News 7/1/11

Top News

  Third-party firms that implement vendors’ applications outperform the vendors themselves – except in the case of Epic. Deloitte earns the highest overall marks among third-party firms in KLAS’s survey. Coastal and Peer Consulting outscored GE in overall customer satisfaction by 30 or more points; ACS and Vitalize beat Allscripts by 20-plus points, and Encore and Vitalize outscored Cerner by 20-plus points. Epic outperformed them all.

Reader Comments

 

From Johnny “Hot Rocks” Garcia: “Re: making appointments online. Check out ZocDoc and take note of its investors!” ZocDoc allows searching for doctors within a ZIP code by specialty and accepted insurance. It’s pretty cool, although available only in eight metro areas so far. They have an iPhone app. Investors include The Founders Fund (run by the founders of PayPal, Napster, and Facebook), Jeff Bezos (Amazon) and the chairman and CEO of Salesforce.com. 

From Glenergy: “Re: Allscripts. A new general counsel – Jackie Studer from GE.” Unverified.

From Jordan: “Re: copied medical records. Kind of expensive for an electronic copy.” Texas Health Resources charges state-mandated fees for medical record duplication: $42.05 for the first 10 pages of a paper record, $64.07 if they’re on microfilm, and a flat fee of $76.20 for electronic records requested in electronic form. The state may set the price, but I would have to guess hospitals had input into the rather large numbers. That makes the paper statements of banks look like a great deal, although their free online option isn’t even offered by hospitals. Charging more for an electronic dump is odd, although if you’ve looked at a hospital chart, your $42.05 isn’t going to go far considering the stacks of paper that go far beyond 10 pages. Maybe they should just charge law firms 10 times that amount and let patients have copies of their own information at no cost. Most hospitals think they’re doing patients a big favor by letting them see what they’ve written about them.

From Viking: “Re: GE Healthcare. A marketing director friend had their job eliminated this morning, saying there’s a sweeping org change underway.” Unverified. GEHC doesn’t respond to personnel rumors, so I didn’t even bother asking.

From Terminator: “Re: PHRs. I wonder if their functions are gaining ground as standalone apps that people actually do use? For example, Walgreens keeps all my prescription records and I can access them from anywhere, so I have no reason to import them to a PHR. I use an online tool for diabetes logging, although it would cool if it were updated automatically from any meter I use. If I see a glucometer that allows batch uploads of data to a site like this one, I’m grabbing it! That’s all I want in a PHR except for lab data and the ability to communicate with providers, but patient portals are adding PHR-like features as well, some of which have access to data and have appointment-setting tools.” That’s the big debate – would consumers prefer an independent but minimally functional tool like Google Health or one that’s rich in function and data, but tied to a specific provider? So far, they seem to be saying B (and who can blame them, given that both are free?) Notice above that Walgreens even offers online pharmacy chat right from the public Web page, although it would be interesting to know who’s on the other end.

From LaidOffInDallas: “Re: UT Southwestern Medical Center. Just laid off several IT employees.” UT Southwestern just announced that, due to the loss of $31 million in state funding, it has cut 350 staff positions, laying off 105 employees.

From Former CIO: “Re: Epic art. I would suggest that Mr. Ciotti’s opinions about wasting client money are focusing on the wrong target. The vendors who are wasting money are those that spend more on marketing and less on development, thus producing products that are not integrated and do not support patient care needs. Perhaps the artwork enhances employee attitudes and they get more work done for the money. The cost of the product is a fraction of the true cost of ownership when one considers clinician time and effort. Even so, the cost of the product is still competitive.” At least Epic is sharing the investment with employees instead of hogging the goodies for its executives in a “we’re better than you” kind of way, such as companies that give the suits reserved parking spaces, private bathrooms, and offices that would hold 20 of the veal pen cubicles that the real workers toil in. I can’t vouch for Judy’s office since I haven’t seen it, but I picture it as quirky but modest. That’s a fun challenge: e-mail me with a description of the top dog’s office wherever you work – I will run them anonymously. If they have really splendid digs, make sure to snark it up some.

HIStalk Announcements and Requests

Stuff you’ll want to check out this week on HIStalk Practice: Micky Tripathi details the difficulties associated with tracking and reporting clinical quality measures for Meaningful Use. HHS halts its mystery shopper program for measuring access to primary care. Experts suggest reasons practices are behind schedule for the HIPAA 5010 transition. Dr. Gregg struggles with HITECH guilt and living on the dole. Costco jumps into the EHR world with deals on Allscripts MyWay. AAFP launches its $90/year clinical messaging system. While you are over on HIStalk Practice, sign up for the e-mail updates like the rest of HIT’s coolest kids.

Listening: reader-recommended Belle and Sebastian, 70s-style indie pop from Scotland. A nice sample is here, if you can overlook the fact that the preachy announcer sounds like Mike Myers playing the Scottish dad in So I Married an Axe Murderer.

I’m thinking about refreshing the look of the site and maybe even changing the smoking doc logo in some way. I’ve been using this layout for years, and while I don’t really care all that much one way or another, I guess it’s time for an update (I think Inga is interested). If you have ideas, let me know. Most of the responses I’ve received in the past have been of the “don’t change anything” variety, so that’s the default course of action to challenge. 

I’ll probably publish a Monday Morning Update even though it’s Independence Day (please call it that rather than the Fourth of July). You can amuse me over the weekend by connecting on LinkedIn and Facebook, signing up for e-mail updates, or just checking in to let me know that I’m not the only one with HIStalk on my mind. Have a great holiday. I’ll be taking a few days off starting next weekend, leaving the fabulous Inga and Dr. Jayne in charge.

Jobs on the sponsors-only Job Board: Director of Marketing – Hospital Segment, Director Sales Operations, Senior Enterprise Sales Executive Hospital Southeast. On Healthcare IT Jobs: CEO & President, Clinical Nurse Analyst, Epic Resolute Consultant.

Sales

Aspirus (WI) signs a clinical documentation contract for MedQuist’s DocQment EP.

University of Utah selects Authentidata Holding Corp. for its three-year telehealth project that includes health information exchange, workflow management services, and remote patient monitoring solutions.

University of Oklahoma chooses OmniMD as a preferred provider for medical transcription services.

VHA signs an agreement with Deloitte to offer RCM consulting services to its 1,350 not-for-profit community hospitals.

Ochsner Health System (LA) signs up for Philips VISICU, which will make it the first eICU program in the state when implementation is finished next year.

Announcements and Implementations

InterSystems names Gila River Health Care (AZ) the winner of its Breakthrough Applications Award for using InterSystems DeepSee BI technology with its Diabetic Analysis Management System.

Scripting automation vendor Boston Software Systems celebrates its 25th anniversary.

Medtronic announces a free smart phone app for its CareLink telemetry system for implantable cardiac devices.

Innovation and Research

Cisco announces its Android-powered Cius tablet, due out at the end of July, with the video above featuring Palomar Pomerado Health Chief Innovation Officer Orlando Portale (starting at around the 41 minute mark). The Cius will cost $700, has no 4G connectivity, has only a few dozen apps available from Cisco’s own store, and is sure to bring up the puzzled question, “Why would I want this instead of an iPad that costs less?”

Technology

Oracle will buy storage startup Pillar Data Systems for an undisclosed price. That company’s CEO and majority shareholder: Larry Ellison, who also happens to be the CEO of Oracle. He claims he recused himself from the acquisition discussions, although he didn’t mention why a guy with an Oracle-generated net worth of $40 billion was off running another company on the side.

Other

The developer of Nashville’s Medical Trade Center says it will not break ground until at least 60% of its space is leased. The developer anticipated this goal would have already been met, but a mere 20% of the space is under contract. Committed lessees so far include HIMSS, Steelcase, and mdi Consultants.

  A Florida doctor who moved to a cloud-based EMR a year ago loses access to the records when his Internet connection goes down. He’s been treating patients blindly for three days so far while Comcast tries to fix his broadband. I’ll predict that ONC won’t make his experience the focus of one of its feel-good EMR stories: “If can’t access a patient’s medical records, I’m afraid in the rush of things I might miss something or not do as good a job as I normally would.” His phones are down, too.

Note to companies seeking to become “leading” suppliers in healthcare: your message tends to be more powerful when you reference the correct vertical market in your press release (unless there’s a connection I missed between vehicle dealers and healthcare). 

I saw a press release about a survey claiming that more than 50% of consumers would choose a hospital based on their Facebook and Twitter presence. I found that hard to believe, so I e-mailed the company to ask for the methodology. They offered to provide it if I bought the report for $1,250. I guess I’ll just remain skeptical.

The coroner says mistakes made at Marin General Hospital (CA) helped kill an ICU patient. A doctor, a respiratory therapist, and three nurses were identified as putting the patient on a ventilator, then leaving the room without making sure it was working. It wasn’t.

A study of electronic prescriptions finds that about 10% contain at least one error, the same percentage as paper prescriptions. I only have access to the abstract, but I notice that (a) the electronic prescriptions reviewed were form 2008 for some reason; (b) the study treated all errors equally, with the most common being omitted information (which causes no patient harm); (c) it looked at “potential adverse drug events,” which could indicate lack of decision support on the e-prescribing end, but not necessarily (for example, I don’t know if they counted potential drug interactions as “errors” if the electronic prescriber of Drug A was the same one who prescribed Drug B, which is not necessarily either prescriber’s fault).

Weird News Andy says this man couldn’t have picked a better place to have a heart attack. He complains of chest pain during a cardiologist’s lecture on heart disease at Central Maine Medical Center, then collapses with no pulse or respiration. One of three cardiac nurses in the room jump starts him with a defibrillator, whereupon he is treated in the ED and is doing fine.

Strange: a former managing director of bankrupt investment banking firm Lehman Brothers is busted for trying to pass photocopied prescriptions for Oxycontin and Ritalin at the local drug store. Police follow his Range Rover to his $35 million home and arrest him.

Not healthcare related, but an indication of pervasive technology. The Pope tweets on an iPad to help launch a media portal. Yes, that Pope. You might want to friend him.

Sponsor Updates

• T-System celebrates its 15th anniversary with a five-video series about the history of emergency medicine and of the company.
• ADP AdvancedMD will expand its workforce by 45% this and add up to 100 new jobs in the Salt Lake City area.
• West Penn Allegheny Health System (PA) will continue its rollout of Allscripts EHR to its employed physicians and begin offering Allscripts MyWay to its 2,000 affiliated physicians.
• East End Health Alliance (NY) and its member hospitals choose MedVentive’s Population Manager for sharing clinical information and monitoring performance against evidence-based medicine. MedVentive also announces that former Massachusetts HHS Secretary Charlie Baker is joining its governing board.
• MEDSEEK enters a strategic alliance with Diebold to offer an automated patient check-in, co-payment, and appointment scheduling solution utilizing Diebold’s self-service kiosk.
• ZirMed earns its highest-ever rating in the most release KLAS rankings. In addition, 100% of its surveyed clients indicated they would buy ZirMed again.
• Indiana University Health Centers select eClinicalWorks for two campuses.
• Iatric Systems announces that its PtAccess, Patient Discharge Instructions, PHR Connect, Clinical Document Exchange, Visual Flowsheet, and PHI Interface solutions have received ONC-ATCB 2011/2012 Certification.
• Capsule’s DataCaptor medical device integration software earns a KLAS score of 90.5 with three Konfidence Level check marks in the 2011 mid-term performance review.
• Washington and Idaho Regional Extension Center (WIREC) includes e-MDs as one of the seven vendors chosen for its initial Group Purchase Program.
• LawLogix joins Perceptive Software’s partner developer network to offer a central document repository with forensic-level audit controls using Perceptive’s ImageNow software, allowing HR departments to manage I-9 and E-Verify compliance requirements.
• A new KLAS report on HIEs names MobileMD as the highest-rated vendor serving the private HIE market segment.

EPtalk by Dr. Jayne

Multiple news outlets (including HIStalk Practice) picked up the announcement that the Department of Health and Human Services is scrapping its “Mystery Shopper” initiative, originally aimed at determining whether physicians’ acceptance of new patients depended on type of insurance. Observant folks will notice they left the door open to bring this one back later though, stating, “we have determined that now is not the time to move forward with this research project.”

I don’t need a bunch of grant money to tell you the answer to the question of “can you get seen quicker with good insurance” is “yes.” And if we’re talking about specialist physicians, the answer is “double yes.”

I practice in a major metropolitan area with multiple health systems, numerous tertiary referral centers, and some topnotch medical schools. From experience, if you are a Medicaid patient who needs to see an orthopedic surgeon or a neurologist, there less than a handful of places that will see you at all, and even then you’re going to wait. Most likely, you’re going to wind up being seen in a residency clinic.

I’m fortunate to work for a health system that doesn’t force employed physicians to cap Medicaid patient panels — we have a mission to care for those in need. As a result, I do more than my share of Medicaid care compared to my private practice colleagues, who may cap at 150-200 Medicaid patients if they even take Medicaid at all (and many don’t). Reimbursement doesn’t cover the cost of the visit, and frankly, I don’t remember the last time my practice made a profit. If not for the mission of the health system and their generous subsidy, I’d have had to go out of business before I ever had a chance to make a go of it.

There are some patients who are working the system, but the majority of my Medicaid patients are folks that have fallen on hard times or have had other life-altering events such as an unplanned pregnancy or a severe medical issue impact their lives. Some of the most rewarding patient relationships I have are with these patients, who are genuinely appreciative of the care they get.

I practice evidence-based medicine and don’t refer unless I have to. It breaks my heart to have patients waiting six months or more to see a specialist when I know that if they had a commercial payer, I could get them an appointment within a few weeks. I’ve been forced to expand my scope of practice because specialists won’t see Medicaid patients. It’s almost like being the Little Doctor on the Prairie when in fact, I’m just a few doors down from Starbucks.

(And thank you to my “generous” specialty colleagues willing to proctor me in expanding my procedural techniques because you didn’t want to actually see the needy patients yourselves. Guess what? I don’t just do them on Medicaid patients now — I keep all the procedures in-house.)

I’d be happy to charge CMS, HHS, or anyone else willing to listen a hefty fee to tell them how to increase access for Medicaid patients. States such as Colorado are already at critical shortages of primary care physicians. Articles such as this should be required reading for the politicians deciding how to carve up the healthcare pie. Some ideas:

• Increase the attractiveness of the primary care specialties by increasing Medicaid and Medicare payments for primary care and other cognitive (non-procedural) specialties. The relatively low primary care salaries — coupled with hefty administrative burden, constant on-call and hospital work, and rising patient expectations — are no match for the financial lure of other specialties.
• Increase loan-repayment plans for primary care and/or offer more zero-interest loans for these disciplines. Most of my classmates came out of training with at least a quarter of a million dollars in student loans. Unless you have a vocation for primary care, a salary of $300-$400K each year looks a lot more welcoming than the $130-$140K primary care starting salary when you’re sporting a student loan payment that’s more than most mortgages.
• Increase the availability of case managers, care coordinators, dieticians, health coaches, and social workers for Medicaid patients at no cost to the physician. Don’t tie it to some ACO-type scheme. I promise with this infrastructure, if you build it they will come. (My apologies to William Kinsella for shamelessly poaching your line.)
• Remove administrative barriers for care of medically and/or socioeconomically needy patients, regardless of payer. In addition to the above, remove the requirement that physicians pay for translator services for patients and reimburse this through payers, public or private. I’ve paid over $450 for interpreter services for a visit that I was paid $24. And this is a patient that needed to come in every month because they were complicated – it was a minimum of $150 to get the interpreter to come. Thank goodness my health system is willing to subsidize this, because most private docs don’t have the luxury.
• Reduce the administrative burden related to health IT initiatives. If you’re going to require something (like submission of data to an immunization registry or submission of syndromic surveillance data) ensure that the states actually have an infrastructure to receive the data. Do not send me on a pointless mission to contact department after department across multiple states trying to find someone who has any idea what I’m talking about, only to find out my state can’t accept either kind of data.
• Make quality initiatives make sense. Micky Tripathi’s Pretzel Logic: The Quality measure Conundrum says it all. Most clinicians want to give good quality care. But when it becomes so complicated that the average physician is torn between the spirit of the incentive program and the somewhat malleable calculations to demonstrate it, there are a good chunk of docs that decide it’s just not worth it.
• Understand that the push for healthcare IT has actually made it easier for providers to “cherry pick” the healthy patients or “lemon drop” those that are non-compliant or have poor payers. Back when we had paper charts, it was a lot of work for providers to weed those patients out. Now docs can report on them on a monthly basis with the click of a mouse and decide which patients are too difficult to manage. Probably not what was intended, is it?

So even though it’s dead for now, I’m taking bets on how long it takes the Mystery Shopper program to show itself again. Any takers? E-mail me.

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

CIO Unplugged 6/29/11

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

Why We Need Transformational Leadership

The labor and delivery room filled quickly with physicians and nurses. The walls turned inside out, revealing sterile equipment. The transfiguration from birthing suite to operating theatre was complete. I figured this was not a good sign.

Despite numerous inducements, my wife’s body refused to give up the gift inside. I went from active coach and participant to frightened bystander. Moved aside, I worked my way behind my wife, out of the path of clinicians and equipment, yet close enough to stroke her hair, hold her head in my hand, and whisper prayers in her ear.

While I wasn’t familiar with all the technology, I knew to keep an eye on the fetal heart monitor. Fluctuating wildly, the bottom kept falling out until the heart rate eventually registered as zero — and stayed there.

Seconds passed like minutes, minutes like hours. After cutting, vacuuming, forceps, and physical manipulation, our baby appeared. “We’ve got a floppy,” the doctor announced. He handed the bundle over to his partner, who whisked our child to a nearby table for resuscitation.

Nightmarish thoughts invaded my mind. Instead of returning home and rejoicing over a new life, would I be planning a funeral? Picking out a tiny casket? Mourning? Wondering if it would be worth trying again? While clinicians huddled around our daughter, we changed her name from Kirsten to Talitha.

Seven forever minutes later, a nurse displayed our child, swaddled in a blanket and breathing on her own. “Here’s your daughter,” she said, before they took her down the hall.

Talitha is an Aramaic word used by Jesus in the Gospel of Mark. A father chased after Jesus and pleaded for Him to heal his recently deceased daughter. Impressed by the man’s faith, Jesus went to his house. Upon seeing the lifeless body, He commanded “Talitha Kuom” (translated “young woman, arise!”). The girl awakened. Ours did also. Miracles still happen.

Talitha slept in isolation in the newborn intensive care nursery. We could look at her, but not touch. Strep B had caused the trauma, but she was also fighting pneumonia and a hole in her stomach. Physicians forecasted long-term physical and mental damage.

In our shocked state, we reviewed options with the clinical team. We signed releases, willing to assume any risk that might help Talitha survive. Our church pastors loved on us, praying for wisdom and healing. We gave thanks for the hospital and dedicated clinicians.

The biggest decision lay ahead. Should we undertake a risky “flight for life” transfer from our hometown hospital Level 3 NICU to a Level 1 NICU 90 minutes away? Adding complexity, Julie was not physically well after the trauma, and I did not want to separate her from Talitha. The receiving hospital specialists said they could consult remotely if there was an automated way to collaborate. But this was the early 90s.

I had been serving as the physician relations coordinator for this hospital. A year prior, I had been given an additional responsibility related to IT. The IT staff was struggling with physician adoption of a clinical system application module that allowed them to dial in (on a 2,400 baud modem) and have real-time access to clinical data. Because of my track record in working with physicians, I took the job of evangelizing this tool to the medical staff. We went from 5% to 90% adoption in one year.

What if?

What if we gave the consulting physicians direct access to the clinical record and they could treat my daughter from afar? Two hours later, they had access. Care coordination and collaboration began. This defining moment made my calling and career crystal clear. I knew I was to combine my leadership talents with my technical skills and apply them to healthcare information technology.

Eight long days later, Talitha was released, albeit on oxygen. The strep was treated, her pneumonia was resolved, and her stomach had healed itself. No physical impairment. Today, because of her high IQ, no one could ever know of the fight Talitha endured to be a part of our family. (Well, perhaps with the exception of her “Goth” period around age 14. LOL.)

And Julie? She, too had a miraculous recovery. The quarter-sized hole connecting her uterus and bladder (caused by a 9.5 pound baby) closed without surgical intervention.

This story is one example that illustrates the power of technology when it’s paired with leadership and harnessed to share clinical data. As we mash up transformational leadership with emerging technology, we will hear many more stories like Talitha’s that inspire us to do greater things.

This fall, we’ll celebrate our beautiful daughter’s 18th birthday. She is the reason I serve in healthcare information technology. I can’t imagine having any vocation outside of healthcare. I am a direct beneficiary, and it changed me forever.

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

News 6/29/11

Top News

French IT services vendor Capgemini is looking for IT services acquisitions in the US, particularly in the healthcare sector. Says the CEO, “We are a marginal player in several of the key markets. For instance, we are non-existent in healthcare in the US, which I think is a mistake. So we need acquisitions.” You may recall that Cap bought Ernst & Young Consulting in 2000, stuck their name on it (above), then sold it to Accenture five years later after losing a ton of money. I worked with E&Y quite a bit at a previous hospital employer back in their heyday and they were excellent for strategic planning, IT governance stuff, and security work. I had a couple of occasions to work with Cap and they were clueless.

Reader Comments

From Susan: “Re: Kettering Medical Center (OH). Went live on Epic May 1 on inpatient, ambulatory, and revenue cycle.” The video is here.

From CloseToEpic: “Re: Epic. Heard from a Madison, WI apartment owner that Epic has hired approximately 2,000 new employees who will be starting end of summer. Apartments filling up around Madison.” Unverified, but reasonable.

From WildcatWell: “Re: Google PHR dead. Told ya so. Give a brother some love! Your EMR/EHR insight is THE industry leader. Let’s get all your readers together – I’ll buy the first round.” WCW is a good information source, but I notice that his drink offer was made anonymously.

From Academic CIO: “Re: HIStalk’s eighth birthday. You have really created a resource that, on top of the insight, information, and perspective you deliver, has replaced the trade mags we used to read to try to get a handle on what was happening in the industry (and which were really only giving the vendor-approved view anyway).” I really appreciate those kind words – thanks. The best part about it is getting to connect with some really interesting people and to help bring a variety of opinions to the table.

HIStalk Announcements and Requests

Inga’s taking a semi-break, so I’m soloing this time around. She’ll be back shortly.

Vince Ciotti poses this (easy) question: “What vendor spends (wastes?) the most of its clients’ money on extravagant architecture and frivolous artwork?” Examples above from Vince’s collection.

Ed Marx added an update to his June 15 post with responses to reader comments.

Sales

Sentara Healthcare (VA) contracts with TeleHealth Services for its interactive patient education solution.

SSM Health Care (MO) contracts with revenue cycle solutions vendor Passport Health Communications for SaaS-based eligibility and financial screening solutions and services for its 15 hospitals.

People

Practice Fusion names Cora M. Tellez to its board. She’s the former president of Health Net and CEO of Blue Shield of California-Bay Region.

Mark Lederman, formerly VP/CIO at Interfaith Medical Center (NY), has been named VP/CIO at Chilton Hospital (NJ). We swap e-mails occasionally and he sent over the update, so congratulations to Mark.

Announcements and Implementations

UMass Memorial Health Care (MA) integrates MyCareTeam’s MCT Clinical diabetes management system with its Allscripts ambulatory EHR, enabling patients to upload their glucose readings.

Chicago mayor Rahm Emanuel announces that Allscripts will add 300 new jobs in the city by the end of 2012. The company will also host its annual user convention at McCormick Place starting next year.

UPMC implements Oracle GoldenGate with Cerner’s 724Access software to help reduce potential EMR downtime.

A Bama Buddy find: a hospital reports that a batter’s box-type outline made of duct tape outside the rooms of infected patients helps reduce infections, reminding employees about contact precautions and giving them a safe zone in which they can still interact with patients without gowning up.

Allscripts announces Allscripts RCM Services at HFMA, which it describes as a cloud-based, outsourced business office for physician practices that is charged as a percentage of monthly collections.

Government and Politics

CMS selects The Lewin Group for a project to reduce the number of hospital readmissions for Medicare beneficiaries and improve quality outcomes for patients transitioning from hospitals to other care settings. The company, which is part of OptumInsight, will receive $2.3 million for the first year of the five-year program.

California lawmakers put together a bill that would require clinicians to flag any information they change in electronic medical records. The bill originally required all changes to be identified by user and to let patients see changes to their own records, but those requirements were removed after big healthcare organizations expressed their opposition that California’s standards would then differ from federal standards.

Innovation and Research

Deborah Peel MD of Patient Privacy Rights sent a link to this story about Personal, a soon-to-be-launched site that lets consumers store information about themselves and then sell it to commercial organizations willing to pay for it. It’s 100 “gems” include such information as when your next oil change is due and what kind of food you like, which they’ll broker on your behalf for 10% of the proceeds. It has some big-time financial backers. Her interest: something like that could give consumers control of their healthcare information, which is being freely sold without their consent for purposes not necessarily in their best interests. It could be used like a PHR, where people enter information that could be made available to sell (to companies) or to providers (for free).

Technology

The Robert Wood Johnson Foundation introduces an online directory that includes performance measurements for hospitals and doctors. It links 197 reports with information on outcomes, cost of care, and whether patients received recommended tests and treatments.

Other

The LA Times picks up the story reported here awhile back, in which a premature baby was killed by sodium chloride overdose due to a data entry error into a hospital pharmacy’s IV compounder software. The article tries to link that human error to IT safety in general, but the problem really was a lack of IT: Advocate Lutheran General Hospital apparently had no interface between its pharmacy system and the compounder software, so they let unlicensed personnel (pharmacy techs) do the manual data entry, where it’s pretty easy to accidentally swap the values of the electrolytes (although properly installed software should have given a warning). I’ve seen that problem first hand (unfortunately) and developed a simple but elegant solution (fortunately). If you’re a CIO, e-mail your pharmacy director and ask how IV formulas get to Abacus or whatever IV compounding software your hospital uses and whether they have warnings set up in it.

1-800 Labwear brings out a lab coat with outside pockets specifically designed to hold an iPad (which they spell incorrectly).

Sponsor Updates

• Kony is named the Most Innovative Company of the Year by the American Business Awards in the technology company category.
• Hayes Management Consulting adds a Regulatory and Compliance services division that will focus on federal healthcare mandates, HIPAA billing and security policy, EDI V5010, and ICD-10. Anita Archer will lead the division.
• Northeast Valley Health Corporation (CA) and Community Health Center Network (CA) are among 32 community health centers to select NextGen EHR solutions.
• Vitalize Consulting Solutions earns an average score of 88.62 in its five service areas as measured by KLAS in its mid-term performance review.
• T-System celebrates its 15-year anniversary.
• Northern Virginia Regional Health Information Organization (NoVaRHIO) launches a pilot program with Picis that will allow ED clinicians from Inova Alexandria Hospital ED clinicians to quickly access prescription information.
• Medicity’s Health Information Exchange Solution for hospitals receives Federal Certification for meaningful use.
• Inland Northwest Health Services announces that the Spokane Virtual Lifetime Electronic Record (VLER) pilot is now enabling the secure exchange of electronic health information using the Nationwide Health Information Network (NwHIN) Exchange. The use of VLER improves the portability of health information to Veterans and active duty Service members in the Spokane, WA area.
• CMS awards the Medicare Part D Transaction Facilitator contract to RelayHealth.
• Orthopedic Institute (SD) chooses the SRS EHR  for its 38 specialty providers.
• East Liverpool City Hospital (OH) goes live on ChartMaxx by MedPlus.
• Thomson Reuters launches Infection Xpert, a clinical intelligence dashboard that combines real-time clinical surveillance information, patient information, and patient-specific reference content from Micromedex for reducing and managing hospital-acquired infections.
• Nashville’s 211 Call Center health navigator program, operated by Family & Children’s Service, chooses MyHealthDIRECT to allow operators to connect callers with available area providers specific to their needs, including the ability to search available provider appointments.
• Ness County Hospital (KS) goes live on the ChartAccess Comprehensive EHR from Prognosis Health Information Systems just four months after its selection. The hospital plans to meet Stage 1 MU requirements by the end of the year.
• Main Line Health (PA) signs a five-year extension with MobileMD for its 4D health information exchange service, which it has used since 2007 to connect four hospitals and more than 30 practices to create a virtual complete medical record.
• Workforce management software vendor Concerro licenses two labor analyses tools from Workforce Prescriptions to allow it to offer labor efficiency review services that cover scheduling practices, agency use, care delay causes, and policies that impact labor ability. Hospitals average $7 million in annual realized savings from labor misalignment. The company’s take on labor management is covered in its blog, with the latest topic being the complexity of managing hospital labor costs.
• NCR is exhibiting at HFMA this week (Booth 1420), talking about self-service solutions that improve efficiency, cost, and revenue cycle.

More Thoughts on Google Health

Nobody’s really disappointed or even surprised that Google Health is dead (actually, few have even noticed, which tells you all you need to know about its problems). The only surprise is that such an unenthusiastic effort came from one-time paradigm-buster Google in the first place.

Actually, maybe the biggest surprise is that Google is shutting Google Health down in an embarrassingly public raising of the white flag. It would be one thing if they were spending a lot of R&D money on it, but there’s no evidence of that. The app is somewhere between simple and ugly, announcements of new functionality or connectivity have come along once in a blue moon, and no lofty promises were made that it would ever be anything more than it was. Given that GOOG’s market cap is $156 billion, and that pretty much nobody was using Google Health anyway, maybe they should have just abandoned it to die quietly instead of convening a very public funeral, raising ugly questions about the cause of death.

The only real traction Google Health got was among folks who wanted to see a brash, smart, and well-funded upstart barge its way into the healthcare IT vendor mix, elbowing out the companies that have been around for decades to shake them out of their maddening complacency. In that respect, Google ironically did what the non-healthcare IT vendors are sometimes blamed for doing: it laid down a smokescreen of rosy PR, under-delivered on even modest promises, ignored the advice that users and experts were giving, and then just cut and run when the going got tough, another healthcare dabbler that should have known better.

I thought Google Health would do OK, if for no reason other than the company seemed committed to hanging in there, at least initially (they threw the stereotypical launch party at HIMSS, then went silent). But the signs were there. The inexperienced folks they put in charge were replaced by even less experienced folks. Their HIMSS booth was a joke, an empty table with a few black-and-white photocopied half sheets of paper handouts. They didn’t make any acquisitions; they didn’t create any innovative technologies; they didn’t differentiate themselves publicly from HealthVault; and they made no apparent attempt to flex their muscle with the providers, EMR vendors, and insurance companies that were sitting on the key asset needed to make their product fly: data.

Sometimes visionary companies can create a market by thinking big and solving a problem consumers didn’t even know they had (MP3 players and Facebook, for example). This wasn’t one of those times. Google Health was a solution looking for a problem, much like its high-flying and equally dead stable mate Google Buzz. If nothing else, Google Health proved that Google is just as fallible as arch-rival Microsoft in thinking it understands what customers want without bothering to actually ask them.

Here’s my epitaph for Google Health, not as a PHR expert (which I’m not, since I have little interest in them) but as an average consumer/patient.

1. Google knows just one business: pushing ads in the faces of users willing to tolerate them in return for getting free access to some reasonably useful Web tools. Without large numbers of eyeballs, Google wasn’t interested, and without those useful tools, neither were the eyeballs.
2. The Google Health model required massive uptake to be successful by its standards, but it was designed to address the health needs of the vocal 2% rather than the indifferent 98%. Hospitals learned that lesson long ago – if you want doctors to use CPOE, you aim your technology at the average doc (busy, struggling, and administration-suspicious), not the geeked out, administration-friendly CMIO who has little in common with them other than wearing a white coat but who sometimes can dangerously convince everyone else they speak for the majority (not like Dr. Jayne, in other words, who actually practices medicine and uses the systems she supports).
3. When it comes to healthcare, consumers are not empowered, and no amount of technology will change that. They have a tiny bit of discretion when it comes to choosing a doctor, but almost none when choosing a hospital or insurance company. Cool Web tools or not, Joe Sixpack has no leverage over the massive bureaucracies of the average academic medical center or insurer.
4. Those massive bureaucracies suck big time at managing their own data. The last thing they want to do is (a) share their crappy and unreliable information with patients, or (b) import unvetted patient information from some other source and then have to figure out what to do with it since they are paid for piecework, not thoughtful reflection of piles of information.
5. “Health” is a good thing that everybody wants for everyone else, but “healthcare delivery” is a cutthroat fight for the financial pie. Collaborative tools are tough sell when the folks at the table are trying to stab each other in the back without being noticed, but especially so when Google didn’t even seem interested in working with them.
6. The average person (be careful who you picture – the masses are not healthcare- or IT-savvy) sees his or her own healthcare as someone else’s problem. They get sick, they use someone else’s money (insurance) to see a provider, they want immediate gratification from pills or surgery, they aren’t interested in information or recommendations of lifestyle changes. Few of them study the government’s dietary recommendations, interface their bathroom scale to a computer program, or participate in online support groups. They just want to be left alone, secure in the knowledge that their poor health choices can be overcome by an insurance-assigned doctor or hospital. Any suggestion that electively unhealthy folks pay more for their healthcare than electively healthy ones is met with cries of discrimination. The only way to get their attention would be to pay them to take better care of themselves, just like giving your kid $10 for each A on their report card.
7. Only a tiny number of zealots will accurately and consistently enter their health information into an online shoe box. Not only is it work, there’s no apparent payoff since most providers don’t have the time or interest to read what those folks entered (partially because the technologies they use don’t play well with others any more than those providers themselves).
8. Consumers use technology for three reasons: it provides them with emotional satisfaction (Facebook), it offers them convenience (Amazon, paying bills online), or it saves them money (eBay, Groupon). Google Health and most PHRs offer none of these benefits.
9. Addressing the convenience aspect requires removing the friction of healthcare delivery system transactions. They are horribly inefficient, often because the doctors, hospitals, and insurance companies themselves are horribly inefficient (which lends credence to the argument that arming either Joe Sixpack or providers with a lot of technology doesn’t necessarily make things better, particularly when it comes to patient outcomes).
10. Nobody really trusts big companies all that much, and people are especially suspicious of who sees their health information. Geeks might trust Google with their entire identity, but the average person probably won’t.

Now is probably a great time to retire the term Personal Health Record. It had a questionable premise to start with, but now Google has tainted it as being a plain, static Web page that’s about as fun to use as TurboTax and a whole lot less useful.

I’m an average patient and I want nothing to do with a Google-like PHR. What I want is to be able to:

1. Make electronic appointments, including being able to search for openings at multiple locations or among competing providers. I don’t want to have get on the telephone or compose an e-mail.
2. Request prescription refills.
3. See my lab results as soon as they are available, with a personalized explanation of what they mean.
4. E-mail my doctor and get a timely response.
5. Get specifically requested information to my doctor efficiently, and know that he’ll ask for the information he needs, it will remain on file in case it’s needed again, and I’ll have a say in the decisions made from it.
6. Get automatic reminders for EMR-triggered events (vaccinations, next physical exam due, etc.) but with the option to suppress those that aren’t helpful.
7. Manage someone else’s health with their permission, such as a child or parent.
8. Earn an insurance or treatment discount for following recommendations that result in measurably improved health.
9. Solicit bids or search prices for services not covered by insurance.
10. View any health information recorded about me with an efficient mechanism to correct any errors.

The average PHR doesn’t do most of these things. They can’t unless providers, insurance companies, and EMR vendors can be convinced to work together. Patients don’t have the sway to make that happen. Employers might, or perhaps some kind of government mandate.

Short of that, PHRs are going to struggle since, by definition, they are trying to bring competing parties together electronically without giving them an incentive to do so. That leaves PHRs as little more than a spreadsheet on which a few consumers can record their own information that nobody will look at.

Many folks who cheerlead for PHRs do so with a vested interest instead of as a consumer. So here’s the challenge to those inclined to comment on this post: instead of the usual pedantic posturing about PHRs as a technology or a business, tell me how YOU PERSONALLY use a PHR, what benefits you’ve received, and what you wish it would do. The “experts” can’t stop talking about Google Health, but none of them so far has admitted actually using it or any other PHR.

Contacts

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

Experian To Acquire Medical Present Value for $185 Million

Ireland-based financial information and technology vendor Experian announced this morning that it will acquire Medical Present Value for $185 million in cash. The Austin, TX-based MPV offers revenue cycle services to providers that include eligibility verification, patient-friendly statements, credit scoring services, and claims software.

MPV, which has annual revenue of $45 million, will become part of Experian’s North America Credit Services division, which offers services for running small businesses. The company’s other healthcare product is SearchAmerica, a 2008 acquisition that evaluates patients for their likelihood of payment and eligibility for financial assistance programs.

Dan Johnson, president of Experian’s Healthcare Services, was quoted in the announcement as saying, “Healthcare providers in the US face growing challenges when it comes to billing and collecting payments for services. With the addition of MPV, Experian is able to provide a more comprehensive set of products and services across the healthcare payments life cycle and help clients manage multiple vendors through a single point of contact”

MPV was founded in 1998 and serves more than 75,000 providers. Its principal investors are Rho Ventures, CenterPoint Ventures, Star Ventures, and Care Capital.

Readers Write 6/27/11

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

Will Meaningful Use and EMRs Help Jump the ACO Hurdle?
By Frank Poggio

The Accountable Care Organization (ACO) is the government’s latest attempt to improve quality of patient care and control the ever-escalating growth in healthcare costs. The Affordable Care Act (commonly known as the health reform law) encourages, via financial incentives and penalties, the formation of ACOs by organizing healthcare teams, technology, and knowledge around patient needs. 

As might be expected, there are many complex organizational, monetary, and other significant policy issues surrounding the ACO model of care delivery.

The ACO concept is not new to the healthcare world. In past decades, we called them PHOs (Physician Hospital Organizations) or HMOs (Health Maintenance Organizations).  Both of these in the 1980s and 1990s had only a small impact on healthcare costs. Many PHOs and some HMOs are still in existence today.

In fact, we have always had some form of ACO going as far back as 1939. For example, the Kaiser Health Plan, The Cleveland Clinic, Sharp HealthCare, Geisinger Clinic, and many others are basically ACOs. If they include an insurance component, they are more like an HMO.

The simplest definition of an ACO is a health care delivery system where the physicians and hospitals work under one corporation, have one set of synchronized patient objectives, and share in the profits  and losses from normal operations. Medicare wants doctors and hospitals to work together and accept one payment for all levels of care and accept the responsibility for coordinating the care of the patient across all modalities of care. 

Where ACOs work and why

The concept has worked at Mayo, Kaiser, and Cleveland Clinic because the attending docs are part owners of the hospital. They get paid a salary and bonus based on both the performance of their practice and the performance of the hospital and other health services.

For example, the physicians readily accept that fewer support staff will save the hospital money, which in turn could result in a year-end monetary bonus while hopefully improving patient care. That, in turn, can lead to more patient referrals and more revenues. The same is true for ordering fewer tests or procedures. Fewer tests equal less costs, and under a fixed payment system like Medicare DRGs, that means more profit.
 
But today, the independent physician makes his or her money seeing as many patients in his or her office as possible. The hospital is just a cost-neutral and convenient place for physicians to perform complex procedures. If an ACO is that simple and beneficial, why are there so few of them?

How did we get here?

Today and for the past half century, we have been in a situation where the person most responsible for “product definition” and most responsible for “bringing in the business” is not an employee of the hospital. That person is the attending physician, or sometimes called the independent practitioner.

It goes back to the establishment of the AMA and the AHA in the early 20th century. Both of these groups were focused on increasing utilization of hospital and medical services. Even at that time, just as today, medical care was relatively expensive. To drum up business, they both came up with the idea to sell a medical insurance policy.

Rather than work together, around 1940, the AMA founded Blue Shield and the AHA started Blue Cross. Each had similar, yet different objectives. Keep in mind that almost all doctors in the early part of the 20th century were independent practitioners and hospitals were places to be avoided.

In 1966, along came Medicare. If you go back and study the legislation of the day, you will find that physicians fought Medicare with a vengeance and wanted no part of the government or the institutional side of the package. Of course today, if you tried to take Medicare away, you’d have a rebellion — and not just from seniors. Medicare in 1966 solidified the doctor-hospital split via separate payment systems by creating Medicare Part A for hospital payments and Part B for physician payments.

Then in 1972, as the health insurance industry matured, the Federal Trade Commission became concerned that doctors and hospitals selling insurance was a little to cozy. The AMA had to spin off Blue Shield and AHA split with Blue Cross. Later, as the Blues saw themselves more as insurance companies than part of the medical establishment, many of the Blues merged and eventually morphed into today’s United Health, Wellpoint, etc.

To drive the hospital-physician wedge deeper, in 1993, Congress passed OBRA, which contained the infamous Stark amendment. The Stark amendment made it a crime for doctors to refer patients to a hospital in which they had a financial interest. The feds saw this as a conflict of interest that would drive up healthcare costs. 

The structure we have today — full physician independence — has been around a very long time. It has been repeatedly fortified through separate provider and piecework-based payment systems.

That raises today’s big question: who is accountable for all the care a patient receives? 
 
How can we create more ACOs?

Now, after more than a half century, the government has come to the conclusion that doctors working separately from hospitals with separate payment systems and different incentives is a counterproductive operating model. (too bad we didn’t see that coming when we initiated the Medicare-Medicaid systems.)

Under the duress of a very large federal deficit (in part, a result of healthcare costs), we are trying to reverse 70 years of misdirected legal and financial incentives. Under an ACO, the feds want both parties to work together, share the payments, and share the risks.

The ACO statute of April 2011 lists the following provider combinations as potentially eligible ACOs:

1. ACO professionals in formal group practice arrangements.
2. Networks of individual practices of ACO professionals.
3. Partnerships or joint venture arrangements between hospitals and ACO professionals.
4. Hospitals employing ACO professionals.
5. Such other groups of providers of services and suppliers as the Secretary determines appropriate.

Combinations 2 and 3 are what I call the “virtual’”ACO. Combinations 1 and 4 are more like the PHO/HMO of the past, or the Mayo model.

As stated by CMS, ACO compliance with the requirement to reduce costs and improve care may involve a range of strategies, which they state includes the following examples:

• A capability to use predictive modeling to anticipate likely care needs.
• Utilization of case managers in primary care offices.
• Having a specific transition of care program that includes clear guidance and instructions for patients, their families, and their caregivers.
• Remote monitoring.
• Telehealth.
• The establishment and use of health information technology, including electronic health records and an electronic health information exchange, to enable the provision of a beneficiary’s summary of care record during transitions of care both within and outside of the ACO.

Promote the virtual ACO

As can be seen from the compliance strategies, CMS is leaning heavily on HIT and EMR to help avoid some very difficult political battles. As an interim step, they are encouraging hospitals and physician groups to use EMR systems to build and support a virtual ACO.

In this scenario, the physician and the hospital would remain corporately separate, but the patient information and the payment would be shared. This dovetails with the new federal HITECH Act that promotes EMRs and stronger coordination of care via interoperability.

CMS has defined the five levels of ACOs and has set target dates for providers to achieve one of the levels. If a provider organization achieves an ACO level during the next five years, they will get a financial bonus. If they don’t, their Medicare payments will be reduced. Sounds like MU all over again.

Initially, the AMA was indifferent towards the ACO concept. AHA gave it mild support. But after CMS issued draft regulations in April noting the bonus-penalty provisions and the shared payment component, both associations came out strongly against it.

Of course, the 800-pound gorilla is who should run the ACOs, physicians or hospital executives? If there’s to be a single payment for Medicare patient services to the ACO, how do you split that payment?

CMS is staying out of this battle and leaving it to the docs and hospitals to fight it out. To say the least, AMA probably views it as the death knell for the independent physician practice, and AHA may see it as the surrendering of institutional autonomy to physicians.

I think it will be a long arduous road getting to real ACOs. Remember, the overall objective is to reduce the costs of healthcare. According to a CMS analysis of the proposed regulation, Medicare could potentially save as much as $2 billion over the first three years, so somebody’s ox has to get gored.

But as we stumble down this long and very bumpy road, I believe in the early years, the focus will be on the virtual ACO. The CIO’s office will be right in the middle of it. If you look at the Meaningful Use criteria for CCR, CCD, and interoperability, the first hurdle is staring us in the face.

Frank Poggio is president of The Kelzon Group.

During the first quarter of 2011 alone, there were media reports of inappropriate access to electronic Personal Health Information (e-PHI) of four sizeable healthcare organizations. This is damaging in terms of public relations, patient confidence, possible revenue loss, and increased costs to protect patients with exposed identifying details. It seems that many organizations are overlooking or delaying the need to perform a security risk assessment.

Yet under the HITECH Act, one of the core Meaningful Use measures is the requirement to “Conduct or review a security risk analysis … and implement security updates as necessary, and correct identified security deficiencies prior to or during the EHR reporting period to meet this measure.”

This measure is, therefore, a key task healthcare providers must conduct before attesting to their ability to meet Stage 1 requirements. Additionally, the risk analysis requirement in the HIPAA Security Rule is not only an integral part of meeting Meaningful Use for HITECH, but also for being in compliance with the law.

A risk analysis is the very foundation from which to build your information security compliance program. A security risk analysis should be conducted with active participation of internal auditors, IT leadership, and IT subject matter experts.

The Office for Civil Rights (OCR), the security watchdog for the Department of Health and Human Services (HHS), suggests that a covered entity use the National Institute of Standards and Technology (NIST) risk-based approach for doing a risk analysis, which encompasses nine primary steps:

1. System characterization to fully understand key technology components in your infrastructure.
2. Threat identification.
3. Vulnerability identification.
4. Controls analysis to assess the capabilities of your existing set of controls to meet your environment’s needs
5. Likelihood determination to assign likelihoods, considering the threat motivation and ability, the nature of the vulnerability, and current and planned controls
6. Impact analysis to analyze that impact, considering for each system the effects of lost confidentiality, integrity, or availability, and the effect of any current or planned mitigating controls
7. Risk determination, a combination of the impact rating and the likelihood determination
8. Control recommendations, a roadmap for planning controls for future implementation
9. Results documentation.

To prepare for Meaningful Use attestation, it is recommended to conduct the security risk analysis at both the technical design and system build phase when implementing a new EHR system. Additionally, it will be important to update the risk analysis further on in the MU Roadmap approximately four months prior to go-live.

As ongoing changes happen, new risk occurs. An annual risk assessment should become part of the compliance process; that is, the risk assessment can be merely updated as an addendum and not as an overbearing intrusion that competes with other organizational needs. A regular review of your risk posture is what is required to protect e-PHI. Too many new threat vectors and vulnerabilities are introduced into information environments each day. A reasoned, systematic, and consistent approach will help to achieve your organizational goals.

Spurred by the HITECH Act, the healthcare industry is embracing EHRs at an accelerating rate. This move carries with it a need for heightened responsibility since digital information can be copied, transmitted, or used so easily. As such, the risk accruing from this transition to electronic records must be well understood.

In its passage of HITECH, the US Congress took special consideration to note that security and privacy of patient records should be a paramount concern. In essence, HHS recognizes that the very success of the HITECH program rests in part on patients’ ability to trust provider information systems with sensitive information.

Jeff White is a principal with Aspen Advisors of Pittsburgh, PA.

Curbside Consult with Dr. Jayne 6/27/11

My colleague Dr. Doug Farrago (self-proclaimed “King of Medicine,” who I interviewed back in March) has recently renamed the Placebo Journal Blog to the Authentic Medicine Blog in an attempt to connect readers back to the roots of medicine. The blog is targeted at identifying medico-political barriers in the way of providers actually treating patients.

I have to give him full credit for sharing a recent article from American Medical News that helps explain why it is that no matter how much money the Medicaid stimulus plan pays to providers who adopt certified EHR technology, it will never be enough to reimburse them adequately for what they do. Following the Accountable Care Organization trend, Arkansas is looking to bundle Medicaid pay. Arkansas Medicaid Director Eugene Gessow proposes groups of “partnerships” that would parallel ACOs but will avoid being labeled as such. Seeing how successful Medicare ACOs have been so far, I’m skeptical. And now we’re going to do it with patients that, unlike their 65-and-up counterparts, are in and out of the payer’s coverage?

This type of restructuring may push some providers over the edge. Many providers are reluctant to accept Medicaid due to the increased documentation and regulatory burden compared to other payers. Many of those with Medicaid populations comprising 30% of their panels (20% for pediatrics) saw the opportunity to receive Meaningful Use payments as a way to try to obtain funding they sorely need to continue that mission.

To put this in perspective, I receive $24 per visit for Medicaid for a visit that with private insurance pays out at $65 to $80. Do the math – it’s increasingly difficult to continue to see patients whose reimbursement is less than the cost of doing business, and these tend to be more medically needy patients with significant socioeconomic-related health issues. Mr. Gessow states, “We need to stop paying fees for the process of treatment and instead reward the successful results of that treatment.” In short: we’re going to take the most medically needy patients and make payment for their care outcomes dependent? It certainly sounds that way.

I understand what they’re trying to do. I, too want to see more funding for care teams, social workers, and ancillary staff so they can work with the patients more directly, allowing physicians and other licensed providers to do what we trained to do rather than figuring out transportation issues and prescription vouchers. Those are essential services for many patients, but it doesn’t take an MD to do it.

Arkansas plans to rely heavily on existing EHR and other health IT systems to meet their quality goals. As an “IT guy” watching the havoc caused in the EHR industry by Meaningful Use mandates, I can’t wait for all fifty states to jump on the bandwagon and come up with a patchwork of state-specific mandates that will disrupt development cycles and create make-work upgrades for medical practices and hospitals. Vendors can barely keep up with state requirements as it is. I’m still looking for a vendor who can correctly render every state prescription blank, has state-specific immunization consent forms, and who ships out of the box with state-specific EPSDT forms for Medicaid child well exams.

Trading my “IT guy” hat for my scrub cap, as a physician, I just don’t see it as a reality in a nation where free will and self determination are key social tenets. Ultimately, it doesn’t matter how fabulous your IT platform is, how endearing your health coaches are, or how persuasive your clinicians try to be. If the patient doesn’t want to do what’s recommended, you can’t make them. No amount of clinical decision support or orders tracking can fix that one (although it does help the process of cajoling, bargaining with, and ultimately harassing noncompliant patients).

I’ve been doing quite a lot of travel lately, and have seen some things that as a physician make my hair stand on end. I have no idea how to successfully counsel against behaviors that patients continue to choose regardless of how negatively they may affect their health. Recent favorites:

1. Motorcycle riders without helmets (regardless of the law).
2. Establishments that serve daiquiris through a drive-thru window as long as there is tape over the lid, rendering the container “closed.”
3. Parents at the airport absorbed in their iPhone and iPod universes who ignore their stroller-bound children (folks, have you ever heard of reading a book to your child? It’s recommended by a variety of evidence-based organizations and my state Medicaid program requires me to counsel you on it or I won’t get paid.)
4. My bikini-clad neighbors on the beach, discussing their wrinkle-preventing Botox injections while sunning themselves to a color that I believe Crayola calls “burnt umber” while smoking (some days I really wish I had trained in dermatology).
5. Parent holding an unrestrained infant in the front passenger seat of the car (yes, I know some of us grew up without car seats and lived to tell, but it’s dangerous and illegal in 2011.)
6. Patients who want to talk about whether Kim Kardashian’s alleged gluteal implants would actually show on a radiologic study  (no kidding, I had this question) rather than their diabetes.
7. Patients who can name the starting lineup of the local baseball team, but not their BMI or cholesterol numbers.
8. Folks who take the concept of the “all you can eat” buffet seriously.

So, good luck, Arkansas Medicaid providers. I wish you well. Good luck to the IT vendors as you scramble to meet whatever regulations they come up with and to the clients who pay for customization while waiting for the vendors to achieve an aggressive go-live timeline for mid-2012. And finally, good luck to the patients who are unwitting participants in an experiment that wouldn’t pass most Institutional Review Board approval processes.

The only silver lining here is for the hordes of consultants that will descend, trying to figure out ways to secure their piece of the “savings” that Medicaid anticipates.

E-mail Dr. Jayne.

Monday Morning Update 6/27/11

Google makes it official: the company is shutting down three-year-old Google Health on January 1, 2012. Google predictably did what its know-it-all technology company predecessors have done over the years: dipped an arrogant and half-assed toe into the health IT waters; roused a loud rabble of shrieking fanboy bloggers and reporters (many of them as light on healthcare IT experience as Google) who instantly declared it to be the Second Coming that would make all decades-old boring vendors instantly obsolete or subservient to the Googleplex; and then turned tailed and slunk off at the first sign of lackluster ROI, leaving the few patients and providers who actually cared high and dry except for those same old boring vendors who have stuck it out for decades instead of chasing whatever sector looked juicy at the moment.

Why did Google Health fail? Simple and obvious: consumer demand for personal health records is close to zero, which has always been the case and probably always will be. Convincing patients to take the time and effort to maintain PHRs is as tough a sell as convincing doctors to voluntarily use CPOE, and for the same reasons: those doing the work don’t get much benefit. Patients don’t want to maintain their own records and clinicians aren’t about to trust patient-maintained information for making treatment decisions (not to mention that taxpayer-incented HIEs and Epic’s MyChart are stealing their thunder by not relying on patient-powered sneakernet in the first place). PHRs aren’t fun. They don’t accrue Farmville points, you can’t put pictures of your cat or a funny YouTube video on them, and you don’t get HITECH money for typing in your weight every now and then. The only model Google knows involves near-universal adoption that gets advertisers salivating, not having a tiny contingent of wellness buffs and savvy chronic disease suffers using their free online service. Ultimately, Google’s problem is that an awful lot of Americans care about reality TV and celebrity gossip more than their health. They’re more interested in patch-me-up-doc “healthcare” than I-need-to-make-better-choices “health” that requires proactive electronic tools. The most shocking aspect of Google Health’s announcement in 2008 was either that Google hadn’t figured that out or that they thought they could succeed anyway.

Want to bet that Google will come crawling back to healthcare one of these days when earnings start to slip? That’s what generally happens with those short attention span technology vendors. Like Microsoft before it, Google has gone from a dominant force that can do no wrong to a clearly fallible company that makes a ton of money, but that often is more of a follower than a leader with surprisingly routine and easily predicted product failures. And speaking of Microsoft, I’m not sure whether Google Health’s timely death is good news or bad for HealthVault, a better product, but still facing the same uninterested market even with the loss of its only high-profile competitor (advantage: Dossia?)

It’s OK to include scanned documents in an EMR, say 86% of respondents, while a less-forgiving 14% of purists say no way, electronic doesn’t just mean electronic, it means discrete data only. New poll to your right, in honor of the dearly departed Google Health: do you keep a current and medical reliable electronic Personal Health Record? I asked that same question in 2007, when 88% of the most technologically and medically savvy people in healthcare said they did not (maybe Google should have taken those results as one of those warning cow skulls in the desert).

Suggestion to anyone claiming to be an insightful Epic expert: your credibility will be enhanced if you spell the company’s name right (it is not EPIC).

A company approached me about sponsoring the HIStalk reception at HIMSS next year (I love that I don’t have to troll to get companies interested since I don’t have the time or inclination to do that). I found out from those folks something I hadn’t noticed: HIMSS has completely screwed around with the Las Vegas conference days, with the pre-conference stuff starting on Monday (Saturday is now Monday, in other words) and the sessions run Tuesday through Friday (so everybody will need to bail out for home on Thursday instead of Wednesday). Great – now you can’t do a Saturday night stay when trying to find a cheap flight and we’ll either have to travel with all the other business schmos on Monday or fly out a day early. They’ve moved my cheese and I’m unhappy, but I’ll get over it. So, despite my concluding HISsies slide from Orlando, the reception is probably not going to be Monday night if I decide to do another one. If you’re slotted to present a Friday session, you might want to plan for a roundtable instead of an auditorium.

I am absolutely loving Vince Ciotti’s HIStory series. He’s getting lots of e-mails and kudos, even from 20-something HIT sprouts who understand the “doomed to repeat history” thing and figure they can learn from the pioneer diaries. Vince recently had calls from Jim Pesce (McAuto) and Mike Kaufman, who are following his series and contributed to the installment above (I’m really impressed with Mike’s history since I didn’t realize his deep roots when he and I have exchanged e-mails over the years).  E-mail Vince if you have some history inside your head or on paper that would round out his recollections. The industry goes back to the late 1960s (Meditech was formed in 1969), so with 40-plus years having gone by, it’s time to document some of this stuff.

Speaking of Mike Kaufman, in Googling to see what he’s up to, I see that he, along with fellow former Eclipsys SVP Hans Boerma MD and money guy Frank Panaccio formed KBT Partners, which offers advisory services to healthcare IT and related companies.

I’m also quite enjoying the work of Micky Tripathi in his monthly Pretzel Logic column on HIStalk Practice. His writing is fluid and personal (not to mention entertaining) and he’s obviously an expert in all things EMR (fortunately, since he’s the president and CEO of the Massachusetts eHealth Collaborative). I just posted his Quality Measures Conundrum piece and it should be required reading for anybody who cares about EMRs or Meaningful Use.

My Time Capsule editorial this week from 2006: Medical Equipment Sales Boom While Health IT Struggles. A snip: “The takeaway message is that, science aside, doctors and hospitals will utilize the hell out of something when they’re paid to do so (equipment, drugs, supplies, and for-profit referral centers). While it’s nice if patient care is improved, it’s only mandatory that it not be worsened.”

A Harvard Business Review working paper covers why creative tension among company executives can be a good thing. One of its examples is Misys CEO Mike Lawrie, who in 2008 insisted that the company’s open source division not be rolled into Allscripts but rather allowed to compete with it for resources, which supposedly benefited both groups.

Speaking of Misys, the company offering to buy it is revealed as Fidelity National Information Services, a Jacksonville, FL-based bank technology firm that has a healthcare division (benefit administration, PHR, consumer health portal, ID cards, lockbox, revenue cycle).

Weird News Andy revives this story: mourners filing past the coffin at a Russian woman’s funeral are startled when she raises up and begins screaming, not nearly as dead as the local hospital had said. The funeral-goers’ time wasn’t wasted, however: the woman had a heart attack from all the commotion and died minutes later in the same hospital.

A survey finds that no surveyed physicians in the UK, New Zealand, Canada, and Sweden said they practice defensive medicine, compared to the 92% in the US who admit to letting fear of lawsuits drive their medical decisions.

CapSite releases the Lite version of its database, strictly for providers and hospitals. The Web-based tool provides access to thousands of contracts and proposals from peer institutions, complete with pricing and T&C covering 800 vendors in HIT, imaging, medical devices, and services. It’s free for 30 days and the company is signing me up to check it out, so I’ll be interested to snoop around since I love looking at contracts.

Athenahealth buys Point Lookout Resort and Conference Center, 396-acre, $7.7 million property near its Belfast, Maine operations center, which it will use for client and employee training. The facility overlooks Penobscot Bay and has 106 cottages, a bowling alley, and a beach. I’m thinking we need an HIT geek summer camp, complete with marshmallow roasts, snipe hunts, and furtive ukelele-inspired groping around the campfire.

OptumInsight (formerly Ingenix) is awarded a patent for its LifeCode natural language processing technology, which can extract content and context from electronic medical records. That technology runs the company’s computer-assisted coding applications,  which the company says can ease the transition to ICD-10.

I’m pleased with this find since I’m thrifty (cheap, some might say, including someone with whom I share a bed). I take low-dose lisinopril for blood pressure (my BP is only 115/55, but my doc likes me to take it for some reason). I thought Walgreens offered $4 generics, but they don’t any more, so they charged me $10 for 30 tablets. I looked for alternatives and found that not only does Walmart offer a long list of maintenance meds for $10 for a 90-day supply, but mail delivery to your door is free. That is Walgreens Strike 2, the first being that they charge almost $50 for a vial of Canine HIStalk’s insulin while Walmart sells their custom-relabeled Novo Nordisk insulin for only $24.88. We may have a healthcare crisis in this country, but it would be a heck of a lot worse without Walmart (at least now that they offer health insurance to more of their employees).

Atlanta-based startup Digital Assent, which developed the PatientPad ad-powered patient check-in tool for practices, raises $7.5 million in a Series B funding round. The founders came from Sythis, which developed an interactive selling solution that licensed its technology for PatientPad.

Sad: a hospital-based physician finds that someone is checking out porn and Googling phrases such as “rat poison symptoms in humans” on his office computer. It turns out to be the hospital’s night shift security guard, who has since confessed to trying to kill his family by poisoning them and who is now charged with beating his pregnant wife, his father-in-law, and his five-year-old daughter to death with a baseball bat and then burning down his house.

Cleveland’s MetroHealth System, getting heat from the county council about no-bid consulting contracts and excessive spending, takes positive action: it hires a $300 per hour PR company (without bidding, I assume) to help its executives practice for their appearance in front of the investigating committee.

Another Weird News Andy story that has me in stitches is this story, which he entitles Four Inches? Just a Flesh Wound. An 11-year-old girl trimming her horse’s mane opens up a 10 cm gash in her chest when the horse bolts. Her mother calls emergency response for an ambulance, only to be told to clean the wound, apply pressure, give aspirin, and then drive to the nearest hospital within eight hours or so. The hospital’s first question when she arrived: “Why didn’t you call an ambulance?”

E-mail Mr. H.

An HIT Moment with … Don Kemper, CEO, Healthwise

An HIT Moment with ... is a quick interview with someone we find interesting. Donald W. Kemper is founder and CEO of Healthwise of Boise, ID.

Describe Healthwise, its incorporation as a non-profit, and how it is similar or not similar to the typical healthcare content vendor.

I see Healthwise as a not-for-profit force for good. Our mission is to help people make better health decisions. It is that mission that drives us both to serve and to lead our clients and partners.

With each advance in technology, our mission challenges us to find new ways to help people do more for themselves, to help them ask for the care they need, and to help them say no to care that is not right for them. And, by the way, to accomplish all that, we develop really great content.

We’ve had this same mission since our founding in 1975. Our mission never changes, but how we implement it changes every day as new technology, new partners, and new policies open new opportunities. After each user session with Healthwise content, we count a “mission point.” We track those user sessions on a mission point counter in our lobby. On June 8, our counter hit our one billionth mission point. That was very cool, but each mission point is a cause for celebration.

How else are we different as a non-profit? Well, we can’t be bought and there is no need to worry about quarterly shareholder reports. Our total focus can be on doing the right thing and helping our partners to be successful.

What are the company’ s offerings and how they co-exist with healthcare IT?

Health IT has enabled Healthwise to innovate in a hundred ways — all for the benefit of the patient. In the old days, we used books and workshops to educate, motivate, and inspire people. Through HIT, we can do it even better, in a more personalized way, and for millions more people than before. Consider the following information services offered with the consumer’s best interest in mind:

• EMR Solutions. Doctors are busy, and with Meaningful Use, they have even more on their plates than ever. Our EMR Module makes it easy to deliver patient education from the EMR desktop, optimized to provider workflow. Patient instructions in English, Spanish, and other languages to support refugee populations.
• PHR Solution. Patients need help understanding the medical data now accessible to them electronically under Meaningful Use. Our Knowledgebase connects the patient’s medical data to plain language information on lab results, medications, problem lists, and patient self-management tools.
• Virtual Coaching Conversations (Shelly Visits). Imagine a private coaching session with a health educator to help you understand your condition and develop an action plan for self-management. Next, imagine the same session with a virtual coach named Shelly who can visit you anywhere, anytime, and as often as you like. Shelly Visits use motivational interviewing, cognitive behavioral therapy, and other proven techniques along with voice and graphics to mimic (and sometimes improve upon) a one-to-one coaching session with a health educator or coach, but without the hourly rate of the professional. So far, we have 15 different Shelly Visits across key wellness and chronic condition issues. You should ask for an appointment with Shelly.
• Decision Points. These interactive patient decision aids walk a person through a six-step process for evaluating what is known about treatment options against his or her values, preferences, and desires. Do I need this test? Should I take this medication? Is this surgery right for me? With a summary from a Healthwise Decision Point, a patient is well prepared to work with his or her doctor to make the right treatment choice.
• Care Management Solution. Our newest solution helps care coordinators to easily prescribe and deliver patient-specific self-management guides and decision support tools and to report back the patient’s use of those tools. The “report back” feature allows the patient’s voice to be better heard in shared decision making and care plan creation. It also provides a foundation for patient accountability within an accountable care partnership.
• Learn to Earn. The self-management courses take people through short, engaging health information tracks, like getting started and prioritizing weight management and goal setting and managing diabetes through lifestyle changes. Learn To Earn measures and reports the patient’s progress and completion back to HIT systems so the care team can understand patient activity or easily connect the learning to an incentives program.

Define information therapy and its value in improving population health in an environment calling for better outcomes and lower cost.

Information therapy is the prescription of the right information to the right person at the right time. Often that means that the clinician who has just made a new diagnosis, ordered a new test, or prescribed a new medication can semi-automatically (i.e. one-click action) prescribe care self-management tools and document it in the EMR. Information therapy brings health education into the workflow of the clinician.

Do the Meaningful Use requirements place enough emphasis on patient-facing applications and readily available information? What would you have like to seen them include?

Meaningful Use requirements have made patient information prescriptions a “must have” rather than a “nice to have.” That is a major advance. Patients have already begun to enjoy the Meaningful Use-delivered benefits of patient-specific educational resources, discharge instructions, and the recognition of advance directives.

The two big items next on the Meaningful Use agenda for patients would be patient access to care plans and the requirement that a patient response to an information prescription be included in the clinical record.

Is the uptake of consumer-facing technologies such as social networking, search engines, and online health support encouraging for what you’re trying to accomplish?

It all helps with our basic mission. People need three kinds of input in their quest to manage health problems. Yes, they need plain language, easy-to-understand, evidence-based information on their condition and their treatment options. That is what we strive to provide.

Next, they need a strong relationship with a primary care provider who knows them well and can help to guide them through the options.

And finally, they need to hear from people “just like them” who have been through the same decisions and faced the same options.

Each piece helps, but no single source will lead to the best outcomes.

Time Capsule: Medical Equipment Sales Boom While Health IT Struggles

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 April 2006.

Medical Equipment Sales Boom While Health IT Struggles
By Mr. HIStalk

GE Healthcare just announced quarterly profits of nearly half a billion dollars. While much of that came from diagnostic equipment sales, it’s still worthy of reflection — whether you helped boost the company’s bottom line through your purchases or whether you have to compete against them.

An interesting phenomenon occurs on the non-IT side of healthcare technology. Vendors of diagnostic imaging equipment and Star Wars-like treatment gadgetry use a little bit of science and a lot of scientifically-designed propaganda to create demand for the latest Gamma this, 64-slice that. Customers plant public relations articles in the local newspaper, bragging on their new toy with a subtle message: “Our competitors are cold-hearted cheapskates for not shelling out for the cool patient care stuff like we do for you.”

What’s the downside?

1. In many cases, the equipment has no proven benefit for patients. Seeing an image more clearly doesn’t necessarily mean anyone gets better faster.
2. Supply creates its own demand, ensuring that all those new private office MRI machines are humming from constant use on patients who didn’t need it until Doc got his first invoice.
3. More billions in costs are piled onto a poorly performing healthcare system.

So how can GE, Siemens, Philips, and other conglomerate vendors make so much money on this stuff and still not necessarily make much of a dent in healthcare IT? More specifically and paradoxically, why are customers so willing to spend millions on a given company’s non-IT technologies while fighting tooth and nail to avoid using that same vendor’s IT products?

The most obvious reason is that providers can make money by running expensive tests, particularly when coached by vendor reimbursement experts who can influence the companies who write the checks (and who eventually increase premiums in response). The patient’s not paying anyway, so everybody’s happy, at least until the next round of healthcare and insurance cost increases.

The science behind this equipment is often no better than the shaky anecdotal suppositions about CPOE or ambulatory electronic medical records. Still, it creates its own demand, mostly because customers have a financial incentive to fit it into their practice, while those other IT technologies are largely ignored and unsuccessful because they require extra work for no extra payment.

The takeaway message is that, science aside, doctors and hospitals will utilize the hell out of something when they’re paid to do so (equipment, drugs, supplies, and for-profit referral centers). While it’s nice if patient care is improved, it’s only mandatory that it not be worsened.

Few health IT technologies have ever caught on that didn’t benefit users directly. The stuff being touted today (RHIOs, CPOE, clinical decision support) doesn’t, so it wallows around with unenthusiastic little pockets of interest here and there. The cheerleaders keep complaining about low adoption and the need for someone else to pay for it.

If providers were paid to reduce utilization and improve outcomes, advanced IT support would be demanded, not refused. Until then, the conglomerate vendors will thrive on the medical equipment side and struggle on the IT side unless someone bribes customers to get on board.

News 6/24/11

Top News

McKesson signs a definitive agreement to acquire Portico Systems, a supplier of provider management tools for health plans, for a reported $90 million in cash.

Reader Comments

From Polymorph: “Re: ambulatory rumors. TactusMD just pulled out of their Meaningful Use / EncounterPro offer. EncounterPro has pulled their open source project and also brought in a new management team.” Unverified. These aren’t companies I follow, so I have nothing to add.

From Bull City: “Re: Duke going Epic. According to job listings on their HR site, Duke is replacing McKesson Horizon with Epic. MCK loses a showcase site and development partner, Epic steals yet another high-profile client.” Even non-psychics could have seen that coming since Duke has Epic ambulatory underway and hospitals rarely stop there.

From David: “Re: home brewery. I saw this article and thought maybe you had some extra time aside from HIStalk and the hospital.” It’s a fun article, but it’s not about me. The high-end home brewery of Tim Artz, a director of Agfa HealthCare’s government health IT and imaging business, is featured (he gets extra points for having a homemade meat smoker, whose product surely goes nicely with his beer).

From Joey Cheesesteak: “Re: Investors Business Daily article. One of my daily reads (along with HIStalk). Their daily 10 Secrets to Success section is highly recommended.” IBD characterizes Cerner shares as slow but steady. I used to subscribe, but finally figured there was no way my casual reading was going to pit me favorably against professional money managers in the zero-sum game of buying stocks. I put my little stash in a wrap account, where it has outperformed my returns and given me someone to blame other than me when it doesn’t. However, I just now remember meeting with some investment guy at Cerner’s user group in Orlando years ago and he kept pressuring me to name one healthcare stock to buy. I told him Cerner. I’m sure he’s taking all the credit.  

From MT Hammer: “Re: Webmedx. Acquired by Nuance, as told to employees in a conference call Tuesday. Webmedx was the #3 player in the MT field behind Nuance and CBay/MedQuist.” Unverified. Webmedx was the #1 KLAS transcription services vendor for 2009 and 2010 and offers natural language processing solutions for clinical documentation.

HIStalk Announcements and Requests

If you still aren’t tuned in to HIStalk Practice, here are some of the goodies you missed over the last week: Henry Schein MicroMD GM Keith Slater shares insights on why physicians should or should not implement EHRs. A whole lot of physician practices are not ready for the 5010 transaction set. Healthcare insurers mess up one out of every five claims processed, costing $17 billion in administrative costs — wow. Don Michaels, PhD of Hayes Management Consulting and the Harvard School of Public Health takes about full plates and the ICD-10 500-pound gorilla. Forbes uncovers Practice Fusion’s vision for making money. The cloud looks pretty good in terms of security breaches. While catching up on the latest HIStalk Practice news, help us keep our supporters happy and our servers humming by touring the offerings of our sponsors.

On the Jobs Board: Solutions Executive, Systems Engineer, Technical Marketing Engineer. On Healthcare IT Jobs: CEO & President, Clinical Application Analyst, Manager of Data Governance, Horizon Implementation Consultant.

Listening: new from Montreal power poppers Simple Plan, cheery, loud summer music mostly about girls, such as You Suck at Love. It’s like sangria on a hot day: fizzy, sweet, unchallenging, and likely to lock in memories of what you were doing during those ephemeral days when you were enjoying it constantly. They’re big supporters of charitable causes.

Your HIStalk punch list: (a) sign up for the e-mail updates if you haven’t already, joining a highly selective group of 7,414 subscribers who have Pavlovian reactions of various types when I ring their inbox bell; (b) engage Inga, Dr. Jayne, and me in social intercourse by making our electronic acquaintance on Facebook or LinkedIn (Dann’s LinkedIn HIStalk Fan Club is up to 1,666 members, universally cute and smart from what I can see); (c) vanquish your predilection for passivity and send me news, rumors, photos, guest articles, or sentimental yearnings; (d) love my sponsors at least a little for their brave support of what may be the most amateurish and off-the-wall site in the button-down world of HIT (You Suck at Love? Really?), appreciate their ads by clicking forcefully, check out the Resource Center, and trust that despite the inevitable role conflicts between you as a prospect and they as a vendor, you at least have HIStalk in common and therefore share an appreciation of the offbeat.

Acquisitions, Funding, Business, and Stock

Healthport merges with Universata, a provider of release of information services.

Shares in Philips take a hit after the Dutch consumer electronics giant warns of lower sales right before the quarter’s end. The company says it will cut costs and restructure.

CSC gets European Commission approval to acquire iSoft, although shareholder approval is still required.

People

Guillermo Moreno, formerly of Diebold and past president of the South Florida chapter of HIMSS, joins staffing firm Experis as VP of its healthcare practice.

Navicure names Craig Potts as EVP of sales. He was previously with Fiserv.

Christine Connelly, the high-powered CIO of England’s Department of Health, will leave her position at the end of the month. She says organization management is being restructured and she has decided not to pursue one of the remaining executive positions.

Announcements and Implementations

Omnicell’s new G4 medication dispensing system earns ONC-ATCB certification as a Modular EHR.

Baptist Health System (AL) and Henry Ford Health System (MI) will pilot a new cloud-based imaging management system from AT&T that provides quick access to images from any system and provides secure image access to referring physicians and facilities.

Mercy Medical Center-Sioux City (IA) makes the local paper for its new Web-based system that allows patients to pre-register, pay bills, and print a medication card.

Government and Politics

ONC announces that it has made its healthcare IT teaching curriculum available to the public at no charge, including higher education institutions in the US and elsewhere. The material was developed with a $10 million ONC grant. Content covers work redesign, technical support, networking, usability, and project management. It also includes modules with hands-on lab assignments that use the free VistA for Education EHR. The links sent to me didn’t work, but check ONC’s site.

The US Supreme Court strikes down a Vermont statute that prohibits the selling of prescription data to drug companies (usually via third-party vendors such as IMS Health) so they can develop customized sales pitches for doctors. The court found that Vermont had a vested interested in prohibiting prescription drug marketing as a form of censorship since it is a purchaser of generic drugs, not to mention that the advertising lobby argued that drug marketing is free speech. IMS wet its corporate pants at the news, vowing to gear up its hugely profitable business in the interest of public health and healthcare reform.

Innovation and Research

The Children’s Boston/Harvard Medical School SMART Platform Apps Challenge chooses the Meducation app by Polyglot System as the winner of its $5,000 innovation prize, which focused on add-on EMR applications. Meducation will be added to the SMART App Store that launches next year, modeled after its Apple counterpart. Meducation pulls medication lists from the patient record, then allows printing simplified instructions in several languages. It was developed under an NIH grant for underserved populations.

Two UCSF medical students create MediBabble, a free  app that lets caregivers play pre-recorded patient history questions in various languages to patients who don’t speak English. It asks questions that require only yes-no answers or pointing to a body part.

Technology

Microsoft’s Craig Mundie pitches the company’s Kinect motion-based game controller at the Pacific Healthcare Summit, citing its potential use in avatar-based group therapy sessions for mental health patients and as a way for doctors to interact with medical records systems using voice and gestures. I didn’t see a video, but above is one from Wake Forest Baptist (NC) showing the use of Kinect to manipulate medical images.

Other

A 21-year-old con man poses as a doctor at OHSU Hospital (OR), providing medical advice to a patient from the hospital’s coffee shop while wearing a fake hospital badge and uniform. He also claimed to be a software developer at Microsoft.

PatientSecure is getting publicity like I’ve never seen from its little press release about NYU Langone Medical Center going live on its palm scanning system for verifying patient identity. Above is a lengthy evening news piece from ABC’s New York affiliate.

Aspirus Wausau Hospital (WI) loses phone service and network connectivity for several hours on Wednesday when a maintenance worker accidentally triggers a fire suppression system, requiring ambulances to be diverted and some appointments to be rescheduled.

Weird News Andy can’t decide if this is real or The Onion. A UK hospital, claiming it’s too broke to install a nurse call system in the wing for elderly patients, hands out tambourines instead. It even provides a backup system: maracas. A relative said, “These people are pensioners – not members of the Monkees or Mick Jagger,” apparently missing the fact that the once-youthful rockers she mentioned are pensioners themselves – Davy Jones is 65, Peter Tork is 69, Mick Jagger is 67, and Keith Richards has to be at least 185.

WNA also weighs in on this gut-wrenching invention: a self-propelled endoscopy device called The Mermaid, a tadpole-like, joystick-controlled camera that can swim the entire length of the GI tract in a few hours, starting from either end.

Sponsor Updates

• MedAptus will demonstrate its Intelligent Charge Capture technology at next week’s HMFA ANI conference in Orlando.
• Also participating in HFMA ANI: EDIMS.
• MED3OOO’s InteGreat EHR passes all required elements in the CCHIT 2011 Ambulatory, Child Health, and Security test scripts and is now a Pre-Market Conditionally CCHIT Certified 2011 Ambulatory EHR additionally certified for Child Health.
• Encore Health Resources is named one of Best Places to Work in Healthcare.
• Besler Consulting will feature its BVerified-Revenue Integrity Auditor at HFMA ANI next week. It allows hospitals to quickly act on revenue enhancement and compliance opportunities.
• Capario achieves full accreditation with the Healthcare Network Accreditation Program (HNAP) from the Electronic Healthcare Network Accreditation Commission (EHNAC).
• Catholic Health Initiatives (CHI) is featured as a case study in “getting staffing right” in the new issue of HFMA’s Leadership. Its eight-hospital pilot of Clairvia’s CVM tracks patient progress through the hospital and tracks progress and expected length of stay against CMS benchmarks, suggesting optimal staffing levels and skill mix along the way.
• Concerro offers a complimentary Webcast that covers Joint Commission Emergency Management Standards.
• KLAS ranks Encore Health Resources in second place (missing first by 0.2 points) in advanced health information technology services.
• EnovateIT’s Fred Calero wins Michigan’s Entrepreneur of the Year.
• Health Language, Inc. unveiled the latest release of its LEAP I-10 at last week’s AHIP’s Institute 2011 Conference in San Francisco.
• Sage Healthcare adds nine new clients for its cloud-based Sage Intergy On-Demand PM/EHR.
• Healthwise offers a white paper on Getting Patients to Meaningful Use.
• GetWellNetwork releases a list of winners of its third annual Interactive Patient Care awards. Top honors went to The Indiana Heart Hospital for using GetWellNetwork’s Heart Failure Care Plan to reduce readmission rates and help cardiac patients manage their condition.
• T-System promotes Bill Hall to VP of solution development, Scott Martin to manager of solution management, and Hank Hikspoors to director of new product development.

EPtalk by Dr. Jayne

A networking site for physicians has been launched by Doximity. Unlike my recent trip to the CMS Web site, a visit to Doximity found that my correct and updated practice address was already on file. Advertising the ability to not only connect colleagues but to allow “HIPAA secure messages,” Doximity is supported on iPhone, iPad, Android, and PC platforms. CEO Jeff Tangney co-founded Epocrates. I’m not sure what advantages it has over other networking platforms just yet, but I’m going to keep my eye on it.

Those of us that work in the primary care trenches have seen a variety of body piercings, some of which have gone awry. Researchers  at the Northwestern University School of Medicine have been using a technology developed at the Georgia Institute of Technology that allows patients with spinal cord injuries to steer wheelchairs using a magnetic tongue stud. The magnet sends signals to a headset, which then transmits to an iPod that controls the wheelchair. Although glue was originally used to hold the magnet in place, trials found that a tongue piercing was more reliable.

Life in the fast lane, literally: personalized medical monitoring devices are one of the coolest and least-discussed types of health information technology. This year I’ve been following IndyCar driver Charlie Kimball, who has Type I diabetes. Kimball wears a continuous blood glucose monitor that feeds to a gauge on the dash right next to other traditional race car data points. He finished 13th in this year’s Indianapolis 500.

News of the Obvious

Surprise, surprise: a Harvard study demonstrates that watching TV, snacking on chips, and staying up too late can cause weight gain. Researchers looked at over 120,000 Americans over a 20-year period and found an average weight gain of three to four pounds per four years. I wonder what the results would look like if it was repeated on IT department staffers, EHR and CPOE implementation teams, and Meaningful Use consultants during the last two years?

More non-surprises, as shared by Bama Bubba: Sleep Deprivation in Medical Caregivers Has Deadly Results.  Extended hospital shifts increase the risk of patient safety compromise as well as vehicular accidents. Having had a close encounter with a rural route mailbox after being up all night, I know this to be true. Starting next month, incoming first-year resident physicians will be limited to 16-hour shifts rather than the current 30-hour cap. Having trained “back in the day” when there were no work hour limits, I see this is a positive step towards a more humane training program, but the jury is still out on what impact the work hour limits may have on resident learning.

Contacts

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

Readers Write 6/22/11

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

Epic Ponderings
By Cam O’Flage

Epic is a marvelous marketing machine, from initially establishing themselves as a boutique firm with a certain mystique since they were able to tell clients whether they were the right customer (rather than the customer telling Epic that they were the right vendor).  And it continues to be a superlative marketing machine.  They tell a good story, present a great vision, and manage customer expectations nonpareil.  They’re superb business people.

Epic doesn’t do everything right, but who does?

Epic makes many good decisions, but they make some bad ones.

Epic releases aren’t always so bug free.

Now, I know that I speak from a biased perspective since I currently am involved with provision of implementation consulting (staff augmentation) services.  But I’ve been around a long time and seen lots of successes and failures across multiple delivery systems using multiple vendor applications.

Epic’s current implementation methodology, however, is circumspect.  While it’s partially in response to ONC’s mandated MU timetable (another source of discussion), Epic does believe that it knows the best way to install its product.  But a tight timetable with little time to consider workflow needs or optimizations or deferral of vital function simply to make a deadline is so wrong.

We’re told time after time, plan and engineer correctly in advance to maximize return on investment and minimize production problems.  It’s in our business school case studies.  It’s in our re-engineering process improvement literature.  It’s in our quality theories.  Yet, Epic – and ONC – have embraced a slam dunk implementation methodology.  Get it in, optimize later.

There are so many choices.  So many informatics considerations (one of my biggest fears since so many of Epic’s designers and installers simply don’t have a good basis in understanding clinical informatics needs – or revenue cycle considerations, for that matter).  So many process issues.  So many opportunities to improve, to ensure that clinical documentation is complete, that patient safety is maximized, that budget is truly aligned with needs and expectations, that appropriate governance has been put into place, that risks are adequately mitigated, that expectations are properly established, that work/life balance is dealt with, etc.

There are too many customers that go apoplectic when there are budget overruns, even if scope has changed.  While that’s not an Epic problem per se, the perception that their plan is comprehensive and constitutes the safest way to attain MU is contributory.  CIOs and COOs and CFOs and VPs simply need to get real.  An EHR implementation is an immensely complex organizational change, fraught with unknowns and potential failure points.

There are too many customers who wish that they had done their implementation differently. There are too many times that customers realize that optimization entails rebuilding the foundation.  There are too many customers who find themselves a year later not where they wanted to be. HIStalk pages certainly document such things.

However, all of that said, I can’t say enough good things about Epic.  Epic truly focuses on improving the patient experience. Their culture is one of excellence, of passion, of dedication and commitment.  Their employees are smart and industrious.  And they continue to deliver what they promise.  I can’t say that about many IT vendors.

Why Are We Still Struggling with CPOE?
By Daniela Mahoney

I often ask CIOs a simple question: what keeps you awake at night? Over the years I have received many different answers. Lately I have been thinking about my work and my experiences from previous days and could not stop asking myself, “Why, after more than 30 years, are we still struggling with getting CPOE going?” What other industry has tried implementing technologies and three decades later they are still in their infancies with the results?

I was excited about the idea of writing an article each month for HIStalk to share some of my insights about what to do with this entire CPOE business and how to best prepare for its challenges. Then I was wondering about our colleagues in the industry, and who wants to keep reading about CPOE? Mine would be just one more article of something you read somewhere, else because “theoretically,” we know what we need to do and there is already a lot of information about it. And that is the exactly the key — we know the “whats” but we oftentimes miss the “hows”.

But, one would ask, why should anyone listen to Daniela? Well, you don’t have to. I am only going to share what I have learned by doing CPOE for over 20 years. I am going to keep it simple because I find that we can achieve much more when we present information in a way that we can relate to and it makes sense to most of us. It is like baking a molten chocolate cake –  it has only six basic ingredients, but the outcome is divine! You can add the raspberries on top if you wish. Simple is good, and we can achieve exceptional results.

Did you know that CPOE has been talked about since the 70s? In June 1971, the National Center for Health Services selected El Camino Hospital, CA, to evaluate and implement the Technicon Medical Information Management System (TDS) to be used by nurses, physicians, and others. The main goal was to expedite the overall patient care processes.

By 1974, 45% of all orders were entered directly by physicians into their CPOE system. Yes, we had it then, and unfortunately at that time in the 70s and 80s, some of the institutions and vendors who attempted had varying degrees of failures, with some limited successes. It was not until the late 80s and early 90s that we experienced a renewed effort and interest in CPOE. I started my journey on this path in 1990, so I can say that we have learned a lot. Or did we?

I am going to begin with the end in mind, assuming that we are not just doing CPOE to meet the political timelines, but also to do the right thing for the patients and give our clinicians a tool they can appreciate and incorporate into their everyday workflow. Based on this assumption, we will work backwards and talk about the right things to do as we prepare for this CPOE journey. Almost three decades later, it is about time that we get it right the first time around! Here is the roadmap we will talk about in the next 12 months:

1. Is it only CPOE, or there is more? We have to think about what is ahead of us more holistically because CPOE is no longer a standalone project.
2. What support we need from our leaders to pave the road for us and why?
3. Why should I (physician) use it? What’s in it for me? How do we create a value proposition?
4. How much will it cost?
5. How do we create the teams (who steers the wheel vs. who shifts the gears)?
6. Don’t let perfection get in the way of good. Setting the scope of what CPOE is and what it is not.
7. Clinical process transformation. How to manage and not get crushed by the magnitude of change.
8. How about the vendor? Where do they fit into this?
9. Did we get it right? How do you know? (aka, success factors).
10. What is going to make us fail? If 30% of CPOE installs have historically failed, how do we rise above this? (aka, risk factors).
11. Large or small hospital, we need to roll out somehow. What are the options and their respective pros and cons?
12. No, I did not forget about training and support. I will address this as well.

And if there are any other readers who enjoy cooking as much as I do, here is the link to the molten chocolate cake. 30 minutes to prepare, six minutes to cook, and 10 minutes to savor your work of art. And while you are enjoying this superbly rich chocolate delicacy, please try not to think of CPOE!

Daniela Mahoney RN is president and CEO of Healthcare Innovative Solutions of Seville, OH.

Thoughts on Lazar Greenfield Stepping Down
By Tiffany Carroca

On Sunday April 17, renowned surgeon Lazar Greenfield MD resigned from his position as president-elect of the American College of Surgeons (ACS). The resignation came just over two months after he had written a controversial article that caught the attention of nearly everyone in the healthcare community, including those in medical coding, and has achieved a level of infamy nationwide as the Valentine’s Day editorial. The controversy of the article stems from a statement made in which Dr. Greenfield suggests giving women semen for Valentine’s Day instead of chocolates.

The editorial was originally published in the February 2011 issue of the American College of Surgeons affiliated newspaper, Surgery News. The paper, made available free to the public online, was pulled from the Web site when the controversy erupted soon after the story ran. Interestingly, Dr. Greenfield was also editor-in-chief of the publication, but was subsequently removed from the position due to the content of his article.

Although Dr. Greenfield apologized for the editorial and reaffirmed his belief in the rights of women in health care, these actions did not end the controversy. Besides offending many female surgeons who have had to put up with sexual harassment for decades in this male-dominated field, Dr. Greenfield managed to dig himself in deeper when he sent an e-mail to several media outlets defending his claims. However, Dr. Greenfield did ultimately determine that resigning would be the best way to put an end to the uproar over his article. In a statement given to ABC News, Dr. Greenfield said, “My personal and written apologies were ignored, and my suggestion to use my experience to educate others rejected. Therefore, rather than have this remain a disruptive issue, I resigned.”

The comments made by Dr. Greenfield on Valentine’s Day seemed like a joke to some and the crass opinion of a womanizer to others. However, the statement does have a basis in scientific and medical fact. Dr. Greenfield was referring to a study published in the Archives of Sexual Behavior in 2002. The study was performed by psychologist Gordon G. Gallup, PhD at the State University of New York in Albany, and gained widespread attention when it was reported in the article Crying Over Spilled Semen by Tiffany Kary for Psychology Today.

The study was conducted on 293 college women who were sexually active. The results showed that women experienced less depression after having unprotected sex, and the depression slowly returned as the time progressed after their last sexual encounter. Women who used condoms did not experience any reduced or heightened rates of depression.

The conclusion reached by Dr. Gallup was that the hormones contained in semen are absorbed through the walls of the vagina and elevate the mood of the woman after intercourse. Other variables that could have caused the reduced depression, such as birth control and behavior patterns, were also taken into account.

The group most outraged by the editorial was women in the healthcare field, most notably women surgeons. Colleen Brophy MD, a prominent professor of surgery at Vanderbilt University School of Medicine and chairwoman of the ACS’s surgical research, explained to Pauline W. Chen MD who reported on the story that she was “aghast” at the editorial. However, when the ACS refused to stand by her response, Brophy resigned from the College in response, claiming, “The editorial was just a symptom of a much larger problem. The way the College is set up right now is for the sake of the leadership instead of the patients.”

Many women in the healthcare field voiced their outrage over Dr. Greenfield’s editorial, but he was not without his supporters. Dr. Greenfield, a professor emeritus at the University of Michigan, had always been highly regarded and was presented with the Jacobson Innovation Award just last year, according to NPR’s Health blog.

A colleague at the University of Michigan, Diane M. Simeone MD, came out in his defense, saying that she has witnessed several accounts of gender bias among surgeons, but never from Dr. Greenfield. Similarly, Dr. Gallup, who conducted the initial study, also came to the defense of Greenfield, noting that what he said may not have been tasteful, but does have “some basis in available science.”

Undoubtedly, Dr. Greenfield’s remarks caused a public outrage even though they were based on science. However, a lewd and womanizing comment based on science is no less offensive that one based on fiction. If Dr. Greenfield was trying to be humorous or otherwise non-offensive with his comments, he failed miserably, as public opinion has shown. Even an esteemed doctor and scientist can fall from grace when injecting personal opinions into the science. As most scientists will agree, it is best to keep the science pure.

News 6/22/11

Top News

The VA awards The Informatics Application Group a $5 million contract to serve as the custodial agent that will manage a proposed open-source development program for VistA.

Reader Comments

From Anon: “Re: ONC. Recently cancelled a number of print and Web ad contracts. They have instructed their ad agency to work with 10% of their original million-dollar budget.” Unverified.

HIStalk Announcements and Requests

Vince Ciotti is loving all the comments, stories, and even corrections he’s getting to his HIStory series. He gave the OK to run his e-mail address for anyone who wants to get in touch. 

Thanks to the following sponsors (new and renewing) and long-term advertisers that supported HIStalk, HIStalk Practice, and HIStalk Mobile in May. We appreciate their support.

Acquisitions, Funding, Business, and Stock

PwC acquires Implementation Specialists (ISH).

athenahealth’s Jonathan Bush and Ed Park are among a group of angel investors and VC firms investing in HIT start-up Kyruus. The company’s software platform compiles data from public and private sources to create predictive analytics and professional profiles on physicians. Sound big brother-ish.

Misys doesn’t have much healthcare presence these days, but for those who still follow the company, it confirms that a potential buyer is interested in acquiring the company at a valuation of $1.4 billion.

Sales

North Idaho Health Network picks MobileMD to provide HIE services for five hospitals and 305 physicians.

People

PatientKeeper president and CEO Paul Brient wins the Ernst & Young Entrepreneur of the Year award for New England and is now eligible for consideration for the national award.

Former Ingenix VP Tom MacDougall joins Curaspan Health Group as the company’s first CTO.

Prognosis Health Information Systems appoints William M. Conroy to its board. He was CEO and president of Initiate Systems until IBM acquired the company in March 2010.

University Health Care System (GA) names Leslie Clonch as VP/CIO. He was previously with Doctors Hospital at Renaissance (TX).

Announcements and Implementations

The University of Kansas Hospital goes live with 240 evidence-based order sets using Zynx Health’s clinical decision support solutions. The ZynxCare tools are deployed via KUMD’s Epic EHR.

Accenture and MOH Holdings announce that the first phase of Singapore’s National EHR system is now live.

The data warehouse appliance product of Health Care DataWorks earns EHR Modular certification for calculating and submitting inpatient and ambulatory clinical quality measures.

Yuma Regional Medical Center (AZ) gets a mention in the local paper for its $70 million Epic implementation.

Cooper University Hospital (NJ) says it’s the first in the country to transmit real-time clinical information for dialysis patients in the ICU. iSirona’s  medical device connectivity software sends the information to the hospital’s Epic system, allowing doctors to monitor the effectiveness of dialysis treatments from any location. They’re planning something similar for vent patients.

Government and Politics

CMS will use predictive modeling to fight Medicare fraud. It’s the same sort of risk-scoring technology that credit card companies use, but modified to analyze Medicare claims. That reminds me of the time VISA called me to see if I really did purchase several hundred dollars worth of goods and services at a strip club (the answer was no.) I wonder if Medicare will start calling up 70-year-old men to verify whether they indeed had procedures performed to sever their vasa deferentia?

The National Library of Medicine launches MedlinePlus Connect, a free service that allows health organizations and providers to link patient portals and EHRs to MedlinePlus.gov for consumer health information. Providers can meet one of the 10 menu set criteria for Meaningful Use by linking to it.

An India-born weight loss doctor who took in $25 million from billing insurance companies for questionable weight loss treatments makes the FBI’s Most Wanted list. The complaint says the doctor’s five clinic locations billed for tests not needed or not performed, allowed employees to hand out controlled substances without asking a doctor, and dressed up unlicensed personnel and passed them off as nurses. He got in trouble a couple of years ago for insider trading.

Technology

SAP is apparently offering an EMR.

Other

Several health systems and a few HIT vendors earn spots on ComputerWorld’s 100 Best Places to Work in IT 2011. Top health systems include Kaiser Permanente (16), Texas Health Resources (19), and Lehigh Valley Health Network (20). Recognized vendors include Cerner (27), Quest Diagnostics (70), and Compuware (86).

NextGen will host a webinar this Thursday called Tips from a Physician on Transforming Your Practice Through Meaningful Use. The physician presenter has already led 29 doctors achieve Medicare Meaningful Use.

Weird News Andy proclaims himself Sad News Andy because  of this tragic story from the UK: a top orthopedic surgeon hangs himself in the garage of his estate, reportedly after making a relatively minor surgical error.

Fallon Clinic (MA) joins Atrius Health. Both are Epic users.

Odd: a man gives a bank teller a robbery note demanding $1, then sits quietly waiting for police to arrest him. The reason: he’s unemployed, ill, and has been turned down for disability and Social Security. He’s hoping the court puts him away for several years (and says he’ll do it again if not) so he can receive medical care, after which he plans to collect Social Security and move to the beach.

Ohio Public Radio covers electronic medical records, with Dr. Gregg as one of the guests along with folks from ONC and Ohio Health Information Partnership.

Sponsor Updates

• CynergiskTek and its partner Diebold will exhibit their enterprise security solutions at next week’s HFMA ANI 2011 conference in Orlando.
• ADP AdvancedMD is sponsoring at this week’s Utah Promontory HIE and Technology Connectivity Conference in West Valley City, UT.
• Emdeon expands its services portfolio with the acquisition of Chapin Revenue Cycle Management, a provider of hospital-based revenue cycle services.
• GetWellNetwork’s chief outcomes officer David W. Wright is appointed to the board of directors for the American Nurse Credentialing Center.
• TeleTracking Technologies will host a free conference on automating transfer center operations August 17-18 in Nashville.
• HMS Direct, a subsidiary of Healthcare Management Systems, will expand its data center capacity by utilizing hosting services from Peak 10 Inc.
• Thomson Reuters’ Pharmacy Xpert  and Clinical Xpert CareFocus earn ONC-ATCB modular certification.
• Medicity announces that its ProAccess technology has received ONC-ATCB modular certification.
• Benefis Health System (MT) selects NextGen Ambulatory EHR, PM, and HIE technology for more than 80 physicians at its hospital-owned practice.
• Access releases a new version of its on-demand forms applcation.
• QuadraMed and Elsevier align to combine Elsevier/MC Strategies ICD-10 e-learning suite with QuadraMed’s ICD-10 Countdown Program.
• Elsevier also signs an exclusive partnership with The Quality Group (TQG) to market TQG’s Health Care Series, a customized process improvement training solution for healthcare professionals.
• McGraw-Hill Higher Education and Greenway Medical Technologies announce an online HIT course for colleges and universities. Integrated Electronic Health Records: An Online Course and Worktext for Greenway Medical Technologies’ PrimeSUITE will be offered through McGraw-Hill’s Connect Plus teaching solution.
• OptumInsight (Ingenix) collaborates with InstaMed to offer CareTracker Payment Connect, an electronic bill payment service for patients.
• Billian’s HealthDATA will exhibit at HFMA ANI 2011 in Orlando next week. Check in on Foursquare and show it to the booth reps and they’ll give you a Starbucks gift card.

Contacts

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

Curbside Consult with Dr. Jayne 6/20/11

Well, it seems Dr. Jayne has a new not-so-secret crush. His name is Ricky Roma. Seriously, I almost swooned reading his response to my recent Curbside Consult. 

Why, you ask? Because 90% of the time, I sit on that wall right beside the fearless IT warriors at my hospital, defending security policies and standards as well as truth, justice, and the Enterprise Way.

I’m the one who has the fun of giving the smack-down to whiny end users (frequently Department Chief types or high-profile surgeons) who don’t understand why giving their passwords to their students and staff is a bad idea. I get to explain why each department can’t have their own customized software when we’ve got a large health system to run. I’m a huge fan of that speech in A Few Good Men and I’ve used a variation of it more than a few times.

One of the things I enjoy most about writing for HIStalk is for Dr. Jayne to be able to represent viewpoints that are not necessarily mine. I’ve been an “IT guy” long enough to know that we do play a somewhat parental role. Like those who celebrated Father’s Day yesterday, giving in to everything that’s asked of us isn’t a good idea.

Another aspect I enjoy is the ability to throw topics out and see what’s hot and what’s not. And this is clearly hot. I’d like to share some of the responses I received. Regarding my comment about an orthopedic colleague who had the wide-aspect laptop, one reader pointed out:

The hardware issue is really a software issue. Your point about software working on 4:3 vs. 16:9 screen displays is valid to a point. However, I find that my Web apps can adjust to my display, especially if the display is a phone. It seems to me that with the growth of HD capable monitors and gaming- and video-optimized laptops that software vendors would let go of their control of each pixel and allow folks to optimize their software for the aspect ratio of their system.

One of the coolest things I ever saw was a technical writer would could take his massive 16:9 monitor and pivot it from landscape to portrait orientation and his application (Word in this case) reoriented the display to take advantage of the orientation. He went from side-by-side book layout of two pages to one page over the other. Very, very cool.

HIT should demand that kind of separation of display from the underlying application. I know it can add to support costs, but is the goal here to reduce support costs or make medical practitioners more efficient and comfortable in their work.

I don’t disagree. More vendors need to make their user interface dynamic. However, when the vendor clearly states in the documentation that there is a specific aspect ratio and resolution required for the product but the IT staff purchases something different, it’s a hardware/people issue. Agreeing on that point, the reader added:

Having started in healthcare at a startup years ago then moved on to other fields, including mobile, and then back into healthcare and EMRs, I felt as if the industry had not changed in my absence. What I see is that there just has not been enough money in the market for anyone to actually maintain apps the way they should be, which is managing the infrastructure as well as just shoveling on more features.

In the ambulatory EMR market, I just see a race to add functionality without investment in redesign so you get these incredibly long series of tabs with very difficult discovery of how to do what you want to do next. In this world of Google, it is crazy that many searches are still bound to a particular field rather than being ‘softer’ and allowing for searches across multiple fields with a list sorted by relevance.

There is this huge disconnect for healthcare workers between the systems they use at work and those they use in their private pursuits.

This last statement is incredibly profound. It supports why so many physicians want to use the technologies available to them in other arenas when they are caring for patients.

Trust me, I understand security. I understand encryption. I understand HIPAA, OCR penalties, and the perils of letting users slap any old device on the network. I also understand load balancing, network and server performance metrics, and a host of other things that, when spoken about in mixed company, render other physicians clueless.

Having had not only my physician data breached (including SSN) but also my own PHI, I really do get it. What I have difficulty understanding though, is an IT department that runs Windows XP across the board and will allow Fujitsu tablets on the network but not HP devices.

Some savvy readers noticed that although many reader comments were of the “no Apple, no way” variety, other than citing the project at Albany Medical Center, I never suggested that IT departments should allow users to put personal devices on the network at their every whim, or that Apple products didn’t have potential security issues. In speaking of the variety of hardware in the market today, I used the word “nightmare” to describe the consequences of lack of standardization. I didn’t suggest that IT departments throw the baby out with the bathwater, but noted that those who are able to temper their requirements have an advantage over those who don’t.

Not every IT department is understaffed, underfunded, or abused. One correspondent cited a hospital where the IT department has more employees than any other business unit, as well as a level of funding that is many times that of the top clinical divisions combined. (word of advice – if you don’t want to “out” your employer, don’t message on Facebook because I can see who you work for. And BTW, I am not surprised!)

What’s extremely hard for CMIOs to do, even those of us who sit in solidarity with our IT brothers and sisters, is to explain to the physician who is working with the ergonomics team because of a visual disability that the IT department does not have any devices to offer her other than a fixed-location PC with a large monitor (even though they’re readily available from the vendor) because they’re not “standard.” As Shipes commented, maybe it’s an IT governance problem.

How should we respond to the colleague who has read about competitors using different technology, or the one who is on staff at a competitor hospital who allows iPads for patient care? HIStalk and other media are full of articles about healthcare organizations embracing the iPad. Clearly some organizations have figured out ways around the security issues, or are able to limit use to certain applications. Clinicians are looking for facts, not fear. As I was thinking that I’d like to hear from those groups how they do it, my inbox made its happy little ‘ding’ sound, and a fellow CMIO hit the nail on the head:

Security and productivity can’t be mutually exclusive, or healthcare is doomed. It is imperative that everyone in IT from the CIO and CMIO down to PC support realize we all share a common mission: (1) patient safety and satisfaction (often forgotten); (2) organizational productivity (no margin, no mission); and (3) physician satisfaction (we like happy docs). If this means devoting resources to figure out how we can provide secure access from physician devices, we should plan on that investment. I often hear from my colleagues that we care little about their practice, we have no consideration for patient care, and we have no interest in helping them with daily activities of being a physician. IT has become integral in the care of patients and needs to act that way.

We are in the process of provisioning the Epic Haiku (iPhone) and Canto (iPad) app to probably close to 1,000 physicians. We did an internal survey and discovered 90% of our physicians use smart mobile devices, greater than 75% the Apple platform. The Epic mobile app allows them to have deep access to the patient’s current chart and past history in real time, and with AT&T, they can be speaking with a nurse or colleague while reviewing the chart simultaneously. Please tell me how that sort of convenience isn’t worth the extra steps to ensure secure PHI. The app is set up as a remote viewer, no PHI is stored on the phone, and it requires three-factor authentication (user ID, password, and unique device ID). That’s much more secure than random papers floating around in hallways and cars.

As a CMIO, it’s my job to represent the physician perspective and help bridge the gaps between the needs of IT, the needs of clinicians, and the almighty budget. When I’m not drowning my end of day sorrows in a nice scotch, I’m hoping for the miracle that allows me to deliver the impossible with solutions that are simultaneously fast, safe, and physician friendly. In the meantime, though, I’m right next to you on that wall, Ricky Roma.

Monday Morning Update 6/20/11

From Cheesy Politics: “Re: Epic. At least one Wisconsin political blogger sees it as evil. She does have a point: isn’t HITECH about government getting more control over health information to be able to push out mandates?” I read that post when it was published, but like most partisan blogs, it was a bit too hysterical for me to mention here. Not to mention factually incorrect, saying HITECH has set aside “almost $100 million in total” for EHR incentives (oh, if only) and that the Health IT Policy Committee that Judy Faulkner sits on is “the federal Health IT board.” I agree that the government runs healthcare and will continue to expand its influence over it, but that’s to be expected – they’re paying for most of it in the form of redistributed taxpayer money.

From The PACS Designer: “Re: Prezi. In a recent blog post on HIStalk, Will Weider mentioned that he used Prezi as his online presentation software which he preferred over other possible choices. Prezi seems to be more user friendly with its zooming whiteboard concept, and is gaining more popularity because this feature.” It can “Prezify” your PowerPoint slides, I note. Price ranges from free to $159 per year. PC Magazine gave it 3.5 stars in October, mostly because of limited design choices, but said presentations are “an animated visual feast.” I’m not sure that’s enough reason to switch, especially if you aren’t already using PowerPoint’s animation tools (and let’s face it, for most in-person presentations, those “animated visual feasts” would be super annoying, so I’d save them for making videos).

From Former CIO: “Re: corporate proxy reports. Not healthcare related, but amazing.” A corporate governance group highlights corporate proxy disclosures that are bizarre:  one company’s CEO agrees to spend 80% of his “business time” on the company’s affairs, up from the previously agreed on 60%. I have to say I was disappointed – the proxy disclosures are nothing compared to the perks executives get that aren’t disclosed. Even non-profit hospitals and groups are quite generous with the executive bennies: cars, private club dues, travel, and big bonuses. Clueless VPs get fashionable technologies to screw up, meaning they’ll make impatient calls to the CIO to demand that the on-call field support tech be sent over to their summer home to fix the hospital-provided, state-of-the-art laptop that the VP’s teenage son messed up while torrenting porn.

Several readers have e-mailed over the years saying that they would like to support HIStalk’s sponsors, but can’t easily figure out who offers what products and services from the ads. They suggested an online guide similar to the one that HIMSS puts together for conference exhibitors, where you can look up companies by category. Great idea, so we’re doing an HIStalk Resource Center that does exactly that. You can navigate by company name or category and jump between companies by breadcrumb links. You can also request information by clicking a “send RFI” link that will let you contact a company directly without having to fool around with composing an e-mail or finding the contact form on their site. It’s a work in progress. I’ve added a tiny clickable banner right below the Founding Sponsor ads that will take you there.

When Ricky Roma left his A Few Good Men parody rebuttal to Dr. Jayne’s complaints about IT, I knew it was too good to not promote to the main page of HIStalk instead of leaving it as a comment. Your reactions proved me correct – it’s darned funny and, for those of us who have worked the IT side of the house, a good description of why IT shops don’t always have the budget or labor to support Apple’s latest gizmo. In case you weren’t around or paying attention back in 2009, check out Ricky’s excellent Tales of the Dark Side (a  snip: “Remember, the demo is an illusion. A lunch demo, doubly so. ”) I’ve been pestering him to write more for HIStalk ever since. If I thought an outpouring of support would convince him, I’d start a petition.

Not good news if you compete with Epic: while survey respondents give differing reasons for its success, combining answers 3, 5, and 6 together suggest that more than 60% believe it’s because Epic’s product is better. New poll to your right: is it OK that an electronic medical record contains scanned documents along with discrete data fields?

Watching: In Plain Sight, my new favorite Netflix series. You could neatly categorize most people by the character they find most attractive: federal marshal Mary Shannon of the Witness Protection Program, her sister Brandi, or her partner Marshall (who I guess would be Marshal Marshall). Brilliant acting and writing, like this quote: “The second revelation came as I sat at the bar in morose solitude, pondering the cantilevered relationship between bartender’s gut and lower extremities. And this is important, so pay attention. Before the big bang, before time itself, before matter, energy, velocity, there existed a single, immeasurable state called yearning. This is the special force that, on a day before there were days, obliterated nothing into everything. It is the unseen strings tying planets to stars. It’s the maddening want we feel from first breath to last light.” And Listening: Yes, The BBC Recordings 1969-70. Truly amazing and polished, complex music played live by guys in their early 20s, one of my favorite bands (through Relayer, anyway). Stupendously good.

Cerner forms a joint venture in Saudi Arabia to offer Millennium to hospitals there, working with a government-owned investment firm and a business development group.

Dr. Jayne is interested in learning more about IBM’s Medical Record Text Analytics solution (a spinoff of Watson), so if you’re an in-the-know IBMer, feel free to contact her. She missed last week’s Webinar on the topic, I assume.

I see from his Facebook updates that Ed Marx has reached the top of Mount Kilimanjaro, Africa’s tallest peak at over 19,000 feet (that’s an earlier training pic above, just in case you were thinking that it doesn’t really look all that tall). Ed’s an ardent HIStalk supporter: he voluntarily writes for us (very well, I should add); he Likes all of our Facebook posts; and he graciously took time out of his HIMSS schedule to speak at our sponsor lunch in Orlando. Therefore, I quite reasonably conclude that Ed is the man.

My Time Capsule editorial this week from 2006: Before You Buy, Look at the Impact on User Productivity.

ONC is using some of its tsunami of taxpayer money for publicity: ghost-written blogs, contests, and now advertising. The one above has a new “campaign” that I’m guessing came from an expensive PR firm: "Putting the I in Health IT.”

Weird News Andy summarizes this story as “The government paying more than necessary and offering less than effective options? I’m shocked, shocked to find that is going on here! </casablanca>” UCSF researchers say Medicaid could save a lot of money by paying for drugs that are on WHO’s Essential Medicines List, which is used by 131 of 151 countries surveyed, instead of letting each state make up their own inconsistent lists. If you’re a fan of creeping socialism, you’ll be happy to note that 20% of the country is on Medicaid. Sometimes I get the feeling that those of us who pay taxes to support everyone else are getting to be a tiny minority.

Speaking of Medicaid’s wasting of money (was that redundant?), North Carolina’s project to replace its Medicaid claims processing system is now two years behind schedule and more than $200 million over budget, not to mention that the state will also pay EDS another $110 million to process claims over two years since the new system isn’t ready. The contractor is CSC, the company that’s even more behind and over budget in Britain’s NPfIT boondoggle, also responsible for Medicaid system problems in other states. The state isn’t blaming CSC, though – they say it’s the federal government’s constant Medicaid tinkering that keeps changing the specs. The state is offering to change the five-year, $287 million contract to a seven-year, $495 million one with Uncle Sam picking up 90% of the tab. I have several reactions: (a) never hire CSC to do anything; (b) North Carolina is obviously ignoring my advice since CSC’s punishment for missing budget and deadline is to get more money; (c) as everybody who knows billing is well aware, the government may talk efficiency and modernization, but its arcane Medicare and Medicaid payment requirements ensure that providers can adopt neither; and (d) it’s pathetic that a mid-sized state has to spend $500 million just to manage Medicaid payments (small compared to Medicare) and none of that money does anything to improve population health or patient care – it’s just an administrivia management system created by an unholy alliance of contactors, lobbyists, and government employees (many of those in the latter category planning an eventually profitable exodus to one of the first two.)

Minnesota Public Radio runs a surprisingly comprehensive and balanced article on electronic medical records in rural hospitals, covering (a) the benefits; (b) the penalties; (c) the shortage of HIT labor for both providers and vendors; and (d) the likelihood that EMR pressures along with healthcare reform will force rural hospitals to sell out to bigger and better-funded organizations or shut down completely. A quote from the CEO of a 14-bed hospital (above): “I’m not sure that even God’s bank has enough money for electronic medical records. Are we working on it? We’re working ourselves crazy. Eighty percent of our capital budget every year goes toward implementing another aspect of EMR.” The article talks a lot about Duluth-based SISU, a non-profit hospital consortium that offers Meditech systems, hosting services, group purchasing, and IT expertise.

Clueless Internetters who probably couldn’t name the Secretary of State or point out Canada on a map focus their limited intellectual capacity on tracking down Haynes Management, a 21-employee real estate company that supposedly fired an employee whose wife was diagnosed with cancer. In their haste to become part of a viral mob reacting emotionally to the one side of the story they read, the nitwits Google over to Hayes Management Consulting (apparently deciding that the N in Haynes is insignificant) and start sending hate e-mail. Hayes issues a press release denying that it’s them. When Inga e-mailed me the press release, I gave an instant reply: “Hayes is brilliant for using this to promote themselves. It’s fun to write about, so I bet it will get picked up.” Which it has. 

Lehigh Valley Hospital-Cedar Crest (PA) kills a kidney transplant patient, a 51-year-old nun, with insulin when defective blood glucose testing strips erroneously show her as hyperglycemic. Communication problems were also involved: a nurse from the hospital’s remote ICU monitoring station noticed the difference between results from the test strips and from blood draws, but didn’t tell anyone.

Chuck Friedman, ONC’s chief science officer and one-time #2 guy there, is leaving to run an informatics program at University of Michigan. We told you on June 8, courtesy of rumor reporter Roman DeBeers, that he was quitting, although Chuck ignored my e-mail asking for confirmation. ONC’ers sure like those academic appointments.

Here’s Vince’s latest HIStory, for which he credits the help of Bob Haist of SMS/ISD and Bob Pagnotta of MDS/Tymshare.

Dell will spend $80 million on an ad campaign pitching its capabilities beyond selling commodity PC hardware, with one of the four TV ads showing a doctor. 

Strange: the medical school dean of the University of Alberta is demoted to professor after parts of the graduation speech he delivered were found to have been taken verbatim from a similar speech Atul Gawande gave at Stanford last year. Graduates claim they Googled a particular phrase, “velluvial matrix,” on their smart phones as the dean spoke, allowing them to follow along from Gawande’s original speech. It was a giveaway since Gawande made the phrase up, as he explains later in his own speech: “OK, I made that last one up. But the velluvial matrix sounds like something you should know about, doesn’t it? And that’s the problem. I will let you in on a little secret. You never stop wondering if there is a velluvial matrix you should know about.”

University of Florida gets a $500K NIH grant to create EHR alerts using genetic information, which will influence treatment decisions involving an unnamed drug to prevent heart attack and stroke (which I assume is clopidogrel). 

A Maryland infrastructure company gets a $45 million contract to work with a China-based counterpart in developing a cloud computing center to host electronic medical records in that country.

Utah announces Clinical Health Information Exchange (cHIE), a statewide HIE (part of the Utah Health Information Network) with participation from Intermountain, MountainStar, IASIS, and University of Utah. It’s actually been around for a year or so as I recall, so maybe the announcement was related to broader participation.

Just in case you need something to run on your iPad: Big Fish Games releases the free Hospital Haste, where you “help Nurse Sally work quickly to diagnose, treat, and cure all of her patients.” (obviously they aren’t intimately familiar with what nurses are legally allowed to do).

E-mail Mr H.

Time Capsule: Before You Buy, Look at the Impact on User Productivity

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 April 2006.

Before You Buy, Look at The Impact on User Productivity
By Mr. HIStalk

A story often repeated: a big organization executes a high-profile rollout of a clinical system, but caregivers say it takes longer to use. They deliver an ultimatum — either you accept a reduction in productivity or you ditch the system.

The latest subject is the Department of Defense, whose new $1.2 billion AHLTA system (which is actually the renamed old system, CHCS II) is claimed by users to be so slow that they have to reduce their patient schedules by one-third. Patients are being diverted to emergency departments and routine checkups aren’t being done.

Maybe this is telling us that we don’t look hard enough at a system’s impact on user productivity. I don’t recall ever having heard of a health care organization that measured how long it takes to write an order, document care, or write a prescription, comparing times before a system install and after. I’ve never heard of someone choosing a particular system because it’s faster for the caregiver, or in many cases, even giving the caregivers a peek at it before the decision to buy is made.

I’ve also not heard of an organization budgeting additional staff to offset reduced productivity with automation. The reason is there’s not supposed to be any slowdown. Everybody knows that computers improve productivity, right?

If that was the case, all those PCs that hospitals have deployed would have caused huge staff reductions. I haven’t heard of that either. Sales prospects are easily impressed with unrealistic projected staff reductions that never seem to materialize.

It gets worse when users are hard-to-find licensed staff, such as nurses or pharmacists. A system that takes up more of their time, no matter what benefits it provides to someone else, may create a staffing dilemma that directly impacts patient care.

This is a customer problem, not a vendor problem. If customers demanded productivity gains for their users, vendors would respond (or lose business). This goes back to a generally casual regard for usability testing — never a priority in the mainframe days and not improved very much since in health care.

Local configuration options make it hard to evaluate an off-the-shelf vendor system upfront to determine workflow impact. You could ask the vendor’s customers, though. Arrange to time how long it takes to chart a med as given, to create a progress note, or to enter an order set as a physician. Then, compare that with the time required by your current process.

You don’t need the vendor’s help to do this. You might want a management engineer to look over your shoulder for consistency in measurement. Otherwise, all it takes is for hospitals to talk to each other, which they’re usually pretty good about doing.

I don’t know about you, but I’d rather not be in the hot seat to answer this question from clinicians — do you want us to take care of patients or to use your system?

HIStalk Interviews Scott Coons, President and CEO, Perceptive Software

Scott Coons is president and CEO of Perceptive Software, a Lexmark company, of Kansas City, MO.

Give me some brief background about yourself and about the company.

I’m an engineer and a computer scientist by education. I’m kind of boring, to be honest. I’m the founder of Perceptive Software. We’re the makers of ImageNow.

We’re in the enterprise content management space. We offer products and solutions around the management of enterprise content across multiple sectors, including healthcare. We’ve got a great team here and lots of happy healthcare customers that are using our product in a lot of different areas.

I was reading Web site write-up on Citizens Memorial Healthcare, an outstanding IT shop in a small hospital. How are they using your technology?

I don’t know all the details in their specific case. However, I’ve spent time with their CIO. They fully endorse our product as a core component to what they’re trying to get done. They really see us as an ECM platform that they can use everywhere in the hospital, from HIM to administration to order management to back office operations as well, including financial operations and human resources.

We preach vendor independence whenever possible. Obviously we try to build software that takes as little professional services as possible. Citizens has really embraced that. They have a strong IT shop and are ideally suited to be able to go in quick, integrate quickly in all the ways that they like to integrate, and then just expand throughout the hospital.

That’s really one of our approaches we take with all of our customers. Obviously we’re there to help them use the technology, configure the technology, optimize the technology any way they want us to. But at the end of the day, we try to build software that is more about the software and less about the professional services that go along with it.

Can you describe the different places in the hospital that your offerings might be found or how they might be used?

In general, it’s all about managing the content, whether that content is derived from paper or some unstructured information that needs to be accessed in support of some clinical process or back office workflow process. Any time you need to manage a workflow around that and have access to that content, we’re used. There isn’t a place in a hospital or acute care facility that our product’s not being used.

How much of your overall business is healthcare?

In terms of new business, it’s our largest industry sector, our fastest growing. I’d estimate at about 35% or so.

The debate continues on the value of the hybrid patient with some scanned components. How do you see scanned documents and workflow built around them fitting in with a completely electronic system creating and using discrete data?

In any enterprise environment, there’s always a collection of data above and beyond paper-based data, scanned-based data that needs to be managed and processed. I think in our case the ImageNow product line can manage any content no matter what its source. Our solution solves the problem of multiple systems needing to speak with each other and needing information for various content stores and various snippets of data. 

We can bridge the gap between disparate systems to do that, environments where they’ve started to centralize on one basic clinical system. There’s always the need to collect and manage a bunch of disparate data in support of that system. It’s more than just dealing with document images — it’s dealing with any type of enterprise content that helps the clinician provide patient care.

With the push toward interoperability, people are always assuming they will need complicated interfaces that may or may not be proprietary. It sounds like you’re saying that documents could be the interface between the systems.

Absolutely, they can be. You’ve got to solve the problem when somebody walks in with a bunch of data you’ve yet to capture into your systems. if it’s a good enterprise content management system, you can just bridge the gap and exchange data between multiple systems.

Interoperability is a big deal for us. We’re fully behind it and participate in various IHE Connectathons.  The engineering team is all over the standards that are emerging.

One of the things that most interested me when I interviewed Denni McColm from Citizens Memorial a couple of years ago was that the only paper they were handling came from outside hospitals that weren’t up to their level of automation. Do you find it interesting that they took that approach to avoid handling someone else’s paper?

It doesn’t surprise me. I think if you do your job and you build software and solutions that are easy to use, then the motivation is to get anything and everything related to the patient in one folder, if you will, so you have access to it. I’m sure they saw the benefit of getting everything into their content store even if it wasn’t originated from their hospital.

The company makes a distinction between not just managing electronic documents, but the information life cycle. Can you describe what that means to you and how it works?

I think that the interesting thing is, from content type to content type, it’s not always about keeping that content around forever. You have to put policies around how long you’re going to keep it, when you destroy it. That’s really the definition of the life cycle from capture to destruction.

It’s a big problem that a lot of the healthcare industry doesn’t always understand … the compliance regulations and whatnot. We have to make sure, based upon content type, that we can manage it completely through its life cycle and put policies around it for destruction. I think that’s a part of just being a solid enterprise content management product.

There are a lot of things that we do outside of healthcare that lend themselves to the healthcare space. The retention policy management suite that we have actually was derived in government and our financial services requirements, so we think it’s something that healthcare space needs. We have a lot of healthcare customers that are using it.

Speaking of that, what lessons that you’ve learned serving other industries that might apply to healthcare? And from what you just said, does that relate to regulatory or audit type capabilities?

It is heavily related to regulatory and audit capabilities. I can come up with hundreds of examples of where what we do and one industry is an advantage to another industry. You’re still building solutions specifically for an industry. You still have to pay close attention to the role of the user. We do a lot with persona-based development. 

But content that’s not closely tied to a core business system — whether it’s a clinical system, CRM, an accounting system, whatever the system might be — managing that content is the same across all industry sectors. It’s really how you put the workflows in place and understanding that role of the user that’s accessing the data needs the data at a moment’s notice. That’s where you really have to customize specifically for the industry, but there’s a lot of overlap. That’s why we service so many various industry sectors.

You mentioned your background as an engineer. It’s uncommon to see an engineer as an entrepreneur leading a company instead of the usual salespeople or suits. What are the advantages of that and how does that fit within Lexmark?

A great question. As you can tell, I don’t give a very good interview. I think that’s one of the disadvantages having an engineer lead the company.

This business is very systematized. Quality is extremely important to us. I think that’s an advantage that comes from being an engineer. Obviously I work very, very closely with the R&D department, being that I was the original R&D department. It’s about building really good software and being able to predict use cases that the customer or the industry can’t predict so that you’re ready for them as they grow into the software, that they leverage the software to serve new processes or new workflows.

But I think that one of the strengths of Perceptive is that we are highly technical. We build a product that’s very scalable, something that we’re proud of that we think is very easy to use. Our mantra is always to put content and context to whatever the problem is that we’re trying to solve.

As it relates to Lexmark, what’s interesting about that is that Lexmark is led by engineers themselves. That was part of the attraction when we first got to know them. I’m an electrical and computer engineering major and their CEO at the time was the electrical engineer. Their current CEO is a mechanical engineer. Their whole executive team is full of engineers. I think that we share a common bond to build really, really good product and to listen very carefully to our customers and have a really closed development cycle on what our customers want and really giving feedback, and then rolling that back into the product line. 

The Lexmark acquisition has been great for us. They understand we’re different. We’re software, they’re hardware. They were public, we were private. They were really big, and we were not as big. They’ve been extremely supportive in where we’re going and what we want to do. They’ve really gotten next to helping us grow and better our product into the markets we serve. They’re a great company and it’s a great fit.

As you were describing the advantages and disadvantages of being an engineer, I couldn’t help but picture you reading Dilbert, and I bet you do…

I do. <Laughs>

Do you have times where you can’t decide whether you’re going to identify with Dilbert or the pointy-haired boss?

<Laughs> I read it everyday, I laugh every day, and yes, I can identify to both characters. It’s a great comic strip.

For a company with an engineering culture, your Kansas City location has a lot of fun employee stuff, like video games and chair massages. How would you characterize the culture there and how does that translate into value for the customers?

I think there’s a passion here that is contagious.  Culture is always a reflection of the people. But is the culture attracted by or created by the people, or are the people attracted to the culture? I think it’s a little bit of both.

We try to hire the best and the brightest, those that have a very inquisitive mind, aren’t afraid to take risks if it means bettering the product for our customer. We really preach innovation. The culture is a reflection of that and they are a reflection of that culture. We have a good time. Our motto is to work hard and play hard. We’re about really building game-changing ECM products that our customers will enjoy, that our customers will put to use, and will have solid things to say about it. Everybody here at Perceptive believes in that mission. We enjoy what we do.

What issues in healthcare do you think will have an impact on how you conduct business in the next three to five years in terms of product development?

The government’s involvement in healthcare is always something that we closely watch. Meaningful Use, all those various topics are things that we have to be aware of. We have to be in tune with what’s going on.

No matter what the trend is in healthcare in the upcoming years, we’re in good shape to be able to handle whatever comes in front of us. As much as an industry might try to exorcise out paper, we have built a system again that can handle any type of content that’s related to the core mission of healthcare. We can manage that content and make it available and put a process around it. 

We feel good about where we are. Obviously you have to continue to work hard and listen to the customer and talk to the customer where they see things are going and what they need. We do a lot of that. We feel pretty good about where we are and where things are going.

Any final thoughts?

I appreciate the time. I think that we have a good story to tell and we appreciate the opportunity to tell it through HIStalk. We’re excited about where we’re going and what we’re doing. We want to thank all of our customers for their support over the last ten-plus years.

News 6/17/11

Top News

The California Hospital Association files suit against the state public health department to block a requirement that hospitals report detailed information about surgical site infections starting June 1. CHA says most hospitals don’t have the information available electronically, so they would have to take time away from patient care to dig through records manually.

Reader Comments

From Ricky Roma: “Re: Dr. Jayne’s IT comments. Doctor, we live in a world that has networks, and that network has to be guarded by men with decreased budget and staff. Who’s gonna do it? You? The executive staff? We IT guys have a greater responsibility than you could possibly fathom. You weep for your iPad, and you curse IT. You have that luxury. You have the luxury of not knowing what I know. Denying iPhones, while tragic, probably saves PHI. And my existence, while grotesque and incomprehensible to you, saves PHI. You don’t want the truth, because deep down, in places you don’t talk about in the doctors’ lounge, you want me on that network. You need me on that network. We use words like governance, security, encryption. We use these words as the backbone of a career spent defending something. You use them as a punch line. I have neither the time nor the inclination to explain myself to a physician who sees patients under the blanket of the very security that I provide, and then questions the manner in which I provide it. I would rather you just said thank you and went on your way, Otherwise, I suggest you log on to a PC like everyone else. Either way, I don’t give a damn what device you think you are entitled to.” Brilliant as always from one of my favorite (but seldom heard) contributors.

From Mile High Club: “Re: WSJ article on use of corporate jets. It includes a searchable database, finding that destinations often coincided with the vacation homes of executives. McKesson had 41 flights to Martha’s Vineyard and Laconia, NH (probably someone’s house on Lake Winnipesaukee).”

HIStalk Announcements and Requests

This week on HIStalk Practice: additional background on the RWJF report that found diabetics treated by practices with EHRs received significantly better care than those treated at paper-based offices. Turns out the paper-based offices also had almost five times more non-insured or Medicaid patients than the EHR-based practices and twice as many non-white patients. Also: Julie McGovern of Practice Wise shares tips for creating a disaster recovery plan. A new organization is launched to certify medical scribes. Less than one-third of physicians are expected to remain independent by 2013.  Dr. Gregg shares HITECH support woes and wins. If you like the ambulatory world (and who doesn’t?) then you’ll want to make sure to sign up for the HIStalk Practice e-mail updates.

In almost totally unrelated to HIT news: a couple of girlfriends and I stayed at a upscale hotel recently for a little getaway. All three of us came home with what I have diagnosed to be bed bug bites (you know, I did the Internet research thing and compared my bites to the online photos.) Which leads me to wonder: are bed bugs the latest work hazard for HIT road warriors? It’s a totally disgusting topic, I realize, but it’s an issue I never really worried about in my traveling days. FYI, I complained to the hotel; they checked the room and told me they found no evidence of bed bugs. BFFs and I are thus considering whether we’d be better off visiting a dermatologist or simply seeking a psych consult.

Listening: Black Joe Lewis & The Honeybears from Austin, TX, recommended by a reader. Here’s what I e-mailed to her: “I’m doing hideously uncoordinated chair-based dance moves to Booty City, thinking I’ve gone back in time to the 60s to listen to Edwin Starr doing 25 Miles from Home. Now I’m going to want to accentuate everything I say with an emotional ‘HUuaaH’ just like this guy (and James Brown) I’m making that ‘white man trying to be funky’ look by scrunching up my nose, sneering, and and squinting as I bob my head out of time with the music and do some walking bass on the air guitar.”

On the Jobs Page: Solutions Executive – Virtual Office, Technical Marketing Engineer – Work from Home, Healthcare IT Technical Recruiter. On Healthcare IT Jobs: Allscripts Test Manager and Test Resource, Implementation Consultant, Meditech PCM Implementation Analyst.

First, do no harm. Once that’s done, (a) sign up for e-mail updates in the box to your upper right (unless your display is set to low resolution, in which case it could be just about anywhere); (b) send me news, rumors, and anything that would tickle my sophomoric humor; (c) find Inga, Dr. Jayne, my sites, and me on your favorite social not-working tool and make the appropriate electronic connections so we can feign mass appeal; (d) accept my personal challenge to randomly inspect five of the admittedly large number of ads to your left and click them, waiting excitedly as in the presence of Monty Hall to see what’s behind Door Number 3 and knowing that you are thereby supporting us keyboard-clackers who work absurd hours after our day jobs; and (e) don’t worry, be happy.

Thanks to Bulletin Healthcare, new to both HIStalk and HIStalk Practice as a Platinum Sponsor. The publishing company sends out electronic newsletters to 400,000 doctors every morning by 8:00 a.m., working with two dozen leading medical associations to meet the unique news requirements of their members  as a valued member benefit (American Medical Association’s AMA Morning Rounds, American College of Physician Executives’ ACPE Daily Digest, and American College of Cardiology’s CV News Digest, to name a few.) The Reston-based company is the medical division of Bulletin News, which provides executive news briefings for the President and most of the Cabinet. They’re happy to tell companies about their advertising programs, should yours have an interest. Thanks to Bulletin Healthcare for supporting HIStalk and HIStalk Practice.

Sales

The Regional Medical Center at Memphis (TN) purchases Carestream Health’s Vue RIS for radiology scheduling and reporting.

The University of Virginia Health System extends its licensing agreement for Streamline Health’s document workflow solutions and adds Streamline’s Correspondence Workflow application.

People

Press Ganey promotes Robert Draughon from president and CFO to CEO, replacing Richard B. Siegrist, Jr. Siegrist will transition to chief innovation officer and remain on the board. We reported this Monday, courtesy of a rumor report from South Bend Snoop.

PatientSafe Solutions names Joseph Condurso president and COO. He was a CareFusion VP and also spent time with Cardinal Health.

EnovateIT president Fred Calero wins Ernest & Young’s Entrepreneur of the Year award for Michigan and Northwest Ohio in the healthcare services category.

Vivek Kundra, the nation’s first CIO, will quit in August to take a Harvard fellowship. Like his boss, opinions vary on whether he has accomplished anything of positive significance. Nobody has said much about a possible successor, so I don’t know if Aneesh Chopra has the cred or interest.

Industry long-timer Rick O’Pry, founder of JR O’Pry Consulting and IntraNexus, launches a consulting company called HIT Strategists.

Announcements and Implementations

St. Michael’s Hospital (MN) will go live on Meditech on July 1.

Mayo-Austin (MN) apologizes to patients for long registration delays caused by the EMR it installed in April, saying it “has temporarily slowed down our registration process and phone response time as we check the accuracy of patient information and become more proficient with the system.” They’ve hired more staff. I bet decreased patient satisfaction and increased headcount to do the same work wasn’t in their business plan.

Omnicell’s OmniRX medication dispensing system wins Best in KLAS for hospitals 200 beds and over.

PDR Secure launches the RxEvent adverse event reporting service, which will allow doctors to report drug problems directly from their EHR. It was developed in conjunction with Greenway, the American Pharmacists Association, and athenahealth.

UPMC announces its HealthTrak mobile app for iPhones and iPads that allows patients to review their test results, history, meds, and appointments. It’s based on Epic’s MyChart.

Innovation and Research

Fujitsu works with a hospital in Japan to roll out a patient guidance system based on e-paper. Patients carry an electronic card holder that guides them to diagnostic departments, checks them in, and accepts their payment. They can wander around while waiting since the system calls them when it’s their turn (not that hospitals have anywhere interesting to wander around in anyway, but at least they could distance themselves from Unemployment TV).

Technology

Ottawa Hospital is deploying mobile technology in a big way, purchasing 2,800 iPads for its 456-bed facility. The CIO notes that its iPad and iTouch users include doctors, nurses, pharmacists, respiratory therapists, and even janitors.

Online physician networking site QuantiaMD finds that over 30% of physicians use tablet devices, 20% of them in clinical settings.

Panasonic announces that it will bring out an enterprise-grade, Android-powered Toughbook tablet in the fourth quarter.

Other

Sparrow Health System (MI) hosts a job fair in an attempt to fill 70 to 80 IT job openings. Analysts will support the health system’s $100 million Epic EHR implementation. Starting salaries are $50-80K.

The Missouri Hospital Association estimates that 90% of the state’s hospitals use an EHR for at least one of 24 functions. On average, hospitals use about nine EHR functions, though 44% use at least 13.

CapSite believes the ambulatory EHR and PM market will exceed $3 billion through 2013, with 63% of physicians replacing their current PM systems for an integrated PM/EHR and 38% upgrading or replacing their current PM. Capsite’s 2011 U.S. Ambulatory EHR and PM Study also predicts that 50% of physician will be investing in ambulatory EHR systems. In terms of current market penetration, Allscripts and Epic each have 16%, followed by eClinicalWorks, NextGen, and GE.

A tornado in Verona, WI left Epic powerless for most of last Thursday, forcing it to run on backup generators.

A California man is arrested for pretending to be a medical doctor. A patient got suspicious after he told her to treat her kidney disorder by eating watermelon in a hot tub.

Weird News Andy is speechless about this story: a woman in Sweden with fever, chills, and aches calls four times over four days for an ambulance, but is turned down because she is still able to speak. She dies. But WNA is tittering at this piece about English hospitals warning employees that their uniforms must not expose their midriffs or “excess cleavage” (whatever that means) after patients complained.

Sponsor Updates

• SCI Solutions posts a video describing its new Arrival Manager product and a cool flipbook of its annual Innovations in Access Management magazine.
• MEDSEEK wins the 2011 Frost & Sullivan North American Health Records Technology Leadership award.
• FormFast and T-System collaborate to integrate the print management portion of FormFast’s workflow software with the T-Sheets documentation system.
• CareTech Solutions announces that two of its clients won 2011 Aster Awards for their Web sites.
• AsquaredM is offering a June 23 Webinar on improving revenue cycle performance with Lean Six Sigma.
• Hanger Orthopedic Group will deploy NextGen Ambulatory EHR and PM at its 675 orthotic and prosthetic patient care centers in 45 states.
• The Tennessee-headquartered RegionalCare Hospital Partners selects Healthcare Management Services (HMS) to provide clinical and financial applications .
• McKesson VP and medical director David Nace, MD is speaking about bundled payments at this week’s AHIP conference in San Francisco.
• A health center customer of TELUS Health Solutions wins an Ingenious Award for using the company’s remote patient monitoring solution to increase nurse productivity, reduce home visits, and save $450 per patient.
• Humana will offer financial assistance to physicians adopting Allscripts EHR as part of is as part Humana Medical Home EHR Rewards Program.
• Pinehurst Dermatology (NC) contracts for the SRS EHR.
• API Healthcare hires Kathy Douglas, RN, MHA as the company’s chief nursing officer. She founded the non-profit On Nursing Excellence.
• TeleTracking Technologies will preview its new RTLS solution at the 2011 Association for Advancement of Medical Instrumentation conference being held June 25-27 in San Antonio.
• HHS’s Office of Minority Health and Quest Diagnostics announce a program to  donate 75 MedPlus EHR user licenses and one year’s subscription fees to physicians in small practices serving minority populations in Houston.
• Perceptive Software names Glenn Cross VP of Marketing.
• MED3OOO is offering an on-demand Webinar on Why ACOs Should Be Physician Led that features Amit Rastogi MD, president and CEO of PriMed LLC, a 70-provider medical group in Connecticut.

EPtalk by Dr. Jayne

Mile·stone (noun)

1. A stone functioning as a milepost.
2. A significant event or stage in the life, progress, development or the like of a person, nation, etc.

I believe in celebrating milestones. With the rapid pace that many of us run each day, it’s easy to overlook key events. We get used to doing the same tasks each day / week / month / year, falling into the cycle of “lather-rinse-repeat” and losing sight of the work that we are accomplishing.

I encourage my team to remember that, although this may be the 43rd time they’ve trained “E-prescribing 101,” this is the first time the users in their classes are seeing it. I remind them to remember the impact they are having on our end users and that completion of each class is an accomplishment.

We just took our 250th physician live on one of our clinical systems. The go-live wasn’t any different than any other go-live — the physician was aggravated that he had to be there and I was aggravated at having to deal with his surliness towards the IT team. However, calculating the number of times we’ve executed the same process multiplied by the number of people needed to work closely together to successfully get that physician live, it becomes significant. If you would have offered me a bet at the start of the rollout that we’d have this many physicians live on that application at this point, I wouldn’t have taken it.

We tend to take for granted the things that seem to be always present. Maybe we celebrate the beginnings and the ends — the new teammates and the retirements — but we forget to mark the events that happen along the way.

The five-year anniversary of an incredibly challenging project is passing without anyone in our organization other than those of us who were on the team at the beginning noticing. On one hand, maybe it’s good that the tool has become such a part of the organization that it’s not a big deal. But for those of us who still have flashbacks from the go-live (and probably a little post-traumatic stress disorder), it’s amazing.

Celebrating milestones helps us learn what others value and why it matters. Last Wednesday was HIStalk’s eighth birthday. Although Mr. H mentioned it, he tends to be the somewhat shy and retiring type, so it was pretty low key. I’d like to do my part to celebrate HIStalk and reflect on the impact Mr. H and company have had on me.

As a reader, HIStalk provides a reliable, humorous, and entertaining source of information that I could not possibly have uncovered without hours of sifting through the announcements, updates, and studies that come through my inbox and across my desk each week. It gives me tidbits of industry gossip that sometimes hit too close to home.

I’ve learned things about competing health systems that I could not have sleuthed out on my own. I’ve surprised vendor execs by asking them to confirm rumors about their companies that they haven’t even heard themselves. I’ve experienced HIStalkapalooza and the IngaTini.

As a member of the HIStalk team, I’ve had the opportunity to see different sides of vendors as Inga and I cruised the aisles at HIMSS, at one point switching badges to see if it made a difference in how we were received. One of the high points was meeting Mr. H for the first time in the HIStalk limo, changing into our doctor disguises and walking down International Drive with Inga in her amazing boots. We saw our sponsors, many of whom compete directly with each other, breaking bread together at the HIStalk luncheon.

I’ve learned that whether people like a particular piece I’ve written or whether they hate it, I don’t take it too personally either way.

This has been an opportunity to meet amazing people, make new friends, and learn that being anonymous can be a challenge. Using Dr. Jayne’s e-mail address, I’ve emailed people I’ve known for years — and have been ignored. I’ve socialized with key players in government and healthcare and have had to bite my lip to keep from saying, “OMG, if you knew you were talking to Dr. Jayne you would not have just said that.”

I’ve also built necessary career skills – namely the ability to keep coffee from coming out my nose when my co-workers quote HIStalk pieces that I’ve had a hand in.

Best of all, I’ve learned that what may seem like an insignificant event at the time can be a life-changing one. I’d like to thank a certain vendor exec for casually asking, “Do you read HIStalk?” over drinks on a certain day in 2009. At the time, I didn’t. But thanks to that simple question, along with the faith and support of Mr. H and Inga, as well as the camaraderie of Dr. Gregg and Dr. Travis (MD recently conferred!) I’m about to click SEND on Dr. Jayne’s 50th post. Here’s to milestones.

Contacts

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