaps to connect IT spending with quality, cost, and the salvation of mankind. The gloss increases the danger that someone might take it seriously and leap vigorously onto the ill-advised bandwagon as a result.

I asked one of my employees to complete our Most Wired application one year. He was struggling with its ambiguity and the knowledge that many applicants were most likely fictionalizing to some unknown degree. Finally, he summarized: “How I answer depends on how badly you want to win.” We had won in the past and he knew the pressure was on for a repeat.

Just about everyone pushing Most Wired makes money on IT sales, implementations, or advertising. They have a vested interested in shaming people into buying and implementing, even when it’s a bad idea. The message is clear: winners buy IT while Luddite losers cower in the corner.

You can’t stop your peers from entering and maybe even winning Most Wired. You should, however, let your executives know what categories it measures, what you’re doing in those areas, and how your IT efforts support organizational goals in ways that go far beyond a simple survey.

If enough people do what they should be doing instead of what the survey pushes, maybe the foolishness will stop. It would be nice if organizations focused on their own strategic IT needs instead of worrying about how they rank on a vendor-sponsored survey that encourages one-size-fits-all conspicuous consumption.

Morning Headlines 11/16/12

A Survey Of Primary Care Doctors In Ten Countries Shows Progress In Use Of Health Information Technology, Less In Other Areas

A study of 10 high-income countries finds that America is rising in adoption of EHRs, with 69 percent of US primary care physicians reporting that they are using an EHR.

Vt. GE Healthcare outpost lays off 10 percent

GE Healthcare announces layoffs for approximately 50 employees at its Burlington, VT offices.

Department of Defense and Department of Veterans Affairs Award EHR Integration Subcontract to DSS, Inc. for Fully Integrated Data

DSS is awarded the iEHR project, migrating VistA and legacy DoD systems onto a single integrated platform.

Cerner to Standardize Health Care for NBA Players

Cerner will implement a single EHR across all 30 NBA teams to securely manage the health of the athletes.

CACI Announces Intent to Acquire Emergint Technologies, Inc.

CACI, a government information systems provider specializing in Intelligence and Defense, acquires Emergint technology to expand its Healthcare IT position and broaden its portfolio.

News 11/16/12

Top News

Sixty-nine percent of US primary care physicians report using EHRs, up from 46 percent in 2009, while about a third of doctors say their patients have the ability to e-mail the practice and have online tools to request appointments, referrals, and prescription refills. The study of 10 “high-income” countries also finds that despite health reform initiatives, a high percentage of physicians in all countries complain of untimely access to information from hospitals and specialists.

Reader Comments

From Mango Mel: “Re: UNC. As you mentioned, they are going Epic.” I heard that rumor again today from an excellent source. If it’s true, that gives Epic all of the big hospitals in the Triangle area of North Carolina, which is almost all of the beds there now that they’ve recently added Duke and the just-announced WakeMed. Other NC users of Epic are New Hanover, Vidant, and Novant.

From The SFTreat: “Re: GE Healthcare layoffs. True – a number of staff from the Seattle office are gone.” We’ve run several rumors suggesting that the layoffs were going to happen Wednesday. A Boston article says the company confirmed that 10 percent of its Vermont workforce has been let go, but the company declined to give specifics. Our GE contact said that fewer than 50 employees were impacted and no office closures or product retirements were involved. According to the official response:

“In fact, GE HCIT is maintaining its focus on the needs of integrated care delivery, and in conjunction with our strategy, we are making choices to redeploy some portions of our resources and capital into new areas of product and service innovation. While these types of decisions are never easy in the near term, we are confident that they are necessary to meet the current and future needs of our customers.”

From Candace: “Re: research and think tank institutions for healthcare technology. What do you think of IDC Health Insights? Can you recommend other research centers? I’m a recent college graduate doing a research project.” I don’t have any experience with any of them, so I’ll open the floor to readers willing to help. Don’t they sound like swell places to work, though, just sprawling back at your desk thinking in a swanky office park?

From DeanInsider: ”Re: rumor of doctor resignations. Not the case. Dean is pleased to have become an Accountable Care Organization and has always put patients first.” I assumed that was the case, but several hospitals have announced layoffs they’re blaming on PPACA. The latest: Wake Forest Baptist Medical Center, which will eliminate 950 positions. A local professor there says hospitals must plan for at least one year of lower payments, reductions in federal grants, and the high cost of EHRs.

HIStalk Announcements and Requests

nice “@ingahistalk: Bowtie Confidential 11/10/12: Tweet Accountable Care Act and its Effects on the Board of Directors bit.ly/S9bQkV”

— Farzad Mostashari (@Farzad_ONC) November 11, 2012

HIStalk Practice highlights from the last week include: MGMA members give Medicare the highest marks among seven top payers. The country will be short 52,000 family physicians by 2025. An 87-year-old doctor who charges $5 an office visit says he didn’t select his profession for the money. Physicians must participate in PQRS in 2013 to avoid 2015 penalties. A list of the worst passwords for 2012. Rob Drewniak of Hayes Management Consulting discusses the need to educate board members on the ACA and its implications for their organization. Dr. Mostashari, by the way, gave Rob’s post a thumbs up. If Dr. Mostashari is reading HIStalk Practice and you aren’t, maybe it’s time to consider what you’re missing. Thanks for reading.

We ran a link to the draft Meaningful Use Stage 3 rules earlier this week, but just to be clear, this is a draft document not yet available for public comment even though its title is “HITPC Stage 3 Request for Comment.” You’re seeing it as it came from the Policy Committee.

Inga’s been a good girl this year, so here’s her Christmas list for your consideration: (a) sign up for spam-free e-mail updates to HIStalk, HIStalk Practice, and HIStalk Mobile; (b) friend, like, and connect with us on all the social not-working sites; (c) send us news and rumors; (d) review and impulsively click some of the much-appreciated sponsor ads to your left, search and navigate to their details in the Resource Center, and send your consulting RFI viral with the RFI Blaster; (e) tell other folks you read our sites because when it comes to our marketing channels, you’re all we have; and (f) give yourself one of those wrapping-your-arms-around-yourself hugs and pretend it’s Inga since it will take her awhile to get to each reader personally. I’m just happy reading down the list of 2,850 impressive folks who have signed up for Dann’s HIStalk Fan Club and thinking how cool that is. That’s the first place I look when considering somebody’s request for an HIStalk-related favor.

On the Jobs Board: Workflow Automation Project Manager, Technical Trainer, Product Analyst, User Interface Engineer.

The most common grammatical crutches I have to edit out of the interview transcripts I run, sometimes in truly startling numbers: (a) “really”; (b) “sort of”; and (c) starting sentences with “so” like someone telling a bar stool yarn. I was at a doctor’s presentation today and counted the number of times she said “sort of” and was up to 79 in the first 30 minutes before I tired of the exercise. I’m not annoyed, just sorry that the power of what she was saying was needlessly diluted by subconscious speech tics.

Acquisitions, Funding, Business, and Stock

CACI will acquire Emergint Technologies, a provider of HIT services and analytics solutions.

WellStar Health System pays $20,000 for the trade name, trademark, and other assets of the bankrupt Center for Health Transformation, the for-profit healthcare think tank founded by Newt Gingrich. WellStar intends to convert it to an independent, nonprofit collaborative of 20 non-competing health systems in the Southeast, focusing on sharing ways to improve quality and reduce costs. 

Salt Lake City-based Remedy Informatics gets a $6 million investment from Merck. The registry and research informatics company is headed by Gary Kennedy, so I assume it’s related to the former RemedyMD. I interviewed him in early 2007 and was pretty impressed, although the hospital-type database products seem to have been de-emphasized in favor of the life sciences ones.

Sales

WakeMed Health & Hospitals (NC) will invest $100 million over five years to implement Epic.

The DoD and VA award Document Storage Systems an EHR integration subcontract.

Oakwood Healthcare (MI) renews its multi-year IT outsourcing contract with CareTech Solutions for $120 million.

People

Harry Jacobson, MD, former vice chancellor for health affairs at Vanderbilt and CEO of Vanderbilt University Medical Center, joins digiChart as chairman, replacing G. William Bates, MD, who was recently named chairman emeritus.

Net Health systems, a provider of IT systems for wound care, hires Kelley J. Schudy (Allscripts) as VP of sales.

Announcements and Implementations

The National Basketball Association will use Cerner’s HealtheAthlete health management platform for all of its teams.

The LSU Interim Hospital and 11 clinics are live on the Greater New Orleans HIE, which will connect to the state-wide Louisiana HIE by the end of the year.

The Pennsylvania eHealth Collaborative signs up 3,449 providers for DIRECT messaging, exceeding the federal government’s goal of 1,000.

Lakeland Regional Medical Center (FL) goes live on Cerner clinical applications with implementation assistance from Healthcare Clinical Informatics.

Elsevier announces the launch of Health Care: The Journal of Delivery Science and Innovation. It will focus on applied healthcare IT and health reform. Founders and co-editors are Amol Navathe, MD, PhD (Brigham and Women’s, Harvard Medical School, Wharton School) and Sachin Jain, MD, MBA (Boston VA, Harvard Medical School, and Merck).

North Mississippi Health Services (MS) wins a Baldrige Award. 

Innovation and Research

Got a flair for design and patient-friendly medical information? ONC and VA are running a Health Design Challenge for creative types who can make CCD/Blue Button information easier for patients to understand. Three prizes are offered in each of four categories (Best Overall Design, Best Medical/Problem History Section, Best Medication Section, and Best Lab Summaries) ranging from $1,000 to $16,000. The deadline is November 30.

Other

A CapSite study finds that almost one-third of hospitals plan to invest in patient flow solutions within the next two years. Leading vendors include TeleTracking, McKesson, Epic, and Meditech, while the vendors most often being considered are listed in the graphic above.

Speaking of CapSite, a HIMSS webinar this Friday afternoon will cover “The CapSite Acquisition and What It Means to You.”

Bill Hersh provides an update on the clinical informatics subspecialty for physicians. Details are being worked out about the grandfathering and initial exam process, but Bill says the first candidates will sit for their test in October 2013.

Allscripts responded to our reader’s question about whether MyWay users will be released from their contracts if they decline the company’s offer of a free upgrade to Professional.

“Allscripts is providing a free upgrade, and the contract does not allow for cancellation of current leases. Allscripts is dedicated to working with our clients to help them succeed, and we believe the upgrade provides the right benefit for the long term.”

Weird News Andy says this never happens to him while listening to NPR. A former Doctor of the Year ED doc faces a long list of charges after hitting several cars in a parking lot while allegedly under the influence of drugs and alcohol with NPR cranked up loud in her Outback. She says her accelerator got stuck on her way to Whole Foods to buy a Thanksgiving turkey, but police found pills and prescriptions she had written for herself.

WNA labels this story “Hello Terry Schiavo.” Scientists performing a functional MRI on a man who has been in a vegetative state for 10 years find brain wave patterns that suggest he is answering the questions they’re ask him. The scientists believe the patient is aware of who and where he is.

Sponsor Updates

• Leslie Kelly Hall, SVP for policy at Healthwise, joins a panel discussion on patient engagement framework at next week’s National eHealth Collaborative Webinar.
• Visage Imaging will demo its Visage 7 processing technology, including work-in-process capabilities, at this month’s RSNA meeting.
• Merge Healthcare will unveil its mobile and Internet platform for patients during RSNA.
• Greater Baltimore Medical Center (MD) reports a reduction in paper output and waste since deploying Access Intelligent Forms Suite and Wacom STU-500 signature tablets.
• TeraRecon previews a pay-as-you-go option for use of its iNtuition advanced visualization tools by physicians who perform aortic repair procedures.
• Kareo offers tips for increasing practice revenue in its November newsletter.
• The Canadian Health Informatics Association awards TELUS Health Solutions its Corporate Citizenship Award for achievements in health and technology to improve patient outcomes.
• McKesson will combine its Episode Management software with the Prometheus Payment model to support large-scale bundled payment programs.
• DrFirst will embed Halfpenny Technologies’ Integrated Technology Framework for CPOE and results delivery within its Rcopia e-prescribing platform.
• White Plume Technologies’ Laura DeBusk and MED3OOO’s Cindy Cain will discuss the impact of ICD-10 on operations, compliance programs, and cash flow in a November 29 Webinar.
• Aprima will integrate Alpha II claim scrubbing technology into its EHR and PM solutions.
• HIStalk sponsors earning a spot on the 2012 Inc. 5000 List of America’s Fastest Growing Companies include Beacon Partners, Culbert Healthcare, Cumberland Consulting, Digital Prospectors, eClinicalWorks, Enovate IT, Etransmedia Technology, Greenway, GetWellNetwork, Hayes Management Consulting, Kareo, Iatric Systems, Impact Advisors, Ingenious Med, iSirona, maxIT Healthcare, MED3OOO, MEDSEEK, Passport Health, Virtelligence, and Vocera.
• HIStalk sponsors included on Deloitte’s 2012 Technology Fast 500 ranking include Etransmedia Technology, Greenway Medical, MModal, MedAssets, NexJ Systems, and Vocera.
• Sandlot Solutions unveils the final results of eHealth Initiative’s 2012 Annual Survey of HIE Initiatives.

EPtalk by Dr. Jayne

The American Academy of Family Physicians releases a summary of the 2013 Medicare Physician Fee Schedule. Increases will only occur if Congress takes its annual action to block the reduction that is scheduled for January 1.

AAFP also publishes (subscription only) its 2012 EHR User Satisfaction Survey. Of 3,088 viable responses (as in previous years, several hundred responses were excluded because respondents said they did not use EHR or didn’t identify their systems) 31 vendors account for 92 percent of the systems. The highest counts (over 200 responses) were reported with Allscripts, Centricity, eClinicalWorks, Epic, and NextGen. As someone who has been documenting with EHRs for more than a decade, I find some of their survey questions suspect. For example, “This EHR helps me see more patients per day (or go home earlier) than I could with paper charts.” They certainly didn’t control for the dramatic increase in federal, regulatory, and payer scut work that has added to the bottom line of my work hours. Even if I was on paper, I’d be seeing fewer patients and going home later just for that reason.

The authors recognize that “practice size is independently related to satisfaction,” noting that except for a few systems, the majority of “large practice” vendors fall towards the bottom and “small practice” vendors hit near the top of satisfaction scores. The cutoff for vendor inclusion was 13 responses, so there is question on whether they are statistically significant. Some of the highest ranking systems are relatively untenable in enterprise environments, so I feel for administrators whose physicians will be marching into the office with the article in hand, demanding that Cerner be de-installed in favor of Praxis, SOAPware, or my favorite: Point and Click EHR.

Another doomsday prediction finds that we’ll need 52,000 more family physicians by the year 2025. I can almost guarantee that if you figure out how to pay them what a cardiologist makes, you’ll get them.

A good friend sent me a link to the “Jane and the Doctor” YouTube video. It’s an oldie but a goodie if you haven’t seen it. For those of you in the implementation trenches, know that you are not alone and there are many others of us who hear the same tired complaining from physicians all day long.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

HIStalk Interviews Seth Henry, Founder and CEO, Arcadia Solutions

Seth Henry is founder and CEO of Arcadia Solutions of Burlington, MA. The company announced Wednesday that it has been acquired by private equity firm Ferrer Freeman & Company and Arcadia’s senior management team.

Describe what Arcadia does and why it was time to bring in a new investor.

Arcadia is built on the premise that healthcare must do three things: bend the cost curve, change the incentives and payments to focus on outcomes, and connect and integrate disparate systems with IT.

To that end, Arcadia is focused on being the leader in helping the ambulatory market successfully adopt, integrate, and make decisions with IT. We believe this part of the market — where 46 percent of the care is delivered — has not been addressed by the IT vendor community while the main focus has been on “wiring” hospitals.  

The changes in the overall system are driving health system executives to address the IT needs in the physician and ambulatory marketplace. To help with this initiative, Arcadia provides comprehensive services implementing, optimizing, and providing strategic decision support to this market, focusing on larger systems and aggregators.

Arcadia has established a proven track record and loyal customer base in the northeast US. However, we have reached a point where it would be helpful to work with a growth partner with deep experience in healthcare and health IT who could help drive an aggressive national expansion plan combined with a continued investment in forward-looking offerings for customers. FFC is that partner.

We’re also excited to have their senior management team join our board of managers, which includes Carlos Ferrer, David Freeman, and Ted Lundberg of FFC as well as Jim Crook, a healthcare IT industry veteran who was CEO of IDX Systems when it was sold to GE Healthcare for $1.2 billion, who will help us drive this strategy.

Ferrer Freeman & Company has been an investor in several healthcare IT related companies that were acquired by large entities, including PHNS (now Anthelio), Vitalize Consulting Solutions, and Webmedx. What do they bring to the table to enable the next level of Arcadia’s growth?

In addition to growth capital, FFC provides a deep understanding and strategic focus on the business of healthcare, having invested in more than 35 companies exclusively in this market. They have a broad network of senior executives in Arcadia Solutions’ target marketplace who have been very engaged in the direction of the business. They also have a  committed partnership with management that is passionate and involved in the direction and growth of the company.

How has the company’s business changed over the years since HITECH went into effect and how do you see it changing in the next few years?

We do not see HITECH as the primary driver of the business. Our firm’s direction of focusing on measurable adoption and aligning IT with cost and quality was well established before HITECH was conceived and our rapid growth preceded HITECH.  

While we think HITECH is directionally correct and consistent, it is not a primary reason our customers buy from us. Our customers in general have a broader purview and mission with respect to transforming healthcare with IT and this is reflected in our consistency of offerings and performance pre- and post-HITECH.

Arcadia has been involved with 2,500 EMR implementations in physician practices. What are the most important trends you’ve observed that you have incorporated into the company’s strategy?

We believe the industry in general has focused too much on the technology aspects and not nearly enough on the people. As a result, the definition of “done” is when the systems are live. Our definition of “done” is when the data in the system has reached a certain level of quality.  

We also believe very strongly — and our data confirms — that the technology chosen can have very little to do with the ultimate results in terms of better performance, more efficiency, and happier physicians.

Scarcity of specifically trained resources and tight timelines driven by HITECH have created a healthcare IT consulting boom, which has in turn led to several high-dollar acquisitions. How do you see the healthcare IT consulting market playing out over the next 5-10 years?

As with all markets, there will be highs and lows, winners and losers. Our strategy is to stay laser focused on providing services with proven and measured value and results while building a great company in the process. The rest will take care of itself.

We are very confident that the healthcare market faces a very long road in getting completely wired and connected with IT and adapting and optimizing the business and delivery model in parallel. I have not met anyone close to this problem that thinks that HIT is not a growth market for 10 more years. 

Morning Headlines 11/15/2012

Rep. Ellmers pushes HHS on safety of health technology

HHS receives a second letter from Rep. Renee Ellmers after failing to respond to an initial letter citing an IOM study that questioned the safety of electronic health records.

MU helps drive interoperability, standards could also help

Farzad Mostashari of the ONC, along with HIMSS Chair Willa Fields, Charles Romine of NIST, and several private sector industry experts testify in congress today defending the results of Meaningful Use thus far among accusations that there should be a higher level of interoperability.

Arcadia Solutions Acquired by Ferrer Freeman & Company and Senior Management

Arcadia Solutions announces its acquisition by Ferrer Freeman and addition of Jim Crook, former CEO of IDX Systems, to the Board of Managers.

Surescripts and NextGen Healthcare Take Important Step to Improve Quality of Care Collaboration and Coordination Across the U.S. Healthcare System

NextGen announces that it will connect its 75,000 users to the Surescripts network enabling e-prescribing and access to a clinical messaging platform.

WakeMed to spend up to $100M on medical records project

WakeMed Health & Hospital System, an 840-bed Raleigh, NC-based health network, announces plans to implement Epic over the next 18 months.

Readers Write 11/14/12

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

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

Formal HIT Education
By Deborah Kohn

I read with interest HIStalk’s news regarding Georgia Tech’s free online health informatics class in the cloud and Mr.HIStalk’s comment, "This looks really good, especially for folks who don’t have a lot of formal healthcare IT education on their resume."

This led me to research four-year baccalaureate degree programs in health information technology (HIT), where I expected students in such programs to earn a BS degree, a Health Information Technologist title, and, perhaps be ready to sit for a rigorous certification exam.

No such programs exist in US colleges and universities – online, on-campus, or combination – as far as I know, except perhaps one at Miami (Ohio) University’s regional campuses. (note: I am not referring to four-year baccalaureate degree programs in health information management or HIM, which are complementary to but different from four-year baccalaureate degree programs in HIT.)

Largely due to 2009 ARRA/HITECH dollars (workforce training), many two-year, community college-based HIT programs exist (before the dollars run out), where students earn an AA degree (or similar), a Health Information Technician title, and are ready to sit for the Department of Health and Human Resources’ HITPro exam. (A certification is not conferred upon successfully passing the HITPro exam.) Unfortunately, contrary to expectations and because of lack of experience, most of these students cannot find jobs.

Many excellent one-to-two-year, post-baccalaureate degree programs exist in health informatics (e.g., Georgia Tech), whereby graduate students (typically clinical) earn either a MS degree or similar or a certificate, allowing the student to officially wear the Health Informaticist title (Nurse Informaticist, MD Informaticist, etc.).

As a college undergrad, I earned a BS degree in medical record science (today, health information management). My program in medical record administration was part of the university’s Allied Health Professionals Division. General Arts and Sciences Division requirements (English composition, sociology, chemistry, biology, etc.) plus anatomy and physiology consumed our freshman and sophomore years. Many of our junior and senior year courses were shared with the Allied Health Professionals Division’s undergrad nurses, pharmacists, lab technologists, dieticians, etc. The remaining courses were specific to HIM (ICD coding, records management, etc.). All Allied Health Professionals Division students experienced a minimum of four months practice in a hospital in the nursing, lab, pharmacy, dietary, and medical records departments.  

I graduated the university with a Medical Record Administrator title and was prepared to sit for a rigorous exam that, upon passing, allowed me to be certified as a Registered Record Administrator (today, Registered Health Information Administrator – RHIA). Similarly, my fellow student nurses, pharmacists, lab technologists, dieticians,etc., became RNs, RPhs, RDs, etc.  In general, we went directly into good-paying jobs as entry-level — but at least semi-experienced — healthcare professionals.

As a graduate student, I had few options except to pursue a masters degree in Health Services and Hospital Administration (or similar), which I do not regret. However, today, those with BS degrees in the healthcare professions can pursue advanced degrees in health informatics, highlighting advanced skills, knowledge, and experience in healthcare and in IT. 

Consequently, I am proposing that four-year colleges and universities, working with or without existing two-year college HIT programs promoting Health Information Technicians, consider offering sorely-needed, workforce HIT programs promoting Health Information Technologists (like lab technologists). Subsequently, graduating students could sit for certification exams and become registered. (This is a subject for another article that would address those associations that would be able and willing to manage the testing.)  

These healthcare information technologist programs would allow the BS-degreed, graduating Health Information Technologist (registered or not) to gain required experience in the HIT industry and, if interested, to choose an HIT advancement and graduate path in health informatics.

In addition, I propose that these four-year, baccalaureate degree programs be incorporated into universities’ existing four-year, Allied Health Professional Divisions. Unfortunately, I learned from one public university with such a division that it is difficult to get the right parties to agree to offer new degree programs at the undergraduate level. I learned from one private university with such a division that undergraduate programs do not generate enough revenue to justify adding new programs, and only post-graduate programs do. Perhaps an accredited online university that is willing to keep the cost reasonable and can quickly establish a program also should be proposed, although program quality might be a concern.

Who or what entity is willing to take me up on my proposal? 

Deborah Kohn is the principal of Dak Systems Consulting of San Mateo, CA.

Value of Meaningful Use Funds Debated at IHT2 Conference
By James Harris

“History will not look positively on how the meaningful use funds were spent,” said Dale Sanders, senior vice president, Healthcare Quality Catalyst, at a November 7 IHT2 Conference in Los Angeles.

The panel was discussing the current status of healthcare analytics. Several panelists, including Sanders, said the $30 billion federal program had erred by not including more incentives for providers to use analytics.

Sanders said a “substantial” proportion of the EHR Meaningful Use fund had gone to large hospitals which had already purchased or planned to purchase an EHR system. “The program has served to further entrench Epic and Cerner” as the dominant systems in the hospital industry, Sanders said. This is unfortunate because neither company has shown a willingness to “opening their API” to outside vendors with analytic programs.

All of the panelists agreed that analytic programs held significant potential to reduce both clinical and administrative costs in hospitals.

According to Steve Margolis, MD, MBA, chief medical informatics officer of Adventist Health Systems, the newest types of analytic programs will offer “visual discovery tools,” which he described as being like Amazon’s system of suggesting additional purchase items based upon the consumer’s buying habits.

Margolis said in the future analytic programs will give “each individual provider, whether she’s in the ER, kitchen, or NICU, will get her own individual ‘dashboard.’” This dashboard would contain specific KPIs for the individual position to help in decision making.

Sanders noted that the most significant barrier to widespread adoption of analytics was the current economic model in healthcare. “Until we move to paying for quality, not quantity,” there is little incentive for hospitals to use analytics.

He added that the “I” in CIO should stand for “analytics.” Margolis countered that many CIOs felt the “I” stood for “insecure.”

In the conference’s opening keynote speech, Brent James MD, chief quality officer and executive director of  Institute for Health Care Delivery Research of Intermountain Healthcare, noted the vast amount of waste in the US healthcare system.

James said $2.83 trillion was spent on healthcare in one recent year and about 50 percent, or some $1.5 trillion, was “wasted.”

He said studies showed that 32 percent of all clinical care was “inappropriate,” meaning unnecessary or without proven clinical benefit.

James said “nobody in healthcare believes we will not be seeing major payments cuts” in the future. He urged healthcare executives to study the principles of W. Edward Deming, the famed engineer and management theoretician.

James said the old advice to American manufacturers, “Do Deming or Die,” takes on new meaning in US healthcare. He said the retail and auto industries have shown that “quality drives down costs.”

James Harris is president of Westside Public Relations.

It Takes One Bad Apple…
By Fernando Martinez, PhD, FHIMSS

I recently hosted an information assurance webinar that focused on security and audit and control functions that are frequently overlooked by healthcare organizations. In order to establish the appropriate context for the discussion, I began by reviewing notable trends and statistics regarding experiences around data security in the industry.

For example, in recent years, almost 21 million patient records have been implicated in reported breaches of electronic protected health information (ePHI). The statistics included a brief review of civil and criminal penalties for HIPAA-related violations which apply to covered entities and business associates alike.

Although the primary industry and regulatory focus has been on covered entities such as providers and healthcare organizations, compliance expectations have also matured and expanded to now include business associates. While business associate agreements are by design typically an affirmation that the business associate agrees to comply with some degree of security and related controls, not until recently have audits been directed specifically to business associates. The expectation is that the business associate has the same level of accountability as the covered entity when it comes to safeguarding ePHI.

Although it seems that some of the impetus for the heightened focus on business associates is related to consumer complaints about HIPAA violations or perceived violations, it is safe to conclude that regulators recognize the need to audit business associates simply because a relationship exists with one or more covered entities. Business associates are expected to conform to the same level of HIPAA compliance as covered entities where applicable, which in turn suggests that a properly designed, executed, and monitored management program must be in place by the business associate.

At the annual NIST/OCR conference held in June 2012, several presentations reinforced the point that a dedicated focus is going to be directed toward business associates. Evidence of this heightened focus is demonstrated in a Wall Street Journal article which appeared late July 2012. A complaint was initiated by the Attorney General of Minnesota directed at a service provider that was implicated in a security breach associated with patients from two local hospitals. The article reported that without admitting to any of the allegations, the service provider agreed to settle out of court. The terms of the settlement speak to the significant risk of not adequately managing compliance with security and privacy standards.

The settlement included the following terms:

1. The provider will pay $2.5 million to the state of Minnesota as part of a restitution fund to compensate patients
2. The provider must cease operations within Minnesota for a two-year period (the company voluntarily decided to cease operations in the state)
3. If the provider wants to do business within Minnesota after the two-year exclusion period, it must first obtain the consent of the state’s Attorney General

The fallout from the incident also resulted in the resignations of several of the provider’s executives, the loss of an estimated $20-$25 million in projected annual revenue, and a 56 percent drop in the stock price of the company.

Fernando Martinez, PhD, FHIMSS is national practice director, enterprise information assurance at Beacon Partners of Weymouth, MA.

The Seven Most Important Soft Skills for Healthcare IT Consultants
By Frank Myeroff

Google “soft skills” and you’ll find that they are defined as the cluster of personality traits, social graces, communication, language, personal habits, friendliness, and optimism that characterize relationships with other people.

While soft skills are a fairly new emphasis in healthcare IT, today’s job candidates and project consultants are either landing or losing positions based on them. Healthcare IT hiring managers regularly ask me about our consultants’ soft skills and consider them as important as their occupational and technological skills.

Therefore, in the event you are interviewing people or even currently seeking a new healthcare IT position yourself, you will need to understand or even demonstrate that there are a number of the soft skills required to be successful on the job. So my best advice to you — get in touch with your soft side and hone these skills quickly!

With that in mind, here are seven top soft skills considered vital for healthcare IT consultants:

1. Excellent communication skills. Emphasis is being placed on IT professionals who are not only articulate, but who are also active listeners and can communicate with any audience. Good communicators are able to build bridges with colleagues, customers, and vendors.
2. Strong work ethic. Organizations benefit greatly when their people are reliable, have initiative, work hard, and are diligent. Workers exhibiting a good work ethic are usually selected for more responsibility and promotions.
3. Positive work attitude. Wanting to do a good job and willing to work extra hours is highly valued. In general, a person having a positive work attitude is more productive and is always thinking how to make things easier and more enjoyable. Plus a positive attitude is catchy.
4. Problem-solving skills. Today’s businesses want IT professionals who can adapt to new situations and demonstrate that they can creatively solve problems when they arise. To be considered for a management or leadership role, problem-solving skills are a must.
5. Acting as a team player. Clearly a worker who knows how to cooperate with others is an asset. They understand the importance of everyone being on the same page in order to achieve organizational goals.
6. Dealing with difficult personalities. Businesses want people who are capable of handling all types of difficult people and situations. Healthcare IT workers who succeed in this area are in great demand.
7. Flexibility and adaptability. The business and IT climates change quickly. Job descriptions are becoming more fluid. Therefore, professionals who are able to adapt to changing environments and take on new duties are becoming more valued in the workplace. Those who rely on technical skills alone limit how much they can contribute.

The importance of soft skills in a healthcare IT environment cannot be stressed enough. Healthcare organizations link them to job performance and career success. Having the right soft skills mean the difference between people who can do the job and those who can actually get the job done.

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

My View from the Other Side
By Vendor Nurse

I have worked in and around the vendor world for about 13 years now. But last month was my first experience as a patient in a practice just going live on an EMR (Greenway). In one day, I experienced two doctor visits. Both had recently adopted an EHR.

The first was a dermatologist using Greenway. My appointment was at 1:00 p.m. I arrived a bit early, was asked to fill out several pages of forms, including patient registration forms, PMH, ROS, etc. I was called back to the front desk window four times to answer questions about race and ethnicity, insurance, and I forget what else.

My nurse (MA, really) finally took me back to the exam room at 1:35 p.m. and started to ask me all the questions I had just filled out. When I said, "It’s all on the forms," she said, "I know, but I have to ask you anyway." As she typed into the laptop, she sat at a diagonal but did not face me or make much eye contact and seemed more interested in entering the documentation than me. Of course, I get that, but geez it didn’t feel good.

The second appointment was with my PCP for URI symptoms. They are a major academic healthcare center and are going live on Epic (who isn’t?)…their third EMR! This doc was a little more fluent with an EMR, but sat with her back to me the whole time. She handed me a patient care summary and e-prescribed my medications, but forgot to print the referral for a mammogram.

Somewhere during that visit I was given information about the patient portal, which I had been waiting for a long time. As it happened, I had a couple of questions come up within the week and absolutely loved being able to send a message and get a response within an hour or two. This rocks! No more automated phone messages that go on so long I can’t even remember why or who I called.

Anyway, just thought I’d share my personal experience with EHRs. I have to say it will help me as I work with other physicians going live on their EHR.

CIO Unplugged 11/14/12

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

Reach

I arrived early to the bar. A bit after five, I was sipping merlot as my first guest arrived. We’d never met.

In fact, I’d never met any of my guests. I had found their contact information a few weeks prior and fired off an e-mail invite. I had no idea who, if anyone, would show. We had little in common, so what should I expect from them?

Our connection? Their CEOs sat on the board of my healthcare system.

I was totally rookie my first year as CIO. My first leadership endeavor was the selection and deployment of an electronic health record. What did I get myself into? I had to guide us through the biggest transformational challenge in the 140-year history of our organization. No pressure!

The guests I had invited all showed. We moved to our private dining room. I was now sitting with seven Fortune 250 CIOs.

I asked them for advice. Although they couldn’t relate specifically to the challenge of the EHR, they had significant experience in other transformative enterprise projects such as ERP. I wanted and needed to learn from their experiences.

Yes, experience is a decent teacher, but other people’s evaluated experience is even better. I had no margin, time, or grace to learn on the job. Unbeknownst to them, they were my lifeline.

The modest dinner cost delivered significant returns. I gleaned more that evening than I ever could have from a library or from endless webinars. I applied their golden nuggets of wisdom and avoided common pitfalls inherent to enterprise projects. Their willingness to share below the surface launched my organization and team down the track of success.

Moreover, these relationships are as important today as they were 10 years ago. Yes, I have maintained these connections. I recently met my friend Tom Lucas (Sherwin-Williams) for breakfast at the Society of Information Management national meeting. Just as I had back in Cleveland, I peppered him with questions, listened, and learned. I needed to talk with someone outside of healthcare, and Tom was there for me.

What I’ve learned: the more I reach out, the more goals I achieve.

I want my direct reports to have similar interactions with their non-healthcare peers. In a post two years ago, I shared how my team routinely collaborates with non-healthcare companies. This summer, we met with the IT leadership team of Kimberly-Clark. The meeting was pretty amazing, at least for us. We shared strategies, challenges, ideas, and opportunities. We commiserated and consoled.

In complete learning mode, I asked questions and took notes throughout the day. I was absolutely humbled. As a result of this interaction, we adopted many of their leading practices, including the following:

• Launching an internal mentoring program
• Deepening our mobile strategy and consumer-centric apps
• Developing a more robust communications capability
• Optimizing our business intelligence

I was schooled and happy. But I have to admit my remorse over the fact we received more than we gave.

Secondary benefits continue: relationships. We have now expanded our network to three non-healthcare companies. My direct reports are genuinely acquainted with their peers in these organizations. They have friends they can call on to give them fresh perspective and to help elevate their capabilities and performance.

Healthcare IT lags behind other industries such as financial services, entertainment, logistics, and retail. This is one way we are closing the gaps.

What I’ve learned: reaching out turns weakness into strength.

What are your approaches to identifying and closing your technology gaps? Find a company you admire and reach.

Post a response and I’ll send you the generic agenda we use for these peer-to-peer meetings.

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.

HIStalk Interviews Seth Henry, Founder and CEO, Arcadia Solutions

Seth Henry is founder and CEO of Arcadia Solutions of Burlington, MA. The company announced Wednesday that it has been acquired by private equity firm Ferrer Freeman & Company and Arcadia’s senior management team.

Describe what Arcadia does and why it was time to bring in a new investor.

Arcadia is built on the premise that healthcare must do three things: bend the cost curve, change the incentives and payments to focus on outcomes, and connect and integrate disparate systems with IT.

To that end, Arcadia is focused on being the leader in helping the ambulatory market successfully adopt, integrate, and make decisions with IT. We believe this part of the market — where 46 percent of the care is delivered — has not been addressed by the IT vendor community while the main focus has been on “wiring” hospitals.

The changes in the overall system are driving health system executives to address the IT needs in the physician and ambulatory marketplace. To help with this initiative, Arcadia provides comprehensive services implementing, optimizing, and providing strategic decision support to this market, focusing on larger systems and aggregators.

Arcadia has established a proven track record and loyal customer base in the northeast US. However, we have reached a point where it would be helpful to work with a growth partner with deep experience in healthcare and health IT who could help drive an aggressive national expansion plan combined with a continued investment in forward-looking offerings for customers. FFC is that partner.

We’re also excited to have their senior management team join our board of managers, which includes Carlos Ferrer, David Freeman, and Ted Lundberg of FFC as well as Jim Crook, a healthcare IT industry veteran who was CEO of IDX Systems when it was sold to GE Healthcare for $1.2 billion, who will help us drive this strategy.

Ferrer Freeman & Company has been an investor in several healthcare IT related companies that were acquired by large entities, including PHNS (now Anthelio), Vitalize Consulting Solutions, and Webmedx. What do they bring to the table to enable the next level of Arcadia’s growth?

In addition to growth capital, FFC provides a deep understanding and strategic focus on the business of healthcare, having invested in more than 35 companies exclusively in this market. They have a broad network of senior executives in Arcadia Solutions’ target marketplace who have been very engaged in the direction of the business. They also have a committed partnership with management that is passionate and involved in the direction and growth of the company.

How has the company’s business changed over the years since HITECH went into effect and how do you see it changing in the next few years?

We do not see HITECH as the primary driver of the business. Our firm’s direction of focusing on measurable adoption and aligning IT with cost and quality was well established before HITECH was conceived and our rapid growth preceded HITECH.

While we think HITECH is directionally correct and consistent, it is not a primary reason our customers buy from us. Our customers in general have a broader purview and mission with respect to transforming healthcare with IT and this is reflected in our consistency of offerings and performance pre- and post-HITECH.

Arcadia has been involved with 2,500 EMR implementations in physician practices. What are the most important trends you’ve observed that you have incorporated into the company’s strategy?

We believe the industry in general has focused too much on the technology aspects and not nearly enough on the people. As a result, the definition of “done” is when the systems are live. Our definition of “done” is when the data in the system has reached a certain level of quality.

We also believe very strongly — and our data confirms — that the technology chosen can have very little to do with the ultimate results in terms of better performance, more efficiency, and happier physicians.

Scarcity of specifically trained resources and tight timelines driven by HITECH have created a healthcare IT consulting boom, which has in turn led to several high-dollar acquisitions. How do you see the healthcare IT consulting market playing out over the next 5-10 years?

As with all markets, there will be highs and lows, winners and losers. Our strategy is to stay laser focused on providing services with proven and measured value and results while building a great company in the process. The rest will take care of itself.

We are very confident that the healthcare market faces a very long road in getting completely wired and connected with IT and adapting and optimizing the business and delivery model in parallel. I have not met anyone close to this problem that thinks that HIT is not a growth market for 10 more years.

Morning Headlines 11/14/12

HITPC Stage 3 Request for Comment

ONC issues a request for public comment on Stage 3 Meaningful Use rules.

Carlyle, Blackstone, TPG bid for Allscripts

Three private equity firms have submitted second-round offers but there is no guarantee of a deal as Allscripts asks for a significant premium over its current trading price.  

Cerner Receives FDA Clearance for Mobile Fetal Monitoring Solution

Cerner receives FDA 510(k) pre-market clearance for its Cerner FetaLink+ mobile fetal monitoring solution.

Texas Hospitals Select Healthland Centriq for Complete Electronic Health Record Solution

Medina Regional Hospital (TX), Red River Regional Hospital (TX), Ward Memorial Hospital (TX), and First Street Hospital (TX) choose Healthland Centriq, adding to the company’s total of more than 70 rural Texas hospital customers.

HHS announces first external class of the HHS Innovation Fellows Program

Six fellows will spend the next 12 months working with HHS on national projects including: accelerating clinical quality measures for ACA, building a more resilient health technology infrastructure to withstand natural disasters, and a national organ transplant tracking system.

News 11/14/12

Top News

ONC releases the draft of the proposed Stage 3 Meaningful Use rule.

Reader Comments

From Minnie Mouse: “Re: NextGen User Group meeting. Over 4,400 attendees have descended on five Disney resorts in Orlando.” The NextGen folks sent over a few pics and we are running a Twitter feed box with meeting updates. The company honored the winners of its innovation awards Monday evening, which included the Flemington, NJ-based Hunterdon Healthcare Partners (above) as Grand Champion. Attendees tweeted positive comments about the food, the presenters, and the enhancements being previewed.

From SideWays: “MyWay contract. Will Allscripts let MyWay users out of their contract if they choose not to migrate to Allscripts Professional?" We’ve asked Allscripts for clarification.

From Peter Potamus: “Re: Allscripts. John Gomez has been consulted by some PE companies asking for guidance and insight into MDRX, and possibly the idea of his returning as CEO. He is getting tremendous pressure to step up, take the helm, and reinvent the company as he did during his early tenure at Eclipsys. I wish he would take it on, but so far he has been resistant. In the Sunrise XA days, he galvanized the client base, rallied the employees, and delivered all he said he would, inventing the App Store, Helios, Objects Plus, and much more.” I’m going to keep my response guarded since Allscripts is publicly traded. I have reason to believe that one or more of the PE companies with an interest in bidding for Allscripts may have approached John for advice that may or may not have included discussion of a possible role if the acquisition moves forward. That’s hardly surprising – if I were a PE guy, l would be calling up departed executives such as John, Jay Deady, Phil Pead, Bill Davis, and maybe even John McConnell for an arm’s length opinion about what they think needs to change to make the company successful. They could also read the advice of the HIStalk Advisory Panel. Or yours, if you’d care to leave a comment – I have a lot of readers who are VCs, equities analysts, etc. so make me proud by showing them how insightful you are.

From Stock Doctor: “Re: cartoon. Thought this was amusing.” I like it.

From Country Lane: “Re: Geisinger. I’ve heard rumors that they will release a commercial product aimed at the ACO market.” Geisinger Consulting Group offers software-related services, but I don’t know if the health system is selling software directly. It doesn’t seem like their core competency, but that doesn’t mean they aren’t doing it.

From G.E. Smith and the SNL Band: “Re: GE Healthcare IT. Layoffs coming, the third large one this year. The Centricity Business line is rumored to be heavily impacted again. Software development for various imaging product lines will likely also be cut. Tragic for employees, unfortunate for customers. In any competitive industry, failure to innovate=death. In this case, GE Healthcare has chosen assisted suicide at the hands of Epic and other more agile competitors.” Unverified.

From Fly on a Wall: “Re: GE Healthcare IT. Rumor has it they’re dumping people (layoffs Wednesday) and capital to prepare for a potential acquisition of a large healthcare IT company that McKesson was rumored to be acquiring last week.” Unverified. The subjects of the McKesson rumor that appeared here were athenahealth and Greenway. Monday’s stock market action gave no hints that ATHN is in play (shares were down in a down market), but GWAY shares rose 2 percent on no news other than a management overview. That’s interesting, but probably means nothing.

From HITEsq: “Re: American Hospital Association. They’re very litigious, with dueling complaints filed in federal court with SSI Group. SSI Group seeks declaratory judgment that the UB-04 codes are not valid copyrights or that any protection ‘is extremely thin.’ AHA filed suit against SSI Group for copyright infringement.”

From Karl Marx Brothers: “Re: ONC. It would seem like a good time to look at the return on investment of ONC. In 2009, this office had a budget of $67 million. I am told that in FY 2012 the budget was over $2 billion. While I understand some increase was needed, this seems excessive in a time where a balanced budget is becoming increasingly important. Do we really need masses of beltway bandit consultants working on HIE interoperability issues, such as communicating lab results, that were solved 10 or more years ago?” According to FY2013 budget documents from February 2012 (the only documents I found), ONC requested 191 FTEs and $66.3 million for 2013, up $5 million from 2012.

From EpicBuzz: “Re: HCA. One HCA hospital went live on Epic earlier this year and now Epic is quietly assembling an implementation team to begin rolling out more facilities. Can they be successful with this huge win? As a former Epic employee, they already seemed stretched to meet customer needs – I was working 70+ hour weeks when I left. This large of a commitment will be a test of their strength for sure.” HCA hasn’t confirmed plans for further Epic rollouts beyond the pilot, or at least the several HCA people I asked said they didn’t know anything about it. Epic is the only vendor that has demonstrated an ability to rapidly ramp up without apparently loss of quality, but HCA has a couple of hundred hospitals and that would indeed provide the ultimate test of turning thousands of brand new liberal arts grads into healthcare IT experts via a short company training program. I don’t think the already-stretched Epic-certified talent bank can even begin to handle a multi-year HCA rollout if it happens, so that probably means a salary war to lure people over. That might throw some disarray into Epic’s carefully managed centralized contractual control over people seeking new opportunities without a waiting period. I don’t have enough fingers to count the percentage of US patient volume that Epic will have if indeed it does land the HCA whale. 

Photo: Michael Henninger/Post-Gazette

From Grizzled Veteran: “Re: UPMC. How is this possible?” UPMC reports Q1 revenue of $2.5 billion, up $39 million, but the real eye-opener is its $300 million net revenue swing from –$120 million a year ago to $180 million. Kaiser Permanente also turned in good quarterly numbers, with $12.7 billion in revenue vs. $11.9 billion and operating income of $561 million vs. $320 million. KP’s net non-operating income got a huge pop from investments, swinging from a $365 million loss last year to a positive $242 million in Q3.

From MadisonHIT: “Re: Dean in Madison. I’ve heard indirectly that they are laying people off and blaming Obamacare because 100 doctors are leaving because ACA doesn’t let them place patients first. Supposedly this is a nationwide occurrence since the election. Anyone hearing anything similar?” I haven’t heard that, but I’m all ears.

HIStalk Announcements and Requests

I’m running “Morning Headlines” early each weekday on HIStalk, a quick summary of the handful of most important news items you should know about. You won’t get an e-mail blast – just go right to the site. If you’re in a hurry or need a quick smartphone HIT news check while eating breakfast at your hotel, this is the place.

Acquisitions, Funding, Business, and Stock

A Reuters report quotes unnamed sources who say that three private equity companies placed bids last Friday to acquire Allscripts: Carlyle Group, Blackstone Group, and TPG Capital. The sources said that Allscripts is asking for a premium to the current share price and a deal isn’t guaranteed for that reason. It also said that Bain Capital declined to bid because of unreasonable price expectations and company management turmoil. Shares closed Tuesday at $12.32.

EarlySense Ltd., a maker of patient monitoring sensors, completes a $15 million Series E financing round.

Emdeon reports Q3 loss of $15.2 million, which represents a 341 percent decline over a year ago. Revenue was up 5.3 percent to $297 million. Emdeon attributes the loss to increased interest expenses and costs associated with the company’s acquisition by Blackstone a year ago.

InterSystems opens an office in Riyadh, Saudi Arabia to support its TrakCare EMR system.

QualComm Life announces availability of its cloud-based health device connectivity solution in Europe.

Sales

Lake Health (OH) selects Accelarad’s SeeMyRadiology.com imaging management and storage solution.

Orlando Health contracts with Phytel for its Atmosphere population management suite, including the Outreach, Insight, Coordinate, and Transition products.

Erie County Medical Center (NY) selects Merge Healthcare’s iConnect Enterprise Archive and iConnect Access for real-time access to images and information from Meditech.

Medina Regional Hospital (TX), Red River Regional Hospital (TX), Ward Memorial Hospital (TX), and First Street Hospital (TX) choose Healthland Centriq, adding to the company’s total of more than 70 rural Texas hospital customers.

Central Washington Hospital (WA) selects patient privacy monitoring tools from FairWarning.

People

Zynx Health announces that President and CEO Scott Weingarten, MD (left) has resigned to return to Cedars-Sinai Health System. He will be replaced by First Databank President Greg Dorn, MD (right), who will run both of the Hearst organizations.

Awarepoint names Vanguard Health Systems Vice Chairman Keith B. Pitts to its board of directors.

Apprio names H. Allen Dobbs, MD (HHS) CMIO.

Announcements and Implementations

McKesson renames Horizon Surgical Manager to McKesson Surgical Manager to convey that the product is not specifically tied to the Horizon product line.

FDA issues Cerner 510(k) pre-market clearance for its Cerner FetaLink+ mobile fetal monitoring solution for the iPad and iPhone.

Piedmont Healthcare and WellStar Health System (GA) create the Georgia Health Collaborative, a partnership which includes 10 hospitals and over 700 physicians. The organizations will remain independent, but will partner to share best practices and create innovations and cost reductions through economies of scale.

Intelerad will offer Nuance’s PowerScribe 360 voice-enabled reporting radiology system to customers of its imaging solutions.

Galaxy Health Network will offer its 400,000-member physician network iMedicor’s SocialHIE, a NHIN Direct-powered secure messaging service that the company calls “the social network for healthcare professionals.”

Steward Health Care System (MA) expands its use of Craneware’s Chargemaster Corporate Toolkit and InSight Audit across 10 hospitals.

Over 1,000 physicians across 422 practices have joined Michigan Health Connect and are using Medicity’s iNexx Referrals app.

The Upper Peninsula HIE goes live on ICA’s CareAlign CareExchange interoperability platform.

An article in the Sarasota newspaper profiles Voalte, including its $6 million in recent funding, the planned tripling of its headcount and physical space, and hints of major new sales in 2013. It says the smartphone hospital communications system vendor is doing $10 million in business annually. Sarasota Memorial Hospital nurses are sending 600,000 text messages and 6,000 telephone calls through the system each month.

Visage Imaging’s mobile viewing app has been enhanced to support the iPhone 5/iOS 6. It’s available in the Apple App Store.

Government and Politics

HHS announces the first class of the HHS External Innovation Fellows, who will spend the next six to 12 months building systems and infrastructure to solve such issues as the acceleration of clinical quality measures for the Affordable Care Act, building technology to withstand natural disasters, and devising electronic tracking and transport systems for the national transplant system. 

Innovation and Research

A Detroit TV station covers research commercialization at University of Michigan, including a profile of real-time patient monitoring software vendor AlertWatch. AlertWatch, used by UM Hospitals and awaiting FDA marketing approval, was developed by a UM doctor who also invented the pulse oximeter.

Other

The president of New York’s public hospital system says it will cost more than $300 million to repair damages from Hurricane Sandy. Full restoration of the hard-hit Coney Island and Bellevue Hospitals will take two to three months.

Here’s a time lapse video of the audience filing in for Monday’s opening session at NextGen UGM 2012 in Orlando.

London-based Future Lab Group launches the FlipPad, a medical grade, ruggedized case for the iPad that’s being piloted in several NHS hospitals.

Bart Harmon MD, chief medical officer for Harris Healthcare Solutions and former Military Health System CMIO, writes a Forbes Veterans Day editorial on the use of healthcare IT to deliver care “both in the field and when they return home.”

In Greece, several hospitals lose their connection to the outside world when protesting students break into the data center and disable servers.

Employees and patients of Cincinnati Children’s Hospital create a video dubbed to Flo Rida’s “Good Feeling.”

Steve Sinofsky, the president of Microsoft’s Windows division and one-time CEO heir apparent, is leaving the company just a few weeks after the launch of Windows 8.

Guaranteed doctor blood pressure raiser: Lawsuit Settlement Funding Company hires a marketing company to help it find medical malpractice victims. The company offers malpractice plaintiffs quick-approve loans of up to $250,000 as an advance against their potential court winnings.

The son of a woman who died after knee surgery at a Massachusetts hospital files a HIPAA complaint, saying that rounding students visited her room without the family’s permission. He also tries to file homicide charges against the hospital and doctors, but police said it’s a civil matter. The son’s song tribute to Fenway Park is played before Red Sox home games, while his mother starred in the song’s video along with William Shatner just before she died.

One Medical expands to Boston, offering concierge medicine for $199 per year whose consumer-friendly experience includes online appointments and e-mail contact with physicians. Unlike most organizations of that type, they accept insurance.

A Chinese man sues his former wife after she gives birth to an “incredibly ugly baby.” He initially accused the mother of having an affair since the baby did not resemble either of them, but later found that his wife’s beauty was due to the $100,000 in plastic surgery she had prior to their marriage. The judge ordered the woman to pay her ex $120,000 for tricking him into marrying her. I hope she hits up the plastic surgeon for a loan in exchange for all the free publicity.

Sponsor Updates

• Transplant solutions vendor OTTR Chronic Care Solutions exhibited at last week’s National Marrow Donor Program conference in Minneapolis. That’s Joy Nock above.
• Five care management solutions providers featured in a recent market report use consumer health education tools from Healthwise.
• Versus offers a Webinar  that highlights the use of Versus RTLS by Northwest Michigan Surgery Center.
• MedHOK enhances its care management, quality, and compliance system by incorporating HTML5.
• Informatica introduces Cloud Winter 2013, which includes enhancements in master data management and end-user integration.
• Prognosis Health Information Systems will integrate Health Language’s provider-friendly terminology and Language Engine into its EHR suite.
• Frost & Sullivan recognizes Humedica for its innovative approach to clinical data analytics and the value it provides to clients.
• Emdeon exhibits its Edge payment solution suite and offers educational sessions during this week’s National Health Care Anti-Fraud Association conference in Anaheim, CA.
• T-System’s VP of Revenue Cycle Management Compliance Greer Contreras discusses the value of relevant clinical documentation to ensure proper reimbursement in a guest article. 
• UK HealthCare (KY) licenses Vendor Selection, Systems Implementation, and Program Management Methodologies from Fulcrum Methods.
• Merge Healthcare updates its Merge Eye Care PACS to support video and the DICOM OPT standard.
• The Nashville Chamber of Commerce and Entrepreneur Center recognizes Cumberland Consulting and Emdeon with 2012 NEXT awards for their significant growth in revenue and employees.
• BridgeHead Software’s file archiving data and storage management systems for PACS is successfully tested by Fujifilm.
• The Huntzinger Management Group streamlines its services offering to include RCM offerings from both its Advisory Services and Managed Services segments.
• CareTech Solutions introduces CareWorks, an out-of-the-box content management system for smaller hospitals.
• Brad Levin and Malte Westerhoff, PhD of Visage Imaging were featured in an Imaging Biz article called “The High-performance, High Speed Enterprise Viewer.”
• Worcester Business Journal awards eClinicalWorks top honors for its employee rewards and recognition.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Morning Headlines 11/13/12

Zynx Health President/CEO Scott Weingarten resigns 

Zynx Health announces that President and CEO Scott Weingarten has resigned and will be replaced by First Databank CEO Greg Dorn, who will run both of the Hearst organizations.

Less Than a Month After Launch, Windows 8 Head Steve Sinofsky Departs 

Steve Sinofsky, president of Microsoft’s Windows division and rumored favorite to eventually replace Steve Ballmer as CEO, departs unexpectedly amid rumors of a deteriorating relationship with the executive level.

VA head envisions big improvements in backlog 

VA Secretary Eric Shinseki reports that problems integrating the Department of Defense and VA electronic health records systems, which caused a massive backlog of health benefits claims, have been resolved.

Healthcare provider attitudes towards the problem list in an electronic health record: a mixed-methods qualitative study

Harvard study recommends defined policy on using problem lists, finding that their use is incomplete because physicians don’t necessarily agree on what they should contain for specific cases and who should be responsible for maintaining them.

Curbside Consult with Dr. Jayne 11/12/12

Bianca Biller and I recently traveled to a continuing education seminar out of town. Although the trip started out as a lot of fun (the flight attendant actually asked me for ID before allowing me to have an adult beverage), it quickly turned dark as we began discussing the challenges faced by ambulatory physicians.

Once again, there is a looming Medicare pay cut. Although Congress has overruled this annually since 2003, it’s nerve wracking to face the medical practice equivalent of the Fiscal Cliff. Based on our recent election cycle, I don’t have a lot of hope for a permanent fix any time in the near future.

Providers who haven’t yet gotten with the program are starting to see their e-prescribing penalties become reality. Although this shouldn’t be a surprise, physicians are still grumbling and generally behaving badly.

Bianca is seeing an increase in prepay audits for high level visit codes – claims are processed and denied (who doesn’t love a zero payment?) with a reason code that requests records. For physicians who don’t have savvy billing staff paying close attention to the reason codes, this could be a problem. Payers have different time limits for receiving the supporting documentation – the clock is ticking, so it’s key to be aware of the different requirements.

This is almost certainly fallout from the transition to HER. At least in our organization, providers are actually billing for the work they do and document instead of under-coding as they have been for more than a decade. It’s sad that this is perceived as potential fraud instead of a move to capture more accurate billing.

Although we’ve started to see some recovery in office visit numbers (which have been nationwide the last several years) the holiday season is upon us, which usually results in a downturn in productivity. Although patients have met their deductibles they’re busier and have less time to be seen for non-emergent issues. This is also the time when physicians and staff tend to take vacation, which can lead to increased charge lag. It’s important to make sure documentation is done and charges are billed to keep cash flowing into the New Year.

The “usual suspects” of ACO, PCMH, and ICD-10 continue to be wolves at the door. Hopefully your house is made of bricks rather than straw and you have your plans shored up to be compliant with the different nuances of each program.

There is one ray of sunshine on the horizon. Medicaid rule CMS-2370-F increases Medicaid reimbursement rates to equal Medicare for key specialties: primary care, general internal medicine, family medicine, and pediatrics. Although positive, it’s both a slap and a kiss in some markets where Medicare payments lag far below commercial.

Ultimately the trip was good, the weather was sunny, and we actually learned quite a bit at the conference. We also had time to discuss our projects and goals for the next year, which we never get to do at the office despite being in countless meetings together. Here’s to good friends, strong teams, and another year in healthcare.

E-mail Dr. Jayne.

HIStalk Interviews Janet Dillione, EVP/GM, Nuance

Janet Dillione is executive vice president and general manager of the healthcare division of Nuance Communications.

How do Nuance’s recent acquisitions of Quantim and J.A. Thomas and Associates tie in with the company’s long-term plans?

For long-term plans specific to the Healthcare Division, we are quite interested in having a positive impact on clinical documentation, especially bridging the world between the clinicians and what you could call the administrative processes of healthcare. That crosswalk, if you will, from clinical documentation to CDI to reimbursement.

I think we are fortunate we have quite distinctive technology to help here. Along with speech, we have our clinical language understanding technologies. We think we are in a unique position to help. As I always like to say, we are morally compelled to leave it better than we found it, so let’s get in here and take a look at these processes and the software and the support and then let’s try to have a positive impact here and help the customers.

Earlier this year, Nuance partnered with 3M for computer-assisted coding. How is the J.A. Thomas acquisition going to impact the relationship with 3M?

3M and Nuance will remain partners. This is not unusual for Nuance. We’ve done this across other lines with businesses like radiology, where we’re both probably called a full-stack workflow provider as well as a technology provider. We are quite comfortable doing that. We’ve done it before and we’ll continue to do that. Right now, there will be no changes.

In addition of Quantim and J.A. Thomas, earlier this year Nuance acquired Transcend, which had purchased Salar. What overlaps, if any, do you see with these products?

Transcend for us is very much about an expansion and an extension into the mid-market. We have a channel strategy that’s really a customer-based expansion, a mid-market expansion with our traditional transcription line of business, great KLAS scores, great customer reputation, great customer relationships. It is really about that. 

The Quantim and the J.A. Thomas acquisitions are about filling out that clinical documentation support, which we can then take into that broader Nuance customer base. Transcend was absolutely about getting a great brand and a great customer base and that has had success. These latest two were really about clinical documentation expansion with the CDI.

I understand that there is quite a bit of development work that is still being done on the Quantim CAC offering. What is the timetable for completing that product?

A good amount of work has already been done. There is development and different types of work and some building up of content and knowledge. The other part is really doing some of the underlying plumbing, sort to speak.

The Quantim team had done quite a bit on the knowledge and the content side of it, so we have a very aggressive plan to be in market. We have product in the market now with Quantim and we’ll continue that and will have further releases the end of the year and early next year. We adapted some of the changes with what we believe is an uplift in technology. The developers are working together on this and have been working on this already for quite a bit. We have a very good idea of exactly what has to happen. We’re very positive about what we need with this one.

Do you anticipate that any of the other Quantim products will be retired or changed substantially now that they’re under your wing?

With Quantim, we’re looking at what they have available for coding and CAC and compliance and reporting modules. We think all of those are well suited. There is some integration work we’ll do, especially in some of the reporting, but we actually feel that in most areas there’s no overlap. It’s not part of the integration plan and it wasn’t part of the due diligence.

We don’t see overlap. We see net new. We actually said this throughout the acquisition plan. This is all about going forward and there’s not a lot of the reverse energy, so to speak.

We understand that MModal may have had some type of relationship with Quantim for CAC. Any plans to maintain that agreement?

I would hate to speak for MModal for any prior agreements, but the CAC solution in the market will be with Nuance technology.

Nuance has been continually diversifying its offerings. Do you see any plans to move into the HIS or RCM world?

[Laughs] Right now we are very focused on providing a unique value-added solution into this very complex world of CDI and clinical documentation and CAC. We’ve made quite an investment here and throughout the market. We’re going to be very focused for quite a while making sure we get these solutions out to the customers.

Any additional comments?

I have been here two years. It’s been great. We are blessed. We have fantastic customers, a phenomenal customer list. Great loyalty with our customers, great trust, which is fantastic. We take it very seriously.  

We didn’t make these extensions, these decisions, lightly. We have a brand that we are very conscious of. We think that this is a space where we can add value. We are excited about it.

I was at AHIMA for three days. I was quite frankly really pleased with the market reaction. Customers coming up and saying, “Great, I get it.” It’s so great when we do something that’s significant and have customers say, “I get it. Wow! I get it. That makes perfect sense.”

That was very validating. These are smart people who have been in this space for years, so it’s helpful when you get that kind of a market reaction. That validates the long hours working into the night.

HIStalk Advisory Panel: Recent Vendor Experiences 11/12/12

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

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

This month’s question: Have you had notably good or bad experiences with a vendor lately or worked successfully with a small or little-known vendor that deserves exposure?

Allscripts

Notably bad experience:  we do pay considerable software and maintenance fees to Allscripts. Typically, software and maintenance fees include either "free upgrades" or minimal costs. We’ve just been told by Allscripts that to move from their MU product (11.2) to MU stage 2/ICD10 functionality (11.4), the cost for the upgrade will be six figures! Not sure if any other vendor in the ambulatory space is priced like this, but it seems pretty steep!

Aspen Advisors

Aspen Advisors is not a household name in HIT consulting and has also done great work for us. Outstanding practice leadership, strategic advice, senior PMs and analysts, and high integrity. Not a body shop.

The Breakaway Group

The Breakaway Group.  They have come in and provided a very measurable training methodology that focuses on end user adoption.

Cerner

Cerner deserves enormous credit for working creatively with me to reduce our Cerner TCO, as well as modifying their products to meet some very unique aspects of care in our environment. In the eight years that I’ve worked with Cerner across two different organizations, Cerner has dramatically improved their culture of customer support and commitment. At one time, I thought my Epic customer service would never be surpassed, but in the last three years, Cerner met it and blew right past it, especially in terms of willingness to help optimize our current products and co-develop new functionality that was critical to my environment.

I’ve been working with Cerner for a few years now, and it’s looking like the competition from Judy has forced them to up their game quite a bit. They are headed in the right direction, albeit slowly and expensively.

My primary experience lately has been with our hospital’s EHR vendor, which is Cerner. On the software side, the product is still poorly designed and clunky with some clear flaws that impact safety and clinical decision making. But those things have been fairly constant for years so not really notable. However, I assume that "notably good or bad experiences" refers to the relationship to the vendor’s personnel and not to the experience with the product per se. The vendor sales group, mid-level and high-level liaisons have been very attentive recently. Our high-level administrators (as well as the entire clinical staff) was quite distressed with the vendor a few months ago when the remote hosting service had several lengthy unanticipated downtimes. Also, the vendor has been working with our administration on developing a rather significant ($$$) new contract. Based on past experience, I suspect that the level of attention will revert to baseline as the ink dries on the contract and the memory of the downtime disaster becomes distant.

Computers Unlimited

Had a nice experience on disputed after hours extra charges with the small vendor Computers Unlimited, related to their CPR+ product in the home medical, durable medical equipment space. We are starting to look more and more at vendors that want to charge extra to do support or maintenance work ‘after hours’, since in the healthcare systems, this should be the norm and not the exception for change management windows.

Craneware

The folks at Craneware produce an awesome suite of revenue cycle management products for a very reasonable price, backed by a great culture. They are quietly one of the best software vendors I’ve ever worked with and will become an increasingly important product line on the CIO’s radar screen as the industry transitions into P4P and value based purchasing.

DFB Consulting

We recently contracted with a firm called DFB Consulting to convert clinical data out of Allscripts Enterprise into Epic. They have quite a cottage industry in this area with so many customers switching. They did an outstanding job of something I thought was going to be a nightmare. 

Elekta

We have had a very difficult time with our medical oncology vendor Elekta recently. As a niche vendor in this space, there was hope that they would provide a strong clinician-focused product. However, they show a lack of change control that results in upgrades being very painful with many session crashes and system response time problems.

Emdat

Emdat, who I noticed recently became a sponsor. I’d give them a thumbs up even though we didn’t go with them. We decided it was too disruptive of a change for the physicians with everything else we’ve thrown at them recently.

Epic

We went live recently with Epic. They delivered what they promised and more, which I found refreshing and unique when compared to past experiences with Cerner, Allscripts, and Meditech.

Explorys

Explorys. We are in the implementation phase, but so far, wow. Best vendor experience I have ever had during an implementation.

Hielix

One vendor that I worked with and I have grown to love and respect as they have never stirred me wrong is Hielix. They have a plethora of experience under their belt and they like to think  of themselves as " the healthcare aggregator!" They deserve your attention and maybe even an interview.

iSirona

MModal and iSirona are two companies we’ve been working with lately. Both have been very positive experiences.

Make Solutions, Inc.

Make Solutions Inc. They supply tools and services geared to improve the transitions that end users go through with each new implementation. The tools assist with process-based testing and role-based curricula development.

MModal

MModal and iSirona are two companies we’ve been working with lately. Both have been very positive experiences.

Phreesia

I have used Phreesia as a consumer/patient in my MD’s office. They put Phreesia on the front end in the waiting room on top of their Allscripts system. They hand you an iPad and a stylus and you zip through updating any new
info, demographic, insurance info, medical changes, etc. As I walked up to the front desk to hand the front desk clerk my iPad, the door opened to the back and the nurse called me. I literally sat in the chair only for the time it took me to tap away on the iPad, probably 5 minutes, and then I was in the back getting my physical. Very easy to use, quick, and great integration to the EMR.

SAIC/Vitalize

Vitalize (now SAIC) supplied 20 Epic-experienced physicians mostly from Allina for at-the-elbow support for two weeks round the clock at our hospitals’ big bang. Wasn’t inexpensive, but the white glove treatment was well worth the investment.

Sayers

We’ve had some pretty positive interactions over the past few years with the company Sayers which would likely qualify as a "little known vendor." We have utilized their services to assist in our tech refresh for end user devices and a few other areas. They seem to provide a high value (low cost vs. services rendered) and their management has always been extremely responsive with rapid and satisfactory resolution to even the smallest of issues brought to their attention. I have particularly had positive experiences with John Kasser, Chris Martinez, and Joe Martinez at the management level in their organization.

Siemens

Siemens has shown great flexibility and willingness to work together, nice surprise

Siemens MobileMD

We are extremely impressed with MobileMD. First rate and affordable private HIE. They are highly ranked in KLAS and now that they have Siemens behind them the future looks even better.

TheraDoc

TheraDoc has continued to deliver for our infection control staff. Our organization has continued to exceed goals in the reduction of healthcare-acquired conditions. At some point we see this potentially moving to our overall EMR vendor suite, but TheraDoc continues to work very well and is a very mature solution compared to the enterprise vendor in this particular area.

Virtual Procurement Services

The only small and little known vendor that I’ve been so impressed with is the one I mentioned above who helps me with our maintenance and other purchasing negotiations, Virtual Procurement Services.

Vitera

 

We are in the process of evaluating ambulatory EHR vendors for primary care clinics owned and operated by our organization. Vitera has been slow to respond throughout the entire process. I’ve expressed my disappointment in their lack of response but haven’t seen much change. They have a number of existing implementations in this area and the customers I’ve spoken with have expressed a decrease in service levels over the last year. They are obviously experiencing management issues, either from the surge
of sales due to MU payments or integration issues from their string of acquisitions (or a combination I guess).  Either way, I’m concerned about their ability to keep up with the rest of the pack. 

Zynx Health

After a somewhat rocky initial relationship, Zynx has really stepped up to the plate. They’ve taken a hand-on approach to getting our order set maintenance process back on track, committing a lot of consulting hours gratis to help compensate for our own lack of resources. We’ve been impressed with their willingness to go the extra mile on our behalf as they become more of a business partner rather than just a purveyor of content.

Morning Headlines 11/12/12

UnitedHealth deal draws concern

Sen. Orin Hatch raises concerns with HHS Secretary Kathleen Sebelius about the acquisition of an IT company that will help build the federal insurance exchange citing potential conflicts of interest.

Guilford business brings telemedicine to the workplace

Online diabetic consultations with physicians from Tufts University were provided to remotely located employees working for a Maine based wood products company.

Dalcon changes name to Amplion, adopts new hospital alert mission

Dalcom Communications Systems raises $3.75 million, changes its name to Amplion Clinical Communications and reinvents business mission to target clinical communications market.

Digital Health Entrepreneur Survey

A survey of health entrepreneurs identifies reimbursement, government, and Epic/Cerner as being the top three barriers to health innovation.